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manifestations. Matter returns to original condition. Mind and soul remain in an unrecognizable condition until the resurrection.
J. P. Stewart said that mind from a medical standpoint refers to the mind, and is manifested by certain idiosyncrasies, notions, whims, fancies, vagaries, and even manias of our patients.
We may, by our psychological influence over certain neurotic patients, restore them to health and happiness by suggestions, hypnotism, mesmerism, or Svengalism (?), get control of their minds by the influence of a stronger mind. He hardly thought that we had inuch to do with the soul, though the idea of soul and its final end may in some degree cause these psychological manifestations in our hysterical patients.
W. Frank Glenn said that lie never could understand the triune nature of man. He believed that man's spirit was his ego, his immortal part, himself. He believed that he lived in every cell of his body, and when death came, he simply abandoned the material residence and advanced to higher spheres of existence. He believed there was a spiritual body, which was recognized by spirit just as clearly as a physical body was recognized by a material man.
Paul F. Eve asked Dr. Glenn “What is Life?”
Dr. Glenn said that he could not define life, but it might be described.
G. W. Drake said life could not be seen, could only be judged by effects. In a paper before the American Medical Association he took the ground that the mind does not become insane. The part affected is the brain. So-called mental disorders are not mental but material. The brain is the part which gets out of order. The mind is the power which controls the brain.
R. M. Cunningham differed from Dr. Drake, that the mind is simply the power that moves the brain. There is as much mystery in cell of liver forming bile, or of the kidney secreting urine, as cells of brain producing phenomena of mind. The power of each is God-given. Mind is a phenomenon of physical action.
B. Sherwood Dunn said that Darwin's theory was built without foundation, as he failed to account for the first cell. The physiologist fails to show what is the incentive that puts in motion the gray matter in the generation of thought.
Dr. Cowan in closing said that we have cell activity in vegetable as well as in animal life. We confound mind with soul. The soul uses
the mind. Writers make the mistake of not differentiating. Not a triune man, the mind is simply the instrument used by the soul.
Seale Harris, of Union Springs, Ala., read a paper, “The Arrest of Smallpox in the Vesicular Stage," based on the idea that smallpox would stop after the vesicular stage if there was no mixed infection. The idea being to prevent by applying antiseptics to the skin. Quoting from Bryan and Bibb he related cases. In a case seen by the writer the treatment was a success. It prevents pitting, secondary fever, the intolerable itching and fearful stench of the pustular stage.
R. M. Cunningham said the pus in smallpox was a secondary infection, but he did not believe that the skin could be made antiseptic, but the case reported seemed to show that the treatment had been a success.
Frank Trester Smith said that it was not necessary to render the skin aseptic if the number of the germs was reduced sufficiently, their development prevented or retarded.
J. B. Cowan related a case where a negro with smallpox lay in a brook an hour with the result that the disease ran a much shorter course than others in the same epidemic.
Seale Harris in closing said that while we might not prevent absolute pus formation it might be lessened so as to prevent many unpleasant results.
Llewellyn P. Barbour, Tullahoma, Tenn., read a paper on "The Pathology and Diagnosis of Early Phthisis," including in this term to the stage where there is breaking down of tissue. In some the diagnosis is easy, in others can be made only by investigating symptoms that may seem unimportant. Skill is required to appreciate physical signs, but the clinical symptoms will often make the diagnosis. When patient says “don't raise any thing" may get a little first thing in the morning. Bacilli may not be found in undoubted case. Hemoptysis is almost certainly due to tuberculosis. Pleuritic pains are characteristic of phthisis. May be absent, as may also increase of temperature. Absence of temperature indicates slow advancement or arrest. Take temperature every two hours, ten to twelve days. If it increase two degrees with exercise, probably phthisis.
Paul Paquin said that the basis of tuberculosis was a battle between the tubercle bacilli and the cells in which they are lodged. The disease may exist a long time before the bacilli are expelled, hence importance of early diagnosis. This is not so difficult. Early clearing
of throat important. An important factor is serous pneumonia. Temperature important, rarely above 101'. This comes late when we have a mixed infection. Malaria may co-exist. Look for plasmodium.
R. M. Cunningham insisted on importance of early diagnosis, which may be made from clinical signs alone. Bacilli may be in sputum of healthy persons. Altered ratio between pulse and temperature important; pulse faster than for temperature. Physical signs show lesions which may not be tubercular. There may be a tubercular nidus with no physical signs. The crepitant râle in apex, unilateral, is diagnostic of tuberculosis. Many cases, treated for malaria, dyspepsia, etc. His post-mortems showed tubercular matter fenced off with connective tissue capsule.
B. Sherwood Dunn related experiments where matter taken from the postnasal space in 1,400 cases showed tubercle bacilli in 856. Many carry bacilli which never develop.
Hazle Padgett emphasized the importance of the slight rise of temperature, 100.5°, or 101°, with perhaps no cough, slight anemia. Examine heart, urine, lungs. An early change in the vesicular murmur important. Compare with other side.
Andrew Boyd thought that enough attention was not paid to the minute clinical history; that this is lost sight of by going off to the unknown too much. The microscope is the “sine qua non," but the suggestive symptoms come, first, hemoptysis, theo pulse (out of all proportion to the temperature), the general malaise, dyspnea, loss of appetite, etc. These come first, then the physical signs, crepitant râle in apex, followed by active physical signs. To sum up, he thought the subjective signs are our first guide, then objective, the physical signs, and microscope to dispel all doubts.
W. F. Westmoreland did not think tubreculosis always began in apex, but that there easiest found. Tubercular skin troubles have increased in his clinics in last few years perhaps ten times. Disregard as to crepitant râle, which is always associated with pleuritis.
Dr. Barbour thought the first lesions at the apex. Pleuritic frictions tubercular as a rule. All can not be expert in physical diagnosis, but all can make diagnosis from signs. The majority get well. Bacilli in sputum sometimes precede physical signs. A weak heart may predispose to tuberculosis. Tuberculin may be used by an expert to clear up diagnosis.
Paul Paquin, St. Louis, Mo., read a paper on Sero-Therapy in
Tuberculosis." The use of serums, nature's remedies, seems to promise much, as all other remedies have failed. Tuberculosis generally a mixed infection; with bacilli we find other germs. The nature of the mixed infection should be determined by the microscope. This is as important as the use of the microscope in the early stage. There is no one treatment applicable to all cases. Treatment should be combined. In mixed infection the serum should be prepared to meet the case. Hygienic measures should be employed, climate in certain cases—altitude not of much importance, the benefit being due to presence of ozone. Climate often tried too late, or may remain too short a time. Hydro-therapy often beneficial by stimulating circulation, also massage. In dieting animal food best. Cream better than cod-liver oil. Whisky and tobacco contra-indicated.
L. P. Barbour said that climate was not a specific, only an assistant. If better in summer send to warm climate, otherwise to cold. Ozone not a specific. Baker's experiments tend to show that it is harmful. Send to climate least irritating (from dust, etc.). There is no specific; we must not rely on any one thing, but individualize cases.
R. M. Cunningham called attention to the difference between tuberculosis and diphtheria. The former tends to get well by cicatrization, by obsolescence, by discharge. Not analogous to typhoid or diphtheria, which are self-limited; hence serum treatment not analogous.
L. B. Graddy related a case which steadily got worse under Koch's tuberculin when first introduced in Berlin. With climate and other treatment it matters not if a little antitoxin is injected. Does not believe that there ever has been a case of tuberculosis of the lungs cured. In one case diagnosed as consumption the symptoms disappeared after cauterizing the uvula.
J. A. Witherspoon stated that this is an infectious disease, but does not have a period of invasion, no incubation; if self-limited the limit is the grave. Believes in serum-therapy. Would not say that none ever got well, but would say that none got well except by the inherent power of resistance. Has absolutely no confidence in serum treatment of tuberculosis. These gentlemen get good results: first, from the fact that some of the cases were not tuberculosis ; second, to hygienic and other measures are due the cure. The bacillus may be found without tuberculosis.
W. F. Westmoreland said that the idea that tuberculosis could not be cured should not be allowed to go unchallenged. Wherever the
diseased area could be removed the disease could be cured. In view of the statistics there can be doubt of the good results from these serums. Climate acts by giving rest to the lungs.
L. P. Barbour claimed that good institutional treatment gave about saine results as climate.
J. A. Witherspoon thought it doubtful if, because a man got better in an institution and remained in good condition for a long time, and finally succumbs to the disease, that we should say that he was cured, and again acquired the disease.
L. B. Graddy said he thought that there had never been any cured. He could even say that some had gotten well. Many had improved, might live to old age, but bacilli would still be found in lungs.
Dr. Paquin said that he had been misunderstood. He had not used the word cure, Had reported the cases as he had found them. Tuberculin is not a serum, but the opposite. Tuberculosis and diphtheria are not biologically similar, and may require different treatment. His cases were not under favorable surroundings, were not picked, The methods were open, any physician could visit the laboratory.
Hazle Padgett, Columbia, Tenn., read a paper on “The Causes, Diagnosis, and Treatment of Valvular Disease.” As causes he mentioned especially acute rheumatism, Bright's disease, violent muscular effort. Diagnosis by timing murmurs, systolic, diastolic, and presystolic. Obscure murmurs may be determined in horizontal position. Important in life insurance. Exercise may bring out murmur, also forced inspiration, the forced inspiration the forced expiration, then suspend respiration. Future of patient should not be darkened by telling him he has heart disease. Tell some one who is interested in patient. Many will live years. Aortic stenosis most dangerous, mitral stenosis akin to it.
R. M. Cunningham, Birmingham, Ala., read a paper on “ The Relation of the Cause to the Immediate and Remote Results and Associated Lesions of Fracture,” in which he gave a study of fracture based on mechanical principles, showing that bending, compression, and torsion are the usual means of fracture lesions in bones, in surrounding tissue, in viscera. In indirect violence injury to soft parts less than in direct. We are sometimes deceived in the amount of violence and consequent injury, and prognosis should always be guarded.
George S. Brown said that the amount of violence is the greatest factor in the prognosis, but when it is less than enough to cause total