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THE AMERICAN MEDICAL ASSOCIATION,
The thirty-seventh annual meeting of the American Medical Association was held in St. Louis, May 4, 5, 6 and 7. The attendance was good, with the notable absence of many Eastern gentlemen who formerly thought themselves quite prominent. The Executive Committee of the International Medical Congress was allowed to continue its work. This was certainly sensible, as it would hardly do to attempt to please every chronic croaker in the profession in America. The Committee on Nominations reported:
President, E. H. Gregory, St. Louis, Mo.
Vice Presidents, B. H. Miller, Stillwater, Minn.; W. B. Welch, Fayetteville, Arkansas; Wm. H. Pancoast, Philadelphia, Pa.; Wm. C. Wile, Sandy Hook, Conn.
Permanent Secretary, W. B. Atkinson, Philadelphia.
Committee on Necrology, J. M. Toner, Washington, D. C., Chairman.
Judical Council, N. S. Davis, Ill.; H. Brown, Ky.; William Brodie, Mich.; D. J. Roberts, Tenn.; R. C. Moore, Neb.; T. A. Foster, Me.: J. A. Gray, Ga.
Trustees of Journal, P. O. Hooper, Ark.; A. Garcelon, Me.; L. S. McMurty, Ky.
Next meeting, Chicago, first Tuesday in June, 1887.
DEATH FROM CHLOROFORM. The Maxwell-Preller mystery bids fair to be only another chloroform accident. Maxwell states that Preller
under his treatment for venereal disease and it became necessary to perform a painful surgical operation. He administered chloroform with fatal effect, and the state of mind induced by the death of his friend accounted for his peculiar subsequent actions. He would have made the confession long ago but for the advice of his lawyers.
If this is a true statemenr of the case it only emphasizes what has been repeatedly said about the danger of chloroform. At any rate only under the most pressing circumstances should any anæsthetic be given unless another physician is present.
MEDICAL CHARITY. — There is a large per cent. of the work done by an active physician for which he neither expects nor gets pay. But does not the profession allow this principle to carry them too far? If a pauper is indicted on a criminal charge, the State appoints a lawyer to defend him. When he gets injured and is sent to a public hospital, the appointed physician attends him. In the former case the State pays a reasonable fee for professional services; in the latter case the professional services are classed under the head of “medical charity," and the attending physician is fortunate if he escapes a suit for malpractice.
It strikes us that this is rather one sided business. Why should not physicians attending pauper patients at hospitals receive pay, just as the lawyer does who defends the pauper criminal, or the grocer who feeds the pauper hungry?
HYDROPHOBIA. - Chas. W. Dulles, of Philadelphia, reports a case of so-called hydrophobia in the Lancet, May ist, which he attempts to demonstrate to be a case of acute meningitis. His proof is certainly conclusive, and his admonition not to call every case of convulsions "hydrophobia,” even if the patient was at some time bitten by a dog, is certainly, a timely one.
He states that cases of so-called hydrophobia have been attributed to the most various causes, to the bites of a great variety of animals, both rabid and healthy, including birds, fleas and lice (Bollinger, Jolly); to the bites of human beings, to germs distributed in the earth and air (Doleris); to the kissing of a mad dog before it was hung (Bardsley); to drinking the milk of a rabid animal, to suckling (Roucher), and to coitus (Bollinger); to the handling of sabres used in killing rabid dogs (Virchow), and finally, to a spontaneous origin, the most recent illustration of which was a patient who died undhr the care of Dr. Judardin-Beaumetz, in Paris, in January of this very year.
There is no doubt that many of the so-called cases of “hydrophobia" are cases of acute mania, meningitis, delirium tremens, etc., and after the symptoms have developed there is little trouble in remembering a dog bite or some of the above causes in the past history of the patient.
A MALPRACTICE Surt.-In October, 1883, Dr. Jas. P. Orr, of Glenwood, Ind., operated on a woman of Connersville, Ind., for supposed ovarian tumor. The abdominal incision revealed, as it has on several occasions before, that the tumor was not ovarian, but in this
was an enlarged spleen. The operator then closed the exploratory incision and the case made a good recovery—the shrinkage of the enlarged spleen having probably been hastened.
After some time suit was brought for $10,000 damages for the exploratory operation.
The case came up for trial at Brookville, Ind., before Judge Berry, a lawyer of excellent judgment. Some portions of the judge's charge to the jury are here given: "A surgeon in performing a surgical operation, is not required to have an infallible judgment or perfect skill. If possessed of fair or ordinary knowledge and skill, and if he exercises these to the best of his ability, he is not bound to warrant his judgment. Acting in good faith, a properly qualified physician or surgeon may do an act or adopt a treatment which may do harm and produce a bad result, yet if done in good faith and in the exercise of a fair and reasonable knowledge and skill, he would not be liable.
"If you find from the evidence that any of the defendants [Dr. Orr's assistants were made parties in the suit] performed the operation in a negligent or unskillful manner and the wife of the plaintiff was injured by reason of such negligent or unskillful act, then you may find for the plaintiff against such defendants as so negligently or unskillfully performed the operation, although such defendant or defendants may have possessed the ordinary or reasonable skill of surgeons of ordinary and reasonable skill and ability.
If you find from the evidence that at the time the defendant, James P. Orr, first conversed with the wife of the plaintiff about her affliction, that he was a surgeon possessed of a fair, ordinary and reasonable knowledge, skill and ability as a surgeon, and that the wife of the plaintiff was then afflicted, said Orr, with the knowledge and consent of the plaintiff and his wife, made such examination of the plaintiff's wife as a surgeon of fair, reasonable and ordinary skill would make in such a case before performing an exploratory operation to ascertain the cause of her affliction, and could not by such examination determine such cause, and then in good faith such surgeon, with the knowledge and consent of the plaintiff and his wife, made the necessary preparations and did perform such operation in the manner such op
erations are usually performed under such circumstances by surgeons possessing the fair, ordinary and reasonable knowledge, skill and ability of surgeons, for the purpose of ascertaining the cause of her affliction or for removing the same, and in so doing used and exercised the usual or ordinary care, caution and diligence of surgeons of a fair, ordinary and reasonable knowledge, skill and ability in such cases, then you should find for defendant.
“If the jury find from the evidence that the wife of the plaintiff was injured by the operation but not permanently so injured, but that a permanent injury has been caused by her acts after the operation, or by subsequent treatment, then the jury could not allow for plaintiff any damages for permanent or future disability of the wife, but if they so find, and find for the plaintiff, could only allow such damages as were caused by a wrongful operation by the defendant."
The jury returned a verdict for plaintiff, assessing nominal damages. This verdict was set aside by Judge Berry as being not sustained by the evidence.
The case is one in which there is not one particle of cause for action. Dr. Orr is one of the most skillful surgeons in Indiana, and the gentlemen assisting him were the best men in their respective locations. The case is only another illustration of the truth of Professor Dawson's remarks at his introductory lecture to his students, “that on entering the practice of surgery the first thing to do was to put your property in your wife's name.”
The laws seem to be defective in that they allow any unscrupulous patient to put his attending physician to great expense in time and money, while the average jury seems to delight in assessing damages against a professional man.
SALICYLATE OF COCAINE IN ASTHMA.—Mosler, in the Deutsche Med. Wochenschrift, relates two cases of asthma in which salicylate of cocaine appeared to give complete and lasting relief.
The drug was administered hypodermically in /4 grain and 12 grain doses during the attack, and, in case the paroxysm was not checked, was repeated in three or four hours. Four to five days' treatment, with four or five injections, sufficed for the cure of the two cases reported.
NITRO-GLYCERINE IN THE TREATMENT OF NEPHRITIS.—Dr. Kinnicutt, in the Medical Record, April 17, 1886, relates a number of cases of chronic nephritis treated with nitro-glycerine, with good palliative results. He gave it in the form of a gelatine pill, in 1-150 of a grain, three or four times daily.
In conclusion he says:
1. That in nitro-glycerine, given in small doses and frequently repeated, we possess a powerful agent for lowering the increased blood pressure which is very constantly associated with the development of uræmic symptoms.
2. That it has the power to control or relieve many of the paroxysmal disturbances of the nervous system which are included under the general term, uræmia; of these, headache and asthma are especially benefitted by its use, the relief being more marked and continuous than that obtained by opium or chloral.
3. That its influence upon the daily excretion of urine and serum albumin in parenchymatous and interstitial nephritis is apparently to increase the former and diminish the latter.
4. That in the systematic and prolonged use of nitro-glycerine, in appropriate doses, in nephritis, we possess a means of maintaining, more or less continuously, a loweredd bloo pressure, of often averting or relieving critical conditions, and thereby prolonging life.
Dr. K. gave the remedy until it would produce its physiological effect, as far at least as a feeling of intra-cranial fullness. To accomplish this end, when distressing symptoms were present, he would give 1-100 of a grain every three hours, or even 1-50 of a grain at the same interval.
A New CURE FOR GONORRHEA.-Dr. Rogers, in the Medical Record, reports excellent results from the use of kava kava in gonorrhea.
He says his usual prescription is from twenty to thirty minims of the fluid extract of kava kava, in water, every four or five hours.
In large doses the drug is said to produce a peculiar form of