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1895, the highest honor in its power to bestow, that of its presidency. On assuming this office, Dr. Jones made one of its most notable addresses. It was a history of the efforts made during the preceding thirty years for securing higher standards of medical learning. It was one of the most instructive productions of its kind heard before a medical society, and was a testimonial of the learning and many-sided character of the man. He showed that as a result of the application of the provisions of the three-board licensing law, which had been enacted in 1890, the standards here established were as high as those of any other country. He
a voluminous writer, with forceful, effective style. In 1893 he was appointed by the Civil Service Commission a member of the Examining Board, to examine and determine the fitness of candidates for the position of physicians and superintendents of hospitals for the insane, and in June, 1894, he was appointed by Governor Flower a member of the first Board of Managers of the Craig Colony for Epileptićs.
In all of these positions he performed his duties with fidelity and zeal, with honor to himself and signal aid to the various organizations with which he was connected.
Dr. Jones was prominent in social and masonic circles and few men held the place of affectionate regard in the hearts of those whom he served as did Dr. Jones. Kind and courteous always, and with an unceasing and generous devotion to those who sought his professional care, he was not only held in high esteem for his professional attainments, he was loved and will be deeply mourned by all who knew him best.
GEORGE E. GORHAM.
Edited by H. Judson Lipes, M. D.
MEDICAL SOCIETY OF THE COUNTY OF ALBANY.— Meeting held December 13, 1899, in Alumni Hall. The following members were present:
Drs. Archambault, Ball, Blumer, Capron, Craig, Dawes, George, W. H., Hale, W. S., Hun, Jenkins, Lewi, Lipes, Macdonald, Moore, C. H., Moore, J. M., Mosher, Richardson, Root, Sheldon, Smith, R. J., Trego, Van Allen, Vander Veer, Wansboro, Washburne, Wiltse, Conley, of Buffalo; Swan, of Saratoga Springs.
The meeting was called to order at 9 P. M., the President, Dr. Van Allen, in the chair.
1. Reading of minutes of last regular meeting.
It was moved by Dr. Hun, and seconded by Dr. Ball, that as the minutes had been already printed, they should be adopted as printed. Carried.
No minutes of special meetings. 3. No reports of committees submitted. 4. No applications for membership were received. 5. No motions or resolutions were presented. 6. There was no miscellaneous business. 7. Reading of papers. Dr. HENRY HUN read a paper on “ Primary Endocarditis." The President declared Dr. Hun's paper open for discussion.
Dr. Dawes: Dr. Hun's paper is of exceptional interest, but I think he has more support for his supposition of primary endocarditis than he cites. Fagge says that primary endocarditis rarely occurs. Quimby says that it does occur but not often. Strumpell also states that it occurs.
Dr. VANDER VEER: We should like to hear from Dr. Blumer on this subject.
Dr. BLUMER : I do not know that I have much to say on this subject. I think the paper is of value as illustrating a fact not recognized by the profession in general, i. e., that rheumatism in children is quite different from rheumatism in adults; that it may present almost none of the symptoms usually associated with the disease, practically no pain and no joint lesions. The subcutaneous fibroid nodules are especially liable to occur in children and stamp this case, I think, as rheumatic. As Dr. Hun uses the term Primary Endocarditis in this case, I think we certainly must recognize its possibility and I think the case is one of rheumatism attacking the endocardium before the joints. There is, of course, a good deal of structural analogy between the joints and the endocardial cavity.
Dr. MACDONALD: Last time I interfered in a purely medical discussion I got so badly used that I have a good deal of fear in entering into this one. It seems to me from the history of this case, that a variety of assumptions might be made. A bacterial origin cannot, I think, be excluded. Recent bacteriological examinations, particularly in surgery, have shown that the so-called idiopathic septicaemias and pyaemias really take their origin from some obscure lesion. The tonsils are favorite seats for such lesions and from what has been said, I think that the tonsils might have been the primary seat in this case. Streptococcus inícctions, particularly, are apt to occur in this way. I have read of such a case only a few nights ago in an article written, I believe, by Hare. In other surgical diseases, such as a mild case of gonorrhoea, the complication of endocarditis has been noticed. Formerly, reports of such cases were few in number, but at the ena of last year one hundred such had been collected. A single isolated case of pneumococcus endocarditis, without marked signs of pneumonia, has also been reported. Without a postmortem examination it is very difficult to decide the origin of such a
Dr. VANDER VEER: This case has been to me exceedingly instructive. It is sometime since I have looked up the subject with care. From a surgical standpoint my experience has been that primary endocarditis is almost unknown. I have had the impression that it was always a secondary change. Typhoid fever gives a good many peculiar lesions and might cause it. Hereditary syphilis sometimes presents in a peculiar way. Lesions in so young a child as this may occur as a result of heredity. The uric acid diathesis should be thought of in this connection. I have listened to the paper with great interest, and the subject has been very clearly and concisely presented. I must admit that it convinces me that there is a primary endocarditis.
Dr. BALL: Some German observers, whose names I do not remember, and probably the same that Dr. Macdonald mentioned, have reported a case which was similar in many respects to Dr. Hun's. In their case the endocardium was infected and there was also marked evidence of rheumatism. I think that the temperature excludes syphilis in this case. I have no doubt that it was a case of rheumatic infection.
Dr. Hun: It was not my intention to cite the evidence in favor of primary endocarditis. I knew, of course, that many such cases could be cited and that the further back you go the more evidence you find. I wished to show that modern medicine rather recedes from this idea of primary endocarditis, perhaps, without sufficient grounds, and cited two modern text-books, Osler and the Twentieth Century Practice, as being, perhaps, the latest modern utterances on the subject, and as illustrating this standpoint. Of course, I am aware of the fact that most of the older writers recognized primary endocarditis. I must have expressed myself very poorly, if Dr. Macdonald got the idea that I did not think primary endocarditis of bacterial origin. I expressly pointed out in the paper that the toxic origin of endocarditis was no longer held, and that bacteria were, probably, always present. Of course, these bacteria must enter somewhere and the tonsils are possibly a frequent site for entrance. They sift out many bacteria, but, probably, allow some to pass through. In this case, I think, the evidence was in favor of the bacteria of rheumatism. As far as I could make out, there was no local evidence of a point of entry. The remarkable points about the case were that no joints were attacked, but the endocardium was primarily attacked. Further than this, the case was under observation for some time, both before and after the endocarditis, which is unusual. Of course, we do not know what the bacteria of rheumatism are, but, assuming it to be a bacterial disease, the bacteria must travel a long distance from the point of entry to the joints. There seems no reason, then, why they should not attack the endocardium first, as they have no further to go to reach it.
Dr. MACDONALD: The mistake in my case rose from the fact that I did not understand that the bacterial origin of rheumatism was established.