REPORT OF FIFTEENTH ANNUAL MEETING

!OF THE

ARIZONA MEDICAL ASSOCIATION.

Tuesday morning, April 24, 1906, 9:30 o'clock. Association called to order by the President, J. W. Coleman of Jerome.

ADDRESS OF WELCOME

By HON. B. A. FOWLER, Phoenix.

Mr. President, Ladies and Gentlemen:

I was invited some two weeks ago to extend to you a welcome for our people and declined

on the ground that it would be impossible for me to be here, and my reason for being here now is owing to one of your number, a man who is largely responsible for my having located here about seven years ago. About four years later he treated me for sometime when I had a little pneumonia which was followed by asthma, and finally he said to me, "you are the worst ad I have in the valley. I wish you would do one of two things, either get out or die and do it quick."

Now, the other day my wife was ill and that same man saw an opportunity for holding me here, for, unfortunately, we called him in and my wife has not been able to leave her bed since, until this morning when she is improving very rapidly. That accounts for my being here and not until yesterday afternoon was informed that I was expected to say anything.

I

I can only express to you my individual feelings with regard to your meeting here, and also the cordial welcome which the whole community gives to this organization. We are always glad to have you meet with us, for while you individually may receive the greater benefit, yet we know that such meetings as this in our community has an effect upon the whole community and we feel the better for it. A community is educated in a degree by the frequent holding of conventions and meetings of various organizations, and appreciating that fact we welcome you here today. We are very glad to have you with us, and yet we know that physicians, like the poor, are always with us, but you do not come to us in the same numbers always that you have here today.

We are glad to welcome you individually, we respect you individually, we are glad to welcome you as an organization and I

feel very sure that Arizona has good reason to be proud of this organization and what has been accomplished through the members of this organization for the good, for the upbuilding, and for the development of our Territory. There is no profession, perhaps, that comes in closer touch with the individual and with the family than that of the physician and we learn to trust them and trust them implicitly, and not only that but we learn to love them.

There are some physicians in my family relatives and I was thinking since last evening that in the death of those of the older ones that there were exhibitions of affection, and of love for those men that was equal to anthing that I have ever seen. I recall especially the death of an uncle of mine who had for fifty years practiced medicine in Massachusetts, and it is very rare indeed that more love and affection is shown than about the bier of that So it is that you come into the closest relations with us, and we not only respect you as a society but we come to love you for what you do for us.

man.

We hope that your stay here will be of the pleasantest character, and anything that we can do to contribute to that end we shall be very glad to do it. We hope that many times this organization shall meet here at Phoenix with us, because, there is an influence that goes out from these meetings to the whole community that benefits us as well as yourselves. May the organization prosper, may it grow and may your work become more and more successful as the years roll on. (Applause).

RESPONSE TO ADDRESS OF WELCOME

By DR. J. W. FLINN, Prescott.

Mr. Fowler and the Phoenix members of the medical profession:-I am sorry that the side partner has to make the response, but in the absence of something better, you will have to take what there is.

us.

We thank you Mr. Fowler, very heartily, sir, for your kind and cordial welcome to us outside members of the Arizona Medical Association. You have said some very kind things about About the truth of these things we have our serious doubts, but we will recognize the kindly spirit in which they are spoken and we accept them in that spirit.

We are glad to come to Phoenix because in coming to Phoenix we have this advantage that we do not have in going to other cities, in that Phoenix is our Capital city and it is our city, it is a part of ourselves. We before have accepted of your hospitality, we know what it is and we accept it because of the same hospitality on this occasion.

In regard to the work of the Association, the only special point that would seem to me to be of interest to the public at large, and more especially perhaps to the Phoenix public, is that

we meet here as general practitioners, not as specialists. We are not specialists, we don't pretend to be, we don't want to be, we are simply common every day general practitioners. For the last year or two the cheaper medical journals, and by cheaper I refer to quality and not to price, have been very fond of telling us that the days of general medicine are fast passing away and that the general practitioner will very soon be a person of the past. A greater fallacy was never foisted upon a gullible public. The practice of medicine pure and simple, internal medicine as it is sometimes called, is today what it was one hundred years ago what it will be one hundred years hence, the very essence, the depth of the practice of our profession. The trained general practitioner, I say trained general practitioner, today occupies his accustomed place at the very zenith of the medical sphere, the leader in the profession. He is the very highest type of all those who practice the noble art of healing. The general practitioner is today the very backbone of the profession. It is to him we look for the broad comprehensive views in practice. His field of vision is not confined to the head, the legs, the heart or the feet. He looks upon the human frame as one grand composite whole, the parts of which are wonderfully constructed and mutually interdependent. The days of promiscuous drugging are about ended but the days of rational medicine is just beginning. Ladies and gentlemen these are the days of the renaissance. Even now we stand on the very threshold in the new era in medicine, an era in which there will arise a grander and broader school of medicine the foundation of which has been laid slowly and cautiously broad and deep and is only now being finished. The superstructure of this it will take years, yes even centuries to build, but it will in time become a pride of the people of the earth. Gentlemen of the Arizona Medical Association it is our heritage, let us not sell it for a mess of pottage, let us rather be proud that it is given to us to work patiently and painstakingly at our little corner of the foundation, and we should be proud that it is given to us to assist even so humbly in so great an undertaking. Mr. Fowler I thank you for your kind courtesies. (Applause).

A Plea for a More Rational Therapy in
Tuberculosis***

By F. M. POTTENGER, A. M., M. D., Monrovia, Cal.

As long as tuberculosis was looked upon as hereditary, little or no headway could be made in its prevention. It was considered to be a matter of fate, and consequently surrounded by an air of hopelessness. The discovery of the specific cause not only paved the way for the overthrow of the heredity theory, but also made it possible for the disease to be discovered earlier than before, thus

bringing it before the medical practitioner at a time when many cases are curable.

Pathologists had seen evidence of healed tuberculosis postmortem; but now the profession is able to find bacilli in sputum and then see the patient get well. The evidence of the curability of tuberculosis has been accumulating so rapidly that we know the disease which was considered to be one of the most hopeless a quarter of a century ago is now recognized, not only as the most curable of all chronic diseases, but the proof is overwhelming that, if diagnosed early and treated intelligently, it will afford a mortality even lower than pneumonia and typhoid fever. In spite of all this evidence, we not infrequently hear physicians say that they never saw a genuine case of consumption get well. Such statements reveal not only a limited experience with tuberculosis, "for genuine cases of consumption do get well," but they also show a lamentable lack of appreciation of the most valuable lessons connected with this disease, viz., that tuberculosis can be diagnosed early before breaking down occurs, and before the advent of that complex condition known as consumption, and that the earlier the diagnosis the more favorable the case for treatment. That most cases of far advanced consumption die is not evidence against the curability of tuberculosis, simply a rebuke to the carelessness of the patient in not seeking medical aid soon enough or to the medical attendant for not exercising sufficient skill to detect it when the disease presented.

Today the curability of tuberculosis is established. No one conversant with facts will deny it. But the question which will bear discussion is, are we curing as many of the cases as we should? Are we curing as many as we can? Are we doing as much in the way of treatment of this disease as is possible, or are we falling into a dangerous rut? Are we worshiping at the shrine of fresh air, good food, and hygiene, and closing our eyes to many other important and helpful measures? Have we advanced only a degree beyond the fetiches of cod-liver oil and creosote to fall worshipers at the altar of fresh air? True, the advance is welcome. It is a wonderful improvement, but whoever would treat a disease so serious as tuberculosis should worship at no shrine except results. He should endeavor to use all remedies and measures which will aid in producing a cure.

As a basis for such a discussion as this, it is well to inquire into the causes which lead up to a cure in tuberculosis. What is it that makes it possible for the organism to overcome the tubercle bacillus and the results of its activity?

Osler is quoted as saying. "Make the patient fat and the local disease will take care of itself," thus making the cure a matter of nutrition. Great stress is laid upon nutrition by all phthisiotherapists, yet all who have had a wide exeprience know that it

is not all. There are many exceptions to Osler's statement. Often we see patients who are thoroughly nourished, and who are progressing favorably toward recovery, begin, through no indiscretion of their own, to go down. The disease does not "take care of itself." Nature cures most of her cases of infectious disease, in spite of a low grade of nutrition. The cure of tuberculosis is more than nutrition. If it were not, we would not see men in robust health become tuberculous; yet every one of us has seen this occur. True, a well-nourished man does not stand in much danger, comparatively speaking, of becoming infected. The inoculation, if of a few germs only, will not produce the disease; however, if there be a great number of germs of a low virility, or fewer of a very virile strain, even well-nourished individuals will not be able to overcome the germs.

Where tuberculosis has made any considerable advance in the system, we have a tendency for it to spread. So many bacilli may invade new tissue at one time that no matter what the nutrition of the patient, the bacilli will gain the day. We, who follow these cases carefully, see this thing happen very often. So, if we can administer any remedies which will increase the natural resisting power of the body and keep the healthy parts bathed in serum rich in antibodies, we are doing more than we can by nutrition alone.

Modern studies in immunity show that bacterial diseases produce toxic elements, which stimulate the cells of the organism to the formation of defensive bodies, which thus tend to cure the disease. To this tuberculosis is no exception; however, for certain reasons, the discussion of which we cannot enter into here, the toxins in this disease do not seem to be set free in the proper manner to be effective, so the disease does not limit itself when it has become well started. If this failure on the part of nature to furnish the natural stimuli for the cells can be supplied artificially, or if the defensive bodies themselves can be supplied, then another aid to cure has been found.

of

That the use of certain culture products will supply this want has been thoroughly established. The original tuberculin Koch, his later preparations, as well as numerous preparations made by other men, when used properly, will stimulate the cells of the individual suffering from tuberculosis to the formation of defensive bodies, as is shown by the increase of the agglutinating and opsonic power of the blood. Further proof of their value is shown in certain cases of tuberculosis which fail to respond to ordinary open air, dietetic, and hygienic treatment, but improve at once when tuberculin is added to the treatment. There are also certain sera which seem to furnish the antidotes already formed which are of some value, the best known of which are the Fisch, Maragliano, and Marmorek.

Aside from the matter of nutrition and culture products, we