CASH RECEIPTS AND DISBURSEMENTS, ILLINOIS STATE MEDICAL SOCIETY, FROM MAY 16, 1904, TO MAY 16, 1913

RECEIPTS

Balance on hand at beginning.

2,700.00

1,362.58 367.50

Interest

Savings fund.

A COUPE ADVANTAGE

A great advantage of a coupé body is the insurance against death from crushing in case the car is overturned.

AXLE STRAIN

The most severe strain that can be placed on a rear axle or driving gear is from efforts to get out of a mud hole by backing up a little and then rushing forward on slow gear.

REPLACING SPARK PLUGS

Spark plugs should not be forced into position by severe wrench action. They should seat firmly against a copper-asbestos gasket with but little more force than can be applied with the fingers.

TIRES COST MONEY

The cost of keeping tires repaired and renewed is the greatest item in the up-keep expense. Why do tires blow out? Why do they wear out so soon? Simply because they are not kept inflated to the proper pressure.

Very few motorists get from their tires the mileage they pay for and which any good make tire would give if kept properly inflated.

Looks deceive. One of the strange things from the point of view of the autoist of limited experience is that a tire with an air pressure of 35 pounds per square inch looks as well inflated as one that has 90 pounds pressure. If run at the former pressure, however, the tire will flex out after a few hundred miles running, whereas if maintained at 90 pounds it will run from 5,000 to 10,000 miles.

The only way to get long service from your tires is to know that the tires are kept properly inflated at all times.

The reason is very clearly explained:

"The side walls are the weakest part of a

pneumatic tire, for here most of the bending action takes place. The more the side walls are and separate. If a tire is run partially inflated, kneaded or bent, the sooner they will break down this kneading action is violent and the tire is bent sharply every time it hits an obstruction. If the tire is kept properly inflated, the converse is true. A tire may be perfectly round under load and yet have only 45 pounds of air in it when it should have 90. The use of a reliable air pressure register is the only way to determine accurately whether or not the tires are properly inflated."

Society Proceedings

CLARK COUNTY

Clark County Medical Society met in the M. E. Church, Westfield, Ill., Aug. 14, 1913, at 2 p. m. Members present: McCullough, Johnson, Haslit, R. H. Bradley, Anderson, Pearce, Hall, Marlow and Weir. Visitors: Drs. Hinkley of Westfield and F. Buckmaster of Effingham.

Dr. R. H. Bradley read Dr. S. C. Bradley's well prepared paper on "Antityphoid Vaccination," reviewing the literature or history of this valuable vaccine and urging its use.

Dr. Marlowe considers it a preventive of importance and thinks it may prove curative also.

Dr. Buckmaster would use it much for immunizing, when people are exposed.

Dr. Johnson recited his observation in a family where two members were vaccinated and had no infection and the others got typhoid fever from the well water. No reaction from vaccine was observed except one had local infection, possibly incidental from other germs.

Others participated in the discussion, recommending the use of antityphoid vaccination, but suggesting care in using all vaccines urged on the profession, except those well understood and plainly indicated.

Dr. Bradley described his experience with vaccine in one well man who had very little reaction and no typhoid. Another case in active fever seemed to be benefited with no untoward symptoms.

Dr. Marlowe reported further on his case of uremia in pregnancy; premature delivery was made and woman and baby are doing fairly well.

Dr. Hinkley reported a case in which a catheter was introduced into the uterus to produce abortion. After twenty-four hours the catheter was removed and introduced another twenty-four hours and woman went on to term.

A minimum fee bill of $5 for giving the three doses of antityphoid vaccine was adopted. Society adjourned.

L. J. WEIR, Secretary.

ANTITYPHOID VACCINATION

S. C. BRADLEY, M.D., MARSHALL, ILL. The only phase of typhoid fever which I have not heard thoroughly discussed at our meetings is antityphoid vaccination. Therefore I have chosen this subject to get it before the society for discussion.

First let me quote the well known statistics of the United States Army during the Texas maneuvers, March to July, 1911. This was the first general compulsory use of the vaccine as the previous ones had been voluntary. At the largest camp, at San Antonio, there were nearly 13,000 men stationed.

All not previously treated were vaccinated. Among the 13,000 men there developed one case of typhoid and he recov ered. The camp was kept in as good sanitary condition as possible, but the men had free access to the city, eating and drinking in all sorts of places. In San Antonio during the four months of the camp there were reported forty-nine cases of typhoid with nineteen deaths. Compare this one case and no death with the 2,693 cases and 248 deaths from typhoid during a four or five months' camp of about 10,000 soldiers at Jacksonville, Fla., in 1908, without vaccination.

Such examples of the value of the vaccine could be given by the dozen, for recent literature is full of them. The results are as striking in civil life as in the army and navy. In the latter, last year, there were only three cases of typhoid and no deaths.

The only poor results seen were in the Boer war, where 100,000 British soldiers were vaccinated, but typhoid was not much decreased. There was a reason. The vaccine was not properly made, being heated far too much to give good results.

The vaccine is a culture of typhoid bacilli, killed by heating to only 127 F. for one hour and then 0.25 per cent. tricresol is added to make sure of the sterility of the vaccine.

The vaccination, to be complete, must consist of three injections given ten days apart. The first dose is one-half billion bacilli, the second and third are each one billion.

The reaction is usually very mild, consisting of a large sore area at the site of injection, slight or moderate fever, sometimes slight aching all over, all of which are gone in twenty-four to forty-eight hours. In all the literature which I have read there have been absolutely no dangerous reactions after the injections.

With this much proved, that it is harmless, that it gives immunity from typhoid infection, its application to our cases becomes clear. We must give it to all children and young adults who live in or are going into a neighborhood where typhoid is prevalent; we should give it to all, of any age, who are directly exposed to cases of typhoid. From my reading and from my own experience I believe it should also be given to all cases of typhoid fever seen during the prodromal stage or during the first week of the fever, at which time there are still few or no bacilli in the blood stream. We have not nearly as much information as we should have on its value after the onset of the fever, because in all the immunizing tests no case was allowed to take the vaccine unless perfectly well. This gave better records in its early trials, but limited our knowledge of its uses. However, it was accidentally given in some cases in the prodromal stage, with the result that they ran very mild courses.

There is one danger in the use of so efficient a preventive of typhoid fever, namely that those about a typhoid case, being vaccinated and feeling themselves immune, may neglect to take all the usual sanitary precautions to prevent its spread. Vaccination is only one phase in an evolution, a make-shift to protect us until we learn to eradicate typhoid completely by more perfect sanitary control of all typhoid cases and other sources of typhoid infection.

In conclusion might I suggest that if any members of our society will use the vaccine in their typhoid cases this fall, they keep accurate records of their cases, and let some member of the society summarize the records and results in a paper next spring.

CLINTON COUNTY

The Clinton County Medical Society held a meeting August 12, at Trenton, with the following program: Dr. E. W. Fiegenbaum of Edwardsville gave an address on "Organization." Dr. J. O. Roane, Carlyle, read a paper on "Puerperal Infection." This paper was discussed by Dr. J. W. DuComb of Beckemeyer. Dr. A. W. Carter, Trenton, read a paper on "Summer Diseases of Children." Discussion by Drs.

O. O'Neil of Shattuc and L. Niess of Trenton. This was a very good meeting, the address by Dr. Fiegenhaum being especially noteworthy. Dr. Phil. Griesbaum of Lebanon attended as a visitor.

L. NIESS, Secretary.

COOK COUNTY

CHICAGO LARYNGOLOGICAL AND OTOLOGICAL

SOCIETY

Regular Meeting, March 18, 1913

A regular meeting was held, with the president, Dr. J. Gordon Wilson, in the chair.

Dr. C. H. Long reported a case of "Stenosis of the Right Auditory Meatus."

Dr. J. Holinger presented a series of specimens of "Otosclerosis."

Dr. J. Gordon Wilson presented specimens showing gross lesions of the middle ear. He also showed a young man on whom he had recently operated for acute mastoid and temporo-sphenoidal abscess.

Dr. Otto T. Freer showed an esophageal bougie fitted with a wax spindle-shaped enlargement for dilatation of cicatricial strictures of the esophagus. Dr. Joseph C. Beck discussed Dr. Wilson's case. Dr. Shambaugh reported a case of brain abscess recently under his observation. This was discussed by Drs. Freer, Fletcher and Hawley.

Dr. Fletcher demonstrated a case of double fistula of the ears and another case of destruction of the function of the labyrinth following a radical mastoid operation. He then read the following paper:

JOHN R. FLETCHER, M.D., CHICAGO

It is quite important, in familiarizing ourselves with the use of vestibular nystagmus in otology, to remember that there are many cases which do not come under the rules and that all cases of this type of nystagmus do not originate in the ears—that is, they are extracranial, as, for instance, the nystagmus with vertigo from auto- and other intoxication, uterine vertigo, etc. No direct ear symptoms and none pointing directly to the cranial contents will speedily put us right on these cases. Other cases, manifestly of the gravest, are at present quite beyond diagnostic certainty and are helped but little by the symptom under consideration. However, in diagnosing and dif ferentiating serous and suppurative, circumscribed and diffuse, manifest and latent labyrinthitis; hyperemia and anemia of and hemorrhage within the labyrinth, and retrolabyrinthine diseases from one another and from non-otologic diseases, its place is well fixed and its value great. The patients we see are referred or come of their own accord; we are asked to see the first because of the nystagmus, and are consulted by the second because they have vertigo. They know nothing of the nystagmus, but for various reasons believe their vertigo comes from the ear or nose, as, for instance, the first patient demonstrated by him that evening, who came complaining of brief attacks of severe vertigo, with sometimes nausea whenever he blew his nose. Careful examination determined beyond doubt that he had a fistula in both ears, which is uncommon, and, further, that but one of them is affected by the nose-blowing. We learn the latter from the fact that performing the fistula

test on the left side produces nystagmus in the same direction, as by blowing the nose, but its velocity and excursion are not so great. If we make the same test on the right, the result is identical with the noseblowing. This and the unique fact that the route of the air current from the Eustachian tube can be followed with the eye make it certain. In addition, a pinhole perforation of the closely adherent left drumhead, directly over the oval window, designates the site of the fistula. Moreover, this perforation would allow air coming from the tube to escape. Another point to make is that gentle pressure over the site of the perforation with a probe wound with cotton causes nystagmus, much the same as the fistula test. The latter is made by carefully blowing air into the external auditory canal through a hollow olive-shaped hard rubber point from a small rubber bag and tube. Of the three clinical tests the fistula test, turning, and the caloric test, the latter is the most constantly useful. The speaker's second patient brings out this point quite well. Her reponse to the fistula test is negative, though one is visible on the right and freely exposed to the pressure of air because of tubal closure after the radical mastoid operation. She is totally deaf in this side. Schwabach localized in the left; Rinné negative. She responds very slightly to turning either to right or left-so slightly that unless very closely observed one might report the response absent. Her response to the caloric test on the right is negative. All these facts signify beyond a doubt total functional inactivity-a functional death of the right labyrinth. The whole exposed lateral labyrinth wall was irrigated with ice water for a long time, without result. The same water used in the left ear caused horizontal and rotary nystagmus to the diseased side, but not so promptly nor so vigorously as in the normal person. Quite warm water caused to flow into the left ear caused a rather feeble rotatory nystagmus to the good or irrigated ear. These caloric tests to the left ear tell us that her left labyrinth is functionating. If we had no other information than the caloric test given us, we could safely diagnose a dead labyrinth on the right and a functionating one on the left, though the left response is normal only in the direction and plane of the nystagmus, not in quickness and degree. In other words, what is known as readjustment has taken place-the good labyrinth is somewhat less keenly doing the work of both. Their action and reaction on each otner has been lostthere is no longer synchronism. The normal reaction to turning a patient ten times around the vertical axis is nystagmus in the direction of turning during turning and in the opposite direction after turning. In turning this patient to the right there is no afternystagmus, and the usual vertigo is absent. In turning to the left the after-nystagmus is so slight as to amount almost to nothing. When we use the turning test to discover pathologic labyrinthine conditions, the rule is that if one labyrinth gives an after-nystagmus of at most half the duration of the other, the labyrinth giving the short-enduring reaction is pathologic. In this case one does not respond at all and the other barely. We may interpret this as nothing equaling the half or less of almost nothing; that is to say, within the rule. Turning must always be used in case of dry perforations, as irrigation is not to be thought of on account of the danger of causing acute suppuration. Of course, the caloric test may be made