partment of Health is now doing Schick test work and immunizing children of the kindergarten and first grade, the consent of the parents being first obtained in each case. From January 1 to February 10, in 63 schools, the three injections were given to 2,029 children. With the continuation of this work and the increasing cooperation of the parents, the department looks forward to the time when diphtheria will become an obsolete disease.

During the past year some 15,000 bills have been introduced in congress. In the first session 81 house bills and 66 senate bills were enacted. In the second session 60 house bills were passed and 28 senate bills are now laws. Of this number only a half dozen or so have been concerned with public health. They include the Maternity and Infancy Act, Veterans' bureau, Prohibition, Social Hygiene. Of the 15,000 bills, 189 have some relation to public health. Included in these are a bill for Physical Education, a Department of Public Welfare, re-organization of the Public Health Service.

Thirty-six states have adopted the Maternity bill and accepted the terms of that act. The congressional appropriations for this act now reaches $1,551,000.

Our members should be able to perceive from this brief statement legislative tendency to health legislation. Are you still willing to sit in your office and manifest no interest in the subject? Are you content to let "George do it" and when he attempts to arouse some activity, cuss him for it? Think it over!!

common

The material for this paper is based upon the case records of 41 patients, seen in the past eight years in private practice, or, in the wards and out-patient departments of various hospitals, who were found to have at the time of observation pleural friction. Ninety per cent of the patients were males between the ages of 18 and 30 years. All complained of acute illness, the most complaint being "a cold." They all suffered from cough and in most instances the cough at first was dry and unproductive, but later mucous was expectorated and finally pus. All but four had fever at some time during their illness. The diagnosis of acute simple catarrhal bronchitis was made from the symptoms, and upon the absence of phyical signs in the lungs, and in addition because of the short duration and the mildness of the attack.

At the beginning of their illness 21 patients had vague indefinite pains over different parts of the chest, but later many of them gave a very definite history of pleural pain on deep breathing or upon coughing.

Of the four females the youngest, a girl of seven years, had severe pain in the upper right obdomen, and for a time this patient was thought to have acute abdominal condition. While a blood count was being made she developed severe pains

an

*Read before the Wm. Osler Medical Society. Ann Arbor, Michigan, April 20, 1922.

As you

in the right neck and the right shoulder. know, the diaphragm receives its sensory nerve supply from two sources, the peripheral portion from the intercostal nerves, so that inflammation of the outer portion of the diaphragm can produce reflex pain in the upper part of the abdomen because of the relationship of these intercostal nerves to the peritoneum and the pleural. On the other hand the central portion of the diaphragm receives its sensory nerve supply through the phrenic nerve, from the cervical nerves which supply the shoulder and neck, hence the pain in the latter region when the central portion of the diaphragm is inflamed. Dr. Capps has proven this clinically in patients who have been operated on for empyema. (1) By irritating the pleura in the central portion over the diaphragm Dr. Capps could produce pain in the shoulder and neck of his patients. His experiments have proven to be of real practical value from the standpoint of diagnosis, because of the fact that many patients in the past have been operated upon for what was thought at the time to be an acute abdominal condition, but which later proved to be either diaphragmatic pleurisy or beginning pneumonia.

On examination very few physical signs were found, a slight diminution of the resonances and varying degrees of impariment of the mobility at the base of the lungs. Percussion gave little information of value. The diagnosis of pleurisy was based upon leathery friction rubs heard for the most part either in the axillae, or in the front of the chest at the level of the fifth and sixth ribs on one side or the other. The friction sounds were heard best over the chest where the movement was greatest, and generally speaking, the sounds were heard over the regions in which pains were complained of by the patients. Friction was also heard bilaterally in five patients and in two of these the signs were such as to warrant an exploratory puncture from which 2 c. c. and 12 c. c. of clear yellow fluid were found respectively. Subsequent culture of this fluid proved negative for organisms.

Of the 41 patients eleven had X-ray examinations of their chests. The plates were negative for evidence of tuberculosis and pneumonia, or for fluid. Unfortunately the two patients who had some fluid were not examined by X-ray. I am of the opinion that small amounts of fluid could be found in a large percentage of these cases, even in the absence of physical signs, if one were of a mind to use paracentesis in such mild cases.

Signs of pneumonia were watched for with the greatest care, and where there was the least doubt such cases have been excluded from consideration. I had my attention called to the ambulatory form of pneumonia while I was in the out-patient department in the university hospital, where during one spring I saw a number of young students with little or no fever, yet with signs of a small era of consolidation at the base of one or the other lung. These patients had a dry cough and suffered from malaise. Similar cases have been described by Dr. David Riesman of Philadelphia. (2).

All of these patients made uneventful recoveries under the usual treatment with salicylates, counter irritation, and strapping.

I had seen several cases of acute rheumatic arthritis complicated by serous pleurisy and recently an autopsy revealed wide spread pleural adhesions without tubercular disease, in a patient who had had many attacks of rheumatic fever. It seems to me reasonable to assume that we may have an inflammation of the pleural attending a simple bronchitis without intermediate changes

in the air cells. Furthermore it must be granted that other organisms besides the tubercle bacillus can produce a serous or serofibrinous pleurisy. My contention is that they do more often than we suspect. Most text books claim that of the dry pleurisies, by far the vast majority are tubercular in origin. It would be easy to follow the line of least resistance and argue that such mild attacks of dry pleurisy were due to undemonstratable tuberculosis of the lungs. Patients who have tuberculous pleurisies are usually given a poor prognosis, because it has always been taught that a majority of them develop pulmonary tuberculosis in later life. Perhaps it is too early to make a definite statement in regard to the future of my patients. Nevertheless over half of these patients gave a negative reaction to tuberculin and I know a number of them to be well up to the present time, while three live in the city of Detroit, and have been under my observation for eight years. One of them recently passed through and completely recovered from an attack of severe pneumonia.

I am inclined to feel that these pleurisies are non-tubercular in origin. I know that from a pathological standpoint it is rare to find disease of the bronchial path without secondary and consequent pathological changes in the attriae. We know that disease of the bronchial path may readily extend by contiguity to the air cells. But the anatomical relations existing between the blood supply to the bronchial tract and the pleura from the bronchial artery and the bronchial veins and the anatomical relations between the subpleural lymph spaces and the peribronchial lymph spaces are such that we may have an infection of the pleura coincident with bronchitis without involvement of the air cells.

I wish to emphasize here that in my experience the bacteriology of the respiratory passages has been extremely difficult to interpret. It is difficult to know with any certainty what organisms play a saprophytic role and what ones are responsible for the bronchial disease. All I know is that there were a number of organisms found in the sputum of these patients and that I was never satisfied as to which ones were responsible for the etiology in any given case. There were no tubercle bacilli found.

Bronchitis is the most common disease of the air passages and we all know that it frequently exists without any clinical signs of disease of the lungs. Why it is not complicated more frequently by pleurisy is a question I have been trying to determine. I feel that we would discover mild attacks of pleurisy in cases of simple bronchitis if we looked for it carefully in each case. To my mind the anatomical relations between the pleura and the bronchi certainly explains the chest pains associated with bronchitis, and very few patients with acute bronchitis are without some form of chest pain. The descriptions of the pains may be vague and indefinite, but they are very real as far as the patient is concerned. Whenever a patient presents himself to me with soreness or vague pains in the chest, I always look for pleural friction and I have been quite frequently surprised to find it in cases where it was little expected.

SUMMARY

To summarize, I have collected 41 cases of acute catarrhal bronchitis, complicated with different degrees of dry pleurisy, without any manifest disease of the lung tissue proper. The etiology could not be definitely determined in any

gives the following interesting figures in regard to those who are practicing the healing art: Physicians and surgeons in 1910, 151,132, and in 1920, 144,977; healers (other than osteopaths) in 1910, 6,834, and in 1920, 14,744. The number of physicians and surgeons is slightly less than a decade ago, while the number of healers has more than doubled.

The Henry Ford Hospital of Detroit opened May 1, 1922, 24 additional private rooms, with a total capacity on that date for 144 patients. It will open from time to time additional units of 24 rooms each. When all the wings are opened the hospital will have accommodations for 560 patients as follows: 144 beds for children, 48 private rooms for maturnity cases, 13 semi-private rooms (accommodating 33 patients), and 335 private rooms for adults only.

The Detroit Homeopathic Society held its annual meeting May 6, 1922. Dr. Bruce Anderson was elected president; Dr. I. S. Morris, vice president, and Dr. B. H. Vollerson, secretary-treasurer. Preceding the meeting a testimonial banquet was given for Dr. D. A. MacLachlan. Dr. Frank Kelly was toastmaster. The out of town guests were Dr. R. S. Copeland of New York, Dr. J. C. Wood of Cleveland, and Drs. D. W. Meyers, H. M. Beebe and S. C. Runnells of Ann Arbor.

Drs. A. S. Warthin, Carl Weller and Frederick Novy read papers before the American Association of Pathologists and Bacteriologists; Drs. D. M. Cowrie and C. W. Edmunds read papers before the Association of American Physicians; Dr. Udo Wile read a paper before the American Dermatological Association. Besides these the following Ann Arbor physicians attended the May, 1922 meeting of the American Congress on Internal Medicine and Surgery: Drs. Hugh Cabot, Carl Camp, LeRoy Abbot, W. R. Parker and R. B. Canfield.

Through recent action of the State Administrative Board and the regents of the University of Michigan, Fairmount Hospital, Kalamazoo, has been designated as a university hospital clinic for juvenile gonorrhea cases. Indigent children suffering from gonorrhea can be sent to Fairmount Hospital for treatment at state expense.

When cases of this nature present themselves, they can be referred by you to the Judge of Probate of the county wherein the family resides, and their admisison to Fairmount Hospital arranged by the Probate Court.

Butterworth Hospital, Grand Rapids, has for several years been conducting a monthly clinical conference to which physicians of surrounding localities are invited. The program as a rule consists of morning operative clinics and demonstrations. In the afternoon there are several ward walks and diagnoses of referred cases. Dinner is served. The evening program consists of papers and discussions. These meetings have been well attended, are extremely interesting and profitable and stimulate one to better scientific work. The staff is very appreciative of the co-operation accorded by visiting doctors.

Butterworth and St. Mary's Hospitals, Grand The Rapids, held open house on Hospital Day. many visitors were shown the equipment and

working methods of the hospital departments and clinics. The orthopedic, mental and out patient departments of Butterworth Hospital demonstrated the splendid services that were being rendered to the public.

St. Mary's Hospital rightly pointed with pride to its chest and heart clinic, out patient clinic. X-Ray and radium laboratories. The visitors expressed their appreciation of and interest in the work being done by these institutions.

The National Research Council announced recently the establishment of fellowships in medicine for the purpose of increasing the supply of thoroughly qualified teachers in medicine. The fellowships are supported by appropriations of the Rockefeller Foundation and the General Education Board. Those receiving awards will be known as fellows in medicine of the National Research Council. The fellowships will be administered by a special committee (the Medical Fellowship Board of the National Research Council). Correspondence concerning the fellowships should be addressed to the Division of Medical Sciences, National Research Council, Washington, D. C.

Dr. Noah Bates, who for more than 40 years has been connected with public health work in Flint, will not seek re-appointment to the city health board this year, according to an announcement made by him. He said that Mayor Wm. H. Keighan offered him re-appointment but that he refused because of his advanced years.

His many years of service in this community has seen health work advance here from its most primitive stages. Dr. Bates was prominent in this service when the present health department was first organized. He has been very happy to see the department expand and do more to relieve suffering and prevent disease.

Besides his public health work, Dr. Bates was a member of the state legislature in 1871 and at that time was the youngest member of the house. During his term Dr. C. B. Burr was a page in the house.

The Wayne County Medical Society gave a dinner April 28, 1922, in the auditorium of the Medical Building in honor of those physicians who graduated in medicine 40 or more years ago. Drs. O. S. Armstrong, Samuel Bell, J. M. Burgess, Willard Chaney, W. R. Chittick, J. E. Clark, D. O. Donovan, L. O. Geib, B. D. Harison, C. G. Jennings, Daniel LaFerte, L. E. Maire, S. G. Miner, Eugene Smith, W. C. Stevens and I. S. Townsend were present as the guests of honor. Letters of regret were received from Drs. Charles Douglas, J. E. Emerson, J. K. Gailey, J. T. Hornbrook, J. R. Jones, C. H. Leonard, A. B. Lyons, Oscar LeSeure, W. P. Manton, J. L. Shaffer and Joseph Schulte. Dr. H. W. Yates acted as toastmaster. The following physicians spoke after Dr. J. E. Davis, president of the Society gave a word of welcome: Drs. Daniel LaFerte, C. J. Jennings, Eugene Smith, Stanley Miner and J. E. Clark. Over 125 physicians attended the dinner.

Dr. Ray S. Dixon of Detroit will succeed Dr. William DeKleine as health officer of Flint. His appointment was confirmed by a unanimous vote of the city council,

Dr. Dixon will assume his duties after 20 days' residence here which is necessary under the city charter. In the meantime Dr. C. H. O'Neil was

appointed by Moyor McKeighan to fill the vacancy. Dr. Dixon will act in an advisory capacity, however, until he takes office

Dr. Dixon, who is a comparatively young man, has been connected with the Detroit health department for more than three years during which time he has been in charge of the field work in that city. He comes to Flint as the result of efforts of Dr. Olin, secretary of the state board of health.

Resolutions, lauding the work of Dr. Noah Bates, senior physician of Flint, for nearly 40 years in the public health work of the city, and a present member of the board of health, and Dr. William DeKleine, former superintendent of the department of health, were adopted by Genesee County Medical Society at a meeting Wednesday. Dr. Bates has requested that his name be not considered for re-appointment to the board of health and Dr. DeKleine recently resigned from the superintendency of the department. The resolutions follow:

Whereas, it has come to the knowledge of this society that Dr. Noah Bates has expressed the desire that his name should not be considered for re-appointment to the Board of Health of this city, and, whereas, the close of his term of office as member of the Board of Health brings to an end an almost continuous service of 40 years in the public health work of Flint, be it

Resolved, that this Society extend to Dr. Bates its hearty congratulations on his splendid record of public service and renew its expression of admiration and esteem for the many personal qualities which have endeared him to his colleagues in this society.

Whereas, Dr. William DeKleine has severed his connection as health officer of the city of Flint, and whereas, Dr. DeKleine has served the city faithfully and conscientiously for several years,. and has built up a very efficient health department, therefore, be it

Resolved, by the members of the Genesee County Medical Society that we express our deep appreciation of the great good he has accomplished for this community, and we bespeak for him the utmost success in his future undertakings.

Deaths

Doctor Arthur A. Metcalf was born in 1853 and died in Crystal Falls, Michigan, April, 1922. He graduated from the College of Physicians and Surgeons, Keokuk, Iowa, in 1882. The doctor was a member of the Michigan State Medical Society and the Washington State Medical Association. He was also a druggist.

Doctor Frank R. Burdeno was born in 1874 and died in Sturgis, March 23, 1922, from septicemia and erysipelas. He graduated from the Detroit College of Medicine in 1907. He was a member of the Michigan State Medical Society.

Doctor Peter S. Mallard was born 33 years ago and died in Detroit February 2, 1922, from pneumonia. He graduated from Meharry Medical College in 1920.

Doctor Russell W. Brown was born in 1864 and died in Bay City April 3, 1922. He graduated from the Michigan College of Medicine and Surgery in 1889. He was a member of the Michigan State

Medical Society and the American Medical Association.

The deaths of the following doctors, not members of the Society, have been reported: John W. McNabb, R. H. Alexander, Marion Crane.

County Society News

GENESEE COUNTY

as

The Genesee County Medical Society met on Wednesday, April 26th, President Miner presiding. A committee was appointed to draw up a resolution of our appreciation of the services of Dr. Wm. DeKleine, who has recently resigned Health Officer. Dr. Dixon, our new Health Officer, was introduced and spoke briefly, asking for the co-operation of the medical profession with his department.

Professor U. J. Wile then conducted a dermatological clinic and demonstrated many interesting cases in his usual skillful manner.

The Genesee County Medical Society met at noon luncheon on Wednesday, May 10th, President Miner presiding. Dr. J. W. Vaughan of Detroit spoke on "Blood Nitrogen Findings in GastroIntestinal and Renal Conditions." This laboratory aid has been used long enough for us to have some estimate of its real value. The work in this field has largely been done by American investigators. He analyzed a group of cases from his service in Harper Hospital and showed the help that was obtained from blood chemistry, both as to the selection of cases suitable for operation and as to prognosis. The genito-urinary cases included Urethral Obstruction, Hyperthrophy of the Prostate, Pyonephrosis and Calculi. The gastro-intestinal cases studied were Intestinal Obstructions, Appendicitis, Strangulated Hernia and Intestinal Paresis.

This paper was highly scientific and will no doubt stimulate us to more careful work along this line.

W. H. MARSHALL,

Secretary.

HILLSDALE COUNTY

The regular quarterly meeting of the Hillsdale County Medical Society was held Tuesday, April 25th, the president, Dr. G. R. Hanke, in the chair.

After the reading of the minutes, Dr. W. H. Sawyer read a paper, "State Medicine," which was a fair and able review of the present day trend toward state control of the practice of medicine and compulsory health insurance. He pointed out the insidious nature of this propaganda and its fallacies.

The discussion was opened by Dr. Barnes and was followed by a general discussion.

The president then introduced Dr. C. W. Edmunds of the University of Michigan, who gave a very instructive and timely address, "The Relation of the General Practitioner to the Pharmacopoea." He pointed out the grave responsibility of those charged with the making up of the Pharmacopoea from time to time and the danger of physicians relying too much on the interested statements of drug houses and manufacturing chemists for their knowledge of the remedies they