Medical News

Bruce Giffen, of Fairport, has recently moved to Colerain.

J. B. Ray, of Harrisonville, is soon to locate in Portsmouth.

J. N. Calhoun and family have moved from New Galilee to Lisbon. D. W. Boone, of Bellaire, is at home again after a month's western trip.

W. B. Hubbell and wife, of Elyria, are in New York for a month's stay.

Fred McKinnery, of Leetonia, is in Chicago taking a post-graduate

course.

J. M. Davis, of Chillicothe, is confined to his home with an attack of pneumonia.

J. H. Pake and wife are in Oklahoma, Miss., where they will spend several weeks.

T. M. Sabin, of Warren, has returned from a three weeks' trip through the west and southwest.

Joseph Blickensderfer, wife and son Joseph, of New Philadelphia, are in Lebanon, Mo., where they will spend several weeks.

The Ohio Valley Medical Association will meet at Lousville, Ky., on November 14 and 15, Louisville College of Dentistry.

R. H. Wilson, of Martins Ferry, who has been in New York for five weeks taking a post-graduate course, is at home again.

S. G. Sewell and wife, of Greenville, have gone to California to spend the winter, where it is hoped the Doctor will regain his health.

O. S. Wood, of Haydenville, has sold his practice to C. E. Little, of West Union. Dr Wood has not yet decided where he will locate.

A. B. Smith and wife, of Wellington, expect to go to Baltimore to spend the winter. Dr Smith will take a course in the Johns Hopkins Institute.

The Union District Medical Society met October 25th in Hamilton. The Society is composed of Butler County, Ohio, Rush, Union and Fayette Counties, of Indiana.

Andrew Bice, of Spencerville, who has been taking a special course at Chicago, expects to leave soon for England, where he is to further his studies of the eye and ear.

D. W. Schumaker, of New Bedford, who has been taking special work in surgery at Columbus and Chicago for the past ten weeks, is contemplating locating in Canal Dover.

C. H. Neilson, a Delaware county graduate of O. W. U., and of Chicago University, spent three months in Berlin and will open an office in St. Louis; he is also to be a professor in a medical college there.

The Boyd County Medical Society met with the Lawrence County Medical Society October 25. Papers were read by W. L. Gambill, of Ashland, J. D. Mutters, of Rush, and J. W. Kincaid, of Catlettsburg.

The regular monthly meeting of the Delaware Medical Society was held October 5. The address of the evening was made by Dr Rodepauch, of Columbus, his subject being an intelligent and interesting treatment of "Nervous Diseases."

A meeting of the Huron County Medical Society was held October 11. Dr Ladd, of Cleveland, was present and gave an interesting talk on "Exophthalmic Goiter." Dr Lower, also of Cleveland, who is state supervisor, gave a talk on the general condition of the medical societies throughout the state.

The Tuscarawas County Medical Association met at Uhrichsville city hall, October 3, with a good attendance. The physicians listened to talks on "Eczema," by Charles J. Sheppard, Columbus; "Genital Hemorrhage," by S. J. Goodman, Columbus, and "Typhoid Fever," by E. D. Moore, New Philadelphia.

The annual meeting of the Marion County Medical Society was held October 16. Program: "Mental Development," Dr Beebe, of Cincinnati: Discussion, Dr Mills, Marysville; "Brain Tumor," Dr Hopper, Cincinnati: Discussion, Dr Hamilton, Columbus; "Internal Medicine," Dr Rankin, Columbus: General Discussion.

The Montgomery County Medical Association met October 5, F. C. Gray presiding. "Pneumonia" was the subject discussed at the meeting; D. C. Mills, of New Madison, reading a paper on "The Diagnosis of Pneumonia"; Webster S. Smith read a paper on "Prophylaxis and Treatment of Pneumonia,” and a number of physicians joined in the discussion.

The Governors of the New York Skin and Cancer Hospital announce that L. Duncan Bulkley will give an eighth series of clinical lectures on Diseases of the Skin, in the out-patient hall of the Hospital on Wednesday afternoons, commencing November 7th, 1906, at 4.15 o'clock. The course will be free to the medical profession. William C. Witter, chairman of the Executive Committee.

The Williams County Medical Society held its fourth quarterly meeting for 1906, October 11. Program: "Drugs and Drugging," Albert Hathaway, Edon; Discussion, Drs Walker, Weitz, Wilber; “Conservatism in Emergency Surgery," W. L. Hogue, Montpelier: Discussion, Drs Alwood, Back, Bechtol; "The Physician and his Legal Relations," F. M. Frazier, Bryan: General Discussion.

Butler County Medical Society met October 10. Three very excellent papers were under consideration during this meeting, announced as follows: First, "A Consideration of one of the Causes of Death from Obstruction of the Bowels, and its Treatment," by Sigmar Stark, Cincinnati, Ohio. Discussion opened by F. M. Barden. Second, "Fracture of the Lower Jaw; its Treatment; with presentation of case," by Frank M. Fitton. Third, "Fracture of Neck of Femur, with Practical Demonstration of its Treatment," by D. B. Bundy, Middletown, Ohio.

A meeting of the Union District Medical Association was held October 25. Dr Hawley, of College Corner, is president of the association, and Dr Houghland, of Milroy, is secretary. Dr W. H. Hawley, College Corner, Ohio-President's address. Dr W. S. Alexander, Oxford, Ohio-Natural Immunity and Prevention of Infection; discussion opened by Dr J. N. Study, Cambridge City, Ind. Noon Hour:-Dr Garrett Pigman, Liberty, Ind.-Treatment of Typhoid Fever; discussion opened by Dr W. S. Salyer, Gratis, Ohio. Dr Geo. H. Grant, Richmond, Ind.— The Removal of Sections of the Calvarium for the Relief of Disease or Injury of the Brain; with Report of Cases; discussion opened by Dr Frank Barden, Hamilton, Ohio. Dr Merle Flenner, Hamilton, Ohio-The Young Doctor; discussion opened by Dr J. E. Cavey, Eaton, O. Election of officers. Adjournment.

The Ninth District Medical Society, comprising ten counties in southern Ohio, met November 8 in annual session. This meeting was held in conjunction with the quarterly meeting of the Tri-State Medical Society. The following is the program for the Ninth District Society. The program for the Tri-State Society will be published later. Pelvic Tumors and their Differentiation-Flint Cline, Portsmouth, Ohio; to open discussion, O. W. Robe, Portsmouth, Ohio. The Nature of Our Recent Epidemic-Jehu Eakins, Gallipolis, Ohio; to open discussion, J. B. Alcorn, Gallipolis, Ohio. Obstruction of the Bowels, Symptoms and ManagementD. B. Hartinger, Middleport, Ohio; to open discussion, L. F. Roush, Pom

eroy, Ohio. Pneumonia in Children-John F. Morgan, Jackson, Ohio; to open discussion, John E. Sylvester, Wellston, Ohio. Contract Practice and Life Insurance Examinations-O. U. O'Neil, Ironton, Ohio; to open discussion, W. F. Marting, Ironton, Ohio. The papers were limited to 15 minutes each, as we will have a joint meeting with the Central Tri-State Medical Society.

The sixth regular and first annual meeting of the Geauga County Medical Society was held at the Burton House, October 10, with 13 in attendance, Chester, Troy, Middlefield, Chardon, Auburn, and Burton being represented. The business of the afternoon consisted of the hearing of the report of the committee appointed to draw up a fee bill, which, after some changes, was adopted by vote of the Society. Then followed the election of new officers for the ensuing year, as follows: N. F. Schwartz of Auburn, for president; Mary Goodwin of Chardon, for secretary and treasurer. A hearty vote of sympathy was extended P. J. Edwards of Montville, who is quite ill with pneumonia. Teed-Cramton of Burton then gave a paper on the treatment of Cardiac Hypertrophy and Dilatation, which was followed by a general discussion on this important subject. A second paper was to have been given by O. A. Hopkins of Middlefield, but because of the lateness of the hour it was decided that Dr Hopkins' paper should be reserved for the special meeting in November.

The thirty-first regular session of Lake County Medical Society was held in the assembly room of the Parmly Hotel, Monday evening, October 8. Prof. William E. Lower, of Cleveland, councilor of the Fifth District, was present. The dictrict includes Cuyahoga, Lake, Ashtabula, Trumbull, Geauga, Medina, Lorain, Erie and Huron counties. Dr Lower is one of the lecturers in the College of Physicians and Surgeons in the city and surgeon to two of the hospitals. Those present at the session were Drs House, Sherman and Hawley, of Painesville; Dr Quayle, of Madison; Dr Lowe, of Mentor, and Dr Moore, of Willoughby. The councilor first rendered a report showing that every county in the state was thoroughly organized, each having an active society, that over the county society is a state society and over the state is the national society, known as the American Medical Association. The object of the whole is the dissemination of knowledge in the art of healing and the suppression of that which is not of a wholesome character. Lake county was highly complimented for its activity in the acquisition of progressive intelligence. After a brief talk on the work pertaining to the office of councilor, Dr Lower presented a paper on "Hernia." In this it was shown that one out of every twenty to thirty people suffer from hernia in some form, that all are dangerous and a menace to the physical ability of those afflicted. He demonstrated from personal experience that operations for the radical cure of hernia were among the safest that operation before the age of five years was seldom necessary. The paper was to the point in every particular from first to last. After a discussion of hernia, in its various forms, a vote of thanks was tendered the doctor for his able presentation of the subject. The councilor announced that Dr McCormick, the itinerant lecturer of the American Medical Association, would visit the district in November and deliver a series of popular lectures, to which the laity are invited, that on the afternoon of November 27 a joint meeting of Lake and Ashtabula counties would be held in Ashtabula. The next session will be held November 5, when Dr F. S. Clark, of Cleveland, will address the society.

Deaths

J. W. S. Goudy, of Newcomerstown, died at his home at the age of 73. Francis Volney Cox, of Martinsville, died at his home September 27.

The Cleveland

Medical Journal

VOL V

DECEMBER, 1906

No 12

Newer Ideas of the Causes and the Treatment of Bright's Disease

BY ALFRED C. CROFTAN, CHICAGO, ILL.

(Author's Abstract).

The terms Bright's disease, nephritis and albuminuria are often employed synonymously. This is wrong. For in Bright's disease in the modern sense, the changes about the heart and the arteries predominate, and not infrequently precede the development of the renal signs. In all other forms of nephritis there are either no changes about the cardiovascular apparatus at all or they are demonstrably consecutive to the nephritis. Albuminuria finally is a sign that generally accompanies any form of nephritis but that may also occur without any renal changes whatsoever.

High arterial tension with corresponding changes about the heart and arteries, then, is the determining feature of Bright's disease. The circulatory disturbances must be immagined to lead to nutritional disorders in a number of organs; and it is clear that those organs in particular are most apt to become affected that are supplied by end arteries. Chief among the latter are the kidneys, the retina and the brain; and as a matter of fact these three organs are most commonly involved in Bright's disease together with the cardiovascular apparatus.

In true Bright's disease the kidneys, as indicated, are by no means always involved first, although the first determinable signs may appear in the urine. If the dimensions of the heart and the blood-pressure were studied as carefully as a routine measure in every case as the urine is, (or should be) the cardiovascular changes would be found much more often before nephritic

Read by invitation before the Academy of Medicine of Cleveland, September 21, 1906

changes develop than is actually the case. This at least has been my experience.1

It seems almost paradox to state that Bright's disease may occur without nephritis; but this is actually the case if we accept the newer conception of Bright's disease outlined above. It is altogether unfortunate that the term Bright's disease is retained in our medical nomenclature at all, for what Richard Bright originally described and what we understand by Bright's disease today are radically different clinical entities.

The causes that determine the high blood-pressure and the cardiovascular changes that usher in every case of Bright's disease are still obscure. It is probable that manifold factors may become operative to produce this syndrome. I am an ardent adherent of the idea that circulating toxins must, in most cases, be incriminated with raising the blood-pressure; the toxins may be endogenous or exogenous in character, i. e. they may be introduced into the circulation from within by some deep seated perversion of the general metabolism or they may be introduced from without, e. g. from the gastrointestinal tract by the abnormal disassimilation of the gastric and intestinal contents.

The former event is probably less frequent than the latter; it is, moreover, less tangible and consequently not so easily remediable. In many cases a deep-seated hereditary element undoubtedly plays a commanding role, and here the metabolic side of the question urgently calls for elucidation. Some steps in this direction have been taken and a number of pressor principles have been isolated from among the intermediary products of intracellular disassimilation. I call attention for instance to the purin bodies, precursors of uric acid, that possess marked pressure raising powers and that are capable, as I showed some years ago, of producing many of the cardiovascular signs of Bright's disease in animals and also some of the renal changes.

In the bowel contents, on the other hand, a large number of pressor bodies have been found, especially when putrefactive processes are allowed to go unchecked. These bodies may directly enter the circulation in small quantities over long periods of time and produce chronic increase of the blood-pressure, or they may lead indirectly to intoxication of the liver cells that try to arrest them and thereby cause a condition of hepatic insufficiency that in itself again leads to the flooding of the blood stream with a variety of abnormal products capable of causing high arterial tension and irritation of the kidneys.3