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COUNTY SOCIETY NEWS

It is the Editor's desire to have this department of the Journal contain the report of every meeting

that is held by a Local Society. Secretaries and urged

to send in these reports promptly

will follow. Five men in the county elected provisionally, (on payment of their dues).

CHEBOYGAN COUNTY. A meeting of the medical men was held at my office last night. The following was accomplished:

Officers elected:
President-Dr. A. M. Gerow.
Vice President-Dr. W. F. Reed.
Secretary-Treasurer—Dr. C. B. Tweedale.
Constitution and by-laws to be printed.

Fee bill revised, to be printed and signed. Every physician in the city a member (nine). Two members secured for state society, and others

TRI-COUNTY.
At the regular meeting of the Tri-County
Medical Society held Oct. 3rd the following
officers were elected:

President-C. E. Miller, M.D.
Vice-President-E. B. Babcock, M.D.
Second Vice-President-E. A. McManus, M.D.
Secretary and Treasurer-W. Joe Smith.

Delegate to State Convention-G. D. Miller, M.D.

Alternate-S. C. Moore, M.D.

Dr. Gruber also announced his intention of moving from Mesick to Cadillac. He recently returned from overseas service.

WAYNE COUNTY MEDICAL SOCIETY.

Officers and Committees for 1919-1920. President-Dr. George E. McKean, 1515 David Whitney Bldg., Cherry 2661.

Vice-President-Dr. Raymond C. Andries, 641 David Whitney Bldg. Cherry 694.

Secretary-Dr. J. H. Dempster, 502 Fine Arts Bldg. Cherry 2012.

Treasurer-Dr. Wm. H. Morley, 33 East High St. Main 3778.

Trustees. Dr. A. D. Holmes (1 year), Chairman, 1745 East Jefferson Ave. Edgewood 1473.

Dr. Angus McLean (2 years), 641 David Whitney Bldg. Cherry 694.

Dr. Frank B. Walker (3 years), 1229 David Whitney Bldg. Cherry 1120.

Dr. Walter J. Whlson, Jr. (4 years), 509 David Whitney Bldg. Cherry 5193.

Dr. Warren L. Babcock (5 years), The Grace Hospital. Glendale 90.

(Dr. J. H. Dempster, Secretary Board of Trustees).

Surgical Section. Dr. James D. Matthews, Chairman, 948 David Whitney Bldg. Main 777.

Dr. E. G. Martin, Secretary, 1447 David Whitney Bldg. Cadillac 4675.

Medical Section. Dr. Herbert M. Rich, Chairman, 1337 David Whitney Bldg. Main 1090.

Dr. E. W. Caster, Secretary, 3004 Woodward Ave. Hemlock 2280.

to

for good of any single attempt to lessen cancer mortality undertaken in this country.

It is no longer necessary to argue the point that delay is the one great factor in cancer mortality. At least four-fifths of cancer deaths could be prevented by early recognition. The conditions necessary for recognition of cancer in ample time for cure are not ideal but distinctly practicable. Public education is one important pathway of improvement, but education of the medical profession itself is of equal if not greater importance. Statistical studies have shown that in the majority of cases the doctor has had the cancer patient, “under observation” over a year before efficient curative treatment is instituted. It is needless to state that during this year the majority of cases have changed from curable to incurable. As the pamphlet itself somewhat mildly puts it, “The conditions call for a far keener appreciation of responsibility for the mortality from cancer than now generally exists in the medical profession." It is not

possible here abstract this pamphlet which is already so condensed. The general facts concerning cancer are outlined and then each important type and site of cancer is taken up

detail and the forms, symptoms, standard treatment, and results to be expected are outlined for each type.

The chief point we would make here is that if every medical man would study and seriously apply the teaching in this pamphlet, which he can read in an hour, the question of delay in cancer would be solved in so far as it is referable to the medical profession. The ultimate possible good obtainable from the wide spread dissemination of this pamphlet is so great that we would urge every possible means to get it into the hands of as many medical men of all classes as possible. It can be had from the American Medical Association, 535 N. Dearborn St., Chicago, for 10 cents. If you are a trained surgeon It will interest you.

If you are further afield get it and study and apply it. If you feel misgivings that some of your cases in the past might have been saved had you been more sure and acted more promptly (and who of us does not have such misgivings) get it. It will help you in future cases.

We would especially beg the assistance of Boards of Health, both state and municipal and of medical societies in distributing the pamphlet. It can be bought cheaper in quantities and sent out with your other mail matter with almost

Book Reviews

get it.

“WHAT WE KNOW ABOUT CANCER." A Hand-book for the

Medical Profession. Prepared by a committee of the American Society for the Control of Cancer, American Medical Associated Press, Chicago, 1918.

The American Society for the Control of Cancer has been in existence and working effectively for a number of years. The sole object of the Society, at present at least, is the “dissemination of facts in regard to cancer to the end that its mortality may be reduced by a wider knowledge of the disease.”

The effort represented by the present pamphlet has perhaps the most far reaching possibilities

no extra cost or trouble. When such a simple means for such far reaching good is in our hands it is a pity to let it lie neglected.

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ACTION OF CERTAIN DRUGS ON THE

BRAIN CIRCULATION IN MAN. 1. Amyl nitrate causes a marked dilation of the brain vessels.

2. Epinephrin induces a primary constriction of the brain vessels which is followed by a marked dilation.

3. Caffein produces no demonstrable change in the dosage employed.

4. Pituitary extract is followed by a dilation of the brain vessels, accompanied by a distinct *leukoreaction.'

(Arch. of Neurol. & Psych. Oct., 1919. Raephael and Stanton).

A STUDY OF HYSTERIA, OBSERVED IN THĘ U. S. ARMY HOSPITAL,

PLATTSBURG, N. Y. 1. Hysteria is purely functional in its nature and the mechanisms underlying its manifestations are entirely mental.

2. The causes to which patients attribute their hysterical symptoms are obviously and absurdly inadequate.

3. It is a mistake to think that hysterical manifestations are an integral and necessary part of the emotional syndrome; they can appear independently of all emotion; and the emotional syndrome has nothing in common with hysteria.

4. Psychic factors to which war neuroses in general have been attributed—fright caused by danger from projectiles, horrifying sights, etc., play a part only in the acute emotional syndrome; hysterical phenomena are not directly produced by them.

5. Those disorders which develop at the front and are in the direct expression of violent emotion are never of long duration; the intensity of their manifestations subsides rapidly and almost all cases can return to the front within a few days.

6. Speaking with special reference to my experience, the mainspring of hysterical conduct consists in a concealed, illicit, morally untenable motive.

7. Its most frequent variations are: (a) To evade the law of conscription, (b) To procure

rejection for physical unfitness, (c) To evade dangerous, disagreeable, or difficult duty, or to evade all duty, (d) To procure the ease and privileges of hospital care, (e) To procure discharge on certificate of disability, (f) To procure compensation for disability.

8. Illicit motive and it alone is the factor which actuates hysterical conduct.

9. Statements which have been made to the effect that war neuroses had not been observed in previous wars in such large numbers are probably not in accord with facts.

10. The factors to which patients themselves attribute cures are apt to be trivial and inadequate.

According to my experience, the particular method of therapy is a matter of comparatively little importance.

12. In cures the following factors are frequently seen to be operative: '(a) Medical officers impressing patients in such a way as to preclude any hope of successful imposition, (b) Denionstration of the unreal nature of the disability, (c) Strict discipline as opposed to sympathy, coddling or humoring, (d) Painful or otherwise disagreeable treatment, (e) Removal of motive by change of situation.

13. Many spontaneous cures occurred in previously refractory cases, en route to the United States and later on the signing of the armistice.

14. Among circumstances contributing to the prevalence of war hysteria is gullibility of the medical profession.

15. Military law places medical officers in a' difficult position. They must either designate the disability by some respectable name, such as hysteria or psychoneurosis, or make a diagnosis of malingering and have to prove criminal intent.

16. All are agreed as to there being a close similarity in the clinical manifestations of hysteria and malingering and as to there being great difficulty in practice of establishing the differentiation.

17. A search through the literature reveals but one point to which the differentiation is generally fastened; namely, conscious or unconscious quality of the motivation.

18. My own experience and study lead me to the conclusion that what some have described under the name of hysteria and what others have described under the name of malingering are one and the same thing. The difference seems to be entirely one of point of view.

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19. War experience has shown that hysterical manifestations can be actuated by motives other than sexual.

20. The essential feature of the hysterical personality seems to consist in a character defect.

21. I would banish from medical classification such euphemisms as 'hysteria,''shell shock,''traumatic neurosis,' etc. and would also banish the expression 'malingering with its implication of crime for which the responsibility is entirely on the patient.

22. I would designate, instead, the cases in question by the term constitutional psychopathic state, simulation.

23. The cases classed under the heading of neurasthenia may be roughly divided into two groups. The first represents a condition allied to the manic-depressive psychoses; the second is characterized by vague general hypochondriasis, may often be shown to be motivated exactly in the manner of ordinary hysterical manifestations and is, to my mind, but a special type of hysteria or simulation.

24. My experience has amply shown that the possession of native intelligence far above the average and good educational and social opportunities are

not incompatible with hysterical character defect and with gross lack of moral sentiment.

25. These cases show what remarkable stability a normal neuropsychic constitution has and how inadequate etiologically, in the absence of a neuropathic predisposition, are the factors to which psychoses and psychoneuroses are so often attributed.

(Arch. of Neurol. & Psych., Oct., 1919, Rosanoff).

5. Abnormal communicating . branches not rare, particularly between the median and ulnar. Such anomalies must be taken into cons.deration in any careful study of nerve injuries.

6. Judging from the level of the lesions. muscles may not be presumed paralyzed but should be demonstrated paralyzed.

7. Total movements may not be offered as evidence of return of function, The action of individual muscles must be given.

8. Reports of peripheral nerve injuries, to be of value, must be accompanied by motor, sensory and electrical findings.

9. By the formation of nerve flaps from the central stump a portion of the nerve from which neuraxes must grow is removed. Distal as well as central flaps may

muscular branches. By reversing the flaps they are taken out of their field. Thus the downgoing neuraxes are prevented from reaching the muscles through these muscular branches, even were regeneration to take place.

10. The nerve flap method to bridge nerve deiects should be discarded in peripheral nerve surgery.

(Leo C. Donnelly, Detroit.)

sever

Restoria.—“Restoria for Bad Blood" is sold by the Restoria Chemical Company of Kansas City, Mo. It is sold as a sure cure for syphilis, but is also recommended for rheumatism, kidney trouble, lumbago, eczema and catarrh. The A. M. A. Chemical Laboratory reports that Restoria contains no mercury or aiseais fuit does contain iodid, probably as potassium iodid, equivalent to 1.693 gm. per hundred Ce. It also was found to contain much vegetable extractive, some alkaloidal drug and a bitter oil or oleoresin (Jour. A.M.A., Aug. 9, 1919, p. 438).

Don't Fail

to

Attend your Society Meetings

regularly.

The Futility of Bridging Nerve Defects by Means of Nerve Flaps. By Byron Stookey, A.M., M.D., Maj., A.M.C. Surg., Gyn. and Obst., CVol. XXIX, September, 1919, No. 3.

1. The repair of nerve defects by means of nerve flaps has not been definitely supported clinically, as evidenced by a critical study of the reported cases.

2. Experimentally it has been shown that nerve flaps do not serve as conducting paths for the down growing neuraxes.

3. Nerve flaps whether central or peripheral are merely degenerated partial nerve segments. Continuity and union of neuraxes does not take place at point of suture.

4. To avoid fallacious deductions it is important to distinguish between the level of the injury to the nerve trunk and the level at which muscular branches arise.

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of these liquids, and therapeutic inefficiency the consequence of poor clinical differentiation. Without intentional pun we may define an ulcer, taken as a whole, as "a tegumentary loss of substance that fails of normal repair.” The lesion must be tegumentary, that is to say affect

VARICOSE ULCERS OF THE LEG;
CAUSES, COMPLICATIONS AND
CONSERVATIVE TREAT-

MENT.*
JOSEPH VAN BECELA ERE, M.D., LL.B.

DETROIT, MICH. Before proceeding with the subject of this paper I wish to offer you an explanation of the particular "..ology" I sall under. Those among you who remember their classics, readily will trace back the term "helkologist”. to the Greek word "helkos," an ulcer, while the others are liable to shy at the very first syllable that sounds like..... well, I won't tell you what it sounds like, on account of the ladies. (God bless them!) whom it will no doubt remind of the Kaiser's place of ultimate consignment.

In the course of my voluminous reading I have come across the statement that a good medical paper is not so much that one describing a clinical curiosum nor yet a therapeutic novelty as that which brings to mind clinical facts neglected, overlooked perhaps or even forgotten. Let this be my sole excuse for opening up today before this meeting on a subject so threadbare as that of varicose ulcers of the leg.

It has been said of Woman, as an entity, that she is pl Infinite possibilities, and that “the more you study her, the less you know her."

Now, since on the one hand "Mankind embraces Woman," both properly-and sometimes Improperly—and since

on the other band Infinity constitutes one of the divine attributes, i bold that Woman's infinite variability constitutes the best proof of the "Divine origin of Man."

This elusiveness of Woman, as a sex, applies in a large measure to varicose ulcers, with the saving clause however that while Woman, per se, constitutes a hopeless problem, dillgent, pertinacious application to the study of varicose vicers may bring a modicum of understanding of the subject.

Apother occasional similitude to "the female of the species'' Is that a varicose ulcer is “a stubborn faet," a very stubborn fact, bounded on the north by varicosis, on the west by parastasis, on the south by kataptosis and on the east by therapeutic inefficiency.

All the slides in this series were made from original photographs taken by the author with the same hand-camera, at the same distance, so that the prints afford correct data for dimensional comparison. All patients were healed in due course of time, except one case of septic ulcer of long stangIng, in an alcoholic, age 32, who died of intercurrent pnev monja at a time when his lesion was more than three-fourths healed.

The term "healed" is used advisedly: Because the lesion has obliterated. patient is not in reality "cured," insofar at lư:: nt as the pulsibility of recurrence is concerned.

None of these patients were necessarily confined to bed while under author's care. the entire plan of treatment being directed toward "keeping them in circulation."

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Varicosis is the result of permanent dilatation of the ve'ns, kataptosis the downward trend of liquids in the leg ; parastasis the stagnation

a surface normally covered with epithelial investment, as for instance the leg, the gastric mucous membrane, the cornea.

Where the healing process begins immediately after occurrence of the lesion and proceeds uninterruptedly to complete repair, there can be no talk of "ulceration," since-however tardy

Read before the Medical Section of Medical Society, May 22, 1919.

the Michigan State

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