COUNTY SOCIETY REPORTS

Daviess The Daviess County Medical Society met in the County Court room, Owensboro, on September 16th, 1915, with thirty-eight members present.

President G. L. Barr called the meeting to order at 10:30 A. M.

After the reading of the minutes the censors reported favorably on the application of Dr. J. W. Griffin. He was admitted by a unanimous.

J. G. Hale presented a transfer card from the secretary of the Grayson County Society, and was admitted to membership.

J. T. Dixon reported a case of continued fever in which the characteristic signs of typhoid nor malaria were found. He considered it due to some infection. The case was discussed by sev eral, some of whom had seen similar cases. Stinson Lambert read a paper on "Interstitial Nephritis, Its Causes and Prevention." The paper was very interesting and was generally discussed.

W. E. Irvin read a paper on "Roentgenology". Adjourned for dinner. After noon Dr. Barr was absent and Vice President E. D. Turner called the meeting to order. Dr. Turner asked C. H. Todd to preside; he did so.

Several discussed Dr. Irvin's paper.

The next essayist, J. E. Payne, was not pres

The society then adjourned.

FIRST DISTRICT SECOND DISTRICT THIRD DISTRICT FOURTH DISTRICT FIFTH DISTRICT

Louisville

SIXTH DISTRICT

ent.

Greenup Winchester Barbourville

Bowling Green

Bowling Green

Newport Owensboro Madisonville

L. H. SOUTH

W. W. ANDERSON

P. D. GILLIM

R. I. BONE,

ASSISTANT EDITORS.

UROLOGY

C. L. WHEELER

DERMATOLOGY

M. L. RAVITCH

Lexington Louisville

J. J. RODMAN, Secretary.

Carlisle The Carlisle County Medical Society. met September 7th, 1915, at the Fair Grounds near Bardwell, Pres. H. A. Gilliam presiding, with the following members present; H. A. Gilliam. Milburn; J. F. Dunn, R. T. Hocker, W. Z. Jackson, Arlington; T. A. Pease, Kirbyton; G. W. Payne, W. L. Mosby, H. T. Croch and T. J. Marshall, Bardwell; Dr. Merritt, Fancy Farm, and W. W. Richmond, of Clinton, councilor for this district.

The society was opened with prayer by Dr. Hocker. The Committee on Arrangements reported and was discharged. The committee to revise the schedule of prices was continued to report at the December meeting.

W. Z. Jackson was the first speaker on the program with the subject "Summer Diarrhea in Children. The doctor had neglected to prepare a paper but made a good common sense talk on the subject outlining causes, symptom treatment.

and

G. W. Payne opened the discussion, Mosby, Crouch, Dunn, Hocker, Merritt and Richmond also discussed the paper, W. Z. Jackson closed the discussion.

The society then adjourned for dinner, which wos one of the enjoyable features of the day It was served in the shade of the trees next to the

graud stand and consisted of fish, bread, pickle, coffee, and so forth, and all present enjoyed the dinner very much.

The society reconvened immediately after dinner and Dr. Pease read a paper on "Rheumatism" which will be published in the Journal. The paper was discussed by Payne, Dunn, Mosby, Crouch, Marshall, Merritt, Gilliam, Richmond, Hocker and Pease closing. This was one of the best papers that has been read before the society in a long time.

W. L. Mosby read a valuable paper on "Hip Joint Disease," this paper is to be published in the Journal. Crouch and Richmond discussed the paper, Mosby closing.

J. T. Dunn read a fine paper on "Care of the Patient During the Puerperla State," which will be published in the Journal.

H. T. Crouch opened the discussion, Payne, Hocker, Marshall and Jackson also discussed the paper with Dunn closing.

The society adjourned to meet in Bardwell the first Tuesday in December.

Cholera Carriers in Relation to Cholera Control. It is emphasized by Munson that in effectively combating a cholera infection the use of laboratory facilities in the making of bacteriologic diagnosis on a large scale is absolutely essential. The recent outbreak in Manila was spread chiefly by personal contact. Cases were isolated so promptly as to do little harm. Lack of the use of toilet paper, certain habits in the use of the toilet, infected fingers and eating with the hands food taken from a common dish were the channels through which the infection chiefly passed from the carrier to another person. Public water supplies and articles of food could be eliminated as channels of infection and flies played an entirely insignificant part in its spread. One of the most apparent lessons learned relates to the possible period of latent infection in cholera and its bearing on the period of incubation and quarantine heretofore accepted for health work. The five-day period usually accepted for incubation and quarantine ordinarily will suffice for the control of infection in the majority of cases; but such a period does not hold good in a very considerable number of instances, which sheds much light on cholera situations not otherwise readily explainable. For example, one carrier, who died of cholera, might have traveled halfway around the world, scattering his infection broadcast during his eighteen-day period as a carrier, and died of true cholera in a place many thousands of miles from any other source of infection. The prompt eradication of a general cholera infection, therefore, includes the detection and isolation of carriers.

Sunlight in Treatment of Tuberculosis.Schaffer relates that, at the instigation of Finsen, at the Vejlefjord sanatorium in Denmark sunbaths were introduced into the routine treatment of bone and lung tuberculosis as long ago as 1902. In the course of the years since, 364 patients have been given systematic heliotherapy, taking a total of 6.500 regular sunbaths. The duration is only five or ten minutes at first, gradually increasing to an hour. The other measures left no time for longer than this. The men's bath is from 12 to 1, the women's from 1 to 2 p. m.; a physician always takes the bath with the men and a nurse with the women. The method was never applied to patients with a tendency to hemoptysis or progressing pulmonary lesions. Of the 364 patients, 20 per cent. were in the first stage, 33 per cent in the second and 46 per cent. in the third. No by-effects were noted except that some of the patients felt fatigued after the first baths, and that a few developed erythema to such a degree that the course had to be interrupted. No direct influence on the lung process was ever apparent, but now and then certain symptoms seemed to improve and the patients enjoyed the baths and seemed to feel refreshed after them. In some cases--three typical ones are described-the sunbaths seemed to be the prominent factor in the rapid and pronounced improvement. One young man in particular had had fever for a year, with bilateral pleurisy and swollen mediastinal glands. Under the heliotherapy the fever subsided in a month and the general health notably improved, when no measures before had induced any benefit. Another patient was a young man in the second stage of pulmonary tuberculosis with sequels of pleurisy. The pleuritic dullness disappeared almost completely in three months under the sunbaths, and this cannot be a mere casual coincidence. Recently the sanatorium had had halls equipped for artificial heliotherapy so as to be independent of the Denmark weather.

The Pancreas and Diabetes.-Visentini's article was awarded the Warren triennial prize at Boston in 1913. It fills over 100 pages and is accompanied by seven double-page plates, some of them colored. Its motto is da Vinci's, Knowledge is the daughter of experience," and it is based on analysis of the literature on the subject and extensive personal experiments on twenty-seven dogs at the institute for pathologic anatomy at the University of Pavia. The final outcome confirms anew and apparently conclusively that the islands of Langerhans and these alone among the elements of the pancreas control the metabolism of carbohydrates in the animal organism.

VOL. XIII.

EDITORIAL

No. 13

Engineering for advice and assistance in the investigation and improvement of water sup

EACH COUNTY.

The provisions and merits of the bill for a health officer for each county in Kentucky, with his office taken out of politics and out of competition with other doctors, and who is so supported that he can give up the practice of medicine and devote his entire time and the best that is in him to the prevention of sickness, is so well understood, and has been so fully endorsed by the profession that, without further explanation, a final appeal is now made to each county society and individual member to bring every proper influence to bear upon their respective senators and representatives in support of this measure. It will be remembered that a similar bill passed the House two years ago by a large majority, and only failed to pass the Senate, where 29 out of 37 members favored it, because of a deadlock in the closing days of the session. The need for such a law is so great, especially in the smaller cities, towns and country districts, where the sick and death rates are so much heavier from typhoid fever and the other preventable diseases, that the bill, which is essentially that of two years ago, can be easily passed if our friends will at once take up its advocacy in a systematic way.

It should be urged upon legislators that the State, as such, has gone almost to the limit of its authority in guarding the public health. In few other states of the Union are the general laws upon this subject more liberal and complete, and, under the wise constructions of the courts, the full police powers of the commonwealth can be relied upon to support every legitimate effort of the health authorities to protect health and life. It has also made ample appropriations to establish and maintain a Bacteriological Laboratory to give free aid to health officials and physicians in the early recognition of communicable diseases; a Bureau of Chemistry and Sanitary

health; a Bureau of Vital Statistics for the practical utilization and permanent registration of births, deaths and morbidity returns; an Annual School for County and City Health Officers for broad training in the duties imposed upon these officials; but, most unfortunately, a large part of this invaluable, yea vital, scientific and statistical information, except in a few counties, cannot be brought into the homes and daily lives of the people, because the carefully selected and personally excellent county boards of health are not provided with a trained, salaried executive to conduct its affairs, as are the courts, schools and other governmental activities.

It is because of this fatal defect in our county health machinery that, in spite of the advanced general legislation and liberal appropriations just mentioned, and the training and devotion to duty of those conducting these larger activities, the returns of the sick and death rates for the five years the vital statistics law has been in operation show as a steady average that 60 per cent. of the sickness and 47 per cent. of the deaths for this period were from diseases which could and ought to have been prevented, and entailed more than twice the loss upon the people each year than all the total taxes they paid into the municipal, county and State treasuries. And legislators and the people should understand it as inevitable, and in the very nature of things, that this high sick and death rate, and consequent economic loss, from tuberculosis, typhoid fever and the other preventable diseases, must go on until we have such a health officer in each county, trained for, and devoted to, this vocation, and out of practice and out of competition with other doctors so that they can and will co-operate with him.. It should not be a political office and the tenure should depend absolutely upon devotion to duty and such an education of the people and such a betterment of sanitary conditions

as will steadily decrease sickness and deaths. As no one can be a health officer of the kind for which this plea is made unless he is trained for this special calling and absolutely taken out of practice, the salary should be such as are given to judges and other officials where a high order of capacity and unceasing devotion to duty are required. In fact, it would be just as reasonable to expect a circuit judge to support himself by the practice of law while serving on the bench, as to expect a health officer to do his more trying and important daily work and at the same time practice medicine to support his family. It should be easy to see why the vocation of health officers and medical practitioners are not only imcompatible, as this bill will provide, but that he would have no time for practice if his exacting official duties were properly performed. In order to make it easier to bring all this about, and in the interest of efficiency and economy, it is suggested that, as soon as the terms of present incumbents expire, efforts be made to combine the county and city health offices, or to arrange in some way that both officers may be held by the same person.

In any event, let us no longer deceive ourselves, or permit the people to be deceived about this vital matter. Sustained, practical health work, in the modern sense, cannot be carried on in any county without at least one trained official to conduct it who can consecrate his life to the task, and if county societies, physicians, and especially family physicians, will take up the subject with their respective senators and representatives at once, before they go on to Frankfort, and urge upon them both the importance and the obvious unselfishness of this measure, it is confidently believed that it will pass with practical unanimity.

ANNUAL MEETINGS.

This issue of the JOURNAL will reach you before the annual meeting of your county society. At the December meeting officers are to be elected for next year. At this meeting a confidential communication from the Council of the State Association will be in the hands of your secretary and it is of the utmost importance that you be present and hear it read, as it effects every member of the Association directly and personally.

The most important matter which will come up at the annual meeting is the election of the secretary. If your secretary is one of the hundred effective ones of the State, be sure to re-elect him. If he is not having regular meetings, with an interesting program for each one of them, and if he is not getting the dues of

all eligible physicians as well as their constant cooperation in his work, try somebody else. When you have elected a secretary, pay your dues for 1916 while you are at the meeting. This will save both him and you trouble later. Your dues should reach the State office on January first. This is of more importance this year than it has ever been before, because the House of Delegates directed that no one should be defended by the Medico-Legal Committee whose dues had not been paid promptly, in accordance with the by-laws. We cannot make this too emphatic, and we trust no member will plead for leniency in view of this notice, which is final.

EVERY MEMBER OF EACH COUNTY MEDICAL SOCIETY IS URGED TO BE PRESENT AT THE DECEMBER MEETING, WHICH IS THE ANNUAL MEETING, FOR THE ELECTION OF OFFICERS AND THE TRANSACTION OF OTHER IMPORTANT BUSINESS.

CONFUSION ABOUT ANTI-TOXINS AND CONTAINERS.

The State Board of Health repeats its request, so often made, that communications in regard to antitoxin and vaccines, and for all kinds of containers, except those for water, be addressed to the Laboratory of Bacteriology, or to Dr. Lillian H. South, who has this work in charge, and that no specimens be sent in to this Laboratory except in its proper containers, and to its address.

Likewise, all requests for water containers should be addressed to the Chemical Laboratory, or to Dr. D. P. Curry, who has charge of this work, and all specimens of water should be sent only in such Laboratory containers and to Dr. Curry.

Much delay and no little criticism has been occasioned from the carelessness of patrons of the laboratories as to these matters, which can be easily avoided in the future by heeding this very reasonable request.

JUST A DAIRY.

Every student of human efficiency, really interested in this most practical subject, should take a few days off for a trip to Dallas and spend at least a day or two of the time in the study of the Tennessee Dairy, owned and organized by the distinguished Mayor of the city of Dallas, and operated by a young man of thirty-three, Mr. Waters, born, reared and trained in the country, near Nashville. has some four hundred and fifty grade Jersey cows and about forty Holsteins in milking. The bacterial count of its milk has never exceeded ten thousand in the summer and is frequently much less than five hundred. The

It

cows are the best fed, best looking, best contented we have ever seen. The milk and other milk products are the best managed and best. prepared we have seen. The barn is not expensive, and there is no comparison in architectural beauty or in the other housing arrangement to such a place as Elmendorf. Naturally we speak of it with special pride because it is operated entirely entirely by southern born and southern trained men, and we know no other institution in the entire South which better shows the importance of human equation in the successful management of great business enterprises.

THE SOUTHERN MEDICAL.

Those members of the medical profession of Kentucky who failed to attend the recent meeting of the Southern Medical Association in Dallas, Texas, missed one of the greatest opportunities that has yet been presented to the profession. The scientific program was replete with interest, especially to southern physicians. The medical and sanitary problems of the southern states are in a measure peculiar. Each and every one of the serious conditions which daily confront us in our practice was discussed by practical men, who are always the ones best qualified to speak.

The work of the general session, under the presidency of Dr. Oscar Dowling, the great President of the State Board of Health of Louisiana, was as full of interest as would be expected with such a leader. The editor of the JOURNAL had the pleasure and honor of presenting an address on "A National Health Program," which will appear in these columns later.

The section on surgery was splendidly attended and the discussions were as good as we have ever heard. This section honored Dr. John H. Blackburn of Bowling Green. by electing him chairman, and we predict for next year's meeting at Atlanta greater success under his chairmanship.

an even

In an extensive experience with medical meetings, we have never before seen one honored by the presence of so many ladies. In entertaining them, as in the entertainment of the members in attendance, Dallas fully lived up to Texas' reputation for hospitality. A standard was set which it will be very difficult for any southern city to exceed. Under the general chairmanship of Dr. Cary, the arrangements were perfected so that the most critical could not find a flaw.

The Southern Medical Association has come to stay. With a membership of over four thousand, and an average attendance for the past three years in the neighborhood of one thousand, it is demonstrating that it has a

sphere of action and that it will fulfill it. The entire membership present voiced its confidence in the Southern Medical Journal and its esteem for Dr. Seale Harris, its secretary and organizer. The editor of this JOURNAL represented Kentucky on the Council at this meeting, and feels that he is not divulging a secret when he says that the internal business report indicated that the Association and its Journal were in a most prosperous condition, and that Dr. Harris' business acumen and sound judgment, as well as his broad medical statesmanship had been demonstrated by every step in the organization of the Association and the publication of its organ.

The next meeting of the Association will be in Atlanta. We hope Kentucky will have a larger representation there, taking an active part in every section. There was a splendid Kentucky delegation at Dallas but not near so many as there should have been. Our hats are off to the Southern Medical Association.

POST CARD REPORTS ON MALARIA.

For a year or more every physician in Kentucky has been receiving a post card at the end of every quarter asking him to make a report on the number of cases of malaria that have occurred within his practice during the quarter. These cards have been mailed to Dr. R. H. von Ezdorf, the distinguished surgeon of the United States Public Health Service, who is making a survey of the Southern states in regard to this important disease. It is a matter of regret that only from seventeen to eighteen per cent. of the physicians of Kentucky have been replying on these cards. This is written with the hope that our members will take more interest in the matter. If you have treated no cases of malaria, say so on the card and mail it in. It does not cost even a postage stamp. In the quarter ending March 31, 1915, 1,798 cards were received from 115 different counties. Eight hundred and sixty cases of malaria were reported of which 709 were white people and 151 negroes.