and organized, I hesitate not to say, is the con- | sibly endure; and it is often only when the trolling power of the profession of to-day. powers of medicine are pressed even to the verge of destroying life that life is saved." See to it then that this force be rightly applied, that it be not the fitful wind or the swaying tide, but constant, persistent, and unyielding in upholding the honor and dignity and progress of our loved profession. I congratulate you, gentlemen, that you are all in accord with the spirit of our great and grand National Association. It is needful that this should be. In the deliberations of the American Medical Association are formulated principles which it is yours to take, present to, and urge upon your readers. Your journals connect the national head with the individual members of the great and legal body of American physicians. Of this body of giant frame and varied membership, it has been said that the brain is situated near the rising sun. Location or causes to us unknown seem to have developed a hydrocephalic tendency, which we may well treat by counter-irritation, compression, or absorption. Meanwhile you are the back-bone, each one a vertebra of strength. In conclusion, we have placed before you this evening food for the inner man, to signify ourappreciation of that mental pabulum which we have received during the year that is past, through the medium of our exchanges. Dr. I. N. Love was elected toast-master, and presented quotations from Shakespeare, which were responded to by Drs. N. S. Davis, William Brodie, J. M. Toner, W. H. Pancoast, H. O. Marcy, J. B. Hamilton, J. V. Shoemaker, W. C. Wile, and J. M. Carpenter. Many others responded happily, especially Drs. Summers, Woodbury, Mudd, Todd, Yan dell, Reynolds, and Gunn.- The Daily Bulletin of The Medical Review. THE TREATMENT OF ACUTE RHEUMATISM.Dr. P. M. Latham (British Medical Journal) says: In gout, uncomplicated with contracted kidney or albuminuria, salicylic acid is often of service. But it is in acute rheumatism that it shows its special power, acting truly, when properly administered, as a distinct specific. Here is a disorder which, under different treatment, may exist for weeks stationary, so to speak, in its intensity, the great heat and nervous and vascular excitement, and pain and swelling exactly of the same amount to-day as they were weeks ago; a disorder which, less than fifty years ago, was said to be " often such in itself, and such in its appalling incidents, as to need, from time to time, that medicine should put forth the full compass of all its powers. Every organ or system of organs, which either directly or indirectly can receive the impression of the remedies are, from time to time, called to bear all that they can pos And now, with or without the administration of a purgative, as the occasion requires, the patient is placed fully under the influence of salicylic acid, and in from forty to sixty hours, not unfrequently in a shorter time, the pains in the joints have subsided, the limbs can be freely moved, and the bodily temperature has reached the normal condition. But more than this-and here the remedy shows its signal power-in no case of rheumatism that has come under my care during the last six years, either in hospital or in private practice, has there been developed, where the heart was previously sound, any cardiac complication, such as endocarditis or pericarditis. If this can be maintained and insured, we have, indeed, in our hands a most potent remedy. Cardiac complications constitute the chief danger in acute rheumatism, and the danger, if the disease is taken in hand soon enough, may, with our new remedy, be averted. But certain conditions must be observed to insure success in the administration of the remedy. They are as follows: First. The true salicylic acid obtained from the vegetable kingdom must alone be employed. If you have to give large doses, avoid giving the artificial product obtained from carbolic acid, however much it may have been dialyzed and purified. An impure acid will very quickly produce symptoms closely resembling delirium tre mens. Secondly. Give the acid without any alkali or base. A very good form is to mix one hundred grains with fifteen of acacia powder and a little mucilage. Allow the mass to stand and harden, and then divide into thirty pills. Thirdly. Place the patient fully under the influence of the drug-that is, let him have sufficient to produce cerebral disturbance—that is, buzzing in the ears or headache, or slight deafness; with the development of these symptoms, the temperature and the pain in the joints will begin to decline. To an adult, I generally administer three doses of twenty grains (six pills) at intervals of an hour, and, if the head remain unaffected, a fourth dose at the end of another hour; and then repeat the twenty grains every four hours, until the physiological effect of the remedy shows itself. In the majority of cases from eighty to one hundred grains are enough. In severe cases, one hundred and forty to one hundred and fifty may be required. Afterwards, about eighty grains a day are sufficient; and, as the temperature declines, smaller quantities will develop their physiological effects, sixty or even fifty grains being then sufficient to produce cerebral disturbance. It would appear that, as long daily and sufficient action of the bowels. The benefits resulting generally in rheumatism, from the so-called purgative plan of treatment, have always been recognized by the older physicians as striking and satisfactory. By the judicious use of cholagogue purgatives, we eliminate the bile from the intestines, and so remove from the system a quantity of glycocine, which, if re-ab as the rheumatic poison is circulating in the system, the physiological effect—that is, the effect it produces in the healthy organism-does not show itself; acting as an antidote, the greater the amount of poison, the larger must be the dose of the remedy; but as soon as the formation of the materies morbi is stopped, then the excess of the remedy acts as it would in the healthy organism, and its peculiar physiological effects are de-sorbed, would lead to the consequent formation veloped. It is a very striking illustration of the difference between the therapeutic effect of a remedy and its physiological action. Fourthly. Give the patient from forty to eighty grains daily for ten days after all pain and pyrexia have passed away. Fifthly. Let the patient's diet consist entirely of milk and farinaceous food for at least a week after the evening temperature has been normal. On the other hand, if the patient have meat and soup, you may look forward with fair probability to a relapse. Sixthly. Take care to maintain a daily and complete action of the bowels. Calomel is the best purgative, from two to five grains at night, followed in the morning, if necessary, with a saline draught. This is the most important adjuvant to the action of salicylic acid, and I will presently explain to you why this is the case. Seventhly. Let the patient be enveloped in a light blanket, and with no more bed clothes than are sufficient to keep him from feeling cold. The object of the treatment now is to cool the patient -not, as in former times, to sweat the poison out of him; and the cooler he is kept the sooner will the temperature be lowered. In fever, increased heat increases the metabolism, just as in a coldblooded animal. of uric acid. Calomel is unquestionably of ser- "Of this plan, often so striking in its operation, and often so satisfactory in its results, I have some further remarks to make. It is called the purgative plan; yet its purpose is achieved by calomel and purgatives conjointly. The purgatives would not answer the end without the calomel; of that I am quite certain; neither would the calomel answer without the purgatives, unless it produced of itself ample evacuations from the bowels. It is probable, in short, that the remedial efficacy of the plan resides essentially in the calomel; in calomel, however, not as mercury, but as itself-calomel. If the specific effect of mercury-salivation-arise, it is not only beside our purpose, and against our wish, but it begets a serious hindrance to the use of calomel in sufficient quantity for the end in view. Thus the whole plan is frustrated. Having began one plan of treatment, we are obliged to take up with another. Time is lost, the case is perplexed, the disease is prolonged, and the patient perhaps in These are the seven rules upon which I act. I have given the true salicylic acid where there have been both aortic and mitral mischief; and I have also given it in rheumatism complicated with pericarditis, and, as yet, I have seen no bad result from it. Of course, in cases of pericarditis accompanied with delirium, the use of the remedy requires caution; you cannot tell when the system is saturated with the remedy and you must therefore trust to smaller doses and other means for controlling the disease. Further, if pericarditis or endocarditis, pneumonia, or pleurisy, have been developed, the remedy is powerless over the mischief which is done; it will neutralize the poison producing the mischief, so as to stop its extension; but the inflammatory exudations will undergo their usual changes, unabbreviated in their course. We see the same thing in ton-jured." sillitis. Given early enough, salicylic acid will stop the mischief; but, if exudation of lymph have taken place, salicylic acid is powerless to cause its absorption. Now, if in the treatment of acute rheumatism, you were to choose one indication and abide by it, and were to trust one class of remedies, and to it only, you will find more cases that admit of a I have referred to the necessity of keeping up readier cure by the method now described, than by either of the two former. You will find the | very well illustrate what I mean here. The presaggregate of morbid actions and sufferings, which ence of urea in the blood may, by its action on constitute the disease, more surely reached and the nerve-centres, determine an increased bloodcounteracted, and more quickly abolished by supply to the kidneys, and so, in a healthy state medicines operating upon the abdominal viscera of things, an increased secretion; but, if the secreonly, than by those which influence either the tory portion be damaged, or the nerve-force conblood vessels only, or the nerves only. You trolling it defective, an increased flow of blood to would find in calomel and purgatives, a better the part, producing a congested condition of the remedy than either venesection or in opium." organ, would not expedite, it would rather hinder, the work of the secretory portion. The simpler the diet, then, the less tax there will be upon the kidneys, and the better they will do their work. Let the diet, then, be chiefly farinaceous, with just sufficient nitrogenous food to satisfy the wants of the system; and, in the acute attacks, let that be in the form of milk, diluted even, if necessary. In the earlier attacks of gout, too, I have often seen marked relief follow the administration of calomel and a saline cathartic. Where there is high arterial tension, as in the gouty paroxysm, this may be distinctly lowered by these remedies. They check the further formation of uric acid, which is stimulating the vaso-motor centre, and causing the increased arterial tension, by eliminating the bile from the intestines. In some persons, calomel has a depressing effect, and, when the kidneys are unsound, is injurious in its action. Where calomel is inadmissible, a gentle laxative, such as rhubarb, is often of service. When the object is simply to unload the bowels in a debilitated subject, it is the best purgative. It is said to act chiefly by increasing the peristaltic action of the bowels throughout their entire extent, but especially that of the duodenum. According to Rutherford it is a cholagogue. Sir Henry Halford recommended, as a prophylactic remedy against gout, a few grains of rhubarb, with double the quantity of magnesia every day; or some light, bitter infusion, with tincture of rhubarb, and about fifteen grains of bicarbonate of potash. The saline cathartics probably act only by causing serous evacutions, and in that way carry off from the blood some of the poison contained in it. They may also act beneficially, perhaps, by relieving the congested liver. The diet is another important point to be attended to in the treatment both of gout and rheumatism. It should be simple and nutritious; jellies and food containing gelatine should be avoided, as this substance furnishes glycocine. Animal food will not, itself, produce uric acid in a healthy system, as is shown in its absence in the urine of the carnivora; but from all kinds of meat a certain amount of glycocine will be produced, and, even if all the rest of the nitrogenous portion, after being absorbed into the system, were converted into urea, this would necessitate an increased elimination of urea, and consequently a greater tax on the powers of the kidneys. If these powers be weakened, there will be, with an increased call upon the organs, less power to act; and not only will the urea, but, still more, the uric acid, accumulate in the blood. The striking benefit and increased urinary secretion, which result in some forms of albuminuria from a skimmed-milk diet, that is the simplest of all diets, The explanation which I have here offered of the symptoms of a gouty paroxysm, helps us to understand the beneficial action of colchicum in this disorder. According to Dr. Lauder Brunton, this drug paralyzes the sensory nerves, the motor nerves and muscles being unaffected. It seems to act best when the bowels are previously acted upon. If in gout, then, uric acid during the paroxysm be stimulating the sensory nerves, and, through them, the more active portion of the vaso-motor centre, and we paralyze the sensory nerves with colchicum, the uric acid no longer produces its effect, and the paroxysm ceases; but the colchicum has no effect in preventing the formation of uric acid, and, after the paroxysm, we must endeavor to prevent its recurrence by putting a stop to the formation of the poison, which we may effect by eliminating the bile from the intestines by mercurial or other purgatives, by diet. In large doses, colchicum will cause purggiving benzoic or salicylic acid, and by suitable ing, but marked symptoms of collapse supervene, so that it is not safe to administer the remedy in this way. AMERICAN MEDICAL ASSOCIATION. — The thirty-seventh annual session of the American Medical Association was held in Exposition Music Hall, St. Louis, on May 4, 5, 6, and 7, 1886. Over one thousand delegates were in attendance, and the entire proceedings were of the most harmonious character. The opening of the session was formally announced by Le Grand Atwood, M.D., Chairman of the Committee of Arrangements, after which the President, William Brodie, M.D., was conducted to the chair. Prayer was offered by the Rev. Montgomery Schuyler, D.D., and the address of welcome was delivered by the Hon. D. R. Francis, Mayor of St. Louis. Drs. N. S. Davis, J. M. Toner, T. G. Richardson, and D. W. Yandell, the attending ex-presidents of the association, were invited to seats on the platform. The protests, which were entered against the admission of the delegates from the Philadelphia County Medical Society, the New York Academy of Medicine, the Davidson County (Tennessee) Medical Society, the Tri-State Medical Association, and the Mississippi Valley Medical Association, were referred to the Judicial Council. The Nominating Committee was announced as follows: Arkansas, Dr. P. O. Hooper; Colorado, Dr. J. W. Graham; Connecticut, Dr. W. C. Wile; District of Columbia, Dr. J. W. Bulkley; Dakota Territory, Dr. J. B. Van Velsor; Florida, Dr. T. O. Summers; Georgia, Dr. J. W. Bailey; Illinois, Dr. J. E. Owens; Indiana, Dr. Dr. William Brodie, the President, then de- T. B. Harvey; Iowa, Dr. W. Watson; Kansas, livered an interesting and instructive address, in Dr. C. V. Mottram; Kentucky, Dr. W. H. which he reviewed the history and achievements Wathen; Louisiana, Dr. Joseph Jones; Maine, of the American Medical Association, and after Dr. Charles E. Webster; Massachusetts, Dr. E. referring to the failure of the attacks which had W. Cushing; Maryland, Dr. G. H. Rohé; Michibeen made upon it during the past year, urged gan, Dr. H. O. Walker; Mississippi, Dr. P. W. the adoption of several measures which would Rowland; Missouri, Dr. G. F. Dudley; Minincrease the sphere of its usefulness. He recom- nesota, Dr. H. H. Kimball; Nebraska, Dr. W. mended that the association approve of the bill M. Knapp; New Jersey, Dr. E. L. B. Godfrey; now before Congress, providing for an investiga- New York, Dr. E. S. F. Arnold; North Carotion into the cause and the possibility of the lina, Dr. C. J. O'Hagen; New Mexico, Dr. W. prevention of yellow fever, and suggested that R. Tipton; Ohio, Dr. H. J. Sharp; Pennsylthe resolutions recommending the employment vania, Dr. J. C. Lange; Rhode Island, Dr. H. of the metric system be rescinded. He also R. Storer; South Carolina, Dr. R. A. Kinloch; recommended the formation of a Section on Tennessee, Dr. Duncan Eve; Texas, Dr. J. F. Dermatology and Syphilis. He denounced the Y. Paine; Vermont, Dr. A. T. Woodward; Virindorsement of proprietary medicines by physi-ginia, Dr. G. B. McCorkle; West Virginia, Dr. cians as discreditable, and recommended that | G. W. Baird; Wisconsin, Dr. W. T. Galliway; the Secretaries of Sections be made permanent, subject to removal on the recommendation of the Section. Dr. Brodie concluded by reviewing the action of the association in reference to the International Medical Congress, and after expressing his approval of the work of the Enlarged Committee, urged the necessity of a united effort to make the Congress a brilliant success. On motion of Dr. J. H. Murphy, of St. Paul, the thanks of the association were tendered to the President for his address, and its recommendations were referred to a special committee for consideration. Dr. John S. Lynch, of Baltimore, then reported on behalf of the Committee on Organization of the International Medical Congress, that the committee had nominated the officers of the Congress and adopted a series of rules for its government, and had transferred the work of further organization to an Executive Committee, composed of the President, Secretary-General, and Treasurer of the Congress, and the Presidents of the various Sections. On motion of Dr. Gihon, of Washington, the report was received and adopted unanimously. Dr. Henry H. Smith moved that the motion just passed be reconsidered, and Dr. Gihon then moved that the motion to reconsider be laid on the table. The latter motion was also passed unanimously. Dr. J. H. Murphy, of St. Paul, Dr. A. L. Gihon, of Washington, and Dr. A. L. Garcelon, of Maine, were appointed a Committee on the President's Address. United States Navy, Dr. W: T. Howard; United The Address in Obstetrics and Diseases of On motion of Dr. I. N. Quimby, an amendment providing for the establishment of a Section on Medical Jurisprudence, was passed. The Committee on the President's Address presented the following report, which was adopted:— 1. That in the opinion of the committee it was proper and desirable for this association, without delay, to memorialize Congress in behalf of the pending resolution to appoint a scientific commission consisting of three members of the medical profession, to visit the habitats of yellow fever, with the view of determining the validity of the claims of Drs. Carmona and Freire, to have discovered the means of preventing or modifying the attacks of the disease. 2. The committee did not approve of the suggested recession from the recommendation of the use of the metric system. 3. That it heartily approves the suggestion of the President that the association, having created a Section of Medical Jurisprudence, shall further establish a Section of Dermatology and Syphilis. 4. It concurs with the President as to the wisdom of the provision that the several Sections shall elect their own officers from men of recognized authority and experience in special Section work; and, further, in its opinion the efficiency of the Sections will be enhanced by a continuance from year to year of the Secretaries of said Sections. 5. It indorses the views expressed by the President respecting the Journal of the Association and of the exclusive proprietary interest of this association in the papers and reports made as part of the transactions. 6. The association should emphatically denounce the indorsement by certificate, advertisement, testimonial, or indirect approval of any form of proprietary remedies and appliances, and should instruct the Judicial Council to take action in all such cases without formal presentation of charges. That, in the words of the President, "the stigma of professional disgrace rests upon any regularly educated physician who allows his name to be advertised as indorser of any patent, secret, or proprietary medicine." 7. That it is desirable that the association appoint a committee at this meeting to consider the advisability of amending the organic law of the association by the establishment of branches, and report thereon at the next annual meeting. 8. It earnestly reëchoes the wish of the President that the members of the profession cordially cooperate in the effort to make the American Session of the International Medical Congress creditable to the country and attractive and instructive to the foreign members-sacrificing personal and private piques and disappointments in generous emulation to contribute to that success which has been unconditionally pledged in the invitation tendered to the foreign members of the Congress to meet in the United States. The Nominating Committee then presented the following report, which was adopted : President.-E. H. Gregory, M.D., St. Louis. Vice-Presidents.-Drs. E. H. Miller, Stillwater, Michigan; W. B. Welch, Fayetteville, Arkansas; William H. Pancoast, of Philadelphia; W. C. Wile, Sandy Hook, Connecticut. Permanent Secretary.-W. B. Atkinson, M.D., Philadelphia. Assistant Secretary.-J. Nevins Hyde, M.D., Chicago. Treasurer.-R. J. Dunglison, M.D., Philadel phia. Librarian.-C. H. A. Kleinschmidt, M.D., Washington, D. C. Section of Practice of Medicine.—Drs. J. S. Lynch, Baltimore, President; J. B. Marvin, Kentucky, Secretary. Section of Surgery.-Drs. H. H. Mudd, St. Louis, President; J. B. Roberts, Philadelphia, Secretary. Section of Obstetrics.-Drs. S. M. Johnson, Kansas, President; W. W. Jaggard, Illinois, Sec retary. Section of Diseases of Children.-Drs. De Laskie Miller, Chicago, President; W. P. Lawrence, Secretary. Section of Oral and Dental Surgery.-Drs. J. S. Marshall, Chicago, President; E. S. Talbott, Chicago, Secretary. Section of Medical Jurisprudence.-Drs. I. N. Quimby, New Jersey, President; H. H. Kimble, Minnesota, Secretary. Section of State Medicine.-Drs. G. H. Rohé, Baltimore, President; Walter W. Wyman, United States Marine Hospital Service, Secretary. Committee on Necrology.-Dr. J. M. Toner, Washington, President. Fudicial Council.-Drs. N. S. Davis, Illinois; Hawkins Brown, Kentucky; William Brodie, Michigan; D. J. Roberts, Tennessee; R. C. Moore, Nebraska; T. A. Foster, Maine; James A. Gray, Georgia. Trustees of Fournal.-Drs. P. O. Hooper, Arkansas; A. Garcelon, Maine; L. S. McMurtry, Kentucky. Time and Place of Next Meeting.-Chicago, first Tuesday in June, 1887. Charles Gilman Smith, M.D., Chicago. Chairman of Committee of Arrangements. Dr. John B. Roberts subsequently tendered his resignation from the position of Secretary of On the Section on Anatomy and Surgery. motion, the resignation was accepted. The reports of the Committees on the Collective Investigation of Disease and on Meteorological Conditions and their Relations to the Prevalence of Disease, were presented by Dr. N. S. Davis. The report of the Committee on Cremation was read by Dr. J. M. Kellar, of Arkansas, and on motion, referred to the Committee on State Medicine. The Address in Medicine was delivered by Dr. James A. Whittaker, of Ohio. The Address in State Medicine was delivered by Dr. John H. Rauch, of Illinois, in the course of which he recommended that the requirements for graduation in all medical colleges should be made to include four years' study and three years' attendance on clinical and didactic lectures. behalf of the Judicial Council, which was reDr. J. M. Toner made the following report on ceived and adopted : In the case of the protest against the admission of delegates from the Tri-State Medical Society, your Judicial Council would respectfully report that, as the Constitution of the association recognizes delegates only from State societies and from such county and district so Icieties as are in affiliation with their State societies, the Tri-State Medical Society not being in affiliation with such State society, its delegates are not admissible to seats in this association. In the case of the protest against admission of delegates from the Davidson County Medical Society of Tennessee, the Judicial Council reported that after careful examination of all printed, written, and oral discussion, they had decided that sufficient evidence had not been presented to warrant them in denying registration to such delegates, but that the Council desired to admonish the said Davidson County Medical Society that it should put itself as soon as practicable, in affiliation with the State Society. In the case of the protest against the admission of the Mississippi Valley Medical Society's delegates, the Judicial Council reported that the protest had been accompanied by no charges, and, therefore, the Council could take no action. In the case of the protest against the Phila |