ALBANY

MEDICAL ANNALS

Original Communications

THE FUNCTIONS OF A COUNTY MEDICAL SOCIETY.

President's address delivered at the annual meeting of the Albany County Medical Society, May 11, 1910.

BY ANDREW MAC FARLANE, M. D.

It seems wise at this annual meeting of our society to review briefly what has been done during the past year and to place on record the successes and failures which have attended its work. The future may thus be made more successful both by the avoidance of our mistakes and by the recognition and further development of whatever may have been of value. The original objects of this society according to its charter were "the regulation of the practice of physic and surgery within this county and the reception and collection of information on different subjects relative to medical science by medical dissertations."

The regulation of the practice of medicine has been taken from the jurisdiction of the county societies except in so far as it refers to the general relationship of physicians to each other and to the community. To-day, however, the purposes of a county society have increased as have the demands of a more intense civilization. It officially gives expression to the highest professional opinion upon subjects of common weal and establishes the standard of the profession in the community. It provides the arena for the presentation and discussion of scientific topics, stimulating the interest of its members in a broader and

deeper aspect of their profession thus enabling them to care better for the sick and to appreciate more keenly the methods of preventing disease. It furnishes the opportunity for social intercourse thus allowing us to know better and a different view of our fellow workers and to develop along broader lines. Although our county society has always taken an advanced position upon matters of public legislation, it is questionable whether as a body we have done our full duty to the public. In these days of fads and fancies, of new cults and chimerical beliefs, of strange wanderings after new deities it would seem to be the present and pressing duty of the medical profession to lay aside its seeming secretiveness and its natural reticence and to stand like a prophet of old pointing out to erring humanity the true road to health. This must not be done in any apologetic, half-hearted tone but like a Samson with the full consciousness of what has been, is being and will be accomplished for the good of humanity by our profession. A moment's thought upon what has been done since Koch discovered the tubercle bacillus in 1882 justifies, even demands, such an attitude.

Tuberculosis is gradually being hemmed in and may within our lives be blotted out entirely. Diphtheria is no longer the fated scourge of childhood. Malaria, yellow fever and cholera are becoming unknown and in a few years will be classed among medical rarities. Typhoid is now recognized as a civic sin due to municipal filth and disappears as soon as that fact is appreciated. Meningitis is being rapidly overcome and cancer that dreaded and dreadful bane of mankind seems likely within our ken to be under control. It is a waste of your time to narrate to you the marvelous growth of modern surgery, the eradication of the dangers of pregnancy and the tremendous saving of child-life by proper dietetics. But does the public understand and appreciate what has been done? Is it not time that we should come out of our shell and educate the people to understand and appreciate this work so that they can themselves see at a glance the difference between scientific methods and quackery. Could not the county societies begin a campaign of education by illustrated public lectures upon subjects so truly vital to mankind?

After the laity had learned the tragedy of the discovery of the cause of yellow fever and the story of the demonstration of the plasmodium malariae; after they appreciated the theory and

the results following the use of the antitoxins and the experimental methods of advancing medical science—all of which are more fascinating than any fiction, do you think they would have any patience with pseudo-science under any name or with the hysterical effort to limit, curb or hinder those who are blazing the way for us to follow and pointing out nature's method of combating disease. Such lectures three or four a year could be given by laboratory workers and would without doubt be very popular. The hundreds of thousands who attend the tuberculosis exhibits prove the vital interest the people take in their own welfare.

The society should encourage its younger members to take a more active part in its work-the report of an interesting case with an exhaustive review of the literature would be a most valuable training and a mine of information to all of us. The older members, rich in the experience of years, and wise from attrition with their fellows, could wisely and kindly criticize and add and amplify out of their full storehouse of experience. They would thus materially assist in the general improvement and keep themselves up to the high level they had placed for themselves.

Another important duty of the society should be to welcome distinguished medical visitors and to invite the presentation of papers by our professional brethren from other cities. This not only gives us the opportunity of manifesting our appreciation of their work but also often presents to us a new view of wellknown subjects or stimulates our mind along new channels. Such gatherings are also helpful in developing us along broader social lines and in taking us away from the routine of everyday practice.

The effort has been made to develop our county society along these several lines. How successful is for each of you to judge.

There have been ten regular and two special meetings during the year past. Two of these meetings were of a quasi-public character, were largely attended and apparently much enjoyed by the profession of Albany and vicinity and also by many nonmedical guests. Five physicians, non-members of our society, read papers which were helpful, stimulating and full of much thought. In six regular meetings fourteen physicians of this county took active part by the reading of papers or by demon

strations. One meeting was given up to a symposium by the Clinical Club of Albany. This meeting demonstrated the valuable work which can be accomplished by concentrated effort upon one topic and reflected most creditably upon all who took part. Two special meetings were held for the sad purpose of placing upon record our deep and sincere appreciation of the life and professional character of two of our deceased members-Dr. Charles Whitbeck, of Cohoes, N. Y., and Dr. John L. Cooper, of Albany, N. Y. Both fought a good fight and faced death without flinching. Our membership has been increased by the addition of twenty-nine new members. With this brief review of my stewardship which has fallen below my hope and expectation, I turn over the responsibilities of this office to my successor.

In conclusion I wish to thank the members for their kind and generous support and especially do I wish to express my indebtedness to Drs. Holding, J. L. Archambault and J. N. Vander Veer for the very successful meetings they arranged.

FRACTURE OF THE LOWER JAW.

Read before the Medical Society of the County of Albany, March 16, 1910. BY LE ROY BLATNER, D. D. S.

Fracture of the inferior maxilla or mandible is the most common fracture occurring among the bones of the face. This results from its prominent position, large size and superficial location.

Fractures are either simple or compound; simple when they do not communicate externally, and are associated with a minimum involvement of the adjacent soft tissues; compound when the tissues between the bone and the skin, or mucous membrane are so destroyed that the line of fracture communicates with the air.

Fractures of the mandible are extremely liable to be compounded into the mouth, because of the close relationship of the mucoperiosteum to the bone; less frequently an external opening may exist through the skin, and in rare cases the presence of both an external and internal opening will allow the escape of saliva through the wound upon the face.

The fact that fractures of this bone are not more frequent is due to its extreme mobility, the strength and density of its structure and the great elasticity afforded by its arched shape.

Fracture is usually the result of traumatism, generally from blows upon the face with fists, often kicks of large animals, less often from falls, the impact of heavy missiles. or from gunshot injuries. Secondarily, a section of mandible is frequently removed as means of treatment for necrosis and malignant condition.

Fractures of the alveolar process are very common, occurring with great frequency, during tooth extraction, portion of the alveolar being loosened or entirely torn away without involving the body of the bone. Falls upon the chin may result in a similar condition by forcibly driving the teeth into their sockets. Such fractures are of little importance, as they give no trouble and usually heal without special treatment.

Of the complete fractures of the mandible one just anterior to the mental foramen the socket of the canine tooth, which is the weakest part of the bone, is of most frequent occurrence.

Fractures in other parts of the bone occur in the following order of frequency; between the cuspid tooth and angle of the jaw; between the symphisis and cuspid tooth; at the angle of the jaw; and at the symphisis.

Fractures above the angle are very rare; they may occur through the ramus; at the neck of the condyle; or through the coronoid process.

The universal concomitant of fracture is pain, sudden, sharp and usually continuous; this is soon followed by swelling at the site of the injury, the jaws become fixed and in the course of forty-eight (48) hours discoloration appears in the immediate region. All attempts to open the jaws to masticate, or to swallow cause an increase of the pain. The swelling and displacement usually cause facial deformity, which is evident upon inspection. The normal occlusion may be altered or entirely destroyed and upon motion of the fragments, one upon the other, crepitus will usually be found.

Fractures through the tooth bearing region may cause the loosening or entire loss of one or two teeth. Pressure externally along the body of the bone will develop a point of tenderness corresponding to the line of fracture. Displacement is, naturally, greater in the compound than in the simple variety, and greatest