EDITORIAL COMMUNICATIONS. Articles for publication under Editorial Communications must be accompanied by the name of the author. No name will be used in the publication unless requested by the writer. All such articles can be sent to Dr. C. E. Denison, 68 West 71st street, New York City.

A COMMUNICATION FROM THE PRESIDENT.

Το the County Associations and District Branches:

Greeting-At the beginning of the new year it seems proper that we, as a medical organization, should consider how we can best employ our opportunities to benefit our individual members and accomplish the objects for which our organization stands.

The year is opening most auspiciously. Every County Association can take inspiration from the November meeting of Ulster and of New York Counties. The meeting of the Ulster County Association at Kingston, November 21st, was reported as one of the most interesting and most largely attended in its history. All the profession of the county, members and non-members, were invited, with the result that the membership roll was largely increased before the meeting adjourned. The November meeting of the New York County Association was phenomenal in its attendance, the audience overflowing into the adjoining reception and refreshment rooms. The list of new members here also showed that Association membership has advantages which are appreciated by the practicing physician.

The annual meetings of the County Associations will be held during the first four months of the year. It is important that these annual meetings convene at the time prescribed by the bylaws, and in accordance with strict parliamentary and constitutional provisions, so that the proceedings may at all times be free from any and all technical objections.

There is wise purpose in these provisions of

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the constitution and by-laws. It was the intent of the originators of these articles that the annual meeting of the County Association should come first, in order that the officers and delegates elected might know the needs of the county units, and so be prepared to present them at the annual District Branch meetings, which follow in May and June. These meetings in turn lead up to the annual meeting of the State Association, where all matters are discussed and decided. All the County Associations are therefore requested to follow the prescribed regulations of the constitution and by-laws in the transaction of business, and especially in reference to the date of the annual meeting.

At the approaching annual meeting, Fellows will be elected to the number of one for every ten members to represent their respective counties in the annual meeting of the Council and Fellows, to be held on the third Monday in October, 1905. It is important that the Fellows chosen shall be men who will attend the annual meeting, and will represent the sentiments of their respective County Associations. The experience of the County Associations having the largest attendance has shown that this is best accomplished by arranging an attractive program of scientific papers and discussions. Make the meetings at all times, and especially the annual meeting, so attractive that the men of the county cannot afford to stay away. One or two men may be invited from a neighboring county or city, men who can speak with authority on their special subject. Arrange with members of your own Association to open the discussions, and the result will be all that could be desired. Such a program requires time and thought on the part of the officers, and cooperation of the members.

Three years ago a club was organized within the Association, known as the Conference Club. The object being to consider, from time to

time, the interests of the Association, and how they can be best subserved. Membership in the club is accorded to all the elective officers of the State, District Branch and County Associations and members of all standing committees. The club meets three times during the year. This organization has been of great service in keeping the constituent branches in touch with each other, cultivating mutual confidence and esteem, and knitting together State, Branch and County Associations into one organic whole. The dates of the next two meetings have been determined and are announced in another column of this JOURNAL. Nothing contributes more to the esprit de corps of our members than attendance upon these meetings of the Conference Club, and we earnestly hope that all who are eligible will make a special effort to attend the coming meetings.

(Signed) J. RIDDLE GOFFE, President.

THE CONFERENCE CLUB OF THE NEW YORK STATE MEDICAL ASSOCIATION.

This club was organized in 1901, when, pursuant to an invitation sent out by Dr. E. Eliot Harris, there assembled in the private diningroom of the Yale Club, on the evening of December 20, 1901, the following gentlemen, all

members of the State Association:

Drs. J. W. S. Gouley, F. H. Wiggin, E. E. Harris, A. A. Hubbell, E. M. Alger, E. L. Cox, C. E. Denison, A. Lambert, G. T. Harrison, E. D. Ferguson, J. C. Bierwirth, C. E. Quimby, F. P. Hammond, P. Syms, E. Mayer, H. Arrowsmith, F. W. Loughran, R. Kalish, M. L. Maduro (deceased), J. J. Nutt, J. R. Goffe, J. A. Wyeth and Mr. J. T. Lewis.

After an excellent dinner, Dr. Harris stated the object of the meeting to be the organization of a club whose purposes and aims were to advance the best interests of the Association, and promote a friendly feeling between the officers, and those serving on committees. It was thought desirable to hold a series of dinners, after which subjects might be discussed that were of special interest to the profession apart from the strictly scientific subjects, which properly belonged to medical meetings. It was felt that if the men knew each other better that matters of interest

could be more freely discussed at such meetings than at the business meetings either of committees or of the associations.

Through the courtesy of Dr. Lambert it was made possible to have future meetings at the Yale Club, where the dinner provided would be far better for the same money than could be secured at restaurants, and where the necessary

Greater New York, should be eligible to membership by the payment of annual dues, all other members by the payment for the dinners which they attended. The other provision was, that the management of the club should be intrusted to the officers and Executive Committee, consisting of the chairman of the six standing committees of the State Association.

At a later meeting Dr. Wiggin proposed, and it was carried, that membership at any time in the club makes the member eligible for continuous membership by payment of dues. This was to keep up the interest of those who had been at one time officers or members of the committees, and also that other members might benefit by their experience.

The first president was Dr. E. Eliot Harris, and the secretary, J. Riddle Goffe. They both served until March 18, 1903, when Dr. Emil Mayer was made president, and Dr. J. J. Nutt, secretary and treasurer. Since its organization, the club has held a number of delightful dinners, and many subjects of interest have been discussed.

At the meeting held December 14, 1904, Dr. Wisner R. Townsend was elected president, and Dr. J. J. Nutt, secretary and treasurer.

It was resolved that two dinners be held in 1905, on Saturday, February 25th, at the Yale Club, 30 West 44th street, New York City, at 7.15 P. M., and on Saturday, April 29th, at the same place and hour. The dues were fixed at $5 for the ensuing year for resident members or for nonresident members $2.50 for each dinner, and all those desirous of joining were requested to communicate with Dr. J. J. Nutt, secretary and treasurer, 2020 Broadway, New York City. It is hoped that every member of the Association who is entitled to membership will join, as he can thus show his interest in the organization, and he will not only enjoy a good dinner, but will have the pleasure of becoming better acquainted with those who have been placed in control of the State. District Branch and County organizations will be presented for discussion, and it has been for the ensuing year. Many topics of interest. the experience of those who are members, that these informal talks have not only been entertaining, but of great value. The proceedings are not published, so no one need feel any hesitancy in freely expressing his views.

Due notice will be given by the secretary in advance of the meeting to all members, but should, by any chance, a member fail to receive his notice, it is hoped that all will feel that they are expected to be present on February 25 and

had.

No formal constitution and by-laws were adopted, the idea being that the meetings should be as informal as possible. The founders made but two requirements, one that all officers and members of committees of the State, District Branch, or County Associations, resident in

ISLAND HOSPITAL FOR CONTAGIOUS DISEASES.

The Government plans to raise an island in the upper bay near Ellis Island and build a hospital for the reception of contagious diseases. Thomas Darlington, president of the Board of Health, is in hearty accord with the scheme and

Dr.

says there is not a particle of danger from it to the health of the people of New York or those nearby in New Jersey. The wind would carry no infectious taint and no taint of the kind would get into the water.

"Under modern conditions hospitals where cases of contagious diseases are cared for are not centers of dissemination of those diseases. What happened at the time of the Slocum disaster was sufficient demonstration of that fact. Survivors of that disaster were actually clothed in the disinfected and scalded garments that had been worn by persons suffering from contagious diseases. We carefully kept track of every instance of that kind and in not a single case was disease contracted. Nor did anybody contract disease from the hospital nurses, who were all about in the crowd ministering to the survivors. People lay on the grass all about the hospital. There was not a case of anybody contracting disease.

"With the hospital the Government proposes to build there might be means of reducing the number of persons with contagious diseases who, under present conditions, get to the city. At all events such a hospital would avoid danger to the patients from transporting them, and I believe would tend to diminish the danger of their diseases being spread. I hope the hospital will be built as speedily as possible."

PURE MILK.

The Health Board of New York, under the presidency of Dr. Thomas Darlington, is making vigorous war on the sellers of impure milk. No milk can be sold in the city without the permission of the Health Department, and the source of the milk supply being known, it is essential to know the character of the dairies. Special agents were sent to Blooming Grove, Orange County, and they visited the dairy owned and operated by the Metropolitan Milk and Cream Company. They found the floor of brick and stone dilapidated, puddles of dirty water in places, and the drainage broken or stopped up. The ground about the creamery was saturated with filth and had an offensive odor. There was dirty water in the milk-room tanks, the water for washing the cans was taken from a spring in the center of the buildings, and a horse was stabled in one of the rooms of the dairy. Cans marked buttermilk were examined and found to contain skimmed milk and water. Several bottles containing a preserving fluid were, on analysis, found to contain formaldehyde. The Department of Health revoked the license of the Metropolitan Company. In connection with securing pure milk in the large cities of the State Dr. Darlington has held several conferences with Dr. W. C. Greene, of Buffalo, to extend the system of examination and control of the dairies supplying milk to the dealers in the large cities. It is expected to carry forward the work among the cities of the second class and thus practically cover all the milk supply in this State.

THE OPERATIVE TREATMENT OF FRACTURES OF THE PATELLA.

It is beyond question that the operative treatment of recent fractures of the patella yields more satisfactory results than the non-operative treatment. In spite of the known dangers of an operation, the tendency at present is to operate more frequently. This is mainly due to improvement in the mode of procedure. It seems needless to state that not all fractures of the patella need be operated upon to obtain satisfactory results and that there are contraindications which need to be taken into account. It is in the class caused by indirect violence and known as "tear" fractures and in "combination" fractures or those caused by a combination of direct and indirect violence that operative treatment is very strongly indicated.

In these fractures there is a decided separation of the fragments with interposition of the torn periosteum and considerable laceration of the capsule on either side of the bone. Great stress is laid upon the importance of the torn capsule, and Joseph A. Blake (Journal of the American Medical Association, October 1, 1904), in a recent article states that "the indications for operation consist, then, not in the extent of injury to the patella itself, but to the lateral extensions of the insertion of the quadriceps extensor muscle." He refers to them as the lateral patella ligaments and considers their function. so important that he is led to state "that when these structures are torn as in 'tear' fractures, no operation based on the suture of the patella alone is correct. The lateral patella ligaments should be sutured as well." He relies mainly on the sutures of these ligaments and uses only enough fine catgut sutures to unite the torn periosteum of the patella. The injury is exposed through a curved transverse incision and all manipulations are performed with instruments. The torn ligaments are united by two chromic catgut or kangaroo tendon sutures; the sutures are introduced on either side and as close to the fragments as possible and tied only after both are in place. A few additional sutures are used to close the extensions of the tear.

The advantages justly claimed for this method are its "simplicity and ease, the avoidance of prolonged manipulation and traumatism, which is unavoidable when the fragments are bored for sutures; the exertion of the lines of the restraining force in the most efficient direction, the absolute coaptation, use of absorbable sutures and its rapidity."

Blake does not wait for the effusion to subside, but operates as soon as is convenient after the injury. He used this method for the last three years and during this time sutured twenty-three fractures of the patella, all healing by first intention and resulting in bony union and satisfactory function in all cases which he could trace. Surgeons are somewhat at variance in regard to the times which they allow to elapse between the time of injury and the operation. E. Eliot

(Medical News, January 11, 1904), in a report upon thirteen cases of uncomplicated fractures of the patella, advises delay until the extravasation in the joint subsides, and waits up to the tenth day before he operates. He also found marked laceration of the capsule on both sides of the patella, and lays great stress upon the exact suture of the torn capsule. J. A. Hutchinson (Annals of Surgery, October, 1904), reports six operative cases and reviews the subject from the time of Lister's first operation. His views are in accord with most of the recent writers. He postpones the operation for seven to ten days after the injury and operates through a curved transverse incision with the convexity downward, not unlike the incision employed by Eliot. Stress is laid upon careful suture of the lateral expansion of the tear, early massage and passive motion. He points out the importance of a quick operation, the use of rubber gloves, continuous irrigation with salt solution and all manipulation carried out with instruments. The operation proposed and practiced by Blake is a great improvement upon the older methods and has many points to recommend it; not the least of these are the avoidance of boring the bone and the use of absorbable sutures. Not being necessary to pass sutures through the bone shortens the time necessary for operating and diminishes the necessary manipulations to a minimum, thus diminishing the dangers of infection very materially. Though the operation for recent fractures of the patella is not difficult, it should never be performed unless the strictest asepsis is possible. Hutchison quotes Lord Lister, who, before commencing his first operation, made the following statement: "No man was justified in performing this operation unless he could say with a clear conscience that he considered himself morally certain to avoid the entrance of any septic mischief into the wound." This quotation should be considered by all who contemplate the performance of an operation for fracture of the patella.

SANATORIA FOR CONSUMPTIVES.

NEW YORK, November 16, 1904. Editor NEW YORK STATE JOURNAL OF MEDICINE, 64 Madison Avenue, City. DEAR SIR-You were good enough to honor me by asking for a few words of comment on the admirable inaugural address of our new and very distinguished president, Dr. Francis J. Quinlan. If I should dwell on and comment all the various and useful subjects dealt with in that admirable address, the comment would be as long as the original communication, and this, I know, you would not wish. You will find it natural then if I pick out for comment the subject in Dr. Quinlan's address which is nearest my heart, namely, the provision of sanatorium facilities for the consumptive poor in our great metropolis.

Here is what the distinguished new President of the largest medical association of New York has to say on this subject: "Let the physician urge that proper places be provided for those suffering both with acute and chronic diseases. Look at that beautiful island lying east of this great city, a refuge placed by the hand of God, where all the healing powers of Nature-air, light, sun-have their fullest sway, and where health, if it

could ever return, would be brought back to the suffering. Situated as it is between the ocean and Long Island Sound, what a haven of refuge it would be to the despairing sick. But no, it is made a luxurious resort for criminals, and the poor tuberculous sufferer who might be restored to health is exiled from all he loves and holds most dear, is pointed at as the leper of old and is really transformed into a useless burden on society. The tuberculous patient has his rights as well as the public."

We have already on Blackwell's Island the Phthisis Infirmary, and on North Brothers Island the Riverside Sanatorium, and in spite of the fact that only cases in the advanced stages of tuberculosis reach these institutions, really wonderful results are obtained by the simple hygienic and dietetic treatment and the excellent climatic advantages these islands offer. I would not wish to have the criminals transferred to any unhygienic locality where disease would likely be added to their punishment or confinement. But I agree with the distinguished president when he says that the honest citizen when sick and suffering should be given the preference of a salubrious locality. What seems to me of equally great importance is that we should have our sanatoria for consumptives as near the city as possible so that nostalgia is not added to the suffering of the poor consumptive. Since he has had to leave his home let us give him at least opportunity to see his loved ones from time to time without too much loss of time and expense to them. It matters less to the unfortunate criminal whether he is removed a few hours more or less from New York. Ever since the GoodsellBedell law was signed by Governor Odell the finding of a suitable locality for a sanatorium has been made well-nigh impossible. Let us hope that the suggestions of Dr. Quinlan will be listened to and our beautiful islands be utilized for the treatment of our consumptive poor. Very sincerely yours, S. A. KNOPF.

At the fourth annual conference of the New York State Sanitary Officers, held in Albany, December 15 and 16, 1904, a resolution was unanimously passed in favor of repealing the Goodsell

Bedell law.

WRITE.

One should write what he sees, or thinks he sees, and not feel that he must limit his writing to mere compilation, though, of course, references to the opinions held by other writers are not objectionable. Whenever anything impresses one as out of the ordinary, that is the thing to study and report. By doing so he will broaden his own mind and possibly assist others to understand similar conditions. Do not be afraid to report facts because they are not in keeping with the so-called "authorities." Mistakes in medicine, as in every other department of life, are handed down from generation to generation until some strong spirit observes the error and dares to combat it.

Writing makes a careful man and the careful man is the safest and best doctor. Writing for one's journal and society gives one a personal interest as nothing else can. Therefore,. by all means write and, of course, write the best you can. Kentucky Med. Jour.

Association News.

The secretaries of the county and district branch organizations are requested to furnish the business office a program of the meetings to be held, and after the meeting a full report of the proceedings, all items of interest, such as deaths, marriages and personals of the members.

COUNTY ASSOCIATION MEETINGS FOR JANUARY.

Rensselaer County, Tuesday, January 3d. (Annual.)

Allegany County, Tuesday, January 10th. (Annual.)

Kings County, Tuesday, January 10th. Niagara County, Tuesday, January (Annual.)

10th.

Wyoming County, Tuesday, January 10th. (Annual.)

Warren County, Wednesday, January 11th. (Annual.)

New York County, Monday, January 16th. Chautauqua County, Tuesday, January 17th. (Annual.)

Orange County, Wednesday, January 18th. (Annual.)

Rockland County, Wednesday, January 18th. (Annual.)

Cortland County, Friday, January 20th. (Annual.)

Westchester County, Thursday, January 26th. Columbia County, Tuesday, January 31st. (Annual.)

Lewis County, Tuesday, January 31st. (Annual.)

Monroe County, Tuesday, January 31st.

COUNCIL MEETING.

The next meeting of the Council of The New York State Medical Association will take place January 5, 1905. All communications should be addressed to the Business Office, 64 Madison avenue, New York City.

Dutchess County Association.-The regular meeting of this Association was held at Vassar Brothers' Hospital, October 26, 1904. The meeting was called to order by the president, Dr. LeRoy, at 2.15, Dr. Bayley acting secretary, and Drs. Van Etten and Wood present. Dr. von Tiling read a paper on the Widal reaction, as modified by Flicker, showing results, and explaining the simplicity of the procedure, and its convenience for the busy practitioner. Dr. Bayley presented a healthy appendix which he had removed this morning under protest, at the urgent request of its owner; also a large fibroid uterus with tubes and ovaries, which he had removed this morning, which was interesting from a secondary growth of large size attached to it by a very small pedicle.

Dr. LeRoy presented a memorial notice of the

late Dr. Barnes, which was read and ordered spread on the minutes. Dr. LeRoy gave a short history of a case of spinal apoplexy which he thought to be a rare condition. Dr. Van Etten gave a history of a case in which two leading physicians diagnosed cancer of stomach, in which the subsequent history proved to be incorrect. Dr. Wood gave a history of a case of twisted gallbladder, which had puzzled several surgeons. He also reported a case of rapid return of malignant disease of the removal of ovary for, cancer, and also reported case of dilatation of the heart greatly improved by the treatment at Nauheim. On motion, adjourned.

(Signed) Guy C. BAYLEY, Secretary, Pro Tem.

Erie County Association.-The meeting of this Association was held December 12, 1904, at 8.30 P. M., in the University Club, Buffalo, N. Y.

Dr. Roswell Park read a paper on "The History of Surgery in America."

Dr. Vertner Kenerson reported nine cases, illustrating six different points in diagnosis and treatment (to be published later.) The meeting adjourned at 10.30.

(Signed) DAVID E. WHEELER, Secretary.

New York County Association.-The State meeting of the New York County Medical Association was held at the Academy of Medicine, New York City, December 19, 1904.

Meeting called to order at 8.30 P. M., by the president, Dr. Francis J. Quinlan. In the absence of the secretary, Dr. W. R. Stone, the reading of the minutes of the last meeting were omitted, Dr. J. J. Nutt, corresponding secretary, acting as secretary. Minutes of Executive Committee were read and approved. The following candidates were elected: Drs. Brooks H. Wells, Jerome M. Waterman, Percy H. Williams and William P. Healy.

A memorial to Dr. William R. Pryor was given by Dr. C. J. MacGuire.

The Treatment of Leukæmia and Pseudoleukæmia by the X-rays, with Illustrative Cases, was read by Dr. Arthur Holding, who is in charge of the laboratory in connection with Cornell University Medical College.

Dr. Holden thought that there were two facts which explain the action of the X-rays in these diseases. First, in lower animals the greatest changes from exposure to X-rays have taken place in the lymph nodes and glands; second, many cases of tubercular adenites have been reported as cured by X-rays by thoroughly trustworthy men.

After a short review of the literature of cases of leukæmia and pseudo-leukæmia, and some statistics upon cases reported, he presented two cases, one of spleno-myllog leukæmia and the other of pseudo-leukæmia, showing improvement on X-ray therapy.