Vol. IX.

RENEWAL OF THE OBJECTIONABLE ATTEMPT ΤΟ RESTRICT

"VIVISECTION."

HE

No. 2

knows that it would be madness for the State to meddle by law with the technical details of the ever advancing practice of medicine. would be to

So

of

all legitimate means Senate Bill No. 170 (Introduction number, 168), introduced on January 21, 1909, by Mr. Davis of Erie, and entitled (like its predecessor of 1908) "An Act to prevent cruelty by regulating experiments on living animals." This bill has been referred to the Judiciary Committee of which Senator Davis is Chairman. The most effective way to oppose it is by a personal letter to one's own representative in the Senate and in the Assembly.

This bill of 1909 fulfills its purpose of "regulating" experiments upon living vertebrate animals "of a nature calculated to cause pain to such animal" by forbidding such experiments to be done, under penalty of imprisonment or fine, except subject to "restrictions" as to who may do such experiments, where they may be done, how they may be done, and for what purposes they may be done. The folly and danger should be realized of causing the State to withdraw from qualified men the complete discretion which they now possess as to what they may do experimentally to animals for the good of mankind. They possess now, and will continue to possess unquestioned, complete discretion as to what they may do to human patients for the good of the said patients. It is against common sense to give to a qualified man a freer hand as to patients than as to animals; and every one

attitude now taken by the State toward both practitioner and experimenter, does not place either above the law more than any other citizen. If a surgeon abuses his discretion by withholding an anesthetic from a patient, not for medical reasons, but from indifference or neglect, he offends against the law regarding malpractice. If an experimenter abuses his discretion by withholding an anesthetic from an animal, not for medical reasons, but from indifference or neglect, he offends against the criminal law relating to cruelty to animals, quite as much as does a carter who misuses his whip. In the City of New York two young men have recently been convicted, under Section 655 of the Penal Code, of a misdemeanor consisting of cruelty to animals, due to unjustifiable "vivisection," and thus the view of eminent lawyers has been substantiated in court, that no special law is needed to protect animals from improper practices at experiments.

No forms of words can be devised by the most learned to define, "restrict," and fix by law in advance, the activities of swiftly moving sciences. Such forms of words would speedily become antiquated and dangerous to the rightful interests of those who had enacted them. This is concisely illustrated by comparing, at a certain point, the bill of 1909 with its forerunner, the

so-called "Davis-Lee bill" of 1908. The list of procedures which may lawfully be done without anaesthetics is headed with these words in the bill of 1908: "a. In tests of foods or of drugs;" and, in the bill of 1909, with these words: “(a) In tests of food, drugs, or serums." Should the bill of 1909 become a law, and should it become necessary, in 1910, for the good of mankind, to test on an animal, without anaesthetics, something which is neither food, drug, nor serum, such a test would be punishable by imprisonment

or fine.

Equally foolish and dangerous are the collective clauses relating to anaesthesia; the clause relating to teaching; and the clause relating to the purposes for which experiments may be done. This last is a tissue of solemn folly, and can accomplish nothing but the raising of questions about which "loose constructionists" and "strict constructionists" will disagree-questions which a court could settle, in an actual case, only by the advice of men of the very kind against which the clause is directed.

The bill of 1909, unlike that of 1908, contains, as "Section IV," a prodigious clause which would make it possible for a professor's or doctor's servant, discharged at one end of the State, to go with a malicious tale to the other end of it, and return with all the members of an "Anti-vivisec

tion Society" at his back, armed with the legal right to enter and scrutinize from top to bottom the laboratory or office or private house of his late employer and whatever should go on therein, at any hour of every day "during the period named in the order." Such a proceeding would be followed, perhaps, by a trial on frivolous charges, and an acquittal; the whole constituting, despite the acquittal, the serious punishment of an innocent man.

Perhaps physicians and men of science in the State of New York may dissent from the demure categorical statement of the promoters of this bill, that it "does not interfere with legitimate

scientific research."

The bill contains other objectionable features not referred to in this article; but the foregoing may suffice to indicate that it should be opposed by every one, whether physician or layman, who desires the unimpaired maintenance and progress of the science and art of medicine in the State of New York.

J. G. CURTIS.

JOURNAL OF MEDICINE

The Annual Meeting

The 103rd Annual Meeting of the Medical Society of the State of New York was notable for two important movements, one to bring about much needed reform in the matter of expert testimony; the other to permit the Society to change the time and place of its Annual Meeting, at present a matter of statute law.

The bill to regulate expert testimony which was approved by the joint committees of the State Bar Association and State Society is to be found reported in full in another place.

It passed the House of Delegates unanimously, after some debate, and the Buffalo meeting of the Bar Association approved of it by a large majority. Never before in any state has any measure of reform in this important matter ever been approved by a State Bar Association.

Whether the present bill, which now has the approval of both state bodies will become a law or meet defeat in the legislature, no one can predict, but whatever its fate, a distinct advance has been made in the mere fact of the agreement of the two societies on any measure. The bill is by no means ideal. Reforms are always gradual. It is better that this should be so. No radical measure of relief would have the slightest chance of becoming a law, but it is hoped that this very moderate bill will recommend itself to fair minded men as entirely reasonable, feasible and constitutional.

For a long time there has been a growing sentithe State Society from mid-winter to a more conment in favor of changing the time of meeting of

venient and pleasant season of the year. There are not a few members who also believe that it would be profitable occasionally to meet in some other city than Albany.

The House of Delegates by a unanimous vote instructed the Committee on Legislation and the Counsel of the Society to procure legislation permitting the House of Delegates to fix the time. and place of meeting. This would not commit the Society to any fixed time or place, and seems conservative.

The Directory and JOURNAL were both continued by the Council to whom the matter was longed debate in the matter of the Directory. referred by the Society, after a somewhat pro

The weather during the two days of the meeting was unusually mild and pleasant, nevertheless but 440 members registered, being 7 less total membership. This fact is worth attention than last year, and less than 7 per cent. of the and reflection. With weather unusually propitious and an excellent and attractive program and a somewhat increased total membership, there was yet a falling off in the attendance.

A. T. B.

Original Articles

THE ONE HUNDRED AND THIRD AN-
NUAL MEETING OF THE MEDICAL
SOCIETY OF THE STATE
OF NEW YORK,

ADDRESS BY THE PRESIDENT.
DR. ARTHUR G. ROOT.

THE PHYSICIAN AND LAW MAKING. To those who make a study of the statutes that are annually produced by the law-makers of the State of New York, the most cursory examination must prove convincing that in their preparation there is a painful lack of an intimate knowledge necessary to make them effective. Drawn from all classes of life, of varying degrees of intelligence, totally unfamiliar with the evils sought to be remedied, the framer of the provision introduced is too often incompetent, and the result is a body of statute law requiring judicial interpretation and construction to ascertain its intent before even an attempt can be made at its enforcement.

In striking contrast to the class of legislation already referred to, is the result of the efforts on the part of the medical profession to put in operation reforms redounding to the public good. Unlike so much of the substantive law, which seems to be designed purely for the relief of corporations, or individuals, and of "personal" character, if such a term may be used, are the provisions introduced and pushed to a consummation by the medical profession which are all designed to effect "the greatest good to the greatest number."

In the enumeration of the inalienable rights of every American citizen, "life, liberty and the pursuit of happiness," the preservation of existence is naturally and logically placed first. For the accomplishment of this it is necessary that the class of public statutes, commonly known as "health laws," should have a prominent place in the body of our laws. The incontrovertible fact that the longevity of mankind shows a decided increase is due to the fact that such laws have been wisely framed.

This follows from the circumstance that the medical profession of the State of New York has steadily and consistently applied itself to the study of hygiene, and to bringing before the legislature each year enactments calculated to promote a proper understanding and application of the rules that appertain to this important subject. Proper sanitation is vastly more important to the public weal than the protection of property rights.

Technical knowledge of the subject is absolutely necessary to a proper construction of a statute intended to accomplish its object and to be effective in protecting the life of the individual. The wisdom of the law-makers in referring this important subject to the medical profession must be apparent to the most casual observer.

As a single instance of an apparently insignificant health ordinance, which in its results is far reaching, reference may be had to the law making it a misdemeanor to expectorate in public places. The spread of tuberculosis is thereby checked, and the "great white plague" of America pauses in its onward progress through the land.

Other instances of the far reaching benefits derived by the public from the medical lawmakers might be found in the laws standardizing drugs and foods known as the "pure food" and drug laws; laws compelling vaccination of the public school children thereby contributing largely to the prevention of epidemic from smallpox; laws preventing the pollution of streams and protecting public water supplies. It is not necessary that I should weary you with a long enumeration of the many public benefits which have been brought about by the medical lawmaker. Those already cited suffice for examples.

It is inconceivable that a politician, elected to serve the private interests of capital, should conceive and carry into execution such measures.

The laws looking to the suppression of contagious diseases, providing for isolation, quarantine and fumigation have robbed the dread diseases of smallpox, scarlet fever and diphtheria of much of their terror. These laws have been the direct result of study and effort on the part of the medical profession. No one but a physician of training and practice would have been competent to frame them, and no class of men other than the physician would have been so inspired by "pro bono publico" as to sacrifice time and effort to the extent necessary to place them in the body of our laws and bring about their rigid enforcement.

That the individual who practices the learned. and responsible profession of medicine should be properly equipped, has been the steady aim of the society of doctors of the State of New York. With the lives of countless numbers entrusted to his care, no breadth of understanding nor extent of technical knowledge can be too great for the physician who is properly equipped to practice his profession. Recognizing this, the standard of requirements for a license to practice medicine has been steadily and consistently raised. No one can deny that the proper judges of these matters are the medical men themselves. And not alone is the comprehensiveness of the preparation an essential, but a uniformity of knowledge this State has at last succeeded in securing a as well. To this end, the medical fraternity of uniform system of examinations that places all aspirants upon an equal footing. Thus the public is protected from such as have a knowledge of only a particular method of healing, and to whom all other means are closed doors. While liberty is given to all who are duly qualified, the ridiculous claim that each school, or system, of alleged medicine should have its separate examination has been definitely and finally disallowed,

and the public permanently protected. Again has the medical profession not only preserved its own high standard, but has protected the individual from useless and dangerous experimentation.

Probably no class of individuals are as susceptible to an appeal to human sympathy as the physician, yet medicine demands heroism as well as sympathy. Experience has demonstrated the absolute necessity of experimentation upon living animals. Vivisection has proven the only method by which this can be accomplished. The resultant good to mankind is almost beyond calculation. In the great and growing domain of lawmaking, the physician is the only natural and logical referendum for the subjects which affect health and life. His training and experience have educated him for this application of his talents. Even a cursory examination of what he has thus far accomplished must convince the most skeptical. Politics should play no part in either the furthering or retarding of his energies in the direction of proper legislative measures, and yet to some of the lay minds this is not apparent; and year after year sentimental and misguided people are asking for legislation which would compel us to take a long step backward and ere long prevent the giving to humanity much of rich blessing in truths which are as yet hidden from us. To a medical body such as this it would seem entirely unnecessary perhaps for me to emphasize the importance of this branch of my subject, but as one whose duty to this Society has been for many years, that of familiarizing myself with medical legislation, it has become apparent to me that if we as medical men are to maintain our position in the ranks of science and are to continue to discharge our full duty to the public, it is incumbent upon us to see to it that a clear understanding of this subject be brought to the minds of our neighbors in the community and our elected representatives. We must not become content with having succeeded in preventing legislation already attempted, but must be prepared to meet whatever demands may be made in future.

Is it not logical to assume that the patient who trusts his life to the skill of his physician should be content to trust him with the framing of laws designed to improve upon the condition of mankind, and is it not just for the physician to expect the loyal support of the public in his fight for the enforcement of laws made for his protection, and should not the public hold up his hands in the fight for their enforcement?

It is my belief that the right always comes out victorious in the end, and I believe that in the struggles of the future, as in the past, that the Medical Society of the State of New York will maintain its position as leading in medical advancement, a body of fair minded. gentlemen working together, unselfishly for the good of all.

JOURNAL OF MEDICINE

PNEUMONIA IN THE AGED.* By HENRY L. ELSNER, M.D. Professor of Medicine, Syracuse University.

W

HEN the renowned clinician Charcot was asked to define pneumonia he said "it is that great enemy of old people and one of the principal causes of death at the Salpetriere." Experience soon teaches the clinician that old age has its special immunities, and pathologic conditions which are unknown to the younger adult.

The reaction and resistance to disease as we enter the senile period has been noted by physicians from time immemorial to be completely transformed. When we consider the number of far reaching pathologic changes, and the way in which these are borne by the aged we are once more reminded of Nature's compensatory efforts and of man's enormous and fortunate resistance.

In old age the organs become more independent of one another than during early life. "They suffer separately and the various lesions to which they may become subject are scarcely echoed by the economy as a whole." It is not infrequently found that the most serious disorders of the aged have either passed unnoticed or have given but few marked symptoms. In old age the latency of disease is often surprising, and not infrequently the post-mortem table reveals conditions unsuspected by the diagnostician. The truth of this statement is furnished by the statistics of large hospitals and by pathologists of experience.

Croupous pneumonia in the aged may exist in the absence of general symptoms; indeed death may be sudden and unexpected in people who were about, attending to their affairs as if there were nothing the matter with them. The memoir of Hourman and De Chambre may be quoted to emphasize this fact. "Old women," say these authors, "do not even complain of malaise; no one in their dormitories -neither among attendants, house-maids, nor neighbors-notices any change in their condition. They get up, make their beds, walk about, eat as usual, and afterwards, feeling a little tired, they totter to their beds and expire. That is what in the Salpetriere is. called 'sudden death.' The cadaver is opened, and a large portion of the pulmonary parenchyma is found suppurating." anatomic conditions are not to be ignored if we would correctly interpret these anomalies.

Changed

In the aged the lung is rarified; there is an increased lightness; the air cells are dilated, often ruptured; elasticity is reduced; large numbers of capillaries are obliterated, while other histological changes modify the pathol

*Symposium on Diseases of the Aged, read at the meeting of the Fifth District Branch of the Medical Society of the State of New York, held at Utica, October 15, 1908.

February, 1909

ogy of the organ. The change in the size of the air cells and the reduced vital capacity are important factors. The rate of diminution has been computed to be one and one-half cubic inches each year. Exhalation of carbonic acid is enormously reduced; consequent excess of venous blood in the aged with pulmonary embarrassment and infection are of grave import. These conditions reduce the reflex excitability of the bronchial mucous membrane; bronchi become blocked and inflammatory change is promptly favored.

In 1898 the writer reported 150 cases of pneumonia, of which 14 were over 50 years of age. Of these, 4 were between 51 and 55 years of age; 2 between 56 and 60; 3 between 61 and 65; 2 between 66 and 70; I between 71 and 75, and 2 over 75.

Among the last 2,240 cases of internal disease seen by the writer there were 90 cases of pneumonia: 51 of the croupous type, 24 bronchopneumonias, II II chronic interstitial pneumonias, 2 tubercular pneumonias, and 2 migratory pneumonias. Included among

the 51 cases of croupous pneumonia there were 13 between the ages of 50 and 75; of the 24 cases of bronchopneumonia one-half were above the age of 52. These figures show conclusively the greater frequency of broncho or secondary pneumonia in the aged.

Bronchopneumonia is of secondary origin. If this symposium serves no other purpose than to emphasize the fact that this form of pneumonia is in truth the last stage of an inflammation extending downward along the air passages into the pulmonary lobules it will have answered its purpose; and if we still further emphasize the fact that the development of bronchopneumonia in the young as well as in the aged is dependent very largely upon the amount of impurity in the air breathed, and sanitarians act upon this information, we shall have made great progress in its prevention.

In the aged, not only in the pneumonias, but with other grave infections, there is a striking lack of the usual co-relation between the local lesion and constitutional disturbances. In childhood, on the other hand, the reaction is just the reverse: "It is exaggerated, tumultuous, and the violent derangement of the functions is very far from proving a serious danger. In old age on the contrary, the organism remains impassive, so to speak, in the face of the gravest changes. It may be that reaction is defective even to the extent of total abstinence, the knowledge of which must lead the physician to remain circumspect that he may appreciate the slightest symptoms, unless he wishes to be surprised by completely unforseen occurrences."

In a recent publication, entitled Medical Lectures and Clinical Aphorisms, by Gee, I note the following paragraph:

"The pneumonic part of bronchopneumonia is a post-mortem disease, or, in other words it can seldom be detected with certainty during life. In severe progressive capillary or suffocating bronchitis which threatens the patient with death we may assume that lobular pneumonia is present inasmuch as it is the last stage of the disease. Neither symptoms nor physical signs help us much; the patient is too ill to bear prolonged examination; nor does it matter in the least whether we detect the pneumonia or not, for our treatment is the same in both cases." This statement is extreme, there is, however, some truth in it.

Rules which in adult life control the relations between symptoms and lesions are completely uprooted in the aged. The number of latent and undiscovered pneumonias of the aged which we have unearthed in our pathologic studies in Central New York in patients. dying with marked symptoms of acute infection or chronic disease has been surprising. Thus with chronic nephritis, with acute pulmonary infection, added sometimes influenza, we have had a few hours of suggestive symptoms; the absence of chills, early increase of blood pressure, only slight febrile movement, subsequent rapid lowering of arterial tension, increasing restlessness, marked lividity, evidence during an hour or two before death of suffocating catarrh, associated edema of the lungs (the patient drowning himself in his bronchial secretion, which is thrown out so rapidly that he cannot relieve himself) and extreme asthenia soon lead to death in many cases. We are not to conclude, however, that all senile pneumonias are fatal. We have had recoveries in a fair number of these, both croupous and catarrhal. Extreme conditions may yield to treatment. The vitality and resistance of these patients is often surprising in the presence of profound changes in many vital organs.

Pneumonia of the aged allows of no classical description yet the majority of cases show great similarity of behavior. I may be pardoned for offering in this connection a clinical history selected from the number already mentioned, which serves as a basis for discussing the leading features and vagaries of pneumonias as we see it in the aged within the limits of this association. A study of pneumonia in other sections and abroad has convinced me that there are features and vagaries which are materially influenced by local conditions.

Mrs. B., seen with Dr. Carpenter, of Oneida, on September 27, 1908; aged 75, a large plethoric woman, well preserved, housewife, of good habits, one child, no specific history, splendid resistance, family history excellent; has for years had troublesome bronchial asthma with frequent acute exacerbations. Last year she had an acute bronchopneu