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M. Sig. Five minims equal gr. 1/100. In this connection the question arises whether it is a good thing to continue or abandon the bromids when the administration of crotalin begins. In the writer's early experience it was thought that such a combination was beneficial, but after a short time this opinion was changed on purely empirical ground, and the practice was

discontinued, and the crotalin has been given

alone ever since. The latter deduction seems to be substantiated by the following very recent experience: In one of our institutions for epilepsy fourteen patients received the usual compounds of bromin with crotalin for a period of seven months, and twelve received crotalin alone for the same time. In the former the seizures increased 3.09%, and in the latter the seizures diminished 34.30% during that time. This is an important showing, and should furnish ample food for reflection to those who hold the belief that the bromides are the only boon for the epileptic.

VE VE VE

IS SALVARSAN REALLY A SPECIFIC? In a paper entitled "Vincula Praeteritorium," which being freely translated meaneth, "there is nothing new under the sun," Dr. William P. Cunningham punctures some of our wonderful "new" discoveries, among them Ehrlich's salvarsan. We quote from the New York Medical Journal:

Across the world of modern medicine came a trumpet blast of triumph from out the city of the greatest living seropathologist. "Syphilis is cured!" Ehrlich hath said it! One injection of his marvelous discovery and the scourge of civilization is no more! The most tremendous achievement since Jenner stayed the ravages of its reputed congener, the smallpox! A wave of delirious enthusiasm swept o'er the medical fraternity, matched only by that of the carnal voluptuary who welcomed such an easy means of dodging the wages of sin.

Throughout the reaches of civilization, and especially in our own beloved country, a feverish activity to put this marvel to the proof was in

stantly aroused. Synchronously thousands of expert hands were eagerly at work. Speedily their hopes were verified. Did not lesions melt before this magic golden liquid, like snow before the sun. Banzai! Great is Ehrlich! He has found a means to sterilize the blood of these infected patients. It was reasonably safe at that. There were a few deaths directly traceable to the injections, but these were airily attributed to other causes, and did not dampen the overmastering jubilation. But now bitterer than death itself came whisperings of failure here and there, of relapses hard to be accounted for, if the patient's blood were sterilized as we had been assured.

Faced with this the prophet of the new dispensation declared that some of the spirochetes must have been hidden in the glands and so escaped destruction. He advised more injections to root them out. It was finally decided that four injections constituted the proper dose for their ultimight have rested to everybody's satisfaction, if mate and complete extinction. There the case the pestilent spirochetes would run according to form and drop dead when directed. But obstinate ones persisted in disconcerting resurrections, until it was certain that further measures must be employed.

With what wonderful skill and courage did the masterly discoverer meet this emergency! Think of it! Could any one but a genius have devised such a plan! Could any one but a mighty heart have dared to promulgate it! Listen now with bated breath to the pregnant words of wisdom falling from his lips. "Give your four injections of salvarsan, and then put your patient on mercury for two years!" In which direction are we looking now? Forward, or backward? And has this worldwide touted, worldwide patented instantaneous annihilator of Gargantuan lues resolved itself into anything better than a cosmetic or emergency remedy admittedly effective in cleaning up surface manifestations?

I know men who use it only because it pays to do so. They say they do not know what will be the ultimate result on brain, and cord, and kidney, and that if they themselves were the victims of lues they would not submit to the administration of salvarsan. Other men are of the opinion that the time consumed in the preliminary salvarsan treatment is a serious detriment to the patient as long as he has to get down to the mercury treatment in the end. These opinions are privately delivered. In public print and lecture they fall in step with the prevailing trend. The only point I seek to make from all this is that after salvarsan comes mercury (for two years or more), and that despite the resounding din of

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SURGERY IN THE AGED.

Before operating upon the aged, says Dr. Ap Morgan Vance, in the American Journal of Surgery, we should consider a number of important principles, a few of these being as follows:

1. That where possible repeated examination, careful anamnesis and prolonged obervation prior to operation, to ascertain the exact present and previous physical condition of the patient, are important desiderata:

2. That after the patient has been admitted to the hospital and before operation is undertaken, appropriate supportive and reconstructive treatment should be instituted (under immediate direction of the surgeon and be continued sufficiently long to restore or improve impaired physical equilibrium in so far as it may be possible:

3. That while general anesthesia may be permissible in certain instances if there be no gross lesion of the heart, liver or kidneys, where it is practicable surgical operations upon the aged should be performed under some appropriate method of local anesthesia:

4. That the fact must not be forgotten the aged, being less susceptible to pain, more serious operations may be safely undertaken with local anesthesia than in younger individuals:

5. That the aged as a rule are hypersensitive to cold, therefore the operating room should be maintained at a high temperature until dressing is completed, and precautions should be observed to avoid chilling of the surface by drafts or otherwise during and following the operation:

6. That ordinarily the aged withstand the loss of blood badly, therefore adequate precautions should be taken to prevent undue hemorrhage during the operation, always bearing in mind that in elderly individuals there is oftentimes a decided tendency toward secondary oozing, the control of which may sometimes be difficult because of preexisting vascular changes:

7. That operative manipulations in the aged should be executed with the greatest care so that instrumental traumatism and shock may be minimized, and the surgical procedure undertaken should be completed within the shortest possible time consistent with perfect technic and requisite asepsis:

8. That while recuperative power may be unimpaired, the aged quickly succumb to virulent infectious processes, therefore the utmost care must be exercised to prevent and limit extension of microbic invasion:

9. That in the aged post-operative nourishment is of great importance, and careful feeding should be commenced as soon as the patient recovers from operative shock, nourishing and easily digested food being permitted in ample amount:

10. That, finally, every effort should be made to promote recuperation and hasten operative convalescence so the patient may be permitted to leave the bed at the earliest moment possible, since in the aged prolonged period of bed-rest, even in normal health, may be extremely hazardous for reasons too obvious to require specific mention herein.

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THE EVILS OF ALCOHOL.

The basic fact underlying all agitation for the restriction or prohibition of the traffic in intoxicating liquors, writes Herbert C. Shattuck in the December Case and Comment, is that alcohol, the essential ingredient of those liquors, is inherently harmful and dangerous when used as a beverage.

The author asks: What in brief is the result of that traffic? and seeks an answer in the decisions of the courts and the pages of special authorities.

"They say," declares the writer, "that intoxicating liquor is an article conceded to be fraught with such contagious peril to society that it occupies a different status before the courts and the legislatures from that of other kinds of property, and traffic in it is thereby placed upon a different plane from that of other kinds of business. There is, therefore, no question in cases dealing with intoxicating liquor of the power of the legislature to say generally what beverages men shall drink or what they shall eat or wear. The argument that laws restricting the liquor traffic are sumptuary as regulating what a man shall drink is not convincing, for when liquors are taken in excess, the injuries are not confined to the offending party. The injury, it is true, first falls upon him in his health, which the habit undermines; in his morals, which it weakens; and in his self-abasement, which it creates. But as it leads to neglect of business, waste of property, and general demoralization, it affects those who are immediately connected with and dependent upon him.

"Judge Wm. N. Gemmill's report for the court of domestic relations in Chicago, covering the year from April 3, 1912, to April 3, 1913, the second year of the court's existence, shows that 3,699 cases were heard and disposed of, 2,432 of which were for wife or child abandonment or failure to support. Among the causes of the latter, excessive use of intoxicating liquors held first place as causing 46%, the next greatest cause being for only 12%.

"The causal relation between alcoholic liquors and

disease is becoming more and more apparent. Sir Victor Horsley names forty diseases due to alcohol alone or as a contributing cause.

"The close relation between alcohol and insanity has only recently been fully realized. Fully 30% of the men and 10% of the women admitted to the state hospitals are suffering from conditions due directly or indirectly to alcohol. These conditions may be brought on by the regular use of alcohol even in moderate quantities not producing intoxication.

"The connection between alcoholism and crime is shown by the continual increase of crimes in civilized countries at just the rate at which the consumption of alcoholic drinks increases; the days and months when crimes are most frequent are just those when alcoholic drinks are most used, a very large percentage being committed on Saturday night and a very small percentage on Monday.

"The liquor traffic is a curse to childhood. This is shown not only in the poverty, wretchedness, and deprivation of the drunkard's home, but in the fact that by such conditions thousands of children are forced to labor in mills and factories when they should be at play or in school. And worst of all, in this connection, is the fact of heredity. Thus it is said that habitual drinkers are not only immoral themselves, but they often beget children who are defective, delinquent, or precocious debauchees. Aschaffenburg, in his book on 'Crime and Its Repression,' p. 69, declares that the descendants of inebriates are seldom of normal health and intelligence."

PUBLIC HEALTH LEGISLATION. Elsewhere in this number of the MEDICAL STANDARD we have discussed, editorially, the topic, “Too Much Law." That discussion was inspired by the following press report, appearing in eastern newspapers:

The present agitation and interest on all public health topics finds its immediate reflex in the work of the 42 legislatures which were in session during the past winter. It is difficult to say exactly how many public health measures were proposed in these legislatures, but between eight and nine hundred have been reported and there are probably many more which have been overlooked, perhaps a thousand in all.

Most of these bills, like most of the bills on any topic which comes before our legislative bodies, were hastily drafted and were, in many cases, proposed. framed, and advocated by men or organizations with so little real knowledge of the particular situation or its needs as to make one a willing convert to the legislative bureau plan now working so admirably in such states as Wisconsin and

Rhode Island. Perhaps the most important lesson which can be drawn indeed from the winter's efforts at legislation is the crying need of fewer laws, so carefully framed and so critically considered before adoption as to avoid the trouble and confusion that careless legislation entails.

Another peculiarity is the tendency of legislatures to follow prevailing fads in law-making. It may seem ridiculous to talk about fashions in public health laws. Yet careful observation will confirm the fact that the legislative efforts are prone to run in certain grooves at certain times. Two years ago every legislature that met was considering bills for the abolition of common drinking cups and roller towels. This year the styles have changed. Bills for the sterilization of criminals, the regulation of marriage, and the medical inspection of schools have been the most generally considered, and this regardless of the peculiar characteristics and needs of the particular state. For instance, in a western state with a sparse and scattered population, few large towns, a single penitentiary, an insane asylum with few inmates, and no public health organization worth mentioning, the legislature considered a bill for the sterilization of criminals, not because of present need for such a law, but to keep in line with other states.

Of specific laws enacted probably the most important were the Seeley bill in New York, reorganizing the state department of health, and the bill enacted in Michigan for the creation of a state commission to make a survey of the state and to obtain accurate statistics regarding the number of defectives, delinquents and dependents in the state with the causes for such condition so far as ascertainable. The Seeley law, which was one of Gov. Sulzer's administration measures, makes the state department of health an actual executive department of the state government and greatly increases its power and effectiveness.

Colorado, Oklahoma, Pennsylvania, North Dakota and Wisconsin adopted laws requiring some guaranty of physical healthfulness as a condition for a marriage license. Kansas, Michigan, Oregon, and Wisconsin provided for the legal sterilization of criminals and defectives. North Carolina and Tennessee provided for the registration of births and deaths. Illinois again failed to provide for vital statistic registration as she has for 10 years past, but established an epileptic colony.

Indiana provided for sanitary schoolhouses; Massachusetts authorized county bacteriological laboratories; Michigan created a state commission on hotel sanitation; Missouri created a board of administrators for state institutions and enacted laws regulating occupational diseases and the employment of women; New York provided for work

shops for tuberculosis convalescents and for medical supervision of country schools. Oregon adopted probably the most advanced law in existence on advertising, forbidding the advertising of cures for venereal diseases in newspapers and making the newspaper proprietor or publisher equally liable with the advertiser; Rhode Island provided for factory inspection and for the regulation of child labor; Texas prohibited the pollution of streams, created a tuberculosis commission, and also created a state child welfare bureau; Washington authorized counties to erect hospitals; West Virginia provided for a whole time state health officer. Wisconsin not only authorized incorporated cities to use money derived from local licenses for the purpose of preventing disease, but she reorganized her state board of health and increased its appropriation. Wyoming strengthened her pure food laws and regulated the sale of habit-forming drugs.

Progress on the whole has been as satisfactory as could be expected under existing conditions of lack of co-ordination and want of any definite plan. What is needed in the public health field, as in many other lines, is the careful collection of data by some central body, the exhaustive study of existing conditions and needs, the formulation of a few model bills on the most fundamental subjects, and the gradual development of a coherent system ofblic health laws and of a perfected, co-ordinated public health machinery. Efforts in this direction for the last 25 years have been spasmodic, individual, and too much influenced by temporary fads. A few carefully framed and broadly conceived public health laws, properly enforced, would be of far more value to the public than the mass of legislation on special subjects which is accumulating on the statute books of many states.

THE LATEST STEP IN ANESTHESIA-
ETHER BY THE RECTUM.

A decided stir was made by Dr. J. T. Gwathmey of New York, in his address before the New York Society of Anethetists last November, in which he described his method of producing anesthesia with rectal injections of a mixture of ether and olive oil. This method, declares Gwathmey (we quote from the Boston Medical and Surgical Journal) has thus far been practically dangerfree. Notably does it meet all Crile's anoci-association requirements. Gwathmey, after exhaustive experimenting on dogs, has used his method in one hundred operations on human subjects. In this series there was one death, which occurred twentyfour hours after the operation; the surgeon for whom Dr. Gwathmey anesthetized per rectum in that case detailed at the meeting above stated the

autopsy findings and demonstrated that the death was in no wise due to the anesthetic but to a complication of lesions-about every organ in the body having been diseased, with the primary cause evidently a vegetative growth in a coronary artery. By Gwathmey's method no patient need experience terror anesthesiae; there will be no struggling; the ether cone, the chloroform mask, the intratracheal tube, the spinal puncture, the intravenous injection are alike superfluous. Indeed, the patient need not know at all that he is being anesthetized. The pious fraud may be perpetrated of assuming the rectal injection (done in the Sims position) to be a medicament-which, indeed, it is. Within a few minutes, from four to twenty, the patient goes to sleep; there is complete narcosis, with an absolute relaxation of tissues as with any other kind of anesthesia. This injection is preceded an hour before by a hypodermic of morphine.

For children, one ounce for every twenty pounds of bodily weight of a 55% solution of ether in olive oil is injected without preliminary medication; for adults, eight ounces of a 75% solution. The ether becomes liberated in the colon, passes into the blood, the supply of which is rich in that region; the patient's exhalations soon demonstrate the odor. In certain of Gwathmey's cases imperfect or ceased respiration evidenced an ex-1 cess of the anesthesia. This was easily remedied by injecting cold water into the rectum, the remaining oil and ether being thus voided; and by administering carbon dioxide in a bag, thus stimulating respiration. After operation the patient is returned to bed when he "comes to" as after ordinary ether narcosis.

The only valid contra-indication to this consummation of Gwathmey's achievements thus far are rectal and anal lesions. Especially to Graves' disease and pulmonary diseases of the upper air passages is it adapted. With fine scientific sense Gwathmey considers that his oil-ether colonic method cannot hold an assured place until he and others have done it on one thousand cases; yet it may not be doubted that the date above given will become a memorable one in the minds of anesthetists.

A DEFENSE OF ALCOHOL THERAPY. No less an authority than Dr. Abraham Jacobi arises (please permit the literary license) in American Medicine to speak a word for that oftcondemned remedy, alcohol, which he considers of exceeding value in the treatment of septic diphtheria, with which he has had, as he says, "uninterrupted contact since 1858." No mixed infection is amenable to diphtheria antitoxin;

the vaccine treatment disappoints, so do the Schiötz applications to the throat; but in these septic cases alcohol is a reliable if not infallible remedy. The following cases are reported by Dr. Jacobi, as justifications of his faith:

"With one of my most respected colleagues I saw thirty-five years ago a boy of five years. Membranes covered his fauces and mouth and part of the lips and were visible in the nares. Round the neck were big lymph body swellings, now known to all of us as the sure proof of thorough mixed infection. Some membranes could be removed by forcible injections into the nose. It had been bleeding and oozing, the odor was foul. The second heart sound still slightly perceptible, pulse 160, hardly felt at the wrist. Boy restless in his semi-coma, tossing about, feet bluish, not cold, covered with erosions and subcutaneous hemorrhages of different sizes. His whole surface discolored, from drab to blue; hemorrhages small and large in and under the skin. No intestinal hemorrhage. Urine could not be obtained.

"My friend told me I was not called by him but by the family of the dying boy; he was going down town and on his way would order the undertaker to send the coffin after dark. I begged him not to do that, but to wait until tomorrow. The undertaker however, came after dark and left disgusted. Meanwhile I had permission to act. The boy's stomach retained my whiskey, from one to two teaspoonfuls every 15 or 20 minutes, diluted in water, occasionally in milk or coffee, and his rectum retained a few doses. Within a day he took a pint and a half, perhaps more. We kept on, the boy and I. He was alive when I happened to meet him twenty years afterwards.

"A girl of seven years I found in about the same condition thirty years ago. She was a patient of one of our great physicians who when he died suddenly a year ago, proved to the world that there are some men who are indispensable. He said, 'Now here I have given your whiskey but she will die.' 'How much is she taking?' 'Besides her other drugs she is taking as much as half a pint each of these two days, and retains it.' 'Very well, just continue, and I will give her my additional half pint.' So we did, she took a pint or more daily. And got well.

"A boy of three years with the formidable symptoms of mixed infection was 'given up.' I held out the hope of recovery provided the doctor would succeed in getting into him with other appropriate medication, at least a pint of whiskey daily. He did succeed. Five days after

wards the father called in despair, saying his child was alive but insane. So he was. The boy was better, in fact on the way to recovery, but drunk. To me that was a welcome occurrence, for I knew, and want my readers to know, that no amount of whiskey will lead to intoxication when its effect is wanted to combat sepsis. I repeat: No amount of alcohol will intoxicate a thoroughly septic person. As soon as my little patient did no longer require his big dose of alcohol, it made him 'insane,' intoxicated. I had enjoyed that experience before, in many cases, and have since. Maybe my first case of the kind was that of a refined lady who had typhoid fever fifty years ago. I learned the alcohol practice from Dr. Ernst Schilling, who sixty years ago treated many hundreds of cases of typhoid and typhus amongst the immigrants on Ward's Island. My lady patient, thoroughly septic, took a quart of whiskey daily ten days in succession until the beginning of her recovery; no other drop since.

"I want these specimens of alcohol treatment to suffice for my purpose, which is to make facts tell their stories. My cases of thorough sepsis relieved or cured by alcohol extend over more than half a century. My cases have not all been cured, I belong to the class that has to meet failures. But I have seen what was considered hopeless to take a favorable turn. There are in diphtheria cases which are not influenced by antitoxin in small or big doses. That class of cases is not always hopeless when the doctor has hope and discrimination and the courage to fight infection and to cheat the undertaker. refuse to deal in theories. I cannot tell the cause of the antiseptic action of alcoholic beverages when administered in sufficient doses. I merely refer to occurrences and observations exLet tending over half a century and more. somebody else explain. Meanwhile take the hint."

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DIAGNOSIS OF CHRONIC APPENDICITIS WITH THE X-RAY.

Some interesting observations upon this subject are made by George and Gerber, in the Boston Medical and Surgical Journal. By the term chronic appendicitis they do not wish to indicate appendices that have necessarily at any time undergone acute inflammation, but refer rather to those cases where the appendix is either kinked or involved in adhesions. Of course, many of these adhesions are of anomalous developmental origin, but their effect in producing symptoms, and their Roentgen appearance, are the same as the others.

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