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appreciate this wish as a protestation against the cruelty of war. Yes, I boldly state, that we who are brought into such close contact with the dreadful miseries of this poor human race, find it more and more difficult to understand, why men do not employe their reasoning powers to a good end by ceasing this destruction of one another. We hope soon to see the "United States of Europe" in friendly intercourse with the "United States of America," and if we salute the eminent men present at this Congress with profound respect, we reserve our deepest admiration for those amongst them, who, following in the footprints of Franklin, Lincoln, Roosevelt and Carnegie, work to assure universal peace.

INTESTINAL ANTISEPSIS THROUGH

BIOLOGIC AIDS.

Dr. Bond Straw, of New York, writes in glowing terms of the method of producing intestinal antisepsis introduced by Prof. Metchnikoff, through using the bacillus bulgaricus, which possess the following qualifications for this purpose: 1. It produces the greatest amount of lactic acid of any lactic-acid-producing organism.

2. It is resistant to external influences so as not to be readily destroyed.

3. It readily withstands digestion and therefore passes the stomach unchanged.

4. It will implant itself in the intestine, reproducing itself for several weeks after the last ingestion.

ileocolostomy as practiced by Arbuthnot Lane of London.

The brilliant results of ileocolostomy for cases of intestinal stasis when accompanied by a high degree of toxemia, as performed by Lane, clearly demonstrate Metchnikoff's theory of intestinal autointoxication. But it must be borne in mind this is a very severe surgical procedure and excepting in cases of serious organic obstructive lesions should not be advised until a most thorough and exhaustive trial of the bacillus bulgaricus has been undertaken.

A proper intestinal antisepsis maintained under the lactic bacillary treatment will reduce to a very small percentage the necessity for this dangerous surgical procedure.

Free drainage is a fundamental principle for the successful issue of a surgical case. Free ilealdrainage is a sine qua non for the successful permanent implantation of the bacillus bulgaricus. Just as a field must be cleared and ploughed before planting the seed, so must the intestinal tract be made ready for the proper reception of the bulgarian bacillus.

The choice of an eliminant is of no small importance. One must constantly bear in mind he is dealing with a viable, microorganism which drug medication may destroy or attenuate.

Naturally then such a purgative as calomel cannot be used. The principle to be observed is that form of an eliminant which will aid the intestinal walls in their natural functions without inter

5. It is always nonpathogenic, causing neither fering with the powers of the bacillus bulgaricus. local nor general injury.

6. The antagonism of the bacillus bulgaricus to putrefactic organisms is twofold: (a) it generates nascent lactic acid from sugars and carbohydrates; and (b) it also produces some kind of enzyme which also inhibits the growth and destroys the bacteria of putrefaction.

Today, declares Stow, the bacillus bulgaricus can be used as an intestinal antiseptic with much assurance of success. But what cultures of the organism should be used? Surely not any old culture, attenuated and of low bacterial count. The physician must assure himself that the cultures he uses are pure, fresh, viable, and of highest possible count.

Persistent daily use of proper cultures (such as recommended by Professor Metchnikoff) taken before meals and at bedtime, when combined with well-directed dietetic measures, will accomplish more to overcome autointoxication with its direful end resultants than any other line of treatment heretofore attempted, not excepting even in severe types the latest proposed surgical procedure,

Epsom salts combined with lemon juice or some mild aperient water as the Carlsbad sprudel salts taken with hot water before breakfast naturally suggest themselves in contradistinction to the strong drastic purgatives. And as early as possible even these simpler eliminants should be abandoned in favor of dietetic measures that induce normal intestinal peristalsis such as stewed prunes and figs (half and half) for breakfast, plenty of fresh fruits and green vegetables with much fibrous residue, and bran biscuits made of molasses and bran flour.

Babies are sacrificed in large numbers to the attacks of these hostile putrefactive microorganisms especially during the heated term of the year, and if physicians and mothers will work together harmoniously in the employment of young, fresh, viable cultures of the bacillus bulgaricus the large majority of these fatalities will be checked.

There is no class of cases where more brilliant successes have been accomplished than in these severe cases of summer diarrhoeas of infants. The bulgarian bacillus when rightly employed in these

cases works with remarkable rapidity and certainty, and it almost seems a public duty that a knowledge of this specific agent and the manner of employing the same should be cast widespread for the saving of these young imperiled lives.

NEW METHODS OF SEROLOGIC DIAGNOSIS OF TUMORS.

subject to cancer. Abderhalden's reaction gave Halpern less than 30 per cent positive results.

As a result of his study Halpern concludes that there is at the present time no specific reaction for cancer.

The preceding is quoted from the Therapeutic Gazette.

ACTIVITY AND STABILITY.

Halpern (quoted in the Journal de Chirurgie, ON TINCTURE OF DIGITALIS (B. P.): ITS tome xii, No. 3, 1914) has conducted a study upon serum diagnosis of tumors with the following results:

In many cases of cancer a test of antitryptic power of the serum (method of Brieger and Trebing) has given positive results. The reaction, however, was not specific since other diseases give a high antitryptic manifestation. The only value of this test lies in the fact that its absence suggests that the affection under study is not cancer. The method of Neubauer and Fisher, applicable only to the diagnosis of cancer of the stomach, is based on the existence in the gastric juice of cancer of a ferment capable of doubling the synethetic dapetides of Fisher. The synethetic test gave in seven cases six positive results. It is also positive in cases of A search of the chronic gastritis and ulcer. blood for the same ferment has given contradictory results. A study of the hemolysins in the blood serum gave twelve positive results in cancer. Also this test is positive in cases of leukemia, tuberculosis, and syphilis. The method of Freund and Kaminer involves a most delicate technique. It is based upon the fact that normal blood serum destroys cancer cells, these remaining intact in cancer serum. A mixture of cancer serum and extract of cancer caused turbidity, which does not appear when normal serum is mixed with extract of cancer. In 20 cancer cases results were positive in 14. In 11 non-cancerous patients the results were positive in three.

D'Ascoli's meiostagmin-reaction gave 39 positive reactions in 46 cases of cancer, and two in 25 non-cancerous patients. Many observers have reported similar results. Indeed, 82 per cent of reactions were given as the result of a study in 399 cancers, and 9 per cent in 548 non-cancerous subjects.

Dungern has studied the deviation of complement and has announced that there were 91 positive results in 102 cancer subjects, and 11 in 16 sarcomas; that all the results were negative in 92 subjects without tumor.

Halpern has found 71 positive results in 79 cancers and four positives in 56 patients not

The British Medical Journal of June 20, 1914, contains an article by Symes on this subject.. He reaches these conclusions:

1. Few tinctures of digitalis are, initially, below standard.

2. Tinctures, not below standard, vary 200 to 300 per cent in initial activity.

3. All such tinctures, after a variable period of constant activity, undergo deterioration, which may commence within a month of manufacture, and may amount in a year to 70 per cent, or more, of their initial activity.

4. Concentrated alcoholic extracts of digitalis leaf compare favorably with, and behave as, the British Pharmacopoeia tincture.

5. Solutions of crystalline French digitalis (German digitoxin) are more stable than the

above.

6. Commercial "non-alcoholic" tinctures, and allied preparations, are not trustworthy.

It was on an East Texas train. The little coffee pot of an engine, having wheezed laboriously over serpentine rails, jolted to a restful spot at no place in particular. Time passed tediously. Some of the passengers stalked nervously up and down the aisles, while others drew their felt hats down over their eyes and tried to forget it. When a half hour had elapsed the conductor came through.

"Say, friend," said a querulous voiced old man, "as near as you can tell, what's holdin'

us?''

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"We're taking on water,' was the explanation.

"Well, why don't you git another teaspoon? That un seems to leak somethin' dreadful!'' 慌慌慌

Tommy went home one day with a nice new golf ball.

"Look at the lost ball I found on the links, father!" he said.

"But are you sure, Tommy," asked Mr. Traddles, "that it was a lost ball really?"

"Oh, yes," said the boy. "I saw the man and his caddy looking for it."

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PHYSICAL REMEDIES FOR THE RELIEF OF PAIN.

There has been so much discussion of the problem of narcotics, and especially of the dangers of drug habits following their use for medicinal purposes, that we have thought it a good time to have a Round Table discussion of the various physical remedies which can be used for the reiief of pain.

Of course, every reader of the Medical Standard will understand that we do not condemn the use of anodyne medicinal agents. No man understands better than the trained physician that there are numerous occasions when it is not only important that powerful narcotics should be used, but that it is equally true that to withhold such narcotics upon such occasions is inhuman, cruel and possibly even dangerous to life itself.

Among the remedies which have conferred the greatest benefits on mankind, the average physician will probably place opium first, and yet, while in its beneficent action it stands at the head of the list, it, also is one of the most dangerous drugs we possess. It is not a remedy to be used lightly. It should be given only in the face of urgent necessity, and it should be withheld until other simpler, less dangerous remedies or expedients have been resorted to.

Unfortunately, the average physician is not as familiar with these physical means for the relief of pain as he should be. It is really marvelous how much can be accomplished by the intelligent use of heat, or the application of electric modalities, by counter-irritation produced in various ways (not necessarily with drugs), by skilful stroking or massaging of certain painful parts. Yet, simple as these remedies are, they must be used with the utmost intelligence and skill. For instance, no doctor would think of massaging an inflammatory area.

With this brief introduction, we leave the whole question with our readers.

Dr. Frank A. Davis, Boston, Mass., attributes the anodyne action of heat in the rase of neuric or muscular pains to the fact that it promotes a better circulation and relieves congestion, which lessens the pressure over the painful area.

He summarizes the action of electricity in its various forms in the relief of pain, as follows: Galvanism relieves pain through the physiological action of the positive pole, which contracts the blood vessels, produces an acid condition and relieves congestion; faradism overcomes stasis, promotes circulation, etc.; high frequency currents improve nutrition, overcome stasis, etc.; the static wave current promotes circulation, and overcomes stasis and congestion.

Doctor Davis advises discrimination in the employment of massage in true neuritis. In synovitis and in the gouty conditions it will relieve pain to some extent, by promoting a better circulation through the area involved and by relieving local congestion. He has also used mechanical vibration, radiant light and heat, and the sinusoidal current, and states that their action is similar to that of the other methods mentioned.

In the treatment of neuralgic and neuritic pains, Doctor Davis employs positive galvanism, high frequency currents, static currents, the brush spray, etc., varying these according to the cause of the pain and the conditions existing.

Myalgia may be treated by static sparks, static wave current, the sinusoidal current, positive galvanism (direct or interrupted), faradism (mild), radiant light and heat, and occasionally by mechanical vibration.

In cases of ocular pain Doctor Davis suggests first that an examination be made by an oculist and glasses supplied if necessary to correct vision. If the pain is due to perverted metabolism, the cause should be found and corrected. Local treatment, in the case of cataract, consists in the use of the high frequency vacuum tube. If the pain is due to eye-strain, he employs galvanism.

positive or negative, as indicated. In the treatment of headache, positive galvanism is advised, through the operator's hand, or high frequency to the base of the brain or over the forehead.

Without going into detail regarding the treatment of deep-seated or visceral pains of inflammatory origin. Doctor Davis declares that radiant light and heat, the static wave current and the sinusoidal current often prove useful in such

cases.

The doctor believes that one of the best physical agents for the alleviation of pain in cancer is x-ray treatment, properly administered.

Finally, Doctor Davis gives the following pointers for the general practitioner:

"Don't forget calomel and castor oil in lumbago, sciatica and general muscular pains. Veracolate is a great liver stimulant and intestinal tonic.

"Look out for appendicitis in cases of acute indigestion.

"Take the blood pressure in all cases over forty years of age. D'Arsoval currents are the best treatment for high blood pressure not due to valvular compensation."

William Benham Snow, New York, writes: "I am very much interested in the subject of your Round Table for the next meeting, but I think there is one important point in the consideration of pain that should be first explained from the point of view from which I consider it in nearly all cases, i. e., that pain is almost invariably due to pressure and wherever we have infiltration or exudation accumulated in an inflammatory field the condition of stasis which holds the infiltration at a status quo is the cause of pain either upon the addition of more pressure or without the addition of pressure, depending upon the degree of pressure.

"Inflammation also causes local muscular spasm and muscular spasm increases pressure and pain. For example; in sciatic neuritis with the infiltration with inflammation of the nerve at the sacro-sciatic notch, the most exposed site of the sciatic nerve where it emerges from the pelvis, the nerve at this site is crossed by the pyraformis muscle and whenever the neuritis occurs the muscle contracts. At this point pain may be referred along the extremities to various points but will always be due to the pressure at the site of the lesion. When such inflammation does occur the spasm arising in the pyraformis muscle produces additional pressure upon the inflamed nerve. The condition then becomes a vicious circle in which each condition tends to make the other worse increasing the pain in the periphery even to the point of causing great discom

fort on movement of the part. No more striking instance of pain can be cited than pain due to the inflammation of the sciatic nerve at this point, and no better example can be given to illustrate the point of view that pressure increases pain from the two points of view, first due to the exudations in the neuralemma surrounding the nerve and second from the pressure due to spasm of the pyraformis muscle pressing upon the

nerve.

"The application of the static wave current with a metal electrode directly over the site of the lesion produces a relaxation of the pryaformis muscle and by successive contractions induced in the tissues of the nerve relieves the pressure by dissipating the exudation through the lymphatic channels.

"A case of acute sciatica may be invariably cured in a few days by the systematic employment of this method. The same is true of the application to a sprained ankle. The stasis which promptly occurs following accident is the first thing to be removed, and there is no agent so active in doing this as the static methods, the static wave current, static brush discharge, and static sparks whereupon the pain immediately disappears and the patient who comes on crutches the first time walks out with little or no pain after treatment. In no case in which fracture of ligaments or bones has not taken place should it require more than three or four days to absolutely restore a sprained ankle to normal. I have done this in more than one hundred cases each of sciatica and sprains, and am fully justified in making the statement which may seem to be an exaggeration to those who are not familiar with the methods to which I refer.

"The great principle which surgeons and physicians have ignored is the fact that local stasis or the accumulation of infiltration and exudation in a localized field of inflammation is the constant cause of tenderness or pain in that area, and also at remote points where a nerve injured or pressed upon is distributed, as in the case of sciatica. The relief of pain therefore in most instances must depend upon the relief of local stasis by the romoval of infiltration and exudation. This is the principle on which the static current is employed; for no other means or method will so effectually drain an infiltrated area as the static current by the induction of successive tissue cell and mass contraction throughout the infiltrated area. Thus tissue drainage removes the pressure, permits or rather induces the restoration of circulation with the recovery of tissue metabolism and repair. This is the basic principle for the treatment of inflammation

where infection is not present, and will some day be generally established as it is proved beyond question in the hands of hundreds of men who are now using the static current intelligently

"I am sending you under separate cover the Report of the Committee on Standards of the American Electro Therapeutic Association, in the preparation of which I have taken an active part and if you find time to read it, you will, I am sure, recognize our point of view.

"I have endeavored to answer the questions on the little sheet which you sent me as fully as space would admit inferring that you, having placed it in this limited space, expected to have my remarks confined to that space. If, however, you care to publish the statement that I have made in this letter you will do so. Personally I believe that herein lies the secret of the treatment of pain in noninfected inflammations."

Doctor Snow's statement follows:

The action of heat for the relief of pain may be explained as due to two actions, first the relaxation of the tissues with expansion which relieves pressure. Otherwise the employment of dry heat, as to an infected arm, or limb with high temperatures ranging from 450° to 500° F. Employing bandages of turkish toweling to prevent collections of fluids which would boil and blister the patient, increases the general metabolism and phagocytosis besides depressing the germs, and destroying them when septococcic and staphylococcic infection is present.

Electricity is employed for the relief of pain. in accordance with two principles. (1) The employment of the static current over infiltrated areas with interrupted impulses, as with the static wave current, static sparks, and static brush discharge, removes local stasis and pressure by forcing out the exudations through the lymph channels and (2) coincidently improves the circulation with restoration of tissue metabolism and repair. Pain being due in these cases to pressure the relief of stasis relieves pain both at the site of the lesion and if upon a nerve, at the peripheral distribution. This method is only applicable where pus or other infection is not present as it would otherwise cause metastasis.

If massage is employed in painful conditions its chief indication is the relief of muscular spasm surrounding the local area, working up gradually to the site of the induration and as far as possible inducing circulation throughout the indurated tissue. Direct application however to the inflammatory area to a degree mascerates the tissue and is certain to be followed by a prompt

return even though the indurations were temporarily relieved. Massage in no sense equals in this respect the application of the static current and other methods.

Radiant light and heat, the x-ray, and mechanical vibration are likewise effective in their peculiar way to conditions as indicated effecting relief from the causes of pain. Radiant light and heat is one of the most valuable agents for the relief of local infection relieving the pain and curing the condition in the pre-pus stages of otitis media, boils, and carbuncles, and effectively curing the condition with arrest of the discharge in chronic otitis media when the ossicles are not necrosed. It is also effective in mastoiditis before pus. Long applications made from focussed radiations or intensified radiations by moving the reflector rapidly about over the infected area approximately for one hour at each application with an intensity as great as can be borne is the essential technic. The earache ceases within the first half hour, the pains of boils and carbuncles are assuaged and if applications are made energetically and frequently before pus the local phagocytosis induced and the depressing effect of radiant energy upon the germs terminates the affection. Heliotherapy or sunlight applied daily for several hours under favorable conditions and for a long time to tubercular joints and local tubercular affections has produced remarkable cures, particularly in the higher altitudes in Switzerland but is undoubtedly applicable to conditions in any climate.

The direct d'Arsonval current or the passage of the high frequency current from the d'Arsonval circuit with the poles placed upon opposite sides of an infected area produce uniform thermal effects throughout the tissues intervening between the electrodes with a resulting hyperemia thereby increasing metabolism, nutrition, and phagocytosis in the heated field. By this means inflammatory conditions that are caused by infection are greatly relieved and often cured with the relief of pain coincident to the tissues relaxation with the heat produced.

The non-drug methods used for the treatment of neuritis are principally the static methods as in sciatica, brachial neuritis, and tie douloureux. In these cases the static wave current and static sparks administered in a manner to produce successive contractions in infiltrated areas at the site of the lesion effectively relieve the pressure. and in acute cases effect a cure in a very few days; whereas in chronic cases of neuritis the same methods tend to relieve adhesions and after a longer period of treatment completely relieve

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