ditions, and the use of radium and other radioactive bodies in medicine. We may safely say that not one doctor in ten really understands any one of those three subjects. But he ought tothey are already important, and will become more So. There ought to be one young man in every medical society in the country who would "specialize" on one of them to the extent of understanding it thoroughly, going through and digesting the literature, boiling it down and assembling the essentials in understandable form, and being prepared to answer all questions about it. The young man who will write such a paper will have laid the foundation for a lucrative kind of special work, and will have rendered a real service to his fellow practitioners.

As to the "experience" papers it is not necessary to say much as to their value. We all appreciate them. These should be the work of the older practitioners; yet, they should be so presented that they will invite discussion and be elucidated by it. The laboratory worker should present his aspect of the case; and the patient himself, should be represented in person or by "specimen." It should be the business of some one to assemble reports of all cases of a similar character presenting points of special interest, and to see that these reports are printed. How often we see the statement in our books that only ten or fifty or a hundred such cases of a certain kind have been reported. There is no doubt that for every rare case reported in our

journals, ten go unreported. Most of us go through our lives with our eyes half-closed at least.

Now-if we could get work of this kind in our medical societies, how the interest in them would be intensified! It can be done, and it should be done; but, as we have suggested, the burden must fall upon our young men.

IS PARESIS OF THE INSANE CURABLE? Two physicians working in the Rockefeller Institute, Drs. Swift and Ellis, have made a discovery that may lead to a means of curing paresis of the insane. This form of insanity has long been known to be due to syphilis, but unfortunately brain syphilis has not been readily amenable to treatment. Furthermore, until quite recently it has been an open question whether this disease were due to the active presence of the spirochaetae, or whether it was purely para-syphilitic. Noguchi's identification of the organism of syphilis in brains of patients who had died

from the disease seemed to settle the questionit is an active manifestation of the disease.

Why, then, does salvarsan prove of so little value in these cases? The answer is that as ordinarily administered, intravenously, it can not reach the cerebrospinal cavities. To give it intraspinously was found to be attended with difficulties and dangers, but finally a solution of the problem was found by Swift and Elis, who gave the salvarsan by the usual intravenous route and then, after a suitable interval withdrew a quantity of the patient's blood in which the arsenical remedy was combined with the blood serum. This serum, when injected into the spinal canal after lumbar puncture and withdrawal of fluid, proved to be not only inoffensive, but also to possess remedial powers of an unusually high order.

Already a considerable number of cases of paresis have been treated in this manner. They were not all cured-indeed, it is a question whether any of them were actually "cured"; but many of them showed improvement, and in some cases the improvement was really remarkable. It seems safe to hope-if not quite safe to promise-that in many of these heretofore incurable cases the disease may be arrested-in some cases actually cured. And already physicians are investigating the possibilities of the method in tabes. In a few such cases great improvement has followed the employment of salvarsan-serum.

DR. S. WEIR MITCHELL.

We shall not undertake to write an obituary of Dr. S. Weir Mitchell, who has recently passed away. We hope there is not an American physician who does not know something about this man, and what he has done in medicine and literature. If there is such a man among our readers, we shall be compelled to refer him, regretfully, to the pages of "Who's Who"!

As a young man, Mitchell attained eminence as a neurologist. The "rest cure" is a monument to his ability in this field. After he was fifty, at the age when most men begin to think about retiring, he took up polite literature and wrote novel after novel. He was nearly seventy when Hugh Wynne appeared-probably the best work of fietion covering the Revolutionary period. The older he became, the more finished his literary work seemed to be, and it preserved his intellectual elasticity and joie de vivre to the end. His verse was beautiful and his "Ode on a Lybian Tomb," s one of the most finished examples.

was

"What gracious mummery of grief is here!
One woman garbed in sorrow's every mood;
Each sad presentment celled apart, in fear
Lest that herself upon herself intrude,
And break some tender dream of sorrow's day,
Here cloistered lonely, set in marble gray.

"O, pale procession of immortal love, Forever married to immortal grief! All of life's childlike sorrow far above,

Past help of time's compassionate relief; These changeless stones are treasuries of regret, And mock the term by time for sorrow set.

"Cold mourners-set in stone so long ago,

Too much my thoughts have dwelt with thee apart. Again my grief is young; full well I know

The pang reborn, that mocked my feeble art With that too human wail in pain expressed, The parent cry above the empty nest."

Dr. Mitchell continued to write up to the last year, for all we know, the last day, of his life. "John Sherwood-Iron Master" was published when he was eighty-four-and it gave no sign of senescence. Last year Dr. Mitchell made a visit to Chicago, where he was the guest of the Physicians' Club at a banquet held in his honor. Those present were charmed by his address, and the reception given the doctor seemed to afford him acute pleasure.

DR. WILLIAM C. COOPER.

Dr. William Colby Cooper, who died at his home in Cleves, Ohio, on December 6, 1913, was one of the most interesting characters and forceful and entertaining writers of the old school now rapidly passing off the stage. While he was an Eclectic, and an enthusiastic and devoted one, his interests could not be limited to any form of sectarianism, and he was a frequent contributor to the regular medical publications.

His literary work was certainly unique. He had an alluring style and a rollicking humor that made him a universal favorite among physician readers. The writer can never think of Cooper without recalling his story of how he cured a case of aconite poisoning. Years ago, when he practiced in Indianapolis, as he was walking down the street a man rushed up to Dr. Cooper and with a face as white as chalk said, "For God's

sake, Doctor, I have swallowed poison-do something!"

The doctor asked the man to open his mouth so he could look in his throat-and then deliberately spit in his mouth. He was chewing tobacco at the time! The treatment had the desired effect -the man threw up with a most gratifying promptness, but Cooper was compelled to take to his heels to save his skin. However, his quick wit and resourcefulness saved the fellow's life. Cooper was a philosopher whose mind was filled with quaint conceits and original ideas, and yet in all his speculations there was a constant and earnest effort to get at the truth, and in this effort he never hesitated to break the chains of accepted opinion. He was not orthodox, in medicine or anything else, but he was always sincere.

The later years of his life were saddened by the loss of his only daughter, and by the growing disabilities of advancing age. The writer cherishes a poem on this beloved child of his heart and a letter from Dr. Cooper in which he said, "Edith was my religion."

We sincerely hope that someone who studies the literary work of physicians will collect Dr. Cooper's work and present it in a form suited for permanent preservation. Surely among our Eclectic brethren there must be someone who has the means to do this, and who would look upon it as a labor of love.

MORE AND BETTER MEDICATION. Some months ago our humble sheet won the momentary attention of the great Association organ because we had the temerity to cite federal statistics showing that the patent-medicine business was increasing, not decreasing. The J. A. M. A. was violently determined that we were wrong, and that there was something sinister in our assuming to have an opinion different from its own.

We are gratified to learn that we do not stand entirely alone, hence we may be permitted to quote from the last number of the Eclectic Medical Journal, which says: "That more patent medicines are consumed today than ever before can not be controverted. Not only are such nostrums freely sold, but the laity can now purchase, without question, and use many of the specialties of manufacturers of proprietary products." Then the writer cites the vogue among the laity of such common remedies as peroxide of hydrogen and the bottled purgative waters. He might have added aspirin, phenacetin, and a horde of other things, simple and mixed, now sold to millions over the counter.

The simple truth is that the people demand medication of some kind. Drugs they want and drugs they will have, and if one "brand" is denied, or "knocked" enough to shake the public's faith in its efficacy, they take up something else. The old gods die, but new gods come to take their places. Such is human nature. With all our effort to instill in the people the necessity of preventing disease, and all our instruction as to methods, our men and women still spend "in riotous living" that precious heritage, good health, and then demand a charm (Christian Science) or a specific (salvarsan) to teach them wisdom and give them back their youth.

And so it is that there is no lessening demand for medicines, either among physicians or laymen. So long as men suffer they will seek relief and when the doctor fails to give it they will seek elsewhere. While the drugless methods of treatment are here to stay, no thoughtful man who is really conversant with the situation will deny that they are making but little headway. The methods their devotees propose are not the methods of the masses. Our age is a chemical age-even the vogue of serum and vaccines proves that— and the research workers of our profession are concentrating their efforts more and more upon the search for some new elixir longae vitae, some variant of Ehrlich's therapia sterilans magna.

Every sign of the times points not toward less medication but toward more medication. Yet, we have many reasons to hope that it will be better, more honest, less commercial, more efficient. But in the meantime, it seems folly to denounce our old drugs. Therapy is in the melting pot and what may come out of it no man knows. We suspect that many of the things we have cherished and for which our young enthusiasts in laboratory research find no excuse, will survive in some form or other.

COOK COUNTY TUBERCULOSIS HOSPITALS. The report of the advisory committee appointed by the Board of Commissioners of Cook County to investigate the hospital facilities for the treatment of the tuberculosis in this county revealed a condition that is both astounding and disgraceful. The accommodations were shown to be utterly inadequate for the competent and scientific are of the unfortunate individuals who were compelled to seek assistance from the county institutions.

At the Oak Forest Tuberculosis Hospital there was only one physician to care for the 327 patients, and the hospital had no laboratory whatever, no instruments or facilities for treating tuber

culosis of the nose and throat, and no medical equipment for the ordinary study and treatment of patients. The diet was found to be frequently unsuitable and improperly served, and not a special or important feature in the regimen. Only ten nurses were available for day duty, and a less number at night, and even these were compelled to attend to menial duties for the lack of competent domestics.

At the Cook County Hospital the facilities for the care of the sick in the Tuberculosis Department were little better. There was insufficient help, both male and female, the diet was found to be sadly lacking, the medical attendance woefully weak and changeable, and again, no provision was made for the intelligent 'study of cases.

The recommendations of the advisory committee were modest, and the things asked for the most ordinary essentials. It is to be hoped that they will be granted promptly and that adequate appropriations are made to give us facilities for treating these cases in a way of which we need not be ashamed. At present it would seem that commitment to one of these institutions is practically equivalent to a sentence of death. It is hardly to be wondered at that patients, even from the poorest homes, refuse to enter our tuberculosis hospitals till their cases are so advanced that there is little hope.

A School for Surgeons. From the newspapers we learn that the recently organized American College of Surgeons is planning the establishment of a school of surgeons, and that Dr. W. J. Mayo, of Rochester, Minnesota, has presented the advantages of Minneapolis as a location for this school. Whether there is anything in this rumor or not we cannot say. However, it is safe to assume that should any institution of this kind be contemplated Chicago can be counted upon to present its own claims. Surgically speaking, we are still the "hub of the universe". Who will dare to controvert that statement?

T

HE medical man who does not add a concentric ring of wisdom under his alligator hide each year is liable to find himself in the moss covered bucket class before he reaches the jumping off place. Moss is a picturesque ingredient of an artistic masterpiece, but it is now relegated to the rear by the health authorities. Time was not so long ago when medical literature was regarded as a sort of blue clay carrying diamonds in the shape of cures for diphtheria. Such gems are now regarded as mostly paste. It is conceded that the time to cure diphtheria is ahead of contracting this contagious disease. More is accomplished with the head and less with drugs each year.

Serum therapy for the eradication of diphtheria can be explained on a rational hypothesis. Physiology and therapeutics both stand for the use of the injection method to reach the blood stream directly. If antitoxin or any other agent is swallowed it insures the transportation of the Klebs-Loeffler bacillus to the stomach, where it is possible to find warmth, moisture and other surroundings conducive to the development of membranous patches in which colonies of the microorganism may multiply and manufacture the characteristic toxin. If this toxin can poison the blood in the general circulation it does not require a stretch of the imagination to give it the faculty of poisoning a secretion from the blood in the shape of gastric juice. Rest for the sets of muscles involved in the inflammatory process which is the cause for the pouring out of the fibro-serous exudate in the fauces and air passages is a consummation to be aimed at.

Twenty-three new graves in the burying ground of a rural community in one season as the result of a malignant epidemic of diphtheria; and an intubation tube to keep clean for six months while another child slowly died is the kind of gray hair making experience which shattered the faith of one practitioner in old style medication.

The new style is better; because today a death due to diphtheria is the exception instead of the rule. Treatment costs more. Both the cost of living and dying has been increased in late years; and those who foot the bills have a right to demand that an expensive remedy should be admin

istered in the way to bring about the greatest therapeutic benefit in the shortest space of time.

Subcutaneous injection of sterilized antitoxin was at first thought to square exactly with the indications. The cause for the disease had to be first captured and identified before it could be dealt with summarily. The bacillus of diphtheria is a slender straight or slightly curved rod shaped organism. Occasionally it is enlarged and clubbed at the ends. Benign bacilli sometimes are found which have identical physical characteristics, and which on that account lead to confusion in diagnosis. It appears to be possible to have a form of bacillus, which so far as power to propagate diphtheria goes, is a eunuch.

Serum therapy in diphtheria is a variant of the original form of vaccination for smallpox. If the Klebs-Loeffler bacilli in a malignant case of diphtheria are killed in the course of convalescence, some of them are probably expelled from the body, so changed by contact with antitoxin as to have lost the power of infecting a susceptible individual. Diphtheria carriers are common and may be loaded with these immune or castrated micrococci. It would be comfortable to believe the bacillus could get religion and exhibit the fruits of reformation, but just now serum therapy does not claim to do missionary work; on the contrary it intends to kill the enemy.

Subcutaneous injections of antitoxin pass very slowly in the blood stream. The liquid portion

of the dose soon disappears, but the actual toxin killer with its protein content may not get into the circulation in maximum amount until the eighth day. Intramuscular injection is an improvement, because it requires less time to reach the blood stream; but intravenous injection is best on account of its prompt arrival where it will do the most good.

The technique of the operation of intravenous injection is kindergarten surgery. First, the upper arm should be ligated to distend the most eligibly situated vein on the upper surface of the lower arm. As soon as this vein is turgid and prominent an assistant should hold the patient's arm rigid while the vein is speared crosscutwise with an aseptic needle. Now thrust the point of the needle into the vein and hold it parallel to its course and unbind the ligature above the elbow. Slowly in

ject the antitoxin and allow the subsiding congestion to help carry the injection towards the heart.

If an initial dose of antitoxin is slowly diffused through the blood stream, certainly a second dose is not needed for some hours; even in desperate cases. Give enough antitoxin the first dose; that is the rule of thumb. If the number of units proportioned to the severity of the symptoms, and the antitoxin is intravenously injected pronounced effects should be discernible in six hours. How is this effect produced?

When the Klebs-Loeffler bacillus attaches itself to a locus, preferably the tonsils, in a susceptible individual, its presence is indicated by the appearance of a pseudo-membrane. Colonies of bacilli rapidly multiply in and on this membranous exudate and during the birth and growth of bacilli, the toxin is developed. This poisonous substance eats its way through the membrane and into the underlying tissues and blood vessels.

Nature undertakes to counteract the effect of the toxin by the production of antitoxin, but her forces are crippled and the human body is in danger of being overwhelmed. The bacillus is only scantily present in the blood. Antitoxin from some outside source must at once be supplied to the blood or the unequal combat will not last long in serious cases. Long ago it was discovered that pepsin in the human gastric juice could be reinforced by a similar substance obtained from the stomach of the hog. The universally distributed appitite for ham and eggs may be connected in some occult way with the production of pepsin for the gastric juice. The gizzard of the common barnyard fowl yields a satisfactory species of pepsin, known to the trade as ingluvin. Perhaps condensed California pepsin will yet be marketed as the result of laboratory treatment of the stomach of the ostrich.

Commercial quantities of antitoxin are obtained best and quickest from the horse. One of Roosevelt's reasons for his African trip was said by Bryan, to be for the purpose of investigating how much pepsin could be distilled from the stomach of the elephant. Vegetarians have been slow to grasp the significance of the discovery of the power of a diet of hay and oats to produce the triumphant conqueror of a dangerous blood poison. Horse meat is not eaten by human beings as a rule; and for that reason horse antitoxin has not lost its effect on the blood content of the diphtheria patient.

Klebs-Loeffler bacilli are of vegetable origin. Statistics are lacking to show how a vegetarian diet has an effect on the rise, climacteric and subsidence of the diphtheria toxin.

Skill in the handling of the new remedy is an

essential in keeping down the mortality from diphtheria. Lately there have been improvements in the making of antitoxin. Serum sickness used to be an occasional unhappy sequel of its administration; this development usually occurred from one to three weeks after the administration of the antitoxin. A rash was one of the exanthematous manifestations and it was common to mistake serum sickness for scarlet fever and measles. The time of development; the site of its first appearance; regional gland involvement; and absence of mucous membrane and tissue involvement need to be carefully weighed in the balances. Koplik's spots, conjunctivitis and coryza are also absent. A scarletinal form of serum rash can fool even those who are fit to be elected to the House of Delegates of the American Medical Association.

Serum sickness has been largely discounted by the isolation of the antitoxin principle, which is now separated from all serum constituent except soluble globulin. Solutions of globulin can be depended upon to produce typical symptoms of serum. A sensitized condition is one of the unfortunate manifestations which makes it more difficult to calculate accurately on the effect of antitoxin.

Antitoxin has become a public improvement because it is possible to point to recoveries which under the old order would inevitably have been fatalities. Forty per cent of diphtheria patients used to die. Every medical man of experience has seen patients, apparently on the road to recovery, suddenly drop dead from alleged heart failure. Those who are skeptical as to the heart ever failing can gain a sheaf of terrible experience by having a seriously ill typhoid patient moved from an upstairs bedroom, down stairs on the supposition that a ground floor apartment will be better ventilated. Move the patient late in the afternoon and then when the telephone rings about three A. M., it will likely be necessary, if death does not beat the medical man to the bedside.

Partial paralysis used to be another dreaded sequel. Only cne other disease of childhood could hold a candle to diphtheria for serious after results. The rival in bad eminence was epidemic cerebro-spinal-meningitis. In the past, older practitioners used to confound meningitis with anterior poliomyelitis. A generation ago some of the sharpest clinical observers had a conviction set like a bear trap in the mind, on the identity of diphtheria, meningitis and anterior poliomyelitis. Diphtheria attacked mucous membranes; meningitis specialized on the coverings of the central nervous system; and anterior poliomyelitis dealt misery to the substance of the spinal cord.

A sufficient dose of antitoxin can be counted