affords protection for from twenty-one to twentyeight days, while a second dose, as a rule protects for only about a week, as shown by the Schick

test.

3. The indications of the Schick test are that the immunity conferred by an attack of diphtheria is usually of short duration.

4. The removal of adenoids and diseased tonsils is a valuable means of freeing diphtheria carriers from germs.

RED-CROSS WORK ABROAD. Every good American should be interested in the earnest, useful work of our Red Cross surgeons and nurses now serving abroad. For the information of our readers we print the following notes, clipped from an exchange:

The American Red Cross unit assigned to Germany has been dispatched to Breslau in Silesia, and the unit assigned to Austria has gone to Vienna.

The unit assigned to Russia reached Petrograd on Oct. 10, on its way to Kiev, where it will be stationed at a hospital of 200 beds.

Despite a rough voyage, all the members of the American party are in good health and enthusiastic. They have been received at the principal stations along the route by delegations of physicians, some with bands. At Raume, Finland, on the way from Stockholm, the Americans were greeted by all the doctors in the city who gave them an impressive welcome. At Petrograd they were escorted to the Emperor's waiting room, where they were welcomed by Count Robrinsky, chief of the Russian Red Cross, as the only foreign Red Cross corps sent to Russia.

Russian officials attach importance to the American expedition as likely to add to the cordial relations between the two countries. The American surgeons probably will be equipped with Russian uniforms so that they escape being made the target of unthinking soldiers.

A movement is in progress for increased hospital facilities at Petrograd on account of overcrowding at Warsaw.

An additional consignment of 3,000 pounds of bandages and 100 stretchers has been sent to Russia from New York aboard the Dwinski, sailing for the port of Archangel.

On Oct. 12 the American hospital relief ship Red Cross sailed from Rotterdam for New York, bringing home 150 refugee American passengers.

On Oct. 16, the total of the New York Red Cross fund amounted to $254,761 and the American Ambulance Hospital (Neuilly) fund reached $84,158. The Belgian relief fund is about $140,000.

A Scottish Red Cross hospital of 100 beds has

been established at Rouen, in Normandy, the staff and nurses being drawn largely from the Glasgow Royal Infirmary.

The German army medical corps is said to consist of over 12,000 surgeons, including many of the most eminent scientists of the day. In England it has been necessary to augment the regular medical corps by volunteers.

The medical profession has responded to the call of the country in a manner worthy of its traditions. Many have joined the Army Medical Service, and not a few are already at the front. In order to serve their country in this way, some have given up professional posts or have left their practices at considerable personal sacrifice. A strong movement has also been started in the profession with a view of carrying on the practices of those away at the war, so that they should receive them intact at the conclusion of hostilities. Another commendable scheme provides free medical service to the wives of the soldiers and sailors away on active service. Those medical men unable by reasons of age limit or from the nature of their work to help in the above mentioned ways, have subscribed liberally to the various excellent funds organized for the relief of distress or for augmenting the comforts of the troops.

SPASMOPHILIA-THE TENDENCY TO
HAVE SPASMS.

Many children have a tendency to recurring convulsions or "spasms." Why this is so we do not surely know, although there is a feeling that something is wrong with the calcium metabolism in many of these cases. An interesting discussion of the problem appears in the Archives of Pediatrics, written by Dr. Heinrich Reye. Coming to the question of treatment he writes as follows:

Most authors recommend that the spasmophilic infant be put on mother's milk if possible or that a wet nurse be secured. In a large number of cases this measure is sufficient to cause disappearance of symptoms. When gastrointestinal disturbances are present it is best to discontinue all food for twenty-four hours and put the child on a tea diet. If severe laryngospasms and eclamptic conditions are present it is advisable to evacuate the bowels with 5 or 10 Cc. of ol. ricini. After the twenty-four-hour water or tea diet it is usually best to start with 5 per cent gruels, to which 3 to 5 per cent of lactose is added. After three to seven days the caloric value of the food may be increased by adding precipitated and washed casein and fat. As soon as possible milk should be slowly added. Though relapses are to be feared, as yet a carbohydrate diet poor in salt

lasting longer than eight days has also its dangers in infancy, especially if there occurs loss in weight, subnormal temperature and collapse. Nothing is surer to prevent the appearance of spasmophilia than nursing the breast. If bottle feeding has to be resorted to, it should be done with limited amounts of milk, that is, 3⁄44 of a liter or at most 1 liter per day in order to avoid the dangers of laryngospasms and eclamptic seizures as much as possible.

Netter recommends calcium chloride as a drug for tetany. He uses 2 grams with prompt results in spasms of babies. Larger doses act even better. Rosen and others recommend phosphorus and cod-liver oil in the proportion of 0.01 to 100. According to Schabad this gradually leads to increased calcium rentention. L. F. Meyer has seen good effects from large doses of calcium bromide in cases of laryngospasm. He gave 2 to 3 drams per day. Quest drew no conclusions for treatment from his experiments. He thinks that the calcium metabolism is not sufficiently known in man and that much depends on the form in which calcium is given. Other minerals and organic constituents are probably important in the retention of calcium. For this speaks the favorable results obtained by the change of diet and by giving phosphorus. Finkelstein thinks that phosphorus is an antispasmodic, but its effects are not remarkable and not pronounced without change of diet. It is possible that the phosphorus produces a favorable effect on the calcium metabolism.

With children over a year, milk can be dropped for a week without harm. In all cases of spasmophilia, cod-liver oil or phosphorus and cod-liver oil is indicated. On this alone, in many cases, without any change in the diet, the symptoms of spasmophilia will disappear. Phosphorus with other oils is ineffectual. The phosphorus must be fresh and renewed every two weeks at least, as it is said to have no action if oxidized. Only elementary phosphorus seems to have any influence on spasmophilia or rachitis.

Chloral is very useful as a symptomatic means to arrest the convulsions. It has the advantage over chloroform that it can be left in intelligent lay hands. The proper dosage is about 5 gram, best given by enema. Young children will bear this dose without harm. Usually it leads to subsidence of the spasm in a few minutes and sleep for several hours. The same dose can be repeated the same day, or even for several days, until the causal treatment becomes effective. Children with predisposition to spasmophilia should be kept from excitement and from eating copiously; they should be much in the open air, and especially

protected against infections, particularly whooping-cough.

In

According to Finkelstein and Zybell, phosphorus and cod-liver oil is not a panacea. twenty-four out of thirty-two of Finkelstein's cases the electrical irritability returned to normal, but it took five weeks to do it. Dubois and Stolte call attention to the fact that the excretion as well as the disposition of the slowly soluble calcium takes place only very gradually. For that reason we do not see any effect of calcium when used therapeutically until after weeks of treatment.

From the experiments of Schabad, we know that 20 to 60 per cent. of calcium acetate is retained by the organism. Calcium phosphate and calcium citrate are not retained at all. Calcium acetate also improves the calcium retention of the food. According to Schabad the good effects of phosphorus and cod-liver oil in spasmophilia depends in the fist place upon its power of increasing the calcium retention. Rosenstern in his investigations gave to infants 110 grams of a 3 per cent. CaCl, solution. He usually noticed a quickly appearing and also rapidly disappearing effect upon the cathodal opening contractions. However, he did not succeed in influencing them for any length of time. The infants did not take kindly to the solution and occasionally vomiting occurred. The maximum effect appeared six hours after the administration; twenty-four hours later the reaction had disappeared. Trousseau's sign was absent only occasionally. The severe laryngospasms disappeared occasionally for twelve hours. In twenty-four cases Risel saw the electrical irritability returning to normal under the effect of the calcium acetate. Bogen and von Pirquet call attention to the fact that the permanent giving of calcium has no effect. According to Grosser, the calcium retention may increase over 60 Fer cent after the injection of calcium glycerophosphate. The calcium content of the food is also retained better. Calcium chloride as well as calcium lactate and calcium acetate used subcutaneously produce infiltration and pain. Berend made this same observation. According to Zybell the favorable effect of calcium was demonstrable in seventeen of the twenty-eight cases. The improvement, however, was restricted in most cases to a temporary change in the K.O.C., while the clinical symptoms remained unchanged. In fourteen cases the K.O.C., increased after the administration of calcium, so that its irritating effects were thus demonstrated. From Zybell's more recent investigations, it appears that the antispasmodic effects of calcium were seen in 61 per cent of the cases. In twenty-five it seemed to have no effect, in fourteen it had an irritating effect, while

the clinical symptoms were, as a rule, not influenced. From the experience with calcium salts we may conclude that in certain cases we are able to influence the K.O.C.; however, occasionally the opposite effect may be noticed. A marked change in the spasmodic condition occurs only in a few

cases.

The facts ascertained by Loeb induced Aschenheim to pay especial attention in the treatment of spasmophilic children to the numerator and the denominator of the quotient Na/Ca, attempting as far as possible to reduce the amount of irritating salts, not only in the food, but also in the body of the child. He gave a whey-free milk ("eine Aufschwemmung des Gerinnsels" which has been washed several times in water, and which results from the treatment of cold milk with Pegnin, in unsalted gruels to which was added a 3 per cent Liebig-Soxhlet zücker or a 3-5 per cent sugar of milk). He takes care that sufficient calcium is retained by giving phosphorus and codliver oil. This, according to K. Meyer, not only improves the Ca balance, but at the same time also diminishes the balance of KO and Na. In the combination of phosphorus and cod-liver oil with whey-free milk, Aschenheim thinks that we have a therapy which, from two different points of attack, diminishes the quotient:

alkalies

alkaline earth

Reasoning from the fact that the magnesium balance was disturbed along with the calcium phosphorus in spasmophilia and that the magesium may at times take the place of the calcium, and that it does not possess the irritating effects of calcium, Berend experimented with injections of magnesium sulphate, apparently obtaining very good results. Bethe and A. G. Meyers emphasized the depressing quality of magnesium which shows itself in the diminution of the existing irritating condition. Fienga comes to the same conclusion. Meltzer has proved that magesium salts have a very depressing effect on both the sensory and the motor spheres. This result can be immediately reversed by means of calcium. On the basis of Meltzer's experiments on animals, Berend injected magnesium sulphate subcutaneously. He began with an initial dose of 20 cg. to the kilogram of body weight. In not a single case did he notice any toxic effects. In the course of his experiments he found that even double the amount is without toxic effects and is borne nicely by infants even if the injection is repeated daily. In all his cases he noticed that the effect of the magnesium showed itself in the disappearance of the restlessness of the child. Occasionally he obtained fever.

Usually he gave for injection from 15 to 20 Cc. of an 80 per cent magnesium sulphate solution. The magnesium sulphate treatment influ

ences most quickly the electrical irritability and the carpopedal spasms; less quickly the eclamptic seizures and Trousseau's sign. The laryngospasm is least affected, but, nevertheless, more quickly than by the usual method of treatment. The course of tetany is always shortened by the magnesium treatment.

Berend thinks that in the magnesium sulphate treatment, artificial foods may be continued during the treatment of spasmophilia with much less danger. If a pathologic K.O.C. alone is present without spasms, phosphorus and cod-liver oil is indicated, but not the magnesium. On the basis of his experience he advises the following procedure: Give the child immediately an injection of magnesium sulphate corresponding to his body weight, empty the bowels with castor oil and after a six or twelve hours fast give a salt-free gruel adapted to the patient's age. In case the spasmodic condition does not show any improvement in two hours, it is best to repeat the magnesium injection.

The subsequent treatment depends upon whether or not the spasms have disappeared on the following day. In case the K.O.C. is still very pathologie, it is best to give another injection. If the spasm has not disappeared, it is advisable to increase the amount of magnesium by onefourth. Usually only one injection in twentyfour hours is necessary. Rarely does the treatment take longer than forty-six days. Berend also administers phosphorus and cod-liver oil, beginning with the second day of the magnesium treatment. In case of reappearance of symptoms a new injection is indicated. If the tetanic spasms have entirely disappeared and only the laryngospasms continue, which are not influenced by the magnesium, Berend stops the magnesium treatment and continues with phosphorus and codliver oil.

慌慌济

ACUTE INFECTIONS OF CHILDREN-HOW TO TREAT THEM.

It is difficult to make an accurate diagnosis early of many of the acute infectious diseases of children-therefore, it is inadvisable to wait for the diagnosis before beginning treatment. Tobler, of Breslau, points out in the Deutsche Medizinische Wochenschrift the desirability of beginning treatment early, and suggests the following plan, which we quote from the excellent abstract published in Merck's Archives:

As soon as irritability, anorexia, vomiting, chilliness, the prodromata of an infection, appear in a child, it should be put to bed, in a quiet room, the temperature of which can be kept at about 66° F. The thirst usually complained of, is satisfied with frequent but small quantities of pure

water or weak lemon or orangeade. During the first days the diet should consist of milk with tea or cocoa added, zwieback or white bread, moderately thick gruels, containing eggs, cold puddings of cornstarch and apple sauce. When the fever has persisted for several days, plenty of nourishment must be insisted upon. Rice, potatoes and macaroni are added to the diet, also vegetable pureés and later even plain meat can be allowed. In infants, if breast-fed, the nursings are shortened and very weak tea, sweetened with saccharin is permissible in the intervals to allay thirst; when bottle-fed, the feedings are diminished by onefifth or one-fourth and the baby gets an equivalent amount of weak tea. Diarrhea is often prevented in this way. In older children a tendency to constipation is frequent. An enema on the first day is therefore advisable, followed by mild laxatives, if necessary.

When the temperature reaches 104° F. or over. antipyretic treatment is required. In infants the most practical physical procedure to reduce temperature is the tepid full bath. 95° F. is the proper warmth of the water when the child is put into the bath; the water is then gradually cooled to 88° or 90° F. in the course of five minutes. The bath should never last long enough to produce shivering or cyanosis. If the child is somnolent, water at 85° F. is poured over it, instead of gradually cooling the water in the tub. Two or three baths may be given in 24 hours. High temperatures in older children are effectively treated in the same way, but cold packs are perhaps more practical. The patient is wrapped in in a wet sheet and blanket serves as an external envelope. The temperature of the water from which the sheet is wrung out, may be anywhere from 68°-85° F. according to the degree of pyrexia and the general condition of the child. The more frequently the sheet is changed, the more rapidly is the temperature reduced. More than two cold packs an hour are, however, never employed and a fresh sheet should only be applied when the preceding one as well as the surface of the body are warm. When it is undesirable to disturb a patient frequently, cool cloths may be laid on the anterior surface of the trunk and changed every 20-30 minutes until the desired effect is achieved.

Regarding chemical antipyretics, Tobler says that there is hardly a doubt but that they are more reliable than physical means and that their effect is of longer duration; besides they seem to act upon the symptoms of intoxication, accompanying high temperature, more markedly. The object in administering drugs of this class must not be to produce normal temperature, but simply

to diminish the fever sufficiently to cause a sort of euphoria, which facilitates nourishing the patient, acts soothingly upon the nervous system and is conducive to sleep. The mode of administration varies in accordance with the temperature. If the latter is high all the time, small doses are given at short intervals; when the temperature chart shows a high peak once or twice a day, one or two larger doses at the time of the hyperpyrexia are in order.

At times with the onset of an infection, symptoms of meningeal irritation are in the foreground to such an extent that the diagnosis of meningitis is seriously considered. Such cases call for lumbar puncture, as it is of service both diagnostically and therapeutically.

To encounter signs of weakening of the circulatory system in the early days of an infection is exceptional. True, the pulse rate of children becomes rapid at the slightest provocation, but cardiac insufficiency is rarely observed, for the muscle of a child's heart is capable of withstanding considerable strain for a long time. When circulatory disturbances do occur, it is usually the vasomotor system that is paralyzed. With faint heart sounds, rapid pulse and peripheral cyanosis, stimulants are indicated. In mild cases Tobler gives caffeine sodium benzoate, 0.03 to 0.5 Gm. according to age, as drops or in mixture, several times a day, but in most cases he prefers to inject onehalf to one syringeful of 10 per cent. camphor oil, repeated if necessary. In serious cases digitalis is called for in addition to the camphor, and in the desolate condition of general vasomotor paralysis, adrenalin is recommended. Tobler's favorite digitalis preparation is the solution of digipuratum, of which he gives 3 to 5 drops from one to three times a day to infants; to older children larger doses are administered and varied according to the results obtained. Of a 1.1000 solution of adrenalin, 1/3 to 1 Cc. is injected several times a day.

to large quantities of fish, game, poultry, rabbits, eggs, cheese, etc. Among the well-to-do the meat consumption has been estimated at between 180 and 330 pounds per year; all this is much more than double the amount consumed fifty years ago, and in the same time the deaths from cancer have increased over fourfold.

The same figures apply roughly to the United States, where the per capita meat consumption is said to be considerably in excess of the European average, and all statistics show that cancer is rapidly increasing in this country. In a recent Bulletin of the Board of Health of New York City the following statements are made in regard to the mortality from cancer in 1913: "The statistics of our seven largest cities recently tabulated, show that in that year the cancer death rate was the highest on record. For New York City the rate was 82 per 100,000 of the population, against an average of 79 for the last five years; for Boston 118, against an average of 110; for Pittsburgh 79, against an average of 70; for Baltimore 105, against an average of 94; for Chicago 86, against an average of 81; for Philadelphia 95, against an average of 88; for St. Louis 95, against an average of 85." This average increase of over 8 per cent. of deaths from cancer in the combined population of these seven cities during the last five years is certainly an alarming fact, and cannot be explained on the ground of greater accuracy of diagnosis; for it is not to be presumed that there has been such great improvement along these lines during the single year 1913. It has been shown that with the same rate of increase of deaths from cancer, unless there be found some way to check its production, the death rate at the end of the century will be appalling.

In striking contrast to the enormous extent and increase of cancer in meat-eating communities may be mentioned the relative rarity or almost absence of the disease in regions where the diet is largely confined to the products of the ground. Williams has collected from all sources the greatest amount of evidence that cancer is relatively rare, and often really unknown, as reported by competent observers, among various aborigines in the interior of many countries, who live on the products of the vegetable kingdom, with little if any meat secured in hunting.

Is it not possible and even probable that the relatively less increase in cancer in New York City during the last five years is in part due to dietary causes? Thus in 1913 the death rate was 82 per 100,000, against 79 for the average of the preceding five years, while the highest increase was in Baltimore, 105 against 94, or 11 per 100,000 to 3 in New York City. It is known that we here,

in New York City, have vast hordes of foreigners, many newly landed, who still live as at home, and are too poor to buy much meat. The Italians still live on macaroni, and cereals form a large part of the diet of those from southern Europe, etc., etc. During a rather extensive trip through the Far East the writer was unable to see any cancer, although he met a large number of medical men and made inquiry regarding the same, and visited hospitals with a total of many thousands of patients; in Japan, Korea, China, the Philippines, India, Siam and Egypt he met the same response, that cancer was rarely seen among these vegetarian peoples.

Cancer has repeatedly been observed to disappear spontaneously, and many such cases are on record by careful and competent medical men ; in certain of these instances it has occurred in connection with a radical change in the mode of life and diet, but in the majority of instances there is no record of the special cause of its disappearance. But the lesson to be learned from this is that there are conditions of the system which are antagonistic to the abnormal proliferation of cell tissue, even when it has begun to take place, as we must believe that there are conditions of the system which favor such diseased action of aberrant cells. An interesting confirmation of this is attributed to Ehrlich, but I cannot find the original reference. He "has shown that mice living upon a rice diet cannot be inoculated with cancer, while mice living on a meat diet can be readily inoculated, cancerous tumors developing quickly and continuing to grow until the animal dies. Ehrlich also found that when mice with cancerous tumors, the result of inoculation, were placed upon a rice diet, the tumors ceased to grow and in many cases degenerated and disappeared." Interesting confirmation of this has been given by Sweet, Corson, White and Saxon. They found that 75 per cent. of 75 mice developed experimentally inoculated tumors when under normal diet, while only 19 per cent. of 75 other mice developed such tumors when under a diet of glutenin and gliadin, that is vegetable proteins; also that the tumors in the latter were in thirty days hardly larger than in the former in ten days. Doctor Bulkley says:

"For very many years I have held the view that meat eating was productive of cancer and have treated very many cases, of both recurrent and primary cancer, with an absolutely vegetarian diet, with results in some cases which were remarkable and most gratifying. But I have hesitated writing strongly on the subject before lest I should be misunderstood or misjudged, as in such cases reliance has to be placed on a clinical diagnosis (always verified by others), while results claimed