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have any standing among medical journals that have the slightest claim to decency."

On the other hand, if you are in sympathy with the battling democracy of the profession, just now very much in arms, you will find the Journal much improved. It is now a fighting publication. Also, it is filled with spice. Furthermore, it is out after the scalps of the oligarchy, and has already made an interesting collection. It is safe to say that few numbers are now left in the covers, unread, as once was too frequently the case. People want to know who is getting it this month, and wondering who is slated for the next issue. From a very dull, uninteresting publication, used editorially mainly for the venting of personal spites, the Journal has become the foreful organ of what is undoubtedly a majority of the physicians of the state. The writer enjoys reading it, and imagines that most other Illinois physicians do also.

EDITORIAL NOTES.

The Bedbug Spreads Tuberculosis, according to Dr. J. Walling Beveridge, of New York. The evidence is accumulating that it is an insect as dangerous to human life than the fly or mosquito. It has been known for some time that it is responsible for the spread of typhus fever, and recently it has been charged with the causation of leprosy and epidemic spinal meningitis. That it may also serve as a carrier for tuberculosis seems extremely likely. The fact that the bedbug may live for six months or more without food makes it especially hard to get rid of, and naturally increases its danger to a considerable extent.

The Army Medical School in Washington, in which our newly enlisted medical officers are prepared for service, is also the headquarters for some most interesting research work. It is no doubt largely due to the influence of this institution that our army surgeons are now taking a foremost place in the development of sanitary science. It deserves encouragement, and especially it needs the new building asked for by Surgeon General Torney. The school is now housed in a rented building, and Congress has been asked to appropriate the modest sum of $350,000 to provide suitable quarters. As the Surgeon General says in his report:

"As it is one of the permanent service schools it would be much more economical, as well as more fitting and convenient, for it to be housed in buildings erected by the government. It is proposed to erect these on a tract of land occupied by the Walter Reed General Hospital, so that the students

may have the clinical advantages and the instruction in administration afforded by the hospital, and that the hospital may enjoy the laboratory conveniences of the school."

Rectal Anesthesia is now advocated by Gwathmey, who has administered a mixture of ether and olive oil to one hundred patients, with what are alleged to be excellent results. The details will be found elsewhere in this number of the STANDARD. While the method has certain fascinating features which will commend it to further trial, the objection which will retard many surgeons from extended experimentation with it will be the difficulty of keeping the anesthetic under control. While this is not an insuperable objection, as witness the growing employment of the hyoscine-morphine method, it seems to be one that must be considered. We suggest a careful study of the Gwathmey method.

The Growing Interest in Anesthesia is one of the encouraging "signs of the times." It shows that surgeons are beginning to consider the feelings of patients, who often complain more of the anesthesia and dread it more than they do the operation itself. The new interest is no doubt quite largely inspired by Crile's remarkable studies in anoci-association. Crile has proved what we all have felt and which we have left for charlatans to say that fear kills. By removing the fear of surgical intervention, making it possible for the patient to come to the operating table with an untroubled mind, he has undoubtedly reduced the mortality rate most decidedly. No doubt our anesthetic technique will be much more improved in days to come.

Radium and Radioactive Bodies generally are now being much advised for the treatment of cancer. During the meeting of the Congress of Surgeons in this city much interest was shown in the demonstrations of Kroenig and Gauss, of the University of Freiburg, with substances of this class. Dr. Howard A. Kelly of Baltimore, has become a somewhat enthusiastic advocate of radium, and has reported at least two cases of apparent cure in inoperable cases of carcinoma. He is also heading a movement to prevent the large areas of pitchblende ore in the United States-which is known to be very rich in this mineral-from falling into the hands of speculators. The outlook seems favorable, and while we have seen too many "cures" for cancer come up and go down to feel any great enthusiasm we certainly join in the hope that in radium we may have a really useful remedy.

M

THE SIMULIUM AND PELLAGRA.

By DR. BAYARD HOLMES, Chicago.

JEDICAL interest in the "black fly" or "buffalo gnat" or Simulium has been greatly accentuated since Sambon' suggested that this insect carried the pellagra infection as an alternate host.

The pest that this fly is to cattle has long been appreciated by cattlemen, farmers and entomologists. In the United States and British America, hunters and trappers have suffered dreadfully from the attacks of the insect.

The Simalium or Pellagra Fly.

The

"Aggasiz Expedition" to Lake Superior was much hindered by the swarms of buffalo-gnats they met every time they tried to penetrate the country surrounding the Lake.

There are many cases of death reported due to the fly, sometimes from a single bite, more often from attacks by swarms of these insects. S. E. Buck (Insect Life, 1888, Vol. I, pp. 60-61) reported that his nephew was left by a fishing party on an island in the Hatchie River. He had no matches with which to light a smudge, and could not swim away from the island. The gnats bit him terribly, and although he was rescued in a few hours, and given every attention, he died the same night with dreadfully swollen face, neck, arms and hands, and Buck declares that the gnats killed him.

The bite of the gnat is terribly painful. F. M.

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Webster says that the sensation of the bite is like that of having the skin rudely punctured by a blunt hat-pin or awl, leaving behind a dull, aching pain. Many persons have been killed by swarms of the insects and hunting and surveying camps have been driven to retreat by the pest.

When cattle and hogs are attacked they suffer terribly and die in great numbers. In certain localities they attack poultry and produce a fatal cholera! (Compare Pellagra.)

The State Entomologist of Illinois has just issued a report on the Simulidae of Illinois." In this report he gives all the information at his disposal from the large collections made during the last thirty years by the collectors of the Laboratory and their correspondents. The material was remarkably deficient and one is reminded of the fact, demonstrated by the recent prominence of the mosquito as a carrier of yellow fever, that exact science is not far ahead of practical science. We did not know much about the mosquito when we found we needed not only specific distinctions but a complete life history of each species. Wher we needed to know all about the bedbug in order to solve the problems of Kala Azar and typhus fever, we found ourselves remarkably ignorant of this domestic parasite of primeval man. Now that we need to know all about the buffalo-gnat and its relation to pellagra, we find ourselves almost as ignorant as the ancients.

There are many indications that pellagra is an infectious process and that there is some inter

The Insect in the Larval State.

mediate host. Sambon has suggested the Simulium as that host. The importance of determining the source of pellagra has been recognized by legislators and the Illinois Pellagra Commission resulted. The report of the Commission is now published, but it is meager, superficial, and inconclusive. The commission should be continued or transformed into a permanent department and co-ordinated with the functions of the Uni

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versity, the Psychopathic Institute and the State Board of Health. The work of this commission should be research into the sources of all the unknown diseases of the citizens of the state, There are many species of the genus Simulium, and twenty-five of the known species are found in North America, fifteen in the United States, and nine in Illinois. At least one special (S. hertipes) is found both in Europe and America. The buffalo-gnat is a small, two-winged insect, with a thick, hump-backed body, and a sharp, piercing, sucking beak. (See Fig. 1.) The several species vary in length from 1/25 to 1/6 of an inch in length. They are notoriously abundant in enrmous swarms in early spring, especially along the larger streams, and they are never to be forgotten on account of the extreme painfulness of their puncture or sting, and the persistency and ferocity of their attack. To man. and the domestic animals, from horses and cattle to pigs and poultry, they are a terrifying scourge.

The larvae are aquatic and hatch about two months after the eggs are deposited, if the water is warm, but they develop slowly in the cold weather or winter. (Fig. 2.) A single hatching disappears in about ten days, but as two months only are required for the complete cycle from the egg, there is time for several hatchings a year. The problem of pellagra is not yet solved. It may take another outbreak to arouse the lethargic public health authorities and the keepers of the insane to the importance of pellagra investigations.

In the meantime it is the obvious duty of physicians to study side by side with the mosquito, the bedbug, the louse and the rat, the little "black fly" that has been accused of carrying the pellagra. Fellaria sanguinis hominis, the malaria plasmodium, and the yellow fever germ, are carried by various mosquitoes. Every doctor should have a box of them and know them by name. Kala azar, typhus fever, and probably other diseases are carrier from one to another by the bedbug; yet who knows anything about this ancient pest? The role of lice as a parasite carrier has only recently been recognized.

The old doctors were botanists, and they studied plants in order to find new remedies. The young doctors of today cultivate bacteria in test tubes to prepare their auto-vaccines.

The pro

With all the naivete of a literary man, a prominent author once wrote me to tell him something about bedbugs: 1st, How old must a bug be before she begins to lay eggs? 2nd, Does she lay eggs at all? 3rd, How many eggs does she lay in a lifetime? 4th, How long after the egg is laid before it hatches? 5th, How long does the female live? 6th, Is she impregnated once for life or often? 7th, How do heat and cold affect the bug and what degrees are fatal? 8th, What means can be used to exterminate bedbugs from a wooden house? etc., etc. I spent a week in the John Crerar Library but was unable to answer these questions.

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Sugars as Diuretics.-In his excellent review of diuretics (Paris Médical, Nov. 1, p. 490), Pic declares that sugars must be considered a valuable diuretic. Not only do these tacoharide bodies act through epithelial stimulation of the kidney-cells, but recent investigations have shown that they also have a cardiotonic action as well. Thus, Enriquez and Gutmann (Soc. Biol., 1913) have demonstrated that in the oligurias of toxic infectious origin in which digitalin, theobromin, and copious liquids are useless, intravenous injections of hypotonic solutions of sugar have a powerful diuretic action, improving the general condition of the patient and increasing the heart action.

Glucose was the sugar employed in these intravenous injections. However, canesugar has been given, for this purpose, by the mouth up to a dosage of 150 Grams a day and in some cases a remarkable diuretic and heart-tonic action was observed, together with absorption of effusions due to cardiac insufficiency. However, according to the experiments of Parisot and Mathieu on the rabbit, only the intravenous injection produced an immediate polyuria.

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ON TAKING MEDICINES.

By H. J. ACHARD, M. D., Asheville, N. C.

JANY people have an idea that if a

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medicine, prescribed for them by a physician, has done them good they can continue to take it ever after and give it to their friends, their sisters and their cousins and their aunts if any of them complain of symptoms in the least similar to the one the medicine was originally prescribed for.

Likewise if a physician prescribes a proprietary preparation and the patient learns the trade name, this preparation will thereafter be recommended indefinitely from one to another. "Strangely" it fails at least as often as it aids and the blame is put either on the medicine or on the luckless physician who prescribed it first; people do not know and cannot understand that it is they who are to blame. This is partly due to an entirely erroneous conception of what medicines are prescribed for. The laity still has the idea that "diseases" are labeled, as it were, in the doctor's brain-box and that with each "disease" a proper remedy or medicine is mentally labeled and pigeon-holed which is at once prescribed as soon as the diagnosis of a certain "disease" is made either by patient or by the physician. It is owing to this fact, for instance, that physicians are thought crazy if they prescribe castor oil in diarrhoea (note that I do not say for diarrhoea, but in diarrhoea). I think it advisable and timely to talk a little about medicines, how and when to give them; about diseases, how and when to treat them.

First of all, you must disabuse your minds of the idea that physicians treat diseases as such. Nothing is farther from our. desires; nothing would be less possible, less feasible. There is hardly a single disease so-called, that is a definite collection of symptoms pointing to a certain disorder in an organ or a number of organs of the body or throughout the body, that ever occurs in what we call its "classical" form. We hardly ever see, for instance, typhoid fever in the form in which it is usually described as typical. The same is true of measles, of scarlet fever, of pneumonia. There are always certain points different which may obscure the diagnosis at the beginning of the case because they may just as much point to the existence of other conditions than the one which is finally declared. That being the case it

stands to reason that one definite remedy cannot be applied to a "disease" which is really largely a mental picture of certain symptom collections. What is disease? It is a disturbance in the power of the organs of the body to carry on their functions normally. If then any organ is disturbed in its function the proper treatment is to restore that function, no matter what the name of the dominant disease may be. For instance, in the early stages of typhoid fever we may have constipation; we may also have diarrhoea. Both are evidences of a disturbance in the function of the intestines, and both call for the same treatment, namely, a preliminary cleaning out. If there is constipation, the feces in the intestines must be cleaned out. If there is diarrhoea, the mucus, the infected stools and all obnoxious material must be removed in order to give the intestines a chance to rest. In addition there are certain symptoms, such as a characteristic fever curve, languor, etc., which suggest a condition due to bacterial, more especially to typhoidal infection, and with our increasing knowledge in bacteriology, biology and immunology we are gradually learning to apply "specific" and bacterial remedies which are each appropriate in its special infectious disease. But in most instances the most efficient treatment in any infectious disorder must consist in raising the organ's resistance to the bacterial injury, in improving his general condition.

As

People will often ask a physician for a fever medicine, and it is a simple thing to give medicines which will lower an abnormally high temperature. Unfortunately, such medicines will only act like the lid of a jack-in-the-box. soon as their effect is exhausted, the fever jumps up again. The only sound treatment of fever is to remove the cause. If the fever is a reaction to a bacterial infection, this must be counteracted. If it is due to constipation, the bowels need cleaning out; if it is autotoxic the general elimination must be stimulated and so on. In every instance the cause must be removed and not the effect. You may fight against effects as much as you please; unless you remove the cause the effect will never be obviated. Take rheumatism, which is a popular lay diagnosis, and which as a disease does not exist, being much rather the name for a multiplicity of symptoms that may be due to a

variety of causes. For this reason it is impossible to give one or the treatment for rheumatism and in every single instance the particular cause must be searched out. There is an idiopathic rheumatism, an infectious rheumatism, a gonorrheal rheumatism, a rheumatism due to indigestion, to autointoxication, etc. The same is true of dyspepsia which also is not a disease, but a symptom of a number of diseases.

One of the conditions which the doctor, and not only the doctor but also the druggist, is most frequently called upon to prescribe for is headache and the all but innumerable mixtures and headache tablets on the market that can be bought over the counter in drug stores and in grocery stores are all equally makeshifts, absolutely unable to cure "headache." Headache is never a disease that can be cured as such but is always a symptom which may be relieved but which cannot be removed unless the underlying cause is attended to. As in the case of fever-remedies, as soon as the (usually depressing) action of the drug is exhausted, the pain returns. Much has been written in popular literature on the causation of headache and I need only mention that it may be due to constipation, to autointoxication, to any one of the many infectious diseases, to kidney disease and to many other causes. It is therefore absolutely futile to expect any treatment for headache as such to be efficient. Collier's Weekly and many other journals have paid attention to this and have exposed the criminality of the manufacturers who put up headache cures for public sale.

Other disease conditions that frequently present themselves to physicians for treatment and in which people expect a definite cure are "scrofula," dyspepsia, catarrh, "female trouble," nervousness, neurasthenia, "weak back," etc., for all of which the advertising "quack" promises most glibly and emphatically a prompt cure in the daily papers and especially in the religious press. All these conditions are due to a variety of causes which cannot be determined by mail or relieved by absent treatment. They all require careful personal and individual examination and study, and protracted, conscientious treatment, and they demand an equally persistent and conscientious obedience on the part of the patient to the directions of the physician.

One of the most dastardly things to advertise and one of the most foolish things to believe in is any drug remedy offered for sale for the cure of consumption. "Consumption cures" that are advertised so much in the lay press are invariably rank frauds, and are at best nothing but sedative

cough medicines which suppress the attempt of the lungs to remove the secretions and the broken down portions of the lungs and thereby to rid themselves of offensive and harmful material. These consumption cures are therefore strictly injurious and by fostering in the patient a foolish belief in their efficacy (because the cough is apparently rendered easier), they delay and postpone proper treatment that might be efficient at the time when it could be carried out; and thus they endanger the life of the patient by diminishing his ultimate chances for recovery,

4

It is never wise for the laity to take any but the simplest medicines or to treat any but the simplest ailments. Since the great majority of everyday diseases are, if not due to, then at least accompanied by, retention of secretions and of fecal matter, a mild physic will always be safe whenever the condition of health is disturbed. If this does not relieve promptly it is always safest to consult a physician, and in many cases the prompt and timely aid of a physician, involving one or two fees, will save weeks of illness and many dollars that would otherwise have to be paid to him for attendance upon a case of illness that might have been cut short.

The drug treatment of conditions of ill health is by no means the only treatment that is required. It is often not even the most important part of the treatment. Attentive and intelligent persons will notice that physicians are always careful to give, in addition to drugs, detailed and exact directions for the general care of the patients in regard to diet, to sponging, massage, applications of various kinds, etc. Drugs can relieve certain symptoms and can aid the organism in its attempt to overcome the effect of the causes of disease, and to this extent drugs are given as an aid to the "healing power of Nature." I do not mean to say that drugs are useless or viciousfar from it. It would be absurd invariably to "let Nature take her course," because all too often Dame Nature has a way of going astray badly and of cutting up high jinks. In every condition of ill health or disturbed health drugs may be of decided advantage in correcting, or in aiding to correct the deviations from the normal; but drugs a rule two-edged swords, at least those that are actively potent. They usually have as much power for harm as they have for good while on the other hand medicines that do not have a possibility for harm are all too often inert.

are as

It stands to reason then that drugs should be prescribed deliberately and knowingly. They should be prescribed for a special purpose to

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