up its heat units. If too great an amount of this debris is allowed to remain the fires of the body are in danger of being put out by these poisonous materials. The elimination of these materials is one of the functions of the intestinal canal. One of the requisites of good health is an educated intestinal apparatus. Perhaps this is even more important than an educated set of brains. Certainly an educated set of brains cannot work effectively so long as the intestinal apparatus is badly operated.

Man in our present state of civilization is obliged to pay particular attention to functions which in a state of nature took care of themselves. A robust man engaged in active exercise in the open air may commit dietary indiscretions which would be exceedingly harmful to a sedentary worker. Exercise as a part of the daily life is, however, absolutely necessary for both. Plain, wholesome food is just as necessary for the brain worker as for him who labors with his hands. Above all, both must keep the human furnace well shaken down and without accumulation of ashes and debris in order that the fires of life may burn brightly and steadily.

PHYSICIANS' REMUNERATION IN HEALTH INSURANCE.

The coming of health insurance is regarded by many physicians and many laymen as an assured fact. It has been successfully acomplished in Europe, notably in England. It is now being agitated in America very extensively. Health insurance is a great advantage to the people insured and correspondingly to the country at large. We are glad that the governments are at last recognizing their duty to their people along this line.

The plan advocated is to have the insured employee bear twofifths of the cost, the employer two-fifths, and the state one-fifth. It is a very elaborate plan and has many details, a large number of which have not been worked out satisfactorily.

The medical profession is most concerned in this matter and must watch every turn the affair takes lest it be caught napping and have some undesirable legislation passed that will be highly disadvantageous to medical prospects, prosperity and progress.

An element of danger to the profession is the fact that the insurance of the public is transacted through the insurance companies. These companies are organized for their own profit, and their aims in pushing this form of legislation are to create more business for themselves with as little remuneration to the medical profession as possible. We think it is a great big, irreparable mistake to permit any of this class of insurance to be carried by corporations. It should all be done by

and through government (state) insurance departments acting as insurance companies. No private companies should be permitted to do any of this insuring. Only then can we expect any proper treatment of the medical profession.

The idea of the insurance bill is to pay the physician a certain sum for each person on his list. The list is limited to a certain number. This limiting of the list of insured employees on a physician's list is a good thing, for otherwise a doctor might have a larger list than he could look after, and some would then perforce receive little or scant attention. This has happened in England. The limit set in the bill of the American Association for the Advancement of Labor is 200 families and a total of 1,000 patients. This is large enough. Curiously, the bill has no provision for the payment of physicians. We believe that the bill should provide that every physician on the panel. shall receive $3000 per year, not a cent less. If the bill when persented in the legislature does not contain such a provision, the profession in every state must see that such a section is incorporated in it.

The insurance companies desire to leave this matter open, so that they can dicker with the doctors separately until they find somebody who will accept the panel appointment for very little. As we said. above, the insurance companies should not be allowed to insure any of this insurance; it should all be done by government insurance.

The profession itself is vitally interested in this movement. The insurance will affect a large number of people, many or perhaps most of whom are now private patients of the profession. Doctors everywhere must look alive to their own interests or their interest will not be looked after.

Our medical societies should also fall in line with the activities of the doctors and assist in shaping this legislation so that the profession will be properly treated. A prosperous profession means prosperous medical societies, well-attended conventions, better medical service, better drugs, better instruments, better health, greater progress along medical lines in treatment and prevention of disease.

The success of the medical profession in getting this legislation made satisfactory to the medical men depends on every physician doing his utmost to see that such a provision is made in the bill for the payment of the doctors as we have just mentioned. Physicians must be properly paid if they are to give their best service. A poorly paid physician cannot do so. If the bill fails to provide for physicians properly it will be because physicians have failed to attend to this matter. No physician is so insignificant or obscure as to have no influence with his legislators. We know that the more of them exert themselves on any subject, the more it is likely to succeed. The insur

ance companies depend on the lethargy, the inactivity, of the medical profession to permit them to get the bill passed in the form best suited to their interests and against the interests of the medical profession. Only a big upheaval by the doctors themselves can prevent the insurance companies from succeeding in their scheme.-(The Medical Summary.)

Primary Infectious Jaundice with General Symptoms Predominating-M. Garnier (Paris medical, December 9, 1916) points out that while in many cases of infectious jaundice the symptoms due to the cholemia and the constitutional symptoms due to the infection are equally marked, in another group, catarrhal jaundice, the infectious symptoms are relatively much less pronounced, and in a third group, which he has specially studied, these symptoms distinctly predominate. In a series of five hundred cases of primary infectious jaundice recently under observation, six were of the latter type. The onset was marked by chills, fever, backache, and at times mylagia, soon followed by gastrointestinal disturbances, nausea, and vomiting, and sometimes diarrhea. The temperature usually ranged between 28 and 39 degrees C., sometimes attaining 40 degrees temporarily; it often dropped at the time of appearance of jaundice. Discoloration of the skin, including that of the face, was only slight, the conjunctivae being alone distinctly yellow. The urine showed the usual mahogany color. Elimination of urobilin in these cases was intense from the start. In this form of infectious jaundice, the system evidently utilizes with success all its resources for getting rid of the pigment. The elimination in the urine, and likewise the skin discoloration, was brief in these cases, terminating twice on the eighth day, and once each on the sixth, seventh, ninth and eleventh days from the beginning of the jaundice. All trace of conjunctival discoloration passed off simultaneously, soon after, or even before bile pigment disappeared from the urine, whereas in other forms of jaundice an interval of seven to twenty-four days elapsed. At no time in these cases did the feces lose their dark brown color. The temperature usually reached nomal three or four days after the appearance of jaundice, but in two cases remained febrile until the jaundice disappeared. In one case a relapse took place. Attacks of angiocholitis in cholelithiasis might be confused with these cases, but in the former the onset is sudden and distinctly painful and jaundice appears with the first sign of malaise, the preicteric period being absent. That the form of infectious jaundice described by Garnier is actually of hematogenous origin was shown by hemolysis test. In one case the A paratyphoid organism was found in the blood.

ABSTRACTS

Metastatic Gas Gangrene Kenneth Taylor (Lancet, December 23, 1916) reports two cases of metastatic gas gangrene as throwing some light on the factors which lead to metastasis in this fatal condition. In the first case the original infection involved one arm, which was promptly amputated with fairly complete removal of all infected tissues in the neighborhood. The second was a wound of the right buttock. In the first case the patient was kept in a sitting posture and in the second the patient was forced to lie on his left buttock. Metastatic gas gangrene developed in the right gluteal region and leg in the first case and in the left buttock in the second. In both cases autopsy confirmed the findings and proved the absence. of all direct passage of the infection from the original to the secondary site. In one of the cases culture from the heart's blood proved positive for Bacillus aerogenes capsulatus, though blood culture had been sterile up to three days before death. In the second case even the heart's blood was sterile. These two cases suggest that the constant pressure of the body upon a given area is capable of lowering its resistance to such an extent that there can be a localization there of the virulent organisms which probably circulate in the bloodstream for some time during the course of the illness.

Small Cranial Injuries and Their Complications-Andre Martin (Paris Medical, December 9, 1916) calls attention to the severe complications which may follow apparently insignificant injuries of the head by small shell fragments. Many of his cases had small wounds apparently involving only the scalp; where several days had elapsed since the injury, the tissues were more or less infiltrated with blood and the pericranium injured, while after a few weeks the skin was often healed, with a small sinus, however, persisting. Upon examining the skull there was found either a small fissure, generally curved or angular and sometimes masked by an organizing hematoma; several fissures diverging irregularly; a few bone fragments, either adherent, with blood, serum, or even pus frequently filtering through the intervening interstices, or partly detached and movable; or finally, a cup shaped depression hardly exceeding the size of a finger tip, sometimes limited to the external table but usually involving the internal. The subjacent lesions revealed by operation comprised extradural fungous formations, bathed in pus, or an extradural hematoma or abscess. The central lesions found among eleven cases comprised two instances of cerebral hematoma, two of cerebral abscess and one of cerebellar abscess. Clinically, the cases fell into three groups, the first showing at first no sign of injury other than

the small scalp wound, often without the least headache, but manifesting unexpectedly after two or three weeks slight fever, with appearance of a droplet of pus through the wound; in spite of the relative absence of symptoms, grave lesions may be found at operation in these cases. In the second group the patient presented himself with such symptoms as headache, nausea, slight slowing of respiration, a variable and misleading temperature, a pulse rate of about sixty, and in particular, a continuous prostration and mental torpor. The focal symptoms were in most instances practically absent, though the cerebellar case presented a complete, typical picture. The symptoms were insufficient to show before operation whether an extradural or cerebral hematoma or abscess existed. In the third group the wounds were apparently healed when the complications developed. On the whole, Martin's experiences showed that in cases of small head injuries which manifest mild or severe bone or brain disturbances after apparently healing, even several weeks after the wound, no time should be lost with half way measures, but the bone and dura at once explored. In fact, it would seem advisable to inspect the skull if necessary enlarging the scalp opening with the knife, immediately after the mildest scalp wounds.

Syphilis of the Stomach-George B. Eusterman (American Journal of Medical Science, January, 1917) maintains that though syphilis of the stomach is rare, it is not as infrequent as is generally supposed. The aid of the Wassermann-Noguchi reaction and of the Rontgen rays are necessary to establish the presence and specificity of the lesion, yet denial of the disease, lack of evidence of a primary lesion, or absence of a positive Wassermann, does not exclude the possibility of gastric syphilis. The diagnosis is based on the history of infection, a consistent positive Wassermann, indisputable evidence of a gastric lesion, and-excluding cases that show irreparable extensive damage—a permanent cure by antisphilitic measures. Often it is made accidentally. The symptomatology is suggestive of benign gastric ulcer; the gastric chemistry and Rontgen findings rather suggest carcinoma. In most instances the condition is characterized by an initial intermittant course, followed soon by continuous symptoms and associated with epigastric pain of variable degree, felt shortly after taking food and not relieved by food or alkalies. From the outset there is a tendency to emesis, a variable degree of flatulence, good appetite, infrequency of hemorrhage and palpable tumor, diffuse abdominal resistance, a progressive course, and marked loss of weight without cachexia. Anacidity or achylia is characteristic of the majority of cases. Extensive gastric involvement is frequently present at the time when gastric disturbance first becomes manifest. A