food passing through the pylorus can be seen, and thus the diagnosis and even the prognosis can be fairly well fixed. The findings have been so illuminating that the prophecy may be made that in the future every suspected case of pyloric obstruction will be subjected to radiographic study before a plan of treatment is determined upon, just as today no surgeon would think of putting up a fracture without the use of the X-rays.

DRUG ADDICTION.

The Medical and Medico-Legal Problem of the Hour.

The problem of the drug addict grows more serious every day. The avalanche of antinarcotic laws that well meaning, but ill informed zealots have been responsible for in so many instances, have accomplished little or nothing aside from placing a few more useless and quite unnecessary restrictions on the busy medical practitioners of the country. Instead of reducing the sale of drugs to addicts, most of the laws thus designed have simply forced the traffic into new channels, and caused the whole matter to take on new and more sinister aspects. It is hardly fair to declare, however, that the anti-narcotic laws are wholly barren of results, for while they have in the main, proven inefficient in actually curbing the drug evil, they have served to bring the problem to the attention of many thinking men and women who would otherwise have given it little or no thought. As some one has said the surest way to correct an evil is to bring it into the light of publicity. If the agitation for anti-narcotic legislation has accomplished little else thus far, there can be no doubt that the people at large and the profession, too-have been taught a great many facts concerning drug addiction that they never knew before. The drug addict, poor soul, is gradually being considered as the unfortunate victim of a pathologic state for which he is in no way. responsible, rather than as a criminal or wanton panderer to vicious appetites. This radical revision of attitude towards the drug habitue bids fair to do much to place his treatment on a just and rational basis. With this idea of drug addiction more generally accepted it is not too much to expect that existing laws will be made more practical and effective, and instead of persecuting the drug addict, will seek to provide means that can be relied upon to restore him to health and a normal physical resistance. Thus again we get confirmation of the doctrine "all things work together for good." Futile as our anti-narcotic laws have been in accomplishing their avowed purposes, they surely have not been in vain.

"No stream from its source, flows seaward, how lonely so ever its

course,

But what some land is gladdened. No star ever rose and set without influence somewhere."

Of direct bearing on the ultimate benefits sure to accrue sooner or later from our anti-narcotic laws, impractical as they may be at the moment, is the announcement of the very important symposium on anti-narcotic legislation to be held under the auspices of the American Medical Editors' Association at the Hotel McAlpin, Wednesday afternoon, October 25th, at 2:30 p. m.

From the imposing list of jurists, national and state officials, social workers, and medical men, who are to take part in the symposium, and all of whom we happen to know have given much careful thought to the question of drug addiction in all its phases, this meeting promises much.

Every physician or layman who is interested in this problem of anti-narcotic legislation should make every effort to be present. The meeting will unquestionably be one of the most important and consequential held thus far and it is earnestly expected that this forthcoming discussion of narcotic drug evils by men whose opinions and utterances command the deepest respect, will have a constructive and far reaching effect on the whole situation.-American Medicine.

Obstetric Surgery.-E. P. Davis, Philadelphia (Journal A. M. A. Oct. 14, 1915), says that obstetrics has been the last department to share in the general advance of modern medical science, but a considerable gain has been made in reducing the morality and morbidity of parturition by the application of modern surgical principlese He reviews generally the history of the development of modern obstetric surgery which dates, he says, from the perfection of the classic cesarean section when Saenger accurately closed the uterine muscle and peritoneal covering separately. This reduced the mortality and morbidity of the classical section to a rate corresponding to that of other abdominal operations .Next came the observation that patients infected during labor became so through repeated examinations after the membranes has ruptured, conveying bacteria from the vagina into the uterus. Especially dangerous are unsuccessful attempts at deliverv bruising and lacerating of tissue. When it was learned that internal examinations should be made as rarely as possible, that diagnosis during labor should be made by palpation, ausculation and pelvimetry, and that attempting vaginal delivery during labor is a serious matter, the patients were brought to section with corresponding good results. There is still a remnant of bad practice in the attempts sometimes made to deliver the unengaged head by the forceps. The views as regards

the organisms living in the vaginal passages have been improved and it is realized that pathologic bacteria are liable to be found there. While obstetric surgery aims to obviate the dangers of contracted pelvis and to deal successfully with infectious foci or pathologic conditions of the pelvis or abdomen and to repair unavoidable injuries, it does far more for the child, not only saving its life, but also saving it from injuries to the nervous system that may compromise its future. Davis goes over the conditions in which surgery is called for and he asks, Do the results of modern obstetric surgery justify its existence? It is hard to estimate the maternal mortality of labor outside of institutions but it is fair to say that it is a fraction of 1 per cent. under favorable conditions. The mortality of spontaneous labor for the child is the mortality of asphyxia. Under the general head of birth pressure also fetal mortality may result from viseral hemorrhage. As regards the fetal mortality in classic cesarean section Davis holds that it is the most certain method of delivering a living child which exists. The high maternal mortality by the older methods of artificial delivery was about 1 or 2 per cent. and the fetal mortality following the use of forceps varies according to the mode of application. In low forceps operations at the Sloan Maternity it was approximately 10 per cent., in high operations 38.5, and the general average was 14.5 per cent. The subsequent history of the child as traced by Gans in the Konigsburg Clinic showed instances of damage affecting future life in a certain number of cases. The fact that version and contraction are fol lowed by a comparatively high mortality makes it difficult to compare it with the cesarean section. Davis believes that the development of laboratory work and the use of so-called instruments of precision have led to the neglect of clinical observation and thorough studies of cases by the senses only. We rely, it would seem in his opinion, rather too much on bacterial cultures for a knowledge of the conditions of the patient rather than on our powers of observation. The most important essential limitation in modern obstetric surgery is the choice of those who shall practice it and practical experience is the basis of all sound judgment in deciding whether to operate and the best method of operation. The opening of maternity wards and the multiplication of hospitals will, he thinks, with the better training of medical students, produce more skilled obstetricians capable of properly performing modern obstetric surgical operations.

In

The health of industrial workers has been safeguarded to a greater extent than at any time in the past. Studies have been made of the occupational hazards of steel workers in many of the leading industrial establishments of the country and insanitary and harmful conditions corrected. the zinc mines of Missouri methods have been adopted which should go far toward eradicating tuberculosis from that district. Investigations of child labor and of health insurance have also been made.

NOTES AND NEWS

GENERAL NEWS NOTES.

The Evanston, Ill., hospital has been given $125,000 by James A. Patton contingent on raising a like sum.

The National Board of Medical Examiners held its first examination in Washington, October 16-21. Ten candidates were examined, of whom five passed and five failed.

San Francisco plans a new half million dollar psychopathic hospital. So as to study South American diseases, Drs. William T. Councilman, Boston, and Robert A. Lambert, New York, are accompanying an expedition fitted out by Dr. Hamilton Rice, well known for his explorations on the upper Amazon, to the region of the upper Negro and Oricnoco. The expedition left New York, November 15.

The Deutsche medizinische Wochenschrift comments on the organization at Copenhagen of a society to study the social consequences of the war, saying that the loss of human life in the war to date cannot be estimated with accuracy. "Germany is the only country," it says, "which publishes systematically reilable casualty lists, and even in these the missing form quite a large proportion. No other country but England makes any attempt to publish the casualty lists regularly. The new society issues a bulletin and this tsates recently that up to July, 1916, there had been 4,631,500 killed in the war."

The Committee on Public Policy and Legislation of the Medical Society of the State of Pennsylvania met in Harrisburg, in joint session with similar committees from the Homeopathic and Eclectic State Societies and the Philadelphia County Medical Society. Legislation bearing upon matters vital to the profession was discussed. It was unanimously decided to work together for the profession. These committees decided to form "The Legislative Conference of the Medical Profession of Pennsylvania," the total membership of which shall be equal from each of the three component medical societies. Dr. John B. McAllister, of Harrisburg, is chairman and Dr. E. A. Krusen, of Norristown, is secretary-treasurer. The conference will welcome all suggestions upon legislative matters. A state narcotic law to supplement the Harrison law, amendments to the workmen's compensation law, the proposed law to incorporate health insurance, and the prevention of optometrists' legislation are some of the subjects that will require the attention of the medical profession of that state at the coming session of the legislature.

Laxness in the registration of negro births makes it probable that "our grandchildren and greatgrandchildren will be marrying persons having negro blood in their veins," according to a statement of W. L. Heizer, state register of vital statistics of Kentucky, made before a state meeting of city and county health officers which closed at Louisville, on December 14, according to The North American. He said the number of quadroons and octoroons who could not be distinguished from white persons was considerable. He recommended that registrars take greater care in accurately fixing of record the racial status. He urged compulsory registration of vital statistics for the whole nation under a card index system supervised by the federal government.

As a result of nearly two years' work, the New York Bureau of Preventable Diseases of the Health Department had, up to October 28, completed a list of thirty-five cases of typhoid carriers and a report of what is being done to prevent such carriers from spreading the disease. Prior to 1915 the department knew of some half-dozen carriers in the city, including the well-known "Typhoid Mary." Systematic work since then has resulted in the discovery of the other cases. It is estimated that in some commun

ities one person in every thousand is a chronic carrier. The typhoid carriers listed by the bureau include persons ranging in age from ten years to more than sixty. Nine were handlers of food by occupation, and they have been compelled to find other occupations.

A committee was formed to investigate the extent of the use of narcotic drugs, opium, morphin and heroin, in Philadelphia and Pennsylvania, to ascertain what help could be given in the cure of the victims of the drug habit and to recommend needed legislation to assist the federal government in its efforts under the Harrison narcotic law to restrict the sale and use of narcotic drugs. In their report, printed in pamphlet form and ready for distribution, they set forth many interesting facts regarding the investigation, make some recommendations and give a draft of a proposed bill to regulate the use and sale of narcotic drugs in the state. The Medical World has sent this committee several copies of their model state narcotic law, similar to the one adopted in Colorado.

The chief of the medical department of the German army, von Schjerning, has published an appeal to physicians for aid in collecting for the library of the Military-Medical Academy at Berlin every work bearing on the medical, surgical and sanitary aspects of the war, the whole to form a complete library of medical war literature. Authors are urged to send copies of their work to the Kaiser Wilhelms Akademie.

A complete Red Cross base hospital of 500 beds, with full personnel, was erected in a Philadelphia park during the recent Clinical Congress of Surgeons of North America. At a practical "field" demonstration for the 1,800 surgeons present, General Wood stated that 10,000 physicians would be needed in a medical reserve corps (taken from private practise) for the 1,000,000 men of the first army in case of war with any first-class power.

The report of the U. S. Bureau of Entomology, just issued, directs attention to the demonstrations of the Bureau specialists that the breeding of flies in manure can be prevented by treating the substance with calcium cyanamid and acid phosphate, which at the same time increase the fertilizing value of the manure.

Soon after the war began Sir William Osler was appointed honorary consulting physician at the Queen's Canadian Hospital, Shorncliffe. Since that time he had also been an honorary adviser in connection with the Canadian hospitals generally in England. To express his sympathy with Surgeon-General Jones, Sir William Osler has cabled his resignation to Premier Borden of Canada, and, it is understood, may go to Canada to speak in defense of General Jones.

Realization of the hope of the University of Chicago, for one of the biggest medical research schools in the world became a certainty today with the announcement of a gift of $1,000,000 from the Billings family, headed by C. K. G. Billings. The gift is to provide a hospital in connection with the school. The total cost of the institution is placed at $5,300,000, and with the Billings gift all but $550,000 has now been pledged.

Attention has also been given to the health of the children of the nation, more especially to rural school children. Over 32,000 children attending the public schools were examined during the year in order to determine their mental status and the causes and percentage of mental retardation and deficiency. In addition 7,000 physical examinations were complete for the determination of physical defects.

What is regarded as the largest and most important single undertaking of this nature yet inaugurated, the investigation of the pollution of the Ohio river,is still in progress. Surveys of the Atlantic coast and New England watersheds have, however, been completed and the extent and effects of their pollution is now known; this knowledge demonstrates that federal legislation to prevent the contamination of water sources is a necessity.