appears that PoDoLax is an aromatized syrup, containing phenolphthalein in suspension and fortified by the addition of an extract of senna. Its laxative action is due chiefly to the phenolphthalein, of which each dose contains about 1.8 grains. Podophylin was not found to be present (Jour. A. M. A., Aug. 15, 1914, p. 595).

SHORTAGE OF DRUGS.—In view of possible drug shortage, physicians should bear in mind that many proprietary foreign preparations are made and sold in the United States under their descriptive names, thus dionin as ethyl morphin hydrochlorid, urotropin as hexamethylenamin and Diuretin as theobromin sodium salicylate (Jour. A. M. A., Aug. 22, 1914, p. 692).

MIXED VACCINE AND PHYLACOGENS.-The unscientific character of mixed vaccines and of the mixed filtered products of a number of vaccines marketed as "Phylacogens" has been especially emphasized and the danger from their indiscriminate use pointed out. Recently John F. Anderson held that the claim that the combination of dead bodies or the filtered products of a number of different bacteria are useful for the treatment of certain diseases with a specific cause, closely approaches quackery. Victor C. Vaughan also has pointed out the danger of the indiscriminate use of bacterial products and observed that untoward results are rarely reported. Physicians who are tempted by the optimistic statements of manufacturers to give complex bacterial products a trial, should remember that the warnings of disinterested scientists are of far more value than uncritical clinical reports put out under commercial auspices (Jour. A. M. A., Aug. 29, 1914, p. 785).

THE RADIO-ACTIVITY OF SARATOGA SPRINGS WATER.An estimation of the radio-activity of Saratoga Springs water, made by the United States Bureau of Mines, shows that the activity is due in the main to radium emanation, which is therefore readily lost, and not to dissolved radium salts. The total activity of the water is rather low, that of the Crystal Rock spring, though not exceptional, is considerably above the average. The activity of different springs varies widely, some being more than twenty times as active as others. A similar variability is known to exist at Hot Springs, Ark., but only the vaguest information has been made public by our government (Jour. A. M. A., Aug. 29, 1914, pp. 788 and 795).

RADIUM IN CANCER.-Radium can be used successfully to destroy growths on the surface whose entire extent can be exposed to its energy. Extensive growths involving deep structures and disseminated growths are beyond its control, and there is no reason to believe that they will ever be brought within its control. The effects and the limitations of radium in the treatment of cancer are the same as those of the Roentgen ray (Jour. A. M. A., Aug. 29, 1914, p. 787).

PERTUSSIS VACCINE.-The Bordet-Gengou bacillus is recognized as the cause of whooping-cough and a vaccine prepared from it is used with success, although it is the general experience that when a child is already in the stage of incubation, the vaccine will not prevent the development of the disease (Jour. A. M. A., Aug. 29, 1914, p. 796).

SCARLATINA VACCINE.-The so-called scarlatina vaccine is said to consist of killed streptococci from scarlet fever cases. While the infectious agent of scarlet fever has not been established, the close association of streptococcus with scarlet fever has been considered a warrant for the use of antistreptococcus serum, and various vaccines prepared from this organism, in the treatment of scarlet fever (Jour. A. M. A., Aug. 29, 1914, p. 796).

BOOK REVIEWS

THE PHILOSOPHY OF RADIO-ACTIVITY. By Eugene Coleman Savidge, M.D. Published by William R. Jenkins Co., New York. Pp. 151. Octavo. Cloth, $1.50 net.

This interesting and at this time highly practical volume enables one, even though not possessed of a profound knowledge of physics, chemistry and biology, to grasp quickly and without much effort the laws and significance of the subject of radio-activity. Radio-activity is defined as the end of a force which vitalizes the universe. Time and space annealed together by the force of the universe slowly disengage according to immutable mathematical laws. Cancer and malignancy are only a small part of this great disengagement and for their understanding as well as for that of all the other sciences, a great remodeling has taken place since the discovery of radium. Savidge presents this thesis: that matter is involuted with selective purpose and that there is an attraction of duration for matter which is as mathematical as the attraction of gravitation.

The book is worth reading, for it opens up new fields and is explanatory of many hitherto obscure points in connection with life and growth and the deviations of growth represented by new growths or tumors. The publisher presents the book in very attractive form.

THE THEORY AND PRACTICE OF BLOOD-LETTING. Presented from the point of view of our present knowledge. By Prof. Dr. Heinrich Stern in New York. Weurzberg, Verlag von Curt Kabitzsch. Pp. 144. Price, paper, M. 3.50; bound, M. 4.50.

Our New York confrère has presented in an attractive garb "the forgotten art of blood-letting." He considers the procedure from a theoretical as well as a practical point of view and has grouped in this monograph the views of those clinicians and physicians who are beginning, after careful investigation and comparison, to say a good word for blood-letting as a therapeutic measure. He is not, in practice, as enthusiastic as Clutterbuck of old, but is hopeful that the progress made during the last few years will revive the procedure. After an interesting histroic introduction, he discusses the changes in the functions of the blood, its quantity and distribution as well as its composition which follows phlebotomy, and then discusses the present status of the technic of phlebotomy.

It is truly refreshing to read in a scientific book concerning "dry cupping" and "phlebostase" and "scarification" and "cupping" proper and "artificial”

and "natural leeches," etc.-names with which the younger members of the profession are not even familiar.

In the second part the various diseases which demand either the local or general abstraction of blood are considered, including the abstraction of blood in children and the prophylactic use of it. The references to the literature are very complete and a satisfactory index, so rare a thing in a German book, materially assists in the reading of this book. The illustrations which decorate the volume are to the point and well executed.

It might be a profitable venture for some one of the many German speaking young men who are waiting both in New York and out of it for an opportunity "to bleed" people, to translate into our vernacular this brochure.

By

A HISTORY OF LARYNGOLOGY AND RHINOLOGY. Jonathan Wright, M.D., Director of the Department of Laboratories, New York Post-Graduate Medical School and Hospital. Second Edition, Revised and Enlarged. Octavo, 357 pages, illustrated. Cloth, $4.00 net. Lea & Febiger, Philadelphia and New York, 1914.

As the author says, "this is the story of the records of the nose and throat in general medicine with the general drift of medical history." The story is most entertainingly written, is full of charm and engages the reader's attention throughout. From the time of Egyptian medicine, the author traces the growth of this branch to its present modern development. The book affords not only pleasure and recreation for a leisure hour but gives the reader breadth and depth of view not only of his specialty but of all phases of medical practice that will be useful in his daily routine.

SCHOOL JANITORS. By Helen C. Putnam, A.B., M.D., Chairman of the Committee of the American Academy of Medicine to Investigate the Teaching of Hygiene. Cloth, 200 pp., 16 mo., $1.00 postpaid. American Academy of Medincine Press, 52 North Fourth Street, Easton, Pa.

This excellent book consists for the most part of contributions previously made by Dr. Putnam to the Child-Welfare Magazine, the organ of the National Congress of Mothers and Parent-Teacher Association. The work contains much information of paramount value to parents that should lead to improved conditions of schools. It is such books as this that will arouse intelligent investigation by the people into the conditions of school life and determine whether or not those conditions are a menace to child life, thus leading to proper remedies. The book will do real service in the work of health protection.

A HANDBOOK OF PSYCHOLOGY AND MENTAL DISEASES FOR USE IN TRAINING SCHOOLS FOR ATTENDANTS AND NURSES IN MEDICAL CLASSES, AND AS A READY REFERENCE FOR THE PRACTITIONER. By C. B. Burr, Medical Director of Oak Grove Hospital (Flint, Mich.), formerly Superintendent of the Eastern Michigan Asylum, etc. Fourth edition. Revised and Enlarged, with Illustrations. F. A. Childs Co., Publishers, Philadelphia.

This small book, now offered in the fourth edition, offers in compact form the experience of a clear

headed, practical man, who has demonstrated his ability to take good and kindly care of insane and nervous folk and to instill into his assistants, nurses and attendants a spirit of gentleness and a desire for efficiency. The book only aspires to fill a modest need and it does that and more. It is worth the while of any physician to read it, and it offers to the nurse and attendant a guide to better comprehension of people mentally sick and of their duty toward them.

OUTLINES OF GREEK AND ROMAN MEDICINE. By James Sands Elliott, M.D., Ch.B., Edinburg, Editor of the New Zealand Medical Journal. London: John Beal Sons and Danielson, 1914. Pp. 165.

Dr. Elliott, who has written a most interesting little work, has gone about it in rather a peculiar way. He treats first of Roman medicine and then of Greek medicine, of which latter he gives an account to 280 B. C. Then Roman medicine is returned and treated of, up to Paulus Aegineta, of the Alexandrian School, who lived in the sixth century B. C. He describes very interestingly the social status of practitioners which, as is well known, was not very high, and the fact that most of the physicians in Rome were Greeks afforded splendid opportunity for such men as Cato and Pliny to ridicule them. Then as now, much of the abuse was of course undeserved, although it was difficult to decide which was the quack and which the learned doctor.

Dr. Elliott has collected many facts of great interest and value to the medical historian and the book will prove interesting reading to those who are just about to get an insight into the beauties of medical history, although we confess that the arrangement of the subjects does not strike us very favorably. The theme is a very large one and would require a very extensive volume for its thorough presentation.

It is gratifying that the English speaking world is awakening to the value of medical history and is presenting it in an interesting and fascinating man

ner.

A MEDICAL HISTORY OF THE STATE OF INDIANA. By G. W. H. Kemper, M.D. ' Illustrated. American Medical Association press, Chicago.

The little volume contains much interesting information, although there are a few statements which might with advantage have been expressed differently. Such illustrious characters as John S. Bobbs, Theophilus Parvino, William H. Wishard, George R. Mears and Joseph Eastman are entertainingly described among the two thousand others which are given more or less consideration. The book represents a great deal of work on the part of its author and should appeal to all those who are interested in medical history in America.

COLLECTED PAPERS BY THE STAFF OF ST. MARY'S HosPITAL, MAYO CLINIC, ROCHESTER, MINNESOTA. 1913, Philadelphia and London. W. B. Saunders Company, 1914.

This latest volume of papers contributed by the staff of the Mayo Clinic comprises a great many reprints, which doubtless are valuable for reference when bound in one volume. The volume is illustrated and well-edited, containing an index of con

tributors, bibliographic index and a comprehensive subject index.

THE SURGICAL CLINICS OF JOHN B. MURPHY, M.D., at Mercy Hospital, Chicago. Volume III, Number 3 (June). Octavo of 213 pages. Illustrated. Philadelphia and London: W. B. Saunders Company, 1914. Published bimonthly. Price per year: Paper, $8; cloth, $12.

A most valuable number. The first group of subjects embraces six Clinical Talks on Surgical and General Diagnosis. These are followed by a goodly array of clinics on a variety of surgical conditions. ANOCI-ASSOCIATION. By George W. Crile, M.D., Professor of Surgery, School of Medicine, Western Reserve University; Visiting Surgeon to the Lakeside Hospital, Cleveland, and William E. Lower, M.D., Associate Professor of Genito-Urinary Surgery, School of Medicine, Western Reserve University; Associate Surgeon to the Lakeside Hospital, Cleveland. Edited by Amy F. Rowland. Original illustrations. W. B. Saunders Company. Philadelphia and London, 1914.

Surgical progression is gradual, and is possible only through knowledge which comes from long records of successes and failures. Only occasionally does some superior mind direct us to facts which make for more rapid and more certain advance. As examples of striking enterprise, we may recall Lister and those who introduced anesthetics; and we venture that almost as distinct an impetus toward the goal of finished surgery is given by the recent promulgation of the so-called theory of anoci-association.

A modest volume of some two hundred and fifty pages of text interspersed with numerous photographs, diagrams and charts, suffices for the elucidation of this new doctrine. The general character of the book requires no particular comment, unless it be to direct attention to some rather novel strategies of the authors who, for example, employ the photograph of an exhausted athlete to drive home the significance of a stated fact! The style is interesting. The authors are positive in their views, and courageous in the expression of them. Indeed, the confident assurance with which the subject of shock is approached is quite infective; the subtle enthusiasm in and between the lines is so compelling that we might willingly acquiesce in the intricate explanation of the problem were we unmindful of the fact that one of the authors has previously offered, with the same consummate assurance, several successive solutions for this complex problem.

The book is in two parts, Part I being devoted to an exposition of the authors' conception of the kinetic theory of shock, and Part II to the application of the kinetic theory to the technic of surgical operations. The fundamental purpose of the book is the practical presentation of the technic of anoci-association. Stated briefly, the hypothesis is that a certain set of organs, among which are brain, thyroid, adrenals, muscles and liver, may be grouped as a kinetic system, whose function is to convert potential into kinetic energy, in response to adequate stimuli. If stimuli are overwhelmingly intense, then the kinetic system-especially the brain-is exhausted, even permanently injured. In other words, shock is

the result of intense stimulation of the kinetic system by physical exertion, emotion, trauma, etc. The deduction from these premises is that the exclusion of both traumatic and emotional stimuli will wholly prevent the shock of surgical operations.

The manner of excluding these stimuli is described in Part II. Different operations are described separately, but we may group the maneuvers as precautions against both emotional and traumatic stimuli. Unpleasant emotions are guarded against by kindly, confident, reassuring management and by careful nitrous oxid anesthesia preceded by narcotics hypodermically. Anesthetics are begun in bed in some instances. The after-treatment is carefully planned. The traumatic stimuli are excluded by local infiltration of the operative site, and blocking off the operative field by injection of quinin and urea. Moreover, emphasis is laid on sharp, clean incisions, gentle manipulation, ample exposure, no traction, thorough hemostasis, and closure without tension. Difficult operations, or operations in weakened patients are to be completed in two stages. Descriptions of some operations are amplified at the expense of others; but the authors satisfactorily explain the seeming lack of balance. Obviously, the method requires an infinite amount of attention to detail, and is hardly applicable in emergency surgery, which furnishes the greater proportion of shocked patients. And further, it is apparent that the technic is of vastly more service in the prevention than in the alleviation of the condition.

An inventory of the book leaves us with two impelling questions, viz.: (1) is the hypothesis justified? and (2) is the application of the technic warranted? We withhold judgment in the first. In support of his hypothesis Crile arrays his evidence to show that the phenomena of exhaustion from physical exertion closely resemble shock; that the phenomena produced by trauma and by extreme passion or fear are analagous; that fear and trauma have a common phylogenetic origin and are akin; and that in the brain cells there is found a physical basis of shock. While admitting the attractiveness of this theory and admitting the indubitable evidence of the effect of mind on body, we feel that Crile's research is so absolutely unique an adventure in investigative fields that we must restrain our credulity and hesitate in accepting until further corroborative evidence is introduced. The chapter on histologic pathology of shock borders on the speculative metaphysical so near as to be semimysterious and disconcerting; for cellactivity and cell-function may not be pictured under the microscope, consequently cannot be accurately correlated with cell-structure. We hesitate not at improbability of correctness of conclusion, rather only at apparent inconclusiveness of proof.

We answer the second question decidedly and emphatically in the affirmative. From a purely practical point of view, the enunciation of this doctrine is of tremendous significance. In his imperative emphasis on preserving the patients' mental poise; on rational anesthesias; on gentleness, thoughtfulness and dexterity on the part of the operating surgeon; Crile outlines essentials which, if observed, will result in a rejuvenation of surgery and will lead to a refined elegance and finish of surgical technic, the superior excellence of which defies definition.

ORIGINAL ARTICLES

THE USE OF THE ELECTROCARDIOGRAPH IN THE STUDY OF THE HEART *

G. CANBY ROBINSON, M.D.

ST. LOUIS

With new methods for the clinical study of the circulation there have come new conceptions of circulatory disturbances. It is one of these newer conceptions to which I wish to direct your attention, and to show how the electrocardiograph has extended and clarified it.

The heart can no longer be looked upon clinically merely as a pump, forcing the blood through the systemic circulation and through the lungs, but it must be considered as consisting of two separately contracting muscle masses composing the auricles and ventricles. Upon this conception rests the large structure of knowledge which has been built up about the irregularities of the heart-beat. The efficiency of the heart in normally maintaining the circulation depends in part on the proper coordination between these two separately contracting muscle masses. I shall endeavor to show how the electrocardiograph is, at present, the best method for studying this coordination and its derangements. Besides this knowledge of coordination there are other facts of distinct clinical value obtained by the use of the instrument which will not be discussed in the present paper. The records to be shown represent the commoner forms of incoordination of the heartbeat which have been met with during the past few months in the clinic. Technicalities will be included only so far as necessary for an understanding of the records, and a complete explanation of the electrocardiographic method will not be undertaken.

* From the Department of Medicine, Washington Union Medical School.

* Read in the General Session of the Missouri State Medical Association, at the Fifty-Seventh Annual Meeting held at Joplin, May 12-14, 1914.

The

The electrocardiograph consists of a string galvanometer which indicates by the movements of its string the passage of minute electrical currents and an attachment by which the passage of these currents may be graphically recorded and which can, in turn, be interpreted as muscular contractions of the heart. string of the galvanometer, which consists of an exceedingly fine platinum or silver covered quartz thread, suspended in a strong magnetic field, is so adjusted that the passage of a one millivolt current through it causes a deflection of the string which yields a wave on the record one centimeter high. The movement of the string is always exactly in direct proportion to the strength of the current passing through it, so that the strength of any current causing a wave in the record is known.

In order to simplify the principles of electrocardiography, let us first explain how the contraction of any muscle may cause a current to pass through the galvanometer. A muscular contraction always begins at the point where the muscle is stimulated, no matter whether this stimulus be mechanical, electrical or the result of a nerve impulse. A normal muscular contraction never begins in all parts of a muscle simultaneously. The point at which the muscular contraction begins becomes electrically negative to all parts of the muscle still in the resting stage. If then, the two ends of a muscle are joined by an electrical conductor, such as a wire, a current will pass through this conductor from the electrically positive to the electrically negative end of the muscle. other words, a current will pass through the conductor from the resting end of the muscle to that part which has been stimulated and has gone into contraction. When the contraction has involved the entire muscle, no current passes, as all parts of the muscle again show no difference in electrical potential, just as they do in the resting flaccid state. As the contraction in the part first contracting subsides, however, an electrical current passes through the conductor in the opposite, direction from that

In