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gas was used. A general anesthetic is useless in this condition, and so also is local anesthesia. If the patient is very unruly, and assistance is lacking, an anesthetic may be necessary in order to do a lumbar puncture.
WHEN TO DISCONTINUE THE SERUM. 1. The condition of the spinal fluid. 2. General condition of the patient.
At the onset of the disease the spinal Auid is nearly always cloudy, contains many extracellular organisms and many pus cells, and is under increased pressure. Usually at the end of five daily injections of serum the fluid clears up, the organisms disappear, and there are very few pus cells, or none at a'l. At the same time the patient's mental condition improves, the temperature drops, and the rigidity of the neck and extremities decreases. The serum should be discontinued under these conditions. After this a lumbar puncture, for a period of another week, should be done upon alternating days, to see whether the fluid remains normal. Even though clinical signs have improved, if the Auid should become cloudy again and pus cells and organisms return the serum should be immediately readministered. If one is uncertain, the patient should always be given the benefit of the doubt, by the injection of serum. The fluid clears up, on average, about the tenth day.
hydrate deficiency, increased protein metabolism means a large increase in the metabolic burden of the body. For the organism with a defective metabolic system, as evidenced by the presence of diabetes, this added metabolic activity is very harmful. Besides, protein metabolism is the most potent factor in the production of acid ; indeed, protein food may be called acid food. In addition to the natural hypoalkalinity of diabetes there is, then, the increased acid production—and acidosis is bound to follow. The administration of carbohydrates reduces the protein metabolism sufficiently to prevent acidosis, where the carbohydrates oxidizing power is not too far gone.
When the value of administering carbohydrates in diabetes was first understood it was thought that certain carbohydrates behaved differently from oth
Oatmeal was supposed to have a special value as a carbohydrate cure because it was thought that the starch in it had a special action; that it had certain special ferments or extractives of value; or that it reduced the permeability of the kidneys to sugar. None of these hypotheses has any substantiation, and any value that oatmeal has in the socalled "oatmeal cure" must be ascribed to the gencral value of carbohydrate administration, where there is a defective carbohydrate oxidation, and where the organism is using up its own body proteins to make up the deficiency naturally withdrawn in a mistaken notion of treatment.
The most recent conception of the proper treatment of diabetes takes into consideration the metabolic disturbance at the base of the disease, as well as the part that the carbohydrates play in the dis
The starvation treatment has for its object, therefore, the resting of the metabolic system for the period of the starvation. The subsequent dietary treatment no longer contemplates the withdrawal of the carbohydrates, but rather that they be given in sufficient quantities for the needs of the system, without necessitating drawing on the body proteins. On the other hand, it is not intended to tax the metabolic processes by administering large quantities of food. Every element of food is reduced to the minimum needs of the body. When it is remembered that a reduction of half of every one's dietary would be beneficial rather than harmful, there need be no fear of underfeeding in an organism whose metabolic system is damaged. Most of all, is the protein kept at a minimum in order to reduce the tendency to acid production.—Boston Medical and Surgical Journal, June 6, 1918.
CARBOHYDRATES IN DIABETES. In the progress of our knowledge of the nature of diabetes there has been a marked reaction against the entire withdrawal of the carbohydrates from the dietary of the diabetic. For a time there was even a tendency to administer carbohydrates as a curative measure and the “carbohydrate cure" seemed all but established. Then caine the understanding that the carbohydrates cannot be withdrawn from the dietary of the individual without increasing the tendency to acidosis, or of precipitating a grave acidosis where previous to the carbohydrate withdrawal there was only a mild one. It is found that when the carbohydrate withdrawal is persisted in, acetone bodies soon appear in the urine. As the sugar disappears the acidosis appears. It must be understood that the presence of sus. in the urine is of importance only as indicating that the sugar is not being oxidized or utilized. As long as enough sugar is oxidized there is no harm in some or even a great deal passing through unoxidized, but as soon as the amount oxidized becomes deficient then acetone appears.
Even in rather severe diabetes the organism can oxidize some sugar. If in these cases not enough carbohydrates are given to satisfy the meager demands and oxidizing powers of the organism, acidosis follows, so that in cases treated with carbohydrate withdrawal, in whom acidosis threatens. carbohydrates must be administered to forestall the event. Moreover with the withdrawal of the carbohydrates, so necessary for the production of heat and energy, the organism draws upon the proteins of the body for its carbohydrates. It is shown, in fact, that with the increase of the carbohydrate intake there is a decrease in the protein consumption. Whether the protein of the body is utilized in great quantities, or more proteins are consumed to make up for the carbo
“AFFLICTION MAY ONE DAY SMILE
He is a man of attractive mien, middle-aged and gray, with clean cut features and an expression of utmost kindliness. And he has done his part in the war as few men have, for in founding St. Dunstan's Hospital for Men Blinded in Battle, Sir Arthur Pearson has brought light to the lives of hundreds of soldiers who have given their eyes for England.
Sir Arthur is proud of his school, as he may well be, and prouder still of its happy pupils who are
haps more deeply than we who have eyes, the students gather about in groups. They are fond of singing. One among them is gifted with a remarkable tenor voice, which gives great promise. And there are guitars, and mandolins and ukeleles whose strings throb with gay soldier songs and song of home and love. There are two blind men with a guitar in a rowboat on the lake. No gondoliers of Venice sing more sweetly. There are two more · engaging in a tug-o'-war, in a moonlit circle on the lawn, cheered on by their companions.
So life at St. Dunstan's is pleasant. The days are filled with work cheerfully done. The blinded soldier comes back to his own and soon retrieves his lost spirit, and in a measure, his lost "sight," for he discovers that he does not see with his eyes, but with his brain, and though deprived of the proper Godgiven medium of sight, soon learns to convey the "message of the light” to his brain through other channels.
It is surprising that Sir Arthur takes such pride in his pupils ? He is giving men back to life and usefulness, showing them the "unknown guest” within whose power no amount of material misfortune can dwarf. St. Dunstan's will go down in history as one of the great institutions of the war, one that has revolutionized the teaching of the blind and made of them merely normal individuals who are doing without their eyes and doing well!
learning to make four senses do the work of five, and still finding life good.
St. Dunstan's was opened in 1915, in the London residence of Otto H. Kahn, of New York. It is the only institution of its kind maintained by private initiative and voluntary contributions. Its student body numbers 400; 600 have already been launched anew in life, well satisfied with the training and encouragement they have received, and well able to meet life and make their own way-not as “blind men," but as "normal men who have lost their sight.” Maudlin sentiment and pity have no place at St. Dunstan's. The men are taught self-reliance from the first and not permitted for a moment to consider themselves afflicted." Handicapped, perhaps, but afflicted, never!
The pupils are taught to read by the perfected Braille system, and it has been observed that the average blind student acquires the rudiments of Braille as easily as a child learns his alphabet, after which progress is rapid. Finger tips are soon trained to take the place of eyes and the fairy world of books is not long closed to the sightless. In the operation of the typewriter, the blind pupils are very proficient and many have already taken their places in the business world as trained secretaries, after having mastered Braille shorthand. Some of these are occupying the positions they held before the war; others have risen to places far superior to those which they previously filled. Upon leaving the institution, each man is given a typewriter, the writing medium of the blind, whose handwriting quickly deteriorates.
Sir Arthur relates an anecdote, showing the rapidity with which the blind soldier learns new things:
Passing through the hall one evening, Sir Arthur, who himself has been blind for five years, heard the rapid click of a typewriter.
"Who goes there?" questioned Sir Arthur.
“Ah, Crocker, how are you getting along?" said Sir Arthur, knowing that the pupil had been at St. Dunstan's but six weeks and had been a miner • before the war.
Did you know anything about a typewriter before the war, Crocker?"
"No, sir-I'd never even seen one!”
This is typical of the progress made at St. Dunstan's. Most of the instructors are blind and there are almost as many as there are pupils, assuring individual attention to each one. There is also opportunity to learn basket making, shoe mending, net weaving. broom making and similar occupations at which the blind are particularly apt, although in so far as possible each man is replaced in his old profession.
Fowl breeding is another special feature of St. Dunstan's. Holding a wiggling buff-cochin Wyandotte in his hands, the blind man can readily tell its breed, weight and size. Many pupils have been successful in this field. Carpentry has also been successfully tried out. It seems nothing short of miraculous to see sightless men using the plane, saw and hammer and turning out attractive little tables, cabinets, shelves, bookstands, etc.
And there is the garden. On moonlit summer nights, whose spell and beauty the blind feel, per
BRITISH DOCTORS IN STORM OVER NEW
GOVERNMENT PLAN. London, Feb. 1.-Changes in England's system of medical service whereby the “panel” plan now applicable to the poor would be extended to all classes are proposed by a government committee. Many physicians are strongly opposing the proposals.
For a number of years, under a health insurance act, wage earners have been called upon to make a small weekly payment to a fund which the goyernment uses to provide medical attention for all classes of the population affected by the insurance law. Every practicing physician must treat a certain number of the socalled "panel" patients, receiving pay for this work from the government. The new scheme provides for whole-time medical service, and practitioners entering it are to be graded into five classes corresponding to military rank, ranging from lieutenant to colonel.
Class 1 would be paid $7,500 a year. Class 2 $5,000 and so on down to Class 5 which would pay $2,000. Examinations would be held for promotion to higher classes. Expenses incurred by the practitioner for drugs, appliances, clinics and traveling expenses would be paid by the government.
Each physician would be expected to look after between 2,000 and 3,000 patients. The higher classes of men would deal chiefly with administrative work and with the giving of consultative advice
The patients would be expected to attend a surgery in the morning. Evening consultation would be discontinued and less visits would be paid at night to patients than is done now. Work out of hours would be taken over by the juniors.
All hospitals would be taken over by the government, under this plan.
According to the secretary of the Medico-Political
union, there is a flow of protests from physicians in the army against the scheme.
"Not one-third of the doctors want it,” he said. "A clinical service is an abhorrence to both medical men and the public. We are not opposed to state control of hospitals. What we object to do in the clinical system is the destruction of the personal relationship between practitioner and patient, and the abolition of free choice of doctor. The women will be dead against it.”
MICHIGAN HISTORICAL COMMISSION,
LANSING, MICH. The first number of the Michigan History Magazine, for the New Year comes to hand fresh and attractive both in appearance and contents.
Col. Roy C. Vandercook, in a review of the work of the Michigan War Preparedness Board for the year just closed, shows that body to have done a patriotic work of inestimable value which has placed Michigan in the forefront of war activities among the states of the Union.
“America and the. Great War" is discussed by two Michigan teachers, Miss Bernice Anna Perry of Kalamazoo and Principal E. W. Tiegs of Crystal Falls.
In "Democracy's Educational Problem," Prof. Claude H. Van Tyne of the University of Michigan sets forth the absurd misconception of our true relations with England due to the prejudices perpetuated by school text-books in teaching the American Revolution, the War of 1812, and failure to emphasize the democratic transformation of England during the later years of the nineteenth century. He pleads that the future welfare of democratic peoples the world over demands that this wrong be righted.
A rare picture of a happy and useful married life is presented in the biographical sketch of Mrs. Ferris by her husband former Governor Woodbridge N. Ferris. A pleasing glimpse is given of their school and college days, their work together in the school room, Mrs. Ferris' regard for young folks, her love of nature, her fondness for great books, her sense of humor, with interesting comments upon her letters and essays.
The story of Gross Ile is charmingly told by Father John R. Command and there is a sketch of the life of Captain W. C. Brown by Hon. Crockett McElroy. The editorial columns contain historical hints for teachers. Any public or school library may obtain a free copy of the Magazine by addressing Michigan Historical Commission, Lansing.
humanitarism, but from a sense of business foresight.
The new registry bureau is prepared to furnish industries with the names of skilled industrial medical advisers on request. The demands for competent medical directors for the factory departments of hygiene are being met by the Service with an adequate list of physicians, all of whom have had experience and training in this particular function. Hundreds of such physicians are listed in the Government's registry bureau in Washington and hundreds are being added to the registration files.
In each instance the Service satisfies itself of the training of the physicians before their names are allowed on the list. Thus, only those best qualified are listed and manufacturers have the advantage of knowing that by availing themselves of this Service their dispensary section will be in competent hands.
In addition to submitting names from the physicians' registry bureau, the Service is making investigations only on request, however-of the gen. eral facilities for protecting the lives and health of employes. This work is carried on from branches of the Service now being established within easy reach of the nation's industrial centers. When such surveys are concluded a report of the findings, with recommendations, is delivered to the responsible head of the particular industry. In this manner industries are assured reliable and unbiased information from authorities who have studied industrial problems exhaustively, with expert training in hygiene, sanitation and related subjects.
Employers and employes have expressed approval of the plans inaugurated by the Working Conditions Service, and have shown a desire to co-operate in the establishment of factory hygiene departments. From the viewpoint of national welfare it is a mighty stride toward bringing employes and employers to a recognition of common purpose and mutual benefit, and the demands upon this newly established Service can only be interpreted as indicative of the value of the medium that has arisen most opportunely.
DEPARTMENT OF LABOR. The demand upon the newly established Working Conditions Service of the U. S. Department of Labor, for industrial physicians and surgeons, has grown so rapidly that the Service has been compelled to establish a bureau of registry of physicians specially skilled in this growing phase of medical and surgical specialization.
Manufacturing interests throughout the country are becoming impressed with the vital necessity of properly safeguarding the lives and health of employes, not only from the viewpoint of the new
IS THE MODERN TREATMENT OF SYPH- .
ILIS A SUCCESS? Most physicians who have been in practice twenty years or more can recall cases of syphilis treated with mercury and iodine via alimentary canal for the then recognized period of two to three years, and to-day can place the patients, having had them under observation for that length of time, or being aware of their presence in the community, and can say that they have evidenced no outward or inward signs or symptoms of the disease. They can even recall sporadic cases in which the disease has appeared twice in the same patient, thus evidencing a cure for the first outbreak. Furthermore, they can bring to mind cases which have been quite thoroughly treated, but which, ten or more years later, have presented manifestations which point all too clearly to the activating syphilitic poison. Whether cases were completely cured or not, it is certain that the disease remained quiescent and did not give the patient any further trouble, often through a long life.
To-day the former treatment has given way to
question of the modern treatment of syphilis by the intravenous method of arsenical preparations, to appoint commissions or committees, and to have the statistics of hospitals and those of private practitioners with sufficient experience along these lines collected and collated, so that the profession of medicine and the patients may become assured of any real value which this modern method of treatment possesses.--New York Medical Journal, Aug. 17, 1918.
intravenous injections of one of the arsenical compounds, supplemented by the former treatment, or at least by hypodermic injections of some mercurial compound. Can the results achieved by this form of treatment be termed successful? Are we any better off with it than with the older treatment? And which is the remedy, the arsenical compound, or the mercury?
If the results achieved at the Toronto General Hospital can be taken as a criterion and on a par with those achieved in other similar institutions, the majority of physicians can hold to no other opinion than that the treatment is neither satisfactory nor encouraging, even though the writer we shall presently quote states: “Considering the class of cases that have been dealt with at our clinic, the results of treatment are not at all discouraging."" This is an opinion of very doubtful value.
In the July issue of the Canadian Medical Association Journal, Dr. W. T. Williams outlines the method of treatment and the results obtained in five hundred cases. Of these five hundred cases, 145, or 29 per cent., were at an early stage of the disease; 355, or 71 per cent., were at later stages. On an average of seven and a half doses of 0.5 gramme plus four and a half intramuscular injections of mercury, negative Wassermanns were secured in only seventy cases, approximately fifteen per cent. Of these seventy cases, twenty-three were in early stages of syphilis, and forty-seven in the later stages. “Practically all of the late cases were given in addition mixed treatment of mercury and potassium iodide." Very important, too, is this sentence: “Twenty-four cases had a return to positive Wassermann, thirty-five still remain negative, while eleven of them passed from our control"--a not uncommon sequence to the treatment of such cases. That is to say, of the series of five hundred cases treated, thirty-five cases, 7 per cent., may be said to be cured, that is, so far as a Wassermann negation indicates a cure.
The number is very, very small, and instead of being problematically “not discouraging," is to say the least, entirely so.
How can the conscientious physician face the patient who seeks a cure for this elusive enemy in his blood or his tissues, and tell him that at the Toronto General Hospital 7 per cent. of the cases are supposedly cured? Surely these results humiliating rather than "not at all discouraging."
Nor can many be found to agree with a further statement that “about 80 per cent. of all cases experienced relief or freedom from all symptoms, which at any rate is encouraging." Has it not been' the common experience that a majority of all cases of syphilis experience relief or freedom from all symptoms either with or without the former treatment after the so-called secondary stage has been passed?
There is, however, another vital point in this modern treatment of a patient with syphilitic infection, the question of expense. Are physicians justified in placing this added financial burden upon patients, when they can probably secure satisfactory "cures” in 7 per cent. of the patients so treated?
The time now seems opportune for the national medical bodies of Canada and the United States (the Canadian Medical Association, and the American Medical Association) to consider the entire
TO THE SOLDIERS AND SAILORS OF
AMERICA. Approximately four million officers and men of the Army and Navy are now insured with the United States Government for a grand total of almost thirty-seven billion dollars.
You owe it to yourself and to your family to hold on to Uncle Sam's insurance. It is the strongest, safest, and cheapest life insurance ever written,
For your protection Uncle Sam has established the greatest life insurance company in the worlda company as mighty, as generous, and as democratic as the United States Government itself. Just as Uncle Sam protected you and your loved ones during the war, so he stands ready to continue this protection through the days of readjustment and peace.
The privilege of continuing your Government insurance is a valuable right given to you as part of the compensation for your heroic and triumphant services. If you permit the insurance to lapse, you lose that right, and you will never be able to regain it. But if you keep up your present insurance-by the regular payments of premiums-you will be able to change it into a standard Government policy without medical examination. Meantime you can keep up your present insurance at substantially the same low rate. The Government will write ordinary life insurance, twenty-payment life, endowment :maturing at age 62, and other usual forms of insur
This will be Government insurance-at Government rates.
The United States Government—through the Bureau of War Risk Insurance of the Treasury Department--will safeguard you and your loved ones with the spirit and purpose of a Republic grateful to its gallant defenders. To avail yourself of this protection, you must keep up your present insur
Carry back with you to civil life, as an aid and an asset, the continued insurance protection of the United States Government. Hold on to Uncle Sam's insurance.
W, G. McAdoo, Secretary.
AN IMMENSE FUND FOR MEDICAL
RESEARCH. According to Science, the will of the late Captain J. R. De Lamar, mine owner and capitalist, leaves nearly half his $20,000,000 estate, in equal shares, to the Harvard Medical School, Johns Hopkins University and the College of Physicians and Surgeons of Columbia University for use in medical research and the dissemination of medical knowledge. The rest of the estate is left in trust to his daughter, with the provision that if she dies without issue the principal is to go to the institutions above named.
Gm., 0.3 Gm., 0.45 Gm., 0.6 Gm., 0.75 Gm., and 0.9 Gm. Dermatological Research Laboratories, Philadelphia Polyclinic, Philadelphia. (Jour. AM.A., Jan. 25, 1919, p. 275).
Some “Patent Medicines” Investigated by the Government. -The following are the names of proprietary medicines which have been the subject of prosecution under the Federal Food and Drugs Act in the government's attempt to protect the public against fraudulent or misleadingly advertised products: Royal Baby's Safety; Simpson's CerebroSpinal Nerve Compound; Constitution Water; Tweed's Liniment; Pulmonol; Crown Skin Salve and Pile Cure; King of the World and Family Liniment; Ka-Ton-Ka; Greenhalgh Diphtheria Remedy; Mountain Rose Tonic Tablets and Herbaline; Parmint; Sulphurro; “Liveon, The 90 Day Consumption Cure;” “Liveon Lung Discs;" White Beaver's Cough Cream and Wonder Work; Watkins' Vegetable Anodyne Liniment, Female Remedy, and Kidney Tablets ; Nature's Creation Co.'s Discovery; Radium Healing Balm; Phuton' Kidney Remedy; Palmer's Skin Whitener; Barnes Baby Relief; Sayman's Healing Salve; Sayman's Vegetable Wonder Soap; Humphrey's Pile Ointment; Witch Hazel Oil (Compound); Hill's Honey and Tar Compound; La Franco Combination Treatment" and "La Franco Vitalizer No. 200." (Jour. A.M.A., Jan. 25, 1919, p. 297).
EGG SUBSTITUTES. The U. S. Bureau of Chemistry has recently turned its attention to the numerous so-called "egg-substitutes" now on the market, concerning some of which extravagant claims are made on their labels, as to their food value and their ability to serve the purpose of eggs in baking and cooking. Analyses show that many of these substitutes consist essentially of a mixture of starch and baking powder, colored yellow with a coal-tar dye. A few contain casein, which is an ingredient of milk. The food value of such preparations, says the Bureau, is far inferior to that of eggs, and experiments show that the substitutes do not have the effect of eggs in cooking. Action has already been taken under the Food and Drugs Act to prosecute the manufacturers of some of these preparations.
Evidence - The Cutter Laboratory advertises that a physician has used between 700 and 800 doses of its Mixed Vaccine-Respiratory Infections prophylactic without a single failure to "protect” against the disease. The Cutter Laboratory thinks this is evidence which "is convincing enough to satisfy even the most conservative." If a physician were to report that 643 of his patients who had used salt instead of sugar in their coffee had remained free from influenza, would this be evidence of the prophylactic value of sodium chlorid? The science of therapeutics is complex enough at its best; and with commercialism dominating the production of therapeutic agents, the likelihood of ever arriving at anything approximating a true science of therapeutics seems hopeless. (Jour. A.M.A., Jan. 4, 1919, p. 45).
PROPAGANDA FOR REFORM. •Misbranded Nostrums.—The following "patent medicines” have been the subject of prosecution under the Federal Food and Drugs Act: Paine's Celery Compound; Botanic Blood Balm; Owens' Wonderful Sore Wash; Lafayette Cough Syrup; Gilbert's Gravel Root Compound; Strange's Rheumatic Remedy; Baur's Diamond Brand Bromides; S. B. Cough and Consumption Remedy; Gowan's Preparation; Urol; Boxenbaum Discovery; Tablets Creavita; Old Lady Fulten's Comforting Pills; C. C. C. (Crownall Elastic Capsules); Victor Injection, No. 19 Compound and No. 6 Compound; Hemogenas Pills; Restorative Tablets-Fountain of Health ; Denn's Strong. Sure, Safe and Speedy Stomach, Liver, Kidney, and Rheumatism Remedy; Dr. Navaun's Mexican Lung Balm; Dr. Navaun's Kidney Tablets; Dr. Chas. DeGrath's Electric Oil; Bovinine; Fritch's Vegetable Liniment; Perkin's National Herbs Blood Purifier, Kidney and Liver Regulator; Dr. Lemke's Golden Electric Liniment; Dr. Lemke's St. Wohannis Drops; Mentholatum; Enteronol; Dr. Harter's Lung Balm; Dr. O. Phelps Brown's Herbal Ointment: Taylor's Horehound Balsam; Breeden's Rheumatic Cure; Sulphur Bitters; Dr. De Witt's Eclectic Cure; Dr. De Witt's Liver, Blood and Kidney Remedy; Payne's Sylak; Dr. Bell's Pine Tar Honey, and Lung Germine. (Jour. A.M.A., Jan. 4, 1919, p. 59).
Digitan.-A digitalis preparation said to contain digitoxin and digitalin in the form of tannates. It is standardized biologically. Digitan was first introduced as digipuratum and is made under the digipuratum patent by license of the U. S. Federal Trade Commission. The actions, uses and dosage of digitan are the same as those of digitalis. It is sold in the form of a powder and as digitan tablets 11/2 grains. Merck and Col, New York.
NEW AND NONOFFICIAL REMEDIES.
Chloramine-T, Monsanto.-A brand of chloramine-T which complies with the New and Nonofficial Remedies standards. The properties, actions, uses and dosage are described in New and Nonofficial Remedies, 1918, p. 156. Monsanto Chemical Works, St. Louis, Mo.
“Aspirin” a Common Name.-The claim of the Bayer Company to the exclusive right of applying the name “aspirin” to acetylsalicylic acid will be · definitely set aside if the recommendation of the examiner of interferences of the United States patent office is upheld. The stand taken by the patent office is in line with the established principle that no one can have a monopoly in the name of anything. Since "aspirin” has become the common name for acetylsalicylic acid, no one firm can have an exclusive right to it. (Jour. A.M.A., Jan. 11, 1919, p. 119).
Ncoarsenobensol (Dermatological Research Laboratories).-A brand of neoarsphenamine complying with the New and Nonofficial Remedies standards. It is marketed in tubes containing, respectively, 0.1