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NEW AND NONOFFICIAL REMEDIES. Emetine Bismuth Iodide.-A complex iodide of emetine and bismuth containing from 17 to 23 per cent. of emetine and from 15 to 20 per cent of bismuth. It has the action of emetine, but when taken by mouth, it is less likely to cause vomiting than the soluble salts of emetine administered orally. It has been used with apparent good results in the treatment of chronic cases and carriers of amebic dysentery, even where the hypodermic administration of emetine has failed. The commonly used dose has been 0.2 Gm. (3 grains) daily for four days, either in a single dose at the midday meal or in divided doses.

H. K. Mulford Company:

Bismuth Emetine Iodide-Mulford.
Cachets Bismuth Emetine Iodide—Mulford, 2

grains.
E. R. Squibb and Sons :

Chlorinated Eucalyptol-Squibb.
Takamine Laboratory:

Arsaminol.
Arsaminol 0.1 Gm. Tubes.
Arsaminol 0.2 Gm. Tubes.
Arsaminol 0.3 Gm. Tubes.
Arsaminol 0.4 Gm. Tubes.
Arsaminol 0.5 Gm. Tubes.
Arsaminol 0.6 Gm. Tubes.

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Sodium Diethylbarbituric Acid-Merck Tablets, 5 grains.—Each tablet contains 5 grains of sodium diethylbarbituric acid-Merck. Merck and Co., New York (Jour. A.M.A., Dec. 28, 1918, p. 2153).

Benzyl Benzoate-H. W. and D.-A brand of benzyl benzoate complying with the tests and standards of N. N. R. Hynson, Westcott and Dunning, Baltimore, Md.

During December the following articles have been accepted by the Council on Pharmacy and Chemistry for inclusion with New and Nonofficial Remedies : Non-proprietary articles :

Benzyl Benzoate,

Emetine Bismuth Iodide. Abbott Laboratories:

Emetine Bismuth Iodide—Abbott.
Hynson, Westcott and Dunning:

Benzyl Benzoate-H. W. and D.
Solution of Benzyl Benzoate, Miscible-H.

W. and D.
Merck and Company:

Diethylbarbituric Acid-Merck,
Diethylbarbituric Acid-Merck Tablets, 5 grs.
Sodium Diethylbarbituric Acid-Merck.
Sodium Diethylbarbituric Acid-Merck Tab-

lets, 5 menins.

To-day whatever may annoy,
The word for me is Joy,

just simply Joy
Whatever there be of sorrow,
I'll put off till to-morow
And when to-morrow comes,

why then 'Twill be To-day and joy again.

- John Kendrick Bangs.

rare.

utilization can occur the nitrogenous equilibrium must be established. The prescribing of a meat diet in this weakened metabolic organization but increases the nitrogenous inequilibrium. Those individuals who exist on the diet heretofore prescribed for the diabetic—that is, high protein and low carbohydrate—are the ones most likely to be attacked with diabetes. Diabetics get along much better on a normal well balanced diet than on any special diabetic dietary that has not the balancing as its chief purpose. Because the basic cause of diabetes is a weak metabolic organization the diet must be at a minimum in order to tax the metabolic process least, but the diet must favor the carbohydrates rather than the proteins. The diet is the provoking element in a damaged organization. With normal metabolism no one can foretell how much abuse the organism can stand without injury. If organotherapy has any value in the treatment of diabetes it is because the basic metabolic weakness in diabetes is probably of glandular origin. It is most probable that not only the pancreas but also the other glands of internal secretion are concerned, and the gland extracts usually administered supply a deficiency that the defective glands cannot.-New York Medical Journal, July 27, 1918.

THE PROTEINS IN THE CAUSATION OF

DIABETES. Whatever the dietetic errors that provoke the diabetic condition it now seems certain that it is not the carbohydrate alone that is at fault. Primarily diabetes occurs only in an individual whose metabolic organization is very weak, but it will not occur unless provoked by some gross and persistent dietetic abuse. Perhaps overeating is the most potent factor in its causation. On the other hand, in races that consume large quantities of farinaceous food with only a minimum of proteins or fats, diabetes is very

Neither underfeeding nor poverty is a cause; it is rather a disease of the rich.

When the expensive proteins are consumed in large quantities by those who can afford them and by those who lead a sedentary life, diabetes is likely to follow. It is more than likely that even without a proper balancing of the food a reduction in the total quantity of food consumed would in itself reduce the incidence of diabetes. It is the protein element that must be curbed rather than the carbohydrates in diabetes. In the newer understanding of this disease this is realized, and far from withdrawing the carbohydrates they are often advocated as a cure for diabetes. It is from this that the so-called oatmeal cure received its reputation. Heretofore the dietetic treatment of diabetes contemplated an almost unlimited supply of proteins and a complete withdrawal of the carbohydrates. Yet it was understood that the threatening of an acid condition was a sign for the restoration of the carbohydrates, in spite of the increase of the sugar output.

Overindulgence is perhaps the most important factor in the production of a systemic hypoalkalinity. The taking of food in which the proteins predominate increases the acid production and increases the hypoalkalinity. The proteins, in fact, are acid foods. It is pernicious in any glycosuria to allow an excessive meat diet. Very often a marked limitation or even abstinence for a period will of itself cause the disappearance of the sugar. Moreover, the defective utilization of the sugar is not nearly as ominous to the organism as an increase in the acid state of the body as a result of protein intoxication or excess. Indeed, it is because of the defective utilization, where only a small amount of sugars can be oxidized at one time out of the amount supplied, that the sugars must be pressed so that at least this small amount can always be carved out of the total supply. There is no harm in the presence of sugar in the urine. It is merely an index of the condition. The amount of sugar only shows how much of it the system could not utilize.

Before much improvement in the carbohydrate

JOBS ARE CLASSIFIED. In an article on "Modern Industrial Medicine," in the August number of the American Medical Journal, C. G. Farnum says:

“In a really modern industrial plant, where the department of medical supervision is worthy of the name and where the safety engineer and the superintendent of employment are alive to modern needs, the individual jobs are classified and indexed as to availability for physical defectives. How simple the whole procedure then becomes! What matters it how many arms, or legs, or eyes, or ankylosed joints a man chances to possess ?

"Some of us have statistics concerning a period of years that bring out two striking facts in connection with this work: That the labor turnover varies inversely as the physical defects of the laborer, and, that the worse the physical defect, the less the accident incidence. These statistics may be considered the measure of the physical and mental compatibility of the man with his job."

Don't worry.

When everybody has been tonsillectomized there will still be the spleen, which seems not to have any useful function.

Some French blind schools display on their walls the warning: “To pity is not to console."

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Original Articles

functionating gland as described by Delille contains an abundance of colloid substance

both intra- and extra-cellular, while in gland THE HYPOPHYSIS AND HYPOPHYS- nearly exhausted the cells are granular, stain EAL DISEASE.

poorly, nuclei are pale and some neutrophilic

cells without vacuoles. The colloid substance E. W. SCHNOOR, M.D.

has been shown by Thaon and more recently GRAND RAPIDS, MICH.

by Grünbaum and Grünbaum to discharge into Confined to a small recess in the sphenoid the blood stream. This glandular lobe is bone is a ductless gland which was first de

surrounded by a connective tissue capsule. scribed by Vesalius in 1553 as "the glans pitui

Sometimes a band of epithelial cells is found tans incipiens," believing it secreted mucus. In

traversing the sphenoid bone connecting the 1778 it was termed the hypophysis cerebri by' pars anterior with a small mass under the Sommering.

pharyngeal mucosa, the Rachendach Hypophyse The pituitary body or hypophysis cerebri is of Erdheim and Haberfeld. This mass of cells a small somewhat rounded organ occurring in may develop into functionating tissue, both all vertebrates except the lowest fishes.

It

normally apparently and as a compensatory hyweighs from 5 to 10 grains. According to Zan

pertrophy in pathological conditions of the der its size is quite variable: 6 to 10.5 mm. in hypophysis. Accessory glandules have been the sagittal diameter, 10 to 14.5 mm, in the found. vertical, 5 to 9.75 mm. in the transverse. The

The posterior lobe or pars nervosa, pracdura mater which forms the inner walls of the

tically non-vascular, develops from a downcavernous sinus is its main support.

growth of the primitive third ventricle with This gland consists of three parts: a large

which it communicates by a stalk or infundiglandular anterior lobe or pars anterior, a

bulum. It is composed of loose neuroglial and smaller pale posterior lobe or pars nervosa and

ependymal tissue, invested by an epithelial the pars intermedia of Herring.

la ver, the pars intermedia. The pars anterior develops from an upgrowth The pars intermedia is derived from the of the buccopharyngeal ectoderm about the

posterior layer of Rathkes pouch which becomes fourth week. This diverticulum is known as

thickened. The pars intermedia may secret a Rathkes pouch and its lumen becomes nipped colloid substance which passes into the pars off by the sphenoid bone later. Histologically nervosa.

This colloid substance is probably this lobe consists of a vascular mass of epithel- the same substance which Herring describes ial cells which Flesch describes as two types: as hyaline bodies occurring between the nerve chromophobe or neutrophilic non-granular pro- fibers. From these spaces Herring believes the toplasmic cells and chromophile or granular substance is probably absorbed by the lymphaprotoplasmic cells. The latter type Schoene- tics and carried into the infundibular cavity mann classifies as to staining characteristics and thence to the third ventricle. Cushing of the granules, eosinophile cells and basophile and Goetsch claim that the cerebro-spinal fluid or cyanophile cells. Sections from different contains the active principle of the posterior parts of the gland differ as to the predominat- lobe. Brown pigment granules are found in ing type of cell, central area the eosinophiles this part of the gland which Vogel in his reseem to be more abundant while at the peri- searches has shown vary as to age, sex and phery the basophiles. Erdheim found the disease. Under ten months they are usually chromophobe cells predominating in infancy. absent but gradually increase after four years Later the chromophile cells predominate. A being more abundant in males. Stumpf considers these granules as degenerative products Claude and Boudouin by the injection of whole of the anterior epithelial cells which have in- gland or posterior lobe extract. They never vaded this lobe. Lewis believes they are of obtained the glycosuria if the subject had fastlittle significance.

ed and only obtained it when a meal of milk, The gland is surrounded by a network of bread and sugar, representing 140 to 150 grams capillaries. The blood supply as described by of glucose, was given shortly after injection of Goetsch and Dandy differs from that described the extract. They offer as an explanation of in some monographs. The anterior lobe supply their results, that probably the pituitary excomes from a number of small arterioles which tract determines a hepatic insufficiency, thus pass down the stalk, while the posterior lobe preventing the fixation of glucose in the state is supplied by a single artery from behind. of glycogen which may be due to direct action The pars nervosa from vessels of both parts. on the liver or to stimulation of the nervous

Dandy has demonstrated sympathetic nerve system. They further state that pituitrin stimfibers passing with the vessels to the gland.

ulates the sympathetic and all the general efPhysiologists have received much of their fects as pallor of skin, malaise, and contracinformation concerning the action of this gland tion of non-striated muscle, are readily explainthrough the use of extracts from the whole ed by the excitation of the sympathetics. In a gland or its individual lobes. Substances have later experiment they showed that, in therabeen extracted with water, glycerin, alcohol and peutic doses, adrenalin also probably acts like salt solution, either from the fresh or dried pituitrin by hindering the fixation of glucose gland.

in the liver in the form of glycogen and proOliver and Shafer were probably the first

ducing an alimentary glycosuria. Aschner to demonstrate that glandular extract, ever

finds that the absence of the hypophysis diminthough raised to the boiling point, when in

ishes adrenalin glycosuria. Miller and Lewis jected intravenously, produced a rise in blood

report that intravenous or intraperitoneal in pressure. This substance was later shown by jections of saline extracts of either the anterior Howell to be derived from the posterior lobe

or posterior lobes will only occasionally pro(pars nervosa and its epithelial investment).

duce a transitory glycosuria in dogs. Following the injection there was an initial fall Anterior lobe extracts were found by Hamin the blood pressure of short duration and burger and later confirmed by Lewis, Miller then a subsequent rise of from 20 to 30 minutes and Matthews to cause a primary fall in the with slowing of heart. The action became less blood pressure followed usually by a secondary with repeated injections. Shafer and Vincent rise in pressure above the level existing at the isolated two substances, one a substance which onset of the experiment. The latter find that stimulates and increases blood pressure, the the pressor substance is derived from that part other depresses the nervous system. They furth

of the pars anterior bounded by a mass of pars er showed that the rise in blood pressure was

intermedia cells. Thus this action is probably associated with a general vaso-constriction. due to pars intermedia secretion discharged Magnus and Shafer observed a frequent and

into the area. prompt distention of the renal vessels with a Lewis, Miller and Matthews found that inresultant polyuria following posterior lobe in- jection of extracts of pars nervosa and pars jections. Wiggers has shown that cardiac intermedia had precisely the same effect and tracings indicate a depressing influence on the believe that the pressor substance is secreted heart to be a constant and characteristic one by the pars intermedia and passes into the pars largely due to direct cardiac action. Pemberton nervosa, possibly by the blood or the hyaline and Sweet demonstrated inhibition of the pan- bodies. Also that the depressor substance of creatic juice by injection of P. D. & Co.'s in- the pars anterior, the pars nervosa and the fundibular extract. Posterior lobe extract also pars intermedia is soluble in alcohol. In hypostimulates the involuntary muscle, in the intes- pituitarism, Cushing's observations show a temtines intense peristalsis is produced followed porary rise in temperature after anterior lobe by purgation and sometimes by vomiting, in injections. Shafer has noted that feeding anthe uterus and the bladder and dialates the terior lobe extract to young rats caused an pupil. The mammary muscle is stimulated exaggeration of their growth. Miller fed a and in breasts containing milk, the milk oozes series of young white rats with anterior lobe out.

extract and another series with posterior lobe Alimentary glycosuria was produced by extract. The results when contrasted with the

a

controls were negative as regards weight and of the gland in young chickens checked their also the skeleton as shown by X-ray. In Cush- growth. Paulesco in 1908 extirpated the gland ing's experimental work life could be prolonged in 22 dogs and 12 cats. Most of these animal's in threatened hypophyseprivia by the injection developed a peculiar symptom complex known of whole gland or interior lobe extract whereas as cachexia hypophysepriva resulting in death posterior lobe extract would fail.

in two or three days. Few survived but at Prolonged administration of either whole autopsy showed viable anterior lobe cells. He gland extract or of pars nervosa alone leads thus concluded that total removal of hypoto marked nutritional disturbances and alter- physis was fatal while partial removal of anations in various organs of the body. The supra- terior lobe was compatible with life. Reford renals are at first stimulated and later ex- and Cushing in 1909 reported results that hausted. The thyroid shows decreased colloid agreed with Paulescos observations. In 1910 and there is a tendency to hypothyroidism, Crowe, Cushing and Homans conducted a more probably due to vaso-constriction in the gland. detailed study of a larger series of canine hypoLiver and spleen show necroses. Kidneys are physectomies and again confirmed Paulesco's congested and there is an increase in the vol- contention, but the average duration of life ume of the glomeruli. Lungs are congested. was longer than Paulesco's observations show

Attempts at implantation or transplantation ed. Puppies lived longer than adult dogs. have been unsuccessful. Exner's rats showed .

They further showed that total removal of the an increased growth for a short time. Crowe, anterior lobe was equivalent to total removal Cushing and Homans prolonged the life of of the gland and that animals deprived of the animals after total hypophysectomy by imme- posterior lobe survived indefinitely. Partia? diate reimplantation of the gland into the cere

removal of the anterior lobe in some of Paulesbral cortex which remained viable for at least co's and Cushing's animals lead to an increase a month.

in the deposition of fat, sometimes associated Disturbances in the internal glandular sya- with polyuria and trancient glycosuria with tem affect the pituitary body. Erdheim and shedding of hair and lessening of sexual activStumme examined 122 hypophyses of pregnant

ities. women and concluded that the organ increases Cachexia hypophyseprivia or the symptomin size and weight in pregnancy and after sev- complex produced by the removal of the antereral pregnancies becomes permanently enlarged,

ior lobe or the whole gland usually appeared there being a tendency to adenomatous hyper

from 30 hours to two weeks after the operation plasia in fully. 10 per cent. The hyperplasia depending on the age of the animal. Early is chiefly of the chromophobe cells. Vogel has usually a transient glycosuria and polyuria. observed a decrease in the brown pigment gran

The animal becomes apathetic, inactive, stiff, ules in the posterior lobe in pregnancy. Gley's gait is unsteady, temperature becomes subnorthyrodectomized rabbits showed a hypertrophy mal, pulse and respiration slow, back arched, of the gland. Fischero noticed that castrated incurvature of tail, irregular contractions and steers and cocks all had at autopsy several coarse movements and finally coma and death. months later, a hypertrophy of the anterior Handelsmann and Horsley in 1911 issued a lobe. Comte noted marked hypertrophy in 12 preliminary report refuting Cushing and coof 13 cases of goitre with degeneration of the workers'conclusions, total removal of the hypothyroid exclusive of Basedows, while Benda

physis in monkey was not incompatible with found the hypophysis small in Basedows. life and further more that three animals, a dog,

What role this small body plays in the de- cat and monkey survived total removal of the velopment and maintenance of physiological anterior lobe. Paulesco also observed that equilibrium has been the subject of much con- mere separation of the infundibulum lead to troversy. Among the early experimenters are death similar to total hypophysectomy. CushMarinesco and Vassale and Sacchi. All their ing disagrees showing it corresponds to partial animals died following total hypophysec- removal of anterior lobe by incomplete destructomy. Friedman and Mass in 1900 tion of blood supply to anterior lobe. Handelsported that extirpation of the pituitary body mann and IIorsley also disagreed and more was compatible with life. La Monaco and recently Morawski who experimented with Rynbeck in 1901, Gagleo in 1902 and Pirrone monkeys and suggested that Paulesco's result in 1903 also arrived at the same conclusion. was probably due to opening the third ventriFischero in 1905 found that partial removal cle. Total extirpation of hypophysis by Ascoli

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