tell him he will probably be worse. They usually are for a time. I tell them, "If you have a fire in a barn, putting out the fire does not replace the barn. At the same time, you will find it important to put out the fire." So we pull the tooth, to put out the fire. That is a homely illustration. I tell them they should not expect to be well after they have the tooth pulled. They come back for further treatment. The tooth having been pulled you have some chance of success in your treatment of myalgia.

The second disorder is frequently asthma. Since Walsh in 1910 gave attention to the symptoms, we have made more progress in the therapeutics and there are very few cases of bronchial asthma now which we cannot at least relieve. While it seems impossible to cure them all perhaps, we can give them relief of a more or less permanent character. Now these patients present a remarkable variety of etiology.

They all exhibit the phenomenon of sensitization or antiphylaxis. In many cases they also exhibit focal infections. Why the new born infant should be sensitized to the egg albumin is a fact I never heard explained nor any attempt made to explain. But it is not very difficult to imagine the reason why a person with pus in his ethmoid cells might not become sensitized. In fact, it is useless to desensitize and leave those ethmoid cells closed in. Bronchial asthma due to such focal infection is never cured until the focal infection is treated. Although you may relieve these patients by temporary desensitization, these forms of asthma due to foods and to bacterial infections fall largely under the same category.

I may only say in closing that I believe it is a mistake to tell patients they will be cured by the removal of the focus of infection because, in my experience, they rarely are. What we do is to give ourselves a chance for successful treatment after the focus is removed. The patient should thoroughly understand that before they have a resection.

THE CHAIRMAN: I think it would be well to hear from a certain man. I would like to call on Dr. A. W. Crane, from Kalamazoo, to continue the general discussion.

DR. A. W. CRANE, Kalamazoo: A paper on this subject is always timely. Ingersoll said once that a question was always as fresh as a daisy until it was settled. It is evident that the question of focal infection is not wholly settled. I confess that I am entirely in accord with Dr. Aaron in his discussion of the subject.

The frequency with which a focal infection about the teeth is associated with some internal disorder and the good result which so often follows the removal of the infection forces belief in the substantial accuracy of that position. I think it has already been fully discussed that the removal of the infection does not always cure the disease, but

of course that does not disturb the accuracy of the general proposition.

Now, in regard to the teeth, there is one point that has not been brought out fully that explains to some extent why a small infection about a tooth is more important than an infection, say, in the gall bladder or appendix or an abscess elsewhere in the body, where the quantity of infectious material is greater than that around a tooth; and that is because it is next to a solid bony process which prevents the carrying off of the infection, and which furnishes an ideal absorptive surface for the infection. There is in some cases a walling off process finally accomplished. That will be seen frequently on the X-ray film. There is a dense area of the bone sometimes about a tooth, and the tooth may be imbedded in it so that when it is withdrawn, that hardened bony part of the alveolar process will be brought away with the tooth. In the X-ray film the tip of the tooth will be seen to be imbedded in this hard bony process.

We may say that here is the final end of the focal infection as it has been actually carried on by the natural processes. The idea that pus under pressure is a necessary condition of absorption is certainly not true. In the apical abscesses at the roots of teeth, shown by X-ray films, there is really not an abscess. but a little bunch of granulation tissue bathed in pus. The pus is not under tension. It will ooze out from the edge of a tooth. There is constantly going on an absorption into the alveolar process that is not walled off and the effort on the part of nature to fill that in with granulation tissue is, in most cases, entirely ineffective.

The subject is almost inexhaustible and has opened up so many avenues of inquiry, such as antiphylaxis and the question of tissue affinity, that I presume many more papers will be presented in the future before this association.

THE CHAIRMAN: Dr. West of Kalamazoo is not here. We have a few minutes left. Dr. Begle, have you anything to say along this line?

DR. HOWARD BEGLE, Detroit: I did not intend to discuss this paper. I am very much interested in this subject in connection with eye conditions. I feel that it is extremely important for a man dealing with eye diseases to carefully examine the teeth, especially this one condition of iritis.

Of course the large majority of cases of iritisI would not say the majority, but perhaps forty per cent.—of iritis cases are due to syphilis. So my very first examination is an examination for syphilis combined with laboratory tests.

I thnk the second important cause is from apical abscesses at the roots of teeth. In my experience, especially the teeth with crowns are the ones which are apt to be at fault. In talking with a dentist not long ago, he made the remark that crowns which were put in a few years ago, ten years ago,

were invariably put in improperly. And it is certain'y surprising how many of the crowns are in poor condition. Of course our main test there is the X-ray; but personally, I don't believe that we should depend upon that too much. If we have excluded every other cause and there are crowns, it is entirely possible and I believe right that the crown or perhaps the tooth should be removed, especially if it is a tooth not extremely valuable to the patient. I have such teeth removed and in those cases it is often a cure of the condition. It is a cure of the condition, and the function of the eye will be restored to normal.

Most of the cases of iritis which occur from the teeth are of the plastic type and not severe cases, cases in which the eye is red and somewhat painful, but they are cases marked by their pronicity rather than by a large amount of exudate being thrown out. The cases in which there is a lot of pus

NEW AND NON OFFICIAL REMEDIES.

Atreol.-An aqueous solution containing as its principal constituent the ammonium salts of a mixture of organic acids containing nitrogen in the sulphonic radical which results from the action of sulphuric acid on certain petroleum distillates. Atreol is applied locally for promoting the absorption of swellings and effusions in contusions following fractures, etc. It is claimed to be useful in dermatologic and gynecologic practice. be used in aqueous solutions, ointments and suppositories. The Atlantic Refining Co, Philadelphia, Pa. (Jour. A.M.A., May 17, 1919, p. 1463).

It may

Gilliland's Concentrated and Refined Diphtheria Antitoxin.-Marketed in ampules containing 1,000, 5,000 and 10,000 units each. For a description of Diphtheria Antitoxin, Concentrated, see New and Nonofficial Remedies. 1919, p. 280. Gilliland Laboratories, Ambler, Pa.

Gilliland's Concentrated and Refined Tetanus Antitoxin.-Marketed in ampules containing 1,500, 3,000 and 5,000 units each. For a description of Tetanus Antitoxin, Concentrated, see New and Nonofficial Remedies, 1919. p. 266. Gilliland Laboratories, Ambler, Pa.

Gilliland's Antipneumococcus Serum, Type 1.Marketed in vials containing 100 Cc.; also in double ended via's containing 50 Cc. each, with a gravity injection apparatus for intravenous injection. For a description of Antipneumococcus Serum, see New and Nonofficial Remedies. 1919, p. 271. Gilliland Laboratories, Ambler, Pa.

Gilliland's Small-Pox Vaccine.-Marketed in sealed capillary tubes in packages containing two tubes each. For a description of Vaccine Virus, see New and Nonofficial Remedies, 1919, p. 274. Gilliland Laboratories, Ambler, Pa.

thrown out from the eye are not due to the teeth. I see more cases which last over a long period. Fortunately they do not do a great deal of damage to the function of the eye. After a case of iritis has run a month or two months or even longer, a few offending teeth are removed and the eye will clear up and you will get a perfect vision after.

I am inclined to believe there must be rather a strong connection between the teeth and the eye. In my experience, focal infections of the tonsils have rarely set up eye conditions. I don't deny they may be set up from that source. I am inclined to believe that the eye affected has relation with the teeth and that the teeth are actually on the same side of the jaw as the eye affected. That would seem to be perhaps only a natural conclusion, In my experience with cases that has been, I think to some extent, borne out.

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Barbital-Abbott Tablets, 5 grains.-Each table. contains 5 grains of barbital-Abbott (see New and Nonofficial Remedies, 1919, p. 82). The Abbott Laboratories, Chicago.

Procaine Hypodermic Tablets, 3⁄4 grain.—Each tablet contains grain of procaine-Abbott (see New and Nonofficial Remedies, 1919, p. 30). The Abbott Laboratories, Chicago.

Procaine-Adrenalin Hypodermic Tablets.-Each tablet contains procaine-Abbott 1-3 grain and adrenalin 1-2500 grain (see New and Nonofficial Remedies, 1919, p. 30). The Abbott Laboratories, Chicago. (Jour. A.M.A., May 17, 1919, p. 1463).

Protargentum-Squibb.-A compound a gelatin and silver containing approximately 8 per cent. of silver in organic combination. It has the actions and uses of silver preparations of the protargol type (see New and Nonofficial Remedies, 1919, p. 307). Protargentum-Squibb is used in 0.25 to 5 per cent. aqueous solutions, prepared freshly as required. E. R. Squibb and Sons, New York. (Jour. A.M.A., May 24, 1919, p. 1543).

Antimeningococcic Serum (Combined Type) (Gilliland).-Marketed in 15 Cc. and 30 Cc. ampules and in 15 Cc. and 30 Cc. cylinders with attachments for spinal administration. For a description of Antimeningococcus Serum, see New and Nonofficial Remedies, 1919, p. 270. Gilliland Laboratories, Ambler, Pa. (Jour. A.M.A., May 24, 1919, p. 1615).

The Journal

OF THE

Dr. Ballin stated Harper's position and Dr. Babcock gave a very fair statement as to the advantages and disadvantages of the open and

Detroit is suffering from the lack of hospital accommodations. It is quite difficult for many of the reputable physicians to get their cases into a hospital. The Henry Ford Hospital at the present time houses Base Hospital No. 36 of the U. S. Army. Detroit has grown so rapidly in the last fifteen years that it has been unable recently to care properly for its sick or its visitors. Hotel Pontchartrain closes its doors next fall?

We are informed that the Board of Trustees of Harper Hospital have decided to make that Institution a closed hospital. As this hospital is always filled, it makes very little difference theoretically whether its patients are taken care of exclusively by its staff or not.

At a special meeting of the Wayne County Medical Society May 26, 1919, there was quite a general discussion on the Harper question.

favor of the open hospital. Mr. Culver of the "Little Stick" who was present at this meeting closes a characteristic article of his with the following:

"If the scheme is allowed to go through, it is up to Detroit's Delegation in the Legislature to see that proper legislation is passed to remove Closed Hospitals from their privileges of tax exemption and it is up to the charitable people of Detroit to see that their contributions are given to institutions which serve all the people and not patients of the selfish clique of physicians and surgeons who are scheming to put this thing over."

Mr. Culver's criticism of the Staff is as far as known an assumed proposition.

However we feel in regard to the closing of Harper Hospital, we all know that Detroit needs more hospital beds and more hospital accommodations. It would seem a good time for the City of Detroit to build and run a modern City Hospital. We also feel that the staffs of the several hospitals should so utilize their beds that the more urgent hospital cases could be taken care of and that those cases which can properly be cared for outside, should be denied admission under present circumstances.

A WORD TO THE MEMBERS OF THE MICHIGAN STATE MEDICAL SOCIETY.

Few things in this world have escaped the disintegrating effects of the great world war and our society has not been one of them.

Absorption in war activities, the absence of many of our members in the service and the overworked condition of those left to carry on civilian practice, have tended to divert our attention from the scientific side of our profession and to make us cold to the social side.

By reason of this the report of our secretary showed at the Detroit meeting that on May 29, there were 797 of our members in arrears for

their subscription to the Journal and 2,026 were paid up. Since that date a few have paid but still the fact stands that over one-third of the members of our society in good standing in 1917 or 1918 are now delinquent. Some of the men unpaid are doubtless still in the service and their County Societies have not paid their dues for them as has been done by a considerable number.

Should these all pay on their return, there will still remain too large a number of unpaid subscriptions to the Journal, which is our standard for ready estimate of the condition of the state society and of the County Societies as well.

Unless the County Societies flourish the state organization is bound to languish and it is up to every former member to get off his coat, put on his jumpers, overhaul the carburetor, test the spark, blow up the tires and then crank his arm off to get his local society going. Get your men together, give them a good feed, pick out the livest wire among them as your secretary, or, better yet, program chairman, then invite some outsider to give you a paper on a subject you will want to listen to; post your men on the proposed subject and have them prepared to slash the paper to pieces.

Nothing adds to the zest of a meeting like a hot discussion that almost draws a blister. Then hold your meetings oftener. Drop the knocker's hammer and pick up the booster's trumpet and blow for all you are worth, and we will make this reconstruction year the best one in the history of medicine in Michigan.

C. H. B.

AMERICAN COLLEGE OF SURGEONS.

NEWS-LETTER CONCERNING HOSPITAL
STANDARDIZATION.

These pages are to express gratitude to the Fellows of the College for their good help in the hospital standardization of the College and to enlist on the part of the Fellows still further conscientious service for the betterment of the practice of medicine through that program. Further, two questions are here briefly answered: First, what is hospital standardization?

and, second, what has the College accomplished toward hospital standardization?

WHAT IS HOSPITAL STANDARDIZATION? To define hospital standardization in a negative way, it is not an effort to make hospitals alike in form of government, of administration, or of equipment; it does not seek to enforce conformity to any given mold nor to limit originality in any phase of hospital work.

Hospital standardization means thinking alike on the part of doctors, hospital trustees, hospital superintendents, laboratory workers. nurses, and the public upon the aims and utility of hospitals. It means that every patient in a hospital is entitled to the most efficient care known to the medical profession; and that every hospital believes itself morally obligated either to render such service to its patients or to state frankly to the patients that it cannot do

So.

The entire program of hospital standardization undertaken by the College is a gift to hospitals and to the medical profession. But in so far as any such program is one of reform, that program may or may not in a true sense be a gift. In what way, then, is the effort of the College a gift? This question is important. The answer to it lies in the method itself with which the College has taken up the work.

There are two methods by which hospital standardization may proceed. The first is scientific; the second, human. These methods are not entirely exclusive, one from the other, but the difference between them is, nevertheless, the difference between a gift of lasting worth as against an uninvited interference of doubtful value.

The scientific method is concerned with its own point of view. It is interested in the outcome of its actions on others. It assumes that men and institutions are to be governed and that, having determined upon a best form of government, there is no right of appeal by the governed. Under the scientific method hospital standardization would say to the hospitals: "I have analyzed correctly my own duty toward you and you must therefore accept all that I do to you. You may not like it. Here is a plan

for the betterment of hospital service. You must co-operate by accepting it. It will do you good."

The scientific method has wrecked many a worthy project of reform. It prejudices men against all systematic progress. It is a prevailing foolishness among us which keeps the millennium undated. It is a blunder which the College in its relations with hospitals and the medical profession resolutely determined not to make.

The human method never forgets the point of view of others. In fact, that is the only In fact, that is the only point of view which it knows. It assumes that men are intelligent and open-minded. But it is not sentimental or merely "sugar and spice and everything nice." It values straight thinking and accurate data quite as much as does the scientific method. Under the human method hospital standardization says to hospitals: "Here is a plan for the betterment of hospital service. It is a plan which grew out of our own heads and hearts after conscientious and long effort on the part of all of us to devise such a plan. Will you please consider whether or not you will accept it? Will you become a rival for the light under the terms of this plan?" This is the method with which the College took up hospital standardization.

That some concerted action for the betterment of the practice of medicine is needed, no one questions. The opportunity to be a part of such action faces each of us. Five years ago the field of hospital standardization, as a means to this end, was unoccupied. When the College entered the field at that time, it did so with exceeding care, for it had no precedent to guide it and it had also to provide itself with the necessary personnel, office machinery and financial support to carry the work.

WHAT HAS THE COLLEGE DONE?

At the beginning of the College in 1913 active work in hospital standardization was accepted by the College as the most practical

means to advance the art and science of surgery, for if surgery is to be advanced, the conditions surrounding the practice of surgery must be correspondingly improved. The fol

lowing paragraphs state briefly what has been done toward standardization of hospitals since that date.

In 1914, in connection with the necessary work of perfecting the organization of the College and of obtaining a sound financial basis, the College began to acquire first-hand information about hospital conditions in Canada and the United States. It conferred with doctors, hospital trustees, and hospital superintendents about the work; with medical societies and with hospital organizations, asking their help and co-operation in formulating a plan of action.

In October, 1916, at the annual meeting of the Fellows in Philadelphia, a report of these informal conferences was made. Further, at that meeting the Fellows were asked to create in each province in Canada and in each state in the Union a standards committee, the purpose of the committees being to advise with regard to a sound and constructive program of action. Promptly after that meeting, in accordance with the vote of the Fellows, these standards committees were elected by ballot through the mail.

For reasons of the war, these committees were not called together until October, 1917. At that time they were called into session in Chicago, about three hundred and thirty being present. About fifty leading hospital superintendents were also, on invitation, present at the meeting. For two days these committees with their guests considered three fundamental questions which were: What conditions exist in hospitals? What do we want in hospitals? What is to be done? This meeting clarified many hazy problems. A full report of the meeting (Bulletin Volume III, No. 1) was printed and distributed to the hospitals and to the Fellows. The immediate outcome of the meeting was the appointment of a committee of twenty-one, upon which were represented physicians, surgeons, hospital administrators, laboratory workers, statisticians, etc., the purpose being to outline a questionnaire through which the College might obtain hospital data essential in its further work and to consider a "minimum standard of efficiency."