-;^i THE BOSTON jfKebical anir ^urgital JOURNAL THE OFFICIAL ORGAN OF THE MASSACHUSETTS MEDICAL SOCIETY , ar , '-"" THURSDA Y, APRIL 1, 1915. ^S^^^iSS^^iS^ CONTENTS ADDRESSES Charles Sedgwick Minot, M.D. By W. T. Porter, MJ)., Boston. James Gregory Mumpord, M.D. By Richard C. Cabot, MJ)., Boston. ORIGINAL ARTICLES The Changed Position of the Profession of Medicine. By David W. Cheever, MD., Boston. The Menace of Syphilis to the Clean Living Public. By J. Harper Blaisdell, MJ)., Boston. An Undescribed Ulnar Nerve Trouble, Die to Tension prom Scar, and Its Curb. By F. J. Cotton, M.D., Boston. Some Nervous Appections in Which Mas-^age Deserves More Frequent Use. , By J. W. Courtney, M.D., Boston. MEDICAL PROGRESS Eighth Rei'obt op Progress in Orthopaedic Surgery. By Robert B. Osgood, M.D.; Rob- . ert Sautter, M.D.; Hermann Bucholz,MJ).; Harry C. Low,MJ).;Murray S.Danforth, M.D., Boston. EDITORIALS New and Non-ofpicul Remedies, 1915. Health Aspects of School Lunches. Syphilis. The Question op Quarantine Transfeb. Miscellaneous Matters of Medical Legislation. For rompIMe table of contenti. N« first text pftye. Stiles on Nervous System yt/ST OU7 Prof. Stiles* faculty of putting scientific things in language easily grasped is nowhere better illustrated than in this, his newest book. He has a way of conveying facts, accurately with rifle-ball precision. This new book is really a physiology and anatomy of the. nervous system, emphasizing the means of conserving nervous energy. You get chapters on the minute structure of the nervous system, elements of nerve physiology, reflexes, anatomy of the nerv- ous system, afferent nervous system, neuromuscular system and fatigue, auto- nomic system, the cerebrum and human development, emotion, sleep, dreams, causes of nervous impairment, neurasthenia, hygiene. : : 12ino of 2S0 paiTM, illiutnled. By PncT Ooldthwait StilB!!, Inatructor Id Phjsiolonr In H»nr»rd"OnjT««»y.*'' Cloth, ''(I'.M iirt. Stiles on Nutritional Physiology This work opens with n brief but adequate presentation of the physiology of free-Uvliig cells and leads up to the more complex function In man. It takes up each organ, each secretion concerned with the process of digestion, discussing the part each plays In the physiology of nutrition — In the transformation of energy. 12mo of 275 pa^'Bi, illuBtratrd. By PcRcr OoLDTiiwiiT SriLia, Imtnictor In Physioicujy in Harvard University. Cloth, $1.26 net. W. B. SAUNDERS COMPANY West Washington Square, Philadelphia — '■ '* — — — * • " — - - — — — ,. -■ '' » ,■■-,. ,. Entered at the Poet-offlct at Boaton aa aeoond-class matter /\ /' 11 BOSTON MEDICAL AND SUBOWAL JOURNAL [APBn, 1, 1915 HYGIENIC fRONT-LACED CORSETS Beneficial in all forms of visceral ptosis and in sacro-iliac strain THE BOSTON HYGIENIC CORSET COMPANY 59 TeaiplB Place Tilsphou, Oxford 4131 E. F. M. Liquid Paraffin Ib m) pxire tjiat aromatics are not re- quired to oOTer up the disagreeable odor or taste which is found in most of the ao-called Paraffin OiLs on the market. Our Ruarian Oil maintaina a per- fect control of the bowels without ir- ritation, its action being purely mechanical without purgatiye prin- ciples. It is extremely useful in surgical and obstetrical practice. We are the sole importers of the genuine. Lane Oil; '■ ,•'. ] SamplM free to Hovltais and PbyslcUiu. E. F. MAHADY CO. Surgical and Hoapital Supplies 673 BoyUton Street, Boston, Mass. (Huxttnt Cttpratur? iepattttwttt ABSTKACTOES. John Bbyant, M.D. Rogeb I. Lee, M.D. Laurence D. Chapin, M.D. Geo. A. Leland, Jr., M.D. Reoinau) Frrz, M.D. Fbancis W. Palfkey, M.D. C. Fbothingham, Jb., M.D. Edwabd H. Risley, M.D. ToBB W. Habmeb, M.D. Geobqe G. Smith, MJ). .T. B. Hawes, 2d, M.D. Lesley H. Spooneb, M.D. Fosteb S. Kellogg, M.D. Wildeb Tileston, M.D. Edw. L. Young, Jb., M.D. MEDICINE. The Reflex Effects of Alcohol on the Cibouiatiok. LiEB (Jour. A. M. A., March 13, 1915, LXIV, No. 11, 898) shows from detailed experimental evidence that though whiskey may raise for a few moments the systolic blood pressure, and thus act as an ap- parent circulatory stimulant, inasmuch as it decreases cardiac effleiency. It raises disproportionately the dias- tolic pressure and lowers pulse pressure. Some Clinical Featubes of the Wasseemann Reaction. Keyes (Jour. A. 31. A.. March 6, 1915, LXIV, No. 10, p. 804) makes the following concise statements backed up by a large clinical experience: A nega- tive Wassermann is not sufBclent evidence of' the cure or absence of syphilis. A positive reaction, un- supported by clinical evidence Is not sufficient evi- dence of the presence of syphilis. A positive reaction does not prohibit matrimony. A fixed positive re- action in the later years of the disease does not in- evitably point to the prospect of brain lesions. A negative reaction after salvarsan, in the first year of the disease, does not mean that the patient is cured, or that lesions will not api)ear before the re- action again becomes positive. The return of chancre, glands, eruption and positive Was'sermann reaction, a few months after control of the disease by salvar- san In its first few weeks, does not prove re-Infec- tion. These are not radical statements, but facts based on large clinical observation of cases. [E. H. R.] Hormonal and Neohobmonal. Dencks (Deutsche Zeitschr. f. Chir., November, 1914) was one of the earlier workers with hormonal, both upon animals and in the wards. There is no doubt that this substance often exerted a specific and highly effective action upon the intestine in ,cases refractory to other medication, and in cases in which hormonal alone was not effective, the simultaneous use of atropine or physostlgmine some- times accomplished results not brought about by the use of any one of these agents separately. Hormonal had, however, one great drawback — its tendency to cause collapse through a sudden fall in blood pres- sure. A new form of the old remedy has been presented under the name of neohormonal, with which Denclts has been conducting observations. The new sub- stance is said to be albumose-free, and owing to this improvement, seems to be free from the tendency to cause the undesirable drop in blood pressure with collapse. In the course of forty observations upon animals and one hundred and forty observations upor, patients, Dencks failed to observe any such effect. Rather there appeared a transient rise In blood pres- sure with its level then falling back not below nor- mal, the pressure rise being paralleled by a rise and fall to normal pulse rate and temperature. Further than this Dencks observed no serious untoward symp- (Continued on page iv.) ^ Vol. CLXXII, No. 13] BOSTON MEDICAL AND SURGICAL JOURNAL 111 A highly appreciated factor in the use of PANOPEPTON is the facility with which this food for the sick is obtained, administered and appropriated. PANOPEPTON is ever>-where known to physicians, everywhere obtain- able; is acceptable to the patient just as it is*; appropriated without "let or hindrance" on the part of the organism, and without expense of energy or efifort. The food substance of Panopepton, the actual food substance of entire beef and whole wheat, has already undergone those "silent transmutations" of phys- iological conversion which fit it for immediate utilisation in the body. There are many physicians with practical clinical knowledge of Panopepton who say freely that this food, through tlie facility and efficiency of its service in stimulating and maintaining nutrition, contributes also to the facility and success of the treatment. Fairchild Bros. & Foster New York • May be Iced If desired, or mixed with whey, the only food well Indicated for admixture with Panopepton. Powder Tablets In one-uunce cattoni 5 grain.. bo«I« of on. hund cd Suppo.itorie. and boic. of ten , ^ " , , . I J grain., boxe. or iix Schering & Glatz 150-152 Maiden Lane, New York A soltible. readily absorbed and prompthj excreted, pracTtcal.efficient and safe Hypnotic, Sedafive Antispasmodic which is firmly holding its place again^allnew comers. iii>eimiil IV BOSTON MEDICAL AND SURGICAL JOURNAL [April 1, 1915 DISREGARD OPINIONS of recognized authorities, that exhaustive clinical tests conclusively prove its de- cidedly superior efficacy and JUDGE FOR YOURSELF after carefully observing the certain, defi- nite action, the natural positive results, why PLUTO WATER is unhesitatingly prescribed by practitioners everywhere in chronic rheumatism, gout, constipation, obstinate intestinal disturbances, nephritis and simi- larly indicated conditions. Hygienically bottled. Samples, clinical data, literature interest- ingly descriptive of the superior advan- tages of America's famous Spa, promptly supplied by /\ FRENCH LICK SPRINGS HOTEL CO. FRENCH LICK, INDIANA Daily usets of Vaccines use Stjetman's SHERMAN'S BACTERINS Preparations with a Record for RELIABILITY Rheumatism is a germ disease. Why not use the most logical treatment, Bacterial Vaccines? In acute cases Sherman's No, 6 has proved very successful. In chronic cases Sherman's No. 35 is of most value. Local Distributors SAMPSON-SOCtt CO., 729 Boylston Street, Boston, Mass. E. r. MAtlADY CO., 671 Boylston Street, Boston, Mass. WRITE rOE UTERATUKE. G. H. SHERMAN, M.D., : : Detroit, Mich. {Continued from page ii.) toms and he feels that neohormonal may be used with safety and advantage alone or in combination with atropine or physostlgmine, to replace the more dangerous hormonal In such conditions as paresis or obstipation where the older remetly would have been indicated. [J. B.] How Shall We Tell Whetheb ok Not the MYOCABDrUM IS COMPETENT? Swan (Arch, of Int. Med., Feb., 1915) made a clinical test of the value of some of the procedures which have been suggested for the determination of myocardial efficiency in forty cases of cardiac and renal disease. The tests studied were: (1) The vari- ations in the pulse rate between the recumbent and the erect postures; (2) The percentage of the pulse pressure formed by the second phase of the auscul- tatory blood pressure reading, which is supposed to indicate cardiac strength; (3) The cardiac efficiency factor of Tigerstedt, pulse pressure divided by sys- tolic pressure (normally 25% to 35%) ; (4) The car- diac strength-cardiac weakness ratio of Goodman and Howell, obtained by determining the percentage of the pulse pressure formed by the different phases of the auscultatory blood pressure and adding to- gether the second and third phases (indicating car- diac strength) and the first and fourth phases (in- dicating cardiac weakness) — the normal ratio being C. S. : C. W. ;: 55.5 : 44.4; and (5) The cardiac overload factor of Stone, determined from the ratio of pulse pressure to diastolic pressure — the normal ratio being 50%, and anything in excess of this rep- resenting overload. The writer concludes that all of these factors have some value in determining the efficiency of the myocardium. He is inclined to think that the car- diac efficiency factor of Tigerstedt and the percent- age of the pulse pressure formed by the second phase are the most important. A cardiac efficiency factor of 40% or over jwints to myocardial inefficiency. A second phase of 30% or under indicates the same condition. The C. S. : O. W. ratio is a less reliable guide, but a C. W. factor greater than the C. S. fac- tor indicates myocardial disturbance. The overload factor of Stone is Indicative more of peripheral re- sistance than of myocardial weakness. A cardiac load below 50%, as determined by this method, giv- ing a negative overload may have some significance. [L. D. C] A Report of the Work Cabeied Out at the Radium Institute, London, in 1914. Pinch (Brit. Med. Jour., Feb. 27, 1915.) presents an abridged report of the work carried on in the London Radium Institute. He first describes in some detail the apparatus in use for giving radium treat- ment, and the duration and method of applications. All tissues treated with radium respond in some manner, but the nature and extent of this reaction vary greatly, and depend upon : first, the apparatus, screening and the dosage employed ; second, the na- ture of the tissue treated ; third, the condition of the tissue treated ; fourth, the extent of the area treated, and fifth, personal Idlosyncracy. The reaction may take the form of a simple ery- thema, or an erythema followed by desquamation. Occasionally vesication with superficial ulceration takes pace, and rarely deep ulceration. Pinch first discusses the results with various forms of carcinomata, such as •epitheliomata, and carcino- ma of the uterus, bladder, breast, rectum, and pros- tate. Rodent ulcer is the form of malignant dis- ease most amenable to radium treatment. The hy- pertrophic nodular type vrith slight superficial ulcera- tion yields the most satisfactory results, whereas the excavating type with undermined and overhanging edges often proves very intractable. Sarcomata, if (Continued on page vi.) Vol. CLXXII, >o. 13] BOSTON MEDICAL AND SUROICAL JOURNAL ^^ THREADED «i« nrcURY BICHLORIDES TABLETS Safety First Plus Accuracy and Efficiency r "SAFETY FIRST" last and all the time to you and your patient is made absolute when you order and get SHARP & DOHME'S Threaded Mercury Bichloride Tablets The tablet's blue color, trefoil shape with the word " Poison"- even the bottle's unique shape are all daylight safeguards. But the Thread that is the greatest of all Night- Watchmen. It says: stopi Think! Poisotl! Made only by SHARP & DOHME Chicago CHEMISTS tince 1860 BALTIMORE NEW YORK St. Louis New Orleans Atlanta Seattle San Francisco Philadelphia What Professor Lewis B. Allyn, Food Authority of the Pure Food Town of Westfield, Mass^ says about RING'S PUREMALT *'We are enclosing herewith analysis of samples of King's Puremalt recently received at this laboratory. "We are particularly pleased with the low acidity, low alcohol and high extract content. We believe this is a product of merit." KING'S PUnEMALT Is packed In boxes containing 1 dozen and 2 dozen each, and In barrels containing 10 dozen. Pronounced by the United States Inter- nal Revenue Department NOT an Alco- holic Beverage. KING'S PCBEMALT is sold at all drug stores and in strict conformity with the Pure Food and DruK Act of June 30. 1906. ASK ANT DRUGGIST ANYWHERE ICING'S PUREMALT DEPARTMENT 30-38 Hawlet Street, Boston VI BOSTON MEDICAL AND SURGICAL JOURNAL [April 1, 1915 THERE IS NO SUBSTITUTE FOR QUALITY IN SURGICAL APPLIANCES // you miss U you do not score at all. TRADE mam MARK iLASTI C kSTOCKING Send us your name and address. We want to mail our catalog and more particulars about the POMEROY idea of QUALITY. > Fully equipped offices with men's fitting department - exclusive ladies' department and mechanical shop - located irjf the lollowing cities: NEW YORK 16 E. 42nd Street 330 Lenox Avenue BROOKXYN 208 Livingston St. NEWARK 825 Broad Street CHICAGO 339 S. Wabash Ave. BOSTON 41 West Street .SPRINGFIELD (340 Bridge Street (Continued from page it;.) taken In their early stages before dissemination has occurred, do very well under this treatment In regard to lympljadenoma, the striking feature of the treatment of this condition with radium is the ex- treme rapidity with which the size of the affected glands is diminished. The best results are obtained when the condition is confined to the glands without involvement of the spleen. He describes his results in various forms of naevl, warts, and papillomata. In tuberculous glands, some improvement can be obtained, but not if the glands are caseating. He prefers to use the Finsen light to radium in treating lupus. Occasionally, re- markable results are obtained in the treatment of arthritis deformans, and in some skin diseases, such as keloid and pruritus. [J. B. H.] The Therapeutic Action of Iodin. JoBUXG AND Petersen (Arch, of Int. Med., Fei., 1915) studied the therapeutic action of iodin in the body, especially its effect in causing absorption of necrotic material. The study here reported con- cerns the influence of iodin on the antitrypsin of the blood and tissues, the writers believing that the antitrypsin is the most important factor in prevent- ing the resolution of necrotic tissues such as are found in infarcts and in the caseous areas in syphi- lis and tuberculosis. They found a great decrease in anUtryptic strength of guinea-pig serum after treat- ment with potassium iodide. In thirteen cases in human beings, eleven of whom were syphilltics, they found that the administration of iodides caused a very considerable reduction in the antitryptic activitj- of the blood. If the action of iodin in causing ab- sorption of necrotic material is due to the general owering of the antitrypsin, they say, large doses should cause an increase In the nitrogen output ow- ing to the increase of proteolysis. The results of a number of experiments with dogs Indicate that the iodides do increase the nitrogen output. In phthisis, when Iodides are taken Into the tissues, a portion of the iodin is liberated and combines with the un- saturated carbon atoms of the fatty acids. As soott as this occurs in necrotic tissue to a degree sufficient to lower or remove the antlferment action, autolysis en- sues, the caseous matter begins to soften and is more likely to rupture Into the bronchi and tubercle ba- cilli appear in the sputum and may be disseminated in the body. In syphilis, iodides bring about re- solution of the process but are not curative in the sense that they prevent the return of the lesions. Iodin neutralizes the action of the agents (unsatu- rated fatty acid radicals) which prevent solution and absorption of necrotic tissue, and at the same time- lays bare to the action of the real germicidal agent (mercury or arsenic) the infecting organism which had been protected by the necrotic tissue. fL. D. C] SURGERY. Tbeatment or Fractdbe of the Elbow bt Hypeb- FLEXION AND EARLY IMMOBILIZATION. Unholp and Wolf (Surg., Oyn. and 06s., March, 1915) in a well written article, with many good il- lustrations, seemingly demonstrate that the old idea of late mobilization of the elbow after fracture is an improper principle on which to work. They show 5.3% of perfect results and by perfect they mean ab- solutely normal arms. They found that the most perfect results were obtained when fractures were immobilized for the briefest period possible: the re- sults were perfect in all of 23 cases In which fixation in hyperflexion was combined with early mobiliza- tion and massage. The following table Is suggestive : (Continued on page viii.) \s, seamless finger cots, bandages, bands, tubes, etc. Absolute freedom from lumps of rubber, thin or thickened spots, or in- ferior material. A dehcitte sviuM; of touch is preserved in the quality of the rubber used. THE MII>LER RUBBEB COMPANY, AKRON, OHIO, U.8.A. Freedom of i'\ery move witbout exertion. No tension to hamper the movement of the Angers. MASSACHUSETTS GENERAL HOSPITAL Dr. E. G. Brackett and Associates will give a course of Clinical Lectures in Orthopedic Surgery in the Lower Amphitheatre in the Out-Patient Department, at 10.30, Thursday mornings (excepting the first exercise, which will be on Wednesday), beginning March Slst, and continuing through April and May. The exercises will consist of lectures, clinical demonstration of cases, the surgical anatomy of the joints under consideration, the x-ray interpretation of the condition included in the exercises, and will be followed with operations when possible. The following subjects will be considered: — I Wednesday, March Slst. Thursday, April 8th. ..] Thursday, April 15th and 22d. General Methods Used in the Diagnosis and Differentiation of Joint Disease. Tubercular Disease of Spine, Hip, Knee. Arthritis. Etiological Factors Detection and Comparative Significance of Various Joint Manifestations. Treatment Affections of the Foot. 1 Static Conditions— Foot Strain, etc. [Thursday April 29th Acquired Deformities of the Foot, etc. J Postural Deformities. T Lumbosacral and Sacro-lUac Affections and their Relation to Backache i Thursday, May 13th and 20th. and Sciatica. J Knee-joint — Various Non-tubercular Affections. Thursday, May 27th. The course is open to graduates in medicine and students of the third and fourth year, subject to their acceptance by the hospital. Women are admitted. Given in connection with Harvard Graduate School of Medicine. A fee of $5 will be charged for the course. The hospital will be glad to place the name of any physician on the mailing list, to receive an- nouncements of all graduate courses. Application should bp made to FREDERIC A. WASHBURN, Resident Physician, Massachusetts General Hospital. BOSTON MEDICAL AND SURGICAL JOURNAL [Apeu, 1, 1915 Double Service Automobile Tires GUARANTEED 7,000 MILES SERVICE ABSOLUTELY PUNCTUREPROOF DOUBLE SERVICE TIRES are double the thickness of the best standard make tires. This 100% greater wearing surface naturally gives that much more mileage and service. The average of 12 plies of tough fabric and one inch surface tread rubber makes these tires ABSOLUTELY PUNCTUREPROOF. These tires excell all others for use in the country over rough and rugged roads as well as on hard pavements. They are as easy riding and resilient as any other pneumatic tire — the air space and pres- sure being the same. They are the most economical and "care free" tires made and are used where tires must be de- pended on and tire troubles cannot be tolerated Many DOUBLE SERVICE style tires are in use in the United States government and Europeain War service. Our output is limited to a certain amount, but for a short time we offer the following reduced special prices as an INTRODUCTORY OFFER. Cross Section of the Double Service Tire. Extra Heavy Tires Tubes 28x3" $ 7.25 $2.20 30 X 3 8.60 2.30 30x3%" 10.85 3.10 31x3%" 11.40 3.15 32 X 3%" 12.75 3.20 31x4" 14.25 4.00 32 x 4" 14.90 4.10 33 X 4" 15.75 4.20 34X4 16.70 4.35 35x4" 16.80 4.60 36x4" 17.45 4.65 37x4" 17.65 4.70 35x4%" 21.20 5.60 36x4y2" 22.50 5.75 37 x AW 23.60 6.20 35 X 5" 24.40 6.35 36x5" 25.10 6.55 37 X 5" 26.30 6.60 All other sizes not included in above list also fur- nished. Non-skids at 10% additional. TERMS: Payment vrith order at above special prices, a 10% discount allowed on orders for two or more tires. All personal checks must be certified. Try these tires and be convinced of their very high qualities. Not sold through dealers. Double Service Tire & Rubber Co. F4, Akron, Ohio {Continued from page viii.) more or less drawn into the palm, although the flexor tendons are not actively contracted. The skin over the thickened fascia may become puckered owing to the fascia fibres. The disease divides itself into four stages: first. In which the palmar fascia only is involved; second, in which the fascia is involved and one or more dig- its are slightly flexed; third, in which the palmar fascia is involved and one or more digits are semi- flexed; fourth, In which the palmar fascia is in- volved and one or more digits are totally flexed. Black has collected 240 cases; and finds that of these, 104 are bilateral. It occurs much more frequently In men than in women, and is a disease of middle and late life. It often runs in families, and seems to be a disease affecting the non-working class fully as much as the working classes. There are two antagonistic theories concerning its causation; first, that it is brought about by external agencies ; and second, that it is due to an internal or constitutional factor. Black does not believe in our existing state of knowledge that the disease Is wholly unconnected with external pressure and other causes, but he does believe that the external causa- tion theory has as yet to be proved. He believes that eventually this condition can be shown to be due to a certain internal condition, possibly akin to a gouty or rheumatic condition among persons of advancing age. Treatment is operative and non-operative. He quotes one writer who believes that it is a symp- tom of thyroid deficiency, and who reports favorable results with thyroid extract. Operation is usually , necessary. [j. B. H.] OBSTETRICS AND GYNECOLOGY. The Cdbe of Adenocabcinoma of the Uterus by Simple Cueettagex BoLDT AND Fedinski {Suvg., Qyn. and Ohs., March, 1915) go extensively into the detailed pathology of carcinoma of the uterus both in its early and late stages and cases are cited — three in all — in which a cure has been effected by simple curettage for diag- nosis. This brings up the question of spontaneous cure to which these authors give little credit. They raise the very pertinent question as to whether cure is possible from curetting only. They warn also against the advocacy of this operation as a cure in place of the radical procedure. The discussion in these papers is of interest to those especially inter- ested in this branch of work. [E. H. E.] Nitrous Oxid Gas Analgesia in Obstetrics. Webster and Lynch (Jour. A. M. A., March 6, 1915) make very timely contributions to the subject at a time when the much-heralded twilight sleep is being advertised to the world in the lay press. Webs- ter especially shows the Independability of this new method and relegates it to its proper place in treat- ment. He then points out the simplicity, safety and freedom from obstetrical objections of gas anesthesia or analgesia during the second stage of labor. It Is vastly superior to ether, chloroform or morfine in its degree of safety and lack of interference with iso- tonic contractions of the mother's musculature. It seems a rational procedure and one worth more ex- tended trial. The administration does not require the skilled anesthetist any more than dental work does. [E. H. R.] Vol. CLXXII, Xo. 13] BOSTON MEDICAL AXD SURGICAL JOURNAL XX ELECTRIC CENTRIFUGES AND VACCINE SHAKERS Send for Catalog C INT[RNATIONAL INSTRUMENT COMPANY 23 (HURCH STRfET CAMBRIDGE, MASS. Fisk & Arnold Established 1865 Oldest Manufacturers in New England of ARTIFICIAL LIMBS For Every Ampn- tatlon. United States Government Bonded Manufacturers The procuring of (n artincial limb i< a most important matter and the Doctor cannot afford to trust hia pa- tient in any but the most reliable hands. Our experience o f nearly half a century guarantees our relia- bility. MANUfACTlJRfRS Of THE IINCOLN ARM The AccompanvinK cut illtutrmtes an arni for amputatipn above elbow with B p r i n ff thumb, detachable hand and elbow locking de- Tice. Full descriptive cata- lo^e on application. 3 Boylston Place, Boston, Mass. Telephone, Oiford 3684-M. Puffed Wheat and Puffed Rice The Fittest Foods Created The Best-Cooked Cereals Known Prof. A. P. Anderson, formerly of Co- lumbia University, has best solved the prob- lem of cereal digestion. And this is how he does it: Whole kernels of wheat or rice are sealed in mammoth j^uns. Then the guns are re- volved for an hour in 550 degrees of heat. The trifle of moisture inside of each granule is converted to steam by this heat. When the guns are shot, that steam ex- plodes. There occur in each kernel more than 100 million explosions. Cooking, baking or toasting break up part of the granules. But this process alone breaks them all. In no other way is wheat or rice even half so well fitted for easy di- gestion. The grains are thus puffed to eight times normal size. They become fragile grain bubbles, crisp and flaky, fascinating to the taste. They are served with cream and su- gar. Or like crackers in bowls of milk. Or eaten dry like peanuts. In many conditions which you meet you'll find these ideal foods. They are de- licious whole-grain morsels which do not tax the stomach. Package on Request "We shall gladly mail to physicians, on request, a package of either Puflfed Wheat or Puffed Rice. The foods are sold by all grocers at 12c and 15c per pack- age, respectively. Address The Quaker Q^\s G>mpany Chicago xii BOSTON MEDICAL AND SURGICAL JOURNAL ' [Apbii- 1, 1915 PHILLIPS' PHOSPHO-MURIATE of QUININE COMP. An Aromatic Syrup Containing Phosphoric Acid and Phosphates of Potash, Magnesia, Lime and Iron with Muriate of Quinine and Strychnine A Reliable Tonic and Reconstructive Free from Alcohol PHILLIPS' DIGESTIBLE COCOA COMP. Made from Fine Selected Beans of Cacao Theobroma A Delicious Food Beverage and Valuable Substitute for Tea or Coffee "THE COCOA WITH A RICH CHOCOLATE FLAVOR" Constipation in the artificially-fed infant most commonly arises from Faulty protein digestion Imperfect fat digestion Lack of energy Starchy diet and is best corrected by making certain changes in the proportion of the constitu- ents of the baby's diet. MellinsFood is of much assistance in adjusting the milk mixture to meet this annoying condition, and we will take pleasure in sending, upon request, the details of the method of procedure to meet individual conditions. Mellins Food Company, Boston,Mass. Zbc JSoeton nr^ebical anb Surgical Journal April 1, 1915 ADDRESSES. Cha«le8 Sedgwick Hihot, M.D. B» W. r. Porter, M.D., Boston 467 Jium GuGosr Mdufobd, M.D. By Richard C. Cabot, MJ)., Boston 470 ORIQINAL ARTICLES. Tub Chanocd Position of the PRorEasios of Mcdicihe. By David W. Cheever, M.D., Boston 478 The Menace or Svfhilu to the CLEUi-Ln'ixa Pcsuc. By J. Harper Blaitdetl, M.D., Boston 476 An Undesoribed Ulnie Nerve Tbooble Doe to Texsioe frou Scar, and Its Curb. By F. J. Cotton, M.D., Boston 480 Some Nertou!i- Affections in Which Uabsaoe Desebtis Kobe Fkeqoent Use. By J. W. Courtttey, M.D., Boston 483 ICEDICAL PR0OBE88, EioMTH Report of Proorbsb in Orthopaedic Sdboebt. By Robert B. Otgood, M.D.; Robert Soutter, M.D.; Btrmann BuehoU, M.D.; Harry C. Low, M.D.; and Murray S. Dan- forth, M.D., Boston. (Concluded.) 486 AdiirfBa^B. BOOK REVIEWS. A Text-Book of the Diseases of the Kose and Throat. By Jona- than Wright, M.D "1 EDITORIALS. New and Nok-Official Reuedieb, 1915 4M Health Abpects of School Lunches MS Stfhilo *•• Tm QicsTioN OF Quarantine Transfer 4SS UlfoaLLAEEovs Matters of Medical Leoislation - ence will never be solved, because the factors and their possible interactions exceed the apparatus for their detection. No mental gifts will ever make us hear the high-pitched sounds audible to insects, nor shall we ever listen to the music of the spheres. Dr. Minot began his new scientific life by a study of growth, senescence, and death, subjects which occupied him for thirty years. Very likely he was first attracted to this field by the memorable researches of Dr. Bowditch on the growth of children. Dr. Bowditch often la- mented that measurements of children in statis- tical quantities could hardly be obtained before and after the school age. Nor was it possible to follow month by month the growth of thousands of individuals from birth to maturity. Dr. Minot determined therefore to study growth as a function of age in one of the higher vertebrates other than man. His observations were begun in the physiological laboratory of the Harvard Medical School about 1885. Hundreds of guinea- pigs were weighed every day from birth up to 40 days, then every fifth day up to 215 days, then three times a month to the end of the second year after birth. Most of the results of this great task were published in 1891, in the English Jour- nal of Physiology. One of the most important fruits of these studies was the recognition of a new and more accurate method of expressing growth. All previous investigators had figured the absolute rate of growth, i.e. the growth of a c(hild in any one year was the number of pounds gained in Uiat year. Minot points out that five pounds gained by a small child is a greater gain than five pounds gained by a large child. The true rate of growth, he very rightly insists, is expressed by the relation between the growth in any one year and the weight at the beginning of that year. This is Minot 's percentile rate of growth. The principal fact developed in the paper of 1891 was that there is in guinea-pigs a progres- sive loss in the power of growth, extraordinarily rapid in the early hours of life. In the first forty-five days the ability to grow decreases four-fifths. The work with guinea-pigs was followed by valuable studies on intra-uterine growth. Eighteen years after his first publication on growth Dr. Minot summed up his studies in this direction in a book entitled Age, Growth, and Death. Here he demonstrates that the rate of growth is highest at segmentation and from that hour declines, at first with great rapidity and then more slowly. The period of most rapid decline is youth ; the period of slowest decline is old age. If we consider death to be the bank- ruptcy of an organism which spends energy be- yond its income, the final dissolution is almost 470 BOSTON MEDICAL AND SUROICAL JOURNAL [Apbil 1, 1915 complete before the highly efficient life in the womb is exchanged for that in a much less favorable environment. The paradoxes demon- strated as truths by Dr. Minot's work show us how far from correct are the conventional ideas of life. Birth and death, the accumulation and the discharge of energy, go on unceasingly side by side. There are no terminal stations. En- ergy is a stream that empties into its source, and life is a function of time. The book on Age, Growth, and Death treats also of Dr. Minot's views, first expressed in 1890, regarding the increase in the amount of proto- plasm within the limits of single cells. By the study of the proportionate volumes of the nu- cleus and the cell body, he believed he could demonstrate certain laws governing that pro- portion, and prove that the variations of the proportion establish conditions which are fun- damental to the correct conception of growth, differentiation, death, and sex. The most char- acteristic peculiarity of advancing age, of in- creasing development, is, in Dr. Minot's opinion, the relative growth of protoplasm. The posses- sion of a large relative' quanity of protoplasm is a sign of age. It is essential to rapid growth that the proportion of protoplasm should be small. The development of protoplasm. Dr. Minot taught, is the cause of the loss of power of growth. It will be observed that this stimulating but incomplete list of Dr. Minot's services to phys- iology touches but one side of his activity. I have not spoken of his many valuable contribu- tions to morphology, of his text-books, the first of which, especially, much enlarged the influence of the young science of embryology; of his ad- mirable addresses at scientific meetings nor of his ingenious inventions such as the rocking mi- crotome. Time does not serve, nor can one man speak with authority of services in so many fields. Perhaps the highest praise a man can have, is that his biography must be written by a company rather than by a single individual. It remains to speak of Dr. Minot as a friend. But of his friendship and our personal relations I cannot trust myself to speak. He shone brightest in the adversity of his friends, both by his resolute bearing toward opponents and by his counsel. Of all the words I was privileged to have from him, I best remember his saying that a scientist should never consult his personal happiness and that injuries were best forgiven and forgotten. I believe that Charles Sedgwick Minot, the friend, the comrade, the distinguished scientist in whose honor we are met, will be in death as in life a staff for the weak, a mark for the strong, a light to guide and cheer despondent men. The weak will see' in him a triumph over circumstance ; the strong will draw new strength from his unremitting years of high endeavor; and the despondent, averting their sad eyes from, the fields on which so many of our ideals have lately fallen, will find in his career fresh hope and a renewed b'elief that life is after all worth living. JAMES GREGORY MUMFORD, M.D.* By Richabd C. Cabot, M.D., Boston. Among those who knew James Gregory Mum- ford and realized his physical limitations, it has become a familiar miracle, — how he accom- plished the enormous and varied work which stands today to his credit. But when one looks back over the remembrances of many years and pictures the man,— his looks, his voice, his man- ner, his build,— the victory over his own temper- ament seems even more remarkable than his conquest of physical handicaps. He was a re- former yet without many of the reformer's natural attributes. Of the reformer's tradi- tional buoyancy and high spirits, he had not a trace. He was never buoyant or spontaneously expansive. He did not bubble over. He had none of the qualities of a steam roller; yet he was always pressing relentlessly on. He was thin-skinned, sensitive, shy and modest, yet he set himself to push through obstacles that would tear the average man to pieces. Reformers are usually cock sure. Mumford was never so. He had almost an ironic con- sciousness of human fallibility,— in himself most of all. His plans and achievements never swept him away. He was their impelling force himself. In a letter written in 1910 to the sec- retary of his college class, he portrays his work without any of the reformer's ardor and con- fidence. "So the simple record runs on," he says, "telling of mild employments in the Harvard Medical School and elsewhere. I like teaching; students pass me out the usual compliments due to credulous senility. (He was 47 when he thus described himself.) I like practising surgery; patients toss me roses mingled with thorns. I like writing about people and things, for the reviewers deal me comments which chasten the soul. Altogether, life continues a pleasant ex- perience. I look forward with composure to the next twenty-five years." Anyone who did not know his arduous achievements, his daring ideals, his ever-renewed battle with fate and conservatism, might gather from words like these. — indeed from most of his writings,— that he took life easily, smilingly, in- dulgently. His style has often the light, whim- sical quality of one who looks on with tolerance and amusement at the crusading reformers. Yet he was himself a crusader and a reformer. His life never mirrored the easy-chair quality of his style ; perhaps it was his way of resting from the sterner efforts of his medical career. He had the look and manner of a recluse and I doubt if he was ever happier than when alone with his wife in the woods or by his library fire • Read at a meeting of the Boston Society for Medical Improve- ment, January 26, 191B. Vol. CLXXII, No. 13] BOSTON MEDICAL AND SURGICAL JOURNAL 471 The retiring, sensitive side of Ms nature must have shrunk even more than the average man's from the buffets of a reformer's existence. No one could have felt more keenly than he, for ex- ample, the crushing weight of newspaper criti- cism by medical colleagues, as for example at the time of his connection with the Medical Ad- visory Board of Emmanuel Church. For he did not love a fight. There was none of the glow of battle in his face. His convictions had not that tough, resistant consistency that makes some of us the surer that we are right when every one yells that we are wrong. In this paradox we face the central mystery of his life. His was a fighting recluse, a sensi- tive militant, a shy reformer, a private spirited publicist, a tender footed pioneer. All this was especially marked in his later years. In school and college, the rift in his nature was less vis- ible. It was then his scholarly and refined tastes, not his pioneering spirit, that impressed his friends. Yet his life-long conscientiousness is exemplified in the earliest of all the stories told of him. He was born in 1863. In 1867, when on a drive with his aunt in Rochester, he was shocked to see from the height of his four years of earthly experience, a clothes line still heavy with the week's washing, though the week was nearly over. "What! Friday, and the wash not yet done!" That conscience, — a New York conscience, not a New England one by the way, — is, I take it, the key to unlock the mystery of his life. Con- science, not buoyancy, made him optimistic. Conscience, not fervor, pushed forward his re- forms. Conscience is written into every entry of the journal where in 1879 he listed the books on the shelves of his first library at St. Paul's school. The handwriting is remarkably concise and neat for a boy of fourteen. This book list includes Mommsen, Thackeray, most of the Eng- lish and American poets, Shakespeare, a good many books of travel, five volumes of the Lives of Engineers and a few modern novels. "We cannot be sure that he had read them all, but many of them" had been lent by him to other boys whose names, with the dates when they took and returned the books, are methodically recorded. I think a boy is more likely to have read the books that he lends, — especially when the boy is Jim Mumford. This bookishness remained with him and grew with his growth from the passive to the active or creative mood. The list of his writings is im- pressive, even from its size. Eight books,* aggregating nearly 3500 pages, came from his hand within twelve years, and during a slightly longfer period, sixty articles in • 1. Mumford Memoirs, 1900, 2. A Narrative of Medicine in America, 1908. 8. Clinical Talks on Minor Surgery, 1908. 4. Surgriral Aspects of Dirc«tivp Di^nnlcro. 1905. 6. Surgical Memoirs and Other Essays, 1908. 6. The Practice of Surgery, 1910. 7. One Hundred Surgical Problems, 1911. 8. A Doctor's Table Talk, 1912. He was also in editorial charge of the History of the Hanard Medical School (3 vols.) written by Dr. Thos. F. Harrington. medical journals. Many of these articles, such as that analysing 300 skull fractures, represented much labor. But the quality and style of thLs voluminous output makes it far more impressive. Mumford was one of the three or four American medical writers who has seriously tried to write good English. The German method of dumping words in piles upon a page and leaving the reader to deal with them as best he may, is that followed by practically all contemporary writers of American medicine. But this method never appealed to Mumford, who had left behind school-boy English before he left school, and ever after labored to make his writings justify the education which he had received. As he was the only Bostonian who has ever produced a text-book on surgery, and as the vur- rent of his interests flowed strongly towards teaching, it can hardly have failed to be a disappointment to him that he never advanced beyond the rank of instructor at the Harvard Medical School. But it is doubtful whether he would ever have desired to occupy the office of a professor of surgery, so long as that oflBce remained what it was and still is. As early as 1906, nearly ten years ago, he foresaw the need of a surgical pro- fessor who should devote himself like other pro- fessors to his office. That a professor should never be obliged to devote a large proportion of his time to private practice in order to make a living, that he should not teach for a merely nominal salary and should give but a small part of his time to teaching or study, is now so gener- ally realized that the anomaly will soon, I believe, be remedied in the Harvard Medical School. But in 1906, — nine years ago, — there were few who dared to hope for such a high standard of instruction. The amateur clinical teacher was the accepted and inevitable portion of every medical school but one in the country. That he saw years before the rest of us the step that medical teaching would take next, by making clinical professors full-time men. was entirely characteristic of the man. We shall find it true in all the great interests of his life. One of those interests was religion. He was old-fashioned enough to believe in God, in mar- riage and in other eternal truths to which the excesses of modern enlightenment have for the time very generally blinded our eyes. He be- lieved that the human body in sickness and in health is usually inhabited by a soul, and he cherished the still more unpopular belief that a man's soul may conceivably be as well known to a clergyman who had given it his life-long study as to a doctor who has studied it but fit- fully and as a secondary interest. Believing this, he thought it not impossible that a clergy- man might help a doctor. He never believed that a clergyman should practice medicine but he was firmly convinced that a doctor should not delude himself with the belief that he owns his patient. That the two professions could work 472 BOSTON MEDICAL AND SURGICAL JOURNAL [Apbil 1, 1915 simultaneously for one patient's good was the belief underlying what was called some years ago the Emmanual movement. Like Elwood Wor- cester, the leader of this movement, Mumford hoped that the doctors would be convinced of this. But they remained unconvinced and as a piece of genuine, widespread and whole- hearted cooperation between minister and doctor, the attempt failed, because the doctors, as a rule, had a low opinion of the ministers. Nevertheless, I have no doubt that in this, as in his other hopes, Mumford was ahead of his age, in 1908-9, not behind it, and that in some form, his attempt will yet succeed. Cooperation between doctor and minister was the ideal of this lost cause, — cooperation was also . the key note of the next reform which in 1910 Dr. Mumford tried to effect. The Emergency Hospital (now Grace Hospital) on Kingston street, was then in the market. This hospital had always been managed upon a partially co- operative basis. That is, people paid a small fee yearly for treatment there and the physicians attached to it were supposed to get their living — in part at least — out of these fees. Mumford believed that, although faulty in execution, this plan marked out in essentials the right way to support a hospital and to get adequate treatment for the vast number of people of moderate means who now get the worst medical and sur- gical treatment that a civilized community per- mits. He wanted to supply the needs of those who will not go to a free hospital clinic or who are refused admittance there, but who are still unable to pay the high prices which accurate diagnosis and rational treatment necessitate. He knew that the poor who visit free hospital clinics are now getting better treatment than any but the very rich. He wanted to bring good medical service within the reach of every one. To do this he proposed that the old Emer- gency Hospital should be secured; that a pro- spectus should be issued explaining the plan of a cooperative hospital, of which he was to be the surgical head and I the medical head. Each of us was to organize a staff of physicians to do under our supervision the work of the hospital and to be paid out of the fees of subscribers who were to contribute so much a year for the right to be treated there without further charge. Dr. Mumford believed that with adequate lab- oratories and x-ray outfits, with a proper system of group diagnosis by a combination of men, each expert in his own field, and by furnishing to every patient the degree of sympathy, cour- tesy and consideration now given by the private physician and omitted in most free clinics, the hospital could be made so attractive that it would pay. Science and sympathy he believed could be combined and, by proper organization at a hospital, could be made available for every one at a low price, while yet providing good salaries for the physicians. Some form of cooperation both with the min- isters of religion and with social service workers he also hoped to bring about at the new hospital. In short, all that we both had failed to accom- plish elsewhere, we hoped here to attain. The plan was wholly his and had it succeeded the credit would have been wholly his. We got as far as a typewritten prospectus, — written by him. Then the scheme fell through for lack of funds. I have told of this plan in detail because, though it came to nothing in Boston, it was im- doubtedly a precursor in Dr. Mumford 's mind of his Clifton Springs undertaking. Hopes nourished during the time when he was trying to figure out the Cooperative Hospital on King- ston street took a further lease of life when it was proposed to him to become Physieian-in- Chief of the Clifton Springs Sanitarium. That title deserves a moment's notice. Not surgeon-in-ehief but physician-in-chief was the name of his office. As head of the institution, he succeeded Dr. Charles P. Emerson, an intern- ist. This he was perfectly fit to do because of his long experience of general medical practice dur- ing his summers at Nahant. For 12 years, from 1894 to 1906, he spent nearly half of each year in general family practice, including in the earlier years, very little surgery. This broad and varied experience prepared him to be the Physician-in-Chief of an institution where sur- gery was by no means the central interest. "I've agreed to take this big institution," he writes in August, 1912, "and build it up, getting together a high-grade staff and other trifles. There's a great opportunity, great interest and great promise. I shall not be cut off from Bos- ton. I am retaining a surgical lectureship ia the University and shall come each year to give a course or courses. I am feeling well and chip- per. " This was scarcely six months after his second serious breakdown, an attack from his life long enemy, rheumatic heart trouble, which two years later cost him his life. With the ir- repressible hopefulness that had been but tem- porarily checked by the failure of the coopera- tive hospital scheme in Boston, he plunged into his last and best crusade, the attempt to make out of. Clifton Sanitarium a great cooperative medical and surgical institution. Despite the splendid leadership of his predecessor. Dr. C. P. Emerson, the staff had not been thoroughly re- organized, so that Dr. Emerson's new methods had not been able to permeate and reinvigorate the old institutiom It had remained a place where people went to rest and sometimes stayed to rest indefinitely. Mumford began to make of it an active institution where people could be treated and put back into the world fit to work. Under his inspiring leadership a splendid body of young physicians and surgeons was rap- idly being accumulated and the methods and standards of the place were being modernized, when a difference of policy between Dr. Mum- ford and the financial heads of the institution led to his resignation, very shortly before his death. Voi, CLXXII, No. 13] BOSTON MEDICAL AND SVROWAL JOURNAL 473 As we look back over this record of Dr. Mum- ford 's, we might well interpret it as one devoted to lost causes. He did not see established at Harvard such a full time Professorship of Clin- ical Surgery as he might well have aspired to fill. He did not live to see that closer coopera- tion of doctor and clergyman for which in the Emmanuel movement he had hoped. In Bo.ston and later in Clifton Springs his eagerness to ■organize a cooperative hospital, serving the whole public, received a check. Yet he was never and could never have become a disap- pointed man. He lived by faith and not by sight. He knew that the reforms he fought for must come to pass sooner or later. He be- queathed his unfinished task to us. We have taken from his hands the tools he was forced to lay down. Two, at any rate, of the three medi- cal reforms for which he lived and died, — full time clinical professorships and a medical clinic where every one, no matter how rich or how poor, can be treated by physicians paid out of the fees thus collected, — these two reforms I be- lieve we shall see carried out here in Boston within the next few years. That is what he most wanted, — the goal itself, not his personal share in it. He ran his distance and passed on his message to us. We are here to commemorate James Gregory Mumford. The sincerity of that intention will be manifest when we dedicate ourselves afresh to the task for which he gave ' ' the last full meas- ure of devotion" when we "here highly re- solve that he shall not have died in vain." To us is bequeathed the task he left unfinished, that his ideal of medical service organized by the medical profession for all the people shall be made a reality in America. (Original ArtirUa. THE CHANGED POSITION OF THE PROFESSION OF MEDICINE. By David W. Cheetbb, M.D., Boston. Having begian the study of medicine in 1854, and its practice in 1858, I can look back over sixty years of medical events; besides this, be- ing descended from two generations of doctors, medical influences surrounded me from child- hood. I therefore feel that I am qualified to survey all this period, while excusing inyself from too much egotism. Two great changes jn medicine will naturally occur to everyone, namely, anesthesia and asepsis. These, how- ever, I do not feel it necessary to detail, but shall confine myself to two classes of influences, one external or arising from outward circum- stances, the other originated by the doctor him- self. Naturally we must consider the external circumstances first; but before doing so, it will be useful to glance at the real condition of the medical profession in my childhood. Active interference with disease and the use of strong remedies were in vogue. Deadly min- eral poisons, such as antimony, mercury, and lead, were largely used. Emetics, now rarely used, were habitually employed, and sometimes, I think, with benefit. There was a strong feel- ing that unhealthy influences could be expelled from the body by purgatives. These were freely and frequently used. It was thought that the taking of blood from the body by repeated vene- section reduced fever and led to the generation of a new and better blood. It was an old-fash- ioned habit with a good many people of adult or middle age to be bled once a year, whether sick or not, as a sanitary measure. My father bled people. I myself have sometimes bled pa- tients by venesection, and in properly selected cases I am convinced it is a remedy of value. All sorts of spring medicine, or "spring cleans- ing" as I call it, were popular, and they are popular still. The other remedies mentioned have mostly fallen into disuse. It thus can be .shown that the medical mind, and hence the popular mind, were very much in favor of con- sidering disease as an entity, which could be "knocked out," so to speak, by a sharp counter- blow given by the doctor. Under these circumstances, about the year 1850 — I cannot be precise — there arose a great medical doubt. Sir John Forbes in England, Dr. Jacob Bigelow and Dr. 0. W. Holmes in America, enunciated a new theory, as follows: that all diseases were self-limited, having a natural rise, progress and decline, and hence were little influenced by medicine. If this were true, it naturally followed that it was the best policy for the doctor to care for the patient by watching his symptoms rather than by using very active medication of uncertain power. From this arose what was called Expectant Treatment : to wait on Nature ; to be sure to do no harm, if you could do no good. I must be allowed to return a mo- ment to myself. I did not seriously study medicine until I was twenty-three years old. I was fairly mature; I had had large collateral reading; I absorbed these doc- trines and I wrote them up in the North Amer- ican Review and in a Prize Essay. I entered upon the study of medicine with an intensity which proved that I had chosen the right call- ing. These nullifying doctrines had a very de- pressing effect on me. What was the use of practising an art which could promise so little? I almost felt tempted to give up my profession. Fortunately for me, I was led to continue the study and teaching of anatomy for eight years, and thus passed on to the pursuit of surgery,' \yhere I found solid ground. As time went on^ like all other doctors of my time, I did practise medicine as well as surgery. Experience taught me that the doctrine of self-limited disease was 474 BOSTON MEDICAL AND SURGICAL JOURNAL [Apeil 1, 1915 not all true, that there was something in drugs; on some I learned to rely; and I still believe they are useful. All this personal digression is for the purpose of trying to bring before the reader the exact condition of medical practice about fifty years ago. We are now ready to consider those influ- ences which changed medicine, arising from without. And the first of these is Homeopathy. This novel and peculiar belief, "made in Ger- many," never attained its full vigor in the land of its birth; prevailed very moderately in France, but to a greater extent in England. It received, however, a prompt recognition among certain of the more educated classes in this country and attained here an exotic growth; following soon after the introduction of the speculative views of German philosophy, it seemed to some to ally itself with them and to be a new advance in reasoning. It had two dog- mas : one that the strength of medicines was in- creased by minute division and sub-division ; the other that if a drug taken in health produced certain symptoms, it would affect or cure any diseased condition which was characterized by like symptoms. Those who professed this method necessarily rejected the older methods which opposed it. Hence the physician who was old-fashioned or regular rejected this belief as an exclusive and one-sided dogma which denied all other things which he believed true; and as these new views were diametrically opposed to his own as to the treatment of the sick, he was consistent in refusing a consultation with the homeopathic doctor, because it could do no good. This new practice attracted many people from the better classes and proportionately dimin- ished the clientele of the regular doctor. Ho- meopathy for some years increased, founded schools, endowed hospitals, established medical societies, divided the public into sects of med- ical belief. As time wore on, it grew less dis- tinctive, and the methods of old or regular practice supplanted it to a large extent. Meanwhile another new belief in healing, of a semi-religious character, calling itself Chris- tian Science, or Mental Healing, arose. Its doc- trine was that the will could control organic processes either wholly or to a much greater de- gree than had previously been supposed. It encouraged all weakly people to try to get well by themselves ; and to a certain degree its influ- ence was salutary. But when it undertook to cope with acute or contagious disease or to seek to control the heart, the stomach, the bowels, the uterus, which were constituted by nature, and purposely so, to be beyond the influence of the will, it failed. The bacteria of diphtheria, un- restrained by Christian Science, were diffused among other members of a family; pneumonia was encouraged to will to be well, and the pa- tient sometimes, rashly exerting himself, has- tened a fatal result; the retained secundines at childbirth destroyed the patient by a fatal flooding, when the will-power failed, as it must fail, to contract the uterus. The mixture of re- ligious belief with these medical theories influ- enced and attracted very many people, and are still in our own day an obstacle to medical prac- tice, although the brilliant advance of medicine in laboratory methods, making our profession a new science, will gradually overcome them. - The next change in the last half-century was the entrance of women into the medical profes- sion. The new woman, emerging from the se- clusion of inherited Puritanism, now demanded admission into our ranks. The regular physi- cians hesitated to admit her claims for two rea- sons: first, that her presence at medical meet- ings would interfere with freedom of discus- sion; second, that many patients of either sex would object to being examined in detail in the presence of both sexes, and that to render such a patient unconscious by anesthesia and then submit him or her to such an examination was unfair. These fears have proved to be well- founded. However, women have freely entered the medical profession ; and practise, so far as I know, every form of surgery, as well as medi- cine and obstetrics. It must be conceded, how- ever, that their services are largely limited to their own sex. An important influence on the materia medica employed by the physician was now exerted by the enormous advance in chemistry. "We can al- most say that it has revolutionized the relation of the druggist to the doctor. The latter had relied on a druggist of repute to select pure drugs and to compound them under the doctor's direction by the so-called prescription. The relations of doctor and druggist were thus intimate; each relied on the other. But now new modes of manufacture and new remedies made by syn- thetical chemistry have taken the place of many of the old tinctures and pills. As another in- stance, the extraction of alkaloids, or the active principle of drugs, has furnished concentrated remedies in minute and cleanly form; these alkaloids are also indispensable in the sub- cutaneous administration of remedies. Being more palatable, the new medicines furnished by chemistry are more sought after by the public; thus they have contributed to enlarge the use of proprietary medicines to the detriment of the ignorant; the abuse of narcotics is thus par- tially to be explained. It is fair to consider, however, that the supposed purity of materials and the supposed accuracy of manufacture de- pend upon the reputation of the manufacturing chemist. Finally, among external influences, the growth of hospitals has been the most potent of all in changing the practice of medicine. Half a century ago, there was but one large hospital in Boston. Through its influence, it came to pass that, since no fees were allowed to be Vol. CLXXII, Xo. 13] BOSTON MEDICAL AND SURGICAL JOURNAL 475 charged by its physicians and surgeons for the care of its inmates, whether rich or poor, some of its medical staff established ! a private hospital, in which they could receive ' remuneration for their services. I mean to say ; that this was a local influence. General influ- ences, however, were abroad in all communities, ! which led to a demand for, and the increase of, | hospitals of every grade. We might say that the hospital has become universal, much to the detriment of the medical profession pecuniarily, for there is often an abase of charity, since others than the poor habitually seek the hos- ' pital, and deprive the doctor of his pay. This is especially the case among those who come and go daily in the out-patient departments. But in the wards also there are occasionally wealthy patients, some of whom would wish t^i pay, while others seek to escape any such obli- : gation. The majority of doctors are placed somewhat at a disadvantage by the abundance of hospitals, and perhaps in comparative repu- tation with the physicians who hold positions in them. Today even moderate communities have their hospitals; cities many, towns or villages one. It must thus be evident that the private physician, surgeon, and even specialist have the amount of their business decrea.sed and their earning capacity limited by hospitals. It is not necessary here to discuss whether the public are not benefited by the hospitals; I confine myself to their influence on the profession of medicine. ] This completes my enumeration of the exter- 1 nal circumstances which have influenced the pro- 1 fession of medicine, 'and we now turn to those changes which physicians have brought about i themselves. Fifty years ago Specialism was al- 1 most unknown and was limited to the special \ senses, as the eye or ear. Gradually specialties i have increased more and more, until now their divisions and subdivisions are so minute as to [ be bounded by a single organ. The spe- cialist justifies his position by saying that he knows more on any single subject by confining himself to it. The family practitioner, how- ever, urges that the specialist loses that full consideration of the general well-being of the patient which he himself acquires. It is cer- tainly unfortunate that the doctor does not have now the whole of his patient, and that the pa- tient does not have an individual doctor. A large family, the members of whieh one general practitioner formerly took care of, knowing by experience their heredity, their tendencies, their habits, now seeks the advice of four or five spe- cialists. Apart from other considerations, ex- penses are thus increased; for the specialist, having fewer patients and fewer calls for his services, is justified in charging larger fees. This leads us to say a word of what has been called Commercialism in medicine. This I un- derstand to mean thinking more of the fee than the patient and charging all that the patient can pay. I wish it distinctly understood that no one is more particular than myself in charg- ing fees to patients who are able to pay, provided such fees are reasonable, and we must all agree that the very rich man or one of social prominence should be charged more for skilful service than his neighbor of limited means. But very large sums claimed as a return for professional services have, as I believe, in- jured the reputation of the profession. The scandal of the "split fee" I have never per- sonally met with. The next change created by the physicians tliemselves is Publicity. The reticence of the doctor was formerly proverbial. It was not deemed wise to tell the patient too much. Every medical utterance has an exaggerated import- ance, and an opinion too freely imparted worries and depresses the patient. So also it used to be thought that to take the public into your con- fidence and to communicate the "little knowl- I'dge which is a dangerous thing" was injurious; that people got false ideas and went astray; and that, on the whole, more harm than good was (ione. Now all this is changed. However, when public medical lectures are confined to carefully selected subjects and limited to hygienic meas- ures, they may be useful. Medicine has been advanced to approximate a Science by Laboratory methods. These methods have supplanted the guess-work of earlier diag- nosis. They are invaluable ; they have been pro- duced gradually by patient investigation and self-sacrificing and sometimes dangerous labors; and they have come to stay. They are the first line of defence against delusion and superstition in medicine. Moreover, they have given us Pre- ventive Medicine. In my earlier days there was t)ut one disease which could be surely averted, and that was smallpox by the use of vaccination. Now the discovery of serum-therapy and the injection of anti-toxins control diphtheria, tem- jiorarily control typhoid, and offer great hope in the treatment of meningitis, tetanus, rabies, and some other diseases still under investiga- tion. No greater change in the practice of medi- cine could be imagined. Finally, the Trained Nurse was introduced among the sick by the doctor himself, first, in hospitals, as was natural, then in private life. She is a great help to the doctor; she relieves him of dnidgery; she lessens his anxiety; she should be his executive assistant, and not aspire to be his partner. She should be modest in her dicta, for her opinion is constantly sought and carries weight. While in acute disease her full fees are no more than they should be, yet in cases of long illness some means will eventually be found by which the very heavy expense of her service may be diminished. 476 BOSTON MEDICAL AND SURGICAL JOURNAL [Apbil 1, 1915 THE MENACE OP SYPHILIS TO THE CLEAN LIVING PUBLIC. Bt J. Haepeb Blaisdell, M.D., Boston, Physician, Skin Department, Boston Dispensary ; Der- matologist, Lynn uospital; Assistant, Skin De- partment, Massachusetts General Hospital. [From the Records of the Skin Department of the Boston Dispensary.] Every community is divided into two classes of individuals, — those who have syphilis and those who 'are exposed to it. Medical science and lay interests have been focussed upon the diagnosis and successful treatment of the disease in those aflBicted with it to the practically total exclusion of the now greater problem of the rights and protection of those who may be ex- posed to it. Two factors enter largely into the present in- difference on the part of the physician and lay- man alike to the relation of this disease to public health. One is th& fact that syphilis has been and always will be closely identified with im- moral sexual relations. The acquisition of the disease is felt to be but a just punishment for the mis-deeds of its possessor. Blinded by the venereal aspect little thought has been given to the question of how active a menace it may be as an infectious disease to the general clean liv- ing public. The second factor making for indifference is that we are absolutely ignorant as to the prev- alence of the disease with which we are fighting. An approximate number even of those having the disease in this Commonwealth is absolutely unknown. Opinions among the medical profes- sion are at the widest variance. One extremist takes the lofty attitude that such a disease can- not be present among the high-class clientele that he may have. Otherwise broad-minded phy- sicians frequently rule out the disease for no better reason than "I have known the family for years." The other extremist sees the spiro- chete at the bottom of every puzzling ease. For several years past syphilis has been made a reportable disease by the City of New York and the figures reported by the health authori- ties there probably represent as accurate an estimate of the amount of the disease in a given community as any now available. During the fourteen weeks from July 4th to October 3d, 1914, 25,633 infectious and contagious diseases were reported in the City of New York with a population of a little over five and one-half mil- lions. Syphilis stood first in the list with 6342 cases or 28% ; tuberculosis second, 5525 cases or 21%; diphtheria third, 3370 eases or 13%; measles fourth, 2750 eases or 11% ; scarlet fever fifth, 1064 cases or 4%. Figures like these be- speak for themselves the urgent necessity of es- tablishing regulations for the control of those having the disease and for the protection of the community. For the purpose of finding out how definite a menace individual cases of syphilis may be to the community, sixty cases in the early stages were selected as they happened to come to the Skin department of the Boston Dispensary and the relation of their infectiousness to their as- sociates studied. The tabulations include sex, age, marital relation, occupation, duration of the disease in weeks, presenting symptoms, methods of living and eating, the number of persons exposed through coitus since infection, the number definitely exposed through family life or association in boarding houses, the num- ber of co-workers exposed; and the number of known infections from the case in hand. The co-workers' exposure column includes only those that came in active contact with the infected per- son through toilets, drinking facilities, etc. No attempt was made to record the number of per- sons exposed by casual contact as for instance, — eating in the same restaurant, being waited on in a store, or consuming food products handled by the infected person. The table in full with a more detailed explanation of some of the more striking cases is as follows: w > s s a ■0.2 2 > o , 1. M. 21 S. None 6 Primary No. see. Home Home 10 2. M. 21 s. Clerk 14 Primary Rash Mucous p. Rooming Restaurants 5 6 10 50 3. M. 21 s. Shoe worker 3 Primary Home Home 5 5 — 4. M. 20 s. Printer 4 Primary Home Home 5 7 — 5. F. 20 s. Clerk 2 Primary Home Home 4 100 0. 6. P. 39 M. Home 10 Rash Mucous p. Condylom. Home Home 20 7. F. 37 S. None Rash Mucous p. Rooming Boarding house 4 18 — ~0" "0" 8. F. 24 S. Cashier Primary of Lower lip Home Home 20 Vol. CLXXII, No. 13] BOSTON MEDICAL AND SURGICAL JOURNAL a 9. F. 19 s. Candy Mucous p. Condylom. a Home it a Home I 6 6 26. M. 19 S. Machinist 26 27. r. 24 S. Nnrse Rash Mucous p Alopecia "Rash Mncoos p. Home Home Family Family 81. F. 42 M. Home 26 82. M. 49 M. Pnllman porter 10 Mucous p. Rash jCondylom- Prlmary Rash Mncons p. 50 80 7 — Home Home Home Boardli« House Home Restaurant 6 — 86. M. 22 S. Cook In dairy lunch 26 86. M. 20 S. Primary of Finger Rash Mucous p. Rooming Restaurant 12 — Dish washer 2 In restaurant Primary Rooming Restaurant 16 40. F. 23 S. Waitress 14 Primary Rash Mucous p. Rooming Restaurant 12 477 l5 10. F. 19 S. Waitress 20 Rash Mucous p. Condylom. Rooming Boarding house Restaurant 6 40 11. M. 28 S. Electrician 1 Primary Home Home ' 3 — 12. M. 27 s. Printer 8 Primary Rash Home Home 10 6 10 IS. M. M. 84 28 s. Shoe 16 Rash Mucous p. Condylom. Rooming Boarding house 2 16 8 14. M. Laborer 8 Primary Rooming Boarding house 2 6 16. M. 26 s. Machinist 12 Muc. patches Rooming Boarding boose 6 6 70 16. M. 80 8. Shoe 26 Rash Rooming Restaurant 2 14 — 17. M. 38 S. Carpenter 10 Primary Rash Muc. patches K(x>ming Boarding Restaurant 2 18 — 18. M. 81 S. Chorus man 7 Primary Rash Ilotcd Restaurant 8 — 40 19. M. 21 S. Pool room 24 Rash Muc. patches Tongue Boarding house Restaurants 3-4 10 — 20. M. F. 21 87 a. w. Messenger boy Candy 6 24 Primary Rash Bash Mac. patches Home Home 9 16 21. Home Home 4 — 22. M. 16 s. Actor 12 Primary of Lip Mucous p. Home Home 2 23. M. 20 s. Teamster 6 Primary Home Home 6 6 24. F. 19 s. Labor 12 Rash Mucous p. Rooming Bestaormnts 3-4 6 — 26. r. 82 M. Labor 7 Rash Mucous p. Rooming Boom 8 2 "0" 28. M. 20 S. Clerk 8 Primary Home Home 8 4 6 29. M. 21 S. None 2 9 Primary Home Home 6 — 80. F. SO S. Cook Primary Rash MOCOQS p. Family Family 1 88. M. 23 S. liongshore 24 Rash Mucous p. Rooming Boarding honse 8 100 84. M. 18 S. Machinist 6 Primary Rash Rooming Restaorants 2 4 7 12 87. M. 23 S. Butcher 4 Primary Rooming Hotel 7 16 88. F. 85 S. Labor 14 Rash Mucous p. Rooming Restaurant 8 20 — 89. M. 18 S. Drug clerk 8 Primary Home Home 8 6 2 478 BOSTON MEDICAL AND SURGICAL JOURNAL [Apbii, 1, 1915 1^ o 41. M. 23 S. Mechanic 14 Primary Rash Rooming Restaurant = .2 42. F. 21 S. Clerk 12 Primary Rash . Home Home 43. M. 24 S. Clerk 44. M. 27 M. Fruit hawker 15 Primary 'Rash Mucous p. Home Home Home Home 20 3 — 45. M. 24 S. Elevator 6 Primary Home Home 8 4 — 46. M. 25 S. Iron worker 7 Primary Rooming Restaurant 4 25 — 47. F. 25 M. Wife of No. 44 12 Rash Mucous p. Home Home 1 2 48. M. 23 S. Mechanic 8 Primary Rooming Boarding 2 6 30 49. M. 30 S. Cook 8 Rash Mucous p. Rooming Restaurant 5-6 2 7 7 50. M. 48 s. Teamster 16 Primary Rash Mucous p. Rooming Restaurant 4 16 7 51. M. 24 s. Waiter 9 Primary Rash Mucous p. Rooming Restaurant 3 8 — 52. M. 25 s. State work 3 Primary Home Home 2 6 — 53. M. 28 s. Actur 4 Primary Mucous p. Rooming Restaurant 2 •2 2 54. F. 24 s. Saleslady ? Wass. ++ + Rooming with No. Restaurant 53 2 2 2 1 1 65. M. 22 s. Painter 3 Primary Home Home 6 — 56. M. 32 s. Metal worker 8 Primary Rash Mucous p. Rooming Restaurant 2 2 10 — 57. F. 17 s. None 10 Rash Mucous p. Condylomata. Home Home 3 3 — 58. M. 26 s. Tattooist 1 Primary Rooming Restaurant 3 59. M. 29 M. Teamster 6 Primary Rash Mucous p. Condylomata. Home Home 2 4 2 60. F.28 S Boarding house keeper 4 Primary of tonsil Rash Boarding Boarding 1 25 Case 6. Married woman. Husband away for six months at a time. Five children from ages of six to twenty at home. Earned extra money by im- moral life in flat up-stairs kept by a professional. Case 7. Poverty stricken woman of subnormal intelligence living on charity and occasional im- moral earnings. Case 8. Girl of good family with primary of lip of unknown origin. Was having occasional inter- course with fiance who neither had nor contracted syphilis. Case 9. Typical "tough" girl working in a candy factory who is in the habit of having promiscuous intercourse with her male friends. Two of them not recorded in this series, were infected. Case 10. Waitress in a well known restaurant with very active and infectious syphilis. Case 14. Italian laborer, sleeping with another man, who planned to return to his wife and two children in Italy within two months. I know of two other similar cases not recorded in this series. Case 21. Woman with active mouth lesions of syphilis, who worked in a candy factory. Had two small children, a husband and a lover. Case 22. Actor in a musical comedy show with a primary of the lip and mucous patches who was in the habit of kissing many of the chorus girls fre- quently. Case 27. High class nurse in a doctor's family. Had active secondaries before the trouble was dis- covered. Had complete charge of two small chil- dren and was treated as one of the family, eating at the same table, using the bath-room, etc. Case 31. Woman with very active sjrphilis and several "friends," who infected her two-year old baby with a primary of the forehead, presumably from kissing. Case 35. Cook in a dairy lunch place with a primary of the finger and extremely active second- ary lesions of many weeks' duration. This man handled all the food, drinking glasses, dishes, etc., of a great many people daily. His infection prob- Vol. CLXXII, No. 13] BOSTON MEDICAL AND SVROWAL JOURNAL 479 ably came from some dish or glass used by a syphi- litic. This case was so extreme as to necessitate its being sent to the State Hospital. Case 38. Young woman with active mouth le- sions eating in the dining room of a local Y. W. C. A. Case 39. Drug clerk with active lesions who served many sodas daily. Case 44. Fruit pedlar who had relations widi many girls to within one week of marriage. Wife showed active lesions of syphilis and was pregnant. Case 45. Elevator boy with large ulcerative primary of penis. Had had relations with as many as eight girls since date of infection and used toilet in common with about 300 people in the oflSce build- ing. Case 58. Professional tattooist following fairs. Denied using saliva in moistening pigments altho knew of its being done. Case 59. Teamster with primary and all the sec- ondary manifestations living at home with his wife and two small children. He could not be prevailed upon to bring them in for examination and the case was soon lost sight of. Case 60. Woman lodging-house keeper with n primary of the tonsil. One of the servants in the house had syphilis, according to the boarders. Woman had a fiance with whom she had been in the habit of having occasional intercourse during the past year. The fiance denied all syphilis and mar- ried the woman two weeks after the diagnosis was made, as thoy had originally planned before the pri- mary appeared. The case dropped from the clinic and the source of the syphilis was never determined. These sixty cases definitely exposed through coitus from the time of their infection to their first appearance in the clinic for treatment one hundred and thirty-four (134) people. Pour hundred and forty-two (442) others were com- ing in contact with them in the intimacies of family or boarding-house life. Six hundred and fifty-one C651) fellow workers had been brought in contact with them sufficiently to run a defi- nite danger of contracting the disease. Of these sixty cases 41 were men and 19 were women. There were four extra-genital and pre- sumably "innocent" primaries, the number be- ing evenly divided between the sexes. One wife contracted the disease from her husband and five girls were infected by their fiances. Thirty- nine of the men and eleven of the women ac- cnts, rather than as compression lesions. Perhaps my haviug seen so many of these cu- rious cases in a short period may be only a chance, but 1 cannot lielp suspcetiug that this lesion may often liave been unnoticed as well as undescribed. The resultant disability is not in- considerable, and it behooves us to keep an eye open for these cases — if for no other reason, be- cause they are so easily cured, and so quickly. SOME NERVOUS AFFECTIONS IN WHICH MASSAGE DESERVES MORE FRE- QUENT USE.* IlY .7. W. Courtney, M.D., Roston. That massage is an important therapeutic fac- tor has long sine*- been an established fact. Whether or not it holds a position as promi- nent as it desei^'es in the therapy of nervous dis- orders is debatable. The (|uestioii is one which I shall, ill this brief communication, not at- tempt to settle. I shall content myself with pointing out to you certain nervous disorders in which massage in some form might with benefit be more frequently employed. In the rather large group of myospasms there * Paper read before the Manachusetto Therapeutic Uitmgt Aian. ciation, January 12, 1015, 484 BOSTON MBDIOAL AND SUROWAL JOVRNAL [Apbil 1, 1815 are two varieties peculiarly rebellious to drug treatment. One of these you probably know un- der the name of wry -neck, the other as writer's cramp — a disorder by no means confined to pen- men, but found also among typists and among artisans whose occupations demand an incessant abuse of the coordinated movement of the smaller muscles of fingers and hands. In the wry-neck variety of myospasm I am thoroughly satisfied that, in most eases, the seat of the trouble is to be found in the cortex of the brain. I hold this belief for two reasons: first, because of the absolute inefficacy of local sur- gery as a curative measure ; and second, because of the relief sometimes obtained in the spas- modic cases through the effect produced upon the mind by a supposed operation. In two cases of very long standing which came under my ob- servation a few years ago. Dr. Bottomley, at my suggestion, excised fairly large pieces of the nerves supplying the muscles involved in the spasm. The operation was painstaking and thorough in both cases. In neither case was any permanent benefit derived. Sedative and anti-spasmodic drugs are like- wise of little value in these cases, so that both surgery and drugs offer but slight hope of relief to the unfortunate sufferer whose plight is al- most inexpressible. Massage, systematic and persistent, resistive motion and muscle stretch- ing, on the other hand, are of genuine and last- ing value in the condition in question. Their ef- fects are not immediate — indeed, it is not to be expected that they should be; but the ultimate relief from them is far more tangible and per- manent than that obtained in any other way. Another distinct advantage possessed by the manipulative method in these cases is to be found on the psychic side. The patient feels that something definite and tangible is being done for him, and his courage to make the fight for recovery is sustained thereby. Those of you who have had occasion to treat cases of spas- modic wry-neck will at once recognize the im- portance of this aspect of the treatment. With- out the encouragement thus derived, the pa- tient is very apt to develop a nielancholy which leads to the taking of dangerous drugs or to actual suicide. In writer's cramp and other vocational myo- spasms, the curative value of massage and gym- nastic exercise is overlooked with regrettable frequency by members of the medical profession. In such cases we are dealing, as I have already said, with an abuse of function of certain finely coordinated groups of muscles, with the result that when the endeavor is made to bring the abused muscles into function, the overwrought nerves which control the desired coordinated muscular activity lose their controlling power; and the end result is spasm of the muscles called upon, pain and other evidence of disordered sen- sibility. No cure is to be expected in such cases so long as the occupation which brings about the spasm and accompanying discomfort is persisted in. But treatment by local rest and tonics sel- dom, in itself, suffices to bring about a cure. What is needed above all things is massage, usually in the form of deep manipulation. This, however, should be applied to the muscles which are the antagonists of those in spasm rather than to the spasmodic group itself. The rationale of this treatment is to be found in the increase in vigor and resisting power which, by the treat- ment, is imparted to the resisting muscles. The next class of cases in which I have finally come to the belief that massage will prove its efficiency, if it is given a fair trial, is that of so-called cerebral contusion. Cerebral contusion of the modern medical nomenclature is identical with what, in former times, was commonly called ' ' concussion of the brain. ' ' The old notion was that when a blow of moderate severity was in- flicted upon the skull, its contents were shaken up like so many dried peas in a pod, and that the symptoms produced were due to a temporary disarrangement of the nervous elements of which the brain is composed. Modern pathologic re- search has shown conclusively that this notion is entirely erroneous. As a matter of fact, when a wounding force of moderate severity is applied to the skull, its immediate effects are primarily made manifest in the brain bloodvessels. These vessels are supplied with sympathetic nerves which afford them an independent power of con- traction and dilatation. Under the shock of an applied force the sympathetic or vasomotor nerves in question are immediately put out of function, and circulation within the brain ceases to a greater or lesser extent. With this cessa- tion in vascular function two things immediately happen — first, a clotting of the blood in certain capillaries; and second, a leakage through the vessel walls of the watery contents of the blood. If only a small area of the brain is involved in this morbid process, the circulation finally rights itself and the watery effusion is absorbed. If, on the other hand, the brain area involved is extensive and the amount of fluid poured out into the brain substance great, the burden of absorption and removal of this fluid thrown upon the great venous pathways from the brain is so overwhelming that these conduits fail in their function, the brain becomes waterlogged and death ensues. Up to the present time the measures adopted by the surgeon in the above-mentioned situation have been inadequate to cope with the effused death-dealing fluid with entire success, and, as I have already said, I cannot help feeling that in massage we have an important adjunct to the surgeon 's endeavors. A stroking or effleurage of the neck tends, as you very well know, to a rapid depletion of the jugular veins and creates a sort of suction. This suction would, in my opinion, strongly favor the evacuation of effused fluid from the brain itself and to a remarkable degree the drainage established by the trephin- ing operation of the surgeon. It is my hope Vol. CLXXII, No. 13] BOSTON MEDICAL AND SVROICAL JOURNAL 485 that in the future the masseur may have increas- ing opportunities to prove the worth of his ma- nipulations in this class of cases. Owing to the fact that most organic diseases of the brain and spinal cord are incurable, the physicians in charge of cases representing these diseases are too frequently wont to limit their tlierapeutic endeavors to the administration of eitlier iodide of potash or of that other standby of neurologic therapy — strychnine. More often than not, under these circumstances, the iodide is useless and the strychnine positively harmful in that, by its stimulating action, it serves to in- crease the painfnl mu.scular contractures accom- panying the disea.se under treatment. In the majority of cases where the lateral columns of the spinal cord are involved, ma.ssage and passive motion are the only therapeutic agents really indicated. It matters little whether the primary focus of disease is in the brain or in the cord itself; the resultant damage is weakness and stiffness — sometimes amounting to actual contracture — of the affected limbs. And to these disabilities a local sluggishness of circulation is not infrequently added by reason of a concomitant disturbance of what we may term the check-rein nerves of the skin blood vessels — the vasomotors. The value of massage in such conditions is twofold : It acts centripetally, stimulating the tissues about the central focus of the disease and peripherally, it improves circulation, re- lards muscular wasting with ita consequent weakness, and prevents severe deformities. There are many who scoff at any measure designed to combat the ravages of organic disease of unknown or doubtful origin in the central nervous system, but after fairly long experience with this form of disea.se I can frankly say that I do not share their pessimism. I have just spoken of the value of massage in lateral column disorders and will now speak in turn of what may be expected from it in affec- tions of those remaining portions of the cord which are of the greatest and best known func- tional importance, — the anterior gray horns and the posterior columns. In that disease of the anterior horns, known as progressive muscular atrophy, I cannot truth- fully say that I have found massage of any par- ticular value, but in what we may term the late regressive stages of infantile paralysis — a dis- ease of this same region — there is no qu&stion of its efficacy. In fact, I consider it of as great im- portance in the maintenance of muscular nutri- tion and the correction of paralytic deformities as any other measure that has ever been adopted. To obtain the best results from it, however, its use must be extended over a long period of time. Locomotor ataxia represents the most com- monly encountered disease of the last-remaining portion of the spinal cord above mentioned, and in it massage — either alone or in combination with reeducation in coordinative movements of affected muscles — serves a useful purpose. Here again its action is twofold, as in the case of lat- eral column degeneration, in the sense that its beneficial effects are felt both peripherally and centrally, although it does not have identical conditions to combat. In Parkinson's disease {paralysis agitans) I have found mas.sage very useful in allaying the feeling of tension, stiffness and awkwardness that so often accompanies the shaking. Hero, however, only the gentlest kneading and the mildest sort of passive motion should be applied. I am sorry that I have not had the time to specifically indicate the other forms of organic disease of the central nervous system in which the employment of the therapeutic agent in ques- tion is attended with undoubted benefit. I will say, however, that it should be more frequently used in all cases of central disease accompanied by deformities of joints and in the majority of those associated with atrophy. In the latter group I make exception of syringomyelia as well as of the so-called progressive muscular atrophy, in which diseases I have found it of doubtful value only. It is hardly relevant in this paper to speak of the use of ma.ssage in cases of peripheral nerve suture because its employment in such cases is the rule rather than the exception. But I can- not refrain from touching upon this subject in order to emphasize one very practical point, namely, the absolute necessity for patient per- severance. Even where early end-to-end suture of a divided nerve-trunk is made, the process of union is, as a rule, tediously slow and inexpres- sibly discouraging. Months may clap.se before massage appears to make any satisfactory im- pression upon the muscles that have been ren- dered wasted and inert by the severance of their nutrient nerve. But persistent ma.ssage acting centripetally will ultimately bring about most gratifying results in the way of improved nu- trition and motion in the affected muscles. In cases where surgical union of a divided nerve is delayed for some time, the problem of the mas- seur is distinctly greater and he must bring into his handling of the case a fund of patience that is well-nigh inexhaustible. With the above digression T come to a final group of morbid nervous phenomena in which the use of massage is by no means unknown, but in which it might, with great profit, be more frequently employed. I refer to phenomena which represent a state of pathologic exhaustion of the nervous centres and which are classified under our present rather unsatisfaetoi^ nomen- clature as symptom-complexes of the so-called psychoneuroses. As you perfectly well know, the patient with hysteria or neurasthenia is, with annoying fre- quency, looked upon by physician and layman alike as the victim of nothing more nor less than his own wilfully morbid imagination. Such a tenet on the part of a layman, ignorant as he is of all knowledge of anatomy, physiology and hygiene, is hardly to be wondered at. When, 486 BOSTON MEDICAL AND SUROWAL JOURNAL [Apbii, 1, 1915 on the other liand, a physician conducts his treatment of the pitiable sufferer from exhausted nerve centres on the basis of the same tenet, the raison d'etre of this treatment is akin to that of the exorcism of mediaeval times. As a plain matter of fact the problem of eti- ology in exhausted nervous centres is far too deep and subtle to be disposed of in any offhand way. Into this problem I shall not here delve, but shall confine myself to the consideration of those clinical manifestations of the exhaustion in which the use of massage is indicated much more often than it is actually employed. Nervous exhaustion is characterized by morbid emotional states, by a prompt fatigability of mo- tor neurons, by perverted- sensibility of the most varied form and by curious morbid fluctuations in the activities of that delicate mechanism known as the great sympathetic nervous system. In the severe cases the feeling of fatigue is so marked and so constant that it is with the great- est difficulty that the sufferer is able to use his upper extremities for more than a few minutes at a time or to drag his weary legs for even the shortest distance. The advice often given to such a person by the misguided medical man is to take more exercise, and if this advice is fol- lowed, it invariably leads to such an increase in the exhaustion that existence is rendered almost unendurable. What such a person really needs is the very gentle stimulation of motor neurones and volun- tary muscles, which skilfully applied massage so marvelously well supplies. Under such manipu- lation the unhealthy tension of over-tired motor nerves is relieved, the muscles lose their vice-like feeling of tension, the skin circulation is equal- ized in the various regions of body and extremi- ties and the emotional tone is altered for the time being from one of irritability, anxiety and depression to one of pleasant languor. Under the same sort of manipulation the ten- der and at times extremely painful spine is re- stored to normal feeling. I have been particu- larly struck by the analgesic action of carefully graduated massage in this condition; indeed, I have frequently seen spines so exquisitely tender at the outset that the lightest effleurage of a gentle operator was intolerable, gradually be- come, under this treatment, so free from morbid sensitiveness that even the heaviest handling was grateful rather than otherwise. We come, finally, to a consideration of the dis- turbances which arise through the faulty work- ing of the great sympathetic system in states of nervous exhaustion. It has always seemed to me curious that Nature has put such a burden of function upon this, the most delicate part of the dynamo that runs the human machine. But such is the fact. At times it governs, at other times it is gov- erned by, our emotional life. It regulates the amount of blood that at any one time is in a particular part of the brain. It controls respi- I'ation, the beat of the heart, digestion, glandular secretion in general, the secretion and excretion of urine, the peristaltic action of the bowels, the menstrual function and the surface circiTlation — in a word, it holds the sceptre over a very large territory in the human economy. Hence, when it is brought by exhaustion to a state of irritabil- ity it produces the over-activity in brain circula- tion which underlies insomnia, the cold, mottled and moist extremities, the suffocated feelings, the palpitations, the sluggish and painful diges- tion, the constipation, the increased or dimin- ished urinary output, and the painful, delayed and scanty menstruation so often encountered in the victims of the so-called psychoneuroses. Here is a pathologic problem with which no system of therapy that does not give a prominent place to massage can possibly hope to cope suc- cessfully. By massage, in the form of effleurage, we can deplete the over-filled vessels of the brain and bring about the much-needed mental peace and refreshing sleep. By the same agent we can equalize surface circulation and surface temperature. throughout the body and limbs; we can stimulate sluggish peristalsis and relieve the pain caused by the distention of retained flatus; we can prevent the sagging of the stomach and intestines due to atony and, in certain cases, we can— I feel confident— bring about a return to normal of the menstrual function. There is probably nothing in this very brief communication that was not known to each and every one of you long since ; but it was not my purpose to bring to your notice those forms of nervous disorder in whose treatment massage has not as yet proved its practical efficacy; on the contrary, my aim was to stimulate a greater ten- dency to its employment in cases in which its therapeutic value is practically indisputable. This T have not done as thoroughly as I should like, but as thoroughly as my limited leisure per- mitted. I ask your indulgence for my short- comings. jnpiitral Pragrraa. KIGHTII REPOI?T OF PROGRESS IN ORTHOPAEDIC SURGERY.* 1?Y Robert B. Osgood. M.D. ; Robert Soutter, M.D. : Hermann Bucholz. M.P. : ITarry C. IvOW, M.D. ; AND Murray S. Danforth, M.D., Boston. (Concluded from page 432.) RICKETS. OSTBOM.\LACI.\. CHONDRODYSTBOPHIA FETALIS. OSTEOGENESIS IMPERFECTA. Weiss'" reports a series of oases of rickets, some mild and some severe, in which there was a very marked improvement in their condition under the administration of tablets of the ex- tract of the hypophysis. This improvement oc- curred in from six to ten weeks. Cavazzani" had observed great benefit follow Vol. CLXXII, No. 13] BOSTON MEDICAL AND SURGICAL JOURNAL 487 the administration of epinephrin in three cases] of osteomalacia. The disease occurred in women i who had borne one or more children. In the first case it was begun about a week after thej first symptoms, which had come on acutely a few days after delivery. The treatment was promptly effectual. In the second case the osteo- malacia had developed not long after delivery, but two months had elapsed before treatment was instituted. The treatment was not kept up regularly and the results were less striking. In the third case, although the disease had existed for a long time and there were irreparable le- sions, a very marked improvement took place. Wagner^^, in reporting a case of chondrodys- trophia fetalis transmitted from mother to child, calls attention to the influence of heredity and the fact that the usual transmission is from father to child. -The author, while admitting that there is no conclusive evidence of specific disturbance of function of any of the glands of internal secretion, believes that there is probably a hypersecretion of the reproductive glands which causes an abnormal development of mus- cles and genitalia. An histological study reveals irregular columns of cartilage cells at the epi- physeal line, the cells being pushed apart, espe- cially at the periphery, as if the periosteum had been driven into the cartilage. Wagner thinks that this abnormality of enchondral bone forma- tion is associated with increased tension in the direction of the long axis of the bone by the hypertrophied muscles, resulting in the micro- melia. Bookman" has accepted an opportunity to study the metabolism in a case of osteogenesis I imperfecta for- a considerable period of time, | especially with reference to the calcium reten-| tion and output. His three conclusions are asi follows: 1. Calcium retention may be much be-; low normal. 2. During the course of the disease it varies widely. 3. Cod-liver oil and phosphorus, I and more especially calicum lactate increa.se the calcium retention. Bookman compares his ob- servations with the earlier work of Bamberg and Huldchinsky", who after a study of their own cases and a review of the literature, conclude that osteogenesis imperfecta (Vrolik) and osteo- psathyrosis idiopathica (Lobstein) present very similar clinical pictures. They believe that fifty per cent, of the cases of osteopsathyrosis, which condition comes on at varying periods after birth, are hereditary. In the earlier congenital osteogenesis imperfecta they find that heredity plays no part. A histological study shows, in contradistinction to the picture of chondrodys- trophia fetalis, aplasia of the compact tissue and spongy substance of the diaphysis and epi- physis with normal growth of cartilage, result- ing in the development of slender bones, with little spongy substance and weak compact tissue. They consider that disturbance of function and defective formation of the periosteum is the di- rect cause of these changes. Both early and late forms show the same changes. In regard to the calcium metabolism, their work seems to show that the disease is not caused by a loss of cal- cium, but by the incomplete rudimentary forma- tion of the bones with irregular distribution of calcium. They agree with Bookman that the re- tention of calcium can be increased by phosphor- ized cod liver oil. The prognosis in the forms occurring before birth is bad. Of 31 cases col- lected, only three survived. In the late forms it is good, in 105 cases there being no death from the disease. soouosis. In a series of 22 cases of scoliosis, not selected, but taking all in which good x-rays were ob- tained, in the Orthopaedic Clinic of the Massa- chusetts General Hospital, Adams" has studied the abnormalities in the vertebral column. Two cases showed abnormalities of the dorsal verte- brae, and nineteen, abnormalities of the low lumbar or sacral segments. The only remaining case was one of scoliosis, following poliomyelitis, in which there was no bony abnormality. [Ed. Note. — Such findings in x-rays made as a routine in a scoliosis clinic, show the need of careful study of the lumbosacral region in all cases of lateral curvature, for upon the cause must depend to some extent the details of treatment, and also upon the cause must depend the prognosis as to our ability to maintain a correction once obtained. If we can become convinced that these abnormalities repre- sent the cause of the deformity, we are at once faced by the question as to whether in many cases at least we should not attempt to correct the static influence of the deformity by opera- tion, either before or after the correction of the scoliosis. This may furnish a further field for bone grafting and spinal surgery in general. The suggestiveness of this paper of Adams is enhanced by the reports which come in from various sources, in which the authors from their observations feel still uncertain as to the perma- nence of the results obtained by the forcible methods of Abbott and others.] JOINT SURGERY. Murphy" has written a valuable paper on the technic of arthroplastic operations for bony and fibrous ankylosis of the temporomandibular ar- ticulation. He believes the cause to be either an infection or a trauma transmitted from the chin. The differential diagnosis as to which side of the jaw is affected may be extremely difficult. In the intra-articular ankyloses there is sometimes a little motion on the unaffected side. An im- portant point is that the face on the affected side is full and round and apparently normal in ap- pearance, while on the opposite or unaffected side it is flattened and deformed. The chin is always more or less retracted and deviates to- ward the ankylosed side. The muscles on the affected side are alwa.vs more atrophied. The most important points in his technic are an 488 BOSTON MEDICAL AND SURGICAL JOURNAL [Apeu, 1, 1915 L-shaped incision in front of the ear and along the zygoma. No attempt is made to remove the head of the bone from the glenoid cavity on ac- count of the danger of penetrating the skull. The pedicle flap of fat and fascia is lifted from the surface of the temporal muscle and turned downward. A wooden wedge is inserted be- tween the jaws on the affected side. Mastication is begun in two weeks. He reports nine cases with good results in eight. W. L. and C. P. Brown" describe an operation for arthroplasty of the shoulder joint, and while they have had only one case, the result was ex- cellent and the procedure is surely ingenious. The joint is exposed by an anterior incision. The pectoralis major tendon is divided at the humerus and the inner fibres of the deltoid are also divided. The short head of the biceps is cut across about 4y2 inches below the glenoid and the muscle with pedicle attached is turned into the glenoid and fastened by sutures. The pec- toralis major is sutured if possible and the arm put up in abduction. Payr's^* experience in arthroplastic operations has been large and his- constant attempts to im- prove his technic and study his results make the report of his further experience of great value. His first cases are now about four years old. He is still impressed with the importance of the removal of the synovia and fibrous carti- lage, and if possible of the whole capsule as well. His experiments seem to show that the final tis- sue covering the bone ends resembles that of tendon sheaths. He has never seen new carti- lage formation, and the bursa-like nearthrosis is a unique structure. He finds that the ends of the bones adapt themselves to the mechanism of movement, the spongiosa becoming more dense and a sort of cortical bone forming. As to the indications, Payr considers that it is essential that the operation should be deferred until long after all signs of active inflammation have sub- sided. He believes this cannot be emphasized too much. Some of his knees have been done in two stages, the first, the mobilization of the patella, and later, after exercise of the quadri- ceps, the main joint has been reshaped. He ap- proaches the joint by two lateral incisions, hav- ing abandoned Kirschner's method of trape- zoidal resection of the tibial tubercle, because it was noticed that the healing of the bone was not good. He has evidently had difficulty, as have the Editors, with the occurrence of bony spurs on the posterior edge of the tibia and femur. He believes this may be avoided by re- moving the periosteum from this region as ex- actly as possible. He begins massage of the muscles early and gentle movements of the joint in two or three weeks. He employs traction sufficient to separate the bones as much as he considers necessary. In the knee he considers 90 to 100° of motion all that is desirable. In bony ankylosis of the hip he considers a pseud- arthrosis of the upper end of the femur may be the best procedure. He reports 11 cases of knee joints, as 2 bad, 2 good, 7 very good; 3 cases of hip joints as 1 bad, 2 very good ; 3 cases of el- bow joints, as 1 good, 2 very good ; 2 cases of fin- ger joints as successful ; 1 case of shoulder joint as unsuccessful. BONE SUEGEKY. Lewis=^ summarizes the results of his experi- mental work in bone transplantation as follows : The cortex, without periosteum, endosteum, or marrow, will remain alive and proliferate when small bits are imbedded in muscle tissue. Direct contact with living bone is unnecessary. Large pieces of bone transplanted onto live bone, re- main alive. Bony growth may fill in without the aid of a periosteal or bony bridge, and strips of fascia may take the place of the periosteum as a limiting and nutritional membrane. In one case three inches of the excised shaft where the periosteum had been scraped away, was re- generated in this way. At autopsy nine weeks later, moderately firm bony callus was present, and the fascia had fused with the periosteum further up the shaft with an almost indefinable dividing line. Bond", in reporting two cases of successful transplantation of the fibula to replace the tibia in which there had been satisfactory increase in size as far as thickening was concerned, but not sufficient growth in length, discusses the con- trolling factors in this growth. There seems to be little reason to doubt that imperfect epiphy- .seal function is the cause of defective growth in length. He believes after consideration of various theories that the increase in thickness is simply in response to the necessity of function, and that we may expect these changes in trans- plants in other parts of the body, although we are unable to describe the process of cell re- production which brings this about. Mareozzi^i recommends a mixture of equal parts of the phosphate and carbonate of lime as a filling in bone cavities. It is easily sterilized, readily but not quickly absorbed, has a marked affinity for bone, and stimulates osteogenesis. He reports good results. FRACTURES AND DISLOCATIONS. Marsiglia^'' reports experiments undertaken on dogs to determine the effects of injections of emulsions of the hypophysis of calves after frac- ture. It was found in the dogs studied that the consolidation of the fractures was very much de- layed and that the dogs suffered markedly from toxemia, loss in weight, strength, etc. Tanton*' believes that the gravity of fractures of the eoracoid process depends less on the break than on the force necessary to cause the lesion. Malgaigne had six deaths in six cases. With dislocation of the eoracoid process inward there is likely to be contusion of the bundles of the axillary nerves, causing complete paralysis of the upper arm, forearm, and hand. This occur- Vol. CLXXII, No. 13] BOSTON MEDICAL AND BUBGIOAL JOURNAL 489 rence is due to the violence rather than to the fracture. Secondary nervous complications often arise from exuberant overgrowth at the point of fracture. In five out of six cases re- ported by Dr. Guelt only fibrous union oc- curred. With displacement of a coracoid proc- ess there may be a functional impotence evi- denced by a lack of power in the forward mo- tions of the arm. Treatment should consist in immobilization for twelve to fourteen days in i forced adduction with a flexed forearm and thej elbow elevated. "Where there are persistent] symptoms from exuberant overgrowth this! should be removed. j Saar** has treated six cases of old fractures of the lower end of the humerus which had | healed with great backward displacement and ! complete or nearly complete loss of function of, the elbow. In all these cases he mobilized the lower fragment by carefully dissecting away all scar tissue. In some of the cases the lower frag- ment lay entirely free. He then corrected the position and retained the bone by mortising it to the shaft. In no cases did necrosis occur, and the results in all his cases were good, in two of them normal motion being obtained. Anzilotti*", from a careful study of two cases of forward dislocation of the head of the radius, one recent and one of a year's duration, con- cludes that in a recent case one should attempt reduction without open operation, but in case of failure to reduce or to maintain the reduction one should make an incision down to the head and replace it, after removing any obstacle. In old dislocations it is necessary to open the joint, remove any obstacles, and if possible replace the head. If this is found impossible one should re- move just enough of the head to permit reduc- tion. Walbaum*' reports two cases of the rare frac- ture of the lesser trochanter, of which, accord- ing to his statement, only 12 cases have hereto- fore been published. In both ca.ses the fracture occurred in connection with running fast; one patient feeling the tear as he abruptly stopped. The symptoms are pain and limping in walking, tenderness over the lesser trochanter, free pas- sive motion, but pain in active motion of the hip joint. Ludloff's sign, the inability to lift the leg from lying position, was positive in one case, but negative in the other. The author be- lieves, therefore, that in the latter case only a part of the lesser trochanter was torn off. Balthazard*' , adds another to the cases on record in which after a fall, the patient com- plaining only of vague pains in the lumbar re- gion, an actual fracture of the spine had oc- curred. He walked home after the fall, but by the sixth month he complained of girdle pains and there was a hump in the dorso lumbar re- gion. He died from an intercurrent disease, and necropsy revealed that the spine had been frac- tured, the body of one of the vertebrae had been crushed, and the transverse lamellae broken, but the spinous processes were intact. [Ed. Note. — We believe that fractures of the spine are much more common than we have been accustomed to consider them. They are associated in our minds with severe immediate symptoms, usually of cord pressure and kyphos, whereas frequently the immediate symptoms are very slight and no kyphos is present. The se- rious nature of the injury is revealed later when pressur^e symptoms begin. We feel sure that all injuries of the spine should have an x-ray examination and that when a fracture is found, immobilization should be advised for several months] Albee** advocates in certain fresh fractures inlaying a bone graft and fastening it with bone autoplastic pegs. With accurately ad- justed twin saws a piece of bone is cut out of the long fragment about five inches in length and a small piece, 21/2 inches in length and of exactly the same width and exactly opposite the trough in the long fragment, is cut from the short frag- ment. From this smaller piece, bone pegs are fashioned by a dowelling machine. The longer piece is inserted in the short fragment and ex- tends an equal distance into the long fragment and is retained by the bone pegs driven tlirough drill holes. Davidson" reports excellent results in six cases of fracture treated by the introduction of autoplastic bone pegs made from the tibia. These were introduced into the medullary canal in all cases except in fracture of the neck of the femur, in which a canal was made through the trocanter. [Ed. Note. — It is quite evident to the Editors that a course in carpentry will soon be a neces- sary part of the education of every well equipped surgeon.] MISCELLANEOUS. Brandes*' has studied the time of appearance and the character of bone atrophy caused by disease. He chose the os calcis of rabbits as most suited to his experiments and observed the changes in it as a result of resecting a portion of the tendo Achilles. An atrophy involving both the spongy anl compact bone occurred in one week. The tibia and the anterior bones of the foot were involved also. When the function was only partially taken away, as by a plaster cast, an atrophy began very early and was di- rectly proportional to the completeness of the lack of use. From these experiments the author concludes, as did Legg as the result of his sim- ilar experiments, that the atrophy seen in dis- ease is the result only of the disuse, and not characteristic of any special disease, — for ex- ample, tuberculosis. A type of enteric fever due to the bacillus Columbensis was first described by Castellani" in 1905. Certain cultural characteristics and sugar differentiate this organism from others in the paratyphoid group. He describes a case 490 BOSTON MEDICAL ASD SURGICAL JOURNAL [Apbii- 1, 1915 of this type of fever, in which there were sinuses in the arm, persisting for over a year, from which spicules of bone were discharged, and from which cultures of the B. Columbensis were isolated. This apparently represented a perios- titis due to one of the organisms of the typhoid group. The infection is always mild, persistent, and runs a subacute course. Dehon and Hertz°^ give the details in fourteen eases of angiosclerotic dystasia or intermittent claudication, and call attention to the fact that syphilis was known in half of them. This large percentage suggests the importance of at least tentative treatment for syphilis in all cases of obliterating arteritis of the legs. One of their patients improved remarkably under specific treatment and the Wassermann reaction became negative. Some with known syphilis had a nega- tive reaction. In some with known syphilis, the intermittent claudication was not benefited in the least by the specific treatment. Tobacco and alcohol seemed to be contributing factors in some of the patients, possibly outweighing in im- portance the syphilis -in these eases. They urge that if any signs of tabes or leukoplakia are present there should be a trial of specific treat- ment in every case of intermittent claudication, even if there is nothing else to suggest syphilis and the Wassermann reaction proves negative at the first test. Bailey" reports four cases of spinal cord tu- mor and calls attention to the fact that in these tumors pain may be absent, or present only slightly and at intervals. Also that the presence or absence of pain is not of value in determining whether the tumor be extra- or intra-meduUary. He says, "We shall have to take the same posi- tion in regard to spinal cord tumors as we have taken for years in regard to tabes, that is, that pains may be absent iii a disease which is usually highly painful, and that the absence of it in any case presenting other suflScient symptoms does not vitiate the diagnosis. ' ' Goldthwait" has written a suggestive article intended to reach the lay public on the effects of habits of posture on health. [Ed. Note. — It is undoubtedly true that faulty posture maintained in industrial life becomes a fixed habit and that careless lack of attention also allows a poor posture to become an habitual position of a physically weak individual. These conditions may predispose to various chronic diseases. Although it is quite true that many persons live to be three score years and ten, work hard, and "never have a sick day," and yet are round shouldered, with sagging abdomen, and pronated feet, the efiiciency of these individuals must be lessened by these factors. Our atten- tion needs to be called to these matters, but let us not stop there. Proper posture should be a study in every school, ranking with other lessons, and its acquirement made essential to promo- tion. Gymnasia, with instructors trained in the methods of inducing proper posture must be developed for general use, if we are going to reach more people than those few to whom we can say, "Sit up straight."] An article by Lovett''' on "The Causes and Treatment of Chronic Backache, with a Consid- eration of the Diagnosis of Sacro-iliac Eelaxa- tion ' ' should be generally read, as the expression of opinion of an eminent orthopaedic surgeon who has given much thought to the subject. Leaving out of consideration the backaches due to tuberculosis, organic nervous disease, and spinal fractures, he considers the common causes are : 1. Pelvic conditions. 2. Traumatisms. 3. Arthritis. 4. Defective balance. Sacro-iliac strain or relaxation as an entity, he considers very rare, believing that the backache when lo- cated in this region may be attributed to strain upon the muscles, attachments and ligaments in this region, causing a condition of hypersensi- tiveness and tenderness in which the sacroiliac ligaments are in some cases involved. He be- lieves that the measures often employed to sup- port the sacroiliac joints, such as adhesive plas- ter and belts, are entirely insufficient to really hold the articulation, and are successful only when they give support to strained muscles or help to maintain a proper balance. The most useful methods of treatment he considers to be : 1. Measures to obtain proper balance, such as corsets, etc. 2. Proper shoes and sometimes sup- ports for the back. 3. Later exercises to develop the musculature. [Ed. Note. — It is not clear from the article what the author considers the cause of the com- mon sciatic and other nerve root pain which so commonly accompanies both the attitudinal, the traumatic, and the arthritic low backaches. These are frequently relieved by protecting the sacroiliac joints and these alone, by such a pro- cedure as the Italian laborer has learned to adopt, when if hard digging is to be done he shifts his belt from his waist to below the level of his anterior superior spines. He does not know that the difference of a few inches in the circular construction makes the difference as to whether the sacro-iliac joints are sprung apart by pressure applied at the level of the crests of the ilia or held together by pressure exerted in the sulcus between the trochanter and the ante- rior superior spines, but such is the fact and he does know that his back does not ache when he is thus protected. The author is quite right in saying that any actual displacement of the sacrum downwards is unlikely and possible only as a result of very great trauma. None of the anatomists or clinicians who have carefully stud- ied the movements of the sacrum have main- tained that this occurred. (Goldthwait: Boston Medical and Surgical Journal, May 25 and June 1, 1905. Bouvarre et Biie: La Presse Medicate, Aug. 9, 1899. Herman Myer : Archiv. filr Anatomie, 1878, p. 1. L. Dieulafe : Bibliog- raphie Anatomique Supplement, 1904, p. 109.) Nevertheless, the rotation of the sacrum on its horizontal axis through the second sacral ver- Vol. CLXXII, Xo. 13] BOSTON MEDICAL AND SURGICAL JOURNAL 491 tebra and slight displacements or subluxations beyond of this normal arc of motion, which the author does not mention, are quite common, we believe, and demonstrable both to palpation and also in good stereoscopic x-ray plates. We can- not explain relief of nerve root pain, when the sacroiliac joints are protected by the theory of relief of strain on the ligaments and muscle at- tachment of the low back, nor can we explain thus the quick relief which is often dramatic, which sometimes follows manipulation of the joints, either with or without an anesthetic. Muscle attachment and ligamentous strain from faulty attitude and balance are surely a very common cause of backache, but there will, in our opinion, be left many cases not explainable on this theory alone, and in these we believe that lesions of the sacroiliac joints and strains in which abnormalities of the articular and trans- verse processes of the fifth lumbar are present, will be found not infrequently.] RirZUHCU. >DiiCosU: Annila of Surgery, June, 1914. •Wilson «nd Roaenberger: N. Y. Med. Jour., June 14, IMJ. * Froelich : Arch, de Med. dea Enfints, March, 1914. * Huntincrton: Annals o( Surgery, June. 1914. •Vulpius: Berliner klin. Woch., Apr. 18, 1914, p. M«. * Jacobs: Illinois Med. Jour., Aug., 1914. ' Becchcrle: Policlinico, March IS, 1914, p. 127. ■Roeenow: Jour. A. M. A., April 11. 1914, p. 1146. •Axhausen: Zfschr. f. orth. Chir., 191S, xxxlil Bd., 1-2 H.. p. 223. ■• von Manteuffel : Deutsche Ztachr. f. Chlr., 1918, cxxir, 821. "Hastings: Jour, of Exp. Med., Julv 1, 1914, p. 52. "Thalhimcr and Rothschild: Jour. Exp. Med., May, 1914. "Moore: Jour, of Inf. Diseuea, Jul.v, 1914, p. 218. "«reeley: Med. Record. June 18, 1914. p. 1078. "Brackett: Boston Mfd. aud Subo. Jou»., July 9, 1914, p. 68. >*Mannir« and Fassett: Arrblvea of Pediatric*. June, 1914, p. 415. "O'Mallay: Annals of Otology, Rhinology, and Laryngology, Dec.. 1918, p. 1007. "Rolant: Diss. Petrograd, 1918; Abstr., Surg., Gya, and Obstet, March, 1914, 263. '•Perthes: Deutsche Ztacbr. f. Chlr., 1910, Bd. 107, p. 111. *>Drehmann: Beitr. z. kiln. Chir., xcl, p. 642, 1914. "O'Reilly: Am. Jour. Orth. Sure.. Jan., 1914. >• Jones: Clinical Jour., London, May 18, 1914. "Saunders, Meisenbach, and Wisdom: Miaiourl State Med. Assoc., March, 1914. >* Francis: Jour, of Infectious Disease*, July, 1914. "Flexner, Clark, and Amon: Jour. Exp. Med., Feb. 2, 1914, p. 194. "Robert Jones: Ijncet, May 80. 1914, p. 1615. "Netter: Bull, de lAcad. de Med., April 7, 1914. "Fraser: Am. Jour, of Med. Sciences, July, 1914, pp. 1-22. "Peltesohn: Berliner klin. Wnrh., June 22, 1914, p. 1162. ••Weiss: Therap. Monatsschr., Berlin, 1918, xxrll, p. 400. •lOaTazzani: Policlinico, April 19, 1914, Txll, No. 16. •"Wagner: Arch. f. Gynlk., 191S. C, No. 1. «* Bookman: Am. Jour. Dls. Children. June, 1914, p. 486. "Bamberg and Huldschinsky : Jahr. f. Kinderheilk., 1913, Ixniil, p. 214. ••Adams: Boston Med. *jid Simo. Jorn., Mar 21, 1914. p. 786. ••Murphy, J. B. : Jour. A. M. A., June 6. 1914, p. 1788. "Brown, W. r,., and C. P.: Jour. A. M. A., May 2, 1914, p. 1889. ••Payr: Deutsche Ztscbr. f. Chlr., cxxix, F. Trendelenberg Festschrift. ••I^ewls: Surg., Ovn., and Obstet.. May, 1914. "Bond: British Jour, of Surg.. April, 1914, p. 610. »>Marc07j:i: 1.8 Riforma Medica. May 16, 1914, p. 680. "Marsiglia: La Riforma Medica. Mar 9. 1914, p. 505. "Tanton: Gazette des Hop., Ixxxvi. No. 107, p. 1667. "Saar: Deutsche Ztschr. f. Chir., cxxvlil, p. 29, 1914. "Anzilotti: La Riforma Medica, March 14, 1914, p. 289. ••Walbaum: Deutsche Ztschr. f. Chlr., cxxvlil, p. 189, 1914. «' Balthazard: Re^■. de Chir.. xxxlv, Mav, 1914, No. 8. "Albce: N. Y. Med. Jour., May 28, 1914. "Davidson: Jour. A. M. A., May 16. 1914, p. 1851. "Brandes: Fortschr. a. d. Geb. d. Roentgenstrahlen, 1914, xxi, p. 551. "Castellanl: Jour, of Tropical Med. and Hygiene, June 16, 1914, p. 177. •• Dehon and Herti : Ar«hlre» des Maladies du Coeur, etc., June, 1914, vii, p. 6. ••Bailey: Jour. A. M. A., July 4, 1914, p. «. •« Goldthwalt : Journal of Outdoor Life, April, 1914. "Lovett: Jour. A. M. A., May 28, 1914, p. 1615. Sook ilrtmma. A Text-Book of the Diseases of the Nose and and Throat. By Jonathan Wriqht, M.D., Director of the Department of the Laborato- ries of the New York Post-Graduate Medical School and Hospital; and Harmon Smith, M.D., Surgeon of the Throat Department of the Manhattan Eye, Ear, Nose and Throat Hospital; Clinical Professor of Laryngology and Rhinology, Cornell University Medical School. Illustrated with 313 engravings and 14 plates. Philadelphia and New York: Lea and Febiger. 1914. This is a new text-book of 650 pages. It is stated in the preface that "the exceptional fea- ture in the book is the emphasis laid upon the etiology and pathology of disease" and that "much of this work rests on original investiga- tion in the laboratory and clinic." One of the authors is an investigator and a philosopher, whose opinion in pathological problems has long been sought, and who in addition to his other writing has given us a classical history of laryn- gology. The other is a well-known clinician and operator. They have worked together so that tliere are no abrupt lines of demarcation between the academic and the practical portions of the text. The first chapter gives briefly the various methods of examination. The next on the exter- nal nose includes the results of the long experi- ence of one of the authors with the injection of paraflSn. The description of the minute anat- omy, both normal and pathological, of the inter- nal nose and also of the pharynx and larynx, is one of the striking features of the book. An- other, which will undoubtedly lead to its wide u.se for reference, is the description of the va- rious neoplasms, not too technical, but given by the hand of a master. The selection and de- scription of operations on the accessory sinuses and nasal septum is good and clear. In the chap- ter on neuroses of the nose is included hay fever, which is apparently looked upon as largely due to a yielding on the part of over-sensitive persons to insignificant irritations. It is disappointing that the large amount of study which has re- cently been given to the theory of anaphylactic reaction from the different proteids should not be taken seriously. The important subject of the borderline between normal and pathological adenoids and tonsils is judicially discussed and various methods of operating described. A val- uable chapter, often omitted from text-boooks, is one on buccal lesions, with which the specialist is often called upon to deal. As a whole the book is a worthy addition to our list of text-books on the subject, and justifies its promise to embody origrinal points in etiology and pathology. 492 BOSTON MEDICAL AND SURGICAL JOURNAL [Apbu, 1, 1915 THE BOSTON An independently owned Journal of Medicine and Surgery, pub- Iish.:d weekly, under the direction of the Editors and an Advisory Committee, by the Boston Medical and Surgical Joubnal So- ciety, Inc. THURSDAY, APRIL 1, 1915. Editors. Robert M. Green, M.D., Editor-in-Chief. GEORflB G. Smith, M.D., Assistant Editor. Walter L. Burrage, M.D. 1 „ ,, „ i .< ., j- i » . Frederick T. Lord, M.D. / ''<"' ">« Uaesachmetts Medical Sonety. Committee of Consulting Editors. Walter B. Cannon, M.D. Allan J. McLAnoHLiN, M.D. Harvey Cdshino, M.D. Robert B. Osoood, M.D. David L. Edsall, ILD. Milton J. Rosenad, M.D. Beid Hunt, M.D. Edward C. Streeter, M.D. Roger I. Lee, M.D. ' E. W. Taylor, M.D. Advisory Couuitteb. Edward C. Streeter, M.D., Boston^ Chairman. Walter P. Bowers, M.D., Clinton. Homer Gage, M.D., Worcester. Joel E. Goldthwait, M.D., Boston. Lyman A. Jones, M.D., North Adams. Hugh Williams, M.D., Boston. ALFRED Worcester, M.D., Waltham. Robert B. Osgood, M.D., Boston, Secretary. Ernest Gregory, Manager. W. M. Leonard, Consulting Manager. Subscription Terms: $^.00 per year, in advance^ postage paid, tor the United States. $6.56 per year for all foreign countries be- longing to the Postal Union. The zditor will be in the editorial office daily, except Wednesday and Sunday, from twelve to one-thirty p. m. Papers for publication and all other communications for the Edi- torial Department should be addressed to the Editor, 126 Massachu- setts Ave., Boston. Notices and other material for the editorial pages must be received not later than noon on the Saturday preceding the date of publication. Orders for reprints must be returned in writing to the printer with the galley proof of papers. The Journal will .urnisk the first one hundred reprints for half the cost price. All letters containing business communications, or referring to the publication, suiscription, or advertising department of the Jour- nal, shoula be addressed to Ernest Gregory, Manager. 126 Massachusetts Ave., Comer Boylston St., Boston, Massachusetts. NEW AND NON-OFFICIAL REMEDIES, 1915. The 1915 edition of New and Non-official Remedies, published by the American Medical Association, has recently been issued. This little work,* which is prepared by the Council on Chemistry and Pharmacy of the Medical Asso- ciation, is not as well known to, or as frequently consulted by, the profession as it should be. As the name implies, the book deals with drugs which have recently come into use and with those which are not yet contained in the United States Pharmacopoeia. Its main pur- pose is to give physicians a truthful account of the chemistry, properties, actions and, so far as these have been determined, the therapeutic use of the drugs discussed. As a source of informa- tion on such subjects, it should largely replace the trade circulars of manufacturers, from * Copies of "New and NonofBcial Remedies" may be obtained at cost price, postpaid (60 cents tor paper-bound, $1.00 cloth- bound), from the American Medical Association, 685 North Dear- born street, Chicago, and also through dealers in medical books. which SO many of the less critical members of the profession derive their knowledge of the more recently introduced remedies. As examples of the drugs discussed in this edi- tion, may be mentioned salvarsan, emetine, theo- bromine and theophyllin (and the various pro- prietary preparations of these, such as diuretin and theocin), novocaine, preparations of the pi- tuitary gland, various vaccines and sera, etc. The list is not limited to substances used for therapeutic purposes; it discusses also the most important chemicals and re-agents recently intro- duced for use in diagnosis, such as phenolsulpho- nephthaleia, the Nogucni, Abderhalden and von Pirquet tests. A very useful feature of the work is the fact that the names of the manufacturers who make such preparations and who have satisfied the Council that their products are as represented, are given. It may not be generally known that the American Medical Association maintains in Chicago an exceptionally well equipped chem- ical laboratory for the purpose of examining new drugs; this laboratory is probably the best source of trustworthy information in the world on such subjects. The fact that so many physi- cians still derive so much of their information on these subjects from commercial circulars or re- tail men, in preference to New and Non-official Remedies, is highlj- discreditable to the profes- sion. An examination of the reports of the chemical laboratory of the American Medical Association, or those of the United States Public Health Service, of the records of convictions un- der the National Pure Drug and Insecticide laws will show how little reliance can be placed upon the claims of many manufacturers. And yet most physicians constantly prescribe and hospitals constantly buy, at exorbitant prices, simple Pharmacopoeia drugs under proprietary names, simply because the manufacturers say, or insinuate, that their products are superior to the U. S. P. preparations, although the quality of the latter is under the jurisdiction of the United States as well as of the state governments. Why do physicians who accept such statements hesi- tate to accept other statements of these same manufacturers — those concerning the value of their various pastes for the checking of cancer, of various toxins for pneumonia, etc., as well as the out and out "patent" medicines (hair growers, "manhood restorers," etc.) which the same firms prepare for the use of the laity ? It Voi,. CLXXII, Xo. 13] BOBTON MEDICAL AND SURGICAL JOVRNAL 493 may well be that the future historian of medi- cine will find this an essentially darker period in some important respects than that of a cen- tury ago, when James Jackson and John C. Warren knew enough about the drugs they used to write a pharmacopoeia for the Massachusetts Medical Society. All drugs are admitted to New and Non- official Remedies provided they meet certain simple requirements — requirements based upon principles universally accepted, but unfor- tunately not adhered to by the medical profession; they must be non-secret, ex- act information as to composition must be given, grossly exaggerated claims as to use- fulness or safety must not be made. Powerful drugs, the use of which by the laity might lead to harm, either direct or indirect, must not, ac- cording to the rules governing admission to the book, be advertised in a way to invite self-medi- oation. With these simple restrictions, the rea- sonableness of which is self-evident, all new drugs of promise are eligible for admission. Physicians should regard with suspicion all pro- prietary preparations which are not included. The reason why the products of some manu- facturers are not in New and Non-official Reme- dies is that these firms are not dealing fairly with the profession or the public. Another feature of the work is that emphasis is laid upon the true chemical names of the drugs. Many physicians will find that they are using proprietary names and so helping create monopolies in certain official drugs, as well as in certain chemical compounds; the use of va^ rious proprietary names for the same official drug (as in the case of hexamethylenamine, for example) often leads to the greatest confusion. HEALTH ASPECTS OP SCHOOL LUNCHES. The medical profession is to be credited with initiating the movement to feed children at school. Its beginning, in England, can be traced to a memorandum issued many years ago, by the director-general of the Army Medical Service which followed the wholesale rejection of re- cruits because of physical disability. An inves- tigation showed that the conditions responsible for this physical decadence were directly attrib- utable to poverty, that this in turn was due to the change brought about by the rapid rise of industrialism following the adaption of labor- saving machinery, and that in consequence of the prevailing poverty the children were being reared as weaklings, incapable of resisting dis- ease and largely impervious to education. As a measure of relief for this deplorable situation the inquisitorial council recommended a school lunch service for needy children, to be main- tained at the public expense. An examination of over 330.000 children (one-third of the school population of the city) by the medical inspect- ors of the New York Health Department in 1913 disclosed some 14,000 eases of malnutrition; and, on the assumption that the same ratio of this condition is to be found in the rest, there would be more than 40,000 children in the .schools whose health is impaired owing to a mal- nourished system. It has been ascertained that in Cincinnati, of 36,438 children examined. 1619 were suffering from malnutrition; in Cleve- land, of 61,578, 671 ; in Newark, N. J., of 27,971, 940; in Rochester, N. Y., of 18,497, 945; and in Worcester, Mass., of 18,342, 389. While, of course, the provision of a suitable meal at noon is inadequate to overcome such mal- nutrition, the school lunch service is undoubt- edly a palliative measure of great practical serv- ice, and one which can be made productive of a widespread influence for good. In the latest Monthly Bulletin of the New York City Depart- ment of Health there is published a valuable contribution on this subject by Edward F. Brown, executive secretary of the school lunch committee of the Association for Improving the Condition of the Poor. From this it is learned that the New York School Lunch Committee was organized in 1907 for the following purposes: 1. The provision of nourishing lunches on a self- supporting basis for public school children. 2. Special observation of children whose physical condition is such as to give evidence of lack of proper nourishment, in order to determine the underlying causes by a study of their homes and environment. An extension of this aim requires tliat these selected cases be followed up, to the end that the proper agency may be apprised and appropriate action taken. 3. The formation of special classes of mothers for instruction in the proper care of children, and particularly those suffering from poor nourishment. It will thus 494 BOSTON MEDICAL AND SURGICAL JOURNAL [April 1, 1915 be seen that the work of this committee is very much more comprehensive than the mere pro- viding of nourishing noonday lunches. The need for a school lunch system, as Mr. Brovm says, ought really to be regarded as a symptom of a serious social disorder. The necessity of feeding children at school usually arises from eithef a demoralized home, where the housewife has to work out, indifference of the housewife, or igno- rance of home economics. The service of a noon meal is at best to be considered inadequate for a number of reasons, among which may be men- tioned the following: Behind each child in need of such a service is a home lacking the facilities for proper feeding; for such a child the need is just as great for its other meals and for feeding on non-school days and in the summer recess; the presence in the family of children of pre- school age ; the fact that any desirable effect re- sulting from the scientific feeding of the child at one meal time at school is likely to be de- stroyed by the kind of food it gets at home at the other meals. Properly, therefore, the feed- ing of children should be made part of a much larger social program. At the present time there are in New York twenty schools, register- ing 32,000 pupils, where tbe lunch system is op- erated. The need for such a service was natu- rally most urgent in districts where the people were impoverished, where mothers worked in factories by day, and where the children de- pended for food on the few pennies which pur- chased candy from the. vendors about school- hoases. An experiment was tried in the equip- ment of a kitchen in a school building, where soup, sandwiches, puddings and cocoa were pro- vided at the rate of one cent a portion — ^the child being required to purchase first a bowl of hot soup. The caloric aggregates of some of the typ- ical trays of food provided, the price of none of which exceeds a total of three cents, are given, and these are samples of them : — Vegetable soup... . 85.00 Kgg sandwich 23H.00 Eice pudding 108.76 Bean soup 111.27 Bread, two slices. 200.00 Prunes 180.00 429.70 491.27 Aside from its other advantages, the school lunch system affords an admirable opportunity to teach the children the science of feeding, in- cluding the purchase, preparation and hygiene of food. Fundamentally, the work is devoid of any mark of poor relief. During the last school term 1,249,489 portions of food were sold; for which the children paid $12,494.89. The service was not quite self-supporting, for a deficit equal to a little over one-third of a cent per portion was incurred, and this was made up by a benevo- lent lady. Naturally, in any scheme for feeding large groups of children, where the prime object is the rearing of a vigorous race, a scientific basis is essential. The working force of the committee is headed by a dietitian, who is responsible for the character of the food and service, and the principles on which food is selected are: (1) nu- tritiousness, (2) palatability, (3) purity, (4) seasonability, (5) inoffensiveness to racial or re- ligious preferences, (6) similarity to home food, (7) balance in accordance with food principles. When the committee is assured that an article of diet meets with these requirements, a sample order of the raw product is secured, and it is then submitted to three tests : chemical, bacterio- logical and food value. Cooperation with the health department is stated to have yielded the most encouraging results. Analyses have been made by it, and also by some of the university laboratories. Furthermore, health authorities in other places have always aided when asked to inspect the manufactories in their communities. Where there is every indication that the product itself is pure, the place where the food is manu- factured is inspected, and, in purchasing, pref- erence is given to firms maintaining the best con- ditions. The social value of encouraging trade where decent conditions of work and welfare prevail is, it is felt, not only a just recognition of good public service, but a rebuke to the manu- facturer who thrives on adulteration, over-work and under-pay ; and here one recognizes another measure in the interest of public health, for in the degree that we demand livable conditions of labor shall we secure a diminution of incapacity, sickness and death. Where foods are found to contain harmful matter, or where the conditions of manufacture or sale are unhygienic, informa- tion is laid before the health authorities for action. This usually prevents the further dis- tribution of a product which is likely to cause injury, and thus there is an educational advan- tage in this system which can scarcely be over- estimated. An additional precaution to ensure the purity of the food dispensed is the careful scanning of the lists of convicted food adulterers prepared weekly by the health department. Of course, scrupulous care is taken to have the kitchen and service equipment entirely hygienic, Vol. CLXXII, No. 13] BOSTON MEDICAL AND BUROICAL JOURNAL 495 and in order to prevent the possibility, of disease transmission in the preparation and handling of food, the committee had the health department make a thorough physical examination of all the school lunch employees, and also of a hundred children who assist in the service. The argu- ment has often been advanced that the feeding of children at school causes shiftless parents to shirk their just share of responsibility in the nurture of their offspring ; but this has not been found to be the case. On the contrary, the school lunch employees, coming in contact with the parents in the districts, are often consulted regarding what foods to prepare for children at home, and how to prepare them. Certainly, the New York School Lunch Committee is to be con- gratulated on the valuable and far-reaching work it is accomplishing. Let us as physicians each and all prepare to do our parts in the campaign already being waged against syphilis, the tragic consequences of which we know full well. THE QUESTION OF QUARANTINE TRANSFER. SYPHILIS. We wish to direct the attention of every reader of these pages, whether man or woman, physician or layman, to the article by Dr. J. Harper Blaisdell which is printed in this issue, under the title of "The Menace of Syphilis to the Clean Living Public. ' ' There is no doubt that many persons contract syphilis innocently and that many more are ex- posed to this danger. It has been pointed out that even those who lead the most sheltered livee are not free from this menace. Must the innocent always be thus endangered, and how great is the risk t Before answering these questions a store of accurate information must be collected. Several years ago, as stated by Dr. Blaisdell, New York City made syphilis a reportable dis- ease with this end in view. Statistics as to prevalence, distribution, and source of infection in a community must prepare the way for effec- tive action. Is it known how many syphilitics there are in our community, how many of them daily en- danger their associates, or how many persons with lesions on tlie hands are engaged in the preparation of food? These things cannot be known until all cases of syphilis are reported promptly to the local health authorities In previous issues of the Journal we have, from time to time, commented editorially on the relative merits of federal and local control of (luarantine service and, after discussion, have ad- vocated the transfer of the Boston Quarantine Station from municipal to national administra- tion. On March 23 the Boston City Council committee on ordinances reported favorably on the pending plan for effecting such a transfer, and it is expected that the necessary ordinance will ultimately be adopted by the council. At a meeting of the committee, the Boston Chamber of Commerce submitted a further report in whicli its previous opposition to the transfer was largely withdrawn. This report was based on a previous report by Mr. Robert Luce, chairman of a special committee of the Chamber, to whom the subject was referred. Mr. Luce's report expressed confidence that the federal govern- ment, in the event of transfer can be relied upon to provide adequate accommodations for de- tained immigrants and that the officials will af- ford the work as prompt and efficient a service as that which it at present enjoys. The final report of the Chamber further calls attention to the high local cost of maintaining quarantine service and the desirability of uniformity in quarantine administration from the point of view both of public health and of the commer- cial and shipping interests. The report con- tinues as follows; — "Furthermore, there appears to be reason- able ground for the expectation that in the near future it will be necessary to build a new de- tention hospital at Gallop's Island or elsewhere, and it is averred that the cost thereof may run as high as $250,000. We were told it would be possible at present in case of emergency, to house nearly 1000 persons under roofs on the island. In the summer more could be maintained in tents, but it seems clear that provision ought to be made for winter conditions. "If the United States takes over the station, it will proceed at once to make repairs under an 496 BOSTON MEDICAL AND SUBOICAL JOURNAL [APBn- 1, 1915 annual appropriation available for the service, and will proceed at once to aecquire from Con- gress funds available for any new construction necessary. ' "Manifestly it is important to the shipping interests that the quarantine station be adequate- ly provided with personnel and equipment to handle vessels with the greatest possible expedi- tion in ordinary times, and the least possible de- tention of the ship itself in ease infection is found aboard. An outbreak of plague here would paralyze commerce by reason of attempts at self -protection on the part of other ports. "Nothing indicates that our local quarantine service is not effective. On the contrary, it is praised. Yet whatever can be done to make it still more effective and to guard against every possible contingency would seem to be the part of prudence. "The chief weakness of the present arrange- ment appears to be the usual weakness that fol- lows a division of authority. Under normal con- ditions, all goes well. When the emergency comes and the second authority steps in, then come uncertainty, misunderstanding, friction, delay, economic loss, danger to the community. Unified administration lessens these chances of injury, and in that particular matter brings about certain specific advantages." As the result of this reconciliation of the Chamber of Commerce to the proposed quaran- tine measure it is earnestly to be hoped that the transfer of the Boston Quarantine Service from local to federal control may soon be effected. MISCELLANEOUS MATTERS OP MEDI- CAL LEGISLATION. Before the Massachusetts General Court, sev- eral measures of medical legislation upon which comment has been made in previous issues of the Journal, have recently been acted upon as fol- lows. The anti-vaccination bill was given leave to withdraw. The anti-vivisection bill was de- feated by the House. A bill was reported by the committee on counties authorizing Barn- stable County to construct and maintain a hos- pital for tuberculates. The public health com- mittee reported favorably the bill requiring ap- plicants for registration in medicine to be grad- uates from a medical school approved by the State Board of Registration in Medicine, or to possess an equivalent training. The text of this important bill (House No. 745) is as follows: — Section three of chapter seventy-six of the Revised Laws is hereby amended by inserting after the word ' ' character, ' ' in the fifth line, the words : — and a graduate of a legally incorporated school of medicine, — so as to read as follows: — Section 3. Applications for registration shall be made upon blanks to be furnished by the board, and shall be signed and sworn to by the applicants. Each applicant for registration shall furnish satisfactory proof that he is twenty-one years of age or over and of good moral charac- ter and a graduate of a legally incorporate^ school of medicine, and, upon payment of a fee of twenty dollars, shall be examined by said board. If he is found by four or more members thereof to be twenty -one years of age or over, of good moral character and qualified, he shall be registered as a qualified physician and shall re- ceive a certificate thereof signed by the chair- man and secretary. An applicant who fails to pass an examination satisfactory to the board, and is therefore refused registration, shall be entitled within one year after such refusal to a reexamination at a meeting of the board called for the examination of applicants, without pay- ment of an additional fee; but two such reex- aminations shall exhaust his privilege under his original application. Said board, after hearing, may by unanimous vote revoke any certificate issued by it and cancel the registration of any physician who has been convicted of a felony or of any crime in the practice of his profession. All fees received by the board shall, once each month, be paid by its secretary into the treasury of the commonwealth. The committee on public bealth reported ad- versely on the bill and recommendation submit- ted by the State Board of Registration of Nurses. This recommendation contained in the fifth annual report of the board, was as fol- lows : — "The board recommends the passage of an amendment to the present act which will pro- vide for the registration of two classes of nurses. The title R.N., meaning registered nurse, author- ized for nurses who are graduates of approved training schools, and who can meet the require- ments of an examination which would determine the fitness of a nurse to do any work a nurse might be called upon to do, and another title, that of H.N., meaning household nurse. Such nurses, with the title H.N., would, under this act, be permitted to take care of ordinary cases of illness, but could not nurse major surgical cases. ' ' The defeat of the anti-vaecination and anti- vivisection measures is, of course, cause of con- gratulation to the medical profession. It is per- haps best that the bill on the registration of nurses should fail to pass at this time. It may Vol. CLXXII, No. 13] BOSTON MEDICAL AND SURGICAL JOURNAL 497 be hoped that that on the registration of physi- cians will have a more favorable fate, and phy- sicians who favor it should write to their repre- sentatives and personally attend any further hearings upon the subject. MEDICAL NOTES. Jordan Memorial Sanatorium. — The recently published second annual report of the Jordan Memorial Sanatorium, River Glade, New Bruns- wick, for the year ended October 31, 1914, gives an interesting record of work accomplished in the cure and arrest of tuberculosis. The num- ber of patients admitted during the year was 87. Of this number six were discharged as cured, 13 as apparently arrested and 36 as im- proved. Poliomyelitis in Dorsetshire. — In a recent issue of Public Health, Dr. Rory McLaren, public health officer of Dorsetshire, England, re- cords an acute epidemic of poliomyelitis in Bea- minster, a town of 1700 inhabitants, eight miles from the English Channel. In this agricultural community the first case of infantile paralysis appeared on August 2, 1914. Sixteen other cases followed within a month, all within a mile and a half of the center of the village. Six of the eases died, five survived with serious paraly- sis and six recovered with slight disability. This typical severe outbreak conforms definit^-ly with the infectious character of the disease and the probable method of its transmission by an inter- mediate insect host. AniRONDACK Cottage Sanitarium. — The thir- tieth annual report of the Adirondack Cottage Sanitarium, Saranac Lake, N. Y., contains a carefully detailed and interesting record of the work of that institution. Of the 229 patients treated during the year, 20.5% were discharged apparently cured, 43.7% were discharged with disease arrested, and 11% improved. The total contributions for the year amounted to $63,- 620.67; contributions to the general fund amounted to $14,432.71; to the x-ray account, $3,100.00. Increasing Death-Rate from Organic Dis- ease. — The Life Extension Institute of New York has recently issued in pamphlet form an address by its president, Elmer E. Rittenhouse, entitled "America's Pressing Mortality Prob- lem." Accompanying the text is a series of charts showing graphically the rapid increase of deaths from apoplexy, kidney and urinary disease and cardiac and circulatory disease in the United States and a corresponding decrease of deaths from these causes in England and Wales. In concluding his discussion of these facts, the author states, as his solution of this problem, that education in indi^adual hygiene is the remedy for these alarming conditions and the ultimate means by which length and efficiency of life may be attained. Typhus in Serbia. — It is reported by the war relief committee of the Rockefeller Foundation, on its return from a tour of inspection through Serbia, that typhus, typhoid fever, cholera, smallpox, diphtheria, scarlet fever, and recurrent fever are all existing in epidemic form. Typhus, the most deadly of these, already has caused the death of 60 out of 400 native doctors of the country. The foreign Red Cross units have suf- fered great losses. Two American units and one British have been compelled to suspend their regular work because of typhus. Nine American nurses and two physicians have contracted the disease. The Serbians assert that Austrian pris- oners of war who were permitted to wander over the country, introduced the disease and infected the population. Annual Report op the Craig Colony for Epiijiptics. — In presenting their annual report to the Legislature of the State of New York, the board of managers of the Craig Colony for Epi- leptics, Sonyea, N. Y., make the following state- ment : — "On September 30, 1913, the census was males, 763 ; and females, 664, total 1,427. There were admitted during the year 125 males, 86 females; total 211. There were discharged dur- ing the year 136 males and 81 females, a total of 217, making the census on September 30, 1914, 752 males and 669 females; total 1,421. From the time of the vaccination against typhoid fever of all employees and patients in the infirm- ary in 1912, no cases of this disease developed until in September, 1914, when three cases were diagnosed. It is believed that a carrier was the source of infection. The number of patients in the colony having tuberculosis approximates 200." As is usual the report contains an interesting record of autopsies performed on 87 patients. Nebraska Orthopedic Hospital. — The senr- enth biennial report of the Nebra.ska State Board of Charities and Correction contains an interest- ing account of the Orthopedic Hospital main- tained by that state. Since its establishment in 1905, it has treated nearly 1,000 patients. A new building for its use is in process of comple- tion and when finished will increase the capacity of the hospital to 150 patients and make it one of the largest strictly orthopedic hospitals in this country. Its record for the two years beginning November 30, 1912 is 690 patients received, 279 discharged as cured, 258 discharged as benefited, 30 discharged as not improved and 16 deaths. 498 BOSTON MEDICAL AND SURGICAL JOURNAL [April 1, 1915 Annual Report of the Battle Ceeek Sani- tarium. — The recently issued report of the Bat- tle Creek Sanitarium, Battle Creek, Mich., for the year 1913 shows a steadily increasing num- ber of patients attending this institution and a constant broadening of the field of work here attempted. Since its incorporation in 1876, the number of patients treated has risen from 182 in that year to 5,693 in 1913. Improvements in- volving the expenditure of more than $50,000 were made during the year. An advance in the work of the institution was initiated by the ap- pointing of a committee to organize and equip a children's ward. In 1913 the number of pa- tients aged 15 years or under was 176, the average number being 17.6. In the first week of January, 1914, a Race Betterment Conference was held at the sani- tarium, the expenses of the movement being borne by the Race Betterment Foundation, a philanthropic association which is closely allied to the sanitarium and which undertakes the support of numerous lines of philanthropic work directly or indirectly connected with it. European War Notes. — On March 27, the to- tal of the New York Belgian relief fund amounted to $995,579.59; the American Jewish relief fund to $579,996.53; the New York Red Cross fund to $475,350.34 ; the New York Com- mittee of Mercy fund to $137,523.71 ; the New York Polish relief fund to $28,916.92; and the New York Serbian relief fund to $25,217.00. On March 28 the total of the New England Belgian relief fund amounted to $238,503.92; the Massachusetts Red Cross fund to $116,-, 495.40 ; the Boston branch of the American Am- bulance Hospital fund to $56,348.25 ; the Boston Polish relief fund to $38,775.87 ; and the Boston branch of the Prince of Wales fund to $12,- 500.00. boston and new ENGLAND. Eugenic Law in Vermont.— Report from Montpelier, Vermont, states that on March 22 the Legislature enacted the so-called eugenic marriage law providing a fine of $500. for any person who marries without a physician's cer- tificate of physical and mental fitness. Massachusetts District Health Officers. — Notice was issued by the Massachusetts State Department of Health on March 23 that the eight new district health officers recently ap- pointed by Dr. McLaughlin are to begin their duties April 1.. IMiLK and Baby Hygiene Association. — The sixth annual meeting of the Boston Milk and Baby Hygiene Association was held in this city on March 23 under the presidency of Dr. Charles W. Eliot. The principal address was by Dr. S. Josephine Baker on ' ' The Community and the Baby." The annual report of the director showed that during the past year 4,097 babies were treated at the 12 milk stations maintained by the association, whose nurses made also 50,- 275 visits to patients in the latter 's homes. Organization of the East Boston Medical Association. — On March 19, a number of physi- cians of East Boston met and organized the East Boston Medical Association. The following offi- cers were elected: Dr. Frank Tilton, president; Dr. Robert Barney, vice-president; Dr. A. L. McLaren, treasurer, and Dr. J. D. Taylor, secre- tary. Epizootic of Foot and Mouth Disease. — At the Westboro Lyman School 61 hogs, valued at $877, were found to be infected with foot and mouth disease following an attack of hog cholera, and were slaughtered. A herd of 70 cows kept near the hogs showed no signs of the disease. Massachusetts Homeopathic Hospital. — The recently published annual report of the Massachusetts Homeopathic Hospital states that during the year ended December 31, 1914, 23,- 260 patients were treated in the various depart- ments of the institution, an increase of 808 over the previous year. In the wards of the Main Hospital there were treated 6,533 patients as compared with 6,508 a year ago. At the Haynes Memorial there were treated 838 patients as compared with 455 patients a year ago. The fol- low up system of the hospital has been enlarged and a social service worker engaged. The meth- ods of fire protection over the hospital have been improved, $3,442.89 being expended for this pur- pose. The report also contains a picture of the new maternity and out-patient building in pro- cess of erection, which will greatly facilitate the work of these departments. Lawrence General Hospital. — The thirty- ninth annual report of the Lawrence General Hospital, Lawrence Mass., conducted by the Ladies' Union Charitable Society of that city, for the year ended September 30, 1914, shows that institution to be in a commendable state of efficiency. The total number of patients ad- mitted to the hospital during this period was 1833. The out-patient department treated 1679 patients, and the orthopedic department, 558. The maximum number of patients in any one day was 93 and the minimum 46. On October 8, 1914, Sarah Frances Shackford, the last survivor of the charter members of the Ladies' Union Charitable Society, died at her home, al the age of 75. She was at that time president of the society, having served contin- uously, in one office or another, since the organi- zation of the society in 1875. The hospital has been enlarged by the addition of a children's ward, the gift of Mr. Joseph Shattuck, and plans are drawn up for another building to be used as a nurses' home. Vol. CLXXII, Xo. 13] BOSTOX MEDICAL ASD SURGICAL JOIRXAL 499 New England Baptist Hospital. — The twenty-first annual report of the New England Baptist Hospital, Boston, for the year ended December 31, 1914, shows that during the year, 712 patients were admitted. Of this number 105 received medical treatment, 499 surgical treat- ment and 70 were maternity cases. The president of the corporation states in his report : "The year just closed has been one of the most interesting in our history from every point of consideration. Our service to the community has been the largest, our receipts from all sources have been very materially increased, the amount of free service has been much larger than any year, with one exception, and the number of major surgical cases has been more than doubled, as compared with former years, with a very gratifying low percentage of deaths." Cases op Infectious Diseases reported to the Boston Board of Health for the week ending March 23, 1915 : Diphtheria, 66, of which 3 were non-resident; scarlatina, 48, of which 7 were non-resident; typhoid fever, 6, of which 1 was non-resident ; measles, 177, of which 2 were non- residfflit; tuberculosis, 53, of which 3 were non- resident. The death-rate of the reported deaths for the week was 19.12. QIarrrB|iondrnrr. PARIS LETTER. iFron Ow Spteial Corretpomlent.t Ttphotd FIveb in thk Westebn Ascra of Wab. Pakis, March 13, 1916. Mr. Editor: in casting about In my mind for a heading to this letter I remembered the title of a book said to have once really existed: "English As She Is Spoke." So I propose to place as a super- scription to the following remarkable document the delightfully ungrnmmatlcal sentence: "Tj-phold fever as she should not be took-care-of !" In my last letter I referred to the universal dis- satisfaction manifested here as regards the care of the sick and wounded from the fightlng-Unes. The main defence of the Service de Sant6 is that they have been utterly swamped by the number of men to be handled, which has proved to be in the proiwrtlon of Ave to two, as regards the number they expected to handle and for which they had made provision. I also cited the somewhat peppery remark which a deputy claimed to have made to the director of this health service. Today I think I will give, nearly In full, a letter received from one of the temporary hos- pitals, to show that, perhaps, this deputy's sentiments were not altogether unjustified. When the war had been going on a few months, and the authorities saw that their antiquated nursing-system was giving such deplorable results, they decided to incorporate quite a body of properly-trained nurses from England into their sanitary formations, in the hope in this manner to leaven the entire lump of dough : arrangements were consequently made for the gradual moving across the Channel of three hundred of these women, to be as picked a body as was possible under the present tight circumstances, the Idea being to distribute them about among the military hospitals in little groups of four or five. The results of this move might really have been foreseen ! The French voluntary organizations of amateur nurses, — who after all had been doing their very best, naturally,- — were stung to the quick at this aspersion on their capabilities; they "saw red," as the expression goes, and in many places made the life of the English invaders a mild little kind of sheol, in which line of action they were often backed up by the medleal attendants. So now the plan has been modified, and the endeavor is being made to place these nurses in groups by themselves, in such a was as practically to give them entire charge of the patients of whom they have the care. Among the first of these nurses to come over was an old friend of mine, a very bright woman of wide experience, and the following is the letter she wrote me soon after reaching her post. Comment on It is unnecessary, I will merely add that another nurse, to whom I showed this letter, tells me that she has seen a typhoid hospital of nearly one thoumnd cases, with fwndltlons similar to these. I certainly am devoutly thankful that I have no son In this war. If I had. I might, jierhaps, stand with fortitude his being killed in battle for his country's ltl)eratlon ; but what would not be bearable would be to have his life played with In thi» fashion. "I am afraid you would be quite overcome by the awfulness of this place ; It is a veritable pest-house we have got to, this time. There are eighty patients in all, and oh ! what a desperate state they are in ! This is only a temi>orar.v hospital, formerly a school, and the sick men are distributed about In different rooms. I'p to the time of our coming there were only two real orderlies for medicine, temperature, hypo- dermics and cupping, two for giving the lotions, a sort of cross between a tub and a sponge, two for oarrying up the foostalrs. The carrying would not be 80 bad, if we only had something to carry in ; there la only one Jug in the whole place' (2V6 litres), and although we ask, and are promised, we have not received anything further yet except five hygienic palls (there was only one when we arrived). There lire just five basins for washing the patients, — five for eighty men ! And not a pillow In the whole hos- pital, only little bol.sters. There were only eight spitting-cups, — the men have been using the floor up to now; but by agitating we have been supplied with twenty condensed milk cans for this use. There la only one chair in each ward, and no bed-tables; so mugs, cups, everything goes on the floor, which i? black, never scrubbed, only sprinkled with carbolic, ns they do In the Paris Metro, and then swept with a wet broom, thereby grinding the dirt into the grain of the wood. The windows do not appear to have been cleaned since the building was put up, some fifty years ago. There is no place yet provided for disinfecting linen. I keep begging for formol, but apparently it is considered too costly. The mattresses are all old ones from the barracks, straw and lumps of wadding, all more than filthy and smelling fright- fully, as you will understand when I tell you that they do not own such a thing as a rubber drawsheet. The men seem so surprised when we want to change a sheet after an Involuntary motion ! The patients have been allowed to walk out of the rooms to the w. c, whether tottering and delirious or not, and when they are to have a lotion the orderlies have been making them leave their beds naked, go to the middle of the ward, and lay themselves down on a 500 BOSTON MEDICAL AND SURGICAL JOURNAL [Afbil 1, 1915 cold wet sheet arranged over an India-rubber sheet on an ordinary stretcher. The lotions are ordered two, three or four times a day, and never at night, regardless of temperature, which is never taken of- tener than twice a day. Nearly every patient gets quinine, and most of them are quite deaf from it. B-naphthol, aspirin, and cinchona vpine are the regu- lation remedies, together with two kinds of hypo- dermics, cafifein and camphorated oil, — a man up and about may be ordered a hypo of camphorated oil ! "When we first got here we all of us stayed on duty all night, to try and clean up the patients and make their beds. The men say one and all that they have not been washed for three weeks, or had their beds made. You cannot Imagine what an awful state their mouths are in. I came on regular night duty on Sunday, and began with a death, a poor lad of only eighteen. I may say that the doctor is never to be sent for; he just comes once or twice a day, and lives In the town. This poor boy died in full view of all the patients, such a thing as a screen being unheard- of here, and after he died two orderlies just carried him away to the attic. As they were doing this a delirious man left his bed and was fumbling at the door, so that the orderlies had to put down the stretcher with the body on the landing and secure the wanderer. In the meantime several other patients were going to and from the w. c. and had to step over the corpse. It Is all so gruesome, and so frightfully unhealthy, — little better than a pesthouse. The w. c. Is on each landing, in full view, and consists of a wine-vat cut in half with a board across for a seat; they are, of course, in almost constant requisition! "I cannot possibly continue for long in these condi- tions, with only one orderly to help me at night. We are also always short of disinfectant. If you could see me in this ward, with ten delirious cases, others coughing all the time, and others muttering! One feature about these men Is curious, there seem to be so few bad hemorrhages; I wonder whether that can depend on the fact that many of them were inocu- lated on reaching the hospital? The majority are very serious cases, with bronchopneumonia, or pleurisy." " s." FIELD SURGERY ON THE POLISH BATTLEFRONT.* Kembung, December 4, 1914. Russian Poland near Lodz. I am still aUve in spite of being now four months in war. You can hardly imagine how sorry I was when I understood at that ominous Saturday, 1st of August, that I could not see you any more. For years and months I was looking forward with joy and happiness to seeing you at my house, and to having you for several days In Berlin, and then you were in Berlin and I could not even see you. The four months following that day were the most event- ful of my life. Right away I was called to the front and was happy to follow and to obey this call. At first for about two weeks I was captain-surgeon in an old and famous dragoon regiment in Allenstein. There it was my duty to examine all the young and old fel- lows who wished to enter voluntary service. The court of the barracks was day by day crowded with men, not only with working men, but mostly vrtth men of the upper classes. The enthusiasm was simply tre- mendous. It was impossible to take them all, al- though they Insisted and begged, considering it as the greatest misfortune of their lives that they had not been able to be enlisted. Besides this business of ex- amining I had to vaccinate all the soldiers of my regiment. You can Imagine that this kind of work did not please me for a long time and after trying a * Letter from Dr. M. BShtn, former director of the Medico-Me- chanical Department of tile Mai«achusetts General Hospital, to Dr. K. B. Osgood, of Boston. while I got another kind of work more like my spe- cialty. I became captain-surgeon at a field hospital. Now I could work surgically and soon I went to the battle fields. My first experiences were at the little battle of Bialla, near the Russian frontier; they con- cerned, however, a very small number of wounded men, Germans and Russians. However, a few weeks later during the last week of August, I had the great luck of participating at the great battle of Tannen- berg. I do not know how much you are informed of the events of this war, but surely you will know this tremendous historical event, one of the greatest victor- ies of this war, where a relatively small German army captured a much bigger Russian army. Two weeks afterward I took part in the second great East Prus- sian battle "at the Masurian Lakes." The numbers of wounded men, both German and Russian, were overwhelming. We worked for weeks, day and night, at our field hospital. Besides this I had the special order after Tannenberg to take charge of one big Russian field hospital captured at Hohenstein. The work of a field surgeon is nowadays quite different from what it was formerly. Whoever expects to do great operations, amputations, excisions, etc., will be greatly disappointed. Conservative surgery is tri- umphing. I mean, of course, right away on the field and at the field hospital. Well adapted bandages, good fixation of the damaged joints and bones, plas- ters, and splints, — that is the point of field surgery, and not only of surgery of the extremities, but also In abdominal surgery it is much better not to operate In the field but later in the so-called "reserve hospitals," which are located near the boundary in a rather safe region. Therefore, again transportation plays an emi- nent rSle in modern war and motor cars are of tre- mendous use for war-sanitary-purposes. I presume that the triumph of conservative surgery in this war will be of eminent advantage for orthopedic surgery after the war. The two above-mentioned battles liber- ated East Prussia entirely from the Russian Invasion, at least for several weeks and our army was free to enter Poland. The first expedition into Poland In which I participated went over Czenstochava, Radow, until very near Varsovie, capital of Poland. It was a march of tremendous laborlousness, the weather be- ing rainy and cold during all the days, the streets of Poland being in an unheard-of-condition, our horses being in morasses sometimes over their knees, and still we did not lose a single horse or wagon of our field hospital, and reached Warnhau or Varsovie, i.e. the neighborhood of this city, in less than twelve days, marching day and night with very little rest. Nobody knows yet, with surety, what the idea of this quick march was and what the task of the re- turn march has been which was made soon after- ward. Surely it was not a flight, for we marched out of Poland more slowly than we marched towards Var- sovie and surely the whole business was Intended by our chief generals. For as soon as we entered Poland and we progressed, I had the exact order to send the wounded back to the frontier and not to treat them here. And every treatment had to be as fast as pos- sible. For instance, in Grojeo, a little town near Varsovie, I had to bandage 450 men in one day and night. In order to fit them for transportation. The whole month of October we spent in Poland. As soon as we returned to Germany orders came for a second invasion into Poland from another point of the frontier. And now for- three weeks our troops stand near Lodz, after having had some victorious battles on their way from Germany. We expect that these battles now will bring us the decision not only of the war against Russia, but of the entire war. It is true the Russians are much more nimierous than we are, but this fact so far during the war was not of so great importance, the Russians thought. To my mind it shows enough the minor quality of the Russian army, that they were not able to carry war for any length of time Into Germany. The point is, — and that I have a hundred proofs for,— the Russian soldier has Vol. CI^XXII, Xo. 13] BOSTON MEDICAL ASD SVROICAL JOURyAL 501 no idea what he Is fighting for. You ask the cap- tured and wounded, — and I have seen thousands, — whether they would like to return to their army if I dismiss them and they all will beg you to keep them. They all have a kind of stupid energy, but no Intelli- gent enthusiasm whatsoever. Lately, during the last fights, the wounded Kussians were often drunk. It seems that alcohol is used to drive them Into the front. I personally believe we shall master the Rus- sians In a relatively short time. Whether this means the end of the war, that, of course, depends largely upon other factors, particularly upon England. This is the most interesting moment In this war. Of course, you probably have your own opinion on this question and you will read in your papers and also In our papers great discussions upon the cause of the war. It is a pity to waste so much Ink on this ques- tion. Nobody Is the cause, history is the cause, gen- eral world conditions have brought It about. I am afraid I have bored you too much with my talk. I have had four free days, living in a lonely Polish peasant house, — that may be my excuse. The purpose of my letter has originally not been to give you a political expose, but simply to send yon my heartiest greetings and wishes for Christmas and New Year. I beg you, since I am unable to write Chri.st- mas cards, to give my regards to all my old good Boston friends, and my heartiest wishes and greet- ings from your old BShm. V.S. If you know what It means it might Interest you that since the battles In East Prussia I am "a knight of the Iron cross." QUESTIONS ABOUT THE HARRISON LAW. Boston, March 16, 1915. Mr. Editor: The new Federal law In regard to the dispensing of opium, the Harrison law, apparently imposes what I consider a dangerous limitation on doctors. For many years I have demanded that the druggist should write on the box a copy of any pre- scription which contained opium. This I consider a safeguard to the patient, and a help to the doctor. I have followed this practise since I knew of a case in which a mother gave a one-fourth grain morphine suppository to an infant to move the bowels. 1 recently criticized a reliable druggist who did not follow my directions, and was told that the Harrison law forbade such a practise. It seems wise that tie Boston Medical and Sdboi- CAi^ Journal should ask for a ruling on this question from Washington. Resi)ectfully, Henby Jackson, M.D. March 17, 1916. Mr. Editor: Since writing the above, two druggists say they consider it proper to put the prescription on the box. They quote the rulings on proprietary medi- cines which demand this practise. Truly, Henry Jackson, M.D. [Note. — There is nothing in the Federal law which prohibits the prescription from being written upon the label of the container. The State law, however, provides that: "The prescription shall not be copied except for the purpose of record by the druggist filling the same." There is nothing In either law which prohibits the proscriber from giving whatever information or di- rection he may deem necessary for his patient to have; and if he thinks It is best, he can direct that the amount of narcotic, which the prescription con- tains, shall be clearly stated upon the label. This can be done without a copy being made, The following rules Interpreting the Harrison Law have recently been Issued by the collector of internal revenue, port of Boston and are reprlntpd here for the further aid and guidance of physicians. "A physician, registered under the law, must keep a record of the drugs disi)ensed, distributed or admin- istered by him in his otlice. A record is also required to be kept of those drugs left with a patient to be taken In the physician's absence. No record is re- quired to be kept of those drugs personally adminis- tered by the physician to the patient when away from his office. I "A physician or dentist who usee only minute quan- ! titles of drugs affected by the act, such as oculists, aurists and other specialists, may keep a record of the date when a stock solution is made and the date when such stock solution is exhausted, without keep- ing a record of the name and address of each patient to whom such drugs are administered. Where a phy- sician engaged In a general practise otherwise admin- isters such drugs, It will be necessary for him to keep a record of the date when any such drug Is dispensed or administered, the kind and quantity, and the name and residence of the patient. "Hospitals and sanatorlums must keep a record of drugs dispensed, distributed, or administered therein. "Government, state, county and municipal officers, lawfully engaged in purcliasing drugs specified In the act for the army and navy, the public health ser- vice and for government, state, territorial, district, county, municipal or Insular hospitals or prisons, are held to be exempt from the provisions of the act re- lating to registry and special tax, to purchase and use of such drugs and to the keeping of records. Any such officers, however, engaged In private practise must register, pay special tax and keep the records, and comply with all the requirements of the law and regulations."] BELGIAN PHYSICIANS' RELIEF FUND. Report or the TREAsraEB of the Committee fob the Week Ending March 20, 1915. CONTBlBUnONS. Sebastian Co. Medical Soc., Fort Smith, Ark. $ 16.00 Or. F. W. Johnson, Boston, Mass 26.00 Or. E. p. Qualn. Bismarck. North Dakota 10.00 Dr. N. O. Ramstad. Bismarck, North Dakota. 10.00 T)r. Haven Emerson, New York, N. Y 15.00 Dr. Edward B. Angell, Rochester, N. Y 10.00 Dr. T. A. Davis, Chicago, ill 25.00 New Bedford Med. Soc.. New Bedford, Mass. 60.00 Or. Newton B. Waller, New York, N. Y 6.00 Dr. Charles O. Elcher, McKees Rocks, Pa 6.00 Dr. William H. Perry, Sterilng. Ill 6.00 Dr. F. A. Spafford, Flandroau, S. Dakota 10.00 Dr. George L. Johnson, NowfoUlen, Minn 1.00 Salt Lake Co. Med. Soc., Salt I-ake City. Utah 100.60 Dr. and Mrs. Clem D. McCoy, Kenton, Ohio. . 50.00 Dr. E. A. Wel.ss, Pittsburg. Pa 10.00 Dr. Hubert Claytor, Hopkins, S. C 5.00 Dr. C. E. Goodman, Virginia, Minn 5.00 Trl-County Medical Society, Copiah-LIncoln- Pike Counties. Miss 10.00 Dr. Harold W. Dana, Boston, Mass 26.00 Receipts for the week ending March 20 $ 391.50 Previously reported receipts 4830.00 Total receipts $5221.50 Previously reported dLsbursements : 1C25 standard boxes of food @ $2.20. .$3575.00 .542 standard boxes of food <(i $2.30. . 1240.60 Disbursements for the week ending Mar. 20: 173 standard boxes of food @ $2.30. . 397.90 Total disbursements $.')219.60 Balance $2.06 F. F. Simpson, M.D., Treasurer, 7048 Jenkins Arcade Bldg., Pittsburg, Pa. 502 BOSTON MEDICAL AND SURGICAL JOURNAL [April 1, 1915 In an address delivered recently by Mr. Lindon W. Bates, vice-chairman of the Commission for Relief in Belgium, he said : "The Commission was granted by the German Gov- ernment not only the sole right to transport food into Belgium but given the active sympathy and aid of the German military authorities. Despite reports to the contrary, not one pound of food sent in has been ap- propriated. The treasury of the Commission draws from the generous heart of the world. Into this treasury has been put also all that the enveloped Bel- gian race could gather of the remnants of their shat- tered fortunes. It registers their struggle for sur- vival. It represents their very all — the all that the better-to-do can give to help themselves and unre- servedly to help their fellow being in the ranks al- ready destitute and starving. This is our main pur- chasing fund — the greatest and the sacredest of all the donations." The contributions made by the American doctors, through the Committee of American Physicians for the Aid of the Belgian Profession, are placed in the Sands of the Commission, for distribution among the members of the Belgian Profession and their families. Mr. Brand Whltlock, American Minister at Brussels, is credited with saying on March 17, that the food then in Belgium would not last longer than April 1. UNITED STATES CIVIL SERVICE EXAMINATION. The United States Civil Service Commission an- nounces an open competitive examination for mine surgeon, for men only. From the register of eligibles resulting from this examination certification will be made to fill a vacancy in this position in the Bureau of Mines, Pittsburg, Pa., at a salary ranging from $2400 to $2700 a year, and vacancies as they may oc- cur in positions requiring similar qualifications, un- less it is found to be in the interest of the service to flu any vacancy by reinstatement, transfer, or promo- tion. Graduation from a medical school of recognized standing, and at least two years' medical and surgical experience with industrial workers, are prerequisites for consideration for this position. Statements as to education and experience are accepted subject to veri- fication. Applicants must not have reached their forty-fifth birthday on the date of the examination. This examination is open to all men who are citizens of the United States and who meet the requirements. Persons who meet the requirements and desire this examination should at once apply for Forms 304 and 2095, stating the title of the examination for which the forms are desired, to the United States Civil Ser- vice Commission, Washington, D. C. ; the Secretary of the United States Civil Service Board, Post Office, Boston, Mass. ; Philadelphia, Pa. ; Atlanta, Ga. ; Cin- clnnaU, Ohio; Chicago, 111.; St. Paul, Minn.; Seattle, Wash. ; San Francisco, Cal. ; Customhouse, New York, N. Y. ; New Orleans, La. ; Honolulu, Hawaii ; Old Cus- tomhouse, St. Louis, Mo. ; or to the Chairman of the Porto Rican Civil Service Commission, San Juan, P. R. No application will be accepted unless properly exe- cuted, excluding the medical certificate, and filed with the Commission at Washington, with the material re- quired, prior to the hour of closing business on April 20, 1915. These lectures are given annually under the terms of a bequest from John Clarence Cutter, whose will provided that the lectures so given should be styled the Cutter Lectures on Preventive Medicine, and that they should be delivered in Boston, and be free to the medical profession and the press. The members of all classes in the Medical School, the medical profession, the press, and others inter- ested, are cordially Invited to attend. Boston City Hospital Alumni Association. The annual meeting will be held at the Copley-Plaza on Wednesday evening, April 7, at 6.30 o'clock. Dinner will be served at seven o'clock immediately after the business meeting. Dr. L. F. Woodward will preside. A luncheon will be served In the hospital library at one o'clock to which members are Invited by the Trustees. WlLOAM H. ROBEY, JB., M.D., 220 Commonwealth Avenue. Secretary. Massachusetts General Hospital. A medical meeting, open to the medical profession, will be held at 12 noon on Monday, April 5, 1915, In the lower amphitheatre of the Out-Patient Depart- ment. Entrance on Fruit Street. 1. Exhibition of Cases. 2. Dr. Roger I. Lee. "Splenectomy in Pernlcioua Anemia." 3. Dt. Oswald H. Robertson. "Urobilin Estimation In the Stools. Its Relation to Hemolysis." 4. Dr. Paul D. White. "Alternation of the Pulse. A Common Clinical Condition." F. A. Washbubn, M.D., Resident Physician. SOCIETY NOTICE. The Society of American Bacteriologists. — The Council of the Society of American Bacteriologists has decided to hold a special summer meeting in San Francisco, August 3, 4, and 5, 1915. The chairman of the local committee of arrangements is Dr. Wil- fred H. Manwaring, Stanford University, California. NOTICES. The Cutter Lectuee. The Cutter Lecture on Preventive Medicine and Hygiene will be given by Joseph Goldberger, M.D., Surgeon, United States Public Health Service, Wash- ington, D. C, on the subject of "Diet and Pellagra," on Friday, April 2, at the Harvard Medical School, 5 to 6 P.M. APPOINTMENT. Dr. Philip J. Castleman has been appointed director of the bacteriologic laboratory of the Boston Board of Health, in succession to the late Dr. James J. Scaflnell. -• -^ '■ RECENT DEATHS. Db. Michael C. Drennan, who died on March 23, at Easton, Pa., was born in 1839. He served as a naval surgeon throughout the civil war and was re- tired In 1899 with the rank of rear-admiral. Db. Daniel J. O'Shea, who died of pneumonia on March 23 at East Boston, was born there In 1876. He was a graduate of Boston College and studied at the Harvard Medical School. He is survived by his widow, two daughters and one son. Db Amos Patebson Webber, for 32 years a practi- Uoner of New Bedford, Mass., died In that city March 20 aged 55 years. He was a graduate of Bellevue Hospital Medical College in 1883 and was a member of the staff of St. Luke's Hospital. He was a Fellow of The Massachusetts Medical Society and of the American Medical Association, and was prominent In Masonic circles. He is survived by his widow. BOOKS AND PAMPHLETS RECEIVED. Discussion on the Milk Supply as a Causal Factor in Relation to Tuberculosis, by Sheridan Deleplne, M.D., M.Se. Reprint. Vol. CLXXII, No. 13] BOSTON MEDICAL AND SURGICAL JOURNAL XUI Gives Rapid and Reliable Results in Circulatory Disturbances FOR ORAL USE Tablet*, 1 '4 grn. in tubes of 12 lableti. Powder in Js-oz. vials. Solution for oral use in 10 Cc. vials. FOR INJECTION Ampule* of 1 Cc. each for intravenous, intramuscular and (ubcutaneous uie. Eacli Tablet or I'z grn. Powder or 1 Cc. Solution or 1 Ampule equals 8 frog uniis. Samples und hull Literature from KNOLI. (SL CO. 45 JOHN ST^ NEW YORK For Sale by MERCK ax CO. NEW YORK and ST. LOUIS yvCciAo^ Agar (Granular), P. D. & Co. FOR TREATMENT OF CHRONIC CONSTIPATION. Agar is a product of Japan, derived from seaweed and sometimes known as Japanese gelatin. It is supplied commercially in dry, transpjirent pieces that are reduced to coarse flakes for medicinal use. It freely absorbs water and retains it It resists the action of the intestinal bacteria and of the digestive enzymes. Its chief use in medicine is in the treatment of chronic constipation. Agar may be eaten with milk or cream, or with a cereal breakfeist food, salted or sweetened to suit the taste. Agar is not digested. It passes practically unaltered into the intestine, where it moistens the feces. It serves as a mechanical stimu- lant to the bowels, aiding in the production of a normctl, hetJthy evacuation— a condition approximating the natural function. Pound and 9^ -pound packages. WRITE FOR DESCRIPTIVE CIRCULAR. Detroit, Michigan. Parke, Davis & Co. XIV BOSTON MEDICAL AND SURGICAL JOURNAL [APBn, 1, 1915 The Home of Clothes-Style and Service Men's, Young Men's and Boys' Suits and Overcoats to fit every phase of life — business, professional and social. Made on the premises — presenting a comprehensive number of models to satisfy every preference. HATS — Stetson's Exclusively. Furnishings. Macullar Parker Company 400 Washington Street Boston Vol. OLXXII, Xo. 13] BOSTON MEDICAL AND SURGICAL JOURNAL XV nDet)ical Schools ant) Ijospitals HARVARD MEDICAL SCHOOL Exceptional laboratory facilities for teaching and research. Abundant opportunities for clinical instruction in closely allied hospitals, a number of whidi are grouped about the buildings of the Medical School. Courses for the Degree of Doctor of Public Health. GRADUATE SCHOOL OF MEDICINE ADMISSION REQUIREMENTS: Either (1) a degree in arts or science from a recognized college or scientific school, or (2) two years' work at a col- lege or scientific school of high rank with evidence that the candidate has stood in the first third of his class; with, in each case, such knowledge of physics, biology, general chemistry and organic chemistry as may be obtained from year's courses of college grade, and a reading knowledge of French or Ger- man. Applications requested before July 1st. Graduate Instruction on a University Basis COURSES are given throughout the year in all clinical and laboratory subjects. INSTRUCTION will be as thorough and scientific as in the Medical School proper. Elementary and advanced courses. Research courses for qualified students. STUDENTS are admitted at any time and for any length of study. For information address HARVARD MEDICAL SCHOOL, Boston. Mass. NEW YORK POLYCLINIC MEDICAL SCHOOL AND HOSPITAL The Tirsl Post-Graduate Medical School in America Chartered by the University of the State of New York 345 to 349 West SOth Street, New York Oty Most modern school and hospital building:, cunsistin): of 3 amphitheatres, 6 Internal medicine. 6 operating, 23 specialty, and 8 Ubontoir rooms. Hospital accommodation. 800 beds; ont-door serrlce, 100.000 Tlalts annnally; am4 an active emergency and ambulance tervioe. In a district containing 360,000 people. General and advanced courses in all branches of medicine, surgery and the special- ties, under eminent teachers, and in completely equipped departments, and at Um bedside. Diagnosis and treatment thoroughly taught, and the courses are arranged to allow of matriculation at any time. For further liiformatlon, addr Pretiident of the Faculty. JOHN A. WTETH, MJ), LLJ), or MB. JOHN GUNN, Superintendent TUFTS COLLEGE MEDICAL SCHOOL, Boston, Mass. This school offers a four-year course leading to the degree of Doctor of Medicine, the school beginning each year on the last Wednesday in September, and ending the second Wednesday in June. Students of both sexes are admitted upon presentation of an approved high school certificate and in addition college credit indicating one year's work in Chemistry, Physics, Biology and French or German. Well-equipped laboratories and abundant clinical facilities furnish oppor- tunity for a thoroughly practical course in medicine. Address all communications to 'FRANK E. HASKINS, M.D. Secretary, 416 Huntington Avenue, Boston, Mass. BOSTON LABORATORIES 30 Huntington Avenue Copley Square, Boston For Bacteriological, Bio-chemical and Patho- T logical Diagnosis Wattermann, $5, Schwartz-McNeil, $5. Quarters forinerly occupied by the Boston Board of Health Laboratory Telephone. Back Bay 5156 HARVARD DENTAL SCHOOL |SYRACUSE UNIVERSITY BOSTON, MASS. k department ol HARVARD UNIVERSITY Forty-seventh year began Sept. 28, 1914. Send for announcement Dr Eugene H. Smith. Dean. Collese of Medicine Ektbaiici RiQcniuiicTi: Two jean in a 1 Oollece or School o( Bdence which mint ia- elude Latin. Oerman, PhTiics, Chemiatrj and Biology. Combination courses recognized. LaIobatost Ciointsss in well-equipped laboratorio under full time teachers. Olixical Conasis in two general, one special an< the municipal hospitals and in the new coUegi dispensary now building, in all of which senioi students serve as clinical clerks. kMn THI SBOUTABT or THB COLI.MB OF JIniei>B SOT Orang* St. BTraeuse, R. T. XVI BOSTON MEDICAL AND SURGICAL JOURNAL [APRn, 1, 1915 professional darbs The Ring Sanatorium and Ariington Health Resort professional Car^s FOR CHRONIC, NERVOUS AND MILD MENTAL ILLNESSES 8 miles from Boston _ , , A 1- » oi ( Sanatorium Telephone. Arlington 81 j Resort ARTHUR H. RING, M.D. Arlington Heights, Mass. Dr. Melius' Private HospltaJ For Mental Diseases NEWTON, MASS. Announcement Dr. Melius has removed his Hospital from West Newton to 419 Waverley Ave., Newton, Mass. Extensive grounds, fine shade trees, five minutes' walk from electrics. Beached by Train to Newton, or by electric can Tla OonmiOD- wealth Avenue, to Grant Avenue. WOODSIDE COTTAGES FRAMINGHAM, MASSACHUSETTS (Ofl ladlaa Head Hill) A private establishment for the care and treatment of chronic diseases, including fatigue neuroses and neurasthenia. No insane or other objectionable cases re- ceived. Three houses with all modem appointments; opportunity for tenting in pine grove; beautiful country location. Illustrated prospectus. Devereux Mansion Marblehkad, Massachusetts. A sanitarium without the usual conditions of invalid- ism. Work and rest under favor- able conditions form the back- ground of all medical treat- ment. Herbert J. Hall, M.D. Medical Director WELLESLEY NERVINE A Sanitarium for Uie Treatment of Nervous and Mild Mentai Diseases New Buildings, every facility for com- fort; in the midst of twelve acres of high land, covered with beautiful oak and pine trees, fully equipped tor hydro-thera- peutic and electrical treatment. Address EDWARD H. WISWAIL, MJ). IVellesIey, Mass. Telephone Wellesley 261 professional Car^s Twilight Sleep Maternity Hospital 197 Bay State Road Physicians wishing to use the Dammerschlaf method in their obstetric cases are invited to use the above- named hospital. Graduate obstetrical nurses only in attendance, under the di- rect supervision of E. T. Ransom, M.D. Telephone, Back Bay 1716 TOWER HALL > DERRY, N. H. Forty miles from Boston. Is admirably adapted both bjr location and equip- ment for the care of nervous and chronic diseases. Several eminent Boston specialists are on the staff of consultants. F. A. TOWER, M.D. CC BELLEVUE 99 Superior home-like accommodationfl for five pa- tients. Nervous and mild mental disease, selected cases of alcoholism, and elderly persons^ for whom medical supervision is desired, are received. MARY W. L. JOHNSON, M.D. 46 WoLCOTT Road, Chbstndt Hill, Hiss. Telephone, Brookline 6S81-W. HERBERT HALL HOSPITAL, Inc. WORCESTER, MASS. EstabHshed in 1872. A Hospital for the Care and Treatment of those afflicted with the various forms of Nervous and Uental Disease. For information address JOHN MERRICK BEMIS, M.D. WALTER C. HAVILAND, M.D. nHANNING SANITARIUM for ^ MENTAL DISEASES EsUblished 1879. Brookline, Mass. Cor. Boylston Street and Chestnut Hill Avenue. WALTER CHANNINO, M.D. NEWTON SANATORIUM For invalids with nervous and mild mental diseases, DR. N. EMMONS PAINE West Newton :-: Massachusetts QLENSIDE For Nervous and Mental Diseases 6 Parley Vale, Jamaica Plain, /lass. MABEL D. GROW AY, H. D. Telephone, Jamaica 44. BOURNEWOOD HOSPITAL FOR MENTAL DISEASES Establtehed 1884 BROOKLINE, MASS. SOUTH ST. Nesr-rt sUtion BeUevue, N. Y., N. H. Ji H. K. K. HiifBT R. Stbdiux, M.D. Oio. H. Torhit, M.D. or. Albert E. Brownrigg receives Nervous Invalids who require a spedftUrt*! constant supervision and intelligent mining car* at his Highland Spring Sanatorium a homelike resort amon? the pines of New Hamp- shire, one hour's ride from Boston. Number limited to fifteen. Trains in six directions throughout New England. Telephone or address him at Nashua, N.H. Vol. CLXXII, No. 13] BOSTON MEDICAL AND 8VRG1CAL JOURNAL xvu professional Cart>0 MILLET TUBERCULOSIS SANATORIUM EAST BRIDCEWATER, MASS. Patienta are under coueUnt ob«ervation daj and night. The MedieftI Director makea • tbotongli wtadj ot each o*ae, thus adjuating treatment to variations in conditioiB. Bmy ajmptom la noted and traced to ita cauee, ao that a regimen baaed on the peraonal idioaTncraaiea of the patient ia accur- ately developed. lacfa day anry patient apeoda at leaat twenty houra out 0< doors. This method, aaaiKad by a tempting, wholeaome, and abundant table, gives the patient a good appetite, aolying the important question of oouriab- meot. The sun hatha are particularly beneBclal to tboae who are anemic or The lliUet Samtorium i* near East Bridgewater aUtion on N. T., N. H. * H. R. R. Twanty-Sva milea southerly from Boston. From Brockton or Bridgewater the laaatorium is eaaily reached by trolley. For further informatian call upon Dr. Millet at hia Boston olBca, til Boylaton Street, oa Tuaadaya and Fridaya. Telephone, Back Bay 4100. Or addraaa CHARLES S. MILLET, M.D.. East Bridgewater, Mass. THC FISK HOSPITAL FOR THFl TREATMENT OP ALCOHOLISM AND DRUG ADDICTION (BY THE TOWNS-LAMBERT METHOD) raiVATa booms — ooHririiiT fhtbiouiiii — tsaixid xntan 1 RICHARD O. OABOT, IIJ>„ Bastaa, Ummm p„yL,r,!„a WILLIAM OTIi FAXON. MJJ, atMSkt.a. Ummm. PBYBIClANa UDONARO HVimuaS, MJ).. Lowell, Mawa. RUFCa W. SFRASira. 1I.D„ Baatea. Ilaaa. Dr. Ricrakd C. Cabot says: "tThe treatment has great value, etpeciatlv in the cure of the morphine habit." THIS METHOD OF TREATMENT bM been published In detail In The Journal of the American iledical Atiooiation, and U endorsed by publica- tion In Osier and McCrae's Modem Medicine, VoL 11, 1914. bis method of treatment, and the results obtained have been moHt satisfactory. on* BrooKllBa S630 106 SEW ALL AVE., BROOKLINE, MASS I c "mam -^^ JlS''^' ""or five years we have used exclusively t :harles d. b. fisk. Supt. rh GLENELLIS SANITARIUM (Established 1906) The looation In the Tvooded hlshlanda of the Raniceley Lake reKlon la eapeclallr beneflelal to a larse number ot Bon-aiir> slcal eondltlona. Special Attention la Given to Caaea at FUNCTIONAL NERVOUS TROUBLB CONVALBSCEINTS AND OTHERS NEEDING REST AND «UIBT Addreaa fRANK I ilM, M.D. ANDOVER. OXFORD COUNTY, HAINB Medical School of Maine BOWDOIN COLLEGE Addison S. Thateb, Dean 10 Deerlng Street - - Portland, Me. Tl^e Westpori Sanitarium ■■TAILUIIBI) 1980 'Wvatport Conn. Licensed by the stata ot Connecticut (or the care and treatment ot Ntroous and Mental Diseases Modem appointmenta. home life, beautiful sorrouad- Ingi, large prirate grounds. Committed and Toluo- tary patienti received. Terma moderate. Inapection of metboda and equipment invited. For further !■• formation and terma, addreaa Dr. P. D. RULAND, WeBtport. Coaa. TWephone, 4. NEW YORK OFFICE, 40EMt4lrtSt Telephone, OSSO Murray Hill First and Third Wedneadaya, 10.10 A.M. to ILIO T.u. West Newton Home School FOR Backward or Nervous Youiut CIrts Toaaf firla reccired who are ncrrous or back- ward or who for any reaaon require speoiai oare aa4 tMrhinc. Home itfe in a pleaaaot country house, aunay TO^a, Tsranda, pine traaa, larye prlrata grtwinda. j MISS KATHASINK BABTIOAM, B.N., 147 WaLTHAif It., Waar Niwtox, Maai, Telephone, Newton Waat t4t-W. MISS MOULTON 80 Hammond St., Chestnut Hill, Mass. Special children in home-school. Lim- ited. Waiting list. Associated many years as Principal with Dr. W. E. Femald, Waverley, Mass. Tel., Newton South 327 | Where and Why? Dr. Oivcns' Sanitarium at Stamford, Cono. (60 Minutea from New Tork City) Offers exceptional opportunitiea for the treatment ot NERVOUS and MILD MENTAL Dlgeases and has separate detached cottagea (or persona who deaire perfect priracy and plcnaant surroundings, and who are addicted to the uae a< STIMULANTS or DRUGS. The sanitarium ia on a hill overlooking Long Island Sound. Write or wire. Dr. Givens' Sanitarium SLamford, Conn. XVlll BOSTON MEDICAL AND SURGICAL JOURNAL [Apkh, 1, 1915 NOTICES ON THIS PAGE ARE PRINTED FOR THE JOURNAL SUBSCRIBERS WITHOUT CHARGE THE ATTENTION PRACTICE FOR SALE $4000 grrowing practice in a town 20 milee from Boston. Population S500 Of Doctors and all others who drive FORD AUTOMOBILES ■" "'"'^y- lO'O^O i" sunimer. Specialty the reason for selling. Tennfl to Is called to the BOSTON STARTER suit pureiiaser. Dr. C, Boston Medical and Suroical Journal. RESIDENT PHYSICIAN WANTED Its advantages are incomparable, especially for physicians. It gives you absolute control of your car from the seat. ; ,. .u r,., o •» *„»,,,■ » ,,• ! At the Channing Sanitarium for Mental Diseases, Brookline, Mass., an aa- Write for testimonials. i sistant resident phjsician to start service July 1, 1915. Applicant should be ^~^^~~~~ young and unmarried. Address, giving qualifications and references. AlltOniStiC Appli8nC6 Co* Donald Gregs, M.D., brookline, Mass. 172 Columbus Ave. Phone 5412 Oxford Boston I WANTED - RESIDENT BACTERIOLOGIST I Inquiries should be made of Dr. Elliott Washburn, Superintendent, Rutland ' State Sanatorium, Rutland, Mass., or of Dr. John B. Hawes, 2d, Secretary, 3 Joy , Street, Boston, Mass. PRACTICES - LOCATIONS - POSITIONS We offer exceptional opportunities to the profession. If you wish to dispose of your practice, secure an assistantshlp, loca- tion, salaried ixmitlon or purchase a practice, write for our plan, stating In which you are interested. The Medical Echo, Lynn, Mas*. AMERICAN ENGRAVING CO. MAKERS OF FINK HALF-TONE LINE ENGRAVING AND COLOR WORK 94 Arch St. and 13 Otis St.. BOSTON. MASS. Orders for Medical Drawings Solicited FRANK HENDRY, MANASIR TaLIPMONI. FOHT HILU 879 DOES YOUR ELECTRICAL APPARATUS need REPAIRING? 5end it to ROBERT C. GODFREY 687 Boylston Street, (cor. Exeter Street) Boston, Mass. Telephone, Back Bay 21980 Everything from the smallest to the largest instrument repaired WARREN CHAMBERS THE OFFICE BUILDING FOR DOCTORS 419 Boylston Street, Boston TO LET : — A small suite consisting of two offices and reception room. Also one of one office with reception room. For further particulars apply to W. E. WENTWORTH, Supkrintendekt. Tel. B. B. 4200. . CLXXir, No. 13] BOSTON MEDICAL AND 8CRGICAL JOVRyAL XIX Prescribe with confidence Welch's Grape Juice is suggested whenever you require a *'pure fruit juice." Its pleasing tart-sweet flavor, purity and full- bodied quality will be welcomed by the patient. To the convalescent it will smack of recovery — will recall memories of the happy days of health, and promise cheer for the days to come. Welch's Grape Juice It is absolutely pure. The reputation of Welch's, in this respect, affords you ample assurance. May we also suggest that you become acquainted with Welch's in your own family circle.' It is a delicious health beverage — one to enjoy all year 'round. Welch's is supplied in convenient 4-oz. , half-pint, pint and quart bottles. Si>ccial literature of intemt to phyticians mailed on requett. The Welch Grape Juice ComfMuiy, Westf ield, New York »-^ ►'■A *v -« >4EW YORKl university medical defartment THe University- and Dellevue Hospital Medical Coll«^«. Session 191iS-16 The MMion besiu on Wcdoadar, September 22, 101S, and cuntlnua (or eicbt month*. Attendance upon (our eounee o( lecture* it required (or cnduatloD. The entrance requirement! are aa (ollom: (1) The Medical Student CertiScate iaaued bjr the Mew Tork Stat* Education Dapartaant upon the coopl*- tion o( a (our-ycar hifli acfaool rourae. (t) One year'a work o( college atandard. which year must include intnictlon in Cbemiatrjr, Phyiic*, Blologr, and German or French. Thia year muKt be in addition to the high w h"ol rounip. Student* who have attended one or more regular couiiaa at other ■ccretliti'd Medical OoUcce* are admitted to advanced rtandinc (except In the Senior year) on presentation of credentials meetinK the requirenirnts o( the riaa* in which they aeek aifiniaaion, and upon examination* on the subjecta embraced in the curriculum of this coUe^i-. ror the annual circular givii« full detail*, addreaa DR. 8AMUF.I. A. BROWN. i'iee-Owm, Sacratery, tsth Street and Firat Avenue, New York City. THE NEW YORK EYE AND EAR INFIRMARY School of Ophthalmolonr iind Otology For Gnulaatoa of M*n liiboratorifs lie Service Tire and Rubber Co hild BroR. ft Fo«ter ft Arnold Artiflcial Limbs -mh Lick Springs Pinto Water XX Godfrey, Robert C x\M\ Harvard Dental School x^' Har%-ard Medical School xv Hotel Cumberland ^ jii FnterimtioiuU liiKtriiment (*o xi King's Puremalt v Knoll k Co Dlgipuratum xiii Macullar Parker Co Clothing xiv Mahadv . E. F. Co ii Massachiisettf^ (>eneral Hospital ix, xii Medical S( hoiil of Maine xvii MelUn'p Food ,^ xii Miller Rubber Co ix New York Eye and Ear Infirmary xix \ew York Polyclinic Medical School xv New York I'niversity, . . .*, xix XX BOSTON MEDICAL AND SURGICAL JOURNAL [Apbu, 1, 19. Prescribed by the Medical Profession for 35 years. A CEREAL FOOT> different from all others Mr.Benger*s I admirable i preparation." The LANCET. t because it contains the natural digestives — Trypsin and Amylopsin, It is used regularly in Hospitals, Sanatoria, Nursing Institutions, etc., throughout the world, and prescribed and recommended by leading physicians in practice and in many standard medical works. The outstanding features of Banger's Food is its power of self-digestion, and milk modification, due to the two digestive principles contained in it. This occurs during its preparation with fresh new milk and is simply regulated by allowing the Food to stand from 5 to 45 minutes ; it is stopped by boiling. Ret:. US. Pat. O^. For Infants, Invalids and the Aged. A physiaan's sample, 7Vtth full particulars^ will be sent Post free to any memhe*- of tht medical profession on apjji^ation t BENGER'S FOOD LTD., 92, William Street, NEW YORK. Manufactory MANCHESTER, Eng. Branch Office SYDNEY (N.S.W.), 117, Pitt Street. Depots throughout Canada. Food The Best Prophylactic Plan to correct Infsuitile Intestinal In- fections is to find a Milk Supply which has proven its relia- bility, and stick to it. In Condensed JMILK THE ORIGINAL you have a Food for Infant Feeding which meets every requirement ; being Clean, Safe, Wholesome, Palatable and Constantly Uniform in Composition. Write'todoY for Samples, Analysis, Feeding Charts in any language, also our 5 o -page book, "Baby's Welfare." BORDEN'S CONDENSED MILK CO. " Leaders of Quality " Est. 18S7. New York Tamaica Printintf ("omipiniy, .Tanutica Plain, Boston. Mass. RETURN TO . 642-4493 BIOSCIENCE LIBRARY 5 40UianntntHi% ALL BOOKS MAY BE RECALLED AFTER oner \fTER 7 DAYS DUE AS STAMPED BELOW P.rcE<\ -£-^ BlOSCldNCe I Jt/N i 1933 '^M^ga^a WAY 25.2PM Ml J^LlZm. BIOS MW 02*94 -US2 AM UNIVERSITY OF CALIFORNIA, BERKELEY FORM NO. DDO, 50m, 1/82 BERKELEY, CA 94720 ®» \-/-\ /-^Z Z.W ®» U.C. BERKELEY LIBRARIES nMiiiiHiii CD5imoa35