Chapter II: Part 2

A recent investigation of diphtheria carriers in Detroit is reported by Goldberger, Williams and Hachtel, in Bulletin No. 101, of the Hygienic Laboratories, of the United States Public Health Service. The problem of diphtheria carriers has become one of considerable importance and has been given special prominence of recent years by the studies of von Scholly, Moss, and Nuttall and Graham Smith. The writers of the report mentioned above studied 4,093 people in the city of Detroit, and found that 0.928 per cent harbored bacilli identical morphologically with the Klebs-Loeffler bacillus. This figure is rather lower than those of some other investigators, but would indicate, as stated by the writers, that there were from 5,000 to 6,000 diphtheria carriers in the city of Detroit.

Of nineteen cultures isolated from nineteen of the carriers, only two were virulent, which would indicate that only 0.097 per cent of the people examined carried organisms capable of producing disease. An interesting further point is that the bacillus Hoffmanii was present in at least 41.9 per cent of over 2,000 individuals examined, and that the forty-nine cultures morphologically identified as bacillus Hoffmanii were avirulent. This would confirm the impression gained, we believe, by most experienced laboratory workers, that a true Hoffmanii can be distinguished with considerable certainty from a Klebs-Loeffler bacillus by morphological examination alone, and that its significance is probably that of a frequently present saprophyte of the throat and pharynx. The studies of Goldberger, Williams and Hatchtel also indicate that in examining for diphtheria carriers, it is best not to confine oneself either to the nose or throat, but that cultures should be taken from both places in every case.—_The Journal of Laboratory and Clinical Medicine._

INJURIES FROM HOT WATER BOTTLE.

In an action against a sanatorium and its superintendent it appeared that the plaintiff had employed the superintendent to perform an operation for hernia. After the operation was performed the doctor carried the plaintiff to the room assigned to him and placed him in bed while still under the influence of an anesthetic. A rubber bottle, filled with very hot water, had been placed in the bed, and the unconscious man was laid upon it, and was burned on his back severely. The witnesses described the wound as being 15 to 18 inches in diameter. He also received a smaller burn on his side; the attendants, believing that his struggles on becoming conscious were due to delirium, having held him down on the bed for a time and then turned him on his side. He was under treatment from the burns for a number of months and suffered excruciating pain. The jury found the doctor, but not the sanatorium, guilty, and rendered a verdict for $5,000, which the trial court reduced to $2,500. On appeal, the court said that it did not mean to condemn the doctor, nor even to say that he was in fact negligent; but, taking the situation as it found it, and as the jury observed it, there was evidence to justify them in finding that the doctor had not exercised proper care; and, having so found, the court had no right to dispute the verdict. It also held that the damages awarded were not excessive.—Grosshart v. Shaffer, Oklahoma Supreme Court, 152 Pac. 441.—_Medical Record._

HEART INHIBITION DURING VOMITING.

Gam says that while experimenting on intrathoracic and intra-abdominal pressures, the blood pressure was observed to fall during vomiting. A series of experiments were performed to determine the cause of this fall. In all experiments the blood pressure, the intrathoracic pressure and the movements of the abdominal wall were recorded. Vomiting was induced in some cases by means of apomorphin; in others by filling the stomach with hot salt solution, hot soap suds, copper sulphate solution, etc. In every case a high negative pressure was observed in the thorax during the act. The pressure would fluctuate rapidly from zero to twenty-five or thirty centimeters (water) of negative pressure. The blood pressure, however, always fell, sometimes to less than half its former level. The fall in blood pressure was found to be due to a vagus inhibition of the heart, for on cutting the vagi while the vomiting was taking place, and while the blood pressure was at its lowest, there was an immediate increase in heart rate and rise to above the normal in blood pressure. Furthermore, when the vomiting was induced after the vagi had been cut, there was a rise instead of a fall in blood pressure.—_The Journal of the Amer. Med. Asso._

HOME TREATMENT OF SCIATICA.

Pœppelmann suggests the following method for the home treatment of sciatica. A pail of boiling water is placed in a tub large enough to permit an old chair to be set in it. A tablespoonful of ol. pini sylvestris is poured into the boiling water, the patient seated on the chair with his feet outside the tub, and two sheets pinned around his neck, so that they reach the floor on all sides, covering him completely but leaving the head free. In this steam bath the patient is allowed to remain for twenty minutes. He is then rubbed briskly with a cold wet cloth, dried and put to bed for an hour. If necessary, especially with elderly people, cold applications may be made to the head during the process of steaming. Internally, iodides are given, preferably iodine-vasogen, 7–8 drops three times daily. The bowels must be kept freely open. The baths are given every other day, and five to fifteen sittings are required for a cure. In the author’s hands a successful outcome has been practically uniform.—_Critic and Guide._

USE OF CAFFEINE IN DIGITALIS ARRHYTHMIAS.

In the _American Journal of the Medical Sciences_ for September, 1915, Barton asserts that all the irregularities of the heart-beat which are brought about by digitalis tend to be removed by caffeine. Although in many cases digitalis arrhythmia will spontaneously disappear when the drug is stopped, instances arise, unfortunately too common, in which after prolonged digitalis administration the conductive system is so depressed that serious results may arise. Under these circumstances the administration of caffeine will be of service and is therefore strongly indicated. The action appears to be due to the increase in irritability of the conduction system produced by the caffeine, which antagonizes and finally overcomes the depressing effects which digitalis exerts upon the auriculo-ventricular bundle.—_The Therapeutic Gazette._

THE EFFECT OF CAFFEINE UPON THE BLOOD-FLOW IN NORMAL HUMAN SUBJECTS.

The _Journal of Pharmacology and Experimental Therapeutics_, for November, 1915, contains a report of a research by Means and Newburgh in which they report experiments upon the blood-flow of two normal subjects during rest, and of one subject during muscular work.

The action of caffeine on the blood-flow was studied in both subjects while at rest, and in one during work.

The average blood-flow of the two subjects at rest was 4.5 and 4.0 liters per minute; the systolic outputs were 61 and 57 cc.; the coefficients of utilization of the oxygen-carrying capacity of the blood were 31 per cent and 41 per cent.

With increasing work a steady rise in blood-flow, oxygen absorption, and pulmonary ventilation was found. The increase in blood-flow was produced first by an increase in systolic output until a maximum of 118 cc. was reached, beyond that by an increase in pulse-rate. This suggested that the supply of venous blood in this subject becomes “adequate” at about 640 kg. meters of work per minute. The coefficient of utilization showed a slight rise during work, indicating a slightly greater economy of the circulation.

After giving caffeine during rest, or when the supply of venous blood is “inadequate,” evidence of drug action was found with both subjects. This action consisted in an increase in total blood-flow without a corresponding increase in oxygen absorption, and hence a decreased coefficient of utilization of the oxygen-carrying capacity of the blood. The pulse-rate was unchanged. Consequently the systolic output was increased.

During work probably no other action was obtained from caffeine than possibly an increase in pulse-rate, and consequently slight diminution in systolic output.

It is suggested that during rest when the supply of blood to the right heart is “inadequate”, caffeine increases the blood-flow by increasing the venous supply through an action upon some mechanism outside the heart. When the supply becomes “adequate” or approaches adequacy, no such action is obtained.—_The Therapeutic Gazette._

OBSTETRICAL

DIURESIS AND MILK FLOW.

There are observations on record which indicate that the secretion of milk may be influenced by a contemporaneous diuresis. Precisely what changes in the composition of the milk may be initiated in this way had not been determined until recently, when the question of the influence of specific diuretics on milk flow was investigated by Steenbock at the University of Wisconsin. He remarks that in view of the importance which heretofore unknown constituents of diets and rations have lately assumed, it is of the greatest interest to dissect the various factors normally operative in the body under ordinary conditions of diet. Steenbock found that urea, for example, administered in a diuretic dose, is able to decrease temporarily the flow of milk. On repeated administration, however, the increased intake of water which follows the impoverishment of the tissues with respect to water content balances the draft for water imposed by the diuretic, and the milk secretion comes back to normal. Other diuretic salts, like sodium chloride, may be entirely unable to depress the milk secretion under normal circumstances, because they call forth a compensating thirst which simultaneously increases the water intake. In cases in which diuresis does lead to temporarily decreased flow of milk, the percentage of solids in the secretion is ordinarily increased, the fat being the principal variable. In ordinary experience, however, the composition of the milk may be regarded as essentially unaltered by slight variations in renal activity.—_The Journal of the American Med. Asso._

INDICATIONS AND CONTRAINDICATIONS FOR ABDOMINAL SECTION.

Dr. Ross McPherson (_Provid. Med. Jour._) summarizes his views in the following conclusions: First. Cesarean section is a very useful operation for removing the child from a pregnant woman at or near term in cases: (a) where there is a relative disproportion between the birth canal and the fetus, sufficiently large to make the birth difficult or impossible; (b) in cases of serious obstruction due to tumors, or deformities congential or acquired; (c) a certain number of cases of placenta previa, convulsive toxemia, or occasionally organic disease. Second. The operation should not be decided upon except by a person whose training and experience in pelvic and abdominal examination is sufficiently large to warrant the acceptance of his judgment. Third. The operation should not be performed by anyone unless he be a skillful abdominal surgeon, preferably one who has given particular thought and attention to this subject. Fourth. A long labor, much handling and manipulation, especially in the presence of ruptured membranes, predispose the patient to infection of the peritoneal cavity, and fifth, therefore, intraperitoneal abdominal Cesarean section should not be undertaken under those conditions, with one exception, namely when the religious prejudices of the family demand the saving of the child at the expense of the mother, and then only in the presence of and with the advice of a consultant and a clergyman, after carefully explaining the situation to the family and obtaining their written consent to the procedure. Sixth. If the above demands and conditions are fulfilled the maternal mortality should be practically nothing, the morbidity negligible, the end result perfect, and with the exception of those cases undertaken solely in the interest of the mother, every child should be born alive.—_Medical Progress._

TREATMENT OF OPHTHALMIA NEONATORUM.

G. A. Neuffer, in the _Journal of the South Carolina Medical Association_ for February, 1915, states that he has met with universal success in this condition by means of the following treatment: A sixty-grain (4 gram) to the ounce (30 c.c.) solution of silver nitrate is at once applied to the conjunctiva and immediately precipitated with a solution of sodium chloride made by dissolving one teaspoonful of the salt in a glassful of water. This application is repeated once every twenty-four hours, until one is satisfied that the disease has been controlled. Only in extreme cases are more than two applications necessary, and often one proves sufficient. In addition, an ounce (30 grams) of boric acid is ordered dissolved in a quart (litre) of hot water and the solution kept constantly warm. With this the nurse or mother is instructed to wash out the eyes as often as any pus collects, even if this is required a hundred times a day. One drop of a one per cent solution of an organic silver preparation is dropped into each eye three times a day as long as there is any pus; after this an astringent lotion is substituted. The author also has squares of lint kept on a block of ice and applied constantly, with frequent renewals, for forty minutes in each hour. The treatment described should be applied both day and night until the condition has been mastered.—_New York Medical Journal._

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SLOW DISSEMINATION OF KNOWLEDGE.

Charles Darwin, in his “Descent of Man,” published in 1871, writes thus of the appendix: “It is occasionally quite absent, or again is largely developed. The passage is sometimes completely closed for half or two-thirds of its length, with the terminal part consisting of a flattened solid expansion. In the orang this appendage is long and convoluted: in man it arises from the end of the short cecum, and is commonly from four to five inches in length, being only about the third of an inch in diameter. Not only is it useless, but it is sometimes the cause of death, of which fact I have lately heard two instances: this is due to small, hard bodies, such as seeds, entering the passage, and causing inflammation.”

But Darwin was not the first to recognize the uselessness and danger of the appendix, since M. C. Martins, in “_Revue des Deux Mondes_,” which was published in 1862, mentioned the fact that this rudiment sometimes caused death. Indeed it is said the ancient Egyptians knew the appendix became inflamed and caused death, but for this we can not vouch.

In spite of these _hints_ of Martin and Darwin, physicians called the symptom syndrome of what is now known to be appendicitis, typhlitis or perityphlitis for years, although the cecum itself is seldom inflamed without some pathological change in the appendix. The latter structure, however, is often very badly diseased while the cecum is perfectly normal.

The first methodical operation for appendicitis was performed in 1886 by Reginald Fitz, and even today it is sometimes hard to persuade a patient to have this structure removed simply because recovery often occurs without operation.

EUGENICS.

The same author, Charles Darwin, in the same book, writes as follows: “Man scans with scrupulous care the character and pedigree of his horses, cattle, and dogs before he matches them; but when he comes to his own marriage he rarely, or never takes any such care. He is impelled by nearly the same motives as the lower animals, when they are left to their own free choice, though he is in so far superior to them that he highly values mental charms and virtues. On the other hand he is strongly attracted by mere wealth or rank. Yet he might, by selection, do something not only for the bodily constitution and frame of his offspring, but for their intellectual and moral qualities. Both sexes ought to refrain from marriage if they are in any marked degree inferior in body or mind; but such hopes are Utopian and will never be even partially realized until the laws of inheritance are thoroughly known. Everyone does good service who aids toward this end. When the principles of breeding and inheritance are better understood, we shall not hear ignorant members of our legislature rejecting with scorn a plan for ascertaining whether or not consanguineous marriages are injurious to man.”

Though the above was written thirty-five years ago, little real progress has been made in eugenics. It is true we have laws against miscegenation and against certain consanguineous marriages; some States have passed and other States have attempted to pass, laws making certificates of health necessary before marriage licenses can be issued; if we mistake not, in some States the habitual criminal is unsexed, and in many States this question has been discussed, but ignorance in regard to the laws of heredity is still the rule and not the exception.

Wealth and social position, rather than health and intellectuality, determine as many marriages today as when Darwin wrote, and America’s highest legislative body has not yet repealed the law against the dissemination of knowledge of means to prevent conception. Yet too many children in poor families not only means dire poverty and unhappiness instead of comfort and happiness, but oftentimes desertion, divorce, forced immorality or crime. It is just as necessary to be able to limit the number of children so that each will at least get a good start in life as it is to bring healthy children into the world, since healthy children can not remain healthy and develop as well under unfavorable as under favorable conditions.

Did the law affect rich and poor alike it would not be so pernicious, but such is not the case, since the largest families in this country are found among the poor and ignorant, the very ones who can least afford to have many dependents. Without being so intended, it is class legislation. The healthy, well nourished and well educated class escapes, the poor, ill-nourished, and ignorant class bears the burden until this burden is shifted on society in the form of beggar, defective, imbecile or criminal.

If all the members of Congress made a tour of the tenement districts of New York or other large cities, saw the overworked fathers and overbred mothers, the ragged, ill-nourished and oftentimes diseased children, inquired into the total earnings of the family and the necessary expenses, ate of their bread and breathed their air, if our congressmen did this, then the fate of the law as it now stands would be sealed. But our congressmen are not going to make any such tour, they are not even going to inform themselves by study of the actual conditions, but will do something far easier by voting an appropriation for the study of hog cholera, the foot and mouth disease of cattle, the Texas cattle tick or some other measure of more apparent benefit to the people—and the congressman. To vote on appropriations like the above can not weaken the legislator, to vote to repeal the present law might lose him a large following in some communities. Yet the repeal of the present law in regard to preventives is the first step in eugenics, and without the repeal the best efforts of the best men and women will accomplish but little.—_W. T. B._

PUBLIC HEALTH SERVICE HOSPITALS CURB TRACHOMA.

The establishing of small trachoma hospitals in localities where this contagious disease of the eyes is prevalent presents the best solution of the trachoma problem, according to the statement contained in the annual report of the Surgeon General of the United States Public Health Service. The Service now has five trachoma hospitals in the three States of Kentucky, Virginia, and West Virginia, and so great has been the number of applicants for treatment that a waiting list has been established. In the past fiscal year 12,000 cases of trachoma have been treated, the larger proportion of which were cured, while those in which a cure was not effected have been greatly improved and rendered harmless to their associates. The great majority of these trachoma patients were people who lived in remote sections far removed from medical assistance, and who, but for the hospital care and treatment provided would have remained victims of the disease practically the remainder of their lives.

“When it is considered,” the report of the Service states, “that thousands of persons suffering with trachoma, a dangerous contagious disease, would otherwise remain untreated, it is realized how farreaching results have been obtained through these trachoma hospitals and the other public health work done in this connection. It would be impossible to estimate with any degree of accuracy the number of people who have been saved from contracting this communicable disease by thus removing these thousands of foci of infection.”

In addition to treating persons with the disease the hospitals have been used for educational work. Doctors and nurses have visited the homes of the patients and have explained how to prevent the development and recurrence of the disease. One thousand three hundred and eight such visits were made during the year in Kentucky alone. “It has taken some time,” the report continues, “to educate the people afflicted with this disease to the importance of cleanliness and the use of simple hygienic measures in their daily life.” That results have been obtained is evidenced by the noticeably better observance of hygienic precautions by those among whom the work has been done.

In addition to the hospital work, surveys were made in sixteen counties in Kentucky, especially among school children. Eighteen thousand and sixteen people were examined, 7 per cent being found to have trachoma. Similar inspections in certain localities of Arizona, Alabama, and Florida resulted in finding the disease present in from three to six children out of every hundred. Periodic examination of school children for the disease and the exclusion of the afflicted from the public schools, are two of the recommendations the Public Health Service lays emphasis upon.

One of the special features of the trachoma work was the giving of lectures and clinics before medical societies in various counties where trachoma hospitals could not be established. Patients were operated upon in the presence of physicians and the most modern methods of treatment demonstrated. Throughout, the purpose has been to stimulate local interest in taking up the campaign to eradicate trachoma.

HOW THE GOVERNMENT IS MEETING THE MALARIA PROBLEM.

Four per cent of the inhabitants of certain sections of the South have malaria. This estimate, based on the reporting of 204,881 cases during 1914, has led the United States Public Health Service to give increased attention to the malaria problem, according to the annual report of the Surgeon General. Of 13,526 blood specimens examined by Government officers during the year, 1,797 showed malarial infection. The infection rate among white persons was above 8 per cent, and among colored persons 20 per cent. In two counties in the Yazoo Valley, forty out of every one hundred inhabitants presented evidence of the disease.

Striking as the above figures are they are not more remarkable than those relating to the reduction in the incidence of the disease following surveys of the Public Health Service at thirty-four places in nearly every State of the South. In some instances from an incidence of fifteen per cent, in 1914, a reduction has been accomplished to less than 4 or 5 per cent in 1915.

One of the important scientific discoveries made during the year was in regard to the continuance of the disease from season to season. Over 2,000 Anopheline mosquitoes in malarious districts were dissected, during the early spring months, without finding a single infected insect, and not until May 15, 1915, was the first parasite in the body of a mosquito discovered. The Public Health Service, therefore, concludes that mosquitoes in the latitude of the southern states ordinarily do not carry the infection through the winter. This discovery indicates that protection from malaria may be secured by treating human carriers with quinine previous to the middle of May, thus preventing any infection from chronic sufferers reaching the mosquitoes and being transmitted by them to other persons.

Although quinine remains the best means of treating malaria, and is also of marked benefit in preventing infection, the eradication of the disease as a whole rests upon the destruction of the breeding places of Anopheline mosquitoes. The Public Health Service, therefore, is urging a definite campaign of draining standing water, the filling of low places, and the regrading and training of streams where malarial mosquitoes breed. The oiling of breeding places, and the stocking of streams with top-feeding minnows, are further recommended. The Service also gives advice regarding screening, and other preventive measures as a part of the educational campaigns conducted in sections of infected territory.

This study is typical of the scientific investigations which are being carried out by the Public Health Service, all of which have a direct bearing on eradicating the disease. The malaria work now includes the collection of morbidity data, malaria surveys, demonstration work, scientific field and laboratory studies, educational campaigns, and special studies of impounded water and drainage projects.

Reviews and Book Notices

“Pellagra.” By George M. Niles, M.D., Gastro-enterologist to the
Georgia Baptist Hospital, Wesley Memorial Hospital and Atlanta
Hospital, Atlanta, Ga. Octavo of 261 pages, illustrated.
Philadelphia and London. W. B. Saunders Co., 1916. Cloth, $3 net. W.
B. Saunders Co., Philadelphia. London.

We are in receipt of the second edition of this work upon a subject that has of late attracted a great deal of attention from the profession. Pellagra has in recent years sprang up in an unaccountable manner, especially in the southern section of the United States, and it behooves every practicing physician to equip himself with such knowledge as will enable him to recognize the disease when encountered in his practice and to handle it in a scientific manner. This work in its second edition, although following the appearance of the first edition so closely has undergone many changes and had numerous additions so that it has been brought fully up with the present state of knowledge. The chapter on etiology contains the results of the recent investigations of Dr. Joseph Goldberger, Special U. S. Agent for the study of the disease, and Thompson-McFadden Commission on Pellagra. The work is that of a southern physician and should receive the warm support of southern physicians everywhere.

* * * * *

“A Practical Treatise on Infant Feeding and Allied Topics.” For
Physicians and Students. By Harry Lowenberg, A.M., M.D., Assistant
Professor of Pediatrics, Medico-Chirurgical College of Philadelphia;
Pediatrist to the Mt. Sinai Hospital; Pediatrist to the Jewish
Hospital; Assistant Pediatrist to the Medico-Chirurgical Hospital
and to the Philadelphia General Hospital; Formerly Instructor of
Pediatrics, Jefferson Medical College. Illustrated with Sixty-four
Text Engravings and Thirty Original Full Page Plates, Eleven of
which are in color. Philadelphia. F. A. Davis Co., Publishers.
English Depot. Stanley Phillips, London. 1916.

Our thanks are due the obliging publishers for a copy of this exceedingly valuable book. The author’s long experience and intimate acquaintance with the subjects treated of eminently qualify him to present a work that will prove of most valuable assistance to physician and students. The work is eminently practical and presents throughout the subject matter in an easily accessible form. The arrangement of the text is systematically perfect and only such material is used as may render the work available for the needs of practitioners and students. The importance of breast-feeding is emphasized and artificial alimentation discussed thoroughly so as to furnish the best schemes for obtaining the best results. The article upon “Surgical Treatment of Infantile Pyloric Obstruction” is by the celebrated surgeon, Dr. John B. Deaver, a chapter that adds much to the value of the work. A feature of the work is the presentation of a number of plates showing in colors the appearance of stools in various conditions of alimentary disturbances. We are greatly pleased with this work and can conscientiously recommend it to students and practitioners.

* * * * *

“Annual Report of the Surgeon General of the Public Health Service of
the United States.” For the Fiscal Year 1911. Washington. Government
Printing Office. 1914.

This is the forty-third annual report of the operations of the Public Health Service, in the one hundred and sixteenth year of its existence, issued by the Surgeon General of the Public Health Service of the United States. This treats of the seven divisions of the bureau under the following heads, viz. (1) Scientific Research and Sanitation; (2) Foreign and Insular Quarantine and Immigration; (3) Domestic (Interstate) Quarantine; (4) Sanitary Reports and Statistics; (5) Marine Hospitals and Relief; (6) Personnel and Accounts; (7) Miscellaneous. The report contains a great deal of interest to the general reader, especially to those interested in sanitary matters, and shows the methodical and systematic manner in which the affairs of the bureau are administered.

Publisher’s Department

“IN PARTICULAR CASES.”

Therapeutic efficiency in the use of the bromides is often as dependent on the avoidance of untoward effects as on the attainments of maximum physiologic activity. For this reason Peacock’s Bromides offer the most satisfactory bromide therapy, for not only does this happy combination of carefully selected bromide salts insure all the benefits of the most active bromide preparation, but it does so with the great advantage that gastric disturbance and all tendencies to bromism are reduced to a minimum. This is why in “particular cases” so many physicians are in the habit of insisting on the use of Peacock’s Bromides.

* * * * *

Notwithstanding the large number of Hypophosphites on the market, it is quite difficult to obtain a uniform and reliable syrup. “Robinson’s” is a highly elegant preparation, and possesses an advantage over some others, in that it holds the various salts, including iron, quinine, and strychnine, etc., in perfect solution, and is not liable to the formation of fungus growths. (See advertisement in this issue.)

* * * * *

“Many cases of acute coryza and naso-pharyngeal irritation are often due primarily to the streptococcus rheumaticus and respond to the usual rheumatic therapy.”

In these cases commonly called “colds,” generally deep-seated, painful and exhausting, Tongaline mitigates the congestion and by rapid elimination of the poison or germs, promptly relieves a condition often very obstinate and if not corrected within a reasonable time, attended with serious results and always with a tendency to become chronic.

For special stimulation to the kidneys, Tongaline and Lithia Tablets; if malaria is indicated, Tongaline and Quinine Tablets.

NOT A DIGESTIVE SUBSTITUTE.

The amount of actual harm done with the best intention, by continually supplying the digestive organs with digestants, or ferments, instead of encouraging them to generate their own, is doubtless greater than we realize. It is not very often that one need order predigested food for a patient, although occasions may and do present themselves when this is advisable. But the indiscriminate use of pepsins and similar substances from the vegetable kingdom, in the management of many patients with weakened digestive powers, is scarcely to be justified. A much more useful remedy, because of its being a true stimulator to the digestive functions, gastric and intestinal, is Seng. This well known preparation contains the active principles of Panax (Ginseng), and is especially useful because it stimulates the physiologic activity of the digestive glands and thus “helps them to help themselves”—obviously the most desirable therapeutics in all functional cases. It should be remembered, therefore, that Seng is not a ferment to digest food which weakened organs can not care for in their natural manner. Instead, its action is to restore tone and vigor to the secretory structures so that they are able to evolve and supply their own ferments. Seng is a very agreeable remedy to take, and its benefits are manifested in surprisingly short order. In convalescence from fevers or diseases impairing the digestive functions it is unquestionably one of the most efficient remedies being used by medical men today.

INTEROL.

The world is full of fallacies—It is fed upon half truths. It drinks in sophistry and then wonder is expressed that the millenium is so long deferred.

Take for instance the unfortunate use of the terms “expensive” and “high-priced” or of “costly” and “cheap.”

Price—be it high or low, is what one pays.

It has nothing to do with what is received.

Quality on the other hand, is what one gets, or fails to get. Service ditto.

A useless, or inferior article or service, even when bought for a low price, is expensive and costly!

On the other hand, the better or higher the Quality or the Service that is obtainable, the higher the price—which is a great natural law. Hence, high-priced should, and usually does men, high quality or service.

In fact, a moment’s reflection will show that the impression created in the mind of a person of average intelligence, by the word “cheap” applied to a person or a thing, suggests inferiority.

A cheap person or thing is apt to prove the most expensive. A high-priced person or thing usually turns out to be the most economical.

And, it is a most important fact that this applies with especial force to therapeutic agents of any kind intended for use by the physician, and with fulminant emphasis to drugs or agents that have to be put into the human body.

The physician who hesitates or is influenced by “high price”, provided he knows the reputation and standing of the parties marketing the product, is false to his obligation to himself and to his patient.

All of which applies with especial force to mineral oil and particularly to Interol.

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TRANSCRIBER’S NOTES

1. Silently corrected typographical errors and variations in spelling. 2. Retained anachronistic, non-standard, and uncertain spellings as printed. 3. Enclosed italics font in _underscores_.