Mar. 21, 1910. This is doubtless an epochmaking discovery, as the field is now open for the workers who are busy with the problems of serums and vaccines for prevention and cure—that is, if the antivivisectionists do not induce legislators to put a stop to such life saving investigations. Metchinkoff thought that prior failures to cause typhoid experimentally were due to the fact that pure cultures were used and he then tried successfully the administration of foods contaminated with weak dilutions of bacillus infected feces. Chimpanzees thus managed contracted characteristic typhoid. (Jour. Am. Med. Ass'n, Apr. 16, 1910). The interests of humanity demand a vigorous assault on the problems now apparently capable of solution. Preventive vaccinations for cholera, bacillary dysentery and plague possess only an academic interest for northern physicians, but it may be taken for granted that no one would think of submitting to all these various doses in endemic territory. So we are safe in predicting that the medical profession will never advocate universal vaccination in those affections, even when it is learned how long each immunity lasts and whether one process does not interfere with another given soon afterwards. Indeed from the difficulty of popularizing smallpox vaccination, it is likely that the profession will vigorously oppose the present suggestions for similar measures in any other disease. The whole trend of prevention is in the direction of isolation of the sick, and reduction of the chances of infection. We must prevent the carriers Preventive vaccinations will apparently from spreading bacilli, instead of attempting become matters of routine in all cases where close contact with carriers is unavoidable. In the matter of smallpox, we have a century of statistics showing the necessity of the operation for everyone but in the other dis eases universal vaccinations are absurdly. impractical. In the case of diphtheria, a prophylactic dose of serum is a matter of routine for the contacts, indeed it is reprehensible to neglect it, and the past mortality of nurses and doctors shows the wisdom of the present method of immunizing the attendants, but no one dreams of immunizing a whole city against a danger which faces only a few. In like manner, typhoid vaccinations are saving the lives of nurses and it is already a necessity to immunize all others brought into close contact with such patients, but the vaccination of a whole community will never be attempted except when there is a serious outbreak where the water and food supplies are not guarded. the impossible task of trying to become strong enough to resist every pathogenic organism. The source of typhoid infection has been carefully worked out of late years by the Germans, who have been conducting a most painstaking crusade against the disease. (Jour. Royal Army Med. Corps, Jan., 1907). The most amazing and yet expected result is the discovery that in nearly all the cases in which the source could be found, it was a patient or chronic carrier, the latter causing about 10 per cent. The medium of transfer of the bacillus was the hands in over 90 per cent., the other media being generally the milk, less often other foods and very rarely the water or clothing. In about two-thirds of cases the source could not be traced, but it is presumed to have been an unknown carrier as a rule, or a mild unrecognized case. Never theless we have a wealth of instances showing that when a city water supply is improved, typhoid is phenomenally lessened, though we have also long known that the drinking water is very rarely the medium of transfer. Indeed sometimes an improvement of the water is not followed by a lessening of typhoid, and in such cases we may rest assured that personal contact with carriers is the main cause or that we have eaten foods infected by them. The tremendous importance of these new facts is the proved necessity for isolating the typhoids, disinfecting their discharges, and immunizing the contacts-nurses, family, etc. The problem of the chronic typhoid carrier has found no solution as yet. The unfortunates cannot be shut up-they are too numerous-and as they do not react to treatment, they might require life imprison ment. We must content ourselves with warning them, and then confining them if they neglect the precautions. The German crusade has already greatly reduced the number of cases and deaths, and we must follow the same lines instead of attempting universal vaccinations. The point is the necessity for far greater restrictions on the typhoid patient-the real distributor of the disease. He is more dangerous than a smallpox case and health authorities must keep close track of all carriers until a way is found to cure them. Luckily the German investigations show that the carrier who is careful, rarely if ever infects anyone else, so that we need not be unduly alarmed about them. Yet we must know who and where they are. The long failure to recognize pellagra in America is not so amazing as the facts would seem to warrant, for it is the rule in all newly arising diseases or epidemics, that the first cases are never recognized. To be sure, the psychiatrists had been puzzled to account for these curious cases of dementia in the asylums, and knew what pellagra was, but they did not connect the two together because very few people can see a thing until it is pointed out to them. When influenza visited us in 1890, the first cases were not recognized, but in a few weeks any tyro could make a diagnosis. When we are on the "look-out," it is easy to detect cases, but when we do not know a disease is present, we never think of it, and it requires thinking of a very high order to detect it. It seems therefore that instead of condemning the psychiatrists, we should give the highest praise to them for the promptness with which they have taken up the matter, now that they have been aroused by their leader-Dr. J. W. Babcock of the South Carolina State Hospital for the Insane. His work has been epoch-making and deserving of far more than "the highest praise." Amebiasis in the insane is the first great discovery following upon the search for causes of pellagra. Siler and Nichols of the Army Medical Corps, report about half of the inmates of the Peoria Asylum have amoeba in their stools, and about 80 per cent. of the pellagrins. This does not show any relation between amebiasis and pellagra or any other mental affection, but it does show that amoeba may be causing far more disease in and out of asylums than we had any suspicion. Dysentery has always been more or less of a bane in the insane and a deplorable number are said to show post-mortem colonic ulceration, even when dysenteric symptoms were not spe cially severe or even very noticeable. More- ears. The arterial relaxation of hot weather is a matter for serious consideration in connection with amoebic dysentery, pellagra and many other conditions which are more serious in the south of Europe and America than in the north. The excessive heat or light or both seem to cause an increased blood supply to all the epithelial structures, with a consequent increased activity. The skin glands become over active and cause all kinds of disturbances. Almost every resident in the tropics, for instance, suffers from excessive production of cerumen in the The gastro-intestinal tract suffers, and a latent colitis lights up almost as soon as the hot weather begins or the sufferer enters the tropics. Disturbances of digestion are almost universal. The respiratory tract also suffers, so that pneumonias and forms of bronchitis are common, severe and difficult to cure. The diarrhoea and skin lesions of pellagra are therefore of the same order of phenomena, no matter what the exciting cause may be. The climatic element is now under investigation, particularly the effects of light with a view of determining why the poison or infecting agent should be so much more active in the south. Perhaps corn may be more easily spoiled, but it is said that the short northern season induces farmers to cut the corn too soon, and it is not properly dried, whereas the southern corn is the best. If climate is a factor, it may be because of its effect on the patient, causing arterial relaxation and laying the foundation for a subsequent infection which would be harmless further north. In every way we look at these new problems brought up by pellagra, they seem destined to have a profound influence upon our conception of other diseases and their relations to climate and season, and the special types of people affected. The irresponsibility of suicides seems to be recognized more and more. The act may have been perfectly normal in former. ages and lower civilizations when life was so cheap that its preservation was not guaranteed, when it was occasionally necessary to destroy men, and when conditions. of living were so bad that death was often preferable. But in modern times society practically guarantees life and tries to make it worth while, so that self-destruction. generally, if not always, means abnormal mentality. Some years ago, investigations showed that more than half of the cases were profoundly neurasthenic, or perhaps we might use the more fashionable term, psychasthenic. At any rate they were suffering acutely from the thousand and one distresses of long existing exhaustion, and judgment became so warped they concluded it were better to end the life than mend it. Little attempt was made to find the causes of the exhaustion, beyond the usual "too much work and too little play." It has been proved over and over again that many of these cases can be prevented, some indeed need only a little strengthening of willpower or a slightly increased incentive to live. Suicides among the insured are markedly decreased by making the policy void under such circumstances and it is a strong incentive to protect the family from dire want, though curiously enough the suicide never realizes that he is removing their real means of existence. The pathology of suicide is therefore of extreme importance and is fortunately receiving more and more attention though not as much as it deserves. Julius Bartel has been looking into the matter in Germany (Wiener Klinische Wochenschrift) and finds quite a high percentage of tuberculosis as the cause of this mental disturbance. The thymus gland was enlarged in many and this fact raises the suspicion that defective or arrested development may be at the basis of many cases-perhaps they are people easily broken by causes which the normal resist. It has long been suspected that every suicide is congenitally abnormal in some marked degree, even if he is much above the average in intelligence. It is quite likely therefore that post mortems will show that every case is really an invalid who should have been under medical care. This does not mean that life insurance companies should remove the clause voiding policies for suicide within the first few years of insurance for that is a beneficent deterrent, but it does mean that it is one more of the forms of death we must try to prevent. It also means that the law declaring attempted suicide a misdemeanor must be revoked as a survival of barbarism similar to the old laws which considered the insane to be criminals. Those who attempt suicide should be confined in a hospital and given gentle care and medical treatment. They are all cases for the doctor to cure, and not for the courts and police to punish. The medical man must take over this burden, as well as the burden of the inebriate. The increase of suicides has been repeatedly denied but the latest statistics published by Mr. E. B. Phelps (Amer. Underwriter, Dec., 1909) and those of Mr. Frederick Hoffman leave no doubt that there has been a steady increase everywhere for many years but particularly in the larger cities. This seems to show that the causes of the underlying pathological conditions are becoming more effective. It is therefore high time to know more about both the causes and the diseases, for surely these cases come within the sphere of preventive medicine. Each case must receive the most painstaking investigation and the results published. Perhaps life is getting too strenuous that is, to keep it requires a greater effort than the body is able to exert, and the feeblest are giving up. Of course, this natural selection will eventually cause the race to become better adjusted to the conditions. Those fit for the life will sur vive, but we don't like to see the sacrifice of the others. Perhaps we can adjust the conditions to the men instead of allowing Nature to adjust man to the conditions in her brutal way of killing off the unadjusted types. To shave or not to shave is the newest hygienic puzzle suggested by the alleged discovery that the bearded man suffers from colds more than the smooth faced-and it is all blamed on the bacteria which flourish luxuriantly on all hairs. Before advising Before advising men to shave, we would like to be convinced that it really has a beneficial result. Of course we acknowledge that he who allows his tangled beard to become a receptacle for the crumbs of years is carrying around. garbage which can serve as a culture medium for almost anything, but not in the case of men who are as clean as Nature presumed them to be. We would like to suggest that someone find out why beards were evolved at all if not for some beneficial purpose which women did not need. It is often said that sexual selection accounted for the matter, a beard in some way being more attractive to primitive women, and the possessors of bunches of hair had increased chances of securing mates, and that the beard may have had no other use or may even have been as burdensome as the enormous feathers of birds of paradise. Nevertheless mating generally takes place before the beard makes its appearance and we must look elsewhere for the physiological reasons for its evolution. The purpose of the beard has some relation to a benefit in fighting and hunting which were about the only things man did at the time his face became differentiated from woman's. Whatever the benefit, woman in her more protected environment did not need it or was even harmed by a beard, and it is safe to say that modern men who do not hunt or fight and who are housed something like women, are as well off without beards or even better off. This much seems to be safe reasoning until we can find why Nature surrounded our mouths with bunches of hair to become smeared with everything we eat. with everything we eat. For outdoor workers we would like to reserve judgment until the physiologists tell us why beards were evolved. This should not be a severe task for the cause must have been potent to have made such a vast difference between the sexes. It is generally assumed that beards are still protective in some way and we would not like to accuse Nature of foolishness until we have the proofs, for we have never yet found her a fool. The right to dispense his own remedies. is one of the most fundamental of the physician's calling. Limit or modify this right in the slightest degree and his whole usefulness as a practitioner of medicine is entirely destroyed. The more one considers the amazing suggestion that medical men. should be prevented by law from dispensing whatever their judgment dictates, the more indignant one becomes. It apparently emanates from the erstwhile management of the National Association of Retail Druggists. From an intimate acquaintance with a goodly number of American pharmacists and a fairly accurate knowledge of their aims, ambitions and activities, we cannot believe for a minute that druggists generally are in sympathy with any proposition to interfere with dispensing by physicians, or that they will lend their influence to promote the enactment of any legislation making any |