SALT-FREE DIET IN THE TREATMENT OF HYPERCHLORHYDRIA. M. Leo, (La Semaine Medicale, June 12, 1912) noted that the amount of chlorides in the feces of hyperchlorhydrics was below normal, and concluded that the chloride content of the tissues must be above normal. The correctness of this assumption was proved by the fact that a salt-free diet was only followed by a reduction of the free hydrochloric acid in the gastric juice after about two weeks, while in the normal subject the acid diminished almost immediately.

Following the publication of Leo's article, Richartz, of Hamburg, resorted to the salt-free diet in an aggravated case of hyperchlorhydria, in a man sixty years of age, which had proved rebellious to all forms of treatment. The pain was practically constant and enormous doses of alkalies afforded only transitory relief.

In addition to the salt-free diet, which included abstinence from all mineral waters, daily lavage was practiced two hours and a half after the principal meal.

Richartz has since applied this treatment in eight other cases, with similar results in six. He thinks, however, that the failure in the two cases was due to the fact that the patients did not adhere faithfully to the regime. In fact, except with intelligent patients, it is only when the pain is intolerable, that they can keep up the diet for a sufficiently long period. He calls attention to sodium bromide, which is an excellent substitute for salt in rendering the food palatable and, in addition, exercises a sedative action, which is very desirable.

He is of the opinion that the salt-free diet alone cannot bring about the desired result in severe cases, but that the mechanic removal of the excessive acid by lavage is a necessary part of the treatment.

PURPURA RHEUMATICA-Gonalons, (La Semana Medica, Aug. 15, 1912) reports a case which appeared following a typic attack of acute articular rheumatism and two months after all rheumatic symptoms had disappeared. The eruption appeared on three separate occasions, lasting two or three days, hemorrhagic, confluent and accompanied by bilious vomiting, joint pains and headache. Later, hemorrhages from the bowel set in. Amenorrhea existed for three months previous to the appearance of the eruption and continued for more than a month afterward when a short metrorhagia supervened. The bleeding was controlled by horse serum and the chloride of calcium.

1

BUFFALO MEDICAL JOURNAL

A Monthly Review of Medicine and Surgery

EDITOR

A. L. BENEDICT.

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Subscriptions may commence at any time. $2.00 per year in advance.

VOL. LXVIII.

JANUARY, 1913

Touting for Quacks

No. 6

A physician who had recently lost a member of his family was pained to receive, shortly after his death, a circular letter addressed to the patient, and offering treatment by mail. This circular came from a distant city. The regularity with which advertising matter of this sort is addressed to the sick, indicates a systematic canvass for victims. It is scarcely imaginable that lists of names can be secured from attending physicians-certainly not in a case of the kind mentioned-nor that reports to boards of health are thus exploited-and, in the present instance, the case was not reportable. We strongly suspect that some of the advertisements of nice, light, remunerative work for ladies (not canvassing), refer to ferreting out of cases for quacks. Perhaps an investigation of the methods of obtaining address lists. for quacks and popular education on the subject might be worth

while.

A Happy New Year

The BUFFALO MEDICAL JOURNAL extends its greetings to its readers; thanks them for their cordial support in the past. and looks forward to still greater usefulness as the details of cooperation to secure professional welfare, are worked out. A New Year message without good resolutions would be like bricks without straw so here are presented a few with the hope

that they

are not needed.

I will pay my debts promptly; have as few as possible; and, so far as possible without working hardship, encourage others in the same resolution.

I will neither pay nor accept commisssions for the reference of cases but I will take this means of increasing my practice in preference to more under-handed methods not at present in the lime light.

I will keep the Hippocratic oath, not only in the narrow sense in which it is sometimes interpreted, but in the broad spirit that I will not exploit for selfish ends any advantage which my professional work affords in my dealings with other physicians, others professions, employees or patients of either sex or any age.

Without being a sore-head or a knocker and with due regard to the legitimate rewards of merit and service, I will use my influence to secure the fair and impartial administration of all professional trusts in the welfare of the profession and the people generally.

I will not step on the fingers of the man below me on the ladder. As to the man above me, I will not incur the curse of Deuteronomy, 25:11.

Water Pollution

A year ago, we discussed the Buffalo water supply. In October 1911, we discussed the Laurentian system of water ways. The first article in the present issue deals with the problem from the Canadian standpoint but in so broad a spirit that it throws light on the whole subject. While depending upon the same. bacteriologic principles, the problem with regard to a well, spring, or water shed for a family or small community, presents quite. different details in engineering and sanitation, economics and law, from that involving a large body of fresh water, although it must be conceded that most insignificant sources of water are tributaries to larger ones and, hence, gradually and remotely, approach the latter in this respect.

It is fortunate that the Laurentian problem is international in scope. While, at first sight, the necessity of joint action by two governments seems to be an obstacle to progress, further reflection convinces us that we are rapidly nearing the point at which the menace of the life and health of citizens of one country by the pollution of boundary waters by the citizens of another country must be considered an aggressive act, persistence in which would justify war quite as clearly as aggressions by traumatic measures or aggressions against property. We speak in no spirit of jingoism and hasten to add that the friendship and enlightenment of both countries preclude any such possibility, quite aside.

from the fact that the interests of each country are the same. Thus, we feel confident that the international scope of the problem will expedite its solution.

Progress in Public Utilities

For most parts of the civilized world, the great moral issues of freedom of conscience and personal action, of arbitrary caste systems, of slavery, of popular education, have been solved. Most of the great questions of policy have either been settled, or have been reduced to minor differences of opinion between opposing principles, each modified so as to approach the other in practical application. For example, the dispute between states' rights and national concentration of power, between protection and free trade, have been reduced to a substantial agreement except as to questions of degree. And neither party in such a dispute would undertake a radical experiment but a cautious extension of theory in one direction, subject to a halt at the first indication of unfavorable result.

Statesmanship and, to an increasing degree, practical politics, are coming to deal with economic problems, with the actual carrying out of principles no longer in dispute, with the extension of fair and honorable methods from theory to practice, in both private and public business. It must not be overlooked that the doing away with great principles such as led to the War of the Revolution, of 1812, of the Civil War and perhaps, also the Spanish War, and the substitution of opinions of minor ethical importance, in political life, is not so much a sign of deteriora

tion

issue.

as of the accomplishment, of moral and religious ideals. It was a grand privilege to write, to lecture, to indure insult and oppression, to sacrifice one's property and life, to wage war and overturn government, with the justification of a great moral But we must not forget the terrible suffering and the horrible moral status of at least a part of society which made. such moral issues possible. We can not wish for the persistence of such great issues any more than for the persitence of great epidemics and professional ignorance in order to return to the possibility of medical heroism of the old type instead of having the routine every-day heroism of effective study and practice.

The era of economic political issues is of direct interest to the medical profession. The maintenance and restoration of health, the saving of life, depend less and less on control of epidemics of whose nature we are ignorant, more and more on economic details. The stress of poverty, not so much in the

literal privational sense as in the difficulty of securing a steady, dependable outlet of one's industry and the ability to meet demands without hardship and anxiety, is rapidly assuming the importance which bacteria have filled.

About a tenth of all deaths are due to violence, of one kind or another. The control of various businesses, especially mining and manufacturing industries, public and private methods of transportation will eliminate a large share of violent deaths. Suicides are largely due, directly and indirectly, to economic conditions. Homicide is largely controlable by education, especially the education of the public, as to the necessity of limiting procreation of criminals. And this education depends largely upon economic principles. A considerable part of the mortality is due to overcrowding in cities and can be remedied only by rational attention to economic details. Whether dealing with the literally overcrowded part of the population or not, another important item in the death rate is the failure to obtain proper sanitation and hygiene in dwellings, shops and other buildings. But, without actual or virtual confiscation of property, this reform cannot be secured until the enormous tax rate of the average city is so reduced by the application of ordinary principles of business economy to municipal affairs, that land lords can afford to provide light, ground space and ideal constructive features and still have a fair margin of profit.

Many acute cases of financial suffering, often leading to suicide, to exposure and overwork of women and children, with resulting disease and death, are due to insecure investments. In our experience, the great majority of instances of loss of savings by our own profession are due to investments in organizations not conducted in good faith. One of the important functions of government, already recognized in various countries and some of our own states, is the control of stock companies so as to secure the interests of active participants, investors and the public buying the commodity or service of the corporation.

Without ignoring various other economic factors, including details of political dispute, as the tariff, control of large industries, etc., the panics and periods of financial depression of recent years have been due, not so much to lack of actual productive wealth, available labor and desire to purchase either material or labor, as to the difficulty of securing the actual cash to effect an exchange. One hundred years ago, with a population mainly dwelling in the country and with each family directly producing most of its own necessities, the per capita cash was five to ten dollars, representing as many day's labor. At present, with the majority of the population depending upon actual cash for