important relationship was acquired. Now, beyond a possibility of a doubt, altho the mills of science in proving facts grind exceedingly slow, internal medicine, as a specialty, has been greatly advantaged by this now established etiologic relationship.

In the locomotor system, probably we see the most frequent metastases of teeth infections. Metastatic infectious arthritis may arise not only from teeth infections but also from tonsils, paranasal sinuses and mastoids. Hypertrophic osteoarthritis, seen in older people, may result from pariapical granulomata. One's disappointment in at once not getting improvement in joints, after the extraction of teeth found to be diseased, is extremely great, but how may we be expected always to get relief in secondary osteoarthritis by the late removal of a primary focus? In addition to joint metastases, there may be infection of tendons, fasciæ, bursæ and fibrous tissue about the joints, which seriously impair function of the joint.

Disease of the circulation secondary to oral sepsis may show itself in acute infectious endocarditis in the young, and subacute infectious endocarditis or endocarditis lenta in the adult. Also, the muscle function of the heart may be markedly affected by an infected mouth. This has been observed frequently by the writer in treating heart affections in cases of extrasystolic arrhythmia. Arterial Arterial disease, increased blood pressure, and low blood pressure are, likewise, not infrequently influenced by the infectious condition of teeth.

Diseases of the blood and the blood-making organs are also a frequent sequel of oral infection. This is seen in the anemias. The diseases of the stomach seem to bear a like relation often times. Infections of the stomach and the functional disturbance of it may be begun by oral sepsis, and ulcer of that organ or duodenum may be finally accomplished by infection from diseases of the mouth.

So, in the urogenital system where there. is glomerulotubular nephritis, pyelitis, prostatitis, etc., this role of the primary infection from the mouth may be played.

In the diseases of the nervous system, oral infection may quite frequently serve as the primary focus. Multiple neuritis, chronic neuralgias, trigeminal neuralgia, in

tercostal, brachial, sciatic neuritis, may be enumerated as illustrations. Sciatica, in the writer's experience, is not infrequently associated with arthritis of the sacroiliac joint and, while extremely difficult to relieve, is associated with chronic infections of tonsils or teeth.

The diseases of the endocrine and metabolic systems, as seen in thyroiditis and Graves' disease, are also affected by oral sepsis. Their relation to ovarian abscess has not been established, nor has their relation to diabetes resulting from necrosis of the pancreas. There is an undoubted causal relationship to the trachitis and bronchitis. The writer has frequently relieved recurrent non-tuberculous cough by having diseased teeth extracted, or chronic infection. of the tonsils or paranasal sinuses cleaned up.

How Doctors Die in America.-The New Year issue of the Journal of the A. M. A. contains the usual prompt analysis of the deaths of medical men in the United States of America during the preceding year. General diseases accounted for 257 deaths, diseases of the nervous system 271, diseases of the circulatory system 404, diseases of the respiratory system 266, diseases of the digestive system 70, diseases of the genito-urinary system 154, senility 77, suicide 32, accidents 102, homicide 14, and sequels of surgical operations 74. The most frequent assigned causes of death were: Organic heart disease 236, cerebral hemorrhage 211, pneumonia 186, nephritis and uremia 142, malignant tumors 91, tuberculosis 59, angina pectoris 50, pneumonia-influenza 37, and arteriosclerosis 33. The causes and distribution of the 102 deaths from accident were: Automobile 27, automobile-railway (grade crossing) 22, poisons 9, falls 8, firearms 7, drowning 6, railway and street car, each 5, asphyxia 3, exposure and burns, each 2, crushing 1, and other accidents 5. The 32 physicians who ended their lives by suicide selected these methods: Firearms 18, poisons 7, . cutting instruments 3 strangulation 2, jumping from high places and drowning, each 1. Of the 14 homicides, 9 were due to fire

arms.

TRIBUTES TO GODFREY ROGER PISEK, M. D., Sc. D.

In the death of Godfrey Roger Pisek, the American medical profession has lost one of its most distinguished members. He died suddenly from heart disease on January 19, 1921. An impressive memorial meeting was held in honor of Dr. Pisek on the afternoon of Tuesday, January 25th, at the New York Post-Graduate Medical School and Hospital. The meeting had been arranged by the Faculty Association and was in charge. of Dr. John J. Moorhead, a lifelong friend of Dr. Pisek. Dr. Ellice M. Alger presided. The Rev. Frederick E. Stockwell made an inspiring prayer. Dr. James F. McKernon, the president of the faculty, spoke briefly of the great loss the school had sustained by the death of Dr. Pisek, and Dr. Knopf and Dr. Brush paid their tributes to the departed friend.

gree and from New York University Medical School, coming upon the House Staff of the Post-Graduate Hospital as substitute in 1896, and by regular appointment in 1897. Advancement was steady and to high places. In Medicine he was paramount as a teacher, and gave the body of his working hours to this, attaining early to such positions asProfessor of Pediatrics in the University of Vermont, Pediatrist or Consultant to many of the better hospitals and children's homes in this vicinity-Memberships in City, National and International Societies, scientific, civic and social, in which he frequently held high and onerous office. He advanced steadily thru all phases of the children's work at the Post-Graduate into the Directorship of the Pediatric Department-consummating twenty-five years of faithful service, dis

BY

DR. FREDERIC BRUSH,

Formerly Superintendent of the New York PostGraduate Medical School and Hospital.

It was the spirit, the light of Godfrey Pisek that made us love and follow him and made this meeting inevitable. The hour is too weighted with deep feeling and with generous meanings to be much taken, it would seem, in enumeration of public and official achievements, notable as they were in his forty-eight years. He was educated in the schools of New York, graduated from New York University with B. S. de

ganization and pioneering.

The Post-Graduate was Dr. Pisek's motive home, his real alma-mater nourishing mother; he has left one of the deepest single marks yet upon this institution and its societies and associations; here he rooted and grew-and dropped down here at the end of a morning of fresh, unselfish planning for her-in a smiling vision of the warmer, truer up-town home he was going to.

Yet how this list of accomplishments, which could be far extended, fails to satisfy this gathering. Even a stranger listening in would justly crave some more intimate

portrayal of the man-Pisek (for so we called him, ever in best way, and shall). Thru these enwreathing public and official distinguishments we press in then to know, while yet we may, the core-fibres of the man -the secrets of our friend's so high success with a little life.

A while ago I was brooding upon the future of our so-called civilization-the trends of the race, within conceivable time; and came out, as have others, upon a person with dominant head carrying luminous wide eyes, that glanced pregnant messages to and from the higher developed brain. A swift play of special senses beyond our ken was evident. The body seemed slight, but ample for the poise and ministration of the exhalted intelligence. Movement, speech and thought gave constant impression of a singular assurance and harmony. Utter kindness, even gaiety, pervaded all.

Quite naturally, I thought back for beginnings, and is it not notable that after a time I settled upon our Dr. Pisek, as carrying, more than any other personally known, the clear indications of the coming man—the racial hope; not in mass so much as in quality and adjustment.

Dr. Pisek won, aided, inspired and led us, and thousands of all classes, by virtue of this triune endowment, symmetry and harmonic balance, sensibilities of the keenest and truest, and an inexhaustible cheer and kindness. A few of these signal men and women are always about us presages of the future. When they drop alongside we begin to understand. We thus come at our friend; we see him now partially, as immured in Time and Fate, and wish our sons to grow up like him.

What a congruous and shapely man. None of our national self-making or selfmadeness was apparent. He came made-as first met in the Medical School, laughing

down the corridor with the serious-looking Moorhead, thru groups of sombreness and doubt-all ready for life as it was in '94. He was born thirty-five years old and stayed so with the playfulness of youth, the will and constructive urge of midde-age, and the judgment and synthesis of senescence; age transformations lessen with the higher types. Such all-roundness of personality is very uncommon: investigator, teacher, author, builder, naturalist, woodsman, wit, comrade and ideal host and home-maker; with the humanities never scrimped. Indeed, a full harmonic life, made possible by a complete Osler-like entry with closed door, into every hour. Each morning was taken in the mood of Howell's fine last line of an obscure sonnet, "Well, anyhow it is another day"; or as another has written, "For this may be the white high day of life, the richest or the holiest or the last." There never came to him DeMaupassant's "Terrible middle-age from which one first foresees the end of the journey." How validly all ages early associated with him, from babe to patriarch—the mark of an advanced being.

Pisek's dauntless cheer and courage will perhaps be longest remembered of all. By sick-bed, in the troubled meeting or council, on the sweaty forest trail-everywhere, always he gave the half-humorous, heartening word or gesture that carried over. And in full self-knowledge of the crippled heart that was bound to shorten things, there is but one record of a brief depressionwhen he could not go with his old friends to the World War. The last of speech was a joke that eased and brightened a friend. He would not wish this occasion to pass without smiles. As we were near quitting, exhausted by night-and-day turmoils of a July hot-spell in hospital, he rallied us (I can see his haggard face) with quip and