tissues and their components. All have a slow dissolving action upon the lipoidal contents of the various tissues. From previous investigations we know that the vitamine elements or constituents of the tissues are charged with the duty of protecting their environment against the destructive action of toxins of low nitrogen content. The lipoids of certain tissues have a similar activity toward toxins of similar nitrogenic content, such as the toxins released during the use of narcotics. During the period of taking opiates (alkaloids) the lipoidal content of the tissues of the system is gradually reduced, causing pathologic changes with the manifestation of phenomena erroneously designated as a drug habit instead of addiction disease.

Believing that addiction is caused by the marked decrease or deprivation of lipoids from the system, and that the release of toxins of different character when set free in the system produces the manifestations of suffering, the writer strove to discover some method of replacing the lost substances, in this way bringing the lipoid starved system to a normal state. During his investigation of the chemistry and biochemistry of lipoids generally, he observed the chemical affinity. of plant lipoids for animal lipoids, and their possible replacement of each other, as well as a remarkable neutralizing influence of plant lipoids upon alkaloids from the same sources. This observation led to various animal experiments in an effort to discover the action of alkaloids and plant lipoids in vivo, and resulted in the evolution of a combination of plant lipoids capable of relieving drug addiction disease in the human being.

The experiments of Dr. Adriano Valenti of the Royal University of Pavia were carried out and further experimentation added.

In doing so certain dogs received daily increasing doses of morphine until 22 grains were tolerated. All dogs were suddenly taken off the drug; some were left without any medication whatever, while others were given lipoidal substance. The result of this experiment was that the dogs without any medication precipitated into a state of intense, suffering very similar to that manifested in the human being during the period of withdrawal. The dogs subjected to lipoid treatment, however, did not develop these intense manifestations, and the restlessness was promptly relieved and disappeared altogether after a short time.

Blood pressure and pulse rates were taken of the dogs given no treatment whatever and those who received the lipoid substance. The difference was quite marked. Violent fluctuation of the rhythm and rate of pulse and of the blood pressure was noticeable in the untreated dogs, whereas in those who received the lipoid substance very little irregularity was observed, and that which was present disappeared after the third or fourth day of treatment. This experiment throws a new light upon the subject of drug addiction as a disease, caused by certain released toxins with well defined pathologic changes. It is needless to emphasize that during clinical investigation much attention was paid to the functions of the most important glands and the emunctories. In doing so, one could not fail to observe the changes in the action of the endocrine glands. It was easy also to note the indirect paralyzing action of drugs upon the whole digestive tract. This action makes it plausible that we have to deal with more than one released chemical complex in drug addiction disease. The various skin manifestations so commonly present in cases suffering from drug addiction disease render it even more clear

that certain substances of protein origin (toxins) interfere with the action of the skin causing various phenomena. We have no space to describe all these very important observations as the writer believes that every careful clinician is in position to make these same observations in his own practice.

After long and careful study the newly evolved therapeutic principle was placed in the hands of private practitioners and of physicians in charge of the county and Federal jails for the purpose of investigating its efficacy as a remedy for the treatment of drug addiction disease in cases under their constant care and observation. The object of treating cases in private practice and in jail was to be in position to draw valuable conclusions regarding drug addiction as a disease in cases of good moral standing, such as we have to deal with in our private practice, and in cases of low moral standing, possibly degenerates with which we come in contact in the various jails.

Both types have seemed to make a remarkable response and make a gratifying recovery from drug addiction, as a result of the use of the lipoidal treatment. Patients in private practice who come to the physician for the sake of being cured will soon become normal and develop a contempt for the opiates which is most pronounced. Cases treated in the jails are of two classes. A large percentage of the patients obtaining their freedom from drug addiction and from the iron bars will look for honorable occupation and will stick to it, whereas the other part of these cases undoubtedly come under the theory' of Lombroso. In these latter cases we have to deal with some other pathologic changes in the brain and central nervous system, not only with conditions

caused by the use of narcotics. These patients, after obtaining their release from the jail, plunge immediately into previous association of the underworld, and sooner or later return again to the use of narcotics, in spite of the fact that the system does not require or need the drug.

THE STATE INCOME TAX AS IT RELATES TO PHYSICIANS.

BY

JAMES A. WENDELL,

State Comptroller, Albany, N. Y. Prescriptions have become popularized since the incidence of the Eighteenth Amendment. The dose as prescribed for the physician by the State Income Tax Law is not particularly hard to either compound or take.

Twelve months' experience in the administering of the State Income Tax Law developed the necessity for some changes in the law. It is thought well to call to the attention of the physician so much of the amendments to this law as may be of concern to him in the computing of his tax liability. Experience developed that March 15 was a confusing date for the termination of the period provided for filing of returns, for the reason that a similar limit was set by the federal authorities in respect of federal income tax returns. The law, therefore, was amended in this respect to the effect that returns for 1920 may be filed at any time subsequent to January 1, 1921 and prior to April 15, 1921.

It is of interest to know that resident physicians may now deduct from their gross income, all interest on indebtedness paid or accrued during the reporting year. They

may also deduct contributions or gifts made to religious, charitable or educational corporations or associations, regardless of whether they are incorporated or organized under the laws of this State. It is now deemed sufficient if the recipient of such contributions be operated exclusively for one of the purposes above mentioned. It should be remembered, however, that the amount of such deduction is limited to not greater than 15% of the physician's net in

come.

It might be noted in passing that the law with reference to personal exemptions has not been changed in so far as the resident physician is concerned, except that in case separate returns are made by the husband and wife, the personal exemption of $2,000 must be equally divided between them. The non-resident physician is, no doubt, well aware of the fact that he is now entitled to the identical personal exemptions allowed to a resident physician.

The scope and nature of the medical profession is such as to ordinarily preclude the necessity for deducting and withholding from compensation paid a non-resident by way of personal services rendered. It may well be, however, that a physician disbursed during the twelve month reporting period, a sum of $1,000 or more to either one or more employees or an associate. If such is the case, it is well to be informed that the law requires an informational return to be filed with this Bureau in respect of such payments. The proper form for this return will be promptly forwarded upon request to either the Albany or a district office of the Bureau.

The resident physician may, generally speaking, deduct from his gross income the ordinary expenses incidental to the carry

ing on of his profession. To be specific, he may deduct an allowance for the depreciation of an automobile which is used solely in his professional work. The rate of depreciation shall be determined by some consistent plan whereby a definite sum, deducted each year, will at the time when the car becomes useless replace the worn out automobile with either a similar car or one of equal value.

In case the physician is practicing electrotherapy, a deduction may be taken each year for depreciation on an X-ray machine, for example. A surgeon may take a deduction for obsolescence in the matter of. certain instruments becoming useless due to replacement by a more practical instrument. It is not practical to follow the idea of depreciation and obsolescence into intricate detail. The doctor will be able to determine those things as to which a deduction may be taken for either of the above mentioned reasons.

There are many cases where a physician, practicing in a rural community, combines a residence and office. It is of interest to know that a deduction may be taken in respect of that proportion of taxes paid on this real estate which the space occupied for offices bears to the entire residence. In case the house is rented by the physician, he may deduct a proportion of rent paid computed in the same manner as here outlined with reference to repairs.

There seems to be a general inclination to include in income reported payments of interest received from investments in Liberty Bonds. The law specifically provides that such interest payments constitute non-taxable income.

It is well known that a doctor contributes more of his time and services without com

pensation than any other professional man. He should be advised that any accounts on his books, which he determines during the calendar year to be hopeless of collection, may be charged off as bad debts and deducted from his gross income earned during such calendar year.

The non-resident physician, practicing in this State, will be pleased to know that he may deduct in general the same deductions that are accorded a resident, so long as such deductions arise out of a source within this State, the income from which is taxable under the law. An example of a deduction . which a non-resident may not take is the case of a mortgage on real estate situated outside this State. Altho this is an indebtedness, the interest which the doctor pays on such mortgage cannot be deducted for the reason that if the mortgage ran to the physician, he would not be required to include in his return of income the sums which he received by way of interest pay

ments.

A permanent list of all doctors who paid an income tax to the State for the year 1919, has been made and filed at the Albany

office of the Bureau. There will be mailed to each doctor on this list a blank form in duplicate for the filing of his return of income for the year 1920. It is, therefore, only the physician who is filing a return for the first time that needs to bear in mind the necessity for obtaining a blank form for his return.

There was considerable confusion during the initial year of the administration of the State law by reason of physicians obtaining short form 200 when, as a matter of fact, long form 201 is the form required to be filed.

Communications received at the home, and district offices reflect some anxiety in

the minds of taxpayers as to the proper procedure to obtain a refund of an amount of tax overpaid. It is the practice of the audit division of the Bureau to promptly refund such overpayments without action on the part of the taxpayer. If it is desired to obtain prompt action on the question of an overpayment of tax, the proper procedure is to request form 110 from one of the district offices of the Bureau and to file this form with the Albany office at the earliest opportunity. This form for claim for refund is attached to the return of the taxpayer and the question of overpayment of tax due is by this method immediately brought to the attention of the auditor as soon as the return is reached for audit in its due alphabetical sequence.

The Director of the Bureau has called attention to the fact that little, if any, trouble has been experienced with an attempt on the part of physicians either to avoid the payment of tax due pursuant to the Income. Tax Law or to evade taxation entirely by concealment of income. It has been noticeably apparent that as a class, the medical profession have willingly demonstrated their desire to cooperate with this branch of State government. The cases where an additional assessment of tax has been made against a doctor can usually be traced to the fact that the business of his profession has so occupied his mind as to exclude his duty and liability under the law.

The attention of medical men is invited to the fact that all returns forwarded to the Bureau, are treated in the nature of confidential communications. A heavy penalty, with the possibility of imprisonment, faces any employee of the Bureau who divulges information contained in the return of any taxpayer.

The Use of Pituitary Extract in Connection With the Induction of Labor.Watson (New York Medical Journal, October 9, 1920) said that Blair Bell in 1909 was the first to employ in practice the results of experimental investigations carried out on the extract of the pituitary gland up to that time. Since then a great mass of literature had accumulated on the subject. It was universally recognized that it was a most valuable agent for accelerating the second stage of labor when delay was due to feeble uterine contraction. In most of the articles which had appeared the reader was warned against using it for the induction of labor or before the cervix was fully dilated. He had used it extensively for the induction of labor and during all stages of labor, and had never had any bad results. In 1913 he recorded three cases in which he had successfully induced labor by its means. One of these was at the eighth month, one at full term, and one at three weeks post term. He stated that the method was worth an extended trial and he thought that his further results bore this out. The method used was to begin with a dose of one-half to one c. c. administered intramuscularly with a long needle. In most cases uterine contractions commenced in about ten minutes and increased in severity during the next twenty minutes. At the end of this time the second injection of one-half c. c. was given. If, after a time, the contractions tended to weaken, or to come at longer intervals, the dose was repeated. As many as six or eight doses might thus be given at intervals of about half an hour. The important point was to administer a further dose before the effects of the previous one had entirely passed off. The effects from a single dose appeared to last only for about half an hour and there was no cumulative effect. Sufficient doses

must, therefore, be given to keep up uterine contractions sufficient to produce a certain amount of opening up of the cervix. When the cervix had begun to open and the membranes to bulge into it the uterine contractions would continue without the further administration of the drug. The failures which he had in the beginning were the result of not pushing the dose far enough. He had found it perfectly safe to give eight or ten one-half c. c. doses at half-hour intervals.

In 19 multiparæ the average duration of labor was 19 hours as contrasted with 18 hours as an average in 18 multiparæ. With the bag method the average time elapsing before labor began was 13 hours and the average duration of labor was 10 hours. This number, of course, was very small and not sufficient to draw conclusions from. With quinine alone, in 25 cases the average time elapsing from the last dose to the definite onset of labor was seven hours, while the average duration of labor was nine hours, seven for multiparæ and 11 for primiparæ. With pituitrin alone in a total of 18 cases the average time elapsing between the first dose and the definite onset of labor was two hours. The average duration of labor was ten hours, 16 hours for five primiparæ and nine hours for 13 multiparæ. With quinine and pituitary extract, in a total of 62 cases, 53 were successful and nine were totally unsuccessful. Six of the successful cases required repetition of the routine before labor began. In the 53 successful cases the average time elapsing between the first dose of pituitrin and the onset of labor was two hours and the average duration of labor was ten hours; 14 hours for 23 primiparæ and seven hours for 30 multiparæ. In the quinine and pituitrin cases labor was spontaneous, except in four cases in which forceps were used when the