head was on the perineum. In the total of 53 cases there were four stillborn babies. Dr. Watson said that recently two of his colleagues, members of his staff, J. G. Gallie and W. A. Scott, had recorded a series of 65 cases in which they had used pituitary extract alone for the induction of labor. Out of this total number 55 were entirely successful. The average number of doses given was three and the average duration of labor was seven hours. There was one fetal death 28 hours after delivery from atelectasis. The delivery was normal in 45, by forceps in nine and by version in one. Taking these results with those which he had recorded, he thought we must recognize that the method had a definite place in obstetrical practice and should be considered before other methods were adopted. It had very special advantages in cases of slight disparity between the head and pelvis, as it did not in any way prejudice the Cesarean operation should it prove to be necessary an argument which could not apply to the bougie or bag method. Effect of Hypophysis Extracts on the Secretion of Urine.- Brunn (Zentralblatt fur innere Medizin, Sept. 25, 1920) states that while, on the basis of earlier animal experiments, it was reported that extracts of the hypophysis exert a diuretic effect on the secretion of urine, a large number of writers today agree that the subcutaneous injection of any of the commercial hypophysis preparations results in a checking of diuresis. Saxl and Brunn found that in from three to four hours after an injection of a hypophysis preparation a very small quantity of highly concentrated urine is secreted. In other trials an artificial polyuria was produced by allowing the subject to drink a liter of water; the halfhourly portions of urine were collected and the volume and specific gravity were determined. In from three to four hours the effect of the extract was worn off and copious diuresis set in, which corresponded to the normal results in experiments with water, only postponed, as it were, for four hours. The excretion of sodium chlorid was not affected, on the whole, by the extract. The checking of diuresis was more marked the greater the original water diuresis and the less the sodium chlorid diuresis; in other words, the more dilute the urine and the lower the specific gravity. As throwing light on the possible mechanism of the effect of hypophysis extracts on diuresis, Brunn calls especial attention to the fact that during the checking of diuresis marked hydremia is noted. This seems to point to a blocking in the kidney and opposes the assumption that the tissues under the effect of the extract hold back the water, to a great extent, and cannot give it off into the blood stream. Hyperthyroidism.-Fussell (New York Medical Journal, August 14, 1920) discusses the importance of diagnosing early cases of hyperthyroidism: the symptoms of mild cases may be mistaken for those of neurasthenia, functional or organic heart disease, or tuberculosis. Hyperthyroidism can be proved by the following tests: 1. Increased metabolic rate (a test possible only in special institutions). 2. Administration of increasing doses of thyroid extract intensifies the symptoms. 3. Hypodermic injections of adrenalin, e. g., 0.5 c. c. of 1:1000 solution, exaggerates the symptoms, with evidence of vasomotor disturbances, such as pallor of lips and fingers, followed by flushings and sweatings and possibly by rise of temperature and diuresis. 4. Decrease of sugar tolerance. Lian calls attention to the presence of hyperesthesia over the thyroid in cases of hyperthyroidism. If the point of a pin be drawn over the skin of the neck, a sharp burning pain is experienced in the thyroid region in this condition, while Marañón gives as a test of hyperthyroidism that of rubbing the skin of the neck lightly with the fingers which produces a redness in the region of the thyroid much more pronounced than that elicited by rubbing the skin elsewhere. Ascoli and Faginoli found that in hyperthyroid patients an intradermic dose of one minim of 1:4000 solution adrenalin produced a local reaction characterized by a central large area of blanching, surrounded by a peripheral zone of reddening. A similar injection of 0.05 c. c. of 1:1000 solution of adrenalin provokes a swelling which almost immediately assumes a dark blue color, as if ink had been injected. By adding a minute dose of thyroid extract to the adrenalin, the reaction to the latter is distinctly enhanced and more protracted. Results with Organotherapy.-Strong, in his valuable article in the Practical Medicine and Surgery, December, 1920, gives his conclusions as follows: 1. Organotherapy is a rational treat ment. 2. That a thoro physical examination is necessary before using them. use 3. That their indiscriminate be avoided, especially in maximum doses, because of untoward results. 4. That patients so treated should be frequently seen. 5. That we should understand their specific actions as well if not better than socalled galenic remedies. 6. Whereas all the glands have a hormonic action as a whole, the removal of one will break the continuity of their action, therefore, we should be as sure as possible before removing any one of them that its function is so impaired that if it remained it would be a menace to the health (this, by the way, is the real rub) and this is the problem of the surgeon. It is no longer a question with a competent surgeon as to how to operate, but what to do and especially what not to do. Internal Secretion of Testis.-The experimental work reported on by Massaglia (Endocrinology, October-December, 1920) is interpreted by him as showing that the testis has an internal secretion, which gives to the male the masculine sexual characters and sexual instinct and keeps the function of the hypophysis normal. His researches indicate that the Leydig's cells have the endocrine function. This conception is supported by the following facts: 1. The Leydig's cells have the characters of secretory cells in that they elaborate fatty granules and mitochondria. 2. The animal remains normal even when we have marked atrophy of the seminal epithelium. 3. It is only when the atrophic testis is removed with the Leydig's cells then in good condition, that changes are noted after castration. 4. No facts exist which speak for the conception that the spermatogenetic cells exercise the endocrine function: they complete a cytologic cycle to become spermatozoa, which have merely the biologic function of reproductive cells. The new information on the internal secretion of the testis that shows the effects of its abolition indicates that there exists thru the internal testicular secretion a functional correlation between the testis and hypophysis cerebri. It lends support to the view that the pituitary body has the function of ruling the skeletal growth, and perhaps throws some light on the obscure etiology of gigantism and acromegaly. In the acromegalic there is found marked hypertrophy of the hypophysis with eosinophilia of its cells and deficient development of sexual organs. But in the acromegalic the more important fact is that it is a lesion (hypertrophy, adenoma) of the pituitary body, whereas in the castrated it is the loss of the internal secretion of the testis, which secondarily produces hypertrophy of the hypophysis. Corpus Luteum in Pain in Breasts.In the three cases cited by Hartwell (Col. Medicine, May, 1920), pain in the breasts was more or less constant, severe and aggravated by menstruation. The use of corpus luteum for about one week gave complete and permanent relief from pain in each case. The Ductless Glands.-Gutman (The Medical Woman's Journal, December, 1920) states that endocrinologic diagnosis is not at simple procedure, but it helps one to decipher the whys and wherefores of life and offers a precise and more satisfactory explanation of conditions not otherwise satisfactorily explainable. It renders possible individualization in diagnosis and therapy, whereas in pathologic diagnosis alone, individualization is impossible. This accounts. for the fact that therapy based solely upon pathologic findings is seldom productive of any very definite or lasting curative results. For these reasons and from the standpoint of the sick individual, correct endocrinologic diagnosis must be the chief aim of the medical diagnostician of the future. By-ways and High-ways a physician still thinks of solely in terms of a trouble maker for digestion. A British View on Prohibition.—American physicians will be interested in the following comments, which appeared recently in the London Observer, on the operation of prohibition in the United States, written by a high British medical authority who attended the recent International Congress at Washington and reflecting the attitude in medical circles in London toward the abolition of liquor. Dietary Justice to the Peanut.—The statistics of the peanut crop in the United States, as an editorial writer in the Journal of the American Medical Association (August 28, 1920) well says, attest the growing popularity of the product. For many years peanuts were eaten essentially as "extra" foods, like candy and other sweetmeats. Latterly, they have begun to claim a more substantial place in the diet. Under the appealing designation of peanut "butter," the ground peanuts are finding treated by the Government of the United widespread use as a palatable, wholesome food. Peanut oil is now expressed in large quantities from shelled peanuts, and has received commendation. From the resulting press cake, peanut flour has been prepared by grinding. Peanuts are unusual in containing a considerable proportion of protein along with both fat and carbohydrate. Water-soluble vitamin is also not lacking. Experts in the Office of Home Economics at the U. S. Department of Agriculture have shown that the nutrients of peanuts are easily digested by man. Johns and Finks of the same department have given an added worth to the food by demonstrating convincingly the high physiologic value of the peanut protein. Various investigators have demonstrated that bread made from wheat flour of current composition is inadequate as the only source of protein in the diet. The government workers have found, however, that bread made with a mixture of 25 parts of peanut flour and 75 parts of wheat flour furnished adequate proteins for normal growth of experimental animals. The proteins of the peanut bread were utilized for gain almost twice as well as those contained in wheat bread. This does not mean that the familiar "staff of life" should be abandoned or regularly diluted with peanut flour; it does, however, put a stamp of real nutritive merit on a food product that many Nothing like adequate attention has been paid in this country to the work of the Fifteenth International Congress against Alcoholism, recently held in Washington. The Congress had never before been held in America, and special efforts were made to ensure its practical success. This is not the place in which to try to describe the forethought and the lavish skill with which the delegates from some forty different countries of the world were States, whose guests we were. But certain medical findings of what must necessarily be a medical congress, by its definition, should certainly be recorded here. Our Government recognized the importance of the data, and comparative studies of the problem of alcoholism in all parts of the world, though our Press did not; for Sir Auckland Geddes attended the opening session, to the very great satisfaction of everyone present, and told us that he had been instructed by his Government to have the proceedings attended, and to make reports thereon to three of our Departments, the Home Office, the Board of Trade, and the Ministry of Health. SOME HOSPITAL FIGURES. When the Prohibition Amendment to the Constitution of the United States came into force last January, it was here described as the "greatest health measure in history." The evidence which accumulates in support of that assertion is far too copious for this place, but I must give some indications of. it by way of comment upon the present plight of our longillustrious hospital system. The following are examples merely of the data submitted at Washington:— In New York, according to the official statements of Dr. Royal S. Copeland, Health Commissioner for the City, there has been, since the enactment of prohibition, an unprecedented decrease in deaths from pulmonary tuberculosis; and the Secretary of the United Hospital Fund reports as follows: "Alcoholism has clogged our hospital systems with unnecessary cases of sickness and accidents." "Physicians, nurses, equipment, time, space, and food have been pre-empted by alcoholics, while other patients have been denied admission." "Recent figures gathered by the United Hospital Fund show that in New York City alone, thanks to prohibition, 7,000 beds have been released." It is also recorded that "700 vacancies for tuberculosis patients are reported in the Departmental Hospital, and 300 vacancies in the private hospitals of New York since prohibition became effective." From Chicago, the second largest city in America, came similar reports, as thus, on the authority of Dr. John Robertson: "Facts speak for themselves; we had 235 cases of alcoholic pneumonia in the County Hospital in September, 1917, 230 in September, 1918, and 71 in September, 1919." The third largest city in America is Philadelphia, and thence came such facts as this: "The Philadelphia General Hospital, which cared for 3,481 alcoholic patients in 1917, and 2,326 in 1918, has closed its alcoholic wards." THE EXPECTANT MOTHER. Similar results were officially reported from all parts of the Republic, north, south, east, and west. Much discussion has necessarily arisen as to the best uses to which the immense hospital resources freed by prohibtion should be put. Apparently the consensus of opinion is that the expectant mother should have first place; and early mental cases, threatening to become insane, the second. These are both British ideas. The first hospital bed in the world for an expectant mother was opened in 1901 in the Edinburgh Royal Maternity Hospital, on the initiative of Dr. J. W. Ballantyne, when the present writer was resident medical officer there; and the name of Dr. Maudsley is associated with the idea of early hospital care for threatened insanity. Thanks to prohibitition, America is now able to realize these great ideas of British Medicine on a scale unimagined elsewhere. One of these days, when we can bear the burden no longer, all resources of charity, taxes, and the rates being inadequate to cope with the results, direct and indirect, of alcoholism, we also shall have to turn off the poisoned tap. Etiology and Diagnosis of Nephritis. McElroy (Medical Record, January 8, 1921) gave the diagnostic features as follows: (1) Nephritis occurred most frequently from 40 to 50 years of age and in men. (2) The good general condition of benign hypertension rapidly declined and soon presented the characteristic cachectic condition of chronic nephritis. (3) The disease ran its course as a cardiovascular renal disease. The cardiovascular symptoms, as compared with benign hypertension, were characterized by a tendency to greater severity. (4) The blood pressure from the beginning was high and constantly maintained, showing the highest values. (5) The cardiac hypertrophy was marked, came on early, and here was found the largest hearts. (6) Edema, when present, was of cardiac origin. (7) The blood showed marked secondary anemia in contrast to benign hypertension. (8) There was mycturia, with day and night polynuria, and the urine showed a low specific gravity, albuminuria, and cylindruria of moderate grades. (9) Papillitis and neuroretinitis were the rule and afforded a certain indication that the case did not belong to the type of benign hypertension, altho the kidney functional test might show little or no impairment. (10) Impairment of kidney function was the chief characteristic of this type. This varied from the slight to the most severe, similar to the last stage of chronic diffuse glomerulonephritis with kidney insufficiency. (11) If death did not occur earlier from the cardiovascular component of the disease or a pulmonary complication, the end results were from true uremia as in the end stage of chronic diffuse glomerulonephritis. Eclamptic equivalents were prominent as in benign hypertension, the psychical symptoms tending to be more severe. Eclamptic uremia might rarely occur. The Diagnosis and Treatment of Neurosyphilis. Solomon (Boston Medical and Surgical Journal, December 30, 1920) concluding his discussion of this subject, points out that: 1. The central nervous system is involved by syphilis very frequently in the primary and secondary stages; that this involvement is ordinarily benign and disapi ears symptomatically with or without treatment. 2. In a small number of cases, acute meningitis, meningocephalitis, vascularitis and gummas occur in the secondary period of the disease. 3. About 10 per cent. of all cases of syphilis develop late neurosyphilis, tabes, paresis, meningitis, meningoencephalitis, gummas, vascularitis. 4. Neurosyphilis is always serious, affecting the mind, utility and life of the patient. 5. Diagnosis is often possible only by the aid of the spinal examination. 6. Therapeutic results are better, the earlier the diagnosis of syphilis is made, and the sooner treatment is instituted. 7. The spinal fluid is often positive long before definite symptoms are present; hence the need of frequent lumbar punctures. 8. More intensive treatment is usually required to treat neurosyphilis than in the treatment of non-nervoussystem syphilis. 9. Cases of meningitis, acute meningoencephalitis, and mild vascular syphilis usually react favorably to intensive intravenous injection. 10. For these conditions intraspinous injections will at times accomplish more than intravenous therapy. 11. Tabes is more difficult to improve than the above mentioned forms. Many cases, especially the early ones, show improvement under intravenous therapy adequately administered but with intraspinous therapy, will frequently do much better. It is often the method par excellence. 12. Many cases diagnosed as paresis make fair recoveries under intravenous therapy. 13. Intraspinous injections and drainage of the cerebrospinal fluid may aid in the intravenous treatment of general paresis. 14. Intraventricular injections may at times give more favorable results than any other in the treatment of paresis. Simple Diagnosis of Heart Lesions.-Weatherson (Illinois Medical Journal, September, 1920) calls attention to the fact that many murmurs are functional. We must find corroborating evidence before we can say positively that an organic lesion exists. Regurgitation is not a lesion. It is an act which ceases at death. We should know the condition present in a case which allows it. Autopsy statistics show that every infection of a valve runs "true to form" and produces its characteristic lesion. Hence the diagnosis of the pathological condition present is simplified by merely determining the etiology that produced it. Syphilis always produces dilatation, and never involves any but the aortic valve. The streptococcus (rheumatism, arthritis, scarlet fever, chorea, tonsillitis, etc.) always produces stenosis. Pulmonary valve disease is always stenotic and is congenital in origin. A dilated roughened aortic arch of the hypertensive type is usually wrongly diagnosed as mitral regurgitation because the systolic murmur is projected backward to the mitral area. No diagnosis of a valve lesion is complete unless we know the condition or infection that caused it. on a Cause of Pellagra.-Bory (Le Progrès Médical, October 23, 1920) gives a short résumé of his recent studies in this field, with special reference to the part played presumably by vitamine deficit. He quotes from a recent article by Goldberger and Wheeler in which a certain restricted diet appeared to be responsible for the appearance of the disease in prisoners. This diet was restricted to cereals, presumably decorticated. Two months were required for the development of the disease picture, which was classical. Other inmates of the prison, staff members, etc., who were balanced diet, presented none of the manifestations. In an insane asylum with cases of pellagra the staff did not contract the disease and an increase in the ration of meat and milkwhich had been extremely scanty-appeared to control the disease in the inmates. There were further tests made in orphan asylums and in small villages where pellagra had appeared, with the same results. There is no doubt, then, that pellagra is a deficiency disease, but we do not know whether a vitamine or an aminoacid or a mineral ingredient is at fault. The general result is, moreover, offset by the appearance of pellagra in well-to-do and well-fed individuals. But on close inspection some of these were found to have a repugnance to certain dietetic articles-eggs, milk, meat-while others restricted their diet because they regarded certain articles as of difficult digestion. These people showed improvement under the theoretic diet. The author is not satisfied with the dietetic explanation alone, and believes that subjects on an exclusive cereal diet fall victims to some obscure infection. The old spoiled maize theory still holds good in support of this view (recently he could add that experiences in Roumania were due frankly to this cause). He cites an endemic case in France of obscure etiology in which Italian laborers may have brought the germ from some pellagrous locality. He invokes a mosquito theory of transmission. The diet was favorable for infection, having been largely cereal and not properly balanced. Treatment of Hemorrhage.-Recognizing the fact that the utility of adrenalin in therapeutics hinges upon its remarkable contractile effect upon the small blood vessels, the physician readily accepts it as the most available styptic we have (The Canada Lancet, December, 1920) its action is manifested whether it be applied directly to the exposed vessel, administered subcutaneously in the bleeding area, or, as in intestinal hemorrhage, given intravenously. When applied locally the response is so vigorous that the tissue is actually blanched; and in combination with local anesthetics it prevents excessive bleeding during and after operations on mucous membranes and other structures. In the advertising section of this issue the reader will find the fourth of a series of little essays on "Adrenalin in Medicine," in which the topic discussed is "The Treatment of Hemorrhage." While most practitioners are more or less familiar with the therapeutics of adrenalin, a perusal of this brief article will serve to refresh the memory of any one who has momentarily lost sight of this remarkable and dependable agent in minor surgery. A notable point that may have been overlooked is that adrenalin not only controls bleeding by vasoconstriction, but it also shortens the coagulation period, whereby it occupies a distinctly unique position among hemostatics. Treatment of Diphtheria Carriers.-Fraser and Duncan in the Lancet, November 13, 1920, differentiate between a "positive throat" and a "true diphtheria carrier." The latter carries bacteria which retain their virulence despite the most energetic disinfection. Stock diphtheria vaccine cures the positive throat, but up to the present time no thoro cure has been |