SAFEGUARDING FOODS AND DRUGS

(U. S. Department of Agriculture)

In the enforcement of the Food and Drugs Act during the last year, U. S. Department of Agriculture officials analyzed 29,833 samples of foods and drugs offered for interstate shipment and for import. A physical examination was made of samples from 76,468 shipments offered for import. Of these foreign shipments, 6,353 were found to violate the law in some respects and were either excluded from the country or admitted only after the importers had relabeled them to comply with the law. Of the samples of domestic products analyzed 3,535, either because of the nature of the product or because the label on it did not tell the truth, were found to be in violation of the Federal law. In 1,364 cases the department recommended to the Department of Justice that criminal prosecution be instituted against the manufacturers or that the goods be seized. In many cases where there was no evidence of intention to defraud, and where there was merely some easily remedied flaw in the wording of a label, the shippers, after being warned in hearings, voluntarily took steps which made their products fully comply with the requirements. In all, there were held 8,715 such hearings, many of which resulted in the prosecutions indicated and the gathering of evidence for a large number of additional cases, which will be forwarded to the Department of Justice.

The Bureau of Chemistry, in its annual report, also calls attention to the fact that through the system of Service and Regulatory Announcements now in use, manufacturers are given due notice of the requirements and thus are enabled voluntarily to make their products conform to the law. In this way the government achieves its purpose, frequently without entering into needless and very expensive litigation.

In the regulatory work, special emphasis has been given to the control of drug products and foods liable to spoilage and pollution. These frequently constitute a serious menace to health. The food inspectors have been instructed to be particularly watchful for interstate shipments of bad eggs, milk, oysters and spoiled canned goods, and false and fraudulently labeled medicines and spurious, synthetic drugs.

Curbing Fraudulent Medicines

Attempts to counterfeit or adulterate imported drugs have been more common since the recent high price and scarcity of many of these products encouraged their imitation. It is interesting to note that of the 1,036 cases terminated in the courts

during the year, 198 were brought on account of the false and fraudulent labeling of medicine. In all of these medical cases, save five, the courts found for the government, and this, it is believed, has exercised an important deterrent effect on the vendors of nostrums shipped from one state to another.

The work of controlling the fraudulent labels of medicines and mineral waters has been greatly strengthened by the establishment of a separate office to deal with these matters. At the request of the Secretary of Agriculture an officer of the U. S. Public Health Service has been detailed to take charge of this work. Moreover, through the close co-operation established with the foods and drugs officials of many of the states, the department was able to direct the attention of the local authoriies to the presence of spurious drugs in their states and, as a result, much of these fraudulent goods in the hands of local dealers and beyond the reach of the Federal authorities were dstroyed by state and municipal officers who, in many cases, prosecuted those responsible for the local traffic.

Milk, Eggs and Oysters

The co-operation in the sanitary control of the milk supply of small cities described in the report for last year has been extended in Illinois, Iowa, Missouri, Kansas, Nebraska, and in New England. It is proposed to repeat this work year after year, extending it each year to new territory. In some localities bad conditions were found, due in the main to insufficient cooling and careless handling. Perhaps the best results of this work has been that it stimulated some of the local authorities to take up similar work independently so that definite permanent improvement of the milk supply of a number of cities has resulted. The co-operative work on the control of the shipment of decomposed eggs described in the report of last year has been extended to cover much of the territory in which shipments originate so that eggs are now candled before shipment far more than formerly, and the spoiled eggs destroyed or fed to poultry and stock. At the same time information given to local officials has helped them to curb local traffic in eggs rejected in candling.

The Bureau of Chemistry, after making co-operative sanitary surveys of oyster beds, issued warnings against the interstate shipment of oysters from polluted and doubtful beds and, where these warnings were not regarded, undertook prosecutions. As a result, interstate shipment from such territory was stopped.

Other Adulterations

The campaign against the sweating of immature oranges and

immature grapefruit so as to give the immature fruit the color of ripe fruit, has been successful, largely because of the active help of the greater part of the citrus fruit producers. Comparatively few sweated, immature oranges were offered during the last year, and it is believed the better quality of fruit resulted in a steadier market so that the producer as well as the consumer benefited.

Other forms of adulteration not already mentioned that received especial attention are the adulteration of scallops and canned tomatoes with water, the substitution of colored starch paste for tomato sauce, the processing of spoiled canned goods, the traffic in cull beans, in decomposed tomato products, in rancid olive oil, in wormy horse beans, the substitution of foreign fat for cacao butter in and the addition of cacao shells to, cacao products, the adulteration of rice bran with rice hulls, the coloring of inferior macaroni and of plain noodles, the misbranding of domestic macaroni in simulation of imported goods, and the adulteration of oats with water or weed seeds.

TUBERCULOSIS CUTIS ANI

By D. C. McKenney, M. D., F. A. C. S., Buffalo, N. Y.

An interesting case of tuberculosis of the anal skin is reported.

From the clinical study of the case Dr. McKenney infers that the infection started from the anal canal rather than in the skin around the anal orifice. An active respiratory infection, associated with aphonia, seems strong evidence that the infection was carried in the feces to the anus.

PRESENTATION

OF CASES DEMONSTRATING SOME FACTORS IN THE EARLY DIAGNOSIS OF INSANITY

By Max A. Bahr, M.D., Clinical Psychiater, Central Indiana Hospital for Insane, Indianapolis, Ind.

In the limited scope of this paper it is not my object to present in detail the many differential diagnostic factors to be taken into consideration in stamping a case as a particular type of psychosis, for such an attempt would necessarily require volumes of material, but merely to illustrate by the few cases before us some of the more common errors in the early diagnosis of insanity which we frequently encounter. Furthermore, this presentation is not in any spirit of censure or criticism of the busy practitioner who is the first to see these patients, for we have repeatedly insisted that his co-operation in this work and the large amount of material furnished us is of inestimable value.

Before the attempt was made to establish nosologic entities in insanity, the classification was purely one of symptoms. Thus, e. g., all cases that were abnormally depressed and sad were classified as melancholia, and those that were abnormally elated and happy, as mania, irrespective as to whether the symptoms were primary or secondary, and irrespective of the underlying cause, pathology, or termination. As an analogy in physical diseases it is probable that some of you can remember, when it was customary to group together under one category, e. g., all cases of dropsy which we realize now is not a disease in itself, but a symptom which may be brought about by many diseases and disturbances of a functional character, as, e. g., renal diseases, diseases of the liver, cardiac diseases, any pressure on the arterial or venous circulation, etc.

Now, in a case of so-called depression or melancholia, there is an essential difference from the diagnostic, prognostic, and therapeutic viewpoint, whether we are dealing with with a depression of the manio-depressive psychosis, a paranoiae who is depressed in consequence of continued and increasing ideas of persecution, a paretic in depression, or in fact any of the other groups of psychoses in which depression may occur. The same holds true of exaltation or mania and, in fact, of all the other psychic phenomena as delirium, hallucinations, illustrations, delusions, disturbances of consciousness, etc.

Structural pathology is gradually taking its proper place in relation to the disease-picture and we are fully aware that, while in many instances the anatomical lesion is directly responsible

for the existing psychic disease or symptom, we must not lose sight of the fact that it may be the result of the disorder of function brought about in some other manner, or may be entirely secondary to disease in some remote portion of the body. Thus, a mental diagnosis should be made with this point constantly in view, that it should represent disease entities, rather than purely symptomatic phenomena, and consequently from a prognostic and therapeutic viewpoint there is a decided difference whether we are dealing with a recoverable depression or exaltation of a mani-depressive psychosis, or whether our case is one of the depressionor exaltation of an incurable paresis.

Before considering some of the early diagnostic factors in the cases before us, I first wish to emphasize the great difficulty at times encountered in the differentiation between sanity and insanity. The brain is an organ whose chief province is that of co-ordinating the different functions of the body with each other as a whole, and with the conditions in the environment, and consequently through the complexity of human life it is frequently called upon to meet situations for which it is not prepared, and thus insanity may result. Likewise, the differentiation between mental abnormalities and insanity is not always easy, from the fact that there are real disorders in both instances, but one case is arbitrarily called insanity, while the other is designated as a mental disorder.

One suffering from an acute disease of the brain may have excitement, incoherence in the stream of ideas, and great psychomotor activity and may even be delirious, but is not necessarily insane. If such symptoms follow an attack of epilepsy they are said to be symptoms of an epileptic psychosis, if they follow upon toxic states, they are referred to as toxic insanity, and if such a toxic factor is alcohol, the case is referred to as having delirium tremens or chronic drunkenness, which are not regarded as symptoms of insanity, unless certain psychic symptoms happen to appear in addition to those found in the above affection. A case of meningitis is to be guarded against accidents and treated, and a physician would be greatly censured if he were to send such a person to a hospital for the insane. If, however, permanent symptoms of mental disorder were to attend chronic meningitis, the insanity would be recognized as the chief affection, or, if melancholia followed or attended basilar meningitis in a tuberculous patient and both affections were prolonged results of the tuberculous lesion, the patient might be diagnosed as insane.

First, I wish to speak of the consideration of insanity in the individual subject to acute alcoholic intoxication or drunken