of the manufacturers, jobbers and dealers of the country are determined to do their utmost to conform to the provisions of this act, to support it in every particular and to accede to the opinions of this department respecting its construction."

Personally, I have had many conferences with the manufacturers and dealers of this city, and the same spirit of willingness to conform with the laws has been manifested on their part.

Our inspectors are constantly on the alert to detect infringement of the laws. Samples of food which may be suspected of adulteration or misbranding are sent to the chemical laboratory of the department and there subjected to analysis. Misbranding may often be detected by mere inspection and investigation. Small fish caught off our coast, packed in oil and labeled "Imported Sardines" may be pure, attractive and satisfying to our sense of taste, but the practice cannot be defended on moral grounds, and a large variety of our supposedly foreign deliIcacies have been unable to withstand a critical investigation of their origin.

A subject which has merited considerable attention on our part has been the large traffic which is carried on in socalled "spot" and "canned" eggs. This practice, which is thoroughly reprehensible, consists of setting aside those eggs which show a spot when held to a light. They are not fit for the fresh-egg trade, so are broken, the contents emptied into cans, a proportion of some preservative, usually formaldehyde, is added and the cans sealed. Packed in this manner the eggs are preserved for a long period of time. Their sale is mainly to manufacturers of pies, cakes and biscuits. The fact that the eggs are themselves in a condition unfit for human consumption, added to the fraud involved in covering

up their deficiencies with a preservative which hides their true state, reveals a double iniquity. Large consignments of these eggs have been seized and destroyed, and the department is at the present time confronted with a suit for damages involving some $2000, the amount claimed as representing the assumed value of one seizure of these eggs.

It is my desire to proceed along the lines of the enforcement of this law in complete harmony and unity with the interests involved, and unwarranted interference with the rights of property or business holds no place in our plans, but evasion or studied non-compliance with the law merits and will receive stringent and forcible attention.

From a legal point of view, canned goods present a rather intricate question. It is manifestly impossible for an inspector or chemist to swear that because one can of a certain brand has been found to contain a preservative not noted on the label all other cans of the same brand likewise contain the same preservative. Condemnation and seizure of the entire stock of a dealer on such grounds would not stand the test of law, but the remedy consists in bringing suit on the basis of the one can whose contents were proved to be adulterated. This procedure is usually effective in forcing the retirement of the whole consignment.

It is not my purpose to take up in detail the specific action on health of each form of preservative. To do so would be simply a reiteration of established facts and a repetition of certain primary dictums of therapeutics; nor, at the risk of a tiresome and too lengthy discourse, may I discuss the full procedure used by the Department of Health in dealing with this class of cases. I would, however, mention briefly our system of meat inspection

which follows up the animals intended for slaughter and food consumption from the time of their arrival within the city limits through the process of slaughtering the animal, dressing the meat and its transportation through the streets, until it passes through the retailer's hands and is sold to the consumer. During the last six months of 1907, as a part of this work, 41,824 inspections were made of slaughter-houses, stockyards, butcher shops, packing-houses and other places connected with the meat industry; during the year 2,974,948 pounds of meat were condemned and destroyed.

The city markets, retail stores, bakeries and other places where food is prepared and sold, and even the pushcarts, are constantly under our supervision. During the past year 3,533,858 pounds of such foodstuffs, including fish, were seized and destroyed, while 7,540,516 pounds of fruits met the same fate. This immense quantity of edibles was unfit for food, some part of it by reason of the addition of foreign substances and some because of its natural decay. In a number of specimens of food analyzed to determine. the presence and character of suspected preservatives 16 instances were found in which chopped meat, or so-called Hamburger steak, contained sulphurous acid. Smoked liverwurst was preserved with both sulphurous and boric acids; frankfurters found both artificially colored and containing boric acid; vinegar doctored with sulphuric acid, and "olive oil" made up largely of cottonseed oil; gelatine containing sulphites; "lemon extract" with no lemon in it, and "pure honey" found to be glucose with a small quantity of sugar.

On the whole the analyzed products have conformed with the letter of the law, and I have simply cited the above exam

ples to show that there is still need of vigilance. I believe that the quality of the food now sold in this city maintains a high average, and I do not wish to be understood as sounding any note of alarm regarding its purity nor the honesty of our merchants.

Although these violations of the law have been brought to the attention of the Corporation Counsel, and actions have been brought by him against the offending parties, as yet no cases have been taken upon appeal, and consequently there are no written opinions so far as the Department of Health is concerned in cases handled by it. A case under the State law, which is somewhat similar to our sanitary code, has just been decided in regard to a brand of tomato catsup which was labeled as follows: "Prepared from whole ripe tomatoes; no artificial color, and contains one-tenth of 1 per cent. of soda benzoate." This catsup was found to contain double the stated quantity of soda benzoate, a clear case of misbranding, and held to be a violation of the law.

Before the insertion in the sanitary code of those sections which have to do with the adulteration and misbranding of food and drugs the Department of Health had proceeded against the evil of drug subtstitution and deceptive branding of medicines. Section 65 of the code gave ample authority for this work, and numerous instances were discovered of direct substitution of drugs in physicians' prescriptions, as well as that other fraud, the careless or intentional difference in the quantity of the drug dispensed from the quantity of drug ordered. In the former class the commonest forms of substitution were the use of acetanilid in place of the then more expensive phenacetine, and the use of wood alcohol where grain alcohol was indicated. In the sec

ond class the evil was even more widespread. Instances were not uncommon where a prescription called for a number of capsules or powders, each containing a definite amount of a drug or a mixture of drugs, the dispensed packages were each found to contain from one-half to three-quarters of the quantity called for. Crude drugs, extracts and tinctures which were stated as of a definite pharmaceutical strength in the United States Pharmacopoeia were ordered, and the dispensed article found to be made up of drugs assaying only a fraction of the standard of total alkaloids.

If substitution in the case of food may be regarded as an evil, substitution in the case of drugs reveals such a greater degree of iniquity that it can only be regarded as a crime. Persons in health and the full degree of an alert mentality may to a great degree protect themselves. against fraud and deception, but the helpless invalid should receive tender consideration and undeviating honesty from those persons in whom he has placed faith to the extent of trusting his regained health, or even his life itself. Many a conscientious physician, trusting in the known efficacy of a drug of known potency and power, has been puzzled and disheartened when following its administration the expected result has not ensued. Here it is not a question of a slight deviation in the standard of normal health. Prolonged illness or even death. may be the outcome of this reprehensible fraud on occasions. The retail druggist may be entirely guiltless and the fault may be traced to the manufacturer.

In an analysis of 29 samples of crude drugs for their alkaloidal strength made by the Department of Health not one was found to conform to the standard. Sam

ples of powdered belladonna leaves with a standard of .35 per cent. of total alkaloids were found to contain amounts varying from .06 to .21 per cent. Powdered opium varied in its percentage of morphine from II to 14 per cent., while a sample of saffron examined showed 28 per cent. fine saffron petals and 72 per cent. analine-dyed petals, probably magnolia or daisy. That crude drugs may naturally vary in these degrees is well known. The fraud lies in the concealment of the true state of affairs, and the remedy in their assaying and the plain labeling of their alkaloidal strength.

In the endeavor to correct these conditions we have had the earnest co-operation of nearly all the large firms of druggists, and such a state of affairs no longer exists.

Misbranding of drugs and medicinal mixtures covers a multitude of sins. The opium, cocaine and whiskey habits often date their onset from the use of patent medicines containing them. The moral and mental degradation of the victims and the resultant and widespread suffering entailed as a result of this vicious taste is too well known to need more than a passing mention. The cocaine habit alone has grown to alarming proportions. Its sale, other than on the prescription of a physician, is now prohibited, and I am glad to record that one of the most notorious offenders in this respect has had the opportunity of repenting of his misdeeds. afforded by an enforced six months' imprisonment.

Catarrh powders, under many designations, have been found to owe their soothing effects and long-continued use to the presence of this drug, while mixtures for internal use and variously labeled as "tonics" and "pain killers" have long

owed their popularity to the soothing effect of the opium or the exhilaration of the whiskey they contained.

Substitution, adulteration and misbranding are potent frauds, but the American people may always be trusted to restore the balance of right. The great moral awakening which has made possible the passage and enforcement of "the pure food and drug law" has also shown

itself in the general co-operation on the part of the producer and dealer. The millennium may not yet be in sight, but conditions are rapidly improving, and the future is bright with promise. Constant vigilance may still be necessary, but the law is becoming less and less difficult of enforcement, and the final recognition of its just and beneficent purpose is well within the realm of possible attainment.

At first sight it appears rather peculiar that opposite conditions as stenosis and patency of the pylorus should be found in one and the same patient. It probably occurs, however, relatively often. I shall first describe such a case and then add a few remarks.

December 27, 1907. Wm. J. B., 50 years old, has been suffering for the last five to six years from dyspeptic attacks, lasting usually from one to two weeks, and consisting only of pains one to two hours after meals. Two years ago his trouble increased and the attacks lasted a longer time (three to four weeks). Pronounced constipation developed. Six months ago patient began to vomit more frequently and he was suffering almost constantly. At times patient felt severe pain in the upper epigastrium, sometimes only a feeling of pressure in the stomach and burning in the scrobiculus. Vomiting now ensued regularly every day or every other day, a large quantity of fluid and food being ejected. Blood was never found. His sleep was often disturbed by attacks of pain. Patient lost steadily in weight, about 50 pounds in all in the last

six months. Patient has always used alcohol freely, as well as tobacco. He denies the history of syphilis.

Present condition: Thoracic organs are apparently normal. Stomach extends to two fingers above the navel. Clapotage can be elicited in the left hypochondrium somewhat higher than normal. The liver dulness begins in the right mammilary line, one finger's width below the mammilla, extending two to three fingers' width beyond the right costal arch.

Examination of the stomach contents revealed the presence of food from the day before, the presence of HCl, some bile and a moderate acidity. Sarcinæ were not found. A few days later patient is examined in the fasting condition after having eaten a plate of rice with milk on the previous evening. Examination with the stomach tube brought up about 300 cc. of greenish contents, in which much rice and other food remnants were found. Free HC was 60. total acidity 80; Benzidin test revealed presence of occult blood.

Urine is free from sugar and albumen.
The blood showed 5,100,000 red, 8600

white blood cells; hæmaglobin, 85 per

cent.

The diagnosis of pyloric stenosis probably of a benignant nature and beginning cirrhosis of the liver was made. The patient was placed on a strictly liquid diet. and the stomach was washed daily in the fasting condition. Medicinally he received magnesia usta and bismuth subnitrate and sajodin.

Patient felt much better, the vomiting ceased and the pains disappeared; he slept well. Examination with the stomach tube, however, revealed every morning the presence of 200 to 600 cc. of greenish contents, containing plenty of food remnants. HCl and bile were always present; the acidity was between 60-80; occult blood was almost constantly found.

Off and on persistaltic restlessness of the stomach could be plaintly seen in the upper left epigastric region.

On January 2, 1908, two beads filled with methylene blue and coated with mutton tallow were left in the stomach for four and a-half hours. The length of the thread of one of the beads was 50 cm., that of the other 75 cm. On withdrawing the beads it was observed that they both contained the methylene blue and tallow; therefore, it was concluded that the distant bead did not pass the pylorus (the bead was too thick to enter the narrow canal).

The above treatment being carried out for two weeks without any improvement of the ischochymia, and patient having lost two pounds in weight, surgical intervention was clearly indicated.

On account of the constant presence of bile in the stomach, the diagnosis of a rigid pylorus, being stenosed and at the same time patent, was made.

On January 12, 1908, 9 P. M., the

stomach was washed and no more solids or liquids were given. The next day at I P. M. the stomach tube brought up about 300 cc. of dark geen contents containing gastric juice and bile. Food was not present; the acidity was 60, free HCI 40, no occult blood.

About 3 P. M. patient was operated on by Dr. Willy Meyer. In the pylorus was found a thickening extending into the duodenum. The stomach was somewhat dilated, with walls considerably hypertrophied. The gall bladder was normal. The liver looked bluish-gray and had a somewhat uneven surface. A posterior gastroenterostomy was made. On the 14th and 15th patient had gastric hæmorrhages, which ceased. Later pneumonia developed, with very high temperatures, and patient finally succumbed on January 19, 1908.

EPICRISIS.

Regarding the diagnosis of the above case, it had to be made "stenosis and patency of the pylorus." The stenosis was certain, owing to the constant presence of ischochymia and occasional peristaltic restlessness. The rice test, as well as the methylene blue tallow bead, also pointed to it.

The proof of the inability of the pylorus to close was not so easy, and rested more on probability than absolute positive evidence. The constant presence of dark green bile in the stomach whether food was taken or not spoke for a continuous regurgitation of duodenal contents (bile) into the stomach.

This may be caused by two conditions-by a stenosis of the duodenum below the papilla vateri or through patency or inability to close on the part of the pylorus. In this case we had to deal with the latter condition. In the cases of stenosis below the papilla vateri, which