as a large proportion of our food is starchy in character and requires complete mastication and admixture of the salivary secretion in order that the Ptyalin, its digestive principle, can come in contact with and transform each particle of starch into sugar ready for assimilation.

This is a simple physiological method of aiding in the establishment of a normal condition, differing entirely from the usual method of using animal ferments to aid digestion, the ultimate result of which is to still further weaken the already partly atrophied digestive glands.

This treatment will improve and to a large extent overcome abnormal conditions such as constipation, sleeplessness, mental depression, etc., dependent upon indigestion.

THE LIMITATIONS OF THE USE AND THE METHODS OF EMPLOYING LOCAL ANESTHESIA IN RECTAL SURGERY.

BY LEWIS H. ADLER, JR., M. D., OF PHILADELPHIA, PA.

The author quoting from a recent article of a distinguished proctologist states: "Patients seriously object to a general anesthetic and because of this and the fact that most minor ano-rectal operations can be painlessly performed under local anesthesia induced by sterile water, or a one-eighth of one per cent. eucaine solution, I have discarded general narcosis in about eighty per cent. of my rectal operations.''

In taking exception to this general statement he questions the wisdom of sending it broadcast and advocating a method which in the hands of one not particularly skilled in rectal work would in his opinion only lead to disaster.

He calls attention to the water logging of the tissues, when sufficient anesthetic be used, whether cocaine, eucaine, sterile water, or other agents and to the subsequent retarding of the recovery of the patient and the danger of hemorrhage from allowing patients to be about on their feet, citing a case which proved conclusively the force of his arguments.

The author claimed a thorough understanding of the underlying conditions can rarely be made without the aid of general anesthesia. The latter when administered by a competent anesthetizer is not attended with any more danger or risk than the indiscriminate employment of local anesthesia.

He calls attention to the fact that it is essential to remove the anesthetic when the sphincter is divulsed, as deep inspiration thus induced would cause too much of the drug to be inhaled suddenly, and might cause alarming or fatal results.

Rectal diseases, which may be treated under local anesthesia he considers under two divisions: (1) Those admitting of office treatment; (2) those requiring treatment at home or in a hospital.

In the opinion of the author external piles or other excrescences around the anal region, some fissures-in-ano, and abscesses (of not too large an extent), are the only affections coming within the range of operations which can with propriety be performed in the office under local anesthesia. He warns the operator that trivial fistula, often have diverticulae and are not readily discoverable except under general anesthesia.

Under the second heading he speaks of internal colostomy and internal hemorrhoids and warns the operator that the temperament of the patient must always be taken into account. Highly nervous patients will not stand manipulation of the intestines and the abdominal muscles are apt to be rigid.

The author mentions the different drugs used in local anesthesia, the vibratory method of Hirschman, the methods used in getting the parts anesthetized and the after treatment.

The trend of the article is not to throw cold water on the valuable procedure of local anesthesia, but to insist that the cases must be suitable and in the hands of men of experience.

THE WASSERMANN REACTION.

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B. Sachs, New York (Journal A. M. A., September 18), reports his experience with the Wassermann test in its relation to diseases of the central nervous system. He remarks that a positive Wassermann reaction may often be wanting in spite of the true luetic nature of the disease, if intense or prolonged antisyphilitic medication had been employed before the first test was made. In his work, therefore, he established a rule that neither mercury nor iodids were to be administered to any patient until the Wassermann test had been made. In the majority of cases, however, in which the negative reaction is obtained the thought of syphilis may be dismissed. What the test indicates is that an active syphilitic process exists somewhere in the system and any inference beyond this point is hardly justifiable. His work was confined largely to the examination of the blood serum. In 28 cases of tabes 18, or 64.3 per cent. were positive, and 10, or 35.7 per cent. were negative. This is a little lower than that of some other investigators but the character of the patients has much to do with the percentatges. Nineteen of his cases were private patients most of whom had been subjected to more or less specific treatment. they had all been hospital cases or patients seen for the first time, the percentage would have been higher. All his female tabetic patients and all his female paretics gave a positive reaction, and all the therapeutic suggestion he has obtained from the reaction was that in every case where it was positive, specific treatment was pushed with more energy than would otherwise have been the case. Of 31 cases of general paresis 32.3 per cent. gave a negative reaction and 67.7 per cent. a positive one. He thinks some of the cases may have been doubtful ones, as a number of them were in the psychopathic ward of Bellevue Hospital where they were detained only four or five days and diagnosis had to be made hurriedly. A positive reaction is not a positive diagnosis by any means for the neurasthenic early stage of paresis, since a syphilitic infection may occur or coexist with neurasthenia. The Wassermann reaction, Sachs says, is of special use in tabes and general paresis only in so far as it tends to corroborate the theory of the specific origin of the two diseases, and also in so far as it justifies one in adopting strict antisyphilitic treatment until the character of he reaction has been altered as a result of this treatment. He gives details of the treatment of cases of both tabes and paresis in patients thus reacting positively, in whom such treatment appeared decidedly beneficial. In doubtful multiple cerebrospinal sclerosis or brain syphilis the test is decidedly valuable in diagnosis and as an indication for treatment, as is shown by several cases in

Sachs' experience. It is also of much assistance in diagnosis of brain tumor or cases in which tumor is suspected, and it has become a routine matter, in his service in the hospital, to use the Wassermann reaction in all cases of brain tumor before operation is decided on, with a view of eliminating specific cases. He has a record of five such cases, in all of which the test was negative, and in one of which the reaction of the cerebrospinal fluid was also negative. In the sixth case a positive reaction helped him out of a serious diagnostic dilemma. As soon as the positive reaction was made out, the patient was put on mercurial treatment by sublimate injections, and within a week astonishing im provement occurred and he now seems to be fairly under way to recovery. Much assistance is given by the test in hemiplegias, especially if the symptoms indicate thrombosis, suggesting the possibility of specific endarteritis. It has also been useful in epilepsy when syphilis has been suspected as the only possible cause. A negative reaction is also instructive, particularly in cases of tumor of the brain, in case of headaches, and in conditions of disease of the peripheral arteries more or less resembling Raynaud's disease and erythromelalgia in which a negative reaction has led him to believe that the suspicion of specificity in these conditions may be given up. Sachs concludes by saying that the test is a valuable one in neurologic diagnosis as corroborating or dispelling the suspicion of specific disease. It is also of value in determining therapeutic procedures and of these, he believes the mercurial treatment the most effective, especially by the injection method.

MEDICAL VERSUS LEGAL RESPONSIBILITY.

A. Gordon, Philadelphia (Journal A. M. A., September 18), criticizes the legal test of responsibility, i. e., the knowledge of right and wrong, which is still influential in legal decisions. He goes over the various forms of insanity in which the question of responsibility may arise and shows how, with the loss of control which they involve, responsibility can not be admitted in a scientific consideration of the subject, i. e., the legal test of right and wrong can not be applied. On the other hand, in cases of voluntary intoxication the knowledge of right and wrong for the moment may be lost and yet the individual can not be considered in the same category and here also the legal test will not apply. The insane man may recognize the distinction perfectly, may appreciate the unlawfulness and immorality of his act, and yet be irresponsible on account of his inability to control conduct. The sane man, however, may intentionally make himself intoxicated and in this condition commit a crime, but, if he is acquitted or only slightly punished on the ground that he was unable to control himself from drink, or was too intoxicated to know right from wrong, there will be a miscarriage of justice. Gordon also holds that we can not consider a man completely normal and responsible during a lucid interval of insanity or in the remission say of general paresis, nor would he consider the legal test of knowledge of right and wrong entirely applicable in cases of dipsomania and epilepsy. His personal experience in the Pennsylvania courts has convinced him that the old test is still strongly adhered to and he believes that medical and legal authorities should make an effort to get together for a revision of the law in this matter. At least the medical expert should' not be limited to the exclusive right and wrong test.

THE SATISFACTION OF SUCCESSFUL THERAPY.

There is always a great and lasting satisfaction to be derived from administering a remedy and obtaining the result desired and expected. Aside from the therapeutic and more or less material benefits, the gain in medical confidence from standpoints of both practitioner and patient, is always considerable. Few remedies have given rise so consistently to the satisfaction of therapeutic dependability as Gray's Glycerine Tonic Comp. For a good many years thousands of physicians have been using this reliable tonic, with confidence born of almost invariable success, and to say that medicine and medical practice have been benefited and strengthened thereby is not only to state the truth, but to give deserved credit to a worthy product.

In prescribing so simple a thing as cathartic the physician can not be too careful for the pills or tablets which he recommends are almost certain to become the family laxative of that household. The choice should therefore be something which after acting as a purge will leave behind it no condition which will create a tendency to greater constipation. Of cathartics possessing this virtue none have proven more satisfactory than Hydro-Blene.

THE SURGICAL ASPECTS OF FILARIASIS.

Charles F. Sokes, U. S. Navy, states that 50 per cent of the inhabitants of our island possessions have filariasis. Not all of them show clinical symptoms. There are three species of filaria. The one that most often causes symptoms is the Filaria sanguinis hominis Bancrofti, or nocturna. The red blood cells are little affected, while the white show a large increase in eosinophiles. The adult worms live in the lymphatics of the trunk and extremities, both sexes being found together and breeding there. The adult worms are from 2% to 31⁄2 inches long and look like white horse hairs. Attacks of elephantoid fever and other complications are due to the dislodgment of these worms by traumatism an their lodgment in the lymphatic glands. The embryo forms are to be seen in the blood stream; they are 40 times as long as the blood cell is wide, and are transparent, and actively motil. About midnight 300 to 500 embryos may be found in a single drop of blood. The intermediate host of the parasite is the mosquito. Chyluria is caused by the presence of the adult worms in the thoracic duct, and may be complicated by serous septic conditions caused by the death of the worms in this situation. Varicose inguinal glands arise from the presence of the worms in the lymphatic glands. Chylocele is an affection of the scrotum. Elephantiasis arabum is due to the occlusion of the lymphatic trunks by the worms, which die and cause a pathological condition of the tissues. There is an attack of lymphangitis, with erysipelatous manifestations. The tissues then become enormously thickened and hardened. All the filarial lesions cause fever with mental depression. Prophylaxis is the best treatment; the worms cannot be killed when once they have gained a foothold in the body. Mosquitos should be kept away by screens. Traumatism should be avoided. Glands should be let alone. Elephantiasis of the scrotum should be removed.— Medical Record, January 28, 1911.

INEBRIETY, ITS TREATMENT AND CURABILITY.

T. D. Crothers, Hartford, Conn., says that the seeking for and using of any supposed specific drug for the treatment of inebriety is unscientific. Its cure must involve a treatment of many of the functions of the body. The so-called moral causes have no place in the progress of treatment. There are nerve defects, toxemia, and derangement of the functional and organic activities of the body manifested by low vitality and nervous exhaustion. The intense spasmodic desire for alcohol or persistent demand for its effects is generally present. The desire to repeat the pleasant effects of alcohol is pathological and points to a defect of metabolism and nerve function, a pronounced neurosis. Some persons are distinctly poisoned by alcohol. The disappearance of the desire for alcohol is not a cure. Removal of alcohol only takes away one of the causes. Disgust for alcohol does not develop strength to resist. The use of narcotics is irrational and unscientific. Two conditions must be recognize.l -a tendency to congestion with hemorrhage and paresis with narcosis. Diminished circulation and dehydrating of the blood and protoplasmic action of alcohol on cell and tissue are present. Gastritis, nephritis, and cirrhosis result. There is derangement of the sensory activities; spirits have a narctoic and depressant effect. A change in diet, sleeping rooms and surroundings is of value in treatment; elimination is the first object in treatment. Baths, electricity and hot air, and measures for the increasing of oxidation have a prominent place in treatment. Bitter tonics in the form of infusions are valuable at the beginning, and phosphates or iodides when there is a specific history. Drugs have but a limited value. Curability is probable with proper treatment at the present day.-Medical Record, January 28, 1911.

PERSONAL EXPERIENCE WITH A VERY RESTRICTED DIET (RICE) IN ACUTE INFLAMMATORY DISEASE OF THE SKIN.

L. Duncan Bulkley, New York, has found of great use in cases treated by him, as well as in a skin affection experienced by himself, a restricted diet consisting of boiled rice, with bread and butter, to be carried out for about five days at a time. The acute inflammatory diseases of the skin are marvelously well affected in a few days by the use of this diet. It is productive of relier especially to the itching and burning of these affections. Diet has a very great effect on skin diseases. An improper diet renders the tissues of the skin more susceptible to the action of micro-organisms. Proper liver action and phagocytosis account for the increased resistance of the skin. A deranged action of the chylopoctic organs is another factor in the production of skin diseases, produsing deranged circulation. Illustrative cases of the use of the rice diet are given. Imperfect or deranged urinary secretion has much to do with the causation of skin diseases. Proper kidney action is assisted by the exclusion from the food of nitrogenous elements of the diet. The patient feels better, lighter, and freer while taking the rice diet. The five days of non-nitrogenous diet causes an increased output of nitrogen, which is lessened when a return is made to the ordinary diet.-Medical Record, January 28, 1911.