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E. Stahl (reviewed in The Literary Digest, August 3), on the protective products of plants.

Concerning leguminous seeds, including beans, peas, and lentils, which form a large part of our daily diet, it is said that they contain a chemical substance, the exact nature of which has not been ascertained, but which is so poisonous as to prevent mice and rabbits from touching these legumes. This avoidance, the author observes, is not due to the hardness of their integument, since even when softened by soaking or boiling they are not eaten.

A significant circumstance, which housewives and the great canning factories would equally do well to take note of, is that, when the experimenter changed the cooking water several times, thus eliminating the toxic principle, the animals ate the seeds immediately. So, also, when the seeds were first ground to powder and extracted with alcohol or ether they were promptly eaten. A confirmatory experiment was then made. The alcoholic or etheric extract thus obtained

was used to moisten the favorite food of the animals, clover for the rabbits and crumbs of zwieback for the mice, and they rigidly abstained from the food thus treated. Further tests, consisting in pouring pure alcohol and ether over their food, proved that the deterrent cause did not proceed from these liquids themselves.

Says Prof. Peyer: "The active principle concerned seems to be volatile, for, on distilling the seeds with water, the first 10 or 15 cubic centimeters obtained had a particularly repellent action [upon the animals]. Similar distillates from grain and sunflowerseeds did not prevent the feeding of the animals."

These investigations of Peyer are of considerable interest and go to verify the opinion which this writer had formed some time ago in the course of some special researches, the results of which are not yet ready for publication; namely, that the active principles of socalled medicinal plants have largely the function or at least have the one important function, among others of acting as means of defense on the part of the plant against its enemies, whether insects, or animals, or other kind.

It is an interesting study and one not very easy of solution; still, the practical application, on the surface appears to be evident, namely, that it is wiser to boil the ordinary vegetables in two waters before eating.

And yet, and yet-the writer hardly had read Prof. Peyer's paper when he picked up one by Forbes Ross, who makes the statement that cancer is due to a deficiency of potassium salts, "owing to the popular custom of pouring away the juices of cooked vegetables, which contain potash and other valuable natural salts." And this view is in exact accord with certain theories recently advanced by Packard in The Boston Medical and Surgical Journal. Then, also, there is the living testimony of the many healthy disciples of a raw-vegetable diet.

On the whole-we shall abstain from giving advice!

Pay fair prices for pure drugs and charge fair prices for your services. Let no one point to you and say: "He is a cheap doctor, he uses cheap drugs, you cannot trust him."-Physicians Drug News.

"SOME UNIMPORTANT DRUGS"

Under this heading the erstwhile limelighted Council on Pharmacy and Chemistry-of late grown quiescent-in a pamphlet recently brought to our attention, discusses a number of vegetable drugs which are little known to the regular medical profession. Most of these have been employed by Eclectics, Homeopathists, and the laity. Now, there are several standpoints from which such drugs could be viewed, as, for instance:

1. That there is a reason for the repute and use one finds among any part of the profession or the people, and it is up to the investigator to account for such repute.

2. That, so long as we, the arbiters, are not convinced of the value of these remedies, they can have none.

3. That if these plants are not treated of in the works of certain therapeutists whom we accept as standard authorities, the remedies have no official standing and are unworthy of consideration.

4. That without favor or prejudice we examine the evidence submitted and render a judicial verdict, giving fair, impartial weight to the testimony.

Which of these points is occupied by the Council in the pamphlet before us we leave its readers to decide. But nobody has the right to assume the judicial functions who does not occupy the judicial standpoint.

For myself, were I in the Council, I should assume this judicial attitude and let the advocates and the opponents of each drug, the optimists and the pessimists present their evidence and arguments and then render my decision impartially. But as I am not the judge I prefer to adopt the first position mentioned and to begin with the assumption that for every popular belief there is an adequate cause. After deriding the silly ideas that toads and the organic tissues of sundry animals possess therapeutic powers, we have at last tried out these things and found the beliefs founded on fact.

"SOME UNIMPORTANT DRUGS"

Many, many times I am reminded that we mistake by basing our reasoning on the assumption of our own completed knowledge, instead of realizing that the entire mass of knowledge possessed by the human race is but partial and fragmentary, and may be fitly represented by the stray pebbles, shells, and weeds gathered on the shore of the limitless of ocean of truth, along which we wander and over which our limited vision peers, dimly, a little way.

Very many doctors, mainly irregulars, believe in the virtues of thuja as an application. The Council gives it mention, without expressing an opinion beyond the condemnation title of the pamphlet.

Apis has been used since Galen, but the regular knows it only as a remedy for rheumatism when applied by means of the hypodermic apparatus of the bee. The Council fails to mention the evidence against the remedy, which, it assumes, far outweighs that adduced in its favor. As to its reputed value in vesical atony and various genitourinary conditions, and so on, no information is vouchsafed save its use by irregulars.

Fucus acts only through its minute content of halogens-according to the Council. Caulophyllum, they assert, was dropped because it failed to sustain its reputation. Failed with whom? Cornus is unnecessary as a bitter or antimalarial, but the writers apparently are unaware of its special value, the same as of that of caulophyllum, and a host of other drugs. Solanum, we learn, is probably of little value "in epilepsy"! Thrush's work on this plant has escaped the notice of Council members.

More interesting is the chapter on cactus, to which four pages are devoted. Here the conflicting evidence is presented, and these conclusions are reached: "(1) It is uncertan what part of the plant contains the active principle, and its nature is unknown. (2) Part of the favorable evidence comes from proprietary sources. (3) The clinical evidence is unsupported by animal experimentation. No reliable preparation has been developed; the action is not that ordinarily attributed to it, since cactus does not increase the heart-force, and despite the clinical evi

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dence the indications are too uncertain. (4) Further investigation should be made in the laboratories." This is as far as they could be expected to go after having positioned themselves incautiously against cactus.

And so on. However, I should be doing the Council and this pamphlet injustice were I to omit to speak of their work in opposing the numerous ready-made conglomerations of little-known plants that have been so energetically and successfully exploited. A dozen of these plants are each believed to influence in a general way the female reproductive organs, but just how or through what chemic principle nobody has as yet determined.

These drugs are often assembled, by enterprising exploiters, in a single preparation, and then this hodge-podge is urged as a remedy for every female ailment, from amenorrhea, dysmenorrhea and menorrhagia, constipation and diarrhea, anorexia and bulemia, to coma and insomnia. It is a disgrace to the profession that so many of us prescribe these crude and unscientific com-. binations, which nearly always emanate from nonmedical men.

If there is real value in helonias, aletris, caulophyllum, mitchellia, viburnum, dioscorea, passiflora, et id omne genus, let us have their true place established by study of their active principles, with the precision of modern methods. If they possess different principles, there are diversities in their powers that would render each better fitted for some cases than for others. If they have one common ingredient, like the arbutin-bearing group, let us know what it is the presence of which in any plant renders it useful for woman.

The Council members turn aside to take an unnecessary whack at condurango, and in their hurry to exhibit their readiness to condemn it they fall into a fit. Thus, they assert that condurango has no specific action and is valueless, and then in the next paragraph they quote Cushny as to the presence of glucosides inducing grave toxic symptoms. If these glucosidic principles exert an influence over the bodily functions, it seems reasonable that their activity might be usefully applied when it is specially needed, as in the case of other positions. The strong evidence favoring condurango is gotten rid of by the simple process of reducing it. Baptisia is condemned because five named pharmacologists fail to mention it and, as the sum of therapeutic possibilities is embraced in their works, of course nothing outside of them can have value.

Our conclusion is, that the Council has not fully grasped the possibilities within its reach, and that, while it has done some needed work, this would have been infinitely more valuable had it been more dispassionate and more broadly judicial in its published reports.

FACTS REQUIRED BY THE NEW POSTAL LAW

At the last session of Congress, an amendment was added to the Post Office Appropriation Bill, requiring the filing and publication of certain information concerning the ownership and editorship of periodicals admitted to the mails as secondclass matter. This amendment reads, in part, as follows:

SEC. 467. It shall be the duty of the editor, publisher, business manager, or owner of every newspaper, magazine, periodical or other publication to file with the Postmaster General and the postmaster at the office at which such publication is entered, not later than the first day of April and the first day of October of each year, on blanks furnished by the Post Office Department, a sworn statement setting forth the names and post-office addresses of the editor and managing editor, publisher, business managers, and owners, and in addition the stockholders, if the publication be owned by a corporation; and also the names of known bondholders, mortgagees and other security holders. A copy of such sworn statement shall be published in the second issue of such newspaper, magazine or other publication printed next after the filing of such statement.

In accord with the provisions of the law we have placed our sworn statement on file with the Postmaster General and with the postmaster at Chicago, and reprint it herewith:

STATEMENT OF THE OWNERSHIP, MANAGEMENT, CIRCULATION, ETC.

of The American Journal of Clinical Medicine, published monthly at Chicago, Ill., required by the Act of August 24, 1912.

NOTE. This statement is to be made in duplicate, both copies to be delivered by the publisher to the postmaster, who will send one copy to the Third Assistant Postmaster General (Division of Classification), Washington, D. C., and retain the other in the files of the post office.

Editor, A. S. Burdick, 2148 Giddings St., Chicago, Ill.; Managing Editor, A. S. Burdick, 2148 Giddings St., Chicago, Ill.; Business Manager, S. De Witt Clough, 4536 N. Hermitage Ave., Chicago, Ill.; Publisher, The American Journal of Clinical Medicine, 4753 E. Ravenswood Park, Chicago, Ill.

Owners: W. C. Abbott, 4605 N. Hermitage Ave., Chicago, Ill.; C. A. Abbott, 4605 N. Hermitage Ave., Chicago, Ill.; J. C. Ryer, 5801 Winthrop Ave., Chicago, Ill.

Known bondholders, mortgagees, and other security holders, holding 1 percent or more of total amount of bonds, mortgages, or other securities: None.

A. S. BURDICK,

Editor.

Sworn to and subscribed before me this 4th day of October, 1912.

C. O. BROWN, Notary Public.

INFANT MORTALITY AND PHYSICAL TRAINING OF POTENTIAL MOTHERS

Below follows a summary of a dissertation on the topic named in the title, from the pen of E. Blanche Sterling, M. D., Wellesley College, and published in The Archives of Pediatrics for August, 1910.

In a series of 112 pregnancies, occurring in 66 women who had much training in physical exercise and in whose student-life the study of hygiene had been especially emphasized, the following facts are noted. It must be remembered, however, that a series of 112 cases is not a large one, and, while the results of this study are very suggestive, we could not call them conclusive unless corroborated by further investigation:

"(1). The death-rate among children of these marriages is lower than that given for the registration area of the United States, which is about 14.5 percent. (2) Eliminating the socalled "unavoidable causes" connected with birth, the death-rate is markedly lower. (3) The percentage of 'premature births is scarcely more than one-quarter that noted by Ballantyne in maternity hospitals. (4) Abortions occur about one-fourth as frequently as in most series of cases. (5) The percentage of breast-fed children is not as great as that given by Holt for New York City, which is probably about the average for all large centers of population in this country.

"We must not forget that in the school which these young women attended subjects pertaining to health were of paramount importance. I do not think that hygiene will ever become vital to the young women of the land until the academic councils of the various schools make as ample provision for such a course as they do for mathematics or languages or literature. Students will not take seriously a subject which the governing boards neglect."

"If we would solve the great problem of infant mortality,' to quote from George Newman's "Infant Mortality," 'It would appear that we must first obtain a higher standard of physical motherhood'."

Leading Articles

Surgical Aspects of Gastric Ulcer*

By HENRY F. LEWIS, M. D., Chicago, Illinois
Professor of Gynecology and Obstetrics in Bennett Medical College

EDITORIAL NOTE. This interesting article was read by Dr. Lewis at a meeting of the Surgical Club of Bennett Medical College. Gastric ulcer and duodenal ulcer are now attracting much interest in the profession, and should be carefully studied in all their phases.

HE etiology of gastric ulcer, aside from

TH

those cases due to caustics, syphilis, cancer or tuberculosis, is somewhat dubious. It is well known that hyperacidity favors digestion of the wall of the stomach and that the socalled peptic ulcer usually occurs in connection with that condition.

Some of the Factors Involved

The determining cause of the ulceration in any particular spot of the gastric mucous membrane may be a thrombus of an arteriole, and perhaps occasionally an embolus. Local traumatism from a hard or sharp particle ingested with the food, the violence due to retching and vomiting from any cause may also be determining and locating causes.

It is generally stated that gastric ulcer, especially of the round peptic variety, occurs twice as often in females as in males. Of late, however, a number of observers are disposed to doubt this statement and even to believe that the preponderance of frequency may be in the males. It is certain, moreover, that far more men than women suffer from perforation of a gastric ulcer.

Ulcer of the stomach occurs more frequently during the ages between twenty and forty than at other periods of life.

The location of the ulcer is on the posterior wall of the stomach near the pyloric end and near the lesser curvature in about four-fifths of the cases reported. On the other hand, perforation of the ulcer is far more likely to take place when it is situated on the anterior wall near the pyloric end. The reason for the latter fact probably is that this portion of the

*Abstract of a paper read before the Surgical Club of Bennett Medical College, December 15, 1911.

stomach has much more mobility than the posterior wall because of the movements of respiration which cause the anterior wall of the abdomen to move constantly up and down and the anterior wall of the stomach to be moved with each breath by the descending liver and the diaphragm. Adhesions which tend to protect the ulcer from breaking into the abdominal cavity are more likely to form behind than in front of the stomach because of the nearly immovable condition of the posterior wall.

The true peptic ulcer is round or elliptical, with clear-cut edges. The base and margin are infiltrated with leukocytes and therefore the older chronic ulcer shows much induration of the margins and bottom. It is the peptic ulcer which is more prone to perforation than the other varieties.

Diagnostication of Ulcer of the Stomach

The diagnosis of gastric ulcer, inasmuch as it depends largely upon subjective symptoms, such as pain and tenderness, is not always easy.

When an ulcer is present the ingested food irritates the ulcerated spot and causes spasm of the pylorus. This is preeminently true in most instances, because as a rule the ulcer is located near the pyloric end of the stomach. The spasm of the pylorus causes prolonged retention of the contents within the stomach, with consequent decomposition and distention with gases. The very spasm of the pylorus pulls upon the ulcer and intensifies the pain. A gastroenterostomy, by virtue of which the food is carried into the intestine by a shortcut, often prevents these distressing symptoms and even may be a valuable aid in perfecting the healing of the ulcer by allowing rest to the stomach.

Hemorrhage occurs at some time or other in about half of the cases. In acute ulcer the bleeding often is very great, sometimes fatal within a short time. In chronic ulcer the hemorrhages may be frequent but scanty in amount, and many times are accompanied by vomiting. In the chronic cases it is only when a vessel of considerable size is ulcerated through that dangerous hemorrhage ensues. The bleeding may not be evidenced in the vomitus, but may be shown by the presence of occult blood in the stools.

Pain as a Symptom

Unless pain is a prominent symptom, it is often impossible to make a diagnosis of ulcer of the stomach. Many cases of perforation are reported where there was no history of severe gastric pain until the occurrence of the perforation itself. Pain and the susceptibility to pain are such personal matters that a history of pain, or its absence, is not always a valuable diagnostic point.

The pain of ulcer of the stomach is usually felt in the middle line of the abdomen between the xiphoid and the umbilicus, often limited to a small area. The pain is frequently intense, especially after taking food. The pain after eating comes on within a few minutes when the ulcer is at the cardiac end, and somewhat later when near the pyloric end. It is likely to be more severe the nearer the ulcer is to the pylorus.

Ulcer of the duodenum usually causes pain some hours after eating and is not so constant a symptom as in ulcer of the stomach.

Tenderness is less frequent than pain. Ordinarily it is confined to a small area in the center of the epigastrium. It is elicited more generally when the ulcer is on the anterior surface than on the posterior. The tenderness of gall-bladder disease is more toward the right of the epigastrium and is more marked.

Differential Diagnosis. Gastric Acidity.
Oligocythemia

Hyperacidity, especially hyperchlorhydria, is almost always observed. However, this sign is not of great value, because it is present in many other conditions. The value of analysis of stomach-contents in cases of gastric ulcer is not so great as might be expected. There is no pathognomonic flora; there are no pathognomonic crystals. The existence of hyperchlorhydria is suspicious only. In general, while we expect a diminution or absence of hydrochloric acid in cases of

cancer and an excess in cases of ulcer from other causes, yet the exceptions are so many that the importance of these signs is minimized.

Anemia is a frequent sign. It is due to the loss of blood and also to the diminished ingestion of food. The extreme pain after eating often compels the patient to limit his diet to starvation quantities. Anemia and so called cachexia are not good points of differential diagnosis between simple ulcer and cancer, for the reason that both may be present to a considerable degree in either.

Tumor. Perforation. Gastric Ulcer

A tumor commonly signifies cancer, although ulceration about the pylorus of benign character may be accompanied by so much induration of the tissue around that valve, even by enlargement of the neighboring lymphatic glands, that cancer occasionally is incorrectly diagnosticated.

The diagnosis of perforation of gastric ulcer presents some sharp points of differentiation. As a rule there is a history of previous digestive disturbances, although rarely a history of a previous diagnosis of ulcer.

The first symptom of gastric ulcer generally is sudden excruciating pain in the epigastrium, with great local tenderness. There is rigidity of the abdominal muscles, especially of the left rectus. Collapse of greater or less degree soon follows; the pulse becomes high, the expression anxious, the breathing rapid and shallow. Collapse, by itself, however, is not of great diagnostic value, because its occurrence is so variable, as well as being caused by so many other conditions. Vomiting occurs in about half of the cases, but the vomit is seldom bloody. Next come signs of advancing peritonitis, tenderness extending throughout the abdomen, especially at the right groin, distention of the peritoneal cavity with fluid and gases, dulness on the flanks; later, obliteration of the liver dulness. This last is a late sign and should not be waited for in forming the diagnosis or in determining the necessity for operation.

Appendicitis. Gallstones. Pancreatitis.
Leukocytosis

Perforation of a gastric or of a duodenal ulcer may be mistaken for appendicitis. The operative procedures often begin with incision for that disorder, and the operator is led to the proper diagnosis because of the paucity of the pathological finding in and about the appendix. As the gastric contents pass down over the ascending colon and the

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