work for the enrichment of the life of the nation.

This is the message for the New Year we wish to leave with our readers.

Patients want to be treated. If physicians tell them that medicines are no good, they go to quacks who have, or pretend, confidence in their modes of treatment.

THE GENERAL PRACTITIONER, AND THE "FLU" or

In the discussion of Doctor Croft's

paper on the recent influenza epidemic (this journal, Dec. p. 895), Dr. G. Frank Lydston asserted that during this epidemic the medical practitioners were a rather panicky lot; that they had permitted themselves to become scared because of the unaccustomed symptom-complex confronting them and also because of the fact that there was known no definitely established bacterial etiology of the disease and, consequently-forsooth-no "scientific" treatment. Doctor Lydston declared that physicians were needlessly frightened and that it was absurd to try to treat a disease when there were patients presenting fairly clearcut symptoms of illness, and who could properly be treated "for what ailed them."

If it were not somewhat humiliating, it would be amusing to investigate this matter a little further. It is very true that physicians were in a panic and that this reflected upon the people, who, consequently, were literally scared to death. Το make a diagnosis of influenza, was almost paramount to suggesting engaging the undertaker, and in many instances the mortality rate during this epidemic was unduly high. This is true especially for places where large numbers of people congregate, as, for instance, in military camps.

Is there any truth in the implication that the intensive pursuit of the science of medicine limits the mental horizon of the physician and makes him helpless when confronting unforeseen contingencies or symptom-complexes that he can not explain "scientifically"? When the attempt was made (and evidently with favorable results) to prevent disease following after exposure to infection and also to modify the severity of an actual attack, by means of combined bacterins containing at least the greater portion of the microorganisms encountered in the secretions of the patients, this

method was discouraged from "authoritative" sources, on the plea that it was not "scientifically" established. Yet, experiences with a "scientific" bacterin containing solely the influenza-bacillus were anything but favorable, while the result secured from the "unscientific" combined bacterin in question were decidedly encouraging.

The remark may be interpolated herein parantheses, as it were that the infectious origin and nature of this epidemic disease appears to us indubitable. This, despite the attempt of Doctor Croft to incriminate some farreaching vitiation of the atmosphere that, according to him, constituted the primary etiologic factor, all infectious conditions being only of secondary occurrence-according to him.

However, while "scientific" physicians fretted and impatiently waited the O. K. of the laboratory for specific procedures that they might undertake for the treatment of influenza, the majority of general practitioners quietly proceeded to treat their patients sick with influenza, and the joke of it is that most of their patients recovered. In the words of Doctor Lydston, these general practitioners, whose names, to be sure, do not adorn the starry firmament of medical leaders, but, who, nevertheless, do a lot of good work, simply went ahead and treated their patients for what ailed them; regardless of the name of the trouble. And, how did they do it?

There was the intense aching all over the body and the marked fever-temperature, associated with severe headache. On general principles, the indication was clear for an intestinal cleanout. Hence, a saline laxative or castor-oil, in some instances preceded by calomel, was prescribed as a matter of course. This, to start things agoing. The fever, headache, and pain in general were controlled with acetylsalicylic acid, phenacetin or similar drugs; given carefully, to be sure, and often while guarding the heart with strychnine, digitalis, monobromated camphor, and so on; but, given to effect, that is, until the patient's distress was relieved.

Then there were the evidences of infection-irritation and inflammation in the upper respiratory passages, coryza, pharyngitis, lacrimation, and all the rest of them. Gargling with antiseptic solution and washing out or spraying the nares and the gullet did much to relieve these symptoms, while iodized calcium loosened viscid secretions, in addition to its mildly antiseptic systemic effect.

Manifestly, there was a condition of severe toxemia, in all probability owing to the overwhelming of the organism by various bacteria, the isolation and recognition of which did not interest the practitioner as much as did the overcoming of the toxic sequels. On general principles, he proceeded to fill up his patient with calcium sulphide or with echinacea. The result was, that pretty soon the very sick man or woman or child felt decidedly easier, say, on the second or third day, and that what looked like a severe attack of illness in the making turned out to be just influenza.

These or similar experience are reported by numerous general practitioners of our acquaintance. By prompt, definite, and positive medication along clearly indicated lines, these men succeeded in preventing complicating pneumonia in a great majority of cases, and they are justly proud of being able to show a surprisingly low mortality rate, as compared with that reported from many centers of medical learning where a monopoly seemed to be held on it.

Of course, it is quite natural that conditions should arise that make the physician look exceedingly grave and apprehensive of serious trouble. But, that a whole class of professional men such as physicians should permit themselves to be stampeded by a scare of a disease, even though they do not know its exact nature, is little short of ludicrous. For heaven's sake, let us keep our heads, no matter what happens. No disease is so pernicious that it does not present certain features that make it possible for us to apply common-sense measures and, ordinarily, to overcome it.

Living exclusively on fruits for a day or two is an excellent way to cleanse and disinfect the alimentary canal as much as it can be. Fruit juices are cooling to the blood and they help the kidneys to throw poisons out of the body. - Babu Balwant Singh, in "The Antiseptic."

DR. ROBERT GRAY IS EIGHTY-NINE

We have just received from Dr. Robert Gray, of Pichucalco, Mexico, a letter and an article for THE CLINIC. In this, he reminds us that he has turned eighty-nine, and says that, despite his advanced age, he still is as well, physically and mentally, as he has been for many years, in fact,

feels younger. The article will appear in an early issue.

Since receiving this letter, a telegram has come in from Doctor Gray, reading as follows:

"Calcium sulphide prophylactic of Spanish influenza. Mail 10,000 one-grain tablets."

This is advice worth considering. Doctor Gray is a man of wide experience with calcium sulphide, so, when he says that it is useful in that disease, you can depend upon it that he knows, for, no man has used more of it than has our old friend Robert Gray.

"CARRY ON"

Carry On is a little journal issued by the office of the Surgeon-General, U. S. A., and intended for the information of those

directly interested in the development of reconstruction work. No subscriptionprice is charged, and those men and women who come within the scope of "subscribers" may put in a request for copies. The editorial office, which is located at 311 Fourth Avenue, New York City, requests that persons asking for copies give, besides name and address, also their occupation.

The October-November number, which is number 4, contains various contributions dealing with what happens to the handicapped soldiers and sailors upon their discharge from the service. The vocationalrehabilitation law passed unanimously by Congress and signed by the President last June provides that it shall be the duty of

the federal board for vocational education to see to it that every disabled soldier and sailor entitled to compensation under the war-risk insurance law is aided in getting his old job or securing a new one. The board is required, furthermore, to give to those handicapped men that need and desire training before going into employment so much education at the expense of the federal government as each man may elect; providing, of course, that his claims are reasonable and that his previous training and the nature of his handicap are not such as to make training useless.

Under this beneficent law, thousands of our returned men will have the opportunity of learning new and useful trades before they reenter industrial life. practical workings will go far toward les

Its

sening the discouragement and misery inevitably following upon the realization of serious injuries and mutilations suffered during the war.

It is the desire of the government to help in every way possible, to make all disabled soldiers over into useful and active members of the commonwealth, that they may not be a burden to anybody, least of all to themselves; rather, that they shall realize that not alone their government, but, their country is grateful for what has been done by our soldiers and is anxious to rehabilitate and reinstate all returned soldiers and sailors in useful and active occupations.

The man who holds the ladder at the bottom is often of more benefit to the world than the one who climbs to the top.

THE VENEREAL-DISEASE PROBLEM

One of the outstanding difficulties in the

willingness of druggists to "help them out" by furnishing such remedies as are believed to be "good for" those maladies.

It is with a great deal of pleasure that we take cognizance of an announcement by the Owl Drug Company that, after December 1 last, no preparations for the self-treatment of venereal diseases will be sold in the 29 retail stores of that company located on the Pacific Coast and in the Middle West. When preparations of this nature are called for, the salesman is instructed to explain the new policy of this concern and to hand the customer a carefully prepared confidential circular, which explains the seriousness of all venereal diseases and the importance of consulting a reliable physician. A list of such will be furnished upon request.

Standard preparations, recognized by the medical profession, will be carried by the prescription-department, however, and sold only upon orders from a physician.

sented by venereal diseases is, the oldestablished habit of people to make light of their afflictions and to treat themselves with the assistance and connivance of some unscrupulous or ignorant drug-clerk.

The shelves of drugstores are filled with patent medicines that, in veiled, but, nevertheless, unmistakable language, promise a speedy cure for diseases that admittedly yield only to persistent and continued treatment carefully regulated according to the individual peculiarities of the patient and to given, momentary conditions.

Many attempts have been made to include venereal diseases among those that are notifiable and, consequently, subject to control of the health-authorities. As in so

many other matters, any laws, rules, and regulations adopted could not be enforced unless the popular opinion was in favor of such enforcement; and while, with respect to venereal diseases, the disastrous "conspiracy of silence" still holds sway to a certain extent and the fetish of personal liberty is being invoked, in every possible way, the purposes of the healthdepartment regulations are constantly being defeated.

Once popular opinion decides that venereal diseases, the socalled social diseases, constitute a serious menace to the social welfare, regulation of this problem will become possible. In the meanwhile, the carelessness of patients has been fostered by the

Company discontinued the manufacture of several preparations for self-treatment.

This innovation was decided upon after the management had given due consideration to the report of the Surgeon-General of the U. S. Army, which showed an alarming prevalence of venereal diseases among the civilians that were examined preparatory to entering the army.

The action of other druggists will be awaited with interest.

EYE LESIONS PRODUCED BY MUSTARD-GAS

The abrupt termination of the war brought an end to a large amount of interesting research-work. For instance, the introduction of poisonous gases in warfare made it necessary to develop means for American researchcombating them! workers have been struggling valiantly with this difficult problem, and undoubtedly had it almost solved possibly entirely solved. As to this, we do not know.

One of the most interesting pieces of work that we have seen is that conducted, at the University of Michigan, by Warthin, Weller, and Herrmann, upon methods of combating poisoning with dichlorethylsulphide, commonly known as mustard-gas. Mustard-gas, as almost everybody now knows, is an intense irritant of every tissue with which it comes in contact, and, as it is a heavy gas, it settles into every little hole and depression. Also, since it was used by the Germans in explosive shells, it soon covered the ground and foliage of the battle-terrain, so that the utmost care was necessary to prevent the soldiers fighting over this ground from becoming seriously poisoned. The peculiarity of these burns was the fact that they did not appear immediately after contact, but, as a rule, only some hours afterward, increasing in severity and, eventually, if the amount of gas coming in contact with the skin and mucous membranes was sufficiently great, resulting in deep necrosis, involving extensive destruction. These skin burns were not easily prevented and were hard to treat.

One of the discoveries made late in the war was, that mustard-gas is neutralized by contact with chlorine, and various applications had been made of chlorine-carrying compounds to skin and mucous membranes for protective purposes. Dakin's solution, chlorazene (as chlorazene surgical cream) and dichloramine-T-chlorcosane were all employed, with most excellent results, in the treatment of these burns.

One of the most interesting pieces of work in this connection was, the study made of the ocular lesions. Contact of the gas with the eyes causes an intense irritation, with degeneration of the corneal and conjunctival epithelium, and, if strong concentrations come in contact with the eye, more or less complete necrosis of the cornea, extending throughout its entire depth. Secondary infection is prone to occur, the result being a considerable destruction of tissue, which in turn frequently resulted in the impairment of vision and only too often in complete or almost complete blind

ness.

After trial of a variety of remedies, including boric-acid solution, colloid-silver preparations, cocaine, and the various common ophthalmic antiseptics, the investigators turned to the use of dichloramine-T in chlorcosane, which had been recommended by various writers for the treatment of infective conditions of the eye, such as trachoma. "Our experiments," they say, "showed that this solution, if applied to the eye before exposure to the gas, has a definite prophylactic action, and that, when applied before and after exposure, the resulting lesions are much less severe. In

cases in which the exposure extends over a period of several hours, the administration of dichloramine-T in chlorcosane causes, naturally, no change in the intensity of the lesion. Here, its after-use is indicated for its germicidal action and the prevention of secondary infection. It seems to us likely that instillations of dichloramine-T in chlorcosane solutions could be used as prophylactic methods on the battlefield during a known gas-attack, and that, in cases of severe eye injury caused by dichlorethylsulphide, its use should be continued, for the purpose of preventing secondary infection."

If the war had continued, it is probable, in view of these experiments that dichloramine-T-chlorcosane would have been generally employed by every soldier prior to "going over the top", for the purpose of protecting the eyes against mustard-gas irritation. It is also probable that either chlorazene cream or dichloramine-T-chlorcosane would have been recommended, for the same purpose, for general application to the body, as well as for the treatment of the lesions caused by this gas.

There is a principle which is a bar against all information, which is proof against all argument and which cannot fail to keep a man in everlasting ignorance, this principle is, contempt prior to examination.- Capt. Cecil Webb-Johnson.

THE VOLUNTEER MEDICALSERVICE CORPS

This organization, which owed its existence to the desire among those physicians that are prevented from joining the Medical-Reserve Corps, as also to the desire, on the part of the Surgeon-General of the army, to have available a complete list of all physicians upon whom he might call on for special service, has vindicated its existence splendidly in the recent epidemic of influenza. Last September, the Surgeon-General of the United States Public-Health Service, who had been charged with the national measures that were to be instituted for limiting the spread of the epidemic, requested the president of the central governing board of the Volunteer Medical-Service Corps to mobilize fifty units of the organization, each to consist of ten physicians, for emergency service in connection with the prevention of, and relief from, influenza. In response to this request, the names of the five hundred physicians asked for were

furnished within seventy-two hours. Three days after the first call, a request for another five hundred physicians issued from the Public-Health Service and, by October 1, the names of 1,135 physicians had been furnished, from among whom more than the necessary number were obtained. Since then, additional offers of service have been received and transmitted to Surgeon-General Blue for his reserve list. In this manner, the Volunteer MedicalService Corps promptly made good upon the first demand made upon it for assistance in an emergency and has thus justified its right of existence.

At the same time, the emergency that has arisen and was met so splendidly in the manner outlined illustrates the necessity to have attached to the United States Public-Health Service a reserve organization that can be mobilized in times of emergency.

In Public Health Reports for October 25, it is recorded that, with the widespread occurrence of influenza in the vicinity of Boston and the unmistakable signs of its starting elsewhere, urgent calls were addressed to the United States Public-Health Service to furnish medical and nursing relief to stricken communities. All available regular officers were detailed to the stricken communities, but, the number available for such detail was insignificant compared with the urgent need occasioned by the epidemic. Moreover, the bureau had no nurses available for service in epidemics.

In addition to his call upon the Volunteer Medical-Service Corps, the SurgeonGeneral issued similar requests to the Red Cross, the medical and surgical professions as a whole, and to the general public for volunteers to help combat the epidemic. At the same time, Congress was appealed to for a special appropriation to meet the expenditure requested by emergency. The necessary fund of $1,000,000 was promptly voted and granted.

More difficult than the securing of volunteer physicians was the problem of supplying nurses, for, it was found almost impossible to discover nurses or trained assistants that were not already extremely busy in urgent medical work.

Nevertheless, a limited number of nurses and trained attendants was secured by the American Red Cross and mobilized for emergency service in the communities most

severely affected. In addition to this, the attention of local communities was called to the valuable nursing-work that could be rendered by intelligent volunteer workers, such as school-teachers, especially when they are directed by trained graduate nurses. In many communities, the organization of this.group of nursing personnel has done much to relieve the serious emergency caused by the lack of trained nurses.

It was made clear from the outset that the United States Public-Health Service desired to aid, and not to supplant, State and local health-authorities in their work. Accordingly, instructions were issued that all requests for medical, nursing or other emergency aid for dealing with the epidemic should come to the United States Public-Health Service only through the State health-officer. Moreover, as soon as possible, all this epidemic-work was organized on State lines, with a representative of the United States Public-Health Service detailed to each State to secure the bestpossible organization and coordination of health-activities of the service; in others, the executive of the State board of health has been given appointment in the United States Public-Health Service as field director.

While the activities of the doctors and nurses working under the Public-Health Service are generally limited to those ordinarily regarded narily regarded as preventive healthmeasures, emergency conditions in some communities have been such that much medical relief work has had to be undertaken. This was the case, for example, in several communities where the few practicing physicians were themselves stricken and where the people were in urgent need of medical attention.

Never be satisfied with yourself! Always be discontented with your present success and strive ever for higher things.-Margaret B. Owen.

"THE MEDICAL REVIEW OF REVIEWS"

The last few years have witnessed notable changes in the medical press of this country, a number of the lesser journals having suspended publication and most of them having been absorbed by more prosperous competitors, either with or without retention of their former names. In a way, this tendency is to be applauded, since it goes without saying that an undue