as hot as possible, to the ear, covering with absorbent cotton and bandage. In all these cases, sodium salicylate should be given internally and thorough elimination maintained. Not infrequently the intense pain may be relieved by the administration of two or three one-grain doses of phenacetin, i. e., one grain every thirty or sixty minutes, with a little hot water. Sodium or strontium salicylate may be given in 5-grain doses, three times daily for a few days. QUERY 6437.-"Phenol in the Treatment of Hemorrhoids." I. P. G., New Mexico, asks: "What information can you give me on the use of carbolic acid in the treatment of protruding piles?" Carbolic acid has been used very extensively in the treatment of internal hemorrhoids, while, at the same time, its employment has been as vigorously condemned. Local applications of phenol are not desirable, although very dilute solutions or mild ointments serve to allay pruritus. One of the most-widely used injectionfluids, especially for the eradication of single tumors, consists of: tannic acid, grs. 20; phenol, drs. 2; glycerin, drs. 2; water, drs. 4. This makes a 25-percent solution of phenol, which, plus the astringent tannin, quickly coagulates the blood when thrown into the pile. Indeed, it is so prompt in its solidification of the hemorrhoid that the puncture where the needle entered often remains open. QUERY 6438.-"Cephalalgia of Obscure Origin." W. E. D., Iowa, asks assistance in the case of a man, who is "in good health, excepting for attacks of a terrible headache, which occurs, sometimes, every few days or may omit for a month or two or even three months." W. E. D. writes: "I have tried nearly everything to relieve these attacks, but, nothing gives relief except a hypodermic of morphine and atropine. The pain is so severe the man has to go to bed. However, 14 grain of morphine with 1-100 grain of atropine always ensures relief. He goes to sleep and the headache will disappear. His father used to have these same kind of attacks. "The patient is now fifty years old and has suffered this since he was fifteen years of age. He is a man of good habits; smokes cigars, but, not to excess. His bowels are regular. I have examined his urine several times when he had such an attack and almost always found it of high acidity; however, alkalis do not give relief. His temperature is normal, the pulse a little slower than normal. I have known him for now fifteen years. Have thought that it might be of luetic nature; however, he denies anything of the kind." Considering the report on the urine and the age of your patient, we certainly should definitely ascertain the man's blood pressure and should also place him upon a low-protein diet. As you will observe, from the chart, the urea output is insufficient; indican and skatol are present in moderate amounts, together with colonbacilli, staphylococci, and a few streptococci; there also are present calciumoxalate crystals in moderate amount, a few large hyaline casts and cylindroids, some renal cells, and pus. We are inclined to believe that, under thorough elimination and proper dieting, most of the symptoms will disappear; still, in a case of this kind, it is essential that frequent urinary tests be made. Do not forget, either, the desirability of administering an appropriate vaccine. A Wassermann test might prove informative. What is the condition of this man's prostate? On general principles, we should advise the administration, at night, of blue mass and soda, gr. 1-2; podophyllin, gr. 1-6; bilein, gr. 1-12; repeated every half hour for four doses, followed by magnesium sul. phate or sodium phosphate the next morning. Midway between meals, we should give arbutin, with hexamethylenamine and acid sodium phosphate; after eating, some such combination as this: pancreatin, gr. 1-2; papain, gr. 1-2; diastase, gr. 1-2; bilein, gr. 1-32; strychnine sulphate, gr. 1-128; ginger, gr. 1-4; vegetable charcoal, grs. 2 1-2; sodium bicarbonate, gr. 1. Coffee and tea should be interdicted, and the patient ordered to drink three pints of water during the day. The skin should be kept thoroughly active. It also would be an excellent plan to wash out the colon once or twice a week with saline solution at body-temperature. If possible, have the patient relinquish smoking. It is unnecessary, we are sure, to call your attention to the desirability of having this man's eyes examined by a competent oculist. We certainly should not continue giving morphine. T About Bloodmakers a HERE has been much discussion of the question as to whether any mineral, especially, iron, can be absorbed directly from the alimentary tract and become part of the blood, and thus of the body-tissues. Because the blood-corpuscles contain considerable percentage of iron, it was, long ago, assumed by therapeutists that, in anemia (more correctly, spanemia), the logical thing to do would be to administer iron. However, in recent years, some members of the profession, and especially those inclined to therapeutic nihilism, have ridiculed this idea, insisting that the ingestion of inorganic iron can not possibly increase the iron in the red corpuscles, for the well-known reason that mineral substances first must be transformed, by vegetable chemistry, into organic compounds, and which only then can be appropriated by the animal-organism. Thus, for instance, the iron in spinach can be assimilated by the animal-body, while that in tincture of ferric chloride or in Blaud's pills can not. No one denies that, as a general thing, mineral constituents of animal-tissues have August, 1919 arrived there by the vegetable route, but, this is not saying that all of them have come that way. For, it has never been proven that it is impossible for minerals to be absorbed or assimilated; it has merely been reasoned out by analogy. But, even if ever it should be demonstrated beyond a doubt that iron or an inorganic salt of it, when taken into the stomach, never reaches the blood, that still would fail to prove the therapeutic nihilist's case. For, it is quite conceivable, and, indeed, by some believed, that the presence of inorganic iron in the digestice tract may exercise some special influence upon the assimilation of food, without itself being assimilated. Thus, the ingestion of inorganic iron-compounds would be justified. In deciding a question of this nature, the one whose observations and opinion ought to weigh most is the experienced therapeutist-the one that prescribes drugs, because his experience has shown him that he can get results with them. With him must rest the final decision. We owe much to the laboratory-investigator and have no desire to deny the debt. Yet, without pernicious anemia, arsenic is found ex- / to deprive ourselves of our most reliable belittling him, we can say that he does not know everything. There are three mineral substances that have acquired a reputation as bloodmakers, namely, iron, arsenic, and manganese. In the anemia resulting from the ravages of an acute disease, iron is a favorite; in out exception, unnecessary. He urges that the medical profession ought to join voluntarily in a movement designed to prohibit the importation and sale of all the habitforming drugs. In other words, although the chief object of medical science is, to alleviate human suffering, it is proposed tremely useful; while in the anemia associated with amenorrhea, manganese has proven especially serviceable. Of course, the employment of these three elements is not limited to the special pathologic conditions; for, as we know, they are prescribed more or less in every form of spanemia. Probably every doctor in general practice has seen cases like the following: A child has had scarlet-fever or some other acute disease. Convalescence is established, but, is imperfect and unsatisfactory. The patient is not regaining his normal condition as rapidly as he should. He is pale, anemic, without appetite. The doctor orders tincture of iron, 5 minims three times a day, and, perhaps, in order to make it less disagreeable, combines it with an equal volume of dilute phosphoric acid, or of spirit of nitrous ether, in a vehicle of simple syrup. In a day or two, the patient's appetite begins to improve and soon becomes fairly ravenThe blood-count rapidly rises, and, in a short time, the child is as well as ever. The skeptic declares that this was merely a coincidence; however, when the familyphysician has been observing just such socalled coincidences for a score of years, he can afford to smile at the cocksure dogmatist who "knows" that it is "impossi ous. ble" for mineral iron to enter the blood. There still remains much that we do not know as to how certain remedies produce their results; yet, when prolonged experience shows that they do produce them, we are quite justified in continuing using them, while we wait with patience for more knowledge about their mode of action. OPIUM MUST NOT BE PROHIBITED Dr. John Dill Robertson, Chicago's Commissioner of Health, has reported, in the daily papers, the result of a six months' experiment conducted in the city's Tuberculosis Sanatorium, in doing without the use of opium or its derivatives; and he draws the conclusion that the use of opiates is, with and efficient instrument to this end. Because a lot of criminals and degenerates are abusing the use of morphine and cocaine, only to degrade themselves still further, the decent portion of humanity are to be forced to deny themselves the relief of pain caused by accident or disease, no matter how agonizing. Incidentally, the Doctor asserts that there are 50,000 drugaddicts in Chicago. This is in line with the assertion lately made by the liquor-interest propagandists, that there are in the United States a million drug-addicts, and that prohibition would increase their number tenfold. Somehow, these assertions bring to mind the famous prediction, some two years ago, of a certain silver-tongued orator, that, if this country were threatened by a foreign foe, a million men would spring to arms between sunrise and sunset. On a subject of such importance, it would seem fitting that extravagant assertions should be abandoned for uncontrovertible facts. Dr. McNamara reports that, in the Cook County jail, in the six years from 1913 to 1919, out of 57,054 prisoners, only 755 were habitual drug-users, that is, 1 in 75. It is a fact that the percentage of drug-users is much higher among criminals than among the community at large. On this aspect of the case, the annual report of Surgeon-General Gorgas throws an interesting light. Out of 894,000 soldiers examined by the army-surgeons, only 403 were rejected as drug-users, that is, 1 in 2218. It seems fair to assume that the proposition of addicts in the community at large would be somewhere near the same proportion, since these soldiers came from every part of the country. Taking our population at 100,000,000, that would give a little more than 45,000 drug users in the United States. Then, if the population of Chicago is, in round numbers, 3.000,000, the same proportion would give the city only 1,350 addicts. It is well enough to be philanthropic and self-sacrificing, for the sake of the un fortunate, but, most of us will decline to go to the extent of denying relief to legitimate and unavoidable suffering for the sake of coddling the criminal classes. Even if it were possible to make consumptives endure their sufferings without the relief afforded by morphine or heroin, that does not prove it either wise or necessary to deny them this relief. Doctor Robertson admits that during the first three days of the experiment the sanatorium was almost a bedlam. No wonder! He asserts that now opiates are not missed there. It would be interesting, indeed, to know just what the patients say about it. It is true that many a consumptive in the world's history has gone to his grave without the relief that morphine might have afforded him; but, was he any better off for having endured that suffering? Does not humanity demand that we make that dreadful period of hopeless misery as easy as possible? Besides, there are other forms of pain that demand relief far more urgently than do the pangs of tuberculosis. What about the agonies of gallstone colic or renal colic or of the mangled and crushed bodies of the railway-accident or of the battlefield? Indeed, it seems almost unbelievable that any intelligent person would seriously advocate a law that would render impossible the relieving of such suffering. What a desolate place would be a world without a flower! It would be a face without a smile, a feast without a welcome. Are not flowers the stars of the earth, and are not our stars the flowers of heaven? -Mrs. Balfour. LEAGUE OF RED CROSS SOCIETIES National Red Cross Headquarters has announced the formation, in Paris, of the League of Red Cross Societies, the purpose of which is, to unify the Red Cross organizations of the world in a systematic effort to anticipate, diminish, and relieve misery produced by disease and disaster. The objects of the League are: (1) To encourage and promote in every country a duly authorized voluntary National Red Cross organization, having for their purpose the improvement of health, prevention of disease, and mitigation of suffering throughout the world, and, to secure the cooperation of such organizations for these purposes. (2) To promote the welfare of mankind, by furnishing a medium for bringing within reach of all peoples the benefits to be derived from present known facts, and new contributions to science, and medical knowledge and their application. (3) To furnish a medium for coordinating relief-work in case of great national or international disasters. The control of the League will be by a general council, composed of representatives of all members of Red Cross societies meeting at designated periods. A governing board of fifteen members will be chosen by the general council to direct the affairs of the League in the intervals between such meetings. Henry P. Davison, of New York, formerly chairman of the War Council of the American Red Cross, is chairman of the League's first Board of Governors. Other members of the board chosen thus far are: Sir Arthur Stanley, of the British Red Cross; Comte Kergorlay, of the French Red Cross; Count Frascara, of the Italian Red Cross; and Professor Ninagawa, of the Japanese Red Cross. Geneva will be the headquarters of the League and the world health-program shaped at Cannes will be further developed. While it is expected that the League of the Red Cross will establish intimate relations with the League of Nations, it should be understood that the Red Cross League, being a purely voluntary, nonpolitical, nonsectarian, nongovernmental organization, has no statutory connection with the League of Nations or with any govern ment. Mr. Davison, commenting on the Red Cross League, said: "The Red Cross Societies of the United States, Great Britain, France, Italy, and Japan have, for several months, worked incessantly through their representatives, to devise an agency that would adequately cope with the world-problems of disease and disaster. We hope it will be universal in membership. From the outset, it was clear to us all that there was no institution in the world so well adapted for this task as the Red Cross, because of the peculiar hold that it has upon the hearts of all peoples, irrespective of difference of face and religion; because of the amazing development of its powers in the recent war; because of the anxiety of its membership not to lose the opportunity for service when war-service no longer was needed. It is generally believed that the health-problems of the world can never be solved by doctors alone, but, must enlist hearty volunteer cooperation of the peoples themselves; and, no organization can mobilize the peoples of divergent views as can the Red Cross. For this reason, the five largest Red Cross societies have united to bring about universal Red Cross cooperation." Live for something. Do good, and leave behind you a monument of virtue that the storm of time can never destroy. Write your name, in kindness, love, and mercy, on the hearts of thousands you come in contact with year by year; you will never be forgotten. No, your name, your deeds, will be as legible on the hearts you leave behind as the stars on the brow of evening. Good deeds will shine as the stars of heaven. -Chalmers. TYPHOID FEVER DURING THE GREAT WAR According to a London newspaper, only 239 men in the British Army died from typhoid and similar fevers, and this low mortality is attributed directly to the antityphoid-inoculation practiced from the first beginning of war-activities; while 11,690 cases in the French army ended fatally before inoculation was begun. From other sources, we learn that, after inoculation against typhoid fever had been introduced in the French Army, the deaths from this disease diminished materially and that here also the protective value of the prophylactic inoculation was abundantly demonstrated. Every now and again we read carping criticisms of prophylactic inoculations against bacterial diseases, and not only ignorant laymen, but, also, physicians who ought to know better criticize this procedure, insisting that it not only is of no value. but, is in fact, injurious. It would seem, in the face of the figures cited in the foregoing, that comment is entirely supererogatory. We need but to remember our own experiences with typhoid fever during the Spanish-American war and contrast them with those during the later occupation of Mexico and also with our own experience, during the great war, in our home-camps and in our expeditionary forces. While, unfortunately, many and serious deaths were demanded by infectious diseases, including cerebrospinal fever, pneumonia, measles, and others, against which prophylactic vaccination is not as yet possisible. the morbidity and mortality of typhoid fever in the American Army have been so low as amply to confirm the observations in the British Army. MEDICAL VETERANS OF THE WORLD-WAR Many readers of CLINICAL MEDICINE will be interested in the new organization named in the heading, which was effected at Atlantic City during the meeting of the American Medical Association. It is designed to include in its membership physicians of the Army, Navy, Public-Health Service, and the former members of the draft-boards. Also, it was voted at this meeting to accept to membership physicians that have acted as assistant examiners during the draft. Colonel Victor C. Vaughan was elected president of the association, and Colonel F. F. Russell, of Washington, D. C., secretary and treasurer. Physicians eligible to membership should write to the latter for the necessarv blanks. The membership-fee is only $1.00. This organization promises to become a powerful one, and we know that every physician who 'did his bit' during the Great War will want to become a member. We urge every reader of CLINICAL MEDICINE who is eligible to send in his dollar and join at once. THE WAR-DEPARTMENT EXHIBIT At the recent meeting of the American Medical Association at Atlantic City, June 9 to 14, an exhibit prepared, under the authority of the Secretary of War and the Surgeon-General, by the curator of the Army Medical Museum, Washington, D. C., was on view, which illustrated the advances attained by the medical department of the army during the late war in its control of sanitation, medicine, surgery, hospitalism, and reconstruction of the disabled. Construction and administration of hospitals for the care of sick and wounded was demonstrated by the Hospital Division, with typical layouts of hospitals and views of scenes at a number of hospitals, including the hospitals at the remodeled Greenhut Building in New York City, the general hospital at Fort Sheridan, Illinois, the Tuberculosis Hospital at Den |