justify the trial of the Moser serum at least in grave cases; but from the theoretical standpoint, the serum is susceptible of criticisms which are seemingly justified.

In the first place, it may be asked why the action of this serum is less marked in light forms of the disease than in severe forms. If it were anti-scarlatinal, and not simply anti-streptococcic, it ought to act as markedly in the former as in the latter which it does not seem to do. Butand this is still more surprising the Moser serum does not seem to be even anti-streptococcic; the infectious complications commonly attributed to the streptococcus are not influenced by it, and Escherich insists upon the fact that it is antitoxic rather than bactericidal.

On these grounds, certain authorities, among whom are Hutinel and his pupil, Darre, raise the question whether Moser's serum does not act merely as a tonic, seeing that, in order to get any good effects from it, we must inject 100 to 200 e. c. In an effort to reach an answer to this question, Escherich practiced injections of simple. physiologic serum in scarlatina patients, using the same dosage. The results were not to be compared with those obtained with Moser's serum.

Conclusions

As a result of this study of the status of antiscarlatinal serotherapy, we believe we are justified in formulating the following conclusions:

1. Serotherapy constitutes, theoretically, the ideal treatment of scarlatin, but the experimental attempts thus far have not furnished sufficiently definite results.

2. Anti-diphtheritic serotherapy, as an adjuvant preventive of curative measure, is justified to a certain extent, by reason of the frequent association of diphtheria with scarlatina, and from the fact of the apparent attenuation observed in the diptheritic wards in patients treated with Roux's

serum.

3. The treatment of scarlatina by means of the serum of scarlatinal convalescents has no foundation in actual practice.

4. The various anti-streptococcic serums recognized in the treament of scarlatina seem to exercise no definite influence upon the development of the disease. Moser's serum alone keeps any advocates; its action seems to be chiefly anti-toxic.

济济济

Eschars and Abscesses from Quinine Hypodermics.-Moreau, in La Presse Medicale, has seen many of these lesions due to the treatment of malaria among the French troops. He states that a deposit of quinine under the skin has the quality of negative chemiotaxis and repels the

phagocytes so that pyogenic organisms can proliferate undisturbed. Abscesses are especially prone to occur in the loose cellular tissue which is best suited for hypodermics. However, these accidents may be prevented by proper technique. The bichloride should be the salt used and the amount injected should not exceed one-fourth of a cubic centimeter unless asepsis can be guaranteed, in which case it may go as high as half a cubic centimeter. The next safety provision consists in not making a second injection in the area of the first. A number of injections made at a single point may cause a large slough. If intensive treatment becomes necessary injections must be practised in a vein. In some quinine abscesses, however, the pus is sterile. How can one explain this fact? The flora when present shows great variety, presumably because various germs could be carried beneath the skin if the asepsis were poor. Such germs then merely transform an originally sterile to an infected abscess. Nor are the sloughs necessarily due to septic infection. Even in simple chemical abscesses there is seen a sterile necrosis of the subcutaneous tissue due directly to the action of the injected irritant. The author illustrates some huge necroses, one involving an entire buttock due to intramuscular injections of quinine. In the absence of any infectious element these must be regarded as due to trophic causes of peripheral origin, set up by the abuse of deep injections in a relatively narrow area. In some of these cases death has occurred preceded by progressive cachexia. In addition to primary sloughs the cavities of abscesses are also found to be lined with necrotic tissues. There is seldom a defensive wall to prevent burrowing, so that suppuration may encircle a limb or dip down between the muscles. In some of these cases chronic malaria furnishes a predisposition to the spread of these lesions through vascular alterations. While not to be classed as wounds already infected, these abscess cavities must be treated exactly like severe infected wounds, for here, too, anaerobes by infecting the abscess cavity can aid greatly the putrefactive changes. In a similar manner must eschars be treated. Dead tissue must be excised. These lesions necessarily leave marked deformities.

What is pain, and why are necessary for its treatment so almost countlessly many things--the opiates and their derivatives; the sedatives; the hypnotics; the analgesics; the anesthetics; the morphias, heroin, codeines; Indian hemp; the great number of bromides; chloroform, ether and the like; the cocaines; the exalgins, the phenacetins; chloral, sulphonal, trional, veronal, and so on and on almost indefinitely.

Within certain areas of the system we recognize a disturbance of the nervous distribution, followed by a troubling of the consciousness that acts as the parallel of the physical upheaval. This consciousness being stirred in one way results in pleasure, in another way, pain. Now, though pain follows upon some antecedent which, often times, is easily discoverable, it is still more often the case that the physical cause is less in evidence, the pain alone appearing to be the symptom and the disease. With the disappearance of the pain the disease vanishes, apparently. Even in those cases in which the disease remains the relief afforded by the banishment of the pain is so great that it amounts to a positive pleasure-as witness Montaigne, who records that he experienced so exquisite a delight upon the disappearance of the pain from his disease, gallstones in the bladder, that he would almost be willing to endure the one for the sake of the other which followed. And doubtless the great majority of men would take little heed of disease- but for the accompanying pain, for even though disease is a disturbance of balance, of right, of order, it is probable that most people would be able to put up with it if that were its sole claim to attention. It is the distress, the discomfort, the pain, which we wish to have removed, and of this there are two kinds-that of the body and that of the mind-both of which may be present at the same time.

us.

As to the relative intensity of the two classes, whether pain of mind is less or greater than that of the body, there have been many arguments on both sides, but these need not concern Either is bad enough, and calls most urgently for relief. Mental pain is more than a psychical whisper, as it has been called in the effort to show that thought alone may remove it, for it can put in motion such forces as will enter the very citedel of the body with disastrous, even fatal, effect, depressing the heart's action not only temporarily, but may even permanetly stop

it. It is abundantly proven that mental as well as physical pain can go to these lengths. Whatever share consciousness has in promoting the evil effects of a pain that is physical, it is certain that inhibitory influences accompany the disturbance which, physically, is the cause of the pain, though pain itself be dissipated. A surgical operation will induce a circulatory depression whether or not the consciousness has been completely routed by an anesthetic.

Shock and syncope-Syncope, or fainting, is a cardiac effect, while shock is a form of circulatory depression that affects the blood-vessels mostly, if not wholly, and pain may cause either one of them. In shock the vessels are rendered toneless by an inhibition which falls upon the muscular fibers that encircle the arteriols, the effect being a paralytic one. Though the pain of surgical operations sometimes brings about this condition, even when anesthetics have been employed, its seriousness is greatly reduced by the modern methods of putting the consciousness asleep. But both it and the syncope remain as incontrovertible witnesses to the effect that pain, so far from being a mere state of thought, and that alone is a force capable in certain conditions of destroying the body utterly, whether the source be mental or physical.

Pain and the Emotions-In its intimate association with the emotions pain highly influences the state of the nervous system, perhaps the most common example being the great degree of acuteness which the emotion of fear lends to the senses. This fact must mean one of two things, either that the emotion tunes up to a higher pitch the carrying paths, the nerve tracts with the terminal sentient expansions at the periphery, so that they will more readily receive and convey stimuli; or that the central perceptive parts of the nervous system, to which the stimuli are brought are themselves made more susceptible to irritation. As these centers are of superior organization, and therefore of greater susceptibility even in the natural state, it is probably in them that we should seek the beginnings of this phenomenon; but whatever the mode, it is beyond dispute that the emotions wield a remarkable influence over the organic functions in innumerable ways. Among the many illustrations of this fact that are constantly occurring in the fields of medicine and psychology, illustrations proving the power

not only of the great but the little emotions over the functions of the body, the following may be taken as an illuminating member of a class.

A man of thirty, having been treated psychologically for the drink habit, announced, after five days' treatment, that he was cured; that he had not used whiskey for two days; that all desire for it had left him, and that he felt certain that he never would want to take a drink again. The very thought of the stuff, he said, made him sick.

"Good," said the doctor, and continued, being a man who would rather know a truth of himself than rely upon the very best authenticated experiences of most people, "if you feel that way we will just clinch the matter," Watch in hand, he then went on: "I shall pronounce a list of words to you, one at a time, and as I speak each one you must speak out as quickly as possible the first word that comes into your head that seems even if only in a remote degree, to be related to the word I have spoken. Speak as quickly as you can, mind you, whether the connection seems bright or foolish."`

Here follow the words which the doctor used as stimuli, the answering words of the patient and the time consumed by the patient in each process:

The great jump from one and two seconds to five seconds was accompanied by a reddened cheek, a shifty eye, a stammer and a general appearance of uneasiness. WHY? The doctor knew that it was because the word "whiskey" struck some emotional complex which the other words did not reach. What, in the circumstances, could that complex be? Only one thing. The man was lying, had been drinking and wished to conceal it, and the embodiment of his sin being suddenly presented to him in the form of a word shook his balance unmistakably. The emotion showed in his face, his attitude, his speech and his hesitation to react to the wordstimulus. Through this clue the doctor found that the fellow came to be treated at his wife's desire, not at his own, and he thought that the quickest method of escape from a thing that he had no belief in was to pretend belief and cure. How many of the so-called marvelous healings have any better base of truth to rest upon than this!

Of course, the above case has more to do with

psychology than with medicine proper, but it nevertheless lucidly points out certain relations of the emotions to the organism, relations that every physician should know; for it's certain that such signs as here were given of the action of the emotions externally must have been preceded or accompanied by corresponding changes internally, and it is easily seen in how many ways such changes might affect the health. And if so varied a reflex may result from an emotion that is not even painful, in the ordinary sense, how great a reflex either good or bad may follow a stimulus of real pain, either physical or mental.

Methods of treating pain-Remedies for pain may be introduced in two ways to the nervous system, first by peripheral treatment, and second by central treatment.

The nervous system consists of a surface adapted to the receipt of stimuli; fibers which convey these stimuli by the sensory nerve; a central cell which receives, modifies and transmits the stimuli; branchings serving to connect the cell with other parts of the body; an efferent fiber; an efferent end-organ, the whole making a reflex arc. Now when a stimulus starts at the surface it travels as a disturbance of a molecular character into and out from the cell, during which passage consciousness is aroused, and finally arrives at the irritable end-organ, in which the efferent stimulus emerges as a motor effect, contraction.

The peripheral remedial approach-The benumbing effect of a remedy applied to the sentient, receptive surface, or to the nerve-fiber, which collects and conveys it, and which constitutes the peripheral approach, should be the first method attempted, chiefly because it assists in localizing the treatment more accurately to the affected parts. In a case of cough due to throat irritation a lozenge of cocaine and rhatany, staying the reflex, will accomplish the purpose: in neuralgia of the surface we paint the affected part with a mixture of liniment of aconite and menthol. Another advantage of the local treatment is that it affects the less important structures, the sentient surface and the nerve-fiber being more stable and not so easily deranged, compared with the delicate and intricately associated central structures. The more the influence penetrates the more it comes into relation with the complex arrangement of parts that is necessary to a central control, so that its own action tends to spread, while at the same time it puts in peril the nice balance of a multitudinous number of parts. The peripheral treatment leaves the central cell untouched, so that its ramifications are undisturbed.

The central remedial approach-The direct

appeal to the central cell is accomplished by such methods as the inhalation of ether and of chloroform, by hypodermic injection of morphia, and by the opiate draught. Though this plan has been a great aid to surgery it is attended by possibilities that are dangerous, inasmuch as the central anesthetic can not be confined in its action to the cells which govern the area of the wound. Once the drug has entered the circulation it is carried to every part of the system. the peripheral structures being subjected to the same degree as the central parts to the drug's action, the greater or less vascularity of the various tissues alone qualifying the conditions. Of course, the drug does not take effect equally susceptible, in accordance with the law of selective cell action, and as a rule it is the more highly organized central structures that are chiefly influenced. This occurs unless there is some special affinity. The commanding central effect, nevertheless, covers the entire body, the sentience of which must be benumbed in order to exclude the perception of painful stimuli coming from a limited part. Not only is this an extravagant procedure, but the depressing influence is communicated to other centers than the sensory. It is the action on the reflex centers of organic life that limits the use of the central anesthetic method, for these include two that are vitally associated with the integrity of life, namely, the centers which govern respiration and circulation. These must always be taken into immediate account. Other functions' may be abolished by an anesthetic for a longer or shorter period, certain as we may be that with the deadening influence of the drug the normal action will be resumed, but the moment the respiration or the circulation is attached the case becomes serious, and we are authoritatively warned either that the drug must be withdrawn or more cautiously controlled. This is the objection against the central mode. Still, there are advantages accompanying the temporary lulling of consciousness, especially with persons of hysterical habit, and in certain cases of urgent need.

Dangers of analgesics-Often a pain is so intense that the sufferer has no room in his mind for the thought of anything but that, and the more he thinks of it the more it is likely to persist and grow. In such a case the patient will welcome relief at all costs. The possibility that an analgesic, which will ease the pain, may carry with it a germ of the fatal drug habit, is too remote for consideration in such urgent curcumstances. Moreover, though the majority of us would fear for a dear friend in such an instance, we have not the smallest doubt of ourselves, and

eagerly seek the present relief. And we may be right in this. But while it is wholly legitimate to oppose a drug to an occasional acute pain, the legitimacy fades in proportion to the frequency with which such relief is sought, for not only is there the danger of thus establishing a poisonous habit, but the drug leaves traces of its effects in the tissues which are not to be avoided. No analgesic confines its action merely to the cancellation of a pain. It goes farther. And whether its beneficial or its disadvantageous effects will predominate is a question that must be left to the good judgment of the patient and the practitioner in each case. It is an individual matter, in which to take or to refrain must depend on the conditions.

Pain and sleep-Perhaps the question above. stated occurs in the matter of sleep more frequently than in any other direction. In view of the fact that sleep is necessary to the body not only as a soother but an invigorator, and that absence of it at the proper time is very far from being an uncommon occurrence, the soporific naturally is in great demand. Sleep is a basal condition of life. But the sleep obtained by the employment of drugs is not a normal sleep. It must be compensated for in some manner, sooner or later. Nothwithstanding this undoubted fact, there are cases in which the advantages of the soporific so heavily outweigh the disadvantages that it may be administered without hesitation, providing the disturbance be a temporary one only. Its value must be judged by the refreshment it brings, the sense of pleasure being left out of the summing up.

Pain of incurable disorders-As one purpose of medicines is that of palliation, of easing, there are undoubtedly times when a sedative may be administered, say in cases of incurable disorders, when there may be risk of initiating a habit. When there is an inoperable cancer, with pain as a prominent symptom, what is to be done? If the body were alone to be considered the answer would be, palliate that pain, or remove it if possible, at whatever cost to the physiological system, for the disease is incurable to what peace we may give him before he goes. But there is another, a psychic, aspect of the case. What of the moral stamina of the man or woman, which the administration of the physical palliative may sap? Every practicing physician knows the danger here. But this, too, is a matter of individual judgment. Each case must stand on its merits. There is no material rule the application of which would fit the general or abstract problem.

I.

Grounded upon the grim facts of personal experience, Dr. Charles Mayo of Rochester, Minn., a surgeon of world-wide reputation, has made the statement that the occurrence of cancer in the field of surgery has increased 700 per cent during the last 12 years, and that the death of every seventh individual after the age of forty, is caused by cancer! Closely sifting the evidences at hand, Dr. Mayo arrives at the conclusion that this ominous increase can have its sole physiological explanation in errors connected with current methods of food preparations.

If this be so, the all-important question to determine is the nature of the particular foodits quantitative and qualitative occurrence in our diet-that gives rise to the alarming inroads on life and health, indicated by Dr. Mayo's clinical experience.

Is the proteid consumption in our diet on an increase? Comparative study of the consumption of different staple foods at the different periods of history makes it quite evident that since the latter part of the last century and the beginning of the present, the indulgence in meat per capita is unmistakably on a decrease. We only need to recall the dietetic indulgences of the English yeoman of the Waverly period, as described by Sir Walter Scott, when, as daily occurrences, entire wild boars were roasted and consumed in a single meal.

In the "lives" of eminent men in France, Germany and England, during the 17th and 18th century, we are entertained by descriptions of feasts which, in quantity and quality of proteid consumption and gross gourmandizing, eclipse any modern Waldorf-Astoria banquet. Furthermore, when we consider the constant increase in later years of vegetarian eating houses and ethical non-meat societies, we have additional reasons for the conclusion that meat consumption, so far from being on an increase, is on a positive decrease in the eating-business of the world.

Nor is the consumption of another danger food, the white bread, increasing to an extent that would warrant the present increase of cancer. The white "French bread," "the " 'German pretzel," and the "English bun," were as popular in the days of Louis Quatorse and Queen Elizabeth as they are today; while the constant increase in the back-to-nature bread productions,

unfermented, hand-milled, new bolted outputthe cracked wheat, shredded wheat, sun-dried, unknown a century ago-bear in themselves testimonies to the fact that white bread, detrimental as it is to health and life, can not, more than meat, be held responsible for the increasing cancer menace of modern time.

II.

But there is one ingredience in our diet that invites the suspicion of every thoughtful student. It is an ingredience the indulgence of which has increased in a ratio directly corresponding to the increasing deadliness of cancer. During the last quarter century the consumption of manufactured sugar has increased at a rate that at present averages 80 lbs. yearly per capita, with a sum total of last year exceeding 7,500 mill. lbs.

No other element in the human dietary has increased with such leaps and bounds. The prodigious feeders of the Elizabethan era, when sugar cost a guinea a pound, consumed less free sugar in a month, than a modern school child, for a couple of penny's worth of "all-day-suckers' consumes in a day. In fact the indulgence of sugar has exceeded every other stimulant, even including tobacco, coffee, tea and alcohol.

On this basis, which can claim both historic and biologic accuracy, we are entitled to raise the arugment that if cancer is due to the excess of any particular food stuff in our diet, it must be sugar, and the combinations in which sugar enters as a part. And with the exception of a few pseudo-scientific writers of the sensational type, the conviction that sugar is a "danger food" is rapidly taking hold of our most advanced authorities on diet. Dr. Elmer Lee, Dr. H. Ellington Brook, Prof. B. H. Jones, Dr. E. Elmer Keeler, Dr. Harvey W. Wiley, Dr. John Tilden, and others, are constantly warning the public for the danger to health in the use of manufactured sweets. In a recent article in his health-department of "Good Housekeeping," Dr. Harvey Wiley makes the statement that up to their present age of respective 7 and 9 years his two boys "have had no candy of any kind, and no sweets or sugars outside of that contained in the natural fruits."'

In an article: "Is sugar consumption increasing," recently published in a current medical journal, the inference is made, that in view of the increasing consumption of sweets in states "gone dry," sugar is claimed to be a positive substitute for alcohol. This would explain the fact of women