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chicken feed. Chicken fanciers know that these fowl require animal food, and will starve if it is not furnished them. Chickens that are confined and fed on vegetable food alone soon begin to eat each others' feathers to satisfy the craving for the nutriment they require, although their troughs may be well filled with vegetable food.

There is no necessity of importing flies for this purpose. If they have a market value, as seems to be the case, this should be known; and the use of such fly-traps as would capture them would be stimulated. This seems to be the most definite proposition yet made in the way of abolishing the fly nuisance. Give the beast a value that will sufficiently stimulate the people in general to use the fly-traps. A single season would go far toward accomplishing the desired object.

Do you sometimes say that luck is against you? It isn't so. If you fail, it is not a matter of luck any more than when you succeed. A man gets in this world what he goes out to get. If he anticipates failure, talks failure, fears failure, what can he get but failure?

FIGHTING WITH GOLD BULLETS

We see, in the press dispatches that "bullets of solid gold were used by the Yaqui Indians in fighting against Porfirio Diaz in the recent Mexican revolution." It is related that in the hospitals, where many of the wounded soldiers underwent operations, the discovery of the golden pellets was a common occurrence, yet this cheering intelligence is tempered by the statement that "few patients received enough of them to pay the doctor bills."

Even with the uncertainly regarding the weight of those golden bullets there are many physicians in this country who would welcome a wholesale immigration of "Yaqui Indians." If they could be persuaded to use some of their ammunition upon the thousands of generous (?) citizens and citizenesses who demand the doctor's services, but who, once that service is rendered, are unwilling or unable to give anything in return for it, then a bounty might be paid for every new comer. There are few communities which could not profitably employ the individual time of at

least one able-bodied and straight-shooting Indian.

Nor would we all demand that the missile be gold. Silver would do for most of us-and many of us would be satisfied if the Indian would shoot our patients full of sand-sand enough to come to the front like honest men and confess that they owe the doctor at least a square deal.

Why should Mexico send these belligerent citizens to the hemp fields of Yucatan? We need them here.

ABOUT HOSPITAL MANNERS

A Kansas City (Missouri) newspaper recently discussed the charge made by Dr. J. F. Binnie, chief surgeon at its city hospital, that there is a deplorable lack of good manners of the military sort among the internes. The doctor complains that when he appears at the hospital for his rounds, the internes are not ready to receive him and to accompany him, and that they even sometimes keep him waiting several minutes if they happen to be busy with a patient. The doctor demands that every hospital should cultivate an "atmosphere," that when the chief surgeon or chief physician comes to take charge of his department at any time during the day, there should be a senior interne waiting at the front door to take him to his work and assist him, that the interne should salute him with the proper deference and be to him what an orderly is to his commanding officer.

Although as a nation we do not yield to any other people in courtesy and good manners, this sort of misplaced militarism seems at first sight excruciatingly funny. Fancy a lot of internes kicking their heels in the hall of a hospital, like bellboys, waiting for the chief to arrive, and fancy them bowing to the ground, or saluting like sentries when the great and mighty does make his august appearance. Fancy them falling in line and walking behind their superior with profound deference and bated breath, speaking only when spoken to, and then with polite reservation, "Yes, sir"; "no, sir"; "please, sir."

Binnie's proposition reminds us of conditions as they obtain in Germany, where military customs prevail through all classes and where teachers, superiors and chiefs are received with much show of deference. In our country we are too busy and consider that we have done our duty sufficiently well when we bid a new arrival a courteous good morning.

We are vividly reminded of an experience which the house officer in a southern tuberculosis sanitarium had with a noted German professor, one of the brightest of Virchow's former assistants. The chief of the sanitarium had gone to Germany and the professor was put in charge. The first morning, when he came to make his rounds, the house officer, with his book under his arm, started to walk with him through the different rooms, when the latter halted abruptly, glared at the luckless assistant, and exclaimed: "You valks behindt!" This professor also expected that, whenever he came to the laboratory, the bacteriologist should stand up and salute; and he demanded that all men whom he might meet in passing through the corridors lift their head-coverings and that the women bow. This sort of thing is most amusing to us of simple democratic ways. Such rigmarole may do very well in an army-ridden country like Germany, but it seems strained and opposed not only to common sense but to good taste, in this country.

If we would devote half as much time to criticising our own work as we do pointing out other people's faults, the chances are our own jobs would prove more profitable.

EFFECT OF CHLOROFORM UPON THE TISSUES

Some important data in regard to the influence of chloroform upon the tissues are described by G. Herbert Clark in an article contributed to The Lancet of January 21.

In these experiments small doses of chloroform were administered to rabbits, and then their weight was taken day by day.

When the chloroform was administered daily, the animal's weight fell rapidly. If

given on alternate days, there generally was but little change, although in a few instances a marked reduction in weight took place. When the chloroform was administered by inhalation, the kidneys and liver suffered considerably, the degeneration being greatest in those animals which survived for a longer period. The spleens were invariably engorged with blood, enormous phagocytes being present, and were distended with red corpuscles and often with pigment. The heart-muscles often appeared flabby and the walls were unusually thin. The liver also suffered when chloroform was administered subcutaneously. When given by the stomach the poison was not so rapidly fatal as by either of the two other methods. The average length of life was sixteen days.

The conclusions reached after this important series of experiments were as follows:

1. Chloroform, in small doses, repeatedly administered by the respiratory passages, subcutaneously or by the stomach, rapidly kills rabbits.

The liver shows degeneration of the cells sometimes so marked that the whole center of the lobule is broken down into débris. The cells in the center of the lobule are early affected, those further out, later. Fat is always present, generally in large quantities.

3. The kidney suffers to some extent, but relatively more when the chloroform is inhaled than when injected or given by the stomach. Fat is occasionally found in degenerated cells.

4. The spleen shows intense congestion, the sinuses being packed with red bloodcorpuscles. Along with the red corpuscles an orange-colored pigment is generally present, which reacts to the stain for iron A large number of very large phagocytes is present in most instances. The average weight of the spleen was 0.46 Gram heavier than that of the controls when chloroform was inhaled, and 0.59 Gram and 0.17 Gram heavier when injected and when given by the stomach, respectively.

5. Degenerative changes were observed in the cardiac muscles. Fat was not observed in any of the hearts examined.

[graphic]

The Etiology, Nosology, and Treatment of Pellagra

The Drying Linolin-bearing Seed Oils and the Abstraction of Sulphur as
Underlying Causes

By GEORGE C. MIZELL, M. D., Atlanta, Georgia
Formerly Associate Professor of Physiology and Gastroenterology of Atlanta College of
Physicians and Surgeons; Formerly Gastroenterologist to Wesley Hospital

EDITORIAL NOTE.-Pellagra is perhaps among the greatest medical problems now confronting the American physician. Here is a conscientious effort for its solution, based upon a logical and carefully worked-out hypothesis. In Dr. Bowling's paper, which follows this one, there is another theory-another plan for treatment. Study both.

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Any theory, to merit credit, must be consistent with the facts. For the history of pellagra, the reader is referred to the work mentioned. The first condition that is to be considered is conformation to history. All will agree that there is only one cause for the disease. Nearly all supporters of the maize-theory are driven by facts to the conclusion that maize is not the only cause of pellagra.

As pellagra is a new disease in the United States, we should look for some new factor that has entered into the conditions of life. As it is conceded by all who have presented

theories that the disease is noninfectious and noncontagious, and as Sambon's conception will not cover the facts attending the development of pellagra in this country, we are forced to look for some vast change in the conditions of life which parallels the progress of this malady. It is claimed that the change which would account for pellagra in the United States is to be found in the fact that there has been much spoiled corn consumed in more recent years, whereas thirty years ago no spoiled corn entered into the diet of the people inhabiting the affected regions.

Until the question is settled, it is well to admit spoiled corn as a cause of pellagra; at the same time, most writers and investigators admit that it is probably not the only cause. This being the case, should look for yet other changes in modes of life and other possible causes.

The Substitution of Cottonseed Oil for
Animal Fat in the Diet

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The one great departure in diet that has been inaugurated during the past twentyfive years is that from animal-fat to vege

table-fat consumption. A casual investigation will convince anyone interested that the cottonseed oil industry parallels the development of Lelagra in the United States. We have entered the ranks of oil-consuming nations. It can be shown that all nations afflicted with pellagra are large oil consumers, and that wherever drying (linolin-bearing) vegetable oils are used to any extent for edible purposes the inhabitants are afflicted with pellagra.

Cottonseed oil belongs to the semidrying order of oils. Below is given a table of this class of oils, together with their place of origin. Many other commercially less important oils are omitted, because less used and only supplementing the more common varieties.

PARTIAL LIST OF SEMI-DRYING EDIBLE OILS Kind Place of Origin Cotton-seed.....United States, India, Egypt, China, Russia, Brazil, Mexico, Japan, Turkey, etc.

Sesame-seed..... The Levant, India, Egypt, Java, Siam, Algeria, eastern and western coast of Afrisca, southern Rhodesia.

Maize. Beech-nut.

Pinot.

Kapok.

Brazil-nut.

Luffa-seed. Rape-seed..

United States, Argentina, etc.

Produced in Europe in 1713, but

not at present. Brazil and Guiana.

East and West Indies, South America, Mexico, Africa.

South America.

East India.

India, northern France.

Pumpkin-seed...Austria, Hungary, Russia. Sunflower-seed. . Hungary, India, China, southern and southwestern Russia. Poppy-seed.. Asia Minor, Persia, India, Egypt, South Russia, northern France. Poppyseed oil is a drying oil, containing a large percentage of linolin, and it is in extensive use for culinary purposes. Some of the oils enumerated contain a low percentage of linolin and hence may be of no importance as an etiologic factor in the origin of pellagra.

Laws regulating the importation of seed oils into some olive-growing countries. have, in recent years, been enacted, with a view to protecting the home industry. Some countries growing enormous quantities of oleaginous seed export it, consuming very little or none of the oil. Such is the case in China and Japan.

These oils differ from the nondrying kind in that they contain linolin, which is

the drying agent. The percentage of linolin varies, being 60 percent in cottonseed oil, and 65 percent in poppy-seed and sunflower-seed oils.

Parallel Prevalence of Pellagra and Seed-
Oil Consumption

Some of these oils have been used for culinary purposes by the people of southern Europe for centuries. It is significant in this connection that the first mill for crushing seeds for oil was established in Marseilles in the year 1817 and that pellagra was first reported to the Royal Society of Medicine in 1829.

A striking parallel is that the introduction of cottonseed oil into Egypt, as a substitute for olive oil, was followed by a report of the occurrence of pellagra. Commercial reports show the extent and area of the consumption of seed oils, and these reports show that pellagra coexists with the consumption of this class of oils, except as modified by climate.

In southern Europe, where pellagra began, these oils, because they are cheap, have been eaten by the peasant classes for centuries as a substitute for animal fat and olive oil.

It may be possible to obtain enough oil by eating maize to produce the disease. However, in view of the extent of maize consumption in the South, which fifty years ago far exceeded the amount consumed at present, it seems improbable unless the diet excludes all other food, especially fats. It is very probable that different degrees of diseased seed and grain will furnish an agent very potent in producing disease. Such a matter as rotten cotton-seed or a few bushels of dead rats in all stages of putrefaction in a vat of oil might render refining inadequate.

It is probable that the oil from such seed will produce much the same symptoms as are produced by the continuous eating of the sound oil, but with the difference that the symptoms from the diseased grain would be immediate and transitory, while those from sound oil would be delayed and in proportion to the quantity and length of time over which it is being consumed. A careful study of the experiments that

have been performed with extracts of spoiled corn tends to show that the results were obtained by a solution of the oxidized products of the oil.

Linolin as the Underlying Causative Factor

Another fact this theory is consistent with is that these oils are capable of producing the disease. The food-oil seeds of this class really undergo decomposition. The constituent which decomposes so readily is linolin.

When linolin is exposed to the air it is oxidized into linolic acid. Linolic acid combines with alkalis, forming salts which undergo oxidation even more readily than do free linolin or linolic acid. Linolin also has a strong affinity for sulphur, giving rise to a compound that does not oxidize. When linolin is brought into contact with an oxidizing agent like alkaline potassiumpermanganate solution it oxidizes more rapidly than in open air, with the same successive formation of linolic acid, sativic acid, azelaic or linusic acid, and ultimately isolinusic acid, besides aldehyde, according to the strength of the solution.

As has been demonstrated, when these drying oils are eaten there is a deposit of linolin in the tissues, and as the conditions are the same in the presence of the alkaline blood containing hemoglobin, an oxidizing agent, there seems to be no reason why this oxidation should not occur. It is perhaps true that linolin may be taken as food within certain limits and produce no deleterious action. This limit is probably restricted only by the amount of sulphur present with the food and in the tissues of the body.

The oxidation products of linolin are the agents suspected of being the cause of the disease. A more complete knowledge of these end-products will probably throw at clear light upon the symptoms and pathologic anatomy. Their nature is well enough known, however, to warrant the statement that they can produce the symptoms.

Observations in Animal Feeding Experimental evidence that this is true. is abundant. Only a brief outline of these experiments can be given here. White rats that have been fed a small amount of

cottonseed oil daily, in addition to a general diet, after a month die from a two-hour exposure to the sun. (Personal observation.) It is known to every farmer in the cotton-belt that cotton-seed and the meal are poisonous to hogs, horses, and cattle. The seed and meal can be fed to farm-stock, with any degree of safety, only in very limited amounts. Cows that are giving milk may eat larger amounts of seed or meal and hulls than dry cattle. It is probable that the immunity of milch cows lies in the fact that the oil is eliminated as butterfat and not stored up in the tissues. The presence of the oil in butter has been demonstrated. When cows are fed cottonseed meal through the calving period they are liable to die or miscarry, and the calves will likely die.

In Germany oil pressed from sesame-seed that has undergone "heating" is known to be poisonous, and the oil-cake poisonous to cattle. Cottonseed products can be fed with greater impunity in winter than in

summer.

The question naturally arises as to the freedom from disease of cattle fed on corn. Oil of corn contains only a small percentage (about 15 percent), while cottonseed oil contains 60 percent.

This theory is the only one yet advanced that is consistent with all the facts. It is the only one by which all the symptoms can be explained.

Symptomatology

There is only one characteristic symptom of pellagra-the dermatitis. All names (erythema, eruption, etc.) given to this symptom have failed to comprehend the exact nature. This symptom when uncomplicated, as stated above, is characteristic. Except in some cases, there is present an erythematous dermatitis around the genitals and anus from local discharge, and irritation of perspiration on opposed surfaces; the dermatitis is always confined to those surfaces exposed to the heat and light of the sun.

The Characteristic Dermatitis The features of the dermatitis vary greatly in different individuals, from a

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