City recommends oil and glycerine to which he adds a little atropia, and says that it controls the desire for stimulants.

A patient going to operation scared half to death already has more surgical shock than most should have at the close of the operation.

Preliminary narcotic medication is of advantage in many cases to eliminate the psychic trauma and prevent the rise of blood-pressure occasioned by the nervousness of anticipation of the operation. One hour before the anesthetic is administered

our patient is given a hypodermic injection of morphine, gr. 4 and hyoscine hydrobromate, gr. 1/100, atropine sulph., gr. 1/150. At this time he is also given a cup of hot coffee or tea unless there is some contraindication.

The morphine steadies the patient's nervous system, allays fear of the impending operation, narcotizes the centers in the brain,

so that they do not so readily receive painful impressions carried by the sensory nerves, tending thereby to prevent shock. Atropine, a good respiratory stimulant, lessens the amount of mucus secreted in the mouth, pharynx and bronchi during anesthesia.

At this time before the narcotic becomes effective it is well for the patient to empty his bladder voluntarily and will usually expel the remainder of any retained fluid

in the bowel.

The surgical cleansing and preparation of the field of operation is a vital procedure, and should always be done by one thoroly cognizant of the principles of asepsis (either a competent nurse or the surgeon himself). The whole operative field should be shaved and thoroly scrubbed with warm water, soap and a piece of gauze. After thoro drying, and not before, a solution of

three and a half per cent. tincture of iodine is swabbed over the skin and then wiped off. Many skins are sensitive to iodine, some are even blistered. Men's skins are often more sensitive than women's. A sterile towel is then placed over the field until the surgeon is ready.

The patient is to be properly clad, that the body may not chill, keeping in mind warmth, comfort and easy access not only to the field of operation but to all parts of the body.

Surgeons are called on frequently to operate on the anal region at a time when no assistance is available. Under such circumstances it is difficult to secure proper exposure.

I have utilized two adhesive strips about 51⁄2 inches (14 cm.) long by 2 inches (5 cm.) wide, according to the size of the patient's buttocks. To one end, which has been folded upon itself, is attached a long

strip of tape or bobbin. The other end is

divided into three equal strips about 3 inches (7.5 cm.) long. The middle strip is then made a half inch (1.3 cm.) shorter.

The patient is put in the lithotomy position or the knee-chest position. The middle strip is attached at the side of the anus (the region being shaved), and the superior and inferior strips are fastened above and below. This procedure is repeated with the second strip on the opposite side. The patient now pulls the buttocks apart while the surgeon ties the tape in front.

In practically every case I have found excellent exposure for the common surgical operations on the anus and rectum.

The choice of anesthetic for rectal operation may often require consideration. Spinal anesthesia, altho ideal when successful, is really the most dangerous; few now remain

When there is no serious heart lesion it seems perfectly permissible to use gas anesthesia when the operation is of short duration but in major operations ether is the choice. Regional anesthesia is particularly desirable in many cases and is very satisfactory.

REFERENCES.

1. REIMANN, S. P. & BLOOM, G. H.: J. Biol. Chem. 36; 211 (Oct.), 1918.

2. SHORT, J. J.: J. Biol. Chem. 41; 503 (April), 1920.

3. CALDWELL, G. A. & CLEVELAND, M.: Surg., Gynec. and Obst., 25; 22 (July), 1917.

4. RFss, E. M.: Canad. M. A. J. 10; 548 (June), 1920.

5. AUSTIN, J. H. & JONAS, A. F.: Am. J. M. Sc. 153; 81 (Jan.), 1917.

6. CANNON, W. B.:

"Acidosis in Cases of Shock, Hemorrhage and Gas Infection." J. A. M. A., 70; 531 (Feb. 23), 1918. 7. MORRIS, W. H.: "The Prophylaxis of Anesthesia Acidosis," J. A. M. A., 68; 1391 (May 12), 1917.

8. HENDERSON, YANDELL: J. Biol. Chem., 33; 345 (Feb.), 1918.

RATIONAL

ORGANOTHERAPY

Hyperthyroidism in Pregnancy.-Robinson states (British Medical Journal, February 11, 1922) that a physiologic hyperthyroidism occurs in every second pregnant woman and is characterized by enlargement of the thyroid gland without symptoms. Graves' disease rarely develops during pregnancy: it is a toxemic condition favoring sterility. The lesser degrees of hyperthyroidism are frequently seen at this time and sometimes are combined with symptoms suggestive of tetany. The thyroid and parathyroids form one glandular unit, the author asserted, intimately concerned with the growth of cells, the development of sexual function, and the regulation of calcium metabolism. During pregnancy the fetal demand for calcium leads to physiologic hyperthyroidism. Calcium depletion from pro

sufficient nourishment is an etiologic factor ing calcium in the tissues and preventing in tetany and parathyroid extract acts fixexcessive elimination by the blood.

Future of Organotherapy.-Sansum and Blatherwick (Endocrinology, September-November, 1923) believe that organotherapy, in general, has a wonderful future. but its future development will depend not on empirical, haphazard methods of study but on the type of study which has led to present knowledge of such products as epinephrin, thyroxin, pituitary extract and insulin.

Pituitary Treatment and Oliguria.Molitor and Pick (Klinische Wochenschrift, Berlin, December 3, 1923) report experiments on ments on the inhibition of diuresis by preparations from the pituitary gland (both

lobes). They were able to counteract it by giving salts, glucose and especially urea, but not by other diuretics. The action of pituitary preparations is extrarenal, but it is apparent only when the kidney is in good condition.

Active Principle of Pituitary Gland Found. The active principle of the pituitary gland has at last been isolated and purified (Harrow, "Glands in Health and Disease," New York, 1922). The announcement of this discovery, which adds one more to the list of glands the active agents of which have been separated in pure form, was made by the discoverer, Prof. John J. Abel of Johns Hopkins University, to the meeting at St. Louis of the Federation of American Societies for Experimental Biology. The only other pure glandular principles so far obtained by scientists are thyroxin from the thyroid gland, and adrenalin from the adrenal glands, both substances being of great use in medicine.

The impure extract of the pituitary gland is known in medicine as a powerful stimulant of the intestines and other structures containing involuntary muscles. It is a specific remedy for the disease known as diabetes insipidus, characterized by excessive activity of the kidneys but not to be confused with diabetes mellitus in which the sugar derived from food is excreted thru the kidneys instead of being utilized in the system. Insulin, an extract of the pancreas discovered in 1922 by Drs. F. G. Banting and J. J. R. McLeod of Toronto, is a remedy for the latter disease.

Professor Abel has obtained pituitary extract as a highly purified salt of tartaric acid and believes it to be probably a single chemical compound which may be made synthetically in the laboratory. His preparation has already been used in several severe cases of diabetes insipidus with remarkable results and promises to be of use in hemorrhage, shock, and uterine inertia. 1,200 times as active as the powerful base, histamine, now used in medicine.

It is

The substance isolated by Dr. Abel has been extracted from the posterior or nervous part of the pituitary body which lies at the base of the brain just above the roof of the mouth. The gland is in two

parts. The front or anterior portion has an important influence on growth, and cases of giantism or dwarfing are sometimes due to disturbances with its function. The posterior part of the gland possesses the powers exhibited by the principle which Dr. Abel has extracted from it and is also thought to have an important influence on sexual development.

Relationship Between Pituitary and Adenoid.-Some recent studies made by Alphonse Poppi of Bologna have emphasized the importance of keeping in mind the relationship of hypertrophy of adenoid tissue to the function of the hypophysis. There are certain symptoms which are supposed to be related to disturbances in both of these organs. Poppi cites the case of two children, each 7 years of age. In one there was a bi-lateral exophthalmus, which disappeared after removal of adenoids. In the second child, the adenoids and tonsil were both markedly enlarged and exophthalmus was prominent. The tonsils were removed, but the condition was unchanged. After an interval, the adenoids were removed and the exophthalmus promptly disappeared. There seems to be no good explanation of this peculiarity unless it be based on disturbance of the internal secretions. Enlargement of adenoid is thought to be due to a persistence of the cranial-pharyngeal canal, which is embryonic, and fetal life connects the vault of the pharynx with the pituitary body.

The blood supply by way of this canal is fairly copious, but at the second month of intra-uterine life obliteration of this canal begins and proceeds rapidly until during the third month it has entirely disappeared, the atrophy beginning from below and extending upward.

In 1888, Killian described hypophyseal tissue in the vault of the pharynx, but he thought it unimportant and laid no stress thereon. However, in 1904, Erdheim confirmed this observation and found this tissue in the fetus and the new born. The Italian observer, Civalleri, in 1907, went a step further and found this tissue not only in the fetus and new born, but in adult specimens taken from thirty cadavers. The amount of hypophyseal tissue is, of course,

very small, being only about 4 mm. wide and 5.5 mm. long. It lies close to the bone of the vault not uncommonly at the articulation of the vomer with the rostrum of the sphenoid. Arai studied the cranial-pharyngeal canal, found this relationship and called the tissue "accessory hypophysis." It seems to be established thru the researches of these investigators that persistence of this canal causes a malfunction of the hypophysis and general body disturbances, so that the symptoms and signs commonly described as characteristic of adenoid enlargement are not dependent solely upon nasal obstruction, but also upon the imbalance of certain internal secretions. Removal of the adenoid interrupts the vascular communications between hypophysis and adenoid, thus re-establishing normal function to the pituitary gland. There is still much work to be done on this subject, but what has been accomplished so far points the way to interesting and perhaps profitable results.

Pernicious Exploitation of Foods.-All civilization in these modern days might be divided into two classes, namely, those who write advertisements and those who read them. But this would hardly be accurate inasmuch as everybody reads, and, presumably, everybody does not write. However, it is unfortunate that the superlative and high-sounding ads. are written by people who for the most part never have seen the vaunted article. A boy or girl just out of college, and with a certain literary bent gets a job in an advertising office at $25.00 per week and proceeds to tell the world about the virtues of vitamines, let us say. He or she has never seen and never expects to be able to recognize a vitamine, except as it is found in the dictionary, and yet such incompetents broadcast information thru the advertising pages of the magazines, which is, of course, entirely faulty.

Thinking along this line, Dr. Frank Vander Bogert, writing in the New York

The

State Medical Journal for January, 1924, speaks of the harm which can come to children thru ignorant and wilful misrepresentation of food values. We are dealing, he says, with the delicate digestive apparatus which ought to be protected and developed for a strong, healthy, adult life, but which is rendered weak and vulnerable because of dietetic indiscretions. modern mother is told about calories, vitamines, iron and salts, until she thinks that in feeding her children according to the advertisements she is "bringing them up scientifically." A study of advertising literature shows the irrationality of the advertiser's recommendations, and violates every principle that children's specialists, for instance, have been trying to lay down for many years past. For instance, catsup is recommended to make food taste better, and soups are advertised to tempt the appetite when it is probably too much tempted already. Sauerkraut is lauded as a stimulant, whereas a healthy appetite needs no such stimulation. Then, too, overeating is encouraged by attractive advertisements of cakes and crackers, and the ice cream makers, relying upon the common statement that milk is a universal article of diet, publish the statement that the child who is "ice cream crazy" is in no danger-in other words, children who dislike milk are encouraged to take it in the form of ice cream, altho Nature may instinctively rebel against it. A dislike for milk or eggs may be something more than a mere notion.

The raisin packer wants you to eat more raisins and, therefore, dilates upon the value of the iron content in raisins, but there are many other foods more easily digested which have an abundance of iron. The advertisers cater to the popular dread of constipation and bolster up the idea that excessive eating of fruit will cure it. One advertisement of dried peaches and figs shows a child with a large piece of pie in each hand. The unfortunate thing about all this is that thru misleading statements, bad dietetic habits are being inculcated in the young, habits which, of course, grow worse with the years. Finally, the bad feature about all of this is that all propaganda cannot be combated with legislation. You cannot overcome natural human tendencies by passing foolish laws which are bound to be disputed, and there is only one

way in which the fight can be carried on, namely, by counter-pointing every misleading and false statement with the truth. This, probably, would cost more money and effort and time than the practitioner can give to it, but it must be done, nevertheless, in the interest of the public welfare.

Advertising by the Cults.-Not long since the writer saw an enormous advertisement covering the whole wall of a brick building not far from the Queensboro Bridge. Not only the gentleman's name, but all his virtues were extolled and a hand pointed the seeker after truth toward the abode of the chiropractic manipulator. This sign has since been painted out by order of the authorities.

There is no doubt that the cults, especially the chiropractors, are skilful advertisers and the stuff they put out seems to appeal even to intelligent laymen. It sounds logic and looks good to them because they have no information other than what is handed them, much of which is false. Therefore, it behooves the regular profession to fight fire with fire and make medical education popular, bringing as much of medical truth to the ears of the man in the street as it is possible to do. Every false assertion of the cults should be attacked by its corresponding truth.

Recently, while passing thru Union Square, the writer was attracted by a crowd standing near a monument and surrounding a spellbinder, who was perched on a special contrivance fastened to the back of an automobile. He was saying something like this: "The doctors are deceiving the people. Look at President Harding. He contracted ptomaine poisoning away up in the Northwest. What did they give him to eat?-eggs. A man sick with ptomaine poisoning was given eggs, which made his condition worse. There were no great doctors in America because it was summertime. The Mayos had gone to Europe. When they came back, they were greatly surprised to hear that the President had been given eggs. What did the doctors tell us? President Harding is getting better! He is getting better every day. The people were deceived, and, finally, when he died, the doctors could offer no explanation.

"What do the doctors know about curing tuberculosis? Here we have an anti-tuberculosis crusade. They used to tell you to eat dozens of eggs and drink quarts of milk. Now, they don't say anything about the eggs at all, and tell you that tuberculosis can be cured only by fresh air and sunshine.

"It is to the interests of the undertaker that you die. It is to the doctor's interest to keep you sick. In this little book you will find out everything you ought to know about diet-articles written by such famous men as Dr. Wm. Osler and Dr. Bukley, two of the most famous doctors America ever had. It would cost you $100 if you could see them once. In this little book you can find out all they know for 50 cents. Come one, come all."

The speaker then began to hold aloft a little red book, and offered to pass it down into the crowd. One of his supporters circulated thru the crowd, offering the book for sale, but, altho the writer stood by for 20 minutes, he saw only three books sold, $1.50 for, possibly, an hour's hard work out of which profits, four men must support themselves and an automobile.

Does anybody who reads this suppose that this street-speaking is not subsidized? Funds must be coming from some source to defray the large cost of such propaganda. Where is the money coming from and how can the medical profession combat broadcasting of such misinformation and wilful dissemination of ignorance and untruth? These are great days for the doctor, but there must be better ones coming-just when, nobody knows.

Public Education Concerning Cancer. -The Royal Society of Medicine of Great Britain, thru the instrumentality of the British Red Cross Society, has formulated what may be termed fifteen (15) points of interest to the public regarding cancer. This has been widely distributed to the British public in the form of a leaflet, entitled "What Ought to Be Known about Cancer":

1. In England and Wales, 45,000 people died in the year 1921 from cancer.

2. There is every reason to believe that many of the patients could have been cured if the disease had been discovered early, and the right treatment adopted.