"Diagnosis," says Dr. Eisener, "is the true password in the medical science of today, and this should be realized by many who continue satisfied with the uncertain methods of the past."

When Leube, in 1871, first recommended the stomach-tube for diagnostic purposes, he cleared the way for ready diagnosis of stomach diseases.

Bacteriologic diagnosis of certain diseases has become a matter of routine importance with the scientific, up-to-date physician, and to him we shall look for the solution of many important problems at this age in the prevention and recognition of dis

ease.

The number of lives annually saved by the application of bacteriologic methods in the diagnosis of disease, cannot be estimated. It has been unjustly stated, that the time occupied in making blood examinations with the microscope, is out of proportion to the knowledge acquired. This is an unjust charge. To gain information of disease should be our aim, regardless of time and expense, but fortunately with our newer methods and modern technic, a thoro blood examination can be made in less than forty minutes. These are important matters, and should ever be kept in mind by the general practitioner. That most valuable instrument, the ophthalmoscope, should constitute one of the important adjuncts to the equipment of the general practitioner, by which he is enabled to recognize the grosser pathologic changes in the eye, leading to a diagnosis of brain, kidney, and nerve lesions, that are often overlooked and maltreated by the so-called pseudo occulist or optometrist. It is no secret that the charge has been made, that too many patients in this country are often ignorantly and incompetently treated, and our medical schools and system of medical education are held responsible

for this unfortunate state of affairs. We must admit that we too often fail to stimulate the "scientific sense"; men are not educated to work systematically, and hence we fall short in many important essentials that go toward rounding up a thoro knowledge of the work in hand.

Many causes might be cited that contribute to this unfortunate state of affairs. A spirit of commercialism seems to have gotten hold of many of our American medical institutions, and as a natural sequence, its influence is felt in the ranks of the profession. That unconquerable thirst for "filthy lucre" has been the indirect cause of more failures in, and has brought more discredit upon, the medical profession of the United States than all other causes combined. In this particular sense the profession has, I am sorry to say, retrograded from the old landmarks. This is, in part, due to the overcrowded condition of the profession, and the multiplicity of secondrated medical colleges, saying nothing of the "Diploma-mill universities," the pseudoscience institutions of the country, all of which are sending out their so-called graduates under the "camouflage" of medicine and religion, deceiving the over-credulous public.

With this overcrowding of the profession, and the intermingling of the pseudo-sciences, it is but natural that competition, antagonism and commercialism will grow keener each year in the ratio of demand and supply. I shall now digress a little in order to present a few facts in the way of statistics and comments of a retrospective character, giving some important data worthy the consideration of not only the general practitioner, but of the entire medical profession. It is a well-known fact, recognized by our best authorities and most careful observers,

that since the great World War, there seems to exist in the profession a peculiar state of "unrest." This state of mental worry and unstableness is more noticeable among the younger portion of the profession, ranging in age from 24 to 40 years. The promiscuous commingling of the nations with the nervous excitement and uncertainty of the final outcome of the war, with its many entanglements and embarrassing sequel of lost positions of professional employment, may in part, be a contributing factor in the more recent state of unrest. This condition of unrest and unstableness of mind is not confined to the medical profession alone, but it is broadcast thruout the world, according to the views of Prof. Wm. Star Myers of Princeton University, a well-known writer and author. He further states that out of the 105,000,000 people in the United States, 45,000,000 have only the mental capacity of a 13-year old youth, while 15,000,000 of our population possess the mental powers of an eight-year old child, and of the remaining 45,000,000 statistics show that 25,000,000 are of the mediocre, while 5,000,000 are classed as "A" in mentality and the remaining 15,000,000 classed as "B" in mentality. These latter two classes, according to this author, do the mental work of the entire citizenship of the country. He further states that we have in the United States 60,000,000 morons. In considering these humiliating facts about our mental stamina as a nation, it is no wonder that we have so many grievances, misunderstandings and unrest. This fact is not confined to our beloved America, but to the entire world, and especially to those nations that are only semi-civilized and are still, with their superstitious ideas, bowing down to idols or falsegods.

Dr. Robert H. Chase, in his treatise on

the "Ungeared Mind," does not hesitate to state, that insanity in its various stages is on the rapid increase and that it is only a matter of time when our hospitals for nervous diseases and our asylums for the hopeless insane, will be greatly enlarged in capacity and quadrupled in numbers. This rapid increase in mental deterioration, may in part, be accounted for by our physical conditions from a health standpoint. The morale of our young manhood has of late years deteriorated, causing a lower percentage of stamina and back-bone. Dr. Thomas D. Wood, of Columbia University in a lecture some months ago, made the statement that out of 32,000,000 school children in the United States, 75 per cent. were physically defective, 1 per cent. mentally defective, 5 per cent. victims of tuberculosis, 5 per cent. with defective eyes and hearing, 25 per cent. suffered from malnutrition and diseased tonsils.

According to the Surgeon-General's report, over 29 per cent. of our soldier boys who enlisted for the great World War were rejected on account of physical disability. In some of the states of the Union, from 50 to 75 per cent. were rejected on this account. The deaths from tuberculosis during the four years of the World War out-numbered the soldiers killed in battle, so says Dr. Livingston Farror, Journal A. M. A. In 1920, 300,000 babies died before reaching the age of one year, 15,000 of these died before the end of one month, 50,000 mothers died in child-birth last year. What a sad commentary on the science of midwifery!

Dr. C. E. Wood of the Crocker Cancer Research Laboratory of New York, states that cancer killed 90,000 persons in the United States last year, and that 180,000 will die this year of that disease, and that 90 per cent. of all these might have been

cured if taken in time. According to statistics, over 500,000 people die of this disease in the entire world every year. One person dies every 6 minutes from cancer. This high mortality from cancer is surpassed by only one other disease, namely, the great white plague, which takes as its annual toll from the world 1,250,000 persons, or 144 human lives every hour. One and a half millions are incapacitated annually from tuberculosis in our own country. The number of deaths from this disease during the four years of the World War among the civilized nations, including those engaged in the armies of all the different countries, ⚫ equaled or approximated the total number of soldiers killed in battle. (Journal A. M. A., October 5, 1918.)

In China, tuberculosis takes one Coolie every 37 seconds, while in Japan it takes one every two minutes, and about the same condition exists in India. These figures vary in different countries, according to the degree of enlightenment and education from a health viewpoint.

You will observe from the foregoing, that I am treating my subject from various angles, and while we may congratulate the great science of medicine and her corps of energetic, painstaking laboratory workers on past achievements, yet there is much to do, and it behooves every medical man to buckle on the armor of war and face these

deadly enemies of the human family, which are so rapidly destroying the nations of the world. Let America take the initiatory steps toward teaching the world the principles of hygiene and preventive medicine, following the example of our much lamented Dr. Wm. C. Gorgas, who made the once God-forsaken Panama country, where neither man nor beast could survive but a short period on account of the deadly malaria and other infections, but afterwards became a haven of rest. See what science and money have done for that once forgotten, maladystricken country. "The successful man is the man who knows human nature as well as his profession."

CANCER-CAUSE AND

PREVENTION.

BY

ADAM H. WRIGHT, M. D.,

Toronto, Canada.

It will probably be conceded that Dr. Schilling in his paper on cancer published in the October issue of AMERICAN MEDICINE is correct when he says: "Cancer is cell life going rampant," due in part, at least, to abnormal stimulation from excesses such as over-eating, over-drinking, etc. This brings us into a large field in which physicians and hygienists can labor without interfering with surgeons.

We have wasted much time in looking for a single or specific cause. Let us examine and study the simple causes coming under the observation of general practitioners in their routine every day work. Dr. Schilling says: "A certain class lives too fast," and one of the results is cancer. Colonel McCarrison, Dr. Hoffman and many others agree, and assert that cancer is essentially a disease of civilization.

Three men on the staff of Guy's Hospital, Lane, Jordan and Mutch concur; and some reference may be made to their opinions after working together for years. Sir Arbuthnot Lane's famous aphorism will be given first:

Cancer never attacks a healthy organ.

Faulty diet and intestinal stasis cause poisoning of the whole system. Dr. A: C. Jordan believes that, apart from long-continued surface irritation, stasis is the main cause of cancer. For example-the stomach

becomes enlarged and dropped, the pyloric portion becomes congested, ulceration occurs and a chronic ulcer becomes cancerous. Then he adds:

A healthy stomach does not become cancerous. Stasis attacks it first.

Dr. Nathan Mutch says conditions incited by stasis may exist for years before they produce cancer, all of which may be demonstrated by serial radioscopy. X-ray examinations, in his own experience, have frequently brought to light lesions which from their severity must have arisen long before the carcinoma began to grow in the stomach. He then makes the following statement:

The prevention of carcinoma of the stomach should prove to be much simpler than the cure of cancer after it has taken root.

From my own experience I have reached the following conclusions:

Cancer of the stomach never occurs suddenly.

The symptoms never appear without warning like "a bolt from the blue."

In all cases it takes years in its production, probably ten to twenty, with symptoms all those years-and nothing obscure about them, but overlooked because they are only the "ordinary signs of simple indigestion."

My endeavor has been for long to treat indigestion with the greatest care, believing it is always serious. I hope, and even believe, that I have sometimes prevented carcinoma of the stomach. Anyway I have done no harm in a single instance. If I thought I had in certain cases prevented— not cancer but only appendicitis or gallstones, I should not be displeased.

BY

OSCAR L. LEVIN, M. D.,

New York.

Instructor and Chief of Clinic, Cornell University Medical College and Clinic; Adjunct Dermatologist, Mount Sinai Hospital; Director of Dermatology and Syphilology, Beth Israel and United Israel Zion Hospitals; Associate Dermatologist, Montefiore Hospital.

Altho dermatologists and syphilologists are generally cognizant of the value of bismuth in the treatment of syphilis, it seems that the attention of the general practitioner has not been drawn to it as an important adjunct, and it is my purpose to describe briefly the advantages and disadvantages which accrue from its use. The facts which I have to present are taken from the reports in the literature and my own experience with the drug, administered in numerous cases of syphilis.

It was the discovery of the spirocheta pallida by Schaudinn and Hoffmann in 1905, and its establishment as the causative agent of syphilis which stimulated the interest of scientists to search for new methods and means of treating the disease specifically. Before this time, and until comparatively recent years, while many drugs were employed in the attempt to attack syphilis, beginning with the primitive herbs and plants like guaiacum wood and the ancient lobelia syphilitica, only two drugs used were at all efficacious. These were mercury and iodine. Mercury, as we all know, had its place in the treatment of syphilis even before it was recognized as a distinct disease, only because its good effect on skin lesions had been observed. It is needless to speak of the im

'Read at the regular meeting of the New York Physicians' Association on October 22, 1924.

the fight against syphilis from the time of the great Arabian physicians who used it by inunction, thru the various pill, suppository and vapor inhalation stages, to the present day when it is used mainly by inunction and by injection.

Iodine, introduced by Williams and Wallace in 1830 as an anti-syphilitic and antidote to mercury, assumed more or less importance, since it was observed that the protean manifestations of the infection disappeared under its use.

Mercury affects the microorganisms mainly in an indirect way by stimulating the body cells to combat their activities. And, if the theory of MacDonough is to be accepted, its chief action is to split up the colloidal protein particles which form a resisting substance and spread them over a larger area, making a greater protective surface, being specific only in that in syphilis there is more protein matter to be broken up. Mercury is only slightly spirocheticidal.

Iodine does not affect the microorganism. It has, rather, a solvent effect upon the abnormal tissues produced by them.

We are familiar with the fact that arsenic, just as mercury, had its many advocates even from the time of Paracelsus, but it was not until the epoch-making discovery of Ehrlich in 1909, who successfully established his theory of chemotherapy—that is, the chemical relationship between drug and parasite that we had the first drug which destroyed the spirochetes and produced only

a minimum of tissue damage.

Since the introduction of salvarsan and its congenitors, neosalvarsan, silver-salvarsan and sulph-salvarsan, other chemicals, like vanadium, copper and antimony have been tried for the specific treatment of syphilis, but none gave the desired effect. How