mittee on eugenics is now called for in every state medical association.

Such a section being equipped to answer, or at least to discuss all questions bearing upon eugenics would be instrumental in securing definite legislative action.

The matter should be agitated in every state until legislation has everywhere been enacted for the adequate protection of the

race.

The excuse which is made for bringing forward a matter which has been freely discussed in recent years and about which there seems to be no difference of opinion in the minds of those medical men who have not been so occupied with other matters that they could not give the subject a few consecutive thoughts is the presence in the human mind of the quality of inertia which with reference to this particular subject will demand a whip and spur for months to come, possibly for

years.

Effect of Pasteurization of Milk on Babies.-J. L. Morse made a collective investigation upon this subject by means of a series of questions which were replied to by fifty members of the American Pediatric Society.

He finds, however, that he cannot draw positive conclusions from the evidence. which was obtained whether babies fed continuously on pasteurized milk thrive as well as those who have been fed on raw milk, or whether the continuous use of the pasteurized milk predisposes to the development of nutritional diseases. There is evidence enough, however, to show that if the continuous use of pasteurized milk is injurious to babies it cannot possibly be as injurious as bacteria. It would therefore seem desirable to pasteurize all milk except that which is known to be clean.

But on the other hand there is sufficient doubt as to the harmlessness of pasteurized milk to justify the evidence of pasteurization when the character of the milk warrants it. The milk problem, like the poor, is ever present with us.

The character of much of the milk which comes to the homes of the poor is so notoriously bad and harmful that as

1American Practitioner, February, 1913.

between this and pasteurization a great gulf is fixed, as the scriptures say, and the evidence is decidedly to the advantage of pasteurization.

Did the writer investigate the data connected with the Strauss milk stations and the influence of the pasteurized milk provided by them upon the babies of the east side poor in New York?

The Day Camp for Tuberculosis.1. A. P. Francine states that the day camp where tuberculous patients can remain the entire day in the open air apart from the squalor of tenements and allies, and under medical supervision has been tested in Boston, New York and Philadelphia.

The author's paper relates to the latter city and states that the splendid sanatorium facilities of Pennsylvania permit any tuberculous subject who applies to go to a state sanatorium for a preliminary course of education, segregation, training and

cure.

But those who are curable cannot remain permanently at such a place and the aim of those who have the subject in charge is to follow patients after returning home from a sanatorium and finish the work, if possible, which was thus begun.

Unfortunately this plan will not always work out well on account of home surroundings which cannot be improved, for various reasons. It is for this large group of return cases, as well as for others, that the day camp of which the author is writing was opened two years ago upon a pier on the Delaware river front in Philadelphia. It has now been in operation two seasons, being open daily from May until November. It is suitably furnished with easy chairs, nurse's office, toilet room and other necessities, and the patients remain there from 9:00 a. m. to 5:00 p. m.

A pint of milk with bread and butter is served to each of them at 10:00 a. m., and a hot lunch at noon. Car tickets are given to those who need them for transportation to and from the camp. Regular attendance is required and each patient reports to his physician or dispensary every two weeks, his home being supervised by the district nurse.

New York Medical Journal, February 22, 1913.

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Thirty patients per day were thus accommodated, and ninety-one have been treated in all. Most of them have been regular in their attendance and they have gained in weight and strength in almost every instance.

Of the seventy-three patients who stayed. more than one week, fifty-eight showed improvement, twenty were able to return to work, and forty-four were placed in sanatoria for further treatment.

The development of this idea is destined. to be one of the most important factors in the settlement of the tuberculosis problem. If anything is definitely settled in connection with the treatment of tuberculosis it is the indispensability of a constant supply of pure air and fortunately this may be obtained even in our great cities, where most of the tuberculous patients are to be found, no less than in the country.

ETIOLOGY AND DIAGNOSIS.

Fat Hernia.-1. A true fat hernia is a protusion of a preperitoneal fat mass or lipoma through one of the ordinary hernial apertures. It follows the course pursued by an ordinary hernia.

2. When a peritoneal process is located within such a hernia, it is always difficult to find, because of its small lumen. Such a process when present (in a minority of our cases) is secondary to the fat hernia and probably results from traction. The ordinary contents of a hernia are not found and can hardly enter into the narrow serous tube within the fat

probable that these cases will only be recognized as fat hernias during the operation, wherefore measures for radical cure will be instituted such as those in vogue for the ordinary forms of hernia.

Heredity as a Factor in Epilepsy.-The authors of this scholarly paper conclude as follows:

1. We have no conclusive evidence that alcoholism in the parents is a cause of epilepsy in the children, although alcoholism is often associated with epilepsy. It may be regarded as a concomitant of epilepsy and an additional evidence of nervous weakness. 2. Feeblemindedness is also associated with epilepsy, and there is some evidence that it is caused by the same defect that caused the epilepsy. 3. Fitting the material to the two hypotheses, first, that epilepsy is a recessive trait that is inherited only as epilepsy, and second, that epilepsy, feeble-mindedness and insanity are due to the same defect which may appear in the form of any one of them, there is no striking evidence in favor of one to the exclusion of the other. The truth probably lies somewhere between the two. 4. While we are not in a position to say at present whether every case of epilepsy is inherited or to say in what proportion of cases it is inherited, we can say that in a large proportion of cases there is some nervous defect on both sides of the family. These defects may be epilepsy, feeblemindedness, insanity, extreme nervousness, migrain, alcoholism, sexual immorality and lack of moral sense.

TREATMENT.

Vaccine Therapy in

Europe.-Inquiries

while in Europe, says a writer in the Bacterial Therapist, indicate that bacterial vaccines in the treatment of infectious diseases are not being as extensively employed as in this country. Several conditions appear to be responsible for this: The European physician, in accord with the prevailing sentiment of the people is very conservative and therapeutic nihilism being strongly represented among them, naturally no material reliance is placed on any remedy. Where bacterins are employed it is usually of the autogenous variety in exceptional selected cases. Wright's early contention that the opsonic index is an essential means as a guide to their administration created a sentiment among physicians on the Continent that this treatment is too technical for practical application. The "fear of the negative phase" is also a deterring factor. The prevailing sentiment of doing things

1E. Flood, M. D. and M. Collins, M. D., Palmer, Mass. American Journal of Insanity, Jan., 1913.

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to conform to recognized authority tends toward following certain routines. A remedy extensively and successfully employed by an American physician in good standing does not constitute authority to a German physician. Stock vaccines not being regularly in the market, such ordinary ailments as colds, bronchitis, bronchopneumonia, pneumonia, rheumatism, otitis and many other diseases are not treated with vaccines.

In England vaccine therapy is more generally resorted to than on the continent, but even here this method is used in the exceptional case rather than the rule.

Stock vaccines are on sale in leading drug stores, but comparatively small sales seem to be the rule.

If conditions in Rotterdam are a fair index as to the use of stock vaccines in Holland, it would appear that they are seldom used. Inquiries at a leading drug store revealed the fact that the concern was not familiar with these preparations. Nor were any stock vaccines to be found at any of the drug stores.

The prevailing sentiment of doing things by authority permeating the entire people seems to be an element that tends toward conservatism and a drawback to progress. A leading Rotterdam physician said he had no trouble in controlling his patient, whatever treatment is prescribed being as a rule religiously followed out. This makes conditions pleasant for the physician, but a critical attitude of the patient, as found in America, no doubt has a tendency to make the physician alert and progressive.

A chemist, living in Frankfort, related a personal experience. His children were sick with bronchitis and bronchopneumonia. After patiently waiting for several weeks for improvement to take place, the attending physician was requested to give a regular stock vaccine, of which the chemist had some on hand. The physician refused to give them because he was not familiar with the remedy, and if their administration should be followed by the favorable conditions ascribed to them the symptoms of the disease would be masked in such a way that the natural course of the disease could not be followed.

Drugs no doubt mask symptoms, causing apparent improvements while conditions are actually growing worse, but where bacterins are used no drug effect is obtained, the improvement observed being a real beneficial curative effect from the immunizing response to the vaccine inoculation.

Contraindications to Radioactive Therapy.'Which one of the indications that may be derived from previous experience with radioactive therapy will stand the test of future empirical and theoretic criticism, cannot naturally be reviewed as yet, says Von Noorden in an exhaustive article on Radioactivity.

'Dr. Carl Von Noorden, Med. Record, Jan., 18, 1913.

3. Morbus Basdowii, diabetes, febrile conditions.

4. Tendency to hemorrhages of every kind, especially menorrhagia, metrorrhagias, hemoptysis, hemorrhagic diathesis, hemophilia.

5. Far advanced affections of the erythroblastic and the leucoblastic systems. (In contrast to early stages, which are excellently suited to this treatment).

6. Cachexias of every kind (pronounced unfavorable influence on cancerous cachexia). 7. Senile marasmus. (In contrast to the beginning phenomena of old age, which are excellently suited to the treatment).

GENERAL TOPICS.

Poverty Due to Tuberculosis. That tuberculosis is responsible for one-third of the sickness that reduces families to dependency is indicated by a study just completed by the New York Association for Improving the Condition of the Poor. In a statement sent out to-day the association says that the facts obtained also indicate that this disease is the cause of over 8 per cent of the destitute homes in New York City.

Having determined by investigation that sickness is the chief cause of dependency among families in its care, the association recently began an inquiry to learn which diseases are most prevalent among dependents so that it can plan more intelligently its preventive work. The 6,565 families which sought the association's aid between October 1, 1911, and June 30, this year, were selected for the study. It was learned that of these families 1,605 were forced to seek aid because of illness. In some the income had been hampered or cut off by the illness of the father or mother. In others sickness of one or more members had exhausted savings and heavily taxed earnings.

Tuberculosis was the disease found in 555 or 34 per cent of these families. Rheumatism forced 187 other families into dependency. The remaining were classified as follows: Illness attending child birth 161, kidney and heart disease 156, anemia 156, operations resulting from injuries 106, pneumonia 99, children's contagious diseases 48, paralysis and epilepsy 48, eye and ear diseases 45, cancer and tumor 44.

"The results of this study plainly show the urgent necessity for more adequate care of tubercular patients, especially those in impoverished homes," said General Agent Kingsbury, "They also demonstrate how important is the prevention of the disease in the campaign

against poverty. The facts justify the effort now being made by the association to devise a practical plan for the treatment and cure of the disease in the home. If the three-year demonstration the association is making in its Home Hospital in the East River Homes is successful, a practical means of wiping out the disease in the tenements will have been effected. As the hospital has been in operation only since last March, Dr. Linsly R. Williams, the medical director, believes it is too early to determine with any degree of accuracy what effect adequate home treatment under proper conditions will have upon the disease. However, the fact that no unfavorable conditions have been noted thus far leads him to believe that the association will before long be able to offer a more speedy and economic plan of wiping out the disease than is now employed. Moreover, the association is, for the first time in the history of relief work in this country, providing on a comprehensive scale, adequate relief, care and treatment for tuberculosis in the tenement homes of the poor.

"Some plan of effective home treatment must be found, for it will be many years before there will be enough hospitals and sanatoria to accommodate all tuberculosis patients, despite the excellent work now being done to meet demands. A comparison of the hospital provisions in the United States with the needs and growth of population shows that the demand is increasing twice as fast as the supply."

Banquet to Dr. William J. Robinson. Over two hundred physicians, writers, editors and others prominent in the life of the city assembled at the Hotel St. Denis, Fri lay, March 7th, at the banquet tendered to Dr. William J. Robinson by his friends and admirers, in recognition of his work as physician, editor, writer, lecturer, and publicist, and in celebration of the tenth anniversary of the foundation of one of his journals, The Critic and Guide. Dr. A. Jacobi, President of the American Medical Association, acted as Toastmaster, and in his usual happy vein told that he read The Critic and Guide as religiously as a religious man reads his Bible and that he hoped he would be able to read it for fifty years more. Letters and telegrams were read from physicians and editors in many other cities.

In the toasts that followed, Dr. James P. Warbasse spoke of the guest of honor as the iconoclast, clearing medical journalism of past traditions and abuses. Dr. James F. Morton, Jr., spoke of his work for eugenics, commending his campaign against prudery as one carried on not for sensational purposes but to gain a serious hearing for questions vitally affecting the race. Dr. H. Edwin Lewis told some interesting history of the days when the manufacturers of unethical products offered unlimited financial backing to anyone willing to bring suit against the Doctor for his exposures of their products. Mrs. Anita C. Block, woman's page editor of The New York Call, hailed Dr. Robinson as the champion of womanhood and the new type of physician. Dr. A. L. Goldwater spoke of him as the physician and Mr. Edwin C. Walker as the social reformer.

Toasting Dr. Robinson as "The Citizen," Borough President McAneny said: "A man who plays the part of Dr. Robinson is not only a citizen but a good citizen. He has dealt with those things which before long will be matters of discussion in many and many a place. He has dealt with those things that we as a city must deal with if we are to raise up the right sort of people. The city, if I may so put it, has been the greatest prude of all in dealing with those things, and when we are thoroughly awakened the fruits of his activity will be seen in the City of New York. I regard him as a pioneer who is blazing the way, and where he has gone many and many a man and woman will follow and push his work to its completion. The City of New York values the citizenship of such a man as Dr. Robinson. Long may he continue to be with us and to aid in our city and social work."

In his response, Dr. Robinson referred to his gratification at the fact that among those present there were so many who did not agree with or endorse all his opinions and teachings, and described the problems besetting a radical medical editor.

Complete Series, Vol. XIX, No. 4. New Series, Vol. VIII, No. 4.

The

Careless dispensary methods are now under fire, but we hope that the reformers will consider whether some of the institutions had better be mended or ended. dispensary is theoretically a "charity" to the sick poor, but it has long been abused by those who are neither sick nor poor; that is, by those who are not sick enough to require a physician's care and are rich enough to pay a poor doctor for his advice if they do need it. The usual argument for the dispensary is that it furnishes material for study by the inexperienced, but the charge is now made that the overcrowding utterly prevents such study and that the cases are really neglected as far as treatment is concerned. All this has been said so often in medical circles that we are surprised to find it occasioning surprise among laymen. We are more surprised still, to learn that the patients are being deprived of something to which they are entitled as a right. Charity is never a right, although civilization has progressed to the point at which it is necessary for the general welfare to restore the temporarily a self-supporting basis. No one can expect to get something for nothing, so that even here, it must be considered either as a loan to be repaid when wages again are earned or as a return for insurance duly paid for previously. Real charity can be given only to those who cannot possibly make a return-the permanently in

efficient. Here too a qualification is necessary. One sided bargains are so harmful that they may be said to be non-existent in nature where no benefits are ever conferred by one organism except in return for value received. Some cases of parasitism apparently violate this law, but when we have searched carefully enough we always have found the value received, and probably will find it in all. In many ways, real charity is an economy in that it prevents far worse evils of theft, murder and callousness to suffering, so common where life is so cheap that there is no charity. Besides, the safer we make others the safer are we ourselves. Charity then is not a right of the permanently disabled, but is basically for the selfish purpose of reflexly benefitting the efficients, and it has really become an instinct in civilization. We must drop the hypocritical mask of claiming to do good that cannot possibly do good to us in return. Bread thrown on the waters always returns. We think it doesn't because we never search for it. Dispensaries, then, must be considered sociological institutions for the general welfare and not charities even in the restricted meaning here given to that word. They must be reorganized on a strictly business basis, and on lines parallel to every other public utility.

The sociologic position of dispensaries as public utilities must be considered by