tering on old age who have been obese for a considerable time.

In most cases allow occasional periods of rest from the rigid diet, and while giving the minimum health rations, take note if the weight increases in consequence.

HYGIENE

AND

DIETETICS

The Importance of Correcting Foot Troubles. -A famous general once pointed out that an army is no stronger than its feet. Military surgeons and the surgeons of large bodies of men who are much on their feet, such as policemen and motormen, are keenly alive to the truth of this epigram, but it is very much to be feared, says an editorial writer in the Long Island Med. Jour., (Dec., 1916) that the average physician has failed to grasp the importance of familiarizing himself in a practical way with the problems arising from bad feet.

It has been the custom to regard foot troubles as comprising flat feet, bunions and metatarsalgia and either sending the sufferer to an orthopedic surgeon, or dismissing the case with the advice to procure a pair of plates. Apparently little or no attention is paid to corns, calluses and ingrowing nails, except by the general surgeon who deals with an occasional aggravated case. As a result the chiropodists, who once upon a time were occasional only and classed with manicurists, have begun to appear in increasing numbers and are no longer satisfied to deal with pedal cosmetics, but have established a school and are being trained in the correction of foot deformities. They are giving advice as to proper footwear and not infrequently undertake minor operative work as well.

The importance of recognizing this situation in its bearing on the future must not be underestimated. Physicians have trained the public to feel that the care of corns and calluses, etc., is no part of their work and except as an occasional orthopedist may be found protesting against the unscientific use of indiscriminately applied foot plates and so-called orthopedic shoes, the profession in general is silent on the subject. It is altogether too common to find early cases of arthritis deformans, of osteosarcoma, of tenosynovitis, diagnosticated as rheumatism and dismissed with a prescription for salicylate of soda. If physicians are content to permit these cases to drift into the hands of a chiropodist, they are permitting a grave injustice to their patients, for it is self-evident that thoro diagnostic training cannot be expected of them, and they will permit these conditions to pass unnoticed causing to the patients lasting harm, just as glaucoma and iritis are being daily treated by lenses by optometrists. It is time for the medical schools to awaken to the need of laying more emphasis upon these lowly but important ailments and impressing upon their students the need for more thoro acquaintance with the practical management of foot troubles.

Dextrose and Diabetes.-Dr. Samuel T. Meltzer and Dr. L. B. Kleiner, investigators in the Rockefeller Institute, believe that in dextrose they have found the cause of diabetes, according to a writer in the Southern Medical Journal. Should their conclusions be sustained by experience their discovery would indeed be a boon to humanity. Government reports available indicate that about nine thousand persons in this country annually succumb to the disease, and as it is very slow in its course and often unrecognized for years, we are justified in believing there are more than twice that many cases in existence. In the cases of youths and young adults, the disease is apt to run a rapid course to a fatal end, but instances are not rare wherein aged people sustain the drain for years unconsciously, and finally succumb to some intercurrent affection.

Dextrose is one of the natural products of our metabolism. When an excess is produced it is eliminated thru the kidneys and, if the process continues, we have diabetes. Dextrose is also, to a certain extent and from natural sources, a wholesome article of diet, being the sugar found in fruits, while glucose, which is almost identical, is the sugar found in grapes, honey, etc. These are natural foods and wholesome for healthy people. But a way has been found to manufacture them cheaply on a commercial scale by the reaction of a mineral acid upon the starches of grains. Enormous quantities of this artificial sweet are used for the manufacture of the cheaper grades of candies and the fancy syrups seen on our breakfast tables. Many of these syrups are elegant in appearance and palatable to the taste, but there is a sticky, glutinous texture to most of them that betrays their chemical origin. It is to these artificial products that the medical profession will attribute the production of diabetes, if the theory prevails.

They should not, however, allow it to prejudice the minds of the people against the sweetness of sweet fruits, nor against that most royal of all sweets, pure honey gathered by the bees from the fragrant flowers.

School Children's Teeth.-A recent investigation made by the United States Public Health service in connection with studies of rural school children showed, says an editorial writer in Public Health (Nov., 1916) that 49.3 per cent had defective teeth, 21.1 per cent had two or more missing teeth, and only 16.9 per cent had had dental attention. Over 14 per cent never

used a tooth brush, 58.2 per cent used one occasionally and only 27.4 per cent used one daily. Defective teeth reduce physical efficiency. Dirty, suppurating, snaggle-toothed mouths are responsible for many cases of heart disease, rheumatism, and other chronic affections. The children are not responsible for the neglected state of their teeth. The ignorant and careless parent is to blame for this condition-a condition which hampers mental and physical growth and puts a permanent handicap on our future citizens. School teachers can and are doing much in inculcating habits of personal cleanliness on the rural school child but this will fail of the highest accomplishment unless parents cooperate heartily and continuously. This is a duty which we owe our children.

(Jour. de Méd. et de Chir. prat., Sept. 10, 1916) attributes dyspepsia to an irritation of the solar plexus, and, consequently, in its treatment makes considerable use of bromide of soda, the most powerful and least toxic sedative of the nervous system. He always prescribes it when the painful sensations, secretory or motor, are not sufficiently checked by dieting. It is particularly successful in these four syndromes: 1. Painful crises; 2. Gastric hypersecretion; 3. Spasm of the cardia or of the pylorus; and 4. The respiratory, cardiac, circulatory, nervous and intestinal symptoms due to ærophagia, with which spasm is so often associated.

The drug is always well borne, provided that it is chemically pure. A dose of 2 grammes a day is sufficient, half being taken in the morning and the rest at night. Leven always prescribes an allowance of 3000 grammes of fluid for each meal, of which half is taken half-anhour before the meal, and the other half during the meal itself. When any lesion is present, or symptoms of spasm form the chief trouble, the bromide in simple solution is given with the second part of the allowance. It should be kept in contact with the gastric mucous membrane as long as possible. This result is obtained as proved by radioscopy, when the bromide is taken in the course of the meal; when taken. on an empty stomach, it passes thru very quickly indeed.

Weill makes use of a more complicated mixture, suggested by Robin, in hypersthenic dyspepsia, and even in the case of intestinal obstruction with severe colic. A tablespoonful is given, in a little water, at the beginning of each meal.

Climate in Bright's Disease and Nephritis.Hinsdale in Urologic and Cutaneous Review (Feb., 1917) says that Bright's disease and nephritis are diseases clearly amenable to climatic treatment. Apparently the first requisite is that the air and soil shall be warm, sunny, reasonably dry, and free from malaria and disagreeable atmospheric changes. It is a disease attended by extensive degenerative changes in the renal and circulatory organs, and hence it is highly necessary to insure an abundant and undisturbed action of the skin. The locality should be conducive to an out-of-door life the year round. This is the well-known advantage of the climate of southern California, where the little rain that falls never does anyone any harm.

Our best course is to advise a warm climate first-one having moderate elevation and only a moderate rainfall, with small diurnal variations in temperature, the humidity being, perhaps, secondary in importance to temperature and wind.

The fact that other localities in the extreme northwest, such as the States of Washington and Montana, as well as Colorado, Minnesota, Wisconsin, Michigan, and Utah, have such diverse climates, and nevertheless, fall on the favored group, should not determine their choice as health resorts for renal cases, but would indicate some advantage in the character of the population and that the sum total of the elements of climate in those localities is conducive to a hardy race.

Tincturæ Hyoscyami

Syrupi Aurantii

Aquam Destillatam

Misce. Fiat mistura.

.3ss. .3iss. ziij.

.ad. 3x.

The arsenic appears to increase the sedative effect. It is particularly in very severe spas

To Remove Drug Stains from Skin and Linen. -Mankiewicz in Medizinische, Klinik, Berlin, mentions, for iodin, moistening with ammonium or sodum thiosulphate. For silver nitrate, washing with a 10 per cent. solution of potassium cyanid or 10 per cent. potassium iodid. The yellow silver iodid spots are removed with

sulphurous acid. He says that 10 parts each of mercuric chlorid and ammonium chlorid in 80 parts water will clear the skin of silver nitrate spots. For chrysarobin, rub with benzol (benzene). For resorcin, weak citric acid. For picric acid, leave the spot in contact with potassium sulphate for one minute then wash with abundance of soap and water. Or apply a paste of magnesium carbonate in water to the spot and after a time rub it off. Old pyrogallol spots cannot be removed. More recent spots can be treated by warming in contact with a 10 per cent. solution of iron sulphate until it turns a bluish black; then apply water freely and afterward a solution of an oxalate, rinsing abundantly. The procedure has to be repeated. For coal tar colors, spirit of soap.

Strychnine as a Tonic.-Milroy is reported in a recent issue of the Medical Record as saying that one of the most gratifying therapeutic results he personally had ever witnessed had been in the use of strychnine in pneumonia. There was no more reliable sign of approaching trouble in this disease than the appearance of edema in the dependent portion of the sound lung. He had observed this edema disappear promptly after the injection of 1-40 grain strychnine and, recurring after a few hours, again vanish with the injection of the drug. He had observed this happen repeatedly in the same case and believed he had seen patients by this means carried over a crisis to recovery. The mode of action of strychnine he must mention as concisely as possible. It acted primarily upon the nervous system, including the sympathetic system, probably most strongly upon the medulla and spinal cord. Without discussing the precise mode of action, whatever this might be, it resulted in a stimulation of the physiological activity of practically the whole body. Admitting that cardiac muscular power and blood pressure were not influenced by strychnine, the fact nevertheless remained that the heart action was influenced favorably in certain conditions. For instance, he knew a doctor with a crippled heart which became irregular and intermittent, with distressing subjective symptoms, whenever he overtaxed it a little. Invariably a few doses of strychnine, in this condition, restored the action to normal with disappearance of the unpleasant symptoms. Now, cellular nutrition was not a process of passive absorption. It was an active, vital process which was under the direct control of the nervous system. Therefore, the profound stimulation of the nervous system by full doses of strychnine, directly promoted a new and vigorous cell activity of the whole body, thus tending to restore the opsonic index. The nervous disorders to which he had referred as capable of being successfully treated by strychnine, represented conditions of depression. The nervous system still retained the ability to respond to powerful stimulation which the big doses of strychnine supplied. In reference to administration he would add that tho the drug might not be wholly eliminated from the body

for as long as eight days, it was mostly gone at the end of twelve hours and therefore the doses must not be too infrequent. Also it was worth while to mention that there was no tendency to habit formation and the largest doses might be abruptly broken off with impunity. Further he would state that this method of treatment was not dangerous. A perfectly safe margin existed between the first appearance of muscular spasm and a really poisonous dose. He had by no means attempted to enumerate the many conditions in which ascending doses of strychnine were indicated. He was convinced that it should be given in much larger doses than was customary and this he was hoping to encourage.

The Height of Specialism.-There is an alleged joke which we have seen in various vestments in divers of the lay periodicals, says an editorial writer in the Medical Record (Dec. 16, 1916). A patient with an injured middle finger is shown into Dr. X's office. The latter, after a casual glance at the injured digit, says, “I shall have to refer to you to Dr. Y, in the next block, who specializes in such cases. My specialty is wounds of the ring finger." We must confess that this burlesque of the present-day tendency of the profession is sufficiently near the truth to register a hit. Many of our conservative members are of the opinion that we will eventually carry our refinements to such an extent that each doctor will become something resembling a skilled mechanic, proficient enough in the details pertaining to that little section of the human economy which he has claimed for his own, but lacking the broader outlook, the comprehensive grasp of the organism as a whole, its material and spiritual needs, which the physician of the old school had. Too bad that Oliver Wendell Holmes is not living to express himself in this matter. The appearance of a large volume dealing with the umbilicus and urachus has given us pause. We remember the awe with which our textbook on anatomy was regarded in our freshman year at college and it was of approximately the same proportions as the present tome. If we are to be governed by the relative importance of the subjects in question, we shall await a publication dealing with diseases of the stomach about the size of the Encyclopedia Britannica and if some enterprising writer should attempt a work on the nervous system he could fill about a dozen sections of bookcases. Seriously, the monumental work of Dr. Cullen on the umbilicus is excellent and since the stars ordained that it be written it is fortunate that it was undertaken by so able a scholar and surgeon. The subject has been so thoroly handled as to discourage any one else from treading the same path for many years to come. Surgeons having to deal with hernias of this region or with the annoying infections which prove so difficult to handle will be grateful to the author for his painstaking researches which have been carried on for twelve years, and for the admirable illustrations with which he has illuminated his subject.