A HEALTH CAMPAIGN.

The little town of Cloverport in Breckinridge County has had a series of epidemies for the past two years which have awakened its citizens to a realization of the importance of the prevention of disease. Under the inspiring leadership of Rev. W. C. Frank, a health revival has been conducted extending over a series of weeks. Addresses have been delivered by prominent sanitarians, local physicians and interested citizens, daily or twice daily. Special meetings have been held on Sunday devoted to this particular branch of religious work. The citizenship has turned out practically unanimously. Everybody is studying how they can best contribute to the public welfare by promoting their own and their neighbor's health. This has been a remarkable campaign and we congratulate Mr. Frank and the citizens of Cloverport generally on their progressive work and confidently predict for them great returns.

SANITARY INSPECTORS.

The public press has carried the announcement that the members of the State Board of Health will hereafter act as sanitary inspectors for the respective districts in which they live. This is a splendid plan and will enable the members of the Board to come in a sort of contact with the health problems and with the profession and people that will enable them. to give more definite instructions and make the rules and regulations more generally applicable in the prevention of diseases. Far more than this, it will help to foster that publie sentiment which is already developing so rapidly for the prevention of disease. We congratulate the State Board of Health on this advanced step.

INTENSIVE HEALTH CAMPAIGNS.

It is announced that the State Board of Health in co-operation with the International Health Commission will be able to conduct intensive health campaigns in a dozen or more counties during the coming summer and fall. Naturally, these campaigns will be conducted first in the counties which show the heaviest hookworm infection. The members of the Board express considerable regret that they will not be able to conduct campaigns in those counties which have previously had the benefit of them. Many of these are clamoring for second campaigns, but limited funds will not enable the Board to conduct them. We are sure we can bespeak for the medical eonductors of these campaigns the hearty co-operation of the physicians of the various counties which will be interested.

THE SEPTEMBER MEETING. In this issue we print a very preliminary subject-program of the September meeting of the Kentucky State Medical Association. We would suggest that members interested in the program write to Dr. J. W. Kincaid at Catlettsburg, immediately, especially if they are willing to prepare papers along the lines indicated in this subject-program. A warrant of the success of the Louisville Meeting is contained in the statement that the Committee of Arrangements representing the Jefferson County Medical Society has just been appointed. It consists of Drs. Charles W. Hibbitt, Chairman, Lee Kahn, E. L. Henderson, R. Lindsay Ireland, Virgil E. Simpson and Charles G. Lucas.

Complete announcement for the meeting will be made in the next issue and in the meantime, we want to ask every interested physician to cooperate with us in securing the best program we have ever presented.

PRESCRIBING SPECIALTIES.

It is with considerable pleasure that we give the following letter to our readers, from Prof. W. A. Puckner, the very distinguished Secretary of the Council on Pharmacy and Chemistry of the American Medical Association. We hope every reader of the J*Z8& (.. will read this over twice and think seriously what it means. The letter is to the point and is fully self-explanatory.

"I have received your letter of April 15th, the price list of the Chemical Company, and am looking forward with interest to the submission of the firm's 'specialties.'

"The tendency of firms of this sort to market shotgun mixtures of well-known drugs under non-descriptive names and with misleading claims appears well-night universal. I wish we could have some legislation making it a penitentiary offense for a physician to prescribe a mixture the composition of which he does not know at the time that he writes his prescription. his prescription. Under these conditions, I am sure that few physicians would prescribe Chillitone.' When treating malaria they would give a dose of quinine instead. I am sure that they would not prescribe Analgesol.' They would take no stock in the claim that acetanilid in the form of Analgesol' is 'A Nondepressant Liquid Antipyretic and Analgesic,' but would prescribe acetanilid when they want it and with due precautions. Similar arguments could be made for almost every one of the 'specialties' which are contained in the price list of almost every firm in the country. It is rather discouraging, is it not? And the worst of it is that the public pays a fee to the man who takes his prescrip

tion hints from manufacturers who in their turn take their hints from the Lord knows whom. Is it any wonder that the public feels competent to treat its maladies all the way from dyspepsia to tuberculosis?"

It is important for us to remember that the medical profession is responsible for the use and abuse of patent medicine and self-medication. If you are prescribing drugs of which you do not know the composition, you are participating in the distribution of these things. It is a question with every doctor as to whether he intends to be a vender of patent or proprietary medicines, or a real physician.

THE BAKING POWDER PROBLEM.

Upon this important subject the Indiana Medical Journal says:

For a number of years there has been much discussion with regard to the effects of baking powders on the health. While minor objections have been urged against all baking powders, the principal charge of unwholesomeness has been made against baking pow ders containing alum. This objection is based primarily on the injurious effects of large quantities of aluminum salts. To this objection the answer has been made that the process of decomposition which liberates the leavening gas when alum baking powder is used, produces an oxid of aluminum which is insoluble, and hence not injurious. For the facts in this matter to be fully understood, it must be remembered that the so-called alum

now used in baking powder is not the alum used in medicine, being a sodium alum (sodium aluminum sulphate) instead of the official potassium salts. This point is held by some to be important in view of the effects of potassium salts on the system. Cream of tartar is a potassium salt, being potassium acid tartrate.

In the discussion of the baking-powder question, it must be remembered that the practical application of the facts concerns only small amounts of these salts and contemplates an occasional and not a constant use. Few people habitually consume breads made from baking powder, hence the amount of patassium introduced into the system by baking powder is unlikely to be of serious moment as regards health. Potassium salts are frequently taken as constituents of vegetable food, and yet there is no evidence that they disturb metabolism in any way. The question whether alum used in this way is injurfous has been settled by the investigations of the Referee Board of Scientific Experts appointed by President Roosevelt, and its decision may be considered as coming from the court of highest authority. The investigation.

of this board covered a period of several years and was the most extensive single investigation ever conducted as to the healthfulness of alum baking powders. The distinguished character and personnel of the board itself lends additional weight to its findings. The board consisted of the following men:

Dr. Ira Remsen, president of Johns Hopkins University.

Dr. Russell H. Crittenden, professor of physiological chemistry, Yale University, and director of the Sheffield Scientific School.

Dr. John H. Long, professor of chemistry in the Northwestern University Medical School.

Dr. Alonzo E. Taylor, professor of physiological chemistry, University of Pennsylvania.

Dr. Theobald Smith, professor of comparative pathology, Harvard University.

The board made the following findings: "Aluminum compounds when used in the form of baking powders in foods have not been found to affect injuriously the nutritive

value of such foods.

"Aluminum compounds when added to foods in the form of baking powders, in small quantities, have not been found to contribute any poisonous or other deleterious effect which may render the said food injurious to health. The same holds true for the amount of aluminum which may be included in the ordinary consumption of aluminum baking powders furnishing up to 150 mg. (2.31 grains) of aluminum daily.

"Aluminum compounds when added to foods in the form of baking powders, in large quantities up to 200 mg. (3.09 grains) or more per day, may provoke mild catharsis.

"Very large quantities of aluminum taken with foods in the form of baking powders usually provoke catharsis. This action of aluminum baking powders is due to the sodium sulphate which results from the reaction.

"The aluminum itself has not been found to be thereby reduced, lowered or injuriously affected."

In short, the board concludes that alum baking powders are no more harmful than any other baking powders, but that it is wise to be moderate in the use of foods that are leavened with baking powder.

In Dr. Taylor's conclusions, a different aspect of the baking-powder question is brought out. It is shown that the product of all forms of baking powders is laxative, and the suggestion is made that the laxative effects of the continuous use of breads made with baking powder may be injurious. The objection applied to the cream of tartar baking powder which leaves a residue of Rochelle salts, to the phosphate baking powders which leave the phosphate of sodium and

to the alum baking powders which also leave the sodium sulphate. Dr. Taylor says: "Apparently, therefore, at present at least, the use of baking powder is associated with the introduction into the alimentary tract of a certain amount of saline cathartic, the salt differing with the use of a particular type of baking powder." In connection with this objection, the amount of soluble residue left by the baking powder becomes of importance.

Here, again, the pertinence of the objection depends on the quantity likely to be eaten. In no case is it likely that a person would consume bread or biscuits enough to get an appreciable effect on the bowels from the laxative produced.

The criticisms with reference to the action of baking powders indicate a tendency to magnify quite incidental matters whenever they seem to favor the interest of one or other manufacturer. Thus the tartrate was at one time highly regarded because it was a product which was destroyed in the system, leaving a natural constituent of the body, that is, potassium carbonate. More recently it has. been discovered that the tartrates are only partially metabolized in the system, removing the supposed advantage of the tartrate powders. On the other hand, there is a disposition to emphasize experiments tending to show the power of tartrates to affect the kidneys injuriously, although there is no evidence that such an injurious action can occur from the small quantity present in baking powders. While the objections to alum are unjustified, the physician will do well to inquire carefully into the probability of any alleged injury occurring from other forms of baking powder.

Malaria and the Puerperium.-After noticing the facts in regard to the relations of malaria and the puerperal condition, as noticed by physicians in the tropics and elsewhere, M. J. Seifert, Chicago (Journal A. M. A., December 19, 1914), reports the case of a woman, aged 25, who had never lived in a strictly malarial region, or suspected malarial infection, who suffered from irregular chills and fever in two consecutive confinements, and never at any other time, with no pelvic involvement and with positive microscopic findings of the tertian parasite in her second confinement, which, he says, is worthy of attention. She had also suffered from chronic nephritis, and malaria was only diagnosed or sought for in the diagnosis, until almost every other possible disease had been excluded. The most important part of this paper, as he says, is the lesson to be learned in regard to the need of thoroughness of diagnosis.

SCIENTIFIC EDITORIALS.

ECZEMATOID RINGWORM.

If we look at this disease superficially and carelessly we are liable to mistake it for a case of eczema. Then we would treat this disease with remedies recommended for eczema and wonder why we did not get results. Had we not been too hasty, had we observed its peculiar location and form, had we made a microscopical examination of the scales, and, if necessary, of some of the deeper tissues, we would have found that this disease belongs to the fungus variety.

In 1860, Hebra described an eczematoid trichophytosis in the inguinal region and called it eczema marginatum, and added that in rare cases the axilla, umbilicus and folds of the breast were involved.

Dry, scaly and pus-forming varieties of trichophytosis have long been known to occur on

the extremities, but eczematoid varieties on the palms and soles were first demonstrated by Djeladeddin-Mouckhlar in 1892, and afterwards again described by Whitfield and Sabouraud in 1911.

Clinical manifestations of eczematoid trichophytosis in the groins appear as flat reddish papules which sometimes coalesce and become inflammatory, particularly when favored by heat and moisture. Soon infiltrated round patches make their appearance on other parts of the body, such as the axilla, anus and even the vagina. Pruritus is rather increased by heat, as when the patient is in bed, and often leads to secondary infection, such as impetigo and furunculosis.

Eczematoid trichophytosis was known long ago in tropical and sub-tropical countries, especially in India. There it was known under the name of Dhobi's itch (laundry-man's itch); the disease is usually met on the extremities in persons whose occupation is laundry work. Soldiers who have done service in India, China, Cuba. Porto Rico and South Africa often bring the disease with them when they return to their native lands. It is rather peculiar that the disease is found among men more than women, probably due to the greater exposure of the men in working in the fields and jungle.

In regard to tranmissibility of the disease, predisposition towards it seems to play a dominant factor. In India it is thought that the disease is transmitted by laundrymen whose hands are affected by the immersion and who are supposed to transmit the virus to their patrons through the clothing. Then it may be transmitted by wearing infected clothes or direct bodily contact, wherefore Turkish baths, gymnasiums and swimming

pools are often responsible for the transmission of it.

The diagnosis of eczematoid trichophytosis is based upon its unusual location, its peculiar form and persistence and its repeated inflammatory attacks at times penetrating the cellular tissue (serotum, labia and pudenda). From erythrasma it can be distinguished by its eczematoid character; at times it may come simultaneously with it. In infection of the sole of the foot the diagnosis may be masked by dysidrosis, but it can be soon found and established by examining the scales in which mycela and spores are found in great numbers. Sabouraud distinguished this disease from other forms of trichophytosis and called it epidermaphyton inguinale.

No therapy should be applied until microscopical examination is made. Flannel dipped in tincture of green soap and hot water should be rubbed over the scaly places, then antiseptic solutions containing bichloride of mercury, resorcin, beta-naphthol should be used. The strength of this solution must be measured according to the severity of the dis

ease.

If too much irritation is caused by these applications some emolient salves, such as zinc oxide, are very grateful. very grateful. Bullous places and pustules must be opened and cleaned. The treatment must be kept up until every sight of the disease has disappeared. M. L. RAVITCH.

Cleft Palate.-L. Emerson, Orange, N. J. (Journal A. M. A., Jan. 23, 1915), details the technic used by him, as well as that of the Brophy operation, as described by Carmody. The Brophy operation, he says, should be performed in early infancy before the end of the third month, and Brophy himself operates as early as the second or third week. The mortality in the early months of life, in the hands of the occasional operator has led him to abandon the early operation altogether. If complicated by hairlip, he usually repairs the lip during the first few months, and closes the palate some time in the second year. The parents of a child with a cleft palate should be told that unless it is remedied within the first five years of life, his power of speech will be seriously and permanently impaired. While he says it is not entirely original, Emerson's own method is to remove a wedgeshaped piece, base down, subperiosteally from the septum, thus avoiding injury to the nerves and blood-vessels; the space from which this is removed is obliterated by forcing back the premaxilla, leaving a septum smooth on both sides. It is necessary to freshen the edges of the premaxilla, and also the maxilla, in the same way as in the case of a single cleft. The technic is described at length, and the method illustrated. The after-care of the case is important.

ORIGINAL ARTICLES

FURTHER RESULTS WITH THE USE OF SALVARSANIZED SERUM.*

By H. J. FARBACH, Louisville.

Some months ago I read before this society a preliminary report of some cases of cerebrospinal lucs treated with salvarsanized serum. I wish to report further on these cases, and on some additional ones.

The technic used was the Swift-Ellis. I mentioned in my first report the other two procedures suggested, namely: That of a mixture of blood serum and salvarsan solution; and the hypertonic neosalvarsan solution.

I wish to reiterate and with more emphasis that these methods should not be attempted. Theoretically they are not rational and present reports show them not only to be without therapeutic benefit but to give rise to serious. harmful and even fatal results.

I wish to again call attention to the fact that absolute asepsis must be observed in every step of the obtaining and preparation of the serum and that it must be absolutely red cell and haemoglobin free. That a serum showing red cells or haemoglobin should never be used even if the color did disappear during the heating of the serum.

In all the cases, to be reported, systemic

medication failed to relieve or to reduce the symptoms present.

It has been my experience that many cases of cerebro-spinal lues with positive spinal fluid findings can be relieved with systemie medication and without intradural medication. Therefore systemic medication should always be tried first. Every spinal fluid with positive findings is not an indication for intraspinal treatment.

Resort should be made to the method, only, when the others fail. But, the treatment should not be postponed after thorough systemic treatment fails to produce results.

Destroyed tissue in the cerebro-spinal system as in every other vital organ, can not be replaced. When the symptoms present are those produced by nerve cell destruction we can not hope to relieve them. Our effort would be to prevent further progress and to improve the patient's general health and welfare.

The grounds upon which this treatment is based are mainly that the cerebro-spinal fluid is a secretion. It is not an exudate or a transudate. It does not gain entrance to the spinal canal by an osmotic or filtration process. It is the product of the activity of the cells of the choroid plexus. These cells allow few if

*Read before the Jefferson County Medical Society.

any of the antisyphilitic substance found in the blood current to enter into its secretion. The man that argues that if such substances are present in the blood stream they must also be present in the spinal fluid because the blood goes to every portion of the body, forgets that this fluid that bathes the brain and cord is a secretion as the gastric or pancreatic juices are a secretion.

Briefly, the conditions produced in the cerebro-spinal system by the treponema pallida are:

1. Inflammatory reaction in the meninges. Gummatous conditions.

2.

3.

Artery changes; and the blood vessels than concern us most are those in the piamater.

These are not all the changes that can and do take place but they are the ones that interest us most from the present discussion.

When we can not bring antisyphilitic substances to bear on these conditions through systemic medication. through the general circulation, as evidenced by failure of such medication to relieve symptoms, we now have recourse to this new method.

General

I will report these cases briefly: Case I. Tabes, paralytic stage. condition bad. Suffers great deal of pain. InBlood shows Wassermann two plus. Cerebrovoluntary action of bowels and bladder. spinal fluid shows Wassermann three plus; globulin three plus; cells 172.

Intra-spinous treatment given every two weeks. Was given eight treatments. Two weeks after last one of this series cerebrospinal fluid shows Wassermann negative: globulin, negative; cells, three. General condition greatly improved, gained twenty so frequent and of little pounds, pains not severity. Has regained sufficient control over bowels and bladder to keep bed clean during the day. Six months later; condition about the same as last reported. Little more pain. Another treatment given. Cerebro-spinal fluid obtained at this puncture showed, Wasserman one plus; globulin two plus; cells twenty.

Case II. Beginning tabes. Lightning pains, trouble in walking at night and in washing face. Knee reflexes practically gone, pupils fixed. Girdle sensation. Lost forty pounds in past year.

Blood serum shows Wassermann two plus. Cerebro-spinal fluid shows Wassermann two plus; globulin three plus; cells eighty.

Was given six treatments. Last puncture shows cerebro-spinal fluid, Wassermann, one plus; globulin, negative; cells, eight. Gener

al

condition: Gained twenty-two pounds, pains and girdle sensation gone, feels strong, still some unsteadiness in gait.

Case III. Beginning tabes. Fixed and un