out loss of mental or physical efficiency. The Belgian exiles whom I have seen show a loss in morale; they are preoccupied, absent-minded, diseased, homesick, weak, dejected, bitter and broken. They have suffered a permanent loss which is beyond compensation and beyond redemption. Thus millions of men, women, and unborn infants have been subjected to a vivisection of unparalleled cruelty unsurpassed in the history of man or of the lower animals. It is as if upon Belgium as a whole every degree of physical, mental and moral torture had been inflicted without anesthesia.

Microscopic sections of liver, adrenals, cerebellum, etc., are given, showing the normal microscopic structure, and adjoining, the same tissues are given showing the structure as altered by the extreme fatigue, fear, etc., that soldiers had passed thru.

Among the hundreds of books on the war there is not another like this one, and none of equal interest to physicians. This is the first showing of the psychology and physiology of soldiers in battle and in military hospitals that we have seen.

THE MEDICAL MONTH.

The State Pharmacy Inspectors of California captured many thousand dollars' worth of opium in their raids in that state. All but the smoking opium was turned over to eleemosynary institutions of California to be used as opium. The "smoking opium," being unfitted for medical use by the process of cooking to make it a "smoking brand," was destroyed by fire, $50,000 worth of captured smoking opium being destroyed by the police. It would be too expensive to extract the alkaloids from the cooked opium.

The American Society for the Study of Alcohol and Other Narcotics will hold its 45th annual meeting at Washington, D. C., December 15 and 16, 1915. This was the first society of medical men in the world to take up the scientific study of alcohol and other narcotics. Its papers and transactions have appeared in the Journal of Inebriety, and comprise the first scientific literature on this subject. Thirty-one papers will be presented at this meeting by specialists and distinguished medical and scientific men. These studies will be confined exclusively to the effects of alcohol and drugs on the body and mind, as seen in the laboratory and from clinical observations. The public is cordially invited. Programs can be had by addressing the secretary, Dr. T. D. Crothers, Hartford, Conn.

The United States Civil Service Commission will hold an examination for a male "assistant in metabolism" on December 8, 1915, in various cities. The duties of the assistant will be to make complete food analyses, including calorimetric determinations and determination of energy metabolism by the respiration apparatus. Salary is $1,500. Those interested should write to the commission, Washington, D. C.

Dr. L. Duncan Bulkley and staff will give the seventeenth series of clinical lectures on diseases of the skin in the Out-Patient Hall of the New York Skin and Cancer Hospital, Second Avenue,

corner 19th Street, on Wednesday afternoons, beginning November 3, 1915, at 4.15 o'clock. The lectures will be free to the medical profession, on the presentation of their professional cards.

The Health Commission of Paterson, N. J., plans to obtain an ordinance requiring from each person applying for a license to marry, a certiñcate from a physician showing freedom from diseases communicable to children. Dr. Thomas A. Clay, city health physician, has gathered a mass of statistics emphasizing the fact that many of the children born in hospitals have diseases inherited from their parents. These statistics cover not only Paterson, but other hospitals and asylums.

The government of the British West Indies has been advertising in North Carolina papers for capable young medical men to serve six months or longer in medical service in the Leeward Islands. These positions offer admirable opportunities for the study of tropical diseases.

Milwaukee, Wis., is engaged in actively suppressing quack doctors, "institutes,” etc.

A marble bust of the eminent Dr. Robert Battey, of Rome, Ga., has been presented to Emory University.

It is impossible in "Medical Month" to give due credit to the many-sided activities of medical men and women in the present world's war. Want of space alone forbids.

In the leper lazaretto at Tracadie, N. B., there are sixteen patients-seven males and nine females. This is the smallest number in years. This is claimed to be the result of the system of treatment now being carried out in that institution. Two former inmates discharged in

1912 remain cured.

The will of the late Henry Rutherford contains a bequest of $200,000 to the Rockefeller Institute for Medical Research.

The Virginia State Board of Health announces that it is preparing to issue its biennial register showing the name and location of all physicians, health officers and registrars of births and deaths in the state.

The Southern Medical Association holds its 1915 session in Dallas, Texas, November 8th-10th.

Steps have been taken by the Navy Department to make the Medical Reserve Corps a reserve in fact for the Medical Corps of the Navy. Under the terms of a circular just issued by the department, medical reserve officers are required to bind themselves to perform active duty in the Navy whenever they are called upon by the secretary. Officers of the Medical Reserve Corps are also required to report to the Navy Department at least once in every six months as to their location and their physical fitness for military duty. Their number is limited to 300, and they are to be honorably discharged at the age of 55 years.

Dr. Edward L. Trudeau, pioneer in America of the open-air treatment for tuberculosis, died at Saranac Lake, N. Y., on November 15th. He did herculean work in the war against that disease and carried on an extensive propaganda for open windows in offices and homes. His work was recognized everywhere and he received the Doctor of Laws degree from McGill University and the University of Pennsylvania.

Copy must be received on or before the twelfth of the month for publication in the issue for the next month. We decline responsibility for the safety of unused manuscript. It can usually be returned if request and postage for return are received with manuscript; but we cannot agree to always do so. Certainly it is excellent discipline for an author to feel that he must say all he has to say in the fewest possible words, or his reader is sure to skip them; and in the plainest possible words, or his reader will certainly misunderstand them. Generally, also, a downright fact may be told in a plain way; and we want downright facts at present more than anything else.RUSKIN.

EDITOR MEDICAL WORLD:-The best example of acute indigestion is seen in those who, on account of indiscretions in food or drink, get a condition of more or less continuous gastric distress, increased on eating or drinking, accompanied by regurgitations, the entire condition subsiding in a few days' time. This is the acute indigestion, cases of which every practician of medicine has seen a number of times. Next to this simple form are aggravations of chronic gastritis, brought on by errors in eating. A person with a chronic gastritis often has what looks like attacks of acute indigestion, which are due to an exacerbation of a catarrhal condition, which chronic state may exist without symptoms, or relatively few, in the intervals between the acute attacks. Added to these are states of acute indigestion wherein the gastric functions are at a high level, due to a greater or less degree of vagotonia, and other states in individuals who are run down in a general way for any of a number of reasons, who get attacks of about the same symptoms due to sympatheticotonic states.

A Terminal Condition of Other Disease. There is a conception abroad in the minds of some medical men, as well as most laymen, that acute indigestion is a clinical entity which may be fatal in type. It is particularly upon this that my article deals, because there are some things which apparently are not sufficiently known. In the New York Polyclinic Hospital, which covers a district in Manhattan of nearly 400,000 people, the ambulances often bring in persons who are supposed to be suffering from acute indigestion. Many of these have died, and the postmortem work has shown that

often what may look like an entity is, after all, only a terminal condition of a serious state of illness, in which there are symptoms of acute indigestion with practically no pathologic evidence of involvement of the stomach or intestines. Among the recent cases I recall is one of pericarditis, with a large amount of effusion, in a man who did not know that he had this pericarditis, but who became acutely ill on the street with what was apparently acute indigestion, and died in a few hours, the autopsy disclosing the above. Ever so many cases of perforated gastric and duodenal ulcers, in which the symptoms, local and general, are not frank enough to suggest a diagnosis of perforation quickly, have been met with; that is, cases in which the perforation apparently ensues in a masked manner. Most of the perforated gall-bladders give symptoms which are distinct enough to suggest marked mischief, but occasionally a gangrenous or perforated appendix is seen in which simple forms of gastric symptoms are present, without vomiting, sub- or supernormal temperature, acute pain, change in the pulse rate, etc. Added to those mentioned are cases of cardiorenal and vascular diseases, the entire class making up an assemblage in detailed pathology too numerous to delineate. Why it is in them that states of acute indigestion are added as a terminal feature, seen just before death, is not plain. It may be due to changes in the innervation presenting themselves in the lower end of the vagi or branches from the sympathetic plexuses in the upper abdomen, and those of the splanchnic cords that go into them, these supplying the stomach, duodenum, liver, spleen, etc. This type of acute indigestion may be specified as terminal indigestion, but cases dying, having these symptoms, are nevertheless fatalities due to the causes in back of them.

Not Connected with Disease Elsewhere.

I desire now to draw attention to some cases I have seen representing a type of acute gastritis which, according to the clinical history and the pathologic findings, are deaths caused by this condition alone. Seven cases have been met with in which there was a marked acute, diffuse, parenchymatous gastritis. These stomachs were all of them practically alike in internal appearance, in which there were seen a smoothing of the mucous membrane, due to protoplasmic and granular degeneration of the

cells of the gastric glandularis, and a marked round-cell infiltration in the intertubular structures. The degeneration of the mucosa with the infiltration of the mucous and the submucous tissues gave to the interior of the stomach its smooth and thickened appearance. Here and there in

At

Severe fatal form of acute gastritis. The flat appearance of the glandulature is due to swelling caused by hyperemia, infiltration of the mucosa with round cells and polynuclear leucocytes, general cloudy swelling of the glandular cells and superficial epithelium, and the exudate in the submucosa. numerous places over the surface of the organ are seen adherent masses of tough, cloudy-white mucus. The tunica propria of the entire stomach was involved, but below the submucosa the structures were not included in the inflammatory process. No pus or bacteria could be found.-(From Bassler's "Diseases of the Stomach.")

these stomachs there were thick clumps of mucus tightly adhering to the surface and small areas of superficial hemorrhage.

Examinations of sections from every part

nations of the contents of the stomach and tissues failed to disclose any bacteria associated with the condition. Examination of these stomachs for the presence of toxic substances, chemical in nature, were also negative, and there was not enough pathology in other tissues of the body to permit one to believe that these indigestions were symptomatic of something else or terminal to some serious condition in other organs. I believe that there is a severe type of apparently acute indigestion in children, those of middle age, and the old, which is commonly a symptom, terminal before death, of serious pathologies in other organs than the stomach; but I believe further that there is a type of acute gastritis which may be so severe in degree that death could be caused by it, the other organs being approximately normal. What the cause of this severe acute gastritis is cannot be stated, but it is probably due to some chemical error, causing, what has been so well put by Cabot, "chemical death."

Treatment.

The treatment of the simple forms of gastritis due to indiscretions in food or drink, those which are acute exacerbations of chronic catarrhal or vagotonic and sympatheticotonic states, are relatively plain. The treatment of the terminal forms, in which these symptoms are due to other states, is the treatment of these other states, most of which are surgical, with the exception of the cardiorenal and vascular cases. The treatment of the fatal types of acute gastritis represented in the seven cases I have seen has been disappointing. Local treatment of the stomach has been of no benefit. I feel that there have been two cases that were saved by treatment devoted to the general condition of the body, of which I would mention hot packs, the hypodermic use of strychnin in rather large-sized doses, abstinence from food and drink, together with absolute rest in bed.

ANTHONY BASSLER, M.D. Professor of Clinical Medicine, New York Polyclinic Medical School and Hospital; Visiting Physician, New York Polyclinic Hospital; Chief Gastroenterologist, German Poliklinik; Visiting Gastroenterologist, People's Hospital; Consulting Physician, Beth David Hospital. 21 West 74th St., New York City.

DEAR DR. TAYLOR:-I just can't afford to part with my many-years'-old friend, THE MEDICAL WORLD, and say good

continue my subscription as per check enclosed. Olney, Md. CHAS. FARQUHAR.

Acute Gastritis-Usually a Misnomer. EDITOR MEDICAL WORLD:-Following the old nomenclature of intestinal and gastric diseases, which is fast becoming obsolete, there are three terms which, while having some claim to existence, need to be carefully weighed before being used, viz., acute gastritis, chronic gastritis and ptomaine poisoning.

Chronic gastritis is a term used by many men to indicate any stomach condition having the element of chronicity and not easily identified as to its precise pathology. Like an ash pile, all conditions not readily identified are called chronic gastritis. Nevertheless, the disease is a distinct entity, and can be diagnosed positively and not merely by exclusion.

"Ptomaine poisoning" is a diagnosis made to fit painful enteritis or duodenitis associated with diarrhea, usually infectious. As a matter of fact, ptomaine poisoning affects the nervous system infinitely more than it does peristalsis; the symptoms are not essentially abdominal.

Definition of Acute Gastritis.

The main point of the paper is a criticism. of acute gastritis or acute indigestion, so called. The term is indiscriminately used for a painful condition of the upper abdomen, abrupt in onset, severe in type, often intractable to treatment and at times fatal.

The expression has been so frequently used that people are learning to be fearful of an attack of acute gastritis, on account of its

unfavorable termination.

Symptoms, Course and Treatment. As a matter of fact, acute gastritis is the simplest form of stomach disease. It arises from rapid eating or overeating or an injudicious meal; most frequently taken when the organ is in a condition unable to receive a meal; for instance, when bodily exhausted. Cold water or cold beer will give rise to it, a banquet may be the preceding factor.

There is an extreme degree of peristalsis; the organ making an unusual effort to empty itself creates the pain. A resisting pylorus generally creates reverse peristalsis, the meal comes up, and, except for the incident soreness next day, the disease has disappeared. The stomach may remain tender for several days. The remedy par excellence is rest and abstinence from food for 24 to 48 hours. Such is a typical attack of acute indigestion.

There is one exception, viz., toxic indi

gestion or toxic gastritis. This condition arises from taking into the stomach metallic poisons, such as copper, mercury, arsenic, acids or alkalies. Here the condition is one of tissue destruction, severe vomiting often with blood, prostration and death from peritonitis promptly, or later from cicatricial stenosis. But these cases are rare, and the history is generally suggestive.

Conditions Mistaken for Acute Gastritis.

There are a number of pathologic entities commonly interpreted acute gastritis, severe in type, serious in nature, some of which may be readily identified clinically, others requiring close study, and some can only be differentiated by laparotomy. The severe pain in the epigastric notch is misleading. Of itself it means nothing distinctive, since most pathologic conditions within the abdomen are reflected to that point. In attempting to properly interpret these seizures, clinical symptoms must be carefully analyzed and laboratory measures instituted, and, most essential of all, a careful history taken. This of itself will in many cases determine the diagnosis.

Among the conditions creating the symptom-complex of gastritis is acute pancreatitis. While this is difficult of diagnosis, the volume of the stool, the slate color, and lack of history suggestive of gastritis should cause one to bear it in mind. Perforating gastric or duodenal ulcer is often mistaken for gastritis. Ulcers above or below the pylorus may exist a long time and give rise

to but little disturbance. Unless a careful history be taken and a fecal examination made, its existence may not be known until perforation takes place.

Pylorospasm, with its sudden onset and frequent recurrences, may be called gastritis. This condition may be caused from hyperchlorhydria or hypersecretion, from ulcer within or beyond the pylorus, or it may be a reflex from a diseased appendix. Cholecystitis and cholelithiasis, with their gastric reflexes, may create the impression. of gastritis. A similar error was made, to my knowledge, a year ago in the case of a perforated gall bladder.

The gastric crisis of spinal sclerosis, in the absence of a history, might be called gastritis. A malignant stenosis of the pylorus is at times unnoticed until almost complete, when pain and vomiting are at once pronounced and persistent.

These are but some of the pathologic en

tities which in the hands of a careless practician may be dubbed gastritis. It is well to bear in mind that, while acute gastritis is perhaps the simplest form of stomach disease, its symptoms are often and generally the first real evidences to the patient of any one of many serious diseases. If this point be kept in mind there will be fewer cases so diagnosed, and, on the other hand, many a patient be given a fair show to recover.

Such a diagnosis is always to be received with suspicion except in children who eat rapidly and unintelligently, or in young men and women who are given to banquets, late suppers, and wine orgies. In middle or late life such a diagnosis should never be made without a very complete history and examination, and without excluding all the possible pathology with which pain and vomiting are associated. J. M. BELL, M.D.

826 Jule St., St. Joseph, Mo. [Our symposium on digestive diseases and associated ailments includes several articles that we cannot present in this issue for lack of space. We have now in type, which we are compelled to hold over till next issue on this account, an article on "Acute Indigestion," by Dr. W. F. Waugh, of Muskegon, Mich., in which is presented a wealth of material which Dr. Waugh assures us is not to be found in any textbook. Also an extensive and thoro article on "Chronic Indigestion," by Dr. J. L. Engle, of Philadelphia, which goes into the subject in a masterly "Intestinal Indigestion" will also be way. treated in January WORLD.-ED.]

tion of the vessels occurred. This was a distinct advance over other existing methods.

Vierordt in 1885 was enabled to measure arterial tension more accurately by means of the sphygmograph than had been possible up to that time, but stated that absolute values were not obtained by that method.

Since that time many investigators have devoted their attention to blood pressure, and mainly arterial tension; so that to-day the terms blood pressure and arterial pressure and arterial tension are practically synonymous terms.

Among those who have done yeoman work in this field of research and in the perfecting of instruments which have been placed at the disposal of the medical profession, since 1880, should be mentioned Basch, Mosso, Hurthle, Riva-Rocci, Hoepfle, Hill, Bernard, Oliver, Gaertner, Stanton and Janeway.

That blood pressure is more and more widely studied cannot be gainsaid. That it is important and of great service in the study and treatment of disease no reasonable medical practician for an instant will attempt to confute.

While there is and probably should be slight differences of opinion as to pressure significance, those best qualified to know seem to be a unit on two things concerning this pressure: One is that the observation should be made as routinely as the taking of the pulse and temperature or urinary or other analysis. And that a mercurial manometer is the most reliable type to be used.

In 1878 Ray and Brown placed a membrane, stretched over a capsule, upon the skin and applied both air pressure and water pressure. By connecting the capsule with a water manometer the readings could be taken with the naked eye when the oblitera

detailed in THE WORLD to such an extent that it would be a redundancy to admit it here. But no other single observation, whether used in the study of cases seen by the physician for the first time, or used routinely in observing and treating them, will offer the attending doctor as many facts concerning their condition as will blood pressure. We do not mean to say that a diagnosis should be placed upon this determination alone, nor should one establish a diagnosis upon a cough alone. A cough may arise from many different conditions, as does a high or low blood pressure. A reasonable physician would never diagnose a case of pneumonia on a cough (some cases,

'A booklet on blood pressure and how to take it will be forwarded to anyone on receipt of ten cents in cash or stamps by applying to the author.