search for it is, or may be made for the antiseptic or analgesic compound, and as the poet wrote, "weak and irresolute is man, and the purposes of today woven with pains and plans tomorrow rends away," forgetful, too, that "the Bird of Time has but a little way to fly-and Lo! the Bird is on the Wing." "Great souls by instinct to each other turn, demand alliance and in friendship burn," thus, "it is meet that noble minds keep ever with their likes; for who so firm as cannot be seduced," remembering that the strength of the pack is the wolf, and the strength of the wolf is the pack," and then, too, “a chain is no stronger than its weakest link," which you may be or have been, or may become in the Medical Chain.

Even if the rewards for virtue and merit are very pleasing for ambition and often very alluring, it may be worth consideration in early life that much time must necessarily be consumed in the pursuit of this axiomatic promise-long drawn out, and that many able men either perish while waiting, or in the race for the golden apples or myrtle wreaths.

This paper is presented especially to young M.D.'s, and assuredly not to him who allows himself to be addressed as "Doc," for he must consider himself of an inferior type-or an outcast from our noble profession.

Belleville, Ontario.

In your cases of pneumonia, do not lose sight of the value of controlling and regulating the circulation. It is true that since the rise of the later theories of immunity and our new ideas regarding fever, such remedies as aconite and veratrum have become less popular; yet we make the prophecy that they will eventually come into their own again. Certainly aconitine, veratrine, strychnine and digitalin have a place in the therapy of this disease-a valuable place.

If you have a troublesome case of arthritis, make it your first business to look in the mouth and examine the teeth and tonsils. If you find pyorrhea or enlarged tonsils, first see that these are "fixed up,” and watch results.

To Summary Readers:

Please be good enough, in your correspondence with advertisers, to mention that you have seen their advertisement in The Medical Summary. This will help all around.

THE RIGHT AND WRONG SIDE OF COFFEE

BY AXEL EMIL GIBSON, M.D.

During the 400 years coffee has been recognized in the western world as a popular beverage, its power to control the minds and palates of its devotees has constantly increased. Its immense popularity as a worldbeverage, however, has not its basis in the taste as is the case with sugar-nor in the cerebral intoxication with its unreasoning and unreal functional exuberancy as we find in alcohol; but in the energies generated in the bean itself, and imparted to the system in the form of muscular and vascular release. Hence the vital difference in the effects on the body between alcohol and coffee lies in the fact that in the former case the system has to pay for its own stimulation, but in the latter-if rightly enjoyed-the bean itself pays for the expense. This accounts for the weakening exhausting reactions of alcoholic stimulations, unknown to the "cup that cheers but not intoxicates."

The effect of coffee on the system, however, is largely determined by the conditions under which it is prepared and enjoyed. Suspended in the bean is found a volatile substance the empyreumatic oil-which gives taste and aroma to the coffee, and at the same time exerts a reducing and modifying influence over the stimulating power contained in its twinprinciple the caffeine. Taken together, these two elements hold in a safe balance the stimulating and invigorating impulse contained in the coffee bean.

But this fine adjustment prevails only when the coffee receives a truly hygienic preparation. Exposed to boiling, the caffeine decomposes into an acid-cafeic acid-which through the empyreumatic oil breaks down into an alkaloid. This changes the entire character of the coffee, which, from a bracing, self-generative invigorant, is turned into a nerve-lashing, exhaustive stimulant, in which the adjustment and balance between the stimulating and regenerative powers of the bean has been destroyed. Hence coffee should be zealously guarded from the boiling pot, and should be prepared solely by the process of infusion through steaming, or the percolating process.

But apart from these constitutional qualities of coffee, there are other conditions connected with its use, of which the coffeedrinking public cannot afford to be in ignorance. Barring a mere trace of nitrogen, the coffee bean contains no element of nutritionconsequently is not a food-and must, therefore, remain classed as a systemic stimulant. For an element which has no cell-building power, has not the vital or physiologic legitimacy in the system maintained by food, and hence should not share the regularity of the latter as a means of replendishment.

Coffee is a remedy-a medicinal agentintroduced by nature in the service of man, under conditions when his system demands it. Furthermore, as a tropical plant, its sphere of virtue must naturally and evolutionally be connected with environmental influences. This will readily be seen when we recognize that the circulation of our bodies in general is under the influence of the quality of pressure received from without and from within the organism-from without, in the low temperature of the atmosphere assisting the blood from the circumference to the center -and again from within, by the pumping action of the heart forcing the blood from the center back to the circumference. In the tropics, however, where the temperature is higher outside than inside the body-the blood in its slow course from the periphery would be assisted if an agent of expediency were introduced as a modifying force in the vascular exchange. Such an agent we find in the high percentage of quick combustible sugar in the tropical fruit; in the high stimulant of the native spices, and in the re-invigor ating principle contained in the coffee bean. In other words, coffee by its power to stimulate the innervation of the blood-stream centerward, accomplishes the same result from within the organism, as the low temperature of the temperate zone does from without.

This makes of coffee a tropical beverage, not only genetically, but also conditionally and qualitatively. But as on the other hand, each individual is a world in himself, with needs and necessities all his own, we may expect to find in the general temperament of man, such tendencies and characteristics which may demand for their modification and adjustment the same expediency which is represented by coffee in the tropics. Hence, as an occasional nerve stimulant and tempera

mental adjuster, coffee may be enjoyed even in the temperate zone by those whose temperament is subdued, and whose nervous exchanges are under control. By the highstrung, highly organized and nervously unpoised individual, coffee should not be used.

Moreover, in the philosophy of nutrition there is a principle which should never be lost sight of that the only stimulant which can be safely enjoyed as part of our daily menu, is the stimulant contained in the food itself. As an integral part of its nature, every foodstuff contains a stimulant, so poised and adjusted that it imparts a natural impulse of power to the processes of digestion and assimilation. Divorced from this combination, the stimulant becomes a mere lash or irritant, which has needs and uses only as expediency, when environments and conditions make such adjustments necessary.

For those whose temperaments permit the use of coffee, no admixture of sugar and cream should be allowed to interfere with its virtue. Cream especially perverts the nature of coffee, by reducing its empyreumatic oil into a tannic acid compound-at once indigestible and toxic, giving rise to the formation of bile acids in the liver, with the subsequent appearance of a muddy complexion-due to bile pigments deposited in the skin. Another precaution of no less importance to the safe enjoyment of coffee is its temperature. From strong physiological reasons no beverage should be permitted to enter the system at a higher temperature than blood heat, and it may be safely said that the greater injury wrought by the consumption of coffee lies in its admixtures and temperature, rather than in native disqualifications.

Los Angeles, Cal.

Gibbon said to Voltaire: "What you drink coffee, this poison?"

Voltaire replied: "It is poison, I know it, but it acts slowly; I am eighty years of age and have been drinking it always."

In cases of intestinal colic with liver torpidity, euonymus (Wahoo) has a decided field of usefulness.

When there is pain over the liver, or in the congested conditions of that organ, euonymus (Wahoo) is indicated.

DIABETES MELLITUS

J. P. SHEPHERD, M.D.

This is surely an age of progress. The old system of guess work diagnosis and empirical therapeutics must give way to rational medicine based on sound physiological, clinical and biological principles. It is results that count -and results only-with the patients who pay their doctor their money to be made well.

True, any radical change in the tide of longestablished treatment is always accompanied by a furious storm of protest, but all branches of science were called upon to contribute to the wisdom accumulated for the cure of disease. This period may be said to have closed with the wonderful discoveries in bacteriology and pathology as well as medicine, and has completely changed the objective mind.

It will not be necessary to go into the history of glycosuria and diabetes any more than to say these two terms are not synonymous and yet we find many who consider them identical.

Glycosuria is one of the cardinal symptoms of diabetes mellitus; it alone does not constitute a disease. The elimination of glucose by the urine must be present and extending over months before a diagnosis can be made from it alone.

Under this heading would come the temporary excretion of sugar found in many of the injuries and disturbances of the nervous system. Injury of the floor of the fourth ventricle seems to upset metabolism of sugar to a marked degree.

In stout people we find a totally unexplainable glycosuria, but which is of a transient

nature.

The only sugars deserving of notice are lactose and pentoses; all others have no clinical significance.

That the status of pentoses is not clear. They appear in the urine after ingestion of fruit and many times after drinking beer. Recent research has shown that they may be produced by the splitting up of certain nucleoproteids, but suffice to say the clinical interest lies in the fact that they may be, and often are, taken for glucose.

Glucose usually is the final end-product of carbohydrate digestion, hence the excess of this product should be immediately eliminated and by the proper channels. It then would

seem reasonable that when the supply of carbohydrates is eliminated or reduced to the smallest amount, a corresponding reduction of sugar should be the showing, but this is not always the case.

Even with a carbohydrate free diet sugar will still continue to be formed and thrown into the circulation for a period of time from the stored-up glycogen in the liver. But in time this must come to an end for the absence of starch or sugar in the diet will prohibit glycogen being stored up to replace that which was used.

Then again we find cases of diabetes mellitus where carbohydrates have been entirely excluded from the diet for long periods, but the formation and elimination of sugar persists in spite of the restrictions. It then behooves us to investigate the action of our proteids, as I have found a number of cases that have been as badly affected by the proteids as the carbohydrates. In this view we are supported by the fact that the usual end-products of proteids "urea" in such cases is reduced.

It will then seem that the power to form glucose from proteids exists in the body but is held in check in some manner, and as long as sufficient digestive fluids are abundant, but as soon as we find the supply reduced this check is removed and diabetes follows.

Would it not seem probable then that the explanation may be found in the internal secretions of the pancreas, and if it is the function of this secretion to prevent the metabolism of proteids into glucose, and if this secretion be interfered with by pancreatic disease or other disease to diminish the fluids, diabetes would result?

Now, if this influence of the pancreas on sugar metabolism exists (and we have no ground to doubt it), the common custom of withdrawing carbohydrates from diabetes cases is useless and criminal. It has been demonstrated time after time that sugar will decrease under strict diet at the beginning, but it will invariably rise to a higher point in due time regardless of the diet, and with the diet and carbohydrate restrictions we always have the danger signal confront us and "acetone" will soon appear on the scene and the finding of acetone in a diabetic is a very serious symptom and the carbohydrates must be given until this condition changes.

It is not wise to allow the patient to use sugars and starches excessively, but they

should be given very cautiously until a point is reached easily determined by examination -where they increase the sugar in the urine. When the point of toleration is reached, we must then turn our attention to the proteids which are always fed to an excessive degree in this disease. Here we must use careful tests and eliminate such foods as cause our disturbance and we have the agreeable manifestations, which are not due to the disease so much as protein diet and the restrictions of the carbohydrate.

All of the different tests I believe are good if worked out as they should be, and with fresh solutions, and we will not touch on this subject.

In the treatment of diabetes, it has been a problem as well as the cause and each physician will have to take his choice of medicine as well as the many involved theories, but I believe almost all diabetics can be benefited and passed through their remaining years with comfort.

It should be understood that a well-developed case of diabetes will never be cured so the patient may eat all foods without trouble, but it does mean that sugar can be eliminated from the urine and remain away as long as the patient will follow certain rules of living and excesses of the food stuffs which result in degenerative changes.

The doctor must have a distinct understanding with the patient and advise him that he is to cure himself and that he, the physician, will remain his skilled adviser who will advise and encourage the patient over the tedious journey of restrictions and tests until he is safely landed to good health and strength. If you take your patient into your confidence and show him each test and explain each step, you will be more than surprised at the active co-operation you will secure, and the ready aid given to the changes in diet or elimination of certain foods, as all are anxious for a cure and will interpret your tests intelligently.

It will be found that the average case can handle safely from thirty to a hundred and forty grams of carbohydrates daily and from fifty to two hundred grams of lean meat, fish or its equivalent in eggs; fats in small amounts and carefully watched; vegetables can be used with freedom and fruits without restriction.

Any excess of protein waste will promptly putrify in the bowel and under no conditions must the bowel retain any waste over twenty hours. Laxative "saline" may be given and bowel flushing continued until they are free, while Jamun Compound should be given three times a day-an hour before the morning and noon-day meal and at bed time.

I have found that by this method all patients improve rapidly and that sugar will disappear within fifteen or twenty days and they do not complain of the excessive thirst which is due solely to the lack of alkalies and the immense amount of sugar circulating in the blood.

Jamun Compound was referred to me by a brother physician and I looked on it as another of the recommendations which we so

frequently hear and without action, but as a last resort it was used and has been continued with the most pleasing satisfaction, and I firmly believe that all who make a test of this combination will be as well satisfied as I, for it certainly has an action that is lasting as well as its quick change of the internal secretions.

It has been used in all the different conditions and even in the gangrene, and in each case has done its work completely. Had I space I would gladly give some of the case reports which will speak for themselves, and know that any doctor who will use the product will be as enthused as I have been. Minneapolis, Minn.

INSANITY OF FOREIGNERS

BY S. R. KLEIN, M.D., Ph.D. Public Lecturer, Pathologist and Bacteriologist, Director of the Norwich Pathological Laboratory

General is the belief that the foreigners outnumber the American citizens as inmates of the insane hospitals and asylums. This is not correct. In proportion to the population, only 40 per cent. of the insane persons are those of foreign countries. So far, I am acquainted with the records of the institutions for the insane in the States of New York, New Jersey and Connecticut. A great number of the inmates are the Poles-Polocks, whose cradle was in Russian Poland, Kurland, Lithuania and Galicia, part of the Austrian Empire. I think the State Asylum in Morris Plains, N. J. has a whole lot of them. No

wonder! The neighboring cities of Morris Plains are full of Polish people. These descendants of Ponyatowsky, Globucar, Goluchowsky, Simalowsky and many other leaders of the Polish Nation have different habits in their own country. There, they do not need to work as hard as here; their food and drink is of an extremely poor grade. Here they cannot digest the products, rich of proteids, fats and carbohydrates. The poor work on metabolism, which produces a certain form of insanity. There are many medical institutions, insane hospitals, asylums, doctor, where this kind of insanity dominates. The inmate goes hungry all the time, which condition makes him nervous, exalted, fighting, disgusted over his life, and-maniacal.

And what shall we tell about alcoholics, the drunkard? Especially the habitual drunkard? Many of them are Hungarians, Roumanians, Italians, but not because they drink much, but because they use and take into their bellies bad stuff, poisoned drinks, etc. In their own old country, they have the best wines of the world, Tokaye, Ruster, Ansbruch, Dalmatines, excellent Italian wines-here all they get on the "corner" is poisoned, sulphurated drinks, large of foam, the rest is "bluff," poison to the intestines, producing enormous indican, bile, uric acid, sugar and phosphates in the urine and craziness to the nervous system. Beside, they have to work hard in the shops, on the street, on railways, in mines, etc., etc. Last, but not least, we forget the hastening to get the dollar, the get-rich-quick, and send it home to pay the debts, the mortgage, etc. At the same time, he lives here on a few cents per week. No wonder, foreigners are frequently brought into asylums as nervous wrecks and dangerous maniacs.

I remember a case happened a few years ago: A man left his native country, Poland and came over here to get plenty of work and money to pay off his mortgage in his native town. He was given a good job on the Brooklyn Bridge and worked there nearly two years. He saved $1,500 and sent the money home. At the time he lived in New York City in the poorest lunch rooms and fifth-class "hotels." The "hunting of money" brought him his fatal breakdown, and so far as I am acquainted with his case, he died in the Manhattan State Hospital at Ward's Island. He was buried at the expense of the City. We know what that means. And

what became of the $1,500? Why-the State of Russia got it. The house was destroyed while the Germans and Russians occupied and re-occupied the City of Gorlice eight times during twenty-four hours.

146 Cliff St., Norwich, Conn.

THE DILATATION OF THE SPHINCTER ANI

By F. A. WIER, M.D.

I have read in text books and medical journals of most marvelous results following the dilatation of the sphincter ani. They said, among other things, that it had a wonderful tonic effect on the nervo-vascular system, increasing the circulation and adding tone. and "pep" to the nervous system; and, was a sure cure for nearly every disease that flesh is heir to, in fact, it is the one best bet as a cure all. But its specific field of action is in curing piles, fissures, pruritis ani, constipation, stomach, liver and kidney trouble. The more I read on the subject the more enthusiastic I became. My mind was on the subject pretty constantly, and I began to speculate on the condition of my own sphincter; it being the only sphincter I ever had I wasn't sure whether it was tight or not. I recalled that up to the age of four years it had been pretty loose, but now I realized it had been growing tighter

every year.

Along about this time I began having vague and ill-defined sensation in this region. It seemed like an electric current would start from the sphincter and run up my back and radiate over my abdominal region. I began to feel bad all over, and finally there came a day-after the night before I had attended a Dutch Lunch. I knew I was an awful sick man—the pain in my stomach and bowels was excruciating. I swelled up like a poisoned pup, the thing wouldn't budge, and suddenly I realized where the trouble lay-I had a tight sphincter, which was holding up the Dutch Lunch and causing this terrible upheaval in the Interior Department, as well as the aforementioned sensations. So, as it is one of the fundamental principals of medicine to remove the cause when found, I decided to consult a well known Sphincter Specialist and have the durned thing stretched. I felt quite happy over the idea and congratulated myself on the fact that I was "wise" enough to have