me they require seven men. This shows that we would require only about sixty men to attend to two hundred thousand accounts costing us not more than a hundred thousand dollars or only fifty cents per member making our insurance only $17.00 per thousand for sickness, disability and life. The officers

mentioned are only for insurance department, drug business, as other stores. How do you like it?

Deerbrooke, Miss.

WOOD ALCOHOL

By G. L. B. ROUNSEVILLE, M.D.

State factory inspector, Oscar F. Nelson, of Illinois, in his annual report, lists new occupational diseases caused by the use of benzine and wood alcohol. As the result of the increase in the number of these occupational diseases, the State factory department has opened a clinic for the free examination of employees, where their cases may be diagnosed. That the State does employ experts to prevent the use of poisonous preparations to be used in the manufacture of merchandise, to properly safeguard the health of employees is a move in the proper direction. Factory inspection has done much to better the conditions in matters of sanitation, and the added clinic to determine the effects of these poisonous preparations used will help

more.

There is still another and even more dangerous manufacturies which seldom comes under the factory inspectors notice. The compounding of perfumes, toilet preparations, cheap household remedies, and the vendor of cheap proprietary medicines, in which wood or denatured alcohol, in whole or in part, is employed. Nor does it end here. Domestic remedies such as spirits of camphor, common liniments, face preparations, and in fact the use of wood or denatured alcohol for sponges and baths in the sick room, and its application for the killing of vermin.

I quote from the Journal of The American Medical Association: "So much has been written concerning the dangers attendant upon the use of wood alcohol, both externally and internally, that one hesitates to enlarge upon it. The persistence of menthylated

toilet preparations upon the market may offer sufficient reasons, however, for once more calling public attention to this grave subject. Not only an active poison, this dangerous fluid, in addition, has the peculiar property of selective action upon the optic nerve. Whether wood alcohol is drunk, inhaled, or absorbed through the pores of the skin, the effect is usually blindness, or death." According to Merck's Report, one of the leading pharmaceutical journals. The use of wood alcohol in any preparation intended for use either internally or externally cannot be too strongly condemned. Numerous experiments and observations have shown that wood alcohol is extremely dangerous to the human body.

A case is reported wherein the eyesight was nearly destroyed from whiskey. Henry P. Eysink, of Baltimore, was awarded $7,500 by a jury, against Lee Sonneborn, a jobber, and Vincent Flacconios, a saloon keeper. Eysink, who sued for $50,000, became partly blinded after drinking whiskey, he said, in Flacconios' saloon. In his declaration he stated that he could not see anything directly before him, and at angles, could distinguish objects only indistinctly.

I wish to mention a few cases which have lately come under my observation. A lady about 40 years of age, health good, complained to me that she was getting blind; the use of glasses did not relieve; when the thought occurred to me, can it be wood alcohol, and on investigation found that she was using a cheap perfumery made with wood alcohol which had been given her for a Christmas present.

In another instance, a lady about 70 years old, an invalid, had been bathed with denatured alcohol for the relief of supposed rheumatism. The patient complained of headache and could not read. The heart action was irregular, the eyes in that staphylobic condition sometimes seen in exophthalmic goiter. There was stasis in the skin where the alcohol had been applied the surface was red and suffused, and upon pressure it was some seconds before the blood would return. The following day, the patient complained of sore mouth, symptoms similar to acute stomatitis; which spread to the outside of the lips in small blisters; the alcohol was discontinued and the most aggravating symptoms were in a few days relieved, but the lips remained sore for some time. The patient today is in good

health, but the sears upon her lips look like those burned with carbolic acid.

A later case, a lady 74 years old, confined to her bed with valvular disease of the heart, with tachycardia, was bathed with spirits of camphor which had been compounded with denatured alcohol. Following this treatment she complained that she could not see, and upon careful examination it was found that she could not see the hand in front of her face, but upon the movement of the hand to an angle at the side, she could distinguish the thumb but not the fingers. The patient's symptoms gradually grew worse and three mornings after, she was found in a state of coma, the entire right side paralyzed, a fatal case of hemiplegia. Mattoon, Ill.

TENNESSEE STATE MEDICAL EXAMINATION QUESTIONS ON PRACTICE ANSWERED BY M. A. BLANTON, M.D.

1. Give your treatment in detail for a case of poisoning from (a) Carbolic Acid; (b) Strychnine; (c) Bichloride of Mercury?

(a). Give the soluble sulphates such as epsom or Glauber's salt to form the insoluble sulpho-carbolates, in the alimentary canal, mucilaginous drinks, hot applications to the extremities, digitalis, strychnine, and counterirritation over the abdomen. If possible, emetics and the stomach pump should be used. Emetics are usually of no effect on account of the paralyzed condition of the mucous coat of the stomach.

(b). At the beginning, if convulsions are not present, give amyl nitrite to prevent them; at the same time use stomach pump. Tannic acid is the chemical antidote, to be followed by the physiological antidotes such as potassium bromide in 60-grain doses to depress the sensory tracts of the spinal cord and chloral hydrate to depress the motory tracts. If convulsions should prevent swallowing the patient should be chloroformed and the antidotes given per rectum in starch water. Amyl nitrite may be given hypodermatically if relaxation does not occur.

(c). Give large amounts of whites of eggs followed by stomach pump with stimulants and external heat.

(2). Enumerate the symptoms of tetanus; give the cause and methods of invasion; name a toxic condition with which it may be confused and differentiate them?

After an incubation of one to two weeks a constriction of the neck and jaws with difficult mastication appears as a subjective sensation. This is followed by a tonic spasm of the muscles which locks the jaws. The mouth is drawn out and the corners down with the eyebrows elevated causing the risus sardonicus. By degrees the muscles of the trunk and extremities are involved producing orthotonus or rigid extension of the body. Opisthotonos and more rarely pleurothotonos or emprosthotonos may occur. There is usually elevated temperature; sometimes hyperpyrexia. In children the spasm may be limited to the production of risus sardonicus.

CAUSE: The tetanus bacillus and its peculiar toxin enters the body through a punctured or contused wound producing tetanus. The soil of certain regions is peculiarly infectious, especially soil about barns. Thirty per cent. of men working about barns and in horse stables harbor the tetanus bacilli against twenty-two per cent. engaged in other occupations. It is said that the spores remain viable for many years.

Strychnine poisoning may be confused with tetanus. The former lacks the early involvement of the muscles of mastication and the rigidity between spasms. The history and the bearing in mind that strychnine poisoning never causes the jaws to be tetanically closed between attacks of spasm should enable us to readily differentiate these two conditions.

(3). What are the causes, symptoms and physical signs of dilatation of the stomach? How would you treat a case?

The nonobstructive form of dilatation of the stomach is caused by defective innervation or constant distention of the stomach by excessive amounts of food or drink giving rise to atony of the muscular coat. Obstructive dilatation of the stomach is caused by (1) stenosis of the pylorus; (2) pressure on the duodenum; (3) constriction of the pylorus; (4) constriction of the cardiac end of the stomach by adhesions and the pressure of abdominal

tumors.

The characteristic symptoms of gastric dilatation are the vomiting long after taking meals, frequently at intervals of days. The vomit which is large in amount consists of

fermented and undigested food with a turbid liquid. In addition to this we usually find the symptoms of chronic gastritis and other affections to which the dilatation is due very prominent. Constipation is the rule.

On inspection the whole epigastric region is seen to be abnormally enlarged and prominent, with usually a tumor in the pyloric region which seems to be connected with the stomach.

If the stomach is empty percussion reveals a tympanitic note having a metallic quality and extending to or below the umbilicus; if stomach is full the note is high-pitched. Auscultation reveals a rumbling and slashing sound-the succession sound is distinctly heard if the body be shaken.

The treatment consists in giving small quantities of a dry diet. Fluids by rectal enema. Washing out the stomach each night before retiring. An abdominal binder may be worn with benefit. Drugs such as the mineral acids, pepsin, nux vomica, creosote, charcoal, salol and bismuth may be employed, as indicated, with benefit. In the obstructive forms such surgery may be done as the conditions demand, as pyroplasty, gastroenterostomy, etc.

(4). Give the symptoms, diagnosis and treatment of myxedema?

A number of years elapse often before all characteristic phenomena are shown. The face, neck and often other parts of the body have a bloated appearance. Wrinkles are obliterated, nose wide and thick, lips thick and everted, the mouth and tongue enlarged, the skin is dense and chalk-like but does not pit on pressure. The expression is immobile and stupid. The hands and feet are enlarged. The mental condition is sluggish and stupid with a tendency toward dementia. A sense of muscular weakness is complained of. Temperature always subnormal. Anemia develops and often grave conditions follow.

continued over long periods. Tonics such as iron, quinine, strychnine and nuclein may be used with advantage.

(5). What is vocal fremitus? What conditions (a) increase vocal fremitus; (b) what conditions diminish vocal fremitus; (c) enumerate the aids that are of practical use in diagnosis?

Vocal fremitus is a thrill caused by speaking or crying and is perceived by the ear of the auscultator applied to the chest. Vocal fremitus is increased when the lung is consolidated as in lobar pneumonia, phthisis and bronchial pneumonia. (b). Diminished or absent in very feeble persons or when any cause interferes with the transmissions of vibrations as in pleural effusions, emphysema, collapse of the lungs, tumors and pulmonary edema. (c). The aids that are of practical use in (physical) diagnosis-stethoscope, bloodpressure instrument, microscope, instruments for urinalysis, etc. I am unable to satisfy myself as to what is intended by the last clause of this question. I have therefore assumed that the author of this question refers to physical diagnosis and has put it in this connection for a catch.

(6). Diagnose mastoiditis; what facial condition is often associated with this disease, and why?

The diagnosis of mastoiditis is not always an easy task. In association or immediately following a suppurating middle ear we have pain which is severe and of a throbbing, boring kind; felt in the mastoid, brow, parietal and even in the occipital regions of the affected side. Perhaps one of the surest guides in the diagnosis of mastoiditis is tenderness upon deep pressure over the mastoid region near the antrum, immediately behind the ear. This associated with a suppurating middle ear and accompanied by a markedly elevated temperature. Facial paralysis is often associated with this disease and is due to the greatly swollen tissues or inspissated puss pressing on the facial nerve.

(7). Describe the symptoms of arteriosclerosis; name the causes, and state what two important organs are mostly involved, and how it may cause sudden death?

The symptoms are not always apparent and vary with the arteries involved. When the process is general the superficial arteries have a feel like whip-cord. There are attacks of vertigo and spell of unconsciousness in the

aged, especially. Sometimes senile gangrene. The arteries of the wrist feel like a string of beads pulsating under the finger. There is increased precordial dullness. As the heart dilates and the walls become diseased, the sounds become feeble and intermittent. The blood-pressure is always high. The principal causes are, senility, heredity, alcoholism, syphilis, lead-poisoning, diabetes, rheumatism, exposures and excesses of various kinds. While the entire body may be more or less affected, the heart and arterial system suffer most. As a consequence sudden death may be caused by cerebral hemorrhage or embolism.

(8). Diagnose acute endocarditis; state the ordinary causes and complications; outline your treatment of the case and give definite reasons for the employment of each remedy used?

The symptoms of endocarditis are by no means distinctive. The physician should therefore make frequent examinations of the chest when treating diseases in which endocarditis is liable to occur. The diagnosis must be made largely by the history and physical signs. This disease almost invariably follows some other affection. In pericarditis a murmur is heard with either cardiac sound and is near to the ear; while in endocarditis the murmur takes the place of, or is associated with, the cardiac sounds, and is transmitted to points beyond the precordium. Occurring as it does secondarily to some other disease the symptoms are masked by the primary disease. We usually find, however, increased temperature, precordial distress, cough, slight dyspnoea, with the hearts action more or less rapid and tumultuous. In the later stages we have evidences of venous stasis and pulmonary congestion.

The ordinary causes are acute rheumatism (especially in young people) chorea, pleurisy, pneumonia, pericarditis and the infectious fevers as scarlatina, influenza, and diphtheria. It may be secondary to chronic endocarditis.

TREATMENT: Absolute rest in bed and a liquid diet as in all other acute diseases. If the heart is weak and irregular digitalis should be given for its tonic and stimulating effects on the heart muscles. The free administration of alkalies such as ammonium carbonate, potassium carbonate, and potassium acetate until the urine is alkalinized may serve to prevent changes in the heart valves. Dyspnoea

may be relieved by small doses of morphine. If cyanosis and edema appear strychnine, atropine, nitroglycerin and other heart stimulants and tonics should be tried. After the acute symptoms have passed potassium iodide should be given for the purpose of absorption. General tonics as needed.

The possible complications are mainly embolisms of the kidney, brain, spleen and of the skin. Embolisms of the skin producing petechial or purpuric spots. The last the least serious, of course. Baileyton, Tenn.

TREATMENT OF CANCER AND A REPLY

BY SAMUEL KING, M.D.

I am well aware that the medical profession has for years considered cancer a local disease, but fortunately for the cancer victim of today a new light is breaking. Medical men whose minds have been deepened, broadened and polished by a classical training in our best universities have laid the foundation for a subsequent medical education that is so liberal that they are most willing to acknowledge failure, and most eager and willing to accept the truth wherever found. These men are thinkers. They cannot be confined by any narrow limits set by schools, creeds, theories, precedents or prejudice. It is through the untiring energy and perseverance of such men that the world moves forward and not backward. They are no weaklings. They are endowed with a thinking mind and genius of their own. They are "not the first by whom the new is tried, nor yet the last to lay the old aside," but make their decision and act after the most careful study, searching inquiries and due deliberations. They are fearless but at the same time conservative, and see some good in all honest effort.

They long since came to the conclusion that surgery is not, never has been and never can be, a cure for cancer, unless backed up and supported by the administration of proper therapeutic and dietary measures, no matter whether the operation was performed early or late, and that back of every diseased condition there is an underlying cause which must first be removed before any operative measure can be successful. J. Compton Burnett, one of

England's greatest physicians and authors, says: "A causeless tumor never existed." The inexorable law of cause and effect operates here just as truly as in any other sphere of the universe, and this law will not be balked of its end in the smallest iota.

If surgery is a cure for cancer, why so many cancer research hospitals springing up here and there? Why does the quack, charlatan and horse doctor with their plasters thrive and grow wealthy, while the doctor with his scientific training and a conscience sits back and allows the robbing to go on from year to year? Simply because the above doctor has tried the plaster, injection and surgery, and found them woefully inefficient.

On the other hand the laity have seen their friends and relatives afflicted with cancer pass under the surgeon's knife at a greater cost with no better results, if as good, as those produced by the plaster. The surgeon cuts out what he sees and feels, when he feels his work is done and leaves an already weakened and depraved system, still more weakened by the operation, to be invaded anew by new growths; or more often he is able to remove only part of the cancerous tissue, and the weakened resistance of the patient now allows the part left to grow more rapidly than before.

Nor is this opinion shared alone by the laity and a few of the lesser lights, like myself, who profess some skill in the science of healing. But, for instance, great men like Dr. Walsh, in his treatise on cancer, says: “The knife can neither be regarded as a means of curing cancer or of prolonging the existence of the person afflicted with the disease." Dr. Thomas W. Cooke, surgeon of cancer hospital, London, says: "From 1851-1863 there were 413 cases of cancer operated on in the cancer hospital, London. The average time before the cancer returned was only 61⁄2 months." Dr. Monroe of Scotland operated on 60 cases of cancer. He says: "At the end of 2 years, only four out of the 60 operations were successful. "Dr. James Wood of the Royal College, London, says: "Gentlemen, I have operated on some thousand cases of cancer, and they all returned but six and these were not cancer." Sir Benjamin Brodie (one of the fathers of surgery) said after he had removed 500 cancers of the breast, that he would not remove another without telling the patient that the operation would not prolong her life." Sir James Paget, one of England's greatest physicians, says in

speaking of cancer: "The number of cases in which cancer does not return after an operation is not more than one in 500." My own knowledge and experience in the treatment of cancer have led me to coincide with the above opinions, the truth of which has been proven to my own satisfaction many times.

For the benefit of my readers or those who care to make use of any of my suggestions, I will try to verify my contention by a brief outline of my treatment followed in a few cases. In later articles I will try to go into the details and give the reason for each remedy, etc., given in that particular case.

CASE 1.—Mrs. W——, age 46, was afflicted with a tumor of the breast. Her physician diagnosed the condition as cancer, and advised an immediate operation, and she was operated upon both early and often. A surgeon of considerable reputation was imported from Buffalo to do the work. (You know we are usually willing to pay more for imported goods, and it sounds a little better to the natives of your own town, even if the goods are no better or not as good as the home product.) The gentleman from Buffalo confirmed the diagnosis and removed the left breast including the tumor. But in a few months another tumor appeared in or near the site of the first. The Buffalo surgeon again operated. Again, in a few months more trouble and worry arose in the way of new growths. These were removed by the home physician. But like the "Ghost of Banquo" they would not down and stay down. When they again appeared she came to me Feb. 18th, 1914. Examination showed two tumors about the size of the end of a hen's egg arising from the old scar. They were accompanied by sharp, stitching pains. which radiated outwards and backwards under the shoulder blade. Her pulse weak and discouraged, hands and feet cold, nervous and irritable, tongue coated, weak and debilitated.

As stated above without going into detail, I gave her syr. phytolacca, strych. sulph., phosphates of iron, potash and lime, double sulphide, and bellis perennis as internal remedies. Over the tumors and scar she kept constantly applied either a compress of epsom salts or a salve made of phytolacca, arnica and belladonna. She was ordered to live upon a fruit and vegetable diet and to take an epsom salt bath two or three times a week.

The patient regained her health, the tumors gradually disappeared without any further