make them in this country? Now is the time to act. A copyright need not be a hindrance. It was overcome in the case of antifebrine. We have acetanilid. This is a fair example. So we may change the wording of a portion of Miss Tarbell's appeal by saying now is our time. Temporarily, at least, the maelstrom which has sucked all Europe has deprived us of some of our supplies. This is the time to learn what our own country's industries can do and rally with all our influence to their support, urging them to make the things we want, pledging them our allegiance. S. E. EARP.

LIQUID PARAFFIN AS A LAXATIVE.

As a laxative, liquid paraffin has become very popular. Some consider it astonishing that it is one of the agents of modern therapy that is based upon empiricism and is yet used extensively. For several years I have found that it answered a purpose which could be accomplished by no other agent. It seems to give nature an opportunity to perform a function without damage such as we sometimes get from certain laxatives or purgatives. There is no pain and no exhaustion following its use, nor is it necessary to increase the doses; on the contrary, we find that it is possible to lessen the dose and its freqnency and still get good results after its use. Oftentimes good results may be noted for a considerable period of time after it has been stopped. Furthermore, it is one of the remedies that will very materially assist in overcoming constipation. In the instance of one patient who had chronic constipation attended with severe pain at each evacuation, who had been using the enormous dose of twelve teaspoonfuls of a proprietary salt each day followed by an enema to move the bowels, I gave the liquid paraffin and on the second day she phoned me that eight ounces had been taken, but there was no movement. On her own volition she took a teaspoonful of sulphate of sodium and in two hours an enourmous amount of fecal matter passed with ease and afterwards only

the paraffin in moderate doses was necessary. In this case as in many others I found that a rectal disturbance was entirely relieved. I thought of going into other details of the subject, but I find that Dr. J. B. McGee, of the Cleveland Medical Journal, has made a concise abstract from American Medicine, which will admirably answer the purpose.

A few years ago no one heard of liquid paraffin and now its consumption is enormous. No doubt in a short time we shall find contra-indications or bad results which will limit its use, but at present it seems to be a permanent and valuable weapon in the fight against intestinal intoxication, and its myriad fatal sequelae, containing no oxygen, is not saponified or emulsified, and produces no fatty acids to irritate as in the case of olive or cotton seed oil, once so popular. It contains no stimulants to the muscle and has no irritative or osmotic action to increase the fluid content of the feces. It acts purely as a lubricant, supplementing the normal mucus, and thus materially assists the peristaltic action of the muscles. All of it may be recovered from the feces. The dose varies from a teaspoonful to two tablespoonfuls from one to three times a day, preferably a half hour before meals. It is cumulative in action, and the full effect may not be experienced for several days or even two weeks if small doses are taken, and moreover the results may persist for a week or more after ceasing to take it. There is some evidence that by relieving the strain on the intestinal muscles it actually strengthens them; by removing the irritation of hardened feces it restores the normal mucus; by facilitating evacuations it re-establishes the lost habit of regular and periodic movements; by coating the fecal masses it restricts absorption of poisons; and it is not accompanied by pain, colic or straining. It is easy to take, being devoid of taste or odor, and of the consistency of glycerine. Many object to the oiliness, and various mixtures have been devised to conceal this characteristic, but a little effort will overcome the objection to the

pure oil. It must be freed of all sulphur compounds, acids and fluorescent lighter hydrocarbons, all of which are more or less poisonous. It sometimes escapes from the rectum, but the sphincter soon becomes educated. It has been proved useful in simple stasis, visceroptisis, hemorrhoids, mucous colitis, pregnancy and the exasperating constipation of infancy and childhood. We must be on the lookout, however, for contra-indications, for it is a comparatively new remedy, and there has not been sufficient time for all its effects to become known. I could furnish a report of cases almost without number but this would seem superfluous. S. E. EARP.

FUNCTION OF THE PERIOSTEUM. (McWilliams-Surg. Gyn. and Obst., Vol. XVII, No. 2.)

The author first reviews the opinions of the following workers as to the fate of the bone graft and the part played by the periosteum:

1. Axhausen (representing the German school) thinks that the bone in a graft always dies and is absorbed. The periosteum of the graft, however, lives, and it is from this that the new bone is formed.

2. McEwen (English) contends that the new bone is formed from the osteoblasts in the graft and that its regeneration is independent of the periosteum which acts only as a limiting membrane to prevent the spread of the osteoblasts into the surrounding tissues.

3. Murphy, of Chicago, thinks that the graft is not osteogenetic but osteoconductive, thus forming a scaffold for the growth of the capillaries carrying osteogenetic cells from the living bone in contact with the graft. The periosteum does not take any part in the reproduction of bone.

The following experiments were made by McWilliams:

Case No. 1. Bone graft without periosteum placed in medullary cavity of a fracture tibia was absorbed. Later a graft with periosteum grew. This new graft later fractured and new callus was

formed. This latter fact against Murphy's view the graft is not osteogenetic. Place in fibula from which graft was taken did not fill in.

Case No. 2. Periosteum stripped from piece of rib and transplanted into muscle grew. Space in rib did not fill in.

Exp. No. 3. Ribs without periosteum split and transplanted into muscle grew, due to sufficient blood supply. Space in ribs filled in.

Exp. No. 12. This experiment showed that to have new bone fill in a defect there must be either periosteum or a bridge of bone.

Forty-three per cent. of transplants with periosteum lived.

Forty-eight per cent. of transplants without periosteum lived.

McWilliams thinks it is difficult to say the exact part played by the periosteum in the reproduction of new bone and in grafts but considers the essential thing to be a sufficient blood supply.

The periosteum may either influence the nutrition of the graft or in case the bone cells in the graft die from insufficient blood supply the periosteum furnishes living cells to the graft by means of which the bone is regenerated.

Conclusions: 1. Remove periosteum and almost all of the bone, leaving but a bridge with nutrient artery, deficit will be filled in. 2. Remove all of the diameter of bone, leaving periosteum, deficit will be filled in. 3. Remove entire diameter of bone with periosteum, little of deficit filled in. 4. Graft, with or without periosteum depends upon sufficient blood supply for its life. 5. Small fragments without periosteum will live in 50 per cent. of cases. 6. If large piece of bone transplanted leave periosteum on it. 7. A graft on a graft neither having periosteum, will die. 8. Periosteum alone in soft parts will form bone. 9. Splitting of periosteum not necessary. 10. Transplants should have as much periosteum as is possible.

E. B. MUMFORD.

"We want the doctor, quick!" "Who's sick at your house?" "Everybody except me. I'd been bad, so they wouldn't give me any of the nice mushrooms papa picked in the woods."

BOOTS AND SHOES-ANCIENT AND

MODERN.

"The custom of wearing some form of foot covering is much older than history," says E. Muirhead Little in the Lancet for June 20, 1914, "and probably it dates from the dawn of civilization," yet, in spite of the great antiquity of this human practice, the shoes of the present are, from a surgical point of view, far from perfection. The functions of the foot are not only to support the weight of the body, but to act as a lever, to play the part of a buffer to protect the nervous system and large joints of the lower extremity from the effects of tremendous shocks, and among primitive peoples to act, to a limited extent, in a prehensile capacity. The foot of the average civilized adult has been so materially altered in its form by the fashions of the day in footwear as to have lost many of its original functions in more or less degree, and it must be considered quite apart from the physiologically normal member of the barefooted savage. Curiously, some of the leading anatomies of today picture as normal the deformed foot of modern man instead of the truly normal foot of the sandaled Oriental-a fact which speaks volumes concerning the neglect of the proper consideration given to the anatomy of one of our most important members.

Little has made a study of the forms of footwear preserved in the museums and covering a period of more than 3,000 years. So long ago as this, man seems to have had an understanding of the proper principles of the construction of a covering for the feet, and the ancient Egyptian sandals have the straight inner side and leave an abundance of room for the full play of the foot under the vary ing circumstances of locomotion. The transition from the sandal to the shoe has been traced from the early days of

Egypt, in which there was merely a large sole which was attached to the foot by straps, one of which passed between the great toe and its neighbor, thus maintaining the large toe in the ideal position of adduction toward the centre line of the body. With time the sides were turned up and a cap was made forward of the toes, but still the toe strap was preserved, even up to the twelfth century A. D. Beginning about this time fashion invaded footwear, and Violletle-Duc has pictured the several changes which took place between the eleventh and fourteenth centuries, during which time the poulaine was developed and passed away. It was not, however, until the early part of the fourteenth century that the practice of curving the inner margin of the sole outward made its appearance.

With the passing of the poulaine there was a change to the extreme in the breadth of the forward part of the shoe, and shoes from the time of Henry VIII measured up to six inches in their greatest breadth. In the fifteenth or sixteenth century, heels made their appearance and the shoemakers began to forget that the two feet are not alike, and to make both shoes of the same shape. This practice was in vogue in the British army as late as the seventies of the last century, as shoes still in existence show. As the shoe began to assume the form of a sheath for the foot, the desire arose to make it fit closely, and with this came the necessary evil of an unavoidable compression of the foot with the production of hallux valgus and a material sacrifice in functional capacity. It is not remarkable that we have so many deformities and painful affections of the feet to contend with at the present time, but rather that we do not have far more, a fact which shows the truly remarkable capacity of the foot to work under dif ficulties.

In the course of his interesting study of man's footwear, Little takes the opportunity to state the proper functions of a shoe. Primarily, it should protect the foot from cold and wet and from external violence; secondarily, it should provide support for the foot under conditions to which the foot alone is unequal; and lastly, the ideal shoe should accomplish these ends without impeding any of the normal functions of the foot. Such an ideal may be approached by making the inner margin of the sole straight and the heel low; by making it fit the heel and the neck of the foot closely as far forward as the middle of the metatarsus, and by allowing ample room for the spread of the foot and the free movement of the toes. Such a model shoe is approximated in much of the present day footwear for men, but the shoes for women have few or none of the essential attributes to comfort or good function. The foot is not heir to the many ills it has to suffer, "for the infant's foot is as well formed, its joints as mobile and its muscles as active as that of the barefooted savage," and it should be given every reasonable advantage for the fulfillment of its important task.-New York Medical Journal, July 11, 1914.

THE GENERAL HOSPITAL AT CIN

CINNATI.

In October of this year will be opened the new General Hospital at Cincinnati, the only instance in this country of a municipal medical school and hospital conducted by and for a city. The hospital will be opened with 850 beds, but all administrative buildings have been built large enough to take care of 1,500 patients.

The buildings are located on a plot of twenty-seven acres. Adjoining this on the west and north are thirty-eight additional acres, also belonging to the hospital, to be used for day camps for children or adults needing sunshine and outdoor life under special medical supervision; also night camps for men with incipient or arrested tuberculosis.

Dr. J. McKeen Cattell of Columbia

University, editor of Popular Science, said in describing the new Cincinnati institution:

"A medical school and hospital, co-operating in their common work and directly controlled and supported by the city, is an example we may expect to see followed elsewhere.

"The city shows its appreciation of the free service that the medical profession renders to the city's poor, by furnishing a meeting place, where not alone the staff, but every physician in the city can come and have the advantages that only a well-equipped teaching hospital can furnish. They need not confine their meetings to the administration hall alone; use can be made of the large amphitheatre where will be placed powerful projecting lanterns and every facility for demonstrations. Or they may meet in the amphitheatre of the spacious pathological building where the professors of pathology and bacteriology can give demonstrations of specimens saved specially for such meetings. Thus the hospital may be made the city's centre for medical education, not limited to the staff, the students and internes.

"Adjoining the administration building is the admitting department and outdoor clinic, where students can see every variety of emergency, medical, obstetric and surgical cases. The base. ment of the admitting department is well lighted by wide areaways. Every patient's clothing passes through the large sterilizer located here, and then goes to the tailor shop to be cleaned, mended and pressed before being stored away. On the main floor of the admitting department and the outdoor clinic in addition to the examination and treatment rooms, we have two wards-one for each sex-where patients who arrive after 9 p. m. are kept till the next morning, in order not to disturb the ward patients. The ambulance or any public conveyance will bring ordinary cases to the front of the building, but emergency cases are brought to the rear and taken directly into the special operating room."

MODERN METHODS OF DIAGNOSIS OF DISEASE.

An old story is it now, to tell how Pasteur, Von Behring, Pfeiffer, Widal and Grunebaum discovered that the blood of those ill with typhoid, pneumonia, Asiatic cholera and other microbic maladies contains some anti-bacterial product which seizes the invading germs, makes them halt at their depredations and clumps them in little, sticky licorice balls. This is the test used to distinguish one fever from another.

Now, with the precision of a sharpshooter, he takes a few drops of blood from the fever-stricken one. He hazards no "guess," "opinion" or "pseudo-diagnosis," but with water he mixes those scarlet dewdrops with the bacilli of typhoid, plague, dysentery, animal cholera and various other distempers.

Within an hour the particular bacteria responsible for the trouble will have stuck to each other in such a way as to lose much of their power for evil. Thus, if they be the typhoid bacilli, you know the patient has typhoid fever and not tuberculosis, as might have been "guessed" by doctors who fail to avail themselves of the laboratory aids to diagnosis.

The year 1914 will be noteworthy in the annals of medical discovery. It has been for some time the aim of scientific research to find a means to diagnose the various noninfectious, nongerm-made maladies. This, however, has until now remained a stumbling block in the path of medical progress.

Very recently Prof. Abderholden, the eminent chemist of Halle, Germanywho, like Pasteur, Roentgen, Ehrlich and others who have opened up new roads of diagnosis and treatment, is not a physician-has gracefully surmounted this last fortress. He has evolved a novel and efficient method by which a diagnosis of liver, kidney, stomach, brain or any other tissue disorder can be obtained.

Just as the fluids and juices of any microbe-infected tissue almost at once manufactures an antidotal liquid to combat and imprison the invading poison, so, according to Prof. Abderholden's prac

tical discovery, there is also made a tissue juice to neutralize the poisons poured into your internal reservoirs, whenever any structure of your anatomy is sick or injured.

These new anti-fluids flow through the catacombs and sewers of your blood and lymph streams. They appear almost at the beginning of cancer, liver, brain, typhoid and all similar ailments.

Prof. Abderholden not only disclosed these facts, but he has without reservation, and without a patent freely given to the world at large a practical way in which these chronic, noncontagious, mysterious maladies can be precisely determined.

"For twenty years, doctor," complains Mrs. Chronic Sufferer, "I have tried every medicine, every quack and every hospital for my trouble, yet nobody knows what it is."

"We shall soon know," says the young Aesculapius, fresh from the laboratory. Just allow me to have a few drops of blood from the crook in your elbow."

With a little needle he painlessly pricks open a vein, allows some blood to drop like sun-tinted dew into each of a dozen or so glass thimbles. Then into each of these he drops first a fragment of liver, then a slice of kidney, in turn a bit of thyroid, brain, muscle, nerve, bone, stomach, adrenal, pituitary, cartilage and tonsil, and soon all are gently deposited in an incubator to keep them at blood heat.

The next afternoon the mixtures are each examined, and lo! that which contains the bits of nerve tissue and the one with the particles of muscle are, per haps, seen to be digested and liquefied.

Plainly these are the units of tissue which have been diseased so many years. For the first time in the history of the earth a correct diagnosis can be sworn to.

It is all due to the fact that any organ of the living body, when ailing, sends its broken parts through your blood stream. These "auto-poisons" irritate the healthy parts. The latter object to the irritant and get busy. They make a liquid army