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To the Editor:— It is implied in the editorial comment (The Journal, February 3, page 415) on the 1939 report of the Committee on Tests for Intoxication of the National Safety Council, Chicago, that there is no question regarding the validity of chemical tests for alcoholic intoxication. While it is desirable to have clarity with respect to legal definitions of such phrases as "under the influence" and "intoxicated," it is also necessary to have confidence in the reliability of chemical tests involving concentrations as small as 0.05 per cent by weight of alcohol in the blood, urine, saliva or breath, if such tests are to be sanctioned legally. Biochemists and toxicologists who have had extensive experience with these tests are not convinced that they are as reliable as might be implied by the recommendation of the American Medical Association Committee to Study Problems of Motor Vehicle Accidents. Based on the

To the Editor:— Pertinent indeed are the editorial comments and the remarks of the Council on Medical Education and Hospitals regarding the financial aspects of the location of a medical school (The Journal, August 17, pp. 1281 and 1357). Medical schools would be wise to seek as close cooperation as possible with existing clinical facilities. The necessity for careful guidance of clinical practices and standards in order to meet the ideals of modern medical education frequently requires regulation to which impatient physicians may often object. For this reason medical schools should have full control of affiliated teaching hospitals or establish their own teaching hospitals. No matter where the medical school is located, it must receive adequate support if it is satisfactorily to fulfil its obligations in our society. Compromises to conserve funds inevitably result in compromises with ideals and standards. It is becoming increasingly apparent that larger sums than ever

Among the most noteworthy features of ethylene-oxygen anesthesia, as noted in the clinical report of Luckhardt and Lewis, 1 are the facts that recovery from the anesthetic is unusually prompt and that the subsequent postoperative condition is distinctly better than after ether. Less than half as many patients suffer from postanesthetic nausea and vomiting after ethylene-oxygen as in a comparable series after ether. These considerations led Dr. A. B. Hertzman and me to try to ascertain whether any differences might be noted between the effect of ethylene-oxygen anesthesia on the acid-base balance of blood and the now well recognized acidotic effect of ether. This action of ether may be a considerable factor in contributing to the postanesthetic complications following etherization. FACTORS INFLUENCING BLOOD REACTION IN ANESTHESIA Apart from the doubtful possibility that anesthetic agents may themselves exert a direct action on the acid and basic elements of bloods, variations in

To the Editor:— The tone of the publicity recently released by officials of the United States Pharmacopeia Revision Committee suggests that these officials may be inadvertently changing the character and function of our pharmacopeia. Pharmacopeias originated in the 16th century for providing physicians, pharmacists, and public officials with reasonable standards by which commonly used drugs could be identified, their purity estimated, and adulteration detected. Drug manufacturers could then offer an implied warranty by labeling their products with the drug name followed by the pharmacopeial reference, eg, "chloroform, USP XI." This would indicate that the product conformed to the specifications given inUSP XI. The pharmacopeia, by giving the accepted standards, would make it possible for physicians, pharmacists, or governmental officials to check the product, and thus would assure that the manufacturer was offering a product that truly conformed to the standard. Pharmacopeial standards are important for commonly used drugs. The

To the Editor:— This is an earnest plea to all American physicians to support to the utmost the development of the Army Medical Library. Serving the profession in a more important way than any other single institution, this great library needs the personal interest and backing of all American physicians if it is to continue to maintain its activities in the manner expected of it. It is particularly important that American physicians support the effort of the Army Medical Library to acquire the permanent fireproof library building necessary to house its great treasures. Plans for such a building are in process, and a location for the new building has wisely been provided near the Library of Congress in Washington. This will assure maximum efficiency in the future development and use of the Army Medical Library for the benefit of the medical profession. It is important that individual physicians inform their

Praesans imperfectum — perfectum, plusquam perfectum futurum.—Grotius. In tracing the historical development of medical ethics, two main paths of progression are to be noted: The first is concerned with regulations imposed on physicians by outside, and usually civil, authority; and the second with regulations imposed on physicians by physicians themselves. Covering generally the question of fees, and designed to protect at once the interests both of society and of the individual practitioner, the first line of development began with the medical provisions of the celebrated Babylonian Code of Hammurabi (about 2250 B. C.),1and culminated with the lengthy fee statutes enacted by the various European municipal authorities2and the American colonial assemblies3during the seventeenth and first half of the eighteenth centuries. These embodied the principle of thelex talionisas late as the medical portions of the Forum Judicium of the Visigoths (about 650 A. D.)

To the Editor:— Perhaps, for the record, it would be wise for you to publish a correction to the Dec. 5 issue. In my letter on "Drug Names" I was given an M.D. degree. I do not have a doctorate in medicine. Your original letter included no degree. I am sure that the manuscript editor was sufficiently aware of your interest in medicine over the years that she thought it would be proper to so honor you. I might well have had the same inclination, if this had been my responsibility.—Ed.

The Asklepian myths are often used currently in the initiation rites of USA Greek-letter medical fraternities. These brotherhoods in the healing arts have chapters at medical schools, and their members are pledged to support the ancient ethical standards of the Hippocratic oath. Medical fraternity rituals sometimes include appearances of Asklepios as the son of the wounding and healing Apollo, born at the death of his mother Koronis. These groups derive from the Kappa Lambda Society of Aesculapius, organized by Samuel Brown (1769-1830) in 1819 at Transylvania University in Lexington, Ky. The purpose of its founding was to improve standards of medical education and practice, which had slumped badly during the rapid frontier growth of the United States, even in the midst of its Jeffersonian-inspired Greek revival. When Kappa Lambda succumbed to political intrigue in 1835, its program became, in 1846, the basis for founding the American Medical Association. While modern

To the Editor:— Dr. Joseph Berkson's letter inThe Journal, Feb. 27, 1960, page 967, prompts me to report a little item relating to the controversy over cigarette smoking in relation to lung cancer. I am reporting in narrative form, without specific documentation or figures. In the summer of 1956, while in Moscow, I visited the Academy of Medical Sciences. There, at luncheon with Prof. V. N. Chernigovsky and Prof. V. V. Zakusov, I asked about the incidence of disease in Russia. They said that it was about the same as in the United States. I then asked about the incidence of lung cancer. Their reply was that an increase in the incidence of lung cancer in the large cities of Russia has been noted but no significant increase in the incidence of lung cancer in rural areas has occurred. I then asked what was thought to be the cause

To the Editor:— Wisely the American Medical Association is undertaking a systematic study of its relationships with allied health professions and services. An impressive committee is arranging for a series of conversations with officials of various organizations associated in the general health effort. These organizations include scientific groups representing experimental biology and the basic sciences for the health professions as well as various allied health professions. The number of these organizations is growing. They illustrate clearly the tremendous expansion of health services and activity. The A. M. A. Committee to Study the Relationship of Medicine with Allied Health Professions and Services is composed of members of the Board of Trustees, and representatives from the Council of Medical Education and Hospitals and the Council on Mental Health. Dr. Raymond M. McKeown is chairman, and Dr. John Hinman is secretary. The proceedings of the 1959 conferences have been issued in mimeographed form

To the Editor:— Many cancer patients from the United States have recently been attracted to Mexico City by reports of a new, allegedly successful method of treatment. We have taken occasion carefully to investigate the situation and we have prepared this statement of our opinion for the benefit of our colleagues who may be wondering about the matter. Personal investigations reveal a modernistic building for hospitalization with inadequate laboratory or other scientific facilities. The physician in charge has a courteous and considerate bedside manner. We think that he makes his patients feel better by virtue of his personality. There is no positive.evidence that he or his associates are successful by their peculiar methods in interrupting the usual course of a malignant process. The theoretical bases for the method of treatment are extraordinary. While they make use of current scientific concepts, they are not in accord in any way with established

To the Editor: —Protest should be entered against the apparently commercialized exploitation of the various unscientific and irrational mixtures proposed by George B. Pitkin, M.D., of Bergenfield, N. J. A few courageous workers were bold enough to call attention to the irrational mixture containing procaine, starch and strychnine proposed for "controlled spinal anesthesia" and exploited under the trademarked name of "Spinocaine" by the H. A. Metz Laboratories, Inc. Recently Dr. Pitkin proposed another irrational mixture of protein, lipoids and emetine, for intravenous injection in the treatment of peptic ulcer. Dr. Pitkin's report on this mixture was grossly uncritical, the exact composition of the mixture was not stated although meticulous directions for its administration were given, and it is obvious that whatever beneficial results were claimed in the report were due to the admitted use of what was essentially a Sippy diet along with this extraordinary intravenous medication. The H. A.

Chiniofon N. N. R., which is sodium iodohydroxyquinolinesulphonate, has been widely exploited under various trademarked names ("yatren," "anayodin") as a relatively nontoxic and supposedly efficient amebacide. It is amazing that there was, until recently, so littlecriticalexperimental or clinical study of this compound, especially in comparison with other halogenated oxyquinolines, of which there are many. Why was iodohydroxyquinoline selected for clinical exploitation from those halogenated oxyquinolines available for study when no evidence was furnished that it has demonstrable advantages over the others? EXPERIMENTAL DATA ON IODOCHLORHYDROXYQUINOLINE As part of a comprehensive survey of the chemotherapy of amebiasis,1this compound was compared with hydroxyquinoline and certain of its halogenated derivatives from the standpoint of oral toxicity in guinea-pigs and cats, amebacidal action in vitro, and balantidicidal effect in naturally infested guinea-pigs. We noted an increase in toxicity with increasing halogenation of oxyquinoline and in proportion to the atomic weight

This report is made for the purpose of calling attention to the extremely wide variations in the normal resistance of red blood cells to hypotonic saline solutions. These variations are more striking when the fragility of the erythrocytes is tested quantitatively, according to Simmel's technic. 1 Briefly, the method is as follows: The standard Simmel's fluid contains 8.2 gm. of sodium chlorid, 0.2 gm. of potassium chlorid, 0.2 gm. of magnesium chlorid, 0.2 gm. of calcium chlorid, 0.2 gm. of sodium acid phosphate and 0.05 gm. of sodium bicarbonate in 1 liter of water. This solution is isotonic with whole blood, is buffered to approximately the same degree as whole blood, has the same p H, and the salts are in approximately the same proportions as in whole blood. This standard fluid is diluted with water to 70, 60, 50 and 40 per cent., respectively. A red blood cell count