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Three years ago we published a preliminary report on the transfusion of blood by a new method (The Journal, Jan. 7, 1911, p. 35). In a first experiment, given in detail in that report, a simple outfit was used consisting of a 100-c.c. lubricated ground-glass syringe and cannula. Blood was withdrawn from a slit made in a vein, the apparatus removed, the cannula inserted into another vein and the blood injected. This technic is quite satisfactory for transfusion of a small amount of blood. The procedure was described with the idea that it might be used for infants and in other instances in which a moderate amount of blood is required. We also experimented with the use of citrate solution to keep the blood from clotting and decided that it is inadvisable and unnecessary. Two years after the publication of our paper, Cooley and Vaughan (A Simple Method of Blood

To the Editor: —After reading the editorial inThe Journal, January 7, condemning the use of camphor and strychnine as cardiac stimulants, I, as a "proponent" of camphor as a circulatory stimulant, must, in justice to the drug, reply. It has, of course, been positively proved that camphor does not increase the cardiac output; but as the heart is only one part of the circulation, it would seem only fair to the drug to consider its effect on the blood vessels. It is a matter of clinical fact, which I have very many times observed, that in cardiac failure and collapsed conditions, with cold skin, feeble pulse and failing heart, subcutaneous injection of camphor in sterile oil has caused the surface of the skin to become flushed, dilated the peripheral blood vessels, and improved the whole circulation. Camphor by the mouth will cause a moderate amount of the same type

Ch_ APTAIN JOHN SMITH, "sometimes Governour of Virginia, and Admirall of Nevv-England," has been a remarkably controversial figure for more than a century. His deeds have been praised and blamed with equal vehemence, and his writings subjected alternately to sublimely uninformed carping and to thoughtlessly enthusiastic adulation. Only now and again has his work been analyzed with at least a moderate amount of dispassion. It has usually been a matter of invective contra or apologia pro Smith. One of the periods of John Smith's life which has escaped careful investigation, so far as the present writer is aware, is that between his capture by the Turks after the "bloudy encounter" in "the valley of Veristhorne" (VWr6storony, or Rothenthurm) and his return to Transylvania about a year later'-that is to say, from November i602 to November i603. Edward Arber, the first modern editor of John Smith's writings, was at a loss to understand, let alone explain, the details supplied by John Smith's own writings, and other editors and biographers have fared little better. It is difficult to decide which to marvel at the more-John Smith's

To the Editor: —Here is another "Tricho" case: M. C., 35 years old, a saleswoman, consulted the "Tricho Institute" cf New York City six years ago for hypertrichosis beneath the chin. She stated that she was treated weekly for about twenty-five weeks. After approximately fifteen treatments had been given, the irradiated area became red and inflamed. She was advised by the doctor at the institute to use warm applications and to continue treatment. The present eruption appeared about two years after the last treatment. She was told by the doctor at the institute that this was due to "dissolving of moles," of which she had many on the face and other parts of the body. The present eruption consisted of an area of profuse and disfiguring telangiectasia, mostly beneath the chin, measuring six by three inches. There was also a moderate amount of telangiectasia on the right cheek. One area

To the Editor.— I find Dr. Robert Jaffee's EDITORIAL (224:897, 1973) to be very thought-provoking on the eve of the opening of our "complaint centered" group. Speaking as one who has emphasized the diagnosis and treatment of headache for years in my individual practice, I agree with him fully that good clinical judgment on the part of a physician who is willing to take the time and effort to get to know, to paraphrase Dr. Jaffee, the whole patient and who has at least a moderate amount of knowledge of headache, and confidence in himself in this regard, would be in a better position to treat these patients than one in a specific clinic. I also agree that "the physical and emotional needs of the public are not being met by the present system of medical care" in this area. Proper precautions can be taken so that all aspects of

Apropos of the brilliant results reported by Dr. Willis A. Whitman1in the treatment of gonorrhea and its complications, the following report may be of interest. REPORT OF CASES Case 1. —C. C., a man, aged 34, entered the hospital, June 28, 1924. Eight years before, he contracted gonorrheal urethritis, which was treated as usual. Four years later he developed urethral gleet and achy pain in both feet, these symptoms resisting all local treatment. Examination revealed a moderate amount of pus in the fluid expressed from the prostate and vesicles; there was a slight swelling and tenderness in the proximal joint of the small right toe. The Wassermann reaction of the blood and spinal fluid were negative at different times. At forty-eight hour intervals, he received four injections of mercurochrome-220 soluble in doses of 10, 14, 15 and 18 c.c., respectively. As the last dose produced colicky pain and

Since it has been shown that schizophrenia is characterized by a variability greater than normal in certain physiologic processes and thus possibly that patients with this condition do not comply adequately with homeostatic principles,1the general question of the effective adaptiveness of these patients to the external environment becomes pertinent. Normal man, as a homothermic animal, is able to preserve the constancy of his body temperature within a limited range regardless of a moderate amount of change in the external environment. The inability to maintain a constant body temperature, or poikilothermism, is definitely abnormal and indicative of a loss of some of the higher protective mechanisms of the body. The purpose of this investigation was to ascertain whether or not patients with schizophrenia could adapt themselves to changes in the external environment as regards body temperature, pulse and blood pressure as readily as could normal controls. This report deals

During the winter of 1922-1923, at St. Luke's Hospital, New York City, we had the opportunity to study the effect of insulin in thirty cases of diabetes, most of them severe. We report in detail thirteen in which the patients have been under long continued treatment. Our work confirms the reports of the value of insulin in the treatment of diabetes in the publications of Drs. Banting, Best and McCleod, and others of the Toronto group. Our method in general has depended on whether there has been a dangerous amount of acidosis present or not. In cases of coma or severe acidosis insulin was given immediately, and the ordinary methods of treatment, such as forced fluids by mouth or rectum with bicarbonate of soda in addition, were employed. When only a moderate amount or no acidosis was present the patients were, in the earlier cases of our series, rendered sugar

History. —The patient, D. F. D., a man aged 40, married, was admitted to the medical ward of the Presbyterian Hospital at 1:30 a. m., July 15, 1913. He had had the usual diseases of childhood, including diphtheria. Since childhood he had been healthy. Fifteen years ago, at the age of 25, he had an attack of rheumatic fever, which confined him to the house for a week but did not damage his heart. Except for occasional annoyance from hemorrhoids, the man has not been sick since 1898. He uses tea and coffee very moderately, but drinks a moderate amount of beer every day and confesses to occasions of inebriety. He denies venereal disease. The family history is negative. For twenty-three years the patient was a bricklayer and has had much climbing to do, especially when employed on tall buildings. It has not been at all unusual for him to

Sagebrush (Artemisia tridentata) is probably the most important winter deer forage of the intermountain country. It is present on most foothill ranges upon which deer winter. Exceptions occur where fire or cultivation has removed it. Commonly it is mixed with other forage as an understory to juniper or intermixed with plants such as oak, bitterbrush and cliffrose. Whatever the associated plants, deer consume considerable amounts of sagebrush and when, as commonly happens, other more palatable plants are gone it may provide almost the entire sustenance for considerable periods. Little is known of the feeding value of sagebrush. Chemical composition figures indicate that it may be fairly high in protein (Esplin et al. 1937) and possessed of only a moderate amount of crude fiber.

This sheet was devised in an endeavor to develop a delivery drape that would permit the patient a moderate amount of freedom of motion without seriously disturbing delivery room technic. Sack-like leggings are sewed directly to elliptical openings in a sheet made of any heavy material, such as Indian Head. The central portion is reinforced with an extra thickness of the same material. Two tapes are sewed on the under side below the opening in the central section. All seams are double stitched. When it is desired to drape the patient, the limbs are thrust into the leggings, and the central aperture is arranged over the vulva. The assisting nurse then pins the attached tapes to the patient's gown, so that the lower portion of the reinforced area is tucked under the buttocks, and holds the drape closely to the vulva. Added security of arrangement may be obtained by the

On the afternoon of November 29, 1929, there ended tragically the last of the seven world-cruises of the non-magnetic ship Carnegie of the Carnegie Institution of Washington. During the three cruises in the Pacific Ocean of the brigantine Galilee chartered by the Institution from 1905 to 1908 and during the first six cruises of the Carnegie in all oceans from 1909 to 1921, chief emphasis had been placed upon the magnetic and electric programs to develop the distribution-surveys in terrestrial magnetism and electricity over the oceans, with only a moderate amount of oceanographic and meteorological observations. The seventh cruise of the Carnegie was planned to determine magnetic secular-variation, to extend the atmospheric-electric survey, and to undertake comprehensive work in physical, chemical, and biological oceanography following a program developed and already described by Fleming and Ault (Program of scientific work on Cruise VII of the Carnegie 1928–31, Zs. Ges. Erdk., Erganzungsheft v. 3, 41–55, 1928). Nearly one-half of the cruise as planned had been completed upon the arrival of the Carnegie at Apia, November 28, 1929, and the extensive scientific program of observation in terrestrial magnetism, terrestrial electricity, chemical oceanography, physical oceanography, marine biology, and marine meteorology had been realized practically in every detail. The development of practical technique and instrumental appliances for oceanographic work aboard a sailing vessel had been outstandingly successful.

Operations on the central nervous system are frequently accompanied by a marked diminution in the blood pressure. This decline in pressure, however, is not of as grave concern as a like drop in blood pressure during an abdominal operation. The pressure may reach a low level during an operation on the central nervous system, but if the operative procedure is stopped immediately, the pressure will usually rise without any artificial aid. In a report from the surgical clinic of Dr. Harvey Cushing, Bird 1 stated, "During operations for intracranial tumors, patients have been observed who, though their blood pressure remained too low to be recorded for from thirty minutes to three hours, recovered after spontaneously 'picking up' or following transfusion, without detectable injury to nervous tissue or other permanent ill effect." Most of these patients had lost a moderate amount of blood. The use of the word "shock" is intentionally

The fauna of sewage filter beds is dominated by certain species of flies and worms, which play an important part in sewage purification processes as they feed on the bacterial, algal and fungal matter which develops in the bed. This growth, if unchecked, would soon block the filter and make it useless for purification. Experience has shown that a filter with large grade medium supplied with a moderate amount of average town sewage builds up a fauna with several successful forms but, under other conditions, the fauna tends to be limited to very few species. It has been suggested that the strength of the sewage is the chief cause of limitation (Lloyd 1945), whilst the method of delivery, the medium used and the way in which the bed is constructed may all have some measure of responsibility (Lloyd, Graham & Reynoldson 1940). On the other hand, it has been held that the loading of the filter is the overriding factor (Tomlinson & Stride 1945). The present studies were made at the Bradford Corporation's works at Esholt and North Bierley. The beds here provide a variety of conditions, both small and large medium with strong sewage and small medium with weak sewage. They were chosen as contrasting with the Knostrop works at Leeds where the medium is large and the sewage relatively weak. The fauna of Knostrop has already been described in detail (Lloyd 1935, 1937). The sewage passing to the Esholt works contains a large proportion of industrial wastes and is characterized by its high biochemical oxygen demand and its low pH. The beds are rectangular in shape, flush with the ground and 6 ft in depth. They are fed from travelling distributors at a rate of 75 gal per sq. yd per day. Hard coal of 3 in. grade is employed as the filtering medium in most of the beds but, in recent years, five acres of this has been replaced by sandstone and river pebbles of 2-21 in. grade. The fungus Fusarium aqueductum (Ascomycetes) is found on both types of medium and is evidently suited to the acid conditions (Butcher 1932). The growth is especially heavy during the winter months when there is a danger of its blocking the filters. There is also a growth of the alga Phormidium (Cyanophyceae) on the pebble beds but not on the coal. In late autumn and winter, this forms a thick leathery growth but

Paris, Ill. To the Editor: —I think Dr. E. L. Munson is right in allowing a moderate amount of carbohydrates in diabetes mellitus. I have done so for the last eight years, and the results have been better than under a strict proteid diet. I also allow the patient to drink all the water he wants, because it dilutes the urine and makes it less irritable to kidneys and bladder and, I think, lessens the danger of coma. Respectfully

The material for this report was derived from the histories of 150 cases of pulmonary tuberculosis treated with tuberculin at the Rhode Island State Sanatorium during the five years 1907 to 1912 inclusive. In this series of cases tuberculin was not usually given to incipient or far advanced patients. The usual type of patient selected was the chronic one whose disease had been arrested or improved, but who was still having tubercle bacilli in the sputum with a moderate amount of signs. Tubercle bacilli had been present at some time in 132, or 88 per cent., of the cases. Only three or four had cavity signs. In a few cases, however, tuberculin was tried in those who had completely failed to improve under the usual hygienic-dietetic regime and who had sufficient temperature to indicate an active process The tuberculin was given after the manner advocated by Trudeau, an effort being

This paper presents methods for grading, by gonioscopy, (1) width and (2) degree of pigmentation of the angle of the anterior chamber. A moderate amount of experience permits accurate evaluation of both angle width and degree of pigmentation and lends objectivity to gonioscopic records otherwise difficult to achieve. The same or different observers, familiar with this classification, can accurately duplicate their findings. A system of grading width of the angle of the anterior chamber is of considerable importance in the diagnosis and management of patients with glaucoma, especially of the primary type. Although gonioscopy by itself has limited diagnostic value in chronic simple glaucoma, one can be certain that if the angle is gonioscopically open and the tension is elevated the disease must be chronic simple in type. If the angle is extremely narrow, exhaustive diagnostic tests may be required to differentiate between chronic simple and narrow-angle glaucoma. Knowing the

An exhaustive review of the literature in all languages indexed at the New York medical libraries proved that congenital pneumothorax is an extremely rare condition, reports of only four previous cases having been found. Knowledge of pneumothorax in general dates back to 1803, when Itard named the condition and recognized its relation to tuberculosis. Laennec, in 1819, first described pneumothorax as a clinical entity, and was perhaps the first to diagnose the condition during life. He described the causes, symptoms and physical signs, and also gave the "succussion splash" its correct interpretation. The significance of this splashing sound had not heretofore been understood, as its presence was thought to indicate a moderate amount of pus in the chest, while its absence was interpreted as indicating a chest filled with pus. When pneumothorax was identified as a clinical entity, the meaning of the succussion splash became clear—a sign of the presence

A review of the literature gives one the impression that emphysema of the head and neck following tonsillectomy occurs infrequently. The youngest case found in the literature is that of a boy, aged 7, reported by Stein, 1 and the only other cases reported occurring in children are those of a boy, aged 10, and a girl, aged 12, described by Richards. 2 The following three cases occurred within a period of one year: Case 1. —J. F., a boy, aged 2 years, presented no abnormal conditions other than large infected tonsils and a moderate amount of adenoid tissue. He was a neurotic child and he screamed with fear when the anesthetic was administered. Following the removal of the right tonsil, considerable swelling of the right side of his face and scalp was noticed. Crepitation was present throughout this swollen area, and crepitation was readily elicited in the neck and

The injection of bismuth-vaselin paste for the treatment of tuberculous cavities, sinuses and fistulas was introduced by Dr. E. Beck in April, 1908. Its use has been enthusiastically advocated by many and it is now a routine procedure in many of our hospitals. Numerous brilliant results have been reported. The simplicity of the technic, the uncomplicated formula of the mixture, and the painlessness of its administration, appeal to all who have charge of these chronic cases. At the Cook County Hospital bismuth-vaselin paste has been used extensively, not only for tuberculous cavities and sinuses, but for empyemas, fistulae in ano, and as bone plugs after mastoid operations, without fear of toxic effect. It is therefore of marked interest to note that in the last four months two cases of bismuth poisoning have occurred following the use of a moderate amount of the paste. A preliminary report of the cases is

Creative products submitted in response to a contest were examined to discover whether creativity was related to the sex and socioeconomic status of the respondent and whether characteristics of the objects could be specified which would predict their level of rated creativity. No sex difference was found, but socioeconomic status was significantly associated with creativity for those objects to which at least a moderate amount of effort had been devoted. Ratings of the objects on several simple dimensions proved effective in predicting rated creativity. Judges differed on which dimension best predicted their creativity ratings, but differences between subsets of the objects were of greater importance than individual differences among judges in determining the bases on which the ratings were made.