mation on this subject in reply to an inquiry by the Department of Agriculture, 66 per cent. state that they use acetanilid less frequently than formerly, nearly 66 per cent. made the same statement with regard to antipyrin, and 51.2 per cent. with regard to phenacetin. The reason given referred in almost every instance to the toxic properties of these agents, particularly their depressing effect upon the heart. The fact that they are poisons in the true sense of the word is recognized by members of the medical profession, but it is doubtful whether the general public is aware either of this fact or that they possess any possibilities for harm whatever. Certainly there is nothing to indicate an appreciation of these qualities on the part of the laity if one can judge from the ever-increasing sale to the public of these drugs and preparations containing them. It therefore appears that the people in general should be informed of their poisonous properties and of the injurious effects which may follow their ill-advised, prolonged, or habitual use. To this end, the Department has recently instituted an investigation to determine as far as possible the status of acetanilid, antipyrin, and phenacetin as toxic agents. The investigation was conducted along two lines: First, an inquiry addressed to medical practitioners in the United States with regard to their personal experience with these drugs; and second, a study of the cases of poisoning recorded in medical literature. The results of this investigation are set forth in the following pages. The purpose of the inquiry was not to depreciate in any way the value of these substances as medicinal agents, but rather to furnish information to the public which would enable them to understand that these remedies should be employed with caution in the absence of reliable medical advice, as can readily be seen from the following correspondence which passed between the Department and one of the physicians who furnished information in reply to inquiries with regard to his personal experience with these drugs: I have been using acetanilid now nearly eleven years, observing the following rules without any but the desired results, either immediate or remote, as far as my observation goes. Never give more than 2.50 grains at a dose. Never give acetanilid or any like preparation when there is reason that some drug should be given to support the heart while this drug is acting. Give it as a rule for its sedative effect on the nervous system during sthenic fevers rather than as an antipyretic. You have not asked for the above, but I can not help thinking that the war made on these drugs is carrying the matter to the extreme, and that their disfavor is due rather to the excessive dosage and promiscuous usage than to the fact that they are rugs not to be used at all, and in your investigation I would ask your earnest consideration of this aspect of the case. To this communication the Department of Agriculture replied as follows: "Your favor of June 9 at hand and in reply we desire to thank you for the information submitted. With regard to the effects of acetanilid we would say that our views accord fully with your own as set forth in your communication, and we would be pleased to publish your letter in the forthcoming bulletin of the Department of Agriculture if it can be used to advantage and if you have no objection. We agree with you that the harm done by acetanilid does not result from its proper use under the direction of the physician, but is mainly the result of the promiscuous and indiscriminate use of the product by the laity. The object of our investigation is not to conduct a war against acetanilid and similar drugs, as you suggest, but rather to throw safeguards around the public and thus prevent, as far as possible, a repetition of the many unfortunate accidents which are reported to have resulted from the ill-advised use of these remedies in the past. Much has already been accomplished along this line through the agency of the food and drugs act, which requires that the label of medicinal preparations shall contain information relative to the quantity or proportion of certain ingredients, which are enumerated in the law, and their derivatives and preparations. By far the greater number of manufacturers have shown a disposition to comply with the law in declaring the prescribed drugs, but an investigation shows that many preparations containing these or other dangerous agents bear statements which transgress the section of the law on misbranding. The misrepresentation in many instances takes the form of assertions to the effect that the remedy is harmless or that it contains no poisonous or harmful ingredients. Again, the public is given to understand in many cases that the medicine can be taken practically ad libitum until the desired effect is obtained. Some of the manufacturers of acetanilid preparations, not content with claiming that their products contain no poisonous or harmful ingredients, go even ⚫ further and assert that the medicine, in addition to being an efficient remedy, acts as food or nourishment for the upbuilding of some particular part of the body; that it is, in short, a "nerve food" or a "brain food." With regard to the use of the word "food" the judge in the case above referred to in his charge to the jury spoke as follows: If that word ("brain food") spelled in the two different ways that it is spelled would convey to the ordinary citizen the idea that it was a food for the brain as contradistinguished from the idea of the whole body, then it is-and I so charge you in this first prayer-misleading, and therefore a violation of the law. The information with regard to the number of instances quoted in literature of the subject in which poisoning, death or habitual use has been known to result from the administration of acetanild, antipyrin, and acetphenetidin is summarized in section A of the table following. The information as tabulated in section B was furnished by 400 physicians, in reply to letters of inquiry issued by the department. Nine hundred and twenty-five of these letters were sent out, and 400 replies were received Granting that the 525 physicians who did not reply had no cases to report, the question may profitably be asked, if 925 physicians have observed 814 cases of poisoning by these drugs, 28 deaths which are attributed to their use, and 136 instances of habitual use, how many such cases have in all probability been observed by the 125,000 physicians scattered throughout the United States? Continued on page 13. Children's Diseases from an Economic Standpoint. WILLIAM F. SNOW. When the medical examiner for a life insurance company begins the examination of an applicant, he is required to obtain a full history of all the diseases which the applicant has had. In order of frequency the following diseases are named: Measles, mumps, chicken-pox, "German measles," whooping-cough, diphtheria, scarlet fever. The age at the time of having each of these diseases is almost invariably within the limits of school age, and largely within those of grammar school age. In the majority of instances the applicant's mother is authority for the diagnosis. On further inquiry it is found that the boy next door had the same disease, that he got it at school where it was "going the rounds," and that the mother understood that some doctor had so diagnosed the disease at school. The examiner cares little for this information except for its value in suggesting the cause of a defective heart, or defective eyes or ears, or a disease of the kidneys, which he may find later in his medical examination. He wants to know from the patient how long he was sick; how long he stayed in bed; how his mother nursed him; how soon he regained his weight and strength; for these things determine how carefully he must go into the medical examination of the applicant. The estimated profits to life insurance companies that have to be forfeited because of physical defects resulting from these "children's diseases" far exceed the total cost of their prevention. Aside from its constituting an important factor in restricting the volume of life insurance business this is a personal loss to the individual seeking the insurance. And these diseases always cause definate family losses the loss from the family's funds of the doctor's and nurse's bills, the nursing equipment and drug expenses, the recalcimining and cleaning-up expense, and many other miscellaneous items of expense. The public does not escape. Disinfection must be carried out. Frequently the schools must be closed by the Board of Health, but the teacher's salaries do not stop. The churches and theaters may be closed with attendant financial loss to both. The milkman may leave bottles, but cannot take any away with him. The doctor has to turn over to another physician several of his cases which he does not like to visit while attending a contagious disease. If the disease spreads the reputation of the town. suffers, and its entire commercial and industrial life is in some measure involved. A few deaths may occur. These may also to some degree be estimated in money values. Any business man knows how to estimate along such lines the cost of these diseases in his community. What would his totals be for the outbreaks of just these four diseases during the past twenty years? The following figures are an average of several of such estimates: ..... The average individual case of scarlet fever... 250.00 to 2000.00 These are estimated community costs, and are additional to the personal loss that each individual may sustain through permanent impairment of his health. In 1908 California had 189 deaths from measles; 72 from scarlet fever; 173 from whooping-cough; 380 from diphtheria and croup." The case mortality in these diseases is variously estimated as 12 per cent to 15 per cent in diphtheria; 8 per cent to 10 per cent in scarlet fever; 5 per cent to 6 per cent in whoopingcough; 3 per cent to 4 per cent in measles. The above deaths would therefore indicate that California had from 4,725 to 6,300 cases of measles; from 2,883 to 3,460 cases of whooping-cough; from 2,533 to 3,166 cases of diphtheria; and from 720 to 900 cases of scarlet fever. The above minimum cost per case gives the following totals: The maximum estimate gives $11,959,000. It is probable that the actual figures lie well within these extremes. Epidemiologists are working for returns more worthy than the saving of expense to the public or the individual-the protection of the health and happiness of the whole human race, but the tools with which the work must be done can only be obtained through the influence and intelligent co-operation of the citizens. These tools are good laws, properly trained and fully equipped health officers, and conscientious compliance with all health regulations. No one can estimate the actual number of the 10,000 to 14,000 cases of these four diseases, which might have been prevented in 1908 by adequate public health measures, but it would undoubtedly have been a large percentage. Continued from page 11. Cases in which deleterious or fatal effects have been produced by acetanilid, anti Everywhere we turn these days-in the daily press, magazines, street corners and at home-we are confronted with the discussion of pure food-what it consists of, its adulteration and its preservation, especially preservation with Benzoate of Soda. The public has been the audience in a very labored discussion as to the physical injury, particularly to the kidneys and digestive organs, calculated to accompany the use of this substance but has seemed to feel that the disposal of this phase of the subject can and ought to be safely left to the scientists and medical men of the country who, alone, are able to decide. But there is a practical side to the question, such as the reason for the use of Benzoate of Soda and other artificial preservatives in the commercial preserving of prepared food that any one may easily investigate and decide for himself. It has been frequently stated and commonly believed that this reason for the use of preservatives is to permit the employment of a class of raw material quite unfit for human consumption-chiefly the waste and refuse of tomato canning factories in making tomato catsup, tomato soup, tomato sauce' for baked beans and various other uses in food and condimental products. This belief has been strengthened by the demonstration of many food manufacturers who do not use artificial preservatives, that all lines of prepared foods can be put up successfully without them. Passing over, then, the question of the harmfulness or harmlessness of Benzoate of Soda as a substance, to be settled finally by scientific authorities, the practical phase of the subject as to whether its principal use is to perpetrate a fraud upon the people by palming off inferior waste materials, carelessly prepared, under unsanitary conditions, is a most serious one and vital to every consumer in the land. It was therefore, felt by your secretary that an investigation in the interests of our members of the use of the waste products of the canning industry would be both profitable and instructive and was undertaken accordingly. A personal visit was made to several of the important tomato canneries of the country to observe carefully the methods of handling the waste refuse, consisting of skins, cores and rotten pulp. The canning season is of very short duration at the height of the tomato harvest and the canning is conducted in cheaply constructed shed-like buildings usually in remote localities, where the proper sewerage and other sanitary facilities are unavailable. These structures are given son. very little attention from year to year and none at all during the canning seaThe help employed being of temporary character, is consequently not of a very high grade-personal cleanliness in particular seeming not to be one of the requirements. In spite of all these adverse conditions however, the canned tomato product, quickly handled into its final containers, and thoroughly sterilized as it is, is undoubtedly for the most part, a wholesome article of food supply and is rarely, in these days at least, subject to any artificial preservative treatment. But the waste-!! This is a most |