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The quickening of interest in all that appertains to medical research, and the sense of its value to the world at large is evidenced by the various funds placed at its disposal. Foundations such as the Pasteur and Jenner Institutes in Paris and London, and the Rockefeller of America; private scholarships and State subsidies are uniting in making possible the entire devotion of skilled workers with equipped laboratories in the investigation of human maladies.

How best to utilize these large benefactions requires much study. We have come to recognize that, as in other callings, medical research men are born, not made: also that the busy medical teacher or practitioner cannot, of necessity, give the intense concentration and specializing demanded by the work.

There are young medical men, not necessarily brilliant in the accepted use of the word, but possessing the peculiar mental equipment that spells success in this direction. To investigate and to achieve are two different things. A man may be a skilled investigator and researcher, yet fail to reach the last stage of discovery. But it is out of such research that the discovery comes: often by what seems a chance—but it is a chance based on long periods of previous work. The man who achieves the final success builds on the labor of un-named and often unknown fellow-workers.

Thus it is that, in considering how to spend most wisely the funds now so freely allotted for this purpose, the all-time research man should be given continued and ample maintenance even though he fail of that last stage: the great discovery. As Sir Ronald Ross says again: "a single success will be

worth all the money spent in this way. The larger the number of seekers, the larger the number of finders. Let every budding Pasteur have his chance; and pray for more Rockefellers."

The Communion Cup

A writer in a contemporary draws attention to a dangerous custom in our religious services-i.e., the common communion cup. The topic has become more strikingly important since influenza has become a frequent periodic unwelcome visitor. There was a serious outbreak in a certain village. It appears the church was open for service from 5.30 a.m., the sacrament being administered on several days in the week, and attended by many men and women on their way to work. Soon after the outbreak of influenza it spread rapidly and the position, became more distressing and heartrending every day. What could be a more likely source of infection than the passing of the same cup from mouth to mouth? This practice would not be allowed in the home circle, why should it be indulged in promiscuously by many people from various households? Think of the danger from possible carriers of other infections-pyorrhea, tuberculosis, staphylococcal, streptococcal infections of the oral cavity and throat!

We would like to learn just in how far the common cup is still used by the various denominations. The health authorities might ascertain this information by a questionnaire addressed to the executives of the various religious bodies, who, in turn, might secure the desired information from their various pastors.

and National Hygiene

Incorporating The Dominion Medical Monthly

A monthly journal devoted to Preventive Medicine, including Social Hygiene, Mental Hygiene, Child Hygiene, Foods and their purity, Serum Therapy, Milk Supply. Drug Addiction, Industrial and Institutional Health Problems, etc.

SUBSCRIPTION PRICE, $2.00 PER ANNUM.

OFFICE OF PUBLICATION, SLEEPY HOLLOW BUILDING, TORONTO, CANADA

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GEORGE G. NASMITH, C.M.G., D.P.H., Honorary Adviser in Public Health, Canadian Red Cross Society.

Kindly address all communications to The Canada Lancet and National Hygiene, Sleepy Hollow Building, Toronto, Canada.

FOREIGN BODIES IN THE STOMACH

LOUIS TUFT, M.D., PHILADELPHIA.

Foreign bodies in the stomach, though always interesting and instructive, are by no means uncommon occurrences. Since the time of Schwabe', who in 1635 removed a table knife from the stomach forty-one days after its ingestion, literature has been replete with numerous examples, all bearing testimony to the infinite variety of foreign bodies that may be found in the stomach. Some of these are swallowed by the insane, others by accident, and occasionally by professional mountebanks as a means of livelihood for the amusement of the public. Buttons, coins, pins, needles, safety pins, nails, spoons, forks, stones, keys, broken glass, false teeth and dental plates, hair balls-these are among the bodies most frequently swallowed. Those swallowed by accident occur mostly in children and are usually single, smooth and round-for instance, coins or marbles. Öfttimes they may be sharp and do damage in their passage through the gastrointestinal tract, although instances have been reported of large objects, such as spoons or forks, having been expelled by the patient per rectum without any apparent injury to the patient's health. Thus in Block's2 case, in a period of eight months the following objects passed through the rectum of an insane patient: 157 pieces of glass, the longest being two inches; 102 pins, 150 rusty nails, three hairpins, fifteen broken fragments of iron, a large piece of lead, half of a shoe buckle and three small hooks. It is remarkable indeed that so many sharp and pointed articles can pass through the gastrointestinal tract without serious consequences. Not all cases are so fortunate; the foreign body may lodge in the esophagus or stomach and perforate or lacerate the walls. Thus in a case reported by Inch3, at operation a perforation of the stomach from a protruding pin was found. After a long illness the patient recovered.

The length of time which the foreign body remains in the stomach before discovery is quite variable. Where it is swallowed accidentally, the accident is usually reported at once and treatment instituted promptly. Among professionals and especially among the insane, the foreign bodies may be present a long time before discovery. Numerous instances are reported in the literature of a most grotesque assortment of articles being retained in the stomach for long periods without injury to the mucosa or producing symptoms. Thus Benjamin in

1907 reported a case of a glass and nail eater who ate pieces of glass as big as his thumb for twenty years and swallowed eight and ten-penny nails for five years. At operation fiftytwo nails in various stages of erosion, and five pieces of glass were removed. The nails were in bunches and a number were embedded in the stomach wall surrounded by exudate.

The symptoms in these cases are variable. In some, there is anorexia, epigastric pain after eating food and occasional vomiting. The vomitus is tinged with blood or sometimes free hematemesis occurs. In other cases local peritonitis has occurred. The size and number of foreign bodies may have but slight effect in the production of symptoms. Thus a single small object when swallowed may lodge in the stomach or intestines and give rise to marked obstructive symptoms, whereas multiple large objects may be swallowed and only cause vague gastric symptoms that may be present a long time before be coming more acute, viz., Benjamin's case quoted above. In all obscure gastric cases with vague gastric symptoms of long duration, accompanied by weakness and emaciation, the possibility of the presence of a gastric foreign body should be investigated. In these types of cases the X-ray is an invaluable diagnostic aid and the earlier it is used the sooner can a positive diagnosis be made and prompt treatment instituted. It is upon these factors, early diagnosis and prompt institution of treatment, that the prognosis depends. Modern abdominal surgery has developed to such an extent as to make removal of foreign bodies lodged in the stomach a comparatively safe procedure. The percentage of recoveries is high, even when they have remained in the viscus for a long time. The sooner the foreign body is removed, however, the better is the result likely to be.

The end results in the vast majority of cases of foreign bodies when not removed is death, either from mechanical obstructions, erosions into vital structures, or direct or indirect infection. Where the foreign body or bodies are small and blunt, it may not be necessary to operate. as the patient may pass them per rectum without any harm. He should, however, be constantly observed for signs of obstruction; if these occur it is usually advisable to operate at once. Frequent stool examinations and X-ray studies should be made in order to watch the progress of the foreign bodies.

In these cases, the patient should be cautioned against the use of laxatives. A diet of potatoes, rice, cream of wheat,

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