Journal of the American Medical Association
to develop an aloofness from the human being because of its devotion to the laboratory. It is assumed that the latter is essentially a factor either for devising methods of diagnosis or for exposing the worthlessness of many supposed remedies. Undoubtedly laboratory investigation has done much to relegate certain drugs and devices to the rubbish heap; but it has also fur¬ nished an intelligible explanation for the worth of many others. In this connection we cannot forbear quoting Cushny's
... ting Cushny's reminder of the debt to the labora¬ tory. It is a fact, he says, that is not always remem¬ bered, that in the last half century no drug of the first importance has entered by any other portal than that of the experimental laboratory. Without it, Cushny adds, we should have to depend on opium and morphin for soporifics ; chloral and its allies would be unknown. Cocain and the local anesthetics and analgesics would not be available, nor the antitoxins and arsphenamin. If it were possible to estimate the value of the life saved and the suffering relieved by even two or three of the remedies introduced by the laboratory route, and put it against the expense of all the laboratory investi¬ gations throughout the world, the dividend would be found so enormous that the cry would be, not for economy, but for lavish expenditure in such a paying investment. Current Comment STANDARDIZATION OF LABORATORY TESTS So long as laboratory tests employed by practitioners of medicine are simple, there is little opportunity for confusion in their interpretation. However, errors of interpretation are likely to occur in the use of complex reactions or when uniform standards are not adopted. Several years ago the writer of a paper on scabies asserted that all persons with scabies had albuminuria ; subsequent investigation showed that the test for albu¬ min which was used was so delicate that it showed the presence of albumin even in normal urines. Many of the modern laboratory tests, such as the Widal and Wassermann reactions, are extremely complicated. The technic of these tests has been gradually modified by different observers so that now many systems of performing the tests are in use. In a recent article by Kolmer and Flick,1 eight different methods of per¬ forming the Wassermann test are compared, and it is demonstrated that each gives different results. The same thing is true of the Widal reaction, as has' been pointed out by Dreyer. Obviously, it is desirable that every one who discusses the results of the Widal reac¬ tion or of the Wassermann reaction should refer to the same thing. When this is not the case, the figures regarding the validity of a-given test presented by different observers are not comparable, and confusion rather than enlightenment results. The time has come when these tests should be standardized throughout the world. Such standardization need not exclude further 1. Kolmer and Flick: Am. J. Syphilis 3: 541, 1919. experimentation on any of the tests in question, and provision should be made for the reconsideration of the standards at stated intervals. As a step in this direction the U. S. Pharmacopeia already has a section on Diagnostic Reagents and Clinical Tests which, thus far however, is chiefly concerned with the strength and purity of reagents. The United States government maintains a Bureau of Standards, and it is possible that through this organization or some similar one the important work of standardizing laboratory tests can be accomplished. In any event, the work needs to be done. THE ACTION OF THE PYLORIC SPHINCTER The current teaching regarding the control of the pyloric sphincter and the emptying of the stomach is largely due to the writings of Cannon and his associates at the Harvard Medical School. They have suggested that it is under chemical rather than purely mechanical control. Acid on the stomach side is regarded as a cause of the relaxation of the pyloric sphincter ; whereas on the duodenal side the same reaction tends to produce a closure of the sphincter and an inhibition of gastric evacuation. Among the evidences of the first proposition is the fact that carbohydrate meals with a low acid-absorbing power leave the stomach rapidly ; but if an alkali, like sodium bicarbonate, is added, the exit from the stomach is delayed. Proteins which combine with acids leave the stomach slowly as a rule, whereas acid proteins are discharged into the duodenum more promptly. This hypothesis fails to explain certain admitted facts, such as the emptying of the stomach in achylia gastrica and the rapid exit of water from the stomach. In extensive roentgen-ray studies on the movements of this organ in man, Cole1 has pointed out that in health, as well as in disease, the first portions of the food ingested by the fasting stomach may leave it promptly. As acidity can scarcely be assumed to develop so early as a relaxing stimulus, Cole correlated the opening of the pylorus with the passage of peristaltic waves and an increased tonicity of the stomach. Investigations of the gastric func¬ tions, both in man and in animals, at the physiologic laboratories of the University of Chicago have brought Luckhardt, Phillips and Carlson2 similarly to the con¬ clusion that certain motor activities of the stomach are intimately associated with the relaxation of the pyloric sphincter, thus correlating this with mechanical as well as more purely chemical developments in the organ. Marked motor activities, either as tonus changes or peristalsis, as well as the presence of free acid may lead to inhibition in the tone of the sphincter .at the pylorus and to its consequent opening. This explains why water alone may issue neutral from the stomach, as Ivy3 has reported. According to the Chicago physi¬ ologists there is a more intimate relation between the muscular activity and the opening of the pylorus than between the latter and the reaction of the intra-1. Cole, L. G.: Am.