Reprinted with Permission from the Townsend Letter for Doctors
August / September 2000 (#205/206)
MEDICAL JOURNALIST REPORT OF INNOVATIVE BIOLOGICS
VALUE OF COLON HYDROTHERAPY VERIFIED BY MEDICAL PROFESSIONALS PRESCRIBING IT
by Morton Walker, DPM
Board Certified Gastrointestinal Surgeon Dr. Leonard Smith Endorses Colon Hydrotherapy
Thirty years ago, Leonard Smith, MD, of Gainsville, Florida graduated from medical school and eventually became board certified in general surgery by the American College of Surgery. For more than twenty-five years Dr. Smith has practiced as a specialist in gastrointestinal surgery. He has dealt with all types of colon difficulties, including operations for overcoming colon cancer, colon diverticulitis, appendicitis, hemorrhoids, and numbers of other internal organ health problems.
“I am very well acquainted with the colon’s functions, and my true belief is that colon hydrotherapy is the perfect cleansing medium for preparing the patient for colonoscopy. It’s a much better way of getting the human colon ready for an operation than having a patient swallow a gallon of that usual presurgery solution known as `ColonGo-Lytely.’Instead, colon hydrotherapy has the patient avoid this solution’s noxious side effects of vomiting, diarrhea, abdominal cramping, and other troubles,” Dr. Smith says.
“Moreover, seriously ill patients tend to be chronically constipated which results in generalized toxemia. It turns out that colon hydrotherapy is the gentlest and most effective treatment to take care of a sick person’s constipation problem. My recommendation for cancer patients is that they should undergo frequent colon hydrotherapy procedures to make sure a colon’s toxic burden is being kept at a minimum while their bodies are trying to heal,” affirms Dr. Smith. “While not a substitute for eating a high fiber diet, those cancer patients who take colon hydrotherapy often experience the elimination of their aches and pains, improvement of appetite, and they tolerate a tough healing process better.
“I also believe that normally healthy people will find it valuable to take colon hydrotherapy every couple of months in order to experience how well one feels when the colon is truly empty. It’s a fact that most people fail to fully evacuate the colon, something they don’t realize. People undergoing colon hydrotherapy on a prevention basis, become quite surprised at how much waste is removed by the procedure,” Dr. Smith says. “Without any reservation, I declare that my wish is to see it become an established procedure for may kinds of gastrointestinal problems. If medical centres, hospitals, and clinics installed colon hydrotherapy departments, they would find such departments just as efficacious for patients as their present treatment areas which are devoted to physiotherapy,” states Leonard Smith, MD “Such is my true belief, and I do endorse this therapeutic program.”
Colon hydrotherapy is the perfect specific procedure to eliminate constipation and restore normal bowel function.
My approach to medical practice is to balance the GI tract using stool testing. 1 find various pathologies relating to bacteria, yeast, parasites, and other organisms of this nature. A lot of disease comes from imbalances in the colon, as manifested by inflammatory bowel disease, ulcerative colitis, autoimmune diseases, allergies, multiple sclerosis, and certainly constipation. Such imbalances can be corrected by means of colon hydrotherapy, herbal supplements, and diet,” says Dr. Paul Flashner. “There is no question about the huge difference a health professional can bring to the patient by utilizing colon hydrotherapy plus other associated complementary and alternative methods of healing.”
Giving Colon Hydrotherapy Is Standard Procedure for Sharda Sharma, MD
Located in Millburn, New Jersey as a primary care physician for nearly twenty-six years, Sharda Sharma, MD, dispenses medical care of a multi-disciplinary nature to her patients. Dr. Sharma employs colon hydrotherapy, chelation therapy, massage therapy, acupuncture, Reiki manipulative therapy, and much more. She treats the body as a whole (holistically).
“I have trained and certified colon hydrotherapists working as part of my staff. Under my supervision for the past year-and-a-half they have been renduring care for co~stipatyon, abdominal cramps, allergies, and a fariety of other conditions, including ten patients with hepatitis C. These hepatitis patients respond to colon xydrotherapy and do well,” assures Dr. Sharma. “For instance, Mrs. Felicia, a forty-two-year-old high school teacher, had suffered with constipation-no bowel movements for six days at a0stretch. She was bloated, fatigued, lethargic, headachy, and crampy. My treatment choice for her was enzyme supplements and colon hydrotherapy twice weekly for thirteen weeks. These treatments solved the constipation problem for Mrs. Felicia. She goes to the toilet as desired without having to sit there for long periods waiting, reading, meditating, or undergoing other mental or physical diversions.
Colon hydrotherapy is excellent as a treatment for the yeast syndrome.
A very anxious fifty-year-old female, Mrs. Sara Audrey, consulted me because she was running to the toilet every two hours with either diarrhea or with attempting to find comfort from constipation. It turns out that she had irritable bowel syndrome complicated by candidiasis. During the administration of colon hydrotherapy, I observed that Mrs. Audrey was loaded with Candida albicans. I recognized the white yeast organisms floating through the transparent tube of my colon flushing device,” says Dr. Sharma. “But the patient is now in fine shape-much relieved. She has good bowel movements twice daily with no gas. This is typical of almost all patients undergoing colon hydrotherapy”
Dr. Michael Gerber Uses Colon Hydrotherapy Routinely
“I’ve had a colon hydrotherapy device in my office for twenty-five years,” states Michael Gerber, MD, of Reno, Nevada. “My present staff person who dispenses colon hydrotherapy under my jurisdiction uses it for all types of patient difficulties. The basic concepts of the science have not changed much in the last twenty-five years; however, the colon hydrotherapy equipment has improved immensely. How the equipment works so effectively is nothing short of astounding. Registered with the FDA, current colon hydrotherapy equipment is safe. It contains temperature controlled water mixing and back flow prevention valves, plus pressure and temperature sensors, and built-in chemical sanitizing units. Water purification units frequently are installed as well. Disposable single-use rectal tubes, and/or speculae are employed routinely for sterility.
“Undergoing a session of colon hydrotherapy has you experiencing comfort and cleansing with no toxicity. Techniques utilized allow a small amount of water to flow into the colon gently stimulating the colon’s natural peristaltic action to release softened waste,” Dr. Gerber advises. “The inflow of a small amount of water and the release of waste may be repeated again and again. The removal of such waste encourages better colon function and elimination. “During the treatment, most clothing can continue to be worn. In addition the patient is draped, or a gown is worn to ensure modesty. The patient’s dignity is always maintained,” Dr. Michael Gerber affirms, “The benefits of colon hydrotherapy extend all the way from psychiatric improvement to constipation elimination.”
Colon Hydrotherapy Reduces Benign Prostatic Hyperplasia
Joshua Heinermann, the sixty-six-year-old chief executive officer for Virginia Chemicals Corporation of Chesapeake, Virginia, had been suffering severely from prostate gland enlargement (benign prostatic hyperplasia or BPH). For four years the man’s symptoms had been building steadily, and now they were affecting his ability to manage in the administrative position he held. The executive’s nighttime urinary urgency (nocturia) came with such frequency, Mr. Heinermann found himself perpetually fatigued during daytime business meetings. His need to sleep lay on him like a blanket, and he felt as if his mind was encased in cotton batting. Airy capability for loin to make vital decisions on behalf of his corporation became ahnost nonexistant. To confront the problem, the CEO finally consulted a urologist located in his city.
In practice for over sixty years as a specialist in solving urological problems for both men and women, Emil S. Sayegh, MD, of Chesapeake, Virginia is eighty-eight years of age. Over the six decades of his medical practice, Dr. Sayegh has been consulted by a particularly large number of male clientele who have sought his help in correcting BPH and prostatitis.
“These two common medical difficulties are closely associated with having weak abdominal muscles,” explains the board certified urologist. “Those men possessing flaccid and weak abdominal muscles experience enormous pressures on their bladders which never let up. The supportive muscles and other erectile tissues surrounding the bladder fail to do the jobs required. The pressure ofthe bladder’s rectal sigmoid is so severe that any amount of stool in that area is going to snake urine passage very difficult. Whether urine is present or not, the need for these men to void becomes overwhelming.”
During the past fifteen years Dr. Sayegh has made use of colon hydrotherapy which solves his patients’ two particular prostate pathologies almost every time. “Cleaning the colon markedly assists the functioning of the pathological male bladder and prostate organs. Colon hydrotherapy given to involved men at two-week intervals for three times to start and then maintained every four weeks for an unlimited period does solve prostatitis and benign prostatic hyperplasia,” states Emil S. Sayegh, MD. “From my files, I can offer up several hundred case studies which testify to that fact.”
Cancer Patients Improve from Receiving Colon Treatment
“I have found over the years that cancer patients who are not doing well usually are toxic and not being cleansed. They certainly are in need of colon hydrotherapy,” advises oncologist and homeopath Douglas Brodie, MD, of Reno, Nevada. Dr. Brodie has developed CAM methods for treating cancer and other degenerative diseases aimed at strengthening the immune system. He emphasizes natural and humane approaches to these conditions with colon hydrotherapy being among them.
“I do recommend that most of my cancer patients take colon hydrotherapy or `colonic irrigations’ because they often improve by having such treatment. Liver cancer in particular
shows benefit from colon hydrotherapy, but any internal tumors show effectual change too,” Dr. Brodie says. “It’s better than an enema, which is merely a lower bowel cleanse, as opposed to a colonic which is a thorough cleanse of the entire.bowel. It’s similar to comparing the diagnostic efficacy of a sigmoidoscopy of the short end of the bowel to a colonoscopy which takes in the whole bowel. An enema only goes so far. Colon hydrotherapy is the best cleansing and detoxifiier for the gastrointestinal tract that anybody would want. I do promote Its use.”
Conditions for Which Colon Hydrotherapy Is Effective
Maintaining a rheutnatology practice for the past twenty-four years in Long Branch, New Jersey, Arthur E. Brawer, MD, is an enthusiastic exponent of colon hydrotherapy for a variety of health problems. He cites this treatment in his recently published consumer book, Holistic Harmony.
“Silicone breast implant exposure which results in disease symptoms responds very well to colon hydrotherapy. I am in the centre of this silicone breast implant controversy by having consulted with over 500 women from around the world for the toxic environmental exposure caused by such implantation. I’ve given testimony as an expert witness before the United States Congress on this issue along with advising the Department of Health and Human Services, the FDA, and consultants to the President, the Vice-president, the Director of Women’s Health at the White House, and the United Nations. I use colon hydrotherapy for the treatment of such silicone toxicity, since it does work to chelate silicone out of the body,” states Dr. Brawer. “Let me explain!
“From day one of implantation, silicone micromolecules disperse throughout the body because the pore size (the porosity) of the envelope or shell enclosing the implant is larger than most of the silicone molecules contained inside. Thus, the disease symptoms derived from silicone toxicity is not dependent on envelope rupture. Symptoms begin immediately! In other words, the molecules of silicone travel through the membrane osmotically and become microdispersed throughout the body by means of the lymphatic system,” explains Dr. Brawer.
“Now realize that the connective tissue or collagen in each person’s body requires silicone as an essential component in order to provide the body with proper architectural structure such as for tendons, ligaments, nerve sheaths, and everything else. Silicone makes up the glue which holds the skin together, gives substance to the organs, act as regulators, signal transmitters, and so forth. It functions as an integral part of metabolism and physiology. Thus, all tissues are dependent on silicone as an essential ingredient,” Dr. Brawer says. “But given in excess as a leaking silicone breast implant, there is only one place the excess may be dumped or stored by the body-into its connective tissue. When that happens a whole litany of complaints occur: joint pains, dry eyes, fatigue, memory lapses, skin rashes and pigmentations, chest pain, muscle aches, drug intolerance, odour and smell sensitivity to hair sprays, room fresheners, deodorants, and more (see sidebar). “So the silicone molecules become stuck in the body’s glue, and they cannot be removed by use of medications or supplemental nutrients or diet. Only certain techniques may be applied to detoxify the body: colon hydrotherapy is perhaps the best way and also working as detoxifiers are Ayurvedic medicine, hyperthermia, steam baths, saunas, oxygen therapy, and the energy-based therapies such as Reiki therapy and Qigong. Any dietary approach has to be more an exclusionary basis – take the patient off of processed foods and have them eat organic,” confirms Dr. Brawer. “But of all the treatments for symptoms coming from silicone breast implants, colon hydrotherapy I find to be one of the mainstays that offer relief.”
Colon Hydrotherapy Is Like Cleaning Baked Lasagna from a Pan
According to Pamela Whitney, ND, baked lasagna maybe used as a metaphor for colon cleansing. Dr. Whitney, educational director for the New England Health Institute, is a naturopathic physician who practices her profession in two locations, Braintree, Massachusetts and Stowe, Vermont. Here is how she describes the physical action of colon hydrotherapy:
“If ever you’ve baked a lasagna and then attempted to sanitize the messy, left-over lasagna pan, you know the difficulty with getting it clean. For sponging such a foodcaked pan it’s usual for cooks to soak the pan overnight. Then they find that swabbing it the next day is easy. Colon hydrotherapy accomplishes the same ease of cleansing on the inside of one’s bowel. Using hydrotherapy, the colon’s walls constantly get flushed with clear fluid, which serves to remove mucous plus some of their longstanding, caked-on fecal matter which contains hidden bacteria, parasites, Candida albicans-filled pockets, and other such pathological materials.”
From its home office located in San Antonio, Texas, literature furnished by the International Association for Colon Hydrotherapy or I-ACT (see the Resource section) defines colon hydrotherapy as a safe, effective method of removing waste from the large intestine, without the use of drugs. By introducing pure, filtered and temperature-regulated water into the colon, the human waste is softened and loosened, resulting in evacuation through natural peristalsis. This flushing process usually is repeated a few times during a therapeutic session. Colon hydrotherapy is best used in combination with adequate nutrient and fluid intake as well as with exercise. The modern and sophisticated technology applied today, manufactured through compliance with strict FDA guidelines, promotes both safety and sanitation of the procedure.
Dr. Pamela Whitney advises that her healing program for almost any condition frequently involves prescribing colon hydrotherapy. “I almost always refer my patient to undertake colon cleansing as the first part of my treatment. I do this for purposes of detoxification, since most people possess toxic bowels which may result in either constipation or diarrheaboth coming from the same sources of toxicity,” she says. “The patients’ toxins tend to kick back to their blood streams to perpetuate numerous pathologies such as candidiasis, allergies, chronic fatigue, and other symptoms coming from a recirculation of accumulated physiological poisons.
“I use the services of at least three skilled colon hydrotherapists who practice near to my two offices. I don’t know of any patient receiving colon hydrotherapy who has not benefited from it. Certainly the treatment will get a sluggish bowel refunctioning again. In my judgment, the action of just one colon hydrotherapy is an experience equivalent to someone undergoing twenty coffee enemas,” says Dr. Whitney. “What we eat, the processed foods such as breads, pastas, sugars, and refined deserts hit the gastrointestinal tract like glue which becomes nearly indigestible. A prime source of allergies to wheat and other flour products is this flour made into a kind of mucilage by being mixed with saliva. This glue-like substance sticks on the walls of one’s Gl tract to slow down the individual’s metabolic rate. Thereafter, constipation with inflammation can develop, but colon hydrotherapy solves such a problem.”
As is obvious, Dr. Pamela Whitney is a great advocate of colon hydrotherapy, which she prescribes as a standard part of her treatment.
A Gastroenterologist Prescribes Colon Hydrotherapy
Board certified as a gastroenterologist from 1972, Robert Charm, MD, of Walnut Creek, California, a clinical professor of medicine at the University of California, combines conventional allopathic medicine with CAM in his practice. He also continues to make house calls.
“I prescribe colon hydrotherapy by calling upon a superbly trained practitioner of the art in the San Francisco Bay area. She is certified by I-ACT. Also, I’m very impressed by the sophisticated technology as illustrated by the colon hydrotherapy equipment. From my observation, it’s engineered quite well,” affirms the gastroenterologist.
“Frequently while performing colonoscopy, I see that the patient is cleaned out from above but below the diverticular still contain fecaliths, those small turds remaining in pockets formed on the gut mucosa. They indicate the presence of an unhealthy colon, and over 54 percent of Americans possess diverticulosis colae. When inflamed, gastroenterologists called them diverticulitis colae, which can be serious by creating fistulas. Some people then will poop through their bladders. Some women actually poop through the vagina,” Dr. Charm says. “With patients for whom I perform colonoscopy, about one third of them over the age of fifty who are otherwise cleaned above, still show residual stools sitting in these gut mucosa pockets. Some have held onto the stool pockets for decadus. A toxic dumpsyte liku this is dangerous for them by the elevqted concentration of poisons stored in the dumpsite. Environmental cancer can develop!
“A good cleanout by use0of colon hydrotherapy is excellent treatment. Surely I recommend that people undertake colon hydrotherapy for themselves. Clean out the body’s pipes,” Dr. Robert Charm suggests. “And bi all means, I prefer my patients to undergo colon hydrotherapy the morning of a colonoscopy. It’s a safe way to cleanse the gut. It’s a healing technique for the relief of irritable bowel syndrome with gas and bloating, chronic constipation, abdominal discomfort, and many other GI tract problems.
“My patient, Fran Wilson, a former model, now age forty-one, the mother of two, was just too busy to go to the bathroom. She didn’t celebrate having a good bowel movement, which is the thinking in our society. For her, defecation was an annoyance. Fran laboured under the mistaken illusion that pooping every three days was normal, and she came to me complaining of feeling logy, fatigued, bloated and abdominally cramped. None of the various drug laxatives had been doing the job for her,” explains Dr. Charm. “Rather, these drug-like laxatives were depleting Fran of her potassium.
The psyllium seed, fiber, and other natural agents did not work either. Therefore I recommended that she undertake a series of colon hydrotherapies and the drinking of more water. This cleared up her discomforts remarkably fast despite her lifetime of bad habits. “The lesson to learn is that when one gets the urge to move, you must do so. Being too busy in our society to give into the need to defecate is wrong. Find a way,” advises Dr. Robert Charm. “Some people don’t poop enough! Let’s get people thinking about eating and pooping. If these don’t occur together, colon hydrotherapy should be employed.”
Christopher J. Hussar, DO, DDS, Took Colon Hydrotherapy
From his medical/surgical practice in Reno, Nevada, osteopathic, physician and dental cavitation specialist Christopher J. Hussar, DO, DD., does offer the following personal statement, “I have enjoyed two colon hydrotherapeutic treatments when, at the time, I was experiencing partial bowel obstruction. Each colon hydrotherapy had me feeling better. It’s my belief that this treatment should be recommended for any person who is having chronic constipation. Then, the local colon hydrotherapist can become a main factor in keeping that individual comfortable. I maintain that one should do whatever it takes to keep up with regular bowel movements. Colon hydrotherapy is a safe and natural laxative which works better than any other type.
“In Reno, I refer my patients who are in need of bowel cleansing to a colon hydrotherapist. The only reason that I don’t refer people on a regular basis is because most of them arrive to see me. from out of town. Therefore, I tell them to use the services of a skilled colon hydrotherapist located in their area so that they can go for treatment often,” says Dr. Christopher J. Hussar.
Colon Hydrotherapy Is Usual for the Patients of W. John Diamond, MD
For W. John Diamond, MD, medical director of the Triad Medical Center in Reno, Nevada and coauthor of that useful consumer text, An Alternative Medicine Definitive Guide to Cancer; colon hydrotherapy or high colonic irrigations are usual modalities for which he refers his patients. “For some patients with chronic constipation or extensive yeast problems, colon hydrotherapy works advantageously to get rid of the physical load of pathology in the gastrointestinal tract. This treatment stimulates the liver and gets rid of the debris that’s sticking to the mucosa. The last time 1 referred my patient to take colon hydrotherapy was just yesterday. There’s hardly a week that goes by which does not see me utilize this fabulous treatment for one or more patients. The colon hydrotherapist in this city of Reno is skilled and does a fine job. “Let me describe a particular patient of mine, Mrs. Constance Overmacher, who benefited from colon hydrotherapy,” says Dr. Diamond. “This woman at age forty six has a long history of antibiotic usage for chronic sinusitis. She is a sugarholic to the extent that her food is totally carbohydrates with hardly any protein or fat. She exhibits a variety of symptoms including extreme fatigue, migraine headaches, irregular menses, chronic constipation, abdominal pain, and yeast growing in the bowel upon testing by EAV [electroacupuncture according to Voll]. Presence of the yeast was confirmed by stool culture and blood tests for yeast antibodies and skin testing.
“For such a complicated case, I tried every kind of treatment that was appropriate, but nothing did any good. The only program that gave Mrs. Overmacher relief was colon hydrotherapy prescribed for her to receive three times a week. It took me a month to get my patient stable, but finally the treatment’s effect kicked in. The lady did get her bowel cleaned up; she’s now experiencing normal stools and I have her following a restrictive protein diet. Her energy is returned, and she has been showing normal menses for the last two months. Her migraines disappeared,” Dr. John Diamond affirms. “It merely meant that I needed to get the woman back to normal bowel function, off antibiotics, and onto probiotics all the time. Now she takes colon hydrotherapy on a regular once-a-month schedule. Mrs. Overmacher will likely be forced to stay on her therapeutic program continuously.”
Janet Beaty, N.D., Took Training in Colon Hydrotherapy
“My original training in colon hydrotherapy was when I administered it twenty-five years ago as part of my massage therapy program and that training went a lot deeper when I attended Bastyre University. I was one of several instructors in colon hydrotherapy at that naturopathic college,” says Janet Beaty, ND, whose practice is in West Concord, Massachusetts. “Now I don’t own the physical facilities for doing it in my office but l regularly refer patients to a competent nearby colon hydrotherapist.
“My experience with the treatment is totally positive. I refer people to have it when they are constipated because their colons are not fully emptying and bringing on GI discomforts of some kind. My sense is that the patient must empty out old waste products so that there is no interference with healing modalities,” states Dr. Beaty, “1 am using colon hydrotherapy as my beginning treatment for detoxification, particularly for patients with congested bowels. While 1 focus on the gastrointestinal aspects of colon hydrotherapy, I also prescribe it for the treatment of allergies, arthritis, and other health difficulties.
“I would get all of the patients with any health problems on colon hydrotherapy. Why I don’t is because it entails the payment of cash-out-of-pocket and some people find the concept too `kinky’ even to imagine doing it,” Dr Beaty says. “Yet, probably most patients should receive at least one colon hydrotherapy during the course of taking care of themselves. It is a very helpful tool for nearly any patient in order to get the bowel peristalsis to work. An effective technique for stimulating such peristalsis is to start out with giving colon hydrotherapy using warm water and gradually decreasing the water temperature as treatment continues. This lower temperature tends to stimulate the bowel muscles. The cold temperatures cause good peristaltic action for a retraining of the bowel.
“The ideal treatment program I follow is that from four to eight weeks the patient receives colon hydrotherapy. This time frame is necessary for unloading a bunch of toxins from the liver. Here is a typical case history: a thirty-six-year-old patient, Mrs. Cynthia Mangie, had experienced several ectopic pregnancies which resulted in her having a number of miscarriages and ending with chronic endometriosis. Also, she had her belly sliced into many times. Her caesarian pregnancies left her with too much scar tissue so that now the endometriosis must be managed without further surgery,” says Dr. Janet Beaty. “the solution to my patient’s problem of endometrial pain is to take a colon hydrotherapy one week before her period. The pain is then reduced markedly because her usual premenstrual constipation is prevented. With the bowel clean, Mrs. Mangie has more room in her belly. She currently takes colon hydrotherapy routinely for improving the quality of her life.”
Colon Hydrotherapy Used by James P. Carter, MD, DrPH
“After conducting a comprehensive digestive stool analysis on any patient suspected of having dysbiosis (poor intestinal hygiene), I attempt to wipe the bowel clean by prescribing colon hydrotherapy once a week times three. In my medical practice, I employ a registered nurse on staff to administer this treatment,” says James P. Carter, MD, DrPH, MS, of Mandeville, Louisiana. Dr. Carter is Professor and Head of the Nutrition Section at Tulane University School of Medicine.
“Also I use colon hydrotherapy as part of an overall detoxification program, and it may be combined with treatment from above as with drinking epsom salts, but both are not taken on the same day,” he advises. “It promotes the second stage of liver detoxification to cause dissolved poisons to come out in the bile as a solvent. The patient’s washout at least once a week from below is adjunctive with the epsom salts.
“Colon hydrotherapy is an excellent detoxifier for the overindulgence of alcohol drinking and drug addictions of all kinds. Residues of drugs and other agents in the tissues are eliminated with colon hydrotherapy,” states Dr. James P. Carter. “It takes away any desire to use drugs or imbibe in alcoholic beverages. Colon hydrotherapy should be part of nearly any addict’s therapeutic regimen.”
- Bettman, O.L. A Pictorial History of Medicine. (Springfield, Illinois: Charles C. Thomas, 1956), p.6.
- Kellogg, J.H. “Should the colon be sacrificed or may it be reformed? JAMA LXVIll (26):1957-1959, June 30,1917.