The inhalation of benzedrine for its vasoconstrictor action occasionally resulted in sleeplessness after overdosage.

This action led to its use 3 and later to the use of the sulfate 4 orally for the treatment of narcolepsy and postencephalitic parkinsonism. The sulfate has also been used rather extensively in psychopathic institutions for its effect on fatigue and mood 5 in certain types of mental cases. The latter studies, along with certain attempts to evaluate the mental stimulation resulting from its use in normal persons,6 came to the attention of the general public. Subsequently some tablets of the sulfate were used in the department of psychology at the University of Minnesota for the purpose of determining its effect in mental efficiency tests. It was noted that the drug prevented sleepiness and "pepped up" the person who was fatigued. Appar ently this information was disseminated to the student body by word of mouth and the drug has been and still is being obtained by the students from drug stores
Benzedrine, J. A. M. A. 101:1315 (Oct. 21) 1933. Bertolet, J. A.: Benzyl Methyl Carbinamine Carbonate, M. J. & Rec. 136:75 (July 20) 1932. Byrne, H. V.: The Use of Benzyl\x=req-\ Methyl-Carbinamine Carbonate in the Treatment of Rhinitis, New England J. Med. 209: 1048 (Nov. 23) 1933. Wood, E. L.: A New Drug for the Treatment of Eustachian Tube and Middle Ear, Arch. Otolaryng. 21: 588 (May) 1935. Scarano, J. A.: Rapidity of Shrinkage and Immediate and Secondary Reactions following Local Applications of Ephedrine and Benzedrine, M. Rec. 140:602 (Dec. 5) 1934. 3. Uhlrich, Helmuth; Trapp, C. E., and Vidgoff, Ben: The Treatment of Narcolepsy with Benzedrine Sulfate, Ann. Int. Med. 9: 1213 (March)
1. 2. 1936. 4. Prinzmetal, Myron, and Bloomberg, Wilfred: The Use of Benzedrine for the Treatment of Narcolepsy, J. A. M. A. 105: 2051 (Dec. 21) 1935. Solomon, Philip; Mitchell, Roger S., and Prinzmetal, Myron: The Use of Benzedrine Sulfate in Postencephalitic Parkinsonism, J. A. M. A. 108: 1765 (May 22) 1937. 5. Myerson, Abraham: Effect of Benzedrine Sulfate on Mood and Fatigue in Normal and in Neurotic Persons, Arch. Neurol. & Psychiat. 36:816 (Oct.) 1936. Peoples, S. A., and Guttmann, Erich: Hyper\x=req-\ tension Produced with Benzedrine: Its Psychological Accompaniments, Lancet 1:1107 (May 16) 1936. Davidoff, E., and Reifenstein, Edward C., Jr.: The Stimulating Action of Benzedrine Sulfate, J. A. M. A. 108: 1770 (May 22) 1937. 6. Nathanson. M. H.: The Central Action of Beta-Aminopropylbenzene (Benzedrine) Sulfate, J. A. M. A. 108:528 (Feb. 13) 1937. Sargant, William, and Blackburn, J. M.: The Effect of Benzedrine on Intelligence Scores, Lancet 2: 1385 (Dec. 12) 1936.

legitimately only as a method for the purpose of avoiding sleep and fatigue when complementary to ordinary methods of preparing for examinations. Previously caffeine and contraception. The "safe period" then, used in that coffee have been used for the purpose of staying awake way, and also as a guide in the prevention or cure of during examination periods. Benzedrine sulfate, how sterility, is a valuable and practical addition to medical ever, has a greater potential danger because it is more knowledge. effective and produces many side actions which are not likely to follow the use of caffeine. The eradication of fatigue and the stimulation of BENZEDRINE SULFATE "PEP PILLS" mental activity cannot be produced for any apprecia Since the advent of ephedrine in modern therapy, ble period without subsequent periods of retribution. a number of similar vasoconstrictors have been proposed primarily for their use in rhinology. Benzedrine, Whipping a tired horse is an inefficient practice. Cases of collapse, fainting and insomnia have been reported one of this group, has been accepted by the Council on the student health physicians. Dr. Ruth Boynton 7 to Pharmacy and Chemistry.1 Benzedrine, as well as its carbonate, differs from other vasoconstrictors which issued a warning in the Minnesota Daily against the use of this drug by students, who refer to them as "pep are used for this purpose in being volatile and effective by inhalation.2 During the past year a nonvolatile salt pills" and, according to Time,8 deans and officials of of benzedrine\p=m-\thesulfate\p=m-\hasbeen introduced and other colleges are finding it necessary to issue similar has been extensively exploited as a stimulant for the warnings. Recently the Minnesota Daily,9 in comment brain and a producer of sleeplessness. This promotion ing on the situation editorially, stated in part : The growing concern of medical men over increasing use followed exaggeration in newspaper accounts of the results of experiments made with the drug in psy- of the stimulant is reflected in an item in the current issue of Time magazine. There the drug is termed "poisonous," although chologic investigations. most physicians are not willing to go so far in condemnation.
it
can

be considered

accessory and

All of them, however, are unanimous in inate and unsupervised use.

condemning indiscrim

Benzedrine differs primarily from other sympathomimetic amines that are used primarily for their vaso constrictor actions in the extent of its ability to produce certain effects on mood and fatigue. These differences make it especially important that the drug be used only under a physician's direction. There is as little excuse for employing it to avoid fatigue and sleepiness during a temporary period of stress and strain as there is for using morphine to produce sleep after that period is over. The approaching final examinations in univer sities and schools suggest that physicians in a position to do so issue warnings of the danger of employing the drug in this manner. The druggist too has an oppor tunity to demonstrate his cooperation with the medical profession by refusing to sell the item except on pre scription. Unfortunately, at one of the university cities where the drug has been obtained it has been purchased principally from the drug stores of a large national chain whose owners are apparently more interested in the immediate profit than in the ultimate effects on the purchaser. The manufacturers, on the other hand, appear to be anxious not to have the drug fall into dis repute through misuse, since it has been presented for consideration by the Council on Pharmacy and Chem istry of the American Medical Association. Benzedrine sulfate thus becomes one more example of a drug which is useful in a limited field of thera peutics but which has been diverted to uncontrolled use by the public for related, but not similar, purposes. If the situation is to be remedied, and it certainly must be as soon as possible, the manufacturer, the druggist, the student health authorities, the college officials and
7. Minnesota
8.

9.

Daily, March 12, 1937, p. 3. Time, May 10, 1937, p. 45. Minnesota Daily, May 11, 1937, p. 2.

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the physicians must cooperate in preventing the use of this drug by students, who through ignorance may be harming themselves, at least temporarily. It is chiefly the ignorant who try such self medication, not realizing that a drug can never substitute for knowledge or intellect. The drug is too new to pharmacology and experimental medicine to warrant any prediction as to possible permanent harm that may result from its con tinued misuse. This drug is one of a group which is contraindicated in certain circulatory conditions, especially hypertension. Some persons have an idiosyncrasy to the drug, which makes its use by them inadvisable. Thus far the reports of difficulties encountered with the drug have arisen from two midwestern campuses. Physicians may well keep this drug in mind when encountering cases of fainting, exhaustion and collapse.
A

PROPOSED SYSTEM

MEDICAL EXAMINER FOR MICHIGAN

In 1877 Massachusetts abolished the office of coroner and replaced it with the office of medical examiner. The law authorized two full time, salaried medical examiners for Suffolk County, in which Boston is situated, and in each of the other counties as many part time examiners on a fee basis as the county commissioners might deem necessary. In such counties the number varies from one to eleven. The office is appointive, the term of service being seven years. Repeated reappointment of the medical examiners of Boston has resulted in a high type of medicolegal investigation not approached in any coroner jurisdiction. The success of the new system in Boston led to its adoption in New York City in 1918 and in Essex County (Newark), N. J., in 1927. In each of these urban centers the superiority of the medical examiner system has been amply demonstrated. In sparsely settled rural counties the problem of the antiquated coroner's office is more difficult to solve because of the relatively small amount of work to be done. In Massachusetts outside of Suffolk County the medical examiner system is an improvement over the coroner system but still leaves much to be desired. With modern transportation facilities there is no neces sity for from one to eleven medical examiners per county. In rural regions the consolidation of two or more adjoining counties into a medical examiner dis trict under a single examiner might induce competent young physicians to enter the field of medicolegal March 29, a bill abolishing the coroner's office and setting up an examiner system was introduced into the legislature of Michigan. The essential features of the title of this bill
are :

pathology.

A bill relative to investigations in certain instances of the causes of death within this state due to violence, negligence or other act or omission of a criminal nature ; to provide for the taking of statements from injured persons under certain circum-

iner, and provide for county medical examiners and assistants, and to prescribe their powers and duties The state medical examiner, who has no counterpart in the coroner system of any state, in addition to quali fications as to residence, profession and licensure shall "possess special training in pathology and the investi gation of violent deaths." He "is authorized to incur such expenses and employ such assistants as shall be necessary in carrying out the provisions of this act." A reasonable appropriation for this provision would assure the organization and maintenance of a central medicolegal laboratory or institute, which would serve the entire state through the county medical exam iners. This would be the most enlightened step in this field thus far taken in this country and would go far in the development of a system of scientific medicolegal investigation. It is further provided that the state medical examiner shall supervise the county examiners, shall consult and advise with them, and may perform the duties of any county examiner who may be negli gent in the performance of his work. For each county there is to be a county medical examiner appointed for a term of three years by the board of supervisors with the approval of the state medical examiner. The county examiner must be a resident of the county for which he is appointed, or of an adjoining county. The latter provision makes it possible for a single examiner to serve two adjoining counties. This is a step toward desirable functional consolidation. The board of supervisors may also appoint, with the approval of the state medical exam iner, such deputy county medical examiners as may be necessary. This would insure the proper performance of the work of populous counties. The state medical examiner may recommend to the county board of super visors the removal of any county examiner or deputy who may fail to perform his duties properly. County medical examiners are authorized to make the necessary examinations of the bodies of such per sons "as are supposed to have come to their death by violence ; without medical attendance up to a time thirty-six hours prior to the hour of death ; abortion, whether self induced or otherwise; or in case any prisoner in any county or city jail shall die while so imprisoned." The county examiner is the sole judge of the necessity for postmortem examination in such cases. He may retain, for so long as may be necessary, such parts of the body as may be necessary for the detection of crime. On written order of the prose cuting attorney or attorney general or on petition of six electors of the county, the county medical examiner may investigate the death of any person whose death is believed to have occurred in the county. No dead body may be cremated without the consent of the county medical examiner. The latter official is author ized to take the statement of "any person who has been
. .

stances; to abolish the office of coroner, and to transfer the powers and duties to a state medical examiner and to county medical examiners ; to create the office of state medical exam
.

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