37 It is to be hoped that the clamor for "serum" will not become great enough to fill the market with a spurious or partially immunized article before scientific investigations have definitely demonstrated its value. The probable therapeutic value of this discovery is too great to be lightly regarded, or prejudiced by the opinions of careless observers. The following, taken from the last issue of Archives of Pediatrics, will be found interesting: DISCUSSION OF THE ANTI-TOXIN TREATMENT OF DIPHTHERIA BY THE NEW YORK ACADEMY OF MEDICINE. Dr. Herman M. Biggs opened the discusssion by referring to the opportunities he had had at the Institute for Infectious Diseases at Berlin during the past summer to study this new treatment. Many eminent bacteriol ogists were engaged here investigating the anti-toxin treatment, and he had been struck with the fact that after having observed five hundred cases so treated, they were unanimous in the opinion that the antitoxin treatment of diphtheria was not only of value, but that it had already passed beyond the experimental stage. Dr. William Hallock Park said that when the diphtheria baccilli or their toxines were injected into animals in gradually increasing doses, it was found that after considerable time these animals were capable of standing a dose far greater than could have been given at the beginning without producing a fatal result. It has also been demonstrated experimentally that after the antitoxin has neutralized the toxines, both of these substances were still present in the body. If an animal were inoculated with diphtheria in the trachea, and immediately after received a dose of the anti-toxin, the characteristic manifestations of diphtheria would not develop; but though the same result would follow the injection of the anti-toxin at a somewhat later period, it would be necessary in this instance to administer a much larger dose. This injection of the anti-toxin of diphtheria into the human subject was followed by practically no reaction, and was an absolutely harmless procedure, in which respect it differed from the treatment of tuberculin. Indeed, the latter was the reverse of the treatment under discussion, for the toxine was injected in order to develop the anti-toxin in the body, whereas in diphtheria the toxines are produced in the body of one of the lower animals, and the antitoxin obtained from the blood of this animal only injected into the patient. The anti-toxin of diphtheria was not an anti-septic, and could not therefore be expected to exert any special destructive effect on the baccilli themselves; in fact, it had been found that the diphtheria baccilli could be grown on cultures impregnated with the antitoxin. As a general rule it might be said that, in animals at least, where large doses of the anti-toxin had been injected, the separation of the diphtheritic membrane had been hastened. The speaker, in closing his remarks, said that he had succeeded in collecting 1,180 cases of diphtheria that had been subjected to this anti-toxin treatment, and the mortality among these had been only twenty per cent. Dr. George F. Shrady recalled the time when diphtheria was a new disease in New York City, and when the mortality had been about ninety per cent. He had employed the antitoxin treatment personally only in one case, but he had followed the cases upon which the paper of the evening was based, and from this experience felt like heartily endorsing the new method. Dr. W. P. Northrup said that the mortality rate from diphtheria in foreign countries was so different from what it was in our own country that it was probable they had to deal there with a different type of the disease. There had been no severe epidemic of diphtheria in this city since early in last July, and therefore in accepting the conclusions drawn from a series of cases extending over a comparatively short period, one should exercise great caution. He had been particularly impressed with the reported beneficial action of the anti-toxin treatment on the pulse rate. He hoped, and was inclined to believe, that the greatest benefit from this treatment would be found in those fulminating cases which occasionally develop in our institutions, and in which death ensues within a few hours from the onset of the disease. Dr. Louis Fischer said that during the past summer he had studied the anti-toxin treatment in Berlin with Professor Baginsky. It was the practice there to subject to this treatment all cases in which the diagnosis of diphtheria was confirmed by bacteriological examination. Personally he had found the Aronson solution of the anti-toxin about three times stronger than that prepared by Behring, yet Aronson had assured him that in very severe cases of diphtheria the physician should not hesitate to push the dose of the anti-toxin solution even as high as fifty cubic centimeters. Dr. W. H. Berg said that thousands of cases must be treated with antitoxin before we would be in a position to pass intelligently upon the value of this treatment, for we had at present no means whatever of determining at the very beginning of the disease whether or not it was a severe type. Dr. J. Lewis Smith asked what was the effect of the new treatment in cases of pseudo-diphtheria. The chairman replied that Aronson had stated that cases of mixed infection were not favorably influenced by it. Dr. Somerset, assistant physician at the Willard Parker Hospital, said that he had been asked to exhibit the aparatus he had devised for removing plugs of diphtheritic membrane from the nasal passage. It consisted of a large and powerful hard rubber syringe, to which was attached by rubber tubing a glass tube with a soft rubber tip. 38 The Chairman said that nearly a year ago there had been at the hospital a severe case of diphtheria in which the naso-pharynx had been firm; ly plugged with membrane. He had stated to Dr. Somerset that if he could succeed in removing this membrane the man would in all probability recover, but that if it were allowed to remain death would surely result. At his next visit he had been pleased to learn that Dr. Somerset had succeeded in dislodging the membrane by the apparatus just described, and the patient was already on the road to recovery. He thought more practitioners would agree with him that it was rare to find a case of death from sepsis in which this obstruction by membrane had not existed. It was for this reason that he had long ago advocated before the Section the use of the Dayidson syringe in perference to the fountain syringe. The latter often failed to efficiently cleanse the parts under ordinary circumstances. Where the intermittent steam from the Davidson syringe failed to dislodge the plug of membrane, Dr. Somerset's method should be tried. as Referring more particularly to the special subject under discussion, he said that from the fact that Koch had excluded from treatment by the anti-toxin treatment for various reasons quite a large number of cases, which ultimately terminated fatally, his observations lost much of their value. We certainly did not have any such mortality rate here abroad. The records of the New York City Board of Health showed that it was between twenty-five and thirtythree per cent. The carelessness displayed in the cure of diphtheria patients was astounding. It was not uncommon to find such patients out of bed after five or six days in spite of the instructions of the physician, and it was rare for a little child to be kept in the recumbent position during the whole period of the disease. As there has been a large number of mild cases of diphtheria during the past few months it was impossible to speak with definiteness regarding the value of the anti-toxin treatment. Dr. Andrew H. Smith said he would like to call attention to the fact that a very convenient rubber tip for an ordinary syringe could be improvised from a small rubber nipple. If the aperature in this nipple were smaller than that in the nozzle of the syringe, the nipple could be distended by the stream of water, and so be made to accurately fit the nostril. He thought that if the anti-toxin treatment did no more than prevent the very frequent and ill-judged use of local remedies, so common in the treatment of diphtheria, it would be productive of great good. Dr. White, in closing the discussion, said that if one compared the mortality rates of like institutions here 39 and abroad, as for example, institutions treating only young children, it would be found that there was no striking difference between them. The severity of the disease in most of the cases which he had subjected to the anti-toxin treatment was sufficiently shown by the fact that fourteen out of the twenty were affected with laryngeal diphtheria, and that, with one exception, the patients were all under five years of age. The statistics of the hospital showed that the mortality in cases of this kind treated in the ordinary way was between forty and fifty per cent., whereas among those treated by the new method the mortality had been only twenty-five per cent. HUBERT WORK, M. D. THE CHRISTMAS HERALD. "The Christmas edition of the Medical Herald, of this city, is one of the prettiest pieces of magazine printing we have seen this season. St. Joseph may well be proud of her medical profession and her Medical Herald The number before us is not only meritorious from an artistic point of view, but contains an hundred pages of practical reading matter for the doctor and student, from the pens of some of the best medical writers. The half-tone engravings which embellish the journal are well worth the price of a year s subscription."-DAILY GAZETTE. "The Christmas number of the MEDICAL HERALD is the handsomest journal so far received. It contains several beautiful half-tone engravings, and the first page of cover is a beauty. The editors of this journal are certainly men of taste, and know how to conduct a first-class journal. It is always full of the choicest medical literature, and there is no journal on our exchange list more welcomed than the HERALD."-WESTERN MEDICAL JOURNAL. "Your Christmas Herald is but another evidence of your success in medical journalism. Although the writer is very busy, he never fails to examine every issue of the Herald, carefully, for it shows a spirit of enterprise from beginning to end. Please continue our advertising right along, and find copy enclosed herewith."- REED & CARNRICK, Per JOHN CARNRICK. "We enclose renewal contract for 1895, and must compliment you on the appearance of your Christmas number, as well as upon the vim and vigor with which the journal appears to be managed. Best wishes for your continned success."-WM. S. MERRELL CHEMICAL CO. "The Christmas Herald to hand, and it is simply superb. It certainly reflects great credit on your company, and is an example of what enterprise and good business management can accomplish.”— FREDERICK STEARNS & CO. "Your Christmas Herald is a great success, from an artistic point of view, as well as in literary merit, reflecting credit on both publisher and editor."-F. E. STEWART, M. D. "The Christmas Herald to hand, and we are much pleased with the style and tone of your magazine. Please continue our advertisement."-VAPO-CRESOLINE CO. "I want to compliment you on the Christmas Herald; it is, indeed, an exceedingly artistic production, and worthy of great commendation."-A. L. HUMMEL, M. D. "The Medical Herald issued a gem like Christmas number. Fassett."-MISSOURI EDITOR. Congratulations to Charles Wood "The most valuable, as well as the handsomest, addition to medical literature we have seen in many a day."-A. S. ALOE CO. "Your Christmas Herald received, and is exquisite, indeed. You deserve to be highly complimented." -R. W. GARDNER. "Very fine. Enclosed find new copy for our advertising space."-MALTINE MANUFACTURIMG CO. "Excels all your previous efforts--and that means a great deal.”—DEACON ROACH. "The Xmas Herald is a beauty."-THE OZONE COMPANY. "A truly artistic production."-F. A. HENRY. 40 Our Book Table. TRAVAUX D'ELECTROTHERAPIE GYNECOLOGIQUE; Archives semestrielles d'electrotherapie gynecologique. Vol. I, Farcicules I et II. Fondies et publices par le Dr. G. Apostoli, Vice-President de la Société Francaise d'électrothérapie, etc. Société d'éditions scientifiques. Paris. 711 Pp. 1894. This large and handsome volume of over 700 pages comes to us as the first issue of a semi-annual periodical devoted to the advancement of gynecological therapeutics by means of electricity. At its head as editor, it has one of the foremost leaders of electro-therapeutical gynecology, Dr. Apostoli, a man who has labored almost the whole of his professional life for the good of this particular branch of medicine, and whose work will forever stand as a monument to his fame. This is one of the most valuable helps to the physician, and more especially to the writer, which can well be imagined, as it places before him at certain intervals, all contributions of a valuable character which occur in any language, and all contained in a uniform tongue, and under one cover, and thus saving great labor, time and expense in reviewing the literature. It is somewhat unfortunate that the great extent of this work forbids an extended and minute review of its entire scope. We find the first 133 pages of this volume devoted to the combined work of Thomas Keith and his son, Skene Keith, and the Treatment of Uterine Tumors by Electricity, this being the translation of their entire work in English, on the subject, containing in all, the reports of 113 cases of tumors treated by this method, together with appropriate remarks, statistics, deductions, etc., bringing their observations on this method of treatment up to date. The remainder of work on electro-therapeutical gynecology from the English is contained in the next following 120 pages, which includes the work on the subject presented to the gynecological section of the Congress of Leeds, the Medico-Chirurgical Society at Brighton, the Edinburg Obstetrical Society, etc., etc., and contains, in full, the papers and discussions of such authorities as T. Spencer Wells, Playfair, Lawson, Tait, Graily Hewitt, Braithwait, Handfield-Jones, Cameron, Wright, Murray, and in fact, all the gynecological lights of all England. Next Belgium is represented in 10 pages by the labors and research of Saulmann. The next 77 pages are devoted to work done by the men of our own country. Among those of United States whose work is quoted are such names as Rockwell, Goelet, A. Laphorn Smith, Martin Massey, Skene, Kellogg, Mundi, etc., etc. The remainder of this volume is made up of contributions afforded by Russia, Italy, Germany, Denmark, Austria, 41 Poland, Hungary, and Canada, and among this array may be found the name of the representative gynecologists of the various countries, such as Slaviansky, Candia, Engleman, Hugo, Jaworowsky, etc. This form of literature is the most valuable that can be made, to medicine, that is, the collection of the literature upon any given medical subject; and it is to be hoped that every gynecologist will subscribe for this very valuable periodical. Too much praise cannot be given it. E. B. L. A SYSTEM OF LEGAL MEDICINE; By Allen McLane Hamilton, M. D., Consulting Physician to the Insane Asylums of New York City, and Lawrence Godkin, Esq., of the New York Bar, with the collaboration of many others. Illustrated. Vol. I, pp. 657, large octavo. New York: E. B. Treat, 5 Cooper Union. Price, $5.50, in cloth. 1894. For several years the need of a comprehensive treatise on medical jurisprudence has been felt by medical and legal practitioners, as well as by instructors in medical colleges. Since the publication of the excellent works of Taylor and Wharton and Steele's treatise so many new questions have arisen, and so many new decisions have been handed down by the courts as to impair, markedly, the value of the older treatises on legal medicine. The present volume is the first part of a "System" which has been under way for some time. Vol. I deals with post-mortem examination, death in its medico-legal aspects, blood and other stains, identity, homicide, poisoning, life and accident insurance, etc., etc. One of the most important chapters is that on certain legal relations of physicians and surgeons to their patients and to each other. This chapter alone is worth the cost of the book to any practicing physician. Always a delightful study, medical jurisprudence is doubly attractive as presented in the first volume of this work. PRACTICAL URINALYSIS AND URINARY DIAGNOSIS: A Manual for the Use of Physicians, Surgeons, and Students; By Charles W. Purdy, M. D., Queen's University; Fellow of the Royal College of Physicians and and Surgeons, Kingston; Professor of Urology and Urinary Diagnosis at the Chicago Post-Graduate Medical School. Author of "Bright's Disease and Allied Affections of the Kidneys"; also of "Diabetes; Its Causes, Symptoms, and Treatment." With Numerous Illustrations, including Photo-Engravings and Colored Plates. In one Crown Octavo volume, 360 pages, in Extra Cloth, $2.50 net. Philadelphia: The F. A. Davis Co., Publishers, 1914 and 1916 Cherry Street. We are more than pleased with this work. We have read it with satisfaction, and can cordially commend it as really the best we have seen. It covers the whole field of urinary examination, and leaves but little, if anything, to be said. It shall be with us a vade mecum. It consists of two parts: I, Analysis of Urine, embracing General Considerations; Composition. of Normal Urine; Proteids; Carbohydrates; Abnormal Urine; Urinary Sedi |