the bactericidal action of sera upon different red blood cells, found that the hemolytic powers of the blood serum of prepared animals depended upon two substances: (1) the alexine, and (2) the sensibilisatrice. Ehrlich and Morgenroth in their experiments carried on later, came to the same conclusions as did Bordet, but they employed a different terminology; they called the "alexine" "complement" or "addiment," and they called the sensibilisatrice substance "immun. koerper" or "zwischen koerper." The arti ficial hemolysins are more energetic than the natural hemolysins; this is due to the sensibilitisatrice substance which is less specific in untreated animals.

There were a number of points not solved when Mioni undertook his investigations, viz., is there a constant relationship between the quantity of hemolysins and the red blood cells? In what proportions are the alexines and the sensibilisatrice substances found in the sera of new or untreated animals? How do they combine to produce a given effect? Mioni performed a number of experiments with the blood of beef and guinea-pigs and came to the following conclusions in regard to hemolysins:

1. The red blood cells of blood do not all offer the same degree of resistance to the hemolysins. From this point of view, we may divide red blood cells into those with minimum, those with moderate and those with maximum resistance.

2. The destruction of a certain number of red blood cells of a high degree of resistance requires a larger quantity of hemolysins than does a similar quantity of red blood cells of lower powers of resistance.

3. Within certain limits of dilution, the quantity of red blood cells destroyed is in proportion to the quantity of hemolysins contained in the serum.

4. In the natural hemolysins of the beef and dog, the alexine and the sensibilisatrice substances are found in the optinum proportions for obtaining the maximum hemolytic effect. Neither the sensibilisatrice substance nor the alexines are in excess.

5. In varying experimentally the relations. between the sensibilisatrice and the alexines in natural hemolysins. the following results are obtained: (a) In the presence of an excess of sensibilisatrice, the hemolysin is in proportion to the quantity of alexine. (b) In the presence of an excess of alexine, the hemolytic power depends upon the quantity of sensibilisatrice substance. (c) When the alexine is not in excess, we can increase the bemolytic power by progressively increasing he dose of sensibilisatrice. But beyond a ertain point, the addition of new quantities

of sensibilisatrice substance diminishes the hemolytic effect. (d) And when the sensibilistrace is not in excess, the alexine reenforces the hemolytic effect up to a certain point, be yond which hemolysis diminishes. But the adjuvant action of alexine is less considerable than that of the sensibilisatrice.

The Quantitative Determination of the Colon Bacillus in Drinking Water. A. Gautie, Annales de l'Institut Pasteur, Tome XIX, No. 2, Feb. 25, 1905). -For a long time controversies have waxed warm between those who maintain that the colon bacillus is ubiquitous and of no significance when found in water supplies, and those who maintain that its presence is an index of sewage pollution. Between these two extreme views there is a meidum which says that the colon bacillus gives us information as to the purity or impurity of a water supply according to its presence in very small numbers or in very large numbers. This is the opinion of Koch and others at the present writing. In order to determine the number of colon bacilli present, various methods have been used, notably that of Petrusky and Pusch, of Germany, that of Pere and Guiraud of Toulouse, France, and lastly, that recommended in the present article. This last method depends upon the addition to a suspected water of a quantity of bouillon in order to make a culture medium, with the addition at the same time of sufficient carbolic acid solution to kill the saprophytes that may be present, without hindering at all the development of the colon bacillus. This method is as follows: 1. Put 100 c.c. of the suspected water in a sterilized flask, add 15 c.c. of ordinary peptonized bouillon and 2 c. c. of a solution of carbolic acid of strength of 5%. Place in the .incubator at 37 C. 2. At the end of from 12 to 30 hours, when growth has developed, transplat one öse of this liquid to a test tube containing 8 c.c. of ordinary bouillon, and another öse to a test tube containing 8 c.c. of ordinay bouillon, plus 4 drops of 5% carbolic acid solution or in the proportion of 1 drop of the carbolic acid solution to each 2 c. c. of bouillon, taking the carbolic acid from its container in a pipette which will hold 25 drops of solution to a cubic centimeter. 3. Place these two tubes in the incubator at 37 C. for six hours. At the end of six hours, whether there be cloudiness or not, take one öse of the carbolic acid tube (second generation) and put it into a tube containing ordinary bouillon, and another one öse into a carbolic acid bouillon. Place them into the 5. Place incubator and wait for clouding. this third generation on gelatin in Petri dishes to isolate the colon bacillus or allied

species. Then employ the different tests for te colon bacillus, etc. This method is precise and will show the colon bacillus if it is present. The writer gives a table showing just how much water should be taken and how much broth and carbolic acid solution should be employed to detect this bacillus. Begin with a sample of 100 c.c. of water, then take 80 c. c. for analysis, then 50, then 20, 10 and 1 c. c., then 20 drops. then 10, 5 and 1 drop, using smaller and smaller quantities of broth and carbolic acid solution. If there is great pollution, use a smaller quantity of water for analysis; if here is but little pollution, use a large quantity.

INTERNAL MEDICINE.

O. E. LADEMANN, M. D.

Classification of Gastric Ulcers.-Benedict (American Medicine, Feb. 18, 1905) states it is somewhat unfortunate that the word ulcer, as applied to the stomach, has not its ordinary general significance, but is used in a special sense. The object of his paper is, first, to plead for the general unqualified use of the word ulcer, as applied to the stomach, as in vogue for other parts of the body, and sceondly, to point out the numerous conditions which may properly be included under the broad term of gastric ulcer, or which, at least, may be confused with true ulcers on the account of hemorrhage. He offers the following classification of gastric ulcers, using the term in its broadest sense, and including certain causes of hemorrhage by diapedesis and punctate or linear traumatisms, which should theoretically be excluded, but which are often unavoidably confused the diagnosis, and which tend to become true ulcer on account of secondary destruction of tissue by peptic digestion, or bacterial lysis: 1. Peptic ulcer, including the majority of cases of gastric ulcer with copious hemorrhage. It occurs mainly in young persons, and by preference in women in the third and early in the fourth decennium, who are anemic, neurotic, and overworked. 2. Erosions by chemic and thermic caustics, as in corrosive poisoning and the ingestion of liquids at or above 60 deg. C. 3. Ulcers due to organic vascular lesions, such as embolism, thrombosis, or obliterative inflammation of a vessel. 4. Catarrhal ulcers are with doubtful propriety separated from the last category, as they occur in chronically inflamed and degenerated stomachs which present minor degrees of vascular disease. Such ulcers are diffuse or irregularly punctate, or more or less confluent from independent lesions, usually occurring in individuals advanced in years and are quite

ec.

analogous to so-called eczematous ulcers of the skin. They may be ultimately due to all sorts of chemic and thermic irritants, including alcohol, alternation of hot and cold foods, 5. Varicose ulceration, analogous to the external condition of the same name, is usnally due to portal obstruction and, especially, to that dependent upon hepatic sclerosis. It is, clinically, difficult or impossible to distin guish between a genuine ulceration and a capillary oozing or rupture of a good sized vein, without the development of a true ul cer. 6. Toxemic diapedesis, with a tend ency to actual rhexis occurring in scurvy, purpuras, jaundice, various infectious dis eases and perhaps in Banti's disease. 7. Vicarious menstruation, due to plethora and unexplained result of the menstrual molimen, so far as location is concerned. 8. Gangrenous ulceration. 9. Phlegmonous ulceration. 10. Specific ulcers, including various neoplastic, granulomatous and non-granulomatous infections, syphilis, tuberculosis, actinomycosis, perhaps also pneumococci, ty. phoid, dysenteric, diphtheric infections and the exanthemas. 11. Traumatic ulcerations, due to external crushing injuries or to internal traumatic lesions and animal parasites.

The Early Diagnosis of Carcinoma of the Stomach.-Noever (Jour. de Bruxelles, No. 9, 1905) gives a retrospect and discussion of the diagnostics employed in the early diagno sis of cancer of the stomach He lays partic ular stress on the following points: 1. Examination of the feces for the detection of blood. 2. Testing the stomach contents for the presence or absence of free hydrochloric and lactic acid, and searching for the BoasOppler bacillus 3. Examination of the urine for fatty acids and albumosis. 4. Examina. tion of the blood.

A Case of Subnitrate of Bismuth Poisoning. -Mahne (Berliner klin. Wochenschrift, No. kind in a delicately built women 35, years old. 9, 1905) reports a unique instance of this who had an extensive burn of the body treated with 10 per cent applications of bis muth subnitrate. After several weeks of this treatment, signs of bismtuh intoxication evidenced themselves together with an acute nephritis, which ended fatally. It is to be remarked that the bismuth preparation was sides an acute nephritis, the entire mucous chemically pure. At the postmortem, beebrane of the colon was of a black discoloration.

The Solar-Plexus in Peritonitis.-LaignelLavastine (Arch. de Med. exper., No. 1,1905) made a study of the solar plexus in the different forms of peritonitis. He observed

in the acute forms, parenchymatous charges in the ganglion cells, while in the chronic forms, the alterations were chiefly interstiital. He believes that certain of the clinical symptoms in peritonitis are directly attributable to these changes and compares a peritonitis as being analogous to a meningitis, in which the ganglion cells of the cortex suffer changes.

On Yellow Fever.-Ott (Ref. Meunch. Med. Wochenschift, No.1, 1905) discusses the subject in an elaborate manner, but fails to consider the more recent investigations in this direction. He bases the following conclusions on personal observations: 1. Yellow fever is endemic in tropical countries, Africa and America. From these countries it is imported to other countries. 2. Certain conditions must exist in order to favor the development of an epidemic after the importation of the disease. One of the most essential of these is the temperature, which must average, at least, 20 deg. C. 3. Yellow fever is a hemorrhagic septicemia with a rapid course. 4. The pathologic anatomic changes show no specific characteristics besides the absence of an acute splenic enlargement, which is quite universally evident. 5. The offending agent still remains undiscovered; Sanarelli's bacillus cannot be regraded as the specific agent. 6. Recent investigations have lead to the discovery of a an agent which is found in the blood during the first few days. It is most likely that the specific agent belongs to the group of ultra microsopic micro-organisms 7. It is an indisputable fact that the mosquito is a conveyor of the infection from man to man.

Hypogenetic Nephritis. Babes (Semain Med., Paris, No. 6, 1905). of Bucharest, understands by this designation a hitherto undescribed form of nephritis. During the last three years he has encountered it in six individuals. The subjects were all anemic, emaciated and under thirty years of age. They did not evidence any distinct signs of a nephritis until during the course of some slight ailment as influenza, bronchitis, etc., when subacute uremic symptoms appeared and the patients developed into a coma, which ended fatally in a day or two. At the necropsy the kidneys were found to be undeveloped with narrow ureters and arteries. The heart was generally enlarged. The writer believes that the congenitally undeveloped kidneys were taxed to their utmost by the ordinary demands of the economy and an extra demand of a trifling illness caused a renal insufficiency.

SOCIETY PROCEEDINGS ORGANIZATION OF THE ANDREW COUNTY MEDICAL SOCIETY.

Pursuant to a call issued by Dr. C. M. Nicholson, secretary of the Missouri State Medical Association, the physicians of Andrew county assembled in the Circuit Court room, Savannah, Mo., on Wednesday, April 12, at 2 p.m. The meeting was called to order by Dr. Chas. Wood Fassett, who stated. its purposes, and introduced Dr. J. N. McCormack, organizer of the American Medical Association, who entertained those present in a very instructive and interesting address. At its conclusion a vote of thanks was extended to Dr. McCormack for his very excellent advice and fraternal talk.

Upon motion, those present expressed themselves in favor of the organization Dr. Bryant of a county medical society. moved that a committee of three be appointed to prepare constitution and by-laws and nominate the officers. The chair appointed Drs Bennett, Bloomer and Jefferies, who reported the following list of officers:

President-D. B. Bryant, Savannah Mo. Vice-President O. T. Bloomer, Rochester. Secretary-Treasurer-C. O. Jefferies, Sa

vannah..

Delegate-E. C. Bennett, Blockow.

Alternate-W. E. Danley, Avenue City. Censors W. M. Kerr, Savannah, three years; E. Houston, Savannah, two years; W. H. Bailey, Savannah, one year.

Upon motion the report of the committee. was duly accepted and the committee discharged.

Upon motion the regulation, by-laws and constitution were adopted, and the dues of the society placed at $2.50.

Upon motion, the date of meeting of the society was fixed the first Wednesday of each month at 2 p.m., and volunteer clinical reports were called for.

Upon motion, Dr. Bryant was extended the privilege of furnishing a lunch to the members of the society on the occasion of the first meeting, May 3d. Dr. Bryant was then conducted to the chair, Dr. Houston, Jr., acting as secretary in the absence of Dr. Jefferies.

After a few felicitous remarks on the part of Dr. McCormack, the society adjourned.

A RECENT monthly report of the Board of Health of the Philipine Islands cites the fact that a total of three thousand six hundred eighty-three lepers are now living in the archipelago. They are scattered throughout the various provinces, Cebu, with 675 afflicted, having the largest number. Only one province is entirely free from the disease.

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MEDICAL MISCELLANY

MISSOURI VALLEY EXCURSION TO PORTLAND.-Special train via Burlington route, carrying party No. 1, leaves Kansas City, St, Joseph and Omaha on June 29, spending a week in Yellowstone Park, and arriving in Portland on Sunday, July 9. Full particulars and Pullman reservations may be ob tained of the secretary, Dr. Chas. Wood Fassett, St. Joseph, Mo.

TEMPERANCE AND LONGEVITY.-A number of actuaries and medical directors of Nyw York insurance companies have, says a contemporary, been working on statistics running over a period of several years. From the record it is claimed that total abstainers as a class live longer by from twenty to fifty per cent than moderate drinkers, so that this class of applicants will soon have to pay less for insurance than the moderate drinkers.

LEPERS IN CANADA.- The annual report presented to the Federal Parliament of the Dominion of Canada by Dr. Smith, Medical Superintendent of the Leper Hospital, at Tracadie, New Brunswick, shows that there are now fifteen residents in the institution. If these ten are males and five females, the youngest patient being ten years and the oldest sixty-two years. Chaulmoogra oil has been used during the last two years with some success. Dr. Smith, who has carefully examined the question, expresses the conviction that leprosy is communicable through contagion.

PHIPPS' INSTITUTE REPORT. According to the report for the year 1904, 2,039 patients were under observation, of whom 1,130 were native-born and 769 were foreigners, while 140 of the nativity was not recorded. Many

of the foreign-born had been in the United States for so short a time that it is assumed they were infected before landing. Of the entire number 6 per cent were negroes—a larger proportion than that of the nergo to the white population of the city. Improvement took place in 537 patients, no improvement in 583, the result was not recorded in 884, and death resulted in 153.

THE COUNCIL ON PHARMACY AND CHEMISTRY OF THE AMERICAN MEDICAL ASSOCIATION. -The board of trustees of the American Medical Association have created an advisory board to be known as the Council on Pharmacy and Chemistry and consisting, in addition to Dr. Simmons, of fourteen of the leading American professors of pharmacy and chemistry. The purpose of the Council is to supply to physicians, through the medium of the Journal of the American Medical Association and by means of a book published, necessary and desirable information concerning those new and unofficial proprietary remedies which it considers unobjectionable. This information will comprise composition, indications and uses, dosage, etc., much along the lines of the U. S. Pharmacopeia.

MAY SURGEONS OPERATE WITHOUT CONSENT OF THE PATIENT ?-In Chicago, the appellate court's decision affirming a finding of $3,000 damages against Dr. E. H. Pratt, charged with operating upon a patient without her consent, will be taken to the State Supreme Court. Judge Tuley heard the evidence in the lower court in 1897. Judge E. O. Brown, of the appellate bench, handed down his opinion. After the operation the patient's condition became critical, and she is now a patient in the Kankakee Insane Asylum. The decision of the appellate court is that any surgeon who performs a major surgical operation without the consent of the patient is liable to damages. The consent of the nearest relative does not relieve the surgeon of the liability.-Review of Reviews.