growth. It would be too much to expect that the enormous increment of power thrust upon those directing its policies and activities should be entirely free from a modicum of errors and mistakes. Things have been done that are certainly open to grave criticism, but when one reviews the enormous work and progress of the past five years, and comprehends the unlimited. power placed in the hands of a few men, the predominating sentiment is bound to be one of admiration. There may be as has been said-inherent evils in the system of organization. There may and undoubtedly has been much abuse of power. But there has been progress and a professional uplift that means everything to the American physician. As we look, therefore, with just eyes on the actual achievements of the past few years we would stultify our sense of fairness if we failed to express a sincere note of appreciation. We are glad to see the criticisms that some of our contemporaries are making-though we do deplore the personalities and vituperation. But Our knowledge of the ability and character of the American physician leaves no doubt in our minds as to the ultimate future of an organization which can already boast of over thirty thousand American doctors. It may have storms and strife galore, it may suffer from the sins of omission and commission of some of its officers, but as true as the needle to the pole, the great American Medical Association itself is going on to successes that are only limited by the needs of the American people. And not the least of its achievemen.s will be the aid and impetus it will be able to give to the evolution of a national department of health.

The treatment of pneumonia has been discussed at length but at present the important and interesting experimental work being carried on in efforts to combat this infection by means of the injection of leucocytic extract, is occupying a prominent place in the field of progressive medicine.

The principle of the treatment is based upon the clinical fact that the presence of a large number of white cells in pneumonia is a good prognostic indication, that the leucocyte as a consequence plays a most important role in the resistance to the infection.

Since the action between tissue fluids containing antibacterial substances, and tissue cells, is the important detail in protection against any infection, the supremacy of one or the other in the process, depends upon the type of invading organism and its virulence. Unless the pneumonic infection is too overwhelming or virulent, the essential element in the progress of the disease is the leucocyte.

The fact that the pneumonia infection is not confined to the lungs but frequently invades the general circulation, led to the belief that it was a local manifestation of a general disease-and it was constantly observed that a stimulation of leucocytes always followed and continued with the progress of the lesion.

Believing that the phagocytic power of the white cells of pneumonia patients was less than that of the normal individual, Hiss extracted these substances, and used them in a diffusible form thus supplying material to the infected organism, which would aid its phagocytic action in protec

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tion against the poison elaborated by the bacteria.

Laboratory experimentation upon animals showed that susceptibility and immunity to pneumococcus infection were to be measured by the degree of phagocytic power of the white cells of the animal employed. Pneumococci from the blood of a pneumonia patient were injected intraperitoneally in animals by the Wright capillary pipette method. Since the peritoneal cavity of the animal exerts destructive power upon certain numbers of pneumococci, and the end results of a pneumococci inoculation depend upon the bactericidal and phagocytic power of the animal, it was found that the reaction produced a general peritonitis in a few hours, and, although phagocytosis was slight, the pneumococci gradually disappeared with no process suggesting lysis taking place. As a result of these intraperitoneal inoculations, it was found by Hiss and others that the severity of the disease was modified and that the lesions were more localized.

Only a small number of pneumonia cases in man is thus far spoken of by Floyd and Lucas (in the Journal of Medical Research)-in which the leucocytic extract was used. An aqueous extraction of leucocytes of rabbits, obtained from pleural excitation, was injected into the subcutaneous tissues of the buttocks, thigh, or back of the pneumonia patient with resulting improvement, especially as to the symptoms due to the toxemia; and with no immediate or subsequent harmful effects. In small children amounts ranging from 5 to 10 c.c. were used twice a day, while in severe cases 15 to 20 c.c. were injected three or four times in twenty-four hours. The effect depends upon the day of the disease that the serum is used. The mor

tality is given as 12%. Fatal cases were in young children with broncho-pneumonia, and in adults of advanced age or with cardiac complications.

Insufficient cases have been observed as yet, to determine final conclusions as to the therapeutic value of the leucocytic extract; but reports show that no harm resulted to the patient in any instance; that in many cases the disease was apparently shortened-with improvement in most of them; that in the severe cases recovery was hastened and the toxaemia diminished; and that in the entire series a lower mortality resulted.

Granted that this treatment may be inefficient owing to the need of more exact knowledge of the infection of pneumonia, and the workings of the organism in protective effort; it still seems to promise much which will be of decided therapeutic value. Among other important factors, it seems that the time of injection of the extract, and the dosage used will be considerations of no small consequence in the final deductions.

Certainly good results have been obtained and reports from more extended series of cases will undoubtedly show that much in the treatment of pneumonia infections can be done by the injection of the leucocytic extract.

The increasing cost of meat is bound to have consequences which physicians must anticipate, for to be forewarned is to be forearmed. We are interested in the causes because they show that the phenomenon is biologically inevitable and will continue for some time to come. The increasing amount of gold taken from mines makes that metal cheaper, so that the dollar buys less and less every year-but that

affects the prices of all things proportionately. The unit of exchange is merely becoming smaller. Nevertheless a greater increased production of some other things has reduced their price even measured by the smaller unit, but in the case of meat the amounts have not increased at the same rate as the demand. A short while ago when land was free, meat was produced in such amounts that the poorest laborer could afford it three times a day. The conditions attracted a flood of immigrants from lands so overcrowded that the vast proportion of the poor could not afford meat once a month, and the movement will continue until there is no attraction that is, until it is as difficult to get meat here as it is in Europe. So we can expect the price of meat to rise until it is beyond the means of the poor and an occasional food for the middle classes.

The results of a non-meat diet are not necessarily bad, if there is plenty of nitrogen of other forms-fish, eggs, milk products, and the nitrogenous grains-so we need not worry over imaginary ills, but the trouble evidently will be the difficulty of getting even these foods. America has always been more or less free of the diseases of under-nutrition, which have afflicted the poor of Europe, but there now seems to be an end of this desirable state, and we must hereafter be on the lookout for them. Moreover our meat diet is generally recognized as causing a magnificent development of the native born children of immigrants who are undersized from underfeeding. The intellectual accomplishments of these new types have astounded the world, for they have far surpassed their ancestors. Our increasing density of population is therefore not an unmixed blessing, and we should moderate our enthusiasm over the

huge numbers about to be accurately reported by the census. There are a few who maintain that such increase of population brings more harm than good and that it would be well for public health to keep down our numbers so that there would be enough meat to go round.

The movement to stop all immigration must be considered by physicians. Surely the medical facts elicited from the present investigations should help to decide the proper course. The phenomenon is just being discovered though it is very old. Perhaps we are on the verge of a change in our national diet in which meat forms a decreasing part. Already we are talking of importing both meat and wheat as we may not produce enough for home consumption—let alone exportation. This will do no harm-we will merely pay foreign farmers for food instead of our own. Yet, there does not seem to be any doubt that we are on the way to a crowded condition in which there will be as much undernutrition as in Europe and as little meat in the dietaries-whether for good or ill remains to be seen. The effect upon school children must be studied, and a determination. made as to whether the percentage of defectives will increase.

The spread of tuberculosis in the best climates is being unjustly laid to the doors of the sanitariums therein established, for it has been proved over and over again that such an institution almost invariably causes a great reduction in the morbidity and mortality of the surrounding population, by reason of the educational effect in methods of prevention and cure. There have been disquieting reports of the ap

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pearance of tuberculosis at places advertised as climatically curative, as for instance among the Mexicans of the southwest and American families in mountain resorts of the east, but in every case as far as we know the sanitariums have nothing to do with it. Patients go to the place not for skilled treatment but for the climate solely. They take board and bed with poor families whom whom they promptly infect through criminal carelessness. Sanitariums prevent this very thing. Perhaps we too can prevent this new disaster from becoming worse, by emphasizing the limitations of climate and the vital necessity of skilled management. Patients must be warned

not to expect a cure from climate alone, indeed they should be told that they might get worse if not under proper care and that in the meantime they might carry the infection to others. The whole wretched business shows that we have all been deceived as to the preventive value of certain climates, for there are increasing reports of cases originating where we thought it impossible. Indeed, there is a beginning suspicion that the very abnormal conditions of these places may even reduce one's resistance.

The danger of nursing the tuberculous in sanitariums has heretofore been considered so slight as to be negligible, indeed one of the commonplace remarks in defense of these institutions is to the effect that they are the safest places in the world on account of the great care exercised to destroy all bacilli escaping from the patients. As usual with all such unqualified medical opinions, a very false impression has been conveyed, for we have recently learned of two female nurses who have contracted pulmonary tuberculosis in a sanitarium sit

uated in a climate which has been widely advertised as God's own for the cure and prevention of the disease. With everything in their favor as to climate and hygiene they have been infected by their patients, and their sad plight conveys the lesson that there is great danger from contact with any infection. It was only a few years ago that we thought typhoid a very safe disease to nurse, but we are now appalled at the enormous number of contact cases and have reversed our teaching to the end that nurses be guarded with extreme precautions. Similarly, though to a less extent of course, we must warn all those in contact with the tuberculous. Perhaps the two cases we mention had become reckless from the proverbial contempt of dangers daily encountered, or have been grossly careless, but even so they show that the occupation is not as safe as we believed.

The post-office fight against quacks seems to be progressing with commendable industry. Every now and then we hear of some of them being refused the use of the mails, so that in time it may be difficult to swindle sick people this way. At the same time, it makes one heart-sick to think of the low level of intelligence of the victims, which makes this form of crime possible. Child-like faith in advertised remedies seems born in us and exposure of the frauds has no effect whatever on most people. They run to the next as eagerly as to the last. The only thing to do is to protect the poor fools like the children they are. A paternal government seems destined to be our fate and our boasted democracy a sham. We wonder whether it will ever be possible to exclude fraudulent

medical advertisements from the lay press. The best papers have succeeded, but the vast majority are in a deplorable condition.

The successful use of trypsin and amylopsin in round celled sarcoma is reported by Capt. F. W. Lambelle, R. A. M. C., in the March number of the Journal of the Royal Army Medical Corps. The case

was that of a man in whom the tumor recurred after operation and became so extensive as to prevent further interference. The enzymes were then tried with the remarkable result of sloughing of the masses and an apparent cure in a few months. The case is remarkable in view of the practically unanimous professional verdict in America that this form of treatment is powerless. It is quite evident that the whole matter must now be reopened for even if

one in a hundred are cured it is well worth while. A spontaneous cure may have occurred but it is so unlikely that we must give credence to the case, particularly as the result followed the treatment SO promptly.

The increasing consumption of sugar is at last receiving the attention of physiologists in many parts of the world, and the general opinion seems to be favorable to this change in habits because it is economical to relieve the digestive apparatus of part of its labor of digesting starches. The change has been so recent that there is not yet time to tell what harm if any can result. The possible atrophy of the tissues, which produce the starch-hydrating enzymes need not worry us. Indeed it would not be disastrous if we entirely lost our power to digest starch, for sugar pro

duction is quickly becoming amply sufficient to replace the starches, though of course such a change in physique is not a matter for a day, but a slow change requiring millenniums. Nevertheless, there is a danger which has already been recognized. When starches are eaten, the sugar is slowly produced and always exists in very weak solutions, but when sugar is eaten, particularly the absorbable varieties, it is apt to be in strong solution more or less harmful. Very strong solutions of all the sugars seem to be used in nature as well as in our kitchens, as antiseptics to preserve other foods, for they are very injurious to living tissue. It is now said that sugar eaters suffer unduly from inflammations of the intestinal tract and liver. We have called attention to this fact before, and it seems important enough to repeat, now that sugar diet is receiving high praise which will doubtless lead many to indulge unduly.

The false reasoning of anti-vivisectionists is well illustrated in a letter published by S. W. Cleghorn in the January American Magazine. There is the usual false assumption that animals experimented upon are in continual severe suffering in the subsequent diseases or conditions produced, but the chief statement is to the effect that while vivisection may be useful, it is cruel and though it may help turn us out strong and healthy, exercise and sanitation would do it better. This opinion calmly ignores the fact that almost every bit of sanitation is based on prior experiments broadly classed as vivisection, and it unconsciously concedes their necessity. To stop them now, means that there shall be no future advances in sanitation and that the problems of prevention and cure shall re