right, that it is lubricated with the very best oil, and the part of that machine-the only part that he cannot build-the machine with brains. because it is a human being, he allows to run down until he can't get efficiency out of the machine, or the person who is trying to run it. ploy, they are turned over to the medical department we have in the store, that handles from 150 to 200 people day. We have taught the people that the best thing to do is not to wait until anything happens, but to use what we call the clinic, and use it freely, in order to prevent anything from happening. A little while ago II should think that, if nothing else, would teach was up in the clinic, and a young fellow had lost a finger; caught it in the elevator machinery, and pulled the finger off. I watched them dress that finger, and a few minutes afterward one of the girls came up stairs, and I said, "What's the matter with you?" She said, "Why, I don't know; I got a pin scratch somewhere, and I guess this is it." That was more important than the fellow that lost the finger. We expected him to go to the clinic, but the fact that we can train our people to go there for pin pricks that are so small that she had to stop to find it, is of great importance, I think. what our professional men here are trying to have people do. We also have, in the store, shower baths for people that work where it is warm, or where they are exposed more or less, and the free use of soap. I believe soap is about the only thing we do use now that really proves we are civilized. We have in our shop a health committee. We have three nurses. One nurse is a visiting nurse. and she does an immense amount of good, because she tells your home conditions. We send all our people to Rutland, or to some of the camps, when we first discover tuberculosis. That we pay for. We allow them their expenses, and in some cases a little bit more than their expenses. We have at the present time, I think, about six or seven cases that we are looking out for, of that kind. We have never yet allowed a case to get beyond the Rutland point before it was discovered. That means that they will accept them in Rutland if there is a fairly good chance of their getting well. We have several in the store today who have graduated and are back, and who have married and are raising families, who, as far as we know, are perfectly cured. We have two girls who have just come back. One of them had tubercular glands, and the other one had trouble with the lungs. Now, someone, in speaking here, used the expression that if the stores, if the shops and the factories did not do these things because of philanthropy, that they ought to be done because of good business. I am not going to say that we are doing this for philanthropy or good business. However, it is splendid business. I can't understand why business men who have problems to solve and who are in the habit of solving problems, can allow their human machines to be as run-down and to be given as little care as they give in the average shop and the average factory. There seems to be a penalty for being a human being. Any business man or any manufacturer will take his machinery and will see that it has the best of belts, that the gears are the business man that the proper thing to do is to look out for his help, and look out for his people. Now, my friend, Henry Abrahams, is going to follow me, and I know he is going to say something about how a person has got to live. They have got to live, and labor must be protected by the employer, and it is his right and his duty to protect that labor. What I mean by that is this: Unless a man can commence his reform in his own establishment it is a piece of impertinence for him to go out to reform the community until he has done the right thing at home. I spoke a while ago when I had more than ten minutes, to a lot of business men who were reforming the city of Worcester, and I know that if they were going to hand to Worcester the kind of reform that they had in their own establishments, then I would say, "God help Worcester!" I believe that every business man, as a good citizen, has the right and the duty to protect his employees, to make them well and to make them happy, from two standpoints; first, because it is good business, and second, because it is philanthropy. If you should ask me to sum up whether we have a successful business or not, I should say that the night before Christmas, as we stood on our first floor, a lot of well, happy people went out and wished us a Merry Christmas and a Happy New Year. I was standing talking to Mr. Edward Filene and he said, "Has the year been successful?" I said, "Yes. Our people are going out of here tonight happy, and they have made money, that does not count so much. wish us well, and we have done our duty. If we The thing that really counts is that the people are well and happy, and they wish us, as I wish you all, well.” DR. OTIS. It gives me great pleasure to introduce Mr. Henry Abrahams, Secretary of the Labor Union. VII. SUGGESTIONS IN THE EMPLOYMENT OF LABOR. BY HENRY ABRAHAMS, Secretary Central Labor Union. been saying in relation to the handling of food. I want to say amen to all that the doctors have But in all large assemblies such as this there is always someone who perhaps strikes a discordant note, and I am going to be that one, I suppose. I want to say if all our employers were like Mr. Cory, perhaps the world would be a great deal better. In one of the circulars on the table here today I saw that it was necessary not to overwork, also to keep clean. It costs money to keep clean; some people don't think that. I believe in a fair day's work for a fair day's pay, but I don't believe in that kind of a day's work from which a man goes home to his family and says, "Never mind, I don't care about any supper. I am tired; I guess I'll go to bed." I don't care about that kind of a day's work; a man exhausts too much physical energy. Our physicians have said a great deal, and they are entitled to a great deal of credit for what the medical fraternity is doing to preIt is a question in my mind if they have got right down to the cause of the disease. They understand the effect all right, and I believe that a great many of them know the cause, but somehow or other, nobody says anything about it. You wouldn't expect a man, a married man having three children, a family of 5, who was getting $1.75 or $2 a day to live under the very best conditions. It is all very well for a number of social workers, perhaps, or a number of philanthropists to tell that man, "You ought to be clean; you ought to do this, and you ought to do that, but if you want to do away with tuberculosis, in my humble opinion, one of the ways, and one of the best ways, is to raise the standard of living. It is all very well to say, "Eat good food and plenty of it," but the man has got to get a living wage. (I learned that in Filene's.) In order to get good food, and plenty of it, he has got to have a living wage. There is no question about that. You can tell a man that he ought to dress warmly, and all that sort of thing, but he has got to have money to do it. You tell a man his children ought to be well clad. So they ought. You can tell a man that everything about his home ought to be in a sanitary condition. That's true. There isn't any question about it; but he has got to have the wages, for the money he gets Saturday night determines where and how he shall live. Don't forget that part of it. That is why I am a trade unionist. I believe that I can help to prevent tuberculosis by seeing that a man is better housed. That's the question that should interest the community. The worker should be well housed; sanitary conditions should be as good at home as they are in the factory or in the shop. Conditions in the factory today are a great deal better than when I was a boy. I don't want to describe the conditions that existed in the various industries when I was a boy, a good many years ago, but they are better today. Let me say, perhaps a great deal of what has been said here today ought to be taught in the schools. Perhaps, as has been suggested by one of the speakers, it would be a good idea for the doctors to visit the labor unions once again. Sometimes you forget that we are over 80% of the population. You don't seem to remember that, and you don't seem to remember that our doors are always open. We are not a secret organization, but are always willing to hear of something that will do something more for the community. We are always willing to work with you. Let me assure the medical fraternity of Massachusetts, the medical association, if they will do what they did once before, send a number of doctors around to visit the various labor organizations, we will guarantee them a hearing. and we will do what we can to help them. EDWARD O. OTIS, M.D. I would say, in summing up what we have heard from others, that the main emphasis in the discussion seems to be upon the education of the public in general hygiene and cleanliness, dwelt upon by Dr. McLaughlin and Dr. Linenthal and others. Dr. Linenthal also suggests that a committee might be appointed to draw up a set of regulations for places where food is prepared and handled; those regulations should be followed by those who employ cooks, handlers and servers of food. These seem to be the main points that were emphasized, education of the people in proper hygiene, and cleanliness, and in the examination of those who handle food, cook food, serve food, or assist in cooking food. This conference, of course, did not intend to draw up any definite rules to present, but simply, and its object I think has been accomplished, to consider the whole subject of the matter of preparing food, having it cleanly, and having it prepared by those who are not infected with various diseases. It seems to be self-evident that so long as both acute and chronic diseases are so prevalent, particularly tuberculosis, typhoid fever, and so on, that those who are serving food to the general public should in some way be examined and certified, that they are not suffering from either acute or chronic diseases, so that those partaking of food in restaurants and hotels shall be safeguarded. If this conference has simply set us to thinking about this matter it has accomplished its purpose. In behalf of the conference I wish to thank those who have been kind enough to give us their attention. (The meeting was then adjourned.) NOTE ON RECENT EXTENSION OF OUTPATIENT WORK IN MASSACHUSETTS HOSPITALS FOR THE INSANE.* BY A. WARREN STEARNS, M.D., BOSTON. ONCE more Massachusetts has taken the lead in forwarding the scientific and human care of the *Being State Board of Insanity Contributions, No. 40 (1915.9). tribution (1915.8) was by E. E. Southard, entitled "On the Direc Bibliographical Note. The previous State Board of Insanity Contion of Research as to the Analysis of Cortical Stigmata and Focal Association of American Physicians for the Year 1914). Lesions in Certain Psychoses," published in the Transactions of the mentally ill. That the care of such patients is by members of the staff of the nearest hospital. part of the duty of the state has been recognized Some hospitals conduct but one clinic, while one for more than eighty years, and eleven years ago conducts as many as six. They vary in freMassachusetts took upon herself the work of quency, from one which is daily (Psychopathic maintaining and treating all dependent insane. Hospital) to several which are monthly. DocThe Massachusetts School for the Feeble-Minded tors in the community are notified of the dates has conducted a clinic once a week for more than of such clinics and are invited to send patients twenty-five years, but till till recently, this for consultation or treatment. Also, advice and has been the only activity of any hospital treatment is given without charge to all cases of staff outside the walls of its own buildings. nervous or mental disease that apply, especial Since 1885 the Massachusetts Board of In- attention being given to former hospital pasanity has maintained a family-care service, dur- tients. After-care and social service in the state ing which time 1242 patients have been boarded hospitals are nearly synonymous, and more than out in homes. Still more recently several hos- ten institutions are doing this work to a greater pitals have taken up this work, and some have or less extent. The clinics are of especial value done a considerable amount of after-care and in after-care, as patients find it more easy to social service work. On Jan. 1, 1913, the Psycho- report when near. As rapidly as possible the pathic Hospital in Boston opened the first full- state family-care patients are being turned over fledged out-patient department to be conducted by any hospital for the insane in this state. Suc- to the hospital nearest their boarding place and cess was immediate, over 1000 new patients visit the hospitals themselves are placing patients out ing the clinic during the first year, and active rapidly. There is no doubt that all of this outsocial service and after-care was begun. In patient activity is the most practical sort of August, 1914, the Board of Insanity determined mental hygiene, but an additional effort is being to make this work state wide, and each hospital made to interest the medical profession in the was asked to arrange for an out-patient depart- work of the hospitals, and many of the speakers ment as such. The work of these departments for the Massachusetts Society for Mental Hywas divided, roughly, into four parts, namely, giene are in the state service. This vast movethe clinic, after-care, family care, and mental hy-ment is a two-edged sword, for important as it giene. Most important, perhaps, are the clinics. is to patients and community, it is of equal value Because of varying conditions, each hospital in the socialization of the hospitals. was left to its own resources in formulating a plan for this work. All that was desired was that a clinic should be convenient for each large city. Where a hospital is in a large city, the show approximate hospital locations and the clinics are held at the hospital itself, others are plain numerals indicate clinics, the lines conheld at general hospitals or public buildings in necting each hospital with the clinics which it is neighboring cities. These clinics are conducted conducting in whole or in part. The accompanying map illustrates the work in a concise manner. The Roman numerals Medfield State Hospital. No clinic. Taunton State Hospital. Clinics at Taunton (9), Fall River (10), and New Bedford (11). X. Bridgewater State Hospital. Clinic at Brockton (12). XI. Boston State Hospital. Clinic at Boston (PsyXII. Psychopathic Hospital. Clinic at Boston (14). chopathic Hospital) (14). Dept. Boston State Hospital. XIII. Massachusetts School for the Feeble-Minded. Clinic at Waverley and also joint clinic at 3, 5, and 9 with Northampton, Worcester and Taunton resp. XIV. State Infirmary at Tewksbury. No clinic. It it hoped that one will be located at Lowell later. Danvers State Hospital. Clinics at Lynn (15), Salem (16), Gloucester (17), Newburyport (18), Haverhill (19), and Lawrence (20). Foxboro State Hospital. No clinic. XV. XVI. REFERENCES. The After-Care Program and Results of the Psychopathic Hospital, Boston, 1913-1914, BOSTON MEDICAL AND SURGICAL JOURNAL, Vol. clxxi, No. 23, p. 850. 2 For detail of organization see Massachusetts State Board of Insanity Bulletins, Nos. 1, 2, 3, 4 and 5. Reports of Societies. of American Physicians, but was not consummated until June 19, 1913, at Minneapolis, Minn., during the session of the American Association. They had now sixty charter members and eight applications for membership. The speaker predicted that they would in a few years be one of the most important medical organizations on this continent, that the physician of the future would be an imand said he believed with Sir Almroth E. Wright munologist. The Production, through Immunization, of Specific Ferments against Bacteria; as Detected by the Abderhalden Test. MR. GEORGE H. SMITH of Glenolden, Pa., presented this paper which was based on the fact first demonstrated by Abderhalden in his pregnancy reaction, that specific proteolytic ferments were elaborated by the body in response to the parenteral introduction of foreign protein. The writer stated that they had proposed to test the limits of this specificity of ferment production by employing bacterial proteins. Rabbits received immunizing courses with Staphylococcus aureus, Staphylococcus albus, Streptococcus, Pneumococcus. B. influenzae, M. catarrhalis, and with a mixture of all. The substrates were prepared from the organisms by washing and drying heavy suspensions. The technic of Abderhalden was employed, using one and one-half c.c. of serum and ten mgrs. of the substrate. The results demonstrated that each serum was able to effect a marked degradation of the homologous substrate, while with the other substrates reactions were negative. Several slight nonspecific reactions were obtained with Streptococcus and Staphylococcus albus substrates. It had been demonstrated that these were due to accidental infection. Sera from rabbits immunized with the mixture degraded all the substrates. The results indicated a relatively high degree of specificity in ferment production. Professor E. C. L. MILLER of Richmond, Va., said that Mr. Smith had given a very good demonstration of the problem he had attempted to solve. From the biological standpoint it fitted in with and corroborated what they had been thinking for AMERICAN ASSOCIATION OF IMMUNOLO- some time. It was obvious that a unicellular or GISTS. First Annual Meeting, held in Atlantic City, N. J., June 22, 1914. The President, DR. GERALD B. WEBB, of Colorado Springs, Colorado, in the chair. A Historical Sketch. DR. MARTIN J. SYNNOTT of Montclair, N. J., gave a brief account of the way in which the idea of this society had been conceived and of the manner in which its organization was effected. He stated that the idea had first occurred to him, in 1912, that a "Society of Vaccine Therapists" made up of men who had worked in the Praed Street Laboratories might prove mutually advantageous to the members. He had therefore written to the men in the United States and Canada who had taken the course in the Inoculation Department of St. Mary's, and later to those who had studied with Metchnikoff, Ehrlich, Wassermann, and in some of the other famous laboratories of Europe. Dr. Gerald B. Webb had suggested the more concise and inclusive title for the organization, "The American Association of Immunologists," thereby widening the scope of the society beyond the original conception of the speaker. A first attempt of organization was made in Washington in May, 1913, during the time of meeting of the Association ganism must of necessity form a ferment if it was to live. If the protein food materials outside the organism were insoluble, as they often were, they must be made soluble by digestion that they might diffuse into the organism. To accomplish this the unicellular organism separated from itself something that they had designated an enzyme, and this power of enzyme formation was one of the striking and essential characteristics of unicellular organisms. It was becoming clearer and clearer that a human body was made up of a mass of cells that were in many respects still unicellular creatures; Nature in working up from the unicellular to the multicellular had not so much produced a new kind of creature as a colony or interdependent community of unicellular forms, each one of which to a large extent retained its primitive functions. The function of reproduction was well shown in the process of repair. The function of motion was uncertain in even the unicellular forms. The function of enzyme formation was probably involved in all cell nutrition and could now be demonstrated in the laboratory by means of the Abderhalden reaction. That each cell maintained to a large extent an independent existence capable of motion, nutrition, reproduction, and response to stimulation had lately been demonstrated by the actual cultivation of tissue cells without the body. All these factors worked together and tended read this paper. He stated that in the parenteral to build up a view of the nature of our bodies that digestion of bacteria, the bacterial proteins were they had not held before. This work of Mr. Smith's digested by the specific ferments in order that they showed clearly the specific nature of the ferments might be eliminated from the tissues. This effect produced. He had seemed to show the cells as pos- sometimes failed while the poisonous action of the sessing an intelligence. They were presented with other part was always manifested. This being the the problem "Devise and produce an enzyme to dis- case the suggestion forced itself upon them that solve the bacteria injected." This was an entirely there was a physical basis underlying the action of new problem and yet the cells responded with an these two parts. That was to say the action of the enzyme so perfectly adapted to its functions that it poisonous part never failed because it was diffusible would dissolve the substance in question and nothing and the tissue offered no barrier to it, while the else. By using such enzymes they often distin- non-poisonous part was not diffusible and under guished between substances otherwise indistinguish- certain conditions the collection of cells in which able. it was located did not permit it to reach those cells capable of responding to its action. Accordingly, on the supposition that the molecule of the poisonous part was relatively small and that of the non-poisonous part relatively large they might divide infections into three classes: 1. Those in which the bacteria were surrounded by a firm wall of inflammatory tissue so dense and so perfect that antibacterial ferments were unable to penetrate the bacteria. The non-poisonous part liberated by autolysis or by ferments within the focus of infection did not escape through the capsule and the rein which the zone of inflammatory tissue was less dense and less perfect. The non-poisonous part of the protein molecule could not penetrate the barrier of inflammatory tissue, but specific ferments formed as a result of vaccination or auto-inoculation might penetrate in sufficient quantity to give positive therapeutic results. The staphylococcus furuncle was an example of this class. 3. Those in which the infecting bacteria were not surrounded by a zone of inflammatory tissue which inhibited the activity of the non-poisonous part and the resultant newly formed ferments came in contact with the bacteria without hindrance. The self limited infections like typhoid fever were examples of this class. For obvious reasons infections belonging strictly to the first class could not be benefited by vaccine treatment. In the third class one might confidently expect much benefit from such treatment. Typical infections of the second class were no more difficult to treat than those of the third class. The diagnosis was made and the vaccine injected; as soon as the ferments had been produced in sufficient quantity, the infection was overcome and the patient recovered. Such simple technique was effective in relatively few diseases, but one must conclude that all other infections belonged to the first class; by far the great majority should be placed in the subvariety of the second class. Although they might react with little or no benefit to the mere injection of the vaccines, careful examination of other factors would reveal that with accessory methods of treatment positive results might be obtained. Experience with Abderhalden Serum Diagnosis Reaction for Carcinoma. DR. OSCAR BERGHAUSEN of Cincinnati, Ohio, read this paper. He said that in their work the technique of Abderhalden had been followed for the most part, the only important deviation being that the serum was subjected to a preliminary dialysis before adding tissue. It was found that the serum of carcinomatous patients was most apt to digest tissues which corresponded most closely to the affected region of the patient. These results led to the conclusion that probably the embryonal origin was of some importance and according to this assistance of the host was not increased. 2. Those sumption those tissues that most probably represented the anatomic pathology of the case were selected. For the most part it was found that serum from a carcinoma patient digested tissue of the same origin as the affected tissue. Although serum usually digested only certain tissues, contrary results were occasionally obtained. The results of cases studied showed that with the exception of one case each of pregnancy, elephantiasis, empyema of the thorax, and tuberculosis of the spine, all control cases gave negative reactions. Serum from malignant cases digested some form of malignant tissue in every instance. Abderhalden's Pregnancy Test. DR. WILLIAM WHITRIDGE WILLIAMS and DR. CLARENCE B. INGRAHAM of Denver, Col., presented this communication. After giving a brief explanation of the theoretical basis of the Abderhalden test, they stated that it had been applied to known and doubtful cases of pregnancy. Aside from the strict observance of the Abderhalden technic, the writers emphasized that the blood should be taken from a convenient vein under strict aseptic precautions with a dry needle kept in a sterile container. The serum should be allowed to clot spontaneously as centrifugalization frequently caused hemolysis. The serum should contain as few dialyzable substances as possible; it must be absolutely free from hemoglobin and from formed elements. If any of these conditions were disregarded, experience had shown that incorrect results were obtained. In the series of cases tested only two were of value differentially. One was a fibroid of the uterus and the other an ovarian cyst. PROFESSOR VICTOR C. VAUGHAN of Ann Arbor, Both gave negative reactions. The earliest case to Mich., said that he and Dr. Wheeler had hit upon give a positive reaction had missed menstruation a method of splitting up bacterial proteins to get only four days. Another case eleven days post- the poisonous and the non-poisonous portion. The partum reacted positively. Observations of toxemic poison was not destroyed by alcoholic solutions of cases with albumin in the urine and increasing potash 1/10 to 2/10 of one percent. They had tried blood pressure, gave very slightly positive results this and were able to split up colon, typhoid, and with both the dialysis and optical methods. This other pathogenic bacilli into poisonous and nonconfirmed the results obtained by Rubesamen in poisonous groups; they then tried the non-pathoeclampsia cases. The test for pregnancy as worked genic organisms and found the same thing. The out by Abderhalden might be considered a definite bacterium which produced the largest amount of proand reliable reaction. tein poison was the B. prodigiosus. In round numChronic Infections and Recovery without Immun-bers it gave one hundred times as much poison per ity. DR. A. PARKER HITCHENS of Glenolden, Pa., milligram as the anthrax bacillus. The conclusion |