baseophiles were only very slightly increased, not enough to be of clinical importance. The blood plates are below the average. From this time on I pushed the treatment with arsenic (Fowler's solution), with tonics and tissue builders. I will add that up to this time there was no perceptible decline in flesh or strength. I encouraged outdoor life, but enjoined freedom from household cares and any immoderate exercise. October 19, 1904, the blood count was taken again, with the following results: Red blood cells, 5,270.000 per cu. m. m. White blood cells, 128.600. Hemoglobin, 94 per cent. Hemoglobin index, .802. Small lymphocytes, 80 per cent. Large, 7 per cent. Polymorpho-nuclear, 12 per cent. Esonophiles, I per cent. This showed her condition to be unfavorable in every way. However, for several months after this there was nothing in her case that would lead any one to suspect a rapid dissolution. She continued to hold her flesh and appetite, and was cheerful, going about all the time, sleeping well and feeling well. March 10 she was seized with a dysenteric trouble which lasted one week, accompanied by fever ranging from 102° to 104°, for only a few days. This was the only fever observed during her illness, except in the very last stage. From this time. on she lost flesh, but not rapidly. She was still able to eat any kind of food to within three weeks before her death, when the appetite failed. The spleen was enormously enlarged, falling far below the navel, but never very tender. The glandular enlargements would at times almost disappear from the neck and face, to return again. About three months before death her feet and ankles became edematous, but there was no general dropsy. An eruption of the skin came on with the edema, and extended to all parts of the body and face. The eruption came in the form of blisters, which emitted serum and tended to ulceration, with more or less hemorrhage. Emaciation was a marked feature in the last stage. She retained her mental faculties to the last, and was cheerful and hopeful. She was finally seized with a severe pain emanating from the splenic region and extending to the base of the brain. The pulse became thready, and fever, going from 101° to 104°, came on. The kidneys and bowels continued to functionate normally. I am of the opinion that congestion of the lung from pressure by the spleen hastened her death, which occurred Sept. 7, 1905, or something over two years after first symptoms. At this time the lower extremities were covered with ulcers from the rash, as well as the face and arms, with a few in the scalp. Blisters first formed as vesicles burst, and left ulcerating sores, with a tendency to hemorrhage. I report this case, believing it will be of general interest to the profession. Selected Articles THE SUBCATABOLIC MECHANISM INVOLVED IN THE ETIOLOGY OF COMMON COLDS. AN ANALYTICAL SURVEY, BASED LARGELY UPON RECENT CONTRI-. BUTIONS BY THE WRITER IN THe field oF MEDICAL BIOLOGY AND CHEMICAL PATHOGENESIS. BY HOMER WAKEFIELD, M. D., NEW YORK. THE following discussion of colds was inspired by a symposium on the same subject delivered before one of our New York State Medical Organizations about three years ago, in which I was greatly surprised to note that not one of the readers of those papers intimated the suspicion that any relationship whatever existed between the state of the distribution of the blood and the subject treated. Four years ago, and in nearly every paper I have since written, I have emphasized the physiological significance and the pathological importance of serious deflections of the blood from the seats of oxidation, the capillaries of the periphery to the splanchnic vessels, yet they have attracted but passing notice, never receiving the attention of many other passages of comparative minor import. The present paper, by virtue of a detailed analysis of the pathology of colds, of the homologous nature of etiological factors and therapeutic agents, combined with a comprehensive application of the governing law of cause and effect, it is hoped will succeed in commanding the attention that its importance deserves. Some idea of the importance of the recognition of the state of blood distribution may be conceived by recalling that the visceral venous stasis of general cardiac debilities, shock and collapse, are but exaggerations of conditions caused by blood deflections by cold. Even sedentation, with less pronounced perversions of circulation, is attended with serious pathogenic sequences, as is well known. "Taking cold" is of such common occurrence, and its conse quences are so varied and profound that the fundamental basis of the condition should be well understood and therapy founded upon it. Many a pneumonia could be aborted in its early stages, and many other diseases arising from this condition, thwarted by prompt measures of restoration of circulatory equilibrium. "Taking cold" is a contributing and exciting factor, cooperating with all other factors of catabolic stasis, and subgrouped under suboxygenation, subalkalinity, and subcatalysis, classifications of the factors of oxidation and autolysis. As a contributing or exciting factor of etiology, taking cold or "a cold" plays important rôles in diseases, particularly that group known as Idiathetic," but undoubtedly all diseases are unfavorably influenced by it. 66 Prefatory to what is to follow in the analysis of the mechanism of common colds, it should be stated that true colds are due to the unequal exposure of some part of the body to cold. The degree of temperature is subordinate to the state of inequality produced. In fact, a cold may be produced by the extrinsic effect of either cold or heat, if sufficiently pronounced or abrupt to insure a localized action of definite heterogeneity from the balance of the economy. As an illustration, a cold plunge bath is not conducive to colds, even cold weather is not so productive of colds as changeable warm weather, and dry cold weather is not so conducive to colds as wet warm weather. The green Christmas" with its humid and wet, changeable weather, has well earned its relationship with "a full graveyard." However slight, a draft of air striking a localized part of the body is sufficient to produce a cold when its temperature is divergent from that of the balance of the body. When the body is very warm, especially if perspiring, a draft of very comfortable sensation produces a cold. It is evident that some equilibrium of the body is disturbed, and this factor is divulged and explained by a discovery of the writer, hereinafter to be analyzed in the present relation. 3 It has been determined by the researches of Hill,' and others, that under the influence of superficial chill, the predominance of the blood is deflected from the peripheral vessels of the skin and muscles to the deeper (splanchnic) vessels, which possesses a very significant relation to the present subject. Complementary to this is the writer's discovery that heat induces expansion and cold contraction, or, in other words, cold heightens, and heat lowers the specific gravity of protoplasm in general, not excepting that of the parenchyma. It is the writer's observation that the molecular weight or density of our parenchyma and all living protoplasm is increased by cold and decreased by heat. Cold is productive of high density, compactness, and tonicity, while heat induces low density, looseness of texture, flaccidity, expansion, dilatation, elongation, and atony. This is not a nervous effect, but a direct responsive reaction of protoplasm, per se, as is at. tested by the fact that it is as marked in nerveless unicellular and multicellular organisms as in those of the highest types of nervous organizations. A significant effect of heat upon the parenchyma of complex animal economies is observed in the dilatation of the blood-vessels of involved tissues, and conversely is their contraction by the action of cold. This is particularly noticeable in the involuntary (unstriated) muscles and in cutaneous structures, which are not so directly contracted by and through nervous impulse as are the voluntary muscles. The condition produced by heat is one of a proportionate degree of flaccidity, atony, and what nerve men term "innervation." There is flushing, but sluggishness of circulation, and but a step removed from cyanosis. All such conditions of parenchyma are paralleled by dilated blood-vessels proportionate to the tissue rarefaction produced; the extreme condition being known as vascularity and vascularization, in general pathology. The counterparts of heat and cold, in the production of the two conditions above described, are observed; of the former, in all factors of tissue suboxidation, viz., acidity, suboxygenation, subcatalysis, subautolysis, and more remote conditions so culminating, |