specific germs in the organism in which they are introduced or exist. He has not as yet given the details of the technique of the methods used to enhance the immunizing power of the blood-serum of the horse; but, since in tuberculosis as in erysipelas one attack does not confer immunity against another, this immunized serum can not be prepared, as in the case with diphtheria, by inoculating the horse or experiment animal with the tubercle virus or its toxines. Therefore, to confer greater immunizing power to the serum, or to increase or produce it artificially in some fluid, we must resort to some other process.

Nuclein, a proteid obtained from yeast cells, the thyroid and thymus glands, etc., is claimed by Vaughan to possess germicidal power, and when injected into the body either supplies a germicidal principle to the blood, or stimulates the white blood-cell to produce a like proteid, a function it possesses in a degree naturally, which neutralizes or destroys the germs or toxines of specific diseases.

2. Medicinal Substances may Confer Immunity. Behring and Kitasato, after having inoculated rabbits with the bacillus tetani, rendered them immune by treating them with trichloride of iodine. The blood from these rabbits not only conferred immunity to mice, animals very susceptible to the disease, but was capable of destroying the tetanus toxines, while, strangely enough, the serum from the blood of rabbits rendered immune to hog cholera by inoculating them with the attenuated virus, though acting as a vaccine against the coco-bacillus serum, does not possess bactericidal or antitoxic properties to the same. The nature of the action of the trichloride of iodine in the first instance is not clear. However, the most rational explanation, I think, lies in the supposition that somehow it stimulates or tones the natural vital resistance of the tissues and cells, thereby aiding the "natural conservatism" of the system. In other words, it allows time and opportunity for the development naturally by the blood of those principles or conditions imparting immunity.

As in diphtheria, tetanus, typhoid fever, and probably cholera, so in regard to pneumonia it is currently accepted that the habitat of the specific virus is localized to the seat of invasion, and its toxic effects are due to a toxin produced by the growth of these bacilli and thence absorbed into the general system. Friedländer's pneumococcus or bacillus during an acute attack of pneumonia is found principally in the exudation of the air-cells and in the lymphatics. Morphia with atropia in aborting an attack of pneumonia, as evidenced by a clinical

report I made at our late meeting, may be rationally explained by studying its physiological action. In the first stage the irritation occasioned by the presence of the bacillus produces an inflammatory leucocytosis resulting in an exudation of serum into air-cells and dilatation of the pulmonary capillaries. Nature's method, then, of conquering disease seems to be through the function of the leucocytes. Now morphia in this case simply comes to her rescue. First, by toning the general system it increases the natural vital resistance of the tissues and cells of every part. Second, by equalizing the circulation and toning the pulmonary capillaries, as explained in my report, it acts mechanically, thus indirectly bringing reinforcements of blood-serum and leucocytes to the scene of conflict, which, having removed the local cause of irritation, the bacillus, by destroying the same, are taken up again by the circulation and the local pulmonary inflammation is checked and the attack aborted.

Hare reports a case of pneumonia aborted by veratrum, which may be explained on the same principle.

And now a word in regard to the abortive treatment of typhoid fever medicinally and the probable estimate of the Woodbridge method. Can there be method in this madness? The profession and the public alike have been disappointed so often by the announcement of preventives and cures for typhoid fever that each new report is regarded with increased skepticism and incredulity, and as yet we are but groping in the dark. Nevertheless we are admonished not to shut our eyes even to a ray of light, so unsatisfactory have been the methods hitherto employed, and such is the harrowing mortality of this dread scourge. If we may lend credence to the author's clinical charts, conceding accuracy of diagnosis, their uniform success bears witness to and is the best evidence of the fidelity of his claims.

Let us see if we can consistently reconcile this treatment to the pathological conditions to be met. It is generally accepted that in typhoid fever the specific infective agent is limited to the seat of invasion, and its inimical effect to the individual is due to the diffusion of its poisonous chemical products into the circulation. The physiological effects of the Woodbridge treatment being antiseptic and eliminative, the claim is made that what microbes within the alimentary canal are not destroyed are eliminated together with their toxines. The claim is further made that the method of administration, small doses frequently repeated, practically renders the alimentary tract aseptic and

limits or in fact cuts short further external supply of infection. The term external includes the lumen of the alimentary canal. If these claims asserted be true, the system then has only to take care of the amount of virus that has already penetrated to its seat of infection, the solitary or agminated glands of the intestinal wall, before treatment was instituted.

The advantages of early treatment are apparent, for not only the intensity but the amount of virus that gains admittance to the organism plays an important rôle as to whether the tissues or the pathogenous germs shall gain the victory. And since the system is saturated to the point of tolerance with antiseptics, it is conceivable that they may increase the natural vital resistance to the toxines resulting from the development of what typhoid bacilli had already penetrated the intestinal walls before the treatment was begun. E. g., trichloride of iodine protects rabbits against tetanus poison.

The treatment failing to abort the attack, may it not play a hardly less important rôle in preventing ulceration, hemorrhage, and perforation; a complication, however, for which we can not hold the Eberth bacillus wholly responsible? It is a notorious fact that the growth of two or more infectious agents may be concurrent in the same body. We may cite the concurrent development of pyogenic micro-organisms with those of diphtheria, tubercle, and the disease under discussion, typhoid fever. Without the presence of these pyogenic or pus-producing cocci I believe we would seldom or never get ulceration, hemorrhage, or perforation. Since these pyogenic germs in the case of typhoid gain entrance through the intestinal mucous membrane, this treatment, by keeping the alimentary tract clear and more or less aseptic, even if it fails to abort the attack, may thus eliminate the dangerous complications and thereby rob typhoid of its chief weapons of mortality, excluding its general depressant action on the heart.

However, the recent advances in sero-therapy, and the fact that one attack of typhoid gives immunity to a greater or less degree and usually for an indefinite time against further attacks, make it probable that this may be the treatment in the near future, supplemented with medicinal therapy.

SALVISA, Ky.

CHLORAL.*

BY T. W. FORSHEE, M. D.

Since the introduction of chloral by Prof. Liebreich, of Berlin, it has taken a front rank among the hypnotic or sleep-producing medicines. The physiological action and therapeutic use of this potent and useful remedy in treating certain classes of nervous diseases is superior to many of the trade-mark remedies now lauded by many of the medical journals.

When chloral is ingested in full therapeutic doses, fifteen to thirty grains, it produces in ten minutes or half an hour a quiet, placid sleep. When the effect passes off the patient wakes with no unpleasant symptoms, feeling refreshed. The effect of chloral is not alike on all subjects, some requiring much larger doses before being fully under its. influence. As a rule, there is an excited condition of the nervous system lasting five or ten minutes, followed by a calm sleep. The patient is easily aroused, and quickly falls asleep again. All sympathetic communication with the brain is seemingly interrupted for the time being. The brain takes no notice of any thing taking place around. In my experience the administration of the drug produces no frightful dreams, no headache, nausea, constipated bowels, or checking of the secretions, as we have in the use of opium. There is a marked reduction of the temperature, the pulse reduces in frequency and force, and there is a reduction in the number of respirations. The blood being less oxidized, combustion is to some extent arrested and less animal heat is generated. I have given large doses and continued its use indefinitely without producing the chloral habit. Not so with the different preparations of opium. We can count its victims by thousands. How many physicians here have been consulted about the terrible habit! And the majority of these cases have been caused by the careless and continued use of the drug and its preparations. I have prescribed chloral in a great variety of diseases, and the experience of eighteen or twenty years enables me, without any hesitation, to say in my opinion it stands unrivaled as a hypnotic. It is indicated more particularly in diseases of the nervous system. Lately it has taken a wider range as a therapeutic agent. I have succeeded in a number of cases of puerperal convulsions by the administration of chloral per os

*Read before the Jennings County (Ind.) Medical Society.

in twenty- to thirty-grain doses every hour until from eighty to one hundred grains have been taken. Convulsions were arrested, and there was no return of them. When the patients were unable to swallow, I injected into the bowels thirty grains every three or four hours until I used one hundred and twenty grains. Armed with this most potent remedy in this, one of the most formidable diseases which physicians are called to treat, we have an agent we can rely upon. It is the opinion of many of our most practical obstetricians that chloroform enhances. the probability of post-partum hemorrhage, and another serious objection to the use of chloroform is that it retards labor by lessening the frequency of contraction and the expulsive force of the womb. Nausea and vomiting frequently follow the administration of chloroform, making it disagreeable and objectionable. In tedious labor with a contracted os, with infrequent pains of a neuralgic character, small and repeated doses of chloral render the pains more expulsive and bearing down, the os dilating more rapidly, and labor progresses naturally and pleasantly. In most cases of primipara we have nervousness; and in irritable women, where the labor is arrested or interrupted, chloral relieves the uterus of the irritability, procures tranquillity and sleep, and is followed by a more vigorous uterine contraction. In after-pain chloral, in my opinion, is far superior to any remedy I have ever used. In ten-grain doses every six hours it has none of those effects upon the lochial or other secretions which generally follow the use of opium.

I have had the very best results to follow the use of chloral in spasmodic contraction of the cervix. In simple rigidity of the external os chloral in ten- or twenty-grain doses is a potent remedy. In infantile convulsion, and especially when the convulsions are produced by dentition, chloral and bromide of potassium are far superior in my opinion to all other remedies. I have also found chloral a very important agent in the febrile stage of intermittent and remittent fevers, especially where there is a tendency to convulsions with children, cutting short the fever. It is generally tolerated by the most delicate stomach. Taken in small doses during the pyrexia, partial or complete apyrexia follows in a few hours. The physiological action of chloral in febrile diseases in my opinion arrests the rapid destruction of tissue, hence the temperature is lowered. This drug is of undoubted value in what we call opium habit, yet I have had but little experience treating such cases with chloral. If this agent was more frequently prescribed and its modus operandi more studied, both the profession and patients would