into the vessels, with enormous quantities of pure diphtheria toxin (sometimes 200 c. c. of pure toxin in a single injection), for the production by them of serum of considerable antitoxic power. Roux explains his procedure by assuming that by injection of increasing quantities of pure, strong toxin the tissues of the horse are again and again stimulated and sustained in their formation (secretion) of antitoxine.

In all infectious diseases the degree of resistance to a given disease acquired by one or more previous infections rests with the blood and the tissues. In some of the infectious diseases, for example, smallpox, scarlet fever, and anthrax, this condition of resistance against a fresh infection amounts to almost complete immunity. This condition of resistance is brought about by and (as far as we know at present) depends on the growth and life processes of the specific microbe in the infected body during the antecedent attacks, whether natural or experimental. The precise manner, however, in which this condition of resistance is created is as yet not clearly made out. Various views have been put forword to explain it, which it is not necessary to enter into here; they are all (including Roux's) based more or less on assumptions. The chief facts experimentally established by the researches of Behring, Kitasato, R. Pfeiffer, Wassermann, and others are, that the blood of an animal which has acquired immunity possesses antitoxic property, that the degree of antitoxic property of the blood stands in direct relation to the degree of resistance acquired by the animal furnishing. it, and, further, that this antitoxic property of the blood not only renders the particular animal capable of overcoming and of withstanding the disease that is in question, but also other animals into which it is introduced. In the case of the sheep and goat, Behring has shown that it is possible by repeated diphtheria injections to render these animals gradually highly tolerant against diphtheria, and at the same time to confer on their blood a high degree of antitoxic power. By virtue of this antitoxic condition of their blood small amounts of the blood serum are capable of protecting guinea-pigs against inoculation of diphtheria bacillus, and of neutralizing in these animals the diphtheria toxin if it be injected. The two substances, toxin and antitoxine, are, then, in their proper proportions, mutually antagonistic.

Now, Roux, as I have said, introduces over and over again large amounts of pure diphtheria toxin into a horse, which has already by previous injections of the pure toxin been rendered to a certain extent resistant against this toxin (it is because of this resistance that he finds it necessary to increase the dose of the toxin)-that is to say, a horse that has by previous injections of diphtheria toxin become more or less resistant must possess a corresponding amount of antitoxine in the blood. But since the two substances, viz., toxin and antitoxine, are antagonistic and neutralize one another, it follows that each successive injection of a large quantity of pure diphtheria toxin into a given horse must neutralize a proportionate amount of antitoxine already formed and present in the blood of the animal. This

possibly explains the extraordinarily long time which Roux's horses take before their blood is rendered sufficiently antitoxic. These considerations led me to adopt a different plan in the preparation of antitoxine serum from the horse-a plan, indeed, which corresponds more closely than Roux's to the natural process. By this plan I have succeeded in obtaining from the horse antitoxic serum in a far shorter time than is possible by Roux's plan; and, as observation proves, this serum is possessed of considerable antitoxic power. The principle of my method is as follows: By a few injections of attenuated living bacilli (the attenuation is due to age of the culture) along with their toxin into the horse, this animal is furnished with a certain degree of resistance. Next, large quantities of living diphtheria bacilli (minus their toxin), taken from the surface of solid cultures of gradually increasing virulence, are repeatedly injected subcutaneously, so as to allow the bacilli to grow and to multiply, and to gradually produce within the body of the animal, as is the case in the natural order of things, the toxin, and ultimately the antitoxine.

Every such injection on my plan is followed by a temporary reaction, a rise of temperature varying between 0.6° and 1.8° C., and a local tumor; but there is no suppuration at the seat of inoculation. As soon as one such tumor has disappeared a new injection is made, as stated above, with large quantities of living bacilli scraped from the surface of solid media (agar and gelatine). By the third week the animal will bear the scrapings from the surface of two whole agar cultures of virulent character. In the case of one horse I, by this method, obtained antitoxic serum in twenty-three days, in another horse in twenty-six days, from the date of the first injection. If, after the first bleeding of the horse, it be again twice or thrice injected with virulent living bacilli (taken from the surface cultures) the further serum obtained from such horse possesses even increased antitoxic power.

The antitoxic power of the serum in the twenty-three and the twentysix days' horse was tested on guinea-pigs, and it was found that one part of serum was capable of protecting from 20,000 to 40,000 grams body weight of guinea-pig against the living bacilli and toxin (not merely against pure toxin), considerably more than a fatal dose of living bacilli having been injected. This serum has been used in cases of diphtheria on the human subject-some of them very severe cases. It was injected in doses of from 5 c. c. to 8 or 10 c. c., and in severe cases the injection was repeated within twenty-four hours. The result was highly satisfactory. In some severe cases it was particularly striking, the further spread of membrane being entirely arrested, and rapid loosening and discharge of the existing membrane being also a conspicuous feature.-Dr. E. Klein, London Lancet.

LAMINECTOMY FOR FRACTURED SPINE. The following case (Weekblad von het Nederlandsch Tydschrift voor Geneeskunde) was treated in the clinic of the late Professor Salzer. About four years ago a house painter, doing some work on a high building, lost his footing, but in his fall grasped a

ledge which projected some way lower down. Rescued from his perilous position, he did not seem at first to have suffered any serious injury, and was able to continue his occupation for some time, his only complaint being of pain in the back. The symptoms, however, gradually became worse, and finally he lost the use of both legs. After admission he was treated for three months by rest and extension, combined with massage and electricity to the lower extremities, without any good results. Compression of the cord was diagnosed and operative treatment decided on. There was a projection at the level of the tenth dorsal vertebra, on each side of which fluctuation was perceptible. The operation was performed in two stages with an interval of eight days. The first consisted in the opening of the abscesses. The incision extended from the sixth to the twelfth vertebra. After cleansing the openings with sublimate (1 in 3,000), the long muscles of the back were kept apart by tampons of iodoform gauze. The second stage began by the removal of the arch of the tenth vertebra, and afterward those of the ninth, eighth, and seventh, especial care being taken for the preservation of the periosteum. The consistence of the exposed dura mater, however, being absolutely normal and the pulsation of the cerebro-spinal fluid distinctly visible, it was clear that the injury had to be sought in the other direction. The removal of the arches of the eleventh and twelfth vertebræ disclosed a dislocation of the spine, the part of the column situated above the fracture having been pushed over the part situated below it. This had caused a narrowing of the spinal canal, and a flattening and compression of its contents. Notwithstanding the removal of six vertebral arches and the fragments of the fractured vertebral body not having been restored to their relative position, the spinal column, either by the renovation of connective tissue or perhaps by bone regeneration, was now capable of sustaining the trunk without any supporting apparatus. The patient could again move freely about and perform some light work. In order to lighten the strain on the spinal column he was, however, advised to wear a corset permanently.-British Medical Journal.

TREATMENT OF VESICO-VAGINAL FISTULA.-Bond, of Leicester (Annals of Surgery), says that certain severe cases of vesico-vaginal fistula are best treated by operating from within the bladder through a suprapubic opening. The most suitable kind of cases for treatment by this method are those in which extensive cicatricial contraction has occurred. In such cases the vaginal roof is often tightly stretched across the pelvis and the neck of the uterus can not be drawn down. If under these conditions the fistula be extensive and situated high up near the uterus, considerable advantage is gained by adopting the suprapubic method. The operation is performed in the following manner :

The bladder is first injected, the finger of an assistant blocking the fistulous opening, or, if this is impossible, a sound is passed into the bladder through the fistulous opening and then a vertical incision is made above the

pubes, which is carried down to the bladder, the cavity of the viscus being opened after the peritoneum has been drawn out of the way. The walls of the bladder are now held apart and the cavity opened out with three metal retractors, and by these means and the upward pressure of the bladder by the assistant's finger in the vagina the fistula and the field of operation can be brought well within reach. The thin cicatricial junction of the two mucous membranes is now incised all round and two flaps of vesical mucous membrane are raised, one on either side of the rent, with their edges turned inward toward the bladder, and are sutured with catgut on a doubly-curved needle, such as is used for cleft palate suture.

At this stage also the rectangular knives and long forceps are useful, and care must be taken at the angles to extend the separation of the mucous membrane beyond the actual limits of the fistula. A few silver wire sutures are afterward used to draw the edges of the vaginal mucous membrane together, these having been already freshened on their vesical surface by the operation within the bladder. It is very important in the after-treatment to avoid the occurrence of cystitis, and to effect this the author advises continuous irrigation of the bladder, day and night, with boracic solution. The reasons given why the suprapubic method offers a surer means of closing the fistulous opening in bad cases are, first, because the vesical flaps when raised and turned inward have their surfaces opposed to the current of urine flowing through the fistula, and are thus more tightly closed by its pressure, unlike the flaps formed by the vaginal mucous membrane. The vesical flap is, in fact, the valuable agent in closing the opening, and it is in proportion to the care taken to thoroughly free and separate these that success depends, even in operating through the vagina; secondly, the suprapubic opening, especially when combined with the urethral drain and constant irrigation, insures complete drainage, that is, the absence of all tension within the bladder.-Ibid.

CACTUS GRANDIFLORUS.-Mr. Gordon Sharp, after a careful study, extending over two years, of the literature, pharmacology, and therapeutics of Cactus grandiflorus, a claimant for favor with digitalis, concludes as follows: "The literature of Cactus grandiflorus is comparatively extensive but vague, too many properties being ascribed to the drug, and upon too slender evidence; there being no authoritative evidence of a pharmacological or carefully carried out therapeutical kind. The chemistry is as yet unknown, authorities on this subject not even mentioning the presence of a glucoside or alkaloid; and, so far as we can make out after extensive trials, we have been unable to obtain either of those bodies. The most important agents we find to be a series of resins. The pharmacology is necessarily indefinite, one having to work with rather insoluble resins. These contract the blood-vessels of a frog, but this is not of the nature of a digitalis contraction, but depends, I believe, on simple acidity. On the heart of the frog the resins have little or no effect, comparisons being made

with digitalis in the same animal. The drug itself would appear to be pharmacologically inert, and there is no proof that it shortens diastole, nor in fact that it has any special action on the heart muscle at all. The therapeutics of the subject I think are clear enough. Cactus grandiflorus can not be included in our list of cardiac drugs. It is not even a simple stomachic tonic, and at most all one can say is that it has some small diuretic action.” The few reported instances in which it appears of any service were cases in which it was combined with some effective drug like nux vomica, and consequently not of any test value.

ARTHRITIS COMPLICATING ACUTE PNEUMONIA.-Meunier, of Hanot's Clinic (Arch. Gén de Méd.) reports the following case in a man aged sixty. On the fourth day of the disease his knee became swollen and painful. On admission on the twentieth day he still had slight signs of the past pneumonia. The swollen joint was punctured with a fine needle, and a dirty yellowish liquid obtained. This liquid, examined bacteriologically, showed not only the pneumococcus but also the streptococcus. The joint was laid open by an incision on either side, washed out and scraped. Notwithstanding all this the patient continued to lose ground. Amputation was recommended, but declined by the patient, who then left the hospital. A mouse inoculated with a drop of the fluid from the joint soon died of a pneumococcus infection. Bouillon was also inoculated, and after the pneumococcus had perished the streptococcus was found, The author then refers to the recorded cases of this complication of acute pneumonia. A mono-arthritis is the most common, and the shoulder and knee joints are most often affected. Edema over the joint is frequent. The lesions are strictly limited to the joint, and the prognosis, after incision and washing out, is favorable, if it be a pure pneumococcus infection. But it is also possible to have a mixed infection, as in the above named case, and then the prognosis is more serious. Hence the importance of a bacteriological examination. British Medical Journal.

A NEW ANTIPYRETIC.-Tussol is the name given to a compound of amygdalic acid and antipyrine. Dr. Rehn, of Frankfort-on-the-Main, has used the drug recently in quite a number of cases of whooping cough in children. He has found it useful in reducing the frequency of the paroxysms and mitigating their intensity, that its action is different from that of simple antipyrine, and that no untoward effects have been observed from its use. It is soluble in water, and as a corrigent raspberry syrup is better than milk. The minimum doses for children are as follows: Under one year of age, from three quarters of a grain to a grain and a half, two or three times a day; from one to two years, a grain and a half, three times a day; from two to four years, from three grains and three-quarters to six grains, three or four times a day; for older children, seven grains and a half, four times a day or oftener.