There have been other methods suggested to attain the same end. Perhaps some day science may so far conquer sentiment that the physically and mentally unfit shall be sterilized and by a safe and easily applied surgical procedure be rendered incapable of propagating their species. Dr. Rentoul, of Liverpool, has given no little thought and attention to this subject and has contributed more than any one else to the literature on this question. He advocates that every safeguard should be provided by law authorizing sterilization. As regards the operation itself, he maintains the procedure necessary is to excise a small portion of the spermatic cords in the male, or of the Fallopian tubes in the female. There is no necessity of removing the glands in either case. With respect to those who should be operated upon, this, Dr. Rentoul says, should be decided by a lawfully constituted board. He suggests that not only degenerates, but all confirmed criminals, tramps, vagrants and sexual perverts should receive attention. Sir John McDougall, Chairman of the Asylum Committee, London County Council, has said, "Some day we shall come to the conclusion that some physical means should be employed to prevent the unfit from producing children." At a meeting of the Medico-Legal Society at London, England, Earl Russell, in speaking on this subject, said, "I think it admits of little doubt that if the ruling classes in this country, in Parliament, and in the law, were composed entirely of people of adequate medical knowledge, some such remedies as those suggested would soon become part of the law of the land." Dr. Barnardo left on record these words: "Some step will have to be taken in the near future, if we are to protect the nation at large from large additions of the most enfeebled, vicious and degenerate type." Dr. Bevan Lewis, a distinguished English alienist, says, "Nothing short of such radical means can stem the tide of increasing degeneracy." Dr. Barr, in his recent work on Mental Defectives, says, "Let asexualization be once legalized, not as a penalty for crime, but a remedial measure preventing crime and tending to the future comfort ad happiness of the defective; let the practice once become common for young children immediately upon being adjudged defective by competent authorities, properly appointed, and the public mind will accept it as an effective means of race preservation, it will come to be regarded, just as is quarantine, simple protection against ill." Quotations such as the above indicate a remarkable growth in favor of rendering the reproduction of their species by the degenerate a physical impossibility. Perchance much that I have herein submitted may seem visionary and impracticable, but I am convinced from the study and consideration of this important subject much that will prove of lasting value may be accomplished along the lines I have imperfectly sketched and from which I submit the following: 1. That the public should be enlightened with regard to the influence of heredity as a potent factor in the cause of degeneracy. 2. That the prevention of mental degeneration is not promoted by merely sudying the phenomena of the disease. 3. That if the conditions under which mental degeneration commence were properly understood many threatened attacks might be avoided. 4. That segregation of all degenerates and the education of public. opinion in favor of encouraging every legitimate means of preventing the propagation of the species are the only effectual methods by which we can reasonably hope to check the increase in the number of degenerates who have already become such a charge upon the public funds of this country. DISCUSSION. Dr. W. C. Herriman, Kingston, said: The degenerate is not only a sexual pervert. He may commit a variety of depredations upon the community. The point of his sterilization seems, therefore, a minor one, though it has occupied much attention in the discussion. The degenerate who is apt to be constitutionally a pauper, and in this way often to some extent at least a burden upon society, would be better cared for in a public institution. Whether sterile or not, he would be safe, he would be happier, often cleaner, and better in every way than when caring for himself. Let the institution be of an industrial character and the problem is considerably reduced. The degenerate will be prevented from reproducing his kind and his expense will be, if not entirely, certainly largely reduced. Dr. John Hunter, Toronto, said: The propagation of degenerates, like the use of patent medicine, is a stain on the medical profession. If each of us would spend a fraction of the time we spend in writing out prescriptions for tonics or cough mixtures-ninety per cent. of which probably do as much harm as good-in enquiring into the environments. of our patients, we would accomplish more good. Take time to find out something of the social, sanitary, and psychological conditions affecting our patients and then we can make suggestions that will conserve the physical and mental stamina of our patients. The question of the propagation of degenerates must of necessity be largely the work of the family. physician in the privacy of home. Neither pulpit nor press can discuss such questions effectively. The appointment of medical inspectors in our schools would be a step that might help some in separating these degenerates from healthy children. The separation of the sexes in our higher forms, and would permit of an opportunity for teaching sexual hygiene. The Government might be asked to put restrictions on the marriage of degenerates. Dr. J. C. Mitchell, Belleville, spoke of the importance of proper marriages. Both father and mother should be mentally sound. Over fifty per cent. of the cases admitted to the asylums are hereditary, and this is likely to increase under our present conditions. Marriages are made indiscriminately and without any special thought as to the future even among those who are intelligent and without the stigma of degeneracy. What can be expected of the feeble-minded or the degenerate classes? It is very important that the children should be more carefully looked after and that early in life it may be ascertained whether their mentality is normal and then education be carried out properly, that children be taught proper control and learn to know something of themselves and their own inner nature. The public require a more general education or the line of marriage, and the medical profession should take up the subject. There is no question that those who are known to be degenerates should be sterilized and more active measures made use of to prevent the increase of this class in our country. Dr. Smith is to be congratulated on bringing a subject of so much importance before us and in proposing a practical method for disposing of it. IMMUNE THERAPY IN PULMONARY TUBERCULOSIS.* SINCE By A. J. RICHER, M. D., Montreal. INCE 1890, when tuberculin was acclaimed throughout the world, to be relegated within a year to that class of toxines called poisonous, therefore dangerous, many clinicians have continued to make use of it in spite of the verdict then passed upon it. To eliminate the danger connected with the use of such a potent poison was a task which there and then fastened the attention of many, so that modified tuberculins have been offered from time to time in such numbers as to be beyond enumeration, much less detailed description. We may mention however, some of the better known ones, such as Koch's T. R. and Bacillen Emulsion, Klebs' T. C. Denys' filtered Bouillon, Béraneck's tuberculin, Landmann's tuberculol, von Ruck's watery extract, von Behring's T. C. and Tulase. Experimentally, the living attenuated culture produces the most pronounced immunity (Theobald Smith). Tuberculin immunity does not protect itself against virulent inoculation of living bacilli, though it does * Read at the Ontario Medical Association. 30th May, 1907. confer a relative bacterial immunity, but renders the animal resistant to lethal doses of tuberculin. Old tuberculin, as you know, contains the culture medium and the bodies of the bacilli boiled down, so to speak, by prolonged heating in this way the more sensitive components are destroyed. The filtered bouillon, on the other hand, contains only the secreted products of the bacilli, and is looked upon as an incomplete toxine, since it is well known that the bodies of the tubercle bacilli contain imunising substances. Koch's "Bacillen Emulsion" is merely a ground preparation of the crushed bodies of the washed bacilli in suspension, containing no secreted toxine or cultural product. Landmann's Tuberkulol (Merck) combines the various features of all the above, and possesses the distinct advantage of rigorous dosage. Landmann' and Frey have both written up this subject in an exhaustive manner, and both are well worth consulting. The treatment of tuberculosis with the various tuberculins is often called active immunity treatment. Passive immunity treatment is exemplified by Maragliano's and Marmorek's serums, and possibly also by Behring's Tulase. Maragliano immunises his animals with a watery extract of dead bacilli (bacillary pulp), supplemented by the filtrate of young virulent cultures, and when complete immunity has been established, withdraws the anti-toxic blood serum. Marmorek3 on the other hand, claims that none of the various tuberculins represent the true toxine of tuberculosis as it is formed in the body during the progress of the disease. The toxine which he makes use of to immunise his animals is extracted from a rapidly growing culture of tubercle bacilli in a leucotoxic serum, and this he maintains, gives the true toxine of tuberculosis. Latterly he has been using in conjunction with the above a streptococcus toxine, thus producing a bivalent serum. Mamorek's serum undoubtedly possesses marked antitoxic properties. Among the many products now available it is really difficult to make a choice, especially as none can and do claim to be all-effective. As a matter of fact, the tuberculins have their limited field of application, and so have the antitoxic serums. In 1899, inspired by the results obtained by Dr. Trudeau of Saranac Lake, I commenced using Koch's old tuberculin therapeutically, though I had made use of it at different times since 1895 as a diagnostic agent. The number of cases treated during the first three years was very limited, only eighteen. The results encouraged me to such an extent however, that in 1894 I submitted fifteen, in 1905, thirty-eight, and in 1906, sixty-four patients to the active immunity treatment, using at various times Koch's old tuberculin, his T. R., and his Bacillen Emulsion, also von Ruck's watery extract, Denys' Bouillon Filtré, and Landmann's Tuberkulol. In 1904 and 1905 I used Marmorek's serum quite extensively with very good results, but in cases which were selected because of their pronounced symptoms. Since 1905 I have made use of it to induce passive immunity in patients I wished to submit to tuberculin or active immunity. Regarding tuberculin the following is Koch's opinion about his own product : "I mantain that its efficacy as a cure is completely proved, provided its application be restricted to still curable cases, i.e., to those not too far advanced and not complicated by streptococci, staphylococci, pneumococci, influenza bacilli, etc. As these processes are almost always accompanied by rise of temperature, the best way of guarding against the misapplication of tuberculin is to use it in cases in which the temperature of the body does not exceed 37° C. That tuberculin exercises an exceedingly favourable influences on all such cases, and even completely cures them as a rule, is a fact of which I have repeatedly convinced myself, and a number of other medical men who have studied the therapeutic value of tuberculin for years, and have either published their experience or communicated it to me privately, have arrived at the same result. As such I name Spengler, Turban, Petruschky, Krause, Thorner, Heron, Rembold, Bandelier, Goetsch, Kirchner and Kartulis, to whose publications I beg to refer you." (Francine.) Trudeaus who had the largest experience with tuberculin therapy on this side of the Atlantic, endorses it in the following words :— "Having stated the facts, I must therefore leave the interpretation of the figures to the individual judgment of those who may be interested in them. Many years ago, in spite of the general denunciation of tuberculin, and long before I knew anything about the statistical evidence, I had formed the opinion that tuberculin when carefully administered, had within certain limits, a favourable influence on the course of the disease, and that the results of sanitarium treatment could be improved and made more permanent in many cases by its application. As years passed, I have seen no reason to change this opinion, which the figures I have just quoted, however they may be interpreted, do not, at any rate, tend to contradict." Now a word regarding the selection of cases for tuberculin treatment, and how to proceed. Here again I wish to let Trudeau speak. (loc. cit.) "With a few exceptions, in which, soon after Koch's discovery, tuberculin was given as a last resort to far advanced patients who begged to be treated, the patients selected at the Sanatorium have belonged to |