The interesting point in this was that she had no care, ate anything the rest of the family did-jerked meat pemmican (which is composed of jerked meat and dried berries ground up with beef marrow), and in spite of this diet and lack of care and moving about she made a good recovery.

In the case of W. B., white, forty years old, mail carrier. He had drank daily from the well. Called to see him June 28. Temperature 104 4-10; pulse 96. Positive Weidal reaction. Gave 250m Typho-Bacterin. Called again June 30. Temperature 104, pulse 96. Gave 150m Typho-Bacterin. Nurse employed July 1. Temperature 102 2-10. July 2, temperature 98 6-10. Given 50m Typho-Bacterin, after which temperature rose to 100 degrees. July 4, temperature 99; 50m TyphoBacterin given. July 6, temperature dropped to normal. Three days later the patient would stay in bed no longer, and the following week began carrying mail.

In the beginning of this epidemic I only gave the TyphoBacterin as a prophylactic, as before stated, and only resorted to it as a therapeutic agent when the cases proved so very severe, all running a course of from five to ten weeks, with exacerbation of symptoms and temperature about the third week and running up to 104, showing an extreme type of infection, and this in cases that had every care, in good homes, with excellent nurses.

After I began the use of the Typho-Bacterin every other day in the seventeen cases in which it was used, fourteen were markedly benefitted, the temperatures went to normal in from three to ten days with no fatalities, and in three cases it had no effect either for better or worse.

In this epidemic I had thirty-seven cases, with one death.

The serum was not used on the one fatal case, unfortunately, she being one of the first cases and her previous health very poor. She became comatose almost from the start. Her prominent social position and the fact that her relatives were widely scattered; and, upon their arrival, I asked for consultation, who advised against its administration. I had, however, given 150,000,000 killed bacteria a few hours before calling him. Twenty-four hours after its administration the temperature dropped from 1032 to 101 degrees F. The patient died a week later from cardiac failure. The reason for administering widely different doses at first was to determine a correct efficient dose, which I found to be 150,000,000 every other day to an adult. I am confident that, had I known of the efficiency of the serum and how to properly administer it, at the onset, I could

have limited the course of the illness to a few days, with no fatalities. It was with considerable timidity that I pioneered in the Serum Therapy of Typhoid.

The only medical treatment employed was strychnia sulphate as a heart stimulant when needed. Phenyl salicylate in capsules of five grains each every three hours was given, with the hope of establishing intestinal asepsis, and where there was troublesome tympanitis, which was rare, five drops each of the oil of eucalyptus, oil of terebene and the essential oil of cinnamon were given in capsules every three hours to control the same. Calomel was used in 14-grain doses every hour, until one grain was given, every two or three days to control the bowels. No other cathartics were found necessary.

DISCUSSION.

William Ream, Walthill (distributing a number of records of cases treated).
Dr. W. O. Henry, Omaha:

I did not want to speak on this, but it is a very interesting paper and the doctor ought to be congratulated on his sort of pioneer work. Two years ago I was in the laboratory of this Sir Almoth Wright, the man who evolved this method of treating typhoid fever. He is the man who worked out the problem and used the remedy in the British army, and reduced typhoid in the British army 90 per cent. Those of you who are familiar with the record will recognize that fact.

While in his laboratory I asked him this very question, if results in using the typhoid serum as a preventive are very good, what would you say of treating typhoid in this way? Suppose you have a case of typhoid, would you use the vaccine? He said: "I never have had a case in London where I have had an opportunity to use it as the treatment," in other words, typhoid is so very rare in London, but he says: "I would recommend it." "When you get back to America, I would recommend you to try it. You will have to act in a very cautious way, though, because I do not know how it will act." So I think the doctor is to be congratulated on doing some good pioneer work. He has shown by his experience here that it was very effective.

Dr. S. C. Beede, David City:

I

Just a word about terms. I am glad the doctor read this paper. hope another year there will be many more reports upon the use of typhoid vaccine or serum, is it, that is what I wish to ask?

Dr. J. Lue Sutherland, Grand Island:

I would like to ask the doctor if he at any time used the serum in cases that he knew were exposed. Of course we have the reports of the cases that were treated in the army with results, but when it comes a little closer home it might encourage some of the rest of us to use the prophylactic as well as the treatment.

Dr. Ream:

Doctor, do I understand you as a preventive in those who have not been already exposed?

Dr. Sutherland:

No, those who have been exposed.

Dr. Ream, closing.

I am glad you brought up that point. There were some eighty people who were at this banquet, who drank water from this well that was infected directly from this vault. There was one that I mentioned in my paper who ran a temperature two or three days after being inoculated. The well was just back of the postoffice; it was the assistant postmaster who drank daily from the well. The postmistress was the case I referred to that died. She was profoundly infected from the first; was a delicate, frail woman. Her parents and relatives were widely scattered through the country and it was not with any small degree of timidity that I began the use of this serum as a therapeutic agent. There were probably fifty people came to me who had drunk water from this well. The method that I employed was this: when they came to me I would take a specimen of blood, examined it, and give them an inoculation if they had been exposed. None that gave a negative Weidal reaction before inoculation ran a temperature with the exception of this one girl and none had typhoid. There are a number of cases that I did not cite in which I began the use of the typhoid serum, after they were taken sick. The patient that I referred to that had pneumonia was practically moribund. We ran our electric light plant there at night. I had them run it day and night to give him all the air we could. I gave him oxygen and as a last resort I began the use of the typhoid serum. His temperature dropped and he ran a typical case of pneumonia. His delirium disappeared and I have several other cases in mind that I began using it in after they had typical typhoid symptoms even, that gave a positive typhoid reaction. I thank you.

ABSTRACTS.

Proyphylaxis of Poliomyelitis.

Netter (Journal de Medecine de Paris for April 20th), considering that his researches and those of others have proved definitely the contagiousness of poliomelitis, advises, for prophylaxis, in addition to sequestration of the patients, rigid cleanliness of the nose. Hydrogen peroxide, menthol, and potassium permanganate are useful locally, and hexamethylenamine is advised for internal use, since this substance appears promptly in the cerebrospinal fluid. Hopes are entertained of endorrhachidian use of a serum.

Alkalies With Phenolphthalein.

Phenolphthalein had been added to certain wines to impart a desired color. Wine thus colored was found to be laxative and in this way the laxative properties of phenolphthalein were discovered. However, it was some time later before it was learned that the action was enhanced by the acid of the wine being naturally converted to a carbonate in the process of digestion. In patients whose stools are neutral or acid, phenolphthalein has little or no effect. An alkaline reaction can be as

sured by giving a fruit acid, sour wine or lemonade along with the drug, or by combining it with sodium bicarbonate in enteric pills. Med. Review of Reviews.

Treatment of Purulent Peritonitis.

In a report from the Surgical University Clinic of Basel Dr. Iselin (Deut. Ztsch. f. Chir., Bd., 110, Hft. 4-6) remarks that prolonged application of heat to the abdomen after operations and in inflammatory conditions is of decided benefit. This is accomplished by the electric thermophore, which is employed after all the author's abdominal operations, as he feels convinced that heat stimulates the peristalsis. In inflammatory irritation of the peritoneum the heat promotes absorption and prevents intestinal atony. The best results, however, were obtained in purulent peritonitis, after the cause had been removed by operative intervention. During the operation it is of special importance to thoroughly irrigate the abdominal cavity with 0.9 per cent saline solution at a temperature of 42 C., this being followed by adequate drainage with a tube.

Tincture of Digitalis.

Goodall (British Med. Journal) has examined some twentythree samples of tincture of digitalis during a period of three years with special reference to their strengths and keeping properties. He found that nearly 50 per cent of the samples showed some departure from an average standard of activity. The limits of the variation were from 275 per cent over strength to 40 per cent under. It seems safe to believe that the tincture retains its full activity for one year, but that after that period deterioration is likely to take place.

On The Use of Radium in Ophthalmology.

Ryerson in the Canadian Medical Association Journal for December, 1911, says he believes that in radium we have a powerful, new aid to the therapeutics of the eye. In the cases of rodent ulcer and epithelioma of the lids, angioma, trachoma, spring catarrh, and in certain ulcers of the cornea, he can safely say that definite results have been obtained.

In conclusion, he asserts he can state, without exaggeration, that radium has proved its worth. As is the case with all new methods of treatment, too much has been expected of it, and the impossible has been attempted. True, carcinoma is still out

side the possibilities of cure, while sarcoma, if superficially situated and of recent growth, will rapidly melt away.

Painting the Peritoneum With Tincture of Iodine
in Tuberculous Peritonitis.

Hofman (Muench. Med. Woch.) reports four cases of tuberculous peritonitis in which he painted the peritoneum with tincture of iodine. He used a ten per cent solution, which he applied not only to the peritoneum, but also to the omentum and to the intestines. He then closed the incision. He observed, forty-eight hours after the operation, a chemotactic peritonitis without fever, after which time recovery followed without interruption. Four weeks after the operation the patients were discharged as cured, and he could not see any detrimental influence of the tincture of iodine. He states that other cases must be added before we can come to a definite conclusion.

Experiences With Rosenbach's Tuberculin.

In order to avoid the poisonous effects of some of the albuminoids contained in Koch's Old Tuberculin, Rosenbach has added to a 6 to 8 week old culture of the tubercle bacillus, a culture of a mould fungus (Trichophyton holosericum). The extract of this mixture can be used in much larger doses than can the old tuberculin, Rosenbach's reports sound encouraging and to test their reliability Kohler and Plant (Abst. in Fortschritte d. Medizin, 14, 1912) working in the clinic of Hiss, made the following tests: Eighty tuberculous patients were divided into two equal groups, as nearly similar as possible. One group was treated with Rosenbach's tuberculin; the other without. The result showed a marked difference in favor of the first group, both as regard subjective and objective conditions, as well as body weight. The Rosenbach product is one hundred times less poisonous than the old tuberculin. Kohler and Plant recommend beginning with 0.1 gm., giving the injections twice a week and increasing each time by 0.1 gm. up to a final dose of 2.5-3.5 gm., being careful to avoid marked reactions. The only objection seems to be that the Rosenbach tuberculin causes a strong cutaneous reaction at the point of injection, which, however, is easily controlled by cold applications.

GIFFORD, Omaha.