like results. I rather think from my own experience with streptolytic serum that the alimentary canal route will be a very important route in the production of artificial immunity. Prof. Theobold Smith has shown in his elaborate experiments that heating the tubercular bacilli to 100° C. does not destroy the toxin of the bacilli entirely. I would suggest along this line might not the eating for ages past of beef affected with bacilli have had a great influence in establishing to some extent racial immunity, and might it not be in rare cases of use in establishing a personal immunity? The Jew for ages was an absolute abstainer from hog meat, but has always been a consumer of beef. Might not this have had something to do with their predisposed immunity, and is it not a fact, that the greater amount of beefsteak eaten or, in other words, has not the beef eater the greatest chance of getting well and acquiring immunity? We have all noticed the effect of beef juice in tubercular conditions and someone is continually making the "new discovery" of the value of beef juice in consumption. Therefore is it not possible for the juice of beef, beef that is immuned before death, to be of use in conferring immunity on the patient who drinks it?

So, now, Mr. President, after this brief review of the work that has been accomplished along the lines of immunity, I wish to bring before this association an hypothesis along the same line of tubercular immunity. Some of you will remember in previous papers before this body, I have claimed for the X-rays only the power of producing local engorgement, or hyperemia of the lung and on account of the increased nutrition, thereby afforded, nature was able frequently to fight a winning battle with the bacilli, where otherwise failure was inevitable. Practically the evolution of the tissues in the old theory is, I think, correct, but I believe that it does not go far enough and does not explain the startling and successful results in many cases.

H. B. Wilkinson, M. D. (Jour. A. M. A., February 3, 1906), physician in charge of "San La Zara Hospital," P. I., reported thirteen cases of leprosy treated by the X-rays and in which three were absolutely cured by means of the X-rays, so that no leper bacilli could be found. All except one, as I remember, were restored to usefulness.

In summing up his report the doctor called attention to the fact that the X-rays were able to benefit the bad cases,-cases

in which there were a great number of leper nodules and ulcerations that could be reached with the rays at one treatment, but in mild and incipient cases the rays seemed to have no effect. He advanced the hypothesis that the lepra bacilli were killed by the rays, and that they were then absorbed by the system, being of the endotoxin group. When absorbed, the toxin was liberated into the blood and lymph streams, where they excited accordingly a production of specific antibodies to be thrown into the blood for their neutralization, which cured his cases.

The part of this most highly interesting paper that attracted my attention most was the different effect of the rays in mild and severe cases.

I had noticed the same effect in my tubercular work, but was at a loss to account for it. I had often noticed that the mild incipient cases of tuberculosis, which get well under almost any kind of treatment will progress very little faster with the X-rays than without it. In fact they are nearly all unsatisfactory cases, while my best results are with advanced and almost hopeless cases.

Therefore I have come to the conclusion from clinical experience that I am causing with X-rays in advanced and suitable cases, a destruction of tubercular bacilli, bacteriolysis, which being absorbed into the blood, the toxin, which being an endotoxin is very likely set loose into the blood and lymph stream, arousing a reaction and production of antibodies or amboceptors of Ehrlich, or possibly in their own mysterious way increasing the opsonic index of the individual, even to the point of changing the negative chemiotaxis for an absolute positive chemiotaxis so that the phagocytosis may be increased sufficiently to take care of all the emergencies that may arise. In other words you produce in suitable cases by means of X-rays an autospecific or tuberculin toxemia arousing a reaction in the host of the liberated toxins that may be of great benefit to the patient. You will notice that there is a wider difference in the class of cases in which X-rays have given me the best result than cases in which the tuberculin group of agents are advised. For instance these agents are recommended to be used only in cases where there is no elevation of temperature, no mixed infection, no pleurisies, no cavities, nor unresolved pneumonias. They are to be used in strictly incipient or chronic tubercular infections, where if you get any toxins to

amount to anything, they must be introduced from without, while in cases best adapted to the X-rays, you must have the germs in sufficient quantity in the pleura, lungs, glands, or somewhere in the body to cause by their destruction the toxin desired. Acute cases with high fever, unresolved pneumonias, pleurisies with or without effusion, cavities, consolidations and

adhesions, none of which are a bar to X-rays, if the effect is properly guarded.

Mr. President, I do not want to be understood in this paper to advocate X-rays as all that is needed in tuberculosis pulmonalis, glandular tuberculosis, or tuberculosis abdominalis: while in advanced cases in my hands it is worth more than all other artificial agents combined, yet it must have its adjuncts, rest, diet, sunshine, fresh air, change of climate,-when it can be judiciously accomplished,-and medical agents. According to my idea the adjuncts arranged in importance are as follows: first, diet; second, rest; third, sunshine; fourth, change of

climate and surroundings; fifth, fresh air; sixth, medicinal and hygienic measures as indicated. I think the fifth of this grouping, fresh air, is the most harmfully accentuated agent in the whole category, and when you couple with it the customary idea "exercise" that is frequently instilled into the patient's mind on leaving home for a change of climate, you have, in a large measure before you the cause of the vast majority of failures and deaths of these individuals. Nothing can be more absolutely harmful in high altitudes for sick individuals than exer

cise, which many think is necessary for "fresh air." Fresh, pure air is a necessity, can be had anywhere and in greatest abundance but is not absolutely a specfic for tuberculosis. I will call attention to a few skiagraphic prints with reports of cases to illustrate to you the points claimed in this paper.

No. 1, M. C., incipient case of tubercular involvement of left lung, as was shown on careful physical examination as well as by the skiagraph. Result, improved slowly but surely. X-rays

hastened the progress very little, if any: results as far as the X-rays were concerned unsatisfactory.

No. 2, Mrs. R., sent to Colorado from Philadelphia and said to have slight tubercular involvement of the left apex. Skiagraph failed to show it. My developer, however, thought he could make out a slight shading of the left apex, and the lady herself thought so and wanted the X-ray treatment herself on account of what she had seen in results with other patients. To

Fig. 3.-Case III, Showing extensive tubercular process.

satisfy herself and husband, I administered the X-rays for a short time but discontinued them as I could see no benefit in her case, and I have relieved her by other mans

No. 3, is a case that has been dismissed for over a year. He has become a successful farmer or rancher, as they are called in Colorado. He has held his own in spite of much hard work and "baching it" on his ranch, and when you look at his skiagraph, you will have no trouble in making out a very knotty lung. This gentleman had been in Colorado for over one year