phritis with complication of the bladder.

Patient, aged 53 years, well preserved. Family history good. Expression of face did not indicate any pain. Conjunctiva somewhat inflammed. Teeth irregular. Else very healthy. The tongue moist and steady. Chest is well developed; muscles a little flabby, pulse rate, 65 per minute. Pulse full and arteries compressible. At the age of nineteen the patient had typhoid fever, and ten years ago malaria. The spleen was not enlarged; liver normally palpable. Patient complained of costiveness and acidity of stomach; says he had dieted himself by fruit and moderate ingestion of foods, leaving little residue.

Diagnosis: Mixed hemorrhoids.
L. LIME.

Appendicitis.

An Egyptian mummy of 2,000 years ago recently examined, showed evidences of having died of appendicitis, so that the disease is not by any means new. Four hundred cases were operated on in London hospitals last year, all but ten successfully. Sir Francis Treves has operated with success on 100 consecutive cases. It is said that the modern fine flour is one of its causes. The increasing occurrence of the trouble has opened a new field for insurance in England. One of the most prominent firms in Lloyd's has made a new departure in the form of policies insuring against appendicitis. For a premium of 5 shillings the insured, should he undergo the operation, will have all his direct expenses paid up to $1,000. In the event of his death under or as a result of the operation a total sum of $1,000 will be paid.

The New York Medical Critic announces that each subscriber to that journal will receive a free copy of the Medical Index next month (March, 1903).

The volume will contain names, place and date of publication, price, circulation and names of editor and publishers of over 600 of the principal medical publications in this country and abroad, and also the titles and authors of each article published

during the year 1902, arranged according to subjects and alphabetically. When it is noted that the list is complete up to January, 1903, it should prove especially valuable in bridging over the period which has elapsed since the index medicus was discontinued.

Considering the expenditure of time and money in the preparation of this volume, and the liberality of the publishers in presenting it free to the profession, the enterprise marks a new era in medical journalism and merits appreciation and success.

RADICAL ACTION SUGGESTED.

There was a disposition on the part of some members of the conference to adopt radical measures. A resolution was offered proposing that the secretary of war be advised that there is danger in bringing troops through the city of San Francisco.

Surgeon General Wyman advised against the adoption of this resolution. Another was proposed placing an embargo on railroads leading out of California unless certain steps were taken by the health authorities toward the suppression of the plague. Neither of these resolutions were adopted. It was decided to send copies of the resolutions adopted to the state and city boards of health with a request that they make a statement as to their proposed plans.

At the opening of the meeting the following resolution was adopted:

"Whereas, This conference believes without a shadow of division of opinion that the plague exists and has existed in San Francisco, the representative from California, Dr. Gardner, is expected to present to this conference within as short a time as possible definite signed assurances from the governor of the state and the mayor of San Francisco, which will bind the city board of health, so far as those men can control those offices, to assume each their several and joint responsibility in the suppression of the plague, and to pursue them to the utmost in harmony with each other and in full co-operation with the United States public health and marine hospital service.— Tribune, Minneapolis.

Dr. Charles Barrows, of New York, Saves a Patient with a Temperature of 108. New York, Jan. 16.-At the last meeting of the New York Obstetrical Society, Dr. Charles Barrows, of this city, submitted a report of an experiment with formaline, a drug known as the strongest of antiseptics, which he had made in Bellevue hospital on a patient who after giving birth to a child, had a temperature of 108 degrees and a pulse of 160. When the patient was admitted she was suffering from sepsis, or bloodpoisoning.

The patient was a negro woman of slight stature. Dr. Barrows had a small portion of blood drawn the woman's arm and a culture was made. This was examined by Dr. Buxton, a bacteriologist of Cornell Medical College, and was found to be loaded with the virulent bacteria of septicemia, which are called stereptococci.

The woman now had a temperature of 108 degrees and a pulse of 160. Never in the history of the medical profession was a patient known to recover from this disease with such a rise of pulse and temperature.

Dr. Barrows resolved to try a most radical measure. He injected into one of the large veins of her right arm 500 cubic centimeters of formaline. The effect was almost instantaneous. The woman was at the time almost in a state of collapse. The strength of the solution was 1-5,000.

By the next day the temperature had dropped to 101 degrees with a corresponding drop in the pulse rate. On the succeeding day the temperature went up to 102 degrees and on the next day to 103. A second blood culture disclosed the fact that although stereptococci were still present they were in vastly diminished quantities. Dr. Barrows then made a second injection. The temperature dropped to the normal in a few hours and the pulse to 86 beats per minute.

An examination of a third blood culture showed that no germs existed. The woman's pulse and temperature have now been normal for ten days and she is practically well.

Experiments are being made on animals, and further important results are expected. The injection of formaline into the veins had never been heard of until Dr. Barrows read his paper.—Journal.

The Specific Action of Normal Saline Solution in the Production of Diuresis.

This subject is treated at length in the Medical News for January 3, by Robert Koleman Kempt.

The author asserts that the normal, or rather deci-normal saline solution has a specific action upon the kidney cells, causing diuresis, whether it be administered by infusion, hypodermoclysis or entero clysis.

This result occurs even when such small quantities are used that the mercurial manometer does not show an increase in blood pressure. Also when the renal nerves are severed.

This procedure is invaluable in renal congestion. The author has noted the disappearance of albumen, blood and casts upon its introduction.

These results were manifest in twenty minutes, the time required for absorption.

Double current irrigation is used. (Enteroclysis.) The bed is protected with rubber sheeting and a bed pan is not used, the water being carried off by sheeting to the pail.

From three to twelve gallons are used at a sitting. Irrigations may be given every three or four hours in severe cases. I he writer advocates a temperature of 110 F, gradually increased to 120 F.

Work It Backwards.

At one of Dr. Weir's surgical clinics, held recently at the College of Physicians and Surgeons, a woman was presented who had a dislocation of one side of her lower jaw. The history was that the injury had been sustained while she was engaged in strapping a very tightly packed dress-suit case. After reciting this history, Dr. Weir asked a student:

"What method of procedure would you advise to bring about a reduction of the dislocation?"

The answer came promptly: "I would advise her to unstrap the suit case, sir."Minneapolis Journal.

The Treatment of Influenza and Coughs. We excerpt the following from the Toledo Medical Compend by David E. Bowman, M.D., Toledo, Ohio, professor of obstetrics, etc., Toledo Medical College: "The elimination of the toxins is too frequently overlooked in these cases. Formerly, in their efforts to relieve the distressing symptoms, the profession have used remedies which produced stomachic disturbances, arrest of secretions, constipation, etc. I find nothing better to overcome the congested condition, in these cases, than two Laxative Antikamnia and Quinine Tablets given every 3 hours. If needed, follow with a Seidlitz powder or other saline draught the next morning, before breakfast. This will hasten peristaltic action and assist in removing, at once, the accumulated fecal matter. Heroin hydrochloride has been SO largely used for coughs and respiratory affections that it needs little or no recommendation in this class of cases, but the favorable synergetic action of this drug used with antikamnia, is, I believe, not sufficiently appreciated. Antikamnia and Heroin Tablets will be found useful by every practitioner, particularly during the winter and spring months. The Antikamnia not only adds potency to the respiratory stimulant and expectorant qualities of the heroin, but it prevents the slight nausea which may at times follow its administration alone." A Remarkable Surgical Operation.

St. Louis, Jan. 19.-A remarkable surgical operation was performed at the St. Louis city hospital last night to save the life of Edward Spilker, aged 19, who had attempted suicide by shooting himself in the left breast. An aperture was made at the wound and between pulsations the wound in the heart was closed with three stitches. A portion of the left lung was also cut away. It is believed the patient will recover. War on Plague.

Washington, Jan. 19.-Surgeon General Wyman, of the public health and marine hospital service, and the representatives of the health authorities of nineteen states, Indian territory and the District of Columbia, met in conference in Washington, D.

C., 19th January, 1903, to consider the subject of bubonic plague in the United States. Among those attending are Dr. T. L. Kennedy, Iowa, and Dr. H. M. Bracken, Minnesota.

RESOLUTIONS ARE ADOPTED. Resolutions were adopted: They stated in part:

"The conference will consider the safety of the country sufficiently assured as soon as satisfied that a competent city board of health of San Francisco and a competent state board of health, in co-operation with the United States public health service, will proceed under definite, harmonious and effective laws and ordinances; that they are provided with ample funds, and that they are jointly and severally in the free exercise of their lawful powers."

Your Pulmonary Quartette.

In a complimentary letter to The Maltine Company, a prominent New York physician makes a happy reference to Maltine with Cod Liver Oil, Maltine with Creosote, Maltine with Hypophosphites and MaltoYerbine. He calls them "Your Pulmonary Quartette."

Timely Remedies.

Lest we forget the importance of guarding digestion in our treatment of coughs which are always present in our work more or less, but particularly so in the fall and winter seasons, it is well to bring to mind the fact that The Maltine Company have furnished to us an excellent combination, Malto-Yerbine.

This is a judicious mingling of Yerba Santa with Maltine. The Yerba Santa is an excellent expectorant, softening the most harsh and rasping cough, stimulating the secretions, and favoring resolution upon the part of the inflamed mucous membranes of the air passages. The Maltine assists in the work and serves as a helper of digestion and a nutrient.

And, by the way, in the administration of Creosote, it is well to remember always that The Maltine Company have provided for the profession a very superior combination of Maltine and Beechwood Creosote. It is surprising how much better delicate and, indeed, all stomachs, will bear the pushing of the Creosote when combined with Maltine.-"Medical Mirror."

Clinical Results With Anti-Streptococ

cus Serum in Scarlet Fever.

If, however, a rabbit become so septicaemic that the streptococcus could be

sician to the Willard Parker and Riverside Hospitals of New York City. In 1896 a series of clinical investigations were commenced with Marmorek's serum, by Professor Baginsky, of Berlin. Mild and malignant cases were chosen, and large and small doses were injected. The results, which were published at that time in a paper read before the Berlin Medical Society,1 were disappointing, and the serum treatment was abandoned by him.

My own experience I owe to the courtesy of Baginsky during the summer of 1896, while abroad, and to continued experience in this city. In a paper read by me before the Section of Pediatrics, New York Academy of Medicine, entitled "Clinical Experience With Antistreptococcus Serum," my conclusions were: "That we are not justified in either using or recommending the use of the antistreptococcus serum, and that the indiscriminate sale of this serum should be prohibited, until clinical experience established the true therapeutic value of the serum."

William H. Park, discussing my paper at that time, said that "the streptococcus serum differs from the antitoxin serum of diphtheria in one important feature the bactericidal action of the streptococcus serum. The virulent streptococcus makes no more toxin than one which is not virulent; the inability to grow alone is what makes it virulent. It is, unfortunately, true that the streptococcus serum is still very weak, but it is certainly a protective. serum, as has been abundantly proved in the experiments at the laboratory of the health department, where a rabbit has been protected from septicaemia by sufficiently large doses of this serum.

the result of the injection of the serum. was negative. It should always be borne in mind that the streptococcus serum cannot be of any value except in inflammation due to the streptococcus.' In a study of 701 cases of scarlet fever, by Professor Baginsky associated with Dr. Sommerfield, the streptococcus was demonstrated in 696 cases.3

The streptococcus was found on the pharyngeal mucous membrane, intra vitam.

About 100 cases were studied post mortem, and the streptococcus was found in the various organs in the heart blood, in the bone marrow, and so on. The constant presence of the streptococcus, although associated frequently with other other germs, requires careful consideration. Because of this constant presence of a streptococcus its association with scarlet fever might be inferred.

Thus the conclusions of Baginsky and Sommerfield were that the streptococcus is a distinct etiological factor in scarlet fever.*

Reasoning by analogy, these investigators determined to produce a powerful serum. The standard adopted was COLWELL

on lines similar to that used in producing concentrated antitoxin for diph

theria.

Dr. Hans Aronson utilized a streptococcus taken from a child with a scarlatinal angina. From this germ he cultivated pure cultures. He also utilized a streptococcus taken from the bone marrow of a child that died of scarlet fever.

From the cultivation of these germs Aronson was able to produce a very active and efficient immunizing

serum.

A series of preliminary experiments were first tried on animals before Baginsky consented to its use in children. He found that "when mice were injected with a very virulent streptococcus bouillon, which usually 1-100 millionth of a cubic centimeter proves fatal, it was found that they could easily withstand an infection of 0.000015 c.cm. of a most virulent streptococcus bouillon, if they were previously injected with 0.03-0.1 c.cm. of antistrepotoccous serum."

Control mice, which were not previously injected with this new Aronson serum, all died when injected with the same fatal dose of streptococcus bouillon.

Mice which were injected with Marmoreck's serum and later received a fatal does of the streptococcus bouillon all succumbed, proving that there was no healing property in Marmoreck's serum.

Aronson used horses to produce immunity. The cultures of streptococci injected by him were derived from cases of scarlet fever.

In Germany, serum of which 0.01 c.c. when injected into mice will prevent septic infection of hog erysipelas is designated as a "normal serum." One c.c. contains one immunizing unit. The serum produced by Aronson, and utilized by Baginsky and myself, is equivalent to twenty times the strength of normal serum.

A series of interesting animal experiments are described in detail by Aronson. After an intraabdominal injection

with at least ten times as much as the ordinary fatal streptococcus quantity. The bacteria enter the circulation very rapidly, frequently in one hour, but positively after two hours the bacterial can be demonstrated in the blood.

Aronson advises amputating the tail and using the blood oozing therefrom

for inoculating the nutrient bouillon. Aronson was able to save most of the animals by injecting zve times the ordinary immunizing dose, two hours after a general infection had taken place. He also reports a series of successful results by injecting this healing serum. even twenty-four hours after the infection.

It is interesting to note that in a seris of animals which had first received a fatal injection of streptococcus culture, and on the following day an injection of a curing dose of serum, "living germs could be demonstrated in the blood at least twenty-four hours after such injection of serum." Thus Aronson reasoned that as long as the streptococcus could be demonstrated in the blood of these animals, that curing injections of antistreptococcus serum were indicated.

Aronson maintains in a paperby him that an important therapeutic indication for the use of antistreptococcus serum was apparent to him as long as streptococci could be demonstrated in the blood of animals. He also insists that this point should be used as a guide in the determination of when to use and when to discontinue serum.

How Is the Action of Antistreptococcus Serum Brought About?—Aronson maintains that even very powerful serum has no direct influence on streptococci. He has found that when virulent cultures of bouillon containing streptococci are inoculated into antistreptococcus serum, that they multiply, sot hat, although the serum seems to inhibit the growth of these germs slightly, there is no direct specific destruction which could be attributed to the serum. There is therefore something else in the animal body in addition to the serum, which stimulates cell activity, or probably by the direct cel