from all other remedies, is water. Water used intelligently will usually do the work alone and unaided, but sometimes therapeutic agents must be used to assist it. To produce sweating, water in the form of the hot pack, gives good results. If the patient does not begin to sweat after being in the pack for 15 minutes, 1% gr. pilocarpine hypodermically is recommended, but pilocarpine is a dangerour remedy and the patient must be carefully watched for increased cardiac depression. If extreme depression should occur, it can be best combatted by using strychnine 1/50 gr. Cold water given by mouth if the stomach will permit, when the patient is ready for the hot pack, very frequently aids diaphoresis. In the diuretic treatment, water plays an important part given in the form of normal salt solution by infusion and enteroclysis. Salt infusion acts by increasing the blood pressure and this stimulating or supporting action may be increased by the addition of ten drops of adrenalin chloride. The infusion may be repeated every six hours or more often. Enteroclysis to be of any service must be done thoroughly, the water hot, 110-115 degrees, amount large, one to two gallons. It may be interesting to you to know that in several cases which came under my observation where normal salt solution had no apparent diuretic action, lithia water was substituted with gratifying results. The last pint of water may be allowed to remain in the rectum to be absorbed. This may be repeated every three or four hours.

Poultices over the kidneys have a diuretic effect. Some use a decoction of digitalis leaves in making the poultice. Medicines that are very often used for their diuretic effect should be used with great caution, especially digitalis, for it is not reasonable to presume that the kidneys will eliminate therapeutic poisons if they will not throw off poisons generated in the body. Therefore it is very easy to get a medicinal intoxication in addition to the uremia. Digitalis then should only be used where the cardiac symptoms demand it. Hypodermic injections of urea is being recommended very highly for its diuretic effect. Of all the therapeutic agents given by mouth, water and especially milk, stand out most prominently. Milk is a medicine in this condition and should be given hot, if possible. In addition to its diuretic action it is the ideal food for this disease. The old school are limited to physiological diuretics which they themselves admit to be dangerous, while we homeopaths have in our armamentarium such remedies as apocynum, terebinth and cantharis, which are homeopathic to this condition.

Elimination through the intestinal canal is accomplished by giving neutral salts, but never containing potash Here, again, we find

the free use of water very beneficial. Blood letting is highly recommended by Bouchard. He says, "It is certain that we remove from the economy more extractives by bleeding than by any other channel, the renal tract excepted," but it certainly is contraindicated where there is severe shock or where the loss of blood has been great. It may be advisable where nothing else relieves and death seems inevitable. Oxygen is another of nature's remedies which aids us materially in combating this toxemia and also acts as a cardiac stimulant. Bouchard, who has made innumerable experiments along this line says, "I have seen exposure to compressed air diminish by one half the urinary toxicity." Therefore it is rational to use inhalations of oxygen in cases of uremia, for in proportion as it reduces the toxicity of the blood it lessens the danger of the severe cerebro-spinal symptoms, namely convulsions and coma. When convulsions occur authorities differ greatly as to what is best to use. If bromides are used the sodium and not the potassium, salt is recommended. A German authority recomends morphine in full doses and says "that in this condition morphine does not lessen or change the character of the urine, but if anything the amount is increased."

Gastric disturbances are usually severe and persistent. They may be of central or local origin. A number of measures and remedies have been used among which are lavage, mustard plaster over the stomach, and cocaine, but we must not lose sight of the principle which governs our choice of homeopathic remedies, for here phosphorus stands out prominently not only as a remedy for the gastric disturbances but also for the pathological changes in the liver, kidneys and heart. Phosphorus is also indicated in the vomiting following the administration of an anesthetic. Of the other homeopathic remedies indicated in this condition, arsenicum alb. cuprum arsenite 2x and apium vir., deserve especial study.

In conclusion I wish to emphasize four things which I deem of the most importance in the treatment of this class of cases. First, the intelligent use of water, second, oxygen before it is too late, third, milk as an ideal food and diuretic, and last but not least, the indicated homeopathic remedy.

Rose Bldg.

The only evidence of an acute intussusception may be the passage of a small amount of blood per rectum. One should always make a thorough rectal examination as even an intussusception high up in the small intestine may sometimes be felt per rectum.

SOME OF THE ASPECTS OF MODERN IMMUNITY THAT ARE OF INTEREST TO THE CLINICIAN.*

BY E. C. MILLER, M. D., DETROIT, MICH.

Immunity has been the subject of profound and fruitful study during the last few years, yet we still know very little about it. It is almost as illusive as life in its ultimate analysis. No one has as yet been able to define life and it is only with difficulty that we can de-scribe it.

The most generally accepted and perhaps satisfactory charac-terization of life is that of Spencer's-that life is correspondencewith environment. In every day life we use this as a test of the presence of life; when one sees a coiled snake or a crouching animal the natural impulse is to prod it lightly with a stick; if it responds to the stimulus it is alive, if not it is dead; when you strike a man or kick a dog there is an immediate response entirely different from the effect produced by a similar blow on a stone. This response to external conditions is also shown by the power animals and plants have of adapting themselves to the various seasons with their changes in temperature, moisture and food supply, and in a moregeneral way by the fact that the animals living in the arctic regions. are white in color, those in the jungle have a tendency to be striped and spotted, while those living on the desert are mostly gray. This is true not only of the higher forms of life but it is true of living matter in even its simplest form, native protoplasm without differentation of form or function, and is also true in varying degrees of the specialized forms of protoplasm we know as cells and of which our bodies are built up.. Of course the more highly specialized a cell becomes the less power of adaptation it possesses, yet as the individual cells lose this power the organ or general system takes it up. For example, Pawlow has shown that the kind of food taken into the stomach determines to a certain extent the kind of gastric juice that will be secreted, the stomach adapting itself at each meal to the kind of work it has before it. How it makes the analysis is not stated.

Living matter carries on a series of functions similar to the functions of the higher animals. It takes up from its environment, nutriment, it digests and assimilates it and excretes the unused residue. Incidentally it grows, reproduces itself and shows that it is sensitive to light, heat, cold, chemicals, and mechanical force, but these are secondary-the essential phenomena of life consist in the

* Presented to the Cleveland Homeopathic Society, Nov. '08.

above noted cycle of ingestion, digestion, assimilation and excretion. Now living matter is so delicately adjusted, so easily disarranged and the visissitudes it encounters are so numerous that for a suc cessful continuance of life something more is needed. It must have: 1. some memory' or means or recognizing its enemies; 2. some methods of defence, and these two aspects of life make immunity possible.

Most life processes are chemical at least in a broad definition of the word, and many of the methods of defense are chemical. There are facts which indicate that living matter having once encountered some noxious influence and having triumphed over it by some chemical means of defense very prudently lays by a supply of this chemical against a second possible attack. Having now clearly in mind the three essential factors in immunity, viz: 1. the ability to devise and execute methods of defense when attacked; 2. the power to recognize an enemy once encountered; 3. the prudence to keep in hand some of the ammunition found useful in a previous conflict, we are ready to take up in detail some of the manifestations of immunity. We will first glance at the oldest and most widely known forms of immunity, that toward smallpox, but concerning the intimate processes of which we know nothing. One attack of smallpox confers immunity for years and even for life, which means that the living matter having once encountered the smallpox virus and having overcome it, retains that acquired power for a considerable time. Not only so, but an encounter with an artificially attenuated smallpox virus such as results from the inoculation of smallpox into cattle, causes the cells to acquire much the same power of defense as an encounter with the disease itself, though perhaps in a less degree. This is the first example of artificial immunity being successfully established in man and has come into almost universal practice. Yet we know nothing about the nature of the virus itself or the changes it undergoes when passed through a heifer,

Let us now take up some of the various forms of immunity of which we have some knowledge. The first and best known form of immunity is the antitoxic immunity. Certain bacteria attack living matter by means of poisons which they produce. For example, the bacillus of diphtheria grows in the throat of many healthy children and does no particular harm. But under certain circumstances this germ may start in to produce a poison, and this poison absorbed from the throat of the child into the system produces a train of symptoms which we know as the disease diphtheria. Now when this foreign substance, this deleterious poisonous substance, that which

we call diphtheria toxin, is absorbed into the blood of the child, the living cells of the blood and the living cells of the tissues, coming into contact with this poison, at once begin to guard themselves. against it; and they guard themselves against it by producing, in some way (we know not how), a substance which will neutralize this. poison, a substance which we know as antitoxin. If the living cells are able to produce this antitoxin with sufficient rapidity and in sufficient quantity, the toxin obsorbed into the system of the child will be neutralized and the child will recover. The cells not only produce enough antitoxin to neutralize all the toxin, but they produce a superabundance so that there is a reserve stored up against a future attack.

Use is made of this characteristic of the cells in the production of antidiphtheritic serum. To do this a horse is injected with a. small amount of diphtheria toxin. The cells respond with the production of antitoxin. After a short interval the horse is injected with more toxin, and the cells again respond and this process is kept up until the cells learn to produce enormous quantities of antitoxin. In some instances the blood of the horse contains sufficient antitoxic. power so that one dram of its blood serum will neutralize toxin otherwise sufficient to kill 1000 horses.

In antitoxic immunity the body protects itself against the invader, the toxin, by the production of a chemical substance which is called antitoxin. Hence there becomes possible the production of what is known as passive immunity. The horse when it injected with the toxin is actively immunized against the poison. It is the response of the horse's own tissues to the toxin which makes the antitoxin. But the antitoxin being a chemical body can be transferred from the horse to a patient suffering from the disease, and in that patient it will neutralize the toxin the same as it would do in the horse. This makes possible the therapeutic application of diphtheria antitoxin. In this case the horse is said to be actively immunized; the patient into whom the horse serum is injected is passively immunized. In other words the patient is immunized to the action of the toxin, not by any virtue of his own, but because his blood contains the antitoxin of the horse.

Another form of immunity may be called lytic immunity, which signifies that the defense put up by the cells against the deleterious agent has a dissolving action. One of the best illustrations of this is the immunity against the typhoid bacillus. If rabbits are injected with dead typhoid germs until they become immune to typhoid, this immunity can be demonstrated in the following way: If some