during three winter months the thermometer goes as low as 15 degrees Centigrade below zero. These extremes of temperature are characteristic of this part of the Middle Kingdom and peculiarly so of Peking, and consequently very trying to those not acclimatized. Rain never falls in winter, and snow but on rare occasions. As a matter of fact the rainfall in and about Peking is slight. The greatest extremes of climate are exhibited in Shan-Si and portions of Shan-Tung. The rivers and streams in these districts are deeply frozen, as is the Gulf of Pechili along the coast line to eight or ten miles from shore. The change from heat to cold and vice versa is extremely sudden, and is therefore certain to have a bad effect upon the health of foreigners. The New York Herald of August 12th says, in an article referring to the diseases of Northern China, "that on acount of the extreme character of the climate, the diseases follow the seasons in a well-marked order. During winter, besides the direct results of the action of cold, such as acute affections of the lungs and rheumatism, typhoid epidemics are noted, as well as typhus fever and diphtheria; their development is due evidently to the confinement to which the rigors of winter condemn the population, which is shut up in narrow houses, generally in overheated air, where the disease-carrying microbes find favorable conditions for development. On the other hand, when the temperature becomes milder, the inhabitants leave their houses to live very much in the open air, and typhoid disappears almost absolutely. Soon, however, under the influence of the heavy rainfalls of the months of July and August, the soil of the cities impregnated with filth exhales miasma, which gives rise to poisoning, manifested under form of fevers, sometimes dangerous, of diarrhoea and dysentery."

Smallpox is the greatest and most deadly scourge of China, the disease always being present to a greater or less extent. This fact is undoubtedly due to the disgustingly filthy sanitary conditions in which the vast majority of the Chinese people live. The three diseases, then, with which an invading army must contend in China are typhoid fever, dysentery, and smallpox. Every care should and doubtless will be taken. to ward off and effectually to fight these maladies. It need scarcely be said that one of the most important protective measures to be enforced will be the providing of efficient means of sterilizing water. Another point only second in importance to that just mentioned is the necessity of revaccinating the soldiers and sailors whose duty will call them to the far East. China has not agreed to the Geneva convention, and the Red Cross Society is not represented in its army. The allied forces must be equipped to meet any contingency, as the wounded who may fall into the hands of the Chinese will not receive the care always given them among civilized nations. The disastrous results from an

inadequate medical and nursing staff has lately had so striking an object lesson in the South African campaign that there can be no excuse for pleading ignorance in this respect, and if the government of the United States does not profit by the experience so dearly bought by the British, the reckoning at the hands of the American public will surely be a heavy one.—Medical Record.

TRANSFUSION.

The 118th Harveian Festival was held in the Hall of the Royal College of Physicians, Edinburgh, on June 15. The society met at six o'clock, when the president, Professor Thomas Annandale, delivered the Harveian Oration on Transfusion.

Professor Annandale, having first given a brief historical account of transfusion, and of the different suggestions, experiments and methods employed from time to time, referred to the more recent experiments and observations made by physiologists and pathologists in connection with the subject, and discussed the results of the more recent studies upon the behavior of the blood and its constituents after it had been injected into a patient's circulation. He then described the various methods employed at the present time, and enumerated the advantages and disadvantages of each. As a result of his experience and consideration of the practice of transfusion, he suggested the following conclusions in regard to the operation, confining these conclusions to cases suffering from loss of blood, as he was of opinion that at the present time transfusion for anæmia and other abnormal conditions of the blood did not rest upon any satisfactory basis, although from time to time a few successful cases of the kind had been recorded: 1. That it may be a valuable aid in saving life in the case of patients suffering from serious loss of blood, provided they show no signs of reaction after the ordinary means have been carefully tried. 2. That the best form of transfusion for ordinary use is the injection into. a vein of human blood mixed with a solution of phosphate of soda and kept at the temperature of ordinary blood heat so as to prevent coagulation. 3. That, if the former method cannot be properly carried out, the injection into a vein of saline solution in considerable quantities is the next best procedure (sodium chloride one drachm to the pint of warm water is the most convenient solution). 4. That intraperitoneal injections of warm water or of warm saline solutions are most likely to be useful when the abdomen has already been opened by operation, for without such an opening there is always a risk of handling the intestines or other internal organs, with the inserted trocar and cannula. 5. That injections of warm water or of warm saline solutions into the rectum is a safe procedure which may be usefully employed

in any sudden emergency. The importance of strict antiseptic precautions in connection with transfusion was strongly advocated, and the fact that Nature has a wonderful power in relieving even great loss of blood was stated in the following terms: "In considering the value of transfusion in saving the life of patients suffering from loss of blood from any cause, it must always be kept in mind that Nature has remarkable powers in overcoming loss of blood, and all have met with cases in which death seemed certain, but which have rallied and recovered. Transfusion, then, should not be lightly practiced, and should certainly not be practiced unless it can be performed at once and with all safe precautions."-British Medical Journal.

FIFTY YEARS OF DEAF-MUTISM.— HEARING AND SPEECH RESTORED THROUGH A FALL.

Thos, H. Temon, age 69; white; protestant; upholsterer by trade; born in U. S. Hospital, case 22,353, Pittsburg Homoeopathic Hospital.

History: When ten years old had smallpox, which left him with a diseased condition of both ears, which discharged for nearly six weeks, and hearing was entirely lost. He could still talk, and continued to talk for two years. During this time the talking became less and less distinct until he gradually lost the power of speech entirely, and became a deaf mute. In the meantime his health remained good, and he was treated from time to time by specialists, but with no improvement in hearing or speech. Eyes remained good; he read a great deal; but was obliged to converse by means of finger signs or writing.

July 9, 1900, while fixing some vines at his home in East End, he fell from a step-ladder to the ground, and was picked up unconscious, and remained so for some time. The fall had bruised his shoulders, hip and eyes. While going to the hospital in ambulance, he inquired where he was being taken. He talked all the way in. When he arrived at hospital he denied being Mr. Temon, and gave another name. After being in bed in the wards two hours, as he tells the story now, he heard his own voice for the first time in over fifty years. He is totally unconscious of having spoken before, either in the ambulance or emergency ward.

When he first heard his own voice he was very trembly and nervous. He left the hospital able to see, hear and speak. The hearing, however was confined to one ear; the other is totally deaf.-Pennsylvania Medical Journal, August,

1900.

Anti-streptococcus Serum was used by Dr. A. W. Harrison* in a very severe case of facial erysipelas, with exceedingly gratifying results. At first the patient was given quinine and the tincture of iron perchloride internally, and equal

parts of ichthyol and lanum externally. In spite of these measures, the inflammation extended and the general condition became worse. Within three days, the iron had to be stopped because of intolerance. By that time delirium had supervened. Four days later the natient was so unconscious that she passed all excretions in bed. She was then receiving half an ounce of brandy every hour. Three days later, the temperature being still high and weakness more marked, with muttering delirium, digitalis and strychnine were ordered and an ice bag was applied to the head. Nevertheless, the patient continued to sink and was practically moribund on the second day following, when she received the first injection of 10 Cc. (21⁄2 fl. dr.) of the serum. Four hours later, she had a short interval of consciousness; and, four hours later still, the temperature had materially declined and the quality of the pulse had improved. Another

injection of 10 Cc. was given with the result that both temperature and pulse were below 100° F. the following morning. A third injection was then given, followed by a fourth in the evening. By the next day the delirium had terminated. After this, there was one injection daily until eight in all had been given. Convalescence was rapid and uninterrupted. rapid and uninterrupted. The doctor is very positively of the opinion that the serum saved the patient's life, which could not have lasted twenty-four hours longer without it.-Merck's Archives.

Hedonal, a new product of the urethane group, is the subject of reports by Drs. Paul Schuster and A. Eulenburg, the former using the remedy in 38 and the latter in 41 cases of insomnia, with practically identical results. On account of its slight solubility in water, it is best given dry on the tongue and washed down with some aromatic elixir to correct the rather disagreeable taste that it leaves in the mouth. Doses of less than 1 Gm. (15 grn.) were generally inefficient, and, in many cases, as much as 2 Gm. (30 grn.) was needed to produce sleep for six or seven hours. When successful the administration of the drug was generally followed within a half hour by a quiet, dreamless sleep. As hedonal is devoid of narcotic powers, it failed uniformly in cases of insomnia due to pain, as in neuralgia, tabes dorsalis, etc., and it was equally inert in cases of maniacal excitement. The best results were obtained in simple neurasthenic conditions. The remedy was taken without manifest repugnance by most patients, and no unfortunate after-effects were observed, although in one case ten doses of 2 Gm. (30 grn.) each were given within twelve days. Diuresis, which was a constant result in animals experimented on, was by no means uniformly observed, and in no case was albumin or sugar found in the urine. Both reporters agree that hedonal is worthy of a place in the materia medica. Merck's Archives.

Vol. II.

No. 10.

CASES.

By Charles H. Hunter, A. M., M. D., Minneapolis.

The success of the diphtheria antitoxin now quite undisputed, led physicians to be extremely hopeful that serums for other infections would be equally effective. This hope does not seem, as yet, to have been realized. Pneumococci serum for pneumonia has been a good deal used, but it does not appear to have been followed by better results than follow the older methods of treatment. Tetanus serum does not seem to have realized the hopes of its introducers.

I have gotten together a few cases of my own septic infections treated with antistreptococcic serum, and some others gotten from the hospitals of the Twin Cities, the study of which will, I think, lead one not to be over-confident of its value. I will say nothing of the methods of production of the different manufacturers of serums, for so far as I know there is no great difference in their preparation, and my experience with the different makes has not been sufficient to be of value. Suffice it to say that all makers claim antistreptococcic serum itself is not harmful in any dose. Any untoward effects, as rashes, and the like, are due to preservatives used or to the products of deterioration. The matter of dosage of the antitoxin used seems to be largely one of judgment, and not susceptible to rigid limitations, as the amount of toxines in a body to be overcome must be quite beyond our powers of estimation, so that, as the antitoxin seems harmless it is better to err on the side of large rather than small doses.

That you may yourself judge of the effects of the serum I will read the history of a number of the most striking of this list of cases that I have tabulated. You will notice that they are so tabulated as to show the supposed source of infection, the germ of infection when determined. then the clinical course, the time in the course of the disease when the serum treatment was instituted, its effects, if any, and finally the outcome of the case.

The first two were cases of meningitis. Case "A," seen in consultation with Dr. Tupper, was that of a child eighteen months old. The usual

hastened in the doctor's opinion.

The second was that of a young woman who certainly was very ill of meningitis, the Meningococcus being demonstrated by Dr. Wilson to be present in the fluid obtained by a lumbar puncture. The symptoms were various and not necessarily fatal. No marked changes for the better or worse were noted after each dose of serum. Extensive rashes appeared in the second week of the illness. The serum used was Mulford's. I would be unable to say that the recovery was particularly influenced by the serum.

The other two were puerperal cases, the one mild and the other serious from complications.

Case five was remarkable on account of the amount of serum used-being something over $60 worth in all. Its long continuance, complicated with pneumonia, rapid pulse, the involuntary evacuations, and the pulse of 140, are witnesses of its seriousness. The reporter of the case, Dr. Clarke, interne at Minneapolis City Hospital, may have been correct in attributing her salvation to the serum, still the course of eight weeks does not seem shorter, nor on the whole the symptoms more severe, than we witness in septic fevers and in which recovery takes place without the serum.

The ten cases of erysipelas present the usual variation of this erratic infection. The average length of stay of fifteen days is certainly not longer than usual. But the symptoms do not stop after the administration of the serum as they are wont to do after the administration of diphtheria antitoxin.

Case 15 shows that the attendant must not abate his vigilance in the use of aseptic methods. because of the use of the serum. One can but feel that free incision and drainage are much more potent to check sepsis than the antitoxin.

The five cases reported from St. Paul City Hospital and St. Luke's Hospital, are not more favorable to the reputation of the serum. Four recovered with no sudden stopping of the symptoms fairly attributable to the serum, while the one case of septic peritonitis showed no retardation in the accustomed march of this malady. While out of these twenty cases only two deaths are recorded the mortality estimate can be of little value, on account of the fewness of the cases, and also on account of the varied character of the infections.

What is important to note is that there are no changes in the evolution of the symptoms and no variations in the march of the disease from that we are accustomed to note in the variable severity of these infections. There is no sudden halt in the disease and quick restoration to health that we associate with the use of a specific. I recognize that it is a possibly fair criticism of the treatment of these twenty cases that the initial dose was not large enough or given early enough to establish a criterion of the value of the serum. The serum obtained was that most readily got in our markets, Mulford's and Parke, Davis & Co.'s, and they have the advantage at least, according to the accompanying circulars, of being fresh and equally effective in all cases, and, above all, free from any harmful effect in any dose. Undoubtedly this statement that any serum will be equally effective in all forms of streptococcic infection loses the chief point of the problem. Our present knowledge warrants the inference that every coccus elaborates its own toxin as each plant elaborates its own alkaloid, and to be effective antitoxin must bear some relation to this toxin. This fact may account for the variable results in the reported

That a useful judgment of the value of these remedies cannot fairly be expected from the general practitioner is coming to be recognized. Accordingly a movement is on foot, starting, I believe, in New York, to refer such remedies to some central authoritative body or university for investigation before their general recommendation. In the interest of general economy of effort, as well as for the preservation of a childlike trust in the efficacy of internal medication, we can but wish such a movement God speed. Syndicate Block.

ON THE PHARMACOPOEIAL RECOGNITION OF DIPHTHERIA ANTITOXIN.

By Joseph W. England.

There is no fact in clinical medicine more clearly established than that the human body. has within it natural resources for combatting disease processes and effects. But these resources have their limitations in the same individual at a given time, and in different individuals at different times, and become progressively weaker after the limit has been reached and passed. The inadequacy in some cases, of the natural resources to successfully combat disease conditions is well known, but it is particularly obvious in certain infectious diseases (e. g. diphtheria, smallpox, tetanus, septicemia, etc.),

where the bacteria causing the disease multiply with almost unthinkable rapidity, and the decomposition products (toxins) are so large in quantity and so virulent in character that they tax the system to its utmost to eliminate them, or, this failing, they cause death.

Within the last five years, however, there has been placed upon the market medicinal products which, injected into a body infected with certain diseases, have the property of strengthening the natural resources to combat conditions arising from the disease. These products are called "Antitoxins" or "Serums," and their use the "Serum treatment."

In their preparation, the natural processes that take place inside of the human body in its fight to overcome infection and its effects are duplicated outside of the human body, that is, in the serum of animals. An "Antitoxin," therefore, is a modified serum (properly purified) which has the property of combatting infectious diseases and their effects in the same manner as that possessed by the human body itself.

In the preparation of smailpox vaccine, the micro-organism of smallpox is developed in calves, and is then transfered to the patient, who elaborates in his own body, from the organism, the antitoxin necessary to confer immunity.

Diphtheria Antitoxin acts in the human body probably by chemically destroying the poisonous products of the bacteria causing the infection. It exhibits, also, a physiological action, supplying to the body the same elements that the body develops to protect itself against the poisonous bacterial invasion.

The true nature of the active principle of Diphtheria Antitoxin is an unsolved problem. It may be an organic substance, an organized product, or an enzyme or soluble ferment (which are proteid or nucleo-proteid in chemical character). acter). The small dose of antitoxin, its rapidity of action, and its profound influence upon the human system, would suggest that it might be enzymic in character, although there is no positive evidence to sustain this theory. The power of some enzymes for work is almost unlimited. A sample of invertase which had inverted 100,ooo times its own weight of cane sugar was found by O'Sullivan and Thompson to be still active. ("Soluble Ferments and Fermentations," p. 120, J. Reynolds Green.)

The preparation of antitoxins is of interest. That of diphtheria antitoxin is typical of the others, and is as follows: A culture of diphtheria bacilli is grown upon Loeffler's solidified blood serum, and the colonies grown are transplanted into faintly alkaline bouillon (in flasks) and kept at a uniform temperature of 37° C. The bacilli rapidly multiply and produce large quantities of a highly poisonous product of toxin (diphtheria toxin), after which the bacilli are destroyed by the addition of 1 per cent. trikresol, and their dead bodies are removed by filtration,

*Read before the meeting of the American Pharmaceutical Association, held in Richmond, Va., May, 1900.