Answer: Every child receives toxin antitoxin and we do not use the Schick test. Superintendent Kepford: We observed something along that line in these cases. So far as I know all of the cases in the hospital excepting the case of the teacher, had the Schick test. I understand you gave the toxin antitoxin with the test. Dr. White: Yes, all new arrivals are given it. Superintendent Kepford: Toxin antitoxin? Dr. White: Yes. Superintendent Kepford: I was going to say that these cases that had been Schicked all of them practically, have shown a very modified form of the disease. We ought to have a laboratory really to make the diagnosis. The doctor could not from the clinical symptoms make the diagnosis. Dr. White: There is a reason behind those facts. There has been a great deal of work done on the relation of the Schick test to immunity. A number of papers have been presented with extensive statistical evidence as to its value. In the first place a very high percentage of children under ten years of age give positive reactions, not having developed a natural immunity, so that where it has been carried out on a large scale as in school children, these schools have abandoned the Schick test because of positive reactions in children under ten years of age. It has been shown definitely that adminstration of toxin antitoxin results in a very low percentage of cases among immunized people. There is a little point Dr. Griswold checked me on when I made a statement at the Rock Island County Society, that our cases had been modified by toxin antitoxin and that clinical signs of diphtheria were not present. He said the fly in the ointment is that immunized children may be carriers and give a positive culture, but do not contract the disease so you find these organisms in the throat, not in a case of diphtheria but a case of tonsillitis with diphtheria organisms present. Thus immunized children harbor diphtheria organisms in the throat and transmit the disease to other children. There is no question but that children in institutions through. contact, with other children and contact with the disease develop a natural immunity so that they do not acquire the disease but new children coming in who do not have this immunity, present some of the most virulent cases. I am very grateful for the discussion, as it has brought out come points I did not have time to mention in order that the paper might be brief. We should make it clear that we are not carrying on an operative clinic in the orphans' home. We only care for the cases that we consider are not safe to transport to Iowa City and need immediate and continued observation, otherwise they would be sent to Iowa City for operation. In schools where it has been worked up from a statistical standpoint in a large way, it has been shown that immunization to diphtheria does protect and is highly desirable. Very few patients have developed diphtheria after they have been immunized. However where the disease is present and other persons exposed, it is necessary to use antitoxin for immediate immunization, as immunity after toxin antitoxin develops only after five or six weeks. Another point I think we ought to remember, was brought out by Dr. Griswold at the same meeting, concerning the dosage of antitoxin. The older members here remember when they thought 1,000 units was about as liable to kill as to cure. Dr. Griswold says, because of the chance that the antitoxin may have deteriorated and you are giving less than you estimate in any event, that not less than 20,000 units should be given intramuscularly to the patient, regardless of sex, weight, race, creed or color, and for immunization not less than 3,000 to 5,000 units. whereas most of the packages say 1,000 units. He points out again that a repetition of doses is the undoing of just what we would like to do with antitoxin. Hence a large initial dose is the best procedure-a dose large enough to counteract the disease as found in its particular stage and virulence. THE OUTLOOK FOR SOLDIERS' HOMES. Member Butler (Presiding): The last paper to be given is on the subject "The Outlook for Soldiers' Homes," by B. C. Whitehill, commandant of the Soldiers' Home, Marshalltown. Iowa. The paper will be found on page 61. Member Butler: Major Hollowell is to open the discussion. Warden Hollowell: I am called upon to answer questions every day about Spanish-American and World War veterans, and I would like to get a copy of the paper for the Legionnaire. I cannot add anything to what has been said by Commandant Whitehill. I was in the Spanish-American war and have just recently begun to hear of Spanish-American soldiers being taken to a hospital or any place else. Member Butler: This seems to end the program as given here. If there are any items of general business or interest to the conference, we would be glad to take them up now. Chairman McColl: I will appoint as a program committee for the June 1924 meeting, Superintendent Hanchett, Member Butler, and Superintendent Stewart. Chairman McColl: An engineer is here from Minnesota who has been connected with the board of control there, and he wishes to discuss the heat question-ways of saving fuel for state institutions. He will be here in the morning and those of you who want to hear him, may hear him at that time. PROGRAM COMMITTEE REPORT. Chairman McColl: Will the program committee for the March conference make a report? Superintendent Scarborough: I will give as the program for the March conference, the following: 1. Health Values, By J. D. Paul, M. D., Physician, Men's Reformatory, Anamosa, Iowa. 2. Training Future Citizens, By Ray M. Hanchett, Superintendent, Mitchellville, Iowa. 3. Child Development, By Prof. Bird T. Baldwin, 4. Liming of Iowa Soils, By W. H. Stevenson, Professor of Farm Crops and Ames, Iowa. 5. Child Placing at Our State Juvenile Institutions, Board of Control of State Institutions, 6. The Menace of Morphine, Heroin and Cocain, Rockwell City, Iowa. The conference adjourned sine die. ORCHARD EXPERIENCE. Max E. Witte, M. D., Superintendent, Clarinda State Hospital. Practically all knowledge we may have has been gained by experience, the experience of ourselves or others. Even research, the exploration into the regions of the unknown avails itself of the experiment, or directed experience for the purpose of solving a problem or verifying conclusions derived deductively. We are so constituted that much the greater part of our active mental force reared or organized knowledge must be obtained by individual experience and we obtain, perhaps, the most lasting benefit from experience which was adverse and costly. Experience is a dear school but we will learn in no other. It is a pity, we cannot bequeath our mental wealth gained by experience to our offspring, or to those who are to follow usExcept by the spoken or written word which is at best so weak and inadequate for the purpose. What has been said, applies fully in orcharding. But that some one interested in the growing of fruit, but without the wisdom taught by bitter experience, may be benefitted, and not fall into avoidable errors, is the purpose of these lines. The subject is so vast, involving as it does all of one half of animated nature-that is the vegetable kingdom; that what I say must necessarily be held very brief and dogmatic, and can touch even on the most important features very lightly. We shall consider the apple orchard, more particularly since the apple is our most important fruit-and what applies to the successful growing of apples is also with some modification perhaps, pertinent to the production of other fruit. It is axiomatic to say; that to obtain good fruit we must have sound healthy trees, of varieties suited to our climate, and growing in soil physically and chemically in a condition to supply the needs of the growing and bearing tree. To meet these indications, we must have a ready and sound knowledge of plant physiology and plant pathology. Location. The orchard, should if possible, be located on the north slope or still better, the northeast slope of conveniently situated land. This, for the reason that, the wintry sun will strike the orchard so situated at a smaller angle than when on south slope, or even when on a level. This means that the soil does not thaw so early or the sap start so soon, and hence trees are longer dormant in late winter or early spring, and renewed plant activity is thereby delayed-so that budding and blossom time is retarded, perhaps beyond killing or at least damaging late frosts. Soil. The soil should be mellow, well drained and of fair fertility, or at least possess all the elements to supply the need of the growing and bearing tree. If the soil does not possess these qualities, we should come |