order that she be able to stand the shock of such a severe operation.

The tapping was done on April 27, and on May 19 the second operation was performed. During this period the patient's dietary consisted of a light native diet, with rice in the form of thick soup seasoned with a little chicken broth, a little taro, bread fruit, bananas, mangoes, and occasionally bread and cabin biscuit (sailor's bread). Meat, tea, coffee, and tobacco were proscribed. During the interval between April 27 and May 19 the patient gained several pounds of flesh, her strength increased greatly, and she was anxious to have the operation performed. For three days previous to the operation the patient was given preparatory treatment in addition to her regular tonic treatment.

The field of operation having been prepared in an aseptic manner and the anesthetic administered, an incision four inches long was made in the median line of the lower third of the abdomen. Through this opening the hand was passed into the abdominal cavity, and the adhesions, which were quite extensive, were broken up. The tumor was found to extend up behind the stomach and liver, nearly to the diaphragm. A small portion of the sac was drawn out through the opening, and a considerable amount of fluid, which had accumulated since the first tapping, was withdrawn. After this the sac and solid parts were tied off and removed. They weighed eight pounds, which, in addition to the fluid removed at the first tapping, made a tumor weighing 60 pounds.

The abdominal opening was closed with strong sutures, and an antiseptic dressing applied. The patient made an excellent recovery, and in three months' time was walking about. At the present time she is working to pay for her operation. Fig. 2 shows the patient three months after the operation.

CASE II.

This patient was another Samoan woman, from the village of Fogaloa, Upolu. On examination it was found that she was suffering from an abdominal tumor similar to that reported in the first case, but considerably larger. Her trouble dated back three years. Fig. 3 shows Case II before the operation.

When the tumor first made its appear

61

Three days were consumed in preparatory treatment, and the final operation was performed on July 27. Two English

men-of-war were in the harbor at the time, and we had the privilege of the assistance of their surgeons at this operation.

The operation was attended with much difficulty, as the tumor was adherent to the abdominal walls, omentum, and intestines. In many places the adhesions between the omentum and cyst had become so firmly united that they could not be broken away, so it was necessary to tie off the omentum in sections with the cyst, and cut both away together. About two thirds of the omentum was sacrificed in this way. We found the solid parts of the tumor which was enclosed in the cyst to be cancerous.

The solid tumor, with the sac, weighed about twenty, pounds, making in all a tumor weighing seventy and one-half pounds.

The patient did nicely until the third day, when grave symptoms developed, and continued until her life was despaired of; but she finally rallied, and made a good recovery. At the present time she is enjoying good health. Fig. 4 shows Case II two months after the operation.

THE regulations. restricting the privileges of the Ecole de Médicine have been rescinded, and the old order of things. restored. Foreigners may now enter and matriculate as in the past.

LOOKING Over the results of some experimental work which had been performed in order to determine the effect of various substances, when held in the mouth, on the rapidity of salivary flow and the intensity of its amylolytic action, it was noticed that maltose and foods containing maltose had a marked tendency to increase the salivary activity. To verify this observation, sixty-four tests were made, involving the examination of one hundred and twenty-eight samples of saliva.

The saliva obtained by masticating paraffin for three minutes was weighed. Then, after subjecting the salivary glands

to the action of the food under observation by masticating it for three minutes, another sample of saliva was obtained, by again masticating paraffin for three. minutes, and weighed.

One c.c. of each of the samples of saliva thus obtained was added to a solution containing o. 1 gm. of boiled starch; and by means of Lugol's solution as an indicator, the rapidity with which the starch was converted into achroödextrin or sugar was determined.

The salivary activity was calculated by means of this formula:

g = number of grams of saliva produced in three minutes.

m = number of minutes required for 1 c.c. of the saliva to convert one gram of starch so that no color would be found on adding Lugol's solution.

The first series of experiments, involving the examination of sixty-eight samples of saliva, gave results from which the following averages were obtained: —

As a result of masticating maltose, the percentage of increase in salivary activity. was twenty-five.

Maltol, a product of malt and nut oil, increased the salivary activity fifty-two per cent.

Ambrosia, a product of malt and nuts,

increased the salivary activity thirty-six per cent.

The salivary activity after masticating. the following substances was decreased: Cane sirup, 16 per cent. decrease. Glucose,

13

· 66

Butter,

Cocoa butter, 25 Nut oil,

13

Following the suggestion that there might be sufficient maltol left in the mouth to affect the result of the second test, a small amount of saliva was caught in a test-tube before saving the second sample of saliva for testing, and tested for the presence of sugar by means of Fehling's solution. In the larger number of cases, appreciable quantities of sugar were shown to be present.

To determine whether the maltose had sufficient amylolytic power to affect the salivary activity by its presence, a series of experiments were performed on the following malt preparations :

1. Diastatic Extract of Malt, a preparation sold for its amylolytic properties by an Ohio firm.

2. A malt preparation manufactured by a prominent drug house.

3. Malt, manufactured for the Sanitas Food Co., according to their directions, and used in various nut foods.

4. Maltol, a combination of No. 3 and nut oil.

2. Maltol was masticated for three minutes, the resulting mixture of saliva and maltol being caught in tarred bottles. The dish of maltol for each individual being weighed before and after the experiment, the amount of maltol used was This readily obtained by subtraction. amount plus the net weight of the bottle subtracted from the gross weight of the bottle gave the amount of saliva secreted.

3. Saliva from No. I was mixed with maltol in the proportion found by experiment No. 2.

The rate of starch conversion was determined as in other experiments. The rapidity of conversion for the three samples were:

66

22.

66

M..... 31⁄2

66 K.. 5/3

Average

was

33 Comparison of sample 3 with sample 1 shows that the presence of the maltol increased the rapidity of starch conversion in four out of the five cases, showing that the amylolytic power of maitols greater than that of saliva in these cases. In the other case (Mr. H.) the amylolytic power of saliva and of maltol was equal. Comparison between sample 2 (in which the saliva and maltol were mixed in the mouth) and sample 3 (in which the saliva and maltol were mixed outside the mouth, but in the same proportions as in sample 2) shows that the efficiency of the saliva itself is increased while the maltol is in the mouth. Hence the maltol acts as a direct stimulant to the salivary glands, causing the secretion of saliva having increased amylolytic power.

CONCLUSIONS.

63

THE CAUSE OF POIKILOCYTOSIS.

BY T. H. RICE, M. D.

ONE day while examining a specimen of blood for plasmodia in the Battle Creek Sanitarium Laboratory of Hygiene, I saw under the microscope what seemed a reasonable explanation of how the red corpuscles are distorted in pernicious and other anemias. Anybody who has examined blood, freshly mounted, with a microscope, has seen, between the cover-glass and slide, currents of blood plasma carryblood corpuscles. By watching these currents, I observed that now and then a red corpuscle would adhere at one of its edges to the surface of the glass, and the current sweeping past elongated it into the characteristic pear shape that we so often see in pernicious anemia. corpuscle slipped from its moorings, and immediately assumed its original shape.

After a while the

Seeing this phenomenon, the query flashed into my mind, Does not this thing take place within the vessel walls? Some of the corpuscles, as they course through. the blood-vessels, undoubtedly adhere to the sides of the vessels in the same manner as observed under the microscope, and the blood current sweeping on pulls on the free end of the corpuscle, elongating it. When the corpuscle is again free, it regains its round shape because of its natural elasticity.

In impoverished states of the blood the corpuscles lose this elasticity to a very great extent, and thus are unable to regain the round shape when distorted by their adherence to the vessel walls. Also the impoverished blood slows the currentl and changes the character of the vesse, walls in such a way as to favor the adherence of corpuscles. Other shapes than the pear-shaped corpuscles may be due to or exerting the corpuscles' sticking to pressure upon each other.

64

(Translated by W. H. Riley, M. D., from the Neu

rologisches Centralblatt, Oct. 15, 1897.) THE published treatise in No. 18 of the Neurologisches Centralblatt, 1897, by Karl Schaffer in Budapest, regarding the` changes in the nerve-cell during rest, led me to communicate the results which I have experienced in like researches.

These researches had, first of all, the object in view to establish whether one can, with the method advanced by Nissl, which up to the present brings to view the best structure of the cell body, prove a change in the body of the cell after the cells have been for a long time in a condition of relative rest.

The animals ordinarily used in physiological experiments, such as the dog, rabbit, etc., cannot be made use of in such researches as these, first, because the rest produced without artificial means remains but a short time; and second, because it is extremely difficult to kill them without allowing them to leave the state of rest. For these reasons an animal was chosen for the experiment which remains weeks or even months in a condition of comparative quiet; for example, the so-called winter sleepers, or hibernates, such as the Erinaceus Europaeus.

Several examples of this kind were retained during the winter-time in a cold chamber in a box, in which they remained coiled up for four to six weeks. The hedgehog kept this position for the entire. time. In the meantime I do not deny that they moved back and forth occasionally.

While the final changes in the motor cells of the anterior horn could have only been produced by either rest or hunger, a second research was begun to ascertain whether changes in the cells of the anterior horn are to be found after inanition caused artificially (method of Nissl).

For this purpose several rabbits were

move about, but they received neither food nor water. The animals endured this from seven to ten days. They lost in weight on the average about fifty grams daily, so that the weight of their bodies at the close of the experiment was lessened from one third to one half. The temperature of their bodies at the beginning of the experiment was something over 39° C., falling at the end from 35° to 32°. At this time the breathing and heart beat were also slower. Otherwise than the marked emaciation, the animals showed nothing in particular until the day on which they were killed. On the last day the animal was stretched out, weak and exhausted, on the floor, the fore legs were spread out and the hind legs relaxed; the head sank to one side. On trying to raise the animal to its feet, it could not stand, but fell to the afore-described position, and felt cold to the touch.

In this state the animals were killed. Though death would soon have taken place naturally, it was not waited for, in order to avoid changes in the nerve-cells which might have been interpreted as preagonal if modified by natural death.

In a few seconds the beast was dead, the medulla oblongata having been cut through the middle, and small pieces. taken from the cervical, lumbar, and dorsal regions of the spinal cord, which were hardened in ninety-six per cent. alcohol for twenty-four hours. From the moment of the death of the animal to the instant when the pieces of the spinal cord, 2mm in thickness, lay in alcohol, not more than five minutes elapsed. After twenty-four to thirty six hours two thick cuttings, from 15 to 20 pd., were enclosed in benzincolophonium, and colored by the new methylene blue method discovered by Nissl, and were examined with an oil immersion pantachromat, 2, Omm. E. Leitz.

In like manner sections were made which came from a normal animal; and I could not discover any difference in the motor cells in the anterior horn in the hungry animals and the normal animals.

The sections were submitted to other competent critics, who were not told which sections came from the normal and which from the starved animals; and they also did not discover in any way a difference worth mentioning between the two.