organs that produce antitoxin, enhance correspondingly the bactericidal and antitoxic efficiency of the blood. This, he showed also, was the effect produced by those germs, toxins, poisons, etc., which are capable of evoking a defensive reaction in the body, as manifested by fever.

Sajous describes in detail all the diseases that are most fatal to mankind and shows conclusively that wherever cure had been effected by remedies, it was through agents which, by stimulating the organs referred to, increased the blood's asset in auto-antitoxin-the name given by him to the antitoxin which our body produces to antagonize disease.

But how does auto-antitoxin destroy pathogenic organisms, the toxins they secrete, poisons, toxic products of metabolism, etc.? Sajous shows that this differs in no way from the process of digestion, and that if auto-antitoxin is present in excess in the blood, the red corpuscles themselves may be digested (hemolysis). As to the process itself, the explanation he submits is based on the well-known fact that ferments are active, up to a certain limit, in proportion with the temperature to which they are exposed. When the temperature is normal, the ferments are active just sufficiently to carry on normal functions; when it is raised, their digestive activity is increased accordingly. Now, in the blood, the temperature is raised whenever its supply of adrenoxidase (the oxygenized adrenal secretion) and the nucleo-proteid granulations (supplied by leucocytes) is increased, owing to a reaction between the oxygen of the former and the phosphorus of the latter. Heat-energy being liberated in excess, the digestive activity of the ferments in the blood (which gives it its bacteriolytic and antitoxic properties) is correspondingly increased.

Yet, how are these germ-killing and poison-destroying substances caused to appear in the blood? How do poisons awaken the defensive reaction of the body?

The Pituitary Body.-Located on the very top of the spinal column in the sella turcica, immediately below the brain, protected on all sides with the utmost care, lies this organ. To its rôle in the economy a recently published text-book of physiology devotes seven lines! Indeed, beyond the fact that it is supposed to provide some sort of a secretion (the purpose of which has never been found), nothing is known as to the actual rôle of its anterior lobe; while its posterior lobe has been relegated to the rank of a vestigal remnant. Sajous demonstrates not only that this conception is false, but that the pituitary body in its relations to the functions of the body at large is even more important than the brain itself. None of these functions are impaired when the cerebral hemispheres of an animal are removed; all cease, however, when the whole pituitary body is submitted to the same

ablation. The brain, as the organ of mind, can utilize the spinal system, with which it is connected, to execute its mandates; but the spinal system is also supplied with its own brain, the pituitary body, which Sajous terms the "somatic brain," viz., the governing organ of all vegetative functions. He shows, moreover, that this "somatic brain" contains a delicate organ whose mission is to protect the body against disease.

In his first volume, Sajous had advanced the view that the anterior pituitary body was a sensitive organ which perceived, as it were, the presence of any adventitious substance in the blood. The existence of such a structure has since been confirmed independently in Europe, Gentès having found histologically therein a sensory structure resembling the olfactory area of the nasal cavity. Dr. Sajous's conception is readily explained: When the blood circulating in the anterior pituitary body contains any abnormal substance-a drug, a poison, a toxin, etc.-it affects this sensitive organ just as odoriferous particles do the olfactory area. Sajous studied this organ in the animal scale, through comparative morphology, and found it in all animals down to such low forms as molluscs, where it bears a suggestive name given to it by zoologists, viz., the test-organ, or osphradium, and is known by them to test the water ingested by these lowly beings. But how, in the higher vertebrates, including man, does this test-organ protect against disease?

Sajous found, as previously stated, that the adrenals were provided with a center situated at the base of the brain. This, he subsequently ascertained, was a nucleus of cells in the posterior lobe of the pituitary body, which nucleus received nerve-fibres from the sensitive test-organ referred to. Now, the manner in which any poison or toxin can increase general oxygenation becomes apparent: it excites the test-organ, and this structure, in turn, through nerve-paths (passing by way of the base of the brain, the bulb, the cord, the sympathetic and splanchnic nerves) increases the functional activity of the adrenals. Thus the blood is provided with an excess of adrenoxides. True, this is but one of the constituents of the body's protective substance, auto-antitoxin, but the manner in which the other components of the latter are formed is readily apprehended: the metabolism of all organs being rendered unusually active by the excess of adrenoxidase in the circulating blood, the formation of leucocytes is activated (leucocytosis) and the proportion of nucleo-proteid, their product, in the blood is correspondingly increased. The secretory activity of the pancreas being also stimulated by the excess of adrenoxidase, more trypsin is produced; and we thus have the three components of auto-antitoxin: the oxygen-laden adrenoxidase and the phosphorus-laden nucleo-proteid to supply the in

creased heat-energy required to enable the trypsin both in the phagocytes and in the blood to destroy bacteria, their toxins, or any other poisonous agent which the blood may contain.

This is not all, however; as shown by Sir A. E. Wright, the bacteria must be prepared for the phagocytic feast. Sajous, as previously stated, has discovered that the thyroid and parathyroids were the source of Wright's "opsonins," i.e., thyroidase. Now, the nucleus through which the adrenals receive their stimulating impulses from the test-organ is also shown by Sajous to transmit stimulating impulses to the thyroid apparatus. When disease-germs invade the blood, therefore, their toxins, by exciting the test-organ, cause the blood to be provided with thyroidase (opsonin) to sensitize the germs, and with auto-antitoxin to destroy them.

The grave mortality from all diseases in the young as well as in the old shows, unfortunately, that although our body is endowed with protective functions, these are often inadequate to prevent, or even arrest, disease. This is where Sajous's labors are to prove most prolific in results, since they have demonstrated conclusively that by means of the remedies in constant use among physicians, the protective mechanism can be activated sufficiently to protect the patient. Pasteur's prophylactic treatment against rabies, Wright's inoculations, bacterial vaccines, etc., are but examples of the protection afforded through agents which stimulate the test-organ, this action differing in no way from that of the drugs referred to, the action of which can, besides, be more readily controlled. All these measures cause the blood to be flooded with thyroidase (opsonin) and auto-antitoxin. Hence the fundamental principle Sajous establishes-that "immunizing medication is the foundation of rational therapeutics," which, as he shows by a comprehensive study of cancer, tuberculosis, syphilis, Asiatic cholera, cholera infantum, bubonic plague, epilepsy, puerperal eclampsia, and many other foes of mankind, is as applicable to the most virulent diseases as to the more benign. He not only points out the meaning of the vis medicatrix naturae, but shows us how we can increase its efficiency and thus master disease.

Those who, like the writer, have availed themselves of Sajous's teachings in their daily work, have been able daily to appreciate the strength of his position, the power of the weapon or key he has placed in their hands, and the renewed confidence he thus inspires in practical medicine.-Monthly Cyclopedia of Practical Medicine.

TREATMENT OF UTERINE FIBROMYOMATA WITH
THIOSINAMINE INJECTIONS.

BY DR. SIDNEY H. GARDINER.

THE satisfactory results obtained by Dr. Sidney H. Gardiner from the treatment of uterine fibromyomata with intramuscular injections of Fibrolysin into the gluteal region were such as to encourage him to believe that the use of this remedy would do much to save such cases from radical operation. One of the important effects also noticed during the course of this form of treatment was that even before the tumor had completely disappeared the patient's general health greatly improved, not only physically but also mentally.

A résumé of the cases successfully treated by the author on the above lines will best illustrate the results.

CASE 1.—A woman of 38, married; one child. Suffering from acute menstruation occurring every three weeks for the past three or four years, accompanied by leucorrhoeal discharges of mucoid character. The examination revealed the presence of a nodulated mass on the left side of the cervix, softer posteriorly and extending into the cul-de-sac. It was evidently a case of prolapsed and cystic left ovary, with either an inflammatory mass of fibroid growth on the side of the cervix immediately in front of, and adherent to the ovary. Local treatment had no influence upon the tumor, and the treatment for fibromyomata with ergot, etc., also showed no noticeable results. After eleven months the first injection of Thiosinamine was made. Upon the fourth injection the tumor was found to be much reduced in size, almost painless when touched, and the patient also bore the examination with less distress. (For the subsequent injections, the author made use of Merck's Fibrolysin, a Thiosinamine preparation put up ready for immediate use.)

After the fourteenth injection no trace of the tumor could be found. Bimanual examination deep into the pelvis behind the uterus, and rectal examination showed nothing left but the ovary, still in the cul-de-sac, but not so painful. With the disappearance of that tumor came a marked improvement in the general condition, and after a period of nine months had elapsed there had been no return of the tumor and the patient had maintained her health.

CASE 2.-This patient was suffering from vomiting during pregnancy, and was unable to retain any food. When Dr. Gardiner was called in he found a basin containing a pint and a half of mucous saliva beside her. An examination revealed the presence of a tumor

on the right lower uterine segment and a larger one higher up. Four years before, this tumor had been mistaken for pregnancy by her attending physician. Fibrolysin injections were made every two or three days until the end of the second week of treatment, when the patient had recovered sufficiently to come to the author's surgery for treatment. Twenty-one injections of Fibrolysin were given in all, and in due time she was delivered of a healthy baby. In this case it was interesting to observe the effect of the medicine in allaying the irritation in the uterus that had caused the reflex symptoms, viz., vomiting and salivation.

CASE 3. This was one of fibromyomata imbedded into the right side of the uterus, and being subperitoneal there were no haemorrhages. The patient had been under the author's observation for nearly eighteen months and his diagnosis had been confirmed by three other physicians, including a gynecologist of ripe experience.

With the exception of the disappearance of a pain in the right iliac and hypogastric region, there was little effect noticeable at first from the treatment with Fibrolysin. However, after the fiftyfifth injection the tumor had almost completely disappeared, and a recent examination showed no return.

The patient at the close of the treatment had improved immensely, and felt better than for years past.

CASE 4. This patient was delivered nine years previously of her last child, and had since had an abortion without any apparent cause. During the past few years she developed palpitating disturbances of the heart, with an impaired digestion and, in her own words, a "general good-for-nothingness." Her mental state became clouded, she failed to think and act in an orderly manner. Upon examination a uterine tumor was found reaching up to the umbilicus, and measuring from side to side over 6 inches, either involving the whole uterus or surmounting the fundus and spreading laterally. Six to eight Fibrolysin injections were administered monthly, and at the time of writing the patient had been given forty-eight in all.

Although still under treatment, the following improvements had taken place: Menstruation, which was formerly profuse and lasted from seven to eight days, is now regular, lasting three to four days and never profuse. The tumor was reduced in size laterally from 6 to 4 or 4 inches, while its length from cervix to fundus was also proportionately reduced, the uterus being freely movable. The waist line had decreased by four inches, and the bust measurement had slightly increased.

Her general health she considered fully restored, she worked better, tired less easily, and her mental fears and emotions had disappeared.

The other four cases in hand were at the time of writing not