the Doctor thinks the result obtained from this serum has been disappointing. This result may be caused by the circumstance that pure streptococcic infection is rare as compared with mixed infection. Where the infection has been purely streptococcic the result has been good.

Antitetanic serum gives good results when used early and in large quantities. Professor Ehrlich is quoted as saying that initial doses of thirty cubic centimeters or more followed by frequent subsequent doses of ten or twenty cubic centimeters may be depended on to produce results satisfactory in character. Authorities differ as to the mode of administering this serum. Among the methods mention is made of subcutaneous, intravenous, intraneural, intracerebral and intraspinal by lumbar puncture. The use of dried antitetanic serum as a dusting powder in dressing suspected wounds is recommended.

Antiplague serum is said to be of positive value when given in large doses from sixty to one hundred and fifty cubic centimeters, or even three hundred cubic centimeters, preferably intravenously.

In exophthalmic goitre the specific serum is said to be so encouraging in results that its use is to be recommended.

Hay-fever serum the doctor thinks is of great but of uncertain value. The remedy may be administered hypodermically but better results are usually obtained by having the patient himself apply the serum to the nasal mucous membrane by means of a dropper when irritation is noticed. In the use of this serum the good effects are not long maintained.

Tuberculin is spoken of as an experimental product and antitubercle serum as being worthy of more extended trial. Serum for rheumatism, secured from horses treated with streptococci, isolated from the throat of the rheumatic sufferer, gives promise of being valuable.

The sera whose standing as curative agents has not been established are mentioned above.

EDITORIAL COMMENT.

THE NEW CLINIC IN PSYCHIATRY AT THE UNIVERSITY OF MICHIGAN.

THE first University Psychopathic Hospital and Clinic established. in America for the observation, care, and treatment of persons afflicted with incipient insanity, and for borderland cases which cannot be strictly regarded as insane, although manifesting various phases of mind disturbance, is now in operation as a component part of the medical equipment of the University of Michigan, under the directorship of Doctor Albert Moore Barrett, late pathologist of the Massachusetts Hospital for the Insane, located at Danvers, and assistant in neuropathology in the Harvard Medical School. The governing power of the institution

is vested in a joint committee, whose appointment rests with the University Regents and the executive bodies of the various state asylums for the insane.

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The institution was created by enactment of the legislature of 1901. A supplementary act of the legislature of 1905 established relationship between the hospital and asylums, and henceforth the two forces will render combined service in the management of the new institution. Another provision of the law invests the director of the Psychopathic Hospital with the title of pathologist to the several asylums, and professor of neuropathology in the medical department of the University. In the capacity of pathologist a requirement contemplates definite knowledge by this official concerning the medical conduct of the asylums throughout the state, exacting frequent visits for the purpose of encouraging the medical staffs to pursue careful scientific study of the various forms of mental disease peculiar to the inmates. As professor in the University the director is required to impart instruction in clinical psychiatry and conduct the laboratory for psychopathic research which was founded in connection with the hospital, the maintenance of which is insured by an annual appropriation of five thousand dollars granted by the legislature.

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The objects sought to be attained by founding the institution contemplate more accurate investigation relative to the nature and causes of insanity. The idea is to make the new acquisition a central pathologic institute which will afford not only expert skill in nervous diseases by reason of coöperation with the asylums of the state, but possess, in consequence of University connection, the additional advantage of specialists in every branch of medicine. It will give asylum physicians opportunity to pursue research work at the clinical laboratory, and qualify students to render intelligent service as asylum physicians or general practitioners. It will exert influence in the direction of creating a correct public sentiment regarding psychopathic ailments and of promoting rational ideas concerning the prevention of such diseases.

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The Psychopathic Hospital is especially designed and equipped for the study of acute cases of mental disturbance. It has accommodation for forty patients-twenty of each sex. This limited number permits the alienists to exercise close observation of every subject committed. for treatment. The clinical laboratory affords apparatus for conducting elaborate investigation bearing on the phenomena of mental disease, and the study of any anatomical material supplied by the various asylums will be pursued according to methods afforded by the most modern neuropathological technic. There will likewise be installed in the building a complete hydrotherapeutic apparatus modeled after the design of Doctor Baruch, together with apparatus for administering

electrotherapeutic treatment whenever this particular therapeusis is indicated.

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The Psychopathic Hospital affords a place where persons may be sent for short observation pending opinion as to the necessity of committing them to one of the state asylums, or as to whether preliminary treatment at this institution will obviate the necessity for such commitment. Thirty-eight patients have already been registered and applications for a number of others are under consideration. Thirty-two of the patients were transferred from the state asylums at the opening of the hospital, and the remainder are voluntary patients or those committed as private and county charges. In addition to the director there. is constantly in attendance the resident physician, Doctor George Milton Kline. Cases are continually presenting in which the question must be determined whether the condition is one of neurasthenia or of more serious transitional form of mental disturbance, and physicians throughout the state are advised that patients may be sent to the institution according to three processes.

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(1) In cases where application shall be made under the statute to send persons claimed to be insane to one of the asylums in the State of Michigan, the Judge of Probate, before whom said application is pending, may require the assistance of three competent and skilled physicians who shall investigate the condition of said person and report the same to the Judge of Probate in writing and if said Judge of Probate upon investigation ascertains that there are present in the condition of the patient such features as render detention in a psychopathic hospital for a brief period advisable as a precautionary or curative measure, or if from such investigation said Judge of Probate shall be of the opinion that the case requires the services or treatment of specialists in the treatment of diseases other than those of the nervous system, he shall pass an order directing that such patient shall be transported for treatment to the Psychopathic Hospital of the University of Michigan. If the patient shall continue insane after any such special treatment he may be removed to and confined in such asylum of the State of Michigan as the Probate Judge may decree in his order of committal to the Psychopathic Hospital.

(2) In case the Superintendent of either of the asylums for the insane shall be of the opinion that the condition of mind of any person confined in such asylum is such that it might be advisable that the patient be sent to the Psychopathic Hospital he shall cause such person to be conveyed thereto. If such patient shall be restored to sanity while in the said institution he shall be discharged, but in case such patient. shall be found incurable, the Superintendent of the University Hospital shall cause said person to be returned to the asylum from which said person was received, the charges for the care, maintenance and trans

portation to be paid by the county or by the state, depending upon whether the patient is a county or a state charge.

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(3) Persons may commit themselves as voluntary patients under the same provisions as apply to such commitments to the state asylums. The exact charge for maintenance cannot be determined at this time, but will depend upon the average per capita cost for maintaining the hospital, and will vary with the number of patients present in the hospital at such time. It will be somewhat higher than for the care of patients in the state asylums, but will be kept as low as is consistent with proper treatment and the purposes for which the Psychopathic Hospital was established. It will probably be about the same as is charged in the other hospitals of the University, which at present is about seven dollars and fifty cents per week. Private patients may be admitted at any time under any of the foregoing provisions. In such cases the joint board in control of the Psychopathic Hospital has fixed the rate of fifteen dollars per week, and requires the friends of each private patient to furnish a bond in the penal sum of one thousand dollars, on substantially the same conditions, so far as applicable, as those required by the Michigan asylums for the insane. There shall be paid by such private patient, or by his or her friends, at the time such patient is admitted, as an advance payment toward the support of such patient, the sum of fifty dollars.

ANNOTATIONS.

THE TREATMENT OF SARCOMA WITH MIXED TOXINS. COLEY, in a contribution to the recent meeting of the Southern Surgical and Gynecological Association, detailed his experience with a mixture of the toxins of erysipelas and the bacillus prodigiosus in the treatment of sarcoma. While the doctor had, until recently, employed the mixture only in such cases as were not amenable to surgical treatment, his success with a large variety of cases has led him to advocate its administration in all forms of the disease wherein primary surgical operations have been performed. Very minute doses should be employed in this class of cases-only large enough to produce slight reaction. Before inaugurating radical measures, such as limb amputation, it is well as a final resort to employ the toxins, since in a number of patients disappearance of the tumor and consequent recovery resulted from their administration. In arriving at his conclusion the author observed the recovery of twelve patients, eight of whom were alive and well for from three to six years after treatment. Eight of the above cases were of the round-cell variety; two of the spindle-shape; while the tissue of the remaining two patients was not subjected to microscopic examination. But three of these cases were personal. However, Coley has detailed the result of the treatment in thirty-four cases under his direct supervision, with which he experienced but five

reverses-recurrence of the tumor and subsequent death. While the demise of this quintet is to be regretted, it would seem to furnish proof conclusive of the correctness of the diagnoses. The cases under Coley's personal study, and those which he has been able to observe outside his own practice, embodied (1) round-celled, (2) mixed-celled, (3) spindle-celled, and (4) endothelioma.

PEDAL CHARACTERISTICS OF DIFFERENT PEOPLES. COMPARATIVE study of the foot in barefoot and shoewearing peoples is detailed by Doctor Hoffmann in a late issue of the Quarterly Bulletin of the Medical Department of Washington University. The relative length of the foot in either class is practically the same, and in both classes the form, function, and range of motion, up to the time of shoe adoption, are markedly similar. Deformation and inhibition of function follow the inauguration of shoewearing. The pedal inheritance of the shoewearer's progeny, so far as form is concerned, is synonymous to the heritage acquired by the offspring of barefoot races, the natural symmetry, however, being altered after encasement in modern footwear. The theory is advanced that the strength and usefulness of the foot is not dependent on the height and shape of the longitudinal arch, and breaking and lowering of the arch to the degree of flat-footedness is rarely resultant from weakness at this point. Moreover, no relationship exists between the gait and the height of the arch.

PHYSIOLOGIC FUNCTION OF THE PITUITARY BODY.

ANENT the various theories that have been expounded regarding the origin of sleep, a recent contribution by Doctor Alberto Salmon, to the Italian Medical Congress, is of vital interest. The opinion of this scientist is that an internal physiologic secretion from the pituitary gland produces somnolence. He further expresses the idea that the bromine contained in the pituitary structure is the active agent in sleep production, and cites the experience of the profession in the employment of the glandular extract in insomnia to substantiate his hypothesis. Somnolence is often associated with certain pathologic conditions of the gland, and the reverse may be true, since in many cases wherein tumor is present, in Graves' disease, in cases of poisoning with consequent inhibition of the secretion, and in many other conditions, including senility, insomnia is the prevailing symptom. While sleeplessness is said to result from an insufficient flow of the pituitary secretion, an increase of the fluid by the ingestion of such toxic drugs as pilocarpine invariably produces a condition of profound sleep.

THE MECHANICAL TREATMENT OF MAL DE MER.

A MECHANICAL device lately invented by Doctor Carl Brendel, a Russian physician, promises relief from seasickness to individuals not proficient in nautical accomplishments. While the condition has been combatted more or less successfully by the administration of drugs and