NE year ago I had the pleasure of reading a paper before this society upon Intravenous Infusion in the Treatment of Tuberculosis. Further studies along this line have led me into the treatment of tuberculosis by the use of a concentrated serum in preference to the intravenous method, which is complicated and time consuming; nevertheless, I am still using the same general methods and with the same general idea in view, i. e., the production. of a natural immunity. Immunity may be broadly defined as the process by which the body develops its defensive. forces and wages war against substances introduced into the system which are deleterious to its welfare. It is gene:ally divided into Natural and Acquired; Natural when the power of resisting any specific infection is the natural heritage of a race or species; Acquired, when a natural state of susceptibility is transformed by various causes into a condition of greater or less resistance. Acquired immunity may be either (a) active or (b) passive. In the active form the cells of the body are stimulated by the infectious agent to generate protective substances, and immunity is thus due to the direct participation of the organism concerned, and depends upon increased cell activity. Active acquired immunity may result from: 1. An attack of the disease after natural exposure; 2. by the incorporation into the animal. body of subtlethal doses of living, fully virulent bacteria; 3. living bacteria of diminished virulence; 4. dead bacteria; 5 bacteria products secreted or excreted during the life of the microbes; 6 products arising from the disintegration of the cells after death; or, 7, by the incorporation of certain microorganisms

or elements or their products, which are not associated in any way with the production of the specific infection. To the latter class belongs, for example, the use of yeast in certain infections, and perhaps the retarding effect of streptcoccus infection upon certain kinds of tumors. The increased resistance of the organism so treated is most likely due to the increased leucocytosis produced, which also causes the production of an increased amount of normal antobodies. In the passive form, the tissues of the individual takes no share in the manufacture of the protective substances, the immune bodies being formed in another animal and transferred to the individual to be protected; e. g., Diptheritic antitoxine. It does seem to me that there is an intermediate ground between these two theories that offers opportunities for research work that will be prolific of very beneficial results to our patients.

It is along this intermediate line that I am now offering for your consideration some results that are remarkable, to say the least, results which may be obtained by any man if he will be but a little persistent and careful in carrying out the instruction that will follow. The essential of the use of Nuclein (which is but a normal cell constituent of bacterial character) is that it stimulates the production, as well as supplying some itself, itself, of normal immunizing agents in the blood; also that you are introducing into the blood a vital cellular substance that aids in upbuilding the devitalized blood that we meet with so much in Tuberculosis. Further studies along these lines has led me into the field of animal nucleins in preference to those of vegetable origin.

There is no question but that the cells

of the blood, both red and white, as well as the endothelial cells of the body, produce continuously normal antibodies for the protection of the system from invasion of germs of various character, that produce the typical disease of which each germ has been demonstrated as the cause. I believe that Metchnikoff and Ehrlich are both partly right in their theories, as well as I believe that Carl Spengler, with his immune kopper-serum is nearer to having an anti-toxin for tuberculosis than any that has yet been produced.

May we not be wrong in many of our theories in continually seeking a positive antitoxin for every form of bacterial disease? Is it not possible and also reasonable, to draw the conclusion from our past experiences that antitoxins will be found of a positive nature only for those germs that are virulent and fulminating in character, i. e., where there is an invasion of this character of germs, the patient is struck down and all the natural resistance of the body is overcome by one blow. In these cases, we must have an antitoxin, one that will neutralize the affect of the invading foe, and thus give the body an opportunity to supply normal anti-bodies to overcome the infection.

In the tubercle bacilli we have a foe of different character from these, one which is slow and insiduous in its invasion, one that manifests itself only after slowly undermining the systemic resistance, one that may take months or years to accomplish its purpose, one that invades the most vital organs of the body, and there slowly, increasingly, continuously, and relentlessly carries on its deadly work, gradually overcoming the normal resistance, then attacking and destroying the organic tissues. To meet this character of germ infection, we must adopt different tactics. We must meet the invader with those natural anti-bodies that the system itself produces. Call these anti-bodies by what

ever name you will, depending altogether upon whose theories you are following or accepting, but supply them if possible.

Nuclein, by intravenous infusion, in my hands, has accomplished much, but as stated in the beginning of this article, it has many disadvantages.

In an endeavor to simplify this idea of producing and supplying normal antibodies of animal origin, I have gravitated towards a serum, and have been using for nearly a year a serum derived from the blood of sheep or goat, in which has been previously produced a hyperleucocytosis, by forcing the animal. upon yeast, which is well known to be rich in nuclein and some complex enzynes. When the animal's blood shows a decided leucocytosis, the blood is drawn off, and the serum is prepared in the usual way. Extreme care is used not to break up the blood cells, but to only take the pure serum. I have chosen to call this serum Leuco-lexin, because of the large number of leucocytes, and consequently the large amount of alexia which it contains.

Laboratory tests have amply demonstrated that this serum is bactericidal in character; in fact it may be termed a super-normal bactericidal serum. It is in no sense an anti-toxin, as no production is attempted by the use of the germs, or their products, as is customary in the formation of all antitoxin serums.

Clinical results have been most satisfactory. Unfortunately, most of the cases that I have had to treat have been cases which were far advanced in the disease, in fact, most of them beyond all hope. In the primary cases, the results have been beyond my expectation. Even in these chronic cases the relief that has been obtained, and the improvement that the patient has manifested, unquestionably warrant us in using it in all stages of the disease. I have now used Leucolexin a sufficient length of time to be able to draw some conclusions, and the recitation of one or two cases with typical

results will be sufficient to give you some idea of the benefits obtained.

S. R., age 23, family history negative. Personal history, had pneumonia with pleurisy with effusion three years ago; been gradually declining ever since. For the past two years has been under the care of a physician who advocates giving all tubercular patients enough opiates to make them comfortable, and let them die in peace. Height 5 feet 10 inches. Weight 108 lbs., temperature 104 F., pulse 130, having one or two septic chills a day. Night sweats very profuse, patient completely exhausted thereafter. Tubercle bacilli streptococci and staphlococci present in abundance, expectoration amounted to over a pint a day. Patient been confined to bed for three weeks. The family were plainly informed that little or nothing could be expected, as the patient was very melancholy and would make no effort to help himself whatever, as his previous physician had informed him he could not live a month. I informed the family that I would use the serum experimentally only. March 13th, injected 2 c. c. of serum. Had a slight chill and sweat that night. Gave another dose on the 15th, 17th, and 19th; had a slight chill on the 16th, and no sweat since the night of the 13th. Temperature 99.4, pulse 100, feeling very much better. Upon the 21st complained of feeling very sore and lame from the last injection, so did not give him one. On the 23rd had a severe chill, temperature 102, pulse 130, had a very bad sweat. Gave an injection on the 30th. Has not had a chill since the 23rd, and only two slight sweats. Temperature has not been above 99.6, and he now walks 21⁄2 blocks to my of fice for treatment every other day.

June 1st. Treatments have been continued every third or fourth day for the past two months, patient is gradually. improving, appetite good, sleeps well, has had no rise of temperature, no chills, and only a few light sweats during this

time. This case is practically beyond hope in spite of this improvement, in my opinion, though the young man insists that he will soon be able to go to work, judging by the way he feels. In view of the fact that he is still alive, able to get about, happy and contented, three months after the expiration of the lease of life given him, is sufficient warrant for the use of the serum.

Probably one of the most remarkable cases that has come under my observation, is that of Mrs. R., age 27, family history bad, as several members of her immediate family had died of tuberculosis. At the same time she was suffering with a severe case of appendicitis, and some pelvic troubles that really called for immediate operation, though her left lung was very much affected with tubercular process. I advised her to go to the hospital, so that she might be prepared for an operation. She declined to do this, and returned to her home, some 150 miles from St. Louis. Three weeks afterwards, they requested that I come and operate upon her at her home. Taking competent assistance, and a trained nurse, I prepared to do this. On reaching the patient's bed-side, the change that had taken place in her physical condition was so alarming that I hesitated to operate at all. After informing the family of the true condition and obtaining their consent, I opened the abdomen. Tubercular peritonitis was present to such an extent and the physical condition of the patient became so alarming (as her temperature was 104, pulse 140 when she went upon the operating table) that I limited the operation proceedings to the abdominal incision and immediately sewed up the wound, expecting the patient to die from shock within a few hours' time. However, I immediately began the injection of serum, 1 c. c. every eight hours for the first fortyeight hours. Leaving the injections and care of the patient with instructions to give her 11⁄2 c. c. every 24 hours, I left

the patient. This treatment has been continued up to the present time, which is now three weeks since the operation; the wound healed by first intention, the temperature after the first 48 hours has not been above normal, nor pulse above 86. Appetite is good, all the emunctory organs are working naturally. Patient has gained 12 pounds in weight, is sitting up nearly all the time, and says she has not felt so well in six years. Inasmuch as she has received no medi-. caments of any character except the Leuco-Lexin serum, credit must be given it for these wonderful results. Of course I fully realize that time alone will demonstrate the eventual outcome of this case, but I am perfectly confident that we have cheated the Grim Reaper out of a victim.

SARTON FOR DIABETICS.

Von Noorden and Lampé, in Die Therapie der Gegenwart, report their experience with a new preparation of soja bean which they recommend as a nutrient in diabetes. The authors were encouraged to use this product as the result of their favorable experience with oatmeal in diabetes. They compared the effect of various other vegetable foods with oatmeal, and found that the latter cereal seemed to be the most suitable in the treatment of glycosuria. One of the difficulties in these diets is to supply other vegetables besides the ordinary cereals. Most of the artificial preparations, such as roborat, etc., have the disadvantage of altering the taste of foods with which they are mixed. The authors, furthermore, did not find dried peas, lentils and beans of advantage in diabetic diet. A number of years ago the authors began to experiment with soja bean, a Japanese plant, which has a fruit that resembles both the pea and the bean, and belongs to the leguminous vegetables. Japanese bean soup, known as "shoyu," is prepared from this bean. The bean

The

is very rich in proteids, and during the preparation nearly all other constituents are removed. On analysis, soja bean was found to contain from 30 per cent to 35 per cent of albumen, and only about 6 per cent of carbohydrates. The only trouble was that the taste of this bean did not seem to appeal to the European palate. The unchanged bean, moreover, had an unfavorable influence upon the excretion of glucose.

A method was found, finally, of removing almost all carbohydrates, as well as the unpleasant tasting constituents from the bean. The new preparation is sold under the name of sarton. The powder is used for the preparation of purées and soups. The powder is mixed to a paste with water, some butter and some meat broth are added, and the whole boiled for ten minutes. Salt and other seasoning may be added, if desired. About 80 grams of the paste are sufficient for a plate of soup. Thus prepared, the soup is pleasant to the taste and was well tolerated by over one hundred patients with diabetes on whom this diet was tried. As a rule, the use of soja soup did not have any unfavorable influence upon the excretion of sugar. The authors consider sarton as a valuable addition to the diet of diabetics.

WE

E have numerous preparations of iodine and they have a wide range of therapeutic uses. Any remedy as iodine which is destructive to all forms of micro-organisms from the most harmless bacteria to the most virulent as anthrax is sure to be a useful therapeutic agent, and have a wide range of usefulness in the treatment of diseases. There are various so-called soluble preparations of iodine on the market which is claimed to give systemic effect by external application.

In the February, 1905, Medical Summary, page 370, Dr. T. W. Williams has the following to say, which I think will be of interest to all that are interested in iodine. "There is no question as to the fact that certain probably most therapeutic agents can be administered via cutis, and that they enter the circulation and produce their known specific effects even more rapidly and certainly in this than in any other way, because they do not pass through the digestive tract, create little or no disturbance, except in over dosage, and can for these reasons be administered in much larger doses. The remidal effects of the iodides are due wholly to the iodine they contain, and if this agent can be introduced into the circulation in its free state, free from the irritant effects of its base, so much the better. When tincture iodine is applied to the skin very little of it enters the circulation. The alcohol evaporates leaving the iodine on not in the skin, and but little of it is absorbed. I want to introduce an entirely new method of administering iodine. Let the chemist add one ounce of resublimed iodine to twelve ounces of alcohol, dilute and sufficient potassium iodide to effect solu

tion. Distill this over in a glass retort. The iodine will all go over with the alcohol, and be condensed in the residue, leaving any crude iodine, the specimen nay contain, and the potassium salt in the flask. To the product thus obtained add sufficient commercially pure glycerin to make one pint, you now have iodine in a form readily absorbed into the circulation through the skin or mucous membrane. The glycerin holds it in solution on the skin until it is all absorbed leaving no stain, unlike the tincture. I have tried all other ways of preparing it by adding glycerin to the tincture or dissolving the iodine in glycerin, alcohol and water, but the product is not the same, and will not produce the same therapeutic effect."

Dr. Williams calls this glycerole iodine another good name would be soluble iodine.

It can be used internally and externally. It is especially prepared for external use i. e. used externally for systemic iodine effect. It can be used on almost any part of the body, but is generally applied over the ingual, and other glands, or over the sides, ribs and

sternum.

In chronic bronchitis Dr. Williams uses one or two drachms over the chest in a streak along the sternum two or three inches wide from the junction of the clivicles to the lower end of the sternum, or over the entire side from spine to sternum, and repeats this night and morning until symptoms of iodism appears, which is usually two or three days, and then omit a day and resume same way. He stops as soon as buzzing and ringing in the ears and other nervous symptoms are complained of. Glycerole iodine is a valuable remedy in