nosis is given befitting credentials. Yet it would seem as if the very word on the page conjures up a kind of negatavism in the reader, and the matter is ignored. Only in this way can one understand why misconceptions fill the air and why the truth is with such great difficulty learned. And yet from the very first it has been pointed out that the physician should qualify himself in this end by men whose names stand for high and conservative worth. I cannot refrain from quoting such a passage as a final convincing word and this from a lecture of Friedrich Hoffmann delivered long ago.1 "Die einsicht in das Wesen der suggestion, welche wir jetzt gewonnen haben, ist ein Fortschritt von unberechenbarer Tragweise. Dank der thätigkeit von hiébeault, Bernheim und ibren nachfolgern seben wir ein material für die wissenschaft gesichert, welches nicht todtgeschwiezen werden kann. As ist jan richtig, dass wir eine Klarheit über dem hypnotischen Zustand nicht besitzen . . für uns ist es aber nichtig zu wissen dass der mit ansehen und einfluss seinem kraken gegenüberstehende Arzt in der Lag ist, bei Patienten diesen Zustand hevorznonfen-und in demselben ist nun die empfänglichkeit für jede Art der suggestion eine so gesteigerte, dass man die Macht des gemüthes, die schon Kant als eine Heilmacht Kannte und uns geschillert hat, zur hinderung zahlloser klagen und Beschwerden, zur Heilung wirklish schwerer Krankheits zustände benutzen Kann. Es wäre citel Thorheit wenn der Arzt diese waffe nicht gebrauchen oder gar aus der Hand geben und andern überlassen wollte," etc. Surely it is high time we look this subject honestly in the eyes, recognize its therapeutic worth and importance and accept it as something genuine and legitimate. SCIENCE AND RESEARCH Notes on the Serum Diagnosis of Syphilis. At the February meeting of the Society of Serology and Hematology there was presented a series of 330 cases in which both the original Wassermann test and the Noguchi modification were used in every case and under conditions identical in each case, the two tests being made upon the one specimen of serum and at the one time. While this is not a long series, the observations were carefully made and the comparisons, therefore, are not only interesting but valuable. Only a few of them may be considered here. 1 Vorlesungen über Allgemeine Therapie ch. von Friedrich Hoffmann-the quotation is from the 4 edition, Leipzig, 1895, p. 323. There were two cases positive to the Wassermann test which were negative to the Noguchi test. One of these cases was only weakly positive to the usual Wassermann, but gave a strong reaction to the concentrated, or absorption Wassermann test. Clinically this case appeared to be syphilitic tho the diagnosis was not unquestionable. The other case was clinically very doubtful, being one of precordial pain with dyspoenea, no history of syphilis, but a mode of life that suggested frequent exposures. There were forty-three cases positive by the Noguchi method and negative by the Wassermann. In none of the forty-three Noguchi positive cases could syphilis be excluded absolutely. In the large majority the history and physical signs pointed strongly to syphilis, and, in many, the evidence of luetic infection was indubitable. We cite one of this group as a fair example: Syphilis forty-four years ago; tabes for the past five or seven years. Wassermann test negative; Noguchi modification strongly positive. While the evidence thus presented was strongly in favor of the Noguchi method, it was the opinion of the essayist, Dr. Jane L. Berry, and of those who discussed the paper that both tests should be employed, preferably in all cases, and always in obscure ones. Among the several agents that we are learning to recognize as influencing the Wassermann reaction the most recent called to our attention is alcohol. Those making such tests are insisting that the subject abstain from alcohol for at least twenty-four hours preceding the obtaining of the blood. Why alcohol may make a positive serum negative while narcosis may make a negative serum positive is difficult of explanation. Truly the last word has not been said on this method of diagnosis. Consideration of these modifying factors may carry us far afield when we contemplate their relation to life insurance examinations and Another paper read at this meeting brought forward a new method for preserving blood corpuscles which will prove of great value in the laboratory and especially in its relation to the complement fixation tests for syphilis. This method consists in the addition of formalin to corpuscular suspensions in strengths of one to eight hundred for sheep corpuscles and one to four medico-legal questions. hundred for human corpuscles. In these strengths sheep corpuscles retain their color and integrity for two months and human corpuscles for about four weeks. Nonformalized corpuscles in the usual solutions of normal salt and one per cent. ammonium oxalate, last from four to seven days. When we realize the difficulties that many hospital laboratories experience in endeavoring to obtain sheep corpuscles at stated intervals for the suspension used in the Wassermann test and for the injection of rabbits in the preparation of an anti-sheep hemolytic ambocepter, the value of stabile corpuscles is very evident. By this use of formalin we are saved innumer DEXTER. REPORT OF THE VALUE OF BACTERINS IN LOBAR PNEUMONIA Robertson and Illman (Pa. Med. Jour., Vol. XV, No. 4, Jan., 1912), report fifty cases of pneumonia treated in the wards of the Samaritan Hospital, Philadelphia, of which thirty received treatment without bacterins with a mortality of forty per cent., while twenty patients who received bacterins only, with a mortality of fifteen per cent. Stock vaccines were employed in doses of from twenty-five to six hundred millions, apparently the more definite results being accomplished by large dosage. The earlier the bacterins were employed the more decided was the clinical reaction. In many instances the temperature reached normal on the fourth and sixth days. They give no record of the opsonic indices in their report. According to their experience the bacterins exercise. no influence on an acute or pre-existing renal condition. WASSERMANN AND MOUSE CANCER The public press has again been excited by the reports emanating from Wassermann's laboratory regarding his experimental work upon the mouse tumor of Jensen. The remarkable discoveries of Ehrlich in chemotherapy inspired Wassermann to seek a chemical agent potent to destroy tumor cells by action after its injection into the circulation. The chemical substances selected after thoro experimentation were designed to act organotropically instead of in a parasitropic manner, as is the working of salvarsan. Sodium tellurate and selenate were found to have a specific action upon cancer cells in vitro. Following this observation these salts were injected into mouse cancers and occasionally a cure resulted. Favorable action was not secured by injecting these substances into the blood stream. To secure the proper diffusible chemical agents thereupon became the subject of further investigation, as a result of which eosin was finally (at this date) selected to act in combination with selenium. After two injections intravenously the mouse cancer appears to become softer and under the constant action of the chemotoxic substances the cancer cells apparently undergo some liquefactive process. The interesting proc ess causing the disappearance of the tumor results from the resorption of the liquified cancerous cells. Too rapid resorption of the cancerous growth is accompanied by the death of the mouse. Within ten days small tumors are completely reabsorbed and do not reappear. Wassermann with true scientific devotion to facts has not made vain references to the applicability of this mode of treatment to the carcinomata of the human family. In brief, as a result of animal experimentation involving the trial of two hundred varied chemical combinations, eosin and selenium were found to be effective in causing the liquefaction, resorption, and disappearance of cancerous tumors in mice. The results were not uniform, as many of the mice died during the first three days, before liquefaction set in, and numerous others perished as a result of the toxicity of the reabsorbed cancer cells. The maximum dose given was 0.0025 gm. (Berliner Klinische Wochenschrift, January 1, 1912). Cancer research has made a distinct advance and specific chemotherapy has received further development. Time and trial will determine the interrelation of the mouse tumors and human cancer both in the field of histopathology and therapeutics. TYPHOID PROPHYLAXIS Anti-typhoid vaccination has now assumed a position of sanitary importance in military circles. Since the introduction of the plan of immunizing against typhoid fever owing to the suggestion of Sir A. E. Wright, there has been uniform appreciation of the method by the heads of the British and German armies. As a result of a conference of members of the Medical Reserve Corps the War Department in 1909 authorized the inoculation of volunteers. The value of the prophylactic procedure is evidenced by the fact that out of 12,801 men, assembled on the Mexican border for a period of four months, only two cases of typhoid fever occurred the anti-typhoid immunization was effective. As a result. of this excellent showing the War Department was quick to act in accordance with the demonstration, and vac cination is now compulsory in the United States army. The value of inoculation, as shown by Captain A. W. Williams (American Journal of the Medical Sciences, March, 1912), consists of a contrast of the typhoid incidence and mortality rate among the inoculated and noninoculated troops. Among the 17,978 men who received the prophylactic inoculation, only seven cases of typhoid fever occurred, with no deaths. There were among the 58,252 non-immunized soldiers 135 cases with 10 deaths. The greatest danger of camp life is now within control. Over 86% of the entire mortality of the SpanishAmerican War was due to the warfare waged by the myriads of Eberth's bacilli. With revaccination every three years it may be possible to eliminate typhoid fever as the most dangerous ammunition of Mars. PRACTICAL THERAPEUTICS UNDER CHARGE OF HENRY E. HALE, M.D. The Karell Milk Diet in Heart Disease This consists in rest in bed on a restricted exclusive milk diet. The thru the reduction of the amount of blood to be forced thru the daily allowance of milk is rigidly kept body. The heart is freed from ab dominal pressure, as stomach is not filled with food, nor is there any distention from gas. The kidneys find rest because of the reduced water intake, the greatly reduced amount of sodium chloride and the freedom from the products of intestinal putrefactions. Diuresis may begin promptly or only after a fortnight. It sometimes happens that diuretics which failed before will become effective during or after a Karell course. Karell gives the following condi tions as ones benefitted by his "milk soon to the influence of the Karell cure." 1. Cardiac disturbances of the obese: he advises for these patients the occasional interposition of a "milk day," but not a long "milk cure" as they are usually accustomed to eat freely and might respond to a sudden. deprivation of their usual ration by evidencing cardiac weakness. 2. With emphysema and chronic bronchitis accompanied by increasing weakness of the right heart, the dyspnea subsides in a few days on the Karell diet and a longer course is seldom necessary. 3. With cardial asthma, with degeneration of the myocardium, the rapid subsidence of the disturbance is often surprising, especially when heart tonics and sedatives have previously failed to relieve. After a week, at most, the patient may be allowed to return to a light diet with fluids up to 1,200 c.c., repeating the Karell diet as required after an interval. 4. Angina pectoris is often remarkably benefitted by the Karell diet, especially the mild form in which the attacks are not severe but occur frequently. Particularly good results are obtained with patients inclined to plethora and meteorism in whom the attacks occur when the stomach is full or the intestines distended. The Karell diet alone is not always effectual but often proves a valuable adjuvant to iodin, the nitrites, massage of the heart and exercise. 5. With insufficiency of the kidneys, the benefit from a transient restriction to a milk diet is conceded by all, especially when the heart shows signs of weakness and uremia is impending. 6. Rebellious effusions in the serous cavities often yield surprisingly cure. Romberg has emphasized the advantages of a salt-poor diet in tuberculous ascites. He endorses Karell's method but notes that in his experience. effusions in the pleura and pericardium subsided more readily than in the abdominal cavity. 7. The Karell cure is often effectual as a supplement to digitalis when neither alone is of any use. 8. Valvular defects as such are no indication for the Karell cure but when the myocardium becomes insufficient and edema is developing, the restricted milk diet may give relief. The intensity and length of the course must be strictly individualized. A SALT RESTRICTED DIET First and foremost comes the use of a restricted or salt free diet in the oedema of nephritis. As far as possible we should understand the reason or reasons for restricting the use of any food, drug or condiment. In many instances reasons are beyond present knowledge. However, we do know, at least in part, why salt should be excluded from the diet of a patient with nephritic cedema. Salt, that is, sodium chloride, is eliminated in large measure by the skin, moderately by the kidneys, and to a less extent by the glands of the digestive tract. Normally, with food as desired and with healthy organs, a sodium chloride equilibrium is maintained in spite of an increased or diminished intake. Usually the ingestion of 2 gms. a day satisfies the desire for salt. The glomeruli pass on a fluid containing filterable constitutents in the proportions of blood serum, that is, |