very severe internal disturbance, due to the introduction of heterologous proteids into the circulation. Recent investigations have revealed the fact that remarkable changes take place in the organism injected with the serum, so that the disturbance has been dignified by a special name "Serum Disease." Although manifest symptoms do not occur in more than one-third of all cases, the cellular reaction is probably present in every individual who receives an injection and the phenomena of anaphylaxis may be observed to a greater or less degree if the proper tests are made. The serum rash varies in character; a very striking symptom is edema of the skin and a very serious form is the hemorrhagic type in which hemorrhages occur in the skin, but this is fortunately rare. Joint pains are frequently observed and dysmenorrhea may be present in women. He offers the following practical rules: Curative sera are not the harmless substances we originally supposed. Immunizing injections of serum should not be employed when isolation will prevent the disease with a reasonable degree of certainty and the children can be watched. Serum should not be used in asthmatics or in those suffering from Graves' disease or the lymphatic constitution, except in developed diphtheria. The use of bactericidal sera of doubtful value should not be encouraged without careful consideration of all the possible bad effects from anaphylaxis. If a second dose of serum must be given during the few weeks following a primary injection, small repeated doses are preferable to a large single dose. On the other hand, one large initial dose is probably less harmful and far more effective than several small doses given over several days.

Mercury in
Tuberculosis:

In the Monthly Cyclopedia and Medical Bulletin for October, Chas. E. de M. Sajous considers the recent claims of Barton L. Wright that mercury produces marked improvement in cases of tuberculosis. The use of this metal in tuberculosis had already run the gauntlet of clinical experience and its disappearance from the horizon some years ago betokens a similar fate for the method employed by Wright. Advocated several decades ago by Baumes and Ramazzini and more recently by Havilland Hall and others, Daremberg's declaration that "the history of mercurials in the treatment of pulmonary tuberculosis is made up of a long series of deceptions" is an appropriate epitaph when the question as a whole is judged from the narrow standpoint of prevailing doctrines. The beneficial influence of mercury observed by certain authors is explained by the fact that the drug increased the bactericidal properties of the blood and a feature to be emphasized is the fact that it is by means of small doses that these authors obtained their beneficial effects and it is also with moderate doses at prolonged intervals that Surgeon Barton L. Wright obtained his good results. The effects of the large or frequently repeated doses are familiar to every one and under such doses the proteolytic or digestive properties of the blood become so intense that blood-cells and tissues even are broken down and a new source of "consumption" is added to the tuberculous process. Sajous' investigations in this connection suggest (1) That small doses of mercury are beneficial in the treatment of tuberculosis because they enhance, to a marked degree, the production of bacteriolytic and antitoxic

substances in the blood and thus insure the destruction of the tubercle bacilli and their endotoxins. (2) That full or large doses of mercury are harmful in this disease because they provoke an excessive formation of those substances and thus cause hemolysis and even cellular autolysis when sufficient quantities to induce mercurialization are administered.

Acute Coryza:

Beverly Robinson, in the New York Medical Journal for October 31, believes that if acute coryza is seen at its earliest stage when the patient has begun to sneeze, with or without slight discharge from the nasal passage, we should try to abort it. While quinin in two to four grain doses every six hours will occasionally accomplish this, his personal preference is ammonium carbonate. No other agent will accomplish it so frequently and with apparently so little objection. It should be given preferably in mistura amygdala or in water with syrup of acacia and orange flower water; a grain to the dessertspoonful is a suitable dose, repeated every hour for 21 consecutive hours and later at longer intervals. Every two or three hours is frequent enough for the second 12 or 24 hours and if at the end of 48 hours the attack is not entirely aborted, it is useless to continue the remedy. He has come to regard ammonium carbonate as nearly a specific in the treatment of acute coryza when used soon enough, repeatedly and in suitable doses. Locally there is no spray, powder or inhalation which per se will abort a coryza successfully. After the effort to abort an acute attack of coryza has failed, the most effective and least injurious treatment is the combination of sweet spirits of niter and spirit of mindererus, 20 minims of the former and a dessertspoonful of the latter every two or three hours, diluted with water. This is not unpleasant and proves effective. While taking it, one must be careful not to sit in a draught or go into the open air unless in mild weather. Locally, when the coryza has lasted several days, he believes that bismuth subnitrate with a little powdered acacia and morphin, blown into the nose with a simple powder blower, is of service in lessening the discharge and irritation. For many years he has made use of the vapor from equal parts of oil of eucalyptus, camphor and menthol in a suitable nasal inhaler. When the discharge is thick and purulent, he advises an ointment of oleoresin of cubebs m. 20, powdered camphor grs. 11, glycerin dram one, and white petrolatum drams three. This ointment should be applied to either nostril with the tip of the finger and sniffed up or drawn upward and backward till detected or felt in the nasopharynx.

Academy of Medicine of Cleveland

CLINICAL AND PATHOLOGICAL SECTION

The fifty-fourth regular meeting was held Friday, November 6, 1908, at the Cleveland Medical Library, W. G. Stern in the chair.

C. A. Hamann presented a patient upon whom he had operated for popliteal aneurysm, the result of a severe wrenching of the knee. A Matas operation had been attempted but, owing to the nature of the sac

wall, which was formed largely from fibrous tissue instead of the true arterial wall, this procedure was impossible. The artery was therefore tied above and below and the contents of the sac evacuated. In the discussion F. E. Bunts mentioned a similar case that he had recently seen and another case of femoral aneurysm just below Poupart's ligament. In this instance he had attempted the Matas opertion but found it impracticable and was forced to tie the artery above and below the fusiform sac. The clot was then evacuated and the wall folded in in successive layers and sutured. The patient made a good recovery. Ralph Updegraff also took part in the discussion which was closed by C. A. Hamann.

J. Phillips showed a woman with acromegaly. The characteristic enlargement of the hands, feet, jaw and head were well marked. There was a fibrous myocarditis with enlargement of the heart and arteriosclerosis. He was inclined to think the vascular changes were as important as the bony ones, since in looking up the literature he found but one case in which there was no cardiac hypertrophy. Discussion by F. E. Bunts, C. F. Hoover, W. B. Chamberlin, W. G. Stern and E. O. Houck.

J. Phillips reported a case of cervical ribs and showed radiographs. The condition had been discovered in a routine physical examination of a patient with cardiac disease. It formed a pulsating tumor extending two inches above the clavicle but caused no symptoms. A shorter cervical rib was found in the opposite side. A resume of the anatomic conditions and symptomatology, as usually found, was then given.

C. L. Cummer showed a patient with syphilis of the spinal cord. The symptoms at first were entirely referred to the bladder. He was unable to void urine and required catheterization. After he left the hospital he was again admitted, having fallen unconscious on the street. There was a clear luetic history and under treatment with mercury the condition was apparently improving.

The program was as follows:

(1) Some Clinical Observations on Dementia Precox, J. S. Tierney. (To appear in full in the JoURNAL.)

(2) A Clinical Report based on a Consideration of 42 Consecutive Abdominal Hysterectomies for Uterine Fibroids, F. E. Bunts. (Appearing in full on page 660.)

M. Rossenwasser in the discussion agreed with the speaker as to the unadvisability of myomectomy. His preference was for supravaginal hysterectomy of which he had had 28 cases with two deaths since 1901. He emphasized the importance of most perfect hemostasis in these operations. A preliminary cureting was quite unnecessary. The appendix

Salt

should not be removed at the same time unless it were diseased. solution he used per rectum if necessary but he did not leave any in the abdomen before closing. The mortality in these cases had been enormously reduced within recent years, thanks to improved technic. W. H. Weir thought that a larger percent of cases would show malignancy than the speaker's figures showed. The removal of the appendix at the time of the operation was a question that depended upon the operator's personal experience, if one had seen a hysterectomy case die subsequently of an appendicitis one would be more inclined to remove the appendix whenever possible if the condition of the patient permitted. The opinion that all fibroids should be removed seemed to be growing, even in a recently published work on medical gynecology, in which presumably medical measures would be advised in all conditions that could be improved by such treatment, operative treatment was advised.

W. H. Humiston thought the cervix should be cureted before supravaginal hysterectomy so as to lessen the chance of infection but the corpus

should not be cureted for fear of additional hemorrhage. Since the ovaries are usually diseased if fibroids exist, he usually removed them, together with the fibroids. Supravaginal hysterectomy is the most satisfactory operation we have in surgery. It is not difficult but careful hemostasis and covering of raw surfaces are necessary. Drainage he thought unnecessary. The possibility of malignancy should always be considered in these cases, it was often found accompanying fibroids. Years ago he had used the Apostoli treatment for fibroids but had abandoned it. A recent case of fibroid complicated by pregnancy and an ovarian cyst was then described and photographs shown.

F. E. Bunts, in closing the discussion, referred to some of the indications for operation but said that these had to be disregarded upon some occasions if the desire for children was great. The pathologic examination of all his cases had not been as complete as it might have been owing to the fact that until recently there was no provision for it at the hospital.

(3) Vagus Neuritis, C. F. Hoover. Five cases of bradycardia were described and two cases of paroxysmal asthma with pulmonary emphysema were cited as due to inflammation of the vagus at various points between the base of the skull and base of the heart. In two of the cases a marked accentuation of the bradycardia could be induced by employing moderate pressure over the vagus trunk at the middle of the neck. In two other cases in which the bradycardia was promptly corrected by the administration of atropine the heart rate was unaffected by pressure over the vagus trunk. In one of these cases the vagus trunk was involved at the site of the vagus ganglia and in the other case the vagus was diseased in the mediastinum secondarily to pericarditis. The response to pressure over the vagus in neuritis of this nerve will depend upon the part of the nerve trunk which is implicated in the inflammatory process. The variety of symptoms resulting from vagus neuritis are not to be wondered at if we consider the very decided dissociation of apparent receptors in spinal nerves which are demonstrable by subjective perception and various reflexes. All experimental devices employed so far have been very crude attempts to reproduce the clinical symptoms of vagus neuritis. The failure to reproduce these symptoms experimentally must not be accepted as evidence against the clinical interpretation of the subject.

EXPERIMENTAL MEDICINE SECTION

The fortieth regular meeting was held at the Cleveland Medical Library on Friday, November 13, 1908, C. A. Hamann in the chair. The program was as follows:

(1) The Nervous Control of Sugar Production by the Liver, J. J. R. Macleod, H. O. Ruh and R. M. Waters. The question as to the nature of the fibers in the great splanchnic nerve which when stimulated cause hyperglycemia, and the behavior of the reducing power and rate of excretion of the urine during the stimulation were discussed. Since the experiments relating to the matter have already been given in this JOURNAL (Vol. VII, p. 448), further description here is unnecessary.

(2) The Cause of Asphyxial Glycosuria, J. J. R. Macleod. This communication dealt with the source of the increased amount of reducing substances in the blood resulting from asphyxia or curare poisoning. It was pointed out that such an accumulation of reducing substance might be the result of increased production or of diminished destruction of sugar in the body. To settle which of these mechanisms are involved,

the liver was removed from the circulation by anastomosing the portal vein to the vena cava and by ligating the hepatic arteries. It was found that asphyxia and curare poisoning no longer caused hyperglycemia. Increased production of sugar from the liver is therefore the cause of asphyxial hyperglycemia. In the next series of experiments, the hepatic nerves were all cut and the animal then asphyxiated with the result that hyperglycæmia still occurred. This shows that the asphyxial blood acts directly on the liver cells and not by stimulating the nerve centers controling the glycogenolytic activities of the liver. A number of experiments were then reported with the object of demonstrating what property of asphyxial blood endowed it with this glycogenolytic effect. In these, pieces of glycogen-rich liver were incubated in flasks containing defibrinated blood and having either oxygen or hydrogen or carbon dioxide bubbling through them. It was found that hydrogen did not accelerate glycogenolysis whereas carbon dioxide did. It must therefore be the excess of this gas in asphyxial blood which endows it with glycogenolytic properties. It was pointed out that the result is in keeping with similar ones by Schierbeck and others who showed that carbon dioxide accelerates the action of amylases. The acids in asphyxial blood may assist carbon dioxide in its action.

Discussion by R. G. Perkins, A. S. Storey. F. C. Herrick, W. H. Weir, C. A. Hamann, J. H. Lowman, D. Marine; closed by J. J. R. Macleod.

Book Reviews

High Frequency Currents, by Frederick Finch Strong, M. D., instructor in Electrotherapeutics at Tuft's College Medical School, Boston. Cloth bound, 289 pages, 183 illustration. Price $3.00. Published by Rebman Company, 1125 Broadway, New York.

This little book, the first of its kind dealing exclusively with high frequency currents, is one of interest to the electrotherapeutist. The electron hypothesis is given due consideration and electrophysics from this standpoint is discussed in several chapters. Sixty-five pages are devoted to types of foreign and domestic apparatus, with good descriptions and illustrations. In eliciting the physical factors involved in the generation of high frequency currents, diagrams, showing the analogy between running water and electric currents, are used. The phenomena and physical properties of high frequency currents receive attention and a chapter devoted to milliampere-meters for measuring these currents is unique. About one-half the book is devoted to the technic and application of this form of currents in the treatment of disease. The author thinks that electrotherapeutics will soon become the most important subject in medical education and also intimates that through this subtle form of electricity the gap between organic and inorganic chemistry may be bridged.

The Colorado Souvenir Book, for the International Congress on Tuberculosis, Washington, D. C.

A well illustrated book of some two hundred pages, published by the Colorado State Organization of the International Congress on Tubercu