378 



MEDICINE, ADVANCES IN. 



per cent, among those not inoculated. Beyond 

 the age of thirty years the results are reversed, 

 the advantage being with the non-inoculated, 

 the incidence among them being only 14.3 per 

 cent., as against 24.7 per cent, among the inocu- 

 lated. 



The first period is that at which susceptibility 

 is greatest. Dr. Crombie also states that a sec- 

 ond inoculation increases the susceptibility to 

 typhoid. 



In a study of the fatality of typhoid in vari- 

 ous sections of the United States at different sea- 

 sons whose results form No. 59 (vol. viii), 1902, 

 of the quarterly publications of the American Sta- 

 tistical Association, the following table of results 

 showing the death-rate per thousand is given. 

 The year is divided into four quarters, 1 indi- 

 cating January, February, and March, 2, April, 

 May, and June, etc. 



It will be seen that, contrary to the generally 

 accepted notion, the fall is the least fatal period. 



As a result of an investigation of the throm- 

 boses following typhoid fever, Drs. A. E. Wright 

 and H. H. G. Xnapp, of the Army Medical School, 

 Netley, conclude that the tendency to throm- 

 bosis is due primarily to an exclusive milk diet; 

 secondarily to an excess of lime salts in the 

 blood, which much increases its coagulability. 

 The milk should either be decalcified or citric 

 acid be given with it. Decalcification may be 

 accomplished by adding 20 to 40 grains of citrate 

 of soda per pint of milk. 



Rheumatism. Investigations by Drs. Poynton 

 and Paine (Lancet, Aug. 2, 1902, p. 273) indi- 

 cate the presence of a definite germ in cases of 

 acute rheumatism. This is a diplococcus, which 

 is found in the blood, the valves of the heart, 

 in the pericardial exudation, in the joints, and 

 in the subcutaneous nodules. Pure cultures of 

 this organism when inoculated into rabbits pro- 

 duce symptoms similar to those of acute rheuma- 

 tism in man. 



In the Zeitschrift fur diatetische und physi- 

 kalische Therapie, vol. vi, No. 4, July, 1902, 

 Menzer describes a curative serum based on the 

 germ theory of the disease. The germ is, ob- 

 tained by scraping the tonsils of rheumatics; it 

 is cultivated on ascites fluid, and then injected, in 

 graduated doses, into larger animals. The serum 

 thus made is antibacterial (that is, a disinfect- 

 ant), not antitoxic, and its introduction into the 

 body is supposed to supply the latter with bac- 

 teriolytic agents. It at first increases the inflam- 

 mation, but finally subdues it. 



In 20 cases treated with the serum Menzer re- 

 ports that although there was no appreciable 

 modification of the symptoms until the defer- 

 vescence stage was reached, after this point 

 convalescence invariably, occurred rapidly and 

 with no relapses. Chronic stubborn cases which 

 had resisted all other remedies, including the 

 salicylates, were cured or greatly benefited in two 

 or three weeks' time. Further experiments with 

 an antistreptococcic serum in rheumatism are 

 described in the Zeitschrift fiir klinische Medicin, 

 Nos. 1 and 2, vol. xlvii, 1902. p. 109. 



Plnyuc and Cholera. According to the report 

 of the sanitary commissioners for Bengal, inocu- 



lations for cholera have lamentably fallen off, 

 because they are now entirely optional. Inocula- 

 tion for plague is also decreasing. In Calcutta 

 only 40 were made during the year covered by 

 the report. 



During the last fiscal year plague has caused 

 over 200,000 deaths in India. The rapid growth 

 in intensity of the present epidemic has led the 

 Punjab Government to appropriate $400,000 for 

 a wholesale inoculation of the inhabitants with 

 plague antitoxins. Arrangements were to be 

 made for over 6,000,000 inoculations. 



New Serum Institute in Denmark. Of interest 

 in connection with the growth of the serum treat- 

 ment of disease is the erection in Copenhagen of 

 a Government school for the instruction of stu- 

 dents in serum therapy and manufacture, and for 

 the conduct of original research. 



In 1894 Prof. C. J. Salomonsen, director of the 

 University Laboratory of Medical Bacteriology 

 of Denmark, made a request to the Minister of 

 Educational and Ecclesiastical Affairs for a 

 small sum of money ($2,000 or $3,000) with which 

 to carry on the manufacture of diphtheria anti- 

 toxin. He obtained the grant, and with it, be- 

 sides making the antitoxin, instituted a small 

 class for the instruction of his students in the 

 technique and theory of serum therapy. The 

 product of the work of the laboratory was distrib- 

 uted free of cost. The experiment proved so sat- 

 isfactory that a site for a separate serum insti- 

 tute was finally secured on the island of Ama- 

 gar, just outside the old fortifications of Copen- 

 hagen. This institution was formally opened on 

 Sept. 9, 1902. 



The following general rules may be laid down 

 as the result of the clinical work thus far accom- 

 plished with the various sera: The method of 

 administration is of considerable importance. In 

 tetanus (lockjaw), for instance, it has been found 

 that injections near the brain are by far the 

 most effective, direct intracerebral inoculation 

 being desirable. Early use of the sera is of the 

 greatest importance, and their administration is 

 recommended even while the diagnosis is pro- 

 visional. The dosage should be large; many fail- 

 ures have probably been due to the administra- 

 tion of insufficient quantities. (In this connec- 

 tion, however, see Prof. Wright's statements 

 above regarding typhoid.) Great care should be 

 taken to secure a fresh, undeteriorated product. 



Phototherapy. The recent work in this 

 branch of medicine has been chiefly clinical. Ac- 

 cording to Dr. L. Freund, of Vienna, all radiant 

 phenomena the X rays, ultra-violet light, Finsen 

 light, etc., have the same physical basis, and the 

 effect of rays on the body varies, like that of 

 chemical agents, with the dosage, and may ranpe 

 from mere stimulation to actual destruction of 

 tissue. 



In weak doses the rays seem to favor organic 

 processes, such as the growth of hair and the 

 production of pigment. In stronger doses they 

 lower vitality and produce inflammatory reac- 

 tion. The clinical effects of all forms of radio- 

 therapy are similar. The physiological effects 

 are in direct proportion to the intensity of the 

 r;i y ing, but in inverse proportion to the wave- 

 lengths. The reaction appears after a latent pe- 

 riod, the length of which is inversely propor- 

 tional to the wave-length and intensity of the 

 raying. Those rays which have the property of 

 exciting fluorescence are physiologically the most 

 powerful. The Finsen lamp has a greater pene- 

 trating power than the ultra-violet lamp. Dr. 

 J. M. H. McLeod describes experiments for in- 

 creasing the reaction after Finsen treatment. 



