cided to puncture again since I still believed there was fluid. First puncture, in tenth space behind, negative. Second, in eighth space near angle of scapula, gave pus, which was subsequently drained by incision. In this case the curved line proved to have been a more valuable sign of effusion than even puncture, and should have led earlier to more energetic measures. 3. Large Effusions.-When the quantity of fluid exceeds a certain limit, the upper border of flatness loses its distinctive "letter of s" form, and becomes a simple curve with upward concavity. Moreover, as the lung becomes more and more compressed and crowded up toward its hilus, the difference between the absolute flatness of the fluid and the resonance over the lung becomes less marked. Still an appreciable difference usually remains, and we find that the area of flatness rises along the outer aspect of the chest, while slight pulmonary resonance is still found along the upper spine behind and in the angle formed by the sternum and clavicle in front. Lines 7 and 8, Figs. 1 and 2, show different phases of the line of increasing effusion. It is, of course, well understood that the characteristic diagnostic feature of a very large effusion is the displacement of organs of the heart, namely to the right or left, and of the mediastinum, as determined by the encroachment of the perpendicular line of flatness upon the healthy side in front. The diaphragm also is displaced downward, causing on the right depression of the liver, on the left the filling of Traube's "semilunar space" and a palpable spleen. The diagnosis of such cases is very easy. When, however, the quantity of fluid is not extreme, when the S curve is still perceptible or only partially effaced (lines 6 and 7), and when, therefore, there is as yet no pronounced displacement of organs, diagnosis is more difficult. At this stage respiration over the effusion is quite apt to be bronchial, and the extent of the area of flatness does not differ so markedly from that of a consolidated lower lobe. It is in just these cases, when upon the left side, that a slight but easily discoverable displacement of the heart toward the right affords, perhaps, the most valuable confirmatory sign of effusion we possess. I have several times, in the past few years, called attention in a casual manner to this point. The recognition of this enlargement depends wholly upon the assumption, which I believe to be invariably true: 1. That in adult life the right border of the normal præcordial area is a perpendicular line extending from the third (usually) to the sixth rib, one-half inch to the left of the median line. This I believe to be a more accurate statement than that of most authors (Weil, Cutler and Garland, Shattuck), that this line corresponds to the left border of the sternum. However, this is parenthetical, and the question is of trivial importance. 2. That under normal conditions in the adult, in the right angle formed by the upper border of hepatic flatness and the perpendicular right border of præcordial flatness above mentioned, the sternum is perfectly resonant. By "perfectly," I mean that the resonance here over its lower half is as good as that over its upper half, although, compared with normal pulmonary resonance, the note is a trifle higher pitched. This fact cannot be too strongly insisted upon. When, in an adult, there is dulness in the median line over the lower half of the sternum, as compared with the upper half, some pathological condition exists. Aside from cardiac displacement and affections of the right lung or the mediastinum, this dulness is usually due to an enlarged right heart. Less often there is pericardial effusion. Rarely, an old pericarditis has pushed back the border of the right lung, and the latter has become fixed in its abnormal position. Whichever may be the In children from the age of five to eight up to about the age of puberty, the conditions are entirely different, as the writer has attempted to show in a paper entitled "The Normal Præcordia in Childhood," read before the Pan-American Congress in 1893. cause, it is certain that dulness in this angle is always significant. It is most easily detected by rather light percussion upon the finger carried from above downward along the sternal groove. Now, in a left-sided effusion, this normally resonant angle is the first locality in which signs of increasing pressure and displacement are clearly manifest. The slightest movement of the heart toward the right is at once shown by relative dulness in this angle. The form of the dulness is shown in Fig. 2, the various lines dropped from the point C, illustrating various degrees of displacement. It is owing to the invariable position normally of the right cardiac boundary, and to the opportunity for exact and delicate percussion which this region affords, that displacement can here be readily detected at a time when that of any other organ or structure would be imperceptible. Of course, the sign is not characteristic, like the S curve. One cannot absolutely exclude a previous enlargement of the right heart or other causes of a similar area of dulness. But in the absence of souffles, suggestive history, or any other sign of complication, the coincidence of such dulness with other evidences of pleuritic effusion strengthens wonderfully the diagnosis. It may here be mentioned that the first movement of a heart subjected to left-sided pressure is not one of rotation upon its axis. At first, the heart is simply crowded over en masse, the relative position of base and apex not being materially altered. Indeed, I believe that it is only exceptionally, and in cases of enormous effusion, that the heart swings upon its base, so that the apex comes to lie in the region of the right nipple. This opinion is the result both of post-mortem observation and of the clinical fact that, even in marked displacement of the heart, so as to cause a dull area on the right as far as the mammary line, the apex beat is usually heard loudest somewhere in the region of the ensiform cartilage. In right-sided effusion displacement of the heart to the left is neither so early nor so easily detected. When it does become evident, other signs are already so prominent that it has no peculiar value. Clinical Department. IS HICCOUGH A SYMPTOM ONLY OR A DISEASE PER SE? BY HENRY LEVIEN, M.D., NEW YORK. THE case of "Fatal Hiccough" reported by Dr. McCartie in a recent issue of the MEDICAL RECORD, reminded me of a similar one I recently came across, but which fortunately terminated in recovery. While hunting up the case in my record-book, I found two more interesting cases, which I would call typical, as opposed to the third one, which looked to me atypical, or one of an unknown cause. CASE I-Miss B, aged twenty-two, occupation housework. On the previous evening she was taken with hiccoughs, which would come on about every fifteen minutes and continue for three or four minutes at a time. She did not sleep the whole night and wore an anxious and prostrated look. All domestic remedies tried were of no avail. I elicited the history of neurosis on her maternal side; she herself had frequent though slight hysterical attacks, and suffered greatly from dysmenorrhoea. This case yielded within a week to sedatives and antispasmodics, and isolation from her friends and relatives. CASE II-Miss M, aged nineteen, shop girl, very anæmic and emaciated. During the last three years she would drop in to see me when an attack of 'biliousness" annoyed her too much. The last time she called on me was on account of an intolerable hiccough. It was indeed of a violent nature, and coming, as it often did, simultaneously with an eructation of gases from her diseased stomach, the cough could be heard at quite a long distance. Believing this case to be purely of gastric origin, I determined upon lavage and resorcin internally as an antiseptic. Within four weeks I used fifteen irrigations of her stomach, adding first sodium bicarb., later creosote to the water, when the disease abated, and she has fully recovered. CASE III.—Mr. M—, aged fifty. He met with an accident, being run over by a heavy express wagon and receiving many contusions and wounds, which were stitched up. Sedatives were required on account of the shock, which acted heavily upon him. I could not detect any internal injuries. On the fifth day Mr. M developed a local peritonitis in the left hypochondrial region. At this stage Dr. A. Brothers was asked to see the case with me, and he, coinciding with my opinion, did not detect any other ailment. Ice externally, and opium in full doses internally, checked the further spread of this disease, and on the fourth day the patient felt well, and both ice and opium were discontinued. An abscess which formed on the patient's knee kept him in bed, otherwise he seemed on his way to full recovery. One morning (three days after I discontinued the opium), when I called to dress his wound, I found him afflicted with hiccoughs, which followed one another in quick succession. Naturally, neither food nor sleep could be indulged in, and in consequence Mr. M was very much exhausted. There could be no gastric trouble, because his nourishment consisted of fluids in small quantities, nor could there be any special nervous element in this case, as he and his family were always in the best of health. I called three times during that day, and nearly exhausted the list of known. remedies upon him, with but little effect. Morphine hypodermically would relieve him for a while, but as soon as the narcotic effect passed off the trouble returned with the same severity. I consulted all the reference books at my command, and finding singultus as a symptom only, I certainly could not find any suggestion how to treat hiccough as a disease. Prompt relief was necessary, as my patient was sinking. Eventually I picked up a medical formulary, and finding in its index hiccough, I was too anxious to find the panacea against this dreadful disease. What I found was calomel, recommended by Dr. Gerhard, to be given ingrain doses every hour. As I had tried nearly everything but calomel, I hurried to my patient and prescribed this last remedy. I was delighted when the report came, that after the fourth dose the trouble stopped entirely-and it did not come back. Where was the seat of the malady in this case, and in what way had the four minute doses of calomel exerted such a happy influence in cutting short this attack? Comparing the three cases reported, I am inclined to believe that besides the typical singultus, which is only a symptom pure and simple, there exists another form of it which is a disease per se, the etiology of which is not yet known. 239 EAST BROADWAY. ample of the above anomaly by Dr. Leonard Landes reminds me of a somewhat similar case which came under my notice, but which has not been published until now. In 1871, when a student with Dr. George A. Sterling, of Sag Harbor, L. I., I went with him to see an infant which had been born the day before of Jewish parents. It was a male, very puny, with a double talipes varus. The forearms were bent inward and the hands flexed, presenting a condition analogous to club feet. It possessed conjunctival sacs, and at the bottom of them were to be seen rounded elevations, the rudimentary eyeballs. The eyebrows, eyelids, and ciliæ were normal. The child died in a few days. No autopsy was allowed. The number of instances of total absence of the eyeballs is very small. In the great majority rudimentary eyeballs are to be found. Still rarer are the cases of monophthalmus. The conjunctival sac is always developed in some degree, as are also the adnexa. At the bottom of the conjunctival sac is to be found a round. reddish-gray body consisting of connective tissue containing fat and having attached one or more rudimentary eye muscles. The optic nerve is sometimes present, oftener absent. In other instances the eyes are microphthalmic, consisting of a sac filled with fluid, and sometimes possessing a rudimentary cornea. It is curious that the eyelids, eyelashes, and lachrymal apparatus are always to be found. ASEPTIC SYRINGES. BY THOMAS HUBBARD, M.D., THE syringe is all but tabooed in surgery because of the useless or filthy condition of the piston packing. For some years I have been using ordinary asbestos sheeting of about three-eighths of an inch thickness as packing, and have found it very satisfactory in all respects. The disc should be cut a little larger than the barrel calibre and after it is fixed firmly by the screw-nuts on the piston one-half should be turned upward to increase suction power and one-half downward for expulsion. It is practically indestructible and can be readily sterilized. For some time after packing small fibres may be found in the fluid, but this is immaterial except in hypodermic syringes. The Overlach syringe has an asbestos packing in cement. Hypodermic syringes intended for injecting escharotics can be packed with the ordinary asbestos. Post-nasal syringes are much improved by such packing. Mr. George Ermold has constructed one for me which is very satisfactory. The nozzle is made of aluminum and the bulbous tip has about fifteen very fine perforations. The barrel and piston are made of vulcanite. For general use these syringes should be constructed with barrel capacity of about two drachms, or have a regulator on the piston shaft. The danger comes from forcing too much fluid into the post-nasal cavity. Properly constructed and expertly used the post-nasal syringe should occupy an important place in our armamentarium. ANOPHTHALMOS. BY G. STERLING RYERSON, M, D., C.M., L.R.C.S. EDIN., PROFESSOR OF OPHTHALMOLOGY IN TRINITY MEDICAL COLLEGE, TORONTO. SOME ten years ago I published a series of cases in the opment of the eye. These cases embraced aniridia, Beer and Degeneration of the Heart and Kidneys.– Dr. Bollinger, director of the Anatomico-pathological Institute in Munich asserts that it is very rare to find a normal heart and normal kidneys in an adult resident of that city. The reason for the kidney disease is the tax put upon these organs by the drinking of excessive amounts of beer, and the cardiac hypertrophy and degeneration are secondary lesions for the most part. Formerly the population of the city was recruited by accessions from the country, but the abuse of beer has spread now to the rural communities, so that this source of healthy new blood is cut off. MEDICAL RECORD: elled that the interests of the paupers and hospital patients and criminals will no longer be pooled with those of the insane. This accomplished, and the insane placed under supervision of a non-political Commis A Weekly Journal of Medicine and Surgery. sioner or Board of Commissioners, another very strong GEORGE F. SHRADY, A. M., M.D., EDITOR. PUBLISHERS incentive for the transfer of our insane to the State system would removed. Could these two possibilities become realities, as in justice they ought, there is no reason why New York City might not continue to care for her own insane, WM. WOOD & CO., 43, 45, & 47 East Tenth Street. and, without expending more money than her tax-payers New York, January 5, 1895. THE PROPER CARE OF THE CITY INSANE. THE investigation of the New York City asylums for the insane, to which reference was made in these columns some months ago, has at last come to a close, and the State Commission in Lunacy, the investigating body, has handed its report to the Mayor. In accordance with our predictions, the report fully and explicitly vindicates General Superintendent Macdonald, and Medical Superintendents Dent and Macy. But while thus praising the direct administration of the asylums, the report severely criticises the Commissioners of Charities and Correction, and unreservedly condemns the system under which our asylums, in common with our other charitable institutions, are conducted. In its main presentation of facts and conclusions as to these things, the report is unexceptionable, and must meet the approval of everyone who is familiar with the conditions under discussion. It does not follow, however, that one must agree with the opinion of the investigating commission as to just what change in system is most to be desired. The commission recommends, as it has previously done many times, that the city asylums be transferred to the State system. Under existing conditions, the city of New York pays about $600,000 annually toward the support of the State system, getting nothing in return. Meanwhile the State insane are cared for well; the city insane, poorly. The law permits the transfer of the city insane to the State system whenever the city authorities desire it. To make such a transfer, therefore, seems the simplest solution of the difficulty; and this, as has been said, is what the report under discussion suggests. Now it may freely be admitted that if the possible choice included only the two alternatives of leaving the insane under present management or transferring them to the State system, there could hardly be two opinions as to the desirability of immediate transfer. But in point of fact, there are other possibilities, and these are worthy of very serious consideration. Briefly stated, these possibilities are the following: 1. It is possible that the State law might be so altered that New York City would no longer be unjustly taxed for the care of insane not her own. Were this done, one strong incentive to transfer our insane to the State would be removed. 2. Movements are under way which make it not only possible but probable that our absurdly organized Commission of Charities and Correction will be so remod are at present assessed for the purpose, place her asylums on such a basis that they would compare favorably with the asylums of the State, or any other public institutions of the kind. This, it seems to us, is the ideal to be aspired to. But if for any reason it cannot be accomplished, if the possibilities just outlined cannot be made realities, then by all means let the city asylums be made a part of the State system. That the city should pay $600,000 for the care of State insane, and only half care for its own insane meanwhile, is an injustice to tax-payers and to recipients of charity alike, that should no longer be tolerated. As has already been said, transfer to the State system would be an enormous advance upon our present method of caring for the insane. The advantages of such transfer would be even greater than at present, should the Legislature make such changes in the State care laws as seem probable. The new constitutional amendment places the Lunacy Commission on a par with the Charities and Prison Commissions. It is reasonable to hope, therefore, that the Legislature, in supplying the details as to these commissions, will follow out the implied spirit of the amendment, by making the Lunacy Commission, like the Charities Commission, an honorary board, say of five members, serving withour pay, and having advisory and supervisory rather than administrative powers. Should such action be taken, properly qualified men being appointed on the new Commission in Lunacy, many disadvantages of the present State system will be overcome. We might do much worse than transfer our city insane to such a perfected State system. But, on the other hand, we might do even better, by perfecting our own system in the way above outlined. men. WINTER MEETINGS OF SCIENTISTS. THE last week has been prolific in gatherings of scientific The American Physiological Society, the Amercan Morphological Society, and the American Psychological Association have all held their annual meetings. Besides this there have been meetings of the Geological, the Historical associations, and many other learned. societies. There seems to be a tendency on the part of the associations of a purely scientific character to meet in the winter vacations, while the more practical sciences pertaining to medicine meet during the summer. Undoubtedly the winter season is the best for work, since the weather compels members to keep in-doors and puts a considerable limit upon junketing. New York, however, is almost the only city in which the physicians congregate in the dead of winter. plan which reduces to the minimum the necessity of knowing a good deal of every department of medical knowledge before entering upon the study of any one. I believe that every faculty should work as a team. The anatomist should precede by a day or two the presentation of the subject upon which the physiologist will discourse. The system of teaching medicine is still somewhat antiquated." Dr. Harrison Allen, of the University of Pennsylvania, brought on the collection of Indian skulls from Philadelphia to illustrate his paper on "The Value of the Nasal and Orbital Indices in Anthropology." Dr. Allen said that races can be graded by the nose. It has been generally conceded, he said, that the long, slender nose indicates a high type and the flat nose a low type of men. The North American Indians have long been represented as a race of men with long, narrow noses. They have been classified as of this type. Dr. Allen's investigations have led him to believe that this is not correct as a general classification. The skulls he has were the skulls of Indians who lived in the Delaware Valley and whose ancestors long ago were friendly with William Penn and with the Quakers. He found that the flat nose was the prevailing type. Only thirty-five per cent. of those he has examined follow the rule of long, slender noses. The Indians who made things so uncomfortable for the New England settlers, however, were of the long, slender-nosed type of men who were born fighters and were proud of it. They made an incursion into the Delaware Valley and defeated the Indians there before Penn arrived. Dr. Allen thinks that one of the explanations of Penn's pleasant relations with the Indians was that those in the Delaware Valley were of the flat-nosed low type. Dr. Wilder, of Cornell, in discussing the "Loose Characterization of Vertebrate Groups in Standard Works," said that many books were made up of contradictions and confusing statements. "The elementary physiologies that are used in our schools," he said, "are filled with a lot of moonshine about the baleful influences of tobacco and alcoholic stimulants. should have logic with our natural science.” We Dr. Frank Baker, of Washington, said that in his experience as an editor of a scientific paper he had been shocked by the bad style and unintelligible writing of men of science. He was inclined to believe that the "pernicious habit of reading the daily papers constantly and saturating one's self with them is affecting the whole American people." Dr. George S. Huntington, of the College of Physicians and Surgeons, read a paper on the "Convolutions of the Hemispheres of Elephas Indicus." The American Physiological Society began its seventh annual meeting at Washington, on December 27th, with Professor H. P. Bowditch, of Harvard, President of the Society, in the chair. He read a paper, "With Regard to Representation of this Society on a Committee to Decide the Place of Meeting of the Societies of Naturalists, Morphologists, Anatomists, and Physiologists." Dr. G. M. Sternberg, Surgeon-General United States Army, read a paper on "Explanation of Natural Immunity," and Dr. William M. Porter, of Harvard, read one on "Inhibition Hypothesis in the Physiology of iration." Several other papers were read. The subject suggested by the council for discussion at the next Congress of American Physicians and Surgeons was "Internal Secretion of the Glands." The American Morphological Society met at Washington, on December 27th. Dr. E. B. Wilson, of Columbia University, was elected Chairman. Indian Territory Medical Association.-The Indian Territory Medical Association met at Wagoner, I. T., December 11th and 12th. The Syracuse Academy of Medicine held its annual meeting for the election of officers December 4th, as follows: President, Dr. Alfred Mercer; Vice-Presidents, Drs. John Van Duyn and Ely Vandewarker; Secretary, Dr. T. E. Halstead. Dr. Behring, the discoverer of the antitoxin remedy, is to be decorated with the Cross of the Legion of Honor in the New Year's list, and Paris discloses increasing confidence that the pest of diphtheria has been definitely robbed of its terrors. Drs. Behring and Roux declare that of 100,000 cases now on record there is not a single instance of the vaccine doing the slightest injury. DR. WILLIAM DETMOLD, one of the oldest and most distinguished surgeons in the United States, died of paralysis at his residence in this city on December 27th. He was the son of Henry G. Detmold, formerly Court Physician to the King of Hanover, was born in Hanover, December 27, 1808, and graduated at the University of Gottingen as Doctor of Medicine in December, 1830. After serving as army surgeon in Hanover he settled in New York in 1837, and introduced orthopedic surgery into this country. He established an orthopedic clinic at the College of Physicians and Surgeons in 1841. In 1862 he became Professor of Military Surgery and Hygiene there, and afterward Professor of Clinical and Military Surgery. Dr. Detmold was prominent in the organization of the Medical Corps of the United States Army in the earlier part of the war, and introduced a knife and fork for one-armed men, supplied by the United States Government as the "Detmold knife." During a surgical practice of over half a century in this city he was Vice-President of the New York Academy of Medicine, Consulting Surgeon to the Presbyterian Hospital, the first President of the New York County Medical Association on its organization in 1884, and one of the founders and President of the Society for the Relief of Widows and Orphans of Medical Men. Dr. Detmold contributed largely to the medical journals of the country, his first publication on orthopedic surgery appearing in the American Journal of Medical Sciences in 1837. Society Reports. PRACTITIONERS' SOCIETY OF NEW YORK. Stated Meeting, November 2, 1894. BEVERLEY ROBINSON, M.D., PRESIDENT PRO TEM. Spinal Paraplegia and Anesthesia.-DR. ROBINSON presented the patient, a clerk, twenty-seven years of age, family history negative as to neurotic taint. Patient denies gonorrhoea, but had a sore, thought not to be specific, two years ago. Slight eruption on legs one year later, and slight mucous patches in mouth. Has been treated for syphilis. Admitted to St. Luke's October 9, 1894. Had been a healthy child. Moderate beer habit. No rheumatic, malarial, cardiac, renal, or hepatic history. Had pleurisy four years ago. Present trouble began thirteen months ago with numbness and slight loss of power in the thighs. Two days later severe cramps in calves, and in five days the left leg was completely paralyzed and right one almost so. For three weeks there was no change. Then there was gradual return of power, so that patient could walk around on crutches. During the first week there was severe diarrhoea, with loss of control of anal sphincter. Since then there has been incontinence of urine and partial loss of control of stools. There has been steady, but very slow, improvement ever since. the first month, and now the patient has pretty good control of right leg, but the left leg is still very weak. There has been considerable loss of tactile sensation in both legs, more so in right. Sense of heat, cold, and pain are affected to a greater degree. Knee reflexes markedly exaggerated, more on left side; ankle.clonus; rigidity of both lower extremities; no disturbance of cutaneous reflexes. Upper extremities normal. Pupillary reflexes normal. Electrical reactions normal. Dr. Robinson said that in presenting the patient he would like to elicit an opinion as to the exact nature of the lesion producing the symptoms, and especially as to the propriety of using electricity, regarding the value of which in cord lesions there seemed to be some difference of opinion among neurologists. He said that Dr. Starr, who had examined this patient, had pronounced the case one of spastic paralysis, the lesion affecting more particularly the lateral columns of the cord, and not, if Dr. Robinson remembered his statement correctly, affecting the anterior portion. Dr. Starr, it appeared, had advised against the use of electricity, and it was particularly on the point whether this agent might not be of some use in sclerotic lesions of the cord that the speaker wished an expression of opinion by the members. He believed himself that galvanism ought to be employed in this case. Regarding the prognosis, would the patient continue to improve, or was the lesion of a nature which made further improvement impossible? On the supposition that it might be of specific origin, the patient had been treated by mercurial inunctions, iodide of potassium internally, and hot baths. Replying to a direct question from the President, Dr. Delafield said he thought galvanism would make very little difference in the result. If the lesion were syphilitic, antisyphilitic treatment might prove of further value, but if syphilis were left out he thought the improvement would cease at a certain point. Since Dr. Starr's experience had been so much greater than his own, his opinion regarding the nature of the lesion. and treatment would be of much more value. DR. HALSEY, who had charge of the case as housephysician at St. Luke's, said that Dr. Starr thought there might be a localized pachymeningitis of the cord, and that antisyphilitic treatment might affect that, but there must also be a sclerotic process within the cord itself which it would not influence. DR. PEABODY though electricity would have no in fluence on the cord lesion; that its only value would be in keeping up the nutrition of the muscles until the time when nerve-power might be restored. But in the present case it was needed for this purpose, as it had been stated the patient walked on crutches, and in that manner kept up sufficient peripheral stimulation without electricity or massage. Later DR. DANA, in reply to a question by Dr. Robinson, but not knowing the history of the present case, said he thought electricity was of some use in certain chronic lesions of the cord, say locomotor ataxia. Cosmetic Effect of the Knife in Lesions of Small-pox. -DR. ROBERT ABBE presented a young lady in illustration of the cosmetic effects of the knife in certain ugly lesions produced on the nose by small-pox. The pitting on this prominent feature was the worst which he had ever seen, and in order to relieve it he resorted to what, so far as he knew, was quite a novel procedure, namely, shaving off the surface of the organ down to near the bottom of the pits. The raw surface had healed without scar and had left this portion of the face less deformed than any other. Without the operation the ugliness of the nose would have made the young lady's life unendurable. Report of a Case of Tetanus, with Exhibition of Cultures of the Tetanus Bacillus.-DR. W. GILMAN THOMPSON read the paper and made the demonstrations (see page 5). DR. R. F. WEIR had found that during the last year some eleven cases had been treated by injections by Tizzoni and others. He had records of nineteen similarly treated cases, twenty with the one just presented, with four deaths. The dried alcoholic precipitate of serum from the immunized horse or dog had been found rather insoluble, while the blood-serum itself, or the serum dried in vacuo into scales, which is quite soluble and permanent, has proved satisfactory. Using the latter, nine out of eleven cases lately collected by him were cured. In great contrast to that, ninety-five per cent. of all cases of tetanus had died prior to the inoculation treatment. The quantity of serum injected had been from thirty to fifty cubic centimeters at a dose, or of the dried serum three to five grammes, the total amount not having exceeded 300 c.c. in any one case. It had not always been followed by reaction. The original inoculation of the immunized animal is made in the proportion of 1 gm. of serum from a tetanized animal to 1,000,000 gm. of a healthy horse, etc. One experimenter while working on mice inoculated himself accidentally with tetanus virus, but immediately began injections with attenuated cultures, kept it up several months, and no result had followed. This method (Brieger's) is not so satisfactory as the bloodserum injections of Tizzoni and Cattani. The dry scales are yet very expensive, costing some $40 a tube, containing 3 gm. each; but he believed this antitoxin would soon be prepared in the laboratory of the College of Physicians and Surgeons, to meet the emergencies of the profession in this city. Of course the demand for it was quite limited, as tetanus was a very rare disease. It was stated that light and oxygen were supposed to kill germs of this kind, yet peroxide of hydrogen had been found to have no effect. Later observers had declared the germ not to be an anæroid one. DR. THOMPSON remarked that Dr. Byron had been able to keep cultures of the tetanus bacillus under oxygen. He Nephrectomy in a Case of Congenital Absence of One Kidney.-DR. F. P. KINNICUTT related the case. had seen the patient with the surgeon to a hospital in a neighboring city. She was poor, and had been compelled because of her sufferings from a tumor of the kidney, to give up work and enter the hospital. An exploratory incision was decided upon, was made in the lumbar region, and led to removal of the kidney, |