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possessed of a pedicle, and free from adhesions to surrounding structures. The prospects of success are least favorable in cases of cancer, on account of the probability of relapse. In the liver, however, as in other organs, a center of infection constituted by a malignant growth ought to be suppressed, and even in cases in which extirpation would be impossible a palliative operation-cholecystostomy, for example-would be indicated, with the object of relieving functional disturbances, and so of prolonging the life of the patient.-British Medical Journal.

THE PRESENCE IN THE BLOOD OF FREE GRANULES DERIVED FROM LEUCOCYTES.-M. F. Muller, an assistant in Nothnagel's clinic in Vienna, in 1896 described certain "small, generally round, colorless granules" which he found constantly present in the freshly drawn blood from healthy and diseased persons. These granules are readily distinguishable from blood plates. Dr. William Royal Stokes and Dr. A. Wegefarth conducted a series of observations in the bacteriological laboratory of the Health Department of Baltimore, and their results were published in the Johns Hopkins Hospital Bulletin, No. 81, December, 1897. The paper is now reprinted in pamphlet form. After detailing their experiments the writers sum up as follows: “In the blood plasma and serum of man and many of the lower animals there are present varying numbers of granules which resemble the granules of the eosinophilic and neutrophilic leucocytes in size and appearance. After addition of dilute acids, dilute alcohol, etc., and subjection to body temperature, the granules of the leucocyte assume marked activity, and such treatment increases the number of granules present in these fluids. These free granules are almost certainly derived from the granular leucocytes. The filtration of the serum of the dog and rabbit through new Müncke porcelain cylinders remove its normal property of causing the agglutination and cessation of motility of many motile pathogenic bacteria and of destroying large numbers of these organisms. This property can be partially restored by adding a sediment consisting of leucocytes, free granules, and red blood-corpuscles. Since the red bloodcorpuscles are not germicidal (Buchner) it follows that the restoration of the bactericidal property is due to the addition of the leucocytes and free granules, and that these cells can furnish a germicidal material.” From these facts Dr. Stokes and Dr. Wegefarth evolve a theory of immunity, but admit that the proof is extremely difficult to furnish, since filtration of a sediment even through double filter-paper will allow leucocytes as well as granules to pass. They suggest that the bactericidal power of the leucocyte of the blood and of the serum of man and many animals is due to the presence of specific granules, especially the eosinophilic and neutrophilic. These observers think that the granular leucocytes when called upon to resist the action of invading bacteria may give up their granules to the surrounding fluids or tissues. They consider that this theory explains how apparently cell-free fluids can destroy bacteria.-Lancet.

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THE INFLUENCE OF ALTITUDE ON TUBERCULOSIS.

At the June meeting of the American Medical Association Drs. William C. Mitchell and H. C. Crouch presented a paper on “the influence of sunlight on tuberculous sputum in Denver; a study as to the cause of the great degree of immunity against tuberculosis enjoyed by those living in high altitudes."

The chief factors in the benefits received by consumptive healthseekers in the Rocky Mountains are according to these observers: first, dry air; second, diminished atmospheric pressure; third, “the powerful influence of the solar rays.” In short, high altitudes present meteorological conditions which inhibit the proliferation of the tubercle bacillus in the body, while at the same time the system is stiinulated to increased resistance, and fortifies itself against the invader. Moreover, in the opinion of some the fierceness of the sunbeam in the dry and rarified air is destructive to the germ of phthisis.

Upon the first point the authors say:

Both the absolute and the relative moisture is low in high altitudes, and this together with the lessened atmospheric pressure and almost constant winds greatly facilitates evaporation. Extremely favorable conditions are thus created for the abstraction of moisture by the atmosphere from whatever substances it comes in contact with. The moist surface of the lungs must suffer considerable loss of moisture; and it is this battle for moisture

compensation that we believe to be one of the factors by no means the least important in granting such a large measure of immunity against tuberculosis here, or in arresting or retarding such processes in their incipiency. The tubercle bacilli grow but poorly, if at all, on media deficient in moisture; and while it scarcely seems possible that enough moisture could be abstracted to leave the alveolar linings too dry to offer a suitable nidus for the bacilli, yet it is not improbable that this constant and rapid pulmonary evaporation creates conditions extremely unfavorable to their development.

It is doubtful if there be any scientific force in this statement. The expired air is always saturated with aqueous vapor, whether the surrounding atmosphere be moist or dry, and it is simply ridiculous to talk of a dry pulmonary mucous membrane when the same is reflected over the pulmonary capillaries which are always full of blood. However, the constant draught of moisture from the lungs occasioned by the wind and dry atmosphere exert a beneficial effect by a quickening of all the pulmonary processes, circulation, oxidation, the elimination of aqueous vapor, carbonic acid, etc. The opinion as to the second is as follows:

Increased atmospheric pressure causes the blood to recede from the capillaries of the skin and mucous membranes, thus producing anemia of these parts. The diminished pressure of high altitudes causes greater dilatation of the capillaries, with a resulting mechanical hyperemia. The mucous membranes are often ruptured, and we may have hemorrhages from the nose, mouth, or lungs. The tympanum is bulged outward, the respiratory and cardiac movements are quickened, and muscular movements are facilitated. In short, we have the condition described by adventurous mountain climbers as mal de montagne.

These factors are physiological and acknowledged by all climatologists to contribute forcibly to the resistance of the system to bacterial invasion; but why leave out the most important factor of all, viz., the enormous increase of red blood-corpuscles which physiologically results from the breathing of rarified air, and the demand of the system for more oxygen carriers, and consequent more rapid delivery of oxygen to the tissues ?

In the following paragraph the third point is perhaps justly set aside, while the first and second are allowed their merited value:

There are two conditions which militate against the spread of tuberculosis in high altitudes: (1) The powerful influence of the solar rays acting through a thin atmosphere rapidly destroys the virulence of exposed tuberculous matter. (2) The vital functions are so operated upon by the various

meteorological phenomena that they are especially fortified against the invasion of the tubercle bacilli. Our experiments seem to demonstrate clearly that immunity does not proceed from the first of these theories, and that by every logical right it may be attributed to the second proposition.

Let objectors say what they may, the mountains are the “city of refuge” to the victim of tuberculosis. Altitude and dry air fortify the system against tuberculous invasion. The improved surroundings limit the disease in those who are not already too far gone, or fatally susceptible, while strict sanitary regulations can and should keep it from attacking the uninfected.

Notes and Queries.

Cervantes AS PATIENT AND AS PHYSICIAN.— It is related that Sydenham, being asked by Blackmore (afterward pilloried in the Dunciad for his epics "writ to the rumbling of his chariot wheels") what works he should read to improve his medical knowledge, answered, “Read Don Quixote. It is a good book. I read it still.” It is probable that our English Hippocrates merely wished to snub a pert youth; but, rightly understood, the advice might with advantage be followed by physicians more largely than it is, especially in these days, when the absorbing pursuit of the microbe tends to make us forget that there is also a macrobe which deserves attention. The physician has to deal with man as a whole, and the human body, whether it be regarded as a piece of “foolish-compounded clay” or as “the Lord's anointed temple,” is something more than a happy hunting ground for bacilli. The great creative works of literature in which human life is depicted by men who, in the words of Matthew Arnold, have seen it steadily and seen it whole, and in which the workings of the complicated machinery of man's nature are made visible, can, if rightly studied, give the physician a knowledge which he will find most useful in his practice, and which can not be got from medical books or learnt in the laboratory or the dead-house. For those who appreciate the value of such knowledge, Don Quixote is indeed “a good book.” It is a proof of the broadminded view which the University of Paris takes of the art of healing that the other day it accepted a thesis, entitled “Cervantes, Patient and Physician,” from a candidate for the degree of Doctor of Medicine. The author, M. J. Villechauvaix, has not, we are bound to say, made the most of his subject, but his essay is interesting as far as it goes, and he appends a bibliography likely to be useful to any one who may wish to make a deeper study of the creator of Don Quixote in his medical aspects. Cervantes was born on October 9, 1547, and died after a life full of suffering, ill-health, and

evil fortune of all kinds on April 23, 1616. He contracted malaria during a visit to Rome early in life, and on the very morning of the famous battle of Lepanto (September 7, 1571,) he was so ill with ague that the captain of the ship on which he served tried to induce him to remain below. He insisted on fighting, however, and received three arquebuss wounds, two in the chest and one on the left hand, which was permanently disabled. He was six months in hospital at Messina, and his wounds were yet incompletely healed when four years later he was made prisoner by Algerian corsairs on the high seas on September 26, 1575. For five years he was held captive by the Moors, suffering much ill-usage at their hands, but at last forcing them, out of fear of the influence which his indomitable spirit gave him among his fellow-prisoners, to set him free. He died of dropsy, which M. Villechauvaix surmises to have been of cardiac origin, but there is really no evidence on the point. There is a tradition that Cervantes studied medicine, and there are in his works many passages which show that he had a considerable acquaintance with the art of healing as it was understood in his day. During his Algerian captivity he ministered to the needs of his fellow-prisoners in sickness with a skill which bespeaks, if not special training, a considerable experience in dealing with disease. How close and accurate an observer he was is shown by the wonderful picture of delusional insanity which he gives in Don Quixote. M. Villechauvaix points out that he anticipated Pinel in the rational treatment of insanity. The books of chivalry which disordered the brain of the Knight of the Sorrowful Countenance are destroyed, and every effort is made to create a new mental environment for him, his very delusions being skillfully taken advantage of to this end. It is somewhat strange M. Villechauvaix should have made no reference to Sancho Panza's famous physician, who in his strict views as to diet may perhaps be looked upon as the scientific forerunner of Sir Andrew Clark. He quotes, however, an apothegm that the "stomach is the laboratory in which health is manufactured," which shows that Cervantes had very sound views as to the important relations of the digestive to other functions of the body.British Medical Journal.

BULLETS IN THE BRAIN AND THE ROENTGEN RAYS.—Von Bergman (Berl. klin. Woch., May 2, 1898,) refers to thirty-two cases of bullet wounds of the brain which he had observed, and in which the bullet has been left undisturbed. Of these eight were severe cases, and the patients rapidly died. Of the remaining twenty-four, nineteen recovered, and these had remained well. Of the other five, two developed an abscess of the frontal lobe, and both subsequently died, although the abscess was opened; two others died apparently from a suppurative meningitis, and the fifth had not been heard of. The patients who recovered either showed no symptoms or were unconscious for a short time, or had a local paralysis or spasm. It is possible that in the first-named group of cases the bullet did not penetrate the brain substance. Thus it becomes important, as Eulenburg has shown,

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