sary, it is stated, do not develop if the antitoxin has been used before they appear. It is claimed that tracheotomy is rarely necesand that intubation will answer in those cases where the larynx is indicated. The antitoxin is not to be looked upon as a direct chemical antidote, for it does not act against poison in the same manner that an acid neutralizes an alkali; for example, there is evidence in support of the view that the antitoxin acts indirectly by rendering the cells of the body capable of resisting the action of the toxines. The antitoxin for one disease may act to some extent in increasing the resistance of the body cells against the toxines of different origin; for instance, while the blood serum of an animal rendered immune against snake poison has no antitoxic effect against the toxine of tetanus, yet an animal which is immunized against tetanus yields a serum which combats the toxic effect of snake poison; and there are other facts adduced which shake our confidence in the specificity of antitoxins. There may be, to a certain extent, an overlapping of the immunities. Diphtheria offers, as Buchner has pointed out, a better opportunity for the study of the effects of a new remedy than does tuberculosis; for, while the former approaches more nearly to a typical infection, the latter is almost a typical intoxication. Again, while tuberculosis runs a protracted course as a rule, and is subject to spontaneous exacerbations and ameliorations, diphtheria is an acute process terminating soon either in recovery or in death; and thus is a disease in which conclusions concerning the efficacy or futility of a given method of treatment may speedily be arrived at. Koch's tuberculin treatment differed from the antitoxin treatment of diphtheria, in that in the former a glycerin extract of cultures of the tubercle bacillus were directly injected into the patient, there to set up a reaction, which after a time was to lead to the formation of healing substances; while in the latter the toxines of the diphtheria bacilli are injected into an animal, the animal suffers the reaction and builds the healing substances, and these are transferred, readymade, to the human being. Should the new treatment of diphtheria prove to be as satisfactory as it promises, the outlook for the cure of infectious diseases in general is bright. We shall, however, be compelled to wait patiently until the bacteriologists, to whom all the credit of this new treatment is due, have perfected the arrangements for the application of the serum therapy to the other infectious diseases. Dr. N. G. Kierle explained the differences between the diphtheria in the human and that of the pigeon and fowls. He exhibited several birds-some having true diphtheria, others the mixed infection. Dr. J. H. Branham reported upon two cases of diphtheria in which he had used the antitoxin treatment: Case 1. Little girl, 7 years of age; had been ailing for about two weeks with a slight sore throat and injection of the mucous membrane over the tonsil. The diphtheritic membrane appeared first upon the uvula. At that time the child was not very sick, having a pulse of 90 and temperature 100°. He made a small injection of antitoxin on the sixth; about eighteen hours after the membrane appeared. On the same day a second dose was given, much larger, at about 4 P.M.; the pulse was then 120, temperature 101.6°. The next morning both pulse and temperature had gone higher, when he changed and gave an injection of a new solution. On the eighth the temperature in the morning was 102°, pulse 130; patient not very much improved. At 9 P.M. a full dose of Behring's solution (twelve cubic centimeters) was given. The next morning the temperature, after twelve hours, was nearly normal, and the patient proceeded to recovery very rapidly. The first solution used was obtained from Pasteur's New York Laboratory; but within twelve hours after giving a full dose of the Behring solution, the patient was very much better, and practically has not been sick since. Case 2. Patient first seen on the fourth day of disease; had been treated by another physician with the ordinary remedies. Bacteriological examination was made, and a dose of the Pasteur material given on the fifth day. On the next day there was a decided manifestation of laryngeal involvement. A full dose of the Behring solution (No. 2) was then given. Sixteen hours later, in a fit of coughing, a cast of the larynx was brought up, which showed the bacteria. After that time the pulse and temperature came down to normal, and did not again rise. The patient recovered rapidly. A full dose in both cases seemed to act beautifully. Dr. J. F. Martenet: I desire to report an interesting case in which I had the opportunity to use this remedy. The case was that of a child two years old, who had been sick ten days. It was primarily a laryngeal case. Another physician had been treating it, and gave the case up as hopeless. When I saw it the larynx and trachea were full of the membrane, and breathing was very difficult. I gave the first injection of antitoxin that evening and the second dose the following morning; the respiration having by that time somewhat improved. In the evening, however, it was worse. The larynx was almost occluded, and the child could scarcely breathe. The temperature was 103°, respiration very rapid, the pulse rapid and weak. I could not get more of the antitoxin at that time, so I had to try tracheotomy, and left the tube in all night. Next morning the child was apparently dying. We removed the tube, and the child, getting more air, improved somewhat. By the next day I had succeeded in obtaining more of the antitoxin, and gave a third injection. Improvement went on rapidly, and by the following day the child was practically well. Bacteriological examination showed it to have been a case of mixed infection. Tracheotomy undoubtedly helped to save the child's life, but it may have been by giving the antitoxin an opportunity to produce its effect. The Oldest Medical Prescription, Says an exchange, in existence bears date of 4000 B. C. It was discovered in an Egyptian tomb, written on papyrus, and has been deciphered by an English professor. It bears evidence that it was intended for some bald-headed Egyptian, and reads as follows: Dog's paw (calloused part), Donkey hoofs, Parts. 1 1 1 Boil the whole in oil and rub the scalp actively with the mixture. Egyptian history does not say whether or not the patient regained his lost hair. Selected Articles. The Gold Preparations in Some Skin Diseases and Syphilis.* Our knowledge of the therapeutical action of gold has, up to within a few years, been based upon the hypothetical dicta of the alchemists. Gradually the matter was taken up again, at first by the Arabian physicians and afterward in Europe. Once more it fell into disuse, and was rescued from oblivion by Hahnemann, who introduced it in his pharmacopoeia. However, this did not give it much of an impulse, and it is only of late years that this metal has undergone any serious investigation concerning its therapeutical properties. Among American investigators Bartholow, Heneage Gibbs, and Shurley are the most prominent. Dr. Shtcherbok has made thorough investigations also. The most active salt of gold is the bromide, and it is particularly so upon the nervous structures, but small doses being necessary to produce effects. The action of gold is essentially that of an alterative. It has no cumulative effect; but, when toxic doses are administered, mental excitement, amounting to delirium at times, manifests itself. A prominent symptom of its excessive action is an excessive flow of saliva, the so-called aurism. Remembering this in connection with the fact that very small doses produce the effect of the remedy, more especially in the form of bromide, some care should be exercised in its administration. Among the therapeutic effects. of gold may be noted the fact that it is tonic, more especially to the nervous system, and this accounts for the fact that it is an aphrodisiac of no mean power. It was highly esteemed many years ago as an antisyphilitic, and recent experience confirms this view, more especially in the latter forms of the disease. The cutaneous troubles in which I have had occasion to employ the gold preparation to any extent are limited. In acne and eczema of a subacute or chronic character I have * By A. H. Ohmann-Dumesnil, A.M., M.D., Prof. of Dermatology and Syphilology in Marion Sims College of Medicine, St. Louis; Consulting Dermatologist to St. Louis City and Female Hospitals; Dermatologist to Alexian Brothers Hospital, Pius Hospital, Rebekah Hospital, etc. VOL. XV-8 found arsenauro an invaluable adjuvant. On the other hand, in chronic eczema and in the latter manifestations of syphilis mercauro has proved itself almost a specific, so much so that its administration was always attended by marked improvement, which ceased so soon as it was discontinued. This it was which attracted my attention to the gold preparations, and in investigating their therapeutical properties I have been impressed by the fact that the most active as well as most efficient salt of gold is the bromide. It not only acts powerfully when administered alone, but seems to increase the therapeutic effects of arsenic and of mercury, and for that reason much smaller doses of these agents may be given, better results obtained, and at the same time, security from toxic effects will be secured. These are the qualities which recommend the preparations mentioned above, which are true chemical combinations and not empirical mixtures. It may not be inappropriate to mention a few cases from practice illustrative of the good effects of gold preparations in diseases of the skin and in syphilis: Case 1. Miss F. B., a dark blonde of seventeen years, has been suffering from a marked pustular acne for two years. She is very nervous in disposition. Vlemingkx's lotion ordered applied at night, and resorcin ointment every morning. In addition the pustules were emptied thoroughly every day. Some little improvement showed itself, but it was not stable. A "nervous" attack would cause the eruption to manifest itself in a marked relapse. After two months of this treatment, with variations of the external measures, she was placed on ten drops of arsenauro three times a day. In one week the eruption had disappeared, and now, after a lapse of two months, no lesions had appeared. Case 2. Miss B. R., a blonde of eighteen years, states that she has been suffering from a papular acne, with comedones, since she was thirteen years of age. Free incisions of the papules, together with a sulphur ointment locally, failed to procure any decided effects until arsenauro was used. Her face is now perfectly smooth and clear and downy. Case 3. M. P. was suddenly attacked by an intense pruritus, accompained by a mild form of ichthyosis. The ordinary anti |