the breadth with which the subject was handled; and, secondly, by the thoroughly scientific spirit that pervaded both the methods adopted and the conclusions arrived at.

After a lucid account of the present state of our knowledge of the pathological process in diphtheria and of the poisons secreted by the bacilli, Dr. Martin gave the result of his own investigations, showing that extensive nerve and heart muscle degeneration-the pathological characteristic of diphtheria was produced by injection of pure diphtheria toxin, from which it is evident that the Klebs Loeffler bacillus is the cause of diphtheria. His experiments on the effect of the diphtheria antitoxin showed that when administered in sufficiently strong doses it counteracted all the effects of the toxin or the diphtheritic ferment. It has only a slight effect on the febrile temperature produced by the albumose, but it completely counteracts the fatty degeneration of the heart, and to a very great extent also the nerve degeneration, which was insignificant in extent. It was found, also, that the injection of large doses of the antitoxic serum into the venous circulation of the rabbit produced but little effect on the body temperature and no loss of weight, appearing to be, as far as could be judged, a perfectly innocuous substance.

It is evident from these experiments, carried out under such exactly observed and controlled conditions, that the actions of the antitoxic serum may be followed with the greatest nicety. The actions are-first, that antitoxic serum even when injected in considerable quantities, produces no appreciable injurious effect even on very susceptible animals; secondly, that this serum, when given in sufficient doses, appears to neutralize completely the action of the active ferment which plays so important a part in the production of symptoms of diphtheria; while thirdly, it also neutralizes in a very marked degree the effect of those albumoses which are formed in the later stages of the disease, apparently through the action of the ferment on the albuminoid substances with which it comes in contact, and which appeared to be stored up in the body for some considerable time after the ferments have ceased to act. Most of the speakers who followed were in full accord with Dr. Martin on most points, and brought

forward strong clinical evidence in support of the position they assumed.

Dr. Goodall, who dealt only with cases in which a bacteriological examination had been made, making every allowance for age and for mildness of epidemic, is satisfied that antitoxin is a valuable therapeutic reagent, especially in those cases in which tracheotomy was performed; as of those so treated without antitoxin only 28.5 per cent. recovered, while of those treated with antitoxin the recoveries were no fewer than 6 per cent. The proportion of cases in which there was albuminuria was nearly the same, but the percentage was slightly higher in those cases treated with antitoxin-53.3 as against 49.2 per cent.; but of the cases in which anuria occurred there were 8.57 per cent. in which antitoxin was used, and where antitoxin was not used 8.89. He showed that antitoxin cannot prevent the occurrence of paralysis, but points out that it is to be expected that "if antitoxin, or, for the matter of that, any other drug, afforded material help in tiding the patients through the membranous stage, the percentage incidence of paralysis would become higher."

Prof. Von Ranke's statistics speak for themselves, but the value of antitoxin in those cases in which some operative procedure is found to be necessary could not, Von Ranke thought, be too strongly accentuated. He specially insisted, however, on the fact that under the influence of the serum treatment diphtheria loses its progressive character, and in support of this he cited the extraordinary result that the laryngostenosis disappeared in 28.4 per cent. of his cases, while formerly he had never been able to obtain a higher percentage of the disappearance of that condition than 5; while operation was never necessary at a later period than twenty-four hours after the treatment had been commenced.

Prof. Baginsky added to his already published statistics, and showed that the mortality in his clinic in Berlin had been brought down from an average (of over four years) of 41 per cent. to 15.6 per cent.

From the point of view of prophylaxis some statistics were brought forward on which to base arguments which up to the present have been founded merely upon experimental data.

Dr. Hermann Biggs' figures are so striking that a protective injection would appear to be valuable in all cases where children cannot readily be isolated, or where they have already been exposed to infection. It is only in such cases, however, that such a course would be valuable, as the period of protection is comparatively limited, though it is certainly sufficiently long to allow of measures being taken to remove those not already infected beyond the danger of infection.

It is somewhat remarkable that there should be such a very great difference in the results obtained in the hands of different observers, and Mr. Lennox Browne, whose experience seems to have been singularly unfortunate, in so far that he has been able to observe little or no improvement in the cases under his immediate observation, must, along with a few others, seek for some explanation of the differences in the results obtained. Several explanations have been offered. Dr. Woodhead suggested that the better results obtained abroad might perhaps be explained on the assumption that those who had had most experience of this method of treatment-that is the French and German physicians-had now confidence in giving larger doses of the antitoxic serum-a confidence which it was evident was justified also by laboratory experiments. It is, of course, obvious that there may be another explanation, and that is that the strength of the antitoxic serums sent out by different firms is not uniform, and that the different methods of standardising the serum may leave the practitioner in some doubt as to the exact amount of serum that may be given. It has certainly been found that the serums from different laboratories vary very considerably in strength, and that even those sent out from the same laboratory are not always the same.

Such being the case, it is impossible, especially in the case of weak serums, to expect that the physicians will give sufficiently large doses to obtain the required results until they have gained that confidence in the use of the remedy which only a careful study of its effects can give. It certainly appears that Behring's system of sending out, not a definite quantity of serum but a definite number of immunising units, is very much better than that of supplying serum which is said to be above a certain strength.

The whole discussion was exceedingly suggestive, and, taken with those in the other Sections, is one of the most important contributions to the question of serumtherapy that has yet been made in this country, and we congratulate Dr. Martin on having given a lead which was so excellently followed, though on somewhat diverging lines, by those who spoke.

THE result of the investigation of Dr. J. H. Kellogg, of Battle Creek, Mich., as to the cause of that widely prevalent disease, so universal in America as to earn for it the title of "American Disease," goes to prove conclusively that the most common forms of dyspepsia are due to the failure to digest starch. "Eat slowly, and chew your food well," is a constant injunction given by the family doctor to those of his patients who suffer from dyspeptic troubles, and the force of this admonition is well evidenced by the result of Dr. Kellogg's commendable experiments. In the August number of Modern Medicine, in an article on "The Food Value of Candy," Dr. Kellogg takes issue with a writer who concludes that since after a test meal consisting of one and one-half ounces of unfermented wheat bread and eight ounces of water, seven per cent. of maltose and a larger or smaller amount of dextrin and soluble starch were found, cane sugar, candy and glucose are important articles of food. To this Dr. Kellogg replies that the product of salivary digestion is neither cane sugar nor glucose, but maltose. He further states that cane sugar cannot be absorbed as cane sugar, and is not acted upon by the saliva, requiring for its digestion an inert ferment, encountered only in the intestine. Cane sugar in considerable quantities, by giving rise to an abundant flow of mucus in the stomach, has a strong tendency to produce gastric catarrh. That sugar and glucose are foods is not disputed, but they require digestion, as does starch, before being taken into the economy. Dry cereals are important as food substances, since they tend to produce the desirable free flow of saliva; the use of dry food therefore being the proper remedy in amyloid indigestion. In concluding this excellent article, from which we have quoted so freely, the investigator has a

word to say concerning malt extract as a digestive agent, believing that, although beneficial in certain cases, its therapeutic value in digestive disorders is limited perhaps to its stimulating, or in some way regulating the process of absorption.

R. B. M.

THE attention of our readers is specially directed to the following important communication from the chairman of the Committee on Malarial Hematuria, of the Tri-State Medical Society of Mississippi, Tennessee and Arkansas:

MEMPHIS, TENN., August 10, 1895.

DEAR DOCTOR: This committee desires to make a complete report at the meeting in Memphis in November next. Due credit will be given each contributor. For the sake of uniformity it is suggested that you put each case of which you have a record on a separate sheet, as follows: 1, number of case; 2. age, color, sex, etc.; 3, previous history; 4, sanitary surroundings; 5, kind of drinking water; 6, season of year; 7, is malaria abundant at the time, and in what form? 8, is malarial hematuria abundant at the time? 9, what type of malaria, if any, preceded the attack? 10, had patient taken quinine, and how much? 11, symptoms, character of urine, etc.; 12, therapy; 13, was blood examined? 14, termination; 15, post-mortem appearance; 16, is it patient's first attack? In answering, question may be referred to by numbers only. Blanks for observation of future cases mailed on application. Write for some. Answer as many of the questions as possible. Let us have all the information you can. Address all communications to the chairman, Dr. Wm. Krauss, Randolph Building, Memphis, Tenn.

THE meeting of the Tri-State Medical Association, to be held in this city November 13 and 14, bids fair to be the largest in point of attendance and most interesting from the number and quality of the papers to be read, since the organization of this association. The secretary of the association, Dr. A. B. Holder, has issued a circular letter calling for papers and reports of cases in practice. The report of the Committee on Malarial Hematuria, of which Dr. Wm. Krauss, of Memphis, is chairman, will certainly be interesting and highly instructive, the committee having gone to no little trouble in preparing to make a complete report. We cannot urge too