points out, and Ehrlich' states that the mechanism of original body, i. e., the toxin, toxoid, ferment, bacterium, hemolysis and bacteriolysis appear to be very similar or erythrocyte. The soluble substance, therefore, which and the study of hemolysis consequently gains a not is produced by the action of the original body (by the unimportant theoretical significance. Ehrlich has ex- toxin, bacterium, erythrocyte, etc.), must chemically perimented with the blood of a goat which had been combine with the original body. If the original body for eight months subcutaneously injected with sheep is a soluble substance from the beginning, as the toxins, serum containing a large number of blood corpuscles. this "neutralization" takes place in the solution. If, The result of his investigations with regard to hemoly on the other hand, the original body is not directly sol sis are identical with those of Bordet. Ehrlich points uble but consists originally of an insoluble substance, out that with regard to furnishing an explanation of the for instance, of a particle of a bacterium or a blood cell, process of hemolysis one is compelled to accept, accord then the respective antibody, which exists dissolved in ing to Pfeiffer's explanation of the process of bac- the blood, is removed from this fluid by the respective teriolysis, the existence of two substances. A specific particle of cell substance (the original body) and be. active and stable substance to which he applies after comes anchored to this cell substance. A similar proPfeiffer the term "immune-body" (Immunkörper) and a cess takes place in Wassermann's classical experiment— substance, present in the normal animal, which Ehrlich which constitutes a splendid corroboration of Ehrlich's preliminarily chooses to call "addiment." By the inside chain theory-where the original body (the tetanus jection of an animal of a certain species with defibri toxin) is removed from its solution in the blood serum nated blood of another animal an "immune-body" by entering into a chemical union with the side-chains forms in an analogous manner as antitoxins and bac. of the molecules of the pulverized brain cells. tericidal antibodies are formed. This immune-body The phenomena observed in Ehrlich's experiments, possesses two different haptophorous atom complexes; concerning the nature of hemolysis, are interpreted by one atom complex which has a great affinity for the this investigator as follows: At a temperature of 30° corresponding haptophorous group of atoms of the red (Celsius) the red blood corpuscle enters into chemical blood corpuscles, and a second haptophorous group of combination with free molecules of the "immune-body," atoms of less chemical energy, which is capable of more as well as with molecules of the immune body or less completely attaching to itself the "addiment" which have already united with the "addiment." contained in the blood serum. This theory corresponds In the latter case the immune body represents the with Ehrlich's "side-chain theory" which furnishes the chain which attaches the addiment to the erythrocyte, most plausible explanation of the formation of antitoxins which is thus placed under the influence of the and bactericidal antibodies. The experiments which addiment. Under the influence of the addiment Ehrlich and Morgenroth describe in the above cited arti- phenomena take place which must be considered-in cle certainly justify the acceptation of Ehrlich's side- harmony with Pfeiffer's interpretation-analogous to chain theory in an equal degree as it has been accepted for the process of digestion, and it will therefore not be the formation of antitoxins and antibodies in general. improper, says Ehrlich, to look upon the addiment as For the sake of brevity, we have omitted a description invested with the character of a ferment. That ferof these experiments. If, according to Ehrlich's theory, any body, be it a toxin or a toxoid, a ferment, or a part of a bacterium or of an erythrocyte-if any such body possesses the capacity to unite with the side chains of pro toplasm, the conditions are fulfilled for the formation of the respective antibody. According to this theory the molecule of any one of these antibodies must possess that group of atoms which unites with the haptophorous (i. e, the specifically binding) group of atoms of the

ments, like toxins, possess two different groups of atoms, of which one is of an haptophorous (i. e., specifi. cally binding) nature, and the other (which corresponds to the toxophorous group of atoms in toxins) is the bearer of the ferment action, has been made highly probable by Morgenroth who has succeeded in proving the exist ence of a specific antibody produced by a process of im. munization with a ferment.

In accepting, then, the theory that Ehrlich's addiment is a ferment, the phenomena which present themselves

"Ehrlich und Morgenroth, "Zur Theorie der Lysinwirkung," Berl. in Ehrlich ard Morgenroth's experiments are explained klin. Wochenschr., No. 1, 1899.

3Ibidem.

"Ehrlich understands by side-chains (Seitenketten) lateral groups of atoms in the molecule.

by these investigators by the supposition that the im mune body attaches to itself the—in the blood normally existing small quantities of (digesting) ferments and

transmits them to those substances, for instance, blood selves certain groups of atoms and to enlarge thereby corpuscles or bacteria, for which it (the immune-body) the molecule of protoplasm. As early as 1885 Ehrlich possesses, owing to its other haptophorous group, specific pointed out that these, by the side chains of protoplasm affinities. This behavior alone, of the immune body, assimilated atomcomplexes, by their entrance into the furnishes an explanation why the digesting activity is living protoplasm, more readily undergo oxidation and not manifested when erythrocytes are mixed with the thus form the nutritive material kať exogen. The study addiment (i. e., digesting ferment) until the immune- of immunity has widened this view considerably and body is added to the mixture, as is shown by Ehrlich has taught that the different antibodies represent deand Morgenroth's classical and convincing experiments tached side chains and that the process of immunization a description of which we have omitted for brevity's consists in forcing the cells of the respective organs to sake, as already stated. We will only state, with regard produce these side chains in excess, in harmony with to Ehrlich's experimental investigations of hemolysis, Weigert's "lesion theory" (Schädigungstheorie). It is, that they have been crowned by most positive and un- according to Ehrlich, highly probable that the side. equivocal results. They show, that under the necessary chains must have, according to their special function, precautions a chemical union takes place between the different properties. If relatively simple bodies are to immune body and the red blood corpuscles; also be be assimilated by the side chains the presence of a tween the immune body and the "addiment"; but not single combining group of atoms will probably suffice. between the red blood corpuscles and the addiment be. Side chains with such constructed groups of atoms evi. fore the immunity body is added. The three ingredients, dently attach to themselves the toxins. But it is en(1) the immunity-creating body (viz., blood cells, bacte tirely different where the assimilation of giant molecules rium, toxin, etc.), (2) the immune body, and (3) the (i. e., molecules of albumen) is concerned. In this case addiment, forcibly remind one, by the way, of Schmidt's there is only a preliminary condition for cell nutrition theory of the formation of fibrin by the combined established by the fixation of molecules. Such a "giant. action of also three substances, viz, fibrinogen, fibrin- molecule" is useless to the cell until it is divided into oplastin, and fibrinferment. In the latter instance a minute fragments by fermentative processes. This ob solid body is formed, while in the former a solid subject is most readily attained when a cell stretches out stance is converted into a solution. its protoplasmic process as a bearer of a fermentative group of atoms to bring into closer contact its booty, the giant-molecule of albumen, which then may be digested and assimilated. An analogous practical mechanism where the protrusion of an organ, which catches the booty, possesses at the same time a digesting function is found in the whole series of the higher digesting plants. The tentacles of the Drosera, for instance, which surround the caught object, secrete a fluid which has strongly digesting properties.

By the immune-body, then, the digesting ferment is gathered from the blood serum in which the percentage of digesting ferment is very small and transferred in rela. tively very large quantities to the erythrocytes, so that its concentration and therefore activity in these is very much greater than in normal blood. It is possible, nay probable, that in normal blood very few, perhaps only one single body exists which has digesting properties, but that a great many different kinds of specific im mune-bodies may accumulate in this fluid, as has been That a lysin-action does not take place with reference suggested by Gruber and others. According to Ehrlich, to toxins, but only in the presence of cell substance, it will have to be premised that in different immune. whether it concern bacteria or blood cells, is explained, bodies only that group of atoms differs (in chemi then, by the fact that the molecules of the latter have a cal structure) by means of which the immune body much more complicated chemical structure than the has a specific affinity for the immunity-creating molecules of toxins which represent only a cell secre substance, but that all immune-bodies have one tion. According to Ehrlich it is to be presumed, theregroup of atoms in common by which they combine with fore, that for the "seizure" of cell substance, and other the digesting substance the addiment. From this bodies of a highly complicated chemical structure, sidestandpoint the otherwise so obscure origin of the lysins chains of a particular kind exist which possess besides the is readily explained by Ehrlich's side-chain theory. "catching" atomcomplex, another group of atoms which According to Ehrlich's definition the side-chains are by the fixation of suitable ferments is capable of creatthe groups of atoms which are bearers of definite ing a process of digestion. If one compells, by the proatomcomplexes that are capable of attaching to them-cess of immunization, the excessive production of side

It was further resolved that in future all matters con.

chains, the entire side-chain with its two functionating the staff by unanimous vote and on motion of Dr. Brown groups of atoms is detached and enters the blood as an seconded by Dr. Morris, it was unanimously decided immnue-body. By Ehrlich's ingenious side-chain theory that this letter was ill advised, that no more be sent out and that the letters be no longer effective. the surprisingly practical mechanism of specific im munity is made clear and comprehensive, and the phe-cerning the medical policy and ethical conduct of the nomenon, that by the entrance of a bacterium into Hospital would be under the control of the medical higher living organisms a substance is produced by staff of the Hospital. which the bacterium is destroyed by a process of solution In response to questions asked by members, whether (digestion), made amenable to scientific explanation by or not the Baptist Hospital or its Superintendent was directly or indirectly connected with any so-called fiftycent hospital association, Dr. Morris said there was absolutely no such connection in any manner whatever, and offered if necessary to make affidavit to that effect. From the above it will be seen that it is the desire and intention of the staff to conduct the Hospital in as ethical a manner as possible.

an hypothesis which most strikingly harmonizes with exact experimental investigation. By Ehrlich's explanation of the phenomena of hemolysis the phenomenon of bacteriolysis is shown to be nothing more nor less than the reproduction of a function of normal cell life. Of great interest is Ehrlich's ingenious comparison of the chemical process, by which the toxins of the body are made innocuous by a process of immunization, to that of bacteriolysis, and the analogy of the latter process to the process of digestion in animal and vegetable life. The results of Ehrlich's research with regard to the nature of immunity and the process of artificial immunization appear to be far reaching indeed, and the scientific horizon concerning the nature of digestion may thereby be enlarged in a heretofore undreamed of measure by the new and important light which his investigations may throw upon the physiology of that important process.

CORRESPONDENCE

The Baptist Hospital.

Editor MEDICAL REVIEW.-With a view of placing the Baptist Hospital before the profession in its true light, I have been directed by its staff to state the following facts:

On Friday, January 6, 1899, the following named gentlemen met and organized the medical staff of the Hospital: Dr. Bransford Lewis, President; Dr. John Young Brown, Vice President; Dr. John A. J. James, Secretary; Dr. C. C Morris, Dr. Robert Barclay, Dr. J. W. Williamson, and Dr. John C. Morfit.

The Indications for the Employment of Hydrochloric Acid in Affections of the Stomach.-In his Lyons Thesis of 1898, according to the (International Med. Magazine; N. Y. Med. Jour.) Perran says that, although hydrochloric acids is already old as a therapeutic remedy for diseases of the stomach, authors are still far from agreeing on the cases in which it should be employed, and, above all, as to the quan. tity of the drug to be employed. Indeed, while certain clinicians prescribe from fifteen to thirty minims per day, others administer much larger doses.

In the work of this thesis Perran describes the favorable effects produced by large doses of hydrochloric acid taken according to the method employed with sucThe minutes pertaining to the policy of the Hospital | cess by Dr. C. Tournier in his private practice, as also and to certain matters which have been under discussion by Dr. Lépine, of Lyons. Dr. Tournier gives hydrolately, which it is desired to explain, are as follows: chloric acid in the French official dose of from three to There was a discussion of various matters pertaining four grammes (forty-five minims to one drachm) daily to the organization of the Hospital staff; Dr. Morris in the following manner: The patient takes fifteen called the attention of the staff to a type written letter drops of the acid a few minutes after finishing each of sent out by the Hospital in November and December the two principal meals, then at the end of half an hour relating to giving one-third of the fees received from he takes another fifteen drops, and lastly, in certain cases to the physicians sending patients to the Hospital. cases, he again takes fifteen drops after an interval of The action of sending out this letter was disavowed by thirty minutes.

This method of taking hydrochloric acid is about the large elongated tumor occupying the central area of the same as that employed by Dr. Ewald, who prescribes anterior part of the organ, and measuring an inch and fifteen drops of the acid three or four times at quarter- a half in length by three qurters of an inch in breadth. hour intervals. However, the hydrochloric acid of the The edges and base of the tumor were moderately hard German pharmacopeia contains twenty-five per cent of and infiltrated, but there was no charteristic sclerosis. the gaseous acid, while that of the French pharma. The central part of the tumor was occupied by a ragged, copeia contains about thirty five per cent. Tournier deep, longitudinal ulceration, covered apparently with therefore employs a larger dose than Ewald. Thus ad- florid granulations. The submaxillary glands were ministered the hydrochloric acid would be tolerated moderately swollen and quite hard. The tumor had and its use prolonged without inconvenience for sev- commenced as a small lump deep in the tongue eight eral months. This medication is indicated in gastric weeks before, and was steadily getting larger. The exhypochloridia in general, and especially in lienteric act time at which ulceration had begun could not be diarrhea accompanied by extreme hypoacidity of the determined; in fact, the patient attached very little imcontents of the stomach. These patients have very portauce to that feature of the affection; there was no slightly accetuated gastric disorders. history of a sudden rupture, as of an abscess. There was absolutely no pain connected with the affection, and the patient complained only of the discomfort and inconvenience caused by the presence of the tumor in her mouth.

One observes neither palpation nor swelling, neither pain nor flatulence. Gastric movements are preserved and even exaggerated, and the chemical analysis alone shows that the fault lies in a lack of acid in the con tents of the stomach. But there is always a lienteric diarrhea occurring generally after each meal, and this disappears in four or five days, under the influence of the acid treatment, although it may have resisted all

other remedies.

No evidences of past or present syphilis were found anywhere, and this, with the age of the patient, her robust health, and the fact that she was a modest girl, had been recently married to an apparently healthy husband, and was pregnant, seemed to exclude tertiary

A second group of cases, where the use of large doses syphilis. No stress was laid upon the history, more of hydrochloric acid produces good results, is found in especially in the case of a woman; but as a matter certain gastric conditions with functional hypochlor- of fact that was entirely negative. Cancer could be idia, which may be observed in neurasthenic patients, excluded from her age and sex. Primary tubercuand shows itself especially in alimentary vomitings with no burning sensations and unaccompanied by sore ness. The use of hydrochloric acid in these cases does not fail to control the vomitings.

losis was excluded from the appearance and course
of the ulceration, and the normal condition of her
lungs, larynx, and general system. The diagnosis lay
between an ulcerated initial lesion and a softened gum.
former.
ma, with the chances apparently greatly in favor of the

under observation. Both the tumor and the ulcration
The patient was therefore given a placebo and kept
increased slowly but steadily in size. On May 4 the

Lastly, this drug is especially useful in cases of gas tric catarrh with hypochloridia, of alcoholic origin, when the troubles consist more especially of alimentary vomitings, distention, sensation of weight after meals, insomnia, and loss of appetite. The conditions which might constitute a formal contraindication to the use of hydrochloric acid are those in which the gastric trou-not a single secondary manifestation had shown itself. bles are accompanied by a pronounced hyperesthesia of

the mucous membrane of the stomach for all acids.

It is easy to understand the favorable influence exercised by hydrochloric acid in cases of gastric catarrh in conjunction with hypoacidity; indeed, physiology teaches us that this action favors the secretion of the gastric juice, the emptying of the stomach, and the dis appearance of mucus; further, that it acts as an anti septic; and lastly, that it is an excitant of the pancre atic secretion. It is, above all, this last property which Tournier invokes in order to explain the curative action of hydrochloric acid in cases of lienteric diarrhea.

eleventh week after the appearance of the tumor, and

mass had become somewhat softer. It was then the

The diagnosis of gumma was then made, and the results of treatment rapidly proved its correctness. Under moderate doses (ninety grains daily) of the iodide of potassium, conjoined with small doses of mercury, the tumor rapidly decreased in size; the ulceration healed up; and three weeks later, when the patient withdrew from observation, there was hardly a trace to be felt in the tongue of the original induration, and the tumefied glands were reduced to one-half their former size.

The interesting point in the case, says the author, apart from the comparative rarity of the affection, is the presence of a tertiary lesion in a patient so young and Gumma of the Tongue Without Other presenting not the slightest evidence of luetic infection. Specific Symptoms.-Dr. William S. Gottheil It is an additional argument, if one were needed of (International Med. Magazine; N. Y. Med. Jour.) rec the absolute necessity of making the diagnosis in ords the case of Mary H., American, 24 years old, who syphilis, as in ordinary dermal affections, from the ob came to his clinic on April 15, 1898, complaining of a jective symptoms alone, and absolutely disregarding sore ongue. Examination showed the presence of a the anamnesis.

side of the neck. These are likened sometimes to The general and special treatment are well known. lumps of dough; the lecturer states that they feel more Warmth is very necessary. For this purpose, change like a large ripe tomato under the skin; these lumps are to a warm climate is very helpful. Thyroid preparamade up of fat, changed connective tissue, dilated tions are the specifics in the disease. Sometimes thyroid veins; these enlargements are characteristic of sporadic is administered in the form of glycerine extract, mxv, cretinism. The hands become broad and unshapely; they were likened by Sir W. Gull to spades.