the infections. The prevailing phagocytic theory accounts for this excessive production of leucocytes by supposing a conflict to exist between the weapons of nature, the leucocytes, and the infectious agents. A feeble or susceptible organism cannot cope with the invading army of bacteria, owing either to diminished production or diminished power of the leucocytes. For purposes of diagnosis it is well to remember that there is an absence of leucocytes in the following diseases: Typhoid fever, malaria, grippe, measles and tuberculosis.

Croupous Pneumonia.-The leucocytes are always increased, and continue so throughout the febrile period. In a pseudo-crisis, the leucocyte remains high, but in a true crisis, the count falls appreciably. Leucocytosis continues in delayed resolution, and becomes reduced to normal when resolution eventually occurs without complications. When abscess, empyema or gangrene supervene, the leucocyte count remains high. The degree of leucocytosis is not commensurate with the amount of lung implicated, nor with the height of the fever. Cabot divides the pneumonia cases into the following groups as regards the degree of leucocytosis present: Mild infection, vigorous reaction, slight leucocytosis.

I.

2. Severe or moderate infection, vigorous reaction, marked leucocytosis. 3. Severe infection, feeble reaction, no leucocytosis.

The cases in class. I all recover; in class 2, which includes ninetenths of all cases, patients may or may not recover, whereas, in the third class, patients almost invariably die owing to the inability of the organism to raise the leucocyte count. Speaking generally, the absence of leucocytosis is a bad sign, while its presence is neither good nor bad (Cabot). Von Jaksch observing the fatality of cases without leucocytosis advised producing leucocytosis by the injection of irritants like turpentine, with the object of creating an abscess. Pilocarpin and nuclein have likewise been employed for this purpose, but with no obvious benefit to the patients. Hare has made the pertinent suggestion of using cold baths in preference to antipyretics for temperature reduction insomuch as the latter check leucocy

The average number of leucocytes in pneumonia is about 25,000. The leucocytosis in pneumonia, as in other pyrexias, is to be regarded as a defensive process of the organism against the virus of the disease. In differential diagnosis, the leucocyte count is of some moment. Take central pneumonia as an instance where there are no physical signs. If the leucocytes are increased in number, we may exclude typhoid fever, malaria and grippe, and make the diagnosis of pneumonia when the symptoms, but not the physical signs are suggestive of the disease.

Phthisis. Here again we are constrained to quote Cabot, the apostle of hematology. His conclusions are practically as follows:

1. In incipient phthisis the leucocytes are normal except after hemoptysis. 2. There is usually leucocytosis after an attack of hemoptysis in deference to the law of ordinary post-hemorrhagic leucocytosis and disappears quickly when the hemorrhage subsides. 3. Cavities are very constantly accompanied by leucocytosis and the absence of leucocytosis negatives cavitation of any great extent. 4. Tubercular pneumonia may cause an increase of white cells, sometimes as great in croupous pneumonia, but this is not

invariable. 5. Fibroid phthisis without cavity formation shows no increase of leucocytes. If there is a normal temperature the leucocyte count is normal, but a febrile state may or may not be attended by leucocytosis (according, presumably, as the fever is or is not due to pyogenic organisms). In a general way, the worse the case, the higher the leucocyte count, yet the signs may be advanced without causing any leucocytosis if cavities are absent. As a rule, we find no qualitative changes in the leucocytes. Neusser advocates the theory that perinuclear basophilia during tuberculosis is a favorable sign, and shows an organism capable of resisting tubercular infection. Basophilia, he contends, is an evidence of the uric acid diathesis, and in individuals with gout, leukemia and bronchial asthma who show this condition, tuberculosis rarely occurs. The evidence of perinuclear basophilia when tuberculosis does coexist with the uric acid diathesis shows that the tubercular process has a tendency to heal. If the theory of so competent an authority is correct, we have at our command a valuable sign in prognosis. Neusser employs the following stain for the perinuclear basophilic granules:

50 c.c.
70
80 "

acid fuchsin....
orange G....

methyl green..

150

80"

Absolute alcohol..
Glycerin....

...

This stain brings out a grouping of dark blue-stained granules around the nuclei of the mononuclear leucocytes, and over and around the nuclei of polynuclear leucocytes.

Abscess of Lung.-Here, as in other pus collections, the leucocyte count is raised. The average count in three cases of lung abscess following pneumonia was, according to Cabot, about 16,300. In empyema the leucocyte count is increased. In differential diagnosis this fact may be of importance in adults. The average leucocyte count in serous pleurisy is 8,820; in pneumonia, 24,000; in empyema, 18, 300. In children a simple serous pleurisy causes such a rapid rise in the leucocyte count, that the latter is not of much value in distinguishing a serous pleuritis from an empyema.

Asthma.-This affection causes an increase in the eosinophile leucocytes in the sputum (65 per cent of all leucocytes) and in the blood. In the lat ter fluid they average normally about 4 per cent, but in asthma they run as high as 14 per cent. This increase is only present at the time of the paroxysm, and for a short time before and after it. A paroxysm may be predicted by demonstrating their increased percentage. The increase of eosinophile cells occurs only in bronchial and not in asthma complicating cardiac or renal disease, a fact of much importance in diagnosis. While the eosinophiles are usually absent after an asthmatic paroxysm, Gobuloff* demonstrated 17 per cent of them in one case one month after an attack.

In chronic bronchitis leucocytosis is uncommon, although in the acute variety, the leucocytes are increased in number.

* Sammumlungen Klin. Vortiage, Nos. 256 and 257, 1899.

(TO BE CONTINUED.)

MEDICINE.

BY FRANK PARSONS NORBURY, M. D.

Formerly Resident Physician Pennsylvania Institution for Feeble-Minded Children; Formerly Assistant Physiclan Illinois Central Hospital for the Insane; Physician to Oak Lawn Sanitorium and Passavant Memorial Hospital; Neurologist to Our Savior's Hospital; Lecturer

Psycho-Physics, Illinois College.

AND EGBERT W. FELL, B. S..

JACKSONVILLE, ILL.

The Treatment of Whooping Cough.- Coggeshall (Med. News, March 31, 1900) advises the following treatment: First spray the nasal mucus membrane with a cocaine solution, then apply a two or four per cent solution of silver nitrate, followed by spray or post-nasal alkaline antiseptic wash. The application of suprarenal extract may be tried.

Contagion in Leprosy as Observed in San Francisco.-Montgomery says (Jour. A. M. A.): "The region west of the Rocky Mountains seems not only to be the recipient of a large number of lepers from outlying leper countries, but the disease appears to be capable of propagating itself in this country. The number of incoming lepers to the Pacific coast from foreign countries must necessarily grow larger with our increasing trade,' but as annexation and trade cannot be stopped on account of so mildly contagious a disease, the remedy must be segregation of the lepers already here, and more stringent examination of immigrants from leper countries.

The Bubonic Plague (Klebs, Med. News, February 17, 1900).-The specific cause of plague is a short, rod-shaped bacillus growing best on normal agar or gelatin agar, in transparent colonies, becoming white, then yellow and granular. Optimum temperature below 36° C. It stains slightly in alkaline analine dyes and is decolorized by Gram's method. Opinion differs as to spore formation. Characteristic involution forms develop on salt agar. It will live in water, milk or urine many days; resists drying for some time; is destroyed by heating to 69° C., and resists freezing. Disinfection is best accomplished by acid solutions; carbolic acid 2 per cent, mercuric chloride .2 per cent, or copper sulphate, or potassium permanganate in .I per cent solutions are effective. Infection may occur from contagion, from rats or insects, or from water or food. Encouraging results have been obtained from vaccination by Haffkine and from anti-plague serum by Yersin. The spread of the plague should be combated by general hygienic measures. Transportation of persons and merchandise should be controlled by especially educated sanitary officers. On the appearance of plague suspected persons, and all cases of pneumonia should be reported; portable laboratories established for rapid diagnosis; the house. disinfected with formalin-steam, and the well members of the family carefully watched. Rats may be poisoned with strychninized-wheat. Special institutions should be erected by the government for experimentation, with a view of obtaining a protective or curing vaccine or serum. The danger of an epidemic in the United States is slight.

Society Proceedings.

THIRTEENTH INTERNATIONAL MEDICAL CONGRESS.

The sessions of this Congress, composed of some thirty or more sections, were held in Paris, August 2 to 9, inclusive. Representatives of thirty-four countries were present to the number of about 6,500; 420 of these were registered from the United States and 226 from Great Britain; Germany sent 572 delegates; Russia, 805; Italy, 324; Spain, 219. The French language was distinctly the official one of the congress, all programs, announcements and reports being printed in French exclusively. This rule was a great disappointment to the delegates who were not familiar with the native tongue. Prior to the formal opening of the congress reunions of the delegates from the various countries represented at the congress were held in the basement of the buildings of the Paris Faculty of Medicine, a separate room being assigned as headquarters for the representatives of each country.

The first general session of the congress was held in the great fete hall of the exposition, and the second and third general sessions were held in the large amphitheater of the Sorbonne. The meeting places for the several sections were selected from among the lecture halls of the various institutions of learning in Paris.

A list of the papers read would fill several pages, while among the authors represented were many of the leading authorities of the medical world. Below is given the titles of a few of the papers presented by authors known in the United States: "The Soldier's Ration, its Use and Abuse in the Tropics," by Major Louis L. Seaman, U. S. A.; "Action of Digitalis and its Active Principles," by Dr. Lander Brunton, London; "The Cure of Consumption," by Dr. Helen Densmore, New York: "The Modern Treatment of Yellow Fever," by Dr. Fernandez de Ibarra, New York; "The Virile or Bulbo-cavernous Reflex Diagnostically and Medico-legally Considered, with at new Method of Eliciting the same and new Suggestions in Practice in Connection Therewith," by Dr. C. H. Hughes, St. Louis; "The Technique in the Interscapulo-thoracic Amputation," by Dr. Robert G. Le Comte, Philadelphia; "Report of a Case of Ligation of the Abdominal Aorta in which the Patient Lived for Forty-eight Days," by Dr. Keen, Philadelphia; "Therapeutic Indications in Appendicitis" (report), by Dr. F. Treves, F. R. C. S., London; "Circumdental Diseases, with Special Mention of Erythrosis of the Gums, its Causes, Different Aspects and Therapeutics," by Dr. Nash, New York; "Remarks on Benign Tumors," by Dr. Knight, Cincinnati; "The Pathology and Treatment of Tuberculosis of the Cervix Uteri," by Dr. H. D. Beyea, Philadelphia. In the Genito-urinary section interesting papers were read by Mr. Reginald Harrison, of London, Dr. Ramon

Guiteras, New York City, and Dr. Hugh Young, of Johns Hopkins, Baltimore.

Owing to the assassination of the King of Italy, the social features of the congress were much abridged. The president of the congress, M. Lannelongue, received the delegates and the presidents of the several sections on Friday evening, August 3d. A soirce was given to the members and delegates in the palace of the Senate and in the Luxembourg Gardens on Monday, August 6th, at which Mounet Sully, of the Comedie Francaise, and Madame Sarah Bernhardt recited poems and M. Renaud and Madame Litvinne, of the Opera, and M. Fugere, of the Opera Comique, sang. The presidents of the several sections all gave either dinners or receptions or both and numerous excursions were arranged for the entertainment of the members.

The most interesting social feature of the meeting was the dinner given to Lord Lister on August 1st by "Scientia," a scientific society of Paris. The dinner was given in the exposition grounds, about fifty guests being present.

INTERNATIONAL CONGRESS OF THE MEDICAL PRESS.

On July 26th this congress was organized in Paris, under the auspices of the French Medical Press Association.

Some three hundred persons, including many ladies, were in attendance at the first session, which was formally opened by the Minister of Commerce in the Press Pavillion of the Exposition. Professor Virchow of Berlin was present, and was the lion of the occasion, being the recipient of many honors as the doyen of the medical press. The proceedings opened with an address by Professor Cornil, who paid a glowing tribute to Virchow's Archives and to the work of its founder in medical journalism. In response Professor Virchow made a brief address, which was received with great enthusiasm.

At the conclusion of the preliminary addresses the following officers were elected: President, Professor Cornil; vice presidents, M. Richet and M. Lucas-Championiere; secretary-general, Dr. Blondel, and treasurer, Dr. Cezilly. The following honorary officers were also elected: Honorary presidents, Drs. Virchow, of Berlin; Posner, of Berlin; Fraenkel, of Vienna; Spatz, of Munich; Love, of St. Louis; Matthews, of Louisville; Jonnesco, of Bucharest; Julin, of Stockholm; Hansson, of Christiania; Valledor, of Madrid; Bacelli, of Rome; Bossi, of Genoa: Ceccherelli, of Parma; Gallet, of Brussels; Podwyssowtski, of Kiev; Ehlers, of Copenhagen; Tigerstedt, of Stockholm, and Sprigg, of London. Honorary vice presidents: Drs. Landouzy, Bourneville and De Maurans, of Paris. The following secretaries were also elected: English, Dr. Chas. Wood Fassett; Italian, Drs.