as they can or rather a good dose if possible, and while waiting for its effects, having more blood in preparation for the serum, and the treatment can be continued with the human serum. The whole blood is rapidly absorbed and has a decidedly good effect in some cases. The subcutaneous injection of whole blood is harmless and can be given in large quantities.

4. The results obtained by Welch and others, who have reported cases in the literature or personal reports to the writer, and the author's results in the reported cases in this paper, give the use of human serum the precedence over all other methods now in use. It is very effective and rapid in its action in controlling the bleeding, and has in many instances checked the hemorrhage when other methods have failed. The apparatus required for its use are in the equipment of every medical man, and the technic of the operation or rather of injecting the serum is exceedingly simple and can be carried out without failure in every instance. It can be used in the home just as safely and effectively as in the best regulated hospitals. Up to the present writing the author has been unable to find one case of sickness resulting from the use of human serum. At present it is impossible to say what a dose should be, but as the human serum evidently is harmless, no matter how much is given, it seems better to give what appears to a big dose rather than one that may be too small. It can be repeated every three or four hours, and that until the hemorrhage ceases. Welch gives the the folWelch gives the the following cases:

First baby 98 c.c. in one day in two doses, 20 c.c. and 78 c.c., and a total of 896 c.c. in twentyone days.

Second, first day, 54 c.c., 39 c.c., 12 c.c., 10 c.c.. four doses, 112 c.c. in one day.

Third, seven days, 630 c.c.
Fourth, five days, 1034 c.c.

The writer has given, as reports show, in one case 320 c.c. and another 280 c.c., the largest single doses being 40 c.c., and the largest daily 70 c.c. The serum itself never gave the slightest evidence of causing any untoward disturbance, and, as stated before, there is apparently no limit to the doses. The question may be asked as to when one should begin the injections of serum in a given case. This is difficult to answer, but in view of the fact that the external evidence of bleeding may be only a small part of the real hemorrhage that is going on, and also that the human serum does not produce any untoward symptoms, one is justified in using human serum very early in these cases as a prophylactic meas

ure, as much as for the use of controlling the bleeding. The writer has given human serum in several instances where there was just a slight hemorrhage from the navel, mouth or genitals. These cases are not reported, as the use of the serum was used in a prophylactic measure, and in all of these instances blood was secured and put away for the collecting of serum, should. more be required, and this is considered one of the strong points in the successful use of serum, that of having at least three or four good size doses ready for use when needed. I have only in one instance had parents refuse to give blood and then gave it myself and had the reward of seeing the baby live and thrive. In three of the writer's cases human serum was used, either donated by the writer or by one of the internes. at Wesley Hospital. In these cases the serum from the father or near relatives of the baby did not check the hemorrhage for reasons unknown, while two, or the most, three injections of foreign human serum checked the bleeding. The first case received 15 c.c. and 10 c.c., and hemorrhage ceased; the second, 70 c.c. in three doses; the third, 60 c.c. in three doses. I would strongly advise in those cases where considerable serum has been used from the mother, father, or near relatives without the desired result, that human serum be given, if possible from one who is not related in any way to the child and who is of a different nationality. The good result obtained by the use of human serum has so far not been explained. William H. Howell says that the good results from serum in melena neonatorum cannot be explained from our present knowledge of the processes of coagulation, and the same holds good for the other forms of spontaneous hemorrhages. Whether the serum acts on the blood-vessels themselves cannot be proven.

Comparing the old line of treatment with the present day use of blood-serum, either animal or human, we have the following statistics to show the great advance made in the treatment of these spontaneous hemorrhages. At the New York Lying-In Hospital, out of 18 cases, 17 died where only therapeutic means were employed. Green and Swift report 51 cases, with 25 deaths; 25 had animal serum, 12 of these died. Abt had fourteen cases, 10 died and 4 lived where only drugs were used. In 1911, the same author reports 7 cases, 6 lived and one died where whole. human blood or serum was used. The one death was excusable, as the child was moribund when brought to the hospital. Welch reports 31 cases with one death where human serum was used. Schloss reports 14 cases with 4 deaths with the

use of whole human blood. The writer has 12 cases with 3 deaths. Many others have reported remarkable cures with the use of human serum, and many babies are saved that no doubt would have died under the use of drugs, etc.

The writer's technic for securing blood and keeping it has been as follows: A large vein is secured in the arm near the elbow, and a good sized needle inserted and blood allowed to flow into large test tubes sufficient in size to hold 50 c.c. of human blood, and with a wide mouth so that the serum can be easily withdrawn from the tube with a syringe that will hold 15 to 20 c.c. of serum. One test tube has been, as a rule, a sufficient dose for one injection and need not be used again. This protects the blood against infection that might occur where a large bottle was used and the cork removed several times. Where whole blood is used, it is withdrawn with a syringe and quickly injected into the patient. The injections were made subcutaneously into. the back just below the scapula.

This is a very

I became

Dr. V. D. Lespinasse, Chicago: interesting paper to me. The first experience that I had in treating these babies was in 1910. interested in it from the standpoint of direct transfusion of live unclotted blood. I have had ten cases so far, with two deaths. Both of the babies that died were syphilitic. They were of all grades of severity, from medium to extremely severe. The worst case I had was one in the service of Dr. Joseph B. DeLee, in which the child, two days old, passed blood from the rectum at 7 o'clock and at 9 o'clock it was practically dead. The pulse was very fast and the child in coma. We transfused as soon as we could, and while working at transfusion the intern reported that the pulse had disappeared, and soon afterward he could not hear the heart beat. In fifteen seconds after we started blood into the jugular vein the heart beat returned, and that baby is all right to-day, and is now 9 months old.

In regard to the relative value of serum and transfusion, the serum will stop hemorrhage in practically all cases, but there are types of cases, particularly from the intestines, that are diagnosed relatively late.

Hemorrhage takes place in the stomach or bowel; it is not passed or vomited, and the first thing you know the baby is in collapse. These cases should be transfused immediately.

I have been called three times now to see cases of gastro-intestinal hemorrhages and to do transfusion, but the baby had been treated with serum, and died before I arrived. These cases have been given serum and in waiting for the serum to act they have died. In cases of the purpuric type, which are diagnosed as soon as the bleeding commences, there is a great field for human serum. But when the bleeding is from the bowel or mouth one is uncertain how much blood has bled into the lumen of the bowel or stomach, and a transfusion should be done as soon as possible.

Several years ago Dr. Graham did work in asphyxiated guinea-pigs, and when the little pigs were born they all had hemorrhages. I should think oxygen might be of value in these cases.

There is one case reported that, if transfused, I think would have lived. I think it is the first case that Dr. Goldstine reports. Transfusion is never too late. It can be done up to the time of or immediately preceding death.

Transfusion will do all that any other method of treatment will do. It will even save cases that are practically dead. Why not use it early and often?

56.

BIBLIOGRAPHY

1. Abt, I. A.: Jour. A. M. A., Jan. 31, 1903.

2. Goodman, C.: Ann. of Surgery, 1910.

3. Pratt: Jour. of Med. Research, 1903, x, 120.

4. Wright: Brit. Med. Jour. July 14, 1894.

5. Cohen, M. Solis: Univ. Penna. Med. Bull., 1907, xx,

6. Von Etlinger: Jahrb. f. Kinderheilk., 1901, lv, 24. 7. Osler: Modern Medicine, iv, 1908.

8. Schloss and Commiskey: Amer. Jour. Dis. of Children, 1912, iii, 216.

9. Vincent: Boston Med. and Surg. Jour., 1912, cxvi, 627.

10. Mosenthal: Jour. A. M. A., 1910, Iv, 613.

11. Lambert, S. W.

12. Swain, Jackson, Murphy.

13. Bigelow: Jour. A. M. A., lv, 400.

14. Green, R. M., and Sift, J. B.: Boston Med. and Surg. Jour., 1911. clxiv, 454.

15. Simons, C. C.: Boston Med. and Surg. Jour., 1912, clxvi, 43.

16. Richards, J. H.: Med. Record. Jan. 13, 1912.

17. Wacher, P.: Gynec. Rundschau, Berl. and Wien., 1912, vi, 207.

18. Griffith: Med. Press and Circ., London, 1910, xc, 411.

19. Weil, P. E.: International Clinics. 1907, lv, 28. 20. Ziegel: Arch. Ped. N. Y., xxv, 120.

21. Harris: Amer. Jour. Clin. Med., 1908, xv, 506. 22. Mackey: Montreal Med. Jour., 1907, xxxvii, 268. 23. Brittin: Lancet, London, 1908, ii.

24. Schloss and Commisskey: Amer. Jour. Dis. of Children, 1911, i, 276.

25. Welch Bull, Lying-In-Hospital, N. Y., 1909-1910, vi, 152.

26. Chisohm: Ophthalmoscope, London, 1907, v, 708. 27. Tuley: Jour. A. M. A., 1908, 1, 2215.

28. Thompson: System Med., Allbutt, 1908, v, 867. 29. Welch: Tr. Coll. Phys., 1911, xxv, 374. 30. Sayer: Jour. A. M. A.. 1912. lviii, 106. 31. Dodge: Denver Med. Times, 1911-12, xxxi, 303. 32. Bradshaw Jour. Med. Soc., N. J. & Orange, 1911, viii, 524.

33. White: Lancet, London, 1912, p. 416.

34. Dingwall and Gootes: Brit. Med. Jour., 1912, i, 725. 35. Graham: Jour. Exp. Med., Lancaster, Pa., 1912, xv, 307.

36. Meyers: Arch. Ped.. N. Y., 1912, xxix, 197. 37. Nicholson: Trans. Col. Phys., Phila., 1911-13, S. 33, p. 366.

38. Spencer: Abt's paper. Reference 1.

39. Larrabee: Osler's Modern Med., iv, 1908. 40. Grandidier: Osler's Modern Med., iv, 1908.

41. Von Lumbeck's: Osler's Modern Med., iv, 1908. 42. Howell, Wm. H.: Welch (29).

In his inaugural address to the 48th general assembly Governor Dunne dwelt at considerable length on the question of the improvement of the highways of the state. He recommended the passage of laws which would promote the efficiency and economy of the administration of the road system of the state. The general assembly has wisely enacted his recommendations into. law. In conformity to this end the Governor has appointed three gentlemen as members of the state highway commission, under whose control will lie the enforcement of the Goods Roads Bill. At the present time, the world over, the subject of good roads is a live and important topic. No member of the community, whether urban, suburban or rural, should have more interest in good roads and a keener desire for the betterment of our highways than the physician.

Good roads extend his practice, widen his sphere of usefulness and increase both the comfort and safety of his daily journeying. Good roads, too, increase the safety of his patients, for in many an emergency the speed with which a

call can be answered will determine the question of life or death.

After appointing the good roads commission the Governor, according to published reports, called the members of the commission to his chambers and instructed them as follows: "You gentlemen are entrusted with one of the most important problems with which this administration has to deal. The good roads problem touches vitally our agricultural, commercial, educational, social, religious and economic welfare, and as well involves the conservation of natural resources.

"Sentiment throughout Illinois is and has been strong for better roads, reasoning as they should, that better roads mean that the farmer can get his produce to the market more quickly; it means better schools; larger neighborhood communities, better social conditions of all kinds. It means that Chicago is closer to Springfield and Springfield closer to Cairo. It directly connects the different communities of the state with each other. Legislation adopted by the 48th general assembly makes possible the perfection of our roadways.

"In the improvement of public highways, Illinois has been very negligent. The latest Federal report shows that in Illinois about 10 per cent. of the 95,000 miles of roads are improved in a permanent manner, as against 38 per cent. in Indiana, 20 per cent. in Wisconsin, 20 per cent. in Kentucky, 28 per cent. in Ohio and 50 per cent. in Massachusetts. Considered from the twenty-fourth in the list of states. standpoint of improved roads, Illinois is the

"Because of inaccessible primary markets, and the abnormal expense of transportation due to bad roads, the loss to farmers must be considered as a contributing cause of the high cost of living. In some Illinois counties, highways are impassable to ordinary loads for a full third part of the year. Bad roads not only hinder crop production and marketing, but they keep the rural consumer away from the store of the merchant for weeks at a time. They keep pupils from the schools, and voters from participation in elections. They impair the efficiency of churches and social, fraternal and other organizations, which depend largely on public gatherings for the efficacy of their work. They contribute also to the unattractiveness, isolation and the monotony of country life, which in turn are responsible for the desertion of rural pursuits, especially by the young. Experts in mental ailments agree that women in remote sections are the chief sufferers from the restriction to social intercourse, which bad roads impose."

In his message to the general assembly, the Governor also recommended that provision be made for the employment of the inmates of the penitentiaries in road work. The legislature has adopted a bill to that effect, and this will lead to many good results.

pensaries and other auxiliary institutions for fighting the disease, the funds for which are to be had from a special tax levied for this purpose alone, and not to exceed one mill on the dollar.

The dispensaries and other auxiliary institutions are a great factor in the prevention of tuber

"I want you gentlemen to give to the positions to which I have appointed you the best that is in you and to work in cooperation with me for the improvement of our roads. Nothing that we can do will mean more to the state of Illinois than to improve its roadways. I leave to you the working out of the necessary details. Yours is a big job, but I think I have selected men competent to fill the places that have been given them. I place the matter in your hands and hope that when our terms of office shall be ended we will turn over to our successors a vastly improved system of roadways in the state we all have been called on to serve."

The subject of good roads is of the greatest interest to the medical profession, and every physician in the state should boost along the cause of good roads. Their efforts in this direction will help to ameliorate, as soon as possible, this one of the many hardships to life in the rural districts, which works a special hardship to the life of practitioners who have a rural clientele.

COUNTY TUBERCULOSIS LAW

Elsewhere in this issue will be found an article by Dr. Mammen, calling attention to an Illinois County Tuberculosis Sanitarium Law, and, in a measure, comparing it to the "Glackin Tuberculosis Law," which was published last month.

This is a good law for certain localities, more especially for the sparsely settled counties which contain no cities of considerable size, and such counties should make use of it just as they should make use of any agency with which to wipe out tuberculosis. It should be given publicity, and where practical the public should benefit from it. We think, however, in most of the counties of Illinois the Glackin Law is more applicable to the purpose intended. The County Law is a sanitarium law, providing only for the building and maintenance of sanitaria, the funds for which are to be had from the general tax fund of the county, which is usually too meager.

The Glackin Law is an anti-tuberculosis law, providing not only for the building and maintenance of sanitaria, but also for tuberculosis dis

very great deal in educating the people concerning the prevention of this disease. Where more applicable the people should take advantage of the County Sanitarium Law, and when the need arises, secure the extension of the law, so that they may maintain auxiliary institutions and operate them in conjunction with and supplemental to the sanitarium.

MEDICAL ECONOMICS

On occasion, a wise and superlatively good man said, "Let him that is without fault cast the first stone."

The members of the medical profession are so far from perfection that very few of them could claim the right to speak, if faultlessness were the test of critical fitness. But the initial rock of just censure for the grave faults which afflict our fraternity was thrown long ago. Admitting our shortcomings, then, we need not keep silence where frank, honest, kindly criticism from our own ranks may help us to recognize and to cure our ethical infirmities.

It is with this in mind that we publish in this issue the communication from Dr. Breakstone. So far as space will permit, the ILLINOIS MEDICAL JOURNAL will be an open forum for thoughtful discussion of vital matters by the members of the Society.

THE ALIENISTS' AND NEUROLOGISTS' MEETING

In the latter part of June there was held in Chicago, under the auspices of the Chicago Medical Society, a notable meeting of alienists and neurologists, great in what has already been accomplished and equally great in its promise for the future. The gathering originated in a plan of the West Side Branch under the presidency of Dr. W. T. Mefford, who secured a similar meeting last year. This gathering was so successful that it was determined to enlarge the scope of the association and place it this year under the guidance of the Chicago Medical Society. The second meeting was attended by a large number of delegates, among them representatives sent by the