The appendix removed was of normal size, slightly hyperaemic, and contained clot of blood. In spite of the operation the disease became worse and the patient died a few days afterward. Autopsy showed characteristic ulcerations of typhoid fever. The night before death Widal's test was positive." In this connection we also note two cases mentioned by Hall (Appendicitis in trained nurses; The Journal A. M. A., July 1, 1905): "One patient whom I did not see, broke out with measles as she left the table, and the appendix showed much redness and swelling, leading the operators to consider it a case of eruptive disease manifested internally as well as externally." The other case diagnosed as appendicitis and operated upon, developed typhoid fever immediately after operation. "It was one of those in which in the beginning it is impossible to state whether the disease is appendicitis or typhoid."

RADIUM

TREATMENT OF CANCER OF
THE ESOPHAGUS.

In addition to his nine cases reported in the Medical Record, July 30, 1904, Max Einhorn (Jour. A. M. A., July 1, 1905) now reports on seven new cases of esophageal cancer healed with local application of radium. The article. gives a description of the apparatus, with illustration, and mode of application.

In each case 0.25 gram of Curie's radium of 20,000 activity was applied to the stricture for one hour daily. In no instance occurred any accidents which might be ascribed to the radium treatment.

In all cases the stricture improved, and all the patients were generally improved by the treatment; five could swallow better; three, in whom stricture had become entirely permeable, were able to take semi-solid and even solid food. The pain was less in five of the patients.

Considering that we have to deal with an affection which until now has not been amenable to treatment, Einhorn looks upon the results obtained as being very promising. He firmly believes, that "in the methodical application of radium we have the means to influence favorably the course and seat of the disease and to retard its progress, even if at present we can not entirely remove it." He He ends his article with the prophecy that "this mode of treatment is certainly destined to play an important role in the therapeutics of cancer of the esophagus, and deserves to be tried on a large scale and in a thorough manner. Should my results be confirmed by other clinicians, radium-therapy should take a high rank in the treatment of cancer of the esophagus." The same method of applying radio-therapy may also be used in gastric cancer.

TESTS FOR OCCULT BLEEDING.

"Occult Blood in the Feces and its Clinical Significance" is a subject receiving able consideration by Steele and Butt (Americ. Jour. Med. Sciences, July, 1905). As to the diagnostic value of the detection of occult bleeding, these writers remark that "occult bleeding has in general the same clinical significance as visible hemorrhage,

except that its recognition is a much more delicate means of diagnosis because the quantity of blood present is so small. Practically, however, the presence of occult blood is of decided diagnostic value only in the detection of gastric or duodenal ulcer or gastrointestinal cancer, because it occurs with considerable more regularity and frequency in these two affections than in any other condition of the alimentary tract."

As the two reactions oftenest employed in the testing for occult bleeding, the authors mention the guaiacturpentine test of Weber and the alointurpentine test of Klunge and Schaer. The former was described in the COLORADO MEDICAL JOURNAL, October,

1903.

The aloin test, however, possesses certain advantages and is by all observers recommended as the more reliable and delicate. It was experimentally found that the reaction demonstrated 0.25 gram of blood in 2 grams of feces.

From the above named article we here quote the technique of the test:

"If the stools are not in a semiliquid condition they must be made so by thoroughly mixing them with distilled water. We usually employed 5 grams of fecal matter in every test. After the material has been thoroughly softened the feces must then be thoroughly mixed with at least its own bulk of ether, and the whole well shaken. This is a very necessary part of the procedure, as it removes the fat, which otherwise produces a thick emul

sion when the stools are extracted with acetic acid and ether, and renders it almost impossible to obtain a satisfactory ethereal extract. After being thoroughly shaken the mixture of feces and ether should be allowed to stand for fifteen minutes or longer and the supernatant liquor is then poured off. The remaining fecal matter is then mixed with one-third its volume of glacial acetic acid and 10 c.c. of ether. The mixture is again thoroughly shaken and allowed to stand for at least fifteen

minutes. The ethereal extract will rise to the top in a clear layer and can be The solution of readily poured off. aloin used is made by dissolving as much aloin as will go on the end of a spatula, in one-third of a test tube of 70 per cent. alcohol; 2 or 3 c.c. of the clear yellow aloin solution are then mixed in the test tube with about the same amount of the ethereal acetic acid extract, 2 or 3 c.c. of ozonized turpentine are then added and the whole is gently shaken.

"If blood is present the reaction may appear in one of several ways: either the whole mixture turns a pink which gradually deepens to a cherry red; second, or the solution of aloin sinks to the bottom and forms a layer beneath the mixture of ether and turpentine, and this lower layer of aloin in positive tests gradually becomes a deep cherry red. Sometimes, if the ether and turpentine are first mixed and then the aloin allowed to flow down the side of the tube, the two sets of fluid will remain separate and a deep red ring will form at their junction. Not more than fifteen minutes should be

allowed for the red color to show itself, for after this the aloin will gradually turn red even if blood is not present. "It is extremely important to make up the solution of aloin freshly, for when it stands exposed to light it changes into about the color that it attains in the reaction when blood is present.

"When the test is negative the color remains a light yellow, which becomes a red after standing for some length of time. Hydrogen peroxide does not work satisfactorily as a substitute for turpentine in the aloin test. The ozonized oil of turpentine should be pre

pared by allowing a chemically pure oil of turpentine, such as that prepared by Merck, to stand exposed to the air for at least three weeks."

The authors have by observations been convinced that rare meats taken in sufficient quantities will give a decided reaction for blood in the feces. To quote: "We found that two meals daily of rare beef or chops will invariably give the reaction, and one meal may do it. Well cooked fowl, ham, kidney, and fish never gave a positive reaction. Our results showed that the ordinary winter vegetables were not liable to give a positive test."

THE PRESENT LIMITATION OF SERUM THERAPY IN THE TREATMENT

OF INFECTIOUS DISEASES.

Dr. Henry W. Berg (Medical Record, May 6, 1905) divides all pathogenic bacteria into the following three classes:

I. Those which produce in living cultures outside of the body (best shown in fluid media) as a free secretion, a virulent real toxin. The chief members of this group are the diphtheria and tetanus bacilli.

set free only upon the death and disorganization of the bacterial cell. The largest number of pathogenic bacteria belong to this class, good examples being the typhoid bacillus, the pneumococcus, and the streptococci.

3. Those bacteria that produce no free toxins nor have in the bacterial cells endotoxins of any power, but in which the cell plasma contains other poisons in addition to the protein poisons which all bacterial cells in common contain. For our purpose the most important member of this group is the tubercle bacillus. (It might be inquired where does tuberculin belong if we accept this classification unques

In the first class changes are due chiefly to the toxins. In the second the pathologic changes are due to the bacteria themselves, and the endotoxins which are set free on the destruction of the bacterial growth. In the third class the symptoms are due to the bacterial growth, there being no toxins or endotoxins. Of course, all three groups may be complicated with mixed infection.

The author says: Our present clinical and bacteria knowledge, therefore, enable us to lay down certain limitations to the use of antitoxic sera in the treatment of disease produced by the toxic bacteria belonging to the first the first group. These are:

I. 1. The bacteriological cause of the disease must be positively identified and known.

2. That it must be an organism which produces a free specific toxin and virulent enough to be effective in the immunization of animals.

3. That the experimental injection of the antitoxic serum in sufficient quantities be successful in saving animals from death when injected with or immediately after a fatal dose of the toxin specific to the organism.

4. The bacterial cause and its antitoxin being both specific, the specificity of the action of the antitoxic serum follows as a natural sequence and must be recognized.

5. The combination between toxin and endotoxin being a chemical one, there must be an absolute quantitative relation between the toxin injected and the quantity of antitoxin required to neutralize it.

6. That the antitoxin, when used

The following limitations are given for the second group:

The bacteriological cause of the disease must be positively identified and known.

2. The experimental injection of the bacteriolytic serum in sufficient doses must be successful in saving animals from death when injected with or immediately after a lethal dose of a living corresponding bacterial culture.

3. The bacterial cause of the disease being specific, the specificity of the bacteriolytic serum follows as a natural sequence.

4. Since the antiserum has a destructive or bacteriolytic action upon the pathogenetic bacteria, their action being dependent upon the combined presence of two known substances. namely, the alexin or complement (an unstable substance present in the normal living body and in fresh serum) and the immune body (present in bacteriolytic sera), and since only a smail amount of alexin is present in the body, in quantity sufficient to produce only a very limited bacteriolysis, it follows that unless the antibacterial serum be freshly drawn, thus securing the unchanged alexin present in the blood of the immune animal, the antimicrobic action of the bacteriolytic serum is limited by the insufficient amount of alexin present in the body of the patient.

5. The bacteriolytic sera have a quantitative relation to the amount of bacteria which they can destroy. At best, the antisera protect only against a limited amount of bacterial infection. When this increases beyond a certain figure no amount of antiserum will protect or cure the animal. Hence very large doses are necessary, sometimes repeated.

6. While enthusiasts might claim that the bacteriolytic action of the antisera seen in animals which are the subject of experimental infections occurs also in patients suffering from infectious diseases, no curative effect can possibly occur with regard to pathological changes which have already been produced by the bacterial infection. So that the later the antiserum is used, the less the chance of its having any curative effect.

Bacteriolytic sera have been prepared for the serum therapy of a number of the infectious diseases, but such sera have had, hitherto, little or no effect. Attempts have been made to

produce antisera in almost every infectious disease the bacterial cause of which is known. It is safe to generalize and say that none of these sera have been therapeutically effective, an occasional report of one or more apparently hopeless cases cured to the contrary notwithstanding. Those failures are probably due to one or more of the limitations inherent in all bacteriolytic sera, especially to the impossibility of providing sufficient alexin complement, and the difficulty of recognizing most of the infectious diseases until symptoms depending upon gross pathological changes have occurred. The serum therapy is thus applied too late. Finally, even the largest practicable dose of the bacteriolytic serum can destroy only a limited amount of bacteria, entirely insufficient to free the patient from the bacterial infection.

[The limitations of the third group are entirely omitted by the authors, but would probably be very similar to those of the others.-Editor.]

FORMAL TREATMENT OF EPILEPSY.

At a recent meeting of the New York Academy of Medicine, Dr. Chas. L. Dana, speaking upon this subject, stated that while it was admitted that the colony treatment of epilepsy was the best condition to obtain for the epi

leptic, it could not be employed in every case. Many of these patients had to be medically cared for while at home, and for this class he had gradually evolved a conventional, or, as he termed it, a "formal," treatment affording him best possible results.