were done was the election of a Council, composed of 10 members, selected from different parts of the State, whose duty it is to go around, organizing and reorganizing medical societies in the different counties and looking after the interests of the profession in every possible way.

We have 88 counties in Ohio, with about 9,000 physicians, 7,000 of whom are denominated regular, and about 4,000,000 of people, all told. Three-fourths of the counties now have county medical societies in successful operation, and these counties contain nine-tenths of the entire popuiation of the State. Before another year has elapsed the remaining counties can easily be organized, and then we shall see what combined influence is capable of doing.

In organizing this mighty power, it has been wisely determined to centralize it in the House of Delegates, which, as you know, is a representative body, made up of the chosen members from every county society, and these, by referendum, are under the control of the Association.

It has long since become a maxim that in union there is strength; that individual efforts avail but little in any great movement; therefore, it is only necessary to state the proposition in order that you may thoroughly appreciate the great importance of a united and harmonious effort.

But how are we to accomplish this union of strength, this union of greatest influence, this union for greatest good? The plan that has been adopted constitutes each county society a unit, with its proportionate representation in the State Association, and being a member of a county society, every physician is a member not only of the State Association, but of the National as well.

By a little effort in each county it has been found quite feasible to have every reputable physician of that county become a member of his home society. Such, in fact, is the case in some of the counties. You should see the happy change of the social countenance in these county societies visited by your Councilors! Really, a half-famished condition seems to have been theirs, who, for years, have not had

the beneficial influences of a good medical society. A more kindly feeling for a brother physician; a deeper interest in professional matters; a greater determination that the ignorant and inexperienced public shall not longer suffer at the hands of the charlatan, the fanatic and the politician; a more intense thirst for medical knowledge; a greater interest in legal enactments for the prevention of disease and the killing of quacks-these are a few of the changes that are • already very apparent from the work of your Council.

The benefits and possibilities of this work, thoroughly and effectively done, are beyond my power to tell. They are too many for my feeble pen to portray. Suffice it to say that in a general way we have been accustomed to sum up this matter in about this manner. A physician's life-work may be viewed from three aspects: First, the scientific or purely professional; second, the social or companionable mingling together; and third, the business side, which looks after the material gain that is so necessary and proper. When these three qualifications, viz., the scientific, social, and business, are properly combined in a physician, we have what may be called an ideal medical man. How may we most easily, certainly and satisfactorily secure, even approximately, this desirable state?

Selfishness is one of the natural instincts of all animal life; indeed, it may be said to be one of the first laws of our existence. But it will be observed that the higher in the scale of life we go, the less selfish should and do we become. The necessity of self-preservation by extreme measures no longer exists. This is an age of enlightenment, and enlightened selfishness says not only to live, but to let live and help to live. It is certainly true that the average of physicians come more nearly to being the true exponents of enlightened selfishness than do any other class of people. But are we not able to go further and accomplish still more, and thus benefit not only ourselves, but humanity even to a greater degree? We can do so by thorough organization, and only by thorough organization.

Now, in closing, permit me to say that, while the work of your Council has been comparatively easy thus far, and great interest in the plan is being evinced by those who are thoroughly informed as to what we are endeavoring to accomplish, there yet remains a still greater duty, which can only be done with your assistance. We, as Councilors, are going to be able to set the machine up and put it in motion, . but your help is absolutely necessary to keep it in running order. If you will lend a willing hand, if you will render your quota of assistance, which will not be great or burdensome for any single individual, you will not only be helping to accomplish the grandest thing of your lives, but helping to create a force which no power in the State of Ohio can withstand.

"Lay on, McDuff, and d-d be he

Who first doth cry, 'Hold, enough!'"

CHAPTER II-MEDICINE

The Septic Infections

BY GEORGE E. MALSBARY, M. D., CINCINNATI Synonyms: Sepsis, septicemia, sapremia, pyemia, septicopyemia, the coccus infections.

Definition. Sepsis is understood by the laity to refer to "a poisoning of the system by the introduction of putrescent material into the blood.” It should not be inferred from this, however, that sepsis is caused by the germs of decomposition. The infections commonly described as sepsis, septicemia, pyemia, or septicopyemia, are pretty generally ascribed to streptococci and staphylococci. Less frequently a septic infection may be due to other microorganisms, notably the pneumococcus, the bacillus coli communis and the bacillus of malignant edema.

Septicemia is a septic infection characterized by the presence of the products, toxins, of pyogenic microorganisms in the blood and tissues of the body. In pyemia there is an infection of the blood and tissues of the body by pyogenic microoorganisms. From a clinical standpoint, in septicemia the symptoms of blood-poisoning predominate; in pyemia, the symptoms of metastatic abscesses assume greater importance. A combination of septicemia and pyemia constitutes septicopyemia. However, it would be difficult to conceive of a case of pyemia without the symptoms of blood-poisoning, which fact has led many writers to consider all cases of pyemia as septicopyemias. Usually all these conditions are included under the term septicemia when there is general infection of the blood.

Localized septic infections are usually considered among the inflammations under special names, e. g., meningitis, pleuritis, peritonitis, arthritis, metastatic abscess, etc.

ETIOLOGY

BACTERIOLOGY

The microorganisms most frequently found are the streptococcus pyogenes, the staphylococcus pyogenes aureus, albus and citreus, the micrococcus pyogenes tennuis, and the pneumococcus. Less frequently cases are caused by bacilli, bacillus coli communis, and the bacillus of malignant edema.

Streptococcus pyogenes (Rosenbach). Numerous attempts to subdivide the streptococci must be regarded as failures, inasmuch as transition forms connect the subvarieties. However, the classification proposed by Von Lingelsheim, a pupil of Behring, has some practical import. Von Lingelsheim, as long ago as 1891, divided the streptococci into the streptococcus brevis (nonpathogenic), and the streptococcus longus (pathogenic). The latter may be subdivided into those that are pathogenic for mice and rabbits; (a) streptococcus murisepticus, (b) streptococcus pyogenes; and those that are pathogenic for rabbits alone: streptococcus erysipelatos. From the standpoint of practice, most interest attaches to the general relation between the length of the chains and the virulence of the streptococci, although it has been shown by Marbaix that such a relation does not always exist. Classifications of the streptococci based upon cultural characteristics are insufficient because of the many transition forms and the great variability of all the properties of the organisms, especially when grown upon various soils, and after passing through various animals in inoculation experiments. Knorr has shown the fallacy of relying upon the specific virulence of the streptococci in the differentiation of species.

From the foregoing, it is not surprising that streptococci may be found in the healthy body, especially in the mouth, nasal cavities, vagina, and even in the cervix uteri. That they may be present in these locations, as well as in the urine and blood, even in virulent form, without causing disease, is readily explained by our knowledge of immunity.

As is well known, inflammation and suppuration may