The account you give of the peculiar epidemic among the students of the Georgia Military Academy is of very much interest. It appears from other reports that the pupils of other educational institutions in the state have not escaped this same "kind of sickness," and just as in your experience, the patients in other schools some of them have had such tardy convalescence as to give rise to a diagnosis of typhoid. I have not seen any of these cases. East Georgia has no prominent boarding school. Your estimate of the trouble seems to me to be the rational one. I thank you for the opportunity you offer of seeing the few cases not yet fully recovered and getting case history of all of them. I am sorry that I may not avail myself of it.

(Signed.)

Very truly yours.

ALBERT DAVIDSON.

ASSOCIATION OF SEABOARD AIR LINE RY. SURGEONS Office of Secretary and Treasurer,

Ailey, Ga., Nov. 20, 1909.

Dr. C. M. Curtis, College Park, Ga.

My Dear Doctor:

Yours relative to the ptomaine poisoning received, and congratulate you on your stand in the matter, because there is no excuse or reason in the world for any physician to call these cases typhoid fever. I say you are absolutely correct, and I believe I know as much about diagnosing typhoid fever as any physician.

Very truly and fraternally,

(Signed.) J. E. PALMER.

These are some of the men who agree with me:

Dr. F. M. Ridley, who is chief surgeon of the Atlanta & West Point Railroad, and who has been president of the Georgia Merical Association, and is recognized authority on any medical subjects on which he will offer an opinion.

Dr. R. V. P. Oglesby, who has had a rich experience in the Army, who saw three thousand cases of typhoid fever in Cuba, and who has practiced medicine seven years in the city of New York, says I am right.

Dr. E. C. Cartledge, a young man of rare education and experience says he will stake his medical reputation that I am right.

Dr. Boland, another young man of high ability and deep learning and rich experience, agrees with me.

Dr. Thrash, who is Bateriologist and Histologist at the Atlanta School of Medicine, says my diagnosis is correct. Dr. S. B. Lee, professor of Medicine in one of the medi cal colleges in Atlanta, and who runs an infirmary where a specialty is made of treating typhoid fever, says he will not say what the sickness is, but knows it is not typhoid fever.

Dr. R. W. C. Green, a country physician of Clayton county, says if it is typhoid, it is different from any he has ever seen.

Miss Hearn, the nurse in charge of the infirmary at the G. M. A., who graduated at Grady Hospital, three years ago, says there has not been a typhoid odor or stool or temperature here.

Our local physicians. Dr. Dennard, Dr. Foster, Dr. Henley, Dr. Ols and Dr. Overby, all absolutely agree with me. There are other physicians whose names I am not at liberty to mention, who also think as I do about our sickness here.

Doctor, I wish to say I hope my motive for sending out the circular letter has not been misunderstood. My principal object was to let the physicians generally know what kind of sickness we had here, and as the school was suspended, the boys all going home, a number of them being sick, and I not knowing who their physicians were, thought my letter might prevent an error in the diagnosis of some cases and possibly save the life of some boy who might die if not given the right treatment, then too, as there are several other schools that have suffered in a

somewhat similar manner, I feel that it is a question that ought to be investigated thoroughly. I believe a large part of the sickness in all the schools may come from a common cause, and the same source, and that source the food supply.

Doctor, it is not necessary ordinarily, and doctors do not usually wrangle over a diagnosis:-it does not make much difference what you call a disease, so the patient gets well, but in this instance, I do not think it right to ruin a school and cast a shadow over a whole community by the mistake of one physician making a hasty diagnosis and stubbornly standing to his first statement in the face of evidence that ought to convince him that he is wrong. In openly differing with a doctor, I feel that I am discharging a duty to science, a duty to humanity, a duty to the community, a duty to the school, a duty to Col. Woodward, and a duty to myself, and Doctor, I am deeply grieved that any of our boys have died, but there may be some significance in the fact that all the boys who have been treated for Ptomaine poison are still living. Fraternally yours,

THE ETIOLOGY OF PROSTATIC HYPERTROPHY.

Edgar G. Ballenger, M.D., Atlanta, Ga.

ARGUMENT

In order that the connection between the different parts of the paper may be clearer, I will begin with a synopsis of my argument. None of the many alleged causes of the gradual progressive enlargement of the prostate gland in elderly men has been accepted as the true cause of this hypertrophy which occurs in about one-third of all men after fifty years of age. (Thompson). This frequently implies that the cause is of very common

occurrence.

One of the first questions to ask is, "What can cause hypertrophy?" Adami says toxic irritation, small in amount and long continued, may cause overgrowth of the tissues subjected to such an irritant. The next question to suggest itself is, "Can a toxic irritant be found in the prostate glands of a sufficiently great number of men for it to be a possible cause of overgrowth in such a large percentage of elderly men?" The answer to this is, Yes. A mere glance through a microscope at preparations of the prostatic secretion, using the Reichert dark field illumination, or stained so that the germs are seen actively motile, would be a much more convincing and also a startling answer, as millioms of microorganisms can be seen, and too from a prostate gland that is not inflamed; the largest number of germs being when no puss cells are found in the secretion. These millions of bacteria have been demonstrated in the prostates of 110 patients during the past year and finding them in so many patients with sexual neuroses, hyperesthesia of the deep urethra, occasional mild irritation of the bladder, itching

of the urethra, "morning drop" discharges, etc, etc., has done more to clear up these dark places in my work than any test I have heretofore used.

It is the enormous number of these non-pyogenic and almost non-pathogenic (excepting the hypertrophy) colon bacilli and staphylococci (occasionally other organisms) which I claim produce the Mild Persistent Toxin which is admitted by pathologists might cause hypertrophy.

Those who doubt my findings may easily verify them by a series of examinations of prostatic secretion obtained and stained according to the technic described later.

Many observers have noted the fact that from the pathologic standpoint the hypertrophied gland presents features characteristic of growths of inflammatory origin, and yet the histories often do not give the symptoms of inflammatory disturbances; they do, however, nearly always show the symptoms of these low grade infections.

In carying out these observations and studies I have attempted to verify the essential features of other work along this line, and to correlate it with my own findings, and I think the most convicing part is its complete accord with the clinical histories, bacteriologic and pathologic reports of a large number of careful workers in all of the different phases of this subject.

Among the alleged causes of prostatic hypertrophy nearly all of them are causitive factors of the above mentioned irritative infections. (Not inflammations). The study of bacteriuria and bacterial infections demonstrates how large is the number of ways in which infections of the genito-urinary tract may occur.

Keyes says, "bacteriuria is usually perpetuated by a renal or a prostatic lesion"; it is with the latter that this paper has chiefly to deal although many phases of the character and sources of genito-urinary infections will be discussed.