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that or the conditions there make the germs less virulent. I am inclined to think that a good deal of it is due to the condition of the blood itself. The effort of nature is always to fortify the system against destruction by the malarial parasite. It fortifies itself against the infection of the typhoid bacillus.

While I was very much interested in the paper and the discussion, I rose particularly to say that some of the remarks that were made were extreme.

Dr. St. J. B. Graham, of Savannah: Unfortunately, most of our text-books on malaria are written by men who reside north of Mason and Dixon's line, and outside of the work of Italians we do not get any idea from our textbooks of the real malaria that we see south of Augusta and even in Augusta.

As regards malaria being produced by a protozoon, an animal organism, and typhoid fever by a vegetable organism, it is impossible to have such a thing as a hybrid disease, because animals and vegetables would not mix. It has been well shown by the records of the United States army during the time of the invasion of Cuba that typhoid fever and malarial fever existed in fifty per cent. of the cases together. It was not typho-malarial, but it was malarial fever and typhoid fever at the same time, because one differs from the other. In malaria the organism is usually found in the blood. It appears in the blood at some time, but not at all times, as is well-known, because we may have a pronounced case of malarial fever without the organism appearing in the blood, but by puncturing the spleen we can obtain the organism. It stays in there; it seeks dark recesses in which to live, to germinate, and sporulate.

As to whether this protozoan organism produces a toxin or not, nobody knows to-day, because we know that all

vital organisms produce a toxin, and patients die not from the germs themselves, but from the toxin produced by the living germs from human organism. Furthermore, gentlemen, I believe that there is not only a third fever, but there are many others. It is well-known that the malarial organism was not discovered until 1885. Previous to that time it was an unknown entity. The germ of typhoid fever was not discovered by Eberth until 1882.

In 1900 I read a preliminary paper before this Society. For nine years I carried on researches along this line, and used all of the precautions known to science to-day. For seven years I have a record of half a thousand cases of this so-called third fever, or disease, taken from the hospitals and military forces in Savannah, Georgia. Those are all pertinent cases, and I went into them both from a bacteriological and biological standpoint. Last summer I had the good fortune to get three men who had nothing else to do who were willing for a consideration to undergo this ordeal. These three men were confined in a sealed room for five days. The windows and doors were barred. There was a doorkeeper at the door, so that nobody was allowed to go in or out of the room unless under orders. These men were confined in the room for eight days. An examination of their blood was made, an examination of the urine was made, and there was no diazo-reaction. There were no malarial organisms in the peripheral blood. One man received a hypodermic injection from a tube culture; one received it by spray in the nose; another drank it. All three men went through a short fever until they got well. They did not get any quinine or abortive treatment of typhoid fever. They got simply brewers' yeast, from which they recovered. I have a record of over fifty cases of this third fever treated by

nothing but brewers' yeast, and it gets well in twenty-one days. These cases do not come to post-mortem. In this third disease you will find no malarial organisms in the blood, no malarial organisms by puncture of the spleen. You find no Widal's reaction; you find no diazo-reaction in the urine. What are you going to do about it?

Dr. R. R. Kime, of Atlanta: Those who have practiced medicine in the different sections of the country, and those who have practiced in rural sections in their early development, have seen many cases of malaria develop, but as the country became more thickly settled, and the ponds were drained and mosquitoes destroyed, there was less malaria, but, on the other hand, an increase of typhoid fever. When you crowd people together you will have an increased number of cases of typhoid fever, on the one hand, and a decrease in the number of cases of malaria, on the other, particularly in country districts, as infection from one patient to another becomes more


Dr. Palmer (in closing): My paper was not based on any pathological or bacteriological researches, but it was simply a clinical bedside study, and I thank you very much for your discussion.



Synonym, Bright's disease. Aetius in the fourth, Avicenna in the eleventh and Van Helmont in the last quarter of the sixteenth century attributed certain cases of dropsy to disease of the kidney, and although Cotunnius, 1770, discovered that the urine of dropsical patients coagulated by heating, our first knowledge and insight into the true condition of non-suppurative diseases of the kidney dates from the memorial thesis of Richard Bright, published in 1827, and subsequently. Nevertheless, it is true that Wells (1806), Blackall (1813), Alison (1820), anticipated somewhat the observations of Dr. Bright. Their contributions were mere fragments of literature, and their reasoning in a large part erroneous.

Shortly after the publication of Dr. Bright's observations concerning the anatomical and pathological lesions, confirmation came from all quarters of the globe. Up to this time limited attention had been paid to the physiology and pathology of the kidney, and but little was known of its minute and microscopical anatomy.

However, this stimulated interest and directed attention to the study of this important organ, and it is interesting to note the wonderful progress made within a few years in histology, pathology and physiology of the kidney. Indeed, with such precision of knowledge and such accuracy of observation many of the statements made have withstood the searching inquiries of recent times.

In this connection, I wish to state that the subject, Nephritis, is too extensive for one to discuss the entire subject within the allotted time-therefore, I shall dwell upon the etiology and treatment of the disease. Nephritis is inflammation of the kidneys involving the epithelium, vascular and intratubular tissue, caused by or arising as a result of overwork and the direct application of irritants to the kidney structure proper; to the effects of toxines upon the kidney structure in transit; second, by affecting the nutritive value of the blood supplying the organ; third, by their poisonous effects upon the central nervous system, thereby interfering with the functional activity of the organ. These causes may act independently of each other, or they may act singularly or collectively.

The toxic agencies that produce this degenerative change in the kidney are no doubt many. The exact chemical composition of these poisons we know but little; however, by their clinical manifestations, they are revealed to us, and from the evidence at our disposal; many of them are products of metabolism, such as xanthin and hypoxanthin poisons, that nominally are oxidized and excreted as a harmless product, uric acid. These circulating toxines not only produce changes in the kidney, but in all those organs that are supplied by end-arteries—the kidney, brain and retina. This explains the frequent involvement of these organs in Bright's disease. The fact that the retina and the brain are injured before the kidney, oftentimes with serious and fatal apoplectiform brain lesions and retinitis, bears out this conception and constitutes a valid argument against the common belief that the brain and retinal changes are secondary to that of nephritis.

Toxines, however, may be divided into two groups:
I. Those toxines arising as products of tissue meta-

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