inaw; Dr. Wm. L. Miller, Saginaw; Dr. James L. Passmore, Saginaw; Dr. Norman J. Pike, Saginaw; Dr. Emil P. W. Richter, Saginaw; Dr. Bert B. Rowe, Saginaw; Dr. John T. Sample, Saginaw; Dr. Roy S. Watson, Saginaw; Dr. Arthur E. Leitch, Saginaw. Sanilac County. Dr. H. H. Angle, Snover; Dr. J. C. Webster, Peck; Dr. C. G. Woodhull, Decker. Shiawassee County. Dr. James A. Rowley, Durand; Dr. Hermon E. Boice, Byron; Dr. Robt. R. Fox, Byron; Dr. Thos. G. Amos, Henderson; Dr. Glenn T. Soule, Henderson; Dr. Alfred F. Arnold, Owosso; Dr. James J. Haviland, Owosso.; Dr. Harold A. Hume, Owosso; Dr. Jesse O. Parker, Owosso; Dr. Geo. P. Sackrider, Owosso; Dr. Egerton T. Wilson, Owosso; Dr. William H. Dunham, Shaftsburg; Dr. Arden N. Howe, Vernon. St. Clair County. Dr. I. P. Bowden, Port Huron; Dr. F. V. Carney, St. Clair; Dr. G. M. Kesl, Port Huron; Dr. A. J. MacKenzie, Port Huron; Dr. D. W. Patterson, Blain; Dr. G. Waters, Memphis; Dr. W. G. Wight, Yale. St. Joseph County. Dr. John J. Kelley, Burr Oak; Dr. Wm. E. Doran, Colon; Dr. Arthur W. Scidmore, Three Rivers. Tuscola County. Dr. F. P. Bender, Caro; Dr. W. C. Garvin, Millington Washtenaw County. Dr. James F. Breakey, Ann Arbor; Dr. H. B. Britton, Ypsilanti; Dr. R. B. Canfield, Ann Arbor; Dr. H. W. Emerson, Ann Arbor; Dr. N. B. Foster, Ann Arbor; Dr. C. George, Jr., Ann Arbor; Dr. H. Malagan, Ann Arbor; Dr. Reuben Peterson, Ann Arbor; Dr. V. C. Vaughan, Ann Arbor; Dr. U. J. Wile, Ann Arbor. Wayne County. Dr. De Witt C. Adams; Dr. Edward J..Agnelly; Dr. Herman F. Albrecht; Dr. Frank C. Anderson; Dr. Warren L. Babcock; Dr. Frederick W. Baeslack; Dr. Max Ballin; Dr. Don C. Bartholomew; Dr. Charles Barton; Dr. Robert J. Baskerville; Dr. Robert Beattie; Dr. Harold A. Beck; Dr. Clarence H. Belknap; Dr. William O. Benjamin; Dr. Zina B. Bennett; Dr. Harry S. Berman; Dr. Isadore I. Bittker; Dr. Fred H. Blanchard; Dr. Jacob R. Bolasny; Dr. Edmund W. Bolio; Dr. Ralph H. Bookmyer; Dr. Richard F. Boonstra; Dr. Henry R. Boyes; Dr. Frank B. Broderick; Dr. Clark D. Brooks; Dr. William H. Browne; Dr. Wm. S. Brownell; Dr. Bruno B. Brunke; Dr. John D. Buck; Dr. Frederick G. Buesser; Dr. Glenn A. Bulson; Dr. John K. Burns, Jr.; Dr. Lowell M. Bush; Dr. Thos. P. Camelon; Dr. Geo. H. Campau; Dr. Duncan A. Campbell; Dr. Clarence Candler; Dr. Edward K. Carmichael; Dr. Glenn B. Carpenter; Dr. James G. Carr; Dr. Henry R. Carstens; Dr. John H. Carstens; Dr.. Albert E. Catherwood; Dr. Aaron Lee Chapman; Dr. Clarence A. Christensen; Dr. Harold F. Closz; Dr. Don A. Cohoe; Dr. Homer C. Collins; Dr. Lannes I. Condit; Dr. Ray Connon; Dr. Bernard F Corbett; Dr. Langdon T. Crane; Dr. Ernest K. Cullen; Dr. Hampton P. Cushman; Dr. Samuel S. Danziger; Dr. Milton A. Darling; Dr. Jos. L. Desrosiers; Dr. Harry F. Dibble; Dr. John C. Dodds; Dr. Daniel R. Donovan; Dr. Ira G. Downer; Dr. David B. Downing; Dr. George A. Drescher; Dr. Leo J. Dretska; Dr. Adolph E. Dreyer; Dr. Charles F. DuBois; Dr. Frederick Eakins; Dr. Clarence H. Eisman; Dr. Rollan R. Ensor; Dr. Arthur W. Erkfitz; Dr. George E. Fay; Dr. Ray L. Fellers; Dr. Charles J. Foley; Dr. Antonio J. Font; Dr. Walter D. Ford; Dr. Henry E. Fraser; Dr. George E. Frothingham; Dr. Claude B. Gaines; Dr August E. Gehrke; Dr. Isaac S. Gellert; Dr. Wm. S. Gonne; Dr. John W. Gordon; Dr. James Gostanian; Dr. Raymond S. Goux; Dr. Wm. Gramley; Dr. Hunter L. Gregory; Dr. Thos. R. K. Gruber Dr. Samuel C. Gurney; Dr. E. W. Haass; Dr. Carl Hanna; Dr. Beverly D. Harison; Dr. Winfred B. Harm; Dr. Albert E. Harris; Dr. Earl R. Harris; Dr. John G. Harvey; Dr. James W. Hawkins; Dr. Austin W. Heine; Dr. Wm. Henderson; Dr. Preston M. Hickey; Dr. Louis J. Hirschman; Dr. Geo. Hoffmeister; Dr. Arthur D. Holmes; Dr. Lawrence N. Host; Dr. Abraham W. Hudson; Dr. Harold S. Hulbert; Dr. Leroy W. Hull; Dr. Willard H. Hutchins; Dr. James W. Inches; Dr. Harry H. Jackson; Dr. Byron H. Jenne; Dr. Alpheus F. Jennings; Dr. Charles G. Jennings; Dr. Nathan J. Jessup; Dr. Morrell M. Jones; Dr. Ladislaus R. Kaminski; Dr. Zeno L. Kaminski; Dr. Wm. J. Kane; Dr. John F. Kelly; Dr. Johnston B. Kennedy; Dr. Wm. Y. Kennedy; Dr. Frederick C. Kidner; Dr. Edw. D. King; Dr. Paul A. Klebba; Dr. Geo. L. Koessler; Dr. Abraham Kovinsky; Dr. Albert H. Krohn; Dr. Duffield R. Kruger; Dr. Alfred D. LaFerte; Dr. Ru.dolph H. Lambert; Dr. Carl N. Larsen; Dr. Bror H. Larsson; Dr. A. F. J. Lecklider; Dr. Ernest C. Lee; Dr. Henry R. Leibinger; Dr. Daniel J. Leithauser; Dr. Alfred E. Lemon; Dr. Paul H. Lippold; Dr. Nelson MacArthur; Dr. Robert B. Macduff; Dr. Frank B. MacMullen; Dr. Otis B. Mallow; Dr. Vincent S. Mancuso; Dr. Walter W. Manton; Dr. Thos. B. Marsden; Dr. Robert M. Martin; Dr. James D. Matthews; Dr. Kenneth F. Maxey; Dr. Emil V. Mayer; Dr. Willard D. Mayer; Dr. Frederick McAfee; Dr. Arthur McArthur; Dr. James H. McCall; Dr. Wm. R. McClure; Dr. Carey P. McCord; Dr. Crawford W. McCormick; Dr. Theodore A. McGraw, Jr.; Dr. George E. McKean; Dr. Angus McLean; Dr. H. O. McMahon; Dr. Charles H. Merrill; Dr. Ellsworth P. Mills; Dr. Robert C. Moehlig; Dr. Stephen G. Mollica; Dr. Harold L. Morris; Dr. Walter Muellenhagen; Dr. Charles R. Mueller, Jr.; Dr. Thos. F. Mullen; Dr. Arthur J. Neumann; Dr Frederick H. Newberry; Dr. Arthur W. Newitt; Dr. Harry J. Noble; Dr. Ralph A. Norris; Dr. Wm. A. O'Brien; Dr. Harold F. Ohrt; Dr. Geo. V. Oill; Dr. Robert W. G. Owen; Dr. Leon E. Pangburn; Dr. W. R. Parker; Dr. G. C. Penberthy; Dr. O. W. Pickard; Dr. Lyman J. Pinney; Dr George E. Potter; Dr, Presley L. Pound; Dr. Wm. H. Price; Dr. Wynand V. Pyle; Dr. O. M. Randall; Dr. Claude B. Ray; Dr. Harry W. Reed; Dr. Heinrich A. Reye; Dr. James M. Robb; Dr. Paul C. Rohde; Dr. Herman H. Runo; Dr. Frank L. Ryerson; Dr. Homer E. Safford; Dr. Wm. G. Schlegelmilch; Dr. Harry B. Schmidt; Dr. Ernest C. Schultz; Dr. James B. Seeley; Dr. Ward F. Seeley; Dr. A. M. Shafer; Dr. Reed A. Shankwiler; Dr. Lyle O. Shaw; Dr. Harold K. Shawan; Dr. Wm. L. Sherman; Dr. Burt R. Shurley; Dr. Arthur R. Smeck; Dr. A. L. Smith; Dr. Clarence V. Smith; Dr. Eugene Smith, Jr.; Dr. Frank H. Smith; Dr. Frederick J. Smith; Dr. T. H. Smith; Dr. Clarence Stefanski; Dr. Frank T. F. Stephenson; Dr. Alexander M. Stirling; Dr. Lindley H. Stout; Dr. Luther H. Stout; Dr. Frank Suggs; Dr. Hugh A. Sullivan; Dr. Angus P. Sutherland; Dr. Rolfe Tainter; Dr. Griffith A. Thomas; Dr. Arthur R. Timme; Dr. Charles L. Tomsu; Dr. Harry N. Torrey; Dr. Emmett C. Troxell; Dr. Arthur Turner; Dr. Clyde R. Van Gundy; Dr. James A. Van Horne; Dr. George Van Rhee; Dr. Colin C. Vardan; Dr. John W. Vaughan; Dr. Victor C. Vaughan, Jr.; Dr. Milton D. Vokes; Dr. Frank B. Walker; Dr. Jos. A. Wall; Dr. Charles R. Walsh; Dr. Frank N. Wilson; Dr. George W. Wilson; Dr. Robert A. Wollenberg; Dr. Grover C. Wood; Dr. Harry B. Yoh; Dr. John C. Young, Detroit. Joseph H. Chance, Eloise; Dr. Robert H. Carmichael, Hamtramck; Dr. Martin W. Caveney, Highland Park; Dr. Geo. S. Foden, Highland Park; Dr Richard H. Juers, Highland Park; Dr. Thomas B. Henry, Northville; Dr. Lewis N. Tupper, Redford; Dr. Roy Du B. Tupper, Redford; Dr. Howard B. Kinyon. Trenton; Dr. Romeo H. Earle, Wayne; Dr. Glen L. Coan, Wyandotte; Dr. Wm. H. Homer, Wyandotte; Dr. Joseph G. Knapp, Wyandotte; Dr. John N. Bell, Detroit. Book Reviews SURGICAL TREATMENT. A Practical Treatise on the Therapy of Surgical Diseases for the use of Practitioners and Students of Surgery. By James Peter Warbasse, M.D., formerly attending surgeon to the Methodist Episcopal Hospital, Brooklyn, N. Y. In 3 large octavo volumes, and separate Desk Index Volume. Volume II contains 829 pages with 761 illustrations. Philadelphia and London: W. B. Saunders Company. 1918. Per set (three volumes and the index volume); cloth, $30.00. Volume two carries out the systematic effort at simplicity of volume one. The author has succeeded well in including up to date proceedures. He has also added a valuable work on regional technic to the library of the surgeon. Some of the illustrations as might be expected are rather diagromatic, but for the younger surgeon and surgical student this is probably an advantage rather than otherwise. THE SURGICAL CLINICS OF CHICAGO. Volume 2, Number 6. October, 1918. Octavo of 193 pages with 87 illustrations. Published bi-monthly by The W. B. Saunders Company, Philadelphia and London. This number gives many helpful suggestions to the general practitioner and specialist. The Presbyterian Hospital Clinics contain some rare and many common surgical cases. "The clinical problems relating to the fancial Tonsils," by Shambaugh shows a conservative point at times and at other times a radical point. The tonsil will always be a disputed ground and must depend upon the specialist himself. It has been handled so nicely that the doctor should be congratulated. The case reports of "Plaster Face," and "Reconstruction of Ears and Nose" are very interesting as so much reconstructive work will have to be done as a result of the war. These cases will form an incentive to follow methods therein advised with variations according to circumstances while remembering suggestions herein made. The simple operation of Perineorrhaphy is very suggestive of good results. Fracture cases are ever with us but the cases of Dr. A. J. Ochsner are very interesting. Dr. Charles M. McKenna's "A Clinic on Genito-Urinary Surgery" is of special interest. Dr. Bernstein's clinics and case reports are extremely important and deserve congratulations as they are of everyday findings. THE MEDICAL CLINICS OF NORTH AMERICA. September. 1918. I. S. Army Number, Volume 2, Number 2. Published Bi-Monthly by The W. B. Saunders Company. Philadelphia and London. This volume is replete with research work of the base army hospital on diseases of the respiratory apparatus, tachycardia complications, measles, mumps, and post operative pneumonias. The study of the epidemics at Camp Zachary Taylor has been attended by such thoroughness and details that the busy practitioner can gain only valuable information. So also in regard to the streptococcal pneumonias of the army camps. To appreciate the functions of a base hospital one must either be a resident of the same in the care of the sick and wounded and in the prevention of disease or have it explained and the reason therefor as given by Dr. Frothingham. Each cantonment having their own particular form and although varying, the ultimate good is the same. The results of the cardiovascular boards, their team work, their early recognition of tachycardia, and their divisions for acceptance and rejection makes by condensation a work finished in itself. In the study of cerebro spinal meningitis on account of the great number of cases that have developed at the cantonment, a conception of causation has been established. The report of Lieut. Morris H. Kohn goes into detail in the discussion of Paroxysmal Tachycardia. All of these keep up the high standards of the North American Clinics. MANUAL OF OTOLOGY. By G. Bacon, A.B.. M.D.. F.A.C.S., formerly Professor of Otology, College of Physicians and Surgeons, Columbia University; Aural Surgeon, New York Ear and Eye Infirmary, etc.; and Truman L. Saunders, A.B.. M.D., Assistant Professor of Laryngology and Otology, College of Physicians and Surgeons; Assistant Surgeon Bellevue Hospital, etc. New 7th edition, cloth, $3.00; 583 pages with 204 illustrations. Lea & Febiger, New York and Philadelphia. This new edition is as it always has been a distinct value to the busy practitioner and student and a reference to the specialist. The chapter devoted to the adenoids and labyrinth has been revised by T. Saunders. SURGERY IN WAR. By Alfred J. Hull, F.A.C.S.. Lieut.Colonel Royal Army Medical Corps: Surgeon, British Expeditionary Force. France. Late Lecturer on Surgical Pathology. Royal Army Medical College, Millbank; and Surgeon, Queen Alexandra Military Hospital. Second edition revised. 210 illustrations, 800, XV + 624 pages. Cloth, $6.00. P. Blakiston's Son & Co., Philadelphia, Pa. A preface by Lieut.-Gen. T. H. J. C. Goodwin, C.B., C.M.G., D.D.O.. Director General Army Medical Service, Great Britain. A preface by the author and an introduction by E. M. Pilcher. Contributors on a variety of phases of war surgery supplement the authors views and experiences. The book is well written. The prefaces and introduction indicate the spirit and purpose of the volume i. e. to give a concise treatise and a practical working knowledge of the new methods and procedures which are bound to supplant many of the older methods of practice in war and industrial surgery. The illustrations are unusually enlightening, particularly those demonstrating the application of splints and treatment of bone injuries. The contributions on the Carrell Dakin treatment of infected wounds, on microbic infection, bone injuries, gun shot wounds of chest and abdomen, brain and spine injuries and injuries to blood vessels and nerves will make this a very useful book not only for army surgeons but for those engaged in industrial surgery. MANUAL OF GYNECOLOGY. By J. C. Hirst, M.D., Associate in Obstetrics, University of Pennsylvania. Cloth. Price $2.50. 466 pages with 175 illustrations. Philadelphia: W. B. Saunders Co., 1918. The aim of the author in this revision was to cut out all nonessentials which go to fill so many manuals, and to present to the student what is possible in this condensed form. The illustrations are very good. The newer methods that have been tested for the safety of the mother during pregnancy and labor have been clearly outlined and facts vital to obstetrics maintained. PATHOLOGICAL TECHNIC. A practical Manual for workers in Pathologic Histology & Bacteriology. Including Directions for the performance of Autopsies and for Clinical Diagnosis by Laboratory Methods. By F. B. Mallory, M.D., Associate Professor of Pathology, Harvard Medical School; and J. B. Wright, M.D., Pathologist to the Massachusetts General Hospital. Seventh edition, revised and enlarged. Octavo of 555 pages with 181 illustrations. Philadelphia and London: W. B. Saunders Company, 1918. Cloth $3.75. This very useful little book comes out in a somewhat condensed and rearranged form. The chapter on autopsy technic is made the last instead of the first, the work beginning with the laboratory examination of tissue followed by the methods of bacterial work. The material is brought down to date by very few additions among which, Good pastures Acid polychrome Methylene Blue method for staining frozen sections, Benians Congo red method for spirochetes, Claudius stain for flagellae, and the method of classifying pneumonia, deserve special mention. Altogether the work sustains its reputation as one of the laboratory workers most useful reference books, and will be a very great aid to all practitioners who do any laboratory work. By Edwin A TEXTBOOK OF GENERAL BACTERIOLOGY. The book on "General Bacteriology" by Edwin O. Jordan, published by W. B. Saunders Co. needs no introduction to the western reader of Bac teriology. Its chief merit is its brevity on the less important chapters. The chapters on pneumococcus and meningococcus together with the new data on trench fever, infectious jaundice and ratbite fever are especially valuable. Not only the Bacteriologist but the general scientific student should add this book to his library. MED PHYSIOLOGY AND BIOCHEMISTRY IN MODERN ICINE. By J. J. R. Macleod. M.B.. assisted by Roy G. Pearce. B.A.. and by others. St. Louis: C. V. Mosby Co.. 1918: 903 pages with 233 illustrations including 11 plates in colors. 800, Cloth, $7.50. The book "Physiology and Biochemistry in Modern Medicine" by Macleod, published by C. V. Mosby Co., is a book for which there is a distinct place in the medical man's library. It seems to have had for its aim the connecting of abstract diadactic laboratory knowledge with the data of the clinical investigator, helping him in the physiological interpretation of the diseased condition. With this aim in view it has wisely avoided the attempt of emphasizing the usual experimental physiology of first and second year which are more directly connected with special medicine, as physiology of nerve and muscle, special senses, and reproduction physiology. It has paid particular attention to the farreaching applications of the latest department of medical science, i. e. acidosis, goitre, nephritis, diabetes, and myxedema. It has also left out any extensive consideration of serum diagnosis which it recognises as a highly special science worthy of separate consideration. I think for the student who is about to enter his third and fourth year clinical work, this is an especially good book, and for the general practitioner who wishes to brush up on the physiological reason for clinical pathology. The references to the outside literature consulted in preparing this work give the reader a feeling of confidence in the conclusions drawn and the text accepted. A TEXT-BOOK OF PHYSIOLOGY: FOR MEDICAL STUDENTS AND PHYSICIANS. By W. H. Howell, Ph.D., M.D.. Professor of Physiology. Johns Hopkins University, Baltimore. Seventh Edition Thoroughly Revised. Octavo of 1,059 pages. 307 illustrations. Philadelphia and London: W. B. Saunders Company, 1918. Cloth, $5.00 net. The seventh edition of a work so well and favorably known appearing thirteen years after the first publication needs no discussion farther than to welcome and commend. The division of the contents into sections together with a carefully aranged index, makes it a valuable work of reference as well as a text-book. While it would be practically impossible to incorporate all the new material that diligent study and investigation have brought forth, in the past three years. this work embodies all that is necessary to make it up-to-date, and covers it in a masterly manner. PRINCIPLES AND PRACTICE OF OBSTETRICS. By Joseph B. Delee. A.M., M.D., Professor of Obstetrics at the Northwestern University Medical School. Third Edition, thoroughly revised. Large octavo of 1.089 pages, with 949 illustrations 187 of them in colors. Philadelphia and London: W. B. Saunders Company, 1918. Cloth, $8.50 net. The more experienced the obstetrician the more thoroughly will be his accord with the teachings of this book. A scholarly and well written treatise gotten up in the easily readable manner with the well chosen topic heads and with the beautiful and instructive illustrations it is a very valuable textbook and ready reference. The author as well as publishers are to be congratulated. NEOPLASTIC DISEASES. A text-book on Tumors. By James Ewing, M.D., Sc.D., Professor of Pathology at Cornell University Medical College, New York City. Octavo of 1,027 pages with 479 illustrations. Philadelphia and London: W. B. Saunders Company, 1919. Cloth $10.00 net. An analysis of so great a storehouse of observation and theoretical consideration is not possible within the limits of a review article. Chapters II and III dealing with the definition, classification, general pathology and malignancy and its effect on the organism, is a masterly review of the knowledge on this subject and should be recommended as a valuable work of reference. The detailed description of the various neoplasms is written in a manner that gives evidence of a profound knowledge of the subject and a wide and sound clinical experience. This important volume should be in the library of every physician. A STUDY OF SEVENTY CASES OF CEREBROSPINAL MENINGITIS. Seham in writing in Minnesota Medicine for October, 1918, as a result of this large experience gives the following advice: In the premengitis stage, if the spinal fluid is clear, the serum may be used intramuscularly or intravenously, preferably the latter, but if signs of meningeal irritation have developed the intraspinal method alone, or combined with either of the two mentioned, must be used. Parke-Davis serum was used in the majority of his cases; in some Lederle, in a few Mulford, and in three chosen cases the serum from the Rockefeller Institute. The minimum number of injections to one patient was two, the largest number forty-four; the average number to each patient was seven. The general rule was to give the serum daily for five days, and then, if the fluid was clear, the general condition of the patient much improved, the serum was discontinued. The dose of the serum has never been standardized, since we have no definite measure of potency. The average dose used for children was 15 Cc., providing that 15 Cc. or more of spinal fluid was removed at the same time. It is not safe to give more serum than spinal fluid withdrawn. In adults 30 Cc. was usually given, and in several instances, where excessively large amounts of fluid were withdrawn, 45 Cc. of serum was given. There is too great danger in giving a large dose at one time of causing undue pressure. If a dry tap was obtained, or only a few drops of spinal fluid, between 5 and 10 Cc. of serum was given. The administration of serum must be considered a major operation. The patient must be watched very closely for signs of collapse. Sophian's method of accurately recording the spinal pressure during the giving of serum must be a very safe procedure, even though it is not considered practical by all authorities. He was not in a position to use this method, because of the very large number of patients and the lack of assistance. The respirations, especially, should be watched, and at the first sign of collapse either camphorated oil or cocaine and atropine should be given hypodermically, and if respiration stops, artificial resuscitation should be employed. Also, at the same time, the tube containing the serum should be lowered, in order to allow the serum and the spinal fluid to flow out. Six of the patients showed such collapse, and these occurred before the gravity method was instituted. At first the syringe apparatus was used entirely; the fluid was directly injected with a syringe, but a death resulted with this method, and the so-called “gravity method” was used entirely thereafter. Very frequently the patient complained of severe pains in the back, legs, and head, sometimes at the beginning of the injection, but usually after. This pain is very severe and may persist for some time. Warm serum has been recommended to lessen the pain, but it possessed no definite value. The so-called "water anesthesia," allowing the patient to suck water through a tube while the serum is being administered, is recommended by Sophian. The pain is, at times so severe that the patient's attention cannot be diverted, and again, the patient may be semicomatose; Seham did not find this method valuable. He used no anesthetic whatsoever, except in one case, in which laughing gas was used. A general anesthetic is useless in this condition, and so also is local anesthesia. If the patient is very unruly, and assistance is lacking, an anesthetic may be necessary in order to do a lumbar puncture. WHEN TO DISCONTINUE THE SERUM. 1. The condition of the spinal fluid. 2. General condition of the patient. At the onset of the disease the spinal fluid is nearly always cloudy, contains many extracellular organisms and many pus cells, and is under increased pressure. Usually at the end of five daily injections of serum the fluid clears up, the organisms disappear, and there are very few pus cells, or none at all. At the same time the patient's mental condition improves, the temperature drops, and the rigidity of the neck and extremities decreases. The serum should be discontinued under these conditions. After this a lumbar puncture, for a period of another week, should be done upon alternating days, to see whether the fluid remains normal. Even though clinical signs have improved, if the fluid should become cloudy again and pus cells and organisms return, the serum should be immediately readministered. If one is uncertain, the patient should always be given the benefit of the doubt, by the injection of serum. The fluid clears up, on average, about the tenth day. CARBOHYDRATES IN DIABETES. ་་ an In the progress of our knowledge of the nature of diabetes there has been a marked reaction against the entire withdrawal of the carbohydrates from the dietary of the diabetic. For a time there was even a tendency to administer carbohydrates as a curative measure and the "carbohydrate cure" seemed all but established. Then came the understanding that the carbohydrates cannot be withdrawn from the dietary of the individual without increasing the tendency to acidosis, or of precipitating a grave acidosis where previous to the carbohydrate withdrawal there was only a mild one. It is found that when the carbohydrate withdrawal is persisted in, acetone bodies soon appear in the urine. As the sugar disappears the acidosis appears. It must be understood that the presence of sug in the urine is of importance only as indicating that the sugar is not being oxidized or utilized. As long as enough sugar is oxidized there is no harm in some or even a great deal passing through unoxidized, but as soon as the amount oxidized becomes deficient then acetone appears. Even in rather severe diabetes the organism can oxidize some sugar. If in these cases not enough carbohydrates are given to satisfy the meager demands and oxidizing powers of the organism, acidosis follows, so that in cases treated with carbohydrate withdrawal, in whom acidosis threatens, carbohydrates must be administered to forestall the event. Moreover with the withdrawal of the carbohydrates, so necessary for the production of heat and energy, the organism draws upon the proteins of the body for its carbohydrates. It is shown, in fact, that with the increase of the carbohydrate intake there is a decrease in the protein consumption. Whether the protein of the body is utilized in great quantities, or more proteins are consumed to make up for the carbo 135 hydrate deficiency, increased protein metabolism means a large increase in the metabolic burden of the body. For the organism with a defective metabolic system, as evidenced by the presence of diabetes, this added metabolic activity is very harmful. Besides, protein metabolism is the most potent factor in the production of acid; indeed, protein food may be called acid food. In addition to the natural hypoalkalinity of diabetes there is, then, the increased acid production—and acidosis is bound to follow. The administration of carbohydrates reduces the protein metabolism sufficiently to prevent acidosis, where the carbohydrates oxidizing power is not too far gone. When the value of administering carbohydrates in diabetes was first understood it was thought that certain carbohydrates behaved differently from others. Oatmeal was supposed to have a special value as a carbohydrate cure because it was thought that the starch in it had a special action; that it had certain special ferments or extractives of value; or that it reduced the permeability of the kidneys to sugar. None of these hypotheses has any substantiation, and any value that oatmeal has in the socalled "oatmeal cure" must be ascribed to the gencral value of carbohydrate administration, where there is a defective carbohydrate oxidation, and where the organism is using up its own body proteins to make up the deficiency naturally withdrawn in a mistaken notion of treatment. The most recent conception of the proper treatment of diabetes takes into consideration the metabolic disturbance at the base of the disease, as well as the part that the carbohydrates play in the disease. The starvation treatment has for its object, therefore, the resting of the metabolic system for the period of the starvation. The subsequent dietary treatment no longer contemplates the withdrawal of the carbohydrates, but rather that they be given in sufficient quantities for the needs of the system, without necessitating drawing on the body proteins. On the other hand, it is not intended to tax the metabolic processes by administering large quantities of food. Every element of food is reduced to.. the minimum needs of the body. When it is remembered that a reduction of half of every one's dietary would be beneficial rather than harmful, there need be no fear of underfeeding in an organism whose metabolic system is damaged. Most of all, is the protein kept at a minimum in order to reduce the tendency to acid production.-Boston Medical and Surgical Journal, June 6, 1918. "AFFLICTION MAY ONE DAY SMILE By Constance Winifred Stumpe. He is a man of attractive mien, middle-aged and gray, with clean cut features and an expression of utmost kindliness. And he has done his part in the war as few men have, for in founding St. Dunstan's Hospital for Men Blinded in Battle, Sir Arthur Pearson has brought 'light to the lives of hundreds of soldiers who have given their eyes for England. Sir Arthur is proud of his school, as he may well be, and prouder still of its happy pupils who are |