ieet, which symptoms disappeared rapidly under the use of faradization. There was no evidence of ptyalism or other ill-effect. Dr. Judd also referred to three other cases, the only ones which he had seen result fatally-in two foolishly fond mothers interfered with the directions specified; in the third there was what seemed to be cerebral involvement. In conclusion, Dr. Judd believed there was no danger of ptyalism; he had never seen a case of diphtheria salivated by calomel or hypercatharsis created. He was not unmindful of the potency of the drug, and recommended its heroic use only with proper discernment, and with good, intelligent, reliable nursing. Sleep, he said, too often meant death in these cases, and the wakefulness necessary for the frequent administration of the medicine would do only good to the patient and reward the nurse, from twenty-four to forty-eight hours generally determining the issue. A Clinical Study of Tachycardia and Its Relation to Graves' Disease and Uraemia.-Dr. Roland G. Curtin, of Philadelphia, in a paper with this title, cited two cases of tachycardia, and mentioned in connection therewith cases of undeveloped Graves' disease, culled from a large number more prominently illustrative in that they had the symptoms of palpitation and excited heart long before the other prominent symptoms presented themselves, and were diagnosticated erroneously as simple essential tachycardia. He considered the careful study of slowly developed Graves' disease very important, and believed that much valuable time could be saved by an early diagnosis. He gave an interesting table, showing the salient points in the differential diagnosis of the tachycardia of undeveloped Graves' disease and simple irritable heart. [To be continued.] FOOTED THE BILLS.-Francis W. Bird, the "Sage of Walpole," once went to see Dr. S. G. Howe, and found him with his feet swathed in flannels and extended on a chair. "Howe, what is the matter?" he asked. "I have got the gout," said Howe. "You have got the gout-such a temperance man as you!" "Yes, Bird, my ancestors drank wine, and I have to foot the bills!"-Boston Transcript. THE IMPROVED TUBERCULIN. Prof. Koch's description of his improved tuberculin ("Deutsche Medicinische Wochenschrift," April 1), is encouraging, but very reserved. He carefully eliminates the word "cure" until a sufficient time has elapsed without a relapse, and confines himself to speaking of "considerable improvement." Moreover, he states. that his remedy is not effective unless used in the early stages of consumption. Concerning the difficulties encountered by him in seeking a lymph which would render the human subject immune, Dr. Koch says that solutions with dead bacilli caused bad abscesses. When he filtered the fluid it had no better effect than his first tuberculin. When, after several years of experiments, he came to the conviction that the bacilli in an unchanged, or, exactly speaking, in an undestroyed state, could not be absorbed, he sought for means to destroy them mechanically without destroying their characteristic properties, as was done by dissolving them by a chemical process. The object was to destroy an integument which covered each bacillus. All the first experiments failed. Only when well-dried cultures were taken and worked about for a long time in an agate mortar, without any admixture, one could see that the bacilli decreased in number, and that finally only a few remained. In order to remove these, Dr. Koch diluted the substance thus obtained with distilled water, and worked it about by means of a powerful centrifugal machine which made four thousand revolutions in a minute. The fluid was in about half an hour divided into a whitish, opalescent, but quite transparent, upper layer, which contained no more bacilli, with a muddy sediment sticking fast to the bottom. Dr. Koch called the upper layer "Tuberculino," abbreviated “T. O.," and the bottom layer "T. R." (Tuberculin remainder), T. O. is very much like the ordinary tuberculin in its qualities. It has almost the same effects as the tubercle antitoxin, but it causes no abscesses. The T. R., however, has a decidedly “immunizing” effect. It certainly also causes some reaction if too large a dose is given, but its effect is quite independent of these reactions. While, in using ordinary tuberculin or tubercle antitoxin, or T. O., reaction must be purposely provoked in order to obtain healing effects. Dr. Koch in using T. R. endeavors to avoid such reaction. For this purpose he tried, by gradually increasing the doses, which were made to follow each other as quickly as the patient's condition allowed, to make him insusceptible to the effects of a larger dose that is to say, render him immune against T. R. and against the tubercle bacilli themselves. Injections are made, as with the The treatment is very simple. tuberculin, on the back with a syringe. cubic centimetre eight milligrammes dredth of a milligramme is given first. that only very rarely reaction sets in. must be still more diluted. The injections are made about every second day, and the dose is increased so slowly that increase of the temperature above half a degree is avoided. The rising of the temperature, if caused by the injection, must have completely disappeared before resuming the injections. As a rule, Dr. Koch increases the dose up to twenty milligrammes, and if no reaction is perceptible he ceases to inject, or does so only after longer pauses. He has gained the impression that complete immunity is attained about two or three weeks after the application of large doses. The preparation has been applied by Dr. Koch in a great number of suitable cases, especially of lupus, and he has achieved without exception an improvement far greater than that gained with tubercle antitoxin. "I say improvement," says Dr. Koch, "though many of the cases may be regarded as cured, in the ordinary sense of the word, but I think it premature to use the word cure before a sufficient time has passed without a relapse." The patients felt well, they steadily increased in weight, and, what was especially striking, their temperature did not show the well-known variations in consumptive patients. The Professor says that he does not venture to regard his lymph as the best possible. He intimates that experiments are being made with a new serum which may prove still more efficacious, but he is convinced that the preparation of the tubercle cultures cannot be brought to greater perfection. Interesting is Dr. Koch's reference to the great danger of his experiments. The cultures used must be as fresh as possible, and an investigator must not forget that it is the most virulent living tubercle bacilli which he has to deal with, and that they are worked upon in a dried state, so that dust cannot be avoided. "I do not," he says, "think the danger connected with these experiments to be little, and I must confess that I often had a feeling as if I were dealing with explosives." As to the curative action of the new tuberculin in guinea pigs, Koch has been able to accomplish a cure in from fifteen days to three weeks in cases of tuberculosis that were not advanced. In the case of man, the initial dose should not exceed 0.002 of a milligramme, and if that amount causes fever it must be reduced. The injections are given every second day, and the dose is slowly but progressively increased to 0.5 or one milligramme. If the new dose causes the temperature to rise as much as a degree F., no more injections should be given until it has fallen. In man, the new tuberculin produces its effects only if the tuberculosis is not of too long standing or complicated with secondary streptococcous infections, on which it has no action. It rarely proves effective with patients whose temperature exceeds 100.4° F. T. P. C. NATURE-STUDY FOR PUBLIC SCHOOLS.-Nature-study, or seeing familiar things in a new light, is a valuable factor in education. How many people can explain, so that a child can understand, why water puts out fire, why some young squash plants bring their shells out of the ground on their backs and others do not; or show the difference between a leaf-bud and a fruit-bud; or tell from whence all the house flies come? The world is full of such common things, about which people do not inquire. Yet, such subjects can be made very interesting to children and they can be taken up in the schools, not as an added recitation, but as a rest exercise once or twice each week to relieve the monotony of the school room and later be made the theme for a language exercise. Here are two important faculties that may be brought into exercise-accurate observation and the power of expressing definitely what is seen. The College of Agriculture of Cornell University, has, under the Nixon or Agricultural Extension bill, undertaken to assist, free of expense, all teachers who wish to introduce this work into their schools. All parents and teachers interested in this work are asked to send their address for more detailed information to CHIEF CLERK, COLLEGE OF AGRICULTURE, LIFE INSURANCE AND PUBLIC HEALTH PROBLEMS. BY FREDERICK L. HOFFMAN. Enough has been shown in the mortality records of various cities to emphasize the importance of a pure water supply to prevent typhoid fever. It has been shown that wherever typhoid fever prevails to a considerable extent, there we meet with undisputed facts of sewage pollution of the water supply. Where means have been adopted to check this pollution, or where a new and unpolluted supply has taken the place of one unfit for use, there the mortality from typhoid fever has been materially reduced. What is probably the most successful and important experiment in this country in the direction of exterminating this most fatal disease is in a New England city. Lawrence, Mass., a city of about 50,000 inhabitants, takes its water from the Merrimac River, the drainage basin of which includes a large number of towns, of which Lowell, only nine miles above, is the most important. Most of the towns discharge their sewage directly into the river and, as a result, the same is grossly polluted. For a long number of years, typhoid fever has been enormously prevalent in both cities, reaching for Lawrence at times a rate as high as 138 per 100,000 (1889). After years of agitation, similar to the past experience of Newark and the present experience of Jersey City, Chicago and Philadelphia, a radical method of purification by means of extensive filter beds was adopted. The first filter was used in September, 1893, and the effect of this method has been as follows on the death rate of that city: This remarkable decrease in the typhoid mortality is referred to in the report of the Lawrence Board of Health for 1894 as follows: |