present alike in the two sexes, and increase in frequency with age, the figures being 60 per cent in persons from 20 to 40 years old, 95 per cent between 40 and 50 years, and practically 100 per cent in older persons. In these findings a ready explanation is seen of the great frequency of arthritic disease, and it becomes easy to understand why an infectious process in the tonsils, the prostate or the gall-bladder is so likely to cause trouble in remotely located joint surfaces.-J. A. M. Ä.

Chronic Arthritis.

F. Billings, Chicago (Journal A. M. A., September 13), publishes the results of a study of seventy cases of chronic arthritis in the Presbyterian Hospital, Chicago, under the auspices of the Otho A. S. Sprague Institute and the Dane Billings Memorial Fellowship of Rush Medical College. The methods used were the same as those described in his former article (Arch. Int. Med., April, 1912, p. 484), and the clinical research has confirmed the principles announced in that paper. In the bacterial studies he has had the aid of Dr. E. C. Rosenow, who finds that the organisms from rheumatism "appear to occupy a position between S. viridans and S. hemolyticus. They are more virulent than the former and less virulent than the latter. Three types of organisms have been isolated from rheumatism. One type produces green on blood-agar and forms very long chains. The second type produces a narrow zone of hemolysis on blood-agar, from the beginning or after several generations, and forms short chains. The third type produces a grayish-brown colony without affecting perceptibly the blood in the mediums, and appears as a diplococcus in short chains and as single cocci. By varying the condition of growth, these types may be changed quite readily, one into another. The most distinctive cultural features are their production of a very high acid reaction in dextrose broth and abundant growth at low temperature. They are more virulent to warm-blooded animals than S. viridans, but less virulent than S. hemolyticus, and, of course, than the pneumococcus." Rosenow's experiments show that these organisms can by cultural methods be made to range from a type of streptococcus to the penumococcus. Experiments with the serum treatment were undertaken, but the results did not indicate that it would be safe, and it is not recommended. In spite of all known precautions, every patient suffered after the second or third treatment from anaphylaxis, in some cases very severely. The indiscriminate vaccine treatment some of the

patients had previously received is strongly condemned by Billings, but practically all the patients were treated with autogenous vaccines, which increased the opsonic and phagocytic indices. The main reliance appears to be still on the time-honored hygienic measures with muscle stretching and graduated exercises, etc. The conclusions of the author are summed up as follows: "1. Arthritis deformans is an infectious clinical entity, manifesting a chronic peri-arthritis, synovitis, proliferative and degenerative osseo-arthritis, chronic myositis, with contraction of muscles and perineuritis or neuritis. 2. Usually coincident but secondary malnutrition and faulty metabolism aggravate the condition of the patient. 3. The infectious source is usually focal and located in the mouth (alveoli), faucial tonsils or antra (sinuses). Occasionally the focus may be in the prostate gland seminal vesicles, the female genitalia and probably also in a streptococcus chronic appendicitis or cholecystitis or a circumscribed streptococcus infection anywhere. That the infection may occur from a chronic streptococcus invasion of the intestines is a question to be decided. 4. The morbid anatomy of the experimental chronic arthritis is the same as that found in man. This morbid anatomy is the specific reaction of the infectious organism. 5. Arthritis deformans may be differentiated from other types of chronic arthritis by the characteristic coincident involvement of peri-articular and articular structures, chronic myositis, consequent contractions of muscles, secondary trophic changes due to fauty metabolism, malnutrition, etc. 6. The treatment and management must comprise: (a) The removal of the cause. (b) Improvement of the immunity by rest, personal hygiene, including good food, pure air and sunshine, rational calisthenics and physical culture, moral support and a cheerful environment. Autogenous vaccination may be added to still further improve immunity. 7. The clinical results confirm the principles embodied in this paper.

Anaphylaxis and Asthma.

During the past four years there have been examined in the Mayo Clinic about 300 cases of asthma. Matthews says that in over 90 per cent of the cases the principal lesions which might be considered as etiologic were in the upper respiratory tract. Chronic suppuration or the retention of mucoid secretions in the nose or accessory sinuses occurred in the majority of these cases. Treatment was directed toward the object of securing free and continuous drainage of every portion of the tract and

little attention was paid to possible reflex factors of etiology. In the majority of the cases the relief of the asthma corresponded almost exactly with the degree of success in obtaining the result sought, that is, the prevention of the retention and reabsorption of mucous secretions. Matthews states that the relief of asthma by any known treatment does not mean that the patient is permanently cured, since the susceptibility remains throughout life and symptoms will recur whenever there exist conditions favorable to the production and absorption of the specific antigen to which the individual is sensitive. Various methods of desensitizing animals have been discovered, but no method yet reported gives a lasting immunity and all are attended by high mortality. Until a safe and efficient method of desensitization is possible the treatment of asthma must be directed as in the past to the relief of symptoms by whatever measures are indicated in each individual case.-Medical Record.

Tetanus Antitoxin.

A study of statistics leaves no room for doubt that tetanic antitoxin is well worth while as a curative agent in developed cases. In its use as a prophylactic agent it must always be kept in mind that tetanus antitoxin does not remain long in the body. Vaillard states that the protective influence in man lasts but one to two weeks. In those cases in which the complete removal of the infectious bacilli cannot be assured, a repetition of the injection is necessary. Cases of tetanus developing some weeks after a prophylactic use of antitoxin are occasionally observed, and are undoubtedly due to the neglect of this precaution.-Journal A. M. A., August 30, 1913, p. 687.)

Discussing ulcers of the rectum in Keen's Surgery, Volume VI., page 626, Robert Abee, of New York, remarks that "in the treatment of the syphilitic lesions, salvarsan seems to offer wonderful results. In cases that have resisted mercurial treatment it certainly should be used. Its primary use (after diagnosis by the Wassermann reaction) is widely advocated."

WOOD ALCOHOL AND BLINDNESS.

Reports of cases of blindness and death from the use of wood alcohol continue to come in. Wood alcohol has had considerable use in painting and varnishing, as it is serviceable as a solvent of shellac. It is unsafe to the eyes even when used in the arts, unless the place where it is used be thoroughly ventilated. It is better to use it not at all. The denatured alcohol is inexpensive and is considered safe.