symptoms for a sufficient period of time. There has remained no sequelæ of the disease that may embarrass other organs in performing their functions. The same attitude should be adopted in regard to empyema, even though surgical interference has been necessary for effecting a cure. So called essential or primary pleurisy, on the other hand, must be looked upon from a different point of view. It is usually due to tuberculosis, and the applicant giving a history of such pleurisy must be thoroughly examined with regard to any manifestations of tuberculosis. Personal and family antecedents, age, sex, surroundings at home, profession, habits, date of the pleurisy, etc., are the points which must be fully considered. Whenever there is any doubt it is always a good general rule to recommend postponing the acceptance of the applicant for a fairly long period of time. DIONIN IN EYE DISEASES. Selenkowski recommends dionin because of its analgesic effect and its power of getting rid of lymph in perforating wounds of the eyeball, in cataracts extruded into the anterior chamber after incising the lens capsule, in corneal ulcer with hypopyon, in detachment of the retina, iritis, irido-cyclitis and glaucoma. Dutoit reports a case of neuroparalytic keratis, and considers that the only remedies that are likely to prove successful when the cornea has lost its nutrition are such as increase the lymph stream and the circulation. For this reason he used dionin (in 1% and 5% solution) and he made the interesting observation that dionin actually caused a visible formation of numerous new vessels in the cornea, and thus promoted its regeneration. In the case fully described by him, he attributes the good result to dionin and recommends its use in similar cases, SE Normal Serums in Infectious Diseases. BY EDGAR P. WARD, M. D., PH. D., Professor of Embryology in the American Medical College, St. Louis, Mo. ERUM THERAPY is yet in its infancy. We are still in the trial and error stage. It is quite likely-nay, practically certain-that we shall have to review many of our concepts and revise many of our conclusions before we finally arrive at a satisfactory and adequate serum therapy. Certainly, the more closely we can imitate and synergise the natural methods of body defense, the nearer we shall get to directness and efficiency; and this must be the point toward which all serum investigation and serum argument must move, But, as stated, such investigation and such argument is, for the present, all tentative, and every contribution is a valuable aid to the illumination of the subject. In this spirit the author offers this little article on normal serums, and in this spirit we publish it for our readers' perusal and thought. It is the intention of the writer to call attention to the action of normal serums in infectious diseases, but more particularly to diseases that are of a chronic type, i. e., tuberculosis, salpingitis, urethritis. Considering tuberculous infections (and the same theory can be applied to all infectious diseases which cause a slow and constant drain upon vital tissues) they naturally distribute themselves under two headings: first, those of a strictly localized infection unaccompanied by any symptoms of constitutional disturbance, including cases. where the infection is limited to a definite area, or one or more lymphatic glands, most cases of lupus, tubercular abscess in the subcutaneous tissues, tubercular affections of the joints, and many slow, progessive cases of tuberculosis belong to this class; second those suffering with general tuberculosis, wherein the constitutional disturbances are well marked. In the treatment of tuberculosis there are certain elements which must be considered in connection with the protection of the body against the invading microorganisms. The leucocytes, with their digestive ferments, constitute one of these elements; the bactericidal substances in the blood fluid constitutes the other. The leucocytes must be considered in connection with resistance to bacterial infection, in virtue of the well-known fact that they are capable of ingesting bacteria and of disintegrating them by intracellular digestion. The bactericidal elements modify the bacteria in a manner which renders them a ready prey for the leucocytes. Protective substances may be defined as substances which enter into destructive chemical combination with bacteria, or, as the case may be, with other foreign elements introduced into the body, either directly into the blood-stream, or by subcutaneous injection. Such protective substances are never absent from the blood. No one recovers from an acute or chronic bacterial disease unless it be by the production of protective substances in the body; no one acquires protection against a disease except, again, by the production of protective substances; and, finally, no one lives in the presence of infection and repels that infection except by the aid of the protective substances in the blood. The immunization method of treating bacterial diseases is nature's method. In the treatment of this character of infection with a normal nucleinic serum this general principle must constantly be kept in mind. Such a serum is not a bacterin or bacterial vaccine; not an antitoxin, but a supernormal, bactericidal chemo-serum, obtained from the blood of the goat, with which there has been developed a complex carbohydrate loosely combined with a proteid molecule of the amido-acid type, and which, when injected into the organism, causes an elaboration of protective substances. It is a powerful reconstructive, and, owing to the increased blood pressure which it produces, supplies to the pathological area a greater amount of oxygen. We have, therefore, a very simple solution to the problem, in that the serum supplies to the blood an increased amount of narmal bactericidal elements which neutralize the toxins of the germs, and through its reconstructive properties aids nature in building up and fortifying the cells of the tissue against the infecting microorganisms which cultivate themselves in regions where antibacterial substances are absent from the tissue fluids or in diminished quantity as compared with the circulating blood. It is of the utmost importance that it should come home to you that we are dealing here, not with mere speculation, but with a generalization which rests upon a large body of veritable facts. I believe that the philosophy of this theory is correct; but the main point is what results are obtainable, what amount of eventual good may the patient be informed they may expect, and what can the physician reasonably expect to accomplish. In the use of serum of this character I have been more than gratified by the good results that I have obtained in the tuberculous. In looking over my case reports I find many cases that have been greatly benefited-some more than others, as might be expected. The average tubercular patient, when he comes under the charge of a physician, has already run the gauntlet of the advertised and advertising curers of tuberculosis, and is usually suffering with a mixed infection which is so debilitating to the system that heroic measures must be adopted if any aid whatever is to be given these poor creatures. It is just this character of cases in which I have been able to accomplish the best results-these accomplishments do not necessarily mean that the patient has been absolutely cured, but that the patient has been given a new lease of life. It invariably reduces the temperature, lessens or stops altogether the sweats, increases the blood pressure, thus giving the diseased area an increased supply of oxygen and normal antibodies that are in the blood stream to combat the infection with, and thus we have a slow but gradual increased resistance built up, and with increased resistance a gradual improvement throughout the entire body. When a patient suffering with a mixed infection is given a serum treatment of this character and it puts him upon his feet, permitting him to again become a breadwinner instead of a constant care and burden upon those that are closest to him, it is "doing something," and that something is worth while when you are raising a patient from hopeless dependency to personal independency. A normal serum (and serum seems to be the best medium we now possess) carrying a large amount of normal antibodies seems to me to be the ideal method of treating all diseases of this character. I believe that it offers more hope for improvement and a possible eventual recovery than any method or medicament of which we now have any knowledge. Measures to Prevent the Spread of Infection from the Bedside of a Typhoid A Fever Patient. S WE HAVE frequently pointed out, the general practitioner in the smaller towns and rural districts is required to be, not only physician, but health officer, family adviser, nurse, and in fact, everything that pertains to the administration of health and the care of sickness. In this multiple capacity he has need of all the varied knowledge which pertains to these several offices, and it is the aim of this journal to minister to his needs in this wide range. In pursuance of this purpose, we publish for our readers' benefit this excellent article on the bedside prophylaxis of typhoid fever-a subject in which every general practitioner is interested-from the Public Health Bulletin of the U. S. Treasury Department, for which Dr. Lumsden is responsible. "The means by which typhoid fever may be prevented from spreading are very simple, very sure, and their cost next to nothing." (William Budd. Typhoid Fever. London, 1873.) "The case of typhoid fever now in your house was caused by the ignorance or the carelessness of some one; don't let your carelessness cause the illness, and maybe the death, of others." (Health Department of Richmond. Va., 1909.) Typhoid fever is communicable from the sick to the healthy. The disease is both "infectious" and "contagious." Every person who has typhoid fever has recently swallowed some typhoid germs which have come in some way from some other person. The germs (the infection) of typhoid fever leave the body of a person sick with the disease in the stools and urine. A number of these germs may be contained in a particle of feces or in a droplet of urine too small to be seen by the unaided human eye. Fingers soiled to the slightest extent with the excreta from a typhoid-fever patient and flies which have had access to such excreta may carry typhoid germs directly to human mouths or to beverages and foods which are subsequently to be swallowed by persons. If excreta from typhoid-fever patients are carelessly disposed of, they may be carried by seepage or drainage, on the feet of animals, and in other ways to water supplies and to certain fruits and vegetables. Infection in water may be transmitted to milk oysters, and other foods. In these various ways the infection proceeding from the discharges of the typhoid-fever patient may be distributed far and wide. To prevent the spread of infection from a typhoid-fever patient the following measures should be rigidly carried out: (1) Disinfect the stools and urine (and the expectoration if there be any) immediately upon their escape from the body. Keep constantly in the bedpan or other vessel used to receive the discharges a small quantity of the disinfectant solution. As soon as the stools or urine are received in the vessel add a quantity (1 to 2 pints) of the disinfectant solution equal in volume to about double that of the excreta to be disinfected. Wipe the soiled parts of the patient first with dry paper and then with paper or a cloth moistened with at solution made by adding 1 part of the disinfectant solution for use in the bedpan to 2 parts of water. If cloths are used they should be either burned or thrown into a vessel containing the fullstrength disinfectant solution, and afterwards boiled in the solution. The paper which has been used for wiping should be submerged in the disinfectant solution. in the bedpan. The disinfectant solution and the excreta should be mixed thoroughly, and if there are lumps of fecal matter they should be broken up, because disinfectants can not kill germs unless brought in actual contact with them. Cover the vessel containing the excreta and disinfectant solution and let it stand for about an hour before emptying. The disinfected excreta should be emptied into a water-closet or a sanitary privy, or in a hole in the ground at least 2 feet deep, dug especially for the purpose, protected against invasion by animals, and remote from wells, springs, or other sources of water supply. If deposited in the ground, the excreta should be kept thoroughly covered with earth. After being emptied, the bedpan should be thoroughly rinsed inside and out with the disinfectant. One of the best disinfectants for the stools and urine is chloride of lime solution, made by adding one-half pound of good chloride of lime to 2 gallons of water. A fresh solution should be made up every day, or if a supply for several days is prepared at one time the solution should be kept in a practically air-tight vessel. An ample quantity of the disinfectant solution should be kept in the patient's room, convenient for use at all times. Carbolic acid (1 part to 19 parts of water) and formalin (1 part to 9 parts of water) are thoroughly efficient disinfectants for stools and urine, but are much more expensive than chloride of lime. If carbolic acid or formalin solutions are used, they should be applied in the same quantity and in the same way as described above for the chloride of lime solution. Only disinfectants of thoroughly recognized efficiency should be used. Many of the patented preparations advertised. as "disinfectants" or "germicides" have little or no germ-destroying property. If good chemical disinfectants are not immediately available, the stools and urine may be disinfected with boiling water as follows: Pour into the vessel containing the excreta an ample quantity (a quart to a half gallon, or at least three or four times as much as the volume of stools and urine to be disinfected) of actually boiling (and bubbling) water. After the boiling water is added, cover the vessel and let stand for one-half hour before emptying. (2) Disinfect promptly (and certainly before removal from the room) everything which may possibly have become soiled to the slightest extent with either the stools or the urine of the patient.— Great care should be exercised to prevent so far as practicable the articles in the room from becoming soiled with the slightest (even microscopic) quantities of the patient's excreta. In preparing the room for the care of the patient, all unnecessary hangings, draperies and upholstered furniture should be removed. The room should be clean, well ventilated, and furnished only with articles which may be readily and thoroughly cleansed. Textile carpets and rugs should be removed and replaced, if need be, with linoleum. The room should be freed and kept free from flies and other insects. Dogs, cats, and other domestic pets should be kept out. The mattress of the bed should be protected from soiling by keeping a rubber sheet or folds of paper (newspapers will do) placed over it and under the bed sheet. It is decidedly advantageous to dispense with bedclothes for the patient's body which extend below the abdomen. Bed linen, towels, and other cloths used about the patient should be placed in a tub, washboiler, or other vessel containing sufficient disinfectant solution to cover them thoroughly and boiled in the solution before being washed at home or sent out to be washed. Chloride of lime solution (2 ounces of the powder to the gallon of water) or carbolic acid solution (6 tablespoonfuls of the 95 per cent acid to the |