and disintegrating tissues. Others consider that the harmful effects are due to the large quantity of gas formed, which, being unable to escape, collects in the tissues, gradually cuts off the blood supply by the pressure it exerts and so causes death of the tissues; this dead tissue is then invaded by putrefactive bacteria which disorganize it, and so gaseous gangrene is established. Still others have maintained that the pathological condition is due to the irritating effect of the large amount of acids formed in the tissues and have claimed to be able to reproduce in animals identical lesions and death by injections of the pure organic acids. These are only a few of the theories that have been advanced to account for the pathology of gas infection. It remains to present the theory of the toxic action of the bacilli. In undertaking a study of gaseous gangrene, one is struck by the fact that the infection, though essentially a local one, i. e., confined to a more or less circumscribed area and rarely, if ever, gaining entrance to the blood stream, is yet capable of causing extreme prostration and death, sometimes within a very few hours after the appearance of the first symptoms. This leads one to compare it with other infections, such as tetanus and diphtheria, which are also purely local in character, and in each of which the active agent is known to be a very powerful toxin, secreted by the bacteria during the process of growth and disseminated through the body by means of the circulating blood. Although neither tetanus nor diphtheria presents the extensive destruction of tissues that we find in gas infection, the other points of similarity make it reasonable to suppose that like them Bacillus welchii might secrete a true soluble toxin which is its chief weapon of offense, and without which it would be powerless to cause the lesions typical of gaseous gangrene. This supposition led to an effort to reproduce in the test tube the ideal conditions for growth that we find in deep, lacerated wounds of the muscular tissues-namely, absence of oxygen and a supply of raw muscle. To this end a 0.2 per cent. glucose beef infusion broth was made up, glucose being the chief muscle sugar and especially favorable for the growth of the gas bacillus. To tubes containing ten cubic centimeters of this sterile broth were added fragments of fresh sterile rabbit or pigeon muscle. These tubes are inoculated with a pure culture of Bacillus welchii and after being incubated over night at 37° Centigrade are filtered through sterile filters. The clear amber filtrate thus obtained contains the soluble toxic products of the gas bacillus. Such a filtrate is capable of causing, in very small doses, the 2 Bull, C. G., and Pritchett, Ida W., loc. cit.

typical picture of gaseous gangrene-edema of the tissues, extensive necrosis of the muscles, and death. Its pathological effects can be differentiated from the infection itself only by the absence of bacteria and of gas. Like all true toxins, it does not immediately produce its effect, but requires a latent or an incubation period. Its toxic action is not affected by neutralization with sodium hydroxide, a fact which rules out the acid as the principal cause of the lesions. It conforms in every way to the requirements of a true secretory toxin similar to those of tetanus and diphtheria. Finally it has been possible to produce with it a potent antitoxic serum which will not only neutralize the toxin so that it produces no lesion, but will inhibit the growth of the bacteria in the body. It has been possible to treat successfully well established infections, so that the lesions healed completely. And most important of all, complete immunity of at least two weeks' duration against both the toxin and the live bacteria can be conferred upon guinea pigs and pigeons by injecting them subcutaneously with a small amount of antitoxin. The animals so treated are entirely refractory, during this period, to subsequent injections of toxin and of live culture that kill normal guinea pigs in a very short time. These facts point to the possibility of a serum prophylaxis for gas gangrene as effective as that already used in the prevention of tetanus.

Rabbits, goats, and horses have all been made to yield antitoxic sera by injecting them subcutaneously or intravenously with carefully graded doses of toxin. At present several horses and goats are in process of immunization. These animals are injected at regular intervals and are bled from time to time to test the amount of antitoxin present in their sera. These antitoxins are carefully standardized, the number of antitoxic units in a cubic centimeter of serum being determined for each bleeding. In this way a record is kept of the increase in antitoxic power of the serum of each animal.

It would appear, then, that there is every reason to look to the serum treatment for a profound decrease in the incidence of and fatalities from gaseous gangrene due to war wounds. The ideal condition would be to give a prophylactic or preventive dose of the antitoxin to all wounded men at the first dressing station as is now done with tetanus antitoxin. In this way it is fair to hope that the development of gaseous gangrene may be prevented in many or almost all cases, besides which the antitoxin appears to be of distinct value as a curative agent in cases of gaseous gangrene already developed.

IS AN INFORMAL PEACE CONFERENCE NOW

T

POSSIBLE?

By CHARLES W. ELIOT

PRESIDENT EMERITUS OF HARVARD UNIVERSITY

HE urgent international problem to-day is how to bring about a frank and sincere conference of the belligerent nations without an armistice-since neither group would now take the obvious risks of an armistice-a conference consultative and not arbitral, and only preliminary to the official conference of governments which must devise and propose a real settlement. This problem is difficult, but not insoluble.

After three years of warfare, strenuous and continuous beyond all precedent, the military situation to-day is described fairly well by the word stalemate. For each party it is inconclusive; and there is no umpire. Either party can hold the other in trench warfare. The Entente Allies can drive the Germans back for short distances; but neither side has as yet won a decisive victory in trench warfare, or captured an army in open country. Because of the superiority of the Entente Allies and the United States in number of men, industrial productiveness and financial strength, Germany in all probability can be brought to a condition of exhaustion before the Allies will be; but this result can be brought about only by prolonged and desperate sacrifices of human life and of the savings of the nations, and at the cost of infinite human woe.

Although all the nations involved are longing for peace, their governments are in no condition to discuss terms of peace. The political and industrial changes brought about by the war are tremendous; but they are manifestly incomplete. Democracies have been obliged to change many of their habitual modes of action; autocracies are facing internal agitations; one autocracy has just disappeared, but no stable government has as yet taken its place; many industries have to be carried on under new conditions as regards both labor and capital; and war itself is conducted in new ways which disregard the ethics heretofore thought to be universally accepted. There is a general wondering as to what is going to happen next, which indisposes responsible persons to large committals, or decisions

which can not be recalled. The Entente Allies do not state clearly their minimum demands or lowest terms for peace, and the Central Monarchies state no terms at all.

Under such circumstances it is wholly natural for combative and indignant men and women to say, "What is the use of talking with the German rulers about terms of peace; they will not keep their word, if they can obtain any military advantage by breaking it? We must fight till we are plainly victorious." On the other hand, the various official and unofficial statements of the terms on which the Allies would be willing to make peace produce on the German mind, so far as their opponents can discover, only this effect-"We are fighting a war of defense against dismemberment or imprisonment; we must fight to the last gasp in the hope that some favoring chance or discord among our enemies may save us from the threatened destruction." This is indeed a horrible dilemma; and many righteous men say that there is no way to escape from it, except by the overpowering of one or other of the combatants. Before settling down, however, to this long struggle, is it not worth while to try a limited preliminary experiment on human capacity for good feeling and sound reasoning even under the most adverse circumstances?

Even under the actual very discouraging circumstances, he would be a bold man who should affirm that it is impossible to bring appointed conferees from all the belligerent nations into one room for the oral discussion of subjects previously agreed upon, the conferees being selected by the several governments, but receiving no instructions either before or during the conference from the appointing powers, and having no power or commission except to make a brief, public report of their conclusions. The function of the several governments would be limited to the appointment of the conferees and the granting of the necessary safe-conducts. In order to keep the size of the conference moderate, each small state might be restricted to two conferees, and each large state to four.

The two principal subjects of discussion ought to be:

I. The means of so organizing the civilized world that international war can be prevented-by force, when peaceable means have failed.

II. The removal or remedying in good measure of the public wrongs, injustices and distrusts which contributed to the outbreak of the present war, or have been created during its course -wrong-doings and passions which will cause future wars unless done away with.

There follows a list of the subjects which might well be discussed under each of these two principal heads, the conference itself making choice among them.

Under I:

(a) Will the nations concerned publicly recognize as a settled principle of international action, that no nation shall henceforth attempt to exercise rule or domination over any other nation, large or small, occidental or oriental?

(b) Can the boundaries of the European states be so readjusted that no European population shall be held by force to an unnatural allegiance contrary to their wishes?

(c) Shall the freedom of the seas and of the canals and channels connecting great seas be placed under international guarantees for peace times but not for war times?

(d) Will all the nations agree that enlargements of national territory, extensions of national trade, and concerted migrations shall hereafter be brought about only by the consent and with the good-will of all parties concerned, and shall be maintained only by the parties' sense of mutual service and advantage? For expansion of trade, the universal reliance shall hereafter be the policy of the "open door"; and for relief from congestion of population, the policy of "peaceful penetration." Enlargements of territory by purchase or other voluntary contract shall be subject to the approval of the International Council. (See below.)

(e) Will the present belligerents agree to form an offensive and defensive alliance for the purpose of instituting and maintaining an international council composed of one delegate from each nation, and an executive commission composed of one commissioner from each of either three or five great powers-such, for example, as Great Britain, France, Russia, Germany and the United States, or the United States, France and Germany, the chairman of the commission to be in either case an American-and an international army and international navy, the function of all these bodies combined to be to prevent international war, if need be by the use of force, and therefore to see that forces adequate to that end are maintained on call, these forces to be decidedly superior to the existing armies and navies of any two nations combined? Other nations might later be admitted to that alliance by the joint action of the international council and the international executive commission, provided that their forms of government might properly be called constitutional or free, and that they were prepared to make some