all uncomplicated cases consider themselves cured by the tenth day and the bacilli as a rule, disappear by this time, but by stopping the drug this early the bacilli and symptoms return in one-fourth the cases three or four weeks later. From the short experience I have had with the drug I readily conclude, however, that an eight day treatment is of far greater value than a four months' treatment with the arsenic preparations. I have never found a case entirely free of the bacilli after treatment with the latter drug. In the very severe cases suppositories or colonic irrigations are of great value. In so short a time it is impossible to have tested the drug thoroughly, but I regard it as a specific. Just how long the spores will lie dormant in the intestine, time only will prove.

The bacilli in all stages of the disease are present in enormous numbers in the contents of the large intestine. I believe they are usually confined to this situation. Their deleterious effects upon the body appear to be largely due to the production of toxic substances which in addition to serious intestinal irritation or lesion may on absorption incite those systemic disturbances which characterize the toxaemia. The disease must be spread by direct contact with the excrement of those afflicted with the malady or by flies conveying the parasite to articles of food.W. B. Page, M. D., of Lumberton, N. C., in Charlotte Med. Jour.

GAS GANGRENE:-All great wars bring their own peculiar medical and surgical problems. The armies of Napoleon contracted trachoma in the Egyptian campaign. Typhoid fever was the chief cause of death in the Spanish-American War. Hospital gangrene was the bane of the surgeons during the Civil War. So far during the present European conflict we have heard comparatively little of diseases as a factor in determining issues. Owing to the high state of development of the medical corps of modern armies it

is not probable that any of the old, time-worn, devastating camp diseases will work great havoc. Cholera, typhoid,

smallpox, measles, and pneumonia will possibly claim a small share of the general mortality rate, but increased efficiency in preventive measures will largely eliminate the danger of widespread epidemics from these diseases. It is the new and unknown which hold the greatest possibility of disaster.

Malignant edema has been known as a dangerous disease for many a decade, but the possibility of its appearing in epidemic form has never been discussed in any text books of medicine or surgery. Now it seems that a surgical gangrene closely resembling, if not identical with, malignant edema has broken out among the wounded soldiers of both armies on French and Belgian soil. This peculiar form of surgical complication has received the name of "gas gangrene." It is liable to affect any wound, whether serious or trivial. It has caused so much mortality that it has been made the subject of a special report to the English Secretary of the War Office from the Field Laboratories of the Allies. The report is published in the Lancet for November 28, and from it we learn that the medical corps and field laboratories are busily engaged in efforts to combat the fearful ravages of this complication of the wounds of modern warfare. From the data so far available it appears that "gas gangrene" is always due to a traumatic infection; that is, the projectile carries infected soil into the wound. The nature of this infection is not yet definitely determined in all its details, but sufficient has been learned to make sure that the particular organism belongs to the malignant edema type. In other words, it is an anærobic, sporeforming, gas-producing bacillus. A rapidly fatal gangrene supervenes upon the implantation of the organism in the tissues. There is no pus infection except at the edges of the wound, but a dark gray discoloration which subsequently turns green and is accompanied by subcutaneous gas

infiltration, rapidly involves the whole extremity, and within thirty-six hours from the receipt of the injury the process has extended so far that amputation is frequently the only chance of saving the life of the patient. From a perusal of the report it would seem that this alternative is often a very doubtful one, because hand in hand with the extension of the local trouble there goes a cardiac depression so great that death usually occurs in spite of all treatment. Consciousness is preserved till the last. There is no delirium, very little fever, and practically no circulatory acceleration, but the heart becomes so weak that its sounds are scarcely perceptible and the radial pulse disappears entirely. The odor from the gangrenous parts is described as being not only diagnostic but also unbearable. So fearful is this smell that a properly conducted autopsy is almost impossible.

The laceration of the tissues and extravasation of blood caused by the tearing wounds of modern shrapnel seem to produce a most favorable nidus for the growth of anærobic bacteria. Anærobic micro-organisms like those of tetanus and malignant edema find their most favorable habitat in barnyard and cultivated soil.-Medical Record.

A NOTE ON ADRENALIN CHLORIDE IN THE TREATMENT OF SPASMODIC ASTHMA:-In the Lancet of August 15, 1914, Waller states that the following notes may be useful as supplementing Dr. W. Miller's experiences with adrenalin, as related in the Lancet of July 18. Waller has employed hypodermic injections of adrenalin chloride in cases of spasmodic asthma for the last five years, having been led to adopt the treatment by the perusal of an article in an American medical journal. The preparation used has been Parke, Davis & Co.'s solution of 1 in 1000, with 0.5-percent chloretone, in doses of 5 or 6 minims to begin with, never more, and these doses have never been followed by any untoward consequences; on the contrary, the relief

to the patient has invariably been prompt, grateful, and in many instances lasting. The American writer of the above-mentioned article put forward as an additional recommendation the fact that in using adrenalin in this complaint smaller and smaller doses would be found efficacious, instead of increasingly larger administrations as might be expected. This statement has been fully supported in Waller's experience, and even such a minute dose as 1 minim diluted with water has been successful in promptly cutting short an attack in a chronic case.

During the last five years Waller has had opportunity of closely observing the effect of the drug hypodermically administered to a chronic asthmatic, a professional gentleman forty years of age. Until adrenalin was tried in the spasm nothing gave him relief, even morphine itself proving unsatisfactory. The benefit obtained by him is invariably immediate, although Waller can confirm Dr. Miller's observations as to the patient's pallor and the smallness, rapidity, and slight irregularity of the pulse for a few minutes immediately after the injection. The patient's own description of his sensation is that he feels "a little cold. and inclined to shiver, somewhat shaky in the knees, and a peculiar empty feeling in the chest." These soon pass off, and the dominant sensations then are a delightful sense of relief from the dyspnea and a desire for sleep. The sleep is always light, refreshing, and dreamless, and Waller has never known it followed by undesirable or unpleasant consequences. This patient has been free of his ailment for weeks and months at a time. Occasionally during a bout Waller has had to give him two injections in the twenty-four hours, but Waller has always been able to decrease the dose, and has never given him more than 6 minims or less than 2. It is now more than six months since the patient has had the slightest return of his trouble, or has received or required an injection.

Waller is aware that the continuous administration of large doses of suprarenal extract is followed in animals. by arterio-sclerotic changes; but the amount of the gland extract injected in the above doses being so infinitesimal this objection cannot, he thinks, be urged against its employment in asthma. Waller has always injected the preparation subcutaneously, never intravenously, and he has never found that any benefit was to be obtained by even quite large doses given by the mouth.-Therapeutic Gazette.

HEALTH IN OUR ARMY:-The report of the SurgeonGeneral of the Army for 1914 is a document of unusual interest. The outline of the report in the letter of transmissal states that the non-effective rate for disease for 1913 (the calendar year covered by the report) is 23.97 a thousand, the lowest rate ever recorded for our army. This rate indicates the average number of men in every thousand incapacitated for duty each day during the year. The death rate for disease was 2.57, the total number of deaths being 397, 40 of which were from tuberculosis, 23 from pneumonia, 17 from nephritis and 15 from organic heart disease. Probably the most interesting portion of the report is that dealing with the control of preventable diseases. The record made in our army in the obliteration of typhoid fever has become a subject of world-wide comment among military and sanitary authorities. Only three cases of typhoid fever occurred in the army during 1913; two were in recently enlisted recruits who were admitted to the hospital with the disease inside of the first six days. of service, while in the third case, only partial immunity through vaccination had been established. All three of these patients recovered. By way of contrast, the report states that in 1912, there were 18 cases with 3 deaths; in 1911, 44 cases with 6 deaths; in 1910, 142 cases and 10 deaths, and in 1909, 173 cases with 16 deaths. Among