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VICTOR HORSLEY LECTURE : THE LATE PROF. JOHN MARSHALL, F.R.S.
1007 into
the femoral arteries, giving them a perfect We have received the following cablegram from preservative without evisceration when circumstancesKharkof, Russia, dated Oct. 26th :required. I sat with him during his last illness, Journal, THE LANCET, London. but he was depressed and disappointed and spoke Our young journal, V?’ec/K?6oe Diélo, sends conlittle. In later years I saw much of the second Tom fromJgratulations to the honourable, old, but always in time to time. He loved good music and had a piano progress young, confrere on his Centenary, and, in his office in the Strand. Moreover, he wouldexpressing deepest esteem, sends thanks from many occasionally come and sit with me in the organ-loft Russian medical generations who got their educaat St. Paul’s Cathedral. In that memorable winter, tion from the pages of THE LANCET. R]TDACTION. 1861-62, the British community at Madeira was an (Signed) interesting microcosm of diverse opinion. The ecclesiastic element was strong and twofold, one faction, INSULIN HYPOGLYCÆMIA. noisy and aggressive, crushed us with an unmitigated mosaic cosmogony ; the other required our passive To the Editor of THE LANCET. acquiescence in whatever decision the Church might SIR,-It is well known that insulin hypoglycaemia promulgate in all matters relating to creation and gives rise to both in experimental animals evolution. Some of us had read the " Vestiges," and and in man. symptoms I think, worth while recording the It is, my copy of the " Origin "-the first in these latitudessymptoms of an attack which I witnessed accidentally was in great request; but it was the rash encounter of a short while ago and which was induced, without " Soapy Sam " with Prof. Huxley which really doubt, by insulin hypoglyceemia, because it is of the stimulated public interest in Charles Darwin, and led that we should become familiar utmost importance men to reflect that the cradle of every new science the very varied manifestations of this condition. with had always been encumbered with the corpses of The symptoms exhibited by the patient, who is not extinct theologians. The focus of our party was the under my care, were, I think, unusual. When first gifted Savilian Professor of Astronomy of those days, seen he was lying down out of doors on the grass, and we kept our views and studies to ourselves. Tom and as the day was fine and he had been taking said nothing. active exercise this did not seem peculiar. As time went on I became personally acquainted moderately attention was, however, attracted by the fact that My with the protagonists of progressive knowledge, and he began shortly to throw his legs about in the air. On it fell to me eventually to touch copiously on these to him I found that he was sweating profusely, matters when addressing the Geological Society on going up behalf of the Royal College of Physicans of London, and was suffering from muscular spasms involving the and limbs. These were sufficiently and I thoroughly enjoyed the sparkling interest of face, trunk, Lord Kelvin in records which for many years he had violent to bend him double and to produce very marked contortion of the facial muscles. was attempted to amalgamate with unbending Presby- able to walk with assistance, but did so inHe a very terianism. Wilberforce never held up his head again, wildly ataxic manner-the ataxia being apparently nor did Owen after the hippocampus minor fiasco-, but the bishop’s ever-ready wit charmed us all and quite independent of the muscular spasms, which He was went far to condone his subtle superficiality and continually interrupted his progress. a little clear-headed, perfectly though naturally questionable sincerity. anxious. His was about 100 ; respiration pulse-rate I could write volumes on the men and matter of did not appear affected except by the spasms. There those days, but I forbear. He had with was no real hyperpnoea or dyspnoea. Yours faithfully, and had taken one him four tablets of 5-gr. glucose, MICHAEL GRABHAM. Madeira, Oct. 23rd, 1923. of these before I saw him, the remainder were taken at once and were apparently quite without effect.
CENTENARY OF THE LANCET.
To the Editor of THE LANCET. SIR,-THE LANCET celebrates its hundredth anniversary amidst a shower of congratulations and good will from the great medical community, in which I join from the other side of the Atlantic. It has been a century of untiring effort in the interests of science. The reputation for impartiality justly conceded to consecutive editors encouraged beginners and unknown surgeons to bring the results of their labours into the a farseeing discrimination, during century, THE LANCET has saved valuable material from the scrap heap, and through its columns British
daylight. Thus, by a
surgery has reaped the reward. THE LANCET has not only rescued much and many from unmerited obscurity, but it has broadcasted the work of great contributors for the benefit of all. I am, Sir, yours faithfully,!, W. I. DE C. WHEELER,
In about 15 minutes from the beginning of the active symptoms we had arrived within reach of a sugar basin, and I gave him six lumps, one after the other. Within 10 minutes of taking them the attack ended, the patient expressed himself as feeling quite well and complained of being hungry. The cessation of the attack after the six lumps of sugar had been absorbed was most striking. So, too, the rapidity with which they appeared to act. The patient was taking large doses of insulin (60 units a day), 30 night and morning, and had once before experienced a similar attack but accompanied by loss of consciousness, which fortunately was prevented on this occasion. I think this occurrence raises the question of the advisability of patients taking fairly active exercise after large doses of insulin, and most certainly illustrates the necessity for such patients to carry an adequate supply of carbohydrate with them in case
Iof emergency.-I am, Sir, yours faithfully,
President, Royal College of Surgeons in Ireland. .
Chicago, Oct. 20th, 1923.
I
C. M. HINDS HOWELL. Harley-street, W., Oct. 28th, 1923.
VICTOR HORSLEY LECTURE : THE LATE To the Editor of THE LANCET. PROF. JOHN MARSHALL, F.R.S. SIR,-On behalf of my associates and myself I desire to have you extend to your editorial colleagues!s To the Editor of THE LANCET. of THE LANCET our sincere good wishes and felicishould like to think that there are many old SIR,-I tations upon the completion of what we trust is only men, besides myself, who have University College the first century of a noteworthy career of your been the cruel comments on Prof. Marshall by pained honoured journal, a career certainly unmatched in the made by Sir Edward Sharpey Schafer in his Victor annals of medical journalism. Memorial Lecture.l In order duly to Horsley Fraternally and cordially yours, was it necessary so wantonly to Lister, appraise GEO. W. KOSMAK, M.D., disparage Marshall ? I attended the first three Editor of the American Journal of Obstetrics and Gynecology. 1 THE LANCET, Oct. 27th, 1923. New York, Oct. 19th, 1923.
I
1008 of Marshall’s systematic lectures on surgery, it is not yet certain that such is the case. Prof. and so informative and thought-awakening did I find Rovsing does not favour vaccines in acute osteothem that I attended several lectures in two or three myelitis. On the other hand, the work of the Pasteur later courses. On the scientific side they were far Institute and Prof. Gregoire, as recorded in your issue ahead of any English surgical text-books at that time of Dec. 6th, 1919, showed that vaccines of the right and for many years after. A more capable judge than type have a definite and valuable role in aborting I of the worth of Marshall’s lectures was James Stanton early cases. The technique has been well worked out be adhered to. To quote Prof. Cluff, intellectually one of the most gifted men that and should strictly ever entered the medical profession. He attended Gregoire’s words, " The picture is so different in these Marshall’s lectures at the same time as myself. He cases that they present quite peculiar features and took full notes in a cursive hand. These he after- are so mild as to make us doubt as to whether we are wards carefully wrote out in elegant manuscript. not dealing with a new disease." After Cluff’s premature and tragic death the notes Nevertheless, we must retain our balance and in became a prized possession of Marcus Beck’s, and after acute case3 be prepared to revert to surgery if abortive Beck’s death they were presented to the Library of efforts fail. Some cases fail to respond to the best the Royal College of Surgeons by Beck’s intimate vaccine in the world.-I am. Sir, yours faithfully, friend and colleague, Dr. Vivian Poore. A. GEOFFREY SHERA. In my opinion Marshall was a cultured, critical Eastbourne, Oct. 25th, 1923. and scientific surgeon, ever ready to try new paths and explore avenues of fresh knowledge. He had been Fullerian Professor of Physiology at the Royal THE ALBUMINURIA OF PREGNANCY. Institution and subsequently was appointed Professor To the Editor of THE LANCET. of Anatomy at the Royal Academy. He served with Council distinction a office in’the term of SiR,—The extremely interesting article published special long of the Royal College of Surgeons and exactly 40 years by Dr. J. W. Russell in your issue of Oct. 27th, and ago was elected its President. Still later he was z, other recent observations on the mechanical factors awarded the highest honour in the franchise of the in orthostatic or postural albuminuria, tempt one to profession-namely, the presidency of the General outline certain investigations which are being conMedical Council, an honour necessarily reserved to ducted along somewhat similar lines in connexion a very few men of exceptional ability and character. with the albuminuria of pregnancy. Although these How are we to account for this puzzling disparity latter are very far from complete, owing to a shortage of opinion respecting a contemporary by intelligent of suitable cases and other unforeseen difficulties, Sir Edward Schafer incidentally it may be of value to compare notes with other contemporaries ? throws a little light upon the question. He says that observers even at this early stage. Thus one is when he attended Marshall’s lectures " most of his already indebted to Dr. Russell for the particular audience were soon fast asleep. I was one of the method which he suggests in his paper ; it is less sleepers." One word more. Sir Edward Schafer direct than that which we have hitherto employed, observed,there is an admirable bust of him.(Marshall) but presents obvious advantages in cases where for at Lincoln’s Inn Fields." It is an admirable bust, but one reason or another ureteric catheterisation is it is a replica of that presented by myself to University contra-indicated. In reviewing the multitudinous data which have College on behalf of the subscribers of the Marshall Memorial Fund, of which Victor Horsley was prime been collected with relation to the so-called toxaemias mover and honorary secretary. of pregnancy, one had been impressed with the I am. Sir. vours faithfully. apparent fact that albuminuria, although in a small JOHN TWEEDY. Oct. 27th, 1923. minority of instances it may terminate in eclampsia, is usually unaccompanied by any other definite deviation whatever from the normal, with the possible VACCINES IN CHRONIC OSTEOMYELITIS. exception of oedema. This applies alike to clinical To the Editor of THE LANCET. and biochemical observations. It therefore seemed SIR,-The annotation on this subject in your issue probable, in spite of the general rejection of the - of Oct. 13th as exemplified by Prof. T. Rovsing, of mechanical hypotheses which have been advanced Copenhagen, corroborates the record set forth below of by Paramore and others, that some simple explanation a truly remarkable case. In recording it I would might account for the occurrence of uncomplicated like to emphasise the vital necessity of adequate albuminuria in pregnancy. In cases of orthostatic albuminuria apparently vaccine treatment in very chronic cases of osteodue to lordosis, Sonne assumed that the two kidneys myelitis. My patient, whom I saw at the request of Dr. Shepheard would not be equally involved, as the left renal Walwyn, of Carlisle, had had, one might fairly say, the best vein would be more liable to compression by an medical and surgical advice obtainable. Notwithstanding, anterior curvature of the spine, and indeed he was his infection recurred over a period of 38 years, beginning in able to demonstrate by ureteric catheterisation left1884, the last abscess being opened in 1921. Originally an sided unilateral albuminuria. Rieser postulated a of the to asserted be osteomyelitis right femur, definitely non-tuberculous by so great an authority as Sir James Paget compression of the left renal vein between the aorta {and subsequently so confirmed), this was followed in 1887 and superior mesenteric artery in conditions of by swelling of the right humerus, which recurred in 1889. visceroptosis associated with lordosis. On these ’This swelling recurred in 1903 and in 1905 it was opened and other grounds it appeared not unlikely that a by Sir Anthony Bowlby. Mr. Bailey had cause to reopen mechanical factor might determine the occurrence :and scrape the humerus in 1907, 1908, and 1909. In 1913 of albuminuria in certain cases of pregnancy and Mr. Paul opened an abscess in the thigh. Cultures showed be demonstrated; might similarly consequently, and A vaccine was used, but staphylococci. streptococci insufficiently in my opinion. In 1919-20 an abscess formed with the cooperation of Mr. V. E. Lloyd, who has in each instance undertaken the actual catheterisation near the knee and was incised, also another in the groin. This last was in connexion with the pelvic bone. In 1921 another (by no means easy in advanced, pregnancy), a small abscess formed near the insertion of the psoas muscle. A few number of cases has been investigated along these ,doses of vaccine were given and the arm swelled up, but lines. Our first observation, made in May last, fortunately subsided. The patient was tested by cutaneous showed a definitely positive result; urine from the injection for tubercle by Sir Thomas Horder, with negative left kidney was loaded with albumin, that from the ,results. I examined some pus from a superficial abscess of Further results the inguinal glands in September, 1921, and found Staphy-i right contained the merest trace. lococcus aureus, S. albus, and Streptococcus pyogenes. I made have not been so satisfactory, although in several there ’has been very considerably more a vaccine, and the dose, at my suggestion, was slowly workedi instances up until by January, 1923, at least 12 doses of 1000 millioni albumin on the left than on the right, and in no case organisms had been given. has the position been reversed. We cannot therefore There has been so far no recurrence. The record draw definite conclusions until our series is enlarged and other factors have been taken into account. :gives rise to hope that success has been attained,
courses
.
I
I
butB
‘
the femoral arteries, giving them a perfect We have received the following cablegram from preservative without evisceration when circumstancesKharkof, Russia, dated Oct. 26th :required. I sat with him during his last illness, Journal, THE LANCET, London. but he was depressed and disappointed and spoke Our young journal, V?’ec/K?6oe Diélo, sends conlittle. In later years I saw much of the second Tom fromJgratulations to the honourable, old, but always in time to time. He loved good music and had a piano progress young, confrere on his Centenary, and, in his office in the Strand. Moreover, he wouldexpressing deepest esteem, sends thanks from many occasionally come and sit with me in the organ-loft Russian medical generations who got their educaat St. Paul’s Cathedral. In that memorable winter, tion from the pages of THE LANCET. R]TDACTION. 1861-62, the British community at Madeira was an (Signed) interesting microcosm of diverse opinion. The ecclesiastic element was strong and twofold, one faction, INSULIN HYPOGLYCÆMIA. noisy and aggressive, crushed us with an unmitigated mosaic cosmogony ; the other required our passive To the Editor of THE LANCET. acquiescence in whatever decision the Church might SIR,-It is well known that insulin hypoglycaemia promulgate in all matters relating to creation and gives rise to both in experimental animals evolution. Some of us had read the " Vestiges," and and in man. symptoms I think, worth while recording the It is, my copy of the " Origin "-the first in these latitudessymptoms of an attack which I witnessed accidentally was in great request; but it was the rash encounter of a short while ago and which was induced, without " Soapy Sam " with Prof. Huxley which really doubt, by insulin hypoglyceemia, because it is of the stimulated public interest in Charles Darwin, and led that we should become familiar utmost importance men to reflect that the cradle of every new science the very varied manifestations of this condition. with had always been encumbered with the corpses of The symptoms exhibited by the patient, who is not extinct theologians. The focus of our party was the under my care, were, I think, unusual. When first gifted Savilian Professor of Astronomy of those days, seen he was lying down out of doors on the grass, and we kept our views and studies to ourselves. Tom and as the day was fine and he had been taking said nothing. active exercise this did not seem peculiar. As time went on I became personally acquainted moderately attention was, however, attracted by the fact that My with the protagonists of progressive knowledge, and he began shortly to throw his legs about in the air. On it fell to me eventually to touch copiously on these to him I found that he was sweating profusely, matters when addressing the Geological Society on going up behalf of the Royal College of Physicans of London, and was suffering from muscular spasms involving the and limbs. These were sufficiently and I thoroughly enjoyed the sparkling interest of face, trunk, Lord Kelvin in records which for many years he had violent to bend him double and to produce very marked contortion of the facial muscles. was attempted to amalgamate with unbending Presby- able to walk with assistance, but did so inHe a very terianism. Wilberforce never held up his head again, wildly ataxic manner-the ataxia being apparently nor did Owen after the hippocampus minor fiasco-, but the bishop’s ever-ready wit charmed us all and quite independent of the muscular spasms, which He was went far to condone his subtle superficiality and continually interrupted his progress. a little clear-headed, perfectly though naturally questionable sincerity. anxious. His was about 100 ; respiration pulse-rate I could write volumes on the men and matter of did not appear affected except by the spasms. There those days, but I forbear. He had with was no real hyperpnoea or dyspnoea. Yours faithfully, and had taken one him four tablets of 5-gr. glucose, MICHAEL GRABHAM. Madeira, Oct. 23rd, 1923. of these before I saw him, the remainder were taken at once and were apparently quite without effect.
CENTENARY OF THE LANCET.
To the Editor of THE LANCET. SIR,-THE LANCET celebrates its hundredth anniversary amidst a shower of congratulations and good will from the great medical community, in which I join from the other side of the Atlantic. It has been a century of untiring effort in the interests of science. The reputation for impartiality justly conceded to consecutive editors encouraged beginners and unknown surgeons to bring the results of their labours into the a farseeing discrimination, during century, THE LANCET has saved valuable material from the scrap heap, and through its columns British
daylight. Thus, by a
surgery has reaped the reward. THE LANCET has not only rescued much and many from unmerited obscurity, but it has broadcasted the work of great contributors for the benefit of all. I am, Sir, yours faithfully,!, W. I. DE C. WHEELER,
In about 15 minutes from the beginning of the active symptoms we had arrived within reach of a sugar basin, and I gave him six lumps, one after the other. Within 10 minutes of taking them the attack ended, the patient expressed himself as feeling quite well and complained of being hungry. The cessation of the attack after the six lumps of sugar had been absorbed was most striking. So, too, the rapidity with which they appeared to act. The patient was taking large doses of insulin (60 units a day), 30 night and morning, and had once before experienced a similar attack but accompanied by loss of consciousness, which fortunately was prevented on this occasion. I think this occurrence raises the question of the advisability of patients taking fairly active exercise after large doses of insulin, and most certainly illustrates the necessity for such patients to carry an adequate supply of carbohydrate with them in case
Iof emergency.-I am, Sir, yours faithfully,
President, Royal College of Surgeons in Ireland. .
Chicago, Oct. 20th, 1923.
I
C. M. HINDS HOWELL. Harley-street, W., Oct. 28th, 1923.
VICTOR HORSLEY LECTURE : THE LATE To the Editor of THE LANCET. PROF. JOHN MARSHALL, F.R.S. SIR,-On behalf of my associates and myself I desire to have you extend to your editorial colleagues!s To the Editor of THE LANCET. of THE LANCET our sincere good wishes and felicishould like to think that there are many old SIR,-I tations upon the completion of what we trust is only men, besides myself, who have University College the first century of a noteworthy career of your been the cruel comments on Prof. Marshall by pained honoured journal, a career certainly unmatched in the made by Sir Edward Sharpey Schafer in his Victor annals of medical journalism. Memorial Lecture.l In order duly to Horsley Fraternally and cordially yours, was it necessary so wantonly to Lister, appraise GEO. W. KOSMAK, M.D., disparage Marshall ? I attended the first three Editor of the American Journal of Obstetrics and Gynecology. 1 THE LANCET, Oct. 27th, 1923. New York, Oct. 19th, 1923.
I
1008 of Marshall’s systematic lectures on surgery, it is not yet certain that such is the case. Prof. and so informative and thought-awakening did I find Rovsing does not favour vaccines in acute osteothem that I attended several lectures in two or three myelitis. On the other hand, the work of the Pasteur later courses. On the scientific side they were far Institute and Prof. Gregoire, as recorded in your issue ahead of any English surgical text-books at that time of Dec. 6th, 1919, showed that vaccines of the right and for many years after. A more capable judge than type have a definite and valuable role in aborting I of the worth of Marshall’s lectures was James Stanton early cases. The technique has been well worked out be adhered to. To quote Prof. Cluff, intellectually one of the most gifted men that and should strictly ever entered the medical profession. He attended Gregoire’s words, " The picture is so different in these Marshall’s lectures at the same time as myself. He cases that they present quite peculiar features and took full notes in a cursive hand. These he after- are so mild as to make us doubt as to whether we are wards carefully wrote out in elegant manuscript. not dealing with a new disease." After Cluff’s premature and tragic death the notes Nevertheless, we must retain our balance and in became a prized possession of Marcus Beck’s, and after acute case3 be prepared to revert to surgery if abortive Beck’s death they were presented to the Library of efforts fail. Some cases fail to respond to the best the Royal College of Surgeons by Beck’s intimate vaccine in the world.-I am. Sir, yours faithfully, friend and colleague, Dr. Vivian Poore. A. GEOFFREY SHERA. In my opinion Marshall was a cultured, critical Eastbourne, Oct. 25th, 1923. and scientific surgeon, ever ready to try new paths and explore avenues of fresh knowledge. He had been Fullerian Professor of Physiology at the Royal THE ALBUMINURIA OF PREGNANCY. Institution and subsequently was appointed Professor To the Editor of THE LANCET. of Anatomy at the Royal Academy. He served with Council distinction a office in’the term of SiR,—The extremely interesting article published special long of the Royal College of Surgeons and exactly 40 years by Dr. J. W. Russell in your issue of Oct. 27th, and ago was elected its President. Still later he was z, other recent observations on the mechanical factors awarded the highest honour in the franchise of the in orthostatic or postural albuminuria, tempt one to profession-namely, the presidency of the General outline certain investigations which are being conMedical Council, an honour necessarily reserved to ducted along somewhat similar lines in connexion a very few men of exceptional ability and character. with the albuminuria of pregnancy. Although these How are we to account for this puzzling disparity latter are very far from complete, owing to a shortage of opinion respecting a contemporary by intelligent of suitable cases and other unforeseen difficulties, Sir Edward Schafer incidentally it may be of value to compare notes with other contemporaries ? throws a little light upon the question. He says that observers even at this early stage. Thus one is when he attended Marshall’s lectures " most of his already indebted to Dr. Russell for the particular audience were soon fast asleep. I was one of the method which he suggests in his paper ; it is less sleepers." One word more. Sir Edward Schafer direct than that which we have hitherto employed, observed,there is an admirable bust of him.(Marshall) but presents obvious advantages in cases where for at Lincoln’s Inn Fields." It is an admirable bust, but one reason or another ureteric catheterisation is it is a replica of that presented by myself to University contra-indicated. In reviewing the multitudinous data which have College on behalf of the subscribers of the Marshall Memorial Fund, of which Victor Horsley was prime been collected with relation to the so-called toxaemias mover and honorary secretary. of pregnancy, one had been impressed with the I am. Sir. vours faithfully. apparent fact that albuminuria, although in a small JOHN TWEEDY. Oct. 27th, 1923. minority of instances it may terminate in eclampsia, is usually unaccompanied by any other definite deviation whatever from the normal, with the possible VACCINES IN CHRONIC OSTEOMYELITIS. exception of oedema. This applies alike to clinical To the Editor of THE LANCET. and biochemical observations. It therefore seemed SIR,-The annotation on this subject in your issue probable, in spite of the general rejection of the - of Oct. 13th as exemplified by Prof. T. Rovsing, of mechanical hypotheses which have been advanced Copenhagen, corroborates the record set forth below of by Paramore and others, that some simple explanation a truly remarkable case. In recording it I would might account for the occurrence of uncomplicated like to emphasise the vital necessity of adequate albuminuria in pregnancy. In cases of orthostatic albuminuria apparently vaccine treatment in very chronic cases of osteodue to lordosis, Sonne assumed that the two kidneys myelitis. My patient, whom I saw at the request of Dr. Shepheard would not be equally involved, as the left renal Walwyn, of Carlisle, had had, one might fairly say, the best vein would be more liable to compression by an medical and surgical advice obtainable. Notwithstanding, anterior curvature of the spine, and indeed he was his infection recurred over a period of 38 years, beginning in able to demonstrate by ureteric catheterisation left1884, the last abscess being opened in 1921. Originally an sided unilateral albuminuria. Rieser postulated a of the to asserted be osteomyelitis right femur, definitely non-tuberculous by so great an authority as Sir James Paget compression of the left renal vein between the aorta {and subsequently so confirmed), this was followed in 1887 and superior mesenteric artery in conditions of by swelling of the right humerus, which recurred in 1889. visceroptosis associated with lordosis. On these ’This swelling recurred in 1903 and in 1905 it was opened and other grounds it appeared not unlikely that a by Sir Anthony Bowlby. Mr. Bailey had cause to reopen mechanical factor might determine the occurrence :and scrape the humerus in 1907, 1908, and 1909. In 1913 of albuminuria in certain cases of pregnancy and Mr. Paul opened an abscess in the thigh. Cultures showed be demonstrated; might similarly consequently, and A vaccine was used, but staphylococci. streptococci insufficiently in my opinion. In 1919-20 an abscess formed with the cooperation of Mr. V. E. Lloyd, who has in each instance undertaken the actual catheterisation near the knee and was incised, also another in the groin. This last was in connexion with the pelvic bone. In 1921 another (by no means easy in advanced, pregnancy), a small abscess formed near the insertion of the psoas muscle. A few number of cases has been investigated along these ,doses of vaccine were given and the arm swelled up, but lines. Our first observation, made in May last, fortunately subsided. The patient was tested by cutaneous showed a definitely positive result; urine from the injection for tubercle by Sir Thomas Horder, with negative left kidney was loaded with albumin, that from the ,results. I examined some pus from a superficial abscess of Further results the inguinal glands in September, 1921, and found Staphy-i right contained the merest trace. lococcus aureus, S. albus, and Streptococcus pyogenes. I made have not been so satisfactory, although in several there ’has been very considerably more a vaccine, and the dose, at my suggestion, was slowly workedi instances up until by January, 1923, at least 12 doses of 1000 millioni albumin on the left than on the right, and in no case organisms had been given. has the position been reversed. We cannot therefore There has been so far no recurrence. The record draw definite conclusions until our series is enlarged and other factors have been taken into account. :gives rise to hope that success has been attained,
courses
.
I
I
butB
‘