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to form areas 1 to 2 cm. in diameter. Therewas marked salivation. By the fourth daythe process had extended to practically all thevisible mucous membrane of the mouth, andthere were minute vesicles or pustules on thetongue. The lips were very red and cracked andshowed several large flat pustules. On Dec. 28than eruption of papules 3 to 5 mm. in diameterappeared on the palms and backs of the handssurrounded by erythema. Later some of thesedeveloped into vesicles or pustules. Vesicles andminute petechiaa also formed on the soles. Afterthe seventh day the eruption subsided and wasfollowed by desquamation. By the tenth day thestomatitis began to diminish. The patient wasdischarged on the thirty-third day with reddishblotches on the hands and some desquamation ofthe palms. The treatment consisted of mouthwashes of potassium chlorate and permanganate,and skin lotions to relieve the itching. The clinicalpicture corresponded to that of foot-and-mouthdisease and to that alone. At the time the diseasewas present in cattle in the neighbourhood ofBaltimore, and infection by means of milk or creamwas possible. ____

COMBINED VACCINATIONS.

A PAPER on Combined Vaccinations by Dr. AldoCastellani, formerly of Colombo, but now professorof tropical medicine in the University of Naples,who has been recently working in the Serbianmilitary hospitals, was read at the Novembermeeting of the Society of Tropical Medicine andHygiene. The following is a short summary of theconclusions of the paper. Professor Castellanithinks he is justified in saying that the preparationof combined vaccines is based on the experimentalwork which he carried out in 1901-02 in ProfessorKruse’s Institute, when he demonstrated that inanimals inoculated with two or three species ofbacteria-provided a sufficient minimum quantitywas given-agglutinins and immune bodies for allthe germs were elaborated, the amount of agglu-tinins and immune bodies elaborated for eachgerm being nearly the same as in control animalsrespectively inoculated with only one species. Hehas prepared and used the following vaccines:-

1. Typhoid plus paratyphoid A and paratyphoid B.2. Typhoid plus paratyphoid A, paratyphoid B, and

cholera.3. Typhoid plus Malta fever.4. Typhoid plus paratyphoid A, paratyphoid B, and Malta

fever.5. Typhoid plus paratyphoid A, paratyphoid B, cholera,

and Malta fever.6. Typhoid plus paratyphoid A, paratyphoid B, B. asiaticus,

and B. columbensis.7. Typhoid plus paratyphoid A, paratyphoid B, B. asiaticus,

B. columbensis, and Malta fever.8. Typhoid plus paratyphoid A, paratyphoid B, dysentery

Kruse-Shiga, dysentery Flexner, dysentery Hys Y, dysenteryFlexner-like No. 1, and dysentery Flexner-like No. 2.

9. Cholera plus plague.10 Cholera plus plague, typhoid, paratyphoid A, and

paratyphoid B.11. Cholera plus plague, typhoid, paratyphoid A, para-

typhoid B, and Malta fever.

The inoculation of the above vaccines in man isharmless; the reaction is not severe, with theexception of those containing plague, but even

simple plague mono-vaccines give generally a

severe reaction. The combined vaccines ProfessorCastellani is now using consist of carbolisedemulsions of agar cultures in normal salt solution

without heating. Those emulsions seem to give aless painful roaction than broth cultures killed byheat. The presence of 0’5 por cont. carbolic acidis sufficient to kill the gorms. The individualsinoculated with those of the above-mentionedvaccines which contain two or three or four speciesof bacteria generally produco agglutinins for eachspecies of bacteria. The amount for each speciesis not much less than that observed in controlindividuals inoculated with simple " one disease"vaccines. Of the vaccines containing more thanfour species, some, as for instance the plague pluscholera, typhoid, paratyphoid A, and paratyphoid Bvaccine, seem to give good results; others are not sosatisfactory, protective substances developing onlyfor two or three or four species and suddenly dis-appearing. The combined vaccines which ProfessorCastellani has found most useful from a practicalpoint of view are the typhoid plus paratyphoid Aand paratyphoid B vaccine, and the tetravaccinetyphoid plus paratyphoid A, paratyphoid B, andcholera. The latter vaccine has been prepared inSerbia on a large scale by himself, with the assist-ance of Dr. Mendelson and Dr. Borvic; it wasofficially adopted by the American Red CrossSanitary Commission and by the Serbian Govern-ment, and more than 170,000 men were inoculatedwith good result. Finally, it may be stated thatthese combined vaccines, when efficient, are ofpractical advantage, saving a great deal of timeand rendering possible a contemporaneous vaccina-tion for several different maladies.

THE LONDON SCHOOL OF MEDICINE FORWOMEN.

I 1874, when Dr. Sophia Jex-Blake founded theLondon School of Medicine, there were only twowomen-Miss Elizabeth Blackwell and Mrs. GarrettAnderson-on the British Medical Register. Theschool has been the principal agent in rectifyingthis, as it has trained more than 600 of thethousand or more registered medical women. Start-ing with 14 students in a small private house inHunter-street, larger premises were built on theoriginal site in 1900, in the expectation of an

average annual entry of 35 students. This numberwas, however, soon exceeded, and during the

years 1908-1914 rose to 60, with the result that thecouncil found itself obliged, in June, 1914, todecide on additions to the chemical, physiological,anatomical, and pathological departments. A pieceof land adjoining the present premises was

accordingly secured, but on the outbreak of warthe project was temporarily abandoned. A criticalsituation then arose, as on the one hand applicationsfor admission continued to increase, and on the otherthe threatened shortage of men students renderedthe education of medical women a matter of doubleimportance to the nation. In December, therefore,of last year an appeal was issued for 30,000 toprovide adequate accommodation for the enlargednumber of students ; of this sum JE20,000 has comein, and the building of the extension has beenbegun. Point has been added to the urgency by therecord entry this winter session of 112 students.Now there remains about ..g1O,000 necessary tocomplete the scheme. We have no doubt thatthis sum will be promptly forthcoming. As Mrs.Willey pointed out two months ago, the prospectiveshortage of medical practitioners in the immediatuture is very disquieting, and it is a grave nationaloncern in which everyone will share to minimise