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SECTION IV.—BACTERIOLOGY AND PATHOLOGICALANATOMY.

President, M. H. PREISZ.Managing Secretary, M. E. KROMPECHER.

Dr. ROSENTHAL (Paris) read a paper onThe Serum Therapy and Vaccination Treatment of Acute

Articulcur Rheumatism.

He divided the investigations made up to the present on thebacteriology of acute rheumatism into four categories. Thefirst contained the early, uncertain, and negative results,many of which were due to conclusions either too hasty orbased on too few experiments, or to errors in technique suchas insufficient dilution of the blood. Without consideringthe finding of pathogenic germs like staphylococcus aureuswhich often occur in symbiosis with the bacteria to be

mentioned, two bacterial theories of acute rheumatism findequal favour with investigators. One concerns the diplo-coccus of rheumatism and the other Achalme’s anaerobicbacillus. The diplococcal theory started in the workof Leyden, 1894, of Triboulet, 1897, and Wassermann,1899. The significance of micrococcus rheumaticus is inter-

preted in two different ways. On the one hand Triboulet ofParis and his followers identify this diplococcus with theenterococcus of Thircelin. On the other hand, Wassermann,Poynton, Paine, Shaw, Conner, Walker, Herry, F. Mayer,Malkov, Predtcdensky, Reyffel, Lewis, and others considerthe diplococcus to be a specific microbe on account of itsvitality, of its power of producing formic acid, of its failureto produce pus experimentally, and the presence of itssensibilisation substance in the blood of rheumatic people, ofits hæmolytic power, and of the experimental production ofthe disease in rabbits by the diplococcus. All these pro-perties, however, are inconstant, and Dr. Rosenthal admitsthe identity of the diplococcus with the enterococcus ofThiercelin, considering it to be a secondary or concomitantinfective organism in rheumatism, subject to a possibility tobe mentioned. The theory of Achalme’s anaerobic bacillusstarted with that investigator’s work in 1891 and hadforce given to it by the positive results of hæmobio-culture, that is to say, culture in living blood devised

by Thiroloix in 1897. More definite confirmation isgiven by the work of Carriere, Pac and Lesieur,Savtchenko, Melkich, and, above all, of Thiroloixand G. Rosenthal. These last two authors estab-lished by a series of experiments that the rheumaticbacillus of Achalme is not the same as the bacillusperfringens, from which it can be differentiated by chemico-cultural tests-namely, the fermentation and inversion ofsaccharose, the nitrification of nitrates, the absence offoetidity from its cultures, as well as by its different methodof sporulation, its power of acting as an aerobe, and itsexperimental causation of the arthro-visceral symptom groupwhich Thiroloix was able to produce by infecting a rabbitwith this bacillus. With a sufficient dilution of the bloodand by the use of the author’s sealed capsules hæmobio-culture gives very numerous positive results. On the other

hand, the anaerobic bacillus is found in cases of rheumatism,both normal or abnormal, in the blood, the secretions, andthe tissues. Achalme and Thiroloix have found it postmortem and it has never been found in any other disease.Both in vivu and in vitro it can undergo transforma-tion to a diplococcus, and this fact probably explainsthe presence of a diplococcus in some instances, at least.This the author calls the theory of the bacterial cycle.The author then described his method by which he preparesWright’s rheumatic vaccine and passed on to the considera-tion of serum therapy. Antidiplococcic serum therapy hasbeen found quite unprofitable in Germany in acuterheumatism, but better results have been obtained withRosenthal’s serum R. which is prepared at the GrenobleInstitute of Serum Therapy and which is obtained fromhorses vaccinated against the anaerobic bacterium by theinjection of cultures of the bacillus at first grown in air andlater anaerobic. This serum causes the articular swellings todiminish and the fever to lessen and prevents visceralmanifestations of the disease. The author, however,considers that it would be bad treatment to refuse patients,treated by his serum, the benefits of salicylate treatment ; andhe finished his paper (which included a valuable bibliographyof the subject) by giving the following summary of treatmentfor a severe case of rheumatism. Give the serum R. with

salicylate of soda and electrargol, and use the vaccine in theintervals of the exacerbations of the disease.SECTION V.—THERAPEUTICS.

(PHARMACOLOGY, PHYSICAL THERAPEUTICS, BALNEOLOGY.)President, M. A. DE BÓKAY.

Managing Secretary, M. Z. DE VÁMOSSY.Dr. C. COLOMBO (Rome) read a paper containing

A Comparative E,3timate of Pharmaceutical and PhysicalAgents in Therapeutics,

in which he reviewed the physiological and therapeutic actionof certain chemical and physical agents on the human bodyin the light of recent medical literature and of his own experi-ences. He considered three possible requirements of a

physician in search of a special remedy. He may want to

produce an effect which could be obtained equally well froma physical or a chemical agent, or an effect which could onlybe obtained from one or other of those agents. In the firstcase Dr. Colombo would always choose the physical agentfor the following reasons. Such an agent constitutes anexternal stimulus of which the nature and effect on the bodyare exactly known. The effect is always the same for thesame stimulus with the intensity of which it is in strict pro-portion. On the other hand, the chemical agent does itswork inside the body in contact with the cellular fluids ; itfollows that, however well we may understand its compositionand its action in vitro, we remain in the dark as to its effectin corpore and of the resulting reaction of the organism. Dr.Colombo quoted examples in illustration of each of thesethree groups of cases.

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SECTION VI.—INTERNAL MEDICINE.

President, Baron A. KORÁNYI.Managing Secretary, M. H. BENEDIKT.

Professor OLIVEJR T. OSBORNE (Yale, New Haven) com-municated a paper on

Disturbances of the Internal Secretions Ulinically Considered.He said that gigantism is a condition due to hypersecretionof the pituitary and acromegaly a condition primarily ofhypersecretion, later hyposecretion, of the pituitary (hypo.physis cerebri). The thyroid may not only hypersecrete andhyposecrete, but the component parts of the secretionof the thyroid gland may vary in amount and inchemical constituency and cause various clinical mani-festations. These symptoms and signs vary in alldegrees and tendency from exophthalmic goitre on theone hand to myxœdema and cretinism on the other. In-sufficiency of parathyroid secretion causes tetany. Adisturbed secretion of the parathyroids may cause paralysisagitans. Hypertension may be due to hypersecretion of thesuprarenals. Continuous low blood pressure and neuras-

thenic conditions may be due to hyposecretion of the supra-renals. Surgical shock after abdominal operations may bedue to the inhibition of suprarenal secretion. Many of thedisturbing symptoms of menstruation are due to ovarian

insufficiency or to increased ovarian activity, and it isdoubtless probable that many nervous symptoms in womenare due to ovarian disturbances. Uterine haemorrhage fromvarious causes may often be stopped by the administration ofmammary gland substance.

Dr. H. SENATOR (Berlin) read a communication on

Polycythæmia.He said that an increase in the number of red blood cells canbe either relative or absolute and can occur under both

physiological and pathological circumstances. Physiologicalpolycythasmia is observed after the loss of much fluid fromthe body, after the ingestion of food rich in albumin, inconvalescence from anasmic disorders, in newly born infants,after residence in a strange climate, and perhaps in hiber-nating animals during the winter months. Pathological poly-cythæmia is found when the blood becomes thickened duringdisease, in various forms of cyanosis, in certain intoxicationsand infections in which haemolysis takes place, and occasion-ally in diseases in which unknown changes in the blood occur,and in many affections of the nervous system. In all thesepathological circumstances, in addition to the relativepolycytheamia due to a thickening of the blood, the diminu-tion of the tension of oxygen in the blood must be considered