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drugs, Dr. SANDWITH suggested calomel in smalldoses on the first day, to be followed bydoses of bismuth, not more than 15 grains,and he still has confidence in large enemata ofnitrate of silver or sulphate of copper. He alsoconsidered cyllin by the mouth to be a useful

disinfectant. The treatment by serum therapy hasbeen carefully investigated during recent years-SHIGA produced antidysenteric serum in the horseby inoculating cultures of the dysentery bacillus.This serum was used successfully in the treatmentof the endemic dysentery in Japan. Dr. SANDWITH

quoted the experiences of Dr. J. G. WILLMORE

and Dr. A. H. SAVAGE who obtained encouragingresults by the employment of serums, but

further trials will be required before definite

opinions can be formed. Most observers have

laid stress on the value of large doses of

ipecacuanha in the treatment of tropical dysentery,and Dr. ANDREW DAVIDSON considers that it has

proved so successful that it should not on lightgrounds be set aside in favour of any other. Dr.

SANDWITH concluded by saying that in any case ofdysentery of doubtful origin the combined treatmentof the patient by emetine and by polyvalent anti-dysenteric serum is both rational and humane.

Dr. SANDWITH’S lectures have given an interest-ing resume of existing knowledge on dysenterycombined with useful information derived from

personal experience. A large field still lies openfor investigation both on clinical and pathological(including, of course, bacteriological) lines. Recent

experiences tend to show that considerable advancehas been made, especially as regards treatment,and it is sincerely to be hoped that during thepresent campaign the losses caused by the diseasemay prove far less than in previous wars.

Annotations.

FORTITUDE.

"Ne quid nimis."

IT is useless to attempt to minimise theseriousness of the disaster that befell the BritishFleet in the North Sea on Tuesday morning last.rhe destruction of three cruisers which, thoughvaluable in a fighting line, were not of the newestpattern does not affect our position of pre-ponderating strength at sea one whit, but the lossof a large proportion of their splendid crews,both officers and men, is a veritable tragedy.But even here we must not lose our sense

of proportion while mourning the solemn andsplendid fate of those who have died tomaintain the honour of their country. The nationalself-control during the past two months of poignantanxiety has been remarkable, and as far as can bejudged the frank admission by the Admiralty of anaval reverse has not shaken the popular nerve.This cannot be because the menace of the occur-rence is not realised. It must be because the

country as a whole has braced itself to bearill-fortune with a stiff lip and good-fortunewith self-restraint throughout a struggle which

must be very prolonged and will leave behindit deep scars. To our psychologists the almostuniversal attitude must have been somewhatof a surprise. Not a few of them have beenprepared to find our populations, rich and pooralike, more softened by prosperity than the eventhas proved. There may, alas I be many oppor-tunities before the war is over for further displayof fortitude, but we are glad to think that thetestimony of the medical profession goes to provethat the fortitude will be generally forthcoming.

RECENT BIOLOGICAL INVESTIGATIONS ON THEDIAGNOSIS OF MALIGNANT GROWTHS.

SOME important researches by Dr. G. Mioni incases of carcinoma and sarcoma have recently beenpublished in the May-June number of Tumori.1 Thehæmolytic reaction, carried out by Crile’s methodswas positive in 62 per cent. of individuals sufferingfrom neoplasms; negative in 32 per cent. While,however, the former consisted for the most part ofoperable visceral tumours, many in an early stage,the latter were either cutaneous cancers or those inan advanced condition where the diagnosis wasclinically evident. These results were, therefore,all the more appreciable in that they furnished anelement of diagnosis in cases clinically doubtful. Con-sidering the fact that the reaction was often positivein suppurative conditions, in acute febrile diseases,and cases of surgical tuberculosis which were alsoinvestigated in the same manner, it must beadmitted that this detracts in some degree fromthe practical value which might be attributed tothe reaction. Elsberg’s reaction gave 11’2 per cent.of positive results, as many in the cases investigatedas in controls. This cannot be looked uponas satisfactory from a practical point of view.Estimation of the antitryptic index gave highvalues in 91’4 per cent. of the cases. This fact isimportant since the presence of a high index in apatient in whom the question of an acute infectiveor suppurative focus could be eliminated wouldlend support to the diagnosis of malignant disease,especially where the symptoms pointed to such apossibility. This reaction is simple, and extremelyeasy and practicable. Methods of biological in-

vestigation based on immunity reactions furnisheduncertain results. The specificity of the antigen isfar from being demonstrated, as our knowledge ofthe etiology of malignant growths is uncertain. Itcannot be denied that in the serum of patientssuffering from neoplasms there are substances

capable of provoking specific reactions (deviation ofcomplement) when in contact with extracts oftumours, substances that are not to be found in theserum of healthy persons or those suffering from otherdiseases; but at the same time it must be recognisedthat nearly similar reactions take place also withnon-specific antigens, and this largely detracts fromtheir significance. The method of passive anaphy-laxis gave the author absolutely negative resultswhen the second injection was endoperitoneal;positive in 33’3 per cent. of the cases when thesecond injection was subdural; but also the controlsshowed phenomena of irritation and lowering oftemperature in an almost equal percentage. Itseems doubtful, therefore, whether the anaphylacticpicture can be attributed to a true reaction betweenantigen and antibody, but it is more probably dueto a mechanical or toxic action caused by the solu-

, tion of antigen coming in contact with the nervous

1 Archivio bimestrale fondato da G. Fichera. Anno III. Fasc.

vi., May-June, 1914. Via Antonio Musa, Rome.