Deaths from typhoid fever, 2,031, or 24.27 per 100,000 of average population.

In Brooklyn for the same period there were reported:

Deaths from malarial fever, 1413, or 32.62 per 100,000 of average population.

Deaths from typhoid fever, 1,002, or 23.13 per 100,000 of average population.

In the city of Baltimore during the same period of time there were reported:

Deaths from malarial fever, 934, or 41.51 per 100,000 of average population.

Deaths from typhoid fever, 904, or 40.17 per 100,000 of average population.

Now, gentlemen, during the seven years the Johns Hopkins Hospital was opened, two of the years being included among those in which these census statistics were complied, there occurred in the hospital: Deaths from malarial fever, 3; deaths from typhoid fever, 48; a proportion of one death from malarial fever to sixteen from typhoid.

It is wholly safe to say that at least nine-tenths of these reported statistics are incorrect, the vast majority of the so-called malarial fever being doubtless typhoid. And we forget that as short a time as seven years ago we regarded such statistics with complacency.

But if the Baltimore statistics are surprising, in Brooklyn and New York, where it is extremely doubtful whether a single case of pernicious malarial fever occurs, apart, perhaps, from a few coming from the tropics, the statistics are simply appalling; and let me repeat, there is no excuse for such statistics today, for the discovery of the parasite has not only given us in itself a sure method of diagnosis, but it has taught us to realize with what complete confidence we may rely upon the therapeutic test with quinin in the differential diagnosis of malarial fever,

The discovery of the malarial parasite has been of invaluable assistance in the differential diagnosis of a number of other manifestations of malaria which might otherwise be overlooked. This is especially true in certain pernicious paroxysms, particularly the comatose form which is frequently confounded with sunstroke. In algid and choleriform paroxysms, which may occur

indeed without a chill and with sub-normal temperature, the examination of the blood may often save life by giving us an immediate diagnosis. The examination of the blood is also of considerable assistance at times in helping us to make a ready diagnosis between tuberculosis and certain septic conditions associated with intermittent fever. Had we in private practice a carefully-kept two-hourly chart to show us the exact hour of onset and the exact duration of paroxysms in all these instances, our diagnosis might be relatively simple, but we know too well that this is not the case, and confusion between early tuberculosis and malaria in the neighborhood, for instance, of Baltimore is excessively common.

A ready means of differential diagnosis between malarial fever and various post partum and post-operative infections is afforded us by the presence of the parasite in the blood.

Careful obser

vation tends to show that the majority of post-partum and postoperative chills are not malarial in nature, and the early recognition of this fact, as permitted by blood examination, should put us on the lookout for some other septic complication.

Now, gentlemen, can we say with assurance that the malarial parasite is always to be demonstrated in the circulating blood in every malarial infection? May we postively deny the existence of a malarial infection from the absence of the parasite in specimens of the circulating blood? Literally speaking, we cannot, for there are instances of malarial infection in which careful search of the blood fails to show the parasite. Practically, however, we can, for such cases are rare and unimportant. In any case of tertian or quartan fever of sufficient severity to produce symptoms, reasonably careful examination of the blood will always show the malarial parasite. Occasionally, in estivo-autumnal fever, in which, as has been before noted, the parasites tend often to gather especially in the internal organs, particularly at a period during or just before paroxysm, the number of parasites in the peripheral circulation may be extremely small, and rarely, though occasionally, a single careful examination may prove negative. Almost invariably, however, a subsequent examination will reveal the parasite.

There are no cases of pernicious malaria in which the parasites are not present in the blood in sufficient quantities to immediately call our attention to the nature of the case.

What have we learned with regard to the treatment of the disease? Much. We have learned, in the first place, that quinin is a true specific. We have definite proof that those occasional cases in which quinin has appeared to be inefficacious are clearly not cases of malaria, or at least are cases in which there is a complicating disease.

We have been confirmed in our ideas as to the time when quinin should be given to be most efficacious, by the explana tion of the cause of its action. It has been shown that the organisms are most readily affected at the time when they are free in the circulation, and that period only occurs at the time of sporulation, namely, just before and during the paroxysm.

In ordinary intermittent fevers a sufficient dose of quinin, given just at the time of the paroxysm, will almost entirely destroy the group of parasites then segmenting, and will prevent, for some time, at least, further manifestations on the part of that group of parasites. Continued treatment, however, is usually necessary to entirely destroy the infection. We have then a practical foundation for the fact already made out that the time at which the best result is to be obtained from the ad. ministration of large doses of quinin is just at the period of the paroxysm, or at the time when the paroxysm would have occured, had previous treatment been omitted.

But I have already passed beyond my proper limit of time. Let me remind you, however, in conclusion, that Lavern's discovery of the parasite, which has done so much to bring order out of the chaos of our continued fevers, was not made by chance; it was the result of carefully planned investigation. Such results as this do more to prove the value of careful, scientific clinical and laboratory observation than books of argument.

We now know the pathogenic agent of malarial fever; we possess a simple and certain method of diagnosis; we have in quinin a true specific remedy for the disease. But we have yet a higher goal to reach. We must discover a means of prevention, and the first step toward this is to discover the method of infection.

It may well be that we are not far from this discovery. It is

one of the most hopeful fields for research which is now open to us, and it is a field in which our climate offers us unusual opportunities for study.

Let us hope that we in America may play as honorable a rôle in the clearing up of the obscure questions connected with malaria as did our illustrious predecessors, the little group of students of Louis, in the differentiation of typhus and typhoid fever, -Cleveland Journal of Medicine.

INFECTIOUS DISEASES AFTER REMOVAL OF THE SPLEEN.-Blum. reich and Jacoby (Berliner klinische Wochenschrif, 1897, No. 21). The enlargement of the spleen in infetrious diseases gave the author the idea of removing this organ, and then infecting guineapigs with various bacteria or their toxins. The authors experimented with biptheria, anthrax, pyocyaneus, and cholera. In the case of anthrax the results were doubtful. With all the others however, it was seen that if injected with the toxin, both the animals with and without their spleens reacted in the same way. However, when the bacteria themselves were used the splenectomized animals lived longer or died less often than the normal ones. The same result was obtained if the splenic vessels were tied. The defibrinated blood of animals before and after splenectomy was mixed with virulent cultures of bacillus pyocyaneus; in the latter case it could be shown to have more marked bactericidal, but no more antitoxic, properties than in the former. The leucocytes were counted in sixteen animals before and several times after the removal of the spleen; fourteen times a marked leucocytosis was found. The increase in white bloodcells does not come from the irritation of the wound. The authors think they are justified in saying "following the excision of the spleen there occurs an hyperleucocis. In connection with this there is an increase in the bactericidal power of the blood and in the protection of the organism against infectious disease."Med. Sciences.

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Editorial.

RELIEF FOR THE DYING.

The function of the physician is preminently to save life; or if it cannot be saved, to postpone the hour of death as long as possible in the belief that "while there's life, there's hope." But it is also the physician's duty to prevent suffering, and there is every reason for him to remember this while he is standing beside the death-bed of a patient. While there are some instances in acute diseases when a change for the better occurs and the patient finally recovers when there had seemed no earthly hope, there are many cases where the physician knows that death is inevitable- that though a rally is possible, it means only a prolongation of suffering. In many of these cases the patient is too weak to make known his suffering, which may only be revealed by the facial expression and the restlessness. There is no reason why these poor creatures should not have relief, and the doctor should not stand by idly, thinking that they are not conscious