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engaged since his first publications on the subject appeared ofin 1890. In the introductory part of his paper Professor ev

Koch makes some general remarks on immunisation, un

saying that-unlike cholera, typhoid fever, &c., which risconfer immunity against subsequent attacks-an infec- tion by the tubercle virus predisposes to new attacks thof tuberculosis. But there are nevertheless indications Wthat under certain circumstances an immunisation may batake place. These circumstances are present in the or

experimental tuberculosis of guinea-pigs and in the gene- thral miliary tuberculosis affecting the human subject, b(where at a certain stage the bacilli completely disappear. su

Immunisation is therefore apparently attained when the alwhole body, as in general tuberculosis, is invaded by great stmasses of tubercle bacilli and when these bacilli come blin direct contact with normal tissue. Professor Koch a

accordingly endeavoured to produce analogous bodily con- m

ditions in the hope of arriving at artificial immunisation. b;He first experimented by extracting tubercle bacilli with cc

decinormal caustic soda. The fluid obtained in this way was not free from bacilli, for in a field of the microscope irthere were from five to ten of them to be seen, lying u

separately, not in heaps; they were, of course, dead. tlThis preparation is designated as TA (i.e., Tuberkulin, si

Alkalisches), and produces when administered reactions

quite similar to those of the old tuberculin of 1890 ; relapses t]

were, however, less frequent. But there was one drawback : pwhen more than a certain dose was given suppuration s

occurred at the place of the injection, the abscesses being ’1due to the presence of dead tubercle bacilli in the c

preparation. The fluid was therefore filtered and the e

bacilli completely removed; when this was done sup- I

puration was avoided, but the action of the TA was c

still identical with that of the old tuberculin of 1890. IAs, moreover, the fluid was easily spoiled and required con- fstant fresh preparation, Professor Koch finally abandoned ithe TA and proceeded to other experiments. Having found r

that normal tubercle bacilli are not easily absorbed by the organism, he endeavoured to facilitate their entrance into the I

body by mechanical means. He has made the very interest- E

ing discovery that the bacilli are covered with a layer of a fatty acid which makes their absorption difficult, and which tmust therefore be previously removed. This he accomplishedby triturating dried cultures in an agate mortar. After some time only a few bacilli remained entire, and they twere got rid of by dissolving the mass in distilled water and treating the solution in a powerful centri-fugal apparatus. In this way the fluid was divided intotwo layers: (1) an upper one not containing any tuberclebacilli, and designated as TO (i.e., Tuberkulin, Oberst) ;and (2) a lower one, which consisted of a colloid sedimentwith a few bacilli, and was designated as TR (i.e., Taber-kulin, Rest). The TR was then again dried, pulverised,and treated as before in a centrifuge, the process beingrepeated till the last bacillus was destroyed and the wholefluid became perfectly transparent. This product caused nosuppuration and was easily absorbed. The action of TOis very like that of the old tuberculin and the TA,with the exception that it does not cause suppura-tion. Its immunising action is very slight, whereasthat of the TR is very marked. When an excessive

quantity is administered to tuberculous patients it, of course,sets up reaction, both local and general, but its immunisingeffect is quite independent of this ; whilst with the oldtuberculin and with the TA and TO reactions are neces-sary for an immunising effect. Such reaction must beavoided in TR. A man immunised by TR does not show anyreaction when he is treated with TO and TA, so thathe is immunised against every constituent of the bacillus.For the preparation of TR the most virulent and recentcultures must be used. The processes are very dangerousowing to the fact that living bacilli of high virulence have tobe pulverised in an open mortar ; indeed, Professor Kochfelt as anxious as if he had to do with an explosive substance,and he points out that in making tuberculin on the largescale every care must be taken to prevent the bacilli frombeing scattered about, adding that this can only be donein a large factory. The Hoechst factory has been entrustedby him with the preparation of the TR. In making useof the TR it is administered by injection into the backwith a well sterilised Pravaz syringe. One cubic centi-metre of TR, containing 10 milligrammes of the drysubstance, is mixed btfore use with weak sodium chloridesolution, and in the first injections 1/500 milligramme

of the substance is given. Injections are to be madeevery second day, and the dose is progressively increaseduntil it amounts to 20 milligrammes. When the temperaturerises the injections must be stopped for some time.

Guinea-pigs treated in this way were so completely immunisedthat injections of virulent cultures had no effect on them.When TR was administered after an injection of tuberclebacilli a marked regressive metamorphosis of the tuberculousorgans was observed. Full immunity is only attained two orthree weeks after the administration of the maximum dose-both in the case of the lower animals and in the humansubject. In the beginning of the treatment there is no

apparent effect and no impression is made on the tuberculousstate until half a milligramme or one milligramme hasbeen given, so that patients who are likely to live onlya few months should not be subjected to the treat-ment. Also patients suffering from secondary infectionby streptococci and those in whom septic processescomplicate the tuberculous affection will not derive anybenefit from it. Temperatures exceeding 38° C. (100-4" F.)indicate a mixed infection and thus render the patientunfit for the TR treatment. Professor Koch has adminis-tered the TR to a great number of patients, especiallysufferers from lupus, and in nearly every instance an

, improvement occurred-he did not say a "cure," because3the time during which a relapse might take place was not yet-past. In lupus it was especially remarkable that, notwith-standing a very small local reaction, the disease became less.; This result is the reverse of that which was found to

occur with the old tuberculin, where the therapeutic effect depended on the degree of the local reaction.- In pulmonary tuberculosis the only local reaction; observed after the administration of TR was a tem-. porary increase of the catarrhal symptoms. After a.- few injections the sputum decreased in quantity, and at last1 it disappeared. In no instance did the general health suffer,1 nor were any undesirable symptoms observed. The patients’3 weight increased, and their temperature remained normal.3 Professor Koch concludes that probably the methods of- administration may be improved, perhaps by combination with serum ; but he thinks it will be impossible to improvei the preparation itself.i It is to be hoped that Professor Koch’s work, which un--r doubtedly is of the highest theoretical interest, will provey to be of practical value. The public and the lay press,,d remembering the collapse of the expectations aroused in thei- year 1890, are rather reserved on the subject, so that dis-o appointments similar to those of the first tuberculin era wille probably be avoided.

April 6th.

ROME.

(FROM OUR OWN CORRESPONDENT.)

The Price of Panic."WHAT the pestis bubonica’ costs the Treasury" is at,

present agitating Italy, whose impecuniosity can ill bear the-additional burden of diminished harbour dues and moneycompensation for excess of sanitary jurisdiction. Theopening of the year found her, principally at her seaports,quite I I off her head" from panic at the apprehended invasion.of the "pestis bubonica," in illustration of which the

following incident and its financial sequelæ are not likely tobe soon forgotten. On Jan. 22nd there arrived at theharbour of Ancona the English steamship Glenorchy with acargo of jute, hailing from Calcutta. According to the regula-tions issued by the Board of Maritime Sanitation on Dec. 29thpreceding, and applicable, as against the importation of the"pestis," to all ships hailing from countries beyond the Straitsof Bab-el-Mandeb, the Glenorchy was forthwith subjected-to sanitary inspection and to all the prescribed disinfectingprocesses. These being duly performed and certified theGlenorchy on the afternoon of the same day was admittedto "free course" (libera pratica). That evening, however,there reached the Prefect of Ancona a telegraphic orderto send to the sanitary station of Alberoni, in Venetianwaters, for visitation and disinfection, all ships arriving

, from British India. This order, as a prophylactic measure,,

was, in consequence of information received by the Prefectand of instructions forwarded from Rome, declared

applicable to the Glenorchy. There arose, in fact, the:

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doubt, after that ship’s admission to " free course,"whether the said admission was legal. This doubt wasmore than accentuated by the panic in. Ancona dueto an arrival from suspected shores-a panic whichseems to have been shared by the law advisers of theCommune, who threatened to absolve themselves of all

responsibility should the dreaded consequences ensue on theadmission of the Glenorchy to free course being sustained. So,"per assicurare anzi tutto lcz tutela dell’ ordine pubblico" (toensure above all things the safeguard of public order), theGlenorchy was made to comply with the detaining ordinance.Against this, however, her captain, in the name of the eminentLondon house which employed him, formulated a regularprotest, and this in due course came before the ItalianGovernment. The captain’s plea was found, on expert con-sideration, to be, indeed, a strong one, and the Government,convinced of the advisability of avoiding an appeal to thelaw courts, and in consequence of negotiations conductedbetween the Minister of Foreign Affairs and H.B.M.Ambassador, Sir Clare, Ford, saw it expedient to

accept the claim for indemnity advanced by thecaptain, to pay him 10,000 lire (£400), and to quashall further procedure on account of the enforcementof the detaining ordinance against the Glenorchy. As I havesaid, the incident has made a profound impression on akingdom chronically suffering from what Lord Beaconsfieldcalled " that ignoble melancholy arising from pecuniaryembarrassment " ; and even if the findings of the Inter-national Sanitary Conference were less significant than theyare against "excess of sanitary jurisdiction," the muletingof the Treasury in f.400 for what was simply a concession tounenlightened panic will teach Italy a lesson she stood muchin need of. In fact, she is gradually coming to see thatsanitary and hygienic reform is a much less expensive policythan her traditional system of "maritime boycotting, andthat if she were better protected at home she would haveless reason to dread epidemic invasion from abroad.

Psittacosis.

The "pestis bubonica" has had its pathological "side-Ughts," and one of these has been the demonstration-formerly a vague suspicion-of the power possessed bylower animals of conveying infective disease. A curiousillustration of this power comes from Genoa, where theCivico Ufficio d’lgiene has just had to warn thecitizens by circular against keeping parrots as domesticpets. A family named Rivalta in that seaport had beenpresented with one of these birds, and shortly there-after its members, one after the other, became affectedwith broncho-pulmonary symptoms which took a rapidlyI pernicious" " course, carried off the father and mother,and placed the rest of the household in imminentdanger of their lives. Similar cases of pneumonia, tracedto the same cause, threw the population into panic, to

allay which the Civic Office of Hygiene had to intervenewith the following manifesto: "Parrots are susceptible of apeculiar infective disease very easily communicable to personscoming in contact with these birds when so affected. Thedisease, known by the name of I psittacosis,’ betrays itselfin marked broncho-pulmonary disorder which very often runsa fatal course. Two parrots, recently arrived in Genoa bythe steamship Manilla, set up two ‘focolai’ (centres ofinfection) of the aforesaid disease, and this has caused anumber of victims. The best mode of avoiding so grave arisk is not to keep parrots ; when they cannot be parted withall caressing of them or contact with them should be discon-tinued, especially if they show signs of malaise. In thislatter case recourse ought at once to be had to the UffizioMunicipale d’lgiene. Such precautions are all the moreindispensable as, in the day now passing, there have occurredcases of psittacosis’-a grave but easily avoidable malady."Some three years ago THE LANCET 1 described the illness anddeath from broncho-pneumonia of a well-known Florentinefamily, supposed to have contracted ptomaine poisoning fromthe consumption of unsound fish. At the time there was acounter explanation of the malady on the part of more thanone consultant, who traced it to the presence of parrots asdomestic pets in the household. This latter theory, which,in spite of the medical certificate, had strenuous supporters,seems to derive confirmation from the Genoese incident, andthe case it accounted for may henceforth be cited as one,not of " death in the pot," but of disease in the parrot."

April 4th.

1 THE LANCET, Nov. 17th, 1894, p. 1169.

NEW YORK.(FROM OUR OWN CORRESPONDENT.)

Physicians’ Claims against Patients’ Estates,A BILL has been introduced into the New York Legisla-

ture having for its object the compulsory payment of phy-sicians’ bills against estates of dead patients. It providesthat every executor and administrator must proceed to paythe debts of the deceased in the following order : (1) Debtsentitled to a preference under the laws of the United States;(2) taxes assessed on the property of the deceased previouslyto his death ; (3) debts of the deceased, because of servicesrendered and materials furnished by physicians, pharmacists,nurses, and undertakers; (4) judgments docketed and decreesentered against the deceased according to the prioritythereof respectively ; and (5) all recognisances, bonds,sealed instruments, notes, bills, and unliquidated demandsand accounts. Preference shall not be given in the paymentof a debt over other debts of the same class, except thosespecified in the fourth class. All debts specified in the thirdclass shall become due upon the death of the deceased andshall be paid within ninety days thereafter.

Compulsory Reports of Cases of Phthisis.The action of the New York Board of Health requiring

physicians to report all cases of tuberculosis has excitedmuch opposition in the profession. The committee on

hygiene of the Medical Society of the County of New York,however, endorses the recent mandate of the health boardconcerning compulsory notification of cases of pulmonaryphthisis as follows : "Realising the need of proper measuresto prevent the spread of pulmonary tuberculosis, and

regarding it as an essential preliminary that all physiciansbe impressed with the importance of making an earlydiagnosis of the same by microscopical examination of thesputum, we earnestly recommend that physicians avail them-selves of the offer of the bacteriological department of theboard of health to make such examinations. We approve ofthe compulsory reporting of cases of pulmonary tuberculosis,if the inspectors are forbidden to visit or to have any com-munication with the patients without the consent of the

attending physician, believing that the attending physicianis capable of giving all necessary instruction."

The Contagiousness of Pulmonary Phthisis.Colorado Springs, Colorado, in the Rocky Mountains, is a

famous resort for phthisical patients. Dr. Solly of that city,son of the late Mr. Solly of London, thus speaks of the con-tagiousness of that disease in that climate: "At least athird of our population are consumptives. The town, whichcontains some 15,000 people, has been established twentyyears. An inquiry made by disinterested physicians into thenumber of cases of consumption that were known tohave originated in the town resulted in a report oftwenty in all. Although it is probable that our bril-liant sunshine and dry air more quickly destroys thevitality of the bacilli than your eastern atmosphere,yet in the poorer lodging-houses of the town there aremany ill-ventilated rooms, inside or on the north side ofthe building, inhabited by consumptives and their families,where recklessness of expectoration and carelessness ofordinary cleanliness are marked features of their domesticménage; yet cases of contagion do not average more thanone a year. At Colorado Springs the consumptives minglewith the other residents of the city on all occasions, atchurch service, theatre, concerts, and in the over-heated andcrowded rooms of private residences during social functions ;they reside in the same hotels, boarding-houses, and privatedwellings with those not afflicted with the disease, and noattempt at isolation has been made. Notwithstanding thisapparent indifference on the part of the local authorities tothe contagiousness of the disease, only twenty cases haveoriginated in Colorado Springs in twenty years."

New York Saturday and Sunday Association.The total of last year’s collections was$22,190.76 from

churches, and$58,919.45 from other sources. Bed patientsnumbering 30,700 were cared for. Of these 23,271 were free.Medical aid was given to 250,000 free dispensary patients.The executive committee in their statement set forth that thehospital expenses of the past year were$1,323,238.15, withan income of$292,581.83 from funds invested, from payingpatients$399,996 79, and from the city$66,047.91. The