.J ._ j..i. -.A., -. f REPORT oF!mE oF!mE I I DIREXTQIROFTHE HOSPITAL. DIREXTQIROFTHE HOEiPITAL. OF Jamrary 19l6. Jamrary 19l6, To the 3oard of Scientifio Directors j of the RoGirefeller Incititute. The Mreotor of the Hospital has the honor to mb- nit the following mport of the work carried oh in the Hospital WiW the pese* q,r Mriwtho opening of'theHospital fim yeaxu~o them baobesoa&mdyin- m388 in the number af patients reqwsti~adtnission to the Hospital for treatumnt, This has been eepsciallymarlced &rin,-the pastmonthe. A hospital several time Inr,r,r cad have been kept filled with patients suitable for the studiee beiry( oarried on. Oa OXprienCt3 more and mora indi~B,kAC?PW3Vt3r, that our work is much more pro- kictive when the number of patients ie kx3pt low. This makes the expanse of th HOW gtal pr patient very hi&, but mterially increases the quality af the work. h November a clinic cm pumnia and diateteew&a held at thm Hospital. To this were invited &yeicians who have referred patiente to t2m Hospital. plb plan :f sending cAIt bulletins frum tims to title describing the kind of patients vth&th axe Wtted has been cantinued. We vmre gratified that the last l&etin was copied 5.n t&a Jouznal of the Amrican l&dica& Aesociatiau, and also in the Bulletin of the New YorkBeard of Halt& which I undaretand is sent to all physiciamt in the City. Thit3 I I and the general mdiaal profession; and also that any feeling of distmst whichaxlr' I isted in thp mind, of the publio is rapidly Qisappearing. I Un4er them circmxmtancea it is poasibxe that tks question of obligatory ! X$`JF:i?h.R EL& ZlQQl be G&.0 hlefloutfly C@llSidsmd. WhentheHoepltal opened1 omasidbred ????? ????????? ???o? o but it ie nm probable that w could ask every patient an admissian ~5 the timpita to sign e petit for an autopsy in cam of death. !Qm opinion aP the :dcxe of t2.a Board on t,hia subject would be weloam. ce :-sar. TL" ;" S.&J:+" 3 30 far oor.firm those previousP~ obtained. In the mouths `;-> - - ._ -w. .a -I .rscr.; i:ld pr.eu:..ozoc:I >xsx.`l arc: 0:' T;T~ IV, except in :ertain instanceo ye :*- .. -:. '.a --- 8 ~t:-;Cr.s ;los >3.;- a:~ocin'leJ .-,it:l Fncuzor.in patbents, ir; which case pneumococci .' ; .a .-X2, t:-ZGtj ZaJ- `;e Fr&$er.t. In three iAstarxec(norma1 parsons] Cthout history of ::i.taCt, preumCco~cu~ ctlcosu8 has hen isolated. Dr Avery ha8 AOV collected about L atr2im of iilis tl-po 0: pncumococcus, including those from patient8 with pAWmOAia, 2; -:Sll 32 those fror; Y :iomal CiOLaiJ, ar,d he 13 making ? thorough study to determine, ii ;3:.siSls, -.i;e-char ar.: son&u-i+, dif f arences( cultural or imunological) exist betwell - : . strdz.3 fox.: it dincni;:: a.3 those prezeat in hcnltt. It is tco OOOL to report :.. :I;L: raa-2,ts 05tcineJ. Jr 902Lex !c; ccf;?inuir,~ his stu-iy oi ar.ti-bla.stic irxxnity. A: preeent he .' ;:tk.;Ftir+~ +,a .C isolate t1:e sutstacsa In ti.:e senm ?Ihioh as% responoible .~ :*,ion of t!le 5+erl,il ?rotsbl;-tic 3nl glycolytiz action. Dr Chic::cring retwnad on December first from California nhere he for the in- had been . . '_ J. :.*..,; -.:ith 3: Gay on the treatmect ol' tyFhoi3 fever by fntraveaous injectiozis of i I :X.Sit!.iefj tyq;;oid va=cines, The zork was aided by a grant from this Institute made kst auf-. The tbrapeutic results are interesting and suggestive. One observa- i :ion zade 3y Dr ChiAerinF, seem to.be of considerable value, that is, that the number i 3:' tyFh0i.d bacillf. in the blood duririg the cour8e of the disease is of considerable yognostic importance. Apparently the injection of the vaccine 18 followed by a he- :raase in the saber of bacilli in the blood or they entirely disappear. The work LS also confirmd the Ob8erVatiOA of Gay that euch injevtions are followed by a v?ave cf hCOC~tOBi8. The injection of vaccines is usually folloned by a severe general ::ac:ion azr? ce;-"vnio of Ceir observation3 sugge st that such reactzions may iA Born3 ..:CUIe iTy be of protective value, even whan they are non-specific in character. \ : !> P - - ?? o I ; 'L Lubzact is worthy og further study. For the prasent, Dr Chickaring is busily ;ngzgod in ~:r~raring a supply of bactarial precipitates, as studisd last y3w by Gay :nd Chic&ring 2s it is planmd to treat a 6erias of cas;'s due to pnaumoaoccu.6 of T>p II with this prqaration. D'r #3sAOy ha8 almost completed a study of th0 rato of growth of pnCuDO- COCA, css;;acial:y of th; phc,nommon which has bUen doscribod a6 bacturizl "lag". b brbth cult$s titsre usually first occurs a pried in which multiplication i6 v\ry slw. F, r z tire; no rmlitplication whatovar um# occur, in&tidj as Gillospio h.zs shown when tkL numb; inoculated is SIXU tkwre may ba no growth et all. FolLo+ ing this ktctnt Fried a period cf L~UC~JYUJ rztcl of mltiplication occurs and then xzin a ~;ricd or` decline. CLfmy ha6 6hom that th6 occurrmm3 or degree of k&ut priod,cr lag, depends upon the otsge of growth of tk culture from which tis SubciUturs ismxdo. If tki fomnr bo fn thd 6tap;o Of! r;axinnun Or lOgar;rthmiO 8, erwth, the rmbculture rnzq show no lag whatever, *ma8 if the culture be in the early or lztti i;tz& thd lag may ba markmd. The curves of #a fir& faw hours of eroxth of the sub-culture parallel alnost exactly those of the original culture &zing the s.3133 pcriod2 If durir-q tho period of nqxima~ rate of growth, the ml- ture 5e plmd in the ice box and kept at O'C, the culture coase6 to graw, but 01) EnGvd from tha ice box it will ;yzain grow at mPri xateki~t lag>, ev3Aif koptaaice foraslongss Thea days, and sUbcu%~efrcan this scum culture kept on ica till aso grow at maximm rate, without lag. Pneumo~occi of Type IV, when fre&ly isolatid frcm t& Huron body, show a mry marked lag, mch greatsr than pnzumococci of Type I or m II frashly iso- latod from the hurmn body. Th6 minimam generation tim3 of pnetonoCo0ci(!&ypS I axi II) has bUan found to be fram 25 to 30 ninutes. T&I idea is entertained fhat lag is an eXpre66iOn of in3ury,whia V&V is .w~~~J?='~~~ b;~ 5ho expzrixmats so far prforrmed. Attempt6 ha36 b00A ISi& t0 dste- zina v;ha *:13r Ye ~.2zuros shaving markd 1~s nro less virulant for mice t&n those not .2.c~:uiir.L: i.,z::, 'C-AT, it has not be:Ln possibls to sacurn clozz-cut rumits, as yat. ?it:, Kr Cuiltin, Dr Cha~;ney hzs follomd tha chmgc in H-ion concentration . . . . .-LA CGCLU in L mlture of pn~ur.~czc~~~ during its grcwth 2nd tha axy;;rimnts dam tlxs far show ;; striking parallelisms buttwan tha growth curw ?l-nd the H-ion con- c.::,;ration cum~ up to tha point wh3m growth wams. Aftar this point is raached, tJ-2 I:-icn ccmxntration rol:&ns constc.n,t for days, zlthouqh the ~plaumococci dacreaae in ntiot;r zd autklysir; occurs as is ovidancad by 3 partial claaring of tha Culture. Nturos of both Tjnpo I clnd TyFo II pnamococci Atain the s2m H-ion concentration, am2 grovti in ;Iach ca% CBQSOB at this particular letml of H-ion concentration. It is intirasting that at tha tim at which this 10~1 is reachad, the "mltuxm of pleu- ~oacccu~ Type f show6 twice AS many or,ymisns par unit volum as does the ailture of Typ II. This would indicati that the mtabolio activity as nmamred by H-ion GOA- mr.tra.tion, is qmater in tha case of Pn~m~coccus Typa II than in the case of Pnerr- LlOC5CC~S Type I& Dr Moore has bean given charge of tha preparation of izmane serum and is slso continuing `ais study of the action of ethylhydrocuprein. Attempts am be- ing rmde to produce rapid and effactive imunity in horse6 by the daily injectim of mall doses of cultures, as was shown last year could ba done in rabbits. The praparatioza of the iimune senrm for expsrfinental and therapeutic purpoi3es has now C;rom to be a considerable undertaking. A very large number of clinics, boards of health etc. am now determining types of pmumococci by the methods devised here ar,d almost daily requests ars mceivad fort serum for such diagnostio and experi- Denta purposes. Rb are also supplying sezwm for a few clinics for therapxxtic us6se It i6 impossible at prosent, homver, to do this except in a very limited way. %erz 02 Tyg~ I and Type II is now being prepared, hovwver, by the New York C-5:; Eozrd of Health, the New York State Board of Hazlth and the Pennsylvania State . . -- B4s.e : i+-; _ : a(\, 4 - - joard of ;ieabth so that it is hoped that we shall be relieved of the need of con- :inui~; or ex%ndinl: this work. The Iei7 York State 3oard of Health is making PXB- ?x-z;lu:e tc det~rxtia the type of infecting went for physician6 in the 16rger cities 02 Ad.*fi . stiat8. In this ray will undoubtedly be obtained obscrvatione and statistics of ,;raat s~ide,mi4o~ic=.l 6igIlifiWla. At FrJc-'nt F. wrie6 of crses due to Pnaumococcus of np II and TOP III 2-G *\- ;.- _ "0 W`.,> trsz&d 3p o~tochin(eti2~1bqdroduprein). L?st spring Dr Moore made a :txd~ of the SxtaricidA. effect of tti blood WITU of rabbits following the atin- :axxi 3~ oi -- optochin. Cave 6 LJc'=Gt by plottim the b?ctz-ricidal power at intGrvdl6 IT311 owiz?~ the ad2inistztion of the drug wra ,-JL&~. %lii~.Z StUdi3S ml% dS0 . . ..LiG 0:: z 26-x acrxd. persons. This StUdJ'patittedthe deVelo~ntofatschniq=' '!:; ;i ~~ r~i %xv be eqlo;tljd in ths stun of patients. The number of patient6 treated is still too fern for any conclusion to be drawn as to the therapeutic effect of the W, but soflarthe results are prcxnicing. In any case, the effect of the drug in increasing the bauteriofckd power of the 6onuc can be readily demonstrated and repeated doses have a @ative effect. TV3 have aireadyhadadistressingexample of the toxic affect of the drug,howwer. One patient 16 years old, received four doses of the dirug'd.5gm. eaoh, over a period of 36 hours. Following this she be- CSD m&ttely bltid, and th6 total loss bf vi$ion lasted six days. she then b6C31d3 able to distiguish light from darkness and there ha6 Tollowed a g* in- ;;rovement. It `is at present irrpossible to w whether or not complete X'SCoVew !Vill 3c&xZ-, 2bi6 seems to be one of the mO6t severe Ga6eS of amblyopia which ha6 omarred follo4.ng the ~66 of this driig. Some caBesare nowbeingtreatedgiving V~L-:~- a.?~11 doses of the drug every two hours, but administering a total amount Of 1.3 ip i2 3% hours, as it is not likely that any 6maller doses can be 0% any value. It is _nlanmd la';ar, iz~ a series of cases to ocmbine the drug with im semen. Las j'6% Listar iri Sa:fi; Africa publFshsd a short papr setting forth y'. + r:.... . ;iie;r ,71e'~~oGocc L x-e grcrm in ix.une serxz they becom aore susceptible to - '-- 2c`LipA, il. .., of ncm2.l s2r.x as shorn by the peer of normal senxn to cause agglu- tl!::.t~l,cr. L&d 2100 oFsoniza:ion. This phenoxmma he called piantication(to fatten fc: 61x(;ht3r), He shomd also that such organisns becorrs less Bu6Wptible to the i:c-,i tn 21 th.9 i:.xune s8n.m. A series of studies hava tkwrefore barn made by Miss Str,. A:: tc ir.\v~ti&ti this ph;nor.xmn, Studying pIIt3UEOCOCCi af VariO'JS type. It h&i t.icT. f-DJIl.2 trss t2,; t tvhe;; pneu~nococcus of Type I for instance is grown repeated- ly in senmi of 'I'yp3 I it mzy baccm ho a slight extent spontmeously ,?rjglutimble vdtk. norm2 s4rz.1, but more striking `and of greater significance is tha fact that it tsx.k3 . -;uch less aq:lutim.ble with the harnologoue 6en.q and also now become readily ag-glutinable with 68~ of TyFe II. With this change in agglutinability the pneumococci lose their virdence. If suck1 pneurnooocci were now observed for t.';.; first tim it would be difficult to at once deternine the typs. Passage through zlir. 318, hoover, readily brinys b&z their virulence 2nd also m.kes evident the specific ;.s;l-dtia~bility, t-which is ztlncp of the S,?J~B character as that originally ~rI;sOnt. The change in the orq-mism 0cm.r~ after five to six passages through brct:i ccntzininl; one tenth part of imnarne serum Or.;;at?isms have now been paseed t2;ZnlJ_;i> 36 IIEUly 26 95 transfer6 in serum broth over a period of One year. 'I%8 obar,:ed character of the org6nian nay persist for a6 many a6 50 transfers on broth, th,xgh, a8 previously 6tated, it mckly rWerts on animal @assage. The inter- pretsticn of this phenomenon is at present difficult, and studies are being xzade by irx2.lni~ation of anirmls against these changed ty$66 etc., in ths endeavour to fim. underlying factors. At the presentt t&e the significance in relation to the question of epide.aitlogy and origin Of typ6 doe8 not 6een t0 be great. In any case it is entirely different frcm the 6OCalled transformation of Organisms as 2esscri'red by Rosenot";. ! ': IL: & i '. , 1,. , i - - B Diabetes: Only children and tits suffering from the most 88vez-e typ c=' this diaeaae are being admItted for etudy, These case8 are under the izmediate :X-e of Dr Stillman. Dr Allen'6 study of this disease has made two radical inno- ~~.:lons ir. the treatrmnt, first, the valuable effect of prolonged fasting has been s;onctrated, end saoond, the important rble which exeroise plays in the twatmnt : a.; bae,r, shwn, l.Soroovef, it has becam evident that the treatment of the patients I I ftcr they have beccEae aglycosuri~ consiet in education - tsaching them how to live .'.it:. their restricted fUnctiona. This cannot be done by general instructions, but .A pcttlent(or if a &ild, the parent) mast taloe a courae of instruction in the diet iitbA:er., and he must learn to examine his awn urine accurately for sugar and diaoetic ' ski. For the aomrate clinical etudy of diabetee and the proper tre'atmmt of the ;Ltiante it has been necessary to develop a quite elaborate organiostion of the diet tit&an and clinical laboratory. This has been scccx@i&ed largely by the e?forts of Dr Stillman and I think it is no mom than true and proper to say that this has iecone a model that is being wtated throughout the ooun&y. l!hemethodaerw plopd am conatautly being demonstrated to very large nu#daers of visiting physicians, Dr Stillman is gMA$ng ready for publication irz a monognbph a ocqplete description of the rpethocia emlplqyed, with full repwte of the oams- trested forillustrati~, At the present tLPe, Ik Allen is giwing his t3.m largely to'the Iprepsration af his erperimental materi fer prblioetion. withthe a.idofMisaWisharthe ia obntinuing sad fiuitthing mtx~ necessarily long and tedious experlpente~ Dr Fita htts made 8orm atudiee on the qphrtion of renal Aplotion in patients ::`ith diabetee, espeoiaJ.ly with reference to the disturbed salt mtabolism frequently ;;ra sent. He is sow, under Dr Van Q&e's direction, working bn xmthada far the de; :enni:;ati,Orl of the &normaJ organic acids in the bloo& and urine for the pU.QOSe Of i~ter;,ixdn& if possible the laws governing their excretion. Ib?Pa&uxwhas cwried an aseries of studiesoonoerning the concentration of sugar in the tik3suesr Althoq-$ muah work on tbs fate of glucom &XI the animal orcsniam hae been reported, little zttentiOn has been glwm to the cenczentration of this mabrityloe la the tiBSW5. The parp~ae af this inwstigatiap ie to deter :tine the amunt ef ~luaoae in tsle tlasuer ttndm varying conditions(nonm.l 8nd die betlo animals, hyflerzlyoasuia artlficlally produced) with the vim? of thrmiry sWtl;sr tight on the utilization of sugar in noti mad abnonrrJ carbohydrate mta- lS.ii33, It mas newssary to develop a suitable rmthod of investigation, whiah ias barn accau@isheG. (Up to the present 26 dogs, 18 of which'were normal and 6 in vcrioue ok.-;es of ~iabetae, as ~11 ae 16 rabbits and 1 monkey have been used). Is several instames the conaentration of glwoae &I 20 different tiasuea has been .i ',~ndne~, '%a retits thus far :.re as followa. T"nf3 GOAQ3AtT3tbA ai 8ur 0.3 in the various tissues, thou& considertily lower, vz.ries direotly with tJB xxentsation in the blood. There EXW~B to be little difference in this re- spot between noti and diabetic anirals. Ao$dosie - on an sxteneivle study doua report, Dr. V2a i;tudy af c&j cxqmity Dr. Van $lyke, Llr. Cullen and Dr. &till- have &wrSod conc3erning acidoeio in diabetes. Ae mentioned in a pa?a- Qyk~ hae devised an accurate but simple r&hod for tti of the blood, which saqms to be tim best clinioal nrsthod available* me 'a618 of of prolozaged fastim is xiclosis have been used mtm swhmathgdis of~matimportance v&mv the method Wing empfopd. This and other methods for detgnnining in the study made here. Fran this study.&. Stillman I. LXS baa able to sqx,r&e the x,sas of ditietes into four tyEae a8 rega;rck xidosj.8. 1. Czaas with only sliE:ht tendenc~~ to fom abnoti acids, either ..a.. ::-.s;tA;~ or oii e i-$3& Lit:& or 30 exoratian af acetone bodice. No tendenoy - . . " .:IY.s.E ~icark3naSe to fall. cases OS this type are usually mild. (2) Cases with a tendency to acute acidas on fasWuz, Patients ma.y be- ;izr %a traatmn: is apparently fairly good condition, but the plasma biMs'bonate %llo rapidly when ';he fast is insfikr+~d, and may result fatally if acidosis is not Stectod and checbd (by feeding) in tm. Since the present me+Aod of plas=le bi- zsLona+& cbteminatian has been employed for detectlzg acidosis, patients of this t:.p kim without exception been detected and successful~ treated. A pecuaiarity of au& cxsee $s tbt a& the second or third attempt to make the urine sugar-free by :'stin&~ no acidosis my ocm. (3) Casea shu~n~acuts wii *- dosie,curable by fast$& This tyF@ shaws a zksriour exactly oppoeite to that of typ0 2. A patient entering the hospital *n a :cr,;itior. of swims acidosis, with plaza blcaxbonate at half the normal level and iti: physical anL tintal symptom of impend- cam, may as the result of fasting; and .xor:zte carbonate dosage, or even withcat carbonate, clear up so rapidly that in tie tr tl-me dayat t&m both the blood tests and the alW&A signs ami 11orm8f~ such :,LtianttY put on a ratianal diet then tend to remain fme of acidosis. (41 $tsses 0hMna chrmio gg&$osie, ?hese patients 8-n after long t-at- snts show subnoam& plaa bimrbanate and ,;hypernoznnl ammonia excmtitm. meyforn aida in abnoxana& amounts end elim$nate them &es6 effioiently than do aaka& indivi- US. &ese casesare inanunstabb condition, andare the mostdffficultofall to treat satisfactor&ly* Evmtually, however, ecme of tkmn agpeax to wmlu8~ WiO tha uUder type deecribed under (;i). :loying ths numrdoal lam governing ths exwetim of urea and sodium Chloride. In :h incUvidt,aaI ca6e one of the execratory tiotiona gs frequently fLffeoted wNle the cth'6 l%la.$JA r&ml&. Urea exoretion function apgwently depends on kidwy factors ~.15nG, bat oonditions remating ealt excretion Sanction are pore complex and appakntly "- l..!x~ci~y axtr6lDrena.l. -. 1 The &wee of nephritis so far studied have been mainly txaes ;:Lr;ir advanced L,ctional cizmge, es;eciafly those liable to uremia,, and also ca@a :`. i t!? 3 dera,. Pi &iitios, cases of primly h;prtansion without apparent kidney f&CL iC:isl Char-,36 ax-0 hiri~ studied. Studies am also bein .zade of the effect of differences in nitrogen intake 1. tiq large aznwlts, as well aa very mall amunte) on the index of excretion. Such :.Av.,-,tjs in intake api-mntly came no charge vaha+Wver on the index of urea excmtion. *He& iii@$ba@'e, . Dr Cohn and Dr Jaa&mon. Bqp , PmfOmnCe pTLtient6 sufferin.: fron auricular fibrillation, and 0eder.a are \c'in; a&itted. In these patients the effect of c!i:italio on heart-rate, kidney fun& :lGil, blOOd pIW66UI%, fever(when this is present) end on the electrocardiocrazn is bin6 at&lied, Blood pressure in patients with fibrillation is tein; studies by recording fu psrcentai;e of total beat6 that reach the wrist with different levels of extemal ;rcss;sB. From these recorda ~u-vt36 m i;eLn; T=pLcB which am believed to ziVe a more Gisfaotory account of the effect of di-;italis on blood pressure than do f&Isa cm- +ed of averges. The time when the clinical effeot of diGitali becorms evident ie being wpLmd with the tti when alteration in the 2 warns ~ca.ra. studiee are 8lso be- ins aada to decide whether alax,pr dose of digitalis Given in a short time has the sar5 effect on the oleotrocard.iqg.am as a small dose given over longer psriode. 2h4 8otion of digitalis in its easea of gzmmoxaia in respect to Wee ia the 2 ~838 and in conduction t$xf8 has been ,studied. 58 cam8 that took no di~ita- lis served a8 oontrols, 50 cams took digitalis. Of thorn oaly4Owere ava&lahle far study, the other43 not havin;f had an mount of digitalis sufficient to influence tile curvs. Cf! the 40 available cases that took di,nita.lie, 37 mm studied. Briefly stated, the observations showed that in the absenas of digitalis 90.3 per Cent Qf the :ms shamd no c&nz;es in the eleotroo#diog%un while of' those Who took the dXU& jr' .2 E;a" rmtt showed chanfe of Pns Sol-t or another, These figume show that dicitalis -:oLces an effe3t emn during the Febrile period in pneumonia. As to wkether the dnr;: is benefici,il in pneumonia the observations offer .; 1 rcziso ilifcmtion. Ce can, homer, draT4 SW deduction from the following : .cts: in exminin;; 126 cases(those(l08) already mentioned, to,ytherwith 18 other :.zris not inoluded in them for oertain reasons), 12 casee(9.5$) developd either fib- :illxclior. or flutter, 9 recovered frm the irqularity; 1 left W hospital with it; 3 died ;-li?ilo it was still present. When the, irrqylarity began 4 cases had ..; .;i itjlio; the others had :_~'.;tie of tLe irregularity. ;i. -it&is was able to reduce had very sc;;ill doses which could not be retarded as If the im@arity existed and lasted sufficiently the hszrt r;zte by blocking auricular impulses, just the 10% . a6 it ASS under ordinary conditions. In thf36e caas6 showing these irre,@llaritiee there- :'ore the benofiaisl aotion of the dxug is very evident. Vk 6re continuiw the study of the action of digitalis in fever with the tiew c? o'ztaining ;trr effoot more rapidly than has been possible by the use of the doses ~~ev1out3ly employed, nsmsly 0.4 gram p%- day by mouth. Digitalis is now being 81121 plcyed in doses of 1.0 gram or more by mouth in 12 to 24 hours. Cgyetalline strophsn- t:?in i6 alSO being given, using very -11 doses, on account of the unexpected ir'rew- larity In Gently to results encountered some time sgo. Thosei studies ham been begun too re- give a report of results. ~perinsntaam being oonduotedwiththe purpose of studyinghypertropby of the heart and its influence on the form of the a&ion current of the heart. The aature of hyprtrophy is being analyzed by studying~the weight of the layers of the heart as obtained by di644GtiCCA8 mad4 %en t&v lqwus are semratsd by this hanber6. Tbie rrethod of study is as cliqg-am are obttined, hypertrpphy is -cording to the methodof~~allumandkll. mthods they am not do4xtmsive with single follows:- tllfter X-ra~r plate8 and electrooa+ produced in on4 group of doge, whioh am made to work by rum&g on a tread mill, and also in other groups in which different al- clhGi~2~ Laboratory ; Dr Van Slykm, with the assiotance of ?fr Cullen and .>r .:;L~LA ;irzs co:;tkiuei ti.e r7or;r on tils fate of protein digestion products in the body, .L -~. .,.`Lcll Dr i,`a~r. Tna v:o 12 titii Dr I.bpvr had ~2~m-n that amino acids fraz dipsted ;,rotaks e::tsr the circtia:ion urxhanged, znd -`ior; it are absorbed by ths tisSU88, each . -1 .:,. * *a. . . . . 1~2. possessea its OLTA store of fme adno acids. It is hxmn that the greater ri.2 " -& 0-P tin protein nitro;;en absorbed is tumed into urea and excreted within a few .." a ..db.L . It ameared possible,homvor, that urea fomtion c;li*t not bqin mtll the ;ic;ma ila ;;eneral have taken u? sclch an axunt of the a5sorbed auino acids aa they .? ;;ir9 , tha Ure~fO~~ rLxxAmisi.1 senti; to rid the body Of t& BXCBSS. k-a &`tar a forty+eir$& hour fast were fed with mat an2 the blood urea was deternined swalal time per h0.z. IL son33 exp3rtint.s X-ray photographs were made in orclm to ,;z.3l;t:e the _nY3;`reSS cf the food +%hrou~h the alimmtary canaL with the production ti . . ..- r -2CL. It maa z'mnd thaz urea i"orma,tian does not wait *until an WX~SS of ad.IAO acids %bbd% 5"AZJ xquire~m&s of the or,-anism have been absorbed, but begins the moment ab- :OrJtian. StCiJt6. Increase in bloodurea occurred within nwh less than an hour after ic. 3 dirig, as soon as the X-ray showed the first pass- of food into the duodem, and -- scan as anjr increase in the amino acid nitrogen of the blood cuuld @ detected. The .rU :*xe+fonning me&~aism is, therefore, tidiately &Mated into action by the absow- tin:i 02 amino acids, and does not wait until they have accumulUed in e%t~6sSm One ather paint in protein mtabolisn attacWd has been thy question &8 to :%+Lh3r not e a&,ng aoj,ds, but also Ixptones or other inter3W3iate protein produsts ~;re iT?jscrbed from the intesti$e into the c;irculation. The blood proteins wire pm- 3, '?ftatcJ. under xztitiorie which leave intennsdiate product& not only peptones bat ,1. . : . . I 1 A%- -;%% 3lbziosea, in solution. The srnino nitrcgen was then determined in the filtrates Ix'ora h;;~olys2s(freo s&no acids) and after hy&olysis(increase =intemmUate pro- ???????????*??? ?? ?o?o???????? o It was fmmd that, althou& in the earn ex~rirmnta : `,r .3 Llzraases in fre mine acids or' the blood occxxed during digestion, no increase nt rdl ti t?s int;irr;ediate protein proticts could be masured. Consequently little tr no e.3scrpior, of "pptoneU as such occurs. All the protein,80 far as deteminatle ':J' pros+112 mt'=lods, is hydrolgped. 156s Vir&frsd is eqczy;ed in a determination of the as;ino acid8 yielded by t..; 21i;;j; ~Li.r, ~2. casgir. fral hewn .tilk. This problen is un&rtaL-n at the suggestion cf Dr Halt. Tr,a observ&ion of clinicall experience 5 J that less protein is required b .' '. i5kltU in ti2 fox: Of hUzli31 &lL m m CQns) L&lk. It is krmw, fras work dons :.xt yea;- iz co-opration with Dr Osborne of Hew Haven, that the albumin of cmsr milk . .- Ati ..:xh richer in hexone bases, e@cially lysins, than is oasein, ad &wine has been I Lx-.3 3y Osborne and Lkmisl to be one 05 ths amino acids absolutely essential for growth. Zzz~ tilk oontains much more of its protein in the fom of albumin than bee ccwel &UC ;?d $1~ richness of ths slbmin in necessary amino acids, such as lysine, may explain tk+ hi;h nutritive valu e of human milk proteins, if ths albumin of humm milk is sini- la-r ir. catipositim to that of cows1 milk. Rr Van Slyke has studied, with the oo-ogemtion of Dr LOam of the Lying-In 30spital the present theories concernin;: the nature of the tolxio agent in toxemia of pr3glalc;s'. The two leadirq theories have been that the toxemia is caused by either (1) UC acids,whi& the degenerated litter fails to turn into u.ma, or(2) acidosis, tLe -fos~~s intoxicatiq the mother by acids whioh if foms. Both theories sxe false, Ii: 30 r&se of toxemia ham abnomal smunts of smina acids in either urine or blood been pJz-??. Sor is acidoeis @nerally present, edcept in isolated cases, and even in ths 1%,;9? it i6 3Ot 89V3rt3. ~%rthsrtoore the foetsl blood obtained fran the umbilical cord -t isliwr,- shws bicarbonate content no lomr than the maternsl blood. The real tab .:i~;t is sot. indioated Sy ~g chmical theory whioh has previously gaimd prominsnwI .