809 advancing or advanced stage of a pneumonia. Delirium I might be treated by an ice-bag to the head and hyoscine was also useful. The pyrexia might be reduced by sponging such parts of the body as were easily reached but antipyretic drugs were not advisable from their heart-depressing tendency.-Dr. BRAMWELL could never reconcile Hughes Bennett's results as he had always found the disease one associated with a high mortality. He was certain that an antidotal serum would be found. He had seen

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... ses of pneumonia mistaken for abdominal disease, as gastric ulcer, and even operated upon. He thought that jaundice in cases of right-sided pneumonia was very unfavourable. Dr. Bramwell did not take so serious a view of a rapid pulse-rate (140) as the President. Irregularity of the pulse was of greater significance. Copious saffron-coloured sputum in influenzal pneumonia was very grave. The expression of the patient was of great value in prognosis. Dr. Bramwell prescribed very little alcohol, but thought that digitalis, strychnine, and oxygen inhalations were of great value and he would wish to treat such patients by the open-air method. -Professor W. S. GREENFIELD said that in above 70 per cent. of cases vomiting at the onset was a feature. As regards treatment he had found that digitalis often produced toxic symptoms and he had never seen any good results from strychnine and his only fatal cases had occurred under its use. It was in no sense a cardiac tonic. In all cases where the heart was failing he used strophanthus. The ordinary tincture was useless and that of the pharmacopoeia of 1885 had always to be prescribed. He employed five minims of this tincture with five minims of tincture of capsicum every three or four hours ; then it might be increased to ten minims or even to 15 minims every half hour. Massive doses might be given even in apparently hopeless cases. Even in cases with a leucocyte count of from 3000 to 4000 improvement had resulted from such treatment.-Dr. ALEXANDER JAMES thought that the eruption of herpes was always a very favourable sign in prognosis. He was in the habit of giving a purge at the beginning of the disease and thought it valuable. He employed the ice-bag for the relief of the pleurisy and at'the time of the crisis he found mistura moschi very helpful.-Dr. G. LOVELL GULLAND said that the pneumococcus was found very often in the blood in fatal or in complicated cases. Leucocytosis was present in pneumonia, but in very severe cases there might be neither increase nor decrease, as might also happen in very mild cases. The case might be apparently going on well, but if the leucocyte count went on diminishing it was likely to prove fatal. The number of leucocytes should fall within one or two days after the crisis and if it did not then it pointed to serious symptoms. Cases where the eosinophiles persisted even in small amount were likely to do well.-Dr. WILLIAM RUSSELL said that the main factor in treatment was the maintenance of the heart's action. Strychnine acted on the vaso-motor centre and so improved the tone of the vessels. He appealed to Professor Greenfield to bring his experience and views more formally and fully before the society.-Dr. ALEXANDER GOODALL stated that he had been investigating the raw strophanthus on the market for one of the manufacturing chemists and he had been surprised at the difference-some specimens bad no more effect than so much water, while others were very potent and highly toxic.communicated a Note on the Use of the Opsonic Index in the Diagnosis of Tuberculosis. In all forms of the disease early diagnosis was essential to successful treatment. Frequently, however, diagnosis was uncertain because of the indefiniteness of the early physical signs. The method which they submitted and at which they had been working for some time was one which rendered possible a diagnosis of tubercle even when the signs and symptoms were not conclusive. It consisted in the injection of a minute dose of tuberculin R. in conjunction with the observation of the tuberoulo-opsonic index of the blood before and after inoculation. The conclusions were based on observations made on 122 consecutive cases of medical and surgical tuberculosis. The cases were divided as follows : 1. Those in which there was reasonable ground for diagnosing tuberculosis. In many diagnosis was based on pathological proof (examination of discharges, operation, &c.), and in the remainder by continued clinical observation. 2. Either normal cases or those suffering from diseases other than tuberculosis. Several observers had shown that the tuberculo-opsonic index varied slightly in health. The normal limits of variation were from 0 -8 to 1 -2. The first group (tuberculosis) consisted of 82 cases. The indices of 41 fell within the normal limits and 41 outside. In the second group there were 40 nontuberculous cases, of which 29 were within and 11 outside the normal limits. A diagnosis based on one examination of the tuberculo-opsonic index would have resulted in an error of diagnosis in one half the number. In the non-tuberculous cases 27'5 5 per cent. were outside the normal limits and a reliance on this test would have led to error to this extent. In acute tuberculous cases the swinging index might also lead to error in diagnosis. In a paper in conjunction with Dr. D. Lawson of Banchory it had been shown that if a small, quantity of tuberculin R were injected into a tuberculous patient there was a diminution in the index but the reverse occurred in a healthy case. The method employed was as follows. The patient's blood was taken on the first day. Tuberculin was injected and the index estimated for the first and two succeeding days. The index of 1 -0 was obtained from an examination of the blood of two healthy people. The bacilli ingested by at least 120 polymorphonuclear leucocytes were counted. The most suitable dose of tuberculin was 6 0 oth milligramme for adults and I I th milligramme for children. The depth of the negative phase was generally less where the primary index was low than where the primary index was high in an infected person. The usual fall in a tuberculous patient was 0' 2. In 62 tuberculous patients inoculated a negative phase was observed in 56, or 90'3 per cent. In 13 cases (normal or non-tuberculous) a negative phase was not obtained after inoculation. The conclusions were: (1) the opsonic index per se was an unsatisfactory means of diagnosis, as both tuberculous and non-tuberculous cases fell within and without normal limits ; (2) if a negative phase appeared after inoculation the existence of tuberculosis might be diagnosed ; and (3) the absence of a negative phase indicated the absence of a tuberculous infection.-Dr.