been tried but they introduce new features, such as the effect of ingested alkali on the distribution of salt between plasma, red cells and tissues. In some cases, however, it is possible to secure a markedly increased salt output in the urine with a fall in plasma chlorides, but the mechanism is not entirely clear. summary. . The blood plasma chlorides were determined in 104 patients showing no obvious evidence of compromising physical disease, the blood being drawn 12 hours after the

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... meal. The ages ranged from 40 to 85 years. No relationship could be established between the chloride values and the blood urea, nitrogen, rate of elimination of phenolsulphonephthalein, blood pressure readings or urine specific gravity. In a second group of 40 cases, the plasma chlorides on fasting blood and blood drawn four hours after the preceding meal were determined. Although 85% of the cases showed a definite and considerable rise after the meal, the rise would not be associated with any consistency with the parallel determinations enumerated above. The small group of cases of so-called essential vascular hypertension studied seem to show an elevated renal threshold for sodium chloride. Attempts to lower the threshold have given no conclusive results. United States than whooping cough, measles, or scarlet fever. It is accountable for 4.4% of the total mortality at ages under 15 years in the registration area, and the average yearly toll is approximately 23,000 lives. Many reasons are put forth for this still too great mortality, such as failure to call the physician early enough, a delayed use of anti-toxin and in very severe and late cases the nonuse of the intravenous administration of antitoxin. All these facts have been strikingly brought to light by investigators of diphtheria mortality. Failure on the part of the parent or guardian to consult the physician early enough means a late administration of antitoxin and lessens the chances of recovery. Evidence is positive and overwhelming that the earlier the use of antitoxin in any given case the better the result and the greater the chance of recovery. Dr. J. M. Clements of Hull, England, in discussing diphtheria in elementary schools, and its prevention, said that the mortality among cases coming under his care from 1903 to 1906, classified to the day of the disease on which antitoxin treatment started, that of those coming under treatment on the first day was nil; on the second day 1.5%; on the third day 8%, etc., the mortality percentage rising with each successive delayed day. The intravenous injection of antitoxin in very late and severe cases lets loose immediately into the blood stream the curative agent and results in a quicker attack upon the diphtheria toxin or poison circulating in the blood. It would seem, therefore, they must. utilize another practical method of immunizing against diphtheria. The Schick test has made it possible readily to detect persons susceptible to the Klebs-Loeffler bacillus or diphtheria bacillus and if susceptible to be actively immunized with three injections of toxin antitoxin at weekly intervals. Schick re-tests should subsequently be made to determine the success of the protection obtained. Already in two institutions in Massachusetts there has been successfully carried out the Schick test and after immunizing with diphtheria toxin antitoxin these two institutions, where formerly diphtheria had been endemic and epidemic at times, have been able to keep their diphtheria rate to almost nil since the advent of this practical method of control. Each inmate on entrance is given the Schick test and if positive (meaning susceptibility to tÄ disease), is given three successive doses of diphtheria toxin antitoxin at weekly intervals. The re-Schick test is tried at intervals of six months, one year, two years, etc. In one institution where the work has been carried out for the past two years under the immediate supervision of the State Department of Health these re-Schick cases on persons once susceptible, that