ton will always have a relatively excessive population in the active period of life. It has also a very considerable excess of females between 20 and 40. Pneumonia at the most impor¬ tant period of life appears to be diminishing, and Washington has precisely the elements of population which enable her to profit by this decline. If the mortality of the District could be equated so as to be comparable with that of such cities as New York, Chicago, Richmond and Baltimore, the true state of affairs

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... would not be found just such as the raw figures indicate. It might appear that Washington has had an increased mortality from pneumonia at a certain period of life, namely, below the age of 5. If pneumonia has really increased, Dr. Fulton's opinion is that the increase has fallen on very early life. Dr. E. F. Wells said that in presenting this paper he inten¬ tionally allowed every mooted question, as he thought, to re¬ main out of the paper. The basis of the belief, for example, that the pneumococcus is the cause of pneumonia, the bearing which different strains of pneumonia have on the character¬ istics of the disease, the possibility of infinitely increasing or decreasing the. virulency of each of these individual strains, the connection between the organism which Surgeon-General Sternberg found in his own mouth, and in the mouths of others, and that of the organism found in pneumonia, and the evidence on which we believe one to be the same as the other, he entirely omitted, and intentionally, because he did not wish to take up time. He desired to present as clearly as possible certain facts which he believes have a bearing on the propa¬ gation and increasing prevalence of pneumonia, and to offer some suggestions by which it might probably be diminished. In another section he presented some facts along these lines, which, however, are well known, that not only are the pneumo¬ coccus and other pathogenic organisms distributed by means of the sputum from the throat and nose of men and women, but in a more insidious manner, by coughing and sneezing, and throwing a minute number of particles into the air, with a possible and probable bearing on the dissemination of this organism and the increasing prevalence of pneumonia. Dr. Wells said that he feels fairly sure of the ground on which he stands, and will continue his efforts to find a public ready for reasonable and available methods for the prophylaxis of pneu-A suggestive coincidence bearing directly on the. dis¬ orders referred to in this paper, epilepsy, puerperal sep¬ ticemia, tetanus and hydrophobia, is that several inves¬ tigators have been led to conclude by experiments, in which each organ was studied individually, that the adrenals, the pituitary body and thyroid not only influ¬ ence metabolism, but that they are also concerned with the destruction of toxic waste-products. Thus, in 1891, Abelous and Langlois1 advanced the view that the func¬ tion of the adrenals was to "neutralize or destroy toxic substances produced or elaborated during chemical in¬ terchanges, and particularly those resulting from mus¬ cular work." In 1894 Lloyd Andriezen2 concluded that "the pituitary gland exercises a trophic action on the nerve tissues, which, in more definite terms, means en¬ abling them, a, to take up and assimilate oxygen from the blood stream, and, h, to destroy and render innocu¬ ous the waste-products of metabolism." As to the thy¬ roid, it may be said to have been connected with both these processes almost since any function was ascribed to this gland. "According to one hypothesis," says Howell,3 "the function of the secretion is antitoxic. In some way it antagonizes toxic substances supposed to be formed in the body in the course of normal metabol¬ ism." The interpretation of the functions of these three or¬ gans which I submitted last year,4 merges all these hypotheses into a coherent whole; it explains, also, the manner in which metabolism is sustained by all three organs simultaneously, and how the toxic waste prod¬ ucts are destroyed. When we consider the vast array of facts on record attesting to a close relationship between these toxic wastes and the diseases in question, it can not but appear that the interpretation referred to may serve to throw some light on the pathogenesis of these diseases, and, perhaps, open new lines of thought in the direction of their treatment. Since my views were published considerable personal work and new facts contributed by experimenters have only served to strengthen the position then taken as to the functional relationship between the adrenals, the pituitary body and the thyroid. To illustrate the connection between the interial secretions and the dis¬ eases mentioned, it is necessary to briefly review the evi¬ dence attesting the existence of what I have termed the "adrenal system" as it appears enriched by these new facts. The marked blood pressure raising power of adrenal extractives and their action on the heart are well known. That the secretion of the adrenals produces identical ef¬ fects has been established experimentally. Gottschau,5 Stilling,6 Manasse7 and Auld8 observed that hyaline masses were secreted by rows of cells in the medullary canal of the organ, and that pressure on the latter caused these masses to pass into the blood vessels. Pfaundler9 discovered similar masses in the latter and in the suprarenal vein where it opens into the vena cava. Cybulski, Szymonowicz10 and Langlois11 then ascer¬ tained that blood drawn from the suprarenal veins pro¬ duced effects similar to those that follow injections of adrenal extracts, and Biedl12 found that, while blood taken from other veins produced no effect when injected intravenously, blood taken from the adrenal veins used in the same way produced the characteristic effects of adrenal extracts, i. e., slowing of the pulse followed by a rise of blood pressure. How is the functional activity of the adrenals in¬ creased? To ascertain the identity of their secretory nerves, Biedl tied the vena cava below the adrenal veins, inserted a small cánula above the latter, and registered the number of drops of blood that escaped from it. On 3. Howell: Trans. Cong.