Following our work on the experimental preven¬ tion, or cure, of the typhoid carrier condition in rab¬ bits, Dr. Claypole and I7 expressed our intention of transferring our results to the treatment of typhoid fever in human beings, largely on the basis of the phenomena of specific hyperleukocytosis which we have described. We found, in brief, that the injection of typhoid bacilli in immunized rabbits, or the injec¬ tion of sensitized typhoid bacilli in normal rabbits, gave rise to a

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... tic crisis which occurred about eighteen hours subsequently, and was accom¬ panied by a complete destruction of the injected living bacteria in the animal's body. Although we had in mind the treatment of patients by means of the killed, sensitized typhoid vaccine sediment, which we had developed for the prophylactic immunization of human beings, before the publications of Kraus and of Ichikawa, it is only recently that it has been possible to carry out our intention. Owing to the courtesy of a number of physicians in Oakland, Berkeley and San Francisco we have been able to treat twenty-two cases of typhoid fever by the intravenous injection of this modified, sensitized vaccine. In all cases the diagno¬ sis was verified by blood culture and Widal reaction. In seventeen of these cases it has been possible to carry out the treatment exactly as intended, and in this lim¬ ited number we have produced an abortive cure in eight, or 47 per cent., following either a single or two or three injections. The average day, in these cases, on which the temperature reached normal permanently and the patient was symptomatically well, was the nine¬ teenth. In no case have dangerous symptoms, refer¬ able to the vaccine, been noted when moderate doses were used. The best dose, apparently, corresponds to about 300 million micro-organisms, and this dose, in an adult produces the characteristic reaction on which the abortive cure apparently depends. This reaction, as other recent observers have mentioned, consists in a chill within half an hour following the injection, accompanied by a rise in temperature of 1 or 2 degrees, followed by a fall in temperature to normal or subnormal in from twelve to twenty-four hours. We find that the initial rise in temperature is accom¬ panied by leukopenia and the corresponding fall by hyperleukocytosis which, in some cases, has reached as high as from 20,000 to 40,000 per cubic milli¬ meter. The increase is due almost entirely to polymorphonuclear leukocytes. The fall in tempera¬ ture is invariably accompanied by symptomatic amelio¬ ration, and in successful cases the temperature either remains normal, or with a few fluctuations reaches a permanent normal in a day or two. We are not able to state, as yet, what relation the pres¬ ence or degree of hyperleukocytosis may bear to the recovery. Another significant fact is that the cases which were apparently cured by this treatment have all given a positive Widal reaction, and usually in high dilutions, for example 1:320 or 1:640. In two of the nine cases that were not abruptly cured, the Widal was negative in a dilution of 1: 10 and remained so, and in none of these cases did it exceed a dilution of 1:80. This suggests, at least, that the cure is due to the cooperation of the hyperleukocytosis and the presence of substances antagonistic to the typhoid bacilli in the serum. Such a combination would give the ideal con-7. Gay, F. P., and Claypole, E. J.: Specific Hyperleukocytosis, Arch. Int. Med., November, 1914, p. 662. dition for the destruction of the typhoid bacilli which may exist in the patient's body. These observations further suggest that a higher percentage of successful results might be obtained by treating patients, particu¬ larly when the Widal is negative, by a combination of sensitized vaccines and immune serum. Following light ether and oxygen anesthesia and the enucleation of enlarged tonsils, a young woman, aged 22, under my care at the Flushing Hospital (private, serial No. 251), developed severe reactive symptoms which led to a diagnosis of hyperplastic thymus. In this manner, my attention, like Crotti's,1 was called drastically to the possibility of discovering this condition prior to operation. Since that time, several cases have been studied, methods of diagnosis perfected and the following sign, which appears during fluoroscopic examination of the chest, uncovered. Delicate shadows corresponding to the lateral borders of the thymus and the shadows internal, move outward and inward with each cardiac systole and diastole. In uncomplicated cases, there is no movement with respiration even when a deep breath is taken. On the contrary, shadows which represent the bronchial tree move upward and downward with each inspiration and expiration and show only slight cardiac movement in the immediate neighborhood of the lung roots. By Roentgen ray, no two thymus glands present the same outline. They may be classified, however, according to their apparent position into two varie¬ ties. The first, smaller, rounded, lies just below ' the "critical space of Grawitz" or the superior outlet of the thorax. The shadow of the upper border is lost behind the sternoclavicular articulations and that of the first ribs. Laterally, this shadow appears in the second interspace, more particularly toward the left. It encloses on the left the shadow of the aortic arch, and as that organ moves in young persons, it gives movement to the thymus shadow. There is little or no movement in the right interspace. The lower border of the thymus in this type rarely reaches lower than the lower border of the third rib. The second type fits over the base of the heart like a toboggan cap. The lower border may reach down¬ ward as low as the sixth rib. Laterally, the shadow will be found to conform to the percussion bounda¬ ries usually given in the textbooks on medicine. Usually, though not always, the shadow is more marked toward the left ; I have seen one case in which the left lateral border measured 4^2 inches from the me'dian line. Toward the right the border may extend 3y2 inches from the median line. The appearance of such a shadow is apparently character¬ istic. It is denser than contiguous lung tissue. The portion overlying the left auricle moves outward and upward ; that overlying the left ventricle, outward and downward ; that overlying the right auricle moves to a less extent than the portions previously men-1.