does foreknow and foretell that when necessary he can with safety open the cavity of the knee, of the peritoneum, of the pleura, of the pericardium and of the pia mater.

In like manner, the hygienist, making use of those same priceless mental faculties,-observation and inference, attains a clear vision of the achievements of preventive medicine of the future, and in that future, which many of you will live to enjoy, there will be no prominence in the list of causes of death of consumption, pneumonia, scarlet fever, diphtheria, typhoid fever or the other communicable diseases; that, just as typhus fever, the plague and smallpox-diseases which, for centuries, caused a majority of all the deaths,-are now, to most countries, mere matters of ancient history; so the historian of the closing years of this century will recount the interesting facts as to the disappearance of the chief causes of our present death-rate.

I have said that the insight of the hygienist makes this expectation legitimate and natural; and have only to add that this medical millenium, while it is the pride, is not the boast or the work of the hygienist, or any other specialist in medicine or in science. When this consummation, devoutly to be wished. comes to bless the earth, it will be seen to be the resultant of many discoveries as to the cause of disease, the perfection of many methods as to the prevention of disease, but above all other forces will rate the work of the little red schoolhouse on the hillside where our humble millions are taught those priceless lessons of the three R's (reading, riting and rithmetic) where intelligent public opinion is made possible, because medical convictions expressed and crystallised in health laws and health ordinances, only become effective when loyally supported and executed by intelligent public opinion.

That the State of New York may, in due time, enjoy this blessing, there must be in the state one medical profession, compact and effective in unity of organisation, of such preparedness as is only possible when its individual members are men of high ideals, inspired with the hope and expectation of great accomplishments in the field of preventive medicine.

I have the belief, nay more, the conviction, that aside from any complimentary or personal element in the proceedings of this meeting, this review of the official activities of your recent representatives can but act profitably, to widen our ideas of the purposes. the scope, the responsibility of our medical societies, to stimulate pride in our profession and its high and ennobling purposes. Should something like this be the result of our evening, you, Mr. President and speakers, will not have striven or spoken in vain.

At the conclusion of Dr. Hopkins's remarks, Dr. Stockton moved that Dr. Hopkins's address be embodied in full in the minutes of this meeting. Motion was adopted.

President Wall then declared the meeting adjourned, and an impromptu reception to Dr. Hopkins imme liately followed, when

personal congratulations were tendered by the many physicians present.

A collation was served and, for a considerable period of time, the members remained in social intercourse.

ABSTRACT.

Excretion of Urotropin in Cerebrospinal Fluid; its Therapeutic Value in Meningitis.

BY S. J. CROWE, M. D.

Hunterian Laboratory of Experimental Medicine; Johns Hopkins Hospital Bulletin, April, 1909.

In a prior publication the author reported a case with cerebrospinal fistula in which a fatal outcome was looked for, and in which at Dr. Cushing's suggestion, urotropin in large doses was given in the hope of its cerebrospinal excretion. The boy recovered; and this led to the writer's further studies. Thus in cases of chronic nephritis, brain tumor or hydrocephalus. when lumbar puncture was to be done, the patients were given a 10- or 15-grain dose of urotropin; the cerebrospinal fluid removed was tested by a modification of Hehner's test, and urotropin was invariably found present. A number of observations made showed that the drug may possibly be absorbed as readily by the rectum as when given by the mouth.

In some instances urotropin was not given till the cerebrospinal fluid was dripping steadily from the needle, By testing specimens every few minutes, the first appearance, maximum concentration and gradual disappearance of the drug could be followed. After a 15-grain dose, the maximum concentration generally appeared thirty minutes to one hour later.

To determine if the amounts which appeared in the cerebrospinal fluid were sufficient to exert decided bactericidal action, the fluid taken from the body was inoculated with organisms and the inhibitive effect noted. The tables and photographic plates incorporated in the paper show a striking antibacterial effect. namely a reduction in the number of colonies from about 30,000 to about 500 within 1 hour 50 min.

The effect of urotropin on meningitis in animals, produced by subdural inoculation with streptococci, was to defer or entirely prevent death.

Though there is no accurate method of determining the amount of urotropin in the fluids. the impression was gained. from the comparative color tests of cerebrospinal fluid and urine, that in the case of animals with meningitis a larger amount of urotropin appears in the cerebrospinal fluid than in the urine. If this be proved, it would suggest some selective action, possibly

through the agency of the leukocytes, which have the power of taking up urotropin, as Vindevogel (Ann. Soc. Roy. Scienc. Med., Bruxelles, 1902, Vol. II) proved.

When the first dose of urotropin was given subsequent to inoculation of the animals, the infection was merely checked during the continuance of active therapy; as soon as the drug was withdrawn, the organisms began to multiply with a return of clinical symptoms. This is much the same experience as with urotropin in genitourinary infections, and is akin also to the author's experiences with the drug in biliary infections. Therefore the most marked therapeutic value of the drug seems for prophylaxis or at least in early infections.

During the past year it has become a routine measure in the Johns Hopkins Hospital to promptly administer urotropin to all patients with lesions, which are not infrequently followed by meningeal infection; and the complete absence of such complication in quite an extensive series of cases seems to fairly well establish the prophylactic importance of the drug. This series included a number of compound fractures of the skull, gunshot wounds of the head and cerebrospinal fistulas, the patients receiving 30 to 60 grains urotropin daily. It is also used prior to ventricular or lumbar puncture, when local conditions make possible the inoculation of the meninges with organisms from an infected skin; just so urotropin should be given before a first catheterisation or one done when urethral infection is present. Possibly, too, the drug may be wisely used in cases of extracranial infection when extension to the meninges is feared, as in infected scalp wounds, otitis media, suppuration of the cranial sinuses. Its use may be desirable also in elaborate spinal or cerebral operations.

The author summarises: (1) Urotropin, given by mouth, invariably appears in the cerebrospinal fluid. This fact has been demonstrated by a large number of observations on man, and is also true for dogs and rabbits; (2) The largest amount of urotropin is present in the cerebrospinal fluid from 30 to 60 minutes after ingestion of the drug; (3) after therapeutic doses, a sufficient amount of urotropin appears in the cerebrospinal fluid to exercise a decided inhibitory effect on the growth of organisms inoculated into this fluid after removal from the body; (4) following a subdural inoculation of dogs and rabbits with streptococci, 60 to 80 grains of urotropin a day, given under conditions which insure absorption, will markedly defer, and in some cases prevent, the onset of a fatal meningitis: (5) the prompt administration of urotropin is advised in all clinical cases in which meningitis is a possible complication, or even when meningeal infection has actually occurred.

BUFFALO MEDICAL JOURNAL.

A Monthly Review of Medicine and Surgery.

EDITOR

WILLIAM WARREN POTTER, M. D.

All communications, whether of a literary or business nature, books for review and exchanges, should be addressed to the editor, 238 DELAWARE Avenue, Buffalo, N. Y

VOL. LXIV.

JUNE, 1909.

No. II

State Educational Building

FOR several years past the need for better accommodations

for the education department of the state at Albany has been felt. Particularly has this been so since the unification of the University of the State of New York and the department of Public Instruction under the law of five years ago. The officers and employees, about three hundred in all, are widely scattered throughout several floors of the capitol building, besides using other buildings in remote sections of the city. This is inconvenient, delays the transaction of business, and increases the expense of administration.

But more than this, the danger from fire is considerable, in which case the probable loss of life must be reckoned upon, which would be without excuse should it occur. The state library needs more room and better light besides greater convenience.

For these and other reasons not necessary to mention at this time, the commissioner of education, Dr. Andrew S. Draper, took the matter up with the regents, who voted to ask the legislature for authority to construct a separate building, to house and properly accommodate all the interests in charge of the education department. Soon thereafter in conference with prominent members of the legislature a bill was prepared by the Commissioner of Education and introduced in the Senate by Hon. John Raines, providing for the acquisition of a site and the erection of a State Education Building. This bill passed the Legislature with but three opposing votes in both houses and became a law on May 31, 1906, through the approval of Governor Frank W. Higgins.

The Commissioner of Education in his fourth annual report went into the matter in great detail, giving a complete history of building. We extract liberally from the report:

Acting under the authority and direction of this act the Trustees of Public Buildings determined upon the two blocks in the city of Albany bounded by Washington Avenue, Hawk, Elk and Swan Streets with the exception of so much of the more