Gallstone ileus is a surgical emergency that occurs almost exclusively in the elderly. It is of increasing significance with current demographic changes. Clinical records and diagnostic imaging of 15 consecutive patients treated for gallstone ileus at one hospital over a 6-year period were reviewed. The median patient age was 80 years. Six plain-film diagnoses were made correctly. Contrast studies provided a diagnosis of intestinal obstruction in four patients. Abdominal X-ray findings were assessed incorrectly in two patients, with one false-positive and one false-negative result. The median preoperative hospital stay was 2 days. Three patients had Bouveret's syndrome, two of whom required a gastrostomy and enterolithotomy, and one of whom required a gastroenterostomy. The remaining 12 patients underwent enterolithotomies. Only one patient underwent a cholecystectomy. There was one postoperative death. No patient had biliary symptoms on follow-up. Gallstone ileus is a difficult clinical and radiologic diagnosis. Enterolithotomy alone is adequate treatment in the elderly, and subsequent cholecystectomy is not mandatory.

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In a previous paper ( I ) we have demonstrated the lipoidal nature of serum antitrypsin and have discussed the various methods which may be employed to remove the antitrypsin from the serum; i. e., by extraction, or by the saturation or oxidation of the unsaturated carbon bonds of the fatty acids on which the antitryptic property depends. In view of the fact that practically all sera contain proteolytic ferments, we undertook to determine whether or not sera from which the protective substance had been removed, with resulting exposure of the serum proteins, would be toxic for the homologous animal; and if so whether complete removal of the lipoids was necessary to produce toxic effects. Apart from the interest that such a study would have in relation to the production of the so called anaphylatoxins, we felt that numerous pathological conditions, which at present are not wholly understood, might possibly have their basis in a protein intoxication,--a true auto-intoxication in the sense that the toxic substances were formed from the serum or cellular protein of the host, and without reference to the gastro-intestinal tract. We have in mind particularly such conditions as arteriosclerosis, nephritis, asthma, and acute acidosis in infants. The work of Longcope (2) supports this idea. He observed that repeated injections of egg albumen into sensitized dogs and cats caused nephritis and other organic lesions.

It is our belief that the analyses of histories of cases of epidemic meningitis which have been presented in this article furnish convincing proof that the antimeningitis serum when used by the subdural method of injection, in suitable doses and at proper intervals, is capable of reducing the period of illness; of preventing, in large measure, the chronic lesions and types of the infection; of bringing about complete restoration to health, in all but a very small number of the recovered, thus lessening the serious, deforming, and permanent consequences of meningitis; and of greatly diminishing the fatalities due to the disease.