MUIR AND BROWNING (1909) were the first to show that alexin is retained by the filter when fresh serum is passed through a Berkefeld candle. Several filtrations are generally required to remove all traces of the alexic activity, although when a fresh candle is employed for each filtration, the third or fourth filtrate is usually devoid of alexic power (Schmidt, 1914). It is not established whether or not the failure of later filtrates to haemolyse sensitised erythrocytes results from the removal by the filter of some one or of all of the known components of alexin from the serum. We have, therefore, studied the effect of Berkefeld filtration upon the alexic activity of fresh human serum with respect to the thermolabile elements, and the thermostable third and fourth components (Whitehead, Gordon and Wormall, 1925;Gordon, Whitehead and Wormall, 1926). EXPERIMENTALThe fresh human serum was passed through a series of twelve properly prepared Berkefeld filters', and the various filtrates were tested for the presence of the several components of alexin. Portions of the same fresh serum which were treated by heat (56°C. for j hour), by zymin2, and by ammonium hydroxide3 and which alone were entirely without haemolytic power (see Table II), were used to test for the presence of the thermolabile elements, the third component and the fourth component respectively. 1 The filters were washed thoroughly with hot, dilute sodium hydroxide followed by distilled water until the filtrate was no longer alkaline to phenolphthalein.2 Zymin was prepared in a manner similar to that described by Whitehead, Gordon and Wormall (1925). A cake of Fleischmann's yeast was shaken with 25 c.c. of absolute alcohol for i hour, then with a like amount of absolute ether for the same period. To the residue was added 25 c.c. of physiological sodium chloride solution and the mixture was boiled for J hour. The sediment obtained by centrifugation represented the zymin employed in this work. The serum was inactivated for the third component by adding an excess (25 per cent. by volume) of the zymin and incubating the mixture for 2 hours.3 Ammonium hydroxide of 1/6.5 normality was used to inactivate the fourth component of the fresh serum. Twenty-five per cent. by volume of the ammonia was added to the serum and the mixture incubated at 370 C. for 11 hours (Gordon, Whitehead and Wormall, 1926). After its pH was adjusted to about 7-5, such a serum was satisfactory to test for the presence of the fourth component.

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Five additional cases of galactosemia are added to the steadily increasing number of reports in the literature. A follow-up note is included regarding a sixth case in a patient now 18 years of age, previously reported from this hospital. Two of these cases developed cirrhosis of the liver in a manner suggesting that galactosemia per se was the cause. Histologic examination of the liver in both cases confirmed the anatomic diagnosis. A 10 year follow-up on Mason and Turner's reported Case 7 demonstrates that the illness is chronic but that with advancing years, demonstrable evidence of somatic damage is lacking. Mental retardation is a common complication of the disorder in the present investigators' experience. Cirrhosis of the liver accompanying galactosemia appears to be reversible, so far as can be determined.

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