are always open to question by some. I have also feared lest I might really do harm by advocating a medical consideration and treatment of cancer, since thereby some might be led to neglect operative measures in proper cases, at the proper time; and so in certain instances great injury and injustice might be done to the patient, and the time pass in which a surgical operation might possibly be of great service.

"I wish, therefore, to repeat what I said before, that with our present knowledge competent surgical interference cannot be urged too early or too strongly in suitable cases; but I wish also to enter my strong protest against the course which is usually followed in regard to cancer, both before and after operation. With a rather extended experience, during the last forty years I have almost yet to find a case which has received adequate and continuous medical care before operation, with a view of discovering and rectifying the cause of the morbid growth. Too often when a cancer is suspected or discovered it is taken as a foregone conclusion that the malady is hopeless, except as the result of the disease, that is the new growth, may be removed by the knife, X-ray, radium, caustics, etc. And after a surgical operation, as far as my observation goes, the patients are invariably left entirely to their own resources, with the hope that the tumor will not regrow, but with no attempt so to guide the life that there shall not be the tendency to a recurrent malignant new formation."

Doctor Bulkley quotes with approval the statement of Ross, that there is potash deficiency in cancer patients, due largely to the method of cooking vegetables so as to deprive them of their natural salts. Potatoes, for instance, should always be cooked with their skins (which are rich in potash) or, better still, should be baked and eaten skin and all. Doctor Bulkley while endorsing this idea advocates the administration of potassium acetate to cancerous patients, and he believes that this practice has been responsible for much good.

teriologic laboratories, and there are also available for investigations the Berlin Institute for Infectious Diseases, the laboratory of the Kaiser Wilhelm Academy, and the Imperial Health Office.

The most important thing in controlling an epidemic is the discovery of early cases, not only persons who are clinically sick, but more especially the so-called germ carriers. These are the most dangerous because they are not confined to bed and may infect their environment. They must be kept under constant bacteriologic supervision as also the sick that are received from Belgium and France, who, although they have been vaccinated against typhoid, may still be germ carriers.

The German population has been made nearly free from contagious diseases through the organized anti-typhoid campaign and the isolation of all typhoid cases that appear in the army. The isolation rooms in hospitals are protected with gauze or wire netting at the windows from the access of flies and mosquitoes, as experience has shown that these are likely to convey disease germs to foodstuffs.

No stagnant water is permitted to remain in the neighborhood of the hospitals, and if pools cannot be drained they are sprayed with crude petroleum. The water-supply is bacteriologically examined, and when found necessary, the water is boiled before being used. Protective vaccination is employed in threatened typhoid and cholera.

The German surgeons serving with the troops at the front have been unremitting in their attention to duty, and the effectiveness of their work is told by the fact that the health of the troops has been exceptionally good, and so far no epidemic has arisen, even though the war has been carried on in adjoining countries where hygienic and sanitary conditions are not as good as they are in Germany. Vaccination has been strictly enforced, and where necessary has been carried out among the hostile inhabitants.

Apparatus for examinations for typhoid, cholera, and dysentery, and vaccination material are carried with the army. No greater testimony as to the progress that medical science has made in the last twenty-five years can be offered than the results presented in health conditions attending the greatest of all wars. When the history of the present war is written, the part that has been played by medical science in preventing and stemming the ravages of diseases which heretofore has crippled armies and added to the death loss, will stand as a monument to the thoroughness and effectiveness with which medical science has acted.

FATAL CASES OF MUSHROOM POISONING. There have been an unusual number of cases of mushroom poisoning this year. There have been deaths in New York City, Hartford, Connecticut, and in South Chicago, to mention only a few of the places where such cases have been reported. In the Indiana Medical Journal Dr. W. W. Vinnedge, of Lafayette, Indiana, reports three more fatal cases, as follows:

In the village of Altamont, about three miles southeast of Lafayette, Ind., there is a tile mill, which was owned and operated by the May brothers; besides this, the proprietors owned and maintained a dwelling house near the factory, and one of the men employed by them acted as cook and housekeeper therein; no females belonged to the factory force. Near the village is a native forest, of approximately twenty acres, known locally as "Morinsky's Woods." On the 5th of September last, five men, owners and employes of the tile mill, partook of supper, Saturday evening about. 6 o'clock, the central dish being mushrooms together with beefsteak, the former having been obtained from the woods above mentioned on the day they were cooked and eaten.

The names and ages of the men at the table were: Jacob May, single, 38 years old; William Ogden, single, 38 years old; George Baudy, widower, 52 years old, and Michael May, single, 40 years old; the fifth man at the fatal supper, Isaac Brickler, did not eat of the mushrooms "because they did not look right" to him. Of those who ate of the prized dish, the three named first died in thirty-six, thirty-eight and sixty hours afterward, while the fourth survives and is slowly recovering his health and strength. The supper was appetizing, and the men were just from the mill and hard work at the end of the day and week, and, it is said, were hungry and ate heartily. All of the unfortunate men enjoyed reputations for sobriety and integrity.

In the details of this sad misadventure, the symptoms of poisoning followed the usual course and behavior of those outlined in the textbooks, namely, first, colic six to eight hours after the supper, ingestion of the mushrooms, which was soon followed by nausea, vomiting increasing in violence, depression, partial collapse, somnolence, and finally death.

According to authorities, children are more susceptible to the toxic effects of poisonous mushrooms than adults, while the difference in its effects in adults is accounted for on the ground of special individual conditions, sometimes of idiosyncrasies, quantities eaten, etc.

The public and the Journal readers will without doubt appreciate the words of J. C. Arthur.

B. S., Botanist to Purdue Experiment Station, etc., a recognized authority and teacher within this subject. He says: "The most deadly mushroom known is the 'death cup,' so called from the cup at the base from which the stem arises. A visit to the field which supplied the mushrooms for the fatal meal revealed an unusual number of individuals of this species (Amanita phalloides). These mushrooms grow singly or grouped on the ground, are pure white throughout, or less often varying to yellow or brown, four to seven inches tall, smooth on top, with a ring around the stem. The cup about the swollen base of the stem is either large and conspicuous or thin and easily overlooked. It is often left in the ground upon pulling out the mushroom. The flesh has no unpleasant taste.

"The poison of this mushroom acts slowly at first, but it is very deadly. No antidote has yet been discovered for it.

"A second deadly mushroom is the 'fly agaric,' so-called from its use as a fly poison (Amanita muscarius). It has a similar form, including a basal cup, but the upper surface is slightly sticky, is usually brilliantly yellow or reddish orange, and rough or ragged, with few or many warts or loose scales.

"The poison of the fly agaric is chemically distinct from that of the death cup. It acts more quickly, and is equally powerful, but atropin has been found to be a perfect antidote for it under favorable conditions.

"Both of these deadly mushrooms (some persons say toadstools) are cosmopolitan, but usually quite rare in Indiana. There are other poisonous, indigestible, or noxious species found in Indiana, but none at all comparable with these two.

"There is no general rule by which one may distinguish a poisonous mushroom from a harmless one. Such tests as taste, color of flesh when broken, action on silver, etc., etc., are worthless. The only safe guide is to know the individual kinds at sight, as one learns to distinguish a carrot from a beet, and only to eat those positively known to be good. Indiana is fortunate in having many kinds of edible mushrooms, some of unusual size and abundance, which should be better known and more largely utilized."

As a further discussion, Robert F. Hight, B. A., formerly instructor in botany and biology in the Lafayette high school, and a recognized authority within this subject, says in substance that there is a popular fallacy to the effect that there is a line of demarcation between toadstools and mushrooms. There is no distinguishing mark between them; they are all simply fungi which vary

greatly in appearance and effects when taken into the human body; some of them are poisonous, some more so than others, while the majority of them are not poisonous and are therefore edible. Some of the poisonous ones contain muscarin, a violent poison, while others contain phallin, a less violent but deadly poison.

The so-called death cup variety contains this principle. It acts on the corpuscles of the blood, frequently causing exhaustive diarrhea. There is no general rule of any value by which one can tell whether those white mushrooms are edible or poisonous. Some persons endeavor to decide which are harmless or which poisonous by observing the color when the stalk is bruised, but sometimes both edible and poisonous ones change color, and some poisonous ones as well as perfectly good ones will turn silver black.

Mushrooms that are in the least decomposed should not be eaten, nor should those that are collected when in the button stage of their development, nor should old ones be eaten, nor those that have a swollen base at the bottom of the stalk. The only absolutely safe mushroom known to Hight is the morel, the sponge variety, generally found in the spring of the year.

LIQUID PARAFFIN AS A LAXATIVE. As a laxative, says Earp in the Indiana Medical Journal, liquid paraffin has become very popular. Some consider it astonishing that it is one of the agents of modern therapy that is based upon empiricism and is yet used extensively. For several years Doctor Earp has found that it answered a purpose which could be accomplished by no other agent. It seems to give nature an opportunity to perform a function without damage such as we sometimes get from certain laxatives or purgatives. There is no pain and no exhaustion following its use, nor is it necessary to increase the doses; on the contrary, we find that it is possible to lessen the dose and its frequency and still get good results after its use. Often good results may be noted for a considerable period of time after it has been stopped. Furthermore, it is one of the remedies that will very materially assist in overcoming constipation.

In the instance of one patient who had chronic constipation attended with severe pain at each evacuation, who had been using the enormous dose of twelve teaspoonfuls of a proprietary salt each day followed by an enema to move the bowels, Dr. Earp gave the liquid paraffin and on the second day she phoned me that eight ounces had been taken, but there was no movement. On her own volition she took a teaspoonful

of sulphate of sodium and in two hours an enormous amount of fecal matter passed with ease and afterwards only the paraffin in moderate doses was necessary. In this case as in many others he found that a rectal disturbance was entirely relieved.

A few years ago no one heard of liquid paraffin and now its consumption is enormous. No doubt in a short time we shall find contraindications or bad results which will limit its use, but at present it seems to be a permanent and valuable weapon in the fight against intestinal intoxication, and its myriad fatal sequelae, containing no oxygen, is not saponified or emulsified, and produces no fatty acids to irritate as in the case of olive or cotton seed oil, once so popular.

It contains no stimulants to the muscle and has no irritative or osmotic action to increase the fluid contents of the feces. It acts purely as a lubricant, supplementing the normal mucus, and thus materially assists the peristaltic action of the muscles. All of it may be recovered from the feces.

The dose varies from a teaspoonful to two tablespoonfuls from one to three times a day, preferably a half hour before meals. It is cumulative in action, and the full effect may not be experienced for several days or even two weeks if small doses are taken, and moreover the results may persist for a week or more after ceasing to take it.

There is some evidence that by relieving the strain on the intestinal muscles it actually strengthens them; by removing the irritation of hardened feces it restores the normal mucus; by facilitating evacuations it re-establishes the lost habit of regular and periodic movements; by coating the fecal masses it restricts absorption of poisons; and it is not accompanied by pain, colic or straining.

It is easy to take, being devoid of taste or odor, and of the consistency of glycerine. Many object to the oiliness, and various mixtures have been devised to conceal this characteristic, but a little effort will overcome the objection to the pure oil. It must be freed of all sulphur compounds, acids and fluorescent lighter hydrocarbons, all of which are more or less poisonous. It sometimes escapes from the rectum, but the sphincter soon becomes educated. It has been proved useful in simple stasis, visceroptisis, hemorrhoids, mucous colitis, pregnancy and the exasperating constipation of infancy and childhood. We must be on the lookout, however, for contraindications, for it is a comparatively new remedy, and there has not been sufficient time for all its effects to become known.

EXPERIMENTAL TRANSPLANTATION OF

TESTES.

Dr. G. Frank Lydston, of Chicago, some months ago undertook a very interesting experiment upon himself the transplantation of a testicle from a young man, recently dead, into his own scrotal sac. He describes this operation in an article printed in the New York Medical Journal.

Seven hours after securing the necessary material, and twenty-four hours after the death of the subject from which it was removed, I implanted in my right scrotal sac one of the experimental testes. The operation was performed in my office, with the assistance of my former associate, Dr. Carl Michel, whose loyalty and intelligent co-operation throughout my experiments cannot be too highly commended.

The conditions,

so far as asepsis was concerned, obviously were not those of an up to date operating room, with the usual corps of nurses, but were as satisfactory as was possible under the circumstances.

Technic: Local anesthesia was employed-a ten per cent. solution of novocaine in one per cent. urea and quinine hydrochloride. Of this I injected about a dram and a half. The anesthesia was satisfactory so far as the skin was concerned, but by no means so as regards the deeper tissues, merely because I took especial care not to puncture the veins of the cord and also to avoid infiltration of the tissues about the cord at the site selected for the implantation.

I made an incision two inches in length, in the mid-scrotal region, about an inch external to the right of the scrotal rhaphé, and dissected down to the cord. The awkward position necessary to the work and the distance of the field from the operator's eye were such that I inadvertently cut into the tunica vaginalis. The escape of vaginal fluid and the appearance of the testicle at the bottom of the wound gave the first intimation of the accident. I requested Doctor Michel to close with a pursestring suture of very fine catgut the opening in the tunica vaginalis, and proceeded with the operation.

I next made beneath the deep fascia a pocket about two inches in depth, at the bottom of which was the cord. Into this pocket, directly upon the cord, I implanted the testis, already prepared by removal of the epididymis and decortication to the extent of about half its surface. The fascia was closed with a pursestring suture of fine catgut, following which, bismuth subiodide and the usual gauze dressing were applied and a suspensory was adjusted.

Postoperative course: Probably because of undue movement, the exigencies of my practice at the time making it impracticable for me to rest

physically, there was a little superficial hemorrhage, forming a small clot immediately beneath the skin incision. Saprophytic infection occurred, with considerable edema of the penis and scrotum, extending well up toward the inguinal ring. On the fourth day I opened the superficial portion of the wound, drained, and asepticized it. There was not then nor subsequently any pus infection during the progress of healing. There was a little over 1° F. rise in temperature, lasting four or five days.

There was considerable pain following undue motion, on the eighth day after the operation, and a small quantity of seminiferous tubules protruded from the wound, the pursestring fascial suture evidently having given way. Although there was no rise in temperature and, as already stated, no pus infection, I now concluded that the experiment was a failure, and decided to remove what apparently was a somewhat dangerous foreign body. I therefore requested Doctor Michel to remove the implanted gland, and as there was a little resistance when traction was made on the protruding gland tissue at the bottom of the skin (i. e., the extra fascial wound), he attempted to remove it entire by forcible traction. The resistance to traction and the pain attending this procedure demonstrated pretty conclusively that it would have been wiser to let the gland remain.

I

The gland splitting longitudinally, only half of it, and, strange to say, the more solid portion, covered by the tunica albuginea, came away. This, on examination, showed well formed and abundant vascular adhesions, which apparently conclusively showed that the implantation was a success. therefore resolved to leave the decorticated remaining half of the gland in situ. At the time of the implantation the semidecorticated gland was so soft and so readily became extruded, that it was with difficulty retained in the implantation cavity while the pursestring suture was being inserted and tied. Had I remembered this circumstance, the mere fact that a moderate amount of traction, or even slight pressure, was not sufficient to dislodge the implanted tissue from its bed and extrude it, would have suggested the wisdom of allowing the gland to remain.

After the removal of the portion of gland there was some increase in the local inflammatory symptoms, due to simple trauma. This, however, subsided within forty-eight hours. Immediately following the removal of the gland tissue, there was a moderate discharge of a mucosanious looking secretion, which continued in gradually diminishing quantity for five weeks, at which time the sinus. was completely healed. The tardiness of healing in a noninfected wound is worthy of note, suggest

ing the characteristics of fistula of glands in other regions, notably the parotid.

Numerous microscopic examinations by Doctor Michel of the fluid from the fistula showed blood corpuscles, leucocytes, and immature spermatozoids, such as normally are found in the testis prior to their complete elaboration in the epididymis. There was no evidence of pus infection, the fluid being free from pus cocci.

After the extraction of the portion of the gland, there was no further appearance of seminiferous tubuli in the wound, neither was there any debris nor broken down gland tissue in the secretion from the "fistula." After the inflammation in the surrounding tissues had completely subsided, a distinetly circumscribed, ovoid, insensitive body adherent to the spermatic cord could be distinctly felt. This mass measured approximately 4.5 cm. by 3 cm. by 2 cm., and was evidently composed of the remaining portion of the testicular gland structure, with a certain amount of new connective tissue investment.

Throughout the progress of healing there was considerable neuralgia of the traumatized cord and testis and moderate pain and sensitiveness in the opposite testis. Later the pain gradually disappeared.

The result has been inspected and verified by a number of my professional friends.

The size of the mass has gradually decreased. June 1, 1914, it was a smooth, fairly movable, ovoid, insensitive, circumscribed, typically glandular body, about the size of a small almond, still loosely attached to the spermatic cord. At present writing, August 1, 1914, the mass is nearly round, about the size of a hazel nut, and, strange to say, slightly sensitive. It has not diminished much if any in size for several weeks, although I have expected still further shrinkage. I have noted that it varies considerably in size at different times. This is very suggestive of actual function. *E VE VE

TREATING SCARLET FEVER. At this time of the year there are beginning to be cases of scarlet fever requiring the physician's attention. Likely to be helpful is the advice given by Dr. Samuel S. Woody, in the Therapeutic Gazette. First, he advises keeping patients in bed for at least four weeks, with a daily bath, and a tepid sponge every third hour where there is fever. Inunctions to prevent the scattering of scales are not called for, the idea that the disease is disseminated through this medium having been abandoned. During the acute stage a restricted milk diet is advised; but in addition to the milk some fresh fruit juice may be given daily. In septic cases additions to the milk diet must be

In

made sooner than in the mild cases, and malted milk, soft-boiled eggs, strained oatmeal and arrowroot are allowed under such circumstances. cases complicated by vomiting rectal feeding may be necessary.

The medical treatment is comparatively simple. A bright, well-developed rash denotes good heart action and is to be desired. Should the rash be scant and not of a bright-red color, the use of external measures, such as the hot pack, the mustard pack, or wrapping the patient in hot blankets, is called for. This is true even when the temperature is excessively high, because the resulting increase in skin elimination will bring with it a drop in temperature and render the patient less restless.

During the fever I routinely give potassium citrate, alone or in combination with sweet spirits of niter and solution of ammonium acetate. These act as a febrifuge or diuretic. The citrate is given until the temperature has been normal for four or five days. Then Basham's mixture is substituted, and later, when the patient is on a full diet, the syrup of iodide of iron with syrup of hypophosphites compound is the tonic of choice.

In the hospital work the hair of all patients under fourteen is cut. In private practice the physician must be guided by circumstances.

Although the treatment aimed to counteract the causative agent of scarlet fever has so far been of no avail, yet this has been attempted. The use of polyglot vaccines from many strains of streptococci has not given results of value and has been abandoned. At present at the Philadelphia Hospital for Contagious Diseases we are making certain investigations in the use of a leucocytic extract, made after the method of Hiss. We hope to say more later concerning this. Attempts also have been made to influence the course of the disease by the use of blood serum obtained from convalescents, the serum being tested by the Wassermann reaction and used with every necessary precaution. Hitherto it has been impossible to obtain the serum in sufficient quantities to furnish facts as to its value.

Treatment of special symptoms and complications of scarlet fever is a matter of greater difficulty than the management of a simple case. The mouth and throat should be subjected to a thorough daily inspection. It is possible for the mouth at any stage of the disease to show evidences of all forms of stomatitis, of tonsillitis, diphtheria, Koplik's spots, or Vincent's angina. In the ordinary sore throat of scarlet fever nothing further is required than a mild gargle-salt solution or a mild alkaline wash, such as liquor antisepticus alkalinus of the National Formulary suitably di