very pale and ghastly looking, was outside under a tree. Like all Indian fathers this one was anxious to have his son married to carry on the race; he had been urging his son for some months past to comply with his wishes. At last in desperation the young man had taken a knife and cut off his penis. He did not wish to enter the hospital as a patient or have any treatment; he wished to become a sadhu, or holy man, and to lead the simple life. The wound was full of clotted blood, but there was no longer any bleeding. He left the hospital almost immediately and did not return to it.-W. W. V. ABDERHALDEN'S TEST FOR MALIGNANT TUMORS. It seems strange that more work is not being done in this country which would lead to definite conclusions as to the value of this test. American observers have carried on extensive investigations in the serodiagnosis of pregnancy, but the field of cancer diagnosis, one of vastly greater importance, has been comparatively neglected. In other countries, on the contrary, series of tests are constantly being reported, and while the reaction seems to be accurate in nearly all instances, there are occasional failures. These are of such a nature as to justify the belief that some modifications in technique may be elaborated after further experimentation by which these occasional sources of error will be eliminated. Brockman (Lancet, November 15, 1913), from his experiments (twenty-five carcinomatous cases, all positive; twenty noncarcinomatous, all negative reactions) and consideration of the literature, believes that there has already been collected sufficient evidence to show that the serum of cancerous patients contains a specific substance not found in the blood of those not affected, and that it has proteolytic action limited to cancerous tissue. He also finds that stale serum becomes inactive, but regains its action upon the addition of a small amount of fresh human serum; and that the better the patient's general state of health the more rapid and intense is the reaction. This latter statement is of especial interest because of its showing the possibility of very early diagnosis in cases of suspected malignancy-diagnosis at the time when surgery offers the greatest hope of the complete eradication of a cancerous focus. This point was shown very forcibly by one of the cases reported by Wolter (Russki Vrach, 1913, No. 32, abstracted in Zentralblatt f. Chir. No. 50), where the patient gave a positive cancer reaction, died from some other affection, and at autopsy there was found a new growth only 1 x 11⁄2 cm. in size in the esophagus. The total number of cases examined by him was thirtytwo, of which seventeen were cancer, all giving a positive reaction. Fourteen of the fifteen noncancerous patients gave a normal reaction. Erpicum (contribution a le'etude du sero-diagnostic du cancer) applied the Abderhalden test in forty-two patients with tumors the histological structure of which was determined after operation. All malignant gave positive, and all benign gave negative reactions. Von Gambaroff (Munchener medizinische Wochenschrift, 1913, No. 30) reports that in fifty cases of malignant tumors the reaction was positive in forty-nine, the single error in diagnosis appearing in a case of lues. He also found that the serum of those having carcinoma reacts only with carcinomatous material; the serum of those afflicted with sarcoma never with nomatous but always with sarcomatous material. He thus confirms Brockman's observations regarding the selective action of the serum.-Editorial in the Medical Record of June 10, 1914. carci HYDROTHERAPY IN TYPHOID. During the course of an article on typhoid fever in the April issue of the New York State Journal of Medicine, Gleason says: "It is evident from published reports of typhoid treatment that the use of cold water as laid down by Brand is losing favor. Whether our typhoids are not as W. W. V. THEORIES CONCERNING THE THY- severe through modern methods of treat- with distinctness at a short distance, ment, or the typhoid state rarer than even though he should shout." twenty years ago, is a question, but it is positive that the cold sponge, wet pack, and ice water enema are much more in evidence than the tub plan of Brand. We appreciate that persistent high temperature must be combatted, and after eliminating any unusual cause, cold water is our best aid, applying it judiciously and holding in mind the principles of governing the temperature curve. Outside of the lines of treatment laid down, the general management of typhoid fever is largely expectant. It is for us to meet emergencies as they arise, using little medicine, but maximum doses of common sense." A correspondent (The Lancet Feb. 14, 1914, p. 500) draws attention to the tuning-fork as a means of diagnosing enlarged organs, or effusions into the pleura, and the like. He says: "A tuning-fork is of great asistance in examining the chest, but it is especially advantageous in marking out lung cavities or dilated tubes. Even in these conditions certain physical factors, such as the presence of much fluid or of pus, will lessen the diagnostic aid of the fork. But when a cavity is dry the reverberation of the dominant note is distinctly increased over the cavity, and is diminished as the instrument is carried away from the lesion. Again, in men with hard, almost solid, ribs the sounds are better conducted, as one would expect, than in children and young people with more elastic ribs, which are not such good conductors. Different cavities have different dominant notes, and therefore respond varyingly to a fork in G or in C or other note. This I believe is in accordance with the experience of speakers, clergymen and others, who have to address audiences in large halls, churches, or cathedrals. If the voice is pitched to the dominant note of the building the speaker is heard at the periphery, but if he speaks on an unsympathic note he will only be heard Grumme considers Graves' disease, myxedema, cretinism, foiter, hyper- and hypo-thyroidism. From his speculations he seeks to draw some practical conclusions, such as: Cretinism, myxedema and endemic goiter are all benefited by organic (thyroid) iodine. In the endemic goiter of mountainous countries, which is to be regarded as an incomplete cretinism, inorganic iodine acts more intensively than organic iodine, causing improvement, i. e., reduction in size of the goiter. In Graves' disease all iodine is harmful, even foods which are rich in iodine (marine fish). Apparently simple goiter of the plain and lowlands, since it often represents a step toward Graves' disease, is also aggravated by iodine. Naturally, cases arise of simple goiter in which the crucial factor of altitude is in abeyance-for example, after a migration from low to high lands. In such cases to give iodine would be a blunder. The history, therefore, must be investigated in cases of plain goiter, and with added reference to previous treatment. Several blood tests are also available to distinguish an incipient goiter from incipient Graves' disease. These concern both the blood count and coagulability (Kocher, Kottmann). Other differential tests are found in special works.-Berliner klinische Wochenschrift. PROGRESS IN SOME DISEASES. New conceptions of some old diseases are of great interest and import. Our attitude toward pneumonia has changed most radically in a few years. Now we direct our efforts toward the intestinal tract, recognizing that it is from that source that disaster is perhaps most apt to come. We restrict or eliminate putrefactive food elements. Some men are washing out the colon, though we confess that this seems to us a formidable procedure in pneumonia. The alleged util ity of guaiacol carbonate in this disease would seem to depend upon its inhibitory effect upon the growth of the pneumococci in the feces. Experiments are being made in various quarters looking to the inhibition of pneumococcus growth in feces by various agents, with a view to the discovery of the most active. During pneumonia the pneumococcus predominates among the intestinal flora. In a number of series of cases the carrying out of the foregoing principles has given astonishingly low mortalities. And so with other diseases; pernicious anemia, for example, which bids fair to be classed among the germ affections. Many conditions that used to be called rheumatism are now clearly differentiated. It will not be long before our ideas will be crystallized on the subject of eclampsia, confusing though they are just at present. Many of the older conceptions are being "knocked into cocked hats." The case of rheumatism is especially interesting. We are familiar with the parts played by the gonococcus and the streptococcus, and Poncet and Stock have shown that tuberculosis is at the bottom of some of the so-called rheumatisms, tuberculin tests causing characteristic reactions in the affected joints.-New York Medical Times for June. Dr. Walter K. Schlosser, of St. Joe, Indiana, described, on May 28, 1914, to the writer a series of cases of congenital and hereditary keratosis of the palms and soles, and June 4th a photograph of the palms of one of the cases, Mr. Collins, of St. Joe, a farmer of 24 years in good health. Of Mr. Collins' seven brothers and sisters, four brothers and one sister are affected. His father and several of his brothers were affected. His father's mother and his great-grandmother were affected also three generations. In these cases the thickening and scaling do not begin until the 6th year. The cases will be reported to the clinical The business world has discovered that to get the most for the money the working man must not be worked over a certain number of hours a day. It has learned that the human mechanism differs from ordinary machines in that the quantity and quality of its work are greatly impaired by fatigue and long hours. By actual measurement, it has been found that more money can be made on short than on long shifts. Not always abundantly fed and comfortably housed, the nurse must work from ten to thirteen hours a day, with none too much time for meals, and that at work which is not only fatiguing, since she must be on her feet all day, but which is also wearing on the nerves. At night she is often in charge of twenty or more patients for ten or eleven hours at a stretch. She usually survives the "training," but does she afford the best results to the hospital? Her schooling is a trying ordeal, and this seems to have leaked out, since many hospitals are having difficulty in finding suitable material for their schools of nursing, and if the probationer had always a taste of what she was entering, we fancy there would be still less material. How the nurse ever gets anything out of her theoretical course is a mystery, for she is so fatigued that she finds it almost impossible to pay attention, or even to keep awake, in the lecture room or over her books. We believe that an eighthour day would tend to give the maximum of excellence in work to the hos TREATMENT FOR ACUTE TONSILITIS. The simplest form of acute tonsilitis due to infection or a cold is easily subdued in the following manner: Spray the throat, while the tongue is depressed and the breath held for a moment, with the Dobell-Pynchon antiseptic solution: R Pulveris sodii boratis (C. P.), M. Then apply a 3 per cent. solution of silver nitrate by means of a curved cotton holder. Follow with a spray of a 3 per cent. solution of camphor-menthol. The cotton carrier is best made of aluminum, with a rather attenuated point so as to penetrate the crypts. The rest of the carrier should be firm enough to prevent bending as it is pressed into the depressions. In spraying the tonsils, with an atomizer having a curved tip di rected toward the crypts, sufficient air pressure (about 15 pounds) should be employed to drive the spray well into the lacunae so as to evacuate all retained secretions or concretions. The patient should not be directed to sound the syllaable, ah, while the throat is sprayed. The expired column of air would tend to eject the spray from the patient's throat and into the physician's face and over his clothing. In rheumatic tonsilitis the detergent solutions used in simple tonsilitis are also applicable. After these, guaiacol renders excellent service. The pure drug, applied to the tonsil on a cotton carrier, may prove painful; in this event it should be diluted with an equal part of glycerin. Constitutional treatment should be instituted at once with such remedies as sodium salicylate, phenyl salicylate, and antipyrin. The latter remedy is useful in doses of 5 to 10 grains every three or four hours, particularly in relieving pain. The other two, in 10-grain doses, have proven efficacious in preventing the formation of abscesses. In ulcerative tonsilitis, after thoroughly washing the surfaces and crypts of the organ, a 10 per cent. solution of silver nitrate should be applied over the ulcerated surfaces and carried down into the crypts as well. Following this, thymol iodide should be dusted with the powder blower over the gland and thrown into the diseased lacunae. Ulcerative tonsilitis occasionally follows cauterization of the turbinated bodies. For this reason, the nasal cavities should be examined for diseased foci, and treated if any are found. Where the tonsils are the seat of recurring inflammation, but the patient objects to operative removal, they can be rendered innocuous by means of an electric cautery employed as follows: Selecting 3 or 4 crypts at a time, a 10 per cent. solution of cocaine is applied to the interior of each by means of a fine-pointed cotton applicator, great pains being taken to prevent any of the solution from escaping to other parts of the throat. After the crypts are sufficiently anesthetized, a |