school children, in whom the desire for a stool is either neglected or repressed, eventually develop a constipated temperament. Many remote and obscure ailments in children can be traced to a constipation which exists temporarily or habitually. Fretfulness, colicky pains, fever, and various nervous manifestations are among the more common troubles which can often be attributed to this sluggish action of the bowels. The main point in the treatment of constipation is a regulation of the habits and diet of the child, the regulation of the habits being as essential as is that of the diet. As soon as possible the infant should be taught to observe stated times for the stool, and as early as four or six months of age this can be accomplished by regularly placing the infant upon a small chamber at fixed hours. Older children should be watched and taught to go to stool at regular hours each day. To hasten the results in temporary constipation enemata may be employed, since they quickly unload that part of the intestine in which fæcal matter is apt to lodge, and exciting peristalis aids the expulsion of what fæcal matter there may be above. Soap and water, glycerine and water, or salt and water, are all good enemata. The long continued use of the enemata has a relaxing effect upon the bowel, and must not be indulged in to excess. Suppositories may be employed in the place of enemata -and of these glycerine, or one containing nux vomica and hyoscyamus, given at bedtime, are suggested. The use of the ordinary purgatives is not to be encouraged, since they are liable to irritate the bowel, causing a catarrh. The intestine becomes accustomed to their action, and it is necessary from time to time to increase the dose.-Medical Standard. to Cancer. If the child is breast-fed, the mother's milk should be examined, and if deficient in Implantation of Tissues and its Relation quantity, additional food given; if the percentage of fat is too low, a few spoonfuls of pure cream from cows' milk may be given with each nursing, or a few spoonfuls of thoroughly cooked oatmeal, which has been slightly sweetened and strained, or one or two teaspoonsful of fresh orange juice. The mother's bowels must be regulated, and she should take regular exercise. With bottle-fed babies, the character of the milk given is responsible for the trouble in many cases. A proper modification of the milk will probably be all the treatment needed. The free use of good water is to be commended, since it greatly aids in overcoming costiveness. When dietetic measures fail, resort can be had to drugs. In acute cases, calomel in small and frequently repeated doses, followed in due time with castor-oil, is the treatment which seems to answer every indication, increasing the intestinal secretions, removing all offending material, and restoring the bowel to its normal condition. In the Third Report of the Caroline Brewer Croft Cancer Commission of the Harvard Medical School, Dr. Edward H. Nichols says that the theories concerning the possible origin of cancer can be grouped under two general heads: First, the parasitic theory, the advocates of which hold that the epithelial proliferation seen in cancer is the result of the presence of specific parasites which have the power of stimulating the irregular overgrowth of epithe lium. Second, the biological theory, the advocates of which hold that the epithelial proliferation in cancer is due to the development of inherent or acquired peculiarities of the cells themselves so that the cells become not only capable of indefinite multiplication, but are also capable of living in abnormal relationship as regards the other body cells and thus become of themselves capable of living a parasitic existence. The writer gives a critical review of the arguments for and against these theories, discussing the subject under the following heads : ever been able to isolate them from the including cells and to use them in reliable I.-General argument for the parasitic inoculation experiments and moreover it is nature of cancer. 1. Apparent relative increase of cancer. 2. The formation of metastases. 3. The occurrence of cachexia. altogether probable that these so-called parasites are simply secretion vacuoles or other products of cell activity. III.-Theories as to the biological origin 4. Possibility of direct transfer from per- of cancer. son to person. 5. Self-inoculation by cancer. 6. Direct inoculation of human cancer into animals. . Inoculation of cancer or malignant tumor into another animal of the same species. 8. The parasitic production of epithelial proliferations analagous to the epithelial proliferations in cancer. These arguments he summarizes as follows: From a consideration of the facts already presented it may be said that (1) the relative increase of cancer is disputed and not proved; (2) local causes of the origin of cancer are improbable; (3) the metastases in cancer, although taking place by the same routes as the metastases in infectious diseases, are of an absolutely different origin, and constitute the strongest theoretical argument against infectious or parasitic origin; (4) the cachexia in cancer, probably, is not entirely due to the character of the cancer itself, but is often dependent upon secondary bacterial infection. to another by contact; (5) transplantation of cancer from one human being to another by contact; (6) transplantation of cancer from one animal to another of the same species is well verified; (7) the production by any known parasite of epithelial proliferation analogous to cancer has not been demonstrated. II.-Special reasons for belief in parasitic origin of cancer. 1. Blastomycetic theory. 2. Protozoon theory of cancer. Although a number of so-called cancer parasites have been described no one has Under this head he discusses the theories of Thiersch, Cohnheim, Ribbert, and Bashford and Murray, and arrived at the following conclusions: On the whole, in regard to the biological theories of the origin of malignant and benign tumors as enunciated by Thiersch, Cohnheim, and Ribbert, it may be said that such hypotheses or a combination of them, is at present supported by a considerable number of clinical and experimental facts; that certain tumors, dermoid cysts, can be produced experimentally under the conditions of the hypotheses, and that in one. doubtful case a truly malignant tumor appeared, and finally that foetal tissues undoubtedly have a much greater inherent power of growth than do adult tissues. Too late to allow of verification by others, certain observations have been made which give support to the theory that cancers may be considered to be a parasitic individual engrafted on a normal individual, and that they are produced by the conjugation of cells in a way analagous to conjugation of sexual cells which produce a normal individual. Farmer, Moore, and Walker investigated cancers, and concluded. that the reduction in the number of chromosomes in the mitosing cells took place in the same way as in the ripening of the sexual cells of animals and plants, and that the number of these chromosomes were half as numerous as in the somatic cells. They studied not only human cancers, but also cancers in various lower animals. These observations show a series of changes in the nuclei of malignant tumors throughout the whole extent of their known zoological distribution parallel to those characteristics seen in the maturation of the sexual elements of the metazoa. If these observations are confirmed, it will be a most important step in elucidating the origin and development of tumors. The writer reports the results of a series of experiments carried out with the idea of ascertaining whether previously normal epithelial, or other tissues, either foetal or adult, would if simply freed from its normal environment lead to the formation of tissue analogous to a tumor growth. His experiments were carried out under the following heads: The implantation of testicular, ovarian, renal, and liver epithelium into the same animal, the implantation of liver epithelium into the kidney of the same animal, the implantation of adult or foetal epidermis into the same animal, the implantation of adult uterine epithelium pregnant and non-pregnant into the same animal, and the implantation of placental tissue into the same (maternal) animal. In a number of these experiments the implanted tissues were able to maintain their vitality and grow to a greater or less extent. This work is summarized as follows: 1. Certain types of epithelium (epidermis) both adult and fœtal, can be experimentally removed from their normal position and implanted into another part of the same animal, and under those circumstances can maintain their “potentiality of growth," retain their own peculiar character, and produce nodules analogous to dermoid cysts or more complicated teratomata. 2. In no case has any epithelium of a highly differentiated function been seen to maintain its power of growth or to proliferate. 3. The "potentiality of growth" is greater in the case of foetal than it is in that of adult tissues. 4. In no case has any infiltration of surrounding tissue by the transplanted epithelium been seen, nor any tendency to epithelial metastases. 5. Certain fœtal connective tissues (cartilage) can be transp anted in the same way as epithelial tissues and retain their "potentiality of growth." 6. Transplanted foetal tissues do not reproduce the stage of development at which they are transplanted, but tend to reproduce the ultimate stage of their normal development.-Albany Medical Annals, October. 1905. Resection of the Hip-joint. At a recent meeting of the Society of Physicians, of Vienna, Austria, Dr. Reiner recently discussed the subject of resection of the hip-joint with total extirpation of the capsule. He presented the case of a child in which last February he had performed a total resection according to the method devised by Professor Lorenz and himself for a purulent tuberculous coxitis. This method is based upon the following considerations: In advanced coxitis, as a rule, both the bone and the capsule of the joint are diseased, and it is difficult to determine the primary seat of the lesion. It has, however, been demonstrated by statistics that primary disease of the synovial membrane occurs much more frequently than was formerly assumed; and even in cases of primary affection of the bone the synovial membrane becomes infected see ondarily, and it is therefore advisab'e to remove it under all circumstances. This has not hitherto been possible by the method of resection employed, which accounts for the many failures. Even the more modern flap method does not render accessible many parts of the joint unless much tissue is sacrificed. The procedure of Lorenz and Reiner consists in first separating the entire capsule from the soft parts, and then opening the joint. To expose the capsule two incisions are made: the anterior along the internal margins of the tensor vaginæ femoris, between the tensor and sartorius, without injury of muscles or blood-vessels. The posterior surface of the psoas iliacus is then exposed by s.ight flexion and adduction at the hip-joint. In a similar manner, by penetrating between the rectus and capsule as far as the base of the femoral neck, the base of the lesser trochanter is laid bare. During this dissection an opportunity is afforded of thoroughly inspecting the surrounding parts. With the patient in the lateral posture, the posterior incision is then made according to the Langenbeck method, parallel with the fibers of the gluteus maximus. The posterior margin of the gluteus medius is lifted up and the posterior wall of the capsule laid bare. Both the gemelli and the obturator internus are then divided. The joint is next opened, the cartilaginous rim being also removed. The capsule now forms a loose cuff around the femoral neck, and as the ligamentum teres is usually absent, it can be readily drawn over the femoral head. The head is now freed of its cartilage and lifted from the acetabulum. After the operation the head of the bone, or what remains of it, is replaced and the customary after-treatment employed. If much of the neck has been destroyed an attempt is made to secure as broad a surface for adhesion between the acetabulum and femur as possible, so that all the remainder of the diseased tissues can be removed. For this purpose the anterior and posterior incisions may be joined, so as to form a flap.-International Journal of Surgery, October, 1905. The Pneumococcus as a Factor in Drs. Flick, Ravenal, and Irwin, in the Medical News of September 9th, report four cases of pulmonary tuberculosis, complicated by hæmoptysis, in the blood of all of which the pneumococcus was found; and, while the number of cases is too small to warrant conclusions, the facts are very suggestive and open a very interesting field for investigations. If the pneumococcus is responsible for the hæmorrhages in tuberculosis the existing views concerning both etiology and treatment of hæmoptysis must needs be changed, and it is probable that we may be able to prevent the hæmorrhages to a much greater degree than we have been able to do in the past.-Review of Reviews. Thyroid Disease in California. H. C. Moffitt, of San Francisco, writes interestingly on thyroid disease in Cali fornia. Observation has convinced him that thyroid disease is more common in San Francisco than in many other cities, and he has studied the subject by correspondence with other physicians throughout the State. Goiter is more common, especially about San Francisco Bay, and less frequent in the southern part of the State and in the mountains, and is endemic. in certain portions of the northern section. Myxedema seems to be more frequent in San Francisco, perhaps because more patients drift there. He has reports of 53 cases in that city and 33 throughout the State, excluding formes frustes, of which he has notes of 11 cases. These are characterized by dry skin, scaling of the scalp, thinning of the eyebrows, and loss of hair from the neck and in the axillæ; pains in the knees and ankles and between the shoulders, and fat pads about the upper back and clavicle are characteristic. Of sporadic cretinism, he has collected 61 cases altogether, 35 of them in San Francisco. Exophthalmic goiter seems to be much more. common in bay counties than elsewhere in the State, and he remarks on the danger of the use of the iodine preparations, especially when a goiter exists, however small. He has had several cases of iodism in patients with small goiters, and he suggests the possibility of the strong sea winds in San Francisco affecting the frequency of cases. The therapy of thyroid conditions is discussed at some length. The reports as to thyroid medication in myxedema and cretinism are enthusiastic; large doses are not required, and they may produce un pleasant symptoms in myxedema. He has seen good results in exophthalmic goiter from long-continued faradism. He thinks many cases of exophthalmic goiter are amenable to surgery, and that more attention should be given to the statement of Horsley that division of the isthmus alone leads to retrogressive changes and shrinking in the rest of the gland.-Journal of the American Medical Association, September 16, 1905. A Test for Pancreatic Activity. The Practitioner for July states that if 60 grains of salol be given in cachets, in divided doses, during twenty-four hours, carbolic acid will appear in the urine; this is due to the fact that the salol is broken up by the alkaline pancreatic juice in the small intestine. If, however, no pancreatic juice makes its way into the duodenum, the salol remains unchanged, and no carbolic acid can be detected in the urine. The most convenient tests for carbolic acid in the urine are: (1) Add to the urine which contains the carbolic acid a few drops of liquor ferri perchloridi, a violet. color is produced. (2) Add to the urine a few drops of bromine water, a yellow crystalline precipitate of tri-bromo-phenol (C,H,Br2OH) is produced. (3) If a small quantity of bleaching powder and a little ammonia are added to the urine, on heating the mixture a blue color is produced. (4) If Millon's reagent (acid nitrate of mercury) be added, a bright-red color is produced. The importance of this test is obvious, as it enables us to diagnose obstruction to the outpouring of the pancreatic juice into the duodenum.-Therapeutic Gazette, October, 1905. Hypertensive Crisis in Arteriosclerosis. Dr. John B. Briggs, after a thorough discussion of this subject, reaches the following conclusions: 1. Albuminuria (and cylindruria) in the subjects of generalized arteriosclerosis, where no other cause is at work, is always accompanied by a state of high blood pres sure. 2. Intermittent attacks of hypertension of the pulse and concomitant albuminuria, separated by longer or shorter intervals of normal blood pressure during which the urine is normal, may be the only clinical expressions of a generalized arteriosclerosis. 3. Therapeutic relief (potassium iodide and the nitrites) of hypertension in this general class of cases, if not carried too far, will tend to relieve the pathological condition of the urine. In a certain number of cases we may reasonably hope by this means to postpone the onset of chronic renal changes.-American Journal of Medical Sciences, August, 1905. Ménier's Disease. This interesting disease is the subject of study for Dr. L. V. Frankl-Hochwart, in an article on the diagnosis and prognosis of Ménièr's disease and its symptom-complex (Yahrbücher für Psychiatrie und Neurologie, Bd. 25, 1905). The author reports upon 205 cases of Ménièr's vertigo, which came under his personal observation, the majority of the patients being under control for many years. He is satisfied with the nomenclature which he suggested years ago, the clas sifications having answered all purposes. The author tells of Ménièr's symptoms. which either begin in an apoplectic manner, or are superimposed on an already existing ear disease. The author reports on 4 typical cases of the apoplectic variety; 13 cases of trau matic origin, 3 of which were "caisson hæmorrhage." He discusses the sympto matology and differential diagnosis of the vertigo, also the polyneuritis cerebralis Ménièr formis, which was described by him for the first time. He also discusses acute |