turbances and even albuminuria, yet in no case did the nutritive value go above 2,000 calories per day, about 2/3 the requirements of health. No wonder our patients emaciated.

To read some of the elaborate menus planned for each week of convalescence as well as of the disease itself found in some of the systems of medicine, while demonstrating the author's profound knowledge of dietetics, and his vivid imagination, could scarcely have found many close followers and would surely have caused dismay in any board of hospital managers if ordered for their patients. The total energy in our diet was calculated by Dr. Wolff to be about 3,500 calories per day with a nitrogen equivalent of about 8 grams, but after the first season I was content to measure the amount needed by the condition of each patient's nutrition and the acceptability of the various articles allowed rather than by exact analyses each day, since it had been proved that such diet, even when forced, produced no real injury-either the patient protested against the amount or at worst had slight gastric disturbance which ceased immediately on reducing the amount.

Rice: Boiled rice formed the basis of our diet. 6 to 8 ounces by volume given at a time. Other cereals have been repeatedly substituted but none were so well borne for so long a period. Theoretically it is the most perfect, being perfectly digested in two hours.

Eggs: Three to six during the day has been my rule, shirred, soft boiled or shaken with sugar, ice and orange or grape fruit juice. A larger number may be employed if for any reason the other articles are reduced. At first only the whites were given in the form of albumin water, but later the whole egg was used with good results.

Gelatine: Gelatine in the form of jellies variously flavored to give pleasing variety is well liked and of great service.

Broths: The various meat broths prepared if possible below the coagulation point of albumin, in order that the maximum of nutrition be retained, furnish proteid for repair of tissue waste and some balance for energy, though it is upon the carbohydrates and fats that we depend.

Bread, etc.: Dried bread, rather than toast, soda crackers, zwieback, etc., are given as the patient desires.

Butter:-Much dependence is placed upon butter and it is well tolerated. During the past year the so-called heavy cream has been used with little if any advantage over butter.

Sugar: It has been my experience that if milk sugar is used alone or in too great proportion, patients object much sooner than if a small percentage of cane sugar is added and no more unpleasant symptoms appear in this latter case.

Our routine has been as follows:

On admission to the ward the patient is given calomel, usually in divided doses, followed by magnesium sulphate. If the temperature is high and the gastro-intestinal tract in bad condition, little besides water is given for 24 hours.

The patient is fed every 22 to 3 hours, being given 6 to 8 oz. of rice with butter and sugar, alternating with an equal quantity of jelly often with sugar, eggs or broth. Sugar is added to the eggs with fruit juice; butter when shirred or boiled. Butter is usually given with the dried bread, crackers, etc., which are served with broth and eggs.

Water is urged upon the patient throughout the course of the disease, nurses being instructed to watch the amount taken. Often the total fluids are entered on the

murs. The X-Ray was not able to demonstrate any tumor of the hypophysis. Treatment with extracts of hypophysis or thyroid have been of no avail. 203 W. 79th St., New York.

ETIOLOGY AND DIAGNOSIS.

The Early Diagnosis of Uterine Cancer. The early diagnosis of cancer of the uterus is one of the most important functions of the family physician, according to Hendrick, for it is to him the patient usually appeals for relief, hence it is his bounden duty by every means available to make the diagnosis if possible. There are three sites for uterine cancer.

I. The vaginal portion from the vaginal vault to external os.

2.

The cervical portion from the external to the internal os.

3. The uterine body from the internal os to the tubal orifices.

Now, cancer of the uterus develops in its mucous membrane, or immediately under the mucous membrane of its elements. That is, the glands of the cervix or the body. This classification is important because, not only the clinical picture of the cancer but the methods of diagnosis are quite different, depending on the starting point and extension of the disease.

There are certain symptoms which one may designate by the name of prodromes of uterine cancer. These are:

1. Bleeding in coitus-due either to engorgement or friction. It is very common, and often the first symptom noted in cancer of the cervix, though it may occur in vascular erosion, endometritis or polyps. It is always a suspicious sign.

2. Metrorrhagia-after the menopause; that is, some months after the menopause. This symptom may occur in fibroids and polypoid disease, but it is most often due to cancer. Irregular hemorrhages before the menopause are not so suspicious, but we must bear in mind the age incidence.

3. A sero-sanguinous discharge resembling greasy dish-water or beef brine occurs in the very early stages of cancer

'A. C. Hendrick, M. D., Canada Lancet, Sept., 1910.

of the cervix, and is rare in other conditions. This modified cervical discharge is characteristic.

Clinical Diagnosis.-The clinical diagnosis of uterine cancer depends upon two factors:

1. The presence of a neoplasm, either proliferation or infiltration.

2. Its degeneration. This leads to the characteristic friability of the tissue which is of great diagnostic value. This friability is recognized by the finger or the sound. This property of breaking up into small pieces under pressure of the finger is very characteristic, and the only other tissues, perhaps, showing it is a necrosing fibroid.

The great tendency to bleed is understood when one recalls the histological structure. structure. Hence, bleeding is characteristic of all three varieties of uterine cancer. But one finds hemorrhages in erosions, endometritis, chronic metritis and polyps, although less, so that diagnosis cannot be based on bleeding alone. When both features of cancer are present, namely, neoplasm and degeneration, the diagnosis is easy, but if only one of these is present difficulty arises. For examples, there may be only proliferation, then inspection with speculum aids, while any infiltration is found on palpation, whilst degeneration is found by both methods.

Cancer of the vaginal portion may be seen and felt through the speculum in the Sims posture, whilst palpation of body cancer may require dilatation.

Vaginal Portion.-Cancer here is the most easily diagnosed of all sites.

I. If of the polypoid variety its surface is reddish in color and friable; that is, easily broken or crumbled down by finger or sound.

2. If of the flat kind, any bulging above the surface is suspicious.

3. If of the infiltrating kind, a nodule is felt cartilaginous in consistence and altering the shape of the vaginal portion. If, however, the mucous membrane over the lump is intact then there is trouble, though the surface of the nodule may be purple in color and spotted by yellow pits due to the

cancer nests.

4. Ulcerating cancers are easily spotted. The jagged fissures with soapy secretion,