men of womanhood, of good color, full of animation and somewhat inclined to be stout. About fifteen years ago a nodule appeared on the right breast underneath the nipple. She underwent an excision of a portion of the breast by a surgeon in the East, where she was then living. Something more than a year ago she called my attention to the breast, stating that it was causing her some pain and that she thought she felt a growth. Examination showed a 24-inch horizontal cicatrix across the breast, which had included the nipple. She told me before I examined it that no matter what was my opinion of it she would never consent to a surgical operation. There were no enlarged glands and there was not at that time sufficient development to warrant more than the suspicion of an oncoming malignant condition. It was a few months afterward that I saw her again, when I thought I could see some increase in the nodule, and she complained quite distinctly of pain. She was still firm in her declaration that she would never think of an amputation of the breast no matter what it might prove to be. I saw her several times within the next few months, mostly on the street, and had

only a verbal statement from her as to the progress of it, when she called at my office and I felt impelled to warn her of the very probable seriousness of her condition. I did not see her again for two or three months, when she told me that she had been under an osteopathist and wanted me to see how nicely she was getting along. I found a mass nearly as large as the fist with all the characteristics of malignancy. Her temperature was about a degree above normal, she had lost flesh and was decidedly cachectic. I then told her there was no alternative from a radical surgical procedure. This was in, March, 1901. Exacting from me a promise. that I would not disfigure her by a sacrifice of all the tissues of that side of the chest, I did as radical a removal of the growth as could be done in compliance with her request. An incision was made as usual for the removal of the mamma, and was carried up under the axilla and the glands, which were very much affected were as thoroughly removed as possible. The tissues

removed were given to Dr. J. J. Clausen of this city for microscopical examination, and he readily pronounced it carcinomatous. Before closure of the wound by cicatrization had taken place nodules were making their appearance above and below the cicatrix. My attention was called soon after this operation to the treatment of these affections by the X-ray, and as soon as the healing of the cicatrix was sufficient to allow its application, the treatment was commenced. At the time it was commenced there was undoubtedly a mass of malignant growth two inches in diameter below the cicatrix and another above it in front of the axillary line. The treatment was commenced on the 18th of April, 1901. It consisted of exposures of four minutes each from three directions. This treatment was kept up daily until August 7th, three and a half months. There is now no evidence whatever of induration or tumor. The cicatrix is normal in every way, the skin soft and flexible and no pain whatever. I very much regret my inability to present

this case.

The second is the case which I have the good fortune to show you. For several months previous to October of 1900, a nodule had been developing on the left breast slightly below and external to the nipple. At this time (October of 1900) the lady began to notice the first real discomfort from it. She sought relief in the various things that were suggested, mostly by way of topical remedies, until in December when she became convinced of the real nature of the disease and sought relief from that benefactor of mankind, Prof. Weltmer of Nevada, Mo. After several months under his kind. ministrations she returned to Kansas City in a deplorable condition. When I saw her the soft tissues of the chest on the left side were indurated to the last degree, the skin was perfectly immovable and the entire mass seemed absolutely fixed to the ribs. She was extremely weak and cachectic, the left arm was useless, the axilla being enormously involved and on the original mass of tissues were three superimposed ulcerating masses of the size of a lemon. (See cut I.) These were bleeding constantly, the entire mass being three or four times the size of the fist. Her temperature ranged at about 100. The erysipelas streptococcus and bacillus prodigiosus were used, but without any apparent effect and I decided to put her under the X-ray method of treatment. The growth had been very rapid for three months. Her weight was now 104 pounds. She was subjected to daily sittings of five minutes each, commencing about April 1st. After three sittings the hemorrhage. entirely ceased. At the end of a month she had gained about seven pounds. in weight and felt very much improved in every way. The ulcerating masses were by this time nearly covered with normal epithelium. The treatment was continued almost uninterruptedly until August 12th, when the parts were badly burned by accident with carbolic acid. Whether through natural suceptibility to the escharotic effect of this drug or whether this effect was enhanced by the condition of the skin as a result of the application of the X-ray or the disease, I cannot say, but for two months she was unable to bear the use of the X-ray treatment, and it was not commenced again until October 6th. Her weight is now 116 pounds, her appetite is good, she suffers no pain, and she has perfect use of the arm and the axillary glands are not noticeably involved. The tissues, as you see, are not now entirely indurated, the skin is not altogether adherent to the mass, the soft tissues being movable to some extent over the bony wall of the chest. The superimposed nodules are nearly gone and the mass is reduced more than two-thirds.

This case is not cured yet, but enough has been accomplished to show that this agent exerts a wonderful influence over malingant growths.

It will probably require years to determine the proper application and the limitations of this treatment, but the cases I have cited convince me that we have at last found an agent which exerts a specific influence over malignant growths. I have not yet had occasion to use it in malignant conditions of the viscera, but I can see no reason why a favorable effect should not be exerted upon the interior as well as the exterior of the body, though probably much less rapidly.

Supposing that this method will cure, what are its advantages aside from this fact over other methods that are now in use? The knife leaves an ugly scar, to say nothing of the parts that are removed. The serum is attended with violent reaction, and some persons cannot stand it at all. Under this method of treatment one is compelled to visit the operator every day from one-half to an hour or so. During this period he is subjected to the simple inconvenience of a dermatitis, but no scar results and no tissue is sacrificed. It also seems to exert its influence in advanced cases that are entirely inoperable.

I wish to state that I have turned over the treatment of these cases as far as the application of this agent is concerned to Dr. J. N. Scott of this city, who has made a special study of electricity and who has had a large amount of experience in operating the X-ray machine, and is fitted up for every detail of the work.

The German army authorities in 1897 made some experiments with regard to the sustaining and invigorating proporties of sugar, which proved conclusively that it is an adjunct to the soldier's diet of almost inestimable value. It was declared that a few lumps of sugar acted like a charm against fatigue as well as in quenching thirst. The British government followed the example set by the Germans, and now provides its soldiers with 37 gm. of sugar daily. The result of the experiment has been most satisfactory in the South African campaign. Our army, too, in its revised ration scale, is allowed a generous amount of sweet food, but the time of trial has not yet been long enough to pass judgment as to its effects, although there is no reason to doubt that the American soldier will assimilate sugar with as much benefit to his health as have his European fellows.-Medical Record.

*REMINISCENCES OF A RECENT TRIP ABROAD, INCLUDING VISITS TO THE LONDON, PARIS. BERLIN, ETC., HOSPITALS, CLINICS, MEDICAL MUSEUMS AND LIBRARIES, AS WELL AS

TO THE BRITISH MEDICAL ASSOCIATION.

JOHN PUNTON, M. D., Kansas City, Mo.

Professor Nervous and Mental Diseases University Medical College, Editor INDEX-LANCET, Etc. A VISIT TO THE BRITISH MEDICAL ASSOCIATION, CHELTENHAM, ENGLAND,

By referring to the program you will observe that the annual meeting of the British Medical Association commenced on Monday, July 29, 1901, but the actual scientific work did not begin until Wednesday morning, July 31st, at which time the thirteen sections of which it is composed duly organized for business. From an American standpoint, too much time therefore is consumed in preliminaries. When once the sections were in actual working order, the proceedings of each were highly interesting and instructive, although much more deliberate and leisurely than that witnessed in our American Medical Association. In each section the talent represented medical men from all parts of the British Empire, and many of them enjoyed not only national, but international, reputations in their respective departments.

The work assigned for each day was much less in volume, consequently fewer papers were read, but their discussions were more lengthy and prolonged contrasting greatly with the large number as well as rapidity of reading and discussion of papers which form the chief characteristic of the sectional work done at the American Medical Association.

A feature worthy of special remark was the graceful manner in which adverse criticism was alluded to in the discussion of papers. It seemed the special desire of each speaker to prevent any remark which might give offense or be construed as a personal injury. While it is possible that the same spirit of rivalry prevails in the British medical profession so common to that of our own, yet on no occasion did I see or hear any unkind or unjust dealing with one another; all seemed to regard each other as members of one great common brotherhood. This is as it should be, and we can learn many valuable lessons from our English cousins on professional courtesy and gentlemanly conduct. One of the most important questions which is now receiving serious attention in England is the reorganizing of the constitution of the British Medical Association. It seems that owing to the rapid growth of the association in all its branches, its present constitution has become inadequate to meet its requirements.

It can be seen that a membership of 18,402 is no small army to manage, and some of these have become dissatisfied with the present methods. so that a possibility of a split is more than possible. To prevent this a new constitution is in course of preparation. A committee was appointed one year ago, and on Wednesday, July 31st, reported to the society, which in substance. was as follows:

The committee in question was appointed to consider and report upon the best means of reorganizing the constitution of the British Medical Associaion, and the chief conclusions arrived at were that owing to the growth of the association both its local and central organization under its present constitution had become inadequate to its requirements; that as to local organization under the present branch system, the opportunities of meeting required for effective working were not furnished to a sufficient proportion even of the members of branches; while one-third of the members of the association were outside of the system entirely; and that under the present articles of association, the ultimate control rested largely with the general meeting of members, a body, the composition of which must be entirely for

Continued from December number, Article III of the Series.

tuitous and non-representative in a society whose members are so numerous and so widely distributed as those of the British Medical Association. The present articles in this respect have been declared by the council unsuited to a concern of this magnitude, and such as to expose the interests of the members at large to grave peril. For the removal of these defects the committee made several recommendations, including that of providing members with greater opportunities of meeting, new bodies to be called divisions instituted as units of local organization, formed on the parliamentary division basis; that local bodies should be enabled to take a more direct part in declaring the policy of the association by means of instructed representatives chosen by the divisions to speak and vote at the annual meetings, such delegates to have voting power proportional to the number of members of the constituency. Other detailed recommendations affecting the constitution and administration are made, and the association is recommended to carry out the scheme of reorganization by modifying the existing constitution under the companies' acts, rather than by winding up the association as a company and applying for a royal charter. A large majority of the branches have approved of such a scheme, and the committee suggests that arrangements be made forthwith for the drafting of new articles of association and by-laws.

Mr. J. S. Whitaker moved that the meeting, without prejudice to the further consideration of details, approves generally of the scheme of reorganization proposed in the report and recommendations, including the principle of reorganizing the constitution of the association under the companies' acts, of instituting divisions, of enrolling all members in the division and branches, and of instituting a representative meeting, and transferring thereto as much as possible of the business hitherto brought before the general meeting. Mr. Whitaker strongly advocated the adoption of a scheme by which members would have more direct representation in the business of the association. Mr. Jenner Verrall (Brighton) seconded. After some discussion, the resolution was adopted.

Among the special events which attract large crowds and which, by the way, are open by special invitation to the public, are the annual addresses, of which there are three. The first is the Presidential Address, the second is one on General Medicine and the third on Surgery. They occur at 8 p. m. It is unnecessary to enlarge upon the presidential address, as it has already appeared in full in the columns of theINDEX-LANCET. The address on medicine this year was by Dr. J. F. Goodhart, and the one on surgery by Sir William Thomson.

The address by Dr. Goodhart was well attended, and he took the opportunity to emphasize the importance of individualism in treatment. In speaking of the position of medicine at the present day and the association of mind and body, he laid stress on the individuality of the patient as to the treatment and kind of medicine to be given. In alluding to the open-air treatment for tuberculosis, he intimated that its value lay in patients there learning a habit of life in good food and fresh air, which they would have to follow all their lives. If open-air treatment was to take its place, the principles of the sanatoria must be followed out in the home. Frequent applause was given during the delivery of the address, and at the close, Professor Clifford Alcutt, of Cambridge proposed, and Dr. Parkinson seconded, a vote of thanks to Dr. Goodhart for his able and interesting address, which was carried by acclamation.

The address in surgery by Sir W. Thomson dealt with the surgical aspect of the war in South Africa. After dealing with the proportion of killed and wounded, he described the action of bullets and wounds on the body-fleshy parts and bones-and comparisons drawn from the American war, the Franco