long and showed signs of old chronic trouble. The stomach and intestines were normal. The left kidney was removed. Macroscopically it was large, and filled with blood. Microscopically it gave the picture of a kidney acutely inflamed. The whole kidney was markedly congested, and the glomeruli were undergoing acute degeneration.

The thorax could not be opened. The heart showed no enlargement or irregularity on palpation.

Nothing abnormal was found about the ankle. It is extremely difficult in this case to say what was the cause of death. The symptoms would naturally suggest septicemia, but the autopsy failed to corroborate such a diagnosis. The chances of infection moreover at examination were very small. An acute nephritis was undoubtedly present but with no suppression of urine, and no edema whatever one would scarcely expect it to be of a sufficiently severe type to cause such a rapid death. The temperature, moreover, was much higher than one would ordinarily anticipate from acute Bright's.

EPITHELIOMA OF THE LIP

IN THE SERVICE OF DR. A. E. BENJAMIN

resting the pipe on the left side of lower lip.

Last August (six months ago) he first noticed the sore. It looked like a pimple, and appeared on the left side of lip in the spot where he was in the habit of holding the pipe. The sore was about half the size of the little finger nail when first noticed. The spot was not tender, but itched. The growth was slow at first, and up until three weeks before coming to the hospital it was not larger than a small chestnut. Shortly before coming to the city he applied some salve. The third day after the application of the salve, he noticed that the tumor was growing rapidly. The salve was discontinued; but the tumor continued to grow rapidly. He had no pain at any time. The size of the growth at the time of the operation was 3 inches long, 11⁄2 inches deep, and I inch thick. It had a cauliflower appearance, was ulcerated, and had pus on the upper surface. There was no glandular involvement.

OPERATION.-A modified Brun's operation was performed. The whole of the lower lip from the angles of the mouth far down on the chin was removed. The modification consisted of Malgaigne's flap from the upper lip on the right side to form the lower lip. The patient stood the operation well.

Sections made from the removed tissue showed the growth to be an epithelioma containing numerous pearls, very little stroma being present. Two weeks later a second operation was performed to correct a defect in the healing of the wound. This lack of firm union was due to the infected condition of the growth at the time of the operation. Stitch abscesses formed, and the approximated surfaces at the center did not unite perfectly.

A large swelling developed on the left side of the neck ten days after the second operation. He had some fever and pain for two days. The enlargement gradually subsided. The patient returned to his home in North Dakota about four weeks from the time of entering the hospital.

The interesting features of this case are as follows:

I. The extent of the growth, as shown in the photograph.

2. The rapidity of the growth, and the almost

3. The amount of ulceration and infection present.

4. The good serviceable lower lip secured after all of the lower lip was removed.

5. The swelling, which came on subsequently with pronounced symptoms and which disappeared a short time afterwards.

6. The case would seem to add one more to the list of cases illustrating irritation as a factor in the production of cancer.

7. The lack of glandular involvement with so large a primary growth.

THE VETOES OF TWO GOVERNORS Governor Johnson, of Minnesota, deserves the thanks of the profession for his veto of a pernicious chiropractic bill that was unduly flaunted and persistently pushed in the last legislature. The reasons given for the veto are clearly set forth, and shows the stamina of the governor. If more vetoes of this kind were promulgated by the governors of the various states there would be less of these fake methods of treatment.

THE GOVERNOR'S REASONS

The best information of which I am possessed reveals to me the fact that chiropractic, so-called, is a discovery of very recent origin, and was discovered and developed by men who were not learned in the science of healing disease. It is not apparent to me that the devotees of this so-called art in this state are posssessed of the proper knowledge of anatomy and kindred subjects to properly constitute a board for the examination of others in those subjects.

The enactment of a law creating a state board of chiropractic examiners and registration, and to regulate the practice of chiropractic in the state of Minnesota, and to license chiropractors, will dignify this new and untried school to the extent that the people will look to it as a panacea and remedy for the ills to which the human body is heir, and must from the very nature of that confidence so established, be more or less imposed upon by practitioners who will have adopted this means to abuse the confidence of the public.

Chiropractic has not yet become a science or even a school, and is at best but an untried experiment which has produced no lasting or definite results. Among the applicants for positions on this proposed board are insurance agents, and men in other walks in life, with absolutely no medical training whatever. The health of the public is the first essential, and should be safeguarded by every possible legal requirement, and if chiropractic must be recognized at all, those practicing this

ination in the essential branches by due and regular examination before the state medical board, which represents the best thought and is the recognized and established standard which has been developed from the experience of the ages.

Governor Cutler, of Utah, has also just vetoed an osteopathic bill, and he gives equally cogent reasons for his action.

GOVERNOR CUTLER'S VETO

In passing upon this act, I have kept in mind the fact that the object of medical legislation is not to benefit the doctors of any school or class, but to protect the public against practice in lines of medical work which the practitioner does not fully understand. Senate Bill 92 gives to Osteopaths the right to practice minor surgery, and to treat cases, including contagious and infectious diseases, without having first passed examination before the regularly constituted Board of Medical Examiners, in fundamental principles of medicine and surgery, as prescribed by the law. It appears to me that this would open the door for incompetent practitioners to enter our state. The present law seems to me to be broad enough to insure fair treatment to competent physicians of all schools; and under its provisions Osteopaths are allowed the privilege of practicing, upon passing examination in the principles underlying their practice, before a board consisting of graduates of various medical schools, and representing broad medical training and sympathy. And I believe that no one should be regularly licensed to practice even minor surgery, without first passing a thorough examination in the fundamental principles of anatomy and surgical practice.

Since, therefore, the present law seems to me sufficient, I am led to withhold my approval from this act.

TUBERCULAR JOINTS

The active discussion by the anti-tuberculosis organizations on the prevention of the disease is limited almost entirely to the pulmonary varieties and the methods by which tuberculosis is conveyed from one person to another. It would be well to keep in mind the dangers of tuberculosis of other organs, particularly the forms which originate from injuries, or, if present in the joints, the dangers to the sufferer. While we are striving to educate the public on the horrors. of the spitting habit, and the dirt and dust, as carriers of the disease, it would be wise to incidentally instruct the patient that the use of a tubercular joint may cause widespread results.

Experiments have shown that a joint inoculated with tuberculosis may remain latent, or may heal if the joint is kept at rest. It is necessary, however, that the joint be absolutely immobilized, with or without extension, to expect a cure. True, a good many tubercular joints are un

protected, and used without marked inconvenience, but they belong to the uncertain and unknown possibilities of human existence. Many of us go through the world missing instant or slow death by chance, but the individual who has. an infected joint is in great danger at all times.

Many cases of tuberculosis of joints develop serious lesions or contractures in less than a month, and many others are followed by a general tubercular infection. It is not uncommon to find joint diseases from injury, develop an acute local tuberculosis, followed by a systemic disease, within six months or a year. An educational campaign for the extermination of tuberculosis should consider the various phases of the disease. Children and grown people should be warned of the seriousness of tubercular joints, and the physician should be in readiness to advise and treat by immobilization all incipient joint troubles in suspected cases.

THYROID TREATMENT OF CHRONIC ARTICULAR RHEUMATISM

C. Parhon, in a paper in the Presse Medicale, Paris, which is abstracted for the Journal of the A. M. A. for April 15, advocates the use of thyroids in pain and stiffness of the knees and other joints. He cites the case of a man of 47 upon whom the alkaline treatment was beneficial for a time, but it was discontinued on account of the annoying dyspeptic symptoms, which were due to the sodium bicarbonate. On account of a constant sensation of cold, dryness, and eczema of the skin and hypo-azoturia Parhon believed the thyroid gland was inefficient. The thyroid treatment relieved all of the symptoms.

Lancereaux, Claisse, and others have reported similar success with thyroids in cases of chronic articular rheumatism on the ground that the defective functioning of certain organs with an internal secretion may have more to do with the origin of certain cases of articular rheumatism than have been recognized hitherto.

It is claimed that the thyroid and ovary favor the formation and elimination of urea. Similarly, a nephritic with edema, oliguria, and albuminuria was put on thyroids with a marked increase in the urine and a disappearance of albumin.

Viala says thyroids stimulate the circulation,

increase the secretions, and eliminate effete matters; reduce weight in proportion to the superactivity of the metabolic processes; and hence cause the disappearance of joint symptoms.

Of course, thyroids should not be used indiscriminately in all cases of chronic rheumatism. In some the ovarian extract would be more serviceable than the thyroid. Both assist in the elimination of urea, however.

There seems to be an antagonism between the ovary and the thyroid. If the one is deficient, the other is excessive in its functioning.

The use of thyroid is sometimes startling in its prompt relief of obscure symptoms; at other times disappointment follows in its application. In many chronic cases we are obliged to experiment in therapeutics, hence thyroids may supply a "something" in the economy that is lacking.

DR. WEBSTER'S ADDRESS

The title of Dr. Webster's paper has been changed for the annual meeting of the Hennepin County Medical Society.

"Appendicitis and its Relation to Pelvic Disease and Pregnancy" is the subject, and it will prove interesting to the surgeon and general practitioner.

Remember, the meeting takes place at the West Hotel Monday evening, May 15th.

FULL TRAINS TO THE A. M. A. MEETING

All the seats in the two special trains starting from Chicago for Portland for the meeting of the A. M. A. have been taken, and the reservations for the Twin City train indicate that many physicians will be unable to get berths on this train. Of course the N. P. Railway will take care of all who want to go to Portland, but much of the pleasure and profit will be lost to a physician if he cannot go on a physician's train; therefore if all who are going will notify Mr. G. F. McNeill, 19 Nicollet House Block, Minneapolis, as soon as they decide, it will be possible to arrange for an additional train, if needed. Do not neglect this important matter, for the neglect of a few men may cause disappointment to many.

REPORTS OF SOCIETIES

MINNESOTA ACADEMY OF MEDICINE A. W. DUNNING, M. D., SECRETARY

The regular meeting of the Minnesota Academy of Medicine was held at the West Hotel in Minneapolis on Wednesday evening, April 5th. There were 28 members present. The name of Dr. Louis B. Wilson, of Rochester, was transferred from the list of active to that of associate members. Dr. Chas. Nootnagel, of Minneapolis, was elected to full active membership.

Dr. F. A. Dunsmoor reported a case of a foreign body removed from the trachea in a very fat, short-necked woman 40 years of age. The right bronchus was entirely occluded, the lung doing no work at all, by a tough, gristly piece of meat. With the alligator forceps a piece of the meat was pinched off, allowing some air to enter, when a severe cough expelled the rest. Recovery was rapid and complete.

Dr. Geo. Douglas Head reported a case of tetany in a woman 32 years old. The diagnosis had been corroborated by the Trousseau sign (a stomach tube wound twice tightly about the right arm, producing the attack artificially). She had as many as seven or eight attacks in a day, lasting from fifteen minutes to three hours each.

Dr. A. E. Benjamin reported a case of hematuria in a man 28 years of age. Medical treatment had not helped him, so after determining which kidney was affected by means of collecting the urine from each ureter separately, an operation was made upon the right kidney. The organ was split, and a small growth discovered between the cut surfaces. Otherwise it was normal. The cut surfaces were then approximated, and recovery from the wound was rapid and complete. The blood continued to appear in the urine for about three weeks, when it ceased suddenly, and he has been well since.

Dr. M. P. Vander Horck cited the case of a young man 19 years old who had hematuria some time ago, which could not be satisfactorily explained at the time. A short time ago, however, prostatic enlargement was discovered, and

investigation revealed tubercular infection of the right lobe of the prostate gland.

Dr. James E. Moore read a paper, "Why We Are Obliged to Re-operate Some Gall-stone Cases." The paper was discussed by Drs. Dunsmoor, Rothrock, Nippert, Benjamin, Head, Stewart, Dennis, and Little, and by Dr. Moore in closing (see page 164).

HENNEPIN COUNTY MEDICAL SOCIETY

F. A. KNIGHTS, M. D., SECRETARY

A stated meeting of the Hennepin County Medical Society was held April 3d, the president, Dr. D. O. Thomas, in the chair, and about fifty members and visitors present.

The Executive Committee reported recommending that papers brought before this Society hereafter be limited to fifteen minutes' length.

Upon Dr. Brown's resolution, referred to the Committee at the last meeting, the Committee reported that the plan outlined therein was outside the function of the Society.

The Committee reported also that the annual banquet was planned for the next regular meeting.

This report was adopted by motion.

The committee appointed to draft resolutions on the death of Dr. W. P. Spring reported resolutions which were adopted, and ordered spread upon the minutes, and a copy sent to Dr. Spring's family. A letter of thanks from Mrs. Spring was also read.

The president appointed Dr. L. A. Nippert to deliver a memorial address on Dr. Spring's life and character at a future meeting.

Dr. H. B. Sweetser presented a patient with tarsus resected for tuberculosis of bone, the case having been first reported four years ago, no recurrence or systemic infection having occurred. He also presented specimens of thyroid removed by operation.

Dr. Chowning presented a patient having epithelioma of the sole of the foot originally supposed to be a corn.

Dr. J. H. Stuart delivered a memorial address on the life of Dr. A. H. Lindley, and reported

THURSDAY, JUNE IST, 1:30 P. M.

resolutions which were adopted, and ordered spread upon the minutes, and a copy sent to the family.

Dr. W. N. Porteous read a paper entitled "The Necessity of Nasal Breathing and Exercise." This was discussed by Drs. Brown, Watson, and Todd, Dr. Porteous in closing.

Dr. B. M. Behrens read a paper giving "Further Observations on Catarrh and Predisposition." This paper was discussed by Dr. A. W. Abbott, by Dr. E. J. Brown and Dr. A. E. Anderson and Dr. Behrens closing.

PROGRAM OF STATE MEDICAL ASSOCIATION MEETING

AT ELKS' HALL, ST. PAUL

The House of Delegates will meet May 31st, 2 p. m., in the Lowry Building.

I.

2.

THURSDAY, JUNE IST, 9 A. M.

President's Address, Dr. J. W. Bell, Minne-
apolis.

Some of the Difficulties in Diagnosis of
Surgical Disease of the Kidneys, and
How to Surmount Them, Dr. A. W. Ab-
bott, Minneapolis.

Discussion opened by Dr. M. C. Millett,
Rochester.

3. A Case of Renal Decapsulation, Dr. L. F. Schmauss, Mankato.

Discussion opened by Dr. H. A. Tomlinson,
St. Peter.

4. Perinephritic Abscesses in Children, Dr. G. R. Curran, Mankato.

Discussion opened by Dr. J. B. Dunn, St.
Cloud.

5. Floating Kidney, Dr. Theo. Bratrud, War

ren.

Discussion opened by Dr. J. W. Andrews,
Mankato.

6. Tubercular Disease of the Kidney, Dr. M. C. Millett, Rochester.

Discussion opened by Dr. J. W. Little, Minneapolis.

7. Bladder Extrophy, with Report of a Case, Dr. R. C. Dugan, Eyota.

Discussion opened by Dr. C. A. Wheaton,
St. Paul.

a.

Tuberculosis and its Care,

Dr. H. M. Bracken, St. Paul.
b. Sanatorial Care of Tuberculosis,
Dr. H. L. Taylor, St. Paul.

c. Dispensary Care of Pulmonary Tubercu-
losis.

Dr. Geo. Douglas Head, Minneapolis. d. The Anti-Tuberculosis Committee of the Associated Charities of Minneapolis. Dr. John G. Cross, Minneapolis. Discussion on Dr. H. M. Bracken's paper by Dr. D. D. Murray, Duluth, and Dr. Thos. S. Roberts, Minneapolis. Discussion on Dr. H. L. Taylor's paper by Dr. Chas. L. Greene, St. Paul. Discussion on Dr. Geo. Douglas Head's paper by Dr. G. S. Wattam, Warren. Discussion on Dr. J. G. Cross' paper by Dr. J. L. Camp, Brainerd.

3. Syphilis of the Liver, Dr. Archibald MacLaren, St. Paul.

Discussion opened by Dr. C. H. Mayo,
Rochester.

4. Eye-Strain, Dr. E. J. Brown, Minneapolis. Discussion by Dr. Arthur Sweeney, Dr.

Haldor Sneve, and Dr. C. E. Riggs, St. Paul, and Dr. W. A. Jones, Minneapolis. 5. The Accurate Determination of Errors of Refraction, without Mydriatics, by Means of Astigmatic Charts, Dr. Chas. N. Spratt, Minneapolis.

Discussion opened by Dr. J. H. James, Mankato.

6. More Practical Methods in Medical Instruction, Dr. F. F. Wesbrook, Minneapolis. Discussion opened by Dr. W. J. Mayo, Rochester.

7. Intestinal Perforation in Typhoid Fever, with Report of Cases, Dr. W. Courtney, Brainerd. Discussion by Dr. J. T. Rogers, St. Paul, and Dr. Knut Hoegh, Minneapolis.

8. The Present Stage of Our Knowledge Concerning the Therapeutic Value of the X-Ray, Dr. Burnside Foster, St. Paul. Discussion opened by Dr. H. S. Plummer, Rochester, and Dr. J. Clark Stewart, Minneapolis.