I am sanguine that their significance will be established. The organism described by Mallory and later by Duval in scarlet fever were found by Mallory in the protoplasm of the epithelial cells of the epidermis, between these cell and free in the lymph vessels and spaces of the corium. The majority vary in size from 2 to 7 microns in diameter. Duval, in addition to these situations, found them in the fluid of blisters obtained by the application of aqua ammonia. The bodies found in the skin are of two kinds, the reticular bodies and the rosettes. The first are round, oval, elongated or lobulated, and stain lightly but sharply with the blue, composed of finely granular reticulum either close-meshed or coarse-meshed. These forms are found both in and between cells of lower layer of corium and in lymph spaces of corium close to the epidermis.

The second group of bodies present a radiated structure (same situation). Sometimes the segments may be free from the central body. The frequent wheel and star shapes of these rosettes has led Mallory to propose the name of cylaster scarlatinalis for these organisms.

These bodies were found, as I stated, in but four cases. These were all early cases; the bodies are not found in the desquamative stage and the difficulty of getting material in early cases of scarlet fever may well be understood.

These bodies, Mallory suggests, may be interpreted in three ways as artefacts, as degenerations or as protozoa Against the first is the fact that in three pieces of skin from one of the cases fixed, preserved and stained exactly in the same way, the bodies were absent in the first, few in the second and numerous in the third.

Against there being degenerations is the fact that they appear not only in and between the epithelial cells but in the lymph spaces of the corium and they were found in cells that were in mitosis, besides their size, morphology and staining reaction separate them from being degenerated leukocytes, lymphocytes or epithelial cells.

In favor of their being protozoa is their distinct morphology (similar to the asexual cycle of malaria). A change can be followed from the small bodies to the formation of rosettes and from segments of rosettes to re-formation of small bodies.

Provided they are protozoa, have they causal relation to scarlet fever? They have never been found in normal skin. In the fifty-four cases of scarlet fever studied at Harvard with

same preservation and fixation, bodies like these were never found.

We can not fulfill Koch's law with protozoa-they can not be cultivated save in the tissue. In order to prove a series of bodies protozoa, we depend on ameboid motion, characteristic morphology and on developmental cycle (and of size, division, re-formation of bodies from which cycle started). In hardened tissue ameboid motion is sometimes suggested but a large of material is necessary to construct a cycle.

If these bodies are protozoa it is impossible to classify them until more is known of their life cycle. The majority of the forms suggest the schizogony of the malarial parasite. Until we can study them in cultivation their significance can not be clear.

I am not familiar with all the details of Duval's work, but it is, in the main, similar to Mallory's. His work is soon to appear in Virchow's Archives. Personally, I believe these bodies to be protozoa and to have an etiological significance in scarlet fever. I shall be glad to demonstrate the preparations I have at any time.

Formalin for Inoperable Cancer.

Seneca Powell recommends the treatment of inoperable cancer by soaking in a 2 per cent formalin solution and laying it on the tumor and covering with jaconet and cotton wool. By changing the dressing every six hours the discharge and fetor ceases, and the further progress is an aseptic one. The tumor loses its elasticity, and becomes friable and insensitive. Separation is accomplished without pain, though it is necessary to snip the fibrous bands passing into the deeper tissue.

Embolism Following Operation.

Dearborn (An. Gyne. and Ped.) claims that thrombosis and embolism are more frequent following pelvic operations than after operations elsewhere in the body. It is reasonable to suppose that a large percentage of post-operative cases of pleurisy, pneumonia and pulmonary abscess may be due to emboli. The prognosis varies with the size of the emboli, the large ones producing almost invariably rapid death from asphyxia. A favorable course frequently results in the event of a very small embolus. An important symptom of thrombosis is a sudden increase in the pulse rate during convalescence, while the temperature remains normal. In regard to the treatment of either embolus or thrombosis absolute rest is imperative.

LEADING ARTICLES.

ACTINOMYCOSIS.

As early as 1826 Leblanc' presented a very excellent description of this disease as involving the jaws of cattle, and to which he gave the name" osteosarcoma." When Rivolta discovered the presence of yellow granules in the contents of the swollen jaw of an ox he remembered that a few years previously Langenbeck had reported the finding of quite similar granules in the pus from a case of caries of the spine in a human patient. To these granules Harz gave the name,

ray fungus" or actinomyces, from their shape. It was about this time that Bollinger clearly demonstrated that the so-called "osteosarcoma," described by Leblanc was due to the ray fungus. Very shortly thereafter Israel and Poufick found that human and bovine actinomy. cosis were due to the same organism-belonging to the cladotricha Actinomycosis is readily inoculable both into the human and bovine organism but, perhaps, carnivora are less susceptible. In cattle the jaw or tongue is usually involved, while in 50 per cent of the cases occurring in man the primary seat of the disease is the mouth and its neighborhood. Cattle are usually infected by eating diseased grain while man is infected, in at least 65 per cent of the cases, by coming in contact with infected cereals, hence farmers are so frequently affected. Any factor that causes an abrasion of the skin or mucous membrane prepares the way for infection. The chewing of straw or grain, or grass may be the cause. In von Partsch's case inoculation seemed to be due to infected surgical instruments.

In man no tissue is exempt from invasion. Von Bergmann' has seen 100 cases in the human, in 45 of which the jaw, and in 35 the neck were the site of lesion. The jaw, cheek and neck are especially likely to be affected. The abdominal viscera are inore frequently affected than the respiratory tract. Israel and Partsch maintain that entrance is usually gained through carious teeth; they have demonstrated pure cultures in the cavities of carious teeth.

Very recently, Dr. Knox' reported 3 cases occurring in the same family. The 3 patients had been in the habit of spending a great deal of their time on the farm. The farmer had consumption, and cattle in the district had died of anthrax. All of the three patients had carious teeth and they all had glandular trouble early in life. Two of these patients died; the other being healthy and strong. Dr. Knox calls attention to the fact that in the early stages it may be difficult to dis tinguish actinomycosis from tuberculosis. He finds that the temperature is an important point. In actinomycosis an evening rise is not common unless the disease is accompanied by suppurative changes which Dr Knox is inclined to classify among the later and more distinctive symptoms. Actinomycosis of the lung may continue for a long time. without temperature or any distinctive symptoms except slight cough and expectoration. A suspicious symptom in any doubtful case is the appearance of swellings in a part of the body, especially if they appear upon the back-and swellings are generally the forerunners of abscess.

Perhaps, the only safe rule is to always examine-and not once but frequently the pus and expectoration. The presence of the ray fungus may be difficult to find; the presence of the typical mycelium or clubs establishes the diagnosis. Dr. Poncet thinks that the clinical diagnosis is more apt to be correct than the microscopic-especially since the parasites may not be demonstrable. Dr. Knox argues that an early diagnosis can be made by the aid of the microscope; suspicious symptoms should always induce the practitioner to examine spu tum, pus, etc., carefully and repeatedly. The specimen should be examined by Gram's method; the typical mycelium may be readily recognized but the typical arrangement of the clubs is not usually present. Dr. Poncet thinks that the most striking clinical feature is the association of a cancer with those of an inflammatory lesion. Von Bergmann lays special stress upon the pseudofluctuating consistence, the dense infiltration of the tissues, the absence of sharp outlines, and, above all, the peculiar bluish discoloration of the skin over the soft

areas.

TREATMENT.

Van Iterson introduced the potassium iodid treatment into practice. At times potassium iodid alone has been shown to effect a cure. In 1885 Thomassen reported that iodid of potassium had a curative

influence, and it is probable, that in former times this drug was administered because the disease was regarded as of syphilitic origin. In some instances the iodids have been of no value. As much as 90 grains a day have been given without any symptoms of depression having been observed. Dr. Carr and others have obtained beneficial results with the iodid combined with scraping of the parts. At present the surgical treatment consists in incising the part, removing the soft tissue with a spoon curette and then packing with iodoform gauze The iodid treatment should also be administered. In some cases frequent cauterization has been found valuable. [E A. BABLER, M D.

BIBLIOGRAPHY.

'Lancet, Oct. 29, 1904.

2Von Bergmann's Surgery, Vol. 2, 86, 1904.

Lancet, Oct. 29, 1904.

J.A.M.A., May 14, 1904.

"Quoted by von Bergmann.

"Lancet, Oct. 29, 1904.

PARASITES OF SMALLPOX, VACCINIA AND
VARICELLA.

In our annual review1 attention was called to the recent assertions of Dr. Councilman and the fact that his findings had been confirmed by those of Dr. Calkins. Very recently Dr. DeKorté' has submitted the vesicular contents collected in capillary tubes from the pocks of smallpox, varicella and vaccinia respectively, to a microscopical examination as a hanging-drop preparation, without any other manifestation whatsoever, large numbers of unicellular elements were found which on a warm stage showed ameboid movement. He thought that such elements could be leukocytes, pus cells or protozoa. To exclude the leukocyte theory variolous matter was examined which had been kept for six months in capillary tubes in a sterile condition, the virility of the lymph having been determined by successfully variolating a monkey. The unicellular elements were still present in large numbers. This made it highly improbable that they were leukocytes, as these latter bodies were found to disappear spontaneously from blood serum kept in vitro at 37°C. after six days, and after fourteen days not a vestige of them could be recognized. Furthermore, on attempting to fix the unicellular elements, especially such as were old, they invariably