grene and tuberculosis. The editor follows this with examples of cloudy diagnoses being cleared up by the aid of the X-ray.

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Finally, we have: Jurgens by no means claims that a diagnosis can always be made from the X-ray picture alone, and the clinical symptoms and history must ever be of considerable value. He emphasizes that the value of the X-rays does not lie in the taking of an occasional picture, but in taking successive ones of the same patient. Changes in the upper lobe are most easily interpreted in the picture, and it is this region which is most frequently the seat of delayed resolution and complications."

Harsh criticism is not meant for these authors, both of whom have done valuable work and have added much to our fund of knowledge of chest diagnosis, but it does seem that this editorial treatment of such a large subject should not go out without a word of explanation and warning. For in advising the "successive taking of pictures of the same pationt" he overlooks the fact that some very severe reactions have been produced by exposing patients but once to the rays.

It is true that Edsal, a very conservative and careful clinician, has suggested the use of X-rays for the purpose of facilitating delayed resolution, but he does so only after telling how one of his patients was profoundly affected by only eight seconds' exposure of the rays and explaining how such accidents may be avoided.

Therefore, should some enthusiastic disciple of the Monitor who has access to a Roentgen apparatus and a pneumonia patient follow out the Monitor's teaching, he would probably have the patient's system deluged with toxins, due to the breaking down of the unresolved areas, to such an extent that the kidneys would be overpowered, elimination could not take place with sufficient rapidity to relieve the economy, the nervous and circulatory systems would be much affected, and death might easily occur. Such one-sided teaching, then, is not fair to the reader or his patients, but, what is worse, its disastrous results would bring a valuable diagnostic and therapeutic agent into disrepute and deprive many doctors of its usefulness through fear for their patients.

The whole trouble lies, I think, in the fact that an editorial, though it has more weight than a simple article, goes into a journal practically unedited; therefore, it is most important that a man think clear through a subject lest the limitations of this knowledge or his unrealized inexperience do harm incalculable.

Genito-Urinary Diseases.

E. O. SMITH, M.D.,

Lecturer on Genito-Urinary Diseases, Medical College of Ohio.

Value of Palliative Operation for Cancer of the Bladder.

Hugh Cabot, of Boston, in the American Journal of Urology for September, reviews the opinions of many well-known genito-urinary surgeons, and finds that most of them have been averse to any operative treatment for the radical cure of malignancy of the urinary bladder. Most of them do not approve of even palliative operations. He, however, believes that palliative operations are indicated, and should be advised in two classes of cases:

1. Those in which it can be taken early, before infection has taken place or become important, and in which there is, therefore, the possibility of actually prolonging life.

2. Those undertaken after extensive infection has occurred, and which must be regarded as purely for relief of symptoms.

Class 1.-Owing to the fact that cancer of the bladder grows slowly and that metastases are slow in forming, he is encouraged to operate early with the hope of influencing the course of the disease. This view is strengthened by several case reports with favorable results after operative treatment. Cases appropriate for early palliative operation should show the following conditions:

1. The disease should be in a comparatively early stage, though the location or depth of infiltration make radical cure impossible.

2. Infection of the bladder must be absent or trivial.

3. Infection of the upper urinary tract must be absent.

4. Cases in which the disease is known to have extended beyond the limits of the bladder and involved the lymphatic glands will not be benefited.

These limitations are necessary, as benefit from the operation depends largely on the prompt closure of the wound; for the creation of a fistula at this stage only makes the patient more uncomfortable and is not indicated. Involvement of the supra-pubic portion of the bladder is very apt to make closure of the wound impossible on account of infection, and, on the other hand, extensive involvement of the base of the bladder can be treated much more satisfactorily. Severe infection of the bladder makes the closure of any bladder wound slow, and at the same time seems to make the growth of the tumor more rapid.

The occurrence of pain at points more or less distant from the bladder is generally due to metastases pressing on nerve trunks, and will not be relieved by operation.

Class 2.-This class of cases contains only those in which operation is undertaken purely for the relief of symptoms. The operation is simple cystotomy to relieve pain, frequent urination, hemorrhage, or severe infection. In addition to supra-pubic drainage he keeps a catheter in the bladder, which makes the patient more comfortable, and he is out of bed very soon.

The use of the cautery aids in checking hemorrhage and probably retards the growth of the malignant mass.

The following conclusions are submitted: 1. That palliative operations are of value in the treatment of cancer of the bladder.

2. That in properly selected cases, operation will prolong comfortable existence very materially.

3. That supra-pubic drainage of the bladder will relieve the symptoms and promote the comfort of patients for whom nothing more radical can be done.

4. That hemorrhage should not be allowed to continue unchecked unless efficient examination has conclusively shown that its cause cannot be removed by operation.

Treatment of Gleet.

Foote (Cleveland Medical Journal, June, 1907) treats of the many pathological conditions that may give rise to a chronic urethral discharge, noticed most frequently in the morning. To some patients thus troubled the real annoyance is psychic and not physical, yet they are worthy of notice. Of course, the most of these cases are due to some pathologic condition. Chronic urethritis is the most common cause, and we should always examine for gonococci, chronic prostatitis and vesiculitis are conditions often overlooked. Foreign bodies and calculi may be present. Sexual over-stimulation, perversions, and constitutional conditions may account for the discharge in persons with a history of a previous urethral infection.

Gleet should not be treated as a simple symptom, but the pathologic condition causing it should be sought and treated accordingly.

In closing, I should like to emplasize the following points:

"1. Gleet is ordinarily a symptom of some local or constitutional affection.

"2. In the large proportion of cases we have to do with chronic urethritis or prostatic disease.

Prevalence of Prostatic Disease.

The transcendental genito-urinary pathologists have been regaling us with all sorts of ultra-scientific reasons intended to account for the comparatively large number of chronic inflammations of the prostate. Unfortunately, most of them are explanations which do not explain. In other words, they are inadequate, insufficient and incompetent. We have never been able to understand why the real cause of this prostatic trouble was not published, carrying with it, as it does, the prophylaxis of the trouble. Our readers are probably aware of the fact that it is a but too prevalent practice to make deep injections, supposed to be urethral, but, in point of fact, prostatic, of strong solutions of silver salts. This is regarded by some as eminently proper practice, and yet its results are disastrous. The prostate is irritated and becomes irritable, and the natural consequences of such a state of affairs follow. The individual so afflicted has his prostate massaged properly or improperly, he is placed in an uncomfortable state, and his life is rendered miserable and one of constant pain, torture and anxiety. Instead of curing his deep urethritis he is given a chronic prostatitis, which is certain to resent the irritation by becoming hypertrophic, and the train of symptoms resulting from this fully declare themselves until finally the close of the whole matter is the operating-table, with the risk of a successful result or a failure. This is no exaggerated picture, and merely points out the necessity of avoiding the injection of the prostatic urethra with strong solutions of silver salts.-Editorial in American Journal of Dermatology and Genito-Urinary Diseases, October, 1907.

Miscellany.

Tuberculosis in Germany.

Consul H. W. Harris, of Nuremberg, Germany, states in a report recently that the management of the Bavarian State railways has adopted additional precautionary measures to prevent the spread of tuberculosis among its employees, owing to the relatively large mortality shown from this disease among this class. The consul continues:

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The measures adopted relate not only to sanitary conditions on railway trains, at stations, ticket offices, baggage rooms and other places where such employees work, but to the dwellings occupied by them and their families and to the treatment of cases where the disease has developed. Provision is made for the dissemination of literature among employees for their better information as to the nature of tuberculosis and the sanitary conditions which tend to lessen its evils and check its spread. Much stress is also placed upon proper medical and other attention to employees affected by the disease in any of its stages. A number of railway workmen in each district will receive careful instruction in the process of disinfection, and especially in house disinfection with formalin and other disinfectants. Official inspections of railway shops and other buildings are to be made from time to time to secure their proper sanitary condition.

The co-operation of the Red Cross Society, of societies of women, of building societies and charitable associations of various kinds is sought to further reduce tuberculosis among railway employees and their families, and indirectly among the traveling public. The purpose will be to conduct the reform not so much as a police regulation, as on a broad humane policy which will cause the least possible distress of mind to the patient or his family and most tend to bring about the end desired."-Houston (Tex.) Post. To Establish a Tuberculosis Colony.

Greene County (Indiana) physicians are making efforts to establish a colony for the treatment of tuberculosis. Dr. Hurty, Secretary of the State Board of Health, will outline a plan for the colony, as requested by the promoters. The letter giving the plans was written to Dr. Hurty by Dr. E. R. Mason, Secretary of the Greene County Board. The County Medical Society," wrote Dr. Mason, proposes to do the pauper practice of the county without pay, if the county will turn the money set apart for that purpose into a fund for the hospital. This

will raise about $800 yearly, and then, if the County Council will make a proper appropriation, the life-saving and happiness-promoting work will begin.'

Here are men,'

" said Dr. Hurty, “who

propose to give their services free to the poor; and this is a duty which obviously belongs to the public. It is a noble work. which they are taking up. One in every seven deaths in Greene County (this is also true of other counties in the State) is caused by consumption. This disease can be found in every township, and perhaps in every postoffice neighborhood in Greene County. The doctors know this, and they further know the cost of the disease to the people.

“The greatest question, however, is, will the people respond to this offer which the doctors have made? I believe they will, and I shall do everything possible to make the venture a success." Dr. Hurty will at once forward suggestions for the establishment of the colony.-Indianapolis News.

A Centenarian's Birthday Celebration.

Dr. William M. Starr, of Washington, D. C., was host, October 14, at a luncheon in celebration of the hundredth anniversary of his birth Dr. Starr was up bright and early, and declared he had never felt better in his life. The luncheon was served in the the Queen Café, within a short distance of Dr. Starr's home. His guests included members af the Association of Oldest Inhabitants.

Many of the members had a store of interesting anecdotes to relate, but Dr. Starr took the palm with an original poem, on which he has been working several weeks. The poem was read by B. H. Warner, Dr. Starr delegating this duty to Mr. Warner in order that it might be read with all its significance. The poem is entitled "The Old House," and reviews Dr. Starr's impressions and interpretation of the laws of nature." He said that many persons have had much to say about these laws, but he has his own ideas, and in order to put them before his friends in a more interesting way than by mere statement of facts, he embodied them in the poem which was read before the association this afternoon.

Additional congratulations were given Dr. Starr at the conclusion of the poem, which served as another proof that his advanced years have not affected his mental faculties or lessened his grasp on questions of the day.

Dr. Starr has no relatives living in Washington; all of them live in the West, but he has many friends, and they united in giving him their heartiest wishes.

all other forms, but many difficulties are in the way.

Three conditions that must be met are: The organism must be grown in living water; it must have free access to atmospheric air; isloation must be maintained for a long period of time-for months or even years.

While isolation is desirable, it is not essential at all periods to the proper study of an infusorian.

Isolation may be maintained for an indefinite period of time by transplantation to a solid culture-medium. Isolation is also effected by transfer of the ray-fungus to a sterile infusion. The latter, though isolation may not be so perfect, is in many ways superior to the former method.

With the ray-fungus a colony is planted with a form that is visible to the unaided eye. Here the form transplanted is not only propagated by fission, but the organism proceeds to round out its life cycle and is limited in its range of reproduction of forms principally by the necessarily small body of the substratum and the changes incident to stagnation. On a solid culture-medium it is so hedged round with the conditions imposed that only the form transplanted can be propagated in its perfection. Any attempt at deviation from this results only in the production of aborted forms. There is not a sufficient amount of fluid to enable the organism to attain to the adult state, and it is unable to migrate to a new focus where it may be rid of the detritus incident to its growth and multiplication in the old. And its supply of air is cut off or very much limited.

Grown in running water with free access to atmospheric air, the animalcule fixed to a cover-glass is seen to be divided into two zones an inner, defined by the limits of the endoplast or nucleus, and an outer, occupied by the ectoplasm. Exceptionally, an endoplastule or nucleolus may be seen within the endoplast or nucleus, but usually this is fragmented, the fragments lying within one or the other of the two zones mentioned. When it persists as a single body within the endoplast, it becomes the neucleus of the freeswimming animalcule when the endoplast is set free. That is to say, if the nucleolus is regarded as the third, the nucleus as the second, and the free-swimming animalcule as the first generation, when one disintegrates, two is set free and three becomes its nucleus. But the forms of an infusorian are not limited to these three. A form that is round will be succeeded by one that is elongate, an active will be followed by an encysted form, an animallike by a vegetative, a zoöidal by a filamentous.

A ciliate protozoan and its life cycle may be compared to a planet and its orbit. The centripetal force holding it to its cycle is heredity; the centrifugal force, because of which there is a constant tendency for it to go off at a tangent, is environment. Acting with heredity in the maintenance of the species, is conjugation. In the continued absence of conjugation environment becomes a potent factor in the variation of recurring forms of a protozoan. Heredity, environment and frequency of conjugation all have to do with such variation.

The perpetuation of a form by fission may be compared to the revolving of the planet upon its own axis, and the rounding out of its life cycle to the coursing of the planet through its orbit. The two occur simultaneously, though one or both may for a time be imperceptible.

As is the case with animal cells generally, the study of an animalcule centres principally in the nucleus. pally in the nucleus. The animalcule, like the animal cell, propagates itself by fission, but it leads an independent existence and is at the same time a matrix for the propagation of its young. These spring from the inner or from the outer zone, or from both simultaneously. For the nuclear zone of one generation becomes the ectoplasm in the next succeeding.

The young protozoa appear in the form of spherules or of filaments, but there are many modifications of these.

The spherules may exist singly or in chains. When they form chains, the nucleus from which they are derived is a sphere or spheroid, with two polar extremities, the chains forming the meridians. These chains or meridians are the streptococcus form of the organism. By the time the sphere disintegrates and the meridians fall apart the streptococcus is fully formed. If in the process of disintegration separation extends to the individuals of a chain, the young spherical protozoa of a sphere appear as staphylococci.

The streptococcus form of an organism appears to be endowed with the potentially highest generative powers of any form of an infusorian derived from the cortex.

(a) It seems probable that conjugation had taken place previous to the appearance of this form.

(b) Ordinarily when a nucleus is set free, it forms a new animalcule with a nucleus of its own. When the streptococcus appears it is in the outer zone (after the nucleus has been set free) corresponding to the ectoplasm and no nucleus is present. All the generative powers of the new individual are centered