States. It may serve to call the attention of your readers to the work now being done in connection with this important subject, and thereby enlist their aid in placing statistics of causes of death upon a more satisfactory basis.

As the edition of the pamphlet mentioned is quite limited, I do not enclose a copy, but shall be pleased to mail you one upon your personal request if desired.

Very respectfully,

W. A. KING, Chief Statistician.

At the recent meeting of the American Public Health Association held at Washington the Committee on Vital Statistics reported that effective cooperation had been instituted between that Association, the Conference of State Boards of Health, the American Medical Association, the United States Census Bureau, and the United States Public Health and Marine Hospital Service for the improvement of the vital statistics of this country. Among the objects sought are the extension of adequate methods of registration, the use of uniform and comparable tables and rates in bulletins and reports, and the improvement of the international classification of causes of death. A pamphlet on "Statistical Treatment of Causes of Death" has been issued by the United States Census Bureau, requests for which should be addressed to Mr. W. A. King, Chief Statistician for Vital Statistics, Census Bureau. It has special reference to the difficulties encountered in compiling deaths returned from several causes, and asks for the co-operation of the profession in framing a thoroughly satisfactory method of procedure in such cases.

Thialion.

"In the treatment of these diseases by means of drugs, I have given all of the accepted remedies a thorough trial and I regret to say I have been unsuccessful, except with thialion, and thialion I feel I cannot praise too highly, for in the way of medicine it has done more for my gouty patients, and when I say gout I mean all cases of uric acid poisoning, than everything else put together."

Extract from a paper published in the New England Medical Monthly, October, 1899, by Henry S. Pole, M. D., Hot Springs, Va., member of the Virginia State Medical Society, etc.

Proceedings of Societies.

SAN FRANCISCO COUNTY MEDICAL SOCIETY.

At the September meeting the following programme was presented:

The first paper was presented by DR. H. C. MOFFITT on the subject

"KIDNEY TUMORS OF ADRENAL ORIGIN." Four cases of "Grawitz tumor" of the kidney were reviewed, a woman of 60 years and a boy from the local clinics; a man of 43 and a woman of 46 years from the Vienna clinics. These tumors belong with primary adrenal growths and vary much in malignancy. They are usually vascular and metastasis occurs through the blood. Fatty changes and hemorrhage often mask the growth. Symptoms may develop either quickly or slowly. "Grawitz tumor" occupies the upper pole of the kidney; it may be palpated in the bath and various positions; the lumbar region rarely bulges though the rib line may be raised. It is often mistaken for liver tumors, but the relation of the bowel in renal and hepatic tumors must be thought of. Pain and pasesthesia often precede other symptoms. Among vein symptoms are varicocele, most frequent on the left side, thrombosis of the cava and resulting ascites. The urine reveals hematuria, sometimes fragments of tumor, fat and glycogen in the cells; if injected into animals it may give the reaction of adrenalin and cause a rise of blood pressure, the secretion, as in the case of the thyroid, may be early increased and later diminished. A diastatic ferment is present in the tumor. Casts and albumen are present later. Fever is irregular and the development of cachexia irregular and slow. Metastases tend to occur in the long bones, skull, etc., and are often the first symptom to call attention to the true nature of the disease. Some pulsate and may be confused with aneurism. Lung and pleural metastases occur with hemorrhage, the latter common. Pain and hematuria are early symptoms. The tumor is soft and pulsating, and breaks into the veins early; hence tie the renal. The physiology of the metastases is that of the adrenal tissue.

DR. E. O. JELLINEK read a paper entitled

"GRAWITZ TUMOR OF THE KIDNEY."

The paper opened with a description of the tumor and its theory of origin. There are pea-sized masses, gray or vascular, adipose, formerly called lipomata-they occur in the medullary portion leading to degeneration of the tubules. Grawitz showed that they originate from scattered particles of adrenal epithelium which penetrate between the lobules before they unite, and upon occasion begin to proliferate. In their beginning they seem benign but later degenerate.

CASE I.-Male, 43 years; slight pain in right side past six years dating from a race. Two years ago the pain became severe and renal colic was diagnosed and treated. He lost weight, muscles became flabby, membranes pale. Tumor was palpable on right side near umbilicus, urine showed leucocytes, scanty red cells, and some tumor particles. A diagnosis of Grawitz tumor was made, operation, and removal of tumor size of head.

CASE II.-Man of 55 years; suffered loss of weight, blood in urine, health good when young. Pains radiated to penis, chills and fever, lost 45 pounds last year; weight, 146 pounds. In right lumbar region a tumor, like a floating kidney, removed. The paper closed with a review of the points that make a diagnosis of Grawitz tumor probable.

DR. REYNOLDS exhibited a kidney specimen of Grawitz tumor from the service of Dr. Bazet, at the French Hospital. The patient gave history of pain in left side and was treated for malarial spleen with improvement for three months-was injured by falling timber and came incachexia muddy, bloody fluid in right pleural cavity, tumor of left side 5 cm. below ribs, freely movable with respiration. Pleura was washed with salt solution. Hemoglobin reduced to 30 per cent, red cells to 2,000,000. Patent died; autopsy showed a tumor of adrenal origin, the kidney not involved. Tumor contained dark thick fluid in a cyst formation, the result of degeneration in a soft vascular tumor.

DR. OFFULS gave a microscopic demonstration of Dr. Jellinek's tumor, and said it was interesting for two reasons: 1. It is one of the best illustrations favoring Cohnheim's theory of tumor formation. 2. The metastases

shows no tendency to malignancy, retaining the structure of adrenal gland.

DR. ROSENSTIRN: I think the dictum true that adrenal tumors of the kidney are frequent, relatively, though kidney tumors are rare. I have had only one such case, a young man of 18 years, and I notice several quoted to-night were young, but usually this type of disease occurs late in life. The common origin of the adrenal and kidney in the epithelium of the Wolffian body supply the first condition for malignancy, and any slight increase in this is carcinomatous, and the rate of growth may vary with condition. I do not think varicocele of frequent occurrence in Grawitz tumor.

DR. EBRIGHT: With regard to the specimens spoken of by Dr. Reynolds the findings were in line with those demonstrated by Dr. Offüls. As to the advisability of operating-of 15 cases reported, 10 were diagnosed postmortem, and 5 were drained with fatal result. I would like to ask Dr. Moffitt his opinion of the advisability of draining these tumors when cystic.

DR. KROTOZYNER discussed the function of ureteral catheterization, and value of cryoscopy and phloridzin in establishing an early diagnosis. Usually the operator complains that the diagnosis is made too late; this can be overcome by segregation, etc.

DR. TAIT added a fact from the experiments of the French school in which adrenal grafts in kidney grew.

DR. COOPER spoke on the diagnostic possibilities that lie

in physical signs.

DR. MOFFITT closed the discussion.

DR. C. G. LEVISON read a paper:

RETRO-PERITONEAL LIPOMA WITH EXHIBITION OF PATIENT.

The patient, in 1891, had a chancre, and the sequelae of syphilis followed. In 1902 a tumor appeared in the abdomen, and a sensation of the right thigh as though asleep. Examination showed a lobulated mass in the right lower quadrant, smooth above. The percussion dullness was as that of ascites, but no change occurred with change of position. Urine and blood negative. Tumors of spleen and kidneys were excluded. Operation showed a free yellow mass with translucent nodules. Because of alarming

hemorrhage the operator desisted till a later sitting, when a portion of the tumor was removed. Sections show the structure of a lipoma.

The Nominating Committee placed in nomination for election in November: For President, DR. JULIUS ROSENSTIRN; First Vice President, DR. E. M. BIXBY; Second VicePresident DR. REYNOLDS; Secretary, DR. W. F. BARBAT; also names to fill the committees. By motion the nominations were closed.

Adjourned.

At the October meeting the following programme was presented:

DR. WINTERBERG presented a patient to the Society who had suffered from faulty union of the forearm bones following fracture. Operation to relieve deformity and restore function was done last May with complete success. Dr. Winterberg said that this case illustrated the advisability of early removal of the splint for inspection, and for the institution of passive motion and massage. A recess of three minutes allowed the members to examine the arm.

"REPORT OF CASE OF TOTAL LARYNGECTOMY AND
EXHIBITION OF PATIENT,"

by DR. WALLACE I. TERRY. The case was from the service at the City and County Hospital. On the 7th of last May Dr. Terry removed an epithelioma from the young man's larynx. Four months later he returned with a recurrence of the growth. Under local cocaine anesthesia the larynx was opened and the growth curetted, and an attempt made to apply the X-ray through the opening left by the operation, but without result. Seven weeks later, following Keene's technique, total laryngectomy was performed under chloroform, which was administered through a tracheotomy tube. No depression was shown by the blood pressure, as measured by the sphygmomanometer, until two hours later, when the respirations fell as low as four per minute. Recovery with complete healing followed. The patient is learning to speak with a phonation apparatus, which he demonstrated by addressing those present.

Dr. Terry concluded that cocaine used locally might avoid shock due to laryngectomy, and that excision should