person presenting clinical evidences of infection indicates that the individual does not require antitoxin, but nothing more; he may be infected with virulent diphtheria bacilli capable of disseminating the disease. While the diphtherin test indicates hypersensitiveness to the protein of the diphtheria bacillus, it has probably no value as an index of immunity and is of practical interest mainly from the viewpoint that the anaphylactic reaction may be mistaken for a positive Schick reaction.

Tendency of the Diphtheria Bacillus to Localize in the Upper Respiratory Tract. Because of past experiences in finding that the organisms of diphtheria may be present in the larynx and absent in cultures taken from the nose and throat, or positive in the nose and absent in the throat, and so on, D. O. Walthall (Amer. Jour. Dis. Child., 1916, xii, 149) made a number of observations with this point in view. Of eight cases, the organisms confined themselves to one locality in five cases, to more than one locality in three cases. Normal and Pathologic Cerebrospinal Fluids in Children.-M. R. Johnston (Amer. Jour. Dis. Child., 1916, xii, 112) investigation was undertaken to determine the relative value of various methods in use in the examination of the cerebrospinal fluid in sundry affections of the central nervous system of children. One hundred and nineteen fluids were examined from 100 patients. His findings are that as an index of pathologic change in the cerebrospinal fluid, the colloidal gold reaction is more delicate than any other test here employed. A positive Lange reaction may be considered sufficient evidence of a pathologic process affecting the cerebrospinal nervous system, though the fluid in question is negative to all other tests. A normal fluid causes no reduction of the colloidal gold. The presence of globulin in the cerebrospinal fluid, as determined by the tests of Noguchi and Nonne, is indicative of an inflammatory process, but is of no specific import. A negative globulin test may occur in a pathologic fluid. The quantitative estimation of organic substances by the reduction of tenth-normal potassium permanganate shows such wide variations in normal fluids and those with slight pathologic change that it has no value as a diagnostic measure. The qualitative presence of dextrose in the cerebrospinal fluid as determined by the reduction of Fehling's solution is of little value in the diagnosis of lesions of the central nervous system. The specific diagnostic import of a given test is dependent on the character of the process causing the change in the fluid examined. Thus the cell content and bacteriologic findings are final in purulent and tuberculous meningitis. In the colloidal gold test the characteristic syphilitic zone reaction in hereditary syphilis is sufficient to establish the actual or potential existence of a syphilitic involvement of the central nervous system. This statement presumes a positive Wassermann reaction on the blood. A number of affections give this same reaction, particularly acute anterior poliomyelitis, and no specific significance can be attached in nonsyphilitic cases. The occurrence of a typical zone reaction in the colloidal gold test on fluids from patients with tuberculous meningitis is probable, and

may be of value in diagnosis in the early stages. The occurrence of a transitory reaction in the lower dilutions suggests an aid in the diagnosis of acute anterior poliomyelitis.

Prevention of Infantile Paralysis. Although we are still in great ignorance as to the mode of transmission of infantile paralysis, it is pretty well agreed that the most common avenue of infection is through the mucous membrane of the nose. Hence it seems to W. S. Whittemore (Bost. Med. and Surg. Jour., 1916, clxxv, 231) logical in combating the disease to use a substance which has been shown to be capable of practically sterilizing the nose and throat and is, moreover, free from any irritating effect. From experience with kaolin powder in the treatment of infections of the nose and throat during the past year, he suggests its use as a possible method of preventing infection of children and adults with infantile paralysis. It should be insufflated into the nose and throat every two hours during the day.

Quarantine Period for Measles.-W. B. Whyte (Can. Practitioner, 1916, xli, 336) says that all are agreed that the most infective period of measles is the invasion and early eruptive period. As most cases are well into the eruptive stage before seen by the medical profession, any measures decided upon to cope with the situation should be directed toward the control of the movements of contacts rather than to prolonged isolation of the original infecting case. Quarantine and observation of contacts for fourteen days from the date of the last exposure to the original case would seem to be the only effective measure in preventing the spread of infection from house to house. If it were possible to provide a routine examination of patients for Koplik spots during the second week of quarantine many cases could be put under strict isolation during the very period when such a measure is of some value. Prolonged quarantine of the original infecting case probably has no bearing upon the prevention of the spread of infection, but the danger of subsequent cases developing within fourteen days, is the more important detail in any effort to control the disease.

Undescended Testis.-D. N. Eisendrath (Annals Surg., 1916, lxiv, 324) úrges that cases of true nondescent or ectopic descent of the testis should be operated upon at as early an age as the condition of the child will permit, the lower limit being about two years. Atrophy of the spermatogenic cells occurs in about 90 per cent. of the cases of retained testis, hence the necessity for early operation. Tumor formation, torsion and the usual complications of the congenital hernia accompanying nondescent of the testis are not as rare as thought to be and must be taken into consideration in weighing the question of an operation. Hypopituitarism is not the result of the nondescent, but an independent and not infrequent accompanying condition. The operation for nondescent, i.e., retained testis, has but little influence upon this lack of development of the male sexual characteristics and one should be guarded in the prognosis for such cases, as well as in the possible development of the testis after operations in young adults.

FOR some years I have maintained that, for all practical purposes, cases of cancer of the cervix that are curable, are curable by cautery amputation. Clinical travel planned in order to observe the leading operators of the world do radical hysterectomy has embraced not only the work of Wertheim and his assistants, but of men like Amann and Franz, Sigwart and Latzko, to say nothing of John G. Clark, and some of the ablest American operators-all men who do better surgery and more extensive removal than was seen at the Wertheim clinic. These observations and my own few cases have turned me back to Byrne's general principle, to which one may add certain betterments of method. The igni-hysterectomies of Mackinrodt were with clumsier instruments than we use and he abandoned his attempts. Gellhorn was his assistant at that period. Gellhorn, though qualified to be a star witness owing to judgment and experience such as few men possess, cannot see any hope in reviving the cautery method. But to me retrial does seem worth while. The low mortality and morbidity, and the willingness of patients to submit to and practitioners to advise a measure with low mortality and morbidity-these are strong arguments. The large number of men who can be trusted with the hot platinum knife is a big item in the argument when you compare this with the relatively few who can have the highest degree of expertness, experience, or skill requisite to carry out one of the most difficult and inaccessible *Read before the Obstetrical Society of Philadelphia, Dec. 7, 1916.