portance of correct diagnosis is the greater since in most undiagnosed cases the patients die, while with proper treatment the prognosis is good, except under one year of age, when the disease is rare or when the disease is bilateral, which also is seldom the case. There is in children a more active metabolism and a greater elasticity of the chest wall, favoring the collapse of the smaller cavity. In the majority of cases, the treatment is surgical, and he believes that every physician competent to treat these cases should also be able to aspirate a serous effusion or to make an incision for an empyema in a child. Of course the more competent the surgeon the better, and in extremely rare cases where an Estlander or a Schede operation is required the highest possible surgical skill is none too good. The cases of two patients successfully operated on by incision are reported. The author concludes by urging most painstaking physical exploration in these cases, with all clothing removed and every possible available instrumental aid. Experience teaches him that too many auscultations are made with the unaided ear, to many percussions through clothes and poultices, and that there are too many snap guess-work diagnoses. The microscope and blood counts may aid.

SOME ASPECTS OF THE CANCER PROBLEM.-G. B. Massey says that he believes that we are already possessed of more information in regard to the cancer problem than is generally acted upon. A point of the greatest importance is a wider diffusion among the public of our present knowledge concerning the disease. Although we know that cancer is purely local in its first manifestations, this fact is not understood by the sufferers themselves, and much time is often lost before treatment is begun. The public should be instructed as to the deplorable results of delay, whereby what was at first a strictly local process is permitted to become generally diffused. The belief that pain is an invariable accompaniment of beginning cancer, and that there is any danger of spread of the disease by any of the ordinary means of infection. must also be combated. It is urgently to be desired that the government and wealthy private individuals should subsidize re

search laboratories devoted to the study of this question, as the private means of investigators are usually inadequate. In regard to treatment the author says that nearly 100 per cent. of external and semi-external growths can be positively cured in their early stage by destruction or removal of the original nidus of the disease. While wide-sweeping knife operations may be curative in effect, the attitude that neglects the value of cauterization, particularly the electrochemical methods of destructive sterilization, and clings to the knife as a panacea, is anything but scientific. If more judicious use were made of the cataphoric or electrochemical methods in these early or small growths, a large percentage would be permanently cured, while the exercise of discretion in the choice of remedies would invite earlier resort to treatment by the patients.- Medical Record, July 1, 1905.

FREEZING POINTS OF BLOOD AND URINE IN PNEUMONIA.F. E. Schmidt, Chicago (Journal A. M. A., September 23), after first reviewing the literature of cryoscopy in medicine, and especially in pneumonia, describes his methods and precautions for thus testing blood and urine, and gives tabulated details of observations in twenty-four-hour cases of pneumonia, in males between the ages of eighteen and fifty, and all apparently in good health before the attack. The tests were made daily, the patients being given essentially the same diet of milk, and later broths and plenty of water, and kept under the regular stimulating treatment. A few had salt irrigations. The freezing points of the blood and urine, the quantity and specific gravity of the urine, and the amount of urea were recorded and albumin and casts noted when present. He finds that there is an absolute lowering of the freezing point of the blood in pneumonia depending in some way either on the extent of consolidation of the lung or on the height of the temperature, or both. This lowering is more than can be accounted for by the increased venosity of the blood under deficient aeration. The concentration of the blood increases, as shown by the lowered freezing point, as the disease progresses up to the time of crisis. Some time is needed for the elimination of the excessive accumulation of products in

the blood, hence several days elapse before the freezing point rises again to normal. In cases in which the heart perceptibly weakens the freezing point becomes still lower, and in fatal cases, when the heart gives out, the freezing point of the blood is extremely low. The lowered freezing point of the blood is apparently not due to deficient kidney function, but may be due to the inability of the kidney to excrete the excessive products of metabolism. The freezing point of urine in pneumonia is considerably lowered, more than would be accounted for by a mere concentration of normal urine. The chlorids excreted are diminished, on account of a lesser amount taken in (Sollmann). The quantity of the urine is decreased while the freezing point is lower, and this lowering is not due to chlorids but to metabolic molecules excreted. The freezing point of the urine does not rise to normal until after that of the blood, that is, several days after the crisis. The specific gravity of the urine is no accurate index of its degree of concentration. The freezing point of the urine bears no constant relation to that of the blood normally, for with a freezing point of blood at 0.54° C. the freezing point of the urine may be normally lower than in a case in which the freezing point of the blood is — 0.57° C., or vice versa.

NUX VOMICA IN HYPERCHLORHYDRIA.-J. H. Musser (Boston Medical and Surgical Journal, June 29, 1905) has found that in cases of gastric neurasthenia with hyperchlorhydria in which sedatives and acids, etc., have failed, large doses of nux vomica gave relief when administered in ascending doses. He begins with small doses, and increases until 40, 50, 60, or even 80 drops of the tincture are given thrice daily. It has been given with effect for a period of four or five months. In young subjects it should be given in much larger doses than in older persons. The beneficial effect of nux vomica does not turn on strychnine alone. There are other elements in the tincture which are of value. The drug should be given until physiological effects result, shown by slight stiffness in the neck and vertigo. Its dose may then be reduced five or ten drops for a while, and then increased again. It is best given before meals.

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SHOULD I desire an excuse for presenting this subject to you to-night, I could find no better than the fact that it has been discussed so frequently and so extensively in medical literature. For any subject about which there is such a diversity of opinion we can at once draw the conclusion that none of them are correct. Retro-displacement is the most frequent abnormal position of the uterus which we meet in gynecological practice, and various authorities estimate that from fifteen to twenty per cent. of the women that come to the examining table have this condition in some form. With these facts before us, should we not be stimulated to some effort along this line? In order

Read at meeting of the Nashville Academy of Medicine, Tuesday, Aug. 29, 1905.

to arrive at a correct conclusion regarding this pathological condition, we shall mention some of the different opinions as to how the uterus is suspended.

A great many regard the perineum as very important in the suspension; but Tate claims that the perineum has no part in its support, and cites the fact that when we have a completely lacerated perineum, the uterus is found occupying its normal position. Of course, when we have an incomplete laceration, the pressure upon the posterior wall of the vagina, making traction on the posterior wall of the uterus, will necessarily pull it over.

Still others think the round ligaments have a part in the support. One of the latest ideas along this line is advanced by Dr. Coffey, of Portland, who thinks that the whole peritoneum, extending from the diaphragm to the pelvis, constitutes its support, and this appeals to me very much, if he will use the term. peritoneum in a broad sense, allowing it to include the fibrous tissue immediately beneath the endothelium which fastens the peritoneum proper to the abdominal wall. He illustrates by likening it to an object that has been pushed into the bottom of a closed sack, the sack covering about three-fourths of the object. This seems quite reasonable when we consider that the liver, which weighs three or four pounds, has no support other than peritoneal ligaments. Coffey also denies that the round ligaments have any part in this, from the fact that they are muscular tissue, and are not designed for continuous traction.

I doubt if the supports of the uterus have as much bearing upon this subject-retro-displacement as is usually attributed to them, for it is possible for the uterus to revolve upon its transverse axis without descending to any appreciable degree. Doubtless many times we do find that there is descent, which should be considered one of the complications.

The forces which retain the uterus in its normal position, which is slightly anteverted, are (1) the round ligaments, which act as guy ropes, holding it forward; (2) the utero-sacral ligaments, which hold the cervix back in the hollow of the sacrum. thereby tilting the fundus forward; (3) intra-abdominal pressure, which is exerted upon the posterior aspect of the fundus.