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tient. After extensive inquiries he finds that ap-
proximately only forty per cent, of breast carcino-
mata showed positive, microscopical metastasis to
the axillary lymphatic nodes, and that eighty-five
per cent, of recurrences in cancer of the breast are
in the chest wall and only fifteen per cent, in the
axilla. He is impressed by the fact that recurrence
after operation for cancer of the breast is almost
invariably in the line of incision, and believes the
knife must sever the continuity of the fluids as well
as the tissues holding them, hence infection is al-
most inevitable because of the manner of trauma-
tism. He reports seven cases successfully operated
in by the chemical method, which he describes as
follows: 1. Cocaine, forty per cent, solution, is
driven into the segregated area by phoresis and as
high as 200 milliamperes of current may be used,
varying with the susceptibility of the patient. 2. The
cuticle is then destroyed with caustic potash. 3. Tis-
sues outside of the condemned area are properly
protected from accidental chemical contact by
means of strips of cotton flannel saturated with
dour paste. 4. A mixture of zinc chloride, with
powdered sanguinaria plus water, to the point of
proper working consistence, is applied and protect-
ed with dressings. 5. In twenty-four or forty-
eight hours a layer of devitalized tissue is asepti-
cally removed and a fresh application is made, re-
peating the process each twenty-four hours until
the entire breast has been removed. 6. Nature is
.allowed to complete the operation in her own way
by granulation. Strict asepsis should be main-
tained throughout. 7. Skin grafting after Ochs-
ner's method is done under cocaine cataphoresis
safely and painlessly.
Gonococcus Vaccine as a Guide in Diagnosis
and Treatment. — J. London injects gonococci,
suspended in normal saline solution, into the endo-
dermal layer of the skin with a hypodermic syringe
and fine needle and obtains a local reaction,' be-
lieving, in obscure cases, where the gonococcus is
a possible infecting agent, as in a joint, tendon, en-
docardial and peritoneal or pleural infection, as
well as in involvements of the genitourinary an-
nexa. both male and female, a means of diagnosis
not dependent upon the discovery of the gonococ-
cus itself is of decided value. To obtain this re-
action the skin on the inner surface of the arm or
forearm is cleansed with alcohol or ether, which
is allowed to evaporate ; then a saline suspension
of dead gonococci in a strength of 50,000,000 to
100,000,000 to the c. c. is injected into the skin un-
til a slight weal is formed. A positive reaction oc-
curs in about twenty-four hours, a central papule,
red in color, surrounded by a lighter red areola,
two to three inches in diameter. A previous injec-
tion, within ten to fourteen days in negative cases,
may cause a positive reaction on secondary injec-
tion. The writer reports that of eighteen cases in
which the gonococcus was found, sixteen gave a
positive reaction. Of fourteen control cases, non-
gonorrheal, twelve gave no reaction, two gave a
slight reaction. Of three cases of gonorrheal
arthritis, two gave a positive reaction. In a case
giving a negative reaction, staphylococci were
found in the prostate, but no gonococci. In three
cases in which the complement deviation test was
performed, two were positive and one negative to
the blood test, but all three were positive to the
skin test. In two cases of stricture, one was posi-
tive and one negative. Of eighteen cases which
were clinically gonorrheal, but where no gonococci
were found, in thirteen the skin test was positive,
in two negative, and in three doubtful. Cured
cases give negative reactions.
November, IQI2.
Tetany Following Extirpation of the Thyroid.
— Francis J. Shepherd, reviewing the literature on
the subject, says the weight of opinion tends to
prove that postoperative tetany is dependent on the
removal or destruction or injury of the parathy-
roids. As to the functions of the parathyroids
there are at present two theories: 1. An antitox-
ine is developed by the parathyroids which neu-
tralizes certain Buy Aerovent waste products of tissue metabol-
ism; and, 2, the calcium metabolism of the cells of
the body is controlled by the parathyroids, and
their removal causes a rapid disappearance of the
soluble salts of calcium from the blood. The
glands are difficult to distinguish without micro-
scopical examination, but as a rule their yellowish
brown color distinguishes them from the deep red
color of the thyroid. For treatment various meas-
ure? have been adopted, transfusion, parathyroid
feeding, injection of the nucleoproteid principle,
calcium lactate, and transplantation from other sub-
jects. The writer had always been a little scepti-
cal regarding the danger of tetany or cachexia
strumapriva following total thyroidectomy until
last winter, when a severe tetany followed thyroid-
ectomy in one of his cases. On the third day after
operation the patient complained of a feeling of
general formication and of a great weight which
pressed on his brain. On the fifth day, in addition
to formication and numbness of her legs and face,
she began to have cramps in both hands, pains in
the joints, and stiffness of the fingers and flexion
of the toes. On the appearance of typical tetany
the writer put her on one drachm doses of calcium
lactate and one half grain of parathyroid extract,
every four hours, which controlled all her symp-
toms. Six months later she had gained twentv
pounds, and the only symptom at present is oppres-
sion in the head, which is corrected by lactate of
calcium of which she now takes only twenty grains,
twice daily.
Surgical Treatment of Aortic Aneurysm. — J.
A. C. Macewen, with a view to obviating many of
the dangers attendant upon the surgical treatment
of aortic aneurysms, namely, anesthesia, ligation
of diseased sclerotic vessels, and embolus, follow-
ing the detachment of a red blood thrombus, pro-
poses a method for inducing the production of a
strong, enduring white thrombus, which was put
forward many years ago by Sir William Macewen
A fine, highly polished steel needle is introduced
into the interior of the aneurysmal sac or dilatation,
and the inner surface of the opposite wall is
scratched very lightly so as to produce a series of
slight abrasions on that surface. In this manner
there is produced a white thrombus by the action
of fibrin and leucocytes. This exudate under fa-

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