their extremely low factor of respiratory safety and a possible lipoid degeneration of cardiac musculature. These patients can be made to take gas, but it is not the anaesthetic of choice by any means. Rather is the administration of vapor of ether with oxygen by means of pharyngeal or tracheal insufflation the procedure of selection, fulfilling as it does the coincident demand. for a powerful cerebral sedative and provision against the most common difficulty in these subjects, namely, the obstruction of the upper air passages, by spasm, by profuse excretion of mucus.

Nitrous oxide oxygen anæsthesia, when carried out in these patients, is forced despite the presence of a varying amount of asphyia, even by the best anæstheists, and the limitation of oxygen necessary to produce the required degree of analgesia is harmful and to be avoided.

One other class of cases is to considered as contraindicating the use of nitrous oxide and oxygen, namely, those in which any serious grade of cardiac disease prevails. The use of nitrous oxide and oxygen is essentially a closed method, and even though sufficient oxygen can be given, respiration occurs under a certain amount of obstructive mechanical difficulty wherever tubes and bags are breathed through.

The low respiratory factor of safety in cardiac disease can little bear any added burden of respiratory obstruction, and the free unobstructed supply of oxygen and ether vapor offers much greater efficiency and safety than the slightly less toxic but mechanically inapplicable nitrous oxide.

To insist on the use of nitrous oxide and oxygen in these two types of cases is simply to court danger and to bring into undeserved discredit a most valuable anæsthetic when used in suitable

cases.

The question of raised blood pressure with nitrous oxide, relative to the possibility of its causing postoperative cerebral hemorrhage, finds answer to date in the observations of Teter in Murphy's Clinics No. 1, and of Prince J. A. M. A., Vol. LVIII, No. 18: "Little variation in blood pressure occurs if plenty of oxygen can be given.

Nitrous oxide is always difficult to administer to the negro on account of the indistinctness of the color changes in the capillary circulation.

Chloroform is especially useful in initiating anæsthesia in

children. The gas mask is a thing from demons' land to them and the fear incident thereto is the cause of struggle and often a never to be forgotten fright. The struggle-free, comparatively smooth induction possible with a skillfully handled, well perfumed chloroform mask has advantages far outweighing the safety of nitrous oxide over chloroform. Ether is substituted the minute consciousness is on the wane.

In alcoholics, morphine habitues, tobacco users, resistant subjects, the excitement-diminishing, smoother induction of chloroform skillfully used eliminates that frequently seen syndrome of obstructive respiratory, phenomena that does so much to make ether a disagreeable agent to handle in these subjects.

Chloroform can no longer occupy the exalted pedestal it has gained in obstetric work; no less an authority than H. Marion Stowe, of Chicago, concludes as follows in Surg., Gyn. and Obst., February, 1910: "Uterine atony and post partum hemorrhage are rare following ether anesthesia; ether should be used in eclampsia or allied toxæmias of pregnancy. Its action is as positive and its danger much less. Ether is far safer to the mother than chloroform and the danger of delayed poisoning much less."

The close similarity between the effect of chloroform on the liver and that of the toxæmias of pregnancy prompts these views. We must conclude that no single anæsthetic nor method of administration are equally applicable to all cases and that the best results can only be attained by intelligent selection.-New York State Journal of Medicine.

ECHAFOLTA IN SEPTICEMIA.

BY J. S. NIEDERKORN, M. D., VERSAILLES, OHIO.

My personal experience with Echafolta and Specific Medicine Echinacea during the past winter and spring has certainly been most gratifying. Cases of septicemia following trauma, burns, or developing in the course of erysipelas, and in which the most alarming and desperate conditions prevailed, were brought out safely, without the sacrifice of limb, and without a death, by the free use of Echafolta, locally and internally, with the addition of frequent and liberal doses of calcium sulphide. These two remedies are positive life savers, as I have repeatedly proven, and that too in cases where other measures proved absolutely worthless. I call

to mind especially three cases where infection showed within 72 hours after injury-pronounced chills, high temperature, foul, coated tongue, delirium, limbs fearfully swollen, red lines over the course of lymphatics along the inside of the lower limbs, painful glandular swellings, in a few days giving evidence of pus buried in various places along the limb. Free incisions to establish thorough drainage for the pus, thorough bowel elimination, constant application to the entire limb of full strength Echafolta on gauze, at the same time giving the Echafolta internally in from onehalf to one teaspoonful doses every two hours, alternated with one-half to one grain doses of sulphide of calcium, brought all of these cases back to full recovery. These infectious cases are desperate ones, and permit of no yielding to sympathy nor to any half-hearted measure. Literally soak them with the Echafolta, externally and internally, and push the calcium sulphide to the limit, together with thorough bowel elimination, not omitting to establish free drainage for any possible existing pus, is my manner of handling all septic and infectious cases. Small doses of either remedy, in my experience, count for little; frequent full doses are imperative, and absolutely necessary.

From the fact that I employ on an averge a gallon of the Echafolta per month, places me in the position of pretty thoroughly knowing my remedy, and when and how to apply it to obtain results. If, in curable cases, Echafolta fails, in all probability enough of it has not been used, or it has been too much diluted.-California Eclectic Medical Journal.

DUST FEVER.

BY FREDERICK J. BOWEN, M. D., MT. MORRIS, N. Y.

An industrial disease which I have several times encountered but have never seen described, is well known among grain threshers as "dust fever."

I have found on inquiry that the ailment occurs also among flax hatchelers. As it is caused by the inhalation of dust in excessive quantities, it probably occurs in various occupations supplying this essential etiological factor. The only cases coming under my observation, however, have been among threshers, or farm laborers engaged in grain threshing.

Grain becomes musty when the curing process, during harvesting, is interrupted by rains; and the production of dust is thus greatly increased. This renders the work of threshing in the barn, as commonly done in the Northern States, particularly disagreeable; and the laborers engaged, subject to the ailment. It is not improbable that certain elements in the dust possess toxic properties and that these, rather than the mere mechanical irritation of the particles, cause the trouble; but this is merely problematical.

Dust is mentioned, incidentally, by some writers as a cause of coryza; but the symptomatology of coryza is so mild, comparatively, that it apparently was never meant to include the subject of this article.

The sickness begins in the evening or during the night following the day's work in dust. The symptoms are severe; often alarming. There is a pronounced chill and usually vomiting. The face is flushed. Patient may be delirious and with a temperature as high as 104. There is marked congestion of the mucous membrane of the respiratory passages. The picture is not unlike that often presented at the onset of pneumonia in a robust subject. The symptoms moderate during the second and third days. A copious exudation from the nasal and bronchial passages, eliminating microscopic quantities of dust.-New York State Journal of Medicine.

EDUCATION OF THE PUBLIC REGARDING CANCER*

BY A. A. MATTHEWS, M. D., SPOKANE, WASH.

Cancer is almost the only disease which is on the increase in the civilized world. Whether this is a true increase or whether it is due to the profession recognizing the disease more accurately, and the statistics are better kept by the profession, institutions and the Government I can not say, but I am inclined to think it is the latter; nevertheless we have to admit there is decided increase in the records of to-day from cancer death, to that of formerly.

This world-wide disease is not confined to any certain people, but occurs among all races of mankind and is, indeed, found throughout the vertebral kingdom. Domestic animals are more susceptible to it than animals in the wild state. Dr. C. W. Mayo

* Read before the Spokane Medical Society, Spokane, Wash., Jan. 25, 1912.

explains this fact as being due to their longer life, the disease being more common in the relatively aged, in both man and animal.

The medical profession, with the aid of the press, the National Government and the antituberculosis societies, has put on foot a crusade against tuberculosis, and it is being brought forcefully to the laity so that they are taking an active part and causing a universal reduction in tuberculosis. Until a like work is done we can not hope to reduce the cancer mortality, for the public must be educated along these lines, that cancer is a local disease in its incipiency and is curable when properly cared for, in the majority of cases. If the laity were properly informed in regard to this, it would make it much easier and more satisfactory to reduce and keep down the mortality of this dreaded disease. This education must come through the physician directly and indirectly, so the sooner it is begun, the sooner may we expect results.

There are precancerous conditions which, if taken hold of when such, would prevent their formation. Most of cancer deaths are due to delay and are therefore unnecessary. The first curable stage has been ignored and cure has been sought only when the disease has become incurable. This delay is not always due to the patient himself, but often to his physician, either directly or by advising him to wait and see what the future will develop, or by temporizing with some placebo which he knows is valueless, but which the patient ignorantly supposes to be curative.

As Greenough has said (relating to benign breast tumors), no tumor is innocent and incapable of harm until removed. Child, of Portsmouth, England, more than any other English or American writer, has emphasized the true importance of the early signs of cancer. He calls them danger signals and compares them with those in other conditions. Danger signals in cancer, just as on the railroad or at sea, mean that there must be immediate and efficient action in order to prevent disaster. The physician who neglects the danger signal in a cancer patient is just as much responsible for the disaster to his patient, as the engineer is to his passenger if he neglects the danger signal and runs into an open switch.

Child's danger signals are briefly as follows:

1. Cancer of the breast. Here the danger signal is a small lump or thickening of any kind. In a woman over thirty-five