continued to spread and grow worse, and in the last six months had spread very rapidly, as you will see from the photograph. At the time I saw him about one and a half inches of the organ had exfoliated and sloughed away, and the entire penis within an inch of the pubis was a solid cauliflower-like mass, through which he was able to slowly void his urine (dribbled away). He had lost 20 or 25 pounds in flesh. While he was very cleanly with himself, the mass had a peculiar, very offensive odor, and a sanguineous exudation. Glands in the left inguinal region were enlarged. I regarded the disease as epithelioma, and advised amputation of the penis and extirpation of the gland as the only means by which I could promise him any relief, with the possibility of a radical cure.

On September 1st I did the operation as follows, chloroform being administered: I shaved the pubes and thoroughly washed the abdomen, pubis and penis with a warm bichloride solution. I now wrapped the cancerous mass tightly in a piece of rubber sheeting to protect the zone of the operation, and then thoroughly cleansed the abdomen, pubes and remaining portion of penis with turpentine. I now tied a soft rubber catheter around the penis against the pubes to cut off the blood supply. This being done, an incision was made about two-thirds of the way around the penis on the dorsal side, about one-half inch from the pubes, leaving under side for the flap. I now cut through the corpora cavernosa and corpus spongiosum, taking up and ligating each blood vessel with sterilized catgut as I proceeded. Cutting down to the urethra I stripped it out about one-half inch in length from the line of amputation and transfixed it and passed a silk ligature through either side. I now made the flap and trimmed it with scissors to approximate the end of the penis, allowing slightly for contraction, made slit near the lower border of the flap in the median line parallel with the axis of urethra, passed the ligatures through the split and pulled the urethra through. I now with carbolized silk sutured the flap to the stub of the penis, had my assistants pull the sutures attached to the urethra in opposite directions, and with a scalpel I divided the urethra about one-fourth of an inch from the flap through median line longitudinally, allowing one-fourth of an inch for contraction. Holding urethra open in this condition, I sutured the urethra to the split in the flap, and then cut urethra off about one-eighth of an inch from sutures; dressed the stub with aristol and iodoform gauze, placed a layer of cotton over this, and applied a T bandage. Í secured union by first intention, never had a drop of pus, and patient made an uninterrupted recovery.

I saw this patient two months after his recovery, and he had gained considerable flesh, had not the slightest inconvenience in passing his urine, and he stated to Dr. R. S. Stanley and me that when he had an erection his stub was about 1 inches in length, and that he was able to have sexual intercourse, but that while he could have an ejaculation, he could not cause his wife to have an orgasm.

PROGRESS OF MEDICINE.

MEDICINE.

UNDER CHARGE OF B. F. TURNER, M.D.

Visiting Physician St. Joseph's Hospital, Memphis.

The Toxemic Factor in Diabetes Mellitus.

McCaskey (Medicine, vol. 5, no. 1) contributes a clinical study of the toxemic factor in diabetes mellitus, of which the following is a summary:

1. That all cases of persistent glycosuria are cases of diabetes mellitus, of varying grades.

2. That diabetes mellitus is a disease of diverse origin, the unity of the clinical picture being for the most part dependent upon the glycemia and glycosuria, which are mere incidents, although dominating factors of the disease.

3. That phloridzin diabetes is not essentially different from clinical diabetes, and that it renders plausible the assumption of a chemic factor, either as a primary or an important secondary cause in the clinical type of the disease.

4. That normal sugar transformation in the blood, the failure of which is responsible for the glycemia and glycosuria, is the result of a chemic product in the blood, derived in man principally, if not exclusively, from the pancreas, and thrown directly into the blood from the pancreatic cells, without the interven tion of the duct.

5. That the direct chemical antagonism of this chemic substance by another is no more improbable than such antagonism of a toxin by an antitoxin, which Martin has recently established.

6. It is probable on both clinical and experimental grounds that certain chemic poisons, for the most part of gastrointestinal origin, but possibly also from faulty tissue metabolism, or as a perverted "internal secretion" from glands, not necessarily ductless, either directly or indirectly antagonize, in whole or in part, the sugar-destroying substance in the blood, thus giving rise to glycemia and glycosuria, and thus either primarily causing or at least exaggerating the clinical phenomena of diabetes mellitus, in a certain group of cases.

7. If further investigations should corroborate the conclusions here provisionally set forth, it would be advisable hereafter to investigate the bacteriology of stomach and intestines in cases of diabetes mellitus, and if evidences of virulent bacterial, protozoal, or parasitic growth are found, these conditions should be

met by suitable treatment, not with the expectation of entirely supplanting dietetic treatment, but as an important auxiliary to the latter, possibly rendering its restrictions less severe, with less resulting impairment of nutrition.

The Therapeutic Value of Marmorek's Serum.

Baum (Medicine, vol. 5, no. 1) discusses the value of Marmorek's anti-streptococcic serum from a therapeutic standpoint and arrives at the following conclusions :

1. In pure streptococcic infections the serum undoubtedly exercises a favorable influence on the course of the disease.

2. In mixed infections the influence of the serum was demonstrable, but it merits further trial as an adjunct to other treatment.

3. Considering the grave character of complications of non-streptococcic nature reported, ordinary rules of therapeutics would demand that in such cases, as with the diphtheria antitoxin, all indicated therapeutic procedures must be employed, as well as the serum.

4. In view of the fact that erysipelas streptococci and phagocytes often exist side by side in the lymph channels, it is fair to assume that the influence of the serum is directly exerted bactericidally on the streptococci and not entirely through stimulation of phagocytic action.

5. The initial dose in all cases should be twenty cubic centimeters, to be followed by ten or fifteen cubic centimeters, according to the indications, each twenty-four hours.

Carnifying Pneumonia.

Fraenkel (Berlin Cor. Med. Press & Cir., vol. 65, no. 3078) exhibited section of lung of patient dead from this rarely observed disease. The patient from whom the preparation was taken was a laborer, æt. 62, who had already had pneumonia seven times. He was attacked on January 29, 1898, with typical genuine pneumonia of the right upper lobe, and was admitted into the hospital "Am Urban." On the ninth day of the disease, jaundice came on and the disease appeared to take an unfavorable turn. There was then a rapid fall of temperature, but without any change in the lung symptoms, and on the fifteenth day collapse set in rather unexpectedly, and death took place. The autopsy showed the following: the upper lobe of the right lung was extremely consolidated, one section had a glistening marble-like appearance like polished granite. The cause of this carnifying process had been a good deal discussed, some had attributed it to adhesion taking place, others thought it due to constitutional anomalies and advanced age, others had observed it after repeated attacks of pneumonia. It was very rare; out of 750 cases of pneumonia, the speaker had only met with it in two per cent. of the cases. No age was exempt, but it was more frequently met with between the ages of 30 and 50. The carnifications proceeded, as the microscope showed, from the walls of the alveoli, and consisted in the organization of the fibrin contained in them. As well known, Hans Kohn had just shown that the alveoli of the normal lung contains delicate canals through which the fibrin passed in fine combining threads. The early date of the carnification was worthy of remark.