became_interested in radium through meeting Mackenzie Davidson, formerly Professor of Ophthalmology at Aberdeen, at the Madrid meeting of the International Congress in 1903. . Davidson was the first, in the treatment of malignant disease, to make use of radium, which had just been discovered by the French scientists. He had tried it in hopes of being able to estimate more accurately the proper dosage than was possible at that time with the X-ray apparatus. It was through the courtesy of this gentleman that the speaker obtained his first tube of radium, a feeble one, but the only one at that time available. A few weeks later, however, he cbtained a more powerful tube of radium bromid. So far he had treated three cases of epithelioma of the lip, five cases of carcinoma, two cases of lupus vulgaris and three cases of what he would call rodent ulcer— chronic indolent non-healing ulcers-which in two instances were situated at the left angle of the nose. The first case treated was a hopeless, inoperable mammary carcinoma of wide extent. The axillary glands were involved and the arm was swollen. Nothing was accomplished nor has he been able to obtain results in extensive carcinoma of any other part of the body. Two cases of cancer of the uterus were treated without any lasting benefit.

The second case treated was that of a man aged 73 who had had for five years an indolent ulcer about an inch in diameter, at the angle of the nose, on the left side, this had eroded the ala of the nose and the lip. It did not present the characteristic crater-like appearance and elevated indurated edges or hardness of an epithelioma. Application of the radium for an hour three times a week resulted in a cure early in 1904. In the fall of 1907 the ulcer recurred, appearing first as a blister changing to a scab and then an ulceration, until it was about half the size it had been in 1904. Application of radium again healed the ulcer and more rapidly this time than before. The history of this case suggests the limitations of the remedy as the condition may recur.

In three cases of epithelioma of the lip there seemed at first to be marked improvement. Two patients were operated upon, as they grew impatient with the radium treatment. The third case did not do well and was lost sight of. The ultimate results of radium in the treatment of epithelioma do not seem encouraging.

Two cases of lupus were also treated with radium. One patient had had the disease for 15 years during which time the lesion had been cured a number of times, first by cauterizing with silver nitrate and employing hygienic treatment, later by the use of X-rays, and the last time by radium. She is probably not permanently cured. In the second case healing was prompt and satisfactory, but less than a year has elapsed since the treatment, a period too short to determine final results.

He would not be without radium as a therapeutic agent. It is applicable to the smaller lesions but does not seem to answer for large areas. He had been using it upon a large epithelioma at the inner canthus of the eye, applying it all day; at first the usual marked improvement was noticed such as is experienced when using X-rays or Coley's toxins for malignant disease. He thought this decrease in size occurred in the surrounding area of small celled infiltration rather than in the cells of the tumor itself, since, as a rule, the tumor later advanced more rapidly than before. Radium seems to have healed, in his experience, small chronic ulcers-so-called rodent ulcers. As in one case the trouble had recurred within three years he has had the other patients return once a month for radium application, hoping in this manner to prevent a recurrence. He believes that the cures from radium are not as permanent as one would at first be led to believe. Nothing else apparently produces such prompt results in treating rodent ulcer or lupus but it does not cure large carcinomata. The operative results in malignant disease on first consideration seem better then they really are, thus if there is no return of a breast carcinoma after three years from the operation we usually consider it cured, when it would be much better to wait until seven years had elapsed. Wyeth gives a very interesting report of the end results in sarcoma. The gist of it is that he had one case living ten years after operation for sarcoma. All the others had died, many of them within a limited time of the operation.

The result in the case shown at this meeting by M. Metzenbaum was a beautiful one and just what one might expect from radium treatment in a limited growth of this nature, but the question is will it prove permanent? From his own experience he doubted it. Possibly radium in the future may show better results than are at present being obtained.

In discussing the paper, M. Metzenbaum agreed with the speaker that radium has no effect in really malignant growths and is useful only in those that are indoiently malignant, such as rodent ulcers. It is absolutely useless when the glands are involved and epitheliomata that invade the mucous membrane do not react at all. Epitheliomata about the eyes and nose and occurring after middle age respond well to X-rays but even better to radium, and remain cured for as long as four years or more. Ordinary rodent ulcers also respond better to radium than X-rays and may remain well for four years, sometimes, however, only for six months. In really malignant disease there seems to be no permanent result.

Lupus vulgaris he has seen remain cured for four years. He has seen over 30 cases of rodent ulcer remain healed for from six months to four years. One case of metastatic sarcoma of the mouth, referred to him by W. Laffer, showed violent ulceration of the mucous membrane after nine or 10 days persistent use of radium. M. Lowenthal asked if the speaker had used any of the special radium emanations. In reply C. B. Parker said that he had had no experience with the use of the emanations.

Abstract of a paper read at the previous meeting, Feburary 21, 1908, upon "Obscure Fever in Infancy and Early Childhood," by John Lovett Morse, Boston, Mass. A daily rise of temperature above 99.5° F. in infancy and early childhood is abnormal and the manifestation of some diseased condition. Elevations of temperature, however, occur from slighter causes at this age than later because of the greater irritability of the nervous system, and are consequently of less importance. Endocarditis frequently causes a prolonged elevation of temperature without any other change in the symptoms. Uncomplicated eczema also frequently causes prolonged fever. The so-called fever of the new-born is almost invariably a manifestation of sepsis. Dentition does at times cause elevations of temperature in infancy, both acute and chronic. In the vast majority of instances, however, the fever which is attributed to dentition is really due to some disturbance of metabolism or to intestinal intoxication. The absorption of toxic substances from chronic inflammation of the tonsils and adenoids is a very cominon and unsuspected cause of long-continued fever. Otitis media, if not the most common, is certainly one of the most common causes of fever of obscure origin in infancy, as in many cases the fever is the only symptom outside of those of general discomfort or of indefinite pain. It is very generally overlooked because of the general misapprehension as to the symptomatology of otitis media in infancy and the neglect of examination of the ears. Bronchial adenitis as well as cervical adenitis is probably not infrequently the cause of obscure fever; the diagnosis, however, is extremely difficult. Another cause of obscure fever, both acute and chronic, more common in infancy than later, is bacterial infection of the urinary tract, usually secondary to some other disease. The fever is usually irregular and often high. As a rule there are no symptoms pointing to the urinary tract and the diagnosis is first made when the urine is examined. The tendency is to attribute every long continued fever in infancy and early childhood, for which it is impossible to find any plainly evident cause. to hidden tuberculosis. This is, however, probably comparatively seldom the cause of continued elevation of temperature in early childhood. In the majority of cases, in which the fever is supposed to be tuberculous in origin, it really is due to disturbances of digestion or metabolism. The explanation of this comparative infrequency of tuberculosis as a cause of obscure fever in infancy and early childhood is presumably that at this period of life tuberculosis tends to dissemination and a rapidly fatal course. Chronic latent cases are consequently relatively rare.

Long continued elevations of temperature without very evident cause in infancy and early childhood are probably most often due to a mild

grade of intestinal toxemia. The temperature is usually not very high and it is often normal in the morning. It may run for weeks or months with practically no intermission; in others it is intermittent, being elevated for days or weeks at a time, then normal for days or weeks, and so on. In some cases the general condition is more or less impaired, in others not at all. In many instances there are symptoms of disorder of the digestive tract; in others these are almost entirely wanting, and in others they are intermittent while the temperature is constant. Intestinal toxemia is especially likely to develop in children who are overfed or improperly fed. In most cases the trouble is due to decomposition of the proteids, but sometimes to an excess of carbohydrates. These cases yield fairly promptly to milk and starchy diet, the object of this diet being to change the intestinal culture medium and thus modify the intestinal flora. In rare cases the temperature is due to milk and continues as long as milk in any form is given. This milk idiosyncrasy is never a primary, but always a secondary condition.

Finally, there is a class of cases of continued fever in infancy and early childhood in which the most careful examination fails to find any cause for the fever, in which no modification of the diet is of any avail and in which the general condition is unaffected, the child being apparently well and gaining normally in weight. The temperature may remain elevated for many weeks or even months, and finally cease without any cause having been discovered. The most reasonable explanation of the fever in these cases is some obscure disturbance of metabolism. Such cases justify the conclusion that if a careful study and careful examination of the child does not reveal the cause of the fever there is, in the vast majority of cases, nothing serious the matter and no cause for anxiety. (Discussion of this paper on page 175, March issue.)

EXPERIMENTAL MEDICINE SECTION

No meeting of this Section was held during March.

THE OPHTHALMOLOGICAL AND OTO-LARYNGOLOGICAL SECTION The thirty-third regular meeting was held Friday, February 28, 1908, at the Cleveland Medical Library, A. R. Baker in the chair.

W. E. Bruner presented radiographs of a case of gunshot wound, taken one month after the injury. When seen the patient insisted that the ball had been removed at the primary operation performed in Toledo. The wound of entrance was in the right temple and the sight of the right eye was gone. The examination of the interior of the eye showed infiltration of the vitreous and total blindness. The radiographs showed the ball embedded in the region of the nose. Unfortunately the patient left the hospital before an operation for removal of the ball could be performed. Two radiographs were taken, one anteroposteriorly and one from the side. C. C. Stuart, A. R. Baker and E. Lauder discussed the case. The program was as follows:

(1) Chondroma of the Larynx with Exhibition of Specimen, J. H. Lenker. Remarks by A. R. Baker.

(2) Buphthalmos: Report of a case with Presentation of Macroscopic and Microscopic Specimens, C. C. Stuart. Discussion by W. E. Bruner.

(3)) The Value of the Tropometer in Heterophoria and Heterotropia, Edward Lauder.

There was a general discussion by various members in regard to a bill proposed in the State Legislature to regulate the practice of optometrists. It was moved, seconded and carried that, "It is the sense of this Section of the Academy that the consideration of this proposed bill to regulate the practice of optometrists should be postponed until the next session of the Legislature."

Agreement between the Milk Commission of Cleveland and The Walker-Gordon Company of Cleveland, Ohio

The following agreement made this third day of December, 1907, between Mr Samuel Mather, Dr E. O. Adams, Dr Hudson D. Bishop, Dr E. F. Cushing, Dr S. W. Kelley, Dr H. H. Powell, and Dr J. J. Thomas, parties of the first part: That the party of the second part hereby binds itself to a fulfillment of the provisions of this contract, for and in consideration of the benefits hereinafter named by the parties of the first part.

SECTION 1. The party of the second part hereby agrees to conduct such parts of its dairy as may be hereinafter named, collect and handle its products in conformity with the following code of requirements.

The milk and cream thus produced shall be known respectively as "Canfield's Certified Milk" and "Canfield's Certified Cream." They shall be designed especially for clinical purposes, and when at any time the demand shall be greater than the supply, the preferred purchasers shall be residents of Cuyahoga County desiring certified milk or cream for infant feeding or the diet of the sick.

SEC. 2. The parties of the second part further agree to purchase and to use, subject to direction, the necessary caps for closing bottles of certified milk and cream from the parties of the first part, paying therefor not more than $5.00 per thousand.

SEC. 3. The parties of the first part agree to appoint a chemist, a bacteriologist and a veterinary surgeon, who shall examine and inspect the dairy and the aforesaid certified milk and cream.

SEC. 4. The following are the examinations to be made for the parties of the first part, at such times as in their judgment is desirable, including a statement of the probable frequency of said examinations:

(a) A physical examination and tuberculin test of each animal to be added to the herd.

(b) An annual examination and tuberculin test of all animals in the herd, exclusive of stock under six months of age.

(c) Inspections of the herd, dairy buildings, and care of the milk. These inspections shall be made without previous warning, at intervals of one month, unless, at the discretion of the parties of the first part, such frequency is unnecessary in cool weather.

(d) Bacteriologic examinations of certified milk and cream at intervals of one month.

(e) Chemical examinations of the certified milk and cream at intervals of two months.

SEC. 5. The following supplementary examinations may prove necessary from time to time.

(a) Additional bacteriologic and chemical examination of certified milk and cream when the regular examination indicates a product failing to reach the standards set by the parties of the first part.

(b) Additional inspections of the production and handling of certified milk and cream by any or all of the experts of the parties of the first part under similar circumstances.

SEC. 6. The above examinations and inspections, both regular and supplementary, are made for the parties of the first part by their experts.

The parties of the first part pay for all examinations ordered by them, but the parties of the second part hereby agree to reimburse the parties of the first part for all examinations and tuberculin tests of animals added to the herd in the intervals between the succeeding annual examinations, and for any inspections, chemical or bacteriologic examinations made necessary by a failure to reach the standards set for certified milk and cream.

SEC. 7. The veterinary inspector shall, at intervals specified above (Sec. 5-c), and without previous warning to the dairy, inspect the cleanliness observed in milking, the care of the various utensils employed, the nature and quality of the food used and all other matters of hygienic nature bearing upon the health of the cows, and the cleanliness of the milk, including also as far as possible an inquiry into the health of the employees on the farm. He shall also see that no animals are admitted to the herd without his approval.

SEC. 8. The bacteriologist shall procure a specimen of the milk from the dairy or preferably from the delivery wagons, at intervals to be determined by the parties of the first part, but in no case at a longer interval than one month. The exact time shall be without previous notice to the dairy. He shall test this milk for the number and nature of the bacteria present in it, to the extent which the needs of safe milk demand. He shall also make a microscopic examination of the milk for pus cells. Milk free from pus and injurious germs and having not more than 10,000 germs of any kind or kinds to the cubic centimeter shall be considered to be up to the required standard of purity. Samples of certified cream shall be similarly secured and examined. For cream the bacteriologic standard shall be 30,000.

SEC. 9. The chemist shall, in similar manner, procure and examine the milk for the percentages of proteid, fat, sugar, mineral matter and water present. He shall also test its chemical reaction and specific gravity, and shall examine it for the presence of foreign or other matters, or of chemicals added as preservatives. Certified milk shall range from 1.029 to 1.034 specific gravity, be neutral or very faintly acid in reaction, contain from 3 per cent to 4 per cent proteid, and from 3.50 per cent to 4.50 per cent sugar, 3.75 per cent to 4.25 per cent fat, and shall be free from all contaminating matter and from all addition of chemical substances or coloring matters. Milk shall not have been subjected to heat before the examination has been made, nor at any time unless so announced to the consumer.

The fat percentage of certified cream shall be 20 per cent, and it shall not vary more than two per cent from this standard.

SEC. 10. Under ordinary circumstances bacteriologic and chemical examinations of certified milk and cream are not made, unless at the discretion of the parties of the first part, until a satisfactory report of its production and handling has been received from the veterinarian.

SEC. 11. Upon the failure of any sample of certified milk or cream, secured by the experts of the parties of the first part for examination, to reach the standards here outlined, a second sample shall be promptly secured for a repetition of the examination, and not until a second report has been received confirmatory of the results of the first shall the examination be held to indicate a product not reaching the standards of the parties of the first part. Upon receipt of such proof of a failure of technic