examination of the feces for evidences of residul amylases and other enzymes. The ingenious method of Dr. Alfred F. Hess of New York, whereby intestinal contents can be removed by the use of the duodenal catheter, has made it possible to obtain data regarding the pancreatic and intestinal secretions which have hitherto not been accessible to direct examination intra vitam. It is of decided interest and physiologic import to learn through the application of the new experimental and diagnostic procedure, that even before new-born infants have been put to the breast, that is, before there is any food factor to incite secretion, the three familiar pancreatic ferments are found in the intestine. Dr. Hess reports that, although the amount of pancreatic secretion is still very scanty during the first week of life, it contains the starch-digesting enzyme with increased regularity. In older infants, a month or more of age, there is a decided augmentation in the amylolytic power of the pancreatic juice. Without attempting to interpret the functional significance of the occurrence of an enzyme at a period when, in normal nutrition, it can scarcely be called on for participation in the digestive process, it is apparent that the findings quoted must modify the point of view of those who still debate the digestibility of starch in early infancy. J. A. M. A.

Some New Evidence on the Tobacco Question

The consideration of tobacco and its dangers has heretofore been largely based on the amount of nicotin contained in the smoke. But there are other products of tobacco which must share the responsibility. Among these are carbon monoxid gas, prussic acid, furfural and some others. Although all of these compounds admittedly are poisonous, their danger depends on the quantities in which they are taken. Recently investigations have been made of some of these toxic products, and the results are of considerable interest. The fact that the action of certain kinds of tobacco has been attributed to the prussic acid in their smoke has induced the Wurzburg hygienist, Prof. K. B. Lehmann, to investigate the charge. He has found that

the amount of this compound produced depends somewhat on the rate at which the tobacco is smoked. The slower the current of air through a cigar, the smaller the amount of prussic acid formed. The entire amount found, however, is too small to account for the effects. So far the burden of the blame for the ill effects of smoking would appear to rest on nicotin. Investigations made by the London Lancet indicate that the ordinary cheap cigaret contains the least nicotin in the smoke and the pipe the most, the cigar occupying an intermediate position. Assuming, then, that nicotin is the essentially injurious substance in tobacco, the cigaret would appear to be the least harmful form, provided that the amount of tobacco consumed was no greater in this form than in others.

The general impression, however, is that cigaret-smoking is the most pernicious form of indulgence in tobacco. This might be accounted for in part by the facts that the form of the cigaret makes it possible for young persons to indulge in it when they would not smoke cigars or pipes, that in older persons it lends itself to overindulgence and that the smoke may be inhaled with less irritation and, therefore, that more of the products may be absorbed into the system. Further investigations indicate that the most injurious forms of smoking are not those in which nicotin prevails but those in which there is a larger proportion of furfural. Furfural is about fifty times as poisonous as ordinary alcohol. There is a probability that the least harmful tobacco will turn out to be that which yields a minimum of furfural in the smoke. Although the amount of nicotin present in the cheaper grades of cigarets is practically negligible, the amount of furfural appears to be sufficient in itself to account for the bad effects attributed to cigaret-smoking. The use of tobacco in its various forms is so general that the subject is of almost universal interest. The Journal of the American Medical Association thinks that the smoker is entitled to know the dangers and the safest methods of using tobacco, while educators and all who have anything to do with the young, whether by example or by precept, will appreciate scientfiic facts with which to back up wise deductions from experience.

The Taboo on Moderate Drinking

The use of alcohol is receiving some hard knocks these days. A prominent railway system, not content with the general rule heretofore in force on railways forbidding employees to drink while on duty, now forbids employees to indulge at all in drinking out of employment hours, or in any other conduct which will impair their health or make them less alert and less capable while on duty. The owner of one of the nation's pets-a prominent baseball team-announced that moderation in drinking is not sufficient; the players on his team must leave alcohol entirely alone and abandon cigarets. The justification for such rules may be found not only in the difficulty of being moderate in indulgence, but also in the cumulative and after-effects of dissipation. The world is moving; the old fetich of "personal liberty" at whatever cost of danger to the public at large seems to be losing its power. The time may come when every man to whom the life and safety of others are entrusted may be expected or even required to be as abstemious as the ball-players and railway employees just mentioned. J. A. M. A.

Senator Owen

"Because of his activity in the interest of public health, United States Senator R. L. Owen, of Oklahoma, has been a shining mark for the National League for Medical Freedom and all of the interests that this unholy organization unofficially represents. Senator Owen was opposed for his seat in the senate by ex-Governor Haskell, a prominent and popular citizen. It was thought by his enemies that with such a man, their many, if somewhat shady, interests would be able to defeat for re-election a man who had been doing so much injury to the cause of dopers, poisoners, charlatans, quacks and the pseudoreligious practitioners of medicine, by shedding the light of public investigation on their shady practices. Our very active friend, Dr. Crutcher, who seems to have plenty of money behind him, toured the state and boldly attacked Senator Owen for his stand in behalf of the proposed Department of Health, otherwise known as the Owen

bill. How many subterranean influences were set in motion against Senator Owen we do not know, but it is safe to say that there were many. His nomination by a vote of about two to one over his opponent is a triumph for Senator Owen and the cause he advocates so earnestly. We congratulate the senator." --Texas State Journal of Medicine.

We also wish to offer sincere congratulations.

Modified Milk in Infant Feeding

The October issue of Pediatrics contains a paper giving a practical resume of existing knowledge upon the modification of cow's milk as a substitute infant food. The author has made a comprehensive study of the subject from all points of view, and dwells especially upon the value of cereal decoctions in the modification of cow's milk. In this issue, there is given a short abstract from the paper, showing its scope and character. The practical nature of the paper will appeal to the general practitioner, and copies can doubtless be had of the author.

Wanted a Share

Proud and pompous the doctor was strolling down the streets, when he was spoken to by a poor woman.

"Good morning, sir," remarked the latter.

"Godd morning, madam," replied the medico.

"I expect you are making a good thing out of attending to that rich Smith boy," suggested the lady.

"O' yes, a fairly good fee," replied the doctor somewhat angrily.

"Well," whispered the lady, "I hope you won't forget that it was my boy Willie who threw the brick that hit him."-London Answers.

A Forecast

"Our esteemed fellow citizen, John G. Harris, will go to the hospital tomorrow to be operated upon for the removal of his appendix by Dr. Smith. He will leave a wife and three children."-November Lippincott's.

ORIGINAL ARTICLES.

The Surgical Congress of North America.

By A. C. STOKES, M. D., Omaha.

The third session of the Surgical Congress of North America closed in New York on November 16th. The registration was above 2,600. It was the largest meeting of surgeons ever held in the world.

It would require to much space to describe all the interesting features observed by the writer. It would, perhaps, not require such an extent of space to described in detail the things which were most striking.

I was interested in the management of cancer as demonstrated by a number of cases seen in the Skin and Cancer hospital. They illustrated the fact that the early and thorough removal of carcinomatous regions worked wonders and that treatment by fulguration after the surgical removal of these areas no doubt prevented early recurrence at least in a large number of cases if it did not entirely cure the disease.

The most striking case that was presented was one upon whom nine years ago the entire floor of the mouth, the tongue, and all the glands of the neck down to and beneath the clavicles were removed for carcinoma of the tongue. The man was still well and was able to talk and to articulate all of the sounds except the linguals. The operation was done in two stages. The first stage was the removal of the glands of the neck from the region above the thyroid cartilage on both sides down under the clavicles. After this operation had healed the second operation was done, namely the removal of the entire tongue and floor of the mouth, and the new floor made by a plastic operation by slipping a portion of the mucous membrane of the linquol surfaces of the jaw, over into the middle line.

All post-operative carcinomas in the Cancer hospital are treated by fulguration, and while all forms of electricity and light have, in one generation or another, been used for postoperative and pre-operative treatment of carcinoma and all have in time been discarded, yet, it seems to the writer that the use of fulguration as described by DeKeating-Harte is a treatment for carcinoma which must have a real effect upon metastasis of the disease. As done in the Skin and Cancer hospital it consists of a large high frequency apparatus in which about thirty thousand volts with about four to five hunder ampares with an interruption of about one million times per minute. This does