In general, however, it is the oleaginous rather than the acetic that appeals to most people. The doctor himself is the great factor in suggestive treatment. His personality, the personal equation, is what counts for most. His dress, speech and mannerisms are taken into careful account by sick people. As a general rule it is bad policy to joke with patients or indulge in humorous remarks, although it is imperative that a quiet cheerfulness should fairly bristle from the doctor while in the sick room. He should appear pleasant, optimistic and' carry a sensible dignity with him. and should endeavor to talk enough without becoming garrulous.

Suggestion and drugs, to reiterate, should go together. If a remedy is reinforced by appropriate verbal suggestion from the doctor the efficacy and potency of the medicine will be increased. In a general way tell the patient about what results he may expect from the remedy prescribed; his imagination and expectancy will aid the medicine in a material way. A man once thought I gave him something to take away his desire for tobacco and he quit chewing and advised his nicotine-soaked friends to come to me and be cured. But the personal index of the patient must always, as nearly as possible, be taken; the same kind of patter does not go with every patient. In giving medicine the most potent suggestion with which you can sometimes back it up is to say nothing, leave all to the fancy of the patient. There is no fixed manner of applying psychotherapeutics, just as all patients do not respond in a like manner to a certain line of drug therapy. We must sort the patients out and apply the treatment accordingly. We should not follow the obsession of drug nihilism or that of curing every thing through the agency of the mind. The greatest good comes from a judicious blending of both drugs and psychotherapeutics.

A Case of Sporotrichosis of the Skin.

Arndt reports a case of sporotrichosis of the right forearm. The differential diagnosis is discussed, which was finally determined by smears and cultures in which the characteristic threads and ovoid spores were found. Sporotrichosis may occur in solitary local lesions or as a disseminated disease. The disseminated disease is more common. It occurs without general symptoms or especial subjective discomfort as very numerous (50-80) round, hard, painless nodules, freely movable in the subcutaneous tissue, over which the skin is normal. As these grow they involve the skin, which is at first pale red, then deep red, even blue red: the center is elastic and later fluctuates. The nodules may remain as such for a long time; finally, however, they perforate and form ulcers which may be either clean-cut with infiltrated edges, or more commonly with irregular jagged border, not infiltrated, bluish, and undermined. These may remain if untreated for a long period. They heal with a smooth scar of bluish color and pigmented at their edges. The prognosis under treatment is good. The therapy consist of potassium iodide 30 to 60 grains a day, which causes recovery with remarkable rapidity. Whereas the skin and subcutaneous tissue is the most frequent site of the disease, it may occur also in muscles, bones, or joints; in the epididymus, larynx, or eyes. It is probable that sporotrichosis of the lung may occur. In these organs the clinical diagnosis is especially difficult.-Berliner Klinische Wochens., Nov. 1, 1909.

FUNGI IN DISEASE.

BY THURSTON H. DEXTER, M. D., Brooklyn, N. Y.

Pathologist to Methodist Episcopal (Seney) Hospital; Williamsburgh and Bushwick
Hospitals; Associate Physician to Brooklyn Hospital.

Some members of the club, considering all bacteria as fungi, may feel that I have chosen to bring before you tonight a subject of vast scope, and almost infinite pathologic possibilities. However, it is not my intention to ask you to consider the pathogenic powers of the schizomycetes, or fission fungi, which make up that group of bacteria responsible for most of the ills to which flesh is heir.

There are two other groups of vegetable cells, bacteria, or fungi, namely, the mucor, or mold fungi, and the saccharomycetes or yeast fungi. It is to certain fungi of these two classes, their products and their results, that I invite your thoughts, desiring to point out some things new, and to emphasize some things old. I hope not to exaggerate the importance of the mold and yeast organisms, but to give to the part they play in disease the consideration that their activity merits.

THRUSH AND ITS ORGANISM.

Perhaps the most common sample of the pathogenesis of these cells is found in that simple disease, rather frequent in infancy, known as thrush, and classed as one of the forms of stomatitis.

This disease is caused by an organism which was for some time considered to be a mold, and to which was given the name of oidium albicans, oidium being the name applied to a genus of the fungi having an elementary organization, many species living as molds. It is now known to be a yeast fungus and is called saccharomyces albicans. Thrush is the disease which first called attention to the pathogenic power of molds and yeast fungi. Its chronologic priority, its familiarity to the general practitioner and its probabilities, all make it the logical candidate for first place in the group of ailments we are considering."

The so-called oidium albicans (truly the saccharomyces albicans) was the first to obtain medical importance, and this about the year 1840. It was first demonstrated in the oral lesions of thrush and quickly, within succeeding years, evidence of similar lesions were found in many and various tissues of the body. I will tabulate some of these, though doing so will entail repetition in subsequent discussion of a few of the cases in which the affection obtained.

TISSUES AND ORGANS INVADED.

Mouth, pharynx, larynx, esophagus, trachea, bronchi, lungs, stomach, intestines, liver, rectum, peritoneum, uterus, vagina, brain and cellular tissue of the neck.

I.

SOME CASES.

Virchow reported a case with the lesion and organism in the esophageal submucosa.

2. In a hemiplegic were found multiple brain abscesses and thrush of the throat. Oidium albicans was demonstrated in the patch in the throat and in the abscesses. Mixed infection was suggested by some as

the explanation of abscess formation, but the original focus of infection was the throat lesion.

3. The same organism was found, in another case, in the lungs; and in this subject it also had a peritoneal focus.

4. In a case of esophageal ulcer with hemorrhage, the oidium was demonstrated in the ulcer.

5. Post-mortem on a typhoid case, with extensive thrush, discovered multiple abscesses of the liver, from which were obtained the thrush fungus.

6. One investigator found, in five children dying of gastro-enteritis, deposits in walls of esophagus, larynx, trachea and larger bronchi, and once in lung tissue.

7.

stools.

Other cases reported with fermentation and intense odor to the

8. The growths have been found in the lung abscess, causing sudden hemorrhage.

9. They have been found in the vagina, and filling the cavity of a senile (83 years) uterus.

IO. Von Herff, in 1895, reported 26 cases of similar (myotic) infections of the vagina.

By these investigators the oidium was considered, in almost all the cases, to be the cause of the lesion in which it was found, and not merely a comitant. Much of the work above recorded was done before these organisms had been definitely and finally classified; but that all of them belonged to either the molds or the yeasts, there is no doubt.

There is so little heard of these conditions, so little space, if any, given to them in textbooks and journals, and withal so little seen of these conditions by the practitioner, and even necroscopist of this country, that their importance, if only because of their assumed rarity, is likely to be considered small. There are several reasons for this untenable stand. One is that these infections are, usually, more or less chronic; and do not, as a rule, produce the intense reactions that characterize many of the diseases caused by the schizomycetes. Another reason is that the proportion of mycotic disease to the total of disease is, in truth, small, though not so small as the superficial observer is likely to believe. And still a third reason, which exists largely because of the first two; but also because of faulty methods of necroscopy, is that a large number of these cases are not recognized either during life or post-mortem.

There is still much doubt about the grouping and subdivisions of these pathogenic molds and yeasts, but as knowledge of them increased, the importance of certain organisms somewhat resembling oidium, and known as blastomycetes and saccharomycetes became apparent. They are found in certain skin lesions and tumors which have been linked for some ten years or more with the term "blastomycetic." The American pathologist, Gilchrist, was the first to describe a pure skin disease caused by a yeast-like fungus to which he applied the name blastomycetic dermatitis. This gave a distinct entity to a disease whose not unfamiliar manifestations had previously been considered as lesions of scrofuloderma, or under the name of lupus. It is my intention to give but scant attention to the skin diseases due to the fungi; but Jackson's brief de

scription of this disease may serve to illustrate the slow but steady advance in this line of research. It is as follows:

BLASTOMYCETIC DERMATITIS.

Under the head of blastomycetic dermatitis, Gilchrist describes a disease that has been recognized for a long time and regarded as a lupus, or, at least, a scrofulo-derma. The disease begins in early adult life, as a small pimple, that becomes purulent and slowly spreads peripherally, while forming an atrophic cicatrix in the older central parts. New lesions appear on different parts of the body and spread slowly. Some of these heal of themselves after lasting a year or more. Clinically the appearances are those of lupus; but there is no suggestion of tuberculosis in the patient or his antecedents. Microscopically the secretions show budding blastomycetes.

Special work with the blastomycetes and saccharomycetes brought to light many cases of mycotic infection in both man and animal. Buist cultivated a blastomyces from the lesions of variola and vaccinia. Babes found the organism in certain ulcers of the skin. Colpe described an oval yeast as the only organism present in a chronic catarrh of the endometrium. Another authority found yeast-like bodies in a long-standing pyosalpinx; also in the products of a three months' abortion. Cultures were sterile in both cases. De Simoni reports that in five cases of hypertrophic tonsils he found blastomyces-like bodies in fresh specimens and stained tissue. They were not present in normal tonsils; but cultures were not made and these bodies may have been the result of degenerative tissue changes. A case reported by Corseli and Frisco that resembled sarcoma of the mesenteric lymph glands and peritoneum, with metastases in the thorax, seems to have been an inflammatory process caused by a blastomyces. The organism produced similar lesions in animals.

In an examination of five hundred cultures from suspected diphtheritic throats, 37 were thrush-like fungi, considered to be blastomycetes. Nineteen of these cases also yielded the Klebs-Loeffler bacillus. The examiner, De Stoecklin, concluded that the fungus intensified the pathogenic effect of the diphtheria bacillus; and that the fungus alone could cause a severe angina. In 1891, Dennue found a red budding fungus (saccharmomyces ruber) contaminating milk. Seven children who drank infected milk suffered from gastritis. Infections of the organisms produced no symptoms in dogs and guinea pigs; but when infected milk was fed them, gastro-enteritis resulted.

Another experimenter, with a yeast obtained from a vaginal secretion produced a cutaneous blastomycosis in animals.

Brazzola in 1896 described a case of general infection of a child by a saccharomyces. The patient had died supposedly of diphtheria, but the author found a pure culture of saccharomyces in the throat. The organism resembled one cultivated by Busse from a case of pyemia, and caused general infection in animals.

The saccharomyces tumefaciens albus was isolated by Fonterton from two cases of pharyngitis, and animals were inoculated. Death often resulted, in from a few days to three or more weeks and granulations, swellings often developed at the site of inoculation, from which the yeasts were again cultivated.

Saccharomycetes have also been demonstrated in several eye lesions; and eye lesions have been produced by inoculations with the organisms obtained. Details of these and similar cases are to be found in the writings of Rixey of Chicago, on the subject.

As I stated in beginning this paper, I do not wish to claim for the fungi a larger or more important field than is their due. I have endeavored to cite the affections less commonly observed, than are the several skin diseases of mycelial origin which are more or less familiar to you all.

. From the data presented it seems reasonable to ask you to concur in the following summary; to wit:

I. That the molds and yeasts have a pathogenic importance; far beyond that generally credited to them.

2. That many of their lesions are either entirely overlooked; or accredited to some other causative factor.

3. That while many of their effects are local and mild, they may become general, constitutional; diffusely metastatic and intensely virulent. 411 Hancock Street.

Fulguration for Cancer.

Like so many proposed cures for cancer, fulguration has given disappointing results so far as a cure without surgical interference is concerned. What is really gained by the use of high frequency currents after the method of Keating-Hart is a very great stimulation of the tissues, and a rapid cicatrization of wounds, no matter how large their extent. Thus it is possible by removing the cancerous mass, without making a clean sweep of all possible infected tissues, to get a cure by applying the fulguration method to all the uncovered and surrounding tissues. The cells that are involved which are left behind lose their malignant power. Large wounds that could not be cicatrized in any other way will heal quickly, permanently and without much scarring, the cicatricial tissues. being soft and pliable, instead of hard and contracted. In cases that are rated as inoperable this method is of the greatest value, permitting something to be done to prevent the spread of the malignant process. In a series of articles by H. Duret and René Desplates in the Journal des Sciences M dicales de Lillie, for August and September, 1909, these advantages are thoroughly discussed. Cases are reported in which vast masses of cancer, after removal, were prevented from recurring and the surfaces cicatrized. Such cases would be absolutely hopeless under any other method of treatment, and surgery gives no hope of even a prolongation of life. The only bad results obtained are due to neglect of asepsis and the use of too strong applications of the current. The results are not so good in cancers of the mucous surfaces as in cancers of the skin. Cancers of the breast have done well in the experience of the authors. The best results have come from cancers which had largely invaded the connective tissues. An element in the cure is the marked lymphorrhea, the result of the removal of lymphatic engorgement, which assists in carrying off toxic materials resulting from rapid tissue changes. --Medical Record, December 4, 1909.