c cord tied about the neck of the
tumor, and secured by successful removal of a scrotal tumor weighing 56
pounds.

Fenger describes a case of the foregoing nature in a German of
twenty-three, a resident of Chicago. The growth had commenced eight
years previously, and had progressively increased. There was no pain or
active inflammation, and although the patient had to have especially
constructed trousers he never ceased his occupation as a driver. The
scrotum was represented by a hairless tumor weighing 22 pounds, and
hanging one inch below the knees. No testicles or penis could be made
out. Fenger removed the tumor, and the man was greatly improved in
health. There was still swelling of the inguinal glands on both sides,
but otherwise the operation was very successful. The man's mental
condition also greatly improved. Fenger also calls especial attention
to the importance of preserving the penis and testes in the operation,
as although these parts may apparently be obliterated their functions
are undisturbed.

The statistics of this major operation show a surprisingly small
mortality. Fayrer operated on 28 patients with 22 recoveries and six
deaths, one from shock and five from pyemia The same surgeon collected
193 cases, and found the general mortality to be 18 per cent. According
to Ashhurst, Turner, who practiced as a medical missionary in the
Samoan Islands, claims to have operated 136 times with only two deaths.
McLeod, Fayrer's successor in India, reported 129 cases with 23 deaths.

Early in this century Rayer described a case of elephantiasis in a boy
of seventeen who, after several attacks of erysipelas, showed marked
diminution of the elephantoid change; the fact shows the antagonism of
the streptococcus erysipelatis to hypertrophic and malignant processes.

Acromegaly is a term introduced by Marie, and signifies large
extremities. It is characterized by an abnormally large development of
the extremities and of the features of the face,--the bony as well as
the soft parts. In a well-marked case the hands and feet are greatly
enlarged, but not otherwise deformed, and the normal functions are not
disturbed. The hypertrophy involves all the tissues, giving a curious
spade-like appearance to the hands. The feet are similarly enlarged,
although the big toe may be relatively much larger. The nails also
become broad and large. The face increases in volume and becomes
elongated, in consequence of the hypertrophy