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it is time that the profession made up its mind

about the matter. Mr. Kunodi’s business appears to be

- entirely legitimate, and one which no one can object to, orhas a right to interfere with. But those members of themedical profession, whether they be leaders or followers,distinguished or undistinguished, consultants or "on the

panel," who contemplate adding their names to his list,may well be asked to reflect a moment upon the "galley" "in which they may find themselves, and the questions theymay possibly be asked about it. If they care to take therisk, well and good ; but they must accept the responsibilityfor adopting a course which will seem to others perilouslyclose to that self praise which, in professional matters at allevents, is still held to be no great recommendation.

BENCE-JONES PROTEINURIA: ITS ASSOCIATIONWITH METASTATIC CARCINOMATA OF BONES.

Dr. Thomas R. Boggs and Dr. C. G. Guthrie report whatmust be an unusual experience even in a large institutionsuch as the Johns Hopkins Hospital-the encountering ofifour cases of Bence-Jones proteinuria within 15 months. It

is true that this experience leads them to suggest that thisphenomenon is often overlooked, but in view of the careexercised in most large hospitals in the routine examinationof urine, it seems probable that their cases exemplify oncemore the curious tendency which rare clinical conditions

- display of occurring in a close-packed series, once or

twice only in the experience of the observer. Be thisas it may, the writers have put their remarkable experienceto the fullest use by making a thorough investigationfreported in the American Journal of the Medical 8ciencesfor December) into the nature of this curious substance,and especially into certain of its biochemical relation-

ships. They confirm the work already done as to the

tests required to establish the presence of the Bence-Jonesprotein ; it is precipitated at a temperature of 45-600 C., andredissolved at 100° C. ; it is thrown down by cold nitric acid,but redissolved by boiling ; and it is also precipitated by theaddition of two volumes of saturated solution of ammonium

sulphate. In the case longest under observation the averageoutput of this protein was 5 to 10 grammes per diem ; in thiscase also the protein underwent spontaneous precipitation.Polyuria was the rule, and there was also a very pronouncedretention of chlorides. They have so far failed to secure theformation of specific precipitins by injecting the protein intothe veins of animals, though this injection led to anuria

within 24 hours, followed by excretion of the protein. After

a second injection the protein was not excreted as

such. Attempts to produce an intradermal or con-

junct! val reaction by the appropriate means were quiteineffective. In the first three of their cases the

proteinuria was associated with symptoms which almostcertainly indicated the presence of myelomatosis of thebones, though this was not definitely confirmed bynecropsy. Their fourth case, which is of peculiar if not

unique interest, is reported fully in the Johns HopkansHospital Bulletin for December. The patient, a woman

of 37, had a cancerous mass of four months’ growth in thefight breast, together with symptoms which pointed to thepresence of metastatic masses in the long bones. Thissurmise was confirmed by radiography, reproductions ofwhich show the secondary growths in the skull, pelvis, long(’Jones, and ribs with remarkable clearness. Further confir-mation was afforded by post-mortem examination of a portionof the femur, which actually demonstrated the presenceof centres of carcinomatous growth in the bone. There

is but one other case on record in which a relation

between multiple secondary carcinomatosis of bone and

Bence-Jones proteinuria has been satisfactorily established ;

in this, Oerum’s case, the primary growth was in the

stomach. The protein seems to have been found in theurine in cases of extensive osseous disease other than carci-noma and myeloma; apparently genuine instances of its

presence in connexion with chloroma, leukæmia, osteo-

malacia, and bony injury, are also on record. On the other

hand, it is not present in every case of widespread diseaseof bone, not even in every case of myelomatosis. The

inference, therefore, is that the source of the protein lies insome disturbance of a province of endogenous metabolism,over which the bone marrow presides, and not in the forma-tion of some peculiar protein by the growth and develop-ment of myelomata. It should be added that in this very

interesting case the blood changes that were noted were notof the special pernicious" " type.

THE ILLNESS AND DEATH OF NAPOLEONBONAPARTE.

THE passing from this life of the world’s heroes, as wellas their actions here, have always been of interest to theirimmediate survivors and to succeeding generations. In

many instances the greater the man the more divided arehis supporters and detractors, so that legend gathers aroundthe death-bed or the disappearance. Thus Romulus was

variously said to have been translated in a whirlwind and tohave been torn in pieces by the Senate- discerptum patrummanibns," as Livy laconically puts it. The manner of the

death of Scipio Africanus is in doubt, for, according to

Plutarch, some say that he died a natural death, some thathe was poisoned, and some that he was strangled, and yethis dead body lay open to be seen of all. So, too, as regardsNapoleon Bonaparte, there were not wanting those who re-ported that he was starved and made to live in an insanitaryhouse and in a deadly climate, and that his death was onelong agony, and that he was a prey to the cruelty of

England. All these legends have been exploded, but inthe most recent work on the subject Dr. Arnold Chaplin’has given us a valuable criticism of Napoleon’s last illnessand death. He argues that the various published reportsof the medical men who at one time or another were in

attendance at St. Helena-namely, O’Meara, Stockoe,Antommarchi, and Arnott-cannot be implicitly relied on,although they were published after the death of Napoleon andwhen the post-mortem examination had made everythingclear. The real opinions of the medical men and the

mistakes which they made are to be found in the Lowe

Papers, deposited in the British Museum. These paperscontain the daily reports of the physicians, and to themDr. Chaplin has gone. The closing years of Napoleon’s lifemake sad reading. Captivity is hard for anyone, how muchthe more for one who, like Napoleon, had lived such atremendous life and had attained to a height of glory practi-cally never reached before or since. The climate of St. Helenais not, however, unhealthy, and if Napoleon could have

refrained from political intriguing he might, apart from thepainful nature of his disease, have passed a restful time.

But, as he himself said, "Je n’aime pas beaucoup les

femmes, ni le jeu, enfin rien ; je suis tout à fait un etre

politique." The policy of his staff was politically the same,and to their shame, be it said, it was the conduct of the WhigOpposition in England which instigated that policy. Thus

La Cases wrote in his diary (Nov. 30th, 1815), ’’ We are

possessed of moral arms only, and in order to make the mostadvantageous use of these it was necessary to reduceinto a system ...... even o2cr privations, in order that we

might thereby excite a lively interest in a large portion of

1 The Illness and Death of Napoleon Bonaparte. By Arnold Chaplin,M.D. Cantab. London: Hirschfield Brothers, Limited. 1913. Pp. 112.Price 2s. 6d. net.