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prefer the naso-pharyngo-laryngeal cavities tients being all children between II and 14 and tissues to those of any other part of the years. He points out that tracheotomy should body, syphilis of the accessory sinuses is not be directed by vital indications only, but rather uncommon.

He describes four cases should be performed oftener as curative meas: that have come under his care. The chief ure. Suitable conditions are represented (1) symptoms were nasal discharge and fetid by juvenile age of the patient, in which the breath. Pain was not constant, but was al- vitality is stronger and the damaging afterways present during mastication. Pus was effects of the surgical interference are much present in all these cases. The writer, in less marked as in older persons, being in making his diagnosis, relied upon the presence youth remarkably slight; (2) by the lack of of a purulent accumulation in the middle any greater tubercular change in the lungs meatus anteriorly, transillumination, and and the existence of fair general condition of puncturing and aspirating the maxillary sinus. health, these latter depending chiefly on the In order to detect pus, the nasal cavities are former; (3) by the benignity of the tubercufirst thoroughly cleansed, and the patient is lar process in the larynx being slowly prodirected to incline the head to the opposite gressive and representing more the forms of side for a minute, then downwards and for- infiltration and tumefaction, not the ulcerative wards. If the middle meatus be then exam- form. Guided by these points of view we ined, pus, if present, will be seen adhering to can expect excellent curative results by the inferior surface of the middle turbinate tracheotomy in laryngeal tuberculosis. anteriorly. A darkened area over the maxillary sinus is noted on transillumination of the

The Use of the X-Ray in Sinus Disease of maxillary antrum. From his experience with

the Nose. — Mosher (Laryngoscope, Feb., these cases, the writer thinks one is justified 1906) claims a superior diagnostic value for in claiming that no syphilitic patient is free

the X-ray plates in sinus disease, and brings from the possibility of tertiary manifestations,

forward some very interesting cases to supin one form or another, even after a thorough

port his contention. He admits, however, the course of antisyphilitic treatment, lasting two

necessity of being an expert operator and the years or more. On this account all syphilitic difficulty of recognizing what is seen, particupatients should be advised to consult their

larly on plates taking a iateral view. physicians every one to three years subsequent to their treatment. A positive diagnosis of empyema of the antrum of Highmore

OTOLOGY. may be reached by means of the proper appli

ALBERT F. KOETTER, M. D. cation of the aspirating needle. Syphilitic empyema of the accessory sinuses quickly re- A Case of Leukemia Hemorrhage in the Insponds to specific treatment and conservative ner Ear with Special Reference to the Pathosurgery. The administration of iodides in logic-anatomic Examination of the Temporal small doses, increasing one grain three times Bone.—(Aage Kock, Kopenhagen, Zeitschrift a day, has proved of more value in the wri- fuer Ohrenheilkunde.)-Man of thirty-two, ter's experience than large doses rapidly in- acquired malaria in China, since then has creased. Finally, he believes that unless ur- been ailing. Based on the clinical and blood gent symptoms demand immediate operation, examination the diagnosis of leukemia, meoperative interference should be delayed, in dulla lienalis was made. Suddenly vertigo order to obtain as great an absorption of the tinnitis and decrease in hearing set in, after gummatous infiltration with the iodides as two days total deafness. The post-mortem possible.

verified the clinical diagnosis. The histoSignificance of Edema of the Pharynx.

logical examination of the temporal bone (Jacob E. Schadle in the February number of

showed the following: Left Ear.-Abundant

fresh hemorrhage in the cochlea, especially in the Laryngoscope.)-In a well written article Dr. Schadle gives a carefully followed his

the basal convolutions, mainly in the scala tory of true edema of the pharynx accompan

vestibuli, every part of Reissner's membrane ied by albuminuria. His theory of an infec

sprinkled. Differentiation of the cells in the tious nephritis caused by an attack of tonsil- organ of Corti impossible. From the scala

vestibuli the hemorrhage continues to the litis is supported by the facts he records.

vestibule, where it is localized on the median Indications for Curative Tracheotomy in wall, furthermore, in the ampullae in the Laryngeal Tuberculosis.-A. Henrici (Archiv endolympphatio as well as the perilymphatio fuer Laryngologie, Vol. XXVII) illustrates his spaces. Hemorrhage in the tympanum also advocation of tracheotomy in laryngeal tuber. cocurs. The medullary space of the malleus culosis by very interesting histories of four and incus are filled with lymph cells. Right cured cases of laryngeal tuberculosis; the pa- Ear.Hemorrhagic changes

pro

more

nounced than in left ear, scalla vestibuli and resting horizontally on the shoulder, in the scala tympani entirely filled with blood; of revolving stool, defect of the eyes upward. the delicate parts of the membranous cochlea In irritation of the anterior semi-circular nothing is visible, the basilar membrane is canal the sensation must appear as if the fenestrated in several places. In the course field of vision were turning from the front of the semi-circular canals the perilymphatic to the rear and the individual himself were spaces in both ears are filled with blood, falling forward. The maculae acusticae of whereas the interior of the membranous semi. the utricle should functionate in upward and circular canals are for the greater part downward, and in rectilineal side movements, olear.

the maculae of the saccule functionate in

forward and backward movements. Clinical Examination of the Sense of Equilibrium.-(Panse-Lucae, Festschrift.)- Ver. The Aqueductus Vestibuli as a Means of Intigo is a condition of space disorientation fection.-(Boesch, Zeitschrift fuer Obrenof our body against its surroundings. The heilkunde). – Based on his own observations irritations that lead to semicircular canal ver- and twenty-one cases reported in the literatigo must be strong enough or they will be ture, the author compiles a statement of the equalized by the eye, or the tactile sense. pathogeny of suppuration in the aqueduotus One can therefore bring about the semicir. vestibuli. Contrary to Hinsberg, Boesch in cular canal vertigo if the control by the eye sixty-five cases of labyrinth suppuration, in -closing the eyes—and control of the tactile which the path of infection from the labysense, putting the feet together, standing on rinth to the interior of cranium was plainly one leg, is inade impossible or rendered diffi- indicated, the extension of the pus through cult by creating an irritation of the semi- the aqueductus, vestibuli occurred twentyciroular canal traok. The latter is reached two times. A fact, which puts the importby turning the head to the side on which the ance of this manner of extension in a proper semicircular canal is to be tested, namely, light. The cases cf aqueductus vestibuli through touching a semicircular canal fistu

suppuration that Boesch gathered where lar, or by turning the eyes to opposite side of obronio suppurations, the labyrinth was in. the canal tested. If we now consider as volved preferable through the fenestra ovalis, the semicircular irritation of the flow of or the horizontal semi-ciroular oanal. From lymph from the

narrow part of canal to the vestibulum the pus extended to the saothe ampullae as the active moment, the kind cus endolymphaticus, providing the oqueof test and the results to be expected for duct has not had time to close up by means the individual semi-circular canal follow of of connective tissue formation, and then its own accord. The factor of the exclusion there occcurs an empyema of the sacous of control through the eye and rendering endolymphaticus. In extremely isolated cases difficult the control through the tactile sense the saccus seems to have been reaobed di. remains equal in the test for all semi.circular rectly from the antrum and surroundings of canals, including utriole and sacoule. Test the labyrinth and aqueductus by the carious for the horizontal semi-circular canal: Turn

process. The pus very seldom extends ing to the side of the canal in question around through the acutely distended saccus, be it a vertical axis, or turning to the opposite subdural through the posterior membrane or side with sudden cessation of the turn, posi. extradural through the anterior membrane. tion of eyes to opposite side of canal tested. In most cases there is time for the formation The body, in test of left semi-circular canal, of adhesion in the vicinity of the inflammaturns to the left side, objects to the right tory focus. The dura hecomes adherent to side, phenomena that have been recognized the pia respectively with the cerebullum in irritation of left semi-circular canal. Cor. which can only be reached in a direct way responding test of the anterior semi-circular by the infection. As moreover the saocus is canal, always supposing that the low of too small and too delicate to become a retainer lymph from narrow part of canal to the am. for the pus, it is therefore probably an accupullae is active: raising of the head which mulation of pus between the dural mem. has been bent, forward or turning forward branes, and Boesch proposes the name interand sudden cessation of revolving stool with dural abscess. Of cerebral complications in head bent forward so that the bridge of the the twenty-three cases of Boesch were as fol. nose is horizontal, defect of eyes downward; lows: one extradural abscess, three purulent, an irritation of the anterior semi-circular meningitis, four meningitis and sinus throm canal causes therefore a sensation of reeling bosis, three meningitis and abscess of cere. backward, and the sliding forward of objects. bellum, ten abscess of cerebellum. The sig. Test for posterior semi-circular canal: drop- moid sinus can be infected by way of vena ping of the head, turning forward, with head aqueductus vestibuli. The prevalence of

a

cerebellar abscesses follows through the ex. SPIRIT OF THE MEDICAL planation given above as regards chronic

PRESS. condition of the case, the formation of ad. hesion protects the meninges and favors the THE NEURONS.-L. F. Barker, Baltimore direct infection of the cerebellum. In all (Jour. A. M. A., March 31 and April 7), recases only the immediate cerebellar hemis

views the history of the neuron doctrine and pbere contiguous was infected. The abscess,

the actual state of our knowledge of the subabout the size of a walnut, is situated in the ject at the present day. He comes to the medullary layer and usually has a pyogenió conclusion that "none of the theories opposmembrane, rarely does a direct fistula from

ing the neuron conception has led to the ob. the primary focus lead through the cerebral jective demonstration of the existence of a cortex to the abscess. A positive diagnosis real continuity among the nerve elements, of saccus empyema cannot be made which is

and that there is a marked difference between deplorable, as this point can be reached So-called neuronists and anti-neuronists in through operation and in chronic character

the interpretation of the known facts. The of disease on extension of the process to the former admit only what is demonstrable and brain and meninges could be prevented. not finding intracellular anastomoses, they Is Inflation of Air in Acute Otitis Media

do not feel called on to admit that they

exist. Purulenta, on Account of Complicated Mastoid

The latter, while equally unable to itis, Indicated or Not?-(Schuetze, Inaugural

demonstrate their existence, hold that they Dissertation.)—After the author' gives the ought to exist, that continuity is a priori different hypotheses of several writers for and

80 probable that those who deny it should against the use of air inflation in acute otitis

be compelled to prove to their satisfaction

that it is impossible. Hy suggests that the media purulenta early and during the course of the disease, he relates his experiments on

multiplication of hypotheses may have been forty-four cadavers, that shall answer the

largely due to the assumption that the neuroabove question. He injeots into the tym panic in the nervous system, a point by no means

fibrils represent the sole conducting element cavity through the posterior superior quadrant with a Pravasz syringe one-fourth, one.

yet satisfactorily prored. The question is of half and one ccm. of methyl blue glycerinae

the possibility of nerve conduction, apart or methyl blue pus, making the perforation

from the cell body and of the auto-regenerasometimes large and sometimes small. After

tion of nerve, are noticed, and the known

facts discussed. wards the inflation is done with a catheter and

Barker does not deny their then the mastoid process opened to see wheth.

possibility. The disputed question as to er the colored solution was diffused into

the unicellular or pluricellular origin of the the mastoid cells. In sixteen cases of large

neuron and its peripheral nerve fibers is perforation only once colored solution was

taken up and the remarkable investigations found in the terminal cells; in small perfora; ing that motor nerve fibers

develop as pro

of Dr. Ross Granville Harrison, demonstrat. tions of eighteen cases, seventeen were found with colored solution in cells. In eight cases

cess of the anterior horns instead of being the colored solution was injected without fol

developed from the neurilemma cells along lowing catheterization with considerable pres

their course, are mentioned as among the sure into posterior superior quadrant to see

most important of the recent contributions to if injection pressure could force fuid into

our knowledge of the subject. But even if mastoid cells. Seven cases were free from

the pluricellular origin of the neuron could fluid. Therefore air inflation undoubtedly

be demontrated, it would still be an anatomic forced the fluid into the cells. After these

unit, but as an organ rather than a single attempts the author answers his question in

cell. The article is very fully illustrated. the following terse way: the air inflation in The Blood-Clot DRESSING.-H. O. Reik, acute otitis media purulenta without large Baltimore (Jour.A.M.A., March 31), believes perforation is dangerous, and should be that the blood-clot dressing, recommended avoided, as it may develop a mastoiditis, it

by Blake of Boston, in the mastoid operation is to be used after the acute condition bas best meets the needs and offers the best resubsided and belongs to the after treatment. sults. Those who have tried it report no un

pleasant results, and he thinks that it more HYSTERICAL DYSPHAGIA.—Levy lately re- nearly restores the natural conditions than ported a case of a woman who had swallowed do other methods in use. Even if the wound no solid for eighteen years, the condition be- is not absolutely clean the normal blood ing cured by suggestion, along with the possesses certain bactericidal power, which passage of esophageal bougies after cocainiz- is greater after it is drawn from the vessels ation.

than while still in the circulation. It is

a

present only when the blood is alkaline, and front-bent gouge gives the best results, since he thinks that some of the failures of the after its use convalescence begins more blood-clot dressing are perbaps attributable quickly. Convalescence is shortened by closto the use of chemical antiseptics in cleang. ing the mastoid wound and allowing it to col. ing the wound. On theoretical grounds, it lapse and partly fill with a blood clot. The would seem more rational to rely on dry postaural cosmetic effect is improved by aloleansing with instruments and sterile lowing the anterior flap of the wound holding sponges or by washing out the wound with

the pinna to fall inward and backward, so as sterile salt solution, wbioh, if it has any effect to lie on the posterior and inner wall of the on the clot, would increase its alkalinity and wound. When packing is avoided a large power to control septio action. He adds cavity which requires a long time to granusome words on the technic of the blood-clot late up is not formed. dressing: First, absolute cleanliness and re

EYE STRAIN AND DIGESTIVE DISORDERS. moval of every particle of infected material; second, the olosure of the wound in such a

-G. M. Gould, Pbiladelpbia (Jour.A.M.A.,

March 24), comments on a statement made by way as to prevent the introduction of new infection and to promote primary union.

Dr. J. H. Musser in The Journal, No. 4, Chemical sterilization should be avoided 1905, that the cure of so-called bilious atand sterile salt solution should be used if tacks, etc., by the correction of errors of reirrigation is deemed necessary. Finally, for fraction is a common and familiar occurrence. the closing of the wound the subcutaneous

He points out that it is sixteen or seventeen silver wire suture recommended by Halsted years since he himself first began to affirm may be used. It can easily be disinfected,

and to reaffirm this truth, and tbis is the and is itself antiseptio and can be removed

second convert made among the diagnostiwithout pain at the proper time. A silver foil cians, leading practitioners or gastrologists. covering over the closed wound will add Notwithstanding the admission that the fact something to the proteotion.

"'is familiar to all." Gould reviews the text. Reik believes

books and literature and shows how little that this will come to be accepted as standard metbod in mastoidectomy.

mention it has received and how generally it

has been ignored by thő authorities. He OPERATIVE TECHNIQUE AND AFTER-TREAT

claims that he began and for ten or a dozen MENT FOR MASTOIDITIS WITH EPIDURAL COM. years was alone in advocating the ocular PLICATIONS.-W. Sobier Bryant (Med. Rec., origin of these diseases, and objects that after Mar. 31,) after reporting two cases, makes being igpored so long it should now be acthe following recapitulation: The front-bent cepted without due credit to its earliest advo. gouge proved very useful in perforating the cate, is simply a truth “familiar to all." mastoid cortex, after which the rongeur and

While the admission, he says, is a bresch in the curette did all the bone work except in

what have seemed the impenetrable walls the second case, where the obisel and the

raised by the authorities and text-book mak. mallet were used for the epitympanic work. ing classes, be doubts its sincerity and calls The first steps of the operations were the same

for honest report of cases from those who as in uncomplicated cases of mastoiditis. As must observe them, and a general scientific the work proceeded, the wounds were enlarged utilization of the truth in practice. sufficiently to uncover all of the affected dura, and bone was removed until healthy dura surrounding the disease area was exposed. After all the inflamed dura mater had been unoovered and all the affected bone bad been MISSOURI VALLEY SPECIAL TO BOSTON. removed, the wound in one case was closed -Arrangements have been perfected for a without sutures, while in the other it was superb special train to Boston, to attend the paoked and left open. The unpacked wound meeting of the American Medical Association, collapsed and partly filled with a blood clot, June 5 to 8. Route: Grand Trunk, via thus reducing the size of the cavity, which Niagara Falls, Toronto, Montreal, Thousand had to granulate up and cicatrize. No com. Islands, daylight ride down the St. Lawrence plications due to the exposure of a large area iver, returning by rail. One fare, plus $1, of dura mater developed during convales. for round trip. This train will run special cence. In the case in whiob the front.bent through from Chicago, and will be made up gouge, rongeur, and ourette did all the bone of Pullman palace sleepers, dining cars, buffetwork, and whioh was closed without sutures, library and observation cars. For reservathe convalescence was very short and the de- tions and, itinerary address Dr. Chas. Wood formity was reduced to a nearly impercepti. Fassett, Secretary, Medical Society of the Misble soar and scarcely perceptible pitting. The souri Valley, St. Joseph, Mo.

The MEDICAL FORTNIGHTLY

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capsules at bedtime every second or third sent topics of interest and importance to physicians, and to this night. end, in addition to a well-selected corps of Departmont Editors, it has secured correspondents in the leading medical centers of Indications.- Castor oil has been found Europe and America. Contributions of a scientific nature, and

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muscular and joint pains of this condition the Contributions and books for review should be addressed to the editor, 319 and 320 Century Building, St. Louis, Mo. following lotion :

B Pot. carb....

Tinct. bellad.... FAVORITE PRESCRIPTIONS

aa 388 Aq. cumph., q. s. ad..

3iy WOUNDS.

Sig. : Apply every hour. Penns. Med. Jour. B Hydrargyri obloridi corrosivi.. gr. vij

MIGRAINE. — Ratchvord, in Medicine, reo. Ammonii chloridi....

ommends the following combination in the Aq. dest...

A z xvj

treatment of migraine: M. Sig. Use as antiseptio wash and to

B Sodii sulph..... moisten dressings.

3 $

Sodii salicylatis. Indications.-Used before and after surgi. cal operations and in accidental wounds.

Mag. sulph..

Litbii benzoatis.. Punctured wounds should be inoised, irri.

Tinot. nucis vom.

m 3 gated with solution, and drained according to

Aq. dest..... antiseptic principles.-Ex.

M. Sig. : To be placed in a siphon bottle HYPNOTISM FOR MORPHINE USERS, DRUNK- and carbonated, and a small amount, suffiARDS, ETC.-Berezinski Roussky Vratch cient to produce a laxative effect, taken daily would treat drunkenness, the morpbine and

before breakfast.--Jour. A. M. A. tobacco habits by the employment of bypno

IRITIS. --If the inflammation of the iris is tism, as there are no drugs wbich will cure these babits. He advocates sanatoria where

acute with intense pain, four or sis leeches

to the temple will give good relief. these cases can be confined and treated hypnotically. He says hypnotism easily and

The atropine solution should be used at an

early date, and readily cures the tobacco habit, but there is In alcoholics 20 to 80 pur

Bo Strong mercur, ointment..... 3iiss soon a relapse.

Ext. of belladonna... cent of cures have been effected.-Ex.

rubbed over the eyebrow URAEMIA.

If the inflammation is very acute, the fol. B Pilocarpinae hydrochlor...... gr. 1 lowing solution might be ordered: Aq. dest....

B Sulphate of atropine... M. Sig. Ten drops hypodermically, or by

Hydrochlor, of cocaine. moutb in case of apasarca.

Solution of adrenalin.. Indications.-Used in conjunction with Aq. (1 to 1,000)...... .. 3iiss hot pack as powerful diaphoretic. In the One drop in the eye every three hours. presence of weak heart or of coma tbe pilo. Paracentesis of the anterior chamber may carpine is dangerous. It should never be ad- be indicated if the tension is great and the ministered if there is edema of the lungs. - pain is severe-N. Y. Med. Jour. and Phila.

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