prefer the naso-pharyngo-laryngeal cavities and tissues to those of any other part of the body, syphilis of the accessory sinuses is rather uncommon. He describes four cases that have come under his care. The chief symptoms were nasal discharge and fetid breath. Pain was not constant, but was always present during mastication. Pus was present in all these cases. The writer, in making his diagnosis, relied upon the presence of a purulent accumulation in the middle meatus anteriorly, transillumination, and puncturing and aspirating the maxillary sinus. In order to detect pus, the nasal cavities are first thoroughly cleansed, and the patient is directed to incline the head to the opposite side for a minute, then downwards and forwards. If the middle meatus be then examined, pus, if present, will be seen adhering to the inferior surface of the middle turbinate anteriorly. A darkened area over the maxillary sinus is noted on transillumination of the maxillary antrum. From his experience with these cases, the writer thinks one is justified in claiming that no syphilitic patient is free from the possibility of tertiary manifestations, in one form or another, even after a thorough course of antisyphilitic treatment, lasting two years or more. On this account all syphilitic patients should be advised to consult their physicians every one to three years subsequent to their treatment. A positive diagnosis of empyema of the antrum of Highmore may be reached by means of the proper appliIcation of the aspirating needle. Syphilitic empyema of the accessory sinuses quickly responds to specific treatment and conservative surgery. The administration of iodides in small doses, increasing one grain three times a day, has proved of more value in the writer's experience than large doses rapidly increased. Finally, he believes that unless urgent symptoms demand immediate operation, operative interference should be delayed, in order to obtain as great an absorption of the gummatous infiltration with the iodides as possible. Significance of Edema of the Pharynx. (Jacob E. Schadle in the February number of the Laryngoscope.)-In a well written article Dr. Schadle gives a carefully followed history of true edema of the pharynx accompanied by albuminuria. His theory of an infectious nephritis caused by an attack of tonsillitis is supported by the facts he records. Indications for Curative Tracheotomy in Laryngeal Tuberculosis.-A. Henrici (Archiv fuer Laryngologie, Vol. XXVII) illustrates his advocation of tracheotomy in laryngeal tuberculosis by very interesting histories of four cured cases of laryngeal tuberculosis; the pa tients being all children between II and 14 years. He points out that tracheotomy should not be directed by vital indications only, but should be performed oftener as curative measure. Suitable conditions are represented (1) by juvenile age of the patient, in which the vitality is stronger and the damaging aftereffects of the surgical interference are much less marked as in older persons, being in youth remarkably slight; (2) by the lack of any greater tubercular change in the lungs and the existence of fair general condition of health, these latter depending chiefly on the former; (3) by the benignity of the tubercular process in the larynx being slowly progressive and representing more the forms of infiltration and tumefaction, not the ulcerative form. Guided by these points of view we can expect excellent curative results by tracheotomy in laryngeal tuberculosis. The Use of the X-Ray in Sinus Disease of the Nose. Mosher (Laryngoscope, Feb., 1906) claims a superior diagnostic value for the X-ray plates in sinus disease, and brings forward some very interesting cases to support his contention. He admits, however, the necessity of being an expert operator and the difficulty of recognizing what is seen, particularly on plates taking a iateral view. OTOLOGY. ALBERT F. KOETTER, M. D. A Case of Leukemia Hemorrhage in the Inner Ear with Special Reference to the Pathologic-anatomic Examination of the Temporal Bone.-(Aage Kock, Kopenhagen, Zeitschrift fuer Ohrenheilkunde.)-Man of thirty-two, acquired malaria in China, since then has been ailing. Based on the clinical and blood examination the diagnosis of leukemia, medulla lienalis was made. Suddenly vertigo tinnitis and decrease in hearing set in, after two days total deafness. The post-mortem verified the clinical diagnosis. The histological examination of the temporal bone showed the following: Left Ear.-Abundant fresh hemorrhage in the cochlea, especially in the basal convolutions, mainly in the scala vestibuli, every part of Reissner's membrane sprinkled. Differentiation of the cells in the From the scala organ of Corti impossible. vestibuli the hemorrhage continues to the vestibule, where it is localized on the median wall, furthermore, in the ampullae in the endolympphatic as well as the perilymphatic spaces. Hemorrhage in the tympanum also The medullary space of the malleus and incus are filled with lymph cells. Right Ear.-Hemorrhagic changes more pro cocurs. nounced than in left ear, scalla vestibuli and scala tympani entirely filled with blood; of the delicate parts of the membranous cochlea nothing is visible, the basilar membrane is fenestrated in several places. In the course of the semi-circular canals the perilymphatic spaces in both ears are filled with blood, whereas the interior of the membranous semicircular canals are for the greater part clear. Clinical Examination of the Sense of Equilibrium. (Panse-Lucae, Festschrift.)-Vertigo is a condition of space disorientation of our body against its surroundings. The irritations that lead to semicircular canal vertigo must be strong enough or they will be equalized by the eye, or the tactile sense. One can therefore bring about the semicircular canal vertigo if the control by the eye -closing the eyes-and control of the tactile sense, putting the feet together, standing on one leg, is made impossible or rendered difficult by creating an irritation of the semicircular canal track. The latter is reached by turning the head to the side on which the semicircular canal is to be tested, namely, through touching a semicircular canal fistular, or by turning the eyes to opposite side of the canal tested. If we now consider as the semicircular irritation of the flow of lymph from the narrow part of canal to the ampullae as the active moment, the kind. of test and the results to be expected for the individual semi-circular canal follow of its own accord. The factor of the exclusion of control through the eye and rendering difficult the control through the tactile sense remains equal in the test for all semi-circular canals, including utricle and saccule. Test for the horizontal semi-circular canal: Turning to the side of the canal in question around a vertical axis, or turning to the opposite side with sudden cessation of the turn, position of eyes to opposite side of canal tested. The body, in test of left semi-circular canal, turns to the left side, objects to the right side, phenomena that have been recognized in irritation of left semi-circular canal. Corresponding test of the anterior semi-circular canal, always supposing that the flow of lymph from narrow part of canal to the ampullae is active: raising of the head which has been bent, forward or turning forward and sudden cessation of revolving stool with head bent forward so that the bridge of the nose is horizontal, defect of eyes downward; an irritation of the anterior semi-circular canal causes therefore a sensation of reeling backward, and the sliding forward of objects. Test for posterior semi-circular canal: dropping of the head, turning forward, with head resting horizontally on the shoulder, in the revolving stool, defect of the eyes upward. In irritation of the anterior semi-circular canal the sensation must appear as if the field of vision were turning from the front to the rear and the individual himself were falling forward. The maculae acusticae of the utricle should functionate in upward and downward, and in rectilineal side movements, the maculae of the saccule functionate in forward and backward movements. The Aqueductus Vestibuli as a Means of Infection. (Boesch, Zeitschrift fuer Ohrenheilkunde).- Based on his own observations and twenty-one cases reported in the literature, the author compiles a statement of the pathogeny of suppuration in the aqueductus vestibuli. Contrary to Hinsberg, Boesch in sixty-five cases of labyrinth suppuration, in which the path of infection from the labyrinth to the interior of cranium was plainly indicated, the extension of the pus through the aqueductus, vestibuli occurred twentytwo times. A fact, which puts the importance of this manner of extension in a proper light. The cases cf aqueductus vestibuli suppuration that Boesch gathered where chronic suppurations, the labyrinth was involved preferable through the fenestra ovalis, or the horizontal semi-circular canal. From the vestibulum the pus extended to the saccus endolymphaticus, providing the aqueduct has not had time to close up by means of connective tissue formation, and then there occcurs an empyema of the saccus endolymphaticus. In extremely isolated cases the saccus seems to have been reached directly from the antrum and surroundings of the labyrinth and aqueductus by the carious process. The pus very seldom extends through the acutely distended saccus, be it subdural through the posterior membrane or extradural through the anterior membrane. In most cases there is time for the formation of adhesion in the vicinity of the inflammatory focus. The dura becomes adherent to the pia respectively with the cerebullum which can only be reached in a direct way by the infection. As moreover the saccus is too small and too delicate to become a retainer for the pus, it is therefore probably an accumulation of pus between the dural membranes, and Boesch proposes the name interdural abscess. Of cerebral complications in the twenty-three cases of Boesch were as follows: one extradural abscess, three purulent, meningitis, four meningitis and sinus thrombosis, three meningitis and abscess of cerebellum, ten abscess of cerebellum. The sigmoid sinus can be infected by way of vena aqueductus vestibuli. The prevalence of cerebellar abscesses follows through the explanation given above as regards chronic condition of the case, the formation of adhesion protects the meninges and favors the direct infection of the cerebellum. In all cases only the immediate cerebellar hemisphere contiguous was infected. The abscess, about the size of a walnut, is situated in the medullary layer and usually has a pyogenic membrane, rarely does a direct fistula from the primary focus lead through the cerebral cortex to the abscess. A positive diagnosis of saccus empyema cannot be made which is deplorable, as this point can be reached through operation and in chronic character of disease on extension of the process to the brain and meninges could be prevented. Is Inflation of Air in Acute Otitis Media Purulenta, on Account of Complicated Mastoid itis, Indicated or Not? (Schuetze, Inaugural Dissertation.) After the author gives the different hypotheses of several writers for and against the use of air inflation in acute otitis media purulenta early and during the course of the disease, he relates his experiments on forty-four cadavers, that shall answer the above question. He injects into the tympanic cavity through the posterior superior quadrant with a Pravasz syringe one-fourth, onehalf and one ccm. of methyl blue glycerinae or methyl blue pus, making the perforation sometimes large and sometimes small. Afterwards the inflation is done with a catheter and then the mastoid process opened to see wheth. er the colored solution was diffused into the mastoid cells. In sixteen cases of large perforation only once colored solution was found in the terminal cells; in small perforations of eighteen cases, seventeen were found with colored solution in cells. In eight cases the colored solution was injected without following catheterization with considerable pressure into posterior superior quadrant to see if injection pressure could force fluid into mastoid cells. Seven cases were free from fluid. Therefore air inflation undoubtedly forced the fluid into the cells. After these attempts the author answers his question in the following terse way: the air inflation in acute otitis media purulenta without large perforation is dangerous, and should be avoided, as it may develop a mastoiditis, it is to be used after the acute condition has subsided and belongs to the after treatment. HYSTERICAL DYSPHAGIA.-Levy lately reported a case of a woman who had swallowed no solid for eighteen years, the condition being cured by suggestion, along with the passage of esophageal bougies after cocainization. SPIRIT OF THE MEDICAL PRESS. THE NEURONS.-L. F. Barker, Baltimore (Jour. A. M. A., March 31 and April 7), reviews the history of the neuron doctrine and the actual state of our knowledge of the subject at the present day. He comes to the conclusion that "none of the theories opposing the neuron conception has led to the objective demonstration of the existence of a real continuity among the nerve elements, and that there is a marked difference between so-called neuronists and anti-neuronists in the interpretation of the known facts. The former admit only what is demonstrable and not finding intracellular anastomoses, they do not feel called on to admit that they exist. The latter, while equally unable to demonstrate their existence, hold that they ought to exist, that continuity is a priori so probable that those who deny it should be compelled to prove to their satisfaction that it is impossible. He suggests that the multiplication of hypotheses may have been largely due to the assumption that the neuroin the nervous system, a point by no means fibrils represent the sole conducting element yet satisfactorily proved. The question is of the possibility of nerve conduction, apart from the cell body and of the auto-regeneration of nerve, are noticed, and the known facts discussed. Barker does not deny their The disputed question as to possibility. the unicellular or pluricellular origin of the neuron and its peripheral nerve fibers is taken up and the remarkable investigations of Dr. Ross Granville Harrison, demonstrating that motor nerve fibers develop as process of the anterior horns instead of being developed from the neurilemma cells along their course, are mentioned as among the most important of the recent contributions to But even if our knowledge of the subject. the pluricellular origin of the neuron could be demontrated, it would still be an anatomic unit, but as an organ rather than a single cell. The article is very fully illustrated. THE BLOOD-CLOT DRESSING.-H. O. Reik, Baltimore (Jour. A. M.A., March 31), believes that the blood-clot dressing, recommended by Blake of Boston, in the mastoid operation best meets the needs and offers the best results. Those who have tried it report no unpleasant results, and he thinks that it more nearly restores the natural conditions than do other methods in use. Even if the wound is not absolutely clean the normal blood. possesses certain bactericidal power, which is greater after it is drawn from the vessels than while still in the circulation. It is present only when the blood is alkaline, and he thinks that some of the failures of the blood-clot dressing are perhaps attributable to the use of chemical antiseptics in cleansing the wound. On theoretical grounds, it would seem more rational to rely on dry oleansing with instruments and sterile sponges or by washing out the wound with sterile salt solution, which, if it has any effect on the clot, would increase its alkalinity and power to control septic action. He adds some words on the technic of the blood-clot dressing: First, absolute cleanliness and removal of every particle of infected material; second, the closure of the wound in such a way as to prevent the introduction of new infection and to promote primary union. Chemical sterilization should be avoided and sterile salt solution should be used if irrigation is deemed necessary. Finally, for the closing of the wound the subcutaneous silver wire suture recommended by Halsted may be used. It can easily be disinfected, and is itself antiseptic and can be removed without pain at the proper time. A silver foil covering over the closed wound will add something to the protection. Reik believes that this will come to be accepted as a standard method in mastoidectomy. OPERATIVE TECHNIQUE AND AFTER-TREATMENT FOR MASTOIDITIS WITH EPIDURAL COMPLICATIONS.-W. Sohier Bryant (Med. Rec., Mar. 31,) after reporting two cases, makes the following recapitulation: The front-bent gouge proved very useful in perforating the mastoid cortex, after which the rongeur and the curette did all the bone work except in the second case, where the chisel and the mallet were used for the epitympanic work. The first steps of the operations were the same as in uncomplicated cases of mastoiditis. As the work proceeded, the wounds were enlarged 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 uncovered and all the affected bone had been removed, the wound in one case was closed without sutures, while in the other it was packed and left open. The unpacked wound collapsed and partly filled with a blood clot, thus reducing the size of the cavity, which had to granulate up and cicatrize. No complications due to the exposure of a large area of dura mater developed during convalescence. In the case in which the front-bent gouge, rongeur, and curette did all the bone work, and which was closed without sutures, the convalescence was very short and the deformity was reduced to a nearly imperceptible scar and scarcely perceptible pitting. The front-bent gouge gives the best results, since after its use convalescence begins more quickly. Convalescence is shortened by closing the mastoid wound and allowing it to collapse and partly fill with a blood clot. The postaural cosmetic effect is improved by allowing the anterior flap of the wound holding the pinna to fall inward and backward, so as to lie on the posterior and inner wall of the wound. When packing is avoided a large cavity which requires a long time to granulate up is not formed. EYE STRAIN AND DIGESTIVE DISORDERS. -G. M. Gould, Philadelphia (Jour. A.M.A., March 24), comments on a statement made by Dr. J. H. Musser in The Journal, No. 4, 1905, that the cure of so-called bilious attacks, etc., by the correction of errors of refraction is a common and familiar occurrence. He points out that it is sixteen or seventeen years since he himself first began to affirm and to reaffirm this truth, and this is the second convert made among the diagnosticians, leading practitioners or gastrologists. Notwithstanding the admission that the fact "is familiar to all." Gould reviews the textbooks and literature and shows how little mention it has received and how generally it has been ignored by the authorities. claims that he began and for ten or a dozen years was alone in advocating the ocular origin of these diseases, and objects that after being ignored so long it should now be accepted without due credit to its earliest advocate, is simply a truth "familiar to all." While the admission, he says, is a breach in what have seemed the impenetrable walls raised by the authorities and text-book making classes, he doubts its sincerity and calls for honest report of cases from those who must observe them, and a general scientific utilization of the truth in practice. He MISSOURI VALLEY SPECIAL TO BOSTON. Arrangements have been perfected for a superb special train to Boston, to attend the meeting of the American Medical Association, June 5 to 8. Route: Grand Trunk, via Niagara Falls, Toronto, Montreal, Thousand Islands, daylight ride down the St. Lawrence iver, returning by rail. One fare, plus $1, for round trip. This train will run special through from Chicago, and will be made up of Pullman palace sleepers, dining cars, buffetlibrary and observation cars. For reservations and itinerary address Dr. Chas. Wood Fassett, Secretary, Medical Society of the Missouri Valley, St. Joseph, Mo. THE MEDICAL FORTNIGHTLY A Cosmopolitan Biweekly for the General Practitioner The Medical Fortnightly is devoted to the progress of the Practice and Science of Medicine and Surgery. Its aim is to present topics of interest and importance to physicians, and to this end, in addition to a well-selected corps of Department Editors, it has secured correspondents in the leading medical centers of Europe and America. Contributions of a scientific nature, and original in character, solicited. News of Societies, and of interesting medical topics, cordially invited. Advertising forms close on the first and fifteenth of each month. Time should be allowed to submit proof for correction Advertising rates on application. Remittances and business communications should be addressed to the Fortnightly Press Co. Subscription, $2.00 a year, in advance, including postage to any part of the United States, Mexico and Canada. 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Contributions and books for review should be addressed to the editors, 319 and 320 Century Building, St. Louis, Mo. FAVORITE PRESCRIPTIONS B Hydrargyri chloridi corrosivi.. gr. vij gr. x A 3 xvj M. Sig. Use as antiseptic wash and to moisten dressings. Indications. Used before and after surgical operations and in accidental wounds. Punctured wounds should be incised, irrigated with solution, and drained according to antiseptic principles.-Ex. HYPNOTISM FOR MORPHINE USERS, DRUNKARDS, ETC.-Berezinski Roussky Vratch would treat drunkenness, the morphine and tobacco habits by the employment of hypnotism, as there are no drugs which will cure these habits. He advocates sanatoria where these cases can be confined and treated hypnotically. He says hypnotism easily and readily cures the tobacco habit, but there is soon a relapse. In alcoholics 20 to 80 per cent of cures have been effected.-Ex. 34 M. Sig. To be placed in a siphon bottle and carbonated, and a small amount, sufficient to produce a laxative effect, taken daily before breakfast.-Jour. A. M. A. IRITIS. If the inflammation of the iris is acute with intense pain, four or six leeches to the temple will give good relief. The atropine solution should be used at an early date, and B Strong mercur. ointment..... Ext. of belladonna.......... rubbed over the eyebrow 3iiss gr. xv If the inflammation is very acute, the fol lowing solution might be ordered: B Sulphate of atropine...... Hydrochlor. of cocaine.. gr. j gr. iv M XXX 3iiss One drop in the eye every three hours. Paracentesis of the anterior chamber may be indicated if the tension is great and the pain is severe-N. Y. Med. Jour. and Phila. Med. Jour. |