UNDER THE CHARGE OF VANDERPOEL ADRIANCE, M.D., Consulting Physician to the New York Orphan Asylum and Pathologist to the Nursery and Child's Hospital. dren. until other causes are eliminated. The protean reflex causes need careful study. The first thing in treatment is removal of the cause, but as this cannot always be determined, a rational treatment is that which will control the convulsion and be most likely to remove possible causes. Very recent dietetic errors may call for emetics or washing out the stomach. Hydrotherapeutic methods properly carried out are more generally effective than any others, and more good can be accomplished by colonic irrigation than any other single remedy, in Lowenburg's opinion. The fluid must be sterile. Balneotherapy is also very useful. Other methods failing to check the attack, the small intestine must be cleared out, and for this he recommends full doses of castor oil as preferable. Hypnotics and antispasmodics are usually called for, and the best hypnotic is chloral hydrate, in small doses, in water, following the colonic irrigation. These remedies must be used only after the temperature has been reduced and the bowels emptied. Convulsions in Chil- H. Lowenburg, Philadelphia (Journal A. M. A., November 23), says that convulsions per se do not constitute a morbid entity; the underlying cause must be sought, and failure to recognize this elementary principle of pædiatric diagnosis. has often led to disastrous results. We must recognize predisposing and exciting causes, and among the predisposing causes, infancy, with its imperfectly developed nervous inhibitions and the potent influence of heredity, are especially mentioned. In diagnosing the exciting causes it must be remembered that the attack may result from direct irritation, irritation of the cortical motor cells or from reflex or toxic irritation of the same or of the spinal reflex centers. In the last case the convulsion is usually tonic in character. The success in treatment directly depends on a correct ætiologic diagnosis. Of the utmost importance is the determination of the temperature, the obtaining of a correct history, the age of the patient, the presence or absence of unconsciousness, the character of the onset and the degree of involvement. Fever generally indicates some toxic condition, possibly some acute infectious disease, but often of gastrointestinal origin. Irregular temperature may suggest meningitis. Normal or subnormal temperature is possible with some toxæmias. brain disease or reflex irritation. Convulsions in a very young infant may have a different signification from those occurring in an older child. Lowenburg is skeptical as to dentition as a frequent Conditions situated in the synoviæ. Epilepsy should not be diagnosed The pains here disappear within two days cause. Surgical treatment is advised when needed to remove an exciting factor. Gum lancing is seldom required. Bier's Method in the Blanc (Revista de after the institution of the treatment. The swelling begins to subside after 10 or 12 days. The function is re-established, as a rule, at the end of a month. 2. Affections located in the epiphysis. In a general way the results are not particularly favorable in this group, since nothing is relieved but the pain. In certain cases fistulas develop, which possibly heal a little more rapidly with than without the congestion.. 3. Severe joint disease without fistula; cases in which secondary infection has occurred for some reason, such as thermocauterization, etc. In this group of cases the hyperamic treatment was found to be positively harmful. Improvement was obtained only in two cases of diseased ankle-joint. 4. Cases with formation of a fistula. No favorable effects were noted in this group. F. R. at Different Temperatures. The Digestive Power Roeder (Archiv. f. of the Stomach Juice Kinderheilk, Vol. 46, H. 3-6, 1907). The artificial feeding of infants presents two important problems, the first concerning the proper temperature of the food, the second involving the correct estimation of the temperature relations of a given article of diet. The former point was studied by means of animal experimentation. A dog which had been operated upon according to Pawlone (gastric culde-sac) furnished the stomach juice, which was added to solutions of casein at different temperatures. It was found that temperatures of 36-38 degrees C. are the most favorable for the peptic effect of the stomach juice, and that artificial food warmed to this point must, accordingly, be the most suitable for the infant. As a matter of fact, milk obtained from a nursing mother's breast presents similar temperatures. It is a matter of common experience, however, that in the majority of all cases of artificially-fed infants the food is administered at a higher tempera ture. Among 200 corresponding cases which were investigated in this particular connection the temperature was 36-39 degrees in 40 instances, 39-40 degrees in 60, 41-42 degrees in 68, 43 degrees in 25, and 46 degrees in 7 instances. With special reference to the estimation of the temperature, the author points out that the customary method of testing the food by the thermic sense (hand, cheek or eyelid) is absolutely unreliable, since individual fluctuations, to a notable degree, are the rule rather than the exception. F. R. Buttermilk in GastroIntestinal Affections of Children. Luisi (Paulina) (Arch. Lat. Americanos de Pediatria. June, 1906). As resident physician in the babies' wards of the Montevideo Foundling and Orphan Asylum, the author was enabled to study the action of buttermilk prepared according to the method of Jacobson and Decherf. Buttermilk is recommended as efficient and . valuable, upon the basis of 22 observations, which were carefully followed up. During the summer term buttermilk was systematically employed as an article of diet and as a medicament. The effect is immediate in acute cases of gastro-enteritis, shown by cessation of the diarrhoea and vomiting. The action of buttermilk is even more convincing in chronic cases, for the children promptly gain in weight. and are soon on the high road to recovery. Buttermilk was found to be essentially superior to kefyr. It was tolerated even by weak and premature infants. It constitutes the best artificial food for sick children. F. R. Brain Tumor. NERVOUS AND MENTAL DISEASES. UNDER THE CHARGE OF WILLIAM B. NOYES, M.D., Attending Neurologist, Demilt Dispensary. A case of brain tumor of unusual type, and interesting on account of its symptoms, its successful localization and operative results, is reported by Drs. J. L. Atlee, Lancaster, Pa., and C. K. Mills, Philadelphia, in the Journal A. M. A., December 28. The case was seen in consultation by several well-known physicians and was thoroughly studied in all its aspects. The patient was a physician, aged 43, with an excellent family and personal history. The important symptoms were headache, left unilateral laryngeal paralysis, localized left unilateral spasm, with loss of consciousness, and later appearing left hemiparesis, with loss of word memory and astereognosis. There was no true optic neuritis, though there was some indistinctness of the nerve margins. The visual fields were normal, or nearly so. There was also nearly complete loss of voice. The left vocal cord. showed adductor paralysis, and both it and the entire larynx were much congested, apparently due to the irritating cough. A triangular area of the skull, bordering the fissure of Rolando, extending upward along the line of the fissure for 1 1-3 inches and back an equal distance, with the base parallel to Reid's base line, was removed and a tumor of 22x2x14 inches was shelled out. It was oval in shape and not adherent to the dura, but no pia was noticed over it. Microscopic examination by Dr. W. G. Spiller revealed its structure to be epithelial in character, resembling that of the chorioid plexus, from which it was probably derived. The patient's memory for words and spelling returned immediately after the operation, and his improvement in other respects has been steadily progressive, with the exception of spasms occurring about three weeks after the operation, which were attributed to the use of faradism. The laryngeal paralysis, however, was still somewhat in evidence at the time of last examination. The authors quote from the recent work of Bielschowsky and Unger on the epithelial tumors originating from the chorioid. plexus, and discuss more particularly the bearing of the case on the question of the cortical innervation of the larynx. Although the physiologic experiments of Krause, Semon and Horsley and Risien Russell would seem to indicate that a unilateral irritative lesion of the laryngeal cortical center should cause bilateral paralysis of the vocal cords, this case and a similar clinical observation of Delevan's, to which the authors refer, point to the possibility of a destructive lesion of the cerebral center for laryngeal movements producing a persistent unilateral paralysis of the vocal cord on the side opposite the lesion. The Technique of Op- Moskowicz (Wiener erations Upon the Hy- Klin. Wchschrft., pophysis. No. 26, 1907.). The author succeeded by experimentation upon the cadaver in devising a 'technique which seems to be more conservative than Schloffer's method. The normal organ was removed in six instances by the new procedure, which varies from Schloffer's method especially through its performance in two sessions. At the time of the first operation the lower surface of the base of the skull is freshened and cov ered with a skin flap passing from the forehead as far as the sphenoid fossa, where the tip of the flap terminates. The last bony lamella in front of the hypophysis is not divided until the skin flap has healed in. The orbital wall, the in ner wall of the antrum of Highmore, and the inferior turbinate are left intact, in contradiction to Schloffer's operation. On the other hand, the author performed a resection of the anterior and inferior wall of the frontal sinus. Extra cranial methods alone enter into consideration, according to the author, for the reason that the intracranial procedures are extremely difficult, without affording a positive guarantee of asepsis. F. R. Epilepsy. Birth Traumatism and Volland (Allgem. Zeitschrift f. Psychiat., Vol. 63, H. 3, 1906-7). Among 1500 artificial labors the author was enabled to determine the existence of epilepsy in 45 patients, or 3 per cent. of the cases. Besides the abnormal labor, faulty heredity assisted in the production of the epilepsy in 13 cases. Tuberculosis of the immediate or remote progenitors was noted in six cases. Only three patients presented changes of the skull which could be positively referred to traumatic influences at the time of birth. In seven cases, without psychopathic heredity, there was infantile cerebral palsy, usually appearing in the course of the first to second year, together with the epilepsy. The traumatic injuries at the time of birth apparently create a predisposition of the brain for the evolution of the encephalitic process. In proportion to the great frequency of epilepsy, however, birth traumatism plays only a minor part in the ætiology of this disease. It is probably to be regarded as a preparatory cause of the subsequent elilepsy in a small number of F. R. cases. Three Cases of Lingual Hoflmayr (Muench. Neuralgia. Med. Wchschrft., December 18, 1906.) The patients were three men, of 68, 44 and 40 years of age, respectively, all of whom presented neurasthenic symptoms, with habitual constipation. The neuralgia in these cases was characterized by pain, strictly limited to the region innervated by the lingual nerve, the two principal nerves of the tongue (glosso-pharyngeal, nerve of special sense, and hypoglossus, motor nerve) being perfectly healthy. The author was enabled to determine, moreover, that the chorde tympani, which governs the sensation of taste in the anterior third of the tongue, was not involved in the pathological process. There was no local inflammation, and the corresponding lymphatic ganglia were not swollen and enlarged, as is invariably the case in the existence of some lingual or buccal affections. The only plausible reason to which the condition could be referred consisted in the habitual constipation and resulting autointoxication. As a matter of fact, the origin of certain hemicranias. shows these factors to be capable of acting upon the cranial nerves, probably through the sympathetic. By accurately regulating their intestinal functions the author succeeded in progressively relieving the lingual neuralgia of these three patients. In the first two cases the patients were instructed to rinse the mouth with camomile tea and a weak solution of potassium permanganate as a local placebo. The three observations published by the author are noteworthy and interesting, for the reason that an isolated neuralgia of the lingual nerve is usualy considered as extremely uncommon. Descriptions of disease affecting the nerves of the tongue almost exclusively deal with Clinical Assistant, Dermatological Department, College of Physicians and Surgeons. The Treatment of (Dermatolog. ZeitSyphilis with Mergal. schr., July, 1907.) Mergal, a new remedy for internal administration in syphilis, has been found from the therapeutic tests of H. Kanity to be of value. The drug is a mercuric oxide of cholic acid combined with an albuminate of tannin. It is put up in thin caps containing .05 grains of the mercuric salt and 10 grains of the tannin. Experiments were tried in 40 cases of syphilis, 29 of them being in the early secondary period, and the rest in the late secondary period. None of the patients. had received any previous antisyphilitic treatment. The course of treatment in every case consisted of three capsules daily, gradually increased to eight to twelve a day until the manifest symptoms had disappeared or complications due to use of the drug appeared. The therapeutic results were only slightly inferior to those obtained from inunctions or injections. Cases of roseola disappeared on an average in 18 days, after having taken 90 capsules. In six cases of papular form the eruption disappeared after four weeks, 180 capsules having been taken. Several other forms required a longer time and greater dosage for their disappearance. Equally good results were obtained in treating relapsing secondary eruptions. In 10 of the cases there was a certain amount of stomatitis, being for the most part only a slight swelling of the gums. In two cases, however, there was pronounced salivation and very superficial ulceration. One of the most noteworthy qualities of mergal is its freedom from irritation of the stomach and intestines. In the majority of the cases the capsules were given for weeks without the slightest disturbance of the gastro-intestinal canal. In a few cases there was slight diarrhoea, and in one fever, pains in the stomach and vomiting. Statistics of Tertiary (Archiv f. Dermatol. |