to that the spinal muscles and ligaments in millions of cases of functional scoliosis (also indirectly of ocular origin) are compelled to persistent strain and function, and thus become prolific sources of pathogenetic action. action. Combined, these two morbid causes account for most functional diseases. That functional diseases precede and beget organic diseases is a truism as evident as it is ignored. Scientific spectacles stop morbid functions of the eyes, and thus prevent all the evil results that are produced by malfunction. The proper placing of the writing paper on a proper desk prevents morbid writing. posture. LARYNGOLOGY AND RHINOLOGY. UNDER THE CHARGE OF S. J. KOPETZKY, M.D., Asssistant Surgeon, Manhattan Eye, Ear and Throat Hospital, New York (Ear Department). Attending Otologist, N. Y. Children's Hospital and Schools, R. I. Pharyngeal Suppu- D. C. L. Fitzwil ration. liams (The Practitioner, December, 1907). Fitzwilliams recalls the fact that this subject has attracted the attention of many eminent writers. He analyzes a series of 75 cases observed among children and divides them into the following groups: 1. Quinsy or suppuration in and around the tonsil, the pus being always superficial to the pharyngeal aponeurosis. 2. Retropharyngeal abscess, in which the suppuration starts in the retropharyngeal space. The abscess is outside the pharyngeal walls, between the buccopharyngeal aponeurosis and the prevertebral layer of the deep cervical fascia. 3. Post-adenoid suppuration, which is between the lymphoid tissue in the mucous membrane and the pharyngeal aponeurosis. 4. Suppuration or caseation in the deep cervical glands and extending inward to the lateral pharyngeal wall. 5. Cold abscess due to spinal caries and lying behind the prever tebral layer of the deep cervical fascia. Opening of these abscesses by incision from the inside is desirable in the majority of cases. A general anaesthetic to a moderate extent should be employed, except in very young infants and in cases in which dyspnoea is urgent. Tonsil. The Cold Wire Snare Henry Perkins in Removal of Faucial Moseley (New York Medical Journal, November 3, 1906). He tries to correct the impression that it is very slow, extremely painful and difficult, saying that by a properly-constructed, quick-working instrument these objections are overcome. The snare gets the tonsil out, and does not merely slice off part of it, as is so often the case when a tonsilotome is used. In children the author always uses a general anæsthetic. In adults pain is largely controlled by the injection of cocaine into the base of the tonsil. Hæmorrhage is rarely more than trifling, being much less than with a cutting instrument. The flat, spread-out variety of tonsil, which extends high into the so-called supra-tonsillar fossa, is more completely and quickly removed with a snare than by other methods. A tenaculum is used to pull the mass out into the snare loop. The snare shown has the following points of advantage: 1. Simplicity. I. 2. Pathology and Ther- Rhinitis. Dr. Schoenemann, Berne (Cor. Blatte für SchweizerAAertze, No. XVIII, 1907). After a short series of remarks regarding the normal physiology and pathology of nasal and mouth breathing, and a brief description of pathological-anatomical hypertrophy of the inferior turbinate, the author states that in a majority of cases he prefers the re Strength. The pistol grip enables section of the turbinate to its treatment hypertrophy of the turbinate. Otitis media catarrhalis chronica and otitis media purulenta chronica and erosion from a foreign body completed his list of indications for the operation. Hereditary Syphilis and Adenoid Vegetations. Gaucher (Annales des Maladies Venerienes, No. 9, 1907). According to the author's views, hereditary syphilis is a causative factor of hyperplasm of the adenoid tissues in the pharyngeal space, as it also is for appendicitis. In fact, he holds the syphilitic taint to play a prominent part, inasmuch as inflammatory changes will follow such taint in the lymphatic tissue at both these localities. He views the adenoid vegetation as a parasyphilitic manifestation, or, as he calls it, "heredo-syphilis quarternaire." Furthermore, since adenoid vegetation represents anatomically a form of scrof ula, therefore the latter is also viewed as a hereditary syphilitic manifestation. On the Late Effects Martinscelli and Ci- particularly at the sites of the lower ex- OTOLOGY. IN CHARGE OF R. JOHNSON HELD, M.D., Assistant Surgeon, Otological Department, Manhattan Eye and Ear Hospital. Suppuration in the H. Gifford, M.D. opened, and also a mastoid operation performed, with the usual pathological findings. Case 2. This case was similar to the preceding, except that there was no mastoid complication and in that the swelling recurred periodically when there. was a fresh infection in the middle ear. Gifford explains this complication in that the pus travels from the mastoid cells to the zygomatic cells and perforating through these latter cells into the temporal fossa. This is explanatory for case I, but in the instance of case 2 the pus must have traveled through the Glasserian fissure or through an incompletely September, 1907). The author covers thoroughly the treatment and diagnosis of mastoiditis, but speaks in particular of several important points. Sagging of the posterior superior wall of the external auditory canal near the drum he considers one of the valuable diagnostic signs, as it indicates a suppurative process in the bone. It should not be confounded with furuncle of the canal wall. Another point of value is placing a hand over each mastoid and pressing each alternately and watching the face of the patient for signs of distress. Swelling of the mastoid tip and extending down the neck is characteristic of a Bezold perforation in which pus has burrowed through the digastric groove and found its way into the tissues of the neck. Pain is usually most severe at the mastoid tip, but where the character of the bone is pneumatic the pain is usually equally severe over the entire surface of the mastoid process. When the cortex is thick or is eburnated the pain is not so constant, and may even be absent. of his paper is limited to some of the relations of those structures which are liable to injury during the performance of what is ordinarily called the radical mastoid operation. The first important structure to be kept in mind is the sigmoid sinus, the position of which varies greatly in different individuals, but even when it occupies the most favorable position. from the point of view of the operator it is still in a position where it can be easily injured in the process of opening the mastoid cells. These cells usually come into more or less of a close relation to the sinus, and the two are separated by a thin bony shell. In case the surgeon does not know the exact location of the sinus or is unfamiliar with the appearance of its bony covering, he may easily open it by a single false stroke of a chisel. The distance between the antrum and the sinus is usually such as to permit a free opening into the antrum. the antrum. The sinus, however, frequently encroaches closely to the posterior meatal wall, and it also comes quite close to surface of the mastoid. The operator in opening the mastoid process must always proceed with the caution necessary when the sinus is close to the surface of the bone, for we have no means of ascertaining beforehand just what location of the sinus to expect. The facial nerve is the most important structure to bear in mind in the radical operation. The nerve enters the temporal bone through the internal auditory foramen and enters the tympanic cavity just above and in front of the oval window. From this point until it leaves the temporal bone at the stylomastoid foramen the nerve is exposed to possible injury when operating on the mastoid. mastoid. In its course through the tympanum the facial nerve lies just above the oval window, and it is here where it is scantily covered by bone, and frequently the bone is altogether absent at this point. In this location injury is frequent to the nerve. The position of the course of the nerve after it has left the tympanum and entered the shelf of bone which forms the posterior wall of the meatus is such that any attempt to remove completely more of this wall than at its upper angle will surely result in a severance of the nerve. The external semicircular canal is liable to injury from the chisel when opening the antrum. Care must be exercised when curetting the anterior portion of the tympanum, for it is possible to injure the carotid artery which lies in close proximity, being frequently scantily covered with bone. The position of the carotid should also be borne in mind when curetting the oriface of the Eustachian canal. A structure that sometimes comes in close relation with the cavity of the tympanum is the dome of the jugular bulb. The thickness of bone separating the bulb from the tympanum varies from a fourth of an inch to a total absence. Prof. Fisher's Diet PUBLIC HEALTH AND FORENSIC MEDICINE. UNDER THE CHARGE OF F. C. CURTIS, A.M., M.D., of Albany, The mechanical diet indicator devised by Prof. Irving Fisher of the department of political economy at Yale University, and described by him in the American Journal of Physiology and in the Journal of the American Medical Association†, is a machine for the purpose of indicating automatically the proteid, fat and carbohydrate in any given dietary. By the use of this device it is easy to discover what proportions these elements bear to each other in any given ration, and if the ration does not conform to any given standard, it indicates what are the directions in which it can be most easily remedied. The machine consists of an iron standard about nine inches in height, from which is suspended a "basket" holding a triangular card, on which is printed a right-angle triangle, called by Professor Fisher a "food map." Each particular food has a particular location on this "food map." The "latitude" of any food represents (in calories) the per cent. of its food value in the form of proteid, and *April 2, 1906, Vol. XV. No. 5. April 20, 1907, Vol. XLVIII, pp. 1316-1324. its "longitude" the per cent. of its food value in the form of fat. Its distance from the third side or "hypotenuse" of the triangle represents, in like manner, the carbohydrate. The machine is most easily used if various foods are served in standard "portions," each containing 100 calories of food value, or in simple multiples or fractions of such standard "portions." The weighted pins are placed on the "food map," the weights of which represent these portions (or multiples or fractions). In this way the food value of every article eaten in the course of a day is represented by the weight of the different pins, while their position on the "map" indicates the percentages of these food values in the three forms of proteid, fat and carbohydrate. The "basket" is allowed then to hang freely, and a pointer indicates on the "food map" the center of gravity of the pins. This center of gravity represents the entire ration, its "latitude" indicating the per cent. of calories in proteid and its "longitude" and the per cent. in fat, etc. The total calories are represented by the total weight of the |