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nition of labyrinthine suppuration with adoption of the appropriate surgical

measures.

A Case of Serous Men- Dr. Albert Blau ingo-Encephalitis, with (Zeitschrift für Autopsy Report. Ohrenheilkunde, Vol. LIII, page 129, 1906). Child 234 years old had measles for three weeks, which was followed by pain in the right ear and discharge, and followed by gradual loss of eyesight and hearing, pallor of the optic disc, with thinness of the retinal arteries, ptosis of the left (opposite) eyelid and occasional convulsions in the left arm and leg. The child became somnolent and reflexes lost. Breathing difficult, incontinence of fæces and urine. No rigidity of neck. Lumbar puncture was not performed. The radical mastoid operation was performed, and considerable necrosis of bone was found. The middle fossa was exposed and the dura incised and the brain punctured in three directions without finding any pus, though a large quantity of clear fluid was evacuated on each insertion of the knife. The sigmoid sinus and the posterior fossa were exposed. Incision. gave the same result as the middle fossa. Ptosis diminished, but death took place in 18 hours. Autopsy showed the lateral ventricles to be enormously distended. The convolutions were unusually flattened. There was a clot in the superior longitudial sinus. A number of conditions confirmed the original diagnosis of purulent meningitis and the possibility of an abscess justified the operation, but the

conditions found at the operation suggested serous meningitis-the enormous quantity of clear fluid evacuated on puncturing the brain. This supposition was confirmed at autopsy. There was no direct communication between the primary disease of the temporal bone and the interior of the skull. A direct bacteriological infection can hardly have. caused disease of the meninges, and the case can probably be regarded as confirming Merkens' suggested explanation of serous meningitis, that it is a disease caused by toxic agents.

Adrenalin Chloride in Dr. Molist (Revue Diseases of the Ear. hebad. de Laryngologie, d'Otologie, et de Rhinologie, February, 1907). Adrenalin chloride has been used with success in a number of conditions seen in suppurative otitis media, as follows: Granulations of Schrapnell's membrane, or the drum membrane proper; polyps and polyoid degeneration of the mucous membrane of the tympanum; passive congestion responsible for otorrhoea; fungosities of the canal and of the handle of the malleus. The technique consists in instilling eight drops of the solution into the affected ear, the head being bent to the opposite side, holding it in this position for five minutes, the canal being closed with a piece of absorbent cotton. This application should be repeated every hour for the first day, every two hours the second day, and afterwards according to the effects obtained. If no result is obtained at the end of about two weeks, the treatment should be discontinued and surgical interference advised.

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.

Turbinate.

Mulberry-Like Hyper- Dr. H. Kubo (Artrophy of the Inferior chiv für Laryngol ogie und Rhinologie, Vol. XIX, No. 2). These mulberrylike hypertrophies are frequently met by the rhinologist and do not shrink under the application of cocaine. The forms of hypertrophy are classified differently by authors, some considering them papillomas, others polypoid swelling, while some place them in the category of hypertrophic rhinitis, describing them as increase. of tissue which is folded, papillary, lobulated, mulberry-like, or grape-like. In order to properly classify this form of hypertrophy, Kubo studied 186 cases microscopically, making serial sections. In these cases the situation of the growth was almost exclusively on the inferior turbinate, especially on its anterior part, the folds of the hypertrophy extending in every direction. The hypertrophy did not shrink under cocaine. In each case the growths were removed by a snare, and the material was then prepared for examination. The author found the following:

(1) The epithelial layer. The epithelium consisted of healthy ciliated cells which were absent in the prominent parts of the hypertrophy, apparently as a result of mechanical destruction in the preparation of the specimens. The deep layer consisted of several layers of cylindrical epithelium, the nucleus of which lay near the base of the cell. At no point was it observed that the cells were changed in character, nor was the layer pathologically thickened.

(2) The membrana limitans was colored regularly and normally by eosin.

(3) In the papillæ or folds within the papillae were found many capillaries, loose, connective tissue, considerable round-cell and mucous-cell infiltration. The papillæ were free from glands or erectile tissue. The tissue beneath the papillæ consists principally of glands, erectile tissue, connective tissue and round cells in various numbers.

He concludes that the mulberry-like hypertrophies are caused principally by the increase in the adenoid and sub-epithelial layers, and that the irregularities of the surface are produced by increase of this material beneath the surface, which is different from smooth hypertrophy, where the changes are more in the erectile tissue layers. Therefore, in classifying these conditions he would differentiate clinically between the ordinary hypertrophies where the increase was in the connective tissue and in the venous sinuses from these mulberry-like hypertrophies where the changes occur principally in the adenoid layer. He deprecates the use of the term "mulberry-like,' and proposes that such hypertrophies. should be termed "polypoid."

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and throat. There seems to be a characteristic, usually spasmodic cough, sometimes resembling whooping-cough. The disease commences with chilliness and slight fever, with sneezing, lacrymation and mucous nasal discharge. There may be an associated bronchitis, but the symptoms indicate the chief trouble to be in the upper end of the air-passages. There are no serious nervous symptoms and little or no physical or mental depression; the average duration is from one week to ten days, though the cough often continues longer. The disease is infectious, running through families, and even animals do not appear to be altogether immune. Epidemic catarrh lacks the gastro-intestinal symptoms, constipation or diarrhoea, due to the micrococcus catarrhalis. So far as the eye symptoms are concerned, the disease is

the same as the pneumococcic conjunctivitis described by Kölle and Wasserman as occurring in Europe in 1896. In most of the cases examined bacteriologically the pneumococcus was found, giving the usual culture and staining characteristics and producing characteristic effects in inoculation experiments.

Crico-Arytenoid Ar- G. Dupond (Rev. thritis, with Obstruc- Hebdom. de Laryntion of Both Vocal gol. d'Otol. et de Cords. Rhinol., August.

1907). A man, 54 years of age, suffering from pulmonary and laryngeal tuberculosis, was attacked suddenly after exposure to cold with suffocative crises and dyspnoea. Examination showed the symptoms complex to be due to an acute arthritis of both crico-arytenoid joints, which fixed the cords in their median position.

PUBLIC HEALTH AND FORENSIC MEDICINE.

UNDER THE OHARGE OF

F. C. CURTIS, A.M., M.D., of Albany, Medical Expert, New York State Department of Health.

Vital Statistics of New York State for Feb

ruary, 1908.

Mortality returns for February, 1908, show a decrease of deaths over those in the corresponding month of last year and an increase Over the average for February, in the past five years. In all 12,465 deaths were recorded as against 13,093 for February, 1907, and a five years' average of II,949. The annual death rate is 17.5 per 1000 population; in 1907 it was 18.8 and the five years' average was 18.7. Of the deaths 1936 were of infants under one year of age; 1000 were of children between one and five, and 4100 were of people over 60 years of age. There was a decrease in deaths from typhoid fever, 83 deaths being recorded,

against 114 for February, 1907, and a five years' average of 120. Measles showed a heavy mortality in comparison with former years-140 deaths; in February, 1907, there were 44 deaths and the average for the past five years was 89. Scarlet fever still continues as a large factor, there being a total of 232 deaths for this month, in comparison with a five years' average of 99, and the record of the corresponding month last year-85. Deaths from diphtheria showed a slight decrease from last year, and influenza dropped from a total of 618 for February, 1907. to 397 for this month. Pulmonary tuberculosis shows a slight increase over last year-1319 against 1292, and a much larger one over the average for the past

five years 1319 against 1193. years-1319 Pneu monia and other diseases of the respiratory system decreased considerably from the high rates of last year, being 1154 and 1160, respectively, against 1465 and 1432 of last year. Other causes of death show comparatively slight variations from former years, when the increase in population of the State is taken into consideration. Deaths from external causes decreased from 715 to 659-an increase, however, over the five years' average of 577. Deaths from suicide by various means increased from 87 in February, 1907, to 115 for this month. There were 95 deaths from railroad accidents and injuries, 27 homicides, 24 from injuries by horses and vehicles and 112 from other accidental traumatisms. The annual birth rate per 1000 population in February was 22.5, 15,733 births being reported.

City death rates of over 20.0 per 1000 population are shown by Albany, 20.8; Troy, 21.5; Utica, 21.2; Elmira, 23.8; Watertown, 23.6; Poughkeepsie, 23.6; Cohoes, 23.2; Rome, 22.3; Middletown, 21.9; Ithaca, 22.9; Watervliet, 26.9; Corning, 20.7; Cortland, 22.7; Port Jervis, 22.0. Of Greater New York, the borough of the Bronx has an annual death rate of 21.6, and the borough of Richmond 20.0. Watervliet has the highest death rate, 26.9, and Oneida the lowest, 6.8.

Peekskill village, classed with cities between 10,000 and 20,000 population, showed the highest death rate, 30.1, but this increased percentage was due to a typhoid epidemic, which caused 18 deaths. to be added to those from other causes.

Cities having a lower birth rate than death rate are Syracuse, Albany, Troy, Elmira, Auburn, Newburgh, Watertown, Poughkeepsie, Cohoes, Lockport, Middletown, Ogdensburg, Ithaca, Watervliet,

Corning, Cortland, Hudson and Oneida. Plattsburg reported no births.-Monthly Bulletin.

Hospital Exempt from The Supreme Court
Taxation as a Public of Illinois says, in
Charity.
the case of Sisters of

St. Francis vs. Board of Review of Peoria

county, that in the St. Francis Hospital charity was extended to all the members of the community, and was not confined to any particular class of individuals. It was an institution of public charity; and where an institution devoted to beneficence of that character is, under the law, exempt from taxation, it does not lose its immunity by reason of the fact that those patients received by it who are able to pay are required to do so, or by reason of the fact that it receives contributions from outside sources, so long as all the money received by it is devoted to the general purposes of the charity, and no portion of the money received is permitted to inure to the benefit of any private individual engaged in managing the charity.

It was argued that this hospital should not be held to be an institution of public charity by reason of the great disparity between the number of charity patients and those who paid for the care and attention they received at it. But this objection seems to the court without merit, so long as charity was dispensed to all those who needed it and who applied therefor, and so long as no private gain or profit came to any person connected with the institution, and so long as it did not appear that any obstacle, of any character, was by the corporation placed in the way of those who might need charity of the kind dispensed by this institution, calculated to prevent such persons making application or obtaining admission to the hospital. The institution could not extend its benefactions to those who did

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not need them, or to those who did not seek admission.

It was also contended that the nurses who were educated in the training school conducted in the hospital received training fitting them to pursue a profitable business for their private benefit, and that for this reason the hospital was not a public charity. It seemed that the students in this training school received board and instruction in exchange for assistance rendered in caring for patients and in doing other work about the building. It did not appear that the value of that which they so received was greater than the value of the service which they rendered, and there was, therefore, the court holds, no merit in this contention.

Again, the court says that it was urged that the institution was, in fact, being conducted, and this property used, for the benefit of certain physicians in the city of Peoria. This contention was based on the fact that the board of managers of the corporation had established certain rules of government, by one of which rules no physicians were permitted to practice in the hospital except such as subscribed to and were governed by the principles of medical ethics promulgated by the American Medical Association. It did not appear from this record what percentage of physicians practicing in the city of Peoria would be eligible under this rule. It did appear, however, from the testimony of those Sisters who were in actual management of the hospital that they understood the rule permitted all reputable physicians to treat patients in the institution, and that but few physicians practicing in Peoria were excluded. The sisterhood did not provide medical attention. The patient was permitted to call any physician or surgeon he desired who was not excluded by the rule in question. When the patient was unable to pay for

medical care he was treated free of charge by the members of the medical profession practicing in the hospital. The question whether or not this was an institution of public charity depended not at all on what class of physicians were permitted to practice there, so long as the institution was not conducted for the purpose of benefiting the physicians of that class. A hospital is primarily for the benefit of the patient, and not the physician. Whether or not it is a charity is to be determined by the treatment which the patients receive at the hands of those in charge of the hospital. It is, of course, possible that a hospital might be established and conducted for the professional and financial benefit of certain physicians, and that it might make a pretense of receiving charity patients for the purpose of bringing itself within the statute exempting the property of institutions of public charity from taxation, but the evidence of this case clearly showed that no such state of affairs existed here.-Journal American Medical Association.

Requests for Fleas for To the officers of the Identification, and for Public Health and Relative

Information

to Local Species of Fleas, Rats and Mice.

Marine Hospital Service, health officers and physicians: Reference has previously been made in the Public Health Reports (December 13, 1907, p. 1799) to the investigations of the British Plague Commission in India. These investigations have established the fact that plague may be transmitted from one animal to another by means of the flea, and it appears that this is the common method of transmission of plague among animals, and from them to man. The species most used in the experiments of the commission is the common India rat flea, known as Pulex cheopis. This flea appears to be identical with the com

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