way gives the credit of checking the epidemic to the health department at Evanston, which first took the matter up and tracked the infection to its source. He He criticizes certain other officials for their delay in this matter, and points out the necessity for a thorough organization of health officials, local, State and national,

so that no possible question of authority can delay investigation and action. He also suggests that State boards can delay investigation and action. He also suggests that State boards of health should be selected by the local health officers instead of being appointees of a non-professional executive.

The Operative Treat- Schlesinger (Berl. ment of Traumatic Klin. Wchschrft., No. Meningitis. 47, 1907. The patient was a man 57 years of age, suffering from a closed meningeal phlegmon, which has originated as the result of injury with a brick. A comminuted fracture found at the time of the first operation was treated by extraction of a sequestrum and removal of the infiltrated bone of the vicinity. Another trephining operation was performed for the reason that the dura failed to present pulsation, and that the condition became aggravated after lumbar puncture, which yielded a serous fluid under a high pressure. Convulsions made their appearance, and the presence of brain abscess or meningitis was suspected. The second operation served to show that the purulent osteomyelitis had progressed further, and the bone had to be removed in its entire circumference. A clear fluid was obtained by puncture of the dura, but the patient's somnolence increased, and a third operation became necessary. The arm center was exposed, and a meningeal phlegmon of the size of the palm appeared (pus between dura and arachnoid, with solid purulent infiltration of the soft cerebral meninges). It is a noteworthy fact that hernia cerebri failed to occur, recovery ensuing after the fur

ther removal of infiltrated portions of bone. The entire defect (17:14 cm.) was closed, all but a piece the size of a silver dollar, by means of plastics from the skull.

As the best operative procedure the author recommends the wide exposure of the affected region. This serves to prevent hernia cerebri, which is sure to occur in small openings. Short tamponing is entirely sufficient under normal conditions. of the wound. Flushing of the subdural space is rejected by the author. The reported case is the third case of solid purulent infiltration of the soft meninges healed by operation. Since the lumbar puncture caused an aggravation of the symptoms, the author recommends that in suspected meningitic cases only just enough cerebrospinal fluid be withdrawn. as is absolutely required for the confirmation of the diagnosis. F. R.

sists, in the first place, in a strict regulation of the diet and general habits of the patient, accurately adapted to individual requirements. The author recommends albuminoid substances and fat in abundance, with a sufficient amount of starchy foods, eggs, fruit and vegetables. He cautions against a uniform mode of nutrition, especially against the rigid vegetarian diet which is becoming fashionable. Meanwhile, the temporary adoption of a purely vegetarian diet is often useful. Alcoholic stimulants are not absolutely prohibited, especially not in the case of patients who are acccustomed to their use. Good beer (Munich and Pilsner) is to be considered rather as a food and as an appetizer, and is therefore allowed in moderate quantities. A moderate indulgence in tea is likewise permissible. On the other hand, the use of coffee is almost invariably forbidden by the author. No success was observed by him from the Weir-Mitchell method and similar forced feeding.

One of the chief problems in the treatment is the regulation of the patient's voluntary movements. Individuals having cerebral neurasthenia will tolerate much more functional motor exercise than those having spinal or sexual neurasthenia. Especial caution is indicated in the presence of a cardiac neurosis, and the work required of these patients should be exactly adapted to the effect it has upon the heart. Hence, a careful control of this effect is indispensable. The regulation and hygiene of the intellectual work, the business or occupation, is of precisely the same importance. In the beginning, it is often necessary to forbid work altogether, but later on, or in the milder cases, it may be permitted, always to a moderate degree and in a strictly regulated manner. The author observed no specially brilliant results from socalled occupation therapeutics.

A change of air under certain conditions has a very favorable effect. As a rule, the patients derive more benefit from the mountains than from the seashore. The value of air and sun baths has not yet been definitely established." Caution is indicated in the prescribing of long journeys or so-called recreation trips, but sensible walks or short excur

sions can only have a favorable effect.

Concerning hydrotherapeutics, in a general way only the mild and gentle pro

cedures are advisable, such as lukewarm or cool full and half baths, friction, washing of the back, lukewarm douches, foot baths in running water, moist cold packs,

etc.

Among the medicinal agents, the preparations of iron and arsenic are the most useful in these cases. The author has a preference for his tonic pills (ferrum lactic. with extr. quin., extr. nuc. vom., extr. gent.), also some other simple iron preparations (ferrum oxyd.-sacch., ferr. peptonat., ferratose, Blaud's pills, etc.), or Fowler's solution, with strychnia, acid. arsenicos, arsen. ferratose, etc. This medication has been very usefully enriched by the non-tonic organic preparations of arsenic, which may be employed subcutaneously, such as natr. kakodylic., arsycodyl, arrhenal, and the latest remedy of all, atoxyl, which may be very advantageously administered internally in shape of atoxyl tablets or in combination, atoxyl-Blaud capsules.

as

The bromine preparations combined. with codein in certain cases likewise find a field of application, and among the new hypnotics, bromural may be recommended (in doses of 0.3 g., to be once repeated during the night if necessary). The employment of narcotics is contraindicated, and should be very carefully avoided in the management of neurasthenia patients.

F. R.

Infectiousness of Gumma.

Fritz Veiel (Archiv. für Dermatol. und Syph., 1907). The writer refers to the fact that the gumma has been proven to be infectious, both from animal experimentation and from clinical observation. The experiments of Finger and Landstiner. and of Neisser have shown positively that apes and even lower monkeys could be inoculated with syphilis from material obtained from gummata. The infectiousness of the gumma is, however, slight as shown by the numerous failures to infect monkeys, and also by clinical experience. Max Joseph reported two cases of gumma of the penis in married men, in neither of which was the wife infected.

After quoting the five cases of syphilitic infection resulting from gummata (collected by Delbaned, including one of his own), the writer adds the history of a sixth case. The writer's case was one of a happily married man of 30 who had contracted syphilis seven years previously, exhibited symptoms only in the first year, and was treated internally with mercury. After four months of married life a lesion appeared on the same portion of the penis where the chancre had formerly been situated. The lesion was a nodule that later discharged and secreted pus. Three months later the young wife presented syphilitic lesions of about three months duration.

The writer concludes that through the irritation of coitus a small gumma appeared at the site of the old chancre, the chancre redex of the French, and from this gumma the wife was infected.

A. Castellani (Jnl. Cutan. Diseas., April,

Framboesia Tropica (Yaws). 1908). A detailed description of the history of the disease, its geographical distribution and symptoms in the primary, secondary and tertiary stages are first given. As some authors appear to be skeptical about the occurrence of tertiary lesions, the writer quotes three cases in which these lesions occurred from two to five years after the original infection. A possible syphilitic infection was ruled out in each case.

The pathology of typical lesions of yaws shows them to be granulomata. There is a diffuse plasma cell infiltration, the plasma cells retaining their original type better than in any other granulomata.

The spiral organism now generally acknowledged to be the cause of yaws was first seen by the writer in February, 1905. After the discovery of the spirochete pallida by Schaudinn a little later the writer continued systematic investigations on the cause of yaws. His first communication appeared as a preliminary note on the presence of spirochete in yaws, and was published on June 17, 1905. In a later communication the writer suggested for his organism the name of spirochete palidula on account of its resemblance to the spirochete of syphilis. However, according to the laws of nomenclature, the correct name would be spirochete pertenuis, a name originally used by the writer. The organism bears a close relation morphologically to that of syphilis. Martin states that it is even more difficult to stain than the spirochete pallida. The writer has not detected any undulating mem

brane, and has occasionally noted a delicate flagellum at one end. He considers the organism to be a treponema rather than a spirochete. In examining nonulcerated lesions of yaws the spirochete pertenuis was the only organism found. In ulcerating lesions various other spirochates, besides innumerable bacteria. were present. One was morphologically similar to the spirochete refringens. Another was thin and delicate and with blunt

extremities. The writer named this the spirochete obtusi. A third form was also thin and delicate, but showed tapering ends. This he named the spirochete acuminata.

From a large number of interesting experiments on monkeys, chiefly of the genus Macacus and Semnopithecus, the writer draws the following conclusions:

I. Monkeys are susceptible to yaws. The skin eruption in the monkeys I have experimented with is, as a rule, localized to the seat of inoculation, but the infection is general, as is proved by the presence of the spirochete pertenuis in the spleen and lymphatic glands. These experiments confirm the results obtained by Neisser and his co-workers.

2. The extract of yaws materials from which the spirochete pertenuis has been removed by filtration becomes inert.

3. The extract of yaws material containing the spirochete pertenuis, but so far as our present methods of investigation permit us to say, no other germ is infective to monkeys.

4. The inoculation of blood of the general circulation and spleen blood taken from yaws patients into monkeys may give positive results.

5. The inoculation of the cerebrospinal fluid of yaws patients is negative. 6. Monkeys successfully inoculated with yaws do not thereby become immune for syphilis.

7. Monkeys successfully inoculated for syphilis do not thereby become immune for yaws.

8. By reason of the Bordet-Gengou reaction it is possible to detect specific yaws antibodies and antigen.

The presence of the spirochete pertenuis in monkeys experimentally inoculated, as well as in yaws patients, is practically constant in the unbroken eruptive elements. It is frequent in the spleen and lymphatic glands.

Yaws is generally conveyed by actual contact, but under certain circumstances it may be conveyed by flies, and possibly by other insects.

That syphilis and yaws are two distinct diseases is shown by paragraphs Nos. 6 and 7 above quoted. Furthermore, syphilis is practically pandemic; yaws, on the other hand, is localized to some parts of the tropics. The histo-pathology is also somewhat different. As to clinical features, yaws presents the following symptoms in contrast to syphilis: Primary lesion generally extra-genital; principal type of eruption a papule which proliferates into a papillomatous growth; extremely well-marked pruritus.

The prognosis as to life is not serious. Out of 10.380 cases in Ceylon, only 51 died of the disease. The prognosis in children is much more serious than in adults.

The best treatment is large doses of potassium iodide, in addition to suitable local treatment.

N. (Archiv

W.

f.

The Treatment of Cryptorchism. Klin. Chir., Vol. 85, H. 4, 1908). Cryptorchism is not so very rare (about one in a thousand). Kocher distinguishes between retentio testis, when the testicle is found along the path of its migration from the abdominal cavity into the scrotum, i. e., in the inguinal canal, and ectopia testis, when the testicle passes from the inguinal canal towards the side; for instance, to the peritoneum, etc. Retention is much more common than ectopia. The causes of cryptorchism are presumably referable to congenital disturbances. The question of treatment is an important one, as the testicle within the inguinal canal (inguinal testicle) gives rise to pain, and has, moreover, a certain tendency towards malignant degeneration. Not infrequently the displaced testicle becomes incarcerated. It is exposed to various mechanical injuries, which are associated with pain, sometimes determining attacks of vertigo, syncope and a series of nervous reflex symptoms. These patients not infrequently develop orchitis, or a gradually increasing hernia, which in its turn may become incarcerated through tension of the spermatic cord.

There are three methods of fixation for the testicle after it has been brought down into the scrotum:

1. Simple fixation of the testicle to the scrotal fundus.

2. The same fixation, with formation of a canal for the spermatic cord, preventing the testicle from rising again. 3. Extension of the testicle, which has been placed in the scrotum, by means

All these methods yield satisfactory results in so far as the clinical symptoms of inguinal testicle disappear, but in a number of cases the testicle does not remain in the scrotal fundus, becoming retracted instead into the upper segment of the scrotum. Further observations must show which of the three above-mentioned methods should be accorded the pref

erence.

During the author's service in the Koslow Hospital (Kasan), comprising a term of two and a half years, 400 hernias were operated upon, and 14 patients having cryptorchism came under treatment. Among these 14 cases 8 were associated with hernia, so that there were two patients with abnormally placed testicles for every 100 cases of inguinal hernia. (According to Lotheissen, there are 3 cases of cryptorchism for 100 cases of hernia.) The age of these patients varied between 4 and 50 years, in such wide limits that it is difficult to base upon it conclusions of any kind whatsoever. According to the type of the disease, the cases may be divided as follows:

The patients with cryptorchism (inguinal testicle) and hernia were 4, 6, 14, 15, 17 and 43 years old, respectively. One patient with incarcerated hernia, 23 years of age.

One patient with bilateral hernia, 40 years of age.

Two in whom the testicle was in the abdominal cavity, 26 and 45 years of age, respectively.

Two with hydrocele, age 15; both patients.