its help to create and keep up disease, organic or otherwise, so proper influences acting through the mind may help to do away with these deleterious factors, and whatever form of appeal aids a man to do or think rationally should be tried. Religious faith is one of these, but the socalled suggestion in induced hypnotic states is entirely outside of the clergyman's domain. Mitchell has not a high opinion of the therapeutic value of hypnotism; he prefers slower but more lasting methods and has seen some rather appalling effects from its use. Appeal Appeal even to the lower motives, the patient's vanity, or his sense of pain, may also be therapeutic aids. Mitchell's protest is not against mental treatment, but against exaggerated statements of what it will do. What can a practical physician say, for example, to Dubois' advice to dispense with aperients in chronic constipation and rely on mental attention alone? He asks, Is there not risk that occasional brilliant results may lead to a false sense of power, even in the educated user of these methods and lead to a too exclusive and general psychic treatment?

Extirpation of a Sub- Adler (Deut. Med. cortical Brain Tumor Wchschrft., No. 20, From the Medullary 1908). The patient, Layer of the Right Motor Region. a man 36 years of age, was presented before the Berlin Medical Society meeting of April 29, 1908. Three years previously the disease suddenly began, without prodromata, with a general epileptic seizure and loss of consciousness. Later on appeared monospasms of the left arm at intervals of one to three weeks; in between, temporarily, almost every day,

there were tonic contractures of the first to third finger of the left hand. In December, 1907, the condition became suddenly aggravated, in connection with another general epileptic seizure, with loss of consciousness. This was followed by com plete paralysis of the left arm, paresis of the left leg and left facial nerve, bilateral choked disk and intolerably severe pains in the region of the right vortex. There was no local tenderness on percussion. This state of affairs, as well as the course of the convulsive seizures, which did not strictly follow the type of Jacksonian cortical epilepsy, suggested the presence of a subcortical brain tumor. The slight disturbance of sensation and of the muscular sense pointed to the seat of the tumor as below the anterior central gyrus, in the direction toward the front. exposure of the central fissure, and introduction of the finger into the groove of Rolando, a tumor could be felt at a depth of 4 cm., and this was slowly enucleated with the index finger. The patient made an uninterrupted recovery. The headache disappeared entirely, also the paresis of the left leg and of the facial nerve. The choked disk very nearly disappeared and the paralysis of the left arm was considerably improved. The general condition of the patient at the time of his presentation before the society was very good. The microscopical examination of the extirpated tumor showed it to be a perithelioma, namely, a cellular tumor originating from the adventitial lymph sheaths of the blood vessels.

After

The number of subcortical brain tu mors which have been successfully removed is very small up to the present time. F. R.

tical Value.

(Zeits.

für Dermatol., January, 1908). As a result of their experiments, the authors conclude that the Wassermann reaction is positive in the majority of cases of syphilis, and that in nonsyphilitic cases a positive reaction is only very exceptionally seen. The following

table shows the results of their examinations:

The cases included in this table were only those of undoubted syphilis, in many cases confirmed by finding the spirochæta pallida. Cases of doubtful diagnosis were omitted.

Positive reactions were obtained in 80 per cent. of cases of manifest syphilis. The percentage is lowered by the presence of the cases of primary and congenital syphilis and of tabes. As a rule the reaction occurs most often in persons with late manifestations or with malignant and early ulcerating lesions. In some of the malignant cases the reaction was positive in spite of energetic treatment with mercury, iodides and atoxyl. The sooner the test was made after the infection the less

frequent were positive reactions obtained. The reaction is frequently negative in latent syphilis. Of the 33 control cases two gave positive reaction. One case was a bar maid, who might have previously suffered from syphilis without her knowledge. The second case was a negro suffering from framboesia tropica.

With regard to the practical value of the reaction, the judgment at present cannot be final. It seems very probable that a positive reaction occurs only when the disease process is not entirely at an end; that is, when some latent focus of disease is still present somewhere in the body.

With regard to the grade of infectiousness (whether marriage should be permitted, etc.), little can be told from the reaction. Possibilities are opened up by the reaction in choosing midwives, nurses and in the regulation of prostitution. In the diagnosis of obscure discases of internal organs, bones, eye, nervous system, etc., the reaction may be of tremendous importance. A negative reaction can be of great value in calming the fears of persons suffering from syphilophobia.

In the diagnosis of the primary lesion the serum reaction cannot compete in diagnostic value with the examination for the spirochata. In cases, however, with unusual secondary symptoms, atypical leucodermias and alopecias, and peculiar late manifestations, such as lupoid and scrofuloderma-like lesions, the serum reaction can be of great diagnostic value. In cases where the history is doubtful and clinical symptoms are absent the reaction

offers the only means of telling whether or not syphilis is present. The same would be true of cases of excision of chancre and failure of secondaries to appear.

To discover a latent syphilis in families where some member has been infected seems a useful possibility for the reaction. Of especial importance would be the diagnosis of syphilis in pregnant women. Further light might be thrown on the subject of Colles' law as to whether the mother is not immune but in reality the bearer of latent syphilis. Another opportunity to employ the reaction would be in children of syphilitic parents who show no clinical symptoms of the disease.

Finally in a certain sense the reaction can decide the important question as to whether a case of syphilis is to be regarded as cured or whether further treatment is necessary. A negative result is not conclusive, but may aid in quieting the fears of the patient. A positive result should certainly cause the patient to carefully watch for a further outbreak of the disease, especially if a long time has elapsed since the infection.

The Cosmetic Treat- Ogata (Dtsch. Med. ment of Nævi and Wchschrft., No. I, Telangiectases. 1908) The following method is suggested by the author for the cosmetic treatment of nævi and telan

giectases: Rice grains are covered with a 10 per cent, solution of potassium hydroxide in such a way that each grain remains separate on the bottom of the dish, which is allowed to stand for six or eight hours, until the rice has become perfectly transparent. The grains are then thoroughly rinsed in water and pounded in a porcelain mortar. The result is a jelly

like substance, which the author designates as "maculanin." By means of a pointed glass rod the spots and structures which are to be removed are painted with this substance several times in succession in the same session, beginning at the periphery. The first application is the only painless one. The others may be preceded by painting the surface with a 5 per cent. solution of cocain, after the maculanin has been washed off with sterile salt solution. Healing takes place without suppuration, under the developing scab, which becomes spontaneously detached in from one to two weeks. This procedure, which constitutes a caustic potash cauterization, modified by the starch or amylum combination, is claimed to lead to an especially desirable invisible scar formation. In cases of deeply-seated nævi it must be repeated a number of times, and since only a small portion can be attacked at one time in the extensive foci of certain cases, the treatment may have to be continued during many months. The maculanin solution must be prepared fresh for every application, since it loses its efficacy at the end of about six hours.

No cure is to be expected in cases of indeed, were obtained in the removal of angioma cavernosum. Very good effects, tattoo marks within a very few sessions. Maculanin is occasionally employed with advantage in the treatment of vitiligo, parasitic skin diseases and acne rosacea. The author's experience in this connection is not yet complete.

The remedy has been utilized by the author for several years with favorable results, especially an excellent cosmetic effect, in the surgical clinic of the Ogata Hospital, in Osaka, Japan. F. R.

Varicocele and Its Operation.

Frank K. Boland, A. B., M.D., discusses

this subject in the Journal of the American Medical Association.

Varicocele is a common condition, being found in 10 per cent. of all men between the ages of 15 and 30. Unsatisfied sexual desire and excessive intercourse have been ascribed as causes. The former must influence the trouble, since it sometimes disappears in young men after marriage. No doubt a predisposition may be inherited. Occupation plays a part in the causation, since varicocele is common among men who stand a great deal, such as clerks, bookkeepers, etc.

More than 90 per cent. of cases occur on the left side, the explanation of which is also on anatomic grounds. The veins in the left cord are larger, the testicle hangs lower, and the left vein empties into the renal vein at a right angle, while the right vein empties into the vena cava at an acute angle. Again, the left spermatic vein, as it runs behind the sigmoid flexure, is constantly subjected to pressure from the accumulation of fæces in the bowel.

A very large varicocele may produce no symptoms, while a small one often gives rise to pronounced symptoms, depending largely on the effect of the patient's mind. In a large number of cases the mental effect is the main. feature of the disease, and requires an operation for its relief. This is particularly true when the condition is associated with masturbation, the patient then being fearful of impotence. There is no proof that masturbation is connected with the cause of varicocele.

The usual complaint is a sensation of weight and dragging in the scrotum, accompanied at times by an aching pain which extends to the back and groins. The veins may become tender or inflamed and spasm of the cremaster muscle may produce an acute cramp. Occasionally the suffering is so marked as to force the patient to lie down before obtaining relief. In the beginning the testicle becomes slightly enlarged from impediment to the return circulation, but ultimately is apt to diminish in size.

Varicocele without symptoms requires no treatment, though it is sometimes necessary to operate to permit a candidate to pass a physical examination. Some cases are helped by palliative measures. The scrotum is douched daily with cold water, the bowels are kept regulated, and a comfortably-fitting suspensory is worn. A suspensory causes much discomfort in hot weather, however, and the sweating and irritation it provokes almost counterbalance the benefit of the support it furnishes.

Operative treatment is best and can be carried out under local anæsthenia, but a general anæsthetic is more satisfactory. The textbooks recommend ablation of part of the scrotum as being occasionally indicated, but in the South, where the pendulous scrotum is so common, it is generally indicated. Cures by this procedure alone have been reported. Certainly it is one of the most important steps in the operation. The shortened scrotum affords a natural and permanent support for the cord and testicle.

If the scrotum be not partially excised, the incision over the veins should