measures.

trepanning of the vault of the cranium and the draining of the subarachnoid spaces through the fossa Sylvia and the injection of medicinal remedies will no doubt have better results in traumatic meningitis. 2. Localized tubercular meningitis up to the present time, but seldom interfered with by operative 3. Tuberculoma.-In children they are often multiple, and therefore not amenable for operation, in adults in whom they simulate symptoms of brain tumor, they are most often solitary, and should be removed as soon as possible. The cases successfully operated upon refer to all tuberculomas of the cerebral hemispheres, especially the motor centers. The cerebellar operations nearly always caused death.

Diagnostic and Therapeutic Value of the Lumbar Puncture.-(Quincke, Deutsche Med. Wochenschrift.)-This work touches those points which are of interest to the otologist without relating much that is new. Author lays stress on the importance of measuring the pressure, whose normal he gives as 125 mm. water, especially in serous meningitis. The latter disease of otogenic origin he declares though toxic diffusion, comparable to the tissue edema in the neighborhood of a suppurative focus. Author always makes the puncture in the horizontal side posture and follows it by twenty-four hours rest in bed. High pressure always demands great care. Sudden sinking allows a diagnosis of incomplete communication between spinal and oranial cavity. In this case the procedure should be interrupted, or the withdrawal be done very slowly.

Discussion as to Headache, Neuralgia and Other Distant Actions in Affections of the

Teeth.-Urban Pritchard (British Med. Jour.) thinks that affections of the ear superinduced by diseases of the teeth are not so frequent as was formerly thought. The teething in children may cause an otitis media acuta with perforation of membrane and suppuration, very likely through the medium of a catarrhal inflation in naso-pharyngeal space, later on through lowering of the powers of resistance and repair of tissue. Eruption and caries of teeth may cause earache, furthermore swelling of the alveolar region may extend to mastoid process. Improvement of the hearing after removal of a carious tooth he ascribes to an improvement of the general condition. Septic disease of the teeth is known as a cause for suppuration of the accessory cavities of the nose, pharyngitis and angina. J. S. Russell emphasizes the fact that empyema of the antrum may cause pain that is often mistaken for neuralgia of the teeth. J. H. Mummery enumerates the

places that show swelling in diseases of the teeth; area fronto-naselis in disease of upper incisors; area naso-labialis in disease of upper canines; area temporalis in disease of second upper bicuspids; area hyoidea with simultaneous swelling of the lobe of the ear and the external canal in disease of first and second lower molars. He has observed a case of deafness relieved and cured by extraction of an upper wisdom tooth which erupted with difficulty. H. A. J. Fairbank believes that an otitis media occurring during dentition. may be due to existing adenoid vegetation. He has observed a case where pain over mastoid was relieved by removal of a carious lower molar.

He

Stricture of the Eustachian Tube.-(W. Sohier Bryant, Annals of Otology).-Of a series of one hundred post-mortems at the Harvard Medical School the author did not find a single case of organic stricture of the tube except in suppurative processes. concludes therefore, that organic stricture of the isthmus are very rare, and that practically only functional striotures should be consid ered. In chronic strictures we may find a passive congestion or edema, sometimes combined with slight paralysis of the tubal muscles and adhesions, therefore circulatory and mechanical strictures. Predisposing causes are gout, syphilis, disturbance of circulation, hypertrophies, adhesions and scars in the naso-pharyngeal space, rhino-pharyngitis. The treatment consists in the application of adrenalin in the tube and silver nitrate in the nasopharynx, besides an inflation and bougie.

Making a Chromic Acid Bead. Sucher (Monatschrift fuer Ohrenheilkunde) recomfollowing simple manner of preparing the mends instead of the prevailing method the chromic acid bead. Several chromic acid orystals are dropped into a porcelain dish which rests on a tripod over an alcohol lamp. extinguished, he dips the probe, made of silAs soon as a few crystals melt the flame is ver and threaded, like a screw, into the solution several times until the bead is of the required size. This method has the advantage that the chromic acid bead may be prepared by the assistant.

Some New Local Anesthetics.-(Stoavin, Alypin and Novakain.)-Braun (Deutsche Med. Wochenschrift) examined and judged these new anesthetics from the following standpoints: 1. An anesthetic in comparison to its local anesthetizing potency, must be less toxic than cocain. The absolute toxicity measured by the percentage of the solu tion is not decisive. 2. The remedy must not damage the tissue locally, or leave dis

turbing hyperemia, inflammation, infiltration or necrosis. 3. The remedy should be soluble in water, consistent in solution and easily sterilized. 4. The vessel contracting qualities of the suprarenal preparations must not be disturbed by the remedy. 5. In application on surface of mucous membrane the remedy must penetrate rapidly. Stovain seems practicable cnly for medullary anesthesia for if used in other methods, viz., injection, like alypin, it causes considerable irritation. As to the glowing reports of Seifert in the use of alypin, 10% solution, on mucous membranes Braun cannot speak from his own experience. Novakain seems to be the most satisfactory in every respect. It is more easily sterilized and is less toxic than cocain.

A Characteristic Symptom of Suppurative Thrombosis of the Superior Longitudinal Sinus.-(Gradenigo, Archiv fuer Ohrenheilkunde).-Farmer's wife, 31 years old, two healthy children, aborted twice; suffered from an acute suppurative otitis media with subperiosteal abscess. After the latter evacuated a fistula remained behind the ear. Short time after a fluctuating swelling appeared in the parietal region somewhat to the right of the median line, painful to the touch, also continuous pressing pain. Swelling was the size of half a nut, round and covered with integument, which showed no changes. Potassium iodide without result. Edema spread to forehead and lids. Fistula behind the ear closed. First operation: Crucial incision over the swelling, granulations on galea aponeurosis removed. During the after treatment pus was discharged from a small opening of the galea, probe disclosed roughened bone. Symptoms the same. Second operation: Piece of bone size of a half dollar exposed, discolored, removed. Dura in circumference of discolored bone, granulating. Dura fistula leads to the bloodless longitudinal sinus. Sinus filled by blood red thrombus, which on account of absence of pyemic symptoms was not removed Outer wall of sinus excised. Death five days later after lumbar puncture twice revealed cloudy fluid, symptoms of meningitis.

Section:

Longitudinal sinus in anterior portion free to the proximity of lesion, from here to the confl. sinuum was filled with suppurative thrombus extending to the right lateral sinus and part of the left. Sinus petrosi and jug. ular free. Eruption of isolated cells of mastoid process into the right sigmoid sinus. Diffuse leptomeningitis. Gradenigo believes that swelling in the parietal region should be characteristic of a thrombosis in superior longitudinal sinus. To the swell

ing, simple dilatation of the veins, hematoma or abscess, may be associated enlargement of the veins (Lermoyez's symptom) edema of the hairy scalp, forehead and lids. Further observations must explain why these symptoms have only been observed in a few cases.

GENITO-URINARY.

T. A. HOPKINS, M. D.

Joulie's Method of Ascertaining the Acidity of the Urine.-The editor of the New York Medical Journal in a recent issue gives the detail of this very important urine test, a test well worthy of our readers consideration: The urine is derived from the blood, and the explanation of how the one, an acid fluid could be derived by a process of filtration from the other, an alkaline fluid, has always presented a problem to the curious. The problem in point of fact has been an imaginary one because the acid urine is derived from a fluid which though leaving a blue stain on litmus paper is nevertheless chemically acid. The acidity of the urine is due to the presence of acid phosphates, and these are also present in the blood and though chemically acid salts, capable of taking up another atom of base, nevertheless give a blue reaction with litmus. The alkalinity of the blood is consequently due to the presence of bicarbonates, which are acid salts, so that it is evident that, whatever may be the reaction with litmus the blood is an acid fluid both chemically and practically. It is known that the phosphates of calcium and magnesium are so sensitive to any trace of alkalinity that they readily become precipitated, even in a medium which is still faintly acid. Furthermore, it is known that these earthy phosphates are very frequently present in the urine, especially during digestion. Now, in order to enter the urine in a state of solution they must of necessity have been in a state of solution in the blood, and inasmuch as they will not remain in solution in an alkaline medium, there is no escape from the conclusion that the blood from which they have been derived is acid and not alkaline. much being established, one is justified in concluding that the degree of the acidity of the urine is a measure of the degree of the acidity of the blood. This acidity in both cases is due to acid phosphates, salts of H,PO4, that is, salts which like NaH,PO, CaHPO, and MgHPO4, are still capable of taking up one or more atoms of base. It is, therefore, obvious that the real urinary acidity is phosphoric acidity. The specific grav

So

ity of the urine to be examined is taken at 15 deg. C. If the temperature differs from this figure, a correction is made according to a printed table. The total acidity, that is to say, the acidity from all sources, is now calculated, and is expressed in terms of the amount present in a hundred parts of the excess of the urine over that of distilled water at the same temperature. In this way the errors inseparable from the varying amount of water in different samples of the same person's urine are altogether avoided. The degree of dilution of a specimen, always hitherto a matter of difficulty may thus be disregarded. Thus, if the specimen in question shows a specific gravity of 1.020, the excess (which is called E) is 20, because the density of the water at 15 deg. C. is known to be 1.000. The total acidity is calculated by means of precipitation with a standard solution of sucrate of calcium (10 grammes of powdered chalk and 20 of sugar to a liter of distilled water). The figure thus obtained is

A

called A. Thus we have × 100 = RA E

(i.e., the percentage of total acidity in E). The normal standard for R A as worked out by Joulie is between 4 and 5-as nearly as possible 4.5. But, as we have already seen, this total acidity is from our point of view a matter of secondary importance. What we wish to ascertain is the amount which the

acid phosphates contribute to this acidity;

in other words, how much of this is serviceable phosphoric acidity, and how much, of it is organic, fortuitous, and undesirable. The next step is therefore to determine the amount of phosphoric acid, combined and uncombined, which is present in the given specimen. This is calculated by the classical method with nitrate of uranium and ferrocyanide of potassium, and is expressed in terms of the amount present in 100 parts of the excess of the urinary density over that of water at the same temperature. If we call the total phosphatic contents thus obtained Р

age of active phosphoric acid, that is, the amount which is capable of neutralizing an equal atomic weight of base, in E, which is the excess of urinary density over that of water. When the readings show that both RA and R P are below the normal, the explanation is simple enough. It is that there is an insufficient quantity of phosphoric acid in the blood and the symptoms are therefore due, at least in part, to the deposition of earthy phosphates in certain organs and tissues, the treatment resolving itself into the administration of phosphoric acid in gradually increasing amounts. An examination according to Joulie's method will not only establish the fact of hyperacidity or subacidity, as the case may be, but will give us the degree of the deviation from the normal and at the same time inform us of the proper line of treatment.

Determination of Lead in the Urine.-A. Lederer, Chicago (Jour. A. M. A., May 26), remarks on the disadvantages of the methods usually employed in testing for lead in the urine, and describes the test which he uses and for which he claims special advantages in accuracy, quickness and simplicity. It consists in precipitating the lead, free from all organic matter, by means of potassium sulphate in sulphuric acid solution, washing down the insoluble sulphate thus precipitated with distilled water, and passing hydroyellowish-brown discoloration proves that gen sulphid gas through it. The slightest lead is present. A great advantage of this test, he says, is that even if bismuth is present, it will not affect it, nor will any other substance that is likely to be present. By comparison with artificial lead solutions containing 1 mg., 2 mg., 3 mg., etc., of lead, per liter, a simple quantitative colorimetric method can be established.

Mortality After Prostatectomy.-B. Tenney and H. M. Chase, Boston (Jour. A. M. A., May 12), have analyzed the mortality statistics of over a thousand cases of prostatectomy, with special reference to the mortality, counting as fatal cases all within six weeks of the operation and excluding such statistics as cover only a shorter period of observation, though they might give a more favorable result. The mortality by the perineal operation in their statistics is slightly less than that of the suprapubic method, and the difference is very much less in the statistics of their collection than in those collected by Proust, Watson and Escat. There is also a decidedly rising mortality from the sixth to the eighth decade, the percentages being, respectively, 5.8, 9.5 and 15, thus indicating the advantages of early operation. The sta

tistics also show certain fatal periods; in the 73 deaths more occurred in the first fortyeight hours than in any other two days, 23 in all. In the seventh, eighth and ninth days there were 12 deaths; on the thirteenth, fourteenth and fifteenth there were 6 deaths, and from the twentieth to the twenty-second days, inclusive, 7 deaths. Two-thirds of all the deaths occurred during these fatal periods. The duration of life following the two operations is almost identical. The favorable statistics of certain operators are noted. Out of the 617 perineal operations, we find two men doing 211 operations and losing 2 cases within 12 days, as compared with 206 of the other operators with 22 deaths in the same period. Including the suprapubic operations, there is a total of 45 fatalities in 790 operations within the same period. These two men mentioned do not appear to have used the most rapid method or to have specially selected their The presence of vesical calculus did not seem to have any favorable influence on the mortality, as claimed by Moullin, Richardson and others. The authors think that many of the fatalities must have been avoidable, and insist on the importance of due preparation of the patient, special care in the selection and use of the anesthetic, and greater attention to the after-care. A prostatectomy is not a completed piece of handiwork, like most clean laparotomies and dissecting operations, but needs constant attention for forty-eight hours especially, and later at intervals.

cases.

DR. H. McC. JOHNSON has been appointed to the St. Loius Board of Health to succeed Dr. H. W. Bond, who is now Health Commissioner.

AN AMBULANCE ADVENTURE.-Some two years ago Mr. E. E. Carruthers, of Scranton, Pa., having been injured in East St. Louis, was removed in an ambulance. He alleged

at the time that he had been robbed of a pocketbook containing $150. On May 10th the ambulance was undergoing repairs when on tearing way the lining, a pocketbook containing $150 and Mr. Carruthers's card was found therein. The amount was forwarded

to him by check.

THE STATE PENITENTIARY HOSPITAL. At a meeting of the State Board of Prison Inspectors, at Jefferson City, on May 9th, it was decided to push ahead with the enlargement and modernization of the old prison hospital, for which purpose $50,000 was appropriated by the last legislature. The warden expects to have the building completed by the end of the year.

PROF. WILLIAM H. WELCH, of Baltimore, has been elected a member of the Board of Trustees of the Carnegie Institution, in place of the late Secretary of State Hay.

A NEW SOURCE OF ALCOHOL.-A Madagascar plant, jutropha manihot, is the source of starch extensively used in the manufacture of glues. It also furnishes food for both man and beast, and promises to rank high as a source of alcohol.

REGENERATION OF LOST PARTS.-T. H.

Re

Morgan, New York (Jour. A. M. A., May 5), reviews the facts and theories regarding the regeneration of lost parts in certain animals and the failure to do so in others. The question, he says, is possibly of some practical importance, for if we could determine why man, dues not replace a lost arm or leg, we might perhaps go further and discover how artificially to bring about this process. generation appears to him as only a phase of the general phenomenon of growth, and if this is the case, why, he asks, does an animal that has ceased to grow begin to regenerate rapidly when a part has been removed If we turn the question around the other way and ask, why does an anima! stop growing at a certain stage, we may attack the problem at closer quarters. It is evidently not because the cells have lost the power of growth: their power in this direction seems unlimited, nor can it, as he shows, be entirely attributed to an equilibrium between food supply and consumption. The question seems to be one of inhibition, and he suggests, as a possible explanation of the cessation of growth, a definite response to a condition of mutual pressure or tension of the cells on each other. When this is reached growth stops, and when we alter the tension by removing a part it begins again. The facts of regeneration of lost parts in the vertebrates are given and the reason why it fails in mammals and in man are discussed. Morgan does not think this can be due to greater complication of structure or to any process of natural selection. He thinks it more probably due to the fact that different tissues have very different rates of regeneration. In the higher mammals the failure to regenerate is observed in cases in which cartilage begins to change to bone, and he thinks the main trouble is in the slowness of the bones to regenerate in time with the other tissues. He says: "If the tissue in man still possess the power to regenerate, may we not hope in time so to adjust their rate of regeneration that the replacement of a lost limb may be produced? I can not but think that some day this may be accomplished."