ers, an unusually attractive illustrated catalogue of their complete list of publications. It seems to us, in glancing through this catalogue, that a list of the Saunders' authors is a census of the leading American and foreign authorities in every branch and specialty of medical science. And new books are being added and new editions issued with a rapidity that speaks well for the success and progressiveness of the house. While compariWhile comparisons are always odious, still we feel it but justice to say that, in the presentation of facts about the books listed that a probable buyer wishes to know, and also for beauty and durability of mechanical get-up, this catalogue surpasses anything we have beretofore seen. It is truly representative of the

house. We advise our readers to write for a copy, as it is educational in itself.

DR. MITCHELL'S NEW NOVEL. Dr. S. Weir Mitchell, whose "Hugh Wynne," "The Adventures of Francois," and "Constance Trescot" are read wherever American literature is known, has written a new novel. It is called "A Diplomatic Adventure, "and the first chapters will appear in the February Century. The opening sentences, quoted from advance sheets, give an idea of scene and setting: "No man has ever been able to write the history of the greater years of a nation so as to include the minor incidents of interest. They pass unnoted, although in some cases they may have had values influential in determining the course of events. It chanced that I myself was an actor in one of these lesser incidents, when second secretary to our legation in France, during the summer of 1862. I may possibly overestimate the ultimate importance of my adventure, for Mr. Adams, our minister at the court of St. James, seems to have failed to record it, or, at least, there is no allusion to it in his biography. In the perplexing tangle of the diplomacy of the darker days of our civil war, many strange stories must have passed unrecorded, but surely none of those remembered and written were more singular the occurrences which disturbed the quiet of my uneventful life in the autumn of 1862."

RETROPHARYNGEAL ABSCESS. This is marked by constant, deep-seated, boring pain, and by a bright red, fluctuating, glazed swelling in the median line, or soft, diffuse purulent infiltration. The treatment, according to Price-Brown, is to open the abscess at once through the pharynx, in the most dependent portion as a rule. The swollen and inflamed tissues may be sacrified before pus is discovered. After evacuation in children, apply tincture of iodine, to swollen glands.

REPORTS ON PROGRESS

Comprising the Regular Contributions of the Fortnightly Department Staff.

OTOLOGY.

ALBERT F. KOETTER, M. D.

A Contribution to the Expert Opinion of the Aurist in Cases of Injury.-Julius Springer calls attention to the fact that in traumas of the head there may be severe disturbances on the part of the ear without outward visible signs of injury to the ear (hemorrhages) and emphasizes again the proposition also put forward by the neurologists, to make an otoscopic and functional examination of the ears immediately after the injury, as the connection between the ear trouble and the trauma is more difficult to prove as the time of the injury lapses. The daily observation of the aurist may show the existence of an ear trouble dating from early childhood, even more often a chronic middle ear suppuration with considerable unilateral deafness unknown to the patient and the injury may bring it to his notice, in fact calling

attention to all disturbances of his health. In the functional examination there is besides the testing of the hearing, the examination for possible disturbance of the static function is not to be neglected, as in the question of being able to earn a livelihood, the deafness is of minor importance as compared to the inability to work which is caused by intense disturbances of equilib. rium, especially in those people who do their work in a standing position, or with the body bent forward. In how far the gaining of a livelihood is influenced by the deafness, depends on the degree of the deafness and the profession of the injured individual (railroad man). The injury to the gaining of a livelihood in a unilateral deafness with other ear normal, the author, in contrast to Passow, thinks is very slight. The examination of the hearing by means of speech must be supplemented by an examination with the continuous tuning-fork series, in many cases there may be relatively good hearing for the whispered voice and still be defects in certain tones, viz., the high octaves, that may give the examiner certain diagnostic support. In examination for disturbances. of equilibrium one must not forget that these often appear after bodily exertion, running, stooping, etc., and may be absent during quiet. Labyrinthian vertigo must not be confounded with certain phenomena that point to an increased psychic stimulation, which the author thinks an expression of a traumatic neurasthenia; the patient while standing with eyes closed, or in fixing his

eyes on an object held above or laterally becomes agitated, the face becomes hyperemic, the eyes take on a staring expression, the head, and later the whole body trembles, excessive perspiration, at the same time a depressive state, finally crying, after a long rest in a sitting or recumbent position these symptoms disappear and a normal condition returns.

Even

Operative Treatment of Acute Otitis Media. Chevalier Jackson (Laryngoscope) reported twenty-two cases of acute otitis media purulenta, on which he operated without any signs of mastoid involvement, and with good result in every case even as far as the hearing is concerned. He opens the mastoid, even in the absence of mastoid symptoms, under the following conditions: 1. When there seems no indication of discharge ceasing after eight weeks treatment. 2. When occasionally rise in temperature appears, irritable disposition, nausea, faetor, etc. 3. While the social position of the patient makes it possible for the ear trouble to become chronic, owing to neglect. 4. In severe suppuration that threatens the hearing, or even the life of the patient, making delay dangerous. 5. If by swelling of the canal it is impossible for the discharge to drain through the canal. 6. If patient intends to take an extensive journey, viz., ocean voyage. 7. If cerebral or labyrinthian symptoms are present. if there is no extension of the suppuration to these parts, drainage from behind the ear will rapidly dissipate the danger. By doing this be reaches the following results: 1. Rapid recovery. 2. Avoid chronic suppuration. 3. Avoid permanent perforation of tympanum. 4. Guard against empyema of mastoid process. 5. Guard against intracranial pyogenic infection, danger to life. 6. Preserving the hearing. 7. Guard against tormenting noises. As illustration author reports history of four cases: 1. Fatal meningitis five weeks after beginning of an acute otitis media without any symptoms on the part of the mastoid. 2. Case of facial paralysis, otorrhea, necrosis of ossicles, deafness, lack of development in body and intellect in child of eight suffering with chronic suppuration following an acute otitis media developed eighteen months ago. 3. Girl of fifteen, daughter of a surgeon, with post scarlatina suppuration existing nine weeks without any tendency to improve. After opening mastoid discharge ceased and wound healed in four weeks. 4. Man of twenty-eight, severe acute otitis media, headache, vertigo, unconsciousness, temperature 103 deg. F., pulse 110, respiration 26. No symptoms on the part of the mastoid. Opening of the mastoid,

no signs of pus. The vertigo disappeared im. mediately after the other symptoms had disappeared before the operation by rest in bed. The discharge ceased after ten days. Healing of the wound in five weeks. Hearing normal, no tinnitis.

Middle Ear Suppuration in Diabetes.(Grossmann, Internat. Centralblatt für Ohrenheilkunde.) In Lucae's clinic there have been admitted since its existence ten cases of middle ear suppuration in diabetics. Of these nine were acute middle ear suppurations, and one an acute exacerbation of a chronic suppurative condition. In one case both mastoids were opened Author gives history of cases and then discussed them individually. He follows with an explanation as to which position may be taken in order to get a clear picture of the course of middle ear suppuration in diabetics, and a proper relation of cases of diabetes which came to mastoid operation, as compared to operative cases in nondiabetics. According to the experience of the Berlin clinic there were 22.7% of operative cases in diabetics as compared to 56.3% in non-diabetics. Grossman arrives at the following conclusions: 1. A particular frequency of middle ear suppuration in diabetes cannot be proven clinically. 2. But an otitis media in diabetics leads more often to disease of the mastoid process than in non-diabetics. 3. The cause is not due to an individual local disposition, but due to the decreased powers of resorption and a greater decline of the mucous membrane, early arteriosclerosis in diabetes, and a change in the composition of the fluids. 4. A characteristic form of mastoiditis diabetica does no exist. 5. Operative interference is as a rule borne well, even though the prognosis must be guarded.

(Springer.) This work, the result of a large Scopolamin Narcosis in Ear Surgery.experience, 120 cases of narcosis of this kind gives a critical review of a large number of cases observed, with disturbance or interruption in the narcosis and some new signs for the performance and indication of the Schneiderlin process. Care should be taken not to administer too large doses of morphine, and precaution in patients whose heart muscle is not intact, fatty degeneration of the heart. It is in just these cases that care must be exercised, after general anesthesia appears, not to inject any more of the drug. This latter condition is reached when the sensibil. ity of the lining membrane of auditory canal has disappeared.

DIABETES has been treated successfully with a diet of pure buckwheat flour.

GENITO-URINARY.

T. A. HOPKINS, M. D.

The

Chronic Discharge in Organic and Functional Disorders of the Deep Urethra; Diagnosis and Therapy.-J. M. Thompson (Med. Rec., Dec. 30, 1905) devotes the first part of his long paper to a general consideration of the fac tors involved in these disorders of the posterior urethra, and points out some of the reasons that make their treatment difficult. He divides the processes of this region that are characterized by persistent or periodic discharge from the meatus, or appearing in the urine, into the organic and the functional affections. In the former group are classed chronic posterior urethritis, chronic prosta. tis, chronic seminal vesiculitis, and chronic cystitis-processes that follow a history of simple or specific inflammation of the urethra due to the gonococcus, pus organisms, traumatic, and toxic sources. No matter how closely the discharge may resemble that in the functional disorders, it is to be remembered that pus is the distinguishing element. The functional disorders include urethrorrhea, prostatorrhea, spermatorrhea, and phosphaturia, all of which result from what may be termed abnormal physiological activity, due to sexual continence, excess, indiscretion, or persistent ungratified sexual desire. functional types are non-inflammatory, and pus is not present in the discharge, whether it appears at the meatus or in the voided urine. Each of the four organic conditions is then discussed in connection with the corresponding functional disorder that simulates it, and in this way the differential diagnosis is elucidated. The treatment of each group is then described. In dealing with the functional disorders the author lays more stress on the personality of the physician and general hygienic rules than on purely medicinal agents. Massage and the cold steel sound are valuable measures in the later stages of the cure. The following plan of treatment for the organic lesions is first outlined and then amplified in detail: (1) Gradual dilatation with steel sounds; (2) copious irrigation with dilute solutions (pure astring. ents, pure antiseptic, or antiseptic slightly astringent); (3) topical applications with concentrated solutions (same as in 2); (4) internal urinary antisepsis; (5) meatotomy when the meatus is constricted, and to permit proper dilatation; (6) massage of prostate and seminal vesicles; (7) administration of oleoresins for acute exacerbations and relapses (8) hydrotherapy, electricity, medicinal tonics, reconstructives, etc., p. r. n. Drawings of the microscopical structures to be found in the

and

urethral secretions, and illustrative case histories are appended.

Antigonococcus Serum.-J. C. Torrey, New York City (Jour. A. M. A., Jan. 27,) gives a preliminary report of good results in the treatment of gonorrheal rheumatism with an antigonococcus serum made by the inoculation of large rabbits with cultures from an acute, untreated case of gonorrhea. The best serums were obtained by inoculations at intervals of five or six days with cultures from six to fifteen days old. The rabbits were always inoculated intraperitoneally. While he thinks that the most important factor in the good results obtained with the serum is its bactericidal action, he is inclined to believe that there is also an antitoxio action. Experiments with guinea-pigs seemed to indicate this, and clinical evidence also pointed the same way. In some of the cases of gonorrheal rheumatism treated with the serum there was a decrease of pain in the joints within twenty-four hours after the first administration, and this seems most reasonably explained by a neutralization of some of the gonotoxin. Mainly, however, the serum acts, in his opinion, by destroying the bacteria. It seems possible, he says, that it supplies enough immune bodies to dispose of the comparatively few gonococci in the chronic forms of the disease, though not enough to bring about the destruction of the great number of gonococci that are present in the the urethra in acute gonorrhea. Experimental evidence fully to substantiate this theory is yet lacking. The serum, however, has been found to contain both precipitins and agglutinins for the gonococcus.

Observations on Nephroptosis and Nephropexy.-Arnold Sturmdorf (Med. Rec., Jan. 13, 1906) considers that vices of skeletal ccnformation play an important part in the production of nephroptosis. Omitting theoretical consideration, he says, normal kidney support may be practically defined as the resultant of two essential factors, a retaining pressure of adequate intensity and a receptacle of accurate conformation. The retaining pressure is exerted by the normal tension of the general peritoneal sao applied to the anterior kidney surface in the manner of an inflated cushion, propping the organ against its receptacle. This pressure is reflexly regulated by the activity of the abdominal muscles. The receptacles applied to the posterior kidney surface are formed by the declivity existing on each side of the anterior aspect of the lower dorsal and upper lumbar spine. They are funnelshaped recesses, narrow below in the male, more cylindrical and shallow in women, a

peculiarity more marked on the right side and appearing with the broadening of their pelvis at the advent of puberty. Deviations in the conformation of these receptacles from the lines of the posterior kidney surface constitute the main predisposing factor in the production of nephroptosis. The causes of such deviations are embraced in the whole category of congenital and acquired skeletal abnormalities. The treatment should, therefore, in many cases have been begun in the developmental period of the osseous framework. The restoration of normal internal as well as normal external conformations should be our orthopedic aim; the organic and func tional spinal deviations of early life, the infantile paralyses, the muscular and ligamentous insufficiencies should receive consideration from the point of normal internal as well as external topography. Much is being accomplished in the correction of external skeletal abnormalities; much may be accomplished by attention to the visceral displacements induced by such abnormalities. Kidney dislocations once developed, nothing short of surgical fixation will re-establish its normal stability. Palliative treatment undoubtedly yields results, but of temporary duration.

Congenital Stenosis of the Urethra.- Faxton E. Gardner (Med. Rec., Dec. 23, 1905) says that this malformation is much commoner than one would be led to suppose from the very scanty literature of the subject. Foisy, in a recent thesis collected 104 cases, and now the reported instances of the condition have

reached a total of 110. The author outlines

the development of the urethral canal, and says that the chief points to be borne in mind are the following: (1) The urethra is formed by three embryological portions: (a) the posterior urethra developed from the urogenital sinus, and separated from the next portion by the cloacal membrane; (b) the spongy portion developed from the urethral groove and closed during the first stages of its development by the cloacal membrane, at its posterior extremity, and the epithelial wall of the glands, at its anterior; (c) the balanic portion developed independently. (2) The spongy and the balanic portions; i. e., the whole anterior urethra are not derived as the posterior, from a hollow embryonic organ, but on the contrary develop in a solid, continu. ous mass of epithelial cells. It is therefore not surprising that congenital strictures are more common in the anterior than in the posterior urethra. The symptoms are then described at length, and it is stated that nocturnal incontinence and diurnal frequency of micturition are characteristic features. In

In

continence in children, if not accounted for by some evident external malformation, is frequently due to a congenital stricture and not to "essential incontinence," or to "congenital irritability," as it is usually alleged. adults every stricture is not necessarily the result of trauma or gonorrhea, and gonorrheal strictures develop much more quickly on the basis of an already existing congenital stenosis. The treatment is gradual dilatation, only rarely is it necessary to resort to internal or external urethrotomy.

Antigonococcus Serum in Gonorrheal Rheumatism. Prefacing his remarks with a general description of gonorrheal rheumatism, its peculiaritis, etc., J. Rogers, New York City (Jour. A. M A., Jan. 27), reports a number of cases successfully treated by the antigonococcus serum made by Dr. John Torrey and elsewhere described by him. The ordinary treatment is notoriously unsatisfactory, and while the serumtherapy has its limitations like all others, it appears to be a real benefit in these cases. It should be remem. bered, however, that it has little or no effect on existing urethritis, and so long as any traces of this persist there is danger of a recrudescence of arthritic symptoms. He calls attention to some of the difficulties of diagnosis, especially in women, in whom it is often undetected, and states that the use of the serum may be of value, as it will relieve the pain in a few days if the patient is gonorrheal.

The possibility of a complication by another infection must of course be considered, but most joint and serous membrane affections occurring in the course of a gonorrhea can usually be attributed to the

coccus.

In any suspicious case he advises the injection of from 20 to 60 minims every day or every other day, beginning as soon as possible after the arthritic symptoms appear and continue as long as the pain and disability last. Aside from an occasional erythema, he has observed absolutely no ill effects. The earlier the disease is recognized and the treatment commenced the better of course are the results.

A Non-Operative Method of Treating Prostatitis.-W. Benham Snow (Med. Rec., Jan. 10,1906) says that he has treated about forty cases of prostatitis in patients of different ages by means of the static wave current and vacuum tubes. In no case has there been failure to produce some degree of improvement, and in 75 per cent of the cases so treated there has been complete relief from the symptoms and a cessation of the disposition to relapse. The technique of the method is described and several especial electrodes devised by the author are figured.

He attributes the effect of the treatment mainly to the mechanical contraction produced and arrives at the following conclusions: (1) Where simple congestion is present in the early stages of the affection the relief is prompt; (2) when the gland has been enlarged for a number of years with resulting infiltration and development of vesical irritation and obstruction of the urethral passage, the lesion is capable of being abated and the congestion relieved with the absorption of infiltrated exudates, the hyperplastic tissue only remaining; (3) in the aged, in whom the gland has become greatly enlarged, and is dense and hard from the growth of hyperplastic fibroid tissue, the inflammatory process will be abated, affording a degree of relief to the obstruction commensurate with the site and extent of the inflammatory process. The dilatation of the bladder which has intervened may be greatly relieved and cured in most cases by the persistent application of the electrical current over the pubis and by an electrode carried high into the rectum and pressed forward against the bladder, together with judicious washing of the bladder and the use of strychnine. The current applied in this manner induces temporarily contraction of the muscular coats, and finally restores sufficient tone to enable the organ completely to empty itself.

ERGOT is said to be our best remedy in epidemic cerebro-spinal meningitis.

A

TOOTHACHE.-H. B.. Ray gives the fol lowing advice on the treatment of toothache by the practitioner: Toothache is essentially an inflammatory condition, and in 99 per cent of the cases there is a cavity in the tooth. In those cases where there is a cavity, but no nerve exposure, the treatment is simple-apply a sedative and exclude the secretions of the mouth from the cavity; prompt relief will follow, and then advise the patient to visit a competent dentist. very effective agent, and one always at hand, is the oil of cloves. It should be applied by saturating a pledget of cotton with the remedy and introducing it into the cavity with a toothpick or other pointed instrument; that being done, the secretions are kept out by filling the cavity with a little beeswax, a household remedy always at hand. The wax can be applied by warming over a lamp on the point of a knife and forcing into the cavity. The wax filling serves not only the purpose of keeping the secretions of the mouth out, but prevents thermal changes from affecting the nerve when hot and cold things are taken into the mouth.-Southern Clinic.

FOR diarrhea due to exhaustion after fevwith opium and iron. ers, Dr. Waring recommends nux vomica

CHRONIC URTICARIA OR HIVES. -Ichthyol in from 1 to 2-grain doses to children and 5 to 6-grain doses to adults relieves and cures. At the same time an ointment should be applied to the affected parts, or even all over the body. The strength of the ointment should be about 2 drachms of ichthyol to an ounce of petrolatum in children, and of ichthyol to 1 ounce of petrolatum for adults. Medical Summary.

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