of different albuminous matters for different periods of time show that the quantity of indol formed increases during the first eight to twelve days, but after this it visibly diminishes, owing probably to its volatility. The phenol formed, however, always increases with the time. These experiments show that the formation of phenol does not run parallel with that of indol, and from this one can conclude that, while an increase of indican in the urine indicates an intense intestinal pu Another important question studied was whether urine containing albumen can be titrated directly or only after separation of the albumen, as is usual. When the quantity of albumen was not over 0.2 per cent. they found that it made no essential difference whether the albumen was separated or not. The facility with which the titration was made, however, diminished, the nearer the limit of 0.2 per cent. was reached. Under these conditions much suboxide of copper went into solution, while the mercury set-trefaction in its first stages, an increased phenol excretled slowly; but while under these conditions Fehling's method might be altogether impracticable, this was not, properly speaking, the case with Knapp's method, the execution of which was only considerably delayed. The authors conclude, therefore, that it is almost impossible to obtain a better reagent for the titration of sugar than Knapp's. Indican. — M. Hennige1 reports the results of his estimation of the amount of indican in the urine in various diseases. The method employed was that of Senator. He found the amount of indican small in chlorosis without complication, increased in a case of pernicious anæmia, diminished in two cases of purpura hæmorrhagica, increased in typhus at its height and during convalescence. In intermittent fever it was generally not increased; but in a case with violent cardiac pains and vomiting it was increased during the occurrence of these symptoms. In a case of arsenical poison the amount was diminished, in three cases of lead poisoning and three of trichinosis increased. Further, an increase was found in peritonitis, in gastrointestinal hemorrhage, cholera morbus, acute gastroenteritis, chronic intestinal catarrh, cancer of the stomach and liver, Addison's disease, and progressive muscular atrophy. A normal or diminished quantity was found in constipation, catarrh of the gall-ducts following upon gastro-duodenal catarrh, cirrhosis of the liver, ovarian tumor, acute miliary tuberculosis, hæmorrhage from the lungs, meningeal apoplexy, and cerebral tumor. In phthisis there was a greater quantity when diarrhoea was present than when not. Phenol. - Phenol, like indol, is a product of the putrefaction of albuminous matters. It has been recognized by Brieger as a substance formed by putrid decomposition in the great intestine and the extract of fæcal matters. Fifty kilos. of fæces furnished 0.2496 grams tribromophenol, corresponding to 0.0708 grams phenol. Phenol is eliminated through the urine in variable proportions in different diseases. The normal quantity eliminated each day by an adult is, according to Munk, on a purely animal diet 0.006 grams, on a mixed diet 0.0165 grams, reckoned as tribromophenol ; according to Brieger, on a mixed diet 0.013 to 0.099 grams tribromophenol, corresponding to 0.003 to 0.028 grams phenol. Phenol exists in the urine as phenolsulphuric acid, and may be separated and estimated by mixing with the urine so much concentrated acid as will furnish a five-per-cent. solution, and distilling. The phenol is precipitated in the distillate with bromine water as tribromophenol, and weighed. Each one hundred parts tribromophenol correspond to 28.3 parts phenol. Б 6 Experiments made by Odernatt on the putrefaction 1 Centralblatt für die medicinischen Wissenschaften, 1879, No. 33, from Deutsche Arch. f. klin. Med., xxiii. 271. 2 The JOURNAL, February 7, 1878, page 170. 8 Ber. d. deutsch chem. Gesellsch., 10, page 1027. 4 Hoppe-Seyler's (Maly's) Jahresbericht, 1876, page 138. 6 Maly's Jahresbericht, 1878, page 219. Maly's Jahresbericht, 1878, page 374. tion would show that the albumen had remained longerin the intestine and had undergone there putrefaction. Brieger has made determinations of the amount of phenol in the urine in different diseases, with the object in view of obtaining a better idea of the putrefactive changes taking place in the intestines. He obtained the smallest quantity in anæmic and cachectic persons in cases of pernicious anæmia, acute anæmia after postpartum hemorrhage, chlorosis, scorbutus, scrofula (a case of gland tumors especially in the neck, and amyloid degeneration of spleen and liver), and cancer of the gall-bladder with secondary cancer of liver. The mean in the foregoing cases amounted to 0.0048 grams phenol per day. In diseases of the stomach the sepa ration of phenol was small, but higher than normal in two cases of carcinoma of the stomach. There was about the normal quantity in pulmonary phthisis; a somewhat small amount, at times only traces or even none, in the acute exanthemata; a trace only in two cases of typhus, but the normal quantity in a third case; a marked increase in cholera morbus; a small amount only in perityphlitis; a slight increase in catarrh of the gall-ducts; a large increase in acute peritonitis and traumatic tetanus; and a considerable increase in rheumatic tetanus. In infectious diseases and septic conditions the increase was especially marked. A patient with purulent empyema separated as a maximum 0.6309 grams phenol; the amount diminishing as the patient improved, finally becoming normal. The phenol was also largely increased in a case of puerperal fever with facial erysipelas and exudation of pus, and in a case of phlegmonous abscess. In the latter case the pus itself contained an abundance of phenol. In other serous fluids and exudations neither indol nor phenol was found. Long-continued constipation, whether pathological or induced by opiates, caused only a trifling increase, and that by no means constant. The result of this last observation seems to indicate that one must seek outside the intestinal tract for the cause of the great increase of phenol noticed at times. Another fact made evident by Brieger's investigations is that the excretion of phenol is not parallel to that of indican. For, although in cancer of the stomach, acute peritonitis, and traumatic tetanus, there was an increase of both, in anæmia and diseases of the stomach there was a diminution of phenol with an increase of indican, while in empyema there is an increase of phenol with a diminution of indican. SalkowskiR also states that the excretion of phenol is not parallel with that of indican, but notes the increase of both in peritonitis, pulmonary phthisis and lymphosarcoma. He also finds an increase after ligature of the intestines in dogs and rabbits, and states that a rich diet of albumen appears to increase the amount of phenol sep 7 Centralblatt für die medicinischen Wissenschaften, 1879, No. 18, page 313, and Maly's Jahresbericht, 1878, page 218, from Zeitschr. f. physiol. Chemie, ii. 241. 8 Virchow's Archiv, lxxiii. 409. arated. Brieger finds an increased separation of phenol as well as associated sulphuric acid in man after the ingestion of tyrosin, which is derived from albuminous substances. 6 solution of sodic hydrate, the mixture soon assumes a ruby red tint. This color is transient, being replaced after some moments by the straw-yellow color of alkaline solutions of nitro-prussides. Fresh human urine In connection with the question as to how far one gives this reaction very distinctly, and it is not promay judge, from the quantity of phenol separated induced by any other substance found in the urine exthe urine, of the intensity of the putrefactive processes cept kreatinin. In an alcoholic solution the reaction taking place in the intestine, certain investigations of is less obvious. Schaffer and Tauber are important. They have Bile Pigments.M. Masset considers the followfound that, after feeding dogs with a weighed amount ing the most delicate test for the detection of biliary of phenol, only a portion of the phenol is found again coloring matters: in the urine. When small amounts are given nearly all is oxidized; in case of large amounts (0.12 to 0.48 grams) from 45 to 65 per cent. is oxidized. It is apparently not changed to oxalic acid (as was suggested by Salkowski, who found a small amount of oxalic acid in the blood of a rabbit under similar conditions), since there is no increase of oxalic acid in the urine, but is probably oxidized to carbon dioxide and water. Salkowski has also noticed the same fact in regard to the oxidition of phenol. There is therefore no direct relation between phenol separation and phenol formation. After phenol has been taken (Salkowski, Schaffer), or tyrosin (Brieger), not only is the phenol increased in the urine, but also the associated sulphuric acid; and the quantity of the latter is considerably greater than is necessary to combine with the phenol and indican in the urine. So that the urine must, under these circumstances, have contained some other substance combined with sulphuric acid. The nature of this substance is unknown, but Brieger thinks that a blue coloring matter which adhered to the baric sulphate obtained in the determination of the associated sulphuric acid, and which went into solution on washing the precipitate with alcohol, may have had some connection with the increase of sulphuric acid. The Urine in Intestinal Catarrh. J. Fischl has repeatedly found casts in the urine both in severe forms of intestinal catarrh and in the mild forms, especially in old persons. These were for the most part small hyaline casts, dotted here and there with epithelium, pus, or fragments of these. The epithelium was from various parts of the urinary tract, and at times, even from the beginning, was in a state of fatty degeneration. Blood globules were rarely found, and then in very small numbers. The urine generally contained more or less albumen, while the quantity of urine appeared to be diminished. These appearances were generally observed within a few hours after the diarrhoea set in, and disappeared after a few days, without leaving any trouble. In young persons and those of middle age these changes in the urine were only found when at the same time vomiting existed. Fischl is inclined to seek for the cause of these changes in the urine in the supposed diminished arterial pressure following upon collapse; just as, though in a higher degree, disturbances of the circulation in cholera are the cause of the changes in the urine which occur in that affection. Kreatinin. According to Weyl5 if one adds to a dilute solution of chloride of kreatinin a few drops of a solution of nitro-prusside of sodium, so dilute as to be scarcely colored, and then drop by drop a very weak 1 Journal f. prakt. Chemie, xviii. 282. 2 Zeitschr. f. physiol. Chemie, ii. 366. 8 Centralblatt f. d. med. Wissenschaften, 1878, No. 31. 4 Centralblatt f. d. med. Wissenschaften, 1879, No. 4, page 55. 5 Journal de Pharm. et de Chimie, August, 1879, page 197, from Berichte der deutsch. chem. Gesellsch., xi. 2175. Two grams of urine are acidified in a test tube with two or three drops concentrated sulphuric acid, and a crystal of potassium nitrite is added, care being taken that it does not adhere to the sides of the tube. The reaction takes place immediately, and consists in the production of streaks of a magnificent grass-green color, if the quantity of the principal biliary coloring is considerable. On being shaken the color becomes uniform and takes on a very deep tint, which persists upon boiling, and which may be kept several days without any alteration. The addition of water simply diminishes the intensity. If the coloring matters are in very minute quantity, the liquid acquires, after a very short time, a pale green tint, equally persistent, and easily observed on placing the tube between the eye and the sunlight, or on looking down the tube as it stands on a white ground. Normal urine under these circumstances assumes a faint ruby tint. Masset considers this reaction valuable in the beginning of certain diseases, when the ordinary reagents are incapable of showing traces; the reaction is always distinct, and is not subject to the errors of observation which may occur with the ordinary reagents and which often lead to indecisive and perhaps erroneous opinions. TOXICOLOGY. Localization of Arsenic. The investigations of M. Scolosuboff upon the localization of arsenic in the organs, from which he concludes that it condenses first Experiments have recently been made by MM. de and foremost in the brain, have been previously noticed." Poncy and Livon, which have resulted in confirming Livon have also observed that when small doses of the observations of Scolosuboff. MM. de Poncy and arsenious acid are given to an animal daily with the food the phosphoric acid in the urine is considerably increased. The authors consider that this increase could have come from substitution only, and not from any pathological condition of the animal; for in cerebral af The fections they have found rather a diminution than an increase of phosphoric acid in the urine. The arsenic then seems to replace the phosphorus of the phosphoglyceric acid, producing arsenio-glyceric acid. periments are described in detail, and show care in their authors are attempting to isolate this base. performance. The ex E. Ludwig, however, has made analyses of the organs of persons who had committed suicide with others from chronic, arsenical poisoning, and in all arsenic, and of dogs which had died, some from acute, cases he has found the greatest quantity of arsenic collected in the liver. In acute poisoning the kidneys also were rich in arsenic, while the bones and brain con 6 Journal de Pharm. et de Chimie, July, 1879, page 49, from Journal de Pharm. d. Anvers, February, 1879. 7 The JOURNAL, July 6, 1876, page 10. 8 Journal de Pharm. et de Chimie, October, 1879, page 344. 9 Chem. Centralblatt, 1879, No. 38, page 602. tained only very small quantities. In cases of chronic arsenical poisoning (in dogs) which were not fatal, and in which the administration of the poison was stopped, he found that the poison remained longest in the liver, while it was separated from the other organs much earlier. Heports of Societies. PROCEEDINGS OF THE SUFFOLK DISTRICT T. M. ROTCH, M. D., SECRETARY. OCTOBER 25, 1879. Fifty members were present, In a fatal case of acute arsenical poisoning the fol- DR. CALVIN ELLIS, the president, in the chair. DR. lowing results were obtained upon analysis:C. J. BLAKE read the following paper on 1480 grams liver, 1481 - brain, 0.1315 grams ammonio-magnesium arseniate. แ The bones furnished traces. 66 66 CHILDREN'S EARACHE. The remark, "Only an earache," so often heard, indicates the familiarity with a symptom which receives the less attention because of its very frequency, and because the appreciation of the facts in the case go no farther than the recognition of the symptom alone. In too many cases the popular comprehension of an earache may be best expressed as a hole with a pain at the bottom of it; and to still this pain the hole through which it can be reached, the external auditory canal, is made the medium for the instillation of various substances whose principal value for the accomplishment of the desired purpose lies in the fact that they are warm when used. [These results are in direct opposition to those of Scolosuboff, De Poncy, and Livon. They are, however, in our opinion of great value, in connection with this question. In every case of acute arsenical poisoning, in our own experience, where the brain has been examined (three in number), and in two other cases of which we have knowledge, only traces of arsenic have been found in the brain, while the liver has contained from one half to two and one half grains. It is desirable that all analyses which have any bearing upon this subject be published, and that further experiments be made. For the present we do not think one is justified in accepting the statement that arsenic is chiefly localized in the brain and spinal cord. It is important, how-of children by lay practitioners for the purpose of reever, that the chemist examine the brain in all cases lieving an earache would be amusing, if it were not of arsenical poisoning, not only because it will be of rather exasperating; for, of the substances usually emvalue in settling the question under discussion, but also ployed, the majority, while giving temporary relief for because the presence of traces even is of importance in the reason mentioned, by remaining in the canal so connection with the subject of post-mortem imbibition obscure the objective field by discoloring or maceratof arsenic which is often raised in criminal trials.ing the lining of the canal and the outer coat of the REP.] membrana tympani as to increase the difficulty of making the subsequent diagnosis as to the cause of the pain, and determining the best measures to be taken for its adequate relief. 2 The list of substances poured and put into the ears Localization of Strychnia. MM. Lajoux and Grandval have presented to the Pharmaceutical Society of Paris an interesting communication concerning this question. According to some authors (Husemann, Dragendorff), the chemist in cases of poisoning by strychnia should direct his investigations chiefly to the liver. Dragendorff states that he has never succeeded in isolating the alkaloid from the brain, even when the whole organ was operated on. He states that Gay has been able to isolate it from some special parts of the nervous system, as the medulla oblongata and pons varolii, and that he himself has been able to discover it in the medulla oblongata. Lajoux and Grandval present the results of their analyses of the brain of a Among the causes of children's earache, including person who died from the effects of 2.35 grams tr. the reflex pain from carious teeth and the pain result nux vomica, equivalent to only 0.0035 grams of strych- ing from furuncular and diffuse inflammation of the exnia. Of this amount about three quarters was admin-ternal auditory canal, by far the most frequent in this istered hypodermically, the remainder by the mouth, Although the quantity was very small, they succeeded in isolating the strychnia from only a fraction of the brain and obtaining its characteristic tests. If these observations prove correct, the chemist should never neglect, in cases of poisoning by strychnia, to examine smothered. climate, and during the winter and inclement spring months, is the acute inflammation of the middle ear accompanying and following the common head cold. The inflammation of the mucous membrane of the nasal passages and naso-pharynx extends up the lining of the Eustachian tube to the still more delicate lining of the tympanic cavity, a membrane exceedingly rich in blood-vessels, receiving its blood supply in part from branches passing along the Eustachian tube. One of the first results of the inflammation of the lining of the Eustachian tube is the closure of that passage, which serves both as ventilating shaft and as drain to the middle ear. The pressure of the apposite walls of this tube, by interfering in a measure with the return of blood from the lining of the tympanic cavity, favors the engorgement of the blood-vessels in this cavity and the serous exudation into the tympanic cavity, which latter is a marked feature in these cases, and is nature's first effort at relief. As this process goes on, there is a gradually increasing accumulation and increasing pressure upon the lining of the cavity, and especially upon the sensitive membrana tympani, rendered more sensitive by its own share in the inflammatory process and by the intrinsic pressure from the congestion and serous exudation within its own tissues. The pain which results under these circumstances is often excruciating, and once suffered is not likely to be forgotten. In addition to the constant and less severe pain, which may be stilled in a measure by dry, warm external applications, there are paroxysms of more severe pain recurring at irregular intervals, due probably in part to an increase of the intra-tympanic pressure, relieved at intervals by the escape of a small portion of the fluid into the Eustachian tube. This view is supported by the fact that as a rule the pain in these cases is less severe in the day-time, when the child is moving, talking, and swallowing, when the movements of the palato-tubal muscles tend to partially open the Eustachian tube, and by the further fact that the pain is usually more severe at night and after an hour or more of sleep, the child often awakening after a sleep of an hour or two with a pain in the ear much more severe than any which has been experienced during the day. The history of many cases of acute purulent inflammation of the middle ear shows that the pain has recurred in this manner several nights in succession before the natural relief has been afforded by a spontaneous perforation of the membrana tympani and a copious discharge. A child suffering from this form of middle-ear disease usually has or has had a more or less severe head cold. There are marked febrile symptoms, as a rule, and the occasional sharp cry marking the access of a paroxysm of pain is peculiar. An examination of the ear shows congestion of the inner end of the auditory canal, congestion of the membrana tympani, especially about the manubrium mallei, or of the whole surface of the membrana tympani, according to the duration of the inflammatory process; or there may be, in addition to these appearances, bullæ upon the surface of the membrana tympani, generally on the posterior quadrant, filled with limpid serum, sero-sanguinolent fluid, and, rarely, pure blood, these bullæ being the result of serous or hæmorrhagic exudation beneath the dermoid coat of the membrana tympani. With these conditions the instillation of warm fluids is evidently likely to do no more than give temporary relief. The thing to be done, under the first conditions mentioned, if possible, is, firstly, to open the Eustachian tube and relieve the intra-tympanic pressure by allowing some of the contained fluid to escape from the middle ear through that passage. This is most readily accomplished, especially in children, by the use of the Politzer air douche. This instrument, consisting of a bag syringe with a flexible rubber tube and appropriate nozzle, is usually used by inserting the nozzle in one nostril, closing the nostrils with the finger and thumb of one hand, making the patient swallow, and at the moment of swallowing compressing the bag, held in the other hand, forcibly. The act of swallowing, accompanied by the elevation of the palate and closing of the naso-pharyngeal from the buccal cavity, prevents the air injected from passing down into the throa. The closure of the nostrils prevents its escape at the nose, and the accumulated pressure in the naso-pharyn geal space is exerted to dilate the Eustachian tube, this end being further aided by the contraction of the palato-tubal muscles which accompanies the act of swallowing. The escape of the fluid from the middle ear may be further favored by turning the head so that the affected ear is uppermost, thus bringing the fluidcontaining cavity directly above the vertically-situated Eustachian tube; or, if both ears are affec.ed, by inclining the head forward. But a child suffering from pain is not always readily induced to swallow at the word of command, and possibly, from the existing condition of the throat, forcible swallowing may have been already found to be too painful an experience to render the child willing to undertake it as desired. Since the broad rule, " peaceably if we can, forcibly if we must," is so applicable to the treatment of children, if the act of swallowing cannot be induced, let the child place its hand over its mouth and blow, strongly distending the cheeks, thus forcing the palate upward. During the continuance of this pressure, the addition of the pressure by means of the air-bag in the nose, with closed nostrils as before, will often sufficiently accomplish the purpose. If the child proves intractable, and can be induced neither to swallow nor to blow, it can be made to cry, if it is not already doing so, and, choosing the moment when a strong cry is sending a column of air out of the lungs and elevating the palate, the desired inflation may be effected. As a Politzer air douche is not always at hand, and as the busy general practitioner cannot be expected to carry about with him "everything except a tackle and fall," some simpler instrument must often answer the purpose for inflation. A common Davidson injection syringe, the in-draw tube doubled up and held in the hand, and the small nozzle inserted in the nose, answers very well; in default of this, a length of rubber tube, through which the surgeon blows, holding one end in his mouth; and in default of this a common clay pipe. In the early stage of the inflammation this inflation of the middle ear often not only relieves the pain effectually, but stays the progress of the trouble. The parents can be instructed, and can perform the simple operation on any recurrence of the pain. When, however, the inflammatory process has progressed still further before proper aid is called for, and the later condition above described exists, the simple inflation is less likely to be sufficiently efficacious, and other treatment looking to a relief of the pressure is called for. This may be afforded often by merely pricking the prominent bullæ upon the membrana tympani, or, if there is much bulging outward of the membrana tympani from the contained fluid in the middle ear, by perforating the membrana tympani itself. This should be done only under good illumination, the child's head being firmly held, and may be accomplished by one or more punctures in the most prominent part of the membrane, or preferably in the posterior inferior quadrant, by means of the lance-headed paracentesis needle, or in default of this by means of a long darning-needle held at an angle in a pair of spring forceps. Acupuncture, unless there is pus to be liberated, is usually to be preferred to an incision, since less violence is done to the already inflamed tissues, and a slight and continuous relief of the pressure is preferable to the complete evacuation of the cavity, which, by removing all counter pressure, favors a more excessive serous exudation, with possibly the breaking down of the tissues and subsequent ulcerative inflammation. With the escape of a few drops of the contained fluid the pain is usually greatly relieved, and the gradual flow of the fluid may be now favored, and the maceration of the outer coat of the membrana tympani and the dermoid lining of the auditory canal prevented, by the insertion of a wick of absorbent cotton, to be removed and replaced by a dry wick so soon as saturated. At this stage the ear should not, as a rule, be syringed, but the dry dressing continued until there is no longer a serous discharge, or until the appearance of a purulent discharge shows that the disease has passed into another stage, when syringing and mild astringent instillations may be resorted to, and the usual treatment applicable to such cases carried out, the more acute stage with its excessive pain being a thing of the past. A word of caution should be added in regard to the use of the air-bag. The inflation should not be too forcible, since the object is rather to dilate the Eustachian tube and favor the gentle escape of the fluid than to force air under extreme pressure into the tympanic cavity. To this end, repeated gentle inflations are preferable, to begin with, to the use of more considerable force. After puncture of the membrana tympani the air douche may also, in some cases, be gently used, and, after both the inflation in the simpler and the puncture in the more severe cases, dry warmth may be externally applied. Moist warmth, the poultice applied over the ear, is as a rule in all of these cases to be avoided. DR. HUNT spoke as follows: Dr. Blake's very practical exposition leaves nothing to be added as far as diagnosis and treatment are concerned; but as to the causation of the affection there are many reasons for doubting the important rôle ascribed to au increase of intra-aural pressure from a secretion that is supposed to have resulted from closure of the Eustachian tube. It has become customary to speak of this cause as quite proven various authors, often evidently led by a loose idea of an analogy between intra-ocular and intra-aural pressure, which is supported by no facts, have described the operation of puncturing the drum membrane as relieving the pressure in the middle ear if but a drop of fluid exudes. It may be well to remember that the closing of the Eustachian tube leaves the vessels of the middle ear subjected to the pressure of the atmosphere for a much longer time than is necessary to produce the most acute earache, as the phenomena usually succeed each other; and that, on the other hand, many cases of chronic disease are known where, after long closure of the tube, no pain and no exudation occur. Taking these facts into account, I have for some time thought that in the earache of children the pain often has its seat in the membrana tympani, and that puncturing the drum membrane relieves the pain by changes which the operation induces in the membrane itself. If we call to mind the anatomical structure of the membrana tympani, its rich supply of vessels and nerves, it is easy to suppose that an incision which drains it may by this means relieve a most intense pain, of which the cause is seated in the membrane alone, and that the minute effect upon the not remarkably sensitive lining of the middle ear has but little to do with the good result. In other words, the case is analogous to that of the painful little furuncles which affect the cutis of the meatus, and which an incision so rapidly relieves. PROCEEDINGS OF THE BOSTON SOCIETY FOR MEDICAL IMPROVEMENT. T. M. ROTCH, M. D., SECRETARY. JANUARY 26, 1880. DR. JAMES C. WHITE, permanent chairman, presided. CONCUSSION OF THE SPINE, SO CALLED. DR. R. M. HODGES read a paper on So-Called Concussion of the Spine, the purpose of which was to show that we have no knowledge justifying the proposition that what is popularly called "concussion of the spine" is due to a molecular disarrangement of the substance of the cord by an assumed shake or jar. That vascular disturbances (anæmia, hyperæmia, hæmorrhages, spinal apoplexy) followed by meningitis, myelitis, or degenerative changes of the spinal cord are shown by pathological as well as physiological histology, by experimental pathology, and, to a certain extent, by post-mortem examinations to be the true cause of symptoms heretofore commonly designated as "concussion of the spine." That, in spite of hysteria and exaggerated or fraudulent manifestations frequently accompanying cases of so-called "concussion of the spine," the reality, if not the precise character, of any existing spinal lesion can almost always be recognized by objective and demonstrable symptoms. That the prognosis of this class of spinal injuries, in severe as well as slight instances, is far more favorable than is usually supposed. That, as a plea in suits for damages, "concussion of the spine" (so called) does not and is not entitled to have the weight and importance usually attached to it. That erroneous impressions in regard to the severity of this injury, prevalent in this country as well as in England, have been fostered by Mr. Erichsen's book on Concussion and Nervous Shock, which presents an exaggerated picture of its symptoms and consequences, not justified by our present knowledge of the subject. Dr. Hodges's paper is to be published. DR. CHEEVER said that one great difficulty in cases of alleged concussion of the spine in claims for damages was in distinguishing between the subjective and the objective phenomena, what the patient said he felt and suffered, and what the physician could see, observe, and appreciate without the patient's statement. Another difficulty was in conveying to a jury what the physician honestly believed. This arose from the faulty mode of employing medical experts. It was difficult to avoid being biased when called by one or the other party as expert; and then, again, the most honest expression of a scientific opinion by the expert was discounted by the jury, and passed for less than its worth, because the jury expect the expert to be partisan, and allow for it. Experts should be called and paid by the court, and should devote themselves as specialists to certain classes of cases. Since the publication of Mr. Erichsen's book on Railway Injuries, the imaginative patient, who thought his spine affected, could find in it chapters to feed his fancy and to suggest every symptom, and the adroit counsel could find in it a counter-statement to break down in a crossexamination every statement of an expert. Dr. |