which did not exist. It was not possible to diagnos distinguished from the embarrassed respiration symp. ticate lesions of the soft parts by means of radiography tomatic of Pott's disease in this region should be borne but if an abscess was known to exist it would aid in in mind. If the abscess were large and could be perlocating it. DR. H. L. TAYLOR said radiographs could not, until further improved, be expected to more than indicate certain physical changes in bone. If the structure had become so attenuated by disease that the x-ray could pass the focus of disease would be indicated, not other wise. Intelligence and experience should be brought to the interpretation of these pictures which are subject to all the distortions of shadows and the errors of photographic processes. A radiogram which was said to reveal the epiphyseal line had really shown a crack in the photographic film. He had a picture of tuberculosis of the carpus in which the diseased foci were shown with the greatest clearness. A cyst of the bone would be revealed if the walls were sufficiently thin to allow the rays to pass. DR. WHITMAN thought that all x ray pictures should be interpreted. They were of great service to one who had clear ideas of what he was looking for. cussed posteriorly, costo transversectomy would be indi. cated. But in this case there was no dullness on percussion and the small abscess lay at a distance of three inches from the exterior of the body, so that it was probable that the large opening of so called posterior thoractomy would have been necessary, a justifiable operation if the difficulties of diagnosis could have been overcome. DR. PHELPS recalled two cases in which the abscess had ruptured into the lung, but in neither did suffocation, which had caused death in Dr. Whitman's patient, occur. On the other hand, he had seen cases of cervical disease in which the abscesses had ruptured into the pharynx and caused suffocation. When the abscess was high enough it should be opened the very moment it was detected by an external incision for it might rupture during sleep at any time and, if the patient did not suffocate, he would die later of tuberculosis due to infection of the lung. DR. A. B. JUDDSON said that the walls of the trachea Pott's Disease-Death Caused by an Ab- were not easily compressible except by force, as by the ease. scess in the Thorax. grasp of a strangler or the hangman's rope. When a foreign body in the gullet produced suffocation it was DR. WHITMAN also related the history of a boy of 4 from spasm of the glottis and not from compression of years of age who, with an angular projection at the the trachea. At the level of the third dorsal vertebra, fourth dorsal vertebra, was subject to occasional pro- however, the trachea occupied, together with the eso. longed asthmatic attacks of such severity that fatal phagus and the deep cardiac plexus of the sympathetic asphyxiation seemed to be imminent. The character of nerve, a narrow strait bounded behind by the vertebral the dyspnea seemed to warrant a diagnosis of abscess bodies and in front by the upper piece of the sternum, pressing upon the trachea. A plaster jacket and jury- and here, if at any point, its lumen might be diminished mast were applid with good effect and a month later by the pressure of a fluctuating tumor. Above this the jacket was removed for the purpose of examining level and below, where the anterior and posterior walls the chest more carefully, but the symptoms of dyspnea, of the thorax diverged, no such pressure was likely to caused apparently, in part by the removal of the sup. occur. It was not uncommon for abscesses, as in port and in part by the recumbent position, became so Dr. Whitman's patient, to occupy this critical position. urgent that it was immediately re applied without The conservative tendency of cold abscesses to move further examination. The boy died suddenly that where there was least resistance often perhaps pre. evening. The internal organs showed no sign of dis-vented interference with the vital function of the On removing the lungs and heart a tense fluctu- trachea. He suggested that the fatal result might have ating tumor was apparent in the median line, the size been due to spasm of the glottis following the passage of a large hen's egg, between the esophagus and the of a part of the contents of the abscess into the trachea anterior longitudinal ligament, on a level with the up- or to some interference with the cardiac plexus. per border of the third dorsal vertebra, its apex at the sixth dorsal. The abscess contained about two ounces of purulent fluid. It appeared to have escaped from behind the longitudinal ligament into the retro esopha geal space at about the time of the greater obstruction of breathing, or about six weeks before death. The greatest projection of the tumor was opposite the third vertebra, where it was forced forward by the spine, above the collapsed vertebral body, against the trachea near its bifurcation. An abscess obstructing the respir DR. MYERS recalled, and continued, the history of a atory passages in the upper cervical region could be boy 7 years of age, who was before the Section March reached and evacuated, but within the chest walls its 18, 1898 (see MEDICAL REVIEW, July 23, 1898, p. 70). diagnosis and treatment were not easy. The signifi- The abscess had burrowed forward into the neck from cance of what might be called asthmatic breathing as the fifth dorsal vertebra and discharged behind the DR. TAYLOR was reminded of a case of Pott's disease reported by Dr. W. R. Townsend in which the abscess was in this region. An unusual form of dyspnea was a feature of the clinical history and the child died sud. denly a few days after admission to the hospital. A rather small abscess which had not ruptured was found in front of the spinal column at the root of the neck. It was supposed that suffocation had been due to some traction upon the nerves rather than to pressure. ABSTRACTS MEDICINE AND THERAPEUTICS. From right sterno-mastoid. The evening temperature rose two degrees when the boy was allowed to be up and was normal when he was kept recumbent, in which po sition the drainage was free. He had therefore been kept in bed for two months after which his general health was entirely restored and the sinus remained closed for several months. He had, however, returned with a profuse recurrence of the discharge, an enlarge Fatal Chronic Constipation From Enormment of the post-cervical glands on the right side and ous Dilatation of the Sigmoid Flexure.an abscess over the manubrium, but with no rise of Dr. Peverell S. Hichens (Lancet; Med Rev. of Rev.) temperature. An irrigating fluid passed from the old says: The patient was a young man, aged 20. sinus out of the pharynx by a passage which was open the day of his birth to the day of his death he suffered for a month but which had been closed for four weeks. from constipation, and his bowels were never opened It was a question whether one of the abscesses perfor- without recourse to artificial means. For the first ated or whether one of the cervical glands ruptured and week of life he was exceedingly ill, passed nothing but discharged. blood and water, and was not expected to live. He DR. JUDSON recalled a case in which, during the then began passing fecal matter, but the motions were progress of purulent hip disease, an abscess over the never those proper to an infant, consisting almost enmanubrium turned out to be from carries at the junctirely of scybala, and they were passed with much pain tion of the upper and middle pice of the sternum. and screaming. They were only obtained by ounce There was spontaneous rupture externally, consolida- doses of castor oil, which often had to be repeated two tion, a scar attached to the bone and recovery with or three times in twelve hours. As the child grew the angular deformity, anterior instead of posterior as in Pott's disease. The angle formed by the manubrium and the gladiolus measured more than 25 degrees. The sinus had closed 17 years ago. Recovery from the hipdisease had been very favorable and the caries of the sternum had left no inconvenience. DR. HOMER GIBNEY said that it was reasonable to be lieve that abscesses occurred as often with disease of the upper dorsal region as of the cervical, but they were not so easily detected in the former and were too often overlooked. DR. WHITMAN said that in the case reported by him the abscess had not ruptured, but was strictly confined to the retro esophageal space in front of the spine. There had been no change in voice or difficulty in swal lowing. An abscess in this region was a direct menace to life, the dangerous symptom being attacks of inspiratory dyspnea. It is probable that an operation would have saved life in this case. Aluminium Corset. DR. PHELPS exhibited an aluminium corset for the treatment of spinal disease. He had experimented largely with various materials, such as leather, celluloid, wood, etc., and considered this material, which was light, clean, able to keep in shape and durable, as the best that he had found for the purpose. Weekly Sanitary Report.-The report of the sanitary division of the Health Department of St. Louis for the week ending March 4, shows that attention had been given to one case of small-pox, twenty-two cases of diphtheria, two cases of croup, fifteen cases of scar latina, three cases of typhoid fever, twenty-four cases of cerebro-spinal fever, nine cases of measles, and six cases of whooping.cough. bowels were only opened by drugs, and with increased difficulty, and at the age of 12 months pint enemas of soap and water were used. Later, enemas of a whole pint had to be given, and very often had to be repeated two or three times. Later, the bowels used only to be opened at intervals of ten days or a fortnight, and only after repeated enemas. A very large scybalous motion was then passed, which was generally succeeded by sev eral loose motions in the next two or three days. motions could only be passed by the help of gravitythat is, by squatting down over a chamber in the posi tion which, as Dr. Lauder Brunton has pointed out, is the natural and proper one for defecation. The The patient very often felt slightly sick before the bowels were opened, and was very much collapsed afterwards, so much so that he often had to go to bed for the rest of the day. His abdomen was always greatly distended, so that he could never button the bottom but. ton of waistcoat, or the top button of his trousers. About a month before he died he was taken ill with influenza. Five days before death he was seized with pains all over his body and slight swelling of the legs. He was treated for rheumatic fever. The night before he died he passed a fairly large motion. The following morning he was seized with severe pain over the heart, shortly afterwards he went to bed feeling fairly com. fortable. During the night he suddenly got out of bed and fell down dead. The body was brought to the hospital, and a necropsy was made. There was very slight edema over the feet and shins, but enormous general distension of the abdomen. The abdominal cavity was occupied by a tense shining viscus, presenting the appearance of a sac rising out of the pelvis and passing under the ribs, where it doubled on itself and returned to the pelvis again-the enormous distended sigmoid flexure. At the point where where the sigmoid flexure left the descending colon it turned on itself and passed directly up the left side of the abdomen. The summit of the viscus then passed behind the ribs and xiphisternum with a gentle curvature and descended along the right side of the ab domen to the pelvis to join the rectum. Some little distance above the junction with the rectum the viscus showed a distinct constriction. The remaining abdominal viscera were entirely concealed by the sigmoid flex ure, which pushed the liver upwards and backwards, compressing the lungs, and rotated the heart upwards and outward. It contained an enormous amount of gas and a large quantity of semi-liquid feces. The total length of the sigmoid flexure when it was opened and laid flat was 224 inches. Fourteen inches from its upper end was a large cicatrix formed by an almost healed ulcer, probably stercoral in origin, which had caused the constriction above mentioned. The circumference of the flexure above the ulcer was 14 inches, at the ulcer it was 7 inches, and below 10 inches. The measurements, of course, represent the circumference of the flexure at its period of least distension, and they also show that the constriction at the site of the ulcer was merely a relative one and could have made no difference, or very little, to the onward passage of the feces. The walls of the sigmoid flexure were uniformly greatly thickened. This thickening was shown on microscopical examination to be almost entirely due to great hypertrophy of the circular and longitudinal muscular fibres. There was also slight thickening of the submucosa. The small intestine showed no lesion, and was not at all distended. There was slight general distension of the cecum and of the ascending, the transverse, and the descending colon. There was no sign of a fibrous band, kink, or constric. tion anywhere except at the ulcer above mentioned The lungs were small and compressed by the abdom inal distension, and were slightly edematous and en gorged. The heart was somewhat displaced, but was otherwise perfectly sound, as also were the liver and spleen. . This case appears to come under so-called "idiopathic dilatation of the colon." Dr. Hale White, in "Allbutt's System" (Vol. III, pp. 967–972), mentions that only 12 cases have been recorded in the last forty years, and he provisionally groups them under two heads-those in elderly patients and those in young children due to some congenital inertness of the bowels. Whatever may be the initial cause-a temporary kink, as Rolleston and Haward suggests, or the length of the sigmoid in children readily allowing kinking, as Jacobi sug. gests, or mere constipation and distension with wind or local spasm of the rectum, as Gee suggests, the attempted remedies in this case probably increased the disease. The patient moved in a vicious circle, and the sigmoid, already distended, was ever being more distended by the successive enemas. So far as could be judged from the post-mortem appearances the only pos. sible treatment which could have had any permanent success would have been lumbar colotomy. Premature Baldness.-Someone said, not long ago, that the ideal symbol of faith was not the tradi. tional maiden clinging to the Rock of Ages, but the bald headed man confidently consulting the bald-headed specialist and faithfully looking for relief for his baldheadedness. It is a very suggestive symbol of human limitations, but when hair follicles are gone it would take a special creative act to replace them and the hirsute appendage they furnish. The treatment of premature balnness, however, is not so hopeless if it is taken in time, and skin specialists are agreed that such can be done for the condition if properly treated by prophylaxis, and early attention. In these preliminary stages, and before the real beginning of the alopecia, properly so called, the cases come into the hands of the general practitioner. Too often he is prone to make little of them, or to consider that they are inevitably progressive anyhow, and so a deformity is allowed to supervene that is unsightly, and a cause of a great deal of annoyance to the patients. Prophylaxis is especially important. Dr. Jackson, in his "Manual of Skin Diseases," insists on two thingsthe influence of heredity in these cases, and the etiolog. ical importance of dandruff. Fathers and sons for generations may grow bald early, or the inherited peculi arity may have to be traced to the grandparents or some collateral line. Not all the children in one family in which baldness is hereditary are bald, but it will manifest itself in two or three of the children. The necessity for prophylaxis in these cases is evident. Hygiene of the scalp must begin at the very beginning of life and be continued persistently. Its details, as given by Dr. Jackson, are irksome, but most mothers whose sons are threatened with their father's early baldness, will be perfectly willing to take the additional trouble, and as for the sons themselves, as soon as they come to the years of indiscretion (or vanity), which is generally considered to be about the age of 15 years, they can usually be depended on to take for themselves all necessary precautions to stave off the unwelcome parental inheritance. As to dandruff, it constitutes, according to Dr. Jackson, the cause of 70 per cent of the premature baldness that occurs. Not that everyone that has dandruff will become bald; experience is against that, but it is very often true that an error in the nutrition of the sebaceous glands causes sympathetic trophic disturbances in the hair follicles, and hair production ceases. In this class of cases early treatment is of the utmost importance. Lassar's method requires the taking of a good deal of trouble on the part of the patient, but it is deservedly popular because of its frequent success. In general, however, the cure of the condition causing the dandruff, which is now considered to be, in all cases, a form of eczema, seborrhoicum will stop the loss of hair. Per "The Ready-Reference Hand-Book of Skin Diseases," by George Thomas Jackson, M.D. Third Edition, just issued. (Lea Brothers & Company). sistance of treatment for months is necessary, but will tage of being definitely decisive, something that is not nearly always be crowned with success if the condition always characteristic of therapeutic suggestion, especially in skin diseases. With the refinements in the use of the electrolytic needle that twenty-five years of prac tical experience with it have given, the depilation is now almost invariably successful from the beginning, was not too far advanced when treatment was begun. When there is absolute baldness, it is extremely doubt ful if anything can make the hair grow. Chloral Eruptions. - The Therapeutic Gazette and a new growth of hair afterwards is an anomalous for January 16, in an editorial says: irritative hyperplasia which is extremely rare, or a sign of failure to destroy the hair bulbs completely at first. The danger of scarring is also reduced to a minimum, and with reasonable care the cicatrization will never be more than the minutest points on the skin, and seldom will be noticeable at all. There would really seem to suffer the discomfort they usually do because of the persistent presence of this undesirable hirsute adornment. SURGERY. "Two theories have been advanced to explain these eruptions. One is that the drug produces an angeio. neurosis or vasoparalysis, probably by an action on the vasomotor centers. The other theory is that some of the chloral is eliminated by the glands of the skin, and in its elimination produces local irritation. According be very little reason any more for sensitive people to to Aviragent, these eruptions may be divided into two great classes. In the first they appear in the presence of conditions of the nervous system characterized by exaggerated excitability, as, for example, chorea, insan ity, tetanus, general paralysis, also in transverse myeli tis and after operative shock. In the second class of cases they occur in instances in which there is retention of chloral in the system, as, for example, in acute and The Causes of Azoospermia.-The functional chronic enteritis, eclampsia, hepatic disease, advanced activity of the testicle, says Dr. M. Simmonds (Deut. tuberculosis, and abdominal tumors. Then, too, it is Arch. f. klin. Med.; The Post-Graduate) knows no age well known that the simultaneous administration of limitation. The damaging influence of chronic affecalcohol with chloral often causes dermal manifestations, tions upon the production of semen is, as a rule, overand hot drinks, given with chloral, particularly if they estimated. In one thousand post-mortem examinations are copious, are apt to produce such effects. Of course, of the contents of the seminal vesicles, the author was in the cases where chloral is applied externally it pro- able to determine azoospermia independent of affections duces a direct local irritant influence."-New York of the genital system in only one hundred and twentyfive instances, i. e., in 14 per cent of the cases. ample, azoospermia was observed in: 280 cases of acute diseases..... 6 times, 2 per cent. 119 cases of chronic heart and renal 130 cases of malignant neoplasm... 9 affections.... Medical Journal. Hypertrichosis.-There are few chronic diseases that give rise to more real discomfort than this cosmetic defect. Numbers of physicians have almost piteous ap peals from female patients on whom the development of a hirsute facial appendage is a source of as much worri ment as it would be of joy to their young male relatives. So many different methods have been employed for its removal in the past, and so many exaggerated claims made for each new method, and yet recurrence has been the rule, that the ordinary general practitioner is apt to doubt that there is really any effective lasting method of depilation, and so advises his patients against attempts at relief. The electrolytic method of removing the superfluous hairs of trichiasis-the invention and practical develop ment of which, by the way, we owe entirely to Ameri cans—has been now before the profession nearly a quar ter of a century. It has been generally adopted in Europe, and especially in Paris is used extensively and with the best satisfaction. "The question is often asked," says Dr. Jackson, in his Manual of Skin Diseases,1 “is the removal of the hair by this method per manent?" This question may be answered: "It is with out a shadow of a doubt." The answer has the advan ........... 43 cases of chronic nervous affec 242 cases of tuberculosis. For ex 7 9 8 6 14 61 But one chronic affection leads to an alarming extent to sterility, namely, chronic alcoholism, as a result of which no less than 5 per cent of all the necropsied cases were sterile. It is difficult to say just how the poison acts, as anatomical lesions are usually absent. An atrophy of the gland almost never occurs, and the author strongly denies the statement made in text books to the effect that fatty degeneration of the epithelia is respon. sible for the loss of function. In regard to chronic interstitial orchitis, the author states that even slight destruction in the region of the corpus Highmori causes suspension of semen production. If this portion of the testicle remains free, however, spermatozoa may occasionally be found in the epididymis and seminal vesicles in spite of extensive cicatricial formation; indeed, this is true even in cases where half or two thirds of the testicle is replaced by 1From advance sheets of the third edition of "Jackson on Diseases fibrous tissue. Twelve individuals were rendered sterile of the Skin." (Lea Brothers & Co., Publishers). by bilateral interstitial orchitis; ten by stricture of the seminal ducts, and twelve by stricture of the ducts of the epididymis. The author emphatically states that, contrary to other glands, the testicle but seldom under goes atrophy after closure of its excretory ducts. Azoospermia in consequence of developmental disturbances was observed only in one incomplete descensus, but in eight cases noted the decided alternations in the epithelial elements fully explained the suspension of function. As to the effect of hydrocele, the author says he never saw a case of azoospermia resulting therefrom, and the same may, as a rule, be said of spermatocele. Genital tuberculosis will suspend semen production in the affected side in all cases in which the testicles, epididymis, or seminal ducts are attacked, and in bilat eral affections, will lead to sterility. If, however, the process is limited to the seminal vesicles, continuance of semen formation is not excluded. In his thousand necropsies, the author met with tuberculosis in some portions of the genital tract in twenty five instances, i. e., in 24 per cent, and among these there were ten in which both sides were affected. In four cases the process was confined to the seminal vesicles, so that in but six individuals could sterility with certainty be assumed to exist in consequence of tuberculosis-certainly not a very high number, when it is remembered that almost one-fourth of the necropsied individuals had died of tu. berculous affections. DISTRICT OF COLUMBIA - Jacksonville... KANSAS Peabody... Louisville. ..... Auburn.... The author draws attention to an early stage of tuber culosis of the seminal vesicles, met with during his re. searches, which has not as yet been considered. In KENTUCKYtuberculous individuals, with or without tuberculous affections of the genital system, we occasionally observe a purulent content in the seminal vesicles without the existence of macroscopic changes in the vesicle wall worthy of mention. Indeed, in many of these histological examination is negative; only a sub-epithelial, small-celled infiltration, without specific structure is found, and the nature of the process would be doubtful did not an examination of the pus show tubercle bacilli in enormous numbers. Since in this condition but few bacilli are found in the deeper portions of the wall, while they are numerous between the lining epithelia and in the pus, the impression is received that the pus offers a medium for the multiplication of the bacilli. The author twice observed this condition without fur. ther tuberculous affection of the genital apparatus—one patiect died of phthisis, the other of tuberculous menin. gitis. From these observations it seems advisable to BRAZILexamine for tubercle bacilli in every purulent seminal vesicle content noted in tuberculous individuals. Among the thousand men examined at necropsy, thirty three, or 3.3 per cent were sterile as a result of former sexual diseases. Finally, the author concludes that one-half of the sterile marriages is caused by azoo spermia in consequence of genital disease in the male. Tourist Sleeping Car to California through, without change, via the Iron Mountain Route, leaves St. Louis every Friday. RHODE ISLAND— 'Alice.... VIRGINIA Alexandria.... Bahia.... . Feb. 23.. Feb. 25..... Feb. 24. .. Feb. 16...... ... 56 Feb. 20... .. Feb. 22. : 1 : :: : 4 ...... 1 SMALL-POX-FOREIGN. 20 : |