bacilli reach the peritoneal tissues. Observations and experiments on animals teach "that in general, by the spread of tubercle bacilli along the blood current a preponderance of true tuberculous nodules arise in the most diverse and widely distributed tissues, while by the spreading of bacilli indifferently through the tissues, whether by means of wandering cells or along the lymph stream, the local symptoms of inflammation prevail."

Analogous to suppurating peritonitis, we can distinguish in the tuberculous variety a primary form-introduction of germs into the peritoneum from distant seats of disease-and a secondary variety-introduction of germs from neighboring tissues. In primary tuberculous peritonitis it is not always easy to ascertain the source whence the bacilli arise, since it is possible that sometimes the tubercle bacilli, as well as the cocci of suppuration, are carried directly onward into the blood or lymph stream without first forming a colony at the seat of entrance. If only a comparatively small number of bacilli reach the circulation a particular tendency of the peritoneum is necessary to bring on tubercular peritonitis. Grawitz mentions a case in which this peculiar tendency was caused by the presence of cirrhosis of the liver.-Dippe.-Professor Dr. Paul Grawitz (Charité-Ann., XI., page 770, 1886) in Schmidt's Jahrbucher, Number IX., 1886.

TREATMENT OF DRYNESS OF THE MOUTH IN FEBRILE DISEASES.

For the tormenting thirst and troublesome dryness of the mouth in fever patients the author employs painting the tongue every ten minutes with chemically pure glycerine. His patients are always remarkably relieved by this treatment.-Dr. Cotter in Journal de Medicine de Paris, page 601, 1886.

STUDY OF BACTERIOLOGY IN THE "ECOLE PRATIQUE," PARIS.

The students of medicine have opportunity, since one month ago, to cultivate bacteria. Under the direction of Professor Cornil, and after much exertion, a laboratory for bacteriology has been opened in the "rue de l'Ecole de médicine." The courses are given by the assistants of Cornil, Dr. Chantemesse and Mr. Clado. In a large, well-lighted and well-ventilated hall there is room for sixteen students. Each student has a table with the necessary apparatus, furnished partly by himself and

partly by the laboratory. With this hall are connected smaller rooms for cultures and different temperatures. Two large rooms are reserved for the instructors.

In six weeks the student learns to recognize and cultivate the most active pathological fungi. Owing to the lack of space an enlargement of the laboratory is spoken of.

Before the building of this official laboratory the study of bacteriology in Paris was rendered possible only through the courtesy of Pasteur or his assistants.-Dr. A. Florand in the Gazette medicale de Paris, Number XII, 1886.

HOSPITAL REPORTS.

MICHIGAN STATE HOSPITAL.

SURGICAL CASES.

SERVICE OF DONALD MACLEAN, M. D.,

Professor of Surgery and Clinical Surgery in the Medical Department of the University of Michigan.

REPORTED BY WILMOT F. MILLER, ANN ARBOR, MICHIGAN.

CARIES AND NECROSIS OF OS CALCIS.

M. L., aged eleven. Admitted October 13, 1886.

History. One year ago, while at play, he was hit on the heel of his right foot with a potato, thrown by a playmate. One week after this, the heel, which had been painful and swollen, broke and discharged some pus. The foot had not been painful until within the past few months. The pain, which has increased in severity, has been so severe that the foot cannot be used, and he is compelled to go on crutches. Some weeks ago several pieces of dead bone came away.

Present Condition.-His general health is good. The heel is swollen, and from several openings on each side is discharged a fetid pus. The pain is most severe at night.

October 14: Clinic.-A probe passed into the sinuses comes in contact with dead bone. Patient given chloroform, and an incision made through the heel to the tuberosity of the os calcis; the tendo-Achilles divided, and the greater part of the os calcis was removed; the interior cancellous portion was scraped out with the spoon and gouge. Wound washed with bichloride solution (one to one thousand) and dressed antiseptically.

October 17: Foot dressed; wound healing nicely.

October 18: Swelling of foot reduced; a small portion of dead bone removed.

November 4: The general condition of the foot greatly improved, but portions of adjacent bones show that they were also involved in the disease. The patient was given chloroform, and the external portion of the foot freely opened, and portions of the os calcis, astragulus and cuboid bones removed.

December 29: Wound nearly healed. Can walk some without the assistance of crutches. Ankle-joint anchylosed. Free movement in other joints of the foot. When standing on foot it is in the natural position. Heel tender and movement painful. Discharged.

NECROSIS OF FEMUR; DISORGANIZATION OF KNEE-JOINT; AMPUTATION.

Justin H., aged fifteen. Admitted October 20, 1886.

History.-Family history good. In August, 1885, he was taken down with a very severe pain in his left knee. This was soon followed by tenderness and swelling, which in time extended to the thigh, and finally involved it throughout its entire extent. The swelling progressed until this portion of his limb had become enormously distended. It was then lanced by the attending physician, which permitted more than a gallon of pus to escape. The incision healed, but several other openings formed spontaneously near the knee-joint, which have continued to discharge unhealthy pus. No dead bone came away until a few weeks ago, when a few small pieces came out through a sinus. During the summer of this attack he went into the water frequently and remained until he would become chilly, but had not gone in for several weeks previous to the occurrence of the pain in his knee. After the pain was first noticed he used his limb for a few days, but since then has not been able to walk.

Present Condition.-Appetite good; sleeps well; has no pain at night; weak and greatly emaciated: temperature, 101°; pulse, 90: Left leg slightly flexed; knee-joint anchylosed and enlarged. Several discharging sinuses. A point of dead bone protrudes through an opening on anterior part of the thigh near the joint.

October 21: Patient presented at clinic,* and being placed under chloroform, Professor Maclean enlarged the opening and removed several pieces of dead bone, but exploration with the finger proved that the femur was so badly necrosed that exsection of the bone or amputation of the limb would be required to remove the disease. Further operation deferred until patient could be consulted.

* For Remarks see THE PHYSICIAN AND SURGEON, December, 1886.

October 21: After operation one-eighth grain morphia. October 27: 6 P. M.-Temperature, 102°; pulse, 105. Ten grains of sulphate of quinine were administered.

October 28: 6 P. M.-Temperature, 103°; pulse, 106. 8 P. M. --Temperature, 98.8°; pulse, 95. Ten grains of quinine.

October 29: 6 P. M.-Temperature, 104°; pulse, 102. Ten grains antipyrine.

October 30: 8 A. M.-Temperature, 100°; pulse, 100. Five grains antipyrine.

November 1: The patient willing to have any operation performed, was placed under chloroform, and Professor Maclean proceeded to operate. An oval incision was made inferior to the patella, through the ligament into the joint, with the view of making a resection of the lower end of the femur, and to ascertain the condition of the joint. The patella and surrounding structures were turned back, and the lower end of the femur exposed. A section of the upper portion of the epiphysis, which was found separated from the shaft, was removed, with about two inches of the lower end of shaft of the femur. The section of the shaft showed that the whole lower end of the femur was necrosed and enclosed in a cylinder of new bone. In addition to what had been taken away, over four inches more of the old shaft were easily removed from the interior of the new femur, allowing a quantity of very fetid pus to escape. Upon examination the epiphysis was found to be spongy and carious, and the structures of the joint were greatly disorganized; consequently the operation of exsection or resection was abandoned, and the thigh was amputated at the middle third. A drainage tube was placed between the flaps, and the stump put up in antiseptic dressings. At 3:40 P. M. given one-sixth grain of morphia. 12 P. M.-One-eighth grain morphia.

November 2: 6 P. M.-Temperature, 99.5°; pulse, 90. Oneeighth grain morphia. 1 A. M.-One-eighth grain morphia. November 3: 6 P. M.-Temperature, 100.5°; pulse, 102. Onesixth grain morphia.

November 6: Stump dressed, the drainage tube and sutures removed, and a few horse-hairs were drawn through between the flaps. There was some discharge, which, having a slight odor, the wound was thoroughly washed with bichloride solution and the stump dressed with bichloride gauze.

November 15: Presented at clinic. Wound dressed. Healing nicely.

November 20: Dismissed.

GENERAL CORRESPONDENCE.

PARIS LETTER.

TORNWALDT'S DISEASE-HYPERSECRETION OF LUSCHKA'S GLAND.

Dr. Luc, formerly hospital house surgeon, publishes in La France Medicale the following contribution to the study of Tornwaldt's disease. The principal object of Dr. Luc is to call attention to the excellent clinical results obtained by Dr. Tornwaldt (Dantzig), in the treatment of obstinate pharyngitis.

In studying naso-pharyngeal affections Dr. Lue was struck by the fact that the true symptoms of ozena were, in certain cases, not exhibited, or only in an incomplete manner; atrophy of the lower turbinated bones, for example, and the abnormal dimensions of the nasal cavities, which constitute the essential anatomical characteristics and mechanical cause of true ozena. The patients, however, were troubled with pharyngeal dryness, and the presence of purulent mucosities, foetid and adhesive scabs in the nasal cavities, more especially in the nasal and buccal region of the pharynx. The washing of the naso-pharyngeal cavity caused these to disappear temporarily, but they returned in their complete form at the end of two or three days. In several cases a curative result by means of a local, modifying treatment, was attempted; tincture of iodine or nitrate of silver in solution applied with a camel's-hair brush, insufflations of caustic or astringent powders applied to the upper parts of the pharynx where the catarrh was supposed to exist. These attempts remained fruitless.

Dr. Luc's attention was then drawn to two articles in the Monatschrift fur Ohrenheilkunde (March and May, 1886) published by Drs. Keimer and Broich, who gave the particulars of cases, similar to those described above, successfully treated by the cauterization of the pharyngeal bursa. These authors stated that they had undertaken their experiments with the object of confirming the facts, published by Dr. Tornwaldt, in June of the preceding year.

In 1868 Luschka gave a complete description of the gland named after him, which Mayer (Bonn) had called attention to for the first time in 1842. This description was as follows: On the median line of the upper wall of the pharynx in the centre of the adenoid tissue there frequently exists an orifice about the