The existence of leprosy in North America has long been known in the foci mentioned by Dr. Ramirez; but these foci are isolated and probably in no way menace the inhabitants of the country at large. But the fact as brought out by Dr. Bracken, that for something like a decade we have been importing lepers into our great Northwestern States, is startling in hygienic interest. It does not appear that leprosy is hygienically any more manageable than syphilis, and therefore it is not impossible that leprosy may yet scourge the modern as it did the ancient world.

At all events, such lax sanitary surveillance as the existence and development of the disease in Minnesota displays calls emphatically for

correction.

Notes and Queries.

BRAIN TUMOR.—A “symposium" on this subject took place in the Section of Neurology and Medical Jurisprudence at the recent meeting of the American Medical Association. C. H. Hughes (St. Louis) discussed the Symptomatology; F. Peterson (New York), Localization; E. Jackson (Denver), Ocular Symptoms; P. C. Knapp (Boston), Treatment from the Neurological Aspect, and W. W. Keen (Philadelphia), Treatment from the Surgical Aspect. Hughes said that conditions of the intracerebral circulation, excited by or preceding the development of a neoplasm, glioma, or other growth, within the brain, by a morbid cause projecting within it from the brain's enveloping membranes or bony covering, caused a symptomatology -cephalalgia, neuro-retinitis often, and sometimes glaucoma-that might exist independently of any form of intracerebral or intracranial morbid growth. Hysteria complicated, even as it was sometimes complicated by, cerebral tumor. Altered cerebral circulatory states, especially of vasomotor origin, independent of intracranial growths, were not continuous as tumors were. Chief among the persisting signs were the ocular fundus and pupillary signs, the paralyses of cerebral source, monoplegias, hemiplegias, etc., monospasm, hemispasm, etc., tremors, epilepsy, vertigo, paralyses of sensory, motor, and special senses, inco-ordination, anesthesia and pain due to regional or general cerebral irritation or pressure and degeneration due to intracranial pressure. Such a symptomatology opened the possibilities and consequences of cerebral sclerosis, atheromatous, inflammatory, or specific vascular changes, emboli, thrombi, or thrombotic inflammation of vessels, apopletic sequelæ, abscesses, interstitial nephritis, uremic, alcoholic, or other toxipathies, involving the brain, its vessels, texture, or coverings, and serous, ventricular, or subarachnoid effusions. Insanity was often a marked

symptom of tumors. Peterson presented several charts, one showing the localization of functions in the cortex, another showing the centers of language and the result of their lesions. Jackson referred to optic neuritis as the most striking and significant symptom of brain tumor, occurring in 80 or 90 per cent in all cases. It could not, however, be regarded as pathognomonic, and it was of little value in indicating the location of the tumor. The typical optic neuritis of brain tumor was characterized by great swelling, sometimes 10 to 12 D. (3 millimeters), abruptly limited, at no great distance from the margin of the disc; with arteries narrowed, veins dilated and very tortuous, and small vessels much enlarged, but not very numerous, because scattered through the swollen tissue; small flame-shaped hemorrhages upon or near the papilla; the other portions of the fundus, except for the alteration in the vessels, being normal or presenting changes that were in most cases slight as compared with those at the disc. In contrast, swelling and discoloration of the disc, occurring as an anomaly, were never of very high degree. Jackson also referred to optic atrophy, changes in the pupil, with impairment of accommodation, paresis of the extraocular muscles, nystagmus, impairment of central vision, and limitation of the field of vision, and impairment of color perception. Knapp said that of four hundred and five cases collected by him the growth in thirty-four was found but could not be removed; in ninety-two it was not found at the point of operation; and in two hundred and twenty-four it was found, but in thirty-four of these it was of such a nature that it could not be wholly removed; in fifty-five, or fourteen per cent, the operation was palliative, and in some of these there was perhaps a mistake in diagnosis. He was not very sanguine as to the results of operation in cases of tumor, but he dwelt upon the advisability of operative procedure for gummata and tuberculous growths. The greatest danger was associated with sarcomata and gliomata, the likelihood of recurrence being especially marked. Keen referred to the difficulty of localization, and urged that every case of brain tumor be subjected to faradism during the operation before the tumor or the brain was touched. As to the technique of the operation, Keen advocated a very large opening, as giving a better opportunity to ascertain the location of the tumor.-British Medical Journal.

THE TREATMENT OF CONTRACTURE OF the Bladder BY HYDRAULIC Pressure. The Johns Hopkins Hospital Bulletin of May contains an important paper on this subject by Dr. H. Young. Since the opening of the hospital in 1889 cystitis has been treated by vesical irrigation performed without the use of a catheter, hydraulic pressure being used to force the fluid through the urethra. It occurred to Dr. Young that this method might be used to dilate the bladder in cases of contracture from chronic cystitis. He reports eight cases, in all of which it proved most successful. For example, a man had suffered from severe chronic cystitis for fourteen years. The urine was alkaline and contained pus and blood, and micturition occurred every

ten or fifteen minutes. He had been treated in numerous hospitals with internal remedies and by local irrigations through the catheter with only temporary relief. Under hydraulic pressure 22 c. c. was the largest amount that the bladder would hold without severe pain. He was treated with irrigations of Thompson's fluid at a pressure of four feet. He rapidly improved, the urine became acid, the capacity of the bladder increased to 115 c. c. in eighteen days and to 250 c. c. in two months, when he could retain his urine for four hours. A year after the treatment was begun there was no tendency to recurrence. Some points in the technique of Dr. Young's method may be mentioned. A conical urethral nozzle which will fit tightly the meatus is required. The patient lies on his back. The bag containing the fluid is elevated three or four feet, and the urethra is alternately distended and emptied to clean the anterior urethra; the nozzle is then pressed tightly into the meatus, and the bag is raised to an elevation of about seven feet. The urethra will become ballooned, and for a time the flow will stop; soon the sphincters give way and the fluid enters the bladder, and the patient experiences a sensation of fullness and gradually increasing pain. The nozzle is withdrawn, and the fluid is ejected with considerable force. The operation is repeated until a quart of fluid has been used. Bland fluids, such as Thompson's or boric acid (two per cent), are the most satisfactory in general; silver nitrate (one half grain to one ounce) may be used occasionally. The effect of the dilatation is probably to separate or loosen bundles of fibrous tissue and to smooth out pockets in the mucous membrane, and also to give the antiseptic the best opportunities of acting on the mucous membrane. Is there any danger of ureteral reflux and of the carrying of pus or organisms up to the kidneys? As a result of his clinical experience and of experiments on the cadaver and on dogs, Dr. Young concludes that there is not.-Lancet.

A FATAL CASE OF GONORRHEA.-Gohn and Schlagenhaufer (Wien. klin. Woch., 1898, No. 24) record the case of a young girl who, when admitted into hospital, had been suffering for four weeks with pains in the limbs and the symptoms of influenza; four days before admission she had begun to have rigors, which were still continuing. On examination it was found that she had acute gonorrheal inflammation of the urethra and Bartholin's glands. Intermittent fever developed, and six days later there was sudden pain in the right foot, which became cold and bluish, while the sensibility of the whole limb was diminished. This became steadily worse, and in five days more the foot was gangrenous, The heart sounds had been previously obscured by murmurs, but now became audible, and enabled the murmurs to be recognized as mainly systolic and most marked at the base on the left side. The patient became rapidly worse, and died next day. At the necropsy it was found that ulcerative endocarditis had attacked the aortic valves, and that septic abscesses were present in the myocardium; the heart was secondarily dilated and hypertrophied. The gangrene of the

foot and leg was the result of an embolus in the femoral artery. There was an abscess in the peritoneal covering of the posterior wall of the uterus. The gonorrheal process had affected the urethra, the vagina, and the cervical portion of the uterus. There was parenchymatous degeneration of the liver and myocardium, together with edema of the lungs. In the heart lesion gonococci were found, and the endocarditis was thus obviously gonorrheal. It is very noticeable that many of the ordinary signs of malignant or pyemic endocarditis, such as septic emboli and enlargement of the spleen, were absent, as also was the typical gonorrheal joint affection. The bacillus was tested by cultivation, and eventually by introduction into the human urethra; it was not present in the embolus, but was found in the retro-uterine abscess. The urethra contained a large number of small, highly vascular polypoid excrescences, developed from the subepithelial connective tissue; these are common in subacute and chronic gonorrhea. The point of entry of the infection into the blood or lymphatic system could not be determined. British Medical Journal.

MUMPS WITHOUT INFLAMMATION OF THE SALIVARY GLANDS.-It is gradually becoming more and more evident that the only essential element of an infectious disease is the invasion of the body by a specific microbe. The resulting symptoms and lesions are indefinitely variable. Of late years, partly from clinical observations, but mainly from bacteriological researches, the limits of these variations have been considerably extended. Lesions once supposed to be so characteristic that they entered into the definition of the disease may be entirely absent. Thus typhoid fever is not necessarily enteric; there may be no intestinal lesions. The pneumococcus, the most usual cause of acute pneumonia and the presence of which in other tissues causes the so-called complications of that disease, may attack these tissues and exempt the lung, producing a primary pneumococcic arthritis, pericarditis, etc. At a recent meeting of the Societe Medicale des Hopitaux Dr. M. A. Beclere read a case which showed without doubt that mumps may manifest itself by orchitis without parotitis or inflammation of the other salivary glands. This has already been stated by M. Laveran, and seems to be well known in France, but it does not appear to have been observed in this country, though Dr. Eustace Smith states that the orchitis may exceptionally appear before the parotitis. A boy, aged fifteen years, was suddenly seized with violent headache, pyrexia, and repeated vomiting. On the fifth day the right testicle became painful. On the following day he was seen by a distinguished surgeon, who finding orchitis with predominating epididymitis, thought, as there was no urethritis, that the case was one of acute-tuberculous orchitis, although the temperature was 104° F. Dr. Beclere saw the boy on the eighth day. He ascertained that three of his school-fellows had mumps, and diagnosed the orchitis accordingly. Resolution was complete on the fourteenth day. All doubts as to the diagnosis were soon removed, for his two sisters had typical attacks of mumps. Dr.

Beclere pointed out that the diagnosis should be made by the history of an epidemic, the sudden onset of the illness, and the interval of four or five days between the general symptoms and the orchitis. The diagnosis is of importance if only to enable the practitioner to warn the patient's friends that atrophy of the testicle sometimes results.-Lancet.

THE EXAMINATION OF THE SPUTUM.-A Hoffmann (Centralbl. f. inn. Med., May 14, 1898) draws attention to two kinds of cells which are differentiated by the eosin stain: (1) There is a cell about the size of the white blood cell which contains several small deeply-stained nuclei. Hoffmann looks upon this as a polynucleated white cell. Such cells are seen in specimens of the blood from marked anemia, especially that occurring in chronic nephritis. (2) The other kind of cell is rarer but more striking. It shows a sharp outline and contains an area inside which is either unstained or only slightly stained. In this area there are several well-stained molecules of varying shape. Sometimes these molecules are so numerous as to fill the unstained area, but they mostly number from two to five. These cells are larger than pus cells. The author found them most abundantly in whoopingcough, but they are also present in other diseases. They are most often found in the sputum of children. They are rarely seen where eosinophile cells are present. In many forms of bronchitis, as well as in asthma, eosinophile cells are found, and Hoffmann would look upon what he terms "eosinophile bronchitis" as an incomplete form of asthma. The second kind of cell described here is present in an acute bronchitis which has no relationship with asthma. Their origin is difficult to explain, but the author regards them as altered nuclei of the cylindrical epithelium of the bronchial tract.-British Medical Journal.

CASIMIROA EDULIS.-This rutaceous tree, the zapote blanco of the Mexican Pharmacopeia, was made the subject of examination by Professor Maisch, of Philadelphia, twelve years ago. He wrote of it, in the American Journal of Pharmacy for April, 1886, that the fruit was anthelminthic; that the pulp of the fruit was said to be hypnotic, though unwholesome; and that the seeds were regarded as poisonous. Now, according to the Therapist for July 15, 1898, a new hypnotic, analgetic, and antithermic has been extracted from the seeds. Long experimentation, it says, and tests on several hundred persons have established its action and its freedom from secondary effects, and determined its toxic dose. It seems "to favor natural sleep, from which one wakes refreshed" in from four to six hours, and its use is especially appropriate in insomnia from cerebral excitement or alcoholism.-New York Medical Journal.

THE article appearing in the issue of November 15th, entitled "Puerperal Eclampsia," was contributed by Dr. D. B. Stone, of Hydro, Ky., and not by Dr. W. B. Stone, as erroneously printed.