entirely, great increase of the so-called pigment, nuclear membrane irregular and twisted, the nucleus atrophied and changed in position, nucleolus pale and irregular, protoplasmic branches decreased in number and irregularly formed. In regard to the pigment, Marinesco does not believe it to be true pigment at all, but it is derived by a chemical transformation from the chromophilic bodies of the cell. He distinguishes three stages in this transformation: (1) The chromophilic elements lose their affinity for the anilin colors. (2) The stage of degeneration; the chromophilic granules do not take the blue of the methylin color but the form of brownish bodies. (3) These brown granules, by the loss of certain substances, are reduced to a fine powder and are yellow in color. The following conclusions are noted: The pyramidal cell acts as any other nervous cell does when its axillary prolongation is destroyed; the progressive degeneration of the pyramdial cells following a lesion of the internal capsule are incapable of regeneration; the degeneration following an internal capsule lesion is confined to the layer of large pyramidal cells and to no other. Some Prophylactic Measures with Especial Reference to Infants and Children -W. L. JOHN In The SON* calls attention to two principles of which we must never lose sight: (1) the strengthening of the resisting powers of the human organism and (2) the elimination of the sources of infection. Water should be freely used; from the time the infant enters the world he should have the daily bath; this should include rinsing the mouth and scrubbing the teeth, if present. fants should be given water to drink at times. subject of clothing is an important one; wool is indicated in cold and in hot weather; it is a slow conductor of heat; its capacity for retaining moisture and giving it up slowly is great and advantageous. The physician should never acquiesce in the use of cow's milk or patent foods for infants unless the life of the mother or infant is in jeopardy, which is indeed rare. concludes with a reference to the lack of proper measures to maintain a good nervous system in young children, and precautions to be observed by physicians and nurses while treating infectious diseases. He Results of a Physical Examination of the Blood When Circulating Apparatus is Sound and When Diseased. It is maintained by DR. JOSEF SCHNÜRERT (1) that under normal circulatory conditions arterial and venous blood contain the same amount of red corpuscles, hemoglobin and dry substances; (2) that stagnation causes in venous blood an increase of the factors just mentioned; (3) that the serum of venous blood contains a larger number of solid constituents. *Phil. Med. Jour., May 27, 1899. +Centralblatt für Pathologie und path. Anatomie, May 1, 1899. Furthermore, the blood from capillaries is practically identical with that from large veins and arteries, while in vaso-constriction the vessels involved contain an increased per cent of solid elements and vice versa. In stagnation, serum leaves capillaries and small veins, is conducted from the tissue by lymphatics to veins entering right heart; thus the blood in heart and arterial system is richer in serum in proportion to the amount of stagnation and size of the lymph stream. In compensated valve lesions the blood is of normal composition. At first in disturbed compensation there is an increase in the watery element of whole blood and likewise serum. Later the whole blood becomes thicker than normal, while the serum remains too thin. The above holds good of blood from all vessels. [Schnürer's thesis is complete as regards the literature of this subject, covering thirty-eight pages; and can not be given justice in a review. (Reviewer.)] . Pathology and Treatment of Nasal Ulcer upon Septum Nasi and Floor of Nasal Passage.— H. I. LEFFINGWELL* believes that the nasal ulcer is due to a varicose condition of the nasopharynx, which has so much affected the circulation at this point that local vitality is at a low stage. His method of treatment consists in the partial removal of incrustation by raising the edges and applying with a small swab hydrogen dioxid until every particle of incrustation is destroyed; he continues the application till bleeding stops. The application should be made daily and then at intervals; this treatment affects the whole nasopharynx; the oxygen is taken up and gives life to the coats of the vessels and lessens the varicose condition to some extent at each treatment. Syphilitic ulcers are not generally accompanied by varicose conditions of the nasopharynx. Gastroenterostomy after the Method of Padrez. -M. A. SAKALOFF comes out strongly against the operation of Padrez, which consists in passing ligatures through the wall of stomach and intestine and leaving the same to cut through. The operation can not be termed a legitimate surgical procedure, as in many cases only the mucosa is thus cut through, leaving the other coats intact. The Lid Phenomenon of the Pupil.-GIOVANNI MINGAZZINI‡ gives the credit of the discovery of this phenomenon to Galassi, and denies that Westphal has the right to claim the discovery as his. The phenomenon is as follows: The eye of a patient is held open by separating the upper and lower lids by the fingers. If the patient is now told to attempt to close the eye, the pupil of the eye becomes narrow with the effort. Westphal has observed this in all cases of accommoda*Phil. Med. Jour., May 27, 1899. +Centralblatt für Chirurgie, May 20, 1899. Neurog. Centralb., June 1, 1899. tative iridoplegia (tabes, paralysis, etc.), but never in Glycosuria Following the Use of Copaiba BETLMANN* made his observation upon the case of a twenty-one year-old merchant who entered the clinic for gonorrhea. His father died of diabetes. The first examination of the urine gave 6.2 per cent. sugar; under a careful diet the percentage of sugar was reduced to 0.9 per cent. It was discovered that before his entrance to the clinic the patient had taken large doses of copaiba balsam-as much as 16 grams a day. The question now arose whether the copaiba itself was the sole cause of the glycosuria. Copaiba was then given the patient and there always followed an increase in the amount of the sugar. It was determined further that the administration of copaiba balsam can cause an alimentary glycosuria. A Case of Paget's Disease.-M. HERZOG† gives a complete report of the microscopical examination of a portion of tumor removed from the breast of a woman forty years old; the patient had noticed a small elevation above the right nipple three months before, which caused no sensory disturbance until accidentally injured; the mass then remained vividly red and looked like granulation tissue. This disease forms an excellent object for the study of the histopathology of inflammation and of plasma cells, since they occur in this affection in large numbers. Herzog believes that it is a true type of carcinoma from the start, but of mild degree of malignancy, the extensive spreading of which is for a long time prevented by the protecting wall of cellular infiltration which is formed in the derma. Sarcoma of the Left Kidney in a Child TwentyOne Months Old.-DR. A. CHIPAULT‡ reports the following case: M. X., 21 months old, was born prematurely and was always delicate. When three months old he became very fretful, putting his hands to the abdomen as if in pain; abdomen was sensitive to pressure and the patient lost appetite, had attacks of diarrhea, alternating with constipation and finally fever, which was practically constant. He lost flesh rapidly, and at the same time the abdomen increased in size, especially on the left side. When seen for the first time, eighteen months after the beginning of the disease, he was very weak and thin, with large abdomen; superficial veins were much engorged, and when seated abdomen reached to the knees of the patient. By palpation an elastic tumor could be made *Berl. klin Woch., May 29, 1899. +Medicine, June, 1899. La Presse Medicale. [JUNE 24, 1899 out, not adherent to abdominal walls and slightly movable as a whole. It extended upwards to the fifth rib on the left side, laterally to a little beyond the middle of the abdomen and downwards to the pelvis. There were no renal symptoms present at any time. Under antiseptic precautions, an S-shaped incision was made from the eleventh dorsal vertebra behind to the median line in front, midway between the umbilicus and the pubis. The tumor, which was adherent at the colon in a few places, was removed. It was then discovered that the ureter and part of the bladder were affected; patient was so weak, however, that further surgical interference was out of the question. Vessels and ureter were ligated and wound was closed. The tumor was reddish in color, with a few indistinct granulations. It weighed very nearly eight pounds, and was eight inches long and seven inches thick. It was solid throughout, except near the point of incision, where there was a small cyst containing 14 ounces of a yellowish, clear fluid. A piece of the tumor examined microscopically showed it to be a spindleshaped sarcoma. Child recovered from the operation and began to gain in general health for a while, but secondary deposits made their appearance all through the abdominal cavity, and child died cachectic with diarrhea and ascites at the end of three months from the operation and fifteen days after the secondary deposits were first discovered. Concerning Operations for Congenital Openings in the Bladder.-J. MIKULICZ* had a case in which a great part of the bladder wall was wanting. He operated at two sittings, first resecting a portion of the ileum (leaving the mesenteric attachment complete) and sewing one open end of the resected gut into an opening in the abdominal parieties, the other end being closed. He now waited seven months to determine the fate of the switched out" portion of ileum. No change took place, so at the second operation he used it to complete the bladder, thus establishing a receptacle capable of holding 100 c.c. Mosquitoes Considered as Transmitters of Yellow Fever and Malaria.-C. J. FINLAY† advances the theory that the faculty of transmitting the yellow fever germ need not be limited to the parent insect, directly contaminated, but may be likewise inherited by the next generation of mosquitoes issued from the contaminated parent. The domestic mosquito" shows no inclination for extensive excursions so long as the female insects find at hand subjects from whom they can draw the necessary blood; the tropical species can not well establish themselves in temperate climates, as he shows by exposing them to a lower temperature in a test tube. When the temperature reached 59° F. the insect became benumbed and fell to the bottom of *Centralblatt für Chirurgie, June 3, 1899. +N. Y. Med. Rec., May 27, 1899. the tube. If entrapped in boxes, parcels, etc., provided that a sufficient degree of moisture and particles of available food exist in their place of confinement, they can be conveyed any distance reached within the term of the insect's life, thirty to thirty-five days. He advocates the protection of houses by mosquito blinds and the disinfection of places where the insects may be bred. into the cord and hemorrhage into the spinal mem- Antistreptococcus Serum in Puerperal Septi- deformity, sudden onset, consciousness not disturbed, cemia and Pelvic Cellulitis.-A. G. DEARDORFF* reports two cases illustrating the rapid and markedly beneficial effect of the use of serum in these conditions. He has also used it in cases of tuberculosis exhibiting pus in the sputum, with great benefit; he considers thirty drops often repeated better than a larger dose usually recommended. A New Modification of the Wedge Excision on the Lips. -DR. J SILBERBERG† describes an operation that is possible only when a little tissue near the angles of the mouth can be retained, an operation calculated to give normal looking red lips; no mere skin scars. If the excision is out of the lower lip he transplants part of the mucous membrane from its mate to it, by moving the angle inward and making the opening smaller. The operation has been done successfully in one case, and seems, after a study of seven "cuts" presented, to be a decided step forward in surgery of the face. Syphlitic Chancre of Larynx.-DR. SARREMANE reported at the meeting of the Societé Francaise D'Otologie, Laryngologie et Rhinologie the case of a man with a syphilitic chancre in the right ventricular band. Cases of primary syphilis of the larynx are difficult to be diagnosticated by themselves, and the secondary manifestations of syphilis are necessary, as a rule, to make the diagnosis complete. In this case the diagnosis was confirmed by the appearance in due season of the syphilitic adenitis and roseola. A Comparison of the Antiseptic Qualities of Asterol as Compared to Sublimate.-M. VERTIM experimented with a one per cent sublimate and a four per cent asterol solution. Bacterium coli commune, proteus vulgaris (Hauser), and streptococcus pyogenes aureus were the organisms upon which the action of the two antiseptics were observed. clusion arrived at was that asterol (a salt of mercury) possesses no important advantage over sublimate as an antiseptic. The con Compression of the Spinal Cord and Spinal Hemorrhage.-A. WOLDERT? discusses the diagnosis of spinal compression, due to fracture, hemorrhage *N. Y. Med. Jour., May 27, 1899. +Centralblatt für Chirurgie. Ber. klin. Woch., May 15, 1899. § Phila. Med. Jour., May 20, 1899. paraplegia with loss of control of sphincters, relaxation of lower extremities, fever absent or moderate; prognosis unfavorable. When hemorrhage is into the spinal membranes, there is a history of traumatism, no deformity, onset slow or sudden, consciousness generally retained, paralysis generally affecting lower extremities and rarely loss of control of sphincters, rigidity of the lower extremities, moderate fever; prognosis guardedly favorable. The Evolution of Twins.-This most interesting article by OSKAR SCHULTZE* brings to light the following salient points: (1) Twin formation results from the action of external influences upon the ovum after fecundation and primary cell division have occurred; (2) it is not the result of more than one spermatozoon entering a single ovum; (3) abnormal cell division of the ovum is responsible for twin formation. author's experiments were performed on the eggs of frogs, and bear upon this subject in man and various forms of lower animals. The Failure of Antitoxin in the Treatment of Diphtheria.-J. E. HERMAN† calls attention to the fact that in late years there has been a decline in the death rate of infectious diseases other than diphtheria, against which no new remedy has been directed. This decrease is due largely to sanitary improvement, a factor which is usually ignored when the antitoxin question is considered. Moreover, these antitoxin statistics are based on cases diagnosticated by the microscope. This has led to the inclusion of cases which would formerly have been classed as simple sore throats, and, in thus increasing the number of cases reported, the case fatality is reduced. Numerous statistics are cited, showing that the actual mortality rate from diphtheria in many places has been greater during the antitoxin years than before its use. Diphtheria exerts its baneful effects especially through sepsis, paralysis of the heart and other organs, impairment of the function of the kidney and the mechanical presence of the false membrane; on none of these does antitoxin act beneficially, but often leads to severe symptoms itself. Until it brings down the diphtheria death rate to a lower point than it ever was before. and keeps it at that point in every place, antitoxin must be considered a failure. *Centralblatt für Path. und path. Anatomy, May 15, '99. +N. Y. Med. Rec., May 27, 1899. The fluoro Examination of an Echinococcus of the Lung With Roentgen Rays.-LEVY DARN* reports a case of echinococcus of the lung, which was located, and the extent and size of which were determined by means of the Roentgen ray examination. scope showed two foci, one in each lung. The author concludes that the process can be explained as follows: Originally there was an echinococcus on the convex surface of the liver, which penetrated the diaphragm and the pleura and broke through into the lung, where a tumor about as large as a fist soon developed in the right upper lobe. At about the same time, by means of the distribution of the echinococcus material, caused by the coughing, expectoration and inspiration of the patient, there took place a similar growth in the other lung. The echinococcus of the sac of the right lung after two years broke through into the bronchus. The left cyst is at present still there. By means of the Roentgen examination the author purposes to study the further development of the cyst and to determine by this means when operation is advisable. The Diagnosis of Trichinosis Made Through the Increase of Eosinophilic Cells in the Blood.A. D. ATKINSON† reports a case of trichinosis occurring in a cook who had eaten large quantities of raw meat. The whole aspect of the case on first appearance was that of typhoid fever or grip, but edema of the eyelids led to investigation as to the character of his food; blood examination showed marked leucocytosis, with marked increase in the eosinophiles; this blood examination, edema of the eyelids, history of eating raw flesh, and myositis of which the patient complained, led to the suspicion of trichinosis. Nonencapsulated trichinas were found in a section of excised muscle. Systematic blood examination showed a gradual and constant decrease in the number of leucocytes and eosinophiles. Treatment consisted in an iron, quinine, and strychnine tonic, together with nourishing food and an occasional purge, and in six weeks the patient was discharged in good condition. New Operation for Epithelioma of the Lip.W. W. GRANT describes the following method: A straight perpendicular incision is made on both sides. of the diseased area and extending well below it; these are united by a transverse incision, removing a quadrangular block of tissue. From each lower angle of the wound an incision is then made, obliquely downward and outward over the upper and lateral surface of the chin, the length, an inch or more, to be determined by the amount of tissue removed from the lip. These incisions give two large triangular flaps, which, with little traction, slide easily over the stationary *Ber. Klin. Woch., May 15, 1899. + Phila. Med. Jour., June 3, 1899. IN. Y. Med. Rec., May 27, 1899. tissue of the chin. The flaps are first united in the center by four interrupted silkworm-gut sutures and the lower borders by continuous catgut sutures. The incisions are confined to the elastic portions of the lip and cheek; there is less tension of the lip, and it is more prominent and natural in consequence than after the old V-shaped incision. Further Considerations of the Mechanism of Ear Vertigo and Its Relief by Removal of the Incus.-BURNETT. * Ear vertigo results from irritation emanating from some part of the auditory apparatus and conveyed through the ampule of the semicircular canals to the motor filaments of the auditory nerve, the peduncles and the cerebellum. This irritation results usually from compression of the labyrinth fluid and the ampulæ, as in cases of impaction of the stapes in the oval window, resulting from parotitic metastases, chronic catarrhal otitis media, etc. The paroxysmal nature of ear vertigo can be explained only by assuming that it is due to temporary increase in retraction and impaction of the stapes in the oval window, or temporary engorgement of the labyrinth from within, without compensatory yielding of the stapes. The fact that the removal of the incus and liberation of the stapes produces a cure in these cases is offered as a proof positive demonstration of the correctness of this theory as to the cause of ear vertigo. The author reports a case of chronic tympanic vertigo resulting from mumps, completely and apparently permanently cured by removal of the incus. Are there Streptococci in the Vaginal Secretions of Healthy Women During Pregnancy and Labor? -GOENNER shows, through a review of the literature, the difference of opinion existing among leading authorities on this point. This he attributes in a great measure to faulty technique. He finds that the results of his recent investigations, carried out with special reference to the technique, correspond with his results published in 1887. Cultures were taken from the vaginal secretions of 100 women, 57 pregnant, 43 in labor, before examinations had been made or douches used. In only five cases were cocci in chains found. These the author does not consider pathogenic streptococci pyogenes. Their microscopic appearance differs from that of the pathogenic form, and they grow differently upon the culture media. White mice, a very susceptible soil, were inoculated with a bouillon culture, but presented neither local nor constitutional manifestations of an infection. The presence of the staphylococci in the vaginal secretions is generally accepted, consequently the author wishes no mention of their frequency in these investigations. He concludes, however, that the streptococci are not present. *American Journal of the Medical Sciences, April, 1899. +Centralblatt für Gynäkologie, May 27, 1899. Obscure Causes of Disease.-W. S. GLEASON* presents a résumé of the present knowledge of the ob scure causes of disease arising from poisons generated by faulty cell interchange and from poisons generated in the intestinal tract. A number of conditions of systemic auto-intoxication can be directly traced to faulty liver metabolisms; the bile and urine are considered with regard to their relation as causative factors, and gout, rheumatism, diabetes mellitus and acetonuria are briefly discussed with reference to their etiology. Our Therapeutics.-J. V. SHOEMAKER† dwells. upon the importance of the recognition of certain blood-changes, and especially toxemia, in our therapeutics. With the improved equipment and perfect technic of the present we are better prepared to take up the pathology and therapeutics of the blood than heretofore. Many alterations in the blood are still beyond our means of recognition except through their effects; these may be divided into three classes: (1) those in which there is a diminution or absence of certain principles of the blood which are necessary for perfect cell-development and metabolism; (2) those in which certain principles, normally present in the blood, are in such relative or absolute excess as to disturb metabolism; (3) those in which abnormal elements in the blood disturb cell action and cause manifestations of disorder or symptoms of disease. The recognition of the rôle played by toxins in producing disease, and the therapeutic value of anti-toxins and organic extracts, has given us a new class of remedies whose numbers will still be largely increased. Peripheral Nerve Transplantation.-PETERSEN reports a case in which the sciatics of a dog were transplanted successfully between the severed ends of the median and ulnar nerves of a man. The ideal method of repairing neves whose continuity has been broken is through suturing the proximal and distal fragments. A loss of nerve substance sometimes renders this impossible. Such was the condition in the case reported. The median and ulnar nerves had been severed and lacerated by a circular saw. Four centimeters of each sciatic nerve of a dog were resected and transplanted between the ends of the severed nerves. Within two months sensation in the hand was complete, sense of touch perfect. Motion of the hand was good and strong. There was some atrophy of the interossei muscles and a slight contraction of the flexor tendons. The author goes into detail concerning the regeneration and degeneration of severed nerves and the method of repair. The regeneration of the divided nerve takes place from the central undegenerated end, as outgrowths from *N. Y. Med. Rec., June 3, 1899. +Jour. Am. Med. Assn., June 3, 1899. ‡American Journal of the Medical Sciences, April, 1899. the axis cylinders. Transplantation of a peripheral nerve is simply an attempt to provide a path of least resistance for the down-growing axis cylinders. Twenty cases of nerve transplantation are carefully summarized and compared with the author's own experience. He concludes that: (1) nerve transplantation is a legitimate surgical procedure; (2) at least partial and at times complete restoration of sensation and motion follow; (3) regeneration is due to downward growths from the axis cylinder of the central end; (4) the longer the time after operation the more favorable will be the results; (5) return of sensation usually precedes that of motion; (6) the rapid return of sensation must be explained by collateral nerve supply. A Case of Dystopia of the Left Kidney Combined with a Uterus Unicornis Dexter.-FRANK* reports a case in which he could, through a vaginal examination, locate a tumor joint in front of the sacro-iliac articulation, extending to the parametrium. It was about the size of the fist, slightly movable, very sensitive to pressure, and presented to the trained touch slight elevations and ridges. A tumor of the adnexa" was offered as a diagnosis, and surgical interference recommended. Upon operation, the socalled tumor was found to be the left kidney with its convexity toward the median line, the pelvis pointing upward and outward. A nephrorrhaphy was made. It is worthy of note that, while acquired movable kidney is almost invariably on the right side, the congenital dystopia, as in this case, is on the left. The uterus unicornis and the dystopia are to be attributed to disturbances in the development of the uro-genital tract. The author considers his mistake in diagnosis a palpable one, since the position, shape, size and elevations on its surface all pointed to a tumor of the adnexa. The Anesthetizer as a Specialist.-D. H. GALLOWAY believes that the people seem to be more alive than the profession to the desirability of expert anesthetizers, but that surgeons also are now awakening to the necessity of skill in this as well as in other departments of medicine. The anesthetizer will have to make his own place in medicine, and as soon as he has demonstrated the value of his services the profession will concede him the position which the importance of his duties entitles him to occupy. After discussing the qualifications necessary in one who would be considered an expert anesthetizer, Galloway defines his duties, from the time he meets the patient until after the operation is completed and the patient has regained consciousness. The prevailing mode of compensating the anesthetizer is radically wrong and results in dissatisfaction to all parties concerned. *Centralblatt für Gynäkologie, May 20, 1899. + Phila Med. Jour., May 27, 1899. |