oped within a radius of twenty-five miles in the Otter Creek Valley one hundred and forty cases of acute infantile paralysis. The disease had been only rarely observed until this time, one or two cases a year only having occurred. But this sudden epidemic caused great alarm to the entire population. Children between the ages of two and ten were the chief victims, though a few cases were observed among the adults. There seemed to be no doubt that the disease was a true anterior poliomyelitis, for it was possible from the symptoms and history to exclude an epidemic cerebrospinal meningitis. The paralysis was of the acute atrophic type with reaction of degeneration in the muscles and that peculiar selection of different muscles which is known to be characteristic of anterior horn disease. It was not attended by sensory symptoms or anesthesia or by any disturbance of the bladder or rectum and bed sores did not occur. In the majority of the cases a partial recovery took place, but most of the children were left with a permanent paralysis in one or two muscles. The occurrence of such an epidemic is certainly proof positive that in some cases anterior poliomyelitis may be regarded as an acute infectious disease.

We know that epidemics of acute multiple neuritis occur, chiefly in trop ical countries, although the forms which we see in this country are usually consequent upon the toxic agents or subsequent to other infectious diseases.

Anyone who has had the misfortune to watch a case of Landry's paralysis in which a rapid extension of total paralysis of motion and sensation occurs from feet to body, to arms, to neck and to face and death comes within a week, must admit that the appearance of the patient is convincing that an infection is pres

ent.

I cannot enter into a discussion of the possibility that chorea, endoarteritis and acute rheumatism, three diseases very closely allied, are due to a single germ affecting different organs in different individuals; but there is much to be said in favor of this view.

Lastly, one must not forget the evident causal relation between numerous forms of nervous disease, especially locomotor ataxia and paresis and the poison of syphilis. Tabes and paresis are not syphilitic diseases in the sense that a gumma is, but that they are sequelae which are directly dependent on the existence of a previous attack of syphilis is undoubted in the large majority of the cases.

It is my firm conviction that as the knowledge of infectious diseases increases, their active relation as causative factors in nervous affections will become more evident. I think I have. cited a sufficient number of examples to convince you of this fact.

CONCLUSION.

In conclusion I think it may be stated that the essential lesion in functional and organic diseases of the nervous system is a change, temporary or permanent, in the chemical and physical condition of the neuron. This change is the same in kind whatever the cause. Such a change may be produced by over-work, by imperfect nutrition, or by active poisoning from toxic agents produced within the body or from toxic agents of an inorganic or organic type received from without, the last named being in many cases germs or their products. Such a classification of the causes of nervous diseases has a great therapeutic significance, as I have tried to show in the course of this discussion. If it leads to practical results in your hands, in the successful treatment of this great class of affections, my object will have been attained.

SOCIETY REPORTS.

CLINICAL SOCIETY OF

MARYLAND.

STATED MEETING HELD MARCH 29, 1895.

In the absence of the President, Dr. James McShane was elected President pro tem.

Dr. E. J. Bernstein read a paper on EAR COMPLICATIONS IN LA GRIPPE. (See page 47.)

Dr. Hiram Woods: I think it does not matter so much what syringe we use as how carefully it is used. One of the best methods for cleaning the ear with a small perforation is to put peroxide of hydrogen into the ear, the patieut lying with the affected ear up and having him swallow while the mouth and nose are held closed. In this way the solution is forced into the tympanic cavity and thus passes on down into the throat. As regards his remarks about the use of cold in mastoid cases, I have frequently seen good results therefrom, but my experience with Wilde's incision is so satisfactory and it is such an easy operation, I rely upon it a great deal, and when patient will consent it is my favorite way of treating mastoid complications. My experience does not lead me to think that the statement made is correct that children suffer more acutely than adults. Some of the most severe suffering I have ever seen was in a case of otitis media in adults. As regards the cases occurring after this present epidemic of grippe, I have seen many cases of acute aural catarrh and the principal feature that impressed me was the rapidity with which the tympanum was perforated after the first onset of symptoms and the marked and persistent amount of deafness as compared with the evidences of local inflammation. I have also seen two or three cases of inflammation of the external ear as the sequel of grippe, one of which was that of a young lady nineteen years of age who had just recovered from what was supposed to be grippe. Her first trouble appeared as an abscess on the cheek, this followed by another on the left side of the nose, and a week later she appeared with a dermatitis of the left side of the face, protrusion of the auricle,

swelling over the mastoid, but suffering little pain. The temperature never went above 100°, pulse varied between 80 and 92. Her left eye was entirely closed by edema of the lids and the mastoid was tender, especially towards the upper part. Wilde's incision was performed but no pus was found. This condition of edema of the cheek persisted for several days, and finally pus appeared in the mastoid cut, well up over the pinna. While this was going on she developed edema of the right side of the face, with the occurrence of two or three furuncles in the right external ear. I instituted constitutional treatment of iron, strychnia and salines and the patient is now practically well. At the hospital I have seen two or three cases resembling this of diffused otitis externa and showing no middle ear disease at all. These cases all gave a history of having had so-called grip.

Dr. Harlan: In the cases of otitis media said to be the sequel of grip I have seen nothing peculiar that was referable to the previous disease, and they were all to be treated as ordinary otitis media. Dr. Bernstein spoke of the application of cold for the relief of pain but said nothing about the use of heat. I have found that even more satisfactory, and usually use it in the form of hot poultices or hot water injections into the ear.

Dr. Edward M. Schaeffer read a paper on SANITARIUMS. (See page 1.) Meeting then adjourned.

H. O. REIK, M. D., Secretary.

CORRESPONDENCE.

NEW YORK LETTER.

Editor MARYLAND MEDICAL JOURNAL:

Dear Sir:-The all-absorbing topic here at present is the antitoxine treatment of diphtheria; the discussion on this subject held recently at the Academy of Medicine indicates that the results obtained by the use of the now famous horse serum are unfortunately not quite so happy as those shown by our Parisian confrères. Dr. Hermann Biggs (to whom is due the credit of having first introduced this method of treatment

into this country from Berlin) in a very carefully prepared paper strenuously advocates its efficiency, basing his conclusions principally on observations at the Willard Parker and other city hospitals and citing a large number of cases of a varied nature. These observations go to prove that antitoxine, although ef fective in the majority, is not quite the specific we at first thought. Dr. Joseph E. Winters had hoped that antitoxine was the great discovery of the age but was sadly disappointed that it was distinctly very harmful in a great number of cases; many of these observed by him at the above hospitals in which death had occurred he attributed the termination to the use of antitoxine, the postmortem examinations showing that death was due to pneumonitis, such as we get in septicemia cases. Great stress was laid on the fact that the fall in rate of mortality was due in part at least to the more general use of the O'Dwyer's intubation operation and furthermore that as horse serum dissolves red corpuscles of the blood á priori, the use of antitoxine undoubtedly increased the already present anemia, defeating the object of all former methods of treatment. There is There is a rapidly growing belief that KlebsLoeffler bacillus is found in a great many pathological conditions other than diphtheria and many practitioners have given up the use of antitoxine excepting where there is distinct clinical evidence of the disease.

At the meeting of the Medico-Surgical Society, Dr. Frederic Lyons read a very thorough paper on "What is Gonorrhea?" illustrating the great importance of making frequent microscopic examinations in all cases before pronouncing them cured, i. e., where all discharge had ceased but which still had present colonies of gonococcd. These latter occupied a very important place in the etiology of all female pelvic affections of an inflammatory character. His method is to obtain "scrapings" from the urethra, using a sterilized platinum wire for this purpose. The above Society is a quite recent organization, select, inasmuch as the membership is limited to one hundred and holding its meetings

at the Madison Avenue Hotel, has as one of its principal features a very enjoyable social atmosphere.

Symphysiotomy was the subject before the New York County Association. Dr. Lusk, in opening the discussion, stated that the chief objection to the operation was that we did not seem to obtain nearly as good results as our brethren in France. This he attributed to suturing the bony parts instead of the cartilaginous attachments and further stated that he had not seen a single case of perfect union in this country. Dr. E. E. Tull, who has just returned from Paris, thought that they (the Parisians) performed the operation oftener than necessary, as within one month at the Hospital Baudelocque thirty-nine symphysiotomies had been done, whereas formerly not as many craniotomies in the same space of time. This latter gentleman was called to Paris to do a Cesarean section but instead of this only found it necessary to remove a fibroid from the cervix, per vaginam, delivering the patient at full term normally.

A committee was appointed to inquire into grave charges made against certain opticians who had dared, however unconsciously, to prescribe glasses for such ophthalmological affections as albuminuric retinitis; incalculable harm has been done in this way and query made as to whether this was not illegal practicing.

Recent arrivals from Paris give the information that Laborde's method of resuscitation has been discussed widely, It is opposed mainly by Professor Pinard of the Hopital Baudelocque, who found by experiment that it is inferior to insufflation by Ribemont's tube. One of the most virulent cases of leprosy was isolated here last week. A portrait of the late Dr. Valentine Mott has been presented to the Academy of Medicine. It has been urged here recently that the teaching of gross pathology is being neglected and overlooked in the craze for microscopic work and there is undoubtedly some truth in this; the various colleges are paying attention to the matter.

R. HARCOURT ANDERSON, M. D.