was also considerable sclerosis of certain of the columns of the cord, especially the posterior columns. They believe this to be the first case on record in which a distinct leukæmic infiltration has been demonstrated in the cord in association with leukæmia, and this process appears to be in no way associated with acute parenchymatous degeneration of the cord not infrequently seen in leukæmia, and which appears to be due to the action of some toxine.

The Origin of the Skin Pigment in Addison's Disease.-In the Centralblatt für allegmeine Pathologie for the 2d of January, 1900, PFÖRRINGER discusses this subject. He mentions the fact that Nothnagel, Riehl and v. Kahlden had already done work which tended to show that the origin of the pigment was the blood, and that in v. Kahlden's case this author was able to demonstrate pigment in the leucocytes. The author then gives the history of a typical case of Addison's disease which came under his observation. There was caseous tuberculosis of both supra-renal capsules in which tubercle bacilli were demonstrated microscopically, but there was no marked change in the solar plexus. The author studied particularly the skin with reference to the origin of the pigment. He found the usual changes in the stratum papillare. Further than this he was able to find in the capillaries of this portion of the skin definite collections of pigment granules either free or else in the interior of leucocytes. As to the manner in which the pigment is formed, the author was unable to find any definite answer.

Immunization against Hydrophobia with Normal Nerve Substance.— AUJESKY in the Centralblatt für Bakteriologie for January 6, 1900, reports his observations on this subject. He refers to the experiments of Babes who was able to immunize animals against weak doses of hydrophobia virus by inoculating them previously with an emulsion of normal sheep brain. He also refers to the experiments of Calabrese who reported these experiments but with strong hydrophobia virus and was unable to confirm them. Going on the supposition that the disagreement between the two observers was due to the fact that one of them used weak and the other strong virus, Aujesky reported the experiments of both authors. He was able to show that both were right. A number of experiments made by him showed that dogs could be immunized against a weak hydrophobia virus by being previously inoculated with an emulsion of spinal cord, whilst on the other hand they could not be immunized when a strong hydrophobia virus was used, some of them under these circumstances dying even sooner than the controlled animals.

A Typical Symmetrical Epithelioma of the Supra-Renal Capsules.CARRIERE and DELEARDE in the Archives de Médecine Expérimentale for January, 1900, published an account of a very unusual case of primary bilateral epithelioma of the supra-renal capsules.

They were able to find but six cases on record of primary epihelioma of the supra-renal capsules, their own case making the seventh. The clinical history of the case was that of any case of secondary carcinoma

of the liver. There were during life no symptoms definitely pointing to involvement of the supra-renal capsules. The post-mortem examination showed bilateral nodular tumors occupying the region of the supra-renal capsules and embracing the kidneys. Histologically they were of an epithelial type, and in places the authors thought that they could make out that the new growth originated from the vesicular zone. In summing up their case they make a number of statements concerning epithelioma of the supra-renal capsules which show much interest. The following are the most important of these conclusions:

Epithelioma attacks the right supra-renal capsule more frequently than the left. It can be symmetrcial as shown by this case. The disease is observed preferably between fifty and sixty years of age, and has only been seen so far in men. Generally it is not diagnosed. Almost all observers agree that the symptoms of Addison's disease are absent. The symptoms observed are those due to mechanical compression of the tumor, of cachexia, and those of intoxication. The pressure symptoms are œdema and ascites. The cachexia is that ordinarily accompanying carcinoma while the terminal symptoms of intoxication, such as vomiting, diarrhoea, dyspnoea, somnolence and coma, are possibly due to suppression of the functions of the supra-renal capsules. It is very evident then, as the authors say, that the disease cannot be diagnosed during life, and that surgical intervention is out of the question.

The Role Played by Fleas of Rats and Mice in the Transmission of the Plague.-GALLI-VALERIO in the Centralblatt für Bakteriologie for January 6, 1900, discusses this subject. He refers to an article by Simond in which this author claims that he has observed in a certain number of plague cases blisters somewhere on the surface of the body which contained the plague bacilli and which he thought were due to the bites of fleas from rats and mice. Simond was furthermore able to find in the intestinal canal of such fleas bacilli of the plague. This paper of Galli-Valerio concerns itself with the discussion of the possibility of human beings being infected in this way. The writer shows that the fleas which inhabit rats and mice are quite different from those which inhabit the human being, and he further notes that he was unable in any instance to get fleas from rats and mice to bite human beings. He, therefore, comes to the conclusion that the work of Simond is far from being conclusive.

Areas of Large Cells in the Follicles of the Spleen in Diphtheria and Other Affections.-TITIANA WASCH KEWITSCH in Virchow's Archiv for January, 1900, describes the occurrence of peculiar areas of large cells in the follicles of the spleen in infectious diseases, particularly diphtheria. In this latter disease they had already been noticed, particularly by Oertel and Barbacci, but it had also been noticed by Langhans that they might be present in other conditions than diphtheria. The writer examined a large number of spleens, not only in diphtheria, but also in other infectious diseases, and was able to find the cellular arcas in a number of them. They were present in individuals of all ages, but occurred with much greater frequency in children and in young individuals. The areas

occurred in the form of large, pale cells, generally occupying the centre of the follicles of the spleen, and resembling, some of them epithelioid cells and other endothelioid cells. The conditions in which they were found other than diphtheria were practically all infectious processes. Thus, there were three cases of peritonitis, one of pleuritis, one of pericarditis, two of meningitis, and one of fresh fracture. The condition was also found in one case of congenital lues. The author is inclined to think that the areas are ue to the action of toxine. In some instances there were associated with them in the infected spleen numerous eosinophiles. The author does not give a very satisfactory opinion as to the origin of the cells, but seems inclined to believe that they are changed lymphocytes.

LARYNGOLOGY AND RHINOLOGY

Edited by C. F. Theisen, M. D.

Gonococcic Rhinitis in an Infant.-H. DE STELLA (Report in Internat. Centralbl., November, 1899) gives the history of a child two months old, who had difficulty in breathing through the nose since birth. Numerous gonococci were found in the purulent secretion of the nose. A purulent inflammation of the eyes preceded rhinitis. An otitis media developed later as well as a syphilitic roseola. An examination disclosed the fact that the father had acquired syphilis and gonorrhoea at the same time, and infected his wife.

Smooth Atrophy of the Root of the Tongue in Tertiary Syphilis.-Dr. ALFRED GOLDSCHMIDT. (Berliner klinische Wochenscrift, 23 October, 1899.) In 1863 Virchow called attention to a smooth atrophy of the root of the tongue in tertiary syphilis. Later Lewin and Heller again brought up the question. In 6,583 sections in the Berlin Pathological-Anatomical Institute they found one and one-half per cent. of the atrophy in question. In sixty-nine per cent. of these cases of atrophy, syphilis was proved anatomically. They believe that the symptom outlasts all other appearances and is irreparable. According to Lewin there are three stages of the atrophy:

(1) A general lessening of the glands as to both size and number; (2) an absolute lack of the glands in the central part of the base of the tongue; (3) an entire absence of the follicular glands generally.

Lewin holds that the atrophy exists only in cases of acquired, constitutional syphilis and in nearly half of all observed cases of this, while no certain relation to other sicknesses can be determined. In children it is lacking and women are more affected by it than men. Skladny, on the contrary, found the atrophy also in cases of hereditary syphilis in its latest stages. He examined with Professor Schweigger all the appropriate cases of interstitial keratitis, because, in such cases, the discovery of hereditary syphilis may, with considerable confidence, be expected. He found a high percentage of cases of this kind showing smooth atrophy in cases of hereditary syphilis. This doctrine as to the presence of smooth atrophy in cases of the latest stages of syphilis has not remained without

opponents. Several of these are quoted in this article. The author says that, as regards his own examinations, he must disregard the pathological, anatomical side of the matter and content himself with this question: "How does the smooth atrophy of the root of the tongue present itself clinically?" with special respect to this further question: "Is such atrophy valuable clinically as a pathognomonic symptom of syphilitic disease?"

His conclusion is that the existence of smooth atrophy is not a trustworthy symptom; that flatness of the region of the glands at the root of the tongue may be coincident with imperfect development of the entire tongue, and that therefore the tongue, like any other organ, may participate in the general degeneration of the general organism, and that, on the other hand, there are cases in which there is no tertiary syphilis, but in which, although the tongue is otherwise as well developed as in the average case, there may be found a greater or less atrophy of its root.

Remarks about Bad Breath.-B. FRAENKEL. (Archiv. f. Laryngol. u. Rhinol., Heft. 1, 1900.) The author states that in some cases the offensive odor does not really exist, but is a pure delusion, a subjective sensation, as in paranoia and hypochondriasis. If for example, a person one of these hypochondriacs happens to be talking to, should turn away the head. he imagines that it is on account of the bad smell he is distributing. The author only considers that class of cases in which an odor is perceptible during expiration. In order to make a correct diagnosis it is important to determine whether the odor comes from the nose or mouth. The patient is told to keep the mouth tightly closed and to blow, first through one nostril and then the other. The examining physician brings his own nose close to that of the patient, and is then able to detect any odor in the current of air. The patient then repeats this process by closing the nostrils and blowing out of the mouth. After it is determined that the odor comes from the mouth or pharynx, the suspicious places are touched with cotton so as to find out whether the odor originates in some particular part of the mouth or pharynx. Carious teeth are of course frequent causes. Retained decomposing secretions in the crypts of the tonsils frequently cause the odor. This is particularly true of secretion behind the plica tonsillaris. Applications of antiseptic solutions to the tonsils or amputation of the tonsils is the remedy. Sometimes the entire secretion of the nasal and pharyngeal mucous membrane has the disagreeable odor. In such cases ant:septic douches and mouth washes must be used. It must also be determined whether the odor does not originate in the deeper respiratory passages of the œsophagus.

The Pathology of Intracranial Suppuration of Otitic and Rhinitic Origin.— W. MILLIGAN. (Internat. Centralbl., January, 1900.) The author first thoroughly considered intracranial suppuration following pathological conditions of the ear, and then the intracranial complications resulting from suppurative processes in the frontal, ethmoidal and sphenoidal sinuses. Degeneration of the mucous membrane in these cavities, exposure of the bone with u'ceration, and at times perforation of the same, is followed by

meningitis extradural abscess, abscess of the frontal lobe, or thrombosis of the sinus cavernosus. The pathological organisms may also be transmitted by way of the vessels or through the perivascular canals without any erosion of the bone. The poor drainage favors the retention of the causes a possibility of infection of the cranial cavity at this point. In one case reported by the author an abscess of the frontal lobe followed an empyema of the frontal sinus, and in a second case a basilar meningitis and septic thrombosis resulted.

Gonorrhoeal Stomatitis In L'Independance Medicale for December 13, 1899, PETIT reports an interesting case of gonorrhoeal stomatitis and reviews the literature of this subject. Petit refers to cases reported by Horand, Cutler, Rosinski, Leyden, and Jesionek, in some of which the stomatitis was secondary to a gonorrheal ophthalmia, and in some of which it was due to coitus ab ore. His own case was that of a young man of thirty who consulted hi'n for an inflammatory lesion of the mouth, presenting as an erythematous condition with a good deal of desquamation There was a well marked glossitis with great swelling of the tongue, and the presence of numerous small superficial ulcerations on the removal of the desquamated epithelium. The symptoms were pain, difficulty of mastication, and fever. The breath was extremely fetid and there was swelling of the submaxillary lymph glands. The patient admitted buccal coitus, but an examination of the genitals of the woman with whom he cohabited failed to show either clinically or bacteriologically any signs of gonorrhoea. Cover slips from the mouth of the man showed many biscuit shaped intra-cellular diplococci, which easily decolorized by Gram's method. Attempts to cultivate them on the ordinary culture media were entirely negative; no attempt was made to cultivate them on special media. The author is unable to account for the infection except on the grounds that the woman had a latent gonorrhoeal infection which lighted up from time to time, and had been in a condition of activity at the time of the infection of his patient.

Lupus of the Nose Cured by the New Tuberculin.- HERON. Internat. Centralbl. f. Laryngol. u. Rhin., January, 1899. Patient was a young man aged 27, with lupus vulgaris of left side of nose, internally and externally. Nodules were also present in the lip and ear. Author treated the cases with Tuberculin R. Whole amount injected in three months was 126.5 mg. in sixty-two injections. There was very little rise in temperature after the injections. The diseased parts got entirely well.

CLINICAL MICROSCOPY

Edited by Arthur W. Elting, M. D.

Leucocytosis in Acute Lobar Pneumonia.-LOEPER, in the Archives de Médecine Experimentale for November, 1899, contributes an article on this subject based upon an examination of twenty-one cases of pneumonia. After carefully studying the different phases of the subject he comes to the following conclusions: