his early youth when running about town with the boys, doing different disgraceful things, mistaking immorality for manliness and acting in accordance with that vicious old maxim that one "must sow his wild oats," than which as my friend Dr. Shurly has tersely put it, no more false and dangerous aphorism was ever current. I have asked my friends, the superintendents of the state asylums of Michigan, to give some statistics in reference to paretic dementia and other brain diseases, the result of syphilis, and in this connection desire to express my obligation to them for their kindness and promptness in furnishing the data. There were under treatment in the Michigan Asylum for the Insane, December 1st, 1905, 1,698 patients; in the Eastern Michigan Asylum, 1,220 patients; in the Northern Michigan Asylum, 1,265; in the Upper Peninsula Hospital for the Insane, 611; and in the State Asylum, 315 patients. In the Michigan Asylum for the Insane there were 81, or 4-10 of I per cent. cases of paretic dementia; and of other syphilitic brain diseases 31 cases. In the Eastern Michigan Asylum, 22, or 2-10 of 1 per cent. of those under treatment were cases of paretic dementia, and 11 of syphilitic brain disease. In the Northern Michigan Asylum, 33 or 2-10 of I per cent. of paretic dementia and 5 of syphilitic brain disease. In the Upper Peninsula Hospital for the Insane, 12 or 2-10 of 1 per cent. of paretic dementia and of cases of syphilitic brain disease 1. In the State Asylum, 2 or 6-100 of 1 per cent. (a rather noteworthy and remarkable smallness of number in view of the character of the patients under treatment, the criminal insane) and of syphilitic brain disease, I. As to syphilis as a causative factor in paretic dementia, there is a wide discrepancy of statement, and a general complaint of inadequacy in early histories. Syphilis is recognized as the principal cause in 68 per cent. of cases in the Michigan Asylum; in 50 per cent. in the State Asylum; in 27 per cent. in the Eastern Michigan Asylum; in 25 per cent. in the Upper Peninsula Hospital for the Insane; in 9 per cent. in the Northern Michigan Asylum. From my own personal experience I am compelled to believe that the highest percentage falls short of the truth as to the importance of this disease in the causation of paretic dementia or paresis as it is more commonly called. Taking percentages as we find them, however, or 117 supported at public expense at $200 per year for an average period of three years (the number paying for their own maintenance being practically negligible) we have a cost to the state of $70,200. Assuming that the average age of patients is 35 years, there should be added to this a loss to the state o fthe productive value of the individual for each patient 31.78 years, the average expectancy of life. Estimating this productive ability at the very low figure of $150 per year per person, the amount of loss is found to be $557,739. The total of the two items is $622,939. It goes without saying that if the statistics of the Michigan Asylum for the Insane are true as to paresis generally, which I believe the majority of authors would claim as a fact, that this amount would be more than doubled. At the lower estimate, however, the facts are sufficiently appalling and when it is remembered that the condition with which we are dealing is absolutely preventable, the lesson of the figures is plain. VENEREAL disease iN OPHTHALMOLOGY. By FLEMMING CARROW, A. M., M. D., Detroit. In the five minutes to which the president has limited my paper I can scarcely do more than mention the names of the eye affections caused by specific disease, and but briefly call attention to those which are influenced in their course, progress, and termination, by the presence of the disease in the system. That venereal diseases have a wide spread influence upon the visual organ is well known to you all, but, I think a list of the affections directly attributed to it would surprise you. Taylor has stated that there are 243 distinct and dissimilar diseases of the eye and its appendages, and I may tell you that 17 of them are due directly to syphilis, and that others are so largely influenced by its presence that they may also be said to have a similar cause. It is only necessary for an ophthalmologist to pass through the room of any institution for the reception of the blind, to observe both with his unaided eye and with an ophthalmoloscope the surprisingly large number of the inmates brought there through the affections which we are discussing tonight. First in point of numbers, come those who have been reduced. to a pitiable state of blindness by ophthalmia-neonatorum, one-third of all cases of blindness being attributed to this affection. The large corneal scars and opacities showing the seat of former perforating ulcerations, the large bulging staphylomata, or the shrunken and atrophied eye-ball, the contents of which have escaped through some large perforating ulcer -all attest the frequency of the conditions brought about by gonorrhoeal infection of the newly born. Affections of the lids also bear their silent testimony to the presence of syphilis. The primary sore may be on the lid border or at any inner canthus, the lymph glands in anatomical relation at the angle of the jaw and in front of the ear, are enlarged. Chancres have been observed to develop upon the ocular conjunctiva as primary sores. So characteristic is this that we have the distinct disease of syphilitic conjunctivitis. Interstitial keratitis with deposits into the substance of the cornea causing blindness during the active stages of the disease and impaired vision for the rest of life, owes its existence to inherited syphilis. The stunted growth-the face of an aged man or child-rhagades at the corners of the mouth-the misshapen irregular and serrated permanent teeth-synovitis of the joints and indurated cervical absorbents all accompanying this affection, emphasize the terrible heritage of unfortunate children. So frequently is the specific disease a cause of affections of he Iris that two varieties have received the special names of syphilitic and gonorrheal iritis. The impaired lustre of the iris-the contracted pupil-the adherent membrane to the capsule of the lenses, frequently baffle the skill of the ophthalmologist and reduce the vision of the patient. The extension of disease of the iris to the ciliary body on account of their anatomical relation also yields unfortunate and dangerous consequences inimical to the integrity of the eye-an extension of the disease backward involves the choroid and as a result we have the various forms of choroiditis from which we get differing degrees of impairment of vision according to the location of the affection. Syphilis is also set down as one of the causes of glaucoma. Bos tells us that it causes cataract. Nearly all of the affections of the vitreous—at least those producing vitreal opacities and following choroidal affections are caused by syphilis. We also have syphilitic Retinitis both as an inherited and acquired disease. Primary optic atrophy-(and I am convinced that there is an atrophy without a previously existing optic neuritis) is caused more frequently by syphilis than by any other affection. Syphilis is the most frequent cause of all those cases of oculo-motor paralysis which come under the observation of the ophthalmologist producing annoying diplopia and disfiguring strabismus. Ophthalmaplegia with its characteristic symptoms also is caused by the venereal disease. Nor do the bony orbital walls escape, for how commonly are we called upon to treat caries and necrosis of the bony boundaries of the orbit in the later stage of syphilis. In the same manner, disease of the accessory sinuses of the orbit— the frontal and ethmoidal sinuses-the nasal cavities, all contribute to a list long enough already. It is, however, to the first named disease, ophthalmia-neonatorum-the result of direct infection of the eyes of the newly born, that I desire to call especial attention. A few years ago a committee was appointed by the State Medical Society, of which I was chairman, to influence legislation looking toward the prevention and cure of this disease by making it an offense on the part of nurses and midwifes to neglect reporting cases of this disease falling under their notice. Not a single case has been reported, either in this or other states where a similar law exists, so far as I know. The average midwife or nurse will not take the trouble to report such a case to the local health officer as the law directs. The reasons are very obvious when it is remembered that the husband who infects the wife is also the employer of the midwife or nurse. Cases occurring in the practice of a physician are generally recognized and cured. It is a sad commentary upon the attitude of the midwife towards humanity, that she will allow a case of blindness to be the result of her negligence or cupidity. 512 Washington Arcade. EXTRADURAL ABSCESS RADICAL OPERATION. By EMIL AMBERG, M. D., Master O. C., 14 years old, consulted me for the first time July 8, 1905, in my office. I learned that his left ear began to discharge when he was two years old. that it discharged at intervals for two years and continuously after he had had the measles at the age of four years. For four or five days he complained of intense pain in his left ear. The left tympanic cavity presented the typical appearance which we find in cases of long standing chronic middle-ear suppuration with caries. The drum membrane was destroyed, the discharge was offensive. The probe entered upward and backward into a cavity containing some pus. The patient complained of dizziness, had no appetite, the tongue was coated and he had a septic appearance. He entered Harper Hospital without delay. I intended to operate on the following day or the day thereafter according to the symptoms. In the afternoon the patient seemed to be rather comfortable. When I saw him again after 8 o'clock the same night a temperature of 103.6 and a pulse of 120 were reported. I operated the same night. Besides pus in the mastoid process proper, thin pus was found over the dura posteriorily to the antrum. The pulse became rather threatening during the operation. The patient was almost 6 ft. tall and rather slender. On the next day, July 9th, the temperature was 100.4 at 4 a. m. and 101. at 8 a. m. The patient was again placed on the operating table and the lateral sinus was exposed freely. It appeared normal on touch and slight puncture revealed macroscopically normal blood. At 6 p. m. of the same day the temperature rose to 102.6 and from that time on it went gradually down e. g., on the 14th and 15th it varied from 99 to 98.5 with an exacerbation to 99.4 at 8 p. m. on the 14th. Later on a Panse plastic operation was done. The further course does not present anything unusual. Summarizing, I should like to say that I had before me a middle-ear suppuration of a 10 to 12 years duration in a boy of an unusual height for his age which appeared to me out of proportion to his size. He had submitted himself to continuous tedious treatment. Moreover, he had carried with him an affection which became suddenly very serious. We notice that the mine, so to speak, exploded without much warning. Only prompt interference helped the patient. Before entering the hospital the very intelligent boy asked me the common question, "Doctor, is the operation dangerous?" I answered him, "The operation is not dangerous, but your condition is." The correctness of my remark was demonstrated on the operating table. 270 Woodward Ave. FIRST COUNCILLOR DISTRICT SOCIETY. The second annual meeting of the First Councilor District Medical Society was held Friday, Dec. 22, in Ann Arbor, in the New Medical Building. Papers: The Diagnosis of Intestinal Obstruction-Theodore A. McGraw, M. D., Detroit. Hematemesis Following the Operation for Appendicitis-Elmore E. Butterfield, M. D., Ann Arbor. The Treatment of the Scalp and Hair After Illness-Charles T. Southworth, M. D., Monroe. The Value of Time and Natural Uterine Efforts in Parturition-Alvah N. Collins, M. D., Detroit. Shortening of the Round Ligaments Within the Inguinal Canals Through a Single Suprapubic Transverse Incision, With or Without Opening the Peritoneal Cavity (with lantern slide demonstrations)-Reuben Peterson, M. D., Ann Arbor. Dr Peterson gave an illustrative clinic at University Hospital 4 p. m. The Unsuspected Parasitic Origin of Many Dermatoses-William F. Breakey, M. D., Ann Arbor. Acute Abdominal Symptoms in Typhoid Fever from Inflammation of Mesenteric Lymph Glands, Simulating Intestinal Perforation and other Acute Abdominal Conditions (two Illustrative cases.)-R. S. Rowland, M. D., Detroit. Borderland Cases of Insanity-Irwin H. Neff, M. D., Pontiac. Concerning the Pathology and Operative Treatment of Chronic Suppurative Otitis Media-R. Bishop Canfield, M. D., Ann Arbor. Infant Feeding-Harry F. Taylor, M. D., Mount Clemens. Modern Skiagraphic Technique-Vernon J. Willey, A. M. Ann Arbor. The Advisability of Eliminating the Terms Meniere's Disease and Meniere's Symptoms from the Otologic Nomenclature-Emil Amberg, M. D., Detroit. The meeting was well attended by Detroit and Ann Arbor members, but representatives from other counties were too few. The meeting and the banquet were presided over by Dr. J. A. Wessinger, the president. The banquet at the Cook House brought together enough to tax the seating capacity. Toasts were replied to with well chosen remarks, and carried the meeting late into the evening. SURGERY: DETROIT MEDICAL JOURNAL A MONTHLY EPITOME OF PRACTICE AND THERAPEUTICS HERBERT M. RICH, M. D., EDITOR Frank Burr Tibbals, M. D. EYE AND EAR: COLLABORATORS: Don M. Campbell, M. D. NOSE, THROAT AND CHEST: Henry Jasper Hartz, M. D., Burt Russell Shurly, M. D. ORTHOPEDIC SURGERY: William E. Blodgett, M. D. INTERNAL MEDICINE: Victor C. Vaughan, Jr., M. D. LABORATORY MEDICINE: Preston M. Hickey, M. D. NERVOUS DISEASES: A. W. Ives, M. D. GYNECOLOGY AND OBSTETRICS : PUBLIC HEALTH: Guy L. Kiefer, M. D. J. F. HARTZ, BUSINESS MANAGER SUBSCRIPTION PRICE, $1.00 PER YEAR. SINGLE COPIES, 15 CENTS. NOTE. We do not assume responsibility for the opinions of contributors. The management cannot undertake to return rejected manuscript unless full postage for the purpose is submitted with the contribution. Requests for reprints should accompany manuscript. Address all communications to 103-105 Miami Avenue. Detroit, Michigan, U. S. A. Vol. 6. DETROIT, MICHIGAN, JANUARY, 1906. Additions to Staff. No. 1. The Journal takes pleasure in announcing the accession of Dr. Victor C. Vaughan, Jr., and Dr. Guy L. Kiefer to its editorial staff. Dr. Vaughan will report on the progress of internal medicine; Dr. Kiefer on public health. Report of Detroit Health Board. The annual report of the Health Board of Detroit has appeared. It is an exceedingly interesting and creditable publication, and should be examined by every physician in the city. The members of the medical profession who do not read the reports of the health of his own city certainly cannot criticise the general public for its lack of interest in matters of public health. Among the interesting items is the reduction of the number of deaths from last year from the various contagious diseases; small-pox was reduced from 99 deaths in 1904 to 44 in 1905; scarlatina from 647 to 384; diphtheria from 1,433 to 893. The total death-rate on a basis of 350,000 inhabitants was 13.51; on a basis of 317,000 according to the state census of 1904, the rate is 14.92. The medical inspection of schools is proving very successful and satisfactory. To it the health officer accredits much of the decrease in the number of infectious diseases. It can hardly be doubted that the medical inspection of schools is an important step forward in the elimination |