peculiarly striking symptom. The most frequent cause of this symptom is probably rachitis depending upon too abundant carbohydrate diet, where the soft bones and relaxed muscles are not in condition to bear the body weight. Return to rational feeding by diminishing the carbohydrates and substituting milk, butter, cream and cod liver oil results in rapid recovery, especially if at the same time fresh air and sunshine treatment, salt baths, massage of the trunk and extremities are carried out. Another frequent cause of the giving way of the lower extremities in children in diphtheria paralysis. If the history does not tell of a recent diphtheria or throat trouble the diagnosis may be safely taken for granted if there is an existing nasal voice or strabismus or regurgitation of fluids through the nose. In cases of infantile paralysis (pioliomyelitis anterior acuta) the development of paralysis after an acute febrile attack accompanied by convulsions is characteristic. Upon examination there is found to be paralysis and after a time marked atrophy of certain muscles or muscle groups. The possibility of hysteric paralysis should not be forgotten, even in very young children; sometimes an attack can be the starting point of functional disturbances. Among those diseases which are rarer yet not to be lost sight of are, brain affections, e.g., cortical sclerosis or cerebellar tumors, cord affection, e.g., Fredereich's ataxia, compression. from vertebral caries, myopathies, e.g., paralysis pseudohypertrophica, arthritic diseases, bone diseases, e.g., osteomyelitis. All of these diseases are accompanied by destructive changes which may be recongized by careful examination.

A New Sign of Heredity Syphilis.-(W. P. Jukowski, Med. Obs. Ixiii, No. 7; quoted Archiv of Pediatrics.)-The author begins with a short critical survey of the usual symptomatic aids to the diagnosis of hereditary syphilis and pronounces most of these signs and symptoms to be inconstant and unreliable. He then describes a new sign which consists in a peculiar dryness and mobility of the epidermis. In the new-born presenting slight atrophy we find this phenomenon only in certain regions, as on the chest, the abdomen, the neck, sometimes only on palms and soles. In cases of syphilis, however, the entire skin is loose and covers the underlying cuticle like a thin skirt. When the child moves, the loose epidermis is thrown into folds and presents a curious wavy surface. The entire picture is very characteristic and cannot be mistaken for anything else. So much can be observed immediately after birth. In a few days the appearance of the skin

slowly changes, owing to deep cracks which now come to view and to the accompanying desquamation. The fissures go through the entire skin, and the bleeding stripes and spots give the surface a variegated aspect. There is no icterus. In severe cases the infants were completely aphonic and died within six days. No other known symptoms of syphilis were present in cases studied by the author. This new diagnostic feature, if it can be confirmed will evidently acquire great importance, owing to its very early presence. The author also goes into a discussion of the histological bearing of his symptom.

The

Whooping Cough; Its Prevention and Treatment. (Louis C. Ager, Brooklyn Med. Jour. Nov., 1905) opens his rather comprehensive paper with the statistical statement that whooping cough causes more deaths than typhoid fever. The danger lies in the complications, especially convulsions, bronchitis and pneumonia. In a historical review of the disease he mentions this fact: In England and Wales from 1881 to 1890 the mean annual death rate for children under five years was 12.97 for respiratory diseases, 4.35 for diarrheal diseases, 3.37 for pertussis, 3.13 for measles and 1.67 for scarlet fever. Etiologically the disease appears to be due (not fully established) to a short bacillus resembling the influenza bacillus, is transmitted through expectorated mucous of infected individuals and may be carried by third persons or infected clothing and utensils. diagnosis is easy when the characteristic paroxysmal cough occurs accompanied by whoop, but for purposes of prophylaxis isolation, etc., the author seeks early symptoms. Among these, a leucocytosis, 10,000 to 20,000, the increase being principally in small and large lymphocytes, paroxysmal croupy cough, especially at night without auscultatory signs of bronchitis; adenoids must of course be excluded. Much value is placed by some on the occurrence of ulcer on the frenum. The urine is said to be present certain characteristic changes, being pale and clear of high sp. gr. 1022 to 1035, the change being due to increased uric acid excretion. In considering the therapy of whooping cough he mentions the waning popularity of belladonna and antipyrine, and later of antitussin. He condemns the "do nothing" plan, and recommends the use of formalin inhalations, being convinced that the length and severity of attacks are much diminished (to three or four weeks). The formalin acts as a disinfectant and expectorant. The formaldehyde may be generated from a small lamp or an aqueous solution may be sprinkled about the room,

upon the clothing and bed of the child. In addition to this he gives a combination of apomorphine muriate and codeine phosphates. Apomorphine 1-30 to 1-16 gr. every half hour for several doses with longer intervals between paroxysms. Digitalis should be given to steady the heart when it is needed. He speaks favorably of the use of elastic bands about the middle of the trunk. He personally used unbleached muslin fastened with safety pins like a post partum binder. It is of value to pull down the jaw during a paroxysm, and to try to train the children to cough with the lungs full of air.

Streptococci and Antistreptococcic Serum.(Herbert D. Pease, Med. Rev. of Rev., September, 1905).-In that part of this article treating of scarlet fever we find that the best results obtained by this serum are those re. ported by Moser and a group of Austrian investigators using the Moser-Paltauf serum in scarlet fever. This serum is prepared by immunizing the horse with cultures of streptococci obtained from the heart's blood of fatal cases of scarlet fever. The dose recommended is 200 cubic centimeters and should be given early. Escherich first used Marmorek's serum with unsatisfactory results. He reported 142 cases treated with Moser's serum. Effect is seen within four to twelve hours. All symptoms are improved without shock or collapse. Temperature falls, pulse and respiration diminish, and nervous symptoms subside. The serum should be given before the height of the disease is reached. The sequelae, otitis, endocarditis, nephritis are not prevented nor influenced, unless the serum is given early in the disease. According to Esherich the death rate in St. Anna Kinderspital was reduced from over 12% to 6% since the use of the Moser serum.

OPHTHALMOLOGY.

WALDEMAR FISCHER, M. D.

Accident with Adrenalin.-David de Beck, Seattle, Washington (Annals of Ophthalmol ogy, July, 1905), reports that a man aet. 37 with a plastic syphilitic iritis, begged that something be done to remove the congestion from the eye, which he feared would prove injurious to his business interests. Several instillations of adrenalin chlorides P. D. & Co., were made. The patient returned the following day complaining that the eye pained him severely about an hour after the adrenalin had been used. An examination revealed a hyphema which filled one-half of the anterior chamber, and was accompanied by the usual impaired vision. The

blood in the anterior chamber was resorbed in the course of four days, the vision being entirely regained. The author reports the cases, as he wishes to direct the observation of others to this rather unexpected result from the application of adrenalin.

Radium in Trachoma.-(J. C. Beck, Chicago, Annals of Ophthalmology, July, 1905.) -The results from the application of radium in iritis, irido-cyclitis and optic atrophy are not as satisfactory as Darier reports. These affections are not influenced by it radioactivity at all. There is, however, a decided improvement and a permanent cure of trachoma. The exposures are at first ten minutes daily, later for thirty minutes three times a week. Burns seldom occur, although some cases show a marked reaction to the treatment.

Inoculation of Rabbits' Eyes with Luetic Material. (Dr. W. Schultze, Berlin, Friedenau, Klin. Monatsbl. f. Augenheilk.)-Very little original research was attempted in this connection as long as the dogmatic belief that syphilis is a disease of man only, was universally accepted. The interesting results obtained by other and very recent investigators in this field, led the essayist to attempt the inoculation of rabbits' irides with syphilitic material. Animals do not contract lues like man, but they can be inoculated with it, as has been demonstrated by perfecting the technique of inoculation. The author carefully inoculated the irides of 28 rabbits from primary lesions, mucus patches and gummatous organs, and lastly from one inoculated animal to another, and in every instance on the third day the injection about the focus of inoculation became intensified, the cornea and aqueous humor became cloudy. The iris became hyperemic, lost its markings, and the pupil became contracted. A thickening of the iris occurred, especially about the focus of inoculation on the fourteenth day, when the acme of the inflammation had been attained, after which all symptoms gradually subsided excepting the nodules which became circumscribed and distinct, and might be slightly visible for three months before their final disappearance. The animals suffer from constitutional symptoms, as drowsiness, ulcerations on the skin, . rhagadae on their lips; some even die. The microscopic findings confirm the clinical picture. Syphilis is probably due to the cytor rhyctes luis of Siegel, they may be classed under the protozoa. They are very minute, their greatest diameter being one-half to two and one-half u., their longest flagellae measuring about 10 u. The pathologic process is

slow, involving chiefly the vessels of the iris. The intima of the arteries becomes loosened, the interstitial increases until the third week when the iris attains its greatest thickness. The vessels have a distinct hyalin colar, and the tissue about the larger vessels becomes edematous. The cytorrhyctes luis are found in the tissue juices, in the connective tissue elements of organs, in the plasma or ground substance, but never in the nucleus of cells.

EDITORIAL NOTES.

Prof. Hjort, of Christiania, died at the age of 70 years. His best known, work was on the "open treatment" of ocular wounds.

Geheimrath Dr. Wm. Hess, of Mainz, died August 27th in this 75th year. He was one of the founders of the Heidelberger Ophthalmological Society and a close friend of Albrecht v. Graefe.

Hofrath Dr. Schubert, of Nürnberg, died in his 56th year. He was a pupil of Herman Cohn, and deserves great credit for his introduction of vertical writing as well as many other improvements in school hygiene.

Brettauer, of Triest, died July 11th of bronchopneumonia. A personal friend of both v. Grafe and Arlt, he cherished the traditions of the golden ophthalmological age. His costly collections of medallions, drawings and other productions of art relating to ophthalmology can be classed as an unicum. Geheimrath Prof. Dr. Schweigger died in his 72d year after a long illness, which eventually led to a paralysis of most of his mus. cles. While the assistant of A. v. Graefe he published important contributions on Embolism of the central retinal artery and on albuminuric retinitis. Schweigger sojourned in the United States for a limited time, when he was recalled to Goettingen as professor from where he was transferred to the University of Beriln as Graefe's successor. His best known contributions to ophthalmology are those about squint, glaucoma, cataract operations, his test-types and his hand-perimeter. manual on the use of the ophthalmoscope enjoyed a wide circulation, and his text-book on ophthalmology was extensively used before the advent of the master text-book of Fuchs. Schweigger's best known pupils are Horstman, Silex, Roth, Greeff and Abelsdorf.

His

Never incise a swelling in the course of a large artery without making sure first that it is not an aneurism.

SOCIETY PROCEEDINGS

MEDICAL SOCIETY OF THE NEW YORK POLYCLINIC MEDICAL SCHOOL AND

HOSPITAL.

Stated meeting held November 6, 1905. The President, Dr. J. J. MacPhee, in the chair.

GALLSTONES.

The next patient, presented by Dr. John A. Bodine, was 72 years of age, the mother of a large family. She had suffered more or less pain in the region of her stomach all of her life, but had attributed it to indigestion, never at any time having been jaundiced. physician a few weeks ago. Pain became so severe that she consulted a A diagnosis of gallstones was made, but the speaker did not make up his mind whether or not to advise an operation because of the patient's age. Palliative measures were suggested. Later, she demanded relief at any reasonable risk. When the abodmen was opened an appalling mass of adherent omentum and intestines was encountered. The line of cleavage was quickly found and the adhesions broken up. In a bed formed by the adhesions between the colon, omentum and liver thirty-six large There was no bile gallstones were found. and not a trace of the fundus of the gallbladder. As soon as the last stone, which was impacted in the neck of the gall-bladder, was removed, bile made its appearance. As there was no gall-bladder to suture to the wound, the margins of the adventitious cavity containing the gallstones were sutured to the abdominal wound and a tube inserted for drainage.

This case illustrates the amount of destruction that may be accomplished with no symptoms other than those attributed to a longcontinued dyspepsia; and it also shows that at 72 years the age-limit of the beneficence of general surgery has not been reached.

PARALYSIS OF THE FACIAL NERVE.

Dr. Bodine also showed a patient on whom he had operated five days previously for paralysis of the facial nerve. Twenty-three years ago the woman had had facial erysipelas, which was followed by facial paralysis. At present there was ordinary atrophy and flaccidity of the cheek, the staring eye and the mouth twisted over to the well side. attempt to cure this patient seemed justifiable, as six cases had been reported in which the dead facial nerve was attached to a nearby motor trunk and two patients had been used. The best results, however, fol

An

low those cases of facial paralysis due to traumatism, as in mastoid operations.

The speaker said he had not attempted an operation for a long time that was easier, technically, than the one he performed on this patient. The facial nerve in this case was represented by a mere fibrous cord, in which, however, some axis cylinder was discovered. The spinal accessory nerve was not utilized, for if it is not cut in two and an end to end anastomosis performed, every time the patient laughs the shoulder jerks. If the nerve is divided, there is a troublesome atrophy of the shoulder muscles.

For anatomical as well as physiological reasons, the motor nerve selected was the hypoglossal. The muscles of the tongue supplied by this nerve are in closer communication anatomically and physiologically than those of the spinal accessory, although the latter nerve is much more easily found and identified.

After the incision through the skin and superficial fascia, beginning at the level of the external auditory meatus and extending downward for two inches along the anterior edge of the sternomastoid muscle, one must be careful to separate the carotid gland from the anterior edge of this muscle without injury to its capsule, otherwise the carotid secretion will flow into the wound. Retracting the carotid gland toward the edge of the sternomastoid muscle posteriorly one may readily identify the styloid process, and winding around its base is always to be found the facial nerve. It does not require five minutes to expose and identify this nerve. The transverse process of the second cervical vertebra is next identified and just anterior to this and posterior to the internal jugular vein, beneath or imbedded in the loose fascia, is the pneumogastric and hypoglossal nerves. The positive identification of the hypoglossal is made by pinching it with thumb forceps, or by electrical stimulation. Usually, however, the more superficial of the two nerves is the one in question. slit is made in the sheath of the hypoglossal nerve, and after cutting the divided facial nerve wedge-shaped, the latter is wedged into the slit and held by two sutures through the sheath, and the wound closed without drainage. Up to the present time the result had been good, but three or four months must elapse before permanent results would be apparent.

A

Dr. W. B. Pritchard said that a difference of opinion exists as to how long after paraly. sis occurs anastomosis could be attempted with success. The consensus of opinion is that it should be done within four or five years, as within this period of time the

nerve to a certain extent is in an active condition.

The paper of the evening, entitled

A SERIES OF INTERESTING PATHOLOGIC FIND

INGS.

was read by Dr. F. M. Jefferies. He said, in part:

In the study of anatomy one is impressed by the frequent departure from what is accepted as the standard. A vessel divides anomalously, an organ is misplaced, or there may be a total transposition of the viscera. We wonder at these unexpected variations more than when we encounter unusual conditions in plant life, because we feel that we can account for such alterations by some extraneous influence, the nature of which we may only surmise, or concerning which we must confess ignorance, or we may attribute them to the effects of hybridizing, or again to a natural reversion to the original type.

Throughout the entire practice of medicine one rarely encounters a disease which, so far conforms to its type in all its manifestations as to be classical. In some points it may be deficient, in others unusual phases are encountered. In animal and plant life we recognize the law that like begets like, each genus producing its kind. This law remains unbroken even to the depths of the bacteriologic world. The laboratory worker, because of the nature of his work, encounters a goodly number of phenomena, and such collections are the more valuable because in many instances several years' subsequent history is available.

The first specimen I show you is a fatty embolus of the lung. Fatty emboli occasionally are produced after fractures and after certain operations. A few years ago I was called to make examinations of certain organs to aid the prosecution in a case involv. ing the care of an insane patient in one of the city institutions. The family of the de. ceased accused the hospital attendants of being responsible for the death of the patient. Two hospitals were in dispute as to the accounting for five fractured ribs discovered at autopsy. Those at the first institution at which the patient was confined declared that no ribs were broken when the patient left it; the other as strenuously asserted that he had no fractured ribs when he died, therefore the breaks occurred after death in the handling of the body. In court it was necessary to convince the jury that fatty emboli could not be produced after death.

In the same set of organs a granular ependymitis was discovered. The ependyma is a very thin and delicate membrane lining

the cerebral ventricles. Acute inflammation of this membrane in which small granular elevations are produced on the surface of the ventricles is nicely shown in the specimen.

The next specimen is adrenal tissue found in the kidney. This condition, while regarded as sarcomatous in character, is known as struma super-renalis. I can only conclude that early in the embryonic state a bit of adrenal tissue, possibly only a cell, wanders away from its own and becomes enclosed in a kidney structure, where it remains dormant until some force acts to give it vitality and it forthwith begins to manifest itself by producing its kind. The specimen shown removed by Dr. Ladinski from a woman, 55 years of age. Her trouble dated from the beginning of her menopause, three years previously, so that this particular neoplasm remained dormant for fifty years or more when the physiologic processes of that period in the woman's life were sufficient to excite the foreign cell or cells to activity.

A still more striking exemplification of this wandering character of cells is shown in the next specimen, in which two nodules of apparently normal thyroid tissue are seen embedded in an otherwise normal lymph-gland. This was removed by Dr. Wyeth from the neck of a woman a few years ago.

A malignant adenoma, the structure of which is typical of pancreas, is the next on the list. This was removed from the abdomen of a child nine years of age about a year ago. There were masses of this tissue everywhere in the abdominal cavity, which was greatly distended by their bulk. The child is still alive, but the growth is continuing, and at last accounts considerable trouble was being experienced in securing action of the bowels, and no hope was ́entertained for the recovery of the patient.

A peculiar form of sarcoma is the next specimen. This is from an infant, and was described as a large growth in the abdominal cavity. Its structure, whilst distinctly sarcomatous, is yet arranged in bodies which are, to say the least, very suggestive of malpighian bodies. The tissue came from Dr. Rolster, of Oklahoma City, and no further history accompanied it.

Cancer of the appendix is rare. Primary cancer of the appendix is still more rare, and therefore primary cancer of the appendix in a girl fifteen years of age would hardly be expected. Yet such are the facts concerning the next specimen. The growth was situated at the tip of the appendix, and was not much larger than a grain of wheat. It was. re

He says

moved by Dr. Goffe five years ago. that the patient is still alive and in good health. The girl's family history makes

mention of cancer in other members of the family. One would presume that the prognosis in this case should be good.

Endotheliomata are fairly rare, and most of those reported are associated, in their origin at least, with endothelial membranes. An endothelioma of the jaw is here shown. It is from a man 39 years of age, and was described as a tumor of the jaw the size of a hen's egg. It was attached to the left submaxillary triangle, and was of two years standing It was removed by Dr. Bodine, and the patient is still alive and in good health, although three years have elapsed since the operation.

Many other unique and interesting specimens were exhibited and their histories given, the last three being an epithelioma from a horse, carcinoma from a dog, and a sarcoma from a canary bird.

NEVER attempt to pack a bladder for hemorrhage without the aid of guy sutures; with them one can make absolutely sure that the gauze goes into the bladder, and not on top of it, pushing the organ away from the space of Retzius.

PROPRIETARY REMEDIES. Many physicians are "on the fence" regarding the use of proprietary remedies. They do not know whether to use them or not. The position of the writer can be stated in a few words. Before using a remedy of any kind, I learn all I can concerning it and, if a compound, I learn what it contains, and then study its effect as I do with any remedy whatsoever. Many of our most valuable new or comparatively new agents are "proprietary remedies, and owing to the great expense attending laboratory research the majority of the new agents of the future will be proprietaries. A large number of the elegant and efficient combinations representing the better class of proprietaries are impossible to extemporaneous pharmacy, or to the average druggist. Worthy proprietaries, those that have stood the test of time and experience, are as ethical as officinal preparations. The trouble in their use lies in careless or thoughtless prescribing, advising a line of treatment without having clearly studied the indications. This, however is the fault of the doctor and applies to all remedies. I see no impropriety in the careful use of worthy proprietaries, but I most heartily condemn the great tendency of the so-called" manufacturing "chemist" to foist upon the profession and public cheap. imitations of standard preparations.-W. H. W. in N. C. Med. Jour.