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if not impossible to draw a sharp distinction tain way about this disease. Some other au. between neuritis and neuralgia, as accumu. thors although they consider otosclerosis as lated facts show an anatomical basis in the an independent disease, do not consider it, in latter affection. 5. In view of these anatom- the same sense as Politzer, Botey calls the ical facts, it is highly important to remove otosclerosis a primary disease without presurgically a nerve affected with so-called neu. ceding catarrh, but includes under this head ralgia as early as possible after a short trial cases of connective tissue adhesions and also of medical treatment is given.

primary disease of the labyrinthian capsulu. Burger and Zwaardemaker speak of these two

forms of disease under the head of sclerosis OTOLOGY.

aurium, this is again divided into progressive ALBERT F. KOETTER, M. D.

dry catarrb and ostitis capsularis.

The work of Möller deals exclusively with Recent Reports on Otosclerosis.- Compila. the otosclerosis in the sense of Politzer and tion of Dr. Jörgen Möller (Internationales speaks in detail of the pathological anatomy Centralblatt fuer Ohrenheilkunde). The liter. and diagnosis, especially the founctional test, ature on otosclerosis is growing so rapidly also mentions the etiology, symptomatology that we are justified, even though Denker's and therapy. As regards the etiology and great work is only two years old, in publish- pathogeny Hammerschlag and Körner have ing a compilation of the work done since reported some interesting researches as rethen; in this resumé several articles will be gards heredity. Hammerschlag reports the mentioned wbich appeared before Denker's pedigree of two families, of wbich one is of book, but were not considered in the same. great importance, the ancestor married twice Otosclerosis is a new disease being first de and in the progeny of the first wife who scribed during the nineties supported by was hard of hearing, many cases of scleronumerous pathologic anatomical examina. sis appeared, whereas in the progeny of the tions. The name itself, at least in its present second wife none appeared. Körner reports importance, emanated from the clinio of the pedigree of three families in the five fam. Politzer and he was the first man to devote a ilies there were no less than forty-three cases special chapter to this disease in bis book on of otosclerosis. It is further of interest that otology. Two years later the large work of Körner reports an unpublished work of HopDenker was published and with this the oto. mann in which the bereditary relations of sclerosis was incorporated as a self-dependent several cases examined clinically and anatomdisease into the system of otology. But it ically were searched and the presence of will be some time before the knowledge of the syphilis could be excluded. Moreover Körner unity of this disease is recognized. Lermogez believes that the heredity of otosclerosis and Boulay mention otosclerosis but only as should be observed in the light of the Weissa special group of the obropic dry middle ear mann doctrine of determinants, the disposicatarrbs, they do not speak of the characteris. tion to disease would be inherited in the tics and do not seem to recognize the shape of a Weissmann determinant, if the proper conception of the disease of otoscler- same becomes active depends on the different osis, of what they consider otosclerosis they external and internal influence, puberty, simply mention two forms which do not puerperium, syphilis and otber diseases, also respond readily to treatment, the juvenile diseases of the mucous membrane of the walls forms of a hereditary basis and the congest- of the labyrinth. By that, an explanation ive form with translucent redness of the mem. would be bad for the fact that the otosclerosis brane. Gradenigo does not recognize the often skips one or more generations and apotosclerosis as a self-dependent disease be parently appears spontaneously. Following cause he believes that it oocurs very frequent. these considerutions Körner wards the female ly as a secondary disease, not only after ca. members of sclerotic families against pregtarrbal lent but also after suppurative diseases. nancy and advises members of such families In England and France otosclerosis is not not to marry so that they may take their derecognized and the modern patbologic apa. terminants uninherited to the grave, tomical examination of the continent are not Botey differentiates between two forms of mentioned. Watson thinks there is no real otosclerosis, one the juvenile beginning bedifference between middle ear catarrh and tween the tenth and twentieth year, frequentotosclerosis, but are simply different stages ly para-syphilitic or para tubercular nature, of one and the same disease. Collier also whereas the other, the ordinary otosclerosis speaks of otosclerosis as such in that he con appearing in middle or late in life of tropbosiders those cases of progressive deafness, in neurotic origin. Möller considers a tropho. which no accompanying middle ear disease neurotic origin of otosclerosis possible espeexists, but expresses himself in a very uncer cially as the two (circumstances often ob

served) that of the canal wall showing atro. ses. A characteristio symptom is tbe rapidphic changes and that solerosis very often 00- ity with which the var loses its sense of ac. curs with atrophic rbinitis. Escat has ob- comodation, so that the first words of a conserved that deafness, tinnitis, pain and hyper- versation are not grasped. Furthermore akusis dolorosa often appear in attacks of mi. those cases which originate from an arthri. graine and that furthermore the majority of tic basis, several times a marked improve. individuals affected with primary otoscler- ment of the hearing has been noticed after osis suffer with migraine. He believes that a typical attack of gout. A new symptom these two diseases can be brought into such mentioned by Lafite-Dupont and Mau petit, relation that they occur on a common dys. namely, that the blood pressure is from 5-11 crastic or toxaemic basis, possibly an auto- mm, consistently higher in the true otosclerintoxication. Mau petit thinks there is a osis, might presumptively play a role in the certain connection between otosclerosis and diagnosis of primary otosclerosis. Mau petit the universal arteriosclerosis. Collier be. brings this symptom in connection with lieves that the otosclerotic process depends his assertion of the dependence of the oto. primarily on an existing nose or paso. sclerosis on a universal arteriosclerosis. Expbaryngeal disease and extends tbrough the amination as to the blood pressure in otoeustacbian tube. An etiologio factor not sclerosis were made by Mengotti but en. often observed is ewphasized by Möller, viz., tirely different results than those of Lafite. that traumas play a certain role in the devel. Dupont and Mau petit were obtained, in fact opment of the disease, not that the trauma he finds intimate relation between the blood cause the disease, but that the disease suffers pressure and solerosis, the (P) blood pressure a severe exacerbation and often is noticed for fluctuates in his cases between 92 and 145, the first time following a trauma.

so that the increase of 5-10 mm. found by As to the pathological anatomy there are the others, disappear entirely compared to reports of three cases, Möller(1), Brübl(2) these fuctuations, the pressure was mostly and all three cases show the well known osse. from 120.140 which is about normal. It is ous changes of the typical otosclerosis. In true that in some cases Mengotti with the Müller's case and in one case of Brühl the improvement of the hearing observed a lowerdiagnosis was made during life time. In all ing of the blood pressure, in' other cases a three cases the microscopic examination rise was noticed. Moreover the figures of the pointed emphatically to primary disease of authors cannot be compared as the examinathe bone without involving the mucous tions were made in different ways and differmembrane of the middle ear, and especially ent apparatus used. in Möller's case a secondary origin after a A symptom pot before mentioned, observed mucous membrane disease or a periosteal by Mygind and also by Möller is the imdisease could be excluded with certainty, provement of the hearing, in the early stages for beside the large focus lying in the par- of a coryza, probably due to congestion of the tition between the tym panic cavity and the mucous membranes caused by the acute calabyrinth, small isolated foci were found tarrh. which at no point reached the surface of the As far as the functional examination is bone. Further the arrangement of the dis. concerned the results of Möller differ very eased bone tissue in this case, the sharply materially from those usually observed as defined outline as opposed to the bealthy tis. characteristic of otosclerosis. Ordinarily the sue, and the ever increasing resorption toward characteristic result is given as Bezold's the older central parts indicate that the prim. triad, but Möller thinks this characteristio ary, as Politzer implies, is a new formation of the ordinary middle ear catarrh but not for of bone to whiob the resorption process later sclerosis. According to Möller we usually joins itself. In the case of Brühl the audi. find shortened bone conduction. Rinne postory nerve had degenerated which can be ex. itive shortened or negative, lower tone limit plained as atrophy due to inactivity,

comparatively little confined, much less than As to the symptomatology and course as in obronic catarrb, upper tone limit markedly reported by the different authors only a few lowered downward. Gelle's test usually negdata are mentioned as the symptomatology is ative, which is not exactly characteristic of well known through former work. Bobone, otosclerosis, but for stapes fixation in general Burger and Zwaardemaker mention the even when of catarrhal origin, Möller in peculiar dryness and the great width of the going over the literature on the subject external canal. A further condition noticed finds in a good many cases a lowering of by the latter authors in true otosclerosis, the the upper tone limit without the author ostitis capsularis is the extreme whiteness Jaying much stress on it, whereas, Möller and acute angular position of the handle of considers it one of the main points. In the the malleus, it often has punctuated exosto discussion following Möller's paper Blegvad rests his acceptance that the upper tone limit nerve of the stomach, neurogenic hyperacid. is narrower, but believes that if it is not found ity plays a prominent role, as is evident in in all cases, it is due to the apparatus used, tabes dorsalis. Boas believes that 75% of all especially the Edelmann Galton wbistle cases of hyperacidity later develop obronio which does not reach the true physiological gastritis. Prophylaxis plays an important role upper limit of the human ear for tones, let in hyperacidity. Regular meals, avoiding too alone reach above it. If more delicate ap cold or hot drinks, alcoholio drinks, tobacco, paratus were obtainable a more delicate etc., are of importance. Cathartics diminish diagnosis would be possible for the earliest gastric glandular secretion while opiates instage of otosclerosis. Burger and Zwaar- crease the same. Atropin temporarily dim. demaker have found the same condition as inishes secretion. At present we are unable Möller in pronounced cases of otosclerosis to cure idiopathic hyperacidity, but we can the upper tone limit lowered, whereas in the relieve the symptoms, e.g. pains, eructations, early stages they often found an abnormal etc., by using a suitable diet. Milk, bread and sensibility for the high tones, Gellé always other starchy foods cause little increase of negative but support Bezold's triad as a char. secretion. while meat decidedly increases seacteristic symptom. Escat on the contrary cretion. Fat checks secretion decidedly. believes tbat the bone conduction is shortened Mastication, temperature of food and . liquid and Rinné always positive. Politzer still in- and methods of preparing food are of great sists that the Rinné negative is characteristic importance. Meats should be restricted, exof pronoucned cases of otosclerosis. Brühl cepting fish, carbohydrates should be used discusses in general, the functional exam. extensively, and fats in moderate amounts. ination and its results, viz., in middle ear Milk is of great benefit. Spices and acids disease, labyrinth trouble and the mixed excepting lactic and butyric acids must be condition and indicates that otosclerosis be avoided. Pure sugar in solution is permissi. longs to the latter category. He expresses, ble but cakes and pies are injurious probably as does Möller, the hope that further re- owing to the method of preparation. White search of the functional tests will enable us wines usually aggravate the symptoms but to recognize the early stages of otosclerosis. most pure red wines do no harm. Coffee and

The therapy offers nothing new. Politzer tobacco are also injurious. Carbonated min. warns against the use of the catheter as it eral water are most beneficial. The proper nearly always causes exacerbation of the con administration of alkalies relieve the symp. dition. Collier urges therough treatment of toms decidedly. The use of sodium bicar. the nose and naso-pharynx. Mau petit rec- bonate is not advisable since the CO, distends ommends lumbar puncture to cause a decrease and irritates the stomach too much. Sodium of the intracranial and by this a decrease of citrate is preferable to sodium bicarbonate, the intra la bryrinthian pressure, furthermore and if habitual constipation is present, mag. the treatment of the arterio-sclerosis with nesia usta may be given with it. Antacids potassium iodide. Sugar discusses the phos. should be given at the time of greatest digesphor medication and believes first that the tion, i.e., one to three hours after large meals. large doses are unreliable and second, that All these remedies give only temporary rethe anorganio preparation should be replaced lief. Atropin is used extensively with good by the organic. He recommends phytin results, but also only temporary. Skopolagiven in 0.25 doses four times daily and later min and enmydoin also give temporary relief. on double the dose. He thinks the phosphor medication has not been thoroughly My Experience with Antituberculosis tested in a scientific manner.

Serum - Mormorek H. Frey, (Wiener Klin.
Therapie, No. 42, 1906.) Frey uses the serum

in the 2nd and 3rd stages of tuberculosis THERAPEUTICS.

chiefly as an enema at times with the yolk of W. T. HIRSCHI, M.D.

an egg. The bowel should be irrigated before

using the enema. He uses 5-10 com. of The Treatment of Hyperacidity.- Dr. l. serum, 1 to 2 times daily. The serum seems Boas, (Therapeutische Monatshefte, May, to have a specific antitoxic effect. The pa. 1906.) Hyperacidity or byperchlorhydrie tients feel better, the appetite improves the usually is a functional disturbance but at temperature drops and tbe expectoration and times we find a pathologic condition of the cough are lessened. Lewin (Stockholm) uses secretory glands in the stomach. At times the serum subcutaneously and he also reports chronic gastritis especially in the early stages favorable results from its use. Hoffa (Berlin) is associated with hyperacidity, and this is prefers to use the serum per rectum and be. now called gastritis acida. Since it has been lieves the results obtained warrant further ex. demonstrated that the lagus in the secretory periments with the serum.

• The Use of Carbohydrates in Diabetes tion in a given case. The diet question in the Mellitus.- Lauistzen, (Med. Klinik, No. 39, case of tuberculous invalids is more than one 1905.) In recent years the use of carbohy. of calories. It cannot be solved merely by drates in diabetes has become more liberal, arriving at theoretical standard amounts and and it is now for us to decide which of the relations of proteids, fats, and carbohydrates. carbobydrates is most advisable. Some pa. The tastes, habits, and peculiarities of the tients tolerate one form of carbohydrates patients, and their beredity are important while others do better on another form. Milk, factors. Variety, preparation, and the mansugar, oatmeal and potatoes do less harm ner of serving foods are all important. Psythan any other carbohydrates. In compli- chotherapy is more important in diet precated cases (renal, cardiac, arterial) a milk soriptions perhaps than anywhere else. In diet is of great benefit to the patient. Many the study of these cases the food require. patients are unable or unwilling to continue ments should be determined and met, if posa strict diet for any length of time and here sible, and the dangerous error of overfeedwe must select the least injurious food sub- ing should be avoided. stances.

Diet in Nephritis.-F. C. Shattuck, Boston The Importance of Anesthetics in Inflam

(Journal A.M.A., January 6), lays down the matory Processes. — Spies (Munob. Med. Woch., No. 6, 1906) recommends local anes

following as the leading principles pertaining

to the dietetio treatment of nephritis: 1. thetics in inflammatory processes, wounds,

Such control as we may have to-day of neph. and in superficial operations. Laryngeal tu.

ritis lies in diet and mode of life rather than berculosis, coryza and similar inflammatory

in drugs.
in denda* 2 Sich

2. Such drugs as are useful are diseases improve decidedly by using anes

so in their effect on the general organism thetics. Orthcform powders often do much

and the heart rather than on the kidneys good, but at times more powerful anesthetics

directly. 3. In all cases of nephritis the are indicated. Opiutes should be used cau.

main aim is to spare the kidneys unnecestiously in chronic processes, but in acute

sary work, remembering that the urinary cases where little danger of acquiring the

system is but one, of the many, making up habit need be feared it may be used advan.

the body. 4. In acute nephritis, as well tageously.

as in the acute exacerbations of the obronic Abdominal Arteriosclerosis. — Rosengart, form, doctors, diet and quiet should work (Muncb. Med. Woob., No. 20.) Very fre together. Starvation for a few days, regulated quently arteriosclerosis first manifests itself by the intensity of the process and the by gastro-intestinal disturbances and not strength of the patient, is the keynote here. until we find otber evidences of solerosis do 5. ln the chronic forms the aim is to lighten we recognize the oondition. It occurs most and to lengthen life. Especially in the confrequently between the 30tb and 40th years of traoted form of kidney disease, many years of life. The patients complain of flatulence, life and comfort may depend on the pbysi. slight pains especially in the right hypo. cian's skill in adapting sound principles to chondriac region, slight colic, belching, and the partioular case and in securing the coother vague symptoms. The patients are ir operation of the patient in persistently carryritable, sleep is poor, appetite good, usually, ing out the directions given. Dietary restricand constipation as a rule. Eventually the tion should, in the main, be quantitative pulse become more frequent and hard, the rather than qualitative. Aloohol in moderaheart dullness increases, a slight systolio mur. tion is not necessarily a poison and may be mur and accentuated second aortic sound are an aid to digestion. 6. The excess of probeard and the diagnosis is easily made. The teid, not proteid itself, is harmful to the gastrointestinal symptoms are due to faulty chronically sick kidney. 7. A varied diet is circulation on account of the sclerotio vessels. more likely, than a monotonous one, to proThe treatment is similar to that of arterio mote the making of good blood and improvsclerosis affecting any organ of the body. ing the general nutrition, and that of the

myocardium in particular. 8. The amount Diet in Tuberculosis.- H. M. King of albumin is in itself no guide as to the ex. (Med. Rec., July 21, 1906) declares that dis tent of dietary restriction. Shattuck remarks turbed metabolism is essential to the develop the advisability of a relatively dry diet in ment of tuberculosis. If, in all respects, the dropsical cases, proportioned to the degree of cell is normally nourished, it will be suffi. dropsy. In cases of contracted kidney, even ciently resistant to the invasion of the tuber- without dropsy, he thinks physicians have ole bacillus. As a rule, one is able to trace erred in forcing water, and that the main errors in nutrition antedating by months and service von Noorden has rendered is in advooften by years the probable period of infec- cating the limitation of liquids.

Obs. Dolaminicago: com

theori Kennual PersoKansas City

SOCIETY PROCEEDINGS

C. 0. Thienhaus, Milwaukee: “The Clini.

cal Picture of Volvulus of the Intestine, with MEDICAL SOCIETY OF THE MISSOURI a report of two operated cases." VALLEY.

W. F. Milroy, Omaba: “Case of Graves'

Disease, treated by Diphtheria Antitoxin." The nineteenth annual meeting of this so. Alfred Scblek, Chicago: “Rational Treatciety will be held at Council Bluffs, underment of Eczema." the presidency of Dr. John E. Summers, Emil Ries, Chicago: "Personal Experience of Omaha, on September 6 and 7. Sessions with Scopolamine-Morphine Anesthesia.” will be held in the banquet hall of the Grand D. S. Fairchild, Des Moines, Iowa: "Some Hotel.

Observation on Pathology and Diagnosis of Following is the preliminary program: Gall Bladder Disease.”

John E. Summers, Omaha: President's W. F. Waugh, Chicago: “Corn Nuclein." Address.

The Grand Hotel will be headquarters, Richard C. Moore, Omaha: Oration on and members should make reservations of Medicine.

rooms at once to secure good accommodations, S. Grover Burnett, Kansas City: "A Sec- as this will be “Carnival week” in Council ond Case of Dual Personality."

Bluffs. Reduced rates on all lines of rail. W. L. Kenney, St. Joseph: "Sarcoma of road within a radius of seventy-five miles of the Optic Nerve-Operation, X-Ray Treatment; Council Bluffs. Programs will be issued Recovery.”

August 25, copies of which may be obtained O. B. Campbell, St. Joseph: “Ectopic by addressing the secretary, Dr. Charles Pregnancy with Report of Cases."

Wood Fassett, St. Joseph, Mo. C. B. Hardin, Kansas City: “The Physi. cal Signs of Disease; their scope and what they reveal to the Modern Physician.”.

Harry Everett, Lincoln, Neb. : “A Prelim. inary Report on a Simplified Method of Pre

In chronio ankylosing catarrh of middle paring Catgut.”

ear Dr. Bishop employs air massage of the W. T. Elam., St. Joseph: Paper.

drum head, in alternation with injections of T. E. Potter, St. Joseph: "Tubercular alvolin into the middle ear. Joints.”

LeRoy Crummer, Omaha: “The Use of THE HIGHEST HUMAN TEMPERATURE. – Digitalis."

It is difficult to give a definite answer to your Mary Strong, Omaha: "Heart Disease in question. The London Lancet (June 2, 1906) Obstetric Cases.”

reports the case of a woman in Bombay with A. C. Stokes, Omaba: “Operative Treat a temperature of 112.4 deg. F. We believe ment in Chronic Gonorrhea of the Male.” still higher cases have been reported, with

Geo. F. Butler, Chicago: "The Treatment recovery. Patients suffering with sunstroke of Chlorosis."

may have exceedingly high temperatures for J. P. Lord, Omaha: "A New Retention a brief time. Departure from the normal · Suture in Operations for Cleft Palate.”

temperature above the standard may be much Bernard A. MoDermott, Omaba: “Some greater, without causing death, than a reducNotes on Peritoneal Adhesions, Post-Opera. tion in temperature. tive."

F. Damour, Bolokow, Mo.: "Old Time MORE TROUBLE IN STORE FOR THE RETreatment of Typhoid Fever.”

TAIL DRUGGISTS.-It seems that the Depart. . F. E. Coulter, Omaba: Clinic.

ment of Internal Revenue of the Government L. L. Ubls, Ossa watomie, Kan.: "The Re- is determined to make life a burden for the lation of the State to the Insane.”

drug trade. The next move may class as re: Frank P. Norbury, Jacksonville: "The tail liquor dealers all druggists who sell Treatment of Sleep Disorders.”

"non-intoxioating beverages" that contain a Leo M. Crafts, Minneapolis: “Observa. trace of aloobol. It is not generally under: tions on the Morbid Physiology of the Duct- stood that some of the vario us summer drink less Glands."

will show from a fraction of one to nearly Palmer Findley, Omáha: “The Clinical two per cent of alcohol. The manufacturer Significance of Latent Infections of the Pel. who sells these goods in lots of five gallons

or more must also pay the wholesale liquor Halsey M. Lyle, Kansas City: “Keratosis tax. Some of the St. Louis manufacturers Follicularis, or Darier's Disease."

have been notified that they must also pay D. C. Brockman, Ottumwa, la.: "Tumors baok license for two or three years. -Meyer of the Breast."

Bros.. Druggist.

latje rank

of Sleep Dinne

vis."

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