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ment of syphilis and describes the technique can't tell you," answered his companion of making the injections.

sadly. “I have never seen any." While Nearly one hundred pages are devoted to thus conversing, they were joined by a wise Obstetrics by Richard C. Norris, M.D. man who proved to be real reformer dig.

This volume is concluded by William G. guised as an oculist, and who, perceiving Spiller, M.D., upon the Nervous System, tbeir error, presuaded them to exchange He urges that gumma is not the most com. glasses. The remedy was simple but effect. mon lesion of cerebral syphilis.

ual. The Muck Raker is now working union hours and is happy and contented, while the other has already made some most astonish

ing discoveries. Moral: A small ray of sunTHE NEW THERAPEUTIC GAZETTE. —The shine, if weloomed and encouraged, will often publishers announce that after January 1st destroy an army of offending microbes.-Denext the Therapeutic Gazette, Medical Agecember Lippincott's. and Medicine will be incorporated in one journal, which will be known as The Thera. THE ABSURDITY OF FRETTING.–There is peutic Gazette, and will be edited by Drs. one absurdity which it seems to us is every. Hobart A. Hare and Edward Martin. The where and by everybody underestimated, and excellent praotical qualities wbich have made too much overlooked in valuatiou of characeach of the three journals among the fore. ter. It is the absurdity of fretting. It is most of American medical publications will common as air, as speecb-80 common that be continued in the greater Therapeutio Ga. unless it rises above its usual monotone, we zette. While we may regret the discontinu do not even observe it. Watch any ordinary ance cf the Age and Medioine deeply, we will coming together of people, and see how many expect the Gazette to more than make up to minutes it will be before somebody fretsus for what we have lost.

that is, makes more or less complaining

statements of something or other, which probGOVERNMENT MODEL FARMS.-James J. ably every one in the room, or in the train, Hill, president of the Great Northern Rail. or at the street corner, it may be, knew beway, believes that model farms should be en- fore, and probably nobody can help. tablished in every agricultural county of the Why say anyibing about it? It is cold, it is United States, under control of the several hot, it is dry, somebody has broken an apstate governments, or of the national govern pointment, ill-cooked a neal; stupidity or ment, or of the two conjointly. Suoh farms, bad faith somewhere has resulted in discombe argues, would radiate intelligence, aotiv. fort. There are plenty of things to fret ity, and reform in tillage, with the possibil. about.-Health. ity of doubling tbe farm product of the coun. try, The December Century will publish

THE HEALTH OF THE AMERICANS IN THE Mr. Hill's discussion of these “Government

CANAL ZONE.- According to the report of Model Farms' and his plea for their estab

the Department of Health of the Istbmian lishment. "Might it not be worth while,”

Canal Commission for the month of Septemhe argues, “to expend the sum that such a

ber, 1906, seven wbite men out of a total of system would cost, even though it should be

5,000 died, two of disease and five from vionecessary to postpone for another year the

lence. Botb of the wbite men died of pneubuilding of a battleship or a couple of cru

1 monia; one was a Greek and the other a Ja. siers.” A significant deolaration by Mr. Hill

maican, and both had been on the Isthmus is that such a scheme should be kept out of

of for eight months. There are about 4,800 the clutches of the spoils system.

Americans on the Isthmus, and Dr. Gorgas

says: “I think it is worthy of remark that THE WISE MAN.-Once upon a time there 5,000 Americans recently from a temperate was a poor, overworked Muok Raker who had zone should have been able to pass two become tired of his job. He was ambitious, months during the height of the rainy seaand felt that his efforts were not appreciated. son, their work extending forty miles He had a long nose and wore magnifying through a tropical jungle, without a single glasses. One day wbile raking assiduously death from disease of any kind. The figures he was accosted by a stranger whose aspect with regard to employees are absolute. We was even worse than his own. This man was get the actual number of employees from our a Herald of Light. His mission was to seek pay rolls, and the deaths from the hospital out sweetness and virtue in a naughty world, reports and the cemetery reports." There and he was admirably equipped with a dark are about 1,000 women and obildren, wires lantern without any oil, and wore spectacles and families of the American employees on with smoked lenses. “What are virtue and the Isthmus, and none of these died of disLonesty?" inquired the Muck Raker. I ease during August and September.

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THE ALEXIAN BROTHERS' HOSPITAL was widening and its management is fully awake founded in 1869, the erection of its building to the situation. was begun early in 1870 on ground acquired at 3933 South Broadway, and the beautiful NEW MEMBERS OF THE St. Louis MEDICAL structure was completed in 1900. The cost SOCIETY—During November tbe following of the ground and building has been about were elected to membership in the St. Louis $250,000. The building contains 250 beds, Medical Society: R. Lilburn Byrd, 1000 Bitand the institution cares for about 1900 pa. ner; Theo. F. Fienup, 3218 Lafayette; Carl tients each year, of whom fully one-sixth are J. oontz, 4551 Delmar; J. W. Marcbil. charity cases. The institution is conduoted don, 2254 S. Vandeventer; George M. Park, by the Alexian Brotherhood of the Roman 5744 Cates; Edward Schulz, 3869 Cottage; Catholic Church. A training school for Selden Spencer, 2723 Washington; Benjamin nurses, which is open only for members of G. Benson, 2136 Benton; W. Antoine Hall, the brotherhood, is an important feature of 1556 Tower Grove; Frederick C. Simon, 1835 the work of the institution. The medical Cass; Nathan N. Yahlem, 1816 Franklin; staff inoludes the following physicians: Gutbrie McConnell, 4421 Berlin; Charles S. Frank J. Lutz, J. P. Hennerich, Ernst Muel. Rebfeldt, 2255 S. Jefferson; Walter B. Yost, ler, D. F. Hochdoerfer, Hy. Muetze, and L. 1119 Union. R. Padberg.

I give you this, you understand, as bush DR Y. E. COLVILLE, of Chattanooga, Tenn., money," the Senator whispered. has become balf owner and editor of the Ok. And, handing the druggist a quarter, he lahoma Medical News-Journal; he will here. took up the bottle of soothing syrup and tipafter bave oomplete editorial control of the toed out. journal, Dr Phelan devoting his attention to its business management. The journal is A primary tumor of the lateral abdominal keeping pace with the rapid progress of Ok- regioh in infants and young children is usulahoma; its field of usefulness is constantly ally a sarcoma of the kidney.

REPORTS ON PROGRESS ward, and that the inner line, both anteri. comprising the Regular Contributions of the Fortnightly De orly and posteriorly, is likely to be the ear. partment Staff.

liest affected. The posterior inner line

changes chiefly or only in its upper twoINTERNAL MEDICINE.

thirds. The dislocation inward of the outer

border generally ocours later, and a change 0. E. LADEMANN, M. D.

of both inner and outer lines is naturally

less common tban of the inner or outer The Value of a Study of the Apical Out alone. In early cases the lines do not apline in the Diagnosis of Incipient Pulmonary proximate at the top, but join their fellows Tuberculosis.- Minor's (Am. Jour. Med. Soi., from the rear; in old cases with marked Oot., 1906) paper presents his impressions of fibroid shrinkage they often run together to an the diagnostio value of outlining the apices apex before they reach the trapezius border. of the lung in pulmonary tuberculosis, based Minor found the diagnostic value of these on the parking of suoh outlines for the past outlines in earlier cases and to some extent six or more years in all cases. He proposes their prognostic value later, to be consider. the term “apical outline" in preference to able. not, of course, when taken alone, for the designation “Kroenig's sign," as being no sign unsupported by others has great more applicable and is self-explanatory. The value: but combination with others, such pathological fact on which the value of this

as dislocation occurring in a dubious case, diaguostic method depends is the well-known with other signs in themselves not final, may tendency to shrinkage of the apex of the lung serve to clinch a diagnosis. A slight inward when a tuberculous process develops in it

alteration of a border anteriorly and posnot alone from fibroid formation with covse. teriorly carefully verified, will raise to a far quent contraction, but even before such higher value ambiguous auscultatory signs. fibrosis occurs, through lessened function in Outward dislocation is neither so early nor the apex. The technique requires great ac. quite so easy to determine, but if certainly curacy. It is best to use the little finger as a demonstrated bas equal value. Dislocation plessimeter; the peroussion stroke peeds to be without marked fattening or hollowing of the very carefully and correctly made, the most supraclavicular fossa would seem to depend vertical elastic stroke possible, generally on lassening of volume from lessened funcvery, lightly made, alone giving accurate tion, while that accompanied by such hol. results. The patient should sit erect or lowing or flattering would point to the exist. stand directly facing or backing the ex- ence of fibrosis, though only postmortem aminer, according to marking of eitber an. evidence could verify this assumption. terior or posterior outlines. The head is to be held exactly in an anteroposterior plane The Roentgen Ray in the Early Diagnosis in order to have muscular tension on both of Pulmonary Tuberculosis.—Lehmann and sides of the neck equal. Percussion for Voorsanger (Am. Jour. of the Med. Sos., the inner anterior line should start well up Oct., 1906) remark that the early diagnosis the side of the neck, above the lung, and of pulmonary tuberculosis is so important, oome slowly downward until pulmonary res. and so far reaching in its ultimate result and onance is found, when the inner border of benefit to the patient, that every aid at our the plessimeter finger should be indicated oommand should be employed to .assure cerby a dot of the blue pencil. Repeating this tainty in its incipiency. They plead for the from behind forward we get a series of dots, use of the X-ray as a means of diagnosis in which we unite with a line. The outer pulmonary tuberculosis. The four points border should be approached from the most important in beginning tuberculosis shoulder and marked off in the same manner. often escaping clinical detection, and if disIn peroussing out the posterior lines it is ad. covered by the X-rays, speak most conclu. visable not to have the upper ends of the an. sively for a beginning process in the lungs terior lines visible, as if they are it will in. are: (1) Williams' diaphragmatic sign-the evitably affect our judgment, while the fact lessening expansion of the diaphragm on the that the upper end of the posterior outline side where there is a beginning tuberculous coincides uocurately at the trapezius bi. process ; (2) the finding of more or less centrallaterally with the anterior line, when run ly located affections, especially small or more independently, adds to our assurance of the pronounced shadows along the bronchi, wbioh correctness of our results. The author found have been explained as, and by autopsy that in early tuberculosis, especially of the proved to be, peribropohitic tuberoulosis; apex, but also of the lower portion of the centrally located cavities, which may escape lung, careful percussion will generally dem. clinical detection, are also brought to light onstrate a dislooation of the inner line out by the Roentgen rays; (3) baziness of the apex or of the whole lung wbiob anatomically matory process; (d) invasion of deep extra corresponds to thickening of lung tissue; and dural abscess through posterior surface of (4) proof of the existence of peribronchial pyramid. Of less practical significance, beenlarged glands. In conclusion, they state cause with them no operative interference that the clinical and X-ray findings have comes in question, are the labryinth condi. agreed in the main; but in the majority of tions that arise metastatically through the cases the X-rays afforded valuable informa circulation, for example parotitis epidemica, tion as to the extent of the lesions—which as also those from the cavum cranii through were often more widespread than the ordinary mediation of the aqueducts or the nerves. cilnioal evidences seemed to suggest. Where With the labyrinth suppurations caused by the diagnosis was in doubt on account of ab- traumas as fractures of the base of the skull, sence or insufficiency of clinical signs, the foreign bodies, injury by shooting, especially X-rays showed a peribronchial or bronchial those suppurations arising from operative gland affection—the value of which in prog- opening of the labyrinth are of interest, be it nosis, as well as in diagnosis, is of enormous that labyrinth opening is intentional, as in importance. In a few cases, involvement of stapes extraction to improve hearing, puncthe apex evident clinically was not recog. ture of the fenestra rotunda, be it uninten. nizable by the X-rays, because recent infil. tional as in extraction of foreign bodies, midtration, though sometimes sufficient to dle ear operations. cause clinical signs may not be sufficiently M ost often the labyrinth suppurations dense to produce a shadow or haziness on arise through destruction of the bony capsule the X-ray plate or screen.

following middle ear suppuration, and indeed A Case of Rupture of the Heart.-Casassus

less frequent from acute than from chronic

(cholesteatomas, tuberculosis). As places of (Jour, de Med. de Bordeaux, Sept. 9, 1906) Derforation most frequently considered, are details the history of a man seventy-one years The windows, then the promontorium and the old, who sought hospital relief for a general.' horizontal semioircular canal. very seldom ized eczema. In spite of his age he appeared the infection comes from the tube or the faoto be robust. While taking a nap half an ial canal. A semicircular oapal fistulu as hour after his noon meal, he suddenly awak.

place of infection has more favorable progened with extreme pain in his precordial nosis than perforation through the windows, region, began to vomit, the face was pale this explains the phenomena that such soli. and the expression evidenced an agitated

tary semicircular canal fistulas are frequently appearance. The forehead was covered with found in the living but seldom in autopsies & sweat and the extremities were cold. It must be remembered that a part of the There was slight dyspnea and the pulse

gaps or defects may come from a rupture was small, irregular and sometimes inter

from within, especially is this the case where mittent. The cardiao sounds were completely

the cardiac sounds were completely multiple fistula occur. muffled and there was a certain degree of Often these perforations. if obser ved arhythmia. The patient died at the end of

olosely, may be discovered macroscopically eleven hours. At the autopsy there was found

during the operation, which practically is of a rupture of the heart muscle on the an.

utmost importance, because through careful terior surface, the tear measuring one and

observation uf the findings of the operation, one-half centimeters in length. The pericar

under circumstances, disclosures as to the exdium contained a large effusion of blood.

tent of the suppuration and indioation as to therapy may be gleaned. The extension of the suppuration in the inner ear may involve

the whole labyrinth (diffuse labyrinth supOTOLOGY.

puration), or on account of formation of proALBERT F. KOETTER, M. D.

tective adbesion limit itself to one part (cir.

cumscribed labyrinthitis), both forms can. Labyrinth Suppuration.-(Hinsberg, Bres not absolutely be separated from one another, lau. Compilation in Internationales Central. as the second form may go over into the first, blatt fuer Ohrenheilkunde.)- Pathological but in practice they are judioiously differenAnatomy.-Of the different routes of infec- tiated from one another, because they demand tion to the labyrinth those going out from a different therapy. the middle ear have a practical significance, Microscopically we find in the early stages namely: (a) the existing vascular connection an exudate rich in cells, that may change, between middle ear mucous membrane and first, into granulation tissue, then into dense labyrinth; (b) congenital dehiscence in the connective tissue, and finally into bony tissue. labyrinth wall; (c) breaking through the Besides this there may be ossification of the labyrinth wall, be it from trauma or inflam. bone, and in this way cause breaking

through from within. In other cases large other cases heal spontaneously, most often portions of the labyrinth frame-work, may the acute inflammation goes into the necrose (labyrinth sequestrium).

chronic form, which may exist for years in Of practical value is the extension of lab. a latent form, unless the above named test, yrinth suppuration into the skull and this for disturbance of equilibrium are made, to occurs either through destruction of the lab- light up suddenly, as for example in pus reyrinth capsule (especially at the superior or tention in the mildde ear, minor operations, posterior semicircular canal) or more often as polyp extraction or following extensive through previously formed paths (spontane. operations of the midle ear and leads to final ous dehisences, acoustic nerve, aqueduots). meningitis. . By transmisson through the aqueductus ves- Because of the frequency of such latent tibuli there appears, first, an empyema of the suppurations of the labyrinth it is necessary saccus endolymphaticus, a disease, accord. to closely examine each patient on whom a ing to the newer reports, much more common radical operation is to be performed, regardthan was previously supposed. All these ing the static function as well as the hearing means of communciation lead into the pos. the latter through adoption of an aid in hearterior oranial fossa, a perforation in the mid- ing for both ears, use of the Lucae-Dennert dle fossa at the anterior crus of the superior method, etc. Besides a thorough revision of semicircular canal has not been observed to the labyrinth wall for fistula, is indispensathe present time.

ble at the operation, by careful probing and Symptomatology and Diagnosis of Laby- the use of H2O, and adrenalin. If there exrinth Suppurations. — The symptoms concern ists before the operation deafness besides disboth parts of the labyrinth, the organ of hear. tinct appearance of irritation, deficiency on ing and the static organ, and, namely, as the part of the static apparatus; at the opersymptoms of irritation (subjective auditory ation stapes defect we can surmise a diffuse sensation, as vertigo, vomiting, disturbance labryinth suppuration. If there exist before of equilibrium, nystagmus), or appearance of the operation symptoms of irritation with deficiency (deafness, viz., disturbance of the relatively good hearing, at the operation regulation of equilibrium of a certain kind, semicircular canal fistula we have a circum. absence of physiological nystagmus and ro. scribed disease of the semicircular canal. tatory vertigo in deficiency of both sides). If there exists before the operation symptoms It is very difficult to interpret the appearance of irritation without proof of labyrinth fisof deficiency on the part of the static organ tula at the operation, we must if there is where labyrinth disease is unilateral. The deafness proven think of breaking through test of the nystagmus and rotatory vertigo at the fenestra rotunda or at anotber place at present yields uncertain results, therefore not visible. But if in the same case the hear. an exact test of the equilibrium is in order, ing has been preserved we are dealing either namely, static test on a horizontal plane and with a labıyinth irritation without infection, static test on an oblique plane, dynamic test viz., through pressure on the stapes, or an in. of von Stein. These symptoms so dominate flammatory process in the labyrinth capsule the clinical picture of labyrinth suppuration (paralabyrinthitis), or there is present a cir. that they may be designated directly as laby- cumscribed infection cf the labyrinth which rinth symptoms. Vertigo may be present cannot macroscopically be proven. in varying degrees, it is strongest in opera- In making a differential diagnosis we must tive opening of the labyrinth. Nystagmus is remember that labyrinth symptoms may nearly always present at the beginning of the appear temporarily in acute and chronic stage of irritation, but disappears more rap- middle ear suppurations, especially in pus idly than the vertigo, it is mainly horizontal, retention, without any infection of the labyseldom rotatory. Proof of the presence of rinth being present, similar conditions may static deficiency is often very difficult, some. be caused by lues and hemorrbage which times patients rarely notice them, as in the may accidentally be present in otitis media. latent stage of labyrinth suppuration he feels Furthermore, the disturbance of equilibrium well and is capable of working. Fever is show very few points of support regarding absent in uncomplicated labyrinth suppura- the differential diagnosis as compared to tion; changes in the fundus of the eye ab- abscess of the cerebellum, only when after ducens paralysis with slowing of pulse in operative opening of the labyrinth the verdicate infection of cavum cranii.

tigo still persists in undiminished strength The course of labyrinth suppuration is for some time, we can with a degree of cersometimes very startling so that between tainty attribute it to the cerebellum, the the first appearance of apoplectiform laby same counts for the nystagmus, this may be rinth symptoms and the death following considered cerebellum nystagmus, when, in diffuse meningitis only a short time elapses the beginning it persists by looking to the

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