Tuberculosis and lupus of nose should not be confounded. During initial stages the diagnosis of lupus is difficult, for the characteristic lupus nodules are not found in nasal mucous membrane in this stage. The disease resembles chronic rhinitis, with gradually increasing infiltration and destruction of cartilage.

The diagnosis of tuberculosis should be determined by demonstration of Koch's bacillus. Volkmann says that many cases of ozona, which are supposed to result from hereditary syphilis, are really examples of tuberculosis.

In five cases reported by the author the disease originated in septum. In two, simple tumors were present, and in remaining three were formations of granulation tissue. Koenig says that nasal tuberculosis frequently appears as tuberculous fibroma, the microscopic examination revealing fibrous tissue and tubercles. The surface of these growths was smooth, except where there existed ulcerative process and bled easily. Two of the patients were anæmic and scrofulous, the others were healthy; there was no hereditary tendency. A swelling of the adjacent glands was observed in all the cases.

The treatment consisted in use of sharp curette and Paquelin cautery, followed by application of ointment of pyrogallic acid to all suspicious granulations.

The cure was prompt, but it cannot yet be said permanent until greater lapse of time.

Tuberculosis of nasal mucous membrane may manifest itself in three forms: 1. As an ulcer, flat, edges undermined, base covered with gray flabby granulations.

2. As smooth, solid tumors.

3. As lupoid proliferations.

In cases reported the microscopic appearances were same in all cases. Epithelium thickened where not destroyed. Free proliferation of stroma with round-cell infiltration, also giant cells containing tubercle bacilli.

Aristol powder insufflations are recommended in the atrophic forms of rhinitis, laryngitis, and pharyngitis. By acting as stimulant to the mucous glands, the secretion is increased and membrane rendered moist. In atrophic fœtid rhinitis crusts are more easily detached. It is contraindicated in acute rhinitis and chronic coryza with profuse secretions, as it acts as irritant and increases the secretion.

CROUP AND DIPHTHERIA.

American Medical Association-Dr. Carl Seiler. Diphtheria and croup are two distinct and separate diseases.

Diphtheria is very contagious, and attacks persons exposed very suddenly, striking down people in apparently good health; and the probability of death depends entirely upon the amount of the poison

absorbed. There is also a characteristic odor from both the membrane and body of the diphtheritic patient.

Pseudo-membranous croup has slower onset; the child is ailing several days before the symptoms are pronounced; the disease is not communicated to others, and the peculiar odor of diphtheria is absent. Both diseases have in common a membrane and febrile movement. The membrane of diphtheria, however, is of yellow hue, the edges are sure to be turned or curled up, while in membranous croup the membrane is white, does not curl up, and the temperature is lower in proportion to the amount of febrile action present.

In criticism of these statements Dr. Solis Cohen remarked: If the condition known as membranous croup does exist, the affection must be local throughout its entire course and termination, not spreading to the pharynx or giving rise to constitutional infection.

The reasons for believing these two diseases identical are as follows: The disease may frequently present pharyngeal symptoms so slight, and preceding the serious laryngeal manifestations, that it is wrongly classed as a local ailment.

There are cases presenting no pharyngeal symptoms, no source of infection, yet the membranous cast of larynx and trachea has proved infectious and caused death.

The disease may ascend, beginning as low down as bronchioles, the pharynx being the last attacked. In very young children the dyspnoea from laryngeal obstruction may be severe enough to cause death before the disease has sufficient time to reach the pharynx.

The disease may be diphtheritic, and not manifest its contagiousness by being conveyed to other children exposed. A case is cited in which a child died from diphtheritic paresis, but two other children, constantly exposed, did not acquire the disease. The so-called characteristic odor is not always present.

In regard to temperature, while high fever very frequently accompanies diphtheria, yet the cases most to be feared are those in which the temperature is normal or subnormal, as this feature indicates great malignancy.

In both pharynx and larynx the diphtheritic deposit varies in appearance, thickness, and adherence with the intensity of the affection. In some cases it may be superficial and easily separated. In the larynx the lymphatic supply is less abundant than in the pharynx, so that an absence of constitutional symptoms is not to be regarded as proving a non-diphtheretic disease.

No positive diagnostic difference can be made between so-called membranous croup and diphtheria. It is recommended to discontinue the use of term "membranous croup," and adopt that generally used by foreign writers, "primary laryngeal diphtheria."

BY JEROME WALKER, M. D.

PERICARDITIS IN CHILDHOOD.

Knoff (American Journal of Medical Sciences, Aug., 1890) reports ten cases. Of these, three were under one year of age; three between one and two; and four between six and ten. Pericarditis in the new born is usually due to a septicemic process, starting in the maternal organism or else from the umbilicus of the child. In older children the conditions which predispose to pericarditis are tuberculosis, inflammatory processes of the pleura, lungs, sternum, vertebral column, bronchial and mediastinal glands, thymus and oesophagus, and of the abdominal organs and the peritonæum. In six of the cases reported by the author, the disease followed inflammation of the pleura and lungs; in one it followed chorea; in two scarlatina; and in one no cause was ascertained. In very young patients the diagnosis is difficult, frequently on account of the absence of ordinary physical signs. Autopsies made by the author showed that the exudation was usually not abundant, and hence it could not influence the position of the heart, the area of dulness, or the relative position of contiguous organs. The exudation was also fluid in character, without fibrinous deposit, and hence the absence of friction-murmurs.

CASE OF RECTAL OBSTRUCTION IN A CHILD.

T. Sympson (British Medical Journal, October 4, 1890). "A boy, æt. ten years, while spending a week with some relations in the country, ate a large quantity of wheat. The day after his return home he was noticed to have lost his appetite, and to be listless. In the evening he suffered greatly from abdominal pain, frequent and urgent desire to evacuate his bowels, and severe tenesmus. These symptoms increased in intensity. On the third day I was called to see him. On examination through the abdominal wall, the sigmoid flexure was felt to be greatly distended, and a few grains of wheat had been found in the bed. On examination, liquid was seen oozing from the anus, and the rectum was enormously distended. Under chloroform, a quart pot of wheat was removed, with complete relief to all the symptoms."

SCARLET FEVER AND SANITATION.

(Brit. Med. Journal, September 13, 1890.) At an inquest held at Sedgley near Wolverhampton, where a child had died from scarlet fever, it was shown that though the home of the child was in good condition, its surroundings were "filthy," there being an open stagnant well near the house and no proper drainage. It was also shown that the sanitary authority sanctioned the removal of night-soil during the day from the vicinity of the house.

EUCALYPTUS IN CATARRH OF THE RESPIRATORY TRACT AND OBSTINATE COUGH IN CHILDREN.

Solomon Solis-Cohen, M.D. (Medical News, May 24, 1890). The author was led, by advice of Prof. J. M. Da Costa, to first try the fluid extract of eucalyptus in a case of obstinate cough. He says: "For internal use in bronchial and laryngo-tracheal inflammations the fluid extract seems to serve a better purpose than eucalyptol. In acute cases my usual custom is to administer it in connection with ammonium salts; in sub-acute cases a little paregoric may be advantageously added. In the obstinate irritative coughs following inflammatory affections which have apparently subsided, the fluid extract of eucalyptus is best given without other drug, in syrups of tolu or acacia, or in emulsion of oil (castor oil, olive oil, cod-liver oil, almond oil), as necessary, to disguise its taste or modify its action. The dose is about five drops for a child of two years."

CONGENITAL HYDROCEPHALUS WITHOUT ENLARGEMENT OF THE HEAD.

Dr. L. Emmett Holt (N. Y. Med. Jour., November 1, 1890) presented in Section in Pædiatrics, N. Y. Academy of Medicine, a brain. removed from a child who had died at the age of three weeks, in which a very marked degree of hydrocephalus existed, the head, however, being of normal size. The lateral ventricles were much dilated, and contained six ounces of fluid. The brain outside was a mere shell. Spina bifida also existed. Death was caused by suppuration in the spina-bifida sac, which had extended upward along the whole cerebrospinal axis. No operation had been performed.

GYNECOLOGY.

BY WALTER B. CHASE, M. D.

ON DIFFERENTIAL DIAGNOSIS OF HYDROSALPHINX.

Dr. Skene, at October, 1890, meeting of the Brooklyn Gynecology Society, related a case of a female having the rational and physical symptoms of hydrosalphinx (the diagnosis having been reached independently by an eminent American gynecologist) associated with disease of both ovaries.

Laparotomy was performed, the tubes and ovaries removed, but the tubes were not distended. After convalescence the physical symptoms of hydrosalphinx remained. On placing the patient in the knee-chest position, the condition simulating tubal distension disappeared, showing it was due to distended veins.

TREATMENT OF CANCER OF THE CERVIX UTERI BY HIGH AMPUTATION.

In a discussion on Dr. Coe's paper on "Limits of Vaginal Hysterectomy," in the proceedings of the New York Obstetric Society, ap

pearing in American Journal Obstetrics, June, Dr. Hanks said he had become so accustomed to high amputation by scissors, knife, and cautery that he seldom resorted to vaginal hysterectomy. The results had been very satisfactory. He had seen many cases of malignant disease. of uterus, and yet within five years only one patient had come under his individual care, in which all the good which could be accomplished would have been by Byrn's, Sims', or Baker's operation.

SECONDARY PERINEORRAPHY AT TIME OF A SUBSEQUENT LABOR.

Dr. Charles Jewett at the October meeting of the Brooklyn Gynæcological Society, gave cases of the above operatiou.

The repair of a former injury to the pelvic floor may be done immediately after labor, when the patient is in favorable condition. Union takes place as kindly as in ordinary primary operations.

The patient's time is saved and the operation less formidable. Have done this in four instances, two in August last in which there was no tear during the last labor. In the other cases there was a slight flesh laceration. Here the old scar-tissue was removed and the whole perinæum restored, instead of simply suturing the new tear. The results were highly satisfactory.

[This new departure by Dr. Jewett, which promises so well, will be watched with interest until larger experience shall determine its proper status as a conservative operative procedure, both as regards results, and any dangers which might follow of the septic variety, particularly in these cases in which there was no injury to pelvic floor at time of last labor.-W. B. C.]

SECONDARY PERINEORRAPHY,

Under this head, Saurenhaus (Centralblatt für Gynäkologie, July 3, 1890), reported at a recent meeting of the Berlin Obstetric Society twenty-five cases in which he repaired laceration of perinæum at periods varying from five to twenty days after the original injury, with only two failures. The surfaces were freshened by the scissors or sharp spoon, and were united by a continuous catgut suture. In the discussion which followed the reading of the paper, the concensus of opinion was in favor of using the continuous catgut suture for the immediate repair of perineal lacerations. Amer. Journal Med. Science, Oct., 1890.

PERFORATION OF UTERUS WITH CURETTE.

(Phila. Obstet. Society, April 3, 1890). Dr. J. Hoffman reports case of perforation of uterus in a septic uterus following a six weeks' conception. Laparotomy was performed four hours afterward, which was followed by recovery.