to a localized inflammation of the articulation. The latter symptom increased until on the seventh day he was unable to separate the maxillæ. There was complete trismus, pain on pressure over the dorsal vertebræ, and anuria for twenty-seven hours; it was evident that the patient had tetanus. Chloral hydrate was given at once, in increasing doses; friction with turpentine applications was made along the spine, purgatives were administered, and a chloral solution was used to wash out the orbital cavity. On the following day the patient could open his mouth and put out his tongue. The temperature never exceeded 37.5° C. His food was bouillon and milk;

appetite good.

The dose of chloral was increased; massage was applied to the arms and legs, and as there was some contraction of the abdominal muscles, they, too, were rubbed with an ointment of belladonna and mercury until ptyalism was produced. On the fifth day a facial contraction, on the side opposite the enucleated eye, was observed, and on the eighth day of the treatment opisthotonos, with an intermittent heart and coldness of the extremities, supervened. The pulse, before 85, now ranged from 100 to 120 and became irregular. Fifty centigrammes of quinin were then given to the patient. On the tenth day bloody expectoration was observed, and on the eleventh day of the treatment the patient died of pulmonary congestion after an apparent improvement lasting three hours. For the four days preceding his death 42 grammes of chloral were given every twenty-four hours.

During the whole illness neither the sound eye nor its pupil showed an appreciable deviation from the normal condition. -Annals of Ophthal.

Prognostic Value of Albuminuric Retinitis.

Possauer (Beitr. z. Augenheilk.), after studying the records of 67,000 patients seen in Haab's clinic in Zurich, finds that albuminuric retinitis was observed in only 131 cases (1.9 per cent.). Authors vary greatly as regards frequency of retinitis in kidney disease: 6.7 per cent. (Schweigger) to 33 per cent. (Galezowski). Most writers agree that as a rule death occurs. within two years at least after appearance of the retinitis.

Possauer has seen seventy-two cases, thirty-nine in private and thirty-three in hospital practice; of the latter there were fourteen men, all of whom died within two years; of the nineteen women thirteen died within two years, two after longer time, and four are still alive. The longest period of life observed was six years. Of the thirty-nine private patients (twenty-six men and thirteen women) sixteen men and seven women died within two years. In those living the retinitis is dated from a minimum of two and a quarter to a maximum of eleven years. The better surroundings of private patients give them advantages, but even here the mortality is 53 per cent. in the first two years.-Annals of Ophthal.

NOSE, THROAT AND EAR.

UNDER CHARGE OF RICHMOND MCKINNEY, M.D.

Laryngologist to East End Dispensary.

Some Diseases of the Respiratory Tract from the Viewpoint of the Pension Examiner.

W. W. Potter (Buffalo Med. Jour., vol. 43, no. 3) says: First, that a person suffering with obstructive intranasal disease, chronic nasopharyngeal catarrh,-is not laboring under a mere inconvenience, but has a malady that involves very serious danger, a danger that increases as years advance, and that, uncured, is a constant menace to the integrity of the lower respiratory tract.

Second, the neuroses dependent upon nasal obstruction are often as serious in their symptomatology, as they are distressing to the patient. They affect not only the respiratory tract, but the heart and other organs, often masking the real disease to an extent that may embarrass the examiner in making a differential diagnosis.

Third, that chronic catarrhal bronchitis is a disease of potential importance, slow in its progress, often depending upon nasal obstruction as a primary factor of cause, and is of most serious import in the aged.

Fourth, that asthma is, for the most part, a reflex manifestation of nasopharyngeal disease, generally obstructive in

character; that it is seldom idiopathic, but its paroxysms are similar whether it be true or false, whether it be reflex or bronchial; and that its chief importance is as a symptom of disease located elsewhere, spasm of the bronchial tubes being a distressing expression of the lesion.

Fifth, that those diseases of the respiratory tract to which the veteran soldier is peculiarly liable, are often expressions of the rheumatic or gouty diathesis, and that these dyscrasia are often underlying factors to be reckoned with in reference to origin as logical sequences of pathology.

Paralysis of the Vocal Cord.

At the Society of Charity Physicians, Schüller (Berlin Cor. Med. Press & Cir., vol. 76, no. 3355) presented two cases of unilateral paralysis of the vocal cords in combination with more extensive paralytic phenomena. The first was a female, æt. 44, with left-sided paralysis of the uvula, left cord, localized areas of the face and neck over the cervical segments in isolated patches, which pointed to an intra-medullary morbidity located in the oblongata and probably extending along the left side of the cord; presumably syringo-bulbar in origin. The second case was also a female, æt. 55, with right-sided recurrent paresis, and paresis in the region of the right plexus cervicalis inferior. The radiogram showed a swelling in the right upper mediastinum and probably an intra-thoracic struma as the cause of the paresis.

These two cases, he thought, presented a clinical picture with many symptoms in common, yet differing in origin. The first has now all the symptoms of a syringo-bulbar origin, although the early symptoms were not so easily interpreted, as syringo-bulbar origin is presumed to follow syringo-myelia ; but from the course of the symptoms one is inclined to believe in a reversal of this doctrine, commencing in the medulla and extending to the spinal cord. It is possible, however, from the rapidity of development, that a tumor may be the cause of this, as in the second case, but located here in some part of the medulla oblongata.

GYNECOLOGY AND OBSTETRICS.

UNDER CHARGE OF T. J. Crofford, M.D.

Professor of Gynecology, Memphis Hospital Medical College,

AND

W. D. HAGGARD, M.D.

NASHVILLE, TENN.

Professor of Gynecology and Abdominal Surgery in University of the South (Sewanee); Gynecologist to the Nashville City Hospital; Professor of Gynecology, University of Tennessee.

One Thousand Cases in Students' Outdoor Obstetric Practice. J. F. Winn (Jour. A. M. A., vol. 41, no. 14) submits a report of a series of one thousand cases in the outdoor obstetric department of the University College of Medicine during a period of seventy-six months. His deductions, which follow, are unique and valuable.

1. The results in this service are confirmatory of Krönig's statement that the vagina of a pregnant woman is free from pus-producing bacteria.

2. Thorough and continuous disinfection of hands and external genitalia are the chief safeguards against infection.

3. The unhygienic surroundings in the homes of the poorer classes must be considered as minor factors in the causation of sepsis. They become operative only when scrupulous care is not observed with regard to vaginal examinations.

4. Not only is the puerperal morbidity and mortality among outdoor clinics greatly below that in private practice (the mortality rate in this clinic being one-half of 1 per cent.), but it would appear that this class of patients is endowed with powers of resistance not found in the higher walks of life.

5. Nature has her own time for separating and expelling the placenta as indicated by a signal easy of recognition.

6. Any method designed to excite uterine contraction before nature indicates that the placenta is ready to be cast off must be regarded as precipitate, and not in accord with natural processes.

7. Just in proportion as the genital tract is regarded absolutely as a noli-me-tangere after the child is born, will the puerperium be marked by fewer deviations from the normal.

Fecundation after Curettage.

Don Policarpo Lizcano Y. Gonzalez (Med. Press & Cir., vol. 75, no. 3345) says:

Pregnancy coming on quickly after curettage is liable to end in abortion; of four cases recorded abortion took place in three. It is noticeable that the form of metritis for which the patient has been curetted has no influence either in delaying or hastening the fecundation. We conclude that— 1. Curettage is not a cause of sterility.

2. Fecundity is restored by the operation.

3. Sterility is cured by the operation.

4. Endometritis following abortion is very amenable to the operation.

5. The more recent the lesion the better the results.

6. Within six months of curetting the majority of patients become pregnant.

7. If pregnancy does not occur within twelve months, its occurrence is unlikely.

Of the 20 cases, 2 were nullipara, 4 unipara, and 14 multipara. The diseases included 11 cases of post abortum endometritis, 4 cases of catarrhal metritis, 30 of metritis hemorrhagica, 1 of septic metritis, and 1 of retroversion. After curettage 12 women were each once confined, 3 women were each twice confined, and one woman was three times confined, 3 women aborted, and one woman was at the time of writing pregnant. Within a year of the operation 11 women were confined, and within two years but over one, 5 women were confined.

Pelvic Diseases in Young Girls.

F. F. Lawrence (Jour. A. M. A., vol. 41, no. 16) says:

1. All cases, whether in young girls or in older women, in which menstrual pain, intermenstrual or premenstrual pain is a prominent symptom, should be subjected to careful and thorough examination to determine its cause.

2. No leucorrhea should be permitted to pass unnoticed or treated by such slipshod methods as ordering a douche, giving medicine, etc., without first ascertaining its cause. In all