induced DR. SAUNDBY, of Birmingham, to put on record fifteen cases of appendicitis which have been under his care during the past six years.

Among these fifteen cases there was only one death-the only case treated surgically-and the post-mortem appearances led the writer to believe that life might have been spared had he adhered to purely medical treatment. 86.6 per cent. were cured, and 6.6 per cent. relieved. The average length of treatment is admittedly long, and a more rapid cure by surgical means might be claimed, though the writer is of opinion that a little time may fairly be sacrificed in view of the inevitable risks of surgical interference. The plan of treatment he adopts is rest, free evacuation of the bowels, hot fomentations or the ice-bag, with the addition, in chronic cases, of repeated blistering over the tumor. He strongly supports the method of treatment by the administration of full doses of sulphate of magnesium which was advocated by a recent American writer, Dr. W. T. Dodge.—Birmingham Medical Review, No. 157, 1891.

CASE OF TRAUMATIC ABSCESS OF THE LEFT ANGULAR GYRUS WITH CROSSED AMBLYOPIA AND WORD-BLINDNESS TREATED BY OPERATION.

DR. BEEVOR and MR. HORSLEY communicated the following case to the Ophthalmological Society of London: F. L. sustained an injury to left side of head last Christmas. Three weeks after accident he became unconscious, and had a general "fit." Six weeks after accident eyesight began to fail, and he vomited daily. He was admitted to the Hospital for Paralysis on March 9th with double optic neuritis and right hemianopsia. There was a seam three inches long along left side of head, which was tender and adherent to underlying parts. Abscess in left angular gyrus was diagnosticated, and Mr. Horsley operated. He found fracture of skull with necrosis corresponding to scar. On trephining, an abscess was found in the upper part of the angular gyrus and the outer surface of the occipital lobe. After the operation the boy had word-blindness, and on measuring the fields of vision the right was found to be contracted on the nasal side to twenty and on the temporal side to five, while in the left eye the nasal was reduced to ten and the temporal to fifty. Hernia cerebri developed and was removed, soon after which the boy died. Post-mortem: The dura mater was found to be thickened and adherent on left side to the margin of the silvian fissure as far forward as the ascending parietal convolution, to the lower two-thirds of the supra-marginal gyrus, to the posterior part of the superior and middle temporo-sphenoidal convolutions. The whole of the angular gyrus, except the upper fourth and anterior part of the outer occipital region on the horizontal section was much softened, extending across the hemisphere to the hernia cerebri.-Medical Press, 1891, No. 2742.

BLACK URINE AND BLACK ASCITES.

SENATOR (Charité-Annalen, xv., S. A.) states that a number of different pigments, having in common only their black color, have been included in the common designation, "melanin." He has recorded a case, in which the dark brownish red urine, becoming darker on standing, responded to the test

with potassium chromate and sulphuric acid, but at the same time contained considerable indican, to the presence of which the intensification of color is to be ascribed. The autopsy revealed the absence of melano-sarcoma. Derivates of biliary pigment in the urine may simulate melanin. It cannot, therefore, be concluded that a melanotic tumor exists if the urine reacts to chromic acid. All melanotic tumors are not attended with elimination of melanin in the urine. It should be borne in mind that the urine of patients with melanotic tumors may contain melanin and yet not react to chromic acid. Bromine water and chloride of iron differentiate melanogen from indican; the latter reacts to neither. In a case of extensive melanosis Senator observed, in addition to melanuria, the evacuation of dark-brown ascitic fluid, which after standing a few days precipitated a dark sediment. The pigment reacted to bromine water in the same manner as that obtained from melanotic urine. In the latter the pigment was present principally as melanogen; in the former, as melanin. The urine passed by four rabbits, into whose peritoneal cavities melanin from melanotic tumors had been injected, contained considerable indican, but no melanogen-it did not become darker in color on treatment with bromine water.-Centralblatt für die medicin. Wissensch., No. 13, 1891.

KERAUNO-NEUROSES.

FRANKL-HOCHWART (Zeitschrift für klinische Medicin, Bd. xix., H. 5 u. 6, 1891) places among the traumatic neuroses the condition, attended by peripheral palsies, that obtains in persons who have been struck by lightning, to which he applies the designation kerauno-neurosis, and of which he reports two illustrative cases. One is that of a cook, twenty-four years old, without nervous antecedents and with no history of syphilis or alcoholism, who, while at work during a rain-storm, was without premonition struck to the ground. On returning to consciousness, two hours later, the course pursued by the current was indicated by large blisters on the surface of the body. A sense of burning pain was felt in the chest and in the occipital region. There were paresis of the extremities, dyspnoea, and defective speech. For one day vision was abolished. From time to time lancinating pains were felt in the upper extremities, especially in the right. Severe sacral pain was a prominent manifestation. In the course of several days complete palsy of the lower extremities developed; the upper became paretic. Diplopia occasionally manifested itself. Sensation was benumbed on the right side. In the course of three months some power of locomotion was regained, though restoration was never complete. The mental condition was depressed. Speech was slow. A little less than five years after the accident, the woman was suddenly seized with vertigo, headache, and vomiting. She lay in bed, was apathetic, and slowly replied to questions. The sense of smell was found blunted on the left, absent on the right. The sense of taste appeared impaired on the left. The pupils were equal, moderately dilated, and prompt in reaction. The fundus was normal, but the fields of vision were contracted. Punctures were imperfectly recognized on the left half of the face. The gait was fairly good for short distances. If, while standing or walking the eyes were closed, decided swaying occurred. Muscular power was dimin

ished in all four extremities. The movements of the upper extremities were slightly ataxic. The knee-jerks were exaggerated, but there was no ankleclonus.

The second case was that of a railroad watchman, fifty-eight years old, also without neurotic antecedents or a history of syphilis or alcoholism, who, during a storm, when about to manipulate a telegraph instrument, saw a blue flash and felt a severe shock in the right hand; the right arm fell to his side, and a sudden pain was felt to dart through the right arm and leg, which for ten minutes were powerless, and for three days remained cold and stiff. This sensation of cold reappeared subsequently once or twice a month for several hours. Some two years later the man was seized with severe pain in the right leg that lasted for two weeks, when it moderated-recurring, however, from time to time in both arm and leg. Vision became impaired and muscular power on right side diminished. Convulsions frequently occurred in the right leg. Occasionally there was intense sacral pain. Memory became impaired. The right pupil was smaller than the left; the reactions were tardy. The fundus was normal, though the fields of vision were contracted. There was slight tremor of the tongue. The circumference of the right lower extremity was smaller than that of the left. The right leg was dragged in walking. The station was good. When the eyes were closed there was some ataxia of movement of the right upper and lower extremities. The tendon reflexes were exaggerated.

UNILATERAL PALSY OF CEREBRAL NERVES DEPENDENT UPON CARCINOMA OF THE BASE OF THE SKULL.

STERNBERG (Zeitschrift für klin. Medicin, 1891, Bd. xix., H. 5 u. 6) has reported the case of a woman, fifty-seven years old, with no diathetic family history, who had borne seven children, and in whom the menopause had taken place seven years previously. For a year there had been a vaginal discharge, with emaciation. Headache, especially frontal and occipital, and on the right side, had been complained of for two months. In the previous six weeks it had been noticed that the hearing upon the right side was impaired, and that diplopia manifested itself when the eyes were directed to the right. For fourteen days speech had been defective and there was some difficulty of deglutition. The headache became aggravated in intensity; the pain assumed a lancinating or boring character, but occasionally remitted. Food would sometimes be regurgitated through the nose. The head was somewhat inclined to the right. The folds of the forehead, of the eyes, and of the nose and upper lip, were less well defined on the right than on the left. The right angle of the mouth drooped; from it saliva occasionally dribbled. The pupils were equal and reacted to light, and with accommodation. All the movements of the eyes were well performed, except that of the right eye outward; as a result there was homonymous diplopia. Vision was otherwise unimpaired; no lesion of the fundus was found. The conjunctival reflex was absent, the corneal reflex present on both sides. No olfactory defect was detected. The right half of the forehead displayed a diminution of sensibility to touch, temperature, and pain. The skin of the face was otherwise hyperalgesic. On opening the mouth the point of the

chin deviated to the left. In gritting the teeth, the right masseter acted but imperfectly. The right side of the head, especially in the region of the mastoid process, was sensitive to percussion. Sudden pressure upon the vertex, as well as rapid lateral movements of the head, caused pain. The tongue protruded and deviated to the right. The right half of the tongue was considerably smaller than the left, and occasionally displayed fibrillary contractions. At rest, the uvula and soft palate were symmetrical and median in position. Upon intonation the right side moved less than the left. Irritation of the right half of the soft palate induced retching less readily than irritation of the left half. The sensibility of the cheek and of the right half of the tongue was unaltered. Taste was imperfect on the anterior part of both halves of the tongue, but decidedly impaired upon the posterior part of the right half. Vaginal examination disclosed the presence of a hard, nodular, disintegrating mass, involving the vaginal portion of the uterus and the posterior and anterior walls of the vagina. The uterus was enlarged and fixed. A diagnosis of carcinoma of the uterus, with metastatic deposits at the base of the skull, involving the right cerebral nerves, was made. The symptoms grew progressively worse; the palsy of the tongue became complete, but improved temporarily in response to faradic stimulation; death, however, ultimately ensued.

At the autopsy a small new-growth was found at the apex of the petrous portion of the right temporal bone, involving the Gasserian ganglion, the commencement of the trigeminal nerve, and the sixth nerve, and partially occluding the internal auditory meatus. The facial and auditory nerves appeared thickened and reddened. The glosso-pharyngeal was surrounded by an extension of the growth, and was also swollen and reddened. At the margin of the foramen magnum, especially about the anterior condyloid foramen, the dura was the seat of a thin layer of growth that surrounded the hypoglossus, which was thickened and reddened. The lateral sinus contained a whitish-red coagulum that was continued into the jugular vein. A metastatic growth was found on the left eighth rib two fingers' breadth external to the chondro-costal junction. The small pelvis was occupied by a large adherent tumor that proved to be carcinomatous, originating from the posterior vault of the vagina.

COMPARATIVE STUDIES OF THE PARASITES OF THE RED BLOOD

CORPUSCLES.

In an endeavor to determine the relation of the parasites found in the blood of lower animals with those found in the blood of man, CELLI and SANFELICE (Fortschritte der Medicin, 1891, Nos. 12, 13, and 14), availing themselves of the material offered by the Roman Campagna, extended their investigations to a large class of animals, both cold-blooded (frogs, tortoises) and warm-blooded (birds, man). Daily examinations of the recent blood were made, the same method being always employed. The blood was imbedded in paraffin kept at the temperature of the room, or in a thermostat at 98.6°. Dry preparations were stained with iodine-hematoxylon, fresh preparations with methylene-blue dissolved in ascites fluid.

Celli and Sanfelice succeeded in finding in the blood of frogs and tortoises

both intra-corpuscular and free parasites, that differed in different kinds of animals. Inoculation experiments from frog to frog were not encouraging. Injections into the pulmonary artery of blood in which sporulation was going on were followed in one of three frogs by the appearance of small and medium-sized parasites. Similar injections into the cavity of the heart succeeded in but one frog. In both cases a doubt existed whether the parasites found might not have existed previously, but have been latent. Inoculations from tortoise to tortoise, and from frogs to other animals, were also less successful.

Observations were made upon two hundred birds. It was at once evident that the intra-corpuscular parasitism was in them more complete than in cold-blooded animals, that is, in birds the parasites have a more intimate intra-corpuscular existence, and live at the expense of the hæmoglobin, which they convert into melanin—as a result of which they display black pigment granules. Besides this, several varieties of parasites may be found in the same animal. Some of the parasites are of slow, some of accelerated, and others of rapid development. Those of the first kind are extremely resistant. As a result of inoculations from one bird to another of blood containing medium-sized," "large," and "free" forms, it was found that the parasites of the red blood-corpuscles are reproduced (but not always) in animals inoculated with the blood of animals of the same kind and variety. They have either a certain degree of individualized existence, and a special acclimatization for each variety, so that forms that appear morphologically identical are perhaps not parasitologically so, or the nutritive substratum, i. e., the faculty of immunity, is not alike in all individuals of one and the same variety.

Celli and Sanfelice divide the malarial fevers of Rome, as seen in man, into two groups-mild and severe; or, winter-spring and summer-autumn. These again may be (a) quartan (combinations of which are represented by the double and treble quartan or triquetan quotidian); (b) tertian (double tertian or bitertian quotidian): (c) quotidian (fever with protracted attacks, subsistent, subcontinuous and pernicious fever). To each of these main types correspond various forms of parasites morphologically and biologically distinct. The cycle of development may be abbreviated; thus arise anticipating tertians and quartans.

In the fevers of quartan type the intra-corpuscular cycle of development is completed in three days. At first there appear small, amoeboid forms, which rapidly become pigmented; then there are to be seen round, slightly pigmented, slightly motile masses, which neither protrude nor withdraw pseudopodia, with tardy movement of the black granules; they grow until they occupy the entire red cell, without deforming it, but taking up its coloring matter. Sporulation takes place in the adult parasite by the formation of a rosette of from nine to twelve spores about a collection of pigment; excep tionally it occurs as a premature development of at most from six to eight spores in the not entirely occupied red corpuscle. The free phase has but little significance. While a greater or smaller number of adult forms undergo sporulation, others (less commonly than in tertian and quotidian) become free in the plasma and degenerate, the pigment losing its motility, and the forms disintegrating or extending flagellæ that slowly oscillate. By their slowness