DR. JOHN R. WATHEN: Dr. Samuel's specimen is certainly very interesting, and especially so at this time, as we are seeing a great deal of tuberculosis, particularly in the testicles. I believe the more we learn of tuberculosis the more we realize that it is more general than might at first be supposed. For instance, in a case like this where we find a diseased testicle, I believe that if other parts of the body were examined many evidences of tuberculosis would be found. I have operated on quite a few cases of this character and my experience has been that where one testicle is very badly diseased, and the other only slightly so, if the worst one is removed the other will improve very much. Why this is I do not know, though it might be accounted for by the theory that tuberculosis is a self-limited disease and will cure itself if given a chance by the removal of the testicle which is worst diseased.

DR. ABELL: I regret, Mr. President, that I did not hear the report of the case; continuing the discussion of the pathology as suggested by the preceding speaker, the specimen shown is a very pretty one and shows that the process began in the epididymis, as is usually the case. It is generally believed that in primary cases of testicular tuberculosis the bacilli gain entrance to the circulation through the mediastinal lymph glands, which have been shown by Bugge to be tubercular in 75 per cent. of cases coming to autopsy; the local conditions favoring their deposition in the epididymis are a previous epididymitis, mild injury to testicle or epididymis (the reaction following severe ones being usually sufficient to destroy the bacilli), and the mechanical hindrance afforded the blood in the branch of the spermatic artery going to the head of the epididymis; under such circumstances the primary nodule is generally found in the intertubular connective tissue, corresponding to the termination of the vessel, while in secondary lesions resulting from an infection descending from a focus higher up in the genital tract, the primary nodule is to be found in the walls of the tubule. From these points the infection spreads to the body of the testicle proper, as was evidently the case in this specimen, instances of a primary deposition in the body proper being very rare, although I have seen three such cases, two of the specimens having been presented to this Society.

DR. MORRIS: I merely wish to report a case along somewhat the same line as that reported by Dr. Samuels. The patient had, about six years ago, suffered an ordinary attack of typhoid fever, lasting about six weeks. When the fever had subsided, and he was beginning to get better, he was attacked by an exceedingly acute pain in the testicle, a short time after which the testicle began to enlarge and became inflamed to such an extent that I called a surgeon to see him, and as soon as he was able to stand an operation the testicle was removed and shown to be tubercular. This was six years ago, and the patient has completely recovered, showing, in my opinion, that the primary trouble, so far as

tuberculosis was concerned, began in the testicle and ended there. has never had any symptoms of tuberculosis from that time to this.

He

DR. SAMUEL (in answer to Dr. Morris): I saw this case recently with one of the surgeons of this city, presenting as a tumor of the scrotum. The man had fever some time before I saw him, but considered it malaria or something of that kind. He had just a slight nodular enlargement of the epididymis, which was not painful to touch. One surgeon diagnosed hydrocele and subsequently punctured it, but obtained no fluid. Two weeks later he was operated upon, and a tubercular condition found to exist. I had always been under the impression that patients of this character suffered a great deal of pain, but in this case the man had practically no pain. It has been my experience that when the testicle begins to enlarge from tuberculosis there is more or less pain, daily becoming greater as the testicle enlarges. I have seen a few cases in which the pain was very slight becoming much greater upon pressure. In malignant cases the patient is often without pain, even after the tumor has attained some size. Where mixed infection occurs in tubercular testicle it becomes very painful. In the case reported tonight the mere approach of a finger to the man's scrotum would seem to cause pain; other parts of the sac were not painful. In tubercular cases pain is a diagnostic feature in contra-distinction to other diseases of the testicle.

DR. JNO. R. WATHEN: In reference to the emergency outfit which I exhibit to-night in connection with my essay, I wish to say a few words of explanation. This bandage has been thoroughly sterilized and sealed up in this package and may be thrown in any dirty place and then picked up and used. These trays may be used for water or any extra dressings which may be necessary. The ligatures, which are always of importance in emergency cases, are carried in this little metal box. The whole outfit is simplicity itself.

DR. W. H. WATHEN: The literature lately has been crowded with a very full discussion of just this very subject, and one authority, I believe, in Europe, reported a number of post-mortems in these cases of splenic leukemia that had been treated with the X-ray, and he strongly condemns the X-ray in these conditions. Most all cases have seemed to be attended by the same fatal end that Dr. Dunn's case has.

PROCEEDINGS OF THE ACADEMY OF MEDICINE,
MAY 3, 1905.

DR. HENDON: I have a pathological specimen to exhibit to the Society to-night. It is an appendix and only becomes interesting when the location in which it was found is taken into consideration.

Recently I was called to see a woman about sixty-nine years of age

who had had a lump in the right groin for some time. In bathing herself she suddenly discovered that it was tender, and a day or two afterward she developed considerable pain. There was no fever, the pulse was about 100, and there was no vomiting, and nothing whatever to indicate appendicial involvement. I diagnosed incarcerated femoral hernia and advised operation, which advice was reluctantly accepted. When I cut down on the mass I was very much surprised to find a tumor about the size of a turkey's egg, very dark, and when I opened it a large quantity of dark fluid gushed out, and the appendix was found floating in the liquid. The appendix had strangulated just where it came through the femoral ring. The extremity was somewhat clubbed, and had begun to undergo gangrenous process. Up to that time I had never heard of an appendix in a femoral hernia, but a few days afterward I received a copy of Dr. Kelly's new book on appendicitis, and found where he illustrates one very beautiful case, it being a counterpart of my own. I simply ligated the appendix as in ordinary appendectomy, pushed the head of the cæcum back into the cavity and sutured the ring. The patient has progressed very well.

DR. SIMRALL ANDERSON: This is a very interesting case. I remember seeing an operation for strangulated inguinal hernia in which the appendix was found. The appendix is not always located on the right side under McBurney's point. I recall a case in which I assisted my father where an operation for pus tubes was performed and the appendix was found adherent to the left tube.

DR. BLITZ: I have a case in which I have been unable to make a satisfactory diagnosis. The patient, a man, gives the history that several years ago after eating bananas and cream he experienced a very severe pain in the back. Several times after that he ate bananas and cream, and each time thereafter he suffered from pain in the back and came to the conclusion that the dish mentioned was the cause of it and did not touch it any more. A week or ten days ago he ate some salmon salad, and upon getting up to leave the table he discovered that his legs were very weak, and he had to have somebody assist him to his room. There was no cramping or anything of that kind; they simply became very weak and numb. This weakness disappeared in about two days, but a day or two after that, while he was going upstairs, they commenced getting weak again; this time it only lasted one day. When I saw him he was very nervous. He was a man who smoked about fifteen cigars a day and drank a good deal of coffee. I would like to ask whether it is the opinion of anyone present that the man's stomach could produce the condition described or whether it is simply a hysterical condition.

DR. HENDON: I wish to inject into the discussion a fact that has been very forcibly impressed on my mind, and that is that the incompatibility of fish and ice-cream seems to be established among the laity.

I have never heard them say anything of ice-cream and bananas, but I have been asked several times about the incompatibility of fish and ice

cream.

DR. HUGH LEAVELL: Two weeks ago I was called to see a man who was suffering with cramps in the lower extremities. There was no fever and no history of digestive disorder of any kind and no headache; merely cramps in his lower extremities from the knees to the ankles. I thought perhaps he had a little autointoxication of some kind, probably due to the liver, and gave him free purgation. Four days later I was

called to see him, and found that he had facial paralysis on the left side, involving also the left half of the trunk. He denied positively the existence of syphilis; he has never imbibed excessively, and particularly is this true of the last year, during which time he stated he had taken no intoxicants. The facial paralysis is to-day in the same condition that it was a week ago; there has been no cessation, no involvement of the ear, no tenderness in the region of the mastoid, and no evidence of any involvement of the facial nerve. The man has been taking iodide of potassium in ascending doses until he now takes twenty drops; he has also been taking strychnia.

It is a question what causes this facial paralysis, particularly at this season of the year. The cramps were intermittent, coming on at intervals of an hour or two, and lasted only three or four days. The man is thirty-eight years of age and is employed as an engineer in one of the railroad offices here, which, however, does not seem to have any bearing on the case.

DR. MOREN: Can he shut his eye or raise his eyebrow?

Dr. Leavell: He cannot shut his eye, but he can move his eyebrow.

DR. MOREN: The chances are that this will prove to be peripheral neuritis and independent of the cramp in the limb. The lesion must be very extensive to affect both centers of the seventh nerve. The branch that goes to the upper face is separate and a little bit away from the branch to the lower face. In cases of apoplexy the lower face is usually the part affected. The eye may be involved for a short time, but it soon passes away and leaves paralysis of the lips only, while in peripheral paralysis the whole face is affected.

DR. TULEY: I wish to exhibit a temperature chart in connection with a case of typhoid fever which presents two unusual features. The patient, a boy about nineteen years of age, developed a typical case of typhoid fever in every respect. On the twenty-seventh day of the disease, the temperature, in about five hours, dropped from 103 4-5 to 96 2-5 without any hemorrhage and apparently no cause for the reduction. Within the same twenty-four hours it rose again to 103 2-5 and dropped to normal the next day. For four days it ranged between 100 and 101.

On the nineteenth day the boy developed paralysis of the external muscle of the right eye, and this exists to a certain extent to-day, although it is gradually improving. There was double vision for a week or ten days after it was first noticed.

The enormous drop in temperature with hemorrhage was a new experience to me. This case emphasizes the importance of the use of temperature charts.

DR. LEAVELL: The condition described by Dr. Tuley might be explained by the theory that a central lesion developed, causing the paralysis of the abducens nerve, which supplies the external rectus and also involving the heat center just at the time the temperature dropped. There must be close relationship existing between these two conditions.

BOOK REVIEWS.

Eye, Ear, Nose, and Throat Nursing.-By A. Edward Davis, A. M., M. D. Professor of Diseases of the Eye in the New York Post-Graduate Medical School and Hospital, and Beaman Douglass, M. D., Professor of Diseases of the Nose and Throat in the New York Post-Graduate Medical School and Hospital. F. A. Davis Company, Publishers, 1905.

It has been a common observation among oculists and aurists that nurses who have received a general training are often very deficient in the knowledge of the requirements of patients with affections of the eye, ear, nose, and throat.

This is especially true in the serious contagious affections of the eye, as trachoma and gonorrheal ophthalmia, and in the care of patients who have undergone operations upon the eye-ball. Drs. Davis and Douglass have supplied in this publication instructions governing the nursing of eye, ear, nose, and throat, which should make the work invaluable to every nurse doing general work. It should also be of value to special and general practitioners, as it deals in detail with the care. of the patient during disease and after operation. The anatomy and physiology of the eye, ear, nose, and throat, is also taken up briefly. The chapter devoted to the care of the operated cases, especially the one devoted to the care of the patients after the extraction of cataract, is especially commendable.

Dr. Douglass has written the chapters on the ear, nose, and throat, and Dr. Davis the ones on the eye. This is the second work from the pen of Dr. Davis to be reviewed by us in the last three months, and is another evidence of the success of this Kentuckian in New York. It gives us special pleasure to recommend this work to every nurse doing general nursing, and to physicians doing ophthalmic and aural surgery.

The publishers have made the work attractive with thirty-two good