dently originated from a scarlet fever epidemic along with milder complications, viz., nothing is mentioned of involvement of the bone by suppurative process. In all but one case cartilaginous tube was free from infection, which Gaessler quotes as an argument against infection from the naso-pharynx, perhaps we must consider the middle ear disease as the self-dependent part of the general infection. Essential for the pathology of scarlet fever otitis is a case reported by Treitel of uremia with deafness. Recovery from middle ear inflammation after scarlet fever, both ears.

Synchronous with the sudden appearance of convulsions, deafness and amaurosis. It is very plausible, to explain the deafness as due to uremia. The hearing returned in five days. A remarkable cases of spontaneous return of the hearing in a case of deafness after scarlet fever is reported by Eitelberg. A girl of ten having a unilateral otorrhea after scarlet fever became deaf, but the examination revealed normal otoscopic result. The prognosis was given as bad, owing to Politzer's experience, that in no case of acquired deafness following scarlet fever or diphtheritic middle ear conditions, in oft repeated examinations later on no perceptible improvement in the hearing could be demonstrated. After a year and nine months hearing returned. Scarlet fever is given as the most frequent cause of laby rinth necrosis, according to Gerber. Of ninety cases of labyrinth necrosis the cause is given in only 27 cases. Of these 15 were due to scarlet fever three to measles and one to whooping cough. We see from these statistics that 11% of the cases are severe ear complications due to measles. An insight into the kind and severity of the ear complications can only be derived in the course of several epidemics by regular examination of the ears, so that the severity of the different epidemics and their influence on the ear affection may be utilized. During the epidemic in Munich, 1903, Nadoleczny examined 100 in different cases at regular intervals for eventual ear complications, and reached the following conclusions: The ear complica. tions appear most often in the first two weeks, less often during desquamation, sometimes they may appear in the prodromal stage. The middle ear disease in measles is more often a primary than secondary nature. As a general rule the disease runs a benign course. By early prophylaxis the development of the exudate in the tympanic cavity may be prevented. A cotton applicator is saturated with a 3% argentum nitricum solution, this is introduced into the nose, then the nostril is pressed against the septum to allow the fluid to run into the nasopharynx. This

method has been used with success by Weiss and Sugar, the former has reduced the otitis in measles from 27.7% to 6.6% and the latter to 7%. To the bacteriology of otitis in measles Albesheim has contributed the following: In five cases he found the streptococcus, in three staphylococcus albus, but never the pneumococcus.

un

A large number of reports as to the involvement of the ear in typhoid infection are at hand. The ninety cases observed during an epidemic in Rostock are reported by Kuhn and Suckstorff. In 7.7% there were ear complications in spite of careful attention to the mouth. Of eight cases of otitis, two developed mastoiditis. During sonnolence in severe typhoid an otitis media may pass noticed. Therefore it is practicable to examine the ears regularly in somnolent typhoids for timely recognition of an otitis media and to avoid complication of the mastoid process. The case reported by Witte and Sturm of extradural abscess of the posterior cranial fossa, with destruction of the sig. moid sinus due to acute mastoiditis following a relapse of typhoid occurred in this epidemic. Operation, recovery and no disturbbance of hearing. Burnard and Labarre report a case fungus mastoiditis and brain abscess following typhoid fever with unfavorable results. Three weeks after the operation for acute mastoiditis, an abscess of the temporal lobe was evacuated. Death three days later due to meningitis.

Two cases of labyrinthian disease due to mumps are reported by Alt, function and hearing fully restored, so that he thinks a benign temporary disease due according to Moos to a serous exudate into the labyrinth. Texier reports two cases of labyrinthitis in mumps, with vertigo, tinnitis leading to total deafness, no improvement after the use of pilocarpin.

Lannais reports that without regard to the localization of the exanthema in the meatus and on the external ear, we sometimes have suppurative middle ear disease in varicella.

Sendziaks reports of the favorable influence that erysipelas exerts in severe acute suppurative middle ear disease. It deals with a middle ear suppuration of five weeks duration, which became worse with the appearance of the erysipelas, with the diminution of the erysipelas the acute symptoms subsided.

To return to the statement made at the beginning of this paper as to the importance of the specialist and the physician working together, we report Henry Fruitnight's paper on the otitis of the exanthemata, from the standpoint of the pediatrician and general practitioner. Of 5000 cases of acute exan

themata Fruitnight saw otitis media as a fatal complication in one-third of the cases. The frequency of the complication was in no direct relationship to the severity of the infection. Oftentimes he moderated the complication and preserved the hearing by treating the disease when it first appeared.

SOCIETY PROCEEDINGS

MEDICAL SOCIETY OF THE MISSOURI VALLEY.

The seventeenth semi-annual meeting of this association will be held in Kansas City, March 23d and 24th. An excellent program is being arranged for the occasion, and the local profession, which is noted for its hospitality, will keep open house for the visitors upon this occasion. Dr. S. Grover Burnett, of Kansas City, is president of the society, and Dr. C. Lester Hall, chairman of the arrangement committee.

Following is a list of the papers which have already been given a place upon the pro

gram:

Address, Jabez N. Jackson, Kansas City, President Medical Society of Missouri. Paper, Geo. W. Cale, Springfield, Mo. Surgical vs. X-Ray Treatment in Cases of Rodent Ulcer and Epitheliomata of the Face, with Demonstration of Operated Cases, C. O. Thienhaus, Milwaukee, Wis.

Transverse Ribbon-shaped Cornea Opacity, J. M. Sherer, Kansas City, Mo.

Rest in the Treatment of Select Cases of Mental Disease, F. P. Norbury, Jacksonville, Ill.

Some Points on Suprabic Cystotomy, E. N. Wright, Olney, I. T.

Column, C. E.

Injuries to the Spinal Black, Jacksonville, Ill. Synchronous Extra and Intra-uterine Pregnancy, with report of case, D. C. Brockman, Ottumwa, Ia.

Remarks on the Surgery of Umbilical, Femoral and Inguinal Hernia, with reported cases, J. Young Brown, St. Louis.

Case of Choroiditis, probably due to Necrosing Ethmoiditis, W W. Bulette, Pueblo, Colo.

Pelvic Inflammation, or Peri and Parametritis, H. C. Crowell, Kansas City, Mo. Renal Affections Simulating Abdominal and Pelvic Diseases, J. Block, Kansas City, Mo.

The New-Born Infant; Its Care and Management, A. D. Wilkinson, Lincoln, Neb. Anesthetics, Dora Greene-Wilson, Kansas City, Mo.

Some Observations upon the Treatment of

CLINICAL SOCIETY OF THE NEW YORK
POLYCLINIC MEDICAL SCHOOL
AND HOSPITAL.

Stated Meeting, Held January 9, 1905. The President, Dr. Daniel S. Dougherty, in the chair.

PATIENT WITH TUBERCULOSIS OF WRIST.

Dr. V. C. Pedersen showed this patient. Several years ago she went to one of the large hospitals of this city, with a condition presenting the early stages of arthritis of the wrist. Expectant treatment was adopted, and was followed by swelling of both the hand and forearm. Notwithstanding the fact that the metacarpal phalangeal joints were ankylosed, no effort was made to reduce the ankylosis by the hospital staff. The patient was then recommended to go to the central part of the State, where she improved in general health. There the supposed diagnosis of tuberculous synovitis of the extensor tendon was made and explored operatively. months later she presented herself to the speaker, who did a resection of the wrist. The trapesium and the synovial membrane between it and the thumb were in fairly healthy condition, and were not removed; likewise, the membrane between the radius and the ulna, and the pouches between the bases of the fourth inner metacarpal bones. About a year later pain and swelling began to appear on the outer side of the hand, and a secondary operation was performed, when it was found that the trapesium and the syno

Six

vial membrane were tuberculous. These were removed. The wrist was opened a year after that, and extensive tuberculosis of the metacarpal surfaces of the ulna and radius, and likewise of the other bones was found, and the third operation was almost as extensive as the original resection. The ariu was elongated, allowing the cavity which was left to fill, with blood-clot, which organized without suppuration. This was done at the suggestion of Dr. Dawbarn, who was called in as consultant, but personally the speaker thought it much better to accept shortening, and approximate the bones of the metacarpus to the bones of the forearm. Cosmetically, the condition of the patient's wrist is very satisfactory, and it is hoped that all tuberculous focci have been removed, but it is only five weeks after the operation, and too soon to tell the final result.

Dr. A. Lyle said that for some years it had been his custom to adopt the expectant treatment in cases of tuberculosis of the wrist, but today he was in favor of operating at once.

Dr. J. A. Bodine said that in tuberculosis of the hip joint, where it was possible to get more or less perfect rest, there are reasons for adopting the expectant method of treatment; but he thought in the wrist, where the anatomical configurations of the joints are so complex, and where it is so impossible to get physiological rest, it was better to operate at once. He thought the result in the case shown very satisfactory, but it was entirely too soon to judge of the outcome of the operation.

PATIENT WITH ARTHRITIS OF THE KNEEPROBABLY GONORRHEAL.

Dr. Pedersen also presented a patient, the victim of a druggist's error, who, realizing himself to be in the early stages of gonorrhea, entered a drug store and asked for flexible medicated urethral bougies, stating to the druggist the purpose for which they were intended. Instead of bougies, the druggist dispensed pure silver nitrate caustic in sticks, which the patient, in ignorance, inserted with the following results: Excruciating pain and burning, after a few moments followed by total absence of feeling, later tremendous swelling and inflammation of the part appeared; total inability to urinate supervened, so that the use of the catheter was absolutely .necessary. The fifth day after the accident there were silver nitrate burns on thighs, as far as the knees, two or three of them having penetrated almost or quite through the skin, as subsequent scarring proved. The entire skin sheath of the penis was swollen to several times its normal thickness; the margin

of the foreskin was burned raw almost completely around; the glans was violently inflamed, swollen and edematous. It was impossible to retract the foreskin even partially. The meatus was with difficulty brought into view, and was completely filled with the typical whitish slough of silver nitrate burn, which extended backward fully four inches, and gave the urethra the feeling of boggy rotten rubber tubing. Behind the slough the urethra was distinctly tender. The prostate was not investigated. The urethra was cocainized, a soft lisle thread catheter was inserted into the bladder, and about 14 ounces of clear urine were withdrawn. The patient was sent to the hospital, and lead and opium was applied externally. The copious discharge was found to contain gonococci. The patient was catheterized once in twelve hours, in order to decrease the likelihood of infecting the bladder. Within twenty-four hours after admission, drainage was carried out through the perineum with the double purpose of stopping the catheterizing and of putting the urethra at rest. At the time of the operation the slough came away in mass, and the urethra and bladder were irrigated thoroughly and copiously with very hot potassium permanganate solution 1:4000. Subsequent treatment was irrigation of the bladder with hot potassium permanganate solution and hot boric acid water two or three times a day. The same substances were also used on the urethra. At the time of operation 32 F. sound was passed, without force, through the urethra. About six days later, 25 and 27 F. straight sounds were passed with some pain to the bulb of the urethra. Later, under gas anesthesia, 30 F. straight sound was passed. All subsequent examinations of the discharge for gonoccocci have been negative, and at the present time the patient passes, with the aid of cocainization, 29 F. sound quite easily.

On the day following the original operation, the foreskin was slit dorsally from end to end, in order to be sure that there were no severe burns of the glans. Circumcision will be carried out upon the patient within a few weeks. Whether it will be necessary to do an internal urethrotomy through the scar of the deepest burn, in order to gain space, remains to be seen.

(To be continued.)

CUSHING GOES TO EUROPE.EUROPE. The well known professor of materia medica in the University of Michigan- Dr. Arthur R. Cushing has resigned his chair to accept a similar position with the University of London.

THE MEDICAL FORTNIGHTLY

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In sciatica, either acute or of long standing, there exists a condition known as sciatic scoliosis; no importance has ever been attached to this, especially from a pathological view point. It has always been supposed that this curvature was nothing more than a result of an attempt on the part of the patient to assume a posture which would give the greatest amount of relief. This is true to a certain extent, yet it is not altogether the whole cause. The intense pain along the course of the nerve and the great amount of irritation existing will cause the muscles in the lumbar region to contract and tilt the pelvis up to one side or the other; this contraction of muscles and the consequent change of the position of the pelvis increases the irritation, and this, in turn, increases the contraction, thus a "vicious cycle" is established.

The above is the result in cases of sciatica in which the etiological factors are exposure and injury to the nerve at some point in its course after it leaves the pelvis, and in which the first lesion exists in the nerve itself. One reason why sciatica resists the efforts of the physician to afford complete relief, is that all his efforts are toward the relief of the pain and are not directed to the correction of the anatomical changes that

have taken place. In those cases in which the doctor is successful in obtaining a complete cure by simple stoppage of pain. the removal of irritation has produced complete relaxation and allowed the pelvis to assume its normal position without the aid of manual manipulation, but these cases are in the minority, the majority becoming chronic and suffering more or less pain at all times. The pain in these cases is always increased, and they are subject to acute attacks, when exposed to any climatic change or any other cause that will produce muscular contracture, the contractures serving to increase the deformity and in this way bringing about an increased irritation to the nerve and again establishing the "vicious cycle." When the pain ceases under treatment, a partial relaxation occurs and the patient suffers less pain.

There is another class of cases in which the first lesion is muscular contracture with production of a tilted pelvis, thus causing the irritation to the sciatic nerve. These cases usually begin as lumbago and the sciatic inflammation does not occur until later. The etiology in this class may be constipation, injury to the spine or pelvis, pelvic tumor or heavy work. These various pathological conditions cause irritation to some of the many plexuses of nerves, either sympathetic or spinaal, and as the irritation persists the pelvis is tilted up or down to one side or the other, and the sciatica develops when the anatomical deviation is sufficient to cause pressure upon the sciatic nerve.

To one familiar with the anatomical changes and who is always on the lookout for it, the latter class of cases afford him an opportunity to produce a cure in the vast majority of all that he comes in contact with, but to one unfamiliar with the condition present, this class of cases will offer the greatest amount of resistance and he will only cure a very small proportion of them.

The detection of the deviation is an easy matter and requires no great skill upon the part of the operator to correct. The patient should be placed upon the back and made to lie as nearly flat as possible. The operator should stand at the foot of the table and after having the patient relax the adductors and abductors as completely as possible, should take hold of the patient's feet and bring the heels together so that the point of contact will lie in a imaginary plane, passing. in such a manner as to bisect the body into lateral halves, i. e., the plane should pass through the center of the forehead, nose, chin, sternum, symphysis pubis and the internal condyles of the femurs. When this is done the physician should then place his thumbs on the under surface of the internal malleoi

when it will be found that there is an apparent difference in the length of the limbs which may be from the fraction of an inch to an inch and a half or more. The next point to detect is whether one limb is too long or too short, as it is often the case that the sciatica is manifested reflexly in the opposite limb. To detect the limb affected, the knees should be drawn up, when, by palpation on the inner side of the ilium at about the height of the anterior inferior spinous process, marked sensitiveness will be found on the side affected, and if the condition has existed sufficiently long a noticeable thickening. in "Poupart's ligament" will be seen. Having ascertained the affected side the operatior should then proceed to correct same. is done as follows:

This

Have the patient lie on the abdomen, then with the vibrator, using a medium stroke and medium pressure, thorougly relax the muscles in the lumbar region. If it has been found that one limb is longer or shorter than the other, the patient should then be placed in a dorsal recumbent position and the deep pelvis muscles relaxed. As an example, suppose that the right limb has been found to be apparently shorter than the left. The patient is then turned upon his left side and the right leg flexed upon the thigh and the thigh upon the abdomen, leaving the left limb extended. The physician should then bring the patient's right knee up against his own body, then he should place one of his hands. upon the patient's anterior superior spinous process of the ilium and his other hand upon the tuber ischii, at the same time exerting pressure backward and downward with the hand upon the ilium and with the other hand pushing downward and forward upon the ischium. This should be kept up until the pelvis is brought back to its normal position. This can be determined by having the patient lie upon the back and going through the same procedure as for the detection of the deviation when it will be found that both limbs are of the same length. This deviaton may again occur when the patient suffers pain, and should be corrected as often as necessary, cr until it remains normal. It will be found that after few manipulations of this character in conjunction with the technique outlined in "Mechanical Vibratory Stimulation" for September, 1904, that a complete cure can be obtained in nearly all cases. Far more so than by any other method of treatment.

In those cases in which the limb is longer it will be found that it is the deep pelvic muscles which are in a state of contracture and pull the pelvis down to this side.

It might be well to add that this anatomi

cal deviation often exists as a causative factor in a great many disturbances in the pelvic organs which may or may not be accompanied with pain along the course of the sciatic or any of the other nerves to the lower extremities. Of course it must be understood that should the lesion originate from a pelvic tumor that it will constantly recur, but that re. lief may be obtained at each treatment. Mechanical Vibratory Stimulation, December, 1904.

ANTI-SPITTING LAW AGAIN. Mich., recently secured its first conviction AGAIN. Lansing, against a violator of the law prohibiting spitting on the sidewalk

DR. DE CASTRO, physician at the court of the Emperor Menelik, has presented to the Italian Minister of Foreign Affairs a report in which he states that the practice of vaccination has vaccination has recently been extensively adopted in Abyssinia.

IN 1890 the population of San Francisco, 6,880; in 1900, population 342,782, deaths California, was 298, 997, number of deaths 6,657. The population increased 43,785 and deaths decreased 223. Death rate decreased

from 23, per 1000 in 1890 to 19.4 in 1900.

STAFF WARNED.-The newly appointed, staff of Cook County (Ill.) Hospital was warned that as it had been appointed without "pull"-political or otherwise-so would no "pull" stand in the way of discharge if the rules of the institution were not lived up to.

THE tent colony for the treatment of tubercular patients, located at Ottawa, Illinois, is proving a success. Fifty-nine patients have been admitted. The colony is under the care of Dr. J. W. Pettit, chairman of the committee on tuberculosis of the Illinois State Medical Society.

BOARD OF HEALTH OBJECTS.-The Rapid of transporting corpses in the smoking comRailway of Cincinnati has been in the habit partments of its passenger cars. Objections

to this practice have been made by the Board of Health-whether for sanitary or anesthetic reasons is not stated.

DR. THOMAS H. MANLEY, of New York, died at his home, January 13, 1905, aged 54 years. His death, which was caused by pneumonia, was somewhat sudden and came while he was in robust life and engaged in an active practice. He was visiting surgeon to the Harlem and Metropolitan hospitals.