Clinical Observations in the Treatment of Inoperable Carcinomata with Formalin.( Powell, British Medical Journal, March 30, 1903.)-Applications of 2 per cent formalin solutions are made on the tumor. These are renewed every six hours, and after 24 to 48 hours the unpleasant odor disappears, and in three to seven days a line of demarcation separates the tumor from the surrounding tissue. The tumor is easily removed after a few days with forceps and scissors. Powell removed two mammae tumors and one epithelioma of the lip with this method without any pain or use of narcotics.

Saline Enema. (Dr. Tscherepnin, Praktitschesski Wratsch, 1903, Nos. 1-2.)-The author reports 31 cases of typhoid fever in which he used saline enemata. The patient lies on the left side with legs flexed, and the enema consisting of six grams each of sodium chloride and sodium bicarbonate in 1000 ccm. water (temperature 15-20 R.) is permitted to flow, slowly into the bowel. The abdomen soon is less painful and softer, and the temperature sinks 0.4 to 0.5 deg. R. Usually 300-500 ccm. of the liquid is absorbed. Their nervous symptoms improve and they sleep better. It requires 20-30 hours to derive the full effect of the enema, or until the toxins are washed out of the system. The good effects continue one or two days when they should be renewed. The patient passes more urine and the stools also improve.

DEPARTMENT OF OTOLOGY.

BY A. F. KOETTER, M. D.

ST. LOUIS.

Bezold's Mastoiditis.-O. J. Stein reports a typical case in the Illinois Medical Bulletin. Miss L. referred for relief of pain in right ear, commenced eleven days ago with an acute earache, swelling back of ear and bloody discharge from nose and ear which gave some relief from pain in ear. When author saw patient temperature was 99 deg. F., no swelling or redness back of ear, dull ache located mainly in the ear, tenderness on pressure confined to tip of mastoid. Membrana tympani reddened and bulging slightly in its upper part. No perforations and canal dry; general health fair. Twelve per cent carb. glycerine dropped in ear every two hours. Ice-bag to back of ear. In a week all subjective symptoms disappeared. Patient did not return until a week later, complaining of tenderness back of ear, and feeling of fullness in the ear. Sensitive area limited to apex of mastoid and neck just below the ear. Membrana tympani same condition as when first seen. Temperature ranged between normal and 99-.5 deg. F. Ice-bag applied, but no relief; second day membrana tympani incised in its post portion; no discharge and incision healed in forty-eight hours. Pain on motion of head and inclination toward affected side. Immediate operation decided on. Post-auricular incision was made, periosteum laid bare and tendonous, attachment of sterno-cleido mastoid muscle was severed; no sign of disease apparent. Elevating the periosteum, the cortex of bone was removed with chisel and deep cells exposed

Large necrotic area was discovered filled with pus. With a probe perforation into neck was found and with pressure exerted on the neck abscess cavity was emptied. Bone in direction of antrum appeared healthy, and after thorough irrigation of wound and abscess cavity, parts were sewed together with silk-worm gut sutures, leaving lower angle open for gauze drain. Dressing removed on fifth day. Patient left hospital on seventh day, and was back at work on the thirteenth day. This disease was first described by Bezold of Munich eighteen years ago. It differs from ordinary mastoiditis in that there occurs a perforating necrosis of the tip of mastoid process through the inner table, opening an avenue into the neck for the formation of deep subfascial abscesses. Disease has its origin in an inflammatory condition of middle ear and mastoid antrum. Some primary cases are caused by injury back of ear when there exist a latent condition of former ear trouble, or in patient who is the subject of tubercular diathesis. The symptoms often lack pronounced character of those in mastoiditis. Pain over mastoid is not severe, but there is a feeling of soreness and tenderness along head of sterno-cleido mastoid muscle. Edema and redness of soft tissues absent as a rule, but sometimes very marked. Swelling in the neck and pain on motion of the head present. Temperature ranges from normal to 100 deg. F., higher in the early stage. Torticollis is prominent symptom. Fluctuation is not felt due to deep location of abscess. Patient usually able to be about and great care must be exercised in watching cases which may be discharged as well returning in a short time for operation. Treatment calls for mastoid operation, making post-auricular incision carrying lower limit into the neck. Tendonous attachment of sterno-cleido mastoid muscle is severed. The cortex of mastoid tip is removed with chisel exposing the cells which are found filled with pus and granulation tissue. Sometimes the deeper cells must be exposed which lie beyond the plane of digastric fossa. Pus will immediately flow from abscess and pressure on the side of neck will usually empty cavity. All the diseased bone should be removed, and it is often necessary to remove entire tip of mastoid process, abscess cavity is irrigated with bi-chloride solution and gauze drain put in, the wound stitched entirely with exception of lower angle.

Acute Mastoiditis.-W. G. Craig in Yale Medical Journal reports five cases of acute mastoiditis. Case I-Patient male, age 55, contracted severe cold which persisted for about two months. One evening he was taken with severe earache in right ear, persisting until membrane perforated six hours later. Discharge continued for five weeks, when patient was seen by author. He complained of acute pain at intervals and tenderness behind ear and down the neck. Canal was full of pus, large perforation of membrane anterior, and bulging of posterior wall of canal. Swelling over mastoid process and below the tip. Temperature 102 deg. In operating usual incision was made. Small quantity of pus found beneath periosteum overlying antrum, no perforation visible. Antrum opened and found full of yellow, offensive pus, cavity cleaned out. Cells of tip were exposed, but found healthy, a probe readily' passed from antrum to attic. Wound packed with sterile gauze; recovery uneventful.

Case II.-Female, age 26. On tenth day of an attack of measles severe pain in right ear developed followed in three hours by perforation

and discharge, pain ceased. When seen two days later temperature 100 deg., no pain, profuse discharge and slight mastoid tenderness. Ear irrigated every three hours, ice-bag, calomel followed by saline. Symptoms persisted and edema over antrum appeared. Operation was suggested and accepted. Antrum was opened and found full of pus. Cells of tip were also full of pus, but no softened bone found. A probe was readily passed into digastric fossa. Pressure on swelling in the neck caused flow of pus. Entire tip was removed and cavity packed with gauze. Wound dressed on third day, temperature normal; fifth day drain removed. Healing uneventful, ear ceased discharging seventh day, and on fourteenth hearing was normal.

Case III.-Boy, age 8, deaf and dumb, due to meningitis when five years old. After an attack of measles complained of difficulty of eating, jaws being stiff, swelling behind and above ear. Temperature normal for five days, when it rose to 103 deg. Examination: membrane destroyed, posterior wall of canal swollen, ear dry; large swelling over mastoid tender and fluctuating. Incision over swelling and carried well down to the tips caused discharge of offensive pus. Bone over antrum softened and discolored, antrum full of pus and granulations; no sinus found. All soft bone chiseled away and wound packed with sterile gauze.

Case IV.-Male, age 35. For eight days pain in left side of head, occasional pain behind ear worse at night. Canal normal, drum slightly congested. Temperature normal; tenderness over mastoid region upward to vertex. Membrane incised; free bleeding and some pus. Cathartic, irrigation with hot bichloride solution. Ice-bag to mastoid for seventytwo hours caused tenderness to disappear. Discharge scanty and serous in character; temperature 99 deg. F. Incision was made, antrum opened and found full of pus. Lateral sinus was exposed, lying just posterior to canal wall. In enlarging bony cavity sinus was pinched by spicula of bone, bleeding was slight and controlled by pressure. Diseased bone removed and wound packed with sterile gauze. Recovery uninterrupted.

Case V.-Female, age 25. Pain in left ear following an attack of measles. Examination showed membrane swollen, red and bulging in posterior half, tenderness over antrum; temperature 102 deg. F. Paracentesis, ear irrigated every three hours. Ice-bag constantly applied to mastoid. Pain ceased, temperature normal; free discharge, some tenderness over antrum. This continued for twelve days when tenderness increased, but disappeared after use of ice-bag for forty-eight hours. Discharge continued for a week, after two weeks hearing was normal.

From the foregoing report it will be seen that temperature give no clue to condition present it may remain normal, as in case IV, where abscess cavity was large. Bulging of posterior wall of canal was present in the advanced cases, but not in the acute. Pain, tenderness and swelling over the antrum was only symptoms of diagnostic value. Case I.-Time of infection of mastoid process not known, but probably existed two weeks. There was but little destruction of bone and abscess confined to anrtum. Case II.-Time between initial pain and operation but four days, yet there was infection of antrum, the cells of the tip, perforation through digastric fossa and pus well down in the neck, no severe pain and temperature ranged from 99 deg.-100 deg. F. Case III.-Nothing to be

seen but cicatricial tissue due to previous ear trouble; ear now dry. Case IV. Marked infection of mastoid and but slight involvement of tympanic cavity. Case V.-Recovery a surprise, as operation was advised when pain and tenderness did not yield to ice-bag. In three cases operation was necessary, as presence of pus was well marked. Operation was urged in other cases when pain and tenderness continued after constant use of ice-bag for seventy-two hours.

Middle Ear Catarrh Due to Enlarged Tonsils.-C. P. Linhart in Columbus Medical Journal reports two cases of middle ear catarrh due to enlarged tonsils. (1) Young woman complaining of deafness, sore throat and susceptibility to colds. On examination found no trouble with nose, but both tonsils enlarged. Both ears discharging. Removal of tonsils advised and consented to. Boric acid used in both ears. In two weeks both ears were dry and perforations closed. Hearing improved considerable. No more trouble with colds. (2) Young man complained of deafness, tinnitus and pain in ears. Nose and nasopharynx clear, tonsils enlarged. Tonsils were removed; when seen after a month hearing had not improved and tinnitis still present, but promise improvement as treatment continues. Results following removal of tonsils are more gratifying in otitis media suppurative than in otitis media catarrh chronic.

PRENATAL SMALLPOX.-Dr. J. H. Franklin reports in the Medical Record the case of a woman seven and a half months pregant, who was vaccinated on account of having been exposed to smallpox. She did not take the disease, and developed no symptoms of any kind, At term she gave birth to a full term dead child bearing the lesions of smallpox in the pustular stage.

X-RAY BURNS.-A dressing which Dr. Engman has found serviceable for itching and burns of minor degree produced by X-rays is applied on absorbent gauze, laid over the surface and covered with a sheet of guttapercha. The following is the composition:

The powder should be well rubbed up in a mortar and the lanoline added. The olive oil and liq. calcis are well mixed, then this mixture slowly added to the powder and lanoline, constantly stirring. When this is thoroughly mixed the rose water is added and the whole beaten up in a mortar into a light creamy paste. If there is much pruritus, 1 per cent or 2 per cent of Calvert's carbolic acid can be added to the whole.

NECROLOGICAL.

Memorial of the St. Louis Medical Society to Dr. Armand Derivaux who Died October 4, 1903.

Dr. Armand Derivaux was born at St. Amarin, Alsace, September 19th, 1849. After entering upon the study of medicine at Strasberg, he left the school to accept the position of assistant surgeon during the Franco-Prussian War. At the termination of this service, he entered the Parisian school of medicine from which he took his degree in 1876. Soon after, he came to St. Louis and entered actively upon the practice of medicine.

Dr. Derivaux was a man of scientific spirit and many accomplishments and soon rose to a prominent place in his profession, where he sustained himself with exceptional success for the past twenty-seven years. He was for many years an active member of the St. Louis Medical Society and the St. Louis Gynecological and Obstetrical Society, having been at one time the honored president of the latter society. In each of these organizations, he was an interested and active worker and had endeared himself to their membership by his many personal charms. Dr. Derivaux leaves a widow and two children to mourn his death.

Resolved, That by the death of Dr. Derivaux, this society has sustained the loss of one of its most courteous members, a scientific worker and student.

Resolved, That this society extends to the family of Dr. Derivaux its heartfelt sympathy.

Resolved, That the above sketch of his scientific life, together with these resolutions, be spread upon the minutes and a copy be sent to the family.

J. K. BAUDUY,
FRANK R. FRY,

Committee.

WALTER B. DORSETT,

Memorial Adopted by the St. Louis Medical Society, October 7, 1903, in Honor of Dr. John Bates Johnson, who died Oct. 6. We have met this evening to pay a tribute of respect to the memory of a departed friend and professional brother, Dr. John Bates Johnson, who for more than sixty years occupied a conspicuous place in the front rank of the medical profession in St. Louis.

Dr. Johnson was born in Fairhaven, Mass., April 26, 1817. His preJiminary education was acquired at the celebrated Friend's Academy in New Bedford, Mass., and his medical education in Berkshire Medical College, Pittsfield, Mass., from which institution he was graduated in the spring of 1840, and subsequently thereto, he was honored to having conferred on him the Ad Eundem degree, by Harvard University. Soon after graduating he was appointed, on competitive examination, house surgeon in the Massachusetts General Hospital, where he remained for one year, enjoying the superior advantage of association with many of the leading physicians of Boston.