narcosis. The authors observed that certain substances, particularly muskarin and pilocarpin caused a diminished current of air within the bronchioles resulting from a spasmodic contraction of the muscular coats. This spasm ceased upon severing the vagus again permitting a free circulation of air through the bronchioles. Atropin and lobelia on the other hand, caused a relaxation of the contracted bronchioles, which, however, continued only a short while. Morphin had a similar effect as atropin and lobelia, although the relaxation with morphia was incomplete and only occurred with a moderately large dosage. Carbon dioxide gas caused a decided tonus of the bronchioles diminishing the circulating current of air to almost one-half its volume. thors were able, by irritating the mucous membrane of the nose, to produce a reflex spasmodic contraction of the bronchioles. Irritating other portions however, as skin, intestines, neck, or pharynx had a negative effect. The results of the authors' experiments prove satisfactorily that asthmatic attacks are produced by tonic muscular spasms of the bronchioles, the therapy indicated to relax the muscular spasticity and the affiliation between asthmatic attacks and diseases of the nose associated with an irritation of the mucous membrane.

The au

Special Aids to the Early Recognition of Pulmonary Tuberculosis.(Dunn, American Medicine, October 17, 1903.)-After a thorough consideration of the symptoms, signs and methods of an early detection of a pulmonary tuberculosis. Dunn concludes the following: 1. The full appreciation of the value of percussion and auscultation findings and of symptoms is dependent upon the recognition of the limitations of the sig. nificance of their presence or absence. 2. Deductions from temperature may be made from only frequent, regular observations. 3. An auscultation chart made while listening to the sounds is an essential aid to an accuracy of both observation and record. 4. Negative sputum findings are never sufficient ground for a negative diagnosis. 5. Blood examinations throw no light upon diagnosis of tuberculosis in its incipiency, except in excluding those conditions in which the blood findings are characteristic. 6. Significance and reliability of agglutination are not yet fully estab lished. 7. The tuberculin test is safe, reliable, practical and justifiable diagnostic resource in those cases in which its use is indicated; that is, in those cases of suspected early tuberculosis in which all other means have failed to clear up the diagnosis. When a positive diagnosis can be made without the tuberculin test, its use is to be condemned as a meddlesome procedure.

In regards to using the tuberculin as a diagnostic aid, the author emphasizes the following: 1. The dose of tuberculin which does not produce a reaction, temporarily increases the tolerance of the patient to subsequent doses; therefore, the smaller the increase in dose, the greater must be the interval between doses. 2. The smaller the dose required to produce a reaction, the more reliable the diagnosis; therefore, the importance of searching for the local manifestations after all doses over 0.005 grams. 3. The salicylates, probably all the chemical antipyretics and some other drugs, interfere with the test; therefore, all drugging must be omitted during the test.

DEPARTMENT OF OBSTETRICS AND GYNECOLOGY.

BY W. H. VOGT, M. D.

ST. LOUIS.

Eclampsia, Enormous Placenta.-(Rini Koenig, Zentralbl. f. Gynaecol., No. 40.)-The author reports a case of eclampsia in which the placenta weighed 1620 gms., but was perfectly normal, otherwise both macroand microscopical. He thinks the large size of the placenta may have had an influence inbringing about the eclampsia on the basis of the disease being due to poisoning by fetal metabolic products.

Four Cases of Eclampsia.-(Windisch-Odön, Zentralbl. f. Gynaekol No. 40, 1903.)-The author reports three cases which were treated with salt transfusion, warm packs and morphine. The three cases made a rapid recovery. The fourth case was not treated so, and promptly died. He believes if with transfusion of salt solution, warm packs and baths, we are able to bring on free perspiration, then with the use of morphine and bringing the labor to a rapid termination, we will be able to improve the prognosis of eclampsia materially.

Vaginal Total Extirpation Without Narkosis. (R. Gradenwitz, Monatsscrift f. Geburtshilfe and Gynaekologie, Band XVI, H. 5.)— The author reports three cases. One was on account of retroflexion with obstinate hemorrhage, phthisis and anemia; another for total prolapse of the uterus and vagina in a patient with a large struma, and the third on account of carcinoma of the portio accompanying severe degeneration of the heart. The last patient succumbed to shock. The only painful steps in the operation was the ligation of the lower part of the broad ligament and the tubes.

A Median Fundal Suspensory Ligament Following Ventral Fixation. -F. Michel, Zentralbl. f. Gynaekol., No. 39, 1903.)-Michel describes a fibrous cord extending between the fundus uteri and the perietal peritoneum, which sometimes follows ventro-fixation by his method. In the course of years this may reach several centimeters in length, and he describes a case of a woman who had been operated on three years before where this cord was fifteen cm. long. He thinks that such a condition may have uncomfortable results for the patient and advises that in ventrofixation one should not make a limited attachment of the fundus to the peritoneum, but make a much more thorough fixation.

A Simple Funnel-Shaped Pelvis.-(W. Paul Richter, Zentralbl. f. Gynaekol., No. 40, 1903.)-Richer defines the simple funnel-shaped pelvis as one in which the pelvic inlet is perfectly normal, but its outlet becomes gradually narrower. The narrowness of the pelvic outlet in itself would not necessarily offer an absolute obstacle for a full term child with an easily molded head, but on account of participation of both bead and pelvis it forms an absolute cause for dystocia. The induction of premature labor changes the absolute impossibliity of birth to a relative one. The relation depends upon the character of the pains, the position of the child, the size and molding capacity of the head and the degree of mobilit of the pelvic joints.

DEPARTMENT OF PATHOLOGY AND BACTERIOLOGY.

By R. B. H. GRADWOHL, M. D.

ST. LOUIS.

Anti-Rabic Vaccination at the Pasteur Institute at Lille.-Vansteenberghe, chief of the laboratory reports (Annales de l' Instut Pasteur, Vol. XVII, No. 9, September, 1903) results of anti-rabic treatment in Lille. Since the foundation of the institute in Lille in 1895, 1, 807 persons have been treated. Of these 1807 cases treated 457 were bitten by dogs which were proven to be rabid by experiments conducted at this institute. Again, 784 of these cases showed certificates from veterinarians proving that the dogs showed clinical or autopsy signs of rabies. Again, 566 were bitten by suspicious animals, but rabies was not demonstrated. Of all these cases, but four have died, comprising a mortality of 0.22 per cent. The method of treatment of all these cases was similar. preserved in glycerin, according to the rules of Calmette.

The virus was

A New Method for Rapid Hardening and Imbedding of Tissue.-A. Stein (Deutsche medicinische Wochenschrift, October, 20, 1903) describes a new method of hardening specimens. It is designed for small specimens where there is a need for quick diagnostician, e. g., uterine scrapings, etc. It is briefly as follows: 1. Fixation for ten minutes in 10 per cent formalin. 2. Immersion in 85 per cent alcohol for five minutes. 3. Immersion for ten minutes in absolute alcohol. 4. Immersion for twenty minutes in pure, water-color anilin oil. (These four procedures should be carried out in the incubator at a temperature of from 50 deg. to 52 deg. C.). 5. Immersion in xylol for fifteen minutes. Change specimen two or three times, two fresh xylol solution during his interval. 6. Imbedding for ten to thirty minutes in paraffin. (Steps 5 and 6 should be carried on in the incubator at a temperature of 58 deg to 60 deg. C.)

Spirillosis in Chickens.-E. Marchoux and A. Salimbeni (Annales de l'Institut Pasteur, Vol. XVII, No. 9. September, 1903) observed a disease of chickens in Rio Janeiro which was quite fatal-as many as one hundred dying in a single day. It seemed to affect the finer-bred chickens more than the common stock. Among the symptoms observed were diarrhea, loss in weight, somnolence, bedraggled feathers, anemia of the combs. The fowl affected refuse to perch; they lie on the ground, with heads down. Death is preceded by a short spasm. In some cases the disease took on a chronic form, with final paralysis and death in from eight to fifteen days. Post-mortem lesions were enormous swelling of the spleen, some enlargement of the liver, with fatty degeneration. spirillum was found ante-mortem and post-mortem. Injection of this spirillum into healthy fowl was followed by the same train of symptoms, with fatal ending. The summary of the investigation of the disease is as follows: 1. The disease is caused by a spirillum. 2. The disease is transmissible by the injection of infected blood into healthy animals. 3. It is transmissible by swallowing the infected blood or infected stools containing the spirillum. 4. In natural infection of the chickens considered in this epidemic, it was found that the disease was transmitted by the fowl eating an insect of the family of Argas, which harbored the spirillum. 5.

A

Serum taken from animals that survived, was found to be slightly prophylactic when injected into other animals which were subsequently inoculated with this spirillum. 6. In vitro, this serum was agglutinative and immobilizing.

On the Medullated Nerve Fibers Crossing the Site of Lesions in the Brain of the White Rat.-S. Walter Ransom (The Journal of Comparative Neurology, Vol. XIII, No. 3,) undertook to prove that there is a new formation of nerve fibers in immature animals after division of nervous tissue. Ransom gives first a review of the literature on regeneration of nerve fibers and of neurons. The healing of wounds in the brains of mammals has been studied by various investigators, with a view of determining whether new nerve tissue is formed. Wounds were inflicted by Tedeschi on the brains of rabbits, guinea-pigs, cats and dogs, some by plunging a hot needle into the tissue, some by the introduction of a foreign body, like a piece of paraffin, and others by the resection of part of the brain. He also studied the effect of the injection of pathogenic bacteria beneath the dura. Some months after the operation, he saw that the foreign body was surrounded by tissue, consisting chiefly of neuroglia, but also containing a few ganglion cells and many nerve fibers. He describes a nerve cell which had sent processes between the lamellae of paraffin and which must have developed since the operation. Vitzou ablated the occiptal lobes of a young monkey; two years after the operation, he removed the tissue which took the place of the excised occipital lobes and found that it looked like normal brain tissue. Owing to the fact that this description is inadequate, likewise his illustrations, this finding may be explained on the basis that this was a displacement of brain tissue inte the gap formed by excision of the occiptal lobes, and not a true regeneration. Ransom's experiments were performed on young white rats. sharp-pointed thin-bladed scalpel was passed through the soft skull and run two to three mm. into the brain tissue, far enough to cut the corpus callosum. The wound was made parallel to and about one mm. to the left of the great longitudinal sinus, and two mm. in front of the lateral sinus. After the operation, the rats were allowed to live for one month and a half. Brains were then removed, hardened in Mueller's fluid at 40 deg. C. for one month, and imbedded in celloidin. The occipital region of each brain was cut in serial sections four to five microns thick, stained by the PalWeigert technique. The results were as follows: very little scar tissue was found in the brain. There was a steady decrease in the amount of scar tissue with the decrease in the age of the animal at the time of operation, with one exception. A degeneration of the fibers of the corpus callosum towards their cells of origin was noticed in two of the younger rats. Shifting of the parts of the cortex with reference to each other was ob served in all but the oldest rat. In the very center of the stab wounds, medullated nerve fibers were seen crossing from one side to the other, from normal tissue into normal tissue. Ransom states that these were not regenerated, but entirely new axons. The number of these fibers was very great in the youngest rats, but decreased very rapidly as the age of the rat at the time of operation increased. Unfortunately, the investigator states, the brains of rats operated on at a more advanced age were spoiled in the process of hardening, so that it cannot be stated definitely at what time. the brain of the rat ceases to have the capacity of sending processes across the site of lesions.

DEPARTMENT OF OTOLOGY.

BY A. F. KOETTER, M. D.

ST. LOUIS.

Etiology, Pathology and Symptomatology of Chronic Otitis Media Suppurativa.-Chas. W. Richardson speaking of etiology, pathology and symptomatology of chronic otitis media suppurativa (Laryngoscope, June, 1903) says most frequent cause of otitis media purulent chronic is transformation of an otitis media purulent acuta into a chronic form. This may be brought about in the following way: (1) Neglect or inappropriate treatment of acute form. (2) Existence of constitutional conditions that have unfavorable influence on local lesions, viz.; scrofula, tuberculosis, anemia and syphilis. (3) Occurrence of otitis media acuta purulent during invasion of acute infectious diseases, as scarlet fever, typhoid measles and diphtheria. (4) Virulence of invasion and character of bacilli present. (5) Acute invasion of attic. (6) Local changes at time of the invasion or during progress of case, viz., development of granulation tissue about membrane or walls of tympanic cavity. (7) Through periostitis or caries of ossicles or tympanic wall, through retention of purulent discharge. (8) Lecal changes within nasal and naso-pharyngeal cavity. Some forms of otitis media purulent chronic may be chronic from the start, namely, those due to diabetes, tuberculosis and anemia. Pathologic changes not only involve tympanic cavity, but may extend to tube and mastoid cells, from labyrinth to external auditory canal. Marked changes take place in epithelial structures, epithelial denudation and necrosis followed by formation of granulation tissue which may form polypi. Mucous mem brane is thickened, due to infiltration made up of small round cells with increase number and size of blood vessels. Caries and necrosis of ossicles most common form of bone lesion in otitis media purulent chronic. Incus on account of its limited nutritive supply, most commonly affected; caries of long process or body, or necrosis of entire bone may take place. Malleus is frequently involved, causing caries of head or tip of long process, or of both of these parts. Disintegration of ligaments or contraction of surrounding fibrous bands may occur, causing dislocation of ossicles, mainly affecting malleo-incudal joint. Caries process may involve walls of tympanic cavity affecting tegumen tympani and the outer wall and portion of external wall, which is formed by auditory plate of the temporal. Inner wall rarely affected except in tubercular cases, and in those secondary to diphtheria and scarlet fever. Destruction of membrane more or less pronounced, may be congested and infiltrated in the cuticular and mucous layers, or opaque from degenerative changes, and showing chalky deposits. Continued irritation of the purulent discharge may cause dermatitis of external canal. Dermatitis may cause an atresia of external auditory canal. Mucous membrane of tube is infiltrated and an increase in the size of the acinus glands takes place. Changes that occur in the mastoid are very important in this serious lesion: (1) Congestion, swelling and polypoid degeneration of lining of antrum and mastoid cells. (3) Complete obliteration of antrum and mastoid cells through development of granulation-like tissue of lining of antrum and mastoid cells. (3) Osteo