eye, as evidenced by dilated and tortuous vessels and blurring of the edges of the optic disc. The diagnosis of tubercular meningitis was made, and later verified, as the patient developed complete meningeal symptoms and died three weeks later.

The above cases are here selected from a number as possibly the most practical illustrations of some of the propositions set forth in the body of this paper. In the two cases of albuminuric retinitis, I made the diagnosis of nephritis, simply upon the condition of the retina. In the case of tuberculosis I made the diagnosis wholly upon the condition of the pupils and the anemic appearances of the patient. In the case of meningitis, I made the diagnosis of meningitis without the symptoms afforded me by the eye, simply using the condition of the eye as corroborative evidence upon which to base a diagnosis.

Kindly understand me that I do not wish to seem extreme in this matter, in the way of having any one believe that it is good practice to make snap diangoses on the symptoms set forth by the eyes, but would particularly call your attention to the value of the eye symptoms described in conjunction with other phenomena, using the ocular conditions to help clear up cases of doubtful diangosis. Taken in this sense, I feel sure that the general practitioner will find himself well repaid for the time and trouble bestowed upon the study of these methods of diagnosis.

BIBLIOGRAPHY.

A. E. Davis, Journal American Medical Association, December 11, 1897.

Gradle, Medicine. March. 1897.

G. E. de Schweinitz Maryland Medical Monthly, June, 1900.

Grober, Archives of Clinical Medicine. German.

T

CATARRHAL DEAFNESS; ITS PREVENTION.

Frederick Roost, M. D.

Assistant Surgeon Manhattan Eye, Ear and Throat Hospital.

HE subject to which I invite your attention is one that has long been the topic for spirited and voluminous discussions. If reckoned by its general and tremendous prevalence, catarrhal deafness is a problem which deserves the active interest of every thoughtful clinician. Certainly as a distressing affliction, regarded both from the standpoint of the sufferer and those who have occasion to treat it, it stands as one of the most important questions in the otological domain.

Of all the cases treated in our larger aural clinics three-fourths are cases suffering from chronic deafness of one form or another. It has been said that chronic catarrh has been made to cover everything except suppuration that occurs in the middle ear. Be that as it may, the elasticity of the term, catarrhal deafness, which has become so generally and conveniently applied for all affections of the tympanic cavity where the chief symptom is the annoying one of chronic deafness, affords us a broad scope in considering the question of prevention. It may be true also that the

pathological condition existing in the cases under discussion vary consid erably when they come to us for treatinent, but I maintain with the most of my confreres that the pathological process, like the underlying factors, had we been present at the beginning, would have been found identical.

In the clinics, the majority of the patients who present themselves for treatment are adults. It is these hopeless cases, note you gentlemen, with the disease irrevocably fixed, from which is gleaned statistical material, which has given such an unfavorable outlook for its cure, and which should serve as a constant stimulus for the medical worker to seek out and destroy the widespread seeds of the evil before it has gained a foothold. Indeed like most of our troublesome chronic affections, .its relation to early life is an important one, and perhaps in no disease is it more necessary, or efforts for prevention and relief rewarded with more certainty, than in the early correction of the causes of catarrhal deafness. We are agreed that every case of the so-called deafness has its origin in childhood and adolescence, furthermore, that the offending factor, in nine cases out of ten, would be found in the nose and throat. I am aware that cases have been plentifully cited by the rhinologists where spurs, polyps, etc., were found in patients who never complained of a single ear symptom. However, more accurate men by a careful and routine functional examination of all nose and throat patients treated have found 75% with at least some impairment of hearing. In children subject to adenoid hypertrophy the percentage is even higher and I believe these subjects would all show a degree of functional impairment if examined at certain times, for of all causes adenoid growths are universally considered the most pernicious.

Briefly, I may say, when it comes to the question of etiology, we are rapidly getting to one opinion; namely, that the etiological factors are manifest at an early age, and that brilliant and beneficial results would be the reward were this appreciated and followed by a timely apprehension.

Much activity has been lately shown along the lines of general instruction. Teachers of private and public schools are taught to recognize faulty conditions, especially of the nose and throat-these occurring with the most frequency and most easily detected because of the ever present and all apparent symptoms attending such disorders. Even the laity is beginning to take notice and will sometimes bring in a youthful member of their family with the statement that the child is not doing well, furthermore that he is always catching cold, snoring, restless in his sleep and a constant mouth breather.

During the eruptive and contagious diseases, common in the early life of every individual, the mucous membrane of the nose and throat are among the first to suffer. If they have been normal, their inherent resistance is sufficient in all ordinary cases to cope successfully with the invasion. On the other hand, added to the specific infection a deviated septum, spurs, or hypertrophied growths in the pharynx, the function of the parts is weakened and perverted, leaving us a condition which, unattended, will eventually lead to grave results; the ear usually being the chief sufferer. Now the doctrine of sprays, douches and nebulizers is one that has been extensively preached and zealously employed, the bane

ful effects of which practice can hardly be overestimated. I want to emphasize that the nasal mucous lining, is in both health and disease, one of the most easily irritated membranes in the human body, and when we insist on forcing on this sensitive membrane high pressure sprays and sometimes intolerant douches our offices, become at the best meddlesome ones. Again, the taking of such patients and removing the tonsils, because to the eyes of the examiner they occupy the larger place in the pathological field, will be a piece of temporizing surgery, which, when intended to relieve the sufferer of his assembled catarrhal symptoms, will surely result in dismal failures when the more important influences, as nasal obstructions, and, particularly, adenoid growths, are overlooked. The conduct of these cases cannot be too careful, but it must be a rational one. When ever it is our privilege to have charge of a patient in adolescence, in whom a catarrhal symptom is marked, or persistent, a thorough search for the offending cause should be made. I appreciate the systemic factors, and these should never be ignored. If tonsils are much hpyertrophied, the presence of adenoid tissue should always be suspected. Spurs and septal deflections will not escape our attention. When all these faults are corrected we shall have done our duty. The task to eradicate thoroughly, however, the morbid processes requires a degree of competency and a nicety of judgment not possessed by all. Unless every vestige of an adenoid tissue can be removed the tonsil likewise need not be disturbed. In fact it is the field where the general physician and expert should work hand in hand to accomplish the best results.

PAPERS READ AT THE SEMI-ANNUAL MEETING HELD IN KANSAS CITY, MARCH 23 AND 24, 1905.

CEREBRO PSYCHIC REST AND REST THROUGH CEREBRO PSYCHIC DIVERSION IN THE CURE OF INSANITY AND INSANOID STATES.

C. H. Hughes, M. D., St. Louis, Mo.

ONG before that eminent and philosophical psychiator in our profession, Dr. Henry Maudsley, of London, set forth his clinical neurological treatise on the physiology and pathology of the mind, the immortal Bard of Avon, in one of his unequalled portraitures of mental action had revealed a marvellous knowledge of the nature and the relation of mental disorder to brain and an astonishingly accurate conception for the time in which he lived and wrote, of the rest aspect of what we now call psychotherapy. He puts into the mouth of the king interrogating the court physician, this forceful interrogatory which Macbeth's physician unsatisfactorily answers by referring Lady Macbeth's malady to the priest. whereupon the king rejoins. "throw physic to the dogs, I'll have none of it." This was the king's question:

Canst though not minister to a mind diseased.
Raze out the written trouble of the brain

And with some sweet oblivious antidote

Cleanse the stuffed bosom

Of that perilous stuff that weighs upon the heart?

Here was the king's conception, evidently of that doctrine, more than two centuries later clearly presented as to the registering of normal and morbid impressions on the psychic centers of the brain and the correlative brain waste and brain repair demanded of morbid mental impression, as well as normal action. He asked to have the written troubles of morbid mentality registered in the pscyhic centers of the gray cortex of the overwrought brain razed out by some sweet oblivious antidote, which would cleanse the stuffed boson of the perilous stuff that weighed upon the heart.

While erroneously adopting the prevailing atrabilis conception or the conception of Atrabilis not only eliminated by the liver, as the cause of her trouble, here was advanced, through, more dimly discerned appreciation than we see it at the present day under the greater illumination of modern biological research, of the ptomaine theory and of the pernicious activity of ptomaine poisoning in the development of morbid mental manifestation in delirium, epilepsy, etc., as well as in the queen's disease, which was a depressed form of insanity or melancholia.

Although the neurone theory was not then dreamed of in the philosophy of the king, yet he knew that the brain was the seat of mental dis order, influenced by toxins, or perilous stuff, as he called it, which needed to be antidoted, and that the impression upon the brain and heart might be changed by system cleansing medicine that would lighten the "stuffed bosom" and lift the the weight from the seat of the feelings and thoughts, and by a sweet oblivious antidote that would bring the restful oblivion of sleep to the brian, as a sweet restorer of tired and perverted nature, a reconstruction of the disintegrating neurones of neurasthenia.

The cleansing out of ptomaines promotes the rest treatment of the exhausted eratically acting and autotoxically poisoned psychic neurones in insanity and insanoid disease, such as the deliriums. Sweet oblivious an. tidotes exist in antitoxine treatments and rest, changed environment gives changed psychic impression and normal diversion to abnormal perception and thought, giving worn, atrophic and asthenic neurones a chance for rest and recuperation from exhaustion or adynamia of the too persistent, prolonged and over-strenuous brain action that has precipitated the mental catastrophe of the queen. Diversion of mental impression, through changed environment promotes rest and repair of overwrought psychic neurones.

Chemical restraint of erratically acting brain cells through judicious and timely impression of rest enforcing and sleep-inducing agents like the bromides in the day-time. hypnotics, chloral, veratrum viride, hyoscine, sulphonal, digitalis or similar agencies at night, anodynes and opiates in states of depression, the coal tar derivatives, opiates, hysciamus, belladonna and all pain obtunders. Relief of pain is often an essential factor in the unrest of delirium and insanity, and the constitutional remedies like quinine, salol, salicylic acid, etc., for diasthetic states is judicius neurotherapy. Heat, cold, ether, opium, locally, when irritations of diasthetic states or acute disease, require these administrations to promote freedom from pain are adjuncts to rest from irritability of body promoting tranquilization of brain and satisfaction of the mind.