Kurschinski, 1888, reports the effects of some digestive and pharmaceutical preparations for promotion of secretion of pancreatic juice. Pilliet, 1889, wrote on the transformation of fat by the pancreas, Zawadzti, 1890, considers the chemical composition of the pancreatic juice of man. Gley, 1891, makes his preliminary report on alimentary glycosuria, and the relation. of the pancreas to it. Abelous, 1891, speaks on the action of antiseptics on the pancreatic ferments, and on giving doses of them as antizymotics. Chauveau et Kaufmann, 1893, speak of the pancreas, and the regulating the function of glycosuria. Dastre, 1893, writes upon his observations on pancreatic digestion in a note to Herzon. Ver Eecke, 1893, speaks of the modification in the pancreatic cells during active secretion. Kassillief, 1893, contributes a study of the physiology and pharmacology of the pancreas. Gottlieb, 1894, contributed an article upon the same subject. Harris and Grace-Calvert, 1894, wrote upon the human pancreatic ferments in disease. Jablousky, 1895, contributed a study on the physiology and pharmacology of the pancreas, and a comment of panolacte on the pancreas. Yablonski, 1895, mentions the activity of the pancreas under the influence of a milk and bread régime. Gutschy, 1898, speaks of the influence. of the spleen on the pancreatic juice. Hedon and Ville made experiments to determine the effects of digestion of fats when the pancreatic fluid is removed by fistula or the extirpation of the pancreas. Schirokokh, 1900, studied the effects of local irritation with the common stimulants on the pancreatic secretion under normal conditions. BIBLIOGRAPHY. Swalve, B. Amstelodami, 1667. Grieslaus, J. G. De repentina sua morte ex panceate sphacelato et obiter de potentia imaginationis. Misc. ecad. nat. curios, 1672; Leipzig, Francof, 1681, iii, 65. Saumarez, R. Med. and Phys. Journal, London, 1806, xvi, 289-300. Rush, B. Med. and Phys. 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Ann. de. la. Policlin. de Paris, 1890-1, i, 56 60. Melissinos, C. U. Arch. f. physiol., Lpz., 1890, 1890, 317-325, 1 pl. Nicolaides, R. Compt. rend., 1891, cxii, p. 752. Gley, E. Compt. rend. soc. de biol., Paris, 1891, 9s, iii, 270. Gaglio. Boliitino delle Scienze Medichi di Bologna, 1890, p. 113. Abelous. Compt. rend. soc. de biol., Paris, 1891, 9t, iii, 215-217. Lepine. Annales de Medicine, 1891. Thiroloix, J. Compt. rend. acad. d. sc., Paris, 1892, cxv, 420. Carvallo, J. et Pachon, V. Compt. rend. soc. de biol., Paris, 1893, 95, v, 641-645. Laguesse. Compt. rend. soc. de biol., 1893, p. 819. Sympson, E. M. British Med. Journal, London, 1893, i, 113. Laserstein, S. Arch. f. d. ges. physiol., Bonn, 1895, iv, 417-433, 2 pl. Kupifer, C. Sitzungsb. d. gellsch. f. morphol. u. physiol. in Muenchen, 1893, ix, 37 58. Arch. de physiol. norm. et path., Paris, 1893, 58, V, 774-778. Compt. rend. soc. de biol., Paris, 1893, 9s, v, pt. 2, 29 54. Compt. rend. soc. de biol., Paris, 1893, 9s, v, 622 624, 696-698. Pawlow, J. P. Arch. f. d. physiol. der supplBd., Lpz,, 1893, 176-200. Chauveau et Kaufmann. Compt. rend. acad. d. sc., Paris, 1893, cxvi, 463-469. Dastre, A. Compt. rend. soc. de biol., Paris, 1893, 9s. v, 818. Ver Eecke, A. Arch. de biol., Gand., 1893, xiii, 61-88, 2 pl. Kassillief, B. N. Arch. d. sc. biol., St. Petersb., 1893, ii, 218-244, 4 tab. Mett, S. G. Arch. f. physiol., Lpz., 1894. 58. Gottlieb, R. Denaturh-med. ver zu Heidlb., 1894, n f. v, 203-208. Kudrewetzky, B. B. Arch. f. physiol., Lpz., 1894, 83 116. Pavlow, J. Arch. d. sc. biol., St. Petersb., 1894, iii, No. 2, 189. Harris, V. D. and Grace-Calvert, G. A. St. Barth. Hospt. Reports, London, 1894, xxix, 125-142. Schafer. Lancet, 1895, ii, p. 321. Jablonsky, I. Arch. de sc. biol., St. Petersb., 1895-6, iv, 377-392. Montuori, A. Compt. rend. de soc. biol., Paris, 1895, 10s, ii, 847-850. Mouret, J. Jour. de l'anat. et physiol.. Paris, 1895, xxxi, 221-236, 1 pl. Carvallo et Pachon, Pouvior. Digestif du pancreas dens l'etat do jeune chez les animaux normaux et derates. In Richet C. Physiol. Trav. du lah, Paris, 1895. iii, 426-444. Kotlar, E. Ueber den einfluss des pankreas auf das wachstum einger patholenen spaltpilze. Centrbl. f. bakteriol. u paraseitenk., Jena, 1895, xvii, 145-168. Albini, G. Riforma med. Napoli, 1895, xi, pt. 1, 220-230. Bourquelot et Gley. Compt. rend. de soc. biol., Paris, 1895, 10s, ii, 238 240. Yablonski, I. Bach. biol. nauk., St. Petersb., 1895-6, iv, 377-390. Floresco, N. Compt. rend. de soc. biol., Paris, 1896, 10s, iii. 77. Savelyeff, N. A. and I. I. Stotski. Med. obozr. Mosk., 1897, xlvii, 964-976. Baldi, D. Arch. Ital. de biol., Turin, 1897, xxvii, 255-259. Gutschy, L. Liec viestnik u. Zagrebu, 1898, xx, 376-378. Biedl. Centralbl. f. physiologie, 1898, p. 624. Bang, I. Ztschr. f. physiol. chem., Strassb., 1898, xxvi, 133-159. Laguesse, E. Echo med. du Nord Lille, 1898, ii, 399-403. Rosenberg, S. Arch. f. d. ges. physiol., Bonn, 1898, lxx, 326-345. Klug, F. 1xx, 329-345. Arch. f. d. ges. physiol., Bonn, 1898, Yung, E. Compt. rend. acad. d. sc., Paris, 1898, cxxvii, 77. Diamare. Internat. Monatschr. f. anat. u. phys., 1899, p. 155. Tuckett. Journal of Physiology, 1899, xxv, p. 63. Palleri e Margari. 1900, iv, 97-109. Racoglitore med., Forli, Schirokikh, J. Arch., de. soc. biol., St. Petersb. Ssobolew. Centralbt. f. allgem. path. u. path. anat., 1900, xi, d. 202. Foster. Lectures on the History of Physiology, 1901, p. 156. Foster. Loc. cit., p. 156. Opie. Jour. of Exper. Medicine, 1901, v. p. 398. Opie. The Relation of Diabetes Mellitus to Lesions of the Pancreas. Jour. of Exper. Medicine, 1901, V, d. 529. Flexner. Johns Hopkins Hospital Reports, ix; also Univer. of Penn. Medical Bulletin, August, 1901. Bang. Zeitschr. f. phys. chem., xxxii, p. 218, 1901. Blum. Deutsches Archiv f. klin. Med. lxxi, p. 146, 1901. Chittenden, R. H. Physiology of the Pancreas. Med. News, New York, August 9, 1902, vol. 81, No. 6, p. 241-246. Von Mering and Minkowski. litus nach Pankreas extirpation. path. u. pharm., Bd. 26, p. 371. Diabetes MelArchiv. f. exp. Minkowski. Untersuchungen uber den Diabetes Mellitus nach Extirpation des Pankreas. Archiv. f. exper. path. u. pharm. Bd. 31, p. 85. Minkowski. Untersuchungen uber den Diabetes Mellitus nach Extirpatiou des Pankreas. Archiv. f. exper. path. u. pharm., Bd. 31, p. 105. (To be continued.) MONOBROMIDE of camphor, in ten-grain doses, until the brain feels it, is an excellent remedy for nymphomania. - Med. Summary. Society Proceedings. THE ACADEMY OF MEDICINE OF Meeting of December 8, 1902. THE PRESIDENT, A. B. ISHAM, M.D., STEPHEN E. CONE, M.D., SECRETARY. DR. DERRICK T. VAIL read a paper (see p. 213) entitled Aprosexia in Relation to the Eye, Ear, Nose and Throat, Especially in Child Growth. DISCUSSION. DR. JOHN W. MURPHY: I wish to thank the essayist for bringing this subject before the society, as I think it is a subject which should be especially brought before the general practititioner. He is the one who first encounters these cases of aprosexia, in which the child is not able to fix the attention upon its books and is looked upon as a backward child at school. In many instances where children are afflicted in this way the parents refuse to bring the children to a physician for examination. The child is looked upon as a negative quantity, and is often made sport of, even when the condition present is responsible for its behavior. The results of treatment in these cases is usually so gratifying that every child of this character should receive the proper attention. I have no doubt that the condition of aprosexia among the children of our schools is even larger than many of us consider it to be. Hill examined about seven hundred children in the public schools of Great Britain, and of these one hundred were pointed out as children far below the average in intelligence, and were looked upon as dull, not able to get their lessons or keep up with their classmates. these one hundred, twenty-five had adenoid vegetations or hypertrophy of the pharyngeal tonsils. Here we have 25 per cent. of the so-called dull children suffering from adenoid vegetations and hypertrophied tonsils, or about 4 per cent. of the total number. I have no doubt that in our own schools we would find 8 to 10 per cent. (if properly examined) suffering from aprosexia. Of The first case which attracted the attention of Guye, of Amsterdam, was a little boy who had attended school one year and had succeeded in mastering only the first three letters of the alphabet. The boy had no ear trouble, but adenoid vegetations were found to be present in the pharyngeal vault. These were removed, and in one week after they were removed he was able to master almost the entire alphabet. This case interested Guye so much that he continued his studies along this line, with the results which we all know. If the frontal lobes are the seat of attention and observation, as some investigators think they have proven them to be, then any hypertrophied condition of the lymphoid tissue of the nose or pharynx would lead to the obstruction of the lymph channels, and there would not be a sufficient carrying off of the waste products. That, I believe, is the rational explanation of this theory. After these cases have been operated upon, the adenoids removed and the lymph channels given free circulation, all of these conditions largely disappear. Of course, not every case of mental defect is going to be cured by operating upon the adenoids, or the lymph tissue, that is found in the pharynx or the vault of the pharynx. The faucial tonsils, which are generally looked upon as the tonsils, are those situated on either side of the tnroat, and the function of these has not been as yet decided. We do not know what the proper function of the faucial tonsil is, and to-day many excellent investigators. differ as to its office. The early investigators considered that it was the function of the tonsils to close the pharynx so that the amniotic fluid could not enter during uterine life of the fetus. Later investigators supposed that it furnished a secretion which assisted in digestion and also in the act of deglutition. I believe the most generally accepted theory to-day is that the faucial tonsils produce leucocytes or aid in the formation of leucocytes which have. the function of destroying pathogenic. germs which are present in the mouth. We know that they are quite active in early life, and we know no harm results after they have been removed. Whatever is formed in the tonsils seems to be secreted on the surface. Situated at the base of the tongue is another tonsil known as the lingual tonsil, which has a different function or office to perform. This we do not often find en larged in early adult life, at the time when adenoids are present, but we find it more frequently enlarged in middle life. The lingual tonsil is almost as large as the faucial tonsil in size. Shurly recently reports a case in which a lingual tonsil was removed from a girl sixteen years of age. She was well nourished and had no symptoms except a slight cough and difficult deglu tition. What he supposed to be the lingual tonsil the size of a pigeon's egg removed from the base of the tongue upon .examination proved to be the thyroid gland, and a marked myxedema followed its removal. This case teaches us that all glandular structures found at the base of the tongue must not be looked upon as belonging to the lymphoid group. This subject of aprosexia is one to which a great deal of attention has been given, especially during late years, and as most of the children suffering with the disease are benefited by operation it behooves us to give them the chance of profiting by it. DR. S. P. KRAMER: I rise to ask a favor of my friend the laryngologist, and that is that they stick to the empirical knowledge they obtain from clinical experience. If they come across children whose powers of attention are diminished and by operation they cure them of this defect, that is very well, and that should be advanced as a reason for making this operation; but I would like to ask that they refrain from such wonderful physiology as they have brought before our attention to-night. The physiologist well knows the deficient oxygenation of the blood manifests itself by dyspnea. Now, the laryngologist speaks of these children with adenoids, etc., as being constantly poisoned by carbonic acid gas, and that they suffer from air hunger. Now, if the laryngologist would say that certain children are benefited by this operation he would, I think, have good empirical ground upon which to stand as the result of clinical observation. Now, the physiologist does not know that the attention center is in the frontal lobes; he does not know that this lack of concentration and attention is due to a hyperemia (as the laryngologist asserts) at the base of the brain, and I think the serious part of the whole affair is that they weaken really an excellent position by their erroneous physiological conclusions. DR. J. A. THOMPSON: The points which have been urged as a cause of the mental deficiency of children with adenoids are well taken. These cases do suffer from chronic carbonic acid gas intoxication. Dr. Kramer has said if such be the case it should be manifested in dyspnea; they should manifest air hunger. Now that is just what these children do. Their breathing is often labored. The intercostal spaces sink in during inspiration, and the effect of this excessive action is shown in the deformed chests of these children. The night terrors, which are common, are really the dyspnea and the sense of suffocation from which these children suffer. It is one of the elementary principles of chemistry that osmosis will not take place through a membrane that is not moist on both sides. Now the interchange between the oxygen of the air and the carbonic acid gas of the blood is a process of osmosis. If the air is not properly warmed and moistened in passing through the normal nose and pharynx, it will take too much water from the lower respiratory passages, and the mucous membrane becomes abnormally dry, so that the proper osmosis cannot take place. The blood is not properly aërated or purified in the lungs and enters the circulation with a deficient supply of oxygen and overladen with poisonous gases which should have been excreted. On account of this failure of the blood to be properly oxygenated all of the reparative processes of the body suffer. These children are anemic. They are undersized and poorly developed. They are deficient mentally and physically, and not up to the standard of children of the same age who do not have adenoids. If we operate for removal of the adenoids sufficiently early we can correct these defects and get results, even if our explanation of them may not be physiologically correct. There is one point in the study of aprosexia that has not been brought out so far in this discussion. This condition may be produced in adults by chronic suppuration in the ethmoid cells. I operated on a contractor of this city some years ago. He told me after the operation and after his mental symptoms had cleared up that just before the operation he was closing out his business and finishing up his contracts as rapidly as possible because he thought he would soon be insane. The symptom on which he based this opinion was his inability to concentrate his mind for more than two or three minutes at a time upon any subject. While engaged in the discussion of any business or making calculations on the plans for his work in spite of himself his attention would wander off to trivial matters. After two or three minutes he would get back to the subject at hand, but in a short time would again find himself unable to concentrate his attention on the matter in hand. After thorough drainage of the ethmoid cells was established his ability to think accurately and plan definitely came back to him. I have seen two such cases in adults, both of them occurring in connection with chronic suppuration in the ethmoid. DR. VAIL: In reply to Dr. Kramer's remarks, I would say that my paper contains no original physiological observations. I merely quoted from the writings of noted European authorities, and have given the citations in the body of my paper. His criticisms, then. apply not to me, but to the noted anatomists and physiologists cited. Aspirating for Pleurisy With Effusion. In aspirating for pleurisy with effusion, cough usually begins after a fairly large amount of fluid has been withdrawn. It may serve to some extent to break adhesions, and in moderation may be beneficial. But if the cough begins very soon, and interferes with the removal of a suffi cient amount of fluid, measures must be taken to stop it. The needle may be withdrawn, and the operation repeated next day, after a moderate dose of opium has been given to quiet nervousness. Better still, leave the needle in place, shutting off the stopcock, and tightly bandage the chest with a broad bandage, pulled more tightly as the fluid is removed. This strong support to the chest will usually stop the cough, and is a good routine measure to adopt in all cases of pleuritic effusion.-International Journal of Sur gery. It is well to bear in mind the fact that enlarged tonsils lessen the capacity for proper breathing, and that once they are inflamed they serve as a possible point of entry for all manner of infections.-International Journal of Surgery. CLINICAL SOCIETY OF THE NEW YORK Meeting of October 6, 1902. THE PRESIDENT, ALEXANDER LYLE, M.D., Fracture of the Patella. DR. J. A. BODINE exhibited a patient with the following history: Six weeks ago this patient sustained a fracture of the patella. As in the great majority of cases in which the line of fracture is transverse in direction, the cause was a sudden involuntary contraction of the quadriceps muscle, while the leg was in opposed flexion. The fact that he is already a cripple in the other leg demanded that bony union, with good functional results, be obtained, and a stringent financial condition urged the accomplishment of this in the shortest space of time possible. I present him to you to-night ready to resume his occupation, with a perfectly functionating leg. "In my opinion, all cases of fracture of the patella should be treated by open suture, as was done in this case, provided it is done by a trained surgeon. Primary union is absolutely essential. The most difficult accomplishment in surgery to-day is not mechanical skill in operating, but comparative cleanliness in technique, with minimized traumatism to tissues. This attainment is only relatively possible to the trained operator, and absolutely impossible to the general practitioner who occasionally operates. "The treatment of fractured patella by mechanical means splints, strapping, subcutaneous suture, etc.-is irrational and wrong fundamentally. If the line of fracture extends laterally into the expansion of the patella capsule, with wide separation of the fragments, in but very few cases will any method other than that by open suture produce a perfectly functionating leg. The reason is simple. When the patella fractures by muscular contraction over a bent knee, the stretched capsule, when it ruptures, projects beyond the edges of the fragments, and, as pointed out by Macewen years ago, falls between the broken fragments. The interposition. of this ever-present fibro periosteal fringe is an obvious obstruction to bony contact or bony union, and must be removed by bony operation Again, blood from the |