with endocarditis in children, and when the laryngologist finds that his procedures do not remove fever, etc., he should remember the possibility of endocarditis. In operating remove all the diseased tonsil, and we must differentiate between the fibrous and spongy tonsil, the first cuts clean, the second requires that a great deal more be removed.

(Read by title.)....

11. A Plea for Thoroughness in the Removal of Diseased Tonsils. .....W. H. ROBERTS, Pasadena. 12. Some Recent Advances and Investigations in Otology and Laryngology. (Read by title by the author's courtesy to hasten the program.).. LOUIS C. DEANE, San Francisco. 13. Cerebral Abscess and Perforation of Skull at Vertex. Extension from Suppurative Otitis Media. Operation; recovery. Demonstration of Case....

.W. FREEMAN SOUTHARD, San Francisco. DR. SOUTHARD did not read his paper because of the lateness of the hour, but gave a brief history and presented the patient. The patient was seen in September with pain about the right supraorbital and temporal regions, the eyes were suspicioned and refracted, found astygmatic and relieved somewhat. She was anemic, gave a history of grippe, 18 months before, followed by a bronchial cough, but no headache. Ear complications developed, the drum ruptured and pus discharged, whereupon the cough ceased and the appetite improved, but the discharge and pain continued, with some mastoid pain. The patient went home. She was seen again the next May. Pain, loss of sight and double optic neuritis made me feel that there was abscess. She was sent to a hospital, a swelling appeared on the head, this enlarged, pain ceased. Aspiration revealed pus, an incision revealed an opening into the skull 1 c. m. in diameter, which was enlarged and cleaned. In 24 hours vision began to clear. The drainage has been kept up till now, the wound not having closed. The mastoid has not been opened. There is only a little moisture from the wound and ear; cultures are being made, but have not shown any infection yet. It is a question whether it would not be well even now to open the mastoid. During the summer the case was seen by several Eastern surgeons of prominence, who advised not to operate. The patient was presented for examination, and the case was discussed by Dr. Stillson.

14. The Throat Affections in Glanders in the Human Subject. (The author waived its reading ).......................

J. DENNIS ARNOLD, San Francisco.

15. Congenital Bone Atresia of the Nose. Report of a Case..... W. SCOTT FRANKLIN, San Francisco. The atresia was posterior to the turbinates, the field being concealed by a curved septum. Chloroform was refused, so under cocaine the bone was drilled through giving the patient great relief, but the bony openings are closing, which is the great difficulty in such cases. Discussed by DRS. FREDERICK and CHURCH.

16. Ocular and Cerebral Affections from Nasal Disease..

HAMILTON STILLSON, Seattle, Wash.

Nasal disease affects the brain and eye. a. Through the arterial and venous anastomoses. b. By continuity through the ethmoidal and sphenoidal bones, and from the antrum and frontal sinuses, the walls of which may even be congenitally absent, or their cavities be the seat of a chronic inflammation. c. Through the lymphatics, which connection is indicated by nasal discharge of fluid when salt solution is injected into the subarachnoid space, also during hydrocephalus. d. By reflex action, through the fifth nerve, and the sympathetic exophthalmic goitre has been caused by nasal operations, also cured, according to whether the sympathetic was stimulated or paralyzed.

Papers 17, 18, 19 and 20 were read by title owing to the absence of the authors who were Eastern physicians.

21. Demonstration of Casts of the Frontal Sinus and of the Antrum of the Highmore ...........J. M. FLINT, San Francisco. DR. FIINT exhibited casts and chiseled specimens saying that they illustrated an attempt to get away from verbal descriptions in their anatomy-teaching in the University of California, and the use of stereognostic means of describing negative spaces, by the use of Wood's metal, an alloy melting below 60°c., a point lower than the shrinking point of connective tissue. The frontal sinus is the most variable of the paired structures of the body, it has no relation to the size of the supro-orbital ridges as yet proven, its size bears no ratio to intelligence. A norm has not been established for the human. It is present in all vertebrates. Its development is postnatal, hence its size and form may be governed by the animal's need. Adjourned.

Literary Department.

Under the charge of WINSLOW ANDERSON, A.M., M.D., M.R.C. P.London; M.R.C.S.England; L.S. A. London, etc., Professor of Gynecology and Abdominal Surgery in the College of Physicians and Surgeons of San Francisco.

VON BERGMANN'S SURGERY. A System of Practical Surgery. By DRS. E. VON BERGMANN, of Berlin, P. VON BRUNS, of Tubingen and J. VON MIKULICZ, of Breslau. Edited by WILLIAM T. BULL, M. D, Professor of Surgery in the College of Physicians and Surgeons (Columbia University). New York. To be complete in five Imperial Octavo volumes, containing over 4,000 pages, 1,600 engravings and 110 full page plates in colors and monochrome. Sold by subscription only. Per volume, cloth, $6.00; leather, $7.00; half morocco, $8.50, net. Volume 1 just ready, 936 pages, 361 engravings, 18 plates.

This System of Surgery by von Bergmann, von Bruns and von Mikulicz, is, without doubt, one of the most important works on the subject that has recently appeared. Its first edition in the original, met with such a demand that the earlier volumes were out of print before the later ones were ready for issue. The second edition, carefully revised and brought thoroughly up to date, is the basis of the present English translation. The work has been done by Dr. William T. Bull and his collaborators with great fidelity and thoroughness. They have brought to their work not only enthusiasm and industrious effort but also a wide surgical experience, enabling them to add judicious references to methods of practice which have gained the preference of English and American surgeons. The number of illustrations in this translation greatly exceeds those found in the original-a feature which, without doubt, will much enhance the value and add to the interest of the text. The work is encyclopedic in character. Many of its chapters exceed in scope and detail special treatises which have been published on their subjects. The great value of the work lies in its practical and clinical character, but there will be found an abundance of pathological data, details of original research and statistical facts, so that there can be no question of the inestimable value of these volumes to the student, the surgeon and the general practitioner. The first volume, which is now ready, covers the following subjects: Injuries and Diseases of the Skull and its Contents; Malformations, Injuries and Diseases of the Ear; of the Face, including Plastic Operations and the Neuralgias of the Head; of the Salivary Glands, including

Anomalies; of the Jaw; of the Nose and its Adjacent Tissues; of the Mouth and of the Pharynx. The other volumes of the System will follow in rapid succession.

FISCHER-INFANT-FEEDING IN ITS RELATION TO HEALTH AND DISEASE. A

modern book on all methods of feeding. For students, practitioners and nurses. By LOUIS FISCHER, M. D., Visiting Physician to the Willard Parker and Riverside Hospitals, of New York City; Attending Physician to the Children's Service of the New York German Polizlinik; Former Instructor in Diseases of Children at the New York PostGraduate Medical School and Hospital; Fellow of the New York Academy of Medicine, etc. Third edition, thoroughly revised and largely re written. Containing 5 illustrations, with 24 charts and tables, mostly original. 357 pages, 5x8 inches. Neatly bound in extra cloth. Price, $1.50, net. F. A. Davis Company, publishers, 1914-16 Cherry street, Philadelphia, Pa.

The third edition of this valuable little work has been received. It embraces the latest scientific knowledge on this very important subject of breast and bottle feeding. The book forms a trustworthy guide to those in search of practical methods in infant feeding.

A MANUAL OF MEDICINE. Edited by W. H. ALLCHIN, M. D, Londou, F. R. C. P., F. R. S., Edin., Senior Physician and Lecturer on Clinical Medicine, Westminster Hospital; Examiner in Medicine, Naval Medical Service; Late Examiner in Medicine in the University of London, for the Royal College of Physicians of London, and for the British and Indian Army Medical Services. Volume 5. Diseases of the Digestive System and of the Liver; Diseases of the Peritoneum and of the Vessels of the Abdomen; Diseases of the Kidneys; Diseases of the Ductless Glands; New York. The MacMillan Company, Publishers, London. Price, $2. 1904.

Volume 5 of this excellent manual has just been issued by the enterprising house of the MacMillan Company. This volume is devoted to the diseases of the digestive system and the liver, diseases of the peritoneum and the vessels of the abdomen, diseases of the kidney and of the ductless glands. Prof. Allchin is an author of international reputation and his manual is eagerly sought after and carefully read.

For Sale.

For $550, a practice in a town, about 50 miles from San Francisco, situated in a dairy and poultry raising country. Receipts almost all cash. Good chance for a physician who also practices dentistry. Address C. R., PACIFIC MEDICAL JOURNAL, San Francisco.

By WINSLOW ANDERSON, M. D., San Francisco.

(The following interesting photographs were taken some two years ago at Pago-Pago, Samoa, some of our new island possessions in the South Pacific. They represent typical cases of elephantiasis seroti and Barbadoes leg such as are seen in tropical coast countries.)

Elephantiasis is a chronic disease of the skin and subcutaneous tissues characterized by hyperplasia, cedema, induration and pigmentation. The lymphatics early become involved in a lymphangitis terminating in swelling, phlegmasia and progressive hypertrophy of the skin. Its synonyms are many, such as: Elephantiasis arabum, Barbadoes leg, etc. The disease may be endemic or sporadic. It is essentially confined to such tropical or sub-tropical coast locations as Africa, India, Indian Archipelago, West Indies, South Africa, and the South Sea Islands, etc. In Travencore, the extreme portion of Southern India, with a population of 2,500,000, it affects as high as 5 per cent of the inhabitants. In some of the South Sea Islands (Samoan) as many as one-half of the inhabitants of an island may be afflicted with the disease. In some of the Society Islands as much as 70 per cent of the male inhabitants have elephantiasis. Sporadic cases may develop in more temperate climates. The congenital variety of elephantiasis, while similar in some respects to the tropical disease, is probably etiologically different.

Etiology.-Elephantiasis may occur at all ages but it usually begins during early adult life. Males are 4 to 1 more prone to become afflicted than females. The native races seem more liable to contract the disease than whites. Heredity is claimed as a predisposing factor. The specific cause of elephantiasis is, in all probability, the filaria sanguinis hominis with the mosquito as an intermediate

VOL. XLVII-17.