Collargol is now being put up in tablet form, so that it can be had for any purpose, in a very convenient form. In septic cases, it promises well when used intravenously.

As adjuncts to the medical and surgical wards in this excellent institution, are the bath rooms and gymnasium. Hot and cold baths, steam baths, electric baths, carbonated baths, sand baths, hot air cabinets and a large orthopedic gymnasium make up this part of the institution. The rooms for the internes are nothing short of luxurious. Both the Stadtkrankenhaus and the Frauenklinik have large libraries. In the reading room are many medical journals, including some American journals.

When we consider that these two enormous hospitals are only a portion of most excellent public institutions for the care of the sick and injured, and that Dresden is only a few thousand inhabitants larger than San Francisco, what must the average Californian think of the disgraceful stupidity and penuriousness of the population of San Francisco, to go on year after year with the third rate, wooden hay shed, which has been dignified by the name of City and County Hospital. The Dresdenite who comes to San Francisco would think he had come to a land of poverty and a place visited by divine wrath, if he were so unfortunate as to see the thing which we call our City and County Hospital.

My stay here has been one of great pleasure and profit, both in and out of hospital. I now realize the popularity of Dresden with the Continental European travelers.

Yours respectfully,

DR. ETHAN H. SMITH.

Spinal Subarachnoid Cocainization.

Mark presents the following conclusions: That the method is as safe as, if not safer than, general anesthesia. That we may safely employ up to 48-100 of a grain of cocaine without fear of toxic results. That shock, when present, is decidedly less than that of general anesthesia. That it is attended with less danger of annoying sequelæ and symptoms. That on account of the variability in the length of its analgetic action it is contra-indicated in prolonged operative procedures.-(N. Y. and Phila. Med. Jour., Oct. 31, 1903.)-Therapeutic Review.

Proceedings of Societies.

SAN FRANCISCO

COUNTY MEDICAL SOCIETY.

The programme of the March meeting was a symposium on brain tumors. Of great interest was a paper on

"DIAGNOSIS,"

by DR. LEO NEWMARK. A resumé of his discussion is here given:

Brain tumors are hard to diagnose, and in some cases lack the objective and leading symptoms. Out of thirty cases, I have tested my diagnosis in one-half at necropsy. This discussion is a rapid survey. We will begin at the posterior part of the skull.

Case.-Male, age 67; vague pain about right ear; onehalf tongue atrophied, which he had not observed; thought congenital, and was disgusted that I took any interest in it; left hospital; returned later with a right hemiparesis and left hemianesthesia, ataxia and loss of stereognostic sense in right hand. This was hard to explain. The paresis shifted to the left. A tumor was diagnosed in the formen magnum affecting the right hypoglossal nerve.

Case of Dr. Kelly.-Right hemiparesis and left facial paralysis, later shifting to right side of face.

Tumors of the Cerebellum.-These growths cause headaches, pressure on the medulla, and fatal termination, the cases I observed lasting three, six, and eight months. The severe pain in the back of the head and neck may radiate down the arm. Surgery is now bolder even in this region, so we should try to diagnose the side affected.

Case of Dr. Bailey.-Right auditory disturbance, right fifth nerve anesthesia, manifested by a slight anesthesia right side of forehead; a tumor diagnosed in left hemisphere of cerebellum. We tried lumbar puncture, which proved fatal, as is often the case when cerebral tumors exist.

Another case of tumor in the right side of cerebellum preferred to lie on the same side as the tumor. Some cases that are easy of diagnosis later in their course are very difficult at an early stage, e. g., [a case, vomiting two months, caused by slight movements of the head. I suspected a tumor, but no confirmatory symptoms arose.

The man went away; later he developed a staggering gait and occasional severe headache, but no optic neuritis, though he had but one eye. Later on all the above symptoms developed, with nystagmus, hiccough about four times daily; a diagnosis was made of tumor in the fourth vertricle, involving the cerebellum, confirmed at autopsy after an operation done at the wife's request.

Occipital Tumors.-Case.-Anesthesia left side of chin, right lateral hemianopsia, diagnosis of tumor on median aspect of occipital lobe. After death a cyst was found in this region.

Case. Sailor; came to Polyclinic dead drunk; could not use fingers of right hand, had really an astercognosis of right hand with a right lateral hemianopsia, but little pain; optic neuritis later, not acute but gradual. Word blindness developed gradually, failing first to read sentences, then long words, then short words, and, last of all, figures. Upon careful questioning, he could recognize what a word was not better than what it was. A diagnosis was made of a tumor below the angular gyrus; confirmed at autopsy.

Case illustrating that optic neuritis does not necessarily bring about a diminution of vision.

Tumors of Rolandic Area.-Case.-Woman; Jacksonia fits three and one-half years, beginning in one foot; no headaches nor optic neuritis. Progressive hemiplegia. Operated by Dr. Rosenstirn; hemorrhage from the diploe was too great to proceed. Autopsy later revealed a tumor. Case.-Boy; four years before had some headache and hemianopsia, and a repetition of the disturbances two years ago. He did not move the left side of the mouth as well as the right, and there was a diminution of the left skin reflexes. A painful spot was found on the scalp anterior to the centers for facial movements. The patient was operated, great pressure found and a sarcomatous mass removed. Optic neuritis followed by optic atrophy developed. A second operation and further incision was performed. The patient is blind and hemiplegic but still living.

Another case illustrated frontal tumor. A girl with exophthalmos of left eye, loss of the sense of smell, paresis of the left eye muscles. Gliosarcoma had destroyed neighboring structures.

Another case with slight anesthesia of the right fifth nerve, paresis of the outer muscles right eye, and neuritis, was operated by Dr. Bazet affording relief till the wound closed, when such symptoms developed that the wound had to be reopened.

"THE MODERN TECHNIQUE OF EXPOSING AND REMOVING BRAIN TUMORS,"

by DR. F. FEHLEISEN.

Summary.-I believe results in brain surgery are as good as surgery elsewhere if limited to definitely localized

cases.

The first successful cases belong to Horsley in 1886, then Macewen in 1888. Of brain tumors but 5-10 per cent are operable-but 25-30 per cent are operable as far as their location is a determining factor. Tumors of the brain are usually less malignant than elsewhere. Tumors of the motor area are the least fatal. Make the flap large so that the tension of different parts of the brain may aid in localization. Through a small opening no larger than the tumor it is often impossible to recognize it. When the flap is formed if the shock is great complete the operation at a second sitting, when, if necessary, chloroform may be dispensed with. The dura must be ligated before it is cut.

Tuberculosis tumors give a good prognosis, and are twice as numerous as any others. Hemorrhage from the brain is not great, but may be great from tumors.

In the after treatment Horsley does not leave packing in the wound.

DR. C. N. COOPER: I think cases of hysteria must sometimes be diagnosed from brain tumor. This illustrates the value of examining the fundus. In a subject so difficult we need to appeal to other systems in the body for symptoms and evidences. Harvey Cushing has showed that a higher intracranial pressure is attended by a higher and compensatory general blood pressure, upon which basis we might expect a paradoxical blood pressure with intracranial tumors, i. e., a higher general pressure when the patient is reclining and so increasing the intracranial pressure. Professor Doyen did his operations in two stages. I witnessed two cases operated in Professor Keene's clinic, in which the operative procedures were

swift and accurate, and the operations completed in one sitting. Death resulted and may it not be explained by Professor Cushing's experiments on blood pressure and its relation to intracranial pressure, it is similar to the effect of the sudden removal of ascitic fluid. Dr. Cooper mentioned the possibilities of the X-ray and the newly-reported N-ray relative to diagnosis of cerebral tumors.

DRS. BROWN, STILLMAN, SHERMAN, PISCHEL and EBRIGHT spoke to the subject. 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.

THE PERPETUAL VISITING AND POCKET REFERENCE BOOK. Including Information in Emergencies from Standard Authors, also the following comprehensive contents: Table of Signs and how to Keep Visiting Accounts, Obstetrical Memoranda, Clinical Emergencies, Poisons and Antidotes, Dose Table, Blank Leaves for Weekly Visiting List, Memorandum, Nurses Addresses, Clinical Record, Obstetrical Record, Birth Record, Death Record, Vaccination Record, Bills Rendered, Cash Received, Articles Loaned, Money Loaned, Miscellaneous, Calendars for 1904 and 1905. Bound in morocco, red edges. Pages 124. Price, Free. The Dios Chemical Company, 2940 Locust street, St. Louis, Mo., 1904. This is one of the neatest and most complete Visiting Lists offered to the profession. The Dios Chemical Company proposes to furnish a limited number of this unexceled Visiting List to the profession absolutely free of any expense. The doctor will readily recognize that the Dios Company is saving no expense in keeping its name prominently before the profession, for whom it manufactures products, of more than ordinary merit, exclusively for the physician to prescribe. Those of our readers who desire this complete Visiting List, have only to write a postal card to the Dios Chemical Company, St. Louis, Mo., and they will receive it, postpaid. WATHEN'S EPITOME OF HISTOLOGY. A Manual for Students and Physicians. By JOHN R. WATHEN, A. M., M. D., Professor of Surgery, etc., formerly Professor of Histology and Pathology, Kentucky School of Medicine, Lonisville, Ky. 12mo, 220 pages, 114 illustrations. Cloth, $4.00, net. Lea Brothers & Co., Publishers, Philadelphia and New York. 1903. Dr. Wathen has written much more than a compend. His experience in teaching the subject has posted him