ITEMS OF INTEREST.

DR. C. MARKT, of Hamilton, O., is convalescent. THE Western Medical Review will undertake to publish monthly a directory of the various medical organizations in Nebraska.

THE Second International Congress for Physical Therapeutics has been called to meet in Rome from the 13th to the 16th of October.

PRELIMINARY preparations for the annual meeting of the Kentucky State Medical Society, which will be held in Louisville next October, are being actively pushed.

AS THE new Science Building has just been completed, the medical department of the University of Mississippi will have greatly increased facilities for work next year.

OF 134 students who presented themselves for licenses at the last examination conducted by the Indiana State Board of Medical Registration and Examination, eleven failed to pass.

THE Democratic convention of the city of Annapolis, Md., on June 28, nominated Dr. Gordon H. Claude for Mayor. The Republicans had nominated previously for mayor Dr. Charles H. Henkle.

ON July 1 the eight Acting Assistant Surgeons of the Navy were examined for the position of Assistant Surgeons in the Naval Medical Corps, in which there are sixty-six vacancies. They passed the examination without exception.

THE Muscogee County (Ga.) Medical Society has a resolution before it which will come up for final action at the next meeting, which provides that physicians belonging to the association shall not contract with any person, firm or corporation as physician or surgeon thereof, except in the case of railroads and insurance companies.

THE Baltimore and Ohio Association of Railway Surgeons held its eighteenth annual convention in Washington, D. C., June 26. At the afternoon session Dr. S. B. Bond, of Baltimore, Md., chief medical examiner of the Baltimore and Ohio, read a paper on "The Examination of Employees and Applicants for Employment as to Their Color Sense."

THE American Institute of Homeopathy, in session last week at Indianapolis, stated that more friendly relations between the members of the two schools was desirable, for many reasons, and the increasing friendliness of the doctors of the old school was noted by the committee. This point was made emphatic by President Hooker in his presidential address at the opening of the session.

SAYS Dr. Andrew Christian, of cultured Boston: "If the physicians should unite through a long succession of years in teaching the people that only physically perfect persons should be allowed to marry and that all the weak and sickly and deformed should be humanely killed off in order to secure a perfect and beautiful human population, is it not possible that the people could be brought to such a notion?”

THE Green County, Ky., Medical Society, on last Friday evening, had for its guest Dr. E. G. Beers, who read a paper on "The Medical Department of the United States Navy and Some of the Tropical Diseases with which I Have Come in Contact in the Philippines while an Army Surgeon in the SpanishAmerican War." Dr. Beers discussed at some length the bubonic plague and the "break-bone fever, having had an attack of the latter himself.

Therapeutics.

E. S. M'KEE, M. D.

The Therapeutic Results of Direct Transfusion.-Dr. Geo. W. Crile, of Cleveland, O. (St. Louis Medical Review), reports positive final results in acute hemorrhage. In pathologic hemorrhage it improves the patient's condition, and in most cases wholly controls the hemorrhage. In shock its value is far greater than any remedy hitherto employed, and from an experimental standpoint seems to be the most effective treatment of illuminating-gas poisoning. Among the negative results are transfusion in pernicious anemia, leukemia and carcinoma, strychnine poisoning and diphtheritic toxemia. Among the undetermined results may be mentioned chronic suppuration, with its attendant debility and anemia; tuberculosis and self-limited diseases. Of the twenty-one clinical cases, all were technically successful. In every instance the donee experienced a heightened vitality, and in the absence of serious organic disease, the patient became buoyant, even jocose. Some had chills during transfusion or soon after, and a majority showed some febrile action later. It is Dr. Crile's intention to go over the field and establish limitations as well as values.

Calcium Salts as Cardiac Tonics.-Sir T. Lauder Brinton (British Medical Journal) advises strongly the use of calcium salts in this condition. He finds a great tendency to cardiac failure in post-influenzal pneumonia, and he thinks the free use of the calcium salts will tend to avert this. He usually prescribes the chloride of calcium dissolved in water in five to ten grain doses every four hours. The taste of the choloride, being very disagreeable, can be very nicely masked by saccharine, one-twentieth grain covering the taste of ten grains of calcium chloride. This mixture may be given either in water or in milk. suggests that the benefit from milk diet in heart disease may be due to the calcium salts which the milk contains.

He

Soluble Iodine.-Wildert (Bulletin of Pharmacy) has found that a 2 per cent. alcoholic solution of iodine to which a small quantity of ammonium iodide has been added will mix in any proportion with water, which is an advantage greatly to be desired. The addition of a small quantity of borax to the solution, by avoiding the formation of hydriodic acid, prevents the decomposition of the solution. Equal proportions of iodine and resorcin

make a solution which is not only soluble in water, but is devoid of the caustic effects of iodine, and therefore of great therapeutic advantage in certain conditions. Some are of the opinion that the preparations of soluble iodine on the market are simply solutions of iodine in hydriodic acid. Dr. C. P. T. Fennel, of Cincinnati, declares that the soluble preparations of iodine, are made by the distillation of a solution containing one ounce of iodine to the pint of alcohol, and contain no ammonium iodide or sodium borate.

Ointment for Burns.-Hugh Jameson, Titusville, Pa, gives the following formula in American Journal for Clinical Medicine for the treatment of burns:

The doctor directs that the wax be melted in a water bath and mixed with the lanoline and vaseline, and then the salicylic acid thoroughly rubbed in. The oil of gaultheria and olive oil are then mixed together and added slowly; then the carbolic acid is added, and finally the bismuth. Apply thickly on sterilized gauze, cover with oiled silk and bandage. The pain was rapidly relieved.

Coffee Heart.-Walsh (International Clinics) directs to reduce the amount of coffee to one or two tablespoonfuls, to be taken in the morning, and to give a mixture of the bromides, at least 15 or 20 grains at 3 P. M., two hours after the evening meal, and twenty minutes before going to bed, with two minims of Fowler's solution incorporated with each dose. He also advises the absence of table salt from the diet and a warm bath every evening or alternate evenings.

Dandruff Cure.-Medical World:

Each morning and night, separating the

by soap and warm water, and finally by plain water. Repeat the washing as often as the hair becomes oily, and the dandruff will soon disappear. The use of this prescription, if persisted in, will cure the dandruff in a few weeks, and the applications may be discontinued. If there is any sign of a return of the trouble, an application once or twice a week will keep the dandruff in permanent subjection.

Styracol in Diarrhea. This remedy in doses of 1 gramme daily in divided doses for infants, older children 1.5 gramme, and adults 1 gramme four times a day, has been used in persistent diarrheas in the first stage of tuberculosis with much benefit. It is said to be without odor or taste, and is insoluble in water and in weak acid solutions. Styracol is the ether of cinnamic acid and of guaiacol. When taken into the body it decomposes, setting guaiacol at liberty.

Paralysis Agitans.-This chronic trouble is said to be favorably influenced, especially as to quieting the tremor and inducing sleep, by the following combination:

Hyoscinae hydrobrobromatis gr. ss, or 0.03 Ext. cannabis indica gr. xxiv, or 1.50 M. S. Pone in capsulas No. C. capsules once or twice a day.

One or two

M. Fiant ungt. S.-Apply once a day.

For Burns.-Unless too severe or deep, Dr. Monroe Morran, of Pinners Point, Va.,

mends the following:

1 per cent.

Phenolis liquefacti. Balsam peru

M.

Oleii ricinii

5 per cent.

94 per cent.

S.-Pour on gauze or cotton and apply to wound, renewing once daily.

Ophthalmology.

D. T. VAIL, M.D.

Intravenous Injections in Ophthalmic Practice. Darier, of Paris, who has contributed more, perhaps, than any one else on ophthalmic therepeutics, has written enthusiastically on intravenous injections, and a careful translation made by De Beck, of Seattle, and published in the Annals of Ophthalmology, January, 1907, would lead us to believe that this method is destined to supersede all others in the hands of expert oculists who are acquainted with the modern rules of asepsis.

Mercury." The intravenous injection of the soluble salts of mercury, and particularly of the cyanide, constitutes the last word in the rational therapeutic application of mercury." Although a delicate procedure, difficult for unskilled hands, if rightly carried out it presents transcendent advantages. These are: Absence of all pain; rapid action, certain and exact; absence of local inflammations and nodosities, and without late secondary effects. There must be no cocaine in the solution used on account of danger to heart and nerve centres. The following is the correct formula:

Of this, two or three cubic centimetres are to be injected into one of the veins at the bend of the elbow, taking care to deliver the injection very slowly.

The technique is as follows: Apply a tight bandage around the arm above the biceps. Sterilize the site of injection thoroughly. "The needle, a fine platinum one with iridium point, is passed through a flame, then introduced cautiously in the vein." (The entire hypodermic syringe should be previously boiled-Vail.) When the injection is partly made, the piston is withdrawn slightly to see if blood appears in the glass barrel of syringe; if so, the vein is successfully entered. The bandage is withdrawn and the liquid gently pushed in the vein. The puncture is compressed with a tampon of cotton and sealed with collodion. It is wise to choose a different vein at each injection. If the patient complains of colic or diarrhea, the size of the dose should be diminished or the administration made less frequently.

After a series of thirty injections a period of rest lasting one month should be allowed; then another series begun, and after the same length of interval a third, if necessary.

Air bubbles do no harm. Davies has injected an entire hypodermic syringe of air without inconvenince, although De Beck comments on this by saying he can hardly imagine making these injections without going through the time-honored routine of previously inverting the syringe and pushing the piston until a drop of fluid shows at the needle tip. No serious complications have shown themselves in ten years' use of this method in thousands of injections.

He has

used other salts of mercury as a substitute where early tolerance is established (the biniodide, 0.01, increasing to 0.03).

Enesol is a salicyl-arsenate of mercury which is very soluble and used in a 3 per cent. solution in the same way, causing but little pain. One or two cubic centimetres of 3 per cent. solution of enesol is the dose. It is especially valuable in certain anemic states where arsenic would be suggested.

Salicylate of soda in doses 0.50 to 0.60 daily in one of the veins of the bend of the elbow has worked far better in certain rheumatic affections of the eye than when given per orem. No gastric symptoms occur.

Collargol has been injected intravenously by Crede in 2 per cent. solution in certain septic blood conditions (septicemia, puerperal fever, ulcerative endocarditis, peritonitis, osteomyelitis, etc., etc.) with marvelous results, and Darier thinks it is destined to supersede all other modes of treatment.

Enucleation of the Eye Under Cocaine Anesthesia.-Ellis, of Boston, and Longworthy, of Dubuque (Knapp's Archives of Ophthalmol ogy, January, 1907), review the literature on this operation in this country, which dates back to November, 1884. That it was not done before this was doubtless due to the fact that cocaine was not introduced until about that date. The technique is simple; 4 or 5 per cent. cocaine solution is dropped in the eye to produce local anesthesia. The conjunctiva is separated from its attachment at the circum-cornea in the usual way and the four recti tendons are divided at their scleral attachments. Tenon's capsule is injected with a weak cocaine solution by means of Anel tear-duct syringe, and if there is much inflammation of the orbital tissues a 1 per cent. solution of holocaine is recommended as a substitute for cocaine, since it acts better than cocaine on inflamed tissues. Some of the anesthetic solution is injected around the stem of the optic nerve. The eye is severed from its nerve and vascular attachments in the rear in the usual way and the operation completed. It is claimed for this that the patient feels

26

scarcely any pain, the sensation when the nerve is cut being unpleasant, but not painful. If the nerve is alive, there is a sudden flash of light, followed by total darkness. The patients complained more of being conscious of the operation and feeling blood run down the temple than of the operation itself.

The authors conclude that the operation is justifiable where there is great fear on the The part of the patient of the anesthetic.

Varying Intensities of Light in Fundus Examinations.-Suker, of Chicago (Journal of Ophthalmology and Oto-Laryngology), states that to examine the fundus properly so that every pathological or anatomical detail possible can be intelligently scrutinized and understood by the examiner, it is necessary to use varying light intensities; from three to twenty candlepower should be available and under perfect and This is true whether gas control. easy or electricity is employed as the source of illumination. Many important processes, which would be unrecognized were one to employ only a brilliant reflection from the ophthalmoscope, would be under distinct and even striking observation if one would employ a feeble or moderate illumination. The various normal markings of the fundus are made to present quite varying appearances under varying illumination intensities, and it adds charm and interest to the work, not to speak of the valuable information gleaned, to employ different grades of luminosity reflection in searching the fundus. The idea is worth pursuing in examining the lens and the vitreous, as well as the cornea.

Otology.

C. R. HOLMES, M. D.

strong.

Otitic Temporo-sphenoidal Abscess Without Symptoms.-Seymour Oppenheimer, New York (N. Y. Medical Journal, December 29, 1906), reports an otitic temporo-sphenoidal abscess in a boy of seven years, in the course of a chronic otitis media purulenta of the right ear. The patient was a robust boy with good appetite, bowels normal, skin clear, temperature 98.5° F. and pulse 60, full and Headaches severe and more marked on right side, extending down over mastoid. Tenderness over antrum. Brown offensive discharge, perforation in Schrapnell's membrane. Absolutely no other symptoms present. Operation revealed necrosis in aditus and antrum. A sinus was found in roof of tympanic cavity, and the overlying dura was studded with granulations. No sinus into the brain could be found. An abscess was encountered three fourths of an inch in the brain substance and a half ounce of pus evacuated. This was washed and drained. Healing took place promptly and was complete in six weeks. The pulse became normal and the headache disappeared within twenty-four hours after the operation.

Subjective and Objective Tinnitus.—E. I. Ferguson, Oklahoma (Medical Herald, p. 79, 1907), reports a case of subjective tinnitus the sound of which could be heard objectively. The patient, a girl aged twelve years, had heard this sound since five or six years of age. It was a distinct ticking, like that of a watch, about twice the rapidity of the heartbeats, but slightly irregular. It can be heard by the examining surgeon fully one foot from the ear. There is present slight nasal and post-nasal catarrh and otitis media chronica, with retraction of the membrana tympani and

rotation of the malleus. Hearing greatly reduced. Treatment has given practically no relief. Ferguson believes it to be due to a spasm of the tensor tympani muscle, but cannot obtain parents' consent to surgical anesthesia for purposes of diagnosis.

The Confusing Reflex Signs of Otitis in Infancy.-J. L. Morse, Boston (Detroit Medical Journal, April, 1907), in the course of an article on diseases of the naso-pharynx in infancy, says: Acute inflammation of the middle ear is usually but not always associated with fever, which is often very high. It is also very commonly associated with reflex nervous symptoms, which direct attention away from the last to other parts of the body. Among the more common of these reflex symptoms are rapid respiration, vomiting and tenderness and rigidity of the neck. Convulsions are not very infrequent. On account of these reflex symptoms almost every disease but the right one is suspected, among which may be mentioned meningitis, pneumonia, gastritis, worms and dentition. He

then gives the intimate details of some most interesting cases in which otitis media suppurativa in infants was mistaken in one case for pneumonia, in another for traumatic meningitis or congenital cerebral defect, in another for Pott's disease of the cervical spine, in another for malaria or tuberculosis, and in still others for rachitis, until an examination of the ears by an otologist and a paracentesis of the membrana tympani established the diagnosis and relieved the symptoms.

Meningeal Infection by Way of the Facial Nerves.-C. N. Spratt, Minneapolis (Archives of Otology, Vol. xxxvi, No. 1) reports a case of leptomeningitis with onset of symptoms sixteen days after a radical operation, the infection reaching the meninges along the facial nerve. The patient, a lawyer, aged forty-five years, had suffered from an acute mastoiditis and had refused operation for sixteen months. Finally partial facial paralysis and edema of the side of the head compelled operation. The diseased bone was thoroughly removed down to the inner table, which appeared to be intact. Neither the sinus nor the dura were exposed. Patient did well and was discharged from the hospital in one week. Sixteen days after operation he passed a restless night. The next day, headache, chill, vomiting, contracted pupils, temperature 103° F., pulse 90. Mental confusion. Fundi of eyes negative. Operation to expose dura and brain. Some bulging of brain substance; injection of vessels of pia and arachnoid. Exploration of

the brain was not thought advisable. Next day, coma, rigid back, twitching of fingers, Kernig's sign, paralysis of bladder. The temporo-sphenoidal lobe was explored with a grooved director, but nothing found. Exitus.

Autopsy: The auditory and facial nerves at their entrance into the internal auditory meatus were surrounded by a mass of yellow purulent exudate. This process extended upward in the sulci of both sides of the convex surface to the longitudinal fissure. The sides and superior surface of the cerebellum of both temporo-sphenoidal lobes were practically free from exudate. The pneumococcus was found in sections and on cover slips. The brain was noteworthy on account of its size; after allowing the fluid to drain the weight was 2,060 gms. The patient had been a very intelligent professional man. The infection had not entered the cranial cavity from the field of operation. The localization of the exudate about the internal auditory meatus and the healthy condition of the bone and dura about the field of operation revealed the course of the infection.

Aural Affections in Relation to Mental Disturbances.-W. Sohier Bryant, New York (N. Y. Medical Journal, March 23, 1907), read before the Medical Association of the Greater City of New York a paper on aural affections in relation to mental disturbances. With respect to mental affections aural diseases may be divided into six categories:

1. Cases of aural derangement which bear no relationship whatever to mental disturb

ance.

2. Cases of aural disease causing mental irritation and leading to psychical affections, usually colored by the ear symptoms.

3. Disturbances of the ear which act as causes of general exhaustion and hasten the psychic symptoms.

4. Diseases of the ear which progress to loss of hearing, destroying the connection with the outside world and thus upsetting the mental equilibrium.

5. Hallucinations of hearing which are a result of a combination of an ear affection with a psychopathic condition and which are caused by the subjective sensation of a disturbed organ of hearing falling upon deranged higher centres.

6. Affections of the ear, which are secondary to the mental disturbance.

The first group occurs alone. The remaining five groups may be found variously combined in any given case. The results of Bryant's experience in the examination of the ears of the insane have convinced him that