a question, because of the uniformity, symmetry and general character of the movements produced, and because they remained the same whatever part of the cut surface was stimulated.

The author is inclined to believe that the sensory elements were the true receivers of the stimulus, and that the movements were executed chiefly through reflex action, the excitation being sufficiently intense to transmit this reflex impulse to the lumbar cord, and thence to the lower extremities.

LARYNGOLOGY AND OTOLOGY.

UNDER THE CHARGE OF W. E. CASSELBERRY, M.D.,

Professor of Therapeutics and of Laryngology and Rhinology in the Northwestern University Medical School; Laryngologist to Wesley Hospital, etc.

Operative and Dietetic Treatment of Suppuration in Accessory Cavities of the Nose.

Dr. Ziem, Danzig (Journal of Laryngology, Rhinology, and Otology, October, 1895), has had occasion to open the antrum of Highmore for suppurative disease, five hundred times, chiefly through the alveolar process. Syringing through the natural opening in the middle meatus, he declares to be, as a rule, impracticable, because of tediousness, pain, necessity for the frequent use of cocaine, inadequacy on account of having no counter-opening, etc. He objects to making a surgical opening through the external wall of the nose, whether in the middle or the inferior meatus, on account of the difficulty in some instances of operating in this locality, and the subsequent difficulty of syringing by the patient. He has failed to open the cavity through the nose by means of Krause's trocar, and does not consider an aspirating needle suitable either for diagnostic or operative purposes; further, this method is, in his opinion, wholly inapplicable in the case of children, who suffer not infrequently from suppuration of the maxillary sinus. If the opening be made in the nasal cavity, there is danger of severe hæmorrhage. "One would not attempt to wash the dregs out of a cask standing on its head by syringing through an opening made in its side, but would either lay the cask on its side or, still better, bore a hole in its lower end."

Three objections have been raised to the method of Cooper through the alveolar process: (1) That it often necessitates the sacrifice of a sound tooth; (2) that it provides too small a space; and (3) that it drains the cavity into the mouth. Regarding the first objection, it does not hold good if we employ fine drills worked by a dental engine. When a set of teeth is complete, the opening is made on the inner side of the teeth, either between the first and second molar, or

between the first molar and the second bicuspid. In this way he has entered the antrum for the purpose of exploratory irrigation in a large number of persons, with the greatest ease and rapidity, performing the operation in seven, five, or even fewer seconds. He does not use chloroform or cocaine, and in place of burs or trephines he has used for several years only spear-shaped drills varying in breadth and length; these are driven directly through the gum without stopping to dissect up the mucous membrane. In statistics which he published seven years ago, 10 to 12 per cent. of such exploratory openings were made with negative result. This percentage has since decreased. When pus is found, the original small opening may be enlarged. When the opening is situated between the teeth, its diameter may measure two millimeters; when in an alveolus, this may be increased to four or five millimeters. He condemns the so-called dry method of treatment, resorting to thorough syringing through the opening thus made.

On Peri-tonsillar Abscesses.

Gouguenheim and Ripault (Journal of Laryngology, Rhinology, and Otology, October, 1895) consider intra-tonsillar abscess to be much more common than the peri-tonsillar. The now recognized site for puncture in peri-tonsillar abscess external to the tonsil is described; and in case of doubt as to the position of the pus, aspiration by means of a hypodermatic syringe is recommended. They do not use bromide of ethyl or cocaine.

This communication is commented on editorially by Dr. Dundas Grant, who states that the peri-tonsillar form of abscess is certainly more frequent in England, and that he always employs cocaine before incising it, in order to make a more complete examination of the abscess, which occasionally points behind the tonsil instead of in the single locality mentioned. Intra-tonsillar abscess must be very rare in the United States, nearly all the cases assuming the peri-tonsillar form.

Staphylococci and Otorrhoea.

Drs. Lemoyez and Helme (Journal of Laryngology, Rhinology, and Otology, October, 1895) state that in the acute stage of otitis media the microbes most commonly found are the streptococcus and pneumococcus, and only very rarely the staphylococcus. At a later stage in the course of the disease the staphylococcus becomes more frequent and ultimately takes the place of those microbes which gave rise to primary infection. This secondary infection by staphylococci, which promotes chronicity of the affection, can take place either by way of

the Eustachian tube or by way of the external auditory canal through the perforated tympanum. To avoid infection by the former avenue, antiseptic spraying of the nose and naso-pharynx is advocated, and in cases of perforated tympanum care should be taken to have all instruments sterile, and especially the cotton wool used for swabbing —this is frequently contaminated by staphylococci, especially if rolled on the applicator by soiled fingers. The authors advocate the use of cotton swabs, previously perfectly sterilized by dry heat, and kept in hermetically sealed bottles until the time of use.

DERMATOLOGY AND SYPHILOLOGY.

UNDER THE CHARGE OF W. L. BAUM, M.D.,

Professor of Dermatology and Syphilology in the Post-Graduate Medical School, Chicago; Fellow of the Chicago Academy of Medicine.

Treatment of Urticaria.—

Berliner (Aix-la-Chapelle) states (La Sem. Méd., May 22, 1895) that he has used with marked success the following applications to allay the itching in uticaria: Moisten the affected skin with cold water, then rub for ten or fifteen seconds with a few grains of coarse salt. The patient feels at first a slight burning sensation, which is, however, rapidly replaced by a feeling of coolness and a notable diminution if not entire cessation of the itching; this is followed by a rapid disappearance of the papules or wheals. Upon the region so treated, apply a little oxide-of-zinc ointment or rice powder. Where there is a general urticarial eruption the treatment is applied to successive zones of the skin to prevent too great an irritation. It is hardly necessary to state that the internal treatment must not be neglected. If it is a case of urticaria due to absorption of toxins, purgatives (especially calomel) should be employed. Tepid baths are also of great service. Hereditary Disease of the Hair and Nails.—

Nicolle and Halipre (Revue Internationale, October, 1895) presented before the July meeting of the French Dermatological Society, a man 28 years old (admitted to the hospital for disease of the fingerand toe-nails) in whom there was marked hypertrophy of the nails, with extreme friability and some suppuration; the hairs were coarse, scarce, and easily broken. The patient, an unintelligent degenerate, belongs to a family in which during six generations there have appeared thirty-six similar cases out of fifty-five individuals. There is no sign or previous family history of leprosy or of hereditary syphilis. In a word, it is an hereditary condition that may be well compared to the great hereditary diseases of the nervous system.

A Case of Hereditary Syphilis.

Haushalter (Revue Internationale, October, 1895), at the meeting of the Society of Medicine of Nancy in May, 1895, reported an interesting case which he observed recently. A young child of unknown parentage was brought to the hospital in a comatose condition, the coma (accompanied by eye disturbances) being interrupted by convulsive crises and rapidly culminating in death. The autopsy showed, besides the lesions of broncho-pneumonia, which beyond a doubt were responsible for the fever, an osteitis of the bones of the right ear, thrombosis in the arteries of the circle of Willis, and finally osseous ulcerations upon the inner surface of the cranial bones about the size of a quarter; in the centre the skull-plate was thin and transparent in plaques and had a perforated, worm-eaten aspect. Haushalter presented the arteries and cranium, the lesions of which were, in his estimation, caused by hereditary syphilis.

GENITO-URINARY DISEASES.

UNDER THE CHARGE OF G. FRANK LYDSTON, M.D.,

Professor of Surgical Diseases of the Genito-Urinary Organs and Syphilology in the Chicago College of Physicians and Surgeons.

Impotence and the Ram.—

In the Medical Summary for April, 1895, Dr. A. H. Burr, of Chicago, writes as follows:

"Dr. Hugo Engel, in the Medical Summary for January, under the caption, 'A Valuable Discovery-The Cure of Impotence,' exploits the virtues (?) of what he is pleased to call Lumbarin.

"Ponce de Leon, in his search for the fountain of perennial youth, was not in it for a minute with the good angel Hugo; for the fountain eluded his quest like a will-o'-the wisp, and he died in despair, while the fountain is still unknown to mortals. Not so with the Doctor's 'valuable discovery.' Exultingly he may cry, 'Eureka, Lumbarin!' Here is a sure cure, remedy, all wool and a yard wide. What a boon to the overworked roue!

"The Doctor tells us that before this great discovery his reliance in cases of impotency had been for many years a mixture of gurania, dilute phosphoric acid, and nux vomica. Damiana he had discarded. Perhaps, like many another hopeful physician, he had found its aphrodisiac powers a damiana fraud. 'With this mixture,' he says, 'I almost universally secured improvement, though it was not always to be ascribed to the medicine, as local methods, massage, electricity, the introduction of bougies, deep cauterization, etc., contributed.'

"There was still something lacking, which the Doctor felt must

be supplied to make a never-failing remedy, for his clientele appears to have been very large in this distressing complaint. Stimulated by the discoveries of Brown-Séquard in testicle therapy and, he adds, 'the possibility of increasing in the human being the impaired functions of certain organs by feeding the patient on the same organs taken from healthy animals,' he experimented 'for a long time without any special effect.' 'Finally,' he says, 'it occurred to me to try the lower dorsal and upper lumbar cord of a buck, the male sheep being well known as an animal of very amorous disposition.' With the assistance of an able chemist, etc., who encountered many difficulties, etc., the cord of Aries finally yielded up its magic potency.

"Now comes our discomfiture. Our faith had mounted on eagle wings. We had followed the Doctor's researches with deepest interest. His announcement had impressed us that some masterly strides had been taken in therapeutics, to the great benefit of mankind, and, we may add incidentally, to womankind also. Alack-a-day! Listen to the good Doctor's artless confession: 'After I had administered it in various ways, I gave it to a patient who had been taking the phosphoricacid mixture with but limited success, and forgot telling him to omit the fluid medicine. He, thinking he should take both, also continued the acid mixture, and in ten days his improvement amounted to a cure.' Is it not a fair conclusion that this 'valuable discovery,' when administered alone, had met 'with but limited success' also? Indeed, with paternal indulgence towards this new-born lambkin, he continues: 'A series of observations then taught me that the best results were obtained when administering the extract and the fluid medicine together.' In short, 'to simplify matters, . . . I added the spinal extract to the acid mixture and gave to the combined medicine the name of Lumbarin.' Without wishing to be captious, why in the name of justice did the Doctor allow the upper lumbar portion of the ram to butt the lower dorsal portion off the tow-path in the christening? Did it not have equal rights by an equal lineal measure? If so, dorso-lumbarin would surely be more equitable. Again, since this new remedy, though taken from the spine of a valiant beast, is unable to stand alone, but must needs be braced up by the very excellent tonic the Doctor had used so long and successfully, we humbly submit that phospho-guranionux-vomicatea-dorso-lumbarin would be the proper title for an all-round descriptive name.

"There are other characteristics of the 'male sheep' which the Doctor has overlooked in his search for extracts, and which we are led to believe, from his hypothesis, would supply the missing links. This same buck is wonderfully endowed with powerful horns, and more testicle to the square inch than any other animal of his size. For