write, by picking out the proper letters, words which they had never heard before; that they could in the same way convey ideas of their own; that they could solve arithmetic problems of considerable complexity. The tests excluded the possibility of sign suggestion by the trainer as they were partly carried on in his absence and partly by sound alone, when no one was in sight of the animals. There was a marked difference in the achievements of the partly and fully trained animals; and even with the latter the results varied considerably according to their moods. GIFFORD.

Enlargement of the Thymus-A Remarkable Case Kennedy in the Glasgow Medical Journal reports the case of a female child 41⁄2 years of age who died after an illness of two months' duration. The thymus gland was found to be enlarged and apparently caused death by pressure on the right auricle and pulmonary vessels. The liver, kidney, spleen and lungs showed a marked degree of passive congestion. There was slight enlargement of the mesenteric glands, but none of either the axillary or inguinal groups and nothing to show the condition of status lymphaticus. Microscopically the thymus showed an angiomatous condition with dilation and hyperplasia of vessels, but it is not certain whether this was due to passive congestion or represented a true angioma of the gland. RODNEY W. BLISS (Omaha).

Hormonal

Zuelzer (Deutsch med. Wochenschr., No. 26, 1912). The intravenous use of hormonal, as a peristaltic stimulant, has of late fallen somewhat into disrepute on account of the observation that alarming symptoms of collapse have followed its administration. Zuelzer, the originator of the treatment, who hitherto has strenuously denied the occurrence of the complication, now states that he too has recently observed it. The fact that the first reports of the treatment, involving some 4,000 injections, did not mention this accident, whereas recently it has been repeatedly reported, led him to infer that there must have been of late some change in the constitution of the drug as marketed. An investigation showed this to be a fact, and the toxic constituent was identified as an albumose. Zuelzer states that at present only albumose-free hormonal is marketed, and that all the older preparations, i. e., those bearing a numeral less

than 51, should be rejected. This new preparation is exceedingly active and entirely non-toxic.

The almost magical properties of hormonal, one or two injections of which often relieve obstinate and habitual constipation, when not obstructive in nature, may now, he states, be utilized by the practitioner without fear of danger.

Laryngeal Changes in Pregnancy

In about 50 per cent of all pregnancies, inflammation is present in the upper air tract, especially on the posterior laryngeal wall. Imhofer draws the following conclusions from a patholo-anatomical study of the larynges of seven pregnant women and fifteen pregnant guinea pigs. The laryngeal changes in the human are not directly due to the pregnancy but to its unavoidable complications. In animals, changes in the connective tissue, slight edema, etc., are present. The changes are most similar to the vaso-dilatation hyperemia of the skin, described by Kreigich. Just why these changes predispose their subjects to tubercular infection is not explained.

Imhofer. Ztschr. f. Laryngol., Rhinol. u. ihre Grenzegeb.(Laryngoscope.)

For a variable time after child-birth the singing voice occasionally fails to respond to the will and fears are entertained that the voice is lost. Owing to the predisposition to tuberculosis at this time, if there is any cough or hoarsness, the larynx should be examined. The loss of the singing voice, however, is generally due to a loss of the tone and of the control of the muscles of the larynx and throat used in the production of the singing voice, and with renewed training, and return of general tone, the voice regains its power. A favorable prognosis can be given in these cases therefore and much anxiety removed.

H. B. LEMERE (Omaha).

The Sound Should Not Be Used in Case of Foreign Bodies in the Oesophagus.

Voss (Zeitschrift f. Ohrenheilk. LXVI p. 1.) reiterates the warning of Koerner as to the dangers of using the sound or bougie, where a foreign body is believed to be in the oesophagus. He gives one case in which the sound forced a fish-bone nearly out of sight through the gullet-wall; and in an addendum to his article Valentine reports a patient who had swallowed a chunk of bacon which stuck five centimetres below the sternal notch.

The family doctor passed a sound clear into tho stomach and assured the patient that there was nothing wrong; but as the man could not swallow, even liquids, he refused to be comforted and went to the clinic at Berne where, with the use of the oesaphagoscope, a piece of bacon 5x5x3 cm. was removed. The sound had simply pushed it to one side. Here, of course, the sound did no harm except to give an unwarranted sense of safety. To the reviewer it appears that while there can be no question that the oesophagoscope is the instrument of choice and that the sound or bougie should never be used in the case of sharp bodies like bone-fragments or false teeth, it may still be justifiable, if the oesophagoscope or the skill to use it be wanting, to use the sound when the foreign body is smooth or soft.

GIFFORD.

Intestinal Disturbance in Grave's Disease

To the kaleidoscopic appearances of Grave's disease, diarrhoea must be added. Schmieden (Deutsch. Med. Woch. 33, 1571, 1912) reports a case in which the intestinal disturbances so overshadowed the other symptoms that the patient, a laborer of 36 years, was sent to a surgical clinic for a more accurate diagnosis of his bowel trouble. Nothing wrong was found in the abdomen, but as the man had slight but typical symptoms of Grave's disease, half of the thyroid was removed and the diarrhoea stopped at once. The other symptoms also disappeared, though more gradually. The diarrhoea was of a nervous type and Schmieden thinks it was due to an over stimulation of the sympathetic by the thyroid secretion.

GIFFORD.

The Operation of Excision of Tarsus and Conjunctiva (Heisrath) in Old Trachoma, Together With Demonstration of a New Instrument, and a Description

of a New Method of Performing It.

Under the above title, Dr. J. Herbert Claiborne of New York has written a most interesting paper, which appeared in the American Ophthalmological Society's Transactions for 1911.

In the Archives of Ophthalmology, March, 1910, Dr. H. W. Wooten described the radical surgical treatment of old cases of trachoma by the combined excision of tersus and conjunctiva after the method of Heisrath. This operation, as Dr. Wooten

pointed out, has met with little favor outside of Eastern Prussia, where trachoma is so prevalent, and where the operation has been in vogue for the last ten or fifteen years.

Dr. Claiborne's modification has simplified the operation to a marked degree. His method is as follows: The lid is grasped with a pair of "U" shaped forceps and everted, the handle of the forceps being turned over the brow. The conjunctiva and tarsal cartilage are then removed by the incision shown

Fig 1

Fig. 2

in Fig. 1. In Fig. 2, the method of applying the sutures is indicated. These sutures emerge on the skin side of the lid, and, when tied over small rolls of gauze, draw down the conjunctiva from the upper fornix and cover the raw surface. Any entropion existing is corrected by this method. This operation is advised in old cases of trachoma with pannus, which are seemingly hopeless. Excellent results have. followed its use in such

cases.

The reviewer lately performed this operation in an old case of trachoma with pannus and trichiasis, which had lasted for over sixty years. The result was surprisingly good.

J. M. BANISTER (Omaha).

The Treatment of Gastric Crises of Tabes

The treatment of gastric crises of tabes has been claiming a great deal of attention of late. Surgery is beginning to promise relief to some of the unfortunates suffering from this condition. Exner (Weiner klinische Woch., Sept. 19, 1912) takes up the method of treating these crises by severing the vagus nerve on both sides.

·Moriquand and Cotte (Presse Medicale, Paris, September 14) report a case in which they applied Franke's method of tearing the intercostal nerves in treatment of gastric crises in a tabetic of 39. They tore five nerves, from the seventh to the eleventh intercostal nerves inclusive, and they think that this is not enough, as the patient already shows signs of recurrence of trouble. The operation put an end completely to the gastric pains, but it did not influence the lightning pains and bladder crises. "The case teaches the necessity for making the operation more extensive, including from the fifth to the twelfth intercostal nerves and possibly the two lumbar nerves. With the Franke and Forster technics there is nothing to prevent regeneration of the nerves, and it seems logical that the functioning of the ganglion should be suppressed as the only certain means to ward off recurrence. If the Franke technic can thus be improved while retaining its comparatively harmless character it will represent a great advance."

Under the medical treatment Hunt in an excellent article on the treatment of tabes in the Amer. Jour. Med. Sciences, September, 1912, mentions the use of cerium oxalate, grain v every half hour, minute doses of strychnia, methylene blue 1 grain doses, chloral hyd., antipyrine, etc. He advises building up and strengthening the patient as much as possible.

Oppenheim speaks of injections of cocaine into the epidural and subarachnoid spaces of the spinal canal, Levy and Pope suggest alcohol and stovaine. Simple lumber puncture has been advised with scant results.

FRANK M. CONLIN (Omaha).

The Difficulties Which May Arise During Pregnancy and Labor After the Operation of Ventrofixation and Suspensio Uteri.

Fergusson (Journal of Obstetrics and Gynecology of the British Empire, September, 1912) presents a very instructive argument for and against ventrofixation of the uterus. While