sand to twenty thousand units and intravenously from twenty thousand to thirty-five thousand units. Despite the large doses no untoward results beyond the usual serum rash were observed. The general indications for the use of the intravenous method of treatment are: (1) Malignant forms of disease with nasal hemorrhage, marked adenitis, cellular infiltration, et cetera; (2) any marked involvement of the lungs; (3) a moribund condition of the patient; (4) a profound toxemic condition of the patient. An initial dose of twenty thousand units is not excessive, to be repeated in twenty-four hours if the patient has not improved.

SCARLET FEVER SERUM.

CHARLTON (Montreal Medical Journal, October, 1902) says he has been using a special antistreptococcus serum in the treatment of scarlet fever for several months, which has yielded most gratifying results. He reports thirteen prompt recoveries out of fifteen cases, almost free from complications. Not one of the thirteen suffered from albuminuria or suppurative otitis media. On using the serum the effect was prompt, the temperature beginning to fall within two hours. No other treatment was given except stimulation and the usual precautions as regards laxatives, diet and rest. The dose given was generally twenty cubic centimeters, repeated when necessary. The author does not claim it as a cure for scarlet fever, but by timely administration, in severe cases, it tends to allay unfavorable symptoms, overcomes complications and prevents a fatal termination.

THE SURGICAL TREATMENT OF EMPYEMA.

DOUD reports (Medical News, Volume LXXXI) the results of seventy-five cases of empyema treated surgically as follows:

(1) For simple cases of empyema the treatment used is excision of about one and one-half inches of the seventh or eighth rib in the posterior axillary line. Light ether anesthesia is usually employed; the purulent coagula are removed; short rubber tubing cut partly across, doubled and held by large safety pins, is used for drainage; abundant gauze dressing is applied and changed when saturated.

(2) If the patient's condition contraindicates general anesthesia, an incision into the chest may be made between two ribs under cocain anesthesia.

(3) Aspiration is only performed to give temporary relief in patients who are in great distress from the pressure of the fluid, or temporarily to relieve the second side of a double empyema after the first side has been opened.

(4) The patients are allowed to leave the bed as soon as possible, and the expansion of the lung is encouraged by forced expiration.

(5) Irrigation is only used when there is a foul-smelling discharge from necrotic lung tissue.

(6) Secondary operations are not done until good opportunity has been given for healing; usually three or four months should have elapsed after the primary operation, and there should have been no noticeable improvement for about a month.

(7) In the secondary operation the expansion of the lung should be encouraged by incising, stripping back, and, if necessary, removing portions of the thickened pulmonary pleura.

(8) The examination of forty-four of the patients at long periods after operation indicates that recovery is usually complete in the simple cases, and that there is surprisingly little deformity in most of the

severe cases.

OPHTHALMOLOGY.

BY WALTER ROBERT PARKER, B. S., M. D., DETROIT, MICHIGAN.

CLINICAL ASSISTANT IN OPHTHALMOLOGY IN THE DETROIT COLLEGE OF MEDICINE.

GLIOMA OF THE RETINA; A REMARKABLE FAMILY HISTORY.

NEWTON R. EARLE (Australian Medical Gazette) reports the case of a child of two years who had been completely blind for twelve months. A glioma mass could be seen through each pupil, involving the lens and growing into the anterior chamber-the irides being pushed forward. The growths were nodular and yellowish gray, the intraocular tension was increased and there was apparently great pain; there was no evidence of secondary implications of the brain or other organ. The patient was the youngest of a family of sixteen. Four of the children were alive and well; two had died within a month of birth, of bronchitis. Ten had all been affected with glioma of the retina, and all except the patient were dead. None lived beyond three years, except one who was operated on for unilateral growth and who lived to five, then died of recurrence.

Of the ten cases, three were unilateral and seven bilateral. Of the seven who died without operation, the eyeballs ruptured in every case except one, and this child was said by the medical attendant to have died of cerebral implication. Five cases were male and five female. One of the father's brothers died in infancy of some eye complaint.

LACTONEURITIS.

BONDI (Wiener Medicinische Presse, April, 1902) reports a case of lactoneuritis in a nursing woman aged twenty-six years. For two weeks she had complained of loss of vision, which was complete in the right eye and only partial in the left eye. In these two weeks she had also suffered with severe headache and orbital pain. She had had two children, the youngest being seven months. She began to wean the child last week, and since then she noticed a slight improvement in the left eye. The ophthalmoscope showed a distinct papillitis, but

there was no hemorrhage nor exudate in the interior of the eye. She was ordered to refuse the breast entirely and was given potassium iodid internally. Five weeks after the first examination she was discharged as cured. Her vision returned completely and the papilla again became normal.

The author then cites several cases found in literature. In most of the published cases both eyes were affected. In one case of Nettleship's the affection began as early as one week before labor. In another case reported by Rayman the eye affection was complicated by paralysis of the facial and abducens nerves.

In conclusion, the author adds: (1) It is positive that during lactation partial or even total loss of vision can occur. (2) The disturbance of vision is caused by inflammation of the optic nerve. (3) Prognosis of such neuritis is usually very good. (4) Treatment-Interrupt the lactation and improve the constitution generally.

LARYNGOLOGY.

BY WILLIS SIDNEY ANDERSON, M. D., DETROIT, MICHIGAN.

ASSISTANT TO THE CHAIR OF LARYNGOLOGY IN THE DETROIT COLLEGE OF MEDICINE.

MUCIN AND MALIGNANCY; FACTS AND THEORIES. WILLIAM STEWART Low, London, England (Annals of Otology, Rhinology and Laryngology, November, 1902). The author calls attention to the lack of study given to mucin, and to the prevailing belief that it is to be gotten rid of from the body as quickly as possible. He calls attention to the chemical character of this colloid and says: “It is largely present in the system and is found under two conditions: First, almost universally distributed as the cementing material between cells-tissue mucin; and second, mucin is found on all mucous membranes, in mucous glands, in many epithelial and all special goblet cells." The author calls attention to its mechanical function and suggests that possibly it has some further function. He believes it has a bactericidal action and fulfils a potent part in the defense of the body against bacterial attack.

The author brings out an interesting fact that where mucus is least abundant, there malignant disease is more commonly found. A few of the locations cited are: Where skin and mucous membranes meet at the edges of orifices, as at the lips, prepuce and anus, in the lower pharynx, on the tonsi!, et cetera. Cancer is seldom met with in the small intestines and lungs where the mucus is abundant. The frequency of malignant disease of the mamma is cited. In this gland no mucus is present. He has also observed a diminution of mucous secretion in malignant disease, a condition of "hypomyxia." In hypomyxia nasopharyngia little or no secretion is found in the nose. Local inspection shows general loss of turgescence and vascularity of the mucous lining. The turbinals are small and sometimes shrivelled. The

fauces and pharynx show a diminution of mucus. A similar condition is also found in the stomach-hypomyxia gastrica, accompanied with dyspepsia and flatulency. In the cases of the malignant disease which the author has studied they were hypomyxatous to a varying extent. In fifteen cases of cancer he noted that they were heavy smokers and salt eaters. Both habits tend to bring about the hypomyxatous state. The author claims hypomyxia is hereditary. City life is more favorable to the development of hypomyxia. A table is given showing a number of cases of malignant disease in whom hypomyxia was present. The author claims good results from the use of mucin in the treatment of malignant disease. He gives no details as to how the mucin is obtained, although he states that it is given in tabloids, ten to twelve daily.

The article, although perhaps not convincing, brings together a number of interesting facts worthy of further study.

ACCESSORY THYROID TUMOR SITUATED AT THE BASE OF THE TONGUE.

RANDOLPH WINSLOW (American Medicine, December 13, 1902). This case occurred in a girl, aged seventeen. Family and personal history unimportant. Patient menstruated regularly. She had muffled voice, complained of sore throat and difficulty in swallowing. Examination revealed an ovoid mass at the base of the tongue, completely hiding the epiglottis and cutting off all view of the interior of the larynx. On palpation it was found to be about one-half the size of a hen's egg, and elastic to touch. The growth was not painful. A diagnosis of accessory thyroid gland was made, and the growth was removed successfully by an external incision. The hemorrhage was not severe. Microscopic examination showed the tumor to be thyroid in structure.

The author, in commenting upon this case, calls attention to the well-known fact that thyroid tissue may be found in abnormal positions, and that these glandular collections may take on increased growth and form tumors of considerable size. In early life the thyroid gland communicates with the oral cavity by a tube known as the thyroglossal duct, of which vestiges remain in the foramen cecum, at the base of the tongue. This is one of the favorite locations of accessory thyroid

tumors.

The views of these authors and other observers may be summed up in the following conclusions:

(1) Tumors at the base of the tongue are frequently thyroid in

nature.

(2) In these cases atrophy of the normal thyroid gland frequently exists.

(3) These tumors do harm only because of their size.
(4) Removal may be followed by myxedema.

(5) If removal of the tumor be necessary, it should be attempted through the natural passages, if possible; if not, by external incisions.

DERMATOLOGY.

BY WILLIAM FLEMING BREAKEY, M. D., ANN ARBOR, MICHIGAN.

LECTURER ON DERMATOLOGY AND SYPHILOLOGY IN THE UNIVERSITY OF MICHIGAN,

THE INFLUENCE OF LIGHT ON THE GROWTH OF HAIR.

SCHMIDT (Archiv für Dermatologie and Syphilologie, October, 1902). Importance has of late been ascribed to the so-called chemical rays of the sun in accounting for the fact that the hair of the head and beard grows more quickly in the warm period of the year than in the cold.

In some cases of lupus treated according to Finsen's method, increased growth of hair appeared in the vicinity of the parts treated after recovery from the reaction caused by the exposure to the chemical rays. Also some of the female attendants observed an increased growth of hair on their forearms, which were exposed to the rays during treatment of patients. Therefore it had been assumed that the chemical rays stimulate the growth of hair. If this assumption could be proven true it would be a therapeutic fact of much value. Schmidt thinks it is not possible to ascribe to the chemical rays a specific hair stimulating influence, as the vicinity of the rays treated is the only part affected, but that it is possible that the increased blood supply resulting from the action of the rays improves the nutrition of the skin, and this promotes growth of the hair. But it is not clear why the Röntgen rays, which also cause an inflammatory hyperemia of the skin, cause falling out of the hair.

Schmidt's experiments on guinea pigs to determine the influence of the chemical rays on the growth of hair were pretty much negative. He reports two cases of alopecia areata treated by the light method. One case was treated with concentrated, the other with diffuse light, yet the reaction was the same in each, but the therapeutic effect was quite different. In the first case, treated seven times from a quarter to a half hour, the normal growth of hair appeared in a few weeks. In the second case, which was treated twelve to sixteen times for an hour, there was a rapid falling of the remaining hair after a few weeks, resulting in almost total baldness. Of twenty-nine cases of alopecia areata treated in the Copenhagen Institute, six remained without result.

Jersild ascribed three characteristics to the chemical rays, namely, bactericidal, hair stimulating and inflammatory. In the cases due to parasitic origin the use of the chemical rays within limits of the weakest inflammatory action may be expected to be curative. In the cases due to trophoneurotic conditions or to death of the rudimentary papillæ no cure can be expected.

At a meeting of the French Société of Dermatologie, Gaston and Nicolau related their experience with some cases of affections of the hair treated by r-rays. On account of the action of the x-rays in caus