mothers may find not only good milk, but above all accurate and stringent directions as to the mode of administering the same. In this way a considerable diminution in the number of cases of rickets will occur. (4) Sterilized milk judiciously given is of the greatest value. In wealthy families its use should be considered preferable to the employment of wet-nurses.

OPHTHALMOLOGY.

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

CLINICAL ASSISTANT IN OPHTHALMOLOGY IN THE DETROIT COLLEGE OF MEDICINE.

PATHOLOGY OF, AND PROGNOSIS IN, GLIOMA OF THE RETINA.

WALTER H. JESSOP (Saint Bartholomew Hopsital report for 1903) reviews the literature of glioma of the retina and reports several cases occuring in his own practice. He considers that glioma probably commences as an alveolar condition with a marked connective tissue stroma. That at first rosettes or balls of cells of clear lumen are found, but as the tumor grows and degeneration begins, there occur finger- or worm-like processes consisting of a mantle of cells surrounding the blood-vessels. This is followed at times, even before the growth has reached beyond the eye, by loss of definite structure, and the growth assumes the form of a round-celled sarcoma. In all growths outside of the eye the structure is that of a round-celled sarcoma. When the growth also invades or infiltrates the choroid or iris the structure consists simply of cells without any tendency to definite arrangement.

In his opinion the obscurity in which the understanding of the origin of this affection is surrounded cannot be cleared until cases can be seen and studied at an earlier period than that in which most cases have commonly been reported. In his own cases the youngest child was aged thirteen months. The changes in most cases take place so rapidly that even the alveolar condition is soon lost and degeneration begins. The rosettes upon which Wintersteiner lays such stress are found chiefly in the earlier stage and only in the intraocular stage.

In his studies Jessop could not define the origin of glioma as taking place in the nuclear layers, because there was a marked dissimilarity between the cells of the new growth and those of the retinal layer; and because of the slight reaction produced by the presence of the tumor cells in the retina. Following Cohnheim, he thinks the origin is from some developmental embryonic tissue. This would account for both eyes being affected so frequently (twenty per cent), and in such cases the growth starting in both eyes separately.

He finds no reason for supposing this tumor to be a carcinoma, either pathologically or clinically; on the contrary, his specimens seem to indicate it to be a sarcoma and it is to be classified as an endothelioma, as the retina surely contains sufficient endothelial tissue to give rise to such a tumor.

He does not attempt, from his own results, to establish a rule as to the prognosis, for in his six cases the intraocular gave one hundred. per cent of recoveries after the removal of the eye, and the extraocular only twenty-five per cent. Nevertheless, he safely presages that success follows the intraocular cases, while it is seldom that any operative procedure can save the patient's life in the extraocular, and there will generally be a recurrence of the malady. As recurrence takes place rapidly, there is little to fear if the orbit is healthy three months after the excision of the globe. So far, no case is reported in which glioma has undergone a spontaneous cure. Hence the neglected or delayed cases must have a fatal issue. In enucleating the globe it is important that the nerve should be excised as far back as possible.

A CASE OF TETANUS FOLLOWING INJURY OF THE EYE. GEUTH (Zeitschrift f. Augenheilk, January, 1903) describes a case of cephalic tetanus as a result of an injury to the eyeball and lid. Despite repeated injections of tetanus antitoxin, the patient died, during a convulsion, on the seventeenth day after the injury. At the autopsy a knife blade, five centimeters long and one and one-half centimeters broad was found sticking in the antrum of Highmore and projecting four millimeters out of the orbital tissues below. The point of the knife had been forced past the roots of the last molar tooth, through the alveolar process, into the gum. The foreign body, which was entirely unsuspected, had carried in the tetanus organisms, which had multiplied rapidly, away from the air, as the wound in the lid had been immediately sutured, and had produced a hemorrhagic empyema of the antrum. Geuth calls attention to the necessity of careful examinations of all wounds of the eye and orbit for the remains of foreign bodies, a maxim which Berlin and Rose have repeatedly urged.

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LARYNGOLOGY.

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

ASSISTANT TO THE CHAIR OF LARYNGOLOGY IN THE DEtroit college of meDICINE.

A CASE OF ADENOIDS WITH MALARIA.

WALTER F. CHAPPELL (New York Medical Record, March 21, 1903) reports a case of adenoids which developed in an infant one month after birth. When the child was five months old ten small pieces of lympoid tissue were removed from the nasopharynx. About two weeks after the operation the child became restless and developed a daily fever, which reached 105° in the evening of the seventh day. A diagnosis of malaria was made and quinin was given with good effect, in four grain doses one hour before feedings. A blood examination revealed malaria. The baby was known to have been bitten on the cheek by a mosquito. Thirty mosquitoes from the locality where the

family resided during the summer were examined and out of the number three of the malaria-bearing variety were found. The case is interesting as it shows how an accidental infection following an adenoid operation may give rise to a high temperature which may be mistaken for direct infection at the site of the operation. Malaria may follow any operation as a rare sequela. Two cases of postoperative malaria. were recently reported by Doctor John T. Moore, in the above journal for February 21, 1903.

SOME CASES OF ASTHMA TREATED BY THE REMOVAL OF THE MIDDLE TURBINATE.

T. W. MOORE (The Laryngoscope, July, 1903) reports four cases relieved by removal of the middle turbinal. The author is governed wholly by the diseased condition of the nose, operating only when the intranasal condition demanded treatment independent of the asthma.

PERICHONDRITIS OF THE LARYNX, WITH REPORT OF A CASE.

EMIL MAYER (New York Medical Record, July 25, 1903) reports a case following typhoid fever in a woman aged twenty-eight years. He gives a resume of eight cases recorded in this country during the past two years.

HYPERTROPHY

OF THE LYMPHOID RING OF THE PHARYNX AND ITS SURGICAL TREATMENT.

H. HOYLE BUTTS (Medical Record, January 17, 1903) describes the structures included in Waldeyer's ring, and calls attention to the frequency with which the faucial and pharyngeal tonsils are hypertrophed in children. He enumerates the symptoms observed when the lymphoid tissue in the vault is hypertrophied, and advises digital examination to ascertain the amount and character of the growths. Removal of the growths in a thorough manner, under a general anesthetic, is advocated. The author has a preference for the Brandigee forceps and the Goldstein curets. In persistent primary or alarming secondary hemorrhage, after the simpler methods have failed, tampon age of the nasopharynx is advised.

Hypertrophy of the faucial tonsils is described, and the methods mentioned for their removal are: By the tonsiliotome; ignipuncture; the galvanocautery, and the cold wire snare. In children the tonsillotome, under a general anesthetic, is advocated. In adults one of the other methods is to be preferred, as it lessens the danger of serious hemorrhage. Hypertrophy of the lymphoid tissues at the base of the tongue is next considered, and the symptoms described. Special mention is made of the sensation of foreign body in the throat, and of cough and blood in the sputum. The destruction of the tissue by the galvanocautery, under cocaine anesthesia, is advocated.

The same author, in an article entitled "Intranasal Obstruction and Its Treatment" (Medical Record, April 11, 1903), gives at some length the causes and treatment of the various obstructions to nasal breathing, such as acute and passive hyperemia, foreign bodies, rhinitis, hypertrophica, ecchondrosis, and, exostosis of the nasal septum, deflections of the cartilaginous and bony septum, abscess of the septum and nasal polypi. The two articles emphasize the importance of correcting any condition that interferes with normal nasal breathing.

CONGENITAL LARYNGEAL STRIDOR.

JAMES E. NEWCOMв (New York Medical Record, July 25, 1903) describes this rare form of stridor. It usually comes on within a few days of birth, continuing for a certain period, measured usually in months, but possibly in years, apparently not doing the child much if any injury, and finally subsiding of its own accord, without sequelæ. The following hypotheses have been advanced to account for the conditions:

(1) Thymus enlargement causing pressure.

(2) Acquired brain lesion causing anatomical deformity.

(3) Cicatricial bands across the larynx.

(4) Lack of development of the cortical centers of respiration, especially of the laryngeal centers.

(5) Posticus paralysis.

(6) Muscular spasm, either glottic, or subglottic, and possibly phrenic.

(7) Adenoids.

(8) Congenital deformity of the superior laryngeal aperture, aided by the flaccidity of the parts in infancy but not entirely dependent thereon. As a rule the stridor passes off by the end of the second year, but in weakly children it may lead to thoracic distortion and prove fatal. The treatment should be of a general tonic and hygienic nature, aided by alkaline sprays and eucalyptus inhalations. Special attention should be given to any abnormality of the air passages, or reflex irritation.

DERMATOLOGY.

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

LECTURER ON DERMATOLOGY AND SYPHILOLOGY IN THE UNIVERSITY OF MICHIGAN.

HERPES PROGENITALIS.

DOCTOR ARONSTAM (Medical Age, Volume XX, Number XXIII) discusses the etiology, symptomatology, pathology and treatment of herpes progenitalis..

After enumerating the various anatomic locations upon which these lesions may be found, he divides them into two varieties: (1) Due to a peripheral neuritis, and (2) Due to local vasomotor paral

ysis, and having less marked subjective symptoms than the first.

The etiology is subdivided under twelve heads, as follows: (a) Neuroses of hereditary type; (b) Debilitating diseases; (c) Autotox emias; (d) Drug intoxications, including alcohol; (e) Senile degeneration; (f) Acquired neuroses and psychoses; (g) The different dyscrasiæ and cachexia (practically included under (b); (h) Local conditions; (i) Local overexcitations; (j) Individual predisposition or idiosyncrasy; (k) Reflexly by various causes; (1) A special bacillus. Under the head of symptomatology and differentiation there is nothing particularly new.

Regarding the morbid anatomy there is likely to be a pathologic state of the local peripheral nerve-endings as a peripheral neuritis or a local vasomotor paralysis; the latter condition following the former.

"The inflammation takes place in the epineurium, comprising the neural cells or parenchyma to such an extent as to induce a curtailment in the conductibility of the nerve current. The nervi vasorum, deprived of their functional activity, engender trophic disturbances in the tunic of the capillaries, which soon become manifested by a diapedesis and exudation of serum between the cutis vera and the layers of the epidermis, resulting in the formation of vesicles."

The treatment should be directed by the cause, with a good prognosis for complete and permanent cure, except in the type of so-called "darthic diathesis," in which cases there is an absolute tendency to recurrence. General and constitutional treatment is demanded quite as frequently as are local applications, while circumcision may be necessary.

THERAPEUTICS,

BY DELOS LEONARD PARKER, PH. B., M. D., DETROIT, MICHIGAN.

LECTURER ON MATERIA MEDICA IN THE DETROIT COLLEGE of MEDICINE.

POTASSIUM IODID IN MIGRAINE.

DOCTOR J. R. CLEMENS (Therapeutic Gazette, May, 1903) says: "Owing to an empiricism bred of despair, I have been prescribing potassium iodid to the exclusion of all other drugs in cases of migrainous headaches, and my results have been so marvelous that I make bold to send you this paper on the subject, in the hope that some of your readers will test the efficacy of the drug I recommend, and thereby either confirm my statements and the claims of the drug to rank amongst specifics, or silence me."

The circumstances that led to the employment of this drug for the purpose here indicated were as follows: Doctor Clemens had become. dissatisfied with the remedies ordinarily prescribed in the treatment. of migraine, and began a search for others that might be of a more satisfactory nature. In doing this he made use of drugs that had the effect of reducing arterial tension.