ANTISEPTIC SPHENOIDS IN THE FIELD OF GYNECOLOGY. THE field of gynecology is in many respects the least satisfactory covered of any department of medicine. Undoubtedly much more is being done at the present day to relieve many of the ailments to which woman is subjected, but even yet at the hands of many practitioners office treatment for these conditions means two, three or four visits weekly, the usual routine of local application carried out, and after the brief freedom from the acuteness of the original complaint she is left in very much the same condition as at first. The dependence with these local conditions have upon the general conditions and upon some conditions which require surgical attention is now more generally recognized, and it will undoubtedly be the case that the large ffice practice of the gynecologist will be more varied as regards the number of his patients, and will not mean the meeting of the same set day after day. He will be more successful and will consequently have a larger clientele, due to the fact that he has recognized the above-mentioned dependence. Instead of the frequent visits being necessary, more reliance is placed upon the local self-made applications or medication, and for this purpose Antiseptic Sphenoids possess valuable properties for accomplishing good results. McCoy, Howe & Co., of Indianapolis, have given great care to the preparation of these Sphenoids and have emphasized particularly the qualities of disintegration and solubility. Such perfection has been reached that often though a coat of petrolatum is desirable when used per rectum, yet their disintegrating properties are not impaired. Many clinical cases could be cited where tincture of iodine, Churchill's tincture, tincture of iodine and carbolic acid, glycerine tampon, hot water injections, and all sorts of sprays, have proved ineffective, but success was attained at last through the use of Antiseptic Sphenoids. The readiness with which they may be applied and absorbed commends them highly, and a trial upon the part of all who have met these obstinate cases will readily convince them of the utility of Sphenoids.-Med. Mirror. The Propriety of Bearing Testimony to True Merit. In a practice of over fifteen years I do not think I have written over three or four testimonials for proprietary medicines, but I cannot see any impropriety in bearing testimony to a truly meritorious remedy, and especially where that remedy has stood the test of time with thousands of physicians who, with one accord, verify its curative virtues in a certain line of disorders. This is true of the preparation, Sanmetto, which I consider a wonderful remedy and almost a specific in all inflammatory diseases of kidney and bladder. I prescribe it daily in my practice, and it has never yet disappointed me, but has frequently surprised me by its wonderful curative powers. When I am called to treat a case of cystitis my thoughts revert to Sanmetto; in fact, I have learned to associate Sanmetto with cystitis, and from the thousands of testimonials received, and the number of favorable reports in the medical journals I hardly see why the manufacturers of Sanmetto desire more. It seems to me that a physician who does not know of the virtues of Sanmetto is very far behind the age.-W. P. Hough, M.D., Columbia, La. Journal of Medicine and Surgery A JOURNAL PUBLISHED MONTHLY IN THE INTEREST OF VOL. XV. TORONTO, JUNE, 1904. Original Contributions. NO. 6. A CASE OF CEREBRAL TUMOR PROBABLY OF LEFT FRONTAL LOBE.* BY CAMPBELL MEYERS, M.D., M.R.C.S.(ENG.), L.R.C.P.(LOND.), As the history of the following case of intra-cranial growth presents some features of interest, I have much pleasure in laying it before you. The patient, J. S., aged 52, male; occupation, farmer; was kindly referred to me by Dr. Barnhardt, of Owen Sound, with a history of cerebral disease. He entered my private hospital, October 14th last. In regard to his family history, his father died of what was considered a tumor of the brain, but no post-mortem was made to confirm the diagnosis. He had an uncle on the paternal side who suffered from brain trouble, for which he was treated by the late Dr. Sweetnam, who diag nosed a tumor of the brain. This diagnosis was confirmed by a post-mortem examination, when a tumor about the size of a hen's egg was discovered in the parietal region of the left hemisphere. A remarkable point in the history of this case was the absence of any severe headache. There was also a history of injury to the head about one year previous to his death. The remainder of the family history presents nothing of importance, the patient's mother being alive and well, aged 75, and the patient has four brothers and two sisters who are in excellent health. There is no history of tubercle or insanity in the family. Previous History.-Patient always enjoyed good health, and worked on his farm until five years ago, when he began business. for himself in Owen Sound. He was always temperate in his habits, and never had any venereal disease. He suffered from an *Read before Toronto Clinical Society. accident about fifteen years ago, having been struck on the left side of his head by the corner of a bale of hay. He was taking a load into Owen Sound, and walking beside the waggon at the time, when one of the bales slipped and struck his head. He was stunned for a time in consequence, but was able to drive his horses home later in the day, and felt no serious ill effects from it. He has never suffered from ear disease. History of Present Illness.-This began with an attack of grippe in January last, 1903. Following this he complained of a feeling of fulness in the head, as though he were suffering from a severe cold. This was followed by a peculiar sensation about the vertex somewhat resembling an ache. He has never had any severe pain in his head. His speech gradually became involved, and he found a difficulty in expressing himself owing to his inability to pronounce words, for while he was quite well aware of the word he wished to use, he had a difficulty, which gradually became more marked, of giving expression to it. His memory became impaired, so that he would forget many of the details of everyday life. Three weeks before entering my hospital, he began to suffer from extreme drowsiness, which would last for an hour or two, but recur several times during the day. He never had any attacks of spasm or any paralysis in any part of his body. About a week after the drowsiness came on, the saliva began to dribble from his mouth, and this has continued more or less constantly since, being present at night as well as during the day. His gait has recently become unsteady, so that he will stagger at times when walking, although he can still walk a considerable distance, but not with the comfort he formerly enjoyed. He does not complain of vertigo. Physical examination, October 14th, 1903, shows a well-developed man of 5 ft. 8 in. in height. He is well nourished and weighs 132 lbs. His general expression is fairly bright, but he is much troubled from his inability to express himself. He can only utter a word or two, being quite unable to frame a sentence. Mentally he is quite clear, and his intelligence quite up to the standard of a man in his station of life. There is a constant dribbling of saliva, which was very irksome to him. The examination of his head shows a swelling, about 2 1-2 inches in diameter, over the left parietal region, which is dense, and appears to be due to thickening of the cranial bone. There is no tenderness about it, and the patient is not aware of the length of time it has existed, as it caused him no inconvenience. He thinks probably one or two years. Except for this, the cranium presents no abnormalities. The examination of the face shows all movements normal and no paralysis of any muscles. He can blow out a candle quite well. His pharyngeal reflex, however, is entirely absent. His tongue is protruded in the median line. The eye movements are all normal, the pupils equal, and react to light and accommodation. He does not complain of any disturbance of vision. The ophthalmoscopic examination, however, showed a well-marked neuritis of the left disc, a beginning neuritis in the right. The right disc was distinctly swollen, the physiological cup filled in, and the border was blurred in its entire extent. This condition of the discs was verified later by Dr. Ryerson, who kindly saw him with me. Taste and smell unaffected, and there is no disturbance of sensibility on face. There is no tenderness on tapping the skull. The upper extremities show no atrophy nor any localized loss of power. Dynamometer, R 65, L 50. Elbow and wrist jerks present, and equal on the two sides. Chest examination shows heart and lungs healthy. Pulse, about 80, and regular. Examination of abdomen negative. Urine was normal in amount, and chemical examination showed no marked abnormalities. In the lower extremities the knee jerks were active and equal on the two sides. The superficial reflexes were not marked, and Babinski's sign was absent. There was no ankle clonus. There was no localized loss of power in either leg, although here, as in both arms, there was some general weakness when compared to the patient's muscular strength before his illness. There was no inco-ordination in any of the limbs, and Romberg's sign was absent. The patient was unable to write either spontaneously or from dictation, but could read to himself. Soon after beginning treatment, the patient gained in flesh, increasing in weight four pounds the first week. Part of this gain he lost later. His aphasic condition was variable, and at times he improved so much that he could put a sentence fairly well together, and within the next day or two this power would be lost. There was no marked change except this in his condition until the end of the third week, when he became much more drowsy, and his gait more staggering. At this time also the sternomastoid on the left side became distinctly weak, the first evidence of any localized loss of power which he exhibited. His temperature was normal throughout, and there had not been any derangement of the heart's action. He took his food well, and had never been troubled with vomiting during any period of his illness. As his condition was becoming serious, I advised the friends to try an operation. They asked if it would cure him, and I replied that there was no certainty of its doing so. Dr. W. P. Caven then saw him with me in consultation, and concurred with me in the diagnosis. As neither of us, however, felt very hopeful about an operation, the friends decided to take him away, which was done on November 7th, the patient walking away with them. The case presents several features of interest: (1) Hereditary influence, which is rare in these cases; the father probably suffering from brain tumor, and the uncle undoubtedly doing so, as was shown by the post-mortem. (2) Had trauma anything to do with this case? While the nutritive changes consequent on mere concussion may be the starting-point of a tumor, I think in many cases this influence is over-rated, unless the symptoms develop within a short time after the accident, and are clearly traceable to it, and such cases form a very small proportion of the total number. In regard to diagnosis, if we assume that the symptoms are due to organic disease, rather than functional, in which I think we are justified from a consideration of the symptoms, the questions then arise: (1) Is the diseased condition due to a tumor? (2) if so, what is its location? and (3) what is its probable nature? As to the question, Is it a tumor? one is at once struck with the absence of nearly all the cardinal symptoms of tumor, such as headache, vomiting, giddiness, general convulsions, etc. Gowers says headache is absent only in very rare cases of tumor, and yet in the case under consideration it was never complained of to any degree. The absence of any spasm or general convulsions is also very unusual. We know, however, that cases of tumor have been discovered post-mortem, which gave no evidence of their existence during life. I recollect especially one shown me by Bramwell, in which the whole upper two-thirds of the Rolandic area had been destroyed by a sarcoma, which had produced no symptoms whatever of paralysis during the lifetime of the patient. Similar instances are recorded by Starr, in his recent work on Organic Nervous Diseases," and Mayer has collected several such cases, as well as Buzzard. These facts are the more interesting since we occasionally examine the optic discs of a patient, to find he has consecutive atrophy of them, due probably to a tumor, which has become quiescent, and which has caused no other symptoms. In the absence of the cardinal symptoms abovementioned, are we still justified in regarding the case as one of tumor? I believe so, the chief point in favor of it being the distinct optic neuritis which was present. Optic neuritis may, it is true, be produced from other causes than tumor, notably anemia, kidney disease, and lead poisoning. The general appearance of the patient at once excluded anemia, examination of the urine showed his kidneys to be unaffected, and there was no source to which lead-poisoning could be traced, nor had he any further symptoms of it. Hence, in the absence of all these affections, the distinct neuritis indicated clearly a new growth in the cranium. In addition to the condition of the discs, the aphasia, although variable to some extent in its intensity, pointed directly to disturbance of function at least, in a certain area of the brain. The marked drowsiness from which he at times suffered, as well as the staggering gait without any disturbance of the reflexes, etc., |