and inability to stand and to walk. When in bed the not dependent upon demonstrable anatomic syphilitic man was able to move the legs quite freely. On the lesions, though perhaps upon the toxic products of the third day articulatory disturbance of speech was syphilitic infection. It is not believed that the mernoticed. The movements of the lips and tongue were cury had alone any influence in the development of the interfered with, and deglutition was difficult, only changes in the nerves, although it is not denied that the liquids being swallowed. Twitching of the face was action of the mercury, by depressing the general bodily present, especially about the eyes and the mouth. In vigor, may have favored the activity of the syyhilitic the course of eight days this ceased, although that in poison.-Jour. of the Am. Med. Ass'n., May 15, 1897. the hands and legs continued. The weakness also per sisted. The ocular disturbance disappeared. At no Congenital Teeth.-J. W. Ballantyne (reprint time was there fever or pain. Later, weakness of the from Edinburgh Medical Journal) gives details of 3 bladder manifested itself and there was an absence of cases and references to some 70 more (Brit. Med. Jour.). erections. Pain in the sacral region appeared, but no He discusses fully the frequency, symptomatology, morgirdle sensation, no palpitation of the heart, no dyspnea. bid anatomy, pathogenesis, and treatment of the anoAfter this improvement the patient gradually grew maly, summing up the results of his research in the folworse again and symptoms of secondary syphilis made lowing general conclusions: 1. Congenital teeth form their appearance. Mercurial treatment was resumed, a rare anomaly, but one which has long been known intramuscular injections of gr. of a mercury salicylate both to the profession and to the public. 2. Their being given twice weekly. Following this the syphilitic presence has often an ill effect upon lactation, partly symptoms disappeared, but the others were aggravated. on account of the imperfect closure of the infant's The urine presented no abnormalty. The pupils were mouth, and partly by the wounding of the mother's active in their reactions and there was no nystagmus nipple; sublingual ulceration may also be a result, and and no ocular paralysis. The face was puffy and ex-infantile diarrhea and atrophy are more distant con. pressionless, but not edematous. The left nasolabial sequences. Sometimes, however, symptoms are altofurrow was not as marked as the right and the left gether absent. 3 Congenital teeth have probably little angle of the jaw drooped a little. There was no appre- or no prognostic significance as regards the bodily or ciable atrophy of the facial muscles and no fibrillary mental vigor of the infant carrying them. 4. The twitching. Sensibility was not obviously deranged. teeth usually met with are lower incisors but. The tongue was not atropic. The palatal reflex was sometimes upper incisors may be seen, and very preserved and speech now presented no defect. The larynx appeared to be normal. There was no disturb ance of the special senses. The arms and legs presented symmetric marked paresis, most pronounced at the per iphery. There was no rigidity. The atrophy was pro portionate to the degree of weakness. There were no trophic disturbances. The movements were ataxic, but there was no tremor. In the affected portions sensibil ity was impaired in all its forms. The tendinous and the periosteal reflexes were wanting and the cutaneous reflexes diminished. The paretic muscles exhibited fibrillary contractions. Some of the larger nerve trunks were tender on pressure, but the paretic muscles were rather more so, and they presented also partial reaction of degeneration. Finally dyspnea set in and became aggravated in attacks of asphyxia from paralysis of the diaphragm. Death took place four months after the appearance of the first symptoms, in consequence of bilateral pneumonia of the bases, which was confirmed at the postmortem examination. The brain, the cord, a number of spinal ganglia, a number of peripheral nerves and a number of muscles were carefully examined. The most marked changes were found in the nerves, which presented degeneration of their medullary sheaths with thickening of the perineurium. No changes were found in the blood vessels. Only slight changes were found in a number of the ganglion cells of the anterior horns of the cord. The muscles were but little changed. From of xanthoma had been assumed to be merely different a careful consideration of all of the elements of the case the conclusion is reached that the symptoms were rarely molars of either the upper or lower jaw. The oc The Nature of Xanthomata.-Dr. S. Pollit. zer, of New York, read a paper on this subject at the recent meeting of the American Dermatological Ass0ciation (N. Y. Med. Jour.). The peculiar yellow plaques and nodules in the skin known as xanthoma, he said, had been the subject of extensive studies on the part of pathologists and dermatologists ever since they were first described by Addison and Gull, in 1850. The greatest diversity of opinion existed as to their nature; this was due, probably, in part to the fact that the different forms clinical manifestations of the same process. The author's histological studies were based on thirteen cases; five of them cases of xanthoma planum palpebrarum, four of elsewhere. At one end of this series we should have the xanthoma tuberosum multiplex, and four of xanthoma diabeticorum. The clinical grounds for separating xan thoma of the eyelids from multiple xanthoma were as follows: The nodules of xanthoma multiplex were firm, round, elevated papules; the patches of eyelid xanthoma were soft plaques at the level of the skin. Eyelid xanthoma persisted through life; multiple xanthoma, sooner or later, underwent involution. Eyelid xanthoma was quite common; multiple xanthoma was extremely rare. If the eyelids were in this preponderating degree the seat of predilection for a common xanthoma, we should expect to find the eyelids affected in every case of multiple xanthoma; but, as a matter of fact, the two forms were rarely associated in the same individual. With the extensive material at his command, the au thor had been able to show that common eyelid xantho ma was not a new growth, but is due to a generation of pre-existing, embryonally misplaced striped muscle tis sue. The so-called xanthoma cell was a fragmented muscle fibre in a state of granulo fatty degeneration, with proliferation of the muscle cell nuclei. The vari ious stages of the change from normal muscle-fibre to xanthoma cell were demonstrated in sections under the microscope, drawings made by Dr. Ira Van Gieson, and micro-photographs. persistent fibrous node of rheumatism; at the other, the transient nodule of diabetic xanthoma; while between them, intermediate in its tendency toward the formation of the fibrous tissue and fatty degeneration, ultimately undergoing involution, would stand the nodule of com. mon multiple xanthoma. Adaptation in Pathological Processes.— This was the subject of Dr. William H. Welch's Presidential address delivered at the recent meeting of the Congress of American Physicians and Surgeons. He described adaptive processes as those causing some sort of adjustment to changed conditions due to injury or disease. Physiological adaptation was a familiar and striking phenomenon full of purpose. In the existing order of Nature, the mechanical theory was our only working hypothesis in biology. Physiological adaptation by organic evolution gave the key to the study of pathology. Compensatory and adaptive manifestations resulted from energy acting upon living matter. The final result did not influence the chain of events. A mechanical explanation of the process must be sought for. Patho logical adaptations had their foundation in physiological processes, but the former were decidedly imperfect. They were divided into the compensatory hypertrophies, This explanation of the origin of eyelid xanthoma the regenerations, and the protective processes. Among harmonize with a number of previously unexplained the first work hypertrophies, as illustrated by cardiac clinical and pathological facts; e.g., the absence of any hypertrophies, were especially important. Such resultclinical signs of tumor; its almost exclusive occurrence in the face, where peculiar muscular conditions prevailed; its heredity; its usual development after middle age, when degenerative processes were apt to occur; the pe cular yellow pigment that was always present in mus cles undergoing fatty degeneration, etc. The structure of multiple xanthoma was shown to be wholly different from that of eyelid xanthoma. It formed a sharply circumscribed tumor in the cutis It was an irritative hyperplastic development of connective tissue whose cells produced fibrous tissue on the one hand, or underwent fatty degeneration on the other. In diabetic xanthoma the process was a little more diffuse and the tendency toward fatty degeneration more marked than in the non-diabetic multiple xanthoma. In both, irreg ular patches of granulo fatty matter interspersed with cellular detritus occurred in the middle of the nodules as the result of the fatty degeneration of the cells. In over 85% of the recorded cases of multiple xan. thoma, far too great a number to be accounted a mere chance, there was either diabetes or some severe lesion of the liver, with jaundice. The author thought it likely that further research might show that the fibrous nodes and fusiform enlargements of tendons in chronic rheumatism were to be placed in the same general class as the nodes of xanthoma. We should then have a large group of diseases, hepatic, diabetic, rheumatic, all char acterized by toxemic conditions, in all of which irritative connective tissue lesions occurred in the skin and ed from changes in the individual cell, not from increased supply of blood or lymph. Cell properties determining the character of the pathological process were original physiological properties. Applying these conclusions to the study of inflammation, we found that this was an adaptive pathological process without special fitness justifying extravagant statements recently advanced for it. In general, the healing power of Nature was overestimated. In the light of modern knowledge, there was ample scope for the intervention of the physician and surgeon. SURGERY. Loose Fibrous Bodies in Joints.-Berthier and Sieur (Archiv. de Med. Experiment et d' Anat. Path) give an account of a case in which three years after an injury to the ankle a man presented signs which led to a diagnosis of tuberculous synovitis of the sheath of the extensor communis digitorum pedis muscle. On cutting down, however, it was found that obstruction was healthy, and eventually a loose body, 3cm. in its greatest diameter and 1.5 cm. thick, was extracted from the ankle-joint. The patient made a complete recovery. Structurally the loose body was composed of epithelioid cells, giant cells which were seen to be myeloplaxes, fibrous tissue, and numerous vessels. In parts the poly feared after destruction of the ganglion than after simple resection of the branches. The evidence indicates that complete extirpation should be superior to simple destruction of the ganglion.-Jour. of the Am. Med. Ass'n., May 15, 1897. hedral epithlioid cells had undergone degeneration. Taste, smell, hearing and vision are variously affected. No fat, cartilage, or bone was found. The writers re. The movements of the jaw may remain impeded. From gard the loose body as resulting from a piece of bone a therapeutic point of view recurrence is less to be chiped off at the time of the accident from the astrag alus or internal malleolus, which had subsequently un dergone regressive changes. The epithelioid cells which formed a considerable portion of the loose body they regard as derived from the bone cells. The fibrous transformation of fragments of bone introduced into the joints of dogs has been described by Poulet and Vaillard (Archiv. de Physiol). The specimen forms a transitional stage between loose bodies formed of bone and those composed of pure fibrous tissue.-British Medical Journal. Resection of the Gasserian Ganglion for Rebellious Facial Neuralgia. - Marchant and Herbert (Revue de Chirurgie) report two cases of extir pation of the Gasserian ganglion for the relief of rebel lious facial neuralgia, and they analyze ninety-three ad. ditional cases collected from the literature. Among the whole number there were seventeen deaths (17.8 per cent). In sixty-six the temporal course was followed, with eleven deaths (12.12 per cent), three of which were open to doubt. In twenty-nine the pterygoid course was followed with six deaths (20.6 per cent) Among fifteen cases of complete extirpation of the ganglion there were five deaths, three of which were open to doubt (13.13 per cent). Among sixty cases of incomplete extirpation there were eight deaths (13.33 per cent). Among fifteen cases of simple resection of the painful branches there was but a single death (a mortality of 6.66 per cent). From a study of the literature of the subject the conclusion is reached that certain rebellious facial neural gias originate in the Gasserian ganglion, and the only treatment of these cases consists in destruction of the ganglion. When no appreciable lesion of the ganglion existed and its removal was none the less followed by a disappearance of the neuralgia, this result is to be ex plained by the destruction of a nervous center contain ing neurons or nervous cells whose prolongations only are affected by simple section of the nerve. The temporo-sphenoidal course is the best to follow for the removal of the ganglion. The finding of one of its branches and especially the inferior maxillary in the oval foramen constitutes one of the most certain guides for the detection and seizure of the ganglion. The ganglion may be completely extirpated. Commonly the extirpation is incomplete and the ganglion is finally destroyed by curetting and crushing. Often only its branches have been resected. Hemorrhage, wounding of the nerve and cerebral compression are the immediate operative accidents to be feared. Secondarily there may be infection, hemorrhage, iodoform intoxication, ocular disturbances and otitis. As an immediate result of the operation there is a cessation of pain and also an abo lition of general sensibility in the distribution of the three branches of the nerve and especially in the second and third branches; but this does not persist long. NOTES: AND ITEMS Mexico Medical Congress.-The annual meet. ing of the Mexico Medical Congrees will be held at Guadalajara, Mexico, July 7 to 10. About 300 delegates will attend. A number of medical visitors from the United States are expected. Dr. J. Ellis Jennings, of the American Journal of Ophthalmology, has been attending the Philadelphia meeting of the American Medical Association. Philadelphia being the Doctor's home, he has combined duty with pleasure in attending the meeting. American Academy of Medicine. - The American Academy of Medicine began its twenty-second annual meeting at Philadelphia in the Continental Hotel. It is one of the societies that cluster around the meeting of the American Medical Association. St. Louis Delegates to the American Medical Association.-The following physicians of this city attended the meeting of the American Medical Association at Philadelphia: J. M. Scott, J. Ellis Jennings, A. F. Bock, Hypes, Hughes, Meisenbach, Lemen, Love, Paquin, Loeb and Brown. American Publishers' Association. The fourth annual meeting of the American Publishers' Association was held at the Hotel Hanover, Philadel phia. President L. E. Edwards, of Richmond, Va., presided. A number of papers were read by members from Philadelphia, Ohio, Mississippi, Michigan, Virginia, Oregon and other States. The Cosmopolitan for June contains the Secret History of the Garfield-Conkling Tragedy, by T. B. Connery; Constantinople, illustrated, by Peter Mac Queen; Moonshine in Georgia, illustrated, by Wm. M. Brewer; Malborougn, illustrated, by Arthur H. Beaven; The Turkish Messiah, by I. Zangwell; Poultry Farming, illustrated, by John B. Walker, Jr.; Modern Education, by President Henry Morton; Etc. Extirpation of Cancer of the Cecum.-The neoplasm weighed 400 grams and was attached to the rear wall of the cecum, of which 20 cm. were resected The meeting was largely attended and the addresses with it (Gaz. d. Osp. e delle Clin.); The operation was and papers were of a highly scientific and practical extra peritoneal, and concluded with the union of the character. The social features were superb. The next end of the ileum to the end of the ascending colon. meeting will be held at Columbus on a date to be fixed Normal intestinal functions were resumed in four days by a special committee for that purpose. and the patient was dismissed completely cured in three weeks. Journal of the American Medical Association. Death of Dr. A. X. Illinski.-Dr. Alexander Xerxes Illinski, of Cahokia, Ill., died at the home of his nephew, Dr. R. X. McCracken in Fayetteville, Ill., Saturday, May 29. He was in his 91st year. Dr. Illinski was the oldest practicing physician in Illinois, only returning from the active profession about four years ago on account of his decling years and feeble health. His practice was extensive, embracing particularly the section of St. Clair County known as the "American Bottom." He was peculiarly sociable, generous and scholarly, his society always being courted by men of letters. Sensations of the Shipwrecked.-According to some authorities Stephen Crane depicted the feelings of a soldier in battle better from his imagination alone, than others had done from actual experience. Those who read "The Open Boat," in the June number of Scribner's Magazine, will agree that he has pictured the sensations of the shipwrecked better from his own experience of it, than others have achieved it by force of imagination. It is a remarkable tribute to his clever nesss that he should have succeeded equally in pure im agination and in transcript of reallty. This is the first elaborate account of his terrible experience, after the wreck of the steamer "Commodore" when on its way to Cuba. Ohio State Medical Society. At the fiftysecond annual meeting of the Ohio State Medical So ciety held at Cleveland, May 19, 20 and 21, the follow ing officers were elected for the years 1897-98: Society of German Physicians.-At a meet ing of the Society of German Physicians of this city, held May 28, in the rooms of the Historical Society Building, Dr. L. P. Pollmann read a paper, "An His torical Sketch of the Development of the Perityphlitis Doctrine," and showed a gangrenous appendix which he had removed by operation for appendicitis. Dr. G Baumgarten related a case of "Floating Kid ney" which he saw in consultation with Dr. H. H. Mudd and where, according to the symptoms, an obstruction of the bowel had probably been caused by an entangle ment of the gut with the loose kidney and its ureter. Dr. L. T. Riesmeyer presented a stone which he removed by supra pubic cystotomy from the bladder of a male child almost two years of age. The stone is oval in shape, three-quarters of an inch in length, a little over half an inch in width, and of a grayish-brown color. The wound healed within a week, and three weeks after the operation the child was entirely free from all symptoms of bladder irritation, including reflex spasmodic seizures which were due to the presence of the stone plus a neurotic condition of the little patient. E. B. Treat & Co.-E. B. Treat & Co., the well known New York publishers, have announced their removal to a new building Nos. 241 and 243 W. TwentyThird Street, near Seventh Avenue. The firm's name was, up to May 1, 1897, E. B. Treat. On and after that date, William H. and Edwin C., sons of E B. Treat, who have been associated in business with him for several years, have been admitted to partnership interests under the firm name of E. B. Treat & Co. The firm has "in press" several new publications for early issue, as additions to their growing catalogue of medical, theological and subscription books. We herewith extend our best wishes. Births and Deaths in St. Louis.-The total number of deaths reported for the week ending May 29, was 159, as compared to 171 the week before, and 236 the corresponding week last year. Based on an esti mated population of 600,000 the death rate last week was 13.78 per 1,000 per annum. One hundred and fifty births were reported during the week. The small number of births reported weekly in comPresident, Wm. H. Humiston, M.D., Cleveland; Vice-parison with the number of deaths shows that a good Presidents, T. Clark Miller, M.D., Massilon; G. Mitchell, many physicians and midwives are not complying with M.D., Mansfield; E. H. Hyat, M D., Delaware; D. H. the law requiring births to be reported to the Health Brinkerhoff, M.D., Fremont; Secretary, J. A. Thomp- Department. son, M.D., Cincinnati; Assistant Secretary, H. M. V. The contagious disease report for the past week is as Moore, M.D., Columbus; Treasurer, James A. Duncan, follows: Small-pox, 1 case, no death; diphtheria, 8 M.D, Toledo; Editor, R. Harvey Reed, M.D., Columbus. cases, 3 deaths; croup, 2 cases, no deaths; scarlatina, 6 cases, no deaths; typhoid fever, 6 cases, no deaths; measles, 6 cases, no deaths; whooping cough, 4 cases, 3 deaths. Pension Surgeons Appointed.-The Pension Office announced May 29 the following appointments of local examining physicians: MISSOURI.-Neosho: H. L. Porter, Abram Mass and J. W. Lamsom; Hermitage: S. D. Dalgliesch; Grant City: OH. Mills, J. H. Howser and William Johnson. ILLINOIS-Rockford: G. W. Rohr, E. P. Catlin and W. D. McAfee; Bloomington: Joseph Hallet, Jehu Little and John Haig; Amboy: A. L. Miller, W. C. Smith and D. H. Law; Rock Island: F. H. Gardner and James Cozad; Litchfield: James F. Blackwelder, E C. Jones and J. B. Carry; Freeport: J. F. Thayer, B. F. Buck with and C. P. Leitzell. fever death rate prevails among the population immediately outside the College walls, who are using unsedimented, unfiltered water. The sudden and permanent fall in typhoid deaths in Kensington, coincident with a change from the Dela. ware River water to that of East Park reservoir, where the water is sedimented and aerated, adds another to the proofs that filtration will remove this deadly potency from polluted water.—Medicine. Science Versus Rabbits in Australia.While Dr. Koch has been endeavoring to isolate the microbe which has destroyed the cattle of a continent, it is interesting to observe the fact that the people of Australia have gone seriously into the business of culti vating a deadly bacillus with a view of saving their con tinent from the devastations wrought by millions upon KANSAS.-Concordia: C. F. Leslie, S. V. Fairchild millions of rabbits. The war against the rabbits has and S. C. Pigman. IOWA.-Lamar: P. L. Birch, W. R. Gray and T. E. State Medicine in Pennsylvania. - A good many changes were made in the health laws by the last Legislature. These are dealt with by Dr. Benjamin Lee in the Sanitarian for January, 1897. A new act constitutes a sanitary code for the restric tion of epidemic diseases. It makes sanitary adminis tration uniform throughout the State, and authorizes Boards of Health to enforce its provisions independent of municipal regulations. been going on for a number of years The government of New South Wales has within the past seven years expended considerably more than $4,000,000 in attempts to exterminate the rabbit pest. This sum, of course, makes no account of the amount expended by private citizens and land owners; and it is trifling sum as compared with the losses that the rabbits have inflicted. The Minister of Public Lands for New South Wales says that since 1890 the government has spent $250,000 in building a little less than 1,000 miles of rabbit proof fencing, a sort of "trocha," as our Spanish friends would say, against the insurgent rabbits. But the rabbits in crease and multiply, and the problem is far from solved. A conference of delegate from all parts of New South Wales has lately been held in Sydney, for further con sideration of this obstacle to the colonie's prosperity. It is in the colony of Queensland that the experiment of enlisting the microbe has been entered upon; it is the bacillus of chicken cholera, as isolated by Pasteur, that they are cultivating in Queensland and scattering over the country where the rabbits prevail, "concealed in pellets of pollard." It would not appear as yet that any great measure of success has attended this scheme. Dr. Koch, fresh from his scientific triumphs in Africa, should The Crede treatment is used, a prescription for now be sent by the British government to aid in the exa two per cent silver nitrate solution being appended, termination of the Australian rabbits.-Review of Retogether with directions for after-treatment and proviews for June. phylactic measures. An act for the prevention of blindness was passed. From 1870 to 1880 the population of the State increased 21.6 per cent, while blindness increased 119.8 per cent, ophthalmia neonatorum being the most productive cause. The act requires the nurse or midwife to report to the Health Officer within six hours after the appearance of inflammation or redness of the eyes of an infant, which officer is required at once to send instructions for treat ment. Small-pox has appeared at only five points during the year, the very general vaccination in 1894, together with the enforcement of the law for compulsory vaccination of school children, largely causing this immunity. Philadelphia still maintains its unenviable reputation as a typhoid center, the death ratio in 1895 being 40 per 1000 population as against 17 in New York and 16 in Brooklyn. This is due to the polluted water supply. In Girard College typhoid was found to be almost always present. The water used by the students was pumped directly from Fairmount forebay in the Schuylkill, with out even sedimentation. A filtering plant was intro duced, and typhoid soon disappeared. An excessive PUBLISHER'S DEPARTMENT. Spurious Coca Wines.-The British Medical Journal, in its issue for January 23, and again in that for February 6, speaks of the dangers that attend the popular use of so-called coca wine-that is, some kind of wine in which a salt of cocaine is dissolved. For the most part, the wine is of poor quality, but sweetened and highly fortified with rectified spirit. The amount of cocaine contained in many of these products is variable, too, and in prescribing them one really does not know what doses of that drug he is ordering. More- |