with only slight improvement. Six weeks ago I treated him for an acute suppurative otitis media in the left ear, the poor ear. Perforation and discharge remained persistent under the ordinary methods of treatment for about four weeks. At this time an attack of acute suppurative ethmoiditis came on which disclosed a chronic suppurative condition of the ethmoid and antrum of Highmore hither to unsuspected. On the application of vacuum to the nose, the discharge ceased and the perforation slowly healed. On the closure of the perforation his hearing had improved to hearing conversation with his left ear which had been impossible for several years.

At the writing of this paper I am using this treatment on two cases of obstinate suppurative otitis media with lessening of the discharge and allaying of pain in each case.

Used in cases in which drainage is deficient and in conjunction with proper operative and cleansing proceedures this treatment is one of the most useful additions to the surgery of the ear, nose and throat in the past few years.

Dr. Lemere closing discussion:

400 Brandeis Theater Building.

I wish to thank Dr. Owen very much for his discussion. I was not sufficiently clear in stating that I consider that the vacuum does act on the middle ear. I consider this ture but am not positive on the point. In cases in which the ear is full of pus I have seen great deal of relief after the application of the vacuum has been made. In a paper by Pratt he claims more than I have done in this paper in this regard. He claims that drainage is established through the ear and so benefit is received. I doubt very much if that is the real reason of the benefit. I concur with Dr. Owen that the vacuum is not directly the reason of the benefit. The ear is too congested and the parts really too delicate to stand the vacuum treatment and it is very hard to regulate the treatment so that we do not get a complete vacuum. I am free to confess that I have not in a single instance found any case, in which drainage has been established, anything but relief from the vacuum treatment.

This method is not a sure cure but to aid the ordinary methods in relieving catarrhal conditions.

Scientific Problems of Nature's Secrets.

*By P. E. KOERBER, M. D., Yutan, Neb.

Most problems of the natural sciences look to the student as simple ones in their point of origin, still the more we study them and try to look into them, we find that the conditions presenting them are a great deal more complicated. There was a time when a number of conditions were explained through chemi

*Read before the Saunders County Medical Society at Wahoo, Neb.

cal and physical methods and processes, and it was thought that these problems were solved, f. i., take the assimilation of food through osmosis and at that time the kidneys were looked upon in their microscopical picture as filters.

Today we know that these conditions are considerably more perplexing and that the activity of the different organs is more complicated than heretofore anticipated. So we find the therapy has changed and is changing. It was thought that to digest albumen HCl must be present and if it was lacking it was given in form of a R, and if it was hypersecreted it should be neutralized by alkalies. Today we know that with these medicaments we influence a very complicated mechanism, not so much the chemical process as we do the physical or mechanical one, say the duration of food within the stomach and that it takes experience to apply the acid or alkalies at the proper time. In chlorosis we found the haemoglobin diminished and that gave us iron as medication, with the assumption that by adding iron the system would make more haemoglobin. We know exactly how it is taken up and excreted, a beautiful experiment, but still there are physicians today who deny the action of the preparations of iron.

Take arsenic in its different forms, it is an old medicament, has been used in different disorders, in infections, skin and diseases of metabolism, and physicians differ greatly as to its action and when we see in the medical papers the favorable effects of the Ehrlich preparation also arsenic, we may think that arsenic is a poison to the cause of syphilis and that it directly kills the spirochaetae, though late experiments and experience with this medicament have shown distinctly that such conditions are far mor complicated. I have read of a case which interested me. A syphilitic woman gave birth to a child exhibiting plain signs of syphilis. The mother received the Ehrlich treatment and improved. So did the child she nursed.

Next thought is that the arsenical remedy was excreted partly through the mother's milk. This, of course, is not an unusual way of treating an infant, say with iodids. But in the above case the milk was examined and no arsenic found. Prof. Ehrlich explains the condition in this way.

His arsenic preparation exhibits upon the spirochaetae within the mother a rapidly destructive action and thereby forms many so-called endotoxins or poisonous substances, which being formed within the body of the spirochaetae, and at once become free by this destructive action of the medicament and are as such secreted by the milk in large amount. Now,

could it not be that this new arsenical remedy does not directly attack the spriochaetae but causing other reactionary processes within the blood forming organs and causing some substances not yet known to be formed by the system, which directly attack the spirochaetae, dissolves them and neutralizes the endotoxins. and forming a direct antitoxin in large quantities to be secreted by the mammary glands. This is only presumption and who can tell what the future will reveal to us. So we see that the system is very reactionary and resourceful, when we study deeper into such questions, we can see which branch of science in the future will help us out the most.

When arsenic is fed to horses it will improve their coat and often improves the amount of adipose tissue deposited. Even here it is evidently not such a simple process as we might imagine.

Let us look at human tuberculosis briefly. The majority of people, I believe, are aflicted with tuberculosis, but are not directly tubercular, that is, sick with tuberculosis. According to late experiments the recovery from a tubercular infection gives to the person a high grade immunity, this link of immunity can only be broken through a so-called massive infection or conditions greatly affecting the resisting power of the system. Why this so-called acquired immunity should suddenly cease is not known.

Let us turn to other conditions which we occasionally find in our practice. i. e., a pregnancy commencing with pains in the region of the appendix. There certainly cannot be adhesions from appendix to uterus or ovary in all cases and if such should exist, why is the general disturbance not greater and why do the symptoms point more towards intestinal indigestion or catarrhal conditions of the intestinal tract. What amount of disturbance is due to tissue reaction and resistance; or pregnancy being accompanied by a bronchitis with asthmatic breathing, disturbances of assimilation, excretion, cardiac hypertrophy more than normal and cardiac neurosis. Why is there in such cases as tontilitis pain in the appendix at the same time? Why is there a general disturbance of intestinal functions following a case of abortion, often accompanied with general tenderness over abdomen; is this a slight shock to all the abdominal organs and affecting the plexus of nerves and similar to the experiments of Schiff percussing the abdomen of a frog?

Look at those cases of asthma which cannot be classed among cardiac, nervous or Cushman spirals and often termed

"chronic bronchitis" and not even exhibiting the Koch Bacillus, could they not be tubercular anyway or give the tuberculosis test. Their system is below par. They offer symptoms of a pure and simple asthma with attacks at different times. Again those cases of heavy breathing accompanied by a localized bronchitis showing the focus to be posterior low, they have no doubt cardiac and myocardiac changes and a consequent venous stasis. They are often times called asthma, only they repeat their attacks less often and these cases are subject to atmospheric influences. Other cases of asthma of long standing slowly developing and later taking on a form of emphysema, general arteriosclerosis or arterio-capillary fibrosis, which latter must play an important part in the causation of this asthma and also in the existing nephritis, especially the granular atrophic kidney. These patients seek medical aid very late and only when the symptons are very marked. What can be done in these cases when fully developed, as they show anaemia, irregular and weak cardiac action, hydrops in different sytles, uraemic symptons still excreting a fair amount of urine, uraemic asthma.

What role do septic infections play during the life of man and in what forms do we meet them? The point of entrance of these poisons varies greatly. The question is also this-during abcess formation has the system not stored away a certain amount of pyogenic germs? Do we not find multiple foci distributed through the system and why are relapses so frequent? Take f. i. acute articular rheumatism which is no doubt a septic infection, a form of pyaemia and which may follow almost unnoticeably local inflammatory conditions or show a focus in the tonsils, nose, ear, furuncle. Now does this poison reach the endocard, pericard, pluera, joints, etc., or does it only show a predelection for those serous membranes. We know of no set time of incubation. We know that those pyogenic bacteria are distributed and deposited over different portions of the body and may not cause any discomfort for a long time, but pathologically we find a thickening of the parts previously affected with pain on pressure. (Muscles neuralgia). The question is what can be done in these acute cases more than we are able at present, to prevent a chronicity of these affections.

The Venereal Diseases, their Causes, Prevention and Cure.

*By W. O. HENRY, M. D., Omaha, Neb.

The following is merely an abstract of a paper read by Dr. W. O. Henry before the Nebraska State Medical association in Omaha last May. The entire paper was too long for the space available in the Review and Dr. Henry kindly consented to cut it down to the space here given. The entire paper can be obtained in the form of a reprint from Dr. W. O. Henry, Omaha.-Ed.

MR. CHAIRMAN AND MEMBERS OF THE SOCIETY:

The subject of my paper, "The Venereal Diseases, Their Causes, Prevention and Cure," is one which should interest not only every medical man, but every intelligent lover of his race, when we see how widely prevalent they are, the fearful havoc they work to the health and happiness of the individual and the home, and how much suffering they entail, and how often death itself follows in their train.

As a member of the Committee of the American Medical Association to study and report upon Ophthalmia Neonatorum, I have been interested and impressed with the widespread and disastrous results of this preventable disease, and with the multitude of its many innocent and helpless victims. Then having for many years given special attention to the diseases peculiar to women, and noted how large a percentage of their ailments are due to gonorrhoea, how many and varied are the manifestations due to this infection, how many very serious operations they are obliged to undergo, as a result of this same disease, how much of invalidism they suffer, and much of all this innocently and often ignorantly, I have asked myself over and over again what can be done to prevent these terrible results. And since this is only one of the serious venereal diseases, it is but a step to the subject of this paper which I present for your consideration.

The physician's real mission in the world today, as never before, is the prevention of disease. True, the relief of suffering, the postponement of death, and the cure of disease are parts of it. But our glory is more in what we are able to prevent than cure.

By the term Venereal Diseases, I wish to be understood as meaning the three infectious diseases usually communicated by impure sexual intercourse, namely, gonorrhoea, chancroid and syphilis.

*Read before the Nebraska State Medical Association, Omaha, May 2, 3 and 4, 1911.