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from the oval window during inflation, etc. The short process measures 3 mm., and in some cases a fraction over; the long process, from the lower edge of the articular surface to the tip, about 42 mm. This ossicle weighs about 24 mg. The short process is directed backward and is lodged in the sella incudis of the posterior tympanic wall, just below the opening into the antrum mastoidea. The long process, downward and inward, parallel and posterior to the malleus handle. At its lower end it turns at a right angle inward to join the head of the stapes. This right angle projection is known as the processus lenticularis or orbicularis. In the fetus this is a separate bone (Quain). In inflammatory conditions of the tympanum the incus is the first of the ossicles to be thrown off and destroyed because of its limited blood-supply, and because of the position of the artery which supplies it, which is so readily pressed on by the swelling of the tissues in that area. The ligaThe ligaments which secure this ossicle in position are the capsular, already spoken of, and the ligament of the incus, which surrounds the short process, passes back and is fastened to the area of the floor of the iter, where the short process is lodged. There is a small ligament which holds the osorbicularis and head of the stirrup together.

The stapes consists of a head, two crura and a foot-plate. The head is directed outward and articulates with the processus lenticularis of the incus. It is disputed as to whether this is a synovial joint, but Rudinger describes it as such. There is a short neck which divides into two crura, the anterior and posterior, which are united to a flat oval plate, the foot-plate. The foot-plate occupies the greater part of the fenestra ovalis, but is in no place in actual contact with the bone, there being a layer of cartilage all around the foot-plate, and another around the edge of the oval window. Between these two layers of cartilage is a ligament. The length of the foot-plate is a fraction over 3 mm., its width 12 mm. The anterior crus measures about 2 mm., its posterior crus 3 mm. This ossicle weighs about 2 mg. The ligaments are the annular which holds the foot-plate in the oval window, and one which unites the head with the incus.

The muscles of tympanum are two, the tensor tympani and the stapedius. The tensor tympani arises from the cartilaginous portion of the eustachian tube, small area of the great wing of the sphenoid around the tube, and from the

walls of the bony canal which lodges the muscle. It is a little over half an inch long. Near the opening of this tube the muscle becomes tendinous, passes through the processus cochleariformis at right angles to its belly, passes outward across the tympanum to be inserted into the inner surface of the manubrium of the malleus, where it joins the neck. Gruber says the tendon is attached to the inner margin and anterior surface of the malleus.

The stapedius muscle arises from a canal in the posterior wall of the tympanum, lying parallel with the Fallopian canal, but a little anterior and internal to it. It emerges through a small opening, the pyramid, to be inserted into the head of the stapes. Rudinger says it is inserted into the lower extremity of the descending process of the incus. In most of the cases which I examined, the muscle seemed to vary in its insertion; sometimes it would be attached to the posterior crus, again to the head and posterior crus, then again some of the fibers seemed to extend from the head to the osorbicularis, but most often to the neck.

Various theories are advanced regarding the function of these muscles, but they are beyond the scope of this paper.

The arterial supply to the tympanum is the tympanic branch of the internal maxillary, which enters this cavity by way of the Glaserian fissure; it supplies the anterior part of the cavity and its branches anastomose along the periphery of the drum membrane with the stylomastoid branch of the posterior auricular. This tympanic branch sends branches into the external auditory meatus and is called the deep auricular.

The tympanic branch of the internal carotid passes through the anterior wall of the tympanum into the middle ear. The stylomastoid branch of the posterior auricular passes up the Fallopian canal with the facial nerve, sends branches through the posterior tympanic wall to the tympanum and drum membrane.

The petrosal branch of the middle meningeal, which anastomoses with the stylomastoid in the Fallopian canal, sends branches into the tympanum. Zuckerkandl mentions a small branch of the stylomastoid artery, which he found constantly passing out from the middle part of the Fallopian canal to supply the stapes and membrana obturatoria, then to the promontory to anastomose with the above branches, which he calls arteria stapedia.

The tympanic branch of the ascending pharyngeal, Gray says, ascends through the Eusta

chian tube, while Deaver speaks of its entrance through the tympanic canaliculus with Jacobson's nerves. All these branches which supply the tympanum anastomose freely; however, Prussak states that the arteries of the tympanic cavity have an extensive course without anastomosing with one another; he says they divide at acute angles into branches, the caliber of which are large in comparison to the parent trunk, these branches passing almost at once into small veins; capillaries in many parts being

absent.

Because of the free passage of the arterial supply through the periosteum to the subjacent bone, inflammatory processes of this cavity have a great tendency to involvement of the osseous wall.

There is considerable controversy as to whether the arteries of the middle ear anastomose with the arteries of the labyrinth. Politzer describes such branches existing. Shambaugh, who has studied this phase of the subject very thoroughly, has found that there is an anastomosis existing between these two chambers (Archives of Otology, 1906).

The venous blood of the tympanum is carried off by the temporomaxillary vein, superior petrosal sinus, lateral sinus, internal jugular and pharyngeal veins.

Numerous small vessels communicate with the dura through the tegmen tympani. Inflammatory processes may travel by these veins to the various areas through which the veins travel, and are, therefore, of pathologic importance.

The lymphatic distribution of the tympanum is not well known, but according to Rauber, they accompany the blood-vessels. There is a close connection with the prevertebral glands, which should be remembered in a retropharyngeal abscess, during middle ear suppuration.

The nerves of the tympanum are derived from several sources. The relation of the seventh nerve to the tympanum has already been considered. The nerve supply of the middle ear is derived from branches of the fifth, seventh and ninth cranial nerves, which form a plexus on the promontory known as the tympanic plexus. The branches which form this plexus are Jacobson's nerve from the ninth, which passes through the canaliculus of the floor of the tympanum just below the promontory; the small deep petrosal from the carotid plexus of the sympathetic which enters through the anterior wall; the small superficial petrosal branch of the seventh which enters the tympanum beneath the tensor

tympani canal; the great superficial petrosal, another branch of the seventh which enters the tympanum just anterior to the oval window. The chorda tympani nerve passes through the tympanic cavity, entering at the upper posterior arm of the annulus through a small opening, the iter chorda posterior, passes forward between the long process of the incus and neck of the malleus, just above the junction of the tensor tympani muscle with the malleus and passes out of the cavity through a small opening at the upper anterior arm of the annulus, the iter chorda anterior. The position of this nerve in the tympanum causes two pockets to be formed, one anterior and the other posterior to the malleus, and known as the anterior and posterior pouches of v. Troltsch. The mucous membrane passes down from the roof of the tympanum, covers over the chorda tympani nerve, then passes up again to be reflected onto the drum membrane, therefore, these pouches open downward and lie between this fold of mucous membrane which covers the chorda tympani and the drum membrane. The posterior pouch is the larger of the two. Troltsch considers these folds of mucous membrane as true duplicatures of the membrana tympani, and has found fibers in them similar to those in the drum. Gruber, after the most careful study, has never been able to demonstrate the fibers of the membrana propria; therefore, he considers them folds of mucous membrane. Rudinger regards them as forming bands of attachment for the upper part of the malleus.

Politzer says there are openings in some cases into these pockets from Prussak's space. I have followed his method of experimenting by putting quicksilver into the pouches and opening Prussak's space in eight cases, but the quicksilver did not leave the sacks. I also examined these pouches under high magnifying power, but could see no such openings.

The nerve supply of the drum membrane has been carefully studied by J. Gordon Wilson, who says, the drum of man is chiefly supplied by nerves which enter from the external auditory meatus. They pass in as one large trunk at the upper posterior part of the auditory canal. Numerous smaller branches enter from the periphery. There are but few nerves entering this. structure from the tympanum. These branches are derived from the auricular temporalis and vagus.

I am greatly indebted to Dr. Jos. Beck for many suggestions which were of value to me in the presentation of this subject.

ECONOMIC CONDITION OF THE

PROFESSION

CHARLES J. WHALEN, M.D.

CHICAGO

Address of Dr. Whalen on assuming the office of President of the Illinois State Medical Society,

at Peoria, May 21, 1913.

In assuming the office of President of this organization it is customary to make a few appropriate remarks which are of some moment to its members.

It strikes me that one of the most important questions confronting our profession at the present time is that of the economic conditions of the individual members. Economics under present-day conditions is quite as much a medical as a sociological problem. It is not a local problem either but is a burning question the world over and is one that demands solution and

unless this is arrived at it means disaster to the individual physician.

You are cognizant of the fact that the struggle for existence at the present time is greater than at any time in the world's history. The physical conditions of the country are not at fault but our demands have increased through our intellectual development out of all proportions to our physical ability to satisfy them.

Are you giving this question due consideration? Remember that we cannot improve our

condition as trade unions improve theirs, that is by increasing their own incomes at the expense of others. If we wish to improve our own status we must put our shoulders to the wheel and give a helping hand to the general movement which has for its aim the physical uplift of the medical profession.

In this respect are you doing your share of the work, or are you waiting for the other fellow to do it for you and then expect to share the benefits with him? Unfortunately, there are shirkers in every walk of life. Oh! well, what's the use; the other fellow is willing to take up my task, let him bear the burden; I will reap the reward. Brethren, that's a selfish view of life. Yet, some become imbued with that spirit through thoughtlessness, never stopping to consider the duty they owe in conducting our mutual affairs. Your interest in, this matter Is as great as mine, and mine is as great as yours. It, therefore, follows that we each should be willing to do our full part for the common good. On this economic basis rests the immediate future well-being of the medical profession.

There are two things in the Christian religion that differ from all others; one is its extreme simplicity, the other its universal applicability. The "Golden Rule" is an epitome of the "Sermon on the Mount." It is also the master rule of ethics in our treatment of our fellow men. To say that it is impossible in practice, is absurd. Every good citizen makes it a rule of his life and just in so far as he fails to live it, he fails to realize his own ideal. If we, who claim to be fair minded and just, are in doubt as to what we should do to our neighbors; put ourselves in

his place and whatever we could expect of a just man under the same circumstances that is our plain duty toward him.

Let us be broad minded enough to look at all sides of men's character, then we will not be apt to condemn many. Smith, you say, is a fraud and you can prove it; don't forget that in all probability Smith is saying the same of you and he is just as likely to be right as you are. Get together with him and talk over your differences and perhaps you will find that you were both wrong.

The many problems confronting us are only overcome by cooperation; out of which comes organization to achieve the common goal. The needs and advantage of such cooperation in our profession are obvious. Mutual support must be

our slogan if we are to exist in perpetuity.

The doctor who tries to go it alone in the

practice of medicine in this day is making a great mistake. The field is so large and the interests involved so many and varied, that no one man can keep in touch with them all without constant help from his fellows; on all sides he is surrounded with difficult problems and many if not all of them can only be solved by coopera

tion.

The legitimate practice of medicine has fallen on perilous times. This is evidenced by the writings of eminent men and by the unrest and agitation of the medical profession the world over, due in part to the fact that sanitation and preventive medicine are reducing disease to a negligible quantity; to some extent to the fact that new "cults" and "pathies" have cut into the legitimate sphere of the practitioner; but most of all to the encroachment on the work of the physician by unworthily bestowed charity, by our hospitals and dispensaries, to people able to pay. These factors with others all operate to reduce a physician's income.

Added to all these we have the specter of a new ghost in the trend of the times toward communistic medicine. It is my belief that the prac

tice of medicine, surgery and allied specialties in the not far distant future will become government, state and municipal functions; a fine outlook for the doctor, is it not?

This is well illustrated by the condition of affairs in England where the doctors had to organize finally in sheer defense of their own means of existence. However, in England, establishing methods of defense was deferred too long, and so, in spite of the belated protests of the profession, there was foisted on it the obnoxious national insurance act.

Shall we in America procrastinate in this matter the same as was done in England, or shall we take steps now to overcome the evils confronting us? By our silence we are renegade to our own interests.

I am pleased to note that there is some evidence that the profession is beginning to realize as never before the benefits of organization, not only to individual members but also to the

(All from Bulletin of Chicago Department of Health) All the time is clean-up time. Keep a scrubbin'. Dirt accumulates rapidly and must be fought steadily-if you wish to be clean.

A once-a-year clean-up is on a par with a once-a-year bath.

An habitually dirty citizen is dirty from choice, not from necessity. A will to be clean will find a way. Cleanliness is a civic, social and health requirement. It is tremendously important-it is imperative. You can be clean-you MUST be clean.

Pay heed, or you will pay dearly for your heedless

nees.

What the American cities are doing and can do toward preventing infant mortality and the high deathrate of children under 5 years of age is the subject of a bulletin now in press by the Children's Bureau. It is the purpose of the bureau to issue a similar bulletin annually and in time to make it a complete manual for municipal and philanthropic activities in the direction of child welfare. Summer campaigns for babies' lives have been waged with such marvelously good effect in some cities, that it seems to the bureau important to enlist the energies of as many cities in this work as possible. To this end it will be helpful to collect and present for the information of all, the little or much that is being done by the various cities.

The efforts of city health officials have resulted in the last ten years in reducing the general death-rate in cities below that of rural districts and villages. This reduction in the general death-rate is an encouraging indication of what is possible of accomplishment in efforts to reduce the infant death-rate. Babies die of diseases which to a large extent are preventable, and thus when welfare work is directed toward saving their lives, the response is immediate and decided. In

individual in his complex relations. There is considerable evidence that the profession is becoming aroused to the necessity of organizing for something more than purely scientific purposes.

Cooperation in medical practice is a necessity in the present day. All professional men should be thoroughly acquainted with their rights, privileges and power for safeguarding their own vital interests as well as the interests of the community.

An organized medical profession in Illinois with its ten thousand members could accomplish much in the way of needed reform and would. be able to do much to prevent further encroachments of the evils now threatening to engulf us.

The watchword of the new administration will be alertness along the lines of organization and cooperation: justice for all practitioners; a helping hand to the general movement which has for its aim the physical and moral uplift of medicine in the State of Illinois.

certain large cities the result of systematic summer baby-saving campaigns has been shown in a reduction of between 30 and 40 per cent. in the deaths of children under 2 years of age, in the city wards where such work was concentrated. Practically the only limit of . the good results to be obtained by well-directed campaigns lies in the financial side of the question. The investigations of the Children's Bureau indicate that the principal impediment to effective work in the health departments of most cities is the lack of adequate funds for carrying on preventive measures intelligently, and experience verifies the truth of the statement: "Public health is purchasable; within natural limitations a community can determine its own deathrate."

One of the employees of this department living in a choice residence neighborhood on the north side was notified last week that the city scavenger refused to empty the large can for refuse. On investigation it was found that the housekeeper had filled the can with mixed refuse and garbage. The contents of the can which had accumulated about two weeks was swarming with maggots and in a very offensive condition. A few flies were in evidence, either hatched out in the can or drawn to the place by the odor. The nuisance was promptly abated by separating the garbage and placing it in covered pails (an unsavory task) and sprinkling it with formaldehyd solution.

In this case the householder, well informed as to the proper disposal of garbage and other waste and with the best intentions, was imposed on by a new housekeeper who came well recommended. As she had been employed in the neighborhood, she was given credit for knowing the rules.

Do you personally see that your garbage and refuse are separated and the garbage kept in tightly covered "fly proof" pails and treated with a disinfectant, or do you let "George" or "Mary" do it?

ILLINOIS STATE MEDICAL SOCIETY

OFFICIAL MINUTES OF THE SIXTY-THIRD ANNUAL MEETING OF THE ILLINOIS STATE MEDICAL SOCIETY, HELD AT PEORIA,

MAY 20, 21 AND 22, 1913

MAY 20, 1913-FIRST GENERAL MEETING The Society met in the Gold Room of the Jefferson Hotel, and was called to order at 2:50 p. m. by the President, Dr. L. H. A. Nickerson of Quincy.

Dr. J. H. Bacon, chairman of the Committee on Arrangements, stated that surgical clinics of the section on Eye, Ear, Nose and Throat would be given at the St. Francis Hospital at 2 p. m. Tuesday.

Immediately following this, the conference of County Secretaries would be held.

In the evening, at 8 o'clock, the House of Delegates would meet in the Gold Room of the Jefferson Hotel. The first and second sections

would hold their meetings in the Shrine Temple.

Wednesday, at 12:15, the ladies would meet in front of the Jefferson Hotel Building, where a special car would be in readiness to take them to the Country Club for luncheon, and they would be entertained until 4 o'clock, when automobiles would take them around the city for a drive.

Wednesday evening the Society and its guests would take a boat ride, ample provisions having been made for 1,200 passengers.

Lastly, every effort would be made to take care of the members and guests in the best possible

manner.

Adjourned.

SECOND GENERAL MEETING

The Society was called to order in general session, May 21, 1913, at 2:30 p. m., by the First Vice-President, Dr. Samuel E. Munson, of Springfield.

President L. H. A. Nickerson of Quincy was introduced and delivered an address entitled "Lifting the Mantle of Reserve."

Dr. Joseph Collins of New York City fol

lowed with the oration in medicine. He selected for his subject, "Syphilis of the Nervous System."

At the conclusion of Dr. Collins' address, Dr. J. H. Stealy of Freeport, on behalf of the Illinois State Medical Society, presented Dr. Harold

N. Moyer of Chicago a beautiful silver set in appreciation of his efficient services as chairman of the Medicolegal Committee, prefacing the presentation with the following remarks:

Mr. President, Ladies and Gentlemen: It gives me great pleasure to offer to one of our members a token of gratitude in the way of recognition for the services he has rendered to this Society in the defense department. Dr. Moyer, you have been an unselfish worker in the Illinois State Medical Society for many years. Your interest for the welfare of the Society has many times been paramount to your own. You have volunteered your services whenever demanded, many times at great sacrifice to yourself. You have never failed to respond to any call we have given at any time to help any of our brothers. Through this unselfishness you have endeared yourself to the hearts of the members of the Illinois State Medical Society. I ask you, Dr. Moyer, to accept this token of respect in behalf of the Illinois State Medical Society, which I now present to you. (Applause.)

Dr. Moyer, in accepting gift, said:

Mr. President, Dr. Stealy, Ladies and Gentlemen: Of course, this is a great surprise (Laughter), or would have been so if your committee had been more discreet. I have noticed symptoms on the part of the committee that were unmistakeable; conferences with Mrs. Moyer, carried on in a way to excite in the minds of any husband serious misgivings; meetings with my better half in odd corners, and when I approached, an abrupt change in the conversation, and a confused look. There was no other conclusion than that something would happen. (Laughter.) I did not know just what it was, consequently I feel in a measure relieved by what

has occurred.

I do not know what I ought to say to you. Perhaps I ought to sit down and shed a few tears and say nothing, but I am prompted to say a few words on this occasion, as I shall probably never have another. All men in the state medical society who attract attention have trouble. (Laughter.) They specialize in some variety of trouble. Perhaps it would be invidious

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