Germicidal Power of Silver Preparations.DERBY undertook a laboratory investigation of the bactericidal power of various silver salts, realizing the difficulty of drawing practical conclusions from laboratory evidence alone. The solution to be tested was inoculated with a growth of staphylococcus pyogenes aureus and cultures were made from this mixture at stated intervals, the blood serum tubes being then incubated.

His results may be shortly given as follows: Silver nitrate killed the aureus in from two to five minutes when used in from 2 to 2% strength; 2% for 30 seconds prevented a growth for 24 hours.

Protargol, 2%-4%, usually killed in 3-5 minutes. Collargol, 4%, did not kill even after 20 minutes exposure. A growth was obtained at the end of 1 hour with 1%.

Albargin in 1% solution is irritating and did not kill with a 15 minutes' exposure. 10% to 20% killed in 2-5 minutes.

Ichthargan is very irritating and kills in 1/101% in from 1-4 minutes.

Argentanin, in 5% solution, gave about the same results as ichthargan.

Largin, also irritating, kills in 10% solution in from 2-5 minutes.

Argyrol is exceedingly weak. The aureus after exposure for one to two hours to solutions varying from 10% to 50%, showed growth, although there was usually a diminution in the number of colonies after exposure for twenty minutes. Its action was also very uncertain.

The argument that these newer preparations penetrate better than the silver nitrate DERBY thinks is not of any importance, as earlier investigations, which were confirmed by some experiments of his own, showed that when these solutions become mixed with body fluids they are all rendered practically inert, so that they would be useless even if they did penetrate.-Bost. Med. and Surg. Jour., V. CLV, p. 341.

Treatment of Spasmodic Bronchial Asthma. -HAYNES thinks spasmodic bronchial asthma is due to contraction of the bronchial muscles caused by a peripheral irritation acting on an unstable respiratory center. He then takes up the treatment of the condition which should be directed first, toward improving the general condition of the patient. The effects of climate differ with the different individuals, some doing better in high, dry places, while others stand low and humid localities better. Diet is of great importance; foods which distend the stomach being very injurious, especially when taken toward the latter

part of the day. Late meals are to be avoided. Arsenic, strychnine and the bromides may be given to lessen the instability of the respiratory center.

Potassium iodide, tincture of lobelia, stramonium, and belladonna each have a tendency to lessen the frequency of the paroxysms.

The nasal mucous membrane is often the seat of the peripheral irritation and Alexander Francis reports over 300 cases cured of the disease by cauterization of the anterior third of the nasal septum opposite and above the third turbinate.

The immediate relief of the attacks must be directed if possible toward the removal of the irritating cause, whether an emetic or cathartic may be indicated will depend on the case. Atropin and the nitrites are often useful and are usually given by the inhalation of the fumes from the burning leaves or of blotting paper which has been soaked in potassium nitrate. Morphine, 1-6 grain, which may preferably be given with atropine, 1-100 grain, rarely fails to give relief, but great caution must be exercised in its employ

ment.

The antipyretics are sometimes of service, as is also caffein, which will act as a central stimulant. -The Practitioner, V. LXXVII, p. 524.

Diphtheria Antitoxin Given Intravenously. -BISSON reports the results obtained in the Plaistow Fever Hospital by the intravenous injection of diphtheria antitoxin. The results showed that altogether 660 cases of diphtheria were treated at the hospital between October, 1904, and April, 1906. In this number there was a mortality of 92, or 13.94 per cent. Two hundred of the total were treated by the intravenous method and of this number 33 died, or 16.5 per cent.

"This result is partly due to the fact that all the very severe cases were chosen for the intravenous method." Out of the 200 cases there were nine tracheotomies with three deaths (33%) and there were 18 intubations with two deaths (10.1%).

As to the immediate effects of the injection, "Serum A" was given up because it caused circulatory depression. There was always pyrexia during the first three hours following the administration of the serum accompanied by chilliness and vomiting. A rash usually appeared sometime afterward, but in one case it made its appearance in two minutes.

"Serum B" was followed by pyrexia; in 20 cases only out of the 184 given this serum did the temperature rise over 2°. The rashes were never as severe with this serum as with "A," and there was no edema and at no time was there vomiting.-Lancet, V. CLXXI, p. 929.

Cerebral Decompression.-Pallative Operations in the Treatment of Tumors of the Brain. Based on the Observations of Fourteen Cases. This interesting paper of SPILLER and FRAZIER which was read in the section on Nervous and Mental Diseases of the American Medical Association, cites the fact that such operations are not new nor their benefits heretofore unrecognized and reviews the literature of the subject showing many reports attesting relief of headache and pressure symptoms from such operations. Mental symptoms, too, have disappeared with the headache, even in cases in which the tumor could neither be removed nor located. "Exploratory trephining where diagnosis of location has been incorrect has taught us that cerebral decompression may give important results."

Relief of headache has been secured in some cases, even when the dura was not incised. In one of Putman's cases, relief of headache and optic neuritis was secured from a large trephine opening, although the bone was replaced.

SPILLER Summarizes, as a result of his review of the literature, that the choked disc, headache, vertigo, nausea, vomiting, and, to some extent, the convulsions are all favorably influenced by this method of treatment, and gives his views, as a result of his experience and study, as follows: "1. Palliative operations should be performed early in every case in which symptoms of brain tumor are pronounced and before optic neuritis has advanced far, especially when syphilis is improbable, or antisyphilitic treatment has been employed.

2. Partial removal of a tumor, especially of a glioma, is a questionable procedure.

3. Palliative operation does not cause atrophy of a brain tumor and probably does not arrest its growth; on the other hand, it probably does not hasten its growth.

4. Palliative operation is not to take the place of a radical operation when the latter can be performed without great risk to the patient.

5. In some cases, the symptoms of brain tumor disappear almost entirely or for a long time after a palliative operation. This result is obtained either by relief of intra-cranial pressure or by removal of some lesion (meningitis serosa, etc.) other than brain tumor and yet causing the symptoms of brain tumor."

FRAZIER reviews the field from the surgical standpoint, calling attention to the necessity of determining the operability of the case in hand; statistics of cases seen in early stages bring the only fair basis for deduction; and that two classes of cases require a decompressive operation, those in which the tumor cannot be removed in its entirety and those in which the tumor cannot be located. He thinks that in every instance the operator should intend first to attempt to expose the tumor if possible or expedient.

A history of fourteen cases is then given, in

eight of which freedom from pain was secured.-J. A. M. A., Numbers for Sept. 8, 15 and 22, 1906.

Some Experience with the Simpler Methods of Psycho-Therapy and Re-education.-Impressed with what he had seen in Paris in the Salpêtrière, where Prof. Dejerine was treating the psycho-neuroses, especially hysteria and neurasthenia, by isolation and psycho-therapy, Prof. Barker of Johns Hopkins University, has sought, and with success, to make use of similar methods in the wards of the Johns Hopkins Hospital. Rest in bed, isolation, suggestion, persuasion, have been applied in a number of cases some fifteen of which are here reported.

Case 1. Hysterical attacks; headache; "fainting spells" with rigidity. No attacks after first week of treatment, the patient resenting isolation and agreeing to have no more "spells."

Case 2. Aerophagia; chronic constipation; hot flushes; symptoms disappeared after two weeks' treatment; discharged after one month apparently well.

Case 3. Hysterical crises; choreiform movements; hemianaesthesia tremor; rapid improve

ment.

Case 5. Hystero-neurasthenia;

pathological character; extreme irritability, tremor of eye-lids; morbid fears, etc. She resisted treatment for some time, then rapidly improved. Case 6. for work. Case 7.

Neurasthenia; fatigability; incapacity
Cure.

Fixed ideas of unworthiness; despondency; fear of insanity. Cured. Case 8. Hysterical crises; cephalagias; blepharospasm. Rapid improvement.

Case 9. Neurasthenia of two years' duration; hypochondriasis; fear of aortic aneurysm, etc. Rapid cure.

Case 10. Severe cephalalgias of many years' duration; emaciation; nervousness; rapid cure, gain of thirty pounds in weight.

Case 11. Nervous gastropathy, fear of gastric ulcer, headache. Rapid cure, gain of twelve pounds in weight.

Case 12. Insomnia, incapacity for work; fear of insanity; obesity. Rapid cure; weight reduced twelve pounds.

Case 13. Entero-neurosis; mucous colitis; nervous incontinence of feces; vasomotor disturbance; rapid improvement, gain of twelve pounds in weight.

Case 14. Neurasthenia, hæmorrhoids; anemia; nicotinism; nervous dyspepsia and diarrhoea; despondency. Rapid cure.

Case 15. Nervous gastropathy; epigastrolgia; nausea; belching; fear of gastric ulcer. Rapid cure.-Lewellys F. Barker in American Journal of the Medical Sciences, October, 1906.

In

Concerning Pressure Sensitiveness of the Superior and Inferior Laryngeal Nerves.Based on a series of 82 cases reported in detail Boenninghaus believes that neuritis of the superior and inferior laryngeal nerves produces a symptom complex which is characteristic and deserving of distinct recognition in laryngology. Pain in different gradations is the most prominent symptom. Sometimes confined to a feeling of pressure, it is often of a burning, stinging character. More marked cases cause a constant ache, often punctuated by shooting pain. milder cases, pain may be noticed only on empty swallowing, which symptom in the absence of visible cause, the author considers almost pathognomonic. The pain is experienced sometimes in the entire throat, sometimes it is localized in the upper or lower half or the right or left side, as the case may be. From here it often radiates toward the ear or more rarely toward the chest. The condition never occurs before puberty and is most frequent between the period of the third and fifth decade. The great majority of cases appear in the course of an acute exacerbation of chronic laryngitis with or without tracheitis, which together with pharyngitis, is most often secondary to obstruction in the nose. In only thirteen of the eighty-two cases reported was the neuritis secondary to an acute process only. In three cases, however, there was no history or evidence of even an acute process, and therefore the neuritis was considered primary. Spontaneous cures occur, but recurrences are common on account of the chronic throat trouble.

Diagonsis rests entirely upon the presence of pressure pain over the typical areas,-for the superior laryngeal in the lateral half of the membrana thyroihyoidea, for the inferior along the side of the cervical part of the trachea. To examine the upper point, one stands behind the patient whose head must be thrown back and with the thumb and forefinger of the right hand presses simultaneously over the points of the exit of the nerves. Increased sensitiveness on One side is conclusive. To diagnose double neuritis, the pressure pain must be very marked. To examine the lower pressure point, still standing behind the patient, one presses firmly with the first and second fingers of both hands along the sides of the trachea until the vetebrae are felt. Pressure is then made first on one side and then on the other, but never simultaneously. After a short time sensitiveness becomes dulled

and if diagnosis is still in doubt it is advisable to wait until the next examination. The difference in diagnosis rests upon the absence of plausible cause of pain in the throat or larynx, paying especial attention to retention of secretion in tonsillar crypts, pharyngitis lateralis or granula, sensitive lymphatic glands and to the exclusion of hysteria, although the combination with the latter is possible. Local treatment consists in external massage thoroughly applied over the affected areas. In the worst cases galvanism may be added. Naturally the primary cause must be recognized and remedied.-Archiv für Laryngol, xvii No. 2.

Pharyngitis Lateralis.-The frequency and the distress caused by pharyngitis lateralis together with the slight attention devoted to it in laryngological works, has lead Uffenorde to present an excellent monograph on this subject. Histologically two forms are recognized, a hypertrophic in which the mucous membrane on the side of the throat following the plica salpingopalatina and the plica salpingo-pharyngea is hypertrophied, and the granular form in which only the follicles are involved. Acute and chronic forms of both varieties are recognized. Pain in the throat radiating toward the ear especially prominent at night, is the most frequent symptom. It may vary from a feeling of slight pressure to a severe ache. The sensation of a foreign body in the throat is very common, and a slight tickling may alternate with a racking cough. Fullness, even pain, in the ear, tinnitus and marked functional disturbances, due to interference with ventilation of the middle ear often divert the patient to the aurist. The voice is often affected by limitation of the palate movement as well as by secondary laryngitis. The reflex irritability of the throat is markedly increased. Etiology is practically identical with other forms of chronic pharyngitis, both local and constitutional, causes predisposing. Diagnosis is easy if one bears in mind that slight macroscopical changes can produce most unpleasant effects. Treatment consists in removing favoring factors, the use of some good gargle and douching the nasal pharynx with two per cent zinc chloride solution. If changes are more marked, cauterization of the folds with trichloracetic acid at the intervals of about eight days is indicated. If very pronounced excision of the folds should be performed.-Archiv für Laryngol, xix No. 1.

Trans-Uretero-Ureteral Anastomosis.-Indications for Ureteral Anastomosis are the following: 1. Any condition in an operative attack within the abdomino-pelvic area which necessitates an interruption of the continuity of the ureter will demand consideration for the restoration of the integrity of the urinary channel. 2. Operative casualties occurring within the abdomino-pelvic area which seriously impair or destroy the continuity of the ureter. 3. Any pathologic conditions existing in the abdomino-pelvic area which so encroaches upon the ureter, whether by extension or pressure, that its function is seriously handicapped or destroyed.

Extensive handling of the ureters and removal of one or both of them from their normal anatomic positions is made possible only because of a generous and more or less elastic blood supply. This has been worked out in detail by Sampson and, briefly, is as follows: From the aorta the renal, ovarian, iliac, uterine, inferior mesenteric, hemorrhoidal and inferior vesical arteries, there arise smaller arteries which through one set of branches, nourish the ureters themselves, and through another set of branches nourish the tissues adjacent to and surrounding the ureters; all of these branches being freely anastomotic; any amount of manipulation is permissible then without fear of necrosis of the ureter, provided that the ureter is not entirely stripped from its contiguous tissues.

The various methods which have been employed to accomplish ureteral anastomosis are in general somewhat similar to those used in intestinal work: (1) transverse end to end; (2) oblique end to end; (3) invagination; (4) lateral implantation. All of these methods have been shown, in the course of much experimental work, to be anatomic possibilities, and most of them physiologic successes. With one or two exceptions the arrastomosis has been an intra-peritoneal one, necessitating, therefore, the withdrawal of one or both ureters very materially from their usual resting places and proportionately dispossessing them of their normal blood supply. The author believing, then, that if a technique could be devised that would more nearly protect the ureter from injury and involvement with other abdominal structures and in addition would conserve the normal blood supply, it would be a great gain, endeavored to ascertain how readily such anastomosis could be made, maintaining the field of operation entirely retroperitoneal. In the cadaver, this was done: In one case the ureter was drawn over to its fellow through the connection tissue be

tween the vena-cava and aorta posteriorly and the peritoneum anteriorly; in the other experiment the ureter was drawn over between the vertebral column posteriorly and the vena-cava and aorta anteriorly. The actual work was done through a short longitudinal incision in the peritoneum over one ureter; this incision was subsequently closed and the entire field of operation was therefore retroperitoneal.

While retroperitoneal trans-uretero-ureteral anastomosis, whether anterior or posterior to venacava and aorta, is admittedly more difficult of accomplishment than intraperitoneal trans-ureteroureteral anastomosis, yet it must be conceded that owing to the shorter hiatus to be bridge, with proportionately less disturbance of the ureters and their blood supply, their probable subsequent vitality and power of function are enhanced. It is also probable that, owing to the replacement of the ureters within beds which are closely allied to, if not in fact actually identical with, their normal surroundings, the interference with their blood supply will be reduced to the minimum, and the possibilty of nourishment to be derived from contiguous connective tissue and the peritoneal covering must not be ignored.

The author's method is, therefore, an anatomic possibilty; but whether it is physiologic success must still be determined. The author's conclusions are as follows:

(1) The blood supply of the ureter is ample, of which probably the peri-ureteral arterial plexus is the most essential factor.

(2) Operative procedures, which conserve the blood supply, in particular, the peri-ureteral arterial plexus, are ordinarily satisfactory.

(3) When the intergrity of the ureter is impaired, restitutional, rather than destructive, surgical measures should be followed.

(4) Of which restitutional measures the various methods of uretero-ureteral anastomosis are recommended.

(5) Intraperitoneal trans-uretero-ureteral anastomosis is an anatomic possibility; it is also a physiologic success.

(6) Retroperitoneal trans-uretero-ureteral anastomosis, whether anterior or posterior to the aorta and vena-cava, is an anatomic possibility. (Further experimentation is essential in order to prove that it is a physiologic success). The route followed is the shortest path between the two ureters. The techincal difficulties are not excessive. It is highly probable that this method impairs the ureteric blood supply less than any other method in vogue.-SHARPE, Annals of Surgery, November, 1906.

Tuberculous Labyrinthian Suppuration.HERZOG, Munich, mentions that tuberculous middle ear suppuration frequently penetrates into the inner ear. The promontorium and both windows seem to be especially apt to let the suppuration wander from the middle ear to the inner ear. While, as a rule, inflammatory processes in the labyrinth show more or less fulminant symptoms on the part of the vestibulary apparatus, we miss disturbances of that nature, entirely, in tuberculous processes, or they are only intimated. Generally, they cannot be used for diagnostic purposes. This fact is rightly, we assume, explained by the extremely slow and gradual extension of the disease process. The affected nerve elements, for this reason, lose only very gradually their excitability, so that the diseased organism finds ample time to cover the defect, step by step, by the auxiliary apparatus. Statistics concerning the frequency of tuberculous labyrinthian affections are only found in the fundamentally important works of Habermann. The examination of 43 temporal bones of tuberculous cadavers established a tuberculous affection of the hearing organ 13 times. Six times the labyrinth took part in the disease. Three times it was almost destroyed by caries. This shows that 46.1 per cent of tuberculous middle ear suppurations were complicated by labyrinthian suppuration.

So far as can be seen from Habermann's communications, he speaks of 37 individuals who had died of tuberculosis, i. e., 16.2 per cent of all those tuberculous patients had labyrinthian suppuration. -(Transactions of the German Otological Society, 1906.)

The Shape of the Auricle in the Insane and Criminals.-BLAU-GOERLITZ examined carefully 210 insane (130 women; 80 men), 206 normal people, 243 prisoners and 20 prostitutes. Blau comes to the conclusion that with insane and criminals, as a rule, a larger lamina auris is present, i. e., an auricle which is more perfect in the sense of Schwalbe. This means an auricle which comes nearer to recollections of animal forms as we find them during the embryonic period. This appears as a somatic sign of degeneration in the strictest sense (ibid).

Clinical and Bacteriological Observations in Acute Middle Ear Suppurations.-KUEMMEL, Heidelberg, considers the parts played by the spe

cies and virulence of the causative microbe, and on the other side the otoscopic type in the course of a genuine inflammation, and comes to the following conclusions: (1) In purely meso tympanal middle ear inflammation, we can expect a mastoiditis which can be cured only by operation, or the appearance of other complications, only under especially extraordinary circumstances, namely, when the power of resistance of the organism or the local power of resistance of the ear and its adjacent parts is especially injured. (2) On the other hand, the probability of a mastoiditis which cannot be cured without operation, is very strong in those cases which show the characteristics of the epitympanic type, i. e., circumscript inflammation, bulging or granulom formation in the region of the posterior upper quadrant of the drum membrane. Our small material shows ten operations, compared with seventeen cures without operation. (3) The kind of the causative organism is not without importance. The staphylococci, even if they are very virulent, do not cause, as a rule, a mastoiditis which does not heal up spontaneously. Pure pneumococcic infection is also not so very apt to do this. If the streptococcus, the pyogenes, as well as the mucosus, is causing the inflammation, the chances for a cure without or with an operation are about equal. (ibid.)

(Remark of Reviewer. It must be taken for granted that in bringing these results before the otologic society, Kuemmel is aware that he addresses otologically trained physicians. A superficial perusal of these data or a blind adherence to these findings might induce the physician who has not a great experience with cases of this nature to delay surgical interference until it may be too late. Only continual and painstaking observations will allow us to abstain for the time being from surgical interference, in suspicious cases, involving, of course, the necessity to be always ready to act quickly.)

A Method to Operate for Othaematoma.— SELIGMANN (Frankfort on the Mein) comes to the conclusion that the cover of the othaematoma consists mostly of cartilage which has become useless to form the shape of the concha. The connective tissue shrinks when the exudate is resorbed. The cartilage cannot follow and those elevations and depressions are formed which produce the known rough and uneven form of the healed othaematoma. Consequently the whole cover must be extirpated with the exception of the normal skin. Arch. f. Ohrenheilkunde, October, 1906.