.--y-'R-,, ■ ..-, ^ _:J"^ THE PRACTITIONERS' MONTHLyf ^ «* DETRorr MEDICAL JOURNAL VOL.. II. FEIBRUARY, 1903. no, ii EDITOR : j^ ' FRANK BURR TIBBALS/lVli D. \ COLLABORATORS: f _ t r. aMA. I A. W. IVES, M. D. JOSEPH SILL, M. dI »|g J^^KWrZ ,'^fi . D. THE PATHOLOGY AND DIAGNOSIS OF OTlftiS^^^gbl^ INSIDIOSA, i. e., SCLEROSIS, WITH REMARKS ON THE TREATMENT, H. J. Hartz. M. D.; - - - ' - - 705 DOUBLE UTERUS AND COMPLETE VAGINAL SEPTUM IN A GIRL 24 YEARS OF AGE, H. W. Longyear, M. D.; - - - - 717 RABIES, Joseph Sill, M. D.; " - - - - - 719 HYDROGEN PEROXIDE, C. E. Boynton, M. D.; - - - - 723 EDITORIAL; . . _ - . 725 EDITORIAL NOTES; - - - - 726 NOTES; ------- 729 NEW INSTRUMENTS AND DEVICES; - - 730 BOOK REVIEWS; - _ - - - 735 ; ADVERTISING INDEX; _ - - - XI DETROIT MEDICAL JOURNAL Co PUBLISHERS. 270 WOODWARD AVE. DETROIT, MICH ENTERED AT THE ^OST OFFICE AT DETRO'T. MICH., AS SECOND CLASS MATTER MAY BTH 1901. TISSUE BUILDING BY BOVINIME is most successful because BOVENiNE supplies absolute and perfect nutrition. It not only stimulates, but completely feeds the new born blood cells, carrying them to full maturity. It increases the leucocytes and thereby most powerfully retards pathological processes. As a food and nutrient it is ideal, requiring little or no digestion, and being at once absorbed and assimilated. For starving anaemic, bottle-fed babies, its results are immediate and most gratifying, as it is a ready alimentation as soon as ingested, and tiever causes eructation. It will be found equally reliable for nursing mothers, affording prompt nourishment and strength to both mother and babe. In typhoid fever and all wasting diseases it may be administered per rectum, and will sustain the strength and support the heart without need for recourse to alcoholic stimulants. Records of hundreds of cases sent on request. THE BOVININE COMPANY, 73 West Houston Street, NEW YORK. DETROIT MEDICAL JOURNAL. THE. RNY->SCHEERER CO. Mantafa<5lurers of and Dealers in High-Grade Surgical Instruments Hospital and Office Supplies. 225 to 233 Fourth Avenue, NEW YORK CITY. The largest establishment of the kind in the United States. Carrying the most extensive and complete line of SURGICAL INSTRUMENTS, MODERN ASEPTIC HOSPITAL SUPPLIES, ASEPTIC OPERATING, WARD and OFFICE FURNITURE, STERILIZERS and DISINFEC- TORS, NURSES' REQUISITES, SICK-ROOM UTENSILS, RUBBER SURGICAL GOODS, SANITARY APPLIANCES, DEFORMITY APPARATUS, TRUSSES, ABDOMINAL SUPPORTERS, SHOULDER BRACES, ELASTIC HOSIERY, CRUTCHES, SPLINTS, [NVALID CHAIRS, ASEPTIC SURGICAL DRESSINGS, BANDAGES and PLASTERS, ELECTRIC BATTERIES and APPLIANCES, MASSAGE INSTRUMENTS, ANATOMICAL MODELS, OSTEOLOGICAL PREPARA- TIONS, LABORATORY SUPPLIES, NATURALISTS' INSTRUMENTS, MICROSCOPES and ACCES- SORIES, ETC., ETC. Correspondence Invited. Inspe<5iion of PREMISES and STOCK SOLICITED. Catalogues Mailed FREK on Application. II DETROIT MEDICAL JOURNAL. Morrison's Surgical Pad. . i i TKe Best Most Convenient and Most Practical TKe Davidson Rubber Co. 19 Milk Street. BOSTON, MASS. DETROIT MEDICAL JOURNAL. lU jf^ "TIB^N, ^ For rough usage, dishwashing, etc., Non=Pa=Reil Gloves . . have no equaL For sale by all jobbers. Booklet free. Ih£ Faultless Rubber Glove is the best glove your money can buy. CAN BE STERILIZED REPEATEDLY. Made in four weights and in sizes and half sizes from 6 to U inclusive. THE FAULTLESS RUBBER CO. AKRON, OHIO, U. S. A. IV DETROIT MEDICAL JOURNAL. THE COLUMBUS ASEPTIC OPERATING TABLE AND CHAIR COMBINED "^^l^rKf TITTade without complicated mechanism, easily adjusted to the largest number of positions possible on any one operating apparatus. Finished in white enamel unless "O • ^0^ 00 otherwise directed. _ _ . '^ MADE ONLY BY ^a-« raUoni of Opium. Morphine. Codeine and Other Narcotics and withal devoid of the toxic or depressing efiFecU which characteme the latter when giveD in doses sufficient to reduce the reflex irnta bility of the bronchial, tracheal and laryngeal mucous membranes THE PROBLEM at .dministering Heroin in proper do«. in such torm « will rv« ^ //(Y^ theraptutic virtues oJ thi» drug full sw.y, mnd will suit the p«l«tr II . If\ of the most exacting adult or the moat capricious child. "^ i(|^ HAS BEEN SOLVED BY idle phamuceutical compound known as l(^( GLYCO=HEROIN(Smith) The results attained with GLvco-HamoiN (SiirrH) m the allev^ atiou and cure of cough are attested by numerous clinical studies that have appeared in the medical journals within the past few years Scientifically Compounded. Scientifically Conceived. GLYCO- HEROIN (SMITH) simply stands upon Its merits before the profession, ready to prove Its efficacy to all who are Interested In the advances In the art of medication. '^-'l!'^'*'-?!,^"''"' I?."'*?' '' supplied to the druggist in sixteen ounce dispensing V>tttea only. The quantity ordinarily prescribed by the physician is two. three or four ounces. The adult doseof Clvco-Heroin (Shithi is one teaspoonful. repeated every two hours or at looger intervals, as the case raar require. Si!'!!!*" °V '*" "' "°'^* years, from a quarter to a half^teaspoonfut Children of three years or more, five to ten drops •OLC aaiTiaM aocnt*. THOMAS CMRISTV a CO.. { OM ■«• IMS. U«M« ?>•«■• S... iONOON. C. C. MANTIN M. SMrrH 4 CO., Chtalats, ■iw rona err*. mus^ DETROIT MEDICAL JOURNAL. XI 5tft 270 WOODWARD AVENUE, o DETROIT, MICH. ♦ »♦»♦»♦»♦»♦»♦»♦*♦»♦»♦«♦*♦*♦■»♦■» *-K-K-K**->t-k-K*-K***-K-K****-K-K-K-K-K-KfJf)f**jf Carpenter's Water-proof Liquid Court p laster j HIGHLY ANTISEPTIC. Protects and heals CUTS, BURNS and ABRASIONS. Can't be beat in emergency cases. Does not wash off. If your druggist does not handle it, send ten cents in stamps for a sam- ple tube to the Carpenter Chemical Co. 3 Home Bank Building:, DETROIT, MICH. Stocked by the J. F. Hartz Co. )fj«-jf)f3f3*4-3fjf**)f)f)f>f3f>f>fJf*)fJ«-Jf)f5f)fjf>f3f)f*)f FOR SALE. d^ -i rkf^A C\C\ -^^ ^y^, Ear, Nose and q)>*UUU*UU ^^^^^^ practice in best town in northern Michigan, office fixtures, etc. included. A good opportunity for a capable man. No opposition. Address <« E,YE " Care Detroit Medical Jouri&al. HOURS TO • • • • • it • • • • • • ir ¥ ¥ ¥ ■¥ COLlMBtS J ■¥■ ¥• UNION STATIONS J IN « ¥■ TOLEDO, AND COLUMBUS ^ ATHENS. i ♦ L. W. LANDMAN, J Gen. Trav. AgL, * ■¥• DETROIT, MICH. J DOIBLE TRACK ALONG OHIO'S GREATEST RAILWAY THE nOCKINC VALLEY XIV DETROIT MEDICAL JOURNAL. SURGICAL INSTRUMENTS FREE By the adoption of RAY'S DIRECT ORDER PLAN You can get all the surgical instruments you need in your practice, of the latest design and best quality, or any make, absolutely free, if you buy your Pharmaceuticals direct from us. WE ARE EXCLUSIVELY A PHARMACEUTICAL HOUSE AND OUR PRICES ARE LOWER THAN THOSE OF OTHER RELIABLE MANUFACTURERS Only the best and purest ingredients, scientific knowledge and skill, enter into our products. Our discounts are large because we operate on an extensive scale. RAY'S DIRECT ORDER PLAN means: — We secure all orders through corre- spondence, employing no salesmen, or detail men, thus saving 20 per cent, of the total cost of getting business; therefore, over and above all regular discounts we credit our customers with 20 per cent, of the net amount of every purchase and use that money to buy the instrument you want. Your instrument credit is redeemable on each order, or can accumulate, just as you choose. We neither make nor sell instruments, but purchase them out- right from the manufacturer. Send us a trial order and convince yourself of the many advantages of adopting our plan. CATALOGUE WITH DISCOUNTS MAILED ON REQUEST JSlS^tr THE RAY CHEMICAL CO. DETROIT, MICH. H. P. ENGELN & CO., Mfrs. Hay Ipparalus Our spark Induction Coils can be connected with any , Incandescent Lamp Sockets They are guaranteed against any break-down. 90 PROSPECT STREIT, CLEVELAND, 0. DETROIT MEDICAL JOURNAL. ■•••^^^•••^•4 FOLLICULAR TONSILLITIS, BY GEO. A. HEWITT, M. D., Philadelphia, Pa, In this disease, so com- mon among young children, Glyco - Thymoline (Kress) may be employed with ad- vantage. Its exosmotic prop- erties are extremely service- able in reducing the size of the swollen glands. The en- largement is apt to subside slowly, even after the active stage of the inflammation has passed. Children who are old enough to gargle may employ the remedy in this manner. In those too young it may be applied upon ab- sorbent cotton. Representa- tive cases are: Case 1. — A boy, 11 years of age, had suffered for a day from headache and fever, with pain in swallowing! Both tonsils were red and swollen, especially the right, which was studded with patches of exudation from the crypts. Case 2. — A girl, age 15 years, had had a chill 24 hours previously, her throat felt sore, and it pained her to swallow. The glands of the neck were swollen and there was fever. Both ton- sils were considerably en- larged. The crypts were ex- uding their characteristic discharge. Case 3. — A young woman, 19 years of age, was attack- ed by vertigo and lost con- sciousness. Twelve hours later both tonsils were found greatly swollen, almost meet- ing in the middle line. The cervical glands were moder- ately enlarged. The surface of the tonsils was dotted by exudation. These three cases were all treatei successfully with Glyco-Thymoline (Kress) as described above. h»-»-^^^»-' THE ALKALINITY OF BLOOD StRUM GLYCO- ^ ASEPTIC ALKALINE. ALTERATIVE Purgative Membrane INDICATED IN ALL CATARRHAL CONDITIONS HASTENS RESOLUTION FOSTERS CELL GROWTH SAMPLES AND IITERAIURE ON APPLICAHON KRESS & OWEN COMPANY. 210 Fulton S«.. New York. XVI DETROIT MEDICAL JOURNAL. )^®^®^®^®^®^®^T£ Of STAPES EMg. 2. Vertical section througli foot plate of stapes. (Bezold.) Male 24 years old, deaf in both ears since seventeenth birthday. Brother and sister likewise deaf. Diagnosis in viro Sclerosis. The functional examination revealed the following: Schwabach's test, A fork, prolonged 19 seconds. Rinne test, a' fork negative R. 9 seconds. L. 10 seconds. Lower tone limit test showed diminished bone conduction. Vertigo without vomiting (necessitating lying down) was exhibited by the patient, being an evidence of involvement of the R. c. 64 V. L. F. 85 V. Whisper R. 6 cm. L. 25 cm. Microscopic Finding Hyperplasia of bone of foot of stapes. Ankylosis of stapes. Labyrinth and tympanic cavity are normal. Fig. iii shows normal size of foot plate for comparison with Fig. ii, which is five times enlarged by the osse- ous formation. into two stages, the first of which con- sists in an active proliferation of all the cellular elements within the bone. New vascular and cellular tissue is formed in 708 OF OTITIC MEDIA the marrow spaces and in the Haversian canals. Among the new formed bone cells may be found giant cells, under the influence of which the basement of the bone substance is principally absorbed. Hollow spaces are formed, and areas of erosion gradually undermine the origin- ally compact bone, which becomes tra- versed by irregular and abnormal chan- nels. Simultaneous to the absorptive pro- cess there is formation and apposition of new bone, but which is unlike the orig- inal, being more voluminous and porous. The second stage is ushered in when the progressive changes cease and when the new bone assumes a lamellar structure. Then the abnormally large and thick bone corpuscles are found concentrically ar- ranged, and the neucleus of these later undergoes atrophy. The vascular system is likewise gradually altered by the forma- tion of connective tissue, in which at times may be found fat-cells. The Ha^ - ersian canals and spaces have been changed in structure by this resorptive and appositional process, and all the cartilaginous elements have been meta- morphosed into osseous tissue, as it can- not be found in the new growth. Thus the process constitutes not only a hyper- plasia and hyperostosis, but also a meta- plasia. The new structure differs from the normal by its affinity and greater absorp- Flg. 3. A vertical section through the round and the oval window.— Slebenmann. A — Utrlculo-ampuUarls nerve. B— Normal bone. C— Facial nerve. D— Macula utrlcuUi. E — Hyperplasia of bone. F— Ankylosis of stapes. G— Caput stapedis. Patient was 60 years old, totally deaf on both sides ; began during exposure in war at age of 25 years. Functional examina- tion was not made. Hyperplasia of the capsule of the labyrinth involving the H— Thickened foot plate of stape. I— Promontory. J— Lamina sulralls. K— Tympanic membrane second. L— Niche of round window. M— Ampullarls posterior nerve. Stapes with incomplete ankylosis. The upper margin of the oval window has a bony union, whereas the lower margin is free. The plate of stapes is much thick- ened. INSIDIOSA, 709 tive power of carmine stains, which fact is utilized in the differential diagnosis. Jlie microscopic evidences of this new formation are the osteophytes, situated usually near the stapes articulation. Fre- quently the stapes is partially absorbed by penetrating blood-vessels and replaced upon an invasion of this bone-formation into the cochlea and the semi-circular canals, may permit a change in the pres- sure and the density of the labyrinth fluid. The mechanical and physical qualities of the endo- and peri-lymph may be so altered as to interfere with the nutrition BMg. 4. Horizontal section through ankylosed stapes and hyperplastic bone of the capsule of labyrinth. — Katz. A— Foot plate of stapes. B— Hyperplasia of bone reaching to endosteum C— Hyperplastic bone involving the foot olate of stapes, causing complete ankylosis. The above specimen was obtained from a woman of 39 years of age, who was very deaf, suffering from tinnitus. She had never had otitis media, but had by osseous formations. Sometimes a dis- location of the stapes is produced by an encroachment of the osteophytes. The function of the oval and round window may also be seriously interfered with by the hyperostosis producing partial or complete occlusion. When the process invades the tip of the cochlea, the patency of the Eustachian tube is threatened. Its lumen is narrowed by thickening of the periosteum, as was demonstrated by the microscope. Owing to the great vascu- larity which attends especially the first stage of this process, it is probable that the distressing tinnitus of progressive deafness may have its origin in the in- I eased capillary circulation. ..., ..... ..^.. D— Vestibular nerve. E— Vestibule. F— Facial nerve. been affected with rheumatism. Family history and functional test were unobtain- able. of the parts and induce disease. The de- tonating sounds heard by some patients and the complex of symptoms of Meniere may be ascribed to a perforation of the septum, dividing the endo- and the peri- lymph systems. While the histologic alterations were found to be identical by different author- ities, yet their designation of the bone- hyperplasia differs and new synonymous terms are consequently introduced. Po- litzer defines it as capsulitis labyrinthi or oto-sclerosis. Siebenmann, noting the re- semblance to sponge by its rarefied spaces and porous structure, designated the new formation as spongification. Katz com- pares the process to Volkman's osteitis vascularis chronica. From personal ob- 710 I. e., SCLEROSIS servations of different specimens the osseous change appears to be identical with the rarefying osteitis of our text- books. Etiology. The etiologic views also differ. Sieben- mann regards the disease as probably a resorptive or physiologic process of ossi- fication of cartilaginous tissues. He does not look upon it as an osteitis, but rather as a final development process, which normally does not take place in the temporal bone, though it is the rule in other bones. Bezold believes that the pure cases of sclerosis are not due to ca- tarrhal diseases (although the two may co-exist). The diatheses of infammatory rheu- matism, gout and scrofula are regarded as predisposing to this bone formation, also the diseases of the naos-pharynx, such as diseased tonsils and adenoids. The theory that a metamorphosis of cartilage into bone may induce the hyperplasia, is strengthened by the fact that Virchow admits the possibility of formation of bone out of cartilage. It is highly prob- able that the calcareous deposits and other products of inflammation, such as synechia and adhesions may, by their ir- ritation, incite this metamorphosis to activity. Sudden climatic changes and exposure to wet, likewise injuries, such as a fall from a horse, have been asso- ciated with the beginning of this disease. It has been frequently observed that the sclerosis is not always a progressive deaf- ness ; it may remain stationary and the individual have sufficient hearing-power for social or business intercourse. The microscopic records show that the nerves supplying the bone have always been normal — a fact which will contradict the theory that a trophoneurosis induces the bone disease. In most cases examined the membrane of the tympanum was found thickened, the result of the active hyperemia which accompanies this pro- cess in its first stage, no evidence of round cell infiltration was found. But in very few cases was it discovered that the bone hyperplasia was the sequel to mid- dle-ear suppuration. The search for bac- teria as causative factors proved negative. Clinical observation and autopsy records affirm that capsulitis labyrinthi may be- gin at an early age, and that its duration may be from three to thirty years. The fact that more women than men are afflicted suggests that pelvic diseases may act predisposingly to progressive deaf- ness. Seventeen per cent, are first af- fected with the disease at the time of puerperium, this fact suggesting to sev oral authorities the justifiability of com- mitting an abortion in those subjects af- fected with progressive deafness, as a prophylactic procedure. Dr. Blake has observed a hyperemia of the promontory in the region of the niche of the ovai window in young women, occurring periodically with menstruation and in those subjects affected with erosion of the cervix, malposition of the uterus and other pelvic abnormality, upon correction of these abnormal conditions, the hyperemia disappeared and an improvement of the hearing followed. It is conceivable that a long continued congestion, reflexly induced by pelvic disease in the sensitive region of the niche of the oval window, may incite not only a connective tissue but also a bony hyperplasia. Statistics show that about lo per cent, of all middle- ear diseases are true sclerosis, and this group, according to new discoveries, re- sults as a consequence of a bony or cal- careous formation. The fact that the dis- ease affects both ears uniformly, would lead to the conclusion that a constitn tional diathesis plays a certain roll. The Toynbee collection of i,ioo pathologic specimens contained many that exhibited (tepositions of calcareous material, a since then the investigations have sho that the gouty diathesis is an import WITH REMARKS 711 factor. Several cases were reported as occurring consecutive to inflammatory rheumatism, which revealed the identical pathologic changes of arthritis deform- ans, in the stapes articulation. Diagnosis. The diagnosis of capsulitis labyrinthi is made by the exclusion of the other forms of progressive deafness, the objective signs, the subjective symptoms and the functional test with tuning forks. This group, then, may be recognized by the tympanic cavity unobstructed to air and free from secretion. The objective signs scarcely show a departure from normal conditions, and do not indicate the high degree of deafness which is usually present. This fact led an author to the facetious definition that sclerosis is a dis- ease in which the physician sees nothing and the patient hears nothing. Fortun- ately, the subjective symptoms, the fam- ily history and the functional test with tuning forks are of great diagnostic value, Fig. 5. Hyperplasia of semicircular canal and co- chlea. — Siebenmann. A— Superior semicircular canal. B— Posterior semicircular canal. familiar sign of sclerosis, such as normal tympanic membrane (with perhaps dif- fuse or circumscribed opacity). The handle of the malleus may be slightly re- tracted, but is not rotated upon its axis. Now and then a red area is visible through the tympanic membrane, which is indicative of hyperemia in the region of the promontory, serving as strong cor- roborative evidence. Inspection of nose, pharynx and mouth of Eustachian tubes reveals normal conditions. The ausculta- tion by catheter demonstrates that the Eustachian tubes are pervious, and the C — Lateral semicircular canal. D and E— Ankylosis of canal. enabling the careful aurist to recognize sclerosis, even in its early stage. The subjective symptoms are high de- gre of deafness, usually of both ears and of insidious origin, more often between the ages of 20 and 35. Some acute pain and sensation of pressure and numbness around the head is felt. Persistent and distressing tinnitus, accompanied at times by detonating noises and some vertigo. Paracusis Willisi is nearly always present. Inheritance plays an important role in this group. In half of this group, some immediate member of the family is affect- 712 ON THE TREATMENT ed, seventeen per cent, originating at the puerperium. It is important for diagnosis to elimin- ate all other forms of progressive deaf- ness, such as arise from industrial pur- suits; the constitutional anomalies, such as leukemia and hereditary syphilis, like- immobility of the tympanic membrane, as seen with the otoscope, also the history of the patient and the absence of para- cusis Willisi. These factors, together with an improvement of the hearing upon inflation, will aid in the differential diag- nosis. Fig. 6. Hyperplasia of semicircular canals, show- ing areas of rarefaction.— Slebenmann. A— Posterior canal. B— Lateral canal. wise the deafness following the acute and chronic infectious diseases ; neoplasm of the tympanic cavity, and also the nervous diseases implicating the acusticus. The deafnes of old age is also to be excluded, as it is not due to an osseous formation, but rather to an atrophy of the acusticus. Most important is the exclusion of ca- tarrhal and suppurative diseases of the middle ear and Eustachian tubes, since relatively the same functional test ap- plies to them. The objective signs of the suppurative class, in contradistinction to sclerosis, are marked, except when co- existent. These are the retraction of the tympanic membrane, the handle of the malleus being rotated upon its axis, the evidences of former inflammation and suppuration, which may be adhesions, a cicatrix, a perforation of the drum- membrane, or calcareous deposits. The C — Facial nerve. D— Posterior canal. Functional Test. By the functional examination with the tuning-fork, we are enabled to measure the intensity and duration of a given tone. Through two avenues, by air and bone, may be discovered diseases of either the sound-conduction or the sound-perception apparatus. It will be remembered that the human ear is capable of perceiving a note as low as twelve vibrations per sec- ond, but the average normal low-tone limit is C2, the equivalent of sixteen vi- brations per second, while the highest note heard by the normal ear is g^, or the equivalent of about 50,000 vibrations, comprising in all eleven octaves of tone. Experiments prove that the chain of os- sicles and drum-membrane are requisite for the conveyance of the lower tones, the higher notes finding more ready ingress through the bone-channel. Through me HARTZ 713 agency of antagonistic forces, the sound- conducting apparatus, that is, the tym- panic membrane and chain of ossicles, is held in a state of perfect equilibrium. This is accomplished by the musculus tensor tympani, the stapedius and the muscular fibres of the tympanic mem- brane, which together prevent excessive tension and relaxation. In consequence, the sound-waves are conveyed more ef- fectually through the sereo-tympanic channel than the osseo-tympanic channel. A disturbance of this exquisite state o^ tension — as by closure of the eustachian tubes, by adhesive bands, by perforation of the drum-membrane, or an osseous or membranous formation causing fixation of the stapes — will result in an alteration of the normal sound-conduction. That of the bone may exceed that of the air- channel. The extent of such interference with the function of the sound-conduct- ing apparatus may be determined with the aid of tuning-forks. There exists in all cases of rigidity or fixation of the os- sicles a defect in the perception of the lower tones by air-conduction. This de- fect of perfection may range from one- A — Facial nerve. B— Jtriculo-ampullaris nerve. C— Macula utrlculi. D— Upper portion of oval window, showing hy- perplasia of bone with slight exostosis into the vestibule. Fig. i. Hyperplasia in the region of oval window and stapes articulation. — Siebenmann. E— Hyperplasia of bone causing ankylosis of foot plate of stapes. F— Tympanic membrane second. G — Base of the stapes dislocated toward the tym- panic cavity. H— Promontory. Figs. 5, 6 and 7 represent sections ob- tained from one subject in whom the hyperplasia affected simultaneously the stapes, the cochlea and the three semi- circular canals. The case was a woman aged 52, who had been deaf for five years. Father had also been deaf. She suffered from vertigo without vomiting and pain in ears. Tympanic cavity, drum mem- brane normal. Diagnosis in vivo. Progressive nervous deafness. Schwabach test shortened 10 seconds. Rinne test, positive 25 seconds. Whisper R. 4 cm. L. 150 cm. Lower tone limit could not be determ- ined owing to impending death. Microscopic Finding Hyperplasia of bony capsule of the three semi-circular canals and cochlea, involving the foot plate of stapes. Formation of exostosis on vestibular and tympanic surface of the oval window, causing dislocation of the stapes on one side, while the other shows evidences of commencing ossification of the cartilaginous covering of the stapes. 714 SCLEROSIS. half to one and a half octaves of the lower tones, depending upon the degree of deaf- ness, while the bone-conduction is pro- longed. The diseases of the cochlea, dis- turbing the sound-perception apparatus, are evidenced by the defective hearing of the high notes through air and by dimin- ished bone conduction. The translations of the highest notes are supposed, accord- ing to the theory of Helmholtz, to take place in the lower region of the cochlea, in the narrowest portion of the basilar membrane. Hence, the locality and the extent of the disease may be estimated by the defect in the perception of high notes. With the aid of Schwabach's and Rinne's tests and the determination of the lower-tone limit, it may be ascertained whether or not fixation of the stapes exists. This can be almost positively shown by the Bezold triad test. These are, first, prolonged cranial bone conduc- tion with an A fork; Rinne's test, short- ened or negative, with al fork ; third, de- fect in perception of one-half to one and one-half octaves of lower tones. When the labyrinthian structure is exclusively invaded, the same test applied will react with almost opposite results. First, shortened cranial bone-conduction with al or A fork ; second, Rinne's test, positive or very little shortened ; third, clear per- ception of nearly all lower tones ; fourth, defect in hearing high tones. Thus, the same process may, according to the loca- tion, produce a bony ankylosis of the ossi- cles or nervous deafness, and may be diag- nosed by the different tests. The accuracy of these tests cannot be questioned ; diag- noses of stapes ankylosis and nervous deafness, made in vivo, have been suf- ficiently verified by autopsy examinations. In more than half of the cases the process was found localized on the vestibular side of the oval window, and affected the lower turn of the cochlea.. The extent of the invasion of this part of the labyrinth may be determined by the defect in per- ception of the high tones. An extensive co-existence of the bone formation in the ossicles and labyrinth renders the differ- ential diagnosis almost impossible. In that event, they may be classified as dys- acusis. In this category also belong the one-sided deafness, where the normal ear of the opposite side interferes with the ex- amination of bone-conduction, and all such cases where insufficient data are ob- tained, as from children and the weak- minded. The term sclerosis is suitable when applied to the sclerotic condition of the mucous membrane of the tympanum, the oval and round window, but is insuf- ficient when an osseous formation exists, as the latter is an increase rather than a decrease of tissue. A more precise definition would be capsulitis labyrinthi, complicated by either stapes fixation or nervous deafness. When a combination of both exists the case could be classified as simply deafness or dysacusis. The term spongification, introduced by Sie- benmann, is as appropriate as capsulitis labyrinthi, but does not convey so pre- cisely the point of origin. Treatment. The discovery that an osseous process, and not catarrhal disease, is the funda- mental cause of sclerosis gives direction to our therapeutic efforts. The me- chanical, the surgical and the medicinal m treatment of sclerosis have been faithfull}' tried, but with unsatisfactory results. The medicinal treatment of sclerosis, with a view of causing removal of the materies morbi obstructing the ossicles by the internal use of absorbents, such as iodin, mercury and phosphorus, has given only negative results. The most promis- ing has been the use of phosphorus in small doses, administered for periods of six months during the year. The thyroid extract was given with some satisfactory results in the early stages of the disease, due probably to the absorption of the granular tissue, which precedes the osse- HARTZ 715 oiis formation. An early diagnosis of progressive deafness, predisposed by heredity, will permit of proper hygienic and medicinal treatment. The use of large doses of potassium iodid has been found efficacious in the hands of Politzer. The administration of potassium iodid should be continued for a period of three months, or longer, during the year. In cases where the rheumatic diathesis is a causative fac- tor the use of solvents for uric acid is in- dicated. Mechanical Treatment. This consists of mobilization of the chain of ossicles, which, if not excessive, may temporarily benefit the hearing. This is brought about principally by transuda- tion of serum, following massage, which facilitates the movement of the articula- tion of the ossicles. The effect of ex- cessive pneumo-massage by the use of rarefacteurs is exerted principally upon the posterior segment of the tympanic membrane, the fibres of which become weakened, resulting in relaxation of the drum membrane. The condition induces not only increased tinnitus, but also a de- crease in the hearing power. Pneumo- massage should be given only for one- half to one minute, twice or three times per week for one or two months. The patient should be advised to return after a period of two months for another course of pneumo-massage. Dr. Blake em- phasized the necessity of gentleness in the use o fthe rarefacteur, as it is apt to pro- voke a misplacement in the whole chain of ossicles, more particularly a relaxation of the posterior segment of the drum head. When this condition exists, Dr. Blake resorts to an application of col- lodion to the relaxed portion of the tym- panic membrane with the view of con- tracting the parts and thus restoring equilibrium. Surgical measures, such as stapedec- tomy, excision of oval window and other procedures, have proven of temporary benefit only. It was found that the trauma of the operation induced a migration of plastic material, which later organizes into a cicatrix and frequently renders the condition for hearing worse. Equally in- effective has been the local treatment, by forcing irritating substances, such as iodin, silver and solvent solutions, into the tympanic cavity. It has been con- demned on the theory that the irritation produced an increased periosteal cell pro- liferation, an exception to this being when catarrhal disease and sclerosis co-exist. A prophylactic procedure is the removal of diseased tonsils in the pharynx and vault, upon the theory that suppurative pro- cesses induced primarily by the diseased tonsils are frequently followed by de- posits of calcareous matter, which in later life may initiate ossification of cartilage in those subjects predisposed by heredity to capsulitis labyrinthi. It is doubtful if the osseous hyperplasia of advanced sclerosis can be removed by any agent now at our command. The cell- stimulating and absorbent effects of the X-ray and the violet ray upon lupus and inoperable malignant tumors have led the writer to institute experiments with these agents in cases of sclerosis and chronic otitis media. Summary. 1. Sclerosis is fundamentally a hyper- plasia of the bony capsule of the labyrinth; the hyperplasia is a trans- formation of cartilage into bone, i. e., metaplasia, accompanied by formation of outgrowth of bone, i. e., hyperostosis. 2. It is initiated by constitutional dia- thesis, such as inflammatory rheumatism, gout, syphilis and scrofula, by diseased tonsils in the pharynx and vault, suppura- tions with calcareous deposits in the tmp- panic cavity, exposure to cold and wet and injury. 3. Its localization is usually in the labyrinth capsule near the stapes articula- tion with the oval window, inducing fixa- tion of the staoes. 716 HARTZ 4. It may involve also the semi- circular canals and cochlea, to produce symptoms of nervous deafness. 5. It may affect simultaneously the sound-conduction and the sound-percep- tion apparatus. 6. The functional test, the subjective symptoms and family history permit an early diagnosis of this disease. These are: 1. Hyperemia of promontory. 2. Heredity. 3. Schwanbach test reveals prolonged bone conduction. 4. Rinne's test is negative in varying degree. 5. Defective perception of one-half to one and one-half octaves of the low tones. 7. Probably ten per cent, of the middle ear diseases are true sclerosis and are designated synonymously capsulitis laby- rinthi, oto-sclerosis, spongification, dry middle ear catarrh and otitis media in- sidiosa. The therapy is effective in early stages of the disease by hygienic and medicinal treatment. The more advanced cases may be improved by judicious treatment, with amelioration of the tin- nitus. 27 Adams-ave. East. Tonsillitis Powder. — Good results have been reported from the use of acetanilid and sodium salicylate equal parts, well mixed and blown over the inflamed parts. Repeat every fifteen minutes until relief is experienced. — {St. Louis Clinique.) Ancient Appendicitis. — And now a mummy of some 3000 years B. C. has the impertinence to prove that appendicitis was performed in those days and that then, as now, patients died from it even though the operation was successfully done. — (Pacific Coast Journal of Homeo- pathy.) [Does the writer want us to believe that if the departed had been treated medicinally, the body would still be liv- ing? It seems scarcely reasonable. Ed.] X-Rays and Honesty. — A Philadelphia firm, according to a press dispatch from that city, has received an order from the Japanese government for several X-ray machines, which are to be used for a novel purpose. The firm some time ago sold to a repre- sentative of the mikado an X-ray ma- chine, which, the Japanese explained, was to be used in the governmental mints in Japan for the detection of dishonest em- ployes, who stole gold coins by swallow- ing them. The machine was used to examine sus- pects as they left the mint daily, and of course it revealed the presence of any coins "in their midst." The test was so satisfactory that the mikado ordered sev- eral more machines, hoping to prevent the form of theft referred to. — (Exchange.) Sugar As A Tonic. — The British Med- ical Journal says : "Keim and Lehmann observe that on the evidence of the activ- ity of sugar in relation to muscular activ- ity, shown by experiment, it has been be- lieved sugar influences uterine contrac- tions. They make out, however, that practically sugar only acts on uterine muscles after the contractions of labor have set in, and has no influence on the expulsion of the after-birth and on uter- ine retraction. They declare, as an in- teresting and instructive fact, that among professional consumers of sugar, such as women who work in refineries, labor is very short, and muscular force is main- tained during the whole labor; indeed, the sugar acts on the muscular system of the entire body. In short, sugar is not only an oxytocic, but also a tonic in- fluencing muscular energy. Attractive Calendar. — The Denver Chemical Mfg. Co. has issued a pleasing folder, with the compliments of the sea- son to its friends in the profession. The calendar is atractively printed in holiday colors, and is a very neat piece of work. LONGYEAR. 717 DOUBLE UTERUS AND COMPLETE VAG- INAL SEPTUM IN A GIRL 34 YEARS OF AGE.* BY H. W. LONGYEAR, M. D., Detroit, Mich. The speciment which I here show you, that of an ovary and Fallopian tube, is not remarkable for any especial patho- logical quality — in fact, it is normal ex- cepting for the remains of an old small hematoma in the ovary — but it is of con- siderable interest for the story which it tells. The patient, from whom I removed the specimen this morning, is the pos- sessor of a double uterus and complete vaginal septum and has been under my care and treatment during the last four years. When she first came under my observa- tion, which was at the Woman's Hospital, she was twenty years of age, but as unde- veloped in every way as a girl of fifteen or sixteen. She was then just beginning to menstruate, and came to me complain- ing of severe dysmenorrhoea. On exam- ination, under anaesthesia, this interesting condition was discovered. The vulva was normal, the vagina was divided into two parts by a firm antero- posterior septum which extended from the introitus to the vault, where, on each side of this dividing membrane a cervix uteri was felt. On passing a sound along the finger into each os, it was found to be deflected well to the left on the left side, and to the extent of two and one-half inches, while on the right side it was de- flected but little from the vertical line and the uterine canal was but two and one- quarter inches in length. Each cervical canal was thoroughly dilated and upon leaving the hospital the patient was di- rected to report occasionally for observa- tion and further treatment. She was not seen again by me until June 13, 1902, (about three years and a half after the dilatation), when she was •Reported at the meeting of the Wayne County Medical Society, January 29, 1903. sent to me by Dr. Samson, of Windsor. Her general development was then remark- ably improved in every way. For several months she had had increasing severe pains at each menstrual epoch, beginning in the right hip, and later extending across the abdomen. On account of the limited room in the vaginal canal, due to the septum, bimanual examination was unsatisfactory, but a small unnatural mass could be felt in the region of the right ovary, which I decided to treat through an abdominal incision, and at the same time destroy the vaginal septum. Accordingly, on June 14, the operation was performed at the Woman's Hospital. The septum was removed in the follow- ing manner: Its whole length was first grasped by two pairs of long pedicle for- ceps — one anterior and one posterior — from the vault of the vagina down, in- cised between the two with scissors, and the edges thoroughly cauterized with Paquelin cautery. On the removal of the forceps, no hemorrhage occurred. This left the cervices projecting into a fairly capacious vagina. The abdomen was then opened, and a careful examination of the pelvic contents made. The double uterine body was nearly three inches in breadth, the right side being somewhat smaller than the left, with a slight indentation at the fundus, marking the junction of the two uteri. The left ovary and Fallopian tube were normal, the right tube was normal, but the right ovary was enlarged to the size of a hen's egg. The latter was removed and found to consist mainly of a hema- toma. Her first menstruation after the opera- tion was while she was still in the hos- pital, and, much to my disappointment, was attended with the same old pain in the back of the right hip. This pain. Dr. Samson reports, had steadily increased in severity until now, regardless of vari- ous kinds of treatment, it had become a 718 LONGYEAR. menace to her life. Dr. Samson sent her to me again on Jan. 29, when, examination revealing no cause for the pain, I de- termined to remove the remaining ovary, and so bring on the cessation of menstrua- tion. At the operation nothing was dis- covered, such as adhesions, or other mal- formation, to cause the pain, so that the supposition must be that it has been due Practices for Sale. — We have two spe- cial and one general practice for sale. The two special practices include one oculist's office in the northern peninsula, and a practice devoted to nose, throat and ear in a large city, established eighteen years. The present holder will stay to introduce successor. Write us about these prac- tices. XT Bilocular uterus and vaginal septum; vertical section. U, Partition which divides the uterus Into two halves; T, Tubes; V, Vagina divided by the uterine septum prolonged. to some unnatural nerve supply or forma- tion, occurring coincidently with the other more apparent malformation. At this operation it was noted that the right uterus, the side from which the ovary had subsequently been removed, had diminished considerably in size. Note. — A bloody discharge from the uterus two days after the operation, caused the same pain in the hip, but some- what less in severity, which ceased promptly with the cessation of the flow. 271 Woodward Ave. The Chinese Idea of It. — The Chinese Penal Code provides that if death re- sults as the consequence of administering drugs or the use of instruments contrary to established rules and practice, and if, upon investigation, the magistrate shall find that only an error can be charged, the physician or surgeon can obtain relief from the penalties inflicted for homicide, but that he shall forever be debarred from again engaging in the practice of his profession. — {Medico-Legal Bulletin.) RABIES. 719 RABIES.* BY JOSEPH SILL, M. D., Detroit, Mich. During the last fall^ rabies has been prevalent in Michigan to a degree un- known for many years. The frequency with which physicians in this state are called upon to deal with bites from dogs supposedly rabid, and the former rarity of the disease, made a brief discussion of rabies not inopportune. Rabies has been recognized since very early times. Democritus of Abdera (460 B. C.) makes the first mention of it. Xeno- phon, Aristotle, and others of tlie ancient Greeks refer to it. Celsus describes it as "a most miserable kind ot a disease, in which the sick man is. at the same time tormented by a dread of food and water, in which condition hope is reduced to a narrow limit." But little of importance was added to our knowledge of this dis- ease until Magendie and Bouchet in 1813 produced rabies in a dog by inoculations of the saliva of a rabid man. Pasteur was the first to put our knowledge of rabies on a sound scientific basis. Of his work I shall speak more fully later. Climate and temperature have little to do with the prevalence of rabies. No part of the world is free from it. It was common in Greenland when the tem- perature was 25° below zero, and it is found in Egypt and Constantinople. It is, I believe, a generally accepted idea that rabies is to be dreaded only dur- ing the hot summer months. I cannot too strongly protest against this. Rabies ,may and does occur at any season of the iyear. In fact there is reason to believe that hot weather prolongs the incubation period of the disease and may delay death. The following table from Suzor will show the error of believing that rabies is a summer disease. He reports: During March, April and May 35 cases During June, July and August 14 cases • During September, October and November 25 cases During December, January and February 14 cases •Written for the Detroit Medical Journal. Keirle* reports three cases in man in December, one in January, and two in February. I can add one in September and one in January. Apparently all mammalia are suscep- tible to rabies. At any rate their suscep- tibility to this disease is so general that an assertion that any variety is immune must be backed up with experimental proof to gain credence. With us it is most frequently seen in the dog, although it may be communicated to any of the other domestic animals. In dogs the disease is seen in two forms, the so-called ''furious" and "dumb" rabies. It must be remembered that both are the same disease, and that an animal bitten by another suffering from dumb rabies may develop the disease in the furious form, and vice-versa, and that dumb rabies is less dangerous than furious rabies, because animals suffering from the former show less inclination to bite than those afflicted with the latter, and not be- cause it is a less virulent type of the dis- ease. The symptoms and course of rabies are quite characteristic in dogs. The disease may be divided into three stages, i. Pre- monitory. 2. Furious. 3. Paralytic. When the three stages are present, we have the furious type of the disease, and when the second stage is either absent en- tirely or of such short duration as to at- tract little attention, the disease assumes the dumb or paralytic form. The first thing one notices about a dog affected with rabies is a change of dis- position. An affectionate animal becomes cross and irritable; one naturally vicious may become unusually affectionate. The dog seeks to escape notice. He will hide in dark corners and out of the way places. He becomes restless, and wanders about aimlessly, snapping and biting at what- *I wish to express my obligation to Keirle's ex- haustive essay on Rabies published in "Twentieth Century Practice of Medicine," vol. xv. It has been a mine of information. 720 SILL. ever comes in his path. He eats unusual and unfit things, and refuses what ordin- arily tempts his appetite. The bark is hoarse and muffled. Gradually, paralysis of the lower jaw develops. There is hyper-secretion of a thick viscid saliva, which drips from his jaws. He is thirsty and laps eagerly at water and fluids, but is unable to drink. Paralysis of the hind legs gradually develops, and the dog trots with a curious wobbly gait. The eyes are red and inflamed, and the face wears a distressed and distrustful ex- pression. The paralysis spreads, involv- ing the abdominal muscles, and finally the whole body, and the dog crawls off to some obscure place and dies. The whole course of the disease is less than a week. This is a picture of the disease in its complete form. The first stage may be absent, and the dog may become suddenly furious, or the first stage may be followed directly by the third, giving rise, as I have said, to the dumb or paralytic type of the disease. In Detroit, contrary to the general experience, most of the ob- served cases have been of the paralytic form. This accounts for the few cases seen in man, notwithstanding the large number of rabid dogs in the city. There are two points in which this description of rabies in the dog differs from the generally accepted idea. These I wish to emphasize. The first is that the rabid dog does not avoid water. On the contrary he is thirsty, and laps it eagerly. He cannot drink, however, on account of the paralysis of ma jaw, and of the mus- cles of deglutition. Hydrophobia is a misnomer, when applied to this disease in animals. The second point is that the rabid dog does not froth at the mouth. Saliva is secreted in excessive quantity, and drips from his jaws because of the same paralysis that prevents his drinking. In man the manifestations are some- what different. At first "there may be some pain at the point of the old bite, which has long since perfectly healed, and may have been forgotten. There may be numbness and vague parasthesia along the course of the nerves coming from the m point where the bite was inflicted. The patient feels a dread of some impending evil, and is irritable, restless, and much depressed. Soon, taking a glass of water to drink, he finds he cannot. The attempt to swallow causes most violent and pain- ful spasm of the muscles of deglutition. Soon the mere sight of food or drink pro- duces contraction of these muscles, and the patient dreads the very sight of water. He has periods of wild delirium, in which he struggles with and upbraids his at- tendants for their thoughtlessness and lack of attention. The delirium passes away, and he is filled with regret for his violence and abuse. He is tortured with thirst and begs for water, but when it is brought he turns away from it with dread and horror. The respiration is labored, and he suffers from a sense of op- pression and suflfocation. There may be a hypersecretion of saliva, which the patient spits about the room, sometimes in the faces of his attendants. The periods of delirium become more violent and frequent, then gradually grow fewer and less violent, and the patient becomes more and more comatose and finally dies. The contraction of the muscles may be slight or severe. It may be limited to those of deglutition or it may amount to a general convulsion of great severity, of the clonic or tonic type. The inability to swallow is occasionally incomplete, and may pass off shortly before death. The patient may suffer from hyperesthesia, and a breath of air, or an unexpected sound may be sufficient to produce a violent convulsion. The last stage of the disease, that of paralysis and coma, may be absent, and the patient may die direct- Iv after a convulsion. The duration of the disease is usually between one and four days. RABIES. 721 The period of incubation is much longer than in any other infectious disease — eight days to eight months in the dog, and fourteen days to eighteen months in man. One or two instances of an even longer period than this are reported, but are not considered well authenticated. One more point I wish to emphasize before taking up the subject of treatment. If a dog is suspected of being rabid, and is knozun to have bitten no one, it should be killed at once. If, however, a dog has bitten any person, or any other dog, it should not be killed, but should be kept under observation for two weeks, for the following reason : The saliva of a rabid dog becomes infective from three to eight days before symptoms of the disease de- velops. The course of the disease is not over a week. If the dog is alive and well at the end of two weeks, no fear of rabies need be felt. If, however, the dog dies, proper measures can be taken to prevent the disease in the person bitten. Never kill or allozv to be killed a dog that has bitten anyone. For the developed disease there is no issue but death. There is no curative treatment. All treatment must be pre- ventive. Immediate and thorough cauterization greatly reduces the danger. Cauterization to be efficient must be both immediate and thorough. The actual cautery is best. When it is not possible, on account of the extent of the wounds to cauterize thoroughly, antiseptic solutions and water as hot as can be borne (130° F.) may be applied. These hot applica- tions can with benefit be repeated for as long a time as three months. In all suspicious cases the patient should be sent at once to one of the Pasteur insti- tutes, and the dog should be watched. All cases in which the epidermis is broken, leven if it be the merest scratch, should be subjected to treatment. The preventive treatment of rabies con- sists of rendering the patient immune to the poison by gradually increasing doses of the virus, or by introducing into the body some substance that will render the poison inert. In general there are three ways of accomplishing this result. First, we may inject the serum of some animal rendered artifically immune to the dis- ease. Second, we may inject the virus directly into the body of the patient, be- ginning with virus diluted very highly, and gradually increasing the strength ; or, third, we may begin with a much at- tenuated virus, and gradually inject a more and more active preparation. The first may be called the indirect method of conferring immunity, and the two latter direct methods, for it will be readily seen that if we inject into the patient the serum of an animal rendered artifically immune, we must first immunize that animal by the same process, whereby, in the second and third methods, we ac- complish that result in the patient. Pasteur's method of treatment — that of conferring immunity by attenuated virus — being, so far as I know, the only one available in this country, deserves a fuller description. The others may be passed with a mere mention. The virus of rabies is found in greatest amount in the brain and spinal cord of the animal affected, particularly in the medulla. Pasteur found that if a rabbit be inoculated subdurally with a small bit of the medulla of a rabid dog, the rabbit would die at the end of a period of about fifteen days. He also found that if a second rabbit be inoculated in the same way with the medulla of the first rabbit, the second rabbit would die after a slightly shorter time than did the first; that a third rabbit inoculated from the second would die after a slightly shorter length of time than the second, and so on, until, after many successive inoculations, he was able to kill rabbits in six days, and that this period could not be shortened by further inoculations. This virus, capable 722 SILL. killing rabbits in six days, is the so-called "fixed virus." This is of the utmost im- portance., for it is necessary for the pur- poses of treatment, to deal with a virus of known virulence, as that is the only way to accurately determine the dose, and as it is always necessary to keep a supply of fresh virus on hand, after it has once been fixed, rabbits can be inoculated in- definitely without increasing its power. It was further determined that after the spinal cord of one of these rabbits has been dried over caustic potash at a tem- perature of about ^2° F. for fifteen days, it becomes practically inert. Thus we can obtain virus of any degree of vir- ulence from that in the fresh cord to the practically inert virus fifteen days old. A cord that has been dried for fifteen days is known as a a "fifteenth day" cord ; one that has dried for fourteen days, a "four- teenth day" cord; one that dried for six days a "sixth day" cord, and so on. The treatment consists of injecting, into the anterior abdominal wall of the patient an emulsion made by rubbing up a bit of spinal cord with distilled water. For the first four days the dose is 3 cc. On the first day of treatment a fourteenth day cord is used ; on the second day, a twelfth day cord; on the third day, a tenth day cord ; on the fourth day, an eighth day cord. On the fifth day two injections of sixth day cord are given at the same time. The dose is now 2 cc. for the next two days, as follows: Sixth day, fifth day cord ; seventh day, fourth day cord. On the eighth day an injection of 13^ cc. of a third day cord is given. The dose is nov.^ 2 cc. daily until the end of the treat- meat. Cords dried for less than three daj-'S are not used, so on the ninth day of treatment an emulsion of fifth day cord is given ; on the tenth day, fourth day cord ; on the eleventh day, third day cord. Then on the twelfth day, fifth day cord is again used. The treatment coatinues in this way until the end of twenty-one days. The dose is not modified with respect to the age of the patient. There is sufficient material for many treatments in a single spinal cord, but it n is necessary to keep always on hand cords If of proper age : i. e., at least one cord that has dried for three days, one that has dried for four days, and so on up to fifteen days. In order to do this it is customary to inoculate two rabbits each day. Since we are using a fixed virus, two rabits will die each day, and the spinal cords must be removed. The keeping up of a supply of cords alone is a large amount of work, and requires no small degree of skill. This work must be carried on uninterruptedly. From the day a Pasteur institute is open- ed until it closes, two rabbits must be in- occulated daily. This is what makes the Pasteur treatment so expensive. It is work requiring constant attention and great care, and the outlay for the single item of rabbits and their feed is large. One more point. No time should be lost in submitting the patient to this treatment, for the treatment itself re- quires three weeks, and two more weeks must elapse before immunity is complete. As the disease most frequently develops about six weeks after the bite, there is lit- tle time to spare. (To be continued.) Bacteria Per Cubic Metre of Air. — Dr. W. Wayne Babcock, in the Brooklyn Medical Journal, gives the following table, quoted from Miquel, by Roger: In the sea, at 100 kilometers from the coast 0.6 Altitude of 2,000 meters 3. Summit of Pantheon 200. Observatory of Montsouris 480. Rivoli Street (in Paris) 3,480. New houses 4,500. The air of sewers of Paris 6,000. Old house 36,000. Hotel-dieu (hospital) 40,000. Pitie Hospital 79,000. BOYNTON 723 HYDROGEN PEROXIDE. Usually in my country practice I carry an eight-ounce bottle of hydrogen per- oxide in my satchel. I use the product of a manufacture that is not advertised in lay journals; I do not carry a trade bottle for patients to gaze at, for I do not be- lieve in taking the laity into my confi- P dence as to treatment. The reader will see that I never lose a chance of reiterat- ing the statement that it is folly to tell a patient what he is taking. I always keep a medicine-dropper handy, and with its aid I use the hydrogen peroxide in a thousand situations. The child with the suppurating ear gets its with the dropper; the diphtheretic membrane gets it with the spray; the chronic ulcer of the leg I treat by pro- viding the patient with an atomizer full of the peroxide, to be used ad libitum. Every kind of a sore requires it, and, if the condition is at all suggestive of erysip- elas, a painting with pure ichthyol. Hy- drogen peroxide will lift gunpowder out of a wound on the foam, and it has a sim- ilar effect on all kinds of dirt. Diluted, I have used it as an eye-drop and as a wash for the newly born. Of all the ways of using this agent, the most serviceable seems to be the spray. In this way it can be handled economically and just at the point where we want it ; the projecting force actually helps us to rapidly under- mine the pus. For suppurating gums and stomatitis, I use it in frequent half-drachm doses, and in the white tongue and sweet breath of blood poisoning it should be used in- ternally and locally almost without stint. It has never been my ill-fortune to treat many obstinate cases of diarrhoea; pos- sibly I use the sulphocarbolates and large doses of calomel too extensively to allow many, but I am inclined to think that hydrogen peroxide by mouth and in enema would be very serviceable. This is one of the preparations in my experience that is constantly extendmg its usefulness over a larger territory of practice. C. E. BOYNTON, B. S., M. D., Los Banos, Cal. Good Work In Ohio. — The Ohio State Board of Medical Registration and Ex- amination recently revoked the licenses to practice of two physicians of Colum- bus found guilty of attempting to pro- duce a criminal abortion with fatal re- sult. In view of the fact that practition- ers convicted of such malpractice too oft- en escape easily at the hands of the Court, the action of the Board deserves the support of all reputable physicians and is an example worthy of adoption by other State Boards having the power to revoke licenses. — {Pennsylvania Medical Journal.) Ipecac In Pneumonia. — Perreau has introduced the following method of treat- ing pneumonia : one gm. of powdered ipecac is mixed with lOO gms. of muci- lage and one teaspoonful is given €very hour for about eight hours, care being taken to avoid vomiting and diarrhoea by lengthening the dose intervals when necessary. The object of the treatment is to deplete the lung and as a conse- quence modify its tissue so that microbic infection may be counteracted. Satisfac- tory results are reported, especially if the method is employed early in the disease. — {St. Louis Clinique.) The Medico-Legal Bulletin publishes an account of a German court's order fining a druggist $50 and his assistant $14, for having dispensed a physician's prescription to the same purchaser about 2,000 times. The nature of the prescrip- tion is not stated, but we incline to the belief that it must have contained malt in some form, and that the court was only taking another way of getting some li- cense-money out of the pharmacist. 724 NOTES International Medical Congress in Madrid. — The central committee of Europe having in charge the interests of the International Congress of Medicine, to be held in Madrid, April 23 to 30, has named the Voyages Pratiques of Paris as the official agency to make all arrange- ments for the transportation and lodging of those attending the congress, to furn- ish membership tickets, and to organize and conduct a series of tours through Spain. The Voyages Pratiques are author- ized to make the bookings for express trains, sleeping cars, hotels, and private lodgings. The regular trains being few in number and always overcrowded, it has arranged for a number of special trains, but since places in these will be filled early, those who expect to attend the congress should make their applica- tions as soon as possible, to insure accom- modations. This is especially advised, owing to the extreme difficulties of travel in Spain, and the overcrowding and irregularities which may occur un- less proper precautions are taken. The Voyages Pratiques are enabled to oft"er members the advantage of 50 per cent, reduction on the railways, for round trip tickets. In order to facili- tate the arrangements of the American physicians and scientists who expect to attend the congress, and to centralize the correspondence in this country, the Voy- ages Pratiques have appointed the tourist firm, Dr. and Mrs. Howard S. Paine, of Glens Falls, N. Y., as their American representative, with full authority to act for them in all the capacities enumerated above. Address all inquiries for informa- tion to Dr. and Mrs. Howard S. Paine, 148 Ridge street, Glens Falls, N. Y. Sarcoma of the Shoulder. — Dr. J. Alex, Hutchinson reported to the Canadian Medical Association an amputation of the shoulder for sarcoma at the joint, with a successful termination. There was a his- tory of previous injury to the shoulder, followed by the development of a growth ^H in the head of the humerus, accompanied by intense pain. An X-ray examination of the parts revealed the presence of a large growth which invaded the joint, and involved the scapula. The patient was in an extremely unsatisfactory con- dition for operation, and presented evi- dence of marked cardiac disease, but was nevertheless subjected to operation. The incision extended from the middle of the clavicle in front down over the pectoral regions to the lower part of the axilla, and behind, passing over the scapula down to meet the anterior incision. After severing the middle of the clavicle, the great vessels were ligated, the brachial nerves divided high up, the muscles di- vided and the scapula freed from its at- tachments. There was little hemorrhage and the wound healed readily. Micro- scopic examination of the growth showed it to be a mixed spindle and round-celled myeloid sarcoma. — (American Journal of Surgery and Gynecology.) Death-Rate In Guatemala and In New Zealand. — Guatemala, with a mortality of 41 in 1,000, is said to be the least healthful country in the world ; while New Zeland has the lowest death-rate, II in 1,000. — (Medical News.) Nitroglycerine for Muscular Spasms. Dr. H. E. Randall, in Prescription, declares that nitroglycerin is one of our most valuable drugs, but it should always be used with caution^ and with knowledge of exactly what it is desired to ac- complish. In muscular spasms, as in hystero-epilepsy, puerperal eclampsia, te- tanus, spasmodic asthma, as well as in renal and gallstone colic, nitroglycerine promptly relieves some of the cases. In paroxysms of of hysteria, with cold hands and feet, it acts like magic. The drug in hysteria is worthy of a more extended trial. The writer usually gives it in one one-hundredth or one-fiftieth grain tab- lets, repeated in five minutes if necessary. EDITORIAL 725 Detroit flEDicAL Journal A MONTHLY EPITOME OF PRACTICE AND THERAPEUTICS FRANK BURR TIBBALS, M. D., Editor COLLABORATORS A. W. IVES, M. D. H. J. HARTZ, M. D. JOSEPH SILL, M. D. WALTER C. BOYNTON, Business Manager. Note. — We do not assume responsibility for the opinions of contributors. The management cannot undertake to return rejected manu- script unless full postage for the purpose is submitted with the contribution. Address all communications to 270 Woodward Avenue, Detroit, Michigan, U. S. A. Vol. 2. DETROIT, MICHIGAN. FEBRUARY, 1903. No. II MEDICAL LEGISLATION. The upward trend of requirements for practice is well illustrated in the Notting- ham bill, now before the Michigan legis- lature. This bill is designed to supple- ment and strengthen the existing med- ical law, passed in 1899. The important features of the new bill are: A higher standard for students be- ginning the study of medicine ; an exam- ination ot all applicants for registration as Michigan practitioners ; the depriva- tion of Osteopaths of privileges granted them under the present act, and the ex- clusion of Canadian graduates who have not spent one year in an American med- ical college. The avowed purpose of the bill is to promote relations of reciprocity with other states by adopting a standard as high as that of any of them. We understand that the bill meets the approval of the practitioners of sectarian medicine, and also of the. various medical colleges in the state; hence the principal opposition to the passage of the bill will probably come from the Osteopaths, who, while claiming not to practice medicine, appear to desire to do so. The exclusion of Osteopaths from the ranks of medical practitioners is em- inently just, until they meet in their schools the four-year educational require- ments for other practitioners. When they are educated as physicians should be, if they still prefer their "system" they have- the same legal right to it as the Homeopath or the Eclectic. Some objec- tion has been made to the portion of the bill relative to Canadian practitioners, which, to some, savors of retaliation. As a matter of fact, the standard of require- ments in the Nottingham bill and those in the Ontario medical act are identical, except that Ontario requires of the grad- uate one year's experience, half of which may be with an authorized practitioner, the remainder hospital or post-graduate work. Why, then, should there not be reci- procity between Michigan and Ontario, when the two standards are identical? But Ontario at present requires a year's attendance at one of her schools from every American graduate, according to Polk's Medical Directory of 1902. The enforcement of the same provision in Michigan would lead either to a sub- sequent modification of both acts, on a reciprocal basis, or would send many Canadian students to Michigan colleges for at least a final year. On the whole, the Nottingham bill is a long step forward, and it should be en- acted into law without material modifica- tion. THE VALUE OF MEDICAL SOCIETIES. The question is often asked, of what value to the individual practitioner is membership in a medical society? We maintain that an active membership is of great direct practical value to the indi- vidual, from which benefit indirectly ac- crues to his brother practitioners and to his patients. The average man swings his shingle to the breeze, equipped with ambition and hope, but with his brain overstocked with a mass of unclassified data, largely the- 726 EDITORIAL oretical in character, needing ten years of practical experience to sort out the rubbish. To him the medical society is a post-graduate school, with the older men as teachers. He is stocked with new theories, they with experience, from the happy combination of which evolves the successful practitioner. He should there- in find his friends and advisers and his incentive to earnest effort in the example of his confreres. Hence the medical so- ciety is an invaluable aid in developing the graduated embryo into the full-fledged doctor. To the older practitioners the need and the profit is not less. He is busy in active work, with limited time for reading and study, and becomes a "back number" just as rapidly in the city as in the woods, but for the burnishing at his command in rub- bing against his fellows. He can learn theory from the well-taught recent gradu- ate and practice from the older man, just as he can in turn contribute from his ex- perience. Let it be understood that we are talk- ing about actiz'c membership. The man who goes to listen, learns, but the man who takes part learns more, for the resume of the literature or study of cases essential to the proper preparation of a paper, or intelligent discussion, helps di- rectly the man who does it. Another function of the medical society is the inculcation of ethical ideas. The condemnation on the part of medical so- cieties of newspaper advertising, division of fees, criminal practices and other evils of this commercial age, deters many men from unethical acts, not through the mere fear of expulsion, but because they want the commendation and dread the con- demnation of their associates. As a matter of fact, society makes its own laws largely by the power of public opinion. Society condemns' crime, drunk- enness and immoral conduct, and more men are good because public opinion con- demns evil than because they imbibed any innate goodness with their mother's milk or inherited a father's strength of character. And to this common law medical men are no exceptions. Lastly, the medical society benefits the entire profession by the power of organ- ization, on the "little drops of water, little grains of sand" principle, and we are about to obtain, in the near future, things heretofore impossible of attainment, through the organization of the profes- sion now under way all over the country. A recent issue of the Philadelphia Med- ical Journal contains one of the most screaming bits of humor that we have read in the medical press for some time. It is a piece of writing calling down op- probrium on the head of Mark Twain. An excerpt will show its nature: "But Mark Twain shows his weakness, both as a prophet and a critic, in what he says about the claim of Mrs. Eddy's religion to be the real thing. Tts great offer,' he says, 'is to rid the race of pain and dis- ease.' This preposterously impossible program seems to Mark Twain to be quite a practical business, and one in the achievement of which Mrs. Eddy's re- ligion will have no doubt and no difficulty whatever. In other words, Mr. Clemens himself comes so near to being a follower of Mrs. Eddy that he has not critical in- sight enough left to see that her claim to be able to abolish disease is the gist of the whole humbug. He already says that Christian Science can abolish four-fifths of the disease that affects mankind! Clearly, Mark Twain is already four- fifths Eddyite, and of all the blatherskite he has ever written his latest is a little » EDITORIAL NOTES 727 the most senile." This is what Mr. Squeers would call "richness." Anyone with a healthy sense of humor who has read even a trifle of Mr. Clemens' crusade against Mrs. Eddy and her followers must appreciate it. It would seem that the writer in the Philadelphia journal has done what David Harum advised his sis- ter not to do, and has caught cold in his sense of humor. "Blatherskite," indeed ! I The last meeting of the Quarter Cen- tury Club was held at the Fellowcraft Club last month. The club is made up of men who have been practicing med- icine for twenty-five years or more and the meeting in question took the form of the sixth annual banquet of the organ- ization. Dr. Henry A. Cleland was mas- ter of ceremonies, and Dr. Justin E. Em- erson and Dr. A. E. Carrier were the toastmasters. The committee in charge of the arrangements for the banquet was composed of Dr. E. L. Shurly, Dr. Leartus Connor and Dr. Justin E. Emer- son, and they were voted a most success- ful triumvirate. Dr. Flemming Carrow, of Ann Arbor, was a guest of the club. The following programme of toasts was presented: "Inability," Dr. Peter Klein; "The Present Time," Dr. George B. Rus- sel; "Living," Dr. Leartus Connor; "Talking," Dr. H. A. Cleland; "Pride," Dr. E. W. Jenks; "Age," Dr. M. H. An- drews; "Passions," Dr. Johann Flinter- mann; "Dogs," Dr. E. L. Shurly; "Love," Dr. S. P. DufHeld; "Labour," Dr. Robert A. Jamieson ; "Cranks," Dr. David Inglis; "Circumstances," Dr. C. A. Dev- endorf; "Nymphs," Dr. Eugene Smith; "Thought," Dr. J. J. Mulheron ; "Kisses," Dr. Daniel La Ferte ; "Care," Dr. N. W. Webber ; "Song," Dr. J. B. Book ; "Hap- piness," Dr. Hermann Kiefer; "Friends," Dr. B. R. Hoyt; "Blushing," Dr. M. J. Spranger: "The Wise Man," Dr. H. E. Smith; "Silence," Dr. H. O. Walker. One of the many examples of the way in which matters are exaggerated in America is shown in the statements made in the lay press about the vast sums of money gained by Dr. Lorenz in America. Some papers put it as high as $160,000 and the general impression was gained that the trip to America was an exceed- ingly profitable one for the doctor. In a recent interview, however, he strongly refutes the claim that his trip had been materially profitable. He states that he got one fee of $30,000 (presumably irom Mr. Armour) and that his fees for four month in this country amounted to a like sum. His private patients, he says, gave most of their fees to the physicians who operated on them after attending one of the Lorenz clinics. This is quite possibly so; but Dr. Lorenz himself feels that his trip to America has been of very great advantage to him from a medical and an ethical standpoint, and he has ex- pressed himself as being greatly pleased with the kindness which he was shown by everyone in America with whom he came in contact. He will return to Vien- na well pleased with the trip and its re- sults. He has certainly gained in reputa- tion by coming here. Lemon juice, we are gravely informed, will positively destroy typhoid germs in water. "One experimenter" so a dis- patch reads, "dropped a little lemon juice into a culture tube containing typhoid germs. To his amazement he found that the acid shriveled up and destroyed the germs." Lataer on, the same dispatch says : "Dr. Asa Ferguson, a practitioner of London, has just published an article in which he gives the results of experi- ments made by European scientists. These experiments have demonstrated that various acids will destroy germs, but as the acids will de'stroy human be- ings as well, no good result is practicable from their use." It is a fact that can be 728 EDITORIAL NOTES demonstrated that a sufficiently hot fire will destroy germs; and building a fire inside a patient who was suffering from germs might well result in the destruc- tion of the germs. The annoying fact that the fire would also probably destroy the subject of the experiment militates against a physician's chances for trying this method of germ extirpation on any but very feeble patients. Dr. Ferguson also recommends that all drinking water shall have lemon juice in it, to the extent of a drop or two. That is, he does, if he is correctly quoted. There seems to be something wrong somewhere. Philadelphia has received substantial aid in the matter of research concerning consumption, in the shape of a gift of $300,000 from Henry Phipps, of New York, formerly a partner of Andrew Car- negie. The money will be used to establish an institution to be known as the "Henry Phipps institute for the study, treatment and prevention of tuberculosis." The in- stitute will be so endowed as to have an income of about $35,000 yearly. The whole plan includes the raising of a fund of $1,500,000 for endowment purposes. The announcement of the generous gift was made by Dr. L. F. Flick, president of the Free Hospital for Poor Consumptives. One of the features which are attrac- tive about a paternal government is the interest which it takes in the health of the public. The Belgian government has recently issued a circular, addressed to the public, and having for its object the prevention of contagion. A chapter on venereal diseases is of especial interest. The language is plain, but without oi- fense, and the dangers of syphilis and gonorrhoea are unmistakably pointed out. It is the first thipg of the kind ever done by a government, and it is regarded by neighboring nations as an important step in the fight against venereal disease in European countries. Belgium herself has been none too free from the results of unregulated morals for many years. Interest in research work in cancer seems to be constantly on the increase, particularly in the British Islands. One of the recent steps taken to combat the disease is the project of J. K. Caird, a wealthy manufacturer at Dundee, Scot- land, who proposes to erect a cancer hos- pital at a cost of $90,000. He has also made arrangements for the payment of $5,000 a year for five years for carrying out original laboratory work of investi- gation. An exchange prints some interesting, if not very cheering, statistics on the financial side of medical practice of med- icine in the French republic. It states that there are 2,600 doctors in the French capital, and that of these forty make from $40,000 to $60,000 a year; fifty make $20,000; fifty make from $10,- 000 to $20,000; two hundred make from $6,000 to $10,000; two hundred make from $4,000 to $6,000; seventeen hundred make an average income of $725. In all France there are reported to be 16,000 doctors, whose gross incomes average $725 apiece. Apparently they are little better off in France than they are in America, At the annual meeting of the authori- ties of Harper Hospital, on the evening of January 12, it was announced that Mrs. John H. Avery had agreed to give $10,000 for the erection of a new building for diphtheria cases, in memory of her mother, Mrs. W. L. Smith. The old diphtheria building will be used for meas- les. The sum of $20,000 is given by the estate of Hiram Walker for aid in the maintenance of the Farrand Training School, and the John E. King estate gives 4 EDITORIAL NOTES 729 $10,000 for the endowment of two ward beds. Corporations Not Professionals. — It is generally conceded that in a majority of the states a corporation cannot be organ- ized or chartered to do a professional business. This applies as well to the medical as to the legal profession. A re- cent decision in a case appealed from a justice court in Omaha, Neb., is of inter- est to the profession. The State Eleciro Medical Institute brought suit against one L. N. Platner for services and re- covered a iudp-ment for the amount m a justice court. The case was appealed and the finding reversed, because, in the words of the court, "As a corporation cannot practice medicine under the state laws, it cannot collect for its services." — (Medico-Legal Bulletin.) Chloroform The Tape-Worm. — In the December number of Southern Practice, Dr. James M. Clopton says that more than eighteen years ago, while practicing in St. Louis, Mo., he was a victim of tape worm, and had been for several years previously, and resorted to all the then prescribed remedies without benefit. Dr. William Porter then prescribed Squibb's chloroform 3iij in a number of large size capsules, with directions to take one every few minutes until well under the influence. Have a medical friend with you tiD tlote effects, etc., and when suffi- cient have been taken to produce stupor, then take an active purgative, such as salts and senna. "Before night came, I was parted from my old enemy; and since that time I have had the pleasure of relieving several patients of this most ob- noxious depraved company. In my opin- ion, if properly given, it will never fail to so stupefy the worm" that it will turn loose its hold on intestinal wall, and its expulsion is made easy. "I have never heard of a failure with its use" when giv- en in the manner indicated. Watch the Salicylates. — Scheyer in Weiner Medinische Presse reports the case of a laundress who was given .5 gm, sodium salicylate five times daily in the treatment of an attack of acute articular rheumatism. After a week's treatment symptoms of an affection of the middle ear developed and persisted notwith- standing the suspension of the drug, re- sulting in permanent deafness, complete in one ear and partial in the other. Sodium salicylate and quinine should be given with caution in large doses, es- pecially to those whose middle or inter- nal ear is abnormal in any degree or in any way. — {Medical Review of Reviews.) A Finishing Touch. — The wit of the elder Dumas is well known, and a recent issue of the Lancet gives a striking illus- tration of it. Gistal, a physician of Mar- seilles, was entertaining Dumas, and asked the author to write a sentiment in his autograph album. Dumas complied, as follows : "Depuis que de docteur Gistal Soigne des families entieres On a demoli I'hospital Et Ton a fait deux cimetieres. The physician was immensely pleased with the first three lines, but the final one took all the wind out of his sails. A Good Start Made.— Dr. E. F. Bash- ford, Assistant to Professor Sir T. R. Fraser, has been appointed Superintend- ent under the British Cancer Research Fund. Dr. Bashford, who has been work- ing recently in Professor Ehrlich's labor- atory at Frankfort, is acquainted with the cancer research work now being done in Germany, and will enter upon his du- ties forthwith. A special subcommittee on statistics is being formed, but the work of the general organization of the scheme is hampered by want of funds, as the sum as yet collected is only about £45,000. — {Medical Reviezv of Reviews.) 730 NEW INSTRUMENTS AND DEVICES Mention of new instruments and devices in this department is entirely complimentary and articles illustrated are judged on their merits. We invite manufacturers and physicians to send us matter suitable for publication under this head. A description of the device and an electrotype or half-tone with a base not greater than two and five-eighths inches should be sent. Always mention the price of the article In question. The management cannot undertake to return cuts unless postage for same accompanies the letter with which they are sent. A NEW AIR PUMP. Dr. H. M. Dunlap, who, several years ago, first introduced the "vapor mass- age" treatment, which has proven so successful in af- fections of the ears, nose, throat and lungs, has re- cently perfected a new air pump, which physicians pronounce a great success. This new pump em- ploys a principle of com- pound leverage which, though very simple, af- fords remarkable ease of operation, even in a pump of large capac- ity, accomplish- ing equal re- sults in the same length of', time with less than one-third the effort required by the ordinary double cylinder lever pump. Every physician who uses or con- templates using compressed air will be in- terested in this pump, as shown in accom- panying cut. MASSAGE HANDLE AND ATTACHMENTS. Modern practition- ers are daily grow- ing more and more in favor of vibratory massage, and there- fore any new device which makes the ap- plication of such treatment simplier and more efficicaci- ous is likely to be of interest to them. We present herewith il- pj Wi lustrations of some '^' ^^ novel means of se- curing massage of the desired strength at any portion of the body. Teh massage handle illustrated is provided with a cable sheath and with a removable cap, which, when taken off, exposes a regulating device, by means of which the strength of the vibrations can be perfect- ly controlled, so that every degree of movement, from the most gentle to the most vigorous, may be secured. The cap is also fitted wit hattachments into which the various vibratodes may be fitted, in such a manner that they may be inserted so as to form a straight line with the handle or to form an angle with it. The vibratory motion itself is rotary, this hav- ing been found to be the most satisfac- tory method to pursue in the treatment of the mucous membrane. In abdominal massage, the handle is used as shown' in the cut, without the necessity of any at- tachment at all. The handle, with all 'of the vibratodes shown below, except Nos. 4 and 6, is furnished at $35.00, and the manufacturers sell a device by means bf which the handle may be operated by a motor of any size for $5.00. Vibratodes Cut No. I, NEW INSTRUMENTS AND DEVICES 731 Nos. 4 and 6, consisting of a soft rubber cone for face, head, etc., and a large cor- rugated hard rubber disc for abdominal massage, are furnished for $1.50 and 75 Papier mache is the material of which the protectoron is made, and every particle of material 'of which it is con- structed is treated antiseptically. The cents respectively. Vibratodes of special shapes are also made by the same manu- facturer. THE RICHARDS PROTECTORON. This device is designed for the protec- tion of the penis, while the patient is suf- fering with gonorrhoea, syphylitic sores, or other venereal diseases, and it is claimed for it by its manufacturers that it is the best thing of the kind on the mar- ket today. It certainly assures absolute cleanliness, a state of things which many physicians have found lacking in other devices for the same purpose, and its use has been recommended by a number of the leading physicians in this country. device is a non-conductor of heat, and this fact renders it cool to the wearer. It is light and convenient, perforated to se- cure additional comfort, and retails for the sum of $1.00. HOOPER RE5T-SHEET AND STRAIT-JACKET. Delirious, violent or insane patients are a source of unending care and watch- fulness, as every physician and nurse who has had charge of such cases knows. The purpose of this device, which is one of the best that we have seen, is to so re- strain the patient that constant atten«l- ance will be unnecessary — and for this purpose it is admirably fitted. The edges, where they come in contact with the body of the patient, are lined with chamois skin, as are the straps which confine the limbs, so that as little discomiort as pos- sible is caused the sufferer. Down eac': side of the sheet are five side straps, to confine the edges to a bed, cot or surgical table, and once they are secured patients are unable to do any injury to themselves or their attendants. Exposure on the part of the patient is impossible, for an apron covers the feet and the straps at the head and sides of the sheet prevent the head being raised. The greatest care has been taken by the manufacturer to turn out a device which shall hold a pa- 732 NEW INSTRUMENTS AND DEVICES tient securely, but which shall not injure him in any way. Not the least attractive feature of this useful and even necessary device is its low cost. The complete outfit, ready to apply to the obstreperous patient, costs $10.00. IMMERSION BOTTLE. This bottle is designed to be useful in any procedure in which the frequent use of the hypodermic syringe is called for, as in the treatment of hernia by the injec- tion method, etc. Tts peculiar shape per- mits the syringe to be wholly immersed in an antiseptic fluid, and the advantages of this must be evident to the practition- er. The bottle is made of Bohemian glass, six inches deep, and is provided with a ground-glass stopper, so fitted as to ren- der the contents of the bottle thoroughly germ-proof. Aspirator needles, and other small articles may be kept in an aseptic condition by making use of this bottle. The solution remains sterile indefinitely, and the container, being made with a wide base, is not easily upset. Among the many advantages which such a bottle offers is the one of low price. It costs $1.00. Eighth Annual Meeting of the Western Ophthalmologic and Oto-Laryngologic Association. — At the meeting of this so- ciety, to be held in Indianapolis, Ind., on April 9 to II, the following program of papers will be presented : Ophthalmologic —Dr. Adolph Alt, of St. Louis, Mo. "Episcleritis;" Dr. J. A. L. Bradfield, of LaCrosse, Wis., "Keratoconus : Etiology, Early Diagnosis and Treatment;" Dr. J. E. Brown, of Columbus, O., "Some Ex- periences in the Operation for Compli- cated Cataract ;" Dr. A. E. Bulson, Jr., of Fort Wayne, Ind., "Hysteriocal Ambly- opia, with Report of Cases ;" Dr. J. Elliot Colburn, of Chicago, 111., "Clinical Ex- periences in the Management of Phoria Patients : Failures and Successes ;" Dr. Lee Wallace Dean, of Iowa City, la., "De- generate Ocular Changes Resulting from Consanguinity of Parents;" Dr. John A. Donovan, of Butte, Mont., "Electro- Cautery Treatment of Wounds and Ulcers ;" Dr. George F. Fiske, of Chicago, 111., "Series of Glaucoma Cases;" Dr. Ferd. C. Holtz, of Chicago, 111., "On Some Points in the Operation of Cicatricial Ectropium;" Dr. Dudley S. Reynolds, of Louisville, Ky., "Blepharitis Marginalis ;" Dr. W. S. Samson, of Lancaster, O., "Sar- coma of the Choroid ;" Dr. E. O. Sisson, of Keokuk, la., "Rare Ocular Lesions in Scarlatina;" Dr. Hamilton Stillson, of Seattle, Wash., "The Influence of En- vironment on the Eye;" Dr. George F. Suker, of Chicago, 111., "Paresis and Paralysis of the Muscle of Accommoda- tion ;" Dr. Cassius D. Wescott, of Chi- cago, 111., "Retrobulbar Optic Neuritis;" Dr. Casey A. Wood, of Chicago, 111., "Ex- section of the Tarsus in Certain Forms of Chronic Trachoma." Oto-Laryngologic — Dr. Wm. L. Ballenger, of Chicago, 111., president's address; Dr. J. C. Beck, of Chicago, 111., "Superheated Medicated Air in Diseases of the Nose and Eaf ;" Dr. Fayette S. Ewing, of St. Louis, Mo., "Progress in Otology in Fifty Years NOTES 733 Past;" Dr. Hal. Foster, of Kansas City, Mo., "Report of Cases of Laryngeal Par- alysis Due to Aortic Aneurism;" Dr. M. A. Goldstein, of St. Louis, Mo., "An Un- usual Case of Spontaneous, Bilateral Hemorrhage from the Ear;" Dr. George F. Keiper, of LaFayette, Ind., "Present Status of the Treatment of Mastoiditis;" Dr. Robt. Levy, of Denver, Col., "Middle- Ear Affections in Tuberculosis ;" Dr. Eu- gene R. Lewis, of Dubuque, la., "Pseudo- Torticollis, with Abnormal Associated Movements of the Head and Eyes;" Dr. Charles E. Means, of Columbus, O., "Tin- nitus Aurium ;" Dr. T. W. Moore, of Huntington, W. Va., "Some Cases of Asthma Treated by Removal of the Mid- dle Turbinate;" Dr. Edwin Pynchon, of Chicago, 111., "The Principles of Rhino- logic Practice;" Dr. James E. Schadle, of St. Paul, Minn, (by invitation), "Inflam- matory Conditions of the Upper Air- Tract, As They Occur in the Northwest ;" Dr. E. L. Shurly, of Detroit, Mich, (by invitation), "Remarks on Etiology of Hypertrophic Rhinitis;" Dr. O. J. Stein, of Chicago, 111., "A Discussion on the Dif- ferential Diagnosis and the Treatment of Osteo-Sclerosis of the Mastoid Process;" Dr. J. A. Stucky, of Lexington, Ky., "Naso-Pharyngeal Fibroma — Exhibition of Photographs and Specimens." Physicians May "Take the Veil."— The Therapeutic Gazette describes as follows a veil mentioned by Wenzel in the Central- blatt fuer Chirurgie: It is a "simple gauze veil which is to be worn during opera- tions and which prevents the moisture from the breath, drops of perspiration, and particles from the hair and beard from falling into the wound. "The veil is composed of a triple layer of narrow-meshed gauze, thirty-two inches long and twenty inches wide. A slit eight inches long is cut in the trans- verse axis of the veil at a distance of twelve inches from one end. A short piece of tape is fastened to the veil at each end of this slit. "The veil is applied by placing the slit opposite the eyes and carrying the long end up over the head and down the back of the neck, while the short end is per- mitted to fall over the nose, mouth and chin. The upper part of the veil is se- cured by tying the tapes back of the oc- ciput, and the free ends of the veil are held in place by buttoning the collar of the operating gown over them. The veil completely encloses the head except at the opening for the eyes. It does not im- pede respiration, and is sufficiently thick to absorb all the moisture from the ex- pired air. It is easily sterilized, and is so inexpensive that it can be thrown away after being used once." Cause of Neoplasms in Malignant Growths Unknown. — We are not quite willing to go with the Harvard commis- sion as far as some of their conclusions. We can readily see that Richardson's negative resits do not prove that a para- site does not exist which resists cultiva- tion on our known media, nor do we care. at the present stage of the investigation, whether the parasite is a blastomyces or protozoa. We are willing to admit that urotozoa-like bodies are found in cancer- ous tissue, but this fact does not establish the etiologic relation of these "parasites" to cancer. It may be readily conceived how various parasites may accidentally contaminate tumors which are exposed to the external air; or these parasites may occur as a secondary invasion and, per- haps, determine the greater rapidity of the growth and the cachexia. It is also possible that in certain cases the para- sites form the source of irritation which excites the predisposed cells to anarchy, just as any other irritant may do; but what the primary cause of neoplasms in general and malignant growths in partic- ular is, we are at present unable to say. — 734 NOTES (Dr. A. Robin, in International Medical Magazine.) Roentgen Method In Cancerous Growths. — Four cases of disease of the breast, that represent four varieties of in- operable malignant tumors, also show the efficiency of this method. The most re- markable results were shown in a carcin- oma that had been operated upon three and one-half years before. The right breast had been removed and a recurrence had taken place two years later in the line of the sca,r and in the left breast. There were numerous ulcerated areas along the scar, while the area over the sternum was indurated and ulcerated. The mass in the left breast measured seven and one-quarter inches from the in- frammary fold to an axillary fold, the line passing through the nipple. All the indurated and ulcerated areas along the line of the scar and over the sternum have healed, and the tissue has become normal. The mass in the left breast has softened, and the measurement indicatea has decreased over two inches. — (Dr. Charles Lester Leonard, in International Medical Magazine.) Foreign Bodies in the Appendix. — At the Canadian Medical Association, 'Dr. James Bell, of Montreal, read a paper on this subject in which he expressed the opinion that appendicitis never depends on the presence of foreign bodies in the lumen of the appendix. There is little doubt, however, that when foreign bodies gain entrance accidentally into the ap- pendix, they aggravate an otherwise septic infection. Among the foreign bodies which he has found in the ap- pendix are, in two cases pins, in two cases seeds, in one case wood-fiber, in one case gall-stone, and in another case a fish-bone. — {American Journal of Surgery and Gynecology.) The Index Medicus. — It is a pleasure to note that an Index Medicus is to be re- established and under such auspicious circumstances that its permanency is as- sured. The Carnegie Institution of Wash- ington will be the publishers. The new publication aims to continue the former Index Medicus. It will be issued monthly and purposes to contain the titles in full of books, pamphlets, theses, contribu- tions to co-operative works and original articles in journals, transactions of med- ical and scientific societies and the like, arranged under subject headings. It will represent the literature of the preceding month of medical publications, both at home and abroad, its issue being delayed sufficiently to allow for the arrival of for- eign journals. — {Brooklyn Medical Jour- nal.) Colonist Tickets. — On the first and third Tuesday of each month until April 30, 1903, one-way second class Colonist tickets will be sold by the Chicago, Mil- waukee & St. Paul Railway from Chi- cago to points in South Dakota, North Dakota, Nebraska, Kansas, Eastern Colo- rado, Texas, Oklahoma, Indian Territory and Southwestern Missouri, at about one- half regular rates. During the same period round-trip Homeseekers' excursion tickets will be sold by the Chicago, Milwaukee & St. Paul Railway on the first and third Tues- day of each month, good to return within 21 days from date of sale, to many points in Iowa, Minnesota and South Dakota, North Dakota and other western and southwestern states. For further information apply to any coupon ticket agent, or address Robt. C. Jones, Michigan Passenger Agent, De- troit, Mich. An Easy Prescription — "Do you know what I can take for indigestion after din- ner, doctor?" "Yes. Pie." — {Yonkers Statesman.) BOOK REVIEWS 735 Progressive Medicine. A Quarterly Di- gest of Advances, Discoveries, and Im- provements in the Medical and Surgical Sciences. Edited by Hobart Amory Hare, M. D., Professor of Therapeutics and Materia Medica in the Jefiferson Medical College of Philadelphia, Etc., etc. ; Assisted by H. R. M. Landis, M. D., Assistant Physician to the Out- Patient Medical Department of the Jef- ferson Medical College Hospital. Volume IV. December, 1902. Diseases of Digestive Tract and Allied Organs: Liver, Pancreas, and Peritoneum — An- aesthetics, Fractures, Dislocations, Am- putations, Surgery of the Extremities, and Orthopedics — Genito-Urinary Dis- eases — Diseases of the Kidneys — Phy- siology — Hygiene — Practical Thera- peutic Referendum. Pages, 409. Lea Bros. & Co., Publishers, Philadelphia and New York. This volume completes a series for the year which any physician would be en- tirely justified in keeping on the shelves of his library in that portion devoted to books which he looks at the most often. A successful physician must keep abreast of the times, and these four books will do much to help him to do this. Attention has already been called to the admirable work of editing that Hare and his assist- ant have done. The present volume fully sustains the estimate we have already placed on their work. The contents of the December issue is as follows : Diseases of the Digestive Tract and Allied Organs, the Liver, Pan- creas and Peritoneum, Max Einhorn, M. D. ; Anaesthetics, Fractures, Dislocations, Amputations, Surgery of the Extremi- ties and Orthopedics, Joseph C. Blood- good, M. D. ; Genito-Urinary Diseases. William T. Belfield, M. D.; Diseases of the Kidneys, John Rose Bradford, M. D., F. R. C. P.; Physiology, Albert P. Bru- baker, M. D. ; Hygiene, Charles Harring- ton, M. D. ; Practical Therapeutic Refer- endum, E. Q. Thornton, M. D. A Manual of Dissection and Practical Anatomy, founded on Gray and Ger- rish. By William T. Eckley, M. D., Professor of Anatomy, and Corinne B. Eckley, Demonstrator of Anatomy in the Medical and Dental Departments of the University of Illinois. One oc- tavo volume of 400 pages, illustrated with 220 engravings, 116 of which are colored. Cloth, $3.50 net. Lea Bros. & Co., Publishers, Philadelphia and New York. For the student who wishes to pro- vide himself with a detailed guide for dissection, and for the surgeon who de- sires to review the anatomy of any re- gion, this book will be found admirably suited. It has been written in such a manner that it may be used with either Gray or Gerrish, and the illustrations found in this manual are largely taken from the works of these two standard authors. The engravings are large-sized, and colored plates add much to the at- tractiveness of the book as a publication and to its usefulness as a guide. Recognizing that tabulation is one of the most acceptable methods for the clear and systematic presentation of anatomi- cal data, the authors have arranged ta- bles for each of the divisions of the body treated in the text, with the result that a clear and easily understood exposition of nerves, muscles, veins, arteries and so on is given. Careful editing has reduced the size of the book considerably, without leaving out the essentials ; and the whole work has been done with great care, to the end that a satisfactory book might be prepared. I 73& BOOK REVIEWS Medical Microscopy. Designed for Stu- dents in Laboratory Work and for Practitioners. By T. E. Oerth, M. D., Professor of Histology, Pathology, Bacteriology and Clinical Microscopy, Medical Department, University of Georgia. With 131 illustrations, some of which are colored. Pages, 350. Price, Cloth, $2.00 net. P. Blakiston's Son & Co., Publishers, 1012 Walnut St., Philadelphia, Pa. Every beginner in the important study of microscopy will find much interest in this book. The author has reduced the text as much as possible without leaving too much to the imagination, and he has avoided giving too many methods for the student to pursue in carrying out a given procedure. In this way the student's mind is free to grasp the important things, without being hampered by a mass of detail which may prove, to a large extent, useless. The comparatively recent attention which is being paid to laboratory work by our schools and col- leges makes it reasonable to suppose that there must be many in the profes- sion who are not over well equipped for work with the microscope, while the necessity of a knowledge of the micro- scope for the modern practitioner is growing every day. Oerth begins with the first principles, and he gives a careful description of each piece of apparatus and each point ot technique involved in the scientific use of the microscope in medicine. The il- lustrations are good, and the tables of stains, and so on are excellent. Lea's Scries of Medical Epitomes. Schalek on Dermatology. A Manual of Skin Diseases for the Use of Students and Practitioners. By Alfred Schalek, M. D., of Rush Medical College, Chicago. One handy i2mo Volume; 225 pages and 34 Illustrations. Cloth, $1.00 net. Lea Bros. & Co., Publishers, Philadel- phia and New York. This is another of the handy little books in this series, which is edited by Dr. V. C. Pedersen. Schalek has crowd- ed a great many interesting facts into his little book, arranging the diseases alphabetically for greater convenience and condensation, and taking up the eti- ology, symptomatology, course, treat- ment and prognosis of each. A number of illustrations that really illustrate, many of them from photographs, are ot great assistance. A number of questions follow the description of each disease, for the use of the student, in order that the chief points of the text may be made emphatic. The series is undeniably con- venient and, for the size of the books, exhaustive. We can recommend them. The Mattison Method in Morphinism. By J. B. Mattison, M. D., Medical Di- rector, Brooklyn Home for Narcotic Inebriates. Price, $1.00. Published for the Author by E. B. Treat & Co., New York, 1902. This little monograph is dedicated to Dr. Joseph Parrish, who first directed Dr. Mattison's attention to the work in which he has been interested for the past thirty years. It contains a description of the author's methods in treating mor- phine drunkards. Promptness In Operation For Appen- dicitis. — The mortality in appendicular inflammations if operated early, say with- in twenty-four hours from the onset, is almost nil, and it must be a rare circum- stance indeed when perforation occurs much earlier than this time. Operation performed at this time will usually result in an uneventful recovery and do away with the protracted convalescence which inevitably follows in the train of a sup- puration and a drain. — (John Bruce Har- rie, M. D., in Annals of Gynecology and Pediatrics. ) I DETROIT MEDICAL JOURNAL. XVII profe: SSIO N Al_ ( D I R ECXO RY ) CARDS: DR. O. O. OSBORN, Orthopaedist and Rupture Specialist, 235 Woodward Avenue, Detroit. DR. F. D. SUMMERS, Gynaecologist and Abdominal Surgeon, 20 Adelaide St., Detroit. DR. H. W. LONGYEAR, Gynaecologist and Abdominal Surgeon, 271 Woodward Avenue, Detroit. DR. HENRY H. COOK. Electro-Therapeutics, 270 Woodward Avenue, Detroit. DR. W. F. M ETC ALF, Gynaecologist and Abdominal Surgeon, 636 Woodward Avenue, Detroit. DR. JOSEPH SILL, Microscopist, 33 Mullett St., Detroit. DR. FRANCIS J. W. MAGUIRE, General Surgery, 778 Jefferson Avenue, Detroit. "' '♦ ^4n Ten Years All Your Anti -Toxin Syringes will be in the Ash Barrel/^ So said a Philadelphia physician lately to some medical friends. As he probably meant the ordinary hypodermic syringe used for that purpose, his prediction is likely to be fulfilled in less than half that time. The Stearns Idea of makin