and Gall-Ducts, with report of five cases. Miles F. Porter, M.D., Fort Wayne. 5:45. The Present Status of the Surgery of the Appendix Vermiformis. John A. Wyeth, M.D., New York. Evening Session. 7:39. President's Address. Edwin Walker, M.D., Evansville. May 13-Morning Session. 9:00. Announcement of the Committee on Nominations. Executive session. 9:15. Report on Bacteriological Iuvestigation. Theo. Potter, M.D., Indianapolis. 9:45. Preternatural Sleep. N. N. Shipman, M.D., Seymour. 10:05. Cerebral Localization. H. M. Lash, M.D., Indianapolis. 10:35. Some Remarks on the Pathology and Treatment of Epilepsy. G. W. McCaskey, M.D., Fort Wayne. 10:55. Purulent Absorption as a Cause of Insanity. W. B. Fletcher, M.D., Indianapolis. 11:25. Reparative Surgery of the Peripheral Nerves. Fred. Jenner Hodges, M.D., Anderson. 11:55. Treatment of Compound Fracture, with a case. Wm. H. Myers, M.D., Fort 9. Wayne. 12:25. Remarks upon Chronic Inflammation and Hyperplasia of the Female Genitalia. G. Frank Lydston, M.D., Chicago. Afternoon Session. 2:00. Report of Committee on Nomina tions. Executive session. 10. [I 12. 3 13. 14. 15 16. 17. 18. 2:15. Report on General Surgery. Joseph 19. W. Marsee, M.D., Indianaoolis. 2:45. The "Third Lobe," with Remarks on Prostatic Obstruction. J. C. Sexton, M.D., Rushville. 3:05. Some Remarks upon the Palliative and Radical Treatment of Enlarged Prostate. W. N. Wishard, M.D., Indianapolis. 3:35. Criticism of Modern Pharmacy. C. G. R. Montoux, M.D., Evansville. 20. 21 22. 23. 24. 25. 26. 27 28. 29. 30. 4:05. "Fatus in Foetu," with Remarks upon Anomalies in Generation in the Human Species. J. R. Jenkins, M.D., Shelbyville. 4:35. Superfœtation. T. R. Rubush, M.D., | Public Institu London. 16 2 9 1151 . 17 1 20 5 3 123 Mortality Report for the week end ing April 29, 1892: Diarrhoeal Diseases.. Other Zymotic Diseases. Phthisis Pulmonalis.. 5 2 I 4-18 20 At the Société de Chirurgie on 15-40 March 23d the following remarkable occurrence was reported by M. Pilate, 128 of Orleans: On April 4, 1890, abdomi85 nal section was performed on a woman, Deaths under 1 year..... OHIO HEALTH BULLETIN. 126 Infectious Diseases reported to the Ohio State Board of Health in 42 cities and towns during the week ending April 29, 1892. -NWNGAHON Cases, : Deaths. aged forty-four, for a painful fibromyoma of the uterus. The uterus was removed with considerable difficulty, the pedicle fixed to the abdominal wound, the edges of which were then brought together. In order to protect the neighboring viscera during the operation, a certain number of sponges and gauze compresses-all carefully asepticized-were introduced into the abdominal cavity, each compress and sponge being held with a forceps. The same evening vomiting and pain came on, lasted for six days, without any elevation of temperature. A month after the operation the woman was considered cured. In the month of August, however, pain attributed to the presence of gall-stones appeared in the right hypochondrium; this disappeared in a few days. In September there was a renewal of the pains, which now involved the whole of the abdomen, and were accompained by vomiting and 2 tympanites, without fever. Palpation revealed the presence, in the region. formerly occupied by the uterus, of a series of hard, movable nodules, resembling cancerous masses. A re-examination under the microscope of the tumor removed showed that it was a The patient repure fibro-myoma. 17 4 4 I Logan... I I I New Lisbon. I 2 Oberlin. 2 Portsmouth. Typhoid Fever: Cincinnati Columbus Dalton .... ... Youngstown... 4 I Springfield.. 2 Toledo 2 3 3 2 I I 3 Ada...... I I .. Akron.... I Whooping Cough: Cincinnati 16 2 Cincinnati .. .. .. I 9 6 mained in much the condition for two months, when one day she passed per rectum a gauze compress enveloped in a hard fæcal mass. All the unpleasant No infectious diseases reported to health symptoms very soon subsided, and the officers in 10 towns. C. O. PROBST, M.D., Secretary. woman has remained well since the event. This curious occurrence demon strates the importance of counting sponges and compresses used in such operations, and furnishes one more proof of the harmlessness of foreign bodies which have been rendered thoroughly aseptic. The course of events must have been as follows: The compress, after having lain encysted must have excited an attack of peritonitis, with perforation of the intestine. That the occurrence of such a contretemps is not altogether unknown in the practice of the most careful surgeons is well attested. One operator now uses in abdominal sections fifteen compresses, hemmed in red, the enumeration of which is carefully made on the completion of the operation. A well-known surgeon once left a forcipressure forceps in the abdominal cavity. The instrument remained in the cavity for eight months, and was then eliminated through an abscess which formed in the umbilical region. Another relates how he once left a sponge in the abdomen, the patient dying of peritonitis three days after the operation. He no longer employs sponges.-N. Y. Med. Journal. UNEXPECTED RESULT OF BUILDING UP A VENERAL PRACTICE AMONG MEN. In discussing Dr. Bedford Brown's paper at the December Meeting of the Southern Surgical and Gynecological Association, Dr. Price (Atlanta Med. and Surg. Jour., March, 1892), said: While a resident physician in the Old Philadelphia Dispensary, it was then the rule not to treat venereal diseases in the institution, but I asked as a special favor of the Secretary that I be permitted to treat all venereal diseases after hours, as I was anxious to have a little experience just then in that direction. Consent was given, and I soon built up a huge clinic for the treatment of veneral diseases. I call attention to this to verify my position in gynecology. I soon had a clinic that took me an hour and a half or two hours to manage. I had a large number of cases of gonorrhoea, chancroid, bubo, phimosis, prostatic trouble, vesical and renal troubles. I took my meals, my dinner and sometimes my breakfast, with my brother. I had a room in the dispensary. My rule was to go to a restaurant near by to get my lunch, and sometimes my breakfast if I had slept late. I soon discovered that it was impossible to dine at a single restaurant with out being waited on by some one whom I was treating for bubo or gonorrhea. I had to give up going to restaurants to take my meals. Some of these patients would salute me: "Hello, Doc, what will you have?" I had to go back to my brother's and take my meals with him. I call your attention to this matter to emphasize the fact that I have since operated on the wives of those men for huge pus-tubes, ovarian abscesses, not by the dozen, but by the hundreds. I am speaking to prominent practitioners, men of large experience and good judgment. I am speaking from the standpoint of a specialist. For the last six years I have treated more cases of pelvic diseases than any one else in Philadelphia.—Maryland Med. Journal. NODOSE RHEUMATISM IN Perret and Diamantberger (Rev. mens. des Mal. d. l'Enfance, 1891) relate a case of this disease in a girl ten years old. The disease began with pains in the knees and hands when the child was seven years old. Then it attacked the great toe, the radio-carpal and metatarsal articulations. There was also swelling around the three lower cervical vertebræ. Peculiar characteristics were painful paroxysms, with contractures of the muscles contiguous to the diseased joints, and a mitral insufficiency murmur. Nodose rheumatism in children should be distinguished from the same disease in adults by the following peculiarities: many joints are involved in an early period of the disease; there is less cen tripetal tendency in the evolution of the lesions, the large joints being fre quently involved before the fingers, and the exacerbations are of frequent occurrence. During the chronic period deformities are less frequent than with In these cases, in consequence of some occlusion of the antral aperture, the antrum gradually increases in size and a consequent thinning of its walls adults, and there is less atrophy. Com- | a condition similar to that present in plications are less frequent; there are no some forms of ozæna. Extension to the disorders of sensibility, no dystrophy of internal ear may considerably impair the nails, no tuberculosis, and rarely bone conduction. any cardiopathies. As to the evolution of the disease, subacuteness is more noticeable at the beginning. The chronic state having been established, there may be improvement and even cure. The ordinary causes are poverty and dampness, but heredity has no influence. Diamantberger recognizes an affinity between this disease and hysteria, Basedow's epilepsy, idiocy, myxedema, acromegalia, and Paget's bone disease.-Medical and Surgical Reporter. OTITIS MEDIA AND ITS COM PLICATIONS. Dr. Lane (The Lancet, September 26, 1891) says: Attention is called to some points in the anatomy of the ear incorrectly described by many surgeons and aural anatomists. There is in the substance of the petrous bone, immediately behind the middle ear, on ovate cavity, inaccurately described as the mastoid antrum. This space may come into communication with the mastoid cells, but is only an occasional occurrence. It seems that the sole, but important, purpose of this cavtiy is to secrete a viscid mucus, which lubricates the lining membrane and contents of the middle ear. It is difficult to say what is the precise function of the membrana tympani and the ossicles. Perhaps not the least important function of the former is to prevent the entrance of cold air. The presence of the bones and membrane is not necessary for hearing the sounds of ordinary conversation. At the same time sounds such as the ticking of a watch are heard less distinctly by such an ear than by one anatomically perfect. In acute inflammation of the middle ear the antral and tympanic cavities become distented with mucus or muco-pus and perforation of the membrane occurs. Usually, with judicious treatment this heals; but instead there may result Occurs. The possible consequences of increased tension in the antral cavity are the following: Inflamation of the bone in relation with the antrum; of the periosteum covering the outer side of the mastoid process, and the interior of the external auditory meatus, and of the dura mater lining the adjacent portions of the middle and posterior fossa. In the large proportion of cases of inflammation of the bone consequent on a primary acute otitis, no pus is found in the antrum, or in the cancellous spaces in the mastoid bone, or beneath the periosteum or dura mater. In other cases, and especially where an acute attack is builded on to a chronic one, all these conditions are exaggerated, and pus may exist between the periosteum and the mastoid process, or between the dura mater and bone, or in both situations. The degree of inflammation of the mastoid process gives the surgeon no accurate indication of the condition of the dura mater. This is obviously a matter of the greatest clinical importance, since pus collected between the bone and dura mater may produce septic arachnitis or septic thrombosis of the lateral sinus. The differential diagnosis between. the various conditions which may result is sometimes easy; in others only a probable diagnosis can be made. Fortunately this makes no difference in the course of treatment. The importance of optic neuritis as a symptom is discussed. Taken in connection with other symptoms it is considered by the author a symptom of the most vital importance, and one that has enabled the writer to save lives, in which the delay necessary for the development of other confirmatory symptoms would certainly prove fatal. Septic thrombosis of the lateral sinus is dis cussed with reference to the frequent production of rigors. Abscesses in the temporo-sphenoidal lobe or cerebellum vary enormously as to symptoms. The symptoms of extensive meningitis are usually unmistakable. In regard to treatment of these conditions, the author's advice is this, "if in doubt, operate." In suitable cases of acute inflammation of the middle ear great benefit may be obtained from leeching, free blistering, warm applications, irrigations, incision of the membrana tympani, etc. The adoption of a definite operative sequence in all complications is urged, upon the principle that it is of vital importance in every case to attack the primary source of the disease-namely, the antrum-and by obliterating that cavity to remove any possible complication in future. hearing ordinary conversation, a freedom from discharge, and an abscence of subsequenet risk from complications. In this as in the previous similar operative treatment, already described, the patient for the future irrigates the middle ear once a day, with warm water, then introduces a drop of glycerine and iodoform into the meatus, and then a plug of cotton, wool, or a compressed cap of the same substance is inserted in order to prevent evaporation. By these means the functions of the antrum and of the membrani tympani are replaced artificially and satisfactorily.-Archives of Pediatrics. THE VALUE AND APPLICATION Meyer (New York Medical Journal, vol. lv., No. 7) comes to the following conclusions as to the value and application of the cystoscope : 1. In all obscure reno-bladder diseases cystoscopy has to be practiced—if necessary, repeatedly-before operative interference for diagnostic purposes is resorted to. 2. There are a number of causes which make cystoscopy impracticable. The course suggested in any apparently complicated case is the following: Expose the mastoid, remove the process with a gouge. A trephine or drill is considered as unsafe and inefficient. If the sinus is thrombosed the jugular vein must be tied below the clot. If the sinus is obviously not completely thrombosed various measures may be used. Having failed to find anything thus far, the cerebrum or temporo-sphenoidal lobes may be thoroughly exposed by a fine aspirating needle through the areas 4. It should be performed as a of the dura mater of the middle and dernier ressort, after all other wellposterior fossa which have been ex-known means for making a diagnosis posed behind and above the meatus. have been exhausted. The author has never experienced any evil result from needling in this region. In any case, whatever else is found, the antrum must be obliterated, any portions of membrani tympani removed, and a large communication established into the back of the middle ear. Fre quent irrigation and free introduction of glycerine and iodoform are relied on to obviate septic infection. In chronic middle ear disease, where there is much deafness, foul discharge, recurrent attacks of pain in the mastoid process, etc., after the failure of ordinary treatment, the writer has cleared the middle ear and obliterated the antrum, restoring to patients in most cases more or less perfect capacity for 3. Cystoscopy is an easy and harmless examination, but its successful employment requires experience. 5. If properly applied, cystoscopy will generally clear up an obscure disease of the bladder. 6. In most cases we can determine, with the help of electric illumination of the bladder, whether we have to deal with a disease of the bladder or of the kidneys. 7. We can thus find out whether there are two working kidneys, also whether only one of the two kidneys is diseased or both. 8. We shall most probably soon be able, perhaps in the greatest majority of cases, after sufficient practical experience and with the help of proper cystoscopic instruments designed for this purpose, to catheterize the ureters, |