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eral German Atlases now used extensively in this country. The literature of anatomy, embryology and histology has been enriched by recent investigations of Americans, and the work accomplished in the laboratories of American medical schools has been recognized throughout the scientific world. It is eminently proper that in a new edition of a book such as Morris, American students and American work should be recognized. Those who have taken this burden upon their shoulders are men who have had experience as teachers and investigators, men who are acquainted with the trend of modern thought, with recent literature and with the best methods presenting and teaching the subjects which they discuss. The publishers have spared no outlay to forward the aims and wishes of all contributors; many illustrations which appeared in previous editions have been omitted, others have been improved, a large number of new figures have been made from drawings specially prepared for the purpose, and pictures from other books have been included where they served the desired purpose.

ALFRED BEIT, the South African multimillionaire, died the other day. His estate is estimated at $500,000,000. He did not take it with him!

LOBELIN.--In spasmodic retention of urine due to stricture, give gr. 1-13, every ten minutes, after atropine gr. 1-250, in a little hot water. Dissolve gr. 1-67 lobelin in twenty drops of hot water and inject into the deep urethra. - Candler, American Jour. of Clinical Medicine.

AN English traveler once met a companion sitting in a state of the most woeful despair, and apparently near the last agonies, by the side of one of the mountain lakes of Switzerland. He inquired the cause of his sufferings. "Oh," said the latter, "I was very hot and thirsty and took a large draught of the clear water of the lake, and then sat down on this stone to consult my guide-book. To my astonishment I found that the water of this lake is very poisonous! Oh, I am a gone man -I feel it running all over me. I have only a few minutes to live! Remember me to-" "Let me see the guide-book," said his friend. Turning to the passage, he found, “L'eau du lac est bien poissoneux ("The water of this lake abounds in fish"). "Is that the meaning of it?" "Certainly." The dying man looked up with radiant countenance. "What would have become of you," said his friend, "if I had not met you?" "I should have died of imperfect knowledge of the French language."-Modern Eloquence.

REPORTS ON PROGRESS

Comprising the Regular Contributions of the Fortnightly Department Staff.

INTERNAL MEDICINE.

O. E. LADEMANN, M. D.

Estimation of Uric Acid in the Urine.Kowarske (Deutsche Med. Wochenschrift, No. 25, 1906) proposes a modification of Hopkin's method, which, in addition to its accuracy posessses the following advantages: (1) Comparatively little time is consumed in its performance; (2) No especially constructed apparatus is necessary; a centrifuge, pipette and burette is all that is required; (3) The analysis requires but a small amount of urine; the method, therefore, is equally applicable for scientific investigation on metabolism in small animals; (4) Several uric acid estimations can be simultaneously made with but little additional time. The estimation is made as follows: Ten co. of urine, measured in a pipette, are placed into a thin centrifugal tube, with a capacity of 15 cc., add to this two or three drops of ammonia and three grams of ammonium chloride; cork the tube with a well fitting rubber stopper and shake the contents until the ammonium chloride is all dissolved. The urates of ammonia separate in the form of a flocculent sediment, the separation being complete after standing two hours. A two minute centrifugation will suffice to precipitate the sediment firmly to the bottom so that the supernatant fluid can be decanted by gently tilting the tube. decanting care should be taken not to disturb the sediment. Five drops of concentrated hydrochloric acid are now added to the sediment and the whole gently heated over a small flame, whereupon the ammonium urate dissolves and uric acid appears in the form of a fine crystaline sediment. One hours standing is required to effect a complete uric acid separation. Two cc. of distilled water is then added and the whole again centrifugated until sedimentation is complete and the fluid above poured off. The sediment is now slightly shaken with two or three cc. of alcohol centrifugated and decanted. The latter step is repeated two or three times until the alcohol reacts neutral to litmus paper. The entire process of washing should not require more than three or five minutes. After the final alcoholic washing and decantation the sediment is slightly agitated with about two co. of hot distilled water to which is added several drops of the indicator phenolphthalein and the hot solution titrated with a one-fiftieth normal piperidin solution in the ordinary manner until the rose color of the solution remains permanent. The simple

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mathematical calculation of multiplying the number of cubic centimeters of the piperidin solution used in titrating by 3.36 gives us the number of milligrams of uric acid in 10 cc. of urine. For instance we use 1.5 cc. piperidin we will then have in the 10 cc. of urine, 3.36x1.5=5.04 mg. of uric acid; 100 cc. of urine 5.04 × 10-50.4 mg. or 0.0504 grams, that is 0.0504 per cent of uric acid.

Tubercular Disposition of the Apices of the Lungs. Hofbauer (Zeitschrift f. klin Medizin, Bd. LIX., Heft. 1, 1906) discusses why the apices are more subject to the invasion of the tubercle hacillus than other portions of the lungs. He believes this predisposition is essentially due to differences in the physiological relationship. The respiratory variations in pressure are most marked in the caudal portions of the lungs, while in the remaining parenchyma this pressure is less and in the apices almost entirely wanting. This pressure difference favors both the blood and lymph supply, consequently its diminution or absence in the apices means a deficient blood supply. Limited apical expansion, therefore, favors the development of the tubercle bacillus, not however, on account of the more firm lodgment of the inhaled particles as was formerly supposed but the result of poor nutrition.

The Origin of Pulmonary Tuberculosis.— Schlossmann and St. Engel's (Deutsche Med. Wochenschrift, No. 27. 1906) research work is a corroboration of Bebrings view and proves incontestably that pulmonary tuberculosis may result from intestinal infection with the tubercle bacillus. Their experiments consisted in injecting into the exposed stomach of guinea-pigs, under the strictest precautions, an emulsion of equal · parts of pure culture of tubercle bacilli and milk or cream. Tubercle bacilli find their way into the lungs shortly after the injection, as the authors demonstrated in a guinea-pig four days old which had been subjected to the above experiment. animal was killed six hours after the injection of the bacilli emulsion and particles of lung tissue were implanted intraperitoneally into a series of other guinea-pigs. These animals, without excepton, all succumbed to tuberculosis.

This

The Origin of Sleep.-Salmon (Revue de Medecine, vol. XXVI, No. 4, 1906) discusses at length the physiology of sleep, promulgat. ing the theory that it is due to some internal secretion of the pituitary body. He supports this view by presenting the following arguments. In eight cases of acromegaly and in other affections in which there is a hyper

trophy of the hypophyses he observed somnolence, while the same is equally true in conditions where the secretion of the gland is augmented, as in slight pilocarpine intoxication, in affections with an associated hyperemia of the pituitary body, as drunknness, injury to the head and the like. Insomnia,

on the other hand, is noted where there is a hyposecretion of the gland as in destructive or degenerative processes, in exophthalmic goiter, where the gland has been found hard and small, those conditions with diminished glandular secretion resulting from nutritional disturbances, as old age, inanition, neurasthenia, etc., atropin by its glandular inhibiting effect, and, finally, emotional influences cause sleeplessness through a hyposecretion.

Angina Pectoris as an Early Symptom of Aneurism of the Aorta.-Osler (Med. Chronical, May, 1906) remarks that pain is one of the earliest and most constant symptoms in aneurism of the aorta, having observed it in 104 cases out of 132. The pain may have the character of true angina. This anginal type occurred in 22 cases. A second type of pain is sharp and neuralgic in character, often extending along the course of the nerves. This type, due to pressure of the aneurism on the nerve, may also be paroxysmal and very greatly in intensity. A third type of pain is dull and boring in character and is most common in erosion of the chest wall or spine. It is not always easy to distinguish this from the second variety, but patients say they can appreciate the difference and it is this form that is most severe. A fourth type of pain is referred to the nerves of the arm or to the skin in the precordial region, or to the pectoral or sternocleido mastoid muscles. Pain down the left arm was a marked symptom in 22 cases. Osler details the history of coses in which typical symptoms of angina pectoris preceded by a year or two the development of an aneurism.

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Is Neuralgia a Functional Disease?-Gordon (New York Medical Journal, July 21, 1906) bases the following conclusions on study of the pathological findings of eight cases of neuralgia, together with those of other investigators: 1. The occurrence of degeneration of the peripheral nerve is frequent if not constant in neuralgia. 2. That this nerve degeneration is very probably a primary condition, which as a neuritis assumes an ascending course and involves secondarily the Gasserian ganglion. Although this contention is still debatable, there is great prob. ability in favor of the above view. 3. The blood vessels undoubtedly play a certain role in the causation of a degenerative state of the peripheral nerve. 4. That it is difficult

if not impossible to draw a sharp distinction between neuritis and neuralgia, as accumulated facts show an anatomical basis in the latter affection. 5. In view of these anatomical facts, it is highly important to remove surgically a nerve affected with so-called neuralgia as early as possible after a short trial of medical treatment is given.

OTOLOGY.

ALBERT F. KOETTER, M. D.

Recent Reports on Otosclerosis.- Compilation of Dr. Jörgen Möller (Internationales Centralblatt fuer Ohrenheilkunde). The literature on otosclerosis is growing so rapidly that we are justified, even though Denker's great work is only two years old, in publish. ing a compilation of the work done since then; in this resumé several articles will be mentioned which appeared before Denker's book, but were not considered in the same. Otosclerosis is a new disease being first described during the nineties supported by numerous pathologic anatomical examinations. The name itself, at least in its present importance, emanated from the clinic of Politzer and he was the first man to devote a special chapter to this disease in his book on otology. Two years later the large work of Denker was published and with this the otosclerosis was incorporated as a self-dependent disease into the system of otology. But it will be some time before the knowledge of the unity of this disease is recognized. Lermogez and Boulay mention otosclerosis but only as a special group of the chronic dry middle ear catarrhs, they do not speak of the characteristics and do not seem to recognize the proper conception of the disease of otosclerosis, of what they consider otosclerosis they simply mention two forms which do not respond readily to treatment, the juvenile forms of a hereditary basis and the congestive form with translucent redness of the membrane. Gradenigo does not recognize the otosclerosis as a self-dependent disease because he believes that it occurs very frequently as a secondary disease, not only after catarrhal lent but also after suppurative diseases. In England and France otosclerosis is not recognized and the modern pathologic anatomical examination of the continent are not mentioned. Watson thinks there is no real difference between middle ear catarrh and otosclerosis, but are simply different stages of one and the same disease. Collier also speaks of otosclerosis as such in that he considers those cases of progressive deafness, in which no accompanying middle ear disease exists, but expresses himself in a very uncer

tain way about this disease. Some other authors although they consider otosclerosis as an independent disease, do not consider it, in the same sense as Politzer, Botey calls the otosclerosis a primary disease without preceding catarrh, but includes under this head cases of connective tissue adhesions and also primary disease of the labyrinthian capsule. Burger and Zwaardemaker speak of these two forms of disease under the head of sclerosis aurium, this is again divided into progressive dry catarrh and ostitis capsularis.

The work of Möller deals exclusively with the otosclerosis in the sense of Politzer and speaks in detail of the pathological anatomy and diagnosis, especially the founctional test, also mentions the etiology, symptomatology and therapy. As regards the etiology and pathogeny Hammerschlag and Körner have reported some interesting researches as regards heredity. Hammerschlag reports the pedigree of two families, of which one is of great importance, the ancestor married twice. and in the progeny of the first wife who was hard of hearing, many cases of sclerosis appeared, whereas in the progeny of the second wife none appeared. Körner reports the pedigree of three families in the five families there were no less than forty-three cases of otosclerosis. It is further of interest that Körner reports an unpublished work of Hopmann in which the hereditary relations of several cases examined clinically and anatomically were searched and the presence of syphilis could be excluded. Moreover Körner believes that the heredity of otosclerosis should be observed in the light of the Weissmann doctrine of determinants, the disposition to disease would be inherited in the shape of a Weissmann determinant, if the same becomes active depends on the different external and internal influence, puberty, puerperium, syphilis and other diseases, also diseases of the mucous membrane of the walls of the labyrinth. By that, an explanation would be had for the fact that the otosclerosis often skips one or more generations and apparently appears spontaneously. Following these considerations Körner warns the female members of sclerotic families against pregnancy and advises members of such families not to marry so that they may take their determinants uninherited to the grave.

Botey differentiates between two forms of otosclerosis, one the juvenile beginning between the tenth and twentieth year, frequently para-syphilitic or para-tubercular nature, whereas the other, the ordinary otosclerosis appearing in middle or late in life of trophoneurotic origin. Möller considers a trophoneurotic origin of otosclerosis possible especially as the two (circumstances often ob

served) that of the canal wall showing atrophic changes and that sclerosis very often occurs with atrophic rhinitis. Escat has observed that deafness, tinnitis, pain and hyperakusis dolorosa often appear in attacks of migraine and that furthermore the majority of individuals affected with primary otosclerosis suffer with migraine. He believes that these two diseases can be brought into such relation that they occur on a common dyscrastic or toxaemic basis, possibly an autointoxication. Maupetit thinks there is a certain connection between otosclerosis and the universal arteriosclerosis. Collier believes that the otosclerotic process depends primarily on an existing nose or nasopharyngeal disease and extends through the eustachian tube. An etiologic factor not often observed is emphasized by Möller, viz., that traumas play a certain role in the devel. opment of the disease, not that the trauma cause the disease, but that the disease suffers a severe exacerbation and often is noticed for the first time following a trauma.

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As to the pathological anatomy there are reports of three cases, Möller(1), Brühl(2) and all three cases show the well known osseous changes of the typical otosclerosis. Müller's case and in one case of Brühl the diagnosis was made during life time. In all three cases the microscopic examination pointed emphatically to primary disease of the bone without involving the mucous membrane of the middle ear, and especially in Möller's case a secondary origin after a mucous membrane disease or a periosteal disease could be excluded with certainty, for beside the large focus lying in the partition between the tympanic cavity and the labyrinth, small isolated foci were found which at no point reached the surface of the bone. Further the arrangement of the diseased hone tissue in this case, the sharply defined outline as opposed to the healthy tissue, and the ever increasing resorption toward the older central parts indicate that the primary, as Politzer implies, is a new formation of bone to which the resorption process later joins itself. In the case of Brühl the auditory nerve had degenerated which can be explained as atrophy due to inactivity.

As to the symptomatology and course as reported by the different authors only a few data are mentioned as the symptomatology is well known through former work. Bobone, Burger and Zwaardemaker mention the peculiar dryness and the great width of the external canal. A further condition noticed by the latter authors in true otosclerosis, the ostitis capsularis is the extreme whiteness and acute angular position of the handle of the malleus, it often has punctuated exosto

ses. A characteristic symptom is the rapidity with which the ear loses its sense of accomodation, so that the first words of a conversation are not grasped. Furthermore those cases which originate from an arthritic basis, several times a marked improvement of the hearing has been noticed after a typical attack of gout. A new symptom mentioned by Lafite-Dupont and Maupetit, namely, that the blood pressure is from 5-11 mm. consistently higher in the true otosclerosis, might presumptively play a role in the diagnosis of primary otosclerosis. Maupetit brings this symptom in connection with his assertion of the dependence of the otosclerosis on a universal arteriosclerosis. Examination as to the blood pressure in otosclerosis were made by Mengotti but entirely different results than those of LafiteDupont and Maupetit were obtained, in fact he finds intimate relation between the blood pressure and sclerosis, the (P) blood pressure fluctuates in his cases between 92 and 145, so that the increase of 5-10 mm. found by the others, disappear entirely compared to these fluctuations, the pressure was mostly from 120-140 which is about normal. It is true that in some cases Mengotti with the improvement of the hearing observed a lowering of the blood pressure, in other cases a rise was noticed. Moreover the figures of the authors cannot be compared as the examinations were made in different ways and different apparatus used.

A symptom not before mentioned, observed by Mygind and also by Möller is the improvement of the hearing, in the early stages of a coryza, probably due to congestion of the mucous membranes caused by the acute catarrh.

As far as the functional examination is concerned the results of Möller differ very materially from those usually observed as characteristic of otosclerosis. Ordinarily the characteristic result is given as Bezold's triad, but Möller thinks this characteristic of the ordinary middle ear catarrh but not for sclerosis. According to Möller we usually find shortened bone conduction. Rinne positive shortened or negative, lower tone limit comparatively little confined, much less than in chronic catarrh, upper tone limit markedly lowered downward. Gelle's test usually negative, which is not exactly characteristic of otosclerosis, but for stapes fixation in general even when of catarrhal origin. Möller in going over the literature on the subject finds in a good many cases a lowering of the upper tone limit without the author Jaying much stress on it, whereas, Möller considers it one of the main points. In the discussion following Möller's paper Blegvad

rests his acceptance that the upper tone limit is narrower, but believes that if it is not found in all cases, it is due to the apparatus used, especially the Edelmann Galton whistle which does not reach the true physiological upper limit of the human ear for tones, let alone reach above it. If more delicate ap. paratus were obtainable a more delicate diagnosis would be possible for the earliest stage of otosclerosis. Burger and Zwaardemaker have found the same condition as Möller in pronounced cases of otosclerosis the upper tone limit lowered, whereas in the early stages they often found an abnormal sensibility for the high tones, Gellé always negative but support Bezold's triad as a characteristic symptom. Escat on the contrary believes that the bone conduction is shortened and Rinné always positive. Politzer still insists that the Rinné negative is characteristic of pronoucned cases of otosclerosis. Brühl discusses in general, the functional examination and its results, viz., in middle ear disease, labyrinth trouble and the mixed condition and indicates that otosclerosis belongs to the latter category. He expresses, as does Möller, the hope that further research of the functional tests will enable us to recognize the early stages of otosclerosis.

The therapy offers nothing new. Politzer warns against the use of the catheter as it nearly always causes exacerbation of the condition. Collier urges thorough treatment of the nose and naso-pharynx. Maupetit recommends lumbar puncture to cause a decrease of the intracranial and by this a decrease of the intra labryrinthian pressure, furthermore the treatment of the arterio-sclerosis with potassium iodide. Sugar discusses the phosphor medication and believes first that the large doses are unreliable and second, that the anorganic preparation should be replaced by the organic. He recommends phytin given in 0.25 doses four times daily and later on double the dose. He thinks the phosphor medication has not been thoroughly tested in a scientific manner.

THERAPEUTICS.

W. T. HIRSCHI, M. D.

The Treatment of Hyperacidity. Dr. 1. Boas, (Therapeutische Monatshefte, May, Monatshefte, May, 1906.) Hyperacidity or hyperchlorhydrie usually is a functional disturbance but at times we find a pathologic condition of the secretory glands in the stomach. At times chronic gastritis especially in the early stages is associated with hyperacidity, and this is now called gastritis acida. Since it has been demonstrated that the lagus in the secretory

nerve of the stomach, neurogenic hyperacid. ity plays a prominent role, as is evident in tabes dorsalis. Boas believes that 75% of all cases of hyperacidity later develop chronic gastritis. Prophylaxis plays an important role in hyperacidity. Regular meals, avoiding too cold or hot drinks, alcoholic drinks, tobacco, etc., are of importance. Cathartics diminish gastric glandular secretion while opiates increase the same. Atropin temporarily diminishes secretion. At present we are unable to cure idiopathic hyperacidity, but we can relieve the symptoms, e.g. pains, eructations, etc., by using a suitable diet. Milk, bread and other starchy foods cause little increase of secretion. while meat decidedly increases secretion. Fat checks secretion decidedly. Mastication, temperature of food and liquid and methods of preparing food are of great importance. Meats should be restricted, excepting fish, carbohydrates should be used extensively, and fats in moderate amounts. Milk is of great benefit. Spices and acids excepting lactic and butyric acids must be avoided. Pure sugar in solution is permissible but cakes and pies are injurious probably owing to the method of preparation. White wines usually aggravate the symptoms but most pure red wines do no harm. Coffee and tobacco are also injurious. Carbonated mineral water are most beneficial. The proper administration of alkalies relieve the symp. toms decidedly. The use of sodium bicarbonate is not advisable since the CO, distends and irritates the stomach too much. Sodium citrate is preferable to sodium bicarbonate, and if habitual constipation is present, magnesia usta may be given with it. Antacids should be given at the time of greatest digestion, i.e., one to three hours after large meals. All these remedies give only temporary relief. Atropin is used extensively with good results, but also only temporary. Skopolamin and enmydoin also give temporary relief.

The pa

My Experience with Antituberculosis Serum Mormorek H. Frey, (Wiener Klin. Therapie, No. 42,1906.) Frey uses the serum in the 2nd and 3rd stages of tuberculosis chiefly as an enema at times with the yolk of an egg. The bowel should be irrigated before using the enema. He uses 5-10 ccm. of serum, 1 to 2 times daily. The serum seems to have a specific antitoxic effect. tients feel better, the appetite improves the temperature drops and the expectoration and cough are lessened. Lewin (Stockholm) uses the serum subcutaneously and he also reports favorable results from its use. Hoffa (Berlin) prefers to use the serum per rectum and believes the results obtained warrant further experiments with the serum.

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