I. If the Rinné test is positive, then Gellé is also unexceptionally positive, and the impaired hearing is due to nervous affections.

2. If the Rinné test is negative absolutely and totally, or up to c1, the Gellé test is unexceptionally negative and the impaired hearing is due to a stapes anchylosis.

3. If the Rinné test is negative below or up to the C limit, and positive above it, then the Gellé test decides whether a stapes anchylosis exists or not.-Campbell.

The Topography of the Facial Nerve in its Relations to Mastoid Operations.

JOYCE, R. D., Dublin. (Journal of Laryngology, Rhinology and Otology, January, 1900). Thirty temporal bones were subjected to systematic examination to ascertain the precise relations of the facial nerve to the surface of the adult skull; its depth as well as that of the external semicircular canal from the surface; and the relation of both these structures to the operations on the mastoid region. Each temporal bone was cut vertically from before backward, beginning in the angle between the petrous and squamous portions, so as to expose the aqueduct of Fallapius in its entire extent; the external semicircular canal was also cut across by the same section in every case. The facial canal was projected on the surface by drilling from the exposed canal outward, the holes being made accurately at right angles to the sagittal plan and parallel to one another. The distance of the facial canal was measured from three points on the surface of the bone, viz., (a) immediately behind the external auditory meatus on a horizontal line passing through its centre; (b) immediately behind the upper part of the meatus and immediately below the level of its upper margin; (c) a point high up over the middle of the meatus on the posterior root of the zygoma.

The results of the examinations were as follows:

1. The facial canal lies altogether in front of the mastoid process and a drill sent straight in from any point on the surface of the latter cannot injure the nerve.

2. Measured from point b, the facial canal was in 43.3 per cent. of cases more superficial than the external semicircular canal; in the same percentage of cases this was just reversed; and in the remaining 13.4 per cent. these two structures were the same distance from the surface. Thus the external semicircular canal cannot be taken as a guide to the facial nerve.

3. The average distance of the facial canal from point b is slightly less than that of the external semicircular canal from the same point.

4. In removing the outer wall of the attic, it should be remembered that the external semicircular canal is almost always (91 per cent.) nearer the surface at point c than the facial nerve; however, as it is 1.5 mm. higher than the latter, it is almost out of danger; besides, it has a thicker covering of compact bone in this situation than the nerve.-Loeb.

Cleanliness and dryness are essential to success with chronic suppurative inflammation of the ear; also good drainage.

Dizziness may result from too great force in syringing or because the water is not warm. All liquids must be used warm in the ears. Astringent solutions are to be condemned.

Nosophen, the most drying of the iodine compounds, is an antiseptic.

It is a bad practice to fill the ear with powder, even one of boric acid.

Merc. dulc. is particularly beneficial in catarrhal involvement of the entire upper nasal tract and the ear drum; the biniodide, if it is limited to the Eustacian tube.

Silicea is for the thin, foul, and often scanty discharge of caries; especially in irritable, poorly nourished children. The progress of these cases may often be hastened by lapis alb. intercurrently.

GYNECOLOGY AND OBSTETRICS.

Conducted by S. S. Smythe, M. D.

Sugar as an Oxytocic.

In "La Semaine Médicale for December 20, 1899, there is a timely note on the history of the employment of sugar in uterine inertia. American physicians have been reading with surprise that lactose is being used in France for expediting the dilatation of the cervix, and the entire idea has seemed so novel that not a few have to recognize in the chemical term lactose the familiar sugar of milk.

Bossi, an Italian physician, first recommended the use of sugas in uterine inertia in 1894; but he gave cane sugar for the purpose, employing it at various stages of labor. One ounce was the dose, and the ecbolic effect was apparent within a few minutes after exhibition when given late in the expulsion period. When given early in labor the action of the sugar while certain was slow in appearing and tended to cease long before delivery was accomplished. No beneficial effects were noticeable in false pains. In a small series of cases, the sugar was administered in massive doses (four ounces) before there were any pains at all, when labor was about due. In each of these cases labor set in violently after five or six hours.

The author of the article contents himself with discussing the cases of Bossi and of Payer, of Graz, but makes no mention of a number of contributions on the use of lactose in opening up the cervix, although this substance is used in the Lyons, Liege and other maternities, and has been the subject of monographic studies.

Sugar (even milk sugar) is such a cheap, accessible and probably harmless substance, and inertia is so common, that the medical profession ought to be able to pass upon the value of this remedy, and a consensus of opinion ought to be readily ar

rived at. The theory upon which its use is based is not given in any works accessible to us, but doubtless the rationale is simply that sugar is a muscle food. Sugar should probably be used in connection with ergot.—Medical Review of Reviews.

Oophorectomy For Cancer of the Breast.

In 1896 Beatson, of Glasgow, published a remarkable article promulgating the theory that cancer of the breast was due to ovarian irritation and announcing his belief that removal of the ovaries had a marked beneficial effect upon cancer of the breast. To substantiate his claim he presented the case of a woman suffering from unnoubted mammary carcinoma upon whom he performed oophorectomy. Eight months after all traces of cancerous disease had disappeared.

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Herman, in 1899 showed a woman to the Medical Society of London whom he believed was cured of recurrent cancer of the breast by oophorectomy and administration of thyroid extract. The breast had originally been removed by the radical operation in May, '95. In October, '95, there was a recurrence. By July, '98, there was a large ulcerated surface over the right breast, with palpable axillary involvement. In July he performed oophorectomy, and subsequently administered thyroid extract. By March the ulcer had healed. The lump in left breast and axillary glands could no longer be felt.

Stanley Boyd presents seven cases subjected to ovariotomy and thyroid extract, and sums them up as follows: Beneficial effect in two cases. Probable in two cases. Absent in three

cases.

In view of the foregoing facts, substantiated as they are by careful observers, we must regard henceforth oophorectomy with administration of thyroid extract as one of the palliative operations in the treatment in inoperable mammary carcinoma. It is not for us to explain the theory of this procedure upon any rational basis except the well known physiological relation be

tween the mammary gland and ovulation. However, the extirpation of the ovaries is a simple procedure, and under strict antiseptic precautions unattended with danger to patient's life. If such a procedure holds out the least amelioration for a condition upon which we must look with despair, it is our plain duty to suggest and urge such an operation as a possible ray of hope.-Ex.

Urine Separator.

The urine separator, an instrument invented by Harris for obtaining the urine from each kidney separately, has proved to be a nearly perfect device for that purpose, and has practically done away with all other methods. It is designed to catch the urine as it flows from one or the other, or both ureters, by means of a double catheter passed into the bladder through the urethra. It works on the water shed principle, by having an instrument in the rectum in the male, and in the vagina in the female, pressing upwards, and forming a ridge, which divides the bladder into two halves, each of which is drained by a suction tube.

This instrument can be used without an anesthetic, and passes easily through any urethra that will admit a No. 26 female sound. Before beginning to draw the urine the bladder must be thoroughly washed out with sterile water. This is done through the instrument itself after it is in position in the bladder. The urine, as it is drawn from each ureter, is collected in separate vials attached to the instrument for that purpose. In this way we may determine accurately the secretory functions of each kidney.

The "Organon" being the best exposition of the homeopathic system should be carefully studied by everyone for himself, and its teachings accepted and indorsed by every teacher of homeopathy when they are not inconsistent with the ascertained facts of modern science.-Dudgeon.