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sites belong, not to the pilz, but to the protozoar, the coccidian or gregarinen. The French, with Laveran, use the term "Hamatczen.” (Scheurben).

LANE. TWO CASES OF SUBDURAL ABCESS RESULTING FROM DISEASES OF

THE ANTRUM AND MIDDLE EAR,

(Brit. Med. Jour., June 7, 1890, p. 1301). The two abcesses resulted from otitis media, and are remarkable for the fact that while the transverse sinus formed for a long time a part of the abcess wall, no thrombosis occurred, and also that no optic neuritis occurred.

OPHTHALMOLOGY.

BY RICHMOND LENNOX, M.D.

Assistant Surgeon, Brooklyn Eye and Ear Hospital.

PARALYSIS OF ACCOMMODATION FOLLOWING MEAT POISONING.

Groenouw (Kl. Monatsbl. f. Aug., May, 1890, p. 166), publishes the details of five cases of paralysis of accommodation due to the ingestion of tainted meat, in three of which the etiology was unusually clear. In these three cases the toxic agent was a ptomaine rather than micro-organisms or trichinæ, as was shown by microscopical examination and by experiments on animals. Only when a certain degree of poisoning occurred was there mydriasis, weaker action of the poison producing only paralysis of accommodation. In diphtheritic paralysis the pupillary reaction is, as a rule, preserved. Atropine, on the other hand, acts primarily on the pupil. As in the toxic paralysis under consideration mydriasis is only present when the paralysis of accommodation has passed certain limits, the relation of the size of the pupil to the range of accommodation is not without a certain diagnostic value, marked mydriasis with slight weakening of accommodation indicating atropine. It is quite possible that some of the obscure cases of accommodative weakness may be due to the toxic influence of food, perhaps without notable disturbance of digestion.

OPERATIVE TREATMENT OF VITREOUS OPACITIES.

In the issue of this Journal for December, 1888, reference was made to a report of seventeen cases in which Bull had operated for membranous opacities in the vitreous. Bull now (Oph. Rev., July, 1890, p. 161) gives the results obtained in a further series of twelve cases, which strengthen his belief in the value of this method of treatment,

notable improvement being obtained in all but one. special change in the technique of the operation.

IRIDESCENT VISION IN GLAUCOMA.

He has made no

Collins (Oph. Rev., July, 1890, p. 196) thinks the appearance of "rainbows" in glaucoma is due to slight "steaminess" of the corneal epithelium. The more pronounced opacity seen in the later stages of glaucoma and that due to the prolonged use of cocaine do not usually cause "rainbows," probably because the epithelial changes are too gross. Stretching of the cornea from increased intraocular tension would tend primarily to diminish the lymph streams circulating through it, and this would result in slight drying of the surface epithelium with possibly some shrinking of the cells and the formation of intercellular spaces.

OCULAR DISTURBANCES IN MALARIA.

Sulzer (Kl. Monatsbl. f. Aug., July, 189c, p. 259) after commenting on the relative scarcity of references to this subject in the ordinary text-books, reviews the literature with moderate completeness. In his paper, however, he only describes the affections of the deeper parts or the eye, omitting those of the eye muscles and anterior portion of the globe as well as those due to malarial albuminuria. He thus groups

his cases:

In chronic malarial affection:

1. Chronic optic neuritis, associated in severe cases with melanosis of the optic papilla.

2. Diffuse infiltration of the vitreous.

3. Numerous small hæmorrhages in the retinal periphery. Punctate hæmorrhages were invariably found microscopically in the eyes of those who died from malarial cachexia.

4. Sudden incurable blindness, probably due to central hæmorrhage or embolus.

In acule malarial fever:

1. Periodic amblyopia of varying degree without ophthalmoscopic change, sometimes amounting to blindness of several days' duration, with complete recovery after use of quinine. 2. Marked hyperæmia (especially venous) of papilla and retina, with loss of retinal reflex and a predisposition to macular disturbances in consequence of reflected sunlight, these disturbances never occurring, according to Sulzer, in normal eyes. 3. Extensive hæmorrhages in the region of the disc and macula. Sulzer's own experience was obtained in cases coming from the East Indies. The majority were of chronic neuritis, due to malarial

cachexia with enlarged spleen, irregular periodic temperature variations, neuralgia, etc. Peculiar were the alterations in visual acuity, at one time good and then perhaps falling within a few days, only to again improve. Both eyes were usually affected, the visual field normal or showing slight concentric contraction, the color sense normal. In many cases there was hemeralopia, sometimes photophobia as well. The dark-reddish gray color of the papilla is characteristic, and is due, according to Poncet, to pigmented giant cells in the dilated capillaries of the disc. This affection of the optic nerve is very amenable to treatment, but apt to recur if exposure to malarial infection be not avoided. Partial nerve atrophy resulted, however, in eight per cent. of Sulzer's cases.

The second variety of cases observed was of diffuse infiltration of the vitreous. This seems at least liable to lead to permanent visual impairment with possible nerve atrophy.

The third variety of cases seen by Sulzer was a consequence of acute malarial infection, and more numerous than that last described. During the fever periods these patients complained of burning in the eyes, light flashes and photophobia. Ophthalmoscopically, both during the attack and the intermission, the optic disc and retina showed marked hyperemia (chiefly venous). The retina appeared without reflex and as if covered with a fine mist. The frequency of macular affections due to reflected sunlight called Sulzer's attention to the above changes, occurring as they did exclusively in soldiers suffering from tertian who had been on duty during the febrile intermission. The macular changes themselves were in no way different ophthalmoscopically from the severe cases due to direct observation of the sun. There were also the changes in the retina above alluded to in connection with chronic malaria, hæmorrhages, etc., in about onefifth of the cases suffering from malaria.

GYNECOLOGY.

BY WALTER B. CHASE, M. D.

PARTIAL REMOVAL OF DISEASED OVARIES.

One view of the conflicting theories concerning the advisibility of partial or entire removal of an ovary, is set forth by Dr. Martin as published in Volkmann's "Klinischer Vorträge," in which, from his own experience, he arrives at the following conclusion, viz. : "Patients recover perfectly after partial removal of ovaries for localized chronic in

flammatory changes, hydrops folliculi and öophoritis. Recovery is also complete in most cases after the resection of obstructed and otherwise diseased tubes. The after-histories of seventeen patients operated upon by Dr. Martin prove that women with resected ovaries and tubes are not more exposed than other women to further disease of parts left behind. Menstruation continued in all cases, and some patients conceived."

Dr. Martin states that "in 1864, Sir Spencer Wells emptied some dropsical follicles in one ovary of a young girl, having just removed its fellow. The girl afterward married and had children." (British Medical Journal, Aug. 9, 1890.)

DANGER OF SYPHILITIC INFECTION.

The danger of infection by the gynecologist is discussed in the Annals of Gynecology and Pædology, March, 1890, by Wm. Gooddell. After referring to several conditions under which gynecologists have controlled the disease, he says: "The knowledge of these facts have made me keenly alive to the danger which physicians in general and gynecologists especially, incur in the examination and in the delivery of women.

"It has also made me very careful to see that all my every-day instruments are kept scrupulously clean, for there is no doubt careless physicians have unwittingly inoculated their patients by their instruments and especially by the speculum."

CONCEPTION WITH UNRUPTURED HYMEN.

W. Macfie Campbell, in a paper read before the Edinburgh Obstetrical Society, gives an account of a case coming under his own observation where pregnancy was present and the hymen perfect. He quotes the experience of Brown, of Vienna, who draws the following brief conclusions:

1st. That an unruptured hymen is no proof of virginity.

2d. An individual may exist as a virgin in the anatomical though not in the gynecological sense.

3d. Pregnancy is possible without penetration. (Edingburgh Medical Journal, Sept. 1890.)

[Every observer of any considerable number of unmarried females, of the class whose purity is unsupected, must have noticed in quite a percentage of cases, that only the remnants of the hymen were present, and that occasionally in ladies many years married the hymen was perfect, being dilatable without rupture, as was demonstrated by digital or speculum examination.—W. B. C.]

OUTERBRIDGE'S INSTRUMENT FOR THE CURE OF STERILITY WHEN DUE ΤΟ

FLEXION OR STENOSIS OF THE CERVIX.

In a discussion of the merits of this device in the Chicago Obstetrical Society, Nov., 1889, appearing in the American Journal of Obstetrics, June, 1890, no positive cures were reported.

[Inquiries from other sources leave the subject sub judice.— W. B. C.]

STERILITY.

Lier and Ascher (Zeitschrift f. Geburtshülfe u. Gynäkologie, Bd. 17, Heft 2), after an analysis of 200 cases selected from 2,500 married women, all of whom had been married at least one year and a half. 76 of 227 appeared on account of sterility. In 70 per cent. of the cases, the trouble was with the husbands; 151 women applied for treatment on account of pelvic disease, 79 of whom were suffering gonorrhoeal infection. Out of 86 husbands, 21 had azoöspermia. In a further analysis, in 227 cases of sterility, 60 per cent. were due to the male. An additional summary of two series shows, out of 227 cases of sterility, nearly 60 per cent. were due to the male. Also 424 cases inquired into revealed the fact that 40 per cent. were due to azoöspermia or gonorrhoea. It is therefore apparent gonorrhoea bears a very important relation to vital statistics.

DISEASES OF THROAT AND NOSE.

BY WM. F. DUDLEY, M. D.,

Attending Physician, Department Throat and Nose, Dispensary of L. I. C. Hospital; Instructor in Diseases of the Throat and Nose, New York Post-Graduate Medical School and Hospital.

RADICAL OPERATIONS FOR THE CURE OF INTRINSIC CARCINOMA OF THE

LARYNX.

H. T. Butlin (Brit. Med. Jour., Aug. 23, 1890). The term intrinsic is applied to carcinomas arising from the ventricular bands, the ventricle, the true cords, and parts below the cords. Extrinsic carcinomas are those originating in epiglottis, ary-epiglottic folds, the intraarytenoid fold, and pyriform sinus. The intrinsic variety do not, as a rule, affect the lymphatic glands; the extrinsic do, at an early period, and constitute, therefore, the more dangerous disease, running a rapid course, and seldom checked or cured by an operation. The operation of partial or complete excision of the larynx should be performed only in intrinsic carcinoma of the larynx.

Statistics of 102 operations for intrinsic carcinoma were reported; these included 28 cases of thyrotomy, 23 of partial and 51 of complete

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