tying on both sides, and then cutting the threads off short. I proceeded at every step on the supposition, from the appearance of the sac and its peculiar adhesions, that it might turn out precisely what it did turn out to be. I proceeded in such a way that I might be able to retreat at any moment. The trocar used was not a very large one, I preferring that size, so that if forced to back down from the operation I might the easier close up a small hole than if it were larger. I found that I could take the tumor away from the uterus without involving any injury to its cavity, and anterior portion of the bladder. The stone was of large size, of rough exterior, and weighed fifty-nine grains. It had been removed entire, but had become broken in pieces by his youngest son, who had bitten into it, mistaking it for a large sugar almond! Dr. Post lastly exhibited a portion of sequestrum which he had removed from the tibia of a boy fourteen years old, which was the result of a contusion of the part some years before. The Society then went into Executive Session. accordingly did so. In my opinion I do not think that NEW YORK MEDICAL JOURNAL ASSOCIA TION. STATED REUNION, FRIDAY, FEB. 7, 1868. DR. GURDON BUCK, PRESIDENT, in the Chair. SPINAL DISEASE AND HIP-JOINT DISEASE. there is any more danger in doing that than in an ordinary case of ovarian tumor with a fleshy pedicle. It required three hours to feel my way along before I could get the tumor out, and an hour more to stop the hæmorrhage, which came from every one of the little adherent bands. The vessels of the omentum were very much developed; one artery was as large as the femoral, and DR. CHAS. F. TAYLOR gave an account of his observathere were several veins of the same size in the neigh- tions upon the state of orthopedy in Europe, the subborhood. The whole amount of the omentum brought stance of which has already appeared in our corresponddown was only four inches in width and six or eight ence. (RECORD, vol. iii., p. 44.) He exhibited and exin length. All these were duly secured. The adhe-plained his apparatus for club-foot, for hip-joint affecsions were all tied and the haemorrhage ceased, ex- tions, and for spinal curvature. (A description of the cept at a little point on the uterus, which seemed to spinal apparatus may be found in RECORD, vol. i., p. 369; have been occasioned by a mere scratch. That kept of the hip-joint apparatus in vol. ii., p. 289.) constantly oozing to the amount of a drop or two per The speaker proceeded to state his views upon the minute. Of course the parts being very vascular it be- pathology of Pott's disease. He had many years ago came a matter of much importance to arrest the bleed-advanced the doctrine that this disease often begins as ing in the proper way. I knew if I should pass a a simple inflammation, unattended by caries; he could needle through the part, that while stopping the oozing not otherwise explain the frequent cases of recovery. from this point, I might transfix some other neighbor- Two classes of cases were to be distinguished, the ing vessels that would give me more trouble. The traumatic and the strumous,-the former almost always mischief was, however, soon put a stop to by applying curable, the latter often susceptible only of palliation. to the point a little persulphate of iron on the end of a He had once heard Dr. Sayre remark (if he remembered probe. rightly) that all cases of hip-joint disease were of traumatic origin. Though he could hardly admit so sweeping a statement, yet this was certainly true of the great majority, and still more emphatically so of cases of spinal disease. Cases clearly traumatic, occurring in subjects previously healthy, progress in exact In closing up the wound, I left a tent in its lower portion, in order that I might with ease wash out the peritoneal cavity, in case there should be any hæmorrhage after reaction was fully established. I have only to add, that no such anticipation has been realized, and up to this afternoon she has had no un-ly the same way as those in which no initial injury can pleasant symptom. I bring this case before you more for the sake of insisting, as I have often done before, that no operation for ovariotomy should be performed without a preliminary tapping, and not until the patient's health begins to fail. The mistake made in the diagnosis of this case is such an one as I believe could not be guarded against by any one. In conclusion, he gave it as his opinion that when the pedicle of a uterine tumor was very large-so large indeed that it could not be separated without carrying the greater part or the whole of the uterus with it, and not opening into its cavity-the operation ought to be abandoned, unless complication should arise in its course that made it impossible to do so. He believed that on the whole the patient stood as good a chance to recover under such circumstances as if the formidable mass were removed. In this connection he referred to a case in which he was forced to abandon the operation, but in which the woman sank within twenty-four hours after having learned that nothing had been done for her in the shape of removing the mass. A NOVEL METHOD FOR CRUSHING STONE. DR. POST exhibited a specimen of calculus removed from the bladder of a child three years old. The main point of interest connected with the case was the impossibility of detecting the existence of the stone until the third examination, it being situated high up on the be traced. Hence it is fair to infer that many, or the most, of these latter owe their origin either to some decided injury which has been forgotten, or to a succession of slighter ones, each too trivial to attract notice. This might easily be the case, owing to the feeble sensibility of the spinal column. If the ankle is sprained, it at once becomes acutely painful; it gets rest, and gets well. But if the spine is injured by a fall or a blow, it may give no protest, either immediately or throughout the course of the resulting disease; or, if pain be present, it may not be referred to the back. Hence the inflammation consequent upon such injuries is often allowed to go on, subject to constant aggravations, unchecked and undiagnosticated, until the projection of one or more of the spinous processes becomes marked; though the means of diagnosis are sufficient where the disease is suspected. These traumatic cases, if taken early, can be completely cured; and at any stage their further progress may commonly be arrested by efficient mechanical support. But in the strumous cases, where abscess has been formed or the vertebræ are perhaps tuberculous, there will usually be a certain amount of progress of the disease, in spite of the treatment, and we can only expect to alleviate. In Rokitansky's extensive collection of specimens of this disease, Dr. Taylor had found the cases classified into "carious" and "non-carious," the latter exhibiting simple absorption of the vertebrae, with no evidence of caries. He had himself made no post-mortem examina tion of patients in the first stages of the disease, but a friend of his had had the opportunity in a case dead of scarlatina. On placing the hand beneath the back and raising the body, one of the vertebræ split open; it was very red, but not carious. In reply to a question by Dr. Post, the Doctor said that cases may often run through their whole course, with absorption of one or more of the bodies of the vertebræ, and yet exhibit no caries at any stage; Rokitansky's specimens established this. He referred also to a specimen in Guy's Hospital Museum, where seven vertebræ were so completely ankylosed that no lines of division could be distinguished. This, in DR. POST's opinion, implied antecedent caries. DR. BUCK thought it indicated that there had been softening of the vertebral spongy tissue. DR. TAYLOR said that not one in twenty of his own cases had abscess after applying support. DR. POST had found evidence of suppuration comparatively rare. DR. BUCK believed that a tubercular origin of this disease was now ascertained to be the rare exception. That was Lebert's conclusion from his researches. DR. SAYRE asked if Dr. Taylor had meant to say "carious" and "non-carious," or "tuberculous" and "non-tuberculous;" and if the former, what were the diagnostic marks? DR. TAYLOR had meant "carious" and " noncarious." In the former class would be found the scars of old caries; and there would be points of caries, not healed, on the vertebræ above and below those most affected; while in the non-carious cases the vertebræ above and below the point of curvature would be sound. the same. DR. SAYRE said this agreed with his own view, that Pott's disease, hip-disease, and all affections resulting in diseases of the joints, were not tubercular. All the cases of hip-disease which he had yet seen could be traced to a traumatic origin, more or less extensive; though he would not assert that all cases were necessarily traumatic. Of course a child with feeble constitution would require a less severe blow to produce the disease than would a stronger one. But most of his cases had been in those of strong constitution, because such were more exposed to injury. A sickly, tuberculous child would not run and risk itself. So far as his experience went with regard to Pott's disease, it was Nine cases out of ten begin as periostitis. The numerous muscles attached along the vertebral column may, in the various gymnastics of children, wrench and strain the fibrous tissues; or, with their powerful leverage, even tear the muscles from the periosteum. This in cases where the disease begins externally. The periosteal inflammation may lead, sooner or later, to extensive suppuration; and the pus, being deep-seated, cannot escape, and you have a large abscess. All these abscesses that he had seen had been connected with necrosis of some portion of the spinous processes; and all could be traced to injury resulting, in this manner, in exfoliation of a portion of bone. Where the disease begins in the body of the vertebra, concussion, or some similar cause, may start the inflammation, which may go on to absorption or abscess. The reflex muscular contraction presses the bones closer and closer together, and in many cases complete ankylosis takes place, and recovery with deformity. The very fact that hundreds of cases of Pott's disease recover, where one dies, shows that it is not tubercular. No deposits of tubercle are found elsewhere in the system. It was this which had first led the Doctor to doubt the tubercular origin of the disease. The patients recover of themselves, but they recover deformed; and the absolute importance of mechanical treatment is to prevent deformity. DR. H. G. DAVIS had found the most common cause to be concussion,-a fall bringing the weight of the body upon the spinal column,-though in some few cases a blow upon the back had been the cause. The patient will complain more of such concussions as press the vertebrae together than of anything else. DR. SAYRE and DR. TAYLOR both agreed with the speaker. He continued, relating the case of a patient under treatment for hip-joint disease, many years ago, who had kept his hand constantly under the hip, for support and protection, and could not be induced to remove it. The result was that he utterly lost the use of the whole side, simply from rest and confinement; all the joints were ankylosed. DR. SAYRE.-Absolute rest will produce joint-disease. That is traumatic; that is an abnormal condition for the joint, to be strained and kept in one position. DR. TAYLOR, in reply to a question, said that, relatively speaking, one class of cases was only to be alleviated. The great number of the cases occurring in healthy constitutions can be cured. In feeble constitutions, the disease, whether due to injury, or, as rarely, to tubercle, can commonly be arrested where it is; but we probably cannot straighten the spine. And in these feeble cases, we must be a little more careful how much straightening we attempt. Moreover, there may be some further progress of the disease. DR. DAVIS. If the treatment were begun early enough, there would be no deformity. I have never commencement, the form could not be kept good, no seen a case yet in which, if properly treated from the matter how far the disease went; except, perhaps, in the upper dorsal vertebræ, where you have no leverage. In other portions of the spine, no matter how many vertebræ may be involved, if you continue the other will be repairing, and bony deposit will straighten treatment, while one vertebra is becoming diseased the it. I frequently have cases where the patients get well, apparently, and can jump, or put themselves in any position; and after two or three months they complain again; and the same process is gone through, at intervals, with three or four vertebræ. If kept in the right position, they recover with straight spines. DR. TAYLOR.—That is exactly what I meant to say. In certain cases there will be progress, but there may be no deformity. DR. DAVIS.-The youngest case in which I have seen the disease stopped at once was that of a child nine years old; but frequently, in older patients, it stops at once upon applying pressure. I think the profession do not consider what can be done in Pott's disease, if they will take action immediately; if, where diagnosis is doubtful, they will call an expert, and apply apparatus in the first stages. It would save the patient a great deal of trouble and much loss of vitality; and equally so with hip-disease. One point may be mentioned regarding the treatment of Pott's disease. In the spine we have two separate means of support, the bodies of the vertebræ and the lateral processes. In the treatment, the design is to take the weight off from the bodies, and throw it upon the oblique processes, which are never, so far as I know, diseased. This gives us every advantage in the treatment. DR. BUCK described a new cheiloplastic operation, illustrating it by means of a beautifully made dissection, and by drawings and photographs. He prefaced the description by a review of some other operations with the same object. The substance of the Doctor's remarks was given as a clinique at the New York Hospital, and will appear in our Clinical Department. STATED REUNION, FRIDAY, FEBRUARY 14, 1868. DR. OLIVER WHITE in the Chair. INSTRUMENTS FOR THE STUDY OF NERVOUS AFFECTIONS. DR. WM. A. HAMMOND presented and remarked upon the Esthesiometer, the Dynamometer and the Dynamograph, and a new invention of his own which he had termed the Encephalometer. The first of these instruments (figured and described in MEDICAL RECORD, Vol. I., p. 510), though known for several years, has not received sufficient attention in this country, where it is very little used. It is valuable not only in cases of hyperesthesia, or of well marked paralysis, to determine the degree of the affection, and its progress towards recovery or the reverse, but also in doubtful cases, as a means of diagnosis. In two or three instances where the patient's sensations of numbness, formication, etc., had seemed to point to paralysis, Dr. H. had learned, by the æsthesiometer, that this was not present, and that some other cause for the sensations must be sought. A very good scale of the normal sensibility may be found in Dr. Seguin's little prescription book. This instrument, an index of tactile sensibility, is properly supplemented by the next, which is a measure of muscular power. The dynamometer, with the dynamograph attachment for registering its indications, is a late addition to our means of positive diagnosis, the one here shown, made for the Paris Exposition, being the only one yet sent out by Mathieu. (Otto and Reynders have made one without the graphic attachment.) It is fully described, with illustrations, in the January number of the Quart. Jour. Psychol. Med. Suffice it here, that it consists essentially of a pair of elliptic springs to be compressed by the hand, and an index to show the amount of compression. By the dynamograph, which can be attached at pleasure, the regularity or irregularity of the pressure exerted is accurately recorded in a trace upon a card moved by watch-work, as in the sphygmograph. (Vide MEDICAL RECORD, Vol. I., p. 580.) This trace shows not so much the patient's strength as his muscular tone, his ability to maintain a steady muscular contraction for a given time. By comparison of the traces made from day to day, the effect of treatment in paralysis and some other affections can be better observed than in any other manner. The instrument has also some value in diagnosis, and will doubtless come to have much more. For it is to be Loped that, when observations are sufficiently multiplied, rules may be discovered for distinguishing, by the form of the trace, the different forms of paralysis. The encephalometer is designed to show the relative amount of blood in the brain, and thereby to determine various questions of physiology, of the physiological effect of drugs, etc. It consists of two tubes, an outer and an inner; the first to be screwed into a trephined opening in the skull, the second partially filled with colored fluid, closed below by thin rubber, and ending above in a graduated glass portion of small calibre, The inner tube is carried down until the rubber presses upon the dura mater, so as to force the colored fluid part-way up the graduated scale. Any increase or diminution of the amount of blood in the brain is then instantly shown by the rise or fall of this fluid. The instrument might be applied without harm after trephining for surgical purposes, and Dr. H. was awaiting a suitable case. He had already tested it upon animals, and upon infants with open fontanelles, to which it could be readily adjusted. He had been able fully to confirm his previous observations, that the amount of blood in the brain is decidedly diminished during natural sleep. Under æther or chloroform the fluid rises rapidly at first; but when the stage of excitement has passed, it falls below the normal waking standard, and so remains until the animal wakes. Hence it is probable that these anaesthetics really induce sleep. But with opium the fluid does not fall, showing that the stupor it produces is not natural sleep. The bromide of potassium certainly diminishes very materially the amount of blood in the brain. DR. BEARD had found the electric current a very good æsthesiometer, applying it by means of a metallic electrode, so that differences of pressure would not, as with the hand or a sponge for an electrode, vary its intensity. The sensibility of the affected parts of the body should be compared with that of the corresponding healthy parts. He had found tests, whether of sensibility or of muscular power, liable to prove fallacious if made immediately after prolonged exercise, as in the movement cure, or a prolonged application of the electric current. STATED REUNION, FRIDAY, FEBRUARY 21, 1868. DR. GURDON BUCK, PRESIDENT, in the Chair. THE TURKISH BATH. DR. E. C. ANGELL read a paper upon the therapeutic uses of this agent. The Turkish bath, as most of our readers know, is that in which hot air, and not vapor, is employed to produce free perspiration, the patient drinking water freely; this is followed by the shampooing process, and this by the application of water, in spray or otherwise, at a graduated temperature; after which the bather is cooled off, and, perhaps, takes a nap. The paper gave the history of the bath; and spoke of its great value to persons of sedentary habits, as supplying the place of exercise, affording its benefits without its fatigue. The air-bath could be used at a much higher temperature than the water or the vapor-bath, without impeding perspiration, accelerating the pulse, or producing debility. Water could not be used advantageously much above 100° F., nor vapor much above 115, while air at 250' might produce no bad effect. Its value in the treatment of the effects of alcohol, and in overcoming the desire for it, was dwelt upon, and illustrated by cases. Heat was the best substitute for the customary stimulus. Its prompt cure of a case of severe eruption from poisonous food showed its efficacy in purifying the system from noxious elements. The poison of rheumatism, and even malaria, could thus be completely eradicated; and nearly all fevers could be aborted, abridged, or greatly palliated. The diseased body was treated as a soiled sponge. The water first passed through it was much discolored, the perspiration being commonly offensive to the smell, acrid to the taste, and stinging to the eyes; but after a time it became perfectly clear and pure. The bath had produced the happiest effect in a case of diphtheria, which was related. It was very efficient in inducing sleep, probably by calling the blood from the brain to the surface, in accordance with Dr. Hammond's view. The perfect safety of the bath was shown by reports from the large establishments in London and Dublin, where, in an aggregate of two million bathers, not a single authenticated case of injury could be produced. In 1861 these baths were introduced into the insane asylum at Cork, more than doubling the percentage of cures, and diminishing the death-rate more than one-half. Dr. Robertson, of the asylum at Hayward's Heath, highly extols the baths in the treatment of insanity, and of the menstrual irregularities often found associated with mania. Dr. Angell had seen several cases in which supposed sterility had, after a few baths, given place to fruitfulness. The baths might be frequently used, in some cases as often as twice a day, with excellent tonic effect. In response to questions by DR. BUCK, DR. FOSTER, and other gentlemen, Dr. Angell said that a bath commonly occupied about an hour; that it should not be taken sooner than three hours after eating; and that for business men the evening was commonly the most convenient time. No danger was to be apprehended from exposure to cold after the bath; the skin was stimulated to withstand it; and the habitual bather could wear thinner clothing than others. There was little or no oppression on first entering the bath. The hot air, being dry, could be breathed with perfect ease. The head was commonly kept wet, and the hot footbath almost invariably used, to call the blood from the At the Jermyn street bath, in London, a heat of 250° was sometimes employed. Low and moderate temperatures were used in England to prevent the night sweats of phthisis. In cardiac affections the bath was used to relieve the heart, by stimulating the surface-circulation. The doctor had seen no tendency to syncope in these cases. In acute rheumatism he had gained the happiest results. A patient had been sent him who had been unable to turn in bed for several days. He was put into the bath for one hour, at 175°, and that was the last of his rheumatism. brain. hyperæmia of the auditory apparatus; 2, malposition of the membrana tympani; 3, anæmia; 4, causes dependent on the condition of the brain and auditory nerve; 5, causes not classified. 1. Of all these, hyperemia is much the most common. It may act by producing hyperæsthesia of the auditory nerve; by causing pressure upon the nerve from intumescence of contiguous parts; or by creating a real murmur in some of the neighboring vessels. The hyperemia may be acute or chronic, inflammatory, or due to such transient causes as a dependent position of the head, violent exercise or emotion, a full meal, or a glass of wine. Its agency may be shown by compression of the carotid, which will often relieve the tinnitus. 2. The most frequent malposition of the membrana tympani is its depression, increasing its concavity, and pressing inwards upon the ossicula, and so upon the fluid of the labyrinth. The abnormal concavity of the membrane may be due to inflammatory or other change in it, or to the pressure upon it of polypi or other growths, of cerumen, of foreign bodies, as a badly adjusted artificial membrane, or of air confined by some occlusion of the meatus externus. On the other hand, tinnitus may accompany flattening of the membrane from distension of the tympanic cavity. 3. General anæmia, upon whatever dependent, will occasionally cause tinnitus, probably both from the vascular murmurs which belong to this condition, and from the defective supply of blood to the auditory nerve. The latter mode of action is exemplified in the tinnitus and deafness which, like blindness, may occur in fainting. 4. Of the fourth class of causes our knowledge is very limited, and must doubtless long remain so. It includes nearly all the morbid conditions of the labyrinth; and when we consider the complexity and delicacy of the mechanism here found, it is not strange that even slight changes should produce decided functional disturbance. The diagnosis between disorder of the internal ear and that of the brain is always difficult and often impossible; either may give rise to the other; and either may have tinnitus among its sympDR. ANGELL called attention to a new system of heat-toms. [The paper gave an account of the structure of ing, by passing the furnace flame through pipes composed mainly of sand, an excellent radiator. He had introduced it into his own establishment, and been gratified by its working. It was quite cheap, and could be introduced, at moderate cost, into the residences of those wishing to avail themselves of the bath at home. DR. C. F. TAYLOR thought it important that it should be generally known that air could be borne at a much higher temperature than water. He always used hot air for paralyzed extremities, a child easily bearing this at 150°, where water could not be borne at 95°. DR. CARROLL said that this had been settled more than fifty years ago, by the experiments in ovens. If the air were perfectly dry, a temperature of 400° could be sustained. As to the therapeutic value of the hot air bath, although Dr. Angell had not claimed it as a specific in any disease, he thought it might be so considered in desquamative nephritis. In the case of his own child, dangerously, and it was thought fatally, ill with this affection, following scarlatina, he had used only hot air and tonics, with decided benefit from the first, and complete ultimate success. STATED REUNION, FRIDAY, FEB. 28, 1868. DR. ALFRED C. POST in the Chair. DR. O. D. POMEROY read a paper upon this subject, the labyrinth, and of such pathological conditions as have been noted by Politzer, Wilde, Harvey, Troltsch, Toynbee, and Voltolini.] 5. Badly constructed hearing trumpets may occasion tinnitus. So may any foreign body, as a hair, resting upon the membrana tympani, though producing no change in its position. Kramer lays great stress upon irritation of the chorda tympani as causing this symptom through reflex action, and plausibly supports his view. Hyrtl states that the internal carotid occasionally sends a large branch through the stapes, whose pulsations move the bone and give intermittent sounds. J. Miller speaks of a snapping noise due to spasmodic contraction of the tensor tympani. Wilde deems non-vibratility of the membrana tympani the chief cause of tinnitus. Certain drugs produce the affection, probably by inducing congestion about the auditory nerve. It is a well known effect of quinine, and may follow its exhibition in very small doses, as half a grain thrice a day. Whenever an impression is made upon any nerve, whether it be a nerve of motion or of general or special sensation, it responds in accordance with its own proper function. The auditory nerve responds by the sensation of sound. This sensation, when excited by sonorous undulations, transmitted through the membrana tympani and the apparatus connecting it with the nerve, is called For an affection dependent upon such varied condihearing; but if excited by other causes it is called tinnitus tions, the treatment must be correspondingly varied. aurium. This tinnitus is not properly to be considered In inflammation, acute or chronic, leeches to the exteran "imaginary sound," but rather, as Watson styles it, nal canal and blisters behind the ear are the main reli"a depravation of the sense of hearing," the fault lying ance. Anodynes also are of material service. In acute usually in the auditory apparatus and not in the hemi-cases, warm water poured into the ear gives great relief. spheres. The symptom presents itself in the greatest In chronic, with considerable redness of the membrana variety, the noises heard being compared to the hissing tympani, a solution of nitrate of silver (gr. xx.-xl. ad of steam, the roaring of water, the discharge of cannon, aq. f3j), brushed upon the membrane, has banished the the playing of musical instruments, human voices, etc., congestion and the tinnitus. Where an acrid secretion bathes the tympanic cavity, irritating, as Kramer thinks, the chorda tympani, he expects relief from etc. The causes of the affection may be divided into: 1, syringing with warm water. Depression of the membrana tympani is often due to closure of the Eustachian tube, the air within the cavity being soon absorbed and leaving no counterpoise to the atmospheric pressure without. In such cases inflation of the cavity through the Eustachian tube, with proper treatment addressed to the condition of the tube itself, gives the happiest results. Where such inflation is impossible, it may be necessary to puncture the membrana tympani and so equalize the pressure. Puncture may also be required for the evacuation of pus in the tympanic cavity, when this cannot be effected by inflation. Total removal of the membrane may be justifiable in extreme cases. This would probably give complete relief (perhaps from its involving destruction of the chorda tympani), if we may judge from the cases in which the membrane has been destroyed by disease; for in these tinnitus is at least very rare. In the removal of foreign bodies or morbid growths, which may be pressing upon the membrane, the greatest care should be exercised, employing glycerin, alkaline washes, and the syringe when possible, and the forceps only under sight. Where the tinnitus depends upon disease of the internal ear or of the brain, there is little prospect of help. In the former case many plans have been tried, and occasionally the introduction of chloroform vapor into the tympanic cavity has proved useful; in the latter, such treatment as we have at command should be addressed to the cause. remedy. For ten years he had been experimenting with electricity. In his own case it had produced no benefit whatever; with others he had sometimes succeeded, oftener failed. The current, passed through one ear, or both, would sometimes give decided relief, though he could not say to what class of cases it was best adapted. The electrode should not be applied to the external canal, where even a weak current would give great pain, but either just below or just in front of the auricle, where a pretty strong current could be borne and should be employed. In his investigations, in conjunction with Dr. Roosa, the doctor had found many deaf mutes troubled with tinnitus. DR. PETERS thought we might sometimes be mistaken with regard to the action of quinine as producing this symptom. Some years ago, in an attack of intermittent fever, he had taken no quinine until after the first three paroxysms, yet experienced a most severe singing in the ears. After that he took quinine and watched the effect of every dose; it made no difference in the singing. DR. FOSTER had suffered about twenty years from tinnitus, which he considered mainly a sympathetic symptom of dyspepsia. It did not increase on him. In reply to a question by Dr. Roosa, he said there was no impairment of hearing in either ear. DR. ROOSA thought the watch-test would probably show some impairment; this was almost invariable except where the tinnitus depended on cerebral affection or anæmia. He wished to know how dyspepsia should cause it; by congestion? DR. BURRALL Would account for this, in many cases, by the irritable condition of the throat apt to accompany dyspepsia. He was at present suffering from tinnitus which he thus explained. DR. ROOSA thought that, in cases of chronic catarrh of the middle ear, the increased concavity of the membrana tympani was often due to its being drawn inward by traction upon the handle of the malleus, the mucous membrane being thickened. These patients complained much more of the noise than of the deafness. He had one under treatment who said this noise was driving DR. BEARD had always supposed it conceded that inhim crazy; and, strangely enough, his deafness had digestion would aggravate tinnitus, doubtless by probeen somewhat alleviated by inflation, forcing the mem-ducing congestion. Tinnitus might probably exist brane outwards, while the tinnitus was unrelieved. In without impairment of hearing, perhaps when caused these chronic cases he had tried nearly every form of by hysteria, which might exhibit almost any symptom. treatment, only to be disappointed; and he now hard- He thought he had seen one case, at least, in which this ly advised treatment for the tinnitus, but simply for the symptom was unattended by the least impairment of deafness. In the subacute attacks, which such patients hearing. were constantly having, warm water within the ear and mustard behind it were as good as anything. Kramer's theory, that tinnitus is due to irritation of the chorda tympani, he thought its author had failed to sustain. It was commonly due to pressure or to disease of the labyrinth. The reason that we had no tinnitus in the absence of the membrana tympani was that there was then nothing to exert pressure upon the ossicula. That it might be excited by introducing an artificial membrane was evidence of this view. Quinine he thought the profession was coming to suspect as dan gerous to the ear under all circumstances. DR. BEARD had taken a very personal interest in the subject, having enjoyed the delights of tinnitus for some twenty years, owing, doubtless, to chronic inflammation of the middle ear. He had heard almost every kind of sound, even long conversations. Often the sounds were synchronous with the pulse. As to quinine, he could hardly imagine a dose so small that it would not increase his tinnitus, and a dose of three or four grains would annoy him for several days. He had had a patient made completely and permanently deaf in one ear by its use. With regard to treatment, subacute inflammation of the middle ear, and the tinnitus dependent upon it, would readily yield to the use of the catheter; but the chronic cases would yield to nothing. He had no faith whatever in counter-irritation. At the best, it could give but temporary relief, and this was more than counterbalanced by the annoyance of the DR. CARROLL asked if tinnitus might not be a mere symptom, without any abnormal condition of the ear itself, a central disturbance being referred to a peripheral nerve. In his own case, after severe mental exertion, he often had tinnitus for three or four days, with no diminution of his acuteness of hearing. DR. ROOSA insisted upon accurate tests and wanted to know if the doctor had employed them. The distance at which the watch-ticking could be heard must be determined by approaching it, not by retiring from it. Wherever the tinnitus was referable to the labyrinth or to pressure upon the auditory nerve, the hearing was inevitably blunted. Dr. Carroll satisfied him that his tests had been sufficiently delicate. DR. POST and DR. BEARD thought the pulsating form of tinnitus the one most frequently due to dyspepsia. DR. POMEROY regarded this and the venous hum as the only forms having any diagnostic value. MICROPHYTES. Among the researches brought before the Academy of Sciences of Paris, a series of the highest interest, undertaken by M. Lemaire, should be mentioned. This ingenious investigator has found, by carefully conducted experiments in barracks, the open air, and upon people in good health, that upon the body, or from its emanations, microscopic beings may be collected, the existence of which will considerably assist those who study parasites.-Lancet. |