In case V, case of inguinal hernia where undescended testicle was found and removed. In case VI, strangulated left inguinal hernia, and scrotum occupied by hypertrophy of cord and epididymitis, measuring eighteen inches in length and weighing twelve ounces. Cut off and stump tied at ring. Rare complication. Patient died of exhaustion. In case VII, multiple cysts of cord. Had been treated by quack for spermatorrhea. Cysts aspirated. In case VIII, tuberculosis of cord had been mistaken for cancer.

Dr. Christian FENGER agreed with Dr. Steele that gonorrhea in itself has nothing to do with tuberculosis; that it will not cause local tuberculosis of the epididymis, any more than a trauma will cause local tuberculosis anywhere else in the body. When there is tuberculosis in the body somewhere, and consequently tubercle-bacilli in the current of the blood, then it may be that the local inflammation from gonorrheal epididymitis, just as extravasation of the blood from a trauma, favors the accumulation of tuberclebacilli in those places. Occasionally local tuberculosis will commence in an inflamed epididymis, but in a large number of these cases of scrotal tuberculosis there has really been no gonorrheic epididymitis preceding. DR. W. T. BELFIELD thought that too much stress had been laid upon the history as a means of differential diagnosis between syphilitic and other enlargements of the testicle; when affirmative, the history is a valuable factor; when negative, the diagnosis must be made without regard to the history. He mentioned a case where there was not only no history of syphilis, but also a nodular enlarge. ment of the epididymis with but slight increase in the size of the testis-features usually characteristic of tuberculosis; yet the patient's age (31) argued so strongly against tuberculosis that it was determined to try syphilitic remedies before proposing excision; the effect was immediate and complete. Primary tuberculosis of the genital organs is evidently an infection from within-hematogenous. The idea of local infection through intercourse with a subject of uterine or ovarian tuberculosis is of course fanciful; indeed, very many of these patients are boys just beyond puberty, who rarely have had intercourse. The growth of the tubercle-bacilli implies some local or general predisposition of the individual; one factor in this predisposition is evidently found in the conditions developed during the rapid growth of a part. Thus in childhood the epiphyses of long bones frequently afford a nidus for the growth of the parasite, while the rudimentary sexual organs

are never affected primarily; but when with puberty the genital organs begin a rapid development, they are especially prone to become the site of the infection.

The tuberculous testicle should be excised, provided the prostate and seminal vesicles are apparently healthy, to remove the chances of further infection. While it is, of course, possible that there may be other and undiscovered foci of infection in various parts of the body-lymphatic glands, lungs or elsewhere -yet castration not only improves one, perhaps the only tuberculous nidus, but especially diminishes the danger of infection of the prostate and seminal vesicles-a necessarily fatal as well as agonizing affection; tuberculosis of the lungs is sometimes arrested by proper climatic and hygienic conditions; but tuberculosis of the prostate never, so far as we know, by either hygienic, medical or surgical means.

DR. MCARTHUR had little to say in regard to the differential diagnosis. In regard to scrotal tumors there was a point upon which he would like to have light, viz., whether Dr. Fenger would have the society believe that tubercular testis is always the result of general tuberculosis; that is that the tubercular bacilli are brought in the blood to the point where the local inflammation occurs. He had privately asked Dr. Belfield, if such were the case, what would be the advantage of an early removal? He had removed a testicle that happened to be a tubercular one. The man was 35 years of age, in apparently robust health, with no evidence of pulmonary or kidney affection. Dr. McArthur advised the removal of the testicle and performed the operation. On microscopic examination all the characteristics of tubercular testicle were found; within two months and a half the man died of acute tuberculosis.

DR. CHRISTIAN FENGER said that fifteen years ago nobody would have thought of extirpating a tuberculous testicle, because we knew that after the abscess has opened and discharged for a long time, such persons, if put under favorable circumstances, given codliver oil, sent to the seashore or country, will recover. So far as general tuberculosis resulting from a tuberculous testicle was concerned, only about 25 per cent of the patients, he thought, would become subject to general tuberculosis. In cases where the miliary tubercles were limited to the testicle, and all other parts of the body not as yet invaded, extirpation should be performed. It is a legitimate operation now, but has only become so within the last five years. It of course has to be limited to cases where, so far as we can

find out, the tubercle is local in the epididy mis. If the tuberculosis has invaded the vas deferens, it is difficult to see what good extirpation of the testicle could do, except as a mere local measure. Another point in tuberculosis of the testicle makes us desire, if possible, to eradicate the local tuberculosis, and thereby, perhaps, prevent the tuberculosis affecting the bladder. The patients are subject to most terrible suffering for a year or two before death when they get tuberculosis of the bladder. He did not think tuberculosis could be called local here, except if it could be transmitted by cohabitation with a woman having tubercles of the uterus, much in the same way as the microbes of gonorrhea are transferred, and this mode of infection is not proved as yet. The tubercles in the epididy. mis must originate in the same way as local tuberculosis in the bones, by arresting and accumulation of tubercle bacilli already pre-existing in the general circulation. He did not think it possible that, in the strict sense of the word, any of these tubercles could be called local.

DR. G. C. PAOLI did not claim to be a specialist, but had seen many tumors of the testicles and scrotum. Tumors of the scrotum often arise in connection with diseases of the prostate glands, and with strictures. He had seen tumors of the testicle produced by affections of these organs. Another thing that gives trouble in practice is neuralgia of the testicles, which is very difficult to diagnose because the only symptom we have is the severe pain in the testicle. Another kind of tumor which has not been mentioned is schirrus, and it is often difficult of diagnosis. Many that have been diagnosed as schirrus have been nothing but chronic orchitis. He once saw a testicle extirpated in the belief that it was schirrus, but it proved to be a case of chronic inflammation of the testicle. DR. J. L. GRAY read a paper on THE TREATMENT OF EPILEPSY BY LIGATION

OF THE VERTEBRAL ARTERIES, first proposed by Dr. Brown, of Calcutta, in 1831. Vertebral arteries furnish blood supply of the medulla, pons, cerebellum and pos terior third of cerebrum. Real seat of local disease in epilepsy supposed to be in the medulla, especially in the vaso-motor centres and regions related thereto, as convulsive center described by Nothnagel. In great irritatability of these centres, attacks of epilepsy due to reflex excitement of these centres. Ligate vertebral arteries, and there will be less blood sent to these diseased and hypersensitive centres. Thus is lessened tendency to epileptic seizures. Also, as several branches

of the sympathetic nerve must be necessarily ligated at the time the arteries are, this serves to lessen vaso-motor spasm in the medulla. Dr. Gray recommends tying the arteries between the atlas and axis. Operation been performed in Chicago seven times, with benfit in one case, temporary benefit in two, no benefit in two, fatal result in one, and result not known in remainder. Dr. Gray drew the following conclusions: 1. Ligation of vertebral arteries should take its place as a recognized procedure in cases of epilepsy in those cases where causes of attacks come from some region outside of brain. 2. The artery should be tied up as high as possible and the ligature should include all fibres of the sympathetic nerve accompanying the vessel. 3. When side of brain first invaded by the disease can be determined, the artery of that side should be ligated, and if the lesion be bilateral both vertebral arteries should be ligated. The operation should be done not as a substitute but as an aid to other forms of treatment for the cure or relief of epilepsy.

DR. D. R. BROWER in opening the discus sion, thanked Dr. Gray for his very able paper so full of interest and scientific importance, and said the case which he reported to the State Medical Society two years ago is now not quite so favorable. Indeed, the child has practically relapsed into the same condition she was at the time of the operation. For two or three months the change for the better in the child's condition was very manifest. In that case the ligation was made at one side, the intention was to have both arteries ligated, but such symptoms of collapse came on that it was deemed unwise to pursue the operation further, and there being so little benefit, the parents refused to have another operation. He thought with Dr. Gray that enough is before us favorable to the operation to recommend it in cases where everything else fails, and he would be disposed to press the operation in those cases where there seems to be some special disorder of the circulation in the medulla. He thought the trouble about the treatment of epilepsy is that we have included under this name a great many diseases. He was sure there are a great many kinds of epilepsy, and he thought we do not know how to differentiate those different kinds: therefore, our treatment must be to a great extent imperfect. There seem to be cases of epilepsy that are confined to the medulla. The history of some cases led him to suppose that the medulla is the seat of the disease, and in such cases it seems that the operation might prove a benefit. He did not believe that the circulation is reestablished

through the circle of Willis nearly so rapidly as Dr. Gray would have us believe. The circle of Willis is made up of minute arteries. In this particular case, there was a manifest and profound impression made upon the area of distribution of the vertebral artery for weeks; and he did not believe the collateral circulation was speedily established. He had no doubt that this operation will do good in some cases, just as any other profound impression will if made upon the nervous nervous system; the cutting and destruction of the connections through the various plexuses is beneficial, so is any extensive counter irritation. A seton added to other treatment that was only partially successful sometimes caused a wonderfully better result to follow. He had a case under observation in which the removal of a cicatrix has resulted in wonderful improvement in the patient's condition, whether due to the extensive counter-irrita tion produced by the operation or removal of cicatrix he did not know. He believed the operation justifiable in cases that resisted the ordinary treatment. He was an earnest advocate of the surgical treatment of epilepsy, the best results he had seen in this disease having followed the use of the surgeon's knife. Quite a number of cases had come under his observation in which the cause of the affection seemed to be in the ovarian region, and surgical interference was followed by better results than from treament by medicine. He thought the treatment of epilepsy by pills and powder one of the most unsatisfactory things that can be undertaken, and the proportion of cases benefited by drugs exceedingly small.

[TO BE CONTINUED.]

MEETING OF MEDICO-CHIRURGICAL SOCIETY OF ST. LOUIS.

The regular meeting of the society was held Tuesday evening, August 24, Dr. H. Hermann serving as president, and Dr. Joseph Grindon as secretary.

No regular paper being before the society, Dr. Frank R. Fry brought up the subject of the propriety of administering ergot in a case of spinal congestion in a pregnant woman. He himself felt a hesitancy in administering it under the circumstances for fear of its oxytocic effect. Opinions were expressed by Drs. Leete, Hermann, Grindon and Love, all of the same tenor-favoring great caution and very small doses, if administered at all.

Dr. Leete related cases of treatment of sciatica by internal administration of croton oil, drop in emulsion every two or three hours.

NOTES AND ITEMS.

"A chiel's amang you takin' notes, And, faith, he'll prent 'em."

A Paris letter says: A controversy is now going on in the scientific world on the conditions and Doctors Marechal, Jacopy and Bull say that under which genius is produced. Senator Naquet it is a neurose and that most great men have had mad or epileptic ancestors or descendants, or been themselves attacked with epilepsy or been in some respects on the very brink of lunacy. Cæsar and Peter the Great had falling sickness. Napoleon was subject to long fits of fainting that resembled catalepsy. Newton had also a disordered nervous system. Byron's mother was a raging irresponsible termagant, and father no better. Isabella the Catholic, who was certainly a woman of genius, had a mad uncle, a mad brother, and mad daughter, the ancestor of all the Spanish and Austrian Hapsburgs. Her (Isabella's) grandson, Charles V., also a man of prodigious political genius, was epileptic and the progenitor of a line which ended in idiocy. Pascal had fits and hallucinations. Luther also had the latter and thought he saw the devil in person coming to tempt him. William the Conqueror was the son of Robert the Devil, who must have had, to judge from the legend which has been handed down, a nervous system that ran riot. According to the new theory genius, like the orchard pear or apple tree, or the double rose, or dahlia, is abnormal, and except in an intellectual sense sterile. Thus Dante (a hypochondriac), Michael Angelo, Raphael, Shakespeare, Cowper, Wordsworth, Byron, Scott and DeQuincey, either left no posterity or families that soon died out. That of Victor Hugo is not apparently destined to live long. Victor Hugo had, on the maternal side, a mad uncle and mad cousins. His brother Eugene died in a mad house, and his only surviving daughter, Adele, has been for years in confinement.-The American.

[All of which goes to prove that genius and strong minds are products of robust healthy bodies. By the way, our own country furnishes an exception in the Flint family. The present Austin Flint, of New York, is the seventh only son in a direct line, every one of whom has been an able and successful physician. However, as Dr. Billings would say, these are the "exceptions which prove the rule."]

The Medical Record says "a cut in time saves nine." The unkind cuts it has been giving the International Medical Congress, are neither cuts in time nor cuts benign.

is evident that it can be carried out only by a limited number of persons.

THE DIET.-The regulation of the diet is a matter which demands consideration in every case of chronic gastritis. In trying to ascertain the best way of feeding these patients, I

IRON IN THE ORGANS IN DIABETES.

Dr. Stanislaus Zaleski.

VIII. DREES'S SOLUTION OF ALBUMI

and that is to feed them experimentally with different articles of food, and then after an interval of several hours wash out the stomach, and see how thoroughly these articles of food have been digested and removed from the stomach. After pursuing this course for a number of years, I have arrived at the following conclusions.

It is necessary that the patient should be well fed; a starvation diet never answers. The stomach does not require any rest from the performance of stomach digestion: on the contrary, it is all the better for

IX. IODIDE OF POTASSIUM IN THE TREATMENT OF INFANTILE BRONCHO-PNEUMONIA.

THE TREATMENT OF CHRONIC GASTRITIS

CLIMATE AND MODE OF LIFE.-These I believe to offer the most certain means of curing chronic gartritis. It is unnecessary to lay down rules as to the sort of climate; that can be regulated by the tastes of the patient. The two points of importance are: First, the locality selected must be one where the patient can lead an out-of-door life. Second, the patient must live in this climate either for several years, or for a considerable part of each year.

tions.

The patient's own ideas as to what food him agrees with are usually erroneous They are apt either to starve themselves or to select the least nutritious articles of food.

The use of artificially digested foods, or of substances such as pepsine to assist stomach digestion, is unnecessary.

The starches, oatmeal, corn meal, bread, the cereals, the health foods, are as a rule bad. Portions of them remain undigested in the stomach for many hours.

Milk in adults is an uncertain article. It answers very well for some persons, not at all for others.

Meat is usually readily and well digested, but there are occasional exceptions to this