of love and friendship. He called it Platonic love, but it was probably the genuine article. In the fighting line Italy has produced the oldest successful general and the oldest successful admiral that history records.

ENRICO DANDOLO (1110-1205) was eighty-three when he was elected doge of Venice. He had been doge ten years when he laid siege to Constantinople and took it, to seat a claimant, Alexius, on the imperial throne. The next year he started on a crusade with a French army to capture the Holy Sepulchre from the infidels, but getting as far as Constantinople and learning that the city was in possession of the opposite party, who had murdered Alexius, he abandoned his crusade, laid siege to the city and took it a second time, by storm, pillaged it, and made Count Baldwin, of Flanders, emperor. What adds to our wonder is that Dandolo was blind.

ANDREA DORIA (1468-1560) was doge of Genoa and one of the greatest sea fighters that history mentions. His main business was fighting the Turks, who at that time were threatening to overrun Europe. He restored the independence of his own country by driving out the army of the French king, Francis I, and was offered its sovereignty but refused, preferring to be a citizen. Like Washington, he was called the Father of his Country.

Examination of the remaining countries of Europe might afford equally as good material as that already cited, but this paper is long enough now, although one name in Spain ought to be mentioned.

CERVANTES, the author of a book-"Don Quixote"-which has probably caused more mirth than any other book ever written. He did not reach so great an age as some, but he was a man who had endured all kinds of hardships, having been a common soldier and a slave among the Algerines. It is sufficient to say that he wrote the last half of that book after he had past the three-score years and ten. Two famous Russians will be noticed in concluding.

COUNT LYOF TOLSTOI (born 1828), reformer, author and advocate of human rights. Suspected by the Russian government and excommunicated by the Russian Church, he is yet as busy as ever with his pen in the good cause.

METSCHNIKOFF (1845), the other famous Russian, has just reached Osler's deadline. He is still at the Pasteur Institute in Paris coralling the phagocytes, and endeavoring to subject them to order for the purpose of studying their habits and thereby discovering how to prevent the dry rot of old age. He has already made some wonderful discoveries, rendering certain things plain that have long been a puzzle. He lives strictly in accordance with his own discoveries and theories, and eats his curdled milk every day for his regular diet to colonize his intestinal canal with its bacteria, one of his most practical discoveries being that the microbes of sour milk are the most deadly enemies of the bacteria of putrefaction, which are always swarming in the intestinal canal ready to riot whenever opportunity presents. What Metschnikoff does in this line henceforth will be watched by the world with great

interest. He has said lately that the problem of producing something practical for the prolongation of life does not seem to present insuperable difficulty.

The above notices of the work of some old folks could be increased indefinitely by including the yet active workers in their eighth decade, but enough has been said to show the nullity of Osler's disparaging estimate of the value to the world of the old, and we may express the hope that he will live to prove it by his own example in his new sphere of activity.

This subject will be resumed in a paper giving the ideas, observations, and theories of the writer on the second proposed question-How to be alive and stirring when eighty-four years have passed over one's head.

NECROSIS OF THE MASTOID PROCESS.

WALTER J. BENN, M. D.

A LABORER, aged forty-two, was brought to me, December 1, by his brother and sister, who complained that their brother had "something the matter with his head." When asked to describe his symptoms, they said that he had "acted queer" for about two weeks; did not seem to be interested in his surroundings; was listless and spent his time in sitting in absolute idleness; constantly complained of pain and a "funny feeling" in his head, and was "getting worse."

History. In early childhood, patient was troubled with frequent attacks of earache, and occasional discharge from right ear. At the age of six, an attack of acute mastoiditis-at which time he "nearly died"-resulted in the breaking down of the bony structure sufficient to allow pus to escape at a point about three-quarters of an inch posterior to the attachment of the concha and about the middle of the mastoid, this being followed by a speedy apparent recovery. Since this first attack, patient has had five similar, though less severe, attacks at varied intervals, the last having occurred about "two years ago." Patient's general health has been comparatively good. I was unable to obtain family history except that two sisters and two brothers are healthy.

Examination.-Pulse, 83; temperature, 99%; face vacant and expressionless; pupils, dilated; watch-tick, at orifice of right external auditory meatus, nil; on right mastoid, nil; at left orifice, faint; on left mastoid, distinct; on frontal, faint. It was necessary to speak very loudly to make patient hear, and he watched my lips to aid him in understanding what I said. Right meatal walls swollen, orifice oneeighth inch in diameter; left meatal walls swollen, orifice about onequarter inch in diameter; left meatus full of fresh pus which had dried around orifice. There is a cicatrix, one inch long, over right mastoid, extending obliquely from a point one-half inch posterior to base of suprameatal triangle, downward and backward to a point three-quarters

of an inch posterior to inferior border of concha. This scar is from one-eighth to one-quarter inch wide, and skin is adherent. Pressure on either tragus and on right mastoid caused vertigo, and nausea followed pressure on left tragus. No pain on pressure of either mastoid. Right middle and inferior turbinated bodies hypertrophied posteriorly, typical chronic condition; left turbinates slightly hypertrophied; septal spur five-sixteenths inch wide, one-eighth inch thick, extending the whole length of septum horizontally, about one-eighth inch above floor of left nasal fossa; slight ozena in anterior area of left nasal fossa; slight ozena in anterior area of left nasal fossa. Posterior walls of pharynx hyperemic and covered with white catarrhal exudation; fauces congested; tonsils slightly enlarged. After irrigating with hot water, swelling subsided sufficiently to admit speculum, and I found right tympanum externum and ossicles absent; inferior posterior two-thirds of left tympanum externum absent, the free border of the remaining third smooth and crescentic.

Diagnosis. Chronic mastoiditis, suspicion of necrosis, right side; chronic suppurative otitis media, left side.

Treatment. I recommended complete mastoid operation as the only means of curing the condition on right side, but neither patient nor his friends would consent to this. I did not feel that I could obtain satisfactory results in any other way, but agreed to attempt a cure by medication alone. I instructed patient to irrigate the meati four times, at intervals of two hours, with water as warm as could be borne, and to return the following day.

On December 2, 1905, I irrigated meati with warm boracic acid solution, and discovered right posterior meatal wall to be soft and of a brown color. With a cotton-tipped applicator, I broke through this wall, and disclosed a large sequestrum, the odor from which was very offensive. After removing about a drachm of necrosed tissue, I found that the applicator entered both the antrum and the tip of the mastoid, the intercellular structure having necrosed and left a cavity between the superior, anterior and inferior meatal walls and the external plate of the mastoid. This cavity I filled with boracic acid solution, and with the cotton-tipped proble I removed what I could of the necrosed tissue. I then had the patient turn his head to the left and filled the cavity with a one to one thousand solution of alphozone, allowing this to remain in the cavity twenty minutes. I then dried the diseased surface and packed cavity with moist, five per cent iodosyl gauze. This line of treatment was followed, daily, for a month, and at each sitting I sprayed the nasal fossæ with alkaline solution and nebulized with camphomenthol compound in abolene, with very little change in condition except that there was a brighter appearance of the face and a more comfortable feeling on the part of the patient.

On January 2, 1906, I removed the septal spur. After the first month, I added to the treatment a second irrigation consisting of a solution-two grains to the ounce-of potassium permanganate, which

I forced through the Eustachian tube, with Politzer bag, from without inward, and discontinued the alphozone. At the close of the third month no more necrosed tissue followed either the irrigation or the probing, and I then discontinued the iodosyl gauze packing, the alkaline spray and the nebulization.

Since April 1 treatment has been as follows: Warm water irrigation; glycothymoline (full strength) dropped into cavity; alcohol dropped into cavity (each application of liquid being forced through the Eustachian tube and the cavity thoroughly dried after each application); insufflation with powder composed of twenty parts camphor and eighty parts boracic acid; a final Politzerization and a loose packing with cotton. Treatment every second day from April 1 to June 1. On June 4, patient went to work in the shipyard, and was instructed to call Wednesdays and Saturdays, and, on June 11, I obtained the last sign of pus.

As this article treats of necrosis of the mastoid, I have purposely omitted treatment of the left ear, and will only say that I followed a similar line of treatment to that indicated for the right ear.

In conclusion, I will say that the patient continues his work at the shipyard; is cheerful and comfortable; hears and understands an ordinary conversation at a distance of two feet without watching the lips; claims to hear the watch-tick against right meatal orifice and can hear it, distinctly, at a distance of fourteen inches from the left ear. The left tympanum externum has reformed with the exception of a central perforation the size of a small pinhead. I am continuing the treatment twice a week, with slight modification, although I consider the patient. practically discharged.

Bay City, Michigan.

ORIGINAL ABSTRACTS.

SURGERY.

FRANK BANGHART WALKER, PH. B., M. D.

PROFESSOr of surgERY AND operative surgery IN THE DETROIT POSTGRADUATE SCHOOL OF MEDICINE; ADJUNCT PRofessor of OPERATIVE SURGERY IN THE DETROIT COLLEGE OF MEDICINE.

AND

CYRENUS GARRITT DARLING, M. D.

CLINICAL PROFESSOR OF SURGERY IN THE UNIVERSITY OF MICHIGAN.

THE PRESENT STATUS OF GASTRIC SURGERY WITH SPECIAL REFERENCE TO THE TREATMENT OF CHRONIC ULCER.

LOUIS FRANK, M. D., of Louisville, Kentucky, in American Journal of the Medical Sciences for June, 1906.

The first portion of the paper deals with the historic part of gastric surgery. The oldest operation on the stomach for the extraction of foreign bodies was performed by Crolius, in 1602, to remove a knife.

Though this was successful only thirteen cases had been reported to 1887. The first gastrostomy, unsuccessful, was done in 1839, by Sedillot. Pylorectomy was first performed by Pean, in 1879. The first gastroenterostomy was performed by Wolfler, in 1881. This was done to procure rest for the stomach. The entire removal of the stomach, which was first successfully performed by Schlatter, since then by Bernays, Richardson, and a few others, is so rarely done that we may dismiss it from our consideration of chronic ulcer.

In the treatment of cancer of the stomach we are concerned with the proposition, Is the disease removable, and, if not, can anything be done to prolong the patient's life, or relieve the starvation and pain caused by obstruction? This condition, if left alone, has but one ending and that is fatal. While having profound respect for laboratory findings, he does not believe it best always to wait until all clinical suspicions have been confirmed by these methods. Many patients would submit to an operation if it were not for the fact that the family physician often counsels against the advice of the surgeon, thus in many instances causing a fatal delay. Cancer, no matter where located, should always be removed upon the slightest suspicion, and the mere fact that a tumor is present does not prove that it is beyond removal. Chronic gastric ulcer, in the opinion of many, should be treated by gastroenterostomy. He lays special stress upon the advice of Deaver, who recommends gastroenterostomy for complications and sequelæ of gastric ulcer; in fact, in all diseases of the stomach where gastric contents are not evacuated.

It is understood that the principal dangers of gastric ulcer are hemorrhage and perforation. The direct treatment of hemorrhage by excision of the ulcer, or direct treatment of the bleeding point when it is possible, leads only to good results. Gastroenterostomy has given the same results in the author's cases. Others have reported deaths from hemorrhage following gastroenterostomy.

Perforation is liable to occur in the mildest case of gastric ulcer. The symptoms of perforation are well known. There is only one course to pursue after the perforation has taken place. The operation of choice in ulcer is a properly performed gastroenterostomy. The mortality of this operation does not exceed fifteen per cent. Symptoms of ulcer are always well defined. Pain indicates a relatively advanced progress of the disease. Vomiting and nausea may be considered of only corroboratory value. Periodic attacks of headache are frequently coincident with gastric trouble. His picture of a victim is so vividly drawn that it should be given in full: "There are few beings so abjectly miserable as those who are the victims of intractable dyspepsia. The meal-time, which should be a delight, is a time of despair and foreboding. The keen relish of good food, which the man in physical health should appreciate, is a joy unknown or long forgotten to the dyspeptic. A patient who has misery written in every wrinkle of a thin, haggard face; who by reason of long suffering and