that many of the so-called homicidal attempts, which come to light in the criminal courts, are attacks of this kind, which may be very uncommon in the subject's life, but are associated with certain forms of excitement or stimulation. It is rare for an epileptic to have nothing but psychical attacks, as they are generally associated with petit mal and occasionally with grand mal. -Med. Rec. Progressive Multiple Localized Neuritis (Mononeuritis Multiplex).-Remak (Deutsche medicinische Wochenschrift) describes as progressive multiple localized neuritis, or mononeuritis multiplex, a condition in which inflammation of several peripheral nerves remote from one another takes place successively, and he relates an illustrative case. A compositor, fiftyseven years old, presented progressive painless weakness, wasting, and sensory disturbance of the left hand of rather more than a month's standing. The previous health had been good, there was no history of syphilis, and none of alcoholism; and there had never been any evidence of lead poisoning. Examination disclosed the existence of an amyotrophic process limited to the peripheral distribution of the left ulnar nerve. The muscles of the first interosseous space especially, and in less degree those of the hypothenar eminence, were wasted. The ring and little fingers occupied a slight claw position. Adduction of the thumb, abduction and adduction of the fingers, as well as extension of the terminal phalanges, were executed feebly, while the movements controlled by the muscles of the thenar eminence were well performed. Pain sense and temperature sense, as well as tactile sensibility, were diminished upon the ulnar aspect of the dorsum of the hand, and upon the hypothenar eminence and the little finger. The ulnar nerve displayed no special tenderness upon pressure. Faradic and galvanic irritability of the nerve in the arm, and in greater degree at the wrist, were diminished, while the muscles of the hand supplied by the median nerve reacted normally, and those supplied by the ulnar presented reactions of degeneration. For this condition no cause could be positively determined, and it was concluded to be due to pressure during sleep. Improvement followed treatment with the galvanic current, but in a short time symptoms of a similar nature appeared in the distribution of the right crural and obturator nerves and progressively advanced. The urine was examined re Meanwhile, the little peatedly, but no abnormality was found. finger of the right hand began to assume a claw position, with weakness in the adductors of this digit and also of the thumb, together with wasting and numbness, and diminished electric. irritability. Med. Rec. TERATOLOGY. Congenital Malformation of the Heart.--Rheiner (Virchow's Archiv.) publishes a full clinical report of two cases of extreme malformation of the heart, where the infants lived to eight months and five years respectively. The first seemed a healthy infant till she was seized with bronchitis. A loud double cardiac murmur was heard. She soon died. The interventricular septum was very deficient; the aorta sprang entirely, the pulmonary artery chiefly, from the right ventricle. The conus pulmonalis was absent; there was stenosis of the pulmonary artery, and complete separation of its valves. The right ventricle was greatly dilated and hypertrophied, the foramen ovale open, and the ductus arteriosus was not completely closed. The second patient was a girl, aged five years, almost an idiot, and subject. to otorrhea and caries of the petrous bone for five months. had become cyanosed, and died of purulent meningitis. withstanding the condition of her heart, she had been a fairly nourished child till her fatal illness. The heart sounds were very puzzling. At the necropsy extreme pulmonary stenosis was detected. The pulmonary valves showed hardly any division. The interventricular septum was deficient. The left tricuspid valve was fissured, and the right ventricle hypertrophied. She Not Congenital Teeth.--Dr. J. W. Ballantyne gives an account of several cases which have come under his observation, also of his researches in regard to this anomaly. His conclusions are as follows: 1. Congenital teeth form a rare amomaly, but one which has long been known both to the profession and to the public. 2. Their presence has often an ill effect upon lactation, partly on account of the imperfect closure of the infant's mouth, and partly by the wounding of the mother's nipple; sublingual ulceration may also be a result, and infantile diarrhea and attrophy are more distant consequences. Sometimes, however, symptoms are altogether absent. 3. Congenital teeth have probably little or no prognostic significance as regards the bodily or men tal vigor of the infant carrying them. 4. The teeth usually met with are lower incisors, but sometimes upper incisors may be seen, and very rarely molars of either the upper or lower jaw. Other facial or buccul malformations may occasionally be met with. 5. They are caused by the premature occurrence of the processes which normally lead to the cutting of the milk teeth; in a few cases it would seem that the anomaly is due to a true ectopia of the dental follicle and its contained tooth. 6. In a few instances a hereditary history has been established. genital teeth are usually incomplete and ill-developed, and likely to be more an inconvenience than an advantage to the infant, they are best removed soon after birth, an operation which can be easily and, except in very rare instances, safely performed. 8. The occurrence of premature teeth in certain well-known historical personages is an interesting fact, the importance of which has been much exaggerated.-Edinburgh Med. Jour. ORTHOPEDIC SURGERY. 7. As con The Local Use of Hydrochloric Acid in Bone Necrosis of Tubercular Origin.-Dr. Jerome H. Waterman reports the results of the use of strong hydrochloric acid used locally on bone necrosis in eight cases. This treatment was used on the theory that the acid dissolved the earthy salts in healthy bone without injury to the animal matter of the bone, and that in this way the disease would be more directly attacked. The acid was applied, after a thorough cleansing of the wound by sterile water, by the injection of a few minims through a glass pipette. Eight cases are reported, of which marked benefit was found to result in four, and improvement in two others. following conclusions: 1. No evil effects have resulted from its use. He gives the 2. The use of the acid in its concentrated form is preferable. 3. When the area of necrosis is extensive, operative methods are advised. 4. Its action is limited to the necrosed area; whereas curetting may remove both diseased and healthy bone. 5. By the disintegration of the dead bone the newly-formed tissue has a better opportunity for its more rapid development. -N. Y. Med. Jour. Treatment of White Swelling of the Knee.--Calot F. and J. Decherf consider the question of operative treatment of white swelling as compared in adults and children. The natural course of the disease is different essentially, varying with the age, which seems to be the result of the resisting power of the individual. In children there is a decided tendency towards spontaneous cure. First, in regard to the treatment of this condition in adults, the chance for cure by conservative methods alone is much less; the time required is much greater, and frequently the surgeon must be guided by the consideration of the economy of time. Second, that the danger of general tubercular affection is not great with a child, but is so with adults; and one must consider the advantage of immediately removing a tubercular focus before it becomes a source of danger for infection. In such cases, when the operation is performed early and the extension of the disease is not great, the amount of shortening is slight. If, however, the lesions have extended, the amount that is necessary to completely extirpate the disease results in a great amount of shortening of the limb. In such cases, when this is necessary and when the general condition is not good, and if there is a reason to suspect invasion of the lungs, it is better to amputate rather than to excise. The resection in these cases frequently gives good results, but the patient more often dies from this than from the amputation.—Rev. d' Orthop. The use of the Bicycle in the Treatment of Scoliosis.— Dr. Kiliani reports in the Medical Record a device by which he uses the principle of the bicycle in the treatment of scoliosis. He distinctly states that he considers it simply one link in a long chain of therapeutic means, but regards it as a valuable method of muscular development in positions which are in themselves corrective. His device is so arranged that the height of the saddle can be changed-its obliquity, the height relative to the position of the pedals and the relative position of the two sides of the saddle. By the changes combined with the difference in height or the length of the pedals on the two sides, an obliquity of the pelvis is obtained, and the person is allowed to use the muscles in this position, which is corrective of some of the conditions found in scoliosis. By his device he is enabled to change the relative position of the two sides of the handle-bars, by which the position of the upper part of the spine is influenced, so that the deformity can be untwisted, as it were, while at the same time the muscles of the lower part of the trunk are made to work in such positions as favors their correction. The machine is so arranged that it may be used as a home exercise, but it is also possible to apply the method to the bicycle as used for exercise. PROCTOLOGY. Notes on the Treatment of Fecal Fistulæ.--At the thirteenth annual meeting of the New York State Medical Association, which was recently held in New York City, Dr. Frederick Holme Wiggin, of New York County, presented a paper with the above title. The chief cause of the occurrence of fecal fistula was stated to be the delay in resorting to operative measures to which patients suffering from typhlo-enteritis, or strangulated hernia, were frequently subjected while their ailment was carefully diagnosticated. The view recently advanced by a writer on the subject under consideration, that the best treatment for this condition consisted in its prevention, was concurred in. But in the case in which this mishap had occurrred, it was pointed out that if the opening was of small size, was located near or below the ileo-cæcal valve and no obstruction to the fecal current existed, operative measures might be deferred, as in most instances the opening would close in a short time spontaneously. On the other hand, if the bowel opening was of large size, was situated laterally, or some distance above the ileo-cæcal value, and was accompanied by the escape of a large proportion of the contents of the bowel, operative procedure for the closure of the opening should be speedily undertaken. The histories of three cases, successfully treated by surgical measures, were cited. In two instances the patients were inmates of the Hartford (Connecticut) Hospital, and were operated upon by Dr. Wiggin, by reason of an invitation which was extended to him by the medical board of that institution, after several previous unsuccessful efforts to close the bowel openings had been made. The occurrence of the fistulous opening was due in the first case to failure, and in the second case to delay in resorting to surgical treatment of typhloenteritis, from which disease both patients originally suffered. In the third case, the bowel opening was caused either by the pressure of the gauze |