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young subjects, as advantage is taken of the natural growth of muscle on which the additional work is placed.

OPHTHALMOLOGY.

Marked Variations, from Time to Time, in the Color of the Irides of a Young Woman.-Dr. J. C. Clemensha, says: A short time ago I was consulted by Miss C. on account of deficient vision for distance and discomfort after using the eyes a length of time for near work. Examination into the state of refraction showed myopic astigmatism, and suitable glasses were prescribed. During the consultation she volunteered the statement that the color of her eyes varied from time to time, which fact had been noted by her family physician and a number of her friends. The color of the irides varies from black to a bluish-gray through the various shades of brown, brownishyellow, yellowish-green. Sometimes, she tells me, they resemble the color of a cat's eyes. The young lady is strong and healthy, has suffered from no serious illnesses, though the fact must be noted that her hair, dark at the time, changed to gray at the age of eighteen, and has remained so ever since. Mental emotion seems to be a factor in the causation of these changes. -Medical Record.

The Light Perception Power as an Aid to Diagnosis and Prognosis in Diseases of the Eyes.-The instruments hitherto in use to determine the light perception power have all failed in exactness as the standard of light used varied and the shape of the object was also a factor in the result. Henry Wall suggests a new instrument for the purpose, which consists of an oblong box, one end covered with a piece of cloth like a photographic camera. In the other end is an opening fitted with nine discs of ground glass, arranged so that they can be removed one by one. A candle stands thirty-three millimeters outside of the box in another box that prevents any flickering of the flame. After remaining five minutes in absolute darkness, the subject puts his head at the large open end of the box, one eye is bandaged and the head is covered with the cloth. The ground glass discs are then removed one by one, and he is instructed to state the moment he perceives the sensation of light. The standard of measurement is the number of discs through which he can perceive the light. By this instrument the disturbances due to

nicotin, alcohol, albuminuria, diabetes, etc., can be differentiated and the chances of recovery estimated. The greatest loss of light perception power is found in pigmentary retinitis.- Opht. Review.

MEDICO-LEGAL.

Unpaid Doctor's Bills an Expense.-In an action to recover damages for a physical injury, sustained by reason of a defective sidewalk, the court of appeals of Kansas holds, in the case of City of Abilene v. Wright, Oct. 17, 1896, that the reasonable cost and expense of medical attendance necessarily incurred may be recovered for, even though actual payment therefor was not made prior to the commencement of the action.

Measure of Damages for Malpractice in Setting Arm.— In an action against a surgeon for malpractice in setting and treating a broken arm, the supreme court of Nebraska holds, in the case of Miller v. Frey, decided Oct. 21, 1896, that the measure of damages is the damage accruing to the plaintiff in excess of that which would have accrued naturally from the breaking of his arm had he been treated with that degree of skill ordinarily possessed by surgeons. It is not the damage resulting from the breaking of the arm. That some damages would have resulted from that injury in spite of the most skillful treatment is pronounced clearly unquestionable. The defendant, no matter how unskillful he may have been, could not be liable for all the injuries resulting from the breaking of the arm. He is only liable for those resulting from malpractice; that is, for the damages resulting from his failure to exercise that degree of care and skill ordinarily exercised and possessed by physicians and surgeons in the treatment of such cases. --Jour. A. M. A.

Jury Decides Injury Caused Septicemia.-The supreme court of Minnesota says, in the personal injury case of Miller v. St. Paul City Ry. Co., decided Nov. 9, 1896, that the evidence as to whether the disease septicemia, with which the plaintiff was afflicted, was caused by her injury on the car of the defendant, was not simply speculative. There was evidence in the case tending to show that it is a germ disease, and that an external blow on the body would not be the cause of introducing the germs into the body, but that the germs might exist dormant in

the system, and be set in motion or "lighted up" by an external blow or injury, and hence that the plaintiff's injury was the direct inducing cause of the disease. The value and weight of the evidence, the court holds, was for the jury, and that it was correctly submitted to them. The jury took the plaintiff's view of it, and awarded damages accordingly.-Jour. A. M. A.

DISEASES OF THE NOSE, THROAT AND EARS.

Tinnitus Aurium.—Drs. Miot and Herck divide sounds in the ears into two groups: (1) The noises which really exist in the ears or their neighborhood. They are called entotic and periotic sounds respectively. (2) The true tinniti or auditory sensations which have no apparent cause. In the first-class are many conditions. It may be an increaseed resonance of the ear or hyperesthesia of the auditory nerve, which make the individual more sensitive to sounds. The sounds may be due to an increased flow of blood through the ear. Muscular contraction and mucous plugs in the external ear cause noises also. The authors recognize two varieties of true tinnitus: (a) The noises due to a lesion of the auditory apparatus. (b) The noises due to nervous diseases, mental disorders, and reflexes, without any lesion of the ear organs. Middle-ear diseases cause tinnitus, especially in cases of circumscribed or diffuse otitis. In this case the tinnitus is caused by a hyperæmia of the region. In the middleear various conditions of the tympanum and Eustachian tube give rise to tinnitus. Inflammation of the mucous membrane of the middle-ear with secondary hyperemia of the labyrinth is a frequent cause. Local applications of cold and blood-letting, combined with catheterization of the Eustachian tube and insufflations of medicinal vapors, give the best results in this condition. If the discharge becomes very great, it must be removed through an incision in the tympanum. Chronic otitis media is a very common and persistent cause of tinnitus aurium, and the authors say the subjective noises resist all treatment. Otorrhoea of a tympanic or labyrinthine origin is a frequent cause of tinnitus, and when the discharge is in the semicircular canals, as in Ménière's vertigo, the noises are extremely violent. The tinniti caused by lesions without the auditory apparatus are of various kinds. In many diseases of the nervous system, the subjective noises in the ears are premonitory or accompanying symptoms:

apoplexy, cerebral anæmia and congestion, cerebral softening due to arteriosclerosis in the aged, paralysis, etc., are ushered in by unusual noises in the ears. Nicoti and Rabioli have described an auditory migraine. In some mental diseases tinniti are prominent. False auditory perceptions are common in the insane; and in the same cases there are auditory hallucinations and confused noises.—Bulletin Médical; Medical Record.

Leukæmic Infiltration of the Larynx.-Ebstein (Wien. klin. Woch.) records the following case: A woman, aged 76, who three years before had had an abscess in the neck opened, came complaining of continued trouble in the neck. The arytenoid cartilages and ventricular bands were infiltrated, and the true cords could not be seen. There was infiltration of the posterior laryngeal wall, and beneath the glottis colored crusts could be seen. The liver and spleen were enlarged and the examination of the blood showed mononuclear leucocytosis with diminution in the number of red corpuscles. Later a large glandular swelling developed in the left axilla. Soon after the patient caught cold, and this was followed by rapid increase of infiltration; the glottis was reduced to a chink 2 to 3mm. wide with immovable walls. Tracheotomy was performed, but the patient died a few days later.

Leukæmic infiltration was found to involve the whole larynx. A similar case is related by Mager (ibid., June 25th, 1896), in a man aged 58. Some six months before admission tumors developed in the neck below the lower jaw on either side and in the axillæ and groins. There was considerable weakness. The liver and spleen were much enlarged. The blood showed an enormous leucocytosis, particularly of mononuclear forms; the red corpuscles were about half the normal in number. He was treated with arsenic and went on without change for two and a-half months, when he suddenly became hoarse and had pains and irritation in the throat. A fortnight later he complained of dyspnoea. Laryngoscopic examination showed immobility of the right half of the larynx and swelling of the whole mucous membrane. The glottis rapidly became narrower, and lumpy. swelling appeared on the hinder aspect of the right arytenoid cartilage. Schrötter now diagnosed leukæmic infiltration of the larynx. Tracheotomy was performed, but the wound became gangrenous, and the patient died in a few days. At the post

mortem examination, in addition to infiltration of the larynx with mononuclear leucocytes, perichondritis of the arytenoid and cricoid cartilages was found, which had led to cedema of the epiglottis and the aryepiglottidean fold. This perichondritis may have arisen from the rapid growth of bacilli from the mouth in the favorable nidus resulting from the leukæmic disease. -Brit. Med. Jour.

TERATOLOGY.

A Giant Fetus. -Olano (El Monitor Medico) performed an autopsy upon a well-formed woman, aged thirty-nine, who had died after four days of labor pains and an unsuccessful attempt to deliver the child by forceps. The fundus of the uterus was just under the liver. It contained a well-formed female fetus with the head downward, which measured 68 centimeters (27 inches), and weighed 10,000 grammes (26 lbs.). The mother had had three normal and two premature confinements. There was non-medical and purely subjective evidence to the effect that the woman was many months past full term.-Medical News.

Supposed Precocious Menstruation.-The reports of menstruation in infancy and childhood which are so often made are not to be too readily accepted. Comby (L'Union Médicale) found ordinary vulvo-vaginitis sometimes accompanied by distinct hemorrhages. In three cases of children, of two, three, and six years of age, which had been mentioned as instances of precocious menstruation, he found that the blood came not from the uterus, nor from the vagina, but from vascular granulations about the meatus urinarius, which bled freely if touched. This condition was cured by weak injections of permanganate of potassium, and cauterization with a 1 in 50 solution of nitrate of silver.

Congenital Absence of one Kidney.-E. Ballowitz (Virch. Arch.) gives a resume of 240 cases of authenticated absence of one kidney, together with three cases observed by himself. He excludes those cases of simulated absence of one kidney, which was really due to the intergrowing of both, or to a hyperplasia of one. His conclusions are as follows: Absence of the left kidney is of more frequent occurrence than that of the right; at least

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