cells and advanced degree of chromatolysis. In the neighbourhood masses of leucocytes, neuroglia cells and phagocytes. Cord. Showed similar changes. Marked affections of the vessels, the cells of the ventral cornua and of the columns of Clarke, partial destruction of the myelin, and of the axis cylinders which were often varicose. Neuroglia. Greatly increased, especially fibre elements. The writer considers these changes are:---(1) Lesions due to syphilis ; (2) lesions of inflammatory origin; (3) lesions due to anto-intoxications. and infection. W. B. WARRINGTON. FRAENKEL (JOSEPH) and HUNT (RAMSEY). Tumours of Ponto-MedulloCerebellar Space. Acoustic Neuromata (Central Neurofibromatosis). New York Medical Record, December 26th, 1903, p. 1,001. A RECORD of five cases of this interesting condition, in one of which an operation was performed, and the tumour removed, but death took place in twelve hours, apparently from shock. The condition. consists in the formation of tumours, single or multiple, on one or more cranial nerves. The pathology is identical with the generalised neurofibromatosis of the cerebro-spinal and sympathetic nerves and the two types are often associated. With regard to etiology the underlying cause is teratological. The growths chiefly affect the acoustic and trigeminal nerves, and in these cases is intradural. When other nerves are affected the involvement is mostly extradural and general neurofibromatosis is found, hence it is to the special involvement of the trigeminal and acoustic nerves that clinical significance attaches. The tumours vary in size from a cherry to a hen's egg, are of fibrous consistency and distinctly encapsulated. The surface is nodular and irregular. Histologically they are neurofibromata, and medullated fibres may be demonstrated by the Weigert method. Sometimes glia tissue may be found and they may undergo myxomatous and cystic degeneration. In some cases and one here recorded endotheliomata and psammomata have been found on the dura mater. Symptomatology. They present the features of tumours of the posterior fossa of the skull. They are essentially distinguished from tumours of the brain stem by the initial symptoms referable to a single cranial nerve. As the growth is often a benign character these initial symptoms may alone be present for some time. Since the eighth and fifth are usually affected the early symptoms are those of tinnitus aurium with progressive diminution of hearing; attacks of Ménière's syndrome and obstinate facial neuralgia. Later follow symptoms of pressure; peduncular ataxia, tendency to deviate or fall to the same or opposite side, cerebellar ataxia, nystagmus, irregularities in size and reactions. of pupils, paralysis of associated movements of the eye-balls, dysarthria, dysphagia, homo- and contra-lateral crossed paralysis of the extremities, paralysis of the facial and abducens nerve of the peripheral type, motor disturbance of palate and tongue, circulatory, respiratory, vaso-motor phenomena, and attacks of Adam-Stokes' syndrome. W. B. WARRINGTON. SMITH (R. SHINGLETON). Scurvy. Bristol Med. Chirurg. Journ., 1903. Vol. xxi., p. 320. THE writer reports two cases of hæmaturia due to scurvy, one an infant eight months old, the other a man, 87 years of age, who had been an invalid for months with feeble heart and anasarca of the limbs. The latter case was also associated with purpuric patches on the dorsum of the hands and on the oedematous legs. In both patients the diet had for some time previously been limited to Pasteurised milk with some proprietary food. Dr. Smith says: "There is no evidence that sterilised milk is itself the cause of scurvy, nor have we any reason to think that Pasteurised milk predisposes thereto; but the persistent deprivation of fresh food at any period of life clearly entails the risk of a scorbutic hæmorrhage." R. W. MARSDEN. MCCOLLOM (JOHN H.). General Peritonitis Complicating Scarlet Fever. Boston Med. and Surg. Journ., 1903. Vol. cxlix., p. 639. IN 8,000 cases of scarlet fever the writer has met with two instances of peritonitis occurring. In neither of the cases was the attack of scarlet fever specially severe, and in each it was due to a streptococcic infection. Dr. McCollom refers to the scanty recognition given to this complication in most of the works in which scarlet fever is described, and gives details of his cases. In one, a boy, five years of age, the onset of peritonitis occurred almost a month after the beginning of the attack of scarlet fever. It was not of a very acute nature, and after withdrawal by tapping of pus from the abdominal cavity, and subsequently from the left pleural cavity, recovery followed. In the other case, a man, 31 years of age, the peritonitis supervened 19 days after the onset of scarlet fever. There was also on admission evidence of cardiac dilatation and mitral regurgitation. On this occasion the onset of the peritonitic symptoms was acute, and though laparotomy was performed the patient died. At the post-mortem, in addition to acute fibrino-purulent peritonitis, there was acute bilateral fibrinous pleuritis, acute vegetative mitral endocarditis, chronic mitral endocarditis, acute nephritis, etc. In this case albumen was present in the urine for four days before abdominal tenderness and suppression of urine supervened. In the case of the boy albuminuria only occurred after complaint of pain in the abdomen and vomiting. R. W. MARSDEN. FOORD CAIGER (F.). Diphtheria. Lancet, December 26, 1903, p. 1771. THE writer deals especially with the diagnosis and management of doubtful cases of diphtheria, e.g., sore throats in which no exudation at all can be detected, or at most a little cheesy follicular deposit, or again purely nasal attacks accompanied by little, if any, indication of illness. He refers to the difficulties in the way of a bacteriological diagnosis, and, despite the few recorded instances in which virulence has been said to have been imparted to the Hofmann bacillus, he concludes that no evidence has been adduced of the transference taking place in nature, so that the balance of opinion is opposed to that bacillus as a potential source of diphtheria. On the other hand, he admits the non-virulent "pseudo-diphtheritic" bacilli which are indistinguishable from the true bacillus in their morphology, staining and cultural reactions as possible ætiological factors, their presence in conjunction with signs of inflammation being sufficient to cause the case to be classified as diphtheritic. Dr. Caiger again expresses the opinion that very little value is to be attached to a negative result from a single examination, and draws attention to some of the usual causes of a lack of detection even though present on the fauces. Incidentally also he again emphasises his belief in the comparative value of Neisser's stain. The important points to be observed in the diagnosis of diphtheritic tonsillitis from follicular tonsillitis, and of pure nasal diphtheria from mucous rhinorrhoea are mentioned, as well as the precautions it is advisable to adopt immediately a case occurs in any community. According to observations quoted it would seem that though the diphtheria bacillus is found in healthy throats where no infection from a previous case can be traced, yet the percentage of such occurrences increases proportionately to the closeness of contact. The recrudescence of diphtheria after measles or other forms of inflammation may be instanced as evidence of the power of the latter to increase the vital activity of the bacillus, and thus influence the "infective capacity" of the host. The use of antiseptic irrigations, especially a freshly prepared solution of chlorine, has been shown to produce a pronounced diminution in the number of bacteria, but Dr. Caiger is of opinion that their power to lower the virulence of the diphtheria bacillus is more than doubtful. R. W. MARSDEN. CASTELAIN (F.). One Hundred Cases of Intubation in Private Practice. L'Echo Méd. du Nord., 1903. No. 47, p. 529. DR. CASTELAIN refers to the experience of several writers according to whom intubation adopted as a general measure shows, by a percentage diminution in mortality, a superiority over tracheotomy. In addition, he says, its performance is admitted as a rule to be less difficult and less dangerous than the latter. On the other hand, tracheotomy becomes necessary if the infant is moribund, when membrane is too abundant, if the tube is repeatedly expelled and if there is a recurrence of asphyxia after detubating several times. Obstruction of the tube taking D place a variable time after its introduction is apparently rare (1 to 6 per cent., according to different writers). Expulsion of the tube, however, is more frequent, and is indeed the most serious objection to intubation not under constant supervision. Attacks of asphyxia may arise from food, mucus or blood reaching the vestibule, the spasm of the muscles thus induced causing a very sudden danger. Taking the various risks into consideration, Dr. Castelain is still of opinion that intubation is to be preferred as the routine practice. He says, further, that detubation with the extractor is much more delicate and dangerous than intubation, and since the need for removal of the tube may be urgent he recommends retention of the thread. R. W. MARSDEN. BABONNEIX (M. L.). Acute Ascending Paralysis in Experimental Diphtheria. Archiv. Génér. de Méd., 1903. Vol. ii., p. 3201. As shown by several experiments detailed by Roux and Yersin, the clinical aspect of the resulting paralysis is the same no matter what method is used for introducing the diphtheria toxin. The experiments also show that with the culture or toxin, if the dose be not too great, paralysis of the posterior extremities of the animal may be seen followed by a rapid extension to the rest of the body. From intra-venous injections in dogs and subcutaneous injections in rabbits Dr. Babonneix obtained the same results, a clinical study of which, according to him, justifies the name of Landry's paralysis. Histologically examined, in one animal were found necrotic foci in the grey substance of the cord, most markedly in the lumbar region. Diffuse cellular changes, viz., hypertrophic swelling, molecular disintegration, chromatolysis, acute atrophy were noted. In addition there were foci of myelitis in the grey substance. Neuritis was present, the most evident changes occurring in the myelin, and especially in the nerves of the posterior limbs. The muscles showed a granular fatty degeneration distributed irregularly in the fibres. In the second case examined the affection of the grey substance of the cord was much less than in the first. The changes in the nerves were, on the contrary, much more marked. It is thus possible, as Dr. Babonneix remarks, to attribute the acute ascending paralysis produced in animals by the experimental injection of diphtheria toxin to a central lesion. R. W. MARSDEN. FROIN (M. G.). The Cerebro-Spinal Fluid in Cerebral Meningeal Hæmorrhage. Gazette des Hôpitaux, 1903. No. 128, p. 1257. THE writer gives details of the case of a man, 68 years of age, suddenly struck by a apoplectic attack, and admitted to the hospital in a comatose state, with evidence of hemiplegia and symptoms of irritation. During the five weeks that life was maintained lumbar puncture was performed on nine occasions, at first with temporary relief to the irritative symptoms. A careful study of the cerebro-spinal fluid removed on each occasion gave much interesting information. In all the earlier punctures there was evidence, from the rapidity of the flow, of increased tension in the sub-arachnoid space, which gradually disappeared as the blood was absorbed. It is mentioned that in other cases there have been indications of a relation between the muscular hypertonus and the hypertension of the cerebro-spinal fluid, a relationship, however, not seen with very large hæmorrhages. An examination of the erythrocytes showed a steady diminution in number, but it is pointed out that this has only a relative value since it may vary with the space in which the puncture is performed and the position or movement of the patient. Throughout the course it was noticeable that on no occasion was there clot or fibrin filaments, showing the absence of any secondary inflammation. For the first three days the colour of the liquid after centrifugalisation was yellow. From the 6th to the 14th day it was red, and gave the spectrum for HbO. On the 17th day it was again yellow, and by the 33rd day it was quite clear. These changes in colour were associated with a diminution of the erythrocytes and evidences of hæmatolysis. Gmelin's reaction was always negative; on the other hand, the rapid diminution in the erythrocytes was accompanied by temporary urobilinuria. The leucocytic count showed great variations in the different specimens, characterised for the first few days by the relatively low proportion of white to red corpuscles, the percentage composition being 5151 large mononuclear cells, 39-39 lymphocytes, and 9'09 polynuclears. In subsequent specimens the two former showed a steady diminution, whilst the latter as regularly increased, the hæmatolysis already mentioned being coincident with these changes. This hæmatolysis attained its maximum at the 9th day, when a marked relative increase of polynuclear cells was observed, which attained its maximum on the 11th day. On the 14th day the mononuclears were again predominant and accompanied by macrophages (ie., leucocytes containing red cells), and further evidence of hæmatolysis and destruction of leucocytes was shown by the relative increase found on that day of serum-albumin and serumglobulin in the fluid. R. W. MARSDEN. FROIN (M. G.). Meningeal Hæmorrhage. Gazette des Hôpitaux, 1903. No. 143, p. 1407. THE writer gives a further contribution to the condition of the cerebrospinal fluid in a case of meningeal hæmorrhage. The patient was a woman, 68 years old, admitted in a state of coma, and living eight days, during which time lumbar puncture was performed four times. The fluid obtained on the first day contained very few white cells, and serum-albumin and globulin were in much the same amount and proportions as in blood-serum. On the third day the amount of blood appeared to be rather larger and the white cells still fewer. On the fifth day the blood was less, the white cells relatively increased with marked preponderance of the large mononuclears (73 per cent.), increase |