The only cause for these changes that the author could discover was over-use of alcohol, and in support of this he cites a case of similar nature in a child of fifteen, with an "exquisite" chronic alcoholismus.

A NEW COLORING FOR AMYLOID.

E. Burchardt (Virch. Archiv, Bd. 117, 1889) by a new process colors only the amyloid material. It is only applicable to hardened sections, which are immersed in a medium strong anilin-water-gentianviolet solution until darkly colored-one to a few moments sufficing. They are next placed in a solution of one drop of concentrated muriatic acid in ten grms. water. In ten minutes everything but the amyloid is completely decolorized, after which sections are washed in water, and examined in liq. potassii acetatis. The amyloid is colored red

blue.

The colloid matter of the thyroid gland takes the same color, but does not retain it as persistently.

Over-coloring is to be avoided.

OPHTHALMOLOGY.

BY RICHMOND LENNOX, M. D.

Assistant Surgeon, Brooklyn Eye and Ear Hospital; Curator and Microscopist, New York Eye and Ear Infirmary.

COM POSITION OF HUMAN LENS.

Collins (Ophthal. Review, Nov. 1889) has examined six clear and ten cataractous lenses in reference to their weight and the amount of total solids, water and ash. His results lead to conclusions somewhat different from the opinions ordinarily held. In the clear lenses he found that there appeared to be a regular increase in weight with the age of the subject, his results thus confirming those of Priestly Smith, and that the percentage of water (about 70 per cent.) and therefore of solids in such clear lenses was remarkably constant, whatever the age. The amount of ash was also constant. In the cataractous lenses the total weight was less than in the clear, and seemed rather to diminish with age. In these lenses the relative proportion of water and solids varied considerably, but on an average the water was diminished (65 per cent.) In both clear and cataractous lenses the proportion of water to solids seemed to depend upon individual peculiarities rather than age changes, and a lens does not necessarily become denser as it grows older. In cataracts, however, the law of continuous lens growth does not hold, but rather shows a tendency to inversion. The ash of cataractous and clear lenses was absolutely about the same, but relatively the former showed an excess of about 50 per cent. From these

results the author concludes that "a cataract is not likely to be more solid because the lens in which the change has occurred is an old one, and any treatment based on such a supposition is fallacious and unsound." We must be guided in deciding as to operation on immature. cataracts by the circumstances of the individual case.

DEGENERATION OF CENTRE OF RETINA IN THE AGED.

Hirschberg (Centralbl. f. p. Aug, Sept. 1889) describes the symptoms and changes in the fundus met with in otherwise healthy old people, changes known in England as "Tay's Choroiditis." The symptoms are a gradual loss of finer central vision, so that reading becomes difficult or impossible, whereas the patients find no difficulty in going about. Both eyes are affected, the centre of the fundus showing with the ophthalmoscope circumscribed light discolorations in which in certain cases a crystal formation may be recognized. In the neighborhood fresher grayish-blue spots are visible lying behind the retinal vessels, and there may be some patches of increased pigmentation. Under the microscope one sees irregular thickenings and concretions of the vitreous lamella of the choroid, the so-called "drusen." The changes are not limited to the centre of the fundus, though here more easily recognized and more disturbing to the patient. The course of the disease is progressive, and treatment without avail; blindness, however, does not ensue. Very rarely one sees a similar degeneration in diabetes or albuminuria.

FATAL RESULT OF IODINE INJECTION FOR RETINAL SEPARATION.

Gelpke (Centralbl. f. p. Augen., Sept. 1889) reports a case in which following Schoeler's method, he injected with all antiseptic precautions three drops of iodine tincture into the eye of a healthy man in whom quite extensive retinal separation had occurred without known cause. This was followed by purulent choroiditis and acute meningitis, which proved fatal six days after the operatton. The source of infection and the channel by which the brain became involved are not further stated, and we look with interest for the results of the microscopical examination of the enucleated eye and orbital tissues.

INFLUENCE OF CORTICAL LESIONS UPON VISION.

Lannegrace (Arch. de Med. exper. et d'anat. pathol., 1889, p. 87), as a result of numerous experiments made on animals to determine the effect of cortical lesions upon vision, the injuries being inflicted with the thermo-cautery, comes to the following conclusions. Disturbances of vision follow lesions not only of the occipital but also of the frontal, temporal and parietal regions. They are, however, not constant and sometimes difficult to establish. Their severity after apparently similar injuries is very variable, and depends upon the location as well as the

extent of the traumatism; is however, much greater after a repetition of the injury. After a single application of the cautery the visual disturbances are regularly of a temporary character, lasting from a few days to several weeks. Repeated unilateral injuries cause more severe and lasting, and sometimes even permanent disturbance. Different areas of the same hemisphere appear therefore to act vicariously for each other. After recovery from injury of one side, injury of the other may cause beside its own special effects a return of the first symptoms, indeed even make them permanent. Very extended bilateral injuries cause temporary not permanent blindness.

The visual disturbance is very variable in its nature, sometimes homonymous hemiopia, sometimes crossed amblyopia, the former being occasionally pure, the latter almost never so, but usually associated with a certain degree of hemiopia. The nature of the disturbance depends on the location of the injury. Lesion of any portion of the cortex may cause homonymous hemiopia, while lesions of the anterior regions are associated with crossed amblyopia. The perception of retinal impressions may be completely but not permanently abolished by cortical injuries. After such injuries impressions on the centre of the retina seem best perceived. This is no exclusive correspondence of one portion of the retina to one region of the cortex. Cortical lesions never cause paralysis of the internal or external ocular muscles. Injuries of the anterior portion of the cortex may cause diminished sensibility of the eye on the opposite side with accompanying amblyopia. Lesions of the frontal and parietal regions may cause trophic disturbances of the opposite side of the body and also of the eye. Lannegrace concludes that the area of cortex injury of which is followed by visual disturbance, must therefore be of considerable extent, including almost the entire convexity of the brain. A limited visual centre in the occipital region (Munk) does not exist.

DISEASES OF THROAT AND NOSE.

BY WM. F. DUDLEY, M. D.

Attending Physician, Department Throat and Nose, Dispensary of L. I. C. Hospital;
Assistant Physician, Brooklyn Throat and Nose Hospital.

TREATMENT OF PHTHISIS OF LARYNX.

Sedziak (Jour. Laryngol. and Rhinol. vol. iii,, No. 6). Cocaine is the most valuable drug as an anesthetic and analgesic in the treatment of laryngeal tuberculosis. In severe cases, solutions of fifteen to twenty-five per cent. are admissible, Period of anesthesia lasts about twenty minutes, commencing in four minutes after applying with brush.

Piniaczek of Cracow, Heryng and Frænkel first introduced injections of ten per cent. solution into sub mucous tissues of larynx. These applications are made in posterior part of larynx, the needle piercing to depth of half centimetre. The anesthesia extends to mucous membrane of throat, uvula and soft palate, and lasts four hours, beginning a few minutes after injection. The merits of this method are: 1. Limitations of this method to certain regions and spontaneous graduation. 2. Anæsthesia lasts longer. 3. In ulcerations of œsophageal surface of posterior part of larynx, injection gives relief from pain where brushing is useless. A solution of carbolic acid, two per cent. being added to cocaine, the intoxication is avoided.

In 1885, Krause first advocated local applications of lactic acid. Schrötter says, "Hitherto I have not known another remedy with which I had succeeded in obtaining so many amendments and such a relatively large number of cures."

Of thirty-four cases, the author reports favorable results in twentyfive from the use of this drug. Where slight or interstitial changes exist in the lungs, where there is a natural tendency to the production of connective tissue, -a conservative process obstructive to the vital energy of pathological micro-organisms--here local treatment by lactic acid does much good in assisting and hastening cicatrization of ulcers in the larynx.

The acid may be applied by brush, at first in weak solutions of ten per cent., which should be increased to seventy-five or one hundred per cent. It acts energetically upon pathological tissues, but has slight effect upon sound tissues, causing in strong solutions a burning sensation and irritation of mucous membrane, without, however, disintegration of epithelium.

The action of lactic acid upon tubercular-degenerated tissues is seen in diminution of infiltration, clearing of ulceration, formation of sound granulations, and finally, cicatrization. Ulcers situated in posterior part of larynx are most resistant to effect of lactic acid; the best results were obtained where ventricular bands were involved. Upon plastic infiltrations, the acid acts slowly, scarification being first necessary, after which the acid should be rubbed in. Parenchymatous injections of lactic acid in twenty per cent. solution to the amount of three to five drops is strongly recommended; the operation is almost painless, the swellings disappear in about three weeks, followed by healing of the ulcers. Almost always this drug diminishes or causes cessation of difficult and painful swallowing. The galvano-cautery has a favorable influence upon absorption of tubercular infiltrations and also produces cicatrization of tubercular ulcers.

Inflammatory symptons, including acute oedema is urged by many

as an objection to use of cautery, but the author has not had this experience. One of the most important advances of recent times in therapeutics of laryngeal tuberculosis is the surgical method, including endo-laryngeal incisions (scarifications) and curettement (scraping). For the first method, those forms of laryngeal tuberculosis are most suitable, in which, besides relatively small change in the lungs and the absence of fever, the changes in the posterior region of the larynx were of oedematous character, in which the epiglottis was thickened and swollen, and there was great dysphagia, which diminished very much, or disappeared entirely after making incisions. As rapid agglutination

of cut edges of sore follows, deep incisions should be made, especially in perichondritis arytenoidea.

The second method, scraping, is advocated in cases of ulcers with sclerotic ground and hypertrophic edges; the merits of this procedure are complete destruction of tubercular process, the small inflammatory reaction after the operation and speedy decrease of difficulty in deglutition.

In summing up, the author concludes:

1. Primary laryngeal tuberculosis exists, although rare, and is curable,

2. From the combined method, lactic acid and galvano-cautery, or surgical treatment, we can expect the best results in treating laryngeal tuberculosis.

RELATION OF TONSILLITIS TO RHEUMATISM.

C. W. Haig-Brown (Brit. Med. Jour. Sept. 14, 1889). Tonsillitis and rheumatism both are most frequent in prolonged wet weather, they also show persistent aptitude to recur. The febrile period of the two diseases are accompanied by foul-smelling perspirations and pains in limbs, which are quite apart from inflammation of joints, and are due to inflammation of fibrous element of inter-muscular fasciæ. In rheumatism, the ends and pericardium are liable to become inflamed; also in tonsillitis, cardiac murmurs of more than transitory importance are at times developed, accompanied by increase of fever, and followed by hypertrophy of myocardium. It is inferred that the inflamed tonsil

is the receptacle for the rheumatic poison and the medium for its conduction into the general circulation, or that the specific germs evidence their existence in inflammation of tonsils and the fibrous and fibroserous membranes. In 119 cases of tonsillitis, 76 or 63.9 per cent. gave histories of possible rheumatic origin. R. Hingston Fox on the same subject says: In acute rheumatism the tonsils are often inflamed, most commonly early in the attack; also acute arthritic symptons are frequent in connection with the various forms of tonsillitis. Scarlatina, diphtheria, enteric fever, acute rheumatism and tonsillitis are