Miscellaneous

great care. Such a work is as indispensable as a Dictionary to any one who desires to be educated up to the times in which we live. Every sub­ ject about which information is desired can be instantly found. The two volumes of “Zell’s Encyclopedia,” costing $32, and “Webster’s Una­ bridged Dictionary,” costing $12, make a complete library, of more use in imparting instruction than any other one hundred books that could be selected. With these three volumes at hand, no one need remain in ig­ norance of any subject of interest.

Microscopical examination reveals a chronic inflammatory process in the membrane with destruction of its tissue, and replacement bv newtonnetl connective tissue showing a tendency to organise. Although no Inherele bacilli can be detected on staining by the Ziehl-Neelsen method, it a]>pears certain that a chronic tuberculous intianunatorv change is •icurring. This condition has been observed and followed in nineteen • uses of phthisis pulmonalis.
The treatment advised consists in non-interference so long ;l s the outer epithelial layer of the membrane is intact : as soon as ulcers develop • Hermetic treatment with trichloracetic acid or lactic acid, or excision of "•arts of the membrane followed by cauterising, or where marked loss of iibstauce occurs. Pfannenstill's method of using perhvdrol and potassium i.»dkle may be tried.
Putnam, J. J.-The Value of Lumbar Puncture in the Treatment of Aural Vertigo. " Boston Med. and Surg. Journ.," (September 28, 1911, p. 472. The author refersto the literature of the subject. The best cases for 'treatment by lumbar puncture are those where tests show the labylinthine apparatus is still in a fairlv normal state, the most favourable being those of pure labyrinthine origin and of relatively short duration. In cases of this class sensitiveness to the galvanic current may i >e poor before lumbar puncture, may become more nearly normal after. Prognosis as to results varies much, but it is verv good Avhere galvanic and other tests indicate a labyrinthine vertigo with lut little nerve degeneration. This paper must be read in conjunction with that of Blake inthe same issue.

lobey, G. L.-A Case of Primary Sarcoma of the Middle Ear and
Mastoid Operation : Recovery. " Boston Med. and Surg. Journ.," November H, 1911, p. 726. Boy, aged eleven, in whom attacks of dizziness on rising formed the f ',rst symptom. After two weeks these ceased. Three months later •''issing tinnitus came on and lasted two weeks. Two days after its 1 ^'ssation, bloody discharge appeared, with no subjective symptoms. A |(i nuer mass filled the lumen of the meatus (right ear). Operation 'October 24, 1907) showed the mastoid necrosed and occupied by growth, vliich was removed, practically the whole ear being involved. Examination on October 9, 1911, showed no signs of recurrence.

M I S C E L L A N E O U S .
Fischer, Prof. B. ^Death from Encephalitis Haemorrhagica following an Injection of Salvarsan. " Munch, med. Wochens.,"' August 22, 1911, p. 1803. This record of a tragic case is of great interest at the present time. i'iie patient was a medical man in the prime of life who accidentally contracted syphilis from a patient. The primary lesion was situated upon 1 'ie right side of the nasal septum, and dining the secondary period, uhen he was first seen by a doctor, he suffered chielly from headache and flight pyrexia, accompanied bv a niaculo-pajmlar eruption with swelling uf the glands below the angle* of the lower jaw (right). After the dia-:U8 The journal of Laryngology, June,1<J 12. gnosis of syphilis had been confirmed by Wassermann's test, an hit ravenous injection of 0 4 gin. salvarsan was carried out with immediate benefit, and a few days later mercurial inunction was begun and continued for thirty applications. A second dose of salvarsan (O-Agnn.) was then administered (fortv davs after the first), and two and a half d a v s later he was suddenly taken ill with serious cerebral symptoms (drowsiness, delirium, cramp, retraction of the neck, and finally coma deepening into deal h four davs after the second injection). The /lost-wortem examination, macro scopie and microscopic, (dearly proved that death was due to encephalitis ha'inorrhagiea acuta : there was found also a commencing cirrhosis of th" liver. A long and careful critical review of the subject, follows, and tinconclusions arrived at, with which the author ends his a r t i d ' , may l» briefly given here: (1 ) In a certain number (very few) of individual suffering from syphilis an intra-venous salvarsan injection is followed, either immediately or after an interval of two or three days, by acute u'deni.i of the brain, which may pass off, but which may develop into encephalitilueniorrhagiea ending in death.
(2) This is more liable to follow i second dose of salvarsan. (3) A similar complication may follow the treatment of svpliilis by mercury. ( 4-) The fact that (edema of the brain and toxic encephalitis occur only, as far as is known, after the use <>i such a, drug /// st/jihi/ifle rour*. indicates perhaps that syphilis has .• special tendency to bring about certain molecular changes in the suh stance of the brain predisposing to these lethal effects. (5) Jt iabsolutely essential that, after a salvarsan injection, the patient should in every case be kept under observation for several days, during which complete rest in bed is insisted upon.
[ Note. -Ln the same number of the journal two further fatal caseof encephalitis h;einorrhagiea following the administration of salvarsai: are fully recorded. 1 J. S. Ihtrr. i.t

REVIEW.
Direct Amongst the many workers who have contributed during the la.-1 thirty years to the brilliant achievements in practical endoscopy ol tin air-passages and upper food-])assages the names of Mikulicz, of Gottsteii 1 . of Kirstein, of Killian, of II. v. Schnitter, of Guise/ and of (Jhevalit r Jackson have stood out pre-eminent Iv, and to this list the name of Brtiniii-( last, but by no means least ) must be added on account of his origin 1 ' and valuable contributions during the present century. Although ' l lname has become almost a household word in medical circles all over H1 1 ' world on account of the popularity of his double eudoscopie tubes, it ! " probable that any enduring reputation associated with his name will depend, not on his ingenious double tubes, but rather in spite of th*' 1 " His numerous anatomical and physiological investigations on the trache"broncliial tree, including tracheo-brouchography and tracheo-broncii"-