became natural, her insomnia changed to quiet restful slumber; there was no failure of circulation or sinking of vital forces, in fact, the perverted functions which had resulted from her habit were changed to the natural ones of the body in less than three days. The renal and cardiac lesions remain the same, except the slight improvement noted before.

She is slowly drifting toward the grave, a victim of chronic parenchymatous nephritis, with a slowly failing heart, but she is a free

woman.

The question is, what broke that habit? Is it possible that the few doses of hyoscyamus in potentized form was capable of starting a train of action in diseased nervous centres which ultimately restored them to their normal condition? It seems impossible, and yet such

is the only explanation I can see. And while one case does not establish a rule of practice this one certainly offers a pertinent hint in the treatment of that dread habit-morphinism.

BILATERAL OVARIAN CYSTOMATA IN Three SisterS.-As a contribution to the subject of the hereditary transmission of ovarian cystomata, Lohlein (Monatschrift für Geburtshilfe und Gynækologie, 1896, B. III, H. 2, p. 91), reports the cases of three sisters, all of whom presented cysts of both ovaries, which were removed by operation. Olshausen, who has probably enjoyed the largest experience of similar nature, has reported the cases of three sets each of two sisters, in which he has operated for the removal of ovarian cysts upon one side.

AN INDICATION OF FOUL AIR.-"In the Zurich Industrial Exposition," says Gaea (Leipsic, January), "an air tester is exhibited, which shows whether and in what degree the air in a workshop is contaminated. The apparatus consists of an air-tight closed glass vessel filled with a red fluid. Through a glass tube that dips into the liquid and is bent at the top a drop falls every 100 seconds on a cord that hangs beneath and that is somewhat stretched by a weight. The fluid from which the drop comes has the property of changing its red color to white by the action of carbonic acid. The more carbonic acid there is in the air the quicker this change in color takes place. If the air is very foul the drop becomes white at the upper end of the cord, while the change of color corresponding to a slight proportion of carbonic acid does not take place till the drop has run farther along the cord. The exact condition of the air can be ascertained by observing a scale that is placed alongside the cord and that is divided into convenient parts, bearing the designations, 'extremely bad,' 'very bad,' 'passable,' 'pure.' This is surely a very useful device, and should be found in every factory, every workshop, and every place where persons are crowded together."-Translated for The Literary Digest.

BY WESTON D. BAYLEY, M. D., AND CARL V. VISCHER, M. D.

Τ

Philadelphia, Pa.

HE following cases are reported because of their general clinical interest; and because such cases should always be placed upon record that collectively they may give us statistics of the greatest importance in formulating the indications for and estimating the value of operation.

Case I.—Male, æt. sixty-three years, who was well, excepting for several slight attacks of vertigo, until July 19th, 1896. On this day, between rising and breakfast, he noticed a "faint giddy feeling about his head." This caused him to sit still for a few minutes, then he went to breakfast. During the week following he had similar vertiginous attacks which seemed to increase somewhat in severity each day. He is rather confused about his history at this time, but at the end of the week he discovered that while apparently able to see quite well he could not READ, that is, he could not make out the meaning of written or printed characters-he could see but he could not discern. For this reason he could not copy any writing, although he could compose and write from dictation fairly well. A week later he had much burning pain in the left eye; this has diminished, but exists in slight degree to the present. He is otherwise in fair health and applies for an explanation of his symptoms. An examination does not give much additional information. There is no hemianopsia; the optic nerve is normal; urinary examination negative; he cannot make out any letters on a spelling card, although he can see everything in the room. He has had no headaches; is right handed; has no motor aphasia. Father died of fatty heart; mother of some chronic disease, the nature of which is unknown; no venereal disease; knee jerks equal and rather free; no ankle clonus. We are obviously dealing with a case of alexia, or as it is called, word blindness, or the loss of the visual memory for words, the centre for which, in right handed people, is in the left parietal lobe posterior to the * Read before The Pennsylvania Homoeopathic State Society, September,

upturned extremity of the fissure of Sylvius. The lesion is most likely cortical, for if deep in this locality there will be hemianæsthesia. It is probably limited to this area, because if it extends anteriorly there would be some motor impairment, or posteriorly, hemianopsia. From the patient's age and the manner of onset of his symptoms, it is most likely a cortical hemorrhage. With these data and this presumptive diagnosis, an exploratory trephining is advised. This was done on August 27th, 1896. After the usual preparation, the parietal boss was exposed on the left side and an inch and a quarter trephine opening was made immediately behind it, this having been somewhat enlarged, their being no brain pulsations present, the dura was incised. The brain presented an unhealthy appearance. A sub-cortical exploration with the trocar revealed a recent blood cyst, the walls and adjacent brain were softened. The cyst having been evacuated and its cavity cleansed, the dura was sutured and the wound completely closed. Recovery from the operation occurred without incident. An examination made at the time of final removal of the dressings showed some improvement in the patient's ability to understand printed letters-he could, with the alphabet card, distinguish correctly perhaps two out of three, and with difficulty and hesitation could spell out some words. He is otherwise as before the operation, excepting that an examination shows a right-sided hemianopsia, and fields taken by Dr. Jessup show an abrupt central termination. Word received quite recently from the patient announces slight further improvement in his ability to discern the meaning of letters.

Case II.-Male, æt. forty-five; was seen August 2d, 1896, with the following history: Left-sided otorrhoea at intervals since infancy. Has had several attacks of acute pain, none, however, as severe as the present one. This attack came on while he was on a trip in the latter part of July, 1896. The pains began in the ear, extended to the head, and he came home almost delirious with their severity. There was tenderness all over the left side of the head. No mastoid swelling. He had fever and some delirium. Could not recall the names of those about him. At this time the knee-jerks were normal and there was no ankle clonus. Dr. Shallcross concurred in the opinion of the writers that the mastoid should be immediately opened. Having prepared the field of operation in the usual manner, an incision was made just posterior to the Pinna and the entire mastoid exposed, after which the antrum was opened in the supra meatal triangle of MacEwen (this being a space bounded by the lower posterior root of the zygoma and the superior posterior edge of the ex

ternal auditory canal), the bone was found unusually thick. On entering the cavity nothing, save a few bubbles of air escaped, and the opening of the mastoid proper was with negative result.

Following the operation, the pain and delirium ceased, but the amnesic aphasia was very pronounced. He could not recall ordinary nouns, especially names of places and people. Did not know the name of a mileage book which was handed him, although he had used them for years. Calls a conductor a passenger," and afterwards a "postal card." Thus showing a degree of paraphasia. The knee-jerks are now exaggerated, especially the right, and there is right-sided ankle clonus.. In the course of a few days the pain returned. This was worse at night, and his headaches were especially severe on the right side of the head. He was very irritable, delirious, and threatened suicide. Early in the morning of August 11th he was trephined one and a quarter inch behind, and one and a half inch above the external auditory meatus, the indications being clearly that there was an abscess in the temporal lobe. On removal of the button of bone the brain protruded; the meninges were quite injected, and there was an entire absence of pulsation. The trephine opening was now enlarged upward and forward after which the dura was incised. On palpating the brain distinct fluctuation could be elicited. The cortex was incised, and this gave vent to a gush of thin foul-smelling pus some ounce and a half in quantity. On introducing the finger, a cavity, the size of a hen's egg, extending anteriorly and toward the median line with apparently a well-defined wall, could be made out. This was thoroughly irrigated with a boracic acid solution and then packed with sterile gauze wrung out of the same solution. The wound in the dura was for the greater part closed allowing merely sufficient opening at the most dependant portion to ensure good drainage. After a few days the gauze drain was replaced by a glass tube because the latter would better drain the pus which had changed to a rather thick creamy consistency. The cavity was also first cleansed with peroxide of hydrogen (full) strength), and afterwards irrigated with boracic acid solution. Healing progressed rapidly, the cavity gradually becoming obliterated from the bottom.

A subsequent examination of the reflexes showed the knee-jerks to be free but less than before the operation. The ankle clonus was not now present. The degree of amnesia since the operation has varied—some days he would be quite aphasic, and again the aphasia was only shown by an occasional lapse in conversation. The general tendency is towards improvement.

Case III.-Boy, æt. fourteen years, who was well until eight months of age, when he fell, striking the left side of his head against a range. This occurred at eight A. M.; he cried some, but was seemingly all right the rest of the day. In the evening he became drowsy, and went into convulsions which were entirely limited to the left side. These continued for several hours and were followed by coma. In the morning he was aroused, but was found to have a left-sided hemiplegia, and he could not make use of his left side for a month. During the first week following the convulsions he would frequently have symptoms as of impending convulsions but they did not supervene. After this, at intervals of from two to six months, he would have convulsions similar to the first one, always with a subsequent paresis of the left side. These of late have been more frequent and quite severe. They are of some minutes duration, but of late have not been followed by such marked weakness of the left side. Does not bite his tongue. Sometimes there are abortive attacks in which his speech gets thick and saliva dribbles." He repeatedly masturbates during sleep, which is often restless, and the occasion of moaning and incoherent talking. It is learned that the convulsive twitchings always begin in the face before the arm or leg are affected; indeed of late the arm and leg are not involved so severely as heretofore, but the facial movements do not improve. Knee-jerks are free; no ankle clonus. The conclusion reached is, that there was a slow traumatic hemorrhage, most likely meningeal, in the Rolandic region, at the time of the injury in infancy. An exploratory trephining was advised.

Now a word about trephining for focal or Jacksonian epilepsy. The results have been rather disappointing as might be inferred. A clot may have been absorbed and left simply cortical instability as evidence of its former presence. This will not be benefited by operation. Again, secondary degenerative changes may have descended through the fibres of the corona even to the spinal cord. We can usually distinguish this condition; there is no use in trephining in the hope of cure then. So that trephining in these cases is simply an explorative procedure, often a mere measure of diagnosis.

In this case a trephine opening of one and a quarter inches was made over the lower Rolandic area of the right side and enlarged upwards. The dura was incised, and no evidence of any pathlogic change found. The wound was closed and an uninterrupted recovery followed. He has had no convulsion since the operation, and his health is very good. But there has not been sufficient lapse of time to make observations of any value.