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[New York Medical Journ; Oculomotor Reaction to Labyrinthine Stimu- lation.— H. B. Lcmcre (Journal A. M. A.. Sep- tember 14, 1918) concludes from a careful investi- gation of the reactions, as well as of the actual ana- tomical positions of the canals in the intact skull, that there is a direct relationship between the stimu- lation of the canals and the reaction of the muscles of the eye. The superior canals influence the su- perior and inferior recti of the eyes ; the horizontal canals, the internal and external recti ; and the in- ferior canals, the obliques. Tlie horizontal canals are influenced by movements with the head nearly in a horizontal plane ; the superior, in a longitudinal plane ; and the inferior, in a transverse plane. The anterior vertical canals should be called the longi- Mesterolone Online tudinal ; the posterior vertical, the transverse, and the conception that the posterior canal of one side is on a plane with the Mesterolone Tablets anterior of the other is erro- neous and should be corrected. Tooth Impacted in a Secondary Bronchus of the Left Lung ; Removal by Lower Bronchoscopy after Two Unsuccessful Attempts by Upper Bronchoscopy. -St. Clair Thomson (Practitioner, August, 191 8 j reports the following, in a child of ten years. The aspiration of the tooth was not noticed or even suspected at the time of the accident. According to the dentist the tooth did not fall from his forceps in the mouth, but it fell on the napkin below the child's chin. As she was re- covering from the nitrous oxide anesthesia she threw up her arms and made a deep wide mouthed inspiration. It must have been at this moment that the tooth was aspirated into the left lung. The first attempt at peroral removal failed, owing to the tight impaction of a smooth, hard body, whose slippery, Buy Mesterolone conoidal surface ofTered no grasp for the forceps. The second eiifort failed because the patient collapsed before removal had been at- tempted. The collapse was possibly due to the trac- tion on the heart necessitated by the obliquity of the bronchoscope tube in the peroral route. The removal through an opening in the trachea was found to be simijle, safe, and prompt and in no way comparable to the difficulties and anxieties of the two peroral attempts. The following con- clusions are arrived at: Endoscopy of the air and food passages must always remain in the hand? of the expert laryngologist. . If he is well experi- enced and in regular practice he will first make his approach through the mouth, and in most instances he will succeed. But in a certain number of cases, particularly the rarer and more difficult ones which occur in the left lung, the lower route, through a tracheal opening, is the preferable one to be taken in the interest of the patient. It will also be the route taken more readily by those who are less ex- perienced. The advantages can be summarized as follows: 1. Less anxiety with the anesthetic, as we all know that the administration through a tracheotomy opening avoids all pharyngeal and laryngeal reflexes, and is therefore much smoother and safer ; 2. ability to succeed with several trained assistants, because there is no longer the necessity to mobilize the head ; 3. the use of a wide- and shorter tube, thus obtaining 4. better illumina- tion, 5. a larger field of vision, and 6. increased facility of manipulation ; 7. less leverage and trac- tion on the important structures at the root of the lung; 8. shorter sitting; 9. greater certainty in re- sult; 10. in the event of failure, or of the foreign body shifting its position during the seance, the tra- cheotomy is a decided security. Lower bronchoscopy will therefore be the necessary method in certain' circumstances, or when foreign bodies are tightly impacted, or when they have receded to the deepest corners of the airway, and particularly in the greater difficulties presented by their entry into the left chest. The only drawback is the insignficant one of a slight scar. Experimental Meningococcus Meningitis. — Charles R. Austrian (BuHctiti of the Johns Hopkins Hospital, August, 1918) found that the cerebro- spinal canal can be infected 'by way of the blood stream. It was impossible to infect the normal cerebrospinal canal of rabbits by intranasal injec- tion of the meningococci. The demonstration Generic Mesterolone of meningococci in the nasal secretion is to be regarded as an evidence of their excretion by this route, but the conclusion is not necessarily warranted that the organisms find a direct portal of entry to the meninges through the nose. When the animal is normal, the presence of a bacteriemia does not lead to the development of meningitis, but when hyper- mia of the thecal vessels exists, meningeal inflam- mation may result. This may explain in a measure the occurrence of the disease in some persons ex- posed, while others who come in contact with th'i same sources of infection remain well. Austrian

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