getic measures taken to insure cleanliness and despite the continued application of drying and disinfectant powders. In both there were blisters and abrasions, and in both the condition was completely cured in the course of three days by the application of glycerin well spread over the soles and toes before the socks were put on, this being repeated each morning.-Therapeutic Gazette.

ARTIFICIAL PNEUMOTHORAX:-In diseases of the lung, not tuberculous in etiology, where the respiratory action and pulmonary tension interfere with recovery, artificial pneumothorax, with its collapse of lung and complete rest, has been curative. Reports in the literature of such cases as pulmonary abscesses, fetid bronchitis, painful pleura from malignant disease, and bronchiectases successfully treated, are becoming more frequent.

Artificial pneumothorax is not a specific cure for pulmonary tuberculosis. It is solely a mechanical measure to give rest to the affected organ, that the reparative work of Nature may not be hampered, and so permit the system more easily to get rid of the disease. It has failed to bring about a cure in many cases, while in many others, for whom no hope of improvement otherwise existed, it has produced wonderful results. The important work with it for us at the present time is the selection of proper cases and securing for them all those benefits which this measure can give. -Thos. A. McGoldrick, M.D., in Long Island Med. Jour.

TREATMENT OF BOILS:-C. W. Allen (New Orleans Med. and Surg. Jour.), who, after using a variety of remedies for furunculosis, including autogenous and stock vaccines, sulphur baths, carbolic acid injections and baker's yeast, all in his own person, finally resorted to dilute nitromuriatic. acid, of which he took 10 to 15 drops in water after each meal. Within a few days he began to note improvement; the well-developed lesions soon disappeared and those in the process of development were quickly aborted.

CARDIOVASCULAR SYPHILIS.

BY W. A. OUGHTERSON, M.D., OF NASHVILLE, TENN. It is difficult in many cases of syphilis of the internal organs to say whether the syphilitic process involves the vessels proper or the parenchymata of the organ. This is especially true of cerebro-spinal syphilis, as the symptoms of small gummata in the brain and those of obliterating syphilitic endarteritis are distinguished with much difficulty.

In the case of the large arteries, especially the thoracic aorta, recent studies have proven that syphilis plays a very important part in many pathological changes seen in this location. This is especially true of aneurism and disease of the aortic valves. Francis H. Walsh, of the British Army, found a history of syphilis in 66% of his cases of aneurism; Malinstein showed a history of 80%; Hamplin showed a history of 82%; Heller 85%; Pancini 85%. Some of these observers did not regard all aneurisms, even in syphiltic subjects, as due to syphilis, attributing some of them to degenerative changes due to typhoid, scarlet fever, pneumonia and erysipelas. Still other observers assigned.

degenerative chanbes to lead, tobacco and other toxic substances.

Since the discovery of the spirochete of syphilis and the blood reactions which have thrown so much light on the diagnosis, it has been found that much higher precentages of aneurism are due to syphilis than those above quoted. It may be true, as some men contend, that even the direct history of syphilis together, with the presence of positive Wassermann reaction does not constitute absolute proof that syphilis is the only cause of aneurism. On the other hand I have never seen but one case of aneurism in which a syphilitic history or positive evidence of syphilis was not present. If the Wasermann test is to be taken as positive evidence, then the percentage of aneurism due to syphilis would be much higher and I believe had a Wassermann been made in the one case above mentioned with negative history, that also would have spoken for syphilis. The spirochete of syphilis may be demonstrated in the aneurismal wall in a high per cent of cases; then, too, the pathological changes seen in syphilitic aneurism are so characteristic as to leave but little doubt as to cause. The process here is characteristic of syphilis seen anywhere productive, always producing a mesarteritis and so marked may the foci be in the adventitia and media that they are like Milliary gumma; the fatty and hyaline changes are very characteristic so that to my mind the pathological findings should leave but little doubt as to cause.

Since the days of Wassermann some investigators claim 98% of all aneurisms are syphilitic, and this I believe is not too high, notwithstanding we do have other causes, demonstrated by Thayer, of America, and by European investigators, that typhoid and other infections may bring about changes in the vessel walls that weaken their coats, and any excessive strain may produce aneurism at a weakened point. Then we have the mycotic form of aneurism; in the mycotic variety of aneurism septic emboli are carried into

the vasavasorum followed by small abscess, injuring one or more coats of the vessel, later producing aneurism by excessive muscular strain or prolonged high blood pressure. In this class of cases periarteritis is a marked feature with swelling and the pulsation may not appear until the subsidence of the swelling.

Fragments from a calcified vegetation may be swept away, lodge in the vasavasorum and produce aneurism. The following are some of the important features of syphilitic aneurism; it usually occurs in a person under forty, the ascending arch is most frequetly involved, angina pectoris may be an early symptom, aortic insufficiency is often associated with it, aneurisms are frequently multiple, several have been described-the small cup-shaped sacs on the ascending arch are nearly always syphilitic. There are other symptoms, gumma of the liver, bones and marked change in the peripheral arteries. I believe 95% of true aneurisms are syphilitic. Aneurism of the heart is frequently seen at post-mortem, rarely recognized by physical signs. I am unable to say what percentage of cases of aneurism of the heart is caused by syphilis. The mortality from this phase of the disease is difficult to determine, in fact cardiovascular syphilis could be much more satisfactorily discussed from a standpoint of its bearing on longevity and economics, as death due directly to syphilis of any form is not common with our present methods of diagnosis and treatment, but indirectly the mortality is very high. The statistics on aneurism would indicate that aneurism is much more frequent in Great Britain than any other country; in 19,000 post-mortems in Vienna there were 230 cases of aneurism; in the same number of postmortems reported from Guy's Hospital, London, 325 cases; it is much commoner in the negro than in white men.

Changes in the heart in syphilis: I believe that luetic involvement of the heart and aorta is much more frequent and much more serious in its direct affect than internists

and syphilographers have noted in the past. In fifty cases studied by Brooks, the following changes were noted:-the visceral pericardium was diseased in twenty-eight of the fifty cases. He calls particular attention to opalescent patches of thickening which correspond to the perforating points of terminal arterials; this same condition may be observed resulting from other causes. The myocardium was found diseased to a serious degree in 44 cases, 88%; and true cardiac gummata in five, or 10%. Merck's report showed gumma in about the same proportion. The most frequent myocardial change was found to be an inflammatory process even up to 90%, according to different investigators, chiefly the late stages of syphilis, by small, round-celled infiltrations about the arteriols or by foci of fibrosis which is most likely due to round-celled infiltrations so characteristic of syphilis followed by fibrosis in all parts of the body; as a probable sequence of such changes cardiac aneurism was found in 6% of the cases. Diffuse

or localized areas of scar formation are frequently encountered; fibrosis is usually associated with other changes degenerative in character, acute purely degenerative changes, not unaccompanied by fibrosis, is not often met with. Seventy per cent of cases show marked changes in the coronary vessels to a relative greater grade than the general arterial change. This change has long since been recognized in syphilis; according to Brooks becomes an important factor in many cases before the secondary eruption appears well developed. According to the same authority the occurrence as well as the degree of coronary disease appears to correspond more or less to the activity of the disease rather than duration of infection. Age appears to play but little part in the determination of coronary disease in lues, ten percent below thirty; nine percent below forty years of age.

The type of coronary disease is variable, six percent coronary thrombosis resulted from an active primary en