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Radical Mastoid Operation in Chronic Sup- purative Otitis. — W. D. Black (Journal of the Missouri Stale Medical Association, April, ic)i8) divides indications for the radical mastoid operation into two classes ; immediate and deferred operation. Immediate operation is indicated in dangerous com- plications such as otitis, brain abscess, epidural ab- scess, cerebellar abscess, thrombosis of the lateral sinus, extensive cholesteatoma, beginning symptoms of meningitis of otitis origin, sudden facial paralysis or labyrinthine involvement. Deferred operation is done in chronic suppuration where, after three months, medical treatment com- bined with surgery through Osu Cialis Generico Italia the external canal has failed. Further, progressively decreasing hearing and persistent discharge regardless of treatment call for the radical operation ; again, if pain occurs within the ear or over the side of the head in an otherwise quiet suppurating ear even if the canal is patulous and the perforation large and clean, the radical operation is indicated. Psychoanalytic Tendencies. — William W. White {American Journal of Insanity, April, 1918) tells us that Freud has now abandoned the theory of sexual trauma m infancy in favor of the incest complex as the root complex in all neuroses. It is a measure of the progress of the individual along the developmental path and with the discovery of this we go far toward solving the problem of the neurotic or the psychotic. To deal with such prob- lems there has arisen an energic concept of psychic force — the libido — and keejiing it in mind we are prepared to attack problems of maladjustment, failure to integrate, etc. Adler has gone away from the purely psychological viewpoint and siiown us that the neurotic's symptoms are expressions Osu Cialis Generico Italia of his attempt to compensate for organ inferiority. In all departments of knowledge we may see analogous process : in physiology, the conditioned reflexes of Pawlow ; in philosophy, the dynamic concept of Bergson ; in philology, theology, Osu Cialis Generico Italia mythology, etc. Thus psychoanalysis forms a common denominator for the progress of knowledge of mankind, never as bad as the realist paints, rarely as good as the ideal- ist fancies, but "human, all too human," with hopes and fears, struggles, successes and failure. This can be illustrated by the modern attitude toward the alcohol problem, it is not a therapeutic or an Osu Cialis Generico Italia eco- nomic problem primarily, but a psychological one. Why does the individual use alcohol ? That learned, we can attack the problem with some degree of hope. Furthermore, by the aid of psychoanalysis. we are beginning to understand our mental patients and actually do something for them. Late Results of Testicle Implantation. — G. Frank Lydston {Journal A. M. A., iMarch 30, 1918) presents the records Osu Cialis Generico Italia of two of his cases of bilateral testicle implantation, the one having been done in August, 1915, the other Osu Cialis Generico Italia in October, 1916. In both patients there has been a return of the absent Osu Cialis Generico Italia sexual functions, removal of most of the secondary female sex characters and acquisition of the sec- ondary male characters, and other evidences of a permanent restoration of the testicular hormones. Tuberculosis of the Cecum. — John W. Sluss (Journal uf the Indiana State Medical Association, March 15, 1918) thus summarizes the points in his paper: Tuberculosis of the cecum is Osu Cialis Generico Italia practically a primary affection. In its earlier stages it may be diagnosed as acute Osu Cialis Generico Italia appendicitis or tubercular peri- tonitis, in its later stages as appendicitis with in- llammatory exudates or abscess formation, in its terminal as carcinoma. The patholog}' is consti- tuted by ulceration of the mucosa, hyperplasia of all the layers and especially the peritoneal covering, and terminal cicatrization with stenosis. The tumor mass is not usually adherent. Excision offers an excellent prognosis if not undertaken too late; be- fore metastasis is general and before obstruction supervenes. X Ray Diagnosis of Pulmonary Tuberculosis. — H. T.ebon {fresse medicale, February 14, 19181 pleads for the Osu Cialis Generico Italia utilization of all procedures calculated to assist in the early diagnosis of the disease Osu Cialis Generico Italia rather than a too exclusive reliance on x ray examination. Doubt is not always removed even by painstaking radioscopy. On the other hand, contrasting condi- tions in adjoining sections of lung tissue, only with difficultv perceptible through auscultation and per- cussion, can be at once made out on the screen. Opacities due to circumscribed but advanced lesions are very precisely revealed. A simple diminution from the normal transparency of the apices is harder to detect under the x rays than are circumscribed lesions, and in this direction the x ray examination is subject to almost as many causes of error as arc percussion and auscultation. Discrete lesions in the apices may not be revealed by the rays, even though alieady causing a diminution of the vesicular mur- mur on auscultation. There is as yet no general agreement as to whether radioscopy will reveal an apical shadow before the expiratory breath sounds are at all modified. The author is inclined to be- lieve that in the presence of an apical shadow posi- tive auscultatory signs can always be made out. Tubercle bacilli can sometimes be found in the sputum where there is only a slight apical x ray shadow : this is due to perforation of bronchial chan- nels- by Osu Cialis Generico Italia a small submiliary focus. Again, an abnor- mal shadow at the apex may result Osu Cialis Generico Italia from an old tn- bercndous focus or an old apical pleuritis. .Slight diminution of clearness at both apices, whether noted by radioscopy or radiography, does not, in the ab- sence of auscultatory signs, warrant a diagnosis of lung tuberculosis. Slight diminution of clearness at •nc apex is of much greater significance, but still docs alone warrant a positive diagnosis. The prob- ability ot an apical tuberculosis does not approach certainty unless the findings of percussion, ausculta- tion and radioscopy are in agreement. Proceedings of National and Local Societies TJIK MEDICAL ASSOCIATION OF THE GREATER CITY OF NEW YORK. Sidled Mcetinci, Held October yj, KjiJ. The Problem of the Feebleminded and Epilep- tics. — A p.iiKT was read by Dr. W . 1!l'kgi:ss Cor-