All the patients recovered spontaneously. Lee states that the etiology of the subphrenic infection was unknown, in his series of cases, although he points to its development after an operation for incarcerated hernia, in one case. In another case there was a pos¬ sible association between the subphrenic infection and a prolonged diarrhea. From the foregoing, it can be said that Lee's contri¬ bution is of distinct value in the presentation of more clean-cut physical signs of nonsuppurative

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... enic peritonitis and in the demonstration that more obscure foci than a diseased appendix, gallbladder, etc., may be the source of the infection. Cases of simple otitis media with bacteremia are sufficiently rare, or are so seldom recorded in the literature, as to warrant the report of the following case: B. S., girl, aged 9, was taken ill, March 5, 1915, with fever and malaise. A saline cathartic was administered, and, March 7, the temperature dropped to 99, but rose during the night, accompanied by severe pain in the left ear. I saw the patient for the first time on the following day, that is, on the fourth day of the illness, and found the temperature 102.6, pulse 110, respirations 24. The patient complained of pain in the left ear. The throat was normal, turbinates congested, right ear normal, left tympanum bulging and deeply congested. An immediate myringotomy was done. Despite the fact that there was a copious bloody serous discharge, the temperature rose that night to 105 and remained the following day between 103 and 104. The right ear drum was pale and normal. There was no pain in the left ear. During the night there was pain in the right ear, and the following morning the right ear drum was found to be bulging, deeply congested, and almost black. A liberal incision in the drum was made. Again the temperature rose during the night to 105. The follow¬ ing day, March 11, there were no pain and no mastoid tenderness ; both ears drained freely with bloody serous discharge, and the temperature ranged from 102 to 105. Smears from the ears showed the pneumococcus. March 12, Dr. E. Libman examined the patient ; he could find no lung, meningeal or other complication. A blood culture was taken. The temperature at that time was 101.6, but rose during the night to 106. The patient was somewhat delirious. Leukocytes, 14,000. Polymorphonuclears, 61 per cent. March 13, blood cultures as yet showed no growth. The temperature fluctuated between 102.5 and 105.8. Discharge from the left ear was almost nil, and the membrane was becoming pale. The right ear was discharging freely. Despite the continued high temperature, I felt reasonably sure that there was no mastoiditis. There were no chills ai any time, the patient was withstanding the high tempera¬ ture very well, and I felt justified in waiting another day. March 14, the ninth day of illness, the temperature in the morning was 98.4. There had been a steady drop during the night from 105.8. My delight was somewhat clouded by a report that the blood culture showed a growth of pneumococcus, but it was slight, only one colony. This was thirty-six hours after blood had been withdrawn. The Read at a meeting of the New York Physicians Association, April 22, 1915. temperature rose in the afternoon to 102.6. The left ear was healed. From the right ear there was a slight dis¬ charge which later became purulent and continued for two weeks. The patient had no more high temperatures after this. Recovery was retarded by the occurrence three days later of a duodenitis, which persisted for about two weeks. This was undoubtedly metastatic in character. The patient was examined, April 17, 1915. Both ears had healed, and the patient was well. It is possible that, if blood cultures were taken, many cases of otitis would show a bacteremia, and would help verify the contention of bacteriologists that there is hardly an infection, no matter how slight and localized, but that, at some time during its course, bacteria are demonstrable in the general circulation. 120 West Eighty-Sixth Street. FOREIGN BODY IN THE BLADDER Max Bornstein, M.D., Milwaukee, Wis. F. M., German, aged 19 years, machinist helper by trade, with poor general physical condition, and mentally below par, was given to frequent masturbation, and was of that type inwhich direct irritation of the urethral mucosa was necessary for complete sexual satisfaction. The chief complaint was general weakness and constant dribbling of urine. Three years before, while he was masturbating with a bougie molded from a piece of chewing gum, it accidentally went beyond his reach, entered the bladder and caused the subsequent cystitis. The patient kept on working as usual, until three weeks before I saw him (Sept. 15, 1914), when incontinence set in and a constant gripping pain began to annoy him at the neck of his bladder. He had not worked since the latter train of symptoms came on, but sat about all day, listless and dull, in clothes reeking with the odor of foul urine. He was placed on urinary antiseptics, was later examined with a stone sound, which revealed a large movable stone resting on the base of the bladder. Suprapubic cystotomy was done through an extraperitoneal incision. The bladder wall was thickened, and the mucosa deeply congested and coated with fine granular salt. The trigon was completely hidden by a stone the size and shape of a medium-sized lemon. A projection from the bot¬ tom of the stone extended into the prostatic urethra. The patient was placed on general tonic treatment, and the bladder irrigated daily; but his general condition continued to grow worse until he finally succumbed seven weeks after operation. 1122 Walnut Street. Japanese Obstetrics.-Even in ancient Japan the treatment of pregnant women received great attention. There was a special birth-chamber in which the woman remained three weeks before and three weeks after delivery. In the second half of pregnancy a belt was worn and by rubbing the abdo¬ men the production of a correct presentation was attempted. During the birth and for eight days afterward a special birth stool was employed. After the middle of the eighteenth century obstetrics received a great impulse through Kagawa Shigen, at one time a rubber and acupuncturer. He published in 1765 an epoch-making work, San-ron, in which he attacked many erroneous Chinese views and collated many sound observations intermingled with a priori conclusions. The successors of Kagawa Shigen worthily continued these rational endeavors. The following particulars may be men¬ tioned as having been known and practiced : the knee-elbow parturient attitude ; care of perineum ; double ligature of umbilical cord and section of same with scissors; powdered gall as a styptic; removal of the retained placenta by rubbing the abdomen and pulling on the cord; eventual instrumental extraction ; nursing only after the fourth day.-Neuberger, History of Medicine.