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CHAS. WILLMS, General Manager.

TREATMENT OF EPITHELIOMATA.

Professor John A. Wyeth, M. D., in a clinical lecture delivered at the New York Polyclinic and published in the International Journal of Surgery for May, speaks of the benefit he had derived from the use of arseneous acid, (we presume he means the oxide,) in the treatment of superficial epithelioma. He says: "If I had a superficial epithelioma develop anywhere on my body where I could use Marsden's paste, I would prefer that method of treatment to the knife. In cases where the disease has existed for so long a period that the paste alone can not be relied upon, I would prefer to have the malignant process first cut or scraped away, and then have the paste applied. In this way we get more satisfactory results than by any other treatment I know of.

The formula for Marsden's paste, which I have given a number of times, is as follows:

R Acid arsenious.....

Pulv. gum Arabic..
Cocaine muriate..

2 drams

I dram
. 18 grains

This powder should be made into a paste by adding water, when it is to be used; and "the paste should be of the consistency of rich cream, and applied to the wound on a small piece of cloth, and left on from eighteen to thirty-six hours. This can be repeated as often as necessary. The above is the formula for the stronger paste. In the weaker, only one dram of arsenious acid is used, and twelve grains of cocaine."

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DEDICATION AT COLUMBIA.

The Academic Hall and the New Department Buildings of the University of Missouri will be dedicated with appropriate ceremonies, and the Commencement Exercises will take place on the 2nd, 3rd, 4th, 5th and 6th days of June at Columbia, Mo. We thankfully acknowledge the compliment conveyed in the invitation to attend the exercises.

PROF. MORIZ KOHN KAPOSI,

the subject of our cover-portrait, was born at Kaposvar, in Hungary, October 23, 1837. He studied medicine at the University of Vienna, where he received his degree of M. D. in 1871. He was a pupil of Hebra as a student as well as after his graduation. In 1875 he became Professor of Dermatology at Vienna, and in 1879, Director of the Department of Skin Diseases. His first notable work was on "Syphilitic Manifestations of Mouth, Nose, Pharynx and Larynx," which appeared in 1866. In 1872, in conjunction with Hebra, he published a "Text-Book of Skin Diseases. Among his principle works are "Syphilis of the Skin and Contiguous Mucous Membranes," which appeared in parts, periodically; "Lectures on the Pathology and Treatment of Skin Diseases;" "Handbook of Syphilis," and on "Xeroderma Pigmentosum Mihi." He has at all times been a liberal contributor to journals, on dermatological subjects.

WESTERN ASSOCIATION

OF OBSTETRICIANS AND GYNECOLOGISTS.

Elsewhere in this issue we present a report of the meeting of this flourishing society, and a number of the papers presented by its members. THE MEDICAL HERALD has been selected as the official journal of the association, and the proceedings will appear regularly hereafter in this maga zine. We congratulate the society upon its disposition of the matter of publication. Instead of having its minutes and valuable papers buried in a volume of transactions, which no one but members ever receive, this society has adopted the more modern plan of having a live medical journal bring its work to the notice of the profession at large, and thus perpetuate the good accomplished along the lines of progress, at its meetings. We are proud of this association, as a western creation, and hope its members will feel free to communicate to our pages, outside of the regular society proceedings, and thus keep up intercourse one with another between the annual meetings. In the near future it is the intention of THE HERALD to present some fine engravings of the officers and executive committee of this growing society.

235

CASTRATION IN ENLarged prOSTATE.

The sufferings which sometimes arise from an enlarged prostate are such as to call for surgical relief. A catheter life is distressing in the extreme, and the sufferer is oftentimes disposed to submit to any measure that promises relief. About four years ago we published an article from Wood's Medical and Surgical Monographs, written by Reginald Harrison, of London, England, detailing an operation which, in his hands, had proved of great benefit.

Of late, a new operation has been proposed; that of castration. It was suggested by Dr. J. W. White, of Philadelphia, in 1893, in a paper read before the American Surgical Association, and has since been practiced by him with favorable results. The hope of success from the operation finds encouragement from the effects of castration on some of the lower animals and from the state of the prostate in eunuchs among men, and also from the effect which retained testes seem to have on the gland.

As the removal of the testes in animals is followed by a diminution in the size of the gland, the hope seems reasonable that a like effect will follow their removal in men. Facts already ascertained show that the gland belongs, at least, to the reproductive or sexual system. It certainly must be a necessary organ in that system, otherwise it would not be present and sustain a connection with the more important organs of the sexual system. Castration has been followed by a diminution of the gland, and a consequent disappearance of the more prominent effects which the enlargement produces, and some remarkable cases have been reported; nevertheless, cautions and protests have been uttered as warnings against its indiscriminate employment. A few cases have been disappointing; and though this should occasion no surprise, since such is the character of the remedy that there will be hesitation in resorting to so radical a measure.

Painful and difficult micturition and retention of urine are two prominent evils attending prostatic enlargement; but the enlargement of the gland is not always the cause of these symptoms. They may occur, even in the aged, without enlargement, and from a cause having no connection with the abnormal condition of the prostate. In cases of la grippe retention has occurred from muscular spasm, of mild or severe character, in which cases the catheter is passed early or with so much resistance as to occasion hemorrhage by its introduction. But such cases are of short duration. Only the severe and chronic form can justify a resort to castration; and the sufferer will submit to any measure that promises permanent relief.

A very considerate article may be found in the New York Medical Journal of May 11th, from the pen of Samuel Alexander, M. D., of Bellevue;

236

the following is an extract from an editorial in the International Journal of Surgery, of April:

Prostatectomy, perineal or supra-pubic, is an operation the dangers of which are well known. If we add to this the fact that we are compelled to operate in men whose age, whose previous sufferings, and whose general exhaustion make them unable to stand severe operative measures, we immediately recognize what a boon the less serious procedure of castration must prove. The common existence of cystitis due to unclean catheterization at the hands of the patient themselves, leads us ever to fear the occurrence of pyelonephritis after direct interference with the bladder itself. With castration shock is less, the hemorrhage is practically nil, the duration of anesthesia greatly reduced, the nursing and after-care incomparably easier, and finally, the improvement is usually rapidly manifested. Patients have urinated easily, and declared themselves greatly relieved, within forty-eight hours after the operation.

It would seem to be the duty of every surgeon to carefully explain to all patients the various procedures that are at their disposal, and to insist upon the advantages to be gained by the less severe, and apparently, more effective operation. It is certain that in a short time we will know the remoter results of castration, and possess statistics that will enable us to judge with greater certainty of the ultimate value of the operation. We do not hesitate to say, however, that a new surgical method is seldom presented with as brilliant a beginning and satisfactory a fulfilment. Performed with prudence and upon cases properly selected, the chances are that castration for enlarged prostate possesses a brilliant future. It must not be forgotten that discredit will attach to every operation that is performed injudiciously, hence the operator must feel assured, in every case, that he is dealing with true prostatic enlargement, and not with abscess, tumors of the prostate and neck of the bladder, and other pathological conditions that might lead to error in diagnosis.

JOHN RICHMOND.

Dr. John M. Richmond has great many friends among the subscribers to THE MEDICAL HERALD who will be pained to learn of a recent heavy affliction that has come upon his family. His son John, a young man twenty-three years old, died in St. Louis May 8th, after an operation for appendicitis performed by Drs. Mudd and Prewitt.

Mr. Richmond was an architect of unusual ability and promise, who has resided in St. Louis for several years past. He was a member of the Architectural Club and of the St. Louis Sketch Club, and held from the latter three prizes awarded for execellence in sketching. His death is peculiarly sad, because of his youth and the promise of great things which he gave. His disposition was a most lovable one, for he was pure-minded, generous and noble-hearted. It is, therefore, not a wonderful thing that