79 AUTHORS' COPY. Medical News. There is the illegible hand-written manuscript, and there is the type-written manuscript, with the medical and orthographic ignorance of the type-writer glaring in every other word. The long-suffering editor hardly knows which is the worse. Type-writers, of course, cannot be supposed to acquire as a part of their stenographic education, a knowledge of medical nomenclature and science; neither has the machine been invented that will mechanically spell our remarkable medical terms with infallible correctness, If the type-writer is used, the physician should revise her, his, or its work with his medical understanding; and if the manuscript be really manu-script, chirography and punctuation should be deemed matters worth careful consideration. Writers should use good paper, say 8x10 inches in size; there should be a full inch of blank space at the left-hand side of the page, and the lines should not be too closely written. Very few writers "paragraph" correctly, and editors, therefore, much prefer that this be left as a part of the editorial work. Write "solid," putting all foot-notes immediately in the next line below that containing the asterisk, and proceeding with the text when the footnote is completed. Draw a vertical line opposite the footnote in the blank space at the left. If one has a drop of the milk of human kindness in his veins, he will not write on both sides of a sheet of paper, and he will not roll his manuscript. Mail, if possible, without folding; but if necessary to do so, fold it once, or not more than twice. Having had a single experience, both editors and publishers are thereafter afraid of a man who rewrites his article on the galley-slips. PRESIDENT CLEVELAND'S MESSAGE. Western Reserve Medical Journal. The following extract from the President's message is of interest to our profession: "I am entirely convinced that we ought not to be longer without a national board of health or national health officer charged with no other duties than such as pertain to the protection of our country from the invasion of pestilence and disease. This would involve the establishment, by such board or officer, of proper quarantine precautions, or the necessary aid and counsel to local authorities on the subject, prompt advice and assistance to local boards of health or health officers in the suppression of contagious diseases, and in cases where there are no such local boards of officers, the immediate direction by the national board or officer of measures of suppression, contant and authentic information concerning the health of foreign countries and all parts of our own country as related to contagious diseases; and consideration of regulations to be enforced in foreign ports to prevent the introduction of contagion into our cities, and the measures which should be adopted to secure their enforcement. There seems to be 80 at this time a decided inclination to discuss measures of protection against contagious diseases in international conference, with a view of adopting means of mutual assistance. The creation of such a national health establishment would greatly aid our standing in such conferences, and improve our opportunities to avail ourselves of their benefits. I earnestly recommend the inauguration of a national board of health or similar national instrumentality, believing the same to be a needed precaution against contagious disease and in the interest of the safety and health of our people." Noting that the President recommends a board of health, or a bureau, it may well be borne in mind that the Department of Agriculture (for instance) began as a Bureau. It is, therefore, the part of wisdom to ask for half a loaf for the present, in the hope of ultimately securing the whole loaf-a Department of Health. A contest for a Cabinet officer to begin with heavily discounts our chance of victory. THE PRACTICE OF MEDICINE BY OPTICIANS. Medical Fortnightly. In 1855 Dr. Williams, after spending several years in the hospitals of Germany, France and England, studying ophthalmology under the masters of that day, returned to his American home and began the exclusive practice of ophthalmology and otology in Cincinnati, O. He did not come unheralded. It had been his good fortune to instruct the surgeons of London in the use of the ophthalmoscope-that wonderfully perfect instrument which Hemholz had just given to the profession. At the time of his arrival Dr. Williams was the only oculist in the United States. For several years practice came to him but slowly. His professional brethren looked askance at his attempt to limit his practice to eye and ear diseases. They were not ready for specialization and specialists. How the idea of specialization in medical work has grown in four decades, every one knows; and we are all ready to concede the benefits of specialization if kept within reasonable bounds. Whence came the optician? Like the mule he is a hybrid--a cross between a quack doctor and a meddlesome jeweler. However, there are a few opticians who grind lenses and do not prescribe them. Like the shoemaker, the optician should "stick to his last." The great majority of lens-grinders, however, presume to practice medicine, and it is concerning the practice of medicine by opticians that we wish to speak. Your average optician prescribes lenses for presbyopia, myopia, and hypermetropia, and halts only at astigmatism. Some have been known to go farther and, after using atropine, have prescribed cylindrical glasses. To say that the giving of glasses to hyperopic or myopic subjects is not practicing medicine, is absurd. might as well be said that the dental surgeon who pulls teeth, opens antral abscesses and manufactures artificial teeth does not practice a branch of medical art. The dentist cannot legally ply his vocation without complying with the law which designed to protect the public from incompetent dentists. So it should be with opticians. If the optician presumes to prescribe lenses instead of grinding them to the order of an oculist, it is time that legislation 81 should step in and protect the public from the optician. The day will soon come when ophthalmology will be subdivided: one man will do ophthalmic surgery; another will treat ocular diseases; and the third will correct errors of refraction. When physicians and laymen recognize the fact that every pair of lenses has a definite therapeutic effect, which may be beneficial or baneful, the meddlesome optician will cease to practice medicine. CASTRATION IN HYPERTROPHY OF THE PROSTATE GLAND. University Medical Magazine. When Dr. J. William White first suggested to the profession the operation of castration for the relief of hypertrophy of the prostate gland (Address at the Annual Meeting of the American Surgical Association, June 1, 1893, Annals of Surgery, August, 1893) on theoretical grounds, although strongly supported by experimental evidence, it is doubtful whether any one appreciated the full value of the recommendation. Cases of prostatic hypertrophy are of extreme frequency. Sir Henry Thompson found that one man of every three, over 54 years of age, examined after death showed some enlargement of the prostate; one in every seven had some degree of obstruction present; while one in fifteen had sufficient enlargement to demand some form of treatment. In this country today, as shown by the last census, there are more than three millions of men over fifty-four; of these, according to Thompson's estimate, which genito-urinary specialists consider a conservative one, about two hundred thousand are sufferers from hypertrophy of this gland. This number seems very large, but the assertions of Thompson unquestionably express a general rule, and in fact every surgeon must have seen men in whom some prostatic overgrowth existed before the fiftyfourth year. The lives of such patients are threatened because, if the obstruction is not removed, the health is rapidly undermined by the retention of urine and the consequent fermentative changes, the deleterious influence of backward pressure on the kidneys, the frequent use of the catheter, and the loss of sleep incident to the incessant demands to void urine. Heretofore the surgeon has been unable to afford distinct relief from the distressing symptoms of an advanced case of this affection. If the patient's general condition would warrant the very considerable risk, some form of prostatectomy was performed. The supra-pubic method was recommended for a time, but the difficulties encountered in its performance, the frequency of supra-pubic fistula as a sequel, and the high mortality following the operation have led to its almost total abandonment. Perineal prostatectomy is also attended with considerable risk, on account of the free hemorrhage, which cannot be controlled during the operation, and the prolonged anesthesia which is necessary. In addition to this, the operation is a bungling one, in which the enlarged gland is removed by cutting, scraping, or gouging, while the instrument is out of sight, and much of the time it cannot be guided even by the finger. Combined supra-pubic and perineal prostatectomy enables the operator to reach and enucleate the gland with greater freedom, but it is an operation of such gravity that it 82 would be contra-indicated in the very cases in which the demand for relief was most urgent. Perineal prostatectomy is little more than a palliative measure, which does some good, temporarily, by draining the bladder and inducing slight contraction of the middle lobe of the prostate in the healing process. All of these operations confine the patient to bed for several weeks, which is, in itself, objectionable, and in addition require the use of the bougie for a long time afterwards. In view of these facts it is not strange that surgeons should have presented Dr. White's suggestion to patients suffering from the consequences of prostatic hypertrophy, nor is it unnatural that such patients accepted this chance of relief from a condition that in many cases, was rapidly and surely impairing the health of a person otherwise vigorous and, apparently, without this trouble destined to enjoy many additional years of life. With the testes already or soon to become functionless, and with the contemplation of a long period of intense suffering which will be relieved only by death, sentimental objections pale into insignificance, and the problem of securing relief without placing the life in danger is the only one entitled to consideration. Cases of castration based upon Professor White's deductions soon began to be reported. Ramm, of Christiania, Norway, recorded two in September, 1893; Haynes, Los Angeles, Cal., and White, Philadelphia, each report three cases; Finney, Baltimore, reports two cases; Smith, St. Augustine, Fla.; Powell, London; Mayer and Haenel, Dresden; Moullin, London; Thomas, Pittsburg; Ricketts, Cincinnati; Swain, Bristol, England; and Bereskin, Moscow, each record one case. Thus far eighteen operations have been published. All have been more or less successful, and usually the relief from the distressing symptoms and the shrinking of the prostate have been marvellous. The least favorable cases have experienced infinitely greater relief than has been obtained by any method heretofore employed. At least as many unpublished cases have been operated upon with equally favorable results. There have been no deaths from the operation; of course few would be expected in the hands of competent surgeons. To those familiar with these cases, the rapid shrinking of the prostate and the simultaneous relief afforded the patient have been truly wonderful. The operation has, therefore, passed the experimental stage, and has legitimately established for itself a position among the most successful of operative procedures. Indeed, the results have been so uniformly favorable that castration may now be considered a specific for hypertrophy of the prostate. It is necessary, however, to utter a word of caution here. Castration is not indicated in every case of prostatic enlargement or urinary obstruction. To secure uniformly successful results one must be certain that the condition from which the patient is suffering is appropriate for the operation. Cases of prostatic abscess, prostatitis, tumors of the prostate and of the region of the neck of the bladder, and other forms of obstruction in the neighborhood of the prostate must be distinguished from true prostatic hypertrophy. Without careful discrimination, both the surgeon and the patient will be disappointed, and the operation will unnecessarily be brought into discredit. 83 As it stands today, however, in appropriate cases, it appears to mark an advance in the surgery of the prostate, which, when the gravity and the frequency of the condition of hypertrophy are recalled, together with the more or less ineffectual and always dangerous methods of treatment which have prevailed, must be a source of congratulation not only to Professor White but to the profession at large, and to thousands of patients who, having outlived their sexual lives and earned an old age of mental and intellectual enjoyment, have had only a few short years of torment and misery to look forward to on account of this hitherto intractable disease. Society Surgeons St. Joseph & Grand Island R. R. MEETING AT ST. JOSEPH, MO., THURSDAY, FEB. 21, 1895. PROGRAM. 1. Thermic Fever in the Western States. F. J. Schaufelberger, Hastings, Neb. 2. Some Errors in Ophthalmology. Barton Pitts, St. Joseph, Mo. 3. Chloral Hydrate. W. R. Pennington, Beattie, Kan. 4. Rupture of the Diaphragm. Report of Two Cases. E. S. Garner, St. Joseph, Mo. 5. Enlarged Prostate in Railroad Men. S. Murdock, Oneida, Kan. 6. Arguments in Favor of a State Board of Medical Examiners. Daniel Morton, St. Joseph, Mo, 7. The Therapeutic Effects of Drugs. Noah Hayes, Seneca, Kan., Hemorrhage and Its Treatment. Jacob Geiger, St. Joseph, Mo. Clinical Reports from any member. 8. 9. Full report in the next issue of THE MEDICAL HERALD, The Arena. This phenomenal magazine continues to amaze its readers with its wonderful vitality and the richness of its pages. Each number is a volume; and so greatly has it grown that a bound volume cannot comprise more than three numbers, so that four volumes are required for each year. It is impossible to speak of the contents of a number or their merits in less space than an ordinary article requires. The range of questions discussed and its pages covers a large field; yet they are most along one line of thought; in philosophy, rationalistic; in government, socialistic in the best sense; and in morals and religion, humanitarian. It is the avenue to the public of free and independent thinkers on all subjects; the arena for all kinds of intellectual contests. It is aggressive in thought, bold in declaration and firm in its advocacy of what it esteems as right, bordering, possibly, a little on the dogmatic. All men of positive convictions are dogmatic in the estimation of thoso who have no convictions, and whose opinions are like the outer garment of cold or hot weather-changeable. The magazine occupies an enviable position in the world, and sheds lustre on the land of its birth and home. The February number is especially interesting. |