Special Notices.

ACUTE INFLAMMATION OF THe Prostate GLAND.—The Journal of the American Medical Association, for August 20th, contains a report on inflammation of the prostate gland, which was presented to The Section on Surgery and Anatomy at the Fortyninth Annual Meeting of the American Medical Association, held at Denver, Colo., June 7-10, 1898, by Liston Homer Montgomery, M. D., of Chicago, Ills. His plan of treatment in acute inflammation of the prostate gland is to wash out the abscess cavity with hydrogen peroxid, give copious hot water enema and hot hip baths frequently, avoid morphine internally, and advise care lest the patient strain at stool or during micturition. On the theory that toxins are retained in the circulation and within the gland, and to prevent degeneration in the gland substance, he administers triticum repens or fluid extract tritipalm freely, combined with gum arabic or flaxseed infusion. Along with these remedies the mineral waters, particularly vichy with citrate of potash, go well together. Hydrate of chloral or this salt combined with antikamnia are the very best anodyne remedies to control pain and spasms of the neck of the bladder. These pharmacologic or medicinal remedies are the most logical to use, in his judgment, while externally applications of an inunction of ten or twenty per cent iodoform, lanoline, as well as of mercury, are also of value.

EDW. L. H. BARRY, JR., M. D., Jerseyville, Ills., says: I have used Aletris Cordial with excellent results in the following: Miss R., nineteen years of age, brunette, welldeveloped, but troubled with dysmenorrhea, called at my office, and after explaining her affliction said, "Doctor, if there is any thing you can prescribe to relieve my suffering, do so, for life is a burden to me now." I thought of the Aletris Cordial at once, and gave her a six ounce bottle, directing her to take a teaspoonful three times a day, commencing four or five days before the regular period. Several weeks afterward she returned with the empty bottle, remarking, "I've come back for more of that medicine, for it's the only thing I ever had to give me relief." I can cheerfully recommend Aletris Cordial to the profession.

J. A. STOUTENBURGH, M. D., late Resident Physician Columbia Hospital, Washington, D. C.:-"We need a remedy or combination of them that will increase the oxygencarrying power of the blood, increase the appetite and stimulate the stomach and intestines to renewed activity. Many so-called blood-makers attempt to do too much for us by supplying pre-digested and artificial food. It is better to give nature a chance, by coaxing her to resume her work, and then furnishing a nutritious and easily-digestible diet. 'Gray's Glycerine Tonic Comp.' is a preparation which has done me excellent service in many cases. I am well satisfied that we have in this tonic a most valuable medium, one sure to grow in favor as its merits become better known."

SANMETTO. I have been using Sanmetto for the past three years in my practice. Have prescribed it in chronic cases of irritable bladder, urethral canal, irritable and enlarged prostate gland, sexual perversion, dropsy, and cystitis. I have found and know it to be an excellent remedy for all the above named diseases. I am more than much pleased with Sanmetto. Every physician should be made acquainted with Sanmetto.

AVONDALE, Ala.

J. P. HAWKINS, M. D.

CHEMICAL FOOD is a mixture of Phosphoric Acid and Phosphates, the value of which physicians seem to have lost sight of to some extent in the past few years. The Robinson-Pettet Co., to whose advertisement we refer our readers, have placed upon the market a much improved form of this compound, "Robinson's Phosphoric Elixir." Its superiority consists in its uniform composition and high degree of palatability.

Certainly it is excellent discipline for an author to feel that he must say all he has to say in the fewest possible words, or his reader is sure to skip them; and in the plainest possible words, or his reader will certainly misunderstand them. Generally, also, a downright fact may be told in a plain way; and we want downright facts at present more than any thing else.-RUSKIN.

Original Articles.

HERNIA AND REPORT OF CASES.

BY A. H. BARKLEY, M. D.

Hernia, in its broadest sense, is the displacement of an organ from its natural cavity. Hernia may occur at almost any part of the abdominal wall, but usually occurs at the weak points in the wall. Hernia may be one of two kinds, congenital or acquired. The sac in a congenital hernia is formed before birth, though the rupture may not be present until some time after birth. In acquired rupture the sac is formed after birth. An acquired hernia may be either direct or indirect.

A direct hernia is always acquired, and enters the inguinal canal low down. Its neck is internal to the deep epigastric artery. An indirect hernia follows the oblique direction of the inguinal canal, and its neck is external to the deep epigastric artery.

It is surprising to note the large number of people who are ruptured. The London Truss Society alone treats about eight thousand every year. It is also interesting to note the frequency in the two sexes. It is said by most authors that one male in every thirteen and one female in every fifty-two are ruptured.

As to age, quite a large number occur during the first year of life, but the majority occur during that period of life when physical powers are most active. The diagnosis of inguinal hernia is, as a rule, easy, but once in awhile we encounter cases in which some doubt arises; therefore it would be well to refer to some points about diagnosis and dif

ferential diagnosis: Pain, tumor, impulse on coughing and return into the abdomen when the patient is in a recumbent position. Practitioners usually pronounce a person ruptured when these four symptoms are present, but these will not suffice, for in some cases other conditions are present which give the same symptoms, that is, hydrocele of a cord, hydrocele of canal of Nuck (in females), varicocele, hydrocele in tunica vaginalis, adenitis, undescended testicle, orchitis, hematocele, psoas abscess. The majority of these conditions can be distinguished from a rupture. Hydrocele of the tunic can be readily recognized by the light test, and history of the case. Swelling begins below, while in hernia it begins above, can not be reduced, and size does not diminish. In infants with congenital hydrocele there is sometimes present an unusual condition, that is, a small opening connecting the tunic with the abdominal cavity, and when the patient is lying down the fluid can be forced out of the tunic.

Varicocele is mistaken for hernia, but can be readily distinguished; there is no impulse on coughing, reducible when lying down, but a truss will not prevent its descent.

Psoas abscess may be distinguished by history of case; tubercular disease may be in evidence in some other part of the body. The other, conditions may, with a little care, be easily diagnosed from hernia.

CASE 1. George T., age eight. I was called to see this young man on January 22, 1897; found him suffering from R. congenital hernia having slipped by the truss, got down, and was with some difficulty reduced; he continued to wear a truss until April 28, 1897, when he was sent to the hospital for operation. He was given three grains calomel, five grains soda bicarb., in capsules that night, and two drachms sulp. magnesia the following morning. No breakfast, and at eleven. A. M. he was operated on. His temperature was not high, and pulse good throughout. He was not allowed any thing except small pieces of ice for twenty-four hours. There was no vomiting; he was placed on light diet for first week, and then the diet was gradually increased; bowels moved on the third day. Stitches were removed on the ninth day; wound had healed. He was kept in bed two weeks longer to allow cicatrix to get firm, and was then dismissed.

CASE 2. W. H., age five years, was sent to me for operation. I found he had a large congenital hernia on right side, which was not controlled by a truss. He was admitted to the infirmary on October 25, 1897, and, after all the necessary antiseptic precautions, he was operated

on the following morning. He was not allowed any thing for twentyfour hours except teaspoonful doses of hot water every fifteen or twenty minutes to settle the stomach; nausea soon passed away, and he was placed on fluid diet for a week; bowels moved on the third day; stitches taken out on the ninth day; wound had healed. He was kept in bed two weeks longer, when he was discharged.

CASE 3. Mrs. A. B., age forty-three years, was referred to me on November 6, 1897. I found she was ruptured on both sides; both were indirect hernias; the right side was much larger. She was advised to go to the infirmary, where I operated on her November 8th. It was my intention to operate on both sides at the same time, but as the right side was so large I concluded to wait a week before operating on the left side. The ligament on the right side was atrophied, the sac was very adherent, pulse and temperature were good, and she was prepared on November 15th for operation on left side, which was easier than on right side, being smaller and of shorter duration, having had the one on the right side twenty-eight years, the one on left side five years. She stood both operations well; was kept on light diet; stitches on right side were removed on the ninth day after first operation. The stitches on left side were removed, some on the fifth day, and the rest on the ninth day. A small stitch abscess, which necessitated the removal of three stitches, occurred, which was healed after some little trouble. She remained in bed for five weeks from date of first operation, when she was discharged.

CASE 4. B. W., age forty-five, was seen by me on September 19, 1897. He had an indirect inguinal hernia about the size of an orange. I sent him to the infirmary, and on the 21st of September I operated on him. I removed the sac easily, as no adhesion to amount to any thing had occurred. He had been ruptured only fifteen months. Nothing eventful occurred in this case; stitches were removed on the ninth day, and he was allowed out of bed three weeks from date of operation.

CASE 5. H. M., male, age eighteen, while wrestling felt something give away, felt sick, sent for a doctor, who tried to reduce the rupture but failed, so he sent for me. I arrived at the house at 3 A. M. No further attempt at reduction was made; he was sent to infirmary, where he was hastily prepared and operated on at 4:30 A. M. The operation was easily and quickly performed. The bowel was found in good condition, so it with a small bit of omentum was returned into the cavity.

He did not suffer much shock; the wound healed nicely, and he was allowed to return home three weeks from date of operation.

CASE 6. F. H., female, age thirty-three, had been ruptured on left side for twelve years. On December 23, 1897, she was sent to the hospital by her physician, who asked me to operate. I did so on December 25th. This case followed the same course as the others, except a stitch abscess, which healed kindly; she was out of the hospital four weeks from date of admission.

CASE 7. A. P., age fifty-four, had been ruptured on left side for two years. He was operated on February 1, 1897; recovery was uninterrupted, and he was allowed to go home on February 24th.

CASE 8. G. B., age nineteen, congenital inguinal hernia, was operated on April 27, 1897; ran a course similar to Case 7.

CASE 9. R. S., age forty, male, came to me to be operated on. I found he had been ruptured since he was nine years of age. His hernia was right indirect hernia, which was very large. I advised the use of a suspensory, which he wore with no relief. I operated on him. May 4, 1897. I had considerable trouble with the adhesions. He did very well until the third day, when his temperature went up. I examined the wound and found a little pus, which was removed. He was a "specific," and the iodide of potass. was ordered, which caused the wound to heal very promptly. He was dismissed in five weeks from date of operation.

CASE 10. H. I., male, age eight months, was sent to me. I found a large congenital hernia on the right side. This baby was prepared for operation, and on December 12, 1897, I operated on it. The parts being small, the tunic was with difficulty tied off high up. It required an hour to perform the operation. Child did not suffer much shock; 30 grain strychnia was given. Chloroform was used, from which it did not thoroughly regain consciousness for nearly five hours. It was allowed to nurse the breast after twelve hours. There was no nausea or vomiting; bowels moved on the second day; stitch was removed on the seventh day; a light dressing was applied, and child was allowed to go home at end of two and a half weeks.

The treatment employed in the above cases has been entirely operative. I have employed trusses and the injection treatment, but not with the same success that I have obtained from the operation. Bassini's operation was the one employed in the above cases. It is as follows: After rendering the field of operation sterile, an incision is made