be absent, but are usually very strikingly manifested in the spirits and temper. These patients first complain of loss of strength, forgetfulness; there are meiancholic or hypochondriacal, there is irritability of temper and mutability of mental effort. Diagnosis. As the history of chronic prostatitis, seminial vesiculitis and chronic posterior urethritis are similar one can only make a differential diagnosis by an exmination of the patient. First, palpating the prostate per rectum. Second, microscopic examination of the fluid expressed from the prostate. On palpation of the prostate is found to be uniformly enlarged and tender, the right or left lobe only involved, or an irregularity on the surface of the prostate, which indicates that only a few tubules are affected. To distinguish between prostatitis and seminal vesiculitis is at times impossible on account of the seminal vesicles also being involved at the same time. On palpation of the prostate it is found that the secretions are more easily expressed than in normal conditions. This is what is termed the expressive-rine test which is made by massaging the prostate through the rectum expressing the contents of the prostatic tubules. In a normal prostate, after massage, the urine is milky from mixture with prostatic fluid while in diseased conditions flakes, masses and strings are formed by the thickened prostatic secretions. By inspection of this we cannot always form a correct opinion, and a centrifugal and microscopic examination mus: be made. Under microscopic examination if no pus is present prostatis can be excluded. The normal prostatic fluid is found to contain many elements-mucus, granular phosphates, oyxlate of lime, calcium phosphates, etc. (2) epithelium from the bladder, glands and ducts, (3) Amylond bodies occur most often in older subjects. (4) Phosphatic concretions are also found in older subjects. (5) Boettschner's crypts. (6) Spermatozoa are usually found under all conditions. Treatment. The confidence of the patient must first be secured for these patients are very suspicious that they cannot be cured. Internal medication-Tonics, saline cathartics, ergot, in half drachm doses four times a day. Massage of the prostate twice a week. Irrigating the bladder every second day oxy. of mercury 1 to 4000, permangante 1 to 5000, silver nitrate 1 to 10,000. TREATMENT OF DYSMENORRHEA. Siredey, in Quinzaine Therapeutique, gives the following advice regarding the treatment of painful menstruation: Before the flow begins to make its appearance the patient should be made to take a warm bath of a temperature of 98 to 100 degrees Fahrenheit, repeated, if necessary two or three times during the day, gradually increasing the temperature to 104 degrees F., if the condition of the patient permits of it. In addition, rest in bed must be insisted upon, and inunction by one or other of the following sedative mixtures, after the application of hot compresses or poultices: The Lymphatics BY E. C. HENRY, M. D., Omaha, Nebraska. Professor of Anatomy, John A. Creighton Medical College, WE doubt very much whether, in ordinary teaching and practice, adequate attention is given to the physiology of the lymphatics and the part they play in health and disease. Dr. Henry gives a most interesting summary of the history of their discovery, which, as he rightly says, reads almost like a romance. He then points out their anatomical significance, and the relations which they sustain to certain disease processes, of which not the least important is the role they play in the metastasis of malignant growths. He enunciates the rule that when such a growth has invaded the lymphatics, operation is useless-except, we take it, as a palliative measure. He regards the lymphatic system, and properly, we think, as a large secretory gland. The discovery of the lymphatic system reads like a romance. In the year of 1622 Asellius was one day showing his friend the arrangement of the nerves and the movements of the diaphragm in a dog, in turning the intestines to one side he noticed some white cords in the mesentery which he had never seen before. He completed his demonstration but the next day he went back to look at the white vessels he had seen, but to his astonishment they had all disappeared. Asellius was a fine anatomist and a thoughtful student. He saw that the only essential difference was, that after first operation the dog had been fed about an hour before, in the second case the dog had had no desire for food owing to his previous operation. So he reasoned that if he would feed a dog, wait an hour or so the vessels would reappear. Imagine his satisfaction when he found his reasoning correct. He called the vessels lacteals because of the white fluid they contained. At that time physiology taught that all food stuffs must be worked over by the liver before it could pass into the blood, so Asellius taught that the lacteals entered the liver. Years before Eustachius found the thoracic duct which he found emptying into the veins of the neck, but skillful as he was he got lost when he followed it into the abdominal cavity. He did not find the receptaculum chyli. That is not especially surprising as the chyla cyst is usually absent and its place is taken by three or four diverticuli into which the lumbar and intestinal trunks empty. It took about one hundred years to work out in detail the lymphatic system as we understand it today. During all these years the medical profession have looked on the lymphatic system, as the great drainage canal of the body, and only within the last 15 or 20 years have such men as Poirier and Cuneo shown that this is but one of its many uses. It is to call your attention to these other uses that I write these lines. At least one-third the weight of the human body is fluid in the form of lymph moving in the lymphatic channels. The lymphatic channels added together would make an immense cyst whose wall is a secreting membrane for the lymph is not a transudation from the bloodvessels, but is the result of vital cell activity. Not only do the lymph vessels secrete this own peculiar products but they receive the internal secretion from the ductless glands; so that the products of the Thyroid Thymus-Supra-renals are poured into it. All the fluid in the lymphatic channels is strained from one to three times before it is allowed to enter the blood stream. This straining is accomplished by passing through a lymph node and comprises changes both chemical and mechanical. In the abdominal cavity we find from three hundred to four hundred lymph nodes and it is to this group of glands we are indebted for at least one of the white blood corpuscles namely the mononuclear lymphocyte. So the two great functions of the lymphatic glands are to stop invasions and to provide soldiers. It is interesting to note the variations in animals. How the circulation is carried on, for example in amphibians the lymph nodes contain muscular fibres which enable them to rythmically contract like the heart. In the frog the lymph canals empty into the veins in the pelvis as well as in the neck. Another interesting point is seen in the lymphatic tissue arrangement. In the lower animals such as the siren the lymphoid tissue is arranged in the submucous coat of the alimentary tract and is not differentrated as in the high types. In man we find a collar of lymphoid tissue at the junction of the mouth and pharynx. We call part of this tissue Tonsil, nasal or phayrngeal according to location. The soft palate and uvula is full of lymphoid tissue. This adenoid tissue is placed as a sentinal to guard the alimentary and respiratory tracts. The oesophagus and stomach contain very little adenoid tissue, but out to the left of the stomach is the spleen, the largest collection of lymphatic tissue in the body. In the upper part of the small intestine we find some lymphatic tissue and as we approach the junction of the small and large intestine we find Peyer's patches and solitary glands, and last but not least, Tonsil, Spleen, Peyer's patch and appendix are all the same kind of tissue and may be infected with the same germs. Typhoid fever may have its primary lesion in the tonsil or in the appendix quite as well as in Peyer's patch. Some of those cases of typhoid fever that finally developed an abscess in the side were simply the adenoid tissue of the appendix breaking down, the same as in regular appendicitis. That case of appendicitis you had and called in the surgeon to operate on and after the operation ran a regular course of typhoid fever, simply had the primary lesion in the appendix and later the other Peyer's patches became involved and the typhoid took its usual four weeks' course. The importance of the lymph canals has been only partially recognized by the Surgeon even in recent years. He knows that they carry infection and distribues malignant neoplasms; but even today few Surgeons recognize how wide is that distribution and how free in the anastomosis. Only today I read the report of a famous New York Surgeon on cutting out half the tongue for cancer and a discussion was raised as to taking out the adjacent glands. If a man will spend a few hours studying the arrangement of the channels in the tongue and note this wide distribution extending almost to the sternoclavicular articulation, he will not stop with any half tongue dissection. A few years ago I saw Wertheim's Charts hanging on the walls of his private office, they presented a picture. never to be forgotten, more than three hundred women had submitted to his very radical operation for cancer of the uterus, which consists in removing the uterus broad ligaments and lymphatic glands up to the bifurcation of the aorta. His charts give the clinical findings the microscopical examination and the final result. Without a single exception when the cancer was found in the lymphatic glands or retroperitoneal tissue he had a return of the disease. So I reiterate my former statement, if the molignant disease has entered the lymphatic tissue, operation is useless. The important points then to which I would call your attention are as follows: First. The lymphatic vessels constitute a large secretion gland. Second. It receives the internal secretion from the ductless glands. Third. The Tonsil-Spleen-Peyer's Patches Appendix are actually the same. Fourth. The lymphatic canals carry infection into the body, and account for the metastatic growths of malignant disease. FOOLISH ECONOMY. Some time ago a man consulted an eminent physician regarding a trouble near his ear or in his ear, he could hardly tell which. He had received treatment for it by several physicians without success. The doctor recognized the affection and knew what in all probability would relieve it, and wrote a prescription containing a certain alkaloid which was to be used as an external application near the ear. The man took the prescription and had it filled at a high grade drug store. Although he expected to pay a good price, he was somewhat surprised to find that his bill for this one prescription was $3.50. However he used the remedy as advised, with marked and immediately apparent improvement. The doctor was pleased with the progress he was making, but like the man was somewhat disturbed at the charge made for filling the prescription, and advised the man to take it, when it needed refilling, to another drug store, where the charge proved to be less than one-half as much. The man continued to use the prescription faithfully, but improvement. was no longer evident. The doctor was not satisfied with the progress of his patient and went to the druggist who had put up the original prescription charging $3.50 for it. "Your medicine," said the doctor to the druggist, "was certainly all right, and I am not pleased with the quality of the drug that my patient got at another place, but I do feel that you charged him altogether too much for it. I would like to have you fill the prescription and I would like to have you make a reasonable charge." "My dear doctor," said the druggist, "at what store did your patient get the prescription filled the second time?" The information was given. "Now," continued the druggist, "will you do me the favor to step down to that store and secure a sample of that drug you spoke of?" The doctor did so and was convinced by examination that the article which had been used for filling the prescription was feeble, inert, and of no more value for the purpose intended than so much flour or epsom salts. He was honest enough to report the exact fact to the druggist, who then in turn, made a slight calculation and found that the druggist who had sold the inert and useless prescription at $1.50 had secured more than twice as much profit for himself in the transaction as the first druggist who had charged $3.50 for what was supposed to be the same thing. Seborrheic Eczema BY A. WINKELRIED WILLIAMS, M. B. and C. M. (Edin.), D. P. H. Lond. Physician to Skin Department, Royal Alexandra Hospital, Brighton, and to the St. Mary's Dispensary, Brighton. S KIN diseases are, as a rule, the bete noir of the general practitioner; and of all skin diseases, eczema is the most commonly encountered and the most obstinate to handle. It is almost Protean in its forms, and ubiquitous in its point of invasion. Hardly any part of the epithelial tissue is exempt from its attack. For these reasons, constituting a combination of great importance to the general practitioner, we depart from our rule of brevity in this special instance, and publish, in full, the whole of Dr. Williams' excellent article on the subject. The reader will find it to be full of helpful suggestion, in characteristic English style-clear and practical. It is the kind of information that can be incorporated, bodily, into the physician's actual work. The unqualified term "Eczema" is unfortunately at the present time a vague covering for a variable number of diseases, originally used by Aetius to describe boils and carbuncles its original definition has been lost and varied by a number of writers. The history of the name and the way the confusion has arisen is described in detail by Unna in the first chapter of his work in "Pathologie and Therapie des Ekzems".* Seborrheic Eczema the subject of this paper is a type of the parasitic forms of eczema, the differentiation of which the world owes to the genius of Unna. The writer retains Unna's title despite the fact that the unfortunate multiplicity of synonyms which complicates the science of Dermatology clings to this condition, thus the terms Eczema, Seborrhold, Descending Eczema, Ascending Eczema, Seborrhoic dermatitis, Pityriasis capitis, Dandruff, Alopecia seborrhoica, Alope. cia, pityrodes, Pityriasis Rubra seborrhoica, etc., are constantly applied to the disease generally or some of its types. The exact organism causing the disease is still somewhat uncertain, the most generally accepted are the Morococcus of Unna or the microbacillus of Sabourand. The scalp is the most common site of origin (Payne's descending eczema) occasionally it may start in the axillary or inguinal regions, or in the feet (ascending eczema). The lesions of the scalp vary considerably, there may be a dry scaling from a pale or pinky punctuated skin tɔ which may be added the more visible inflammatory reactions of redness or swelling followed by more or less leeting and crusting. In other cases there may be an oily flux; some authorities maintain that this invariably precedes the other lesions, but its degree being slight it is often overlooked. The Glabrous Skin lesions present even greater variety. Usually they commence on a somewhat greasy skin surface as small yellow red macules which become slightly raised above the general surface; later scales develop at first greasy but generally become drier as the disease progresses. The patches increase in size, infiltration, etc., they may become confluent, sometimes involute in centre forming spreading rings. Papules, vesicles, pustules with sequelar, leeting, crusting, etc., may accompany the above lesions often due to addition of other organisms to the original offenders. In many cases the dry surface predominates, extensive scaling may result and the patches then can only be destinguished from Psoriasis by the history of their mode of evolution or the possibility of observing their mode of |