ables the patient to dispense with the use of the catheter and to discharge urine spontaneously. The bladder troubles, also, are much relieved, and the general condition is improved. In the selection of suitable cases attention should be paid to the condition of the muscular structure of the bladder. If the detrusor muscle be paralyzed to such an extent that the bladder cannot be completely emptied even by the use of a catheter, it would be useless to expect a restoration of normal function as a result of removal of the obstruction to the flow of urine. In two of the cases here re corded, however, good results in this respect were obtained in spite of considerable weakness of the detrusor. In many cases the diminished size of the prostate after double castration permits of the more ready introduction of a catheter, and thus wards off the dangers of retention. In the author's opinion, the treatment of hypertrophy by double castration compares favorably with other operative measures in being simpler in performance and less dangerous. It can be performed without subjecting the patient to the risk of general anesthesia, and necessitates but a very short stay in bed, which with regard to old and enfeebled subjects is a very important point. The operation, it is stated, should be recommended only to those whose sufferings have attained a high degree, and can no longer be relieved by mere symptomatic treatment. The author met with no objection to the operation from any of his patients, all of whom were well satisfied with its results. The recorded instances of success are so numerous and striking that the author has been led to the conclusion that the surgeon is certainly justified in suitable cases of enlarged prostate in advising and performing this operation. Although a more extended series of observations is needed before a clear and absolute judgment can be formed on this new method, there can be no doubt, the author holds, that this procedure is a valuable addition to the operative means of dealing with advanced and grave forms of prostatic hypertrophy. The observations with regard to the influence of unilateral cas tration on the growth of the prostate are very contradictory, and further information is needed before any definite conclusion can be reached on this question. FRACTURE OF THE FEMUR FROM MUSCULAR ACTION.— Dr. Irving S. Haynes reported in the New York Medical Journal the case of J. W., an athlete, thirtysix years of age, who, while bowling, had attempted to throw a heavy ball, in doing so had lost his equilibrium, and, in endeavoring to regain it, had brought such a strain upon the left femur as to fracture it in the middle. The line of the fracture had extended slightly obliquely from above and inward, downward and outward. He had been in unusually robust health, and had been free from any specific disease; hence the manner in which the fracture had been produced was of unusual interest. Dr. J. W. S. Gouley recalled the case of a healthy young man, under thirty years of age, who, while endeavoring to hurl a ten-pound dumb-bell to a considerable distance, had thrown back his right arm so far that it was beyond the control of certain muscles, with the result low the deltoid insertion. Of course, in that the humerus had snapped just bethis case the weight of the dumb-bell had been a decided factor in addition to the muscular action. The fracture had united satisfactorily. No disease of the bone had been found, although the speaker said that when fracture occurred in this way he was usually suspicious of the existence of malignant disease of fractures of bone to occur from very the bone. It was not uncommon for slight causes, such as movements in bed, where there was malignant disease of the bone. AN EASY AND READY METHOD OF CIRCUMCISION. --John W. Ross, Surgeon, United States Navy (Retired), says in the Medical Record, August 31, 1895: Retract the foreskin; insert the glans penis up to the corona into the open mouth of a glass test tube; draw the foreskin well forward over the end of the tube; tie a strong, small silk cord very tightly around the foreskin immediately in front of the flange of the tube; amputate the foreskin one-eighth of an inch in front of the constricting cord by a circular sweep of the knife; unite the mucous and cutaneous edge of the stump of the prepuce by eight or ten fine interrupted sutures; cut the constricting cord; remove the tube; cover the cut edges well with powdered iodoform; encircle the anterior half of the penis with a roller bandage of iodoform gauze, allowing the meatus to project slightly for facility of urination without soiling or removal of the dressing; and keep the patient in bed, with the penis elevated, for from twenty-four to forty-eight hours. * * CODEINE IN IRRITANT COUGH.-C. W. Ingraham(American Medical and Surgical Bulletin) says: One of the most valuable preparations the author has ever used for the relief of irritant cough is a mixture of codeine sulphate and ammonium bromide. The addition of the latter assists expectoration and increases the effect of the codeine ; or, rather, a smaller amount of codeine will accomplish the desired results when given in conjunction with ammonium bromide. His favorite prescription is as follows: Codeine Sulph. (Merck's) 16 grn. (1 gme.) Ammonium Bromide. 320 grn. (20 gme.) Water. 2 fl. oz. (60 c.c.) Syrup. To make 4 fl. oz. (120 c.c.) Teaspoonful, 2 to 4 times a day. In cases accompanied with bronchial catarrh, or in those in which a. more powerful expectorant is desired, the above prescription may be modified, as follows: Codeine Sulphate. Dr. Ingraham recommends that care should be taken to obtain a reliable preparation of codeine, as many inferior grades yield results which indicate that morphine is one of their component parts. The dose of codeine (for adults) varies for different individuals; in some 1-3 grn. (0.02 gme.) will give the desired relief; while in others no results are obtained until 2-3 grn. (0.04 gme.) is given at a dose. When the correct dose is found, it is seldom necessary to increase it. The value of codeine, according to the author, lies in its power to reduce the irritation or excitability of the nerves governing the pulmonary mechanism. It gives rise to no gastric disturbances, and is not constipating. The author found that in unusually susceptible patients a peculiar dulness followed the use of codeine, which, however, is only transient, and much to be preferred to the results which ordinarily follow the use of many other preparations used for the relief of cough. * * * A FEW POINTS IN OBSTETRICS.—EWust 24) advances a few aphorisms relating (Medical and Surgical Reporter, Auging to obstetrics. 1. Examine the urine a week or so before the expected confinement. Albumin need not cause alarm, unless present in large quantity, in which case the woman should be restricted to milk diet, given one-tenth grain of sulphate sparteine four times a day, and bowels kept open with cream of tartar, the object being, of course, to relieve congestion of the renal veins. 2. Make no digital examination without first cleansing the hands and nails, together with the external genitals, with a solution of bichloride of mercury (1 to 2000) and ethereal soap. 3. Empty the rectum thoroughly with an injection of warm water. 4. Make as few examinations as possible during progress of labor, and each time dip the hand first in the antiseptic solution. 5. If the presenting part emerges slowly from the womb, do not allow your impatience to so get the better of your judgment as to induce you to "assist nature" by pulling on the os. Probably all the deep pathological tears, calling for surgical interference, found on the right and upper anterior sides of the cervix, are caused by the finger of the accoucheur. MARYLAND drewes and Mr. J. Parry Laws (British Medical Journal, August 31) that it is extremely difficult to find evidence of the presence of Medical Journal. PUBLISHED WEEKLY. TERMS OF SUBSCRIPTION, $3.00 a year, payable in advance, including postage for the United States, Canada and Mexico. Subscriptions may begin with any date. DATE OF PAYMENT.-The date following the subscriber's name on the label shows the time to which payment has been made. Subscribers are earnestly requested to avoid arrearages. CHANGES OF ADDRESS.-When a change of address is ordered, both the old and new address must be given. Notice should be sent a week in advance of the change desired. TO CORRESPONDENTS. Original articles are solicited from members of the profession throughout the world. Reprints will be furnished in payment of accepted articles if the author's wish is so stated at the time. look upon the emanations from decaying organic material as in some way dangerous and that which was offensive to our sense of smell has come to be regarded as of necessity noxious to our physical well-being. But it is remarkable how little scientific evidence there has been to substantiate this view. The micro-organisms of certain diseases, as typhoid fever and cholera, are excreted with the stools, it is true, and thus find their way into the sewers, and it was quite natural to suppose that their harmfulness did not stop here. It was supposed that sewage swarmed with the specific germs of various infectious diseases. But it has been shown by Dr. An and that instead of sewage being a favorable soil for its multiplication, as stated by many, it gradually, but surely, exterminates it. Again the undoubted communication of certain diseases, as smallpox, through the medium of the air, lends probability to the existence of similar organisms in the air of sewers. What more natural than to suppose that specific germs can rise into the air with the malodorous volatile substances and can be wafted about as freely as the latter. Here again the same investigators have shown that the micro-organisms of sewer air bear no relation whatever to those of sewage, and that the predominant organisms of sewage are entirely absent from sewer air. "If," say they, "sewer air is free from those special organisms which exist in immense numbers in every drop of sewage, how infinitely improbable, nay, almost impossible, becomes the existence of pathogenic organisms which can only be present in sewage, relatively speaking, in most minute proportion." This seems to dispose of the matter and hence we may conclude that it is an error to regard sewer air as one of the modes by which the germs of disease may be spread and this gives additional emphasis to the necessity of attention to the character of the water supply. The term "water-borne" is now applied to such diseases as typhoid fever, cholera and dysentery to indicate the increasing realization of the view that looks to this source and this alone for their origin. by Professor Schäfer of University College, London, in an address entitled "Internal Secretions," at the recent meeting of the British Medical Association. Before noticing this-even briefly-it may be well to define some of the terms which are used in such investigations. A secretion is material which is removed from the blood by a gland. It usually undergoes some sort of change in passing through the gland. It is either poured out again upon surfaces connected with the exterior, or is returned to the blood from the gland directly. The former glands are known as external secretions, the latter as internal secretions. The latter are supplied by the ductless glands, but not by them exclusively; some of the ordinary secreting glands, the liver, pancreas, etc., also supply them. The knowledge of this is a very recent acquisition of physiology and much remains to be learned regarding it, but we know that the internal secretions are of no less importance thau the better known and ordinary ones, such as the bile, pancreatic juice, urea, etc. Professor Schäfer considers in succession the liver, the kidney, the pancreas, the thyroid, the pituitary body and the supra-renal capsules, and shows that they all elaborate such internal secretions. The facts with regard to the thyroid are well known and practically utilized since the discovery by Ord of myxedema and the value of thyroid extract in that disease. With reference to the supra-renal capsules, Professor Schäfer has confirmed the observations of Brown-Sequard and others showing that an invariable fatal result follows the removal of these glands. The blood of animals thus treated is poisonous to other animals. The principle to which this effect is due is found in the medulla and not in the cortex of the glands. Its properties have been investigated and among other things it is found to exert a powerful action on the voluntary muscles, the blood-vessels and heart, resembling in this respect the action of veratrine. This principle is absent from the capsules in Addison's disease and some cases of this disease appear to be distinctly benefited by oral administration of the extract of the capsules. A very remarkable circumstance is the infinitesimal quantity of this principle required to produce the effects named. One millionth of a gramme per kilogramme of body weight, for example, will produce appreciable, though transient, effects. Similar results have been obtained in the case of the pituitary body, death from removal, evidence of a secretion tending to increase contraction of heart and arteries and influencing nutrition. The relations of pancreatic disease and diabetes have been well established, both experimentally and clinically. Frerichs found lesions of the pancreas in 20 per cent. and Rokitansky in 43 per cent. of cases. Extirpation of the organ in animals is followed rapidly by glycosuria in extreme degree, polyuria, wasting and death. This has been proven not to be due to the loss of the pancreatic secretion or of the secreting structure. If one-fourth of the gland be allowed to remain or if a portion of it be grafted in an unusual situation, the symptoms of diabetes do not occur. Of the same nature and origin are doubtless the changes taking place in eunuchs and others as the result of loss of the generative organs. Now, with reference to the mode in which these effects are produced. Professor Schäfer points out that there are two theories. 1. That of internal secretion. 2. That of autotoxication. In the first the organ at fault is supposed to form something which is essential to the normal processes of the body and the absence of this consequent on the removal of the gland leads to toxic effects. In the other excretory products are supposed to accumulate from the same cause which in the healthy condition of the gland it is able to dispose of. Of these Professor Schäfer gives his adhesion to the former for reasons which he gives at length. The subject is one of extreme interest and of the utmost practical importance. It is most ably treated in the address, which gives much information in a condensed form not readily accessible as yet to physicians in general. That it has a vast future there can be no doubt, for in spite of the advances which have been made in elucidating it during the last few years a great number of points still remain obscure. Nevertheless, the way which the physiologist has attempted to show may be followed by the practitioner, and the result of these physiological experiments may now be utilized for the diagnosis and treatment of disease. The Index Medicus fund has now 105 subscriptions; 95 are still needed. Harvard Medical School had 454 students last year. It also has nearly 100 teachers. There was not a complete skeleton in all Europe until 1658, when one was set up in Vienna. In Norway and Sweden no couple can be married without producing a certificate of satisfactory vaccination in both. The Milner Fothergill gold medal in therapeutics has been awarded by the University of Edinburgh to Dr. Edmund Smith of York, for his essay on the digestive ferments. Dr. Horatio N. Hollifield of Sandersville, Ga., a native of Howard County, Md., died on September 24, aged 63. He was a graduate of Jefferson Medical College of Philadelphia. He leaves a widow and two children. Dr. George Dock, Professor of Theory and Practice of Medicine in Michigan University, says the Homeopathic Department of that University is almost defunct and is kept alive only by the appropriations of the Legislature. Professor Henri Adolf Bardeleben of Berlin died September 24, aged 77. He was born in Frankfort-on-Oder and after studying in Berlin, Heidelberg and Paris, became professor in the University of Giessen in 1848. Subsequently he held the chair of surgery in the University of Greifswald. In 1868 he became director of the surgical clinic in the Royal Charity Hospital at Berlin. He was chief of the medical and surgical staffs in the war of 1866 and 1870. He was associated with Virchow and Müller in several medical works. He attended the late Emperor Frederick in his last illness. The new buildings of the University of the City of New York will be formally opened October 19. They are on University Heights overlooking the Harlem River. Between $50,000 and $60,000 have been received as gifts during the summer. The American Pharmaceutical Association held its Forty-third Annual Meeting in Denver, Col., August 14. There were 450 members registered and 231 new applications for membership. The Committee on Prize Essays awarded the second prize to Dr. Alfred Dohme for his contributions to the chemistry and pharmacognosy of ipecac and stramonium. Dr. Dohme also delivered an admirable address as Chairman of the "Section on Scientific Interests," and four other papers. Montreal was selected for the place of meeting in 1896. The following officers were elected: President, James M. Good, St. Louis; VicePresidents, Charles E. Dohme of Maryland, A. Brandenberger of Missouri and Mrs. Mincr of Kansas; Treasurer, S. A. D. Shepperd, Massachusetts; Secretary, Charles Caspari, Jr., Maryland. The daily papers announce the death of the celebrated man, Professor Pasteur, in Paris, on September 29. His death was due to an apoplectic stroke eight days prior to death and a second attack on the day before. For some years he had been the subject of hemiplegia. He was born at Dole, Javra, December 27, 1822. After passing through the University of Paris he held chairs successively in the faculties of Strassburg, Lille, the Ecole Normale and the Ecole des Beaux-Arts. He was not a graduate in medicine. He was a member of the Institute and Academy and a grand officer of the Legion of Honor. He was the author of numerous works on chemistry and bacteriology. His best known work was in connection with fermentation (for which the government granted him an annual pension of 10,000 francs) and hydrophobia. His Pasteur Institute" has a world-wide celebrity. At his request his remains were interred there, although the Government desired that they should rest in the Pantheon. |