conversations with wide-awake physicians we believe is often overlooked, or forgotten. It is specific ela terium as a remedy in chronic cystitis, with much pain. The dose must be small. Ten drops to four ounces of water; a teaspoonful of the mixture every hour. Med. Gleaner.

DR. R. CANTALUPI, writing from Naples. Italy, under date of July 24th, 1893 says: Bromidia has produced successful results in all the most varied forms of Insomnia. Among others who have been benefited by its use is Professor Cesare Olivieri, well known as a most distinguished surgeon in this city, and who, after undergoing tracheotomy for neoplasm in the larynx, suffered terribly from Insomnia, which the usual hypnotics all failed to relieve. Hearing of this from a mutual friend, I advised the use of Bromidia, which promptly produced the desired result.

SANMETTO IN ALL URETHRAL INFLAMMATIONS, AND AS
A VITALIZING TONIC TO THE REPRO-
DUCTIVE SYSTEM.

I desire to give unqualified recommendation to Sanmetto in all cases of urethral inflammations. As a vitalizing tonic to the reproductive system, I know of no preparation, or combination of medicines, that will do its work so quickly and pleasantly as Sanmetto. My experience with it has extended over quite a large number of cases, embracing cystitis, difficult and painful micturition, chronic gonorrhea, seminal emissions, enuresis, and enlarged prostate, and I propose to use it in all diseases of the genito-urinary organs for the best reason, viz: It does not disappoint the patient or the physician. F. D. CHAPMAN, M.D., Chaska, Minn.

Do NOT fail to see the new advertisement of the Abbott Alkaloidal Co., this issue. The Alkaloidal Clinic is replete with interesting and instructive matter and the cases advertised are themselves fully worth the prices asked.

THE HORLICK'S FOOD Co., Racine. Wis., are sending out two or three neat half tone reproductions from cabinet photographs of "Twins" and "Triplets." Any physician asking for samples of Horlick's MALTED MILK as described on page xx and mentioning this publication will receive copies of them, also a very convenient metallic desk tool, a ruler, measure and paper cutter combined,

THE Kola nut is just now receiving considerable attention in therapeutic circles. It is stated that this article was first introduced in the United States by Frederick Stearns & Co.

THE cloth made from the wool of the Llama, of Thibet, possesses many superior qualities for business and dress suits. The enterprising clothing merchant, E. O. Thompson, of Philadelphia, will supply suits made of that material.

A PRONOUNCED OPINION FROM THE VETERAN EDITOR OF THE MEMPHIS MEDICAL MONTHLY.

The "Antikamnia and Codeine Tablets" were exactly what I wanted. Having been exposed to the Gulf breeze all day, I returned suffering intensely

with gastralgia and pleurodynia. One of the tablets gave me relief.

In the fact that your preparation, antikamnia, has no depres ing effect upon the cardiac force, you have much for congratulation, and the field for its usefulness may be viewed like the horizon-the nearer you approach it the wider its recognized extent.

Yours cordially, F. L. SIM, M.D.

J. L SPITZMESSER, M.D., Windfall, Ind., says: I was called to see Mrs W, mother of three children, aged twenty-three years; her weight, when first called to see her, was seventy three pounds. She had been treated by eight physicians for muscular rheumatism of a shifting character, invading nearly all parts of her body and limbs, and a leucorrheal discharge that had been a great source of trouble and annoyance, since birth of last child, then seventeen months old, with chronic metritis and left lateral displacement. Patient confined to her bed most of the time, of a nervous, irritable temperament, coughing and expectorating to an alarming extent, and without hope of ever getting well. Indeed, it was a hopeless case, one in which I could give but little hope and encouragement, as it had been treated by at least three or four physicians, my peers. I prescribed:

R. Celerina.......

Tinet, Rhus Tox....

Fl. ext. cimicifuga.

M. Sig.-Teaspoonful every three hours.

R. Aletris cordial.....

.7%1⁄2 ounces ....10 drops 1⁄2 ounce

..8 ounces

M. Sig.-feaspoonful alternating with above. Locally applied:

R. S. H Kennedy's ext. pinus canadensis (dark)......

Boracic acid. Glycerine.........

1 ounce ..30 grains .1 ounce

M. Sig.-Lamb's wool thoroughly saturated, and womb kept in place by impaction of the above.

Patient was received May 16th and discharged October 26th of the same year, cured, and is now doing her own housework; present weight is now 108 pounds. This case took three bottles of Aletris Cordial. I have other cases that I have treated in a good deal the same manner, with equally as good results, and my shelves are never complete without the above remedies in stock. I have gotten results from them that I have been unable to get from other sources.

THE first chair of Visceral Anatomy established by any medical school in America was established by the founders of the College of Physicians and Surgeons, Kansas City, Kansas, July 8th. By taking the initiative in this important matter this new school has sprung into national prominence. The rapid strides in abdominal surgery justified the step.

GOITRE.

If you have an obstinate case of goitre on hand, and the usual pot. iodide internally, injections of tincture iodine, carbolic acid, etc., have failed, give the following--possibly time would be saved by giving it first: R. Tinct. trophanthus. ..dram vij

Syrup acid hydriodic (Hostelley's)...ounces iv M. Sig-Teaspoonful twice daily for one week, them three times daily.

If this treatment is persisted in, the swelling will almost certainly disappear. Oxide of mercury ointment may be used locally in severe cases to advantage in conjunction with the above.

DID the Indiana preacher libel all woman kind, or has his experience with Indiana women been such as to justify him in making the following assertion in a sermon?: "God made the earth in six days, and then rested; then he made man, and rested again; then he (Continued on next leaf.)

Acetanilid as a Surgical Dressing.

Thus far the principal articles in use as antiseptic agents have had serious disadvantages. Iodoform is expensive, poisonous and betrays its presence by its disgusting odor. Bichloride of mercury in solution is irritant and poisonous and it corrodes instruments. One after another, various agents have been proposed which, upon careful trial, prove to be unsuited to the requirements of the case. The ideal agent for this purpose should be inexpensive, non-poisonous, non-irritant, and it should not be objectionable to patients on account of its odor or color.

From time to time in the past we have called attention to the gradually extending uses of acetanilid in surgical practice, as one prac titioner after another would cautiously report his favorable observations. It now seems to have fully demonstrated its most valuable qualities in this regard, and to have established its po

sition so firmly that it will be but few months ere it will have largely displaced the other agents now in common use.

At a recent meeting of the Philadelphia. County Medical Society, Dr. Thomas S. K. Morton read a report of the use of acetanilid in surgery, based upon his observations in an ex. tended hospital and private practice. The re. sults were so exceedingly favorable that he recommended its general adoption. In all operation wounds, including amputations, used as a dusting powder, it promoted healing without suppuration. Its effect was to thoroughly dry the wound so that the usual drainage tube was not necessary. In cases of scalds and burns it dries and soothes the affected surface, allowing healing to take place rapidly. As a dressing to chronic sores and ulcers it proved superior to other dressings. But two cases of constitutional effects were observed, one in his own practice and one reported by a surgeon in California; and, in both, the powder was applied over a large area in cases of extensive burns. Neither case was fatal.

Dr. J. Abbott Cantrell published a paper in the American Therapist, December, 1894, giving excellent results from the use of this drug in various forms of skin diseases. It proved of decided benefit in intertrigo, eczema, herpes, ivy poisoning, seborrhea, pityriasis, ulcers, both syphilitic and non-syphilitic. In ringworm and other distinctly parasitic diseases its effects were not encouraging.

Acetanilid is very cheap, being at present only forty cents per pound. It is colorless and non-odorous. It is soluble in five parts of alcohol, and in four-tenths parts of boiling alcohol; in 194 parts of water at 59° F., and in 18 parts of boiling water; in 18 parts of ether; in equal parts of chloroform, and in the various petroleum oils in the proportion of 40 grains to the ounce. In powder form it may be mixed with pulverized starch, boracic acid, or,

if an alkaline powder be desired, bicarbonate of sodium. The best preparations are as follows: For dusting powder. pure acetanilid, or, one ounce of acetanilid to two to four ounces of starch, freely triturated; for a solution, one dram of acetanilid dissolved in five drams of alcohol, to which add about eight ounces of boiling water and let cool; for an oily solution, 40 grains of acetanilid to one ounce of liquid petrolatum; for an ointment, 40 grains of ace tanilid to one ounce of petrolatum; for a collodion, 40 grains of acetanilid to one ounce of collodion. These proportions will be modified by the practitioner to suit particular cases as his experience advances.

From the above noted properties of acetanilid it should prove also very useful in treating diseases of the nose and throat.

We wish now that our enterprising readers would take up this useful agent and promptly report their results with its use, that its benefits may be rapidly extended and its limitations properly defined.

Treatment of Hypertrophy of the Prostate Gland by Operations which Terminate the Activity of the Sexual Function.

Last month we referred briefly to the operation of castration as a successful proceedure for the relief of prostatic hypertrophy. We wish now to consider more in detail the subject from a logical stand-point of cause and effect.

The enlargements of the prostate gland which may not be considered as possible to be favorably affected by any such treatment are comparatively rare, except in the wide consultant practice of the surgical specialist-carcinoma, tuberculosis and cystic degeneration. These can only be treated by suitable local, radical operation.

There remain to be considered the two exceedingly common affections-diffuse myoma and simple hypertrophy. These are the result, in a few instances, of a previous acute prosta titis, but in most cases of prolonged undue sexual activity or of continued sexual excitement without normal gratification. This is analogous to over growth of any part, exercise bringing an increased supply of blood to the part.

It is also with this organ (consisting, as it does, of at least two-thirds muscular tissue to about one-third glandular structure) as it is with the over developed muscles of the athletewhen activity is suspended a process of involution takes place, resulting in atrophy or in degeneration. In the cases of the uterus after the removal of the overies and of the prostate after castration, the change takes the form of atrophy. This is the direct result of the cessation of function caused by the removal of the exciting organ, with a consequent reduced blood sup ply to the affected organ.

But most men near middle life will naturally object to the operation of castration. In fact, it is exceedingly difficult to obtain the consent of men, even in advanced age, to this mutilation. In this extremity it is with relief that we turn to an operation which involves no mutilation, no loss of organs or tissue.

This operation is that of ligature of the spermatic cord. This was first proposed by Dr. J. Ewing Mears, of Philadelphia, to the American Surgical Association in 1893. He has since then read a paper on the subject before the Philadelphia Academy of Surgery, in which he reported several observations of the atrophy of the testes and decreased size and irritability of the prostate in cases in which this operation had been performed for varicocele. He also mentioned one case in which it had been performed for hypertrophied prostate with entirely succe38ful results.

While this operation, like castration, obliterates the sexual function, it does so more gradually, as is likely sooner or later to occur any way. The result should be explained to the patient and the operation urged by the surgeon. It seems that this dread of advancing years in men, irritable hypertrophied prostate, is now subject to rational control.

The Diphtheria Antitoxine.

The reports in regard to the use of this remedy continue to be favorable. Philadelphia is establishing a laboratory for the preparation of the serum, as are several other cities in this country, following the lead of New York.

Articles accepted must be contributed to this journal only The editors are not responsible for views expressed by contributors.

Copy must be received on or before the twelfth of the Unused month for publication in the next month. Manuscript cannot be returned.

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 possibl words, or his reader will certainly misunderstand them. Generally, also, a downright fact may be told in a plais way; and we want downright facts at present more thas thing else.—BUSKIN.

Radical Treatment of Hernia,

[By JOHN B. DEAVER, M.D., Professor of Surgery Philadel. phía Polyclinic; Assistant Professor Surgical Anatomy, University of Pensylvania; Visiting Surgeon to the German and Philadelphia Hospitals; Consulting Surgeon, St. Agnes', Germantown and St. Timothy's Hospitals.]

Editor MEDICAL WORLD:-I present this paper* upon the "Radical Treatment of Hernia" with some hesitancy, because of the difficulty I have experienced in following up the cases I have operated upon, and in recording

the ultimate results. The total number of radical operations I bave done up to date is one hundred, and include MacEwen's, Barker's, McBurney's, Bassini's, Halsted's, and my own modification, which is a combined Barker and MacEwen, and was the one I most frequently performed until the introduction of the Bassini and Halsted operations.

The indications for the radical cure of hernia are, first, hernias which are complete, and in which the external abdominal ring is so large as to make it difficult, if not impossible, to apply a truss that will hold the rupture; second, irre ducible hernias, this being a form in which it is difficult to obtain a truss to fit accurately enough to prevent the escape of a new portion of the gut, and, third, strangulated hernias, in which the bowel is not gangrenous, or if deeply injected, when it responds to the application of moist heat sufficiently to permit of its being returned.

The Bassini and Halsted methods have given such satisfactory results, with so small a mortality, that I believe that simple reducible hernia should be included among the indications. Granted that a hernia so treated showed a ten

dency to relapse after either of these operative

[*This paper was read by invitation before the Surgical Section of the College of Physicians, Philadelphia.]

procedures, the adjustment of a light fitting truss will eliminate all possibilities of subsequent strangulation. I have recently operated for obstruction of the bowels in a patient who was the subject of a reducible hernia; the obstruction was due to a band formed by the omentum, which had become rolled upon itself and had become adherent to the sac of the hernia just beyond the internal abdominal ring. The fact that such a state of affairs can arise seems to me to offer itself as an indication in considering the advisability of this operation in simple reducible hernias.

It is hardly necessary to state here that patients, the subjects of chronic coughs, and those who have large, flat and flabby belly walls, especially in advanced age, are unfavorable cases. When the hernia is very old and large, the abdominal cavity must necessarily have contracted more or less in accommodating itself to the absence of the viscera which occupy the hernial sac; therefore it is questionable if, under these circumstances, it would be wise to perform a radical cure at all. In cases of this character the patient should be kept in bed for some days with the hernia reduced and retained before the operation is even attempted.

The contra-indications to operations in general are applicable to the radical cure of hernia, except, of course, in the case of strangulation, where the operation becomes a life saving

measure.

The choice of operation must necessarily deThe Bassini, pend upon the individual case. with or without the Halsted modification, is applicable in the great majority of uncomplicated hernias, and to all cases of simple reducible hernia. When strangulation has occurred it may be necessary to treat the wound after the method of McBurney.

All, however, agree that the mortality is small. Of course, when we say a cure we must modify the statement as to time for a relapse. The chief etiological factors in the production of hernia are a weakened abdominal wall and an elongated mesentery, either congenital or acquired; and so, while we can remove and cure a rupture, we cannot altogether remove these anatomical weaknesses, although in a large percentage we can and do add largely to the strength of the abdominal walls.

Too much importance cannot be laid upon the after treatment of the case, especially during the first six months. While in bed the ordinary dressing of the wound is quite sufficient. After the patient is up and about, a light fitting truss should be worn constantly for a long period of time, so as to permit contraction, and fibrous changes in the scar to become solid. Abdomi

nal massage and electricity are of use as strengtheners of the abdominal walls.

We are all so familiar with the modern methods for the radical cure of hernia, that I will not attempt to go into a detailed account. of their individual merits, but will give the results of my experience in favor of those which I believe have best fulfilled the indications in obtaining a cure.

The strongest objection to the MacEwen operation is, that the sac is not opened. By this it seems to me we take a great deal for granted in not inspecting the contents to determine the presence of adhesions. These, while they may not enter as a factor in the reduction of the rupture may at some future time play an im portant role in an acute mechanical intestinal obstruction. The same objection can be urged against the Ball and Kocher operation. Another objection to these operations is, that there is an attempt made to close the old canal.

The objection to the McBurney operation is, that the permanency of the cure is dependent upon the presence of a large amount of scar tissue. It is a well-established fact that abdominal wounds that heal by primary union are less liable to be followed by hernia than those which heal by granulation.

Bassini's and Halsted's operations are so logical, and based upon such firm anatomical and physiological grounds, and have given such satisfactory results, that they have practically supplanted all other methods of operation.

Between the Bassini and the Halsted operation, I give the decided preference to the latter. I agree with Halsted, that it is not always ad. visable to bring the cord out at the internal abdominal ring; but that this should be deter mined by the condition of the muscles at this locality. By exercising the superfluous veins of the cord, the latter is reduced in size, and consequently its opening of exit is correspondingly smaller, thus offering greater resistance to the entering wedge of a subsequent hernia.

Another feature of the Halsted operation is the position which the cord holds when the operation is completed The fact that the cord overlies the aponeurosis of the external oblique, makes the new canal more circuitous, and therefore less liable to be followed by a relapse than in the Bassini operation, where the cord lies below the aponeurosis. This further simplifies the operation by doing away with a second row of sutures.

In the operation for the radical cure of her nia, several points present themselves which are well worth discussion, namely:

1. The propriety of enucleating the entire sac of an old and large scrotal hernia. This ques

tion must be decided according to the condition of the sac itself, and the answer must depend largely on the surgeon's judgment. If the sac be tightly adherent to the tunica vaginalis and the lower portion of the cord, necessitating a prolonged dissection, particularly if the patient be advanced in years, I think it is better judg ment to content ourselves with the removal of that portion of the sac which occupies the inguinal canal. The presence of the remaining por. tion of the sac does not interfere with the reparative process following the operation. I have

seen gangrene of the testicle follow the determined efforts of the surgeon to free the fundus of such a sac.

2. When a mass of irreducible omentum is encountered, it is best to ligate it and cut it away, including only a small portion in each ligature. Care must be exercised in tying the ligatures when the vessels are atheromatous. Under the latter condition it is better to use heavy ligatures, preferably catgut, as the larger ligatures are less liable to cut through the thinwalled vessels.

A condition I have met with a few times, and to which Dr. William T. Bull has called attention, is that of inflammation of the stump of the omentum, with localized peritonitis. One of these cases went on to suppuration and opened spontaneously above Poupart's ligament. While the risk of ligating and cutting away a portion of the omentum is slight, still it is not justifiable to expose our patient to this additional risk, and therefore when reducible it should be returned.

A chronic irreducible omental hernia may undergo a variety of changes, viz.: calcareous, cystic or fibrous degeneration. Where the fatty element of the omentum becomes absorbed, and the peritoneal surfaces crowded together, adhesion takes place, and the omentum is thus converted into a fibrous cord. Again, the peritoneal surfaces may adhere, and the serous fluid accumulating in the cavity thus formed, convert it into a cyst. Where the quantity of fluid contained is small, and the hernia has been of long duration. these cysts at times resemble intestine or testicle.

It is not very uncommon to meet with the vermiform appendix within and adherent to the sac. As it does not complicate the operation, it should be removed. Although it is true that the spleen, the kidney, the ovary and the Fallopian tube, a Meckel's diverticulum, and the epiploic appendages, and even a dermoid cyst, have been found in the sac of an inguinal hernia, I have never met with any of these except an epiploic appendix. Certain loose bodies, generally derived from the epiploic appendices,