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Subpreputial Medication.

Some years ago a medical friend of large experience in the treatment of venereal diseases gave us what he had found to be the most useful injection in gonorrhoea. It consisted of mucilage of acacia, subnitrate of bismuth and sulphate of morphia. This we used for some time with greater satisfaction than anything else. Soon, however, we noticed that the degree of benefit depended largely upon the proportion of morphia. The anodyne influence of morphia upon the inflamed and suppurating membrane is certainly desired; but the temporary contact of an injection, the unfavorable condition of the membrane for absorbing, and the slight irritation caused by the direct application of the salt to the membrane-these considerations led to a belief that a better means might be devised.

Subjecting the general system to the influence of opiates, by oral administration, is beneficial to any inflammation, but this is manifestly a very indirect mode of medication for gonorrhoea. Rectal injection of opiates is rather more direct, particularly in bladder difficulties, but the effect upon the general system is greater than is desired in proportion to the local benefit derived.

Hypodermic injections of morphia into the substance of the penis were not then thought of, and have never been practiced, to our knowledge. (This would probably immediately relieve priapism).

We finally thought of introducing morphia beneath the prepuce, hoping that it would be absorbed and exert a local effect upon the urethra. By occasionally moistening the morphia, enough of it could be induced to absorb to produce a marked anodyne effect upon the sensitive urethra, and to be of much value in irritable or inflamed bladder, while the effect upon the general system was very slight. But the necessity of occasional moistening was a great disadvantage, and even when this was done the influence was hardly strong enough to be entirely satisfactory, so the treatment soon fell into disuse. A solution of five grains of morphia in half a drachm of glycerine was applied beneath prepuce and upon penis, but found unsatisfactory. Laudanum was used in the same way with same result. Perhaps if a paste had been made of morphia and glycerine and inserted beneath prepuce it might have done well, but it was not then thought of.

The recent discovery of the readiness with which wool-fat (lanolin) is absorbed called to mind our old experiments and invited their renewal. We had five grains of morphia rubbed with a half drachm of lanolin, and rubbed a piece about the size of a grain of wheat beneath the prepuce (on each side of the frænum, so as to be as near as possible to the urethra). This was a case of acute inflammation of the urethra, particularly the bulbous portion, possibly involving neck of bladder, with seeming relaxation of mucous membrane and very slight mucous discharge-a very unusual case indeed, and caused, as near as could be ascertained, by sitting on a cold surface. The tissues surrounding the urethra where perhaps involved; prostatic congestion was suspected but found not to exist, unless in a very

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slight degree. This peculiar case proved peculiarly indifferent to treatment. It was about the tenth day that the above mixture of morphia and lanolin was used. By that time the discharge had somewhat increased and contained some pus, the bladder was becoming irritable, and tenderness had extended along the urethra to the meatus. The mixture was absorbed, and much, almost complete, relief was obtained without much systemic effect, by repeating the application two or three times a day. This was continued several days, but while the more prominent symptoms where relieved during the effect of the morphia, progress toward a cure was not satisfactory; slight discharge continued, and all symptoms returned when the application was not made. Then a happy thought came-to use cocaine instead of, or combined with, the morphia. We then combined muriate of cocaine with some of the above mixture, so that about one-fourth of a grain of cocaine would be used at each application. In a few hours the penis was found to be perfectly numb, discharge ceased and all symptoms relieved. Continuation of this treatment soon effected a cure. The modus operandi is as follows: the diseased tissues being anesthetized, they are robbed of pain and sensibility, thus being free from impressions or disturbance of any kind; cocaine causes vessels to contract, thus removing congestion and inflammation.

Thus it seems that we have an efficient and easily managed mode of treatment for most of the local diseases of the genito-urinary apparatus; if begun promptly we believe that it will abort gonorrhoea; it will certainly cure urethral and vesical irritability immediately, and the cure may be permanent when not dependent upon stone or other mechanical causes of irritation.

Without waiting to make other tests, we hasten to give the idea to the profession, so that many thousands may make tests and report results upon what seems to be a very promising mode of treatment. Of course the part should be cleansed before each application. Be sure to have the mixture strong enough to produce decided effect. Try, and report in full as to strength of mixture used, amount and frequency, condition before use, and results. Details are neces

sary to the establishment of a new mode of treatment, and this is now as far as we know.

Is Dr. Hofmann's new method of treatment of fistula in ano (see another page of this issue) destined to revolutionize the treatment of this troublesome disorder? This plan cures in a shorter time than by the cutting operation; and has the very great advantage of but little pain, and the patient can go about his business while the treatment is in progress.

The Doctor will soon give, through these columns, a new and original treatment of another important disease. Such articles, from as careful observers and original thinkers as the Doctor, will always find a ready place and warm welcome in these columns.

Nearly every new subscriber (and their name is legion) orders his subscription to begin with January last, in order to have the volume complete. This is as it should be, and it is fortunate that we printed plenty of extra copies to reserve as back numbers. Always order binder (only thirty cents) in which to preserve your journals, and when the year is complete you will find that you have a bound volume.

THE second edition (enlarged and corrected) of "Officinal Formulæ of American Hospitals" is at last completed. It is in every way a great improvement on the first edition. No physician should be without it. Price, $1.00.

The Current Medical Thought.

Resorcin in Chronic Diseases of the Skin. Resorcin has been found of much value in chronic skin diseases, particularly those of a parasitic nature. In tinea versicolor, herpes tonsurans and sycosis parasitica the results have been most favorable. It may be used in solution or in form of ointment, in strength varying from ten to eighty per cent. It is contraindicated where much inflammation exists.

Respiratory Croaking in Infants.

Dr. Gee describes in the Practitioner a dozen cases of what he calls "respiratory croaking" in babies. The breathing is accompanied by a croaking noise limited to inspiration, which seems to be produced in the fauces, and is noticed both during sleep and when awake. Otherwise the child seems to be in good health. The duration of this strange ailment is indefinite, and although different forms of treatment were tried, none were found to be particularly efficacious.

Cure for Erythema.

Dr. Villemin, of Paris, considers the different forms of erythema-papulatum, tuberculatum, nodosum-only varieties of a common morbid type, and includes them all under the name of "polymorphous erythema," a general disease of a specific nature, of which the cutaneous eruption, the pains in the fibrous tissues and limbs, indurations, insomnia, prostration, etc., are only symptoms. He maintains that iodide of potassium is a veritable specific in all forms of this disease. In the course of forty-eight, or even twenty-four hours, incisive doses of the salt, say ten grains three times a day, will modify or remove the main symptoms in a surprising manner; the temperature falls, the redness disappears, swelling of joints is reduced, indurations soften, and in three or four days the disease will usually be conquered. Iodide of sodium would probably be equally efficacious.

For Fistulæ.

Oil of turpentine, besides being an antiseptic, has a marked stimulating action on granulations, and in that direction has proved highly successful in promoting the closing up of anal and other fistula. It may be injected through a small blunt-pointed syringe, either by itself, or, when found too irritating, diluted with olive oil, once in every two or three days. Many cures are reported under this treatment, avoiding the necessity of operative measures in some instances.

The Progress and Prospects of the Oxygen

Treatment.

It is with no little interest that we have been watching the revival of the use of oxygen gas and oxygenating agencies in therapeutics. That the reports of some recent enthusiastic investigators in this field should have been received with the usual degree of conservative questioning was to be expected. But the reports are being emphatically corroborated, and observers are multiplying. As an evidence of this rapid progress it is only necessary to cite the fact that a leading dealer in oxygen apparatus and supplies in that line recently received an order for one hundred cylinders of compressed oxygen10,000 gallons in a single shipment to the West. The same company within the last three months has supplied outfits of apparatus to practitioners in nearly every State in the Union. Many of these experimenters have as yet had too limited experience to report anything of value, and some of them no doubt, for various natural reasons, fail of any noteworthy results. Others of them will give to their efforts that punctilious care and perseverance which is sure to result in valuable data.

Dr. Lothrop, in the Southern California Practitioner for May, publishes a report covering one hundred cases treated by oxygen. While he makes no extravagant claims, his results are encouraging in the extreme.

The following is an analysis of his cases (a slight discrepancy may be noticed in the phthisis cases):

Dr. Wallian, of New York City, the acknowledged pioneer in this particular field-at least in America,-informs us that he is collecting the results of this practice from other observers and will, ere long, publish a resumé of the whole, together with his own more recent observations. We shall await the appearance of this collective evidence of the value as well as the limitations of what we consider valuable addition to modern therapeutic resources.

Send us one dollar and we will mail you the "Officinal Formulæ of American Hospitals."

Toleration of Poisons.

In certain morbid conditions of the system, there appears to exist an immunity, or a central "non-impressibility" to large doses of agents which are under other circumstances highly poisonous excepting in small doses. In acute alcoholism, for example, strychnia is tolerated and beneficial in large doses. Digitalis is admissible in large doses in "shock." Strychnia may also be pushed in spinal myelitis. The bite of the cobra is said to be inert when the patient is already saturated with alcohol. Drugs have no action in the stomach of a cholera patient, when in the stage of collapse (perhaps, however, from non-absorption).

Nitric Acid Test Preferred.

At the Clinical Society of London, May 28th, the "Albumen Test Committee" presented a report of the work accomplished by them, which, according to custom, was received without discussion. In it, the Committee briefly reviewed the various modes of testing for urinary albumen, etc., in common use, and compared in turn Dr. Oliver's test papers, Dr. Johnson's picric acid method, the potassio-mercuric iodide and acid, Dr. Pavy's pellets, the acid brine method, picric acid and brine, the acetic acid, and the nitric acid methods. After careful consideration and

experiment, the Committee arrived at the conclusion that the papers of Dr. Oliver possessed advantages in the way of portability and delicacy of reaction over the other similar preparations; but, apart from the question of easy carriage and compactness, they described nitric acid as being most reliable and delicate. All the methods, however, were said to be respectively useful for the determination of different proteids in the urine.

The early appearance of the cholera this year in so many scattered and distant parts of Italy is of bad omen, and a rapid and extensive diffusion of the epidemic with the increasing summer heat is almost inevitable.

Temporary Gantz Albuminuria.

Gouty subjects are liable to temporary attacks of albuminuria, under great excitement or nervous irritation, even though the kidneys are unaffected. In such cases the albumen may entirely disappear from the urine within twentyfour hours, by resting in bed.

A HUMAN skeleton weighs from ten to sixteen pounds, and the blood of the body about twenty-eight pounds; but cremation reduces the whole to no more than eight ounces; all else is restored to the gaseous elements.