withholding the drug for a fortnight, then renewing for three or four weeks, again withholding; and so reduce its administration gradually. It is astonishing at times, the great temporary benefit to be had in these cases by such therapeusis. A case in my care of a woman 55 years old, is greatly improving under the use of tr. hyoscyamus, tr. conii, equal parts. Attempts at re-education of musculature by the method of Fraenkel, will frequently avail much in bettering the co-ordination of the individual. It is advisable to insist on the patient's carrying a cane to act as a support and prevent falling. In bad cases with marked tremor of the head and weakness of the cervical muscles, a light jury mast may be worn to steady the head, thereby permitting the patient to go about with greater comfort. With Dr. John H. Musser, I have seen the case in a very intelligent woman much benefited by the use of Brown-Sequard injections given under the advice of Dr. S. Weir Mitchell. She has had the disease for at least thirty years. This line of therapeutics has been reported by the author in a paper before the Medical Society of Pennsylvania in May, 1896. THE PREVENTION OF OPHTHALMIA NEONATORUM. In an article on this subject, Dr. Lucien Howe of Buffalo (Phil. Med. Jour.) urges the enactment of laws which will make it compulsory upon the practitioner to adopt some form of prophylaxis against this disease which is responsible for so many cases of blindness. He cites statistics by Kostling showing that in 17000 births where no prophylactic treatment had been employed some trace of ophthalmia developed in over nine per cent, whereas in 24000 children treated by the Crede method the number who developed the disease was only one-half of one per cent. The Crede method however has the disadvantage of always producing some pain and usually more or less conjunctivitis while in a few instances it has given rise to corneal ulceration. According to the statistics of Piotrowsi, in 1030 children treated with a strong solution of boric acid and a ten per cent solution of protargol, not a single case of ophthalmia occurred, while slight catarrhal conjunctivitis was observed in only 12 per cent. Aside from the numerous favorable reports on the value of protargol as a prophylactic against this affection, by European authors, the drug is preferred for this purpose by many ophthalmologists in this country, including Drs. Alt, Peck, Cheney, Fox, Hotz, Zimmerman, Converse and Todd. In commenting upon Dr. Howe's paper the Philadelphia Medical Journal remarks editorially: "If we cannot reach the fons origo of ophthalmia neonatorum, we can at least save the offspring from a life of darkness, and protect the community from a source of burden and expense.. That this can, to an enormous extent, be accomplished by prophylactic instillation, need hardly be repeated, and its negligence constitutes a sin of omission that deserves commensurate punishment. The enactment of such a law is feasible, its interpretation obvious, and its enforcement not difficult, provided the accoucheur receives the intelligent support of an intelligently instructed community." MEDICINE. BY FRANK PARSONS NORBURY, M. D., Physician-in-chief and Superintendent Maplewood Sanatorium for Nervous Diseases; Neurologist to Our AND EGBERT W. FELL, B. S., JACKSONVILLE. ILL. Latent Gonorrhea in the Male as a Factor in Diseases of the Female Organs of Generation (Wheat, Atlanta Jour. -Rec. of Med.).-The great majority of cases are readily cured if properly treated, both in the male and female, but a few result in violent systemic infection. In another class the disease lies dormant, ready to break out upon excesses, or may give rise to no symptoms whatever. Such cases are nearly certain to infect their wives. In the female the disease rarely presents conditions physically analogous to those in the male and the trouble is often unrecognized till irreparable damage has been done. If recognized sufficiently early gonorrhea is more certainly and easily cured in women than men. Noeggerath says that of every hundred women who marry men who have had gonorrhea, hardly ten remain well, but this, according to the author's experience, is exaggerated. ter. Tertiary Syphilis (Shoemaker, Med. Bul.,) Case I.-A woman 53 years of age. Lesions in position and arrangement resembling herpes zosCenter free from eruption and slightly pigmented; around the border are many large spots covered with small scales, some dark, others grayish. Scars are also to be seen. The disease has been in existence for more than three years. Case II.-Man 30 years old upon whose cheeks and neck is an eruption which has been present a week. It consists of tubercles of a dull-red color and without evidence of suppuration, although the man asserts that pus and scales have been in existence. The eruption is on the right side in the region of the beard and also on the right side of the chest. Pigmented spots are seen on various parts of the body. The man had a chancre five years ago. Case III.-Woman 38 years old with well marked lesion on forehead. Another on right side of chest is covered with. characteristic crusts. The disease began two years ago in the form of papules of a dull-red color which enlarged, but contained nothing but blood. The arrangement and form of the lesions is distinctive. They are large, excavated, and surmounted by crusts of a dark-yellowish brown, or even blackish hue and composed of strata or layers which diminish in size as they ascend. However unlike in gross appearance there is one point in which these three cases agree. There is more than one form of lesion; they are polymorphous in arrangement; the color is comparable to that of copper or lean ham. They exemplify different forms of tertiary syphilis, the first being tubercular syphilide, the second pustulo-cutaneous, the hird nupia. Tubercular syphilide does not usually appear till two to four years after infection. The tubercles ranges in size from a split pea to a chestnut; are usually present in large numbers; persist for several months; disappearing by fatty degeneration, absorption or ulceration. The ulcers may be superficial or deep; secretion yellowish or greenish; edges infiltrated and of a dark red color. The pustular form is divided into the accuminated and plat varieties and each of these subdivided into large and small. Accuminated pustules may be either superficial or deep, those on the second patient being of the small superficial variety. The incrustation on the third patient may be the result either of the bullous or the large, flat, pustular syphilide. Tertiary syphilis attacks all organs and tissues. At the same time the eruption is developing on the skin a gumma may be forming in the brain. The lesions respond promptly to the iodides. potassium salt is generally used and answers every purpose. Beginning with a small dose the remedy is increased until the stomach becomes intolerant, then decreased or discontinued for a time. If the author uses mercury at all he prefers to give it separately. Tonics should be given and hygienic requirements observed. Stimulant ointments may be used to promote cicatrization. The Causes, Diagnosis and Treatment of Cystitis (Guiteras, Med. News). -Acute cystitis is always bacterial in origin and generally due to extension of an acute gonorrhea. Injury to the bladder during confinement or during pelvic operations is almost invariably followed by acute cystitis. In the beginning of the attack there is often depression, nausea and loss of appetite, but no febrile movement. Urination is frequent and precipitate. Pain in the perineum and tenesmus in neck of bladder are almost constant. Urine acid, of normal specific gravity, containing bladder epithelium, blood, pus, bacteria, and perhaps crystals. The bladder is extremely sensitive to the introduction of instruments or fluids. Posterior urethritis is the most common antecedent, and the line between them is not sharply drawn. The differential diagnosis is best made by the three glass test, the first glass containing, in posterior urethritis, the largest amount of pus. In acute prostatitis the febrile element is marked; there may be retention of urine; there is pain in the rectum and examination will show an enlarged prostate. In acute vesculitis there is very little pus in the urine, and rectal examination will show enlarged seminal vesicles. In vesical irritability there is no pus in the urine. If the diagnosis cannot be made otherwise the cystoscope may be used. In chronic cystitis the active cause is entrance of pathogenic germs. Predisposing causes are uric acid or oxalate of lime; alcoholic or sexual overindulgence; stricture and enlarged prostate. Symptoms vary much in development, duration and intensity. Frequency and pain are not so marked as in the acute form. Pus is always present in the urine, which is light in color and alkaline, containing a small quanity of albumen and blood, and bladder epithelium in abundance. In chronic posterior uretritis and prosatitis the fails to show the products of bladder inflammation. From surgical kidney the diagnosis is not difficult, pain in the loins, enlargement, and the microscopical findings serving to distinguish it. Different forms of chronic cys titis considerably by the author are those due to urethral extension, stricture, prostatic tuberculosis. In treatment of the acute form, rest in the recumbent posture is essential. Hot sitz baths and rectal douches as hot as as the patient can stand should be given. Alkaline diluents, urinary antiseptics, such as salicylates and benzoates, antispasmodics, as belladonna and codeine, should be given. If the urethra is not too sensitive bladder irrigation of potassium permanganate or nitrate of silver should be given by the Javet method. In acute exacerbations of the chronic form the treatment is as above described. In most cases rest in bed with hot sitz baths and rectal injections are of benefit. Urotropin is of great value. Bladder irrigations of boracic acid followed by permanganate of potash or nitrate of silver are of great benefit in every case. In the form due to extension a solution of nitrate of silver 1 to 2000 to 1 to 4000 is introduced by hydrostatic pressure and passed in the natural way. If due to stricture the cause should be removed either by dilation or cutting. When prostatic hypertrophy exists either enucleation or the Bottini operation should be performed. Stones may either be crushed or removed by suprapubic lithotomy. In tuberculous cystitis the general condition of the patient should be improved as much as possible. Antiseptic irrigations do little good as a rule, but good results may follow the use of 5 per cent iodoform in liquid vaseline. Borolyptol 1 in 8 to 1 in 16 has given the author good results. A Case of Cystinuria Complicated with Uricacidemia is reported by Gilbert (Chicago Clinic) in which neuralgia of the eye and head followed every exposure to cold or overwork. The patient lost flesh; limbs were swollen slightly from the knees down; slight puffiness appeared over the eyes. These was blurring of vision and mental confusion. Roentgen Rays have the power of causing pulling out of the hair, produce inflammatory reaction, and influence the nutrition of connective tissues (Pusey, Chicago Med. Rec.) It is of use in hypertrichosis for the removal of hair; in diseases of the hair and follicle, as sycosis, tina tonsurans, favus, where removal is an essential part of treatment; in inflammatory conditions, a chronic eczema to stimulate the tissue and cause absorption; and in specific affections like lupus. The advantages claimed in the last condition are: practically certainty of cure, freedom from pain, and the soft, pliable, thin character of the scars. Too great strength of primary current; too great tension of secondary.current; too long and frequent exposures; too close proximity should be avoided. The evidence that the exposures have been carried far enough are: appearance of erythema or pigmentation; blanching and loosening of the hair. The method should be used with caution in hypertrichosis, but less care need be taken in inflammations. AN EXCELLENT DEFINITION.-Substitution is the Universal sin; it is pacing the right for the wrong, a lie for the truth, a fraud for the original, an idol for God. Substitute nothing, live in the light, be manly and speak the truth-Ex. MEDICAL MISCELLANY The Treatment of Inoperable Sarcoma.-About a year ago attention was called to certain cases in this country and in England in which the use of the sterilized toxins of erysipelas and the bacillus prodigiosus was followed by permanent cure. Dr. Coley at the last meeting of the section on Surgery of the New York Academy of Medicine reported a case in which cure lasted for three years. Drs. Wyeth and Richardson have both reported cases of the same nature. The therapeutic mechanism of such cases is not understood, but inoperable sarcoma must not be pronounced hopeless until the toxins, or even actual infection have been thoroughly tried. Med. News. The Nature and Principles of Psychology.-(Sidis, Amer. Jour. of Insanity). A more careful study of this subject would be of great value to the general practitioner, and enable him to better appreciate subconscious phenomena and psychically induced disturbances, which are as often psychically cured. To give the imagination as the cause of the whole field of functional psychoses, the phenomena of hypnosis, the manifestations of the subconscious, and also the methods of psycho-therapeutics based on these is simply to confess ignorance of the subject. Psychology and especially that part dealing with abnormal mental action has proved useful in giving a better understanding of these phenomena. Cancer of the Breast.-Lloyd (Med. Age) first gives a short resume of the last year's work on the etiology of cancer. A parasite has been isolated by several observers which when inoculated into animals produced tumors with the typic structure of fibrosarcoma and carcinoma, these tumors constantly containing the parasite. If then we accept the parasitic theory of cancer the decrease in the percent of recurrences which has followed more extensive operation and removal of adjoining lymph tissue is explainable on the ground that the infecton follows the lymph channels and these diseased portions must be entirely removed before the process is permanently stopped. The mortality from radical operaion has been reduced to less than two per cent. Following the papers by Halsted and Meyer in 1894 the author removed the pectoralis major and adjoining structures as follows: An incision along the anterior border of the axillary space is carried down to make the upper incision for the removal of the breast. The pectoralis is cut away close to the humerus and its clavicular and sternal attachments divided. The fat and glands are dissected out of the axillary space, the lower incision made and the mass removed entire. If the patient's condition permits the supra-clavicular glands should be removed. Immediate skin grafting is not advisable; drainage should be employed. Pruritus Ani.-Tuttle (Med. News) does not believe that pruritus ani is a disease per se. He says that although there must be a constitutional condition underlying it, it occurs only as a symptom in other disorders. Constipation, hemorrhoids and numerous other troubles may occur concomitantly, but the author thinks that the true causes are as follows: 1. Paracitic diseases, as erythrasma, tinea, scabies and pediculi. 2. Rheu |