cussions of the first day, will be found in this issue. The proceedings of the other days, with abstracts or the full text of the papers, will appear in our next and subsequent issues. ANTISEPTIC FOR OBSTETRIC USE. Last month an English surgeon sent the following query to the London Lancet: "What is the best antiseptic for the hands of midwives?" In answer to the question, Mr. A. W. Mayo Robson suggests the use of the silicofluoride of sodium, which he claims to be both safe and efficient. It is commonly sold under the name of "salufer," and is claimed to present the following advantages: It is cheap, inodorous, non-irritating in a solution of one grain to the ounce of water, non-poisonous, does not stain or alter in any way the complexion or character of the hands or linen, and it may be conveniently carried in the form of compressed tablets, or in powders, of size sufficient to make a quart of solution. Each tablet or powder will contain thirty-two grains, and the resulting solution, in the parlance of the antisepticists, will be a little more than 1-500. The author claims to have tested its efficiency as an antiseptic in many surgical cases, such as hernias, abdominal sections, amputations, etc., while the evidence of obstetricians is not wanting as to its efficacy as a vaginal and uterine douche. An antiseptic which does not offend the sense of smell, which is competent to destroy septic and pathogenic microbes, and which may be freely applied to the hyperemic, bruised, and excoriated genital canal of the parturient woman without irritation or danger of toxic effect, has long been a desideratum in obstetric medicine. Of the long list of drugs employed, from carbolic acid to corrosive sublimate, none has been found which will escape impeachment under the offenses or short-comings above stated. Carbolic acid and iodoform go down under the first and second counts, mercuric chloride and permanganate of potassium under the third, while salicylic and boracic acids with hydronaphthol, eucalyptol, gaultheria, and not a few others, tumble under the second term of the impeachment. Silico-fluoride of sodium is not new, it having been for many years familiar to the chemist as a resultant of one of the few tests for sodium. Up to this time, however, it would seem that the therapeutist has not subjected it to study, since neither the dispensatories nor the lesser works on materia medica and therapeutics make mention of it. In view of the peculiar chemical qualities of fluorine, the timehonored aseptic uses to which the chloride of sodium has been put, and the well-known antiseptic power of sodium silicate, the silico-fluoride of sodium affords good a-priori grounds for confident expectation. In this day, when the correct theory of septicemia seems to be well understood, and when surgery, acting upon this theory, is every day scoring successes not dreamed of in the ante-microbian era of pathology, the obstetrician must own the humiliating fact that puerperal septicemia is still opprobrium medicorum. It is not too much to say that he who shall discover a powerful germicide, that may be exhibited in quantity sufficient to do its perfect work without danger to the patient, will confer an inestimable blessing upon womankind, and lift an incubus from the obstetrician's breast. Notes and Queries. - MEDICAL APHORISMS. A correspondent, signing himself "Artz," sends to the Canada Lancet the following professional aphorisms of Amédée Latour: (1) Life is short, patients fastidious, and the brethren deceptive. (2) Practice is a field of which tact is the manure. (3) Patients are comparable to flannel-neither can be quitted without danger. (4) The physician who absents himself runs the same risk as the lover who leaves his mistress; he is pretty sure to find himself supplanted. (5) Would you rid yourself of a tiresome patient, present your bill. (6) The patient who pays his attention is but exacting; he who does not is a despot. (7) The physician who depends on the gratitude of his patient for his fee is like the traveler who waited on the bank of a river until it finished flowing, so that he might cross to the other side. (8) Modesty, simplicity, truthfulness! cleansing virtues, every where but at the bedside; there simplicity is construed as hesitation, modesty as want of confidence, truth as impolite ness. (9) To keep within the limits of a dignified assurance without falling into the ridiculous vauntings of the boaster constitutes the supreme talent of the physician. (10) Remember always to appear to be doing somethingabove all, when you are doing nothing. (11) With equal, and even inferior, talent, the cleanly and genteelly-dressed physician has a great advantage over the untidy one. DRUGGISTS AND THE PRESCRIPTION OF POISONS.-The Indiana Legislature has passed a law declaring that, "From and after the passage of this act, no pharmacist, druggist, apothecary, or other person, shall refill more than once prescriptions containing opium or morphine, or preparations of either in which the dose of opium shall exceed one fourth grain, or morphine one twentieth grain, except with the verbal or written order of a physician." A violation of the law is declared a misdemeanor, punishable by a fine of not less than ten nor more than twenty-five dollars. daily for ten days. He has used it externally, as usually done in skin diseases, with good results, and has prescribed it internally in phthisis, in doses of 8 to 15 grains daily, with advantage. As it is eliminated by the kidneys, he suggests its internal use in cystitis, thus avoiding the irritation produced by catheterization.-Gazette Médicale de Paris. INNERVATION OF HEPATIC VESSELS.-At a recent meeting of the Imperial Royal Society of Physicians, of Vienna, Dr. Pal made a communication on the innervation of the hepatic vessels. Claude Bernard was the first to formulate the hypothesis of hepatic nerves, though their existence had not been directly proved. Dr. Pal had tried to decide this problem in the following manner. He ligatured, below the anastomosis of the hepatic veins with the portal vein, all those blood-vessels which conveyed blood to the liver, such as the thoracic part of the aorta and the ascending vena cava. On irritating the peripheral part of the splanchnic nerve, considerable increase of the blood pressure was produced; the same was also observed when the ascending cava was ligatured above the implantation of the hepatic veins, but in this case to a lesser degree. Experiments which he had made with the view of determining the rapidity of the outflowing blood showed that the liver pressed out blood on irritating the splanchnic nerve, thus proving the presence of vaso-constrictors in the liver.-The British Medical Journal. BY E. R. PALMER, M. D. Professor of Physiology and Pathological Histology, Medical Department University of Louisville. In view of the large number of papers promised for the present meeting, I have determined to occupy a comparatively short portion of your time with this report, and to give as succinctly as is possible some of the most interesting of the novelties that have appeared in genito-urinary literature since our last meeting. Gonorrhea still keeps firm hold on its old place among the obstinate and often intractable diseases, and as a result many novel suggestions appear in the journals of the day looking to its speedy cure. It seems more and more firmly established that, be the treatment what it may, a cure in six weeks is a good result, and that a discharge from the urethra that yields to any treatment in two to four days is a bastard gonorrhea that would have in all probability gotten well itself if let alone. Retrojection, about which so much has been said in the last year or two, is useful in subacute claps, and especially in those so frequently seen that represent the lighting up of old cases imperfectly cured. In a large percentage of such cases the prostatic urethra, and often the bladder as well, are involved so that retrojection, to accomplish greatest *Read at the Thirty-third Annual Meeting of the Kentucky State Medical Society. No. 3. good, should be carried out by injection into the bladder, the fluid to be discharged by the patient's volition after withdrawal of the catheter. In such cases a fourth or a third of a grain of bichloride of mercury to the pint may be advantageously used in a supersaturated solution of boric acid. The formula for the latter is as follows: Calcined magnesia... Boric acid.... Water........ 3 iss; 3 xij; O viij. Triturate the first and second; add the water; agitate and filter twice. This represents about forty-five grains of the acid to the ounce, or double the strength of the ordinary saturated solution. Such a wash should be heated to near 100° F. before using. For the urethra itself irrigation with a Kiefer nozzle, as described last year, is preferable to retrojection. Stronger bichloride solutions and the super-saturated boric still hold first place for this purpose. I think I have materially shortened the course of some cases by allowing the patient to use an ordinary injection immediately after irrigation, and also twice or three times during the day. In addition to the usual zinc or lead, or hydrastia washes, I have had excellent results with three per cent to five per cent solutions of thalline sulphate and the following: ter has been especially lauded by Fröhner and Von Esmarch as a coal-tar derivative superior to carbolic acid," while according to Gawalowski it is a mixtum compositum containing about a dozen constituents mechanically incorporated-what in our parlance would be denominated a nostrum. Oil of wintergreen, which was recommended recently by Taylor in gonorrheal rheumatism, has since been advocated by Wyeth as the equal of boric acid for the sterilization of urine by internal administration. Naphthaline is excreted by the kidneys chemically unchanged. In large doses, one fourth to one half dram, it produces distressing symptoms. It has in toxic doses produced cataract in the rabbit. In doses of five grains thrice daily its beneficial effects in gonorrheal cystitis are often pronounced. With terebene and pyridene I have had but little experience, but salol, like the wintergreen and naphthaline, is a most excellent agent. The gonococcus has held its place as a pathogenic agent. Its relation to questions of medico-legal interest should make the surgeon exceedingly careful in his examination. This specific micrococcus may be discerned in a dry mount with one eighth inch lens combined with a B eye-piece. According to Professor Welch, of the Johns Hopkins University, when zoöglia of diplococci are found in the pus serum of a urethral discharge, the discharge is of specific origin. Where extreme accuracy is desired, a high power immersion lens and the bleaching process of Roux should be applied. The fact that these germs thrive in acid media has led Castellan, Rohé, and others to recommend alkaline injections. In immediate connection with the subject of gonorrhea comes the exceedingly interesting question of sterility. Up to within a few years it was generally asserted that in sterile unions eight times out of ten the fault lay with the woman, and in most such cases her barrenness was vaguely explained by the terms, version, flexion, stenosis, atresia, acridity, etc. Gross, in the third edition of his work on Disorders of the Male Sexual Organs, places the percentage of sterility in the male, in barren unions, to one case out of every six. Kehrer, of Heidelberg, found in ninety-six men of unfruitful union whom he examined: Impotent, 3; having semen containing dead spermatozoa, 29; deficient spermatozoa, 11; excessive spermatic fluid, 53. The percentage of sterility in the male, according to this, being 33.32. Both of these, as well as other authorities not quoted, place gonorrhea as the chief cause of this sterility. Indeed, it may be safely asserted that in nearly every case where double gonorrheal epididymitis has existed sterility is among the results. Fournier has examined twenty-one cases of bilateral epididymitis, and found in the discharges of eighteen no spermatozoa. In the matter of sterility from gonorrhea in the female, Professor Goodell, in a lecture delivered upon the subject in October last, after quoting Noeggerath, who has asserted that "a woman who has once had gonorrhea never afterward conceives," said, "Personally I can not recall a case in which a woman bore a child after suffering with gonorrhea." This to my mind is hardy a scientific way of putting so grave a question, especially coming as it does from one so high in the ranks as Dr. Goodell. The frequency of gonorrheal salpingitis has until quite recently been underestimated; but it seems to me that here, as in the analogous epididymitis of the male, a double pyosalpinx should be necessary to effect barrenness. It is a matter in which statistics are not without our reach, and one where statistics are badly needed. In the same lecture Dr. Goodell clearly lays down the correct law for treatment of gonorrhea in the female, namely, the application by the surgeon of strong solutions of mercuric bichloride, not only to the vagina, but to the cavity of the womb also, swabbing the latter with 1 to 1,000 solution, "in the hope even that some of the fluid may get into the tubes as well." I have recently had the temerity to treat a cyprian suffering with right gonorrheal salpingitis by injections, through a patulous os, of a hot 1 to 1,000 solution, directing the stream with considerable force toward the affected side, thereby materially lessening the pain, swelling, and discharge. M. Fritsch recommends, in the treatment of vaginal gonorrhea, two irrigations to the recumbent patient daily, consisting of twenty grams of chloride of zinc in equal parts of water, dissolved in a quart of water at a temperature of 90° F. Contrary to usually taught doctrines, urethral infection is the rule rather than exception in recent cases of gonorrhea in the female. Dr. Sternschneider, of Franzenbad, who examined thirty-four cases of this sort for Neisser, found masses of gonococci in each instance within the urethra. In the last issue of the PRACTITIONER AND NEWS, copies of which have been distributed at this meeting, I have collated and published what is new in the management of urethral stricture. I shall therefore to-day say nothing on this question further than that, so far, the treatment of stricture by electrolysis has failed to meet that general indorsement at the hands of genito-urinary surgeons that its advocates claim it deserves. In a discussion, November 2, 1887, of Dr. Watson's paper on treatment of stricture, read before the Surgical Section of the Suffolk District Medical Society, in Boston, "Electrolysis, so far as tried or observed by the various speakers, was unfavorably considered." "Internal urethrotomy in cases where stricture was not deeper than five inches was incontestably accorded the first place." Improvements in the cystoscope have rendered the observation and study of the interior of the bladder measurably easier. Epicystotomy, which has been revived, is, under antiseptic management, a reasonably simple and safe operation. By means of this operation and the cystoscope, Dr. Iversen, of Copenhagen, has successfully catheterized the ureters in the diagnosis of purulent inflammation of the kidneys. patient suffered no ill effects from the operation, the wound healed, and death supervened later from the renal disease, which was by The the exploratory operation found to be of too serious a nature to admit of nephrectomy. Weir, of New York, has suggested the introduction of a drainage-tube into the scrotum after the ordinary tapping operation for hydrocele, the washing out of the sac with 1-15 carbolic acid and the application of antiseptic dressings, these to remain undisturbed five or six days, the tube to be taken out in nine or ten days. Keyes has made an improvement in his varicocele needle. The Lister operation seems preferable to that of Keyes. It consists in an incision over the cord, just below where it crosses the ramus, and the separate ligation at this point of the two venous trunks found. By this operation the result is better and the danger of ligation of the spermatic artery as by other methods is avoided. It requires, to be safe or successful, the extremest antiseptic precautions. Harrison, in his recent Lettsomian lecture on enlarged prostate, demonstrates that the prostate is a funnel-shaped muscle developed at the base of the human male bladder as a retentive floor demanded by the erect posture, and the direct impinging of the urine upon the bladder neck. Its absence in the human female is obvious anatomically, and it has so far been found in the males of no other race, except possibly the dog, where rudiments of it are sometimes detected. This is thought to be due to the peculiar posture the dog assumes when urinating. Mr. Harrison somewhat facetiously remarks that he doubts not but that when the "missing link" is found, he will be found paying the penalty of his advanced state by having enlarged prostate. He compares the prostate to the heart, and speaks of compensatory hypertrophy, drawing the lines of dif ferentiation sharply between this condition and that of fibroid degeneration. In this matter of prostatic hypertrophy, Belfield has, in an article published in the Record of March 10th, with his characteristic clearness shown how, with comparatively little diffuse hypertrophy, serious obstacles to the outflow of urine may arise in the shape of myomata, analogous to uterine fibroids |