who have referred to this proceeding, I would quote the following remark from the writings of the late Dr. Gross, of Philadelphia:

"My conviction is that this operation is destined to come into general use in this class of cases, of such frequent occurrence in advanced life and a source of much suffering."

The operation consists in puncturing the bladder with a special trocar and cannula, made for this purpose for me by Messrs. Tiemann, of New York, one inch in front of the anus. The trocar is made to pass through the large prostate at a lower level than that of the normal canal, the object being to make a "low-level" urethra, and thus to favor a thorough drainage of the viscus. Where the bladder is largely distended with urine, the process is simple enough; when this is not the case, and the operation is undertaken with another object, I advise the following procedure: The patient being placed in the lithotomy position under an anesthetic, a catheter is passed and the bladder distended with tepid water; the beak of the catheter should then be reversed so as to lie in the dip above the large gland. A temporary ligature being placed around the penis and the escape of any fluid through the catheter being prevented, the trocar is then plunged from the perineum into the distended viscus; as the point of the trocar enters the bladder, it will be found to strike against the end of the catheter, toward which it should be directed.

A few words in reference to the instrument: The trocar is hollow, with an opening by the side of the point. Immediately the instrument penetrates, the prostate fluid escapes at the handle. The trocar is then withdrawn, and the cannula left behind. The latter is fitted with a movable collar, perforated at the sides for fixing with a T bandage. The collar is movable, so that by means of a screw it can be nicely adapted to the thickness of the tissues through which the cannula may have to pass, as it is undesirable to have too much of the tube projecting into the bladder cavity. The cannula being thus adjusted and fixed with an ordinary perineal bandage, a piece of tubing is attached to the end of it, by means of which urine is conducted to a vessel by the patient's bedside. After a few days in bed the patient gets up, and then tucks the end of his tube into a belt round his waist. A pair of bulldog forceps will be found to act as a convenient compressor. When the patient requires to pass water, all he has to do is to take off the compressor, and let the tubing fall between his legs; urine thus flows by gravity, and without any expulsive effort on the part of the patient. After six, eight, or ten weeks'

wear, according to circumstances, the patient will now and then be conscious that slight gushes of urine along the natural passage will involuntarily take place. Like as when urine passes along the urethra for the first time after lithotomy, I have known its first occurrence, after prostate puncture, followed by slight indications of reflex action in the form of a rigor, and some elevation in temperature. Where these involuntary gushes take place, they may be regarded as indications that the gland has undergone such an amount of atrophy as to cause the urine to prefer the natural to the artificial channel for its exit. The cannula can then be removed, when this wound speedily closes. One benefit the patient derives from catheterism being unnecessary, the easy way the bladder is washed out, the non-confinement to bed, and undisturbed repose, is obvious.

It is interesting to observe, in connection. with this subject, how it sometimes happens in cases of large prostates, where catheterism has been found impracticable, and it has been necessary to empty the bladder by the repeated use of the aspirator for considerable periods of time, that both micturition and catheterism may again become permanently passive, circumstances which seem to point to some diminution of the size of the gland having in the interval taken place. In conclusion, I would urge the adoption of tunneling the prostate from the perineum as the best method of tapping the bladder in all cases of emergency, where retention of urine from an enlarged prostate occurs and catheterism is found to be impossible; and, secondly, this operation may be undertaken with the view of inducing atrophy of the gland in cases where the functions of the bladder are so disturbed as to render life almost unbearable. In the observation of a considerable number of cases of difficult catheterism and large prostates, I have often thought that, in some instances, far less damage would have been done, and the patient's chances improved, had the practitioner, on recognizing his difficulty, used a trocar in a suitable position, rather than persevered with the catheter.-Reginald Harrison, F. R. C. S., Gaillard's Medical Journal.

PURE TEREBENE AND TERPENE.-I have received so many letters from medical men, in different parts of the country, giving the results of their experience with pure terebene in the treatment of winter - cough, that practically there has been an informal collective investigation. I have before me brief notes of ninetyfour additional cases, and in eighty-one of these a distinct success is recorded. In six of

the cases of failure a further investigation showed that there had been an incomplete diagnosis, the patient suffering from some complication, such as aneurism or aortic disease, the existence of which had not previously been suspected. In ten cases the patients complained of nausea after taking the medicine, and in several instances, when inhaled from lint, it excited the cough and apparently acted as an irritant. The explanation is, that much of the pure terebene now sold is of very inferior quality, and would be more accurately described as "impure" terebene. Medicines, as a rule, do not improve by keeping, but pure terebene is certainly an exception, for most of the old stock, which, in consequence of the small demand, must have been in druggists' shops for years, has now disappeared, so that greater care has to be taken in the selection of good specimens. Much of the pure terebene now sold is crude and irritating, and quite unfitted for medicinal use. My attention has

been called to the fact that there is a terebene which is labelled "patent." I distinctly stated in my paper that the substance I employ is not a "patent" preparation. In almost every case I find the pure terebene has been given on sugar, and has not been used in the form of spray, probably from the difficulty experienced in obtaining the atomizing apparatus. The combination of oil of cubebs, oil of sandalwood, and pure terebene, which I used with success, has given good results in other hands. I have had no returns of cases of phthisis treated in this way, but most of my correspondents speak of having found pure terebene of benefit in acidity, flatulence, and other forms of dyspepsia. The smell of violets which the terebene imparts to the urine is often referred to, and in one instance it gave rise to complications. A lady called on her lover who was ill in bed with bronchitis, and was very angry because he would not show her his violets. She searched for them but did not find what she had expected. I am surprised that pure terebene has not been recommended for diseases of the bladder and urethra. My experience of its employment in these cases is limited, but I have certainly found it useful in cystitis and gleet. Delicate and fastidious women sometimes object to the smell and taste of pure terebene, and I then use terpene in the form of tabloids with good results, although I do not think it is equal to pure terebene.- William Murrell, M. D., British Med. Journal.

ON THE TREATMENT OF RINGWORM.-Dr. R. W. Leftwich writes to the Lancet: Last August a lady asked me to examine her nursemaid's head. I did so, and found a well

marked patch of ringworm about an inch and a half in diameter. The mistress was naturally unwilling to expose to the contagion her children, who presented no sign of the disorder, and almost equally unwilling to part with the girl for a time. After some reflection I told her I thought the difficulty might be gotten over with only very slight risk to the children, and treated the case in the following way. Having cut the hair close to the scalp, all round the patch, I first painted it with an alcoholic solution of iodide of mercury-an old-fashioned but excellent remedy, obtained by adding calomel to tincture of iodine and using the supernatant colorless fluid. As soon as the slight soreness it produced had passed off, I applied an iodine plaster, obtained from a formula in Beasley's book and attributed to Roderburg, an ounce of the plaster containing a half a dram of solid iodine. This spread on kid was carefully applied to the patch, which it overlapped all round. At the end of a fortnight it was removed, and the ringworm appeared practically cured. peared practically cured. To make sure, however, it was again painted with the abovementioned solution and a fresh plaster applied for another fortnight. Upon being taking off, the whole surface of the patch was found covered with short hairs. No other patch has made its appearance upon the head or elsewhere, and not one of the three children with whom the patient was in daily and hourly contact took the complaint. Possibly the plaster alone would have been sufficient, but I thought it safer to use the paint in addition, and I feared that if I used a more powerful plaster the irritation might tempt the patient to remove it. I might also have used a plaster containing oleate of mercury, but doubted whether it could be made sufficiently adhesive. The advantages of this mode of treatment are obvious enough, for by its means the risk of the disease being spread by actual contact, by means of caps and by the common use of hair-brushes, is reduced to a minimum. I find no allusion to this method in the ordinary works on the subject, and therefore infer that, if new, it is not widely known.

HEPATIC ABSCESS.-The three varieties of idiopathic, traumatic, and metastatic abscess of the liver occur in all countries and all climates, in varying proportions according to the relative frequency of their predisposing and exciting causes.

There is no such thing as a spontaneous hepatic abscess. Every suppuration of the liver has, if not a predisposing, at least an exciting

cause.

The predisposing causes are of two kinds:

(a) A constitutional tendency to liver disease. (b) An acquired tendency from an overindulgence in food and drink. The exciting causes are equally of two kinds: (a) One derived directly from without, as for example, chills, injuries, and parasites. (b) One generated within, suppurations, gallstones, and embolisms. Pathologically speaking, all abscesses of the liver naturally divide themselves into two groups: (a) Those essentially primarily local, including the two forms of idiopathic and traumatic. (b) Those essentially secondary, including the pyemic and metastatic varieties.

The pathology of all forms of liver abscess is the same, though materially modified by the nature of their exciting causes.

Hepatic abscesses vary in size from that of a walnut to that of the whole liver. Two and a quarter gallons of pus have been evacuated from one. Sometimes the entire liver tissue is broken down and the capsule of Glisson simply forms the sac of the abscess.

Abscesses are far more common in the right, than in the left lobe of the liver. When multiple they are frequently met with in both lobes.

An abscess may form in the liver at any period of life between early infancy and advanced age.

Suppuration may occur in an atrophied as well as in an hypertrophied, in a fatty as well as in a cancerous liver.

Jaundice is in no case a necessary concomitant of liver abscess. Indeed, it is most frequently absent.

The signs and symptoms are nearly identical in the three varieties, the constitutional peculiarities of the patient alone modifying them.

Hepatic abscess is more common among men than women.-Dr. George Harley, London Medical Press.

PATHOGENIC BACTERIA.--In a paper upon the Practice of Surgery and its Results in the West London Hospital since 1880, Mr. C. B. Keetley says (London Medical Press):

Of course there are authorities who do not regard tetanus as a blood disease. There is no time to debate this. But I will just ask two questions: (1) How is it that tetanus so frequently attacks compound fractures, while there is probably not a surgeon here to-night who has ever seen it follow a simple fracture, however much the bones have been comminuted, and the nerves lacerated in the latter case? (2) How is it that the class of wounds which are most liable to bring on tetanus are just those which most commonly surrender to the recognized traumatic infective diseases, for example, lymphangitis and cellulitis?

But there are many powerful reasons for classing tetanus with the traumatic infective diseases. The general history of the epidemic in the hospital is scarcely consistent with any other theory.

As regards principles, I hold that the germtheory of putrefaction has long been absolutely proved. Nothing can be more lame than the efforts of the persons with any pretense to be called scientists who have opposed this theory. Indeed, at this moment scarcely any such opposition may be said to exist.

With regard to the germ-theory of the origin of the traumatic infective diseases, such as erysipelas and pyemia, I do not say that the proof of it is exactly absolute, but I do say that the mass of evidence points all in one way, and I believe it to be for the good of my patients to act as if this theory were also proved.

With respect to the theory that there can be no suppuration without bacteria, that also is still an unsettled question. But it may be fairly taken as proved that the cases in which suppuration can possibly be quite independent of bacteria are rare.

With regard to means, during 1881, the ordinary eight-fold carbolic gauze dressing, with gauze packing, jaconet, and protection, were used exclusively, and the spray was only omitted where it could not possibly be used, e. g., in operations on the face. This included the commencement of the most successful run of cases I have had. But the greater part of this successful run was during a time when I had begun to use iodoform powder and iodoform gauze extensively. There was a series of over one hundred operations without a death, broken at last by a double amputation.

I used the spray diligently for nearly three years, but, for nearly two years, I have substituted the douche. The latter, though more sloppy, is also much more convenient.

One grave objection to the spray is due to no fault of its own. It is the fact that it is apt to lead all young dressers and most stupid and careless people, whether young or old, to regard the spray as every thing. They then neglect far more important points. I have frequently used salicylic wool, but generally more with an eye to its mechanical use as so much elastic padding than as an antiseptic absorbent, in which respect it is not to be named in the same breath with iodoform gauze or with turf-moss.

All the cotton-wools have very grave faults as absorbents. Their power of absorbing water is no criterion whatever, for water is not an albuminous, coagulating fluid.

When I wished to lessen discharge, I often

used, instead of iodoform, a mixture of bismuth, zinc oxide, and iodoform in equal parts by weight. This can be dusted out of a pepper box, or mixed fresh with any form of lotion and injected.

The gauze and wool dressing I have constantly made strong at the edges with broad stripes of strapping, and I have covered the whole dressings with rubber bandages, a great protection against recurrent hemorrhage and diminisher of discharge.

For a year I have been using sublimate lotion (1 in 1000) to disinfect the hands, the site of the wound, the fresh wound itself just before covering with the first dressings, and, in the last three months, I have been using sublimate dressings entirely, consisting mainly of bags of turf-moss, soaked in 1-500.

The relative advantages of the different substances are very important and interesting, but much more important than the choice of a dressing is the careful and correct use of that which the surgeon does happen to choose.

THE DIGESTION OF MILK.-Dr. M. Reichmann draws the following conclusions from a number of elaborate experiments as to the digestibility of milk in the human stomach (Deutsche Med. Zeitung, No. 82, 1885):

1. Boiled milk leaves the healthy stomach more rapidly than an equal quantity of unboiled milk.

2. The digestion of boiled milk is more rapidly accomplished than that of unboiled milk.

3. The coagulation of unboiled milk in the stomach is complete in five minutes.

3. This coagulation is not caused by the acid of the gastric juice, but by the influence of a special ferment (milk-curdling ferment).

5. The acidity of the gastric juice is at first due almost solely to lactic acid, and, later in the process of digestion, to the presence of hydrochloric acid.

6. Hydrochloric acid first appears in perceptible amount forty-five minutes after the ingestion of half a pint of milk.

7. For the first hour and a quarter after the ingestion of milk the acidity gradually increases, and then decreases, until the milk has entirely left the stomach.

8. The curds of casein in digestion of boiled milk are much softer than in the digestion of uncooked milk.-Therapeutic Gazette.

SOME FOREBODINGS OF INCIPIENT INSANITY. The Medical World abridges the following from a paper by Dr. Sutherland, Lecturer on Insanity, Westminister Hospital, London:

(1) Irritability and tendency to take offense.

(2) Moroseness and silence, or sometimes faultfinding with servants. (3) Suspicion and jealousy of best friends. (4) Impairment of memory, forgetting hours of meals. (5) Inattention to exercise and state of bowels. (6) Neglect of personal appearance. (7) Altered facial expression, notably in melancholia, with marked furrows. (8) Prominence and brilliancy of cornea, in hysterical and puerperal

mania.

Bodily Symptoms. (1) Harsh, dry skin, as a rule, though sometimes perspiring. (2) Sometimes a peculiar odor. (3) Coated tongue, with offensive breath. (4) Constipation and feeble circulation. (5) Headache and pallor of face. (6) Sexual appetite, either in abeyance or abnormally strong. (7) Frequent suppression of menses in females. (8) Subjective deafness, or abnormal auditory sensations. (9) Altered conversational style, and talking to oneself. (10) Delusions and illusions later on.

ENDOMETRITIS.--Before the Glasgow Obsettrical and Gynecological Society, February 10th, Dr. Robert Bell read a paper on "Endometritis," in which he expounded some rather peculiar views regarding its etiology and pathological relations. He endeavored to make out that constipation of the bowels is a very common and important factor in its causation, especially in young women, leading not only to endometritis, but to displacements of the uterus and subsequent dysmenorrhea; and, moreover, is the most frequent cause of anemia, "from the constant absorption of fetid matter into the blood, which destroys the health and even the vitality of the red corpuscles, thus reducing their number and quality." In regard to treatment, Dr. Bell advocated the ordinary means for the removal of uterine congestion found in the text-books, such as the prolonged hot-water douche "at bed-time," and the use of his medicated tampons of glycerine, alum, and boracic acid, and the weekly introduction of iodine and carbolic acid into the interior of the uterus. Where constipation existed, "systematic and prolonged use of the enema."-London Medical Press.

COCAINE IN OINTMENTS AND SUPPOSITORIES. Cocaine being insoluble in oily and fatty substances, it is advisable, in cases where it has to form an ingredient of a pomade or suppositories, to first dissolve it in oleic acid, and afterward to add the other substance to it by small quantities at the time. Treated in this manner the cocaine will assimilate itself with the greasy substance, and a homogeneous preparation will be obtained.-Druggists Circular, February, 1886.

Notwithstanding the able discussions in our day elicited from various sources on the subject of immunity in disease, the scientific world has reached no definite explanation of the fact. Indeed, it is difficult to decide whether greater ingenuity has been expended by the various contestants in destroying the theories of others or in trying to establish their own. It is, however, certain that, of the two, the former task has been much the better done.

The first attempt at an explanation of the immunity conferred by disease was made by Pasteur. He found that when, in a culture fluid containing torule, the sugar was exhausted the micro-organisms perished. He thereupon concluded that the same principle obtained in the natural history of zymotic diseases; that the microbes in these affections set up a kind of ferment in the tissues; that as soon as this exhausts all the pabulum of a certain kind the germs die, and that the system, being never again able to reproduce it, remains ever after a soil sterile to their growth.

This theory was championed by Professor Tyndall, whose masterly researches in bacteriology are familiar to all, and who brought to its support the remote and incomplete analogy traceable between immunity in zymotic disease and circumstances attending the cultivation of certain crops in husbandry; it being a fact that the same kind of crop grown continuously upon the same soil will in time exhaust it of the elements necessary to the growth of that crop. But Pasteur observed that on adding a new supply of sugar to his exhausted fluid the yeast-plant flourished as before; and it is well known that by adding to exhausted soils the required elements fertility is also fully restored and can be always maintained. To complete the analogy, a continuous supply of the accustomed articles of food to the human body ought to enable it to produce sucessive crops of a given microbe indefinitely.

Chauveau, Klebs, and Klein, finding the dif ficulties of this explanation insurmountable, came to the conclusion that a material of some kind was secreted by the disease germs which, remaining in the tissues after the departure of the disease, proved poisonous to subsequent invaders

Chauveau, however, found that a very large subcutaneous injection of the bacilli of anthrax in any animal that had survived a primary attack would give it the disease a second time. Smaller doses, such as would have been sufficient to engender the disease in non-protected subjects, had no effect upon it. This fact has been abundantly verified by Drs. Salmon, Law, Detmar and others in this country, who have proved that the exact degree of immunity possessed by an animal can be gauged by using a virus of standard strength. The lesson of the foregoing, well presented by Dr. R. G. Eccles (New York Medical Journal, May 23, 1885), is as follows:

"If immunity is due to abstraction, how can many microbes subsist and flourish, where a few will starve to death? If due to the addition of something that would be fatal to a few, it would seem as if that would be also fatal to the many. If the many triumph over it by superior numbers, there still remains the question, how can such a substance, foreign to