bougie being preferred to solutions, in order that the antiseptic may stand a stronger chance of being more completely brought into contact with the inflamed surface. I have been unable to find in such journals as I have read, any strong endorsation of this plan. My experience of it is not sufficient to allow me to pass any opinion upon it. I can only say, with my predilection, I wish it were more effectual than it seems to be, as a treatment so easy and rational deserves to be.

In the treatment, we can find an ample field for discussion. As a student, I recollect well how much some used to praise the abortive treatment, effected by the internal use of balsam of copaiba and cubebs, in large and frequent doses, and at the same time the injection of nitrate of silver, or other similar strong caustic fluid, repeated at short intervals. Indeed, one well-known surgeon at the Infirmary, whose eminence in this direction was undisputed, was vulgarly called "The perfect cure in three days."

Few surgeons would now-a-days, I think, undertake the abortive treatment, even at the urgent request of the patient, and his assurance that all risk was his own; for except in mild cases, it frequently does much harm.

The expectant plan has had at times strong upholders, perhaps has some still. I do not find, however, that any of the advocates of this plan have ever brought forward an array of facts to prove that the disease if left to itself will get well in a short time; certainly the majority of those who have studied this disease at all closely, have come to a different conclusion.

What should be embraced in a safe and effectual treatment. Several factors make it up.

to hang, and thus permit the discharge to run freely out of the urethra, the mouth of which should not be firmly pasted up, as it so often is, with a piece of lint; but left open, or at most, having a piece of salicylic or borated absorbent wool lightly placed over it, or in a water-proof bag secured over it.

(c) Make his diet as simple as possible; pure milk diet, if you can get the patient to conform to it; at any rate, excluding all irritating and stimu-t lating articles-fluid and solid, giving also diluents and alkalies freely, to make the urine as little irritating as possible.

(d) Internally, I have used for a long time, the liquor santal flavæ et cubebs of Hewlett, with great satisfaction; it is the most pleasant of an unpleasant family of drugs, and I deem it most useful.

Injections what is their place and value in the treatment of this state. Certainly in the acute stage they are not beneficial, and I find them positively harmful. A good many cases that I see, come to me after they have treated themselves for a time on prescriptions and advice of a friend, or have been acting under the advice of a chemist. These usually use injections from an early date, often I feel satisfied with bad effects increasing the violence of the complaint and aiding in the extension to the deeper parts of the urinary tract, or producing one or more of the so-called complications or sequelae of gonorrhea.

The

When the acute symptoms are passing off, and the pain has gone, though the discharge may still be muco-purulent, yet I think it is then quite judicious to use astringent injections of various kinds. list of what has been used and proposed is a long one, and the difficulty of accurately estimating their value is not small; but the zinc salts, sulphate, sulpho-carbolate, nitrate of silver, and boracic acid are certainly most useful, with or without a sedative adjuvant.

surgeon by internal and local means; at times being reduced to an amount just sufficient to glue

the lips of the meatus together, and the expectation is that it is about to disappear; when, due to some slight cause, some error of diet, some indulgence in alcoholic liquor, it returns again almost to a state of true gonorrhoea This is an universal experience; it tries the patience of the surgeon and his patient to the uttermost.

Why should this be so? Is it because the part from which the discharge comes is so far back in the urethra, that it cannot be thoroughly reached? I think not; for if so, why then do we find strictures, the result of long continued irritation from gleet, situated invariably anterior to the triangular ligament, in the spongy portion of the urethra, probably, most frequently, just at or in front of the bulb; next, not far from the meatus, and, lastly, anywhere in the urethral spongy part. Some surgeons do talk about strictures in the membranous and prostatic portion, but if they are in the membranous they are the result of some injury to the perineum, as by fall or blow, secondarily implicating the urethral canal. The prostatic portion is never truly the seat of organic stricture. Is the explanation of this chronicity to be found in believing that the urethral mucous membrane gets into such a debilitated state, that it is constantly shedding, in an imperfect state, its superficial layer on the slightest provocation? or should we agree with Prof. Otis, and look upon its continuance as an evidence of an abnormal contraction, however slight, of the urethral calibre; in other words, that "chronic urethral discharge means stricture." I cannot go as far as this last statement. I have tested a number of cases, both with olive-pointed and ordinary bougies, and found in many cases that no sign of stricture existed. It is true, I did not use Otis' urethra-meter. Perhaps some member would give his experience with that instrument However, if stricture does exist, it should be combated by appropriate means; more than this, the very passage of large-sized steel bougies in those cases in which I said I could not find evidence of stricture, were benefited by them.

Some cases are managed only by injections, and all cases are in a measure benefited by them; but they should be mild astringent ones, frequently changed.

It is probable that the truth lies as to the pathology in this debilitated state, and that the disease begins in the mucous membrane,

extends into the sub-mucous tissue, and continues there very often sufficiently long for the infiltration to become fibrous and make a stricture, while on the surface the epithelial stratum is thickened, the upper or superficial cells of this stratum are constantly dying, exfoliating and mingling with the secretion of mucus from the glands and lacunæ along the utheral tract, and this makes the discharge of chronic gleet, on this basis.

I lately noticed a paper on this, by Lecoper, of Berlin, in which he claims the method he recommends to be tried has the advantages of combining the mechanical and chemical treatments, and I propose to try it at an early date. It is as follows: nickel-plated bougies are used, slightly conical; there are six shallow grooves on them, becoming shallower near the points, before reaching which they cease. Into the grooves of these bougies he pours a paste, which hardens at the ordinary temperature of the air. He tried various forms of paste, containing as the active ingredients, iodoform, zinc, resorcin, and others, but found them all inferior to nitrate of silver; the proportion being, cacao butter, 100 parts; nitrate of silver, 11 parts; balsam of copaiba, 2 parts. He gives careful directions as to the making of this paste, laying stress on the fact, not to employ too much heat in first melting them, else the nitrate will be reduced to silver and be inefficient. After the salve has become hardened, the bougie is smoothed with any sharp-edged tool. This bougie will readily pass down the urethra. At the temperature of the body the salve melts in one minute.

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He maintains no bad effects follow; no chill or fever, or at least no more than an ordinary bougie might produce. The length of time they may be left in varies according to circumstances, but the longer it is left in the more favorable the effect on the infiltration. Improvement begins at once, and in the later stages, when there is little or no discharge from the meatus, by observing the urine in the ordinary way, the character of the discharges found in it will indicate roughly this improvement. Thus, at first, the flakes of matter will contain more pus and fewer epithelial cells; as improvement goes on, the epithelial cells increase in number and the pus cells decrease, until a few only (embedded in the epithelial cells) are seen. It is of course no new idea to employ bougies in these cases, covered with simple salve, or even covered

with a paste which dissolves at the temperature of the body; but in the manner just described, there is to my mind a most happy combination of the chemical and mechanical.

PROSTATORRHOEA, SPERMATORRHOEA. When several glands discharge their own peculiar secretion into a common cloaca or outlet, it is not easy to say how far the discharge from such common outlet is simple or compound in character, and if compound, to what extent. This difficulty supplies one reason why urethral discharges, other than gonorrhoea, have long been the chosen field of the empiric and the quack. With a proportion, usually very small, of truth to back them up, they delight to paint in connection with such discharges, a picture of misery and woe, the dark coloring of which has done a vast amount of injury, bodily and mental, to multitudes. This dates as far back as the time of Lallemand and his followers, the consequences of whose ill-judged writings are still every day apparent.

Prostatorrhoea as a separate and distinct discharge from the prostate gland, was first described by Dr. S. W. Gross, of Philadelphia; previously, all involuntary discharges were regarded as seminal, and even now writers appear to differ in opinion as to the nature of this discharge. It may be defined as a discharge of clear glairy mucus from the prostate, especially after the bowels or bladder relieve themselves, and more so, if straining efforts have been made. It appears probable that the discharge comes from the acini or ducts of the prostate, over-distended with fluid, due to anything which is likely to produce a determination of blood to the pelvic organs; for example, affections of the rectum, much riding on horseback, masturbation, gonorrhea. It exists sometimes with or without inflammation of the prostate. Let me give the particulars of one case as an example.

E., single; at the age of 20 had gonorrhoea, and again at 22. It was not until some years after, that he noticed first a discharge of tenacious matter during defecation. General health fairly good. Examination of the discharge was frequently made with the microscope, probably fifty times, but nothing was found except a few columnar and squamous epithelial cells, and on two or three occasions only spermatozoa. The facts pointing to a prostatorrhea, a large-sized bougie was passed;

no stricture was made out, but no apparent benefit followed. It was then passed and left in for about five minutes; within twenty-four hours there was sense of weight and pain in the perineum, sense of fulness and desire to empty the bowel, an indication that a certain amount of prostatic inflammation had been set up. This completely and readily subsided, but the discharge still continued, and the urine showed filiform muco-purulent casts of the follicles and ducts. After a time injection was tried, with a Gross' syringe and solution of nitrate of silver. It produced no pain, only a feeling of warmth; this was repeated on three occasions, at a week's interval; the discharge at once began to lessen, and by the end of a month or so a discharge which had existed for years was completely cured. This patient also had intermittent phosphaturia, great headache at short intervals, and general debility. He has much improved in all these respects since. Tonics were administered liberally, especially iron and nux vomica.

This case serves well to illustrate this disease. It followed irritation at another part of the urethral tract. It showed little tendency to self-cure. Its nature, by the use of the microscope, was readily diagnosed. The treatment was completely successful. I could cite numerous other examples, but my purpose is served if I have shown the necessity for an accurate diagnosis, and the result of certain manner of treatment.

Spermatorrhoea, the escape of seminal fluid, is the last urethral discharge I would briefly mention. In its strict meaning, it is a slight flow of semen, more or less continuous, from the urethra, without any specific sensation, or during an excitation or defecation; but generally it is understood to embrace-nocturnal emissions during sleep, and diurnal pollutions which take place when the patient is awake, and which are excited by slight mechanical or psychical causes, and usually the erection is incomplete and the sensation diminished. The first class, or involuntary nocturnal seminal discharges, is one variety of this affection; this frequently is but an expression of vigorous health, not feebleness or disease, provided they occur in men living a strictly continent life, and do not recur with too great frequency. They require only that the person be informed that they need give him no concern; but when they occur frequently, and are followed by depression, more or less mental

and bodily lassitude, they are becoming abnormal or pathological, and require judicious treatment. The local causes leading to spermatorrhea are most frequently hyperæsthesia and chronic inflammation of the prostatic urethra, induced by masturbation, gonorrhoea, sexual excesses, and the like. But it is chiefly in the direction of treatment that I would direct attention. It is very wise in these cases to lay down strict hygienic and moral rules for the patient. Thus, avoidance of all alcohol; light, simple, nutritious diet. Direct him to empty his bladder the last thing at night, and as early in the morning as possible. Riding on horseback or over very rough roads is not advisable. The mind and body should be given sufficient exercise, to keep the thoughts away from the subject. Habitual constipation is often met with, and requires close attention. Medicinally, bromide of potash is indicated. But chiefly, remove any reflex source

of irritation.

If there is an elongated prepuce, with or without phimosis, circumcision is to be performed; in one troublesome case, I found this act most speedily. If the rectum contains any irritation, it should be at once remedied--as external and internal piles, or fissure of the anus. The over-sensitive or chron

ically inflamed urethra, as in the cases of prostatorrhoea, is best met be the passage of the sound, and the injection of nitrate of silver.

ON THE NECESSITY FOR A MODIFICATION OF CERTAIN PHYSIOLOGICAL DOCTRINES REGARDING THE INTERRELATIONS OF NERVE AND MUSCLE.

BY THOMAS W. POOLE, M.D., LINDSAY, ONT.*

OBJECTIONS TO THIS THEORY.

a

1. It has been objected to this theory that " muscle can contract when irritation is directly applied without the intervention of nerves." Now, I am not in the least disposed, or obliged, to dispute this assertion, for reasons which will appear later on. My thesis has much to gain, and nothing to lose, by the fullest admission of the independent irritability of muscular tissue. But it is exceedingly difficult, if not at present impossible, to say when a still irritable muscle has been de

* Read before the Physiological Section of the Ninth International Medical Congress, held in Washington, September, 1887.

Cer

prived of "the intervention of its nerves." tainly such is not the case in the experiments edited by Dr. M. Foster, in the Hand-book here tofore referred to, where the experimenter, in order to produce the ideo-muscular contraction, is to choose "a muscle which has been much exhausted by treatment or by long removal from the body," and to "wait till neither muscles nor nerve give any ordinary contraction with an electric stimulus." It cannot be held to be proven that in such a nerve-muscle there is not still remaining a force in the weakened nerve sufficient to contro the equally weakened muscle.

CURARE AND THE MOTOR NERVE ENDINGS.

2. It has also been objected that, while the motor nerve endings are paralyzed by curare, the muscle does not contract, as it ought to do if this theory were correct. To this I have to reply, that if the muscles are not found contracted it is partly due to the insufficiency of the poisoning of the motor nerves, and partly to the fact that curare diminishes the contractile energy of the muscle (a). Nicotine and conine act precisely like curare (6), and in the final action of these three poisons, motor nerve paralysis and spasm, or convulsions of the muscles, occupy a prominent place. (Ringer). The special results vary, of course, in different animals. Nicotia sometimes acts like an anæsthetic (c); and the same is doubtless true of the others. Now, anæsthetics induce muscular relaxation by deoxydizing the blood; and nicotine is known to disorganize the red corpuscles which are the oxygen carriers. It is doubtless in this way that, under the slow action of these poisons, muscular relaxation is brought about. If death be rapidly produced by curare, convulsions occur (d). Here the motor nerves are paralyzed before time has been afforded for the poison to lower the irritability of the muscle, which passes into tonic or clonic spasms according to its freedom, thus behaving as it "ought” to do. Is not this a sufficient answer to the objection?

But more remains to be said. The experiments with curare are not so conclusive as to be beyond the reach of criticism. They were intended to

(a) Rosenthal, Muscles, etc., p. 254. (b) Ib., p. 253.

(c) Stille and Maisch, p. 372. (d) Stille and Maisch.

prove the independent irritability of muscle, which is now generally an accepted fact among physiologists. M. Rosenthal asserts that these experiments (and those of Kuhne upon the sartorious muscle), do not prove this; which is equivalent to stating that it is not proved that curare paralyzes the motor nerve endings.

More direct evidence upon this point is that of Dr. Onimus, who, not long ago, "read a paper before the Academy of Medicine, Paris, upon electro-muscular contractility and the action of curare. Contrary to the opinion of M. Claude Bernard, Dr. Oninus believed that curare does not act on all parts of the motor nerves, but only on their trunks; the nerve centres and terminal filaments being unaffected" (a).

In view of these authoritative opinions (and doubtless of others to which I have not access), it is evident that this objection falls to the ground and loses the weight which otherwise might attach to

it.

But suppose it were established beyond doubt that the influence of the nerve were completely eliminated from the muscle in any case, and that the contractile protoplasmic masses of muscle were left wholly to themselves, and their life being not yet extinct, that they gave token of that still flickering life when comparatively rudely assailed by a shock of electricity or a corrosive or injurious agent, what then? Such signs of irritability, elicited under such circumstances, would not militate against my thesis; for such would be the behaviour to be expected from still living protoplasm, wherever found, and would in no way disprove the contention that in the association of nerve and muscle in the organism the role of the nerve is to restrain or control the protoplasmic energy of the muscle so long as their mutual relations continue. For, after all," the contraction of muscular tissue is, in fact, a limited and definite amœboid movement, in which intensity and rapidity are gained at the expense of variety" (b).

Indeed, I think the rational view of the situation just depicted, turns the argument the other way; and tends to show that in the joint role of nerve and muscle the function of the nerve is not to goad or stimulate the muscle to contract. To suppose this is to assign to nerve energy the re

(a) Dr. M. Foster, Phys., p. 63.
(b) N.Y. Med. Record, 1880, p. 73.

lative value of the fifth wheel in the coach. Such enduring power of contractility as the muscle here exhibits evidently needs no supplementary aid from the nerve. What it really does need, however, is restraint, control and co-ordination for the purposes of the organization of which it is a part.

OTHER OBJECTIONS.

A further objection has been suggested, on the ground that on a nervous impulse reaching a muscle, an electric current is generated during the period immediately preceding the contraction of the muscle; but this is an objection which is only of any force on the assumption that electricity is a stimulant. There is nothing in the action taking place here to show that the electric current is a stimulant rather than a paralyzer. There is simply a "freeing of the forces in the muscle," just as the spark of electricity frees the forces bound up in gunpowder, and so fires the train (c).

As for the additional plea that nerve force and muscle force are too much alike for us to consider one a paralyzing and the other a contracting agent : that is merely begging the question. Nothing whatever is known regarding the nature of these forces; and the intimate structures of nerve and muscle are so widely different as to justify the idea that the product, so to speak, of each, is equally diverse.

This theory has been objected to as a proposed addition to the inhibitory system of the text-books. If the views here enunciated This is a mistake. were adopted, the huge incubus of the present inhibitory hypothesis could be in great part swept. away, to the great advantage both of physiology and therapeutics.

If it be claimed that on the cutting of the spinal cord or of a nerve trunk, the "irritation" set up at the point of cutting, or the generation of electrical current as the result of chemical change in the transverse section, act as a stimulus, and the contraction of the corresponding muscle is thus produced, such a claim must be regarded as untenable for the following reason:-The acts just referred to cannot be stimulating acts, because they are attended by precisely similar effects as are produced in the muscle by death from any cause, in which condition, it is needless to say nervous activity is not increas d. The proof of

(c) Rosenthal, p. 250.