The extension of the habitat as to tissues, of Neisser's gonococcus is a matter of frequent note in the current literature of this subject. I have quite recently observed some things which lead me to think that its emigration from the urethra by whatever means conjectured may be commoner than it is at present admitted. In a rather severe case, in which the meatus urinarius measured 12 French, all of the unpleasant initial symptoms had subsided under treatment and the discharge had much decreased when somewhat extensive oedema of the prepuce came on suddenly near the end of the second week. It continued, in spite of evaporating lotions and multiple punctures; and patches of brawny infiltration of the skin and subcutaneous tissues were observed alongside the urethra and on the dorsum, both near the glans after a day of unusual activity. Very soon a minute spot in the skin near the frænum necrosed, and a small quantity of pus was discharged, nearly one-fourth of whose corpuscles contained gonococci. The same thing occurred in the swelling on the dorsum, the evacuation taking place through an opening near the free border of the prepuce in the middle line. The amount of the discharge in each case was very trifling, and the openings, neither so large as a crow's quill, closed without active treatment in three days, leaving a little infiltration. I do not think that either of these minute abscesses had a direct connection with the urethra through a breach in its walls; the position of one of them renders this fact certainly very improbable. So, when one reflects upon the sudden accession of oedema, which I have seen in a good many cases, in which it was explained away by the constriction of the dressings, by excessive exercise, and by causæ non cause of the most utterly diverse natures, it will suggest itself that this oedema is most probably the resultant of the activity of vital forces too com. plex to be accounted for by simple irritation or by mechanical congestion. In a case in process of "ripening" some years ago I saw several square inches of the skin upon the inner surface of the thigh almost entirely denuded of its cuticle and deeply inflamed from the constant presence of pus upon its surface. It was not determined here whether this was chemical irritation di rectly by the ichor of the pus or the result of specificaction of the micro-organisms in it upon the epidermic tissues. There are undoubtedly some individuals, whose tissues appear to invite this organism to make the most extended excursions, and facts at present grouped under the comprehensive labels predisposition and immunity await the inquiries of genius. U. S. Coast Defense Vessel "Monterey," San Diego, Cal., April 15, 1894. CHLOROFORM ANESTHESIA.* BY Q. C. SMITH, M.D., AUSTIN, TEXAS. Every surgeon and physician is painfully aware that the great burden of anxiety, in a large majority of surgical operations, is to produce and maintain safe and pleasant surgical anæsthesia. The prominence of this well-known fact, and the controversy and want of agreement concerning the comparative and actual safety of chloroform anesthesia, and the proper method of its administration, that has been waged incessantly for many years, by surgeons in different parts of the world; and the transcendant importance of this subject is the writer's excuse for again coming before his fellows in reference thereto. That fashion-the stinging whip with which vain shallowpated Mrs. Grundy so imperiously and mercilessly lashes the so-called enlightened world-has much to do in controlling the practice of medicine and surgery no one can dispute. Hence, some eminent surgeons tell us that in former years they used chloroform anesthesia in many thousands of cases without bad results; but now use ether in deference to public opinion. Then, indeed, may we welcome light on this vastly important subject, even from the so-called "benighted heathen" of a distant clime, whose enlightened magnificent liberality in advancing life-saving science, has forced some of our distinguished but prejudiced countrymen to, in some degree, acknowledge the error of their way. And it is most fortunate indeed that sur *Read before the Texas State Medical Association, April, 1894, at Austin, Texas, geons have been divided in opinion as to the comparative safety of different anæsthetics; that the advocates of no one anæsthetic have been sufficiently powerful to cause their favorite to be legally recognized as the anaesthetic which surgeons must use in order to acquit themselves of criminality in cases of deplorable accident or fatality occurring in connection with anaesthetics. But this reprehensible, we may say contemptible, aggressive, domineering, presumptious spirit, manifested by misguided zealots, who would smirch the white robes of Science with the dirty fingers of the law, has doubtless hastened and energized the labors of those who believe, and have proved, chloroform to be a valuable, if not the most desirable, general anesthetic now known in a majority of cases requiring prolonged full surgical anesthesia. So, out of evil has come great good. One salutary and far-reaching beneficial result of the arbitary presumptiousness of those who advocate that chloroform be debarred, and its users made criminally liable, has been to bring chloroform prominently before an international court, the distinguished judges and investigators of which are not confined to, or can be controlled by any party, country, corner or. clique. And chloroform is, and should so remain, before a still higher court of appeals-the great body of close-observing, sagacious private clinicians throughout the world. And from these-not laboratories the independent, liberty-loving, practical-private workers in the healing art should and must come the final verdict in reference to the real or comparative value of remedial means, measures or agents. It is plain to any close observer that the questions of the real or comparative safety of chloroform anesthesia cannot now be correctly estimated or answered, much less permanently "settled or established," by the statistics now available, however large, widely gathered or complete; owing mainly to the improper method by which this anesthetic has been and is still often administered. But, if we must "answer cudgel with stave," we may be permitted to say we have gathered and aggregated the statistics of, twelve general operating surgeons, of different countries, whose combined number of chloroform anæsthesias is about 300,000, without a single death in all their experience up to date. So, when we consider that such a number of eminently capable operators, of different countries, climates and races, have administered chloroform anesthesia with such uniform success, in such an immense number of cases, to all sorts, conditions and ages of patients that come unselected to a general surgeon's care, in private and hospital practice, we are irresistably driven to the assuring conclusion that there must be some known method of administering chloroform anesthesia that is, at least, almost safe. For many years, we have gathered and carefully studied a large amount of current and standard literature, published in various parts of the world, in reference to the questions germane to the subject of chloroform anæsthesia, and now desire to give, as briefly as we may, the practical essence of our conclusions and limited experience, leaving out most of the whys and wherefores, many of which are very interesting and instructive to investigate, but the discussion of which would consume more time and space than the present occasion will allow. If circumstances permit, patients for chloroform anæsthesia, especially in major operations, should be well prepared by several days' previous careful constitutional treatment, that all the organs of assimilation, secretion and excretion may be caused to functionate as well as possible. Part of this preparatory treatment should be two to four drops liquor sodii arseniatis, three times a day, just after meals, to strengthen the cardiac and respiratory functions and aid in wound healing. The bowels should be thoroughly evacuated twice per diem for several days before an operation, especially if it be a laparotomy. Patients should take small, easily-digested meals for at least forty-eight hours before anesthesia; and, for five to seven hours before anæsthesia, no food except a cup of hot soup, or hot milk mixed with coffee, two hours before anæsthesia. In this class of patients-capital operations--always at least several days before anæsthesia, the condition and functionation of the lungs, heart and kidneys should be carefully ascertained; but no such examinations should be made for twenty-four hours before anæsthesia, or anything else done or said at any time that tends to cause the patient to doubt the safety of anesthesia. For many, even sound persons imagine their hearts, lungs, or PIL. CHALYBEATE COMP. (WM. R. WARNER & CO.) Same as Pil. Chalybeate, with % grain Ext. Nux Vomica added to each pill to increase the tonic effect. Dose, 1 to 3 Pills. PIL. DIGESTIVA. A VALUABLE AID TO DIGESTION. B-Pepsin Conc' .I gr. Gingerine.. .1-16 gr. Pulv Nux Vom. gr. Sulphur........ .. gr. This combination is very useful in relieving various forms of Dyspepsia and Indigestion, and will afford permanent benefit in cases of enfeebled digestion, where the gastric juices are not properly secreted. As a dinner pill, Pil. Digestiva is unequalled, and may be taken in doses of a single pill either before or after eating. PIL. ANTISEPTIC. Sulphite Soda.. ... gr. Ext. Nux Vomica.. gr. Pil. Antiseptic is prescribed with great advantage in cases of Dyspepsia attended with acid stomach and enfeebled digestion, following excessive indulgence in eating or drinking. It is used with advantage in Rheumatism. PIL. ANTISEPTIC COMP. (WM. R. WARNER & CO.) Each pill contains Sulphite Soda.......1 gr. Powd Capsicum..1.10 gr. Pil. Antiseptic Comp. is prescribed with great advantages in cases of Dyspepsia, Indigestion and Malassimilation of food. PIL. ALOIN, BELLADONNA INGLUVIN A POTENT AND RELIABLE REMEDY FOR THE CURE OF MARASMUS, CHOLERA INFANTUM, INDIGESTION, DYSPEPSIA and SICK STOMACH, caused from debility of that organ. It is superior to the Pepsin preparations, since it acts with more certainty, and effects cures where they fail. A Specific for Vomiting in Pregnancy, In doses of 10 to 20 grains. |