Malignant New Growths of the Skin are treated by of State upon application of the Secretary of the Board John T. Bowen, of Boston. The Volume is concluded by a chapter on Malignant Diseases of the Female Organs of Generation, by Edw. McGuire, of Richmond, Va. The same high standard of excellence which characterized all preceding volumes is also maintained in Vol. ume XVII. The Practice of Obstetrics: By American Authors. Edited by CHARLES JEWETT, MD, Professor of Obstetrics in Long Island College Hos. pital, Brooklyn, N. Y. In one handsome octavo volume of 763 pages, with 441 engravings in colors and black, and 22 full-page colored plates. Price, cloth $5.00, net; leather $6 00, net. [Philadelphia and New York: Lea Brothers & Co.] of Health when supported by satifactory evidence that the school has violated any of its provisions in this regard. A clause will be incorporated fixing a penalty for violations of the act. Medical Society of City Hospital Alumni, Throat Infection with Subsequent Involvement of DR. JOHN P. BRYSON: Report of Two Cases which have Sustained the Bottini Operation-Presentation of a Prostate (and bladder) which has Undergone the Bottini Incision. Dr. L. BREMER: A Contribution to the Morbid Anat. omy of Paretic Dementia. FRANCIS REDER, PA J. HEUER, Committee This volume is a clear and practical treatise suited to the needs of medical students, and a concise and comprehensive guide to the practitioner and teacher of medicine. The work covers the whole subject of obstetrics and cognate branches in a concise form as un derstood and practiced by authorities on the subject. The arrangement of chapters is a most practical and rational one. The work includes a singularly rich series St. Louis Medical Society Programme.of engravings and plates in black and color which by The scientific programme announced for the meeting to elucidating the text is of special value in the particular be held Saturday evening, February 4, 1899, is as follows: branch of which the volume treats. The entire external makeup of the work-paper, print and binding, harmonize with its general excellence. NOTES AND ITEMS St. Louis Mortuary Report.-The death rate was decreased during the week ending January 28, over that of the previous four or five weeks during the prevalence of grip and pneumonia. The number of death certificates issued last week was 196. This was 63 less than during the previous week, but 53 more than for the corresponding week of 1898. Twenty five deaths resulted from pneumonia, 21 from consumption, 14 from old age, 2 from surgical operations, 2 from suicide, 1 from homicide, and 5 from accident. The births re ported last week numbered 246. Death of Dr. W. M. Callo.-Dr. W. M. Callo, of Decatur, Ill., was killed January 27, by being caught between two freight cars. He was at Assumption, Ill., holding a consultation with Dr. Holt. He was trying to cross the track to board a passenger train to go home when crushed to death. He was well known all over Central Illinois, and was one of the best physicians in Decatur; was 40 years old and a native of Canada. He leaves a wife and two children. A Curious Case for Forensic Medicine.According to the Gazette Modicale de Paris for Decem. Medical Diplomas in Illinois.-The Illinois ber 17, Prof. Lacassagne recently examined at Lyons State Board of Health will prepare a bill to be intro- the cadaver of a man taken from the river Saône whose duced as a substitute for the Rogers College degree bill trunk was surrounded by an enormous serpent. The introduced by Representative Curtis. The provisions cadaver was mummified, and it was thought must have of the substitute will be very simple, and will apply been at least two years entombed. A professional only to medical colleges or schools. It will provide naturalist stated that the serpent was a boa of Senegal. that no school or college of medicine shall grant a It had not been dead more than a month at the outside. diploma in medicine or surgery unless sanctioned by M. Lacassagne thinks that the corpse was probably that the State Board of Health, and that the charter of the of a suicide which, for some reason or another, had been institution may be declared forfeited by the Secretary retained at the bottom of the water for a long time until it was brought to the surface by a swell. By mere chance the boa, thrown probably into the Saône by the proprietors of some traveling menagerie, must have en countered the cadaver. The affair has caused consider able interest, attracting crowds to the morgue.-N. Y. Medical Jonrnal. Gouty Angina.-Dr. R. Le Clerc (Normandie Medicale; N. Y. Med. Jour.) concludes a paper based on the observation of six cases in which pharyngeal manifestations preceded an attack of gout, and disappeared when the articular phenomena appeared, as follows. 1. There is such a thing as gouty angina. night's rest,' or, 'these will remove your headache.' And the remarkable thing is that they do. In fact, with bread-pills the medical man can produce quite a variety of effects."-Medical Record. Charities of New York State.-From an Albany (N.Y.) clipping we learn that the inmates and . other beneficiaries of the institutions, societies and associations included within the jurisdiction of the State Board of Charities, aggregate over 2,500,000 and the expense of their maintenance amounts to nearly $22,000,000 annually. The following statistics show the number and classification of beneficiaries in institutions subject to the supervision of the Board, October 2. This term should be applied only to such cases as 1, 1898: Aged and friendless persons, 6,627; almshouse are premonitory to an access of gout. 3. This angina is characterized in general by an intense congestion with edema, occupying the velum palati and even the laryngeal vestibulum. inmates, 11,788; dependent children, 31,090; disabled 4. The description of this angina corresponds to 6. It is not amenable to any special treatment, save to such derivative measures as may tend to hasten the articular determination, and in this it resembles rheumatic angina, which is not ameliorated by salicylate of sodium. Non-Virulence of Dust in Military Barracks.-Kelsch (Bull. de l'Acad. de Med.; Jour. Amer. Med. Ass'n) has renewed his experimental inoculations with dust taken from barrack floors, and on the surface and neighborhood of cuspidors. He reports that not a single guinea pig out of 122 thus inoculated showed the slightest trace of tuberculous lesion; 58 are in per. fect health to day, the rest succumbed to encysted peritonitis or septic phlegmasia, with the exception of 12, which were killed in the search for tuberculous lesions. Another series of 91 animals was inoculated with mucus from the nasal passages. Only one died of an acute generalized tuberculous infection, and this one had been inoculated from a vigorous cuirassier in perfect health; 41 died of acute peritoneal phlegmasia; 77 are still apparently well. The Microbe of Vaccinia.-The London papers state that Mr. Stanley Kent, of St. Thomas' Hos. pital, who has been working at vaccinia since 1893, has succeeded in discovering the specific organism upon which it depends. He has further prepared pure cult. ures of the germs, and has used them for vaccination. The discovery, it is contended, while being of high scientific interest, is of more importance from a prac. tical point of view, as the possibility of using pure culture for vaccination disposes of the chief argument of the antivaccinator, viz., that disease may be communi. cated to the children vaccinated by the use of impure-In the February number of this excellent periodical American Monthly Review of Reviews. lymph.-Medical Record. Bogus Medicines That Cure.-An English lay journal says: "A curious proof of the influence of imagination is the little trick so often practiced by doctors on their patients. In some diseases medicine is not only useless, but actually injurious. Yet when a man is paying money for medical attendance he expects to see some sign that he is getting value in the shape of bottles and pill-boxes. The doctor in that case has no option but to deceive. In typhoid fever, for instance, no known drug is of any use. The microbe must be left to tire himself out. But to please his patient the knowing doctor always prescribes a bottle of colored water. It is called a 'placebo.' In other cases it is usual to give bread pills. There are many extremely nervous people to whom any kind of medicine would do harm. So the doctor gives them a couple good sized bread pills, and says: These will give you a sound the editor seeks to apply the lessons of our National failures in the South during the reconstruction period following the Civil War to the present problems of a similar nature in Cuba, Porto Rico, and the Philipines. His deductions are interesting and instructive. He says: "The true way to restore the South to the Union after the war was to restore the South to its own people." The same principle applies to-day in the new territories just coming under our control. The editor warns us against a new type of "carpet-bagger" who is threaten. ing to invade Cuba-namely, the franchise.grabber. A large proportion of space in this number of the Review is given up to editorial and contributed articles on the management of foreign dependencies. Sylvester Baxter contributes an interesting study of the Dutch rule in Java, and Dr. Danial Dorchester makes a statistical ex· hibit of the recent drift toward colonial and protector. ate governments. PUBLISHERS DEPARTMENT also are sending out half tone illustrations of photo. micrographs contrasting the crystalline talcum with the truly impalpable Palvola. Drop them a postal, men. An Old Established Theory Disputed.- tion the MEDICAL REVIEW. The following letter from Dr. John H. Baer, Chief Sur. The Dios Chemical Co., of St. Louis, Mo., geon Philadelphia Eye, Ear, Nose and Throat Infirmary, are determined to stop the nefarious business of substi disposes of the theory of cellular growth. He writes as tuting their two products, Dioviburnia and Neurosine. follows: "I wish to tell you what remarkable work Physicians recognize the therapeutic value of these pro Unguentine did for me in a case just dismissed. Eight ducts in the class of cases in which they are indicated, weeks ago a young girl, daughter of one of our promi and whereas this Company caters exclusively to the nent men in this city, was playing with matches. Her profession, we believe it is due that the physicians codress caught fire and she was frightfully burned, the operate in stopping substitution, and if they will report extent of the burn being faom the ninth rib to the axilla, to the Dios Chemical Company such druggists as atand from the axilla to the elbow. I kept Unguentine tempt substituting their products it will be considered on as a dressing and the result was not a scar to show strictly confidential and their names will in no wise be of the great area of burned skin and flesh. It is creat mention. We trust the patrons of this journal will co ing quite a talk amongst the physicians here as it over- operate, not only in protecting the manufacturer, but throws our theory of cellular growth. These unusual themselves as well. results obtained by the ointment are contrary to our teaching that no integument can be destroyed by any means and re formed without eschar tissue. Tourist Sleeping Car to California through, without change, via the Iron Mountain Route, leaves St. Louis every Friday. Upbraiding the Doctor.-Dr. Samuel Wolf, Physician to the Philadelphia Hospital, and Neurolo. gist to the Samaritan Hospital of Philadelphia, presents among others, a case which is of special value at this time. He says: "The entire experience of the writer with Antikamnia is not confined to the series of cases on which this paper is based, although its previous use had been limited to a few prescriptions, and those in cases where it was given after the usual routine had been exhausted. It is, however, to a striking result in one of these instances, that the incentive to investigate more fully, is to be largely attributed. A man, aged 42 years, in the course of an attack of la grippe, was en during extreme torture from the pain of a trigeminal neuralgia. The second 10 grain dose of Antikamnia gave such complete and permanent relief, that my pa tient, a druggist of large experience, upbraidingly asked me, "Why didn't you prescribe this remedy before?" Send to Max Wocher & Son, of Cincinnati, Ohio, for a defcriptive catalogue of the Combination Surgeons' Sterilizers-for gauze, instruments and water. Size: 15 inches long by 8 inches high. Price, $11.50. Well Known-Well Liked.-The other day, the superintendent of one of the largest city hospitals in this country, said to a representative of The Imperial Granum Company, the manufacturers of that reliable dietetic preparation, Imperial Granum: "It is not neces sary for your firm to send any one here to tell me about their product for I have used it both in private and hostal practice for over twenty five years, and can hardly believe that even the youngest members of the medical profession do not know of the merits of this well known and well liked food for individuals and convalescents." "We Believe," says The New York Polyclinic "that as a rule, leucorrhea is not well treated, therefore we make no apology for alluding to the treatment of so common an affectio.n Unless the vaginal flow be of in tra-uterine origin, we know of no other means so simple and yet so effectual as the use of Pulv. Antiseptic Comp. -Tyree's. It is in every way preferable to all the usual remedies used, many of which stain and are otherwise objectionable. The quality of endorsements given to this preparation are such as to stamp it as an article of unquestionable merit for the various forms of leucor. rhea. Scarcely an article on this subject is being writ ten or discussed in the medical societies but what reference is made to this preparation. Surely this is a commendable sign." Medical Review Visiting List for 1899 now ready. Price, 75c. postpaid. Send for it. To California.-The Pacific Coast Limited leaves St. Louis every Tuesday and Saturday at 8:00 P.M., vis the Iron Mountain Route, Texas & Pacific and Southern Pacific Railways. A train without an equal. Buffet, barbers shop, bath room, libraries, etc., on the train, and a most superior dining car service. The Palvola Chemical Co., of New York, have opened up a new era in the therapeutics of exter nul medication. Their little brochure on "Dolomol Compounds in Dermatology, Syphilography, etc." is a dignified, scientific presentation of the subject of dry treatment of diseases of the skin, and its therapeutic in dex is a comprehensive guide to the solution of many vexed questions in the treatment of many cases that come to the attention of the general practitioner. They ana, New Mexico and Mexico. Winter Tourist Rates via the Iron Mountain Route now in effect to principal points in Texas, Louisi MEDICAL REVIEW VOL. XXXIX. A Weekly Journal of Medicine and Surgery. ST. LOUIS, MO., FEBRUARY 11, 1899. ORIGINAL ARTICLES Conservative, Yet Effectual Treatment of cision, Done Through the Urethra; Incisor.1 BY BRANSFord Lewis, M. D., 8T. Louis, Genito-Urinary Surgeon to Baptist Hospital; Consultant in Genito- The treatment of hypertrophied prostate with obstruction has been divided into the palliative and the radical or operative plans. The former, during the many years that the profession has been working on the subject, has embraced pretty nearly everything under the sun that could be applied to the patient or his prostate, either externally or internally, that gave any promise whatever of exercising an alterative or reducing ef. fect on the enlarged gland; while the operative plan, after having been sifted through numberless illusory, though often alluring procedures, of late years has been practically reduced to three modes that have been widely recognized by the profession; they are prostatectomy, castration, and vasectomy. These methods have now been on trial for a sufficient length of time to justify some definite conclusions as to their merits. NO. 6. knows the marked danger of giving them either chlo roform or ether. He knows, in the first place, that such patients are the subject of backward urine-pressure on account of the obstruction; which backward pressure has been in effect for months or years before medical assistance is sought; and which has, in the meantime, in a very large proportion of cases, already involved the kidney-pelves in chronic suppuration. So that, aside from any danger coming from prostatectomy it. self, a serious danger threatens from the anesthesia which makes the operation possible. But when we remember that to this danger, in an aged individual, usually already debilitated from the various effects of the disease, in doing prostatectomy we open up the bladder, make entrances for infections, cause hemorrhage sometimes very severe, institute drainage that is never free from objectionable features, often accompanied by leakage, wetting of clothes, etc., even if it is fortunate enough to drain the bladder ef. fectually. Considering these various conditions that are inseparable from this operation, it is no wonder that it has a mortality of from 15 to 20 per cent; and no wonder, also, that the medical world hailed with delight the proposal of another operation, a few years ago, that, it was at first thought, would answer the purpose of prostatectomy without entailing its dangers. Castration was that operation; and from the strong theoretical considerations backing it, as well as the nu merous cases of apparent relief or cure reported, it gave promise of being a great acquisition in the surgery of the prostate. Later, when the simple operation of vasectomy was proposed as a substitute for even the mild operation of castration, it was considered that almost the acme of surgical simplicity had been reached in this connection. But a few years' collective investigation has taught the profession that very little can be expected from these two procedures; that though their mortality is Prostatectomy, consisting in the removal of the pros-only 7 or 8 per cent, their promise of cure is so small tatic tissue to re establish the urinary channel, whether as to furnish very little temptation to the man to sacriit be done through the perineum or by suprapubic in- fice his testicles or his sexual ability. cision, or both combined, must be done with the patient under general anesthesia-chloroform or ether; and everyone who has had such cases under observation 'Read by invitation at the twenty-fourth semi-annual meeting of the Southern Illinois Medical Association, held in Cairo, Illinois, November 17 and 18, 1898. So that, until the advantages of the electro-incision operation were made known to the profession, the choice in the radical treatment of prostatic hypertrophy has lain between prostatectomy with its dangers, and castration or vasectomy (ligation of vasa deferentia, with removal of a portion of the tubes), with their small hope of relief and their attendant sexual mutilation. However small this last consideration may be theoretically or from the medical standpoint, it is of large import from the patient's standpoint. A B So the choice has not been an inviting one. F G C A. Trido-platinum blad · C, Handle. D. Water-cooling tubes. F. For battery-attachm't. operating at the office, where the direct current is made, the only converter that has proved equal to the demands was that furnished by the Wilbrandt Surgical Instrument Company. The technique of the operation is, briefly, as follows: After a cystoscopic examination to determine the lo cation of the obstructing prostatic overgrowth, the bladder is emptied as completely as possible. A halfdram or more of four per cent cocaine solution is introduced by means of a deep urethral syringe into the prostatic urethra and vesical neck. While awaiting the five minutes allowed for cocainization, a final test of the electro-incisor is made. The blade is brought to a cherry red glow and the current is shut off by opening the switch of the converter. The connecting screw on the incisor should not be used for this purpose as it works too slowly for such a strong current as is necessary. The water-cooling stream working perfectly under an Later still, Freudenberg, of Ber-assistant's charge, the incisor is introduced into the lin, simplified the mechanism of the bladder. As it enters the bladder its beak is naturally instrument and made it sterilizable turned upward. The obstruction is, in the great maby boiling. It is this latter instru- jority of such cases, located at the floor of the vesical ment that I present to you now. neck-the so-called third lobe. This, then, is the prinNotwithstanding the fact that cipal point of attack. The instrument is turned within Bottini did his best to keep the pro the bladder so that the blade points downward; the fession informed of the progress of beak is thereby hooked over the prostatic bar or third his work by regular and numerous lobe and is drawn forward, so as to tightly hug that reports in the medical press, it is part of the organ. While it is being held in this posionly in the last few years that the tion with the right hand, the left forefinger is intro. profession has given the subject the duced into the rectum and feels for the point of the incisor through the posterior wall of the bladder. This maneuver tells much with regard to the thickness of the obstructing part and the extent of incision needed, as well as of the proper adjustment of the incisor. The finger is then withdrawn, to prevent any disarrangement of that adjustment. The assistant turns on the current and the cautery-incision is slowly carried forward through the obstructing bar or nodule. Time given for the advance of the blade insures the thorough searing of the wound surfaces and wards against hemorrhage. Bleeding is practically nil-the most that I have seen being merely a slight tinging of the first fluid coming from the bladder after operation. attention it deserves. Bottini has operated upon 80 ca. ses, with only two deaths; and in those that obtained relief, there has been no recurrence. That is, to put it statistically, a mortality of 2 per cent. As you see, the Freudenberg Bot tini incisor is shaped somewhat like a lithotrite, having a handle, staff and base for electrical attachment, with a wheel to control the play back and forth of the irido-platinum cautery-blade that slides in the groove of the staff. The latter 18 tunneled for the passage of ice wa ter up and back through it, for cool ing purposes. The effect desired is that of a cauterizing incision, not electrolysis; consequently the blade must be red hot to produce that effect. An ordinary battery will not suffice. I have been using the ordinary alternating street current of electricity, modified by an Aloe's converter; or, if 2 "Galvani," 1874, tome x; La galvano-caustica nella practica chirurgica, Milan, 1876; Arch. f. klin. Chirurgie, Vol. xxi, 1877, and Vol. liv, 1897, Heft 1; and La Clinica Chirurgica, July 31, 1896. Since it often occurs that the obstructing outgrowth assumes the shape of a collar around the urethro-vesical opening, it is advised to make more than one incision; and the custom has been to make one incision poste riorly, one anteriorly, and one into the lateral lobe that is most enlarged. I prefer to make them posteriorly and on both sides, omitting the anterior one, as I believe obstruction seldom arises from that direction. Having completed the three incisions, the blade is returned into its niche and the current is turned off. This latter was overlooked by one operator, who began to take out the instrument with the blade red hot; the result was embarrassing, to say the least. Now comes one of the most gratifying features of this operation: The patient gets up and walks to his |