Picric Acid in the Treatment of Eczema.Picric acid has been recommended in the treatment of burns. Naturally it would be regarded as of use in the treatment of inflammations of the skin. As early as 1896, McLennan drew atten tion to the value of picric acid in the treatment of inflammatory disorders of the skin. In his method the raw surface is freely painted over every morning and evening for three or four days in succession with a saturated watery solution. Recently Brousse and Radaeli have both reported very favorable results in the treatment of eczema. Observers generally agree that the excessive application of the drug does not cause toxic symptoms; that immediately after the application there is considerable smarting, which lasts for ten or fifteen minutes, but is usually not severe. Radaeli, before applying the picric acid, carefully cleanses the affected part with a solution of boric acid. The hair is clipped short and all dried secretions removed. The part is then carefully dried and a compress of cotton, wrung out of a saturated aqueous solution, is applied. Over this a sufficient amount of dry, absorbent cotton is placed to absorb the discharge. On the whole, the method seems to be an efficient and somewhat more simple one than most of the plans heretofore tried.

Vaginitis in Children. This troublesome disease is usually met by careful cleansing and injections of boric acid. The inefficiency of these methods is shown in the obstinacy with which the affection commonly persists. It is well to remember that where the disorder is not specific, it is frequently dependent upon constitutional condi. tions. In the treatment of the disease, strict attention to the general health, abundant exercise in the open air, and careful attention to diet, are of the utmost importance. The local treatment frequently presents considerable difficulty, and the best results are commonly reached by the use of small suppositories. The following formula for a suppository is given:'

MISCELLANY

DR. D. R. BROWER, of Chicago, it is reported, advocates the revival of the "Tarpeian Rock" punishment for criminal degenerates.

THE legislature of Minnesota is considering an examining board law, which possesses the unusual feature that no examinations are required in practice of medicine, materia medica and therapeutics.

THE Philadelphia Medical Journal complains that the anti-vivisectionists fail to alleviate or prevent the 100,000,000 vivisections performed in this country in the castration of our domestic animals.

THE following is the program for the meeting of the St. Louis Medical Society of Missouri, Saturday evening, May 6, 1899: Antitoxin, Therapeutically Useless, and Biologically Faulty," by DR. J. B. Ross; "Presentation of a Case of Scleroderma," by DR. JOSEPH GRINDON.

THE Southern Illinois Medical Association will

celebrate its silver anniversary at its twenty-fifth annual meeting at Carbondale, on May 11 and 12, 1899. A review of the progress of medicine during the twenty-five years of the society's existence will be a feature of the meeting. Dr. J. O. DeCourcey, East St. Louis, is president, and Dr. C. G. Rayhill, Belleville, is secretary.

DR. M. C. STARKLOFF has been reappointed Health Commissioner of St. Louis for a term of four years. His work as chief of the city health department for the past four years certainly merits this reward. The following other appointments were made: Superintendent of the City Hospital, Dr. H. L. Nietert; Superintendent of the Female Hospital, Dr. N. J. Hawley; Superintendent of the Insane Asylum, Dr. E. C. Runge; Superintendent of Quarantine, Dr. M. C. Woodruff; Milk Inspector, Dr. Howard Carter; City Chemist, Dr. W. C. Teichman; Members of the Board of Health, Dr. Albert Merrell and Dr. H. N. Chapman.

PROF. CHAS. ZUEBLIN, of the University of Chicago, opposes the construction of the drainage canal, which is to carry the sewage of Chicago into the Mississippi River. He says: "As a sewer the drainage canal will be a failure. Sanitary engineers anywhere but in Chicago will acknowledge it. It may take a few years to convince people here that it is a failure, but Chicago should be prepared to acknowledge it. Methods of disposing of sewage have improved since the canal was projected. So far as that purpose is concerned, we have spent $35,000,000 for nothing."

CYSTOSCOPY IN THE MALE;
Preliminary Report Upon a New Instrument.

Br T. C. WITHERSPOON, M.D., St. Louis,

Professor of Special and Clinical Surgery and Surgical Pathology in the Marion-Sims College of Medicine.

OME months ago, following out the sugges

tion made in Dr. Howard Kelly's work in

the direction of examining the female bladder with his simple speculum, I had an ordinary urethral endoscope lengthened by two inches, and began work upon the male bladder. I was fully aware that something had been done by others in the same fashion, but nothing with a creditable report as to any advantage. Feeling that there was decided need for improvement over the methods in vogue, I began to use the instrument wherever occasion called for such an examination.

In the male there are many difficulties to be overcome in the passage of a straight instrument, among the most important of which are the suspensory ligament and the prostate body. It was easy to pass through some urethras, while in others, especially those with enlarged prostates, it was impossible to use a straight instrument on account of the pain it produced and possible damage to the urethra. Another disadvantage was the withdrawal of the instrument, after the obturator had been removed, so as to get a good view of the posterior walls in the area of the uretheral openings, at the same time preventing its slipping to the extent which would allow the internal sphincter to close over its edge. The lateral pressure is quite great in the deep urethra posteriorly, especially since the speculum must be lowered so considerably to permit the posterior lower segment of the bladder to come into view.

Any attempt to push the instrument back well into the bladder cavity, after it has allowed the sphincter to close over its end, is apt to injure the neck and cause considerable pain. With the straight instrument having these disadvantages, I

YEARLY SUBSCRIPTION, $1.00 SINGLE COPIES, FIVE CENTS

was nevertheless able to see a great deal that was of service, even if there was still much to be desired. To overcome the disadvantages I had the Blees-Moore Instrument Company construct for me the instrument which I have been using since with much satisfaction. The length is nine inches, which is amply sufficient for any urethra. The last inch is given the normal curve of a sound, be

outline, varying from one-half to three-fourths of an inch in its long diameter, depending upon the size of the instrument. Looking directly through the canal, however, it appears to be as a straight tube. The obturator is so fashioned as to fill in the oval space, making the instrument completely closed at the distal end. This obturator consists of the semi-oval end-piece, a strong slender shaft and a handle. The handle has upon its side a smooth facet opposite a notch in the funnel-shaped end, to act as a guide if it be necessary to reintroduce the obturator while the instrument is within the bladder or urethra. Along the straight face of the end piece there is a groove which allows the ready ingress of air while withdrawing the obturator, and thereby prevents the suction, with the consequent red spot on the posterior wall, seen after using the straight instrument. This cystoscope possesses these advantages over the straight one: First, its ready introduction, which is possible except in those persons with very large and irregularly enlarged prostates. Secondly, it is much more comfortable in its introduction. Third, the obturator is grooved so as to prevent suction; and finally, the internal sphincter of the bladder does not slip over the end with necessary painful reintroduction. As the instrument is withdrawn from the bladder the sphincter may be seen to fall in upon the incline plane of the opening, and it can be gently pushed back into the bladder again, and without discomfort to the patient. As an additional advantage, the urine can frequently be caught in the oval openings as it comes from either ureter and thereby catheterization is avoided.

Good results in cystoscopy with an instrument of the sort just described are frequently not obtained because of neglect of the following precautions:

An injection of cocain into the urethra will not suffice, as it only succeeds in benumbing the anterior portion of the urethra. A deep injection of a ten per cent solution is also necessary. There is a method, however, which I have found more admirable than any other for all operative work upon the urethral canal and bladder-neck. It superinduces complete anesthesia, and the comfort to both patient and physician therefrom is very great. Two one-half grain hypodermic cocain tablets are placed within the meatus and softened down to a paste with a small drop of pure water. A soft 15 F. bougie is then passed through the canal, carrying this cocain paste (which becomes smeared upon it) into the bladder, and allowed to remain two minutes or more. It is then withdrawn and two more tablets used in the same manner as the first. This will render the canal absolutely insensible to the necessary instrumentation.

Before placing the patient in the knee-chest position, and while he is standing, the bladder should

be emptied by means of a soft catheter dipped in glycerine. If the catheter be gently withdrawn when the urine has ceased to flow, the last little remaining urine will, in the majority of cases, drawn off. Where there is still some residual urine, an evacuator is necessitated after the introduction of the cystoscope.

The male bladder can be examined both in the knee-chest position and with the patient upon his back, having his hips well elevated. In the kneechest position, when the urethral curve is rather far back from the suspensory ligament, it will require a very careful and slow introduction to reach the bladder. Under the thorough cocainization, however, it is not painful and the necessary stretching does afterwards no harm.

Having introduced the sound, several difficulties present themselves which are more apparent in the male than in the female. First, the cystoscope must be lowered much more to inspect the trigonal region. Secondly, the irritability of the male posterior urethra is greater than that of the female, and the operator will be annoyed more frequently by the spasmodic expulsive effort of the bladder brought on thereby, rendering examination impossible until relaxation occurs. When such a contraction takes place, air and urine will be driven out together, and the posterior wall will fall in upon the cystoscope's inner opening, making further inspection impossible. When the trigonum is too elevated to be readily seen, air injected into the rectum will bring it into view, or the finger introduced will enable the operator to press any part directly down upon the open end of the cystoscope. In conclusion, I may state:

1. The cost of the instrument is small.

2. The illumination with the head-mirror is simple and uncomplicated.

3. The bladder can be treated as well as examined.

4. The field is directly seen and not modified in appearance by lens, reflector or fluid in the bladder. 5. Catheterization of the ureters is simple.

There are many interesting details in the examination of the bladder in the male which I shall dwell upon in another article to follow this.

4318 Olive Street.

SOME THOUGHTS ON DIPHTHERIA.* BY I. N. LOVE, M.D., St. Louis, Mo. IME was when diphtheria was dreaded probably more than any other disease incident to childhood, but those who have kept pace with the progress of science and in touch with the *Read before the St. Louis Medical Society, March 25, 1899.

literature of our profession, who are not wedded to preconceived opinions and prejudiced against progress, will admit that the disease has been robbed of most of its terrors.

The most definite progress made in the management of diphtheria was when the real cause was discovered. The Klebs-Loeffler bacillus, as the established cause of diphtheria, gave us our first inspiration for its proper cure along the lines of disinfection. The work of Behring, Roux and others evolved the antidote, and there can be no question now as to the fact that antitoxin is a real cure for diphtheria, and a probable preventive if used at the right time and in the right way. When the diphtheria antitoxin was first presented to the profession, I felt that while the probabilities were that a real solution of the problem had been evolved, yet it was our duty to move slowly in the matter of acceptance. It was my pleasure or misfortune to be impressed in the beginning with a paper read by Lennox Brown, before the British Medical Association, wherein he reported one hundred cases of diphtheria treated without antitoxin and one hundred cases treated with this remedy. In both series of cases the same result followed-death-rate being about 24 per cent-and his conclusions were unfavorable. Realizing the fact that our profession has almost invariably been too readily carried away in these latter years with enthusiasm in favor of new thoughts, I advised at that time that we should be extra conservative in weighing the evidence for and against antitoxin. As each year has passed, the evidence has grown stronger that antitoxin is practically the beginning of a revolution in therapy. The entire scientific world has now accepted the antitoxin treatment of diphtheria. Of course, there are a few doubting Thomases in the professional world, but they are so few as not to be worthy of much consideration. While I believe the case is closed and further argument regarding antitoxins unnecessary, still we should have a care "lest we forget" that epidemics vary in intensity, and that it takes at least ten years to establish any therapeutic agent permanently. The strongest evidence which I have personally secured in favor of this remedy has been the cases of tracheal diphtheria which have come under my care. These, as you know, are the purest forms of diphtheria; they are not mixed infections. In other words, the streptococci and the staphylococci enter but little into the problem in these cases. The absence of vascularity in the tracheal tissues is unfavorable to the mixed infections and to the blood poisoning which is so frequent in pharyngeal and particularly nasal diphtheria. Under antitoxin I have been able to save more than 75 per cent of my cases of tracheal diphtheria, even those requiring tracheotomy or intubation;

and, as we all know, under the old régime this could not have been done.

Of course, when called now to any case of sore throat of an acute character, the temptation will be to hastily use the antitoxin treatment, particularly upon the part of enthusiasts; and I am sure that our statistics, as they accumulate, will be much more favorable to antitoxin than they should be. The busy doctor will, in his confidence in the treatment, and on account of being crowded for time, fail to establish the fact that the case is one of real diphtheria before applying the remedy. So far as the well-being of the patient is concerned, this is not important, but it certainly is objectionable so far as the making of our statistics goes.

For many years prior to the introduction of antitoxin it had been my custom to look upon every case of sore throat as a possible case of diphtheria, advising, invariably, complete isolation in all cases.

My chief reliance for many years-fully fifteen years-was to purge my patient promptly, saturating him with the benzoate of soda and the bichloride of mercury, both remedies accompanied by large quantities of water. However dry and angry the surfaces of the throat, however pronounced the tendency toward the accumulation of secretion and the disposition to the formation of membrane on the throat, by this therapeutic course, exosmosis, a moistening of the surfaces, a tendency to throw off the secretions and accumulated membrane was promptly accomplished.

In addition to these measures, it was my rule to apply locally, cleansing, disinfecting, soothing measures. I do not believe, even now, that these measures should be neglected. They are certainly not called for so strongly, but they are helpful, and we are, at least, taking no chances. I believe on general principles in the management of all diseases, and particularly the infections, that we should give close attention to elimination, the secretions and excretions; and we have no better stimulant to the excretory organs, we have no better eliminative agents than the benzoate of soda and the bichloride of mercury. I believe, further, that whether we administer antitoxin or not, whether we have a case of diphtheria or not, that in every sore throat we should use, not only for the comfort of our patient, but for disinfection, with a view to the benefit of our patient and the protection of others, remedies which accomplish this purpose (and there are no better), such as hydrozone, alternating with diluted listerine or some similar preparation. A point which I would. particularly emphasize is, that in our devotion to the microscope and the test-tube, we are too frequently depending upon these agents for