titis, septic, the use of a catheter is necessitated for a long time to drain off the urine. This being performed through the perineal opening, damage may be done, and serious damage, as the above case shows, to the vas deferens and testicle. It may be avoided by draining. through a suprapubic opening.

Society Reports.

RICHMOND ACADEMY OF MEDI

CINE AND SURGERY.

REGULAR MEETING HELD SEPTEMBER 13, 1898. DR. M. D. HOGE, JR., president, in the chair; Dr. Mark W. Peyser, secretary and reporter.

Dr. J. W. Henson read a "Report of the Surgical Treatment of a Urethral Stricture, with Remarks" (see page 852).

Dr. J. M. Winfree reported a somewhat similar case. It was a stricture through which it was impossible to pass a filiform bougie. Suprapubic cystotomy was done and the bladder drained for a month, being washed out every day during that time with a hot boric acid solution. At the end of this interval he succeeded in passing a whalebone bougie and performed an internal urethrotomy.

Dr. Henson asked Dr. Winfree if the patient could pass water before the operation was done.

Dr. Winfree responded in the affirmative.

Dr. Henson said that put an entirely different aspect on the case. He had He had seen operations for external urethrotomy in which as soon as the perineum was incised the sound could be passed the whole length of the urethra before the stricture was cut. He was unalterably He was unalterably opposed to internal urethrotomy under any circumstances, as one worked in the dark and there was danger of death from hemorrhage and of septicemia.

Dr. Mark W. Peyser reported the following: Woman, age twenty-five years, of short stature; previous history very good; nervous tendency; had had three children, the last a still-birth at term. During the first stage of labor, upon attempting to arise from the bed she found she had lost the use of the lower extremi

ties. Two weeks later I was sent for, and found her in this condition. There was anesthesia of the external surface of both legs, hyperesthesia of the internal surfaces; extension and flexion were possible to a limited degree; other motions absent. There was no involvement of either bladder or bowels, nor were there any symptoms that could be traced to the cord. Under iodide of potassium, arseniate of strychnine and tincture of cinchona she is progressing toward recovery. What was the cause?

Medical Progress.

FORMALDEHYDE AS A DISINFECTANT. Drs. William H. Park and Arthur B. Guerard, in a very elaborate article in the Philadelphia Medical Journal on the use of formaldehyde as a disinfectant in infected dwellings, clothing, books, etc., draw the following conclusions:

1. Disinfection of Infected Dwellings. Dwellings may be superficially disinfected by means of formaldehyde gas, all apertures being tightly closed, when employed in the proportion of not less than I per cent. by volume strength, the time of exposure to be not less than two hours and the temperature of the apartment not below 52° F. Under these conditions the common common non-sporebearing pathogenic bacteria are surely and quickly destroyed, when freely exposed to the action of the gas. Sporebearing bacteria, such as anthrax bacilli, are not thus destroyed; they require at least twice the volume of gas at the same temperature for their destruction. But these are of such rare occurrence that in house disinfection they may practically be disregarded, and, if present, special measures can be taken to destroy them. The penetrative power of formaldehyde gas at ordinary room-temperature, even when used in double the strength necessary for surface disinfection, is extremely limited. Articles, therefore, such as bedding, carpets, upholstery, clothing and the like, should be subjected to steam, hot air or formaldehyde disinfection in special apparatus constructed for the purpose.

2. Disinfection of Bedding, Carpets, Upholstery, Clothing, etc. - Bedding,

carpets, clothing, etc., may be disinfected by means of formaldehyde gas in the ordinary steam disinfecting chamber, the latter to be provided with a heating and vacuum apparatus and special apparatus for generating and applying the gas. The gas should be used in the proportion of not less than 10 per cent. by volume strength, the time of exposure to be not less than three hours, and the temperature of the chamber not below 110° F. In order to insure complete sterilization of the articles they should be so placed as to allow of a free circulation of the gas around them; that is, in the case of bedding, clothing, etc., these should either be spread out on perforated wire shelves or loosely suspended in the chamber. The aid of a partial vacuum greatly facilitates the operation. Upholstered furniture and other articles requiring much space should be placed in a large chamber, or, better, a room which can be heated to the required temperature. The most delicate. colors and fabrics, furs, leather and other articles which are injured by steam, hot air at 230° F., or other disinfectants, are unaffected by formaldehyde.

furniture

3. Disinfection of Books.- Books may be satisfactorily disinfected by means of formaldehyde gas in the ordinary steam chamber as previously described and under the same conditions of volume of gas, temperature and time of exposure. The books should be arranged to stand as widely open as possible upon perforated wire shelves set about one or one and one-half feet apart in the chamber. A chamber having a capacity of from 200 to 250 cubic feet would thus afford accommodation for about sixty books at a time.

Books cannot be satisfactorily disinfected by formaldehyde gas in houses or libraries, or anywhere except in special apparatus constructed for the purpose, because the conditions required for their disinfection cannot thus be complied with. The bindings, illustrations and print of books are in no way affected by the action of formaldehyde gas.

4. Advantages of Formaldehyde Gas Over Sulphur Dioxide for the Disinfection of Dwellings.-Formaldehyde gas is superior to sulphur dioxide as a disin

fectant for dwellings (a) because it is more efficient and rapid in its action; (b) because it is less injurious in its effects. on household goods; (c) because it is less toxic to the higher forms of animal life; (d) because, when supplied from a generator placed outside of the room and watched by an attendant, there is less danger of fire. Apart from the cost of the apparatus and the greater time involved, formaldehyde gas, generated from commercial formalin, is not more expensive than sulphur dioxide, viz., from seven to eight cents per 1000 cubic feet being the cost of the disinfectant in either case.

5. In Conclusion.-Formaldehyde gas is the best disinfectant at present known for the disinfection of infected dwellings. It is inferior in penetrative power to steam and dry heat at 230° F., but for the disinfection of fine wearing apparel, furs, leather, upholstery, books and the like, which are injured by great heat, it is better adapted than any other disinfectant.

THE STOMACH MOVEMENTS UNDER THE ROENTGEN RAYS.-In an article in the Journal of Medicine and Sciences by D. W. B. Cannon the following summary is given:

1. By mixing a harmless powder, subnitrate of bismuth, with the food the movements of the stomach can be seen by means of the Roentgen rays.

2. The stomach consists of two physiologically distinct parts-the pyloric part and the fundus. Over the pyloric part, while food is present, constriction-waves are seen continually coursing toward the pylorus; the fundus is an active reservoir for the food, and squeezes out its contents gradually into the pyloric part.

3. The stomach is emptied by the formation, between the fundus and the antrum, of a tube along which constrictions pass. The contents of the fundus are pressed into the tube and the tube and antrum slowly cleared of food by the waves of constriction.

4. The food in the pyloric portion is first pushed forward by the running wave, and then by pressure of the stomach wall is returned through the ring of constriction; thus the food is thoroughly

mixed with gastric juice, and is forced by an oscillating progress to the pylorus.

5. The food in the fundus is not moved by peristalsis, and consequently it is not mixed with the gastric juice; salivary digestion can, therefore, be carried on in this region for a considerable period without being stopped by the acid gastric juice.

6. The pylorus does not open at the approach of every wave, but only at ir regular intervals. The arrival of a hard morsel causes the sphincter to open less frequently than normally, thus materially interfering with the passage of the already liquefied food.

7. Solid food remains in the antrum to be rubbed by the constrictions until triturated, or to be softened by the gastric juice, or later it may be forced into the intestine in the solid state.

8. The constriction-waves have, therefore, three functions-the mixing, trituration and expulsion of the food.

9. At the beginning of vomiting the gastric cavity is separated into two parts by a constriction at the entrance to the antrum; the cardiac portion is relaxed and the spasmodic contractions of the abdominal muscles force the food through the opened cardia into the esophagus.

10. The stomach movements are inhibited whenever the cat shows signs of anxiety, rage or distress.

THYROID EXTRACT IN FIBROID TUMORS. At the recent meeting of the American Gynecological Society Dr. William E. Moseley of Baltimore made a very interesting communication on the use of thyroid extract in the treatment of fibroid tumors founded on his experience in five cases observed in the Maryland General Hospital and abstracted in the American Journal of Obstetrics. In the first case one grain of the thyroid extract was given daily at first, and this dose was increased up to fifteen grains a day. The flow was much reduced, and when last seen, February 9, she was perfectly normal. She has continued to take nine grains daily. There had been no heart, kidney or stomach symptoms. The second case was a colored woman, thirty

three years of age, whose uterus was enlarged by an intramural fibroid. Beginning with three grains, the dose was increased up to fifteen grains a day, and when she left the hospital on February 16 she was still taking a daily dose of nine grains. Her menstrual flow had become normal and her general health had been greatly improved. Examinations of the blood had been made for him by Dr. E. L. Whitney during this treatment, and he had found a moderate increase in the small mononuclear and a corresponding decrease in the polynuclear, nutrophiles. Dr. Moseley's conclusions were as follows: (1) Whereas some patients can take comparatively large doses of thyroid with impunity, others are injuriously affected by it, even when taken in small doses; hence one should begin with three grains daily and increase the dose very slowly; (2) in cases of bleeding fibroids thyroid has a very marked influence on the excessive loss of blood, and in certain cases causes a diminution in the size of the growth; (3) in appropriate doses (nine to fifteen grains a day) improvement in the general health occurs, probably from the cessation of the loss of blood, and (4) the average duration of the treatment was about nine weeks.

DIET IN DIABETES.-Treupel (British Medical Journal) discusses some points in diet. In diabetes the objects are (a) to lessen the production of sugar, and (b) to promote the consumption of the sugar already present in the fluids of the body. Both these objects are effected by limiting the carbohydrates. Thus a strict diet of albumens and fat should be imposed, but for not longer than four weeks. Then an amount of carbohydrates may be allowed according to the case. Beer should as far as possible be avoided. Pentose and ramnose belong to carbohydrates, which are well borne without increasing the amount of the sugar. Individualization must always be practiced in the treatment of diabetes. The author then details (a) strict and (b) more generous diets for diabetics. As regards subcutaneous feeding, fat is best adapted for it. After the injection of sugar painful infiltration is often observed, even when ster

ilized solutions are used. Albuminous solutions are not to be recommended. Artificial foodstuffs are useful in cases of blood diseases accompanied by wasting, in the febrile, and especially in tuberculosis, where the ordinary foodstuffs cannot be employed. Artificially-prepared fats are comparatively little used, but lipanin and some others are readily absorbed. The ordinary fats, as in butter, cream, yolk of egg, are, however, very digestible. Many artificial preparations of carbohydrates are in use. In infants' foods diastase has converted the starch into sugar. It must be remembered that milk, sugar and other forms (especially honey) contain valuable and soluble carbohydrates and have the advantage of being cheap. Of all artificial foods the albuminous are the most important. Somatose, nutrose, eucasin, sanatogen and sanose are excellent preparations. The

two essentials of these albuminous foods are that they should be palatable and cheap. As yet an ideal preparation-that is, one which will satisfy these two conditions has not been discovered.

1. Make a thorough physical examination of the patient.

2. Prepare the patient carefully; the minutest details to secure the best conditions should never be regarded as too insignificant.

3. Give the least amount of anesthetic consistent with the required degree of narcosis.

4. The cardinal points to recognize are the respirations, pulse, pupil and color.

5. Safety in anesthesia means accurate knowledge and stringent application.

6. To resuscitate-inversion, artificial respiration, heat over cardiac region, over cardiac region, strychnine, nitroglycerine, ammonia, amyl nitrate and divulsion of the sphincter ani.

By close attention to these few fundamental principles you can hold in abeyance almost all complications and inter

cept many sequelae. If I can leave no other thought with you today I wish you to grasp the important fact that intelligent anesthetizing means knowledge of the physiological actions of the agent employed; caution and vigilance in its administration; keen perception in the discernment of complications, and quick, cool-headed judgment in averting or combatting the same. combatting the same. There are times when nature proves refractory, and the endeavors of the most experienced are sometimes frustrated. But if we have done our work well our cheeks need not blush, our lips need not apologize.

* * *

SYPHILIS CAUSED BY LUNAR CAUSTIC. Burwinkle, in the Albany Medical Annals, reports the case of a peasant twenty-four years of age. The entire tip of the nose, alae nasi and cartilaginous septum were absent. The cervical glands were much enlarged., Iodide of potash, with mercurial inunctions, was prescribed. The patient had been entirely well up to his twelfth year. He was then troubled with difficulty in breathing, due to a polypus which obstructed the right nostril. A physician was consulted, who applied lunar caustic to the polypus a number of times. Since that time the ulceration of the nose started. The lunar caustic undoubtedly caused the disease, because there had never been cases of tuberculosis or syphilis in the patient's family. The author reports one of Fournier's cases, in which there were two typical syphilitic ulcers in the middle of the patient's forearm, which had undoubtedly been due to cauterization there a few weeks before. In conclusion, the author asks the question, "How long may syphilitic poison remain virulent on instruments?" He quotes Berner, who claimed that this was only possible for a short time, as in the antiseptic period few cases of direct infection from surgical instruments had been reported, and in the cases that had been reported the infection had taken place where one case after another had been treated with the same instruments. In the case reported by the author the nose got well, that is, a cicatrix resulted, after the anti-syphilitic treatment had been used some time.

CONGENITAL FACIAL PARALYSIS.-At the recent Congress of Physicians in Hamburg Dr. Nonne related the case, reported in the Lancet, of a child, two years of age, who had suffered since birth from the signs of right-sided facial paralysis. The labor was normal and no artificial aid was necessary. The deformity of the face was noticed as soon as the child cried. Syphilis and alcoholism in the parents could be excluded and no anomaly could be felt in the parotid region of the affected side. The child heard equally well on each side and no abnormality of the ears was apparent. There was no affection of any other cranial nerve, and mentally and physically the child seemed perfectly well but for the facial weakness. In the region of the

THE INTERNAL SECRETION OF THE TONSILS.-Dr. G. Masini (New York Medical Journal) has been experimenting with an extract of the tonsil of the dog and that of the calf. After administering subcutaneously to a guinea-pig seven or eight grains of the extract for each kilogramme of the animal's weight he has found a notable increase of arterial pressure, with characteristic oscillations like those following the use of suprarenal extract. It is not maintained very long, and it is followed by a drop to less than the normal pressure. At the same time the action of the left ventricle is accelerated and then retarded. Extracts of tonsils that had long been inflamed or hyperplastic proved of no effect. The author concludes that one of the functions of the tonsil is to furnish an internal secretion capable of causing augmentation of the arterial pressure.

PHOSPHORUS AND MORPHIA POISONING. According to the Medical Age, potassium permanganate has been used generally as an antidote against the above-named poisons. The action of the drug causes an oxidation of the phosphorus and morphine, making them harmless. Potassium permanganate, on account of the potassium it contains, cannot be given in large doses; therefore Schreiber substituted sodium permanganate in its place. His experiments on animals prove the sodium salt as effective as the potassium, and it can be given in larger doses. The author advises in poisoning to wash out the stomach with a 0.2 per cent. solution of sodium permanganate and then allow one, pint of the solution to remain in the stomach.