ment of the general health. The writer had seen several cases of laceration in the acute stage healed by first intention after the enforcement of absolute rest and the carrying out of measures of strict cleanliness and disinfection. Warm douches containing borax, boracic acid, and carbolic acid were used gently two or three times a day. If the lacerations did not heal within two weeks they would not heal at all by first intention. In the treatment of old lesions the author had obtained the best results with graduated solutions of nitrate of silver. He applied a solution of thirty grains to the ounce freely to the interior of the cervical canal, and another of fifty grains to the ounce was painted over the whole external surface of the os and cervix until a uniform thick white coating was formed. This coating protects the exposed nerve filaments, allays inflammation, stimulates the growth of healthy granulations and prevents the absorption of septic matters from the discharges. The solution should be made to penetrate to the very bottom of the fissure in order to insure success. If hypertrophy and induration of the cervix remain after the lacerations are healed, an application to the external surfate is made of a solution of the nitrite of silver, 3 ij to j. Several of the patients thus treated became pregnant, whereas while the disease existed they were sterile, and being examined after the birth of their children, the cervix and os were found in every case to be normal and entirely free from disease.-Med. Record.

LANOLIN, A NEW OINTMENT-BASIS.-DR. OSCAR LIEBREICH read a paper on lanolin before the Berlin Medical Society on Oct. 8th, (see the Berliner Klin. Wochens., No. 47). This substance is a mixture of cholesterin fat (from keratin holding tissues, such as sheep's wool in particular) and water. This pure cholesterin fat stands, as BERTHELOT has said, between a resin and a fat, but is capable of taking up its bulk of water. It is perfectly neutral, and possesses properties which are not shared by the ordinary fats nor by vaseline. In contrast with ordinary fats, lanolin with difficulty decomposes, and, which is its chief property therapeutically, it is extremely readily absorbed by the skin. It is, in fact, the neutral fat of the skin, and of epidermic tissues generally, such as hair, hoofs of horses, feathers, etc., from all of which it has been obtained.

As a proof of this high power of being absorbed, a five per cent. carbolic acid ointment, made up with lanolin, produced a feeling of numbness, without irritation, in the hand in from one to two minutes after being rubbed in. The presence of lanolin is easily ascertained by LIEBERMAN'S cholestol test. The fat to be tested is dissolved in acetic anhydride (not glacial acetic acid). The solution gives a rosecoloration, passing quickly to dark blue and green when concentrated sulphuric acid is added. Glycerin fats do not give it this reaction.

The advantages of lanolin over vaseline and such paraffin derivatives consist in its ready absorbability. Vaseline, as is well known, greatly hinders the absorption of therapeutical agents. It is an advantage to add five or ten per cent. of ordinary fat or of glycerin to lan

olin, so that the unctuous character may be better preserved.-Brit. Med. Journal.

MISTLETOE AS A PARTURIFACIENT.-The writer has noticed of late but little mention of an agent which he believes promises much as a uterine stimulant in those slow cases of parturition, not less painful to the patient than embarrassing to the accoucheur, in which, after a considerable number of "hard" but fruitless pains, nature seems to have called a halt.

In three recent cases of this description, the writer has exhibited a fluid extract of mistletoe (phoradendron flavescens) prepared by PARKE, DAVIS & CO., in doses of from twenty to forty minims, repeated at intervals of twenty minutes, with the happiest results.

In a recent case, occurring in a patient aged thirty-seven years-fifth confinement-in which hard pains, simulating those of labor, had existed at long intervals for some two days, followed by a sudden gush of liquor amnii and then a complete cessation of any pains for two hours, an exhibition of this preparation in the manner indicated above, was followed in less than an hour by effective contractions, and the birth of a nine-pound male child in less than two hours thereafter-the shortest labor ever experienced by the grateful patient.

There seems to be no contra-indication to its use at any stage of labor-other things being equal, of course-and it seems probable that we have in mistletoe a parturifacient not excelled, if equaled, by ergot or gossypium.-DR. G. V. HALE, in Texas Courier-Record of Medicine.

MOUNTAIN AND SEA AIR.-Highly nervous persons, the victims of hypochondria, those suffering from excessive brain-work-above all, those in whom these conditions are found in conjunction-should not, as a general rule, be advised to try the seaside. A quiet inland locality, or some mountainous spot of moderate elevation, will be found to suit their cases better. The monotonous aspect of the sea and the ceaseless beat of its waves are mentally depressing, while the highly strung neurotic patient is irritated instead of braced by the stimulating effects of the sea air. Those who are just recovering from a serious illness, such as pneumonia or typhoid fever, should not be sent prematurely to the seaside, as an accession of febrile symptoms is frequently the untoward result. An inland locality is more suitable during early convalescence; but, later on, nothing conduces more to complete cure than a resort to the seaside. The marvelously restorative effects of sea air in cases of slight general debility, in persons of strumous habit, and in those with family predisposition to phthisis, are well understood, and must not be regarded as being in any degree impugned by the opinions expressed in the present article.-British Medical Journal.

CARBON DISULPHIDE IN NEURALGIA.GUERDEN (Revue de Thérapeutique, December 1st, 1885,) recommends, as far superior to the menthol pencil in neuralgia, the application, for three minutes, of:

In superficial neuralgias, whether facial, dental, or intercostal, and in superficial rheumatic pains, this application produces instantaneous relief, and not unfrequently a cure. In the deep neuralgias, as sciatica, it is necessary to project the solution upon the painful part by means of an atomizer. Actual freezing of the skin is unnecessary. Dental neuralgia usually succumbs to this treatment applied to the corresponding cheek-a slight application to the gum, or the insertion into the carious tooth of a pledget of cotton moistened with the solution being occasionally advisable. Very obstinate facial, dental, and pharyngeal neuralgias may be subdued by gently introducing into the external auditory meatus a pledget thus moistened, squeezed out, and covered by a layer of dry cotton. Med. News, Jan. 2, 1886.

TREATMENT OF FAVUS IN THE ADULT.-The crusts should first be removed by lotions of green soap, preceded, if necessary, by poultices. The hair is then to be cut as short as possible, and an ointment of eight to fifteen grains of bichromate of potassium in one ounce of lard applied, the head being afterward covered with a cap of linen or cotton cloth. The head should be thus washed with green soap, and covered with the ointment every morning and evening. If the application caused much smarting the proportion of potassium bichromate should be reduced, or if the crusts fail to become detached it should be increased. A trial of a few days' duration will suffice to determine the relation between the individual tolerance and the degree of activity of the ointment. The hair should be cut very close, but epilation is useless.-Journal de Médecine de Paris, November 15, 1885.

STRYCHNINE IN ACUTE ALCOHOLISM.—DR. LARDIER has long employed strychnine in the treatment of delirium tremens, and regards it as the best remedy we possess for this condition -as, in fact, a veritable specific. He insists upon the necessity of giving the drug in large doses. In one case he had given granules containing each grain every two hours for several days without any appreciable result. then increased the number of granules and also administered the drug hypodermatically, giving in all 1 grains in the space of 23 hours. The result was a most happy one. The patient soon fell into a refreshing sleep, never exhibiting the slightest symptom of strychnine poisoning.-The Practitioner, Dec. 1885.

He

REDUCTION OF TEMPERATURE BY ICE-BAGS. -DR. F. A. BURRALL, of this city, writes to the Journal of the American Medical Association: "STEPHAN, of St. Petersburg (see Jourdal, September 26, 1885), is of opinion that the temperature in fever may be lowered by the application of ice-bags over the superclavicular region. This effect is produced by bringing the cold in contact with the large superficial veins of the neck. I have noticed that in some cases of pneumonia a sensation of intense heat is one of the most trying sensations from which the patient suffers. In two of my cases much relief was afforded by the continuous application of the ice-bag to the occipito cervical region. One of the patients told me 'it was the only comfort he had.'"-New York Medical Record.

COTTON ROOT IN THE TREATMENT OF UTERINE HÆMORRHAGE.-MASSINI ("Korrespondenzbl. f. Schweiz. Aerzte:” “Ctrlbl. f. klin. Med.") thinks that this drug is to be regarded not only as an efficient substitute for ergot, but as having some advantages over that remedy. Although less prompt in action, it is more enduring; hence, while it has been used success

SPHACELINIC ACID IN THE TREATMENT OF ROSACEA.-At the Fifty-eighth Congress of German Naturalists and Physicians, DR. UNNA ("Dtsch. Med. -Ztg.") reported excellent results in the treatment of uncomplicated cases of rosacea with ointments containing from five to ten per cent. of an extract of ergot that was rich in sphacelinic acid (either that known to the trade as GEHE & Co.'s "extractum secalis cornuti cornutino-sphacelinicum" or an extract prepared by Mielck, of Hamburg).-New York Medical Journal.

MELANCHOLIA.-DR. S. A. DEFOE, of Washington, N. J., writes that he has found the following to give excellent results in melancholia. B. Valerianates of zinc, quinine, and iron, each twenty grains, to be divided into twenty pills. One pill is to be taken three times a day before meals. The drugs should be absolutely pure. DR. DEFOE says he has tried this remedy thoroughly, and finds it a specific for the worry of nervous women and for incipient melancholia.-New York Medical Record.

Vol. IV.

Original Articles.

SURGICAL CLINIC, HELD AT HARPER HOSPITAL, JANUARY 16, 1886.

BY H. O. WALKER, M. D.*

'Reported by MR. A. P. BIDDLE.]

EXTERNAL PERINEAL URETHROTOMY,

Gentlemen:-This patient, Wм. B., aged 58, I presented to you at our last clinic, but as he had just entered the hospital, I deemed it advisable to first ascertain by urinary analysis, whether he had any disease of the kidneys, and at the same time allow a few days of preparation before making the operation, which I propose to do to-day, namely, external perineal urethrotomy.

He gives the following history: In 1863 he had an attack of gonorrhoea, which lasted until the summer of 1864, when his horse fell upon him (being at that time in the cavalry service of the U. S. army), injuring him in the region of the chest, kidneys, bladder, and perineum. For two days he was unable to void his urine, and for several days afterwards passed blood from the urethra and bowels. He was confined to bed at this time for three months, his chest injuries being considered the most seri

ous.

The difficulty in urination continued to grow worse, with occasional retention of urine for several hours at a time. In 1876, he informs us, internal urethrotomy was made, with considerable benefit for a time. Now, he voids urine frequently both day and night, with great difficulty, passing, at times, quite a quantity of pus.

Analysis of the urine denotes a specific gravity of 1019. Alkaline reaction. Pus cells in quantity, bladder and urethral epithelium, but no casts. Alkaline urine continued for some time, indicates cystitis, which has already become a part of this man's trouble.

We will now explore his urethra, which, you observe, just admits this urethrometer (in size 12 m.) into the meatus; at 2 inches, it is stopped. After some efforts, I have succeeded in passing the smallest filiform attachment of

* Professor of Orthopedic Surgery, Genito-Urinary Diseases, and Clinical Surgery in the Detroit College of Medicine.

No. 2.

MAISONNEUVE'S instrument, indicating that the largest calibre is at the meatus, 12 m., and the smallest in the membranous urethra, 1 m. I will here state that our patient has been under preparatory treatment for several days, namely, quinine in five-grain doses, three times a day. The administration of the quinine is said to prevent shock and urethral fever. This statement I believe to be true, as I have seen it verified in very many urethrotomies that I have made. Our patient is now perfectly anæsthetized, and an operation of this kind should not be made unless the patient is thoroughly under the influence of the anesthetic, for the penis is about the last part of the body to succumb to its influence. As the filiform bougie is in situ, I will now screw on the grooved staff and introduce it well through the urethra into the bladder, and then pushing the largest sized knife of the instrument the whole length of the groove, thereby cutting the floor of the urethra so as to admit a lithotomy staff. This simplifies the operation, when it can be done, and is preferable to first passing a filiform bougie and then over it a GOULEY'S tunneled sound, for the filiform bougie fills up the groove and interferes with the cutting down upon it. The staff is in position, to be held there by the assistant, pressing it well out against the perineum I make, as you notice, my incision directly over the median raphe, about two and a half inches in length, extending to within a-half inch of the anus, cutting down to the urethra, where I distinctly feel the groove in the staff which the point of my knife enters, when I divide it for an inch or more, completing the cut to the prostate body by this triangular probe-pointed knife which I have devised for this purpose. I will now, after withdrawing the staff, gradually stretch with the prostatic forceps the prostatic urethra so as to admit my index finger into the bladder for exploration, a proceeding that should never be neglected in these long-standing cases of stricture where cystitis exists. A temporary paralysis of the prostatic urethra undoubtedly benefits the cystitis, a fact that I have frequently observed in several cases; at least my cases have done much better since I adopted this procedure. The completion of this operation consists in introducing OTIS' urethrotome into the urethra and out at the cut in the perineum, and distending it to 36 m., the size of this man's urethra; at least we conclude so, for the circumference of

his penis measures 3 inches, and the size of the urethra is as 1 to 2g, the proportion of the circumference of the penis to the urethra, a fact first noticed by DR. OTIS, of New York. The knife is now withdrawn to within about an inch of the meatus, along the upper floor of the canal, while we divide with the meatotome the remainder of the constriction on the lower floor of the urethra. You notice that I can now pass with ease a No. 36 m. steel sound. After the hemorrhage ceases, which is minimum in this case, I will wash out the urethra and bladder with a warm solution of corrosive sublimate, 1 to 1,000, and apply sublimated gauze of several thicknesses to the perineum, held in place by a bandage, and to be removed at every urination. DR. WEIR, of New York, informs me that he rarely has urethral fever in these cases when this precaution is adopted.

The quinine will be continued, together with drop-doses of tincture aconite every hour for several hours, also the application of an ice-bag over the parts, using care not to freeze theman accident that once happened me through the carelessness of a nurse. Day after to-morrow we will again introduce the 36 m. sound and continue to do so at intervals of every other day until he is well, for we expect that we will cure this man of his stricture if all cicatricial tissue is divided and the after-treatment is properly conducted.

The operation of external perineal urethrotomy is not a common one, and is only advisable in long-standing strictures of the deep urethra. It is much safer than internal urethrotomy at this point. Strictures of the pendulous portion can be cut internally with comparative safety.

The dangers to be apprehended in this operation are hemorrhage, which can, as a rule, be controlled by continued compression; urethral fever ushered in with an active rigor followed by high temperature, which usually disappears in a few hours; it may occur after urination or the passage of the sound. Septicemia may occur, as it is impossible to adopt thorough antisepsis in these cases.

Extravasation of urine and pyæmia I have only seen when the deep urethra has been cut internally.

REMOVAL OF AN EPITHELIOMA OF THE FACE,
USING A FOUR-PER-CENT. SOLUTION
OF THE MURIATE OF COCAINE
SUBCUTANEOUSLY.

J.F., æt. 58, first noticed, about eight years ago, a small pimple or wart near left ala of nose, it grew gradually until about four years ago, when it was burnt out with some caustic. returned some months ago, grew rapidly, and was quite painful at times.

It

As it is you now observe it measures an inch in diameter, flat with indurated edges, and

covered with a scab. It is what is called a squamous epithelioma. You will frequently notice that these warts on the face remain quiescent for years and then suddenly develop into a true epithelial growth, and if not removed will develop secondary complications, destruction of tissue and finally death.

We will use in this case as an anæsthetic a four-per-cent. solution of muriate of cocaine injected subcutaneously around and beneath the tumor, using about fifteen minims. I have removed the growth, twisted several spurting vessels, coapted the edges of the wound with sutures, and he states that the only pain that he felt was when I introduced the needle the last time, and that was but slight.

In minor operations such as opening abscesses, fistulæ, paracentesis thoracis, radical cure of hydrocele, injection of hemorrhoids and the cutting of strictures in the pendulous urethra, I have used the cocaine with the most satisfactory results. When used subcutaneously the operation can be commenced within three minutes after its introduction, and if its effects disappear before the operation is completed, it can be applied through the medium of absorbent cotton wrapped on the end of a probe.

In cutting strictures I introduce it into the urethra by means of a dropper, using one or more droppers full as may be necessary, having the patient hold it in by compressing the lips of the meatus with the thumb and finger, retaining it for from ten to twenty minutes, when the operation can be proceeded with.

A CASE OF SPONDYLITIS WITH

OF PLASTER JACKET.

APPLICATION

Edward C., aged 37, presents himself with a trouble in his spine. His history is as follows. In 1873, while hunting whale on the Pacific ocean, he was struck by one and thrown into the air, falling with great force upon the loggerhead of the boat. He became unconscious and continued so for about three weeks. The first treatment received was four days after the accident, when he reached Honolulu, where he remained in bed for about seven months, afterwards using crutches for a considerable time to aid him in getting about. Lost control of his urine immediately after the accident, which continued up to 1878, when I applied a plasterof-Paris jacket. In 1877 had complete paralysis of the lower extremities for several weeks. When I first saw him in 1878 he had irregularity of action of the muscles of the eye, severe frontal headache at times, unsteadiness of gait, general distress and weakness, and complained of considerable pain when pressure was made over the spine extending from the fifth to the eighth dorsal vertebra inclusive. I applied at this time a plaster jacket, and repeated it two or three times. The application of the jacket gave

instant relief, and he made a good recovery with entire subsidence of all symptoms just mentioned.

To-day he comes back for treatment of theold trouble-I was going to say, but you will see that it is a new one, for he states that after taking off the last jacket he has done all kinds of manual labor up to the time that he was a victim of a second accident, which occurred on the 28th of last July, when, while working on a building in St. Paul, Minn., he fell a distance of fifteen feet, striking on a stone pavement, breaking three ribs on one side and two on the other, together with injury to the lower dorsal vertebræ.

Was confined to his bed three weeks, when he went to Chicago and had a plaster jacket applied, which he wore for thirteen weeks with some benefit. During this time he had more or less incontinence of urine, blurred vision, with considerable pain in the head and lower dorsal region. Has not worn a jacket for some time. His symptoms to-day are pain on pressure over the last four dorsal vertebræ, with a slight prominence at that point, difficult and painful locomotion, twitching of the muscles of the eye, and considerable headache.

This case is one of interest, and is a case of spondylitis, due to a traumatic cause. We will now apply a plaster jacket, extending it down to the great trochanters, just allowing room for locomotion, and there is every reason to believe that this man will get well.

CHICAGO MEDICAL SOCIETY.

OFFICIAL REPORT.

Stated Meeting, Jan. 4th, 1886. The President, C. T. PARKES, M.D., in the chair.

The first paper read was entitled

THE EFFECTS OF COCAINE ON THE CENTRAL NERVOUS SYSTEM,

by DR. D. R. BROWER.

We have recovered from the primary effects of the brilliant discovery of DR. CARL KOLLER, that sixteen months ago electrified the medical world, and can now reason together calmly and dispassionately about this powerful therapeutic agent.

I have been using in private and hospital practice the preparation of the coca leaf for about six years, and for about one year past the alkaloid cocaine, and have reached certain conclusions as to its beneficial and its baneful effects on the central nervous system, that I propose to present for discussion in this paper. I say beneficial and baneful effects, for my first proposition is, that it is as powerful for evil as it is for good.

First. Its Effect upon the Brain.-In small doses, that is, three or four drachms of the infusion, or one-half to one grain of the alkaloid, it is the most certain and agreeable of all cerebral stimulants. It increases the frequency of the pulse and respiration, and elevates the body temperature. It gives a sense of well-being, a freedom from care, and a pleasant mental exaltation. The first effect of the drug is upon the cerebrum, then upon the medulla oblongata, the sense of mental exhilaration preceding the stimulation of respiration and circulation. In small doses it also stimulates the spinal cord, producing a desire for muscular activity, and increasing activity of reflexes.

The effect upon the spinal cord, according to the experiments of DR. ALEXANDER BENNET,* are due entirely to its effects upon the posterior column of the spinal cord; an observation that may make the drug useful in locomotor ataxia. I am now making clinical investigation in this direction.

This increased activity of the central nervous system is usually followed by a quiet, composed, self-satisfied condition of the mind and body that eventuate in sleep. These agreeable effects are accompanied with loss of appetite, frequently with nausea, constipation and diminished activity of the kidneys, of the sexual functions, and on the skin. In large doses, two to ten grains of the alkaloid, there are produced tinnitus aurium, photophobia, illusions, hallucinations, great loquacity, and a marked tendency of the mind to exaggeration and misrepresentation. If continued for some time this dose produces perversion of the affections, a disturbance of the moral emotions, a tendency to quarrel with friends and former associates, and to form alliances with persons formerly regarded as inferiors.

This state of the nervous system may become very like delirium tremens, with the same kind of muscular tremor, and the same kind of horrible hallucinations. During this time the loss of appetite and diminished activity of assimilation result in extreme pallor of the face, dryness of skin, extreme constipation, very much diminished urinary excretion, loss of sexual function, and great emaciation.

Second. Cocaine in the Alcohol and Opium Inebrieties.-Much has been written upon the use of this drug in efforts to cure this form of nerve mal-nutrition. LEWIS BAUER, M.D.,† in an admirable article details his experience with it in a case of alcohol inebriety. He began with one-fifth of a grain, which the patient soon increased to ten grains by hypodermic injection, with the same disastrous results upon the nervous system as has been mentioned; but he expresses the opinion that cocaine inebriety was less objectionable than the alcoholic.

* British Medical Journal, April 18, 1874. 4 Weekly Medical Review, Vol. 1, No. 12.