an elevation of temperature of about four degrees, with considerable prostration, leading me to believe that the attacks were of a rheumatic character. On examination of the urethra, I found the meatus so small as to barely admit a small probe, and excessively tender and inflamed. A slight gleety discharge was noticeable, which the patient stated had been a constant symptom for years. I at once enlarged the meatus to 34 French, and attempted a thorough exploration of the canal. I found that steel sounds would not pass the muscular urethra on account of the intense spasm which they induced, soft bougies, however, passed readily up to 18 French. Above that size could not be passed without producing intense pain. No organic contraction of the canal could be demonstrated by either the urethrameter or bougies a boule. The second night after the meatotomy, the patient slept soundly for the first time in some years, and he has continued to secure his natural rest ever since, it being now three months since the operation. The flow of urine has become quite free, and starts as soon an attempt at micturition is made, the act of micturition being of normal frequency. A marked improvement in the general health is noticeable and the nervous irritability has in a great measure disappeared. There has been some increase of weight, but as the patient is naturally spare, this has not been very marked. The attacks of pleurodynia have not recurred, although the usual time for their occurrence has passed; and as time goes on, I am confident that the theory of their dependence upon the urethral irritation will be confirmed. The gleet has disappeared entirely, and there has been a decided increase of sexual vigor; in short, as the patient expresses it, he is "himself again."

CASE II. General sympathetic disturbance and neuralgia of the testes, from stricture of large caliber and follicular prostatitis.

J. G. R. aged 45. This gentleman had several attacks of gonorrhea, the last one having occurred some twenty years ago. For the last four years he had been suffering with irritation of the urethra, which had been referred to stricture, and treated by dilatation. Later on he had been " quacked" for diabetis, prostatic enlargement, Bright's disease, rheumatism, and several other afflictions, with no effect save to convert the patient into a confirmed hypochondriac. At the time he consulted me, he had been suffering from paroxysmal pain in the testes, with occasional "burning" sensations in the testes, perineum and cranial vertex, and pains of a rheumatic character in the limbs. On examination of the urethra I found that it would admit an 18 English sound quite readily save some pain was experienced at a point one inch from the meatus. At this spot the bougie a boule, demonstrated the existence of a linear stricture of large caliber. The prostate was found to be somewhat tender, but not enlarged. On examining the urine I found that it contained membranous shreds, which from their appearance I judged to be from the prostatic urethra, and the result of follicular prostatitis. A slight gleety discharge was noticed, evidently of a similar origin.

The meatus and stricture were cut to a 40 French, with a complete relief to the neuralgia of the testes. The rheumatism in the limbs has greatly improved, but the feeling of heat in the testes, perineum, and head has in a measure persisted, although much better.

These latter symptoms I attribute to prostatic

irritation, more particularly because applications to the prostatic sinus, of a sedative or astringent char acter, produce a marked and speedy amelioration of them. I have found also that the shreddy appear ance of the urine was increased by each application to the prostate. Hot boracic acid irrigation has been substituted for these applications, and the case is slowly improving. The connection between the neuralgia of the testes and the stricture in this case is demonstrated by the improvement resulting from urethrotomy.

CASE III. Pseudo-impotence from contracted and irritable meatus. This case and case IV. I will not give in detail, but will present the salient points:

A young man of 27 had suffered from several attacks of gonorrhoea, the last of which ran into a gleet which lasted about a year. There had been no trouble with urination, but about six months before I saw the patient, he noticed a loss of sexual power. He would suddenly succeed in securing an erection at times, but erection would suddenly cease in the act of copulation. On examination I found the penis and testes apparently normal, but the meatus was quite narrow and excessively sensitive. There was no deep or penile stricture.

The meatus was incised to 34 French, and sounds passed to the bladder every third day for several weeks. At the end of a month improvement was reported, and in about two months the patient reported himself as entirely recovered from sexual disability.

CASE IV. Vesical atony from contracted and irri table meatus.-This patient, forty years of age and a gambler by profession, gave the usual history of numerous gonorrhoeas and also syphilis. Micturition had for a long time been attended by pain and smarting at the meatus, and a slight gleet had been present for some years. For about a year the stream had grown less and less forcible, until quite a strenuous effort was necessary to empty the bladder. On examination the meatus was found to be only moderately contracted, but very tender, the lips being everted and reddened. No deep strictures were discoverable. The feeble flow of urine through the catheter demonstrated the vesical atony. As the obstruction was only moderate and was congenital, the atony was explicable only upon the theory of reflex spasm of the cut-off muscle and inhibition of the detrusor urinæ. Meatotomy to 40 French resulted in an almost complete cure as demonstrated by examination six months after operation.

Many other cases of a neurotic character have occurred in my genito-urinary practice, but these cases will serve for the purpose of illustration. In all my cases, due attention has been paid to general hygienia and medicinal measures, but the details of treatment would simply result in prolixity, without adding to the value of the report. I have found that reflex neuralgia of the testis, penis and cord and chronic spasmodic stricture are by no means rare, as several instances among my patients serve to demonstrate.

Rhus or Poison Ivy.

BY R. L. PATTERSON, M. D., Bridgeville, Penn.

A common form of inflammation of the skin is that which is produced by contact with certain species of sumach. Belonging to this class is the so-called poison ivy or rhus toxicodendron.

Poison ivy and the characteristic inflammation produced by it, are known in different localities by several aliases. It appears not only as a vine, but as a bush of considerable size, and grows abundantly almost everywhere.

The virulent principle of this plant, says an eminent specialist on diseases of the skin, is a volatile acid, which exists in all its parts, especially in the leaves. All persons are not affected by it; some handle it with impunity. Actual contact with the plant is not always necessary for the production of the poisonous effects on account of the volatility of its active principle, and there is good reason to believe that persons sensitive to the poison not infrequently suffer from passing by places where the vine grows abundantly.

The plant is supposed to be most actively virulent during the flowering season, in early summer, but cases occur with great frequency during autumn. Even in the winter, twigs and stems are alive to mischief to those who handle them.

One writer tells of a patient who cannot drive through the woods where the poison sumach grows without subsequently suffering with the characteristic inflammation, and that in merely passing to the leeward of a field where the farmers were burning brush has repeatedly been sufficient to evoke the eruption. The poisonous influence of the plant is transmitted with the greatest facility on clothing and other articles in use.

It is with great pleasure that I acknowledge the superiority of Declat's glyco phenique in the treatment of the soul-harrowing, peace-destroying inflammation over all other treatment known to the medical profession. I use the following formula:

B.-Glyco-Phenique each..aazviii.

Ol. Olivæ,

H. Stillmark, in the St. Petersburg Med. Wochenschrift, strongly recommends vinum ipecac for weak pains during labor. He recommends 10 to 15 drops every hour for two or three doses. He reports a case where the results of the administration of this drug were most satisfactory.

Beclére, in the Revue de Therapeutique MedicoChirurgicale reports two cases of gonorrhoeal rheumatism in children. Both were girls, aged 51⁄2 years and 20 months, and both suffered from purulent vaginitis with urethritis. The joint affections speedily recovered under treatment by immobilization and pressure by means of cotton pads. He is of the opinion that arthritis in children is more frequently due to this cause than is ordinarily supposed, and may even follow ophthalmia neonatorum.

EXODYNE. Exodyne (Odyne pain) marketed by the Orange Chemical Co. as the greatest analgesic and antirheumatic, consists, according to F. Goldmann (Pharm. Zeit.) of approximately ninety per cent acetanilid, five per cent sodium salicylate, and five per

cent sodium bicarbonate.

Subscription, $1.00 a year; to Europe, $1.25.

Entered at Chicago post office as second-class matter.

THE EDITOR would be glad to receive any items of general interest in regard to local events, or matters that it is desirable to call to the attention of the profession. Letters written for publication or containing items of information should be accompanied by the full name and address of the writer, although not necessarily to be published. All communications should be addressed to

WESTERN MEDICAL REPORTER, 1101 Masonic Temple, Chicago.

Some More Peculiar Ethics from the Fountain Head.

It is a peculiar fact, that some of the most flagrant violations of the Code have cropped out within the classic shades of the institution, which has been the fountain head of all that is ethical for lo, these many years. We called attention to some of these ethical discrepancies in a previous issue of the REPORTER. We clip the following from the Chicago Herald, July

21st:

"Surgeons E. W. Andrews and C. W. Crary, of the medical board of pension examiners, have performed a remarkable surgical operation on Major O. C. Towne, a veteran living at Argyle Park. He has been confined to his bed for nearly a year from an abscess in his right lung. Two months ago the abscess was cut and drained. His condition became worse. Last Sunday Dr. Andrews determined upon another operation. He opened the lung cavity for the better draining of the diseased spot. After the incision. was made almost the entire lung was found to be affected, and so four ribs were removed. In the cavity was found a quantity of stony substance, some of the pieces being as large and as hard as marbles. The walls of the cavity were petrified.

Yesterday the patient was feeling better than in weeks. The physician says the case is the most remarkable one he ever handled Nothing similar has been reported in medicine. They look for the Major's recovery.

That our readers may fully appreciate this ethical advertisement, we will state that Dr. Crary is a homœopath. But, of course, this was not a consultation, oh no. The above is not a defense of that superannuated old fraud the code, but it is illustrative of the hypocrisy of medical men in general. Your "regular" will not advertise-unless he gets his advertisement gratis. He will not consult with a homœopath-unless he gets a good chance and a fee. We dare say, that 50 per cent of the Chicago medical society have violated the code at one time or another, yet the society still subscribes to the letter and spirit of the code. It is about time for the regular profession to throw off that mask of hypocrisy— the code, and do its advertising and homopathic consulting on the square, if it must do it at all. The old code must go; the handwriting is on the wall.

Quackery on the Pacific Slope.

The epidemic of quackery from which this country is suffering prevails more largely in California than. elsewhere if the journals published in that State present truly the state of affairs. The Pacific Medical Monthly offers the following suggestions for its relief: 1. The practical application of the Malthusian idea in the medical schools-fewer conceptions and a lengthened period of gestation.

2. Exportation of the surplus crop of learned and conscientious doctors to less favored lands, as Central Africa, China, Siberia, Thibet, India, Siam, etc. Much as the heathens of these countries may be in need of medical and surgical aid, we should not like to inflict on them such a calamity as to send them the sweepings from our own fair land.

3. Deportation to South Victoria (within the Antarctic circle) of all quacks and charlatans both with and without diplomas, where they will have an opportunity to cool off their passion for notoriety and gold.

4. The inculcation, early and late, of the doctrine. -alas, long since forgotten: "Thou shalt love thy neighbor as thyself."

The following decidedly practical observation was recently published by the intelligent editor of the Northwestern Lumberman. It contains a germ of therapeutical truth which might be worth investigation :

"SALT AND HEALTH.-Salt and lumber go together in Michigan. In Saginaw and Bay counties nearly 2,000,000 barrels of salt are manufactured yearly, and we are not aware that any is made except by sawmill and planing mill operators. It is claimed, and no doubt truthfully, that salt making, as an independent industry, could not be carried on at the present price of salt. As now conducted no fuel account enters on the expenditure list, as exhaust steam from the mills is used. Salt has recently sold as low as 50 cents a barrel, and the barrel is worth 19 or 20 cents. Hence, 280 pounds of salt brings 31 cents!

The manufacture of salt is a simple process. Wells are bored several hundred feet, and the brine pumped out of them into vats. The salt blocks are medium or large size buildings, as the case may be, filled with evaporating vats and bins for the salt. Through these vats steam pipes run, and the heat from them is what does the work.

The process, however, is old, and so well understood that it is hardly worth writing about. It is another phase of the question that will be here considered. The Lumberman representative is by no means sure that he has made a discovery, but he has seen nothing written on the subject, neither can it be learned that it has been discussed even orally.

There may be a rare life-preserving and life-giving quality in these salt blocks.

It was remarked by mill operator that the men in his salt block were very healthy. On being asked as to details, he thought they had been exempt from catarrh and lung diseases. Others were questioned, and all gave about the same testimony. C. W. Grant, a Saginaw valley pioneer, and a close observer, was very decided in his expression. He could not remember during all his years of experience a case of

catarrh, consumption, pneumonia, or hardly any other disease among his salt workers. He had seen these men many a time leave the blocks, and sit and stand outside in a raw, raking wind, with no bad results. At times, after he had contracted a cold, he had taken a sweat in his block, and came out as good as

new.

This was layman testimony; something more explicit, or rather, more professional, was wanted. Two of the oldest, and said to be the ablest, physicians in Saginaw were visited, and their views were kindly given. One said that during his many years of practice he had not known a case of catarrh or consumption among the salt men, but he did remember that he had been called upon to treat pneumonia. The other one said that he had never known among these men a case of catarrh or lung disease, either chronic or acute. Moreover, many a case of malaria had been cured in the blocks. The physician first visited was asked if he had ever recommended what might be called a salt block cure, and he said he had not, that he had no idea a patient would persevere in the treatment.

The writer of this is neither a physician nor the son of a physician, nevertheless he is somewhat interested in health topics, and he has never known of but two authentic cases of consumption being cured. One of these was a salt cure, pure and simple. The consumptive, who by the way was a physician, pinned his faith to salt. He carried it in a box in his pocket, and many times a day eat a pinch of it. He fully recovered, and after death from another disease, a post-mortem disclosed the fact that the cavities in his lungs were thoroughly healed. The other case was related by an old physician of Chicago, now in government employ, who performed a post-mortem on a sailor, and found sound lungs, which at some time had been badly diseased. Years on the salt water had worked a cure. There are physicians in every large city who brazenly advertise that they can cure consumption, but everybody, except the consumptive, knows they lie. How many cases of consumption do you know have been cured? You will think, and probably say, not any. But few, at any rate.

These salt blocks are filled with a hot, salty, medicated vapor, and the inmates become thoroughly pickled. If cannibals were to get hold of them they would be already seasoned for eating. The sweat is running from their pores from morning till night, and their skin is as white and soft as a babe's. Here they live in these hot, vapory places ten hours every day, and are absolutely exempt from the diseases named above-diseases which are a constant dread of the people outside, and which fill our cemeteries.

The Lumberman representative now feels that if he had a serious case of catarrh or incipient lung trouble, he would ask permission of some kind-hearted mill man to sit around in his salt block. He would pull off his shirts, and shoes and stockings just as the salt workers do, and paddle around in the salt with them. He would pursue this course of treatment believing that if anything on the face of the earth would work a cure this would.

Is not the testimony most favorable? The treatment would be inexpensive. It would be new; and the good Lord knows that something new is needed in these diseases, as the old style treatment means, by an overwhelming majority, a prolongation of the malady, and finally death.

Announcements.

The State Board of Health has addressed the following circular to the physicians of the State.

OFFICE OF THE SECRETARY, SPRINGFIELD, July, 1892. S DOCTOR.-The State Board of Health, in view of the increasing indications of another pandemic of small-pox, has undertaken to secure the general vaccinal protection of the Commonwealth in due season. To this end it has addressed cirular letters of warning and advice to the municipal authorities of every city, town and village in the State; to all health officials; to the editors of every publication; to the managers of all railroads and other corporations, and, individually, to upward of 100,000 employers, business men and others.

The way is now paved for your own professional and personal effort. All these people have been warned of the danger, advised of the safeguard, and urged to "employ a reputable physician at once and be protected in season."

The State Board now relies upon you for coöperation and assistance. It will furnish you carefully selected, fresh and reliable vaccine on ivory points, at actual wholesale cost-about five cents per point in packages of ten points. Upon the recommendation of any reputable physician it will furnish a supply gratis to any community or establishment unable to purchase vaccine. And it will also furnish supplies gratis to any reputable physician who will undertake to secure the vaccinnation of any considerable number of the poor or dependent.

The Board urgently requests that you use your influence with your municipal and other authorities to secure the passage and enforcement of the necessary ordinances, proclamations and other forms commanding the present vaccination of all school children— public, private and parochial; of all public officials and employés; of all officers, employés and inmates of jails, almshouses, infirmaries, etc.; of all tramps and others who come within the purview of the police; and, especially, of all new-comers within the municipal jurisdiction.

The Board will be glad to hear from you and promises prompt action, to the extent of its ability and resources, upon any suggestions with which you may favor it. W. A. HASKELL, M. D., President.

F. W. REILLY, M. D.,

Secretary.

New Journals.

The American Therapist. A monthly record of modern therapeutics, with practical suggestions relating to the clinical applications of drugs. Edited by John Aulde, M. D. Published by the American Therapist Publishing Company, New York. Subscription price $1.00 a year.

This modest publication is filled with valuable material and will prove a valuable aid to the wise physician who subscribes for it.

The Practitioner's Monthly. A journal of practical medicine. Edited by C. L. Dodge, M. D., and J. Chambers, M. D. Published by the Practitioner's Monthly Pub. Co., Kingston, N. Y. $1.00 per annum.

A thoroughly good journal, well up with the times. and conducted by men who know what the profession demands.

The National Popular Review. An illustrated journal of preventive medicine and applied sociology for the profession and the people. Edited by P. C.. Remondino, M. D. Published by J. Harrison White, San Diego, Cal. $2.00 per year.

This journal is a new departure and under the able guidance of the talented editor will make for itself a field of usefulness and become a welcome visitor throughout the land.

Pamphlets Received.

CLINICAL LECTURE.-Deformity of the hip and knee following acute osteitis; lumbar abscess resembling incipient hip-joint disease. By H. Augustus Wilson, M. D., Clinical Professor of orthopædic surgery, Jefferson Medical College, etc.

The necessity for early correction in congenital club-foot, by H. Augustus Wilson, M. D., Clinical Professor, etc.

Typhoid fever in Chicago, by Wm. T. Sedgwick, Professor of Biology in the Massachusetts Institute of Technology, and Allen Hazen, in charge Lawrence experiment station.

Two cases of tubercular osteomyelitis of tibia, by J. T. Jelks, M. D.

Comparative value of mercury and the iodides in treatment of syphilis. By J. T. Jelks, M. D. Blennorrhoea. By J. T. Jelks, M. D.

Two cases of carcinoma of the uterus. By J. T. Jelks, M. D.

Some effects of blennorrhoea in women. Jelks, M. D.

By J. T.

DIAGNOSIS OF ANEURISM OF THE DESCENDING THORACIC AORTA.-The writer gives in full the history of two cases which have come under his own observation, together with notes on several others recorded at the Middlesex Hospital. He finds very little information on the diagnosis of this peculiar condition. The cases are rare. Only ten are recorded in 2,982 post-mortem examinations. So it has occurred once in 298 or 0.33 per cent of a general hospital's postmortem examinations.

Of these ten cases eight were males, the average age being forty-four and a half years. There was nothing special observed as to any particular occupations predisposing to the disease.

There was nothing to point to lead poisoning occurring in any of these cases, and in only one was there distinct mention of high tension of the vessels and evidence of Bright's disease.

In none of the cases was any history of syphilis

given, nor that any signs of it were found; though in only two was it distinctly negatived.

Now taking some of the common signs of thoracic aneurism, as differences in the radial pulses of the two arms, or in the size of the two pupils, or paralysis of the vocal cords, all these we should expect to be wanting in an aneurism confined to the descending portion of the aorta. This seems to be exactly the case. Two of the cases tend to prove this point: aneurism being diagnosed with different sized pupils, a paralyzed vocal cord, hoarseness, and brassy cough, but in each a dilated arch was found which probably alone accounted for the pupil and vocal cord signs. If the aneurism has extended and become superficial with obvious dullness, tumor and pulsation, we only have, then, signs and symptoms common to all thoracic aneurisms, and they need not be considered separately in our present subject, except to mention that, if the bulging be backward, erosion of the bodies of the dorsal vertebræ occurs without angular curvature, as in Pott's disease, and with no pain or only slight indefinite pain.

Now, to consider the signs that may occur and in an advanced state probably do more or less occur; interference with the expansion of the left side, together with weaker breath sounds and diminished vocal fremitus and vocal resonance, and perhaps sonorous and sibilant rhonchi, occasionally increased dullness of base of lung-these signs are often found in cases already by other means diagnosed as aneurism, but to diagnose an aneurism by these means alone would seem rash and not justifiable.

The two most trustworthy signs are cough and pain in the left side and between the shoulders. Molson concludes as follows:

Firstly, pain and a cough brassy and laryngeal are the earliest and most reliable signs of a descending thoracic aneurism. Dyspnoea, palpitation, and stridor may occur with, perhaps, weakened breathing, diminished vocal fremitus and vocal resonance, and sonorous and sibilant rhonchi occasionally.

These appear to be the only early signs peculiar to this kind of aneurism. When the case is advanced, and we get superficial dullness, tumor and pulsation, any refinements are no longer required.

Secondly, that aneurism of the descending thoracic aorta cannot be diagnosed in an early stage with our present means of investigation. Montreal Med. Jour.

MACKENZIE ON VENOUS PULSATION.-Before a recent meeting of the Manchester Medical Society M. gave a demonstration of a means of graphically recording pulsation in the veins, whereby the movement of the apex beat or carotid pulse could be employed to time the events occurring in the veins. The essential features in the method were the covering of the vein or other pulsating part with a small leaden funnel. This funnel was connected by an elastic tube with a tambour, the lever resting on which recorded the movements communicated by the vein on the smoked paper of a revolving cylinder on Dudgeon's sphygmograph. The veins of which the pulsations were recorded were mostly the internal jugular, but tracings were also shown from the axillary vein, the femoral vein, and from the liver. The conclusions arrived at from the consideration of a large number of cases were summarized as follows: Pulsation in the veins arises when from any cause dilatation of the right

heart and great veins, with incompetency of the tricuspid and venous valves, takes place. While the auricle can vigorously contract, there is a wave synchronous in time with and caused by the auricular systole (auricular wave). When the dilatation of the heart and veins is moderate, the auricular wave is followed by a great depression synchronous with and caused by the auricular diastole (auricular depression). In most cases there is a wave produced by and synchronous with the latter portion of the ventricular contraction (ventricular wave). The greater the incompetence of the tricuspid valve and the greater distention of the auricle, the earlier does the ventricular wave appear, and the larger space of time it occupies. The ventricular wave, in cases of extreme dilatation of the right heart, may occupy the whole period of ventricular systole; the depression caused by the auricular diastole is then replaced by the ventricular wave. In such rare cases the auricle has ceased to contract independently, or its contraction is represented by a very small wave preceding the ventricular wave. The great depression then shown in tracings of the venous pulse is caused by and synchronous with the ventricular diastole (ventricular depression.)-Lancet.

To be taken in the course of the afternoon, a spoonful every fifteen to twenty minutes.

According to the writer, the action of salipyrine, like that of the salicylates, is especially manifest if one administer it during the afternoon, in frequently repeated doses, with a total dose of from four to six grammes. Two to three hours after the last dose the temperature falls one or two degrees and the pains become less. The patient passes a good night, and, although the temperature rises the next morning, it does not reach the height that it did before. —LancetClinic.

CLASSIFICATION OF DIPHTHERIA. -Hoegyes divides diphtheritic cases as follows:

1. Toxic Diphtheria. The local phenomena are slight. The false membranes are circumscribed and disappear at the end of five or six hours, sometimes causing gangrene of the mucous membrane. On the other hand the symptoms on the side of the nervous system are most grave, and death results in thirtysix to forty-eight hours.

Septic Diphtheria. General symptoms grave, with the local process very severe, extending to all