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in any given case, and may be either transitory or permanent.

When properly used, the galvanic current stimulates the circulation, stimulates the absorbents, and allays irritation and spasm. In addition we have the mechanical effect of the bulb of the electrode.

To put the case concisely, I will state my belief that galvanism, judiciously used, will often subtract the plus conditions of stricture and facilitate the penetration of otherwise surgically impermeable stricture. Once these conditions are removed, electricity is no longer useful, and we must seek other means of relief. It may thus be seen that if these statements are true, the range of application of electricity is not wide. I do not believe it is ever curative of organic stricture, nor do I believe it is often of value in the pendulous urethra. Strictures of this portion of the canal are very likely to require urethrotomy; certain it is, to my mind, that electricity will rarely obviate the necessity for the operation. case of deep stricture occasionally arises where electricity will relieve retention, and so facilitate subsequent dilatation as to be invaluable, but such cases are not frequent. Surgeons may report cases of impermeable stricture in which electricity succeeded, after all else had failed, by the dozen; but there will still be those among us who believe that the man who sees so many impermeable contractions is either a paper surgeon, unworthy of belief, or his reported. cases are simply impermeable to him. Impermeability of stricture upon one end of the bougie sometimes means impermeability of brain upon the other.

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In thus stating what I believe to be the merits of the "electrolytic," or, more properly, the galvanic treatment of stricture, I have endeavored to present them fairly and without bias.

A Tumor of the Urethra.*

BY R. F. HENRY, PRINCEVILLE, ILL.

In the case of Mrs. F, a housewife, aged fortyeight years, in good general health, and recently married to her second husband. The signs, which indicated the existence of the tumor, as given by the woman herself when I called upon her on the second day of April last, were pains in the genital organs which she had experienced for some time, when sitting in the upright position and when having connection with her husband. The former compelled her to take an awkward position when sitting, but the latter gave rise to the greater trouble, not only on account of the suffering which it produced locally but on account also of the suspicions which it excited in the mind of the husband that the wife was blameful for her unfortunate condition. She expressed a fear that a divorce would be the result if the aforesaid suspicions were not removed and she be enabled to "render unto her husband due benevolence."

She felt conscious of her innocence and expressed a desire to know what the cause of the trouble might be and to have it removed if possible.

Being called upon to give counsel and help in the case, I examined her and discovered, first, the free end of a tumor which had the likeness of a drop of blood in size and color, and proved to be very sensitive when touched. A further examination revealed

*Read before The Military Tract Medical Association at Peoria. Ill., Oct. 20 and 21, 1891.

the other end of the tumor which was attached to the mucous membrane in the anterior part of the urethra. The dimension of the tumor, as measured by the eye, was about three-eighths of an inch in length, oneeighth of inch in breadth and one-sixteenth of an inch in thickness. As regards consistency it was very soft and therefore became more globular in form when taken from the position which it had occupied.

The tumor had caused but very little uninary obstruction and would have given but little trouble had it not been extremely sensitive on touch or pressure from without. The case was new to me and I have come to the conclusion that such cases are extremely rare, from the fact that I have not been able thus far to find a case on record like it in all respects.

In Holmes' System of Surgery, vol. 2, he says: "Such bodies do exist but they are excessively rare. Those which are found at the anterior part of the canal and which appear almost confined as regards situation to the fossa navicularis are usually soft, of a rose red color, bleed very readily, and are not very sensitive." This case differs from those in the last two particulars named above. As no authority could be found for the treatment of the case I used my own judgment and suggested excision, to which the patient gave her consent, and on the eleventh day of May last the tumor was removed with the curved scissors, with the assistance of Dr. T. E. Alyea, who accepted my invitation to see the case on this occasion. But very

little hæmorrhage followed the excision, and no after treatment was used but a few washings with carbolized water.

The results of the treatment have been satisfactory to all parties concerned. The woman has experienced permanent relief from the local pains with which she had been annoyed and from the fears which she had entertained. The man was satisfied that his suspicions were unfounded and that no one was to blame for the existence of the cause of their trouble. We will also add that the other party concerned in the case was well satisfied and complimented.

Elements of Thorough Diagnosis.*

BY E. N. CAMPBELL, M. D., GOOD HOPE, Ill. One of our American humorists has said, that it is better not to know so much, than to know so many things that are not true. Early errors accepted in the practice of medicine, as well as in other branches of business, is not easily gotten rid of.

No subject (not the minutest thing) can be so exhausted, that further thought, and the insight of genius, may not discover still deeper meanings, and more subtile relations: and thus the mighty labor becomes progressive. Each generation receives its inheritance of knowledge; makes its own additions, and bequeaths the whole to its successor. So that we of the present, stand as the heirs of all the ages, in the foremost files of time. Life is too short and humanity too frail, for one to undertake to solve all the great principles that arise before him.

If there is one thing more than another that should give the heart cheer, it is to know we are dealing with facts, and that our time is not lost or wasted by unfounded and unproved theories. If a person becomes proficient in the practice of medicine, he

*Read before The Military Tract Medical Association at Peoria, Ill., Oct. 20 and 21st, 1891.

must early bend his energies toward that difficult problem of separating truth from error. In no profession do we find such heroic tendencies to error, than in this one of ours, the practice of medicine. And why? Remembering that medicine is not an exact science, and to be able to deduce truth from error, requires trained and well cultivated minds, as well as long and continued research, which at once indicates, that the proficient practitioner unqualifiedly must become a life student, and a diligent searcher for truth. In the practice of medicine, as well as in other professions, we find persons who are not so constituted, as to undergo the ordeal of much mental exertion, and in consequence of which, he soon takes up the line of empiricism, under the reputation of the profession, and gains for himself a livelihood in accordance with his own ambition.

The first prerequisite of a good diagnostitian, is a clear head and an honest heart. If a person is in possession of these elementary qualifications, then is he fitly prepared to study and learn morbid signs, and separate truth from error.

The truth is, that the detection of disease is the product of close investigation and observation of symptoms, and of correct deduction from those symptoms. This art of observation, implies close thought and practice.

No one aspiring to become a skillful observer, can depend exclusively upon the writings of others, it must be by his own persistent and careful investigation, reflected from his own enlightenment, that he is enabled to elucidate the truth.

The knowledge to be gained by reading, is of course serviceable, in this way it helps in overcoming the main difficulties at first experienced, (i. e.) to know where to look, and what to look for. Of course there are in almost every affection, some symptoms which can be detected by the merest beginner, but others again, do not appear on the surface, and which will tax the most experienced physician to find. And it is in this search for hidden signs, that medical information, as well as cultivated tact is demanded. In earlier days we could not go further than our eyes could see, ears could hear, and the sense of smell and touch could carry us. Science has lent her aid, and furnished us means, by the help of which we can clearly detect that of which before, we only got a glimpse. We now possess instruments by which we

can

ascertain with accuracy the size of organs. Thermometers tell us of the fraction degree of heat. Specific gravity bottles to give us the relative value of fluids. The microscope unveils to our view the hidden mysteries of past generations. The laryngoscope demonstrates the appearance and the movements of that wonderful organ of speech. The ophthalmoscope informs us of the state of the vessels of the brain. And chemistry with its unparalleled teachings, is bringing to our minds amazing truths that belong to the morbid state.

The effect of all these improved methods of study has been, to give immense impetus to clinical researcn, and thus to lead to the establishment of solid ground work of experience, which is certainly in striking contrast with the looseness of former times. The advance in diagnosis thus attained, to me forms one of the most pleasing portions of medical history.

Now we will suppose the symptoms of a certain malady have been discovered, our next step in diag

nosis would certainly be a proper appreciation of their significance and relation toward each other. Knowledge, and above all, the exercise of the reasoning faculties are now indispensable.

The daily habit of discovering disease, the skillful use of the microscope, and the searching analysis of chemistry would be of little use, unless we could place side by side the morbid signs they expose, and be able to consider their individual and respective value, otherwise the science of diagnosis would be simply a matter of memory. There are few symptoms in themselves distinctive; and often a symptom may be due to several causes. Semeiology informs us of their different causes, but to find out the precise meaning of the abnormal manifestation in a given case, we have to draw our inference from all the signs encountered, to compare them with one another, to seek out those that are in the background. To accomplish all this effectually, the physician has need of much and varied knowledge. He must be master of something more than the information supplied to him by semeiology. He must be an anatomist, a physiologist, and above all a pathologist in the full sense of the term. From what has already been represented, he must be a correct reasoner, for a good observer will by bad reasoning arrive at a faulty diagnosis, just as sometimes a bad observer by some process blunders into the truth. There is indeed no end to the extent of knowledge which may be brought to bear in working out a conclusion regarding the character and seat of a malady.

Having thus indicated the elements of a thorough diagnosis, we may next inquire in what way this is the most easily arrived at, when at the bedside. In the first place we will say, the main facts of the case on which the deductions are to be based, must first be ascertained. Now take these main facts, especially those which have the most direct sign or bearing on morbid action, then these morbid signs are coupled together, and we start a chain of inquiry as to what organ they point as the seat of the disease. This often has been already settled in your mind by the very mode of examination.

Now right here is the place that so many practitioners drift off into mistakes, and I desire to call your especial attention to this point. Instead of jumping at once at a conclusion or being satisfied that the diagnosis is complete, we should proceed to investigate the precise nature of the disorder by analyzing the symptoms and the previous history. We must go back and compare the facts ascertained, giving each its individual bearing as compared with the peculiar history of the case. As stated above, there are few signs in themselves pathognomonic, therefore special pathology is brought to bear on the accumulated symptoms in order to establish a correct opinion.

Let us cite a case: A patient consults us for a cough brought on by exposure; he says he has been ill for four or five days, his health having been previ ously good. We notice that his breathing is hurried, he has fever, the lower portion of one side of the chest is dull on percussion, and the respiration there is wanting, the action and sounds of the heart are normal. The facts point to the lung or its coverings as the seat of disease. We also know from the history of the case we have to deal with an acute disease. Now are you about to say pneumonia? Right here again gentlemen comes in that particular

time, not to be in a hurry to conclude your diagnosis. It is much easier to take a little more time now, than to take back an opinion once given.

We should first ask, what are the acute pulmonary affections: We say, acute bronchitis, acute phthisis, acute pleurisy, and acute pneumonia. In all these we have fever, cough, and impaired breathing.

Now do you say pneumonia? No; for notwithstanding there is in this complaint in addition to the general symptoms mentioned, dullness on percussion, the dullness is associated with a blowing respiration; whereas in the case before us, no respiration is heard. Look at the sputum, see if it is tenacious or rusty. Let us see if acute pleurisy will explain all these signs.

The patient says that he had at the start sharp pain in his side, and this we are aware takes place in pleurisy.

Then take the local vibrations, they are noticed to be absent on the affected side of the chest, which, when measured is found to be enlarged. The disease is, therefore, pleurisy in the stage of effusion. This process of arriving at an opinion is the simplest, and it is astonishing how rapidly it may be performed, by habit. This method aims so far as the symptoms permit, at a direct diagnosis, which in truth is differential.

To prove what a thing is, by proving all that it is not, is a very tedious process, yet there are many close observers that depend upon the process of exclusion to clearly establish diagnosis, but owing to the many draw-backs, diagnosis by exclusion is not, on ordinary occasions, to be encouraged. The most serious obstacle to a precise diagnosis lies in the fact that frequently lesions coexist. We know disease is a very complex state, and when one portion. of the economy gets out of order, another is apt to follow.

One great advantage indeed of attending carefully to diagnosis is, that it enables us to use remedies knowingly and with decision, and appreciate what they are effecting. It is sometimes urged that the accurate detection of disease makes timid practitioners, and deprives them of confidence in medicines. Nay, verily; but it does show, unfortunately, that our skill to detect disease is far in advance of our power to cure it.

Therefore, gentlemen, the medical man who is able to clearly and intelligently diagnose his case, is also able to give a correct prognosis regarding it, and in any event that follows, if these two elements have been correct, it forms one of the strongest bulwarks the practitioner can possess, and puts him in position to successfully face the ever present conflict of a criticising public, and justly crown him with an abiding confidence that truth and merit will always prevail.

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say (as of old) you have consumption and will most likely not get well-in other words has the germ theory improved the treatment of consumption; I do not think so. But we do know ever so much more than we used to know. We will soon be able to point out to our students the different germs of all maladies. We can have them in conveniently arranged apparatus and pass them around during lecture hour and each student will know from the pedigree attached which particular malady is being lectured upon, and we will also have the name of the most efficient germicide printed in large letters and attached to the bottle. Oh, I tell you "we are flying now." I imagine some swamp doctor like me will some of these days discover and isolate the alcholism germ and will describe him as follows: He is mostly male, wears his hair short and has only two legs and two arms, walks sorter tottery, falls down occasionally and has an enormous appetite for fluid diet, such as apple brandy, fluid extract of corn and rye, and when he is bolled up in good shape has a tendency to quarrel and fight. Now this germ could be arranged in a suitable frame and be called the bacilli-whiski and the name of the most efficient germicide would be bichloridi goldi Dwighti. So much for germs. The next thing to call to mind is what we know concerning the differentiation between habit and disease. If a man gets drunk twice a week it is habit, if he gets drunk four times a week it is disease. If a man chews five cents worth of tobacco a day it is habit, if he chews ten cents worth a day it is disease. If a Dutchman drinks a dozen glasses of beer a day it is habit, but if an Irishman drinks one glass of beer a day and there is any whisky to be had, the Irishman is diseased.

If a

So you see understanding the different nationalities we readily discern between habit and disease. boy smokes a package of cigarettes a day it is habit, but if his father catches him with a pipe in his mouth it is disease. These things are easily learned and other people besides doctors are beginning to understand them. One of my patients told me not long since that to mix sulphur and chlorate of potash in a pipe and inhale the fumes was a good remedy for catarrh. I told him to try it on himself but not to give any of it to his wife, he is very pious and would make a lovely angel.

Now all jokes aside will some one tell me just where habit ends and disease begins? I know three men all of whom have large families and each man consumes more food than his entire family; all these men so far as I am able to judge are healthy. These three examples go to show that quantity consumed is no criterion to go by in judging where habit ends and disease begins. If a man was credulous enough to believe everything he sees in print concerning the germ theory he would soon come to the conclusion that man was only a moving mass of germs of different varieties, one army of them looking after his digestion and another after his circulation and another after his mental work, and that his health and happiness here below depended largely upon which army of germs were in the ascendency. If the digestive army were "on top" he would be found eating and drinking most of his time. If the circulation battalion were holding the fort he would not need any antipyretics. If the intellectual giants were doing business for him he would be trying to write an article for the journal of the American Medical Association.

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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, 163 State Street, Chicago.

Christian Science Cranks.

The daily papers were filled a few days ago with the examination of a Christian Science crank who testified at a coroner's inquest on the body of a woman she had allowed to die of typhoid fever without calling medical assistance. If the woman's statements were sincere her proper place is in a lunatic asylum. She should not be allowed at large to work upon the credulity of unfortunates as weak-minded as herself. The cost of the injury she will do would care for her in an asylum many times over. Legal prosecution in such cases will have little effect if the accused is earnest. Martyrdom is what they seek and if it can be attended by notoriety they ask no

more.

A Charge of Plagiarism.

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The Nedical News of Philadelphia in a recent issue charges Dr. C. C. Rohning of Brussells, Ill., with plagiarism. In the March number of this Journal was published under Dr. Rohning's signature an article entitled, What I Learned to Unlearn in Gynecology," which the Nedical News claims is from the pen of Dr. Goodell and was published in its issue of November 20th, 1890. The Nedical News is not on the exchange list of the WESTERN MEDICAL REPORTER and this charge was not brought to its notice until too late to communicate with Dr. Rohning and receive his reply before going to press.

Dr. Rohning has been informed of the accusation made by the Nedical News and requested to forward a reply for publication in the next issue of the REPORTER.

Announcements.

THE COMMITTEE appointed at the last meeting of the American Medical Association to consider the best means for promoting the prosperity of the sections of the Association will hold an adjourned meeting in the Hotel Cadillæ, Detroit, Mich., June 6, at 3 P. M.

Members of the Committee are requested to notify the Chairman of their intention to be present at this meeting.

The Committee would esteem it a favor if each member of the Association would communicate in writing his or her views concerning the best measures for promoting the development of the sections. Such communications may be sent to the Chairman of the Committee. JOHN S. MARSHALL, M. D., Chairman, 9 Jackson Street, Chicago.

Notices.

IMPORTANT NOTICE AND REMOVAL.-To avoid failure or doubtful success in use of Peroxide of Hydrogen, be sure you get MARCHAND'S MEDICINAL; no substitute can replace it, statements of dealers, interested or unscrupulous parties to the contrary notwithstanding. There is great inducement to substitute in this article, for the reason that Peroxide made for bleaching and varying trade purposes costs to produce only a fraction of what MARCHAND'S MEDICINAL costs, and the unscrupulous druggist or dealer pockets the difference in profit at the expense of the physician's reputation for skill and MARCHAND'S PEROXIDE OF HYDROGEN MEDICINAL.

Put up in 4oz., 8oz., and 16oz. bottles only, with which every careful physician should be familiar in order to frustrate dishonest substitution and assure success in practice.

DREVET MANUFACTURING Co.,

28 Prince Street, New York.

ABSTRACTS.

Medicine.

DIABETIC COMA.-Dr. J. M. Hopper. Medical and Surgical Reporter, reports the following case. -A boy, aged 14 years; history of constitutional or hereditary taint, negative; all moral and material surroundings of best character. It was the school vacation; he was a close student and had made some progress in Latin grammar. Had never been ill. December 27, 1891, parents noticed that he drank three or four glasses of water at dinner; that he passed a half chamberful of water during the night; drank water at night and mentioned thirst during day. Symptoms continued, were remarked upon, but thought to be mutually cause and effect. Was skating January 4, 1891, and engaging heartily in the winter sports of the holidays. On the 5th, exhibited dyspeptic symptoms which were promptly met; tendency to constipation. Other symptoms were of the nervous character accompanying la grippe epidemic. The excessive micturition and thirst continue. 8th, labored respiration, mostly thoracic; decided hebetude. 9th, at turn of night, moribund; stimulants and external applications, rallied; temperature from 96° to 98.5°. Enough consciousness six hours before death to attempt to protrude tongue. Cried out several times, and being spoken to, said: "It hurts." Died comatose at 101⁄2 A. M. of January 9th, or about ninety-six hours after treatment begun. Urine passed evening of 8th gave this analysis: "Color, limpid; reaction, acid; specific gravity 1.032; loaded with sugar, one-quarter part by Prof. Haine's test and by improved bismuth

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the plasmodium of malaria, and its action upon nucleated red blood-corpuscles, induced Guttmann. and Ehrlich to make a trial of it therapeutically. Their expectations have been well fulfilled. They have found a very decided influence with regard to malaria, febrile attacks ceasing under the use of methylene blue in a few days, and the plasmodia disappearing from the blood after eight days. In a patient suffering from tertian ague, seven and a half grains were given before the expected attack. Two hours afterward slight strangury ensued, and the urine was colored blue but caused no other inconvenience. The shivering fit was very slight, as were also the rise of temperature and the critical sweating. In blood preparations taken shortly after, the plasmodia were not colored. For the next six days the patient had daily seven and a half grains of methylene blue, in separate doses of one and a half grains, at intervals from noon to midnight. No further febrile attack occurred, and the plasmodia vanished from the blood. A similar favorable result took place in a second patient suffering from quotidian ague, to whom the five doses were given with an hour's interval between, and begun between ten and twelve hours before the expected attack. This treatment was continued for eight or ten days after the cessation of the fever. Chemically pure methylene blue was used, and administered in capsule form. It has no unpleasant consequences which may excite uneasiness, the only disturbing effect being the form of spastic bladder irritation with increased micturition. This may, however, be speedily relieved by a little powdered nutmeg. Whether the methylene blue treatment of ague will prevent recurrences of the disease, which happen so frequently after quinine, Guttmann and Ehrlich are not in a position to say, as their opportunities of treating malaria. are not sufficiently large. (Berlin klin. Wochensch., No. 39, 1891.)

TREATMENT OF DYSENTERY.-Lancet.-Drs. Lardier and Pernet strongly recommend the use of salol and iodoform in the treatment of dysentery. Salol, in four-grain doses suspended in mucilage, acted in a most salutary manner; but iodoform-from four to six grains daily, combined with opium-gave the most beneficial results. The iodoform was given in capsules, each containing three-quarters of a grain of iodoform and a quarter of a grain of opium, to be taken five or six times during the day. The pain and tenesmus were relieved by warm boracic acid enemata, and in obstinate cases by a suppository containing hydrochlorate of cocaine and opium. In addition to this treatment great cleanliness was observed, the patient being washed daily with a saturated solution of boracic acid or with a solution of corrosive sublimate of the strength of 1 in 500.

ABORTIVE TREATMENT OF CORYZA.-Dr. Capitan (La Médecine moderne, No. 12, 1891,) for the aborting of an attack of acute coryza, recommends the insufflation of the following powder into each nostril:

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.grs. xxx. .grs. iv.

A pinch of this may be frequently used without the disagreeable symptoms caused by the first given.

ALCOHOLISM AND ITS TREATMENT BY STRYCHNINE.E. Haffter. In a pamphlet recently published in Tena, G. Beldau discusses all the papers, hitherto published in Russia and France, on strychnine treatment of alcoholism. Of peculiar interest and importance are the animal experiments performed by S. W. Jaroschewski which demonstrate that in dogs strychnine possesses the property of neutralizing the inebriating action of alcohol, and that dogs who are given strychnine and alcohol at the same time, are under incomparably better vital conditions than dogs taking alcohol alone. The latter died spontaneously without an exception while the former (excepting one who died from strychnine poisoning) continued living.

The result of experiences in man is the following: 1. Strychnine is a physiologic antagonist of alcohol and treatment of alcoholism by nitrate of strychnine gives more or less favorable results.

2.

The best results are obtained in dipsomaniacs, less good results in chronic drinkers.

3.

The higher the doses, and the longer the treatment is continued, the more satisfactory is the result. Luton administered 0.005 subcutaneously, or 0.03 internally, three times daily, Korona 0.005-0.01! once daily, and they noticed gradual disappearence of the longing for alcohol after a few injections.

4.

Alcoholics support disproportionately large. doses of strychnine without secondary phenomena, without accumulative effects.

5. It appears that strychnine has the property of eliminating the craving for alcohol in the potatory.

The author engaged in experiments in the Clinic of Tena abstains for the present from an expression of his own views on the value of the remedy, promising some early communications on the subject.—Pac. Rec. of Med. and Surg.

THE TREATMENT OF PLEURITIC EXUDATIONS BY MASSAGE. Med. and Surg. Reporter.-Dr. P. Poliakow reports 10 cases of primary pleuritic exudations, 7 serous and 3 sero-fibrinous, which were benefited by massage of the affected half of the thorax. The massage is conducted in the direction of the lymphatics, the strokes all converging toward the axillary space. The rubbings at first are slight, but must later be energetic. The sittings are daily, and last from 10 to 20 minutes. By this treatment exudations disappeared in from 8 to 20 days, whereas, the other symptoms of the disease lasted from 9 to 35 days longer. The action of massage of the thorax is that of a counterirritant, which can be applied daily. The massage also relieves the thoracic pain, and increases the strength of the muscles, thus rendering the amplitude of thoracic movement greater, a condition which beneficially influences the absorption of the exudation and dilatation of the compressed lung.—Wiener Med. Presse.

MASSAGE OF THE PROSTATE.-Med. and Surg. Reporter.-Dr. Eberman presents the following conclusions as to the value of massage in prostatic disease: 1. It can be advised (a) at the decline of an acute

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