THE

A Rare Condition of the Male Sexual Organs.

BY EDWARD BOWE, M. D.,

JACKSONVILLE, Ill.

Reported to the Jacksonville Medical Clnb.

HE case I wish to report is of interest, owing to a rare condition of the organs of reproduction in the male. The patient, a farmer, 27 years of age, has always enjoyed good health, but since the development of puberty has been embarrassed by this rare condition. Although he is possessed of an intense sexual desire when stimulated by favorable association with the opposite sex erections are firm, persistent and complete, try as he may he has never lost one drop of semen, or experienced a sexual orgasm. The sensation that he experiences during the sexual act is that of increasing sexual desire and pleasure with the sensation of approaching ejaculation and emission, but never reaching the climax or experiencing the phenomena of the completed sexual act.

This is not a functional but an organic disorder due to an occlusion of the ejaculatory duct near the urethral orifice. The reasons for this diagnosis are the sensations during the sexual act; the sensation of approaching ejaculation and orgasm being the same as in the normal sexual act. The phenomena of ejaculation begins in the testes, and progresses along the vasa deferentia; during this he has the sensation that accompany the normal sexual act, but as the seminal fluid never escapes into the urethra, the reactory phenomena of the completed sexual act are not present. It is the reabsorption of as highly a vitalizing secretion as the seminal fluid that is responsible for the excellent condition of the patient's general health, and his persistant sexual stamina. This condition may occur as a sequela of gonorrhea, but as a congenital condition I am unable to find a single case recorded in the literature at my disposal.

MERITS THE SUPPORT OF LOYAL PHYSICIANS.

SPRINGFIELD, N. J., May 12, 1900.

THE FORTNIGHTLY PRESS CO., St. Louis, Mo.

Gentlemen:-Please find check enclosed for my subscription to your magazine. I thank you kindly for past favors, and hope you will pardon my neglect in not sending my renewal earlier.

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JA. STITES, M. D.

BY FRANK PARSONS NORBURY, M. D.

Formerly Resident Physician Pennsylvania Institution for Feeble-Minded Children; Formerly Assistant Physician Illinois Central Hospital for the Insane; Physician to Oak Lawn Sanitorium and Passavant Memorial Hospital; Neurologist to Our Savior's Hospital; Lecturer

Psycho-Physics, Illinois College.

AND EGBERT W. FELL, B. S..

JACKSONVILLE, ILL.

The Mortality and Treatment of Acute Intussusception.-Kammerer Arch. of Pediatrics, February, 1900) says that operative interference is becoming more and more popular with the profession. Of the bloodless methods the only one of value is the injection of fluids into the rectum. This is practicable only in intussusception of the large intestine. The chief objections to this method are the liability to rupture, inability to recognize that reduction has taken place, and the liability to recurrence. It should be employed only in mild, acute cases under complete anesthesia; hot water should be used. If the above treatment fails laparotomy should be resorted to. The author thinks that a lateral incision as close to the seat of trouble as possible is advisable. Reinvagination is not likely to occur, and the author does not advise fixation of the bowel. Mortality of irreducible cases is very high; of reducible cases about half as much. If reduction is impossible, either of the following procedures are available: Resection of the entire intussusception; resection of the intussusception after longitudinal incision; establishment of lateral anastomosis or an artificial anus. The first two are the most satisfactory. Kammerer says that children bear laparotomy as well as adults.

The Necessary Factors in the Treatment of Intussusception.-Gibson (Arch. of Pediatrics, February, 1900) limits his paper to the influence of the duration of obstruction on the prognosis and results of operation. His cases are all acute, and he finds either of the three following conditions existing, depending on the duration of the obstruction: reducible, irredu ci

ble or gangrenous. Combined forms may exist. If the intussusception is found in a reducible state and free from septic infection the prognosis is favorable. The mortality is very high in irreducible cases, and almost hopeless if gangrene exists.

Dr. A. Jacobi in discussing the above papers maintained that injections of water, if properly administered, gave good results. His method is as follows: Under complete chloroform anesthesia, with the hips raised, warm water should be introduced from a height not greater than twelve or eighteen inches. Gentle manipulation should be made at the same time. If the first attempt is unsuccessful it should be repeated at intervals of an hour or two for two or three times, and if still unsuccessful laparotomy should be at once performed. However, he did not think that early operation was justifiable in all cases.

A Study of Lesions of the Liver in Young Children.-(Freeman, Archives of Pediatrics, February, 1900.)-This paper may be summarized as follows: 1. Descent of the liver below the crest of the lium is not rare in infants, particularly if the liver is enlarged. 2. Fatty degeneration was found in 41 per cent of all cases examined. 3. The absence of fat in general and wasting of tissue seems to have no connection with the fatty con-, dition of the liver, the condition of nutrition in the cases of fatty liver averaging as good as the others. 4. Fatty liver really occurs in tuberculosis, marasmus, malnutrition, rachitis or syphilis, unless complicated by an acute disease. 5. Fatty livers occur most often after infections and gastrointestinal diseases. 6. The author's two cases of cirrhosis ran an acute course. The livers showed a hyperplasia of the so-called new-found bile ducts. 7. Local necrosis may occur in measles.

A Clinical Lecture.-(A. Jacobi, Arch. of Pediatrics, January, 1900.) Scarlet Fever.- Negro baby with hands and arms peeling; eruption occurred three weeks previously and desquamation began at the end of the next week. Contagion is possible from the beginning of the eruption. A second desquamation sometimes occurs, during which the patient should be isolated. Frequent bathing and use of a bland ointment lessens the liabil ity of contagion. The urine shows albumin in the second week. A bad nephritis sometimes shows little albumin, and may originate as late as the eighth week. Bedner's Aphthæ. - Sore surfaces under the tongue, on the palate and alveolar ridge. The mucous membrane of a baby's mouth is very tender, and any injury may cause ulceration, giving an easy ingress to bacteria. Tuberculosis may be produced in this way. Rough scrubbing may cause the injury. A weak solution of chlorate of potassium gently applied will give relief. Geographic Tongue.-Large and small red spots on the tongue caused by swelling of the papillæ filiformes. These are surrounded by more or less regular branching and interlacing raised lines. The condition is sometimes congenital and persistent, is of itself harmless, but may permit microbic invasion. Treatment is of little use. Meningocele and dermoid on the median line just below the lambdoid suture. Incision may result in opening the meningocele, and the operation should be delayed until the bones unite and separate it from the cranial cavity.

Society Proceedings.

BRAINARD DISTRICT MEDICAL SOCIETY.

[CONTINUED FROM PAGE 514.]

DR. RYAN showed a series of interesting specimens with brief history of the cases. (1) Gall-stones. Woman had had attacks of gastralgia for four or five years, no jaundice, a tumor visible near the liver. Operation. The gall bladder could not be brought into the wound, so adhesions were allowed to form for forty-eight hours, and then the bladder was opened through the liver; 986 stones were removed. The lady made a good recovery and remains in good health. (2) Repeated attacks of pain and jaundice, with final discharge of gall-stones through the bowels. From their size they could not have passed through the duct, and doubtless escaped through a perforation following adhesion between the bladder and the bowel. (3) The stone was found lodged in the common duct, and was forced through into the bowel by injecting water into the cystic and common ducts. (4) When operation was done the patient had a pulse of 140 and temperature 104. A good recovery followed. (5) Vesical calculus. A child had pain and fever, and could not urinate. The calculus was found in the urethra and was removed from above. Patient recovered. (6) Man, had severe pain due to a "stricture." It was impossible to pass a catheter by an obstruction which could be felt externally as a stone. By careful manipulation it was worked down to the meatus which was unusually narrow and had to be incised before the calculus could pass. (7) Appendicitis. Girl of eleven years. On Sunday she felt severe pain. Tuesday noon operation was performed; the appendix with a concretion was removed. Recovery. (8) Boy. Appendix found constricted and gangrenous half its length. Recovery. (9) Boy. Had suffered three days with "stomach ache." On operating found pus and general peritonitis. Died in forty-eight hours. Beware of these attacks of "old fashioned belly-ache." They may prove fatal. (10) Man. Circumscribed abscess. Appendix with concretion removed. Recovery. (II) This case had been called "malarial fever" for four weeks. The appendix lay in a large abscess. Recovery. (12) Boy of 14. Pulse quick, temperature 102°. Next morning the operation was performed. No pus was found and a prompt recovery occurred. (13) Man, similar to case 12. (14) This was a case of so-called appendicitis obliterans.

In circumscribed abscesses do not hunt for the appendix if it does not appear in the wound. There is too much danger of breaking down the protective adhesions. Examination by rectum is often helpful in diagnosis. Dr. Ryan also showed a diagram of the common locations of the appendicitis abscess.

DR. KREIDER, by consent of the Society, spoke of the work of the State Society, urging all members of this Society to unite with it and to give their aid in making the Journal as valuable as possible to the profession, especially by reporting local happenings among the profession, removals, etc. Discussion of Dr. Ryan's report followed.

DR. BLACK. The lack of a prompt and positive diagnosis with consequent delay in decision as to treatment is the point to be emphasized and deplored. All the cases of early operation that I have seen, before general infection, recovered. The general practitioner sees these cases and virtually decides the time of operation. The surgeon is at his service and has no voice in the decision as a rule, but must simply do what he can when called, often too late to do anything. If a person has a pain in the abdomen without discoverable cause, be on the safe side and call it appendicitis.

DR. KREIDER has seen one person who had had five attacks of "typhoid fever"! It was appendicitis. Where there are repeated attacks of biliousness or indigestion look out for this trouble.

Dr. Coppel.—While in some cases the diagnosis is difficult, in most cases a careful consideration of the symptoms and history will make it clear. Most cases which I have had have been operated from four to seven days after the onset of the disease. Patients and friends always ask, must you operate? 1 explain the conditions and advise prompt operation. If they decline they must take their chances. While 60 per cent to 85 per cent get well a large number of these relapse after a time. like sitting over a powder keg to go without operation. Two of my cases. were puzzling. One was referred to a surgeon for operation, but the uncertainty led to further delay. Finally incision just above the pubis opened the abscess. Recovery followed. (2) The trouble was very low. down and the man had marked bladder symptoms. Early in the morning of the day he was to be taken to the hospital a tumor appeared like a distended bladder. It was not reduced by catheterization, however. The incision was close to the pubis and plenty of pus appeared. This was the only fatal case in my practice.

DR. WHITLEY.-Good authorities say operation is required in case in 20. I am often in doubt for forty-eight hours. Like other inflammations this will take about a week to show its character. If fever subsides at this time look for resolution, but if it raises again look out for most serious condition. I have seen successful operations on the seventh, ninth and tenth days. Cases of perityphlitis sometimes recover partly, but continue far from well. Two cases I have known died, refusing operation, from a second attack.

Most of the gall stones shown might have passed through the natural passages. Most of the jaundice is caused by catarrhal conditions. Searching for a remedy that would dissolve the stones I found they simply vanished when chloroform was applied, and though I did not suppose that the drug could reach the stones in the gall bladder I gave twenty drops of a ten per cent solution of chloroform in alcohol after each meal and have found it very useful in these cases, securing apparent cure in some protracted oues.

DR. HOLMES.-Cases of typhlitis sometimes opened into the bowels. and recovery followed. Is there apt to be any difficulty in the diagnosis between appendicitis and floating kidney? In the case of a young lady with