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Doctor, have you given nasola a trial in your practice! If not, you are overlooking a good thing. Send for a sample, and you will never be without it in your own family.

Rectal Irrigation in Entero-Colitis of Children.-Dr. Clarence G. Clark, New York City, reports the following interesting case:

Baby D., age four months. History: Child was nursed by mother for one and and a half months but as her milk was of poor quality and the child did not thrive, she was advised by her attending physician to stop the breast and substitute bottle. This she did, feeding the child on a mixture of milk, cream, milk sugar and barley water in a 3-6-1 proportion. The baby thrived on this for about two months, but early in July it developed a diarrhea. The mother gave it home remedies but still continued the milk, feeding even more frequently than before as the child was fretful and apparently hungry. The stools averaged seven to eight a day and occasionally the child would vomit. I first saw the case on July 16th. Examination: Baby extremely emaciated, and weak; tongue fissured; cheeks sunken; abdomen tympanitic (slight). Temperature 105.2; weight seven pounds; stools ten to twelve daily, full of mucus and curds of undigested milk. I gave the mother a very favorable prognosis but told her to secure a nurse for the aby and we would do all that was possible. Treatment: Milk was stopped at once. Child fed on barley water and albumen water. I then ordered the nurse to wash out the colon twice daily through a catheter with two quarts of a solution containing glyco-thy moline one part and water ten parts. By the mouth I gave 1-20 gr. calomel tablets every hour for ten hours and twenty drops of brandy every two hours. July 17, child in about the same condition except that it had had only nine stools in twenty-four hours and they were of a trifle better color with less mucus and no curds. Continued irrigations, but stopped calomel. Continued with brandy. July 18th. Seven stools, quite watery but of a much better color. Treatment continued until July 24th, at which time the child was much improved, having only three a day and passing very little mu

On this date I started the milk again, using a very dilute formula with three ounces of milk sugar and fifteen ounces of boiled water. Continued irrigations with glyco-thymoline,one to eight ounces a day but stopped all other medicine. The baby started to thrive at once and in two weeks more we again weighed the child and noted an increase of three pounds. I gradually increased the strength of his food until at the present time he is taking eight ounces of milk to eleven ounces of water and one ounce of lime water, which is almost the average for a child of his age (540 months). This is only one case of a number that I have treated with nearly the same routine this summer and all with satisfactory results.. In conclusion, I would state that although in this case I did not give much treatment by mouth because the symptoms seemed to point more to a lower bowel affection, yet in many cases where gastric symptoms have been more predominant, I have combined with the irrigation treatment glyco-thymoline in 15-30 M. doses combined with liquor bismuth as follows: Glyco-thymoline.

3 ss Liq. bismuth..

3 i Aqua.....

3 ii M. Sig. 3 iq. 2-3 h. This in connection with rectal irrigation with glyco-thymoline in proportion indicated will suffice in nearly all the cases of gastro-enteritis, entero-colitis and enteritis so common in artificially fed infants.

Another Phase of the Proprietary Question.-There is at least one phase of the proprietary question which we believe has not been seriously considered, and that is, that while every effort is being made by some of our earnest and really conscientious, though misguided, workers to destroy the faith of the profession in practically ali remedies of this class, and to bring them into ridicule, practically nothing has been done to provide satisfactory substitutes for them, except to make the suggestionand excellent one, too—that physicians should familiarize themselves with the official and semiofficial preparations contained in the Pharmacopeia and National Formulary. In making this suggestion they forget to add that a very large share of these "official” preparations are old proprietaries under other names. In other words, the great "reform" consists in the denunciation of such remedies as antiphlogistine, arsenauro, bromidia, lactopeptine, Fellow's hypophosphites, antikamnia and Hayden's viburnum compound, while the use of practically the same things under other names is suggested or advised. In some instances the very formulas are used that proprietors have published or that analytical chemistry has elucidated.

There is a reason for the popularity of the proprietaries. Whether many of these were “wonderful discoveries" or not, they have enabled the average physician to secure results more satisfactory to himself and his patients than he was able to secure without them. Very, very few medical men are able to extemporize prescriptions which at the same time are effective, palatable and not uselessly polypharmacal. All doctors ought to be able to do this, but they are not--and whose fault is it? And even if they were, who but the sheerest crank would claim that he could properly write for, or the average druggist dispense, substitutes as elegant, as cheap and withal so satisfactory as many of the best type of the proprietaries? It is best to look all these facts squarely in the face and be sensible in our conclusions.

Vol. XXX


No. 5


Papers for the original department must be contributed ex- various works on pathology, to wbich referclusively to this magazine, and should be in hand at least one month in advance. French and German articles will be trans- ence should be made. lated free of charge, if accepted. A liberal number of extra copies will be furnished authors, and

It will however, be remarked that included reprints may be obtained at cost, if request accompanies the in the inflammatory processes may be rec. proof.

Engravings from photographs or pen drawings will be fur- ognized means by which nature provides a nished when necessary to elucidate the text. Rejected manuscript will be returned if stamps are enclosed for this purpose.

way of liberating urine that is suddenly ex.

travasated and imprisoned. It is well known COLLABORATORS.

that there is no animal Auid so destructive to ALBERT ABRAMS, M. D., San Francisco. M. V. BALL, M. D., Warren, Pa.

normal tissues as urine charged with ammonia FRANK BILLINGS, M. D., Chicago, Ill.

by the decomposition of urea.
CHARLES W. BURR, M. D., Philadelphia.
St. Louis, Mo.

Though these effects by their violence are
S. SOLIS COHEN. M. D., Philadelphia, Pa.

not infrequently in themselves fatal they have N. S. DAVIS, M. D., Chicago. ARTHUR REDWARDS, M. D., Chicago, Ill.

occasionally by mortification liberated pent. FRANK R. FRY, M. D., St. Louis.

up urine saturated with ammonia and Mr. REGINALD HARRISON, London, England. RICHARD T. HEWLETT, M. D., London, England. proved the means of saving life, though at the J. N. HALL, M. D., Denver. HOBART A. HARE, M. D., Philadelphia.

cost of much suffering and permanent damCHARLES JEWETT, M. D., Brooklyn. THOMAS LINN, M. D., Nice, France.

age to the parts, wbioh by timely surgical aid FRANKLIN H. MARTIN, M. D., Chicago.

might bave been prevented. This urea may E. E. MONTGOMERY, M. D., Philadelphia. NICHOLAS SENN, M. D., Chicago.

be said figuratively, to furnish the dynamite FERD C. VALENTINE, M. D., New York.

for this purpose. EDWIN WALKER, M. D., Evansville, Ind. REYNOLD W. WILCOX, M. D., New York.

I think that urea bas justified its existence H. M. WHELPLEY, M. D., St. Louis. WM. H. WILDER, M. D., Chicago, Ill.

as a natural constituent of the urine by providing for a contingency in connection with

obstruoted mioturition which has proved ocCLINICAL LECTURE.

casionally of no little service.

I have met with several instances of per

sons who, in places far beyond the reach of THE URETHROTOMIES. *

surgical aid, have suffered from extravasa

tion of urine and sloughing whose lives were REGINALD HARRISON, F.R.C.S.

undoubtedly saved in this way. Further I have recorded a cases where apparently by

the absence of urea extravasated urine was Consulting Surgeon to St. Peter's Hospital.

rendered chemically harmless to the tissues UNDER the title of the urethrotomies I pro- which confined it. pose taking a review of their application to some diseases and injuries of the male urin


In looking back at surgical opinion and It will be convenient to consider in the practice which prevailed about the time prior first place those specially applicable to to the general adoption of antiseptics it stricture, namely: (1) Internal urethrotomy; could hardly be said that this operation was (2) external urethrotomy, otherwise called favorably regarded, though numberless inperineal section, and (3) the combination of struments were devised for this purpose, and these two proceedings.

some important observations were made on It is hardly necessary to point out the ser- the subject. ious effects that are liable to follow uny per- Amongst the latter I would include the manent obstruction to the discharge of urine

almost forgotten work of the late Dr. Fessenalong the urethra.

In this way may be den Otis, of New York, who demonstrated brought about all degrees of disorganization the larger dimensions of the male urethra, and of the urinary apparatus from the kidneys thus exercised not only a marked influence on downwards as well as various local effects

the treatment of stricture, but led up to the about the seat of stricture which include in.


great improvements that followed in connecflammation, suppuration, extravasation of tion with the removal of stone from the bladurine and mortification. These consequences der by Dr. Bigelow of Boston. will be found illustrated and described in

Notwithstanding the various communica* This is No. 1 of a series of lectures on this subject, deliv

tions which were made on the subject of in, ered at the London Post-Graduate College. To follow: (2) Internal and External Urethrotomy. (3) The Conbina- + Surgical Disorders of the Urinary Organs. Fourth Ed. tion of External and Internal Urethrotomy.

p. 133.


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ternal urethrotomy at the time referred to, One of the earliest communications in ref. by far the larger number of strictures were erence to the nature and prevention of urin. almost indiscriminately treated by some form ary fever as a sequence of surgical interfer. of dilatation with bougies, whilst in the min. ence with the urethra was by Dr. Palmer, of ority of these cases the selection of a more Louisville, U. S.A., in 1867. He showed radical operation was largely determined by by a long series of cases that by sterilizing the mechanical impossibility of proceeding the urine beforehand with boracic acid given to carry out the former treatment.

by the mouth the liability to urinary fever The objections which were then urged after passing catheters and bougies or causagainst a more general'adoption of urethrot. ing any lesions of the urethra, was greatly omy were chiefly: The frequency with which diminished. this operation was followed by paroxysms of Dr. Palmer's results in reference to the urethral or urinary fever attended with rigors. sterilization or adulteration of the urine Teevan stated in treating of this subject that with certain drugs led me to make some ob. two-thirds of the cases thus operated on suf. servations on more direct means of influencfered in this way and in a much larger pro- ing the excretion. portion than where dilatation was alone prac- For some years past I have made a habit ticed; that greater risk was incurred; and in cases of operation on the male urethra lastly, on the ground that urethrotomy did such as internal urethrotomy, or wbere there not prevent a recurrence of the contraction is reason to beliere that the canal has been or dispose of the necessity for the occasional abraded or actually wounded by the passage use of a bougie subsequently as a preventive along of catheters, bougies or sounds, of 6ll. of relapse. In the light of more recent de ing the bladder with a solution of borio acid velopments having a direct reference to the and asking the patient to retain it for some general recognition of antiseptics I will refer time. to these several considerations.

Thus the first urine that is voluntarily

passed after what may have been done operaURETHRAL FEVER.

tively is not only a diluted specimen of the In the pre-antispetic days the rigors and excretion, but is charged with an antiseptio fever wbich not uncommonly followed surgi. solution. It should be remembered that the cal interference with the urethra however earlier rigors oocurring after these lesions slight or transieut it might be, were almost are those wbioh are sometimes premonitory universally regarded as of a neurotic origin, of the more serious symptoms that may fol. or as due to shock propagated by the sympa- low, such as suppression. In the few fatal thetio nervous system. It has always seemed cases I have seen of the latter, after interference to me that there was little or no support for with the urethra, the first rigor happened this explanation.

within a few hours. The rigors and fever There is no analogous example connected whioh ooour after an interval of twenty-four with other injuries or lesions of the body. hours or so following the use of an instruThe rigors and fever which follow and may ment. I have not thought of any moment. reasonably be expected after an internal Since adopting this practice generally I urethrotomy are conspicuous by their absence have found the occurrence of urinary fever wbere in addition to the urethrotomy a peri- much less common than formerly, and when deal cystotomy is provided for efficient drain. it happened correspondingly less important. age.

For this purpose injections of boric acid soluFurther, some experiments in sterilizing, or tion seemed more potent than those containrather adulterating the urine as will presently ing mercuric preparations. be referred to, are directly opposed to the Where a catheter is retained for some days, neurotic hypothesis.

as after internal urethrotomy, and the escape The only evidence of shock propagated by of urine is controlled by a plug or tap at the the sympathetic nervous system I can recall orifice of the instrument, I have succeeded I

I in connection with surgical lesions of the by repeating these injections into the bladder, genito-urinary apparatus is distinctly at var- of averting these intermittent febrile attacks. iance with such a theory. I refer to the shock which in

THE RESULTS OF INTERNAL URETHROTOMY degree is obvious both to the operating sur

RELATIVE TO ITS SELECTION. geon and to the anesthetist, who are both in- In dealing with the urethrotomies it is not terested in the phenomenon, when, for the re- to be presumed that I undervalue the methods moval of a testis, the spermatic cord is liga- of treating strictures by various forms of di. tured and divided. Here beart and breath. latation with bougies. On the contrary, there ing often indicate this. I do not think it can be no doubt (except per baps, with some necessary to pursue this argument further. of the traumatic varieties resulting from


ruptures of the urethra) that all strictures of siderably lessened by giving effect to certain an inflammatory origin bave a place or pre principles of treatment having special referliminary stage of various duration. A period ence to injury and repair as uniquely obwhen so to speak they may be moulded by served in connection with some lesions of the the band and instrument of the surgeon or urinary apparatus, and which hitherto have educated patient, as the potter moulds clay not received due consideration. while it is impressive.

To this aspect of the subjects have devoted When, however, this stage has been allowed considerable attention.

considerable attention. In 1900 I prepared, to pass by and the obstruction not only dis- by request, a report for the International torts or alters the urine stream, but assumes Medical Congress at Paris on the remote efthe characteristics of an increasingly con- fects of structural lesions (interventions santractile svar, section and the introduction of gulantes) in urethro-stenosis. This entailed wbat I shall again refer to descriptively as a a very full investigation, and many persons splice or interval of new tissue becomes a were examined who bad undergone operations necessity.

for stricture at varying intervals previously. All strictures are liable to obange as age The conolusions I arrived at were that the advances and to undergo fibrous degenera- normal calibre of the urethra might be comtion. In this way even after years of careful pletely and permanently restored, and that attention they may become india.rubber-like the absence of recurrence, as demonstrated by and resist treatment which hitherto bad been many cases which were curefully investi. carried on with success. It may then be gated, was not necessarily dependent on th3 necessary to substitute division for dilata

use of a bougie after operation. In several tion.

cases, such as those I am referring to later In determining the time and stage when this on, recurrence was due not so much to the substitution should take place the whip" or original stricture, but to a general sclerosis graduated bougies* I described many years which the entire length of the urethra had ago, and wbiob are now much used for treat- undergone. ing strictures will be found reliable indicators.

The term "doctor" was invented in the Some perhaps have never heard of these

twelfth century, about the time of the first flexible instruments, yet I think most sur. establishment of universities. The first pergeons will on trial find them a useful addi

son upon whom this title was conferred was tio to their armementarium. They are particu. Irnerius, a professor of law at Bologna Unilarly serviceable in commenoing the treat

versity. The title was created by Emperor ment of striotures which are difficult to enter.

Lobaire II, but was suggested by Irnerius In advising an internal uretbrotomy as a

himself. The term extended to the faculty substitute for dilatation I think the follow

of theology, and was first given by the Uni ing paragraphs taken from the Annual Surgi. versity of Paris to Peter Lombard, the fam. cal Reports of St. Peter's Hospital, London,

ous theologian. In 1329 the College of Asti indicate the favorable opinions that bave been conferred the first title of doctor of medicine fcrmed of this operaton in recent years:

upon William Gordenio. "One hundred and thirty-six cases of urethral stricture were admitted (1903) of which COSTAL OR RIB-BREATHING.–Costal or 92 were operated upon by internal urethroio- rib-breathing is the most efficient. It enables my with one death from acute suppression the singer and the speaker to take in the thirty-six hours after the operation; and 119 greatest amount of breath, and the effort is cases of stricture were admitted (1904), of not great because it is sbared by all those these 90 were operated upon by internal muscles whose function it is to pull the uretbotomy with no deaths.

ribs upward and outward. If the thorax is This gives a total of 255 cases of stricture unconstricted, the greatest expansion will in two consecutive years, of which 182 were be about its lower and middle portions operated upon in this way with one death, where the ribs are more movable and where whilst cases were treated by dilatation and in the angle of their inclination with the spine

is most acute. Another reason why this Satisfactory as these figures are it has been type of breathing is the most effective in that said, “once strictured, always strictured.” this uplifting of the ribs puts the thorax into By this is implied that however suocessful the best possible position for the expiratory treatment may be, recurrence is liable to take control that follows during the act of vocal. place.

ization. The diaphragm for artistic purposes In the course of these remarks I shall en. is not an inspiratory musole; it should be deavor to show that this liability may be con- used only in the expiratory effort of singing

and speaking • The Lancet, Feb. 3, 1883.

other ways.



ible and so easy to say, "if you cannot find

the exact condition, open the abdomen and DIAGNOSIS OF PYLORIC STENOSIS. see exactly what the trouble is." It must

not be forgotten that it is diffioult through EDWIN WALKER, M. D.

the ordinary opening in the abdomen to fully explore all parts of the stomach and ulcers

and gross lesions are often overlooked. On ACCURATE knowledge of the pathology, di. the other hand, by careful study of the clipi. agnosis and treatment of diseases of the cal history, supplemented by modern methods stomach is of very recent origin. The last of physical examination, we will be able, in twenty-five years bave contributed more useful most cases, to accurately diagnose the condiinformation than all the time preceding. It tion, and in some of them, better than we is true that Kussmaul gave us the stomacb- could by an exploratory incision. tube in 1869, and in 1871 Leube pointed out I would say, in chronic organio stomach its importance as a means of diagnosis and diseases, in which stenosis of the pylorus exmade some valuable contributions to our ists, or in cases of chronic ulcers, which have knowledge of the motility and secretions of resisted rational treatment, and also in cancer the stomach. In the early eighties, Ewald, of the pylorus, where the patient is in fairly Boaz and Riegal studied further the secre- good condition, an exploratory incision is intions of the stomach and many other work. dicated. There probably wonld still be a few ers joined them and gradually a fairly good other obronio organic cases in wbich it would knowledge of the chemistry of the gastrio be justifiable, but there would not be many. juices was formulated. But so many were This would leave a comparatively small numthe methods and so extensive was the liter- ber of cases which would require an exploraature in this mass of information. It has

ory incision, and I venture to predict that been so difficult to get distinctly the essential with the increased knowledge of diseases of points and cuntradictory statements have the stomach, the indications for operative in. kept the profession from employing methods terference will be greatly curtailed and the which were useful.

number of operations much smaller, but the The surgeon came to our aid about the results, both as to mortality and benefit of same time; before 1880 few operations bad the patient, will be better than at present. been done. During the five years following, Some authors speak of operations for ulcers Billroth, Czerny and Peau bad proven that in a way to leave the impression that is in. surgery was worth investigation and from dicated in a very large proportion of cases, that time a large number of operations were while I know of no recent statistics on which done by many operators.

The mortality of to base a conclusion; from my own limited the reported cases was bigb, and doubtless observations I think the percentum would be had all been reported, it would bave been below ten. The older statistics of the cure very much higher, but not withstanding this, of uloer by dietetic and medical treatment real progress was made, not only in technique are not to be relied upon, more recent results but in pathology, as well. By the united being much more favorable. Operations for efforts of the internist and surgeon, we

are far from satisfactory; resections slowly clearing the way to a better under. are almost without exception a total failure, standing of the indications and limitations and conservative operations offer at best only of surgical interference. Still at this time temporary improvement, and few subjects live the conscientious practitioner finds great more than one year. Cancer of the lesser difficulty in discerning the truth, for the vast curvature represents 80 per cent of all cases, amount of literature is confusing, and it and surgery can do nothing for them. At seems to me that indications laid down by the pyloric end, the condition is more farormost surgeons are not altogether reliable or able both as to early diagnosis and operasafe, and are too often vague and unsatisfac- tion, but operations, so far, have done but tory. For example, we are directed to make little permanent good. an exploratory incision in "chronio stomach I wish, therefore, today to direct your at. troubles” which have resisted treatment for tention to pylorio stenosis for this is the consome months or years. Such directions are dition in which an operation may do good. entirely too indefinite for they would include The benign ones furnish our most satisfactory many functional cases. I admit that an ac. cases and of the malignant ones, while far curate diagnosis is not ulways possible, but from promising, by early work we may be reit is so in a very large proportion of cases, warded by a small measure of success. the failure being rare exceptions. I think, We must first determine that stenosis of too, that exploratory incisions have been the pylorus exists, then the lesson which given too much prominence; it sounds plaus- causes it.



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