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consisting of daily doses of 1.5 to 8. grains of chaulmoogra oil. Improve ment gradually set in, and after two years of treatment the patient was free of symptoms with the exception of small scars upon the face. A slight area of anæsthesia on the elbow and slight thickening of ulnar nerve also remained. Later all symptoms disappeared except thickening of ulnar nerve. Lepra bacilli which were present in large numbers nine years previously could not now be demon


cream, used in ships that visit different
climes, of greater strength than those as-
sociated with the names of Colonel F. J.
Lambkin and Dr. Julius Althaus, and said
to be even more satisfactory in use than
are the other preparations.
It is as follows:



20 parts by weight.

35 parts by weight.

2 parts by weight.

Liquid paraffin, sufficient to produce 100 parts by measure,

Five minims of the cream contain one

Mercurial cream for In- There is a growing grain of mercury.
jections in Syphilis. tendency to treat
syphilis, particularly severe syphilis, in
its earlier stages by the intramuscular in-
jection of mercury preparations into the
buttocks. This method of treatment is
and has been extensively employed in the
army with great success, and Colonel
Lambkin's cream of mercury used for the
purpose is well enough known.

The main objection to the treatment is its painfulness: although, in order to get rid of syphilis rapidly and thoroughly, it is well worth while to submit to a certain amount of pain. This pain, however, is necessarily influenced to some extent by the volume of material injected. It is, therefore, like:y that the more concentrated the mercury the less bulky

will each dose need to be, and the less will the patient suffer, provided that the concentration does not itself have deleterious effects.

We are indebted to the Pharmaceutical Journal for a formula for mercurial

The mercury is rubbed down with a portion of the wool-fat in a warm mortar until no globules are visible with a hand lens; the remainder of the wool-fat is then added. The chlorbutol is dissolved in a portion of the liquid paraffin by the aid of gentle heat, mixed with the woolfat and mercury, and made up to 100 parts by measure with more liquid paraffin. The whole is heated on a waterbath until just fluid, then strained through three or four layers of white gauze and stirred with a glass rod until cold.

It is essential that the wool-fat used should have been purified by being heated with about twice its volume of water,

stirred well, strained through lint, the mixture being then allowed to cool in an ice chest. The cake of wool-fat separated is then scraped free from any brown deposit on both its surfaces. This purifying operation should be repeated until the fat is perfectly clean.-Hospital.



Genito-Urinary Surgeon, Roosevelt Hospital, O. P. D.

The Treatment of Urinary Incontinence with


Suprarenal tions.

Zanoni (Gazz. degli Ospedali, No. 48, 1907). The method of treating urinary incontinence with the substance of the suprarenal gland has been successfully employed by the author for some time past, and, with the assistance of other observers, he is now enabled to report the results obtained in 134 cases. Among these patients, 66 were cured, 21 were improved, 14 were better during the duration of the treatment, 21 were not changed; in 12 cases the statements were not sufficiently accurate for classification. A considerable share of the failures is referred by the author to certain deficiencies in the treatment, especially too short a duration. The earlier these children come under treatment, the better the prospects of a cure. However, good results have still been noted. at an age of 14-15 years. The dosage of the remedy must not be too small. Serious sequelæ were not observed in any instance; in four or five cases the patients complained of some abdominal pain and a tendency to vomiting, more particularly when the remedy was given on an empty stomach. These symptoms promptly subside when the dose is diminished. In order to guard against habituation, it is advisable to interrupt the treatment for several days at a time. F. R.

Continuous Catheter- Cardenal of Madrid ism of Ureters in Blad- (Zentralb. für Chir., er Lesions. No. 21. 1908) advocates the practice of continuous catheterism of both ureters as a means of keeping the bladder dry in certain cases of supra

pubic cystotomy. Such practice, the author states, has been found very useful in his own surgical work, and he believes that it can be applied without any risk of setting up ascending septic infection. Ureteral catheterism has been carried out by Albarran in both the preventive and the curative treatment of renal fistulæ following nephrostomy, but the value of this procedure has not hitherto, it is held, been tested in the operative surgery of the bladder. The author, after he has opened the bladder above the pubes for the extraction of a calculus or for the excision of a tumor or an enlarged prostate, introduces a No. 9 or 10 Charrière into each ureter and then passes the other ends of both catheters along the urethra. The retention of the catheters for several days after the operation serves, by keeping the vesical cavity free from urine, to improve the results of suprapubic cystotomy. Troublesome post-operative hæmorrhage may be more effectually controlled by packing the vesical cavity with compresses that remain dry and firm, and if the flow of urine through the suprapubic wound be suppressed the duration of the after-treatment will very probably be shortened. The abdominal wound is closed or kept open, according to the nature of the case, and the patient when able to take fluids should be treated by repeated doses of some urinary antiseptic such as urotropin, helmitol or vesipyrin. The permeability of the catheters must be carefully tested from time to time by the injection of small quantities of a 4 per cent. solution of boric acid or a 1 per cent. solution of nitrate of silver. If, as will be indicated by the arrest of the flow of urine, and by feelings

of discomfort and pain in the region of the corresponding kidney, either catheter becomes blocked, this, it is stated, can be readily replaced by a fresh one guided by a long mandrel, in accordance with the instruction of Albarran. On the fourth or fifth day, if no complications have occurred, the compresses are removed from the bladder and the operation wounds closed by sutures. After another interval of one or two days the ureteral catheters are removed and the bladder is drained by

a retained urethral catheter. The author has had occasion to prolong ureteral catheterism over nine days, but neither in this clinical experience nor in experiments on animals, in which the catheters were retained for 16 days, were any complications observed. The practice of continuous ureteral catheterism may be capable, the author suggests, of giving excellent results in the surgical treatment of vesical and of fresh vesico-vaginal fistulæ.British Medical Journal.

The Connection Be Sendziak (Med. Klinik, No. 9, 1908). The author contributes a compilation of the disturbances which have been observed in this con

tween Disturbances in the Upper Respiratory Passages and Diseases of the Uro-genital Apparatus.

nection, beginning with the nasal or nasopharyngeal disturbances, especially in shape of nasal hæmorrhage in nephritis. Mention is likewise made of the changes in the buccal cavity as well as the pharynx, namely, hæmorrhages, swelling, nutritional disturbances of the mucosa, such as anæmia and dry catarrh. Other less common complications in nephritis consist in tonsillitis, stomatitis and pharyngitis of the uræmic type, and membranous glossitis. The disturbances of the larynx and trachea include oedema, anæmia, uræmic asthma, uræmic aphasia, hæmorrhagic laryngitis and diphtheria.

Nasal disturbances are of common occurrence in the course of disease, especially of the female genital organs, appearing most frequently as hyperæmia, swelling and hæmorrhages; also as reflex neuroses. The author claims that menstruating women are predisposed to acute infectious disease of the buccal and pharyngeal cavity. Great importance attaches to the relations between laryngeal tuberculosis and pregnancy, which exerts an extremely unfavorable influence upon the affected larynx. F. R.



W. M. CARHART, A.B., M.D.,

Assistant Surgeon, Manhattan Eye and Ear Hospital, New York City.

Hygiene of the Eye in W. M. Carhart School Children. (American Journal of Obstetrics, July, 1908) draws the following conclusions:

I. The increase of late years in the number of children wearing glasses is not due to an increase in the number of weak or diseased eyes so much as it is due to the greater strain upon the func

tion of vision necessitated by our more extended use of the eyes for close work in the complex civilization of the present day.

2. The normal child is born hypermetropic and without astigmatism. The myopic child is either defective from birth or has acquired myopia from the stress of eyestrain, usually through the "turn

stile of astigmatism." Astigmatism is not congenital, but is practically always acquired in the normal child during the early years of life by excessive strain upon the muscles of accommodation.

The Treatment of

In the Long Island
Medical Journal for

August, 1908, J. C. Hancock discusses
the various methods of treating the symp-
toms of trachoma by medicinal applica-
tions. He has reached the conclusion
that there are few diseases, local or gen-
eral, in which a longer list of remedies
has been employed, but the more he has
seen of trachoma the more he has been
convinced that any patient presenting ob-
jective symptoms sufficient to permit of a
diagnosis is a case for operation. It is
his belief that the only way to cure
trachoma is to rupture the granules and
express their contents, and to follow these
procedures for a number of weeks with
instillations of a mildly stimulating anti-
septic-the last to eliminate traces of in-
fection in a germicidal way and by ab-
sorption small and deep granules not af-
fected in the operation. The instrument
he prefers is the Jameson trachomatome,
which does its work thoroughly, he says,
without injury to the conjunctiva. He
recommends that the eyelids should be

5. No young child should be encouraged to compete with its companions for prizes. Mental and ocular overstrain are the inevitable results of such educational monstrosities. In the primary schools es

pecially there should be no grading of subjected to a thorough squeezing after

the children.

the operation in order to expel the con-tents of the granules.

3. Kindergarten and primary work should be arranged so as to avoid strain upon the muscles of accommodation of the eye in the plastic years of childhood. Hence sewing and all weaving exercises should be limited in amount, if not absolutely eliminated.

4. Systematic study should be only begun when the delicate and soft tissues of the child's eyes have attained sufficient formation to resist distortion on

moderate use of the accommodation. This means, in my estimation, that prolonged, close work should not be allowed until the age of 10 or over. A child beginning systematic study at that age will, with suitable care, be able at 16 or 18 to acquire all the knowledge possible to its more precocious companion and will have the inestimable advantages of normal eyes and healthy physique.

6. A child incapable of the prolonged use of the eyes at the proper age should not be classed as culpably lazy. In the majority of cases there will be found uncorrected refractive error.

success in medicine than follows the correction in children of refractive error. Ocular hygiene is all important in preventing educational overstrain.

7. Inability to concentrate the mental attention and deficient powers of observation are often caused by bad visual memory resulting from eyestrain.

8. The symptoms and physical signs of eyestrain in children can be easily recognized, and there is no more brilliant

Treatment of Pene- J. A. Donovan
trating Wounds of the (Journal A. M. A.,
July 25) makes a
plea for a better prognosis in penetrating
wounds of the eyeball. He concludes:


1. Mild antiseptic cleansing-I to 5000 mercuric iodide (preferable), I to 2000 mercuric cyanide or 1 to 5000 mercuric bichloride or saturated boric acid. Argyrol in special cases.

2. Remove all magnetic foreign

bodies at once, also any or all that can be removed easier and safer now than later. Those remaining to be removed from time to time when the eye can most safely stand interference.

5. Keep patient in bed at least a few days, longer if possible, remembering that detachment of retina may have occurred.

A. E. Davis read a

paper (Journal A. M. A., July 25) before the Section on Ophthalmology of the American Medical Association, of which the following are the conclusions:

1. Diffuse interstitial keratitis may occur as a result of acquired syphilis.

3. Enucleate at once only such eyes as have been totally destroyed. Even then it might often be better to wait till about the fourth day to avoid the possibility of any question arising later. Others should be cleaned, filled with salt so

2. It usually occurs as a late secondary sign of the disease or during relapses in the tertiary stage of the general disease. Stephenson gives the average time

lution if necessary, prolapsed iris replaced of development of interstitial keratitis as

or cut off and got in the best possible condition.

4. Cauterize infected wounds; stitch when lids will not hold edges in apposition; use atropin and dionin as indicated. Hot applications are always safe and usually preferable to cold.

10.8 years after the primary sore. Loewinson has reported one case as early as three weeks after the appearance of a primary sore, while Ellett reports a case appearing as late as 23 years after the in


6. Never interfere with an eye until you feel reasonably certain you are now doing the best thing and that this is the best time to do it; otherwise always wait.

After 10 years of active practice, constantly dealing with these injuries in the mines, smelters, railroads and shops, by carrying out the above suggestions, he has yet to enucleate his first eye that was not destroyed at once or did not contain a foreign body, and so far, fortunately, he has never seen a case suggesting sympathetic ophthalmia where this line of treatment has been followed from the time of injury.

Diffuse Interstitial

3. It almost invariably affects but one eye, although there are a few exceptions reported where both eyes were affected. 4. It runs a quicker and lighter course, as a rule, than the cases due to inherited syphilis, and is rarely harmful to the sight. It should be remembered, however, that Griffith has reported one case in which the sight was entirely lost.

5. True salmon patches occur but seldom in these cases.

6. It is difficult to make a clinical diagnosis between the syphilitic and the tuberculous forms of the disease, and even a differential pathologic diagnosis is not always conclusive.

7. The prognosis is favorable, though it should be somewhat guarded from the fact that sight has been lost entirely in

one case.

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