also the so-called expectant plan of treatment. tion of the seat of the lesion. The three-glass Not less reprehensible, he states, are the reme test of the urine should be used, and sound dies in vogue at present, prominently among introduced to detect strictures and diverti. these, figure tbe alkaline diuretics.'' The oula. Rectal examination is imperative in author claimes that alkalies when absorbed nearly all cases, ard search must be instituted are completely destroyed as far as the acid for possible diseased conditions of Cowper's radicle is concerned, being converted into glands as this is_apt to cause an obstinate normal oblorids or salines and not carbonates, uretbrorrhea. Folliculitis of the urethral and he states that they exert beneficial effect mucosa may produce a mucopurulent dison the inflamed urethra, not as alkalies, but charge. Meatotomy

and circumcision as diluents and diuretics. The therapeutics should be performed in proper cases. Affecvalue of boric acid and salol is also doubtful; tions of the bladder, ureters and pelvis of the balsamics are condemned, presumable benefit kidneys or of the kidney itself must attract from these remedies being due to the water attention as possible causes in all ultrataken in them. In the acute stage the pa chronic cases. Cystoscopy and, if necessary, tient should take plenty of water, avoiding ureteral catheterization should be performed alcohol, tea and coffee, and condiments as before definitely arriving at a diagnosis. In well as soups and nitrogenous foods. The conclusion the author remonstrates against anterior urethra is flusbed with a normal sa unscientifio inethods of treatment and the line solution by means of the Valentine failure to recognize the gravity of gonococdouche or similarly devised apparatus, with cio urethritis. The treatment undertaken a good valre attachment to regulate the flow. by the physician must be in conformity with The apparatus should not be elevate higher the most modern principles governing it. than six feet. The üretbra having been cleansed, 20 minims of a solution adrenalin Some Observations on Prostatectomy.-L. (1:1,000) is instilled through an ordinary Bolton Bangs (Med. Record) considers the bulb eye dropper into the canal, retained five following factors in deciding whether or not minutes and allowed to escape. The saline to advise prostatectomy; the general condiirrigations are continued once or twice daily tion of the patient, bis social condition and for ten days, after which potassium perman- environment, his temperament and bis accessi. ganate is substituted in ascending strength, blity to judicious medical advice and assist1:10,000 to 1:1,000 at the end of the third ance; whether or not catheter life is likely to week. By this time the discharge will have fail, and, if it has failed, in what degree; and, ceased, or nearly so, and a prescription of finally, what measure of relief is to be gained zinc sulphate, adrenalin and colorless Auid if, after the operation, some imperfection extract of hydrastis in distilled water may should remain which is insignificant in combe used, which, in a short time, will check it parison with the prior condition. The writer completely. Three weeks suffice in the ma then gives the histories of a number of pajority of instances to effect a cure. The treat

tients which show how often significant ment of the chronic form of uretbritis is symptoms are appreciated or overlookled. He more difficult, tedious and complicated than speaks of certain cases in which small prosthat of the acute variety. The author rec tates have been removed when there were few ommends as an injection a solution of pro or no signs of obstruction. In these cases it targol (5 per cent) together with adrenalin was not recognized that chronic interstitial chlorid and Magendie's solution of morphine cystitis bad reduced the capacity of the blad. if necessary.

In some cases silver nitrate der so that frequent urination bad become a acts more favorably than other silver com necessity. Each case must be studied by itpounds. Irrigations with potassium per. self. The final outcome of the operation canmanganate or zinc sulphate may be useful. not be foretold definitely, but when the inThe introduction of sounds is indicated: dications are clear it can be wisely advised first, in incipient and formative stages of on account of the great relief and comfort stricture; second, in involvement of the pos which result. terior urethra without implication of its adnexa; third, as a powerful stimulant to the uretbra in catarrbal treatment affecting its

In protracted cases of summer complaint anterior segment, where no gonococci

give fresbly pressed grape and other juices demonstrable. The author recommends uretbroscopy for table practice as a means of

to prevent sourvy. diangosis and as a therapeutic auxiliary. The For toothache nothing is better than oil value of internal treatment in chronio gono. of cloves and tincture opium, equal parts, apcocoic urethritis is questionable. The proper plied to the aching tooth on a pledget of cottreatment in all cases depends on determina. ton, says Dr. J. L. Fennel.



should be as condensed as justice to the subject will allow.

the disclosure of which would constitute a libel, he ought to give the certificate to the

patient (not to a third party, as in this case). A Cosmopolitan Blwoekly for the General Practitioner

Then any responsibility for disclosure to The Medical Fortnightly is devoted to the progress of the Practice and Science of Medicine and Surgery. Its aim is to pre

others would not rest entirely with the pa. sent topics of interest and importance to physicians, and to this tient.-J. A. M. A. end, in addition to a well-selected corps of Department Editors, it has secured correspondents in the leading medical centers of Europe and America. Contributions of a scientifio nature, and PHARMACOPEIAL OR PROPRIETARY PREPARoriginal in character, solicited. News of Societies, and of inter

ATIONS: WHICH?- Dr. J. Ritter, Chicago esting medical topics, cordially invited.

Advertising forms close on the first and fifteenth of each (Jour. A. M. A., Sept. 1), discusses the month. Time should be allowed to submit proof for correction Advertising rates on application.

task confronting the medical profession of Remittances and business communications should be addressed to the Fortnightly Press Co..

providing an effective method of checking the Subscription, $2.00 a year, in advance, including postage to practice now in vogue with many of its mem. any part of the United States, Mexico and Canada. Postage to foreign countries in the Universal Postal Union, including New bers of prescribing and recommending vari. foundland, $1.00 a year additional. Entered at the St. Joseph post-office as second-class matter.

ous proprietary preparations, many of which The Medical Fortnightly will not be discontinued at expira are fraudulent. It is difficult, be states, to tion of ubscription, as many of our readers prefer not to have their files broken on account of failure to remit. Unless we re

draw bard and fast lines regarding what con. ceive a distinct request to discontinue, and payment for all ar

stitutes an etbical preparation in contradisrearages, this magazine will not be discontinued.

Subscriptions may begin at any time; volumes end with tinotion to the so-called nostrums. He declares June and December.

Contributors should understand that corrected typewritten that it is not good practice to condemn in copy is essential to clean proof aod prompt publication, and is

toto, as undoubtedly even some nostroms much more satisfactory than manuscript. Original articles

possess therapeutic properties, since in their Editorial offices in St. Louis and St. Joseph, where specimen copies may be obtained, and subscriptions will be received. composition well-known drugs are used.

Contributions and books for review should be addressed to the Managing Editor, 319 and 320 Century Building, St. Louis,

Ritter states that it would be a good plan for Mo.

physicians and druggists alike to look into the composition and combination of all new

chemical and synthetic and Galenical prepMEDICAL MISCELLANY

arations, not excluding the patented" nos

trums which from time to time are offered to LEPROSY HOSPITAL IN THE HAWAIIAN IS

physicians as therapeutic agents. He refers LANDS.-Dr. Walter R. Brinckerboff, of the to the claims made for the various cod-liver Harvard Medical Sohool, has received the ap- oil preparations on the market and states that pointment as director of the United States by the addition of expectorants, anodynes and Government Leprosy Research Hospital corrigents a pleas

corrigents a pleasant-tasting elixir, cordial which is established on Molokai, the island or tonic is made which does not contain a on which the lepers are now segregated. trace of cod.liver oil. He advises pbysicians Dr. Brinckerhoff lately sailed and is now in to devote about half an hour daily to study. charge at Molokai.

ing the Pharmacopeia, a good dispensatory, SUIT FOR CERTIFYING TO GONORRHEA.

or the National Formulary, in order to ac. The annual report of the London and Count.

quaint themselves with good, reliable and ies Protection Association contains, as usual,

accurate formulae and remedies. an account of various actions taken or threatened against physicians, wbich as a rule the

CAUTION.—The season is approaching when association was successful in defending. One

sudden changes may endanger the health of case, wbicb was unsuccessfully defended, is

your delicate patients, especially those suffer. of particular interest. A physician wrote on

ing from bronchial and pulmonary troubles. a certificate the fact that a member of a sick

In addition to giving good advice as to olub was suffering from gonorrhea and gave

proper clothing and the importance of keepthis certificate to the secretary of the olub.

ing the feet dry and warm, prescribe McThe member brought an action for libel and

Artbur's syrup of hypophopbites for ibe conslander. The physician pleaded that the

valescent, and thus forestall any tendency tocommunication was privileged, but the jury wards tuberculosis, and promote a prompt re. decided against him and awarded $750 dam.

turn to health. ages to the plaintiff. The case shows that a physician should never give his opinion of MR. GARDNER: "Well, dear, how are the the nature of an ailment to any one but the tomatoes you planted?" patient without the latter's consent in writ. Mrs. Gardner: “Oh, Jobn! I'ni afraid ing or in such form as to be capable of legal we'll have to buy what we need this year," proof. The solicitors of the association state, Mr. Gardner: "Why, bow's that, Mary?" in commenting on the case, that when a phy. Mrs Gardner: “I recollected today that sician, in the course of his duties has to fill when I did the planting I forgot to open the up a club certificate, and the ailment is on cans !''





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Diseases of the Nose, Throat and Chest.-
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Qui pro sunt omnibus


Sole Importers for the United States,

2 and 4 Stone Street,


Vol. XXX

St. Louis, OCTOBER 10, 1906.

No. 7


Papers for the original department must be contributed ex 1. The perineal section that immediately clusively to this magazine, and should be in hand at least one month in advance. French and German articles will be trans follows the internal incision is made on lated free of charge, if accepted. A liberal number of extra copies will be furnished authors, and

large grooved staff instead of a small one. reprints may be obtained at cost, if request accompanies the This renders the operation easier and fur. proof.

Engravings from photographs or pen drawings will be fur. ther guarantees its completeness. nished when necessary to elucidate the text. Rejected manuscript will be returned if stamps are enclosed for this purpose.

2. It enables the surgeon to divide what

remains of any stricture tissue that the inCOLLABORATORS.

ternal uretbrotomy has not included. ALBERT ABRAMS, M. D., San Francisco. M. V. BALL, M. D., Warren, Pa.

3. Repair is effected by the introduction FRANK BILLINGS, M. D., Chicago, Ill. CHARLES W. BURR, M. D., Philadelphia..

within the obstructed portion of the canal of C. G. CHADDOCK, M. D., St. Louis, Mo.

new tissue wbich shows no tendency to conS. SOLIS COHEN, M. D., Philadelphia, Pa. ARCHIBALD CHURCH, M. D., Chicago.

tract. In this respect resembling tbe heal. N. S. DAVIS, M. D., Chicago. ARTHUR R EDWARDS, M. D., Chicago, Ill.

ing by granulation and cioatrization which FRANK R. FRY, M. D., St. Louis.

usually follows lithotomy and other well Mr. REGINALD HARRISON, London, England. RICHARD T. HEWLETT, M. D., London, England. drained wounds of this part. J. N. HALL, M. D., Denver. HOBART A. HARE, M. D., Philadelphia.

4. It deals radically with the stricture, inCHARLES JEWETT, M. D., Brooklyn.

variably a serious one, and provides a direct THOMAS LINN, M. D., Nice, France. FRANKLIN H. MARTIN, M. D., Chicago.

escape of urine which otherwise is liable to E. E. MONTGOMERY, M. D., Philadelphia NICHOLAS SENN, M. D., Chicago.

be diverted by the irregular channels and FERD C. VALENTINE, M. D., New York.

sinuses that the first rush of extravasation EDWIN WALKER, M. D., Evansville, Ind. REYNOLD WEBB WILCOX, M. D., LL.D., New York has made under the pressure of the muscles H. M. WHELPLEY, M, D., St. Louis. WM. H. WILDER, M. D., Chicago, Ill.

concerned in the act of a very forcible at. tempt at micturition.

During the earlier portion of my professCLINICAL LECTURE.

ional life as surgeon to two general bospitals

in Liverpool, I had ample facilities for see. INTERNAL AND EXTERNAL URETHROT

ing cases of this kind.

Many of these pa OMY COMBINED. *

tients were landed from ships not having dootors. Not infrequently the penis, soro.

tum and adjacent parts were mortifying from REGINALD HARRISON, F.R.C.S.

the effects of confined and ammoniacal urine.

The cases were treated as a rule by inci. Consulting Surgeon to St. Peter's Hospital.

sions into the swollen perineum, scrotum and

neighboring tissues, but the mortality was This combination is suited to some cases considerable and much in excess of what it of strioture where an instrument can be

should be. passed into the bladder.

I examined after death many of these In 1885f I described an operation under

persons to ascertain how far the perineal and this title for various purposes connected with other incisons which bad been made where the bladder and urethra. At this time I was

urine was extravasated, had been sufficient unaware that Dr. Annandale, of Edinburgh,

in providing drainage. had anticipated me, and thus I omitted to

In a number of instances it was found that acknowledge my obligations to him for his

the central perineal incision in the direction important communication. Though applica- where the leakage from the urethra first ocble to strictures not amenable to dilatation or

curred often failed to provide incontinent to internal urethrotomy alone, where a guide drainage, and that extravasation into the sur. can be passed into the bladder, the combin

rounding tissues continued to go up to death. ation of internal with external urethrotomy These examinations also showed bow oiris specially adapted to strictures complicated cuitous the sinuses connected with the sur. with acute extravasation of urine.

rounding incisions as drains for urine often The reasons for this are as follows:

were, and their liability to become blocked *This is No. 3 of a series of lectures on this subject, deliv.

by sloughs and pus. ered at the London Post-Graduate College.

In the next place the stricture, invariably The Urethrotomies, appeared in the issue of September 10. NO2, on Internal and External Urethrotomies, appeared in an old one, was often found unrelieved, and the issue of September 25.

as much an obstacle to the natural flow of † British Medical Journal. It occurs to me that a somewhat urine along the urethra as before the extrasimilar operation had been performed by Dr. R. A. Kinlock of Charleston, S. C.

vasation had occurred.


No. 1, on

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