line layer, is acted upon and digested by the gastric juice, thus causing a solution of continuity. Proper feeding is the great element of cure. Dr. Foster, of England, first proposed to treat these cases by feeding by the rectum, thus insuring absolute rest to the stomach, and he has had very good results from this method. As a rule, gastric ulcers tend to get well of themselves, but now and then we will have a severe and obstinate case, when rectal feeding must be considered. When this is not feasible, the diet should be restricted to skimmed milk. Fowler's solution, one or two drops thrice daily, will do good, as will also oxide of silver, one or two grains. It will rarely be necessary to do more than regulate the diet and give Fowler's solution. If the liver be deranged, it must be attended to.

COCAINE IN GONORRHŒEAL ORCHITIS.

BY

W. C. MAXEY, M.D., OF MARCUS, IOWA.

On Dec. 4th I was called to B. F., aged 28, of full habit. On examination, found acute orchitis of left testicle, with a gonorrhœal discharge from urethra; the testicle much swollen, hard and painful, with darting pains up spermatic cord, and pain on pressure over inguinal region of left side. By questioning, patient stated he had contracted the disease in July, five months previous, and had been treating himself by using free medicine receipts, at times better, but the disorder would persist in returning, and so remitting and returning up to final result. He ha quite recently married a very estimable young lady from Illinois, and had communicated the disease to her. The patient and wife, with his father and mother, all at the old home and all highly respected— a close place, you see.

I told the old gent his son had inflammation of testicle, and he appeared satisfied; and to the patient's wife, that pus was poison, and if applied to a denuded surface or injected under the skin, or coming in contact with a mucus surface, would produce inflam

mation, with burning and pain. She replied that she did have the burning and pain, especially at micturition. Seeing that she anticipated my object, I then explained that in all probability her sexual organs had become poisoned through the medium of the sexual act. She looked me square in the eyes, as if to catch any expression to the contrary. I had told no falsehood, so the lines of my face were as composed as a saint.

To the husband I prescribed pulv. doveri gr. viii. every four hours. Also

B Distilled ext. copaiva

Distilled ext. cubebs...

Spts. ether nit........

Glycerine......

.3ii.

.3iss.

.ii.

.3iiss.

M.-A teaspoonful every four hours, with warm fomentations to testicle.

Saw patient Dec. 5th. Much better and easier. Prescribed for wife. Exit. Saw patient again Dec. 7th; temperature 99; pulse 96. Discharge from urethra unchanged in quality or quantity, paiu in back, groin and thighs, abdomen tense, testicle much swollen and painful. Removed warm fomentations. Prescribed a lotion:

R Tinct. aconite rad....

Tinct. arnica aa.....

Ol. olive........

.3iss.

.3iss.

M.-Apply on cotton-flannel to parts continuous. Also, calo

-Twelve hours after was sent for in great haste.

Messenger said patient had been having chills. When I arrived found the bowels had acted well; tension of abdomen reduced, but was still having rigors. Temperature 103; pulse 108.

My conclusion was that the rise of temperature and the rigors was due to formation of pus, and that I must puncture the testicle. The testicle being so very sensitive, made me think to test the efficacy of cocaine.

Pinching up the skin over testicle, I inserted the hypodermic needle just through the skin and carefully instilled five drops of hydrochlorate cocaine, 4 per cent. solution. I did this in three

different places, injecting five drops in each, between skin and epididymis; then I bathed the skin with the solution. Waited five minutes; patient said pain in testicle was not so bad, but that he was so sick. I waited longer; he was white around the mouth. Said he, "Oh, I am so sick." Respirations short and intermittent,' his face deathly pale. "Oh, doctor, I am so sick." The respirations dropped to about fourteen per minute. Pulse soft, depressed, and about 100 per minute. I gave him a good draught of brandy, placed his hands under his head, and told him to keep them there; then, grasping the testicle with my left hand, with the right I made an incision one inch deep into the anterior convex portion of testicle, cutting upward and outward.

There followed a gentle flow of sanious lymph and matter. I waited one hour. Pulse 86; temperature 102; respiration 22, and more regular. Applied linseed poultice to testicle and gave morphia sulph. gr. 3, with orders to give 10 other medicine until I saw him again.

Returned next morning; patient easy; had breakfast, felt well; testicle much reduced, and not so tender.

There was a discharge for three days and nights from punctured testicle, the discharge from urethra gradually subsided, and at this writing, Dec. 16th, both patients are doing well, he contending that he is well.

My object in reporting this case is to show the dangerous action of cocaine in this particular case. The patient expressed a feeling of deathly sickness, but made no effort to vomit; there was alarming apnoea and neurasthenia, and the patient said his cheeks felt heavy and dead, and actually brushed them with his hand to see if they were there.

I think the drug was quickly taken up into the lymphatic vessels, and passed into the circulation in a very short time, the absorption being rapid, hence the shock.

I had used the drug on other patients, on and into cervix uteri, on the cornea, and applied it in extracting teeth, and never had occasion to regret its use, but in the future I shall use it with dread caution, especially over and into lymphatic ganglia.

Selections.

WAXHAM: TREatment of CROUP.-(Chicago Medical Journal and Examiner, June, 1885.)-In the treatment of this disease the author approves of trypsin as one of the most, if not the most, valuable agents for dissolving the false membrane. His fomula is

R Fairchild's ext. pancreatis.....

Sode bicarb........

Aquæ dist

Glycerinæ.......

....

..gr. xv. ......................gr. iij.

This mixture may be used with an atomizer, and great pains must be taken that the spray may reach the affected parts. Lime water is mentioned as an excellent solvent, but only when the membrane is immersed in it. The vapor from a boiling solution does not dissolve it, as was shown by exposing a large fragment of false membrane to the vapor constantly for three hours. In the given experiment the membrane was neither disintegrated nor softened. The author admits, however, that benefit may be derived from the heat and moisture of the vapor. The same piece of membrane which was exposed to the vapor was placed in a two-ounce phial which contained an officinal solution of lime water; in seven minutes it had been completely dissolved. Another piece of membrane was subjected to a spray from a hand atomizer which contained the pancreatin solution according to the formula already given. It was sprayed four times, at intervals of half an hour, and at the end of that time the membrane was disintegrated. Again, a similar piece of membrane was sprayed with officinal lime water every half hour and was dissolved after six applications. A spray of a ten per cent. solution of lactic acid softened the membrane in three hours and a half, being used, as in other cases, at intervals of half an hour. The membrane was not completely disintegrated, however. The con2 S: P.

clusions which were reached were: (1.) A solution of pancreatin with soda and glycerine furnishes the most satisfactory solvent. (2.) The spray of lime water will dissolve false membrane, but not so efficiently as the pancreatin. (3.) The vapor from boiling lime water is of no use as a solvent. (4.) Lactic acid is not a good solvent.

O'Dwyer's method of tubing the larynx in croup receives unqualified praise. Its advantages are: (1.) The tube can be introduced and without danger. (2.) There is no mutilation. (3.) No wound as a cause of shock, or source of infection. (4.) The tube can be worn more easily than a tracheotomy tube, and without greater hinderance to coughing and expectoration. (5.) It does not require constant attention as does a tracheotomy tube. (6.) Bronchitis and pneumonia are less likely to occur than when tracheotomy has been performed, the respired air being warmed on its way through the natural air passages. (7.) The operation is less likely to be objectionable to the parents.-Archives of Pediatrics.

SANGUINARIA CANADENSIS.-L. B. Anderson after thirty years use of this drug esteems it more highly than any other one agent of the materia medica. In a paper in the Therapeutic Gazette, Dec. 1885, he writes at some length concerning it.

As to its modus operandi, he says that it causes an increased secretion from the respiratory mucous membranes and more or less also from other mucous surfaces, as evidenced by its sanative effect where there is obstruction of the hepatic ducts, and a dry condition gastric an intestinal mucous membranes. It seems to exert a special influence upon vaso-motor nerves controlling the capillary circulation in the mucous membranes and upon their trophic nerves as well.

Among the therapeutic uses he mentions the effect of a full dose at bed time in an incipent catarrh whon it will often effect such rapid and complete resolution that when arising in the morning all unpleasant symptoms will have disappeared. When pharyngeal inflammation has become so intense as to cause a rapid