After quieting the nervous system, vomiting and tenesmus, give sulphate of quinia, grs. xx; bromide of potassium, 3jss.; hydrastin,grs. M. Makes fifteen powders. Sig.-one powder every three hours o its volt puusb

This is the general treatment I have pursued for the last years, and with it I have success.

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If we give any remedy in this or any other disease without knowing its action, and the pathology of the disease, we certainly are groping in the dark, at the expense of the patient. I ask an impartial consideration of these thoughts.

་(དཀ

TRANSLATED BY JOHN TASCHER, M. D., CHICAGO,

ILL.

...

In an article by Prof. Lewin for the Annales des Cherite Krankranhouse zu Berlin, V. Jarhrg, 1880, he states that he has had, within the last three years, thirty-two cases of constitutional syphilis, all of which he treated by subcutaneous injections of pilocarpin. In twenty-five cases a permanent cure was effected. Seven were not benefited. In five out of the above-mentioned seven, the subcutaneous injection produced symptoms of collapse, hemoptoe and pericarditis. In these he was obliged to discontinue the subcutaneous injection without any apparent mitigation of the syphilitic symptoms. In the other two cases of syphilitic pustulosa, after thirty injections had been used, the disease still remained persistent; these were afterward cured, by the mercurial treatment. Among those that were cured, there were several affected with condylomata. In one case there was periostitis, gummata of the frontal bone, with syphilitic ulceration of the thigh. The time required to bring about a cure ranged from fourteen to forty-three days. On an average the cure was effected in thirty-four days. Daily injections of 0.015 Gram.;” or nearly of a grain, were made, where the, condition of the patient would permit.

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V

I

The first point was that retention of urine in children was always caused by a stone, unless othere is some mechanical obstruction in the escape of urine, such as a contracted meatus or tight foresking ended, ena

"

Second PointThat incontinence of urine, which is diurnal, as well as nocturnal, may be caused by a calculus impacted in the deeper portions of the urethra. He explained how it was that in one case a stone would give rise to retention, and in the other to incontinence. When a calculus was at the meatus internus it was accurately and firmly embraced by the sphincter, so that no urine could escape. When, however, the stone advanced half an inch further forward, it acted as a gag, and prevented the sphincter from closing, so that the water dribbled away along the sinuosities in the calculus.qdn.e Third Point That incontinence of urine in boys may be caused by a congenitally contracted meatus. If the urine could not escape freely in the act of micturition, reflex irrita tion was set up, and dribbling took place...

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Fourth Point That dribbling of urine in men, signifies retention, not incontinence. He explained the apparent paradox, showing how, in cases of enlarged prostate or stricture, the patient always left some urine behind after each act of micturition, which gradually accumulated, the over-distended bladder not being able to contract on its contents, the action of the sphincter being still perfect. At last, however, the stricture became weakened a little by the great pressure, and leakage followed, so that urine was always dribbling away. tia Fifth Point That if, when a catheter was passed in a man, the urine was expelled with great pain and violence, not only through the instrument, but in streams by its side, there must be calculus impacted in the deeper portion of the urethra

Sixth Point-That it is not possible to empty every man's bladder with a catheter, as the organ is sometimes sacculated. Seventh Point-That a gleet of more than six months' duration means an incipient stricture.

Eighth Point-Behind an enlarged prostate always suspect a stone, as there are in that complaint all the conditions present for the local formation of calculus.

Ninth Point-If a man who complains of painful and frequent micturition is worse in the day than at night, he most likely has a stone. Prostatic cases were very much worse at night than in the day, whereas calculus patients were most comfortable while in bed, but when they moved about in the day they suffered greatly from the movements impressed on

the stone.

Tenth Point-When a man who complained of frequent and painful micturition was very much worse when riding in a vehicle or on a horse, he most probably suffered from The explanations in the former point applied exactly

stone.

to this also.

Eleventh Point-Before delivering a child see that the mother's bladder is empty.

Twelfth Point-If a woman had retention of urine after childbirth, she ought to be relieved with an elastic olivary catheter, the interior of which was completely filled by a bougie. For the want of this precaution the catheter often became plugged with mucus, and cystitis was set up by the nurse's ineffectual attempts to withdraw the urine.-Mr. Teevan, in Medical Press and Circular.

TWO CASES OF TREPHINING RECOVERY.

BY WEBB J. KELLY, M. D.

While attending my first course of lectures, I distinctly remember visiting the Academy of Medicine one evening, and sitting two hours and listening to a discussion on whether it was best to operate before or after the patient had passed into a comatose condition, in fractures of the skull. Our professor of surgery arose and said: "Gentlemen, if you are going to operate, do so at once." It struck me very forcibly that he

was right, and, as it has been my good fortune to operate twice successfully, once when the patient was in a comatose condition, and once when he was not, I will give the profession the benefit of my experience.

CASE I. Charles Yager, seven years of age; American; rather delicate; farmer's son. June 11, 1877, was called, in consultation with Drs. Reed and Bennett, of Iberia, to see this boy. He had been playing in the yard, and, as was afterward ascertained, struck a horse's heels with his hat, when the horse kicked, striking him in the head. He was found by his mother in a comatose condition, which state he was still in when I saw him, four hours afterward. Examination revealed a compound comminuted fracture of the right parietal, at the junction of its articulation with the left parietal and the occipital, with decided compression. I advised an operation, and, after warning the parents of the danger connected with it, proceeded to operate. Chloroform was administered, and, although our light was miserable, we were very successful in elevating the detached fragments without rupture of the membranes. Two of the pieces taken away were quite large, one being two inches long by one and a quarter wide, the other being about two-thirds the size of the former. The patient recovered consciousness immediately after the pressure was removed from the brain, and was able to recognize his parents. The wound was left open, and the patient placed in a darkened room in a position to favor drainage. Controlled the circulation with veratrum viride and aconite, and, as he showed extreme signs of anæmia, ordered ten-drop doses of tinct. ferri chlor. An "ice-bag" was applied to his head, and kept there until he was out of danger. In seven weeks from the time of injury he walked into my office, feeling well, and to-day he is attending school, and is apparently as bright as if he had never been injured. The aperture caused by the loss of bone is gradually filling in, and is covered with a thick scalp. It seems to me that, in this case, the operation saved the patient's life.

CASE II. Arthur Nasor; residence Ontario, O.; aged twenty-three years; farmer; good habits; strong and healthy.

While crossing the railroad track he was struck by a freight engine, which was running about twenty-five miles an hour. When the train stopped he was found hanging to the rods above the pilot. When taken down he was able to walk back to the caboose, and, when they arrived here, he walked to my office, a distance of eight blocks. Inspection showed a large wound over the front part of the head, from which arterial blood was flowing pretty freely. An examination revealed a compound, impacted fracture of the frontal bone a little to the left of the median line, and at the junction of the articulation of the frontal and left parietal bones. This examination was at about 2 P. M., and it was my wish to operate immediately, but, owing to the absence of his friends, I was delayed until 6.30 P. M. He was already beginning to pass into a comatose condition; pulse very slow and full, showing signs of congestion. He was etherized; the wound enlarged, and a button removed from in front of the fracture. It was then with the greatest difficulty that I could remove the impacted fragment, part of it having gone through the membranes into the brainsubstance itself. The removal of the bone was followed by such an extravagant rush of blood that death seemed inevitable. The patient lay unconscious some ten or fifteen minutes, and then opened his eyes and was able to recognize friends. The bone which was removed was exactly the size of a silver dollar, and the shape of the bolt which drove it into his brain. The wound was dressed with carbolized water, and the patient made to lie in a position to favor drainage. His room was darkened, and the ice-bag applied to his head. What shall I say of the treatment? This, and nothing more! The ice was kept to his head night and day, and whenever there was the slightest symptom of congestion he was given a good full dose of Rochelle salts. Not another drop of medicine was given him, and to-day, ten weeks from the day of injury, he is in as apparent good health as he ever was.

Both these patients recovered without a single bad symptom, and, when I say I do not agree with Ashurst when he makes the assertion: "Hence, in impacted fractures, though compound and depressed, I would not advise an operation even