Ulceration of the urethral mucous membrane of the prostate, as a consequence of previously existing lesion, may occur, but as an idiopathic condition we believe it will not. There is nothing special or specific in the form of ulcer affecting the prostate, nothing peculiar to it as an organ. Hypertrophy of the prostate among men who have passed the prime of life, or those who have passed the fifty-fifth year, as far as most carefully prosecuted researches tend to show, a peculiar affection of the prostate, is commonly, but by no means generally, met with. The organ enlarges by a slow and gradual process, and almost always produces more or less obstruction to the discharge of urine from the bladder.

This enlargement is not a product of inflammatory action, but it is due to an increased formation of the normal tissues of the prostate, and may, therefore, be classed as an hypertrophy.

Neither the length nor the transverse measurement may be increased, while the measurement from before backward (erect position) is almost invariably increased; the gland is thicker than natural, hence the fullness and pressure. Any or all portions of the gland are subject to enlargement, either the right or left lobe, or both, as well as the middle lobe or median portion, are alike subject to hypertrophy. This enlargement may distend the gland in its entirety, until cases are recorded that reached nine or ten ounces in weight, although about as many drachms is the usual weight of hypertrophied prostate.

The diagnosis is comparatively easy, the patient suffering but little or no pain, except the inability to pass water, a sense of fullness in the perineum, while in all inflammatory conditions the symptoms are marked by pain and suffering. As has been noted, then the age of the patient will generally decide as to the nature of the trouble. The treatment is rather palliative than curative; to prevent the encroachment of the organ upon the urethra, so as to obstruct that duct, is the most that can, in many cases, be done; and for this purpose gradual and continuous pressure is the most successful treatment. Commencing with a small gum flexible catheter, or bougie, the instrument should be carefully introduced, and allowed to re

main for several hours at a time. After a few days, an instrument of larger size, gradually increasing the size of the instrument until the required distension has been accomplished, then requiring the patient to have the instrument used daily and allowed to remain in the urethra for three or four hours. By this gradual and continuous distention, the gland accommodates itself to its new position, and leaves the urethra almost, if not quite, natural size, through the prostatic portion.

This same course of treatment may be demanded again in the course of a few months. Counter-irritation is of but little or no avail. In some cases, constitutional treatment proves beneficial, but not as a rule. As a secondary disease, the prostate may become affected with simple or malignant growths, or even tubercle or cancer, but, so far as I know, in no case is this organ the seat of idiopathic cancer or malignant tumor, and can only suffer secondarily from pre-existing diseases of this type in the immediate vicinity, when it may become involved in the difficulty and completely destroyed.

[XXXIV.]

THE LAW OF TEMPERAMENTS AND DISEASE. BY S. H. POTTER, M. D.

The study of no bodily influence is more generally neglected than that of temperament, in our advice to the healthy and in the treatment of diseases. There has been a good deal of hair-splitting among medical writers about temperaments. It is not important to revive controversies or recapitulate the names of classes under which the several "temperaments have been grouped. The truth is that the term "temperament" has been used to designate very different qualities of the physico-medical organism, such as general type and constitution, and, rather too vaguely, perhaps, the temperament or temper in its true sense.

The popular significance of the word temper, as applied to steel, for instance, holds good, and is especially suggestive and accurate, as employed to describe the habitual state of the animal organism. A sound temper or temperament is a well balanced and regulated condition of mind and body, wherein

normal degree of tension is maintained by the proper equipoise of the inherent qualities of which the nature is composed.

An irritable temper or excitable temperament is one which is too highly or unevenly strung, and will therefore jar on the slightest provocation. A stolid or dull temper, merging into moroseness, indicates a condition in which the tension is low, and certain of the more selfish faculties are not duly equilibrated. Just as in the muscular system, if opposing muscles are not of equal strength or duly energized, the limb will not be in a condition to act either quickly or continuously in obedience to the will, so in a temperament showing want of proper circulation of the inner forces, the judgment has seldom the readiness to decide, and the active life of relation is quite sure to be defective.

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Temperament has very much to do with the preservation of health and the restoration from disease. The sound and good-tempered resist disease, passing unscathed through great dangers, as the strong craft, bending steadily and riding gallantly before the winds, and under the control of a sound helm, threads the narrow passage among the rocks, or as the horse, bearing equably the rein grasped by a firm hand, can be driven safely through a crowded thoroughfare.

Those of variable, uncertain, irritable, and, more than all, of sullen temper, are a misery to themselves and all around them; the trials incident to life fret away their strength; the perils that lurk in their path can seldom be pleasantly avoided or overcome. The only way to live a healthy and a happy life is to cultivate a temperament in which the most opposite or contradictory qualities and properties of the organism are perfectly counterbalanced or equalized and combined.

Now, it becomes impressively obvious to the practitioner that one temperament is open or liable to attacks of most prevailing diseases, while the opposite, or well-balanced temper, is proof against every malady except accidents, and may live to extreme age, and at last die at the natural limit of life. It is equally apparent, that, in the treatment of the various temperaments, the action of remedies must be as diverse as are the temperaments, and that our own temper must be wisely

adapted to each successively to become successful. The first step in each case is to gain and secure the entire confidence and esteem of the patient, which will make after procedure harmonious and pleasant at each returning visit. The mind, to a large extent, controls the body. The adaptation of remedies, their character and efficacy, depend, to an important extent, in our knowing the peculiar temperament of the patient in our charge, and to the equalization of our own as well.

Here I may enumerate and describe some of the prominent acknowledged temperaments, for the purpose of refreshing our memories as to them and their combinations, so as to have clearly in mind how these will readily influence health and disease; the appetite, digestion and action of remedies, and how the patient will be acted upon by all surrounding influences: 1. The Sanguine.-Ruddy and red, with blue eyes, red hair, strong muscle, quick perception and movements, restless limbs, etc. In such, disease is usually acute, runs rapidly through its course, either to favorable or fatal results. Upon such a constitution, medicine has a ready and marked action, requiring but moderate doses.

2. Bilious.-Dark eyes, dark skin, black hair, stolid expression, thoughtful brow, with slow and feeble circulation of the blood. In treating such a temperament, a supporting treatment is required throughout, and the most cheering surroundings.

3. Nervous.-Fair skin, light hair, blue eyes, quick but feeble movement, timid glance, yet, perhaps, unbounded ambition. Such are the most sensitive to everything; must be humored to the verge of propriety; not depressed by medication, but treated through the mind as much as possible. Such are much like the sensitive-plant-shrinking from the slightest touch. These often possess the noblest natures.

4. Lymphatic.-Large body, pale, with gray or blue eyes, brown hair, shambling step, watery lip and slow determination; will rouse to action, both mental and physical, with the full assurance that either effort will do anything but good. Average practitioners can readily deduce the proper treatment and management adapted to so peculiar a temperament.

5.-We meet with intermixtures or modifications of these marked temperaments almost ad infinitum, and it is our duty to familiarize ourselves with the subject of tempers or temperaments, and, with Argus eyes, inspect each case. After due reflection, form a sound judgment as to what is indicated, and what the patient will most likely bear successfully in treatment, feeling that we are dealing with the most priceless gems-health and life. The functions of the physician, I need not say, are fraught with the highest responsibility of any human pursuit. We need in that pursuit

"Breasts to whom all the strength of feeling given,

Bear hearts electric—charged with fire from heaven.
Long shall we seek this ideal-wish to become this kind
Only through culture of both body and mind."

BY I. G. M. GOSS, A. M., M. D.

Prof. of Materia Medica in the Eclectic Medical College of Georgia, at Atlanta.

Rheumatism attacks either the fibrous tissues, joints, aponeuroses, the sheath of the tendons, the neurilema, the periosteum, or the tendons and muscles. One of its characteristics is an acute pain in the affected part. In the acute form the seat of the disease is in the synovial membranes of one or more joints. By some nutritive disturbance, those membranes become influenced, and yield a scanty exudation, which contains but little fibrine or pus. The swelling is the product of an inflammatory oedema of the surrounding cellular tissue. But in cases of a very high grade of inflammation, the exudation may be quite rich in fibrine, or pus globules. And although post-mortem examination show but slight traces of inflammation or hyperæmic and ecchymosed spots in the synovial capsule, which is often filled with a purulent exudate, yet the ends of the bones implicated may be infiltrated by bloody extravasations. In recent cases, the heart and large vessels may contain a considerable amount of fibrine, and the heart itself may exhibit structural changes, such as pericarditis, endocarditis and myocarditis.