changes in the eyes. Since 1895 however he has used the new silver salts, also such solutions as salicylic acid recommendod by Bishoff, chloric-water by Schmitt-Rimpler, thymol by Schirmer, boric acid by Crede-Wecker, potassium permanganate by Valenta, and carbolic acid, mercuric chlorid, and sulphocarbolate of zinc. Olshausen while using a 1% solution of carbolic acid had 8% ophthalmia; with the 2% solution he had but 3% of ophthalmia, while Spath with 1% carbolic acid had 1.4 of ophthalmia; Krunkenberg with a 2% solution had 13.4% of ophthalmia. Schroder with a sublimate solution had from 46% ophthalmia and with sulpho-carbolate of zinc he had but 3% ophthalmia; finally Erdberg with a 1 to 7000 sublimate solution had but 4% of ophthalmia. The acetate of silver has been employed with boiled water with comparatively satisfactory results; thus he treated 43 children with this salt and had two cases of ophthalmia, or 4%.

Bolignini's symptom in measles consists in a peculiar sensation of friction, felt when gently rubing the tips of the fingers over the surface of the abdomen with gradually increasing force; this phenomenon can be appreciated from the prodromal period on to the end of the disease, and is due to a morbilious eruption upon the peritoneum, according to Bolognini. In an epidemic of three hundred and sixteen cases Chapin observed this symptom in one hundred and fifty-four cases; he did not notice a sensation of friction, however, but rather a fine crepitation which recalls that given by subcutaneous emphysema, and seems to be due to the presence of bubbles of gas in the intestines; hence, Chapin does not regard this sign as a pathognomic of measles.

Koplik's only diagnostic sign of measles consists in peculiar spots on the mucous membranes of the cheeks and lips, varying from 0.2 to 0.6 mm. in size, are round, bluish-white, slightly raised, and with a reddish centre about the size of a linseed. They are found in no other disease and appear on the first or second day, but not invariably.

The prodromal rashes of measles appear within the first two days of the disease; frequently they precede the catarrhal symptoms, Koplik's spots, and the characteristic stomatitis, being usually very transient, which accounts for the scanty attention they have received from writers. The scarlatiniform eruptions, however, may last for a day and a night, and the isolated macules and papules longer, with a strong tendency to be localized.

Even the scarlatiniform rashes, which are the most widely diffused, seldom occupy the same extent as the fully developed rash of

scarlet fever; their distribution being capricious, and no special situation being affected. Highly characteristic is the simultaneous association of several varieties of eruption. Accidental eruptions also occur in the other acute exanthemata, e.g., scarlet ferver-but coexist or follow, instead of preceding the specific efflorescence. The prodromal eruptions of measles are strikingly free from any symptoms of cutaneous irritation. There is no pain or pruritis, nor is there any subsequent desquamation, and unlike smallpox, initial rashes appear to be of no aid in prognosis in measles.

What relation school bears to infectious diseases is interesting: Cohn, medical inspector at Charlottenburg, has been collecting the statistics of the four largest cities of Germany during the last ten years to learn whether infectious diseases are more prevalent or less so during the school vacations; of course if they are less prevalent at this time, it would be an argument in favor of closing the schools. at the outbreak of an epidemic, but he finds that the vacations do not seem to have any effect on the prevalence of diphtheria and scarlet fever, although measles, drops abruptly so soon as the schools close. He explains this by the fact that scarlet fever and diphtheria are not so contagious in the early stages, while the child is usually so sick that it is kept home before the really contagious stage is reached, but in measles the disease is highly contagious from the start, and he recommends to close the school room at once whenever measles is prevalent.

The only way to control smallpox is by vaccination; it has been proved again and again that the strictest quarantine is utterly useless when used alone. Without vaccination there is no reason why smallpox should not again become as great a scourge throughout the world as it was in the "prevaccination era;" so compulsory vaccination laws are important. Physicians should ever throw their influence in favor of vaccination, but they should not place themselves in false light by trying to force legislation demand. ing compulsory vaccination laws, but such laws should be demanded by the people for self-protection. Bracken believes that quarantine is either evidence of a lack of scientific knowledge as to the proper means to be employed in the control of a communicable disease, or inability to apply such knowledge. Therefore, the attempt to control smallpox by means of quarantine alone should be abandoned, for it is unscientific, impractica ble, expensive and a failure. The present methods of quarantine for smallpox can be abandoned after a sufficient time has elapsed to permit the creation of compulsory vaccina

tion laws, and smallpox has been eradicated completely for some years.

The best way to remove adenoids from the post-nasal region is by the sterilized finger nail. In this way it is possible to outline and remove the growths in the obscure recesses of the nasopharynx, guided by touch. Cousins uses a mouth-gag consisting of a short rod of hard wood carrying a wooden ring to regulate its insertion between the teeth, and with one end larger than the other to suit the capacity of the various mouths; his forefingers being protected hy metal rings and nasal probes, inade of flexible metal, are used to clear the posterior nasal apertures. He prepares the patient by the frequent application of some deodorizing mouth-wash, and carefully examines the teeth, removing any loose tooth before the introduction of the gag. Whatever anesthetic is employed only enough should be given to arrest corneal sensibiilty, and it always should be stopped short of suspending the reflex actions of coughing and swallowing; the patient's head is brought well over the edge of the table and is supported by the hands of a nurse or by the arm of a surgeon; at the same time the shoulders are raised on a pillow. The nasal probes are passed through the inferior meatuses into the pharynx; the gag fixed in the right angle of the mouth and the left forefinger is introduced into the pharyngeal fossa, and with it the sides and roof of the eustachian orifice

and the posterior nasal apertures are rapidly cleared; shifting the gag to the left angle of the mouth the operation is repeated on the right side with the forefinger. After clearing away the adenoids, he excises the tonsils, should they be unhealthy and enlarged.

Our Fourth of July problem is growing to be bitterly a serious one. The average sane adult dreads the day and looks relieved when it is over. The "problem of problems" is the toy pistol; here comes Dolley who has examined the blank cartridges from the principal manufacturers and finds: (1) Aerogenes capsulatus (Welch) was present in a large proportion of the wads of the three makes of cartridges examined. (2) The wads of the Peters Company, inoculated in rats, guinea-pigs and rabbits, produced characteristic symptoms of tetanus. (3) The powder of the three varieties of cartridges examined was negative for B. tetani and B. aerogenes capsulatus. (4) My efforts at isolation of B. tetani from wads have so far been unsuccessful. (5) There is abundant evidence, from clinical observations and animal experiments, that the wads of certain blank cartridges contain B. tetani. Welch considered it diagnos

tic to see an animal in convulsions; so the toy pistol is not the real offender after all. but the cartridge used. A report on the ball cartridge would be equally interesting.

PERMANENT CATHETERIZATION IN NON-SURGICAL CASES, WITH CASE HISTORIES, AND DESCRIPTION OF APPARATUS FOR RETAINING CATHETER IN PLACE.

C. A. BOICE, M. D. WASHINGTON, IA.

THIS is a subject of considerable importance to every physician, and of momentous importance to the patient.

We have been taught to fear and avoid the use of the catheter. Catheterization is selMedical literature is not very replete with dom mentioned except to be condemned. papers bearing on this class of work. A careful review of the literature-as indexed in the Journal of the A. M. A.-for the past five years, finds but two papers treating of this trouble. They are both written by the same authority, and treat of catheterization in surgical cases only.

I do not wish to be understood as minimizing the possible dangers of the introduction of a foreign body into the urinary blad

der, but I do think that the dangers have been greatly overestimated. A few months since, I heard a prominent authority relate a

case in which death had resulted from the Such cases do ocsingle use of a catheter. cur, and their possibility must ever be borne in mind.

There come under our care not infrequently cases of old men with serious urinary difficulties-urethral, cystic or prostatic. You cannot operate on all of them; possibly, and very probably, they are not operable cases.

Some of them have been more or less regular users of the catheter for a considerable time. I will detail four typical cases of which I have had charge recently, and hope to draw up some conclusions therefrom which will be both interesting and instructive.

CASE I. A farmer, aged 70, had always been a very active man until some three years since, at which time he suffered from a brain. hemorrhage with resulting hemiplegia. Following this he had to cease all work and live a very retired life. After a time the muscles at the neck of the bladder became involved in the paralytic state. The prostate was not

Read at Burlington, Iowa. June, 1905, before the TriState Medical Society of Iowa, Illinois and Missouri.]

enlarged. As the patient lived some ten miles in the country, intermittent catheterization was not feasible. The urine dribbled away constantly from the distended bladder, ammoniacal decomposition was beginning, and cystitis was threatening.

The best course seemed to be to leave the catheter in place permanently, only removing it every few days for cleansing. The instrument was easily introduced and secured in place, bladder irrigated with 2% carbolic solution. A No. 10 E. soft rubber catheter was used. A son was instructed in the introduction of the catheter and in irrigation. The instrument was removed every four days and thoroughly cleansed, and a new catheter was used as soon as any signs of maceration of the rubber was evident. Within a few days the urethral mucosa became tolerant to the presence of the foreign body. There was no pain or tenesmus unless the catheter projected too far into the bladder. There was very little urethral secretion.

Under daily irrigation, the cystitis soon disappeared, and never again gave any serious trouble. Irrigation was continued thereafter every fourth day. If any evidence of cystitis was noticed, daily irrigations were again resorted to with an early subsidence of the symptoms.

The greatest trouble was from the precipitation of the alkaline phosphates around the end of and within the lumen of the tube. This was very annoying at times, necessitating frequent removal and cleansing. Rendering the reaction of the urine acid would overcome this condition.

The patient was able to be up most of the time, and a soft rubber urinal was worn strapped to the thigh. The catheter lead into this.

The catheter was first introduced April 21, 1903. In March, 1904, the patient contracted a severe attack of la grippe, from the effects of which he never recovered and died of prostration on June 25, 1904. The catheter was continuously in place between the dates above mentioned, a period of four hundred and thirty-two days.

During this long period there was never any inflammatory trouble of the vesical neck or of the prostate from the foreign body. The patient was very comfortable and enjoyed life.

CASE II.-A laboring man, aged 72 years, but if a man is as old as his arteries, this man would have registered not less than 90. A very marked case of general arteriosclerosis. He had always been a very hard worker, had, had gonorrhea at the age of 18. This had left him with three strictures in the anterior

urethra. Prostate was very large and tender. He had been an intermittent user of the catheter for several years, and a constant user for some months past. Catheterization had always been difficult and painful. A chronic cystitis of long standing was present. I found considerable difficulty in inserting the catheter, a No. 10 E. soft rubber one. It was securely fastened in place and daily irrigations with 2% carbolic acid solution was instituted. The catheter was removed every fourth day and cleansed. The cystitis diminished gradually in severity, pain lessened, and there was no strangury or tenesmus unless the catheter was in the bladder too far. Death resulted from

the rupture of one of the atheromatous arteries, probably the coronary. The catheter had been in place continuously from January 10 to March 14, 1904, a period of sixtyfour days.

CASE III.-Retired carpenter, aged 72. Had always been a very active man prior to the onset of transverse myelitis in 1895. The myelitis gradually increased until it involved the nerve supply of the rectum and bladder. The bowels were evacuated but once a week, and then only by the use of drastic cathartics

More and more difficulty was daily experienced in urination until finally complete obstruction occurred. Catheterization was a very difficult undertaking, and when successful the instrument was anchored. As the patient was bedfast the urine was lead into a bottle at the bedside. After the first few days the presence of the catheter caused no irritation. Twice weekly irrigations were practised, there was never any sign of cysti tis, phosphatic deposits were an occasional troublesome condition. If the catheter was not in place the urine soon became ammoniacal, and was expelled involuntarily. bladder did not empty itself, the bladder walls possessed no contractive or expulsive power. The catheter was continuously in place until death occurred from the extension of the transverse myelitis, from July 1, 1903, until February 7, 1905, a period of nearly twenty months, or to be exact, 588 days. The patient was comfortable with the instrument in place, had no pain or strangury, did not have any evidence of inflammatory reaction.

The

sary to offset the constipating action of the morphine. His prostate was very large and projected backward against the rectum. The severe catharsis produced an acute inflammation of the prostate with consequent obstruction to the urinary outflow. During this time he had been mistreated by an osteopath, but urinary obstruction refused to be relieved by such methods, and other help was needed. The passage of the catheter was very difficult and also very painful to the patient. A No. 9 E. catheter was used; it was firmly anchored. The morphine cough medicine was discontinued, rectal and prostatic congestion relieved by suppositories. Daily irrigations were practiced. Patient was comfortable with the catheter after the first

2. Of the cases found in the literature of permanent catheterization, the longest was a period of sixty-five days, while one of my cases was four hundred and thirty-two days and the other was five hundred and eightyeight days.

3. Within two or three days the urethral mucosa becomes tolerant of the soft rubber tube and no secretion of consequence result.

5. If the tip of the catheter project just far enough into the bladder to permit of the escape of the urine, no pain or strangury or tenesmus result.

5. The bladder must be irrigated at least every fourth day with some mild antiseptic solution, the instrument removed frequently

day. The instrument was in place constantly until all inflammatory action had subsided and the patient was again able to urinate naturally. The catheter was in for a period of twenty-nine days. He is now in good health after a period of fifteen months and has never had any return of the trouble.

CONCLUSIONS.

1. While catheterization is not a condition. to be desired, yet I believe that the dangers have been greatly overestimated; in witness whereof we have but to refer to the great number of men in the catheter age. These men have been users of the instrument for several years and have never suffered any serious discomfort.

for cleansing, and a new one introduced as soon as the old one shows any evidence of maceration.

6. Permanent catheterization is indicated in acute and chronic cystitis, acute prostatitis, traumatic conditions of the urethra or prostate, paralyzed states of the bladder mus. cles, in cases of enlarged prostates in which operation is not feasible, and in operated cases in which the continuity of the urethra is impaired.

7. Catheters of larger size are tolerated better than those of small caliber.

8. The administration by the mouth of urinary antiseptics-salol or methylene blue -are undoubtedly of value in the treatment of cystitis.

After the catheter has been inserted into the bladder, a quarter inch strip of adhesive plaster is wound around the catheter about one-half inch from the end of the penis. About ten turns should be made, if it does not firmly adhere to the rubber, a stitch may be taken through it to hold it in place. This band is to fasten the stay straps to. Next a quarter inch collar is made to surround the penis. This must be doubled so that it presents no sticky surface. Three or four narrow strips pass from this collar to the band on the catheter.

To the collar is attached a narrow band to pass under the scrotum. Also from the collar two wider strips of plaster pass upward to be attached to the skin of the scrotal region. The stay straps are fastened to the band on the catheter by single stitches and are easily cut when it is necessary to remove the catheter for cleansing, thus leaving the rest of the harness in place. All the straps are double except the two which are fastened to the body. There are no attachments to the penis. This harness is simple, easily and quickly made, and is inexpensive. The adhesive plaster does not irritate the skin. If less than three stay straps are used from the collar to the band on the catheter, the catheter will force itself out of the urethra. A picture of the harness is here given with the hope that it may help others in managing these troublesome cases.

WHAT THE WORLD OWES THE DOCTORS. — It would be commonplace to point out the advances made in both medicine and surgery during the last half century, for in that time medicine has come to be a real science and surgery both an art and a science. Sanitation, hygiene, the broad principles that underlie the health of communities and states, are now well understood and the individual is made safe because the public may be thoroughly safeguarded against pestilence of any kind. The doctors have conquered smallpox, diphtheria, yellow fever, the bubonic plague and all but one of the dreadful scourges that devastated the homes of our fathers, and they are now on the right track in the systematic, relentless, intelligent and heroic war they are waging against tuberculosis. Typhoid fever, pneumonia and scarlet fever are robbed of much of their terrors, for where either was once likely to prove fatal now they are very likely not to. Who, then, has done so much for his fellowman as the doctor? Who else has lived for him so self-sacrificingly and died for him so uncomplainingly?-Portland Oregonian.

THE MEDICO-LEGAL ASPECT AND CRIMINAL PROCEDURE IN THE POISON CASES OF THE XVI CENTURY.*

CHARLES GREENE CUMSTON, M. D.

BOSTON, MASS.

Member of the Medical Historical Society of France; Corresponding Member of the New York Medical Legal Society, etc.

IN the long chain of history one is constantly meeting mysterious deaths seizing vigorous people in robust health. The subjects usually occupy some high position and who disappear just at the time when their presence becomes an obstacle to an heir or a competitor. One immediately has the feelof homicide, although there are no absolute ing that all these deaths are merely instances proof in favor of this hypothesis. Blood was not shed, the sword leaves no trace, nobody saw the assassin accomplish his crime and nevertheless general opinion refuses to believe that all these victims died natural deaths. the terrible and detested name of poisoner. They designate certain people by In point of fact poison has played a great part in history and was a much too convenient arm to be left aside and it is always found in the hands of those who, devoured by ambition, had not the courage to end their desire by the price of an outright murder. The latter had the misfortune of leaving some trace behind, which sooner or later would denounce the culprit, while poison would only leave a doubt as to the true nature of death and, for this reason, in all times it was employed in order to avoid intrigue. Poison was the arm of the aristocracy and kings did not disdain it, so that an example starting from so high a source was naturally followed by the courtiers in the first place and the people afterwards.

The true home of poison was the Orient and the princes of Asia, tired of bloody spectacles, searched for new voluptuousness by witnessing the effects of poison given to their slaves and consequently the history of Asia represents a long chain of dramas from death by poisoning. From the Orient this method came to Greece, but without making such impression there, because the loyalty of this people made them repugnant to such crimes, and they reserved poison for those they wished to put to death legally. In imperial Rome things were not the same and the then reigning conditions represented an essentially favorable midst for the development of homicide by poisoning and such instances rapidly became numerous. During the Middle Ages this crime appeared to be

From advance sheets of the Medico-Legal Journal.