The purity of Scott's Emulsion, the excellent quality of its ingredients and their skillful combination, and the excellent work it has done in the thirty years of its existence, make it the standard cod liver oil preparation. Samples Free. SCOTT & BOWNE, Chemists, 409-415 Pearl St., New York. TRI-IODIDES (HENRY'S) Colchicin 1-20 grain. Liquor Sali-lodides. A powerful alterative and resolvent, glandular and hepatic stimulant, and succedaneum of the iodides. Indicated in all conditions dependent upon perverted tissue metabolism; in lymphatic engorgements and functional visceral disturbances, in lingering rheumatic pains which are "worse at night" Bone, periosteal and visceral symptoms of late syphilis; for the removal of all inflammatory, plastic and gouty deposits. A remedy in sciatica, megrim, neuralgias, lumbago and muscular pains; the gouty and rheumatic diathesis; acute and chronic rheumatism and gout; chronic eczema and psoriasis, and all dermic disorders in which there is underlying blood taint. An hepatic stimulant increasing the quantity and fluidity of the bile. Relieves hepatic and intestinal torpor; does not cause the unpleasant gastric symptoms of potassium iodide. THREE CHLORIDES (HENRY'S) Liquor Ferrisenic. An oxygen-carrying ferruginous preparation, suitable for prolonged treatment of children, adults and the aged. Indicated in anemia and bodily weakness, convalescence from acute diseases and surgical operations; boys and girls at the age of puberty, and the climacteric period in women. In children with chorea, rickets, or who are backward in development, or in whom there exists an aversion to meats and fats. Prolonged administration never causes "iron headache." As an adjuvant for potassium iodide the undesirable manifestations known as iodism can be removed. Stimulant to the peptic and hydrochloric glandular system of the stomach, especially serviceable in the impaired appetite, nausea, vomiting and other gastric symptoms of alcoholic subjects. MAIZO-LITHIUM Liquor Lithium Maizenate. A genito-urinary sedative, and active diuretic; solvent and flush indicated for the relief and prevention of renal colic; a sedative in the acute stage of gonorrhea, cystitis and epididymitis; in dropsical effusions due to enfeebled heart or to renal diseases. As a solvent in the varied manifestations of gout, goutiness aand neurotic lithemia, periodical migrainous headache, epigastric oppression, cardiac palpitation, irregular, weak or intemittent pulse; irritability, moodiness, insomnia and other nervous symptoms of uric-acidemia. Decidedly better, more economical, extensive in action and definite in results than mineral waters. Those cases of irritable heart, irregular or intermittent pulse so frequently met with by insurance examiners and found to be due to excess of uric acid, are special indications for Maizo-Lithium. HENRY PHARMACAL CO., LOUISVILLE, KY. OFFICIAL JOURNAL: Buchanan County Medical Society ST. JOSEPH, MO., JANUARY, 1905. Contributed Articles PROSTATIC SURGERY.* T. E. Potter, M. D., St. Joseph, Mo. HE prostate gland, in the healthy adult is the size of a large chestnut, with a right and left lobe surrounded by a capsule and is felt about one and one-half to two inches from the anus. It has from twelve to twenty ducts of its own, and passing through it and opening into the prostatic portion of the urethra are the two ejaculatory ducts from the testicles, as well as the orifices of the procularis sinuses, and there is a ridge in the median line, the verumontanum. The widest and most dilatable portion of the urethra is the prostatic. The "bas fond" of the bladder is felt immediately beyond the prostate, as a soft and somewhat elastic structure at a distance of two and one-half inches from the anus. By placing the fingers upon the "bas fond." and palpitating over the bladder when it contains considerable urine, fluctuation can be felt. The seminal vesicles may be felt beyond the prostate gland as two soft oblong bodies at the side of the "bas fond." They can be more easily felt when the bladder is full and during constipation when there is pressure from the hardened fecal mass, there may be when straining an escape of seminal fluid which may alarm the person and he may be afraid that he is suffer. ing from spermatorrhea. The histological study of the gland shows that it is made up of small compound tubular glands, imbedded in an abundance of muscular fibres and connective tissue with ducts of small size uniting and forming larger ducts, then finally opening out into the urethra for the secretion of the acini to pass. These acini are smaller in the anterior portion than in the posterior. Large vessels pass into the interior of the organ to form a broad, meshed, capillary system. Nerves with numerous ganglion-cells surround the cortex. Pacinian bodies are sometimes found in the substance of the organ. Under sexual excitement this body secretes a quantity of mucilaginous fluid that Jubricates the entire urethra; when it becomes diseased, from any cause, this fluid may be excessive. In young men this discharge is sometimes so great as to make them believe it is loss of semen. The prostate gland impresses me as being the analogue of the uterus, and may take on some of the conditions that are found in the womb. Read before the Buchanan County Medical Society, November 4, 1904. It will take on disease by infection through its numerous ducts, malignancy, tubercle, and numerous growths that vary as we find them varying in other organs. The most common troubles surgeons have to deal with are abscesses following inflammations in the young, and enlargement of the lobes in the old. Both may be attended by severe cystitis, acute or chronic, and incontinence as well as retention of urine, the result of the narrowing and tortuous condition of the urethral canal. Abscesses appear in men early in life, the result of the gland becoming infected through the various openings into the urethra. The most frequent source of infection is that of gonorrheal inflammation which may terminate in an abscess. Still we may have the gland injured by blows or external violence. I have known young men, who were constant bicycle riders, suffer from inflammation of the gland. Such cases when the history is clearly given show that there has been a former attack of gonorrhea. The cause of hypertrophy of the gland is certainly full of interest, and many theories are given. It is as common in old men at the age of from 65 to 80 and upwards as gray hairs. Few men escape this trouble after 65 years. It begins at as early an age as 40. I have known many cases in men from 45 to 50 years. That the prostate gland has much to do with sexual organs, I believe cannot be denied, and my opinion is and I think this will be corroborated by some of the best writers, that excessive venery is conducive to this trouble. When it begins there is often slight hemorrhage and frequency in micturition. The patient has difficulty in holding his urine for many hours. He has to rise at night often to relieve himself, and as he becomes. worse this is such a common thing that he may not be able to sleep over thirty or forty minutes at a time. Chronic cystitis is liable to develop and the urine becomes quite ammoniacal, and he is unable to relieve himself except by the insertion of a catheter from two to four times a day. Sexual desire is often stronger than in ordinary health. Such troubles not only cause physical suffering, but a great deal of mental distress, and a high spirited man is mortified by having to excuse himself when with friend or attending to business to obtain relief. The prognosis is always unfavorable so far as recovery is concerned. The sufferer tries all the medicines that are recommended. Some may give a little temporary relief, but there is soon a return The remedies used are many times strong diuretics which hasten or develop a nephritis, which shortens the man's life. It is not my intention in this short paper to discuss the well-known medicinal treatment, for all of you are familiar with it, every student of medicine knows this routine. In the past few years, there has been placed in the hands of the surgeon a method of giving relief to men who are most wretched by enlarged and diseased prostates, as well as those who suffer from abscesses. This method of relief is one of the great advances in our profession and has come to stay. I mean prostatectomy. That it is free from danger cannot be truthfully asserted by anyone, but it is as safe as any operation of like magnitude. There is one proposition that makes the operation justifiable. If the patient is allowed to suffer on, his general health soon becomes very much impaired, and we are forced to expect sooner or later the development of a septic nephritis which will end the patient's life Further, it is, in my mind, a sad thing, to see any man, who has, by economy and business sagacity accumulated a large competency to be deprived of the enjoyment of it in the latter part of his life by the constant suffering night and day which an enlarged prostate and its sequela entails. As to the treatment of prostatic inflammation and abscesses in the young. First all efforts should be exhausted to reduce the inflammation and prevent the formation of pus, this should be done by rest and such medication and local applications as the symptoms require. If an abscess forms within the right or left lobe, nothing will be satisfactory but an operation, if not operated upon, the abscess will more than likely break into the bladder, causing a chronic septic cystitis and possibly a nephritis. If it does not evacuate itself well, the abscess cavity does not heal properly from lack of drainage. In operating, the surgeon must select either the perineal or suprapubic course. The perineal is, in my judgment, to be preferred, although good results may be and are obtained by the suprapubic. If the operation could be done as well, we would always prefer the suprapubic course, but the bladder cannot be as effectually drained by this course as the other. Uphill drainage is not so satisfactory as when the opening is below the seat of injury. To be able to see, examine, and treat the interior of the bladder is an argument in favor of the suprapubic method. This may count for something, and I know the abscess cavity can be packed and caused to granulate, but as the opening gets smaller this is no easy thing to do. There are objections to the perineal incision: first, hemorrhage at time the work is done; second, stricture afterward; third, wounding of the rectum In its favor is then natural and thorough drainage which we believe overcomes all argument against it, as this is what we want, for the interior of the bladder gets well when the source is removed, which is done by thorough and complete drainage. We further believe that there is, in the suprapubic route, some danger of infecting the peritoneum. So, for abscess of the prostate, we would prefer, if only one incision is made the perineal. There are conditions that may require both if this is the case-make them. Now we wish to discuss prostatectomy for the removal of enlarged prostates and thorough drainage of the bladder. In this operation we have embarrassments. The first which is against us cannot be overcome, and it is age. Second, from long standing, or as a result of a septic cystitis, a nephritis. Third, this condition may be complicated with stones in the bladder. In making the operation of prostatectomy, the operator has to select one of three methods. The suprapubic, perineal, or double where the bladder is opened and then the perineal incision made for drainage, as is advocated by Alexander. I do not think any surgeon should be so wedded to any one of these methods that he cannot be persuaded to change his mind in the event there is any reason for him to do so. We have conditions of the bladder where there are fungus growths, or where the mucous membrane is diseased, and we have every reason to believe that in order to recover the patient has to receive more attention than can possibly be given by the perineal route, so it would be bad practice not to make the upper operation. Then if after opening the bladder in this way, the surgeon should believe drainage would not be sufficient through the opening, he is justified in making the perineal incision for the purpose of more completely effecting this. In fact when great necessity for perfect drainage is required, the Alexandrian method is in my judgment the ideal one. When there is nothing to indicate an extreme pathological condition of the bladder, the perineal operation is the one we prefer. The instruments required in making the perineal operation are scalpel and lithotomy knife, scissors, dissecting forceps, hemostats (12 or 16) grooved director, tenaculum, vulsellum forceps, curette, staff (urethral guide), rectal bag, needles, retractors, both dull and sharp pointed, Ferguson's scoop or double curette for peeling out the gland. General anesthesia preferred. The patient placed in the lithotomy position with thighs extremely flexed, so as to crowd the bladder down. The staff inserted previous to doing this, although I noticed that Murphy of Chicago uses instead a large sound. I believe the grooved director is best. A median incision made from the base of the scrotum down close to the margin of the anus, or a cresentic incision from ischii to ischii, the membranous portion of the urethra exposed in either incision. The holder of the staff should draw up the bulb, so there will be no danger of cutting the artery of the bulb. Then separate or push down the rectum so it will not be wounded, draw aside the tissues with the retractor and the gland may be exposed. At this time stop all bleeding vessels by clamping or tying. With the scalpel open the membranous urethra. Then insert the probe point of the lithotomy knife and gently press it inwards following the groove in the staff, while the handle of the staff is lowered by the assistant, as is done in making the operation for stone. The finger is inserted into the bladder and the enlarged lobes are easily made out. The capsule is either torn with the fingers, or snipped with a pair of sharp pointed scissors towards the posterior portion, and the gland is peeled out from below upwards. The opposite gland should be encised in same manner. The posterior portion of the urethra is destroyed, but if the staff holder retains his grip well upon the staff, the anterior portion of the urethra is not so liable to be torn, and all operators should labor to preserve the anterior part. After the removal of the glands, the staff is removed, a good sized rubber tube should be inserted for drainage. If there is much oozing, pack around well with iodoform or sterile gauze. This tube should be kept in the bladder from three to five days. Although some claim, like Goodfellow, that they have had as good results without the packing and tube as with it. The urine has been known to begin to pass the right way within 48 hours after the operation, if there is no tube or packing to interfere. Incontinence of retention may last for several days, but if the bladder is not injured this usually ceases after five or six days, and the patient can hold his urine. The sound should be passed about the tenth or twelfth day. In one case I saw at Chicago hospital the sound was passed at the end of the tenth day, and then a soft rubber catheter where at least one-half pint of urine was withdrawn. The man was 81 years old. His health was good, and he told me he was perfectly relieved. I will not discuss Bottini's operation of searing the prostate gland with the cautery, as I do not believe it will ever be a popular surgical pro |