to the bulbo-membranous junction, yet the congestion extends forward along the mucous membrane into the sinus of the bulbous urethra, and from this point a moderate oozing of pus occurs— as well as, to a very moderate extent, from the true focus of disease behind the bulbo-membranous junction. Now, the injection reaches and acts as an astringent upon the turgid vessels in the bulbous sinus, and the astringent exerts itself along the continuity of muco-membranous surface to a moderate extent into the membranous urethra and beyond the bulbo-membranous junction, and a repetition of the injection by a continuance of astringent action keeps down the discharge without reaching or curing the actual focus of disease itself; for if the anterior injection be too strong or be forcibly crowded back too far, cystitis or swelled testicle is, as is well known, a not uncommon result.

That a local application, acting simply upon the livid congested membrane in the sinus of the bulb, may control a gleet without curing it, can be often demonstrated by touching this livid membrane carefully with an astringent through an endoscopic tube; and that an application made on one side the bulbo-membranous junction extends its influence more or less to the other side may be also demonstrated by making a membranous urethral instillation of nitrate of silver, ever so carefully, and then inspecting the mucous brane of the bulb, anterior to the triangular ligament, through an endoscopic tube. This spot, before of a more or less livid red, shows the pale white staining of the nitrate of silver solution. This fact was first observed and pointed out to me by Dr. James P. Tuttle; the only possible criticism upon its accuracy is that a minute portion of the silver solution has followed the injecting instrument on its withdrawal, in spite of all precautions taken.

mem

But my subject drags. I came here to make some practical suggestions to cure posterior urethritis, and must hasten to that point. My suggestions are certain substances to be injected into the seat and focus of the disease with the deep urethral syringe. Though the method is not new, some of the substances are not ordinarily in use. I do not at all claim that posterior urethritis must be treated locally to get well. On the conrary, most cases ultimately get well, and they do so without local treatment. Rest, the balsams and alkalies, the demulcent drinks, counter-irritation, time, change of air, sea trips, treating the anterior urethra, iron in chronic cases-all these things are potential, and most of them can be happily combined with the local posterior treatment, to the great advantage of the latter, and their cooperation is sometimes essential to the rapid and perfect effectiveness of the posterior treatment. I do claim, however, that most cases are

suitable for local direct treatment, and that such cases under suitable local applications improve with a rapidity which is gratifying to the physician, and quite obvious to the patient; and I claim further that by recognizing the malady and treating it locally, many a urethra may be spared the use of the knife, and very much time saved.

Finally, I state candidly that a few cases are positively unsuited to local treatment, and get worse under it, no matter what substance is injected. To this class belong most tubercular cases and some simple inflammatory, and some ordinary gonorrhoeal cases. When, however, the treatment disagrees, the symptoms (notably the discharge of pus) becomes so promptly and so obviously aggravated, that the futility of repeating the application becomes at once clear, while very little time is lost in making the test. I may add, finally, that there is practically no danger of producing cystitis or epididymitis, if the instrument be used carefully, and not inserted too far. The risk of occasioning these complications is vastly less, according to my experience and belief, than that incurred by treating the malady with anterior injections or with sounds or indeed less than is the risk of these complications if it is left untreated locally, and internal medication be relied upon.

The instrument I employ is the syringe that bears my name. It is founded upon Ulzman's model, and is superior to the latter in being made in one piece, so that no injection soils the fingers, and in being more solid. Guyon's syringe has a bulb at its extremity and injects backward. It must, therefore, be introduced through the inflamed area to be effective, a manoeuvre which inflicts unnecessary mechanical violence upon the tender parts. The same objection obtains in the case of all syringes having lateral holes or slits. My syringe and that of Ulzman have only one minute opening at the tip. This tip need be inserted only just within the hole in the triangular lig ament, just beyond the bulbo membranous junction. So inserted, the membranous urethra grasps the tip of the instrument and the contents of the syringe-twenty minims or more-may be gently thrown in, and the entire injection will quietly flow backward along the membranous urethra, through the prostate, and into the bladder, with as little violence as possible, not one drop escaping at the meatus upon the withdrawal of the syringe. The little air sucked up into the syringe upon charging it may be disregarded, as it remains at the top of the instrument and in its tube, and need not be discharged into the urethra.

Formerly, in using strong injections I deemed it important to throw in only a very few drops at the diseased focus. Now I endeavor to produce my result by using much milder injections than formerly, and I throw in the entire contents of the syringe in every instance, except where nitrate

of silver is used in a strength greater than ten grains to the ounce, when I use a few drops only. I increase the strength of injection of a given substance only gradually, after establishing a tolerance of the milder strength, and in this way I avoid irritation, formerly more common. When the source of the flow of pus is reasonably well forward in the membranous urethra, I generally make the injection before the patient urinates. When the inflammation extends farther backward and the supply of pus is considerable, I cause the patient to urinate just before making the injection, so that the injected fluid may flow into the bladder and become applied thoroughly to the mucous membrane at the internal prostatic urethral orifice, without being there diluted or neutralized by coming into contact with urine in the bladder at this point.

In suitable cases the free pus first disappears from the second urinary flow (the urine being voided in two parts), then it disappears entirely from the urine, some shreds still remaining These are attacked by increasing the strength of the injected fluid, or, if there be some stricture in the membranous urethra, by the safe use of sounds after the catarrhal surface has been modified by the previous use of the injections, combined often with anterior astringent injections, which the patient administers himself.

I have employed in deep urethral injection most of the substances which have repute in controlling the flow of pus from mucous membranes, even Pond's Extract. Such substances as hydrastin, boro-glyceride, nearly all the lead and zinc salts, iodoform, creolin, pyoktanin, etc.; but at the pre sent writing I have come to rely almost exclusively upon four substances the sulphate of thallin, the glycerole of tannin, the sulphate of copper, and the nitrate of silver. I never now make a preparatory injection of cocaine, as I consider it unnecessary, often harmful.

The Sulphate of Thallin.-This I consider a very valuable drug. Its chemical name is tetrahydrotarachinanisol. It was introduced into anterior urethral medication as an ordinary injection, with words of high praise, by Goll, of Zurich, about five years ago, and since that time has constantly appeared as one of the ingredients of the antrophore, an instrument of torture, when employed in the deep urethra, which I only mention to protest against. I am not aware that anyone else has employed it in solution for deep urethral medication. I have so used it for about four years, and always with increasing frequency and confidence. It is bland and practically unirritating, and may be used up to a saturated solution, which is about twenty-four per cent. It is suitable for all the acuter forms of inflammation (except in cases of acute, recent gonorrhoeal cystitis, in which the nitrate of silver has the preference), and it is

the substance I almost invariably commence with in a solution in water of about three per cent., increasing at each injection up to six, nine, and twelve per cent. The last named strength will usually do all that thallin can do in reducing the show of free pus in the first urinary rush. The intervals of making this mild injection are best spaced by two, three, or four days, according to the effect, which is sometimes wonderfully prompt and gratifying. The injection causes practically no discomfort, only a little warmth as a rule, and may be retained as long as the patient chooses.

The Sulphate of Copper.-This substance I use in a ten per cent. solution in pure glycerine. This I dilute with water for use, commencing at about one grain to the ounce and working up rather rapidly, if it agrees and has a good effect, to the full forty-eight grains in the ounce. It is markedly astringent in suitable cases, and generally in weak solutions, pains but little more than thallin; very strong solutions, however, of course feel hot and cause precipitate and moderately painful urination for perhaps several hours. The stronger the solution, the longer the interval before a second application is advisable. I do not very often go above a strength of ten grains to the ounce.

The Glycerole of Tannin.-This substance, pure, is too thick to be sucked up into the syringe easily. I use it reduced by adding water, seventy-five, fifty, or twenty-five parts, where a more astringent (but sometimes less irritative) influence is aimed at than that procured by the copper solution.

The Nitrate of Silver.-I employ this remedy as high as a ten per cent. solution, but very, very rarely-practically never in catarrhal cases-use anything like this strength. It is most useful in acute gonorrhoeal cystitis, and as a final astringent when copper and tannin are not efficient. dilute it with water at each time of application, commence usually at a strength of one grain to the ounce, and very rarely have to go beyond ten, making the applications every three to eight days

I

studying the effect and being guided by it. This is the harshest of the applications, causes the most pain, precipitancy, and urgency of urination (which often lasts several hours), but frequently renders incalculable service. Carefully used, it is free from the danger of producing complications.

By the careful and observant use of these four solutions, which anyone may easily master after a few trials, the greatest advantage may be obtained in suitable cases of posterior urethritis. Did I not have them at my command, I think I should give up the treatment of gleet. When they disagree the fact is immediately obvious, and their good effect equally clear when they suit a given case, while their employment is generally progressively satisfactory. The thallin makes a black solution when used in the same syringe with the nitrate of

silver, which it takes some time to wash out. I therefore use two syringes, one for thallin and tannin, the other for copper and silver.-Dr. E. L. Kees, New York, in Med. Rec.

METHYL-VIOLET AND PERCHLORIDE OF MERCURY IN THE TREATMENT

OF CANCER.

In the Hospital Gazette of last February I see that Professor Von Mosteg believes be has discovered a new cure for cancer in the hypodermic injection of methyl-violet.

As I have myself been experimenting in the same direction for the relief of malignant growths, the following notes of a case of cancer treated by me last year may be of interest to your readers.

On my return from Capetown on the 25th of August last, I received a telegram requesting my immediate attendance on a patient in a distant district.

Providing myself with methyl-violet and other germicides, I left the same evening by train, and arrived on the evening of the 27th, having crossed a mountain range 6,000 feet above sealevel, its peaks covered with snow, at the base of which he lived.

The patient J. H. S., a Dutch farmer, aged 52, of healthy parents, but whose sister died from cancer of the stomach-had been hale and strong until two years before, when a small pustule appeared on his lower lip, where his pipe usually rested. It was destroyed twice with nitric acid, and then cut out in June, 1889. Four months afterwards, an enlarged gland appeared in the neck, which, in December, was as large as a walnut, increasing slowly till June, and then rapidly. When I saw him, the tumor extended from near the sternal end of the clavicle nearly to the point of the shoulder and to the lobe of the left ear, measuring 6 inches across, and 33 inches verti cally; and round the neck, over the two colloid prominences, 17 inches. Pulse feeble, 88; temperature, 102°; tongue furred, swollen, indented on edges, sublingual glands swollen and painful, difficulty in swallowing, no appetite, unable to lie down, sleeping in a chair at short intervals as the pains would permit, restless and low spirited, complains of fixed pain at back of neck, and a burning sensation with partial deafness in left ear, head on one side from pain and pressure of the tumor. He had been visited by a medical gentleman from the town, who declined to give an opinion

A most unfavorable case certainly, and in a locality not favorable for remedial treatment, his residence being situated in a village of gardens and cornfields, on the alluvial banks of a moun

tain stream, flooded at times, and receiving the silt and drainage of the cultivated farms and homesteads above; with a deep impermeable clay subsoil.

After frankly representing the hopelessness of a cure in such an advanced stage of the disease, whilst firmly believing in the curability of cancer of relieving the pains and other distressing sympin the earlier stages, I could only hold out hopes toms without opiates, and of checking the progress of the disease for a time at least; and tried to cheer him up by instancing cases of lupus (" Die Wolf ") which I had cured, a disease more dreaded by the Boers than the worst forms of cancer. started excitedly, "Well, doctor, if you have cured 'the Wolf,' you must try my case; the tumor has not yet burst, you may be mistaken. Do your best; I promise to do all you advise."

He

I injected at once 3ss. of liq. hydr. perchlor., P.B., in three places round the hard base of the tumor, and gave a dose of sodæ sulphas to remove vitiated secretions. Next morning I was surprised at the change. He told me he had more sleep than he had had for weeks past, the pains were less severe, the colloid mass less tense and flatter, his pulse 80, and temperature normal. Hope and confidence had been restored by the sleep without drugs and he decided to accompany me to Grahamstown to the Albany Hospital, if I would remain two days for him to prepare for the journey. I saw a case of lupus, and one of goitre, and heard of two more, one of which had quite recovered after removal to the Orange Free State, that day. I drove into the town next day, and saw both of the medical men who had attended him, and both considered the case hopeless, and agreed with me that the only chance for relief was removal to a higher altitude; and indeed, on the journey the reduced barometric pressure, change of climate, scenery, and dry, keen air of the upland plains had already produced a marked change in his condition and spirits. No medicine was given,

On arrival at Grahamstown on the 2nd September the germicide treatment by lotions and subcutaneous injections of mercury perchloride was commenced, 10 m. at first every day, increasing gradually to 20 and 30 with marked improvement in all his symptoms. The pains left with the removal of pressure as absorption progressed. In a few days he could lie down, and slept sometimes all night. Injections of methyl-violet were now alternated with the perchloride.

Both my confréres on the hospital staff examined him, Dr. Greathead on the third, and my brother, Dr. Edwin Atherstone, a few days later, and though both deemed the case hopeless they advised him to continue the treatment. The appetite improved, and he was able to walk into the Botanic Gardens, and even to attend to business.

One of his sons and his wife were always with him. On the 7th I injected the colloid cysts with 3ss of perchloride daily for three days, and afterwards alternately with methyl-violet. It soon began to break up, and showed signs of necrosis, but did not open till the 25th, when three openings gave vent to a brown, grumous, offensive discharge. Sulphurous acid (one to six water) was then injected into the cyst, 3ij at a time, and afterwards one part to four, which quite removed all offensive smell, although the mass was entirely necrosed.

On the 25th, September internal medicines were for the first time commenced, to support his strength, his appetite beginning to fail. Quinine, phosporic acid, and methylene-violet were given internally with good results three times a day, with wine. He had been taking nutritious soups, eggs, etc., from the time the difficulty of swallowing ceased, which was a few days after his arrival.

On October 6th, I was confined to bed, completely prostrated by a severe attack of epicemic influenza, and Dr. Edwin Atherstone took charge On the 16th, the patient's of the patient for me. brothers came up and induced him to leave for home, and all attempts to dissuade him failed. He thanked me for my care and kindness, but went off the same evening by train to travel 600 miles, over a hundred of it in a spring wagon over the mountain range in winter. I heard that he died eleven days afterwards from exhaustion, free from pain and in the possession of all his senses. He died on the 28th of October.

In this case I trusted entirely to local treatment by hypodermic injections of germicides; it was too far advanced to trust to methyl-violet alone, as I intended to do if in the early stage, but the combination of the two by alternate injections, and afterwards by both combined, sufficed to reduce pressure and consequent pain; and there was no constitutional disturbance, no extension to glands, etc., no anodyne of any kind was given, either internally or by hypodermic injections. Forty-five injections were given during the fifty-two days of treatment. The sulphurous acid injections into the necrosed colloid mass prevented the poisoning of the system by the gangrenous discharge usual in such cases. I gave the methyl-violet in the quinine mixture more to affect the mind, the color being so exquisite, and mind and faith have a marvellous curative effect in disease. rate, I think this local treatment is worthy of a trial.-W. Guybon Atherstone, M.D., F.R.C.S., England, in the Hospital Gazette.

At any

Ar a conference of public bodies held in Edinburgh, it was stated that Sir Archibald Geikie has been nominated for the Presidency of the meeting of the British Association in Edinburgh in the year 1892.

The past year having been to me an exceedingly prosperous and successful one, I desire to tender to you my sincere thanks, with the hearty wish that during the New Year we all may enjoy all of Earth's richest blessings. For the past year I have manufactured all my medicines in lozenge form, dispensing with alcoholic menstroum, and find that their medical virtues are in no wise imholic stimulants and avoiding the pernicious results therepaired, thus preventing the formation of a habit for alcofrom. All medicines are manufactured at my Labaratory under the supervision of a careful and practical chemist, who, after much study and many laborious experiments, dies the only true temperance medicine EXTANT. perfected my medicine in lozenge form-making my remeIn conclusion, allow me to say, give me and my medicine a fair trial, follow my directions and I will build up your debilitated constitutions, renew the vigor of life, and restore you to health again. I have treated during the past year 36,791 people, and established a business unequaled by any other medical man in the United States.

PSYCHOLOGIC SPECIALIST.

clairvoyant diagnosis either by lock of hair or presence of This science is fully understood by me. I will give a person, telling you how you are, better than you can yourself.

In the progress of civilization, old ideas, in almost every department of life, give place to those which are new, or essentially modified by them. Foremost among the interests which pertain to society, is health. With health, what can we not endure?-what can we not enjoy? Without it, trifles become burdens and the joys of life are turned into mourning.

VITAPATHIC SYSTEM, OR LIFE-PRINCIPAL.

The extraordinary cures which this system has affected, very naturally attract toward us the profound attention of the public. Medical men, clergymen, philanthropists, all see that we are performing a most valuable service. Under this system we give chyle and lymph of Roots, Herbs and Barks, acting in harmony with the great laws of Nature, gradually and kindly removing the hidden cause of disease. Nature's operations are almost invariably of the gentlest kind, all healthful ones certainly are. The gentle rain and the gentle dews teach us & lesson on this point. The wonderful power of medicine under the Vitapathic system cannot be too strongly urged.

To purify the blood is one of the cardinal principles of the Vitapathic system, which embraces a combination of various medical sciences and experiences-taking what is good from others and rejecting the rest. All medicine given in lozenge form.

CONSULTATION FREE.

References from every State in the Union. All

O. G. W. ADAMS, M.D. Colfax, Iowa.

Our correspondent was so affected by this wonderful lucubration, that he immediately forwarded the doctor a lock of hair from his Gordon setter. In reply he received the following, which very fairly represents the diagnostic acumen of this worthy and reverend practitioner of the divine art of medicine:

OFFICE OF

O. G. W. ADAMS' SANITARIUM.

COLFAX, IOWA.

Thine at hand and contents noted. I find thee has nerve Blood and Seminal weakness and Rheumatism of the Blood Kidneys Spine Stomach Heart lungs and fluids of body all affected and Neuralgia of the Blood thee can be Cgred

It will cost thee 5 Dollars for two months medicine. Registered Letters, Money Orders or Express Orders at my risk. All medicine sent by Express

Write the Town, County, State and nearest Express office plainly to avoid mistakes. In ordering medicine return this diagnosis. No medicine sent unless money accompanies the order.

References from every State in the Union. All medicine made at our pharmacy. All letters must be accompanied by five 2-cent stamps.

O. G. W. ADAMS, M. D.

The dog is being watched with extreme solicitude, but bears his numerous inflictions with equanimity. This man Adams is registered in Polk's Directory as an Eclectic; but his name is followed by a star, showing that no record of his his graduation was furnished.-Times and Reg.

SUMMER DISTURBANCES OF CHILDREN.

There are times when it is desirable to change the food of the babies the same as we need to change the bill of fare upon our own table. We must not forget that the palates of the little ones are to be consulted. That "variety which is the spice of diet" may be applied in a mild way even to the babies. The food that agrees with the baby to-day, or this week, or this month, may need changing next month. I present the following conclusions:

1. During the heated term keep the baby cool, but not too cool, just cool enough. Uniformity should be the ruling thought. Babies do not enjoy extremes of anything.

2. The proper regulation of the diet, the proper degree of sleep, the proper uniform temperature, pure air and the proper relief of thirst will enable every infant to weather the time of the hot sultry days of midsummer.

3. The severe intestinal diseases and the one which is the very acme of infantile danger

we impress upon the mothers the fact that the very first variation from the proper digestion should be corrected by the family physician and not by the "busy body" neighbors.

4. The mother should be impressed with the fact that the opinion of the physician is of so much importance in the matter of food as though medicine were to be administered, in fact it is of paramount importance, in that food is life to the child.

5. Experimentation at all times is risky, and particularly so when dealing with infants, and doubly so when the experiments are not conducted by an expert experimentalist. In the correction of disturbed direstion we should aid nature in getting rid of undigested and indigestible materials.

6. We should bear in mind the antiseptic thought.

7. We should see to it that less diet and a more digestible diet be brought into requisition.

8. During the entire period of infantile life we should protect the abdominal region against possible chilling by the wearing of a light woollen belly-bandage.

9. Relieve the thirst by good pure water instead of the breast or the nursing bottle.

or

10. Proper rest and tranquilization of the little one is desired; above all things let it be kept away from the heated body of the nurse mother, who in addition to elevating the temperature of the child by contact with her own personality, will more than likely after each filling up with milk proceed in an affectionate way to trot it up and down, from side to side, and in a generally gymnastic way exercise her motherly muscles in giving the little one the soothing effect of thorough agitation, resulting in that which we find at every street corner, the "milk shake," more than likely the baby will reject the particular milk shake made in that particular way, but the result is not always so fortunate. It is far better for the little one to be placed upon a recliner the bulk of the time in a manner favorable to sleep and digestion.

11. Religious regard for cleanliness of all food utensils, refrigerators and nursing bottles should be insisted upon.

Not less than three or four of the simplest form of bottles should be always on hand.

The nursing nipples should be plain black. rubber. The handy but filthy tubular affair should be condemned in toto.-I. N. Love, M.D., in Dietetic Gazette.

Two Chinese, alleged to be lepers, were admitted to the New York Charity Hospital last Monday.