ACUTE INFLAMMATION OF THE PROSTATE GLAND.-The Journal of the American Medical Association, for August 20th, contains a report on inflammation of the prostate gland, which was presented to the Section on Surgery and Anatomy at the Forty-ninth Annual Meeting of the American Medical Association, held at Denver, Colo., June 7-10, 1898, by Liston Homer Montgomery, M.D., of Chicago, Ill. His plan of treatment in acute inflammation of the prostate gland is to wash out the abscess cavity with hydrogen peroxid, give copious hot water enema and hot hip baths frequently, avoid morphine internally, and advise care lest the patient strain at stool or during micturition, On the theory that toxines are retained in the circulation and within the gland, and to prevent degeneration in the gland substance, he administeres triticum repens or fluid extract tritipalm freely, combined with gum arabic or flaxseed infusion. Along with these remedies the mineral waters, particularly vichy with citrate of potash, go well together. Hydrate of chloral or this salt combined with antikamnia are the very best anodyne remedies to control pain and spasms of the neck of the bladder. These pharmacologic or medicinal remedies are the most logical to use in his judgment, while externally, applications of an inunction of 10 or 20 per cent. iodoform, lanoline, as well as of mercury, are also of value. SUBCLAVIAN ANEURYSM:-Dr. B. G. A. Moynahan in the Annals of Surgery for July reports a very interesting case of subclavian aneurysm which presents many interesting features: the mode of exposing the artery, the mode of treating the aneurysm by excision, the perfect operative recovery, the formation of a second aneurysm on the 59th day on the proximal side of the primary one, its treatment, by ligation of the innominate and common carotid artery, are all points worthy of consideration. In the first operation the artery was exposed by excising a large section of the clavicle, which with the attached subclavian muscle were displaced backward by means of a silk retractor. The manner in which this section of bone was removed is claimed as original: "The clavicle being cleared on its anterior surface four holes were now drilled through it, two about inch apart, at a distance of 1 inches from the sterno-clavicular articulation, and two, the same distance apart, at the junction of the middle and outer thirds of the bone. Between the inner and outer two the bone was sawn through with Hey's saw." In the second operation, that of ligature of the innominate and common carotid arteries, the vessels were exposed by excising the inner end of the clavicle and a section of the sternum in a way similar to that described. A review of the history of spontaneous aneurysm of the third portion of the subclavian discloses but 58 cases, but 8 of which recovered. Of these 58 cases 43 were treated by proximal ligature (with 3 recoveries), 6 by distal ligature (with 1 recovery), 6 by amputation at the shoulderjoint (with 2 recoveries), 2 by opening the sac and 1 by excision, the latter procedures with 1 recovery each. In selecting a method of treatment one must either choose distal ligature or excision of the sac; comparing these two methods from the standpoint of the mortality, of the probability of the recurrence, or of gangrene, and of the "quality" of recovery, the balance weighs in favor of excision, for after this operation there is a far greater chance of recovery, there is absolutely no risk of recurrence, there is far less risk of gangrene, and finally there is less likelihood of there being any of those sequelæ due to nerve. interference. NITROGLYCERINE IN SPASMODIC CROUP.-G. G. Marshall, writing in the Atlantic Medical Weekly of May 28, 1898, says he has found nitroglycerine to be an ideal remedy; it being tasteless and stimulating rather than depressing makes it especially suited to these cases. As children vary in their susceptibility to this drug, it is best to give it in small doses, frequently repeated until relief is obtained or the physiological effect of the drug is manifest. Children from five to ten months old can take from Too too grain, repeated in five to ten minutes, if no effect is noticed. Usually in ten minutes there is marked relief in the dyspnea and general appearance of the child. By repeating these doses from every ten to fifteen minutes to once in one to three hours the laryngeal spasms are controlled. Sometimes it is not necessary to repeat more than once or twice; at other times it has to be continued at more or less frequent intervals for two or three days. By this treatment, in the majority of cases, one avoids the unpleasant use of emetics. The immediate and definite results obtained by the use of nitroglycerine are extremely gratifying to the physician and certainly not less to the parents. Not only in difficult laryngeal breathing of children does nitroglycerin give relief, but many times in adults, especially in nervous and hysterical women. And those cases of dyspnoea which would be relieved by bleeding are equally well relieved by free doses of nitroglycerin. In membranous croup also we get more or less relief, for a time at least, and it may be sufficient to avoid the necessity of intubation. Those cases that it will help and those that it will not cannot be determined except by trial. When it fails you have lost little time, and can then resort to the usual methods of treatment.-Medicine. SURGICAL HINTS.—Never allow rubber plaster to come in contact with a surface uncovered by normal skin. Since it cannot be sterilized by heat, it must be considered as dirty. Before operating, always find out whether the patient has any malarial history. The discovery of this fact will save you many a bad scare when temperature rises suddenly after operation As long as any urine issues from the urethra it cannot be said that there is an impassable stricture. Patience and gentleness will do wonders. The most skilful surgeons see very strictures that prove impassable. few An aseptic dressing placed over a wound that is expected to unite by first intention should be left undisturbed until it is time to remove the stitches, or until there is reason to believe that the case is not running the expected aseptic course.-Inter. national Journal of Surgery. THE OIL OF SASSAFRAS will destroy all varieties of pediculi and their ova with a single application. Care must be taken to prevent its coming in contact with mucous membranes. Any burning from this cause can be allayed in a few minutes by pouring on olive oil.-Medical Brief. DISCUSSION ON ABORTION BEFORE THE LOUISVILLE CLINICAL SOCIETY.*-Dr. W. C. Dugan: I was called this morning to see a case in consultation with a gentleman in the western part of the city. A young woman, twenty years of age, had been bleeding very actively from the uterus for the last four weeks. The doctor asked me to see the case with him, and come prepared to do a curettment. I found the young woman in good flesh, but rather anemic, as she had lost considerable blood. She was put upon the table and examined. I found the os soft and patulous, so that my finger could be introduced into the uterus, which was very large, and membranes protruded through the os. Of course I recognized immediately that an abortion had caused the trouble. The young woman was growing worse from day to day. The doctor had been thrown entirely off his guard in the case, because of the standing of the family, etc., and had not suspected for a moment that the girl had been pregnant. A criminal abortion had evidently been performed, and the question I desire to ask the society is, what should be done in a case of this kind. I went to see the patient, supposing it was a chronic case of endometritis. I believe we ought in some way to protect ourselves in a case of this character. Suppose the woman should die; being the picture of health an autopsy might be held; it would be shown that the other physician and myself visited the patient this morning and we would probably he accused of producing upon her a criminal abortion. I would like to know what action should be taken in such a case. Dr. W. H. Wathen: This is a serious question to decide, and each case will have to be decided upon the conditions that exist and pertain to the particular case. Where there is danger of death from sepsis or any other cause, I feel that the physician ought to protect himself by telling some one the nature of the He ought to do it in confidence, and if everything turns out right there will probably be no trouble resulting from it. But I do not believe any doctor is justified in taking the risk, subjecting himself to the danger of being reported as an abor case. *Stenographically reported for the N. Y. Medical Times by C. C. Mapes, Louisville, Ky. ar. tionist, and probably written up in the papers or rested as an abortionist to save the reputation of some woman who probably has not much reputation to savē. I would not attend a case of this kind without telling somebody of its nature. We are constantly in danger of getting into trouble by being called to see patients upon whom others have performed abortions. And again women not infrequently, either purposely or through ignorance of what they are doing, deceive us, and we are apt to do something unless we are very guarded that will induce an abortion. believe that Dr. Dugan and the physician who has attended the case are justified in telling the parents or nearest friends the nature of the girl's illness. Dr. W. F. Boggess: General practitioners meet these cases often, not only where abortion has been criminally performed in a bungling way, but where it is done by the professional a bor. tionist, and it is a question that makes the young practioner's hair stand on end to know just what to do in such cases, and even should he decide to attempt their protection, there is alwayı a certain odium in connection with the case should it terminate fatally. for the I recall two cases of this kind, one was five years ago, the other more recently. Five years ago I remember to have been asked to see a case where a doctor was treating a young lady typhoid fever. She had a septic fever, and in feeling over abdomen I found no tenderness in the right iliac fossa, but there was exqusite tenderness in the uterus; there was also considerable tympany. I asked the mother to bring me a bowl of fresh water-simply an excuse to get her out of the room. I then said to the girl: "You have had an abortion. She said, "Yes, that is true; but do not tell mother." When her mother came back in the room I told her all about it, and made the girl con fess not only who had performed the abortion, but the author of the trouble, and the next day after that the girl died. Now, the question came up in my mind, and I take it Dr. Dugan referred to the same question in reporting his case. Should the patient die, as happened in my case, ought we to report the occurrence to the authorities? I think not, simply because there I |