Extracts from Home and Foreign Journals.

SURGICAL

PROSTATIC OBSTRUCTION.

Belfield reports four cases. The first patient suffered from sclerosis of the gland, which was treated by channeling a canal through the fibrous vesical orifice by means of the galvanic cautery introduced through a median perineal urthrotomy. The second patient had a hypertrophy of the prostrate. A large middle lobe and two lateral outgrowths were removed by the same median perineal urethrotomy performed for galvano-prostatotomy in the first case. The third patient, the victim of carcinoma, was treated in a manner different from the usual custom followed in these cases. A simple puncture was made with a small trocar and canula and a small soft catheter was then introduced through the canula, which was withdrawn, leaving the catheter to drain the bladder. After three or four days the catheter was removed, cleansed and reintroduced through the fistulous tract. Thereafter the catheter is removed and cleansed daily and the bladder washed out by the patient himself. Belfield advises inspecting the vesical interior of determine the presence of calculi. If the cystoscope can not be introduced through the prostratic urethra, a straight cystoscope can be introduced through the suprapubic canula at the time the puncture is made.

The fourth patient illustrates two of the common evils of perineal prostatectomy, viz., a permanent perineal fistula and permanent incontinence of urine. Belfield says that this operation, the removal of the prostate through its posterior surface, should be generally abandoned. He mentions three operations for the removal of prostatic obstruction: I, galvano-prostatotomy for channeling a fibrous prostate; 2, enucleation of adenomatous masses from the mucous surface either (a) through a median perineal urethrotomy or (b) through a suprapubic incision, the former when the growths can be reached from the perineum, otherwise the latter. The suprapubic incision is best made in two stages

the first incision extending to, but not through the bladder; four or five days later the second incision-through the bladder-is made, and the prostatic masses are enucleated. In this way the chief danger of the suprapubic operation-septic infection of the suprapubic tissues is minimized.-Journal American Medical Association.

THE RECTAL INJECTION OF ETHER VAPOR.

The sequelæ, oftentimes dangerous as well as unpleasant, which attend the administration of ether as an anesthetic, have prompted the introduction and use of numerous adjuvants and substitutes. The respiratory apparatus is most often affected by the drug as the result of the usual manner of oral administration, and the complications to be dealt with include respiratory disturbances, depression of the cardiac reflexes, resulting from irritation of the laryngeal or bronchial mucous membranes, pneumonic processes, etc. Attempts have been made in great number to overcome or at least to diminish these effects of ether by the preliminary administration of nitrous oxide, ethyl chloride, etc. Another suggestion in an entirely different vein was made as long ago as 1847 by the well-known surgeon, Pirogoff, in Paris. He proposed, in place of the inhalation of ether, its introduction in vapor form into the rectum for the purpose of inducing general narcosis. The method did not meet with any enthusiastic reception, but from time to time it is revived or is suggested independently by some one who has not heard of the previous attempts in this direction. Some fifteen years ago the method was revived in Denmark, and was received with favor by surgeons all over the world. It fell again into desuetude, and now a Russian military surgeon, Dr. Krugiline (Der Frauenarzt, December 15, 1905), writes that he has used it altogether in 43 cases requiring operations of moderate severity and extent, such as harelip, bone tuberculosis, hernia, lupus etc. Two conditions must be fulfilled in order to insure the success of this procedure: the colon must be absolutely empty and no fluid ether must be permitted to enter the rectum, as the mucosa of the latter is particularly sensitive. This

can readily enough be avoided by the use of a properly constructed apparatus. If thorough catharsis has not been obtained the entrance of ether into the rectum will produce unpleasant symptoms, especially an annoying tenesmus. Ordinarily, however, with an empty colon, sensation is lost in from two three minutes, and the odor of ether may then be detected in the breath. Narcosis is soon complete, the pupils become contracted to a marked extent and do not react to light, but as a general rule the corneal reflex remains. The writer is quite enthusiastic regarding the advantages attendant upon this method, the narcosis being produced rapidly and the usual respiratory difficulties being avoided; he also claims that there is no period of excitement, and no reactionary symptoms are noted. For all ordinary cases the narcosis produced by this method was found to be sufficiently deep, but if not, the intermittent inhalation of a few drops of chloroform was enough to make it so. Although particularly adapted for operations upon the head and neck, Dr. Krugiline thinks that the method may be used with equal advantage in other cases, the only apparent contraindication being furnished by intestinal inflammations and ulcerations, and peritonitis. It is not likely, however, that this suggestion of the rectal administration of ether will be taken up with any great enthusiasm so long as the generation of surgeons who once tried it and abandoned it is still living.— Medical Record.

VENTRAL AND MORAL EFFECTS OF ADENECTOMY.

Edw. A. Huntington, Principal Special School No. 3, Philadelphia (American Medicine, November 18 1905), reported to the American Psychological Association the detailed histories of three defective children whose mental and moral characteristics were very materially improved by the removal of hypertrophied pharyngeal tonsils. The first boy was a liar, a thief and avery combative and persistent truant. A few months after operation his moral improvement was so great that he rarely needed correction. His pugnacity had almost entirely disappeared and he had become an orderly and faithful worker; the second boy was mentally back

ward and made but little progress in the comprehension of any branch of the school work. His color sense was defective and his hearing very bad. After operation mental improvement was steady but slow, and in six months' time he was making satisfactory progress in first year work, his reading, spelling and arithmetic being good. His color sense or recognition of colors was markedly improved. The third boy was "a centre of disorder" in school. He stole from his teacher and ate the other children's lunches. He was cruel and took pleasure in hurting smaller children. He was obscene. He collected and hid bones and rusty nails. On entering the Special School No. 3 his mentality was that of a middle-grade imbecile. A few months after the operation he began to progress, and it was not long before he had become the equal of his classmates. At the end of the year he was promoted into the work of the second-year class with the highest mark.-Lancet Clinic.

FRACTURES OF THE OLECRANON.

J. B. Murphy, Chicago (Journal A. M. E., January 27), concluded that while operative treatment of fractures of the olecranon is most advisable, the open method, as applied to fractures of the patella, is sufficiently risky to be avoided. The subcutaneous and exarticular wiring of the olecranon, therefore seemed to him the simplest and most advisable method, but so far as he can learn from the literature no one else has ever made use of it. He reports a case in which he, by means of four small incisions, passed a fine aluminum bronze wire through the base of the olecranon, then upward to its apex and through the triceps tendon above, then back to the point of entrance where it was drawn tight till the widely separated fragments were perfectly coapted and secured by twisting. The elbow was secured in extension by an anterior plaster splint and a bandage, which were removed on the third day. Passive motion was practiced for four weeks; the results were perfect except for a small bursa at the point where the wire was twisted, but which causes no inconvenience. He recommends this operation as practical and safe, requiring no great surgical skill and giving perfect results.-Lancet Clinic.

MEDICAL

ACUTE YELLOW ATROPHY IN A CHILD.

Wentworth reports a case of acute yellow atrophy occurring in a boy of 5 years. At 18 months the patient had tuberculous peritonitis, from which he recovered without operation in about six months. At the age of 3%1⁄2 years he had lobar pneumonia of the left lower lobe. The first symptom of the final trouble was a slight jaundice. This was followed in a day or two by vomiting and a slight degree of malaise. The child was about the house and out of doors until within four days of his death. On the sixteenth day of his illness he became delirious. The urine was negative. A diagnosis of the condition was not made during life. When the abdomen was opened at autopsy firm adhesions were found everywhere. The liver was not diminished in size, and the cut surface presented areas of a bright greenish-yellow color on a dark red background. The most striking feature of the case was the extreme degree of destruction of liver with the absence of macroscopic signs of atrophy. The liver cells were destroyed in at least three-quarters of the liver. The urine had not been examined for leucin and tyrosin.-The Journal.

ALCOHOL IN CARBOLIC ACID POISONING.

After reviewing the history of the use of alcohol as an antidote to carbolic acid poisoning, T. W. Clarke and E. D. Brown report the results of a clinical and experimental study of the subject. The general conclusions from the experiments were: "(1) due to its solvent action. (2) There is no evidence of chemical antagonism between alcohol and phenol. (3) There is no effect produced by alcohol on carbolic acid poisoning after the latter has been absorbed into the system, as is shown by the intravenous experiments on dogs. (4) Alcohol and phenol placed in the stomach give no different results from phenol alone. (5) Lavage with alcohol is effective when the phenol is in the stomach, but its superiority over lavage with water is not pronounced." From the clinical aspect, alcohol seems to have a local antagonism to