Current Surgical and Medical Selections.

THE THERAPEUTIC VALUE OF UROTROPIN.-Dr. Emil Suppan, of Vienna, says, in the Wiener Medizinische Blätter, that since the time that Nicolaier first introduced urotropin for the treatment of bacterial disease of the urinary tract and the uric acid diathesis numerous reports have been made fully confirming the therapeutic value of the remedy. It is of immeasurable value in practice to possess an agent for the relief of those severe forms of cystitis occurring in old men, due to prostatic hypertrophy, and leading, as a rule, to chronic pyelitis or pyelo-nephritis and all the symptoms of chronic urinary intoxication. Urotropin is of the very greatest value as an aid to the local treatment, and in many cases can replace it entirely.

The author advises that urotropin be always employed in every case of urosepsis of the aged with prostatic hypertrophy, in all the non-acute and septic bladder and pelvic catarrhs which are the consequences and complications of this growth, as also in inflammatory conditions dependent upon atrophy of the prostate, neoplasms and diverticulæ of the bladder, and stricture.

Dr. Suppan mentions a case among others treated some eight months ago. A patient aged seventy-two years had had for the last fifteen years frequent, almost hourly, urination, especially at night. His color was faded, he was much emaciated, and there was no appetite. His prostate was very large, especially the median lobe, which projected into the bladder; and there were deep recesses behind and at the sides of this protuberance in which the urine was constantly stagnant and undergoing decomposition. The bladder was hypertrophied and trabecular, and was never completely emptied, the residual urine being about 400 c.cm. (thirteen ounces). The urine was purulent, and contained masses of mucus and pus. His fever frequently reached thirty-nine degrees C. (102.2 degrees F.), and he was often kept to his bed with chills and diarrhea. He had been having vesical irrigations for three weeks without the slightest effect. These I ordered to be stopped, after informing the relatives of the gravity of the outlook. gave him two grams (thirty grains) of urotropin in one-half gram (seven and one-half grains) portions every four hours dissolved in half a glass of soda water. Even in four days there was a slight improvement in the urine; there was less clotted mucus and pus, and the repulsive ammoniacal odor had diminished. The fever, general malaise, and prostration gradually disappeared. On the eight day the patient was able to leave his bed, and the administration of nourishment, which had sunk to nothing, was in full swing again. Cautious lavage of the bladder with boric acid and permanganate of potash, with nitrate of silver, could then begin. The urotropin was continued in doses of 1.5 grams (twenty-two and one half grains) daily.

In the morning the bladder was thoroughly washed out with a large quantity of fluid; in the the evening the patient removed the residual urine with a Nélaton catheter himself. Improvement was continuous for several weeks. But as soon as the patient stopped the urotropin for several days the urine became worse; so that I directed him to take the drug for four days in each week. Under the continued employment of the drug, and the careful nursing that he had, the patient was finally put in a very fair condition, though of course there was no question of curing his old vesical malady. About twenty-four other cases of septic cystitis and pyelitis in the aged ran a similar course under the same treatment.

The reason why urotropin is inefficacious, or why its effect becomes less after a time in certain cases, has been explained by Casper and various other investigators. They found that in certain cases the urotropin passed into the urine unchanged, and no formaldehyde could be demonstrated in the secretion. The action of the drug, according to Casper, depends upon the presence of free formaldehyde in the urine; the more there is of it, the more of the noxious micro-organisins are destroyed. Only a portion of the urotropin is split up; and severe cases of cystitis require large doses to get its effects.-Medical Review of Reviews.

POST-PARTUM HEMORRHAGE: ITS PREVENTION AND TREATMENT.Third day of the sixty-eighth annual meeting of the British Medical Association, August 2, 1900.

The papers and the discussion on this so interesting and important subject brought forth many useful points, at the same time showing that, in spite of the high standard of the Edinburgh Obstetrical School, the British obstetrical profession still lacks the thoroughness and exactness which nowadays is considered essential in medical science.

Bryers, of Belfast, mentions only two pathologic conditions as causes for post-partum hemorrhage, viz., uterine atony and a wound of the parturient tract. One of the most frequent causes of post-partum hemorrhage, and a condition which furnishes the most serious cases, at the same time the most difficult ones to deal with, atheromatosis of the uterine vessels, is entirely omitted. As "clear" causes of post-partum hemorrhage albuminuria and ⚫ mental depression are mentioned. As to prophylaxis, the essayist says we never should attempt to deliver in the absence of pains. How about cases of extreme exhaustion of the mother, where no pains are present, but a strict indication for immediate delivery exists on account of the danger for mother and child? The hot-water douche, a means which makes us only lose valuable time, is still recommended. The bimanual compression of the uterus, which only is a temporary means to check the hemorrhage until everything is ready for the definite hemostasis, is still considered as an independent method itself.

It has to be favorably acknowledged that drawing down the cervix by vulsellums and Dührsseu's tamponade are recognized as the most valuable methods.

The essayist says that Schauta advised, if packing had failed, the uterus should be forcibly inverted and a piece of gauze should be tied around its neck, leaving it on for six hours. I am sure Schauta would most emphatically protest against this insinuation. Schauta teaches that when, in spite of packing, there should still be present oozing through the tampon and flabbiness of the uterus, to remove the tampon at once and renew the tamponade by firmly packing the uterus. He mentioned only occasionally the possibility of inverting the uterus and catching the bleeding vessels. In the treatment of the anemia following hemorrhage auto-transfusion is not mentioned at all.

Boxall, of London, cautions against the injudicious application of forceps.

Campbell, of Belfast, recommends drawing down the uterus with a vulsellum, and uses hot water through a flushing curette.

Griffith, of London, thinks chloroform interferes with uterine contraction, a long ago refuted statement, and administers always ergot before giving chloroform.-The Chicago Clinic.

THE TREATMENT OF SPRAINS AND SOME FRACTURES.-(The Lancet) A. H. Tubby. A sprain may be defined as a momentary disturbance of the normal relation existing between the opposing joint surfaces, but varying very much in degree. In any case some stretching of the surrounding parts must take place, accompanied by hemorrhage and lymphatic effusion. In some cases the injury may cause only temporary inconvenience; in others the ligaments are ruptured, and in the severest a small portion of the bone is torn away, and in this case the injury is known under the name of sprain-fracture. Tubby notices the symptoms, the severe pain occurring shortly after the accident, then being apparently quiescent for a short while, and later recurring with increase of swelling. The first stage is that of the injury associated with stretching and tearing of the parts and effusion of the blood. The second stage of pain after the quiescent period is due to tension and continued effusion of the blood. A great deal of damage is often sustained by the patient when he attempts to use a sprained joint. during the quiescent period. This retards the period of convalescence. It is important in severe cases to make the diagnosis as clear as possible, and the X-ray may be valuable in case of sprain-fracture. Even when no fracture has taken place, there are frequently found about the joints some tender spots, as at the knee, where a spot is found just below the patella, and in the ankle, in front of the external malleolus. These are first noticeable during the second period of pain, and last for a considerable time and are due to rupture of the ligament in the first place and later to the persistence of roughened, inflammed synovial fringes. If they should persist for some weeks or months after a sprain, their usual cause is the formation of bands of adhesions. There are certain predisposing causes of sprains, malformations, club foot, ankylosis of the knee, atrophy of the

muscles, etc., which cause abnormal tension of the joints. As to treatment there are two methods, the mobile and the immobile. The principal thing to remember is what to do and the right time to do it. At first the author recommends applications of cold water for a short time during the first two or three hours after the accident. The position is important, as the joint should be put in the position of least tension and the potential cavity be lessened. For instance, the knee should be placed in extension and not flexion and the ankle at a right angle. Bandaging should be done in such a way as to relieve pressure over the point where it can cause more tension and tenderness. If the sprain is seen within the first two or three hours he insists on the following treatment: Apply cold vigorously for a quarter of an hour, either by pouring on cold water, applications of ice or the spirit lotion, then wrap the joint around with lint or other material soaked in cold water, and put on the cotton-wool in such a way as to relieve the pressure over the prominent points, and place the joint in such a position that there is the least potential cavity for effusion to be poured into, and firmly bandage the part. During the period of quiescence the same round of treatment should be followed out where there are still some quiet effusions going on, but when the second stage of the pain occurs the right thing to do is to apply heat, as hot applications exercise a permanent effect on the duration and the amount of swelling. The most important question is the duration of the period of rest. It may be said that as a rule most joints are rested too long. On an average of three or four days after the swelling has subsided movement of the joint should be commenced. The direction of the movement is an important point, so as not to interfere with the healing of strained and ruptured ligaments. When the amount of swelling is very great, hot applications and rest are not sufficient, and here properly applied friction comes into play. Together with rubbing, frequent applications of hot water and gentle movement should be carried out. If after ten days' treatment the thickening about the joints has not disappeared and there are still tender spots, use counter-irritants by blisters. In from ten days to three weeks a severe sprain ought to cease to give trouble and the patient be able to go about with comfort, but if at this time acute pain sets in with movement, the only treatment is absolute rest. Six weeks is not too long a period to keep such a joint quiet. The mobile treatment of sprains can only be used in very slight cases, and then with some misgivings. The author concludes his paper with the treatment of fracture about the elbow-joint and separation of the lower epiphysis of the femur.-Journal American Medical Association.

ACUTE YELLOW ATROPHY OF THE LIVER, TERMINATING IN RECOVERY.-Albu (Deutsche med. Wochenschrift) reports this case, which makes the eighteenth that has been published. The patient was a man of thirty-six years, with a negative past history, who three weeks before coming under observation had become jaundiced after an emotional shock. This condition continued for some time, until mental hebetude and great

There was

prostration developed, when the author was called to the case. then noted profound muscular weakness without any emaciation, slight impairment of the mental faculties, a temperature of 103 degrees, and slow pulse. The liver dullness was greatly decreased, extending from the sixth rib only two inches downward, there being tympany under the free costal arch. The spleen was palpable, the urine bile-stained and containing no albumen, but large amounts of indican, leucin and tyrosin. The stools were acholic. At the end of the sixth week from the first access of the jaundice the temperature stayed down permanently, the liver dullness began to increase, and the enlarged spleen receded. The patient soon regained his former strength and vigor, though the jaundice did not wholly disappear until about three months later.-Medical Record.

EVERSION OF THE TUNICA VAGINALIS AS A REMEDY FOR HYDROCELE. Dudley Tait (San Francisco Annals of Surgery). Touget's operation is considered the best procedure in all cases of hydrocele. It is carried out as follows: Under local anesthesia a fold of the scrotum is taken up over the testicle and cut with scissors down to the serosa. This is taken up and cut through in a like manner. Neither the superficial nor deep incision should exceed 3.5 centimetres in length. The testicle is turned out and drawn upward and forward till the tunica vaginalis and overlying cellular tissue are turned inside out. The tunica is held in place by two or three catgut sutures passed so as to avoid constricting the cord. The testicle is replaced in a new bed in the inner lip of the incision, made by dissecting a space in the cellular tissue. When replaced, the testicle is retroverted and twisted a quarter of a circle on its long axis, so that its anterior surface is against the raphé. The operation is completed by suturing the wound. There is no reaction and no tenderness after a few hours, and the patient may resume his work on the following day. After a few months the scrotal tissue becomes freely movable over the testicle.-Georgia Journal of Medicine and Surgery.

TREATMENT OF GASTRIC ULCER.-Dr. Mayo Robson says, with reference to this question, that the treatment of this condition is at first essentially medical, and if properly carried out and for a sufficient length of time it is usually completely successful; but in many cases, either from the uncertainty of diagnosis or from the impatience of the patient, care in diet and rest are not persevered in for a sufficient length of time and relapses result; treatment is again resorted to, and relief, but not cure, follows, until in the long run complications supervene or the ulcer becomes chronic, when surgical treatment is in many cases the only method capable of affording relief.-British Medical Journal.