We cannot hope for such good results from non-surgical treatment. If we can get such results from operation as a last resort, what may we not expect when the cases are operated upon early, when the danger is only from the operation and not from the disease itself?

Willy Meyer thinks the proper time to operate is before the catheter life has begun. He says: "If the amount of the residual urine is found to be considerable, and the patient demands relief, I propose operative interference. I emphasize the superiority of prostatectomy, pointing out that it will yield the most satisfactory and lasting results. Should the cutting operation be refused, or I should come to the conclusion that in the given case Bottini's operation is preferable, then I urge the latter. If both operations are refused by the patient, the catheter must of course be resorted to."

As to the technique of the operations it is given much better in the recent text-books and magazines than I could hope to give it in an article of this scope, so I will pass it by. The Bottini operation is falling into disuse except in a few selected cases, prostatectomy by the suprapubic or perineal route being preferred, with the balance being in favor of the latter as being the easiest in the majority of cases.

The general practitioner will see these cases first, and many times will have to treat them to a finish. Many cases cannot, for one reason or another, be operated upon, while others will not listen to the suggestion of an operation. For such we must do the best we can without surgery, and that best is a great deal, if diagnosis is made and treatment is begun early. In order, briefly, to state what I believe to be the best non-surgical treatment, I will give the history of one of my late cases. The patient was a nervous, broken-down man, sixty-three years old. He had been suffering from bladder trouble for three years, and had been catheterized a few times. The usual symptoms of prostatic hypertrophy were present—all of them. He urinated on an average of every half hour during the day, and from eight to twelve times during the night. He was seldom free from tenesmus. The urine was very cloudy, alkaline, full

of pus and swarming with bacteria. The prostate was so large it was impossible to reach its upper border. I began massaging the gland every second day and followed this with bladder irrigations without a catheter or instrument in the penis. I used a quart of antiseptic fluid at each sitting, and at the close of the treatment allowed a few ounces of the solution to remain in the bladder. Internally I gave him first Horwitz's formula of methylene blue comp., and fifteen drops of solution adrenalin chloride three times a day. I had gotten good results from adrenalin chloride in the treatment of congestions and enlargements of the uterus, and reasoned that like results might be expected from its use in the treatment of enlarged prostate, provided the case had not progressed too far. After a few weeks I substituted cystogen for the methylene blue. I also had to lessen the dose of the adrenalin after a couple of weeks on account of it causing a little dizziness. I dropped the dose to ten minims three times a day, and kept it so for a number of weeks.

At the end of three months he declared himself well. He had gone back to his usual work in his store, doing full work every day. The urine was transparent, free from pus and germs, and acid in reaction. He voided his urine only from four to six times a day, and did not get up at all during the night, except when he drank considerable milk for supper or ate water melon. His prostate was about one-third smaller than when treatment was begun, and the finger easily reached up over the upper border. Morning erections, which had been absent for more than a year returned; and altogether he considered himself a well man. He stopped treatment some time ago, but reports occasionally to say he is all right.

I shall continue to watch him with a good deal of interest, as I cannot help believing that much of his improvement was due to the adrenalin.

HEMATOCHYLURIA SINE PARASITO.

BY DR. FREDERICK CORSS, KINGSTON, PA.

READ SEPTEMBER 7, 1904.

The case herein reported is interesting because of its rarity. I never saw the like before. The literature upon the subject is very meagre and incomplete. There is no allusion to it in "An American Text Book of Pathology" by Hektoen and Riesman. In Osler's "Practice of Medicine," page 859, in a chapter on Anomalies of the Urinary Secretion, are ten lines which I quote in full, viz.:

CHYLURIA-NON-PARASITIC.

"This is a rare affection, occurring in temperate regions and unassociated with the Filaria Bancrofti. The urine is of an opaque white color; it resembles milk closely, is occasionally mixed with blood (hæmatochyluria), and sometimes coagulates into a firm, jelly-like mass. In other instances there is at the bottom of the vessel a loose clot which may be distinctly bloodtinged. Under the microscope the turbidity seems to be caused by numerous minute granules-more rarely oil droplets, similar to those of milk. In Montreal I made the dissection of a case of thirteen years' duration and could find no trace of parasites."

In the Practice of Wood and Fitz, page 1000. “It is likely that a non-parasitic type of chyluria also exists, from the fact that this symptom occurs in persons who have never been near the tropics, and may last for years without other disturbance than painful micturition from the presence of clots in the bladder." Hematochyluria is common in Egypt and tropical America, caused by a parasite, the filaria sanguinis hominis nocturna and diurna, which should be called filaria sanguinis hominis dormientis and filaria sanguinis hominis ambulantis as it is the sleeping state of the host and not the night which is the distinguished trait. The form here called dormienitis does not appear in the superficial blood of a host who is ambulating.

William J., a Caucasian, aged 50 years, complained of bloody

urine. He is of good family history and is in good health. He has never been in the South. His blood contains no malarial parasites and no crescents. By the Tallquist scale hemoglobin is 80, and by the Daland hematocrit the blood corpuscles are normal. Most specimens of his urine were bright pink, as you see; but sometimes one was smoky, which became pink on exposure to air and light. This, I suppose, was hematin, which became oxygenated and combined with some proteid, thus passing into oxyhemoglobin. The urine was of normal specific gravity and slightly albuminous. The first question was whether the color was hemoglobin or bilirubin. A long search revealed no corpuscles except one bottle, in which was a distinct blood clot. In this corpuscles were found. Tincture of guaiacum mixed with an equal part of ozonized turpentine uniformly showed the characteristic blue tint in the brown specimens as well as in the red. Heller's test gave the same result.

In the test-tube ether caused a precipitation of the color, and a drop of the clear layer dried upon a slide showed oil globules (chyle). It is useless to speculate as to the cause of this affection or its pathology. Ordinarily the blood corpuscles and the sugar of the lymph fail to reach the urine in both the parasitic and non-parasitic forms of the malady.

I cannot find that the non-parasitic form ever causes lymph scrotum or elephantiasis. A diligent search at favorable hours failed to reveal the embryo of the Egyptian parasite in this

case.

Now, June 30, 1904, William is fully free from the symptoms, and has seen no blood for a month. I do not know what cured him or whether he is cured. He took ergot about a month; afterwards strychnine with elixir gentian and iron for two months.

September 6, 1904. William J. remains well, without a return of hematuria.

P. S. Blood examination excluded a diagnosis of lipemia.

THE REGULAR PRACTITIONER AND SOME THINGS HE HAS TO CONTEND WITH.

BY DR. R. P. TAYLOR, WILKES-BARRE, PA.

READ SEPTEMBER 21, 1904.

Mr. President and Members of the Luzerne County Medical Society:

The title of my paper to-night is The Regular Medical Practitioner and some things he has to contend with.

What is meant by regular practitioner? One who practices his profession according to the rules established by law or professional custom. A practitioner of the school of medicine that represents the old system and who is duly authorized as having completed a prescribed course of study according to that school; so called generally by themselves, but by adherents of other schools usually allopath. The honorable regular physician knows no path but the right path which should lead to (I won't say financial) success, honor and renown. He is not a wolf in sheep's clothing, he practices what he preaches, and prescribes whatever drugs he thinks will effect a cure, either in infinitesimal or maximum doses as the case requires. It was not fair of Hahnemann to charge all other practitioners with uniformly proceeding on some one opposite principle as allopathy or antipathy, for neither homeopathy nor allopathy was ever heard of till he chose to invent the terms, and taking one himself gave the other to all the rest of the medical world. Truth is powerful and will prevail; all the other pathies will come and go, but the regular practitioners, as to-day, will be found on the top rung of the ladder, long after we have outlived our usefulness and our bodies lie mouldering in the grave. The things the regular practitioner has to contend with in practicing his profession are legion, viz. The patent medicine man. The druggist that supports patent medicines. The newspaper proprietor that advertises patent medicines. The indiscriminate dispensary practice. The mid-wife, etc., etc. And as it is impossible to discuss the subject fully in a paper, and as these have been pretty well aired in medical journals for some time back, I will touch on some others I consider more important.