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that operators were much inclined to follow beaten tracks and routine procedures rather than base their operative treatment on the especial conditions found in each individual case. tioned some points in the histories of some of cases which had a bearing on the subject. The first was one in which he himself
. had failed to cure. It was a case of prostatic retention, treated by means of the Bottini electro-incision. He then bad desired to open suprapubically, but the patient objected. Later, the patient consulted another physician and had consented to the suprapubic operation, at which time an intravesical projection was removed, with the result of giving complete relief to the patient. The second case was one in which perineal prostatectomy had been done a year before by another surgeon, and yet no benefit accrued. The patient was compelled to depend on the oatheter for evacuating his bladder for six months thereafter. In January of the present year, Dr. Lewis made a suprapubic incision and removed an intravesical collar that surrounded the urethral open. ing, and which had been causing the complete retention, notwithstanding that prostatectomy had been performed. A cure followed the second operation. The third case was that of a man sixty-five years old, very infirm, whose urine was albumin uric, and who had twenty-eight ounces of residual urine, and who urinated thirty-five times in twenty-four hours. Upon this patient he made one prosterior incision with the Bottini-Freudenberg incisor, affording practically a prompt and complete relief from his various symptoms, with reduction of the residual urine from twenty-eight down to two ounces, and the frequency from thirty-five to seven or eight times in twenty-four hours, with the removal of the albuminuria and a rapid improvement in his general health. Later the patient had been operated upon for inguinal hernia by another surgeon, became infected, suffered from erpsipelas and gangrene of the lunga, intestines, and of the wound, from which he died, permitting the exhibition of the port-mortem specimen, which the author presented. It showed the groove made by the cauterizer, through which free urination had been accomplished. The form of obstruction had been a prostatic bar. The fourth case mentioned was one of a gentleman who, four years ago, had been advised by a genito-urinary surgeon to undergo some operation for hypertrophied prostate,
but, on consulting the reader of this paper, was advised by bim not to accept any operation, as he did not need any. Oply antiseptic and dietary regimen bad been prescribed for this case, and yet, during the past four years, he had had no indication of any trouble with his prostate or bladder. There had been no residual urine in the first place, and no reason for an operation had ever existed. The practical lessons to be derived from these cases were: That the proper selection of the operarive procedure is of the greatest importance in attaining successful results. This was satisfactorily explained by the dozen or more specimens and models of hypertrophied prostates exhibited by the reader. In these, the various forms of prostatic enlargement and obstruction were clear, including intravesical tumors and projections, the prostatic bar, the biliteral hypertrophy, sessile and pedunculated tumors, the nodular valves, and the median outgrowths, adeno. mata, etc. From all of these it was plainly evident that no one operative procedure could possibly fit all cases, and that the operation should be selected according to the cases at hand, rather than the personal inclination of the operator. The condition favorable for the several operations in vogue were summed up as follows:
Favorable for the Suprapubic Route.—(1) General enlargement of the prostate, with extreme intravesical projection of the median or lateral lobes, diminisbing their accessibility from the perineum; (2) Marked pedunculation of the intravesical tumors, with absence of obstruction from other sources.
Favorable for the Perineal Route.—(1) General hypertrophy involving the lateral lobes, without extreme intravesical projection; (2) Large or very thick bar formation; (3) Severe com. pression of the urethra between massive lateral lobes; (4) Excessive development of the prostate in the direction of the rectum; (5) In most cases where the patient is in good general con. dition, is not too aged, and there is not a special indication favoring one of the other procedures.
Favorable for the Bottini.—(1) Cases of extreme debility or of extreme age, unable to stand one of the severe operations; (2) Cases of bar or median sessile obstruction, if not too great dimensions; (3) Howitz says it should be employed as a prophy. lactic against further obstructive tendency, at the beginning of catheter life; (4) In complete collar formation.
J. H. KIRKLAND, A.M., Ph.D., LL.D., Chancellor. LLIAM L. DUDLEY, B.S., M.D., DEAN, W. H. WITT, A.M., M.D., Professor of
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rics. GEORGE H. PRICE, B.E., M.S., M.D., RICHARD A. BARR, M.D., Adjunct ProSec'y., and Professor of Physiology.
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PUTREFACTIVE PROCESSES. —As an antiferment, to correct disorders of digestion, and to counteract the intestinal putrefactive processes in the summer dirrheas of children, Listerine possesses great advantage over other antiseptics in that it may be administered freely, being non-toxic, non irritant and nonescharotic; furthermore, its genial compatibility with syrups, elixirs and other standard remedies of the Materia Medica, renders it an acceptable and efficient agent in the treatment of diseases produced by the fermentation of food, the decomposition of organic matter, the epdo-development of fetid gases, and the presence or attack of low forms of microzoic life.
An interesting pamphlet relating to the treatment of diseases of this character may be had upon application to the manufacturers of Listerine, Lambert Pharmacal Company, St. Louis.
WHY COCA IS A PANACEA.—How many of our readers ap. preciate the true value of Coca as an all around remedy? Not Cocoa, from which Chocolate is made, but Coca, from which that potent substance Cocaine is produced. It requires one ounce of Coca leaves to make one grain of pure Cocaine, and that alkaloid is but one of many contained in these marvelous leaves. It is because of the modified action of all the constituents that the whole drug is possessed of different therapeutic properties, and is specifically greater than any one of its parts. Coca is a nervous stimulant, acting primarily on the cerebral cells, but in this action having an elective affinity for the respiratory center and a chemico-physiological depurative influence on the blood. It is from this latter cause that Coca has such a wide-spread usefulness, which seemingly classes it as a panacea for all ills. With a purified blood stream, the organs of assimilation and the muscu. lar and nervous systems are not only repaired, but maintained in equilibrum.
Unlike any other nervous stimulant Coca is not followed by