lish authority, Dr. Morris, places the percentage of uric acid kidney stones as high as 95 per cent.; in other words, of the many phosphatic stones removed from patients, the greater number are formed over nuclei of uric acid stones.

The speaker next showed the largest stone in his collection, which was taken from a man 36 years of age. The stone had existed for thirty-five years when the patient went to Bellevue Hospital in 1860. A diagnosis of cancer of the bladder was made, and he died without an exploratory operation, exploratory laparotomies not being as common then as now. At the autopsy a stone thirteen ounces in weight was discovered, which was unquestionably the cause of death. The interior of the stone is oxalate, covered by layers of phosphatic deposit. In the oxalate stone the outside and inside are "bumpy," so to speak, and there is no regular formation, while in a uric acid stone in the collection there are systematic thin layers, one upon the other.

The shape of a calculus is sometimes interesting, but not important, perhaps. The stone generally takes the shape of the cavity in which it lies, in a general way. All the stones are concentrically formed. There is a nucleus of what may be termed a "foreign body"-either an actual foreign body or formed from the salts of uric acid. Layers of the same substance or of a new substance keep forming, and in a general way there is a roundish shape, with the exception of the oxalate stone, in which, in certain cases, the nucleus is not central. The speaker showed several stones which had formed upon nuclei of actual foreign bodies. One or two had formed upon the ends of catheters which had broken off in the bladder, and one especially interesting specimen which had formed on the end of a hair. The patient developed a tumor with a hairy surface, and the inflammation thus set up caused a cystitis with alkaline secretion, and phosphates were thus deposited on the hair. There were thirty-one small stones, each formed in the same manner, at the end of a hair.

Dr. Charles H. Chetwood presented two specimens of vesical calculi which he thought of special interest in connection with the general consideration of the subject of Dr. Keyes. The first specimen presented had been removed from a 3-year-old child about a week previously in the clinic. The size and compactness of the specimens were such that he thought it

probably a fetal formation. The diagnosis was made with a silver probe, with which he touched the stone without difficulty. A suprapubic incision was made and the stone removed. It weighed 5.44 grammes. The patient has a suprapubic fistula, which the speaker thought would heal in a few weeks. The other stone formed upon a broken-off catheter, and was removed from a patient 72 years old who had an enlarged prostate. It weighed 10.44 grammes and was composed of a triple phosphate and ammoniam urate. The catheter nucleus was broken off in the bladder some three years before the calculus was removed.

CYSTIN CALCULUS.

Dr. Manges showed a cystin calculus which he thought particularly interesting because there are probably not more than fifteen specimens in the entire world. The stone, which weighed fifty grains, was passed spontaneously by a boy 20 years of age. The patient disappeared, so that no chemical analysis could be made. These stones are closely associated with a putrefaction which goes on in the intestines and are excreted in the urine as well. This disease often occurs in families, but the chemical analysis is unknown.

Dr. Manges showed two specimens of renal calculus, and the kidneys from which they had been taken. A patient who was operated on for the relief of difficulty in secretion of urine died, and upon examination it was found that extreme atrophy of the kidney had resulted from the impaction of a stone in that organ.

The second specimen was a very good demonstration of the stone in situ. A very large kidney had been packed with stone, which had in time caused a hydronephritis. At the lower end of the specimen, part of the kidney could be seen beyond the pelvis, showing what extensive changes may be produced by the long residence of stone in the kidney.

X"-RAY DEMONSTRATION OF STONE IN THE URETHRA. Dr. Albert Kohn presented an X-ray photograph of a patient who had suffered from attacks of colic for fifteen years. His symptoms were relieved by hypodermic injections of morphine. After one of these attacks he had a chill, and the

diagnosis of "surgical kidney" was made and a surgeon called. The patient was removed to a hospital, where he could be watched for confirmation of the diagnosis, and three days afterward he developed a second attack and one week later a third attack. An exploratory incision was made into the kidney, and no stone was found, but there was an acute infection. This wound was barely healed when the patient had another attack of colic, followed by a chill. The surgeon went in from below and catheterized the ureter and found what he thought was a stricture. The patient was sent to have an X-ray photograph taken and fortunately the stone lay directly in line with the photograph. The surgeon cut down on the ureter and removed the stone.

RENAL CALCULUS.

Dr. J. Riddle Goffe presented a specimen of renal calculus removed by him from a woman aged 40 years, who was sent to him for operation for ovarian cyst. She had suffered from severe pain, from chills and fever, for about six months, and was treated for malaria. Her urine had been examined several times and no pus had been found. Upon examination it was found that she had a large tumor, which had no connection with the pain, and upon opening the kidney a large stone was discovered, which blocked the passage. It was removed without difficulty and without opening the ureter.

The speaker said that the specimens of calculus growing upon the end of a hair, shown by Dr. Keyes, recalled to his mind a patient, female, aged 45 years, who, several times a year, plucked tufts of gray hair from her anus. It always reappeared in a few months. She had a tumor, and on operating a large dermoid cyst was found, and over the pelvis it had lacerated through the rectum and the rectum had closed around it. This was the origin of the tufts of hair.

Dr. F. M. Jeffries said it is impossible to give a definite explanation of the etiological factors in the formation of these calculi. A number of theories have been advanced. One thing is certain, three factors must be present before calculi can be formed; first, the chemical constituents of the urine; second, nidus; third, a substance capable of entering into and making a stroma. It is true that two substances at least manifest in themselves a cohesive power, as seen in the uric acid of roseate

crystals and in calcium oxalate, where the crystals are found in rare spherical and dumb-bell shapes. The reaction of the urine will control the kind and variety of stone that is formed, an acid urine allowing only those to form that are insoluble in the acid, and an alkaline urine causing those that are insoluble in alkaline fluids. As regards the nidus, Dr. Keyes had shown a number of specimens in which it was crystal; what forms on that afterward depends on what takes place iu the bladder. One substance which Dr. Keyes did not mention, which is sometimes found forming the nidus, is a blood clot. A peculiar feature regarding the formation of calculi is that they are particularly liable to occur in particular, definite, fixed localities, while territories in the close vicinity may leave their population comparatively free from this affliction. This led to a strong opinion that the variety of waters might have something to do with their formation, but investigations on this line have not thoroughly satisfied those who adhere to this theory.

A GENITO-URINARY SYMPOSIUM.

Report in abstract of the regular monthly meeting of the Northwestern Branch of the Philadelphia County Medical Society, held March 10, 1904. Dr. Samuel Wolfe, President.

LOCAL TREATMENT OF GONORRHOEIC INFECTIONS.

Dr. H. R. Loux read a paper entitled "The Local Treatment of Gonorrhoeic Infections."

Dr. Loux stated that, although a continuous service of eleven years in one of the largest genito-urinary clinics in America had afforded him unusual opportunities for observation, he had never written a paper upon the treatment of gonorrhea, because no method heretofore suggested proved, upon prolonged trial, to be an advance worthy of commendation. Clinical observation in thousands of cases convinced him that gonorrhoea is too often grossly mistreated. He deprecated the use of strong, irritating injections because they aggravate the disease and damage the urethra, and stated that treatment of acute anterior urethritis by irrigation is to be condemned because it causes an extension of the disease by continuity;

he quoted statistics, reasons and authoritative statements to show that these opinions represented the beliefs of the leading and most conservative genito-urinary surgeons.

The speaker stated that during the past year and a half the results at his clinic at the Jefferson Hospital and in private practice, had been much better than ever before; this statement he based upon the observation of several thousand cases of gonorrhea at all stages. The reasons for this improvement he ascribed to careful local treatment in which he abandoned, absolutely, the use of any drug as an injection which can cause the slightest irritation. Dr. Loux stated that, in a general way, his methods of treatment were as follows: For acute gonorrhea, he prescribes light diet, with very little meat, no fats, fruit or alcoholic beverages, but allows as much skimmed milk as the patient can drink. If the infection is confined to the anterior urethra, he prescribed the injection of two drachms of a 10 per cent. solution of argyrol, held in the urethra ten minutes; this injection is made in the morning, at noon and at night. Internally, he prescribes capsules of copaiba, cubebs and sandalwood three times daily. This treatment is practiced for one week, during which time the discharge will almost if not entirely cease, there will be no pain or irritation by the injection or upon urination, and the gonococci will disappear.

If, at the end of one week, the urine remains continuously shreddy, a weak solution of astringents is employed and of these drugs he preferred zinc sulphate, iodide, chloride, hydrastin or berberine muriate, but emphasized that these astringents should not be used during the first week of the disease and never in solutions sufficiently strong to produce pain or irritation.

If the two glass test shows cloudy first and second portions of the urine, showing the presence of antero-posterior urethritis, he irrigates the anterior urethra with a warm solution of boracic acid in order to remove the accumulated secretions. Then he makes deep instillations of 20 per cent. argyrol solutions once daily or on alternate days; the inflammation of the anterior urethra is treated in the manner already described.

The writer quoted from statistics of four hundred cases, treated since July, 1902, by the methods described, and stated the advantages as follows: Simplicity; the relief afforded the