Dr. Peaslee answered, in cases of passive congestion, which it increases, irritating the spine and increasing the eretherism. Dr. Fay thought it was in cases of irritation and not of weakness that bromides produced erections. Dr. Cory asked what symptoms referable to the heart would lead the Doctor to treat them with heart tonics. Dr. Peaslee replied, when the veins of the hands and elsewhere were full, and there was insomnia, dreams, a weak pulse, and perhaps bronchitis. The mental depression when there were occasional emissions, leads to cardiac weakness. Dr. Russell considers that a faulty heart accounts for many ills, but does not understand how it can produce albuminurea, or congestion of the renal veins, nor how a weak heart can cause emissions. Albuminurea is caused by congestion of the malpighian tufts, and he would consider the heart trouble to be secondary to the renal trouble with albumin. Passive congestion of the genital organs would probably diminish the irritability. He would look for a local irritation. Dr. Peaslee said that many authors have claimed that distension of the renal veins and albuminurea are caused by venous tension. Many diarrhoeas arise from blocking up of the portal system. Dr. P. D. Rothwell asked if the heart itself be at fault, or whether it be the nervous supply which is abnormal; would you medicate the heart, or the nerves the heart. Dr Peaslee replied: It depends upon what is the matter with it. The heart may sympathize with the general system being weak, or with bronchitis or disease of the valves of the left heart, and this governs the treatment. Dr. Purcell spoke of cases of high fever with quick pulse, having emissions; but had not seen them occur in weak or debilitated subjects. They are frequent in delirium tremens. Excessive drinking is a frequent cause; this stimulates the heart and the whole system, which he considers the cause. Dr. Davis mentioned a case of chordee which was caused by a growth within the substance of the penis, without gonorrhoea. Dr. Peaslee said venous congestion caused erections by cheeking the veins, giving congestion of the penis. Has seen cases of diabetes insipidus do well under uva ursi and digitalis. Dr. Mavity thinks there is a cause back of the heart which produces weakness. The treatment holds good; stimulating the heart restores and nourishes the parts giving relief. Dr. Peaslee asked how to account for absorption of the testicle which may result from varicocele. Dr. Rothwell thinks disease affecting nerve force may cause the varicocele. Dr. Peaslee said a scrotal hernia may be forced down by abdominal pressure: so may pressure on the illiac vein cause varicocele. Dr. Cory asked if you would increase the heart's action to cure these cases. Dr. Peaslee said he would do so, thus relieving the heart's congestion. Dr. Wood considered that something more than simple weakness of the heart was needed to cause venous congestion; some obstruction to to the circulation, which might result from disease of the cardiac valves disease elsewhere. Pressure upon the veins or any cause which retards the return of the venous blood to the heart, will cause venous congestion, and, if this be of the renal veins, may produce albuminurea; but he doubts if it be often the result of simple cardiac weakness. Dr. Russell reported a case of chronic cystitis. An Irishman aged 50, had always had bladder trouble, and could only hold his water for an hour or so. This has been worse for two years; the urine being ammoniacal, and having a strong, offensive odor. There was tenderness over the bladder, the prostate was enlarged; could not pass a small sound but a large one passed readily; the internal surface of the bladder was roughened. The doctor washed out the bladder with a fountain syringe; there was a good deal of mucus, pus, and small clots, and about a half drachm of small gravel, brought out at the first washing. The bladder was washed out twice daily for a week, afterwards once daily by the patient himself. He was instructed to always pass his water through a catheter, and also to wash out the bladder with hot water. He can now hold his water 8 or 9 hours. Used suppositories of opium and belladonna for first week. In chronic cystitis it is necessary to be sure of emptying the last few drops of urine from the bladder. Dr. Davis thought the cure was a rapid one, and liked the idea of diluting irritating urine, as well as using hot water for inflammation of the bladder, and compared this with its use in uterine diseases. Would have it retained several minutes, as its first action is to cause congestion, longer use causing depletion of the parts. The removal of the last few drops of urine is very important. Dr. McMartin thinks hot water would not be endured, would use warm water. [TO BE CONTINUED.] HOME ENTERPRISE. At the request of the committee in charge, I. Durbin, proprietor of the Dental and Surgical Depot, 406 Lawrence St., made a very creditable display of surgical goods at the recent State Medical Convention held in this city. The exhibit, while necessarily limited, impressed us as of unusually fine quality and finish and embraced many of the more expensive instruments, which we would not expect to find west of New York. Mr. Durbin has greatly increased his stock during the past year, and proposes to furnish the Profession with the most modern and improved surgical goods to be found in Europe and this country on favorable terms. The encouragement of home enterprise is manifestly the true policy of doc tors. Many Eli Lilly & Company displayed a handsome line of their pharmaceutical preparations, consisting of fluid extracts, gelatine coated pills, sugar coated pills, elixirs, wines, syrups, etc., together with their specialties, succus alterans (McDade), elixir purgans, aromatized liquid pepsine, all of which are largely prescribed throughout the state. physicians tested their syrup yerba santa aromatic, which they pronounced the most perfect mask for the bitterness of quinine they had ever tried. The firm was represented by Mr. Jas. E. Lilly, manager of the western branch of this popular house at Kansas City. Their HandBook of Pharmacy and Therapeutics, containing one hundred and twentyfive pages of valuable matter,also samples of their preparations were presented to physicians in attendance. McKesson & Robbins, of New York, made a large display of their own make of quinine, morphine and scale preparations. They exhibit a case of one hundred dollars' worth of the most desirable varieties of these capsuled pills. Every delegate was presented with a neat little six-vial case of granules and a package of pure proto iodide of mercury John Wyeth & Brother. Manufacturing Chemists of Philadelphia, exhibit nearly a full line of their preparations. Among their specialties we notice the Hypodermic and Fehling's Test Tablets, a c.p. boracic acid in an impalpable powder, Lawton's absorbant cotton for surgeons use; also compressed powders or pills, fluid extracts, medicinal wines, syrups and elixirs. MISSOURI MEDICAL COLLEGE, The Oldest and Largest School West of the THE FORTY-FOURTH YEAR, BEGINNING OCT. 1, 1884. Entire Course of Lectures, including Matriculation Fee, Hospital Tickets, and admision to Dissecting Room, $75. For circular address, T. F. PREWITT, M.D., Dean. THE DENVER MEDICAL TIMES, A MONTHLY JOURNAL OF MEDICAL SURGICAL AND OBSTETRICAL SCIENCE. SEPTEMBER, 1884. STRICTUE.* By W. H. DAVIS, M. D., DENVER. Contraction, congenital or whether due to disease, chanchroidal ulcers, etc., when situated near the external orifice of the male urethra is rarely amenable to relief by dilatation. Under theise circumstances it is not surprising that diminution in the caliber of the external meatus should exercise a powerful influence over the welfare of the organs to which it acts as a gateway, especially the bladder, ureters and kidneys. In a word, any narrowing of the urethral outlet, predisposes a patient to all forms of obstructive derangements of the urinary organs. More time is required to empty the bladder than in the healthy urethra, and there is a constant temptation to cut short the act of micturation, thus leaving a little urine constantly in the bladder. A trifling indigestion, or a scarcely noticed febrile action, loading the urine with uric acid crystals or a slight cold implicating the genitourinary apparatus, thereby increasing the urethra sensibility and congesting it somewhat, at once developes vesical irritability. The sensitive urethra rebels against the irritating urine. *Read before the Arapahoe County Medical Society. A constant desire to urinate may be experienced, but the discomfort excited by the passage of but a few drops stimulates the vesical sphincter, and the evacuation ceases. This interrupted function has its effects upon the blood supply of the parts. Congestion of the mucus lining slowly extends from the meatus along the spongy and membranous portion of the canal. The vesical sphincter sympathizes with any disturbance of the membranous urethra and stimulates the bladder in such a manner that the patient may experience an almost constant desire to pass water. As the congestion extends along the prostatic urethra to the neck of the bladder, the orifices of the seminal ducts become affected; the seminal vesicals become loaded with blood, their sensibility increased and too frequent seminal emissions are often complained of. An increased flow of mucous may manifest itself in a slight discharge from the urethra. In the bladder a similar excessive secretion from the glands of the vesical neck and adjacent parts, developing other phenomena; for instance, the reaction of the urine is acid while that of the mucous of the bladder is alkaline. The effect then of this hyper secretion of the vesical mucous is to discharge into the bladder a fluid of different chemical quality, from the normal state of the contents of that organ. We are told by our chemical friends, that, as a consequence, more or less of the urine has its acid reaction neutralized by the alkaline mucous, while at the same time the organic matter of the secretion may act as a ferment. The urine thus rendered alkaline deposits an amorphous sediment of phosphate of lime. The decomposing action of the mucous transforms more or less of the urea into carbonate of ammonia, the lining membrane of the bladder already deeply congested, is now so irritable that pus is formed. The viscid mass resulting from the mingled mucous and pus, thickened by the deposited phosphate of lime, when acted upon by the newly formed ammonia, may form a nucleus for the ammonial magnesia phosphate to collect upon. In this manner we see initiated that chain of phenomena which commence in a trivial and perhaps unnoticed contraction of the urethral orifice, which may end in vesical calculus, the development of a spasmodic stricture of the urethra, inflammation of the bladder and genital apparatus, or, worse than all, organic disease of the kidneys. The influence exerted by the small sized orifice in developing calculus may not be apparent, perhaps it may have none; but once the bladder becomes inflamed it is almost impossible to cure until the avenue of |