dation in fact, and is due to the husky, inarticulate sounds often made in the effort to speak. The spasms become more frequent, and death either occurs in one, or the patient passes into the third, or paralytic stage. The second stage lasts from one to three days. The third stage lasts from one to twelve hours. In this stage the spasms cease; the patient becomes unconscious; the heart becomes weaker and weaker, and finally death pityingly ends the tragedy.

What can be done to cure and prevent hydrophobia? When a dog bite is received, whether the dog is mad or apparently perfectly normal, the bite should be immediately cauterized with 95 per cent carbolic acid, no matter how extensive the wound may be. This strong acid is to be brought freely in contact with every portion of the wound; the wound enlarged, if necessary, to reach all parts of it. If the wound is on the extremities, it is well to apply a rubber bandage above the injury to make the field perfectly bloodless during the application of the acid. After allowing the acid to remain in contact with the tissues for sixty seconds, it should be washed out with ninety per cent alcohol, and then dressed with a moist boric acid dressing and allowed to heal by granulation.

The question of the value of the prophylactic Pasteur treatment is differently answered in different countries. In France, the value of the Pasteur treatment is generally accepted as a demonstrated fact. In Germany, there is still much skepticism in regard to it.

In America, the Pasteur treatment has been fairly generally accepted. The results from the Pasteur institute in Paris appear very convincing. From 1886 to 1901, inclusive, there were treated 25,986 people. Of these, 112 died, a mortality of 0.43. Less than one half of one per cent. About one out of two hundred. The reports of the local Pasteur institute, from 1890 to November 1, 1902, give a total of 1,538 persons treated. Of these, seven died, giving a mortality of 0.45. In spite of these seemingly brilliant results, I confess to a certain amount of skepticism in regard to the Pasteur treatment for hydrophobia. First, because of the difficulty in establishing, in most cases, the fact that the animal producing the bite was mad; second, because of the difficulty of determining the proportion of cases developing from bites of animals actually mad. Horsley states that not more than 15 per cent of those bitten by rabid dogs become affected by the disease. And, third, one cannot lose sight of the terrible possibility of producing the disease by the preventive inoculation in an individual bitten by a dog suspected but not in fact suffering from rabies.

I believe, however, in the light of our present knowledge, that it is our duty to recommend the Pasteur preventive inoculation in cases of bites from proven or strongly suspected rabid dogs.

It is not the intention of this brief paper to enter into a discussion of the purely scientific side of hydrophobia and the question of the value of the Pasteur treatment. The sole object of this paper is to discuss the all important practical question of the prevention of hydrophobia. Can hydrophobia be prevented? Yes. It has been practically eradicated from England and parts of Germany by systematic muzzling and quarantining of dogs.

In 1896, there were 672 cases of rabies in Great Britain. 1897, Mr. Walter Long, the Minister of Agriculture, issued an order known as the muzzling order, which provided for the quarantining, licensing, muzzling and leading of dogs, and this has been rigidly enforced. In 1897, there were 438 cases. In 1898, 151 cases. In 1899, 17 cases. In 1900, 9 cases. In 1901, 5 cases. The disease is now practically

extinct.

In Ireland, to which the order did not apply, the disease is as rife as ever.

Dr. Arthur R. Reynolds, the commissioner of health, kindly furnished me with a report of the deaths from hydrophobia in Chicago during the last eleven years. In 1891, 4; 1892, 15; 1893, 5; 1894, 5; 1895, 8; 1896, 5; 1897, 5; 1898, 4; 1899, 12; 1900, 7; 1901, 7; 1902, 14; a total of 91 deaths, and I am satisfied that this does not represent the actual mortality, as undoubtedly some cases were not recognized, or not properly reported.

Since the first of the year there have been in Chicago many cases of the disease among dogs. There is, in fact, a danger of a widespread epidemic of hydrophobia in this locality, and there is an increase in the number of human victims.

The existing dog laws in the city of Chicago are stupidly inefficient, and are not effectively enforced. The dog law is as follows: "That it shall be unlawful for any dog to run at large on any street, alley or other public place within the limits of the city of Chicago between the first day of April and the first day of November, unless such dog shall be securely muzzled or led by a chain, so as to effectually prevent it from biting any person or animal, and any owner or keeper of a dog who shall suffer the same to run at large during the period hereinbefore named without a muzzle shall be fined not less than two dollars, nor more than ten dollars, for each offense, and for

every day he shall suffer the dog to run at large without a muzzle after having been convicted under this ordinance."

Why did the wise city fathers make this law inactive between November 1st and April 1st? Because I imagine that they still believed in the old fairy tale that dogs did not go mad in the winter. This is, however, no excuse, because they could easily have found by investigating the subject that hydrophobia is as common practically in winter as in summer. And it is the duty of men in their positions, positions of responsibility, to investigate such important subjects.

But even if we had a proper law, it would be of no value unless efficiently enforced, and even the existing poor law is not being enforced.

There are today an enormous number of homeless and ownerless dogs roaming the streets of the city, which are a menace to the really valuable dogs, and to the people, and no effort is being made to rid the city of this menace. It is not the purpose of this paper to attack the authorities who have this matter in charge. I believe, however, that it is the duty of this Society to convince the authorities of the great importance of this subject; to point out to them the weak points in the dog laws, such as the suspension of the law during the winter months; to educate them to the possibilities of eradicating this terrible disease, if proper laws are properly enforced. If we could make each member of the City Council, the Chief of Police and the Mayor of Chicago see this subject as we see it; if they could stand at the bedside of the fifteen or twenty victims of hydrophobia who will die in Chicago in 1903, as some of us must stand; if they could watch these terrible pictures, the results of ignorance and neglect, of stupid law, and of inefficient administration, what would happen? Immediately, unanimously, proper laws would be passed and properly enforced, and hydrophobia would be eradicated from the community.

We ourselves cannot escape entirely from criticism for the existing bad state of our dog laws, and the prevalence of hydrophobia, for we, the members of the Chicago Medical Society, are the one class of citizens who are best informed on this subject, and to whom those in authority might well look for advice and instruction. We have, to be sure, made one effort in this direction this year, i. e., when this Society adopted resolutions urging the enforcing of a muzzling act. Referred these to the Mayor.

I believe that it is, under the circumstances, our duty to again volunteer our advice. I, therefore, suggest that the Chicago Medical

Society, through its Board of Councillors, call the attention of the city authorities to the fact:

First. That the disease hydrophobia is prevalent in the city of Chicago.

Second. That it is possible to practically eradicate the disease by proper dog laws, properly enforced.

And, that we respectfully petition the mayor and common council to immediately take such steps as are necessary to accomplish this result.

103 STATE STREET.

THE INDICATIONS FOR OPERATION IN HYPERTROPHY OF THE PROSTATE GLAND.

BY DR. A. J. OCHSNER, M. D., CHICAGO.

The indications for operation in hypertrophy of the prostate gland have changed very greatly during the past few years, principally because the operative treatment has changed to such a great extent with the introduction of properly performed perineal prostatectomy.

Whenever it becomes possible to offer prompt and permanent and relatively safe surgical relief for any condition which could formerly be only ameliorated at best or treated radically at a great risk to life, we find a very marked change in the indications for operation.

Until the work of Fuller, Syms, Murphy, Ferguson, Alexander and others demonstrated the fact that by means of exceedingly simple methods the enlarged prostate could be safely removed through the perineal route, the radical treatment of this condition was very unsatisfactory in the hands of most surgeons, both as regards the permanency and percentage of cure. At the same time the mortality was so high either immediately after the operation or within a relatively short time, that it was difficult to see much benefit in the surgical treatment of these cases, and consequently only the gravest conditions could be considered as valid indications. This very fact served to make the prognosis in these operations still less favorable.

In reviewing the literature of this subject one is impressed with the fact that the principle referred to above applies most perfectly Chicago Medical Society, April, 1903.

to the subject under discussion, and I have found in going over my own clinical experience that it is true in connection with my own work.

I had all of the cases tabulated which I have operated at the Augustana Hospital during the past ten years for the relief of obstruction due to hypertrophy of the prostate gland.

This table shows that during the eight years from October, 1893, to October, 1901, there were twenty-two operations for this purpose. These included suprapubic cystotomy for permanent drainage, suprapubic prostatectomy, castration, vasectomy and combined prostatectomy by means of a suprapubic and a perineal incision. Of these twenty-two cases eleven were cured, seven improved and four died. All of the patients of this series, with the exception of two, were over sixty years of age.

During the fifteen months since January, 1902, when I first performed the present perineal operation, the table shows eighteen cases with fifteen cured, two improved and one died. All of these cases were operated by the perineal method. Five of the cases in this series were under, and twelve over sixty years of age.

This shows an enormous improvement both as regards the recoveries and the results, the percentage of cures being very much greater and the deaths being greatly reduced. It is likely that the one death could have been avoided.

The patient fifty-eight years of age, entered the hospital in an exceedingly grave condition. He had suffered for several days from complete obstruction before a physician was summoned, as he lived alone in a cottage a considerable distance from his neighbors. When he was brought to the hospital he was delirious. His bladder was saculated and extremely distended with fetid urine. He was greatly reduced in strength, his pulse and temperature were high, and it was not to be expected that he could recover. The urine was gradually withdrawn, the bladder catheterized and irrigated systematically, but the patient's condition did not improve. In the hope of benefiting the patient by establishing permanent drainage of the bladder, the operation was performed five days after admission. The patient improved somewhat during the first forty-eight hours after the operation when the drainage tube was accidentally withdrawn. It was replaced, but the drainage never became re-established properly, and the patient died from exhaustion and sepsis on the seventh day after the operation.

Since this time I have sutured in place two rubber drains in