appropriate treatment to the lids, has nearly cleared the

cornea.

Now, in the above cases, wherever there was photophobia and lachrimation, both were very greatly or completely relieved, to the extent that the eye was left free of the excess of secretion; in fact, quite dry.

As for the manner in which these effects are brought about, Lunewski, in the Wochenscrift, for "Therapie and Hygiene" gives an explanation that seems to apply, viz: "It produces a more abundant flow of blood plasma in the stroma, and the result is that a certain amount of pressure is exerted upon the yielding walls of the veins, and we have as a result of this, venous stasis, and an acceleration of the lymph circulation throughout the eyeball. The pressure which is exerted upon the veins is also exerted upon the nerves, and we have a certain amount of paresis which explains the analgesic effect. It is contra-indicated in old people with arterio-sclerosis."

DR. DEANE: Dr. Payne's experience with dionin has been most interesting, and, though my experience with the drug has been more limited, I can not but speak of this new and altogether unique derivative of morphine. It is essentially an eye drug, for its use in other parts of the body has not been followed by the same results. This is apparent for several reasons. First, because its action upon the lympathatic circulation is so marked. (The eye is the most perfect example of lymph circulation in the body, especially the cornea on which dionin has such a marked effect.) Its antiseptic power can only be demonstrated here as this action is produced only secondarily through the stimulation of the flow of tears and of the lymphatic circulation within the tissues. Dr. Payne only gives his own experiences of its use in diseases of the cornea, but to stop here would be to limit its action. It has been favorably spoken of in connection with detachment of the retina due to serous effusion; also, Gottschalk mentions it with retrobulbar neuritis, comparing it to heat, both of which effect the circulation of lymph. Its use in glaucoma with a myotic has been highly spoken of not only to relieve the pain immediately, but as a curative agent. I have used dionin in combination with atropine, in a case of subacute cyclitis, where the pain and

deposit in the anterior chamber were notable symptoms. This drug has been mistaken and used instead of local anesthetics, of course, with disappointment, as it is distinctly not an anesthetic but an analgesic.

DR. BRADY:

Typhoid.'

"Acute Glaucoma an Initial Symptom in

The case that I wish to present is that of a woman normally delivered of twins. She passed through an eventful puerperium of twenty-one days; although still weak attended to her household cares for the ensuing two weeks. On Sunday she partook of a full evening meal. About five hours later her medical attendant was summoned and found her in the following condition: Temperature, 102.5° F.; greatly exhausted from persistent vomiting; unable to raise right arm; both wrists swollen and showing purpuric nodules. The left eyelids were markedly swollen, almost to closure, with strongly bulging chemotic conjunctiva. He gave her repeated hot applications to the eye, but the pain not subsiding after twentyfour hours, called me in. The temporal pain was then intense; lids markedly inflamed and edematous, the gelatinous and strongly hyperemic conjunctiva bulging 2mm.; forward and overlapping limbus 1mm.; marked ciliary pain. Iris, dirty green color; pupil, medium dilation, immobile; A. C. deepened; T = 2; light projection poor; light + perception limited to shadow outlines. Marked yellowish green vitreous halo, no fundus detail; installation of eserine resulted in reduction of tension to + 0.5, and great relief of pain. (Hot compresses continued.) Typical typhoid curve led to Widal test, which was positive on tenth day.

Positive Diazo: b, typhi obtained in pure culture from cephalic vein; marked anemia, reds to 1,250,000; hemaglobin, 35 to 40 per cent; bacteriological examination of genital tract and urine, negative; asthenic symptoms and fever increased; exitus lethalis on fifteenth day. No autopsy allowed.

Hourosine.

'I prescribed Hourosine in a case of hysteria, with most excellent results. It is par excellence in insomnia."

Shohola, Pa.

N. B. JOHNSTON, M. D.

MEDICAL SOCIETY OF THE STATE OF
CALIFORNIA.

Medical Legislation and Education.
(Continued from May)

"Medical Education," DAVID STARR JORDAN. (Absent). "Medical Education and State Examinations," W. S. THORNE, San Francisco: We render at this time an account of our stewardship as Medical Examiners. At the threshhold of this discussion let me assure you the putting of such a law into effect meets with many obstacles. The policy of the Board has been fair, theory has been carried only so far as necessary, and we have rather sought to invite discussion and reason, and made the questions as practical as possible in so high a standard of examination. The practitioner with age, experience and practical knowledge should be treated with discretion, but illiteracy and commercialism should be discouraged. A few years ago very low standards existed in America, and but few American colleges were recognized abroad. Diploma mills were springing up without any required qualifications. The advance to a four year course marked an unheaval. On August 1, 1901, the Act in California went into effect. In every State these laws have been attacked but have been sustained. The State examination will eventually reform or annihilate those who prostitute medical education. Reciprocity by State Boards has been inaugurated so far in 16 States -in the past few years many States have secured from their legislators laws more or less effective, but these laws have cut out of some States older and more experienced practitioners, and favored more recent graduates. The evidence is overwhelming that the medical profession of this country has determined on higher standards for the M. D. degree, which stood for anything from illiteracy to the highest education. There is much to learn, but the adequacy of this great movement will be more and more apparent. I suggest that examinations be limited to their applied phrases at present and eliminate the abstract.

66

Genito-Urinary Section.

LOUIS BAZET, San Francisco, Chairman.

Indications and Counter-indications for Prostatectomy," by DR. LOUIS BAZET, San Francisco: Pathogeny of the accidents of prostatism. Necessity of a complete diagnosis of

a prostatic. Indications for prostatectomy based upon conditions which vary with period of disease. Three periods described. Counter-indications are age, mal-nutrition, sclerosis and renal affections.

Discussion by DRS. MACGOWAN, KROTOZYNER and MORTON. DR. MORTON: I have had only twelve cases, a few Bottini operations, the greater part total prostatectomy, most in catheter life, one with much residual urine. In my only fatal case the age was 76 years, amyloid casts came from kidney; this was done under cocaine and the patient did well three weeks, then secretion stopped and he died. I am surprised at ease with which prostatectomy is usually done. Enucleate, do not cut vesicle neck, and I think hemorrhage is slight if we can enucleate without removing the capsule. I keep in a large self-retaining catheter a few days for drainage. Gne more point, I do not think it best to keep up drainage long, we may have a fistula.

"Determination of the Functional Capacity of the Kidneys with Special Reference to Kidney Surgery," by DR. MARTIN KROTOZYNER, San Francisco: Despite the progress of surgery recently the fatality in this line of work has been high. Palpation, percussion and radiography does not give certain results. Importance of urea to estimate activity of kidney, but it must be considered in relation to intake. The methylene blue test. Cryoscopy should give a freezing 0.6-0.8 below that of distilled water, this can be done separately for each kidney by ureteral catheterization. May use ploridzin and take, 1, and 1 hr. specimens from each kidney by ureteral catheter to determine relative sufficiency.

DR. TAIT said cryoscopy now excites much less enthusiasm in Europe than it did a few years ago. He urged against ureteral catheterization, difficulty of technique, existence of strictures in many cases, danger of infection. of healthy ureter, passage of urine between the small catheter and wall of ureter, etc., and advocated the use of the segregator to which bladder wall adapts itself.

DR. EATON: In regard to chemicals I think more is to be done. Fifty years ago it was found that benzoic acid was changed to hippuric in kidney. It has been proved that in the elimination of methylene blue only the tubules take part, while hippuric acid is found in all parts. The

use of adrenalin with segregator will clear up source of blood.

DRS. RIGDON and MACGOWAN spoke.

DR. KROTOZYNER defended cryoscopy and attacked the accuracy of methylene blue. Isreal, of Berlin, will soon recede from his conservative attitude toward ureteral catheterization. If cryoscopy of blood is below 0.6 we can say surely renal insufficiency exists. Dr. Krotozyner attacked the accuracy of the segregator.

"Contracture of the Vesical Neck," by DR. R. L. RIGDON, San Francisco: Experience has forced on the author the conviction that a form of obstruction of the prostatic urethra exists which is due to a contracture of the vesical neck. The cause seems due to conditions which cause hyperesthesia of the prostatic urethra.

Typical Case. -Young man with urinary obstruction without apparent cause, resulting in urinary trouble and neuralgic pain. There seems no better name than contracture of bladder neck, or fibroid infiltration with spasmodic element; cause seems to lie in chronic congestion of prostate. The symptoms are frequent urination day and night, pain, terminal pain if interrupted; symptom complex of calculus and cystitis. Treatment embraces relief of hyperesthesia, prostatic massage, sexual hygiene; if marked must operate by dividing with modified Bottini through perineal opening.

DR. MACGOWAN: Many cases of prostatic hypertrophy operated are of this form, and not true hypertrophy. They are treated successfully by overstretching; I have been a little loth to use the Bottini on these cases. I have sometimes thought these cases due to gout or rheumatism, with deposits of uric crystal incrustation.

DR. BAZET: This recalls a case of eleven years ago in which I found induration of vesicle neck. I dilated first and trouble returned, then cut posteriorly and partially relieved it. I think it was due to inflammation of neck of bladder.

DR. KROTOZYNER: I have had in such cases good results by leaving in self-retaining catheter some weeks, in some cases with permanent results. But where infiltration exists permanent drainage is desirable.

DR. EATON cited a case due to overindulgence.