think the above will be found correct. The seeming incongruity in the union of symbols is accounted for by the excess of spts. nitre used. Also, it will be found, as above stated, that it is less deadly in the transient stage than when the reaction has been fully completed. Left in an open vessel, it evaporates, collecting on the edge in reddish, snowflake-formed crystals-the nitrilin. A drop of the liquid put on a fly exterminates him in a few seconds. A small amount will kill a cat in a few minutes.

The liquid is an iso-nitroso compound. Some authors differ as to the formula of antipyrine; the above is from Potter's Materia Medica. It is isomeric with the methyl derivatives of the tolylhydracines. The spts. nitre decomposes the antipyrine, forming a poisonous element. This product, nitrilin, C,H,N2O2, may be obtained by evaporating the solution in an open vessel and collecting the crystals. Crystals are reddish, flower-shaped, transparent and feathery, and gummy in consistency. The fluid is aromatic, and burns with a bluish-green, rainbow-colored flame, giving off odorous gases. The water of crystallization may be driven off, leaving a finely-divided, red saffroncolored mass. To see the crystals develop nicely, place a small amount of the fluid in a tin salve-box and set on fire, let it burn and put aside the residue for a minute or so, and then examine; then you will see the beautiful phlox-shaped aggregation of nitrilin.

Dr. W. A. Brown, use for acute rheumatism:

Would answer other inquiries, but have already encroached too much on the BRIEF'S valuable space.

WM. R. LOWMAN, M. D.

Orangeburg, S. C.

Goitre Can be Cured.

In observing the columns of the BRIEF for the month of March, I find an article written by Dr. Snyder, asking if goitre can be cured, if so, how?

I have witnessed the cure of many of these enlarged thyroids while at college, and that has only been a short time since. I will not say definitely, whether or not the treatment is a specific, but if the case is seen early, I do not hesitate to say that it can be cured if medicine is used regularly and constantly. The treatment may have to be continued for a period of from two to six months or longer.

It consists in the injection of a five per cent solution of carbolic acid into the goitre, using from seven to fifteen minims at each sitting, this to be repeated every five days, and if the growth is large it may be injected on both sides at one sitting, so as to check its progress much earlier. In connection with the above the patient should receive three drops of Donovan's solution of arsenic three times daily.

After the injection the patient may feel somewhat dizzy, but this sensation will soon pass off. Care should be taken while injecting, not to penetrate a vessel.

The BRIEF, as I consider it, is one of the leading journals of America. The articles which it contains are written in such an applicable style, that the physician who fails to have it by his side, is like a "ship at sea without a rudder." WILLIS B. CAUBLE, M. D.

Sidell, Ill.

Gonorrhea and Conception. Some of the correspondents of the BRIEF have proven, of their personal knowledge, that a woman may conceive after having had gonorrhea. Now, I wish to inquire if she can conceive while having the disease? Also, if a man can beget offspring while in this condition, and whether the disease or syphilis can be communicated to a beast?

Hudson, Ill. SILAS HUBBARD, M. D.

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A VIGOROUS and thorough study of the differential diagnosis of the diseases with which the physician has to contend may lead to a more successful treatment.

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THE time has arrived when no writer, who writes long and learnedly on a subject, that he might have condensed into a short practical item, is read by the major portion of the doctors.

Books and journals are necessary to complete that system of education which is only commenced in the college. Journals like the BRIEF that come within the reach of all, containing vast sources of valuable information, tend to expand the minds and increase the means to combat disease in an intelligent and satisfactory

manner.

Hydrocele of the Tunica Vaginalis Testis.

The tunica vaginalis testis is a shut sack. About the eighth month of embryonic life of the foetus, the testicle descends to the scrotum, the upper part of the sack is obliterated. The tunic is for the purpose of protecting the testicle, and is a serous membrane, consequently has and is endowed with the principle of secreting serum; any injury, such as a bruise, etc., the membrane, changes from a physiological to a pathological condition, the result is a pouring out of serum, the sack fills up with this serum, and soon the scrotum assumes a globular form, or tumor; the quantity of fluid ranges from two or three ounces to

twenty ounces. When the tumor gets large it causes great inconvenience to the patient, yet accompanied with very little pain, if any. On account of the inconvenience and anomalous condition of the parts, the sufferer calls upon the surgeon for relief. There are several methods of treating hydrocele adopted by the profession.

1. The palliative and the radical. The palliative consists in local applications, tapping, physic, hygiene, etc. The radical method, generally adopted, consists in tapping, removing the fluid, then injecting the sack with tincture of iodine, or

2. Incising the sack, introducing lint, and allowing the sack to contract; or Volkman's operation, which is, in my opinion, the best operation yet adopted. Puncturing the sack is not devoid of danger, yet it is a simple procedure and easily performed. The injection of tinct. of iodine is not always successful.

Dupuytren, at one time, satisfied him-. self of the transparency of a hydrocele, made a puncture, the trocar passing through the testicle.

Dr. Jacobson reports that of forty-four cases, which had been injected with iodine at Guy's Hospital, the treatment failed in eight cases.

Dr. Curling uses the following solution: Iodine, two drachms; potass. iodidi, onehalf drachm; spts. vini. rect., one ounce. For adults, this is probably the best; for young patients, half the strength.

Dr. Jessop, surgeon to the Leeds General Infirmary, reports several cases of sloughing of the scrotum, after tapping for hydrocele.

Sir Astley Cooper states that he has known fatal cellulitis follow the injection of an irritating fluid into the cellular tissue, instead of into the tunica vaginalis.

Therefore, there is some danger in these simple surgical procedures, and it behooves the practitioner to be thoughtful, and use skill and judgment. The operation for the radical cure of vaginal hydrocele that I prefer to all others is the McDowell incision, modified by stitching the tunica vaginalis to the skin (see cut, with stitches in place ready to tie, the edges of the tunica drawn up to the cut margins of the skin). This operation, properly performed under antiseptic precautions, is safe and always successful;

thoroughly with solution bichloride of mercury, 1-2000; 4th, anesthetize the patient. When fully under the anesthetic, grasp the scrotum, hold it firmly, then make the incision. Commencing about one inch below the abdominal ring, carry it down almost to the bottom of the scrotum, not through the tunic, but through the skin to the tunic; then, when all bleeding is stopped, make a small opening through the vaginal tunic at the bottom, when the fluid will escape; then introduce a director, and with a slender scissors split the tunic the whole length of the incision; then wash out the sack with four per cent solution carbolic acid, or 1-3000 bichloride mercury solution. Then, after irrigating the wound and surrounding parts with sol. bichlor. mercury, stitch the tunic vaginalis to the skin by three catgut or silk ligatures (first disinfected), three on each side. Sprinkle the wound with iodoform, then apply Lister protective, over this about four layers of bichloride gauze; fill in about the groin with borated cotton, the whole sprinkled with iodoform, and secured with a triangular bandage with a hole cut through it for the penis. Let the dressing remain undisturbed four days; remove, take out the stitches, redress as before, and let it remain four or five days,

when the wound will be healed and the cure complete.

If the weather is cold and wet, the patient should be kept indoors for several weeks, after the wound is well, to avoid orchitis, which is about the only complication to be feared from the operation. It occurred to a patient of mine who was operated on February 5th, 1888. About February 14th, the wound was healed. The patient was very anxious to go to work; the weather was cold-rain and snow-what might properly be called PNEUMONIC weather; the inflammation was very severe, but the patient has made a good recovery. Had he remained indoors during that weather, he would have been all right. S. B. HOUTS, M. D.

803 Pine Street, St. Louis.

Vesico-Vaginal Fistula-Operation.

Mrs. S., primipara, age fifteen years, began labor about eight P. M., December 3d, 1887; did not see her until six A. M., December 6th; found that nature had failed to do her work (as also the midwife in attendance). I at once administered chloroform, and, as it was a transverse presentation, performed version by the usual method, and delivered her (without the use of instruments) of an almost putrid child. At seven A. M. all was over. An hour later, she appeared bright and cheerful.

December 8th, was called again; on examination, per speculum, found a vesicovaginal fistula, about the size of a quarter of a dollar, situated high up in the canal.

From above date until January 28th, 1888, her condition was such that I did not think it advisable to undertake an operation at closure of fistula. On above date (Jan. 28th) two P. M., my friend, Dr. W. H. Frizell, and I, after having made all the necessary preparations for the operation, though finding an extensive adhesion of the upper two-thirds of the vaginal canal, after breaking it down, we decided the light was not sufficient. We used an antiseptic wash, and left off until next morning, which was a bright day.

After exposing the opening, I was careful in denuding the borders to secure an ample raw surface, completely encircling it, so that the surface opposed, after the introduction of the sutures, would be de

nuded. This, of course, is of the utmost importance in order to obtain complete union. For the purpose of introducing the sutures, I employed a pair of longhandled forceps, which locked on a stout, slightly-curved needle, with an eye in the point. This needle I introduced about the sixth of an inch outside of the margin of the denuded surface. Armed with silk, I introduced the sutures at the two extremes of the opening first, thereby lessening the opening. The parts being in a relaxed condition, I had no difficulty in approximating the surface, which required five sutures. I also used the clamps, as proposed by Dr. Frizell, in the operation, in connection with perforated shot, to which I attach much importance, as I think lacerations of the tissue are less liable to occur and a more uniform tension is brought to bear. A metallic, self-retaining catheter was kept in the bladder for a period of ten days. On removal of the catheter, the patient was able to empty the bladder by the urethra, being used for that purpose the first time in about two months. I had only a few difficulties to encounter in obtaining this favorable result. The greatest one was commencing it.

I do not report this case for the purpose of shedding any light to the profession, but to arouse physicians in the backwoods, like ourselves, to undertake such cases, and, by so doing, give relief to suffering humanity at their homes, and obviate the necessity of carrying or sending them to specialists. Liddell, Miss.

P. R. BROWN, M. D.

Cancer-Cases in Practice.

BY J. ELLOTT CHAMBERS, M. D.

Case I.-H. K. B. was sent to me for treatment by Dr. Geo. W. Fringer, of Tower Hill, Ill., February 20th, 1888. Found, on examination, an epithelioma of lower lip merging into the third stage on its lower inner margin (the oldest part of the growth), while the great mass of the growth presented the characteristics of the second stage of development. The vessels around the growth for onehalf to three-fourths of an inch presented under the lens a much engorged and enlarged appearance, showing that its pe

culiar temperature of production not only affected the growth but the vessels for some distance around.

Examination revealed the following history: About nine or ten months previous, the patient cut the inner side of the lip on the mucilage margin of an envelope, in sealing a letter, which was so slight as to only attract a passing notice. It refused to heal, possibly because the saliva may have digested the plastic matter thrown out to heal the wound. The edges became pouty and shortly began to thicken, and the growth was the result. The growth was elevated about one-fourth of an inch, was oval, its long diameter being one to one and one-eighth inches and its short diameter being three-fourths of an inch, situated to the right of the center of the lip, and was consequently fed by only the vessels of one side, which is much more favorable than when situated in the middle, as it will develop slower and is attended with less hemorrhage. The base of the growth dipped down into the orbicularis oris muscle, which made treatment more painful.

I placed the patient under our alterative treatment, and applied to the growth

The object of this application was to overcome the temperature by contracting the vessels and anæsthetizing the ends of the nerves and thereby arrest development, and contract and harden the growth ready for removal.

The lip being so sensitive, electrolysis would be very painful, and the patient being sixty-seven years of age and subject to paroxysms of nervous depression, I preferred not to use chloroform to make electrolysis bearable. Its removal was effected by alternate applications, morning and evening, of saturated solutions of zinci sulph. and zinci chlor., and the destroyed part "digested off," or softened, and was removed by the application of concentrated lactic acid. During all of these applications, the healthy parts were protected, and the treatment modified according to the vascularity of the part.

After removal, antiseptics were used, combined with anesthetics and astringents, to overcome the cancer productive temperature, and the patient went home for one week. When he returned, the wound had taken on a warty growth from the sub-mucous membrane. Its growth was rapid, but it readily gave way under the acid treatment. The temperature subsided, and healing was rapid.

During the removal of the growths (both epithelial and warty) free use was made of ergot, tannin and arnica to the chin and sides of the face, to control the blood supply and temperature. Case was discharged April 6th.

Remarks.-Obstinate warty growths frequently follow the application of the zinc salts to an abraded epithelial or mucous membrane.

Cocaine in these cases must be closely watched, for when used too strong it may so thoroughly anæsthetize as to affect the vessels, expand them, and thwart the design for which it is used.

The removal of tissue destroyed with zinc salts, with lactic acid, will be followed by inflammatory softening and sloughing, unless the temperature be carefully controlled.

Case II.-Mrs. O., Formosa, Ill., age forty-five, vascular epithelioma of the orbit, of five years' standing. Case placed in my charge on February 28th, 1888. Eye had been removed two years prior,