Operation for Hydrocele-Castration.

May 17th, was called upon by Dr. D. to operate on a patient of his for the radical cure of hydrocele. Upon examining the patient, found a medium sized tumor of right testicle, or rather left side of the scrotum, about the size of a goose egg, globular in form, giving all the evidences of containing fluid. There was a distinct crease or depression in the scrotum, giving the impression of a double hydrocele. (See Fig. No. 1.) Below the depres

cised the membrane to the top of the sack. About eight ounces of fluid escaped.

When I examined the sack and surrounding parts, I was somewhat surprised. I went coon-hunting and met a lion. The cremaster muscle was hypertrophied, the inter-columnar fascia, the fascia propria, and all the parts adjacent to and composing the cord were in a state of cysto-mucoid degeneration, extending up as far as the abdominal ring, making a mesh of diseased tissue a little bewildering. The vas deferens issued from the substance of the testicle.

(See Fig. 3.)

Fig. 1.-Condition before Operation. sion the tumor was not so large as above, but it had a soft, boggy feel.

My diagnosis was double hydrocele. The hypodermic syringe determined that the upper tumor contained fluid, but was not used on the lower one, which subsequently turned out to be the lower part of the testicle, enlarged, in a pulpy, diseased condition. The patient had been on a preliminary treatment, for several days before the operation, of cathartics followed by quinine, iron and digitalis, as he was suffering some from the effects of malaria.

The scrotum was cleanly shaven, then washed with soap and water, then with 1-2000 sol. bichloride of mercury. The patient being anesthetized with equal parts of ether, chloroform and alcohol, which is a favorite anæsthetic of mine, I grasped the scrotum firmly, commenced the incision about one inch below the abdominal ring, carried it down to the bottom of the scrotum, then made a small opening through the tunic at the bottom, introduced a grooved director, and in

Fig. 2.-Cysto-Cartilaginous Degeneration of Testicle. The epididymis was apparently absorbed or immerged into the body of the testicle -as not a trace of it could be found-its natural anatomical relations and contour were entirely absent. The tunicæ vaginalis testes was thickened, at some parts as much as a quarter of an inch, white, of the consistency of cartilage. (See Fig. 2.)

After making the incision, and finding the above described condition of things, there was only one course to pursue, and that was to remove the testicle, which I proceeded to do. The testicle was dissected out of its bed, and the cord isolated and ligatured, including the spermatic artery as I supposed, then severed the cord, but, to my surprise, the artery was not included in the ligature, and immediately there was lively spurting of blood. Then the search for the artery commenced-it was something like looking for a needle in a pot of mush to

find the artery in that mesh of cystic membranes-and we experienced much trouble. We finally concluded to pass a ligature around the whole mass, which we did at several points along the cord, but the artery had contracted, and when one ligature was tied the bleeding continued. The incision was finally continued up to the abdominal ring, and the cord carefully separated from the surrounding tissue. A needle armed with a strong silk ligature, passed under the cord and tied, the bleeding stopped-to our great relief.

VAS DEFERNS

Fig. 3.-Same as Fig. 2. Reversed. The wound was thoroughly irrigated with a 1-2000 sol. corrosive sublimate, then sprinkled with iodoform, dressed with layers of borated cotton, wet with bichloride sol.; the whole secured by several layers of sublimate gauze, retained by a triangular piece of cloth used as a napkin.

Next morning it was found that there was a great deal of waste; the dressing was completely saturated with a bloody serum, so much so that a fresh dressing was applied. From this on, under antiseptic treatment, the wound remained sweet and healing was uninterrupted. There was very little suppuration, and no bad odor at any time.

The most remarkable thing, and which proved as troublesome as the original operation, was the removal of the silk ligatures; under antiseptic dressing, the

granulations grew right over the ligatures and incorporated them in the living flesh. Of course, silk is very difficult to digest, and sooner or later they would be a source of irritation and abscesses would form and they would make their way to the surface, thereby prolonging the healing process.

Wounds healing so beautifully as they do now under antiseptic treatment, surgeons will hesitate to implant in a wound a cause of disturbance. Therefore, in the future, in operations of the kind descibed above, I shall use the cat-gut, cut the ends short, and let them remain in the wound to be digested and absorbed.

I am much indebted to Dr. Wait and Dr. Davisson for efficient and able assistance, and to Dr. J. Ellott Chambers for the illustrations. S. B. HOUTS, M. D. 803 Pine Street, St. Louis.

Snake Bite-Fatal Case.

I will briefly report a fatal case of snakebite which occurred in my practice recently, and ask suggestions of those who have had actual experience in similar

cases.

Saturday evening, June 16th, Gracie B., aged three years, was bitten on the bare ankle by a Masasanga. Unfortunately I did not see the case until three hours after the accident. The leg was already swollen to the knee, with considerable ecchymosis and discoloration about the foot and ankle.

The parents had already been giving it a liberal supply of whisky. Thinking it useless to try to remove the poison at this late stage, by incision, I did not attempt it, but applied a large blue clay poultice mixed up with a solution of aqua ammonia. Gave internally tinct. iodine comp., one drop, in solution, every two hours, and at the intervening hour, full doses whisky, in solution with spts. ammon. aromat.

Saw the case again in twelve hours (Sunday morning). Swelling extended from toes to groin. Leg more than twice the size of its fellow, and very much discolored and spotted. Flesh on leg hard and cold. Blood seemed coagulated in veins. Pulse 120 per minute. No apparent fever in axilla. Patient covered with cold, clammy moisture. Quite nerv

ous. Could hardly lie still in bed. Continued same treatment except to increase the amount of whisky and ammonia. Gave all the patient could take, at least two teaspoonfuls, pure whisky, in solution, every hour.

Saw patient again in twelve hours. Swelling about the same as in morning. Pulse 140. Cold sweat over body. Patient at times delirious. Very restless. Must be moved every three to five minutes. Crying and screaming without tears.

Sent for counsel. Continued treatment, and in addition, gave morphine in proportionately large doses, which seemed to have little effect in quieting the child, though for a time seemed to strengthen the heart's action and warm the surface a little. Counsel arrived at three A. M. Soon the pulse ran up again—160 to 170. Difficult to count. Very feeble. Coldness of surface and condition of collapse. Gave, hypodermically, ether sulph. and alcohol. Also whisky, per rectum. Friction to body and limbs. However, all we did had little effect. Could not warm up the surface. Noticed swollen ridge extending up left side (injured side) from leg to breast, over region of heart. Patient had a convulsion and stopped breathing. Practiced artificial respiration. Commenced breathing again. And thus we managed to hold the life of patient until ten A. M., when it got beyond our control, and we gave her up as dead.

I neglected to state that, during the last few hours of life, we gave frequently a few drops of ether and permanganate of potass. in addition to the other stimulants.

Now, brother M. D's, I shall be pleased to learn of a certain cure for the bite of the rattlesnake, as I know of nothing except it might have been an amputation, that perhaps might have saved my patient at the time I first saw her. J. I. BAKER, M. D.

Sonoma, Mich.

Peculiar Case-The Horse Hair Loop.

I

In the January BRIEF of this year, reported the case of Miss H. I continued the treatment of broken doses of calomel and blue mass, except that I gave her ferri, nux vom., and Fowler's solution, and cascara sagrada as an alterative.

The enlargement began to descend until it reached the region of the uterus, there it remained for two months. She had all the appearances of being three months enceinte. I never made a specular examination. She has since married and all the hardness has left, although she is not taking any medicines. This hardness extended from the right to the left iliac region. Her health continued good until about the time for menses, when she would almost get convulsions, owing to the cramps.

Will some of the contributors please tell me what it was?

I wish to thank Dr. W. C. Spangler, of Peterstown, W. Va., and say that I had her on the same treatment he suggested when he wrote.

In passing a mill, recently, a man called me in, saying he had a small piece of the mill stone, he was picking, in his eye. An examination revealed a small piece imbedded in the cornea. I had no instruments with me to remove it, so I took a hair from my horse's mane, made a hook by bringing the two ends together, and by raking the loop over the eye-ball, I had the satisfaction of removing it.

Long live the BRIEF. May it reach the office of every practitioner in the United States and Canada, for it is certainly indispensable. W. H. SMITH, M. D. Heidenheimer, Tex.

Come to Stay.

After several years' absence, I return to the BRIEF, and have come to stay. Have taken several medical journals, North and South, since my name was erased from your list.

After all, the consultations on all subjects, medical and surgical, with your solid, practical contributors, is worth more to me than all the information I get from other journals aggregated. Am with you to stay.

B. T. MOSELEY, M. D. Burke Station, La.

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Trachoma.

Mr. Lawson, of the Royal London Ophthalmic Hospital, recommends the following treatment: First paint the parts with a solution of nitrate of silver, ten grains to the ounce; then wash this off with a solution of chloride of sodium, five grains to the ounce. The patient is then ordered to use a weak solution of chloride of zinc, one grain to the ounce, three times a day. The nitrate of silver and chloride of zinc are used as antiseptics, not as caustics.

Higher Standard of Medical Education; New Regulations for all Homeopathic Medical Colleges.

At the recent meeting of the American Institute of Homeopathy, at Niagara Falls, Dr. T. Griswold Comstock, of St. Louis, chairman of the committee upon medical education, made his report, which is decidedly a new departure in medical education. The Homeopathists propose, hereafter, to require all their colleges to admit no uneducated young men to be allowed to matriculate, and they require a four years' course of study and three courses of lectures, before the candidate can apply for a degree.

The following is a resumé of Dr. Comstock's report:

After 1890, medical colleges shall receive no matriculants except such as have a good collegiate or academical education, with a knowledge of Latin and Greek, or, at least, one foreign language.

Four years of study are required, and three full courses of lectures, before the candidate can apply for the degree of Doctor of Medicine.

The term of the lecture-course shall be not less than six months (a complete semester), and it is earnestly recommended in the report that the term be prolonged to nine months.

The report suggests (very sensibly) that physicians thus educated will form a veritable corps d'elite."

The report was adopted unanimously, and showed that all the members were enthusiastically in earnest in their desire for a much higher standard in medical education.

The Institute resolved to acknowledge no diplomas after 1890 from any colleges, unless they conformed to the above regulations.

From this, it would seem to be the earnest wish of the Homeopathists to outstrip their "old school" brethren, and

be the first in the field to advocate and enforce a higher standard of medical education.

WE note that the last annual announcement of Jefferson Medical College, of Philadelphia, gives official notice of the adoption in 1890 of a systematic obligatory three years' course. The examples set by the Homeopaths and this influential school will cause an awakening

among the better class of colleges. The time set gives ample time to make all the necessary arrangements, and allow the two-year colleges to fall in line.

Exophthalmic Goitre-Convulsions

Sycosis.

Exopthalmic Goitre.-To J. F. Fox, M. D., I would say the judicious use of electricity is the best treatment for the disease.

Convulsions.-To T. F. Burnett, M. D., I would say have the patient keep a certain law of Moses, not to have sexual intercourse during menstruation, nor short of eight days after.

Sycosis.-To R. B. Longmire, M. D., I would say apply a solution of creasote to the affected part two or three times per day. One drachm of creasote to four ounces of water.

The Treatment of Ulcers. An article appeared in the London Medical Record, for December 15, 1887, giving interesting details of the treatment of ulcers by phosphoric acid, as shown by the experience of Dr. Grossich. By his method of treatment, he used a ten per cent solution of pure phosphoric acid in distilled water. The ulcer is covered with a bit of lint dipped in this solution, and the dressing renewed three or four times a day. The patient, for the first few minutes, feels a slight burning sensation, but this soon passes, and within twenty-four or thirty-six hours the ulcer cleans, and looks better. Inflammation or eczema of the surrounding parts disappears, and all pruritus ceases. The ulcer cicatrizes rapidly, and the cicatrix is firm and healthy.

Kollischer treated tubercular affections of the joints with injections of the phosphate of lime, with great success. Dr. Grossich has also had good results with this treatment, and cites some very interesting successful cases.

The treatment by the solution of phosphoric acid was further employed in a case of tuberculous abscess of eight months' duration, and also a case of eczema marginatum which had lasted

more than a year, and good results followed.

The above suggests the superiority of Horsford's Acid Phosphate as a substitute for the phosphoric acid.

The effective acidity of this preparation is about the same as the ten per cent solution of phosphoric acid which is prescribed in the above treatment, and it may therefore be justifiably employed by the profession in the treatment of disorders of this character. It has the advantage of containing the phosphates in solution, notably the phosphate of lime. It follows, then, that all cases that require the phosphoric acid treatment can be more advantageously treated by Horsford's Acid Phosphate, and the suggestion is hereby commended to the profession.

Lilium Tigrinum.

Some time ago I wrote a short account of the medical effects of the tiger lily, and 1 have been flooded with letters asking many questions which are fully answered in any good work on materia medica.

And, I have letters every day or two, asking for private prescriptions for the treatment of various diseases, which the parties asking for for prescription, only name the disease, without giving the pathology. I will again say "I can not give private answers to any one." Ask your questions in the BRIEF, to be answered in the BRIEF, so the readers will all be able to read the answers. This would be of mutual benefit, not private information.

As regards the many questions that have been propounded to me, they are all answered in most of the late works on the materia medica, in regard to tiger lily.

1st, It grows in yards and gardens wherever planted and cared for.

2d, The flower is gathered when they are matured, which is in August, and immediately covered in 60 per cent alcohol, and kept in it for twelve to fourteen days, then percolated off. The dose, of a saturated tincture, is from one to five drops, three times a day.

3d, Just who cultivates it I can not tell.

4th, All good pharmacists have it for sale. And as regards its medical virtue,