PROSTATECTOMY.-R. Harrison says of perineal prostatectomy that he believes it of limited applicability adapted principally to partial removals of the gland. Freyer's operation of supraprostatectomy is considered the operation of choice in the majority of cases, some of its advantages being that it may be completed with a knife aided by the fingers in a very few minutes, and that the bladder and prostate are approached from their most accessible position where there is little or no danger of encountering hemorrhage or of permanently damaging the sphincter or retentive apparatus of the bladder. The drainage provided is free so that secondary strictures need not be feared, and any calculi present are sure to be detected and removed. Partial supraprostatectomies have not proved, on the whole, successful. In regard to the mortality attendant upon the two types of operation the author believes there is not much difference between them, and he puts it, including all causes of death, at about ten per cent.- Medical Record, May, 13, 1905. DYNAMICS OF DREAMS.-A. E. Gibson presents an exhaustive analysis of the physical and psychical basis of dreams. He sums up his views in part as follows: To sum up the argument, dream and waking differ in degree and form of manifestation only, not in principle and essence. Like waking consciousness, dream reveals, but does not create. The same world that surrounds the waking individual surrounds the dreaming, only the viewpoints and media of observation are changed. As the life experience of an individual in his waking consciousness receives its character and value by and through his power of response to environment, so in a similar way the value of a dream depends upon the power of the Ego to respond to consciousness in its various forms of emotions, ideas, and feelings which constitute the environments of the subjective of a dream plane. Waking or dreaming, the individual is, or becomes, what he chooses to be at any given moment of his existence. The background for ordinary dreams consists of undigested remnants of waking life. Hence, ordinary dreams are merely undigested life, being made up by longings, desires, anticipations, idle hopes, and miscarried realizations, which, oc cupying the mind during the day, are overtaken by sleep before having reached their fruition. Hence the mixture, in most dreams, of the sane and the insane, of truth and delusion. On the other hand, the life lived out and assimilated in a purposeful existence becomes absorbed in the formation of character and leaves no residue to form the bizarre staging for the confused dream. And to such an individual the intuitions of dreamlife, with their dazzling imagery, will introduce symbols, which, properly interpreted, may carry the significance of prevision or prophecy. Therefore, to turn dreams into useful, intelligent, and intelligible factors, we must fill our waking life with deeds and thoughts of universal usefulness, and freight the train of events with an unflinching devotion to duty and virtue.- Medical Record, Aug. 12, 1905. A CASE OF MENSTRUAL URTICARIA.— D. J. M. Miller epitomizes the literature of this condition and describes its occurrence in a girl of fifteen, who menstruates regularly and whose attacks of urticaria make their appearance seven or eight days before and cease two to three days before, each period. Occasionally the urticaria persists until the flow begins, rarely during the first day or two of its course. During the intervals between the periods the patient is quite free from attacks and she is perfectly healthy in other respects. The urticaria itself is of the ordinary type. - Medical Record, May 13, 1905. LARGE DOSE OF QUININE IN PNEUMONIA.-F. H. Poole, Ross Fork, Idaho (Journal A. M. A., June 3), reports that he has recently treated thirteen consecutive cases of pneumonia among Indian school children with large doses of quinine, according to the method advocated by Galbraith (Journal A. M. A., Jan. 28. 1905, p. 291) without mortality. The initial symptoms common to all cases were intense frontal headache, epigastric distress and vomiting, and in eight cases epistaxis also occurred as an initial symptom. Three of the five boys had epistaxis at the onset and all had it repeatedly during the quinine treatment. Of the eight girls five had it as an initial symptom. Two of these had never menstruated, but the menses appeared during the treatment; in the other three they also appeared, though not due, and in spite of the fact that the patients had always previously been regular in this respect. In none of the girls did epistaxis appear after the initial symptoms. Poole asks: Was this hemorrhagic tendency a part of the disease and peculiar to this epidemic, or were the epistaxes of the onset due to the infection and the later hemorrhages to the treatment? The minimum single dose of quinine given was fifteen grains, the largest thirty-six grains. These large doses proved a genuine stimulant to the heart and circulation, and appeared largely to allay the anxiety of the patient and to secure sleep. INCONTINENCE OF URINE.-E. C. Dudley, Chicago (Journal A. M. A., June 3), describes a new operation for the relief of the urethrocele with imperfect urinary control, sometimes met with in multipata. It is based on the same principle as the operation of Albarran for the same purpose; the urethra however is not dissected free and the danger of sloughing is avoided. The first step consists in denuding a horseshoe-shape surface between the meatus and the clitorus, and to either side throughout its length. In the second step of the operation the meatus is drawn up to a point near the clitoris and secured there by means of two sutures. The lateral portions of the denuded surface are then closed. The first two sutures stretch the urethra upward toward the clitoris, and the lateral ones tend to hold it in its new position. The idea is to straighten the urethra by longitudinal tension and to collapse it and to hold together the dilated walls and to overcome the sacculation at the neck of the bladder by lateral traction. In many cases it may be necessary to operate at the same time for the associated cystocele, and in nearly all cases to perform perineorrhaphy for the relaxed posterior vaginal outlet. When there is very much relaxation of the tissues about the clitoris, and there is danger of it being pulled down, he would take a reef in the tissues above that organ, enough to keep it sufficiently high to hold the urethra taut. He has performed this operation five times since Jan. 1, 1905. In the first four, the relief was immediate, and, so far as known, continuous. The last case is still too recent to be correctly estimated. INCISING AND SUTURING THE LIVER.-J. Frank, Chicago (Journal A. M. A., August 12), describes his method of excising a wedge-shaped portion of the liver and suturing and its advantages over other methods, such as packing, cautery and other methods of suture. He has experimented with it in 16 dogs. It consists in removing a wedge-shaped portion, including the diseased area, ligating the arterial bleeding with catgut sutures and, as soon as the hemorrhage is checked, bringing the flaps together, and with a long non-cutting needle making a running suture from one end to the other in the following manner: In case the excision is in a transverse direction, one suture is carried through the liver tissue near the bottom of the trough, and then one superficially, and so on, alternating, until complete closure. It requires but very slight tension to approximate the flaps. The mode of suturing can be varied, according to the fancy of the operator. The main object is to bring the two flaps together, obliterating all dead space. The continuity of the liver surface is re-established, appearing as if a new border had been constructed. No raw surface or ragged edge is left. If a portion of the liver is to be removed in a longitudinal direction to the viscus, the following method is then pursued: A wedgeshaped portion of the entire thickness of the liver is first cut out and the two broad surfaces left are now converted into troughs. This is accomplished by the excision of wedge-shaped pieces. The troughs thus formed have two flaps. When the operation is completed, the raw surfaces left of the original V are transformed into smooth, continuous liver tissue assuming the form of liver borders, and the V space left persisting as a notch." The operations are illustrated by figures. Frank thinks that this operation has an important future. ICHTHYOL is a most valuable substance to reduce inflammatory swelling, and in septic conditions affecting the skin. Its disagreeable odor is very distressing to many patients, but it can be concealed by the addition of oil of citronella minims xx, to the ounce of ointment. Oil of roses also does well, but is very expensive.— International Journal of Surgery. GRAND RAPIDS THE BEST RE-CONSTRUCTIVE Phillips' Phospho-Muriate of Quinine, Comp. (The Soluble Phosphates with Muriate of Quinine, Iron and Strychnine.) PERMANENT-Will Not Disappoint, PHILLIPS', Only, is Genuine, THE CHAS. H. PHILLIPS CHEMICAL CO., 128 Pearl St., New York GALL-STONES in the common duct have been found once in every five cases operated on by Robson, and once in every seven cases by the Mayos. It is estimated that sixty-seven per cent. occur in the duodenal end, fifteen per cent. in the hepatic end, and eighteen per cent. in the middle of the choledochus. They vary in size usually from a split pea to a nutmeg, although exceptional instances of much larger stones have been recorded. They are usually solitary, though more than one are frequently found. * Read at 72nd Annual Meeting of the Tennessee State Medical Association. |