exists in connection with the currents of high frequency. The reviewer, however, desires to call attention only to that portion of the article dealing with the subject of fulguration. “Malignant or semimalignant lesions of the skin, epithelioma, lupus, lupus erythematosus and sarcomata, when of small size and conveniently located, have been destroyed in very many instances by the caustic spark from a metallic electrode connected to one terminal of a coil transformer, the other terminal being grounded or connected to the person of the patient. This little operation is exceedingly painful for the moment, but as it lasts for but two or three seconds at the utmost, it is usually borne without flinching. There are many reports in confirmation of this, especially

I

in France, where it was first used. know of no better means of aborting a commencing feruncle, as it does in a moment that which nature requires several days or a week to accomplish. In other words cocci are instantly destroyed together with the follicular wall, and the leucocytes have simply a small inert necrotic plug to deal with, which they usually do with but little accompanying inflammatory reaction." The author obtains the high frequency current for this purpose from one terminal of the secondary coil of the transformer which bears

required than their removal. The cosmetic result must receive due consideration and any agent possessing the ability to destroy a disfiguring defect is worthy of attention. of attention. The high frequency current is used by the author for the removal of warts, freckles, pigmented and vascular nevi, etc., and in the great majority of cases very satisfactory results were obtained. The most pleasing feature about the use of this modality was the character of the resultant scar which, without exception, was either imperceptible or, at the worst, left only a pinkish scar of soft texture. The current is derived from an Oudin type of resonator, energized by an induction coil carrying from one and the primary and interrupted by a mercury three-quarters to three amperes through

jet break. The electrode consists of a pointed metallic needle covered to the point with heavy rubber and inserted into a suitable handle. The current passes by one wire from the resonator-the monopolar method.

The site of application should be rendered as clean as possible. It is seldom necessary to use a local anesthetic. It is

preferable to commence the application

with a mild current and have the needle in contact with the part. This is followed by a greater volume of current and at the same time the electrode is withdrawn

in connection with a Ruhmkorf coil and an electolytic break.

HIGH FREQUENCY CURRENTS IN THE TREATMENT OF SMALL BENIGN NEOPLASMS AND HYPERTROPHIES OF THE SKIN. (John T. Rankin, M.D., The Archives of Physiological Therapy, September, 1906).

The writer calls attention to the fact that in removing blemishes or growths of various kinds from the face that more is

centimeters in length is secured. This, of course, must be regulated by the toleration of the patient and the amount and the rapidity of tissue destruction desired. The first action of the spark is to cause a constriction of the blood vessels and an anæmic condition ensues, to be quickly followed by a dilatation of the vessels with a consequent reddening of the area affected. When the part is vascular, an oozing of yellowish or reddish serum

takes place. Soft non-vascular warts become quickly blackened and shriveled and there may be little or no discharge.

The time of individual treatments and the number of treatments necessary to secure the desired result cannot be stated as, obviously, these factors must depend upon the degree to which the destructive action should be carried, and this can only be determined by experience. The beginner, to be on the safe side, should use a current of moderate intensity, even though it may be necessary to repeat the application a number of times. It is not essential, but advisable, to lightly dress the wound after the treatment. In treating vascular nevi, measuring from two to four centimeters in diameter, onefourth to one-half the area may be treated at the first seance, leaving the balance for future daily installments of sparks. A heavy yellowish or brownish scab forms over the part which the spark has bombarded, this scab falling off in from six to ten days. Deep port wine marks may require several applications and, although the improvement is always well marked, they cannot, as a rule, be entirely eradicated. The action of the spark upon hairy nevi does not extend deep enough to destroy the hair follicles so that the galvanic needle is frequently required to complete the obliteration. One small scar was treated in this manner, followed by its disappearance through the development of capillaries in the cicatricial tissue. THE HIGH FREQUENCY METALLIC DISCHARGE; ITS POSSIBILITIES. (Finley R. Cook, M.D., Medical Record, December 21, 1907).

Cook has found this method of treatment serviceable in cases of hypertrophied tonsils, hypertrophic rosacia, keloid

and scars, acne, moles, suppurating sinuses from broken down tuberculous glands, hæmorrhoids, etc. The writer claims there is little or no pain produced, especially in the case of tonsils and hæmorrhoids. As a rule a radical cure in one treatment is not attempted, it being preferable to accomplish this aim by two or more applications. A white membrane forms on the tonsils the day following the treatment and when this is spontaneously separated the glands and crypts are found considerably reduced. The sparkings are then continued until the desired result is obtained. In the treatment of internal hæmorrhoids the tumor is brought down without dilatation of the rectum and without pain by the use of suction obtained from an ear pump operated by an electric motor. By reversing the valve of the pump compression may be utilized for replacement.

FULGURATION IN A CASE OF CUTANEOUS EPITHELIOMA TWO TWO YEARS AFTER TREATMENT. (M. Delherm, Archives d'Electricité Médicale, May 25, 1908). This short paper consists of the report of a case of rodent ulcer situated at the inner angle of the eye for three years, treated by fulguration in 1905, since which time the patient has remained well.

M. D., 62 years of age. Disease began in 1902 and when fulgurated was the size of a large kidney bean. Radiotherapy

was first tried without benefit. The lesion then received six treatments with the high frequency current from a metallic electrode, followed by a complete disappearance of disease. The patient was last seen on January 15, 1908. There was no evidence of activity and the site of the lesion appeared like normal skin with the exception of a pale red color.

When a case presents for the treatment of enlargement of the prostate the ætiology should be carefully studied. Age will always be an important factor. Enlargement presenting under 50 will not infrequently give a history of early gonorrhoeal infection, or similar causes, or there may be present the history of some surgical lesion following an operation for hæmorrhoids, for ulcer, fissure or fistula-in-ano. These conditions not infrequently produce an acute inflammatory condition resulting in an abscess. Early attention to all inflammatory conditions is very desirable. When the patient is suffering from pressure, a feeling of fullness about the perineum, with frequent desire to movement of the bowels, frequent micturition, a direct examination, per rectum, will often indicate a sensitive, tender state, which may presage an abscess. Sitz baths are now of great service, the bowels to be thoroughly emptied, a soft diet given the patient, at times the application of the ice coil to the perineum is advisable, and in plethoric patients, the use of leeches, or the Bier cups, is often of great benefit. When the inflammatory condition advances rapidly, and an abscess forms, prompt evacuation of pus is absolutely necessary, either through the perineum; or, what is now recognized as a very proper and justifiable method, opening through the rectum, washing out the abscess cavity, curetting carefully, in such cases as may seem nec

*Read at the meeting of the Onondaga County Medical Society, Academy of Medicine, Syracuse, N. Y., May 21, · 1908

essary, and draining. In a simple abscess, where there is not much necrotic tissue present, these cases recover very rapidly.

It is after the age of 50 that we come to treat the really important factor in enlargement of the prostate, i. e., passive or positive obstruction from permanent. hypertrophy. At this time of life we look for carcinoma and other forms of tumors of the prostate. The symptoms of a gradually increasing desire to urinate, the necssity for rising once, twice or three times during the night, with pain that sometimes accompanies it, should attract our earnest attention when the patient comes to the physician for observation and treatment. At this time examination of the urine in every detail is of great aid. If very acid this condition should be remedied as promptly as possible. The use of alkaline waters, the giving of carbonate of soda, the bicarbonate of potash, or some of the lithiated waters is of great comfort to the patient. In all cases of enlargement of the prostate the rectum should be kept emptied, the bowels watched with care, and while it is not advisable to give active cathartics, particularly preparations containing aloes, it is very necessary that a soft, free movement of the bowels be secured each day. Laxative mineral waters are of great service. Great attention should be paid to the diet. Cream, milk and cereals are of value. Many of these patients are benefited by limiting them in the use of meats, particularly beef. The excessive use of asparagus and string-beans should be avoided, and the various berries have an un

pleasant effect with many patients. Patients should be encouraged to drink plenty of soft water, and the use of lemonade is not objectionable, often being beneficial. Milk is often of benefit, yet, in some cases, not well tolerated. The use of alcoholic drinks should be avoided, wines used with great caution, and the same may be said regarding malt liquors.

If the urine is alkaline we have reason to fear there may be vesical retention; that the patient may be developing a pouch in the inferior fundus, with a depression behind the prostate that holds a small quantity of residual urine, this latter so often a source of much distress and infecting the upper portion of the urinary tract. In these cases the use of phosphoric acid is of service. Patients will sometimes drink of Horsford's acid phosphate, knowing they will get relief in this manner. The diet is to be watched with as great care as in an acid condition, although the patient may now indulge somewhat more in articles of food which have been previously restricted. It is in these beginning conditions that we should pay attention to the secretions, also the possibility of our patient being unnecessarily exposed to physical exercise, to over-exertion, and the mental condition, regarding nerve strain, etc.,

should

be relieved as much as possible. When the urine is alkaline and contains pus, the washing out of the bladder is absolutely necessary in some cases, and here the preparations of urotropin, cystogen and uriseptin seem to be of service. I am an earnest advocate of medical treatment of these cases that present with symptoms of prostatic obstruction. Cases that present with a condition of atony of the bladder, the latter greatly distended, and the patient passing only a small quantity

of urine at a time, often, not infrequently, give evidence of an overflow, with the urine absolutely normal. These cases are to be treated with great care. Only a portion of the urine should be withdrawn with the catheter, the patient to be given the benefit of full doses of nux vomica, which I have reason to believe is of much more service here than the use of strychnia, also other tonics, such as iron, quinine, etc., as may be necessary, with the application of electricity, the galvanic current preferably, through the sacral and hypogastric plexus, with the negative pole in the rectum, the positive over the sacral and hypogastric region, I have seen result in great good. In many of these cases the tonicity of the viscus returns, and patients go on very comfortably for years, perhaps suffering an occasional attack, but many, many cases go along favorably under the above treatment, and an operation is avoided. Where atony continues they are bad subjects for operation, as Dr. John Vanderpoel has pointed out.

In the study of prostatic obstruction I have often been impressed with what I believe to be a family tendency. The grandfather, father and son all having had the same serious experience after the age of 56 or 60. Cases of sudden retention of urine that come to us, cases that present with frequent desire to urinate every 15 minutes, half hour or hour, with all the evidence of residual urine, are the ones that are often beyond the point of medical relief. Surgical intervention now becomes necessary, and with the patient, who is suffering from complete retention, every possible effort should be made to learn the nature of the obstruction. I am frank to say that in the study of our own cases, 67 in all, not including a large number seen in consultation, acute retention

of urine is most frequently found, due to enlargement of the middle lobe or isthmus. In these cases the acme of distress is reached in the sudden retention, and most urgent desire to urinate. Enlargement of the lateral lobes presents in a rather more gradual onset of symptoms. The patients give their obstructive symptoms with less emphasis. As we all As we all know, the lateral lobes may one or both be enlarged at the same time, and the use of instruments is made successful or unsuccessful by the physician or surgeon reaching a proper diagnosis as to what part of the gland is involved. The habits and occupation of our patients should always be taken into consideration. Exposure and cold are factors of importance; the use of alcohol and habits of dissipation are not to be forgotten; stricture of the urethra is one of the most pronounced conditions that enters into the study of these cases, and should always be treated.

The history of the treatment of prostatic enlargement is exceedingly interesting to me. Up to within a decade and one-half the surgical treatment has been largely that of the ability of passing some form of catheter that would relieve the patient and make him somewhat more comfortable for the remaining days or years of life that might be left to him. Of these instruments there have been not a few, and of them all the old English elastic catheter is about the only one that has retained any source of authority.

About 1867 we had our attention called. to the vertebrated catheter, which, in theory, was thought to be most effective, but proved to be a complete failure. Following this was the rubber catheter, looked upon with great distrust by the older surgeons at that time, but which I soon discovered was our good friend. Then we had the silk-web catheter, with or

without the Mercier curve; then the spiral steel ribbon catheter, also with or without the Mercier curve; the silver, and later the celluloid catheters with an immense prostatic curve have been of service. All forms and shapes of soft catheters have been made use of, and now, of late, we have the flat catheter, which is of great assistance in bilateral enlargements. Surgeons had noted that in doing a median perineal section we could at times almost roll out portions of the prostate, but this was not quite understood and made use of until after our antiseptic methods of surgery were introduced. Tapping or draining through the rectum with the trocar, when instruments failed, was not infrequently our last resort. Then came the aspirator, which has proven of so much value in many cases of retention. A little later we had suggested the removal of the testicle, but a disappointment, a number of patients becoming insane, which occurred in the first two cases where I did this operation. Then came vasectomy, but neither of these two methods was satisfactory. Next followed suprapubic operation, with drainage, a method elaborated so earnestly by the late Hunter McGuire of Richmond, and which I have employed in a number of cases, but seldom use at the present time. About this time a number of us were doing perineal section and removing the middle lobe through the incision by means of a form of drawing-knife, that cuts from behind forward. These cases did fairly well. Suprapubic cystotomy next followed for removal of the middle lobe or isthmus by means of various forms of forceps, and, finally, complete removal of the gland was attempted, and with great success, leading to the introduction of the operation of prostatectomy.

When medical treatment does not af