prolonged, perhaps indefinitely, and is rife with the consequences which should never supervene.

The second witness in this unfortunate case, like his predecessor, seems, from the Lancet's report, to have burdened himself with a microscope as little as with the sanctity of professional confidence. He caps his testimony with a statement which might mislead people into believing that the amount of inflammation and quantity of discharge were sufficient data for diagnosis. He, let it be charitably assumed, did not know that a very slight watery excess of moisture, without perceptible inflammation of the meatus, may contain enough gonococci to infect an army; while a thick, yellowish-green copious flow, attended with heavy swelling at the meatus and great pain on urination, may be free from the characteristic microbes of gonorrhea. The varieties of urethral discharge which may obtain in people who are perfectly chaste would seem a closed book in England, unless one is familiar with its literature or has had the high privilege, like myself, of seeing the splendid work of Fenwick, Harrison, Freyre, and others at St. Peter's, the London Hospital, and elsewhere.

The testimony of Dr. Dingle and of Mr. de Meric takes from the English profession the obloquy under which it might rest and is the really valuable part of the report. In Mr. de Meric's statement that the discovery of the bacillus of gonorrhea is necessary for diagnosis, the word bacillus is doubtless a misprint for diplococcus.

The possible recrudescence of an old, residual gonorrhea in the respondent does not appear in the report. I have endeavored to show in two papers* on the subject that a man may have deemed himself cured twenty or more years previous to marriage and, before the honeymoon has waned, infect his wife. One of the means by which this may occur, stripped of complications, is as follows:

Being married to a woman he knows to be virtuous, he has no fear of infec

*When may Gonorrheal Patients Marry? American Medico-Surgical Bulletin, October 1, 1895; and The Protection of the Innocent from Gonorrhea. The Medical Fortnightly, October 15, 1896.

tion from her, and for the same reason no dread of impregnating his partner in the sexual act. Consequently he does not hesitate to continue intromission until all vestige of erection has subsided. The so completed act, the secretion of the crypts, glands, and follicles of the urethra, possibly harboring residual or "latent" gonococci, may empty some of them into the vagina where, finding fresh soil, they proliferate. The husband's urethra having become hardened, practically immune to gonococci, may be uninfected. fected. Thus the innocent wife may alone be the sufferer physically and mentally, too, from the suspicion that may attach to having an acute gonorrhea. The husband may be infected. from her, or may not, according to whether his urethra offers a culture medium for the gonococci she gener

ates.

A husband with residual gonorrhea, which gave no evidence for many years, may, by the sexual excesses most recently married people commit, produce in himself a urethritis ex libidine, or, by the feasting which often accompanies the early married state, a urethritis ab ingestis. The local inflammation may again render the urethra a good culture medium for the gonococci that have lain quiescent in his urethral annexa and set up a fresh gonorrhea without infecting the wife. Indeed, the frequency of precisely this situation leads to the conclusion that many women must be immune.

In case the wife alone develops gonorrhea, and the husband shows a normal meatus, passes perfectly clear urine without discomfort, it by no means proves her guilt. In such a case, no conclusion can be reached before searching examination by the beer test, the nitrate-of-silver test, ramonage as proposed by Professor Guyon, urethroscopy, expression of the prostate, and stripping the seminal vesicles proves beyond doubt that the husband is free. from gonorrhea.

It is only with a view to again urge upon even those colleagues who do not make a specialty of genito-urinary diseases the need of exceeding carefulness in the questions concerning gonorrhea.

that these suggestions are written. No attempt is made at a complete statement, as that would consume more space than you could allow.

The Value of Hydrastis in the Treatment of Uterine Hemorrhage.

Hydrastis has been employed by both regular and irregular practitioners for many years as a remedy for catarrhal conditions of the stomach and intestines, and also for inflammatory conditions of a catarrhal character in the genito-urinary tract of the male. rather than of the female. The question whether it exercises any considerable power over the genito-urinary apparatus other than by acting as a tonic to the gastro-intestinal mucous membrane, and thereby improving general nutrition, is one of considerable interest and about which there seems to be a good deal of difference of opinion. As long ago as 1886 an abstract of a paper by Kugelmann appeared in one of the early numbers of the American Medical Digest, in which he claimed that the use of hydrastis very materially checked the menstrual flow, and it has been suggested that it be employed not only in cases of excessive menstruation, but in those instances of profound anemia where, in the opinion of some clinicians, moderation or almost complete arrest of the menstrual function is of value as a means of preventing the periodical drain on the system. A few years after Kugelmann's paper had appeared the late Dr. Jackson, of Chicago, reported that he had found this use of hydrastis distinctly valuable, and his evidence may be taken as supporting that of Schatz, of Rostock, who was one of the first to employ hydrastis as a uterine tonic. Dr. W. Reynolds Wilcox has also recorded his experience with the drug in arresting excessive menstruation, and it is worthy of note that Dr. Jacobson considered hydrastis superior to ergot for the purpose named. At most, however, it can not be expected that the hydrastis will do more than modify the menstrual flow; and Jackson admitted in his paper that by no means in his power, such as 'tamponing, the use of heat, the use of ergot, or the use of hydrastis, or of all

three together, had he been able to produce artificial suppression of menstruation. That the drug does, however, possess some influence upon menstrual flow and upon hemorrhages from the uterus seems pretty well proven at this time by the gradually accumulating reports which have been placed before us, and while it is by no means a specific, it is one to be considered when the physician comes face to face with a condition which these peculiarities of the remedy will meet.-The Therapeutic Gazette.

The Operative Treatment of Hemorrhoids.

The author describes a method of excision which he employs in preference to ligature or clamp and cautery in many cases, though he is partial to the ligature.

As to preparation for an operation for hemorrhoids, it is advised to administer a purge at least two successive days previously, and early in the morning of operation to give an enema of soapsuds, and another just before operating. Next stretch well the sphincters, which in itself will sometimes cure hemorrhoids. Through a speculum introduce a piece of gauze to prevent discharges from coming down, grasp the apex of the pile with a hemostat, raise it and apply the long slender forceps. With a round sewing needle threaded with catgut, pass a stitch through and back again beneath the clamp and tie. Repeat this until the whole amount of tissue included in the clamp is ligated. It is essential that a round and not a cutting needle be used. If the skin has been included in the grasp of the clamp, an incision should be made through it with a scissors. The portion of the pile above the clamp is then cut away and the latter loosened. Any bleeding points should be ligated. The operation is completed by inserting with a curved needle and catgut as many sutures as may be desired to approximate any cut or bleeding surfaces. The sponge is removed from the rectum, an iodoform and opium suppository introduced, and a T bandage applied. To move the bowels on the fourth day with the least pain, a two

way catheter is introduced, washing away with warm saline or borax solution any accumulative feces. This procedure may be repeated for two days, when teaspoonful doses of epsom salts can be given until fluid movements occur.-Gwilym G. Davis, Philadelphia. (Therapeutic Gazette.)

Modification of Schede's Thoracoplasty in

Cases of Empyema.

Sudeck (Deutsche Zeitschrift für Chirurgie, 47 Bd., 2 and 3 Heft, 1898) proposes what he considers a serviceable modification of Schede's operation of thoracoplasty. Schede's operation he describes as follows: An incision is to be made beginning at the outer border of the pectoralis major at the level of the fourth rib, curved downward to the lower margin of the pleural cavity, then upward, outward, and backward to the middle of the scapula, which is thrust out of the way by turning the arm upward over the breast. This flap is raised and the whole chest wall, including the second rib, is resected: The remaining cavity is filled in as far as possible by a musculo-cutaneous flap.

The greatest difficulty is experienced in so arranging this that the apex of the pleural space is carried in. There often results a persistent fistula.

This operation is usually performed on extremely weak tuberculous individuals. It is therefore important that the operation should be as simple as possible, and it would seem advisable to complete it at several sittings.

Sudeck's method is as follows: The first incision begins at the cartilaginous insertion of the fourth rib and runs horizontally outward and backward across the scapula as far as the vertebral arch. Parallel with this incision a second is made on a level with the floor of the suppurating cavity. These two incisions are connected in the axillary line by a vertical cut making the figure H. The two flaps on the bar of the H are then turned forward and backward.

The ribs are resected from the tenth to the third inclusive, and the thoracic walls, together with the thickened

pleura, are removed throughout the whole extent of the cavity as far as the second rib. In spite of the shrinkage which occurs in the flaps, when they are spread out it will be found possible to nearly cover the remaining exposed pleural surface, the tongue-like flaps being stretched past each other. They are held in place by packing, and the part which is uncovered remains an open surface. At the second sitting this can be covered either by transplantation or skin-grafting. At the third operation the depression made by the costal pleural at the apex of the lung can be closed either by transplanting the flaps or by resection of the second rib.

Gonorrhea as a Cause of Pelvic Disease.

Dr. Madden (Lancet) recorded by Dr. Chase in the Brooklyn Medical Journal for October, 1896, after speaking of the invasion of gonococci into the uterus, fallopian tubes, etc., concludes as follows:

With reference to the other intrapelvic complaints of which gonorrhea is a fertile source, I shall only here observe that long clinical experience has convinced me that in a large proportion of instances, peri-uterine phlegmon, or in other words, all those chronic inflammatory lesions of the pelvic serous and connective tissues formerly included in the term pelvic cellulitis, and subsequently better known. perimetritis and parametritis, may be found traceable to that affection.

"Husa" as a Remedy for the Opium Habit.

as

The February number of the Texas Courier-Record of Medicine opens with a remarkable account, by Dr. W. W. Winthrop, of Fort Worth, of his experience with an unclassified plant which he thinks may be indigenous to the everglades of Florida, one known by the name of "husa." He first observed its use in connection with that of the arrow-leaved violet, viola hastata, a plant that is found growing from Canada to Florida and westward to Arkansas.