all the signs of disease had vanished. The boy was now well developed and could perform gymnastic exercises without trouble.

The second case was that of a man, æt. 26, who had gone through a similar illness and presented similar features. There was a feeling of illness, palpitation, and shortness of breath. There was redness about a cicatrix where thoracentesis had been performed, and there was some discharge of pus. There were also ascites, cyanosis, imperfect cardiac action, and drawing in of the thoracic wall over the apex. Cardiolysis was performed. Complete recovery had taken place in three months. Thoracoplasty was then performed after Schede's method with implantation of the scapula. The patient was now quite well and able to follow his employment.

The third case was that of a man, æt. 26, who had had tuberculous pleuritis. In 1902 he had edema, albuminuria, and engorged liver. Here there was no contraction at the apex. The patient, when first seen, was so ill that no operation could be thought of. When the general condition had improved, however, from rest, digitalis, and camphor, cardiolysis was performed. Here there were tuberculous metastases and tuberculous swellings on the pericardium. Complete recovery took place.

In all three cases the mischief was associated with pleurisy, and in all grave cardiac disturbances had been going on for several years.

Prostatectomy.

J. B. Murphy (Jour. A. M. A., vol 42, nos. 23, 24 and 25) says of this operation:

The results are more gratifying as time progresses and we become more familiar with the technic in the complicated and difficult cases, but my first case has not been excelled by any subsequent one in its result.

The capsule of the prostate should be displaced backward with the rectum to insure the integrity of the latter.

The hemorrhage was quite profuse in two cases. This was controlled by placing hemostatic forceps on the bleeding points,

and allowing them to remain for forty-eight hours, as in vaginal hysterectomy. The packing with subiodid of bismuth gauze is sufficient to control venous hemorrhage.

The permanent catheter has been abandoned in my later cases. It is not only unnecessary, but injurious. The perineal drain is retained until the urine is practically free from pus, usually from three to eight days. The bladder is not usually irrigated.

It is important to remove the redundant prostatic urethra, to avoid the tendency to perineal fistula, and the opening should be closed with catgut sutures down to the drainage tube. He arrives at these conclusions:

1. The perineal route gives the best ultimate result.

2. It is accompanied by less danger than the suprapubic or Bottini operations, as regards (a) hemorrhage; (b) sepsis; (c) injury to the neighboring structures; (d) life. In fleshy patients the hemorrhage is more profuse, repair slower and the urethral fistula lasts for a longer time.

3. The drainage is excellent, and favors rapid restoration of the bladder to its normal condition.

4. The period of wound repair is much shorter than by the suprapubic route. All cases had primary union down the drainage tube.

5. The vesical control is almost uniformly good.

6. The sexual power is usually destroyed.

7. The relief of vesical irritation is great, and the frequency of urination is reduced to about normal.

NOSE, THROAT AND EAR.

A Consideration of the Value of Topical Applications to the Upper Air-Tract.

F. W. Hinkel (Therapeutic Gazette, vol. 28, no. 5) says:

1. Insufflation of powders is not an efficient form of local medication of the upper air-tract.

2. Inhalation of medicated steam is of service in the early stage of catarrhal inflammation-the higher the temperature

and the saturation of the inhalation the greater is its efficiency. Dry inhalation of the volatile parts of drugs is of little utility. Inhalation of smoke from a smudge of suitable medicaments will usually control a paroxysm of asthma, but finely nebulized oils suitably medicated are more elegant when equally efficient.

3. Gargles are of little value unless the patient be directed and trained to use them in a way to give the greatest possible access to the pharynx and nasopharynx. They can be used occasionally as an efficient means to cleanse the nasopharynx and nasal chambers.

4. Douches are used chiefly to apply cleansing alkaline solutions to the nasal passages and the nasopharynx. Cleansing solutions are the most important topical applications in the upper air-tract. Much irritation is kept up by decomposed secretion retained mechanically in the various recesses of this region, and the douche is the most efficient means for its removal. Care must be taken that fluid be not used in this way in too large amount or with too much force, lest infection be carried to the middle ear.

5. Drugs used for other than cleansing purposes act chiefly either as irritants to the surface of the mucous membrane or by absorption into its tissues. Such medicaments are best applied as pigments or sprays. Both irritants and absorbents in the hands of the physician should be applied usually as pigments directly to the region which it is desired to affect.

This is true even within the larynx and the trachea. In the trachea the medicament may be injected through the glottis directly upon the tracheal walls. Sprays should be reserved usually for use by the patient during the intervals between local treatments by the physician, if it be desired to keep up a continuous influence of a drug.

6. We have positive evidence of the prompt absorption by the mucous lining of the air-tract of certain active drugsas cocain, adrenalin, stramonium, and atropin. Experiments in regard to the relative absorbability of various drugs by this route are needed to establish a more certain and rational local therapeutics of the nose and throat.

7. It is not improbable that the massage attending the application of pigments to the mucous surface is an important factor in producing reactions in the circulation and in the glandular secretions.

8. While we continue to lack experimental knowledge of the local effects in the upper air-tract of drugs topically applied, local therapeutics must remain inferior to surgery in accuracy of application and in efficiency in the treatment of most of the chronic diseases of the nose, ear, and throat.

GYNECOLOGY AND OBSTETRICS.

The Final Results of the Apostoli Treatment in Some Cases of Fibroid Tumor of the Uterus.

G. B. Massey (Proc. Phila. Co. Med. Soc., vol. 25, no. 5) says: 1. A prolonged observation of cases of fibroid tumors of the uterus under the Apostoli treatment teaches that three-quarters of the cases subject to the method will be practically cured, as attested by inquiries made from three to sixteen years after the cessation of the treatment. 2. The cases that responded poorly or not at all to this treatment are not harmed by it, when properly applied, and heroic measures may then be adopted with the certainty that milder means are of no avail. 3. Hemorrhagic and interstitial fibroids are best adapted to the Apostoli treatment; while subperitoneal or degenerated fibroids and those complicated with pyosalpinx are least adapted to be relieved by it. 4. So far as my inquiries and circulars show, there have been seven deaths among these 110 patients during the sixteen years or less that they have been under my observation. It is an interesting fact, moreover, that but one of these deaths was due to the progress of the growth itself, proving the nonmortal character of this affection. Of the remaining six, one died long after treatment, of an affection totally unconnected with the growth, one of septicemia under electric treatment as related and four while being operated on with the knife.

Vol. 24-32

Peritoneal Drainage.

H. C. Taylor (Am. Jour. Obs., etc., vol. 49, no. 6) in a consideration of the practical value of drainage in abdominal operations, analyzes his last one hundred consecutive abdominal operations, with three conclusions resulting. Of the 100 cases, 79 were operated on through the abdominal wall; 21 through the vagina. Of the 79 cases operated on from above, 8 were drained all through the vagina, 5 on account of intestinal injury and 3 for other causes. The three latter cases were drained to this extent, in 2 cases the top of the vagina was left open but no gauze at all in the peritoneal cavity; in 1 case about 12 inches of gauze was used in the abdomen. Of the 21 cases operated on through the vagina 20 were drained. In 16 cases the operation was an incision posterior to the cervix for drainage without removal of any organ. In 4 cases the operation was a vaginal hysterectomy, and he uses a little drainage in practically all of these cases as he is not sufficiently sure of absolute hemostasis.

Six cases died; of these 3 had been drained and 3 had not been; of the 3 drained cases 1 was carcinoma of the cervix, died of an embolus; another was a fibroid of the uterus with a pyosalpinx and a suppurating ovarian cyst that had previously ruptured into the rectum; the third was a pyosalpinx and an ovarian abscess, in the acute stage. The 2 last cases died of peritoneal infection.

Of the 3 cases not drained 1 was an ectopic pregnancy, died of pneumonia at the end of five days; another was an ovarian cyst in a patient in poor general condition; a partial autopsy showed no peritoneal infection; the third case was a hematoma of the abdominal wall in a case of typhoid fever on whom I made an exploratory laparotomy. Taylor is sure drainage would not have influenced the outcome in any of these 3 cases.