When we creased transparency: The turbid aqueous It is applicable also in those ulcers due to becomes clearer. The trifling pain following the entrance of foreign bodies. the operation soon ceases. If there is hypo- adopt the expectant plan of treatment in order pyon it is speedily absorbed. The zone of to test the efficiency of the ordinary therapeuinfiltration rapidly recedes and fades. And in tic means, the hypopyon being insignificant, many cases within the next twenty-four hours yet the ulcer is extending slowly, and delay such an improvement will be manifested as to often leads to considerable destruction of corshow the destructive process to be at an end, neal tissue in depth and breadth. With the and the process of repair already begun. galvano-cautery we can promptly destroy the However, if after twenty-four hours the ulcer poisonous intruder, and induce a new, fresh shows a tendency to extend, a similar "touch-reaction in the entire tissue. ing" should be again resorted to. The loop should be applied until the masses of detritus clinging to the floor and sides of the ulcer are destroyed. The bordering infiltration for a short distance should also be destroyed; none of this parasitic material should be allowed to remain; it should be completely sterilized. If this be done a recurrence need not be feared, for it is a fact now universally admitted, that the development of spores becomes impossible on sterilized soil. The treatment by the galvano-cautery, as outlined, secures benefit to the tissues in a threefold way: And, lastly, in the chronic indolent ulcer, painless and apparently lifeless, showing no tendency towards a reparative process, the galvano-cautery is an efficient agent to stimulate and bring about a healing process. As naked facts and not general commendations are to be expected, I shall now take leave to present six cases, all of which came under my observation and treatment, in the past three months. Case 1. Austin S., age 16, after a six weeks' siege of intestinal obstruction, reducing him from 150 pounds to a mere skeleton of 95 pounds, and being scarcely able to walk, was brought to our office June 2, 1890, with the lower half of the cornea white, as the family called it, which they said came on during the last week of his illness. Examination showed an indolent suppurat It stimulates the tissues to take on a ing ulcer extending transversely, almost enhealthy reparative process. tirely across the lower half of the cornea. The Especially applicable is the galvano-cautery infiltrated zone covering fully one-half of the in the treatment of rodent ulcers, in which corneal area; also hypopyon, accompanied every new point of infection demands its with intense photophobia, lachrymation and prompt destruction. Here we require a whitehot tip sufficiently delicate to allow of the nice manipulation necessary for working in a district of no more than a millimetre in extent. And this is only possible with the galvano-caustic loop, which is brought to a red heat at the exact moment when it is needed, and cools as quickly, and produces no annoying light effects by the glowing of the wire. It is also highly serviceable in scrofulous ulcers of the cornea, which show a deep crater-shaped excavation, with sharply cut edges, accompanied by a light grade of ciliary irritation and muco-purulent conjunctival secretion, and which defy all therapeutic agencies. pain. After securing local anesthesia, the entire surface involved was thoroughly cauterized with the platinum loop, and the debris was completely cremated. This was repeated every other day, but much lighter each time, for one week. Fearing an increase of tension and liability of rupture, owing to the thinness of the corneal walls, a week solution of atropia was used every two or three hours to secure mydriasis, and prevent possible prolapsus of the iris and synechiæ, should perforation occur. To render support to the thin walled globe, a roller bandage and compress were applied, and he was directed to maintain a reclining posture as much of the time as possible. Notwithstanding his debilitated and emaci- tion treatment was tried, but its effect was ated condition, and the meagre allowance of only temporary; then sulphate of copper food yet apportioned him for fear of a return of his intestinal trouble, in two weeks he was permitted to go home with the eye free from pain; surface of ulcer smoothed over with new epithelium. A leucoma marks the site of the battle-ground, but the eye is a useful one. No pencil was applied, but this only increased the hyperæmia, the ciliary injection and pain. Finally the galvano-cautery was applied, following the entire route of the ulcer. This had the prompt and desired effect. The inflammatory symptoms subsided almost as rapidly as they had appeared. Authorities are Case 2. Mrs. H., Nickerson, Kansas, pretty generally agreed that this form of ulcer while disinfecting a bedstead with a mixture is due to mycotic fungi, and we know no betof kerosene oil and concentrated lye, was ter germicide than heat. A single application struck in the left eye with some of this fiery was all that was necessary in this case. liquid. Destruction of the corneal epithelium opacity remained. ensued, necrosis and infection of the underCase 4. Sammy L-, of Garfield, Kansas, lying lamina followed. She suffered excruci- August 4, while herding cattle thought he was ating pain, intense photophobia and lachry- struck in the eye by an insect or bug of some mation, continuing three weeks. When sort. An unpleasant sensation was all that brought to our office June 15, 1890, the lower was felt at the time, and was soon forgotten. half of the cornea was involved, presenting a In a few hours the eye became very painful, yellowish, dirty appearance. Infiltration of accompanied with intense photophobia and the remainder of the cornea was rapidly tak- lachrymation. A semi-lunar whitish yellow ing place and there was deep scleral in- discoloration along the lower border was soon jection. After cocanizing and applying the galvanocautery thoroughly, with an occasional drop of a weak solution of atropia and hot water baths she passed a comfortable night, the first since the injury. noticed; this rapidly increased in size and extent until the third day, when the whole eye was thus covered and suppurating profusely. Poultices of various kinds were applied in rich measure to hasten (?) recovery, as his friends thought, but only to hasten the deThe cautery was re-applied a few times struction of the ocular tissue. On the fifth whenever the surface of the ulcer appeared day after the injury, August 7, 1890, he was roughened. At one time, while using the brought to our office. Extensive sloughing cautery, the cornea perforated, the aqueous of the cornea was then taking place; sheets of escaping with a hissing, spurting sound. This fibrinous pus was fast escaping from between is a cause for alarm, but usually it is an ad- the lids; palpebral and ocular conjunctiva vantage, if there be an increase of tension and deeply injected; Some extravasation of blood hypopyon, as the then diminished tension will had occurred in the palpebral conjunctiva: prevent the possible formation of a staphylo- lids oedematous; palpation of ciliary region matous cornea, and the opening will give free gave pain; light imperceptible. egress of the pus from the anterior chamber; also, the aqueous in passing through the perforation, if it be in the site of the abscess will wash out its contents. In about two weeks the infiltration became circumscribed, the denuded surface smoothed over, pain ceased, dread of light absent, and simply an opacity below the pupillary range remained to mark the site of the ulcer. Case 3. Mr. W, of Topeka, presented himself with ulcer serpens of the cornea, August 3, 1890. At first the calomel insuffla The eye was thorougly washed with a hot saturated solution of boracic acid. After cocanizing, the galvano-cautery was most thoroughly and effectually applied, keeping well over the centre of the cornea, taking care not to burn the limbus of vessels near the sclerocorneal junction. This was repeated every day for a week. Much to our surprise, at the expiration of one week, we had the pleasure of seeing the dim outlines of the pupil and the grayish cast of the iris. Sloughing of the cornea had ceased, and destroyed, the cautery was reapplied but with no better results than before. The eye was irrigated with a weak carbolized solution 1-100, also a boracic acid hot solution. Not seeing much of any improvement on the following day the ulcerated surface was touched with concentrated carbolic acid from the end of a probe. though somewhat hazy, yet he could discern he had to be led about. Thinking possibly objects as they passed before the eye. At the the destructive process had not been entirely expiration of three weeks he was discharged. Case 5. Mrs. P―, farmer's wife, fifteen miles north of Topeka, about 35 years of age. Had some trouble with her eye for several days, when she noticed a white speck in the left eye. April 26, 1890, she called on us, and examination showed a small, circular corneal abscess at the upper and outer margin of the pupil, 3 m. m. in diameter. At this time there was no pain, and although circumscribed and involving the corneal tissue proper, we advised the use of hot fomentations for fifteen to twenty minutes, three or four times a day. There was a decrease in the amount of pus for two days. On the morning of the third day onyx appeared, and the abscess was opened; but the pus was thick and tenacious, and the hot applications were continued. The pus broke through the posterior wall of the cornea; hypopyon ensued and a paracentesis was done letting out the pus, and the hot water was continued for twenty-four hours. The ulcer showed no signs of healing. The eye was then cocanized, and the whole ulcerated surface was cauterized, opening the anterior chamber. The next day a marked improvement was noticed. Three or four applications were all that were required, and in three weeks she was well, with a useful eye, but a small opacity in the site of the ulcer. The eye appeared to be growing worse despite all efforts at cauterization. These were then discontinued. Hot bi-chloride fomentations, 1-5000 were directed to be used every hour, with frequent irrigation of the conjunctival sac with boracic acid, saturated solution, and the occasional use of a mydriatic. This procedure has been kept up for three weeks, during which time all pain has ceased, vision is slowly returning to the eye as the infiltration disappears from the cornea. A leucoma marks the site of the ulcer. I. CONCLUSION. 1. The galvano-cautery is always indicated. in those ulcers which take their origin in mycotic infection. In such cases it gives the most thorough disinfection of the floor and sides of the ulcer, and at the same time stimulates the process of repair. 2. Repair is shown almost at once after the application, in the clearing of the aqueous humor, dilatation of the pupil is more easily obtained, absorption of the hypopyon and increased diffusion of the corneal tissue. 3. In most cases it does away with the necessity of the corneal (Saemisch's) incision; because when the evacuation of the contents of the anterior chamber is required, it can best be effected by means of the heated loop for the reasons I have before mentioned. 4. The operation causes but slight painno assistant is necessary. Case 6. Frank B——, age 20, has had granulated lids for two years; had an ulcer on the right eye about eighteen months ago. Five weeks ago came to our office with trouble in his left eye; photophobia and lachrymation intense, accompanied with severe pain. Examination showed a row of ulcers, some three or four in number in the upper half of the cornea, extending transversely across it; a heavy pannus covered the intervening space between the row of ulcers and the periphery of the cornea above. This eye was his visual organ, his right being totally and heavily covered with pannus. After cocanizing, the galvano- 6. Dr. Noyes, in his recent work on Discautery was applied to the row of ulcers, fol- eases of the Eye says: "It is in the early lowing which pain increased; infiltration of and progressive stage that the cautery may the remainder of the corneal tissue ensued, most confidently be employed." In case 3 it and light became almost imperceptible, so tha, was employed in the early stage, but in cases 5. The healing process is considerably shortened, and the final result shows a much less extensive and dense opacity of the affected corneal tissue. 1, 2, 4 and 5, it was employed late in the disease, when destruction of the eye seemed certain, and with gratifying results. 7. The pain following the application of the galvano-cautery is less and of shorter duration than that of any other caustic. By this latter term we understand that at one or more spots within the urethra, the epithelium has become so damaged, by the prolonged inflammation, that it ceases to make the canal urine-tight, and a slow process of escape of some of the constituents of the urine into the tissue comprising the urethra and around it, takes place. As a consequence of this and to prevent urine soaking further into the tissue, 9. The mode of applying the heated gal- inflammatory exudation is excited and barriers vano-caustic is exceedingly simple and easy of lymph, which eventually become organized 8. The extent and limitation of cauterization can be definitely measured-not so with any other caustic. to master. The Formation of Urethral WITH are thrown out opposite the places where the leakages take place. Thus splints of plastic tisStricture, sue are formed where the spot or spots of epithelium have been denuded by the persisting inflammation. In this strengthening of the urethra we recognize, in the first instance, a con SPECIAL REFERENCE ΤΟ ITS TREATMENT. Read before the Golden Belt Medical Society, servative action. But, eventually, however, as October 2, 1890. BY F. B. BROWNE, M. D., SALINA, KAS. A stricture of the urethra is generally considered to be due to more or less prolonged inflammation, specific or otherwise, of the lining membrane of the canal, which ultimately leads to the deposition of organized lymph in the peri-urethral tissues. This ultimately is converted into a dense connective tissue, which subsequently shows a remarkable tendency to contract. in all other compensating processes, it constitutes an independent disease. Though the mucous membrane is the tissue chiefly invol ved in the primary inflammation, it is, as a rule, only secondarily implicated in the stricture-forming process. In many instances it will be found after death that the dimensions of the mucous membrane are not altered. The plastic exudation which makes up a stricture differs from exudation provoked in other parts of the body by inflammation, in the degree of its density and tendency to contract. I known of no tissue in the human body Thus the escape of urine from the blad- except perhaps that found after scalds and der is interfered with by the degree to which these contractile masses encroach upon the calibre of the canal. burns, where the original tissues are entirely destroyed-which is so tenacious and resisting as that constituting the usual form of Here we have a cicatrix This contraction becoming a source of an urethral stricture. noyance, either by causing gleet, if of large formed, which of all strictures is the most calibre, or by interfering with free flow of resisting and contractile. Cicatricial tissue urine if small. Now, all this may be true on manifests this tendency to contract and oblitthe whole, but it does not enter into details erate the canal more strongly than tissue with which we must be familiar for the pre- formed by cell-proliferation after ordinary invention and treatment of the disorder. It flammation. One cannot help thinking and will be convenient to take an illustration for wishing that it were possible to transplant this the purpose of tracing more gradually the process of tissue-thickening and contraction, process of stricture, making as a consequence of specific urethritis or gonorrhoea, which is admitted to be the common cause of urethral stricture. The acute form of this disorder, unless care is taken, is very apt to merge into the condi as observed with the formation of traumatic urethral strictures, to the parts constituting the weak points we are desirous of consolidating in the abdominal parietes for the radi cal cure of hernia. Here it would be serviceable instead of tion known as chronic granular urethritis. detrimental. The form in which stricture tissue is deposited, and ultimately exercises to the value of boracic acid as a prophylactic contractile pressure on the urethral passage, against urethral fever. These observations is strongly suggestive that in the first instance indicate to me, that the kind of contact beit served the purpose of strengthening the tween fresh urine and a recently made wound. wall of the canal, and thus preventing further was, in itself sufficient to cause urine fever. leakage of some of the constituents of the What these toxical products are my chemistry urine taking place at points where the epithe- does not inform me. Let me quote from an lial coat had been more or less permanently essay of one of the most original thinkers the damaged. medical world ever produced: I refer to the Having referred several times to urine-leak- late Dr. Austin Flint, "Analytical Chemistry" age as being a potent factor in the causation he observes, "carries investigation beyond the The of urethral stricture, I come to speak of limits of to speak of limits of microscopical observation. what to my mind seems incontrovertible latter at the present moment, both in patholoevidence in its favor, namely, urine fever. gy and physiology, seems to promise most; In surgical practice we have long been ac- but is it not a rational anticipation to look for customed to recognize, after injuries and future results from chemical analysis of the operations, a form of excitement generally components of the body in health and disease, known as wound or traumatic fever. It varies which in brilliancy and practical utility may in degree according to circumstances, attend- surpass those of the labors in this field ed by slight elevation of temperature, and of investigation during the past half century? usually declines without proving either serious "The medical centenarian can recall the enor fatal. In striking contrast with this we thusiasm aroused by the labors of Liebig. have a distinctive form of fever, not unlike Histology is now in the ascendant, but it is ague, which is alone seen in lesions involving safe to predict that before the lapse of another the urinary tract. Let us take for example, half century there will be another era in and many times have I observed in my own organic chemistry, and that light will penelimited experience, the simple introduction of trate dark recesses which histology cannot a catheter or a sound, and even during an at- reach. The supreme objects of study in tack of gonorrhoea, where the patient urinates pathology at the present time are the discovvery frequently over the extensively abraded ery of micro-organisms and their natural hisurethral surface, that in a few hours, he is tory. But these agents, it is probable, are seized with a rigor, which terminates in fever pathogenetic, not directly, but indirectly, by and an elevation of temperature. Cases are means of the toxical products of their activion record where the operation of internal ty. What are these products, and how do urethrotomy has been followed by rigors, they give rise to the phenomena of disease? convulsions, suppression of urine and speedy death, post-mortem examination failing to discover any reasonable or recognized explanation. We may ask the same question of certain of the poisons introduced from without the body. "How is it that fractional quantities of morphia, hyoscyamin, strychnia, aconitia, atropia, and other alkaloids produce their lethal effects? It conveys no adequate information to say that they act upon the nervous system. This is merely the statement of a fact, not an explanation. For the latter we must look to the organic chemistry of the future." Since the due recognition of those principles upon which Listerism is based, I found that certain antiseptic precautions, directed toward the wound as well as the bladder, for the purpose of acting upon the urine tended to prevent it undergoing changes and yielding products which were calculated by absorption to produce this special kind of fever, and considerably reduced, both the frequency of these attacks as well as their severity. I have reference to corrosive sublimate locally and quinine internally. Writers bear testimony different methods of treatment, namely, grad There are a few practical points relative to the treatment of stricture and injuries of the urethra, arising out of what I have thus ventured to bring under your notice, to which I would like to refer. There are at present four |