Dr. Reynolds closed the discussion, mentioning a case of hip-joint disease, in which the burrowing of pus simulated a rupture. Paper was received and will appear in the November number of the KANSAS MEDICAL JOURNAL. Dr. Gray, of Kansas City, read a paper on "Surgical Treatment of Tuberculosis of the Knee Joint. DISCUSSION. shock, and that cerebral anemia existed in a boy of neurotic constitution. Dr. Griffith wished to know why cigarette smoking caused tobacco heart and nervous symptoms quicker than cigar or pipe smoking. Dr. Pelton described a case of pericardial pain under similar circumstances to Dr. Peers' case. Dr. Bidwell thought that cigarette smoking Dr. Griffith considered that most cases of was more dangerous than pipe or cigar smokbone disease were due to some organism. ing, being carried on by a younger class of persons, and inhalation of smoke being also more frequent among them. Dr. Sands, of N. Y., prefers thelongitudinal to the U shaped incision. He thought that fixation and extension were very often indicated. Ex-section was preferred to erasion because a better cleaning was accomplished, and nails were preferred to wiring. The Dr. had put up some joints before taking off the Esmarch bandage. Dr. Rodgers thought the opening of the dressings for daily irrigation was inadvisable. Dr. Jones favored daily irrigations to avoid the formation of sinuses. Dr. Lewis stated that Dr. Thomas, of Liverpool, was the originator of the practice of extension and fixation, and Dr. Gibney was his follower. Dr. Gray closed the discussion, stating that all the diseased tissue was not removed, hence the necessity for irrigation. Paper was received. Dr. Carpenter agreed with Dr. Bidwell, and found the tobacco heart was very common among applicants for life insurance. Dr. Lindsay thought there was no indication of cerebral hemorrhage in Dr. Peers' case. Dr. Lewis spoke of the symptoms resembling multiple neuritis, as in the case of arsenical poisoning. Dr. Peers closed the discussion. A bill of $5 for postage and programs was allowed. It was moved and carried that the January meeting of the Society be held in Topeka. An adjournment to an elaborate banquet, spread by the Topeka brethren, was then taken. Peace and harmony prevailed, and at an early hour the medicos sought refreshment by "Tired nature's sweet restorer, balmy Dr. Theo. W. Peers reported a case of "Pois- sleep." oning by Cigarette Smoking." Moved and seconded that the paper be received. DISCUSSION. Dr. Schenck opened the discussion by remarking the action of smoking upon the heart, and that vastly greater evil results were brought about by the use of tobacco than any that had been mentioned. Dr. Porter described a case of violent convulsions in a young man similar to the one described by Dr. Peers. Dr. Tyree spoke of the swelling of the mouth and gums, so often occurring in cigarette smoking. Sizth District Medical Society. The Sixth District Medical Society met at Downs, October 9, 1890. Meeting was called to order by Dr. W. A. Leigh, of Stockton, President. Dr. Poole was appointed secretary, pro tem. Present-Drs. Leigh, of Stockton, Poole of Downs, Daly of Scottville, Swigart of Beloit, Lobdell of Beloit, Sawhill of Concordia, Dillon and Chilcott of Osborne City, Brierly of Glasco, Cullimore of Atchison, and Wall of Topeka. Moved by Dr. Daly, that all visitors wishing Dr. McVey thought the case of Dr. Peers to join do so by signing the constitution. was due probably to some severe mental Carried. Drs. Brierly, Lobdell, Chilcott, Swigart, Cul- For several months this pataient has had limore and Wall, were elected to membership. "trouble in passing his water," giving history Dr. Cullimore read a paper entitled "Zonu- of a close urethral stricture with prostatic enlar and Congenital Cataract." He gave the largement. definition of these forms, stating their cause, laying particular stress upon the advisability of early diagnosis. Spoke of the cause as twenty-four hours and while still straining in being rachitis, scrofulous, and especiallyconvulsive. Advised early operation; as early as 3-6 months. Dr. Daily—Had never seen a case of zonular cataract. Considered the operation very simple. Has no fears of suppuration from needling. Says he has no fear of pus. On Monday night October 8, 1890, after an unsuccessful attempt to void the urine for his attempts to relieve the urgent desire to do so, he suddenly felt a "giving away" sensation in the perineum accompanied by a tearing and distending pain and soon thereafter he noticed a swelling in front of the anus which rapidly extended to the scrotum and penis until all semblance to the male genital organs were destroyed. No urine escaped from the meatus. Dr. Cullimore closing, said, that the child should not be left after the operation. Treat the child half an hour before operation by The escape of this quantity of urine from antiseptic washes, Boric acid gr. xx, aquæ the distended bladder, into the tissue caused a camph. i, aquæ Dest. iii.. Wash out temporary relief of the urgent and uncontrolhoroughly. Should cover the eye with iodo-able desire to urinate, and as the case was beform and vaseline (gr. x-3i). After the oper- ing treated (?) by a Christian Scientist, his ation atropine to avoid iritis. Should be care- faith prior to this time during the preceding ful in its use as it quickly reddens the eye. twenty-four hours had almost vanquished, but Says there is no retinal chorroidal changes. now with renewed assurances from this miraDr. Daily read a paper "How to Practice cle (?) performer and a temporary relief caused Antiseptic Surgery in the Country." by the urethra giving away and a large peri The paper was freely discussed by Drs. neal and scrotal urinary infiltration, thus reBrierly, Sawhill and others. lieving the over distended bladder, he immeDr. Daily laid stress on cleanliness; said diately renewed his allegiance to "faith cure" iodoform prevents the formation of bacteria. and postponed sending for a physician for Would not use bichloride in surgery. Thinks another twelve hours or until the capacity of that medicines are detrimental to wounds Buck fascid was taxed to its utmost capacity when used in wounds; says if wound is kept by the escaping urine and his bladder became clean will not get pus. over distended again. Now for the first time he lost all faith in promises, "that all will be well if you only have faith and think so," and sent for a doctor. Dr. Burtt of Canton, was called, who called Dr. George of same town in consultation, both agreeing as to the advisability of an immediate operation. The patient refusing to submit to the more rational and radical operation of external urethotomy. The physicians after long and tedious effort with the patient anæsthetized, succeeded in introducing a small hard rubber catheter, and in relieving the distended bladder, the patient feeling much relieved as far as the desire to urinate was concerned. The scrotum and perineum remaining dis White male, age 50 years, of sober and tem- tended. perate habits. October 10-Late in the evening of the third day after the urethra had given away, I was a success." The old saying, that the "operatelegraphed for to see the case with Dr. Burtt. tion was a success, but the patient died" I I found the patient with a temperature of 102° was afraid could not be applied to this case. F, pulse 110 very feeble, with a countenance In recent cases, I mean by recent cases, imindicative of a loss of sleep, suffering and mediately after the rupture of the urethra the much prostration. The bladder was full and operation is considered by the most expert tender to pressure. The scrotum as large as operators, to be one requiring much time and a good sized cocanut, very dark, bordering on considerable anatomical and surgical knowla gangrenous condition. The perineum was edge and skill. Dr. Keys says: "When you greatly swollen, very tender to touch. Has go to do an external perineal urethotomy not passed urine for nearly twenty-four hours. without a guide, have your patient facing a Will not submit to an operation. After a window where you will have two hours of careful effort I succeeded in getting a very small instrument through the stricture and on its passing through the stricture, it immediately entered a cavity, meeting with no resistance for nearly two inches, it now refused to go farther. As soon as the stricture Dr. George administered the ether, Dr. was passed a bloody purulent fluid began Burtt assisting in the operation Patient passing through the catheter, having the placed in the perineal lithotomy position. characteristic odor of decomposed or ammoniacal urine. I knew I was in the cavity of the deep layer of the perineal (superficial) fascia at the site of the rupture in the urethra, and that the fluid escaping from the instrument was decomposed infiltrated urine. After patiently and carefully waiting for fifteen minutes I succeeded in striking the proximal end of the urethra, entering the bladder and drawing off its contents and washing out its cavity. The instrument was left in, that as much of the urine might escape by that channel as possible and thus avoid further infiltration, trusting that nature (the patient refusing to be operated on) would relieve the infiltrated urine by a fistulous opening in the perineum, or by a slough as is the usual termination in like cases where the art of surgery or death does not relieve them of their suffering. During the night he removed the catheter and the next morning Dr. Burtt found the bladder in a distended condition the same as the day before, but all efforts at introducing the catheter were unsuccessful, so I was wired to come prepared to perform the operation of external urethotomy without a guide. At time of operation patient's temperature was 102° F, pulse 110 and the general and local state of affairs were not such as to cause one to feel that the "operation would ever be good and continuous light." This remark he makes in speaking of operating to relieve a close stricture when the perineum is not distended and distorted almost beyond a semblance to the normal perineum. Thorough antiseptic precautions taken in getting parts ready for operation-Thiersch's solution hot for sponges and instruments. A groved staff was introduced as far as the stricture or as far as it could be passed, a median incision was made, the back of the knife being turned toward the rectum in which the finger of left hand was introduced to act as a guide to the knife on its hunt for the proximal end of the urethra. The first thrust of the knife gave vent to a profuse flow of the pent up infiltrated ammoniacal urine and pus, about eight ounces escaping. On introducing my right fore-finger into the wound I found a large abscess cavity as a result of the decomposed urine remaining in the tissues so long. Two inches of the urethra was found entire ly dead and sloughed off so that it came away during the irrigation of the abscess cavity. After some little difficulty the proximal end of the urethra was found and a soft Nelaton's catheter introduced and tied in. The bladder was relieved of its contents and thoroughly irrigated with hot Thiersche's solution, wound washed, an injection of hot whisky was given (per rectum,) patient placed in bed and warmth applied to prevent or ward of shock. The scrotum and penis were incised in a number of places to allow the urine to drain away that had been infiltrated. The patient soon rallied from the effects of the operation and anæsthetic. The next morning October 12, temperature 982 F, pulse 80. Rested well during the night. Takes some nourishment. Urine passed by catheter in perineum. Thinking it impossible for the urine to ever pass by the natural outlet by the urethra and meatus, from the fact that two inches of the canal was lost I thought all we could expect from the operation was to give immediate relief to the suffering, prevent sloughing of scrotum and perineum, prevent or check the poisonous effects of the absorption of septic matter and support the vital forces until nature would repair the damage done to the perineum and leave a fistulous tract for the urine to escape through. I have reported this case at length because: First, the extreme infrequency of like cases. Second, From the fact that two inches of the urethra sloughed. Third, that in a practice of ten years this is my second case. The first I did not report. Fourth, As a warning should this article fall into the hands of a layman and should he ever have an urgent desire to urinate and an inability to do so, to send for a physician and not a christian scientist for relief. "I find that the action of Ponca Compound is very favorable for inflammation of the cervix uteri and for irritation of the ovaries." E. BRINKERHOFF, M. D., BRISTOLVILLE, OHIO. October 18, one week from date of operation "I have used Tongaline extensively and the patient has been doing very nicely; tem- have been well satisfied with its results. You perature and pulse have remained about nor- are to be congratulated on the value of the mal. The prospect for a recovery with a fis- article which you offer to physicians." tulous opening in perineum and good control of bladder are good at this time. NEW YORK. R. A. VANCE, M. D., A NEW MEDICAL DICTIONARY. Square 8vo, Hf. Morccco, wtih Thumb $4.25 Plain Dark Leath., without thumb index. A Compact, concise Vocabulary, including all the Words and Phrases used in Medicine, with their proper Pronunciation and definitions. BASED ON RECENT MEDICAL LITERATURE, By GEORGE M. GOULD, A. B., M. D., Ophthalmic Surgeon to the Philadelphia Hospital, Clinical Chief It is not a mere compilation from other Dictionaries. The definitions have been made by the aid of the most recent standard text books in the various branches of Medicine. It includes, Several Thousand New Words not Contained in any Similar Work. It contains TABLES of the ABREVIATIONS used in Medicine, of 'he ARTERIES, of the BACILLI, giving the Name, Habitat, Characteristics, etc., of GANGLIA, LEUCOMAINES, MICROCOCCI, MUSCLES, 3 25 NERVES, PLEXUSES, PTOMAINES, with the Name, Formula, Physiological action, etc., and the COMPARISON OF THERMOMETERS, of all the most used WEIGHTS AND MEASURES of the world, of the MINERAL SPRINGS OF THE U. S., VITAL STATISTICS, etc. Much of the material thus classified is not obtainab'e by English readers in any other work. FROM PROF. J. M. DACOSTA. "I find it an excellent work, doing credit to the learning an' discrimination of the Author.' Completecirculars and sample pages upon application. P. BLAKISTON, SON & CO, Medical and Scientific Books, 1012 WALNUT STREET, PHILADELPHIA, PA. VOL. II. TOPEKA, KANSAS, DECEMBER, 1890. The Water Supply of Leavenworth. Read before the Eastern District Medical Society, Topeka, Kansas, October 14, 1890. BY CHAS. R. CARPENTER, M. D. No. XII. ed in a less aggravated form, and enteric disorders of a similar character have been common ever since with a diminishing frequency, to the present time, varying in intensity and character according to the season and the circumstances. It is a significant fact that it was just preIt has been a matter of common observa- vious to this date that the character of the tion among the physicians of this city that water supply of Leavenworth began to change. typhoid fever has been more prevalent of late In 1882 the ordinance was passed by the city years than ever before. In fact until about council authorizing the organization of the five years ago it was considered a rare disease, Leavenworth Water Company, but it was conand one physician, who is not now in siderably over a year before it was in actupractice says, that in an active practice al operation. This brought the date well of over twenty years he never saw a case down to 1884. case down to 1884. During 1883 and '84 the presof genuine typhoid fever, the period spoken ent system of sewers was constructed. Miles of extending up to 1883. Another gentleman of great ditches were dug through the streets says that the first case that ever occurred in and alleys, varying from three to sixteen or this city occurred in his practice in 1875. eighteen feet in depth. It was one of the common experiences of the workmen who dug these ditches and laid the sewer pipes, to find that neighboring vaults and cess pools. were being drained to a greater or less extent into the excavations and their work was not only impeded but rendered extremely offensive from this cause. It is a fact worthy of comment also that diphtheria, which is a disease incident to the same conditions that produce typhoid fever, was almost an unknown disease here until the last few years. It has never assumed an endemic form, but cases have been reported with sufficient frequency to enroll it in the list of our local diseases. The proposition is here submitted that at this time the purity of the well water in every well in the city, not more than two blocks outside the area covered by the sewers, was either destroyed or rendered questionable. The digging of these ditches over so extended an area, so disturbed the equilibrium of the In the records of Mount Muncie cemetery it is scarcely possible to find the name "sum mer complaint" until about five years ago. Of course this is partly accounted for by a change in the current nomenclature of disease, but there is little doubt that the pathological conditions aggregated under this name as it is stratum of moisture as to place vaults and now used have been more prevalent during the last five years than they were previous to that time. "Winter cholera" was never heard of in Leavenworth until about the year 1886, when it made its appearance in the form of a well marked endemic. The next year it was repeat cess pools in direct communication with all wells extending to the same depth or below them. Scattering cases of typhoid were reported as early as 1875 as has been said, but the increase in their number was so slight as to be readily accounted for by the accidental contamination |