DYSMENORRHEA.-The Am. Med. Digest gives seats, a call was made for those who did not pay the following as useful in dysmenorrhoea : Boiling water, Ol. menth. pip., 3j. Oj. gtt, v. their debts, and one solitary individual arose and explained that he was an editor, and could not pay because all the rest of the congregation were owing him their subscription to his paper." MIGRAINE.-The Am. Prac, and News says that Cannabis Indica is highly useful in the treatment of migraine, not only as a palliative, but as a curative agent. One-third of a grain of the alcoholic extract in pill form should be given every night, or night and morning, which may be increased to one half or two-thirds, and should be continued for several weeks. MASTITIS. In the Columbia Hospital for Women (Obs. Gazette), a liniment composed of half an ounce of camphor, dissolved in three ounces of Shake well and bathe the affected parts freely turpentine, has been found most effective in checkwith a soft sponge. ing the secretion of milk in mastitis; it alleviates HÆMORRHAGE.—Dr. Huchard (Therap. Monat.) pain, lessens induration, and is more effective in reducing inflammation than any other remedy that has been tried. recommends the following prescription to arrest hæmorrhage: EUREKA. Dr. W. H. Oliphant read a paper on Minor Surgical Cases, at the late meeting of the Canadian Institute of Homœopathy, says the Med. Counselor, "In which were included four cases of cancer cured by internal medication, coupled with external application of thuja." ANESTHETIC.-Sir Spencer Wells (Br. Med. Jour.) prefers the bichloride of methylene to any other drug, for anæsthetic purposes, as it is safer and equally good as an anesthetic. WATER IN THE STOMACHS OF Drowned PERSONS. -It has been proved by the experiments of Obo S. To be carefully applied at night, and removed in the morning by means of wadding satur-lovsky, that water found in the stomachs of persons found drowned, does not prove absolutely that death took place by drowning, as water may enter the stomach after death. DR. BELL, of Glasgow, considers the uterus, in the large majority of cases, the source of the mischief in a great many of the affections to which the tubes and ovaries are liable, and, therefore, averts these evils by suitable treatment of the uterus. Iodized fennel gives the best results, being aseptic and antiseptic in the highest degree. Carbolic acid exercises a powerful anodyne effect on the endometrium, and has powerful alterative properties. In long-standing endometritis, the granular condition of the mucous membrane should first be removed by the curette. It is said, Med. Reg., that "Chloride of lime spread on the soil near plants will protect them from insects or vermin. Dusting over the leaves of plants with a solution of the chloride will keep all insect plagues at a distance." Dr. Walker, of Dundas, sailed for England on the 25th ult. He intends to spend the winter in studying and practising under Lawson Tait. He will on his return open a sanitarium in Toronto, similar to the one he has lately conducted in Hamilton. Dr. J. W. F. Ross, of this city, lately left for Europe, where he intends taking a special course in gynaecology, preparatory to making that depart ment of medicine a specialty on his return. PROFESSOR to medical student" How would you treat post-partum hæmorrhage?" Student "I would tie the post-partum artery." That student is now carrying the hod.-Med. Reg. It is said that 15 grains of antipyrin, taken in the morning and repeated in an hour if necessary, will often quite relieve the distress of hay fever. WANTED, a copy of Bright's Medical Cases, for which a good price will be paid. Address, Editor LANCET. BARTHOLOW regards the bromide of lithium as almost a specific in muscular rheumatism. Books and Lamphlets. THERAPEUTICS: ITS PRINCIPLES AND PRACTICE, by H. E. Wood, M.D., LL. D., Professor of Materia Medica and Therapeutics, and Clinical Professor of Diseases of the Nervous System in the University of Pensylvania. The Seventh Edition, rearranged and enlarged. Philadelphia: J. B. Lippincott Company. Price $6.00. It is with great pleasure we refer to a new edition of this very excellent treatise on therapeutics. In this, medicines are grouped in accordance with their known therapeutic actions, and such action thoroughly and scientifically explained. If we speak of one portion of this work in preference to another, we would particularly commend the chapters on depresso-motors, and also the one on Cardiants. We can truthfully say these chapters in themselves mark an era of great advancement in therapeutics. To read this work carefully is to obtain a clear and scientific basis upon which all medical treatment must rest. This work cannot but meet with commendation wherever it is received, nor can any practitioner be without it who desires to be abreast of the times. MANUAL OF CHEMISTRY:-A Guide to Lectures and Laboratory Work for Beginners in Chemistry. A text-book specially adapted for Students of Pharmacy and Medicine. By W. Simon, Ph.D., M.D., Professor of Chemistry and Analytical Chemistry in the Maryland College of Pharmacy, Baltimore, Md. Second edition, enlarged and illustrated. Philadelphia: Lea Brothers & Co. This is a commendable treatise on chemistry, in which the author has treated the subject in a most concise and practical manner. The characters and methods of obtaining the precipitate tests are especially well treated, and the chapter on Examination of the Urine is especially good. We can recommend this treatise very highly. : EXCESSIVE VENERY, MASTURBATION AND CONTINENCE. By Joseph W. Howe, M.D., late Professor of Clinical Surgery in Bellevue Hospital Medical College, etc. New York E. B. Treat. This little work deals with the etiology, pathology and treatment of the diseases resulting from veneral excesses, and is useful in that it treats in a clear and practical manner that field of practice which is so often avoided by the respectable practioner, and as often scandalously utilized for the benefit of the quack. The work is a very creditable one. THE opening lecture at Trinity Medical College will be delivered on Monday 1st inst., by Rev. Dr. Johnston, of Jamaica. Toronto University Medical College opens the same day, Dr. Richardson occupying the rostrum; while the Women's Medical College will be opened on Tuesday the 2nd, Dr. Powell giving the opening address. Births, Marriages and Deaths. At Millbank, Sept. 11th, Dr. R. Whitman, of Shakespeare, to Kate, only daughter of Mr. Jacob Kullman. decomposition and irritation that indefinable THE CANADA LANCET. something that is said to underlie the inflamma A MONTHLY JOURNAL OF MEDICAL AND SURGICAL SCIENCE, CRITICISM AND NEWS. VOL. XXI.] TORONTO, NOV., 1888. Original Communications. CYSTITIS.* tory process. The causes of retention may be summed up as follows:-Congenital or acquired narrowing of the meatus, and tumors of that aperture such as frequently are found in the female; stricture, prostatic disease, especially if accompanied by [No. 3. hypertrophy; a calculus lodged at the neck; and atony and paralysis of the bladder, a not uncom mon trouble of old people, and a complication of various forms of spinal lesion. In a subacute form, cystitis often occurs at the climax or towards the close of an attack of gonorrhoea; and, indeed, in the female, the almost constant existence of urethritis and its inclination to invade the bladder, are set down as some of the diagnostic features of specific, as distinguished from simple vaginitis. Inflammatory diseases of any of the neighboring but this pertains more especially to its peritoneal organs may, by extension, invade the bladder; BY W. BRITTON, M.D., TORONTO. Idiopathic acute cystitis is rarely observed, excepting as a complication of some pre-existing malady. It is said to originate de novo, occasionally, in scrofulous and rickety girls in whom there is manifest a predisposition to vaginitis and other varieties of mucous inflammation. It is found as a complication of pyæmia, typhus fever, and in certain cases of the exanthemata. The gouty and rheumatic diatheses are said to be predisposing causes; although, if cystitis be in progress and a fit of gout supervene, the consequent diminution of uric acid excretion is thought to allay temporarily the bladder symptoms. Primary acute cystitis, with the few exceptions mentioned, is probably always a traumatic disease, although the injury is often inflicted in a secondary manner. Of the direct injuries may be mentioned, calculus, lithotomy and lithotrity, the unskilful use of the sound, external blows (especially when the bladder is much distended), the prolonged pressure of the fœtal head and some of the mechanical aids to delivery; the irritating effects of ill-advised or too free use of such articles as the balsams, turpentine and cantharides may be included in the category. All the indirect causes of traumatic cystitis may he narrowed, in their modus operandi, to the two elements of over-distention and retention of urine covering. tunic, occasionally the peritoneum, and if it ever Usually the disease invades primarily the mucous attacks the muscular coat, it has its starting point in one of the other two-commonly the innermost ; and, indeed, this order of origin is not difficult to account for when the structure and functions of the bladder are taken into consideration. An eminent pathologist says that two-thirds of the diseases to which human kind are subject have their starting point in mucous membrane, so sen sitive are its delicate' cells to irritation; and in this particular instance we have to deal with an instrument of expulsion of, a fluid ever varying in organ which is at once a receptacle for, and an character and quantity according to the protean conditions of the system and its surrounding influences. It is protected from undue irritation in part by that normal vital principle that exists in healthy tissue, and in part by the constant secretion of a protective mucous coating, normal in quantity and character; it should not be distended beyond what its muscular fibres can bear without -apparently one and the same thing, but widely weariness; and, when expulsion occurs, exit should diverse in the transition from cause to effect. Over-distention means unnaturally violent efforts to expel and consequent hyperæmia, while prolonged retention is the forerunner of urinary * Read before the Toronto Medical Society, Oct. 16, 1888. be so unobstructed as to necessitate only such a subdued contraction as is necessary for dilation of the outer portions of the urethra; unless it be shown that the longitudinal fibres assist also in opening the sphincter. Any wide divergence from health in the condition of the urine, especially if from retention; an abnormal quality or quantity of mucus, or want of harmony between the sets of muscles concerned in urination may, separately or conjointly, bring about a state of irritation which, sooner or later, is followed by hyperæmia; and Rindfleisch says that disordered and hypersecretion are the concomitants of hyperæmia, and that this hyperæmia is a proximate cause of the mal-secretion; also the more or less remote cause of other disturbances, viz., tumefaction, hæmorrhage, pigmentation, hypertrophy, etc., which, taken together, constitute the anatomico-pathological picture of catarrh of mucous membranes. sur It may be asked, why should undue contraction of the muscular wall of the bladder induce congestion of the lining? The returning venules, as they pass through the muscular coat, are rounded by a much thinner coat of connective tissue than the arterioles, and are, therefore, in more immediate contact with the muscular fibres; in consequence of this anatomical arrangement, inordinate contraction compresses the veins more than the arteries; hence the passive hyperæmia of the mucous coat, induced by such violent efforts as the bladder perforce must make to overcome all sorts of obstructions to the urinary flow. The same result naturally follows those spasmodic contractions that are excited by the presence of calculus and tumors. As in other mucous membranes the acute attack may be catarrhal or croupous in character; this latter, the form usually excited by cantharides and other irritants introduced into the system; and may end in resolution, ulceration, suppuration or gangrene, or may degenerate into the chronic form. After the inflammatory process is once set up, not simply the superficial layers of cells, but all the elements of the mucous membrane appear to be involved; and, indeed, one pathologist maintains that the trouble lies not in the mucous tissue alone, but in the underlying layer of connective tissue, so universal is the invasion. At any rate every cell is changed, if not in form, at least in character and ability to withstand undue irritation; therefore, even after the urine is restored to a healthy condition, the mucous secretion normal, and all symptoms have disappeared; for a considerable period of time, there must still remain a locus minoris resistentia and danger on slight provocation, of re-excitement of the disease; this interval lasting until a new generation of cells is formed throughout. Hence, also in part, the tendency towards chronicity. On examination, the mucous membrane is found discolored and softened seldom universally, but usually in patches, which occur most frequently in the vicinity of the neck. Here and there may be erosions; or, if the disease has run very high or lasted long, there may be ragged ulcers laying bare the muscular fibres, or even gangrenous spots; although these last seldom are seen, excepting in the aged and debilitated, or as the result of severe traumatic causes. The spots of discoloration and erosions are mostly to be found on the rugæ, and may be covered with ropy mucus, sanious offensive fluid, or may be invaded in part by croupous membrane-this often is coated with phosphates. Rindfleisch says, that this croupous membrane, although it has the gross appearance of being fibrous in structure, really consists of corpuscles which have assumed a change of outline; the protoplasm having arranged itself in an irregularly radiating form by the corrugation of the cell, so that an agglomeration of the cells gives to the neoplasm the appearance of being made up of fibres. Occasionally it happens that the ulcers spoken of extend and cause perforation, which fortunately does not in every instance prove fatal, as the surrounding zone of inflammatory action may bring about adhesions to neighboring viscera. The disease in the acute form is usually ushered in by malaise and chills, with frequent desire to urinate, followed by high temperature and the general symptoms of fever. The pain at first is not severe unless the peritoneum is involved, but considerable uneasiness is complained of in the hypogastrium and the perineum, perhaps in the glans penis and shooting down the thigh. If the anterior wall is the part chiefly involved, which is rarely the case, tenderness on pressure is felt a good deal in the hypogastric region; but, as the inflammatory process is ordinarily confined to, or greatest, near the neck, the perineal and perrectal tenderness are usually found to be the greatest. In these last cases the vesical irritability is more marked. The chief symptoms complained of are irritability, straining and scalding in the urethra as the urine flows in small quantities, and in case the bas-fond is much involved, there may be some tenesmus, which, in one case, I saw extreme. The pain and uneasiness are alleviated after urination and commence again as soon as urine accumulates, the interval of rest being shortened according to violence of the attack, and the closeness of the inflammatory process to the neck of the bladder. Should resolution set in, these symptoms gradually subside and nothing is left but a condition of occasional irritability, which, as already stated, ends when there has been time for the formation of a new set of mucous elements. But should the inflammation continue, ordinarily, in two or three days, the urine is changed much in character; it is ammoniacal, and contains large quantities of mucus, also pus corpuscles and occasionally blood globules. Ammonio-magnesian phosphate is found plentifully and is recognized by the microscope; carbonate of ammonia and amorphous phosphate are present, as also occasionally sulphuretted hydrogen in small quantities. The sediment forms quickly with the pus in an opaque yellowish layer on top, and the clear supernatant fluid having often a yellowish tinge. Later on, if the disease pursues a severe course, the urine assumes a darker color, caused by the disintegration of the blood corpuscles by the carbonate of ammonia, and has a highly ammoniacal and fetid odor. How the urea becomes converted into carbonate of ammonia does not appear to be decided. There exist two or three theories in the matter. Dr. Rees thinks that secretion being abnormal, on account of diseased and hyperæmic mucous membrane, this degenerated mucus acts as a ferment. Others suppose that some hitherto undiscovered ferment enters from the blood, while it is imagined by the majority of observers that bacteria play an important part in the process I heard of an incident that occurred before much deference was paid to the pranks of these little bodies, that bears somewhat on this matter. In the good old days, when the rite of initiation, with all its mysteries, was a sine qua non in a certain medical school, one of the impressive ceremonies in the chamber of horrors was the passing of the catheter, ostensibly to investigate the physical competency of the aspiring but timorous candidate. This delicate operation was, I suppose, relegated to the most experienced of the inquisitors, and I believe the instrument used was the gum elastic; therefore it is likely that no undue violence was used towards the victim. The inference was that he had been continent, at least there was no stricture, and the catheter entered the bladder easily; but a magnificent sample of cystitis was the result. Of course it is barely within the limits of the possible that some member of that august tribunal may have had an attack of gonorrhoea, and hence the consequence. But at any rate, Niemeyer records cases where the introduction of a dirty catheter has resulted in inflammation. The presence of pus or blood is easily recognized by the microscope and by the tests for albumen. Coulson says that it is almost impossible to distinguish the corpuscles of mucus from those of pus; that it is probable that epithelial cells become transformed into pus corpuscles, and that the latter are spherical, granular on the surface, and have divided nuclei. Occasionally shreds of false membrane are voided with the urine, and cases are recorded where obstinate retention, caused by large sheets of detached membrane, has rendered cutting operations necessary. Should the case progress unfavorably, the condition of active sensibility to pain passes eventually into a quasi typhoid state, manifested by hebetude, subsultus, obstinate vomiting and purging, and ends fatally by way of coma. There may be contraction of the bladder; but, as a rule, towards the end, if unrelieved by the catheter, sensibility being lessened, the bladder is allowed to dilate to enormous proportions. In the majority of these cases the disease has affected the ureters and pelves of the kidneys; and, as a consequence, the secreting structure of the kidney itself; so that the tubules are often dilated, the cellular elements atrophied, cysts may be present and the capsule adherent. As a rule an uncomplicated case of cystitis is easy of diagnosis, but it is comparatively easy to overlook some of the diseases that bear a causative relation to it. The limits of this paper will not allow a full discussion of the distinguishing features of these different maladies; but a mere enumeration and brief reference to the salient points of contrast will suffice. Diseases of the urinary tract, all the way from a diseased meatus up to nephritis, may be accompanied by pain; and, with few exceptions, more or less of this takes the form of irritability of the |