II. The Commencement, Duration (chronic, intermittent or temporary), and Safest Treatment of Constitutional Syphilis. (4) On the Treatment of Inflammatory Diseases of the Skin. (5) The Special Indications for the Various Methods of employing Mercury in the Treatment of Syphilis. (6) To what Exciting Causes is the Outbreak of Tertiary Forms of Syphilis to referred? (7) On the Influence of Diatheses, of Nervous Causes, and of Parasites, in the Etiology of the Group of Diseases termed Eczema? (8) On the Nature of Exanthemata due to the Use of Drugs. (9) Lupus Erythematosus, Its Nature and Treatment. (The above programme has been a good deal and unfavorably criticised by resident dermatologists, as, for instance, in regard as to what gonorrhoea has to do with such a section, being covered by neither head. Then, again, there is, or would seem to be, an "intolerable quantity of sack" (syphilis) to the amount of bread. The questions, too, are so broad in their scope that it would take nearer fifty than five days to adequately cover the ground laid out. Still, hope for the best is always permissible, and doubtless some useful sparks will be smitten out by the collision of heads, decidedly not all wooden.) ABSTRACT OF EXTRA-GENITAL CHANCRES OBSERVED IN THE SERVICE OF THE CLINIC (PROF. FOURNIER'S) FOR CUTANEOUS AND SYPHILITIC DISEASES. By M. Veslin, "Externe du Service," 1888; M. Henri Foulard, 1890 (Annales de Derm. et Syph., April 25, 1890, pp. 317 to 325. M. Veslin states that in the same service, in 1886, forty-nine cases were reported by M. Nivet, then in charge; forty-five in 1887 by M. Morel-Lavallée; but that in 1888 he had but twenty-six of such cases to report; however, during that year the service was closed about six weeks, from August 1st to September 17th. M. Henri Foulard reports for the same service during the year 1889. Thirty-four cases, twenty-seven of whom were purely hospital cases, the remaining seven having been seen by Prof. Fournier in private consultations. (It must not be considered, as from the title it would seem, that all the cases presented themselves with the primary lesion in bloom, in a fair proportion only the induration was manifest and history of infection given.) Collation of the years 1889-'89 gives statistically Many had multiple chancres, but out of the whole number given above a total of thirty-two were cephalic chancres, occurring either on the cutaneous or mucous surfaces or cavities of the head and face. The whole of the briefly-detailed histories which accompany the figures are of great interest as pointing out the relative frequency of extragenital infection, and by inference the dangers to which carelessness. as well as vice expose the individual. (A chancre on a very unusual site has lately come under our notice; it was situated on the skin of the upper right eyelid.) BACTERIOLOGY. BY B. MEADE BOLTON, M. D., Director of the Department of Bacteriology, Hoagland Laboratory, Brooklyn. PROTECTIVE INOCULATIONS. (Continued from page 491.) These observations attracted very lively interest and called forth strong opposition, especially in France, but also won many advocates. A correct judgment was of course not possible until Pasteur could establish his claims by a large number of experiments. Before he was able to do this, however, Colin, Peter, Lutaud, and Percheron, in France, and Biggs, in America, all opposed Pasteur's inoculations for hydrophobia, partly on a priori grounds, partly on the very inadequacy of the statistics of Pasteur and his followers, and partly on account of the contradictory results obtained by other experimenters. Abreu, von Frisch, de Renzi, and Amoroso pronounced the use of Pasteur's inoculations in human beings unadvisable and even dangerous, as a result of their own experiments. The experiments of de Renzi and of Amoroso were shown to be open to criticism, but those of Abreu and of von Frisch seem to be trustworthy. On the other hand, Pasteur, in his letter to Duclaux upon hydrophobia, dated December 27, 1886, says in one place: "For every unprejudiced mind, the facility with which it is possible to render dogs refractory to hydrophobia, before or after the bite [of a mad dog], by the prophylactic method, described in my note to the Academy of Sciences, of the 26th of October, 1885, and the statistics which I presented to the Academy, March 1, 1886, and November 2d following, show, without any possible dispute, the efficacy of this method. The results in foreign laboratories for the prevention of hydrophobia are no less satisfactory. Insuccesses are very small in number. Many of the laboratories have not as yet had a single death. Dr. Budwid, in Warsaw, wrote me, under date of November 22d, that he had treated 84 cases up to that time, and that all are doing well. The Laboratoire Antirabique, of Prince Alexander of Oldenbourg, at St. Petersburg, had treated 118 cases up to the 8th of November. The treatment was unsuccessful only in one case, and that was an old man of seventy years with very severe bites on both hands; the period of incubation in this case was only twenty days, which necessarily placed difficulty in way of the success of the method. Under date of October 26th last, Dr. Petermann, of the Military Hospital at Moscow, informed me that of 112 cases which he had treated he had only 2 deaths, and in each of these cases the disease made its appearance before the end of the treatment." The insuccess of Gamaleïa, in Odessa, was regarded as a serious set-back; but Pasteur explains them from the fact of the severity of the wounds and the weakness of the material used to inoculate with. Gamaleïa had 7 deaths, with from thirty-five to ninety days' incubation, out of a total of 101 cases. Gamaleïa's subsequent results, with lessattenuated virus, gave much better results. He treated in all 325 cases. Vestia, in Naples, obtained good results. Ullmann, in Vienna, treated 96 cases without a single death. Parschensky, in Samara, Russia, had one death, after the second inoculation of the series, in 47 cases treated. In this case the patient died twenty-three days after being bitten. The statistics since the publication of the foregoing have been more and more favorable. The most trustworthy statistics are those published from Pasteur's laboratory. In the June number of the Annales de l'Institute Pasteur, for 1887, are given the results of the inoculations for the thirteen months from November 1, 1885, to December 31, 1886. Taking from these statistics only those cases where the persons were bitten in the face or head, there was a mortality of only 5.6 per cent. Out of the 214 cases treated, only 12 died. These results are very striking in view of the fact that without treatment the mortality is variously stated at 80 to 88 per cent. in 214 cases, 178 to 192 deaths. General statistics for persons bitten in various parts of the body show a mortality of 1.30 per cent. in 2,682 cases, 35 deaths. Without inoculations most trustworthy statistics give a mortality of from 12 to 16 or 20 per cent. for bites in various parts of the body. [CONTINUED.] THE BROOKLYN MEDICAL JOURNAL PUBLISHED MONTHLY BY THE MEDICAL SOCIETY OF THE COUNTY OF KINGS. EDITORIAL COMMITTEE: JOSEPH H. RAYMOND, M. D., ALEX. HUTCHINS, M. D., JOSEPH H. HUNT, M. D., GLENTWORTH R. BUTLER, M. D., FRED. D. BAILEY, M. D. VOL. IV. No. 9. BROOKLYN, N. Y., SEPTEMBER, 1890. Single copies 25 cents. $2 a year, in advance. ORIGINAL ARTICLES. TWO CASES OF OPERATION FOR REMOVAL OF PIECES OF CATHETER FROM THE BLADDER. BY J. S. WIGHT, M.D., Professor of Operative and Clinical Surgery at the Long Island College Hospital. Read before the Brooklyn Surgical Society, June 5, 1890. CASE I. Mr. S., a business man and farmer, about forty-one years of age, had some urinary difficulty, and called his family physician, who introduced a No. 8 soft catheter in order to draw his water and give him relief. When he came to remove the catheter, it broke and left some six inches of it in the urethra and bladder. The doctor, assisted by a surgeon, worked for about an hour on the evening of the same day to remove the piece of catheter, and did not succeed. Another attempt to remove it was made on the following afternoon : it failed. Three attempts were made with urethral instruments, and the result was that the piece of catheter was entirely in the bladder. This case was brought to my attention by Dr. Bartley. I advised him to have his friend come to the College Hospital, where I could make an examination, and determine what could be done. This was in the first week of September, 1887, about fifteen days after the accident. In brief, the examination disclosed the usual symptoms of stone in the bladder. The sound struck a hard substance like a calculus. The patient and his friends were anxious to have the offending body removed through the urethra, without a cutting operation. This I declined to do, for it was impracticable. I advised an operation the same as for stone in the bladder. Assisted by Drs. Bartley, Cochran and Rogers, I operated September 8, 1887. The perinæum was not very deep; the membranous and prostatic urethra was quite short; the bladder was low down, and was easily reached with the knife and fingers; and so there was nothing special about getting into the bladder, except that the tissues were soft and easily torn, and great care was required to keep from pushing the bladder away from its inferior attachments. The operation was that of left lateral lithotomy. With a narrow forceps I removed three pieces of catheter; they were nearly equal in length, and together measured about six inches. They were all completely encrusted with calcareous matter, from one-sixteenth to three-eighths of an inch in thickness, thus making them veritable calculi with large nuclei. This patient did well after the operation. Yet the progress of the case was rather slow. A small fistula kept open for several months; it finally closed. The following remarks are now proper: Two prolonged attempts to remove the piece of catheter by urethral instruments completely failed. The urethral and vesical irritation caused by these instruments was no doubt harmful to the patient. At the time of my operation it would have been impossible to remove the encrusted pieces of catheter through the urethra. And it is reasonably certain that they could not have been satisfactorily crushed, in order to wash them out of the bladder. Truly, we did the very best thing for our patient under the circumstances. CASE II. Mr. E., about forty-five years of age, in January, 1888, introduced a flexible catheter into his bladder to draw the water, and when he removed it there was a piece left. The catheter had broken, and the length of the piece was not accurately known. In June of the same year calcareous matter had concreted about the piece of catheter in his bladder, so that he was in the condition of a man having stone. He suffered very great pain. His emaciation was considerable. He was operated on by a surgeon of skill. The operation was litholapaxy, after the method of Dr. Bigelow. The crushing was thoroughly performed, and the bladder was well washed out. But, unfortunately, the patient did not have complete relief from pain and difficulty. In fact, it was not long when his condition was even worse than before the operation. He got along as well as he could till the following year, when he consulted Dr. A. W. Ford of this city. In June, 1889, Dr. Ford requested me to see his patient. The symptoms of stone were marked. The sound confirmed the diagnosis. The stone was large, or was |