been married for several years, without issue, the cause is supposed to be that of the woman, but this is not always the case, and not as much so as it was several years ago, as it is now stated by good authority that most men, especially young men, have had gonorrhea, and in many instances when a man has swelled testicles from gonorrhea he never becomes the father of a child. ' There is another disease spermatorrhea, which was not a common disease several years ago, but now is a very ordinary complaint, and often it greatly diminishes the size of the testicles and weakens not only the sexual strength, but the patient's mental and physical strength also. When spermatorrhea takes place too often, or when the testicles have been greatly diminished by it, the semen will often be lacking in spermatozoa. When a physician is consulted in regard to a childless couple they should, in all cases, examine the man as closely as the woman, and by so doing they will occasionally find the man at fault. And when this is the case it should, in all instances, be made known to the woman, and not, as is usually the case, kept a secret from her and make her believe she is at fault. I have observed, by personal attention, that there are but a very few women who will live single very many years after they reach the age of puberty if they have a reasonable chance to get married; while men, for various reasons, put the matter off for several years. I have also noticed that women have a greater desire for children than men, and, in most instances, they more often have a choice of the sex which they desire their children to be. When a man or woman reaches mature adult age, and marries a suitable companion, they do not do what they should; they, in many ways, miss many of the joys of the world. The men become boorish, and more often criminals; while the women will become melancholy, and more often insane. Physicians, in many instances, could give young men and women advice on marriage, and on selection of a suitable companion, which would be very profitable to them, for marriage will be a complete failure if the couple are not suitable to each other; and when the marriage is not congenial, it is justice that they should have a divorce. No man and woman should be compelled to live together when their natures are not compatible. I will here state that on rare occasions a couple will get married and at the time of the marriage will be well suited to each other, while after living together for several years they will drift apart in various ways and are not any longer suitable for each other, and in such instances they should separate and get a divorce, while yet young and childless. On the other hand, a couple may get married who are not well suited to each other, and after living together for several years, they will become suitable to each other. [Written for the MEDICAL BRIEF.] A Lost Catheter Regained. BY E. S. BREESE, M. D., Dayton, Ohio. I desire to report a case of unusual interest which came under my care some time ago. P. C., age sixty-nine, had been leading a catheter life two years. Condition otherwise fair, except debility of advancing years and occasional alcoholic debauches. No One afternoon he presented himself and stated that while attempting to catheterize himself he let the catheter pass into the bladder. A No. 10 silver prostatic catheter was passed, and turned gently from side to side. The resiliency of the lost instrument could be easily felt. anesthetic was given, as the patient was partially under the influence of liquor. A lithotrite of medium size was passed without difficulty, and after three times opening and closing the instrument the foreign body was caught, two inches from the end, bent upon itself and withdrawn. It was a linen catheter No. 10. Quinine, ten grains, and tincture of belladonna, ten drops, were administered, the patient put to bed, and external heat applied. A slight chill followed the same evening. After three days, the case was dismissed and allowed to resume his accustomed mode of living. The mild sequelæ were probably due to urethral tolerance. 628 North Main Street. [Written for the MEDICAL BRIEF.] The Modern Treatment of Pulmonary Tuberculosis. BY CARL SANDZEN, A. M., M. D., Kansas City, Mo. Medical statistics show that at least oneeighth of all deaths in civilized countries, where records are kept, are caused by tuberculosis of the lungs. The history of medicine, as far back as it gives the least reliable information, indicates the same status rerum since centuries back. Pulmonary affections have always been considered grave, and medical science has fought this dreaded disease with all available weapons, but until the last one or two decades these have been very poor and inefficient. The enemy had held the field of death as a victor more merciless than any. Time and again there has come a scientist who claimed to have discovered a powerful weapon against the foe, but we know how sad their defeat has been, when brought eye to eye with the destructor. Modern bacteriology found the cause of tuberculosis, the tubercle bacillus. New hope arose, and when Koch came with his lymph many, even the doubters, dared hope for, if not a specific cure, at least something near it. Suffering humanity labored under the impression that the most terrible of all diseases could be cured and controlled What new hopes and still greater despair! Since that time others have followed his steps, taking up his ideas, but we can hardly say that one of these has been entirely successful. Nevertheless, there is no cause for complete despair. Although we have found no specific cure against tuberculosis, we have at least gained knowledge by hundreds of years of defeat. We have learned to win by losing battles. We said that bacteriology had discovered the cause of tuberculosis, viz.: a specific organism, a bacillus, but the real nature of the bacillary action has not been understood until lately. Bacilli act through their secretions, the so-called toxines. The germs can either be very virulent, that is, creating great masses of substances of a certain chemical formula, or less virulent. It is, therefore, readily understood that not only the multitude of bacilli, but their virulence, is the cause of the severity of the attacks of the above mentioned disease, and all other diseases of bacterial origin. The necessity of finding a germicide which would kill the germs without injuring the animal system was strongly impressed upon the scientist of yesterday, and many still adhere to this theory, but the latest, the scientist of to-day, is struggling for the solution of the problem of the neutralization or annihilation of the toxines secreted by the germs. It would take us beyond the limits of this treatise to review or criticize those theories. There is, as yet, none worth mentioning in preference to the others. We know of no germicide powerful enough to kill germs without injuring the animal system. Many scientists have given us different hypotheses about the way Nature tries to dispose of the toxines, a special branch of vis medicatrix naturæ. We will mention the two most likely, viz.: Metschnikoff's phagocyte theory, and the so-called chemical neutralization theory. We have found that the animal system has a safeguard against the germs, and many other enemies in the ever-watchful and ever-ready-for-battle leucocytes. These little warriors fight their fierce battle against the invading enemies-the bacilli. Time does not allow us to speak of the phagocyte theory in extenso, however interesting it may be. Also the phagocytes, or bacilli-destroying or bacillieating leucocytes are our best defenders. We have found that a strong, healthy constitution can, so to say, send a greater army against the intruders, the bacilli, and is, therefore, more able to destroy the germs and their toxines. This is, in short, the first mentioned hypothesis. The other says: We know that the juices or secretions of the healthy body, and especially the pure blood, possess bactericidal properties. A strong constitution is also here considered the main factor in the fight against bacilli. The final consequences of above reasoning is also to demonstrate that the strong, healthy body annihilates both the germs and their toxic products better than the weak. The axiom follows: Strengthen the body, in that way enabling it to withstand the attacks of the ever-present disease-producing bacilli. For building up of the body, sunshine and fresh air and proper nutrition are required. Without these necessities of life, health is impossible. Science has shown that bacterial life can not exist, or is at least less vigorous in sunshine, light and exposure to oxygen. These discoveries have led to the understanding of the great importance of the inhalation of pure air by people affected with tuberculosis, and also to its importance in other diseases of the respiratory organs, which, as a rule, are combined with pulmonary tuberculosis. After these necessary preliminary excursions on the field of bacteriology and hygiene, let us draw our conclusions as how to best treat tuberculosis of the lungs, and guard humanity against such a dreadful enemy. Fresh air, sunshine, proper food and medicinal aid against complications are all that is required. Let us now analyze, and see how to use above mentioned necessities. The general advice to a consumptive, or a person with "weak lungs," is: go to a better climate. It is true that this advice is good, but fresh air and sunshine can be had almost anywhere. There is a mistake concerning the necessity of proper climate for pulmonary tuberculosis. The dry, hot climate is the best, but is more necessary for sufferers from bronchial affections than real pulmonary tuberculosis. This must always be remembered. For an ordinary case of aforesaid lung disease, good fresh air is obtainable everywhere, except in some very damp locations. The truth of this statement has impressed itself upon many eminent physicians, who instead of, as before, sending their patients away, advise them to stay at home, but instruct them how to get enough fresh air and sunshine. This constitutes what we now call the outdoor treatment of pulmonary tuberculosis. It can be safely carried out in many ways. Some erect a tent on a porch or in the back yard, and sleep there, well covered and well dressed, after undressing in the house, in the evening, and dressing in the morning. The same result is certainly gained from sleeping in the house, with all the bed room windows open, only with sufficient protection against storm, snow, etc. Good ventilation can be arranged in many ways. The patient should stay outdoors as much as possible during the day, and should stay in the sunshine, not trying to protect any part of the body, except the eyes, from the beneficent rays of the sun. I do not need to explain in detail how this should be carried out. Any inventive mind will find some ways and means. A limited amount of exercise should be taken. I mean by limited that consideration should be taken to the strength of the patient. Overexertion is altogether forbidden. No person with fever should be allowed to be up and around. The bed is the only place for the fevering consumptive, but even in his bed he should have the advantage of fresh air and sunshine. Mild hardening of the skin, through cool, not too cold, washings of the whole body every morning in a warm room is desirable. There is very little danger of "catching cold," if properly handled. The food should be sufficient and good, but plain. One should never overburden the stomach with great quantities. It is better to take many small meals than a few heavy ones. Good rich milk, if necessary, sterilized, and fresh eggs, are the best food for a consumptive, and they should be taken in as large quantities as considered advisable to evade distress. If the milk goes against the patient, or causes any kind of dyspepsia, it is good to add a small amount (teaspoon to a tablespoonful) of good brandy or whisky to each glassful of milk. The eggs can be taken raw or soft boiled or scrambled, etc. Nobody should. believe that eggs have such an enormous value that only a few can be taken without overfeeding. It is too old a mistake to be even mentioned. One-half dozen to one dozen a day is not too much. No special food need to be forbidden, except in positively diagnosed diseases of the digestive organs. The day should begin and finish with some food, preferably milk, or milk and raw eggs. Remember that increase in weight is a very favorable sign. The medical aid that can be given a patient is either symtomatic, or tending to work hand in hand with the feeding. We have no remedy which has any proved beneficial influence upon the disease itself. The symptomatic treatment is, for example, expectorants in bronchitis, opium in excessive cough, bitter tonics in lacking appetite, hypnotics in sleeplessness, etc. Every physician knows that part of the treatment. The other part, or the socalled artificial feeding, is an important part in our days. We have so many of these preparations that it is very hard to know what is good or not. I, for my part, have preferred the old time-honored cod-liver oil, given in some more pleasant way, as for example, the very palatable preparation put on the market by Waterbury Co. (Waterbury's cod liver oil compound). It contains a considerable percentage of fat, and the admixture of creosote and guaiacol make it a good expectorant. Many preparations might be very good, but every physician has, more or less, some favored preparation which has won his confidence by giving good results. In the foregoing lines I have tried to shortly explain the "why" and "how" of the modern treatment of the most dreadful disease with which we have to deal in our everyday practice. I hope that some, if even the slightest, benefits will be derived from this expose. If so, it is not written in vain. 320 Rialto Building. [Written for the MEDICAL BRIEF.] Treatment of Pneumonia. BY L. C. WASHBURN, M. D., I think I have written for your valuable work before, but as the season for pneumonia is here, too much can not be done for the cure of this most fatal malady. It comes on suddenly and is too well known to need description. It is characterized by high temperature, and fever, the pulse in adults about one hundred and twenty per minute, and respirations from twenty to thirty-five per minute in single pneu monia. I have treated double pneumonia, where the pulse was one hundred and eighty-five per minute, and the respirations eighty per minute, day and night for five days, the usual time to look for the crisis, and followed by complete recovery. I never saw a recovery where one could not cough, as the cough is Nature's effort to remove the sputa, and give the lung exercise, that the blood may circulate freely into all parts, to overcome obstruction and supply needed nourishment. I encourage the cough. I do not often find more than one physic required, and I prefer the improved comp. cathartic pills, seven or eight at a dose, which will cleanse the alimentary canal freely, while a small dose stirs up the poisons in the system without sufficient relief, and I give this early in the attack. The medicine I rely upon most is lobelia. I give a saturated tincture of the seed, with brandy, once in three hours, just enough to slightly nauseate, and if the case is obstinate, or the lung about to become filled up and hepatized, I give lobelia with stimulants and aromatics, to produce free vomiting. The action and reaction of vomiting, while the system is relaxed, dislodges the sputa and obstruction. I give the emetic every day and sometimes twice a day, if the case is dangerous. I have abandoned blisters and rely upon stimulating liniments. Hot baths are of great importance. Quinine and hydrastis are good tonics. The lobelia is a great anodyne, as well as curative. The temperature and fever are Nature's efforts to cure, and the harder and faster the pulse the faster the system is eliminating. Sedatives and opiates are in all cases injurious. I have practiced medicine in Indiana, Missouri, Illinois and Florida over fifty years, and I do not think I had a mortality of two per cent, and I treated all cases called upon from three weeks old up to ninety-five years of age. Please find enclosed one dollar for 1905. I find the MEDICAL BRIEF one of the best journals for ready reference for the busy practitioner. Success to the Editor and BRIEF. I have been in the harness for thirty-one years.-D. M. MCKNIGHT, M. D., Okra, Indian Territory. [Written for the MEDICAL BRIEF.] An Interesting Obstetrical Case. BY J. W. BRYANT, M. D., Shamrock, Mo. On the night of October 27th, last, I was called to attend a case of confinement, or rather, to look after the third stage of labor delivery of the placenta. I reached the bedside at midnight, the child having been born at 6:40 in the evening. The patient was a large, rugged country woman, aged forty years, in her fourteenth confinement. She had never before been attended by a physician. Her cases had always before been "grannied." The old grandmother who had been with her in twelve cases was now present-a woman seventy-seven years of age. The woman in confinement is what is called a "bleeder." Her tendency to bleed had been further promoted by the "granny" breaking the cord. The bedding was simply saturated from the hemorrhage. There had been no after-pains. I made examination and found "hour-glass" contraction. There was great pallor of the face; no apparent pulse, either of the radial, temporal or carotid artery. Hav. ing just gotten up from a five-weeks' attack of typhoid-malaria, I was too weak to undertake the forcible extraction of the placenta, and was afraid that if I administered chloroform, the woman would die under my hands. I had the family send for another physician-the nearest, ten miles away. I administered onefourth grain morphia (guarded with one one-hundred-and-twentieth grain atropia) hypodermically. Then immediately commenced the hypodermic administration of one-fortieth grain strychnia sulph. every hour. At three A. M. the other physician arrived. He immediately began the forcible extraction of the placenta without the use of an anesthetic. After much difficulty the placenta was brought away in pieces. I remained with the patient until seven A. M., having kept up the strychnia treatment, lengthening its administration from two to four hours. Nourishment in the form of raw egg, milk and whisky was given from time to time. When I left the patient at seven o'clock A. M. there was no improvement in her condition, except that the hemorrhage had ceased. I expected she would die, and notified her husband. I returned at 11:30 A. M., having been away four and one-half hours. There was no perceptible improvement. I visited another patient and returned at three P. M. A feeble pulse was perceptible, but not countable. I had with me on this trip a household syringe, and ordered a vaginal douching of hot water, and a flushing of the colon with a quart of saline solution. In the meantime, I had administered my dose of strychnia with each visit. It was 8:30 P. M. when I made my third visit that day, and found that her pulse was distinct at one hundred and twenty per minute; temperature 99 3-5° F. Early on the morning of the 29th of October (third morning), temperature and pulse were the same. I ordered a vaginal douche, and another quart of the saline solution to be given per rectum. At eleven o'clock A. M., I got a hurry-up call to go and see my obstetrical patient. I reached her at noon, and found that from nine to ten that morning, she had had hard labor pains and had expelled two fragments of the placenta that had failed to be removed early the morning before. For this reason I call them labor pains, rather than after-pains. Pulse was still one hundred and twenty, temperature 100° F. Two drops of Norwood's tincture were ordered given every four hours, and an occasional dose of migranda powder was given. Condition, in some respects, as regards temperature, had improved. No after-pains; no abdominal pains. Clots had ceased to pass after first day, and a slight colorless lochial discharge was present. I failed to see the patient on November 2d (seventh day), but early next morning was called on account of a fever having risen that night. I reached the patient at about seven A. M., and found her with a temperature of 104° F. Upon questioning, I learned that all treatment had been discontinued since my last visit, and that the husband had brought beer home for his wife. I again put her on Norwood's tincture and migranda powder, and ordered the hot douche (antisepticised with hydrg. chlo, cor.) twice a day. On November 4th (ninth day) the |