phosphate crystals when cystitis is alkaline, bacteria, etc., are easily found with the microscope. We should always stain for the tubercle bacillus when examining a case of chronic cystitis.

Bacteriological cultures should be made in all doubtful or stubborn cases, and the urine should be procured by aspiration above the pubic bone to avoid contamination of the urethra. This is an easy operation and devoid of danger.

In regard to the cystoscopic examination, we should use Pawlick's or Kelly's method, or any of the modifications, as Koch's, to examine the female bladder, except in cases where we wish to balloon or distend the bladder walls, in which case we should prefer a Nitze or Casper irrigating and catheterizing cystoscope.

Preston, of this country, has of late invented or modified a cystoscope in which he uses air to dilate the bladder instead of water, but this could also be done with the Nitze or Casper as well. There have been many objections raised to the use of air in this work, and Fenwick strongly condemns the method.

A

In acute cystitis, cystoscopic examination is contra-indicated. few points for differential diagnosis between tubercular and gonorrheal cystitis are the following:

In all doubtful cases catheterization of the ureters should be done to eliminate kidney disease, as the finding of bacteria and pus in the urine will not alone diagnosticate cystitis. As regards the treatment, we should always be guided by the cause and stage of the disease.

In cystitis due to bacterial infection the first indication is rest in bed, light diet, opiates, preferably in form of extract of opium and belladonna in suppositories as often as needed; citrate or acetate of potass. to render urine less acid and prevent irritation. As soon as the subacute stage is reached, give the patient a tablet of urotropin, which is an ammonia formaldehyde salt, three or four times a day. This liberates formaldehyde gas in the urine, and is our best germicide. Saloform is another preparation especially indicated in a rheumatic

diathesis. Boric acid and salol have long since been discarded by most of the genito-urinary surgeons.

Irrigations of the bladder are in less favor to-day than formerly, but in cases where much granular debris is present they will aid to clean out the bladder.

Self-retaining catheters are used by many to put the bladder at rest and drain, but as a general rule they are poorly borne and occasion much irritation. Curetting ulcers in chronic cases has been done by Fenwick, Cumston, and others with splendid results; also applications of silver nitrate, etc., have been found beneficial.

In the case of stone in the bladder, which has been followed by infection, remove the stone by suprapubic cystotomy. An acute perforating ulcer should be treated by laparotomy, the same as a gastric ulcer. In tuberculosis the diseased area of the bladder is now often curetted or removed.

In conclusion, I would say of the treatment to first find the true cause, and we can then always institute the proper and successful treatment. Our failure in the past to successfully treat cystitis has been due to applying the same methods of treatment to a great variety of diseased conditions due to independent causes, and not selecting our remedies with careful investigation and regard to the true etiological factors.

LOUISVILLE.

VARICOCELE AND ITS RADICAL CURE.*

BY HARRY C. WEBER, M. D.

Lecturer and Clinical Instructor on Genito-Urinary, Venereal, and Skin Diseases in Kentucky School of Medicine; Member of the Louisville Society of Medicine, Kentucky State Medical Society, etc.

Varicocele is a venous dilatation and elongation of the pampiniform plexus of veins, and is an affection of puberty and young manhood, usually appearing between the ages of sixteen and twenty-five, and as a rule disappearing after middle life. It is rare in infancy and seldom seen in old age, giving little inconvenience before puberty, and is nearly always a left-sided disease, and practically never occurs on the right side for anatomical reasons. In most instances it develops slowly and insidiously and without pain, but in exceptional cases it comes on rapidly and with great pain. During a period of six years in the

* Read before the Louisville Society of Medicine, January 8, 1901.

genito-urinary clinic of the Kentucky School of Medicine I have seen but one case of varicocele in the negro.

The causes are the following: Anatomical peculiarities are great factors. The length, position, tortuosity, and pressure caused by the contraction of the abdominal muscles on the veins and feeble vis-a-tergo owing to the great length and small caliber of the spermatic artery. The left spermatic vein empties at right angles into the corresponding renal vein, and may be pressed upon by the sigmoid flexure when distended by fecal accumulation. Modern method of dressing and heredity may be causes; hernia and tumors in and near the groin, ungratified sexual desires, masturbation, and excessive venery, inflammation, epididymitis, and traumatism. Some authors claim there is a valve on the right side at the junction of the spermatic vein and the vena cava which prevents the damming of the blood.

The patient complains of a sensation of weight and dragging pains, which may extend to groin, loins, and lumbar region; dull, aching pain in the testicle at times and tenderness of veins and cord. All of these symptoms may be increased by heat, overexertion, jolting, or riding a bicycle. Fatty and calcareous degeneration may take place. Elongation of the scrotum, atrophy of the testicle, and want of sexual power are frequent symptoms; derangement of the digestion, melancholia, headache, and nocturnal emissions. The mental symptoms are many and varied, and an operation is necessary for their relief. The tumor has the appearance of a bag of angle-worms, which partially or completely disappears on lying down, but reappears on standing, increasing in size gradually from below upward. Pressure exerted over inguinal region does not prevent the appearance of the tumor.

Considering the treatment, I prefer to give the patient a thorough purgation and shave the pubes and surrounding parts. After a general bath, scrub the field with soap and water, wash with a one to two thousand bichloride solution, and follow with ether. Under general or local anesthesia make an incision through the skin over the pampiniform plexus an inch and a half long, beginning just below the external abdominal ring. While your assistant picks up the fascia with a pair of tissue forceps on one side of the incision, you do likewise on the other, and with a bistoury gradually divide down to the sheath of the cord, separating the vas deferens, arteries, and nerves from the veins with the fingers. Transfix a ligature of number

one catgut at the upper and lower extremity of the incision around the veins, about two inches apart. Run a suture through the center of the cord, extending behind each ligature, and with the scissors cut out the intermediate portion of the veins, leaving each stump one fourth of an inch long. Approximate the ends of the veins with the ligature just introduced, tie securely, and trim off the superfluous ends of the suture. Close the scrotum with as many interrupted silk sutures, dipped in bichloride, as is necessary. Put on a double spica bandage supporting the testes well upon the pubes. Move the patient's bowels after the second or third day, and remove the stitches from the scrotum on the third or fourth day. Instruct the patient to remain in a recumbent position, using the urinal and bedpan for four days; then after the seventh day put on a close-fitting suspensory bandage. He may resume his business after the tenth day, wearing the suspensory until the swelling and infiltration have disappeared from the cord. I have never had a bad result.

LOUISVILLE.

A SINGULAR CASE OF INSECT BITE.*

BY T. B. GREENLEY, M. D.

On March 20th, in the evening, Mrs. C. was bitten on the middle finger by an insect in shape of a worm, about half an inch long, with black head and white body. She was eating a banana when the insect grabbed her finger. It was within the rind of the fruit. She informed me that it was somewhat savage in its efforts to bite, and lacerated the skin, making an open wound.

In a very short time her finger began paining her, and slight swelling took place. The pain soon extended up her arm to the shoulder, and made her quite nervous, rendering her unable to hold her arm and hand still. When I visited her she was in so much pain and so nervous I administered an hypodermic injection of morphia and atropia, which in half an hour rendered her comfortable. I kept the finger wrapped up with raw cotton moistened with turpentine.

21st. Saw the patient twice to-day. She was complaining of pain in her arm and side, and still nervous. I kept her on powders of morphia, to be given sufficiently often to control pain and nervousness.

* Read before the Muldraugh Hill Medical Society, April 11, 1901.

22d. About same. Her temperature was not affected by the insect bite, but it had a depressing effect on the heart. She had to keep in bed on this account, as she came near fainting several times on assuming the erect position. On this account I gave her heart supporters, strychnine, digitalis, etc.

23d. Symptoms pretty much the same, only not quite so severe. Same treatment continued, keeping her bowels gently relaxed.

24th. Much relieved and dismissed, only to continue heart tonics as required. On the next day she could be up and felt about well.

The insect was destroyed at the time of the bite, which I regretted, as I would like to have seen it. I am unable to give a genesis of it. It must have been a young insect of a poisonous character, having the banana for its habitat, and perhaps may be developed into a large and very dangerous insect of a poisonous character. It is possible that they remain in the banana during their embryonic state, and at the proper time escape to the surface of the fruit.

I have heard of poisonous insects being imported with the banana, hidden in the bunches, called tarantula, a spider-like insect, the bite of which is very poisonous and dangerous. But from the description of the little worm by the patient there would have to be quite a metamorphosis effected to have converted it into a spider-shaped insect. From its description it resembled a centipede much more nearly, being in the shape of a worm and having legs.

MEADOW LAWN, KY.

Reports of Societies.

THE LOUISVILLE MEDICO-CHIRURGICAL SOCIETY.*

Stated Meeting, March 15, 1901, the President, Louis Frank, M. D., in the Chair.

Subserous Fibro-Myoma of the Cervix. Dr. Louis Frank: The specimen which I exhibit was removed this morning at my clinic in the Kentucky University, a large subserous fibro-myoma, undergoing gangrenous degeneration or sloughing, not from constriction, however.

The patient presented herself at the clinic some days ago, but I did not see her then, and only saw her this morning before she was operated

* Stenographically reported for this journal by C. C. Mapes, Louisville, Ky.