are left out of the physiologic solution, or relaxation is the result; when present alone in the physiologic concentration they also produce relaxation, but here a physiologic relaxation, which, when antagonized by the contractile calcium ion produces a true cardiac beat. To add sodium ions then where either pathologic or physiologic relaxation is present is irrational on the stimulant basis. Precisely the same argu

ment holds on the tissue or cell food basis.

Furthermore, the number of sodium ions in the 30th potency of natrum muriaticum would have but a transitory stimulant effect, and certainly a much more transitory period of action as cell-food when we consider the innumerable cardiac muscle cells, the instant and continued metabolism, and the vast (comparative) volume of blood (4965cc. in the adult) whence is derived the cardiac nutrition.

But one rubric is left to explain the action of a single dose of the 30th (or 200th) potency of natrum muriaticum, action historically verified in the clinical experience of a century and estimated by Hahnemann to extend from 40 to 60 days, namely: catalysis.

Quoting again from the physiologist we note: A most interesting feature of the activity of enzymes (or catalyzers) is that it is specific. Each ferment is adapted to act upon or become attached to a molecule with a certain definite structure fitted to it, in fact, as a key to its lock. Attention has been called to the fact that this adaptability of enzymes to certain specific structures in the molecules acted upon resembles closely the specific activity of the toxins, and many useful and suggestive comparisons may be drawn between the mode of action. of enzymes and toxins. At present the tendency is to attribute each new kind of activity to a different enzyme and, as a consequence the number of different enzymes supposed to exist in the body is increasing rapidly with the spread of experimental work.

The catalytic action of a dose of the 30th or 200th appears to be indubitable. No other hypothesis seems tenable. The "dynamis," the "spirit-like force" develops in modern terminology, as enzymic.

Drug-pathogeny or proving disarranges molecular organization, and hence function, until a certain specific imbalance of various or all cells and organs is obtained, which we term a drug-disease or proving; more or less evanescent on discontinuing the supply of the disturbing element. From this we gain the specific, enzymic or catalytic, ionic key which when fitted to the lock of a natural morbidity opens by its catalytic action upon the suspended normal activities, evolutions, and metabolisms of the organism, the door of healing.

Thus we behold at the dawning of the twentieth century the fair daughters of Science unfolding their apocalyptic scrolls at the feet of Hahnemann, whose meditative mind

Could find no law to guide; no light to cheer.
The universe was law; the stars that fell

From heaven shot through space obeying law;

The shimmering snows that crowned the mountain top
And fed the bubbling springs which cooled the vale,
Thence hast 'ning to the wild impetuous sea;

The clouds, the flow 'rs, the seasons, e'en the mind
Of man adept in subtlety, . . . . all these
Bound fast by law to run appointed course,

Yet here no law! . . . . dull hearsay, duller chance,
Tradition's babbling words, all meaningless;
Empiric farce to meet the solemn hour

When life and death are poised upon the scales.
Great God, give light! he cried,

And searched again the learning of the age
To find surcease of sorrow. None was there.

Yet still he sought, and moaned: 'Tis blasphemous
To think that He who wrought man to His form,
Tracing the subtile windings of his soul,
Crowning the wondrous body with a mind;
Who cares for e'en the insect in the dust;

Who heeds the sparrow's fall should love man less;
Should thus abandon him whose soul he freed,
To undeserved tortures of the flesh.

Nay, there is God, and God and Law are one.
And then he fled the sophistries of schools,
Their vain traditions and their cruel arts;
And with a grand simplicity sought facts,
Not theories, impalpable and vain.

He gathered up the herbs and made of each
A purest tincture; brought the sea-shell's heart.

In clear solution; took the drifting sand,

Shattered its crystal bounds and drew therefrom
A magic strength; from earth's deep mines conveyed
Its healing oils, and bruised the gleaming ores
To potent dust.

Then on the altar-stone

Of sacrifice he lay him down, and said:

Not on the sick shall these be tried.

Nay, I

Will one by one prove these, and if there dwell

A virtue in them it shall then be shown;

And if there be a Law the sun of truth
Shall glint it for me with refulgent ray.

And through laborious days and grievous nights

He garnered in the harvest, the great Law
Of Similars, whereby most dread disease,
Fought with swift weapons of as keen a steel,
Is made to cringe and supplicate and fly.

Thus with pure science, sinking to the depths
And rising to the stars, he built the fane
Which stands today unshaken, permanent,
So true the fabric that the storms of time
But fix its firm foundations, and the years
With subtile touch add beauty unto strength.

A METHOD OF CONTROLLING THE BLEEDING AFTER SUPRAPUBIC PROSTATECTOMY.

BY J. EMMONS BRIGGS, M.D., BOSTON, MASS.

Having been interested for some years in the advancement which has been made in the surgical treatment of hypertrophied prostate, I have watched with keen interest the Botinni operation, from its early days, to the time when it passed into decadIt always presented itself to me as a hazardous procedure, of doubtful utility. Satisfactory results were frequently obtained; amelioration often occurred; poor drainage and sepsis followed the cautery incision, and indefiniteness marked the procedure from beginning to end.

ence.

The perineal prostatectomy developed with its precise technique and comparatively low death rate in selected cases. This is a procedure far superior, in the writer's opinion, to the Botinni, yet open to a few serious objections. Among them may be mentioned:

1. The time necessary for its performance.

Some operators claim that it requires only fifteen minutes for its performance, but in the hands of the average surgeon threequarters of an hour would be excellent time. This necessitates keeping the patient under complete narcosis over an hour; not a long time for a tolerant patient, but for an old man with kidney, lung or heart complications this in itself is no insignificant factor.

2. Danger of wounding the rectum.

This may not occur very frequently in the hands of an expert operator, but I venture to say that few surgeons who have done any number have escaped this accident. If the rectal wound is immediately sutured it may close, but too frequently a rectoperineal fistula follows, and in a case which has recently come under my observation an urethro-recto-perineal fistula has persisted for the past three years.

3. Loss of sphincter control.

If the whole prostate is enucleated through a perineal incision it is quite possible that complete or partial incontinence may result.

This has been obviated by limiting the operation to a partial extirpation of the prostate, which is now the operation of choice.

It is not my purpose to decry perineal prostatectomy. In fact it has certain very decided advantages over the supra-pubic method, chief of which may be mentioned dependent drainage and shorter confinement in bed.

To Fuller of New York and Freyer of London belong the credit of the supra-pubic operation, an operation which may be undertaken when perineal prostatectomy is out of the question. I refer especially to lung, kidney and circulatory conditions which would render prolonged narcosis hazardous. The supra-pubic operation may be performed under nitrous oxide anæsthesia in an incredibly short time.

The supra-pubic incision is made with the bladder distended, the entire prostate is enucleated with the tip of the index finger (the index finger of the other hand is inserted into the rectum and presses the prostate upward), and the time necessary for the enucleation will not average over five or six minutes. In a case which I operated upon recently just two minutes time sufficed for the enucleation. If the line of cleavage between the sheath and capsule is carefully followed there ought to be only very slight bleeding. It sometimes happens that this line of cleavage is departed from, or that inflammatory changes have occurred which render the parts abnormally vascular.

Should troublesome bleeding occur it can usually be checked by hot water irrigation. Should the bleeding be alarming it has proven difficult to pack the wound in a satisfactory manner. My experience has led me to give this matter some consideration and the Davidson Rubber Company, following my suggestions, have made for me rubber bags in three sizes, which I have used with gratifying success. In fact, of late I am using one in every case, as it stops all bleeding and thus avoids the annoyance caused by blood clots in the bladder.

The instruments as constructed consist of rubber tubes twelve inches in length, which terminate in a rubber bag varying in size from one to one and one half inches in diameter, slightly oval in shape. These bags are made in three sizes to be selected with reference to the size of the prostate removed. They are elastic and capable of considerable distention. (See Plate I.)

In order to insert the bag a flexible olive pointed bougie is introduced along the urethra into the bladder, the point of the bougie is allowed to protrude through the supra-pubic incision. The open end of the tube which is attached to the bag is pushed

over the end of the bougie for about one half inch and a piece of silk is tied tightly about it. This temporarily attaches it firmly to the bougie. The bougie is then withdrawn from the penis bringing with it the end of the tube attached to the rubber dilator. The silk is now cut and the rubber bag is drawn into

the bladder by pulling upon the free end of the tube, and with the index finger the rubber bag is crowded into the bottom of the wound from which the prostate was removed. (See Plate II.) A syringe nozzle is now inserted into the free end of the tube and sufficient water injected to distend the bag to conform to the walls of the sheath of the prostate gland. While the water is being injected it is desirable to press the bag forward, but when distended it usually remains in position.

A clamp is now applied to the tube and the end of the tube secured to an adhesive strap placed just above the knee joint. This maintains a constant elastic tension upon the bag and holds it in position. These rubber dilators may be thoroughly sterilized by boiling and can be used repeatedly.

NORMAL liver tissue stores up all sugar of the food in the form of glycogen. This same power seems to be possessed by other tissues for all sugars except fruit sugar or lævulose. Both experimented and clinical evidence indicates that the liver is the only organ that can convert and store up lævulose. Therefore, by giving moderate amounts of lævulose as food and watching for its appearance unchanged in the urine, we have a method of determining the functional efficiency of the liver, at least of its glycogenic function.-Laidlaw, Hahnemannian Monthly, January, 1906.