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the vital powers of healing are on the decline. Largeveins are concerned, and frequently the urinarysecretion is far from being an ideal lotion for a

large wound. Patients often die immediately fromhaemorrhage and from shock.

UNDESIRED SEQUELS.

If these be avoided or recovered from, all is not

yet plain sailing.1. Natural micturition may not return.2. Very troublesome urethral obstruction or

stricture may result.3. Painful phosphatic deposits may occur at the

neck of the bladder.4. The shock of the operation may be so severe

that the patient may never again be the man he was,and often dies within a short period.

5. And, finally, troublesome suprapubic fistula andeven vesico-rectal fistula are not unknown.In the days before prostatectomy, a prostatic

patient, or any other patient who from atony orparalysis failed to empty his bladder, had to learnto pass a catheter. Before the introduction of. thesoft catheter this was indeed a sad affliction, and whenthe use of a metal catheter by the patient himselfwas difficult, I have known the patient obliged toreside close to his doctor’s house. During my life time the soft catheter has been brought by manu-facturers, under the guidance of surgeons, to greatexcellence, and I myself have had something to dowith perfecting a simple aseptic apparatus whichenables a patient to be as active as he likes and yethave a pure catheter always at hand.

I have known busy surgeons. physicians (two withRoyal appointments), busy practitioners, judges,explorers, sportsmen, sailors, and ministers of religion,who have led active, happy, vigorous lives whileentirely dependent upon the catheter. I once hadthree judges on the bench, all pupils of mine, andindeed I remember one saying to me,

" I much preferthis method to the natural one ; before, I was

disturbed every 20 minutes, now I am good for sixor eight hours." At the present moment I haveseveral friends busy and happy, one of great age,and one a distinguished golfer, quite resigned -andcontent with the catheter life.The cases where prostatectomy is a necessity are

those rare ones where the middle lobe is very large,projecting into the bladder and causing intenseirritation, and where catheterism is exceptionallydifficult, or the patient unusually clumsy, blind orpartially blind, or possessing only one hand.

"DUPLEX THERAPY."

IN an address delivered before the Royal Societyof Arts on Nov. 25th, Mr. G. G. Blake, M.I.E.E.,described a form of treatment by diathermic andgalvanic currents in combination, both currentsbeing passed through the body at the same time byway of the eame two electrodes. From this " duplex "treatment he claimed successful results in cases ofgout, fibrositis, sprain, and even early arthritis,although in regard to the last-named he admitted itwas not fair to speak of cure. Symptoms howeverhad been eradicated, with relief of pain for longperiods ; a number of patients not requiring furthertreatment after an interval of nearly two years.Hundreds of similar cases treated by diathermy orionisation, separately applied, before he hit upon theduplex treatment, had, he said, given results fairlygood but not comparable with those obtained by thenew method, either for speed, relief of pain, or lastingresults. All the patients had been referred to himfor treatment by various medical men. The electro-medical practitioner, who would like to know moreexactly the types of arthritis that were submittedto the duplex treatment, will admit that the resultsas stated are remarkable. It remains however toexplain how any treatment applied to the jointscould produce such results in arthritis due to infection

from a distant focus or to endocrine disturbance.The true value of any therapeutic agent must neverthe-less be determined by its effects.

In the course of his demonstration, Mr. Blakeshowed that the diathermic current (which is alternat-ing) is rectified when the electrodes are asymmetricalor do not make good contact. He has devised aninstrument (which he calls a contactometer) to indicateon the galvanometer the amount of unidirectionalcurrent that flows when the rectification occurs.

He pointed out the importance of good contact withthe active electrode when the eye, for instance, issubjected to diathermy, and he believes that thiscontactometer would afford protection against burnsduring diathermic application to rectum, urethra,cervix, or other internal organ. It seems more likelyhowever that damage would already be done whenthe contactometer gave evidence of it, and in any casecorrect application of electrodes should precludedamage. Mr. Blake also made some interestingremarks on the psycho-galvanic reflex which, whenabsent in cold-blooded subjects, may often be broughtback by friction, radiant heat, or diathermy. Hisskilful and ingenious experiments illustrate the needfor the physicist interested in biology in the investiga-tion of the problems that confront the practitioner ofphysical medicine.

INQUIRIES.I.

A boy of 15 and a girl of 16, living in a doctor’s house-hold in London, have not had measles, and are likely to beexposed to infection from attendance in one case at evening(L.C.C.) classes, in the other by visits as pupil teacher toelementary schools. Should they be partially immunisedby convalescent serum over the peak period of risk ofinfection this winter ?

The immunity conferred by convalescent serum isa passive one, and lasts for not longer than four weeks,possibly less. By giving a single dose of convalescentserum when the measles epidemic would be approach-ing its maximum, a person exposed to risk ofinfection could be protected during the- period whenthe risk was greatest, and thus his chance of con-tracting measles during the course of the epidemicappreciably lessened. The period of protectioncould, of course, be prolonged by giving more thanone injection of serum, spacing the doses at intervalsof about three weeks, and since the serum is homo-logous there would be no risk of anaphylaxis. Whetheror not it would be worth while minimising the riskof contracting measles in this instance by givingone or more doses of convalescent serum would dependlargely on individual considerations. If, for reasonsof health or on economic grounds, it was highlydesirable that these two people should not contractmeasles, then it might be worth while giving themserum.

II.A resident teacher in a Yorkshire nursery school, where

there have been cases of diphtheria, is returning shortlyto spend her holidays with her family in a south countrycounty borough where there is scarcely any diphtheriaprevalent. Should she submit herself to Schick test or

faucial examination ?

It would certainly be a good thing for this womanio submit herself to both Schick test and examinationof the nasopharynx for diphtheria bacilli beforereturning to her family. Should the Schick test benegative, and the cultural reaction also negative,she would have the satisfaction of knowing thatshe was not liable either to infect others or to contractthe disease herself. If the Schick reaction were

negative and virulent diphtheria bacilli were presentin the nasopharynx, then she should neither returnto her family nor continue with her occupation untilshe ceased to be a carrier. On the other hand, apositive Schick test with a negative culture wouldalso enable her to return to her family with a freeconscience; but if she were likely to be exposed toinfection on her return to work she would be welladvised to be actively immunised, say with anatoxin,before doing so.