other craze. Let us discriminate and find out whether these cases are from infection or from other causes, and treat it accordingly. That is why I wanted Runnels' paper called "Specific Urethritis."

DR. COMSTOCK: I am surprised at a statement that ninety-nine out of a hundred cases of gonorrhoea get well by themselves. This a very serious matter, and it is very unfortunate that the lay people and the physicians believe that gonorrhoea is a very slight thing and doesn't amount to anything. I have heard young men say they have had it forty times and it never amounted to anything. That is wrong. Gonorrhoea is not a very slight thing. They also say that syphilis is never curable; that is also wrong. I would rather treat an ordinary case of chancre any time than a case of gonorrhoea. I remember when studying in Vienna, at the end of two and a half years the professor delivered a lecture to the physicians present on the subject, "Is syphilis curable?" He said that question arose oftentimes with physicians themselves. He decided that it was curable. Another point: In speaking of sterility, when gonorrhoea has affected the males, if they have had epidydimitis or inflammation of the prostrate gland, those are the cases that will probably never get well. I presume that Dr. Cowperthwaite's patient was affected five years ago; that she probably had a slight attack of endometritis. Those cases are liable never to get well; and those are the cases where men are liable to be sterile.

DR. O. S. RUNNELS: I wish to emphasize the fact that the bladder is just about as prone to take on this sympathetic debility, this manifestation of reflex trouble, as any other organ of the body. You well know that the symptom of tympanitis is met with after operations, or that any simple operation on the uterus may be followed by a pronounced distension of the intestines. Only a week ago I had a case of cystitis in which the most pronounced tympanitis followed. I was somewhat at a loss to know why, but I found it to be a mere reflex condition from the bladder.

DR. CLAYPOOL: Dr. Runnels' paper is valuable from the fact that you find in it many important points that are not commonly found or spoken of in our medical works. Those diseases or affections of the bladder, the reflex affections, have been very much mixed up in our literature. I want to call attention to the fact that this paper so thoroughly demonstrates the difficulty of prescribing exclusively on the symptomatology of the case. The point I make and maintain is, that in all these pelvic troubles there is an absolute necessity of making a thorough diagnosis, and of understanding the pathology as well. Inflammatory affections of the bladder, whether from mechanical or other irritation, will produce a very similar symptomatology, and if you depend upon the symptomatology alone you will fail in your treatment; and you will

wonder why your homœopathic remedy will not do its work, when the fault is your own in not properly diagnosing the trouble.

DR. COWPERTHWAITE: That one special point of reflex troubles is of daily occurrence. I wish to call attention to one particular remedy for this nervous reflex action of the bladder, and that is gelsemium. The same things hold true in the male. You will find the remedy acting the same; the bladders are practically the same. I was called to see a clergyman, or rather he called to see me, and wanted a prescription for a condition of that kind, where he could never stand before an audience without having to go out to urinate. Another case is that of a lady who could not urinate when any one was in the room, and gelsemium relieved her promptly.

DR. LUDLAM: I spoke of reflex action or sympathy between the rectum and bladder, and am asked if it is my experience that there is any relationship existing between rectal pockets and the troubles mentioned in my paper. If I might use a classical phrase I should remark that this has come to be a nasty subject. I haven't the time or temper to talk about that thing here. Some time when I get my gun loaded I will touch it off perhaps, and the first effect will be to make a stink when the powder has disseminated itself. I have no confidence in that sort of thing whatever; nor do I place any reliance whatever in the cures that have been reported in this direction. Pockets were known to good old Dr. Physick, who made a good deal of reputation from these same pockets, and put something into his own pocket. That rectal troubles do cause vesical irritation has been known, as I have said in my paper, for a long time and are a matter of record in our medical works. I want to thank those members who have spoken of gonorrhoea in the papers presented. My design was to bring something as practical as possible,-something that would be of real service and real utility, and hope this will prove to be so to the profession. I believe that the documents and reports of this bureau will be of value to us. The bureau has done well to take up this important subject, as it has not received near the treatment in the text-books that it should. I feel jocosely inclined, and wish to ask Dr. Cowperthwaite whether he has observed any effects of gelsemium in controlling the desire to urinate in those who are preparing for examination.

DR. COWPERTHWAITE: I desire to say that that has been a standing joke of mine for these many years.

A. A. WHIPPLE, M.D.: Regarding the use of alcohol I would say this: that my practice has been never to use alcohol under any circumstances in pneumonia and typhoid fever, as I cannot see that it will do any good, and it sometimes does harm. I think physicians should be as careful in the use of alcohol as they are in the use of remedies, and in small doses and in attenuations; then they could do no harm. Those

who use stimulants use them as stimulants and not as remedies. I have always advised people not to do so.

W. J. MARTIN. M.D.: I wish to enter my protest against a statement made that a physician treating a case of pneumonia without giving bryonia is dallying with the moral law. I have treated many cases of pneumonia without using a dose of bryonia, and they got along all right. I have also treated pneumonia and given nothing else but bryonia, and the patients made good recovery. We don't prescribe for pneumonia; we prescribe for the patient and the case in hand. Patients within the last four weeks that I have treated-I remember two cases particularly were conducted throughout the whole sickness on aconite, and got well in nine days. Bryonia would have killed those cases, because it was not indicated. I prescribe for the symptoms of the disease, and never for the name of a disease.

J. M. SCHLEY, M.D. In the treatment of pneumonia there is a medicine that is used perhaps rather empirically, and that is iodine. Dr. McMichael of New York recently tabulated 112 cases of pneumonia in children and in adults treated alone with the tincture of iodine without a single death. It may be questioned if all these cases were pneumonia; but in some of them I had the privilege of being present in consultation; he used the tincture of iodine very strong, putting fifteen to twenty drops in a glass of water and giving a teaspoonful every twenty minutes until the temperature fell nearly to the normal, and kept it up that frequently as long as the temperature didn't rise; if it remained quiet at 100, he gave it every half-hour or hour; if it ran up he gave it more frequently. In most of these cases the result was an immediate and permanent return to the normal temperature, a result which the giving of the simple remedies such as bryonia, cantharides, arsenicum, and so forth, could not accomplish. He lays great stress upon the way the iodine is given. It is very rapidly eliminated from the body. He has seen no injurious results from its exhibition. It is well known that iodine exposed to the atmospheric influence rapidly undergoes changes and perhaps removes the virulent effect to

some extent.

DR. W. DANFORTH: I have practised medicine for twenty-five years, and have not lost one case of pneumonia, and I have had my complement of serious cases. I think that this favorable result was due with me, if to anything, to the absence of the flax-seed poultice on the chest. Neither do I grease my patient. The way I treat my cases is to apply a pack of soda-water, a teaspoonful of soda to the quart of warm water, and that is placed about the chest, completely encircling it. I cover this with a wrap of three or four thicknesses at six o'clock in the morning, and renew it at six o'clock in the evening-two times a day. As

to remedies, I attach very much less importance to them. I select, of course, the indicated remedy, and as these have been already mentioned I will not dwell upon them.

TUMORS OF THE DURA MATER.*

By S. B. PARSONS, M. D.

O little attention has been given to the subject of tumors of the dura

have very few words to say concerning them.

It is only in those cases where the tumor protrudes through the skull and forms a swelling beneath the scalp that excite much attention. Such cases possess two important features: First, they are generally malignant; and second, they perforate by absorption of the bony constituents. All tumors of the dura mater are not malignant. We may have the fibrous, fatty, osseous, and other forms of benign growths. develop here; and in point of fact, very few of the growths originating in this membrane ever find their way through the skull. But there are cases where the cranial bones are perforated by tumors showing their seat in the dura mater, that possess no malignant elements in their composition.

Occasionally fatty and fibrous growths force their way through an opening to the outside of the head, but such instances are rare, and are either congenital, or make their exits from some opening already existing, or are of the semi-malignant or recurring variety. Nor can we always tell whether a protruding growth has its seat in the dura mater or brain previous to opening the cavity.

Although it is alleged by some writers that innocent tumors never perforate the skull, yet there are a few such cases on record, one in which was found a growth on the dura mater and another beneath the scalp, the two being connected by a small pedicle through an opening in the parietal bone, and both were of the fatty kind. It is not known whether this was a condition developed in adult life or a congenital formation very probably the latter.

This class of carcinomatous, as well as the sarcomatous, growths are the varieties most frequently seen appearing externally, and which are known under the name of "Fungus of the Dura Mater."

It has been a question of great interest to me, and one to which I gave no little thought and research, why it is that in those cases only," with very rare exceptions, where there is an undoubted malignancy, do we find tumors boring their way through the solid bones of the

*American Institute of Homoeopathy, 1889.

skull? It appears to me that the explanation of these perforations, as usually given, is not sufficiently well based to be accepted as the true cause that of absorption. If it were due to pressure and absorption only, would we not have as a result of pressure more perforations in fibrous, fatty, and other forms of tumors? For the amount of pressure in the one case is, in all probability, as great as in the other case. There seems to be a link lacking, and that link, I believe, is found in the fact that in all cases of perforation there precedes absorption a condition of arteritis or endo-arteritis, with their usual accompanying fibrinous deposits upon the intima of the vascular canals, that generally produce occlusion, partial or complete, by which the blood-supply is thus cut off, and the parts, losing their proper amount of nourishment, are readily disintegrated by the enlarg ing growth. The probable reason why we see perforations in malignant disease, and not in innocent growths, lies in the fact that in malignant types there is a tendency to invade and draw into themselves, and convert into heterologous structures, like their own, all tissues they come in contact with.

Growths originating in the brain substance, or the pia mater, or the arachnoid, very rarely penetrate the skull bones, be they malignant or non-malignant in their character.

The malignant growths of the dura mater may occur as a primary or as secondary growths. Primary growths are not so frequently seen as secondary growths, and occasionally we find them spreading to the dura mater from adjoining parts; as, for instance, from the orbital cavity when it commences in the orbit or its coverings.

The primary growths are nearly always single; the secondary are usually multiple; the latter running a more rapid course than the former.

Pathologists aver that the primary tumors are always sarcomatous in nature, but there is some evidence in support of the theory that some of the secondary forms are carcinomatous; and although the disease is usually spoken of as cancer, there can be no doubt that, in the majority of instances, they are sarcomatous new growths.

There is such a marked difference in clinical and physical features between the sarcomata and carcinomata that they should never be confounded, one with the other.

The sarcomata are, as a rule, enclosed in a capsule; the carcinomata are not encapsuled.

The sarcomata tend to displace the parts around them; the carcinomata invade and infiltrate the parts about them.

The sarcomata attain large size before they break down; the carcinomata break down when the tumor is small in size..

The sarcomata seldom produce glandular enlargements; the carcinomata always do.