he find a chancre and calls it something never make the mistake of doubting else, he might wish he had never been your beliefs or believing your doubts." born. The diagnosis of extra-genital It may be that some of us have thus chancre is one of the most difficult in erred. Strychnin as a cure for the medicin, especially if our minds are pre- liquor habit has been assailed; perhaps judiced by previous knowledge of the justly, but possibly wrongly. This drug patient or his or her standing in the com- has rendered valiant service in the hands munity. We can only act the impartial of regular, homeopathic, eclectic and judge, as the old Roman father who con- quack, in treatment of tobacco and alcodemned his own son to death, and it is holic habitues. We hope the growing entirely within the bounds of possibility sentiment is in error. Yet we believe in that some of our readers may face the "hewing to the line, let the chips fall problem of such condemnation. It is true where they will." If strychnin be responthat respectability will not counteract the sible for the things charged against it, and specific virus, and it is equally true that if the recorded cases were not those of syphilis apes every other known disease. idiosyncrasy toward the drug, then let it All one may do, in diagnosis, is to remem- pass from our armamentarium into the host ber that no known condition or disease that have been well tried and then past precludes the possibility of a complicating into oblivion. syphilis, whatever the symptoms may indicate as the proper nomenclature. Not only because of the consequences of error, but because it is now a recognized fact that syphilis, originating from an extra genital sore, is much more likely to be severe than when taking origin in sexual intercourse, does it behoove us to be most cautious. Learn the literature of the chancre well, remember it and act in every case with discretion. The treatment of the extra-genital chancre, and its secondary phenomena, does not differ from the treatment of the disease originating elsewhere. We have but two reliable drugs: mercury in some form, and the iodide of potassium. All the rest of the host commended by regular, eclectic and homeopathic, are but adjuvants or delusions. So far, no doubt as to its employment being advisable in cases of the tobacco user have reacht us; yet if it act so injuriously in cases of the drunkard, may not its use in the tobacco habit be questioned and investigated? Dr. E. P. Hershey, in the Denver Medical Times, reports success in destroying the craving for alcohol by the use of grain of pilocarpin three times a day. He reports six cases thus treated, with universal success. It is said to be much preferable to strychnin in such cases. Salicylate of sodium has been put forward by another observer as an efficient drug for use in such conditions; the latter claim being strengthened by Haig's observations regarding its value in treating the opium habit. While we regret the passing of a once trusted agent, we rejoice in the fact of two Strychnin as a Remedy in Alcoholism As promising substitutes being tendered. The sailed; Substitutes Offered. mere fact that strychnin has been placed under suspicion should encourage all our readers to thoroly try the other drugs. So soon as you have thoroly tried them, please report impartially either success or failure. The army of WORLD readers can furnish valuable testimony in a very few We have so few remedies of undoubted and universal efficiency in indicated cases, that one always feels regret when he is compelled to permit himself to doubt the wisdom of continuing to use them. Yet some one has said, "Always doubt your doubts, and believe your beliefs; and weeks. The free sweating often following the administration of pilocarpin must not be forgotten or overlookt; warn the patient; remember the old dosage and limitations of the drug, and proceed fearlessly in the interests of humanity and science. Sodium salicylate may be pusht to 60 grains three or four times daily; dilute well and follow with copious drafts of water. Butter vs. Cod-Liver Oil. One of our exchanges devotes considerable space to the theory that butter may be made to take the place of cod-liver oil. We do not believe that they could be interchanged with advantage either as articles of diet or as medicin. While both are oils, both have properties peculiarly their own, even tho both have constituents in common. The major reasons advanced by our contemporary as to why butter should replace cod-liver oil are that: (1) It is cheaper; (2) It may be given ad libitum; (3) It protects the system against the influence of cold. Admitting all of which one hardly considers the point proven. Numerous articles along similar lines have appeared in journals, and we find that many physicians are thus learning to look upon cod-liver oil as a mere fat that may be substituted with any fatty or oily substance. When such a belief gains ground, it is well worth our consideration since the value of cod-liver oil has been well proven. We have too few reliable medicaments to permit the escape of even one. We are glad to admit the value of butter as a food and as a medicin (see WORLD, September, 1900, page 331), but we insist that it is entirely different from cod-liver oil in action, food value, and therapeutical properties. Butter is the oily portion of the milk of mammalia obtained from the fat globules by a process of agitation. It is made up of the glycerides of oleic, palmitic, and stearic acids (insoluble), and the glycerides of butyric, caproic, caprylic, and capric acids (soluble). The insoluble acids are present to the extent of 88 per cent., and the soluble acids to the extent of 6 per cent. The specific gravity is .910 to .914, and the melting point varies from 85° to 92°F. Artificial butter has less of the stearic acid, and requires a higher temperature before melting. Cod-liver oil is the drippings, or steamed out fat, of the liver of the codfish. It contains oleic, margaric, butyric, and acetic acids; and glycerin, gaduin, billiary principles, iodin, chlorin, bromin, phosphorus, phosphoric acid, and various other substances (Wood), many of which are not found in butter. It is not proven that the oil of the liver of the codfish has any superior qualities, over the fat from the liver of any other species of fish; but the past history of the medicament and even the most meagre clinical experience indicates that it is a valuable medicin. No substitute for it has ever been found. It seems that here synthetic chemistry is baffled by the workings of nature's mysterious physiological laboratories; science may produce the constituents of the oil, certainly, but when mixt they do not make cod-liver oil, nor does their artificial product produce the well known clinical results attained by the natural product. Efforts have been made to combine the synthetic alkaloids corresponding to the natural alkaloids found in the true oil, on the theory that only the alkaloids were therapeutically activ. The combination was easy, but the results were practically nil. "Cod-liver oil has some influence upon nutrition not shared by ordinary fatty matters; it is an alterativ." (Wood.) The intense efforts exerted to find a substitute have only demonstrated that the virtues of the oil depend upon some weird mystery of nature by which she defies all efforts to separate the constituent parts, and insists upon the remedy being given as a whole combination of her own. Cod-liver oil checks cellular hyperplasia and hence is used in enlarged glands, and the deposition of fat in the system; but a given fat may do this and another given fat may do much more: i. e., may also act as a valuable therapeutic agent along other lines than the increase of adipose tissue. Butter has the advantage in the matter of satisfaction of taste, to most people (tho we know many who would as lief take cod-liver oil as butter), yet cod-liver oil, if pure and properly prepared, is not more nauseous than many other commonly used medicins. There is no more excuse for giving rancid oil than for eating rancid butter. in all forms of the manifestations of the Group of Nerve Sedativs. Many practitioners feel that their armamentarium is exhausted in nervous cases when they have tried the various bromids, valerian in some form, and perhaps camphor. Each of the following drugs has nerve sedativ properties, and as nervousness seems in many cases idiopathic and tified in extending his list so as to include in every case truly distressing, one is jusa wider field of therapeutics. Acetanelid, Acid hydrobromic, Bromalin, Bromids, common Bromoform, Codein, Duboisin sulfate, Ethyl bromid, Ethylene bromid, Hyoscin hydrobromate, Hyoscyamin, Lactucarium, Lobelia, Caesium ammonium bromid, Peronin, Camphor, Cannabin tannate, Chloral hydrate, We did not start to write any eulogy Camphor mcnobromate, upon cod liver oil; it will never need one. We are not interested in any cod liver oil industry; but our memory, our sense of justice, our gratitude for past results and our assured hope of future benefits, impels us to defend this old and reliable friend. We wish every success for butter; but in therapeutics, as in any field of action, we dislike seeing any drug forced to win its way to prominence over the discarded remnants of its superiors. We shall "hold fast to that which is good" till something better is proven. Any fat, ingested and digested, tends to promote Morphin, Narcein, Paraldehyde, Many of them are, of course, "edged tools,' "to be handled with care; both as to proper dosage, and with regard to the formation of an unfortunate habit. But do not permit a patient to tell others that you can not get her nerves quieted. Methylene Blue; Condenst Information. This drug is latterly attracting considerable attention in various fields of general and special medicin. Enuf has now been written to prove its potency and value, tho the text books are, as usual, slow in getting for us the desired information. Perhaps its greatest successes have been recorded as against carcinoma, gonorrhea and malaria, tho other lines have had considerable benefit from it, notably that of cystic disorders. Culbreth, November 1900, in his Materia Medica and Pharmacology (Lea Brothers & Co.), mentions its properties as "anodyne, antiperiodic, antipyretic, analgesic, antiseptic; in rheumatism, neuralgia, cystitis, intermittent fevers (substitute for quinin), urethritis." It colors the urin blue; warn the patient. It is sold in two forms; be sure you get the C. P. Medicinal. Unguarded, it may cause stranguary; give some aromatic oil with it. Dose, 1 to 2 grains three times a day. It is well worth a trial and a report. Extra-Renal Albuminuria. A doctor need not be very old to remember that he was taught that any trace of albumin in the urin was ominously significant. Late writers deny this, and the investigation has proceeded far enuf to prove that there are cases of "albuminuria" which are not in any way related to Bright's disease." In examiIn examination of urin, if we had any means of being certain that discovered albumin originated in the kidneys, then no problem would present; but we have not such method (even urethral catheterization catheterization being fallible). It is certain that there are many channels thru which albumin may enter the urin without in any sense indicating a serious pathological condition. The time is past for the assertion that all albumin in urin is indicativ of degenerativ changes in the kidneys. Yet one can hardly be reconciled to the statement that albumin can occur in strictly normal urin. In this whirlwind of discussion among "authorities," the average general practitioner must sustain his balance; and yet he must keep up with the advance along both lines of thought, or speedily become a back number. Albumin may be found in almost any normal urin; but only after the fluid has been concentrated to the extreme limit by evaporation, and only then by the most delicate tests. But the very fact that it may be thus found, robs our old horror of much of its import. It may now be accepted as a clinical fact that one must not only strive to search out the origin of the albumin, but also estimate its amount and the regular and persistent occurrence, before he dare concondemn his patient to a slow and lingering death. The kidneys may be organically and functionally sound, and yet one may find albumin. The causes which go to produce it are legion, yet we must remember that either blood or pus in urin will cause the fluid to render reaction to any test for albumin. The examiner must carefully exclude every disease of urethra, bladder, ureter, and also any extraneous influences such as fistula, dyscrasia, diet, mental emotion, excessiv fatigue, exposure to cold, and possible innocent contamination of the sample, before rendering either diagnosis or prognosis. The problem at once forces us before the ancient and revered tribunal: is this albumin consequent upon deranged functional activity, or is it the result of organic change in the kidney itself? When we have solved such a problem we may then speak before the court of the professional world without fear of successful contradiction. Yet the difficulty of obtaining the data for such confident assurance still persists. We now know that one may obtain albumin from urin excreted by a healthy kidney provided any one or several of the following conditions exist: (1) leucorrhea, (2) gonorrhea, (3) fistula, (4) prostatic disease, (5) urethral disorder, (6) prostatic affection, (7) cystic inflammation, (8) urethral lesion, or (9) abnormal conditions in the renal pelvis. Thus one must be more than ever on guard lest thru faulty conception of Nature's voice we coax ourselves into deceit. Nature is all right, and science is "O.K'd." by centuries; yet we are still checkt and baffled by too little knowledge. The experts are baffled; may not some "ordinary" man lead them to the light? It is thought and energy which keep the world moving, and no man has a monopoly on either. We hope that some one will soon prove to us the actual prognostic value of albumin in urin, whether it be extra or intra renal. The intra-renal form is impeacht as fatal; has the extra-renal any significance? Late writers state that albumin may be found in urin declared normal after the heat and the nitric acid tests, if tests of greater delicacy be employed. In another column we give the latest and most accurate method. Even tho the albuminuria be functional or cyclical, one feels greater confidence in his diagnosis if he can accurately estimate it or absolutely deny its presence. Galactagogs. We have often been askt for a recommendation of drugs which would establish a flow of milk. While this is mainly a matter of good nutrition thruout pregnancy, the following drugs will each be found to have more or less galactagog properties: Lactic acid; castor oil, topically; extract of malt; galega; jaborandi; chlorate of potassium; fresh sweet milk in quantity is valuable; tea; and the lighter beers have been successful in a number of cases. Disinfection of Catheters. Dr. Seillikovitch will save risk of infection by preparing his steel catheter sound or bougie, in the following manner: Have a deep bottle filled with steril glycerin; this may be made steril by heating in a stew pan or crock and poaring into the bottle while hot, and keeping it tightly corkt except when in use. (The bottle is heated before pouring the hot glycerin into it.) A similar bottle contains alcohol. When it is desired to use the instrument, it is dipt into the alcohol and immediately on withdrawal is toucht with a lighted match; the alcohol while burning effectually disposes of all danger of infection while at the same time warms the instrument. While warm, the instrument is then dipt in the steril glycerin. No wiping whatever is needed, except after use, and then any cloth will do, as the next burning will make everything safe. The advantage of this method is in its absolute safety, great celerity and markt convenience. We have used it for years, and never wipe our instruments with anything until after they are used, or just before plunging into the alcohol, and we would just as lief use the office towel or dust rag as anything else so far as danger of infection is concerned. Only one precaution is needed: as your instrument is not toucht with anything after you begin preparing it, it is necessary to learn to know when the instrument is cool enuf to use. This is best learned by experiment in timing the cooling process a number of times; in this way one will never burn the patient. The Effect of the Obstruction of the Vas Deferens on the Sexual Appetite. Editor MEDICAL WORLD:-Six years ago I injected six minims of pure carbolic acid into the lumin of the vas of a healthy man, on each side. It caused a slight epididymitis which past off in a few days. The spermatozoa disappeared and have not been seen since, after repeated microscopic examination. The semen is normal in all of its constituents except the spermatozoa. The amount is not reduced, ejaculation is perfect, erection is perfect, and there has been no atrophy of the testicles. There has been no pain, tenderness or swelling of the epididymis since the first few days after the operation. His desires are not affected and sensation is unimpaired. I have done several operations for this same purpose, but the one just related is the simplest, is attended with the least risk and seems to be the surest except some which involve a greater risk. Twelve months ago I did the same operation on another man, with identically the same results. We have a great many cases of obstruction of the vas by gonorrheal infection and some of those cases have been studied; but an operation on a healthy individual for the purpose named has never been done before, so far as I am aware. There have been a few operations done on the insane and the effect studied, but not on a healthy man. As I have never dissected a case I don't know whether the carbolic acid plugs the vas by cicatricial contraction or whether it destroys the epithelum lining of the epididymis and testicles. What effect the operation would have |