sult of former attacks, and the inability of the physician to control the imperious habits of his patients, and last but by no means least, the mental disturbances so often found in this class of cases, which have been produced to a great extent by the terrible expositions contained in these "marriage guides" and other damnable devices of quacks.

There is a singular tendency in the human mind to believe whatever they see in print, no matter how thorough may be their contempt for its author, and it has been my experience, as I dare say it has of many others, that it is next to impossible to convince many of these nervous subjects that their simple gonorrhea is not spermatorrhea or stricture, vesical ca tarrh or some one of the many conditions that are ever at hand to render them impotent for the rest of their lives. With these nervous conditions present gonorrhea is not the simple disease that the "old rounder" would have us

believe, but it is, as I find it oftentimes, a de

bilitating, rebellious and disappointing affec tion, frequently leading to decided cachexias, which if not dangerous in themselves prepare the way for other more formidable foes.

But we have digressed further than we intended, and must return to the practical question of the treatment of this disease. The discovery of the gonococcus, like that of other so called specific organisms, has not aided much in the cure of the disease. And the practical value of these discoveries can only

[Our respect for "old age" caused us to reproduce this for the consideration of our readers, and at the same time to show how little advance has been made in the treatment of this omnipresent and always annoying condition. We know of no disease in which there is more anxiety, more discontent to the patient, and at the same time more annoyance and disappointment to the physician than in gonorrhea. There are many causes for these features of the case, which may he found in self treatment by the "prescription of a friend," the neglect to receive proper Cattention in time, the presence of stricture, the re

sult from a knowledge of their existence. The soluble bougie, incorporating iodoform and other germicides, which a few years ago came so highly vaunted as a specific, has had its day and gone out of fashion. So with the other agents of this army of germicides, they are mustered in and mustered out, and we are scarcely aware of the fact.

There are a few believers in the theory of germs who make up preparations entirely sat isfactory to their scientific taste, but when the crucial test is made they too are found wanting, and gonorrhea remains uncured until the necessary three to five weeks have elapsed and the discharge stops.

There are occasional cases which get well during treatment in the first week or ten days, but they are rare exceptions. And now, after all the experimenting and investigating that has been done, we find a live medical journal calling attention to a prescription of alkalies, copaiba and cubebs internally, and an injection of acetate of lead and sulphate of zinc.

Surely this is not the result of ignorance concerning the "newest and best treatment of the day!" It is rather the evidence that the writer like many another of his brethren has tried the so-called "specifics," one after another, and found them no better, perhaps not so good as the time-honored salts of zinc and lead. In the treatment of gonorrhea I fear we are about ready to take up our syringes and advance backwards (?)

At the last "Congress fuer innere Medicin," held at Wiesbaden, considerable attention was given to the above subject, Prof. Kaposi, of Vienna, leading in the discussion. He called attention to the fact, that now, as four hundred years ago, mercury constitutes the standard treatment, and only a single addition has since been made to the therapeutics of syphilis. He affirmed that not only was syphilis curable, but of the constitutional infectious diseases it was the one which, with proper treatment, was most easy of being thoroughly eradicated from the system. He propounded three questions, and discussed them as follows:

First: Is there any positive method whereby the primary effects of syphilis may be treated and an immediate eradication of the disease produced?

If the initial step of the disease be viewed in its proper light, to wit: that the specific virus remains a certain (although indefinite) time in the primary lesion, and is drawn up from here in the lymphatics and blood vessels, three possible ways remain of effecting the desired result.

They are: The destruction of the virus at the point of infection in and with the primary lesion, by means of cauterization or excision. The objections to this procedure are that we are in absolute ignorance as to the time the virus may remain in the primary lesion, before it is absorbed, and that even favorable results are not of statistical value, as every sclerosis is not necessarily syphilitic. Neither the presence nor absence of glandular enlargements gives us definite data for knowing whether a primary lesion be syphilitic or not. If the relation of Lustgarten's bacillus to syphilis were fully demonstrated, their preswould form a valuable criterion for diagnosis of the primary lesions. Excision is practicable under certain circumstances, as for instance when located upon the margin of the prepuce, but almost wholly impracticable if situated on the glans or in the sulcus. Emplast. hydrarg. is effective in the local treatment of primary lesions.

Second: The disturbance or destruction of these vessels which form the pathway of absorption for the virus. Prof. Kaposi thinks whoever made this suggestion should have been more specific in his instructions. Which lymphatic vessel should be severed? The whole penis lies imbedded in a network of lymphatics, and, without more exact knowledge how can the prevention to be incurred by the very sweeping operation necessary under the circumstances be kept down to its traditional proportional ounce?

Third: Preventive measures. Although it is theoretically wrong to proceed with the eradication of a disease by first letting it fully develop, still he has observed that early treat

ment does not prevent the subsequent appearance of tertiary symptoms, which, under such circumstances, often appear in severe forms. He urgently advises not to be too hasty with the mercurial treatment.

[It would seem from this advice that Kaposi believes the early administration of mercury has a tendency to render the subsequent stages more grave, n opinion from which many eminent syphilographers will differ.]

Second question: What are the respective advantages of the different remedies used in the treatment of syphilis?

Hospital statistics are of no avail since patients generally disappear so soon as the lesions are removed; and since private statistics are not to be had, we are referred to individual cases, from which it is impossible to form any comparative judgment. Mercury is applied endermically, hypodermically and through the organs of digestion. Of the endermic means, inunctions are the most important. The plain ung. hydrarg. is the most reliable method of treating early syphilis. Intestinal affections and ptyalism very infrequently accompany the application of blue ointment, and by means of it is obtained a happy medium between absorption and elimination. Mercurial baths are very effective in the treatment of newly born infants and adults suffering from ulcerous eruptions. The hypoder mic method is direct, exact and convenient, and beside the original sublimate solution of Lewin, a number of other preparations have been experimented with. The following three groups of Hg. remedies have been arranged by Bockhart with reference to their perma

nency.

1. Most permanent.

a. Inunction method (ung. hydrarg). (Subcutaneous).

b. Calomel injection.

c. Lewin's sublimate solution.
2. Moderately permanent.
(Subcutaneous).

a. Sublimate-chloride of sodium.
b. Hg. albuminate and peptonate.
c. Blood-serum mercury.

3. Less permanent.

(Subcutaneous).

a. Hg. bicyanide. b. Hg. glycocoli. c. Hg. formanide.

The formanide is the least painful. Internally the customary Hg. preparations (sublimate, calomel and hydroxyd. tann.) act usually more slowly than the others; still, they are quite effective, and especially the last causes but slight discomfort to the stomach. In France, proto- and deuteroiodide of mercury find great favor as internal remedies.

Mercury is best adapted for all forms of affections of the skin, both in early and late periods, and in acute conditions of the bone, the parenchymatous organs, and of the cere bro-spinal system, whereas the later nervous affections of the joints and cephalalgia syphilitica yield decidedly more quickly to iodine treatment. The more promptly and actively treatment is begun in the first acute stage of the disease, the less is the probability of a relapse. Therefore inunctions, or, if these are not possible, injections should be energetically begun at the proper time, and the most permanent remedies should be selected. All slow-working remedies cause only a prolonga. tion if applied in the acute stage. Only in cases of later affections, such as localized papulous formations, may they be applied, but in affections of a dangerous nature, such as iritis, ulcerative nasal or throat affections, or those of the brain or spinal column, it is essential to use the most energetic means, and especially the inunction method with ung. hydrarg.

Iodine is especially good in cases of bone and joint affections, and also for nocturnal pains in the bones and in the head. It can also be prescribed for syphilitic symptoms during the later periods, but should never be used alone in the beginning of the disease, owing to the protracted course of eruption which follows it. That iodine may be used as a corrective against the misuse of mercury is a total misconception, and utterly without foundation.

Zittmann's decoction of herbs is a very

potent measure for later stages, and especially for ulcerative formations of the skin and throat.

Prof. Kaposi often combines the use of this decoction with inunctions, and observes that the presence of Hg. does not affect its activity. Sulphur baths, sea baths, and hydropathic treatment have not the slightest specific effect upon the disease.

How long should treatment be continued? Concerning the third question, as to the length of time and the repetition of treatment, Prof. Kaposi advised a long and careful course for from three to six months, and to repeat the treatment only when relapses occur, and not in order to prevent them. He did not object, however, to a light course of treat ment for safety's sake.

Prof. Neisser, of Breslau, did not agree with Prof. Kaposi, in his views with reference to an advisable delay in the treatment. He believed in cauterization with concentrated carbolic acid, or if possible excision. He believed it advisable to use every opportutunity for the prevention of an outbreak of syphilis, and destruction of its virus. He agreed generally with Fournier in his views and in the treatment preferred, as he said, to recognize the individual and fashion his treatment thereafter, than to recommend any sin gle system for all cases.

Prof. von Ziemssen, of Munich, recommended especially hypodermic injections of bieyanide of mercury, and after a lengthy discussion Prof. Kaposi closed by expressing the hope that physicians generally might add statistics from their private practice, so that more extensive data may be available. Deutsche Med. Wochenschrift - Jour. of Cut. and Ven. Dis.,Aug. 1886.- Maryland Med. Jour.

ORIGINAL ARTICLES.

OUR THERAPEUTICAL INHERITANCE.

BY FRANK W. VANCE, M.D., MEMPHIS, TENN.

dom, and regard the crude ideas of our preWe are prone to look to antiquity for wis decessors as embodiments of truth gathered by ages of experience. The ages have be queathed to us their truths of experience, and also their dogmas of false theory and undeveloped knowledge, which bearing the stamp of authority have commanded respect wholly unentitled to. False ideas have brought forth dogma, while dogma has moulded practice to fit its forms; and erroneous practice is beexperience that is above question. queathed to us, a seeming product of human

It is only at a late day that anatomy and physiology, with dissections and vivisections, have brought to light the mysterious architiquity forbade dissection, consequently phytecture and function of the human body. Ansiology was impossible, and in place of our modern science, a nescience was established, based on vague metaphysical principles and formula, that was carried into the domain of could not but originate a false therapeutic pathology. A false physiology and pathology system, but strange to say, although we have abandoned the literal interpretation of the nomenclature of the fathers of medicine, the great majority have not given up their therapeutics. When philosophy sounded the deathknell to the paganism of the Greco-Roman world, there were yet many who clung to the superstitions of their fathers. Literal paganism was an impossibility, but by amalgamation with the science of the age, a philosophic paganism was developed, the literal expression of which symbolized truths approached at by preceding antiquity, but left for the succeeding age to elaborate into scientific perfection.

Even so have the medical superstitions of our predecessors been looked upon as inklings into physiological and pathological truths, and associated with modern physiological, pathological and therapeutical endeavor.

If the fathers of medicine had stopped after elaboration of their false physiology and pathdertook to build thereon a false therapeutic ology, all would have been well, but they unsystem that has been the bane, and still is, even at this date, of suffering humanity. The power of modern physiological investigation has broken down the nescience of the past, but where is the power that can destroy the modes of therapeutical procedure based on

demolished theories? For these modes are the inheritance of the past and slovenliness of judgment, on which authority has set its seal -except in the case of a physiological fact brought direct before the mind contradicting a former theory-is by no means an easy matter to overcome. And then there is deliberate falsification of clinical facts by many, whose respect and reverence for authority antagonizes any independence that they ought to and should possess. Excepting bleeding, that is to a great extent abandoned, purgation, vomiting and counter-irritation are still persisted in, although correct clinical report has failed to show that either has ever resulted in anything but real harm. I allude to purga. tion and vomiting in the sense as means to treat disease based on ancient theories of

morbific humors and revulsion and fluxion, and not as any endeavor to get rid of a poison intentionally or accidentally received into the system. In regard to counter-irritation it was practiced long before anatomy, physiology and pathology were dreamed of, and the same inethod of procedure was brought about, not by experimental good, but as the natural off. shoot of metaphysical theories of disease. To follow out the evolution of medical dogma from the earliest times is foreign to my purpose, but by consultation of the oldest authorities down to John Hunter, and even to the orthodox therapeutics of the present day, we can witness the development of erroneous ideas and assertative dogmatism, whose only claim is that the judgment of preceding authority is superior to ever advancing scientific achievement that completely demolishes one by one the ideas of our boasted inheritance of the past.

WEEKLY MEDICAL REVIEW,

EDITED BY

THE MEDICAL PRESS AND LIBRARY ASSOCIATION 914 LOCUST STREET, ST. Louis, Mo.

Contributions for publication should be sent to Dr. I. N. Love, Secretary Executive Committee, Cor. Grand and Lindell Aves.

SATURDAY, SEPTEMBER 25, 1886.

PROF. L. CH. BOISLINIERE, M. D.

We congratulate Dr. Boisliniere and the medical profession of St. Louis upon his restoration to health after a long illness; for a time we feared that we might again be called to mourn the loss of a valuable member of our profession. The doctor has been practicing medicine very successfully in St. Louis for thirty-eight years, having commenced in 1848; during that time, who, but he, can tell how many of his co-laborers he has seen borne to the quiet shades of Bellefontaine or Calvary Cemetery?

During these years he has seen St. Louis pass from the position of a small village upon the western bank of the Mississippi to be the great central city of the continent with her half million inhabitants.

In those early days, Dr. Boisliniere was a prominent and respected member of the community, and to-day he ranks among the most eminent men in our midst. His patients are numbered among the thousands, and we are sure that each and every one of them is his loyal and loving friend.

For fifteen years he was Professor of Obstetrics and Gynecology in the St. Louis Medical College, having been elected to succeed Dr. M. Pallen. He resigned active work in the college last spring, and is now Emeritus Professor of the Department. In pursuance of the discreet and wise plan of husbanding his strength, he has eliminated nearly all out-door material from his practice and confines himself now mostly to office and consultation work.