ise other than temporary relief, and never a cure, by any other treatment other than radical surgery. BIBLIOGRAPHY. Hectoen-Text Book of Pathology. The Journal of The American Medical Association, April 1, 1905. The Monthly Cyclopædia of Practical Medicine, December, 1904. The Journal of The American Medical Association, February 18, 1905. Von-Bergman's System of Practical Surgery. The International Text Book of Surgery. An American Text Book of Surgery. DISCUSSION. Dr. Wilder: I am sorry that I did not hear all of Dr. Gay's paper, but I had the pleasure of listening to the last part of it. I agree heartily with what he has to say. As to elastic stockings, rubber bandages, etc., they do not do more than an ordinary truss does for a hernia, and in this day of aseptic treatment, what is known as the subcutaneous operation is not done any more. Of course when you can open and see what surgery you are going to do, a man would be foolish to try an operation in the dark, when he can get an operation in the light. I have never tried the subcutaneous operation in my life, and I don't think I ever will, because I am sure I could not do as well as when the vein is before my eyes. A few years ago we tried these operations for varicocele. I cannot see how the operator can tell whether he is going to ligate the artery or cord; for it is sometimes hard to tell with the field of operation before you. If the technique is perfectly clean, the wound will heal by primary union. I favor taking the vein out in toto; this can be done with less incision than you might suppose. You can leave a space a couple of inches below a veinany number of inches you desire,-and if you have been surgically clean in your work there, all the incisions you have made will heal kindly and nicely. That is by all odds the best method of removing these veins. Exactly the same principle as hemorrhoids. If the vein is taken out, in fully three-fourths of the cases you get a permanent cure, and it is almost void of danger if done aseptically. Dr. DuBose: I wish to commend the paper read by Dr. Gay. One suggestion is that the operation for varicose veins is one suitable for local anesthesia, using the Schleich infiltration method. It has been my pleasure to do this, ligating the main trunk, and in another case to do the circular method, with complete relief of the varicosity and the ulcers of the leg. The electro-therapeutic treatment as opposed to surgical methods has been presented very elaborately in the discussion of this paper. It has been my good fortune to have opportunities for the study of this branch of therapeutics under Massey, of Philadelphia, and to see eminent workers abroad do work in this line, having installed in my office static machines. Table plates (Galvano-Faradic), D'Arsonval high frequency apparatus, coils, etc., and working with these appliances for several years in the treatment of diseases, I feel competent to pass judgment on the electro-therapeutics of to-day. This is a valuable addition to one's armentarium, and I do not wish to condemn it, for it has its uses, and uses which connot be replaced at present by other known means. It has some very remarkable effects; in removing superficial growths, nevi, epithelioma, etc.; in checking uterine hemorrhage uncontrolled by curettage; in the treatment of some ulcers of the leg, etc., and other conditions, such as neuroses, neuralgias, myalgias, and similar affections it has a use, but a limited use. As an enthusiast who has been through all the stages of enthusiasm, even to the impoverishment of his pocket for appliances and apparatus, I am one who wishes to go on record as a witness to the fact and statement that it has not an equal range of usefulness when placed alongside modern surgical practice, nor can I now, and I doubt if ever, replace the knife, as we would be made to believe by one in this discussion. To depend upon it as a cure all, to laud it as a remedy to heal ulcers due to a vitiated circulation, is asking too much. To permanently eradicate varicose ulcers, the cause must first be removed. You cannot coagulate the blood in the veins by the negative current. The positive current is the one for this purpose, and then only when used through an electrode of some non-corrosive metal, such as platinum or gold. The positive current acting on copper, zinc or mercury, or the alloys of these metals, when introduced in animal bodies, deposits the oxy-chlorides of these metallic substances in the tissues; they are caustics, and if you have sufficient amperage you will produce tissue necrosis. If you use a brass electrode, and attach it to the anode of your battery, you will not only coagulate your blood and its vessel, but also the tissue immediately surrounding, and when this necrotic mass comes away as a slough, secondery hemorrhage is not uncommon. This process is one of weeks, while a clean surgical operation is one of days. These electro-therapeutists really try. to believe that the knife is robbed of its terrors by being supplanted by electricity, while every man who has had any extensive observation or experience in this line, knows that death is not totally eliminated as a sequence of electro-therapeutic treatment, the mortuary reports being on record. The man who employs electricity to-day in its modern advanced way, and imagines that he has a harmless agent in his hands, and uses it indiscriminately will soon find he is in error, and its harmfulness will be a sad lesson to him. It is a most useful agent with well defined limitations, used by surgeons all over this country who recognize its merits, and who do not let its untimely use rob certain cases of their chances of recovery, which the timely use of the knife would insure. Dr. Camp: I endorse the paper from a surgical standpoint. Of course there is plenty of evidence to verify what the assayist has said. There is one point that I wish to discuss. I hold that the conditions can be cured as effectively by other means, without any of the dangers of the surgical method; that is, by electrolysis. I do not mean to say that surgery will not; of course, by removing the veins you will cure the condition. I have in mind a case in which there was varicosity of both limbs, with ulceration of both legs; he was told by one or two doctors that nothing could be done for him. I cured him without putting him to bed, by the use of electrolysis. He was a mechanic, doing manual labor, and the ulcers have remained healed. The cure is affected by the coagulation of the blood. You introduce one of the most powerful antiseptics you have, an ordinary brass pin or needle. Only one danger exists, which you likewise encounter in the open operation, and that is the danger of embolism. The entire vein becomes coagulated and it is permanent, and you accomplish it without any of the unfavorable conditions attending ligation. Dr. Welch: Some time ago I was in consultation with a friend a few miles from town; the case was one of gangrene of the lower extremity, which gave a history of an attack of varicose veins some two years before; she had been suffering during that time with varicose veins of the lower extremities, and I supposed that thrombosis of the iliac artery had caused the gangrene of the lower extremity. She was found in a septic condition, an extremely serious condition, when I saw her. The limb was removed as the near the body as it was possible to take it off. She revived somewhat, and died in the course of three or four days as the result of the septic condition. Dr. Gay (in conclusion): I wish to thank the gentlemen for their free discussion of the paper. It has been a surprise to me in looking through the literature in getting ready to prepare this paper, how little interest there seems to have been taken by the profession at large in this subject. There is not one of the medical journals that I have not gone through the index to find what they have to say on the subject. To my surprise, I have not found over a half dozen that had anything to say, and then small clippings from other journals. It seems to me that from the frequency of these diseases, and the benefits we can derive by surgical treatment, there ought to be interest manifested by the profession. In reference to the electrical treatment, I will say that I have the usual current, but I have not been an enthusiast. It may be on account of my ignorance of the subject; but when it comes to introducing a needle, or anything else, into the diseased vein, and producing thrombosis, I would not do it, and I would not allow any one else to do it on me. I think a man doing that would court more danger than if he left it alone. MODERN THERAPEUTICS, FROM THE STAND POINT OF RATIONAL MEDICINE. BY HENRY ALTAMONT MOODY, M. D., OF FLORENCE. Senior Counsellor of The Medical Association of the State of Alabama. Dorland's definition of Therapeutics is "the science and art of healing." Therefore, Therapeutics concerns every material, means, or method employed for the relief of suffering or the cure of dis To intelligently consider a subject so broad, or any considerable part of it, some form of classification is indispensable. The first grand divisions into which it naturally falls are, Rational Therapeutics, and Empirical Therapeutics. Most of the measures now considered rational first served an apprenticeship as empirical, until long and repeated observations of their effects revealed their modes of action, or as much thereof as our present physiological knowledge enables us to understand; they were then transferred to the rational class. The next step in classification is not yet a matter of general agreement. Many writers upon Materia Medica arrange its elements in alphabetical order. This plan at once removes it from the domain of Rational Therapeutics, and makes that subject one of reference merely, like a descriptive dictionary, easily consulted, but barren of suggestion. Another plan is to present materials in the order of their botanical, chemical, or cosmic relations; a very suitable order for laboratory use, but not helpful to the physician. Materia Medica is not Therapeutics, but is vitally necessary to it. Their relations may be compared to that existing between architecture, and the wood, iron, stone, brick and mortar upon which it depends for the erection of its splendid crea tions. The architect should be so well informed that when tensile strength is suggested he would recall not one substance only, but a whole class of materials suitable for the purpose; and so the therapeutist, when confronted with a failing heart, should remember not one drug only, but a whole class of remedies |