My last case was discharged in just nine days, cured by the sulphide of calcium. I must say here that this agent is rather troublesome to the pharmacist, and the preparations in the market are not all equally reliable. Those used in the case mentioned came from the Philadelphia Granule Co., and were perfectly satisfactory, as have been all the granules I have used of their make.

Next to this comes salol, and this also is usefully given from the beginning of the attack. But the best time to give salol is when there are indications that the bladder is becoming affected, the urination being frequent, and a disposition to straining manifested. From twenty to forty grains daily should be given, in pill or capsule. The same indication is met by the use of benzoic acid, in doses up to twenty grains daily. Both these agents relieve the pain and tenesmus, and check the discharge. I prefer salol in the early stages, benzoic acid in the later, when the acute inflammation has subsided. The salicylate of lithia may be substituted for salol if the latter disagrees, or may be given with it if it be deemed advisable not to give large doses of salol. For instance, if the urine becomes brown or smoky, salol should be discontinued and the lithia substituted. The benzoate of lithia is admirably suited to the later stages, when the potash salts have been laid aside.

Still later, when al acute symptoms have passed away and the discharge continues freely, from relaxation and atony of the mucous membrane, the oleo resin of cubebs and tannate of iron are indicated. I prefer to give these agents alternately, each for a week. Other remedies for this stage are eucalyptol, thymol, copaiba, myrtol, myrrhic acid, barosmin, menthol, liatrin, collinsonin, and oleo resin of piper nigrum. The barosmin is best if the bladder be implicated. As to the others, I have not been able to establish any certain guide as to their selection. The action is very nearly identical; some being stronger, others agreeing best with certain persons.

Del

Chordee is not so likely to develop if injections and copaiba are not employed in the acute stage. Tartar emetic or colchicine should be given in full doses, to produce nausea. phinine has the reputation of a specific. The bowels should be kept open by salines, and iridin or enonymin to act on the liver. If the erections are frequent, piperazin, gr. v. thrice daily, should be added. But if the regimen suggested be carried out, there is rarely any trouble with chordee.

Cantharidin is a useful remedy when a slight gleet hangs on, with feebleness of the bladder

or impairment of the sexual vigor. exceedingly active remedy and or three times a day is quite enough.

This is an grain two

For gonorrheal ophthalmia anemonim has been recommended; but for this, and for gonorrheal rheumatism as well, I prefer the sulphide of calsium and the iodi le of arsenic; the latter in doses of gr. thrice daily, before meals.

Hydrastine is of value in the same cases as tannate of iron. Caulophyllin is said to be useful, but I have never tried it in this affection. Gelseminine is an efficient remedy for chordee, and to allay sexual excitement. It should be given cautiously, yet in doses large enough to have the desired effect; or at least to reduce the heart's action materially. Perhaps the most generally useful combination is calcium sulphide and gelseminine.

Are injections really required? So much harm is done by unskilful topical medication that I would prefer not to use injections at all, unless they are administered by the physician in person. In that case, a weak solution of potassium permanganate in hot water, or the acetates of lead and of morphine, or bismuth sub nitrate suspended in water, or hamamelis water give the same relief that hot salt water does in coryza, or hot water alone in dysentery. It is the heat that relieves; the antiseptic being of less importance. The solution should never be strong enough to cause smarting; the object being sedation strictly. If the local inflammation be severe it is better not to employ injections at all, but to apply tincture of iodine, or the yellow oxide of mercury ointment to the under surface of the penis. When I use injections at all, I employ a delicate little rubber tube with the orifices at the end directed backwards. This is inserted just after the patient has urinated, so as to avoid, if possible, carrying the gonococci back into the healthy portion of the urethra. The tube is inserted beyond the inflamed section, and a stream of the liquid allowed to run through and out at the meatus for five or ten minutes. Thus the urethra is thoroughly flushed. This is repeated as often as pus shows itself at the meatus.

A case recently treated by me showed some unusual features. The man had had gonorrhea four years previously. At that time a tumor appeared on the left side of the penis, increased to the size of an egg, and was lanced, discharging pus and urine. It soon closed, but left a hard lump about the size of a large bean, and on erection, the penis was curved toward that side. One month before coming to me he had a second attack of gonorrhea in which the abscess reappeared in the same spot, and opened

Another

spontaneously, discharging pus. abscess also appeared on the right side, nearer the glans. One testicle also swelled; and at the lower end of this organ there was detached a harb mass about the size of a walnut; the testicle being softer than normal. The inguinal glands on the right side were also indurated; the remains of a suppurative bubo following the first attack of gonorrhea.

There was no history of syphilitic rheuma. tism, syphilides or sore throat; but an examination of his back showed small rupia and scars. The absence of the usual specific phenomena were attributed to partial protection by heredity. The patient was sent to bed; lead water applied to the testicle, sulphide of calcium given internally, and an ointment of yellow oxide of mercury, seven grains to the ounce of benzoated lard, applied to the hard masses. The discharge dried up, the swelling subsided, and in one week the case was so nearly recovered that he was allowed to return to his business. The hardness was fast disappearing, and I have little doubt but that under the influence of mercury locally and internally the indurations will be entirely absorbed.

I have frequently been consulted in regard to these hard lumps, and the deformity they occasion; and I believe they are due to the same cause-inflammatory exudation or suppuration attendant on gonorrhea, when the gonococci have penetrated more deeply than usual into the tissues of the penis. It is not necessary to assume that they are specific because they melt down and are absorbed under the influence of mercury or iodine. These agents cause the absorption of the normal tissues; still more the pathological growths, because their structure is feebler; and most of all do they affect the syphilitic growths because the vitality of these is so feeble that they even tend to spontaneous destruction by breaking down. WILLIAM F. Waugh, M. D.,

103 State St., Chicago.

Nuclein Medication.—Its Physiological Basis and

Therapeutic Applications.

Editor MEDICAL WORLD:-The subject of nuclein medication being of recent origin, it seems the part of wisdom to acquaint your many readers with some of the elementary facts which led up to the practical adaptation of certain well-recognized physiological principles upon which the theory rests. Professor Virchow, in his classical work, "Cellular Pa:hology," gave the medical profession exact, and in many instances, surprising data relating to the pathological changes occurring in tissues and cells during the progress of various diseases. About

seven years ago I began to study, from a clini'cal standpoint, the changes taking place in tissues and cells in the case of recovery from disease. Thus, in the case of disorders of the rena]} function, we can estimate the clinical effects of various medicaments in restoring the functional activity of these structures. Aconite, for example, not only increases the urinary water, but also the output of urinary solids, the results being due, evidently, to its influence upon cellular activity. In prescribing remedies for different ailments, we always take into consideration the effect which the drug or remedy will have upon this function, and knowing from physiological and experimental investigation the par. ticular structures upon which a drug or remedy specially acts, it was but a step to designate this universal practice by a name which should cover the entire domain of therapeutics. In this manner originated the name "Cellulartherapy," and so far as my observations and study extend, it appears to be appropriate and complete.

Nuclein therapy is substantially a branch of cellular therapy, since it has to deal directly with the causes at work in the restoration of cell-function, as will be understood from the following illustration: When a person eats a hearty meal, there follows, in the course of a couple of hours, an increased number of white blood-corpuscles in the circulating fluid. These, it is now believed, are not formed de novo, but are simply brought into the blood-current through some agency which we do not now fully understand. This is called "digestive leucocy tosis." Now, it is a well-known fact that a person feels much better after partaking of food, and when the food is readily digestible, and, as we say, assimilable, this sense of well-being continues for some time. After cuts, bruises and surgical operations, a similar train of conditions obtain, and is called "inflammatory leucocytosis." In pneumonia, daily examinations of the blood will enable the attendant to determine with a reasonable degree of certainty the final outcome of the disease, inflammatory leucocytosis always boding a favorable prognosis. This seems to be Nature's method of conquering disease and we are thus brought face to face with so called "natural conservatism."

It is but recently that the medical profession has been able to form a true conception of the function of the white blood corpuscles. Metschnikoff taught that certain leucocytes, which he termed "phagocytes," possessed the power to envelope bacteria and destroy them, and for many years the doctrine of phagocytosis was strongly advocated and as persistently denied. Later on, it was demonstrated that leucocytosis

had a wider and more far-reaching significance than that which had been advanced in respect to phagocytosis, inasmuch as certain leucocytes (the multinuclear white blood-corpuscles) possessed certain peculiar properties, hitherto unknown, namely, the power to attack bacteria as pointed out by Metschnikoff, and the additional function of producing a non-irritant and nontoxic antiseptic. This product occurs in the form of a phosphorized proteid, having a somewhat complex base, the phosphorus existing in the form of nucleinic acid, and is called nuclein, or nuclein acid. This substance is found in both animal and plant life; wherever there is a nucleus, there do we find nuclein. It can be obtained from yeast cells, from the yelk of the egg, from the blood itself, from the testicles, from the brain substance, and from the blood-making organs, such as the spleen, the bone marrow, the thyroid and thymus glands. The source of supply is practically unlimited. In this country, but two products have been studied clinically, viz., that from yeast cells and that obtained from the thyroid and thymus glands. The latter only will be referred to in this paper.

Nuclein, in the form of a solution, is prepared by artificial digestion after preliminary maceration in water, and when introduced into the economy, appears to enact the role of a ferment, establishing an artificial leucocytosis; in other words, it stimulates cellular activity, and thus emphasizes the true physiological basis of cellular therapy. There are a number of diseased conditions in which its effects can be easily studied, both physiologically and clinically. In simple anemia, debility from any cause, and convalescence from acute diseases, the results of nuclein medication are prompt and permanent. In malaria, the improved subjective sensations of the patient will be noticeable within a few days, but a more satisfactory test will be found in the examination of the blood under the microscope. In diphtheria, the changed condition of affairs within the first twenty-four hours is sometimes remarkable. In fact, all throat affections are ameliorated, and most of them quickly relieved by the exhibition of nuclein solution.

The question will be asked, How does this remedy relieve and cure such a varied class of disorders? That brings us to a consideration of the physiological function of nuclein in the human economy. If it were not for the presence of this substance in the organism, what would be the condition of the mouth, the nose, the bronchial tubes, the stomach and intestinal tract, the bladder and the skin? Why, if Nature did not provide some form of an anti

septic, all the structures mentioned would very soon become diseased. Pathological changes would result in destructive metamorphosis, and as a consequence, breaking down of tissue would follow, with the absorption of poisonous products. Auto-infection from the intestinal tract is all too common, but auto-infection from the naso-pharyngeal space, from the tonsils, from the bror chial tubes, from the stomach, from the liver, from the kidneys and the skin is too frequently overlooked. Thus, we see that it is the function of nuclein in the organism to destroy-through its antiseptic properties-the thousand-and-one poisonous products that are liable to accumulate through faulty elimination. The white blood corpuscles have been credited with being the scavengers, but the foregoing is believed to be the true explanation. Just as an yeast poultice cleanses a foul ulcer, or a gargle of the same arrests a sore throat, or a little taken into the stomach, destroys an unhealthy fermentation, so nuclein, taken into the bloodcurrent corrects an abnormal condition of the circulating fluid by enacting the role of a ferment. It is, therefore, indicated in all cases characterized by a disorganized state of the blood.

Reasoning from these premises, it might be assumed that a remedy which affords such remarkable results in diseased conditions would be of service in preventing the invasion of disorders dependent upon the presence of micro-organism or their products, and, fortunately, this also is true. Investigations have now been in progress for a sufficient length of time to warrant the assertion that this nuclein solution— from the thy roid and thymus glands--will prevent the development of a number of diseases which, hitherto, we have been wholly unable to control; but it would not be policy to enter into an elaboration of this subject, as that will be reserved for a special paper.

The therapeutic applications of nuclein solution will be referred to in the briefest possible manner, the object of the present paper being to incorporate or ly those diseases in which its value has been repeatedly demonstrated by quite a number of clinicians in different parts of the country.

case

Malaria.-Nuclein solution has proven effective in the treatment of the various types of malaria, acute, chronic, recurrent and masked. Professor E. F. Wilson, of the Ohio Medical University, Columbus, Ohio, reports a (Columbus Medical Journal, January 22, 1895) in which, after the long continued use of quinine, occasionally as much as sixty grains in the twenty-four hours, and subsequently arsenic and Warburg's tincture in full doses, utterly failed, where very small doses of nuclein effected

a marked change in the space of two days, and where the patient recovered at the end of a week. Professor Frank C. Wilson, of Louisville, Ky., reports (American Practitioner and News, November, 1894), having used it with success in a number of cases of malaria, acute and chronic. Dr. W. H. Park, of Nashville, Tenn, reports (Medical Summary, July, 1894), distinct benefit in three days and apparent recovery in ten days in a case which had resisted quinine and other medicaments for eight years.

The dose of the solution in this disease will depend upon the age of the patient and the stage of the disease. An adult will take a drop at intervals of two hours, or one minim every four hours, either in the form of tablets or granules, or the solution can be added to a little water or elixir calisaya and taken every two to four hours. In giving it hypodermically, to avoid unnecessary punctures, the dose may be larger, two to five minims (five to ten drops), and the remedy administered diluted with a small quantity of sterilized water every day, or on alternate days.

Diphtheria. -The peculiar virtues of the remedy are most manifest when the disease af. fects mucous structures, as in the case of diphtheria, tonsillitis, pharyngitis and laryngitis. Thus, in diphtheria, Dr. J. Mount Bleyer, of New York (American Therapist, September, 1894), reports four cases successfully treated, in which the patients recovered in from two to five days after beginning treatment. In some of his cases other treatment had failed to relieve or modify the disease. The following extract will show the standing which the remedy has attained in his confidence:

"Attention should be called to the most noticeable features of the foregoing cases, occurring in the first twenty-four hours:

1. A fall of temperature amounting to three degrees.

2. Loosening and discharge of the membrane. 3. No rise in temperature when once reduced.

4. No unfavorable after-effects from the use of the remedy or attack of the disease-all going to show the power possessed by nuclein for checking complications or holding in abeyance other disturbances."

The dose in diphtheria will vary according to the age of the patient and severity of the attack. In ordinary or comparatively mild cases, when seen in the early stage, a tablet containing onethird of a minim (or four granules, each containing one-twelfth minim of the standard solution), can be given hourly for the first twentyfour hours. Later, the frequency and size of the dose can be determined by the effect pro

duced. In serious cases, or when the patient is not seen in the early stage, it is probably best to administer the remedy hypodermically. At the age mentioned, two minims (five drops) should be added to sufficient sterilized water to make a syringe-full, and this quantity injected under the skin at some indifferent point at intervals of from two to four hours, for the first twenty-four hours, after which the amount and frequency of the dose must be determined by the attendant.

Bronchial Affections.-Bronchitis being an inflammation of the mucous membrane, naturally comes in the same category with tonsilitis, laryngitis, rhinitis and like disorders. Nuclein solution is useful only in the subacute and chronic stage of bronchitis, although it may be given with appreciable benefit in the latter stages of an acute attack, after the activity of the circulation has been brought under control by vascular and cardiac sedatives. In this disorder we must recognize a derangement of function, rather than an entity. Whatever produces the disorder leads to what has been termed an inflammatory leucocytosis, where Nature attempts to remedy the evil by sending an increased supply of leucocytes to enact the role of an antiseptic. But nature is too often handicapped by reason of the fact that those who suffer from bronchitis usually suffer also from a debilitated condition of the system; hence, there is lacking the needed pabulum to maintain the integrity of the nuclein-producing power. To supply quality, increased quantity is sent to the disordered structures, and, as a rule, there is generally profuse expectoration. Now, in the opinion of the writer, it is sheer folly to exhibi: expectorants, when the bronchial mucous membrane is already water-logged. What the patient really needs is a re-inforcement of the nuclein producing power, and this is secured by the administration of nuclein ar tiffcially. In these cases, especially the chronic variety, it is truly wonderful how quickly the expectoration ceases and the persistent cough subsides. And yet it does not act in any respect like opium or other iodines; on the contrary, the appetite improves, the bowels become regular, the cutaneous transpiration is increased, and the patients express themselves as feeling greatly improved from the first dose.

Tuberculosis.-Nuclein solution was not originally recommended in the treatment of tubercular affections, simply for the reason that the writer felt that too many remedies had been unnecessarily burdened with the claim that they could relieve or cure tuberculosis. This statement is interpolated in order to bring to the notice of the profession that no claims have

been made as to what may be expected of it in the treatment of this disease. Nevertheless, the writer has employed it quite extensively, and several reports have appeared from others, in which its administration has been followed by fairly encouraging results. Dr. Charles P. Knapp, of Wyoming, Pa., is about to publish an account of two cases of enlargement of the cervical glands, undoubtedly tubercular in character, in which the administration produced marked benefit. It will be sufficient to say here that nuclein solution in tuberculosis will relieve certain symptoms. For example, it lessens the expectoration and improves its character, and incidentally, there is much less disposition to cough, while the chest pains and abdominal soreness subside. Furthermore, the appetite improves, the bowels are regulated, so that the necessity for anodynes and opiates disappears, while night sweats are usually arrested and show no disposition to return.

JOHN AULDE, M.D., 1411 Walnut street, Philadelphia.

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