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and morning. B Ol. copaibae, ol. cubebae, ol. santal flav., aa3j; magnesiae, 3ij. M. Ft. pil. no. lx. Sig: Two pills every four hours."-Page 784.

"The most important application of cubeb is in the treatment of gonorrhea. Unlike copaiba, it may be administered with good effect during the acute stage. The best results are obtained from a mixture of the two agents."Page 786.

"The oil of juniper acts similarly to, and is indicated under the same conditions as, turpentine in chronic pyelitis, chronic cystitis, gleet, prostorrhea, etc. Diuretic effects may be obtained by inhalation of the vapor of the oil. For this purpose a few drops may be put into hot water, and the vapor be inhaled."-Page 789.

"Gleet and postorrhea are benefitted by cantharides when these maladies occur in subjects of a relaxed fibre, with feeble circulation. Ringer makes the extraordinary statement that one drop of the tincture given three times a day will prevent chordee."-Page 799.

"Blisters are as a rule, inadmissable in acute affections of the kidneys and bladder. A succession of blisters to the perinaeum is unquestionably serviceable in chronic prostatitis and in gleet."-Page 807.

"In gonorrhea hydrogen dioxide is an excellent injection, destroying the gonococcus and arresting the formation of pus. According to the severity of the symptoms, it may be used in the strength of the official solution or diluted one-half or one-fourth."-Page 369.

PATHOLOGY AND THERAPEUSIS OF UTERINE GONORRHEA.

By Dr. Heinrich Schultz (La Revue Medicale, Nov. 29, 1899.

Neisser calls attention to the fact that although the treatment of gonorrhea in the male has made vast strides in recent years, the treatment of this affection in the female has made little progress. Many gynecologists consider cervico-uterin gonorrhea as incurable. This is exaggerated. Every purulent cervical discharge is not gonorrheal. Again, even transparent secretions may show the presence of the gonococcus. In the absence of the latter a discharge may be regarded as non-contagious. Uterine gonorrhea can only be diagnosticated when the cervical discharge contains gonococci.

In 200 sick prostitutes the secretions were purulent in 108 cases, transparent in 10, and more or less turbid in the remainder. Uterine gonorrhea was found in 76 cases, with purulent secretions in 45, transparent secretions in 4, and turbid secretions in 27. Gonococci were discovered in 50 to 60 per cent of the cases. Microscopical examination is of prime importance in the diagnosis. In about 38 per cent of the cases cervical gonorrhea extends upwards into

the uterine cavity. Most cases of gonorrhea occur in young prostitutes; also adnexal gonorrhea.

Schulz makes twice weekly intra-cervical or intra-uterine injections with 4 per cent sol. of protargol, with pyroligneous acid, with 5 to 10 per cent nitrate of silver solution, or with 10 per cent solution of argentamin. Only the first injections are apt to be followed by painful reaction. Of 2,000 injections made in 200 women it was necessary to suspend the treatment in 10 cases because of pain. In 2 cases periuretritis with exudate resulted but passed away in several weeks. After 9 injections with 5 to 10 per cent nitrate of silver or argentamin (up to 10 per cent) the majority of cures have followed. The nitrate of silver sometimes provokes metrorrhagia or painful reaction; hence the author prefers argentamin in 10 per cent solution.-PostGraduate.

BLENNORRHAGIA

Has received from Vogl, of Munich, critical study as to the results obtained from its modern treatment in the military hospital of Munich, since 1882, leaving out of consideration all but specific treatments.

In 1893 patients were treated by Neisser's method and given injections of silver nitrate I5000. In 1894 potassium permanganate, I-4000: sodium sulphophenate, 1-180; and later silver nitrate 1-3000, were used. In 1897, protargol was the remedy.

Before the employment of these remedies the average duration of treatment was 45 days; since their introduction, 45 to 47 days. In 1896-1897, Neisser employed various silver salts and lowered the average by five days, but in 20 of the cases there was recurrence. In 1898, when the nitrate, the permanangnate, and protargol were all used the average was reduced to 42 days, but there were 7 cases of recurrence. At best, reduction averaged but 5 days.-Mericks' Archives.

EFFECT OF REPEATED COITUS ON THE SEMINAL FLUID.

Victor G. Vecki, in his book on the "Pathology and Treatment of Sexual Impotence" (Philadelphia: W. B. Saunders), puts forward certain. statements under the physiology of the sexual act, which have roused quite a commotion in the ranks of German oldfogydom. He rejects the ordnary views as to the infrequency and insufficient vitality of spermatozoa after repeated coitus. A series of microscopic observations have shown him that in vigorous, healthy men coitus, after weeks of abstention from the act, is not accompanied by the ejaculation of seminal fluid. teeming, as has been said, with abundant and lively spermatozoa, but that, on the contrary they are comparatively rare. Many show no mani

festation of life, and others are by no means active. Repeated coitus is followed by an abundance of young, very active spermatozoa.

Observations on the fluid of seminal emissions, though often made within an hour after the event, rarely showed many spermatozoa, and the few present were, as a rule, not especially active. Spermatozoa seem to degenerate while in the seminal vesicles, and it is only after these are emptied that really active germinal particles are to be found in the seminal fluid. The importance of this for certain forms of sterility is evident. This theory, too, gives a new biological significance to nocturnal emissions that occur normally in the continent. Nature is getting rid of germinal material that is no longer in proper condition to fulfill its function perfectly not merely wasting, as has been taught, precious reproductive elements.-Medical Times.

URETHROSCOPIC DIAGNOSIS.

By Ferd C. Valentine, M.D., New York. In a paper presented to the Am. Medical Association the author deprecates attempting to treat diseases of the urethra without ocular inspection, and attributes the large number of chronic sufferings to the fact that hitherto no cheap, easily managed urethroscope had been devised. He demonstrated a new instrument devised by him to cover these needs.

The urethroscope devised by the author of this paper, is essentially a set of urethral tubes of the necessary calibres, a dry-cell battery for light, a light carrier, and a megaloscope to magnify the urethra sixteen diameters. The light is encapsulated, so that it gives no heat when inserted into the urethra-all parts of which are illuminated as distinctly as if they were exposed to direct sunlight. All operations within the anterior and posterior urethra, from finding the opening of fine devious strictures, the removal of growths, can be done under guidance of the eye-Modern Medical Science.

GONORRHEA.

The Medical News for January 13th has the opening part of Neisser's article on gonorrhea, its dangers to society.

The author first shows the widespread character of the disease in all civilized countries. 15.8 per cent of the German army have gonorrhea, 32 per cent of the Austrian, 21 per cent of the Belgian, and 27 per cent of the French.

Gonorrhea is a serious and often dangerous disease, because it does not remain limited to the primary focus of infection but progressively invades other parts.

Once the infection has gained a foothold in the uterine mucosa there is scarcely any medical treatment of any service.

The affection does not limit itself to the superficial mucous membrane, but through the toxic products produces effects at a distance from the original focus.

The gonococci may force their way into the connective tissue and find entrance into the lymph and blood currents producing arthritic affections, affection of glands and tendon sheaths, serious disease of the heart and blood vessels, and systemic intoxication. Gonorrhea may occur in the conjunctiva, rectum and mouth.— Charlotte Medical Journal.

PROTARGOL

Has been, recommended by Kopp as an efficient and safe prophylatic against gonorrhea, but it has been open to the objection of its sparing solubility in water. The same author now publishes a new method of preparation which overcomes the difficulty and makes universal application of the remedy possible. The protargol is to be triturated with an equal weight of glycerine and then enough luke-warm water added to make a 20 per cent solution. A few drops of this solution instilled into the fossa navicularis after a suspected coitus makes an efficient safeguard against infection without any unpleasant irritation of the urethral mucous membrane.Merck's Archives.

THE ABORTIVE TREATMENT OF GON

ORRHEA.

Hutchinson, in his Archives of Surgery for October, says that a two-grain-to-the-ounce solution of chloride of zinc will certainly cure a case of gonorrhea in a short while and without danger.

He thinks the use of injections prevents orchitis rather than causes it.

His plan is to instruct the patient to first void his urine, then inject with warm water, let it run out and then use the solution.

This abortive treatment also tends to prevent gonorrheal rheumatism.

In addition to the chloride of zinc injection he gives all his cases purgatives and the bromide of potassium and insists upon a light diet.

GONORRHEA IN WOMEN.

Clark, in the American Journal of the Medical Sciences for January, makes a critical summary of recent literature on this subject, though his study appears to have been confined exclusively to the writings of Bumm of Basel.

He considers Neisser and Bumm the epoch makers among the investigators of this disease.

The varying virulence of the gonococci is dwelt upon, though this peculiarity is shared by other germs and is perhaps more dependent on environment than character.

Noeggerath states that this disease is, as a rule, a life time affliction in woman, but Bumm says not.

The pathological anatomy is most logically and vividly described by Bumm.

He says that the disease is confined to the epithelial layer, Wertheim and Madlener to the contrary notwithstanding.

Bumm also states that the peritoneum is a very poor culture ground for the gonococci and. that a venereal peritonitis cannot occur from this source, though the cases reported by Cushing show that the gonococcus was the primary cause of a general peritonitis. The clinical course, diagnosis, prognosis, and treatment, according to Bumm, will be continued in the next number of the Journal. Charlotte Medical Journal.

THE OPERATIVE TREATMENT OF URETHRAL STRICTURE.

A satisfactory result of a stricture operation depends on an exact determination of the location of the stricture; the extent, quality and caliber of the constriction; accurate cutting and proper after treatment, says Kreissl in the Chicago Clinic for December.

He considers the bougie a boule, which is provided with a scale on its shaft, the proper instrument for determining a stricture.

The author uses a "localizer" which shows whether the stricture is anterior or posterior, or annular, and in this way we cut the stricture and not healthy tissue.

He says that internal urethrotomy is not indicated in callous strictures, especially not in those of 11⁄2 centimetres or over in length. The infiltrated areas surrounding the strictures should be reduced by sounds or electrolysis with a weak current, before urethrotomy is done, to avoid. hemorrhage and urethral fever.

He recommends the Otis urethrotome for internal work, which is only practical for the anterior eight or nine centimetres of the urethra. -Charlotte Medical Journal.

GONORRHEA AND VULVO-VAGINITIS

IN CHILDREN.

Dr. Nosotti (British Med. Journal, Sept. 30, 1899,) speaks well of protargol in the treatment of gonorrhea at all stages. The solutions used varied from 1⁄2 per cent in the early days to 2 per cent in the later stages. No ill-effects were noticed, no epididymitis or other secondary inflammation. It was more satisfactory as an injection than permanganate of potash. It was found very useful in the vulvo-vaginitis of children. Protargol causes a free elimination of epithelial and pus cells of gonococci from the urethral mucous membrane.

THE BACTERIOLOGY OF GONORRHEA. Pothier, in the New Orleans Medical and

Surgical Journal for January, reviews the bacteriology of Gonorrhea.

The organism was discovered in gonorrheal pus by Neisser in 1870.

They are micrococci, usually joined in pairs or in groups of four and are biscuit shaped.

His method of staining is with Loeffler's solution for 12 to 20 seconds, wash and dry, then stain in 12 per cent solution of eosin in 50 per cent alcohol.

The gonococci do not stain by Gram's method, and they are found within the pus cells. They develop best at a temperature of 36 C.

They are pathogenic to man alone, but the toxin produces some reaction in animals. As the result of experiments he concludes that the gonococcus is the specific cause of gonorrhea, that they produce a virulent toxin, and that the effect of this toxin on the tissues may produce changes in them allowing access of other septic organisms which may become more dangerous after the action of the toxin.-Charlotte Medical Journal.

SIXTEEN YEARS' EXPERIENCE WITH

GONORRHEA.

Vogl, in the Münch. Med. Woch., summarizes the experience in the military hospitals with gonorrhea. The old method of general treatment, hygiene, dietetics, rest, milk, cold applications, etc., required an average of 45 days. Niessen, 1896-7, used silver salts as injections, treatment occupying 40 days, but with some cases discharged uncured. 1897-8, silver nitrate, potassium permanganate and protargol were successively used, with a duration of 42 days, but a few were discharged uncured. Various remedies were tried and discarded, for one reason or another-hydrochinon, iodoform, thallin, zinc salts, sozoidol.-American Therapist.

URETHRAL EXPLORATION.

Valentine, in the International Journal of Surgery for January, says that the improper entrance of a rigid explorer may injure the urethra gravely and may mislead the operator.

He advises against the ordinary method of placing the instrument parallel to the inguinal fold, as it causes torsion and complication.

The explorer should be held across the patient's right thigh in an imaginary line that prolongs Poupart's ligament.

We should remember that the fossa stands at an angle to the urethra and that the explorer's tip should be guided along the floor of the urethra and not its roof. The urethra must be drawn over the instrument as it is forced forward.

The tip must not be moved from the posterior orifice. If the instrument turns on its axis it

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pecially of the nasal and respiratory passages and severe pain and soreness and pains throughout the nervous and muscular structures of the body. To allay the pains and soreness and restore more active eliminations from the skin, kndneys and intestines are the rational indications to guide us in the choice of remedies. If called in the early stage of the disease, in all the milder cases a single powder containing from 15 to 18 grains of Dover's powder, 3 grains of calomel, and 3 grains of pulverized gum-camphor, given at bedtime and followed in the morning by a saline laxative sufficient to produce two or three intestinal evacuations has very generally relieved all the important symptoms; and by giving 3 grains of quinine sulphate three times a day for three or four days the convalescence has been complete.

In the more sever cases, instead of one powder at bedtime, the same should be given every four hours until four have been taken, then move the bowels with the laxative and follow with moderate doses of quinine, alternated with 5-grain doses of sodium salicylate, until all the active symptoms have disappeared. When the bronchial symptoms have been persistent, with soreness in the chest, instead of the sodium salicylate I have given, with very good results, a teaspoonful of the following mixture every four or six hours until the chest symptoms were relieved:

Hydrochlorate of ammonia, 31⁄2 drachms,
Ant. et potass. tart., 2 grains,
Mercuric bichloride, 2 grains,
Morph. sulph., 3 grains,

Syr. of licorice, 5 ounces.-M.

When the influenza has at the beginning, so much irritation of the gastric and intestinal mucous membrane that the powders of Dover's powder and camphor cannot be retained, I have given instead 4-grain doses of salol aided by 11⁄2 or 3 grains of calomel at night for the first two days with entirely satisfactory results. Then smaller doses of the salol, alternated with very moderate doses of quinine, has been all the medication necessary to complete the recovery of the patient. In all cases, during the active stages the patient has been kept at rest, and as far as practicable in a well-ventilated, warm, but not over-heated room.

In only a very few instances has the fever temperature reached over 104° F., and when it did it was readily reduced by free sponging of the surface or a few doeses of aconite or veratrum viride. The diet should be light and carefully adjusted to the ability of the digestive organs to receive and appropriate it. When pneumonia or any other complicating disease supervenes, for which the practitioner should always be on the alert, it should be treated promptly and on the same principals as would govern its treatment under other circumstances.-Nathan S. Davis, Chicago, in Sajous' Annual and Analytical Cyclopedia of Practical Medicine. Volume

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Original Articles.

*REMARKS ON JOINT-DISEASES.

By Knut Hoegh, M. D., Prof. of the Principles of Surgery and of Clinical Surgery in Hamline University, Minneapolis.

(Continued from last issue.)

After this article, that was intended for a previous meeting, was prepared, I have met with two cases in which I think I have discovered the signs of tuberculous spondylitis, while the patients have been treated, the one for sciatica, and the other for some dyspeptic disorder. What called my attention to the true nature of the first case, that came complaining of pain in the heel, a pain, by the way, that could be traced along the course of the nerves on the whole posterior and external aspect of the extremity, was the tonic spasm of the erector spinæ muscle on the affected side. Digital pressure elicited tenderness on the third lumbar vertebra; rest in bed had a marked influence upon the sciatic pain; the injection of tuberculin produced a transient elevation of temperature. But there was no stiffness in bending, no kyphosis, and the patient was the very picture of good nutrition. The other case attracted my attention by the peculiar formation of the body. When he stood upright, a horizontal crease in the abdominal wall, on a level with the navel, was seen, which means, as is well known, a certain degree of spinal deformity, usually lordosis. Upon inspecting the back, I found a slight prominence of one of the lower dorsal vertebræ, a slight backward tilting of the pelvis and atrophy of the buttocks. Many years ago this man had consulted me for sciatica, first in one leg and then in the other. His most prominent symptom now was pain in the pit of the stomach. These pains were not connected with ingestion of food; chemical examination of the stomach contents showed a small amount of muriatic acid and abundance of lactic acid. I look upon these evidences of impaired digestion as concomitant symptoms of the tuberculous infection which had its chief seat in the dorsal portion of the spinal column.

Tuberculosis of the ankle joint gives, in my opinion the poorest prognosis; in fact, I do not believe that I recall a single case of an adult where the disease was finally and permanently cured. Not quite so bad is the prognosis in children, where I have one case, at least, where resection saved the limb.

Next to the ankle, the wrist gives the poorest prognosis. While amputation seems to be the final outcome in the ankle, at least in the adult,

Read at the meeting of the Hennepin County Medical Society, January 8, 1900.

I have preserved some hands by resection of the wrist joint. A girl, on whom I performed Lister's resection, twenty years ago, and who retained her hand, certainly in a maimed condition, has ever since been able to earn her living as a servant girl.

Resection in the elbow usually leads to a stiff joint, but if that is at the proper angle the limb remains useful; worse is it if a so-called flail-joint is the result of the operation.

In tuberculosis of the knee, resection is not so popular a remedy as formerly. Mechanical treatment leads often, even in bad cases, to a fair result.

Resection of the hip in adults is usually of poor prognosis; in children and youths the operation has scored many victories.

There is one joint where I believe that the disease is often overlooked, and the suffering ascribed to other conditions, and that is the ilio-sacral joint. I should like to ask the members of the society how often they make the diagnosis. of inflammation of this joint; my impression is, that it is rarely diagnosticated, but that its presence is not very uncommon. I have two cases. here in the city, that were treated for rheumatism, sciatica, or hip-joint disease, but I have established, at least to my own satisfaction, that there was tuberculosis of this joint. A misleading feature of this disease is that sciatica is often present as a complication. present as a complication. In fact my first case impressed me as one of sciatica, and it was only the subsequent history of the case that taught me the real condition.

It is outside of my plan to enter particularly into the treatment of joint tuberculosis, but a few general remarks may be appropriate. In the first place the practitioner must remember that these diseases are extremely chronic in their course; if the patient is not, from the very moment the diagnosis is made, informed that the treatment must be continued very long, not for months but for years, he will not retain confidence in his physician; no matter how satisfactory the progress may seem to the expert who knows how long a time in must take before the disease is brought to a standstill, the uninformed patient will rebel, when he sees, for instance, that his inflamed knee is not well after three months in a plaster cast. I must express my disapproval of the common practice of treating tuberculous joints with local derivatives, such as tincture of iodine, various liniments, blisters, etc. In my opinion all these applications are useless, and as they give the patient needless pain, expense, and labor, they should be condemned. It is possible that the systematic use of ice, occasionally, does good, but I have never used it myself, as I immediately advise more effective treatment. Without going into details, it must be enough to state. that the principle of the non-operative treatment of tuberculous joints is to place the joint at absolute rest, and to take all weight away from it. The many ways in which this may be accom

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