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twelve inches long, bulbous at one extremity and open at the other. The bulb is placed in hot water, which rarefies the air within the instrument, when, by inverting it in a glass of cold water, a drop of water is forced up the tube, and the instrument is completed and ready for use.

To illustrate its value in a diagnostic point, I desire to briefly allude to a case, which I have just seen, where it proved an efficient aid.

Quite a prominent physician of this city (Louisville), fell some two weeks since, hurting the knee, which has occasioned him considerable trouble since on account of the pain, no other iuflammatory symptoms, however, being manifest. This pain was restricted to a very small spot over the internal lateral ligament, the seat of the injury. After making a very careful examination, Dr. Sayre decided that there was rupture of a few of the fibres of the internal lateral ligament. The question of treatment hinged upon, whether there was inflammation at this point, and by this instrument the information was secured. The normal temperature at a corresponding spot on the unaffected knee was obtained, and then transferring the thermoscope to the injured knee, the water rose (11°) one and three-fourths degrees in two seconds, thus solving the problem, giving us the evidence of heat, which could not be obtained by the sense of touch.

A vote of thanks was tendered Dr. Holloway.

Dr. E. H. M. SELL, of New York, desired to present again the patient whom he had brought before the Surgical Section at Detroit, as the case had elicited more than ordinary interest.

Among those who had then expressed an opinion upon the diag. nosis and prognosis, expressions were as diversified as they had been among the European doctors, from tertiary syphilis to cancer and from a perfect cure to death within three months.

Some predicted, that the two soft tumors would soon become hard as the third one, others were equally certain that the tumors were cancerous and would rapidly enlarge, suppurate, and destroy life, while still others did not venture to express an opinion.

Professor Davis, of Chicago, having examined the patient at his office, agreed with us, that it was some obscure purulent disease, analogous to, yet not syphilis.

The doctor had before met with a few similar cases, and was disposed to make a favorable prognosis.

As several had specially requested us to report the result of the post-mortem, we take pleasure to present the patient once more alive, and in every respect improved, though not yet entirely well.

The soft tumor over the left parietal bone bas disappeared entirely, the hard one of the forearm almost, and the large soft tumor, situated a little above the one just mentioned, has also entirely disappeared.

This one we punctured with a hypodermic syringe, and the microscope revealed the presence of blood and pus. Only for the puncture, this tumor also would doubtless bave disappeared with. out suppurating, but being once punctured it discharged an immense quantity of matter.

The patient has gained about twenty pounds, and most of the symptoms have either very much improved or entirely disappeared. Vertigo is scarcely if ever present, nor does looking up now produce dizziness.

The patient is much stronger; four hours walking scarcely tires him, and reading, writing, and thinking no longer fatigue or con. fuse him, unless he indulges in them too much at a time.

The following has been some of the treatment adapted to the symptoms as they presented themselves.

As a general alterative: B. Sodii iodidi, dr. iij; hydrg. bichlor. gr. j; ex. conii fl. dr. vj; ex. stillingiæ fl. oz. iss; syr. cort. prun. virgin. fl. oz. ij. M. S. A teaspoonful three times a day.

Later in the treatment the bichloride was omitted, when the effect of the remedy was even more marked.

As a resolvent of uric acid and as a cholagogue: R. Magnes. sulphat., sod. sulphat., āā dr. ij; ex. anthemid. nob. fl., ex. eupatorii perfol. A., āā fl. dr. ij; aq. menth. pip. fl. oz. iss. M. S. Teaspoonful every three hours.

As a capillary tonic, hæmatic, and with a specific effect upon a chronic inflammation of the neck of the bladder: B. Tr. ferri chloridi insipidi. fl. dr. vj; tr. cantharides A. dr. ij. M. S. Gtt. x ad gtt. xxx three times a day, after meals.

As a laxative, one or two of the following pills at night: R. Podophyllin, ext. bell., āā gr. iv; nuc. vom., ex. byoscyami, pulv. capsici, äā gr. x. M. et div. in pil. No. xl.

āā As a general tonic and diffusive stimulant, with laxative effect : B. Podophyllin, ex. bell., āā gr. iij; ex. nuc. vom., ex. hyoscyami, pulv. capsici, āā gr. vij; xanthoxylin, ferri sulphat., āā Diss; acidi arseniosi, strychnia, āā gr. ss. M. et ft. pil. No. xxx.

S. One pill three times a day.

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For flatulency and dyspepsia: R. Tr. nuc. vom. fl. dr. ss; tr. cap. sici, mxv; acid. nitro-mur. dilut. fl. dr. iij; tr. gentian. co. fl. oz. iij. M. S. One teaspoonful after each meal in water.

For catarrhal diarrhea: R. O1. ricini, f. dr. iv; pulv. acaciæ, dr. ij; ex. hyoscyami, gr. x; con. tr. gelsem. gtt. xxiv; aq. menth. pip. fl.oz. iv. M. et ft. emulsionem. S. A tablespoonful after each motion.

For insomnia: B. Ex. cypriped. fl., ex. asclep. fl., ex. dracontii fl., ex. scutellariæ f., āā.-S. Half a teaspoonful to one teaspoonful three times a day, or on retiring.

For chronic cystitis: R. Ex. buchu fl., ex, uvæ ursi Al., ex. senecio grac. fil., āā. M. S. From balf to one teaspoonful three times a day.

For the same with an effect also upon the kidneys, liver, stomach, etc.: R. Ex. buchu fl., ex. uvæ ursi fl., ex. helonias fl., eupator. pur. fi., āā dr. iv; ex. hydrastis fl. dr. iss; tr. gelsem. dr.j; septandrin dr. j. M. S. One-quarter to one-half a teaspoonful three times a day.

The bladder was washed out daily with a warm solution of potass. chlorat. by means of Dr. Potter's water-bag; and a catheter was used several times a day to draw off a residue of urine, which the patient failed to pass per viam naturalis.

The digestion of the patient was very much improved by using lactopeptine, one of the best remedies ever devised for indigestion, dyspepsia, etc.

The compound strychnia pill, as a nerve tonic, improved the memory, and ability to read, write, and think very materially.

In conclusion, we desire to make but this one remark, namely, should any one feel disposed hastily to conclude that the result of the treatment proved this case to have been syphilis, in spite of the absence of all primary or secondary symptoms in the patient, in any of the ancestors or offspring, we do not feel disposed to quarrel with him.

Those who have syphilis on the brain, and find almost every conceivable disease nothing but syphilis or the result of syphilis, may willingly hold their views, while we will hold ours, until fur ther developments in medical science will prove beyond all dispute which view is true.

The CHAIR. We will now hear the report of the Committee on Dr. Gross' paper respecting syphilis.

Dr. MORRIS, of New York, read the report.

Dr. Gross, of Pennsylvania, stating that it was drawn up by Dr. Morris.

Dr. ANDREWS, of Illinois. I would inquire if all the members of the Committee have signed this report ?

Dr. MORRIS. It is either signed or has the tacit approval of every member of the Committee. Some of them have not had time to read it all over and sign. It has the approval of Dr. Gross, Dr. Sims

Dr. ANDREWS. It is always proper to receive the report on motion.

The motion was put and the report received by the Section.

Dr. ANDREWS. The difficulties which hang over this subject are very great. Some years ago I gave the matter considerable attention, and the more attention I gave it the more the perplexities multiplied, and the more grave did the subject become. If I were prepared to say that I could enlighten this assembly upon the subject I would be inclined to make a long speech, but I simply desire to suggest that we be cautious in what we do. I remember at our last meeting that the honorable head of the Committee made some remarks liable to provoke severe criticism.

Allow me to call attention to some of the difficulties of the subject, as I desire that this body will not commit itself to anything hasty or precipitate, but to that which every member of the Sec. tion will be willing to stand to.

The efforts to attain the object desired in other countries have been directed in two different directions, viz., suppression and prevention. This, at first glance, may seem a very simple matter, but there are difficulties connected with it which have baffled the entire world. The first thing that confronts us is that the police of the most tyrannical country in the world (for certainly such was France under the reign of Louis Napoleon) confess that they were unable to abate but a very small fraction of the prostitution in Paris, although the laws were enforced rigidly wherever possible. As in Paris, so it was in Berlin.

Without stopping to go into details, I will simply state here that statistics show that the disease of syphilis increased in Great Britain after the Contagious Diseases Act went into operation.

The Chief of Police in Paris estimated that about one-seventh only of the prostitutes of that city were under his control. The Chief of Police of Berlin gives a similar account. I bad considerable correspondence with the Chief of Police of Berlin upon this

VOL. XXVI.-16

subject, and he informed me of some of the difficulties which stood in the way of the execution of the law there. It is proper for us to know here, however, that European countries endeavored to keep these people under control, not so much to prevent the disease as to have this class under supervision. Among the reasons given in the above-mentioned correspondence for the failure of the law, was (1) These women love liberty and do not care to be under control, especially for more than a year or two, and in this way the registration falls off. Some have been simple enough to think, because of the registration growing small, that prostitution was becoming less. (2) The great mass of syphilis is not distributed by prostitutes, as is generally supposed, but throughout Berlin and other cities of Europe, as well as here, by washer-women, tradeswomen, etc., who spend their days in attending to business and their nights in something else; it is such people as these that spread syphilis.

Now, these women have more or less hold on respectability; they even marry and settle down to a virtuous life; others become disgusted with their course of life and withdraw from it, and thus large numbers reform from this semi-respectable mode of life, while a few of them become prostitutes. In Chicago, to-day, there are upwards of one thousand women who were formerly prostitutes but are now permanently reformed. Numbers of them are married, and many of them to husbands high in life, to some of the wealthiest citizens, who are aware of the previous life their wives led. These are the women who defy the laws, who are called clandestine prostitutes; the police know they are practising prostitution for gain, but what shall they say? what are the Committee going to do with them? They say they will register them as common prostitutes in order to put them under control. The Chief of Police of Berlin says that it is impossible to control these women. It is very easy to say wbat a person would do if he were chief of police, but once chief of police and he will find himself as powerless as his predecessors. These women have hope of a better life; many of them have intimate friends who know not of their practices; the people at large have not the remotest idea of their secret shame, and yet you say you will register them. The most despotic police in the world dare not lay their hands upon these women. The system is so extensive, and the interference in these cases would necessarily be so frequent, that it would raise such a howl of indignation as to shake to the very foundations any government

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