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anemic, shows a loss of weight and some fication. A positive Wasserman is not only suggesatrophy of leg muscles, especially on the
tive of syphilis by itself but is suggestive of a slight left side. He is clear mentally.
or a considerable degree of a continued syphilitic respond sluggishly to light and accommo- Again the high lymphocytosis linked to the clinidation. Tongue has slight fibrillary tre: cal history is significant; in this relationship it mor. Motor power generally impaired.
points to a specific or para-specific pathology. The Rhombreg sign marked. Ataxia well de
essayist's statement of the lateral pyramidal tracts
being the seat of the lesion is true only in part in as veloped. Intention tremor slight. Babin. much as his further clinical descriptives indicate ski and Oppenheim's signs positive. All ten- even more damage to the ingoing or sensory route. don reflexes increased. Abdominal and
This would indicate a previous or present spinal cord
syphilis, leading again to Dr. Skoog's question as to skin reflexes absent. Cremasteric reflexes
whether we now have a para-specific condition; I sluggish. Tactile sense normal. Lynıpho think we have. cytes, uncentrifuged specimen, 70 to cu.
DR. MILLER: Another point. The Wasserman mm. Wasserman reaction negative. No- both in the cerebro-spinal fluid and in the blood was guchi butyric acid reaction prompt and negative, while the Nouguchi test was positive, positive. Nonne-Aplet test prompt, cloud- showing these cases of late syphilis can be detected ing and curding.
by the Nouguchi and butyric acid tests; they being Luetin test mildly posi- of more value than the Wasserman in either blood or tive.
spinal fluid. Differential Diagnosis.-1. From heredi
DR. SOPHIAN: If I may be permitted, I should tary spastic. paraplegia, by lack of history, like to call attention to the cerebro-spinal fluid in, by ataxia, sphincter and cerebral symptoms. these cases referred to. A lymphocytosis in these 2. Combined scleroses by vagueness of
cases is not diagnostic of syphilis, because lymphoentity.
cytosis is commonly seen in other types or condi
tions. First, tubercular meningitis often shown up 3. Diffuse myelitis, by the symptoms re- to 99 per cent lymphocytes. Another common conferable to the brain.
dition is infantile paralysis, making as high a differ4. Tabes dorsalis, lack of Argyll-Robert- ential count practically, as tubercular meningitis.
The other type is syphilis of the central nervous son pupil, by increase of deep reflexes, lack
system. A point to bear in mind is that lymphocyof optic atrophy and crises.
tosis is not diagnostic, but only suggestive. 5. Paralytic dementia, lack of character- Nouguchi's test referred to also is simply signifiistic mental disturbances as changes in
cant of an increased proteid element, which simply
means an inflammation in the central nervous syscharacter, delusions of grandeur, cerebro
tem, so I think the only positive examination of the spinal fluid findings against.
Auid present in syphilis of the central nervous sys6. Multiple Sclerosis.--Of extreme diffi- tem, not present in other conditions, is the positive culty to differentiate. Against it is age of
Wasserman. The Wasserman in these cases is often patient, 52, and the definite history of lues.
negative, but a positive Wasserman is more than suggestive and means something.
Increased proFor such a diagnosis is a mild, not classical teid content only, is what the other tests show. intention tremor, a speech defect, hardly They are not of absolute diagnostic significance. scanning, hystagmoid movements with ver- saw a case several years ago where diagnosis of intigo, spastic weakness, sphincter involve- peared. One of the earliest diagnoses was made by
fantile paralysis was made before the paralysis apment and lost abdominal reflexes.
Dr. Flexner. Paralysis appeared later, and Dr. Diagnosis.-Late cerebrospinal lues, Flexner had already predicted infantile paralysis. para-specific in type; on history of lues, He found positive Nouguchi test, high lymphocytocerebrospinal fluid findings and reflexes so
sis, the inflammation coming on with general con
stitutional symptoms. With fever and high lymoften found in late specific lesions of the phocytosis, one is warranted in suspicioning infanspinal cord; the multiplicity of symptoms tile paralysis. I saw a case, with acute onset, and and the regions involved; spinal cord, lat. with the same picture in the spinal Auid, and I made eral columns, particularly pyramidal tracts,
the diagnosis before the paralysis appeared. In the
cases of syphilis of the central nervous system, the but not the anterior horn cells. The brain Wasserman is necessary it seems to me to make a changes limited to base, may be meningeal positive diagnosis. or nuclear changes.
DR. LYLE: Notwithstanding the results of these (b) Pathological report, Dr. Skoog.
tests in diagnosis, their reliability, etc., I would
like to ask what are we to do with these cases? One (Dr. Skoog read notes on pathological other treated with
we see treated with 606 may make a recovery, an
other, treated with mercury makes a recovery, specimens from two patients. Then Dr.
while in other cases, both fail. What are we to go Skoog showed slides projected.)
by? What is the general practitioner going to do?
Are we to use the arsenical preparation to treat these, DISCUSSION.
or should we use the old mercury treatment, and
hope for results? These are some of the things I S. GROVER BURNETT: There is not much to
would like to be enlightened on. add to Dr. Skoog's definite, detailed clinical findings, leaving little mystery as to the diagnosis, notwith- DR. SKOOG (closing): I did not rely on any of standing a negative Wasserman. A negative Was- these things as diagnostic. We have to consider serman does not exclude syphilis but it does sup- every factor, and that is what I tried to do here. I port the doctors contention of a para-specific classi- am cognizant of the fact that we have lymphocytosis
in other things than syphilis of the nervous system. The relation between love and sexual de. For instance in infantile paralysis before paralysis sire is dual and in its better phase is little appears, in tuberculosis and I had one case of multiple sclerosis with active lymphocytosis.
understood. Sexual desire does lead to atI have classified this man as a para-syphilitic. tachments between man and woman. On While we so classify tabes and paretics it is a ques- the other hand, love for a man instinctively tion of whether we have a right to do it here, or is
prompts a normal woman to wish to mother this a plain case of syphilis. Some rely too much, I think on 606 for these cases.
This patient has his child. never had 606. He is better today than six to eight From all this generalization I desire to weeks ago. He received mercury, and is now on an report a case of an entirely different kind, iodid preparation.
one in which the woman desired motherhood for financial reasons. After corres
pondence I met her at a hotel in IndianSOME CHILDLESS WIVES.
apolis. She had written for me to meet her
at a certain date, in her home city, but had SECOND PAPER.
fixed a time when I would be in attendance G. HENRI BOGART, M. D., Paris, Ill.
on a convention, and I so wrote her. The
morning of the convention, I had not been Barrenness was once woman's most in the lobby of the hotel where our associadreadful fate, back in those days when "Go tion foregathered, for fifteen minutes until ye forth and replenish the earth” was I was paged out. She was in the city, wait. spoken, and thence to the pioneer days ing me at another hotel. Angered, I sent when the family greeting to the bride and her messenger back with a note making an groom, as they turned from the altar was appoinment for 8:30 in the evening. My "May you live long, prosper, and have big cavalier treatment resulted partly from rebabies." And the big babies were an ele- sentment that she had presumed to come on mental part of the prosperity, for each boy for consultation regardless of my conveniand girl was a valuable asset in the earlier ence, and partly because of disgust for her days of the pioneer. It was a disgrace, or mercenary reasons for desiring maternity. at least a misfortune, not to have children. A childless uncle wished to make her But the old order changeth, and instead of husband his heir, provided there were chil. a dozen or more olive branches the family dren to perpetuate the family,otherwise anof une and two became more frequent than other nephew was to inherit it. She was greater numbers.
anxious that the money should come to her At the same time the long rows of tiny husband. When I came to her room. I found tombstones in family burial lots are no her a magnificent jewess married at sixteen longer common.
and now thirty. She had brought written Prevention of pregnancy became more reports from examinations of both herself common and by the crudest methods. Va and her husband. ginas were tanned into leather by astrin- A careful reading of these reports congent douches and washes. Fallopian sec- vinced me that neither partner should be tion as a preparation for marriage was re- sterile. sorted to. It was to this illicit operation, For a long time I talked with her hoping indeed, that the world is indebted for the to stumble on to a solution. Finally I boon of sterilization by vasectomy.
learned that orgasm occurred much more Thus was repeated the truth of that age quickly and forcibly with her than with the old truism told in Samson's riddle, “Out of husband. This, with a sharply acid reacthe eater came forth meat, but of the tion of the vaginal secretions offered a pos strong came forth sweetness.” Some of sible answer. At orgasm the uterus after these women have later come to know the its usual suction action, would close firmly holy desire for maternity, and have come and exclude the semen ejaculated later, begging oh, so piteously that the severed while the acid secretions would kill the tubes be reunited, but I have never known spermatozoa, before admission to the uterus the operation successfully performed, either was possible. in the male or the female.
I explained this to her and advised that There are some of these women who had she procure a bivalve speculum and a long contracted loveless marriages, mere sexual smooth syringe. Before coition thoroughly partnerships for reasons of finance, social cleanse the vagina with borax solution. position, or other conventional cause, who Then after intercourse the speculum was have later developed love and affection to be introduced, the semen taken up in the strong as their nature will admit. These syringe then injected into the uterus. I inwomen, invariably desire to bear a child sisted upon the speculum, and also that in for the husband who later became a lover. the first instance the husband should have
his physician to demonstrate its use, as there are many fatal terminations to attempts at lay introduction of probes, lead pencils and syringe nozzles into the uterus, which instead puncture the culdesac.
She was much impressed with the idea, but demanded to know as to its use, “What do your books say?" I had to tell her that my advice was not from literature but from reason, and pressed for an answer told her of Zola's novel, “The Son of a Gun, founded
a similar condition. She wanted to know if such operation had ever really been done, and I told her that every expert horse-breeder in the land kept and used an impregnator.'
Then she was angry, gloriously, imperi. ously angry, because I had compared her to a beast, a brute! It took some time to pacify her-I added ten dollars to my fee because of her temper-but when she did understand that no offense was intended, she apologized.
She wrote me that pregnancy followed in six weeks treatment, and when in due time
the child was born, the parents sent me a handsome honorarium.
Since I have considered similar treatment for some other cases in which there is no other adequate reason for the sterile condition, here arises a delicate, a very delicate question:
If the semen from another man be used, is it more culpable to inject it in the usual manner than with a syringe ?
In the instance cited in a former paper of this series, the husband was impotent, or rather sterile. In such cases would the woman be justified in resorting to mechanical impregnation? Would it be permissible for a physician to secure semen by milking a prostate and then injecting it?
In the novel by Zola, aforementioned, the priest furnished the semen to the physician, the woman was impregnated, and the plot hinges on the question of the child's legitimacy. By the way. the Jewess is now pregnant with her third child, according to a recent letter.
We shall do so much in the years to come,
But what have we done today? We shall give our gold in a princely sum,
But what did we give today? We shall lift the heart and dry the tear, We shall plant a hope in the place of fear, We shall speak the words of love and cheer, But what did we speak today?
THE DOCTOR'S AMUSEMENTS.
Edwin Thomson, Kansas City, Mo. Physicians are sometimes amused
By what they hear folks say;
By laymen every day.
When heard by the M. D.
Be freakish things, indeed;
'Tis easy to mislead.
Mean to communicate; Alluding thus they misconvey,
And make a bad mistake. And these are easy recognized,
Although quite frequently Pronounced and sad epitomized
In ways most horribly ; Typhord is just colloquial
For typhoid, and so is Cerebral known as .cerberal;
Some say they've rheumatiz!
Under the editorial direction of
P. T. BOHAN, Therapeutics
C. C. CONOVER, Diagnosis
DON CARLOS GUFFEY, Obstetrics
H. C. CROWELL, Gynecology
FRANK J. HALL, Pathology
J. E. HUNT, Pediatrics
JOS. LICHTENBERG, Ophthalmology
HERMAN E. PEARSE, Surgery
J. ELLIOTT ROYER, Neurology
R. T. SLOAN, Internal Medicino
R. L. SUTTON, Dermatology
EDW. H. THRAILKILL, Rectal Diseases
J. M. BELL, Stomach
C. A. GOOD, Medicine
A. L. GRAY, Obstetrics
J. W. MCGILL, Rectal Diseases
L. A. TODD, Surgery
H. M. MCCLANAHAN, Pediatrics
H. S. MUNRO, Psychotherapy
WALTER L. BIERRING, Medicine
In Dr. Sophian's lecture to the Buchanan. Dr. Sophian is the practical exponent of Andrew County Medical Society, given in that knowledge acquired by the strictest the assembly hall of the Public Library, at attention to minute detail, and the most St. Joseph, on January 15th, 1913, he said painstaking care and patience which char that the experimental work looking toward acterizes the laboratory worker in the cause successful serum treatment of this disease of scientific medical research. Experiment was done in 1905-1906, and the first really and observation constantly and indefatiga practical work in 1907, by Flexner of the bly repeated, errors corrected and over- Rockefeller Institute, in New York, who sights remedied, for weeks and months at a established the fact that the serum must be time, until finally accurate conclusions are injected into the spinal fluid to successfully formed, which stand the test of criticism, combat the disease. It is a highly infec. and show the same results in the hands of tious and contagious disease, and his obother investigators. - This is evidently the servations, taken during the epidemic, laborious path he has trod, and he has had showed that as many as 70 per centum of the opportunity of demonstrating the prac- healthy people harboring the causative tical value of laboratory work in the out- micro-organisms in their noses or throats. break of the epidemic of cerebrospinal men. Natural immunity, with healthy mucous ingitis last year in Texas, where he acted membranes, saved the majority of these as chief adviser to the Boards of Health in people from contracting the infection. The the afflicted communities-notably Dallas. portal of infection is through the nose or throat to the blood current, causing a gen- usually only temporary, lasting about two eral bacteremia, later being carried to the to three weeks. Another objection is the meninges of the brain, producing menin- fact that it is frequently complicated by gitis. Treatment consists in the care of serum sickness and sensitizes the patient, both the sick and healthy. The latter by so that he is exposed to the danger, remote means of reasonable quarantine regulations. as it may be, of anaphylaxis should he be He characterized arbitrary quarantine as a later again injected with the serum. mistake, stating that accurate measures
However, vaccines injected subcutaneshould be used by making suitable cul- ously in three doses at week intervals of 100 tures, and quarantine enforced as long as
million, 500 million and 1000 million killed the offending cocci persist in the nose and
bacteria, have been used successfully, and tiate these cocci from pseudo and similar give a high and prompt immunity to the
individuals treated. varieties, which are Gram negative. Dif
Active curative treatment is obtained by ferentiation must be made by suitable cul
the production and injection into the spinal tural examination.
fluid of an immune serum. The serum is Active measures of prophylaxsis are to obtained by immunizing a horse by the prevent crowding in public places, prohibit methods indicated by Jachman, Wasserman spitting, and local spraying of the nose and Flexner. The symptoms to combat are and throat, with mild antiseptic solutions, septic phenomena
and hydrocephalis. of persons suffering with colds, who are the Sepsis is best treated by subdural injections most susceptible to infection.
of the anti-meningitis serum at proper inVarious antiseptic solutions have been
terval and in suitable doses. used; among them being hydrogen peroxide, argyrol, menthol, chlorine water and
Hydrocephalis, due to pressure of the pyocyanase. The anti-meningitis serum
cerebrospinal fluid in the ventricles of the has also been used as a spray for the nose.
brain, is best relieved by lumbar puncture, The following are the detailed instructions
and drawing off a portion of the offending for the disinfection of the nasopharynx as
fluid. In performing this operation the issued by the French Army in 1910:
blood pressure should be taken and care1. All carriers must have the naso
fully watched by a competent assistant, as pharynx, mouth and tonsils carefully disin
a drop of over 20 m.m. of mercury indicates fected by antiseptic inhalations and swab
extreme danger to the patient. bing.
When injecting the anti-toxic serum the 2. For inhalation the following mixture syringe method is open to objection, as it is is recommended: iodine 12 grms.; guaiacol, difficult to control, and is more liable to be 2 grams; thymol, 25 per cent.; alcohol, 60 accompanied by a large fall in blood presper cent (200 grams).
If shock occurs during the operation In order to dissolve the iodine six grams the patient should be raised, the injecting of iodide of potash should be added to the needle left in place, and the Auid withmixture. This mixture is put into a porce- drawn till response is noted, with also the lain which is floated in a basin of boiling internal use of atropin and cocaine, as the water. The patient is directed to sit with latter is especially useful as a respiratory his head bent over this at a few inches dis- nerve center stimulant. tance and to inhale the fumes, treating General anesthesia should not be given, slowly through each nostril. The sitting when administering serum therapy, unless should last two or three minutes and should absolutely necessary, and then only with be repeated five times in twenty-four hours. extreme caution, on account of its depres.
Dr. Sophian states that in his experience sing action on the respiratory nerve centers. very satisfactory results may be obtained The repetition of the injection of the antiby using a preliminary cleansing salt solu- toxin serum should be made every twenty. tion douche for the nose and gargle for the four hours, usually to the extent of two or throat followed by spraying with peroxide three days consecutively, being guided by 14 to 1/2 per cent. Internally urotropin the change in the cerebrospinal Auid and by (hexamethylenamine) in 15 to 30 gr. daily the clinical condition of the patient. Imdoses may be used. This drug finds its provement is indicated by the diminution, way into the cerebrospinal Auid and is also later disappearance of the meningococci in excreted by the nasal mucous membrane. the cerebrospinal fluid and by their inclu
The anti-meningitis serum in doses of 5 sion within the polymorphonuclear leucoto 10 c.c. injected subcutaneously may be cytes. With each injection absolute aseptic used as a prophylactic. It produces a high precautions must be employed. As a suband immediate immunity which however is stitute for the syringe method of injection