sauces; also forbid use of coffee, but sometimes allow use of weak tea.

If ye Editor deems this worthy of publication, I may in future give my experience in treatment of old chronic gonorrhea. C. L. NEY.

Baltimore, Md.

[Come again, Doctor.-ED.]

Varicose Ulcers.-Syphilis.--Gonorrhea. Editor MEDICAL WORLD:-I would like to report a case of varicose ulcers. Male, aged 25, family history good. Came to my office in August, 1901, and askt me to treat him for two ulcers on the lower third of his right leg that had resisted treatment for ten years and had been treated by eight physicians at different times. There was no swelling of the limb.

The sores

were about the size of a silver half dollar, edges indurated, and the surrounding skin a deep purple color. My treatment was as follows: Washt the wounds with a strong solution of creolin, mopt them out with pure peroxid of hydrogen, dried them and applied a 20 per cent solution of nitrate of silver; then strapt the limb from toes to knee with an unbleached homespun bandage. I removed the dressing three times a week and used the same remedies, and discharged him as cured in eight weeks. He is now, and has been since I stopt treatment, wearing an elastic stocking.

in

I heard from him yesterday, eleven months since the last ulcer healed, and he says he is still perfectly well. (He promises to bring some money next week!) I have been " 'up to it in the woods treating syphilis and gonorrhea, and find the following treatments very satisfactory: Syphilis Mixt treatment: iodid of iodid of potash and bichlorid of mercury; local applications of 20 per cent solution of nitrate of silver to mucous patches, erosions, etc.

:

Gonorrhea: Injections with a 1 per cent solution of protargol, first making the patient clean out the urethral canal with injections of warm water before using the above solution; comp. methylene-blue capsules by the mouth.

Both of the above have been used successfully by me a good many times. Boykin, S. C. J. T. HAY, M.D.

Sexual Weakness and Neurasthenia. Editor MEDICAL WORLD:-Having been. an interested reader of THE WORLD for some months, I thought I would "chip in " a few words this month on the above subject, as I notice that a number of the WORLD "family" seem to be having trouble with that line of cases. The first thing to do is to get the confidence of your patient. Don't grab for that bottle of nux, phos. and damiana pills, saw palmetto, salix nigra, etc., but have a little "heart to heart" talk with your patient. Disabuse his mind of the fears engendered by quack literature on the subject; get his mind on healthy subjects, and teach him that the sole object in life is not the performance of the sexual act; that the earth does not revolve around his sexual organs, and will not cease to revolve if his emissions are not checkt at once. Let him realize that "there are others" in worse shape than himself, and that his cure is only a matter of time and patience and faithful following of advice. The patient should refrain from sexual intercourse entirely for a time, in order to get his mind away from such subjects, for the. mere thought of the sexual act will often cause an emission, especially in highly nervous subjects. The quicker the patient realizes that there is something higher than the sexual act in this life, the quicker will improvement commence.

Having treated the mind, the next thing is to examin the genitals and orifices carefully; remove all mechanical sources of irritation; an adherent or long prepuce or urethral stricture is often the exciting cause of the whole trouble, which will quickly disappear under surgical treatment; tight sphincters should be thoroly dilated and old hemorrhoids removed surgically. "Orificial "irritation, as a cause of disease, is too often overlookt by the busy brothers" in the profession.

Now, a few words in regard to medical treatment: In the August WORLD Dr. Chapman, in speaking of flushes of the menopause, says to "treat the patient, not the flushes. I fully agree with him on that point; and incidentally, that statement applies also to all diseases at any time and anywhere.

Nux Vomica.-This remedy is adapted to persons of a quick, excitable temperament; disposed to be quarrelsome, and given to high living and the use of much coffee, alcoholic stimulants, highly seasoned foods.

The nux patient is nearly always troubled with acid dyspeptic symptoms, constipation and hemorrhoids. He is very sleepy early in the evening, hours before bedtime; awakes about 3 a.m., falls into a dreamy sleep finally, and gets up feeling tired and weak; backache is very markt; must sit up to turn over in bed; frequent desire to stool, passing small quantities, with a feeling as if not done.

Phosphorus.-Adapted to tall, slender subjects of sanguin temperament, who are very sensitiv to both physical and mental impressions. The phos. patient is very apt to have a tuberculous or hemorrhagic diathesis; he complains of a burning, hot spot on the spine and is exceedingly sensitiv to touch on the spine. Unlike nux, the phos. patient is usually troubled with chronic looseness of the bowels and always seems worse in every way when lying on the left side.

Picric Acid.-This remedy is suited to those who are "a picture of nervous prostration." It is as near a specific for this condition as anything known in medicin, but here again I agree with Dr. Chapman, that it is not a specific, as it is not always indicated by the symptoms of the patient. It is useful for wasted and wornout students and overworkt business men, with brain fag. Priapism; violent and longlasting erection, with very frequent and profuse emissions. There is much headache in the occipito cervical region, and burning and sensitivness along the spine (as in phosphorus, but less in degree). Picric acid is a very valuable remedy in these conditions and very litle used.

Phosphoric Acid.-Persons in whom the debility and weakness was brought on by great grief or disappointment. The mental condition is one of the strongest indications for phos. acid, the patient being listless, apathetic; perfectly indifferent to his business and all things formerly most interested in; the face is pale, eyes sunken, with blue rings around them. The urin is milky or there is profuse urination of clear, watery urin at night, which forms a white cloud at once. Onanism-the patient is mentally distrest by the act. Inclined to looseness of the bowels.

Agnus Castus.-This is the remedy for "old sinners" with impotence and gleet; there is complete impotence; no sexual desire with relaxt, cold, genital organs (just the opposit of the intense desire and violent erections of picric acid). The

patient is very absentminded; very dull of comprehension. Gleet discharge from very relaxt parts, which stains the linen yellow. Premature old age in young persons who have abused the sexual powers.

Selenium.-Impotence, but with desire; the patient has lewd thoughts, but is physically incapable. Partial erections, with involuntary dribbling of semen and prostatic fluid. The selenium patient is nearly always constipated, the stool so hard it often requires mechanical aid for removal. There is a longing for spirituous liquors. There are many other remedies indicated in this condition, among which cinchona, saw palmetto, salix nigra, digitalis and gelsemium stand high. A careful study of the symptoms of the patient will indicate the proper remedy in each individual case. In conclusion, to sum up "in brief: (1) Get the confidence of your patient. (2) Remove the obstacles to recovery. (3) Adapt the remedy to the patient. F. M. EVANS, M.D.

66

Bellaire, Ohio. [It will be noticed that the therapeutics are given homeopathically.-ED.]

A Leukocyte's Narrativ. Editor MEDICAL WORLD:-The circumstances surrounding my birth are somewhat obscure, but my earliest recollections found me in the spleen, while war with all its horrors was raging around the appendix vermiformis.

The blood-forming organs had received leukocytogenesis orders, and the ranks of the standing army of leukocytes was swelled to quadruple its normal numbers by volunteers, who were moving toward the scene of action.

Our division reacht the appendix by way of the ileo-colic branch of the superior mesenteric artery. The temperature was warm, but on nearing our destination it was simply hot.

The regulars arriving first had thrown themselves with self-sacrificing deliberation in a solid phalanx upon the enemy with telling effect in checking invasion.

The blood vessels, our natural channels of communication, were crowded; and the red cells, which we consider civilians or the industrial class, by their agility had appropriated the middle of the stream, compelling us to move along the walls in the slower current. Our progress was further impeded by thousands of blood plates, which being unable to resist the demoralizing effects of the heat and toxins, had clung to the rough projections from the walls and died.

Pressing on, we found the smaller vessels dilated to double their usual diameter to accommodate us, but our numbers, dead and living, had almost occluded them, making that route impracticable.

The rush in our rear increast, and the disintegrating blood plates were render ing things sticky and disagreeable, when we sought a way around by the inter-vascular spaces. In this we were favored by the enlarged inter-cellular spaces in the smaller vessel walls. I protruded a film and thrust it thru an opening, but my body would not follow; so I threw out a broad protrusion from behind, which narrowed my body so it could get thru. The broad projection was elongated and easily followed. I found that I had emerged from an aperture less than onefourth my actual diameter. I found that many of my comrads had preceded me in

like manner.

We then began the tedious march thru

the jungle of connectiv tissue and fixt cells, which was rendered more difficult by dead blood plates and red cells which had been crowded thru the capillary walls by high pressure.

Thus far I have not sighted the enemy, but the depressing effect of the loathsome toxins instinctivly apprised me of the streptococcus.

I am averse to criticising my superiors, but I have often thought that the nerves were thrown into a panic that day, and in their temporary excitement were sending reinforcements so fast that their presence was an actual hindrance in our limited field for action.

A circumstance occurred at this time which I think contributed to our victory. The doctor arrived and applied an ice bag. Oh, what a delicious sensation to our parched and thirsty protoplasm! We paused to watch the result, when the vessels contracted as tho to compress the minute, mural thrombi that were beginning to form, and then they relaxt, and the blood pressure rose and swept them away.

The effect was like magic. The fixt tissue cells, which were rapidly undergoing dissolution, but too far from the lesion to be of any use in tissue proliferation, took on new life. The columns moved up rapidly, and at last I was in the line of battle, and my spirit of patriotism rose at the sights of personal bravery and heroism which I saw around me.

I saw my comrads rush in, grab up a few links of cocci, fold them into their nuclei, some to win in the hand-to-hand conflict only to die later from the toxins of their vanquished foe. Others were overcome and their bodies were used to conceal the victorious germs as they eluded our vigilance and drifted along in the lymph channels.

Our battlements of cells piled thick and high, cemented with a mortar of fibrin, surrounded the invaders, who were strong in their entrenchments but no longer agressiv, and we felt that the victory was ours. We had only to maintain the siege and our enemies would starve and die in their filth.

Our wall was growing stronger, but one great peristaltic wave might sweep it away and liberate a million poisonous demons. Our doctor, however, forestalled that. The stomach was empty and the colon was evacuated, after which total

abstinence was rigidly enforced, so that there was little occasion for peristalsis.

He debated the advisability of an early and immediate operation, and we shuddered at the thought of the results of another conflict, should our enemies be scattered thruout the peritoneum, while yet in the height of their virulence.

The operation was temporarily postponed, and as the smoke of battle raised, the red cells began the work of clearing away the debris and repairing the damage.

I should like to live to see the final victory and complete this narrative, but my once round and shapely nucleus has undergone segmentation, and granulation must soon follow. Modesty forbids any reference to my own personal achievements, but premature death awaits the results of my country's service. It may seem strange that I should have observed all these details, but I have heard that the perceptiv faculties are the keenest, that impressions are the most vivid and lasting, and that deductions and conclusions are reacht with the greatest accuracy and celerity, amidst the fiercest conflict. Florence, Colo. W. V. WATSON.

Notes and Comments. Editor MEDICAL WORLD:-The remarks in THE WORLD for October on "Development of the Bust," lead me to remark that it may not always be safe to develop this part of the body. I have in mind a lady, slender in build, who used one of the developers that act by atmospheric exhaustion the cupping glass principle. The drawing of the blood into the mammary gland may be accomplisht, and it is a well-recognized principle that where there is a fluxion of blood there will be

increased growth. But where does the blood come from? And can the organs thus deprived of blood get along as well without it? The lady did not succeed in increasing the size of her breasts, but her lungs fell into a consumption; and I have always wondered whether there were not a connection between the two. Thin, skinny women, who have not the layer of subcutaneous fat that gives roundness and soft outlines to the female form, will hardly succeed in increasing the size of the breasts, unless they at the same time restore this fat layer to the body in general.

Can syphilis be cured? Well, what evi

me

dence do you want? I have known men affected with syphilis who were treated with mercury till pronounced cured, who then married and raised children, who never manifested any sign of that disease, or any that could be attributed to syphilis with reason. One such child, now twenty-six years old, was to see recently, and as I have had her under observation all her life, I feel reasonably justified in calling her father's case an absolute cure. It is rarely possible to use the words "never," and "always," in science. Nature deals in generalities, in groupings, and separates her groups by imperceptible shadings rather than by sharp lines.

The

Let me express my hearty appreciation of Dr. Rimmer's report on page 421. time to "rest on one's oars" is after the doctor has done his duty and got back to his bed. If ever the doctor earns his crown of glory, it is when he has skilfully and successfully used his chloroform and forceps, and saved mother and child. Then his heart may well warm at the thought that he is a member of our noble profession.

Senile gangrene! I have just had a report from a patient whom I have been treating for Raynaud's disease, by massage and atropin, to favor the circulation. The pains that threatened gangrene gave way to the massage, and the atropin opened the vessels and let in more blood, so that the danger has been tided over every time it threatened, and that is over a year now. Would not this be the best thing imaginable to ward off senile gangrene? Keep the feet warm.

We may cure gangrene all right, but here is something that is not so easy. Seatworms! Ordinarily they give way to quassia injections, but sometimes they resist this and every other remedy I have as yet tried. Two cases have left me in the thirty-odd years of my practise, for whom I failed to find any relief. I have used enemas of limewater, iron, glycerin, asafetida, and many others.

The pain of burns is relieved by any smooth oleaginous application, the best being carron oil; but the real problem is to prevent sepsis, and there are better agents than this. I have painted the burned surface with campho-phenique, with excellent results; and recently the recommendation has been quite general to apply pure carbolic acid, neutralizing in

one minute with pure alcohol. This is good if you have them handy, for the best remedy is the one that will most quickly cover the surface and exclude the bacteria. White lead is very good. We all recollect the man who fell in a vat of boiling soap, and the doctor, thinking him hopeless, let him alone; whereupon he recovered the soap being aseptic in this case, and not a certain "germicide soap" once marketed, that proved phenomenally swarming with microbic life. My boy was burned severely by an explosion of giant caps in his hand. They are supposed to contain fulminate. I applied solution of sodium bicarbonate, which relieved the pain as long as he kept the burned surface immerst; but when it was withdrawn the burning returned, even when pure petrolatum, or carron oil, was applied. The soda probably relieved the chemical burn as well as the fire burn.

WILLIAM F. WAUGH, M.D. Chicago, Ill.

[If the reader will refer again to our editorial on page 414, October WORLD, on "Development of the Bust," he will see that we did not advise the vacuum method. That the methods there recommended are "always safe," can scarcely be doubted.-ED.]

Goiter.

Editor MEDICAL WORLD:-A copy of THE WORLD for October, 1901 (Vol. xix, No. 10), came to my desk recently, and in perusing its contents my attention was drawn to an article upon the treatment of goiter, by D. A. Johnson, M.D., of Dundee, N. Y. (page 425), wherein he highly recommends an "alterativ" treatment and the external application of common adhesiv plaster over the enlargement." The favorit medicins the Doctor recommends are phytolacca, stillingia and iodid of potassa." By this efficient treatment, the Doctor no doubt has relieved many unfortunate patients in his extensiv practise. My experience during many years of medical practise in treating the various variety of this dreaded disease (the writer one of its victims), leads me to believe that this chronic enlargement of the thyroid gland arises from some hyperplastic material in the blood and an altered circulation, and in some cases, impaired innervation.

Our materia medica affords a very extensiv list of remedies, alterativ in action, which have been employed with great

success in the treatment of common goiter, but probably the most valuable remedies we have are phytolacca decandra, iris versicolor, and kali iodid, internally and externally. Specific phytolacca is one of the first remedies; it exerts a specific influence in all inflammatory or enlarged conditions of the glandular structures, especially in various affections of the lymphatics, with hardness and swelling. Specific iris ver. is an important alterativ, and is certainly the remedy for the common goiter, but its superior value is not fully appreciated by fully appreciated by many physicians. Specific iris is indicated in enlargements of the glandular system, especially the enlarged thyroid and lymphatics; it acts by increasing waste and improving nutrition.

The curativ action of iris is believed to be due to its power to directly stimulate the glandular system, lymphatics and skin. Kali iodid is another of the greatest gland alterativs. I most frequently substitute it for specific stillingia with the specific phytolacca and iris for internal use. Kali iodid assists in the removal of worn-out tissue, and acts thru the glandular system by producing slight chemical changes upon the tissues, thereby being absorbed into the circulation and thrown off by the different secretory organs.

A simple compound may be formed of the above remedies and given internally with other remedies that may be indicated in the disease at different times. Externally I employ a local application of specific phytolacca and stillingia compound with massage manipulation twice a day instead of applying iodin or the common adhesiv plaster" advocated by Dr. Johnson. F. E. HILL, M.D.

66

Bainbridge, N. Y.

Remedy for Poison Oak.

Editor MEDICAL WORLD:-Answering R. L. Mathews, regarding treatment for poison oak, I would say that this is a clear case of "the hair of the dog curing the bite." A decoction of the leaves of the plant, say about half a dozen leaves at a dose (or they may be simply chewed and the juice swallowed), will cause an eruption of blebs, or water blisters, which contain an antitoxin that neutralizes the poison in the blood, when the serum from them is reabsorbed. One or two doses is usually sufficient. I have known a copious eruption to follow swallowing the juice of a dozen well formed leaves. The