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duced by the gonococcus may act deleteriously like alcohol or lead. A healthy man had gonorrhea, followed four weeks later by vesical symptoms. With these he had a gradual loss of power in the legs, and muscular tenderness. Ten days later the legs were wholly, and the arms were almost wholly paralyzed; the knee-jerks were lost; the electrical reactions were diminished; the sensibility was unimpaired, and the nerves and muscles were extremely tender. Later the face and larynx were involved. Convalescence was established in nine weeks.

A healthy girl was impregnated and infected one month before. The gonorrhea was followed by gradual paralysis, first of the arms and then of the legs, with pain, tenderness, and reaction of degeneration. She improved in five months, and was delivered of a healthy child at term. EngelReimers also thinks that there may be an isolated neuritis of gonorrheal origin, especially of the sciatic nerve, analogous to the multiple swellings of the joints, inflammation of the sheaths of the tendons, iritis, etc., due to gonorrhea; such a neuritis may vary in its severity with the gonorrhea. He also reports a case of acute spinal meningitis, and quotes two other cases. Gonorrhea alone seems inadequate to produce this condition, and some exciting cause, especially cold, seems also necessary. His own case was that of a young coachman, who had gonorrhea three weeks before, and who sat on his box in a severe north wind for several hours. He had a severe chill, sudden headache and backache, vomiting, fever, stiffness of the neck, herpes, and erythema. The spleen was not enlarged, and the sensorium was free. The spine was rigid. The headache and stiffness of the neck disappeared in forty-eight hours. The knee-jerks were exaggerated, and there was much pain and tenderness over the vertebræ. Eleven days later the temperature fell, and in four weeks he recovered.

Tambourer reports the case of a man who had chronic gonorrhea of three years' standing, associated with stricture, arthritis in the larger joints, and phlebitis in both legs. The phlebitis disappeared and the arthritis improved, but he had a sudden attack of cerebral embolism with right hemiplegia, and died in three days. The phlebitis and embolism were considered due to gonorrhea, Leyden having demonstrated gonococci in the vegetations on the valves in a case of acute gonorrheal endocarditis. Muscular atrophy and exaggerated reflexes were present, and were ascribed to the arthritis.

Pitres supplements this by the report of two cases. A man with acute gonorrhea and arthritis had a sudden attack of apoplexy, with right hemiplegia and aphasia. Eight weeks later he had attacks of Jacksonian epilepsy and died. There was a large area of softening in the left hemisphere, and abscess of the kidney. The heart and vessels were healthy. Another young man with gonorrhea was attacked with left hemiplegia, from which he made a partial recovery. The heart and vessels were healthy. Pitres commits himself to no explanation of these cases, but states that he was simply struck by the coincidence of the two affections, especially so in the last case, in a man who had none of the ordinary causes of hemiplegia. He

adds that if the observations multiply we may find that gonorrhea may produce softening of the brain, as it seems to produce myelitis.

Cullerre reports the case of a woman with stupidity and hallucinatory confusion, symptoms of meningo-encephalitis, and ideas of satisfaction and riches, which he thinks indicated an infectious psychosis. The only infection was by the gonococcus, but moral causes and possibly alcohol entered into the etiology, and provoked the explosion of nervous accidents prepared by infection. The second case had a bad nervous heredity; a young woman, after gonorrhea, developed hallucinations, stupor, and outbursts of mania. and melancholia.

Venturi, in twenty-two cases of hebephrenia, found gonorrhea in twelve. It usually preceded the mental trouble, and none of the cases recovered until the gonorrhea was cured, the cure of the mental trouble usually coming two or three months later. Venturi thinks that there is a specific morbid process, a serous subarachnoid effusion provoked by the gonococcus.

These latter cases do not seem very conclusive. Proof that the embolism is really due to any action of the gonococci is lacking, and, as Pitres says, embolism may be merely a coincidence. In the reported cases of psychoses, gonorrhea seems to have been merely one factor in the etiology, and it is not unreasonable that the idea of having gonorrhea may have had a greater effect upon the brain than the gonococcus itself.-Boston Medical and Surgical Journal.

THE TREATMENT OF INOPERABLE MALIGNANT TUMORS WITH ERYSIPELAS AND PRODIGIOSUS TOXINES.-In an article on this subject, in the Medical Record for January 19th, Dr. W. B. Coley gives the following summary of his results:

Up to May 31, 1894, he had treated with mixed toxines twenty-five cases of inoperable sarcoma, eight of inoperable carcinoma, and three of sarcoma or carcinoma. In carcinoma he had noted marked improvement in a number of cases, but no cures. They were all very advanced recurrent tumors. In sarcoma he stated that there were six cases in which he considered there was a reasonable hope of permanent cure. Six months have passed, and none have shown any recurrence. Of two others, which were merely mentioned among the tabulated cases as improving, one has gone on to entire disappearance of the very large tumor and promises to be a cure, and the other, a six-times-recurrent sarcoma of hand, is in perfect health at present, nearly two years after the beginning of the treatment. Since May 31, 1894, he has treated twenty-four cases of malignant tumors, all inoperable and mostly recurrent, with the mixed toxines. Of these cases, thirteen were sarcoma and eleven carcinoma. In many cases of carcinoma the injections had an undoubted retarding influence, and in some the improvement was extraordinary, but in none did the tumor entirely disappear. In the cases. of sarcoma the effect was far more marked; and although in a number of them the disease was so far advanced that there could be no possible hope

of recovery, still the powerful controlling influence of the toxines was demonstrated. In three of the thirteen cases the sarcomata have entirely disappeared, and although no great length of time has elapsed, the results in his older cases make it improbable that relapse will occur. Of his total of thirty-eight cases of inoperable sarcoma, therefore, nine promise to be permanently successful.-Ibid.

THE ANTITOXIN TREATMENT OF DIPHTHERIA.-It seems necessary, from certain facts which have come to our knowledge, to insist that to obtain good results by the use of the antitoxic serum it is absolutely essential to abide by the directions as to the quantity given. The dose, as stated by Dr. Klein, is 14 drams to 2 drams. A dram or 14 drams is a minimum dose for a child, and to inject quantities of 10 or 20 minims is merely to waste the material.

The necessity for careful nursing, also, after the use of the antitoxic serum must be insisted upon. The curative effect of the serum can not of course extend to the removal of actual structural lesions already produced by the disease; it can not do more-and no conceivable remedy could do more than check the extension of the morbid process. Further, the very fact that the arrest of the morbid process brought about by the action of the serum leads often to an extensive detachment of membrane is an additional reason for the utmost care in nursing. We are led to dwell upon this point because a case has come to our knowledge in which, after tracheotomy was performed and marked improvement in the general symptoms had followed the use of antitoxic serum, the child died suddenly of asphyxia due to the blocking of the tube by a piece of detached membrane. There was no medical assistance at hand, and the child was not attended by a skilled nurse.-British Medical Journal.

THE TREATMEnt of CholERA BY INTRAVENOUS INFUSIONS OF SALT SOLUTION.-In Kronstadt, between June 8 and July 21, 1894, 218 cases of cholera were treated (J. Hazen Torn, St. Petersburger Med. Woch., 49; from Wratsch, No. 34). Of 42 cases treated before June 23d, 27 died. On June 23d the treatment by intravenous infusion of salt solution was begun; 193 infusions were performed upon 124 cases. The immediate effect, as is usually the case, did not last. Of the 124 cases treated by infusion, 67 recovered and 57 died. Of the 67 who recovered, 49 received one infusion, 16 two, and 2 received three infusions. Of the 57 who died, 22 received one, 22 two, I three, and 2 were given four infusions. Of the 124 cases treated by infusion, there were only 10 which did not belong to the severest type. Leaving out these 10 cases, we have 114 cases of cholera gravis with 57 recoveries and 57 deaths-a mortality of 50 per cent. Under the treatment by infusion of normal salt solution, then, the mortality is lowered to 50 per cent. Under the usual methods of treatment the mortality in these cases amounts to 75 per cent.-Boston Medical and Surgical Journal.

Vol. 19.

"NEC TENUI PENNÂ.”

SATURDAY, FEBRUARY 23, 1895.

D. W. YANDELL, M. D., and H. A. COTTELL, M. D., Editors.
JOHN L. HOWARD, M. D., Assistant Editor.

No. 4.

A Journal of Medicine and Surgery, published every other Saturday. Price, $3

per year, postage paid.

This journal is devoted solely to the advancement of medical science and the promotion of the interests of the whole profession. Essays, reports of cases, and correspondence upon subjects of professional interest are solicited. The editors are not responsible for the views of contributors.

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Subscriptions and advertisements received, specimen copies and bound volumes for sale by the undersigned, to whom remittances may be sent by postal money order, bank check, or registered JOHN P. MORTON & COMPANY, Louisville, Ky.

letter. Address

THE ANTITOXIN TREATMENT OF DIPHTHERIA.

The topic which just now is absorbing the attention of the profession and the laity almost to the exclusion of all else medical is diphtheria and its treatment by means of Behring's antitoxin. No society meets that the theme is not brought up for discussion, while the writers, the talkers, and the hospital attendants are daily producing an amount of matter so great that the medical press groans to get quit of it, but without avail.

Already the literature of the subject is heavy and voluminous, and he who attempts to read it finds it crude, chaotic, and confusing.

Much winnowing, sifting, and condensing will have to be done before the conscientious doctor who wants the truth, and desires to apply it in practice, can settle the question as to whether he shall inject or not inject, putting his patient to the extra expense of forty or fifty dollars for drugs in each case, or saving him from what is a manifest extortion on the part of the producers of the new remedy.

What is the duty of the general practitioner at this writing can scarcely be set down. If he fail to apply the remedy and the patient should die, he will be severely criticised. If he employ it, and the patient. die, he will be accused of having experimented upon the victim with a fruitless and expensive fad.. If, however, the patient should recover under the new remedy, it may still be said that many patients have gotten well, and probably this one would have done so without

the antitoxin, and that still the doctor is experimenting with expensive and fruitless fads.

Just what the doctor's duty in the case is can not be stated till time shall give us a great number of reports, and some gifted compiler shall deduce from the vast accumulation of literature upon the topic a volume of statistics reducing the question to a mathematical certainty. Till then we think the practitioner would do well to lay the question of the new treatment fairly before each patient or his friends, and to advise its use in all cases wherein the financial condition of the family will allow of it.

Statistics to date, so far as they are attainable, pronounce the treatment effective in the saving of life; but the usual liberal discount must be made in drawing conclusions from the reports of enthusiastic experimenters with new remedies.

A few chapters like the following, which we clip from the Berlin correspondence of a recent issue of the British Medical Journal, would do much to bring order out of chaos.

At a discussion of the antitoxin treatment of diphtheria before the Berlin Medical Society, Prof. Virchow said:

Treatment by diphtheria antitoxin was begun last March in the Kaiser and Kaiserin Friedrich Hospital. At that time Dr. Aronson had placed his serum at the disposal of the hospital-a present of the value of about 4,000 marks (200)-for which the hospital owed him sincere thanks. In June and July nearly all diphtheria cases were treated with the serum. The results were as follows:

In the first week, cured 13; deaths, I child.

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Suddenly the supply of serum ceased, as, unfortunately, the very horses from which the serum was taken died. The old methods of diphtheria treatment had again to be resorted to, and the results were:

In the first week, cured 5; deaths, 7 children.

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