Prognosis. A constitutional affection. Secondary symptoms, unless prevented or retarded by treatment, declare themselves in about six weeks from the appearance of the sore, and very rarely delay longer than three months. We have thus given, as near as possible, the present position of venereal pathology, and as we before stated, these points are still under investigation, but for ourselves, from all we have read and seen, we have come to the simple conclusion, that all venereal diseases have one cell formation-that the pus contains the same cell, whether a Blennorrhoea or a bubo, or the pus from a chancre-and that it has originated from the impure connections with women with the whites, and that it still occurs and is occurring every day. Within a short time I have treated a man and his wife one for a Leucorrhoea, with hemorrhages, and the other for a bad case of Blennorrhoea. I have no right to doubt either's words, and they had talked over the matter with each other before I was called, which to my mind gave truth to their statement. Another gentleman, in whom I have entire confidence, applied the same week and was treated for a pretty severe case of Gonorrhoea, and was cured, and afterwards for an eruption on the scrotum and thighs of a syphilitic character. He protested his entire innocence, and I did not once doubt him, as I had known him long, and had been intimate in his family, attended his children and wife, and himself, for four years before. TREATMENT.-I have only a few practical hints in the way of treatment. As to Gonorrhoea, we have already given our treatment for this disease in a late number of the Galveston Medical Journal, and shall not repeat what we there said. Primary Syphilis.-As I assume that the various forms are one and the same in nature, I treat them all on general principles. If I see the chancre before it becomes so large that I cannot remove it, I lift it up with a forceps and cut it off with the scissors or a knife, and then dress with simple cerate and give internally Iodide of Potash and Syrup of Sarsaparilla, or watery solution of Iodide of Potash. I continue this for four or six weeks, and if there are any indurations of the skin around the sore, I add Corrosive Sublimate to the solution forming the Bini odide of Mercury. Thus Potassæ Iodidi, vi drs. Hydr. Ch. Corrosivæ, ii grs. Syrup Sarsaparilla, i quart. Tablespoonful three times a day, two hours before each meal. Continue this until I cure the disease. If it salivate I stop all medicines and feed my patient. I allow them their usual diet in all forms of veneral disease. If the chancre is too large to be cut out, or burnt out with caustic, I make a solution of the Chloride of Zine, thus Zinci Chloridi, xxx grs. Aquæ Pluvialis, 1 quart. Bathe the sores well after washing the parts, and saturate some lint and place over sore-continue this treatment, if the ulcer begins to heal; if not I use the Black or Yellow Wash in the same way. If any of these produce ulceration, as they will sometimes, I use Tannin R. Tannin, i dr; Aquæ Pluvialis, i quart; in the same way, or Tincture of Gum Myrrh. From the ulcer I can generally tell which of these will be the most useful. The Black and Yellow Washes are best for indurated chancres; the Zinc for the soft or chancroid ulcers, and the Tannin alone does good in the Phagædenic. Where the patient is debilitated I give Quinine and Belladonna or Cicuta. For all the Syphiledes, the above form of Mercury and Iodide of Potash has proved successful in my hands, not having to use anything else in an otherwise healthy constitution. Buboes are the most tedious form of the disease and the hardest to remove. I usually blister them and apply Iodide of Mercury Ointment over the blistered surface, lance them when they have pus in them, and generally when they form pus and it is let out they soon recover. But it is best to produce resolution if possible, and this we should endeavor to do. In ulceration of the throat, I have mostly relied on the internal prescription given above, but have often found the Syrup of Iodide of Iron, made of Glycerin, an excellent remedy-teaspoonful three times a day. I also cauterize with Zinc, x grs. to ounce, and Nitrate of Silver, as in primary ulcers. In Syphilitic Ophthalmia, I use compression over the lids, Mercurial Ointment on the lids, and Atropine solution, ii grs. to an ounce of water, internally on the conjunctiva. This has generally proved successful, and I have not lost an eye yet from this disease. In caries of the bones and ulceration of the nasal cartilages, I apply the Zinc solution three or four times a day, with the Ether-Spray Apparatus, or with a syringe. Of Strictures and Hypospadias I have already written my experience; also perineal fistulas, of which I could report some eight new cases successfully treated. [Extracts from Dr. Fenner, on Yellow Fever.] The Epidemic of 1853 at New Orleans, FEVER STATISTICS. In my previous memoranda frequent allusion was made to the various types or kinds of fever that were designated in the reports from the cemeteries during the prevalence of the epidemic. The following table will show the principal types of fever that appeared in the mortuary reports of the Board of Health during the months of June, July, August and September: Various names of fever found on the reports from the cemeteries, such as nervous, hectic, Chagres, putrid, ataxic, worm fever, etc., have been omitted, as the cases amount to but few. From this table it will be seen, that in the month of June the deaths from all the fevers specified amount to 143; of which yellow fever, 46. In July, all fevers, 1,482; yellow fever, 1,380. In August, all fevers, 4,962; yellow fever, 4,797. In September, all fevers, 779; yellow fever, 722. The total number of deaths from all fevers during these four months, as published, was 7,472; of which 6,945 died of yellow fever, and 527 died of other types. From these mortuary statistics it will be seen that during the reign of the great epidemic, which slew its thousands, people likewise died of all sorts of fever. The statistics of the living, which I shall now present from the Charity Hospital, also show a similar variety of fevers prevailing together, though in somewhat different proportions: TABLE showing the number of patients admitted into the New Orleans Charity Hospital, for all diseases and for all kinds of fever, during each month of the year 1853. 3 3 Pernicious. 0 272 193 207 168 223 314 335 181 112 229 237 169 63 39 44 36 86629125 11 .13 6824 200 2640 15 21 34 12 21 442 2 1157 From this table it will be seen that the admissions for all diseases amount to. If we now examine the five months during which yellow fever chiefly prevailed, viz: June, July, August, September and October, we shall find that the admissions for all fevers were.. Of which not quite two-thirds were yellow fever.. 66 more than one-third were intermittents. These statistics will doubtless surprise those who are under the impression that when yellow fever prevails as an epidemic, all other types of fever vanish from the field. And furthermore, when we take into consideration the established fact, that these different types of fever prevailing together, are often merged into one another, it appears to me to indicate the existence of a close relationship between them. In the mass of testimony from various quarters, which I shall present in this paper, I hope the reader will bear in mind the fact noticed both here and elsewhere, that physicians often supposed they were treating bilious remittent fever, until they saw the disease terminate in black vomit. In my previous writings on the fevers of New Orleans, (N. Orleans Med. and Surg. Journal, and Southern Medical Reports,) I have given the statistics of a number of years, tending, as I think, to establish this point; but the reader may think differently. The intermittent and remittent bilious fevers of a sickly summer and autumn in the country, are known to interchange type, or run into each other, and are generally considered varieties of disease, arising from a common remote cause. The very same thing takes place in respect to the intermittent, remittent, and yellow fevers of this city. What it is in this locality that gives rise to the variety or type of endemic fever, called yellow fever, I cannot tell; but the facts surely stand as I have presented them. The number of yellow fever cases admitted into the Charity Hospital this year, was not so great in any month as it was in 1847, whilst the proportion of intermittents was greater: thus, in the month of August, 1847, the number of yellow fever cases admitted was 1,611, and of intermittents, 74; whilst in 1853, in August, the yellow fever cases were 1,495, the intermittents, 181. There would have been more admissions in 1853, but for the many temporary hospitals that were established by the Board of Health, and the Howard Association, which greatly relieved the Charity Hospital. There having been 3,052 cases of yellow fever admitted into the Charity Hospital, and 1,765 deaths during the four months stated, it follows that the mortality was 57 per cent. Considering the malignancy of the epidemic, and the late stage in which a majority of the cases were admitted, this rate of mortality is by no means discreditable. From a report to the Board of Administrators on the 1st of October, by the house-surgeon, Dr. Choppin, I find the following items relative to the length of time the patients were sick previous to admission, in 1600 fatal cases: |