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I shall give them a trial, and feel sure that I shall derive much benefit from them.

In regard to the operations on the nose and ear, I have only favorable comment to make. In even the slightest operation on the nose I resort to the suprarenal extract made in my office or the adrenaline chloride. The effect is not infrequently quite wonderful. Before this remedy was put into our hands we were confronted for a few days with a condition of swelling due to the reaction caused by the operative procedure. With the suprarenal extract there is usually no reaction of any consequence. I remember the first experience I had with this remedy. I cautioned the patient, who was nervous, telling him he would probably not be able to attend to his business for a day or two, and asking him to report. In a few days he reported, and I asked him why he had not been in. He said he had not had the slightest inconvenience. The nose had been freer than it had been for months, and he felt better every hour since the operation was done. I can commend the suggestions made by Dr. Herron by personal experience. The suprarenal extract is also a marked tonic for the heart. By its use we get rid of the effects of cocaine and have none of the distressing symptoms following the use of that drug.

DR. HERRON (closing): In writing this paper I could have cited dozens of similar cases, but I wanted to make a short paper of it. In speaking I wanted to lay stress on the use of the syringe. I believe patients are injured every day by its use. I think I have injured them without knowing it. By the use of the syringe we force the germ into the drum cavity and set up a mastoiditis and get into trouble we could have avoided, had we used some other means of relieving the patient. Therefore I want to lay stress upon this. In this girl I know the pain was brought on by the use of the syringe and the hot water. After rupture of the drum membrane we usually have relief, but in this case the pain continued for two days. After that the intense pain stopped, and she got along nicely. She went home and did not use the syringe, but used the above preparation, and relief was soon obtained. I have never used the adrenaline chloride, because I had the other preparation. I commenced with this and continued with it, and the results have all been satisfactory. I think it is risky to place the adrenaline in the patient's hands. It is a thousand times as strong as the suprarenal liquid.

DR. PRICE: I will say that I usually prescribe this in the strength of 1 to 10,000 for patients' use. There is no danger in that.

DR. HERRON: That places it on the same basis as the suprarenal liquid. I have not performed paracentesis for some time, because with the use of this remedy I have gotten rid of the inflammation before an operation was necessary.

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THE TREATMENT OF SYPHILIS,

BY JAMES W. HANDLEY, M.D., Professor of Genito-Urinary and Venereal Diseases, Medical Department

of the University of Tennessee.

cases.

Gentlemen :

During the past twelve years I have devoted a large amount of my attention to the treatment of syphilis in its different stages and the multiple phase of each stage, and am convinced that the routine breatment practiced by many general practitioners of medicine, is open to severe criticism. Many physicians only know one treatment, and apply it to all

Some rely upon Keyes' “tonic treatment,” in which he uses the protiodide of mercury granules, generally known as the G. & L. pills, and for which he claims much success. Some rely upon that conglomerate mixture of mercury and potash, known as the “mixed treatment,'' while others use the inunction, than which there is no better treatment, if properly applied.

While patients are following closely the directions of the physician prescribing the above, mucus patches, syphiloderma and ulcers are constantly manifesting themselves, and both patient and doctor are often disappointed with the course the case is taking, which can be attributed to but one thing, namely, "routine treatment."

There is no disease that comes under our care that yields as readily and certainly to medicine, properly applied, as syphilis. The question of diagnosis is the all-important point before beginning any form of treatment.

Read at Meeting of Nashville Academy of Medicine, March, 25th,

1902.

Everyone must recognize a distinction between chancre and chancroid. These two diseases are no longer treated alike. No longer do we have syphilis (?) with no secondary symptoms, not even a slight adenitis of the nearest lymphatic glands.

We count the red blood corpuscles and estimate the hemoglobin, and demonstrate the effects of syphilis upon the system. Blood is anæmic; the red blood corpuscles are decreased in number, and there is diminished hemoglobin. In many cases a marked leucocytosis and general lymphatic and glanular engorgement is present. This accounts for the malaise, lassitude, loss of energy, so pronounced in the earlier stages of syphilis. This oondition is not unassociated with fever of 991 to 1001° F., rarely higher, unless other septic infection has taken place, involving the neighboring glands. The next question is, when shall we commence constitutional treatment. Some syphilologists teach us to wait for the appearance of secondary symptoms, claiming that the disease can be eradicated just as soon as though we come menced treatment when the chancre appears. I am fully convinced that such an argument is untenalbe, and it is not borne out by the experience of a large number of the profession. I do say, however, that if you are in doubt, give the patient's hopes the benefit of the doubt, and wait until you are certain. But, on the contrary, when you have a history corresponding to the primary incubation of syphilis, a slow, indolent induration, free from sensation, pus, and surrounding inflammation, non-autoinoculable, whether solitary or multiple, with symptoms of multiple adenitis, and without tenderness, you can feel reasonably sure that you have a chancre to treat, and constitutional moasures are indicated immediately. Often have I seen this form of sore melt away with suprising rapidity, as soon as the patient was placed on constitutional treatment, where it had shown no signs of healing under previous local measures. Mercury ad. ministered as a diagnostic measure, is admissible in many doubt. ful cases, but as an indiscriminate mode of diagnosis, it is certainly to be condemned, as a chancre might take a turn toward recovery and heal as soon as the mercury is given, and leave the patient ever afterwards in doubt as to his having had syphilis. I believe that the frequent counting of the blood corpuscles is a practice worthy of careful consideration in the administration of mercury

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