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occurred. The treatment of syphilis should be offensive, not defensive. Keep the disease in as quiescent a state as possible by inhibiting the life action of the organism; prevent contagion from lesion formation; promote the elimination of the toxins as quickly and completely as possible, and pay attention to the general nutrition of the patient. This constitutes the correct treatment of syphilis according to our present knowledge.

Mercury is the only agent that acts upon the microbe, hence it should be given during the entire microbic stage in such manner as to secure the best action. Iodid of potassium should be given only as an aid to the mercury, or as an alterative in later stages and at all times when tertiary lesions represent. It is rarely indicated during the first six months of the disease, and never during the microbic stage, as the only agent.

Against the parasy philides one should produce a proper degree of alkalinity of the system, advise avoidance of everything that causes circulatory disturbances and of things

that interfere with tissue metabolism, especially alcohol, local irritating agents, etc.

Dr. E. L. Keyes, Jr., opened the discussion of this paper. He said that while he agreed with all the conclusions reached therein, he disagreed wholly with all the premises. Briefly, in his opinion, the way to treat syphilis is as a disease and not as an array of symptoms. The most practical method is to settle in one's mind the amount of medicine considered necessary in all cases to overcome the disease. One grain of iodide of mercury every day for three years will conquer, and even though the skin lesions have disappeared, together with the mucous patches in the throat and other outward manifestations, the physician should still try to live up to his ideal of the amount of mercury or iodid that should be taken by the patient, whether he stands it well or not. He disagreed absolutely with the speaker regarding the method of treatment at the beginning of syphilis. It is extremely dangerous to proclaim that syphilis should be treated before the appearance of a cutaneous lesion, because, in a very fair proportion of cases, one is unable to make a positive diagnosis until the appearance of the secondary lesions. Theoretically, if it is proved that the existence of the spirocheta pallida is conclusive of syphilis, treatment may begin as soon as it is recognized, but until this is possible, it is wiser to wait for secondary evidence He recalled two instances in which patients who had presented themselves for treatment within twelve hours of the sup

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posed inoculation had developed a chancre six weeks later.

Dr. Charles H. Chetwood said that there seems to be a general tendency at the present time to question whether syphilis should be treated in the primary or in the secondary stage. The reader of the paper had emphasized the point that the question is not when to treat it, but that it should be treated when the diagnosis has been made. For his part, he had always treated it when the secondary safe procedure. eruptions appeared, and had considered it a He would not advise commencing treatment earlier unless the presence of the disease could be positively substantiated by the spirocheta pallida or some other germ. He treats all cases according to the general exigencies of each individual satisfactory. condition, and the results have been most

Dr. J. H. Abraham said that next to the dermatologist and the genito-urinary surgeon, the nose and throat specialist sees as many They rarely see any primary syphilis, but cases of syphilis as any of the specialists. many secondary and tertiary cases come to their notice. Personally, he had seen five cases. One patient had the initial lesion on the lip and the other four on the tonsils, and in one case the upper respiratory glands showed marked symptoms of intoxi

cation. Another marked feature is the en

largement of the leutic glands. He agreed with the principles laid down by the reader of the paper for the treatment of primary syphilis. Secondary syphilis of the larynx should be treated entirely by personal rule. He relies upon one drug, carbolic acid. An application of 10% chromic acid to the larynx gives rise to practically no pain and accomplishes the desired result. If the patient is given a sufficient amount of mercury for a long enough period of time, he is less liable to require the iodids or to suffer from a marked tertiary form later. He has never found it necessary to give more than 75 or 80 grains of the iodid at one dose, and always begins with 5 grains and increases one grain daily or every other day. The absorption occurs as desired and the digestive tract is not disturbed.

Dr. R. H. M. Dawbarn said that he believes the wisest course is to begin treatment of syphilis as soon as one is sure of the character of the lesion. He did not agree with the statement that the iodids of potassium have no direct bearing upon the foundation of syphilis. In his opinion, over eating and over drinking may so change the metabolism of the human system as to render the effects of syphilis mcre intoxicating.

Dr. J. A. Bodine said that the time to begin treatment depends greatly on the character of the patient. The primary

duty of the physicain is to effect a cure. If the patient is a highly intelligent one, the treatment may begin as soon as the diagnosis is positively made, as that character of patient may be depended upon to carry the treatment through to its logical conclusion. With a more ignorant patient, it is often necessary to first convince him that he is a victim of this disease in order to impress upon him the necessity for systematic and long-continued treatment, and in this case the appearance of the skin eruption following the sore convinces him that he has syphilis. Dr. Robinson closed the discussion by saying that he still thought the treatment should be begun, if possible, during the first stage of the disease. If the patient presents what he considers the initial lesion, he recommends a six weeks' course of treatment with mercury, and if, at the end of that time, there remains any question as to the diagnosis, it is very easy to bring out a small lesion as convincing proof.

WHEN palpating the common bile duct for stone, make sure that a suspected calculus is not a gland.

IN exploring for tumors of the brain, the best guide for determining an isolated hardness is the finger; the use of a needle is very deceptive.

THE use of an "invalid table," the shelf of which projects over the patient's body, will be found a great convenience during operations as a receptacle for instruments in immediate use. It saves time and temper, and avoids accumulation of instruments on the patient's body.

THE MEDICAL FORTNIGHTLY

A Cosmopolitan Biweekly for the General Practitioner The Medical Fortnightly is devoted to the progress of the Practice and Science of Medicine and Surgery. Its aim is to present topics of interest and importance to physicians, and to this end, in addition to a well-selected corps of Department Editors, it has secured correspondents in the leading medical centers of Europe and America. Contributions of a scientific nature, and original in character, solicited. News of Societies, and of interesting medical topics, cordially invited.

Advertising forms close on the first and fifteenth of each month. Time should be allowed to submit proof for correction Advertising rates on application.

Remittances and business communications should be addressed to the Fortnightly Press Co.

Subscription, $2.00 a year, in advance, including postage to any part of the United States, Mexico and Canada. Postage to foreign countries in the Universal Postal Union, including Newfoundland, $1.00 a year additional. Entered at the St. Joseph post-office as second-class matter.

The Medical Fortnightly will not be discontinued at expiration of subscription, as many of our readers prefer not to have their files broken on account of failure to remit. Unless we receive a distinct request to discontinue, and payment for all arrearages, this magazine will not be discontinued.

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Contributions and books for review should be addressed to the editors, 319 and 320 Century Building, St. Louis, Mo.

SUTURE OF HEART WOUNDS.-J. H. Gibbon, Philadelphia (Jour. A. M. A., Feb. 10), makes a third contribution to the subject of penetrating wounds of the heart, reporting his second case of suture of the heart and his first successful one. The patient, a healthy colored man, aged 38, had received a pen-knife wound in the right ventricle of the heart. Hemorrhage had been spontaneously controlled to some extent by pressure of the clot and liquid blood in the pericardium, and was readily controlled by digital compression during the operation, though the wound in the external surface of the heart was from half to three-fourths of an inch in length, and apparently half as extensive in the endocardium. The heart was held firmly against the pericardial opening with a traction suture of chromicized gut and four other sutures introduced with an intestinal needle closing the whole thickness of the wound in the heart The patient was out of bed in two weeks, and was discharged in twenty days after the operation. At present he is well, and the heart action is normal. The pleura was uninjured, either by the wound or in the operation, no osteoplastic flap having been made, but merely excision of costal cartilage. In future similar case Gibbon would not attempt to drain the pericardium. The external wound, however, he thinks should always be drained. Whenever there is suspicion of a wound of the heart and exploratory operation should be made. Gibbon advises against any too vigorous stimulation when wound of the heart is suspected.

IN strapping the chest for fractured rib, two points should be particularly noted: 1. The straps should pass well beyond the median line. wall. 2. They should be applied in full expiration. One or two straps passed over the shoulder belp much to secure immobilization.

ALTHOUGH the anal reflex requires profound anesthesia to abolish, chloroform or ether is not always needed in order to divulse the sphincter ani. This may be accomplished painlessly, and usually with entire satisfaction, under ethyl chloride or nitrous oxid narcosis if, especially, an opium suppository is introduced a half-hour beforehand, and a pledget of cotton wet in cocaine solution is applied just before the operation.

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Look well to your prescriptions-a careless or dishonest pharmacist may ruin your reputation.

IMPORTANT TO PHYSICIANS

LITHIA SALT

(Wm. R. Warner & Co.)

For Alkaline Treatment of Rheumatism, Gouty Diathesis, Cystitis, Gravel, Kidney Troubles, Uricemia, etc.

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The "Princess Irene" of the North German Lloyd Steamship Co., upon which the American party to the last congress sailed. This boat is a sister to the steamship "Koenig Albert," which will carry the American party to the Congress in April.

WILL YOU JOIN THE

AMERICAN PARTY?

AND ENJOY A DELIGHTFUL TRIP TO ATTEND THE

INTERNATIONAL
MEDICAL CONGRESS

TO BE HELD IN

Lisbon, Portugal, April 19 to 26, 1906

ROUND TRIP, FIRST-CLASS all through, $300, including board and all expenses. Sails from New York on the "Koenig Albert " April 7. Return trip may be arranged to suit the pleasure of members, with extension of time, if desired. Full particulars and itinerary may be obtained by addressing

DR. CHAS. WOOD FASSETT, St. Joseph, Mo.

MEDICAL MEMORANDA.

Best Uterine Tonic and Antispasmodic.-Dioviburnia is the best uterine tonic and antispasmodic, relieving the pains of dysmenorrhea and regulator of the uterine functions. I cheerfully give this recommendation of dioviburnia.-L. ch. Boisliniere, M.D., late Professor of Obstetrics, St. Louis Medical College.

Cystogen-Lithia Effervescent Tablets.-The many indications for the use of lithia in combination with cystogen have resulted in the preparation of cystogen-lithia effervescent tablets. Physicians will find these tablets of special value in the treatment of many conditions suggesting the addition of lithia as increasing the efficiency of cystogen. In rheumatism, gout, urinary deposits, ammoniacal urine, cystitis, etc., cystogen-lithia hastens the exertion of urates and uric acid and prevents the formation of calculus. These tablets are composed of, cystogen 3 grains, lithium tartarate 3 grains; usual] dose, one to two tablets three or four times daily, dissolved in half a glass of water. Samples will be sent to physicians addressing the Cystogen Chemical Company, St. Louis, Missouri.

The Season of the Year has again come, in which the practitioner is called upon to give relief from the various diseases of the bronchial organs, as cough, chronic and acute, bronchitis, asthma, pneumonia, phthisis, tuberculosis, etc. Of all remedies indicated in the treatment of these disorders, guaiacol has long been recognized as the leading agent. In triacol, Alpers, a preparation is given to the medical profession that contains all of the beneficial qualities of guaiacol, without any drawbacks. It is an aromatic solution of the tasteless, odorless, soluble, guaiacol salts of potassium, sodium, and ethyl-morphine. Triacol, Alpers, has received the most hearty support of the leading practitioners all over the country, and is indicated by them in the treatment of all bronchial affections. Samples and literature can be obtained by application to Alpers Chemical Company, 4-6 White St., New York City.

A Pocket Case Free. Great interest is mauifested by the profession just now, and rightly, in the nostrum evil-the practice of promoting secret, ready-made prescriptions for the doctor to use as the manufacturer advises, all of which has a distinct degenerative effect upon the profession as a scientific body of thinking men. The Abbott Alkaloidal Co., always alive to the best interests of the physician and obviating, in their idea, any excuse for all this, offer to the profession standard active principles which the doctor can apply, singly or in combination, at his own dis. cretion-dispensing or prescribing as he may prefer. To any practising physician who will write asking for it, and mentioning this journal, they will send, free of charge, a neat pocket case containing six vials of the essential (most used) active principles-the smallest and neatest emergency pocket case ever made-just fits the fob-pocket and but little larger than your watch. See their ad. on page 55. Hundreds of positive doses for the asking, and a postal card will do it.

Relief of Sciatic Paln.-We wish to refer to a comparatively new combination of drugs, one which has been used largely for the control of cough and which has also been employed to a great extent for the relief of pain. It is claimed that its use in many cases renders the same service as does morphine, its influence often lasting for as long a period of time, and possessing the advantage that it does not disturb the digestive tract, nor cause constipation or habit. The remedy we mean is antikamnia and codeine tablets. In several instances in which the patients were suffering from severe acute sciatica, it was found that they acted most satisfactorily. Each tablet contains 44 grains of antikamnia and one-fourth grain codeine sulphate. The prompt and excellent results obtained with this preparation is due, in a great measure, to the specially refined and purified codeia which The Antikamnia Chemical Company employs in these tablets. Impure or ordinary codeia irritates, constipates and depresses, and to avoid this, the said company purifies its codeia by a special process, and this should be remembered by the physician when prescribing codeia.

Catarrhal Diseases of the Nasopharynx.-(By H. M. Narsh, M. D., Auburn, Ky.) -As the season is now fast approaching when this class of diseases take up most of the physician's time, and is the cause of more suffering among more people than all diseases combined, I wish to say something in regard to a simple and effective treatment of this class of diseases. In this climate, this is the commonest of all diseases, there being very few who do not suffer from it in some of its various forms. Chronic nasal catarrh is in most cases a result of repeated attacks of acute catarrh or "common colds." In this short article it is not necessary to go into details or take up time or space with causes or symptoms; everyone is familiar with them. My object here is to simply give my plan of treatment plain and simple, yet eminently successful. In the treatment of these cases every physician is well aware of the fact that cleanliness is in most cases all that is necessary for a cure. Every physician also knows that in order to have a perfect cleansing agent it must be both alkaline and antiseptic. My success in treating these diseases, viz., acute and chronic nasal catarrh, including ozena, acute and chronic tonsillitis, pharyngitis, catarrhal deafness, etc., has been due almost entirely to the systematic and thorough cleansing of the mucous surfaces with glyco-thymoline. I have been using this ideal alkaline antiseptic in my practice for years, and have never been disappointed in it.

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