Mr. "X" was treated by tonics, by massage of the vesiculæ by the finger and recal staff, and by hot rectal saline douches. He was advised to avoid situations in which he might become sexually excited and he was advised not to allow his bladder to become over distended. These measures were continued up to January 15, 1905, when his condition was much improved; the vesiculæ were much softer, more easily stripped of their contents, but were still considerably indurated and much larger than normal. The strippings revealed nothing of pathological importance. The treatment was not kept up so rigidly thereafter, but examinations were made from time to time up to September 15, 1905, when the condition was in much the same state as at January 15, 1905.

He resumed sexual intercourse and again gave unbridled license to his physical passions up to September 1906, when he had a recurrence of the bleeding. Examination again revealed. the vesiculæ enlarged but not tender, hard but not stony hard as they had been two years previous. The strippings were examined; blood and pus were demonstrated. Treatment similar in character to that used previously was again instituted. On November 23, 1906, Mr. "X" had a hemorrhage following a condition of intense sexual excitement and distended bladder. Thereafter the condition gradually improved until the vesiculæ became quite soft and easily stripped of their contents, which showed nothing of pathological importance.

On March 24, 1907, much to my surprise, a copious hemorrhage occurred following a condition of intense sexual excitement and full bladder. The question of operation arose, as it had a number of times before, but I decided to postpone operative measures until I had made an opsonic investigation. The strippings were examined and nothing of pathological importance was found, but on cultures being made a good growth of streptococci was obtained with a few isolated colonies of staphylococci; a bacillus was also noticed. The streptococci were exceedingly difficult to grow and to keep alive. The opsonic index to both the bacillus and the staphylococcus was normal but that to the streptococcus was extremely low, about 3. Separate vaccines were prepared from the staphylococcus and the streptococcus for the reason that it is necessary to give larger doses of the staphylococcus and also that it is necessary to give the streptococcus more frequently than the staphylococcus.

On May 7, 1907, I injected 20 million streptococci and 100 million staphylococci; twenty-four hours afterward, without warning, an exceedingly copious hemorrhage occurred. Thereafter I injected 10 million streptococci every other day and 100 million

staphylococci twice a week, no other treatment being employed. His condition gradually improved, his weight increased, his hemoglobin percentage raised up to normal; his vesiculæ became soft, decreased in size and were easily stripped of their contents, which proved, on examination, to be normal in character. The index to the streptococcus was raised and maintained at a high level by the appropriate doses of the vaccine as mentioned above.

In conclusion, I would like to express the opinion that, in this case, there was a chronic ulceration of the vesiculæ seminales, involving not only the mucus membrane but also the submucus and muscular layers. How this ulceration arose I am not prepared to say but it was, undoubtedly, kept existent by the microörganisms discovered through the cultures made. The condition. was aggravated by excessive sexual indulgence and the bleeding was caused by the rupture of small vessels in the bases of the ulcers. I would like to draw attention to the fact that, with the exception of the hemorrhage occurring after the first injection of the vaccines, the bleedings always took place during or immediately after a condition of intense sexual excitement associated with a distended bladder, but in which, however, intercourse did not take place. During such a state the blood vessels in the region of the base of the bladder are greatly engorged, the blood pressure is high and the small vessels, mentioned above, are very liable to rupture. This gives a mechanical explanation to the actual bleeding and in my opinion such is the true explanation. In the case of the hemorrhage occurring after the first injection. of the vaccines, the lowered vitality or resistance following an inoculation would explain the bleeding taking place without the usual raised condition of the blood pressure; but in addition I believe that there is a certain local congestion of the diseased part after an inoculation.

The anemia, demonstrated on several occasions by examination of the blood, was undoubtedly secondary in nature and improved as soon as the hemorrhages ceased to occur.

The treatment, especially the avoidance of conditions in which a high blood pressure existed, allowed the ulceration to improve and in fact to become quiescent but never becoming completely cured until the opsonic treatment was instituted. After the first inoculation all other treatment was stopped in order to give the procedure a fair and thorough trial. The general condition of the patient improved, pari passu, with the improvement of the vesicular disease.

327 DELAWARE AVENUE.

The Proteid Iron Preparations of National Formulary, or the N. F. Propaganda, With Some Queries

and Conclusions.

[Editorial in Critic and Guide, June, 1908.]

INTRODUCTION.

HIS is a very important editorial. It is the most important editorial that I have written in several months. It deals with fundamental principles. It is going to present certain questions. And unless these questions are answered satisfactorily, our leaders in pharmacy, aided and abetted by some temporarily misguided physicians, will stand convicted before the world as engaged in a nasty business, injurious alike to pharmacy and medicine and criminally wrong as far as our patients are concerned.

I am entirely willing to be judged by this editorial as to my knowledge of the situation and as to my ability to reason fairly, logically and unanswerably. I am either right or wrong. If I am shown to be wrong, then I am unworthy to be a leader in medicine or in medico-pharmaceutical journalism, and the professors of pharmacy and therapeutics and the pharmacists in general who are paid subscribers to the Critic and Guide should show their displeasure by discontinuing their subscriptions. If, however, I am right, absolutely right, then this editorial should and will mark an epoch in American pharmacy and medicine (or rather medicinal therapeutics).

I have an unshakable belief in the invincible power of truth. It may be temporarily overshadowed by falsehood, you may succeed in filling the people's eyes with dust for a time, but after all the immortal saying of the immortal Lincoln about fooling the people remains an eternal verity.

When we have the temerity to state that some of the pharmacopeial and most of the National Formulary preparations intended as substitutes for well-known standard remedies are not "just as good" as the originals, that in fact some of these imitations are nasty, ill-tasting and ill-smelling concoctions (and) that it is therefore wicked to mislead the physician and the pharmacist the former to prescribe and the latter to dispense these substitutes), we are accused by some narrow-minded druggists, and some misguided or ignorant doctors, of bias. To assure our accusers that we are as free from bias as any living human can be and, that our only misfortune is, that we have a penchant for telling the truth, regardless of consequences, would be a waste of time. Let us therefore see what pharmacists themselves and real pharmacists with laboratory facilities-have to say about some of the National Formulary preparations.

Prof. W. H. Harrison, of the Northwestern University School of Pharmacy, Chicago, read a paper before the Chicago Branch of the American Pharmaceutical Association entitled "Notes on Proteid Iron Solutions." The paper appears in The American Journal of Pharmacy for April, and we advise every honest physician and pharmacist to read it there in its entirety. An abstract of it also appears in the A. Ph. A. Bulletin for May. Dr. Harrison considers the three proteid iron preparations of the National Formulary: Liquor Ferri Peptonati, Liquor Ferri Peptonati cum Mangano, and Liquor Ferri Albuminati. Of the first Dr. Harrison has the following to say:

LIQUOR FERRI PEPTONATI.

"The present National Formulary formula yields a product which is a thick red-brown liquid, with a very disagreeable qluey1 odor. It is clear in neither reflected nor transmitted light, and of such a colloidal nature as to render filtration impossible even under greatly increased pressure. The taste is at first pleasant, followed by a strongly alkaline and ferruginous aftertaste, which persists."

He then proceeds to show the reasons why a good preparation is impossible. The chief trouble lies in the peptone, of which it is impossible to obtain in the open market satisfactory or uniform specimens. Whether obtained from meat or fish albumin they "are prone to rapid putrefaction and yield iron combinations of most offensive odors."

Of Liquor Ferri Peptonati cum Mangano, which is openly and frankly intended as a substitute for Pepto-Mangan Gude, and on which substitute an immense amount of time and labor has been expended, the author has the following to say:

LIQUOR FERRI PEPTONATI CUM MANGANO.

"When made according to the present formula, with the materials obtainable on the market, the National Formulary preparation may be described thus:

"A dark brown sluggish liquid, with a most offensive odor, not unlike a mixture of ammonia and putrefied beef extract. Taste alkaline, saline and nauseating. It deposits after a time a dirty white sediment, which soon covers the bottom of the vessel.

"The finished product contains about .15 per cent. iron, .145 per cent. or less manganese, and .234 per cent. ammonium hydroxide, the latter serving the sole purpose of developing more offensive odors.

"I have prepared four samples, in each case using different samples of peptonised iron, the finished products being almost identical.

1. Italics ours throughout.-Ed. C. and G.

"The trouble with this preparation lies principally with the peptonised iron, and ammonium hydroxide, although there is room for improvement elsewhere.

"Of six samples of peptonised iron examined, the products of the principal manufacturers of pharmaceutical chemicals, all showed that putrefaction was in progress1. Of seven examined for iron content, only one showed over 5 per cent. Fe O (3.5 per cent. Fe), and this one sample has not yet been on the market under the name of peptonised iron or iron peptonate.

"At the time this work was started, but two samples of iron peptonate and none of the soluble manganese citrate were obtainable on the Chicago market.

"After some time I succeeded in collecting some direct from the manufacturers, seven samples of peptonised iron and two of soluble manganese citrate.

"These two samples of soluble manganese citrate, although bearing the same title, are entirely different substances.

"(1) A light red-brown powder with a strong odor of acetamide and ammonia. It is a manganese-ammonium citrate containing about 18 per cent. manganese. Incompletely soluble in water, but solution is rendered clear by standing for some time with a slight excess of ammonia.

"(2) Pearl-colored scales (evidently made after the formula of F. B. Power, Proceedings A. Ph. A., 1902, 937). Contains 13.5 per cent. manganese. It is a manganese sodium citrate freely water-soluble.

"In view of the above facts, it seems that a satisfactory preparation according to the present N. F. formula is impossible. although with a good sample of peptonised iron it could yield a passable one."

Now, gentlemen of the medical and pharmaceutical professions, please read the above carefully, very carefully. Here we have a preparation of great, thoroughly established, therapeutic value. That it is of great, thoroughly established, therapeutic value is seen from the fact that it is prescribed by physicians universally throughout the country. That it is prescribed universally is seen from the fact that every manufacturer, big or little, and every would-be pharmaceutical chemist is racking his brains and spending his time and labor in his endeavor to prepare a successful substitute for Dr. Gude's pepto-mangan. And what

1. Dr. Harrison is not alone in his opinion. All pharmacists who investigated the matter think the same. Mr. M. I. Wilbert, one of our foremost pharmacists, and a member of the Council of Pharmacy and Chemistry of the American Medical Association, says: "This formula (for Liquor Ferri Peptonati cum mangano) directs that commercial ferric peptonate be used. This substance, at best is variable, is unstable, and, as usually met with, is decomposed and unfit for use. Commercial manganese peptonate, suggested in the alternative formula, is even more unsatisfactory than the ferric peptonate." (American Jour, of Pharmacy, May, 1907, p. 211.)