COLUMBIA LIBRARIES OFPSITE 
 
 HEALTH SCIENCES STANDARD 
 
 RC201 .K522 
 
 HX64119289 
 
 Some fallacies conce 
 
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 .cies Concerning Syphilis, 
 
 E. L. Keyes, M. D., 
 
Columbia ®nifaersitp^ 
 
 intteCitpofjaetogorfe 
 
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 AND SURGEONS 
 
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THE FAIEOHILD PREPAEATIONS 
 
 — OS^ 
 
 THE POM mmm mum, 
 
 Active, Permanent and Reliable. 
 
 TRYPSIN 
 
 (fairchild) 
 
 Especially Prepared as a Solvent for 
 Diphtheritic Membrane. 
 
 PEPTONISING TUBES. 
 
 (fairchild). 
 
 Foi the preparation of PEPTO- 
 NIZED MILK and other 
 predigested food for 
 the sick. 
 
 PEPSINE IN SCALES. 
 
 (fairchild). 
 
 The most active, permanent and re- 
 liable pepsine made in the World. 
 
 ESSENCE OF PEPSINE 
 
 (fairchild). 
 
 For administration where a fluid 
 and agreeable form of pepsine is 
 desired^ and for the prepara- 
 tion of Junket and 
 Whey. 
 
 EXTRACTUM PANCREATIS. 
 
 (fairchild). 
 
 Containing all the digestive ferments 
 of the Pancreas. 
 
 PEPTOGENIC MILK POWDER 
 
 (fairchild). 
 
 For the modification of cows' milk 
 
 to the standard of Normal 
 
 Mother's Milk. 
 
 PEPSINE IN POWDER. 
 
 (fairchild). 
 
 Prepared from the scales without the 
 admixture of any other sub- 
 stances, to facilitate dis- 
 pensing and the pre- 
 paration of saccharated pepsine. 
 
 DIASTASIC ESSENCE OF 
 PANCREAS. 
 
 (fairchild). 
 
 For the digestion of starchy foods. 
 
 Fairchild Bros. & Foster, 
 
 82 AND 84 FULTON ST. NEW YORK. 
 
SOME FALLACIES 
 
 — BY 
 
 E. L. KEYES, M. D., 
 
 Consulting Surgeon to Bellevue, Charity, St. Elizabeth's, and Skin 
 
 and Cancer Hospitals of New York; Professor Genito-Urinary 
 
 Surgery, Syphilography and Dermatology. Bellevue 
 
 Hospital Medical College (j8j4 to i8&)). 
 
 1890. 
 GEORGE S. DAVIS, 
 
 D«TROIT, MICH. 
 
Copyrighted by 
 GEORGE S. DAVIS. 
 
 1890. 
 
Some Fallacies Concerning Syphilis. 
 
 1. 
 
 Syphilis is necessarily a severe disorder, disfiguring its posses- 
 sor, entailing social ostracism, destroying the domestic 
 life of its victim, and impressing its stamp upon his issue 
 from generation to generation. 
 
 2. 
 
 There are essential differences in the quality of the syphilitic 
 poison — in other words, there is a mild and a virulent 
 syphilis, per se. 
 
 S. 
 
 A local sore appeari g upon the penis after sexual exposure, 
 necessarily means that a poisoning of some sort has been 
 experienced, while a recurrence of sores upon the penis 
 without further exposure is proof positive of syphfiis. 
 
 Syphilis is at first a local disorder, capable of modification by 
 local treatment. 
 
 Syphilis is acquired only during sexual contact, and is conta- 
 / gious only through that channel. 
 
 6. 
 
 A person with svphilis is so poisoned that he may communi- 
 cate the malady by any contact of his body with that of 
 another. 
 
VI. 
 
 7. 
 
 Mercury is an evil only less serious than syphilis itself, and to 
 be accepted in the treatment of syphilis on the same 
 ground that one would advocate jumping from a high 
 window in order to escape from a burning building. 
 
 8. 
 
 Mercury, when used by the method called " the tonic treat- 
 ment," effects a cure by virtue of its tonic action. 
 
 9. 
 Mercury cures syphilis. 
 
 10. 
 
 The iodides are less harmful, and as effective, in the treatment 
 of syphilis, as mercuiy. 
 
 i 1. 
 
 The treatment of syphilis consists only in the use of mercury 
 and the iodides. 
 
 12. 
 
 Syphilis in the parent often shows itself as scrofula in the 
 children. 
 
 13. 
 
 The Hot Springs of Arkansas have some specific effect in 
 modifying the syphilitic poison, curing the disease, or at 
 least shortening its duration. 
 
PREFACE. 
 
 I have thrown together the following thirteen fallacies 
 which I find to be entertained, to a greater or less extent — by 
 the profession or the public, as the case may be — for the pur- 
 pose of making a running commentary upon them, with a view 
 to help to spread abroad what seem to me to be correct views. 
 If I differ anywhere from what others believe, I am willing to 
 be held responsible. My opinions are stated without reserve, 
 and they are honest ones. 
 
 I Park Ave., Oct. 14th, 1889. 
 
 E. L. KEYES. 
 
SOME FALLACIES CONCERNING SYPHILIS. 
 
 FALLACY NO. I. 
 
 Syphilis is necessarily a severe disorder, disfiguring its pos- 
 sessor, entailing social ostracism, destroying the domestic 
 life of its victim, and impressing its stamp upon its issue 
 from generation to generation. 
 
 There is an Eastern saying that runs somewhat 
 in this wise: "Whenever you mount your horse, do 
 so with a prayer upon your lips, for the grave lies 
 open before you." Yet who would venture, out of 
 this sententious crystallization of an obvious truth, to 
 evolve the broad generalization that equestrianism is 
 a fatal exercise. 
 
 It is from generalizations like this that syphilis 
 has suffered. Syphilis is indeed a picturesque malady, 
 full of surprises; occasionally startling us by the 
 severity of its developments, and often doing some 
 thing that is unexpected. Yet on the whole, in the 
 whole, in the present day and generation, in this 
 country, it is far from being the severe malady which 
 it is reputed to be generally, among the laity, and 
 largely by the profession. 
 
 On the contrary, cases that are carefully watched 
 and properly handled, as a rule do very well, and the 
 
disease has gained probably more credit for medical 
 skill than most other maladies, on account of the 
 facility with which its symptoms may be managed by 
 appropriate medication. 
 
 Those who see much of syphilis, undoubtedly, 
 have learned that it is not, usually, a disastrous dis- 
 ease. But it has been my unfortunate, (perhaps,) ex- 
 perience to see so many young men who, when they 
 find themselves to be the victims of this malady, feel 
 that they have lost all hope of success in life, and that 
 their malady practically ostracises and places them 
 beyond the pale of polite society, making them feel 
 as though when they appear someone should go 
 in front of them and cry out unclean, that I cannot 
 fail to signalize this as one of the special fallacies by 
 which the disease is misjudged and to raise my voice 
 against it for what it is worth. 
 
 As for the mortality of the disease Dr. Van 
 Buren, my late associate, has often expressed to me 
 the opinion that gonorrhoea, indirectly, is more often 
 the cause of death than is syphilis; and when we con- 
 sider the far-reaching influence of gonorrhoea, notably 
 its effects upon the Fallopian tubes in the other sex, 
 and its indirect effect upon the issue of those who 
 come under its influence, and when we reflect that 
 bladder and kidney disease often arise as a direct con- 
 sequence of a gonorrhoea which has resulted in stric- 
 ture, one may appreciate why this conclusion is 
 capable of being sustained upon rational grounds. 
 
— 3 — 
 
 But even allowing that such a statement is over- 
 drawn, it is, I believe, certain that, considering its rela- 
 tive gravity, syphilis has, very often, little to do with 
 terminating the life of the individual who possesses it. 
 On the contrary, he generally lives out his term and 
 dies of some disorder entirely independent of the one 
 in question. 
 
 Some insurance companies have adopted this 
 conclusion, and placed patients who have had syphilis 
 and been treated by mercury for a sufficient period, 
 after a certain number of years have elapsed, upon 
 the same footing in rating the risk, with other individ- 
 uals who have not had the malady. 
 
 As for the personal disfigurement of syphilitic 
 patients, I believe that the public greatly over-rate 
 the risk of this misfortune. 
 
 Syphilitic patients, regularly seen and systemat- 
 ically treated, as a rule, escape all permanent physical 
 blemishes; and, although this rule has its exceptions, 
 and the exceptions are sometimes undoubtedly very 
 brilliant, nevertheless, as a rule, I think it is capable 
 of abundant demonstration. 
 
 The social status also of the syphilitic individual 
 is influenced almost entirely from moral considera- 
 tions. He exagerates the possibilities of his dis- 
 order, and, fearing disclosure, denies himself to a 
 certain extent to society, and often runs away from 
 his associates during the eruptive period, feeling that 
 they will see v/hat he knows, and that his disease is 
 
written out as plainly upon his face as it is in his 
 mind. That this fear is an expression of morbid self- 
 consciousness is clearly demonstrated by the faithful 
 wife, who has acquired syphilis from her husband and 
 is unconscious of the fact. Innumerable instances of 
 this sort might be cited, where the patient has passed 
 through her entire disorder, perfectly ignorant of its 
 nature, attending to her duties and mingling with her 
 associates as usual, without any of that unnatural 
 sensitiveness which is felt by the possessor of the 
 malady who has acquired it in a guilty manner. 
 
 Finally, regarding the alleged transmission of the 
 taint from one generation to another, in this par- 
 ticular, also, I believe that the public estimate is 
 vastly in excess of the truth. 
 
 Many years ago, when I was much younger in 
 my knowledge of this malady than I am at present, I 
 counted the children of young men who had passed 
 through their syphilitic course under my observation, 
 and counted over a hundred children, their issue, 
 none of whom presented any evidence of an acquired 
 syphilitic taint. 
 
 I can make the same remark to-day. The num- 
 ber of children I hesitate even to guess at, but it is 
 very considerable. 
 
 I never have seen a syphilitic child born from a 
 syphilitic father, where the mother remained healthy, 
 when the child was conceived after the beginning of 
 the fifth year from chancre, and when the patient had 
 
— 5 — 
 been treated systematically by mercury for a pro- 
 longed period. 
 
 As for inheritance in the third generation, I do 
 not believe, from my own observation, that it ever oc- 
 curs. Two or three isolated cases are on record 
 which endeavor to uphold the possibility of second- 
 hand transmission, but in any case it would take more 
 than two or three exceptions to upset an established 
 rule, and even the exceptions are mostly observed in 
 a manner which does not carry conviction with it. 
 
 If all these foregoing views appear more rose- 
 colored than is sustained by the actual fact, I can 
 only remark in justifica,tion that I have made my state- 
 ments in a rather pronounced manner because my ob- 
 ject is to contravert a fallacy, and the one picture 
 should be as well defined as the other. Yet, candidly, 
 I believe my statements are accurate for the vast 
 majority of instances, and it has been my happy ex- 
 perience to feel gratified with my general policy of 
 having encouraged syphilitic patients in the belief 
 that the amount of suffering they are to experience 
 will be largely in accordance with their own conduct; 
 and the result has. justified my convictions more often 
 th^n the contrary. 
 
 Syphilis is a serious malady in two senses. The 
 possibility of severe and unexpected outbreaks during 
 the activity of the malady, and the uncertainty as to 
 obscure internal and, often, serious disorder, (possibly 
 fatal), affecting the viscera, notably the brain and 
 
spinal cord late in the disease, long after all surface 
 manifestations have ceased. 
 
 This latter is the one grave aspect, the other is 
 the annoying one; namely, the unceasing tendency to 
 relapse, observed in a certain fair majority of the 
 cases, the annoyance created by everlastingly recur- 
 ring mucous patches and other mouth symptoms, the 
 pertinacity with which such sets of symptoms remain 
 as localized cutaneous lesions and some localized af- 
 fections of bone, which resist treatment and persist for 
 a very long period, to the great distress of the pa- 
 tient and annoyance of the physician. 
 
 The shattered constitutions, wrecks of life, found 
 in the course of syphilitic disease, where the internal 
 organs have been permanently damaged, the bones of 
 the nose and throat or other portions of the skeleton 
 seriously compromised, where cachexia and general 
 failure of all the vital organs have resulted, where 
 paretic and paralytic symptoms, unevenly distribu- 
 ted, have made life a burden, — all these distressing 
 evidences of the severity of the disease are constantly 
 encountered, yet their number is not great 
 when compared with that of the enormous mul- 
 titude, who may be claimed, legitimately, by syphilis 
 as its victims, and who have yet escaped any perman- 
 ent damage. 
 
 As a rule also, other things being equal, the pa- 
 tient is often more responsible for the severity of his 
 attack than any other one influence. 
 
Over-excited, at the beginning, his zeal expends 
 itself, and when he finds that his malady does not 
 amount to as much as he supposed it would, he yields 
 to irregularities of life, neglects his treatment, in- 
 dulges again in dissipation, and thus draws down up- 
 on himself a revenge which he, afterwards, is liable to 
 ascribe to the natural malignancy of the disease, or to 
 the inefficiency of the physician who had its treatment 
 in charge. 
 
 A given syphilis may be malignant in the case of 
 an individual who leads an exemplary life, but many 
 cases that would have undoubtedly been mild, become 
 severe through the carelessness, the viciousness, or the 
 indifference of the possessor. 
 
FALLACY NO. IL 
 
 There are essential differences in the quality of the syphilitic 
 poison — in other words, there is a mild and a virulent 
 syphilis per se. 
 
 This fallacy seems to have a pretty strong hold 
 upon the lay community, I find myself quite fre- 
 quently confronted by the question as to whether 
 syphilis in a given case is of a severe type or not, 
 my answer being expected to be influenced by the 
 source from which the poison has been derived. 
 
 My personal belief is, that this is not generally a 
 matter of the least importance. There is but one 
 syphilis; like the sun, it shines for all; but its effect 
 is different according to the soil upon which it germi- 
 nates. People have an idea that there is some 
 especial virulence naturally attaching to the acquisi- 
 tion of syphilis in China, in South America, in Cen- 
 tral America, or elsewhere; but, with a slight reserve 
 on a certain ground which I shall presently allude to, 
 I do not believe that this difference exists as a matter 
 of fact. 
 
 I have frequently observed a very mild syphilis 
 which has been derived from a source of excessive 
 virulence, and, on the other hand, many instances in 
 which the type of the disease has been severe where 
 the source from which it has been derived is found to 
 be exceedingly mild. 
 
 My belief is, that the physical peculiarity of an 
 
— 9 — 
 
 individual, so far as regards his aptitude for syphilitic 
 cultivation, shows itself up when the poison is ac- 
 quired; and that the virulence of the disease depends 
 more upon the physical status, as to syphilis, of the 
 individual who acquires it, than it does upon the 
 source from which he derives it. 
 
 What this physical peculiarity is, I do not know. 
 It is not necessarily a depraved constitution. It is 
 not, apparently, the possession of the scrofulous, 
 tubercular, or the rheumatic diathesis. Other things 
 being equal, patients with these additional tendencies 
 to physical deterioration might be expected to show 
 up unfavorably under the influence of a new depress- 
 ing agent such as the syphilitic poison; and, in fact, 
 they very often do so, but not necessarily. 
 
 I have seen scrofulous, tubercular, cachetic, 
 rheumatic, and malarial patients, have syphilis in an 
 exceptionally mild manner; and, on the other hand, I 
 have seen most severe syphilitic manifestations occur 
 in individuals possessing otherwise the most brilliant 
 health. 
 
 That there is something special and peculiar in 
 the physical state of the individual, which allows him 
 to show up badly under the overshadowing influence 
 of the syphilitic poison, I believe capable of demon- 
 stration by recalling two sets of facts. In the first 
 place, I have on several occasions treated two or 
 three men, members of the same family, and possess- 
 ing the same physical traits, diathetic peculiarities, 
 
lO 
 
 and general constitutions, who have acquired their 
 syphilis from different quarters and at different times 
 of life respectively, and I have noticed that the type 
 of disease in these cases was quite uniform, in the 
 various instances which have come within my range 
 of observation. 
 
 A second and still stronger well-known fact, bear- 
 ing upon the point now under consideration, is this: 
 Children, it is well known, have stronger constitutions, 
 and are physicially in better general condition than 
 adults; yet the physical soil of childhood seems to be 
 the best for syphilis to develop upon, and the disease 
 acquired in childhood is much more often fatal than 
 when it has been taken on at any later period of life. 
 No demonstration of this can be more convincing than 
 the various epidemics of vaccinal syphilis which have 
 been recorded from time to time. The mortality, in 
 these instances, is tremendous, and it seems to bear 
 no relation to the country, or section, or district in 
 which the epidemic of vaccinal syphilis occurs, and to 
 have no close relation to the diathetic or constitutional 
 status of the infants vaccinated. 
 
 In one respect, however, there seems to be a dif- 
 ference in the virulence, the actual virulence, of the 
 syphilitic poison, namely, in its perpetuation upon 
 members of the same national family. The syphilitic 
 poison, in other words, seems to become, finally, ac- 
 clamatized in a given country, and to become less 
 virulent the longer it lasts in that country, so far as 
 
— II — 
 
 the inhabitants of that country are concerned, but not 
 for others. 
 
 It has been stated that, in Portugal, practically 
 everybody has syphilis, and that the type of the dis- 
 ease there is exceedingly mild. It is well known also 
 that when syphilis has been carried by sailors and 
 planted upon an island where the disease had been 
 hitherto unknown, that the virulence of the type of 
 the malady becomes intense and its mortality rela- 
 tively very high. This, in a measure, accounts for 
 certain facts that have been observed: namely, that 
 sailors suffer, as a rule, more severely from syphilis 
 than other individuals in the same community. The 
 reason for this is probably to be found in the fact that 
 they pick up their syphilis in foreign ports, and ac- 
 quire that form of disease which has not been ac- 
 clamatized to their particular style of physical consti- 
 tution. 
 
 In this way it may be, and, doubtless is, some- 
 times a fact, that a stranger travelling in China, in 
 South America, in Central America, or elsewhere, 
 and getting syphilis, acquires it in a more severe form 
 than he would have done had he been poisoned by 
 the home product which had been bred in-and-in upon 
 constitutions similar in peculiarities to his own. 
 
 Of course this generalization does not cover all 
 cases. But it seems to me to fit pretty accurately in 
 many instances in which I have observed exceptional 
 results. The truth is, however, it seems to me, that 
 
12 
 
 no syphilis can be pronounced to be either mild or 
 virulent until it has developed itself, and then it ac- 
 centuates its own type by the manifstation of its own 
 symptoms. Yet a disease apparently mild is not al- 
 ways so, and may in revenge make up for its mildness 
 by a prolongation of its moderate symptoms and an 
 obstinacy in their appearance, which brings despair 
 both to the patient and to the physician. On the 
 other hand, a seemingly desperate case, a virulent one 
 in the beginning of the attack may make up for its 
 severity by disappearing at a comparatively early date. 
 These irregularities are observed sufficiently often to 
 make it possible to signalize the fact. 
 
 A constitution which in itself may not be favor- 
 able for the development of severe syphilis, may be 
 made so by irregularities of life, excesses of any kind, 
 and especially by drinking, while a certain influence 
 cannot be denied to the patient's constitutional dia- 
 thesis. This drinking and irregularity of life is an- 
 other reason, probably, why sailors often have more 
 intense late symptoms than the generality of man- 
 kind. 
 
 The moral is that when a patient has syphilis he 
 should keep himself constantly in mind, and lead a 
 regular, sober, and God-fearing life. In this way he 
 stands the best chance of getting only what he is en- 
 titled to, which, considering the uncertainty of the 
 disease, ought to be all he is willing to endure. 
 
FALLACY NO. IN. 
 
 A local sore appearing upon the penis after sexual exposure 
 necessarily means that a poisoning of some sort has been 
 encountered, while a recurrence of sores upon the penis 
 without further exposure is proof postive of spyhilis. 
 
 This idea, of course, torments only the ignorant — 
 the medically ignorant; but the number is great in the 
 community of those who, being over-solicitous about 
 themselves on account of the consciousness of morbid 
 dread of the expected horrors of syphilis, regard a 
 little discoloration, a pimple, a vesicle, above all a 
 pustule, upon the penis, with more alarm than they 
 would view a carbuncle upon any other portion of the 
 body. 
 
 • This dread is made use of by the unscrupulous 
 physician who doses (with or without mercury, as the 
 case may be) his anxious victim for a certain time 
 after each abrasion, or each attack of herpes, and then 
 congratulates him upon the success of treatment in 
 preventing the disease from gaining a foothold upon 
 the rest of the body. 
 
 The bad morality of this course is no worse than 
 the folly that endorses it, for sooner or later a true 
 sore, — chancre or chancroid, — appears and then the 
 doctor exposes his incapacity, and the patient seeks 
 other advice. 
 
 The truth is, as any observer may easily convince 
 himself, that vastly the greater number of sores as 
 
— 14 — 
 
 found at random upon the penis, are abrasions and 
 herpetic outcrops — with a few ordinary pustules and 
 some eczematous spots, — and that these are in no 
 way or sense contagious, or due in any degree to a 
 poison in the party of the second part — although 
 unmistakably they are brought out by friction and 
 local irritation, — and are vastly more common after 
 sexual contact than at any other time. 
 
 Then again, every physician has seen persistently 
 recurring attacks of herpes progenitalis — in both 
 sexes, — coming on sometimes after every sexual act, 
 at other times relapsing in an irregular way, at dates 
 having nothing to do with sexual contact And a 
 curious thing about these attacks is a fact that I have 
 often verified by close questioning, namely, this re- 
 lapsing herpes,. the kind that comes on after sexual 
 contact, the kind that comes on after contact with a 
 strange woman, and the kind that relapses spontane- 
 ously at irregular intervals without having any imme- 
 diate association with the sexual act; all these varie- 
 ties owe their first origin distinctly to a given chan- 
 chroid, to a badly ulcerated herpetic cluster, or a 
 severe gonorrhoea. 
 
 Before the occurrence of this distinctly marked 
 primary affection, the patient has been locally well; 
 after it he suffers for a longer or shorter period from 
 his annoying relapsing malady. 
 
 This sequence, of course, does not always exist, 
 but it is common enough to be noticeable, and, I be- 
 lieve, must be recognized as a fact. 
 
— 15 — 
 
 Many cases of relapsing herpes, on the other 
 hand, arise, as it were, spontaneously, and continue 
 until the improved health of the patient or the suc- 
 cessful employment of remedial means has effected a 
 cure. 
 
 Relapsing outcrops of ulcerative trouble under 
 the foreskin, although possible in the course of syph- 
 ilis (mucous patches), are by no means uncommon, and 
 their occurrence alone is no indication of syphilis, no 
 matter what the form of primary irritation which may 
 have given rise to the recurrent outbreaks. 
 
 I have no reason to believe, from personal obser- 
 vation, that herpes is contagious, or that its advent 
 can be ascribed to contact with any especial kind of 
 secretion, or any virus. It does, in many individuals, 
 bear a direct relation to the sexual act — so much so 
 that I have more than once heard a patient excuse 
 himself for not noticing and attending to a syphilitic 
 chancre on the ground that it was quite a common 
 thing for him to have herpes after sexual intercourse, 
 and that on one occasion having a herpetic ulcer that 
 remained sore longer than usual, he shortly found 
 himself covered by an eruptiou which his physician 
 pronounced syphilitic. 
 
FALLACY NO. IV. 
 
 Syphilis is at first a local disorder, capable of modification by 
 local treatment. 
 
 This fallacy is about equally spread among the 
 public and with physicians, but for different reasons. 
 The patient, either from his own experience or from 
 the assurance of his friends, believes that a local sore 
 upon his penis may be destroyed by burning or other- 
 wise, and, in that manner, that he may escape subse- 
 quent disease. This belief is encouraged by the cases 
 of individuals who have been alleged to have syphilis 
 by their physicians, and who, after local treatment, 
 have suffered no further discomfort. The truth is, 
 that in these instances the physician has made a faulty 
 diagnosis; but naturally the patient knows nothing of 
 this, and the conclusion as he draws it seems to him 
 to be accurate. 
 
 The medical profession, on the other hand, enter- 
 tain the same idea on account of the encouragement 
 which has been given to this notion by the assertions of 
 German physicians. High authorities about syphilitic 
 matters in Germany have alleged, and still allege, 
 that the destruction of a local sore, if it does not de- 
 stroy the actual existence of syphilis, at least, modifies 
 the subsequent severity of symptoms. 
 
 I believe that this assumption is entirely false. I 
 have myself destroyed a number of chancres, and 
 have treated a greater number of patients whose 
 
— 17 — 
 
 chancres had been excised at other hands; and I have 
 no reason to believe that the subsequent syphilis has 
 been in any way modified by this primary treatment. 
 Burning the sore, of course, is not now, in the profes- 
 sion, believed to have any controlling effect upon the 
 subsequent development of symptoms, and I believe 
 that those who advocate the excision of chancre will 
 eventually retire, from their position. How long it will 
 take to educate the public up to an understanding of 
 the fact, that, when the chancre appears, syphilis is 
 already well under way, I do not know; but I think 
 that the sooner this undoubted truth is recognized the 
 better it will be both for the patient and for the 
 physician. 
 
 A belief in the efficacy of the excision of chancre 
 has still a hold upon the profession in Germany, and 
 to a moderate extent in France. I think it has been 
 practically given up in England and in this country. 
 There is undoubtedly no objection to the excision of 
 chancre. The wound heals quicker than the chancre, 
 and a focus at which in after years a gumma may ap- 
 pear, is disposed of, but to tell a patient that cutting 
 out his chancre will prevent him from having syphilis 
 is a mistake. 
 
 3 LL 
 
FALLACIES NO. V. AND VI. 
 
 V. Syphilis is acquired only during sexual contact and is con- 
 
 tagious only through the chancre. 
 
 VI. A person with syphilis is so poisoned that he may com- 
 municate the malady by any contact of his body with 
 that of another. 
 
 These fallacies, of course, app^ly only to the 
 public. No well-educated physician for a moment 
 aquiesces in either of them. Yet they are constantly 
 brought to his notice, and some intelligent sugges- 
 tions about them, to the patient, are often necessary, 
 in order to shield certain members of the community 
 from the danger in which they exist during the pres- 
 ence of syphilis in their neighborhood. 
 
 The idea that syphilis is only acquired during 
 sexual contact, absurd as it is, is so wide-spread that 
 many patients believe that a knowledge by others of 
 the existence of their malady carries with it their own 
 disgrace. Yet all teaching, and all experience, demon- 
 strate that no shrine of virtue is sufficiently im- 
 pregnable to be able, under all circumstances, to be 
 free from the possible access of syphilis in some of 
 its protean forms, and a person in absolute innocence, 
 one who has never had sexual contact with another, 
 may be a victim of the disease, as well as the most 
 vicious member of the community. 
 
 On the other hand, the unnecessary solicitude of 
 patients about syphilis, regarding its contagion, is 
 
— 19 — 
 
 equally unwarranted. Many a man feels when he 
 has the disease that he cannot use the same basin 
 with another, or the same towel, or the same bath- 
 tub, and that he must keep his person from any con- 
 tact, either by shaking hands or in kissing, with those 
 who are about him, and who naturally expect his 
 caresses. It is simply necessary in cases of this kind, 
 to impress the patient with the fact that the earlier 
 manifestations of the disease alone convey the poison 
 through their secretion. I am not aware that it has 
 ever been proved that a gummatous ulcer ever com- 
 municated the disease to another. 
 
 I know that in one instance it has been alleged 
 that a physician acquired syphilis while operating 
 upon a gummatous necrosis of the forehead, and I 
 know of another surgeon who ascribes his syphilis to 
 a poisoning received from gummatous disease of the 
 anus— but when a physician claims that his syphilis 
 upon the finger is due to a given source, it must be 
 remembered that the same abraded finger has been 
 in many other suspicious neighborhoods besides the 
 one which its owner recalls, and a possibility of error 
 is consistent with the most absolute honesty of con- 
 viction. Indeed it seems strange to me that all 
 physicians do not sooner or later become infected, 
 since they are proverbially careless in their habits, 
 and become careless of a danger with which they be- 
 come familar by constant contact. Their fingers are 
 as subject to hang-nails, and more liable to be covered 
 
20 
 
 by cuts and abrasions, than those of the rest of the 
 community, yet their profession makes it necessary 
 for them to thrust these fingers into all sorts of sus- 
 picious and foul cavities, and to manipulate all vari- 
 eties of contagious sores. 
 
 Among the early lesions of syphilis, also, it is 
 wjpU for the patient to know that only those yielding 
 a moist discharge are capable of spreading the dis- 
 ease, and then only when such discharge is brought 
 into contact with an abraded surface upon the person 
 of another. 
 
 Kissing is perhaps the most fruitful source of the 
 non-sexual spread of syphilis in the community, and 
 its indulgence, especially in any excessive or pro- 
 tracted manner should be forbidden to patients with 
 mucous patches upon the tongue or lips. 
 
 Yet the innocent must and do sometimes suffer. 
 I remember being much impressed on one occasion 
 by the following circumstances: 
 
 A modest young girl was brought to the hospital 
 covered with a syphilitic roseola, and with corrobora- 
 tive symptoms of the nature of which there could be 
 no doubt. Examination proved her to be a virgin, 
 and she had no knowledge of any primary sore. 
 Finally a small livid scar was found upon one fore- 
 arm, and above it engorged, indolent, very large epi- 
 trochlear and axillary glands. Upon having her 
 attention called to it, the girl remembered that she 
 had, some months before, scratched this spot with a 
 
21 
 
 pin, and that later upon the scratched area a sore 
 had appeared which had been very slow in healing. 
 It turned out that she was in the habit of taking care 
 of a baby, as nurse; and when the baby was sent for 
 and examined, its anus was found to be still the seat 
 of numerous mucous patches. The parents were 
 poor; the baby did not wear diapers, and the nurse- 
 girl carried it upon her bare arm habitually. The 
 scratch of the pin was the missing link. 
 
 The pearly patches of changed epithelium found 
 upon the tongue very late in syphilis, do not convey 
 the poison. They' yield no secretion. 
 
 The dry, scaling patches on the palm, which 
 so often persist for months, even years, are also, in 
 my opinion, free from the imputation of possibly con- 
 veying the disease. 
 
FALLACY NO. VII. 
 
 Mercury is an evil only less serious than syphilis itself, and to 
 be accepted in the treatmetit ot syphilis on the same 
 ground that one would advocate jumping from a high 
 window in order to escape from a burning building. 
 
 This fallacy includes in its ranks of adherents all 
 the laity and a greater part of the profession. Its 
 adherents are strengthened in their belief by the 
 opinions of many regular and irregular practitioners, 
 and especially by the loud-mouthed pretensions of 
 charlatans who preach, publish, and pretend to prac- 
 tice a cure of syphilis without the aid of that so-called 
 enemy of the blood and bones— mercury. 
 
 I believe this general impression to be with- 
 out any foundation in fact — at least, relatively so. 
 Doubtless, mercury is not as directly useful to a 
 patient's blood as iron, but I believe it to be as harm- 
 less as quinine if used in a proper manner. The result 
 of my investigations upon this subject need not be 
 repeated here. They are accessible to all who desire 
 to look into them. The conclusions I have reached 
 were arrived at during my study of the effect of mer- 
 cury upon the red blood-corpuscles in the treatment 
 of syphilis, and I found, while following up that sub- 
 ject, that in conditions of health, chronic disease, and 
 syphilis, alike, the continued use of small doses of 
 mercury augmented the number of red blood-cells, 
 and was of apparent advantage to the patient. 
 
— ^z — 
 
 I do not believe this advantage great enough to 
 justify a patient, in ordinary conditions of health, in 
 resorting to mercury as a tonic; but I know that 
 many of the best physicians in New York city pre- 
 scribe small doses of mercury in conditions of chronic 
 disease, not syphilitic, involving the lungs, liver, kid- 
 neys, stomach, and blood. 
 
 It has been maintained with every possible show 
 of accuracy, that the reason the red blood cells are 
 increased under a mild mercurial course is, not be- 
 cause their number is augmented, but because their 
 death is delayed; and it is by arresting the metamor- 
 phosis of tissue that the red blood corpuscles are re- 
 latively increased and not by an actual tonic influence 
 of the drug. This is very likely the case but is a 
 matter of no importance relatively to the effect aimed 
 at by the physician, and I think it need not be to the 
 patient in consideration of the great benefit to be ex- 
 pected from mercury in the treatment of so serious 
 an enemy to mankind as syphilis. 
 
 And even if it were a fact that the prolonged use 
 
 of mercury did harm, yet time, the great judge of all 
 
 methods, has as yet failed to offer any other remedy 
 
 \ of anything like comparable value in the treatment of 
 
 syphilis. 
 
 The alleged bad effects of the drug are only 
 found after its excessive use, a use which sound 
 medical judgment does not justify. Salivation is 
 rarely ever allowable in the treatment, and the general 
 
— 24 — 
 
 opinion of most authorities in all parts of the world 
 is, that mild mercurial medication, more or less pro- 
 longed, is essential to the correct management of the 
 disease. 
 
 I have had patients continuously upon a mer- 
 curial course for three and a half years — and for all 
 periods of less length, and I have yet to see a case in 
 any way, either as to his bones, his nerves, or his 
 digestion, injured by its use. 
 
 As for the immediate effect upon the patient's 
 consciousness of well-being, I have on more than one 
 occasion, when it came to be time in my opinion for 
 the continuous mercurial course to be stopped, had 
 the patient seriously ask me whether it would hurt 
 him to continue the course indefinitely on the ground 
 that he had never felt as well in his life as while upon 
 his mild mercurial dose. 
 
FALLACY NO. VIII. 
 
 Mercury when used by the method called "the tonic treat- 
 ment," effects a cure by virtue of its tonic action. 
 
 I feel it not unjustifiable to give this statement a 
 position among the fallacies because I am responsible 
 for the name '' tonic treatment," and because the 
 view obtains generally in the profession that I 
 have named the long-continued use of mercury 
 in mild doses, "the tonic treatment of syphilis," 
 because I believe that mercury, so used, cures 
 syphilis by virtue of some tonic action possessed 
 by the drug. This position I do not, and have 
 never held. I do believe that mercury in small 
 doses, continuously given, acts practically as a tonic, 
 but it is not because it acts as a tonic that it is useful 
 in syphilis, when administered in this manner. On 
 the contrary, other drugs are more valuable as tonics; 
 but do not, by virtue of their tonic action, cure the 
 disease. They may improve the patient's condition 
 but the disease goes on in its manifestation of symp- 
 toms uninterruptedly, in spite of the tonic action of 
 the drug, as for instance, when iron, the vegetable 
 bitters, mineral acids, etc., are used. I only claim, 
 and have claimed, that mercury, used in large doses, 
 in an attempt to abort syphilis or to crowd out the 
 symptoms by its specific power, while it effects its ob- 
 ject upon the symptoms, does so to the detriment of 
 the patient, and deteriorates his blood, being in no 
 
— 26 — 
 
 wise a tonic remedy. I claim also that the drug may- 
 be used continuously, in small doses, so as to elimin- 
 ate the disease gradually, and to keep the symptoms 
 within check, and perhaps control them entirely, in a 
 majority of the cases, as they are ordinarily en- 
 countered, while the drug continues to act as a tonic 
 by increasing the number of red cells in the blood. In 
 this way it is not because it is a tonic that it is useful 
 in syphilis, but because it is a specific; yet its method 
 of use is such, that while exerting its specific action, 
 it still acts also as a tonic, much to the advantage of 
 the patient. 
 
 Very often, while used in its tonic form, mercury 
 fails to entirely control symptoms, and under these 
 circumstances, it is of coursedesirable, even necessary, 
 to increase the dose, and to forego for a time the 
 tonic effect, which I believe should be generally and 
 continuously aimed at during the entire treatment if 
 the patient can be managed and kept under proper 
 observation. Mercury is a tonic in small doses, and in 
 small doses always moderates, sometimes controls, the 
 disease, not because it is a tonic but because it is a 
 specific, and the specific effect persists even while it 
 is used in such a way as to be also a tonic in its 
 general effect. 
 
 It seems to me that this distinction is clear; and 
 I cannot understand how or why, if it is a fact, any- 
 one can find serious objection to it. That it is a fact, 
 is clear, because I have demonstrated it, and that 
 
— 27 - 
 
 demonstration has never been controverted. When it 
 is controverted, it will be time enongh to deny the 
 fact. 
 
 My demonstration consisted in proving that mer- 
 cury used continuously for periods of three years and 
 more, in small doses (and I also proved the small 
 dose to be one-half the quantity that in a given case 
 produced irritative or medicinally specific effects — 
 diarrhoea, or commencing salivation) — that mercury 
 so used, not only, as a rule, moderated the intensity 
 of the syphilitic symptoms and postponed their ap- 
 pearance, more or less, but at the same time increased 
 the number of the red blood-cells in the blood, and 
 maintained them at a relatively high average. 
 
 A continued experience with the same method 
 enables me now to assert that no detriment of any 
 kind that I can discover in prolonged observation 
 after the treatment has been stopped, attaches to the 
 treatment — there is no deleterious after-effect, no 
 damage inflicted upon the patient. 
 
 These statements I believe now to be demon- 
 strated facts — I say demonstrated, because no one 
 has controverted them, and they have been before 
 the profession since 1876. 
 
 One serious effort has been made to controvert 
 the statement that mercury continuously used in 
 small doses is a tonic. A gentleman in Germany, 
 named Schlessinger, undertook to upset the theory by 
 a protracted set of experiments upon animals, and 
 
— 28 — 
 
 published his results in an extended thesis. He 
 found that the long-continued use of mercury in ani- 
 mals did increase the number of the red blood-cells 
 and maintained a high average of the same; the ex- 
 ceptions, if I remember rightly, were the hen, and, I 
 believe, also the goat, but in the main the same result 
 obtained in animals as in man. Yet his dog, which 
 he kept caged for a year, grew over-fat, and when the 
 mercury was suddenly intermitted and he was turned 
 out, he got diarrhoea and rapidly lost flesh — an occur- 
 rence not to be much wondered at, on account of his 
 changed conditions as to exercise. When this dog 
 was killed, there was fat between the muscular fibres 
 of the heart, and the same between the tubules in the 
 kidney, while there was an atheromatous patch upon 
 the aorta. 
 
 The temperature also was not changed (as after 
 the use of iron as a tonic), and the excretion of urea 
 was diminished — hence Schlesinger concluded that 
 (i) mercury is not a tonic— (because it does not work 
 in the same way as iron and other tonics), and (2) 
 that it tends to produce accumulations of fat, and to 
 lead to degenerative processes, and that the increase 
 in the number of blood-cells, which is most obvious, 
 is due not to an acutal increase in their number, but 
 to an arrest in their death — they live longer and do 
 more work. 
 
 Accepting all these statements, I still maintain 
 that mercury is essentially a tonic for all practical 
 
\ 
 
 — 29 — 
 
 purposes. I, further, do not believe that mercury, 
 long-continued in small doses, produces either an accu- 
 mulation of fat, or leads to fatty degeneration, much 
 less to atheroma, for a long and unbiased observa- 
 tion has failed to disclose these things to me. That a 
 healthy dog caged for a year, dosed with mercury and 
 deprived of his exercise, should run into fatty degen- 
 eration, I believe to be quite natural; but a man does 
 not copy the same conditions, and practically he d5es 
 not grow fat under the prolonged use of mild doses 
 of mercury; moreover, the dose to the dog may have 
 been somewhat excessive for him. 
 
 It is idle to maintain that this so-called tonic 
 treatment is the only correct course. I do not so 
 maintain, but I do hold that it is a good course, that 
 it is generally efficient, that it is well borne as a rule, 
 and that no possible injury comes of its use. It is the 
 best course I know, and if I had syphilis myself I 
 would prefer it to any that I know or have ever heard 
 of. 
 
 No special form of mercury need be employed 
 in carrying out this treatment — any kind of mercurial 
 preparation that can be taken internahy may be used. 
 
 Here, again, I have been judged by the profes- 
 sion, and my generalizations narrowed down to very 
 small limits. I am constantly confronted with the 
 statement that " my treatment of syphilis is by the 
 long-continued use of the protoiodide of mercury," 
 This is not a fact. I use also grey powder, blue pill, 
 
— 30 — 
 
 corrosive chloride, calomel, biniodide, tannate of 
 mercury, or any form — in selected cases. 
 
 It is not the form of the drug upon the value of 
 which I insist, but rather upon the form of the course 
 — continued use of mild tonic doses. 
 
 I generally, it is true, use the granules of the 
 protoiodide, one centigramme each — and I use those 
 made by Garnier and Lamoureux, sugar-coated, be- 
 cause I find them reliable and generally uniform. 
 They may be obtained all over the country, and are 
 the same wherever found. They do not change in 
 hot climates. They do not stick together. I have 
 selected them on account of these qualities and for 
 no other reason. The protoiodide as freshly put up 
 by the apothecary — the green iodide — varies greatly 
 as found in one shop and another. It is unstable and 
 does not keep, undergoing changes from exposure to 
 light and heat, and from simple lapse of time. So 
 that if a patient is taking a given dose of protoiodide, 
 made up in New York, and his prescription gives out 
 in Chicago, the pills he receives there, if freshly made, 
 are liable to have a different effect from those he has 
 been taking. 
 
 On this account, and on this account only, it is 
 de&irable to have a uniform and unchangeable pre- 
 paration that will be found of about uniform quality 
 everywhere. 
 
 Finally several manufacturing pharmacists have 
 come to me with a beautiful yellow iodide of mercury, 
 
— 31 — 
 
 and have convinced me that this is the chemically- 
 pure protoiodide while the green iodide owes its color 
 to impurities. On this account I have been asked to 
 adopt a yellow iodide— but why ? I do not use the 
 green iodide because it is green, I do not care 
 whether it is pure or not. I use it because it is uni- 
 form (when sugar-coated) manageable and effective 
 — and I see no reason to change it because it is im- 
 pure. Indeed, I know that the French granules are 
 very impure. Crack a granule and one may see in- 
 side the sugar coating first a purple layer— iodine 
 liberated under the sugar coating — then rub down 
 the contents and use a strong glass and there will 
 appear metallic globules of mercury and often a faint 
 bright red line — the biniodide— both products due to 
 a partial' decomposition of the green iodide. 
 
 I know therefore that the granules are very im- 
 pure — but I use them because they seem to be uni- 
 formly impure, and because their effect is continu- 
 ously reliable. The yellow iodide granules I tried 
 patiently. They are too strong for general use, too 
 irritating; they, too closely, resemble biniodide pre- 
 parations in their general effect. Truly they might 
 be used in smaller — perhaps milligramme granules — 
 but still their general irritative quality would be in 
 my opinion unnecessarily pronounced. 
 
 I do use the yellow granules in selected cases, 
 notably when constipation is a natural tendency; for 
 then sometimes the green iodide granules do not 
 
— 32 — 
 
 carry themselves off and too great a mercurial effect 
 is induced. 
 
 This brings me to state why I select the green 
 iodide at all, as a proper drug with which in most 
 cases to follow out the tonic treatment of syphilis. 
 It is not because generally speaking I consider it the 
 best mercurial preparation, but because I consider it 
 medicinally speaking the very worst — possibly not 
 the very worst, because the red (biniodide) and the 
 yellow (pure protoiodide) are still worse, — medicin- 
 ally speaking. 
 
 Most of the other mercurials are better, the blue 
 pill is more bland, the grey powder milder, the bichlor- 
 ide far more prompt, more effective, and in minute 
 doses I believe more actively tonic; but these drugs are 
 like a two-edged sword, potent for harm as well as for 
 good. It must be remembered that the tonic treat- 
 ment of syphilis puts the responsibility very greatly in 
 the patient's hands. It does away a good deal with 
 the old pottering method, which compels the patient 
 to show up every few days and have his prescription 
 changed. The patient knows what he is taking, and 
 why he is taking it; and he may go off for a month or 
 longer after his ** tonic dose " is regulated, and only 
 need show up when something new appears. 
 
 The mild and the bland, and the sharply efficient 
 mercurials are not usually as trustworthy in such a 
 course. Their influence is too insidious, and with 
 their use the patient may be on the verge of, or 
 
— 33 — 
 
 actually in a state of, salivation before he fairly 
 knows it. 
 
 This is not likely to occur if he uses the proto- 
 iodide. This drug is irritating. It irritates the in- 
 testinal tract. If a patient from some change of con- 
 dition, some irregularity of diet, some excess of acids 
 ingested, some cumulative effect of the drugs, is in 
 danger of getting beyond the tonic influence, the pro- 
 toiodide generally gives him the most efficient warn- 
 ing in the shape of griping pains and loose diarrhoeal 
 movements; and, though a fool, he can appreciate 
 this, and stop his medicine until his digestive com- 
 motion is over. Not so, perhaps, if he were taking 
 one of the more bland and efficient forms of mercury. 
 They might get him beyond his tonic influence and 
 into trouble without proper warning. 
 
 This bad quality of the protoiodide, therefore, is 
 its safety. The quality is possessed even in a greater 
 degree by the yellow and the red iodides, but here 
 the irritative quality is too great, and the drugs not 
 suitable for very general use. 
 
 Sometimes even the green iodide is too irritating 
 to be used. I have encountered patients more than 
 once who could not take even one centigramme a 
 day of the green iodide without having immediate in- 
 testinal pain and diarrhoea. In such cases, manifestly, 
 the protoiodide is not a proper drug to use, and some 
 other form of micrcurial has to be selected. 
 
 I hope I have made these points clear, (i) In 
 
 4 LL 
 
— 34 — 
 
 my opinion the tonic treatment of syphilis is not cura- 
 tive by reason of the tonic dose used, and (2) the pro- 
 toiodide is the best drug to employ, not because it is 
 any more tonic or any more curative than another, 
 but because it irritates the intestine when used in any 
 excess, and therefore is safe in the patient's hands. 
 
FALLACY NO. IX. 
 
 Mercury cures syphilis ! 
 
 This is and is not a fallacy, yet it is so positively 
 true that its discussion finds a natural place here. 
 If it does not cure syphilis there is no other drug that 
 will, as far as I know, and the fact that it has stood 
 the test of centuries of use and abuse, that it has out- 
 lived strong popular prejudice, that it is to-day the 
 most universally employed of all drugs in the man- 
 agement of the disea'Se, goes largely to prove that in 
 the minds both of patients and the profession it is 
 curative. 
 
 Furthermore it is resorted to by those who be- 
 lieve that its effect is pernicious when they have to 
 do with cases of particularly severe type which do 
 not get on well with other remedies. Thus, Diday, of 
 Lyons, claims that the type of syphilis, as he en- 
 counters it, is mild, and that mercury is not required 
 in its treatment yet in all severer cases he uses the 
 drug. So also Boeck, of Christinia, that honest and 
 gentle apostle of syphilization, told me when he was 
 in New York, that when syphilization failed to con- 
 trol symptoms, he also after a time had recourse to 
 the ordinary drugs — notably, however, to the iodide 
 of potassium in the case of gummata— which latter 
 he claimed were rarely, although occasionally, en- 
 countered after treatment by syphilization. 
 
-36- 
 
 This fact, by the way, the occurrence of gum- 
 mata after non-mercuric treatment, ought to weigh 
 largely in proof of the lack of connection between 
 the early use of mercury and the subsequent develop- 
 ment of tertiary lesions — a connection which has 
 been asserted to exist by all anti-mercurialists. 
 
 But to return to the subject in hand: Does mer- 
 cury cure syphilis ? Perhaps not. It surely causes 
 the symptoms to disappear, but then, as a rule, they 
 continue to reappear during a certain rather long 
 period, and finally in a majority of instances they 
 cease to reappear. Is it then the mercury that cures 
 the disease or is it Time, and does the disease only 
 really cease after the individual has exhausted his 
 capacity to produce symptoms. Certainly mercury 
 does not cure the disease actually, nor does it in my 
 opinion materially shorten its natural period of ex- 
 istence. It is not uncommon to read in connection 
 with this or that method of using mercury in the report 
 of a case — so many inunctions, so many injections, 
 so many perigrinations or what not, and a remark that 
 the patient is discharged cured — that he returned with 
 what is called a relapse later. Surely this is no cure. 
 When a patient with tertian ague has a good day he 
 is not well. To be well he must go over in safety 
 not only a day upon which a paroxysm was due but 
 often a seventh day and sometimes a twenty-first day, 
 before the prudent physician pronounces him well. 
 
 'On the other hand very many patients go through 
 
— 37 — 
 all their syphilitic manifestations without ever taking 
 mercury and at last they get well— at least symptoms 
 cease to appear, they remain for long periods, per- 
 haps indefinitely, free from evidences of disease, and 
 finally die of something having no connection with 
 the original disorder. 
 
 Therefore, perhaps it is Time, and Time only, that 
 cures syphilis; but still this is no reason why mercury 
 should not be used, since its power over symptoms is 
 well known, and since ample testimony asserts that it 
 does no harm. Measles and scarlet fever run their 
 course; medicine's certainly do not cure them, but 
 this is no reason why means that comfort the patient 
 and moderate the intensity of symptoms should not 
 be employed. 
 
 Yet the question is: Does not mercury do more 
 than simply moderate or control symptoms ? Does it 
 not help to cure the disease itself by actually antago- 
 nizing and gradually overcoming the poison ? I per- 
 sonally believe that it does this. I believe that it not 
 only controls and abolishes symptoms, but that its 
 continued use renders the next coming out-crop less 
 intense, and that it postpones its appearance to a 
 period later than that at which it would have shown 
 up had no mercury been used — therefore it saves 
 tissue, prevents scarring, and shields the functional 
 activity of organs whose quality would have been 
 deteriorated had the full force of a given syphilitic 
 lesion been allowed to expend itself upon them— a 
 
_ 38 - 
 
 force that is restrained and moderated by the action 
 of mercury. 
 
 I believe also that tertiary symptoms, though by 
 no means prevented by the use of mercury, are cer- 
 tainly less common in patients who have taken a pro- 
 longed and effective mercurial course — other things 
 being equal — than in others who have not had the 
 benefit of such a course. 
 
 I base this assertion upon a reasonably long per- 
 sonal observation. My own professional life is only 
 twenty-four years, but during sixteen of these years I 
 was constantly associated with Dr. Van Buren, and 
 constantly seeing patients that had been treated mer- 
 curially by him for syphilis at varying dates pre- 
 viously. His case books, now in my possession, com- 
 menced in 1847, therefore the scope of my observation 
 is practically forty-three years. Dr. Van Buren, as is 
 well known, was largely interested in venereal and 
 genito-urinary work during his entire professional 
 life, and the number of his cases was very consider- 
 able; yet an immense majority of the cases treated 
 mercurially for long periods during their earlier years, 
 have entirely escaped tertiary manifestations. Ex- 
 actly what the percentage is I cannot say, but I know 
 that the number is relatively very small, and that the 
 severe cases of late disease that I have encountered 
 have come from outside sources. 
 
 Undoubtedly a certain number of cases do suffer 
 severely in the late period, in spite of any variety of 
 
— 39 — 
 
 earlier treatment, but less, I believe, relatively, are 
 supplied out of the number of those who have under- 
 gone efficient and prolonged mercurialization during 
 their earlier years of disease, than from the other 
 number treated by other methods or by irregular and 
 excessive mercurial courses. 
 
 On a question of this sort, perhaps some further 
 testimony is needed to be convincing, outside of my 
 personal impression and statement. Without, there- 
 fore, going learnedly into authorities, which a running 
 commentary of this sort does not justify, I think I 
 can sum up a little quite recent evidence very properly 
 by giving the views of some well known gentlemen as 
 expressed in the discussion on tertiary syphilis in the 
 International Medical Congress of Dermatology and 
 Syphilography, at Paris in the summer of 1889. 
 
 The discussion turned mainly on the relative fre- 
 quency of tertiary syphilis, and the conditions that 
 favored its development. 
 
 Dr. Newmann, of Vienna, believed that the con- 
 dition which most prominently favored the appear- 
 ance of late lesions was a neglect of early mercurial 
 treatment. He granted, as all must do, that certain 
 cases which had been allowed to go untreated, yet 
 escaped tertiary disease, but he believed such cases 
 to be exceptional, and he believed also that many 
 other cases suffered from tertiary symptoms because 
 their mercurial course had not been sufficiently active 
 and not sufficiently prolonged. • 
 
— 40 — 
 
 He mentioned also as factors in the causation of 
 tertiary phenomena, tuberculosis, malaria, diabetes, 
 old age, alcoholism, unhygienic surroundings, any- 
 thing that tends to weaken the organism and lessen 
 its power of resisting disease. 
 
 He did not think that tertiary symptoms bore 
 any relation to the virulence of the original sore or 
 the violence of the secondary manifestations. 
 
 Dr. Fournier, of Paris, who is always statistical, 
 presented an analysis of the 2,595 cases which he had 
 observed in his own practice. According to these he 
 believes that tertiary phenomena appear most fre- 
 quently from the first to the third year after infection 
 — especially in the the third year — decreasing gradu- 
 ally from the fourth to the twentieth year, being quite 
 infrequent between the twentieth and the thirtieth 
 years, it being phenomenal for tertiary syphilis to 
 appear for the first time after the thirtieth year, 
 although it is possible. In the first year also, the 
 number is small, but he had seen the exceptionally 
 large number of 129 cases, in which the tertiary mani- 
 festations appeared during the first year. Among his 
 cases, 1,085 involved the nervous system — or exclud- 
 ing locomotor ataxia 68t. 
 
 These statistics are given for their general in- 
 terest — not because they bear directly upon the ques- 
 tion under discussion. 
 
 Dr. Vajda, of Vienna, presented the statistics of 
 the hospital admissions of tertiary syphilitic patients 
 
— 41 — 
 
 in Vienna, for the years 1870-77 — 632 cases and of 
 these 62 per cent, had not had any previous treat- 
 ment at all. 
 
 The average date of appearance of the tertiary 
 symptoms had been in cases not treated, three years 
 and seven months; in cases which had been treated 
 during the early stages, six years and four months. 
 How efficient or prolonged this early treatment was 
 he does not state. 
 
 Dr. Haslund, of Copenhagen, gave the statistics 
 of 600 cases which he had encountered m his own 
 practice. Of these 444 (74 per cent.) had not been 
 treated previously at all, or had been inefficiently 
 treated. He believes that alcohol, excesses, and 
 chronic malaria are important co-operators in the 
 production of tertiary symptoms and that the reason 
 for the allegation that tertiary complications are 
 especially common after extra-genital chancre, is be- 
 cause such chancre is liable to be overlooked or 
 ignored, and the patient therefore less likely to re- 
 ceive efficient constitutional treatment. He believes 
 also that cutaneous tertiary symptoms are the most 
 common, next those of the nervous system, finally 
 lesions of bone and the internal organs; as to date he 
 expressed a belief that most cases of tertiary disease 
 appeared within the first twelve years after infection. 
 
 Dr. Mauriac, of Paris, stated that, as near as he 
 could estimate, the number of persons who suffered 
 from tertiary manifestions varied between five and 
 
— 42 — 
 
 fifteen per cent., taking all syphilitics to estimate 
 from. The symptoms most commonly come on be- 
 tween the third and sixth year — according to his 
 observation. 
 
 Finally, Drysdale, who formerly was an anti-mer- 
 curialist, stated that, in his belief, the proportion of 
 those who develop tertiary symptoms, when not 
 treated for their earlier symptoms by mercury, is 
 about eight per cent. Since he had returned to the 
 use of mercury, he believed that he could assert that 
 its use had power m averting the appearance of ter- 
 tiary manifestations, although he does not attempt to 
 express it by giving any definite figures. 
 
 Thus it will be seen that an array of very repu- 
 table testimony from Austria, Denmark, France, and 
 England, is in accord in ascribing to mercury a defi- 
 nite power in averting the appearance of tertiary 
 syphilis — a fact that ought to be very consoling both 
 to those who administer and those who take the drug. 
 
 This, then, seems to me to stand as a proof that 
 mercury has curative power over the disease itself — 
 as well as over the symptoms. 
 
FALLACY NO. X. 
 
 The iodides are less harmful than mercury, and as effective 
 in the treatment of syphilis. 
 
 This statement I believe to be clearly a fallacy. 
 In the first place, I believe, and I think I have de- 
 monstrated, that mercury properly used, even over a 
 period of many years, is not at all harmful, and that 
 no deleterious immediate or after effects can be hon- 
 estly ascribed to it. When mercury is used as it is 
 generally— in fact always has to be during a certain 
 part of the treatment,— in its specific, and not in its 
 tonic dose, it is temporarily, perhaps permanently, 
 harmful if the specific dose is carried too high (saliva- 
 tion) and maintained too long. But here, in spite of 
 the moderate harmfulness of the drug, the old argu- 
 ment holds, and its employment is justifiable because 
 if it be not used worse harm will come to the patient. 
 Moreover, no judicious practitioner will keep up the 
 deleterious specific dose any longer than the intensity 
 of the symptoms and their obstinacy imperatively 
 calls for. Practically used in syphilis, mercury is 
 effective and is not harmful. 
 
 How does the case stand with the iodides? Their 
 use also in moderate doses is tonic, in excessive doses 
 the reverse. They, too, cause the early as well as late 
 symptoms to disappear. They are indispensable in 
 attacking gummata and in many conditions of the 
 ulcerative and hyperplastic order occurring early in 
 
— 44 — 
 
 the disease as well as late — notably some of the earlier 
 tonsillar ulcerative symptoms accompanied by neigh- 
 boring brawny induration. Why, then, are not the 
 iodides as useful in the treatment of syphilis as the 
 mercurials, and at least as little harmful? 
 
 In answer, I state it as my belief, that the iodides 
 are (i) not so useful in opposmg syphilis as mercury, 
 (2) more likely to do harm, and, finally, (3) that it is 
 squandering our resources to appeal to iodides for 
 help in a great majority of cases of syphilis during the 
 earlier months— say perhaps the first year of the dis- 
 ease. 
 
 I. The iodides are not so useful in opposing 
 syphilis as the mercurials. This is evidenced by the 
 greater rapidity with which the symptoms of early 
 syphilis disappear under mercury if vigorously given, 
 as in the mercurial fumigation, thorough inunction; 
 and by the further fact, based largely upon the gen- 
 eral consent of those who use both drugs, that while 
 the earlier symptoms undoubtedly disappear, and 
 often promptly under iodides, yet such disappearance 
 is more rapidly followed by another eruption than 
 when mercury is used; in short, mercury not only 
 cures the early symptoms, but it postpones the ap- 
 pearance of the next succeeding outbreak, a thing to 
 desired, because the other element in the case is at 
 work night and day, namely Time. 
 
 Furthermore, the patient's morbid sensitiveness 
 during the early months of syphilitic outbreak is to 
 
— 45 — 
 be considered. He is shy of each pimple more or less 
 that appears upon the uncovered parts, therefore it is 
 not well to weight him with the pimples of acne on 
 the face which are so liable to come out when the 
 iodide is first used. 
 
 Indeed, this is one of the tricks of charlatans. 
 Many and many a frightened patient, free from all 
 evidence of syphilis, past or present, has consulted 
 me for his fancied ill, alleging as the basis of his be- 
 lief in his own syphilis that Dr. So-and-so treated 
 him for a sore by giving him medicine which " drove 
 the disease outin pimples on his face." 
 
 2. The iodides do harm— that is, they do harm 
 in many cases if used in large doses for a length of 
 
 time. 
 
 To be consistent, if one treats syphilis with 
 iodides from the start, he does so not only to moder- 
 ate symptoms, but with the express intention of cur- 
 ing disease. Therefore, the patient takes his drug 
 more or less largely for a long period of time. Any 
 alkaline medication long persisted in is liable in a 
 certain percentage of cases both to upset digestion 
 and to thin the blood. This is seen in those who 
 abuse the use of bicarbonate of soda, and the same is 
 true, although to a less extent, of the iodide of po- 
 tassium. 
 
 Finally, heavy doses of the iodide long continued 
 are capable of congesting and irritating the kidney, 
 even producing transient albuminuria with hyaline 
 
— 46 - 
 
 casts. This I have more than once seen, and noticed 
 the casts and albumen disappear with . a discontinu- 
 ance of the drug. 
 
 If, therefore, there is no compensating advan- 
 tage, why use iodides early in syphiHs ? They have 
 a function even here, but it is for certain symptoms 
 only, and then, in my opinion, only for intermittent 
 use. 
 
 3. Using iodides in early syphilis is really 
 squandering our resources and throwing valuable 
 material to waste. It is something like the faithful 
 bear who kills the fiy upon his sleeping master's brow 
 with a rock. It may kill the fly, but how about the 
 master. It is like going into battle and employing 
 all the reserve forces in the first charge. If the for- 
 tunes ot war are against one, he finds his resources 
 crippled or exhausted. 
 
 It is against the more serious possible ravages of 
 the late symptoms that we should hold the iodides in 
 reserve. There they have to be used without stint to 
 save tissue and function, and it seems like folly even 
 for those who admit the greater efficacy of the iodides 
 to send a man to do a boy's work. 
 
 Finally, many patients become habituated to the 
 use of a given drug, so that if it is employed for a 
 time, a greater quantity must be employed later to 
 produce a given amount of effect than would other- 
 wise have been required. This alone is a sufficient 
 reason for not using the iodides early in syphilis, for 
 
— 47 — 
 
 it should be our effort not to make the patient take 
 all the medicine he will stand, but rather to manage 
 his symptoms with the least amount of drugging pos- 
 sible consistently with his safety and general advan- 
 vantage. 
 
FALLACY NO. XI. 
 
 The treatment of syphilis consists only in the use of mercury 
 and the iodides. 
 
 This notion has its stronghold among the younger 
 members of the profession, and the inexperienced. 
 Every graduate from a medical school thinks himself 
 fully competent to manage syphilis. All he has to 
 do is to make a diagnosis, and then give mercury for 
 secondaries, and potash (as he terms it) for tertiaries, 
 and he is sure to succeed. 
 
 This is very far from being the case. Outside of 
 the intricacies of diagnosis in many conditions of ob- 
 scure syphilis, tact and judgment are all — essential to 
 the proper management of this protean and persistent 
 malady. Were it not so, patients would do as well in 
 the hands of one honest practitioner, as in those of 
 another, which is obviously not the fact. 
 
 All attention must be paid to the various sur- 
 rounding internal and external modifying influences, 
 which are more or less constantly at hand, if the pa- 
 tient's loyalty to treatment is to be maintained, and 
 his course to be made as smooth as possible under 
 the circumstonces. In each case the patient must be 
 studied and treated as well as the disease. Diathetic 
 influences have to be considered, the patient's habits, 
 his hygienic surroundings, the state of his blood, his 
 greater or less anaemia, the condition of his digestive 
 
— 49 — 
 
 machinery, his capacity for, and tolerance of, drugs in 
 one form or another. 
 
 Many a patient will fail to get well upon mercury 
 or the iodides given in one form, or by one method, 
 when a change in that form or in the method of ad- 
 ministration will promptly yield a brilliant result. 
 
 I have seen patients absolutely refuse to improve 
 under the internal use of mercury, and promptly 
 change for the better when inunction, fumigation, or 
 hypodermic medication was resorted to. 
 
 I have seen patients grow worse under iodide of 
 potassium, and improve when the sodium salt was 
 substituted — or fail to respond to the iodides as ordi- 
 narily given, and yet to be able to take it effectively 
 in milk or carbonated alkaline water. I have fre- 
 quently seen a stomach intolerant of an effective dose 
 of iodide, take the same dose and a larger one with- 
 out complaint after a change of food, or a change of 
 air. 
 
 In the common straightforward case, often the 
 routine use of mercury and iodides is practically all 
 that is called for; but in others, all of ones therapeutic 
 and dietetic resources are taxed in order to accom- 
 modate the organism to the necessary medication. 
 
 No care and attention is thrown away in this 
 study, and to be most effective the physician should 
 be the friend and counsellor of the patient as well as 
 his doctor. 
 
 5 LL 
 
FALLACY NO. XM. 
 
 Syphilis in the parent often shows itself as scrofula in the chil- 
 dren. 
 
 This, in my opinion, is altogether a mistaken 
 notion. Syphilis in the parent, if transmitted at all, 
 is handed down as syphilis, and as nothing else. 
 
 The whole question of the transmission of syph- 
 ilis by inheritence is still sub judice. If the mother is 
 in a condition of acute syphilis, all observers are in 
 accord that the child is also syphilitic. The mother 
 very often first aborts, perhaps several times succes- 
 sively, then is delivered of a dead child, then of a 
 child apparently healthy, which, after a few weeks, 
 shows up its syphilis by snuffles and a variety of 
 eruptions; gets jaundiced, has an aged aspect, and a 
 cracked quality in its vocal sounds, and shortly dies — 
 very likely in convulsions. The next following child 
 dies also, at some later period of its existence. Finally, 
 a child is born apparently healthy, but it has bone 
 disease, probably rickets, grows up with notched cen- 
 tral incisor teeth in the upper jaw, has the syphilitic 
 countenance, and later interstitial keratitis with some 
 ulcers in its mouth, and perhaps gets gummatous 
 disease of the bones of the nose during adolescence, 
 deafness, or some more serious expression of tertiary 
 syphilitic disease, which may or may not terminate 
 its existence. 
 
 But all this is syphilis, and not scrofula. The 
 
— 51 — 
 
 symptoms when they yield at all, do so to the same 
 treatment that controls syphilitic manifestations in 
 the adult. 
 
 Finally, such a mother may have a perfectly 
 healthy child, which may grow up without ever show- 
 ing any indication of the possession of the syphilitic 
 taint in any of its various forms. 
 
 When the father is syphilitic, and the mother un- 
 contaminated, the question is still open and under 
 warm discussion as to what happens. 
 
 The leading view taken by a majority in the 
 profession is that such a child, while it may be 
 healthy, is quite likely to be diseased— in a syphilitic 
 way; yet there is a large and reputable minority in 
 the profession which maintains that syphilis in the 
 father is not transmitted to the child under any cir- 
 cumstances, unless the mother is also syphilitic. 
 
 I shall not attempt to give the two sides of this 
 argument here. There is much to be said on both 
 sides, but this is not the place for it. Certain it is, 
 that the child of a syphilitic father, who marries five 
 years after chancre, having himself had a thorough 
 and prolonged mercurial treatment, and the mother 
 being healthy, certain it is, according to my experi- 
 ence, that the children of such a union remain per- 
 fectly healthy so far as syphilis is concerned. I have 
 yet to see in my own practice a single instance to the 
 contrary. 
 
 My belief is, this rule is invariable. Many sources 
 
— 52 — 
 
 of possible error exist in studying this question. I 
 cannot go into the matter fully here, but I will simply 
 state that the past history of a woman is much more 
 difficult to get at than it is in the other sex, and that 
 women, from ignorance or a more subtle motive, may 
 make it impossible for the truth to be arrived at 
 under any system of examination or cross-question- 
 ing. 
 
 I will give two personal instances in point which 
 to me are full of interest. 
 
 A young gentleman, many years ago, came to me 
 with chancre, and asked me to examine for him a 
 young and beautiful lady, the daughter of a distin- 
 guished citizen, who in the folly of youth had yielded 
 her person to his embraces. 
 
 The lady had a chancre. I treated her continu- 
 ously with mercury during about three years. Her 
 secret was religiously kept. She moved in the best 
 circles of polite society. Her elegance, her dress, 
 and her beauty found their way into print m the 
 fashion items of the daily press. Her symptoms, 
 fortunately mild, but distinctive when they did occur, 
 never attracted attention in her own family circle, 
 and she passed through her entire course of treat- 
 ment without ever exciting the suspicion of any one. 
 She has now been perfectly well for many years, and, 
 indeed, after the first eighteen months had no symp- 
 toms upon her person except an occasional small 
 mucous patch in her mouth. 
 
— 53 — 
 
 Long before her disease was well, she had dis- 
 carded her lover, and tried to force herself to the con- 
 viction that she was sound in health. 
 
 Now, let lis suppose, a supposition that is entirely 
 a possibility, that during the second year after her 
 chancre she had married, and let us further suppose 
 that her husband had had syphilis ten years previous- 
 ly, what would have been the result? Assuredly, a 
 syphilitic child, a (seemingly) healthy mother, and 
 the source of disease imputed to the old and extinct 
 syphilis of the father. Fortunately, in this instance 
 there has been no marriage. 
 
 The other case in point is this: A gentleman 
 came to me with a syphilitic child, the disease said to 
 have been contracted from a wet nurse in the South. 
 He also was syphilitic, the source of his malady being 
 imputed to the child. The mother seemed to be a 
 blooming specimen of most perfect health. 
 
 After a year these people came back to me from 
 the South, bringing a new baby which was manifestly 
 syphilitic. It had extensive mucous patches on its 
 lips and was being suckled by a wet nurse to whom it 
 had given chancre of the nipple, which chancre I saw 
 and treated. 
 
 The mother was still in blooming health and de- 
 clared that she was not, and never had been ill. I 
 kept her in town for some time under close observa- 
 tion, and finally was rewarded by detecting in her 
 mouth a full crop of mild mucous patches, and dis- 
 
— 54 — 
 
 covering upon her entire body a marked fine maculo- 
 papular syphilitic eruption, accompanied by some 
 moderate glandular engorgements. 
 
 I showed her 'these symptoms and assured her 
 that she also was syphilitic, but she would not believe 
 me. She asserted that the mouth spots were caused 
 by indigestion, and the eruption by the warm weather. 
 She took a few mercurial pills at my earnest solicita- 
 tion, always under protest, but she soon ceased taking 
 them, declaring that she was, and always had been 
 well. She had no anaemia, no headache, no loss of 
 hair; positively nothing except her short-lived crop of 
 mucous patches with the eruption, which were as 
 brilliantly pathognomonic as any possible array of 
 more prolonged symptoms. 
 
 Her child died syphilitic. Later she had an- 
 other which never had eruptions but died suddenly in 
 convulsions. Then a child which had some muscular 
 atrophies but still lives although an imperfect speci- 
 men physically speaking. 
 
 Finally a child in perfect health. All this took 
 place without treatment, the mother asserting, her 
 confidence in the fact that she was not, and never had 
 been diseased. Had I not had the good fortune to 
 catch her in her one mild eruptive demonstration of 
 disease, it would have been impossible for me to have 
 asserted that she was syphilitic, but she certainly was 
 so, and had she nursed her children she would surely 
 have demonstrated Colles's law, that a syphilitic child 
 
— 55 — 
 cannot give chancre of the nipple to the mother who 
 nurses it. 
 
 I might still further multiply instances, but these 
 two cover a greater part of the ground — and this 
 pamphlet does not aim to be controversial. 
 
 But to return to the question of scrofula. 
 Scrofula is a tubercular malady. A patient with 
 syphilis may himself have also scrofula, or his wife 
 may have it and show no visible sign. The issue of 
 such parents may, of course, be scrofulous, and pos- 
 sibly, if the condition of the parents was low in a 
 general way, ■ because of syphilitic disease at the 
 moment of conception or during gestation, the child 
 is more liable to show scrofulous symptoms than if 
 the parents had been in better condition, but I do not 
 believe that because of syphilis the child will be any 
 more scrofulous than if the parents at the time of 
 conception, and during gestation, had suffered from 
 ship-wreck, privation, stravation, bad hygiene, ma- 
 laria, or any other debilitating condition. 
 
 Certain ulcers and bone and skin diseases, and 
 glandular enlargemeuts in children of syphilitic 
 parents, are certainly called scrofulous, but they get 
 well under anti-syphilitic medication if at all — a fact 
 that cannot be asserted of true scrofulous conditions 
 of apparently similar character but of tubercular 
 nature. 
 
 Syphilis might be wiped out from the face of the 
 earth, such, at least, is my personal belief from what I 
 
- 56 - 
 
 have seen, and scrofula would flourish none the less. 
 Cod-liver oil, tonics, iron, and hygienic surroundings, 
 may, and do also, more or less, improve the physical 
 condition of the syphilitic child, but this by no means 
 proves that its malady is scrofulous — for the same 
 medicines, hygienic and dietetic means, are equally 
 valuable to the broken-down syphilitic who has ac- 
 quired his disease in the usual way. 
 
FALLACY NO. XIII. 
 
 The Hot Springs of Arkansas have some especial effect in 
 modifying the syphilitic poison, curing the disease, or at 
 least shortening its duration. 
 
 This fallacy is very widespread, but I believe it 
 to liave no foundation in fact. The Hot Springs have 
 a certain positive value, in my opinion, bnt it is not 
 this. I visited the Springs some years ago, and talked 
 with many of the physicians who lived there. I re- 
 mained ten days, aud accumulated considerable 
 information. I have seen a great number of syphil- 
 itics who at one time or another in their malady have 
 been to the Springs. I have sent a number of patients 
 to the springs myself, and I have seen incalculable 
 benefit derived from their treatment at that place. I 
 have advised large numbers of other syphilitics not 
 to go to the Springs. I have done this honestly and, 
 I believe, to their advantage. 
 
 I have, therefoie, some definite views upon the 
 subject; views, I believe, not biased by prejudice, 
 and these I shall proceed to unfold, for I believe a 
 correct idea of what may be expected from the 
 springs is a desideratum. If I am wrong in my con- 
 clusions I regret it, and can only state in justifica- 
 tion that I have used all the common sense I happen 
 to possess, aided by personal inspection and much 
 evidence derived from the observation of patients, in 
 reaching my conclusions. 
 
- 58 - 
 
 To begin with, when I was on the spot, I soon 
 learned that there was no common consent among 
 the physicians practicing there as to either what it 
 was in the Springs that did the good, or the manner 
 in which the supposed therapeutic agent acted. 
 
 One thought it was the heat, another magnetism, 
 another electricity, another silicon in solution. Most 
 believed that there was real virtue in the water; but 
 one gentleman of very high position and experience 
 there, assured me that, in his opinion, there was really 
 nothing of any value in the Springs; that the hot- 
 water was like any other hot-water, and that the 
 reason why patients, as a rule, did better in regard to 
 their symptoms at the Hot Springs than at home, was 
 because they came to the Springs frightened and de- 
 termined to make a serious effort to throw off their 
 malady; therefore, they obeyed instructions, took 
 their medicines as ordered, gave up tobacco and alco- 
 hol, took a proper diet and exercise, rested their 
 nerves, and kept proper hours. He assured me, also, 
 that it was his belief that if the same patients would 
 do the same things, including the use of common hot- 
 water, at home, they would do equally as well as at 
 the Springs. 
 
 This may seem like a startling statement, coming 
 from a man in high position, of large experience and 
 very successful with his patients at the Springs. 
 
 There are a number of springs on the spot, along 
 the main avenue of the town. They are alleged to 
 
— 59 — 
 
 contain 'various ingredients in different proportions 
 in the varying springs, —iron, sulphur, etc., — but in 
 truth they are all remarkably weak in mineral 
 ingredients; and, to my mind, it is exceedingly doubt- 
 ful whether any of the salts they do contain possess 
 the least value in effecting what the water is sup- 
 posed to effect. 
 
 This may be made more clear when I state the 
 fact that the water of one of the most popular springs 
 is used, when cold, for ordinary drinking water at the 
 table of one of the largest hotels. It is as clear as a 
 crystal, and absolutely without medicinal effect of 
 any sort or description that I could discover — being 
 in fact an admirably pure drinking water. 
 
 Another evidence going to show that there is 
 nothing in the mineral composition of the water that 
 possesses value, is the fact that nobody pretends to 
 bottle it for export, or to assume that it has any value 
 — except when used directly at the springs. 
 
 When the water is hot, however, as it flows out 
 of the rock, it has certain peculiar properties, some 
 of which I personally tested, and it is in the value of 
 this heat, as above other heat, that the quality of the 
 water, as a healing agent, is by most people — and I 
 agree with them — believed to reside. 
 
 All sorts of assertions are made about the heat 
 of this water, which I did not test because I consid- 
 ered them unimportant. For instance, it is alleged 
 that if water be caught in a vessel as it pours from 
 
— 6o — 
 
 the rock, and its deat accurately tested by a ther- 
 mometer, and in a similar vessel other common water 
 be placed which has been brought by boiling to ex- 
 actly the same degree of heat — and then these two 
 vessels be placed side by side under similar circum- 
 cumstances, — that the hot-spring water will lose its 
 temperature very much more rapidly than the arti- 
 ficially heated water, down to a certain point, after 
 which the artificially heated water when it catches up 
 with the natural specimen in its loss of heat, will 
 cool faster than the spring water; in short, the spring 
 water loses heat rapidly at first, then retains what is 
 left a long time, in this way not acting like common 
 hot water. 
 
 It is also alleged of the Hot Springs water, that 
 if a wire be thrust up the small stream into the rock, 
 enough electrical current comes through it to deflect 
 the needle. It is stated also that the clean, bright 
 blade of a knife may be magnetized by holding it in 
 the current of the running hot water. 
 
 All these things I do not know from personal 
 experiment, because I did not think it worth while to 
 investigate them, but I did look into the action of the 
 water in a practical way, and I promptly convinced 
 myself that its quality of heat was not the quality of 
 heat of ordinary hot water. For instance, the hot 
 bath that one takes at the Springs is not from the 
 water as it runs out of the hill-side. A quantity of 
 this water is collected in a reservoir, where it cools. 
 
— 6i — 
 
 and this cooled water is mingled with the hotter 
 natural current until a bath is prepared at 98° F. 
 This temperature of water, as an3''one may readily 
 convince himself, is not very hot. One may take at 
 home a bath of 98° F., and not be over-heated by it, 
 even if he drinks some water as hot as he can sip it at 
 the time. But the result is totally different at the 
 Springs. Here one lies in his bath at 98° F., and sips 
 a little hot water, which the attendant hands him, 
 and presently, as he lies in the bath, the whole head 
 and face breaks out into a profuse perspiration, the 
 drops running off his hair and trickling down in a 
 stream from end of his nose — at least such was the 
 effect upon me. 
 
 I did not sit in the sweating room, but I entered 
 it, and saw others sitting about in blankets and drink- 
 ing hot water, with pools of sweat running off them, 
 an effect which cannot be reproduced in Ne\f York 
 by the employment of ordinary hot water in the same 
 way. 
 
 Another curious result which I observed to fol- 
 low the hot bath was a sense of general exhiliration. 
 Ordinarily, when one takes a hot bath, the immediate 
 result is soothing rather than depressing. The ten- 
 dency is to lie down, perhaps to sleep. Not so after 
 the Hot Springs bath. The individul is a little keyed 
 up by the bath. He passes immediately after it, 
 without any special protection, from the bath house 
 to his hotel. I did this without any idea of the pos- 
 
— 62 — 
 
 sibility of catching cold. I found that the tendency 
 was to sing or to whistle, to walk briskly, and to go 
 up the hotel stairs two steps at a time. About a 
 couple of hours later, however, reaction came on. 
 Then there was experienced a certain languor with 
 moderate depression and tendency to sleep. 
 
 These effects have not been noticed in my own 
 person as the ordinary sequences of a hot bath. 
 
 Finally a demonstration of the rapid giving up 
 of its heat which this water seems to possess is this: 
 I placed a board across a bath-tub and sat upon it. 
 Then I allowed water to run from the two faucets, 
 the hot and cold, into the tub to a depth of almost 
 four inches and mixed them well until the tempera- 
 ture of the water was iio° F. Then I endeavored 
 to take a foot bath but found it impossible, the foot 
 could not tolerate the heat of the water for a longer 
 time than perhaps a second, after which the scalding 
 pain made it necessary to withdraw the foot. I there- 
 fore took my foot bath by plunging first one and then 
 the other foot into the scalding water, retaining it 
 there as long as was possible, then withdrawing it for 
 a moment and plunging it in again. With this alter- 
 nating movement I took my foot bath, meantime 
 holding a clinical thermometer in my mouth. I'he 
 room was only moderately warm. The thermometer 
 in my mouth was raised to 103° F. 
 
 At home I repeated the same experiment with 
 Croton water. I found it possible to take a hot foot 
 
_ 63 - 
 
 bath keeping both feet continuously in the bath when 
 the temperature of the water was 114° F. A ther- 
 mometer held in my mouth during this test marked 
 normal. A full prolonged hot bath at 104° F. only 
 made the face slightly moist. No drops collected. 
 Surely this is a decided difference, and I think estab- 
 lishes the fact that it is the peculiar quality of the 
 heat in the water that accomplishes whatever it is 
 that the water effects. 
 
 The actual stimulating properties of the water I 
 heard much comment upon; but I did not have an 
 opportunity to verify the statements. I was told that 
 the baths aggravated acute disturbances, and intensi- 
 fied acute rheumatism, while they bettered the chronic 
 forms. A fomentation with the natural hot water up- 
 on an acute abscess instead of soothing it was said to 
 cause acute pain and to be unbearable. Malarial at- 
 tacks were said to be intensified by the baths, and 
 acute tubercular troubles also made worse. It was 
 said that old ladies past the change of life, coming to 
 the springs, sometimes again saw their menstruation 
 return. 
 
 All forms of chronic ulcers seemed forced more 
 or less into granulating under the stimulation of 
 the prolonged contact with the water moderately 
 hot, and this was said to be as true of the chronic 
 varicose ulcer as of the scrofulous ulcer, or the old 
 syphilitic ulcer. 
 
 The direct influence of large doses of the hot 
 
— 64 — 
 
 water seemed to be to act as a diaphoretic, a distinct 
 diuretic, and apparently somewhat as a tonic and ap- 
 petizer, none of which qualities remained with the 
 water after it had become cold. I did not personally 
 observe any cathartic effect. 
 
 Now, I think that all these peculiarities of the 
 water distinguish it from ordinary hot water. That 
 ordinary hot water possesses some of them in a mod- 
 erate degree I grant. I had a patient with a very 
 obstinate ulcer on the back of his wrist. He was too 
 poor to go to Arkansas. His specific doses of mer- 
 cury and the iodides did not cure him, so I put him 
 upon the Hot Springs method at home, with ordinary 
 hot water in all its forms, baths and prolonged local 
 fomentations. He recovered and his ulcer healed — 
 but it stayed well only for a few months. So con- 
 vinced was he, however, of the value of the new effort, 
 that upon his relapse he got together enough funds 
 to go to the Hot Springs, where he finally became, 
 and remained, entirely well. 
 
 What then is the value of the Springs? I think 
 it is this, that by reason of the diuretic and diaphoretic 
 action of the water, a patient properly managed may 
 take at the Springs, vastly more mercury and iodide 
 of potassium without being either salivated or iodized, 
 than he can at any other spot upon the face of the 
 earth with which I am familiar, and thus the medi- 
 cines, not the Springs directly, cure him. 
 
 If this is a fact, and I believe it to be so, the Hot 
 
- 65 - 
 
 Springs possess very great value, and can be used 
 when required for emergencies. 
 
 Ordinarily there is no object in running up mer- 
 cury to a high dose, and the use of iodides beyond 
 the point at which they fully control the symptoms is 
 not only not necessary, but even harmful; perhaps it 
 is better to say dangerous. Commonly, in the begin- 
 ning, the middle, and the end of treatment, there is no 
 occasion whatsoever, to push either mercury or the 
 iodides to the point of tolerance. In a great majority 
 of the cases in which it does become imperative to 
 push either mercury or the iodides to the point of 
 tolerance, it may be done just as well at the patient's 
 home as anywhere else. There is no call or occasion 
 for the assistance of the Hot Springs influence, and 
 the patient most certainly does equally well without 
 it; but there are occasions, and they are grave ones, 
 when it is life or death, when an important function 
 hangs in the balance, when the physician conversant 
 with the treachery and possible reach of syphilitic 
 lesions feels that he owes it to his patient, owes it to his 
 own honesty as a guardian of the health of whomso- 
 ever it may be who puts confidence in him, to bend 
 his energies to the work, and crowd in the specific 
 medication in doses capable of overwhelming the 
 lesions which he is attacking. 
 
 If the patient's vitality does not hold up under 
 the weight of the combination of disease and heavy 
 dosing, if the stomach gives out, then, and then only, 
 
 6 LL 
 
— 66 — 
 
 I think is the time to send a patient to the Hot 
 Springs. 
 
 The physician is in the position of one who sees 
 a child struggling in the water. If the child can 
 swim a little, or if its clothing holds it up and the 
 water is still, the rescuer may calmly walk out, swim 
 out, or take a boat and row out, to pick up the child. 
 
 This is like what happens in ordinary manage- 
 ment of syphilis. 
 
 But if one stands by a mill-race and sees a child 
 whirling toward him in the water and about to go 
 over the wheel, he must act boldly and without fear 
 of consequences, or be recreant to his trust. If 
 nothing better is at hand, it is his plain duty to grasp 
 a boat-hook and fish out the child by its clothing, if 
 possible; and if m his effort he dislocates a joint, 
 breaks a bone, or tears the flesh, but saves the child, 
 he has done his manifest duty. The Hot Springs for 
 the syphilitic patient sometimes, in my opinion, 
 makes the difference between the clothing and the 
 limb. They may save the patient unharmed, when 
 the physician could only pull him through without 
 them at the ultimate expense of tissue or function. 
 
 I have quite an array of cases which, to my satis- 
 faction, demonstrate this fact. I shall detail only 
 two of them — although the experience has been 
 repeated for me more or less brilliantly many times. 
 
 A gentleman, suffering from syphilitic symptoms, 
 was sent to me by a physician because the latter 
 
- 67 - 
 
 could not manage the case satisfactorily. This pa- 
 tient had had a brother who had died syphilitic some 
 years previously, of what was called softening of the 
 brain — although he was only in early middle life. I 
 treated this gentleman to the best of my ability, and 
 he got on sometimes well, sometimes badly, for a long 
 number of months — but he was never quite satisfac- 
 tory, either to himself or to me. He finally concluded 
 to consult a very prominent specialist in nervous dis- 
 eases, and under his management, as usual, did well 
 and badly, until he concluded to return to me. 
 
 I resumed my efforts and got him into a fair con- 
 dition, when the time arrived for me to take a vaca- 
 tion in Europe, and I instructed the patient to keep 
 under the care of my assistant during my absence. 
 
 Some time after my return home, I learned from 
 a relative of the patient, that the latter, when I went 
 away, concluded, that as he had been long ill and had 
 not recovered under my advice and that of other 
 competent practitioners of regular medicine, he would 
 do well to make a change, so he put himself under 
 the charge of a homoeopath in high standing in the 
 community. 
 
 The homoeopath, of course, assured him that his 
 nervous symptoms were not syphilitic, that they were 
 due to the fact that he had been over-dosed with 
 mercury, and particularly with the iodide of potas- 
 sium, and so commenced to dose him with minute 
 pills and powders, the nature of which I did not think 
 it worth while to inquire into. 
 
— 68 — 
 
 The result was disastrous. All the symptoms 
 became rapidly worse. The occular muscles became 
 involved, the eyes crossed, paralysis of the left side 
 came on, and the brain utterly gave out with symp- 
 toms of moderately acute mania. 
 
 Then his homoeopathic adviser gave a fatal 
 prognosis, told the family that the case was one of 
 softening of the brain, and practically deserted the 
 case. 
 
 When I resumed charge, the patient was in a 
 pitable condition — a physical wreck. I employed in 
 his case every expedient with which I was familiar — 
 dietetic, hygienic, therapeutic — and endeavored to 
 make up for lost ground, but without success. No 
 method that I could devise succeeded in raising his 
 dose of the iodide of potassium beyond three hun- 
 dred grains a day, and this, while it upset his stomach 
 and overwhelmed him with iodism, failed to control 
 his progressive symptoms; his mania, his paralysis, 
 his occular symptoms, persisted, became, indeed, 
 aggravated, while his general physical state de- 
 teriorated. 
 
 Under these circumstances, I recognized that the 
 time had come for a final effort, and I insisted that 
 the Hot Springs must be tried. The patient was 
 taken by a relative and a trained nurse to Arkansas. 
 There he was put under the usual treatment, baths, 
 heavy mercurial inunctions, and progressively in- 
 creasing doses of the iodide of potassium. He at 
 
- 69 - 
 
 first slowly, then rapidly, improved. He appropriated 
 through his skin several ounces of mercurial ointment 
 without becoming saturated, and his dose of iodide 
 of potassium was run up to eight hundred grains a 
 day — a thing which I had found absolutely impossible 
 in New York. 
 
 He returned home after a time with his malady 
 arrested, but still with a brain incapable of the least 
 exertion, and it required several years of rest and 
 persevering effort to re-establish his health. He had 
 to give up his business absolutely for a considerable 
 time, but finally he was rewarded. To-day he is 
 practically a well man, and has long since left off all 
 specific medication. His eyes are straight and his 
 vision normal, he has no paralysis, he has returned to 
 active business life, and is little else than a resurrec- 
 tion. Had it not been for the Hot Springs, I believe 
 that he would have been food for worms long before 
 this, or a vegetable in human form without intelli- 
 gence. 
 
 In another instance a gentleman whom I saw out 
 of town, had been so far given up that the wood out of 
 which his coffin was to be made had been selected; 
 since he lived far from a city and out of the region of 
 anything elegant in the way of undertaker's goods. 
 He was paralysed, bed-ridden, kept alive only by 
 opium, cocaine, and milk. He could be moved only 
 on his bed. The iodides and mercurials had failed. 
 I ordered him a special freight car and had him put 
 
~ 70 — 
 
 into a bed in the car and sent with a physician to the 
 Springs. There he tolerated the mercury and enor- 
 mous doses of iodides, and was restored to many years 
 of moderate usefulness, though he never entirely re- 
 covered. 
 
 So much for the possibilities of the Hot Springs 
 in some desperate cases. All the bad cases, of 
 course, do not get well there. The disease may have 
 advanced too far for any medication to succeed. We 
 fight disease, not death; we may cure an ulcer by 
 medicine, not a scar. 
 
 Again it may happen, as it has to me on more 
 than one occasion — though such cases are unusual — 
 where a patient failing to improve at the Springs, 
 manages to do better elsewhere. A most striking ex- 
 ample of this occurred under my observation last year. 
 A patient in very advanced syphilis, cachectic, and 
 crippled by a gummatous knee-joint, after prolonged 
 trial at the Springs gave up the fight there, not being 
 helped, and was brought to me in New York by his 
 physician. We both concluded that his case was 
 desperate, nearly hopeless, yet by the hypodermic use 
 of mercury (since the stomach refused it and inunc- 
 tion had failed) coupled with great attention to diet 
 and the heroic use of the iodides, I was enabled to 
 send him to his home in six weeks a well man. He 
 resumed his business, and when I last heard from 
 him, was in excellent health. 
 
 On the other hand, on many occasions a patient 
 
— 71 — 
 
 has been seen by me with chancre, and on learning 
 the nature of this sickness he has, either from his own 
 conviction or by reason of the solicitation of his 
 friends, fled away to the Hot Springs. These patients 
 I have seen later and I have been unable to observe 
 that their malady has been in any way benefited or in 
 the least curtailed by their visit to Arkansas. I have 
 also treated a considerable number of individuals 
 who had made one, two, three and more visits to 
 the Springs. The malady goes on just the same. 
 They nearly always get promptly well of their symp- 
 toms when they go to the Springs, and they remain 
 well for a certain time afterwards, but other symp- 
 toms come on later, and they find out generally that 
 so far as being radically cured at the Springs is con- 
 cerned, they have had their labor for their pains. 
 
 I feel justified in giving a similar opinion about 
 the special courses at Aix-la-Chapelle. These Springs 
 do not cure syphilis — no springs do it. Time alone 
 brings the malady to^ an end, safely, and without 
 leaving serious marks behind it, in the vast majority 
 of instances where patients are faithful to an intelli- 
 gently managed prolonged mercurial treatment. 
 
 That a given case may not get well and entirely 
 well without mercury no one can assert. It is un- 
 doubtedly true that a man may cross the Atlantic 
 Ocean safely in a small boat — it has been done — 
 but he who prefers that course to taking a regular 
 liner does not exhibit any remarkable degree of 
 common sense. 
 
PICHI 
 
 (£--^Bx.A.3sr.£i. ij>w£b:ric^^'x.a. 
 
 AN EMOLLIENT, SEDATIVE, AND DIURETIC IN DISEASES 
 OF THE URINARY ORGANS. 
 
 Of the remedies which have recently been added to the materia 
 medica none so thoroughly as Pichi have been proven to possess specific 
 action in certain hitherto diflScultly curable conditions. 
 
 Pichi is undoubtedly a valua:ble sedative and emollient in inflamma- 
 tion of the mucous membranes of urinary organs. It possesses also 
 considerable diuretic action. 
 
 In cases of vesical catarrh, acute or chronic, following a mechanical 
 cause, such as gravel or calculus, or a' uric acid diathesis, this remedy 
 will .quickly modify the urinary secretion, calm the irritability, and favor 
 the expulsion of the gravel and calculi 'that can be passed through the 
 urethra. 
 
 It favorably modifies also purulent mucous secretions. Its action 
 on affections of the liver must be attributed to its diuretic^properties, 
 though it is recommended for icterus, hydropsy, and dyspepsia due to 
 insuflScient biliary secretions. In this case the essential oil, when ab- 
 sorbed and carried into circulation, acts as a stimulant of the secretory 
 apparatus in general, but the specific action of Pichi is directed without 
 doubt upon the organs of the urinary apparatus. 
 
 The pharmaceutical preparations of Pichi are as follows: 
 
 Fluid Extract and Powdered Extract Pichi, and Soluble Elastic Cap- 
 sules Pichi, each containing four grains of a specially prepared extract, 
 representing the active medicinalj constituents of thirty grains of the 
 drug. 
 
 PARKE, DAVIS & CO., 
 
 DETROIT AND NEW YORK. 
 
IN EXPLANATION 
 
 OF 
 
 Tie Plysicians' Leisnre Irary. 
 
 We have made a new departure in the publication of medical books. As you 
 no doubt know, many of the large treatises published, which sell for four or five or 
 more dollars, contain much irrelevant matter of no practical value to the physi- 
 cian, and their high price makes it often impossible for the average practitioner to 
 purchase anything like a complete library. 
 
 Believing that short practical treatises, prepared by well known authors, con- 
 taining the gist of what they had to say regarding the treatment of diseases com- 
 monly met with, and of which they had made a special study, sold at a small price, 
 would be welcomed by the majority of the profession, we have arranged for the 
 publication of such a series, calling it Tlie Physicians' lieisure Liibrary. 
 
 This series has met with the approval and appreciation of the medical profes- 
 sion, and we shall continue to issue in it books by eminent authors of this country 
 and Europe, covering the best modern treatment of prevalent diseases. 
 
 The series will oertairdy afford practitioners and students an opportunity 
 never before presented for obtaining a working library of books by the best authors 
 at a price which p]ace>< them within the reach of all. The books are amply illtw- 
 trated, and issued in attractive form. 
 
 They may be had bound, either in durable paper covers at 25 Cts. per copy, 
 or in cloth at 50 Cts. per copy. Complete series of 12 books in sets as announced, 
 at $2.50, in paper, or cloth at $5.00, postage prepaid. See complete list. 
 
 PHYSICIANS' LEISURE LIBRARY 
 
 PRICE! PAPER, 25 CT?. PER COPY, S2,50 PER SET; CLOTH, 50 CTS. PER COPY, 
 
 $5.00 PER SET. 
 
 SERIES I. 
 
 nhalersi Inhalations and Inhalants. 
 By Beverley Robin'-on, M. D. 
 
 The Use of Electricity in the Removal of 
 Superfluous Hair and the Treatment of 
 Various Facial Blemishes. 
 By Geo. Henry Fox, M. D. 
 
 New Medications, in 2 Vols. 
 
 By Dujardin-Beaumetz, M. D. 
 
 The Modern Treatment of Ear Diseases. 
 By Samuel Sexton, M. D. 
 
 The Modern Treatment of Eczema. 
 By Henry G. Piflfard, M. D. 
 
 Antiseptic Midwifery. 
 
 By Henry J. Garrigues, M. D. 
 
 On the Determination of the Necessity for 
 Wearing Glasses. 
 
 By D. B. St. John Roosa, M D. 
 
 The Physiological, Pathological and Ther- 
 apeutic Effects of Compressed Air. 
 By Andrew H Smith, M. O. 
 
 G ran ularLid sand ContagiousOphthalnriia. 
 By W. F. Mittendorf, M. D. 
 
 Practical Bacteriology. 
 
 By Thomas E. Satterthwaite, M D. 
 
 Pregnancy, Parturition, the Puerper«( 
 State and their Complications. 
 By Paul F. Mund?, M. D. 
 
SERIES II. 
 
 The Diagnosisand Treatment of Haemor- 
 rhoids. 
 
 By Chas. B. Kelsey, M. D. 
 
 Diseases of the Heart, in 2 Vols. 
 By Dujardin-Beaumetz, M. D. 
 Translated by E. P. Hurd, M. D. 
 
 The Modern Treatment of Diarrhoea and 
 Dysentery. 
 
 By A. B Palmer, M. D. 
 
 Intestinal Diseases of Children, in 2 Vols. 
 By A. Jacobi, M. D, 
 
 The Modern Treatment of Headaches. 
 By Allan McLane Hamilton, M. D. 
 
 The Modern Treatment of Pleurisy and 
 Pneumonia. 
 
 By G. M. Garland, M. D. 
 
 Diseases of the Male Urethra. 
 By Fessenden N. Otis, M. D. 
 
 The Disorders of Menstruation. 
 By Edward W. Jenks, M. D. 
 
 The infectious Diseases. In2voto. 
 
 By Karl Liebermeister. 
 Translated by E. P. Hurd, M. D. 
 
 SERIES III. 
 
 Abdominal Surgery 
 
 By Hal C. Wyman, M. D. 
 
 Diseases of the Liver. 
 
 By Dujardin-Beaumetz, M.D. 
 
 Hysteria and Epilepsy. 
 
 By J. Leonard Coming, M. D. 
 
 Diseases of the Kidney. 
 
 By Dujardin-Beaumetz, M. D. 
 
 The Theory and Practice of the Ophthal- 
 moscope. 
 
 By J. >ierbert Claiborne, Jr., M. D. 
 
 Modern Treatment of Bright's Disease. 
 By Alfred L. Loomis, M. D. 
 
 D., 
 
 Clinical Lectures on Certain Diseasss of 
 Nervous System. 
 
 By Prof. J. M. Charcot, M. D, 
 
 The Radical Cure of Hernia. 
 
 Bv Henry O. Marcy, A. M., M. 
 L. L D 
 
 Spinal Irritation. 
 
 By William A Hammond, M. D. 
 
 Dyspepsia. 
 
 By Frank Woodbury, M. D. 
 
 The Treatment of the Morphia Habit. 
 By Erlenmeyer. 
 
 The Etiologly, Diagnosis and Therapy of 
 Tuberculosis. 
 
 By Prof. H. von Ziemssen. 
 Translated by D. J. Doherty, M, D. 
 
 SERIES m. 
 
 Nervous Syphilis. 
 
 By H. C. Wood, M. D. 
 
 Education and Culture as correlated to 
 the Health and Diseases of Women. 
 By A. J. C. Skene, M. D. 
 
 Diabetes. 
 
 By A. H Smith, M. D. 
 
 A Treatise on Fractures. 
 
 By Armand L^espres, M. D. 
 
 Some Major and Minor Fallacies oon- 
 cerning Syphilis. 
 
 By E. L. Keyes, M. D. 
 
 Hypodermic Medication. 
 
 By Bourneville and Bricon. 
 
 Practical Points in the Management of 
 Diseases of Children 
 By I.N Love, M. D. 
 
 Neuralgia. 
 
 By E. P. Hurd, M. D. 
 
 Rheumatism and Gout. 
 
 By F. Leroy Satterlee, M. D. 
 
 Electricity, its application in Medicine. 
 By Wellington Adams, M. D. 
 
 Taking Cold. 
 
 By F. H. Bosworth, M. D. 
 
 Auscultation and Percussion. 
 
 By Frederick C. Shattuck, M. D. 
 
 B^rita IV will h» isatied one a month, beginning ivith N tvevnber, 1889. 
 
 GEORGE S. DAVIS, Publisher, 
 
 E". O. Bo3= -i'T'O. IDetxoit, I^Xloli. 
 
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