disappointment of the physician. In Dr. Woodson's experience, "vomiting followed in all the [nine] cases but one in from fifteen minutes to twelve hours." In these "fluids of all kinds were denied the patient for two or three hours before and after taking the medicine." I conceive that four hours is a better minimum of abstinence. Bat notwithstanding that disagreeable symptom they all promptly recovered. When we remember how mild the vomiting of ipecacuanha usually is, there are few patients who would not willingly endure it, if necessary, to escape the suffering and danger of an attack of dysentery. But I trust that it has been demonstrated that emesis is not a necessary result of this mode of treatment.

Notwithstanding the smallness of this series, I think that the results attained, confirmatory as they are of the earlier traditions and of the recent Asiatic experience, warrant, on purely empirical grounds, a greatly extended trial of this treatment in dysentery, and point to the restoration to the drug of its old title, "radir anti-dysenterica."

In this connection attention is invited to the following modern reports of the use of this drug in affections of the bowels. The list does not profess completeness, but it may assist others who care to investigate the subject. Some Indian papers are: Docker, ( Lancet,* July, Aug., 1858, pp. 113, 169;) Cornish, (Madras Med. Jour.,* Jan., 1861, p. 41; Ranking's Abs.* xxxiii., p. 91;) Blacklock, (Madras Med. Jour.,* Jan., 1861;) Donaldson, (Edin. Jour.,* v., p. 583;) Ewart, (Indian Ann. Med. Sci.,* 1863, p. 396; Brit. For. Med.-Chir. Rec.,* xxxii., p. 58;) Cunningham, ( Edin. Jour.,* vii., p. 25). (None of the foregoing papers have I been able to examine.) Dr. Richard Whittingham, Surgeon Peruvian Navy, contributes a paper on its use in tropical dysentery (Am. Jour. Med. Sci., 1860, xl., p. 379). In simple specific dysentery, either common or bilious, he gives from half a drachm to a drachm of the powder fasting or early in the morning, and says, "The medicine is not given as an emetic but to produce its specific action on the disease." He also gives an enema of ipecacuanha night and morning. The above is repeated for three days: or he gives ten grains with one grain of opium every six or eight hours, and uses vegetable astringents such as pomegranate root. Such cases are well in a week or ten days if seen early. In other varieties the treatment is modified accordingly. In the malignant form he relies on nux vomica and opium. The mortality in hospital is

less than two per cent. of the cases seen before the colon is ulcerated. Dr. E. H. Janes (Am. Med. Times,* 1861, iii., pp. 28, 274,) gives an abstract of treatment of acute dysentery by large doses of this drug, with statistics of the result. Dr. A. A. Hohling, U. S. Navy, (Med. and Surg. Rep., 1868, xix., p. 327,) reports ipecacuanha as the chief reliance in the treatment of this affection in Chili, and cites a case as a type where a man ill five weeks was restored to health in seven days mainly by the use of this drug. Dr. John Stephen, of Reading, Penn., (Med. and Surg. Rep., 1870, xxiii., p. 419,) reports three cases of severe acute dysentery cured immediately by ipecacuanha in doses of from thirty to eighty grains. These are well worth study, and are presented by that gentleman as examples "out of quite a number" that all yielded in the same manner to the same means. He considers it "as much of a specific in acute dysentery as is quinine in intermittent fever." Dr. A. P. Morrill (Med. and Surg. Rep., 1870, xxiii., p. 503,) confirms the experience quoted and recalls the usual practice on this point fifty years ago in the Southern States. Dr. Dyce Duckworth (St. Bartholomew's Hosp. Rep., 1871, vii., pp. 111-113,) quotes corroborative modern evidence from Mr. Hunter, Belize, Dr. Yandell, [Louisville?] Dr. Clark, London, and Mr. Eccles, Bombay, the last-named frequently using emetia as a substitute for the powder.†

In favor of the treatment of chronic dysentery with large doses of ipecacuanha, somewhat in the manner of that of the acute form, evidence is gradually accumulating. Dr. H. D. Bulkley (Am. Medical Times, 1862, iv., p. 64,) reports four cases of chronic dysentery and diarrhoea in which ten-grain doses were administered. Of these one patient vomited, but all were immediately relieved. Dr. Bulkley refers to Dr. McKidd's article, (Edin. Med. Jour., July, 1861,) where a diarrhoea of ten years' standing was promptly cured by the administration of ten to twenty grains every twelve hours. I have the impression, but cannot vouch for it, that certain forms of chronic diarrhoea are now habitually treated by large doses of ipecacuanha in at least one of the New

*

†The latest essay on this subject known to me is Polichronie's. That, arriving after the completion of this paper, has compelled certain additions to the text at the last moment. Attention is invited to it as probably the latest mo ograph on this subject. The author freely confirms all that bas been said of the power of the drug over dysentery. See final note to this paper.

York hospitals. Dr. Bulkley's article contains this sentence: "It is said that the native doctors of Constantinople invariably give large doses of ipecacuanha in dysentery, and that their treatment of it is very successful." Dr. Willshire, (Lancet, 1862, ii., July, p. 62,) reports a grave case of chronic dysentery with severe exacerbations, which, after thirty days' unsuccessful treatment, immediately improved upon a prescription in which four grains of ipecacuanha three times a day held the chief place. Dr. W. E Whitehead, U. S. Army, reported (Partic Med. and Surg. Journ.,* iv., p. 11,) three cases treated successfully by large doses of ipecacuanha; and under date of August 24, 1874, he writes me, "Since that time I have treated many cases of chronic dysentery after the same plan and always with satisfaction to myself." To this I may add the memorandum of a case in Colorado, several years ago, of which I kept no notes, where, after exhausting the ordinary round of treatment, I supped the patient, a civilian, with a number of twenty-grain powders, directing him to take one whenever an exacerbation came on. There was no attempt to use it systematically, but he was relieved for the time by one or two doses whenever he saw fit to employ them. It appears also (Med. Record, 1871, vi., p. 84, fr. Med. Times and Gazette,*) that, at the English Hospital, Metz, during the late Franco-German war, "the most obstinate and fatal disease the physicians had to deal with was dysentery of a very chronic character."' After other methods "the ipecacuanha treatment was then tried, and with fair success; doses of five to fifteen grains of the powdec were given three or four times a day; it rarely cansed vomiting, except at the first dose, sometimes not even then." Dr. Duckworth (St. Barth. Rep., 1871, vii, p. 116,. quotes Akenside as saying of the use of the drug, Neque interest utrum iutą st dy:enteria, an chronica: utrin sanguinem naberit dejectiones, on muco tantum constent.”—{ De Dysenteria Commentarius,* 1764, p. 39.) Duckworth (p. 113) reports a case of chronic dysentery cured by enemata of ipecacuanha, and further says (p. 117), "It is a fashion in India to employ an injection of the drug in dysentery f * * The plan was tried in the hospital St. Bartholomew's] in the case of a woman, * * who was sinking apparently froul uncontrollable dysenteric diarrhoea, which ensued after an operation for strangulated femoral hernia." It was successful after the usual remedies had failed. No nausea or vomiting occurred."

† See Dr. Whittingham's article already citer.

(This case will be referred to in a subsequent section of this paper.) He also quotes a successful case in a child reported by Dr. Hillier (Med. Times and Gaz..* Jan., 1864,) but adds that when attempted "in those very obstinate cases of diarrhoea which occur when the lower bowel is the seat of tuberculosis and ulceration" it failed. But on the contrary we have the experience of M. Chouppe (Practitioner, No. lxiii., July, 1874, p. 58, fr. Bul Gen. Ther., June 15, 1874,) who has used it by injection "with very satisfactory results in the diarrhoea of tuberculous patients and in the choleriform diarrhoea of young children.† In these cases "vomiting was never observed." Of the seventeen cases of phthisical diarrhoes thirteen were cured and two improved. (Sup. Med. News and Lib., Nov., 1874, p. 211.)

On the other hand there are two articles in the Medical Times and Gazette (1873, i., pp. 102, 194,) upon the failure of ipecacaanha in chronic dysentery. But no claim has ever been set up for its uniform success in that form of disease. §

Finally, attention is invited to a group of singular cases reported by Dr. James D. McGaughey (Phil. Med. Times, 1872, ii., p. 407,) as epidemic duodenitis. The treatment he found most useful was active purging, the free use of ipecac., cantharidal blisters over the tender points; and generally after free purgation, a thorough relaxation with ipecac., and a blister, the pain began to decrease. I cannot help suspecting that "the free use of ipecac." was an essential element of the cure.

(Continued in next number of Journal.)

† MM. Bourdon and Chouppe followed Trousseau in using the drug in infantile cholera, changing the administration from the mouth to the rectum. (Polichronie, op. cit., p. 19.) M. Polichronie gives in detail M. Chouppe's five cases of infantile cholera and adds one by M. Huchard. There was one death in the six, which is attributed to errors of diet.

Inflammation of the rectum, passing off when the treatment is suspended, frequently follows these enemata. M. d'Ornellas, using emetine, met with it in every case; M. Chouppe, using ipecac., found it in only five cases in thirty-four. (LeProgres Medical, No. 28, 11th July, 1874.)

Polichronie (op. cit., pp. 29-31) gives details of one case of acute and three of chronic dysentery treated by enemata of ipecacuanha. One of the last was unsuccessful.

5 Maclean declares that many cases of the chronic form are not the result of unhealed ulcers, but are met with where no breach of surface is detected. The drug is indicated in an acute outbreak during a chronic attack. (Duckworth: St. Bart. Rep., vii, 1871, p. 116.) Is it not possible that there is a flaw in the common teaching as to the essence of dysentery? On this subject more will be said later. Meanwhile hear Trousseau: "l'ulcure est comme un bourg brule; ce n'est pas la guerre, c'est l'effet de la guerre.'

VOL. XIL-No. 12.-88.

"

THE TREATMENT OF CONSTITUTIONAL OR TRUE SYPHILIS.

Extract from a Paper read before the Augusta Library and Medical Society.

BY EUGENE FOSTER, M.D.,

Assistant Demonstrator of Anatomy, Medical College of Georgia, Augusta, Ga.

It has become fashionable to talk of the natural history of syphilis. It is not uncommon to hear physicians assert that the failure to study the natural history of syphilis has caused us to attribute the recovery of the patient to medication, when really it was due to the fact that the disease ran its natural course, and terminated in recovery. Why, say they, do we resort to active medication in a disease which essentially tends to recovery? Why are we not the humble interpreters of nature's laws? Leave the disease to itself, and nature will eliminate the poison from the system. Active medication retards this process. Feed your patient upon full and nutritious diet, and give him the benefit of hygiene, and we have nothing to fear. Is this true sciencǝ? Because nature unaided by art can perform this desirable task, does it necessarily follow that we may not advantageously avail ourselves of the aid of art? The accurate pictures and the masterly delineations of the natural history of this disease by syphilographers of undoubted authority teach us that the former conclusion was arrived at only through ignorance or prejudice, and that medication was resorted to only because of the disastrous consequences of inaction.

Leaving the question of the natural history of syphilis to those who possess a greater fondness for it than myself, I now come to the consideration of a subject which has distressed the medical mind ever since the discovery of the disease-the treatment of constitutional or true syphilis. The literature of the the subject is vast. If all that has been written upon this subject were collected into a single library, and it should be assigned to an energetic mind as a lifetime study to peruse in detail these works, none but the most daring would fail to become appalled at the magnitude of the task.

When I assert that mercury is the remedy above all others in the treatment of syphilis in all its stages, and that it is necessary to the cure of the disease, methinks I see that class of medical philosophers who boast of the high estate of anti-mercurialists hold up their hands in holy horror and exclaim, the rattling