Jjelaroare Jjitaft j||ediral Jjoridjg. 
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Session al Dover, Delaware, June, 1811, 
ADDRESS OF THE PRESIDENT, 
JOHN J, BLACK. M, £).. 
OF ]MeW pA5TLE, pELAWAF(E. 
WILMINGTON, DEL.: 
James & Webb, Printers. 
1877. pdatrait Jjtate jjjeJkal 
Session at Dover, Delaware, June, 1811, 
ADDRESS OF THE PRESIDENT 
JOHN f. BLACK, M. B„ 
OF fy\pTLE, J)EJ-AWAF(E. 
WILMINGTON, DEL.: 
James & Webb, Printers. 
1877. /<?/ 
ftreu' Castle, Delaware, 
JOHNJ. MACK. if. D., Gentlemen of the Delaware State Medical Society : 
Whilst acknowledging the great obligations I am under 
to the society for the honor conferred upon me of presiding 
over its deliberations for the present year, I feel under no little 
embarrassment in preparing an address suitable to such an 
occasion ; nevertheless I feel that your generosity has made 
me greatly your debtor, and I should fail in my appreciation 
of it, should I let pass the occasion without an effort, feeble as 
it may be, to return at least in a small degree some practi- 
cal acknowledgment o{your appreciation. 
My embarrassment does not end here, for the subject of 
such an address demands a consideration on my part second 
only to that of its preparation. 
We are eminently practical men in this society, dealing 
chiefly in those matters which may confront us at any mo- 
ment in our daily routines of busy lives. Hence our subject 
should be rather practical than theoretical, concerning rather 
that which has been tried than that which is still wrestling 
with the vagaries of unproved theory. Such being the case, 
with many misgivings and without any claim to presumption, 
I beg your kind indulgence and generous consideration. Again 
I say we in this society are by compulsion, if for no other 
reason, being more or less remote from the medical centres, 
eminently practical men, and for this reason we deal in emi- 
nently practical subjects, and on this account I ask your atten- 
tion to three subjects of an eminently practical nature— 
Syphilis, Medical Thermometry, and Hypodermic Medication, 
partly because I believe they are pre-eminently of importance 
to us as general practitioners of medicine, partly because I 
find from my general intercourse with medical men that they 4 
are matters which need to be very strenuously enforced upon 
the attention of the profession at large. 
As to the first. 
SYPHILIS. 
This, probably the most terrible of the scourges to hu- 
manity, coming masked in every form, clothed in every dress, 
usurping in its sway the rights of the guilty and innocent, the 
poor and the rich, the elevated and depraved alike ; coming 
masked as it often does in the pure embrace of consecrated 
love, or from the unholy pollution of the harlot's kiss, this 
subject, I say, demands our every thought, our every exer- 
tion, and it is from my belief that much more attention should 
be paid to it than is common among physicians, that I make 
bold to call it to the attention of this society. Not in its posi- 
tive or physical form is it only to concern us, but we are to 
watch it in every turn, I may add in every case almost that 
is in any way obscure, must we examine for its tracings. I 
undertake here to say that to those professional men who at 
all times and under all circumstances, keep fully in view in 
their diagnosis of obscure cases the possibilities of the exist- 
ence of latent Syphilis and latent Malaria, to them will be 
most frequently given the consciousness of work well done, 
of merit fully and deservedly rewarded. As to the origin of 
Syphilis all we know is that it is obscure and uncertain. It is 
for us only to take cognizance of its existence. As to the 
discussion going on among Syphilographers in regard to the 
unity or duality of the Syphilitic virus, this does not so greatly 
concern us as practical men. Whilst inclined myself to be a 
dualist, not a unitist, I always in practice give my patient the 
benefit of any doubt. Whilst Ricord may be able to make 
the diagnosis at sight, others of us may only see the light 
after darkness has, in a measure cast its shadow on our 
patient. That the Chancroid is adto-inoculable on the person 
bearing it, and the chancre is not, or that the Chancroid is the 
result of transmission of the syphilitic virus through a system 
already infected, these matters have no practical bearing on 
the purposes of this address ; nor can we confirm our diagnosis 5 
as to the true or false nature of our cases by such experiments 
in general practice. It is of importance for us to know that 
the secondary lesions of Syphilis are contagious as well as the 
primary, and that a sore contracted from them is a true chan- 
cre, and of course infectious ; that the blood of a syphilitic 
person will infect a non-infected person if placed upon an 
abraded surface, and this is important in its relation to vacci- 
nation, for although there may be doubt of the vaccine virus 
from a syphilitic person, (which of course none would know- 
ingly use,) infecting with syphilis a healthy person, it is well 
known the blood will do so, as has been done by vaccinating 
immediately from the lymph of an infected person. It is also 
of importance for us to know that the semen of an infected 
man will infect the ovum, and through it the mother, but that 
the semen itself can infect the mother by mere contact is at 
least decidedly doubtful. At the risk of going beyond my 
province in assuming to instruct in primary matters in an ad- 
dress of this kind, still the very great importance of this sub- 
ject impels me to take at the risk of some presumption at 
least a cursory review of the diagnosis and treatment appro- 
priate to the chancre and chancroid and their attendants. 
Fortunately the treatment of the chancre and chancroid being 
or should be, so nearly alike, it is not important to go into 
any detailed differentiation as to the diagnosis. This we do 
know, that locally the chancroid is generally to the uninitiated 
much the most serious trouble of the two, and how often alas 
does the direful poison in the apparently harmless pimple of 
the true chancre lull to sleep with the siren’s song, the hapless 
victim of its coming rage. Chancroids are generally multiple, 
chancres rarely so. Chancroids, as a rule, heal more slowly 
than chancres, and are much more apt to become phagedenic. 
If the glands enlarge after chancroids, they generally, if not 
checked, suppurate and the pus is often inoculable, and the 
enlargement generally takes place in one of the groins 
forming the bubo. After a chancre the enlargement is more 
general, they do not suppurate as a rule, and if suppuration 
does occur the pus is not inoculable. 
The chancroid has no regular period of incubation—the 6 
chancre always has, and is from two to three weeks. The 
chancroid generally commences as an open sore or pustule, 
the chancre as a papule, which does not, in every case, ulcer- 
ate. The chancroid has, as a rule, no indurated base—the 
chancre has such induration generally. The chancroid is gen- 
erally painful ; the chancre not painful, and hence so insidious 
its consequences. Chancroids may affect the same person an 
indefinite number of times. Chancres generally afford pro- 
tection against another. Mercury is supposed to act as a 
therapeutic test, improving the chancre, not improving the 
chancroid. The crancroid will inoculate the lower animals ; 
the chancre will not. Chancroids don’t affect the system ; 
chancre always does within three months. Notwithstanding 
all this differentiation, the only safe plan I believe is to treat 
every sore locally as though it was a chancre, and if there is 
any doubt at all, then constitutionally too. The error of 
omission will be greater than the error of commission, and if 
a bubo threaten with the chancroid we will thus surely get 
rid of a foul accompaniment, bringing exposure and pain upon 
our patient. I am speaking now for ourselves as general 
practitioners, not as specialists, and experts in diagnosis. 
Whenever a suspicious sore presents itself, cauterize it, using 
nitric acid or the acid nitrate of mercury. Almost immedi- 
ately neutralizing it with an alkali. Then dress it with the 
well-known black wash of the Pharmacopeia or some more 
astringent dressing. 
Why do we cauterize the sore ? Because if a chancroid 
we probably make it heal faster, especially if in the sloughing 
stage, and render the chances of bubo less. If a chancre, and 
a recent one, we give it the chance of the abortive treatment, 
and hence prevent infection of the system. Or if we are of 
those who don’t believe in the abortive treatment, but believe 
our patient infected from the first, then we probably do nothing 
worse than help the sore to heal. Put your patient at once 
on iodide of potassium, and if he has a chancroid you prevent 
bubo. You had better add very minute doses of corrosive- 
chloride mercury. It all acts as a strong tonic, as well as 
alterative, and if your patient has a chancre it may save him 7 
untold misery; although some high in authority object to 
any mercurial, until secondary symptoms appear. These 
rules are not for them, they are for the busy general practi- 
tioner, and in whose hands the fate of thousands of unfortu- 
nates hangs. As to the induration of the ganglia and lym- 
phatics attendant upon the true chancre, this treatment will 
modify it to a great extent. And as in the case of the 
threatened suppurating bubo after the chancroid, we at least 
give the patient great mental comfort. At this point we 
take leave,of the chancrpid and chancre, and induration of the 
ganglia and lymphatics, the manifestations of the primary 
stage of syphilis, true or false, and are brought face to face 
with the terrible array of the consequences of the syphilitic 
chancre. General syphilis, I believe, always follows from a 
chancre as the initial lesion, (excluding, of course, those cases 
of hereditary origin,) and this has its period of incubation, after 
which we come to the stage of 
SECONDARY SYPHILIS 
which comes within six months of the initial sore—or not at 
all. And thus we can say definitely to our anxious patient, if 
you escape secondary symptoms for six months you are safe, 
but these secondary symptoms are to be subject to the severest 
scrutiny of an intelligent medical attendant. Here it may be 
well to speak in regard to the prognosis of syphilis ; and, I 
refer here to any stage after the primary stage. It cannot be 
doubted that many cases tend to cure, even without very ac- 
tive specific treatment, others require to be aided vigorously 
by specific treatment, and in other cases, I have seen remedies 
appear only to palliate the disease, and the wretched victims 
pass a life-time suffering from the manifold tortures of the dis- 
ease in all its forms. Happily for humanity, these cases are 
comparatively rare, but there can be no question that they do 
exist. As it runs in some families to invariably die with small 
pox, if attacked, so, I believe, in syphilis, there are now and 
then cases, and I have met with them myself, which, in spite 
of every light of modern investigation, end their miserable 
existence, unaided, or certainly unrelieved by remedies. There 8 
is one point which comes in here and that is, at the present 
day we are commencing to see greater ravages in the late 
stages of syphilis from the fact of the falling off in, or almost 
general abandonment of, the use of mercury in general prac- 
tice. Formerly persons who may have been infected and hence 
more or less delicate, were certain, at longer or shorter inter- 
vals to get a good soaking of mercury from the old doctor 
with the gold headed cane ; and thus, 
been benefited in one way, was more fortunare 
unfortunate brother,$ the former wm. cured of Jaifi, syphilis, 
whilst the latter, probably from a pneumonia may have de- 
veloped a cheesy lung. 
As regards the forms of syphilis we call secondary, we may 
include syphilitic skin eruptions ; mucous patches ; falling out 
of the hair and troubles with the nails ; iritis ; enlargement 
of the lymphatic glands, &c. After these come gummy tumors, 
syphilitic testicles, diseases of the bones and cartilages,nerves, 
and the deep-seated organs of the body in general, which we 
place under the general head of Tertiary Syphilis. A few 
words as to the treatment of syphilis, (and in this we include 
all periods after the primary,) will be in place at this time. Of 
course, it is here intended to give only a general resume of the 
general principles, nothing more. Mercury, iodine and tonics 
are our sheet anchors here. We have no faith in or patience 
with the non-mercurialist here, whether he comes in the garb 
of the enthusiast, truthful with his expectancy, or the quack 
with his granules potent for good, but sugar-coated with lies. 
In the secondary stages, I believe, it is best to combine mer- 
cury with Iodide-Potassium,as for instance such a combination : 
Potassii Iodidi, 3viii. 
Hydrarg : Chlor : Corros. gr. i. 
Ext. Anthemis Fid. f?ss. 
Aquae, f^viiss. 
if 
S. Take one tablespoonful one hour after each meal. The 
iodide may be reduced or increased at will. 9 
This prescription generally acts as a tonic, patients rapidly 
increase in flesh, and the red corpuscles of the blood are mul- 
tiplied. In the tertiary stages, as a rule probably, the Iodide 
of Potassium answers better alone, and should often be given 
in very large doses, as much as one hundred grains or more in 
24 hours. If the Iodide of Potassium should disagree in any 
way, the Iodide of Sodium may be substituted for it with the 
best results, as noted by me in an article in the American 
Journal of the Medical Sciences, for July, 1865. Mercurial 
fumigation and mercurial inunction and possibly mercurial 
subcutaneous injections may, at times, be used with great ad- 
vantage As to the treatment by inoculation or syphilization 
as advocated and practiced by Prof. Boeck, of Christiania, very 
little is necessary to be said of it here. It is as yet on trial, 
with no great tendency to gain converts. We certainly would 
have difficulty in persuading any of our patients to submit to 
it, yet, possibly, as in vaccination, its good results to come 
may establish it upon a firm foundation. 
As to the duration of the treatment of syphilis, it cer- 
tainly with rare if any exceptions should be continued as 
long as syphilitic symptoms continue. Some would stop when 
these disappear, watching always for their re-appearance; 
others again insist on a very long period of treatment. Dr. 
E. L. Keys in his “ Tonic Treatment of Syphilis,” says, he is 
in the habit of keeping patients two and a half and three years 
or more under treatment continuously, and then he sees them 
marry and produce healthy children. Bad cases he says, gen- 
erally have been over-treated or under-treated early in the 
disease, and have not pursued a regular and systematic course. 
As an example, he gives one-sixth of a grain of the protoiodide 
of mercury or grain blue mass, and if ancemic combines with 
iron and extract gentian. This is a minimum dose. He in- 
creases this until intestinal disturbance appears or the gums 
may be slightly touched. “ Beyond this, he cannot go with- 
out aid from opiates, or damage to health. This is his full 
dose. Now the active symptoms subsiding, he reduces the 
dose one-half ; this is his tonic dose. If symptoms re-appear 
he adds the half dose dropped to the tonic dose again, and 10 
continues the full dose until the symptoms again subside and 
the tonic dose is resumed. He here may use, in 
the tonic dose, mercurial fumigation or mercurial inrewlation0 
He strongly deprecates positive salivation. The patient is 
not safe until two years of treatment have passed, and he has 
been free from all symptoms for at least six months. In late 
secondaries and tertiaries he combines the Iodides with mer- 
cury. He says, in reference to the Iodide of Potassium : “ No 
means in the physicians hands place him so near the Deity as 
the Iodide of Potassium. With it in well selected syphilitic 
cases, he can sometimes almost effect a resurrection. Wasted 
and lost functions are restored, the mind, the memory, the 
speech, the hearing, the sight, the taste, the touch, all maybe 
recovered by its aid. To effect such restoration, however, the 
drug must be boldly pushed. See review in Hays' Journal, 
April, 1877. All of this appears to me to be sound doctrine, 
and worthy of trial, at least in many cases. Surely we can- 
not watch these cases too long or too closely. It has always 
been my rule to keep my patients under surveillance and treat- 
ment, at least six months, and tell them what they may pos- 
sibly expect, so long as they may live, and to seek proper med- 
ical advice on the appearance of the least symptom. I caution 
them if they ever have any ailment whatever during their 
lives, to unfold their syphilitic history to any physician whose 
aid they may summon. I believe, by such a course, many per- 
sons would be saved untold misery. Without spending much 
time it may be well here merely to enumerate by name some 
of the more prominent syphilitic troubles : Skin affections ; 
Erythema ; Lichen, Pityriasis, Psoriasis, Lepra, Vesicular Erup- 
tions (rare), Pemphigus, Rupia, Impetigo ; Ecthyma ; Tu- 
bercles, Ulcers* (Bumstead’s Classification). They are cop- 
perish in color generally. There is usually no itching, have 
often peculiar situations, &c. As to any special treatment 
nothing is necessary to be said in this address. Then we have 
Syphilitic Alopecia ; Syphilitic teeth ; Onychia ; Mucous 
Patches ; Gummy Tumors. Here is an interesting group. As 
an illustration, I will give the case of a gentleman which came 
under my own notice. A gummy tumor rapidly developed on 11 
the under part of the left thigh to the size of a child’s head. 
He was sent home to die, by intelligent physicians, of an en- 
cephaloid-cancer. It entirely disappeared in six weeks under 
large doses of the Iodides of Potassium and Sodium. I may 
add, there was ulceration with irregular undermined borders, 
which, in my mind, was almost if not entirely diagnostic. Then 
we have affections of the Mammary Gland ; Syphilitic affec- 
tions of the Digestive Organs ; Mucous Patches and Tubercles 
of the tongue ; Gummy Tumors of Soft Palate ; Rashes and 
Patches in Pharynx ; Stricture of Qfsophagus ; Syphilitic Dys- 
pepsia; Affections of Liver and Pancreas ; Fatty and Amyloid 
Degeneration ; Ascites ; Affections of the Spleen and Thyroid 
gland ; Deep Lymphatic Glands ; Kidneys, &c. Then the 
Nose, Larynx, Trachea, Bronchia and Lungs. Syphilis of the 
lungs is always to be watched for ; in old cases I have seen it 
simulate consumption in every symptom. It is a consumption 
as much as tubercle or cheesy degeneration. It affects the 
Heart and Blood Vessels, the Genito Urinary Organs, Ovaries, 
Fallopian Tubes, Uterus and Vagina. What an array! In fact 
syphilis is everything, or rather almost any chronic trouble may 
be syphilitic. (The above classification follows Bumstead.) 
Now we come to that class of syphilitic diseases, which 
has been so much elaborated of late, and to the physician are 
of surpassing interest. I refer to 
SYPHILITIC NERVOUS AFFECTIONS. 
Every person who has had syphilis, may sometime or an- 
other, have it attack some part of his nervous system. It is 
generally supposed to come on not before two years—or even 
after thirty years—yet I have met with a case of syphilitic pa- 
ralysis of the portio-duraof the seventh pair coming on with the 
erythematous rash three months after the initial lesion. Up to 
this time the case had not had proper treatment, but soon yield- 
ed to Iodide of Sodium and Bi-chloride of mercury. We have no 
given signs of these troubles, viz :—“ that a nervous disease is 
syphilitic.” We must get the history of the case, and if we have 
reason to suspect syphilis from the age or other circumstances, 
give the Iodides as a therapeutic test. Dr. Thomas Buzzard 12 
says, “ putting aside cases of injury, hemiplegia or paraplegia 
occurring in a person between 20 and 45 years of age—not as- 
sociated with Bright’s disease—nor to embolism from valvu- 
lar disease of the heart, is in at least 19 cases out of 20 the 
result of syphilis. Syphilitic epilepsy is a trouble that some- 
times occurs. For the differential diagnosis between it and 
ordinary epilepsy I refer you to works on this subject. The 
therapeutic test of the Iodides is of great use here. Some- 
times these cases are embarrassing, and sometimes we might 
hope them to be syphilitic as we could almost certainly bene- 
fit them. Here is a case from my note book :—A young man 
married, remarkably able physically, had always enjoyed ro- 
bust health, except had had ague frequently during the last 
few years—age 25 years. One day he suddenly fell in a con- 
vulsion ; had another the next day. I put him on large doses 
of quinine and Bromide Potassium ; could find no trace of and 
could get from him no syphilitic history. In a few months, 
keeping up the Bromide and also Iodide Potassium, he was at- 
tacked again, and had six or eight convulsions at short inter- 
vals. Attacks were preceded by pain in the head. Here were 
a series of convulsions following each other. They commenced 
after 2o years of age from no apparent cause, except malarial. 
He told me he often had little attacks but knew what was 
going on all the time. Now, certainly all these phenomena 
pointed to syphilitic epilepsy. This case was treated with 
that view with all the light that modern research could throw 
on it, yet it went on from bad to worse progressively. For 
nearly a year before he died there were no more convulsive 
attacks apparent, yet he became nearly imbecile, pain in the 
head at times was intense ; paralysis of right side came on 
gradually until it was entire, and he was insensible several days 
before death. The therapeutic test has almost if not thorough- 
ly convinced me here that the trouble was not syphilitic, but 
a non-specific tumor in the brain substance, probably the left 
hemisphere anteriorly. If this case had had a specific cause 
I believe the treatment would have saved him. The ophthal- 
moscope furnishes a valuable guide in diagnosis of these cases 
and every physician should become acquainted with the ma- nipulation and use of this instrument. I now even look upon 
its use as almost a necessity in general diagnosis. So electricity 
may be a useful guide. We are not here so much interested 
in the pathology and morbid anatomy of these cases, for 
these subjects we refer to works devoted to them. The clini- 
cal aspect is what concerns us. The temperature in syphilis 
depends much on the presence of inflammatory tendency or 
not, yet I believe my experience teaches me that in all cases 
of constitutional syphilis, the temperature is almost always a 
little above normal ; not going above ioo°, except for cause. 
Insomnia is often an effect of syphilis Dr. Buzzard says, 
and recommends the therapeutic test of the Iodides even in 
children. He also recommends always to test urine for albu- 
men, and examine heart and blood vessels so as to exclude 
these as a cause of the nervous trouble. If a woman mis- 
carries frequently, syphilis may be at the bottom of it in some 
way. So it may be in children who have unreasonable crying 
spells. Here in these and many other cases you can quietly 
use the therapeutic test, and thus gain much credit for your- 
self You will practice intelligent, not routine medicine. Re- 
lapses are prone to occur in syphilitic nervous diseases. Less 
so in those from secondary lesions than in those from tertiary 
lesions, and in tertiary troubles the treatment as a rule must 
be long continued. The treatment in syphilitic nervous affec- 
tions does not essentially differ from that in general syphilis. 
Many of these cases require not only the Iodides pushed to 
the extremest lengths but mercury combined with them, also 
good strong diet ; often arsenic, iron, and Cod Liver Oil, as 
tonics. In the treatment of all syphilitic cases of course the 
moral treatment must prevail. Every dissipation of whatever 
kind must be abstained from, and many require the total stop- 
page of tobacco in every form. This subject of syphilitic ner- 
vous diseases, is to me one of the most interesting and one of 
the most satisfactory in its clinical results of all diseases in 
the whole domain of medicine. There is no limit to research 
here, and the whole matter is yet in its infancy. As an ex- 
ample of what can be accomplished by remedies when guided 
by an experienced and accomplished hand, I will close these 14 
remarks on syphilitic nervous diseases by quoting a case of 
Dr. Thomas Buzzard, reported in his admirable work on this 
subject. I give it without note or comment. Any of us may 
meet with and gain credit from such a case. 
CASE I. 
A man aged thirty-nine was wheeled into the consulting 
room on a chair, being unable, except in the slightest possible 
degree, to move either leg. Neither could he lift his right arm, 
and his face was also partially paralyzed on the right side. He 
had great trouble, besides, in expressing himself, being con- 
stantly at loss for the right word. A touch was felt very im- 
perfectly on the right side of the face and arm, and on both 
legs. There was incontinence of urine, of faeces, as well as 
absolute impotency. He was very cachectic in appearance. 
There was no evidence of disease of the heart, kidneys or blood 
vessels, and there was no history of an injury. During a voy- 
age to England, five months previously, he had complained of 
extreme weakness, which gradually merged into a definite loss 
of power in the right leg, and was accompanied by incontin- 
ence of urine. Two months after his arrival in this state, he 
suddenly became paralyzed in the right arm and face, without 
any attack of loss of consciousness, and a week after this his 
left leg began to lose power, until it became as much para- 
lyzed as the right. The left arm was the only limb unaffected. 
He had been under constant medical treatment, which includ- 
ed, as I ascertained, strychnine, iron and quinine, but had un- 
interruptedly grown worse. I found,on inquiry,that seven years’ 
previously he had suffered from a chancre, for which he took 
mercury till his teeth were loose, and which was followed by 
sore throat, but no skin eruption. I at once gave him Iodide 
of Potassium. In a month he could walk a mile with the help 
of two sticks, and could hold his urine for a short time. In 
another fortnight he could walk a little way without sticks, 
and a month after this, he could manage four miles by the help 
of a stick. His reproductive powers had returned, and he had 
much more command over his bladder and sphincter ani. Six 
months after his first visit to the hospital, he had almost en- 15 
tirely recovered his usual health, could walk six miles, “at a 
spell,” and more than that in a day. His grasp was and 
perfect with either hand. There was still a little hesitation in 
speech, but he had ceased to employ the wrong word. There 
was also some slight remaining weakness of the sphincter 
ani. He told me he could feel nothing the matter with him, 
and was about to start for one of the colonies. I advised him 
to resort to the iodide (of which he had taken thirty grains 
daily for six months) in case he felt any tendency to a return 
of his ailment. 
CONGENITAL SYPHILIS. 
With a mere mention of another very interesting phase 
of this protean disease, “Congenital Syphilis,” which is acquired 
from father or mother, or both, during the uterine life of the 
child. The disease may not be apparent in either parent but 
latent entirely, yet the poor little victim may present a sad 
spectacle. Again, the mother may contract syphilis after 
conception, in a healthy state, and yet the offspring may be 
syphilitic. Of course, syphilis in an infant, is not always con- 
genital, for it may acquire a chancre from the nipple of the 
mother or nurse ; and thus, I have seen a child and its mother 
and father, infected from an infected woman, who now and then 
was allowed to nurse it. Some deny that a father can infect 
his child, if the mother is free from infection ; others think he 
can.* I decidedly think the father is often alone at fault, and 
have known cases confirmatory of this view. If a man has 
been infected with syphilis, and has had no symptoms for a 
year, Bumstead thinks he may marry. It would be better for 
posterity if he never had offspring. As a rule, this form of 
syphilis rarely appears before the completion of the first month 
of life,and,not often after three months have been safely passed. 
Of course, if once developed, its re-appearance is liable, as 
long as the sufferer may live. The general aspect of syphilitic 
infants is that of old age or monkeyish. They are badly de- 
veloped, weak and debilitated, and, of course, cross and diffi- 
cult to nurse, if any vigor remains in them. Pain may cause 
all this—for the disease may affect any part—any chronic trou- 
* In this case the mother may become infected through the infected ovum. 16 
ble the child may have, is probably syphilitic, and almost any 
chronic'trouble may be present, whether of the nose or eyes 
or head, or stomach and bowels, or liver, or bones, or what 
not. As to treatment, if the mother is known to be infected 
whilst carrying the child, treat her specifically. She will not 
be half so liable to lose it, as if let alone. As to the infant, 
treat it by the stomach, if it will bear it, and also by inunction. 
If the stomach is irritable under treatment, use inunction 
alone. You may give the iodides through the child’s nurse,as 
an adjuvant. With this synopsis, I bring these remarks upon 
this subject to a close. If any of you gentlemen object, that 
I have confined myself too much to detail, and have gone, for 
this occasion, too minutely into the purely didactic relations of 
this theme, my apology is, that none of us can be too familiar 
with it. Indeed, I think it would be far better if there were 
more familiarity among the people in general, with these mat- 
ters, which pertain so much to their happiness or misery. It 
is commonly spoken of only in whispers, and its mere mention 
surrounded with every bound of secresy. I believe the masses 
generally, who look to us as guides in their hygienic relations 
should be placed on their guard, and be rendered more intel- 
ligent in these grave matters. The ignorance of the world in 
regard to the terrible results of the syphilitic poison is indeed 
appalling. From this, I believe, results much of the cruel suf- 
fering that follows it. If we can prevent this in any measure 
great or small, should we not make the warning so clear, that 
“he who runs may read ?” 
THE USE OF THE THERMOMETER IN CLINICAL MEDICINE. 
Of the many important accessions to the armamentarium 
of the physician in recent years, I look upon the clinical ther- 
mometer as one of the most important, if not the most impor- 
tant of all. Indeed, after one has accustomed himself to its 
use in general practice, the aid he receives from it in diagnosis, 
prognosis and treatment, is so immeasurably great, as to cause 
him to wonder that it were possible that such a help had been 
so long neglected by medical men. I know many physicians 
belonging to this society avail themselves of its use, yet in a 17 
consultation practice, somewhat extended, I now and then 
find gentlemen still reluctant to make those changes in their 
method, by which they may attain to advantages so unspeak- 
able to themselves and to their patients. For this reason, 
among others, I deem it of importance to introduce it to this 
meeting. The general application of the thermometer in 
clinical medicine, is of comparatively recent date, and has 
been particularly elaborated by the laborious work and re- 
searches of Wunderlich and Ringer in Europe, and Seguin in 
this country. I remember well, seventeen years ago, when 
that rare old medical philosopher, Samuel Jackson, of Phila- 
delphia, used to impress upon us in his lectures the import- 
ance of taking into consideration the temperature of the body 
in health and disease, and often in giving his clinical history 
of illustrative cases did he impress upon us the importance of 
the temperature under the tongue, as affecting the case either 
in diagnosis, prognosis, or treatment. As to the form and style 
of instrument some remarks may be of use. There are many 
forms and sizes, but one that you can conveniently carry in 
the vest pocket is the handiest and least liable to be broken. 
I say this from experience, for before I used this form, I have 
broken sixteen dollars worth in one month ; now, with the 
thermometer four inches long, I rarely ever find one broken 
in its case. Therefore, I advise you to reject those over four 
inches in length, or four and a half inches at most. They 
should of course be compared and accurate, and those sold by 
J. H. Gernrig, of Philadelphia, with the Kew certificate, leave 
nothing to be desired in this respect. They come self-regis- 
tering and otherwise—of course, the former are in all respects 
preferable—and, if the break in the column should unite, it 
can be readily re-arranged. The scale may extend from 90° to 
iio°, or the range may be greater, and the degrees should be 
subdivided into one-fourth or one-fifth degrees. There are 
also thermometers prepared for surface temperatures, and 
whilst they are in many cases of great use, yet from their frail 
construction are very expensive for general practice out of 
hospitals. Dr. Segnin also uses what he calls the Thermo- 
scope to mark the activity of the heat-making function. 18 
There are also very delicate arrangements on the Thermo- 
electric order, for noting differences of temperature. See Da 
Costa’s Medical Diagnosis. As to the method of applying the 
common clinical thermometer, the axilla is the preferable 
place, although the rectum or under the tongue may be chosen, 
bearing in mind the rectum is naturally a little higher in tem- 
perature and under the tongue a little lower than in the axilla. 
Wipe off all perspiration ; this is very important, and having 
run down the column, if above normal in the self-registering 
instrument, apply the bulb deep into the apilla, carry the arm 
across the chest, and allow the instrument to remain for from 
five to ten minutes. The range either above or below 98.5°, 
ninety-eight and one-half degrees, will give you the temper- 
ature of the body you are seeking it in. In using the ther- 
mometer, I, generally, in a given case, keep a record in the 
room, in which, twice in twenty-four hours, and as near the 
same hour as possible, I note the temperature as expressed in 
the axilla, and also at the same time the condition of the pulse, 
its number of beats, &c. ; and also the number of respirations. 
Take this record after the case is over to one accustomed to 
this mode of clinical investigation and registration and he will 
read you its clinical history. Take for example a case of ty- 
phoid fever. What satisfaction this method gives those who use 
it ! and I say here,by this method cases are more intelligently, 
and, I believe, more successfully, treated. By it we can see 
into the future, and ward off in a great measure occurrences 
which without these guides to warn us, might suddenly fall 
upon and overwhelm our hapless patient. As physicians, 
charged with the lives and destinies of communities, we have 
no right to neglect these lights that modern research furnishes 
to us. As to the normal temperature, it may be slightly al- 
tered by circumstances, as the time of day or night, exercise 
or rest, food, &c. As alcohol diminishes the temperature, so 
a cup of hot tea increases it. The body may seem of a natu- 
ral temperature to the touch, yet the thermometer will tell 
you it is much above the normal standard. Our senses easily 
deceive us here, as in other places. The patient may say he 
feels cold, and yet the thermometer may indicate increase of 19 
heat. So he may feel not, and yet sometimes the thermometer 
indicates a grave fall. If the temperature goes to io6°, the 
patient is, (except, probably, in malarious disease, and this is 
very important to know,) in great danger, if it goes to io8°, 
he will scarcely get well, yet cases have been reported where 
the temperature went far above this and the patient recovered. 
Scarlet fever and tetanus may now and then do so, but the 
situation must excite the greatest apprehension. Sometimes 
I notice in our typho malarial fever, common in Dela- 
ware, particularly in the fall of the year, that the thermometer 
will run up to io6° to 107°, but large doses of quinine as also 
of salicin or salicylic acid will as quickly drive it down. I 
have often been seriously alarmed by such cases, but now I 
don’t often allow it to happen, for by watching the thermom- 
eter 1 prevent the creep and fever. This one use of the in- 
strument in this one disease renders it invaluable in my eyes. 
No sick man, as a rule, is well or is getting well whilst the 
thermometer keeps up. Take a case of the above fever. If, 
when the time comes for convalescence, and yet the ther- 
mometer don’t come down, there is some complication. I 
have in my note book some interesting cases here, and some 
very interesting thermometrical histories, which I hope at 
some time to lay before the profession in another form. If 
the thermometer fall from night to morning, it is favorable ; 
if the reverse is the case, it is unfavorable. If during the 
course of a disease there is a sudden and marked rise of tem- 
perature, there is either a malarial complication or one more 
grave, portending even unto death, and sometimes at once, 
we cant always tell whether it is one or the other. I have 
seen mistakes in prognosis here. It is rare for the thermom- 
eter to fall suddenly below the natural standard ; sometimes 
it does so in concealed hemorrhages, &c.; also in the col- 
lapsed stages of disease. The thermometer is also of great 
service in diagnosing between acute and chronic diseases. It 
has also been asserted that when tubercle is forming in any 
part of the body the temperature is above normal, but if it 
be cancer that is forming it is normal or below the average. 
Further observation on these points is needed. The former 20 
proposition is undoubtedly true. I have great faith indeed in 
the clinical use of the thermometer, and I think we should not 
only urge its use among physicians, but I think all persons 
should rely upon it more than is usual. Colorification is indeed 
an important matter in every relation of life. We should 
urge the use of the thermometer upon mothers and nurses. 
By its judicious use they may save themselves many a pang, 
and save us, as physicians, many a sigh for the fruitlessness of 
our labor. Train the mother to watch the temperature of her 
children, and by it she may. at the very earliest minute, be 
made aware of the insidious approach of such a terrible 
scourge as diphtheria or scarlet fever, and thus give the 
physician precious moments for the exercise of his treatment, 
which otherwise would have been frittered away as mere im- 
aginings of baby’s frettings. 
Gentlemen, I do not intend to say more upon this sub- 
ject, but I hope I have fulfilled my intention, and that was to 
so open up this question, that it should receive, at your hands, 
that absorbing attention which its great and increasing im- 
portance deserves and demands. 
HYPODERMIC MEDICATION. 
Another addition to the Armamenta of the physician of 
very great usefulness and importance is the hypodermic 
syringe, introduced within the recollection of all of us, and I 
believe it to be of American origin, however little this may 
concern us in our present inquiry. I believe some physicians 
yet practice medicine without resort to its use, hut how they 
can do so, either in justice to themselves or to their patients, 
is a mystery, I fancy to us who do use it, unfathomable. I 
do not believe they appreciate its advantages, and I hope here 
to remove any prejudice existing in the mind of any one 
against its use. Once tried, I am satisfied the most skeptical 
will be the most enthusiastic in its praises. As to the kind 
of syringe for general use, there are many ; some composed of 
glass, some of metal, and some of rubber, and some of a com- 
bination of materials. Dr. Barthotow, our highest American 
authority in these matters, recommends a metalic instrument 21 
made of silver. This is in all respects very satisfactory. Those 
of hard rubber are generally cheaper and less reliable. I can- 
not recommend them. If of a reliable make, I prefer and 
recommend the glass syringe ; with metallic ends and piston, 
the latter graduated to minims with a screw top; thus giving 
the greater exactness in the dose. I bought one of this des- 
cription from Liier whilst in Paris in 1866, and it alone has 
served me faithfully ever since, and with its case to-day is as 
perfect as ever. I have used everything in it, even iodine and 
liquid subsulphate of iron, and for all purposes, as aspirator, 
or syringe, and it has never failed me. It has fallen on the 
floor repeatedly and never been broken. It has three different 
needles, and rimmers in abundance for cleaning them. From 
my experience with this one, I recommend it above all others. 
It cost me twenty francs in gold. As to its uses, if we meet 
with a case where pain is intense, as one of the various forms 
of colic, in ten minutes we most probably have our patient 
entirely comfortable. Indeed almost as though by magic, he 
passes from a state of absolute torture to one of absolute rest. 
Such comfort could not be brought about by the mouth or 
rectum in hours of anxious care on the part of both the pa- 
tient and physician. In mania we can use it with impunity, 
the patient volens aut nolens. If the stomach is irritable and 
unable to retain remedies, we here have recourse to the sub- 
cutaneous syringe. In collapse absorption in the alimentary 
canal having almost ceased, we have much better results in 
using stimuli hypodermically. Now we come to steps in ad- 
vance in medicine, “ only made possible by the hypodermic 
syringe. The injection of ergotin for the eradication of 
uterine fibroids, the injection of ergotin in the subcutaneous 
cellular tissue over the seat of aneurisms. Even aneu- 
risms of the arch of the aorta have been seen by careful and 
reliable observers to have been much benefited by this plan. 
Langenbek, I believe, was the originator of this treatment. 
It should be accompanied by large doses of iodide of potas- 
sium. Prof. Wm. Pepper speaks of using it in splenic en- 
largements. In haemoptysis, I believe the best and most 
reliable treatment is the hypodermic injection of ergotin ; 22 
also in Purpura Hsemorrhagica ; also in certain forms of con- 
gestive neuralgia, Dr. Pepper has found it of great service 
introduced over the course of the affected nerve, or near its 
point of emergence. The injections of ergotin at first are 
painful, but as now prepared rarely cause abscess. If you use 
ergotin, use it in strength of about ninety-six grains to fluid 
ounce of distilled water, and of it ten minims represents gr. ii 
ergotin. As much as eight grains ergotin may thus be given. I 
have before me a specimen of extract of ergot made by Hance, 
Bros. & White, of Philadelphia. Fifteen grains dissolved in 
f?i distilled water, will produce a solution representing one 
grain ext. ergot to each five minims, equal to eight grains 
powdered ergot. This preparation is highly recommended. 
Thus we can bring the whole system under the influence of 
the vasa motor system. And this remedy should not be 
overlooked in treating obstinate cases of uterine hemorrhage 
of whatever kind. The remedy most used and most useful 
by this method is undoubtedly morphia, and the most avail- 
ble salt is the sulphate, because it is the most soluble. 
Never use this in solution prepared with an acid. It is often 
irritating and causes abscess in the cellular tissue. Never 
use a solution of any of the salts of morphia if it has to be 
kept any time, or you will constantly be annoyed with irri- 
tations and abscesses in your patients. I scarcely ever meet 
with even an irritation which causes the patient to remark 
it, and I believe it is because I always dissolve the powder 
fresh when about to use it. I carry with me powders of the 
sulphate of morphia of one quarter of a grain each. If I want 
the average dose, one quarter of a grain, I call for a tea- 
spoon and a little rain water if I can get it. I empty a pow- 
der into the spoon, then draw the syringe full of water and 
throw it on the powder ; then dissolve it, redraw it into the 
syringe, and I have it ready for use. With the powders of 
one-quarter grain each, I can decrease or increase the dose 
at will. As to the point to apply the injection, I prefer 
under the skin of the back of the fore arm, and as a rule 
with morphia, I don’t think it necessary to apply the remedy 
at the seat of pain. You can relieve a colic as soon by ap- 28 
plying it to the arm as to back or abdomen. The sulphate 
of morphia don’t cause abscess even if not thoroughly dis- 
solved in the water before using, provided no acid is added. 
In commencing to use morphia, hypodermically or indeed, 
most any remedy, it is safe to use about one-third the dose 
usually given by the mouth. Commencing thus, it may be 
increased almost indefinitely. I had one patient with can- 
cer, in whom I used the almost incredible amount of twenty- 
one grains sulphate morphia under the skin in sixteen hours. 
In this case I commenced with one-quarter of a grain, and 
in six months, using more or less daily, arrived at this 
amount. It really appeared to have lost its effect on the 
system, and for the remaining week of the life of the patient 
I resorted to chloroform internally or by inhalation. The 
agony suffered in this case was beyond anything I ever con- 
ceived of. Some physicians report that it is not necessary 
to increase the dose so rapidly by the hypodermic method 
as by the mouth and other ways. In my own experience, 
there is no very great difference in this respect. The con- 
stitutional effects of the dose are more rapid and satisfactory, 
but in the end about the same as in those cases where ad- 
ministered by mouth or rectum. As to the sequelse, they 
are also about the same, and I believe the nausea and other 
symptoms experienced, is as great if not greater than that 
following other modes of administration. Two ordinary 
doses in 24 hours will keep a patient under its influence. A 
man may as readily become an opium eater by the use of 
the hypodermic syringe, as in any other way. Another 
important remedy hypodermically, is atropia, but, gentlemen, 
atropia is an edged tool, and too great caution cannot be 
exercised in its use, like morphia the effects are the same 
used hypodermically as any other way, only more intensi- 
fied and more rapid. It may be used in asthma, forms of 
neuralgia, and muscular rheumatism, to dilate the pupil of 
the eye, bladder troubles, vomiting, &c., but even in almost 
all these cases should be combined with morphia. The hy- 
podermic dose should be small ; certainly not over one- 
sixtieth of a grain to commence with, and except in excep- also in Purpura Haemorrhagica ; also in certain forms of con- 
gestive neuralgia, Dr. Pepper has found it of great service 
introduced over the course of the affected nerve, or near its 
point of emergence. The injections of ergotin at first are 
painful, but as now prepared rarely cause abscess. If you use 
ergotin, use it in strength of about ninety-six grains to fluid 
ounce of distilled water, and of it ten minims represents gr. ii 
ergotin. As much as eight grains ergotin may thus be given. I 
have before me a specimen of extract of ergot made by Hance, 
Bros. & White, of Philadelphia. Fifteen grains dissolved in 
distilled water, will produce a solution representing one 
grain ext. ergot to each five minims, equal to eight grains 
powdered ergot. This preparation is highly recommended. 
Thus we can bring the whole system under the influence of 
the vasa motor system. And this remedy should not be 
overlooked in treating obstinate cases of uterine hemorrhage 
of whatever kind. The remedy most used and most useful 
by this method is undoubtedly morphia, and the most avail- 
ble salt is the sulphate, because it is the most soluble. 
Never use this in solution prepared with an acid. It is often 
irritating and causes abscess in the cellular tissue. Never 
use a solution of any of the salts of morphia if it has to be 
kept any time, or you will constantly be annoyed with irri- 
tations and abscesses in your patients. I scarcely ever meet 
with even an irritation which causes the patient to remark 
it, and I believe it is because I always dissolve the powder 
fresh when about to use it. I carry with me powders of the 
sulphate of morphia of one quarter of a grain each. If I want 
the average dose, one quarter of a grain, I call for a tea- 
spoon and a little rain water if I can get it. I empty a pow- 
der into the spoon, then draw the syringe full of water and 
throw it on the powder ; then dissolve it, redraw it into the 
syringe, and I have it ready for use. With the powders of 
one-quarter grain each, I can decrease or increase the dose 
at will. As to the point to apply the injection, I prefer 
under the skin of the back of the fore arm, and as a rule 
with morphia, I don’t think it necessary to apply the remedy 
at the seat of pain. You can relieve a colic as soon by ap- 23 
plying it to the arm as to back or abdomen. The sulphate 
of morphia don’t cause abscess even if not thoroughly dis- 
solved in the water before using, provided no acid is added. 
In commencing to use morphia, hypodermically or indeed, 
most any remedy, it is safe to use about one-third the dose 
usually given by the mouth. Commencing thus, it may be 
increased almost indefinitely. I had one patient with can- 
cer, in whom I used the almost incredible amount of twenty- 
one grains sulphate morphia under the skin in sixteen hours. 
In this case I commenced with one-quarter of a grain, and 
in six months, using more or less daily, arrived at this 
amount. It really appeared to have lost its effect on the 
system, and for the remaining week of the life of the patient 
I resorted to chloroform internally or by inhalation. The 
agony suffered in this case was beyond anything I ever con- 
ceived of. Some physicians report that it is not necessary 
to increase the dose so rapidly by the hypodermic method 
as by the mouth and other ways. In my own experience, 
there is no very great difference in this respect. The con- 
stitutional effects of the dose are more rapid and satisfactory, 
but in the end about the same as in those cases where ad- 
ministered by mouth or rectum. As to the sequelae, they 
are also about the same, and I believe the nausea and other 
symptoms experienced, is as great if not greater than that 
following other modes of administration. Two ordinary 
doses in 24 hours will keep a patient under its influence. A 
man may as readily become an opium eater by the use of 
the hypodermic syringe, as in any other way. Another 
important remedy hypodermically, is atropia, but, gentlemen, 
atropia is an edged tool, and too great caution cannot be 
exercised in its use, like morphia the effects are the same 
used hypodermically as any other way, only more intensi- 
fied and more rapid. It may be used in asthma, forms of 
neuralgia, and muscular rheumatism, to dilate the pupil of 
the eye, bladder troubles, vomiting, &c., but even in almost 
all these cases should be combined with morphia. The hy- 
podermic dose should be small ; certainly not over one- 
sixtieth of a grain to commence with, and except in excep- 24 
tional cases, not going beyond one-twentieth of a grain. 
The doses of one-twelfth or even one-sixth of a grain, as 
recommended sometimes by Trousseau, in his writings, ap- 
pear to me to be almost criminally large. In giving it, use 
the fresh solution. My syringe holds one-third of a fluid 
drachm, and from this I make my calculation. A most use- 
ful combination is morphia and atropia. Here you can carry 
the powders and dissolve them fresh. Each powder may 
contain one-quarter of a grain of sulphate of morphia, and 
one one-hundred and twentieth of a grain of sulphate of 
atropia. This is a very full dose to commence with. Half 
of it will be usually sufficient. By using this combination, 
we relieve pain more promptly and reliably, provided we 
don’t use too much atropia, for, if we do, it may exert its an- 
tagonistic powers, which appear to have some foundation, 
either directly, or, as is more probably the case, by its action 
in keeping the vital machinery going, whilst the effects of 
the morphia exhaust themselves harmlessly. The toxic 
doses of each may be overcome by the other, at least this 
effect should always be sought for in these unfortunate cases. 
Atropia stimulates the heart, whilst morphia may depress it. 
By using morphia and atropia together, we have less sick 
stomach following, much less constipation of the bowels, 
and less trouble with the urinary secretion. This combina- 
tion is therefore preferable to morphia in many cases, with- 
out taking these advantages into account. In all neuralgic 
rheumatism, in some forms of convulsions, augina pectoris 
and asthma, especially in bladder troubles, where bella- 
donna is so useful. In Bright’s Disease of the kidneys, we 
should be as careful of doses of opium hypodermically, as 
given in any other way, or even more so. So with the hy- 
podermic syringe ; we may use the calabar bean, strychnia, 
alcohol, quinine, and many remedies useless to enumerate 
in a paper of this kind. I have used quinine with good effect, 
and especially would I have recourse to it in a case of con- 
vulsions, which I had reason to expect, were of malarial 
origin, or after a congestive chill, to prevent a return. I 
believe I have seen one of these cases thus rescued from 25 
death. I mean a case of convulsions in an adult. So in 
connection with whiskey in great weakness or collapse. The 
best way to use it is to make a concentrated solution with 
as little acid as possible ; you must use some. The great 
objection to its use hypodermically, is that you almost aJ- 
ways have great irritation or abscess following it. The 
dose is active in about one-sixth of the dose by the mouth. 
In case of great depression or collapse, or in case of veno- 
mous bites, we might inject whiskey and ammonia into the 
veins, although Halfourd’s experiments in the bites of ser- 
pents have not been reported favorably upon by the com- 
mission sent to investigate the subject in Australia. Thus, 
gentlemen, we see from this superficial retrospect, the many 
uses to which this handy little instrument can be applied, 
and I think I have said enough and shown enough to re- 
commend its adoption to the most skeptical. Although I 
know, gentlemen, this medley has already grown too long, 
there are one or two matters I feel that I must refer to as 
of some practical interest, and in the use of which my ex- 
perience has been considerable. First, in regard to the use 
of the Liquid Subsulphate of Iron, (Liquor Ferri-Subsul- 
phatis, U. S. P.,) in Post Partum Hemorrhage. I will pre- 
mise by declaring my belief that if we are particular in the 
various stages of labor in keeping the possibility of this 
terrible complication in view, and towards the end of the 
second stage give a dose of ergot, and deliver the placenta 
by Crede’s method, and put the child to the breast as soon 
as possible, we will have, comparatively few of such cases to 
deal with. The treatment by astringents is not new, but 
the use of this particular preparation of iron is of more re- 
cent date. It may be and has been objected to as danger- 
ous to the woman, because coagula may be carried to the 
centre of circulation, but with even its dangers, I believe, 
that if properly used without forced injection, the rate of 
mortality from Post Partum hemorrhage would be reduced. 
In these cases, gentlemen, we must not be timid. As to the 
method usually employed and recommended by Barnes and 
others, that of conveying the liquid more or less diluted into 26 
the cavity of the uterus by means of a syringe, this I think 
should be objected to for several reasons. First, the in- 
jection may pass through the fallopian tubes into the peri- 
tonical cavity and cause peritonitis. In the hurry of the 
occasion, the most careful and self-possessed operator might 
too forcibly inject the uterine cavity. And one of the greatest 
objections, the annoyance from many reasons of carrying the 
apparatus about with you in general obstetrical practice. In 
my general obstetrical practice, I usually carry with me a 
two-ounce vial of the Liquid Subsulphate of Iron, and two 
small, fine sponges, the size of a large hen’s egg. 
If I meet with a case of threatened port partum hem- 
orrhage, and it does not yield to mild remedies at once, or 
if from the start is one of those of particularly alarming na- 
ture, I make a mixture of one part of the iron to five parts 
water. Soften the sponge first with water, then fill it with 
this liquid, grease the hand and arm thoroughly, turn out 
the clots, and carry the sponge boldly up to the fundus of 
the uterus. From the stimulus the uterus almost immedi- 
ately closes and expels gradually the hand, and the bleed- 
ing gradually ceases. Sometimes there are alternate con- 
tractions and relaxations, but the bleeding is very rarely 
severe after the first. If it continues, withdraw the hand, 
regrease it, and go through the operation again with a new 
sponge. In two cases I have met with, such was the des- 
perate character of the bleeding that I used by this method 
the iron entirely undiluted, and both patients made a most 
satisfactory recovery. In withdrawing the hand, or rather 
in allowing it to be expelled, withdraw all the clots possible, 
and you will leave the uterus and vagina in a tolerably 
good condition, the grease facilitating their removal. Of all 
the cases I have known this method to have been pursued 
in, all have made the rapid and satisfactory recovery that 
general obstetrical cases usually do. Pursue this method, gen- 
tlemen, and in your general obstetrical practice go armed 
with this little bottle and your small sponges, and I assure 
you, you will feel abundantly fortified and strengthened. 27 
One other matter and I finish. I refer to a combination 
of iron and milk, which I shall designate as, 
Ferrated Milk. 
“ I usually prescribe it thus : 
“ ft. Tinct : Ferri Chlor : f?i. 
S. Add 20 drops to one tablespoonful cold water, and 
add this to from £ to a whole glass of new milk, and drink 
it with or after each meal. 
By adding the iron to the water there is no co-agula- 
tion or disturbance of any kind, the taste is pleasant and 
agreeable, and we have the iron tonic “par excellence 
In Bright’s Disease in its various forms, in the different 
forms of anaemia, and especially in those cases of malarious 
origin, in fact wherever we want a combination of iron and 
food I look upon it as of all remedies” 
“Facile Princeps.” 
Iodide of Potassium dissolved in water and added to 
milk is probaly the the most advantageous and palatable 
method of administering that more than valuable remedy. 
My experience in thus using it has been most satisfactory. 
Gentlemen, in closing, again I thank you for the honor 
you have conferred upon me of presiding over the delibera- 
tions of this body. Let each one of us strive to preserve its 
ancient honor and good intentions, and more, let us all col- 
lectively unite in extending its field of labor. Let us make it 
indeed a society for the propagation of useful knowledge 
among medical men. Let us make it a working society. I 
think I already see a disposition for a change to the better. 
Let us, whilst this feeling is active among us,extend the time 
of our yearly meetings. Let us extend our committees for 
research and report. In fact,gentlemen,let each and all of us 
be up and doing ; let us improve the time and faculties that 
God has given us for good. Where is there a field greater 28 
than the field of medicine for their employment ? Thus do- 
ing our part, gentlemen, may we 
“ So live that when our summons comes to join 
The innumerable caravan, which moves 
To that mysterious realm, where each shall take 
His chamber in the silent halls of death, 
We go not, like the quarry slave at night 
Scourged to his dungeon, but sustained and soothed 
By an unfaltering trust, approach our graves 
Like one who wraps the drapery ot his couch 
About him, and lies down to pleasant dreams.”