Where is syphilis now? Really, it seems to be almost everywhere. If you believe that syphilis manifests itself only in the form of chancre, eruption, bubo, or nodes, etc., allow me to disabuse your mind at once. I assure you there are many reasons for different forms of this disease, the constitution of the individual, hygienic surroundings, the virulence of the poison, age, irregularities, excesses, etc. The germ may remain latent in the human system for generations and then break forth violent in form, not as original syphilis, but different in its garb. Believing in the history and relying implicitly upon statistics, I am forced to believe and do most emphatically make the statement that, if we never had any syphilis, we would never have any lupus. If no syphilis, no leprosy. If no syphilis, no cancer in any form; no syphilis, no consumption or tuberculosis in any form; no syphilis, no scrofula in its various forms; if no syphilis, no coxalgia, no rachitis, no curvature of the spine, and but few, if any, abortions from natural causes, but few cases of tabes dorsalis, neurasthenia, paresis, or locomotor ataxia. I believe that all the above enumerated diseases have their germ not exactly as that of syphilis, but somewhat different in form and appearance; but they are the offspring, illegitimate though they may be, yet all belonging to the same family. In other words, "Old Rall” is the great, great-granddaddy of them all. It may seem strange and wonderful that he should father so many diseases; yet, if you will take into consideration the long time he has been at work and try to count, if you can, the millions of human beings under his influence and serving their time in licentious pleasures, you can not be surprised or astonished; for the ravages of syphilis are most wonderful to contemplate. In a communication presented at the late international Congress at Moscow, Krafft Ebing, speaking of progressive paresis, says: "It is a very interesting fact, and, in the main, is strongly confirmatory of the opinion that is now all but general, that paresis is a sequence, if not a direct result, of syphilitic infection in a vast majority of cases; indeed, it may probably be said that it is such in all but exceptional instances." His deduction is syphilization, and civilization, the stress of modern life acting on a system prepared by the results of earlier infection, is likely to be accepted by alienists generally, though there are yet, possibly may be for a long time in the future, some few who reject it against all the weight of evidence in its favor. In the Gazetta digli Ospedali, of Nounberg, Morcelli reviews the general facts as to the etiology and extension of paresis in rather a striking manner. He quotes statistics to show that it is very markedly increasing in its prevalence. In Italy the number of known cases, for example, has nearly doubled in a little over one decennium, and in Bavaria it increased from 9.3 of all the insanity in 1869 to 23.2 per cent in 1874. It is undoubtedly, in his opinion, the special disease of the nineteenth century. He holds, moreover, with Naecke, and in opposition to the French school, that it is a disease to which there is a predisposition, not by a congestive heredity, but by general degenerative peculiarities, which, it would appear, are becoming more common in our modern civilized populations, where the fierce struggle for existence is fought out under constantly and ever increasing severer conditions than ever before. Its immediate existing cause is, therefore, the stress of modern life acting on a predisposed and weakened nervous organization, which is itself, probably, more or less the result of the same general conditions. This alone, however, is not an efficient cause; there must generally be superadded still another, the toxin of syphilis, which renders the catastrophe more inevitable; and Morcelli follows Krafft Ebing in his etiologic duet, but reverses the order, making it civilization and syphilis, inasmuch as the greater diffusion of the latter is, with that of alcoholism, the direct result of the former. In closing his article, Morcelli says: "We have not long since realized that all the venereal diseases are disastrous, and hence have more than ever reason for desiring their suppression. If it is generally admitted, and this seems probable, that syphilis once acquired, no matter how thoroughly and successfully treated, leaves behind it a possible liability to the most formidable of brain affections, paresis; we therefore have another strong inducement for additional means to check its extension." Dr. Daniel R. Brower, of the Post-Graduate School of Chicago, says of tabes dorsalis, "that at least ninety per cent of the cases of tabes. dorsalis have an antecedent syphilitic history, yet it is not a true syphilitic disease, for, in the remaining percentage of cases, other etiological factors are at work, among which are trauma, the acute infections, alcoholism, and the auto-intoxications, so that we may call the disease rather a degenerative sequela of these various processes, and we know not whether disease begins in the neuroses, in the connective tissues, or in the blood vessels." To a great degree syphilis is the cause of paresis and neurasthenia, as well as tabes dorsalis. Therefore we may say that it is largely the cause of the crowded condition of our lunatic asylums and of our feeble-minded institutions, and causes more distress than we realize. Prof. Shoemaker, of Philadelphia, in a clinical lecture a short time since, said: "Tubercles, rupia, and gummata point nevertheless to a syphilitic origin. In fact, what other disease than syphilis could cause such lesions?" Tuberculæ are common to syphilis, lupus vulgaris, lepra, carcinoma, and certain rare forms of cutaneous diseases which need not here be taken into consideration. Prof. Dudley S. Reynolds, of Louisville, says the disseminated choroiditis coming on at any period in life he regards as distinctly characteristic of syphilis. He does not think that it is often seen in cases of acquired syphilis. Testimony has been steadily accumulating in favor of the tremendous influence of syphilis as a causative factor, until at the present time there is not wanting high authority for the assertion that locomotor ataxia is nothing more nor less than a sequel of lues, and that the cachexia venerea constitutes the background whereon all cases are projected, no matter what may be the exciting cause that starts them into activity. Mobins, of Leipsic, declares that tabes is a syphilitic disease. Darkschewitsck, of Kazan, argues that syphilis must be considered as the cause of the disease. Blashner, of Berlin, points out a sort of cross-action of syphilis in tabes, as revealed in the not infrequent insufficiency of the aortic valves. Of 1,016 optic nerve atrophies examined by Galezowski, eight hundred were found in tabetic subjects, and more than half of these were syphilitic. Germeix insists that syphilis is the cause of locomotor ataxia. Strumpell holds that all cases are due to syphilis, the lesion not being, however, strictly syphilitic, but rather a metamorphosis brought about by the slow selective action of the toxin. Vermel and Raymond voice the same opinion. Erbs' recent list of five hundred cases of tabes admitted syphilis in 98.2 per cent. Specific disease was found to have been present in ninety per cent of the four hundred cases of Gajkiewicz, of Warsaw. Maria, of Paris, a pupil of Charcot, who was notoriously conservative in regard to the influence of syphilis, has lately declared that syphilis is practically the only cause of tabes. In 1887, Karger, of Berlin, reported that fifty-three per cent of one hundred and seventeen cases of tabes were syphilitic. In the same year Naglei, of Zurich, studied a list of 1,403 cases, and found that 46.1 per cent were positively syphilitic, while 60.6 per cent were merely suspiciously so. Gerlach observed among one hundred and fifty-six cases of tabes that 56.25 per cent of the men and 66.7 per cent of the women were the victims of syphilitic disease. Mettler says: "There must be some exciting cause, some determining cause to act upon the general cachectic state produced by this syphilitic toxin, or else it will be incumbent upon the advocates of the syphilitic etiology, such as Maria, to explain, first, why all or at least a larger percentage of syphilitics do not contract posterior spinal sclerosis, and secondly, why this universal widespread toxin floating through the blood selects spinal parts of the nervous system whereon to expend this force." Of all the extra spinal lesions, the optic and other Iocular nerves are the commonest. Out of 1,016 cases of optic nerve atrophy observed by Galezowski, eight hundred were tabetic. Kayer, of Berlin, found impairment of vision in thirty-five per cent of one hundred and seventeen cases of locomotor ataxia in Mundel's clinic. Morpurgo observed that forty-three out of fifty-three cases of tabes had some auditory trouble. If time permitted, and I had at my command the statistics, I might prove to your satisfaction that tuberculosis and many of the other diseases mentioned above, as well as locomotor ataxia, neurasthenia, tabes, etc., have their origin in syphilis. That syphilis is the cause of these diseases last mentioned is, in my opinion, a fixed fact. If the distinguished and learned members of our profession do not agree with me, I can not help it. Refute, if you can, the statements from which I have drawn my conclusions. HARRODSBURG, KY. STRONTIUM SALICYLATE, STRONTIUM ARSENITE, AND OTHER BY LEON L. SOLOMON, A. B., M. D. Secretary of the Section on Materia Medica, Pharmacy, and Therapeutics of the American Medical Association for 1898 and re-elected for 1899; Lecturer on Materia Medica and Therapeutics to the Louisville City Hospital Training School and to the Norton Infirmary Training School for Nurses; Director of the Chemical Laboratory, Kentucky To Dr. J. V. Laborde belongs the real credit for the introduction, in 1890, to the medical profession of strontium and some of its salts, although in 1885 Vulpian had already established the therapeutic value of the element and of as many of its compounds as were then known. It was Laborde who demonstrated, after a very exhaustive study, that the metal strontium and its salts were not toxic, as had so often been asserted, if it could be entirely freed from the harmful metal barium with which it is usually found in native association. His experiments and those of others, made upon animals, indicated that when strontium was regularly mixed with their food an improvement in general health and a decided increase in weight came about. To explain this positive result Laborde insisted upon the antiseptic influence of strontium, during its elimination by the intestine and the kidney, and up to the present time no effort seems to have been made to establish another claim or to refute this one. Classification, Properties, and Preparation. Strontium, symbol Sr, Valence II, atomic weight 87.3, melting point unknown, specific gravity (15.5°C.) 2.54 (therefore belonging to the light metals whose specific gravity ranges from 0.6 to 4), is placed in the class, "metals of the alkaline earths," including Ba, Ca, (Mg), Sr, which, along with Na and K, were discovered in 1807-1808. Davy, at the same time, discovered a method for the separation of the metals from their oxides. The occurrence of strontium in nature is never free, but usually as a carbonate (sometimes as a sulphate or a silicate). Its name is derived from "Strontian," a village in Scotland, where the native carbonate is found. Flame coloration: Crimson red, appearing intense red through the indigo prism (unless the coloration be faint). A decided sedative property belongs to the metal, which at once differentiates it from the two metals, sodium and potassium. Preparation: The French, Barthé and Fulières, have devised the best method for preparing pure strontium salts. This method is now in common use. The native carbonate or native sulphate is employed by them. If the latter, by reduction, the sulphide is first prepared. Analogy between the strontium salts and the potassium or sodium compounds: No metals are probably more largely used than are potassium and sodium in their various and varied combinations. These salts make up a very long and very useful list of preparations, and for many years they have occupied a prominent place in the armamentarium of the physician. When we, however, stop to inquire the reason for their popularity, as remedies, no particular reason can be found which depends especially upon the metals themselves. In fact, natrium and kalium, per se, are possessed of no decided therapeutic property. On the other hand, we read (Shoemaker): "Potassium is a |