HARVARD UNIVERSITY. MEDICAL DEPARTMENT, ONE HUNDRED AND FIRST ANNUAL ANNOUNCEMENT (1883-1884) CHARLES W. ELIOT, LL. D., President. HENRY P. BOW DITCH, M. D., Dean, and Professor of Physiology. FACULTY. OLIVER W. HOLMES, M. D., LL. D., Professor of Anatomy, Emeritus. HENRY J. BIGELOW, M. D., Professor of Surgery, Emeritus. FRANCIS MINOT, M. D., Hersey Professor of the Theory and Practice of Physic. CALVIN ELLIS, M. D., Jackson Professor of Clinical Medicine. HENRY W. WILLIAMS, M. D., Professor of Ophthalmology. CHARLES F. FOLSOM, M. D., Assistant Professor of Mental Diseases, J. COLLINS WARREN, M. D., Assistant Professor in Surgery. WILLIAM H. BAKER, M. D., Assistant Professor of Gynecology. WILLIAM F. WHITNEY, M. D., Curator of the Anatomical Museum. -NSTRUCTORS. DAVID W. CHEEVER, M. D., Professor of Surgery. оті SAMUEL H. DURGIN, M. D., Lecturer on Hygiene. G., fog; h JOSEPH W. WARREN, M. D., Assistant in Physiology. MAURICE H. RICHARDSON, M. D., Demonstrator of Anatomy. The following gentlemen will give special clinical instruction: JOHN HOMANS, M. D., in the Diagnosis and Treatment of Ovarian Tu J. ORNE GREEN, M. D., and CLARENCE J. BLAKE, M. D., in Otology. AMOS L. MASON, M. D., and FREDERICK C SHATTUCK, M. D., in Ave Lon. JOSEPH P. OLIVER, M. J., and THOMAS M. ROTCH, M. D., in Diseases of Chil dren. SAMUEL G. WEBBER, M. D., and JAMES J. PUTNAM, M. D., in Diseases of the A New Building has just been completed at a cost of more than a quarter of a million of dollars. Its numerous apartments are spacious, well lighted, and provided with carefully contrived apparatus for heating and ventilation. The comfort and convenience of the students have been constantly borne in mind is the arrangement of rooms, the construction of seats, and in the furnishing of the various laboratories, halls for lectures, and rooms for recitations, study, and conversation. The building is devoted to laboratory instruction and didactic teaching, while the general and special clinics take place at the various hospitala and dispensaries. Greatly enlarged and improved facilities are offered at the Massachusetts General Hospital and the Boston Dispensary, both of which insttutions have constructed buildings to meet the constantly increasing demands for their usefulness. Every candidate for admission not holding a degree in arts or science must pass a written examination on entrance to this School, in English, Latin, Phys and any one of the following subjects: French, German, Elements of Algebra or of Plane Geometry, Botany. The admission examination for 1884-85 will be held June 23d, at Boston, June 26th, at Exeter, Andover, New York, Philadelphia, Chicago, Cincinnati, St. Louis, and San Francisco; on September 224, at Boston only. Instruction is given by lectures, recitations, clinical teaching, and practical exercises, distributed throughout the academic year. In the subjects of Anatomy, Histology, Chemistry and, Pathological Anatomy, laboratory work is largely substituted for, or added to, the usual methods of instruction. The year begins September 25, 1884, and ends on the last Wednesday in June, 1885, and is divided into two equal terms. Students are divided into four classes, according to their time of study and proficiency, and during their last year will receive largely increased opportunities for instruction in the special branches mentioned. Students who began their professional studies elsewhere may be admitted to advanced standing; but al persons who apply for admission to the advanced classes must pass an examination in the branches already pursued by the class to which they seek admission. Although the course of study recommended by the Faculty covers four years, until further notice the degree of Doctor of Medicine will continue to be given upon the completion of three years of study, to be as ample and full as heretofore. The degree of Doctor of Medicine cum laude will be given to candidates who have pursued a complete four years' course, and obtained an average of 75 per cent. upon all the examinations of this course. In addition to the ordinary degree of Doctor of Medicine as hitherto obtained, a certificate of attendance on the studies of + h year will be given to such students desiring it as shall have attended the course, and have passed a satisfactory examination in the studies of Collins ORDER OF STUDIES. — FOUDuctions of the SE. Anatomy, Physiology, and General Chemistry. Seventh Ann - Practical and Topographical Anatomy, Medical Chugust 29-31. Medica, Pathological Anatomy, Clinical Medicine, Surgery, Arthur Van For the First Year. and Clinical Surgery. For the Third Year. - Therapeutics, Obstetrics, Theory and Practice Index iinical Medicine, Surgery, and Clinical Surgery. For the Fourth Year. — Ophthalmology, Otology, Dermatology, Seytin yngology, Mental Diseases, Diseases of the Nervous System, Diseases of Women, Diseases of Children, Obstetrics, Clinical and Operative Obsteide. Clinical Medicine, Clinical and Operative Surgery, Forensic Medicine. THREE YEARS' COURSE. Practical and Topographical Anatomy, Medical Chemistry, Materia Medica, Pathological Anatomy, Clinical Medicine, and ClaTherapeutics, Obstetrics, Theory and Practice of Medicine, Clinical Medicine, Surgery, Clinical Surgery, Ophthalmology, Dermatology, Syphilis, Otology, Laryngology, Mental Diseases, Diseases of the Nervous System, Diseases of Women, Diseases of Children, Forensic Medicine. ANNUAL EXAMINATIONS. At the end of the first year - Anatomy, Physiology, and General Chemistry. End of second year - Topographical Anatomy, Medical Chemistry, Materia Medica, and Pathological Anatomy. End of third year—Therapeutics, Obstetrics, Theory and Practice of Medicine, Surgery. (Students of the three years' course are also examined in Clinical REQUIREMENTS FOR A DEGREE. - Every candidate must be twenty-one years of age; must have studied medicine three or four full years, have spent at least one continuous year at this School, have passed a written examination upon all the prescribed studies of the course taken, and have presented a thesis. COURSE FOR GRADUATES. - For the purpose of affording to those already Graduates of Medicine additional facilities for pursuing clinical, laboratory, and other studies, the Faculty has established a course which comprises all of the special subjects of the fourth year in addition to private instruction in Histology Physiology, Medical Chemistry, and Pathological Anatomy. Any or all branches may be pursued. If the full fee is paid, the privilege of attending any of the other exercises of the Medical School, the use of the laboratories and library, and all other rights accorded by the University will be granted. Graduates of other Medical Schools who may desire to obtain the degree of M. D. at this University will be admitted to examination for this degree after a year's study in the Graduates' Course. Examination on entrance not required. FEES. For Matriculation, $5; for the year, $200; for one term alone, $120; for Graduation, $30. For Graduates' Course, the fee for one year is $200; for one Term, DR. H. P. BOWDITCH, Dean, Harvard Medical School, Boston, Mass. The Boston Medical and Surgical Journal is published weekly by Houghton, Mifflin & Co., 4 Park St., Boston, where subscriptions are received and single copies of the Journal are always for sale. TO THE MEDICAL PROFESSION. LACTOPEPTINE DEMONSTRATED SUPERIORITY OF LACTOPEPTINE AS A DIGESTIVE AGENT. Pharmaceutical Society of Great Britain. Certificate of Composition and Properties of Lactopeptine by Prof. ATTFIELD, Ph. D., F. R. S., F. I. C., F. C. S., Professor of Practical Chemistry to the LONDON, May 3, 1882. dered sugar of milk. The acids used at the factory - lactic and hydrochloric - are LACTOPEPTINE having been prescribed for some of my friends during the past five the best to be met with, and are perfectly combined to form a permanent preparation; years-apparently with very satisfactory results - its formula, which is stated on the the milk sugar is absolutely pure; the powder known as " diastase," or starch-digestbottles, and its general characters have become well known to me. But recently the ing (bread-, potato-, and pastry-digesting) material, as well as the " pancreatine," of manufacturer of this article has asked me to witness its preparation on a large scale, fat-digesting ingredients, are as good as any I can prepare; while the pepsin is much to take samples of its ingredients from large bulks and examine them, and also mix superior to that ordinarily used in medicine. Indeed, as regards this chief ingredient. them myself, and to prepare LACTOPEPTINE from ingredients made under my own di- pepsin, I have only met with one European or American specimen equal to that made rection, doing all this with the object of certifying that LACTOPEPTINE is what its maker and used by the manufacturer of LACTOPEPTINE. A perfectly parallel series of experi professes it to be, and that its ingredients are in quality the best that can be obtained. ments showed that any given weight of acidified pepsin, alone, at first acts somewhat This I have done, and I now report that the almost inodorous and tasteless pulveru- more rapidly than LACTOPEPTINE containing the same weight of the same pepsin. Sooner lent substance termed LACTOPEPTINE is a mixture of the three chief agents which en- or later, however, the action of the LACTOPEPTINE Overtakes and outstrips that of pepable ourselves and all animals to digest food. That is to say, LACTOPEPTINE is a skill- sin alone, due, no doubt, to the meat-digesting as well as the fat-digesting power of fully prepared combination of meat-converting, fat-converting, and starch-converting the pancreatine contained in the LACTOPEPTINE. My conclusion is that LACTOPEPTINE materials, acidified with those small proportions of acids that are always present in is a most valuable digesting agent, and superior to pepsin alone. the healthy stomach; all being disseminated in an appropriate vehicle, namely, powJOHN ATTFIELD. LACTOPEPTINE contains all the agents of digestion that act upon food, from mastication to its conversion into chvle, thus combining all the principles required to promote a Healthy Diges tion. One of its chief features (and the one which has gained it a preference over all digestive preparations) is that it precisely represents in composition the natural digestive juices of the stomach, pancreas, and salivary glands, and will therefore readily dissolve all foods necessary to the recuperation of the human organism. LACTOPEPTINE is sold entirely by Physicians' Prescriptions, and its almost universal adoption by physicians is the strongest guarantee we can give that its therapeutic value has been most thoroughly established. The undersigned, having tested LACTOPEPTINE, recommend it to the Profession. ALFRED L. LOOMIS, M. D., Prof. of Pathology and Practice of Med., University of the City of New York. SAMUEL R. PERCY, M. D., Prof. Materia Medica, New York Medical College. F. LE ROY SATTERLEE, M. D., Ph. D., Prof. Chem., Mat. Med., and Therap. in N. Y. Col. JAS. AITKIN MEIGS, M. D., Philadelphia, Pa., Prof. of the Institutes of Med. and Med. Juris., W. W. DAWSON, M. D., Cincinnati, Ohio, Prof. Prin. and Prac. Surg., Med. Co. of Ohio; ALFRED F. A. KING, M. D., Washington, D. C., Prof. of Obstetrics, University of Vermont. D. W. YANDELL, M. D., Prof. of the Science and Art of Surg. and Clinical Surg., University of Louisville, Ky. L. P. YANDELL, M. D., Prof. of Clin. Med., Diseases of Children, and Dermatology, Univer- ROBT. BATTEY, M. D., Rome, Ga., Emeritus Prof. of Obstetrics, Atlanta Med. College, Ex- PROF. H. C. BARTLETT, Ph. D., F. C. S., London, England, For further particulars concerning Lactopeptine, the attention of the Profession is respectfully directed to our 32-page Pamphlet, which will be sent on application. THE NEW YORK PHARMACAL ASSOCIATION, Nos. 10 and 12 College Place, New York. P. O. BOX 1574. Entered at the Post Office at Boston as second-class matter. November 23, 1883. Our First Death and its Cause. A Letter from the BOSTON, Oct. 22, 1883. I am satisfied that fully two months of comparative comfort were added to her life by the use of your Liquid Food. I am using your Food, in a variety of cases, with great satisfaction. Thanking you for all kindness to my self and patient, I am Very respectfully yours, Mrs. S.. born in 1841. Married; mother of two chil dren. While carrying the second child she was very ill all the time, and had a very severe labor, causing laceration of the mouth of the womb, and other injuries incident to such severe deliveries. Since that time he has suffered more or less from these injuries and other diseases, which in turn have contributed to depress her nervous system, and bring her into a state of great suffering, which has been long and tedious. To alleviate these suffering opium was administered as the only remedy that would give relief, until the opium habit was contracted. In this condition she came to the Murdock Liquid Food Hospital. Not able to walk or stand, weak and restless, passing her nights in pain, vomiting her food almost every meal, often deeply colored with fresh blood. Four weeks' treatment with Liquid Food cured all the vomiting, overcame the opium habit, and now the patient sleeps well, eats well, and retains her food, and has gained some ten pounds in flesh. Miss T., aged 24 years. In health weighed 140 lbs. In December, 1880, was taken sick with pleurisy, which resulted in an effusion of pus into the pleural sac. Several times pus was drawn by aspirating. At one time two quarts were drawn. Finally the sac was opened, and a drainage tube was put in, and the sac has continued to discharge until the present time. She was admitted to Murdock's Free Hospital, May 5, 1883, weighing only 80%1⁄2 lbs., having lost 60 lbs. of flesh, being unable to take and digest food enough to sustain the system under such a drain, and has been badly con MADAME MARGUERITTE CHEVALLEY'S KOUMYSS, OR SPARKLING MILK CHAMPAGNE. A Genuine Article may be obtained daily from Mme. Chevalley's Brookline Dairy, made fresh from rich Alderney milk, and possessing every essential virtue of the delicious "Champagne Koumyss of Northern Europe. KOUMYSS may be obtained from all first-class Druggists, or by addressing MME. CIIEVALLEY direct through the telephone, No. 8094, or by post. box 534, BROOKLINE, MASS. Mme CHEVALLEY refers by permission to Dr. CHAS. D. IIOMANS, 90 Boylston St.; Dr. FRANK PAGE, Nerving Hospital; Dr. C. F. NICHOLS, 56 Boylston St; Dr. JAMES H. DENNY, 7 Newbury St. Ask for MME. CHEVALLEY'S Koumyss. Professional Notices. DR. J. F. A. ADAMS, of Pittsfie d, Mass., will pass the present winter and DR. J. P. BANCROFT, Lately Superintendent of the New Hampshire Asylum for the Insane, can be consulted in Diseases affecting the Mind, in Concord, N. H., or elsewhere by appointment. DR. BUCKMINSTER BROWN Ilas removed to 39 Marlborough St., Boston. DR. WALTER CHANNING will receive a few cases of Mental and Nervous Diseases at Brookline. P. O. address, Brookline, Mass. Office in Boston, 146 Boylston St. Office Hours, 12 to FOR SALE. A strictly first-class Medical Practice, together with Real Estate, near Boston. There are several highly desirable features connected therewith, and the advertiser believes the opportunity unsurpassed for a physician desiring to establish himself. Full particulars can be obtained by calling on or addressing DR G. A. LELAND, 349 Marlborough St., Boston, Mass. HERBERT HALL, A Home for the Care and Treatment of Per sons afflicted with Mental Diseases. For Terms, etc., address MERRICK BEMIS. M D., HERBERT HALL, WORCESTER. MASS. Town Office, 34 Pearl St., Worcester. Office hours, 10 to 12 A. M., 2 to 4 P. M. 1. From June 1st to October 1st, in Boston by appoint F. M. LORING, PHARMACIST, ment only. DR. C. H. COBB Will receive a few Lying-In Cases at 358 Columbus Avenue. Office Hours: Belore 6 to 7 P. M. Telephone No. 4852. A. M., 2 to 4 and stipated for three years, being obliged to take medicine DR. NORTON FOLSOM weekly for the same. Ou Liquid Food she gradually began to gain flesh and strength. The discharge from her side diminished 4, tube reduced the same per cent, and has been relieved of constipation. Iler spirits revived, and she improved and was able to ride and take short walks daily, until in August she received a severe mental shock, which upset her nervous system so that she refused food of all kinds for several weeks. She bas finally recovered her mind, and now takes food again, and is gaining daily and able to ride out. Miss V., Oct, 1882, was blind, had both eyes operated on, but without success. Other troubles followed piles, kidney trouble. Casts were found in the urine, the left kidney being badly affected. Peritonitis and cystitis followed. After being in a hospital three months, entered ours Oct. 5th, unable to retain food, vomiting incessantly, and in a helpless condition. Has taken tour teaspoonfuls of Food daily. Retains her food, is able to go around some, sitting up and working at what her sightless eyes will allow, gradually improving in health, strength, and spirits. She Mrs. O. for four to five months was unable to retain any food except four to five ounces of milk daily, with lime water; her weight reduced in one year fifty-five pounds; suffering from many complaints, she was obliged to take morphine daily in increasing quantities. has been in the Hospital two months, has taken no morphine, and after the first week able to retain common food, and has gained seven pounds since, gaining one pound per week, and now discharged. Her last physician wrote us that she was incurable, and all the many that treated her gave the same opinion. Mrs. A. was for one ye r under treatment for uterine hemorrhages and extreme nervous debility, by the best physicians, with no beneficial results. She became completely prostrated by the disease. Her nervous system was so run down that she had no control of her nerves, passing the nights in a wakeful horror of some dreaded misfortune or death. Previous to this illness her weight had been one hundred and sixty pounds, but her sufferings soon brought her weight to one hundred and twenty pounds. She at last concluded to try what could be done for her at Murdock's Free Hospital, as she had taken medicine enough and thought she needed something to build her up. She entered in July, began taking one teaspoonful four times a day, and now, using her own words, "is perfectly well both physically and mentally," and we are of her opinion, as she left us in September and is now in perfect health. Murdock Liquid Food is in general use at TURDOCK LIQUID FOOD CO., Boston. Has removed, and will meet those desiring to consult him in cases of Mental Disease at No. 15 Pemberton Square, from 11 to 1 o'clock daily, or elsewhere by apephone 7014. 655 Tremont Street, Roston. DISPENSING PHYSICIANS PRESCRIPTIONS A SPECIALTY. All the preparations of the New Pharmacopoeia, and re liable foreign and domestic remedies, constantly on hand. STATE ASSAYER AND CHEMIST FOR MASSACHUSETTS. Analysis, Expert Testimony and Investigation, Sanitary Research. W. FRENCH SMITH, PH. D., 235 Washington Street, (P. O. Box 3126), BOSTON. (Correspondence invited.) pointment, Residence, 19 Berkeley St., Cambridge. MASSACHUSETTS DR. CHARLES H. MALLETT, Graduate of Harvard Medical School, eight months DR. IRA RUSSELL, Assisted by his son, DR. F. W. RUSSELL, receives patients into his "Family Home," WINCHENDON, MASS., for the treatment of Nervous and Mental Diseases. DR. GEO. B. TWITCHELL, President of the Board of Trustees, N. H. Asylum for the Insane, will receive into his family a few cases of MENTAL or NERVOUS DISEASES. P. O. address, KEENE, N. H HOSPITAL. GENERAL Warren Triennial Prize, $450. "On some subject in Physiology, Surgery, or Pathological Anatomy." Dissertations to be forwarded on or before February 1, 1886. For further particulars address J. H. WHITTEMORE, M. D. BOSTON, May, 1883. Resident Physician. MEDICAL ESSAYS. 1842-1882. BY OLIVER WENDELL HOLMES. Including "Currents and Counter-Currents in Medical Science," "Border Lines in Some Provinces of Medical Science," with Addresses and Essays not before collected, and a new Preface. Crown 8vo, gilt top, uniform with the new edition of Dr. Holmes's other works, $2.00. HOUGHTON, MIFFLIN & CO., BOSTON, MASS. Madame La Chapelle's "Health Preserver," And REVERSE CORSET for preventing and overcoming Uterine disease. Preeminently useful during Pregnancy. Especially adapted to treatment of Functional Derangement. It affords immediate satisfaction. Heat and pain in back and pelvis, prolapsed bowels, ovarian weakness, troubles of the Bladder, and attendant reflex troubles of Heart, Brain, Stomach, and Liver, are relieved by its application. Every one made to order, from glove kid and calf. In measuring give exact size (under all clothing) of Waist; Abdomen at Umbilicus; Hips, largest part; Thigh; and length from Waist to Pubes. Retail price, with Leggings, $15, to Physicians, $10; without Leggings, $12, to Physicians, $8. Send for Circulars and Measure Cards. Measurement must be accu rate to insure perfect fit. WHITE, WILLIAMS & CO., "No Doctor will fail to recommend or furnish them after knowing their value." One of the Physicians to the Hospital, and Professor of Nervous Diseases means of which we are able to decide whether or not a in the University of Pennsylvania. GENTLEMEN, patient is suffering from cerebral syphilis, I ask no ques- You will remember that when I last tions, but apply the test where I have reason to sushad the honor of meeting you we considered the sub-pect any disorder. It is a serious matter to mercurialject of cerebral syphilis, with special reference to the disease as it affects the brain membranes. There is another form of specific disease of the brain which is much more rare. Cases of this form of cerebral syphilis are not often seen in the wards of a general hospital, but find their way into the insane asylums. I am, therefore, unable to illustrate my remarks by the presentation of a case, unless a brain which is now being removed from a man who died in the ward yesterday should prove to be the seat of this lesion. This man came into the hospital in a condition of absolute dementia. He was also partially paralyzed on one side. In the absence of any history it was, of course, impossible to make a diagnosis. The case, however, presented some of the aspects of the disease known as dementia paralytica, but later in the course of the lecture I shall bring the brain before you. ize a patient, but it does no harm to produce iodism, so that when making the test I always employ iodide of potassium. If I find that ten grains three times a day produces symptoms of iodism I am almost sure that the case is not one of specific disease. If, on the other hand, the patient takes from one half to one drachm of iodide of potassium and waxes fat thereon, I am almost sure that he is the subject of specific disease. There are some persons, not syphilitic, who will stand large doses of iodide of potassium, but such cases are rare, so that when a patient will take half a drachm of the remedy three or four times a day it may be concluded that he is syphilitic. I say this with one reservation. Persons who have gradually accustomed themselves to the use of iodide of potassium, as, for instance, those who are asthmatic, will stand large doses of this drug, even when not suffering from syphilis. In such a case there will be the history of the long-continued use of the remedy. You must remember, also, that there is a syphilitic asthma, so that the relations of iodide of potassium to asthma are in many cases easily explainable. I shall speak of the method of using iodide of potassium when I come to consider the treatment. It is important when employing iodide of potassium as a therapeutic test that you should be familiar with the symptoms of iodism. The most frequent manifestation of its constitutional action is the development of coryza, which exactly simulates that produced by cold. There will be dull aching in the temples, dependent upon congestion of the frontal sinuses, followed by a discharge from the nose, which is sometimes thick, but more usually watery, and often very free. In other cases, instead of coryza mild salivation is produced. When the salivation is severe the probabilities are that the patient has been taking mercury, and that the condition of the mouth has been produced by the liberation of the mercury which has been concealed in the tissues, for, as you know, iodide of potassium has the power of causing mercury which has been stored up in the body to take a soluble form. Sometimes an acne eruption is produced. Sometimes the eruption is of an ecthymatous character, while in other cases it takes the form of an erythematous dermatitis resem As I have said, I cannot illustrate my remarks by the presentation of a case, but in order to make the subject more complete I shall ask your attention for a few minutes to a consideration of syphilitic insanity dependent on disease of the gray matter of the brain. Sclerosis and atrophy of the gray matter are frequently found associated with disease of the membranes, and the cerebral symptoms which are present in disease of the membranes are always due either to primary or secondary involvement of the brain cortex or to derangement of its circulation. It is possible, however, for syphilis to attack the brain cortex without attacking the membranes. Under such circumstances the symptoms are not to be distinguished from the symptoms present in general paralysis of the insane. There is progressive mental failure, with a condition of depression, melancholia, or hypochondriasis, or with exalted delusions or mania, in which the patient thinks that he is the emperor, the czar, or that he owns millions, has great power, or strength, or, in some way, manifests the features of the delire des grandeurs. Then there is failure of muscular power, and fibrillar tremblings manifest themselves. The symptoms are sometimes not distinguishable from those of general paralysis of the insane, and it is often impossible in these cases to make the diagnosis from the symptoms alone. There may, however, be the evidences of syph-bling erysipelas. ilis of the membranes of which I spoke at the last lecture. If you have these you can make the diagnosis. But where the cortex is alone involved, it is not possible to determine the true nature of the lesion without a knowledge of the history or the aid of the therapeutic test. At the last lecture I spoke of the therapeutic test of the existence of syphilis. Most of you know that this test consists in the power of the patient to bear mercury or iodide of potassium. In private practice it is my invariable rule never to ask questions in these Before discussing the treatment of syphilis of the nerve centres I wish to say a few words in regard to the prognosis. Formerly when I took charge of a case of specific disease of the brain I always gave a favorable prognosis, but experience has shown me that sometimes such prognoses are not realized. Syphilis of the brain is a serious disorder, and in a certain proportion of cases you will fail to obtain the result you desire. The first element in the prognosis is the fact that because the symptoms are due to syphilis they are more amenable to treatment than if produced by any other cause. Thus the fact that in any case insanity, palsy, or headache have a syphilitic origin makes them more amenable to treatment than if they were due to other causes. The prognosis must be guided by the manifestations in individual cases, but it always must be guarded. If a patient has severe hemiplegia, if the headache is severe, if the epileptiform attacks are violent, and if the history is that of long continuance, the prognosis is far more grave than if the nature of the disease is discovered at an early period of the attack. Even, however, in the most desperate cases almost complete recovery may be brought about by proper treatment. I remember reading in a London journal a short time ago the report of a case in which a man, absolutely paralyzed and demented, incapable of lifting hand or foot, and hardly knowing enough to have knowledge of his own existence, who in the course of a year or eighteen months was so far recovered that he won a rowing match on the Thames. Having made up my mind that the disease is specific, I tell the patient, no matter how severe the symptoms may be, "You have a chance for recovery." And however slight the symptoms may be I never say, "You are sure to get well." The proportion of chances, of course, varies with the extent of the lesion and the severity of the symptoms. It is a good plan to endeavor to put the prognosis in numbers. You make up your mind as to what you think the chances in his favor are, and then you tell the man, for instance, that he has three chances out of six. This satisfies him, and if he does not recover you simply say that he took one of the other three chances. It is related of a celebrated New York merchant that when on what he thought was his death-bed he asked his physician if he had a chance of recovering. The doctor told him that he had one chance out of a hundred. The merchant said that that was all right; he never wanted more than that in his business. He recovered. he was. Here is a patient whom I want to show you as a case of recovery. This man came into the ward two years ago. He then had severe specific basal meningitis with apparent implication of the brain substance. He had very marked oculo-motor palsy with ptosis and dilated fixed pupil on the left side. He had severe headache, great general weakness, and very little mental power. He had no epileptiform attacks. He suffered from a form of delirium which is seen in many of these cases, and is somewhat characteristic. During the day he would seem rational, but at night he would be dazed, not knowing what he did, and had a great tendency to get out of bed and wander away. When away from his bed he was unable to recognize where It frequently happens in nervous diseases that the patient loses control of the sphincters, and passes urine and fæces in bed. In these cases of syphilitic disease this is not seen except in the last stages of the disorder. What we did see in this case was that the patient would go to a corner of the ward, and, supposing that he was in the water-closet, would void his excrement there. You see that there is an important distinction between these two conditions. In the one case the patient loses control over the rectum and bladder; in the other the patient does not recognize the position in which he is. Where you have this latter form there is always a suspicion arising that the disease is of a syphilitic origin. It is sometimes seen in general paralysis of the insane. For several months this patient did not improve under treatment, but he is now almost recovered. The recovery is not absolute, and this happens in most instances of severe cerebral syphilis. Here is a second patient who came in about two months ago. The disease was not so severe as in the previous patient, and it is probable that he will make a complete recovery. In treating cerebral syphilis it is sometimes necessary to treat the symptoms, but the basis of the treatment is the use of antispecific remedies. If a patient has a violent attack of acute meningitis from cerebral syphilis, this is to be treated by counter-irritation or by bleeding, as may be indicated. If there is chronic or sub-acute meningitis or violent headache it is to be in part treated by the application of counter-irritants to the back of the neck and such other measures as are indicated; but although you do this you know that this is the mere frill, the entrée to the real courses of the dinner, and that the pièce de resistance is antispecific medication. There is no use of employing small doses in these cases; in order to cure the patient it is necessary to give large doses. This is one of the rare cases in which it can be truly said that the doctor effects a cure. The question at once comes up as to the choice between iodide of potassium and mercury, and you will frequently find it somewhat puzzling to decide this point. Mercury is certainly more rapid than iodide of potassium, and when it is of great importance that the symptoms should be relieved at once, mercury should be used in preference to the iodide. Some years ago I saw in consultation a tavern keeper in whom epileptiform convulsions had developed after he was forty years old. I diagnosticated cerebral syphilis, and he was put on the use of large doses of iodide of potassium. The fits grew less violent and came at longer intervals, and he was in a fair way to recover, and he would have gotten well, but one day he had a fit which stopped respiration a little too long, and he died. That man ought to have recovered, and he would have done so if it had not been for the accident of his death. If instead of giving iodide of potassium and being satisfied with a gradual improvement that patient had been mercurialized at once, the probabilities are that the fits would have been immediately reduced in severity, and he would not have died. You therefore see that we are to be guided to some extent in our choice between these remedies by the symptoms of the disease itself, leaving out of sight the condition of the patient. If the only manifestations of the disease are a little squint and a dilated pupil, we know that these will not kill the patient, and the slow action of iodide of potassium is sufficient. But where there are violent epileptiform attacks, or such a condition of the meninges that we fear the development of an attack of acute meningitis, mercury should be employed. In the great majority of cases it is sufficient to use iodide of potassium, but where there is any doubt, the administration of the iodide should be preceded by the use of mercury. Many combine these two remedies, but my own experience has not led me to have much confidence in this method. When the drugs are combined too small doses are usually given. If only ten grains of iodide of potassium are ordered, mercury should of course be given, but if one hundred grains of the iodide are given, I do not think that it is necessary to add to it one twelfth of a grain of the bichloride of mercury. If both are given at the same |