may be absent. Individuals may fail to present recognizable primary or secondary symptoms, and yet may eventually develop definite tertiary lesions. In subjects relatively insusceptible the disease may be limited to the primary cutaneous manifestations not followed by secondary lesions. Like tuberculosis, congenital syphilis begins with what may be termed the secondary stage of the acquired disease-i. e., the stage of general dissemination of the virus through the organism. There is a lack of sharp definition between the anatomic changes in early and late generalized syphilis, as is well shown by a study of the syphilitic liver. In the liver of the newborn infant with external evidences of the secondary stage of the disease there may be several varieties of syphilitic manifestations. All the changes seen in congenital syphilis of the liver are those usually considered to characterize the tertiary stage of the disease. The lesions of the congenital and the acquired disease are identical, and are brought about by the same processes. Intravenous Injections in Syphilis.-C. F. Marshall' holds the following views: 1. The intravenous injection of mercury has not been proved to have any advantage over other methods as regards either rapidity of disappearance of symptoms or convenience. 2. It is obvious that in private practice it is almost impossible to carry it out even if the patient consents-which is very doubtful. 3. Chopping has said "we are able only to judge of effect by quantity administered"; and hence " it is very important to know, if possible, the exact quantity of mercury introduced into the circulation. In answer to this I would state that if symptoms of mercurialization were the same in all individuals, such measurement of the dose administered would be scientific. But, as we know, there are very great differences in the way different persons react to mercury, and our only guides in its administration are the symptoms produced, together with the rapidity of disappearance of syphilitic lesions; therefore I consider the exact dosage of minor importance.' Syphilis Treated by Intravenous Injection.-A. Chopping 2 has reported 84 cases so treated. A tourniquet is applied to the arm, and when the veins stand well out the needle of a hypodermic syringe containing 20 minims of a 1% solution of cyanid of mercury is introduced into the vein selected. The injection is made every morning unless diarrhea occur. The advantages are: 1. As the patient is treated daily he is under constant observation. 2. The exact quantity of mercury taken is known. 3. The patient is brought quickly under the influence of the drug. 4. The rapidity with which serious lesions clear up. In 2 cases only did salivation occur; antiseptic washes controlled this. In the worst cases adjuvants, such as codliver-oil, iron, iodid of sodium and ammonium, were used. The average stay in the hospital was 23 days; all the cases, with but 1 exception, showed marked and rapid improvement. Hereditary Syphilis and Explosive Phagedena.—Concerning a severe case in which mercury in all its forms was taken without success, Besnier said that in such rebellious cases it was necessary to exceed all ordinary doses and proceed to the extreme limits of toleration. Fournier recalled the fact that in a recent case in which the injection of calomel and inunction had been employed separately without avail, a cure 1 1 Lancet, Apr. 1, 1899. 2 N. Y. Lancet, Apr., 1899. * Med. Bull., Apr., 1899. resulted when both these methods were used in conjunction. Galezowski pointed out that it is useful not only to carry out an intensive treatment, but also to suppress the administration of the iodid, because the latter eliminates the mercury, and is therefore objectionable in cases in which mercurialization should be carried as far as possible. Iodipin in Syphilis.-V. Klingmüller' has reported success in the treatment of tertiary lues by iodipin. He claims for it a specific action, and also that the subcutaneous administration is acceptable and effective. The tissues are kept under its influence a long time by injections several days apart without unpleasant results. Later reports are even more satisfactory, especially in bone-lesions. Iodipin is an organic combination of iodin and sesame oil. Danger of Error in Diagnosis between Chronic Syphilitic Fever and Tuberculosis.-Janeway" directs attention to the possibility of errors in diagnosis occurring through ignorance of the fact that fever may attend the late manifestations of syphilis, more particularly of visceral syphilis; and in illustration reports the histories of 7 cases with various forms of late syphilis in which a history of tuberculosis had been made on account of the presence of more or less continuous fever. In all these cases the administration of specific remedies caused cessation of the fever and restoration of the patient's health. Gastric Syphilis.-Flexner3 reports a case of perforating syphilitic ulcer of the stomach. The patient was a man, 52 years of age, who had been ill for a period of 3 years, suffering from spells of vomiting, irregular chills, and, after a time, ascites. After having dined upon highly indigestible food he was seized with severe abdominal pain accompanied by tympanites, and death occurred within a few hours. The autopsy disclosed old adhesions between the liver, stomach, spleen, and pancreas; a large hepatic gumma; a syphilitic ulcer of the stomach, with perforation and consequent peritonitis. The author believes the ulcer to have been due to an indirect form of necrosis of the mucous membrane, brought about by the combined softening of the submucous gummatous infiltration and the obstruction and obliteration of blood vessels in the same situation. Syphilitic Reinfection.-Tarnowsky supports his views concerning the curability of syphilis and the possibility of reinfection by the report of the following case: A man, 30 years of age, consulted him for 2 ulcers on the skin in the left inguinal region which followed repeated intercourse. The base of these ulcers was hard, and the glands of both inguinal regions were swollen. Seven weeks after the first appearance of the ulcers a syphilitic erythema appeared upon the extremities and trunk, which disappeared after the use of mercurial inunctions. A year later a papular eruption was noticed in the left palm, which was removed by mercurial inunctions. In the third year swelling of the left inguinal gland occurred, which subsided after mercurial treatment. the 7 following years there were no syphilitic manifestations. Ten years after the first syphilitic lesion 2 small ulcers were noticed, 4 days after a suspicious intercourse, in the sulcus glandularis. These were cauterized with carbolic acid, but the edges became infiltrated and hard, and 34 1 Berlin. klin. Woch., No. 25. 2 Am. Jour. Med. Sci., vol. cxvi., 1898. 4 Vratch, xix, 1898. 3 Ibid. months later there were dry papules upon the head of the penis, a papular erythema upon the trunk, scaly papules on the right palm, and an impetiginous syphilide in the scalp. From this case the author concludes that syphilis is entirely curable by proper treatment. A Calcified Gumma in the Suprarenal Gland in Congenital Syphilis.-Vinogradov, in 420 autopsies of children with congenital syphilis, but once found a gumma in the suprarenal gland. In this single instance the subject was a girl, about 2 months old, dead of diphtheria. There were changes in the liver, bones, kidneys, and in the right suprarenal gland. The central portion of the last was occupied by a nodule with a fibrous capsule, in the periphery of which were pinhead-sized calcareous concretions. The microscope showed the alterations to be due to congenital syphilis. 2 Syphilitic Phlebitis.-Heuzard concludes that syphilis may affect the veins, causing 2 forms of phlebitis. The first form is acute or subacute, and occurs in the secondary period. The second form is chronic, and corresponds to the tertiary period; it occurs as a localized processgumma-or as a sclerosis of the vein. Syphilitic phlebitis affects by preference the veins of the lower extremities. The prognosis is favorable; the average duration about 2 months. The treatment should be that commonly known as mixed. Proksch has collected 107 cases of syphilis of "the intraparenchymatous and extraparenchymatous veins." Of the latter, it is chiefly the cutaneous veins and those of the lower extremities that are affected, either with secondary forms of syphilis or gummas. There are no pathognomonic symptoms, and a diagnosis must be made by considering the accessory symptoms. Occurring during the secondary period, several veins may be affected at once, or one after the other. Gummata of the veins are in most cases circumscribed. Specific treatment, together with local applications and rest, will usually cause the disappearance of the trouble. MISCELLANEOUS. The Skin Affected by the X-ray.-V. Zarubin' gives a detailed account of our knowledge of its influence on the healthy and the diseased skin. 1. Therapeusis: Observers agree on its value in lupus vulgaris, chronic eczema, certain cases of varicose ulcers of the leg, acne vulgaris, lupus erythematosus, hypertrichosis, favus, psoriasis, and elephantiasis. 2. Injury to normal tissue: Cases of dermatitis, necrosis, abscess-formation, etc. are noted. 3. Unna and others, in experiment, find the skin colored brown; this seems due to an increase in pigment of the upper layers of the corium, that of the epiderm receiving no addition. 4. The mode of action is thought by some to be trophic, by others to be chemic; few agree in explanation. At the close of the article an index of the literature of this subject is given. Subacute Infectious Purpura.-Mossè and Iversenc report the case of a youth, aged 17 years, who, after some excesses and a slight 1 Russ. Arch. f. Path., klin. Med., u. Bact., 1898. 2 Thèse de Paris, No. 179, 1898. 3 Jour. Cutan. and Gen.-Urin. Dis., Dec., 1898. Monatsh. f. prakt. Dermat., May 15, 1899. 5 Jour. des Mal, cutan. et Syph., Nov., 1898. traumatism, showed lassitude, and later a typhoid condition, accompanied by marked elevation of temperature. An eruption of macules appeared, which rapidly extended; melena followed, and death shortly occurred. During life examination of the blood showed it to be sterile; but at the autopsy 3 varieties of microorganisms were found in the liver-the Bacterium coli; an organism resembling the colon-bacillus externally, and a short, thick bacillus. In the lungs streptococci were found. The authors regard the previously debilitated condition of the patient as furnishing a soil favorable for infection. Experimental inoculations practised upon animals produced in one instance hemorrhages into the lungs; in others, the characteristic picture of infection with the colon-bacillus. A Pigmented Affection of the Skin Due to the Demodex Folliculorum.-DeAmicis' has described a parasitic affection of the skin due to the Demodex folliculorum, which appeared as a pigmented patch, of a café-au-lait color, upon the chin and lip of a woman, aged 27 years. The discoloration was at first thought to be due to the Microsporon furfur, but this fungus could not be found. Large numbers of demodex were present, however, and treatment directed to the removal of this organism was followed by gradual disappearance of the pigmentation. Majocchi likewise has seen 2 cases in which the demodex was found in pigmentation of the skin accompanied by slight desquamation. In senile pruritus Parisat2 recommends the following plan of treatment: The bowels must be kept well open and a milk-diet employed. In addition, benzonaphtol is given in daily doses of a dram. Improvement begins within 24 hours, and a cure results speedily in the most obstinate cases. Leredde regards methyl salicylate as the most effective remedy in the treatment of pruritus, affording relief very speedily. He recommends the following ointment: R. Methyl salicylate, 3ss; zinc oxid, vaselin, āā 3v.—M. Eruptions of the Face Due to Nasal Pressure.-Murray * reports a number of cases of facial eruption dependent upon reflex neurosis caused by nasal pressure. These eruptions were of an inflammatory type, in most instances resembling eczema or acne. Such eruptions may arise from pressure from hard or soft parts. In those cases in which there were intranasal spurs the cutaneous trouble did not appear before puberty, for the reason that such spurs do not occur before that time. The muddy complexion and friable skin noted in some of these cases are characteristic of nasal obstruction. These eruptions disappeared promptly after operation. They appeared first and were always worse on the side corresponding to the pressure, and cleared first on the side opposite to the pressure. Milliamperemeter Recommended in Electrolytic Work.— M. B. Hutchins writes on the necessity of measuring the current in all electrolytic work. Accuracy is required for satisfactory results. He insists that it is impossible to state the number of cells suited to a given case, as resistance in the tissues varies in individuals and in the various locations of the body. Interesting experiments are given. 1 Brit. Jour. of Derm., Jan., 1899. 3 Med. News, June 3, 1899. Treatment, Apr. 27, 1899. 5 Jour. Cutan. and Gen.-Urin. Dis., May, 1899. MATERIA MEDICA, EXPERIMENTAL THERAPEU TICS, AND PHARMACOLOGY. BY REYNOLD W. WILCOX, M. D., AND A. A. STEVENS, M. D., OF NEW YORK. OF PHILADELPHIA. THE trend of therapeutic investigation during the past year has been rather toward a working out of details and following out of theories proposed than in presenting new measures. The practice has been in the direction of harmonizing the results of laboratory work and bedside-study. Therefore no startling claims have been advanced for novel methods nor have new remedies been unduly lauded. Since pathology is teaching us that the list of diseases caused by or in fairly constant relation to pathogenic germs should be further extended, the questions bearing upon toxins and antitoxins have been prominent in the literature. While definite statements cannot as yet be made as to what an antitoxin is, save as inferred from its effects, it is likely that in the near future our knowledge will rest upon a secure foundation. A large amount of empirically reached information is at hand as to the effect of the various antitoxins upon diseases associated with toxins other than those to which they are supposed to be opposed. Of the antitoxins, other than diphtheria, none has reached so secure a position, although evidence as to their value is gradually accumulating. The exploitation of the yellow-fever serum by certain scientifically irresponsible persons has done much to discredit the really good work which others have performed in that direction. In opotherapy the thyroid extract has reached a secure and well-defined position. The suprarenal extract has been found to be a powerful vasoconstrictor, and its field of usefulness has been well indicated during the year, with the prospect of further extension. Various morphin preparations have been presented, and while their advantages have been fairly well established and their usefulness is assured, it is by no means clear that by them habit may not be established, and thus may they be open to the same objection as are the more familiar forms. The preparations of soluble silver constitute a real advance in local, and offer hope in general, therapy. The testimony as to their value is marked by practical unanimity. Which of the organic salts shall prove to be the best for local use time alone will determine; at present the long-used nitrate seems likely to be effectually superseded. That the number of new coal-tar products offered is diminishing is reason for congratulation. Of more importance is the general disposition on the part of physicians to abandon their use as antipyretics and to place a proper estimate upon fever as a symptom. As analgesics they have an important place, and investiga |