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logical fact ? Is there any certainty that a fresh infection of the
woman comes from the husband ? May not the present exacer-
bation of gonorrhea in the wife antedate to an earlier period,
and, in short, is nothing but the old infection brought into
activity again ?

But especially is it often the case that a woman, two or more
years after her married life, will consult a specialist in women's
diseases, presenting certain phases of chronic gonorrhea, all symp-
toms of the disease having long since ceased. The husband, at
the same time, consults the andrologist. Is it to be wondered
at that there are no gonococci to be found in the husband when
they have long since disappeared in the wife ? With such uncer-
tain presentations of a case, it is almost impossible to arrive at a
satifactory conclusion, and we should not select such cases as
examples upon which to base a final judgment.

Generally speaking, then, in cases of gonorrhea in women, how
long should one search for the gonococcus in order not to overlook
it ? That this will happen in many cases, I must not dispute.
We cannot question the safe clinical etiological basis created by
Wertheim for the diagnosis of gonorrhea, which was accepted by
gynecologists long ago. In many cases, especially those present-
ing a difficult chronic character, it should be proved whether the
infection of the urethra, the uterus, etc., originated from the
gonorrhea, and, above all, to discover whether the irritating causes



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THE mCBOSCOPB IN BXAIIINATION FOB GONOBBHEA. 477

of the disease are still present ; also, whether the therapy should
be regarded as first in order and perhaps alone, or whether we
have to deal with the remains of certain disease products, the results
of an earlier gonorrheal infection, and, now, whether or not there
still remains any virus. In certain cases, these latter and the
methods of treatment go hand in hand ; but very often it will be
necessary to decide what the ultimate outcome of the disease of
the urethra, uterus, etc., will, amount to, whether any gonococci
are still present, or whether there are any cicatricial adhesions, infil-
trations and the like. These same conditions are also found in the
male, with the exception that the remaining structural changes
consequent to a previously existing gonorrhea, long since cured,
are more easily kept in abeyance than in case of the woman.

No one will attempt to cure an organic stricture, a cartilaginous
epididymis, or perhaps post-gonorrheal nervous affections excited
by a diseased urethral mucous membrane, by means of anti-gonor-
rhoic treatment, if he has not direct proof that the gonococci are
«till present. It is unfortunate that many gynecologists are loth
to accept these points. In the first place, they mistake the earlier
manifestations of the disease, with its more or less rightly sup-
posed gonorrheal cause, for later ones, and as a result the
woman's suffering is more profound than that of the man ; and,
secondly, they disregard all those consecutive results whose
•etiology and course is undoubtedly due to some other affection of
the adnexa.

Both of these teachings are unmistakably wrong, and I rejoice
at the extraordinary and effective support given these principles,
which I have always advocated and upheld, by Dr. Schauta at the
gynecologists' congress at Breslau. His arguments were based on
sufficient data; he claimed that in inflammatory suppurative
diseases of the female adnexa, the gonococcus together with the
streptococcus and staphylococcus, conjointly, were, in most
instances, the cause of the diseased process ; that, even with
women who have unquestionably been infected with gonorrhea
with subsequent suppurative changes, the latter might have been
<^aused by streptococci ; that the clinical progress and the symptoms
are not characteristic enough to warrant a differential diagnosis.
These opinions of his as regards the diseases of the adnexa led
me to the following conclusions, as regards the inflammatory
purulent processes of the external genitalia : Without a micro-
scopic examination, a correct diagnosis is impossible, and again.



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478 TBAMSLATION.

without a correct diagnosb, that is, an etiological diagnosiB, there
can be no rational therapeatics, because the latter is dependent
upon the former, hence very variable.

Dr. Menge, after his investigations at Zweifel's clinic, was also
led to the same final conclusions ; that the microscopic proofs of
any case showing the undeniable etiology are unconditionally
essential as the basis of further therapy.

My honored friend, SUnger, my bitterest opponent in this whole
question, nodded contentedly at Schauta's remarks, as if approving
a mixed infection. Schauta, if I understand correctly, has not
spoken so much about mixed infection — much more of the non-
gonorrheic suppurations produced by the streptococci. Mixed
infection of gonococci and some of the other pus-producing cocci
are not acknowledged by either him or Wertheim, and the suppu-
rative process by mixed infection requires no explanation any
more than, as Wertheim has shown, that the gonococci alone may
produce suppuration of connective tissue bands, peritonitis, etc*
After all, the questions just mentioned, as regards the suppuration
in the adneza, is identical with the question as to the causes of
abscesses of Bartholini's glanduIsB. These are, indeed, often of
gonorrheal origin, but not always (Ulcus molle-infection), and it
requires an examination of the pus in order to make an etiologicy
differential diagnosis.

I do not deny, however, that by anamnesis, by a careful investi-
gation for gonorrhea in the male, by the appearance of optbalmo-
blennorrheica in one or more children, and finally, by certain
anatomic changes (pointed chondylomata, catarrh of the glands of
Bartholini, the macula gonorrheica of the excretory ducts of the
same, etc., etc.), one is encouraged to look at once to the diagnosis
gonorrhea. I am willing to admit that, in many cases, thi&
supposition is correct, but I deny that with all this status upon which
the physician makes his prognosis and therapy, they should not be
relied upon ; it should be a settled fact whether there still exists
any gonorrhea and are gonococci present, or have we to do with
an exterminated gonorrhea, or only with the remnants or consecu-
tive results ? The necessity of this is so much the greater when
we find that, with women, all gonorrheal processes, like urethritis,,
may become chronic.

A physician who is successful in finding the gonococci is in
possession of an important positive factor for the future medical
progress of the case ; and, naturally, repeated negative results^



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THE mCBOSCOPE IN EXAMINATION FOR GONORRHEA. 47 ^

following microscopic examinations, will, undoubtedly, enable one
to handle the case more intelligently as to symptomatic treatment.

I must add a few more words about the significance of the
pointed condylomata. I most decidedly oppose the view that there
exists any direct relation between these exuberant growths and
the gonococci. There might exist one possible relation between
the two ; that is, in the process of suppuration, the fluor causes
maceration and irritation to the mucous membrane. However,,
many other irritations may produce the same result. The pointed
condylomata are not proof positive of the presence of gonorrhea.
Where you find pointed condylomata, it is always well to suspect
gonorrhea, but to risk any diagnosis on its supposed existence ia
entirely untrustworthy.

Is there anyone who still denies the importance of searching for
the gonococci to support the prophylaxis and therapy ? I think
none. Therefore, (1) microscopic examinations of the secretions
for the gonococci enables us to show, in a great many cases, where
macroscopic and clinical means are inefficient, the existence of a
still lingering contagion. Through this means we may possibly
prevent further spread of the contagion, by constraining prosti*
tutes and others, partly by instructions and partly by force. (2)
The therapeutics should not be considered thorough when only
certain symptoms of gonorrhea have been removed, e. g,y pains^
fluor, hemorrhages, etc. The patient should be wholly cured of
his gonorrhea, and, therefore, it is advantageous to know whether
the therapeutics perfected a complete cure, and whether every
trace of the gonococcus has been removed, and this can only be
done by a microscopic investigation.

If Broese would only resolve to base his results upon a micro-
scopic research, he would ofttimes observe that there are still
gonococci present in the secretions in which he assumed to have
destroyed all contagious elements ; then, too, he would be con-
vinced that the apparent, or simple, forms of gonorrhea should
either be treated lightly or left alone, he probably using, for the
destruction of the virus, the most heroic means.

I am convinced that Broese, although attaching little import-
ance to this procedure for the assistance it affords, and the security
and certainty it gives to the therapeutics, would not like to see this
blessed progress interfered with, the advantages and conveniences
of which I and so many colleagues have endeavored to support
and advance for years.



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480 TRANSLATION.



CONCLUSIONS.



1. It cannot be doubted that the gonoooccus is the caase of
gonorrhe.a.

2. The diagnosis of gonorrhea in man or woman can, in many
cases, be made by observing only the clinical manifestations, with-
out searching for the gonoooccus.

3. In many cases, especially those inclined to a chronic coarse,
with few subjective and objective manifestations, the diagnosis is
dependent upon a demonstration of the presence of the gono-
ooccus.

4. For this very reason, in all cases of '< cures," the investiga-
tion for the gonoooccus is indispensable to solve the question,
whether the discharge is still contagious, or whether we have to
deal with only a morbid process, the remains of a former con-
tagion.

5. At all events, the therapy should be based upon the exist-
ence or non-existence of the gonococci, and a search for the same
should be made not only before, but also during, the whole pro-
gress of the treatment.

6. In most cases, microscopic investigation for the gonococci
should be sufficient, and, on account of the difficulties which some-
times arise in cultural methods, the progressive treatment is assisted
by this means only in particular cases.

1. In every instance where positive results (gonococci) are
found, there can be no doubt as to the usefulness and necessity of
this means of diagnosis.

Negative results should not be conclusive, because we know of
the possibility of gonococci being deeply concealed in the tissue,
or in the lamina or folds (invaginations), while at the same time
the superficial secretions of the mucous membrane, which we
examine, may contain gonococci so few in number as to escape
detection. The certainty of their existence, however, will be
proven by more frequent examinations for them, and by artificial
<)ultural observations.

The clinical manifestations should always be studied and their
relationship strengthened by the use of the microscope.

8. If we have to do with gonorrhea in married people, then
both husband and wife should be examined, and, if necessary, both
should undergo a course of treatment.

137 West Tcpfeb Street.



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CLINICAL MEMOBANDUM. 481

©finicaf Memoranc^um,

WHITENS OPERATION FOR ENLARGED PROSTATE.

By FBANCIS L. HATNES, M. D.. Los Angeles, Cftl.

In the last number of the Joubnal was published a very interest-
ing discussion of the treatment of prostatic hypertrophy. Allusion
was made to the operation for its cure, devised by Prof. J. William
White, of Philadelphia, (castration,) which has now been per-
formed at least four times in this country.

The first operation (by myself) was m%de eight weeks ago.
The patient seems to be practically cured.

Two weeks since, I made White's operation on a very aggra-
vated case. The patient stated that he had passed no urine, except
through the catheter, for two years. Since then he has daily passed
several ounces, and yesterday more than a pint.

I am informed that two operations have been made in addition
to these, but as it is probable that the originator of the operation
will publish them, I will not further allude to them.

I do not doubt that when sufficient experience has demonstrated
the place of this operation, it will prove as beneficent as the
analogous operation has proven in appropriate cases of uterine
myoma.

It is to be hoped that hereafter patients with enlarged pros-
tate will not be allowed to reach a desperate condition, but will by
. an early operation be granted a fair chance for many years of
comfortable existence.

929 South Main Street.



Tannin and Bobic Acid in Dysbnteby. — Liebersohn (Vratchy)
reports two cases of severe acute dysentery which were treated
by hot enemata of tannin and boric acid. The results seems to
show that the injection speedily arrested the intestinal hemorrhage
and quickly restored the natural character of the passages. Pain
and tenesmus were immediately relieved and the course of the dis-
ease materially shortened. The enemata were given every three
hours, each consisting of one fluid pound of a four per cent, solution
of boric acid, tengr^iins of tannin, and threeand three-quarter drops
of tincture of opium, the whole to be dissolved in a tumbler and a
half of hot boiled water. The injecting fluid was retained in the
bowel for one or two minutes. — University Medical Magazine,



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482 ABSTBACT.



THE TREATMENT OF UTERINE FIBROIDS.

Db. Augustin H. Goblet, in a paper read before the New Tork
County Medical Association, (American Medico- Surgical Bulletin^
January 1, 1894,) says the important question which arises in
dealing with these growths is, When is interference demanded,
and what treatment is indicated ? A careful review of the litera-
ture of the subject, and the opinions of those who are entitled to
be regarded as speaking authoritatively, leads to the conclusion that
the majority do not regard the removal of these tumors indicated
unless they give rise to sufficient inconvenience to warrant the risk
of the operation and the mutilation which it involves ; that the
mortality attending their removal is still too great, even in the
hands of expert operators, to warrant its being lightly undertaken.
If, then, it is possible to relieve the symptoms caused by these
growths, the actual necessity for operative interference is narrowed
down to a very small field.

The writer does not agree with certain ultra-gynecologists, that
these tumors should all be removed when they are small and cause
no inconvenience, but he strongly urges that they should be sub-
mitted to treatment in this stage, because treatment yields the best
results when the tumor is small and of recent growth. The indi-
cation for the different methods usually employed are carefully
reviewed — electricity, curettement, hysterectomy, and removal of
the appendages.

Of electricity, he says that frequently a symptomatic cure is
all that may be anticipated. The results that may be obtained by
this method are classified as follows :

1. Cure of coexisting endometritis.

2. Loosening of adhesions between contiguous peritoneal
surfaces.

8. Relief of pain and pressure symptoms.

4. Control of hemorrhage.

5. Arrest and some retrogression of the growth.

The writer takes a bold stand in favor of vaginal puncture,
believing it to be perfectly safe, if properly don^ and strict asepsis
is observed ; that is, if as much care is taken with this as with
other grave surgical operations. He believes that more success
would have followed the use of this agent if puncture had not been



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AB8TBACT. 483

abandoned as a hazardous measure. He believes, likewise, that it
is important to discriminate in the choice of the pole to be
employed against growths of different structure, just as important,
in fact, as in dealing with such growths as warts, moles and nsevi
upon the external surface of the body. That is, when the struc-
ture is hard and fibrous, the negative pole should be selected, and
that when it is soft or myomatous, the positive.

The writer lays stress upon the fact that both subperitoneal and
submucous fibroids, when pedunculated, are not amenable to treat-
ment by this agent. He positively declares that, though asser-
tions to the contrary have been made in some quarters, the proper
use of electricity in these cases does not complicate a subsequent
operation for the removal of the tumor ; but, on the contrary, its
use facilitates the removal of adhesions and produces a marked
improvement in the general condition of the patient. In fact, he
often employs it for improving the local condition and for build-
ing up the health of the patient preparatory to an operation. It
has been asserted that the symptoms return after discontinuing
treatment, but the writer believes that, when this occurs, it is either
due to a mistaken diagnosis or a faulty technique, which may be
unavoidable.

Curettement he thinks is useful as a preliminary measure, but
it does not yield a permanent result. In support of this opinion,
attention is directed to the fact that the mucous membrane,
removed by the curette, is rapidly reproduced and the same causes
for the hemorrhage which previously existed still remain. For
the control of hemorrhage when both these measures fail, he advo-
cates ligation of the uterine arteries per vaginam, as suggested
by Martin, of Chicago. He expresses no confidence in ergot alone
in these cases, but regards it as a useful auxiliary in the treatment
of certain submucous and soft interstitial myomata when it is
desirable to excite urine contraction.

Goelet believes that the principal indication for hysterectomy
is to be found in large subperitoneal and very large and hard
interstitial growths, which yield little, if at all, to any form of
treatment. In these cases, even if the symptoms are relieved, their
size is usually a source of so much inconvenience as to warrant
the risk of their removal. This operation would also be indicated
where treatment fails to permanently control the symptoms, when
the tumor is situated unfavorably for treatment and when compli-
cated by disease of the appendages.



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48 4 EDITORIAL.

BUFFALO MEDICAL AND SURGICAL JOURNAL

A MONTHLY REVIEW OF MEDICINE AND SURGERY.

EDITORS:
THOMAS LOTHROP, M. D. - - WM. WARREN POTTER* M. D.

All oommunioatlons, whether of a literary or business character, should be addressed
to the managing editor: 281 Franklin 8trbbt« Buttalo, N. Y.

Vol. XXXIII. MARCH, 1894. No. 8.

THE MEDICAL SOCIETY OF THE STATE OF NEW YORK.

The eighty-eighth anDual meeting was held in Albany, February
6, 7 and 8, 1894. Following our usual custom, we make suoh
comment on the details of the meeting as the circumstances seem
to warrant.

The society was fortunate in its presiding officer, Dr. Herman
Bendell, of Albany, who conducted the duties of the chair with
dignity and a clear understanding of the needs of the society. On
Tuesday morning a less experienced officer might have become
entangled in the meshes of parliamentapy usage. When the ques-
tion came up with reference to the nomination of State Medical
Examiners, Dr. BendelFs position was so clearly right that the
house would have sustained him overwhelmingly on the appeal of
ex-President Pilcher, had the latter not exercised his great good
sense in withdrawing it. The President's two addresses, inaugural
and anniversary, were carefully-written and well-worded papers.
The latter was especially rich in classic lore, and will take a high
place in the annals of the society.

The papers announced on the program were of an unusually
high scientific order, and showed the skilful joint work of the
President and his able business committee. It required great tact
and judgment to dispose of such a rich and extended program to
the satisfaction of all concerned. The number of out-of-the-State
guests who participated in the proceedings was unusually large
and representative. Among the number were Dr. William H. Daly,
of Pittsburg ; Dr. Joseph Price and Dr. Charles P. Noble, of Phila-
delphia ; Dr. E. W. Cushing, of Boston ; Dr. George H. Roh^, of
Baltimore ; Dr. A. W. Johnstone, of Cincinnati ; Dr. James F.



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MBDICAL SOCIBTY OF THE STATE OF NEW YOBE. 485

W. Ross, of Toronto ; and Dr. Dudley P. Allen, of Cleveland.
Dr. Ross has been a guest of the society heretofore, and his return
gave occasion to his many friends to greet him with a cordiality
that was as heartfelt as it was spirited. The same, too, may be
said of Drs. Price and Cushing.

The dinner to the ex-presidents of the society, given by Dr.
William C. Wey, of Elmira, at the Fort Orange Club, on Monday
evening, February 5th, was a delightful* occasion , and the guests
were especially happy in their geniality and well-timed speeches.
The host was at his best, which is all that need be said to
those who are familiar with the ease and grace and genial ban
homme of the veteran from Chemung.

This meeting, more than ever, demonstrated the propriety of
separating the business and scientific proceedings, henc^ Dr.
Albert Vander Veer, of Albany, wisely moved that the committee
on by-laws be requested to consider this subject and report at the
next meeting.

The interest in the several sessions was well maintained, even
a large number remaining during the final sitting on Thursday
morning.

The following ofiScers and committees were chosen to serve for
the ensuing year :

Presidenty Dr. George Henry Fox, of New York; Vtce-
President^ Dr. Frank S. Low, of Pulaski ; Secretary^ Dr. Frederic
C. Curtis, of Albany ; TVeaaurery Dr. Charles H. Porter, of
Albany.

Committee of Arrangements — Drs. William J. Nellis, Albany ;
Josiah Hasbrouck, Port Ewen ; Reynold W. Wilcox, New
York.

Committee on By-Laws — Drs. H. D. Wey, Elmira ; A. R. Sim-
mons, Utica ; F. C. Curtis, Albany.

Committee on Hygiene-^Drs. Charles E. Bruce, New York ; H.
R. Hopkins, Buffalo ; A. N. Bell, Brooklyn ; D. S. Burr, Bing-
ham ton ; Lewis Balch, Albany ; E. H. Loughran, Kingston ; O.
W. Peck, Oneonta.

Committee on Legislation — Drs. D. B. St. John Roosa, New
York ; Daniel Lewis, New York ; D. V. O'Leary, Albany.

Committee on Medical Ethics — Drs. John S. Warren, New
York ; Charles Jewett, Brooklyn ; Eugene Beach, Gloversville.

Committee on Prize Essays — Drs. Franklin Townsend, Albany ;
A. Walter Suiter, Herkimer ; Charles Stover, Amsterdam.



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486 SDIT0R1A.L.

Committee on Publication — Drs. F. C. Curtis, Albany ; William
Warren Potter, Buffalo ; F. D. Baily, Brooklyn ; C. H. Porter,
Albany.

The next annual meeting of the society will be held in Albany,
N. Y., February 6, 1895.



TOPICS OF THE MONTH.

Db. Nicholas Senn, of Chicago, has presented his collection of
medical books, valued at about $50,000, to the Newberry Public
Library. This is in line with similar benefactions that we have
lately mentioned in these columns, and is to be commended as one of
the best methods of increasing the usefulness of medical literature.
Private libraries rarely benefit anybody excepting their owners,
whereas a public library is accessible to the masses, and thus bene-
fits mankind. Professor Senn has been engaged a number of years
in gathering his library, many of its most valuable books having
been purchased from the executors of Dr. William Baum, Pro-
fessor of Surgery in the University of Gottingen. These were
valued at over $40,000, and Dr. Senn was fortunate in securing
this collection, which contained a number of antiquarian volumes
separately valued at enormous prices. Dr. Senn deserves the
thanks of the medical profession everywhere for this magnificent
gift.



Medical stenography is becoming an important specialty among
shorthand writers. There is a constantly growing necessity
among physicians for the services of such as are competent to
receive dictation in medical terms not only for purposes of letter-
writing, but also for the writing of medical papers that are to be
read before societies or published in magazines. Then, again,
authors of text-books or treatises find it an absolute necessity to



Online LibraryJ. A. (Joel Asaph) AllenBuffalo medical journal → online text (page 48 of 78)