spontaneously, discharging pus. Another abscess also appeared on the right side, nearer the glans. One testicle also swelled; and at the lower end of this organ there was detached a harb mass about the size of a walnut; the testicle being softer than normal. The inguinal glands on the right side were also indurated; the remains of a suppurative bubo following the first attack of gonorrhea.

There was no history of syphilitic rheuma. tism, syphilides or sore throat; but an examination of his back showed small rupia and scars. The absence of the usual specific phenomena were attributed to partial protection by heredity. The patient was sent to bed; lead-water applied to the testicle, sulphide of calcium given internally, and an ointment of yellow oxide of mercury, seven grains to the ounce of benzoated lard, applied to the hard masses. The discharge dried up, the swelling subsided, and in one week the case was so nearly recovered that he was allowed to return to his business. The hardness was fast disappearing, and I have little doubt but that under the influence of mercury locally and internally the indurations will be entirely absorbed.

I have frequently been consulted in regard to these hard lumps, and the deformity they occasion; and I believe they are due to the same cause-inflammatory exudation or suppuration attendant on gonorrhea, when the gonococci have penetrated more deeply than usual into the tissues of the penis. It is not necessary to assume that they are specific because they melt down and are absorbed under the influence of mercury or iodine.

These agents cause the absorption of the normal tissues; still more the pathological growths, because their structure is feebler; and most of all do they affect the syphilitic growths because the vitality of these is so feeble that they even tend to spontaneous destruction by breaking down. WILLIAM F. WAUGH, M. D.,

103 State St., Chicago.

Nuclein Medication.—Its Physiological Basis and

Therapeutic Applications.

Editor MEDICAL WORLD:-The subject of nuclein medication being of recent origin, it seems the part of wisdom to acquaint your many readers with some of the elementary facts which led up to the practical adaptation of certain well-recognized physiological principles upon which the theory rests. Professor Virchow, in his classical work, "Cellular Pa:hology," gave the medical profession exact, and in many instances, surprising data relating to the pathological changes occurring in tissues and cells during the progress of various diseases. About

seven years ago I began to study, from a clini cal standpoint, the changes taking place in tissues and cells in the case of recovery from disease. Thus, in the case of disorders of the renal function, we can estimate the clinical effects of various medicaments in restoring the functional activity of these structures. Aconite, for example, not only increases the urinary water, but also the output of urinary solids, the results being due, evidently, to its influence upon cellular activity. In prescribing remedies for different ailments, we always take into consideration the effect which the drug or remedy will have upon this function, and knowing from physiological and experimental investigation the par ticular structures upon which a drug or remedy specially acts, it was but a step to designate this universal practice by a name which should cover the entire domain of therapeutics. In this manner originated the name "Cellulartherapy," and so far as my observations and study extend, it appears to be appropriate and complete.

Nuclein therapy is substantially a branch of cellular therapy, since it has to deal directly with the causes at work in the restoration of cell-function, as will be understood from the following illustration: When a person eats a hearty meal, there follows, in the course of a couple of hours, an increased number of white blood-corpuscles in the circulating fluid. These, it is now believed, are not formed de novo, but are simply brought into the blood-current through some agency which we do not now fully understand. This is called "digestive leucocytosis." Now, it is a well-known fact that a person feels much better after partaking of food, and when the food is readily digestible, and, as we say, assimilable, this sense of well-being continues for some time. After cuts, bruises and surgical operations, a similar train of conditions obtain, and is called "inflammatory leucocytosis." In pneumonia, daily examinations of the blood will enable the attendant to determine with a reasonable degree of certainty the final outcome of the disease, inflammatory leucocytosis always boding a favorable prognosis. This seems to be Nature's method of conquering disease, and we are thus brought face to face with so called "natural conservatism."

It is but recently that the medical profession has been able to form a true conception of the function of the white blood corpuscles. Metschnikoff taught that certain leucocytes, which he termed "phagocytes," possessed the power to envelope bacteria and destroy them, and for many years the doctrine of phagocytosis was strongly advocated and as persistently denied. Later on, it was demonstrated that leucocytosis

had a wider and more far-reaching significance than that which had been advanced in respect to phagocytosis, inasmuch as certain leucocytes (the multinuclear white blood-corpuscles) p03sessed certain peculiar properties, hitherto unknown, namely, the power to attack bacteria as pointed out by Metschnikoff, and the additional function of producing a non-irritant and nontoxic antiseptic. This product occurs in the form of a phosphorized proteid, having a somewhat complex base, the phosphorus existing in the form of nucleinic acid, and is called nuclein, or nuclein acid. This substance is found in both animal and plant life; wherever there is a nucleus, there do we find nuclein. It can be obtained from yeast cells, from the yelk of the egg, from the blood itself, from the testicles, from the brain substance, and from the blood-making organs, such as the spleen, the bone marrow, the thyroid and thymus glands. The source of supply is practically unlimited. In this country, but two products have been studie clinically, viz., that from yeast cells and that obtained from the thyroid and thymus glands. The latter only will be referred to in this paper.

Nuclein, in the form of a solution, is prepared by artificial digestion after preliminary maceration in water, and when introduced into the economy, appears to enact the role of a ferment, establishing an artificial leucocytosis; in other words, it stimulates cellular activity, and thus emphasizes the true physiological basis of cellular therapy. There are a number of diseased conditions in which its effects can be easily studied, both physiologically and clinically. In simple anemia, debility from any cause, and convalescence from acute diseases, the results of nuclein medication are prompt and permanent. In malaria, the improved subjective sensations of the patient will be noticeable within a few days, but a more satisfactory test will be found in the examination of the blood under the microscope. In diphtheria, the changed condition of affairs within the first twenty-four hours is sometimes remarkable. In fact, all throat affections are ameliorated, and most of them quickly relieved by the exhibition of nuclein eolution.

The question will be asked, How does this remedy relieve and cure such a varied class of disorders? That brings us to a consideration of the physiological function of nuclein in the human economy. If it were not for the presence of this substance in the organism, what would be the condition of the mouth, the nose, the bronchial tubes, the stomach and intestinal tract, the bladder and the skin? Why, if Nature did not provide some form of an anti

septic, all the structures mentioned would very soon become diseased. Pathological changes would result in destructive metamorphosis, and as a consequence, breaking down of tissue would follow, with the absorption of poisonous products. Auto-infection from the intestinal tract is all too common, but auto infection from the naso-pharyngeal space, from the tonsils, from the bror chial tubes, from the stomach, from the liver, from the kidneys and the skin is too frequently overlooked. Thus, we see that it is the function of nuclein in the organism to destroy-through its antiseptic properties the thousand and one poisonous products that are liable to accumulate through faulty elimination. The white blood corpuscles have been credited with being the scavengers, but the foregoing is believed to be the true explanation. Just as an yeast poultice cleanses a foul ulcer, or a gargle of the same arrests a sore throat, or a little taken into the stomach, destroys an unhealthy fermentation, so nuclein, taken into the bloodcurrent corrects an abnormal condition of the circulating fluid by enacting the role of a ferment. It is, therefore, indicated in all cases characterized by a disorganized state of the blood.

Reasoning from these premises, it might be assumed that a remedy which affords such remarkable results in diseased conditions would be of service in preventing the invasion of dis. orders dependent upon the presence of micro-organism or their products, and, fortunately, this also is true. Investigations have now been in progress for a sufficient length of time to warrant the assertion that this nuclein solution— from the thyroid and thymus glands-will prevent the development of a number of diseases which, hitherto, we have been wholly unable to control; but it would not be policy to enter into an elaboration of this subject, as that will be reserved for a special paper.

The therapeutic applications of nuclein solution will be referred to in the briefest possible manner, the object of the present paper being to incorporate only those diseases in which its value has been repeatedly demonstrated by quite a number of clinicians in different parts of the country.

Malaria.-Nuclein solution has proven effective in the treatment of the various types of malaria, acute, chronic, recurrent and masked. Professor E. F. Wilson, of the Ohio Medical University, Columbus, Ohio, reports a case (Columbus Medical Journal, January 22, 1895) in which, after the long continued use of quinine, occasionally as much as sixty grains in the twenty-four hours, and subsequently arsenic and Warburg's tincture in full doses, utterly failed, where very small doses of nuclein effected

a marked change in the space of two days, and where the patient recovered at the end of a week. Professor Frank C. Wilson, of Louisville, Ky., reports (American Practitioner and News, November, 1894), having used it with success in a number of cases of malaria, acute and chronic. Dr. W. H. Park, of Nashville, Tenn, reports (Medical Summary, July, 1894), distinct benefit in three days and apparent recovery in ten days in a case which had resisted quinine and other medicaments for eight years.

The dose of the solution in this disease will depend upon the age of the patient and the stage of the disease. An adult will take a drop at intervals of two hours, or one minim every four hours, either in the form of tablets or granules, or the solution can be added to a little water or elixir calisaya and taken every two to four hours. In giving it hypodermically, to avoid unnecessary punctures, the dose may be larger, two to five minims (five to ten drops), and the remedy administered diluted with a small quantity of sterilized water every day, or on alternate days.

Diphtheria. The peculiar virtues of the remedy are most manifest when the disease af. fects mucous structures, as in the case of diphtheria, tonsillitis, pharyngitis and laryngitis. Thus, in diphtheria, Dr. J. Mount Bleyer, of New York (American Therapist, September, 1894), reports four cases successfully treated, in which the patients recovered in from two to five days after beginning treatment. In some

of his cases other treatment had failed to relieve or modify the disease. The following extract will show the standing which the remedy has attained in his confidence:

"Attention should be called to the most noticeable features of the foregoing cases, occurring in the first twenty-four hours:

1. A fall of temperature amounting to three degrees.

2. Loosening and discharge of the membrane. 3. No rise in temperature when once reduced.

4. No unfavorable after-effects from the use of the remedy or attack of the disease-all going to show the power possessed by nuclein for checking complications or holding in abeyance other disturbances."

The dose in diphtheria will vary according to the age of the patient and severity of the attack. In ordinary or comparatively mild cases, when seen in the early stage, a tablet containing onethird of a minim (or four granules, each con. taining one-twelfth minim of the standard solu. tion), can be given hourly for the first twentyfour hours. Later, the frequency and size of the dose can be determined by the effect pro

duced. In serious cases, or when the patient is not seen in the early stage, it is probably best to administer the remedy hypodermically. At the age mentioned, two minims (five drops) should be added to sufficient sterilized water to make a syringe-full, and this quantity injected under the skin at some indifferent point at intervals of from two to four hours, for the first twenty-four hours, after which the amount and frequency of the dose must be determined by the attendant.

Bronchial Affections.-Bronchitis being an inflammation of the mucous membrane, naturally comes in the same category with tonsilitis, laryngitis, rhinitis and like disorders. Nuclein solution is useful only in the subacute and chronic stage of bronchitis, although it may be given with appreciable benefit in the latter stages of an acute attack, after the activity of the circulation has been brought under control by vascular and cardiac sedatives. In this disorder we must recognize a derangement of function, rather than an entity. Whatever produces the disorder leads to what has been termed an inflammatory leucocytosis, where Nature attempts to remedy the evil by sending an increased supply of leucocytes to enact the role of an antiseptic. But nature is too often handicapped by reason of the fact that those who suffer from bronchitis usually suffer also from a debilitated condition of the system; hence, there is lacking the needed pabulum to maintain the integrity of the nuclein-producing power. To supply quality, increased quantity is sent to the disordered structures, and, as a rule, there is generally profuse expectoration. Now, in the opinion of the writer, it is sheer folly to exhibi: expectorants, when the bronchial mucous membrane is already water-logged. What the patient really needs is a re-inforcement of the nuclein producing power, and this is secured by the administration of nucleia ar. tiffcially. In these cases, especially the chronic variety, it is truly wonderful how quickly the expectoration ceases and the persistent cough subsides. And yet it does not act in any respect like opium or other iodines; on the contrary, the appetite improves, the bowels become regular, the cutaneous transpiration is increased, and the patients express themselves as feeling greatly improved from the first dose.

Tuberculosis.-Nuclein solution was not originally recommended in the treatment of tubercular affections, simply for the reason that the writer felt that too many remedies had been unnecessarily burdened with the claim that they could relieve or cure tuberculosis. This statement is interpolated in order to bring to the notice of the profession that no claims have

been made as to what may be expected of it in the treatment of this disease. Nevertheless, the writer has employed it quite extensively, and several reports have appeared from others, in which its administration has been followed by fairly encouraging results. Dr. Charles P. Knapp, of Wyoming, Pa., is about to publish an account of two cases of enlargement of the cervical glands, undoubtedly tubercular in character, in which the administration produced marked benefit. It will be sufficient to say here that nuclein solution in tuberculosis will

relieve certain symptoms. For example, it lessens the expectoration and improves its char. acter, and incidentally, there is much less dispo. sition to cough, while the chest pains and abdominal soreness subside. Furthermore, the appetite improves, the bowels are regulated, so that the necessity for anodynes and opiates disappears, while night sweats are usually arrested and show no disposition to return.

JOHN AULDE, M.D., 1411 Walnut street, Philadelphia.

..drams ij ..grains x

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Cocaina hydrochlor....

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Aquæ....

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M. Sig.-Teaspoonful before rising (if due to pregnancy). Otherwise, teaspoonful doses till effect is obtained.

Sig-One drop thrice daily in water, increased as directed.

Sig-Fifteen drops four times a day, increased as directed

R Ol. eucalyptus.......

Divide in capsules No. vii.

Sig. One every two hours.

Sub-acute cystitis:

R Ext. buchu fil

Potass. citratis.

Spt. eth. nitr..

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M. Sig.-Dessertspoonful every four hours.

Dr. Tyson says the salicylates should be continued long after the disappearance of the symptoms when used for articular or other rheumatic affections, and failure to do this is responsible for the very frequent relapses from attacks of this affection.

When the symptoms are banished he reduces the dose one half and continues it for several weeks.

If the stomach rebel at any period of the course, substitute oil of winter green, gtts. x, in a capsule, instead of the salicylate for a few doses. The oil is almost as efficient as the sali cylates and the patient does not suffer.

The salicylates should be given in solution diluted notwithstanding the disagreeableness of dosage, for the size of dose makes too formidable a capsule for the average patient, if given in that way.

Dr. Balliet speaks highly of the nitrate of silver solution in all throat affections. It should be used in the strength of drams j to the ounce and is, in this strength, an efficient abortive of quinsy. It is to be applied with a camel's hair brush and only enough at a time used to make

the membrane look milky. If used till it looks dead white the resulting inflammation would be worse than the disease. Syphilitic sore throats are relieved quickly and even the tubercular variety is checked for a time by its judicious

use.

Nitrate of silver for stomach affections should never be given except in pill form. If given in solution the silver never reaches the stomach, but is converted into silver albuminate all along the esophagus. If given in capsule, the gelatine of the capsule reduces the silver before the capsule is dissolved.

Dr. Massey says never make a diagnosis of lympho sarcoma without a full history, lest you make the error of a diagnosis when the disease does not exist, the tissue not being sufficiently characteristic for an absolute microscopical diagnosis.

Never give the cause of death after making a post mortem. It is seldom you can tell it. Your only duty is to report faithfully all lesions found and allow the coroner's jury (or whoever has the temerity to declare the cause of death) to make that statement; for your statement, once made, binds you, and frequently in very embarassing situations.-Massey.

The elixir of phosphorus is the preparation to use in sexual exhaustion following excessive venery. One dram contains gr. of the drug.

Dr. Griffith disguises the taste of quinine with syrup of yerba santa.

Dr. Griffith gives the following as the best scheme known for ascertaining the dose for children It obviates all guessing at weight, etc., so objectionable to the other rules: