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ferably at the usual time of such vacations, namely, between the first of June and the first of October. The number of weeks taken must, of course, be regulated by the circumstances and opportunities of the individual. Physicians and the community at large have come to recognize more and more the importance of the summer vacation, but the same is not true of the short vacation of late winter or early spring. It is a well-known fact that It is a well-known fact that nervous, disorders are more numerous and more severe in the early weeks of spring. If the busy man or woman could so arrange matters as to allow of a holiday of from two to three weeks late in February or early in March, in the most congenial climate accessi ble, it would be found that this would do almost as much in maintaining health and vigor as the usual longer summer vacation. Unfortunately February and March are usually a time of hard work and high tension, and yet much could be done to make a short vacation at this time popular if its value was fully recognized by members of the medical profession. The short vacation in late winter or early spring is usually best spent by going to some quiet and healthful resort in a climate less taxing than that in which the overweary man habitually dwells. For Americans north of the Maryland border, the springs of Virginia, or of North Carolina, the southern seaside resorts, the Bermudas, Nassau, Cuba or Jamaica will be found desirable. Continuous travel is not usually a good therapeutic measure for neurasthenia. In exceptional cases, however, a trip to the Mediterranean or to Japan or elsewhere may prove useful, but in all cases the journey should be made under conditions which do not tax. Much sight-seeing and hurrying from place to place should be avoided. Very high altitudes do not agree with neurasthenics, although they may do well at resorts not higher than one to three thousand feet.

I have said little about the use of medicines in the treatment of neurasthenia, and this is because there is comparatively little to say. Attention should always be directed to the digestive tract: stomachic tonics, digestants and mild cardiac or metallic tonics and even the antispasmodics have some place. Among the remedies of most value are preparations of strychnin with lactopeptin, nux vomica and gentian, cascarilla, cactus, preferably in the form of the fluid extract, arsenous acid, sodium and gold chlorid, zine valerinate, and in some cases preparations of iron like the albuminate or sulphate. Veronal and trional are among the most valuable hypnotics. Bromids should, as a rule, be avoided, but can be used in moderation in particular instances, especially when the pa

tient's condition is one of general nervousness and great irritability. In the majority of cases alcoholic preparations should not be used. Next, perhaps, to the sufferers from migraine and from hypochondria, the neurasthenic man or woman is the most frequent victim of the advertising pharmacy of the day. He turns in every direction for the nostrums which will take away his feelings of fatigue, discomfort and depression, and too often resorts to such vicious stimulant narcotics as Vin Mariani and coco-cola, or to the too relieving sedative anodynes like antikamnia and cocain combinations. These stimulant tonics, these sedatives, anodynes and narcotics of alluring name are among the worst enemies of neurasthenics as they are of other members of the community.

GONORRHEA AND SOME OF ITS RESULTS.*

E. G. BALLENGER, M. D.

ATLANTA, GA.

Lecturer on Genito-Urinary Diseases, Atlanta School of

Medicine.

GENTLEMEN:-Before beginning our regular course I desire to present to you a few facts which I have taken some pains to collect, to show you from the start the im. portance of gonorrhea as a causative factor of many diseases not only in this branch, but all through your medical course and in your practice in after life.

Of course it is natural for every professor and lecturer to think that his own branch is one of the most important, I believe though if you will consider carefully the facts I have collected to show the far reaching effect of gonorrhea, you will be willing to admit that the time you devote to this subject will not be entirely misspent.

I also will touch briefly upon a few points as to the education of the public, and especially the young men in regard to the dangers and the methods of prophylaxis.

So common is gonorrhea and so mild are many of the cases, that not only the laity, but a large per cent of physicians and surgeons have developed an indifference that is almost criminal.

Neisser holds that gonorrhea with perhaps the exception of measles, is the most widespread of all diseases (1). Morrow asserts that it is even a more potent factor of depopulation than syphilis, and that a large per cent of involuntary childlessness is due to it.

*Opening lecture at the Atlanta School of Medicine.

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He also thinks the extent to which gonorrhea prevails in private life is much greater than is generally supposed, and makes the startling statement that there is more infection among virtuous wives than in professional prostitutes. The truth of this statement becomes more reconcilable, when one considers how much larger is the number of virtuous wives than is the number of prostitutes, and that "powerful motives lead to their concealment.' Unfortunately the mildness of many cases gives the patient a false sense of the gravity of his condition, if neglected, and his suffering is rarely sufficient punishment for his sin, until some complication follows, or he desires to marry, but cannot, because of the uncertainty with which he is harrassed, not only on account of the danger of infecting an innocent woman, but also as to his future health and potency. Many of these cases become utterly miserable neurasthenics from the profound mental impression made by the disease affecting the sexual organs, for next to a man's love of life comes that of procreation, and his sexual instinct, which is given to man for two reasons, to perpetuate the species and to rivet the tie between husband and wife by mutual endearment" (2). Is, then, his mental anguish unnatural?

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This is only the history of a certain class; others are apparently cured and of their own accord, or upon the advice of a careless physician, who gives his consent after merely inquiring as to the general symptoms and the discharge, the patient then marries a pure woman "only to deposit in her lapas a wedding gift from his first wife, the prostitute the seeds of a foul disease which makes her innocent wifehood a source of pain and misery, and often renders motherhood impossible. The prostitute takes a poetic revenge, and by the disease she gives her paramour forever seals the fountain of nature and restrains her supplanter from acting beyond her own (the prostitute's) (the prostitute's) sphere, even though she be a thousand times legalized as a wife by church and court" (3).

Is it right to treat so serious a matter as a joke? Should not a young man early in his youth receive a certain amount of education upon such an important subject and one with such disastrous possibilities? Ought this part of the education of a son be left to the servants or his ignorant (and perhaps profligate) companions, who little realize the dangerous pitfalls even if they themselves have fallen therein?

A father cannot ease his conscience by thinking his son will not yield to the temptation or will come out unscathed. With the plain fact staring him in the face, that 80%

of men contract gonorrhea, the sophistry of such reasoning is evident. The time to educate is before the disease is contracted, for then if a competent and conscientious surgeon takes charge of him, his one-sided education will be completed, but think what a price to pay! Consider the moral degradation, the physcial weakness and the mental changes that have been wrought as chains of iron to handicap his career and perhaps wreck his life. It is not claimed that education will create an Utopia, but fear of impending danger would certainly save many from the maelstrom of venereal diseases if they were only shown the dangers in time. This education in addition to warning as to the peril should also encourage and even urge the young man that continence is not incompatible with perfect health. The double code of moral laws, is to be condemned, whereby a man may sin without offending society, and yet the same sin means the woman's ruin. I do not advocate lowering the standard for women, but raising it for men.

Morrow says thousands of young women suffer moral and physical shipwreck from ignorance of the fact that loss of virtue often carries with it the loss of health. "The vast majority of men who carry disease and death into their families do so ig. norantly" (4) Undoubtedly many disasters in married life and untold suffering could be averted if the patients were properly advised even after they have contracted the disease. Who is to blame in these cases? Most

assuredly the physician, who is almost al ways insufficiently trained in the methods of determining whether or not a patient can marry with impunity. This should be a standing question in all examinations in surgery, not only in the medical .colleges, but also in the state board examinations, and in this way compel the student and physician to be prepared upon this subject. I assert no question could be asked that would be more practical, nor one that will be of more value in preventing sterility, disease, suffering and death.

Gonorrhea is the most amenable of venereal diseases to individual prophylaxis, and yet one hestitates at first to advocate any method which might perhaps increase the evil by lessening the danger which undoubtedly is a great conservator of social purity. When, however, we consider that the social evil has existed through all ages, and that all attempts at suppression have failed, from the rigid laws of Maria Theresa at Vienna. and the Popes at Rome (5), down to the present day, and have invariably increased the numbers of the clandestine prostitutes (who is always more dangerous), that control meas

ures have been equally as inefficient as those directed toward suppression, that all history and knowledge of human nature have shown that prostitution cannot be suppressed, and as venereal diseases are the worst results, it follows then that efforts must be directed toward protection from these dangers, in behalf of the wife and the state as well as the sinner, if he insists upon exposing himself. Explain to him that there is always danger and urge continence, but also advise him as to prophylactic measures, in case he exposes himself, which, it is sad to relate, will be of frequent occurrence. If he will not reform we are justified in behalf of an innocent wife to protect her and their offspring.

The use of the condom greatly lessens the danger of gonorrhea but it may rupture during coitus. Good results also follow injections of 10% argyrol after urinating and thoroughly washing the penis. The region of the meatus should be smeared with the same solution to kill any gonococci outside, while if the in jection is properly given and retained five minutes the germs in the anterior urethra are destroyed. There is, however, always the danger of syphilis and a chancroid which must be impressed upon the patient.

Other important sociological problems are to be considered in attempting any method preventing venereal diseases; the regulation of sexes in industrial life; the low wages received by working women; the more rigorous attempts to control abortions; and efforts to segregate the prostitutes in certain sections of the cities and leave them there undisturbed in order to lessen the number of the more

dangerous clandestines. I regret that it is not within the province of this lecture to enter into the deails of these subjects.

To show further the necessity of devoting more time and attention to this widespread though insidious disease that stalks through every nation, causing untold suffering, and making invalids of strong men and women, let us consider briefly some of its various phases:

I. The Monetary Loss.- So enormous are the figures and so meager and unreliable are the statistics, that I will ask you to make a mental calculation for yourself and estimate about the average cost of an average patient for necessary expenses incident to the disease, and to that add the loss of time, the loss in business from physical weakness and mental worry, and the loss to the nation from lessened capacity for production. Eighty per cent is the usual estimate of the men who have gonorrhea (6). According to the U. S. census 1900, there are about 20,000,000 men in these United States be

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tween 20 and 50 years of age. Eighty per cent of this number is 16,000,000. multiply this by the average loss of each patient to himself and the state, and the quotient will show part of the monetary loss from gonorrhea alone.

2. Invalidism and Operations in Women. -It is under this head that we see the appalling results of gonorrhea. Humiston and Price claim from 90 to 95 per cent of abdominal operations performed in the world today, are required on account of infections, adhesions and pus collections due to gonorrhea (7). These are higher than the percentages given by other authorities, but even the lowest is enough to stir the most indolent to activity.

In addition to the operations, equally frequent are those patients who are made invalids for life. Worse than these, however, are the cases who become mentally unbalanced on account of the removal of their sexual organs which were so damaged by the inflammatory process that the gynecologist found them useless or dangerous. A large number of these cases are due to latent gonococci from apparently cured husbands.

3. Sexual Neurasthenia, so frequently caused by gonorrhea, is one of the most intractable conditions with which they have to contend, and undoubtedly makes the patient more unhappy than any other non-fatal disease. From the number of cases with which I have come in contact, who have explained how depressed they were, and that on a number of occasions they had contemplated suicide, I feel justified in saying that this condition next to financial embarrassment and love affairs is the main cause of self-destruction. I am equally positive that a certain per cent of these cases become insane. It is also without doubt a frequent cause of di

vorce.

4. Sterility.-Through its effect on the epididymes and prostate gland it plays the main role in causing sterility and impotence in men. Benzler (8) followed the history of 474 soldiers with gonorrhea and found sterility resulted in 10% of the cases of urethral involvement; 23% where there was unilateral epididymitis and 41% where the epididymitis was double. Impotence is one of the disastrous results of damage to the prostatic urethra by the inflammation. It may be complete or partial, as imperfect erection, premature ejaculation, or loss of normal sensation apparently due to the destruction of the nerve endings in this part of the urethral canal (9).

According to Neisser, 50% of all involuntary childless marriages are due to gonorrhea. Cervical catarrh prevents the entrance of the spermatozoa, thereby rendering the woman sterile. After the inflammatory process has reached the endometrium and tubes, still further obstruction prevents the fertilization of the ovum even when the disease has not progressed to pus formation. Bland-Sutton says gonorrhea is the chief cause of sterility of the prostitute class (7). Morrow has shown that women having it frequently can only give birth to one child, and subsequent trouble is likely to date from this event which furnishes ideal conditions for the growth and spread of the gonococci.

Some of the worst results of gonorrhea are not due so much to gonococci, which as a rule limit themselves to the mucous membranes, but to the secondary infections that are afforded extremely favorable conditions for their growth.

De Warker (10) gives the first place to gonorrhea in the three diseases (gonorrhea, tuberculosis and syphilis) that press urgently for solution. He gives it the first place, not because it is more destructive to life than tuberculosis, but on account of its greater dangers to society, in its power to impair fertility and to permanently infringe upon usefulness.

5. General Gonococcal Infections have also been reported very frequently in recent years, and Winn (11) states that the lesions and symptoms depend upon three factors:

(1) Direct infection with the gonococcus itself; (2) absorption of a toxin (gonotoxin), and (3) mixed infection with other germs. Krause (12) demonstrated gonococci in the blood during life, and Ullmann has reported five cases of fatal gonorrheal pyemia, in four of which a necropsy showed the point of origin to be a prostatic abscess. Gonorrheal infection has no special clinical features which can differentiate it from.other pyemias, and a positive diagnosis can only be made by a bacteriological examination of the blood or from an accessible lesion. Krause calls attention to the ease with which gonococci may be overlooked, which only grow to small colonies in blood, and in cultivating them the agar must not be heated above 41 deg. C.

6. Blindness.- Formerly about 50% of all blindness was due to gonorrhea, but since the adoption of Crede's prophylactic measures this has been reduced to about 20%. Even with this reduction it may still be given as evidence against gonococci, and to further strengthen the case against their attack on the innocent helpless children Holt has recently shown that gonococcal infections

and vaginitis are exceedingly frequent in institutions for children, highly contagious and difficult to control. He says where this infection is known it is justly regarded as the bete noire of institutions for children, the importance of which has only just begun to be appreciated. Twenty-six cases of gonococcal arthritis are reported, and it is claimed that a pyemic arthritis in a young infant is much more frequently due to the gonococcus than to the streptococcus or any other pyogenic organism.

7. The Need for Reporting These Diseases. All efforts to study venereal diseases are hampered by the absolute lack of any reliable statistics in this country, and the attempt to have them reported purely for statistical purposes, without the names of the individuals, is most heartily approved. "While venereal diseases cause more deaths and deplete the population by causing abortion and preventing conception more than any other known disease or condition, this in their registration of contagious diseases" subject is laregly ignored by sanitary bureaus (7). It is only in this way that the laity, physicians, and especially philanthropists, are to be shown the necessity of taking steps to check the ravages of these diseases which, although sapping the vitality and life blood of the nation, continue to be ignored. city in this country has adequate hospital accommodations for the venereal patients. There is no more crying need today than for efficient treatment and medicine for all poor patients before the disease has tightened its relentless hold, and they are doomed, for life, to be sterile, imputent, or invalids.

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In conclusion, gentlemen, I hope the facts I have reviewed will enable you to appreciate more fully the importance of gonorrhea, its widespread and far reaching effect, and trust none of you will admit it a disease to be feared no "worse than a cold in the head," and will combat any such criminal ideas on all occasions.

BIBLIOGRAPHY.

1. Holton: Journal American Medical Association, March 11th, 1905. 2. Peterkin: North West Med,, Vol. II. No. 9, 1905. 3. Kelly Jour. A. M. A, March 4th, 1905.

4. Heidingsfeld: Jour. A. M. A. January 30th, 1904. 5. Weiss: Jour. A, M. A., January 24th, 1903.

7. Johnson: Jour A. M. A., March 11th, 1905.

8. Benzler; Archiv f. Dermatol. and Syph., Band XLV, Heft 1.

9. Progres. Med., December, 1899.

10. De Warker: New York and Philadelphia Med, Journal. 11. Winn: The Lancet, February 11th, 1905. 14. Krause: Berlin klin. Woch., May 9th, 1994.

IF an incised wound in the soft parts does not heal as readily as it should, examine the urine for sugar.

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A Happy New Year.

EDITORIAL

IN entering a new year the FORTNIGHTLY follows what has become a custom, in wishing all our friends "A Happy New Year;" custom though it be it is no less heart-felt and sincere. We would have each of you in the new year experience an excess of prosperity and true happiness beyond that of any of the years past.

THE FORTNIGHTLY looks to 1906 to be one of advances in its worth and usefulness. We look back on our work during the past year with a pardonable degree of pride, and at the same time with a thorough appreciation of the fact that our large audience has at all times encouraged us and proven an incentive to endeavor. The managing editors also feel that they will be expressing the sentiments of our readers in expressing their appreciation of the work done by the Fortnightly Department Staff, the increasing excellence of our departments is bringing us flattering commendation, and for this our thanks are due the men who are so ably doing this work.

The outlook for 1906 is indeed flattering, there promises to be a very material increase in the amount of department work presented, and our original department will be materi ally increased by the papers presented before the Medical Society of City Hospital Alumni, the FORTNIGHTLY having been selected by this prosperous society to publish its proceedings. It is our belief that our readers will see improvement in all departments and a gratifying increase in the amount of matter furnished, for it is our purpose to make the FORTNIGHTLY for 1906 the best yet.

If possible. always tie each component of a kidney pedicle separately, not en masse.

THE ST. LOUIS MEDICAL SOCIETY held its annual meeting on the evening of December 30th, the interest in the election brought out the largest attendance in the history of the society, 235 members being present.

The Annual Meeting of the St. Louis Medical

Society.

The reports of the officers and committees

for the year showed that 1905 has been in several respects the best year of the society's history. Thirty-nine meetings were held with an average attendance of 49.7. Fiftyone essays and addresses were delivered and a large number of anatomic and pathologic specimens were demonstrated, and various other matters were considered within the scope of the scientific work of the society, all of which marks the work for the year as of exceptional excellence. Sixty-four physicians were elected to associate membership during the year, and a number of lapsed memberships were revived, bringing the total active membership to 461 at the close of the year. The society lost seven members by death during the year, Drs. Wm. Johnston, W. M. McPheeters, R. M. King, C. V. F. Ludwig, J. J. Curl, A. Schlosstein and Will Rinninger.

The new building under way, the foundation having already been laid. The work will be pushed from this on, and it is expected that the society will be meeting in its own hall before the summer recess.

The election of officers for 1906 resulted as follows:

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Local Birth and Mortality Statistics for 1905.

ADVANCE reports from the St. Louis Health Department indicate that 1905 has been a prosperous year in health matters as well as in growth and financial affairs; to have better than 1000 less deaths than in 1904, and that with a greatly increased population is indeed "prosperity." There were 10,325 deaths during 1905. These figures are not official, as the number for the ast two days of the year was estimated by the mortuary clerk. During the year 1904 there were 11,506 deaths recorded. The number of births reported up to the time for closing the office, December 30th, was 12, 168, by months as follows: January, 907; February,

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