Modern German opinion is summed up by Nothnagel.2 After mentioning that sarsaparilla is always given in conjunction with other vegetable substances which are supposed to act in an analogous and auxiliary manner, he says: - "That this method of treatment often produces good results is positively certain; the particular cases will be presently indicated. In what way sarsaparilla and similar remedies arrest (zum Schweigen bringen) syphilis, has not been explained. The old view, that sarsaparilla exerts a specific operation against the syphilis poison, appears to be much more incorrect even than the corresponding phrase as applied to mercury; there is no trace of a proof of such specificity. It is now generally assumed that the vegetable remedies (sarsaparilla, guaiacum, etc.) produce a cure by means of such increase of natural evacuations (diuresis, diaphoresis, purgation) as hasten the metamorphosis of tissues, and thereby the natural elimination of the morbid matter which is the origin of the syphilitic manifestations. This view has much in its favor. It is supported, for instance, by the fact that in many cases a patient suffering from syphilis rapidly gets well by the use of simple warm baths, and the drinking of a warm tea which promotes sweating and urination. These latter cases also favor the opinion, so frequently put forward, that sarsaparilla per se is superfluous in the cure, and that the menstruum is the only active agent. This opinion cannot be directly disproved, since it is not possible distinctly to prove the great activity of sarsaparilla.

" Experience teaches us the following facts respecting the use of the vegetable remedies for syphilis: - the wood-drinks (Holz-tranke) neither •can nor ought to be exclusively employed against syphilis, any more than mercury should be so used. History shows that physicians have repeatedly abandoned the exclusive use of each of these. We have already spoken of the advantages and applicability of the mercurial treatment, but it is also known that syphilis, under favorable circumstances, may disappear spontaneously. This natural cessation may be assisted by a methodic use of the vegetable cure; this mode of procedure is also indicated in the simple, ordinary secondary phenomena, either in robust, or more especially in scrofulous, tuberculous, or scorbutic individuals; in the former mercury is usually superfluous, in the latter it is usually hurtful. Sar-saparilla is also appropriate in the inveterate syphilis of persons who have already undergone various mercurial courses without success; here the vegetable cure is often strikingly effective; also in obstinate and severe secondaries and tertiaries; in the last usually best in conjunction with iodine. Sarsaparilla is superfluous in primary indurated chancre, for it hardly at all hinders the occurrence of secondary symptoms; it is also almost always useless in bone affections; and finally it is inapplicable, from its slow operation, in cases where rapidity of effect is essential (Iritis, brain symptoms).

1 Practitioner, 1870, vol. i. 2 Arzneimittellehre, p. 489.

"We cannot enter into any detailed discussion of the much disputed question of the advantages and drawbacks of the non-mercurial treatment. One point, however, may be brought forward; it does seem certain that the average time required for the vegetable is longer than that required for the mercurial cure; it is not true that relapses are rarer after the former than after the latter; on the other hand, it seems certain that they appear earlier and oftener after sarsaparilla, but in a milder form; though indeed cases have been seen in which a thorough vegetable cure has been followed by no relapses whatever. The vegetable cure really does appear to have the advantage of not being followed by the fearful tertiary symptoms to any extent so frequently as happens with the early and forced treatment by mercury; but it must be admitted that in some cases, even of the vegetable cure, tertiary phenomena have been observed, and in others there have been repeated recurrences of secondary symptoms."

Miscellaneous Uses of Sarsaparilla. - This drug is employed in affections of the stomach which appear to arise from its own morbid secretions. Also in chronic rheumatism, in conjunction with powerful sudo-riftcs or anodynes, such as opium and hyoscyamus, especially" when there is reason to suspect that venereal taint is lurking in the system.

Scrofula, elephantiasis, and some other cutaneous disorders, are likewise usefully treated with sarsaparilla, the value of the medicine depending in these cases chiefly upon the tonic and alterative effects. The diaphoretic influence must be assisted by the use of diluents and warm clothing.

In chronic abscesses, attended by profuse discharge; in obstinate ulcer; in diseases of the bones; in chronic pulmonary affections, where there is great wasting; and in many other complaints which indicate a depraved state of the system, sarsaparilla is a very useful medicine.

Again, in the irritable condition of the system which often ensues upon severe operations, or which arises from long continued suppuration, sarsaparilla is employed with marked success. Such, at all events, was the experience at Guy's Hospital, under Sir Astley Cooper. Sarsaparilla increases the appetite, brings down the pulse, augments its tone, and, conjoined with milk, is both food and medicine.

Mr. Lawrence used to say that physicians had no confidence in sar-saparilla, but that surgeons had a great deal. This is very likely still to be true up to a certain point, physicians being less frequently called upon than surgeons to deal with the class of cases in which sarsaparilla is specially beneficial.

Preparations And Dose. - Extractum Sarsaparillae Fluidum, 3 ss. - j. (2. - 4.); Ext. Sars. Fluid. Co., 3 ss. - j. (2.-4.); Syr. Sars. Co.. 3 ij. - 3 iv. (10. - 20.). Decoct. Sars. Co.,

Smilaoeae Sarsaparilla Smilax Officinalis Continue 26

- j. (15. - 30.).