A Puzzling Case. Editor MEDICAL WORLD:About four years since my wife began to complain of fullness and pain in the stomach; would last her from one to two hours, being relieved only by an eructation of gas, which would last an hour or more, when she would be well several days before it would return. Finally it would occur daily in the fall and winter and rarely in spring and summer. Her general health seems to be good, age 48, weight near 200 pounds, very industrious, moves quickly, high spirited, never low spirited, appetite good, pulse and temperature normal, bas florid complexion; no uterine trouble, is a mother; no constipation or any irregularity of other organs, or perceptible disease; is a great talker and laughs heartily. Sometimes eating causes it, but more frequently stooping to pick up a shoe or pin, or to bend for any cause.

I have tried all the antidyspeptic remedies, nitrate silver, salicylic acid, strychnia, and liver remedies. Now I want you and all who can to tell me what to do, and what the trouble is, bearing in mind that her general health is good in all respects as far as can be seen, except the stomach trouble. No pain at any other time, but all life and cheerfulness. Please answer through THE WORLD, or otherwise. Earlysville, Va. GEO. A. WOOD, M.D.

Enlarged Testicle.

Editor MEDICAL WORLD:-I would like to have treatment, through THE WORLD, for chronic enlarged testicle in a young man, caused by being hit with a ball bat three years ago. It has been about the size of a goose egg, but has recently taken to growing again. It is not sore nor painful. The testicle is quite hard. H. O. WELLS, M.D.

Milan, Ind.

A Question of Ethics. Editor MEDICAL WORLD:-Would like to ask the opinion and advice of the readers of THE WORLD, in the following case :

I have a medical friend, who attended a "case of labor," a primipara 25 or 30 years of age; labor was slow, but terminated all right. Child seemingly all right when born; in a few days-might have been a week-the child had convulsions, and came near dying, and was never just right afterwards. The child, now four years of age, is a helpless idiot; cannot sit up at all, seems weak in his back, and has but very little use of lower limbs. My friend, Dr. H. continued to do the practice of the family, but told them frankly that nothing could be done for their child. A year, perhaps, after the birth of the child, Dr. P. an eclectic, was asked to examine the child, and,

after getting a complete history of the case, asked the mother if the doctor gave her any medicine while in labor; she did not at first remember, but thought he did. Dr. P. then took from his case a bottle of dark fluid, and asked, if it "did not look like this?" she thought perhaps it did. Dr. P. then informed them that it was the medicine given to the mother before the child was born that caused the child to be so, and that the child must now have some of the same medicine, to be cured. Now this has damaged my friend, Dr. H. as the family and many of their friends and neighbors believe Dr. P.'s theory. It seems to have been used by the friends of Dr. P. against Dr. H. in electioneering for Dr. P.

He

This was allowed to go for some time, before Dr. H. knew what he was accused of. knew he had lost the practice of the family, and also, of the neighborhood, and when he heard what Dr. P. had said, he only refused to consult with him in a case or two when he was requested; then Dr. P. wrote to enquire the cause. Dr. P. now denies everything, but the father and mother say that they will swear to the fact. The father acknowledges that he has done all he could to injure the reputation of Dr. H. and he now says, that if Dr. P. denies telling him the above, he will "mash his mouth," etc.

Now Dr. H. does not want to do anything rash; he asked my advice. He talks of prosecuting for slander and, of sending the affidavits of the father and mother to the State Board of Health, to have Dr. P.'s certificate revoked, etc. Dr. H. acknowledges to having given the mother tinct. opii et camph., with, perhaps, fluid extract of cimicifuga, five or ten drops of each. He never give ergot before delivery, and don't think any drug would have produced such an effect on the child, and not hurt the mother.

Brothers, what do you think of the case, and what would you do, if you were Dr. H. ? Replies will be appreciated by me, as well as my friend, Dr. H. J. D. HART.

Eddyville, Ill.

[We shall be obliged to our readers if they will kindly communicate their views personally to Dr. Hart; Illinois physicians especially, should take notice of it. Caution should be observed, to note that Dr. P.'s action was not taken because he happend to be practicing the eclectic school. It touches his inherent character as a man. There can be but one opinion in regard to the character of the offense. It is grave, and should be pushed to the extreme limits of lawful redress. However, as you have the testimony of unprofessional people in it, it is partly a question of fact. Proceed cautiously, legally, but vigorously.-ED.]

A Case for Diagnosis. Editor MEDICAL WORLD:-On Thursday, August 29, 1889, at half past four, a. m., I was hurriedly summoned to see B. M., a bright, intelligent boy of six years of age. He had been at play the day before, as usual. Had hard chill at bedtime, 8 p. m., 28th, with vomiting. Mother said his bowels acted twice (after fever came on) in the bed, and that he had been very restless all night, turning and groaning, but could not tell what hurt him, only "sick in head."

I found him presenting the following symptoms: conjunctiva congested and very red; pupils contracted; lying in comatose condition; temperature 10534° in axilla; pulse 160, very much diminished in strength; cool extremities; red-looking spots on arms and face; tetanic convulsions, with rigidity of arms and neck; involuntary action of bowels; tongue red, with but slight coat; stertorous breathing. Patient died about 10 a. m. Had black patches on body and face, which did not disappear on pressure, nor after death, and were not elevated.

Treatment: three and a half grains of antefebrine at 5 a. m.; mustard to extremities, back of neck and stomach; cold applications to head. At half-past five gave four drops of paregoric; at six, small dose of bismuth and calomel.

Left bismuth and calomel, to be taken each hour until bowels acted. Was with patient about two hours. Temperature at seven, 1050 in axilla.

Will you please diagnose the case and give your line of treatment? I like THE MEDICAL WORLD, and welcome it to my office each month. N. C. WILLIAMS, M.D.

Clifton Hill, Mo.

Help Wanted for Urticaria. Editor MEDICAL WORLD:-Will some of the readers of your valuable journal kindly suggest a treatment for an intractable case of urticaria of three years' duration? The case is one of a young married lady, 21 years of age, the mother of one child, and apparently in good health. The rash appears periodically every night, thus suggesting to my mind a malarial influence. Could malaria be a causative agent in this case? Any suggestions as to treatment and causation in this case will be gratefully accepted, either through the columns of THE MEDICAL WORLD or privately.

Patterson, La. W. D. ROUSSEL, M. D. [Doctor, there is very likely some malaria in the case. Do you not also consider the possibility of uric acid? For this, we have had good results with salicylate of soda, together with benzoate of lithium, with also bromide of lithium if there is much itching.-ED.]

Help for Chronic Cystitis.

Editor MEDICAL WORLD:-Please give us the best treatment for irritability or chronic inflammation of the bladder. Patient a male, 52 years of age, well nourished, tips the beam at 220 pounds. Frequency of micturition and only a small quantity at a time. Commenced about five years ago. I hope the readers of THE WORLD will give me a fair treatment of this disease. H. H. BORDNER.

Shamokin Dam, Pa.

Editor MEDICAL WORLD:-Will you please give the best treatment for chronic enlargement of the tonsils. Is there any medicine that will absorb the exudation by local or internal use? Trinity, Texas. C. C. CEMER.

[Doctor, galvano-cautery is the most rapid, painless and certain procedure we have ever seen tried. ED.]

Chronic Diarrhea.

Editor MEDICAL World :—Will some of your readers kindly furnish treatment for an obstinate case of diarrhea, contracted 5 years ago in Mexico, during a very hot summer. Little trouble is encountered in retaining movements of bowels, ordinarily one or two evacuations daily. Stools are offensive and when restrained as above, nearly natural in consistence, but salvy and grayish in color. Suspension of treatment for over a day is followed by pain and frequent stools, thin but not watery. The patient is an elderly gentleman. Claremont, N. H.

Ivy Poisoning.

A. H. J.

What is the Disease? Editor MEDICAL WORLD:-I am a young graduate; been in practice two years. I have had to treat in my practice this year four patients with the following symptoms: patient took with chilly sensations or distinct chill one with neither; headache the first few days; pain under scapula generally through the whole course of the disease; no pain or soreness anywhere else; no enlargement of liver or spleen; nothing wrong with kidneys; a little fetid breath; appetite not good; sometimes vomiting, but not enough to notice; a little bad taste in mouth; tongue after a few days becomes coated with a heavy white coat; no fever at all. Two cases had a temperature of 100° the first two days; after which none; bowels costive, but not much so; no jaundice; circulation a little weak; patient rests well and suffers but little; but in spite of the simple type of the disease, it will go on from two to four weeks.

It has all the appearance of a continued type of malarial fever, and has all the symptoms of a mild type of this disease except tenderness over the epigastric region and fever.

Treatment: I have been using calomel, bicarbonate of soda, mineral acids, quinine, bromide of potassium, chloral hydrate, and, after a few days of the disease, good brandy and tincture of digitalis. But I think my patients would have done as well without me and my medicine as with them. I write this to get some help. If you or any of the many readers of THE WORLD can give me any help as to diagnosis and treatment, it will be gladly received. T. S. BURFORD, M.D.

Cookville, Tex.

A Peculiar Case.

Editor MEDICAL WORLD:-I have a case to report which has baffled the skill of a number of doctors. I, like others who have seen it, being unable to form a satisfactory diagnosis, and most of us not attempting to treat it, and those who have, having signally failed, I come now for help to THE MEDICAL WORLD fraternity, hoping that some of its numerous family may readily come to my assistance. The case is as follows:

Boy, aged seventeen, has, since infancy shown a peculiar condition of umbilicus and immediately surrounding parts. The navel is of a deep, or dark red color, and for about an inch around the same hue. From these deep colored parts, which have much the appearance of a partially abraded mucous surface, there is constantly oozing a serous fluid, almost transparent. The parts are quite sensitive, but not painful when protected by soft material. As near as I can

learn this condition has been present since birth. The child has always been well nourished and is now strong and healthy, able to perform a full amount of manual labor, according to his age. Will the brethren of THE WORLD family speak out, giving diagnosis and suggest treatment? Such will receive my heart-felt gratitude. WM. DERBY, M. D.

113 Adams street, Chicago, Ill.

What Caused It?

Editor MEDICAL WORLD:-About the first part of May of the present year I was called in consultation with the city physician to see a patient, suffering from apparent cystitis. On arriving at the house I found the city M. D. in waiting, who went on to give me a history of the case from its inception, stating that five days before, the patient had been suddenly taken with an inability to pass water; that after using all known remedies and some unknown, he attempted to pass the catheter, which was with the greatest difficulty introduced, when a flow of blood followed. For three or four days the catheter had to be used, and according to their statement, he was recovering nicely, when he was again taken with a relapse, and I was called in.

I found a man of middle age, seemingly in great pain, every muscle in his face testifying to the fact. Examining his organs, I found the penis greatly swollen and highly inflamed, as was also the scrotum. At this time it was impossible to pass a catheter, and it was only by the greatest effort on his part that he was able to pass any water. On the right side of the penis, a little back of the centre, mortification had already set in, which continued notwithstanding everything that could be done for him. At my second visit, to try to relieve his great distress in passing his urine, I made an incision into the urethra, in the portion that was mortified and had begun to slough; that gave some relief, as the hindrance to the passage of urine seemed to be nearer the head of the penis. The mortification kept increasing from day to day, and his life was despaired of; but resolution took place at the body, and the line of demarcation showed itself about the fifth day after I first saw him, and about the tenth day I removed the last portion of the diseased member. The man made a good recovery, minus the organ.

Having in no way met with any injury to the member, external or internal, save the passing of the catheter (?), what could have produced such serious results?

D. M. B. THOM, M. D.

Mardin, Turkey in Asia.

Electro-Therapeutical Department.

DR. W. H. WALLING, 2005 Arch Street, Philadelphia, Editor. Cases, questions or views upon electricity in medicine are invited.

[Letters should be addressed to Dr. Walling, separate from any letter to the business department.]

The Editor of this department, in order to render it still more useful, will personally answer any inquiry regarding batteries, milliamperemeters, instruments, books, etc., and will select and forward any of the above that may be wanted by the great army of WORLD_readers, the amount of money requisit to accompany the order.

He will also take a limited number of students for instruction in Electro-therapeutics. Unusual facilities afforded. For terms, etc., address as above.

THE failures in so-called electrical treatment are constantly being reported. That these will occasionally occur is but reasonable to expect, even in the most skilful hands; but in unscientific applications, the wonder is that more such negative results are not recorded. I will cite one instance of the manner in which many cases are treated, not benefitted, and then electricity is blamed; for "we tried it, and it did no good."

A lady came to me last winter with a synovitis of the left knee-joint. She suffered very much, could hardly walk, and it was complicated with rheumatism. She had been "treated" by electricity in the following way: Her feet were placed upon a metal plate, connected with one pole of a Faradic Battery, the other pole placed in her hands, and all the current which she could bear was turned on and allowed to run for half an hour. The knee was not examined, rest was not enjoined, and nothing done except as above. Of course she derived no benefit from such treatment.

After a careful examination of the knee, being satisfied that it did not require puncture, I treated it as follows: First covering it with a well-wetted bandage, over this placing another bandage of tin-foil, to which was attached the positive pole of a galvanic battery, the foot resting upon a large wet sponge laid upon the negative plate; a current of five milliampères was turned on, gradually increasing it to ten and fifteen, for as long a time as the patient would bear, say from three to five minutes, allowing a short rest and repeating two or three times with weekly sittings. The improvement was marked and rapid, resulting, as she afterwards wrote me, in a cure.

After treatment the knee was firmly bandaged,

and at one time she used for a few weeks the following ointment:

R. Ichthyol.

.dr. ij ...dr. vj.

Lanolin (Liebrich's). SIGNA-Apply to the knee night and morning, warming it in before the fire.

I have used this ointment in other and similar cases but found that the continuous current met all the indications, the only other treatment being rest and bandaging. I wish to impress this thought upon all who would get good results from electrical treatment. There is no haphazard rule-of-thumb method to be taken up hastily that will avail; but only by patient and painstaking effort, and a proper understanding of the laws governing electricity and their effects, can any one hope to succeed. Also, let it be remembered that the three forms now in use, Franklinization, Galvanization and Faradization,-differ in their effects upon the human economy, and no one can justly condemn electricity until he has carefully, properly. and scientifically applied all these forms.

There is altogether too much sneering at electrical treatment; it smacks of both ignorance and jealousy. Not wishing, however, to appear unfair ourselves, we shall from time to time publish such adverse reports or criticisms as are suitable for our columns. Note, for instance, the extract given below from Bull. Med.

"Now it does not follow that electricity was not indicated, even in this case, because, apparently, peritonitis was set up. If the whole matter was thoroughly understood it might appear differently."

Peritonitis Due to the Passage of the Constant Current in a Patient with Double Salpingitis.

A year since the author was called to a woman in whom the presence of abdominal tumors could be made out, which, after some hesitation were diagnosed to be uterine fibromata. M. Terrier, however, doubted the accuracy of this diagnosis, and acting in the belief that it was a case of double salpingitis, warned the patient that only an operation would relieve her. Disregarding his advice, she resorted to the electrical treatment, which promptly determined a severe attack of acute peritonitis. The patient, however, survived; but the salpingitis had obviously increased in size, and the matting of the intestines could be felt in one spot through the abdominal parietes.-M. TERRIER, in Bull. Med.

On the Treatment of Uterine Tumors by Electricity.

Thomas Keith, M.D., LL.D., states that he was old enough to have seen the old methods of applying electricity in the so-called "discussion" of uterine and ovarian tumor, and that the resulting disasters had been so common that it was speedily given up. Since that time until lately he has avoided the practice. Although Dr. Kimball and Dr. Cutter cured some patients, he still thought the introduction of the needle through the abdominal wall too dangerous. After a very large experience with these tumors, he says he has only met with disappointment. The tendency for a uterine fibroid is to grow, and he doubts if he has ever seen a decided case where it disappeared during the active stage of its existence. Curetting the uterine cavity gave the best results, but they were generally only temporary. He has never had a case of fatal hemorrhage, though many have come near it. Plugging the vagina, or better the cervix, a hot-water injection has always saved them. He cannot account for those sudden floodings which occur with uterine fibroids. He has never seen any permanent good resulting from repeated visits to mineral watering places. The change of life was our great and almost only hope, and that was often delayed; moreover, the preceding three or four years are the most dangerous and trying times for a woman with a bleeding fibroid.

more

Apostoli's treatment is the only one (not surgical) worth speaking of which does any good, and is free from danger. He thinks he should have held on to hysterectomy if any one did, for his results are better than any one else's; but he has given up all surgical operations for this treatment, and he is more and more satisfied with it the longer he uses it. Two years ago he had just succeeded in getting a new building for the special purpose of lowering the mortality from hysterectomy (for he found it four times as large in general hospitals as in private) when Apostoli's method was fully explained by Dr. Webb. After going to Paris to visit Apostoli's clinic, and after testing the method, the work on the special hospital was suspended and soon abandoned. Hysterectomy is the quick plan; but Apostoli's method, though slow, requiring much patience, tenderness of manipulation and thought, is still sure in its results. Sometimes, on account of the slow progress, the patient becomes discouraged, two or three months sometimes passing by without change. After a while, though, there is always improvement in general health and in local symptoms. Menstruation becomes easy and painless. This treatment puts a woman with a fibroid tumor, who suffers

much, into the position of one who does not suffer. It does not cause the disappearance of the tumor, or rarely does so; but the size is often lessened one-half, one third, two-thirds. Tension is taken off all round, irritability of the bladder relieved; in a word, the woman is well, her whole life is changed, and all this without danger to life.

On the other hand, the opponents to this treatment have nothing to offer except in the most favorable cases; for these they offer hysterectomy. He has often had the best results by Apostoli's method in cases which could not be operated on because of too great weakness or too many adhesions. The mortality for hysterectomy is about twenty-five per cent. But by far the larger proportion of women with fibrous tumors need no treatment. They are best left alone unless there are bad symptoms.

He thinks many are prejudiced against elec tricity, because they consider it quackery and know nothing about it. His confidence in its power to relieve disturbing symptoms of uterine fibroids and to cure many chronic inflammatory conditions in the pelvis continues to increase. He has no fears for the future of electricity. He thinks we have much work before us to understand it more thoroughly. He concludes by pleading that all bloody opera tions for uterine fibroids should cease, and that Apostoli's method should be given a fair trial. Hysterectomy kills every fourth or fifth woman, and ten per cent. of those who get cured become insane. So he thinks it time to stop such an operation, and this is the plea of the surgeon who has been more successful in this operation than any other surgeon.-British Medical Journal.

Electrical Treatment of Uterine Fibromata.

The author is of the opinion that when uterine fibromata give rise to metrorrhagia or severe pain in young women, the proper treatment is the removal of the appendages; if the tumor be of large size, then hysterectomy or ovariotomy is indicated. In other cases, when the patients near the menopause, when the symptoms are not unduly severe, or when the tumor is inaccessible, the electrical treatment is indicated. In seven cases in which the method was employed the results were satisfactory. Metrorrhagia promptly ceased, and the general condition of the patient improved, together with marked improvement in the pain and discomfort to which these tumors gave rise. The size of the tumor is usually rapidly reduced, but this he attributes, not to any real diminution in volume, but to "decongestion" and the absorption of inflammation exudations. He