this matter thoroly, investigating particularly the various kinds of puerperal infection, and the various points of origin, as the bladder, uterus, tubes, vagina, etc. Thus only can you get a comprehensiv grasp of the subject.-ED.] Egg Idiosyncrasy. Editor MEDICAL WORLD:-Male, 43 years of age, weighs 143 lbs. Height 5 feet 7 inches; appearance healthy. Has had comparativly good health during whole life, except was affected with trouble resembling chorea when very young, and at times now when in a hurry or laboring under stress of excitement has slight symptoms of it. So much for history. Now, what I want your help on is this: The taking internally of any quantity of egg, be it ever so minute, gives rise to decided symptoms; and when coming in contact with the skin acts as an irritant. When egg is taken internally, symptoms commence by a stinging, tingling sensation of tongue, mouth, throat, and esophagus, which lasts for about 3 hours. During this period there is intense nausea and pain in the stomach, which become easier about the time the mouth and throat symptoms disappear. Immediately after the above train of symptoms an acute diarrhea develops, which lasts for 3 or 4 more hours. Stools very thin but not particularly offensiv; 8 to 10 in number; slight pain in bowels; burning, tingling sensation around rectum. Frequent discharges of urin accompanied by burning and tingling sensation in bladder and along urinary passage; and if the quantity of egg is as large as he would get in a piece of cake or dish of ice cream, there is a burning and tingling condition of the skin and an eruption resembling urticaria. The symptoms vary according to amount of egg ingested So small an amount as would be received in a cup of coffee made from coffee glazed with an egg compound is sufficient to give rise to decided symptoms. Egg applied to the skin causes only the local symptoms of burning and tingling, together with the hive-like eruption. Any help you may give me in this case will be greatly appreciated. The only mention of such a case that I know of was in THE MEDICAL WORLD several years ago, and I cannot now find it. The above idiosyncrasy has existed from infancy. H. H. KOONS. New Lisbon, Ind. [Your case is interesting, but not a great rarity. There is nothing you can do for your patient. No drug or method of treatment will have any influence over his peculiarity. All that can be done is for him to abstain from the use of eggs in any form and to avoid all contact with them. They are poison for him, just as certain drugs are poisonous to certain people. We once set up a case of severe urticaria in a grown and healthy male by ordering a single half-grain dose of quinin. It took three days for the symptoms to subside, and some of the wheals were three inches across. We have always believed that a large dose would have killed him. Among other articles of food which cause cutaneous erythema in certain individuals may be mentioned strawberries, oysters, clams, radishes, turnips, veal, etc. Idiosyncrasy in the matter of drugs has never been explained, and the condition of your patient is exactly similar. Highly nervous persons are more apt to manifest such peculiarities than are those of the phlegmatic temperament.-ED.] Elixir of Buchu. Editor MEDICAL WORLD:- I wish you would give us a formula for putting up an elixir of buchu with other preparations, for instance, juniper berries, etc., that will be sightly. W. F. PERSONS. Sullivan, Ohio. [The compound fluidextract of buchu of the National Formulary contains buchu, cubeb, juniper, and uva ursi. You can buy this cheaper and more satisfactorily than you can make it yourself; but if you want the formula for preparing it from the crude drugs, make it the text of another query, and we will be glad to publish it. To make compound elixir of buchu, proceed as follows: Mix the compound fluidextract of buchu with the alcohol, then add the aromatic elixir, the syrup, and the purified talc. Shake well, and if time permits, occasionally during the twelve hours; then filter, returning the first portions of the filtrate until it passes clear. One fluidram represents fifteen minims of compound fluidextract of buchu. Average dose is one fluidram. (The above is taken from the National Formulary, which any druggist can procure for you.) Unsightly preparations are due to insufficient or imperfect filtering.-ED.] Book Reviews.-Manikin. Editor MEDICAL WORLD:-Tell the doctor who writes the review of new books to be careful in his recommendations. I, for one (and I know that other doctors are the same way), send for books on what he says. I don't remember how many books I have sent for on the recommendation in your journal, and I give the credit to your journal. Sometimes the book is not as good as I expected. And when I write to any one advertising in THE WORLD I mention THE WORLD. Will you please tell me where I can obtain an anatomical manikin, or something on that line, small, in book form? G. L. DINES, M.D. Mine La Motte, Mo. [We use extreme care in reviewing all the books which come to our table, as we are well aware that such pains on our part are appreciated by many of our subscribers. In reviewing, we keep in mind the general needs of the profession, or of large sections of the profession; it is not possible for us to review for individual tastes. If, however, at any time, you wish personal advice regarding any certain book, write to Dr. Russell and tell him exactly what you want. He will then be able to tell you whether or not he thinks you will be suited in the prospectiv purchase. You can obtain manikins from Frank S. Betz, Hammond, Ind. If we understand your wishes, you will not be able to get a "small" manikin "in book form." Such a manikin would not be practical, either from the bookmaker's or the user's standpoint. If, however, it is an atlas you wish, a very excellent one is publisht by W. B. Saunders & Company, of this city, at $6, called Atlas and Text Book of Human Anatomy, SobottaMcMurrich. The same publishers put out a similar work, called Atlas and Text Book of Topographic and Applied Anatomy, SchultzeStewart, at $5.50.-ED.] Probably Rheumatic. Editor MEDICAL WORLD:-The following case is giving me quite a bit of trouble: Male, age 35; single; occupation, farmer. After a day's work, regardless of the season, he gives the following symptoms: Pain in muscles of neck, back (upper), shoulders, arms, legs, and hip-joints; mostly in region of neck. No rigidity of muscles. After a few days' rest, pain is greatly relieved, but then the smaller joints-fingers and toesswell a little, and on motion produce a crackling sound. Very little pain accompanies this swelling. Appetite good; sleeps well. Examination of urin reveals nothing. Have treated him for rheumatism, gout, and given potassium iodid with no results. This man is ambitious and very anxious to regain his health. F. O. KAPS. Winfred, S. D. [We deem the trouble rheumatic. You should have stated what measures you had taken against rheumatism. We would suggest cutting out all meats from his diet, and adding all the fresh fruits he can take. Let him suck the juice of a lemon each morning on arising. Try him with a hot air bath of the entire body just before. retiring, every night for a considerable period. Have him drink all the water he can take. Suggest the wearing of light woolen underclothing thru the summer season. If you have saturated him with potassium iodid and salicylates, put him on eliminants, tonics, and reconstructiv medication.-ED.] Pathogenic Cocci. DEAR EDITOR:-Kindly answer in full (thru the next edition of your valuable WORLD) question No. 2 (page 421, Oct. no.) under Pathology and Diagnosis. H. C.; Washington, D. C. [The question is a difficult one. Pyogenic, of course, is understood to refer to pus-producing organisms. If the question had read "pathogenic" it would have been a fair test of the applicant's pathological knowledge. It would puzzle expert pathologists to decide, sometimes, whether or not a given variety of pathogenic cocci were pyogenic or not. To go into this matter in detail would take many pages, which we cannot afford here, for the subject is not of sufficient practical impor We append, however, a list of the pathogenic cocci. When the term "cocci" is used, it is rather elastic, being applied as follows: As to number: Monococci; Diplococci; Tetracocci. As to arrangement: Streptococci; Micrococci (staphylococci); Ascococci; Sarcinae. When the cocci occur in pairs, they are known as diplococci. If in sets of four, tetracocci. The term monococci refers to such as are not definitly associated with one another. When found in chain-like arrangement, they are called streptococci. The staphylococci are arranged in irregular masses, each individual being embedded in a gelatinlike substance elaborated by itself. Ascococci are associated in circular or globular masses, held together by a gelatinous substance. Sarcinae are found in clumps or cubes of eight or more elements, the yeast cell being a common example. The pathogenic cocci are: Gonococcus: Producing gonorrheal inflammation when inoculated upon mucous membrane. May also be found in joints, heart valves, etc. Micrococcus of trachoma: Conjunctiva, follicles, and in the enclosed follicles of trachoma. A diplococcus. Diplococcus pneumonia: Sputum, empyema, cerebrospinal meningitis. Diplococcus intracellularis meningitidis : Recent exudate of cerebrospinal meningitis. Cerebrospinal fluid. Micrococcus pyogenus aureus: Pus, draft, air, earth. Injected subcutaneously, produces abscesses; into veins, pyemia. Micrococcus pyogenes citreus: Resembles above in every detail, except that it produces a lemon-yellow pigment. Micrococcus pyogenus albus: Resembles above in all details, except that it produces a milk-white film. Micrococcus pyogenes tenuis: Found in mild, tho extensiv suppurativ processes. Tests have yet been negativ in attempts at inoculation. Micrococcus cereus albus: Found in pus, usually associated with other cocci. Micrococcus cereus flavus: Resembles micrococcus cereus albus, except that it develops a yellow pigment. Streptococcus pyogenes: Found in erysipelatous eruptions and in pus. Produces erysipelas and suppuration; ulcerativ endocarditis; puerperal fever; secondarily in diphtheria and other acute infectious disease; occasionally in chronic processes, like tuberculosis. man. Micrococcus tetragenus: Saprophytic in Found in sputum and tubercular cavities, tho bearing no relation to chronic ulcerating pulmonary tuberculosis (Coplin). Baccilus diphtheria: Diphtheritic mem brane. Bacillus coli communis: Intestinal tract of man and animals. Thru migration may induce any kind of abscess. Bacillus edematis maligni: Found in garden earth. Produces extensiv subcutaneous edema. Bacillus anthracis: Found in animals dying of splenic fever; causes wool-sorter's disease and malignant carbuncle. Bacillus pneumonia: Found in pneumonic lung. Bacillus pyogenus fetidus: Found in fetid suppurations. Bacillus pyocyaneus: Found in green pus. [We cannot apply either of the terms "successful” or “best” to any of the treatments now used against leprosy. Many drugs, in time past, have enjoyed considerable repute in treatment of this affection, but, tho some seemed to do good for a time, each, in turn, passed from popular favor, with the exception of the few now in use, and it is likely that these will follow the path of their predecessors. It is certain that no drug yet discovered is in any sense a specific in the sense in which quinin is considered a specific in malaria or mercury is considered a specific in syphilis. Clinicians are easily deceived as to the value of a drug given in leprosy, because the leper applies for treatment just after one of the exacerbations of the disease and at a time when the eruptions and nodules are pronounced. As a matter of course, as time passes, these manifestations tend to become quiescent. This would happen if no drug at all were given; but the clinician, having the patient under observation and treatment, naturally ascribes the temporary improvement to the drug. Hence, we are continually having new drugs exploited for the "cure" of leprosy. Chaulmoogra oil, in doses of from 2 to 10 or even up to 40 or more drops, three times a day, according to tolerance on the part of the patient, together with inunction of the same drug blended with some mild oil, is now the drug of choice among most practicians. Those who can assimilate large doses appear to do well on it. Sandwith has reported a case which took readily 70 minims of this oil by the mouth three times a day, and in addition had a daily hypodermic injection of 1 dram. Not many patients will tolerate such doses, however. This case improved rapidly, so far as symptoms go, but the bacilli in the nodules did not decrease in numbers. Icthyol is recommended by Unna, who claims to have cured several cases with it. He gives it in ascending doses, and rubs the arms and legs vigorously with 10 percent pyrogallic acid in lanolin twice a day; the cheeks and trunk are likewise rubbed with chrysophanic acid, 10 percent in lanolin; and at the same a plaster is applied to forehead and chin which is composed of chrysophanic and salicylic acids in creosote, changing the plaster twice a day. This treatment is followed for a month, and is then followed by a course of warm baths before being resumed. Crocker records a case which did well on weekly injections, hypodermically, of of a grain of perchlorid of mercury. Danielssen believes salicylate of soda, combined with cod-liver oil, quinin, and iron, good food, and good hygiene, the best medication in leprosy. He claims if the treatment is begun within a few months of the inception of the disease that a cure will result. He gives 15 grains of the salicylate four times a day, and gradually increases the dose thru six months or a year. Manson has had good success with thyroidin during a three years' trial of the drug. Scrupulous cleanliness obtained thru frequent bathing with warm water and soap; good food; plenty of fresh air; judicious exercise; and avoidance of fatigue and exposure are all of prime importance in the handling of leprosy, whatever drug medication be selected. Tropical Diseases, Manson, publisht by Cassell & Co., London, Paris, New York, and Melbourne, at $3.50, is one of the best books in our knowledge on this disease; it has 40 pages on leprosy.-ED.] Exfoliativ Endometritis. Editor MEDICAL WORLD:-Mrs. R. B., age 28, weight 160 pounds, family history good; healthy when a child except measles and chicken pox; had typhoid fever for eleven weeks when 18 years of age; diphtheria when 20 years of age; recovery from both good. Menstruated near the 15th year; always regular until 16, when she became somewhat irregular. As she grew older suffered much pain, bearing-down sensation, and severe backache. Badly run down in general health from hard work. Condition remained about the same until about 17 or 18 years old, when all symptoms became aggravated and pains and bearing down became much worse at periods; however, flowed quite freely after getting started, and pains subsided after first day. A rest of a few weeks caused a gain of weight of 15 pounds. During the next few years suffering increast until patient was compelled to remain in bed for the first 24 hours of menstrual periods, general health being fair between times. When 26 years old fell backwards from a chair she' was standing on while at work, coming flat down on the glutei. Menstruation occurred the following week; suffered worse than before and flowed more freely. A few months after this, patient noticed that after flowing about four days it ceased, a series of cramping and bearing-down pains commenced, and a clot was expelled from the uterus, the flow recurring with great severity for a day or two, when it would gradually cease. The clot was enveloped by a membrane of grayish color, and in a short time increast from one to three. Married when 26 years of age; came to me on November 1, '04, with history as above enumerated. Patient was tall, extremely nervous, and very despondent. Urin, heart, and lungs normal. Digestiv organs normal except constipation. Examination of pelvic organs demonstrated a very sensitiv left ovary, uterus tipt to left and extremely tender, cervix eroded, some leukorrhea; was unable to pass sound owing to constricted inner os, Advised thoro curetment after some local treatment by depletants. November 10, 1904, patient was anesthetized at her home, and the uterus thoroly dilated and cureted with a sharp curet, interior of uterus painted with carbolic acid and swabbed with pure alcohol, then packt with iodoform gauze, which was removed in 36 hours. Douching then commenced twice in 24 hours by an experienced trained nurse who was on the case, gallons of very hot water being used each time. A small amount of sodium bicarb. was dissolved in the water. This treatment was continued for nearly three weeks, when menstruation occurred perfectly normal in every respect. After this, permitted patient to be up around house, but did not allow her to work; kept her on fl. ext. Aletris farinosa, 10 drops in hot water, after meals and at bedtime, this constituting all the internal medication used except some symptomatic treatment. Preceding each period a few days the interior of the uterus was packt with a narrow strip of gauze saturated with Churchill's comp. tr. iodin, which was removed in three or four minutes. Pregnancy was advised, and a conception occurred six or eight months after operation, she having menstruated free from pain and normally in every respect up to this time, her health being the best it had been all her life. In February, 1906, was delivered of an 8-pound boy, after an easy normal labor. Child healthy and mother made a nice recovery, and in one month was attending to her household duties. When child was about eight weeks old it had an attack of indigestion, causing high fever and a number of convulsions, having had a dozen or more before I arrived. It was very sick for two weeks, having as high as 20 convulsions in 24 hours. It was removed from the breast and put on albumin water, and later on Eskey's food. As it became better it was returned to breast. For a month the child got along nicely, except a little colic, but passed mucus in the stools constantly; gained, however, from one to one and one half pounds in weight every week. Mother and child feeling fine and doing well for about six weeks, when the child, which was three and one-half months old, became very sick again with an enteritis. Had numerous convulsions and bloated frequently; in fact, almost every time nourishment was administered. Passed an enormous amount of mucus in stools, which was very green and offensiv. In spite of good nursing and careful attention by myself and a consultant, child grew worse; had a great many convulsions and died. Mother inconsolable and went down in health rapidly. Menstruated normally in about six weeks, and on tonic and sedativ treatment built up to her usual health. In five weeks menstruation recurred, free from pain until fourth day, when it ceased; cramping and bearingdown pains came on for a few hours, and three clots were expelled from uterus. Flow recurred for 24 hours and ceased. Felt well until six weeks later same phenomenon occurred. I am sending you herewith the last clots passed for examination. I have examined some which resemble a complete cast of uterus. Have had them examined by a competent pathologist, who pronounced them an organized blood clot. Ät present am using galvanism to interior of uterus by a copper electrode; tho following the technique of Massey and Nieswanger carefully, can see no improve ment. The text-books touch very lightly and are very meager in their discourse on membranous endometritis. Perhaps some good M.D. has had a similar case and been successful in handling same; so in order to draw him out and learn his methods, I am presenting this case to THE WORLD. GLENN E. MERSHON. Mount Carroll, Ill. [Your specimens were totally decomposed when they reacht us, consisting only of bloody serum and grumous sediment. We have no reason, however, to doubt the correctness of your diagnosis, as the case seems very plain. Exfoliativ endometritis is rare in women who have been pregnant. It is always rebellious to treatment. The books occupy little space with its consideration because there is so little to be done. It is summed up in dilation and curetment, with attention to the general health. The latter is of great importance, and is neglected by many practicians who think that all their efforts should be directed toward the local manifestations. As a rule, the curetments must be repeated several times before markt improvement is noted. We think this is where you have erred; i. e., in expecting too much improvement after one cureting. We suggest that you pay special attention to her general health for two or three months; then curet; then another period of the best of care; then another cureting; etc. We would not make so much" fuss "" over a curetment. Let her feel that it is not such a great event. Dispense with the trained nurse unless the patient is amply able to bear the expense. Do the whole thing yourself, or with the aid of a friendly neighboring practician. even, where it is desirable to impress the patient with the absence of serious consequences, curet without an anesthetic.-ED.] How to Get Rid of Roaches. We [A highly commended poison for roaches is prepared as follows: Add 1 ounce powdered anise seed, ounce powdered saltpetre, ounce white lead, and 4 ounces of essence of hops to a pint of alcohol. Keep warm for an hour and then add 30 drops saturated infusion of quassia. Allow to stand for 48 hours and bottle for use. Saturate bread, meat, or other food with it and lay about their frequented places. This is said to be equally good for rats and mice. Another formula is as follows: be useless. One party, pestered with the insects, laid a train of powder all around the room an inch or so from the wall, so that no roach could enter without wading thru the powder. In a short time the room remained free from the pests.—ED.] The Succinates and Wild Yam in Gall Stones. Editor MEDICAL WORLD-I wrote some time ago for the opinion of the Editor and WORLD subscribers for their experience with succinate of sodium, succinate of iron, and wild yam in treatment of gall stones. Would it be asking too much for the Editor and subscribers to give their experience with said remedies, especially wild yam? L. N. BEAR. Vevay, Ind. [Will any of the family having had personal experience with succinate of sodium, succinate of iron, or wild yam, in cases of gall stones, kindly communicate with the doctor? The Editors have not employed any of these agents in this connection.-ED.] CURRENT MEDICAL THOUGHT Seasonable and Efficient Preparations, as Prepared by the Directions of the National Formulary. (Publisht by The American Pharmaceutical Association, Baltimore, Md, and obtainable thru any wholesale druggist in the United States or Canada.) 11⁄2 Troy ounces 71⁄2 Troy ounces 11⁄2 Troy ounces grains Auidounces Emulsion of Petroleum. 3 230 minims Water, a sufficient quantity. Melt the petrolatum and mix it thoroly with the almond oil. Mix the acacia and tragacanth, in a capacious mortar, with 4% fluidounces of water, and add the oil mixture gradually, triturating rapidly until a smooth emulsion is formed. To this add the syrup and tincture, and enuf water to make 32 fluidounces, and mix it well. Average dose, 4 fluidrams. Compound Cathartic Elixir. Fl. ext. frangula (U. S. P.) Fl. ext. rhubarb (U. S. P.) 4 fluidounces 3 fluidounces 2 fluidounces Spirit of peppermint (U.S. P.) 3% fluidrams Solution of potassium hydroxid (U. S. P.). Saccharin I fluidram 60 grains Aromatic elixir (U.S.P.), a sufficient quantity. Dissolve the saccharin in about 20 fluidounces of the aromatic elixir, previously mixt with the solution of potassium hydroxid; then add the fluidextracts, the spirit of peppermint, and sufficient aromatic elixir to make 32 fluidounces. Mix well, allow to stand 24 hours, and filter. Average dose: aperient, I fluidram; cathartic, 3 fluidrams. Bitterless Fluidextract of Cascara Sagrada. Lime. 30%1⁄2 Troy ounces 11⁄2 Troy ounces 13 Troy ounces . 12 minims 6 minims Slake the lime and mix with 64 fluidounces of water. Stir in the cascara and digest on a water-bath 6 hours, or till only a faint bitterness is apparent to the taste. Then transfer the mixture to a percolator and allow to drain. Now pour on water until the cascara is exhausted. Evaporate the percolate on a water-bath to Mix them intimately by trituration. Should cumarin not be available, or should it be objectionable to the patient, the odor of iodoform may also be more or less maskt by many essential oils, for instance, those of peppermint, cloves, cinnamon, citronella, bergamot, sassafras, eucalyptus, etc. Another efficient covering agent is freshly roasted and powdered coffee. The odor of iodoform may be removed from the hands or any utensils which it has come in contact with, by washing them with an aqueous solution of tannic acid. Dissolve the sugar in the milk, contained in a strong bottle, add the yeast, cork the bottle securely, and keep it at a temperature between 73% to 89% Fahrenheit for six hours; then transfer to (ice or) a cold place. Comprest yeast, 24 grains, mixt with a little milk, may be used in place of the semi-liquid yeast. In place of preparing kumyss with sweet milk and waiting till it turns sour, the casein may be precipitated at once by the addition of one-third of ready kumyss to fresh milk. Yeast is not necessary, but sugar must be added to produce enuf carbonic acid gas to cause effervescence. 4% Troy ounces Sulfuric acid, commercial 9% fluidounces Water, cold 32 fluidounces Proceed in same manner as above. NOTE:-Sodium dichromate is more soluble than the potassium salt, and its products of decomposition, in the battery, are also more soluble. As it is also much cheaper, it is now preferred in all large electric laboratories. When it cannot be obtained, potassium dichromate may be used in place of it, as heretofore. The two salts may be substituted for each other, weight for weight. (C) For the Leclanche battery: Ammonium chlorid. 10% Troy ounces 32 fluidounces |