QUIZ

New books as they appear, are sent to our Assistant Editor, Dr. A. L. Russell, of Midway, Washington Co., Pa., for review As the Doctor thus has all the late books for reference, and is made familiar with them by reviewing each one carefully as it reaches him, he is unusually equipt for answering queries. Therefore it has been our custom for a long time to send queries to him for reply. In fact, the Doctor made a special request that this be done, as he enjoys this work. It now occurs to us that time will be saved if you will send directly to Dr. Russell matter intended for the Quiz Department, which has grown so much under his vigorous treatment Please notice that our query department is not used to "boost" proprietary remedies, almanac fashion. THE MEDICAL WORLD has no interests other than to give to the medical profession the greatest amount of honest service possible. It has absolutely no interests in any proprietary preparation nor any medical supply house. Other medical editors have become, and are becoming, wealthy, by using their pages to increase the sale of preparations that they are interested in; but we prefer to render service to our subscribers that is above suspicion of personal pecuniary interest. How can a man interested in the sale of certain preparations render the best service? He is always trying to push one of his preparations in. That is commercial journalism. We prefer ethical journalism-and so does the profession, for THE MEDICAL WORLD is growing in popularity faster than ever before-and our subscribers are paying ones. They must be, for we have no medicins to "boost," nothing to sell, nothing to depend on but pure journalism; but doctors that want honest, straight journalism are willing to pay for it-they are glad of the opportunity.

Only such queries will be publisht as are likely to interest and Instruct many others as well as the one asking help. No charge has ever been made, nor will any charge be made, for this service to our subscribers. However, those who wish an immediate and personal reply by mail may obtain the same by inclosing two dollars to Dr. Russell. This is really a consultation in the interest of the patient, and should be charged to the patient-two dollars being a very moderate consultation fee. The Doctor agrees to give full, careful and immediate attention to such consultations. We reserve the right to publish in this department any such consultations that may be interesting and helpful to our readers. Name and address will be withheld if requested. Come freely for help, but read up as fully as you can before coming to us.

Goiter.

Editor MEDICAL WORLD:-I have three cases of goiter; two in women 32 to 37, and one in a girl 17 years old, the daughter of the last named. This daughter is very nervous, and during any excitement the gland enlarges very much, and any excitement will cause her menstruation to come, regardless of time. Have been giving her iodid of potassium internally, oxid of mercury and ichthyol externally, with very little success. Have tried thyroid extract with little benefit. Would be pleased if you can give me any thing to cure these cases. INDIANA.

[You should have stated the duration of the disease, and the length of time you had adhered to treatment of a given kind. Effect of medication is always slow, and nearly imperceptible in goiter.

In severe goiter, especially in those in which the nervous symptoms are well markt, no treatment is so effectiv as complete rest in bed, massage, liberal milk feeding, and electricity: In other words, the well known S. Weir Mitchell "rest cure." Belladonna, continued just short of the maximum physiological effect, for several months, has workt well in numerous cases. Hydrastis canadensis has many cures to its credit. Arsenic, in the form of Fowler's solution, is useful in nearly all cases. Suprarenal gland, in tablet form, has been administered with benefit. Digitalis is the best drug to quiet tumultuous heart action. The ice bag, locally applied, will give service in emergencies.

Beside seeking a method or combination of

drugs" to cure the goiter," you must learn to treat the case symptomatically, and to keep it in the best hygienic condition. Fatigue must never be allowed. Indigestion and constipation must be corrected. They must be removed from all opportunity for excitement of any kind. Vary the preparations of digitalis as distaste arises for the drug; and at the very outset of the treatment it may be laid down as a safe rule, to never allow patients to know what they are taking.

There is no absolute cure for every case of goiter; study each individual case, and you will probably derive benefit for each from a different method.-ED.]

Labor Complicated by an Ovarian Cyst.

Editor MEDICAL WORLD:-I have just been reading in a medical journal as to an ovarian cyst and preg nancy being present in the same patient at the same time, and as to the probable effect or cause of such a condition. Years ago I was consulted by a lady who had noticed an enlargement of the abdomen. I found a cyst, supposed to be ovarian. It was not large, but still it was quite noticeable. In a few months this lady became pregnant, when she had two growing tumors. They continued about equal size until about the seventh month, when the womb became and continued the larger. Of course the abdomen was over sized, but the patient got along quite well. I feared that when labor should come on, the abdominal contractions might burst the cyst, with fatal effect. So at this time, when the cervix was sufficiently dilated, the forceps were applied to assist the effect of the pains, and at the same time chloroform was administered to keep the patient as quiet as might be. A twelve pound boy was born, who is now attending our public school; and, altho ten years have elapst, the lady is still coddling that watery cyst, being about as large as a pregnancy at term. Her health is fairly good. Pierre, S. Dak. O. N. HOYT, M.D.

[Both the patient and yourself are to be complimented on the happy termination of the labor, as labor complicated by ovarian cyst is frequently a very serious matter. If she were to again become pregnant, we would not advise risking the expectant plan again, as your luck" might fail you. The accepted teaching in such cases is to remove the cyst as soon as the pregnancy is positivly diagnosed. Such operation rarely causes an untoward interruption of pregnancy. In 17,382 births in the Berlin Frauclinik, but 5 ovarian cysts were found. Of 321 pregnancies complicated by ovarian cyst, 55 underwent premature expulsion of the fetus. In 271 cases of delivery complicated by an ovarian cyst, there was a maternal mortality of over 25 percent and a fetal mortality of 66 percent. In version without puncture, in forceps deliveries, and in puncture, the maternal mortality has been about 50 percent (Hirst).

The lack of trouble in your case may have been due to the cyst being in the upper part of the abdomen, where it could not fall into the bony pelvis to obstruct the presenting part.-ED.]

Acromegaly.—A "Granny "Superstition. Editor MEDICAL WORLD:-Acromegaly: Correct pronunciation? Cause-i. e., what is the matter with the pituitary body? What is the_ultimate_result of the affection? Can it be cured? The remedy?

A female infant a few days old had a slight hemorrhage to "stain the diaper" for a day or two. The grannys" said she would be barren. She has grown and now been married five years and never been pregnant. Where did the blood come from? and what has that to do with sterility?

Pa.

A. K.

[Acromegaly is pronounced as ak-ro-meg a-le, and Acromegalia as ak-ro-meg-a-le-ah.

Our knowledge regarding the pituitary body is very limited, as yet. It is known to be essential to life, but in what way is not known. The anterior lobe of the pituitary body is derived from the epiblast, and differs from the posterior lobe, which consists of nerve tissue. The structure of the anterior lobe is somewhat like the structure of the thyroid, consisting of roughly spherical alveoli containing a semifluid substance as well as nucleated cells. It is not even known that the pituitary body is at fault in acromegaly. All we know is that various pathological changes have been noted in various parts of the body in conjunction with certain pathological changes in the pituitary body. An enlargement of the face and extremities, due to enlargement of the bones, has been noted. With this there is some thickening of the skin. The countenance becomes coarse and the hands and feet gigantic. The result is merely an exaggeration of the natural prominences of the bones. The back is bowed, and the condition is not infrequently associated with a great physical strength and power which gradually diminishes until in the later stages of the disease there is great muscular weakness. Enlargement of the pituitary body has been noted in acromegaly; sometimes due to simple hypertrophy and sometimes to a new growth. Enlargement of the thyroid gland is also at times an accompaniment. Later results are mental dulness; alteration of the voice due to changes in the vocal cords, sometimes becoming an actual paresis; impairment of the senses of taste, smell, and hearing; blindness due to optic atrophy; palpitation, and even hypertrophy of the heart; menstrual derangement and early cessation of the molimen, etc. The disease has no definit duration; the course is long, and in most cases, ultimately fatal; rare cases are reported as having been arrested. No treatment of value has been discovered.

You do not state whether the hemorrhage was from vagina or rectum. We presume from vagina. Such cases are not rare, and have absolutely no bearing on fertility in later life. The superstitions of the grandmothers arise thru ignorance. When the blood comes

from the vagina, it usually takes origin in uterin secretion, and disappears without treatment and leaves no subsequent effect. One might as well say that because the breasts of a female infant became inflamed, that she would never be able to perform lactation in later life -nothing in it, Doctor.-ED.]

Protection against Physicians Carrying

Infection.

Editor MEDICAL WORLD:-I am a late subscriber to THE WORLD, but by ordering several back numbers I have gotten five or six numbers, but failed to find anything concerning disinfection of the physician when treating contagious disease. I have not had any such cases yet (excepting measles), but I may be called to such cases at any moment, and I wish to know the best methods of disinfection for myself, as I have two children at home and I do not wish to take any chances. What do you advise me to do in the way of disinfecting my person and clothing when treating scarlet fever, diphtheria, whooping cough, or smallpox? OREGON.

[Purchase a pair of blue overalls and a blouse to match; let them be of good quality so that the cloth will have sufficient weight; and get them large enuf to allow for shrinkage, and so they will slip on and off easily. If there is no pocket in the blouse, have a pocket attacht on the outside for watch; another for thermometer and pencil; and another for handkerchief and towel. Get a dollar watch, a penny pencil, and a thermometer that you can leave in the suit. Get a yard of ordinary table oil cloth, with long tapes sewed on. Have your wife make a hood attacht at the back of the neck, and with a "draw string' at the front, so it can be drawn closely about the face and tied under the chin; have draw strings put in at the wrist; and have large "stockings" sewed to the foot of the trousers large enuf to admit the shoes and all. Five dollars will cover the cost of watch, thermometer, pencil, handkerchief, towel and suit. If you attend a case where you will not have opportunity to use a clean basin, put one in your buggy. When called to a case you know infectious, sprinkle your suit liberally with 1 to 1,000 bichlorid of mercury solution and wrap it in the oil cloth and put the bundle under the buggy seat. When you reach your patient the suit will be uniformly moist. Leave your hat in the buggy; don the suit; tie the strings at wrists and under chin. When you leave the house, wash the face and hands (the only parts that have been exposed) in bichlorid of mercury solution, 1 to 1,000, remove the suit and wrap it in the oil cloth; push it under the buggy seat and go home or to your next case in perfect confidence. People may laugh at you at first, but they will not when once the wisdom of the precaution is explained to them. Your opponent who leaves a case of scarlet fever or smallpox and immediately enters another house

Editor MEDICAL WORLD:-I have a hard case on hand: A young man who was salivated about two months ago. His teeth are loose, and his gums are red and sore. I tried everything in the astringent line, also peroxid of hydrogen, but cannot get his mouth well. Have you a remedy that will do his case any good? If so, please give it to me thru WORLD. Halstead, Kan. J. C. GIRK, M.D. [Diluted tincture of myrrh, saturated with potassium chlorate, is the best local application, and may be used freely. Another very good local application is the fluid extract of rhus glabra diluted with six parts of water, and saturated with potassium chlorate. haps the most efficient method of checking the secretion is the employment of atropin, in doses of grain; it must be carefully watcht, of course.-ED.]

1

Progressiv Neuritis.

Per

Editor MEDICAL WORLD:-Tho. H., aged 69, youngest of twelve children, all of which still live except four who died of some fever. Father and mother died at 60 and 58 respectivly; mother had suffered from "liver trouble" for 20 years. Patient served 5 years as a regular in the U. S. army on the plains, from 1854 to 1859. Was in perfect health till age of 49. Had two attacks of malaria while living in swamps of Missouri. At this time was taken very suddenly with excruciating pains in lumbar regions, which was almost unbearable; was in bed two weeks; from this he apparently recovered, except a slight curvature of spine to right; also right thigh "perisht away," but it finally assumed normal size.

He has been a Baptist preacher for 39 years; has been a close student all his life, and a moral man, never using whiskey nor tobacco. About two years ago he began to get numb in hands, which gradually went over the entire body. At present he can't feed himself, but can walk about the place. Reflexes in right leg exaggerated; in the left leg entirely lost; sensation very acute; coordination perfect; pupils contract and dilate normally; memory good; apex beat moved a little to right; arteries sclerosed.

He is a very intelligent man and would love to get well. Now, what shall I do? Shall I call it senile paresis, and give up? Or must I tell him to go to a neurologist? I want help as a young practician who knows but little.

He has never been under treatment by a regular physician. I saw him only recently. He is taking strychnin at present to increase peristalsis. He never wants water.

Henderson, Okla.

J. T. MILLS.

[We would not advise your "calling it" anything, at least in his presence, unless compelled to give a diagnosis. It is a chronic and progressiv neuritis, which it is not likely any medication will succeed in checking. We think the strychnin good, and would gradually increase it until he is taking about

grain at

a dose every four hours. We would also begin with small doses of potassium iodid, and increase them up to the point of toleration. Let him accustom himself to regular and mild exercise in the open air, always stopping short of fatigue. Let him accustom himself to taking fairly large amounts of water, whether he is thirsty or not; in fact, if you can get him to take it no other way, prescribe a glass every three hours, as medicin. Examin his urin repeatedly for evidences of the uric acid diathesis. Keep his bowels free, and let him avoid stimulating foods. In short, keep him in as good hygienic condition as possible, and keep up the tonics and eliminants.

We would not send him to a neurologist; you can do just as much for him as a specialist.-ED.]

Rheumatism.

Editor MEDICAL WORLD:-About seven weeks ago I was called out in the country and found a man about 38 years old lying in bed suffering with excruciating pain in the knee; stiffness of the joint; unable to extend the limb; cannot stand pressure on either side of the joint. I examined the knee and hip joints carefully; found no sign of inflammation. I askt the patient how long he had been suffering. A year," he said. The pain first began on the anterior of the joint a little below the patella; pain at first was very slight but gradually increast and spread on each side of the joint. He consulted a physician and took treatment; no improvement; on the contrary, the case grew worse until patient was unable to get about; had to remain in bed. The joint has never been swollen at any time, nor has the patient ever had any fever; has not received any blow nor fall on the knee. He has had several doctors to treat him, but got no benefit from their treatment. I diagnosed his case one of chronic rheumatism. I put him on the salicylate co., given in large doses, and a liniment of tr. opii, tr. aconit, tr. belladon.; ammon., alcohol and ol. gaultheria; and a hot poultice around the joint. Kept him on that for two weeks; found no change. Have also given him, in different prescriptions, potass. iodid, Fowler's sol., sarsaparilla, colchicum. Have applied locally small blisters, menthol, camphor-chloral, ichthyol, soap lin., and chloroform liniment. I am now giving him vapor baths. Since he has been taking them the pain has diminisht, but he is still unable to straighten the limb or walk. Have also dieted him; have examined his urin and found it about normal. He has never had gonorrhea; had always been healthy. Now Mr. Editor and readers of THE MEDICAL WORLD, please give me your advice in this case. Am I correct in my diagnosis? What would be your treatment and prognosis? C. J. VITAL, M.D.

New Iberia, La.

[We would consider the prognosis good, and have no criticisms on your diagnosis nor treatment, both of which we consider correct. Since the improvement has been but indifferent under the salicylates, we suggest a change to colchicum. We would perhaps say to combine the true salicylate of methyl and colchicin. Wm. S. Merrell Chemical Company put this combination up in pearls containing grain of the latter drug, and 21⁄2 minins of the former, and guarantee that the salicylate is made from true wintergreen. We would also suggest that you substitute the super-heated air

for the vapor bath. Keep his skin acting freely and insist on his drinking large amounts of water. See that the urin is never permitted to become acid.-ED.]

The Urin of Pregnant Women.

Editor MEDICAL WORLD:-I noticed some time ago, in some journal, an article on early diagnosis of pregnancy by an examination of the urin. Will you please tell me if it was in THE WORLD? and if so, what number? D. F. RICE.

St. Louis, Mo.

[You did not see anything in THE WORLD from the editorial pen regarding the early diagnosis of pregnancy from an examination of the urin, but it is possible some subscriber might have mentioned it. This erroneous idea bobs up every few years and runs the rounds of a certain class of medical journals that fill their columns by clipping from neighbors quite as ignorant as themselves. When the urin of pregnant women (and of other women, frequently, for that matter) is allowed to stand for a time in a vessel, a pellicle is formed on the surface. This was formerly called the "kyesteinic pellicle," and was supposed to be diagnostic. It is no longer considered as of any diagnostic significance whatever. The urin of pregnant women increases in quantity, and becomes more watery, the specific gravity often approaching 1,014, yet the quantity of urea and other solids excreted remains at the normal point. During the last three months of gestation the urin of pregnant women contains twice or three times the normal amount of urobilin-showing the greatly increast work thrown upon the kidneys. There is no diagnostic change in the urin of the pregnant woman.-ED.]

Asthma.

Editor MEDICAL WORLD:-Man about 55 years of age suffers greatly from asthma. His father who died during a paroxysm of the disease (probably from cardiac dilation from what I can learn from the symptoms) had it for years, and the brother of this man also has it. The paroxysm comes on at night shortly after dark and continues until daylight, during which the patient suffers extreme agony and sometimes pain. The paroxysms are more frequent in fall and winter. His chest is somewhat emphysematous, and heart sounds are accentuated and probably heart is some larger than normal. Arterio-sclerosis present. Kidneys normal as near as can be ascertained. What will lessen the frequency of the paroxysms? Have tried heart stimulants, syrup hydriodic acid, etc., with little benefit, E. T. KREBS.

Bridgeport, Cal.

[Where they are nicely tolerated, large doses of the less irritating bromids, combined with iodid of potassium, help to retard the paroxysms in nearly all cases of asthma. Such is the composition of one of the most popular internal remedies among the nostrums. The manufacturers ask $3 per bottle, and get it, too. A combination of equal parts of powdered

lobelia leaves, powdered stramonium leaves, powdered nitrate of potash, and powdered black tea leaves, made into a powder, and a half teaspoonful burned under an inverted funnel and the fumes deeply inhaled, will give relief during the paroxysm. This powder is similar to a nostrum of great popularity among asthmatics, and sold at $1.00 per box. Protect him in as far as possible from cold drafts and sudden atmospheric changes. Have him wear light woolen underclothing at all seasons of the year; or if he will not submit to this, at least insist on a light woolen shirt. Keep the skin, bowels, and kidneys acting freely. Do not allow him to eat more than the system really demands. Keep the air in his sleeping apartments warm, and it is generally preferable to make it moist by steam which may be impregnated with balsams, or spirit of turpentine.

Institute appropriate treatment for the cardiac condition. This, in itself, will frequently cure asthma of which any other exciting cause can not be ascertained. Always remember that the proper treatment of asthma, even when actual emphysematous changes are well advanced, is instituted by endeavoring to ascertain the exciting cause. Too many practicians approach asthma as a disease; it is always a symptom.-ED.]

worse.

"A pulsation all thru me; when I lie down it is This flashing in my head is mostly on the left side. When not flashing, have a burning, cutting feeling nearly all the time, also a constant numb, dead feeling in the bones; in head, neuralgia or rheumatism in left side, and right too at times. The pain is very sharp; darts and flashes about. The burning, gripping sensation similar to the feeling in my head is all over my body in places, but not so bad. I feel it in my feet (more so than elsewhere except face and head) especially in heels. I have a numb pain in my left side. It extends to my stomach, across my kidneys, on the left side. Have pains like rheumatism, at times all over my body. It itches awful, especially my hands and arms; at the same time have a breaking out; it almost sets me crazy. Also suffer with a burning in my feet, and suddenly they are icy cold." Wayside, Md. T. L. HIGDON.

[The pain is probably rheumatic in character, and the eruption likewise a manifestation of the uric acid diathesis. There is probably a nervous element in the case, and it is likely that the nerves themselves are affected. In such cases there is no practical benefit to be derived from attempting to make a differentiation between rheumatism and neuralgia. At her age, a complete cure of what is probably a chronic tendency is hardly to be expected; yet great relief will be experienced by a prolonged course of the following treatment.

Maintain complete control of the nervous system by camphor monobromate; this will require five grains every four hours for a time, when the dose may be reduced, or it may be given intermitently as required. Keep her bowels acting freely, yet not to the point of purgation, with any of the salines, say Rochelle salt. Have her drink freely of water, and incorporate with it effervescent lithia salt in small doses, yet taken frequently enuf to keep the system constantly saturated with the alkaline effect; the full amount taken in a day should reach the maximum dosage. See that the soap used in bathing is non-irritating. If the itching does not rapidly subside under this treatment, make her a liberal supply of solution of hyposulfite of soda and direct that it be sponged freely over all itching areas as frequently as necessary to allay the itching.--ED.]

Obscure Trouble in Back.

Editor MEDICAL WORLD:-Mr. G., farmer, aged 30, married, habits, appetite, and bowels O. K. History: Some years ago an attack of blood poisoning. Can get no information regarding it, but it was while a boy at home. About three years ago he began to be troubled with a severe aching in the lumbar region (bilateral), at times extending to occiput. Pain comes on only when in recumbent position. In the morning on rising there is a stiffness and slight tenderness of the muscles of the back, which wears off in an hour or so. Gives little if any trouble during the day, except occasionally on receiving a jar or jolt. But during the night the severity of the pain causes him to writhe, moan, and grind his teeth in agony till he is compelled to rise to rest his back. Examined patient about three months ago; no tenderness along spine, in muscles, or kidneys; no evidence of aneurysm, Pott's disease, or stone, except as above. Urin: Amount normal, but slightly clearer than normal; no odor; reaction acid; sp. gr., 1,015; no albumin. Diuretics have raised the sp. gr. to normal.

Patient has tried patent medicins, been the rounds of the doctors here, tried the osteopaths, all with little, if any help. I have tried lithium citrate, the salicylates, diuretics, saw palmetto compound, tonics, various liniments, with slight temporary relief. W. B.

Iowa.

[Doctor, you need waste no time or money on liniments in such cases. That is the first treatment instituted by the patient before consulting a physician, and it is usually pretty thoroly done, too.

We believe you will find the trouble in the kidney. Read up carefully on floating kidney, and then examin again. The position dominating the appearance of the pain could hardly be accounted for in any other way. You may possibly have stone in the kidney or in the ureter, but a good X ray examination at the hands of an expert radiographer will probably settle that matter of doubt; do not base a conclusion on such an examination conducted by yourself, or by any other person except one who has had extended experience in such work. Examin the urin repeatedly and carefully. If you do not have a microscope and centrifuge, it would be advisable to get them.

Success in this case would mean much to you in the way of prestige, and if this man has "suffered many things of many doctors," he would probably be satisfied to pay generously for relief or cure.

Try adjusting a firm bandage of several thicknesses of muslin so pinned as to fit the body closely from iliac crest to ribs, while in a standing position, and then allow him to lie down, and note effect. You are perfectly competent to make a diagnosis in this case, and were we in your shoes we would not rest until we had succeeded. Study your case well and make your examinations thoro, and as frequently as you think of something new to look for. Do not make the mistake so many practicians make; i. e., making an examination without having anything definit in view as to what to look for. Look for something definit, and make a diagnosis by exclusion. We hope the suggestions may give you some new thought, and believe when you succeed on this case that a carefully written report would be of interest to the family.-ED.]

Whooping Cough.

MR. EDITOR:-Would be glad if you would give me VA. the best treatment for whooping cough.

[Your query is of sufficient general interest to warrant considerable space at this time, and we therefore quote from Diseases of Infancy and Childhood, Koplik, publisht by Lea Brothers, the complete treatment that author gives for whooping cough. This author is a

leader in this class of practise, and you can consider the extract on pertussis as up to date and authoritativ.-ED.]

The patient should be isolated, and should sleep in a large, well ventilated room. During the day the sleeping-room may be filled for an hour with the vapor of formalin (set free by means of a small formalin lamp). The object is to destroy suspended germs. [We presume that the author means that the patient shall be removed to an adjoining room during the fumigation.-ED.] If two communicating rooms are available they may be occupied alternately every twenty-four hours, the unoccupied room being fully ventilated in the interval. In this way reinfection may be avoided. In spring and summer, if the weather is favorable, the children should be constantly in the open air during the day. In large cities the mother is directed to take the children into the park. When in the open air the paroxysms are notably lessened. The child should be warmly clad in winter. Sea air seems to aggravate some cases and benefit others. Pine woods and moderately high altitudes are probably the most beneficial, for the patients are not exposed to the unfavorable climatic conditions peculiar to the sea coast.

Medicinal treatment consists of inhalations, topical applications, and internal remedies. Simply to enumerate all the remedies which have been proposed and used in pertussis would take up the space of a monograph. Inhalation of ozone has been advocated by Caille. The remedy is expensiv and the apparatus not readily procurable. Inhalation of a mixture of 20 percent nitrous oxid and 80 percent oxygen is beneficial in cases in which the heart is weak. The inhalations are given with a cone for ten minutes twice daily. Insufflation of quinin or other drugs has not