Quiz Department.

Questions are solicited for this Column. Communications not accompanied by the proper name and address of the writer (not necessarily for publication), will not be noticed. The great number of requests for private answers, for the information and benefit of the writer, makes it necessary for us to charge a fee for the time required. This fee will be from one to five dollars, according to the amount of research and writing required.

Phthisis Pulmonalis.

EDITOR MEDICAL WORLD:-I have a case of tuberculous phthisis in a young lady, a family friend. The disease is in its first stage, with no breaking down of lung tissue. Physical examination shows a beginning consolidation at the apex of right lung. I have had her examined by several men, and all agree as to her condition. Fever is very moderate, very little night sweats now, less than there was a month ago, but she is considerably wasted, and has been troubled with diarrhea for the last three months. She has taken cod liver oil, hypophosphites, pepsin bismuth, and hydrastin for indigestion, &c. She is now confined to her bed from weakness. What would you recommend?

T. E. COMSTOCK, M. D.

Andover, N. Y. [The treatment of a case of phthisis requires great tact and almost infinite resources on the part of the physician. The Koch remedy has not yet demonstrated its position in therapeutics. There yet remain to us, however, the benefits to be derived from climatic changes, hygiene and symptomatic treatment.

The best climate for hope of recovery is, perhaps, the mountain region of Costa Rica, Central America. But this involves an ocean voyage. Yet, perhaps, if an American family settle there, while the climate restores health, their Yankee enterprise might also win wealth. Next in value would be any of the dry regions of the Southwest, from San Antonio, Texas, to California.

In dietetics, cod liver oil should be used, but cautiously. It should be suspended for awhile at the first intimation of gastric revolt. The diet should be nutritious and constantly varied.

The air should be kept warm, fresh and pure. If confined to the room. the air should be impregnated with the vapor of menthol or encalyptol by means of a cup of water on the stove on which a few drops of the oils may be dropped occasionally.

For the diarrhea, coto bark, sulpho-carbolate of zinc and the bismuth salts-especially the salicylate-will be found valuable.

For the fever, Niemeyer's pill (pulv. opii, gr. 4; pulv. digitalis, gr. 1⁄2 ; quinini sulph., gr. 1 in each pill), one four times daily until tever is reduced, will be found beneficial. Of like benefit, also, will be found a pill com. posed of two grains each of quinine and acetanilide, with one-sixth grain of cocaine and one hundred and twentieth of strychnine. It will be best when the fever is quite high.

Yet the sheet-anchor is Churchill's treatment with the hypophosphites of lime and soda: but you must be absolutely sure of the purity of the chemicals, and proceed cautiously, according to Churchill's directions.-ED.]

Prolapse of the Cord.

ETITOR MEDICAL WORLD:-About 11 P.M. one night I was called hurriedly to a case of confinement, multipara, third child; last pregnancy ending in miscarriage.

When I entered the room the woman said to me, "Something has come down." I made an examination and found a fold of the cord protruding from the vulva. On making still further examination I found more of the cord ready to protrude; in fact, I think all the cord had passed out of the uterus. I found the os uteri dilated to about the size of a half dollar. I tried to push the cord back between the pains, but the head of the child was so firmly pressed against the os that it was impossible. I also tried the knee and elbow position, but to no avail. The bag of waters had ruptured eight or ten days prior to this, as well as I could learn. The pains continued to increase, and at 2 A. M. the chi'd was delivered in an

asphyxiated condition. I succeeded in getting the child to breathe after about thirty minutes' effort. The placenta immediately followed the birth of the child.

The child seemed extremely weak and exhausted, and its breathing was quite diffi cult. About 5 A. M. the child died.

I would like to ask the readers of THE WORLD what is the best method of procedure in these cases.

After breathing was established in the child I felt somewhat relieved, thinking that the child would live. The mother made a normal W. M. NIBISER, M. D.

recovery. Keedysville, Md.

JEQUIRITY. The effect of this drug can be produced from abrin, its active principle. It is a brownish-yellow powder, soluble in water. It seems to be a phytalbumose, of enormous toxic powers, 100 gr. per pound of body weight being fatal if introduced directly into the blood.-Providence Medical Journal.

A Rare Obstetrical Case. EDITOR MEDICAL WORLD:-I send you the following report of a case, which is to me a very peculiar one, and I would be glad to know if any of the readers of THE WORLD ever had a similar experience.

In November last, I was called to see Mrs. S., a strong, healthy woman, forty years of age, the mother of six children, and, as I knew, was at that time six months pregnant. She appeared to be much frightened, but in no pain. She informed me, that while at stool, she had a slight attack of coughing, and at once felt something slip from her vagina, which on making an examination, herself, she found it to be a cord. She got to bed and sent for me. I found that the umbilical cord was protruding from the vagina at least twelve inches, but to my surprise it had a free end, being broken off at one extremity. There had been considerable loss of blood, but she did not know whether entirely from cord or not, but she was losing no blood then. The os was considerably dilated, and on further examination, I diagnosed cross birth, owing to a roomy pelvis and vagina. I had no difficulty in turning, by external manipulation, and two fingers in uterus, and bringing down one leg, delivered a child, about eight hours after first seeing her, and found that the cord was attached to child, so I lost no time in going after placenta, which I easily brought away entire. The woman made a good recovery, child was normal in every respect. But what was the cause of the cord breaking in two? She assured me she had not pulled at it, and I feel confident that she had not been doing anything to interfere with the natural course of

events.

Lindsay, Ont.

J. SIMPSON, M. D.

EDITOR MEDICAL WORLD:-I wish to ask my brother physicians for help, diagnosis and treatment. Mrs. S., aet., 45, married, no children. Fourteen years ago something like tetter appeared on the back of the middle finger of both hands, gradually extended up the back of the hands and forearms until it now shows above the elbows. The skin on the fingers and back of hands got dry, cracked, and bled freely from the cracks. Threw off dry, white scales. Then an active inflammation seemed to set in, little round red papules the size of a millet seed appeared, skin got red, hot, painful and swollen, with intolerable itching. The papules became so thick that they ran together.

At this stage the disease resembles exactly a

recent case of poisoning by poison oak. The surface discharges a transparent, ropy fluid, which dies into scabs and scales of a dirty white color. It does not appear on the palms, but the peculiar miliary eruption comes out on the face and neck, and, at times, all over the body. The little papules are elevated, hard and dry at first, redder than the natural skin. After a while they fill with transparent fluid, and, if not ruptured, the fluid turns a bright yellow. Also around the wrist, where it resembles a chronic eczema, there come blisters, two or three lines in diameter, which discharge, on being broken, the thick, clear fluid spoken of. The arms are now swollen to twice their natural size, deep induration, and the bone seems to ache at times. The disease gets entirely well in summer, apparently, but comes again on the first appearance of cold weather. Patient has not menstruated for five years, and noticed that the disease ran worse when menstrual function was deranged. Chrysophanic acid, the only thing used by a physician, failed. The patient has used externally muriated tincture of iron, sulphur, sanguinaria, glycerine, salt, sulphate of zinc, turpentine, acetate of lead, alum, sulphate of iron, and iodine. Internally she has taken sarsa parilla, iron, quinine, sulphur,, iodide of potassium, and many other remedies, with no good effect appreciable. What is it? and what will cure it ? M. M. HILL, M. D.

Turkey Cove, Va.

EDITOR MEDICAL WORLD:-My wife is 34 years old. She was 29 when our first child was born, and 32 when our last was born. She is rather delicate, and of a nervous temperament, but her health seemed moderately good, with the exception of severe attacks of nervous headache, which at times were almost more than she could bear, and which have been the bane of her existence since early childhood. These headaches came on at any and all times, when or after there was any act or event which called for unusual mental activity, or when she engaged in any occupation which required a concentration of sight, as reading or sewing, it would be followed in six or eight hours by an attack of headache, which would last her usually in a mild form about twelve hours, and then, without any apparent cause, the symptoms would become more severe, and, unless relieved by morphine, the suffering for the next twelve hours would be almost unendurable. Since the birth of our last boy, who is now eighteen months old, my wife has had but five or six attacks of the headache, when

She

ordinarily she would have averaged one every two or three weeks. Her general health has been as good or better than usual. nurses her boy yet, giving an abundance of milk. Appetite and digestion good. No catamenial period since the birth of last baby. Her health in every respect, with one exception, is as good as I ever saw it; but for the last six or eight months she has complained of severe soreness through her bowels, which is so severe as to awaken her by 3 a. m., and by the time for arising they are so sore that she can hardly bear to move or be moved. After being up for two or three hours the soreness, to a great extent, subsides, and does not return, generally, until the latter part of the following night. This morning she told me to put my hand over the region of the ovaries for the greatest soreness and pain; but, after making pressure over the bowels, I could not see but that the bowels were as sore at any point as another.

Will you kindly make some suggestion as to cause, diagnosis, treatment, etc.

Greenfield, Tenn.

D. W. SCATES.

EDITOR MEDICAL WORLD:-Will some of the experienced readers of THE WORLD give their views concerning a case with the following history and symptoms:

Lady, aged 49, climacteric, good physique and family history, plethoric, appetite and assimilation good, urine normal in quantity, reaction, sp. gr. and color, with a slight increase in uric acid (about .08 per cent.), first complained of acute pain in the cerebra-spinal junction, which could not be relieved by the bromides, morphia, counter-irritation, bloodletting, or alteratives. Bowels chronically constipated, but relieved by an infusion of senna and serpentaria. The pain lasted six weeks, at which time she became very stupid nad could only be aroused long enough to take nourishment and medicine. At this time, also, there was well-marked mental disorder, shown by asking repeated and foolish questions concerning some member of the family. The pupils became widely dilated, and with consequent fear of light. These three latter symptoms ran an unaltered course for three weeks, at which time there would frequently be involuntary eructations of food and gas and alvine evacuations, all of which she knew nothing about.

She rapidly grew worse in stupor, mentality, etc., until it became impossible to get her to speak intelligently or awake long enough for nourishment.

The diagnosis was cerebral hyperemia,

C. D. MOORE, M. D. Camp Knox, Green Co., Ky.

[Calcium sulphide is the preparation used by the homeopathists as "he par sulphur " or "liver of sulphur." It is a true chemical sulphide, and is prepared by heating powdered oyster shells with sublimed sulphur, to a white heat, according to definite directions.

Sulphurated lime is a mixture of calcium sulphide and calcium sulphate. It is formed by heating powdered lime and precipitated sulphur according to directions. This is the substance commonly used and known in medicine by the incorrect name of sulphide of calcium. It is very efficient in diseases characterized by the suppurative process.-ED.]

THE following are some of the hospitals, the formulæ of which are given in The Official Formulæ of American Hospitals": University Hospital (Philadelphia.) Episcopal Hospital (Philadelphia.) Philadelphia Hospital.

Children's Hospital (Philadelphia.)
Pennsylvania Hospital (Philadelphia.)
Jefferson College Hospital.

New York Hospital.
Roosevelt Hospital (N. Y.)

Bellevue Hospital (N. Y.)

Charity Hospital (N. Y.)

Long Island College Hospital (Brooklyn.)
City Hospital of Boston.

Mass. General Hospital (Boston.)

Chicago Marine Hospital, and many others.

The book is a neat, cloth-bound volume of 272 pages, and the price is only $1.00. It is worth many times the price, and should be in every physician's library. Published by THE MEDICAL WORLD. Order when you send your subscription for '91.

EDITOR MEDICAL WORLD:-Allow me to give a little experience and ask opinions of sɔme of your many readers.

On March 3, 1889, I was called hurriedly to see Mrs. K., a primipara, in labor, full term. Three days previous she said she had had some pains, when her parents' family phys. ician was called in. The waters broke before he arrived, pains became weak and infrequent, whereupon he took his leave, directing them to call me, as I was nearer, if pains should again set in. During the interval she had been up even doing some of her work. Upon arrival I found pains regular, the os well dilated, head presenting, well down. Could not, however,

satisfactorily outline it. In a short time I delivered her of a still born anencephalous female child, labor comparatively easy. Said she had felt no movements for several days previous. Patient made a good recovery. On January 21, 1890, I was called at 4 a. m. to attend her a second time Had had pains for two or three hours, but upon my arrival they had entirely ceased. As there were no indications of labor, I, after waiting a few hours, left, directing to be called should they again set in. Two weeks later I was called and found her in active labor. Had felt pretty well in the meantime, having done most of her housework, but in that interval had felt no signs of life and, through the talk of some knowing old women, she feared a repetition of the other cases. I found the os well dilated, broke waters and in a short time delivered her of a full term dead male child. Was perfectly formed, but cord was tightly wrapped three times around the neck. Ere I could remove it the child was expelled, the cord being larger than normal and much twisted upon itself. Upon removing the cord the cuticle came away with it, as it was also gone about the umbilicus, as well as signs of decomposition about head and other points.

The woman again made a good recovery. On December 6, 1890, I was again called to attend her. Waters had broken, I found the os moderately dilated, breech presenting, but pains not very strong. These soon increased, and after another short and easy labor she was delivered of a seven months dead, anencephal ous fetus. She had not felt life for several weeks, and thought herself at full term.

Husband and wife both now fear they can not have children. They had both been healthy farmer's children, and above suspicion as to any specific trouble. She had taken the best of care of herself during each of her pregnancies and had but little trouble during that time, until the absence of the child's movements

Obstruction of the Bowels.

EDITOR MEDICAL WORLD:-I desire some aid from the members of THE MEDICAL WORLD family. A very active, hard-working farmer of sixty or more years, has had several attacks of impacted feces during the last two years; two attacks during the last five weeks. The first of the two recent spells lasted nearly a week. I worked three days before my efforts were a success. I read several years ago that belladonna, pushed, was very successful in a certain doctor's hands. I read in THE WORLD that coal oil was very effective. I used large injections of warm water, also combined with turpentine, coal oil and salt, using about five quarts of the various combinations named, distending the bowels to the utmost. During this distension I used the battery over the bowels, also kneading the bowels during a partial distension. The injections were given in the knee and chest position. All this treatment was used during the attack. The first of the two attacks was produced by apple skins and the last by large raisins. Do you think that a stricture of the bowels is the cause of the trouble? Can I do anything more in a future attack? Would you advise cutting down and seeking for the trouble after all other means have failed and the symptoms are becoming urgent? W. E. CORNOG, M. D.

Sergeantsville, N. J.

EDITOR MEDICAL WORLD:-I would be very glad to have the formula for the use of iodide of zinc in tonsilar hypertrophy.

Would some of the numerous brethren also give best treatment, also pathology, of socalled hemorrhagic fever "?

GEO. S. ATTMORE, M. D. Stonewall, Pamlico Co., N. C.

Treatment of Cephalhematoma. EDITOR MEDICAL World-:—I would like to ask if any of the readers of THE WORLD ever punctured a cephalhema toma and drew off the fluid? I have just recently had a case to treat. The tumor nearly covered the left parietal

bone, the upper edge connected with the posterior fontanelle. At first I thought it was only a very large caput, but in a day or so after birth the tumor showed itself to be something else. There was no inflammatory action about it, and no constitutional symptoms that I could see. I only used some local placebo, more for the anxious parents' sake than for the child's, although the temptation to aspirate was great. I held back for fear of setting up an inflammation, and was pleased to see the tumor disappearing in three weeks, but the enlargement is still very distinct. There was a complete ridge of bone thrown out around the enlargement, and the ridge is more distinct since the tumor has begun to disappear.

I find no literature on the subject, except a mere mention of it by Smith. Did I do.right to do nothing?

Hopkins, S. C.

J. R. HOPKINS, M. D.

EDITOR MEDICAL WORLD:-Will you kindly allow me space in your valuable journal to report a case that, to me, is peculiar, and may be to some others who are just making their "debut" in professional life.

Mr. M. C., aged 72, farmer, used tobacco from his thirteenth year until about one year ago, when he stopped using it and took to chewing plantain; to use his own expression, "so as not to forget what his teeth were made for." About four months after stopping the use of tobacco he noticed a "salty taste" in his mouth, which has continued steadily up to the present time. The secretions of the mouth are so impregnated, that on standing, a granular deposit settles to the bottom of the container. He sleeps well, bowels regular, kidneys normal. He never had anys ickness excepting rheumatism; has gained in flesh since he stopped the use of tobacco. Would like to hear from some one as to the cause and treatment.

Lundy's Lane, Pa.

R. M. POWERS, M. D.

EDITOR MEDICAL WORLD:-A note written for the columns of the MEDICAL WORLD, and addressed to you in September last, has presumably, gone astray, as I have seen no mention made of it in my paper. However, I will again ask for the information therein called for, with hopes that some confrere will enlighten the undersigned, a practitioner of only three years standing.

A friend of mine complained that for months after he had been visited by la grippe (in March

or April, 1890), he was much inconvenienced by erections which would come on about three or four o'clock in the morning. Not a day passed without this being the case and yet these erections were not accompanied by any seminal emissions. The patient, who is a married man, says that he would have to get up and walk the floor for a long time in order to let this feeling of extreme unpleasantness die out. He was treated with bromide of potassium and sedatives, but without any good result. I have not had occasion to speak to him about this matter since September last, though then he had suffered for five months. What was the cause and what could be proposed for treatment? I ask for the benefit of a more experienced one's advice. Dr. E. T.

Quebec, Canada.