the prescription, as given, the patient gets less than 1 minims at a dose. Of course, if any patient were to take the contents of the bottle at once, he would “go over the river "; but the lobelia would act likewise even if there were no nitrite of amyl in the prescription. Your druggist was over-cautious. When we print communications from our subscribers, we do not necessarily endorse what they say. Their names are signed to the articles, and they alone are responsible for the statements therein contained. The doctor has great confidence in his prescription, and in his hands it has done good service. An experience holding good thru twenty years is not to be lightly cast aside. If we had a patient in whom we deemed amyl nitrite indicated, we should certainly try it.-ED.]

Appendicitis in the Negro.

Editor MEDICAL WORLD:-Are negroes immune from appendicitis? J. E. INGLISH.

California, Mo.

[No human being can be considered as immune from appendicitis. This disease is, however, rare in the negro. We quote from Kelly-Hurdon, The Vermiform Appendix and Its Diseases, publisht by W. B. Saunders & Co., of this city, as follows: "The negro race seems to be comparativly exempt from the affection. In order to obtain some information upon this point I wrote to several surgeons practising in southern cities having a large proportion of negro inhabitants. S. C. Briggs, of Nashville, Tenn., out of several hundred operations for appendicitis, could recall only one upon a negro. He stated, however, that as the colored race in the South have their own physicians, they did not always come under the observation of others; nevertheless, he thought that the disease was rare. H. J. Inge, of Mobile, Ala., out of 149 operations, had but one in a negro, and by inquiry among other physicians found its occurrence in the race to be equally rare in their experience. L. L. Hill, of Montgomery, Ala. (in the black belt'), with a colored population of 9000, could collect the histories of only four cases that had occurred among them, and found that the physician who had been consultant for a number of years at Booker Washington's school, where there are about 1400 colored subjects, did not remember ever to have seen a case there; at the Alabama Polytechnic Institute, however, twenty miles distant, where there are 400 boys, there was an annual average of eight cases. The explanation given for this relativ exemption of the negro is that their diet is simple, that they take a good deal of out-door exercise, and that they are free from digestiv disturbances."-ED.]

As an antiseptic to the gastro-intestinal tract, ingestion of the yellow oxid of mercury in doses of grain, will often be followed by happy results.

To the compound spirit of orange add sufficient alcohol to make 250 cc. To this solution add the syrup in several portions, agitating after each addition, and afterward add, in the same manner, 375 cc. of distilled water. Mix the purified talc intimately with the liquid and then filter thru a wetted filter, returning the first portions of the filtrate until it passes thru clear. Lastly, wash the filter with a mixture of 1 volume of alcohol and 3 volumes of distilled water, until the product measures 1000 cc.

To prepare 2 pints of aromatic elixir will require 3 fluidrams of compound spirit of orange, 12 fluid ounces of syrup, 8 fluid ounces of alcohol, ounce of purified talc, and sufficient distilled water to make the volume 32 fluidounces.

If you have no method of preparing distilled water, use water from the exhaust of an engine. Of course it will be necessary to see that no oil contaminates it, and that it is caught in a clean vessel. With these precautions, it is just as good as any distilled water. -ED.]

Possibly Floating Kidney.

Editor MEDICAL WORLD:-Male, occupation farmer, age 48 years, height 5 ft. 8%1⁄2 in., weight 168 lbs. Previous illness: Suffered from malaria 6 years ago; has had a few attacks of muscular rheumatism at different times, of more or less severity; suffers some from gastric indigestion; has been a moderate smoker and drinker. Recent illness: Pain in left hypochondriac region under ribs and extending thru to back, but confined to left side. Pain is constant and worse at night. No temperature, no cachexia, no vomiting or passing of blood at any time; digestion, appetite, and bowels are fair. Some of the physicians thought at one time they could outline an enlargement, but if so, it has disappeared; but the pain continues. He has a large abdomen, and it is difficult to palpate. Some of the ablest physicians and surgeons in the South have seen this case, and it has stumpt them all so far. I ventured an enlarged spleen, but could not palpate it owing to his thick abdominal wall. Patient walks about, but suffers all the time. He claims it began from accidentally coughing one day. Has been complaining about six weeks. Auburn, Ala.

C. S. YARBRough, M.D.

[Altho rare, in such a patient floating kidney should be thought of and excluded, if possible. Were such a condition present, the disappearance of the enlargement would be explainable. The sudden onset of the pain would correspond with this hypothesis, and violent coughing could produce such a condition. In this connection, also, a dislocation of the spleen is to be considered, tho such cases are not often painful. You might be

aided in an examination by etherization. This would not, of course, reduce the thickness of the abdominal wall, but it is astonishing how great facility it adds to palpation in such cases.

Splenitis, too, is to be included in the consideration of the case; yet one would not expect a sudden onset were this the condition.

We cannot make a diagnosis, but we suggest a trial of the following: free catharsis, to unload the portal system; and either the application of a good-sized fly-blister over the tender area, or the thoro inunction of belladonna ointment.-ED.]

How Long Should a Child with Whooping Cough be Kept from School?

Editor MEDICAL WORLD:-The legislature of our state has ordered that every school in the state shall be in care of a medical inspector; and also that no child suffering from certain diseases, among which whooping cough is prominent, shall be allowed to come back to school until all danger of contamination is passed, and this is left to the wisdom or guessing of the inspector. After 52 years of practise, I have not sufficient knowledge to state the exact time of safety concerning whooping cough for either the patient or the well children. As the disease is prevalent in town, I am anxious for information. Essex, Mass.

W. H. HULL, M.D.

[Your inability to tell when whooping cough is no longer contagious is shared by the rest of the profession. Your law is weak. Why don't you take a hand in sending a few good doctors to your legislature so such silly laws will not be enacted? No doctor can tell when the child will no longer transmit the disease. If the state is going to exclude children who have suffered with this disease, the only way it can do it successfully will be to fix a maximum limit, as no two cases maintain the power to transmit the contagion the same length of time.

The ruling of the Commissioner of Health of this commonwealth, also, places the whole responsibility on the physician issuing the certificate; altho fixing a limit of 21 days from onset of measles, mumps, and chickenpox, together with a certificate of the attending physician certifying that "proper precautions have been taken for the prevention of the spread of the disease."

The duration of whooping cough varies from a few weeks to four or more months; and, doubtless, the subsidence of the ability to transmit the contagion varies thru similar limits.

In this case zeal has overstept discretion and common sense. The laity are not yet educated to the point where they will appreciate such extreme measures for their protection. The proper plan would have been to have instituted a campaign of education among the laity, teaching the reasons for imposing such strictures. We presume your law includes chicken-pox. Many families never call a physician in chicken-pox, and children from such families will attend school

right thru the course of the disease in some member of their family. This fact will not reach the ears of the health board. Then, where is the precaution of any benefit to the school children? Another family will summon a physician, perhaps; then, after recovery, the children are excluded from school for 21 days-the neighbor failing to call a physician allows his children to go to school during the time the disease exists in the home, and as soon after recovery as he sees fit. Such measures are not only senseless, but do much to prejudice the laity against all hygienic precautions. It is proper to take measures to prevent the spread of serious diseases, but to take agony over chicken-pox, which has practically no mortality, nor any complications, and only lasts a few days, would be ridiculous.-ED.]

A Case of Devilish Precocity.

Editor MEDICAL WORLD:-Please tell me what it is, and what is the best thing to be done. The case baffles me and my medical associates here. A boy three years old, colored, robust in appearance, and quite activ, both physically and mentally, appetite good, bowels regular, urin normal; has had none of the diseases common to childhood except rubeola and colds. His mental activity is best shown by the fact that, tho three years old, he reads, counts, and could enter first grade in school if he were old enuf.

For the past six weeks his mother has noticed him (especially in the mornings) laying across a chair and going thru movements just as if he were in the act of sexual congress. He has been threatened, whipt, and attempts made at scaring him, but all to no purpose. He will get behind curtains and lean against the walls to carry out his purpose. He has not been seen to use his hands. She (the mother) has, upon several occasions, caught him in the act and jerkt him from the chair and he would clinch the chair or a portion of her clothing and hold it tightly and tremble as if every nerve was exerted in the act. Upon examination at such times, his penis is found to be in a perfect state of erection, and he emits a fluid that, macroscopically, looks like normal semen-probably a trifle thinner. Examination of the penis and testicles reveal nothing out of the ordinary save an abnormal amount of moisture about the glans penis, which is covered by an irritable prepuce. The flat end of a silver probe was passed around beneath the prepuce and no adhesions, tenderness, or appreciable accumulation was there.

The mother claims that she never enjoys sexual congress, and when she does indulge, it is for her husband's sake. She has two sons, the elder being about fourteen years older than this one in question, and of an entirely different disposition. She had ten miscarriages between the two living children. The grandmother, on mother's side, was afflicted similarly to the boy, but she was not noticed until she was six years of age. Her habit was to sit with her legs crost and squirm as if in the act of coitus. The habit grew upon her so that when she was twelve years old she was stopt from school on account of it. She married at the age of fifteen years and is the mother of six girls, all married, the eldest of which is the mother of the boy in question. None of the other five daughters have ever conceived, yet none are indifferent to their husbands as is this one.

The father of the boy is a man of sober habits, and according to his and his wife's statements, he is not exceptionally passionate sexually.

The boy is very resolute and exceptional in every respect. I told his mother in his presence that "such things kill little boys, and very soon; and that if she didn't stop him he would die." He did not wait for his mother to reply, but promptly, and with a confidential air, said: Oh, no; nothing like that kills any

body; nobody dies from that; you can't scare me.' Fancy a child of three years so resolute. He will stand in the door and watch women pass the house, and if they are holding their skirts he will stoop low and peep at their "shins" and run in and comment to his mother. He even comments upon their skirts if they are attractiv. He is particularly fond of stout ladies. Upon one occasion, when askt why he liked a certain lady, he said," Because she has big, fat legs." Moral persuasion seems almost impossible, as he turns a deaf ear to it. You cannot scare him, nor does whipping help any. For two weeks I have had him on the following prescription:

Have suggested circumcision, which will probably be done sometime soon. For the past four days, tho watcht closely, he has not been seen to go thru the performance. Tho temporary relief seems to have been obtained, the history of the grandmother and the apparent determination of the "child-man" make me doubt the efficacy of drugs in the case. I have "Taylor & Wells' Diseases of Children," but I find no reference to such a condition. If there is a book that will put any light upon the subject, kindly tell me where I can purchase it. Would get it regardless of cost. Asbury Park, N. J.

W. J. PARKS.

["What is it?" We should diagnose a case of sheer devilment cropping out. The case is unusual as illustrating precociousness. We would not be surprised to learn of the child developing into a markt degenerate. We do not believe you will accomplish anything of permanent benefit by drug giving. Circumcise him, of course. See that there are no pin worms in the rectum. Have his eyes examined to be certain that no trouble arises there. Search for and eliminate any possible source of reflex irritation.

The above being carried out, we would surely advise a further and extended trial of castigation. Doubtless it will take more than the ordinary amount of whipping to conquer him. We have never known it to fail in the absence of any pathological condition. Probably this boy is but repeating the conversations of associates. If this be suspected, try isolation and diversion.

Small blisters plentifully applied over the penil surface will stop the process for a few days, and may be repeated until the "habit," if habit it be, is thoroly broken. An ordinary "spermatorrhea ring" would doubtless also accomplish results-this, you know, is a ring fitted back of the corona glandis in such manner that small teeth press against the mucous membrane when erection takes place, but do not do so when the organ is in a flaccid state.

We do not consider that family history or heredity enter into the case at all. You have an individual to deal with.—ED.]

Bites His Finger Nails.

Editor MEDICAL WORLD:-What can be done for a

youth who bites off his finger nails? The youth I have in mind is a boy 9 years of age, and seems to chew the ends of his fingers unconsciously until the nail is nearly entirely gone, and his fingers become

very sore. His parents have tried to break him of this habit, but it seems impossible.

Can you recommend me a good firm who make all kinds of abdominal supporters according to physician's direction? if so, I would be very thankful for the information. E. T. KREBS.

Carson City, Nev.

[If the chewing of the nails is practised during sleep, fasten heavy gloves on the hands so that they cannot be removed by the patient unless he wakens. Dip the tips of the glove fingers in a mixture of glycerin and bitter aloes, or of glycerin and quinin.

Gloves worn constantly thru the day will subject him to so many questions that he will soon abandon the habit. They need not be "medicated." Chastisement does such cases no good, as the biting is done unconsciously, so that the act is committed before the culprit realizes it. Firm insistence on the use of the gloves, as indicated, will not fail to cure any case of this habit.

See our advertising pages for answer to second query.-ED.]

Heart Trouble.-Pain in Toes.

One

Editor MEDICAL WORLD-Case 1: Man, farmer, age 33, married, no previous illness, appetite good, sleeps well, well nourisht, bowels regular, stomach good, not nervous, urin normal, no headache, skin fair, not rheumatic, habits good, does not use tobacco, liquor, or coffee, is strong and healthy in appearance. Parental history negativ; no bilious history. day in November, 1904, this patient, while driving, suddenly felt a peculiar sensation about the heart. He described it as being irregular, missing a beat or so at times, then beating much faster. At times it is perfectly normal; aggravated when he attempts doing physical labor or is frightened. Examination shows no organic valvular lesion. He has no pain; simply this disagreeable and irregular heart action. Has not been able to do his farm duties for a year or so. Complains some of choking sensation about the neck. No swelling; slight hacking cough. Pulse is soft, at times very irregular. I called it functional disorder. This man has been under the care of four doctors. Cardiac stimulants, etc., and sedativs have been used; no improvement. I beg the Editor and WORLD readers to give me a helping hand.

Case 2: Woman, age 55, landlady, history negativ, past the menopause, seven children, bowels inactiv, headache, especially in morning, appetite and sleep good, urin acid; has fainting spells at times. For the last three months she has had considerable trouble with three of her toes, second, third, and fourth of right foot. Pain is severe; more so when wearing shoes. She is compelled to wear slippers. Walking is difficult at times; complains of sense of numbness at plantar surface, extending from tip of toes to metatarsal bones. No swelling or redness noticed. Does not complain of pain any other place except headache. Might the condition be due to a toxemia, and eliminants indicated? Please outline the treatment. How is strychnin in people who complain of being short of breath at times? C. S.; Ohio. [We suggest that "cardiac stimulants and sedativs "" are not indicated so long as there is no evidence of cardiac weakness or disease. It is our impression that this case needs nerve treatment in the line of tonics and sedation. A patient may have an irritable heart, or suffer with palpitation of the heart, and yet fail to display the slightest sign of the popular ideas regarding "nervousness." Potassium iodid, by dilating the coronary

arteries, furnishes nutrition to the heart itself. Arsenic, especially if combined with iron, is valuable in all neuroses of the heart. Cimicifuga might also act well in his case. We suggest a careful examination of the thyroid gland, to make sure you are not dealing with an incipient goiter.

In your second case eliminants are strongly indicated. Get the skin, bowels, and kidneys acting as nearly properly as possible; free stimulation for a time would be advisable thru all the emunctory avenues. The condition in the foot may be "Morton's toe," or it may be simply rheumatic. During this "cleaning out" process, make the urin alkalin or neutral, and keep it so for a considerable period. Examin the arch of the foot with care to see that the arch is not impaired; if it is, get a support to wear inside the shoe. Even where weakness of the arch is not demonstrable, such a support often cures these cases.

If the dyspnea is of cardiac origin, strychnin may be indicated, or it may not. Make a diagnosis of the cause of the trouble before you institute treatment, always. Strychnin is, of course, a strong respiratory stimulant. ED.]

Traumatic Injury to Urethra and Testicle. Editor MEDICAL WORLD:-R. F., aged 60, good family history, straight life, married. Has had no serious illness. Orchitis in right testicle when about 18, with some little permanent enlargement. Fell upon a wagon wheel 12 years ago, injuring the perineal region. Has considerable enlargement of testicle, and considerable pain in it recently. Several years ago found slight tenderness and narrowing of the urethra about 11⁄2 inches from bladder.

The thing I fail to permanently relieve is that every night (more frequent in cold weather) there occurs in his sleep erections which do not subside until he gets up and urinates; or rather it subsides and he urinates. This is repeated from 2 or 3 to 6 or 8 times every night. Has no sexual desire, or ability for it, and has seen no spermatic fluid in 10 years, except on one occasion in his sleep.

Is troubled by a small amount of urin escaping if he does not hurry in preparation when the desire to urinate comes. Urin normal. I can relieve this last difficulty, but have been able to do but little to stop the erections. He would be willing to sacrifice the testicle if that would offer relief, but I cannot promise that it will. Bromids control somewhat, but cannot be used constantly. Local treatment gave no relief several years ago, used in urethra. He wears suspensory. Can THE WORLD or its readers help me to get this condition relieved? Had a similar case some years ago that was not helpt by several different physicians. Edmeston, N. Y.

WM. B. CAMPBELL, M.D.

[The erections, most probably, are due to reflex nerve action proceeding from the bladder. If the testicular condition were responsible, they would be diurnal as well as nocturnal. The lack of control of the "cut-off muscle" strengthens this hypothesis. The stricture may be a factor in this irritability; and the prostate, either thru hypertrophy or as a result of the injury at the time he fell upon the wagon wheel, may also enter into the case.

We suggest examination of the prostate to

find if it is enlarged or if it be the seat of chronic inflammation; and if such conditions are found, institute proper treatment. Even if local treatment some years since failed to relieve, we would use cold sounds in that urethra, employing gradually increasing sizes, until the limit is reacht. You have, of course, made certain that the bowels are never allowed to become constipated. The urin should be made neutral, and then keep watch over it that it does not develop any pronounced reaction, either acid or alkalin. Very likely there is a subacute cystitis present; have you made examinations for epithelium, mucus, or pus? The milder and soothing diuretics may serve you well, such as saw palmetto and santal, and demulcent drinks like infusion of flaxseed or of slippery elm might give a measure of relief. Colchicum, salicylate of soda, and potassium iodid have been successfully used in similar cases.

We can see no reason for advising castration unless, perhaps, the patient might be found to have an enlarged prostate and be willing to take his chances on reduction in the size of the prostate following the operation; or, if you were convinced of malignancy. Perhaps others of the family may write you with suggestions.-ED.]

Mix the bone ash with 32 fluidounces of water, add the sulfuric acid, diluted with 64 fluid ounces of water, and mix thoroly with a porcelain or glass stirrer. Now add the remainder of the water and set the mixture aside for 24 hours, stirring occasionally. Then transfer the mixture to a strong muslin strainer, and subject this to a gradual pressure (avoiding contact with metals), so as to express as much of the liquid as possible. Lastly, filter this thru paper.

The specific gravity of this solution is about 1.113 at 59° F. Average dose, 2 fluidrams.

NOTE.-The quantity of product obtained depends upon the degree of force used in pressing. By strong pressure, about 3,500 parts should be obtained. If desired, the magma may also be poured in a glass percolator, the neck of which contains a layer of fine quartz sand or asbestos, previously deprived of matter soluble in sulfuric or phosforic acids. On cautiously pouring water on top, so as not to mix with the magma, the acid solution will be displaced. But the percolation must be interrupted as soon as the specific gravity of the percolate begins to fall below 1.113. The sulfuric acid used in this preparation may be the commercial variety, provided it is free from arsenic, and of a specific gravity not less than 1.830.

-ED.]

Oleate of soda is excreted by the liver and renders the bile more fluid. For these reasons it has been advocated in the treatment of gall-stones. It may be given in pill form.

Bisulfide of Carbon for Rheumatic and Neuralgic Pains.

Editor MEDICAL WORLD:-In the July, 1901, Medical Summary, page 302, the late Dr. Ben H. Brodnax says: "Carbon bisulfide seems to be a good idea. Won't some one who has used it in other troubles give us their experiences? The druggist I bought it from said he could not send it by mail because it is inflammable. To what extent and under what circumstances? It scared me, and I kept it out of doors under a plank until I could send it to a woman who had chronic neuralgia or rheumatic pains. It cured them, for the time at least, and to this date (five months after) there has been no return of them."

In the late Dr. Ball's Multum in Parvo, he gives the following for sciatica and neuralgia: "Rub in half an ounce of bisulfide of carbon over seat of pain with finger tips. This relieves immediately; never fails."

Do you consider carbon bisulfide reliable and safe for external use in such conditions as recommended by Drs. Brodnax and Ball? Does it cause any pain when applied? and will it injure the skin? What effect does it bave when applied to animals? There is a remedy called "high-life" that when applied to an animal will almost set it "afire" for a while, and I have heard that it was carbon bisulfide.

Dean Spring, Ark. JOHN ALBErt Burnett. [When pure, carbon bisulfide is a very mobile and colorless liquid of an agreeable ethereal odor. When it has a fetid odor, this is due to the presence of other volatil compounds. It evaporates rapidly and is very inflammable-even more so than ether. It burns with a blue flame, and even the heat contained in a burning cigar will cause it to ignite if the fumes come in contact with the cigar. It is soluble in chloroform, alcohol, and the fixt oils; and it readily dissolves phosforus, sulfur, bromin, iodin, fats, volatil oils, caoutchouc, and unites with the sulfur bases to form the sulfocarbolates.

It should be kept in a cool place, in well cork-stoppered container, and remote from lights and fire.

Carbon bisulfide is a local anesthetic, also rubefacient, antiseptic, and anodyne. It sometimes gives benefit in facial and intercostal neuralgias, in sciatica, and toothache. It is reputed, when applied to the spine, to relieve the lancinating pains of tabes'dorsalis. It has also been applied to lymphatic enlargements and to syphilitic tumors, but there is little evidence that it is of value in these latter cases.

Carbon bisulfide is safe for external use, with the precautions outlined above, but the word "reliable" cannot be applied to it if you mean by that to include quotation from Ball: "Relieves immediately; never fails." We do not know of any agent or method that will relieve immediately and never fail in sciatica, rheumatism, or neuralgia. But, unquestionably, it does give quick relief in some cases. Its local application is not painful, but one should avoid inhalation of the fumes, as they are apt to induce headache, vertigo, or even talkativ delirium. Workmen continuously exposed to its fumes develop paralysis, with impaired hearing, sight, and loss of desire for food. It would injure the skin if applied in sufficient amount, and

perhaps if the area of inunction were quickly covered with an impervious covering (such as oiled silk), it might blister. In this connection, it is to be remembered that all such efforts vary with the individual susceptibility of the skin of the patient.

We do not know anything about "highlife" or its composition.-ED.]

Basham's Mixture.

Editor MEDICAL WORLD:-Will you kindly give formula, and detailed instruction for making Basham's mixture? It is about the only thing I ever write a prescription for and then the druggist (the only one here) always asks the party, Who has Bright's disease?" How long has he been sick?" "Is he bedfast?" etc. "Now you needn't go to the doctor any I can treat you as well as he. Just bring the bottle back when empty and I will fill it again." I want to get independent of that druggist. OHIO.

more.

[To prepare 1 pint of Basham's mixture requires 308 minims of tincture of ferric chlorid, 460 minims of diluted acetic acid, 8 fluidounces of solution of ammonium acetate, 2 fluidounces of aromatic elixir, 2 fluidounces of glycerin, and enuf water to bring the volume up to 16 fluidounces. To the solution of ammonium acetate (which should not be alkalin in reaction) add, successivly, the diluted acetic acid, the tincture of ferric chlorid, the aromatic elixir, the glycerin, and lastly, enuf water to make up the amount. The dose is two to eight drams.

Solution of ammonium acetate is prepared as follows: Ammonium carbonate, 5 grams; diluted acetic acid, 100 cubic centimeters. Add the ammonium carbonate (which should be free from white pulverulent bicarbonate and in translucent pieces) gradually to the cold diluted acetic acid, and stir until it is dissolved. It is to be made freshly when it is wanted. If kept on hand it absorbs ammonia from the air and becomes alkalin and unfit for use.

Diluted acetic acid is prepared by adding 1 part of acid to 5 parts of water, by weight.

Thus you can easily be independent of any druggist. All dispensing physicians should keep Basham's mixture in stock, or be prepared to make it up when needed. -ED.]

Diabetes.

Editor MEDICAL WORLD:-Please give the best you have on diabetes mellitus. N. Y. SMITH, M.D. Terral, Ind. Ter.

[We refer you to a symposium on the therapy of diabetes mellitus collected from the leading authorities, and quoted from Potter, to appear in this or an early issue. -ED.]

Diabetes Complicating Pregnancy.

DEAR DR. TAYLOR.-I said to Mrs. Lowry some days ago "Well, my subscription to THE MEDICAL WORLD has expired and I might as well send in $3 for four years, for so long as I practise medicin I won't do without it." I will carry out that idea by inclosing check for that amount. I have $5 and $3 publications coming to my table that fall far short when compared with THE WORLD, so far as information for the general practician is concerned. Keep it up to the present high standard and you will always have readers.