which meets this contention squarely, was prepared for these columns by a Michigan lawyer. Any who shall hereafter contend that State medical laws are out of harmony with the Federal Constitution, should be referred to the above.-ED.]

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.

The

[We have never observed, nor do we remember of having any report of any "special affinity" for the lungs in cases of dengue. lymphatic involvement is a well known characteristic of this disease, and the (presumable) facility with which infection could pass thru the right or left lymphatic duct might bring about such tendency. Your success should inspire you to further efforts and investigations. There is much yet to be learned about dengue. If your experiences were not merely local, and due to climatic or other assignable causes, you may be on the track of that which will tell something, and that is what the WORLD wants. -ED]

Attacks of Great Pain in Neck.

Editor MEDICAL WORLD:-Will you kindly help me in this case? Male, age twenty-nine, married seven years, in good health until four years ago, when he was suddenly seized with a terrific pain in neck, near medulla oblongata. The pain was spasmodic. During the paroxysms the pain was so great that patient seemed to be partly unconscious; pulse twenty, temperature normal, respiration thirty two. With the most heroic treatment, such as morphin, chloral, bromid, etc., the pain lasted three to four hours, with as above stated paroxysms of more intense pain, lasting ten to fifteen minutes, with about the same interval. Since having first attack, patient has had three to four attacks (just the same as first) every year. After having one of these spells patient will be very weak for a day, after which time he is as well as ever. What is it, and what shall I do to relieve this man's pain and shorten the attack when called again? Maxville, Mo.

M. Y. O'B.

[Your data are insufficient upon which to base a diagnosis, but the sudden attack and short duration, together with the regular periodicity, are indicativ of the culmination of an autointoxication. The trouble may be stomachic, hepatic, or renal in origin. We suggest a careful examination of the habits of the patient as regards elimination thru the bowels and kidneys about the time of impending at

tacks.

Saline cathartics and alkalin diuretics would be indicated.

In addition, we would suggest application during the attack of a small fly blister to the nape of the neck; or, perhaps the more quickly acting mustard plaster would be preferable. Perhaps aconite or veratrum viride would be of service, but of this we cannot say, since you fail to give the condition of the pupils or circulation. Such pain often yields promptly to gelsemium, in two drop doses; or to full doses of the fluid extract of ergot. Certainly some

such treatment would be more rational than the repeated administration of morphin.-ED.]

Do Acids, after the Ingestion of Mercury, Cause or Favor Salivation?

Dear Editor:-"Ptyalism," page 31, January WORLD: "The juice of fruits has no influence in producing ptyalism after the ingestion of mercury in any of its forms. Within the past five years I recall a score of patients who drank lemonade after the ingestion of calomel; all salivated. Twenty-four hours after taking four grains of calomel I suckt the juice of one tomato. Result: my mouth was so sore for three weeks that sweet milk was all I could attempt to chew. I strongly suggest to you, kind Editor and any doubting members of the WORLD family, that a true test can be obtained by trying the experiment at home-"yourself." Lemon City, Fla. J. G. Du Puis, M.D.

[Your patients would have suffered from ptyalism if they had not taken the lemonade. Give the same patients the same dose, under the same conditions, and withhold the lemonade, and watch the results; then write us, if you wish. Try the very same dose, under the same conditions, in your own case, and omit the tomato, and report results. You are wrong, Doctor, with the sole reservation that idiosyncrasy may have existed in all the cases cited ED.]

Dr. W. M. Holton, of New Harmony, Ind., writes that he has parts two and three of the Medical and Surgical History of the Rebellion, four volumes, in good condition, which he will sell at a fair price, as he is "about past work.”

the child, and the proper prophylactic measures. Later, one may consider the possibility of extension of the infection thru the customary channels. We believe the duty of the physician well performed, in such cases, if he prevent the specific ophthalmia. All good textbooks consider these matters thoroly, and unless your desire is along the lines of something specific outside, we believe you will get ample information there. Write us freely if we have failed to grasp your meaning.-ED.]

A Point in Ethics, or Professional Propriety.

Editor MEDICAL WORLD:-I would like to have the opinion of the Editor as well as the profession as to the propriety of a physician who is doing a special line of work, publishing in the daily papers and otherwise a card similar to the one below. Physicians in general practise are very loth to refer their patients to specialists, even tho it be cases that they themselves cannot manage successfully. Patients often say to me that they would have come to me long before had they known that I made a specialty of the disease of which they were complaining. I know of a case where a patient has been under treatment by the family physician for a year that a properly qualified specialist ought to cure in two weeks.

[The custom of the community, and the views of the profession in the locality, should be taken seriously into consideration in deciding such a question; indeed these factors should decide the question. For example, here in Philadelphia such a thing as proposed above would be frowned down immediately by the profession. Specialties are not even mentioned on modest, professional signs. specialist here gets his practise largely by making himself and his attainments known to the This is done in various ways: profession. reading papers before societies, embracing every opportunity to do clinical work, etc. Doubtless in some parts of the country a modest card in the papers might be permissible; but even then, the above card would not do. "Pelvic diseases" is too indefinit an expression even for the profession to understand clearly, much more so the laity. "" diseases successfully treated" is not strictly professional. "Consultation strictly confidential" verges on the quackish. It is understood of course that relations between physician and patient are always confidential. Let us hear from various parts of the country, but only from those in good standing with the local

Bulbar Paralysis.

Editor MEDICAL WORLD:-I would like for you and other members of the family to give me a prognosis and treatment for a case of asthenic bulbar paralysis of three years' standing, and with the following prominent symptoms, besides other characteristic ones. During the first year and a half there was a slow, gradual decline which was precipitated into a collapse in the summer of 1902. The symptoms were all made worse by a course of daily massage and baths, and in July, 1902, death came near resulting, but since then, most of the time, there has been a very slow, steady improvement until at present the patient is able to be up and around most of the time; can walk the distance of four or five blocks each day. He can talk with difficulty and in a very short time his voice fails him until he rests awhile.

There is paralysis (partial) of the muscles of the face and neck, but no dribbling of saliva nor dropping of lower jaw.

Eye reflexes are normal, and no ptosis at present, but the reflexes were impaired for a while, and a markt ptosis of one eye was present.

Dyspnea was a markt symptom for about one year, but has not bothered to speak of for one and a half years, and none in last six months. Patient cannot protrude tongue beyond lips, and can swallow no food scarcely except liquids and semi-solids; still, for a while he could only take food with the greatest difficulty.

There exists great general weakness. Sphincters are normal except from general weakness.

There is

no specific history; and habits were good, except was over-workt mentally and had considerable worry. Is twenty-seven years of age. I have tried about all the medicins recommended for such. He can't stand strychnin. Electricity does no good. At present using scutellaria, cactus, and glycero-phosphates comp. All help will be gratefully received, as the patient is myself.

Indiana.

W. L.

You

[The prognosis in asthenic bulbar paralysis is always questionable. If we knew the exact extent of the anatomical change, or if we could with certainty differentiate between it and the true bulbar palsy, it would be different. should have stated just what your exercise has been, or if you have been on the absolute "rest cure" for a time and are now walking five blocks a day. The temporary improvement following rest, if one has been accustomed to activity, is very deceptiv; sometimes it proceeds to gradual recovery, but more frequently terminates in persistent paralysis. persistent paralysis. Your data are entirely insufficient upon which to base a prognosis.

As to treatment: All cases are benefited by rest, and avoidance of mental worry or excitement. You do not state what currents you used.

Galvanization of muscles, and even central galvanization of cord and medulla is commended; but faradization irritates the myasthenic state, and is not to be used. Arsenic and phosphorus would be the next best drugs to strychnin. Drugs alone are disappointing; for there is no specific. Hygiene, careful study of foods, and the proper mastication of them, or their artificial digestion if proper mastication is impossible, is of more practical benefit than drugs. Time is the great essential to enable us to estimate the actual damage al

ready done, and to allow nature to assert herself. We will gladly answer your further queries, but it is necessary that you ask your questions more definitly and describe your case more completely, if it is to be of general interest to the balance of the family. We can only hope to keep this department open by making the answers of general interest to all.-ED.]

Nurse Should not Assume the Responsibilities of the Physician.

Editor MEDICAL WORLD:-Being the daughter, stepdaughter and sister of physicians, I was raised on therapeutics. I see you" know no man in the flesh" -you cut to the quick and "carve all around the aorta" when you call them down. Kind Editor I want you to advise me as to how far we are justified in temporizing with a patient when we feel uncertain as to the issue of an illness, especially when we know the person and his or her idiosyncrasies and peculiarities of disposition, and are satisfied that to tell the whole truth would do a positiv injury. As medicin has not as yet been reduced to an exact science, we are never entirely sure of results, until in some cases the patient is at the point of articulo mortis. Your opinion will be highly valued, not only by myself, but by a large num ber of nurses who read your pages with great interest.

I would like also to speak of a peculiar experience which occurred in my line of work recently. Mrs. S. in confinement, multipara, easy, natural labor, every condition having been as favorable as could be desired, on the tenth day at 9 p. m. she complained of feeling chilly. I put a hot water bottle to her feet, extra blanket on bed, and in a few minutes she seemed all right. But I found she askt for water in an hour after, and her face was flusht with fever.

My experience has taught me that the slightest deviation from the normal temperature in the lying-in room needs watching. Imagine my consternation when at 10 p.m. I found her temperature at 105°, and pulse 120, with rapid respiration, and a great thirst. At 12.10 a. m., patient flighty and muttering unintelliWell! gibly. I went hot and cold myself, for I feared I had met my Waterloo. No sleep for me now, and a vista of the unimaginable, and indescribable; of defeat, and a reputation for carelessness looming up in the middle distance before my eyes, making a picture very unpleasant to contemplate. This condition of things continued during the night and up to 5 o'clock a. m., when fever gradually subsided, and she progrest from that time on without the least trouble or relapse of any kind.

At this time, with a baby one month old, she is doing her own light housekeeping. Thrown upon my own resources, I used the cold compress upon the head and of course sponged the body to reduce the temperature.

I would like some one to suggest an explanation of the probable cause of this condition coming up when the functions all seemed positivly normal. The breasts were well filled, no tenderness nor symptom of mastitis, and no odor from lochia. There was no mental worry-actually no apparent cause for this condition of things. MRS. M. W. NEES, Trained Nurse.

Brazil, Indiana.

[The physician, not the nurse, should announce to the patient, or to the family or friends, according to his judgment, the nature of the illness and its probable outcome. This is the duty of the physician, and not of the nurse; and the responsibility should rest on the physician and not on the nurse. The less the nurse assumes the functions of the physician, the better for all concerned. Most physicians

will not, and they should not, tolerate a nurse who assumes the prerogativs of the physician. In the case mentioned, where was the physician? No mention is made of him, as tho none had been employed in the case. If there was not, one should certainly have been sent for upon the appearance of the symptoms described. You should never take such a risk again. You were taking a grave risk yourself, and at the same time subjecting the patient to a still graver risk.-ED.]

Backache.

Editor MEDICAL WORLD:-Mrs. N. B., age thirtytwo, mother of one child, a healthy little girl four years old. Mrs. B. complains all the time of an aching in the small of her back. About once a month she has a severe diarrhea, which makes her feel very weak. We cannot find anything wrong with the generativ organs; all seem to be in a normal condition. She has

no trouble with her stomach. The constant aching in her back, and the periodical looseness of the bowels are all that give her any trouble. Her periods are regular and all right every way. She says she feels tired most every morning on rising, like she had not slept or taken rest enuf. Will the Editor and readers of our good WORLD please tell me what to do to relieve, or cure my patient? E. E. REYNOLDS, M. D.

Seattle, Wash.

[Nearly all women have some reflex nervous manifestation every month, preceding or accompanying the molimen. You do not make it clear as to whether the periodical diarrhea is connected with the monthly flow. If it is, we do not advise interference. The ache in the back is more probably due to kidney insufficiency than to disease of the generativ organs. You should examin the urin carefully and repeatedly, and we believe you will find some abnormality in constituent or quantity. Tho woman has been described as constipated biped with a pain in her back," we do not believe any woman in seemingly otherwise perfect health should be allowed to suffer continuously with an ailment of this kind, and her doctor not be able to ascertain the cause. Insist on her drinking freely of water, and in the selection of diuretics, choose the milder ones, and the alkalies or lithia.ED.]

Mucous Colitis.

a

Editor MEDICAL WORLD:-On page 77, February WORLD, F. E. T. asks help for his wife. Tell him to give her fl. ex. chaparro amaragoso (Parke, Davis & Co.). The manufacturers issue a brochure on its use. For me it has cured three or four cases of mucous colitis and chronic dysentery, and is an invaluable remedy in these cases. It is tonic, astringent, stomachic. the Doctor wishes he may write me direct as I will gladly aid him in any way possible. Cissna Park, Ill.

W. R. ROBERTS, M. D.

If

[We were very glad to. get your suggestion, and equally glad to publish it. If you had the Doctor's address you could have written him direct, and saved us time and space. Possibly it may not now reach his eye, and be

Intestinal Tuberculosis.

DEAR DOCTOR TAYLOR:-Since writing to you in regard to my wife, (see "Enteritis," page 77, February WORLD) I have sent a sample of the mucus to Professor Kennedy, of the Barnes Medical College, of St. Louis, for microscopical examination, and he said there were a great number of tubercular bacilli in each slide examined, and said their was no relief to be had from the use of medicin. He said the only thing to do now would be to give her plenty of milk, eggs and fat meat, (the latter she can't take, it nauseates her); he also said change of climate wouldn't do her any good. Dr. Kennedy says the mucus comes from the small intestins.

I am giving her duotal and manola; duotal, grs. iij every three hours, or as much as she can take without nauseating; manola one tablespoonful four times a day, after meals and at bedtime; neurilla often enuf to keep nerves quiet. I don't know as there is any thing better that can be done. If you know, I would be glad to hear from you.

She is some better apparently than she was when I wrote before, but still has shooting pains in her bowels at times, and she don't seem to gain very much strength. The small intestins are slufing; what she passes now looks just like the mucous membrane of the intestin. I should have had the microscopical examination made before I wrote you before, but was so workt up I didn't know what to do. F. E. TRIGG. Fairmount, Ill.

[It seems to me that you are giving her too many proprietary preparations, the constituents, and consequently the value, of which, no man knows very definitly. I suggest that you abandon all medicins as soon as possible and adopt the fresh air treatment, which you

are doubtless familiar with, and which can be practised in practically any time of year, and in any part of the country, and push nutrition to the utmost limit. Professor Kennedy's advice to you was very good, but if she cannot take fat meats, give her fats in some other form; as some preparation of cod liver oil. And as

well as giving the oil internally if possible, I would also apply the plain oil externally to the abdomen. Do this every night, possibly every night and morning. Cod liver oil can be be quite effectivly introduced by inunction in this way, over a more extended surface than the abdomen. I suggest the abdomen particularly in this case, because I have known of cases of intestinal tuberculosis, particularly in children, to be apparently saved from the grave by free application of cod liver oil over the abdomen.

The time for treating tuberculosis by drugs is past. The open air treatment sounds the note of the the new treatment. It not only

Pains of Locomotor Ataxia.

Editor MEDICAL WORLD:-I am one of the unfortunate ones, suffering from locomotor ataxia since 1897, the exciting cause being diphtheria contracted from a patient. I wish some member of the profession would tell me of a tried remedy that will relieve the ataxic pains. No theoretical advice about new drugs, but some treatment they have found of real benefit in this most painful disease. I am able to walk on crutches for short distances, and came here on account of climatic conditions, which are very equable and temperate. Many invalids are sent here whose physical conditions are not suited to the climate at all, and would do better at their homes.

I would like to get something to relieve the fierceness of these pains, when they come. I would also like to get the work of testing sputa and other secretions for physicians if such were possible thru the mail.

MEDICO,

care of, ARTHUR A. COTTEW, M.D.

637 Boston Ave., San Diego.

The average expenditure upon liquor by the people of this country is seventeen dollars ($17) per head, mostly for beer; for tobacco in all forms it is six dollars ($6). Taken together, the expenditures for liquor and tobacco come to twenty-three dollars ($23) per head, while our expenditures for the support of the government last year, including the cost of war, were only six dollars ($6), or about one-fourth the cost of drink and smoke. We are proud of our system of education and we boast of our common schools, yet we apply only three dollars ($3) a head, on the average, to the support of common schools, varying from a minimum of less than a dollar in the cotton states to five dollars in Massachusetts.-Jour. of Inebriety.

The

University of Virginia, January 9, 1904. To the Editor:-About ten years ago I saw a case of typhoid fever in consultation. It was suspected, at first, that the case was one of pelvic abscess, but when I reacht the patient the symptoms were unmistakable. At this time the young woman was lying in a condition of semi-consciousness with a dry mouth and sores on the tongue, which was dry and crackt. gentleman who askt me to see the patient complained that he knew no way of preventing this distressing symptom, so often found in bad cases of continued fever. He said he had used the usual remedies, but they were unsatisfactory. Since then the treatment by the cold bath has done much to prevent, but has not entirely prevented, the dry mouth. At the time I suggested that, as the trouble arose from the weakness of the patient allowing the mouth to remain open, thus permitting evaporation from the moist surfaces of the tongue and buccal cavity, the use of an apparatus such as is customary with a fractured jaw might, by keeping the mouth closed, relieve the trouble. I had not heard from the doctor until a few days ago when writing to me he mentioned this case, and said that he had frequently made use of the suggestion, since my visit, and with unvarying success. Whenever, in such cases, the mouth became dry he used a wire cup and a bandage under the lower jaw, and in a few hours relief was always obtained.

I think it worth while to suggest this plan to gentlemen who are seeing many such cases.-A. H. Buckmaster, M. D., in N. Y. Med. Jour.

One of the best eye washes for routine work is prepared by adding three drams of powdered borax to four ounces of camphor water. Bathe the eyes freely with it four times a day, allowing a little of the fluid to run under the lids. The camphor water is prepared by dropping a few pieces of gum camphor in a quart bottle of water and allowing to stand a few days, and picking out the camphor. This is fully as good as the U. S. P. method, and much less tiresome and expensiv. Such a wash is quickly and cheaply prepared. If the pieces of camphor are large enuf to be retained in the bottle readily when dispensing from it, they may be allowed to remain, fresh water being added as fast as any of the camphor water is taken out; then one is certain of always having a supply ready for immediate

use.