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Powder Stains.

embody the appearance of the lesion in the Editor MEDICAL WORLD :-Please send

name, but as the appearance is so variable and treatment for powder stains of two years' standing. My son, 13 years old, got burned on right side of face.

shifting, this is manifestly impossible. Butlin Have not found anything that would remove the dis

and Spencer, and they are the best authorities, coloration.

F. L. Foscue, M.D. prefer the name Wandering Rash, and this is Demopolis, Ala.

the name adopted by the College of Physicians [We quote from Stelwagon, - Diseases of

of London. It is a rare disease at best, but is the skin,” publisht by W. B. Saunders & Co., generally noted in children. If you observe Philadelphia, as follows : “ Powder stains are

one of the patches long enuf, you will note practically similar to tattoo marks. If the case

that it gradually enlarges until the outer circle comes under observation shortly after the acci

reaches the edge of the tongue, when it will dent, many of the marks can be pickt out.

pass to the under side and thus become in outLater, this same plan may prove of service, but much better is the removal by the method of border does not contain pus. Subjectiv symp

line but the segment of a circle. The yellowish using a cutaneous trephine of extremely small

toms are generally so mild, or absent entirely, caliber, as originally suggested by Watson, and

that the disease is discovered by accidental exsubsequently brought into general use by the

amination of the tongue; yet in a few inpaper by Keyes. The punch is placed over the

stances mild salivation has been noted. Of the powder speck and given a slight rotary motion,

cause, nothing is known absolutely. Parrot pressing firmly, but not going down to un- claims it to be due to congenital syphilis ; necessary depth; the little disk of skin tends

Fournier to “parasyphilis"; other observers to jut out, can be snipt off, and the cavity deny any connection with syphilis. Debility filled with powdered subsulfate of iron or a

and weak digestion may have something to do paste of tincture of benzoin and boric acid, or

with it. The course is one of incurability for with a compound powder of boric acid and

months or years, regardless of what treatment acetanilid. With care and skill, not cutting 'may be adopted. It occasionally undergoes too deeply, the little scars left become prac- complete spontaneous cure.

The variations are tically unnoticeable. More recently the appli, often rapid, but in many cases are so slow as cation of peroxid of hydrogen has received only to be noted by weeks. favorable comment, Crile, Rhoads, and Clark

It is generally necessary to do something to reporting satisfactory and rapid results. It is allay the minds of the parents, and mildly applied in full strength, freely and often, and astringent lotions of tannic acid, alum, sulfate if not irritating, it can be kept constantly ap- or chlorid of zinc may be employed locally; plied on lint, wetting this from time to time.

and cod-liver oil, iron, quinin, and strychnin Crile used a 'concentrated solution, which

may be given internally. In most cases the was applied on lint until a white zone had ap- actual results of the disease are nil; and it may peared around and under the grains, and until

be considered trivial; yet its great rarity, and bubbling had ceast, after which they are

the likelihood of its being taken for something readily removed by any pointed instrument. serious, is deserving of attention. It would be Clark used a solution of one part glycerin and

a good thing for you to take good photographs three parts hydrogen dioxid, and applied of the case from time to time, and send them freely, on lint if not irritating, and the stains

to us for possible use. Do not curet, or do disappeared. In addition to these several

anything else radical. All treatment has been methods, the tattooing in of glyceroid of found unavailing by the best and most experpapoid has also been commended.”—ED.] ienced pediatrists, and you would better stay Erythema Migrans.

on the safe side, and do nothing more than

treat the case expectantly. It would be but Editor MEDICAL WORLD :- Male, aged 2 years. Family history perfect. A circle of rings or elevated patches right to tell the family the whole truth; then on tongue; has existed since birth, Looks like if they wish to discharge you and waste their ringworm. Looks worse at times, like it might con- substance on quacks, you are well rid of the tain pus. I have given him intestinal antiseptics, and applied H2O full strength locally. Child seems to be

case except for scientific purposes.-ED.] in perfect health otherwise. Please give diagnosis and treatment. I think to curet it would be the thing to do, and apply some antiseptic.

Best Anesthetic for Cervix Operations. Nesbitt, Tex. C. A. CANTRELL, M.D.

Editor MEDICAL WORLD:-Can cocain be used with [The affection is known as Erythema Mi- safety in repairing old lacerations of the cervix ? grans, or wandering rash of the tongue. Many

Many Quantity of cocain that can be used hyp. safely? Is

there any anesthetic as safe or safer and as satisfactory names have been applied to it by observers in

as ether or chloroform? If so, please give details. different countries; some endeavoring to find Pittsburg, Ohio.

J. O. STARR, M.D. a nomenclature assigning a meaning along the [It is not possible, in the space at our dislines of skin diseases, such as “ringworm of posal in this department, to cover the ground of the tongue”; others have endeavored to general and local anesthetics. You can only get such information from careful study of the a good way to lose some money, or at least to best modern text-books.

pay pretty high for something you should know Ether is the agent of choice in operation for already. The plan is very much like advertisold laceration of the cervix. The necessary ing a cure for constipation, and expecting a manipulations involve much more tissue than medical man to “bite." You note that none of the cervix itself; the vagina must be put on the circulars tell anything, and that no backing the stretch to gain room for the instruments; or references accompany the “guarantee.' the uterus must be drawn down so as to render -Ed.] the cervix accessible; and there are many

Tooth Extraction without Pain. other considerations which render the use of

Editor MEDICAL WORLD:-Some of the dentists at cocain inadvisable in such cases. Ether and

Buffalo extract teeth without pain by brushing a liquid chloroform are the agents of choice in all but on the gums and teeth. Can you give the formula of the minor operations, ether being the safer, yet any liquid preparation that will do it? I am too old to

learn many new tricks, but would like to know this. the most disagreeable. Nitrous oxid gas is the

Inclosed $3 for WORLD, four years. safest general anesthetic, but it requires a

M. H. COLE, M.D., Newfane, N. Y.

(8 N. Y. Vol. Cav.) special apparatus for its administration. One of the most pleasant and the safest methods of

[There is no drug which will entirely relieve inducing general anesthesia, is to start the

the pain of tooth extraction when employed in

that manner. anesthesia with nitrous oxid gas, and follow it

Strong solutions of cocain, or of with ether after the patient is partially uncon- any of the proprietary medicins resembling it, scious; it requires no special skill, but the

will obtund the sensibility of the gums to a special apparatus is necessary. No one should

certain extent. Cocain may be employed in attempt to give the anesthetic and operate at

solution in strengths of 10 percent, but it the same time, and no one should give any

should not be used recklessly nor in excess. general anesthetic until he has studied the protracting teeth has been publisht in Secret Nos

The following local application for use in excess repeatedly as conducted by an expert anesthetizer.

trums and Systems: Cocain is rapidly absorbed by the mucous

Hydrochlorate of cocain

5 parts Crystals carbolic acid.

6 parts membranes, paralyzing the peripheral nerve Pure gum camphor

6 parts endings, and is used in solutions up to 20 per- 95 percent alcohol, enuf to make 120 parts cent strength. The dose is the same as by the and is used by saturating a piece of absorbent mouth, and you can readily figure out the cotton with it and pressing against the gums maximum and minimum amount. Unless co- for a few moments. -Ed.] cain can be confined by ligature in the circulation of the immediate part to be operated

Enlarged Vein. upon, it cannot be said to be either a safe or a Editor MEDICAL WORLD:-I have been a subscriber satisfactory anesthetic. It is treacherous, and

and reader of the most instructiv MEDICAL WORLD

for many years, but have not yet seen the enlarged the minimum dose may kill, or the maximum blood vessels discust. Have a case, a woman with dose be insufficient.-ED.]

enlarged vein in the right leg; begins seven inches above knee, on posterior surface till below the knee,

then comes to anterior surface of leg to the foot; “ How to Grow Tall."

blood seems to spread out over the leg just under the Editor MEDICAL WORLD:-1 inclose circular skin. It is very painful. I will try an elastic stockand literature from “The Cartilage Company," of

ing. Rochester, N. Y., and would like your judgment in

Also, here is a very perplexing subject on which I regard to the claims made by said company.

wish to hear the World's experience. A child, who Granger, Mo.

W. M. MUNSELL. was as fair as any child till the age of 5, when his

neck lookt to be sunburned; but now, at age of 6, [We do not know anything about this sys

it is very dark and the skin is dry and rough. What tem. It is advertised extensivly in the pop- is the cause, diagnosis and treatment? LA. ular cheap magazines of the day. Before [The elastic stocking will give relief, but it investing, it is well to make sure that you is but a palliativ procedure, and the expense of thoroly understand the terms of the “guaran- keeping the stocking in good repair is considtee,' and it is also well to have your local bank erable. You should have stated the age of the ascertain what value such a guarantee has com- patient, and how many children she had borne. mercially. It is intimated that electricity Operation is the best method in aggravated forms part of the “ treatment," and if this be cases in women who are no longer young. We the case, that part of it can be set down as a quote from Operativ Surgery, Bickham, pubpure and simple “fake." Possibly some form lisht by W. B. Saunders & Co., Philadelphia, of exercise is prescribed with it which will Pa., price $6.00, out in 1903, as follows: be beneficial, but any doctor should be " As illustrativ of the technic of phlebectomy able to tell any patient off-hand how to in general, partial excision of the internal go thru just such movements for the benefit of saphenous will be described for varicosity of any part of, or of the entire body. You are in that vein and its branches—the operation con

. I ounce

. 2 ounces

sisting in the total removal of sections of the crease the proportion of corrosiv sublimate; vein and its branches at intervals along its we have used it in much stronger solutions with course. (1) The site and course of the veins much success. It is not at all dangerous, are previously markt with nitrate of silver stain locally applied. The danger is in confusing (on the previous day, to allow of darkening), the solution with other medicin. The followthat the landmarks may not be lost during the ing prescription has been employed with satisoperation. The limb is shaved. An Esmarch

faction in many cases of chloasma arising from is generally used to control hemorrhage. (2) various causes : Over the course of the vein (or slightly to one R side, or obliquely crossing it) incisions of from Ointment oxid of zinc 8 to 15 cm. (3 to 6 inches) are made at inter

Ointment ammoniated mercury

4 drams vals-extending, if necessary from the inner

Simple cerate, enuf to make .

Mix, and apply daily. side of the foot to the saphenous opening in

Give due attention to the hepatic function the thigh. These incisions are especially by means of cholalog remedies, and mair tain placed over the most markt groups of veins

perfect excretory action of the skin by frequent and those nearer the saphenous opening are and thoro bathing.—ED.] the first attackt. The skin and bands of fibrous tissue binding down the vein are divided and the involved veins exposed. The vein and its

Venereal Warts. branches are entirely isolated to the extent of the

Editor MEDICAL WORLD :-Can you give me some

good application for venereal warts? Patient will not incision, by blunt and sharp dissection. The have them cut off. What can I do for them? vein is then gently drawn upon, so as to bring


J. N. T. into the open wound as much of itself and [A very efficient application is glacial acetic branches as possible—when it is gut-ligatured acid, full strength, three times daily until soreat both ends, each branch being also ligatured ness is experienced, when the treatment is sus-after which the main vein and its branches pended till soreness disappears, and is then are cut away. This site of operation is then again resumed. It is really unnecessary, expacked with gauze, until removal at all indi- cept in rare instances, to cut them off and then cated sites is accomplisht-to allow cessation cauterize; and such treatment is repugnant to of all bleeding before suturing. (3) The edges most patients.

most patients. Or, if the condylomata give of the skin wound are then sutured with silk, rise to moisture, the parts are washt with bior silk-worm gut-after which the limb is chlorid of mercury, i to 4,000, dried with abdrest,: immob lized, and slightly elevated. sorbent cotton, and painted with a ten percent Comment : (1) The removal of the vein in sec

nitrate of silver solution. Finally the parts tions appears to give as good, or better, results are dusted with a powder containing equal parts as the attempt to remove the entire vein. (2) of calomel and bismuth subnitrate and proAvoid wounding the veins in operation, which tected with a thin film of absorbent cotton ; increases the difficulties. (3) Avoid including this dressing should be changed sufficiently a nerve filament in the ligature, which has often to prevent any moisture collecting about caused much subsequent pain."

the site of the condylomata. Other powders You do not give enuf data on your second may be used, but care must be taken that they case. It may be simple chloasma; it might be are neither lumpy nor gritty. If the discharge eczema; it might be one of a dozen other is excessiv, it is necessary to check it by some things in so far as your description indicates. astringent, such as powdered alum or tannic If you want us to attempt a diagnosis, tell us acid. This will speedily dispose of the trouble. all you can about it, but first read up on the -Ed.] diseases of the skin that in your judgment come nearest this.-Ed.]

Swollen Leg.-Obscure Eye Trouble. Editor MEDICAL WORLD :- I have two cases to re

port to the World family for advice or criticism. Liver Spots.

No. 1.-I was called to see a mulatto woman, SepDEAR EDITOR:-Some time last year I noted the

tember 29, 1903, and she gave me about the following

history: Aged 56; two children, 28 and 30 years of following for liver spots :

age; no other pregnancies. Knew nothing of her R

family history. For two or three months her right leg Tinct. benzoin comp.


had been swollen so she could hardly walk on account Corrosiv merc. chlor.


of its size and numbness ; had given her no pain, and Distilled water, q. s.

Zviij she felt well otherwise till about a week before I was I have a lady of bilious temperament who is very

called to see her, when she was taken with a pain in much mortified by these socalled liver spots on face.

her right hip and right iliac region and had to take her Have tried the above, as well as other treatments, all

bed. I found her with a leg so badly swollen it was to no good. Is there anything that will clear up the

almost ready to burst, with tender spots in her thigh spots?

D, A. M.

and a diffuse swelling over her abdomen, with a slight Washington.

tenderness about McBurney's point. Temperature

101°, pulse 90, respiration 26; constipation and no [With due caution, you could materially in- appetite. The tender points in her leg gradually went

down to the sole of her foot. She lost the use of her Editor MEDICAL WORLD:-On page 92 of WORLD leg entirely, and the swelling in her abdomen grew for March you say : Smallpox is different from “Cuban worse until it extended over the whole abdominal itch." Will you kindly give diagnosis of “Cuban region, which was as hard as wood. The tender places itch?"

WARREN. in her leg and foot were so sensitiv she could scarcely bear for them to be toucht. Her temperature re

[Perhaps this clause should have been more mained the same, and she died October 6, 1903, with- carefully worded ; it was not intended to conout any other change of symptoms. No. 2.-Aged 30. General health always good, ex

vey the meaning that “Cuban itch” and cept a few brief attacks of malaria. Has led an out- smallpox are different diseases, but that there door life with plenty of exercise, etc. But here comes is a difference-in degree-just as we have the trouble. When he was a boy of 8 years, one morning about 7 o'clock, he took a pain in his eye which

separate words for mild smallpox, and for grew worse until 12 or 1 o'clock and gradually sub- severe smallpox. “Cuban itch,” as applied sided till next morning, when it returned a little worse, and so on for a week or more; and since that time it

to the eruption most frequently, refers to a has visited him from once to three times a year. Some

mild form of smallpox; and they are one and times it seems to be the most excruciating pain ever the same thing, differing only in severity. borne. Never hurts at night. Eyesight normal. Has been treated by specialists, quacks, grandmas, etc.,

Never use the term “ Cuban itch;" let it die. without relief. Case No. 2 is myself.

It was always a misnomer, and never really Have never been able to understand Case No. I to meant anything, and we are sorry we have my satisfaction. This is my first attempt to write thru the columns of

used it as often as we have. You will note that a medical journal, and as I am only a boy in the field we use it in quotation marks. The name itself of a great science, I have yet many things to learn.

has no right to existence. There is no diagnosis Spotville, Ark.


of “Cuban itch” different from the ordinary [Case I might have been one of elephanti- diagnosis of mild cases of smallpox. Our asis, but its course was very rapid for that soldiers returning from Cuba after the Spanish disease. Read up on phlebitis in connection

war brought with them an eruptiv disease that with your notes on the case.

popularly became known as “ Cuban itch." In Case II you do not give sufficient data

It was afterward discovered to be a mild form to enable us to even approximate a diagnosis.

of smallpox, for the smallpox poison becomes There is a periodical pain in the eye, aggravated mild in warm countries, and severe in cold by light; 30 years of age, and has suffered since

countries.-ED. 8 years of age: and that is all you tell us. Now if you will write out a detailed and com

Is it ethical for a doctor to insert card in local plete symptomatology of the case, we will study


H. it for you; or, better, buy some of the late Colo. good works on the eye and study it out for [This is largely according to the custom ot yourself. Any good specialist could tell you the community, and the wording of the card. whether or not there was any organic lesion or -Ed.] change in the eye; if not, it is functional, and the thing to do is to ferret out the cause, and

“ Be Wise Today.” you can do this better than anyone else. We

A rather unusual letter (addrest to the Editor are not scolding, but trying to help you by personally, which is a bad habit, as all business comleading you to a way to help yourself.' Have munications should be addrest to THE MEDICAL

WORLD-the Editor might be temporarily away) reyou taken quinin for the periodicity ?—Ep.] ceived recently, reads as follows:

“Please find inclosed check for $6, for which please place to

my credit on subscription to THE MEDICAL WORLD." Editor MEDICAL WORLD:--Please publish a test for

When I saw the check for $6, I at once thought it detecting formaldehyde in milk.


was a $3 subscription and an order for “ The Story of [We have read that a “certain test" for

New Zealand" combined, which would occasion no formaldehyde in milk is to allow a dish of it to

surprise at all; or two $3 subscriptions combined, as

friends sometimes do, or an order for two New be placed before a cat; if formaldehyde is Zealand books from some subscriber who had gotten present, even in minute quantity, she will re

one and wanted two more to present to friends. But

as I read the letter the second time and lookt at the fuse to drink the milk. We do not vouch for

check, I wondered why he should be sending so much the delicacy of the test.

money for THE WORLD. I turned the matter over We are not able to give any chemical test for

to the subscription department, where in a moment it

was discovered that our friend was in arrears since formaldehyde in milk, altho there have been

April, 1901. Three dollars of the amount paid for the publisht formulas purporting to give reactions three years back, and the remaining $3 paid for your said to be distinctiv. It is used in milk as a

years in advance. My object in mentioning this is to

show that you get more for your money when you pay preservativ only in the proportion of i to promptly, than when you are paying a back debt. 32,000, and in such quantity is harmless. -Ed.]

Moral : Don't get in arrears; but send your $3 before you get in arrears, and get credit for four years for it.

All the aphrodisiacs of value may be summed up as follows: Nux vomica, phosphorus, cantharides; the anaphrodisiacs which give results are hyoscin, bromids, camphor and lupulin.

Spirit of turpentine sprinkled on the clothing and about the bed of those suffering from urinary incontinence, will remove all the offensiv odor.-Medical Times.

CURRENT MEDICAL THOUGHT excess of mucus in the stools suggests the use

of mercurius, sulfur, or gummi gutti. Dr. Osler's Prophesy.

In appendicitis, pending operation, or when We need interstate reciprocity which willob- it is refused, the above cited author advises as viate the necessity for a doctor to take a special follows: “Early in the attack such remedies examination in each state in order to practise. as belladonna, bryonia, colocynth, cuprum, This is an outrage, and we ought to set our nux vomica and sulfur may be given; the onset faces against it. We should see that it is of suppuration calls for mercurius or hephar ; changed and that we have reciprocity between and peritonitis frequently affords indications boards having respectable qualifications.

for the use of such remedies as arsenic, canTo-day we are facing the need of a merger tharis, and mercur. corr." in medicin. We should look forward to the During a paroxysm of biliary colic some consolidation of our teaching bodies. We relief may be obtained by the application of waste much money in duplicating plants. heat and the administration of symptomatically There is not the shadow of a doubt that ten indicated remedies (belladonna, calcarea carb., years from now in this city (New York) there nux vomica); but since the cause of the pain will be only one large medical school, all teach is essentially mechanical, only an opiate can be ing being in the central body, and all practis expected to afford decided relief. Morphin, cal work being done in hospitals under a cen. grain, 64, with atropin, grain ito may be given tral organization. We should frown on the hypodermically, and in aggravated cases system of several medical schools, especially in chloroform may be necessary. When the the smaller cities.

attack has subsided, the patient should be These are the labors we have before us. placed on a diet free from alcohol, fat, sugar, Some we shall see come. Our profession to- and starch. Medicins should be selected in day, gentlemen, is not what it was twenty-five accordance with the indications present; the years ago; but what has been done is little more important are calcarea carb., chelicompared with the things we shall see done in donium, cinchona, lycopodium, nux vomica, the future.—Dr. Osler, in a speech at the St. and sulfur. John Roosa dinner.

Diet in the Control of Dystocia.

Read before the Physicians' Scientific and Protectiv Association, Homeopathic Treatment of Diarrhea in Chil. at Carnegie, Pa. By A. L. Russell, M.D., Midway, Pa, dren.--Appendicitis.--Gall Stone.

The practise of dietetics during pregnancy Referring to the diarrhea of children, Law- has been practised in a wavering and uncerrence, in Practical Medicin (Homeopathic), tain way for many generations. It had for its publisht by Boericke & Tafel, Philadelphia, object the limitation of the size of the fetus or says : In many cases alcoholic stimulation the retardation of the ossification in its bony is advisable; add half an ounce of brandy, the structure, with a view to favoring eutocia. white of an egg, and a little sugar to a tumbler. Altho the method has recorded undoubtedly ful of water, strain, and administer a tea. brilliant successes, it is not mentioned in the spoonful every hour. (Raue).

majority of text-books, and it is only in the “In mild cases early febril symptoms will sug- byways of medical literature that the matter gest the use of aconite or belladonna, while in occasionally

occasionally “ crops out." the absence of fever nux vomica is generally The idea of an exclusivly vegetable and indicated. Later manifestations will be met fruit diet for pregnant women was promulgated by such remedies as ipecac (nausea, vomiting, as early as 1840 by Rombotham, of London, green stools), veratrum viride (purging pre- who workt out his dicta upon the theory that dominating), cuprum ars. (cramps, diarrhea), the acids present in the vegetables and fruit chamomile (colic, flatulence, fretfulness), and prevented the deposition of earthy salts in the podophyllum (thin, copious, painless stools). fetal bones, and thus retarded their ossificaIn severe cases, arsenic is demanded by chole- tion, and thereby facilitated an easy delivery. raic symptoms, such as severe vomiting and There is no record in any standard work on purging, thirst, restlessness, and a tendency to midwifery of his teachings, but the principle collapse. Croton tig. may be suggested by forms the groundwork of a book popular yellow watery stools expelled with great force. among the laity, known as “Tokology." Cuprum ars. is valuable in the condition The credit of promulgating a recommendaascribed to arsenic, but with severe nervous tion for a rational diet to endeavor to limit the symptoms and pain. Veratrum alb. is re- development of the fetus belongs to Prochowquired in conditions of impending collapse, the nik He began his investigations because of patient being bathed in cold sweat. Complete the frightful mortality following induced labor collapse calls for the use of camphor, zincum in cases of contracted pelves. At the same met. or cyanide, or hydrocyanic acid. An time he noted the results following the dieting

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