Demopolis, Ala.

[We quote from Stelwagon, "Diseases of the Skin," publisht by W. B. Saunders & Co., Philadelphia, as follows: "Powder stains are practically similar to tattoo marks. If the case comes under observation shortly after the accident, many of the marks can be pickt out. Later, this same plan may prove of service, but much better is the removal by the method of using a cutaneous trephine of extremely small caliber, as originally suggested by Watson, and subsequently brought into general use by the paper by Keyes. The punch is placed over the powder speck and given a slight rotary motion, pressing firmly, but not going down to unnecessary depth; the little disk of skin tends to jut out, can be snipt off, and the cavity filled with powdered subsulfate of iron or a paste of tincture of benzoin and boric acid, or with a compound powder of boric acid and acetanilid. With care and skill, not cutting too deeply, the little scars left become practically unnoticeable. More recently the application of peroxid of hydrogen has received favorable comment, Crile, Rhoads, and Clark reporting satisfactory and rapid results. It is applied in full strength, freely and often, and if not irritating, it can be kept constantly applied on lint, wetting this from time to time. Crile used a concentrated solution,' which was applied on lint until a white zone had appeared around and under the grains, and until bubbling had ceast, after which they are readily removed by any pointed instrument. Clark used a solution of one part glycerin and three parts hydrogen dioxid, and applied freely, on lint if not irritating, and the stains disappeared. In addition to these several addition to these several methods, the tattooing in of glycerid of papoid has also been commended."-ED.]

embody the appearance of the lesion in the name, but as the appearance is so variable and shifting, this is manifestly impossible. Butlin and Spencer, and they are the best authorities, prefer the name Wandering Rash, and this is the name adopted by the College of Physicians of London. It is a rare disease at best, but is generally noted in children. If you observe one of the patches long enuf, you will note that it gradually enlarges until the outer circle reaches the edge of the tongue, when it will pass to the under side and thus become in outline but the segment of a circle. The yellowish border does not contain pus. Subjectiv symptoms are generally so mild, or absent entirely, that the disease is discovered by accidental examination of the tongue; yet in a few instances mild salivation has been noted. Of the cause, nothing is known absolutely. Parrot claims it to be due to congenital syphilis ; Fournier to "parasyphilis"; other observers deny any connection with syphilis. Debility and weak digestion may have something to do with it. The course is one of incurability for months or years, regardless of what treatment may be adopted. It occasionally undergoes complete spontaneous cure. The variations are often rapid, but in many cases are so slow as only to be noted by weeks.

It is generally necessary to do something to allay the minds of the parents, and mildly astringent lotions of tannic acid, alum, sulfate or chlorid of zinc may be employed locally; and cod-liver oil, iron, quinin, and strychnin may be given internally. In most cases the actual results of the disease are nil; and it may be considered trivial; yet its great rarity, and the likelihood of its being taken for something serious, is deserving of attention. It would be a good thing for you to take good photographs of the case from time to time, and send them to us for possible use. Do not curet, or do anything else radical. All treatment has been found unavailing by the best and most experienced pediatrists, and you would better stay on the safe side, and do nothing more than treat the case expectantly. It would be but right to tell the family the whole truth; then if they wish to discharge you and waste their substance on quacks, you are well rid of the case except for scientific purposes.-ED.]

Best Anesthetic for Cervix Operations.

Editor MEDICAL WORLD-Can cocain be used with safety in repairing old lacerations of the cervix? Quantity of cocain that can be used hyp. safely? Is

there any anesthetic as safe or safer and as satisfactory as ether or chloroform? If so, please give details. Pittsburg, Ohio. J. O. STARR, M.D.

[It is not possible, in the space at our disposal in this department, to cover the ground of general and local anesthetics. You can only

get such information from careful study of the best modern text-books.

Ether is the agent of choice in operation for old laceration of the cervix. The necessary manipulations involve much more tissue than the cervix itself; the vagina must be put on the stretch to gain room for the instruments; the uterus must be drawn down so as to render the cervix accessible; and there are many other considerations which render the use of cocain inadvisable in such cases. Ether and chloroform are the agents of choice in all but the minor operations, ether being the safer, yet the most disagreeable. Nitrous oxid gas is the safest general anesthetic, but it requires a special apparatus for its administration. One of the most pleasant and the safest methods of inducing general anesthesia, is to start the anesthesia with nitrous oxid gas, and follow it with ether after the patient is partially unconscious; it requires no special skill, but the special apparatus is necessary. No one should attempt to give the anesthetic and operate at the same time, and no one should give any general anesthetic until he has studied the process repeatedly as conducted by an expert anesthetizer.

Cocain is rapidly absorbed by the mucous membranes, paralyzing the peripheral nerve endings, and is used in solutions up to 20 percent strength. The dose is the same as by the mouth, and you can readily figure out the maximum and minimum amount. Unless cocain can be confined by ligature in the circulation of the immediate part to be operated upon, it cannot be said to be either a safe or a satisfactory anesthetic. It is treacherous, and the minimum dose may kill, or the maximum dose be insufficient. -ED.]

"How to Grow Tall."

circular

Editor MEDICAL WORLD: I inclose and literature from "The Cartilage Company," of Rochester, N. Y., and would like your judgment in regard to the claims made by said company. Granger, Mo. W. M. MUNSELL.

[We do not know anything about this system. It is advertised extensivly in the popular cheap magazines of the day. Before investing, it is well to make sure that you thoroly understand the terms of the "guarantee," and it is also well to have your local bank ascertain what value such a guarantee has commercially. It is intimated that electricity forms part of the "treatment," and if this be the case, that part of it can be set down as a pure and simple "fake." Possibly some form of exercise is prescribed with it which will be beneficial, but any doctor should be able to tell any patient off hand how to go thru just such movements for the benefit of any part of, or of the entire body. You are in

a good way to lose some money, or at least to pay pretty high for something you should know already. The plan is very much like advertising a cure for constipation, and expecting a medical man to "bite." You note that none of the circulars tell anything, and that no backing or references accompany the "guarantee.' -ED.]

Tooth Extraction without Pain.

Editor MEDICAL WORLD:-Some of the dentists at Buffalo extract teeth without pain by brushing a liquid on the gums and teeth. Can you give the formula of any liquid preparation that will do it? I am too old to learn many new tricks, but would like to know this. Inclosed $3 for WORLD, four years.

Newfane, N. Y.

M. H. COLE, M.D., (8 N. Y. Vol. Cav.)

Editor MEDICAL WORLD:-I have been a subscriber and reader of the most instructiv MEDICAL WORLD for many years, but have not yet seen the enlarged blood vessels discust. Have a case, a woman with 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; blood seems to spread out over the leg just under the skin. It is very painful. I will try an elastic stocking.

Also, here is a very perplexing subject on which I wish to hear the WORLD'S experience. A child, who was as fair as any child till the age of 5, when his neck lookt to be sunburned; but now, at age of 6, it is very dark and the skin is dry and rough. What is the cause, diagnosis and treatment? LA.

[The elastic stocking will give relief, but it is but a palliativ procedure, and the expense of keeping the stocking in good repair is considerable. You should have stated the age of the patient, and how many children she had borne.

Operation is the best method in aggravated cases in women who are no longer young. We quote from Operativ Surgery, Bickham, publisht by W. B. Saunders & Co., Philadelphia, Pa., price $6.00, out in 1903, as follows: "As illustrativ of the technic of phlebectomy in general, partial excision of the internal saphenous will be described for varicosity of that vein and its branches-the operation con

sisting in the total removal of sections of the vein and its branches at intervals along its course. (1) The site and course of the veins are previously markt with nitrate of silver stain (on the previous day, to allow of darkening), that the landmarks may not be lost during the operation. The limb is shaved. The limb is shaved. An Esmarch

is generally used to control hemorrhage. (2) Over the course of the vein (or slightly to one side, or obliquely crossing it) incisions of from 8 to 15 cm. (3 to 6 inches) are made at intervals-extending, if necessary from the inner side of the foot to the saphenous opening in the thigh. These incisions are especially placed over the most markt groups of veins and those nearer the saphenous opening are 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 branches are entirely isolated to the extent of the incision, by blunt and sharp dissection. The vein is then gently drawn upon, so as to bring into the open wound as much of itself and branches as possible-when it is gut-ligatured at both ends, each branch being also ligatured -after which the main vein and its branches are cut away. This site of operation is then packed with gauze, until removal at all indicated sites is accomplisht-to allow cessation of all bleeding before suturing. (3) The edges of the skin wound are then sutured with silk, or silk-worm gut-after which the limb is drest, immob lized, and slightly elevated. Comment: (1) The removal of the vein in sections appears to give as good, or better, results as the attempt to remove the entire vein. (2) Avoid wounding the veins in operation, which increases the difficulties. (3) Avoid including a nerve filament in the ligature, which has caused much subsequent pain."

You do not give enuf data on your second case. It may be simple chloasma; it might be eczema; it might be one of a dozen other things in so far as your description indicates. If you want us to attempt a diagnosis, tell us all you can about it, but first read up on the diseases of the skin that in your judgment come nearest this.-ED.]

Editor MEDICAL WORLD:-Can you give me some good application for venereal warts? Patient will not have them cut off. What can I do for them? Ill.

J. N. T. [A very efficient application is glacial acetic acid, full strength, three times daily until soreness is experienced, when the treatment is suspended till soreness disappears, and is then again resumed. It is really unnecessary, except in rare instances, to cut them off and then cauterize; and such treatment is repugnant to most patients. Or, if the condylomata give rise to moisture, the parts are washt with bichlorid of mercury, 1 to 4,000, dried with absorbent cotton, and painted with a ten percent nitrate of silver solution. Finally the parts are dusted with a powder containing equal parts of calomel and bismuth subnitrate and protected with a thin film of absorbent cotton; this dressing should be changed sufficiently often to prevent any moisture collecting about. the site of the condylomata. Other powders may be used, but care must be taken that they are neither lumpy nor gritty. If the discharge is excessiv, it is necessary to check it by some astringent, such as powdered alum or tannic acid. This will speedily dispose of the trouble. -ED.]

Swollen Leg.-Obscure Eye Trouble. Editor MEDICAL WORLD-I have two cases to report to the WORLD family for advice or criticism. No. 1.-I was called to see a mulatto woman, September 29, 1903, and she gave me about the following history: Aged 56; two children, 28 and 30 years of age; no other pregnancies. Knew nothing of her family history. For two or three months her right leg had been swollen so she could hardly walk on account of its size and numbness; had given her no pain, and she felt well otherwise till about a week before called to see her, when she was taken with a pain in her right hip and right iliac region and had to take her bed. I found her with a leg so badly swollen it was almost ready to burst, with tender spots in her thigh and a diffuse swelling over her abdomen, with a slight tenderness about McBurney's point. Temperature 101°, pulse 90, respiration 26; constipation and noappetite. The tender points in het leg gradually went

was

down to the sole of her foot. She lost the use of her leg entirely, and the swelling in her abdomen grew worse until it extended over the whole abdominal region, which was as hard as wood. The tender places in her leg and foot were so sensitiv she could scarcely bear for them to be toucht. Her temperature remained the same, and she died October 6, 1903, without any other change of symptoms.

always good, exHas led an outBut here comes

No. 2.-Aged 30. General health cept a few brief attacks of malaria. door life with plenty of exercise, etc. the trouble. When he was a boy of 8 years, one morning about 7 o'clock, he took a pain in his eye which grew worse until 12 or 1 o'clock and gradually subsided till next morning, when it returned a little worse, and so on for a week or more; and since that time it has visited him from once to three times a year. Sometimes it seems to be the most excruciating pain ever borne. Never hurts at night. Eyesight normal. Has been treated by specialists, quacks, grandmas, etc., without relief. Case No. 2 is myself.

Have never been able to understand Case No. 1 to my satisfaction.

This is my first attempt to write thru the columns of a medical journal, and as I am only a boy in the field of a great science, I have yet many things to learn. Spotville, Ark. DANIEL MCCALL.

[Case I might have been one of elephantiasis, but its course was very rapid for that disease. Read up on phlebitis in connection with your notes on the case.

In Case II you do not give sufficient data to enable us to even approximate a diagnosis. There is a periodical pain in the eye, aggravated by light; 30 years of age, and has suffered since 8 years of age: and that is all you tell us. Now if you will write out a detailed and complete symptomatology of the case, we will study it for you; or, better, buy some of the late good works on the eye and study it out for yourself. Any good specialist could tell you whether or not there was any organic lesion or change in the eye; if not, it is functional, and the thing to do is to ferret out the cause, and you can do this better than anyone else. We are not scolding, but trying to help you by leading you to a way to help yourself. Have you taken quinin for the periodicity?-ED.]

Editor MEDICAL WORLD:-Please publish a test for detecting formaldehyde in milk. ARIZONA.

[We have read that a "certain test" for formaldehyde in milk is to allow a dish of it to be placed before a cat; if formaldehyde is present, even in minute quantity, she will refuse to drink the milk. We do not vouch for the delicacy of the test.

We are not able to give any chemical test for formaldehyde in milk, altho there have been publisht formulas purporting to give reactions said to be distinctiv. It is used in milk as a preservativ only in the proportion of 1 to 32,000, and in such quantity is harmless.-ED.]

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.

Editor MEDICAL WORLD:-On page 92 of WORLD for March you say: Smallpox is different from "Cuban itch." Will you kindly give diagnosis of "Cuban itch?" WARREN.

[Perhaps this clause should have been more carefully worded; it was not intended to convey the meaning that "Cuban itch" and smallpox are different diseases, but that there is a difference-in degree-just as we have separate words for mild smallpox, and for severe smallpox. "Cuban itch," as applied to the eruption most frequently, refers to a mild form of smallpox; and they are one and the same thing, differing only in severity. Never use the term "Cuban itch;" let it die. It was always a misnomer, and never really meant anything, and we are sorry we have used it as often as we have. You will note that we use it in quotation marks. The name itself has no right to existence. There is no diagnosis of "Cuban itch" different from the ordinary diagnosis of mild cases of smallpox. Our soldiers returning from Cuba after the Spanish war brought with them an eruptiv disease that popularly became known as "Cuban itch." It was afterward discovered to be a mild form of smallpox, for the smallpox poison becomes mild in warm countries, and severe in cold countries.-ED.]

A rather unusual letter (addrest to the Editor personally, which is a bad habit, as all business communications should be addrest to THE MEDICAL WORLD-the Editor might be temporarily away) received recently, reads as follows:

"Please find inclosed check for $6, for which please place to my credit on subscription to THE MEDICAL WORLD."

When I saw the check for $6, I at once thought it was a $3 subscription and an order for "The Story of New Zealand" combined, which would occasion no surprise at all; or two $3 subscriptions combined, as friends sometimes do, or an order for two New Zealand books from some subscriber who had gotten one and wanted two more to present to friends. But as I read the letter the second time and lookt at the check, I wondered why he should be sending so much money for THE WORLD. I turned the matter over to the subscription department, where in a moment it was discovered that our friend was in arrears since April, 1901. Three dollars of the amount paid for the three years back, and the remaining $3 paid for four years in advance. My object in mentioning this is to show that you get more for your money when you pay promptly, than when you are paying a back debt. Moral: Don't get in arrears; but send your $3 before you get in arrears, and get credit for four years for it.

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

Dr. Osler's Prophesy.

We need interstate reciprocity which will obviate the necessity for a doctor to take a special examination in each state in order to practise. This is an outrage, and we ought to set our faces against it. We should see that it is changed and that we have reciprocity between boards having respectable qualifications.

To-day we are facing the need of a merger in medicin. We should look forward to the consolidation of our teaching bodies. waste much money in duplicating plants. There is not the shadow of a doubt that ten years from now in this city (New York) there will be only one large medical school, all teaching being in the central body, and all practical work being done in hospitals under a central organization. We should frown on the system of several medical schools, especially in the smaller cities.

These are the labors we have before us. Some we shall see come. Our profession today, gentlemen, is not what it was twenty-five years ago; but what has been done is little compared with the things we shall see done in the future.-Dr. Osler, in a speech at the St. John Roosa dinner.

Homeopathic Treatment of Diarrhea in Chil

dren.--Appendicitis.—Gall Stone.

Referring to the diarrhea of children, Lawrence, in Practical Medicin (Homeopathic), publisht by Boericke & Tafel, Philadelphia, says: "In many cases alcoholic stimulation is advisable; add half an ounce of brandy, the white of an egg, and a little sugar to a tumblerful of water, strain, and administer a teaspoonful every hour. (Raue)."

"In mild cases early febril symptoms will suggest the use of aconite or belladonna, while in the absence of fever nux vomica is generally indicated. Later manifestations will be met by such remedies as ipecac (nausea, vomiting, green stools), veratrum viride (purging predominating), cuprum ars. (cramps, diarrhea), chamomile (colic, flatulence, fretfulness), and podophyllum (thin, copious, painless stools). In severe cases, arsenic is demanded by choleraic symptoms, such as severe vomiting and purging, thirst, restlessness, and a tendency to collapse. Croton tig. may be suggested by yellow watery stools expelled with great force. Cuprum ars. is valuable in the condition ascribed to arsenic, but with severe nervous symptoms and pain. Veratrum alb. is required in conditions of impending collapse, the patient being bathed in cold sweat. Complete collapse calls for the use of camphor, zincum met. or cyanide, or hydrocyanic acid. An

excess of mucus in the stools suggests the use of mercurius, sulfur, or gummi gutti.'

In appendicitis, pending operation, or when it is refused, the above cited author advises as follows: "Early in the attack such remedies as belladonna, bryonia, colocynth, cuprum, nux vomica and sulfur may be given; the onset of suppuration calls for mercurius or hephar; and peritonitis frequently affords indications for the use of such remedies as arsenic, cantharis, and mercur. corr."

"During a paroxysm of biliary colic some relief may be obtained by the application of heat and the administration of symptomatically indicated remedies (belladonna, calcarea carb., nux vomica); but since the cause of the pain is essentially mechanical, only an opiate can be expected to afford decided relief. Morphin, grain, 4, with atropin, grain 10 may be given hypodermically, and in aggravated cases chloroform may be necessary. When the attack has subsided, the patient should be placed on a diet free from alcohol, fat, sugar, and starch. Medicins should be selected in accordance with the indications present; the more important are calcarea carb., chelidonium, cinchona, lycopodium, nux vomica, and sulfur."

Diet in the Control of Dystocia. Read before the Physicians' Scientific and Protectiv Association, at Carnegie, Pa. By A. L. Russell, M.D., Midway, Pa,

The practise of dietetics during pregnancy has been practised in a wavering and uncertain way for many generations. It had for its object the limitation of the size of the fetus or the retardation of the ossification in its bony structure, with a view to favoring eutocia. Altho the method has recorded undoubtedly brilliant successes, it is not mentioned in the majority of text-books, and it is only in the byways of medical literature that the matter occasionally "crops out."

The idea of an exclusivly vegetable and fruit diet for pregnant women was promulgated as early as 1840 by Rombotham, of London, who workt out his dicta upon the theory that the acids present in the vegetables and fruit prevented the deposition of earthy salts in the fetal bones, and thus retarded their ossification, and thereby facilitated an easy delivery. There is no record in any standard work on midwifery of his teachings, but the principle forms the groundwork of a book popular among the laity, known as "Tokology."

The credit of promulgating a recommendation for a rational diet to endeavor to limit the development of the fetus belongs to Prochownik. He began his investigations because of the frightful mortality following induced labor in cases of contracted pelves. At the same time he noted the results following the dieting