[Acromegaly is pronounced as ak-ro-meg a-le, and Acromegalia as ak-ro-meg-a-le-ah.

Our knowledge regarding the pituitary body is very limited, as yet. It is known to be essential to life, but in what way is not known. The anterior lobe of the pituitary body is derived from the epiblast, and differs from the posterior lobe, which consists of nerve tissue. The structure of the anterior lobe is somewhat like the structure of the thyroid, consisting of roughly spherical alveoli containing a semifluid substance as well as nucleated cells. It is not even known that the pituitary body is at fault in acromegaly. All we know is that various pathological changes have been noted in various parts of the body in conjunction with certain pathological changes in the pituitary body. An enlargement of the face and extremities, due to enlargement of the bones, has been noted. With this there is some thickening of the skin. The countenance becomes coarse and the hands and feet gigantic. The result is merely an exaggeration of the natural prominences of the bones. The back is bowed, and the condition is not infrequently associated with a great physical strength and power which gradually diminishes until in the later stages of the disease there is great muscular weakness. Enlargement of the pituitary body has been noted in acromegaly; sometimes due to simple hypertrophy and sometimes to a new growth. Enlargement of the thyroid gland is also at times an accompaniment. Later results are mental dulness; alteration of the voice due to changes in the vocal cords, sometimes becoming an actual paresis; impairment of the senses of taste, smell, and hearing; blindness due to optic atrophy; palpitation, and even hypertrophy of the heart; menstrual derangement and early cessation of the molimen, etc. The disease has no definit duration; the course is long, and in most cases, ultimately fatal; rare cases are reported as having been arrested. No treatment of value has been discovered.

You do not state whether the hemorrhage was from vagina or rectum. We presume from vagina. Such cases are not rare, and have absolutely no bearing on fertility in later life. The superstitions of the grandmothers arise thru ignorance. When the blood comes

from the vagina, it usually takes origin in uterin secretion, and disappears without treatment and leaves no subsequent effect. One might as well say that because the breasts of a female infant became inflamed, that she would never be able to perform lactation in later life -nothing in it, Doctor.-ED.]

Protection against Physicians Carrying

Infection.

Editor MEDICAL WORLD-I am a late subscriber to THE WORLD, but by ordering several back numbers I have gotten five or six numbers, but failed to find anything concerning disinfection of the physician when treating contagious disease. I have not had any such cases yet (excepting measles), but I may be called to such cases at any moment, and I wish to know the best methods of disinfection for myself, as I have two children at home and I do not wish to take any chances. What do you advise me to do in the way of disinfecting my person and clothing when treating scarlet fever, diphtheria, whooping cough, or smallpox? OREGON.

[Purchase a pair of blue overalls and a blouse to match; let them be of good quality so that the cloth will have sufficient weight; and get them large enuf to allow for shrinkage, and so they will slip on and off easily. If there is no pocket in the blouse, have a pocket attacht on the outside for watch; another for thermometer and pencil; and another for handkerchief and towel. Get a dollar watch, a penny pencil, and a thermometer that you can leave in the suit. Get a yard of ordinary table oil cloth, with long tapes sewed on. Have your wife make a hood attacht at the back of the neck, and with a "draw string at the front, so it can be drawn closely about the face and tied under the chin; have draw strings put in at the wrist; and have large "stockings" sewed to the foot of the trousers large enuf to admit the shoes and all. Five dollars will cover the cost of watch, thermometer, pencil, handkerchief, towel and suit. If you attend a case where you will not have opportunity to use a clean basin, put one in your buggy. When called to a case you know infectious, sprinkle your suit liberally with 1 to 1,000 bichlorid of mercury solution and wrap it in the oil cloth and put the bundle under the buggy seat. When you reach your patient the suit will be uniformly moist. Leave your hat in the buggy; don the suit; tie the strings at wrists and under chin. When you leave the house, wash the face and hands (the only parts that have been exposed) in bichlorid of mercury solution, I to 1,000, remove the suit and wrap it in the oil cloth; push it under the buggy seat and go home or to your next case in perfect confidence. People may laugh at you at first, but they will not when once the wisdom of the precaution is explained to them. Your opponent who leaves a case of scarlet fever or smallpox and immediately enters another house

will hear from his patients. The damp suit will not mould, however long it may be tightly wrapt. Some physicians prefer to cover the hands with rubber gloves, which may be subjected to to the same disinfection as the suit, but we prefer the hands bare. Others, once the suit has been thoroly wet with the bichlorid, merely sprinkle it with water when using it afterwards; but we prefer to use the bichlorid each time.-ED.]

Editor MEDICAL WORLD:-I have a hard case on hand: A young man who was salivated about two months ago. His teeth are loose, and his gums are red and sore. I tried everything in the astringent line, also peroxid of hydrogen, but cannot get his mouth well. Have you a remedy that will do his case any good? If so, please give it to me thru WORLD. Halstead, Kan.

J. C. GIRK, M.D. [Diluted tincture of myrrh, saturated with potassium chlorate, is the best local application, and may be used freely. Another very good local application is the fluid extract of rhus glabra diluted with six parts of water, and saturated with potassium chlorate. Perhaps the most efficient method of checking the secretion is the employment of atropin, in doses of grain; it must be carefully watcht, of course.-ED.]

Progressiv Neuritis.

Editor MEDICAL WORLD:-Tho. H., aged 69, youngest of twelve children, all of which still live except four who died of some fever. Father and mother died at 60 and 58 respectivly; mother had suffered from "liver trouble" for 20 years. Patient served 5 years as a regular in the U. S. army on the plains, from 1854 to 1859. Was in perfect health till age of 49. Had two attacks of malaria while living in swamps of Missouri. At this time was taken very suddenly with excruciating pains in lumbar regions, which was almost unbearable; was in bed two weeks; from this he apparently recovered, except a slight curvature of spine to right; also right thigh" perisht away," but it finally assumed normal size.

He has been a Baptist preacher for 39 years; has been a close student all his life, and a moral man, never using whiskey nor tobacco. About two years ago he began to get numb in hands, which gradually went over the entire body. At present he can't feed himself, but can walk about the place. Reflexes in right leg exaggerated; in the left leg entirely lost; sensation very acute; coordination perfect; pupils contract and dilate normally; memory good; apex beat moved a little to right; arteries sclerosed.

He is a very intelligent man and would love to get well. Now, what shall I do? Shall I call it senile paresis, and give up? Or must I tell him to go to a neurologist? I want help as a young practician who knows but little.

He has never been under treatment by a regular physician. I saw him only recently. He is taking strychnin at present to increase peristalsis. He never wants water.

Henderson, Okla.

J. T. MILLS.

[We would not advise your "calling it" anything, at least in his presence, unless compelled to give a diagnosis. It is a chronic and progressiv neuritis, which it is not likely any medication will succeed in checking. We think the strychnin good, and would gradually increase it until he is taking about grain at

a dose every four hours. We would also begin with small doses of potassium iodid, and increase them up to the point of toleration. Let him accustom himself to regular and mild exercise in the open air, always stopping short of fatigue. Let him accustom himself to taking fairly large amounts of water, whether he is thirsty or not; in fact, if you can get him to take it no other way, prescribe a glass every three hours, as medicin. Examin his urin repeatedly for evidences of the uric acid diathesis. Keep his bowels free, and let him avoid stimulating foods. In short, keep him in as good hygienic condition as possible, and keep up the tonics and eliminants.

We would not send him to a neurologist; you can do just as much for him as a specialist.-ED.]

Rheumatism.

Editor MEDICAL WORLD:-About seven weeks ago I was called out in the country and found a man about 38 years old lying in bed suffering with excruciating pain in the knee; stiffness of the joint; unable to extend the limb; cannot stand pressure on either side of the joint. I examined the knee and hip joints carefully; found no sign of inflammation. I askt the patient how long he had been suffering. "A year," he said. The pain first began on the anterior of the joint a little below the patella; pain at first was very slight but gradually increast and spread on each side of the joint. He consulted a physician and took treatment; no improvement; on the contrary, the case grew worse until patient was unable to get about; had to remain in bed. The joint has never been swollen at any time, nor has the patient ever had any fever; has not received any blow nor fall on the knee. He has had several doctors to treat him, but got no benefit from their treatment. I diagnosed his case one of chronic rheumatism. I put him on the salicylate co., given in large doses, and a liniment of tr. opii, tr. aconit, tr. belladon.; ammon., alcohol and ol. gaultheria; and a hot poultice around the joint. Kept him on that for two weeks; found no change. Have also given him, in different prescriptions, potass. iodid, Fowler's sol., sarsaparilla, colchicum. Have applied locally small blisters, menthol, camphor-chloral, ichthyol, soap lin., and chloroform liniment. I am now giving him vapor baths. Since he has been taking them the pain has diminisht, but he is still unable to straighten the limb or walk. Have also dieted him; have examined his urin and found it about normal. He has never had gonorrhea; had always been healthy. Now Mr. Editor and readers of THE MEDICAL WORLD, please give me your advice in this case. Am I correct in my diagnosis? What would be your treatment and prognosis? C. J. VITAL, M.D.

New Iberia, La.

[We would consider the prognosis good, and have no criticisms on your diagnosis nor treatment, both of which we consider correct. Since the improvement has been but indifferent under the salicylates, we suggest a change to colchicum. We would perhaps say to combine the true salicylate of methyl and colchicin. Wm. S. Merrel: Chemical Company put this combination up in pearls containing grain of the latter drug, and 21⁄2 minins of the former, and guarantee that the salicylate is made from true wintergreen. We would also suggest that you substitute the super-heated air

for the vapor bath. Keep his skin acting freely and insist on his drinking large amounts of water. See that the urin is never permitted to become acid.-Ed.]

The Urin of Pregnant Women.

Editor MEDICAL WORLD:-I noticed some time ago, in some journal, an article on early diagnosis of pregnancy by an examination of the urin. Will you please tell me if it was in THE WORLD? and if so, what number? D. F. RICE.

St. Louis, Mo.

[You did not see anything in THE WORLD from the editorial pen regarding the early diagnosis of pregnancy from an examination of the urin, but it is possible some subscriber might have mentioned it. This erroneous idea bobs up every few years and runs the rounds of a certain class of medical journals that fill their columns by clipping from neighbors quite as ignorant as themselves. When the urin of pregnant women (and of other women, frequently, for that matter) is allowed to stand for a time in a vessel, a pellicle is formed on the surface. This was formerly called the "kyesteinic pellicle," and was sup posed to be diagnostic. It is no longer considered as of any diagnostic significance whatever. The urin of pregnant women increases in quantity, and becomes more watery, the specific gravity often approaching 1,014, yet the quantity of urea and other solids excreted remains at the normal point. During the last three months of gestation the urin of pregnant women contains twice or three times the normal amount of urobilin-showing the greatly increast work thrown upon the kidneys. There is no diagnostic change in the urin of the pregnant woman.—ED.]

Asthma.

Editor MEDICAL WORLD:-Man about 55 years of age suffers greatly from asthma. His father who died during a paroxysm of the disease (probably from cardiac dilation from what I can learn from the symptoms) had it for years, and the brother of this man also has it. The paroxysm comes on at night shortly after dark and continues until daylight, during which the patient suffers extreme agony and sometimes pain. The paroxysms are more frequent in fall and winter. His chest is somewhat emphysematous, and heart sounds are accentuated and probably heart is some larger than normal. Arterio-sclerosis present. Kidneys normal as near as can be ascertained. What will lessen the frequency of the paroxysms? Have tried heart stimulants, syrup hydriodic acid, etc., with little benefit, E. T. KREBS.

lobelia leaves, powdered stramonium leaves, powdered nitrate of potash, and powdered black tea leaves, made into a powder, and a half teaspoonful burned under an inverted funnel and the fumes deeply inhaled, will give relief during the paroxysm. This powder is similar to a nostrum of great popularity among asthmatics, and sold at $1.00 per box. Protect him in as far as possible from cold drafts and sudden atmospheric changes. Have him wear light woolen underclothing at all seasons of the year; or if he will not submit to this, at least insist on a light woolen shirt. Keep the skin, bowels, and kidneys acting freely. Do not allow him to eat more than the system really demands. Keep the air in his sleeping apartments warm, and it is generally preferable to make it moist by steam which may be impregnated with balsams, or spirit of turpentine.

Institute appropriate treatment for the cardiac condition. This, in itself, will frequently cure asthma of which any other exciting cause can not be ascertained. Always remember that the proper treatment of asthma, even when actual emphysematous changes are well advanced, is instituted by endeavoring to ascertain the exciting cause. Too many practicians approach asthma as a disease; it is always a symptom.-ED.]

An Old Lady's Ills.

Editor MEDICAL WORLD:-A lady, not married, 78 years old. I was called to her about 18 months ago. At that time found her suffering from what she called "flashing (a spasmodic contraction of muscles, mostly of face). Here is a description written out by her:

64

A pulsation all thru me; when I lie down it is worse. This flashing in my head is mostly on the left side. When not flashing, have a burning, cutting feeling nearly all the time, also a constant numb, dead feeling in the bones; in head, neuralgia or rheumatism in left side, and right too at times. The pain is very sharp; darts and flashes about. The burning, gripping sensation similar to the feeling in my head is all over my body in places, but not so bad. I feel it in my feet (more so than elsewhere except face and head) especially in heels. I have a numb pain in my left side. It extends to my stomach, across my kidneys, on the left side. Have pains like rheumatism, at times all over my body. It itches awful, especially my hands and arms; at the same time have a breaking out; it almost sets me crazy. Also suffer with a burning in my feet, and suddenly they are icy cold.” Wayside, Md. T. L. HIGDON.

[The pain is probably rheumatic in character, and the eruption likewise a manifestation of the uric acid diathesis. There is probably a nervous element in the case, and it is likely that the nerves themselves are affected. In such cases there is no practical benefit to be derived from attempting to make a differentiation between rheumatism and neuralgia. At her age, a complete cure of what is probably a chronic tendency is hardly to be expected; yet great relief will be experienced by a prolonged course of the following treatment.

Maintain complete control of the nervous system by camphor monobromate; this will require five grains every four hours for a time, when the dose may be reduced, or it may be given intermitently as required. Keep her bowels acting freely, yet not to the point of purgation, with any of the salines, say Rochelle salt. Have her drink freely of water, and incorporate with it effervescent lithia salt in small doses, yet taken frequently enuf to keep the system constantly saturated with the alkaline effect; the full amount taken in a day should reach the maximum dosage. See that the soap used in bathing is non-irritating. If the itching does not rapidly subside under this treatment, make her a liberal supply of solution of hyposulfite of soda and direct that it be sponged freely over all itching areas as frequently as necessary to allay the itching.--ED.]

Obscure Trouble in Back.

Editor MEDICAL WORLD:-Mr. G., farmer, aged 30, married, habits, appetite, and bowels O. K. History: Some years ago an attack of blood poisoning. Can get no information regarding it, but it was while a boy at home. About three years ago he began to be troubled with a severe aching in the lumbar region (bilateral), at times extending to occiput. Pain comes on only when in recumbent position. In the morning on rising there is a stiffness and slight tenderness of the muscles of the back, which wears off in an hour or so. Gives little if any trouble during the day, except occasionally on receiving a jar or jolt. But during the night the severity of the pain causes him to writhe, moan, and grind his teeth in agony till he is compelled to rise to rest his back. Examined patient about three months ago; no tenderness along spine, in muscles, or kidneys; no evidence of aneurysm, Pott's disease, or stone, except as above. Úrin: Amount normal, but slightly clearer than normal; no odor; reaction acid; sp. gr., 1,015; no albumin. Diuretics have raised the sp. gr. to normal.

Patient has tried patent medicins, been the rounds of the doctors here, tried the osteopaths, all with little, if any help. I have tried lithium citrate, the salicylates, diuretics, saw palmetto compound, tonics, various liniments, with slight temporary relief. Iowa.

W. B.

[Doctor, you need waste no time or money on liniments in such cases. That is the first treatment instituted by the patient before consulting a physician, and it is usually pretty thoroly done, too.

We believe you will find the trouble in the kidney. Read up carefully on floating kidney, and then examin again. The position dominating the appearance of the pain could hardly be accounted for in any other way. You may possibly have stone in the kidney or in the ureter, but a good X ray examination at the hands of an expert radiographer will probably settle that matter of doubt; do not base a conclusion on such an examination conducted by yourself, or by any other person except one who has had extended experience in such work. Examin the urin repeatedly and carefully. If you do not have a microscope and centrifuge, it would be advisable to get them.

Success in this case would mean much to you in the way of prestige, and if this man has "suffered many things of many doctors," he would probably be satisfied to pay generously for relief or cure.

Try adjusting a firm bandage of several thicknesses of muslin so pinned as to fit the body closely from iliac crest to ribs, while in a standing position, and then allow him to lie down, and note effect. You are perfectly competent to make a diagnosis in this case, and were we in your shoes we would not rest until we had succeeded. Study your case well and make your examinations thoro, and as frequently as you think of something new to look for. Do not make the mistake so many practicians make; i. e., making an examination without having anything definit in view as to what to look for. Look for something definit, and make a diagnosis by exclusion. We hope the suggestions may give you some new thought, and believe when you succeed on this case that a carefully written report would be of interest to the family.-ED.]

Whooping Cough.

MR. EDITOR:-Would be glad if you would give me the best treatment for whooping cough. VA.

[Your query is of sufficient general interest to warrant considerable space at this time, and we therefore quote from Diseases of Infancy and Childhood, Koplik, publisht by Lea Brothers, the complete treatment that author gives for whooping cough. This author is a leader in this class of practise, and you can consider the extract on pertussis as up to date and authoritativ.-ED.]

The patient should be isolated, and should sleep in a large, well ventilated room. During the day the sleeping-room may be filled for an hour with the vapor of formalin (set free by means of a small formalin lamp). The object is to destroy suspended germs. [We presume that the author means that the patient shall be removed to an adjoining room during the fumigation.—ED.] If two communicating rooms are available they may be occupied alternately every twenty-four hours, the unoccupied room being fully ventilated in the interval. In this way reinfection may be avoided. In spring and summer, if the weather is favorable, the children should be constantly in the open air during the day. In large cities the mother is directed to take the children into the park. When in the open air the paroxysms are notably lessened. The child should be warmly clad in winter. Sea air seems to aggravate some cases and benefit others. Pine woods and moderately high altitudes are probably the most beneficial, for the patients are not exposed to the unfavorable climatic conditions peculiar to the sea coast.

Medicinal treatment consists of inhalations, topical applications, and internal remedies. Simply to enumerate all the remedies which have been proposed and used in pertussis would take up the space of a monograph. Inhalation of ozone has been advocated by Caille. The remedy is expensiv and the apparatus not readily procurable. Inhalation of a mixture of 20 percent nitrous oxid and 80 percent oxygen is beneficial in cases in which the heart is weak. The inhalations are given with a cone for ten minutes twice daily. Insufflation of quinin or other drugs has not

proved beneficial. The practise seemed to intensify the paroxysms. Prior, Coggeshall, and others have proposed the application of solutions of cocain, 4 percent to 10 percent, to the nares and throat. I have had no experience with this method, nor with the local application of antitussin. [It would seem that in the hands of intelligent nurses or mothers, the weaker cocain applications might be made safely and do great good.-ED.] If the cough is very troublesome, I first endeavor to control it with full doses of antipyrin combined with tincture of digitalis. The digitalis, in doses of a drop or two several times a day, supports the heart, as is shown by the rapid disappearance of the edema and cyanosis after its administration. Antipyrin is given in doses of 1 grain for every year of age up to 5 grains every three hours. If the cough is not perceptibly relieved by this remedy after forty-eight hours, I suspend its use and give codein in full doses every three hours. Codein is to be preferred to morphin, which is advocated by Henoch. If vomiting is severe, the food is given in very small quantities in fluid form every few hours. By this method food is retained and absorbed, whereas a full meal is invariably rejected. The use of belladonna has not imprest me favorably. In several cases it seemed to aggravate the cough by drying the laryngeal mucus membrane. Bromoform I consider dangerous and of questionable utility..

Quinin in full doses three or four times daily is a favorit remedy with many pediatrists. Vaccination and the injection of diphthería serum have been proposed to abort the disease. I have had no experience with the serum treatment. In a word, the treatment of pertussis consists in applying the rules of hygiene, in mitigating the cough with antipyrin or preferably codein, and in supporting the heart with digitalis. The complications should be treated after the modern' method of bronchitis, pneumonia, and pleurisy.

Doctor Draws His Dead Line.

An interesting point in medical ethics was raised yesterday when Dr. H. John Stewart, 2118 West Lake street, appealed to the Superior Court for an injunction to restrain Dr. P. D. Whyte from practising medicin within a radius of two and one-half miles of Dr. Stewart's office.

The plaintiff alleges that he employed Whyte as an assistant a year ago, with the understanding that the young man was not to engage in his profession in opposition to Stewart.

This agreement, Dr. Stewart asserts, is being broken by Whyte, inasmuch as he has recently treated several patients of his former employer.-Chicago American, May 5, 1904.

DEAR DR. TAYLOR:-This is the H. John Stewart

CURRENT MEDICAL THOUGHT

Epsom Salts for Obesity.

A recent writer gives his experience with the strong solution of epsom salts, locally applied, in the treatment of scar tissue. He uses a 1 to 16 solution. He also recommends the drug.in treatment of obesity; in such treatment he sponges the body twice a day with above remedy, and gives a dram internally three times a day. According to his experience, obesity. yields rapidly. [External application could do no harm and is well worth trying, as the idea is novel. We would fear that a dram of epsom salts, three times a day, would unduly purge most patients.-ED.]

He

Cheyne-Stokes' Respiration. Cheyne-Stokes' respiration is commonly considered as an ominous sign, indicating immediate danger. Dr. C. O'Donovan recently reports cases which might question this. has observed in one case nocturnal attacks thru a period of seven years; in another case it was noted for four years. Both patients finally succumbed to Bright's disease. [It is evident that Cheyne-Stokes' respiration may occur at any time in any attack of acute or chronic dis

The competent and alert practician will be able to scent danger long before the respiratory centers fly such signals. While the danger is imminent, life may last for years; it is enuf to guide us in refusing to make any positiv prognosis. ED.]

Germs Not Killed by Low Temperatures.

It would appear that whatever benefit liquid air may be to medicin and surgery, it will not be along the lines of antisepsis. We quote from Gould's Year Book of Medicin, 1901, Saunders & Co.: "A. MacFadyen and S. Roland report their experiments concerning the influence of liquid air upon bacteria. They exposed a series of organisms for 20 hours to

VERE V. HUNT.

Try painting the eruption from poison oak or ivy with pure sweet spirit of nitre, renewing the application frequently.

to-192° C., without observing any changes in the virulence of the organisms or in their morphology. The typhoid, colon, diphtheria, proteus vulgaris, lactic acid, anthrax bacilli, spirillum of cholera, staphylococcus,