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While the editors make replies to these queries as they are able, they are very far from wishing to monopolize the stage and would be pleased to hear from any reader who can furnish further and better information. Moreover, we would urge those seeking advice to report their results, whether good or bad. In all cases please give the number of the query when writing anything concerning it. Positively no attention paid to anonymous letters.

ANSWER TO QUERY

ANSWER TO QUERY 5821.- "Sure Signs of Pregnancy." As to the sure signs of pregnancy, I should like to say that you certainly have covered the ground. I wish, however, to add that in my twenty years' experience I have found but very few cases of early pregnancy that would not answer to the following test:

Between the periods of the first and third months (the most tedious to test), I have

found that, by titillating or using friction over the parts between the anterior wall of the vagina and using the pubes as a base for the thumb, at the same time using friction over the clitoris, the uterus will not straighten out in the axis of its canal, when pregnant, but will recede. The exception is where the woman uses extra effort.

Dayton, O.

QUERIES

QUERY 5848.-"Wood, not Worms." R. H. H., Arkansas, sends some unusual substance voided by a woman of about 55 and asks us to identify the "parasite" which she has been passing for ten to twelve years.

What you have sent us, doctor, are not parasites, but wood-fiber, or lignin. As we have no idea of the patient's occupation or mental condition, we are unable to venture any intelligent comment, but it is possible that there is some gastric or intestinal irritation which causes the woman to desire to chew wood-toothpicks, excelsior, pine shavings, etc. It is just possible, of course, that she has worked at some place where tiny particles of excelsior float in the air, and which she swallowed, but this is very unlikely. There is no question as to the character of the substance. We trust you will look into this matter carefully and favor us with further information.

QUERY 5849.- "Elixir of Life." "Pensions for Old Doctors." J. H. F., Delaware, writes: "Do you know that Dr. Frank Starkey of Philadelphia has at last discovered the elixir of life? We may now be able to reach the one-hundred-mile post.

E. P. CLEMENS.

"Don't you think the government should grant pensions to old and worn-out physicians, men like myself, who have been in the field over fifty years, fighting an endless battle with death and disease?"

Dr. Starkey does not claim to have discovered the "elixir of life," and regrets the publicity given his preparation by the press. The real value of the Starkey formula has yet to be decided by rational clinical tests. Unfortunately, experience teaches us that birth, maturity and decay are three basic conditions which cannot be materially changed; man like every other living thing upon the earth has his "set seasons." He is produced, matures (or ripens), and dies, then disintegrates, to become again a part of the elemental substances.

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desirable thing, and nine out of ten of the octogenarians we have known have expressed a willingness-even a desire to enter upon their last long sleep. Very old people live in the past. They have no future, and the events of today are of little interest to them. As an old patient recently expressed it: "When one has to drop out of the procession it is time to go home. Nobody wants to straggle along in the gutter a half a mile behind when his fellows are marching four abreast, down the middle of the street, with the band playing ahead."

We quite agree with you that something should be done for the old and worn-out physician. He has fought a good and long fight for others, and has generally failed to secure a sufficient supply of life's good things for himself. We are trying our utmost to teach the doctor that it is his duty to be a business as well as a professional man. Where his heart and duty tell him to serve another, without reward, he should do so, but where patients are abundantly able to pay for service rendered they should be made to pay and the doctor should see that they do pay promptly. He should invest his earnings wisely while he is able to work, then, when the twilight comes and he finds himself pushed into the background, he will be independent, and, more important still, he will not enter the valley wondering what is to become of the wife who so nobly struggled with him during the years of activity, or such children as may yet be unable to make their own way in life. The first duty of every man is to see to it that those near and dear to him are protected from want when he is no longer able to care for them.

We wish our correspondent and others of the "old guard" would write short pregnant papers upon this very topic, thus impressing forcibly upon the young doctor the necessity of making hay while there is hay to make and he is capable of "getting it in." Hay there will always be; but what boots the most bountiful crop if it belongs to some other fellow or one lacks the ability to harvest the yield of his own fields. If we serve our fellow men for pay we must save part of our earnings for the inevitable "rainy period"; if we serve them faithfully and to a real extent gratuitously we are entitled to caregenerous care in our old age.

QUERY 5850.- "Cystitis and Ascending Infection." J. T. M., California, asks a diagnosis in the case of a lady, age 30, weight, 145 pounds. She has complained of

enuresis since childhood. There have been occasional attacks of mild cystitis, lasting a week or two, during the past twelve years. Two children, youngest eight years; labors normal. No history of any illness except the bladder trouble and six attacks of menorrhagia, lasting two weeks, with much pelvic or cystic pain. No reason to believe that she ever interfered with possible pregnancy, as she desired more children.

Backache and leg-ache very severe during each period since puberty. Uterus normal in size and position. Little discharge. Present trouble severe last six months, characterized by periods of a week or ten days of extreme frequency in urination with burning and tenesmus, passing usually very small quantities, usually associated with constant backache over kidneys. At these times she complains of marked uterine prolapse and dragging which she manually relieved with finger pressing uterus up. Uterus at that time very large. She was thoroughly curetted a few months ago. Her bladder capacity is 14 ounces.

This viscus has been thoroughly and repeatedly washed out with boric-acid solution, and hexamethylenamine has been given persistently, also oil of santal and various other drugs, with no apparent results. The Moro test was positive, but no tubercle bacilli can be detected in the pus, and the general appearance is robust.

One of the strange features is the passing of large quantities of high specific-gravity urine, alternating with small quantities of low, with the widest variations in its character. There has been no typical attack of renal colic and repeated radiographs fail to show stones in the kidney or ureter. No enlargement or malposition of kidney can be detected. The typical pains of nephritic colic have never appeared. The ureteral segregation test has not been made. On two occasions there has been moderate fever at the time of aggravated tenesmus and backache, both times at a menstrual period, when there was an unusually free flow. Bladder is not tender on palpation at any time. Exacerbations usually marked by pronounced general weakness and depression, although no loss in weight. (A urinary chart is omitted for lack of space.-ED.]

We regret to say that we are unable to arrive at any positive conclusion. As you are well aware, tubercle bacilli need not be detected even though the Moro test is positive, but as this woman has been ill for twelve years and still remains robust and has not at any time presented a temperature, the evidence is against tuberculous kidney. Have you thought of the possibility of an old-standing infection with the Neisser bacillus?

CONDENSED QUERIES ANSWERED

It seems to us that one kidney is not functionating. Disease may be in the kidney itself or the ureter may be occluded with debris. Note that on certain days only, small quantities of urine are voided, then all of a sudden about double or three times the quantity be passed, and this contains pus and colon bacilli. This would lead us to believe that certain times the obstruction washed away and urine from the affected side enters the bladder. It is probable that the bladder was infected primarily, and that you have to deal with an ascending infection.

A cystoscope and separator should be used in this case. You state in your letter, "uterus normal in size and position," and later say "at these times she complains of marked uterine prolapse which is relieved with the finger pressing up the uterus, which at that time is very large." If there is uterine engorgement and prolapse, that organ should receive attention and be replaced. We are inclined to think, however, that this is a complication, and that the really serious disease will be found in the kidney. However, you must not forget the possibility of ovarian involvement.

This woman requires the most thorough examination and very careful treatment, possibly an operation. If it is impossible to use the cystoscope, we suggest that you secure and send to our pathologist a specimen of discharge from cervix, a blood smear, and 4-ounce specimen of urine, secured, if possible, when the amount voided in twentyfour hours is below normal; and a second specimen of urine secured when full voidance occurs should also be sent.

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Examine the lower bowel carefully. See if there is any venereal history on the husband's side. This is a very interesting case and we present it for discussion.

QUERY 5851-"Helminthologic Riddle." A. H. H., Iowa, reports the case of a man who, during the past five years, has been in the hands of "all the other doctors in town and in several of the neighboring towns, also of Omaha specialists." He had spent all his money and became a county charge. One physician said he had "cancer of the liver"; another said, "cancer (or tumor) of the stomach"; Omaha specialists said he had "anemia," but without naming any cause.

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When first seen by our correspondent, there was a "lump" a little below and to the right of the pit of the stomach, which he maintained was gas, as he could "rub it away." He complained also of pains about the liver. To quote:

"He was put on iron, chionanthus, and chelidonium, with the daily use of the wallplate and vibration over the liver and course of the colon, for inveterate constipation; the colon was flushed with cold water daily. He was placed on a Bennett spiral electrode, attached to the positive, with the negative over the abdomen. Once when the electrode was over this lump, it (the electrode) was thrown up about two feet high and fell off on the floor. After a while he began passing dead worms. He was then given three 2grain doses of santonin in one afternoon, but without results. This passing of dead worms continued at intervals. At the beginning his blood tested 50 in a scale of 100, at the end of the year it was normal. This year he fell into other hands.

"In August his wife saw the doctor and asked him to call. He found the patient's feet and legs badly swollen. The man had been told to call the doctor when he had got rid of any worms, and so one day when the doctor passed his house the patient said to him, "There is one of those dead worms in that paper out on the steps." Upon examination, little more than a greasy streak was found, at its greatest width about 1-16 of an inch and 12 to 14 inches long; the head seemed to be as thick as any part of the body.

"All the authorities on the subject of worms and the yearbooks were consulted, and it was noted that thymol had been given for 'rare kinds of worm' with good results. All authorities agreed it should be given in from 2- to 7-grain doses. It was explained to the patient (a very intelligent man) that the anemic condition was caused by these parasites and if they could not be gotten rid of he would most likely pass in his checks in two or three months. The doctor explained the action of the drug and what the authorities said about the dose, and said, 'If you will take the chances, I will give you 2 drams in 3-grain doses, and, if it kills you, it will only cut you short two or three months. 'Go ahead with your rat killin', replied the sick man.

"The next morning he took a saline cathartic. With other matter passed, there was a double handful of slimy pieces of worms of all sizes. He has passed five hundred or more of these pests. No bad effects from the thymol were experienced. He gained twenty-three pounds. Later, however, he again began to have a 'raking sensation like a nutmeg-grater,' as he explained it, and again dead worms began to come away. The thymol was repeated, but with no perceptible results.

"These things seem to be thrown off dead at stated periods of from two to four weeks, the head evidently remaining in the host.

"It is strange that he never saw any more pass for more than five years, until when the battery was used for about six months. He says he told several doctors that he had worms, but they laughed at him."

Truly this, as reported, is a puzzling case. We understand that the "lump a little below and to the right of the pit of the stomach" has disappeared, so it would be safe to exclude malignancy. We cannot understand, however, the activity of the said lump. Even a bunch of roundworms in the colon could hardly be active enough to "throw an electrode into the air." It would seem probable that in that instance the current was a little too strong and the abdominal muscles contracted sharply enough to cause implement to bound.

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The parasites voided should have been examined by an experienced pathologist. It is not possible to make an identification from the meagre description furnished. If more specimens can possibly be secured, send them to our laboratory promptly.

A good preparation of aspidium may be depended upon to remove tenias, but, to get rid of lumbricoids, santonin and calomel or the Barron formula should be exhibited. Thymol destroys the hookworm, and, if one does not give oil or fat with or immediately after the drug (to cause solution) it is comparatively safe.

In the present case, we would suggest thorough massage of the abdominal area or the use of the faradic current, after a preliminary cleansing of the intestinal tract with calomel, 1-6 grain; podophyllin, 1-6 grain; and iridin, 1-6 grain, half-hourly for four doses, followed by a saline laxative the next morning; repeating this every third night. Then let the patient take a teniacide.

Carefully examine the resultant stools, and if any parasites whatever are passed send them to us. If of unusual character, it would be well, we think, to send some of the feces also. Should the teniacide not expel worms, give, two days later, half that dose at 8 in the morning and at noon. At

this time give a good dose of castor oil. Watch the stools carefully. Repeat the procedure the third day.

QUERY 5852.- "Icterus Neonatorum." J. H. W., Ohio, is treating a lady 37 years of age who has had five children, the two oldest of whom are living (aged 17 and 15, respectively), while the other three died, when a few days old, of jaundice. The woman is now seven and one-half months pregnant, and the doctor asks: "Is there anything I can do before birth and after the child is born to prevent jaundice? Both father and mother are in good health and always have been."

You do not give us any clear idea, doctor, of the condition of the mother. Is there, possibly, any possibility of a syphilitic taint? As to the cause of icterus neonatorum, that is not as yet well understood. However, in the more simple form it can hardly be looked upon as pathologic; indeed, a very large percentage of children present symptoms of jaundice not very long after birth.

If the child is icteric at birth, we should advise to give a few doses of calomel and podophyllotoxin, 1-10 and 1-64 grain, respectively, and follow with an ounce or two of a sweetened solution of effervescent magnesium sulphate. Or, 1-10 grain of calomel every four hours, and 1-64 grain of podophyllotoxin with every second dose; the saline laxative solution, administered with a dropper every ten or fifteen minutes, until 2 ounces has been given, three hours later, usually proves effective. Chionanthoid, 1-6 grain, may be given to the child every four hours for the next few days, the granule being placed in the child's mouth just before giving the breast. The mercurial and podophyllotoxin should be repeated on the third and seventh night, at the end of which period you should have a "white" baby.

Some of the more serious forms of this disease can not be controlled, and we very much question the possibility of directly affecting the infant in the womb at this late date in the case of your client. Carefully examine the mother's urine, and be sure to maintain elimination of solids, and urea especially. Keep her bowels freely open and stimulate hepatic activity. Institute medication as soon as the child is born if there is the slightest sign of jaundice.

In this connection, doctor, let us call your attention to the chapters on icterus neonatorum in the more modern works on diseases of children. Chapin and Pisek treat this subject extensively, while Jacobi's articles, which appeared in Modern Clinical Medicine, are worth careful study. Chapin and Pisek agree with the writer that the disease is frequently of luetic origin and also state that the infant need not necessarily die.

CONDENSED QUERIES ANSWERED

The graver form of icterus, fortunately, is very rarely met with. In such cases certain inflammatory changes have occurred in the liver, with, perhaps, inflammation of the biliary canals. This lesion is apt to be one of the results of congenital syphilis. A perihepatitis may cause the complete obliteration of the biliary passages.

Pisek states that perhaps the commonest manifestation of the graver form of icterus is seen in connection with septic poisoning, generally accompanied by phlebitis. The bile itself may carry an infective agent, as can readily be understood. Unless the mother is syphilitic, such inflammatory conditions would not occur in a number of her children.

In Fischer's "Diseases of Infancy and Childhood," a case somewhat similar to that reported by you is described by Dr. Mahrenlander, who tells of the fourth child of such a series born of apparently healthy parents. Three children had previously died of jaundice a few days after birth, nothing having been noticeable except yellow pigmentation of the skin.

In the case directly under Mahrenlander's observation, the child had expired shortly before his arrival at the house, having lived three days. The skin presented a deep yellowish-green pigmentation, more marked on the abdomen. There was no inflammatory condition of the umbilicus; the cord had been aseptically dressed and no infection from this source could be suspected. There was one stool just before the infant died, but there was no vomiting or other symptoms. Bear in mind that this was the fourth child in that family which died of icterus a few days after birth. In each instance the children died without apparent suffering, their temperatures were normal, and there were absolutely no symptoms of illness. Syphilis in the father was suspected, and this, later, was proved.

Voorhees states that all the women confined at the Sloane Maternity receive chloroform, and that about 33 percent of the infants born are jaundiced. All the premature infants were also icteric. It is the opinion of several observers that icterus may result from the effects of chloroform passing through the placenta; however, the writer

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has delivered under chloroform anesthesia more than fifty times, but none of the children were jaundiced.

Look into this case further, doctor. If the coming child should suffer from icterus neonatorum, institute the treatment suggested. Should it fail, as it naturally will in the graver form of the disease, try to secure an autopsy and, if possible, forward the liver to our pathologist for examination.

QUERY 5853.-"Goiter." H. P. H., Montana, writes that he finds it difficult to obtain reliable information about simple enlargement of the thyroid gland, or goiter. He continues:

"For some reason, not as yet determined, there are, in Helena and over Montana generally, an astonishing number of women, small girls, and even men, afflicted with this trouble. One can count as many as six or seven while walking the length of a city block. Girls so affected that have not yet reached the age of puberty, even as young as six or seven years of age, can frequently be seen. Some of the physicians here attributed it to the water, as most of it flows down the mountain sides and is collected in reservoirs for the city's use, assuming that the water holds in solution some chemical that acts as an irritant to the thyroid gland. Others think it is the high altitude. Still others ascribe the condition to the large consumption of mutton. None of these theories is convincing, and some even are absurd. I have observed closely, but I cannot determine anything that may reasonably be suspected as the exciting cause.

What I wish to know about especially is as to whether there is a treatment more effectual than that with calcidin in large doses and the use of iodine locally. Also, have you any theory as to the cause of goiter; and, then, is there anything new in recent medical literature on the subject? I have tried thyroid extract and find it useless. I have such an excellent opportunity for studying the disease and of trying out any new theory in regard to its treatment that I intend to do all I can to determine its causation and compass a cure. In pursuit of this purpose, I am anxious to obtain all the information possible on the subject, for at best it will be meagre enough; therefore, any and all knowledge you may have on the subject or any suggestions as to where information may be obtained will be gratefully received." The following will be found a very efficacious treatment for simple goiter; still, one must

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