meals. Thereafter, begin with the sodium iodide.

QUERY 6414"Sudden Death During Convalescence from Influenza." I. E. С., Quebec, Canada, desires our opinion in the matter presented in the following letter:

"On October 14, I was called to a patient of mine, a young woman, aged twentyfour; single, who was ill with the socalled Spanish influenza. Typical symptoms; temperature, 102° F.; pulse, 100; respiration, 20. On the 16th, the temperature rose to 103 degrees; pulse, 116; respiration, 28; and some 'rusty' sputum appeared. Breathing was very harsh over the base of the right upper lobe posteriorly, with some fine moist râles. Some crepitations were audible in the upper left lobe anteriorly. Definite blowing breathing developed over the base of the left upper lobe on the 18th, when the temperature went up to 105 degrees, the pulse to 118, respiration, to 30, and the patient was very delirious. There was little coughing and no expectoration. She was very cyanosed. She remained in this condition until the night of the 20th, when the crisis occurred, the temperature dropping to 98° F. in about ten hours. On the afternoon of the 23rd, a violent fit of coughing occurred, breathing became very rapid, and, the temperature rose to 102° F., but, receded to normal in about six hours. Nothing worthy of note occurred until the evening of the 27th, when the patient suddenly became very dyspneic and died in about ten minutes. At the time of my last visit, about eight hours earlier, her condition was perfect: temperature, 98 degrees, pulse 84, respiration 20, color good, and heart-sounds perfectly normal. The blowing breathing still was very marked over the area mentioned. My theory is that on the 23rd, when the cough and rapid breathing occurred, she had a pulmonary embolism of slight degree, with recovery, and that death resulted from a second, more extensive, one. What is your theory?"

It seems to us, doctor, that your explanation is a very plausible one and that, in all probability, it is quite acceptable. In conversation with physicians, we have heard of similar cases, more than once, in which the patients had virtually recovered from their influenza and then suddenly cumbed to an attack of whatever it may have been. Such distressing acci

dents occur without the slightest warning and, in the absence of a necropsy, it is exceedingly difficult to determine the cause.

It is different in the case of those patients who succumb to their influenzal pneumonia. In them, death is actually due to "drowning," as Doctor Richardson, of Boston, has put it.

If any readers of this department have cognizance of similar occurrences, the Query Editor would be glad to receive their reports, and, likewise, their opinions as to the cause of death.

QUERY 6415.- "Myxedema in a Baby?" C. L. K., Kansas, was recently called to see a 9-months-old child, a boy. About four weeks before, this little boy was afflicted with an eruption, which the attending physician pronounced "hives." The eruption grew worse and the case was diagnosed "measles," the family being quarantined. At about the same time, the baby's whole body-arms, legs, hands, and feetbegan to swell, when the case was considered to be of a dropsical nature. "As the attending physician, after two weeks, seemed to be unable to afford any relief or reduce the swelling (attributing the symptoms, evidently, to some hepatic or gastric disturbance, if the medicines given were any criterion), I was called in by the father.

"I found the child, which was rather large for its age, lying quiet, occasionally emitting a 'grunt,' making but slight movements with head; with large, full face, but, not unintelligent; cheeks a ruddy red;

a

confluent measle-like eruption on the arms and slightly on the body; the skin on back and buttocks scaly and yellowishbrown, scrotum size of a duck's-egg, also considerably bronzed; the whole body, legs, arms, feet, and hands considerably swollen; a leathery skin that did not leave any dents upon pressure. After looking the boy carefully over, I decided it to be a case of myxedema, but, found difficulty in explaining the meaning of that word, without suggesting cretinism. I had never had a case like it before.

"After administering a brisk laxative and hydragog, which seemed to relieve the child considerably, I put him on desiccated thyroid gland, 1-3 grain at a dose, at first twice then three times a day, then 1 grain at one dose daily. After a week,

decided improvement set in and now, after a month, there have been no untoward symptoms or relapse, the boy still taking 1 grain of the gland daily.

"Question: Are there any prospects of an entire cure, and what treatment should best be followed?"

We dare not venture a diagnosis with our limited knowledge of conditions. Myxedema, as you know, rarely occurs in so young a child. Is there any possibility of congenital syphilis?

You do not give us any idea of the condition of the thyroid gland, neither does there seem to have been any prior anemia. What was the character of the eruption that was pronounced "hives"? Urticaria could not possibly resemble measles. It is just possible that this was a typical case of measles or even scarlet-fever, with involvement of the kidneys. On the other hand, you have reasonably good grounds for your diagnosis. Do not forget, however, that the whole train of pathological symptoms might be relieved by, and marked improvement follow, a course of laxatives and desiccated thyroid gland. Were this true myxedema, one would hardly expect very decided improvement within one week, as it occurred in this patient.

What is the child's condition at the present time? You merely say there have been no untoward symptoms or a relapse. Do we understand that the discoloration on the buttocks has disappeared and the leathery condition of the skin no longer obtains? Is there any eruption whatever? What about the facies? Is the expression bright or dull?

Give us all the light you can in this rather peculiar case, and, if possible, send us a photograph of the little patient. While myxedema must be thought of, we are not sure that this disease exists here. What was the condition of the child prior to the appearance of the eruption-the supposed

"hives?" Was the child at the breast or fed artificially? Be sure and note the pulse rate.

In reply to the foregoing letter of ours, the Doctor wrote as follows:

"Regarding the case of supposed myxedema, I wish to add that congenital syphilis is not improbable, owing to the lifehistory of the mother and her father; but, I had this considered and, as I had read somewhere that myxedema brought on through syphilitic causes would yield only to antisyphilitic treatment and this case responding so quickly to the thyroid gland treatment, I excluded that factor.

"There was inactivity of the kidneys and bladder just before I was called, but, the hydragog cathartic I administered relieved these symptoms at once and the only further treatment given was the thyroid gland and arsenious acid. To obviate any eventual deleterious effects of the thyroid preparation, the latter was omitted after the first week. The gross conditions disappeared entirely within a week and no other symptoms have shown since, except a cold and cough the last two weeks, accompanied by otitis media, which latter was controlled with a boric-acid, glycerin, and alcohol solution. The condition of the child prior to this trouble was satisfactory, he being bright and playful, although he is large and has a rather large head. The child has been nursed by the mother, but, will be weaned this week, being now thirteen months of age. The discoloration of the back and buttocks and all swelling, also the leathery and scaly condition of the skin disappeared and there is no further eruption. The only eruption I saw on my first call was on the arm and of an erythematous nature, so I can not tell anything about the previous symptoms, except, for the statement of a lady attending the child, who has some experience with children, that she did not consider it measles or hives.

families in their homes and to detect overcrowding in the slums of the city. Make available self-sustaining, sanitary boardinghouses for single men and women; protect the children from the evil influences of star-boarders and the like. Segregate tuberculous subjects. Have a social-welfare committee regularly appointed and managed by Red-Cross staffs, these to teach to the foreign-born the American way of clean living and to see to it that pure air and, in winter, sufficient heat is supplied the needy, and that the children are properly clothed. Give the American public the benefit of the experience for which they had to pay so dearly. Americanize the foreigners, by paying more attention to their welfare."

God help the man who has no friends.

THE NEXT LIBERTY LOAN

If any of us think that, with the signing of the armistice, on November 11 last, we were through with the war and could now definitely turn to other pursuits, they decidedly have another "think" coming. True, the fighting-work of the soldiers and sailors that we sent abroad is accomplished. There is little for them left to do, although that little is tedious enough. However, when we sent our soldiers across the water, we undertook to maintain and support them. The debts that were incurred in connection with our participation in the war are, by no means, liquidated, and Uncle Sam, we are told, is getting ready to make another "touch."

There can be no question that it is for us stay-at-homes to pay those bills. Yet, the government, by no means, desires to make it a donation-party; all it wants is, to have the necessary funds advanced by way of loans for which promissory notes will be issued, just as they were during the first four Liberty-Loan Drives.

Whether the next bonds issued will be designated as Liberty Loan or Victory Loan or Victory-Liberty Loan, or as something else, is of small import. The essential point is, that the American people continue with a will to place the necessary funds at the disposal of the government, that it may liquidate the obligations assumed by its participation in recent events. The money raised on the four previous

Liberty Loans has been spent, and there yet are bills to be met. Also, it will cost many millions of dollars to bring back our American soldiers from overseas. In the meanwhile, the men must be fed and kept up in every way, in order that the American army may maintain its excellent reputation for efficiency.

The point of all these remarks is, that it is incumbent upon all of us to keep on saving as we have been doing during the past year, and, more, to put by every dollar we can, investing it in government paper, such as War-Savings Stamps and Thrift Stamps, or to put it in the bank in readiness for the Fifth Loan whenever the government may decide to announce it. In order to make available needed funds before that time, the Treasury Department now is selling Anticipation Certificates that cover the Federal Taxes due this year and designate the subscription for the coming Fifth Loan.

All this is nothing to be complained of. As a people, we have learned to save our pennies and dollars, to do without nonessentials, and to live more simply than before. It is this lesson of thrift, as it had been inculcated into the French people fifty years ago, that enabled them to recover so rapidly from the reverses of the Franco-Prussian war. We, on our part, do not have such a humiliating incentive. We have the encouraging knowledge of having aided in a good fight and in an undertaking that is bound to make the world a better place to live in. All the more reason why we must be willing to do our full share, and not to stop as long as this is demanded of us.

FOR AN AUTOMOBILE-TRIP

Nearly every doctor drives a car, and every doctor ought to take a vacation. The ideal vacation is, a trip with a car a trip on which you can take along the wife and the kiddies, wear your old clothes, and sleep in the open. (Of course, the madam may object to sleeping in the open, in which event, you will defer to her wishes and sleep in hotels.)

Now the purpose of this editorial item is, to introduce a symposium on automobile-vacations, this symposium to appear in one or more subsequent issues of CLINICAL MEDICINE, in or after our June issue. Many of you have taken trips of this kind. You know all about the scenery, the roads, the entertainments, all the many advantages as well as disadvantages of such a trip across the country. Write this up and let us have it for publication; and, if you have any advice to offer about the car that you drive, as also about car "diseases" and how to cure them, put that into your story.

May I tell you a deep secret? I am going to take an automobile-trip myself next summer, and I want to know just where to go. I am looking forward to the receipt of your letters, because I am sure that among them I shall find just the tip that I am looking for. So, then, I am hoping that there will be coming in a bunch-a big bunch--of stories. And, don't put off the writing of them too long. Put on your thinking-cap and yank out your fountain-pens. Procrastination, you know, is the thief of time, and has killed many a child before it was born.

THEODORE ROOSEVELT

AMERICAN

The American Review of Reviews reproduces in its February number a cartoon from The New York Times, depicting how, in the opinion of the artist, Mr. Marcus, the late Theodore Roosevelt will be remembered. The drawing shows a memorial tablet with the name Theodore Roosevelt. Underneath are crossed out his various attributes and pursuits, namely, president, statesmen, soldier, historian, explorer, naturalist, orator. All these are marked out by History who stands before the memorial tablet and has written underneath, in large letters, the word American.

That is as true a tribute to the memory of Mr. Theodore Roosevelt as has come to our attention. Much has been recorded and will be written concerning this remarkable figure in the history of the American people for the last quarter-century. But, nothing will be able to equal in truth and terseness the one attribute that will keep his name before posterity as that of having been an American in the best meaning of the word. Fearless and true, industrious and eager to learn, and to complete and round out his knowledge, with an almost passionate desire to benefit his fellowmen, to uphold the cause of justice

and truth and liberty, Roosevelt could not fail to make just as good and cordial enemies as he did friends; but, no matter who were his opponents, nobody could deny him honesty of purpose and sincerity of action. Mr. Roosevelt's name is recorded with those of the greatest Americans. He lived a full life and leaves his memory green behind him.

Friends made for an end don't last till the end. Any friendship that has to be bought, not, necessarily. in dollars. but, by fawning or flattering or dining or entertaining, is not worth the price; it is

not worth having. Smiles don't win the best kind of friends; it's what is behind the smiles-personality, ability. Friendships inspired by your pocketbook are not friendships; they are, as far as you are concerned, frauds, for, they are not genuine, they are not true-blue, they are not sincere. Deliberately setting out to win friends for selfish motives is like deliberately setting out to win happiness; you gain friends as you gain happiness, not by purposely trying to obtain them, but by meriting them in the course of the day's work. -Albert H. Wiggin.

DISEASES THAT ARE TRANSMISSIBLE FROM THE DOMESTIC ANIMALS TO HUMANS

In this issue of CLINICAL MEDICINE, we publish a discussion by Lieut. G. H. Conn of the Veterinary Corps, U. S. Army, concerning those diseases that are prevalent primarily among animals but which also possess or can acquire pathogenic properties for humans, so that the diseased animals become dangerous to persons handling them or coming in contact with them.

Lieutenant Conn has enumerated the most important and frequent diseases the epidemiology of which concerns both animals and humans. There are, however, several other maladies that are transmitted to man in a similar manner and which, therefore, become of considerable economic importance. While it is not always the case that these diseases occur primarily in domestic animals, they, at least, often are prevalent in animals that infest the domiciles of man as for instance rats as carriers of plague. Moreover, the transmission does not necessarily take place by direct contact but frequently is intermediated by insects, such as flies or fleas. Nevertheless, it is of interest to refer to a few diseases not mentioned by Lieutenant Conn in order to supplement the list.

For us, in America, the diseases of greatest importance are, plague and Rocky Mountain spotted fever; in other countries