has plenty of good reading matter, and that's all I want for my money. More success to you. Chicago. PAUL HULLHorst.

4269 N. Ashland Boulevard.

[Doctor, there would be "millions in it" for any one who could invent or produce a "sure cure" for sterility. We hope that some of the brethren will write you directly. In the meantime we will say that in addition to what you find in the books and what has appeared in these columns, there is something else that is so vague and indefinit that it is hard to put into words, yet we feel convinced that here lies the cause of sterility in many cases where the parts of both the wife and the husband seem and are normal in every way. It seems that some temperaments will not breed together. Two fat people are usually unfruitful; the same is true of "nervous" couples. In many instances the temperamental characteristics may not be well markt, yet there is something inherent that prevents that particular couple from producing offspring. Many of our readers have doubtless observed instances of a barren married life followed by fruitfulness after the death of either the husband or wife, followed by re-marriage of the living partner. This will probably be a new line of thought to most, or possibly all who read these lines; but with the thought only hinted, as above, doubtless memory will call to the minds of many of our readers numerous facts illustrating and proving the truth of the theory. Would not a discussion of this phase of the question be of interest?-ED.]

Probably Epilepsy.

Editor MEDICAL WORLD:-I desire advice in following case: Female, age 3 years and 5 months, began having spasms fifteen months ago, at intervals of about two weeks. Spasms come at night. Come on with fright, kicking both feet, throwing hand or grasping anything she can get hold of; face draws to left side. Will be drowsy and cross during day before spasm comes. Will strangle and groan as spasm goes off. Will swallow, and call her mother as tho she were frightened. Each spasm lasts about one minute; will have from ten to fifteen during the night. When askt what hurts, she says her head. Family history is good. I began treating her about three months ago; gave her bromids and alterativs, with some improvement for a time. She is now about like when I began treatment, or may be the spasms are a little harder. Dixie, Ind. Ter. J. J. BENSON.

[The case looks like one of epilepsy. It is possible, however, that it may not be that; but you must find the cause of the convulsions before you can hope to cure them. It is evident that the empirical use of the bromids and alterativs is futil. Carefully search for every possible source of internal and external irritation. Exclude worms in the stomach and intestin by full dosage of santonin, preceded by a fast and followed by a purge in eight hours: repeat at intervals of a few days till worms are obtained or three such courses have been taken.

Exclude pin worms by giving repeated injections of strong infusion of quassia and retaining it in the bowel as long as possible. Make sure that there is no irritation from decayed or undevelopt teeth. Get the digestion up to a normal standard and guard the diet from all indigestible foods. Keep the bowels loose without keeping up a complete purgation. See that the ears are normal. Make sure that the clitoris is not bound down by adhesions or buried under inspissated smegma. Such a search will enable you to make a diagnosis of epilepsy, by exclusion, if no other cause is found. If cause be found, remove the cause. When the attacks come on, empty the rectum by enemas of half a pint of warm water containing two ounces of castor oil or glycerin. Give a large dose of castor oil by the mouth and follow in a half hour by a large dose of bromids and chloral: children take both remarkably well, and especially in cases of convulsions.--ED.]

Peculiar Intestinal Worms.

Editor MEDICAL WORLD:-Please find in accompanying vial some specimens of worms. Please permit me to ask you what worms they are. I don't know them. Never saw or heard of any like them before, nor can I find anything about them in all my books. These are put in water, but when they come (at every passage) they are about one inch long and one-eighth inch thick; one end is sharp, serving as a head, the other is blunt and brownish. Their movements are those of a snail. They come from an old lady of 70 years, but who is otherwise as well as one of 17. She is one of my best patrons, and it is of much interest to me to retain her confidence. I have given her santonin, cina, spigelia xx, also injections of salt water. I should be so glad and thankful to you if you would give me all the imformation about it that you can, and what you think best to do for her, in the April WORLD. JOSEPH A. MOKÉ, M.D.

Crosswicks, N. J.

[We have examined carefully under the microscope the specimens of worms sent us, but fail to recognize them. They were not in the best condition when they arrived, and it is possible that they may have parted with some of their distinguishing features. We have lookt thru the various works of reference, but do not find illustration or description of any such worm. There are many rare forms of intestinal worms not commonly known, but each should be readily recognized by its illustration and description. We would suggest protracted courses of santonin in full dosage, watching carefully for symptoms of full physiological effect, and remembering that santonin is occasionally illy borne by the aged. We would also try injections of strong infusion of quassia chips, or a rectal suppository contain. ing quassia. Calomel sometimes acts well on intestinal worms. Oleo-resin of male fern given after a fast, and followed by a purgativ is a very efficient treatment, tho somewhat nauseating and exhausting. Gradually increas

ing doses of thymol are commended by others : this we have never tried clinically. We should be pleased to hear further from the case.— ED.]

Absence of Orgasm in Wife.

Editor MEDICAL WORLD:-Will some member of the "family" help me on the following case: Husband and wife, aged respectively 35 and 28, parents of two healthy children, both in excellent health, but fail to enjoy the sexual act because the husband is "too

soon."

The wife, in their twelve years of married life, has failed to realize once what should be in store for her. Nor has she ever any desire. I do not think there are any anatomical defects. Husband admits having masturbated a great deal in his boyhood. Now, will some brother tell me how to "slow him up," and how to "hurry her up," so they will be better pleased with each other, and that they may be better pleased with me? Best wishes for THE WORLD.

INDIAN TERRITORY.

[It is not at all rare to find a married woman totally devoid of sexual passion, and in the majority of such cases no anatomical abnormality is found. In such cases the husband's sole pleasure in the act is the sensation at the time of emission; hence he unconsciously or by reasons of the wife's pleadings to be let alone, hurries the act to completion. He thus gets his sexual organs trained to early ejaculation. There are many things to be studied in such cases, and sometimes success attends the effort, but more often failure. The first step is to gain the absolute confidence of both wife and husband, and explain just what you hope to attain. Explain to the wife as nearly as you can what an orgasm is, and what it means to a woman in the maritial embrace. Inquire if coitus is painful or disgusting, and why? Where is the disagreeable sensation located? Does pain or discomfort persist after coitus is completed by the husband? Does the vagina secrete mucus during the act, or does it remain dry? These facts may aid you in managing the case. Advise the husband to be less frequent in his sexual demands; to fondle his wife for a considerable time without making attempt at intromission; to hold his own passion in check till the proper moment; then to be gentle and considerate in the act, even to the extent of remaining still for a considerable time after intromission; to select the day before or within a few days after menstruation for his first intelligent attempt. If this plan be a failure, encourage them to reverse positions during coitus; this will induce orgasm in many females who never experience it in the usual position. The husband's ardor may be subdued by 10 grain doses of sodium bromid four times daily. We are assuming that you have seen that the clitoris is not hooded or adherent to its prepuce.-ED.]

Editor MEDICAL WORLD: - Inclosed find check for $3 00. Please advance my subscription four years. I find THE WORLD the most practical of all the medical magazines for the busy practician Penobscot, Me. MELVIN A. WARDWELL.

Cystocele with Pregnancy.

Editor MEDICAL WORLD:-Mrs. S., 31 years old, married six years, one child 5 years old, had an easy labor lasting eight or ten hours; urin had to be drawn for two weeks after childbirth; otherwise did well, and has had good health since, excepting a rather obstinate constipation. Family history bad; father, mother and two sisters died of consumption. Is pregnant again since last September. Reported to me a prolapse about four weeks since, and on examination I found a cystocele that protrudes when she is on her feet much, as much as an inch thru the labia majora; also a bad vaginismus that interfered very much with manipulations.

I put her upon lithia tablets, one in a glass of water five times a day, and saw palmetto and sandalwood, and succeeded very well in relieving a slight cystitis, from which she had some trouble; and I also found that the increast amount of water had a good effect on the constipation. I have been unable as yet to introduce suppositories, and have had to rely on astringent injections. She seems to be doing very well; the bladder retains its proper position better, and the vaginismus is less troublesome. I would not trouble you with this were it not for the coexisting pregnancy.

Will the Editor and the family please come to my aid? I think it not advisable to try an operation for cure, but fear consequences of labor aside from development of tuberculosis. JNO. B. WHITE, M.D.

Cave City, Ky.

[Your treatment for the cystitis was good. It will be advisable to examin her urin carefully in the last month of pregnancy, every week, to exclude any possibility of albumin being present. If you would get her an easy labor you must get rid of that constipation. Continue the increast supply of water (without lithia), and still further increase it. Cathartics are not advisable, and laxativs should be selected with care. The most suitable preparation for her case would be a tablet triturate containing aloin 4 grain, strychnin sulfate grain, extract belladonna grain, powdered ipecac grain, chocolate coated;

these are sold by tablet makers. Begin by having her take one night and morning, and if this is not sufficient to induce at least one free daily stool, increase to two night and morning. In a short time you can reduce the dose to one night and morning, and later to one at night; but see that she takes one every night even if the bowels do move. In this way you will get rid of the constipation without purging her or upsetting the digestion. You will not get a sufficient astringent effect from injections to permanently influence the cystocele. Get boroglycerid vaginal suppositories incorporating astringents; they are small in calibre, and you may be able to insert them; or if you can not, she may succeed in introducing them herself. These will help both the vaginismus and the cystocele. If neither of you can get them introduced, cocainize the labia and vagina with a camel's hair brush dipt in cocain solution, gradually advancing toward the os, till the obtunded sensibility admits of the insertion of the suppository. A few such treatments should reduce the vaginismus to a degree that will admit of insertion without cocainization. If you have basis for fear of the development of tuberculosis, there is no contraindication to administration of cod-liver oil and the hypophosfites, and the phosfate of strychnin would be a very good tonic for one in the condition she is; the latter is said to act beneficially at the termination of gestation by increasing the force of the pains and thus shortening labor.-ED.]

Chronic Nephritis.

Editor MEDICAL WORLD:-Lady 54 years old, mother of three children, ceased menstruating at 46 years of age; weighs about 225 pounds, but has not increast in weight lately (which was always gradual); complains of pain in region of kidneys, which is very painful to the touch; has aching pains in lower limbs; pain in arms and chest; has no leucorrhea now, but did before the uterus was replaced. She had a retroflection, which I thought was partly the trouble, but she complains just the same with pain in the back. Urinalysis showed acid reaction, sp. gr. 1,025, amount of albumin considerable, no sugar; amount passed in twenty-four hours, thirty-two ounces. She sweats profusely, has a weak, irregular heart beat, and is easily fatigued. Has no ascites, anasarca, nor puffed lids. My diagnosis is chronic nephritis, as the history dates back ten years. I have been treating her now for two months, and she improves very slowly. The treatment is bichlorid of mercury, 24, and pot. iodid, 5 grs., three times daily, with opiates to control pain, and one nitroglycerin tablet (DaCosta formula) every six hours to increase action of heart for the diuretic effect. Patient is some improved, but I would like suggestions from the Editor and readers. E. S. HARRIS, M.D. Buckner, Mo.

[Your diagnosis is probably correct, but the amount of albumin (which you do not state) would have considerable bearing on the diagnosis. The diminisht quantity of urin may be due to excessiv perspiration, instead of being a symptom of chronic nephritis. We believe

she has the rheumatic diathesis. We would place her on lithium carbonate in large quantities, and encourage free ingestion of milk, buttermilk and water. Potassium iodid is better suited to those cases which develop dropsy. In view of the doubt as to diagnosis, we suggest that you examin the urin repeatedly for evidence of uric acid. If there is any excuse for giving purgativs we giving purgativs we would select salines. Diuretics are indicated in either case. She may have chronic nephritis with rheumatism, or she may have rheumatism alone. The albuminuria in chronic nephritis is not usually the most serious symptom; it is the gradual reduction in the amount of urin voided which should receive the most attention. The inflammatory process in the kidney in chronic nephritis is not sufficiently activ to demand special attention. In view of her excessiv weight, and the suspicion of rheumatism, we would suggest giving her phytolacca in phytolacca in some form. Do any of the family feel like making a positiv diagnosis for the Doctor?-ED.]

Acute Nephritis.

Editor MEDICAL WORLD:-Will the Editor or some of the WORLD readers kindly suggest diagnosis and treatment for the following case? Mrs. O., age 24; weight, 115 pounds; been married six years; mother of three children, the youngest now six months; family history good except uncle died of cancer.

Two years ago after being in a shower of rain felt slightly chilly; complained of head, limbs and back aching, especially back over region of both kidneys; temperature 102° to 103°; frequent voiding of small quantities of bloody urin. The hematuria lasted four or five days, but she complained afterward of deep, dull hurting in the lumbar region, increast by violent exercise. Has had a number of attacks since it came on, as often as three times a month, and missing as many as three months at a time, there being no regularity.

This patient has gradually grown worse, becoming very weak and anemic after each attack. She is now recovering from a spell which was very severe, the hemorrhage amounting to about one quart of pure blood; it also contained small lumps of solid substance resembling flesh or shreds of broken down tissue. No fever excepting the first time or two. Specific gravity of urin 1,010; alkalin in reaction, and traces of albumin Physical signs of kidneys negativ; no tumor outlined; no swelling of feet, hands nor eyelids. Have made repeated examinations for stone in bladder, but none there. Sometimes passes from bladder thick, ropy mucus. After washing out bladder well, water comes away perfectly clear till allowed to collect again, when it is bloody.

Treatment: Rest in bed, feet elevated; cups and hot cloths applied over both kidneys; washt bladder out with boracic acid solution; opium to relieve pain ; ergot fl. ex., gallic acid, nitroglycerin, and tr. digatalis to check hemorrhage. Tonics, such as iron, nux vomica, and hydrochloric acid between times. Have also given the salicylates to no effect. Am very much interested in this case and all assistance given me by Editor and WORLD family will be greatly appreciated. Success to the WORLD, the best journal publisht. India, Tex.

W. H. KINCAID, M.D. [Your patient developt an acute nephritis from exposure to the rain. This has since developt into the chronic form of nephritis. The hematuria may be either vesical or nephritic,

66

as you doubtless have a complicating cystitis. The attacks to which she is subject are acute exacerbations of the chronic nephritis, probably aggravated by the existing cystitis. The lumpy substance" and shreds of broken down tissue are from the bladder; you can easily verify this by the microscope. The gradual decline in health, the low specific gravity of the urin, the aching back, the slight or absent fever, all give a typical clinical picture of the condition we describe. Your line of treatment is in the main correct. We would not confine her too closely to bed, since such treatment often makes such patients worse. Of course she should not attempt hard work or violent exercise. The skin should be kept acting freely by frequent bathing and diaphoretics when needed; you might use Dover's powder when opium seems indicated, and thus secure the double effect. In view of the success attending administration of the extract of the suprarenal gland, we would use it in her next case of hemorrhage. If it should fail, we would give gelatin solution or inject subcutaneously. We do not see any indication for the salicylates. If the urin is diminisht under fifty ounces, encourage her to partake freely of milk and of pure water. The use of astringents to check the excretion of albumin is of doubtful utility, since there is danger of interfering with the digestiv functions, and the albumin in itself is of minor importance in such cases. If free diaphoresis can not be readily induced by hot baths and the ordinary diaphoretic drugs, pilocarpin may be tried cautiously, but one must bear in mind its liability to induce alarming pulmonary edema. Free purgation is a valuable aid, and the drugs of preference are epsom salt, jalap, or the compound jalap powder of the U. S. P. The chief risk in the early stages of chronic nephritis are the acute exacerbations accompanied by hemorrhage; hence avoid sudden changes in temperature; insist on woolen underclothing of weight adapted to the season; and never allow her to go without a light flannel abdominal binder next the skin. The keynotes of treatment are diaphoretics, hvdragog cathartics, diuretics, and tonics.ED.]

Eczema for Twenty-three Years.

Editor MEDICAL WORLD:-Mr. W., age 47, occupation farmer, family history good. His trouble commenced twenty-three years ago. Commenced on back of the hand: a breaking out in a clear blister, would discharge a watery fluid, then form a solid sore, then dry up and peel off. This would come on about January every year, but would not bother him in summer and fall. The second year it commenced breaking out on his feet; third year on his face and neck, but still on his hands all the time. No pain, only itching. There was not any change in this condition for ten or twelve years. For the past eight years it has broken out on breast in the way of small boils, but would not run any pus. These would come on different

parts of the body, tho mostly on face and breast and hands. His condition at present: his face is swollen, dry and scaly, his eyelids are swollen so that he can scarcely see; a few small yellow pimples are on edge of lids. His scrotum and penis are swollen, dry and scaly. He has some pain like needles sticking in him, tho you might say no pain, only a horrible itching. His bowels are regular, kidneys act well, no fever; has gone the rounds of all the doctors, and tried all patent medicins. J. F. MCKISSICK, M.D.

Farmersville, Texas.

nosis.

[You have an eczema, chronic in type, the characteristics of which have been altered from some unknown cause so as to obscure the diagPut him on calcium sulfid in grain doses, three times a day until pus ceases to It is preferably administered in coated pills or tablets. Give him Fowler's solution in Io minim doses with each meal until you get the physiological effect of the arsenic; then stop a few days and repeat. Locally, have him apply the following lotion freely, and as frequently as possible, but never less often than three times a day:

You can probably assure him of a cure, but naturally he must agree to stay with you for some time. Have him use only pure soap in bathing, and advise bathing only when necessary, since the water will prove irritating. We will be glad to hear from you on the case again. ED.]

Headache, Apparently of Menstrual Origin.

Editor MEDICAL WORLD:-As I am just a beginner I wish to ask your advice. I have been askt to treat a lady 37 years old; fleshy, healthy looking; dark complexion; widow; well educated, and a teacher. Seven years ago she had a child, which lived only a few days; did not menstruate for four years after child-birth, but was well during that time. Now she has menstruated regularly for two years, but for three months past has been compelled to give up a lucrativ situation on account of severe headaches occurring near time of menses. It is something dreadful the way she suffers, and she has been treated by good doctors in her town. They gave her ammonol tablets, acetanilid, etc., and this causes a queer pounding of the heart, and she says it keeps her awake because the beating of the heart sounds like some one pounding the pillow. After two days' suffering I was called in and found her in a bad way; tips of ears, ends of fingers, and lips and tongue purple, heart bounding and she screaming in almost delirium. gave an injection of morphin and ordered bromids every three hours. They relieved her slowly, but she is still suffering pains in head and is weak. Tell me how to treat her, will you? She is tired of medicin and is anxious to get to her work. Between spells she sleeps and eats well; is a careful and small eater. L. L. BRAIN, M.D.

Alliance, O.

[Doctor, before we could make a diagnosis or suggest treatment, we must know something of the case. You give us absolutely no information further than that she has headache; has dysmenorrhea; and becomes cyan

otic under administration of acetanilid compounds. Ascertain the condition of the uterus by a careful bimanual examination. What is the condition of the os uteri and vagina? Does leucorrhea exist, and does it arise from uterus or vagina, or partly from both? Is there markt tenderness of vaginal vault, or of either ovary? How many days does the menstrual flow last? Does the menstrual flow clot? Is the menstrual flow offensiv? What is the color of the menstrual discharge? Does the pain prove most severe before, during, or after the flow? What is the condition of her bowels and kidneys? Is she nervous? With a concise answer to such questions, we will be able to make suggestions which will aid both yourself and patient.-ED.]

Cystitis and Polyuria.

Editor MEDICAL WORLD:-My age is 79 years, weight 162; have been troubled with bladder trouble more or less for several years. Outside of this am a healthy, robust man. About three months ago I was caught out in a shower and got wet; the result was a serious attack of cystitis; had a desire to urinate almost constantly, with great pain. Finally had to have the urin drawn off about every two hours. The urin has been examined and does not contain any albumin nor sugar. The prostate is not enlarged; have fever every day; my general health has improved some, but I still have to urinate so frequently, and have the urin drawn off three times during the night. The quantity of urin has been from one gallon and one-half to two gallons in twenty-four hours. Am irrigating every day with boracic acid and bismuth in warm water. Will the Editor and the brethren come to the relief of a poor old country doctor who has been in the harness over forty years? J. M. C.

Rush Medical College, Chicago-1860.

[Doctor, if you are passing one and one half to two gallons of urin every day and it does not contain sugar, you have diabetes insipidus. Do you have great thirst? Is the skin dry and harsh? Do you perspire? Are you nervous? How much water do you drink each day? An answer to these questions would help make clear the diagnosis. Of all drugs used in cases such as yours, valerian in some form is the most generally successful. The ammoniated tincture may be taken in dram doses four times daily, increasing the dose gradually as tolerance is establisht. Other drugs of benefit in polyuria are ergot, turpentine, strychnin, arsenic, potassium iodid, and red mercuric iodid: you will understand how to use those you select. We assume that you have used saw palmetto and santal for the cystitis. A little used but very valuable remedy for the cystitis of the aged is tincture cantharides in one-half drop doses every three hours, cautiously increasing the dosage to one or even two drops. Are you certain that all the fluid returns from your irrigations? Is it not possible that some of this fluid is retained and voided later so blended with urin as to appear if all were urin ? The constant current is often of use in both

cystitis and polyuria; apply one pole over the kidneys and the other on the lower part of the abdomen.-ED.]

Anterior Lip of Uterus Caught Between Head and Pubis.

Editor MEDICAL WORLD-I was called to a confinement case last night and on examination I found things too high to make a diagnosis. By bimanual examination I found head to be in left iliac fossa and buttocks in right. I advised patient to get up and be on her feet, which she did for half hour, when everything became normal, but the anterior lip of the uterus protruded ahead of occiput, was wedged tight and I could not push it back. It was the most painful case (seemingly) I ever attended; but after labor started it was the briefest I ever attended; no time to give chloroform. Expulsion was completed with anterior lip under pubic bone. Any attempt to push lip back only seemed to increase the pain. This is the first case I ever had that I could not push back the protruding lip; neither have I ever seen such extreme pressure of the head against the pubes in the beginning of labor. The babe and mother both seem well this morning. Please inform me if there is anything I could have done in the case.

A dear lover of THE MEDICAL WORLD.
Murray, O.

W. H. TIPPIE, M.D.

[It is no unusual thing to observe the os pusht downward with the advancing head in precipitate labors, until it appears under the pubic bone and in the vulva. It is a common error to believe that the os allows the escape of the head by a process entirely one of dilation; it is fully as much due to a retraction of the os back over the head as to true dilation itself. The uterus being more or less movable, is carried toward the vulva during each pain, and the os, while dilating, tends to draw backward over the head. But if the descent is rapid, the anterior os is frequently caught between the head and the arch of the pelvis. When this occurs in protracted labors, or in labors where there is great disproportion between the head and the birth canal, the pressure may be so intense or so long continued that slufing may result. You could not have done anything to prevent the condition.-ED.]

Hippocratic Oath.

Editor MEDICAL WORLD:-Will you please publish the Hippocratic oath? J. N. APPLEWHITE. Pope, Va.

The following is the text of the Hippocratic oath :

I swear by Apollo the physician and Esculapius and Health and Allheal and all the gods and goddesses that according to my ability and judgment I will keep this oath and this stipulation-to reckon him who taught me this Art equally dear to me as my parents, to share my substance with him, and to relieve his necessities if required; to look upon his offspring in the same footing as my own brothers, and to teach

them this Art, if they shall wish to learn it, without fee or stipulation, and that by precept, lecture, and every other mode of instruction, I will impart a knowledge of this Art to my own sons and those of my teachers and to disciples bound by a stipulation and oath according to the law of medicin, but to none others. I will follow the system of regimen which, according to my ability and judgment, I consider for the benefit of my