You may lose some cases but in the end you will come out triumphant. Do your obstetrical work conscientiously and well, and charge the proper fee.-ED.] Chronic Constipation. Editor MEDICAL WORLD:-A male aged twenty-five years has been troubled with constipation for twenty years. He has attacks of ulceration of the bowels which come on two or three times a year and last one to three days. In such attacks his temperature is about 1023, pulse feeble, tongue heavily coated, and has markt nausea. He complains of a tearing or grinding sensation about the umbilicus, which requires morphin hypodermically to bring relief. He is a merchant, and has good health between attacks. He has been treated by other physicians without benefit, hence I ask for diagnosis. Millican, Tenn. A SUBSCRIBER. [You have not "ulceration of the bowels" in this case, but probably intestinal colic due to gaseous fermentation resulting from constipation. Treat the constipation.-ED.] [This was an error in proof reading; it should read "five drams to the quart.' We frequently use this strength after labor, even after the soft parts are lacerated. In most cases, the cause of complaint is not from irritation in vagina or wounds; but from the fluid flowing over the anus. Protect the anus by a firmly prest pledget of cotton and you will find you can use much stronger solutions. The severity of such injection is hardly a condemnation, if the pain does not persist. Usually five minutes, or less, will see it subside. We use the five dram solution frequently in lacerations of the perineum, and have yet to see a case refuse to heal kindly under the soothing qualities of that "awful solution." If an abraded and lacerated surface is not painful after five minutes, when a five dram solution has been applied, we would take the com plaints of office patients with considerable salt. We have the authority of Professor Barton Cooke Hirst, of the University of Pennsylvania, as to the strength of solution in puerperal cases. We sometimes use it in lesser strengths, because of the wild. wailings of wilful patients, but we believe the five dram solution none too strong. It is extremely painful for a short time, but the suffering is evanescent, and the results so far exceed those following the danger of systemic poisoning is comemployment of any other agent, and the pletely nullified; so that we tie to and commend creolin above any other powerful antiseptic in obstetrics and gynecology. ED.] Editor MEDICAL WORLD:-Would you kindly publish an article on the test of breast milk as related to its butter fat, purity, and fitness for the child? I have been unable to find anything on the subject. THE WORLD is the best journal I take. G. T. VAN VOORHEES, M.D. Kernville, California. [As regarding the fitness of breast milk for an individual child, no office chemical analysis is worthy of consideration; the milk may often register up to every standard chemical and physiological test, and yet kill the infant. A case of tuberculous infection, in which the bacillus was demonstrated, and which was believed to be due to infection by means of the mother's milk, is reported in Gould's Year Book of Medicin for 1901, pages 76, and Tests for formaldehyd, borax and boric acid, salicylic acid, and sodium bicarbonate were given by Dr. J. M. Whitfield in Medical Register, September, 1899; any of these drugs unfits the milk. The percentage of cream may be rufly estimated by allowing the milk to stand in a test tube, or by the use of the centrifuge. The matter of accurate analysis of human milk is a procedure which can only be carried out accurately in a well equipt laboratory. The best general practitioner's test of "breast milk as related to its butter fat, purity, and fitness for the child," is the way in which the child acts. There are few mothers who cannot suckle their babes if they attend to their own bodily functions; the bowels, skin, and kidneys must be kept acting freely. A judicious amount of exercise must be taken. Proper food is an essential. Regular nursing of the infant at proper intervals is important. If the infant's bowels are kept in proper condition, the chances are that in almost every case the mother's milk will agree well. It is well to weigh the infant regularly in case it does not do well; if its weight increases steadily, no matter how slowly, stick to the breast milk. We are sorry, Doctor, that we can not give you specific tests for office use; but there are none known of sufficient accuracy to prove of any practical value. Study the habits, food, and health of the mother, and see that the proper hygiene is observed for the infant. -ED.] Stomatitis Materna. Editor MEDICAL WORLD:-As I am now a member of THE WORLD family, I will trouble you and other brothers with a question, respectfully asking advice from all, and especially from the Editor. I want a line of treatment suggested for a case of stomatitis materna, or "nurse's sore mouth," which has so far baffled all efforts to relieve. It is of about eight months duration; came on during the last five months of pregnancy, and has continued with varying intensity since. The child is now about three months of age. Tongue is highly inflamed, and intensely red, with sensitiv papillæ, enlarged and elevated. Bowels and stomach are deranged. Discharges from bowels amount to a diarrhea, and are of a serous nature. Fermentation of feces is also a markt feature. Patient has been treated with tonics, iron, quinin, etc.; and also the remedies usually employed in stomatitis: potassa chloras, hydrastin, berberis, and various digestivs, without any satisfactory result. Child has been weaned. I want the Editor's advice as to treatment. Also please give symptoms, cause, etc. of such affection. I cannot say enuf in praise of THE WORLD, as I consider it the most practical, instructiv, and useful publication of the kind extant. It certainly fills the needs of the general practitioner admirably. Carter, Tenn. R. J. FERGUSON. [This affection is reflex. Correct the source from which the disturbance is reflected. In the above case, address the alimentary tract. Intestinal antiseptics Intestinal antiseptics are indicated; as the sulfocarbolates. Consult standard works on practise for clinical history, etc. Perhaps some of our older readers will discuss this subject, particularly as to treatment.-ED.] Chronic Follicular Tonsilitis. Editor MEDICAL WORLD:-I have a case which worries me very much, and does not submit readily to treatment. If any brother could help me, it would be gratefully received. H., age 20 years, wellnourisht, fleshy, fair, complains of nothing except her throat. From her father's people she inherits tuberculosis. Both parents living; father's health poor; one sister died of consumption, aged 17 years; the remainder of the family in good health, one aunt died of cancer. Saw the case about eight months ago. Found the tonsils somewhat enlarged; one with a clean, circular cavity extending thru the organ about the size of a leadpencil. Two crusty yellowish spots on opposit side, one on tonsil the other one-half inch above. Deep seated and diffused redness. No cough; no lung trouble. Heart normal. Temperature normal. Patient said she had raised hard, yellowish, cheesy, badsmelling substances from her throat. Advised a specialist to amputate tonsils and direct in her case. About two months ago she came back to me after doing as directed, and also trying several other M.D.'s. tonsils are amputated, but the deposits continue to come up, and repair does not go on satisfactorily. Treatment at present is listerine and peroxid of hydrogen spray (with atomizer), iodid of potassium and comp. syr. of sarsaparilla internally. What more can be done? I think of cauterizing with silver nitrate. NEW BRUNSWICK. The ["The hard, cheesy, yellowish, foulsmelling substances which she expectorates are tonsillar secretions; and the fact that they continue proves that diseased glandular tissue remains. Your treatment is good; and we would only suggest that the peroxid of hydrogen be applied directly to the site of the tonsils by means of a camel's hair throat brush, as by this method the drug only reaches the diseased area and does not leave so unpleasant a taste in the mouth. Search the stump of the tonsils carefully and you will find small openings from which the secretions come. A long, fine probe is the best searcher. When an opening is found, pick out all the secretion possible, swab with the peroxid, and cauterize with nitrate of silver. It is very difficult and tedious to get such a small amount of cotton on the probe as is required to thoroly swab and cauterize these small openings; but it is the only satisfactory method of treatment. Cauterization of the tonsillar surface would be worse than useless; it would probably seal the openings into the gland so that serious abscess or phlegmon might easily follow. The tonsils often seem to act as a sieve for inspired germs, and are prone to easy infection. She has chronic follicular tonsilitis. We do not believe enuf glandular structure has been removed; but you can hold and cure the case as well as any specialist.-ED.] Sterility. Editor MEDICAL WORLD:-I have a married couple who are very anxious to have children. Married two years. Both healthy, and neither have ever had any sexual disease. The sexual organs of both are normal, and the sexual act is entirely complete and orgasms are simultaneous. Menstruation is regular and normal. The cervix was dilated with tents. Wool tampons have been used after coitus, as the semen had a tendency to flow from the vagina. This plan of treatment brought no results. Can you give me a cure for this sterility? Will the family also suggest any efficient treatment? Quincy, Ill. · STERILITY. [Since the cervix is patulous, pregnancy should occur. Attempt to get more tone in the vaginal mucous and muscular tissues by astringents. One of the most con venient is : Zinc sulfate Sodium borate. of each 34 gr. 4 gr. gr. Make up into a lozenge or into a suppository. Pass one up to uterus every second or third night. This will constringe the vagina so that it may retain the semen. In such cases, success has been attained by coitus "modo brutorum." Try having the couple abstain from connection for two or three months, and then indulge immediately following a period of menstrual flow. All else failing, examin the semen of the husband to see if his spermatozoa are mobile. Write us again; we think some of these methods will be successful, if the husband be virile.-ED.] WORLD four years for $3.00. Injection for Hydrocele. Editor MEDICAL WORLD:-Will you please give in your next number of THE WORLD a formula for fluid to inject for the cure of hydrocele? A SUBSCRIBER. Sligo, Pa. [There have been a number of formulas used, and they all have their champions. The leading formulas are the iodin and the carbolic acid solutions, the iodin being perhaps most frequently used. After draining off the fluid, leave the canula in position and inject thru it into the sac, from one to four drams of undiluted official tincture of iodin; plug the canula, and manipulate it so that the iodin will reach every part of the sac, then remove the plug and drain out the iodin. After removal of the canula, seal the wound with collodion, and keep the patient in bed. Reaction comes on in about two to four hours, and the scrotum swells to about its size before removal of the fluid. Fever is common. Support the scrotum, and relieve the pain with morphin; but do not use cooling lotions on scrotum lest the desired reaction be checkt too soon. swelling gradually disappears. Patient is usually up in a week, and the Levis, of Philadelphia, drains the cavity, and without removing the canula, injects thru it with a long nozzled syringe 10 to 20 minims of a 95 per cent. solution of carbolic acid. The acid should not be liquefied by water or heat, but is dissolved in as little glycerin as will take it up. The subsequent treatment is the same as that of the iodin, if the reaction be pronounced; but many patients go about immediately after the injection. It may be repeated as required. No fear need be felt of carbolic acid poisoning, unless excessiv quantities be used. It is a good idea for the patient to wear a supporter for a considerable time after recovery. ED.] Pink Eye, or Spring Catarrhal Conjunctivitis. Wright, in his recent Text-book on "There is a form Ophthalmology, says: of conjunctivitis which, if not chronic, is not altogether acute. It is known by many authors as spring catarrhal conjunctivitis or pink eye. The affection is characterized in the beginning by a serous discharge, congested conjunctiva, pain as of dust or other irritating substance in the eye, and the matting of lids during sleep. The inflammation increases rapidly, the discharge becomes muco-purulent, and there is swelling of the conjunctiva almost to chemosis. Following, there is often severe photophobia and blepharospasm. If the affection is not promptly treated it will merge into a well developt case of granular conjunctivitis. Like all inflammatory conditions of this character, it is infectious, and great care must be exercised to prevent its being communicated to communicated to others. The cause of this affection is obscure, but it is probably due to a very fine vegetable fiber or dust which is found upon the surface of new leaves and upon certain fruits in the spring of the year. "This affection, like all others, must be treated upon general principles. The eyes The eyes should be thoroly cleansed of all mucus, and if the lids are matted together with mucus, they should be cleansed with some mild alkalin solution like ten grains of soda bicarbonate in an ounce of distilled water, after which they should be flusht with a five grain solution of boric acid. The alkalin solution should be applied to the edges of the lids by a small pledget of cotton. If there is much conjunctival inflammation, fomentations of very warm water should be applied to the eyes often, and the patient should be confined in a dark room until the activ stage has subsided. During this time, and from the very beginning of the affection, a few drops of the following may be instilled into the eyes every six hours during the day: Upon retiring at night, the edges of the lids should be anointed with white vaselin." [The inquirers regarding "pink-eye" will please consider this an answer to their communications. The general practitioner pays too little attention to eye affections; he either treats them carelessly and unscientifically, and thereby loses patients and fails to get good results; or he has read enuf to be " 'stage struck" when a case presents itself. If any organ should be the proper field of the general practitioner, it should be the eye in all ordinary cases.-ED.] As an after-thought, let me congratulate you, Mr. Editor, on your very logical and advanced thoughts on public questions of the day as given in your "Monthly Talks." Many of us may have at first sight thought them out of place. For my part, I believe they fill a place and supply a want of incalculable benefit to your thinking readers.-G. Schmidt, M D., Milwaukee, Wis. What the Cause of the Pain? Editor MEDICAL WORLD:-Mrs. S., aged twenty-two; blue eyes; black hair; weight 135; height, five feet two inches; married December 20, 1900; menses normal, one week before marriage; three weeks later was suddenly attackt with what I diagnosed as cramp colic. Gave her ten grains calomel and one-fourth grain of morphin, which relieved promptly. Summoned again a few days later, I found her with intense paroxysmal pain at the pit of the stomach; temperature normal; pulse full and strong; intense nausea and vomiting; the bowels and kidneys had acted normally during the day; the paroxysms of pain in stomach would gradually subside and appear in the sacral region. Careful examination revealed nothing abnormal. I gave her one-fourth grain morphin hypodermically, and ordered powders of three grains calomel and one-eighth grain ipecac every two hours, followed by epsom salts afterwards. In an hour she slept; but I was again called at midnight, and found all the symptoms aggravated. I repeated the morphin, and began chloroform inhalation, when she at once ceased breathing. I gave whiskey and strychnin hypodermically and began artificial respiration; in five minutes she breathed again. For twelve hours whenever the pain left the stomach and appeared in the sacral region, she would cease breathing and could only be revived by inverting the body and practicing artificial respiration. We had hot water bottles to feet, back, and stomach. Gave internally whiskey, strychnin, and gelsemium, every two hours. The paroxysms gradually grew less, and finally disappeared in twenty-four hours. Will you kindly diagnose the case, and criticise the treatment? JOHN B. LUCAS, M.D. [When you first saw her you had undoubted stomachic cramp, possibly due to constipation or indigestion. Her second attack may have been due to cramp colic, gallstones, or the passage of a renal calculus. Was she jaundiced after the attack? Did you search the stool? Did you exam ine the urin? Your treatment in the emergency could not have been improved upon; you "pulled her thru," and enuf is said. Do you use atropin with your morphin hypodermic tablets? We do not like chloroform in such cases; it may mask the symptoms, but is not in any sense remed ial, and one needs to search for the primal cause. You got heart failure from its use. With the history given, we could not venture a positiv diagnosis, but we would say that the case will bear watching. Keep her on digestivs and laxativs; elixir pepsin compound with nitro muriatic acid, and sodium phosphate will be good. Regulate her diet, and interdict excessiv amounts of starch. If she has another attack, search both stool and urin carefully. Better omit the chloroform next time. Let us hear from case again.- ED.] Brain Trouble.-Dry Throat.—Skin Disease. Editor MEDICAL WORLD:-I would like to have some suggestions from physicians experienced in brain diseases. A little girl at the age of two years had a severe case of bronchitis, but recovered with the exception of an impaired brain with symptoms as follows: She is now nine years old, very large for her age, well developed, grows very fast, can not learn to read or even learn her letters, remembers faces and names for a long time, and will remember punishment for years, and greatly fears she will be punisht again; will ask over and over: Will Edith be punisht? and each question must be answered: Edith will not be punisht. Her appetite is good, bowels regular, urin colorless, heart irregular, a few beats slow and regular, then very rapid, then intermits and again regular. Has no pain, except some times says she is sick here, placing her hand over her heart. She is very nervous, does not sleep before midnight; but then sleeps well until morning. When awake keeps hands moving almost constantly. Doctors, can she be improved? or is her case hopeless? Please suggest. For Dry throat case is a chronic one. years she has suffered with rheumatism and neuralgia without permanent benefit. But the hard thing to benefit is that dry throat and also tongue. Tongue never coated but clean and red, deeply fissured; has headache almost constantly, bowels constipated, urin changeable. Old lady age 56 had a severe eruption which for weeks resisted all treatment until I used powdered thyroids five times a day, combined with iron, quinin and strychnin. After a few days improvement began, and she is now almost completely cured, after three weeks' treat ment. F. M. SHIRK, M.D. Lost Springs, Kas. [The first case had more trouble than bronchitis, had her physician been alert enuf to have noted and recorded it. Give ber strychnin and bromids, combined with asafetida. Absolutely forbid this "punishment;" your nine year old girl is but a nine-months' old baby in intellect, and can not appreciate or understand why pain should be inflicted upon her. Has Kansas any good schools for feeble minded children? If so, send her there. Such a transfer will be better for her, and a relief to you; she will improve, but will not likely ever recover entirely. While she remains under your care, you can only keep digestion good by acid and pepsin mixtures; see that bowels are regular, without undue purgation; and keep the nerves quiet, and the system supported by tonics. You do not give enuf details on your third case to permit us to diagnose the case. —ED.] Enlarged Liver. Editor MEDICAL WORLD:-Mrs. C., aged 50 years, fell into my hands a few months ago for treatment for enlarged liver. She told me that her liver became very large several years ago; she was treated for it and the trouble gradually disappeared, and has not troubled her since till about three months ago, when she came to me saying her "liver was growing again." I made examination and found her liver very large-extending as low as one or two inches below the umbilicus, and could be easily graspt between my fingers and thumb, thru the relaxt abdominal wall. I made further examination of other organs and found organic heart trouble, which from all indications was in the right side of the heart. Heart's action very irregular and labored. Stomach in fairly good condition, considering the amount of crowding by the liver. Breathing very short. A small amount of swelling of feet and ankles occasionally. No pain about liver. Bowels constipated. Action of kidneys is good. Patient weak and anemic. My treatment in the case has been addrest mainly to the condition of the heart. I have used general tonics, and for the heart such things as digitalis, strophanthus, strychnin, etc. I have also kept patient part of the time on such things as muriatic acid, pepsin, etc.; also very small doses of mercury occasionally, and looking out for the condition of the |