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This is the method commended by Sir Ranald Martin. Professor H. C. Wood prefers making a pad of canton flannel or spongio-pilin of several layers, each about 8 by 10 inches. This pad is dipt in a solution of the acid varying from one to three drams to the pint of water; it is then wrung lightly and placed over the liver, covered with oiled silk, and bound in place by a bandage. Such an application produces a prickling sensation and at times profuse local perspiration. It is generally left in place thirty minutes to one hour; tho many patients can wear it almost continuously. The method of Dr. Wood is generally preferable if the patient can be seen often, or if he may be trusted to follow directions. Keep up the supervision of the heart, but leave off the digitalis unless some special indication presents; the stropanthus and strychnin are better drugs in such conditions.-ED]

Dr. M. L. Dutton, of Floyd, Va., writes: "I would not miss a single number of THE WORLD for the price of a year.

Chronic Hepatic Congestion.

Editor MEDICAL WORLD:-I am one of your recent acquisitions, and I must say I am well pleased with THE MEDICAL WORLD and the manner in which it is conducted. Too many medical journals read like a yellow-back almanac. Too many editors seem to have the interest of some proprietary medicin concern at heart rather than the men whom they depend upon for subscriptions. Seems to me they must have some financial interest in the sale of such remedies, or they would not urge them so continuously and earnestly upon us. I know of one editor of a well known journal to whom I will venture to say you can not go with any array of symptoms, asking for help, but that he will fill the greater part of his prescription with certain proprietary medicins. In my early days of practise I tried many of them, only to find that they were no better than other remedies, and were put up for the express purpose of making some man rich.

"Excessive Venery in a Female." After reading the article with the above caption in the February WORLD, I pusht myself back in my chair, drew a long breath, pincht myself a time or two, ran my fingers thru my hair and exclaimed:Holy Moses! Am I awake? Wonderful woman; cohabitating twice a day, yet reformed. Surely it must have been "excessive" before reformation; no wonder all pleasure was lost. To think of such excesses as practist by this woman is simply horrible. Better button-hole the labia majora and swing a padlock thereto, or give her Dr. Waugh's chlorine water mixture for bad breath.

"How to Get the Most out of Us" in the February WORLD is a timely article from the hand of the Editor. I never before realized that an editor desired that his journal should be so earnestly and carefully read; that each and every article should be well digested, even to the ads. That certainly is indicative of the great earnestness, time and labor that the Editor of THE MEDICAL WORLD puts forth in the work which is destined for the good of those to whom the journal may go. It is a pleasure as well as recreation to me to get my journals down and read each and every article therein. No, we are not practising for fun or health. I am quite sure I am not, for if I were to consult my own feeling many times I would sit in my

office instead of riding many miles in storm and darkness.

Then let us read, think and digest; and if we have an inspiration or something good to tell, let us write.

A Case for Diagnosis and Treatment.-A widow lady, aged 62, formerly a farmer's wife, six children. Husband died ten years ago of consumption; two children have died since of same disease; both were married. She has not been confined to her bed on account of sickness in the last twenty years until last fall, when she was taken down. Her family physician cared for her until within the last two months when I was called in to see her. Found her as follows:--Emaciated somewhat, eyes sunken, skin and conjunctivae icteroid, tongue clean, severe pain in right temple, dyspepsia, distressing cough, slight expectoration of frothy mucus. Cough sometimes provokes vomiting of a green and very bitter material. Right side in axillary line, very painful. Appetite fluctuating, constipated, stools lighter than normal. No abdominal pain. Feet, ankles, and legs swollen to knees. Skin of limbs bluish and veins distinctly seen. All the large joints are very painful and stiff at times. No inflammation. Pulse full and strong, running about 90 per minute. Slight elevation of temperature at times. Sharp bruit heard with each systole of heart; more distinctly heard at apex; second sound slightly accentuated. Carotid pulsation. Very nervous at times and extremely sensitive to pain. Melancholic. Urin normal in amount, no albumin.

At first I put her on apocynum and calomel, which soon reduced the swelling. Later I put her on

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hard enuf to throw up her shoes if she had them on. Seems as tho the throttle has been thrown wide open with a full head of steam on, then better again,

etc.

Now Mr. Editor if I have not already worried your patients and mine too, I would be pleased to have a suggestion from you and the brethren of the WORLD family. A diagnosis and treatment of this case will be thankfully received.

L. J. SPICKARD, M.D.

Russell, Ohio.

[You have drawn us a clinical picture of chronic hepatic congestion, which may be cirrhotic. We do not believe tubercular involvement exists, but we would examin the sputum. We would use nitromuriatic acid internally and externallysee reply to Dr. E. L. Lawrence, this issue, for details. The evident obstruction in the heart may be primary or secondary. Treat both hepatic and cardiac involvement, and constantly supervise the kidney action. Search again for albumin, and also for casts. Examin stool for gallstones. Keep her on laxativs, tonics, and digestants; and, above all, regulate her diet. Such a case may often have permanent benefit from judicious diet. In her presence be always cheerful and confident without being boisterous or silly. Make her sure you will cure her soon. If organic tissue destruction has progrest far enuf, she will die; if the trouble be entirely functional, as is possible, she will recover under medication, diet, suggestion, and hygiene. Your drugs were good, but we would add dietetics and hygiene. Secure control of your patient morally as well as therapeutically.

Many proprietary medicins, prepared for physicians' use, are all right; but the proper place for presenting them to the attention of the profession is in the advertising pages-not in the reading pages, a la patent medicin almanacs.-ED.]

Loss of Virility.

Dear WORLD:-I would be glad to know what some experienced members of the WORLD family would recommend in the case of a patient I have under treatment for lack of virility, which is puzzling me, and not improving under what I have recommended so far. The following are the symptoms or condition of my patient, whose age is thirty-eight, height five feet ten inches, weight 153 pounds; general

health quite good, habits regular, does not smoke at present, has smoked moderately at times, good worker, does not tire easily, appetite regular, sleep natural. Varicocele of left testicle and some redundancy of foreskin, but these are conditions that existed before his present trouble commenced, which appears to be loss of erectil power when attempting to cohabit, tho at other times there are occasional temporary erections, but no emissions at any time, no masturbation, no excessiv coition or disease in the part. Desire normal; only one or two cohabitations during last year; other attempts failures. Wife's organs are small, and she has but little sexual desire; no children. Patient says when suggestion is made to him by a woman at times a nervous tremor follows that sometimes lasts quite a little while. Now what is best to do for him? I have used an aphrodisiac tonic (phosphorone, strychnin, etc.), in very moderate doses; also a vacuum tube for a while, tho the organ is natural size. The trouble appears to be loss of virility and erectil power at the right time; but why should the powers of a healthy man of good habits fail so early in life, with no seminal losses apparently? Should be very glad to hear from some of the "family" who have had

experience in similar cases.

Nogales, Arizona.

A. H. NOON, M.D.

Editor MEDICAL WORLD:-Hoping that some of the WORLD readers will give me treatment, I submit the following case:

Mr. L., aged about thirty-five years; unmarried; engaged in stationery business. For past three or four years, regularly upon rising in the morning, has been attackt with violent sneezing, which continues for several minutes and greatly exhausts him. Sometimes has such an attack while in the barber's chair; occasionally has an attack at some other time of day, after which there is a copious watery discharge from eyes and nose. The different seasons seem to have no effect upon his case. General health is good; formation of throat, posterior nares, and nasal passages normal; mucous membrane slightly congested. Has been under treatment of other specialists without receiving any benefit; says they made a local application of cocain. Complains of nothing but the sneezing; and this he says, makes

life not worth the living. What will stop it?

I am, and have been for the past ten years an interested reader of your valuable journal. HENRY R. BELL, M.D. San Francisco.

Editor MEDICAL WORLD:-I have a patient two years old, who has a scaly eczema, or some thing of the kind. Will give a slight description: Scaly all over, except a small space around privates; conjunctivae red and inflamed; lids somewhat everted. Cracks open in some places on body, and a dirty-looking fluid runs or oozes out at these fissures. Child has been this way ever since birth. I inquired if any of the relativs on either side had been afflicted similarly, and parents said not. I used the following ointment:

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Editor MEDICAL WORLD:-I wish to ask a few questions on the subject of embryology. (1) Take a male with right testis healthy and perfect and the left either absent or incapacitated; what will be the offspring? (2) Take the condition of the two organs vice versa; what will be the offspring? We may take it for granted that an orchitic testis cannot yield fertile sperm. Take again analogous conditions in the woman; (3) right ovary; (4) left ovary; what about the offspring? I have recently read in medical journals several cases of pregnancy where only a remnant of one ovary was present. Animals with a single testis procreate, and the fact is well known; the opinion prevails among some observers that their offspring is specially strong. I have an impression that the right and left organs in both male and female are essentially different; but I cannot prove my theory without the induction process, and I believe that by a thoro canvass of the experiences of the

profession the problem can be made an o. e. d. one. JAS. DAVIS, M.D.

Mt. Clemens, Mich.

[See article by Dr. Waugh in this issue.-ED.]

Current Medical Thought.

Chancroid and Chancre.

66

The

Sturgis and Cabot, in the seventh edition of their Manual of Venereal Diseases (publisht by P. Blackiston's Son & Co., 1901) say: I wish the term 'mixed sore could be abandoned, as it is confusing and does not convey a correct idea of the facts. It is really a double sore; there is no mixture whatever of nature, course, or virus; it is simply where inoculation of a chancroid and syphilis occur simultaneously in the same person. The two poisons being received at the same coitus, they operate differently as regards the time of their appearance. The chancroid appears first; remember it has no period of incubation, and runs its course and perhaps gets well before the initial lesion comes upon the stage. At a later period, usually varying from ten to twenty one days after the infecting coitus, the initial lesion appears, markt by its peculiar characteristics. It sometimes happens that the chancroid has not healed before the first symptom of syphilis is due. This, then, is what happens: the chancroid is surrounded with a ring of induration, the secretion becomes less copious, the floor fills up and appears redder and healthier, and the nearest chain of glands is indurated; the chancroid, in other words, has changed into an initial lesion. But thruout the whole performance there is no interchange of characteristics; the two lesions remain entirely distinct, and 'mixed chancre' is, to my mind, a misnomer. It is in these cases of double infection that you will be most likely to meet with a suppurating bubo, the pus of which is auto inoculable, and which, unless you are forewarned, may lead you to believe that syphilis is attended by a suppurating, auto inoculable bubo. The bubo is chancroidal, similar to what we have already studied, has nothing to do with the syphilis, altho it is contemporaneous with the initial lesion, and will require the treatment appropriate to chancroidal buboes.

"As regards treatment, it is simple, and

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Butyl-chloral hydrate,
Chloral hydrate,
Decoction of cinchona,
Fluid extract of cinchona,
Infusion of catechu (con.)
Sulfate of iron,
Iron salts in solution,
Tinet. hamamelis,
Tinct. iodin,

1 dram.

2 drams.

Antipyrin Incompatibles.

Antipyrin may be decomposed when brought into contact with nitrous compounds, a new and poisonous compound being supposed to be formed, of uncertain composition, but resembling the anilin greens. The mixture of this drug with sweet spirit of nitre is therefore highly dangerous, if this supposed reaction is at all likely to occur. It is more or less decomposed or thrown out of solution by a large number of chemical compounds and other preparations, of which the following are the most important: Dilute hydrocyanic acid, Tannic acid,

Solution of the iodids of arse-
nic and mercury,
Mercuric chlorid,
Beta-naphthol,

Nitrites in solution (acid),
Sodium bicarbonate,
Sodium salicylate (solid),
Tinctures of tannin, iron or
quinin,

Infusion of rose or urva ursi.

POTTER.

Sub-cutaneous Infusion of Normal Salt

Solution.

Progressiv Medicin, for November (Lea Brothers & Co., Philadelphia), gives the following concise directions regarding subcutaneous salt water infusion: "The procedure is a very simple one. One should have a fountain syringe or any form of vessel to which is attacht a rubber tube. To the end of the rubber tube is attacht an ordinary aspirating needle of medium size. The whole should be sterilized by boiling, which can be done in a few moments. The vessel is filled with salt solution at a temperature of about 100° F. There seems to be no danger if the temperature is 102° or 103°. The skin thru which the puncture is made should be carefully cleaned; alcohol, followed by bichlorid, 1 to 1,000, is, as a rule, sufficient. The introduction of the needle is seldom

painful. The needle should pierce the skin and the subcutaneous tissue, and, if possible, the fluid should be infused intermuscularly. The place of selection is a pectoral region in male or female. The needle should pass between the fascia of the breast and the pectoral fascia on the axillary side of the breast. In this area there are a great many vessels, the circulation is good, the tissue is loose, and one can infuse a litre of salt solution rapidly, without pain and with practically no danger of bad after-effects. A second infusion can be made in the same place in four to six hours without harm; it is better, however, at the second infusion to use the opposit side. The buttocks, the outer lateral surface of the thigh, the lumbar region, the abdominal wall, and the muscle over the scapula have all been used. There is a distinct objection to the buttocks, especially for the infusion of any amount, as the fat in this region is not vascular, the circulation does not compare with that of the axilla, and pressure is frequently followed by gangrene. The same is true in the thigh infusion beneath the tense fascia lata. As Georgii emphatically says, not only the surgeon but every practitioner should have a transfusion apparatus in his armamentarium, and should familiarize himself with the simplicity of the method. The fountain syringe with the needle can be boiled in a few moments, or for emergency cases it may be kept steril wrapped in two towels. It takes but a few minutes to sterilize the skin; boiled water, to which the salt can be rapidly added, is generally of easy access, so that a subcutaneous infusion should be but a matter of five or ten minutes. As far as the surgeon, the gynecologist, and the obstetrician are concerned, I feel that it is almost criminal for any of them to be ever without a transfusion apparatus. In addition to the careful technic, the subcutaneous transfusion should be done, as a rule, slowly; say about 30 minutes for 500 c. c., and during this time gentle massage should be made of the infusion tumor to aid absorption. Normal salt solution seems to be the best fluid for infusion."

[Since Senn has proven that transfusion of blood is impracticable and never useful, the saline infusion is valuable. Any one can do it in a few moments. The normal

salt solution is made by adding a dram of common table salt to a pint of boiled water. We have seen cases lost from hemorrhage

which saline infusion would have likely saved. Add a medium sized aspirating needle to your fountain syringe, which ought to be in every obstetrical kit, and your equipment for infusion is complete. While the sterilization of instrument and skin is preferable, we would not hesitate in an emergency, say after exhausting postpartum hemorrhage, to use boiled water and risk infection from instrument or skin.—ED.]

State Boards of Medical Examiners. In the following states and territories diplomas from colleges of medicin do not now confer the right to practise medicin, an examination being required in all cases: Alabama, Arizona, Connecticut, Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Indian Territory, Cherokee Nation, Iowa, Louisiana, Maine, Maryland, Massachusetts, Minnesota, Mississippi, Montana, New Hampshire, New Jersey, New York, North Carolina, North Dakota, Oregon, Pennsylvania, South Carolina, Utah, Vermont, Virginia, Washington, West

Virginia.

The following require the licensing examination only: Connecticut, Hawaii, Maine, Massachusetts, Mississippi, North Carolina (diploma after 1900), Oregon, Washington, West Virginia, Secretaries of examining boards (or a member when secretary is not known) are given below:

Alabama: The authorized Boards of Medical Examiners are the Board of Censors of the State Medical Association, which is known as the State Board, and the Boards of Censors of the County Medical Societies holding charters from the State Medical Association. There are sixtysix of these county societies, and therefore sixtysix county boards of medical examiners.

Arizona William L. Woodruff, Phoenix. Connecticut State Medical Society, Dr. Max Mailhouse, 151 Meadow street, New Haven;

Homeopathic Society, Dr. E. H. Linnel, Norwich; Eclectic Association, Dr. G. H. Faber, 57 Center street, Waterbury.

Delaware: Regular, Dr. J. H. Wilson, Dover; homeopathic, Dr. C. M. Allmond, 913 Tatnall street.

District of Columbia: Dr. J. S. McLain, Nineteenth street, N. W.; homeopathic, Dr. J. B. G. Custis, 912 Fifteenth street, N. W.; eclectic, Dr. Thomas Robinson, 1204 G street, N. W.

Florida First District Board, Dr. C. B. McKinnon, Pensacola; Second District, Dr. G. W. Lamar, Quincy; Third District, Dr. J. A. Townsend, Lake City; Fourth District, Dr. J. H. Durkee, Jacksonville; Fifth District, Dr. G. E. Welch, Palatka; Sixth District, Dr. L. W. Weedon, Tampa; Seventh District, Dr. R. L. Harris, Orlando. Homeopathic Board, Dr. C. W. Johnson, Jacksonville. Eclectic Board, Dr. W. J. Sears, Kissimee.

homeopathic, Dr. R. E. Hinman, 153 Whitehall, Georgia: Regular, Dr. J. B. Holmes, Atlanta; Atlanta; eclectic, Dr. M. T. Salter, 68 S. Broad, Atlanta.

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