Arsenauro.

Editor MEDICAL WORLD: In June WORLD, page 255, I askt for help on three cases diabetes mellitus that I had at that time under treatment. At this writing I have ing I have dismist them as cured. Briefly I will report my treatment:

Sneedville, Tenn.

Cancrum Oris. Editor MEDICAL WORLD:-I was called to see Alvin South, age 19; previous health good, family history good. Upon arriving I found the boy was suffering from a severe chill. Upon examination, I found a circumscribed dark skin about the size of a silver dollar, extending from the angle of his mouth over the masseter muscle. The line of demarkation was well formed, with sluffing of the alveolar processes, and a foul odor was present. I at once made a circular incision around the whole mass of the darkened area, including the masseter muscle, and extracted 2 molar teeth and curetted off the whole mass of gums and the cavities of the teeth. I then sprayed with peroxid of hydrogen and applied iodoform and acetanilid, and covered with gauze; changed the dressings twice daily; kept patient upon tonic treatment consisting of emulsion of cod-liver oil, with 20 gtts. of tr. mur. iron every 6 hours, and large doses of quinin.

Patient was convalescing from an acute fever. Was treated by Dr. C., who had produced ptyalism. Patient had decayed ragged teeth. Made a rapid recovery with loss of an extensiv amount of flesh covering the superior and inferior maxillary bones.

Patient's manner of speech is perverted. Cannot speak words distinctly.

This patient lives in the mountains of Northern Tennessee, always spent an outdoor life, good surroundings, six in family. The cause, I think, was ptyalism and decayed teeth.

The reason I write this is to show that cases are met with outside of crowded cities and in sparsely settled and salubrious districts.

Travisville, Tenn. Dr. A. H. CROUCH.

Case No. 1: J. B., female age 41, family history negativ. Had for eighteen months been in bad state of health, losing flesh, passing abnormal quantities of urin, uncontrollable thirst, and in short, had all the symptoms accompanying a well developt case of diabetes mellitus. Had been treated during 1900 by a prominent M.D., but was gradually growing worse. When she came to me examination of urin revealed considerable sugar, sp. grav. 1,036, quantity in a day from two to three gallons. I put her on nitrogenous diet and prescribed strychnin sulf. with directions as to hygiene, etc. This improved the general health and slightly diminisht the sugar. I began looking up literature on diabetes mellitus and was so imprest with the reports on arsenauro that I determined to test it. So I discontinued strychnin and began arsenauro, five drops three times a day in two-thirds of a glass soft water, increasing one drop a day, making examination of urin twice a week. I noticed no important change until about the thirty-first day; at that time she was taking fifteen drops three times a day. The face began to puff. Examination of urin showed sp. grav. 1,028; sugar less than when last tested; amount urin past very much less. Discontinued treatment for four days, then began again with twelve drops three times a day. Saw her again in ten days. Sp. grav. 1,022; no trace of sugar; amount of urin past, accurate measure, fifty ounces a day. She was greatly improved in general health. Able to go at her home work with energy, had gained in flesh, slept well, relieved of indigestion and in my judgment cured. I directed her to take twelve drops three times a day regularly. She discontinued it with our instructions about ten days ago. At this writing no trace of sugar is present; sp. grav. normal (1022); quantity past normal. She tells me she eats anything she wants except sweets.

Case No. 2; Male age 34. Noticed he was passing urin too often and in too great quantity in January, 1900. Since that time has gradually grown worse, with all

the symptoms attending such cases. When seen first was very nervous, suffering with insomnia. Had an eruption on limbs and genitals. Examination showed sp. grav. 1,045, sugar in abundance, and passing three gallons of water a day, with a thirst he could not satisfy. I gave proper direc tions as to hygiene, diet, exercise, etc., and directed five drops arsenauro three times a day, to be increast one drop each day until fifteen drops were taken three times a day; then increast a drop each dose until forty-five drops were given three times a day. At that time, sp. grav. began to lower, quantity past to lessen, and sugar to disappear. I held him at this dose (forty-five drops three times a day), and in a few days sp. grav. was 1,020, quantity past forty-five ounces, no trace of sugar. He has discontinued all medicin, does regular field work on a cotton farm, eats regular diet (except sweets) and at last examination, June 30 [he is writing July 5-Ed.] sp. grav. 1,020, no trace of sugar, quantity past normal.

Case No. 3: C. B., male, age 37; health had been failing for three years. During that time had to pass urin two to four times a night. His thirst could not be satisfied. Examination of urin revealed sugar; sp. grav. 1,042, and passing over three gallons of urin in twenty-four hours. Arsenauro in five-drop doses three times a day was prescribed, increasing one drop a day until fifteen drops three times a day were given; then increast one drop each dose. When twenty-one drops had been reacht he began to have vertigo, and his eyelids puffed. I discontinued for three days, then began again, eighteen drops, three times a day. He began at once to improve, and to-day his health is good, no trace of sugar; sp. grav. 1,020; doesn't pass urin at night; sleeps well; has good digestion, and has gained fifteen pounds in flesh. Have discontinued arsenauro. Now, I wish to say, these three cases had all the symptoms of genuin diabetes melli

tus.

By three different tests sugar could be detected, and to-day these same tests fail to reveal the slightest trace of sugar. Treatment has been suspended and patients dismist as cured. This is my first experience with genuin diabetes mellitus, and I am not prepared to say that it will not return. Allow me just here to thank those who were so kind as to answer my query by letter. C. B. HOLMES, M.D.

Palmetto Home, Miss.

reported above is certainly very commendable. But, Doctor, when all the recognized authorities agree in stating that true diabetes mellitus is incurable, don't you think that it is somewhat rash to use the word "cured" in relation to the above cases after so short a time? We wish you would report the condition of these three cases to us every three months for the next two years.-ED.]

Diabetes Mellitus.

Editor MEDICAL WORLD:-After reading Dr. R. G. McCullough's article on page 269, July WORLD, also your comment, I am prompted to report a case now under treatment. The patient is a man about 35, and gives a history of typhoid fever some three years ago, when the physician attending him gave him large and continuous doses of spirits of turpentine. On examining urin I found sugar, and at once put him on Fowler's solution. He has been on this treatment four weeks. Urin is now normal, patient has gained ten pounds in weight, and is able to perform his work (he is a farmer), and reports feeling better than at any time since the fever. I see some physicians are claiming much virtue in brewer's yeast for diabetes mellitus. Has any of the WORLD family had any clinical experience with it? Let's hear more from the brethren on this hitherto unsatisfactory malady. Parsons, Kan. F. WARREN LANOIX, M.D.

Curetment of Uterus.

Editor MEDICAL WORLD:-While doing postgraduate work last year and the year before, I made a special study of post partum infections and took pains to obtain the opinions of such men as C. S. Bacon, Henrotin, Denslow, Lewis, Clarence Webster, Bangs and others prominent in Chicago as obstetricians.

The opinion given below is that arrived at after careful study and consideration of the opinions of the above named men.

Manifestations of fever, pulse, pain, etc. encountered after delivery are usually caused by the invasion of micro-organisms, excepting, of course, the slight raise of temperature and pulse resulting from fibrin absorption, so well known to obstetricians. Rheumatism, autointoxication from the intestins and various other causes may produce symptoms resembling the invasions of micro-organisms. It is the duty of the obstetrician to diagnose dif

The chief organisms concerned are the streptococcus, staphylococcus and the putrefaction-producing bacteria. While the bacillus of diphtheria with others may play an important part, still the above named are the causes of the majority of the infections of the mother.

When the discharges of the vagina become foul smelling, it is the work of the bacteria of putrefaction. The cause is usually a clot or a piece of placenta left behind by carelessness on the part of the obstetrician or nurse either before, during or after delivery. There is no reason to believe that a clot or a shred of placenta, even tho it be left in the uterus, should not remain aseptic for a considerable time; long enuf, at any rate, that no harm will result and the eventual expulsion of the offending matter be possible.

Still, because of the difficulty of asepsis, it is desirable and most important that there should be no focus of infection left within the uterus; should such a focus be present, it should be removed, if possible, at once.

There is no excuse for the obstetrician when he allows a piece of placenta to remain in the uterus. Blood clots can be exprest by the method of Crede.

The placenta should always be carefully examined under water, to float the membranes, wash off blood and make the examination easier. The uterus should be made to contract firmly by kneading and administration of to 1 dram of ergot. (I use P. D. & Co.'s normal liquid.)

Should a very small piece of placenta remain, I do not think it advisable to expose the patient to infection by removal; but should the piece be of any considerable size, sayinch broad and an inch long and inch thick, one would be justified in its removal either with the finger or curet. I have allowed even larger pieces to remain because of the objection of the patient and friends to its removal and have had no bad results, because of the care used before, during and after delivery, the expulsion of offending material taking place spontaneously in one or two days, careful irrigation of vagina and aseptic facts having been made use of.

This brings up the question of the postpartum douche. While the fact is that a normal labor is aseptic, it remains true that cleanliness demands the washing out of uterin and vaginal secretions. With the word "cleanliness" comes the thought

of bacteria. If the serum exuded and the debris, which constantly flows from the vagina, is a good culture medium for bacteria, is it not rational to wash away this possible source of infection? Tho an antiseptic pad over the vulva exerts a powerful preventiv influence, the entrance of infection is made more sure by "cleanliness." I do not advocate the use of strong antiseptics at this or any other time, but advise a dram of sod. bicarb. to a quart of water once a day, and should a stronger antiseptic be wanted, creolin 3ss to i to a quart of water. The sod. bicarb. acts mildly as an antiseptic, but chiefly as a solvent. The heroic douching with strong coagulating and corrosiv antiseptics is to be condemned because of the lowering of the vitality of mucus membrane and possibly necrosis of same, thus inviting infection, if not already present, or opening new avenues to infection', should infection be present already. All important is the care used to have the douche aseptic. A careless nurse may produce an infection more severe and with greater certainty than if the douche had not been used. Should the conditions be such that the doctor's instructions be misinterpreted or neglected, it is better to avoid the douche and be satisfied with careful washing of the vulva with 1-2,000 bichlorid of mercury solution and a pad moistened and wrung out in creolin solution 3ss to a quart.

At

These instructions and precautions may be foreign to the question of curetment, but should they be more generally observed curetments would not be so frequently necessary, hence they are So carefully described. Should there be a streptococcus infection with the putrefaction infection, the course must be the same, viz.: the removal of the focus. the same time the procedure must be done with care. It is a well-known fact that nature always tries to limit infection and build barriers to prevent the spreading of the infection. This must be borne in mind during a curetment because it would be essentially wrong to break down these barriers and, in addition, scrape away the entire lining of the uterus, thus opening a thousand more avenues for infection. This is essentially the objection to the curet, and because of this the aseptic finger does better work, not only making it possible to locate the offending body by the touch, but the traumatism resulting is

much less. The use of the curet in acute infection by the streptococcus is to be condemned in toto because of the immense harm, the destruction of the intact lining of the uterus. It would be just as rational to curet an infection of the arm or any other part of the body. A curetment can accomplish nothing but harm. If a radical measure is demanded, the rational one would be removal of the entire uterus. In beginning infections, such a severe measure would be criminal; and if the obstetrician is not to curet or extirpate, what is left for him to do? In my opinion the uterus is to be treated as would be any other infection, viz.: by free drainage. The injection of anti-streptococcic serum is indicated beyond a doubt; the failures reported were probably due to an infection due to a microorganism other than the streptococcus, viz.: a mixt infection, possibly of streptococcus, staphylococcus and

others.

Should sluffing and necrosis take place in the uterus, the curet must be employed just as in other parts of the body, tho its abuse may result in the speedy death of the patient. There is a possibility that the application of a 10 per cent. solution of peroxid of hydrogen would prove beneficial, tho great care must be used because of the danger of producing a complication because of the possible escape of infectious material thru the Fallopian tubes. Alcohol 95 per cent. is advised by some, but I would prefer to douche once a day with mild solution of creolin, 3ss or less to one quart. The fact that foci may form in the pari-uterin tissues must not be overlookt. Where the infection has spread from the vagina, one may have the cavity of the uterus entirely free from infection and a pus cavity just above the cervix, or any of the tissues thru which the lymphatics pass. The early evacuation of the pus, and drainage, are here indicated.

Tho this paper has digrest somewhat from the original subject, I hope I have not done so uselessly. Should a new idea have been given to any reader, my object has been accomplisht at the expense of the

reader's valuable time.

Pigeon Falls, Wis.

C. S. WASSWEILER.

Where ladies suffering from superfluous growth of hair object to depilation by caustics or electrolysis, the most annoying feature may often be removed by bleaching the hair by repeated applications of peroxid of hydrogen, full strength.

Determination of Sex.

Editor MEDICAL WORLD:-In the May WORLD Dr. Waugh writes on the determination of sex, as one having authority and not as the scribes." It is true as he says, that "it must be settled by observation, and not by devising some fanciful explanation without any data of facts for its basis." After reading this, it seems a little strange that he accepts as a "law" the theory of cross heredity, mainly on the observations of a Georgia stockbreeder, of whom not one breeder or doctor in a thousand ever heard, and a Vienna professor who was dismist from his chair and forbidden to lecture in the university because those who knew him best believed him to be a fraud. He says that he has

known of efforts made to establish the theory of alternate sex ovules and it was a failure." It would have been more satisfactory if he had told what the efforts were, and how long they were continued. Five, or even ten years are not sufficient. When we attempt to establish any physiological law by observation, we should include not only humans, but also the lower orders of animals, and observations on domesticated animals should, when possible, be supplemented by observations on the same or allied species in their nativ wild state. Such observations as I have been able to make, have convinced me that sex is determined in the ovary, and not in the ovum; and that the normal sequence is the alternate maturing of the sex ovule. When, or where the theory originated I do not know; but probably it was among horsebreeders. The mare will always accept service when her foal is eight or nine days old, and in at least seventy-five per cent. of such services the foals will be of opposit sex to the foal recently born. This normal sequence is occasionally broken among wild animals, but only I believe when the female approaches senile sterility. It is oftener broken among domesticated animals, and oftener still among women. The longer the interval between two consecutiv pregnancies, the more likely it is that the sequence has been broken. Hence when I determined to try and satisfy myself of the truth or falsity of this theory, women were divided into two classes: first, women whose menses had always been regular up to the time of the first conception, and who again conceived within twelve weeks after a normal par