prepared nitro-muriatic acid, strong, in five drops doses in a glass of water before meals. Absolutely forbid any starchy food. If necessary, keep him on lime water and milk, or buttermilk, for a time. Convince him that he will live a number of days without eating anything. We belive your diagnosis correct and your treatment too therapeutic. Try hygiene, exercise, massage electricity continued, diet continued and restricted, and moral suasion and advice laid on thick. Regular lavage would bring good results. If your patient has no leading symptoms beyond those described to us, such treatment will result in alleviation; he may wait for a cure. The Weir Mitchell plan would probably suit him well. We can not fully advise without minute details. We will be glad to hear from you and the case again, but please give minutiae.-ED.]

Editor MEDICAL WORLD:-Please give me some help thru your journal in the following case: Married lady, age 28, no children. Complains that to open her eyes first on waking in the morning causes an indescribable feeling as of heaviness or a drawing sensation, somewhere about the eyes, tending to keep them closed. This occurs almost every morning and occasionally in the evening, when it tends to close the eyes, and it is with the greatest difficulty that she can keep them open. It is not accompanied by any drowsiness, but as it "will not down" in the evening, she goes to bed. In the morning it lasts five to ten minutes. She does not overtax the eyes by reading or fancy work at night nor in day time. She has consulted oculists without number, each of whom fitted glasses, but not the slightest benefit followed in any case. Eyes and lids look perfectly well save that occasionally there is a slight redness about edges of lids. Vision is absolutely normal. Health is perfect in every way. Please give me Please give me your diagnosis. B. B. SNODGRASS, M.D.

to some weakness of the nerves connected thereto. If the "slight redness about edges of lids" is permanent, bathe frequently with a saturated solution of boracic acid in camphor water and anoint outside of lids twice daily with yellow oxid of mercury, four grains to the ounce of lanolin. We believe such treatment will cure your case if persisted in, unless beginning exopthalmic goiter complicates the case.ED.]

Editor MEDICAL WORLD:-Please give diagnosis and treatment of the following case: Male, 42 years of age, height 5 feet 8 inches, present weight 125 pounds, former weight, 145 to 160. Gives history of some consumption and kidney trouble on father's side. Farmer, but at present not able to do much work on account of weakness. When a boy he had a very uncommon appetite; could scarcely get enuf to eat; now has no appetite, digestion very bad, tenderness over stomach, constipated, tongue coated with dirty pasty coat, bad taste in morning, and spits a good deal of whitish, frothy mucus in afternoon. Dull headache over eyes and in temples, very nervous, memory bad, specks before eyes, and don't rest well in forepart of night. Urin usually scant and high colored, specific gravity 1,025 to 1,040, no sugar nor albumin. At times urin is pale; at or about these times patient feels worse; sometimes burning on urination. Has used tobacco to excess, but at this time has about quit; don't use tea, coffee nor alcohol. Physical examination reveals nothing whatever wrong with lungs or heart.

I have called this chronic gastric catarrh, and am treating with drop doses of Fowler's sol. with nux vom. before meals and elix. lactated pepsin and syr. hypophos. comp. after meals. Any suggestions Editor or family can give will be appreciated. A. C. L.

Kentucky.

[The prominent characteristic of this. case is a condition of chronic biliousness, which should yield to persistent use of the milder cholagogs, laxativs, and aperients, when combined with a rigid rule of diet, and suitable digestants When you consider tuberculosis, you would better exclude "night sweats" and temperature, and then examin the sputum. Better go thru each process repeatedly. You do not say that you have done this. After you have

excluded beginning tuberculosis, you must get his stomach and bowels in a condition of proper functional activity, and then have some competent specialist examin his eyes; but beware of the "optician" Have him drink water freely, and give mild diuretics until you can test a specific gravity of about 1,020, and when you have done this, there will be no scalding on urination. Your diagnosis may be taken as temporarily and provisionally correct, but if we took your pis, we would wish examinations repeated more frequently and thoroly, and would wish more strenuous medication. What can you expect to accomplish by "drop doses of Fowler's solution"? If he needs arsenic, give it to him until you get the effect of the drug. We concur in your diagnosis of the present conditions, but we must mildly chide you on your report of your examinations as to prognosis. If this man is now in the incipient stages of tuberculosis, you ought to so ascertain and treat; and if you are not competent to do this, you should certainly refer him to some one who can do him justice. Do not risk any guess work; but do the best possible for the patient, and if you honestly feel that you can not do this, send him elsewhere. We can only suggest more vigorous medication until you give us more data; for we feel like commending you so far as you have gone, and condemning you for not going far enuf.-ED.]

"Bilious" Headache.

Editor MEDICAL WORLD:-F. M., male, aged 35, merchant, height six feet, weight 180 pounds, complexion dark and slightly sallow about eyes, temples and forehead, quite deep furrows downward and outward from inner angles of eyes and beside nose. He is generally healthy. Has had no illness except ordinary diseases of child hood. Bowels regular; smokes four or five cigars daily. Drinks a couple of glasses of cold water before retiring and after rising. Has had occasional sick headaches since childhood. The attacks average once in two weeks, but the period varies. Ten or twelve hours previous to attack (usually the night before attack) his mouth is very dry. Patient thinks that by taking a full dose of liver pills at this time he has warded off the attacks, but this seems less certain to act than formerly. Three or four hours after the headache begins he is usually nauseated and vomits. If he

completely empties the stomach he is usually relieved. Vomiting is green or yellow or both at different expulsiv efforts in same attack. No food in vomits. Attacks generally last about a day, beginning in the morning and improving about sundown. Patient's father had these attacks as long as he lived, but patient is the only one attackt of a family of four boys and two girls. The pain is usually on right side of top of head and across at the base of the brain. Prior to a year ago it was mostly back of the eyes. Patient is much worse if during the attack he lies on his left side. Pressure at the base of the brain, as in lying with the head resting across the footboard of his bed, seems to relieve the pain. Now, I should like to hear from yourself and "family" as to prognosis and treatment of this case; and judging from the frequency with which I meet similar cases I believe a few words as to its etiology would not be out of place, and might benefit others as well as myself. A. M. LOOPE, M.D.

Poplar Ridge, N. Y.

[See editorial on headache in August WORLD. If vomiting relieves the case, we would suggest an emetic at the beginning of each attack, or before, when the mouth becomes dry. Careful regulation and restriction of diet ought to greatly benefit or cure this case. If he would live for a month on one half his customary food (most people eat about double the amount they ought to) and banish nitrogenous foods entirely, or almost entirely from his diet, he would doubtless be greatly benefited during that month. fited during that month. Will he do it? Few patients will. No, that month won't cure him. He will have to continue the diet as long as he wants to be better, or cured. Taking water night and morning is good. is good. He ought to take six or eight more glasses during the day. Omitting breakfast entirely has cured many cases of headache. Perhaps he should avoid sweets; certainly pastry.-ED.]

Is It Hystero-Epilepsy?

Editor MEDICAL WORLD:-I desire to present to the readers of your valuable journal the following case for diagnosis and treatment: Mrs. W—, age 45. This lady was very delicate during infancy and childhood. Mother died of consumption at age of 56. Father's health always good. Patient is the mother of one child now a healthy young lady. Had a severe attack

of typhoid fever when about 20 years of age. Has three sisters and two brothers living, all in good health. First menstruated at the age of 21. Menstruation regular until four years ago, since which time the intervals have been from four to nine months. The mother of this patient was of a very nervous temperment.

At

At the age of 22 this woman commenced to have light attacks of momentary unconsciousness. During and for a few moments subsequent to the paroxysms she would not know her name nor where she was. the onset of these attacks they came on during or just prior or just after the menstrual epoch. At this time the attacks numbered two or three per day. Spells became more severe and frequent until she would have several every day during the month. She commenced to have severe epileptic attacks eleven years ago. The severe attacks were about six months apart at the beginning, but increast so that she would have an attack nearly every month. Some time. after the onset of the severe attacks she was under the care of a physician who was successful in relieving her so that she went two years with no attacks of any kind. Six years ago the attacks returned and the physician in question was unable to relieve her. Four years ago a new phase in her condition developt, viz.: A screaming attack or paroxysm from any sudden noise, as a bicycle bell. In these attacks the patient will utter a sudden scream and grasp her face or head with her hands. This condition debars her from attending church or mingling with society, as the slightest noise or other provocation will cause her to scream, after which she feels mortified over her actions.

In this case there seem to be three different kinds of attacks, viz. the severe epileptic attacks, the paroxysms of temporary unconsciousness, and the screaming attacks. When she has one of the light attacks of temporary unconscious ness, and as the paroxysm is ending, the patient will ask who she is, where she is, what day it is, or what time it is, and when she is answered she appears to be all right.

There is no female trouble in this case. Bladder, heart and kidneys normal. No headache; always sleeps well at night. Bowels costiv without medication. Have treated her for a few months with the various nerve sedativs and tonics, but find that nothing relieves her but the triple bromids, combined with cannabis in

Editor MEDICAL WORLD :- -A patient was treated four months by different physicians for boils, which appeared in successiv crops. He finally went to the Mineral Springs at Colfax, Iowa, for treatment. While there he was told that his boils were due to nicotin poisoning. The patient had served on a jury and was kept in a room overnight where most of the jurymen smokt cigars. Patient was not a user of tobacco and the experience made him sick at the time His boils began to appear soon after his service on the jury.

I find nothing in my books to show that his breathing air laden with tobacco smoke could cause his attack of boils. Many physicians at sanitariums and springs feel it incumbent on them to gouge the general practitioners whenever opportunity presents itself, to impress the laity with their superior skill (?). This may be such a case.

I respectfully ask the Editor's opinion, as well as others of the family.

Grafton, Iowa. S. M. MANN, M.D.

[There are many curious instances of idiosyncrasy toward drugs in certain patients. We know a man who will suffer for a week with severe giant urticaria after the ingestion of half a grain of quinin. We have never heard of such a case of poisoning as the one you report, and cannot imagin how any physician could get the data on which to make such an assertion. The effect of nicotin poisoning is generally prompt and almost immediate. A general practitioner's opinion would be as valuable as any sanitarium physician's opinion on such a matter. We presume the patient in his earlier treatment, had calcium sulfid to saturation, and that his urin was examined for evidence of the uric acid diathesis. We have little trouble in breaking up "successive crops" of boils, even in strumous patients.-ED.]

Enlarged Prostate. Editor MEDICAL WORLD:-I am now nearly two years old in the WORLD family and could not do without it. I have a case I want help with. A man 60 years old complained for two or three years with pain in region of kidneys before I saw the case, but is much better of that now. Cystitis and enlarged prostate seems to be the trouble now. Passes water with more or less difficulty every two or three hours, about a normal quantity in the twentyfour hours. Urin nearly normal, general health good. Does some office work, and walks about considerable. I have tried all I could think of or find in the books, but with poor satisfaction to both patient and myself. Can't some one of the WORLD family, or the Editor, help me out? as the trouble seems to be very disagreeable. DR. A. LEROY MOORE.

Pomeroy, O.

[We would very much like to "help you out," but such cases have been and still are a great annoyance to the best men in the profession. Perhaps you are acquainted with the claims made for castration in this condition. However, few patients will consent to this operation. We have nothing new to offer, but we hope that some of the WORLD readers may help you. We can only say, read up extensivly, provide yourself with the best instruments needed in such a case, be patient, don't expect too much nor lead your patient to expect too much.-ED]

Dyspepsia with Flatulence.

Editor MEDICAL WORLD: -I have a patient 44 years old, light complexion, weighs about 170 pounds, married, and has about nine children. About every two or three weeks he begins to feel numb, his hands feel as if his elbows had been struck, which is a complete dead feeling. He also belches all the time this feeling is on him—that is, he belches every minute or two. He has a feeling as if there is enlargement in the hypochondriac region; as if the colon is distended with gas. He also sometimes suffers with sudden cramp in same region. His hands are cold while attack is on. I diagnosed his case as nervous dyspepsia, but he did not seem to be satisfied, so I promised to write to you. Please let me hear from you as to diagnosis and treatment.

Milner, Ga. J. H. PHILLIPS, M.D.
[This man undoubtedly has dyspepsia

with gaseous distension of the stomach and bowels, but it is possible that the coldness and numbness may be due to cardiac oppression from the distended stomach. We would have him take a light dose of some laxativ each night before retiring, not enuf to purge, but enuf to produce semi-solid stools. We would supervise the diet and exclude starches so far as possible. We would give him two drams of elixir lactated pepsin (80 grains to the ounce) in a little water before each meal. When the coldness and numbness appears we would give him a full dose of strychnin hypodermatically and a tablespoonful of chloroform water every 15 minutes till relieved, or four doses are given. The following formula is good in such cases: B

Camden, Mich.

[Mix equal parts of fluid extract saw palmetto and best oil of sandal wood, and dissolv in alcohol; add to this enuf of the best aromatic elixir, and filter thru paper. If a clear solution is desired, it is well to add enuf carbonate of magnesium or phosphate of calcium before filtering. This method yields the best preparation possible to obtain when such nauseous drugs are used. If properly prepared, it will be found satisfactory. Generally it is preferable to administer such drugs in capsule or cachet.-ED.]

Possible Gastric Cancer, or Ulcer.

Editor MEDICAL WORLD:-Please give diagnosis, treatment, and prognosis, for the following case: Mrs. W., aged 70, has been suffering some months with nausea and gastralgia. Very much emaciated. Stomach will not tolerate solid foods. Temperature subnormal. perature subnormal. Action from bowels two or three times a day. Tongue dry and furrowed. Appetite ravenous, and especially for certain articles of diet. Patient has been a habitual user of tobacco for years. I think we have a

chance here of diagnosing gastric ulcer in its early stages. There has been no characteristic vomit as yet, but the cadaveric appearance and tenderness in the region of stomach give some grounds for suspecting ulcer. Do you think so? This is an important case and I will be much pleased if you will help me out. THE MEDICAL WORLD, is a great help to me in my practise. It acts as a sedativ, and stimulant both at the same time, and will certainly relieve the puzzled mind in hours of distress and suspense, and stimulate us to a full sense of our professional duties. J. U. ROACH.

La Follette, Tenn.

[Data insufficient to base a positiv diag nosis upon. While you may have ulcer, you may also have incipient cancer, or merely chronic gastritis. Ulcer is generally a disease of younger people, tho any age may be attackt. Intestinal antiseptics are indicated. Digestants will come in good play. We would certainly use nitrate of silver, twenty minutes before meals; it is best given in about of a grain in a dram of distilled water. Do not have your pharmacist make up more than three ounces at a time, and have your patient keep it dark and cool. It is given without adding water, and from a small glass and not from a metallic spoon. Condurango is often beneficial in such cases, but it is not at all the specific for cancer or ulcer as has been alleged. We would be glad for you to submit all the symptoms, but the treat. ment suggested will fit in any of the three cases.-ED.]

Editor MEDICAL WORLD:-Will the Editor and brethren give diagnosis and treatment for the following case?

Boy, aged 18, large and strong. Attacks commence with a sticking or tingling sensation in the toes, gradually spreading upward to the knees, when it flashes all over him. Patient will strike and kick about, biting anything he happens to get hold of; pull bed clothing to pieces, shake his head, or nod it backward and forward. Does not bite his tongue; keeps eyes tightly closed. Either can not or will not speak while spell is on. Generally carries on a two-sided conversation as the fit is going off. In a few of the fits he has been motionless. Heart's action feeble, breathing difficult; feet and hands rather cool. In all of the attacks, breathing is at times panting. First attack came on after par

[The history of the first attack points to the digestiv tract as the probable origin. Careful regulation of diet, and total abstention from tobacco and whisky, and a regulation of his habits, as to anger, violent exercise, etc. would, perhaps, stop these attacks. A slight element of hysteria is also suggested. During an attack his stomach should be promptly emptied, either with an emetic by mouth or apomorphin hypodermically. His bowels should also be moved as promptly as possible by cathartic, or enema, or both. If he then persists in his foolishness, good, stiff treatment for hysteria, as has been frequently given in these columns, nauseous doses frequently repeated, or tr. capsicum and lobelia injected into his rectum, will probably bring him to his senses, and he will not give up to another attack so easily.ED.]

Editor MEDICAL WORLD:-Case 1. Married woman, age 44, married twenty-five years; has had five children, the youngest aged 9. Menstruation for the last three years irregular, the period between the last two menstruations seven months. Woman is strong, a hard worker, weight about 150 pounds; formerly had a good deal of sick headache. headache. I mention all these things because I believe the menopause is the cause of her trouble, which is a persistent irritable skin eruption; the itching, especially at night, is almost unbearable. The entire body is covered with a scaly, rough eruption, resembling ringworm, but it is not ringworm. I have used about everything externally, but it does not remove the itching nor the eruption. My idea of the cause is that it is a reflex from the uterus. Advised local treatment, which was refused. Advised pregnancy, which was spurned with contempt; in fact, onanism has been practist for years to prevent pregnancy. Now if the Editor or any reader of THE WORLD can tell me what to do for this case, the information will be thankfully received.

Case 2. My own daughter, age 19.