ANSWER TO QUERY 5714.-"Shock-Bath for Brachial Neuritis." The best thing I have used for acute neuritis is the shock-bath. One application relieves the pain better than morphine, and its continuous use cures, provided the cause of the neuritis does not continue to act.

The shock-bath consists in alternate applications of dry heat and cold. A hot flatiron and a lump of ice are all the apparatus necessary. The iron should be applied over a piece of dry flannel. After passing it up and down the course of the affected nerve two or three times, apply the ice to the bare skin in the same way, and wipe rapidly. Repeat the process for ten or fifteen minutes, according to the reaction. The treatment should be given from twice a day to twice a week, according to indications.

I do not recommend this procedure for rheumatism, neuralgia or myalgia, but in true neuritis it seems to be a specific. Probably it would not now be beneficial. in the case related, except to relieve the "rain-pains." I would suggest pushing antirheumatic treatment (unless another cause is demonstrated), with application of hot air to the affected arm, hand and shoulder, followed by thorough petrissage of the same area, finishing with centripetal effleurage.

If the lost motion is due to false ankylosis, the remedy is passive Swedish movements. If it is due to paralysis, galvanism or the sinusoidal current to the supraspinatus and deltoid and to the muscles of the foreCHAS. F. MORRISON.

arm.

Klamath Agency, Ore.

"Brachial

ANSWER TO QUERY 5714. Neuritis.". Vibration for Brachial Neuritis. Brachial neuritis is one of the troubles I have been very much interested in, and one which I soon relieve with the vibrator and leucodescent light. From the description of the doctor's treatment, he has missed the vital point. He should use deep vibration at a point behind the collar-bone over the brachial plexus, every other day. That will cure both shoulder and arm, also hand pains as well. Generally the harder and firmer the pressure of the vibrator, the sooner the pains get well. J. W. ARNOLD.

Columbus, Ind.

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ANSWER TO QUERY 5716, July number. "Is Calomel Harmful?" I have a word to say to calomel kickers. I will first say I am an advocate of, and don't see how I could practise medicine without, it. In my thirty-one years of practice I have never seen a child under five years of age salivated or have a sore mouth from calomel; have never seen salivation during any age that could not be cured up in three days. When I commenced practice 10 grains was the average dose, and now the average dose is about 1-100th part of that. Twentyfive years or more ago I was also engaged in the drug business at the county seat of Carter County, Kentucky. In that town. lived an old man about 65 years of age. He came to my store often to purchase calomel, and in large quantities. I asked him one day how he made use of so much calomel. His reply was, "I take it myself." I next asked, "How much do you take at a

dose?" His reply was, "About a teaspoon level full." I again asked, "How often do you take such doses?" His reply was, "Once a week, and sometimes twice." I could not believe him, so I asked his wife about it. She informed me that he had not misrepresented. I explained to the old gentleman that 10 grains would do him as much good as a teaspoonful, but he was not ready for the explanation and kept up his regular dose as long as I lived in that town, about five years.

Now, I suppose some of these calomel knockers will say, "That fellow is a kin to Ananias." However, Uncle Sam has honored me with three government positions in my time and I am not a Republican either. Furthermore, I have been in the employ of the C. & O. Railway as a surgeon for fifteen years. I am only stating these facts to show you that I am not an amateur in the medical profession.

Chattanooga, Tenn.

QUERY 5727.-"Mammary Fistula." J. O. W., California, recently delivered a woman, aged 24, of a boy baby, after a tedious labor (completed with forceps) of fifteen hours. No accident or bad aftereffect occurred. All went well for about ten days, when a large lump appeared in the axillary border and right lower segment of the left breast; this had been preceded by cracked nipples, which seriously interfered with nursing. After exhausting all usual remedies to dissipate the swelling, about the twentieth day after delivery a large abscess was evacuated by incision just below and to the right of the nipple. A quantity of purulent fluid mingled with what appeared to be soured milk and detritus of areolar tissue was discharged, whereupon the fever and all pain disappeared. Later, the right breast took on the same conditions, though not so extensively, and a small superficial opening through the skin at the lower border gave immediate relief. During all this time the babe has been nursed at the right breast, besides receiving artificial feeding.

A "strange feature is the great quantity of what certainly is decomposed milk which continues to flow steadily from the wound in the left breast", yet no secretion manifests itself at the nipple in this breast. The doctor asks: "Can it be that this is truly milk, flowing from ruptured lacteal ducts? If so, how can I remedy the trouble? The wound seems to be healing nicely from the bottom, a drain being kept in it for five days. There was little or no blood

A. F. HILL.

drawn by the incision (none since), which was only through the skin and areolar tissue. Should I continue to permit the nursing of the child at the breast or dry up both breasts?"

We regret to say that it is impossible for you to do anything further than you are now doing, that is, heal up the wound from the bottom. We gather (perhaps erroneously) that the incision was made in the wrong direction and that the lacteal ducts were severed. As you, of course, know, in mammary operations, the incisions should radiate from the nipple. Very great care must be taken when the deeper tissues are reached.

We question the advisability of drying up the milk supply. Keep the parts scrupulously clean; give nuclein and echinacea internally, and apply to the affected breast compresses wrung out of a dilution of echinacea and thuja. Gentle elastic pressure should be maintained.

We wish we were able to aid you more effectively, doctor, but a most unfortunate condition obtains and, as already pointed out, the wisest thing to do is to secure granulation. It is possible that this breast. will never again functionate normally. Should the woman bear another child, prepare the breasts carefully before delivery.

QUERY 5728.-"Enuresis Diurna. Menorrhagia." V. S. E., Canada, is treating two cases that have "gone the rounds" and he would like assistance.

1. Patient, a widow and mother, age 57, of nervous temperament and sedentary habits, weighs about 160 pounds and is in fair general health. For the last twentyodd years she has been troubled with enuresis when walking on a level surface; rarely troubled when going up or down hill, and never when sitting or in bed. Sometimes it occurs when coughing or sneezing, but which is rarely the case. The condition is worse when the rectum is full or when her nerves are unbalanced from excitement. Occasionally she is better for a few days, without any observable reason.

The urine contains oxalates. Uric-acid crystals and indican were found, as well as a few pus-cells. The reaction is generally slightly acid. The specific gravity ranged from 1026 to 1013-quantity about 48 ounces. No sugar or albumin were found. No calculi could be discovered. The sphincter ani is rather tight. The woman has been examined and treated by doctors galore, without benefit, and in several cases was made worse. Her tissues seem flabby and she is pale. The doctor is now giving her Blaud's pill compound, and strychnine. Has kept bowels clear and clean, also, with pilocarpine and minute doses of veratrine, together with dieting and plenty of water, has gotten the urine in fairly good condition. Atropine, thuja, and cantharidin have been prescribed till the patient became sick of taking pills. The trouble began about four years after childbirth. There is a slight tear in the perineum, but not sufficient to be regarded as the cause of this trouble.

Now, Doctor, before you can cure enuresis you will have to discover the causative disorder. We note that the woman is of a nervous temperament, autotoxemic, and anemic. We, therefore, first of all should dilate the sphincter ani, then secure thorough elimination and as nearly normal body-chemistry as is possible. The fact that the discharge of urine occurs when the woman is walking upon the level leads us to suspect a vesical polypus or of other body which acts as a "ball-valve" when the body is erect. Weakness of the vesical sphincter is of course a primary

cause.

Insist upon plenty of outdoor exercise; also a cool salt sponge-bath two or three. times a week. Cantharidin is not likely to prove efficacious in this case. Thuja with hydrastin, strychnine nitrate and delphinine are more likely to prove beneficial. We should also give nuclein in rather large doses, preferably with the phosphates of lime, soda and magnesia, three times a day.

Have you catheterized this woman? See if there is any hyperesthesia or abnormality of the urethra; note also position of uterus. The cause of the trouble may lie there. We should be inclined to irrigate the bladder three or four times with a 2-percent ichthyol solution, or you may use borated calendula. Have the perineal tear repaired even it it be small. Order an abdominal supporter and see that it fits snugly and "lifts upward."

2. "A maiden of twenty-two has membranous dysmenorrhea, but is not willing to undergo an operation. The doctor writes:

"I have been trying sanguinarine, gr. 2-67 four times a day; during, intervals, Buckley's formula; gelseminin and cicutine hydrobromide during menstrual week; all with but little success. She expects to marry within a few months. Would childbearing help her, or would she probably be sterile? How would the application of iodine to the endometrium answer? She is fleshy, of nervous temperament and sedentary in her habits. Her general health is good. Can you advise anything except curettement?"

In membranous endometritis we should urge a thorough curettage, this condition rarely yielding to less vigorous treatment. You can, of course, dilate the cervix and apply to the endometrium thymol iodide or iodine and ichthyol in glycerin; but curative results can hardly be expected in a case of this kind. An oophoritis may coexist. A saturated solution of iodine in glycerin has given the writer good results; it should be applied on a cotton-wrapped applicator; strips of gauze saturated with carbenzol are then packed into the fornices and the vagina slightly filled with plain (sterile) gauze.

Internally, calx iodata, ergotin, hamamelin, and hydrastin are perhaps most useful; chromium sulphate also may be tried. However, such positive results follow thorough curettement that it seems a pity to waste time on treatment which is apt to prove unavailing.

QUERY 5729.-"Cystitis Following Prostatectomy." C. W. H., Oklahoma, has a patient, aged 67, who had his prostate and also a vesical calculus removed at the same operation. He now suffers constantly with a burning sensation in the penis, which can be relieved only by morphine. A chronic cystitis is present, which clears. up almost completely by using the general diuretic formula or arbutin. The amount of urine voided is over 30 ounces in the twenty-four hours; specific gravity, 1020; color, straw-yellow. He is continuously passing calculi that are very hard and rough. There seems to be constant spasm in the deep urethra or neck of bladder, so that it is impossible to irrigate the bladder without an anesthetic, which is not desirable on account of an organic heart lesion.

At present glycerin is being used to prevent formation of stones, according to the ideas of the Germans. The man sometimes passes six or eight at a time of about the size of a pea.

Were we in your place, Doctor, we should substitute the combination of hyoscine, morphine and cactin for the plain morphine, using just enough to control the spasm and pain. Do not tell your patient the nature of the medicine.

Of what do the calculi consist? Send some of the concretions and a 4-ounce specimen of urine to the laboratory. Upon receipt of the pathologist's report, we will outline a treatment which will, we think, prove effective.

Formin with lithium or ammonium benzoate, according to acidity or alkalinity of the urine, with laxative salines and arbutin, would seem to be indicated. As a cystitis exists, we presume the urine is alkaline. In that case ammonium benzoate should be given in 5-grain doses, with formin, every three hours. Large quanti

ties of barley water, made as follows, should also be consumed: Soak in water two tablespoonfuls of barley for a few hours or over night. Throw away the water. Then pour on one quart of fresh water and boil continuously for six hours, keeping the quantity up to a quart by adding more water. Strain through coarse, previously boiled, muslin, and preserve in the ice-chest or other cool place.

The bladder should be washed out once or twice a week with a 2-percent ichthyol or 1 1000 antinosin solution. Anodyne. suppositories containing hyoscyamine and carbenzol (or ichthyol) will prove useful.

QUERY 5730.-"Prevention of Adhesion." W. C. E., Minnesota, has a patient, 15 years old, who has just undergone appendectomy; there were many adhesions. The doctor asks: "What medicine, internally or externally, would you recommend to prevent their return? Would you advise the use of a vibrator? The patient is naturally strong and his habits are good."

As we glean, adhesions existent before the appendectomy were broken up at the time of the operation. Provided the operation was thorough and normal (nonseptic) conditions obtained thereafter, adhesions are not very apt to form again. Gentle massage or vibration over the affected area and the exhibition of calx iodata or arsenic iodide suggest themselves. If adhesions do form, we should feel disposed to give chromium sulphate internally and a course of thiosinamin hypodermically, provided the abdominal scar is small, so that, if softened, rupture is not to be feared. Maintain normal conditions.

QUERY 5731. "Chronic Urethritis. Cellulitis." E. B. D., Ohio, writes: "What can I do for chronic gonorrhea, to stop the discharge, the socalled 'morning drop?' Also what can I do to reduce a mass of inflamed cellular tissue posterior to the womb? Is there any depleting remedy that I can use by the vaginal route? The woman seems well every other way. There is a mass of inflamed tissue in the hollow of the sacrum-just enough to keep up a little fever all the time."

We have mailed you literature outlining the modern treatment of urethritis, specific and nonspecific. This subject is too extensive to be dealt with satisfactorily in the limited space at our disposal here. You might advantageously read Query 5718, in the late July number. Then carefully examine your patient, and if you care to do so, report the exact conditions which obtain, sending to our pathologist at the same time a smear of the urethral discharge. We shall then be in a position to prescribe intelligently.

Any one of several pathologic conditions may cause a persistent gleet-and it is essential to recognize the basal lesion before instituting treatment. For this For this reason, we hesitate to offer advice in the case of the woman. A salpingitis may have existed and the tube-or even an ovarybe embedded in a mass of adhesions in the cul-de-sac. As there is a persistent temperature, you probably have to deal with a collection of pus, and drainage in such a case would be essential. What is the history, the present condition of the uterus and adnexa, and is there any venereal taint? Examine through vagina and rectum, and describe the pelvic conditions. How long has the condition obtained? What remedial procedures have been tried?

You cannot go far wrong if you use, temporarily, copious antiseptic douches: one teaspoonful of a standard vaginal antiseptic powder to the quart of hot water. Thoroughly dry and cleanse the fornices with pledgets of cotton and then pack lightly with strips of gauze saturated with thymol iodide dissolved in oil. Iodine and glycerin, or glycerin, ichtyhol and iodine may also be used. Application should be made every other day. Wash out the bowel with warm solution of epsom salt. Maintain intestinal activity and cleanliness. Give echinacea, calcium sulphide, and nuclein in rather large doses.

QUERY 5732.-"The Frequent-Dose Bugaboo Appears Again." E. G. R., Missouri, has one objection to the alkaloids, namely, the method of administration. "We are advised," he says, "to give one or two tablets every fifteen or thirty minutes to

effect. How are we going to manage that in the country, where we are from one to twenty miles from our patients and when we have five or six calls like this to make

every day. We cannot stay with one patient that long. It is, examine your patient, issue your medicine, give directions, and hurry on to the next patient. If one could formulate dosage so that the medicine. could be given every two or three hours, it would be all right and I think many more physicians would use the alkaloids. The patients also object to taking medicine so often. Why not make the doses larger, give farther apart, and still get the desired effect, as we do with quinine, morphine, and strychnine?"

Do not allow frequency of dosage to become a bugaboo. As a matter of fact, only a few of the more active remedies are given at frequent intervals, and then only in acute conditions, that is, where it is desirable to secure action as speedily as possible. In treating most diseases, the active principles and synergistic remedies are given three or four times daily, or, in some cases, half-hourly or hourly for four to six doses.

For instance, you are treating a child with measles or any one of the acute infectious diseases. You would order 1-6 to 1-10 grain of calomel with perhaps 1-6 grain of podophyllin half-hourly for four doses in the evening, with a saline laxative the next morning. It is just possible that you would wish to give the mercurial combination at once and follow the last dose with the saline. It is a very simple matter for any adult to attend to such medication, and the results surpass those obtainable by any other method.

The child's temperature is high, and it is desirable to reduce it. We will say the child is 12 years old. You will dissolve 12 granules of aconitine in 24 teaspoonfuls of water, and order a teaspoonful half-hourly or hourly until the skin cools or until the child complains of tingling in the throat and of the tongue. In nine instances out of tenespecially if the bowels are cleaned out, and the body has been sponged with an epsomsalt solution, as it should be the temperature will fall two to three degrees in four or