Quiz Department.

Questions are solicited for this Column. Communications not accompanied by the proper name and address of the writer (not necessarily for publication), will not be noticed.

The great number of requests for private answers, for the information and benefit of the writer, makes it necessary for us to charge a fee for the time required. This fee will be from one to five dollars, according to the amount of research and writing required.

EDITOR MEDICAL WORLD:-Will some of your readers in Michigan inform me by letter, or through the columns of THE WORLD, of the laws regulating the practice of medicine and pharmacy in that state? Brandon, Florida.

E. D. LOING, M. D.

WE have received several requests for an article giving an authentic history and description of the "mad stone," with a correct account of its supposed effects in the prevention of hydrophobia. If any of our readers wish to respond with such an article, we shall take pleasure in publishing it.

EDITOR MEDICAL WORLD:-For three years I have enjoyed your bright and entertaining columns, and have gleaned valuable information there from that have more than once come to hand in times of emergency and distress, when occasion for consultation of office literature was out of the question.

I want advice and treatment from your ingenious contributors in the following case: A lady, multipara, aged 58, whom I treated six years ago for erosion of cervix, accompanied by jerking of the voluntary muscles of the limb. I relieved the erosion and she passed from my hands until a few days since, when I was consulted by her husband in regard to this jerking, which has ameliorated somewhat, but yet remains with such persistency as to keep her awake at night to a great extent. I am inclined to the opinion that her trouble is a localized chorea, caused probably by u erine reflex. I have made no examination of late, and cannot state her condition in that respect. She has suffered since the birth of last child, which was twenty years ago. Jerking is more annoying and persistent at night. Any information through THE WORLD or by private letter will be gratefully received. Milner, Ga. A. M. SPEED, M. D. EDITOR MEDICAL WORLD:-I would like diagnosis and treatment in following case:

Mrs. B., aged 34, had a miscarriage at 3 months term, three years ago. The case was managed by an old mid-wife, who didn't know that a three months fetus had a placenta till it was gouged out ten days after the miscarriage by a physician who had been called in great

haste to save the patient from dying from hemorrhage. Soon after the patient got up her mouth got sore, and in spite of all that has been done for it, it steadily grows worse. The tongue and throat are a good deal swollen. The membrane looks like it had been scalded, and is covered at times with white patches. The sorenes; extends to the stomach. She is not troubled with nausea, but has obstinate diarrhea at times, also severe pain in the front part of the head. Her mouth is getting so bad now that she can hardly eat anything. Patient is a member of my family, and any help will be very gratefully received. "SUBSCRIBER."

EDITOR MEDICAL WORLD:-I write to ask a little help in treatment of a patient that occupies an interesting position of enormous dimensions in my mind. My patient is a lady aged 32 years, of large physical dimensions, weighing 196 pounds, and possessed of an absolutely irresistible and insatiable sexual desire. She will have from 10 to 12 sexual embraces daily. which do not seem in the least to relieve her amorous desires.

This deplorable state of affairs dates back to a miscarriage that occurred about the last of last December. The fetus came away without any unusual accompaniment, but the afterbirth was adherent, and I prepared to try to deliver with my placental fo.ceps. When all was in readiness to enter the uterine cavity in quest of the now foreign body, my patient took the position that the further conduct of the case should be entrusted to dame nature, and I was obliged to acquiesce in this decision. The retention continued until within a few hours of two weeks after discharge of the child, and then came away in the midst of an exceedingly copious and truly alarming hemorrhage. This hemorrhage was so extensive as to threaten the lady's life. But she rallied in an amazingly hopeful manner, with every prospect of a return of her customary good health and strength. After a reasonable measure of strength had been gained, symptoms of exist

ing nymphomania began to manifest themselves, and have continued to more abundantly declare themselves until the present time, with every prospect of added continued growth, if not by some means checked. She seems to be given to gloomy and foreboding imagination and meditation. Is more or less despondent, easily excited to expression of tears and petulant; has some headache, but as a rule eats and sleeps usually well. There seems to be no evidence of general or special sexual derangement, she is regular and normal in catamenia, with no possible mal-demonstration, save the one which furnishes the headline caption of this article. The fetus was between two and three months, and when it came away the pelvic quarters were greatly decomposed. No evidence of decay exis:ed in placenta when it was thrown off. Anything I have done with view to amelioration of existing sexual mania has proved wholly futile; and, as the case is one of absorbing interest, because of certain existing contingencies, which I do not feel at liberty to explain at the present, I supplicate assistance from some of the competent members of the great family of THE WORLD'S readers. Have the goodness, my dear friends, to lend aid in this my hour of absolute need.

London, O.

J. W. SWARIZ, M. D.

DR. M. J. KENYON, of Decatur, Neb., asks for the O. E. Miller patented treatment for hernia. Can any of our readers give it?

A. E. WESSEL, M. D., of Brooklyn, Iowa, asks for the composition of "Eureka Hair Restorative," made at Grinnell, Iowa

EDITOR MEDICAL WORLD:-A few days ago a long, loose jointed, lank individual came into my office, wishing a tooth extracted. After the operation, which, by the way, was a very easy one, he asked me my charge. I What!" he cried, replied, "fifty cents." "fifty cents ?" "Certainly; that is the regular charge." As he reluctantly laid the money on my table, he said, "I'll just be dog goned if that don't beat gosh! (or words to that effect). Why, Dr. M. pulled a tooth for me last fall and he upset the chair and dragged me all over the floor, and he charged me only fifty cents." Fact.

I would ask the readers of THE MEDICAL WORLD if any of them knew of a fat person having a tape worm? Bromfield, Neb.

C. E. BROWNE, M D.

and 120.

2. Illustrate the difference between the doctor and the merchant from the stand-point of public charity, See pages 18 and 19.

3. How do physicians' charities help the large capitalists, and what is the logical remedy? See pages 27, 28 and 29.

4. What is the basis of the physician's fee? See pages 30 and 43 to 47.

5. What are average reasonable fees for different services? See pages 71 to 75.

6. How should physicians' Sunday work be regarded? See page 75.

7. How do medical fees compare with those of other professions? See pages 80 to 82.

8. What is the most practical bill form? See page 88. 9. What do you think of cooperative efforts at collecting accounts? See pages 104 to 110.

10. What kind of account-books are most practical for physicians' uses? See pages 122 to 127.

11. How can the building association help the doctor? See page 128.

12. What obstetrical fee is charged by the profession in different parts of this country? See pages 48, 49, 55, 57, 63, 65, 68, 69, 72.

Price of "The Physician as a Business Man" is only $1.00. See order blank on page 238.

Current Medical Thought.

Ordinary Summer Diarrheas.

AS THE physician is called upon to treat many more cases of these complaints than of true cholera infantum, we think it well to give the subject some attention in this number. In doing so we wish to present pretty fully the views of Prof. W. S. Christopher, of the Chicago Polyclinic, reported in Jour. Am. Assoc.

There are two distinct types of summer diarrhea-the one with sour stools, the acid of sugar and starch fermentation proving to be an irritant to the intestinal membrane and causing the diarrhea, and the one with putrid stools, from the decomposition of nitrogenous food, as meat, milk, eggs, fish, &c. The sour diarrhea is not very dangerous, as the general system is not poisoned. The putrid diarrhea is accompanied by the production of alkaloidal ptomaines, which invade the blood and poison the system, producing fever, convulsions, collapse, coma, and, if not successfully treated, death. Prof. Christopher says:

"In many cases where the stools are green, due to the growth of certain chromogenic bacteria, we have no general systemic trouble, but on the other hand, where we have rather innocent looking stools, nothing but a little rice water discharge, our patient is seriously ill. In every such case of cholera infantum there has always been putrid stools at first, and they are no longer putrid, simply because everything has been washed out of the bowel. My own experience is, that brown stools are the most foul in point of odor, and the most apt to be accompanied by severe symptoms on the part of the general nervous system. Some of these patients have fever, and some have not. Why? Simply because in some instances poisons capable of producing rise in temperature are formel, in other instances poisons of this kind are not formed, so in one case we have fever and in another we do not. Fever is then purely an accidental condition. Again, we will have on the part of the brain such symptoms as convulsions. But convulsions are not due, I take it, to simply the draining away of the serum which the large number of movements has produced, but to the production of a convulsive poison, something that can produce convulsions, something like strychnia. I do not say that strychnia is elaborated in the bowel, but a poison having a somewhat similar action. Another point of importance is the question of coma in these cases. Some years ago, when I treated these cases exclusively by opium, I used occasionally to find a little one with what I considered opium poisoning. Later, after I had stopped using opium, once

in a while the same kind of case would occur. On questioning the mother I would find that no opium had been given outside of my direc tion, and something else must be at fault. I see several such cases every year, characterized by contracted pupils, stupor, sometimes coma, by slow respiration and slow pulse. Now there has been formed in the bowel of that child a poison which acts like opium and produces these symptoms. How shall we get rid of it? I have invariably given the nitrate of potash and water, and in the course of two hours, invariably profuse urination has occurred and with it all symptoms have disappeared; in other words, the poison has been washed out through the kidneys. Here, then, is one set of symptoms which is evidently produced, so far as clinical information can teach us, from something developed in the bowel. Again we have patients troubled with insomnia, and it is likely that this sleeplessness is caused by poisons in the same general way. Now, let us take up the question of depression, for that is the most important one. Our little patient is weak, the fontanelle has sunken, the eyes have sunken, the skin is cold and the pulse indicates collapse. Now to what is that due? Is it because the baby has had four or five or a dozen stools that day? No. If you had given the baby sulphate of magnesia there would be the same loss of serum. Would the child be in that shape? No. There is another element there besides the number of stools. I believe the mere number of stools is of secondary im portance. The question of loss of fluid we have been taught to think much of too much indeed. But let us suppose we had introduced a motor depressant into this child's blood, say conium or curare, what would have happened? Almost the same condition of collapse. It is evident that the collapse has been produced by some poison, and not simply by the number of stools that have been passed. If we believe the collapse to be due wholly to the number of stools we would most rationally proceed to stop the stools; we would give the child opium, tannic acid or anything to stop the flow from the bowels. But if it is due to a poison that has been formed in the intestine, what are we to gain by stopping the number of stools? Nothing. We may even do damage by retain ing in the towel the source of the trouble. I beg of you, then, to regard summer complaint as presenting various phases, but due entirely to poisons formed in the intestinal canal. On the other hand, we find that sour stools cannot produce poisons of this kind, but still we have movements from the bowels, and we can only explain the phenomenon on the ground that products of acid fermentation are directly irritating to the mucous membrane of the

bowel and act by locally stimulating the bowel, by locally increasing its functions. But remember that such irritations do not and cannot produce collapse; that they do not and cannot produce coma; that they do not and cannot produce convulsions; all the serious conditions are thrown to one side and only the local ones of increase in the number of stools and pain remain. Now then, here comes in the explanation of Dr. Rachford. If these depressed conditions occur, no matter what the number of the stools may be, the trouble is due to poisons formed from nitrogenous material. If we can stop the proteid fermentation, even if we have to leave an acid fermentation, we shall make a decided gain for our patient. "Now as to the treatment proper. It consists of two general steps: First, to remove the cause, second, to repair the damage done. These two steps apply to almost any disease, but particularly to this one.

"First, remove the cause. How? We have found that the cause is due to certain fermentations going on in the bowel; let us get the poisons out of the bowel. How? By the use of laxatives first. To empty the bowel of a baby, gentlemen, is a work of art, it is not a simple thing."

The author recommends calomel, one grain every four hours until three doses have been taken, and the employment of copious enemata of hot water, a quart at a time. Instead of the calomel, we have often found the use of equal parts of castor oil and syrup of rhubarb, accompanied with some antiseptic, as sulpho-carbolate of zinc, quite satisfactory. *

* * *

After cleansing the bowel, a good intestinal antiseptic should be administered to prevent further development of the trouble. Christopher says calomel, one-tenth of a grain, and bismuth fifteen grains. Regarding another method of preventing the germs from multiplying, he says:

"Fortunately we have a much better means at our disposal. Suppose we have a diarrhea and the stools are distinctly putrid; we know there has been fermentation and that the germs producing it are living on proteid material, so we simply keep that kind of material out of the bowel and starve the germs; there you have the keynote of the whole method of feeding. Starve the germs, do not try to get them out with chemicals, because you cannot do it. You accomplish something in that way but you cannot kill them all. But when the child has a putrid diarrhea you must keep away from it all proteid material, keep away meat, fish, milk, and eggs. Keep away those foods which are capable of undergoing putrefaction. Meat would not be given to a child of that age; fish would not be given to a

child of that age; eggs would possibly be given, but milk would most certainly be given. Milk has been the chief diet of this child before it was taken sick, and the proteids of milk are what the germs in that intestinal canal are best adapted to live on. Above all things stop milk; this is the first thing to do when you have a putrid diarrhea. Do not be led into giving milk because the books tell you that it is a bland and non irritating diet. That means nothing. We are not trying to save that bowel because it is in an irritated condition, but we are trying to prevent the formation of poisons, and therefore we will keep out of the bowel material from which they can be formed, and that is in this instance proteid material. Now, if we have to keep proteid material out what shall we put in? Anything which cannot support the obnoxious germs; anything which will starve them out and still be focd for the child. The books tell us that in severe cases we should stop all food. If we stop all food we can certainly starve the germs but it strikes me we are going to starve our little patient also, and put a strain upon him that is unnecessary. If we must take away meat, fish, eggs, and milk let us give him the starches and sugar.

Many years ago, Moore,

of England, advised that these cases be fed on cane sugar exclusively. Such a diet is right, but you don't need to limit them to cane sugar; give them starches. I take a child six months old with putrid diarrhea and give it arrow root, or rice, or crackers, or baked potato, but not milk But you look surprised to hear me advocate potatoes and crackers-solid food in diarrhea. When we have the theory of this disease that I have attempted to give you, that it is not due simply to an irritated condition of the bowel, why not give solid food? I assure you, from a personal experience of several years in this matter, that solid foods act most beneficially. Milk is a solid food; it is not liquid. It is only liquid before ingestion. The first thing that happens to it in the stomach is coagulation, so that it is probably more irritating from a mucous membrane standpoint than any amount of starch. We are told these babes cannot digest starch because they have no salivary secretion and no distinct pancreatic secretion. I will admit the physiological statement that their salivary and pancreatic secretions are both deficient, but I deny the other statement. It has been assumed that because these two secretions are deficient, that infants cannot digest starch; but we all know of babies who have been given arrow root from their birth, and who have digested it perfectly. We all know that babies can and do digest starch; they do it daily. Why, there is hardly a secretion in the body but is

capable of digesting starch so that it can be absorbed. Right here I wish to be understood that I do not advocate starch as a continuous food for infants, but I am speaking of its use for temporary purposes; it does help that child along when it is poisoned; it does serve a pur. pose with that child when we want to take away other kinds of food, and in giving starch we have the advantage of not depriving that little one of all food. How about predigesting How about predigesting the starch? We do not need to predigest the starch; the great bulk of children can digest starch, particularly the small amount necessary for our purpose.

I told you that milk was bad for this condition; how about peptonized milk? Peptonized milk is worse. Why? I know some of you have used peptenized milk, and in some cases with good results, but I wish to assert that if you did get good results in those cases, you could have gotten better results in some other way. This preparation is generally bad. In the first place, it is peptonized by means of a pancreatic ferment. If you will experiment, by putting some hard boiled egg in a solution of pepsin and hydrochloric acid, and leaving it over night at the temperature of the body in a suitable oven, you will find that it has not only digested completely, but that it has a peculiar odor that is not unpleasant; but take the coagulated egg albumin and put it with trypsin in an alkaline solution, and subject it to the same condit ons, and you will find, as you open the incubator, that it has a distinct fecal odor. If you leave it a few hours longer, the fecal odor will become stronger, and in a few more hours the odor will be unbearable. The mass has become putrid. Now the action of trypsin upon proteid material is to break it up in such a way that the germs of putrefaction can thrive therein. They thrive readily in the products of tryptic digestion, but not readily in the products of peptic digestion. The milk partially peptonized by this pancreatic extract, is only in a better shape to undergo putrefactive changes when it reaches the stomach and bowels. If you put it into a perfectly healthy alimentary tract, no harm will occur; but if you put it into a bowel that is already contaminated with putrefactionproducing micro organisms, you have only helped those micro-organisms to the extent to which you have digested that focd. Understand, I do not say that there are no conditions in which peptonized milk may prove useful, but am merely condemning its use in the putrid diarrhea of infants."

Regarding sterilized milk, he says that it is good as a preventive, but of no value to give during treatment.

"Milk from the mother's breast does just as

much damage as milk from any other source. Other things being equal, I would rather treat an acute case of diarrhea in a bottle baby than in a breast baby, because I can give the bottle baby just what I want to. Frequently I would take the baby from the breast for thirty-six hours, keeping up the mother's secretions by the breast pump, and feed the baby as I would like to; but we cannot always do this, and where I cannot do it I find that I do not get as good results in treating diarrhea in breast fed babies as in bottle fed babies; I cannot cure them so quickly because I cannot feed them right. Such a procedure is only neces sary in severe cases.’

"How long is it necessary to withhold proteid food in acute diarrhea? Twenty-four hours will usually suffice to correct the odor of the stools; at the end of that time stools which have been rotten will have lost their putrid odor, usually, and at the end of forty eight hours they will certainly have lost their putrid. ity. In chronic cases, where there is already ulceration of the intestine, the putridity is maintained by something besides the intestinal contents. Let us say the putridity has ceased, what will occur?. Almost always the stool will become sour; in other words, an acid fermentation which has been going on in addition to the putrid fermentation continues, so that we still have left a cause for diarrhea, but we have transformed a diarrhea which was capable of causing nervous symptoms into one which is only capable of producing local symptoms in the bowel; we have transformed a dangerous trouble into one comparatively simple. That is what has been gained by the method of feeding.

"I think this will give you, in a general way, my idea of how to remove the cause. Remove it by purges, remove it by washing out the bowel, remove it by antiseptics, and above all by starving out the germs by withholding their proper food.

"We have removed the cause, how shall we repair the damage done? Ordinarily, with the removal of the cause, the child promptly recovers. But the matter is different in a severe case where the child has been seriously ill from a sharp attack of cholera infantum, and at the end of a few hours of illness is in a state of collapse; sunken eyes, sunken fontanelle, and pale, cold surface; rolling the eyes about, opening the mouth, showing the dryness of the lips, etc. What shall we do? Evidentaly, in such a case, there is no time for delay, the damage is too severe, the poison must be directly combated. We will of course stop all food at once, because we cannot run the risk of doing that child further harm; particularly would we stop milk. We would