q. s. to make..

ounces ij.

M. Sig-Shake One teaspoonful in water each time the bowels move, but not more often than every hour.

It matters not whether the discharges are shreddy, blood and mucous mixed, or thin and serous, running through the napkins like water through a sieve, and smelling like the offense of Hamlet's uncle; a few doses corrects all this.

Of course you must see to the sanitary surroundings and dietetic care of your patients.

Should there be much ga tric irritability, a few one-tenth grain doses of hydrargyri chloridum mite dropped dry on the tongue, or washed down with a teaspoonful of cold water, giving one each time the patient vomits, will quell that trouble nicely. Mulvane, Kan.

W. K. HARRIs, M. D.

A Case of Cholera Infantum With Recovery.

EDITOR MEDICAL WORLD:-Your cholera infantum number was read with interest and appreciation. These special numbers are very useful to the busy practitioner.

I

I would like to report the only case of chol era infantum I have attended this season. consider it almost a typical case. I was called between the hours of eleven and twelve o'clock Found patient, Robert W., aged two p. m. years, very delicate child; was first seized with violent vomiting and purging; first vomited partially digested food, then watery fluid and considerable bile. The stools were profuse, very offensive, and their odor rather musty; eyes sunken, features pinched, abdomen flaccid and clammy to the touch, tongue slightly ccated; raging thirst, but when given water violent emesis immediately ensued; pulse very rapid; temperature 104°.

I gave mild chloride of mercury, grain 1.20 every thirty minutes, and dram j of the following prescription every hour till three teaspoonfuls had been given, and emesis ceased; after that dram i every four hours:

Had cloths wrung out in hot water and vin egar placed on the abdomen, and changed every thirty minutes till emesis and purging ceased; then continued at longer intervals; and gave cracked ice to appease thirst and cool the stomach. Patient became quiet about two o'clock a m., and dropped into a deep sleep and rested well for several hours, though very hard to arouse. Temperature sub-normal

bowels had acted twice; odor not so offensive. About nine o'clock a. m. commenced administering the following:

B Zinci sulpho. carb.. Bismuth subnit....

...grains jv ..grains xxjv

M. ft. cht. No. xij.
Sig. One powder every two hours.

Kept up the hot cloths; gave catawba wine, dram i, every three hours. Patient very listles and dull all day; stools ceased to become feca lent; patient took some nourishment. Several days after the attack patient badly emaciated, eyes sunken and with dark rings around them. Temperature slightly exacerbated; gave bath to control hyperpyexia, and wine to stimulate At three o'clock patient suddenly rallied ( fever-pulse normal) called for something eat; gave beef tea, dry bread, etc. recovery.

St. Charles, Ky.

Rapid

CYRUS GRAHAM, M. D.

Divide into ten powders and give one every three

hours.

Before closing let me say one word about eclampsia. After forty years practice, I do

EDITOR MEDICAL WORLD:-I have a case which is very interesting to me, and which may be of some interest to some of THE WORLD readers.

On Feb. 10, 1892, I was called to see Mr. J. W., aged 76 Found him propped up on lounge. Breathing very much labored, pulse 100 per minute, jerky and irregular; tongue heavily coated with a brownish coating; temperature 100°; abdomen and stomach greatly distended with fluid; right leg swollen to the size of an ordinary man's body, edematous and of a bronze color, covered with a scaly efflorescence; left leg not so swollen, yet much larger than natural, and normal color; penis and scrotum greatly swollen, so that the penis was almost hidden by the swelling of the scrotum. He had not been able to leave his room for some weeks and had been under treatment by another physician. He was not able to control the flow of urine, which dribbled from him and created a very offensive odor.

I put him upon the hypophosphites and gave tincture digitalis, with nitrate of potassium and acetate of potassium in large doses. He is now able to walk about the farm. I forgot

to say that his right arm and hand were very much swollen and of nearly as dark a color as the right leg.

What interests me in this case is the discoloration of one side of the body, its remaining so after the the shrinking of the limbs, which are now two-thirds less than when I began treatment, and the cause of the discoloration.

This could not be Adison's disease could it? Yet I believe the seat of the disease is in the kidneys.

Lancaster, Ind. C. A. BURDSAL, M. D.

DOCTOR-Have you been wishing to adopt the convenient and most efficient alkaloidal or dosimetric granules in your practice, but hesitated on account of lack of definite knowledge as to how to use them? The new book "Outline of Treatment with Dosimetric Granules" will meet your needs admirably. It is the only book published treating this important subject from the standpoint of the American practicing physician. It meets the difficulties that are encountered at the bedside and in the consulting room. Bound in flexible cloth, small pocket size, 100 pages, price only 50 cents. See order blank on page xxiv.

EDITOR MEDICAL WORLD:-Will you kindly admit to your Quiz Department this description of a case that sorely puzzles me? Your readers may regard it as a sort of "Help me Cassius" appeal.

Mrs. H. Clark, aged seventy, of medium temperament, fairly well nourished, appetite, digestion, &c., fair; no dyspepsia, kidney disease, heart lesion nor paralysis. During childhood was in good health with the exception of an attack of pertussis at six, which induced strabismus. When about twenty years of age, an unskillful attempt to correct the deformity ended only in producing marked divergence and some protrusion of said left eye, which still remains, the organs never having harmonized since their primary alienation. I should add also that the sight of this eye and also the function of the left ear have been gradually failing for several years and now are of little use. When from sixteen to twenty years of age she developed goitre, which became quite prominent, but has steadily subsided by absorption, and is now not especially

noticeable.

When about forty-two years of age she removed from the upland and resided about one year in a low, marshy region where, after about three months, she was one day suddenly seized with vertigo or dizziness ("everything went round") causing her to fall, but she remained conscious. Immediately succeeding the fall she was seized with severe and persistent vom ing. The seizure is commonly attended with an apparent flash of light. She usually screams when attacked. With the exception of one interval of some six years has suffered constantly with more or less giddiness and severe sub occipital "headache." For much of the time, during the last few months has been afflicted with the "spells" in their severest form, but instead of the vomiting she has a

longer period of an indescrible sense of "sickness and sinking." Complains latterly of a disagreeable commotion just left of the stomach as if some living creature were struggling there ! ! Of course, on her first attack, some thirty years since, the physicians diagnosed it as malaria, giving her the most confident assurance of a speedy cure, but it never came. She is now much of the time confined to her bed and miserable at that. A sudden or even a gradual elevation of the head causing "everything to go round." Complains too of outward pressure of both eyes.

Now, brethren of THE WORLD'S family, what is the matter? Was it malaria? or are the

symptoms caused by ocular deformity, or by an irreparable lesion of the blood-vessels of the brain? Or, is it none of these: but, a vicious neurosis? Above all, what will relieve or cure? The pulse gives no hint of hardness. Yet, may not blood letting, in moderate quantity, be advisable? Bromide sedatives, nervines, antispasmodics and tonics have repeatedly failed. What next? I would be grateful for a word from the editor on this case.

J. A. MOWRIS, M.D.

La Fayette, N. Y. [We submitted this case to Dr. Waugh, whose opinion we give herewith:

Degeneration of the nerve structures in the left retina, travelling up to nucleus of optic nerve, extending to necleus of left aural nerve; the dizziness of rising due to the central lesion. Treatment: phosphorous, strychnine, arsenic, atropine, quinine: a powerful combination; followed or accompanied by massage or faradization, good food, and a purgative saline. W. F. WAUGH.]

Help Wanted.

EDITOR MEDICAL WORLD:-A lady, married, about thirty years of age, has for several years been troubled as follows:

First an itching sensation appears at some point on the body or limbs, face or neck, on the flexor or extensor surfaces indiscriminately. No sign of eruption at first, no swelling, no discoloration. After a few hours a slight elevation of the skin, apparently the whole thickness of the true skin, something resembling the slight elevation after a small hypodermic injection. Itching continues. After a few hours more a slight vesicle appears, which is scratched or rubbed open. There may be only one or two of these elevations, or there may be a dozen. Sometimes only one crop in an isolated district; sometimes in several parts of the body at once. During the whole time she is nervous and irritable. A slight exudation from the opened vesicles and small scabs are formed more or less covered with blood to a dark

EDITOR MEDIcal World:—I would like to thought or known of a ask your many readers, if they have ever thought or known of a case of skin diseases resembling eczema simplex or psoriasis annu lata when the local development was caused by the common bug, known in general as the lightning bug, glow worm, etc. I have had four cases of the above character all in children who had for two or three weeks, nearly every night, caught the lightning bugs and put them into bottles, and of course such children scratched their heads, faces and necks more or less; at any rate each of the four children had the disease come out in occasional places on their faces, necks and in the hair. Other children have not had it in the same vicinity. Charlottesville, Ind. A. D. AYER, M. D.

EDITOR MEDICAL WORLD:-I have to me a very interesting case, which I desire to report in your valuable journal, and ask the assistance of its readers.

Willie R., aged 12 years, has the following history as given by his parents. At two years of age he was attacked with typhoid fever, from which he made a good recovery. Two years later he suffered with an attack of dysentery, from which he seemingly made a good recovery. At about the age of six he began to have severe hemorrhages of the bowels, principally during the night, having about three or four evacuations of black clotted blood each time. About eight months ago he was placed in my care. Un a careful examination of the rectum it was found to be healthy. There was no fullness, tenderness or soreness of the bowels at any point that I could detect. The hemorrhage seemed to be the only trouble. As a result, of course. he was pale, poor and weak. I put him on bitter tonics and iron, which decidedly improved his general condition. He still has about one evacuation of blood (always black when first voided) every morning. I have tried other remedies but can get no further improvement. Any assistance will be thankfully received.

Floris, Iowa.

J. SWINNEY, M. D.

EDITOR MEDICAL WORLD:-Will you please call for a good and reliable formula for testing the purity of well water? Let it be as simple as it is reliable. I wish to test well water taken from thirty feet below. There are several holes bored down to the water for the pur. bose of carrying off filth. The water is in the quick sand, and probably flows with the river. Please give all the reliable information you can, and oblige a constant reader of THE WORLD. Fairbury, Neb. I. HUMPHREY, 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 col. lecting 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 xxiv.

Current Medical Thought.

M. Sig.-Ten drops three times daily in water. Another agreeable way of giving iron for the anemia, combined with arsenic, is

B Ferri et quininæ citratis....
Liq. potass, arsenitis...
Syr. limonis...

quinine and

.drams ij ..drams ij ..ounces iy

M. Sig.-Teaspoonful three times daily.

Iodide of potassium, as an alterative, in 5 grain doses, is highly recommended in enlarged spleen and liver; if it disagrees with the stomach after giving it in milk, stop it at once. Nitrate of potassium, in from 15 to 20 grain doses, three hours apart, has failed in my hands to produce the good effects claimed for it by some.

Vomiting is one of the most obstinate symptoms in some cases. I usually encourage it by salt or mustard water until the emesis is free; then with

Study of the Germs of Malaria.

BY PROF. B. DANILEWSKY, CHARKOFF, RUSSIA. [From Bacteriological World and Modern Medicine. We are indebted to the publisher for loan of cut.— ED. M. W.]

IN Annales De L'Institut Pasteur, p. 758, a long article appears by Prof. Danilewsky giving the details of experiments and observa tions on malaria, a comparative study of the parasite in birds and human beings. The article relates chiefly to numerous investigations carried on with birds, but greatly elucidates the question of malaria in man. At the outset the professor insists on the discovery that birds suffer like man, not only from chronic malaria, but also from an acute affection resembling intermittent fever in man. From his observation he is of the opinion that the hematozoa connected with malaria in man and birds are, to say the least, closely connected by their resemblance, if not identical. As in man, this investigator has observed that malarial microbiosis of the blood in birds may become very severe and cause death. The destruction of red blood corpuscles occurs as in man. This phenomena causes very great anemia, loss of appetite, exhaustion and death. He also observes the temporary disappearance of the hematozoa, and their reappearance after a time in greater quantities than before, and this, too, after the birds had been kept in a laboratory.

These cases show an analogy to those which occur in human beings suffering from malaria, apparently cured, but succumbing to a relapse away from infectious grounds or malarial districts, without having been again exposed to influences where the germ; existed. These are cases which do not respond to treatment by quinine. This might be explained by the fact that at that time the germ; are not ameboid, but in the crescent form of Laveran, and it has been demonstrated that quinine acts only on ameboid forms. The author insists that the ordinary hematozoa in the blood of birds is not simply a sign of symbiosis, but truly of a chronic infection. Besides this, he states that the birds are subject also to an acute form of the disease. In birds apparently in good health, in which the blood contains hematozoa, the red blood corpuscles are suddenly attacked. In the interior appear bright red spots formed by the cytozoa (pseudo-vacuoles). These bodies increase in size and become filled with granules of melanine. Their number is variable. weak subjects there is a blood corpuscle attacked among several hundreds of normal ones. In ordinary cases, the proportion is from 1 to 20 or 50; in more serious affections, it is 1 to 5 or 8. As all microbes of animal nature, living or developing themselves in the

In

interior of cells, are usually called cytozoa, cyto parasites, or cyto microbes, the author proposes to give to the malaria plasmodium in man the name of cytameba instead of the ordinary term of hemameba; but as in the bird the same parasite is not mobile, and is not, therefore, ameboid, he proposes to change the word to cytosporon malaria.

It will be seen, then, that the acute and chronic forms of malaria in birds and man are attributed, by this author, to two different parasites, at least so far as their appearance is concerned; the first having the amebɔid form of movement, and the second the crescent form, being non-mobile (the parasite of Laveran).

The shape of these organisms, however, seems to vary greatly, according to observation, in the same individual. Sometimes the development appears sn the form of a spore, and again in the form of a rose or a marguerite. At other times there are large or small spherical bodies, and again, various other forms (as may be seen in the accompanying plate). Observations tend to prove that the chronic form in birds pertains to the period of life of the cytosporon, and in man to the cytamoeba, and the chronic form corresponds to the exist ence of the crescent of Laveran. The author establishes the fact that the chief seat of the action of the parasite is not the blood, but begins in the generating organs of the blood, the spleen and tone marrow. This is true in warm-blooded animals and cold-blooded animals, for investigation has also been made in frogs.

The facts related tend to prove that in both birds and man malaria exists in three forms: First, acute affection, with rise of temperature and symptoms of serious disease. The microbiosis of the blood is due, in this form, to the presence of cytosporozoa in birds, and to cytamaba in man (malarial typhus of man).

Second, chronic infection, without manifest fever: microbiosis by an attack of the red blood corpuscles, by the polimitus and the Laverania in both birds and man.

Third, mixed infection: characterized by the simultaneous appearance of ameboid forms of acute cases and the polimitus of chronic cases, both occurring in birds and man.

The following is a table of explanation of the figures appearing in the plate. It will be seen by those who have observed the parasite of malaria in man that those of birds, frogs and lizards, are closely related, if not identical.

EXPLANATION OF THE PLATE.

Parasites of Birds.-Figs. 1, 2, 3, 4.—The smallest cytozoa in the shape of pseudo-vacuɔles; Figs. 2, 3 correspond to the intensive infection.

Fig. 5 Change of the form of the cytoza