in this location because it has been deprived of support from the dorsum of the penis. We have often noted this result following unskillful operations of circumcision. It is likely that if you will abandon irritating applications which tend to inflame and thicken the skin, that the greater part of this edematous pouch will be absorbed, in time, so that it will not be noticeable to any but a good anatomist. If, however, the patient insist on a better cosmetic result, you can readily obtain it, and perhaps a good fee in addition, by excising an elliptical piece of skin which will include the "pouch," and bringing the edges together by fine sutures. This can be done under cocain anesthesia, preferably by placing a band of constricting rubber around the penis a little back of the glans, till after the operation is completed.-ED.]

The Age of Tapeworms.

EDITOR MEDICAL WORLD:-In the numbers of cases of tape worm reported, no one has mentioned the age of the worm. Can you advise me as to the usual span of life of the tenia saginata? I recently removed one for a patient that had been passing segments for eight years. During that time several unsuccessful attempts had been made to get the worm. Large portions of the body had been passed, but the head always staid behind. Thymol and sugar of milk, each 60 grains, on empty bowels, followed by salts, did the work. Waycross, Ga.

J. E. KNIGHT.

[A search thru a dozen standard textbooks on pathology reveals the fact that none of the authors say anything about the age of a tapeworm, and it is our impression that no one knows anything about it. They have been found in persons of all ages, from the nursling to men 80 years of age; but, of course, the old man may not have ingested his cysticercus till he was well on in life. It takes about two months after ingestion of the larva for the worm to develop to an extent which permits of its throwing off the segments. Can any of the family give the Doctor any information regarding the "span of life" of the tenia saginata? ED.]

Central Nerve Trouble a Sequel of Uncured Syphilis.

EDITOR MEDICAL WORLD:-I would like very much to get some help as to diagnosis and treatment of the following case: J. M., aged 61 years, male, began in May, 1910, to complain of a coldness and numbness of the right side of the body up to the waist, right hip and leg, and right side of the penis and scrotum; losing the

use of the left leg; had to use a catheter; sometimes by straining could cause the urin to dribble away: Bowels'would move only by the use of the strongest purgativs. After about one week, the left side up to the waist became affected in the same way. The bowels would move then, and he would not know it. Urin dribbled continuously. Has had rheumatism for ten years, enlarged prostate, stricture about 1 inches back. Bowels now very loose at times, and at other times very constipated. Patellar reflex gone. Appetite good. He is as strong as ever from waist up. Urin, amount not ascertainable, on account of the dribbling; reaction alkalin; sp. gr., 1030; trace of albumin; phosfates and pus in large quantities. This man came under my care about two months ago, and says he has been the rounds without results. He is married, has three children, all of whom are more than 20 years of age, all in good health; has had all the diseases of childhood; no tuberculosis in the family. Father died at the age of 45 of cholera. Mother drowned at 55 years of age. Has two brothers and two sisters in good health. Joined the army before he was 15 years old, and served 17 months. Had typhoid fever while in the service. Had measles about 30 years ago, since which time he has had a severe cough. Had lues about 20 years ago, for which he was treated and pronounced cured, but had some leg ulcers afterward which were hard to heal. He improved slowly under anti-syphilitic treatment. He can cross his right leg over left one, but cannot raise his left one at all. Any help from THE WORLD or its many readers will be appreciated by me. WEST VIRGINIA.

[Doctor, you ask for help, and do not wish us to publish your name and address. How do you expect the family to come to your aid? Much of the best help inquirers get is by personal letters mailed them by other members of the family after we publish the query. We could not print all the letters that are sent to many querists, even if they were sent to us; it would flood this department. Many doctors will write a brother, tendering him suggestions and advice, who would not write to our office for publication. We very much fear, Doctor, that you have lost heavily on this.

It is possible that you may have a gumma of the brain causing the symptoms, but it is more likely a nerve trouble of central origin due to an uncured syphilis. Your case has not progrest far enuf, or you do not detail symptoms enuf, to enable us to make a differential diagnosis between the various diseases of central nervous origin. What is the pupillary reaction? How about Romberg's symptom? Is coordination impaired? In short, there are many distinctiv symptoms lacking which are essential to a diagnosis in a case like this.

To our mind, potassium iodid is the only drug which you can hope to benefit your patient in the least, and it should be pusht to the limit. Forget the dose printed in the books, and give it to him to the point of intolerance. Massage and electricity may serve to keep his mind occupied while a thoro try-out is made of the drug.-ED.]

Treatment Wanted for Results of Acute Anterior Poliomyelitis.

I

EDITOR MEDICAL WORLD:-I have a little patient concerning whom I wish to consult you. About one month ago the little girl, about 16 months old, was taken with paralysis of lower extremities; lost the use of her little legs. put her on treatment; gave her tinct. of nux vomica and bathed and rubbed the affected limbs with alcohol, followed by thoro rubbing limbs and spinal column with cocoa butter.g also adjusted a brace to keep the foot straight. The right leg is greatly improved, and she can use the left a little. I am also using a galvanic battery once a day. If you or the family can aid me I will be greatly obliged.

Pine Beach, Va.

R. A. ATKINS, M.D.

[You are doing all that can be done, Doctor, and the patient is doing as well as could be expected.

Continue the mas

sage of the limbs, and keep her in the best. physical condition possible. Accustom her to being carried out into the fresh air each day, avoiding stormy weather. Teach the family to use the battery at the proper strength, and leave it with them, so that it can be used about four times each day. Only time for growth will determin the degree of ultimate damage to the muscular structure of the legs. but we would expect it to be slight or not very noticeable in the right, on account of its early and pronounced improvement. Be very guarded in your prognosis on this point, however.-ED.]

Glossitis.

EDITOR MEDICAL WORLD:-Will you suggest a treatment for glossitis involving not only the tongue, but also the gums? In fact, the entire mouth. I have had a number of these cases which seem to exist independent of any other trouble and are without discoverable etiology. Louisville, Miss. M. L. MONTGOMERY, M.D. [Glossitis and gingivitis are always to be presumed to come as a consequence of some irritation, internal or external, and the etiology generally becomes clear immediately that such cause of irritation is discovered. In adult males, tobacco is the most common cause. Quite often the injudicious use of calomel, either by some doctor or on the patient's own prescrip

tion may be found to be the basis. Simple lack of cleanliness about the teeth will cause it thru irritating products of decomposition setting up an inflammatory action. Doubtless some cases are due to hyperacidity of the stomach. Illy fitting artificial teeth, or ragged edges on the natural teeth are a frequent cause, thru the irritation of the tongue rubbing against them. Often, indeed, after the most careful examination, one is forced to ignore the etiology and treat the case empirically. A dentist should put the teeth in good condition mechanically.

As a rule, saline purgation is indicated, and this is often followed with benefit by iodid of potassium internally. Frequent washing of the mouth and throat with a solution of chlorate of potash, with glycSometimes an erin added, is beneficial. astringent wash or gargle of fluidextract rhus glabra, with glycerin, is good. If there is markt ptyalism, it is well to use atropin internally until the excessiv secretion is checkt. Twenty grains of subnitrate of bismuth, with an ounce of glycerin, and of water, makes a nice inflammation in erythematous cases. Tonics are often indicated, and iron and quinin are found serviceable.-ED.]

seven

ounces

Edema Angioneuroticum.

EDITOR MEDICAL WORLD:-Can you give me any information in the following case? Miss R., age 26, slight figure, weight 110 lbs.; menstruation regular and normal; slightly anemic appearance; appetite good; no digestiv disturbances, but inclined to be constipated. Sleeps well; not of markt nervous temperament. Since having scarlet fever sixteen years ago, upon exposure to cold, exposed parts will begin to sting and burn. Large white wheals appear, the skin surface between being a dark red. If out in cold for some time, entire body becomes involved; face bloated, eyes nearly closed, while burning is nearly intolerable. No rise of temperature or other systemic disturbances. Placing hands in cold water during the summer will bring about the same symptoms. Patient has been the rounds of the M.D.'s. She has had iron, arsenic, and hydrastis compounds as tonics, but to no purpose, as every succeeding winter seems to make matters worse.

My diagnosis is angioneurotic edema. Am I correct? Anyway, let us have some treatment for the above case. W. S. JOHNSTON, M.D. Kemp, Ill.

[There seems to be no doubt as to the correctness of your diagnosis. Unfortunately for the patient, there is little promise of permanent cure, tho the intervals between attacks may be lengthened. Antacids and saline laxativ medication is

most important, like magnesia and sodium salicylate. Some practicians have derived satisfaction from sodium benzoate, in 5 to 20-grain doses three times a day. Salol and betanaphtol are invaluable as intestinal antiseptics, preventing intestinal decomposition of ingested food, and partially eliminating the theoretical cause, i. e., autointoxication. Arsenic, atropin, ergot, and the bromids have been commended highly by various observers.-ED.]

Kada-yaga.-A Case of Seminal Losses. EDITOR MEDICAL WORLD:-Can you tell me what kada-yaga is? I inclose a sample. Persons using it here claim it is helping them, but the claims appear to be extravagant.

I am reporting a baffling case of seminal losses on which I would like to have help. Myrtle, Fla. DR. T. C. WHITMAN.

[We do not have facilities for making complete analyses of samples of any preparation, but we have examined the sample sent us, and believe it consists chiefly of a crudely ground meal from white corn. It has no such powers as claimed in the "literature," of course.

The case of seminal losses requires a line of treatment adapted to his individual case, which can only be elaborated by one familiar with his environment and personal peculiarities. If you will get the books we name, you will be able, with their aid, to give this man such hygienic directions as will enable him to regain his health. You may be forced to give him some drugs, or placebos, for a time, for the mental influence they will exert. We cannot spare the space in this column to print your letter in full, as the case would not be of general interest, and no one except yourself would learn anything from our review of it, for the reasons given in the first three lines of this paragraf. The Sexual Disabilities of Man, Cooper, publisht by P. B. Hoeber, 69 East 59th St., New York, N. Y., at $2 net; Sexual Impotence, Vecki, publisht by W. B. Saunders & Co., Philadelphia, Pa., at $2.-ED.]

Was it a Case of Landry's Paralysis, or of Acute Anterior Poliomyelitis?

EDITOR MEDICAL WORLD: I have been in practise for 16 years. I am going to report my first case. Was called to see Miss M., a school girl 15 years old, October 6, 1910, at 9 a. m. Patient complained of headache and extreme weakness of limbs; temperature 99 degrees; pulse 95, full and strong. She had slight nausea; restless; bowels sluggish. Prescribed mild doses of mild chlorid followed by

saline, which acted o. k. Saw patient October 7th, at 8 a. m., the second time. Subjectiv symptoms none, except the increast weakness. Physical examination: temperature, 991; pulse, 100; bowels slightly distended with gas; lower limbs paralyzed. Saw patient again at 2 a. m., October 8th. Paralysis had extended up the cord, involving the upper extremities, so that the hands and arms lay lax in the position they were placed by nurse. Breathing irregular; pupils oscillating, first contracted and in a few seconds widely dilated; pulse, 110, regular; temperature, 99 degrees; muscles of the throat so weak patient could speak with much difficulty. These conditions deepened until patient died at 9 a. m., October 8, 1910. My diagnosis was acute ascending paralysis. Was I

correct?

I forgot to state that this patient had never been seriously sick, and enjoyed seemingly perfect health before the sickness which caused her death. She received a severe nervous shock some six years ago in an earthquake in California. DR. W. S. BURCHER.

Beallsville, Ohio.

[We cannot tell you, Doctor, and no one can. You had not time for the development of any distinctiv symptoms, death occurring too quickly for anything of note being manifest except the erratic pupils and the paralysis, both of which might present in any one of several diseases. One may theorize to the extent of reflecting that Landry's paralysis is a very rare disease, while the last two years have seen many cases of acute anterior poliomyelitis, in all ages and both sexes, many of them proving rapidly fatal, presenting themselves in almost every section of this country.

We can only tender our sympathy, Doctor, and assure you that no one could have benefited your young patient by any method known to science. We regret that a diagnosis is impossible in this case.-ED.]

Obstinate Eczema.

EDITOR MEDICAL WORLD:-I am asking help in the following case, which has resisted treatment for some time. Patient, male, has had affection of the middle and ring finger of right hand for some time over two years. It seems to be confined to these two fingers, none of the others having become affected. Appearance and symptoms are, first, there appear small vesicles, watery, over portions of the fingers, exuding a watery discharge; this is accompanied with itching and burning and fevered condition of the parts. In a day or two it changes and becomes dry, when the skin will begin to shed much like desquamation in scarlatina. This condition is followed by cracks or fissures, becoming very sore, particularly from movement of the fingers. This condition is also accompanied with burning and itching, aggravated by water and cold weather. After a week or two the fingers will heal for a short time, when the above appearances and symptoms will be repeated. As before stated,

the affection is located and confined to the two fingers mentioned and has never spread to any of the other fingers. It has resisted treatment thus far. My diagnosis is tetter, and treatment was directed accordingly. Can you or any of the family suggest treatment that will relieve? New Castle, Pa. B. W. STILLINGS, M.D.

[Your diagnosis is probably correct. If so, you can cure the affection by having him shun water as much as possible, cleansing the hands when absolutely necessary with warmed glycerin. Let him make a finger cot from chamois skin, large enuf to accommodate the affected fingers. This must be worn constantly. On the lesion, spread thickly, twice daily, oxid of zinc ointment. A few weeks of such regime will banish the trouble for a time, tho it may return with the cold weather of another winter.

Put him on arsenic, internally. Neutralize any undue acidity of the urin. Make sure there is no existing constipation. Cut down his diet of meats. Insist on frequent warm baths of unaffected portions of the body to maintain good elimination thru the skin, but keep water from the lesion.-ED.]

Probably a Case of Ataxic Paraplegia. EDITOR MEDICAL WORLD:-Can you help me in the diagnosis of the following case: Male, 57 years old. In the winter of 1908-09 he was sick with what one doctor pronounced "la grippe" and another pulmonary tuberculosis. When I was called in the spring, he had a severe cough, night sweats, jaundice, and vomiting. I was unable to make a diagnosis of tuberculosis. After two or three weeks' treatment the jaundice and gastric symptoms subsided, but the cough and night sweats continued. The cough left him in about six months, the night sweats bothering him occasionally for several months longer. He has not had a sweat now for six or seven months, and no cough to speak of. For a year afternoon temperature has always been normal when I have taken it.

After getting up from his sickness, patient noticed a feeling of heaviness and weakness in one limb from the knee down. This feeling has gradually progrest until at present both limbs are involved and the abdomen. He walks with a cane, but very slowly and carefully. Knee reflexes exaggerated; Romberg symptom present; Argyll Robertson symptom absent; eyesight good; sensation unimpaired; vertigo almost constant; often falls; pulse, 72; urinalysis negativ; temperature normal; sexual desire lost. The symptoms are similar to those of ataxic paraplegia or combined lateral and posterial sclerosis, except for the lack of spasms of the limbs. I believe it to be some form of spinal paralysis, but am unable to locate the lesion. The disease has not progrest much for several months. P. E. BRYANT.

Lacota, Mich.

[We think you have made as good a

diagnosis as any one can make. Probably, as the case progresses, one may be able to classify it more exactly when distinctiv symptoms of the later stages develop. At this time, it looks to us as tho it were probably a beginning case of ataxic paraplegia. In all these diseases there is more or less dispute as to the location of the lesion, some observers claiming one site as a rule, and others as stoutly claiming most cases may be referred to another location. A middle, and more reasonable, ground to take is that the lesion is not always located at the same point in different individuals presenting much the same symptoms. Of course, when a definit nerve area is involved one sees definit and uniform symptoms in all cases; but outside these areas, it is always more or less guesswork. Perhaps some of the family may differ, or may have something to add. Will any of our osteopathic friends tell us if spinal manipulation would promise anything in a case like this?-ED.]

Paralysis in Legs Following Typhoid Fever. EDITOR MEDICAL WORLD:-I would like your opinion concerning a patient who is of much interest to me. Mrs. T., age 44, rather stoutly built, the mother of two children, youngest born 18 months ago. Had had fairly good health till last spring. About the 9th of May she went on a tour to Baltimore, Old Point Comfort, and Norfolk, Va. During this trip she had a succession of irregular chills and a diarrhea, but did not get sick enuf to remain constantly in bed. She returned home about the 1st of June, and for about a week had irregular chills. From this time developt typhoid fever that lasted till the 25th of September, before her temperature remained normal. She was treated rather rigorously during the first of her attack for malaria. One peculiar feature of her fever was that after seeming convalescent she would take repeated exacerbations of fever, each to run for some days, without any evident cause.

She was treated by a careful physician who remained at her home, and with whom I saw her repeatedly. She was given intestinal antiseptics, and repeatedly sponged with cold water when temperature was elevated.

During the latter part of July she complained much of numbness and pain in feet and legs. Up to the present time, while she eats heartily and rests well at night and there is no swelling of ankles, still she cannot stand upon her feet by reason of weakness of knees and hips. Massage has been systematically employed twice daily. Could you suggest a treatment that would hasten recovery? J. P. ANDREWS.

Marionville, Mo.

[We do not think the trouble is mere weakness, but believe you have a case of post-typhoidal paralysis. We would refer her to an electro-therapeutist if she is able

to go to a city and take such treatment. If she has not the necessary finances, we suggest that passiv motion be combined with the massage, and that regular bathing with salt water be tried.-ED.]

Gastritis; Movable Kidney; Chronic
Endometritis.

EDITOR MEDICAL WORLD:-Would appreciate very much if you would give prescription and advice thru your columns on following case: Female, age 32. Family history negativ; has had three children, youngest 6 years old. Lacerated perineum repaired, curetment, and a retroversion fixt. Womb attacht to abdominal

wall about three years ago. Womb diseased; right ovary was removed at same time.

About eighteen months ago patient began to have water brash (profuse salivation), followed by nausea and vomiting, and with occasional intervals of a week without nausea. She has vomited several times a day ever since. Vomited matter consists of mucus, some bile, and whatever food has been taken within last few hours previous. Normal weight about 120 pounds; present weight about 87 pounds. Urin examination shows no sugar, albumin, nor pus, but at times some mucus when pressure of heavy uterus seems to press on the bladder. Menses now about every three weeks, lasting 6 to 10 days, and apt to be quite profuse. Right kidney movable. No history of "crises,' but considerable distress in region of liver and right kidney. Stomach analysis shows at different times 4 to 12 per cent. HCl. Patient has had dil. HCl. as well as ipecac, tabacum, and various other homeopathic and allopathic remedies, with very little permanent benefit. Would nephrorrhaphy for the nausea, or removal of the remaining ovary for the menstrual trouble, be justified? Patient is weak, but able to be about all of the time.

Any remedy, prescription, or surgical procedure that you may suggest will be seriously considered and the suggestion will be appreciated. T. E. WILLIAMS.

Shreveport, La.

[The mass of symptoms which she presents is confusing you, and you are seeking for "something for the symptoms." We would positivly never for one minute entertain the idea of a "nephrorraphy for the nausea," nor would we consider removal of the ovary unless it is unquestionably diseased. If you bring an artificial menopause on this woman by removal of this remaining ovary, you will have a larger problem on your hands than ever before. When the molimen appears, permit it to go for three to four days, and then check it, to prevent exhaustion thru excessiv loss of blood, by administration of the following pill or tablet:

then one every two hours till a cessation is secured. Keep her in bed. If this fails, try 10 to 20-minim doses of oil of erigeron; or stypticin may come in good play.

Between menstruations, keep the uterus supported and drained of congestiv products by large wool tampons of boroglycerid inserted every other night, and give a five-gallon douche of hot water when the tampon is removed. Use a vulvar pad on the nozzle of the syringe so that she will be able to endure the highest temperature possible. Such a douche is best given in a hammock, with a tub underneath to catch the return water; an assistant is convenient to keep the water hot and the reservoir filled. A course of such treatment may not only work wonders on the ovarian and uterin condition, but it may have quite an influence on the condition of the digestion.

Such a case is admirably adapted to the Weir Mitchell rest cure, and this woman should be in bed anyway. Any of the peptic digestants sold by reliable houses might help out, for a time. If you can demonstrate actual degeneration of the ovary, removal may be necessary; but we would try the above line of treatment first, as we think the exclusivly milk diet, with enforced rest and quiet, would be beneficial.-ED.]

Information Wanted on Formaldehyde.

EDITOR MEDICAL WORLD:-What is formaldehyde? What are its uses? Is it a poison? Is it a therapeutic agent? What are its medicinal and economic properties? How is it used as a preservativ for foodstuffs? Why is it not found in the National Dispensatory? Kindly answer in THE WORLD. PENNA.

[Formaldehyde is a colorless gas, possessing a strong, pungent, irritating odor. It is used to disinfect rooms and articles which have been exposed to contagion from communicable disease. It is a powerful antiseptic, disinfectant, and preservativ. It has been used to preserve milk and other foodstuffs subject to rapid deterioration. It has been used in medicin, to a certain extent. It is employed, in solution, diluted with 3 to 10 parts of water, as an injection, to retard the growth of uterin cancer, tho its use is not devoid of danger. Largely diluted, in solution, it has been injected intravenously in septicemia. It has been employed, largely diluted, as a wash for wounds, tho its use is extremely painful. You will find it fully discust in the National Dispensatory,