I treated him two years ago for chronic indigestion. Never suspected pellagra. But this summer he had an excoriation on his chest and arms as well as hands emaciated; no strength.

I then pronounced it pellagra, and put him on the following treatment: Calomel, 4 grain every hour till 8 or 10 tablets were taken. Follow with Epsom salt. Repeat every 3 or 4 days. Calcium sulfid, 1 grain 3 times daily. Strychnin arsenate, 1/67 grain 3 times daily, and ordered him to take warm Epsom sponge bath every night. Patient has been picking cotton nearly all fall, and says he weighs as much as he ever did, and has gained wonderfully in strength. Says he can work without it tiring him. I never used anything locally. Excoriations soon healed, but he still has a red callus on back of hands. I would have used some form of arsenic other than he was getting in strychnin, as was suggested by all who wrote me, and also those that suggested it thru the WORLD, but he improved so nicely and well under the treatment I gave him that I thought I would just try it out.

I am very thankful to those who so kindly suggested treatment. Will also state that as a diet, put him on bread, milk, potatoes and some bran once in a while.

I am still of the opinion that pellagra is a chronic diseased condition of some vital organ, and not a disease itself, and most all starts from the gastrointestinal canal. DR. J. M. HAWK.

Medicine Mound, Texas.

Pellagra Fatal in a Child.

EDITOR MEDICAL WORLD:-I had my first case of pellagra come into my office the last of July. The patient was a child, male, 18 months old. I found the child suffering with a severe diarrhea, fever, and no appetite. Was not sure as to cause of same, but prescribed accordingly, and requested them to return ten days later. Returning about two weeks later, I found the diarrhea better, fever had somewhat subsided, but child was rapidly losing flesh; no other symptoms, only extreme thirst. I could not decide on case as yet, so had them return later. Upon their return to my office the third time the fore part of September, I found other symptoms had developt; there was that peculiar sunburnt condition of dorsal surface of hands and feet. To make sure as to my diagnosis, I sent the case to Oklahoma City, and they returned with statement confirming same. The child did not respond to any treatment whatsoever, and it died the 28th of September. Thus you see, my introduction to this new disease has not been very satisfactory. A. H. OWEN.

Meeker, Okla.

Treatment of Pellagra.

EDITOR MEDICAL WORLD:-I have received so many inquiries about my short article on pellagra in October WORLD, page 399, about how to give the remedy-which was omitted. I give the pills three times a day. They are made by Upjohn Co., and are listed as No. 1114. I think this will be of interest also, as other manufacturers list them. I have no interest in the manufacturer, but I do believe they will cure nine out of ten cases if given in early stage and a well-balanced diet. Newnan, Ga.

PAUL PENISTON.

DEAR DR. TAYLOR:-Your "Monthly Talk" in this December WORLD is worth more than one year's subscription. Yours for Peace. A. P. TWIGG, M.D.

Flintstone, Md.

Ordinary office visit or prescription..
General examination..

Examination of eye, ear, nose, throat, larynx,
or local treatments thereof.
Examination of heart, lungs.

Examination of rectum, or local treatment thereof.

Vaginal examination-manual or with speculum,
or local treatment thereof.
Examination of stomach, gastric lavage, or
treatment thereof.

Urethral catheterization, passing of sounds, or
local treatment thereof.
Irrigation of urethra or bladder.
Retaining fee in gonorrhea..
Retaining fee in syphilis..
X-Ray examination or treatment.
Electrical examination or treatment.
Examination of urin-chemical..

Complete (chemical and microscopical).
Examination of blood...

Examination of sputum, feces or other dis

charges...

.10.00 to 25.00

.25.00 to 50.00

3.00 to 25.00 3.00 to 25.00 1.00 to

3.00

2.00 to 10.00

2.00 to 10.00

2.00 to 10.00

were held in the office of the society. Dr. Alexander Lambert, who is the treasurer of the medical society, is chairman of the committee of the medical society.

Detention at investigation as witness, per day..

$25.00 to $50.00 Detention at court as witness, per day.... 25.00 to 50.00 For testifying as expert... 25.00 to 500.00

All terms are cash at the time of the service rendered, unless otherwise arranged.

All bills are due and payable when services are completed. Statements of accounts will be rendered monthly. Prompt settlement is expected. Interest will be charged on all unpaid accounts of six months' duration. After one year unsettled accounts will be listed as undesirable with the county society. Patients listed as undesirable and strangers will be requested to pay in advance.

There will be no gift visits made by members of the society in obstetrical or surgical cases. Fees for visits in after treatment of obstetrical or surgical cases will be at the regular

rates.

Fees for surgical dressings or treatments will be rendered according to the time and skill required.

The physician can make any reduction of fees deemed proper, in the form of a gift, to the worthy poor.

All office work cash unless otherwise arranged for.

New York State Medical Association and Claim Men Hold
Conferences as to Payment for Operations
Under Compensation.

The New York State Medical Society has held conferences with representativs of the casualty companies, and has agreed upon a fixt schedule of charges for services to injured workmen under the workmen's compensation law. A series of conferences have been held in the past to discuss this question as under the workmen's compensation law, as it now stands, it is provided that while regular weekly indemnities cannot begin until two weeks after the injury, the employer must pay for medical attendance. The problem was to fix a rate. This agreement is to last until next July.

The law says that a physician shall charge according to the fees he would receive for treating such patients in the community in which they were injured. A further thing to be considered is that heretofore these patients have been receiving their care in the hospitals, giving no fees to doctors, or the doctors have been able to collect only a small percentage of fees charged for this work. It should never be forgotten that these fees, according to this schedule, are considered just when used among individuals and families earning about $600 a year, for it is a known fact that east of the Rockies and north of the Mason and Dixon line three-fourths of the male wage earners and nineteen-twentieths of the female wage earners earn less than $600 a year.

The cost of medical fees has worried the stock and mutual companies considerably and a reduction of 20% of the premium was offered to employers who would pay their own medical fees. In view of this, claim men and physicians have been working together in an endeavor to reach an equitable basis. Most of the conferences between the casualty men, which consisted of George C. Taft, Dr. W. L. Gahagan and H. S. Recknagel, and the committee of doctors

Under the schedule a physician will charge $2 for an ordinary day visit at the home of the patient, including an antiseptic dressing when necessary, and $1 for each subsequent treatment at the office or $2 at the home. Hospital visits will be charged for at the rate of $1. Night visits between 9 o'clock and 7 o'clock a. m. will be charged for at the rate of $3. For a formal report at the request of the insurance carrier that rate will be $1. First attention at the physician's office including operativ procedure and the dressing of wounds will draw a fee of $1.50.

Specific operations, including amputations, fractures, dislocations, sprains and other injuries calling for treatment call for specific fees. For an amputation of the hip, including first aid, operation and full treatment, the doctor will receive $75. For the amputation and subsequent treatment of the finger and toe the fee is $15. Laparotomy for traumatic peritonitis will command a fee of $50. Minor operations generally call for $5.

For assisting at a major operation the fee is $10, and from $2 to $5 for similar work at minor operations. For an examination in lunacy including one day's attendance at court or before a commission, the fee is $50. Subsequent court or commission attendance will command $25 a day. Other general fees are as follows: Complete physical examination and report by other than attending physician, $3; autopsy, complete with written report, $50; autopsy, attending, but not performing, $10; microscopic and chemical analysis of organs, $50; testimony in court or before commission as to simple fact of injury, $10; testimony at coroner's inquest, $5; expert testimony, per day, $15 to $20; introducing catheter, $2; X-ray picture, including plates, $5; subsequent pictures, with plates, $3 each; administration of general anesthetic, $5. Treatment shall not extend over 60 days as provided by the law, section 13, from the date of injury except upon special arrangement with the insurance carrier. Reports respecting the condition of injured employees under treatment are to be made without extra charge. The schedules, endorsed by the society, are to be sent to all physicians in the State for their signatures.

Mind Cure.

Said the learned apothecary, as he handed me his pills, "These will make you blithe and merry, they will cure all human ills. They will kill the microbes buzzin' in your vitals and your head, if you'll only take a dozen just before you go to bed." So I took them for the glanders, which had held me for a spell, for the mumps and yaller janders, and they made me sound and well. Oh, those pills I recommended, till I saw their sales advance, and their merits I defended every time I had a chance. Then the able druggist perished, and a new one took the store, and the pills I loved and cherished weren't compounded any more. Then a sample pill I carried to an analyst of fame, and around his study tarried while he analyzed the same. And his laughter made him totter when his task was done, by jing: this is made of flour and water, and it wouldn't cure a thing!" Thus the man of science lilted, for his task had made him gay; and I humbled felt and wilted, as I took the pill away. Just the same, those pills had cured me, changed my health from bad to good, as the pharmacist assured me, on his honor, that they would!-WALT MASON in Philadelphia Bulletin.

DEAR DOCTOR TAYLOR-I have taken THE MEDICAL WORLD for many long years-am in my 71st year of life; was a Union soldier for the first three years of the Civil War. I could get around better than many men of thirty-five to forty years until I had a step-ladder accident, ten weeks since, when I injured an ankle, which is still very painful at times and it looks like tempting Nature to renew my subscription for four years, but I am doing it all the same.

I wish THE WORLD and its staff a Merry Christmas and a Happy New Year. D. P. MORGAN.

Clarksburg, W. Va.

Dr. A. Y. Linville, of Winston-Salem, N. C., writes: "Glad you have returned from the war-torn countries to God's country. We have all enjoyed your Travel Talks, giving us an idea of every-day living abroad, splendidly told. I thank you for all this, and for your never-tiring interest in the financial condition of the hard-working doctor. Merry Christmas to you."

This is applied to the vagina by a spoon, introduced thru a speculum. It raises the specific gravity of the vaginal secretion and the stimulated flow converts the powder to sublamin + Wright's solution + aluminum acetate + white lead. If applied to a septic wound or burn and rapid healing does not start promptly, it may be safely assumed that the patient is in need of surgical drainage or iodid of potassium, or both.

The vagina should be well cleaned with dry absorbent cotton before each application of the above powder. The white lead is insoluble and precipitates in the vagina, and must not be mistaken for caseous discharge.

Or compresses of hydrogen dioxid solution, boric acid solution, or a saturated solution of picric acid may be employed.-New York Medical Journal.

Dissolve the iodin in the alcohol, then add tannic acid and 1 oz. of syrup. Heat this to near the boiling point until it gives no evidence of iodin by the starch reaction (about 20 minutes). Then cool and add remainder of syrup. Each dram contains 2 grains of iodin. It may be administered in water or wine before meals, and avoids gastric disturbance.-Windgrave.

A camphor and phenol compound useful as a stimulant and antiseptic where those drugs are indicated can be made as follows: B Camphor

Phenol

Liquid petrolatum

.gr. xl

.gr. xx .m. xl

Quassia makes a good bitter tonic to combine with iron, and since it contains no tannic acid, is one of the few compatible drugs that can be found in this connection.

J. C. Wilson finds the syrup of the iodid of iron serviceable in articular rheumatism and other forms of arthritis after the salicylates have failed. He uses the drug in maximum dosage.

Ipecac in minute doses will often control intractable vomiting when organic disease of the stomach has been excluded.

The nicotin of tobacco has been found to stimulate secretion of the activ principle of the adrenal gland, producing constriction of the blood vessels.

Buchu is the drug of selection in chronic irritability of the bladder associated with desire for constant micturition.

M. M. PALMER, M.D.

[We imagin that the condition has been brought about by the long-continued indigestion incident upon the vicious diet. It is not necessary that we express our opinion of parents who would feed a child for two months on sugar, potatoes and ice Our treatment would have been thoro elimination by castor oil and salines when first seen; a rigid diet if food would be accepted, and nothing at all if suitable food were refused; and later tonics and hematinics.-ED.]

Autointoxication.

DEAR DR. TAYLOR:-Will be pleased if you can find space in THE MEDICAL WORLD for account of following case:

Child, female, 6 years. Two months previous to trouble had eaten nothing but potatoes, ice cream and sugar, sugar being eaten with potatoes. Child would not eat bread. Was called one week after child became sick on account of rash, which caused the parents to become alarmed, after the patient had lain around for one week or more with vomiting, loss of appetite, tongue slightly coated, no sore throat, constipation and cramps in stomach, as they called it. Patient had normal temperature. A rash appeared principally over forearm, pectoral and epigastric regions, tibial surface and back, a papular discrete rash, and, after four days these papules became pustular, and the redness became general with many papulo-pustular pimples. After this developt over body, palms of hands became same as body, which coalesced after the papules became pustular, and the entire palm came off in patches size of half a dollar, with new skin forming under as the top was ready to come off. At same time soles of feet were affected, while palms have peeled off, leaving red surface and soles acting similar to hands.

Body was very itchy and child complained of itching and intense burning of palms and soles, which lasted for two weeks. Patient could not sleep without an opiate. No local application relieved burning.

Urates

Urin, sp. gr. 1.018, somewhat turbid. and phosfates present. Amount first two weeks was very scanty. At present writing, after seven weeks in bed, child has had a papulo-pustular eruption over breast from fifth rib down to lower border of stomach once each week. Note that the first eruption had disappeared for one week after remaining the first three weeks of sickness. This eruption remains for about three to four days and only effects anterior surface of chest, back and thighs. From beginning of sickness to present date, during the day or night, the temperature was normal or 1⁄2 degree sub. Heart 130, respiration 20 to 24. Child very nervous and hard to wait on. Child is gradually becoming weaker. Slightly coated tongue, never had the appearance of a strawberry tongue.

Will be pleased to receive suggestions as to a

Copenhagen.

EDITOR MEDICAL WORLD:-What is "Copenhagen" made of? It is a snuff or tobacco-like substance, is sold in small boxes and smells rotten. Everywhere you will see signs "Chew Copenhagen"! The stuff makes a man feel "dopy" and seems to have a general bad effect.

Rockwell, Iowa.

F. A. COGSWELL.

[We presume, from your description of the advertising features, that the substance to which you refer is the ordinary Copenhagen snuff sold thruout the world for many years. Snuff is simply powdered tobacco.-ED.]

Neuritis.

EDITOR MEDICAL WORLD:-I have been having what I have termed a "neuritis." It seems to be at the insertion of deltoid muscle on left arm. Have had it for nearly a year and as yet have Vibration, found nothing that gives it relief. massage, electricity (both faradic and galvanic and high frequency) aggravates rather than relieves. Think I might have strained it in getting off of street cars, or raising a window in my office that would stick.

Salicylates have no effect. There are times when I do not feel it at all and other times it seems worse than ever. Most of the time I cannot lie on it. It doesn't seem to bother when I have to use my left hand in making vaginal examinations nor in obstetrics. I generally use the arm or hand that is most convenient and it has happened this summer that my left was called into play more than the right. Sometimes it bothers me when I carry my medicin case; frequently when I put on a shirt or coat, and when reaching above my head.

I am 47 years of age, weigh 185 pounds, general health good. Only started to use glasses a year ago and then only for reading. Have only three teeth out. Particular as to my diet. Live close to Mosaic law, altho I am not a Jew. Never use pork or its compounds. Seldom eat white bread or potatoes. Drink percolated coffee clear; use but little sugar or salt; never eat tomatoes nor potato salad.

Generally have an attack of dysentery a year, in late summer or fall. Haven't been sick in bed

for twenty years. Have practised medicin for seventeen years. Use neither tobacco nor liquors. Neither do I use them in my practise. Do not know how to swear, but chew gum. Some say neuritis is caused by bad teeth. Mine are extra good. Have three gold crowns, but no amalgam fillings.

Have had patients with this same trouble but could give them no relief nor have I heard of any other doctor that did. Heard of one case here last