September, 1912, page 409, we mentioned the receipt by us of a clipping from the Kalamazoo Gazette in which a woman of that town recommended the oil of collie puppies for tuberculosis. It reminds us of a patient dying of gastric carcinoma who asked her niece, a young lady who had been cured of tuberculosis at a tuberculosis sanatorium, if she thought the aunt herself might be cured by going there. Neither the patient nor the niece knew what ailed the elder woman; but the young woman was expected to give medical advice on the subject. Thus the laity gives and takes "advice" on medical topics without considering whether the adviser is capable of speaking on the subject.

Dog fat would have no more effect on tuberculosis than any other fat. Fat is a food of greater value than most people appreciate. Read our editorial on "Fat as a Food," in March WORLD. In that article we called attention to Dr. Kendall's treatment of tuberculosis by feeding his patients on cream.-ED.]

[First eliminate the constipation by continuous use of an aperient, and we have never found anything better than Drysdale's-one or two every night on retiring. See that not enough are taken to produce catharsis-very few need to take more than one tablet each night.

Next, instruct her carefully in oral hygiene, if she is negligent in this matter. Let the teeth be thoroly cleansed just before retiring. Use a mouth wash afterward of some mild antiseptic, such as peroxid of hydrogen or liquor antisepticus, N. F.

Touch the ulcerations with the solid stick of silver nitrate every two or three days until they disappear. Attack new ones with the caustic immediately on their appearance.

For a time, put her on 2 teaspoonfuls of elixir lactated pepsin, 80 grains to the ounce, before meals. Also, we should think a thoro course of Blaud's pill indicated.-ED.]

Dr. L. R. Emerick, of Conover, Ohio, inquires which preparation of lobelia gives the best results, hypodermically used, in asthma? Also if anyone has had any success in treating cataract with succus maritima.

MEDICAL FRAUDS.

Croney's Epilepsy Remedy. EDITOR MEDICAL WORLD:-I have patient, age 12, boy, that has had epilepsy for six years.

Family History: One aunt died of paralysis at 30. One greatuncle died of epilepsy; grandmother, neurasthenia.

I have tried everything and nothing does him any good but for a few weeks. His father has been trying Dr. Croney's "Specific for Epilepsy," put up at Columbus, Ohio, and sold for $5 a pint. He says it has helped him more than anything. Can you give me the formula for it and do you think it is any good, please? B. W. WILLIAMS.

Red Sulphur Springs, Tenn.

as

[Croney's "specific for epilepsy" is sold on the mail-order plan by Dr. James T. Croney, of Columbus, Ohio. Examination in the A. M. A. chemical laboratory showed it to be a solution containing ammonium bromid and potassium bromid essential constituents, containing bromid equivalent to 16.9 grains potassium bromid per dose of two teaspoonfuls (two fluidrams). Like other epilepsy "cures," Croney's "specific for epilepsy" is merely a bromid mixture and is both worthless and dangerous. (Journal A. M. A., April 17, 1915, p. 1344). -ED.]

Gowan's Pneumonia Cure. EDITOR MEDICAL WORLD:-Please give formula of Gowan's treatment of pneumonia. Eaton, Ohio.

C. W. CONLEY, M.D. [According to "Nostrums and Quackery," Gowan's pneumonia "cure" consists of lard, camphor, turpentine, carbolic acid, opium, stearin, quinin and quinin sulfate. The proprietors of this nostrum were convicted and fined under the Food and Drugs Act for misbranding their product.—ED.]

Relief of Pain and Possible Cure of Cancer. This is the title of a book by Skene Keith and George E. Keith, English practicians, and publisht by the Macmillan Company, of New York. We have referred to it in our columns before this, but, on account of various queries from various subscribers, again mention the matter. The authors themselves are not radical or unreasonable in claiming a "cure"; but they are reasonable and rational in setting forth fully the results they have obtained, and the possibilities of the treatment if further developed. To quote their attitude thruout the book, we cite the following: "The disease itself varies in such an extraordinary manner that it does not seem to us probable that one line of treatment will ever be discovered that will make a permanent cure in every case. We doubt if any doctor has ever seen two cases run an identical course."

The following is a description of the method advised by the authors:

Exact directions for making the injections from the separate ingredients with what we considered a standard dose. This strong standard injection consisted of a solution of iodipin in oil, arseniate of iron, cacodylate of iron and cinnamate of sodium. The iodipin is a 25% solution in oil. The arseniate of iron contains 4 grain of iron and 1/45 grain of arsenous anhydrid in 1 c c. (15 minims). The cinnamate of sodium is a saturated solution containing 11⁄2 grains to the cubic centimeter. The emulsion which is formed is a mechanical mixture and is not a new compound.

The average proportions of the emulsion which we have used most are as follows: One dram of the iodipin and 20 minims each of the other three. If the mixture is made by shaking by hand, it is advisable to thoroly shake together the iodipin and cacodylate first, then add the cinnamate of sodium and finally the arseniate of iron. The reason for mixing in this order is simply that it saves a great deal of shaking. If the mixing is done by machinery, all the ingredients can be put in together. These proportions may be taken as a standard, but we are accustomed to vary

them materially in some cases. This is a matter more of experience than anything else; it is difficult to give even general directions, but it may be taken as a general rule that in all abdominal cases the amount of arsenic should be lessened and in uterin ones increased.

The dose varies also. Some patients appear to do well with 5 c. c. of the emulsion given every second day or even every day, while it seems to be advisable with others not to give more than 2 or 3 c. c. This is also very much a matter of experience. One indication of the strength of the dose is to be found in the immediate effect of the injection. If the patient feels sick at once, it is probable that the dose is too large, and we are accustomed to reduce it to the point which will avoid this feeling of nausea. Sooner or later a more or less strong odor of garlic will be noticed in the breath; in some, it is very noticeable, and as a rule the odor does not appear in the early stages of the treatment, and only when the disease has begun to improve. We hoped that some indication would be obtained from this sign; for if the injection is used in a non-malignant case, the odor is strongly noticeable after the first injection. This we discovered in the experiments on ourselves. Like everything else connected with the disease, the appearance of the odor is not to be depended on, as occasionally, tho rarely, it appears at the beginning of the treatment of a case of undoubted cancer.

With the exception of the feeling of nausea if the dose is too large, and the odor of garlic in the breath, the injections should not have any disagreeable effects.

Any serum syringe can be used. We have found Record's as convenient as the all glass, and while it can be kept clean as easily, it is not nearly so liable to break, and this is a consideration in several ways. Another objection to the glass is that spicules of glass are apt to crack off from the end of the piston, and, passing in with the injection, set up irritation and lead to the formation of an abscess. The needle should be kept very sharp, as it makes a great difference to the patient; it should also be put in quickly. It may seem unnecessary to go into such trifles, but it is really wonderful what a fuss can be made over a little matter like this of an injection. When they are being repeated often, little details are worth attending to.

Thoro bathing with very hot water after an injection helps to prevent bruising and keeps the parts soft; or a good liniment may be rubbed in. The injections are to be made subcutaneously, not into the muscle, as with the arseniate of iron alone. The most convenient place, as a rule, is the outer part of the upper arm; next in order come the buttocks, abdominal wall, and outer parts of the thighs. But the best plan is to try to find the part which gives the least trouble.

X-Ray Treatment of Cancer.

In a "Textbook of Radiology" Dr. E. R. Morton* says that as to the x-ray treatment of carcinoma it cannot be too strongly insisted upon that every operable case should be operated upon at the earliest possible moment. As soon afterward as practicable thoro x-ray treatment of the whole area should be started and twelve doses given as *Publisht by E. B. Treat & Co., New York, N. Y., 1915. Price, $3.

follows: The tube should be from 9 to 10 Wehnelt, and a filter of 1 mm. of aluminum interposed; 0.75 of a pastille dose is given twice weekly up to a maximum of twelve doses, or until a slight degree of hyperemia shows itself. The skin may become "tanned" (see our editorial on "Actinotherapy," in June WORLD, page 206), but at the first sign of reaction the treatment must be stopped for a week or two. If the condition of the patient and other circumstances permit there is no reason to delay the commencement of the treatment more than two or three days after the operation, and in treating cases of this kind we should not attempt to confine the rays accurately to the site of the operation, but allow as much as possible of the surrounding area to come under the influence of the irradiation.

After three months' interval, if all goes well, a further six applications are to be given, and again after a six months' interval. If this procedure were carried out for two years in all cases, we should hear less of recurrences.

The great trouble is that post-operative treatment is not begun soon enough in a large proportion of cases, and in many of them deep extension has commenced, making all efforts to prolong life practically futile. There is not the least doubt that immediate post-operative x-ray treatment in carcinoma cases does definitely increase the patient's chance of making a complete recovery, and delay in applying this method not infrequently means that we are throwing away a victim's one chance of escape.

In no class of case is it more difficult to lay down definite rules for treatment; every case must be dealt with according to the conditions present. In most instances, the treatment will be more vigorous than stated above. Full or even double pastille doses three times a week may be necessary for a time so as to produce a profound impression on the growth more or less quickly. If there seems to be deep extension, this is all the more necessary, but here we must use a thicker filter-say 2 mm. of aluminum. The risk of dermatitis is very small when using such thick filter, but as we are giving massive doses we must act with all caution and discretion. On the other hand, only massive doses will be of any avail in a serious case, and we have to remember that if let alone the patient's life comes to an end in a short time; so that while we must not do anything to add to his sufferings thru x-ray dermatitis, we are justified in doing anything short of this that gives him a chance of escape or even an extension of comparatively comfortable existence.

Mercuric Cataphoresis in Treatment of
Cancer.

The following description of the technic is taken from "Medical Electricity and Roentgen Rays," by Dr. Sinclair Tousey*:

The term is usually applied to the method introduced by Massey. Extremely heavy currents of about 100 ma. or more are applied from the active positive electrode, consisting of sharp pieces of zinc amalgamated with mercury, thrust into the tissues while the patient lies upon a

Second edition, publisht by W. B. Saunders Company, Philadelphia, Pa., 1915. 1219 pages. Price, $7.50, net.

large indifferent negative electrode. A general anesthetic is required. There is coagulation necrosis or acid necrosis of the tissues for almost 1⁄2 inch around each metal point connected with the positive pole, and the portion of tissue thus destroyed dries up, and, eventually, after one or more weeks, separates, leaving a granulating surface. The

Correct technic is extremely important. indifferent negative electrode had better be a pad of kaolin laid over a smaller sheet of metal, which it more than covers. Any small area of metallic contact or markedly greater conductivity would permit a more concentrated flow of the current, and produce, at the indifferent electrode, a negative burn, which is characterized by alkali necrosis or colliquative necrosis-a moist gangrenous process like that produced by the action of a caustic alkali. The patient is under the influence of an anesthetic, and so cannot give warning of the occurrence of a burn. The positive wire may be divided into about five strands, and it is best for the zinc points (pieces of sheet zinc, such as signs are painted on, about 1/4 of an inch wide at the base, about 3 inches long, and tapering to a very sharp point) to be soldered to the copper wires. If this is inconvenient, they may be bent around the wire and securely pinched. The points are galvanized by dipping them first in dilute acid and then in metallic mercury. The first point should be introduced before the current is turned on, and a rheostat should be used to very gradually increase the strength of the current from zero to 30 or 40 ma. Then another point is gradually introduced, and it will be found that the milliampere-meter registers an increased current, due to the larger area of contact. Other points are introduced so as to transfix the tissues all around, and, if practicable, beneath the growth. The current may then be found to be 50 or 60 ma., the increased area of contact at the metal points having greatly reduced the resistance at the positive pole, while the resistance at the negative pole has not been changed. Additional current is now turned on very gradually until 100 or even 200 ma. are indicated by the milliamperemeter. The flesh is seen to turn white, and a white froth exudes from the different punctures. The exact length of time that the current should be allowed to flow varies with the amount of tissue that is to be destroyed. It is usually between five and ten minutes. The current must be turned off just as gradually as it has been turned on, and the last metal point must not be removed until the current has ceased to flow. The 110-volt direct current is most suitable for the work. This may be obtained from the direct 110-volt electric light circuit, or from the alternating electric light circuit, by a rotary transformer, or a storage battery or a galvanic battery of the necessary number of cells to produce about 110 volts may be used.

This treatment has been applied to cancers of the breast and tongue, localities where turning the current on or off suddenly would cause serious shocks.

The advantages of this treatment are the freedom from hemorrhage, the complete destruction of the part to which it is applied, the presence of a sterilized and usually dry slough, which changes to a dry scab and comes away by natural processes. The disadvantages are that it does

not have a selective action upon the morbid tissue, nor one extending beyond the area actually destroyed, and that its cicatrizes are very bad compared with those left after a case has been cured by the x-ray or by surgical removal and a plastic operation.

While the method is certainly a valuable one for use in occasional special cases, it may not be unfair to characterize it in some other cases as an imperfect form of surgery. There is a question as to whether the destructive effect is at all due to the transportation of mercury into the tissues, or whether it is due altogether to the action of the electric current. The author feels that the latter is the chief factor in the case.

Books on Cancer.

The following books, bearing directly upon the principal subject treated on in this issue, will be of interest to those who wish to equip themselves with literature on this vitally important disease:

"The Conquest of Cancer," Saleeby. Publisht by F. A. Stokes Company, New York, N. Y. $1.75, net; postage, 18 cents. 361 pages. 1907.

"Cancer-Relief of Pain and Possible Cure," Skene Keith and George E. Keith. Publisht by the Macmillan Company, New York, N. Y. $1.25. 155 pages. 1908.

"Medical Electricity and Roentgen Rays," Tousey. Second edition, publisht by W. B. Saunders Company, Philadelphia, Pa. $7.50. 1,165 pages.

1915.

"A Textbook of Radiology," Morton. E. B. Treat & Co., New York, N. Y. 1915. $3. 217 pages.

"Medical and Surgical Electricity," Rockwell. E. B. Treat & Co., New York, N. Y. 1907. $5. 666 pages.

"Therapeutic Action of Light," C. E. Rodgers, Chicago, Ill. 1910. $3.50. 318 pages. Publisht by the author.

"Radium and Cancer," Wickham and Degrais. Publisht by Paul B. Hoeber, New York, N. Y. 1913. $1.25, net. 111 pages.

Gleanings from Current Literature. Which do you prefer-one idea in twenty pages, or twenty ideas in a single page?

Neural pangs subside under atropin or hyoscin. Acute myalgias respond promptly to ammonium chlorid in scruple doses every 8 hours. Many subacute pains fall before iodids. Rheumatic suffering is quelled by salicyl. Glonoin unlocks anginas; spasm relaxes under hyoscin.-WAugh, Southern Practitioner.

Wolbarst admits the value of the Wassermann test, but protests against the tendency to rely wholly on it to the neglect of clinical evidence.Am. Jour. Urol.

The development of an acute traumatic nephritis following a shock is incontestable. Manual exploration of the kidney may cause the appearance in the urin of all the elements found in this malady.-PouSSON, Am. Jour. Urol.

Bovrie reports a case of unquestionable syphilis, treated with 606, which was followed by rapid development of general paresis.-Am. Jour. Urol. Chronic Gastritis: The single remedy which has exercised the most direct influence in relief and cure is hydrastis canadensis.-ELLINGWOOD.

Chronic Gastritis: For years I have prescribed berberin, with nux, xanthoxylum or capsicum, iron carbonate if anemic.-ELLINGWOOD.

In typhoid fever the life-saving power of rhus above all other remedies is many times made manifest.-N. M. DEWEES, Ellingwood's.

When quinin fails to relieve malaria it is because it is not properly given, not absorbed, not continued long enuf, or we have failed to correct something that arrests the action of this greatest of specifics.-J. H. MCCURRY, Ellingwood's.

Disease of the heart in children is much more amenable to treatment than in adults. Recovery in the early stages may always be counted upon with proper treatment.-Ellingwood's.

I failed in earlier experience to realize the importance of closed fractures with swelling of the leg even where the main artery was not completely severed.-C. H. LEMON, Wis. Med. Jour.

It is possible in simple leg fracture to have in 48 hours thru hematogenous infection a moist gangrene which with delayed amputation will invariably end in death.-LEMON, Wis. Med. Jour.

Chaney subjected many morphin habitués to immediate withdrawal and never saw dangerous symptoms develop, tho patients reach a very pitiable state.-Wis. Med. Jour.

When a patient emerges from the hyoscin treatment of morphin cure he is in an unfortunate condition and requires care for 4 to 8 weeks.-H. W. POWERS, Wis. Med. Jour.

There is no known malady that is not bettered by removing from its symptom-complex all that is due to fecal toxins in the blood.-Southern Practitioner.

By the time the Widal has satisfied us that we have to do with a typhoid fever all the practical result is to know what we might have done with benefit a week before.-Southern Practitioner.

To strap a swelled testicle use an inch-wide rubber bandage. Never apply adhesive plaster.

Orchitis subsides swiftly under applications of silver nitrate, 25 per cent.; but a cream of bismuth subnitrate and water does about as well and doesn't make the skin sore.

Extragenital syphilitic infections are exceedingly more common in physicians than in any other class of individuals.-HEIDINGSFELD, Am. Jour. Urol.

Oliver says eclampsia is twice more frequent than it was 25 years ago. This he attributes to the change in our foods that has reduced the content of mineral matter, especially phosphates and lime.-Practitioner.

Scurvy and beriberi are deficiency diseases. Oliver suggests that not only eclampsia but appendicitis, duodenal ulcer and many others may be found in the same etiologic group.-Practitioner.

In a case of mental derangement due to high pressure Thomson had to give 180 drops of 10% aconite tincture with veratrum viride within 3 hours to get enuf relaxation. Markt improvement followed.-Am. Jour. Med. Sci.

There is no source of knowledge to the doctor worth nearly as much as the study of the patient. All we get from general information is general.Southern Practitioner.

It is so easy to shoot morphin in that it is apt to become a habit to pull out the hypo before the patient is thru the tale of woe.-Southern Practitioner.

The utero-ovarian sedatives are employed almost exclusively in shotgun prescriptions, and this has interfered with the scientific study of the single remedies.-Ellingwood's.

Clinical errors are due to ignorance, faulty judgment, obsession, failure to think anatomically (logically?), and reluctance to accept responsibility.-ABRAHAM.

A doctor, before a 40-mile ride, took a dose of macrotys; and the expected soreness did not materialize.-Ellingwood's.

However learned a man may be, he is not fully equipt as a practitioner until he is acquainted with the native plant remedies.-IRA WARREN.

Relief of any mechanical cause of constipation in an epileptic resulting in restoration of bowel function will temporarily cure the epilepsy.C. A. L. REED.

Kerr has a good word for chewing gum. It keeps the mouth clean and stimulates the flow of saliva; valuable in fevers.-N. Y. Med. Journal.

In 63% of gallstone cases there is a tender point over the interspace of the 9th, 10th or 11th ribs; and pressure on the end of the 11th rib will cause sharp pain.-Binet.

Tuberculosis: Of 373 cases, there were 142 positive x-ray diagnoses in which the sputum, if any, was negative. No case that could be classified as an early tuberculosis was found in which the x-ray report was negative.-GIFFIN AND SHELDON, Journal-Lancet.

If we are to develop a nation of physically sound men and women, more is necessary than action on the part of the public authorities.-L. K. FRANKEL, Am. Jour. Pub. Health.

Jeannette Marks says there are four million drug addicts in the United States. There is no village in which habitués cannot get from druggists all the opiates they want.-Am. Jour. Pub. Health.

Tenderness on percussion over the right kidney is especially valuable in differentiating between disease of the gall bladder, appendix and kidney; over the left, it distinguishes between kidney and pancreas disease.-MURPHY.

Disease is neither medical nor surgical, nor does it hover on the border lines; treatment has become more surgical, and the division is not scientific.-J. W. HEDDENS, Med. Herald.

There is a greater place for usefulness than ever before for the family practician, if he be at the same time a competent diagnostician.—HEDDENS, Med. Herald.

One of the most interesting and annoying things with which a surgeon has to deal is a fecal fistula. The attempt to effect a cure without opening the abdominal cavity as a rule will prove a failure.-T. E. POTTER, Medical Herald.

The Bulgarian bacillus is of benefit in cholecystitis, regulating the bowels and attenuating the action of the colon bacillus, and along with calomel in small doses followed by salines is the necessary treatment of the bowels.-CONRAD, Med. Herald.

Sinus suppuration is accompanied by blurred vision, exophthalmos, divergent strabismus and

blindness; history of severe cold, many months, headache, dizziness, local tenderness, slight fever, possibly chills.-LEONARD, Med. Herald.

With 100,000,000 population we import 400,000 lbs. opium yearly; 90% used by habitués. Italy, with 30,000,000, uses 6,000 lbs.; Austria-Hungary, with 45,000,000, uses 3,000 yearly.-JEANNETTE MARKS, Am. Jour. Pub. Health.

A number of physicians in reporting on lobelia have observed that patients who are addicted to drug habits find themselves relieved of the disease after they have taken a few hypodermics of lobelia.-Ellingwood's Therapeutist.

Avoid all criticism of colleagues in private conversation, and save critical energy for the medical society meeting.-ROBERT T. MORRIS, in Medical Council.

Some of the most obstinate cases of pruritus recti et ani, resisting all external applications, even painting with pure phenol and a 50% solution of silver nitrate, are at once relieved by a few properly performed prostatic massages. We have had several remarkable cases of this kind which we will report at a later date.-Critic and Guide.

EXAMINATION QUESTIONS.

Kentucky, December 11-13, 1913.

HYGIENE, MEDICAL JURISPRUDENCE, MENTAL AND NERVOUS DISEASES.

1. Give period of incubation for scarlet fever, mumps, and measles. 2. (a) What is uncinariasis and (b) what is the prophylaxis?

3. (a) What is meant by occupational diseases? (b) Name four of the most common kinds. (c) How may they be prevented?

4. (a) Give the diagnosis and symptomatology of herpes zoster. (b) What are the characteristics of syphilitic eruptions of the skin?

5. Under what conditions is the induction of an abortion legally justifiable?

6. (a) Define a poison and (b) name five of the most common ones.

7. (a) How would you diagnose an impacted stone in the right ureter and (b) from what other conditions is it to be differentiated?

8. What is the clinical significance of acetone and diacetic acid in the urin?

9. What is meant by (a) Babinski's sign, (b) Stellwag's sign, (c) Kernig's sign?

10. Give differential diagnosis of tuberculous meningitis.

Answers.

1. Incubation period of scarlet fever is about one day to three weeks; of mumps is about two to three weeks of measles is about ten to twelve days.

2. Uncinariasis is hookworm disease, due to ingestion of the eggs of the hookworm. Prophylaxis consists in the use of proper toilet facilities and the wearing of shoes; flies should be excluded.

3. An occupation-disease is a disease which is directly traceable to the effects of a particular trade in which a person is engaged. Caisson disease, writer's cramp, miner's nystagmus, and plumbism are occupational diseases. They can be prevented by a careful study of the etiological factors in each case, followed by removal or lessening of the harmful features.

4. Herpes zoster is characterized by the formation of groups of vesicles along the line of a cutaneous nerve (such as an intercostal nerve), and accompanied by neuralgic pains. The disease is self-limited, is generally unilateral, and seldom recurs.

Syphilitic eruptions of the skin are generally roughly symmetric, ham-colored, do not itch, may assume several different forms, and are more or less grouped.

5. Conditions that justify the induction of premature labor : (1) Certain pelvic deformities; (2) placenta previa; (3) pernicious anemia; (4) toxemia of pregnancy; (5) habitual death of a fetus toward the end of pregnancy (6) hydatidiform mole; (7) habitually large fetal head.