ment? About this point has hinged bitter controversy, with no definite settlement. If it is used, it is our opinion that it should be injected deeply into the muscles, in dilute solution, as in pernicious malaria. Given by mouth, it deranges digestion, and may not be absorbed.

It is certain that we have, as yet, no specific for this condition. What has proven of service in one case may not at all benefit the next case under treatment. A number of treatments have been heralded as useful, but have, in the long run, proven disappointing-an example of these is methylene blue. Quennec's chloroform treatment has advantages in the control of vomiting, increase in amount of urine, and diminishing of albuminuria. Cardamatis has secured strengthening of the pulse, and relief from vomiting, dyspnea, and precordial anxiety, as well as profuse diuresis by the use of ether-hypodermically and by the mouth. Vincent extols the use of calcium chlorid in doses of 4 to 6 grams (1 to 11⁄2 drams) by the mouth in the course of the day, or from 1 to 2 grams (15 to 30 grains), dissolved in normal salt solution, hypodermically.

Have you read the book: "Practical Study of Malaria," by Deaderick? Or, "Malaria,” by Henson?

We think you would get many hints from them.-ED.]

Phenolphthalein an Indicator of Alkalinity. EDITOR MEDICAL WORLD:-A combination of milk of magnesia and phenolphthalein gives a red reaction. What is the cause, and does it affect its action? R. B. H.

Kansas.

EDITOR MEDICAL WORLD:-The red color obtained by bringing phenolphthalein in contact with milk of magnesia is exactly what should occur.

Long years before phenolphthalein was used internally as a laxative it was, as it is now, used as an indicator for alkalin hydrates and carbonates (but not bicarbonates); consequently, when it contains magnesium hydrate Mg(OH)2, an alcomes in contact with milk of magnesia, which kalin hydrate, it should show a red color.

The combination is not injurious within the normal dosage of either or both.

It gives a red color with alkalies but is colorless in neutral or acid media.

J. C. ATTIX, M.S., M.D., P.D. 2355 N. 13th St., Philadelphia.

Identifying a Plant.

EDITOR MEDICAL WORLD:-Inclosed find a milkweed. People here use it for dysentery when nothing else will do. Kindly let me know thru THE WORLD the name of the weed. Jewell, Kan.

DR. JULIUS WESSELOWSKI.

[No botanist could identify the plant from the specimen sent. When you desire to identify any plant, it is necessary to give all the details you can regarding its habits of growth, height attained, color and appearance of bloom, character and appearance of seeds and how borne, etc. After this, it is time to prepare a specimen by taking it from the ground entire. The roots are carefully washt free of soil. If the root is not fleshy and promises to "press" well, it is not necessary to give it any further attention. But if the root is thick, it will be necessary to cut it so that the external surface will show after

pressing, and then to fully describe the size and contour of same. The entire plant is then placed between two sheets of blotting paper, on a hard and smooth surface, and weights applied for twenty-four to thirty-six hours; dry paper is then substituted without disturbing the plant itself, and this is allowed to remain under the same pressure for two or three days, when, if necessary, dry paper is again substituted. When the specimen is absolutely dry, it is carefully shifted to a sheet of cardboard, and fastened in place by a number of very narrow strips of adhesive plaster. It is now ready to submit for examination, with all the data concerning it which would help in describing it so the investigator can form a "picture" of it in his mind as you see it actually growing.

With a specimen, so prepared, any botanist can identify a plant from any section of the world, in almost every instance. Without such a specimen, and details concerning it, no botanist could venture an opinion as to the group or family to which the plant belongs, much less positively identify it.-ED.]

Purpura Hemorrhagica.

EDITOR MEDICAL WORLD:-We have often drawn on THE WORLD for advice, and would like to report the following case, and request the WORLD "family" to give us any information on it within their power.

Mrs. F., of German parentage, age 35 years. There is absolutely no history of hemophilia in her family, as far as she knows. Her mother is still living, and in good health at the age of 57. She married at the age of 20 years. Had four children, whose ages are 14, 12, 7 and 4 years. All are in good health. She never had any sickness, and was well up to the birth of her youngest child, some four years ago. When this boy was born she never ceased flowing, and after six weeks her attending physician curetted the uterus. The flow continued unabated, and removal of the body of the uterus was advised, and carried out. She continued to bleed from the vagina, and began to bleed from other organs.

The remaining portion of the uterus was then removed, but the hemorrhages continued. When the patient was first seen by us, she was bleeding from her mouth, as well as the vagina, and subsequently from the nose, eyes, ears, breasts and urethra. She had hemorrhagic patches on her extremities. All medical agents of known value in such cases were tried, but without success. As a last resort the ovaries were removed. There was a two month's respite after this operation, and we were on the point of congratulating ourselves, when the hemorrhages returned. Her present condition is as deplorable as ever. She has had hemorrhages from every orifice in the body except the rectum. In spite of all this loss of blood, she keeps up fairly well, and does her housework.

When the attacks come on, she states, she has a slight feeling of dizziness, and a creeping sensation in her limbs. The bleeding stops spontaneously after sometimes as much as a pint of blood is lost. Often we have checked it by the use of adrenalin chlorid injections. If we had not seen this case with our own eyes, we should not have believed its existence, and we presume many readers of your journal will be equally

skeptical. We have never seen or heard of anything like it, and considered it of value to be on record, as well as the fact that we would be greatly indebted to any brother who could offer any advice as to its further treatment.

DRS. M. & M. H. ROSENHEIMER.

Milwaukee, Wis.

[The case is an intensely interesting one, and we are glad to have the report. We cannot hazard a guess as to the etiologic factor influencing the onset of the hemorrhagic condition in this patient, other than to suggest the possibility of infection following the birth of the child as having deleteriously influenced the component elements of the blood in such manner as to have destroyed the natural coagulability. Injections of horse serum are in great use. Your statement that "all medical agents of known value in such cases were tried, but without success" excludes us from suggesting anything else that might have proved of service.-ED.]

Charging for Expert Opinion in Court. EDITOR MEDICAL WORLD:-In your comments on "The Doctor in Court" (September WORLD, page 361) you say: "Watch him (the attorney), and if he shoots any expert questions at you, appeal to the presiding judge as follows: 'Your Honor, I can answer that question; shall I do it? You know it is an expert question, and if I answer it, I ask you to instruct the clerk of court to enter me as an expert witness at the legal fee.'" This was done in Illinois in the well-known Dixon case. Dr. Dixon was ordered to answer by the court. He refused unless granted an expert's fee. The court held him in contempt. The case reached the supreme court. A decision sustaining the lower court was rendered.

Dr. Dixon lost his case and physicians in Illinois to-day must answer all questions and no expert fee can be claimed unless agreed upon by the parties concerned. FRANK P. NORBURY, M.D. Jacksonville, Ill.

[We are glad to have the information. We presume the "supreme court" you refer to was

the supreme court of Illinois. In Pennsylvania, it has been held according to the position we took, but we are not aware that it has ever been tested out in the higher courts of the state.

Had such a position been taken by a trial judge, with the writer on the stand, we would not have carried our opposition so far as to put ourselves in positive contempt of court, but would have answered under protest, and with notice that expert fees would be claimed. Such a position would have placed the claimant in much better standing in a suit than to go before the higher court convicted of contempt of court-and it might be that the very fact of the contempt being proved or admitted was a powerful factor in the decision as you record it. However, we are not an attorney, and will not attempt administering points of law; we speak merely from our personal observation and experiences, in none of which has a cool and capable physician been worsted by an attorney.-ED.]

Employing Cigarette Smokers.

EDITOR MEDICAL WORLD:-At a Chautauqua held here recently a lecturer, Mrs. Nannie Webb Curtis, of Texas, stated that large employers of labor, such as railroads, are rejecting applications not only of people habitually using intoxicating liquors, but also, so far as it relates to positions which might call for quick action in an emergency, applications of those using cigarettes, on the ground that those having used them long, while still quite competent to manage ordinary business, yet become unable to make a quick decision, and take quick action in a serious emergency.

This was news to me, so far as cigarettes are concerned, and I wondered how much truth there is in her statement.

I have always considered the use of tobacco more or less injurious in spite of the fact that many users do live to a good old age, in seeming good health, and would like to have the editor, or some one competent to give reliable information, give the latest and best consensus of medical opinion, with reasons therefor, on this subject. Also whether

cigarettes are more injurious than other forms of smoking, and why. I believe it is, but am not fortified with any reasons other than that I think with cigarettes so much more smoke is inhaled that there must be a much greater amount of nicotin absorption thru the mucous lining of bronchial tubes and air cells.

Whenever I warn any young cigarette user, he at once asks: "Why, then, are the doctors using them?" It seems to be a fact, according to my observation, that nearly all the younger doctors graduated for a number of years past, some of them good men and good practicians, too, are great cigarette smokers.

Please kindly tell us thru THE WORLD all you can about this subject, and so enlighten not only myself but probably many other of the older ones among your readers. W. C. QUINCY, M.D.

Lowell, Ind.

[The statement made by the lady is true in so far as the great trunk line railroads are concerned, in their employment of men, in relation to users of alcohol. Doubtless it is also true of other employers of many men for positions of trust and responsibility. Scientific tests have indubitably proven that no man can use alcohol without impairing his natural powers of perception, quickness, endurance, etc. We think she has "stretched a point" as regards cigarettes. We understand that Thomas A. Edison will not employ a cigarette smoker. There are few corporations or business houses who will tolerate cigarette smoking about their premises or by their employees while on duty. You are right in the assumption that the inhalation of the smoke from the cigarette is the cause of the more pronounced effects from use of tobacco in this form. There is a persistent belief that the tobacco or the paper used in manufactured cigarettes is "doped" with some deleterious drug, but this has never been establisht. The " aroma following the burning of a manufactured cigarette is readily recognized as foreign to the similar effect of burning tobacco on the olfactory nerves.

You can obtain much of the class of information you desire regarding the publication of data on the use of tabocco from Dr. Charles E. Slocum's book, "Tobacco and Its Deleterious Effects," publisht by The Slocum Publishing Co., Toledo, Ohio, at $1. Also from the Sunday School Times, 1031 Walnut Street, Philadelphia.-ED.]

[The "usual remedies" are bromids. If you had told us what you had given it would have simplified matters much, as we may likely take up valuable space by suggesting drugs already tried. In the vast majority of cases, it is very easy to relieve or banish the "hot flashes." The chief trouble is to get the patients to persist in medication long enough to derive any benefit. First, of course, make sure that the eliminative functions are properly performed; too many physicians absolutely neglect to make a searching inquiry in this regard, and treatment is useless without it.

A drop of aconite, hourly, till relieved, will

quiet many cases of "fidgets." If the "flushes" predominate, followed by cold, pale and clammy skin, use small doses of amyl nitrite. Cannabis indica is notably efficient in the excruciating headaches so often in evidence. Picrotoxin is a valuable remedy for the various vasomotor disturbances. For "fluttering heart," with fulness of head and hot and cold perspirations, give tincture of chlorid of iron in generous dosage three times a day. Hyoscyamus, extract of valerian, and camphor, in pill, makes a good routine combination.

Doubtless some of the above will start new lines of thought and contribute much relief to the patient.-ED.]

DEAR DR. TAYLOR:-I have had my wife in bed nine months with a compound fracture of hip and abscess of bladder, the result of a fall down stairs. I have irrigated bladder with boric, ichthyol, protargol, borax and am now using glyco-thymolin, 50%, the makers kindly sending me three bottles on describing the case. The pus still comes. am giving oil of sandalwood (santyl) internally, and alkalithia. Also triple arsenates with nuclein. I think there is sacculation of bladder and stone. Any suggestions you can give me will be greatly appreciated. Age 73. DANIEL BARCLAY, M.D. 581 Third Ave., Detroit, Mich.

I

[You can easily exclude or confirm your provisional diagnosis of stone in the bladder—even if sacculation be present-by the use of the x-ray. If your wife is unable to endure the trip to a specialist's office, no doubt you can locate a portable outfit which can be taken to her bedside. If this condition you suspect be present, why continue irrigations which cannot possibly accomplish any material benefit while the irritation by the foreign body is acting continuously? Have you thought of the origin of the pus as being elsewhere than in the bladder? If stone be present, and it can be grasped by the instrument, the crushing operation in the female is neither very severe nor notably dangerous.-ED.]

Epilepsy.-Auto-intoxication.

EDITOR MEDICAL WORLD:-I have two cases which I will report.

M. W., age 10, spasm at 4 lasting 4 hours. One month previous swallowed pin. Another spasm 3 years later. Then one year later, then 3 months, now once a month. Abscess on thigh, below groin, four months ago, almost well; constipated, appetite

good; craves tobacco; parents have been letting him have a little on the (not my) doctor's orders. Two months ago broke out all over with sores. Heart beat sitting, 102; standing, 110. When he exerts himself has weak, dizzy spells. Boy had prepuce grown fast to the frenum. I believe that enough to cause his spasms. What do you say? What is your opinion and treatment suggested by Editor or brother physician?

F., age 33. Family history good. Mother of 2 children. Has had catarrh in nose and head all her life (since a baby). Found her with temperature 101°. Sore throat, been sore several months. Appetite poor. Has what she terms cholera morbus twice a year. Bowels sometimes loose, then constipated. Has pain in bowels now, not constant, but bowels seem sore. Her throat is so sore she can scarcely swallow at present. She thinks it due to medicin a physician gave her to use in atomizer. Her weight is about 85. Did weigh 117 in May. Kidneys do not act well. Constant spitting. Sputum sent by another physician showed no tb. Gave her belladonna for checking saliva; acted well. Have her on hypophos. comp. (Fellows') as tonic. Succus alterans (McDade's) as alterative, and painted neck with iodin. Diagnosis please, and treatment. Will put her on Budwell's emulsion as soon as I can get it. Randlett, Okla.

J. D. KERNODle, M.D.

an

[It seems evident that your first case is developing epilepsy. Better immediately release the prepuce, and endeavor to ascertain if there are any other foci of continual irritation. Better positively exclude intestinal parasites, not forgetting the possibility of "seat worms.' The description is entirely insufficient upon which to base a diagnosis. It is certain that you should institute treatment by attention to digestion and absolute regulation of the bowels, with due care to appropriate diet. After this has been done, it is quite likely that he will need iodid of potassium or calcium sulfid, to clear up the depraved condition of the blood.

Your second case may quite likely be one of chronic auto-intoxication, as evidenced by the periodic attacks of diarrhea. She should be put on a formula similar to Drysdale's aperient, which will banish the irregularity of the bowels, and probably do much for the chronic catarrh. The continual use of a good atomizer, four to six times daily, containing a good bland oil in which you have dissolved 3 to 5 grains of menthol crystals to the ounce, will clear up the catarrh, in time, if there is no gross lesion of the nasal fossa to perpetuate it.-ED.]

solution in a pint of water, and place the feet in it for the interval indicated above each night before retiring. It must not be used in those cases where there has been excoriation between the toes, or your patient will curse instead of blessing you, as it would be very painful-which the potassium permanganate lotion is not.

A dusting powder may be given them to place in the socks every morning, containing a dram of salicylic acid to a couple of ounces of powdered boric acid. Socks should be changed daily until a cure is effected, and it is a good idea to have several pairs of shoes in use at one time, so as to prevent wearing the same pair on successive days.-ED.]

EDITOR MEDICAL WORLD:-Please answer thru your columns the following:

1. What is the physiologic action of chromium sulfate, and does it manifest any deleterious effect on the kidneys, heart or liver when taken for a prolonged period of time?

2. Does it possess any superior value in the treatment of neurasthenia and allied conditions? Iowa. J. B. K.

[The use of chromium sulfate is yet too new to have found its way into the textbooks. The special investigations and experiments upon which it has been so extensively employed within the last few years have been undertaken and carried out by manufacturers devoting special attention to the preparation and marketing of the drug. It is from them, therefore, that one is able to get the best and fullest reports. If you will write the Maltbie Chemical Company, Newark, N. J., we are sure they will be glad to furnish you with information upon the drug.—ED.]

EDITOR MEDICAL WORLD:-Can you tell me anything about the Hayes treatment for hay fever? I have had patients inquire about it, and doubt if it is reliable. I am inclosing a bulletin from him and stamp for reply. C. V. TYNER.

224 E. 32d St., New York City. [The Hayes remedies were described in MEDICAL WORLD for February, 1913, page 80.ED.]

Tucker's Asthma Remedy.

EDITOR MEDICAL WORLD:-I have been a subscriber to MEDICAL WORLD for some time, but to date have not noticed any comment on Dr. Nathan Tucker's asthma specific, of Mt. Gilead, Ohio. I would like very much to have your opinion on its merits and whether or not it is an ethical formula. DR. CECIL BICKLEY.

Waterloo, Iowa.

Dr. Kilmer, who graduated from "college (unnamed) with honors," and who has since perfected the marvelous "Swamp Root" for a humanity suffering from loose teeth, ingrowing nails, falling hair or appendicitis, bladder complaint or liver trouble, now has his 1916 almanac ready for distribution, which reminds us that the pure food law and the federal department of agriculture still have some work ahead of them. The fifty prosecutions and confiscations have only threatened, not obliterated, the patent nostrum business.

the University of Cornell and the office of the state chemist of the New York department of agriculture, appropriately sandwiched between grateful "testimonials" from former sufferers, who had finally been persuaded to take one-half bottle of this miracle man's product.

The letters can mean nothing to the casual or ignorant reader, or even to the intelligent who are unacquainted with the chemists' niceties. But everybody gets the impression that somehow or other they give old Doc. Kilmer the official passports. As a matter of fact the letters really say nothing more than that the mixture contains no poisons. "Swamp Root," we are told, is as harmless as pink

tea.

The letters omit to say what the mess will do for the gullibles who pay the high prices for it, tho, and as such they are distinctly unfair. Why do public agencies that have earned a reputation allow their names to be employed in such trickery? It is no defense to say that no untruth is uttered. What is left unsaid can make as dangerous a falsehood as an affirmative perversion. Whether they like it or not, or whether it was so intended, these institutions are aiding a business by allowing the continued use of these testimonials. They have said that Swamp Root does not kill. But since it doesn't cure, either, they might have said that.-Chicago Tribune, October, 1915.

Fifty Falsely Labeled Medicins,

More than half a hundred legal actions have been terminated successfully under the Sherley amendment to the Food and Drugs Act, which prohibits false and fradulent claims as to the curative or therapeutic effects of drugs or medicins. Criminal prosecutions against the manufacturers were brought in 25 cases, but in 31 instances the falsely and fraudulently labeled medicins were seized while in interstate commerce. Claims made by the manufacturers for the curative powers of these preparations ranged from tuberculosis, smallpox and diphtheria to coughs, colds and scalp diseases. A number of other criminal prosecutions and seizures are pending in various federal courts thruout the United States because of alleged violations of the Sherley amendment similar to those which have already been tried. The officials charged with the enforcement of the Food and Drugs Act are of the opinion that the evils of the patent medicin business can be stopped only by the most drastic action.

It is pointed out that traffic in medicins for which false and fraudulent claims are made is not only an economic fraud of the worst kind, in that a worthless preparation that costs but a few cents is frequently sold for a dollar or more a bottle, but that health, and even life, is endangered by failure to secure the service of a physician in such serious diseases as tuberculosis, diphtheria, pneumonia and scarlet fever until too late, because reliance may have been placed in the curative powers of some worthless preparation which is claimed to be a never-failing remedy. The deluded victim may not realize his danger until the disease has reached a stage too far advanced for even the ablest physicians to cope with it. Effective treatment depends in most cases on applying it during the early stages of the disease.

Suggestive Name of "Family Physician" Fails to Save This Preparation.

The Houchens Medicin Company of Baltimore, Md., pleaded guilty to the charge that a preparation called "Family Physician," and shipped by them into interstate commerce was falsely and fraudulently labeled. Among the many diseases for which this medicin was recommended by the manufacturers in statements appearing on the labels and accompanying circulars were diphtheria, scarlet fever, typhoid fever, smallpox, bronchitis, neuralgia, croup and all diseases of the throat and lungs.