required. Long continued administration would induce deleterious effects in the system of the mother which would react unfavorably on the child, as noted in the children of "dope fiends," but this would not be considered in the demands of ordinary practise.

3. The wires are generally left in situ permanently unless some special indication occurs which demands their removal and a re-opening of the wound.

4. Formaldehyde, properly diluted, and mixt with glycerin, is one of the finest wet dressings for any kind of open lesion. We have induced healthy granulations with it. when we were postiv no other agent would have accomplisht the result. It is severe if applied too strong, and the strength of application must be regulated by the sensations of the patient. Begin with a I per cent, solution in water to which a little glycerin has been added, then increase or decrease as indicated. We have used it in some cases as high as 4 per cent., but few patients will tolerate this. In making solution, consider the commercial article (which contains but 40 per cent. of the gas) as full 100 per cent.

5. The papers got so "workt up" over the chloroform joke of Dr. Osler that he has been accorded a great deal of notoriety. This is to be regretted, as Dr. Osler is one of our finest men, and is irreproachable from an ethical standpoint.-ED.]

Goiter.

Editor MEDICAL WORLD:-Do you know the formula of Dr. Haig's Goiter Cure? Is it really a good preparation? Will you kindly give me the latest and most successful treatment for this disease? J. A. VIGER, M. D. St. Eugene de Grantham, Quebec, Can. [We are not familiar with the preparation named; can any of the family supply us with the formula for publication? The treatment of goiter depends upon the variety and the individual peculiarities of the patient. Your best plan will be to purchase some of the modern text-books on the practise of medicin, and follow out the line of treatment there detailed for the class of cases most closely resembling yours. It is not a wise plan to experiment with your patient without intelligent study, nor yet to depend upon any nostrum or "secret remedy." Goiter if not exophthalmic, is generally amenable to treatment to a certain degree, and the limitation of and the indi

Nevada, Mo.

W. H. WHITE, M. D. [Such a preparation would only be indicated in the most sluggish class of cases, and then only for a limited time. much too strong and irritating for the average case, and would be very apt to set up a severe dermatitis in susceptible individuals. Such preparations are used sometimes until the resulting inflammation causes the "scales" to be exfoliated, when a milder preparation is substituted.

Always repair a lacerated perineum at once; that is, within 12 hours. If left longer, union is uncertain. If repair is made immediately after completion of the third stage of labor, and any reasonable care and skill are exercised, union will occur in nearly every case. The suture is immaterial, as it is removed in about a week to 10 days; personally, we are accustomed to use heavy silk, as it is very flexible and thus conveniently introduced. Another argument for immediate repair is that no anesthetic is then necessary, as the parts are sufficiently benumbed that but little complaint is made by the woman.

No, a satisfactory examination and diagnosis cannot be made without employing an anesthetic, except in certain locations of the tumor and in those cases where it has reacht a considerable size. It is much better to use the anesthetic, and thus be prepared to make a complete and thoro examination of any tumor or abnormality that may be encountered, whatever the character or location. The fibroid may be located within the cavity of the uterus, within the walls of the uterus, or entirely outside the walls; hence several different methods of diagnosis may be required before arriving at a definit conclusion.-ED.]

[It all depends upon the size and character of the "birthmark." Certain forms are easily removed, while others are more difficult; electricity is the preferable agent in some cases, and in others caustics are to be preferred. We could not answer your question satisfactorily without knowing all the details. But, as the matter may be of sufficient general interest to warrant considerable space, we will print in another place, in the near future, the entire text along this line from a recent work on dermatology, and you may possibly find in this article the answer you desire.-ED.]

Quack Use of the Word Oxygen.

Editor MEDICAL WORLD:-Kindly inform me as to the value, therapy and professional judgment of what is known as "The Oxyoline Inhalant Method" of treating diseased conditions. It is the invention of a Dr. Neel, of Chicago, and is being used in Philadelphia and this city. It is claimed to have remarkable oxidizing properties.

Pittsburg, Pa.

W. M. HOLTZ, M.D.

[We do not know anything about any such "treatment." If this is the Dr. Neil who advertises so extensivly in the lower grades of lay papers, you can be assured that the "method" is the rankest kind of a swindle, and that all there is in the "method" is the method of separating credulous people from their cash. You know, doctor, the nature and properties of oxygen. You know, too, how to use it as well as anyone. What is there about disease processes which would lead you to think that they demand "oxidizing"? Oxygen is of very limited usefulness as a therapeutic agent, except in the form of peroxid of hydrogen. These quack schemes incorporating phraseology intended to convey the belief that oxygen is a principal constituent of their nostrums are but a shrewd bid on the gullibility of the laity, who have learned that oxygen is of considerable importance in air, water, etc., and who have by some occult process of reasoning (?) arrived at the conclusion that it must be also "great medicin." Nothing in it, doctor; read up on oxygen. There is little more oxygen in such nostrums than you can extract from reading the advertisements.-Ed.]

Santonin is of value in persistent incontinence of urin.

Possibly Some Form of Nephritis.

Editor MEDICAL WORLD:-Case brought to me a week ago; had been under the care of another physician before that. Girl, 2 years old, youngest of a family of seven unusually healthy children; parents both healthy; positivly no alcoholic nor syphilitic taint. Has had none of the acute fevers (yes, I am sure), but has always been delicate. Mother states that period of gestation and labor were normal. About 8 months ago, while playing with other children, had a hard fall and was picked up unconscious, but was apparently all right in two or three hours. Then next day they noticed a puffiness under the eyes which gradually extended until at the end of a week there was great general anasarca. A physician was called, who administered salines, and she was relieved except an ascites.

About 3 months ago the same condition_occurred again, and was relieved as before. The physician said it was "some bowel trouble" and did not examin urin.

My examination: Heart and lungs sound; no fever, no enlargement (other than considerable ascites) nor tenderness; no thirst; pronounced anemia; bowels acting regularly (as they have always done); fair appetite; sleeps well, and apparently is as well as before the fall except cannot stand as much exertion.

Urin: Was unable to ascertain amount passed in 24 hours, but mother, who is a sensible woman, says that she passed about one-third more than she should. Specific gravity 1,030, slightly acid, no sugar, color pale; when heated, albumin will settle to about one-fourth volume of urin. (Am sure it is albumin.) No microscopical examination. There have been no uremic symptoms.

This is the first case I ever reported, and no doubt have omitted some important points; but I want help. I have diagnosed the case chronic parenchymatous nephritis, but am "stumpt" on the large amount of pale urin of high specific gravity and no sugar. Have her on iron and liquid lactopeptone with small doses of cantharides. J.; Nebraska.

[Your case does not correspond in symptomatology to any of the classical forms of nephritis, yet we think it approaches acute parenchymatous nephritis more closely than it does the chronic variety. As experience widens, one learns not to confine himself too closely to the somewhat arbitrary specifications of symptomatology in kidney diseases. Again, however intelligent a mother may be, she is decidedly prone to estimate the "amount" (?) of urin voided (when no measurements have been made), by the number of urinations; thus frequent urinations will generally instigate the positiv statement to the physician that large amounts of urin are being voided.

The only proper way to get at this case is to investigate it thoroly and completely, and then to make a diagnosis on the findings. If you do this, you will not only be

able to treat the case more scientifically and with correspondingly heightened chances of success, but you will also be able to give a definit prognosis-something you can not do without a full and thoro examination of the urin. Such an examination will include an accurate knowledge of the number of ounces voided each twenty-four hours; the percentage of albumin-and this may be estimated by "bulk" as you have been doing, or by accurate percentage; a careful microscopical search for casts, and a definit knowledge of their character and approximate numbers; a decision as to whether oxylates or urates and phosfates predominate; and whether or not there is a tendency to arterial atheroma. If you are not equipt to make such examinations, you can forward the urin to any of the numerous laboratories making a specialty of such examinations. Numerous examinations, however, must be made, as no opinion of value could. be given from a single examination.

We would like to give you therapeutic suggestions for the management of the case, but you can see that it is manifestly impossible. No one, without the results of such repeated examinations, could make either a diagnosis or prognosis, much less formulate an intelligent line of therapy. Should you, after securing such data, have any doubt or difficulty in diagnosis, we will be pleased to offer suggestions; but we do not believe you will need any aid when you examin the case as we have outlined.-ED.]

A Diaphoretic Wanted.-Veratrin. Editor MEDICAL WORLD:-Some time ago I noticed in your columns a request for a good diuretic. I would like to ask you, or any of the WORLD subscribers, for a good diaphoretic; one that will produce an effectiv perspiration in a reasonably short time without depressing the heart. I wish to effect diaphoresis without use of an opium preparation (Dover's powder) or jaborandi, as I find the latter often has a bad effect on the heart when taken in sweating doses. Please also inform me where I can obtain the veratrin, gr. 1-134, mentioned in July WORLD, 1903, page 299.

According to Merck's Manual it is an eclectic drug, and from this I suppose it would differ to some extent from veratrin, which is the alkaloid used by the regular school. Seattle, Wash.

M. D. SKINNER, M. D. [The choice of diaphoretics, if opium and pilocarpin be eliminated, is narrowed down to Warburg's tincture, alcohol (particularly if ingested hot and diluted), sweet spirit of nitre, and ammonium acetate. The two latterly named are but feeble and uncertain in

action. Why not employ the pilocarpin in connection with a heart stimulant?

You can purchase granules of veratrin from any dealer in granules or tablets. If you will note dosage given in Merck's Manual for "veratrine," you will observe that the reference is to the regular drug, the correct spelling of which is veratrin, the final e being dropt. In the Merck Manual the dose of the Eclectic veratrin is given as one-eighth to one-half grain. It will probably be necessary for you to use the old style spelling-veratrine-in ordering.-ED.]

Skin Transplantation Following Cancrum Oris. Editor MEDICAL WORLD:-Please ask for a paper on skin transplantation following cancrum oris. Some one that has performed the operation successfully. G. T. T.; Texas.

[You will find a four-page discussion of the various methods and technic of meloplasty in Vol. I of von Bergmann's Surgery, publisht by Lea Brothers, Philadelphia, at $6.00; the matter is also taken up in other modern surgeries to a limited extent. Skin grafting does not come in place in such an operation except in so far as required to protect the vitality and promote the elasticity of the flap. Skin grafting is useless unless there is underlying support for the grafts, and in the case of destruction of the tissue of the cheek, the operation of meloplasty to replace that tissue is the only procedure available. Many times the replaced tissue must be reinforced by skin grafting, and for the mere technic of the grafting process we refer you to any modern surgery, but the complete operation is a very different thing. Into the consideration in this case enters the subsequent cicatricial contraction of the flap; the difficulty of obtaining suitable tissue; the provision for mucous membrane, etc.-Ed.]

Probably Rheumatism.

Editor MEDICAL WORLD:-I have a patient that bothers me, and has bothered a good many other M. D.'s in the past. A Frenchman, age about 50; farmer; has drank considerable hard cider during winter months for some years. I think he has quit it now. Liver is enlarged and tender to touch; bowels normal. Rather stout, heavy build; a little corpulent; uses tobacco; has hemorrhoids.

Trouble started some five years ago in one knee while he was picking berries; he was unable to walk for some time. Wore flannel bandages on knees until I had him leave them off. Has severe pain in spine at juncture with pelvis, also pain in hips opposit spinal pain about 4 in.

on each side. Pain in spine gets him down at times.

Thru summer had pains more or less in knees, elbows, muscles of lower parts of legs, arms, etc., which kept him from sleep occasionally.

I have had him on the usual rheumatic remedies with little avail: such as macrotys; colchicum; poke root; aspirin; Fowler's sol.; sodium salicylate, etc. I also used massage along spine and around joints, with little benefit.

Can the Editor or some of the family help me in this case? Am I right in my diagnosis (rheumatism)? Would hot air treatment benefit any? or electricity?

Beaver Creek, Ill.

F. E. BARNES, M.D.

[We should deem your diagnosis of rheumatism correct, and the presumption is strong that the habits of the patient are responsible. Order a cessation of all alcoholic drinks immediately, and place him on a diet incorporating a large amount of fruits. Have him drink considerable quantities of water, at stated intervals. Keep the bowels acting more freely than natural. Then, when these preliminaries are arranged, you may hope to derive some benefit from the very drugs you have been using. We also suggest giving him a course of potassium iodid.

The hot air treatment does not promise much in cases of this kind; it is better suited to localized areas of rheumatic trouble. We do not believe that electricity will benefit him appreciably, either. In such cases it is necessary to eliminate the retained products of faulty metabolism induced by his previous vicious habit.-Ed.]

Insomnia.

Editor MEDICAL WORLD:-Male, 65 years old, good habits all his life, uses tobacco, but not excessivly, has no pain except rheumatism in his hip and shoulder occasionally. May be perfectly free from all pain when retiring, but can't sleep. He will get what he calls "the fidgets" and can't sleep a wink. I can only make him sleep with morphin or some other preparation of opium. I do not think opiates are indicated, for the reason that pain is not the cause of his restlessness. I would like a prescription from you and others of the WORLD's family to procure sleep without opiates.

Clingman, N. C.

C. L. Cook, M.D.

[You should not give him morphin; it is not indicated, and you will most certainly be responsible for inducing the habit. Doctor, do you read the advertising pages of THE WORLD? Merck's advertise a drug which will give your patient sound and refreshing sleep, without subsequent nausea or deleterious effect, with no danger of inducing a habit, without baleful effect on any organ or function, and easy of admin

istration. We are not taking Merck's claims for this; we know from personal prescribing of the drug. It is superb where the trouble is simple insomnia, but it is useless in the presence of pain. But don't depend permanently on medicin. Get all that can be gotten out of hygienic management. A glass of hot milk before retiring will frequently cause sleep.-ED.]

Amenorrhea,

EDITORS AND BRETHREN :-What would you do for the following case? Mrs. B. H. C., age 22. Began to menstruate at II years of age. Had typhoid at 16. Married at 17; weight at this time, 130 lbs. Menstruation regular. Sexual appetite normal-perhaps more than average. Had varioloid at 18. Menstruated but once or twice after this. Supposed she was pregnant. Weight rapidly increast. Five months later, menstruated very profusely. Regular for three months, then skipt several months. Very irregalar since. Has not menstruated now for nine months. Sexual appetite absent for past two years. Dislike for intercourse. Present weight, 215 lbs. Hearty eater. Bowels regular, but rather loose. Good sleeper. Strong and energetic. Uterus is rather small and retroflext. No other trouble with sexual organs discoverable. Been examined by several doctors. Has had electrical high frequency treatments; also ergot and caulophyllin. Has dizzy spells. Feels like falling at times. Flesh feels firm, not flabby. Iowa. F. A. C.

[Considering the looseness of the stools, it is probable that the vertigo is due to gastro-intestinal indigestion. The avoirdupois may likewise be consequent upon this condition; there are certain forms of indigestion, you know, which result in the excessiv deposit of fat.

The irregularity of menstruation and the 'loss of sexual desire are doubtless due to the excessiv fat. It is quite common for fleshy women to have trouble with irregular menstruation, and to fail to experience pleasure in copulation. Consequently, to relieve her of all the symptoms, it is necessary to get rid of the excessiv flesh. This, of course, is easier advised than accomplisht, especially when you must combat a voracious appetite. Diet and exercise may work wonders in this line; but do not depend on drugs of the "anti-fat" class. If vou have no books treating on reduction of fat, you would better secure some before attempting treatment.

If the uterus is really an infantil one, intra-uterin application of electricity promises more than anything else. It would be interesting to have a further report on this case after a year or so, and especially if you