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QUERIES AND MINOR NOTES

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					                                QUERIES AND MINOR NOTES
           The answers here published have been prepared by competent authorities. They do not, however, represent
           the opinions of any official bodies unless specifically stated in the reply. Anonymous communications and
           queries on postal cards will not be noticed. Every letter must contain the writer's name and address, but
           these will be omitted on request.


                         PETIT MAL EPILEPSY                                                           CANCER OF PROSTATE
To the Editor:\p=m-\Awhite girl, age 5 years, mental age 4 with a diagnosis    To the Editor:—What percentage of men after I he age of 50 have
  of petit mal epilepsy with cortical atrophy has no visible seizures but is                                                                     malignant
                                                                                 lesions of the prostate? What is the best advice to give patients in case
  very dependent on food and becomes weak and irritable if food is with-         of early malignancy?
                                                                                                             j M Covington, M.D., Wadesboro, N. C.
  held an hour or more past routine. Is this child in the group for which
  glutamic acid is used?                B. C. Clyne, M.D., Yale, Mich.           Answer.—The incidence of carcinoma of the prostate gland
                                                                               in   men over SO years of age has been
                                                                                                                                 variously esti¬
  Answer.\p=m-\Reasonablygood results have occasionally been                   mated, usually around IS or 16 per cent. "Early malignancy"
obtained with the use of glutamic acid in cases of the kind                    is an indefinite descriptive term. Although symptoms which
described. The child should have a psychometric examination                    lead to the discovery of prostatic carcinoma may be of recent
by a competent child psychologist before, and some six months                  origin, the disease itself may have existed for several years and
after, the beginning of the treatment. An attempt should be                    may have extended beyond the prostatic capsule. If by "early
made to give up to 30 Gm. of glutamic acid daily, either in the                malignancy" is   meant the discovery of the carcinomatous area
form of powder mixed with jams or jellies or in the form of                    in the prostate when it is still small and apparently confined to
half-gram pills, if the child can swallow them. A high protein                 the prostatic capsule, the best treatment would be extirpation
diet and the use of moderate doses of diphenylhydantoin sodium                 by radical perineal prostatectomy. It is doubtful whether any
might be helpful in preventing the irritability apparently pro¬                attempt to remove the gland should be made when the lesion
duced by lowering of the blood sugar.                                          has already extended beyond the prostatic capsule. In such
                                                                               cases the best treatment would be to limit
                                                                                                                             androgenic stimula¬
                         "GLUELIKE" STOOLS                                     tion either by administering estrogenic substances or by castra¬
To the Editor:—A man, aged 49, in excellent general health, complains          tion. The former treatment would seem to be preferable
  that at times his stools have a peculiar gluelike or "ropy" consistency,     initially and should be under the guidance of one who is familiar
  sticking to the perianal area. At other times his stools are well formed.    with administration of such drugs. If such treatment does not
  What foodstuffs should he avoid?                  M D-/ Massachusetts.       cause recession of symptoms or of the
                                                                                                                       prostatic lesion, castration
  Answer.—The       most likely cause of the stool described is                may be indicated. When the bladder becomes blocked by the
an   abnormal content of mucus. Mucus when mixed with feces                    carcinomatous prostatic tissue the obstruction is best removed
gives the stool a pasty consistency, making thorough cleaning                  by transurethral resection.
of the perianal skin time consuming. However, from the
 information submitted no definite conclusions can be drawn. It                                            STILL'S DISEASE
would be necessary to have a detailed gross and microscopic                    To the Editor:—A child aged 3'/2, has Still's disease. Would you please
description to permit a final opinion. Mucoid stools, occurring                  send literature or information available for the suggested care and treat¬
                                                                                 ment of this patient.
intermittently, may be due to intestinal parasites, bacterial                                                                         M D/ Benson¡ Ar]z
types of colitis, neurogenic disturbances of the colon or gastro¬                   Answer.—Therapy is symptomatic. During the active
intestinal allergy. The diet should be low in residue. Other                                                                                        stages
                                                                               bed          important, and measures to prevent deformity, such
                                                                                      rest is
approaches to treatment depend on a knowledge of the cause.                    as  light splints and foot pads to prevent foot drop, should be
                                                                               instituted. If any foci of infection are detected they should be
                   CATARACTS AND GLAUCOMA                                      removed. Warm, dry climate is beneficial and full, nutritious
To the Editor:—A   man 32 years of age living in California until last win¬    diet with high vitam'n content is recommended. A great variety
  ter enjoyed perfect health. At that time he had pneumonia and was in         of remedies, such as salicylates, vaccine therapy, protein therapy,
  a  hospital for several weeks.    After this illness an ophthalmologist      use of thyroid, snake venom and large amounts of vitamins A,
  found that he had glaucoma as well as senile cataracts. The man has
  been a jeweler all his life and was an expert engraver. Now his vision
                                                                               B and D, have been recommended. Occasionally splenectomy has
  Is so poor that he cannot get around alone. The doctors out there say        been followed by favorable remission of symptoms, and trans¬
  that removal of the lens would do no good and that operation would be        fusions, particularly where anemia is severe, may offer real
  impossible on account of the glaucoma. What is your opinion?                 benefit.   Physical therapy in the chronic inactive stage may be
                               H. E. Vander Bogart, M.D., Goshen, Ind.         beneficial. While the course may be protracted and the arthritis
                                                                               produce considerable crippling, ultimate recovery is the rule.
  Answer.—It is not unusual to find glaucoma and cataract in                   Recoveries usually take place without evident reason and seem¬
the same patient, and a cataract operation can be performed                    ingly quite apart from the treatment employed.
provided the glaucoma situation is controlled. It is understood,
of course, that the field of vision is not too seriously involved
as the result of the glaucoma.    The problem is handled in dif¬                               LARGE GENITALS IN AN INFANT
ferent ways, depending on the training and experience of the                   To the Editor:—A parent is concerned about a recently born infant who
                                                                                 has genitals as large as those of his 15 month old brother. Is it likely
responsible ophthalmic      surgeon.                                             that the parts will continue to develop and be proportionately larger than
                                                                                 average at maturity? If so, of what significance would it be?
        SEXUAL AGGRESSION FOLLOWING VASECTOMY                                                                                       M.D., Texas.
              am in charge of psychiatric examinations at a reformatory
To the Editor:—I
  and I have to   give an opinion in the following case. A man aged 28,             Answer.—Larger than   average  external genitals in the male
  father of four children, was sterilized at the request of the wife. He has   may be suggestive of the corticosexual or adrenogenital (andro¬
  no previous criminal record.    Even before the sutures of the vasectomy     genic) syndrome.      The other symptoms of this syndrome
  were removed, he attempted rape on a girl less than 15 years of age.         may be absent.      In the case described, the fact that the
  This assault was followed by several acts of a similar type. The subject     recently born infant has genitals as large as those of his IS
  is an extovert and has been successful as a salesman.          I would be    month old brother may indicate this syndrome. Considerable con¬
  interested to know whether cases have been published concerning acts         fusion may occur in determination of the sex of some of these
  of sexual aggression committed after vasectomy.
                               P. R. Newkirk, M.D., Sedro Woolley, Wash.       husky youngsters. At times laparotomy with gonadal biopsy is
                                                                               necessary to permit one to determine the sex, especially where
  Answer.—There is no physiologic reason why the operation                     a basic femaleness is overwhelmed by excess adrenal androgenic
of vasectomy should cause sexual excess. No cases have been                    output. One would be justified in following the development
reported which describe excessive sexual reaction following                    of this youngster. If he develops into a "child Hercules,"
vasectomy. The psychopathic traits of the man in question                      enters precocious puberty and shows acceleration of bone devel¬
doubtlessly were present before the attempted rape.                            opment, assays should show increased urinary 17-ketosteroids.



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Perirenal air injection may show adrenal hyperplasia, in                                   SPASTIC CONDITION OF LOWER LIMBS
which case surgical treatment would be indicated. This child                  To the Editor:—A man has a spastic condition of the lower limbs, due to
may, on the other hand, have normal sexual stature at ado¬                      a tuberculous abscess and scarring in the region of the left sciatic nerve,
lescence. An excellent reference is "Tumors of the Adrenal                      affecting the hip and knee. Because of drainage and lack of cooperation
Gland," by George F. Cahill and Meyer M. Melicow (/. Urol.                      I have been unable to do much in regard to extension or manipulation.
                                                                                I have hesitated to use tape because of the patient's tendency to decu-
64:1 [July] 1950).                                                              bitis ulcers. Do you think priscoline® (2-benzylimidazoline hydrochloride)
                                                                                would relax this man's muscles, help make him comfortable and thus
            COFFEE AND CIRRHOSIS OF THE LIVER                                   enable me to try extension? If so, what would the dosage be? He is
                                                                                at present taking paraaminosalicylic acid (PAS) and streptomycin, abdol
To the Editor:—I would like help in a case of liver cirrhosis believed due
                                                                                with vitamin C (vitamin A, 10.000 U. S. P. units; vitamin D, 1,000 U. S. P.
  to excessive ingestion of coffee. Since childhood the patient has had
  an average of 12 to 15, or more, cups of strong coffee a day.      She is     units; thiamine hydrochloride, 2.5 mg.; riboflavin, 2.5 mg.; pyridoxine
  now 33 years of aae.   Six years ago she weiçhed 170 pounds (77.1 Kg.);       hydrochloride, 0.5 mg.; nicotinamide, 20 mg., and ascorbic acid, 50 mg.)
                                                                                and % grain (15 mg.) of codeine according to need. Can you describe
  she now weighs 125 pounds (56.7 Kg.) Married four years, she has a
                                                                                an extension apparatus which would be tolerated by a patient of this
  son 14 months old who is strong and healthy.      The patient's skin at
  times is icteric, with more or less gray bronzing.     The patient has        type for more than four hours at a time without the use of tape?
  never used alcoholic beverages, but she smokes cigarets almost con¬                                           Anna, G. Segler, M.D., Crown Point, Ind.
  stantly.  She stopped drinking coffee six months ago for three months,
  and her condition showed some improvement. Cessation of the diuretic           Answer.—The problem of continued traction for a patient
  effect was conspicuous. She now drinks at least two or three cups a day     who is in poor general condition and who also has ulcérations
  and suffers from myalgia and neuralgia, especially involving the right      and draining sinuses can be severe. The case discussed cer¬
  leg. She was advised by another physician to go to bed and not to stand     tainly is one in which traction would probably do more to
  at all for 10 days. After the period of bed rest, the pain in her legs      relieve this man's muscle spasm and discomfort than any medi¬
  was possibly lessened, but she was very weak.
                                                                              cation, including the antispasmodic drugs. It would serve to
                                 E. K. Loveland, M.D., Watertown, Conn.       put the muscle in spasm at rest and to immobilize the hip. Also,
  Answer.—It is unlikely that the excessive ingestion of                      it would permit ease of bed care and would accomplish much
coffee has any injurious effect whatever on the liver and almost              in preventing contracture deformities of the hip.
certainly none which would lead to cirrhosis. If coffee were                     Russell's traction with skeletal fixation rather than skin
a causative agent, certainly far more cases would have been
                                                                              traction is a most satisfactory technic. This is best carried
encountered among the great number of coffee drinkers. Spices                 out in such a case by means of a threaded wire placed through
and even tobacco have been blamed for hepatic injury, but coffee              the upper part of the tibia at the point of election posterior
has never been under suspicion. In this particular patient one                to the tibial tubercle and a second threaded wire placed through
might consider a possible nutritional basis, since many patients              the lower part of the tibia, about 2 inches (S cm.) above the
who drink great quantities of coffee and smoke constantly eat                 ankle joint. This is a balanced form of traction which is com¬
                                                                              fortable. The threaded wires in such a case seem preferable,
poorly and often have a highly selective diet. On this basis                  as they do not have the tendency to slide back and forth in
one mi<rht also consider the neuritic pains and weakness of the
                                                                              the bone as the smooth Kirschner wire and Steinman pin tend
patient's extremities as being due to a nutritional variety of                to do. Usually, a 4 or S pound weight attached to this traction
polyneuritis.                                                                 is sufficient.
   It is difficult to suggest treatment and prognosis without
more   knowledge about the patient, especially in regard to the                                   DERMATITIS FROM JEWELRY
size of the liver, the depth of jaundice and the results of                   To the Editor:—A pruritic eczematoid eruption developed beneath a plati¬
hepatic function studies. If the cirrhosis is on a purelv nutri¬                num ring one year ago in a woman aged 23.         This has spread slowly
tional basis, the outlook may be fairly good, provided the                      to the contiguous portions of the adjoining fingers. Wearing a ring of
                                                                                either platinum, gold or silver causes a flare-up. An exacerbation was
patient can be induced to eat a full diet and maintain an ade¬                  also produced by the application of a cream containing zinc oxide.
quate protein and vitamin intake. However, if the cirrhosis is                  A similar reaction, due to a gold ring, occurred on the opposite hand
on the basis of a former infectious henatitis, as the patient's                 two years bsfore and was treated successfully with small doses of
age suggests, the ultimate outlook is rather poor. No treatment                 roentgen rays. However, occasional itching is noted on this hand when
                                                                                the condition on the other hand flares up. Jewelry can be worn in other
seems to have any particular effect on the course of the                        locations without reaction. Can you suggest therapy?
chronic type of liver atrophy which follows henatitis. Inci¬
                                                                                                                               M.D., Pennsylvania.
dentally, the peripheral neuritis in this case may respond to
the above treatment even if the liver condition does not materi¬                  Answer.—Dermatitis caused by jewelry is usually due to
ally improve.                                                                  collections of sensitizing agents under the rings, alloys in the
                                                                              metal or friction from tight rings. In this case there is a
            INTRAVENOUS ETHER CONTRAINDICATED                                 strong possibility that the metals of the rings themselves are not
                                                                              the sensitizing agents, since these precious metals contain dif¬
To the Editor:—Do you advocate th? intravenous use of ether for cardiac       ferent alloys and since jewelry can be worn elsewhere without
  patients with atherosclerosis. Cardiologists in the Philadelphia area do
  not accept this therapy.                                                     reaction. Dermatitis produced beneath rings, especially those
                                Joseph L Barthold, M.D., Norristown,  Pa.     with stones with openings under them, is frequently due
   Answer.—Of the few published reports, none has recom¬                      to the collection of creams, soaps, cleansing materials and other
mended this drug for "cardiac patients with atherosclerosis,"                  sensitizing substances that get* under the rings and are in
i. e., coronary artery disease. Even the most enthusiastic advo¬               direct contact with the skin for long periods of time. The
cates of this therapy for peripheral vascular disease acknowl¬                alloys used in the metals might be the cause. Nickel is a com¬
                                                                               mon sensitizer and is used in white gold.      Most patients who
edge that favorable results are temporary and not uniformly                    exhibit a hypersensitivity to one substance will be found to
obtained. No definitive rationale has been indicated, and the
mechanism of action is unknown. Moreover, experience with                      react to other substances in a similar manner. The fact that
this mode of therapy has shown that it is not without dangers.                a person does not react to jewelry worn elsewhere may be due
Fatalities have occurred, attributable to shock or fat embolism               to local sensitization, which may result from (1) the allergen
(/. A. M. A. 136:827 [March 20] 1948). In view of these                       being in close contact with the skin, (2) the hands being fre¬
facts, the use of this drug in the treatment of coronary athero¬              quently wet from perspiration, (3) contact with soap, water,
sclerosis would appear to be dangerous and contraindicated.                   creams and other moist substances or (4) a local sensitization
                                                                              of unknown cause. The itching of the opposite hand can be
                   PROLAPSE OF THE ADNEXA                                      explained by "fBcal flare" as shown in patch tests. The best
To the Editor:—In the treatment of ovarian prolapse has a Baldy-Webster
                                                                               therapy for contact dermatitis is to remove the sensitizing
  type of suspension been described, and has successful use been reported?     agent or agents. In this case it is suggested that the rings
                                                                               be left off for several weeks. Local therapy depends on the
                                                        M.D., California.      stage of the dermatitis. If it is an acute eczematous derma¬
   Answer.—Uncomplicated prolapse of the adnexa need not                      titis, ice cold compresses of 1 : 20 aluminum acetate solution are
be treated by surgery. Prolapse of the adnexa is often asso¬                  helpful. As soon as the acuteness subsides, one may use a mild
ciated with retrodisplacement of the uterus, but uterine                      emollient and small fractional doses of roentgen rays. After
suspensions are rarely indicated under these conditions. Simple               the dermatitis subsides, one may make a patch test with nickel
postural exercises usually suffice to keep these pelvic structures            or with the scrapings from the rings to ascertain whether the
mobile and symptomless.                                                       patient is allergic to any of the alloys in the metals. If the
   The Baldy-Webster operation will provide some suspension                   result of the patch test is positive, it can be assumed that one
of the adnexa if it is effective in maintaining the uterus in an              or more of the alloys is the sensitizing
                                                                                                                           agent; if negative, in
anterior position. Often there are recurrences of the retro-                  order to rule out a local sensitivity it is best for the patient
displacement after this procedure.                                            to wear one ring for a week at a time to ascertain which one




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contains the sensitizing alloy. She should be careful to remove                        not of significance, since they reside there as saprophytes in
the ring whenever she washes her hands or uses creams and                              about IS per cent of normal persons. If the mucous membrane
cleansing agents. Before the ring is put on, the hands should                          of the respiratory tract or the tissue of the lung is injured by
be thoroughly washed and dried. This will also eliminate the                           other cause, Monilia may multiply greatly and become invasive.
other sensitizing substances which may be accumulated under                            In the case cited, search should be made for some underlying
the ring.                                                                              cause such as tuberculosis, bronchiectasis, foreign body in the
                           ASTIGMATISM                                                 lung or other chronic or debilitating condition, which if found
To the Editor:—Will anything other than the wearing of glasses correct                 should be treated first. There is no satisfactory treatment
 astigmatism? A boy aged 10 years complains of headaches when studying                 otherwise for moniliasis.
 or viewing motion pictures, burning and itching of the eyes and occa¬                   No reports of the use of undecylenic acid for moniliasis have
 sional spots before the eyes. The conjunctivas are usually injected.
                                                                                       come to our attention, nor has information concerning an oral
 There are times when viewing a film causes no symptoms. Examination
 when he was 5, 7 and 10 years of age by three different oph halmologists              preparation of caprylic acid. It is doubtful whether either agent
 revealed a short eyeball and slight hyperopia. All three said that this               would aid in the treatment of moniliasis.
 condition would correct itself. One physician said that the boy had mild
 astigmatism which would require corrective lenses for the rest of his                                SHRINKAGE OF REMOVED ORGANS
 life. Physical examination otherwise reveals essentially normal conditions.           To the Editor:—When a uterus is removed for fibroids, is it any smaller
                                                         M.D., New York.                 after being removed from the body? Our pathologist tells us that he
                                                                                         has measured organs by the volumetric amount of water which they
   Answer.—There is no practical form of therapy for mild
                                                                                         displace, and that there is no shrinkage when they are placed In a
astigmatism except glasses. Severe forms can be cared for                                fixative. My feeling is that, if the organ were placed in a fixative
by the use of contact lenses. Nature, however, comes to the                              directly when removed from the body, there would be minimum shrink¬
rescue in many instances, for the headache and other symptoms                            age, but if, as so often happens, it lies in a basin for an hour or so,
gradually disappear during the developmental years in which                              there must be some decrease in size. Would it not be almost impos¬
                                                                                         sible to compare accurately the organ in vivo and in vitro, since some
hyperopia and astigmatism frequently decrease as the eye                                 blood and fluid is necessarily lost during removal?
grows and its anomalous refraction changes to a degree
                                                                                                           James H. Watt, M.D., Manhasset, Long Island, N. Y.
approaching emmetropia or goes to a myopic form, when head¬
ache is rare. The years of greatest change are 8 to 12. If the                           Answer.—There are so many variants in the shrinkage of
glasses relieve the headache they should be worn : if they do                          organs, depending on room temperature and rapidity of drying,
not, they need not be worn. The glasses themselves do not                              that exact information is difficult to obtain. In general, there
change the refraction.                                                                 should be constant shrinkage of organs exposed to the air for
                                                                                       some time before fixation.   Its degree is difficult to estimate.
               PENICILLIN, BUTTERMILK AND CHEESE                                       Fixatives are of greater importance in this respect. Fixation
To the Editor:—A local dairyman asked me how to neutralize the effect
                                                                                       is particularly likely to produce decided contraction in the organ
  of penicillin on milk.     He states that milk from cows treated with                or tissue placed directly in strong alcohol.
  penicillin cannot be used for the production of cheese or buttermilk. He
  thinks that the penicillin inhibits the action of the bacteria used to sour
  the milk. Any information you can supply will be appreciated.
                                                                                                             DIET AND RENAL COLIC
                                                                                       To the Editor:—Kindly indicate the proper diet and medication to prevent
                               William H. Kauffman, M.D., Willard, Ohio.                 formation of new stones in a 45 year old farmer who a few weeks
                                                                                                                                                              ago
  Answer.—When cows are being treated with penicillin they                               had his only attack of right renal colic and passed a small calcium
have infection. When the udder is infected and penicillin is                             oxalate stone.   Intravenous pyelogram, results of urinalysis, including
                                                                                         examination for sediment, and calcium level in blood were normal after
used, there will be an inhibition of growth and destruction of                           the colic
bacteria that are necessary for cheese production. There is no                                                                                   M.D.,
                                                                                                                                                     New       York.
way of neutralizing the effect of penicillin on milk. Experi¬                            Answer.—The diet should be low in calcium (avoid milk
ments might be carried out with penicillinase, but this would be                       and cheese) as well as in oxalate-rich foods (rhubarb, spinach,
a major research project.                                                              chocolate or cocoa, figs, beets, plums, tomatoes, potatoes). The
                                                                                       urine should be kept acid by means of acid sodium phosphate
                           BIOPSY OF CERVIX                                            and diluted by increased fluid intake.
To the Editor:—Does the    Gusberg endocervical curet      enable    one   to obtain
  a   complete biopsy specimen of   squamous columnar cervical tissue?                              CHRONIC FOLLICULAR CONJUNCTIVITIS
                                    J. J.   Simon, M.D.,   Castro   Valley,   Calif.   To the Editor:—A patient presents the clinical picture of chronic follicular
   Answer.—The Gusberg special coning biopsy curet has                                   conjunctivitis with no inflammatory component. I would like to know
                                                                                         what the most specific treatment of this disorder is and the prognosis
distal and proximal cutting cups which enable one to obtain                              after treatment.
all the tissue necessary for examination of early carcinoma of                                                                                  M D., Arkansas.
the cervix. The biopsy curet serves as a useful corollary to                             Answer.—True chronic follicular conjunctivitis has little
the vaginal smear technic and could make such detection studies                        conjunctival discharge, and the symptoms are rather minimal.
 available to pathology laboratories that are not set up for                           There is, indeed, no inflammatory component. The disease runs
cytologie diagnosis.                                                                   a chronic, relatively asymptomatic course and usually heals
                                                                                       spontaneously in from one to three years. Local treatment has
          STREPTOMYCIN, AUREOMYCIN AND THE LIVER                                       proved ineffective. Some improvement has been noted follow¬
To the Editor:—Can   large doses of streptomycin   or   aureomycin cause swelling      ing" mechanical expression of the follicles.
  of the liver?                         A|fred R Ross¡     M.D., Almond, N. Y.
   Answer.—As far         as   has been determined, neither strepto¬                              BRASS STOPCOCKS IN BLOOD TRANSFUSION
                                                                                        To the Editor:—Is there any contraindication for the         of brass stopcocks
mycin    noraureomycin produce hepatic damage, even in fatal                              in blood transfusion?
                                                                                                                                               use

doses in animals. No instances of enlargement of the liver or                                                                                          tA.D. Illinois.
other signs of hepatotoxicity have been reported clinically.                             Answer.—Theoretically, in the use of brass stopcocks in
Early, impure preparations of streptomycin were reported to                            blood transfusion there is danger of copper forming a chemical
produce mild hepatic damage in animals, but such changes have                          complex with citrate in citrated blood. Therefore, plated equip¬
not been observed with pure or crystalline preparations.                               ment (nickel or chrome) or stainless steel equipment would be
                                                                                       preferable to brass.
                       PULMONARY MONILIASIS
To the Editor:—Are there any   specific agents available for the treatment                          WATER SOFTENERS AND HYPERTENSION
  of a case of pulmonary moniliasis in a woman aged 20? What is known                   To the Editor:—I would appreciate an opinion as to whether the use of
  about the efficacy of oral undecylenic acid? Is an oral preparation of                  water softeners affects drinking water in any way that would be detri¬
  caprylic acid available, and, if so, what is the opinion regarding its                  mental to patients high blood pressure.
  effectiveness?              Richard A. Welsh, M.D., North Star, Ohio.                                                      C. T. Mason, M.D., Superior, Neb.

  Answer.—Primary pulmonary moniliasis is rare. The diag¬                               Answer.—Softened          would have no appreciable effect, one
                                                                                                                water
nosis of it should not be made unless the sputum contains a                             way or the other.   If the water is made more palatable and
great predominance of yeast bodies. In most instances a few                             therefore a liberal intake is encouraged, the use of water
Monilia cells found in the oropharynx or in oral secretions are                         softeners would be desirable.




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