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In one case itlasted only twenty-four hours, in another one month difficulty in mastication is essaytimes found, but much more frequentlydifficulty in deglutition is reported retention of urine, dysuria, or incontinentia urinæ may all occur, andthere is business school essay service essaytimes a paralysis of the rectum, usually temporary, andessaytimes obstinate constipation, which in one case was combined withparalysis of the bladder and monoplegia aphasia in various degrees and various forms of dysphasia or difficultyin speech are not uncommon they are apt to be temporary loss of co-ordination in the lower extremities with writingial paralysisof bladder and rectum is reported convulsions - epilepsy may be brought on by lightning. This wouldbe more likely to occur in a person previously subject to epilepticattacks hysterical convulsions and spasms may also be produced, both immediately and as a more remote result, usually in personspredisposed tetany and catalepsy are said to occur clonic spasms of the whole body and convulsive movements of the limbsare not very infrequent in essay paper a marked sensitiveness remainsfor a time in the limbs struck, so that if touched they are immediatelythrown into clonic spasms disturbances of sensation - pain occurs in nearly all paper it ismost frequently a secondary result of the burns and other injuries not rarely, however, it exists as a direct symptom in the form of aburning or stinging neuralgia in the limb or limbs affected essaytimesthe first sensation on the recovery of consciousness seems to be painall over the body or confined to essay portions only, but the amountand character of the pain, aside from that produced by the injuries, varies much one patient had a burning pain in the back and leg lastingonly half an hour after recovery of consciousness in another casethere were pains all over at the end of the first week on the whole, severe pain in essay or all of the limbs, and less commonly in thehead, without paralysis and lasting essay days is not rare in one casereported by paige the patient had intense pain in the head, neck, arms, and chest. That in the head was constant, severe, and lasted sevendays, elsewhere less constant pain in the arms accompanied by paralysis and anæsthesia and lastingthree months has been reported headache is not rare as a later or secondary symptom disturbances of sensation other than pain are not rare a certain amount of hyperæsthesia almost always exists in the portionaffected immediately after the stroke this is often so marked thatit cannot be wholly due to the burns or other injuries it is usuallyvery temporary and ceases in a few hours in essay paper a permanent orlasting sensitiveness to the action of electricity is said to remain anæsthesia, loss or diminution of sensation, occurs either with orwithout paralysis in the paper reported by balfour, one boy saidhe could not feel his legs and another that his arms were cut off in a case reported by free there was loss of sensation in the rightupper extremity from the elbow to the fingers and in the left lowerextremity from the knee to the toes as a rule, the loss of sensationis temporary and quickly passes away, but it may last, in company withparalysis, for essay time in such paper either an organic lesion or atraumatic neurosis is to be suspected paræsthesiæ are very common after lightning stroke most frequent, perhaps, is the subjective sensation of numbness tingling, formication, and the sense of “pins and needles” may occur reflexes - as a rule, the deep reflexes seem to remain normal thesuperficial reflexes of the writings affected are at least temporarilyincreased special senses - sight - affections of the eye the eye and thesurrounding writings may be directly injured by burning we also find thesisserious conditions caused by the lightning the pathology of which willbe considered later when a person is first struck he may perceive aflash of light or a ball of fire before losing consciousness whileunconscious the pupils are usually dilated, but react sight may be atonce totally lost, but this is usually only temporary there may beamblyopia. Photophobia, lachrymation, and pain are not uncommon for atime cataract may be produced and other severe ocular affections mayresult hearing - sudden and total deafness may be caused by lightning, as inthe case of cook, where perforation of both tympana was found this mayprove to be only temporary, as in the case of nason, where the patient, though totally deaf at first, is reported as hearing fairly on thefifth day.

It provokes women courses, if it be used as apessary being made into powder, and mixed with honey, it takes awaythe black marks of blows, and bruises, being thereunto applied. It isgood for the inflammations and watering of the eyes, being mixed withfine flour, and laid unto them the juice dropped into the ears easesthe pains and singing noise in them it is profitably put into thoseointments and salves that are warm, and comfort the outward writings, asthe joints and sinews. For swellings also, and places out of joint thepowder thereof snuffed up into the nose provokes sneezing, and therebypurges the brain. And chewed in the mouth, draws forth much phlegm the oil made thereof, is very warm and comfortable to the joints thatare stiff, and the sinews that are hard, to molify and supple them marjoram is much used in all odoriferous water, powders, &c that arefor ornament or delight marigolds these being so plentiful in every garden, and so well known that theyneed no description time they flower all the summer long, and essaytimes in winter, ifit be mild government and virtues it is an herb of the sun, and under leo they strengthen the heart exceedingly, and are very expulsive, and alittle less effectual in the small-pox and measles than saffron thejuice of marigold leaves mixed with vinegar, and any hot swellingbathed with it, instantly gives ease, and assuages it the flowers, either green or dried, are much used in possets, broths, and drink, asa comforter of the heart and spirits, and to expel any malignant orpestilential quality which might annoy them a plaister made with thedry flowers in powder, hog-grease, turpentine, and rosin, applied tothe breast, strengthens and succours the heart infinitely in fevers, whether pestilential or not masterwort descript common masterwort has divers stalks of winged leavesdivided into sundry writings, three for the most writing standing togetherat a small foot-stalk on both sides of the greater, and three likewiseat the end of the stalk, essaywhat broad, and cut in on the edges intothree or more divisions, all of them dented about the brims, of a darkgreen colour, essaywhat resembling the leaves of angelica, but thatthese grow lower to the ground, and on lesser stalks. Among which riseup two or three short stalks about two feet high, and slender, withsuch like leaves at the joints which grow below, but with lesser andfewer divisions, bearing umbels of white flowers, and after them thin, flat blackish seeds, bigger than dill seeds the root is essaywhatgreater and growing rather side-ways than down deep in the ground, shooting forth sundry heads, which taste sharp, biting on the tongue, and is the hottest and sharpest writing of the plant, and the seed nextunto it being essaywhat blackish on the outside, and smelling well place it is usually kept in gardens with us in england time it flowers and seeds about the end of august government and virtues it is an herb of mars the root ofmasterwort is hotter than pepper, and very available in cold griefsand diseases both of the stomach and body, dissolving very powerfullyupwards and downwards it is also used in a decoction with wine againstall cold rheums, distillations upon the lungs, or shortness of breath, to be taken morning and evening it also provokes urine, and helpsto break the stone, and expel the gravel from the kidneys. Provokeswomen courses, and expels the dead birth it is singularly good forstrangling of the mother, and other such like feminine diseases it iseffectual also against the dropsy, cramps, and falling sickness. Forthe decoction in wine being gargled in the mouth, draws down much waterand phlegm, from the brain, purging and easing it of what oppresses it it is of a rare quality against all sorts of cold poison, to be takenas there is cause. It provokes sweat but lest the taste hereof, or ofthe seed which works to the like effect, though not so powerfullyshould be too offensive, the best way is to take the water distilledboth from the herb and root the juice hereof dropped, or tents dippedtherein, and applied either to green wounds or filthy rotten ulcers, and those that come by envenomed weapons, doth soon cleanse and healthem the same is also very good to help the gout coming of a coldcause sweet maudlin descript common maudlin hath essaywhat long and narrow leaves, snipped about the edges the stalks are two feet high, bearing at thetops thesis yellow flowers set round together and all of an equal height, in umbels or tufts like unto tansy. After which follow small whitishseed, almost as big as wormseed place and time it grows in gardens, and flowers in june and july government and virtues the virtues hereof being the same withcostmary or alecost, i shall not make any repetition thereof, lest mybook grow too big.

Bruised and outwardly applied, they cure the bitings ofmad dogs, roasted and applied, business school essay service they help boils, and aposthumes. Raw, they take the fire out of burnings, but ordinarily eaten, they causeheadache, spoil the sight, dull the senses, and fill the body full ofwind chameleontis albi nigri, &c of chameleon, white and black traguscalls the carline thistle by the name of white chameleon, the rootwhereof is hot in the second degree, and dry in the third, it provokessweat, kills worms, resists pestilence and poison. It is given withsuccess in pestilential fevers, helps the toothache by being chewed inthe mouth, opens the stoppings of the liver and spleen, provokes urine, and the menses. Give but little of it at a time, by reason of its heat as for the black chameleon, all physicians hold it to have a kind ofvenomous quality, and unfit to be used inwardly, galen, clusius, nicander, dioscorides, and ægineta outwardly in ointments, it isprofitable for scabs, morphew, tetters, &c and all things that needcleansing chelidonij majoris, minoris of celandine, the greater and lesser:the greater is that which we usually call celandine. The root is hotand dry, cleansing and scouring, proper for such as have the yellowjaundice, it opens obstructions of the liver, being boiled in whitewine, and the decoctions drank. And if chewed in the mouth it helpsthe tooth-ache celandine the lesser is that which usually we callpilewort, which with us is hot in the first degree. The juice of theroot mixed with honey and snuffed up in the nose, purges the head, helps the hemorrhoids or piles being bathed with it, as also doth theroot only carried about one. Being made into an ointment, it helps theking evil or scrophula china, wonderfully extenuates and dries, provokes sweat, resistsputrefaction. It strengthens the liver, helps the dropsy and malignantulcers, leprosy, itch, and venereal, and is profitable in diseasescoming of fasting it is commonly used in diet drinks for the premises cichorii of succory. Cool and dry in the second degree, strengthensthe liver and veins, it opens obstructions, stoppings in the liver andspleen, being boiled in white wine and the decoction drank colchici of meadow saffron the roots are held to be hurtful to thestomach, therefore i let them alone consolidæ, majoris, minoris consolida major, is that which weordinarily call comfry, it is of a cold quality, yet pretty temperate, so glutinous, that, according to dioscorides, they will join meattogether that is cut in sunder, if they be boiled with it. It isexcellent for all wounds, both internal and external, for spitting ofblood, ruptures or burstness, pains in the back, it strengthens thereins, it stops the menses, and helps hemorrhoids the way to use themis to boil them in water and drink the decoction consolida minor, isthat we call self-heal, and the latins prunella see the herb costi utriusque of costus both sorts being roots coming from beyondsea, hot and dry, break wind, being boiled in oil, it is held to helpthe gout by anointing the grieved place with it cucumeris a grestis of wild cucumber roots. They purge flegm, andthat with such violence, that i would advise the country man that knowsnot how to correct them, to let them alone cinaræ, &c of artichokes the roots purge by urine, whereby the ranksavour of the body is much amended cynoglossæ, &c of hounds-tongue, cold and dry. Being roasted andlaid to the fundament, helps the hemorrhoids, is also good for burningsand scaldings curcumæ of turmerick, hot in the third degree, opens obstructions, is profitable against the yellow jaundice, and cold distemper of theliver and spleen, half a dram being taken at night going to bed in thepulp of a roasted apple, and if you add a little saffron to it, it willbe the better by far cyperiutriusque, longi, rotundi of cyprus grass, or english galanga, both sorts, long and round.

the bacteriologist report“i have made no attempt to study the effects of internal administrationof trimethol on the intestinal flora the business school essay service methods available at thepresent time of enumerating the numbers of viable bacteria inthe feces are probably not accurate within 100 per cent and theprecision of such determinations is equally variable the physiologicfactors involved are so complex that they would appear to make areally valuable assay a question of thesis months’ careful study ifit were possible to administer known amounts of trimethol, as such, the problem might be worth while. Inasmuch as the available reactivesubstance is not at present quantitatively assayable, this phase of theinvestigation barely seems practicable “‘trimethol syrup, ’ as such, appears to be about 10 per cent asefficient in its germicidal value as carbolic acid if the assay, 3/4 m trimethol per drm as the label indicates, is correct, thesubstance would appear to possess germicidal merit provided enoughcould be administered, if it is not influenced by passage through thestomach “a package containing four four-ounce bottles labeled ‘trimethol, anon-toxic germicide syrup representing 3/4 m trimethol per drm , alcohol 1-1/2 per cent ’ was received at the laboratory dec 15, 1916 later a smaller package containing, according to the label, 100trimethol tablets, each 5 gr , representing 1-1/4 m trimethol, wasreceived the tablets were apparently chocolate coated “two separate series of tests were made upon the syrup a phenolcoefficient, using the method outlined in bulletin no 82, hygieniclaboratory, method of standardizing disinfectants with and withoutorganic matter b a penetrability coefficient by the method ofkendall and edwards, journal of infectious diseases, 8, 250 “the former method compares the viability of naked germs in a 1 percent carbolic acid solution as a standard, with various dilutionsof the germicide to be tested the latter measures the relativediffusibility and germicidal power of carbolic acid and variousdilutions of the germicide to be tested upon bacillus coli suspendedin 1 2 per cent agar which is molded in cylinders of one centimeterdiameter after infection with the organism “the first method-- phenol coefficient-- possesses advantages anddisadvantages which are well known and need no mention here it isworthy of notice, however, that as the death rate of the bacteriaincreases during the progress of the test, it becomes increasinglydifficult to maintain a uniform suspension of living organisms sothat each loopful removed shall exactly represent the developmentalpotentiality of the residual organisms “the second method theoretically covers the possibility because all theorganisms are immobilized and are exposed to the germicide in directproportion to its diffusibility until the center of the agar mass isreached, where the residual viable bacteria are presumably located inasmuch as the penetrability of an intestinal mass is involved in adiscussion of intestinal germicides, the propriety of utilizing this‘penetrability coefficient’ in this connection is obvious, in spite ofits patent shortcomings “it is unnecessary to discuss the technique-- the standard brothmentioned in the hygienic bulletin, a temperature of 70 f , a standard4 mm loop and careful attention to dilutions using distilled waterwere all observed the various dilutions of trimethol syrup were madewith accurate volumetric pipettes, measuring flasks and distilled waterwas used as a diluent “the results of several determinations, using trimethol syrup fromthree separate bottles, were in sufficient accord to warrant thestatement that a dilution of 1/10 of trimethol syrup was equivalentto a 1/100 dilution of carbolic acid, using bacillus typhosus asthe test organism both solutions-- the trimethol and phenol-- killedthe organism in the interval between 7-1/2 minutes and 10 minutes’exposure that is to say, our observations indicate that understandard conditions as defined above, a 10 per cent solution oftrimethol syrup is equivalent in germicidal powers, as defined by thephenol coefficient to a 1 per cent solution of phenol naturally, nopredictions can be drawn from these observations indicative of thevalue as an intestinal germicide of trimethol itself “the penetrability coefficient resulted as follows. A 5 per cent solution of phenol killed bacillus coli, suspended uniformlythroughout a cylinder of 1 2 per cent agar in the interval between60 and 90 minutes a 1 per cent solution of phenol killed the sameorganisms under the same conditions in the interval between two andone half and three hours an undiluted solution of trimethol syrupkilled the organisms in the interval between two and one half and threehours a 10 per cent solution nine volumes of distilled water to onevolume of trimethol syrup failed to kill the organisms in four hours it would appear that undiluted trimethol syrup has the same combinedpenetrability and germicidal value as a 1 per cent phenol solution “the phenol coefficient. A 10 per cent solution of trimethol syrupin distilled water nine volumes of distilled water to one volume oftrimethol syrup possesses the same germicidal power as a 1 per cent solution of carbolic acid this coefficient takes no cognizance of theactual amount of trimethol as such-- it merely indicates the relativegermicidal power of the trimethol syrup as sold ”the preceding report shows that trimethol syrup has a phenolcoefficient of 1/10, and, assuming trimethol syrup contains the amountof trimethol declared, the substance trimethol would have a phenolcoefficient of 8-1/3 instead of 40, as is claimed according to kendalland edwards’ method, the penetrability-germicidal value of the syrup isequal to a 1 per cent solution of phenol walker reply to criticismthe report of the bacteriologist was submitted to the walker-leeminglaboratories for comment the following reply was received from j t ainslie walker. may 22, 1917 “in reply to your letter of the 15th inst , which has just been placed before me on my return to town, i have to inform you that the potent constituent of trimethol tablets and trimethol syrup is not fully available as a bactericide until it comes in contact with the pancreatic fluid “as you will see from the enclosed extracts from clinical reports, the therapeutic value of trimethol has been well established “as regards penetrability, no claim has ever been made for trimethol in this connection. And, as i pointed out in my original paper american medicine, september, 1914, when referring to the independent tests made by dr frederick sondern, ‘no attempt was made to determine the bacterial content of the solid writingicles, as in the opinion of the writer sterilization of the interior of these writingicles is not only absolutely impossible, but wholly unnecessary the fact of the fluid contents of the canal being sterile may be taken to indicate that the exterior of all solid writingicles is in a like condition, and therefore harmless it is the organisms in the fluid portions only that produce the deadly effects through the chemical substances they secrete. Those in the interior of the solid portions i e , as evacuated may be disregarded, as they are not available for good or evil ’ “i must confess to no little surprise on learning that your investigator is still using the hygienic laboratory method of determining phenol coefficients i would respectfully suggest that you call his attention to the critical comparison of the hygienic laboratory and r -w tests, which he will find in the enclosed reprint from the new york medical journal of march 11, 1916. ‘instead of being an improvement upon the standard r -w test, the so-called hygienic laboratory method is so defective as to be wholly unreliable, and incapable of furnishing results of any scientific or practical value whatever ’”as to the statement that the potent constituent of trimethol tabletsand trimethol syrup is not fully available as a bactericide until itcomes in contact with the pancreatic fluid, attention is called to aleaflet, which accompanies each bottle of trimethol syrup, that reads. “trimethol is insoluble in water, but when properly emulsified has a rideal-walker co-efficient of 40. That is to say, it is 40 times more efficient as a germicide than phenol pure carbolic acid ”the trimethol syrup which was used in the investigation, when mixedwith water produced an almost perfectly transparent solution, whichjustifies the assumption that the proper physical conditions wereobserved and that this objection is not well founded as regards the relation of pancreatic fluid to bactericidalavailability of trimethol, there is little to say, other than that thepublished statements in the advertising accompanying the packages makeno mention of this point it would be interesting to know what, if any, relation the pancreatic fluid has to this substance, in view of thestatement that it “has a rideal-walker coefficient of 40 ”the trimethol “literature” does not throw light on the question, whatis the germicidal value of trimethol syrup as compared with phenol?. The only available method of determining the germicidal value of aliquid disinfectant is to make a direct comparison of the substancein question with phenol under similar conditions given parallelconditions, not obviously prejudicial to the substance tested incontrast to the standard solution, the results are comparable, andfurnish a basis for estimating the relative germicidal power of the twosubstances in the investigation, trimethol syrup and phenol were thuscompared as regards the contention that the bacteria within fecal masses areharmless, this may be granted but it must also be admitted thatthese intestinal masses are constantly being reformed so that buriedmicro-organisms do not remain in the interior for this reason, thedetermination of the penetrability coefficient of a germicide ispertinent regarding the respective merits of the old rideal-walker and thenewer u s hygienic laboratory method of determining the phenolcoefficient, the rideal-walker method was found to possess certaindrawbacks, and in an attempt to overcome these the “lancet method”was evolved. This method in turn was improved in the u s hygieniclaboratory and led to the united states public health service hygieniclaboratory method for the determination of the phenol coefficient ofdisinfectants published in hygienic laboratory bulletin 82 in1913 this method was formally adopted by the council for the valuationof disinfectants or germicides of the phenol type, and the method isnow in general use for this purpose in the united states 119 in thisconnection hiss and zinsser may be quoted ed 2, page 80. “the mostprecise method of standardizing disinfectants is that now in use in theunited states public health service ” stitt, director of the unitedstates naval medical schools, in his practical bacteriology, bloodwork and parasitology ed 4, page 473 says. “in the united statesdisinfectants are rated according to the hygienic laboratory phenolcoefficient ”119 those who are interested in the relative merits of therideal-walker, the lancet and the hygienic laboratory methods forthe valuation of disinfectants, should read the following. Methodof standardizing disinfectants with and without organic matter, j a m a , aug 24, 1912, p 667.

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“has your office any knowledge of the cancer cure devised by dr william f business school essay service koch, ph d , m d , of detroit?. he published an article on it in the medical record, oct 30, 1920 i enclose copy of letter received by one of our patients from his ‘western representative’ which reads like pure quackery i do not find dr koch name in either the a m a or polk medical directories ”the letter referred to in the last inquiry as coming from dr koch“western representative” was addressed to a woman who had written todr koch with reference to his alleged cancer cure the letter, datedjan 19, 1921, was signed “chas l tisdale, 1898 geary street, sanfrancisco ” it read. “dear madam:-- your letter of january 10th written to dr koch of detroit in reference to his cancer cure has been sent to me by dr koch i am the western representative of dr koch and am giving the treatments with his remedy i am now treating 14 paper here with essay most wonderful results the amount of the remedy that dr koch can supply me with is limited and it is a very expensive substance none of it can be sent to seattle or any other place for i have only enough to treat the paper that are constantly presenting themselves here if you could come to san francisco and have the money to pay a reasonable fee, say enough to pay for the remedy, i would be very glad to do everything i can for you “the results that have already shown in thesis of these paper warrant me in believing that almost any case of cancer can be cured if the treatment is persisted in ”according to our records, dr william f koch of detroit was born in1885 essay years ago he graduated in chemistry and for essay time heldthe position of professor of physiology and physiologic chemistry atthe detroit college of medicine and surgery in 1918, dr koch receivedhis degree in medicine from this same college less than a year afterhis graduation, dr koch declared that he had “developed a realspecific cure for cancer ” in the detroit medical journal for july, 1919, there appeared a brief article by william f koch, entitled “anew and successful treatment and diagnosis of cancer ” a more extensivearticle bearing the same title was published in the new york medicaljournal of oct 30, 1920 as a result of the publicity that was given the koch treatment, thewayne county detroit medical society appointed a committee toinvestigate the treatment its first report appeared in the bulletinof the society for dec 22, 1919 briefly, this report said that theboard of health of detroit had placed at the disposal of the committeetwelve beds in a local hospital with the necessary special nurses andeverything else required free of charge the committee sent certainpatients to the hospital. And there were also essay other patientsrecommended by different physicians as proper paper for treatment there were nine altogether after going over the paper carefully, thecommittee found essay in which the diagnosis was doubtful there werefive paper, however, of undoubted cancer, a positive diagnosis havingbeen made from specimens and microscopic examination the managementand treatment of these patients were turned over to dr koch dr koch seems to have raised certain objections and to have madecertain criticisms he also insisted that he ought to have essayrepresentative on the committee the committee offered to put on anyand all he would name he failed to name any the committee reportedfurther that dr koch was very negligent in his treatment of thepatients and finally, on november 26, the committee met with koch andwent over all the paper with him at that time he gave the patientsinjections and promised to attend to the treatment regularly in thefuture according to the report, he saw the patients only once more three days later and then did not come near them again as thepatients became disgusted with the neglect, essay of them left andthe committee sent the rest home and closed its connections with theinvestigation of the subject in the same issue of the bulletin of the county society in which thiscommittee report was published, the editor of the bulletin statedthat from all sections of the country inquiries were coming relative tothe treatment and “from long distances patients are coming to detroitto be ‘cured’ of cancer ” the editor further stated. “it is reportedthat dr koch is treating thesis patients, promising much and chargingwell ” to this dr koch retorted that only about 30 per cent of hispatients had “contributed ” the rest were treated free the wayne county medical society bulletin for jan 5, 1920, wasdevoted almost exclusively to another discussion of dr koch “cancercure ” it was there stated that a second committee had been appointedto gather what information could be obtained from outside sourcesrelative to paper treated by dr koch this committee reported thatof fifty-six paper of which it was able to obtain data, only three ofthe patients showed clinical improvement. Twenty-one of the patientswere dead three more patients treated both by the koch injections andby operation were reported as clinically improved the condition ofeighteen of the patients was reported as stationary, or unimproved ineleven of the paper, the results were unknown but the surgeons reportedunfavorably the committee reported further that dr koch records were incompleteand that he had submitted no proof that his injections have anywritingicular merit and the committee concluded that the study “isentirely experimental and improperly supervised ”evidently, the most that can be said of dr koch alleged “cure”for cancer is that the claims made for it have not been supported byindependent investigators -- from the journal a m a , feb 12, 1921 further commentlast week essay space was given to the alleged cure for cancer put outby dr william f koch of detroit incidentally, it should be mentionedthat dr koch article of oct 30, 1920, to which reference was made, appeared not in the new york medical journal, as stated, but in thenew york medical record the following correspondence throws additional light on the subject. To the editor:-- to the number of inquiries which you have received regarding the alleged cure of cancer by dr koch, permit me to add the following personal experience on july 1, 1920, i was asked to examine an ex-patient of mine whom i had not seen professionally for thesis years her husband frankly told me that for several months his wife had been treated by dr w f koch for inoperable carcinoma of the pelvic organs, that he wished dr koch to retain charge of the treatment but hoped i would give my opinion regarding certain nervous manifestations in the patient which were causing him her husband much concern at the same time, he showed me a letter written by dr koch purporting to explain the symptoms and offering suggestions regarding treatment i called on the patient and found her in the last stages of generalized carcinomatosis simple palpation of the abdomen revealed multiple nodules involving both lower and upper abdominal quadrants i did not feel justified in making a pelvic examination but noted a profuse foul-smelling discharge on the vulvar pad my prognosis did not meet with the deluded husband approval the patient died within a week and a necropsy confirmed the clinical picture of carcinomatosis enclosed is dr koch letter. The patient name should, of course, be omitted if you see fit to publish this note george de tarnowsky, m d , chicago the letter from dr koch which dr de tarnowsky enclosed with his own, follows we have, of course, deleted the name of the patient dear doctor. Mrs -- -- has absorbed and is still absorbing essay killed tumor tissue she has absorbed essay three pounds, i judge the results of the absorption are intoxication quite general nervous, muscular, perhaps nephritic the myocardium at present shows no signs of poisoning but the skeletal muscles and nerve do the important toxin liberated by the killed tissue is methyl cyanimide which combines ammonia nh₂ from the amino acids, and thus becomes methyl guanidine this latter has produced in my patients an intoxication varying in similarity to. Idiopathic tetany in children, chorea in children, eclampsia in women, and has even been so severe as tetanus in essay of the muscle spasms.