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In a list of some “Peculiarities” of Antiphlogistine, its makers give the following: “It is well to remember that Antiphlogistine stands alone as a non-toxic, non-irritating abstractor of fuid exudates in superficial affections, and is the only remedy that through an inherent bygroscopic property will relieve deep-seated congestions by inducing superficial byperæmia and that without irritation.” If you do not know Antipblogistine, see their adv. on page 13 and write for literature.

Do you want a combined faradic and galvanic battery, with diagnostic lamp? Then see the special offer made by Mr. P. G. Williams on page 10.

In ordering elastic stockings, remember the Master," made by the Pomeroy Co., New York. They are made with side straps, which not only enable them to be pulled on like boots," but materially strengthens them, giving them a longer life. See adv. on page 29.

MCCOY, HOWE CO.

INDIANAPOLIS, IND. Elements of Homoeopathy

196 pages, Cloth, $1.00. Postage, 5 cents A complete course in Homoeopathy, giving history, theory, dosage, pharmacy, materia medica and practice.

BOERICKE & TAFEL, Publishers 1011 Arch Street

PHILADELPHIA, PA. THE PATTEE COUCH CHAIR

$5.00–$12.75 When closed makes a Morris chair. Just the thing for the phy. sician. Many are

using them. Cat. OPENED.

alogue on request. BARNETT-PATTEB Co., Poughkeepsie, N. Y.

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Tongaline and Lithia Tablets are particularly indicated in diseases which are caused by deposits of urates in the tissues, especially in the joints and in the kidneys.

REDDING, CAL. Wheeler Chemical Works:

Gentlemen :- I would not take ten times the cost of Noitol and be without it. It is, without exception, the finest application I have ever used in Eczema. Yours truly, F. P. MITCHELL, M.D. See adv. on page 26.

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Messrs. Strong, Cobb & Co. recommend thier Echitone in chronic eczematous conditions, in all pus forming cellular inflammations, boils, old ulcers, and all conditions caused by a blood dyscrasia or a depraved condition of the body fluids. See adv. on page 32.

THOROUGH PREPARATION FOR

All State Board alegere end depravad condition of the bodo duiasMedical Examinations

Instruction Personally or by Correspondence

In addition to their full line of nebulizers, the Globe Mfg. Co, call our attention to an electric air pump they have put on the market. They claim for it automatic action on either direct or alternating current; adaptation to pressure or vacuum; bigb pressure and large capacity in proportion to power consumed; air filter, with special claim for compactness and durability. We advise users of

(Continued on page 22.]

As time is an important factor, I give as much attention to showing what NOT to read as 'what should be carefully stadied.

Physicians removing from one State to another can obtain valuable assistance, and save much time, trouble and money.

Address DR. R. J. E. SOOTT, Domllt Dispensary 88d Street and Second Avenue Now York Oity

Circulation : April, 1906, 35,571.

The Medical World

The knowledge that a man can use is the only real knowledge; the only knowledge that has life and growth in it and converts itself into practical power. The rest hangs like

dust about the brain, or dries like raindrops off the stones.-FROUDE.

The Medical World

C. F. TAYLOR, M D., Editor and Publisher A. L. RUSSELL, M.D., Assistant Editor

Entered at the Philadelphia Post-Office as Second-Class Matter.

SUBSCRIPTION RATES: To any part of the United States.

Canada, and Mexico, ONE DOLLAR per year, or FOUR YEARS for THREE DOLLARS; to England and the British Colonies, FIVE SHILLINGS Six PENCE per year; to other foreign countries in the Postal Union, the equivalent of 5s. 6d. Postage free. Single copies, TEN CENTS. These rates are due in

advance. HOW TO REMIT: For their own protection we advise that

our patrons remit in a safe way, such as by postal money order, express order, check, draft, or registered mail. Currency sent by ordinary mail usually reaches its destination safely, but

money so sent must be at the risk of the sender. . We cannot always supply back numbers. Should a number fail to

reach a subscriber, we will supply another, if notified before

the end of the month. Notify us promptly of any change of address, mentioning both old

and new addresses. If you want your subscription stopt at expiration of the time paid

for, kindly notify us, as in the absence of such notice we will understand that it is the subscriber's pleasure that the subscrip

tion be continued, and we will act accordingly. Pay no money to agents unless publisher's receipt is given. ADDRESS ALL COMMUNICATIONS TO

“THE MEDICAL WORLD" 1520 Chestnut Street

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Language is a growth rather than a creation. The growth of our vocabulary is seen in the vast increase in the size of our dictionaries during the past century. This growth is not only in arnount, but among other elements of growth the written forms of words are becoming simpler and more uniform. For example, compare English spelling of a century or two centuries ago with that of to-day ! It is our duty to encourage and advance the movement toward simple, uniform and rational spelling. See the recommendations of the Philological Society of London, and of the American Philological Association, and list of amended spellings publisht in the Century Dictionary (following the letter z) and also in the Standard Dictionary, Webster's Dictionary, and other authoritativ works on language. The tendency is to drop silent letters in some of the most flagrant instances, as ugh from though, etc., change ed to t in most places where so pronounced (where it does not affect the preceding sound), etc.

The National Educational Association, consisting of ten thousand teachers, recommends the following:

“At a meeting of the Board of Directors of the National Eaucational Association held in Washington, D. C., July 7. 1898, the action of the Department of Superintendence was approved, and the list of words with simplified spelling adopted for use in all publications of the National Educational Association as follows: tho (though);

program (programme); altho (although);

catalog (catalogue); thoro (thoroughi;

prolog (prologue); thorofare thoroughfare);

decalog (decalogue): thru (through);

demagog (demagoguel; thruout (throughout):

pedagog (pedagogue). « You are invited to extend notice of this action and to join in securing the general adoption of the suggested amendments. -IRVING SHEPARD, Secretary."

We feel it a duty to recognize the above tendency, and to adopt it in a reasonable degree. We are also disposed to add enuf (enough) to the above list, and to conservativly adopt the following rule recommended by the American Philological Association :

Drop final "e" in such words as definite." “ infinite." favorite." etc., when the preceding vowel is short. Thus, spell "opposit.” “preterit." "hypocrit." "requisit," etc. When the preceding vowel is long, as in " polite," “finite,'

"unite," etc., retain present forms unchanged. We simply wish to do our duty in aiding to simplify and rationalize our universal instrument-language.

Vol. XXIV.

MAY, 1906.

No. 5

The Study of Mental Diseases. In no other department of medicin is the great majority of general practicians so deficient and so negligent and so absolutely ignorant, as in the domain of mental affections. There is ample cause for this carelessness, in the nature of the instruction imparted in this branch by even the medical schools recognized as belonging to the better class, and which are continually prating in their prospectuses of their thoroness and completeness of instruction in all branches, when it is considered that many of the profession attend schools of admittedly inferior standards, and that such schools make no

pretense, even, of imparting instruction in psychiatry, the lack of interest in the matter is explainable. The average practician has never been taught anything about mental diseases, and consequently he does not know anything about them; he has never had his interest aroused in them by even a glimmer of instruction, and hence he does not want to know anything about them. He has a vague conception, based upon impressions he has imbibed during his attendance upon lectures, and upon the fact that the faculty of his school either ignored them completely or slurred over what instruction they gave, that such diseases are difficult to under

stand and are intricate, profound, and con- cases are not numerous in general practise, fusing in study. He is aware that his the principles of the study can be mastered brother practicians are as densely ignorant without patients being at hand, and many as he is himself, and he is content to remain matters connected with it may be cleared up in darkness. One of the greatest legal in a satisfactory manner, simply by a study farces ever perpetrated is the average ex- of the text books upon the subject. It is amination of the average commission in the duty of every practician to know somelunacy; as appointed by court for the dec- thing of the commoner mental aberrations laration of the insanity and consequent in- and diseases, and no man should assume carceration of a given patient. The two the responsibility of complicity in the inphysicians and the one layman constituting carceration of a fellow man on grounds of the "commission” know as little about the insanity, while he himself is absolutely matter of insanity as they would about how ignorant of the valid symptoms and signs to go about extracting aluminum from the of the condition. clay bank along the road. The subject of inquiry, if he knows that such a commission !

Brief Points on the Diagnosis of Typhoid

Fever in Children. is to visit him, and that upon their decision

It is more difficult to make a satisfactory rest his hopes of liberty or his certainty of

diagnosis of typhoid fever in a child than imprisonment, has good cause to become worried enuf to show it, or to make an

in the adult. The Widal test and the diazo answer or two answers not as lucid as might

reaction are not available until late in the be expected: when, presto, the decision is

disease, and are not so certain as in the made that he is insane. Our asylums are

adult. The extreme cerebral congestion filled with just such cases; criminal records

which arises at times, aids, too, in obscuring teem with the evidence that many such com

the diagnosis. missions have perpetrated a great wrong.

Perhaps the most important factor to How many patients, slightly worried, de

make search for is the absence of leucoprest, or in a temporary melancholy state

cytosis. Meningitis, either tubercular or because of some great grief or loss, are non-tubercular, is the only disease with plunged into hopeless insanity because of which the experienced clinician is apt to their brutal examination and incarceration confound typhoid fever in a child. In tyat a time when their enfeebled minds could phoid, leucocytosis is absent, while in mennot endure another annoyance?

ingitis it is usually present, especially if the These are matters which all thoughtful process be to any degree purulent. E. S. · men recognize, and which are sufficiently Wood has called attention, also, to the fact reprehensible to make all conscientious men that in meningitis the chlorids of the urin take a greater interest than they have diminish rapidly; heating the urin precipiformerly done. An erroneous impression tates the phosfates readily, and the amount maintains regarding the difficulty in master- of indoxyl is increast: the diametrically ing the principles and practise of psychia- opposit is the case in typhoid fever. trics. While it is true that many of the principles of the practise are based solely

Exact Prescribing. upon theories, and that the great majority

There is a growing tendency, fostered by of the rules and the diagnoses are essentially

specialists and professors in medical schools, empirical, and that every case has intrica

when writing upon a given subject, to skim cies and complications, it is also true that

over the therapeutic phase of the subject. well defined laws are known whereby the

After long dissertations upon a given disease,

rheumatism for instance, they sum the whole interested investigator may sift the extra

treatment in the too terse phrase: “The neous symptoms from the essential manifes

salicylates are indicated.” While they themtations until he arrives at a diagnosis which

selves may be familiar with all the salicylates is commonly correct. The subject is not as in all their fine points of difference. we are difficult as are many other branches of certain that the mass of the profession are not. medicin, and it is a special field which will To most of them, such an expression would easily and well repay the time and study simply mean sodium salicylate, because they devoted to it. The books upon this obscure are ignorant of the fact that there are other field of medicin are not numerous, but they salicylates possessing features distinct from are comprehensiv and practical, and are those of the sodium salt. within the reach of every practician. While We are aware that to surgery is conceded

the privilege of declaring the operation "a Anesthetics in Obstetrical Cases. success,” even tho the patient die, but we There is a prejudice in the minds of the decry any tendency to obliterate known facts majority of the better, class of general practi. and distinctiv features in medicin. There are cians against the use of anesthetics in the avergreat differences in solubility, rapidity of age case of obstetrics. So deeply rooted is action, tendency to produce undesirable effects, this prejudice that men who are in all other disagreeability of taste, rate of elimination, respects most considerate of the interests of etc., among different salts of the same base, their patients, will permit their patients in and no physician is excusable for either being labor to suffer until they are completely exignorant of them or of failing to take advantage hausted before administering an anesthetic and of them. “Bromid” means to most practicians, terminating the hopeless travail by instrupotassium bromid. This, despite the fact that mental aid. Even when forceps are to be in most cases nearly any other bromid or used, many practicians, if the operation gives salicylate would be better. These facts main promise of being a short one, do not consider tain thruout the materia medica, either because the anesthetic necessary. So firmly rooted is of indifference or of a habit which permits one this bias against the use of anesthetics in midto continue prescribing regardless of effect or wifery in average cases, that this boon is not result. Any practician who prescribes in this accorded many times when the sufferings of the manner might almost as well have a number of woman are protracted and excruciating. mixtures made up ready, and he might label Such a position is just as surely wrong as is one “fits," another “ rheumatism," and still the position often taken by the young and inothers “diarrhea," "constipation," etc.

experienced practician, who is all too ready Take the bromids, for example; we know with his chloroform bottle and forceps, and that potassium bromid has many points in who leaves in his wake a lot of repair work for which it resembles the ammonium salt, yet we the gynecologists, and numbers of victims who must also know that it has other actions will never again enjoy good health. differing essentially from the said salt. The W e do not believe that any woman, in normal sodium salt, also, has points of resemblance to health, with normal pelvis, and efficient exthe others, yet it has but half the toxic power pulsiv efforts of the contracting uterus, and of the potassium salt. The lithium salt has with a normal fetus of average size, in the abthe advantage (valuable in many cases, if one sence of any obstructiv difficulty or abnormal but stop to consider) of being gently tonic condition, ever should be given chloroform. and sometimes diuretic. As long ago as 1870, Our belief is founded on the time honored Dr. S. Weir Mitchell called attention to the dictum that “meddlesome midwifery is bad," fact that the lithium salt had twice the hyp- and on both observation of the results achieved notic power of the potassium salt, and that in by those who do and those who do not employ some cases of epilepsy it acted after the potas- anestheties, and on our own experience. But it sium salt had failed. The bromid of strontium is readily admitted that all of the above favorhas been well exploited by Wood, who has able conditions are frequently not found; yet proven it much less irritating and fully as even in the absence of one or more it is not efficient as the other salts. Many thoughtless always necessary to employ either an anesthetic practicians endeavor to gloss their conscience or the forceps. by making a “shot-gun” prescription when the The indications for the administration of an bromid is called for, and prescribe a combina- anesthetic are quite as distinct as are ever any tion of the sodium, potassium, and ammonium indications in medicin, and are readily recogsalts, when they have no indication for induc- nized by the well trained or the experienced ing the action produced by such a combina- practician. The great trouble with many of tion, and could not tell what such combined the prosession to-day who have practised over action would be, any more than they could ten years is that they had no adequate obstetgive a valid reason for such a combination. rical training during their course of lectures

The basis of the fault is ignorance of the for the doctorate, and have never learned any. materia medica ; and the remedy is to study thing about the refinements of the obstetrical drugs until you know the action of each, and art since graduation. Simply because a practhen to prescribe them in such manner that

tician believes from experience in other cases exact effect may reasonably be expected. that a woman will survive a difficult labor, and

that the infant has good chance of being born In many cases enemas of water are dangerous be alive, is no excuse for failure to interfere if the cause of the violent peristalsis incited. We have

indication for such interference is present. seen patients with appendicitis in agony for hours, because their physicians persisted in employing There is another unwelcome truth which we enemas of warm water, and utterly failed to note the

wish to assert in this arraignment of the proconsequent misery entailed or appreciate the danger incurred by such practise.

fession, and that is that in their inner souls

many men are afraid to give chloroform, be. never seen as a result of anesthesia, unless it is pusht cause they have had neither training nor ex

too far." perience in its use to justify them in presum

Every other experienced teacher and writer ing to guide a patient " into the very valley holds practically the same views. It is a quesof the shadows of death.” This deplorable

tion no longer suitable for discussion. The condition is neither the fault of the patient only views that now need expression upon the nor of the anesthetic. We do not know of a

matter, are a condemnation of those who use single medical school in the United States to.

anesthetics too frequently and when they are day that gives its students anything approxi

not indicated, and a like condemnation of mating adequate training in practical clinical

those who do not use them when indicated. obstetrics. Many of the best of them only

In other words, we make a plea that every require their graduate to have seen one to

practician will fit himself by experience so that three cases under the care of a “ resident".

he shall be competent to administer an anes. often nearly as inexperienced as themselves. thetic when it is indicated. Too many of them will (and do) graduate doctors who have never seen a labor case thru to How Doctors are Classed as Investors. completion. What can be expected from such

My mail, and perhaps the mail of many conditions ? Only the minority of practicians

medical men, still indicates a great desire on can attend the best of the schools, and how

the part of schemers to get the savings of docshamefully inefficient is even the best of them

tors; and there are still evidences that doctors when actual experience in the parturient room

are disposed to be "easy"—that is, it is easy is made the test! There is, however, a rem

to induce them to part with their savings withedy for these lax conditions of training, and

out adequate security. Moody's Magazine is the men now in the schools are taking advan

“A Monthly Review for Investors, Bankers tage of the opportunity. The older practician

and Men of Affairs.” Perhaps but few doctors can do the same, if he will. In every large

read it. For this reason I will quote quite city now may be found a lying-in hospital

freely from an article entitled “Modern Getwhere instruction and experience may be ob.

Rich-Quick Schemes," by John Moody, aptained by either student or graduate, and this

pearing in the February issue of that magazine : experience may be as protracted as the noviti. ate desires.

As an illustration of how persistently and easily un

suspecting people are misled and swindled, instance Hirst, in his Text-book of Obstetrics, sums the following: up the matter in few words, and yet so sensi

A very conspicuous concern has been operating for

the past five years or so one of the largest and cleverest bly and completely that we quote him :

mining swindles ever known in the United States.

Sumptuous offices are maintained in Broadway, New "As the first stage of labor advances, the suffering York, and about forty branch offices have been estabof the woman increases with each succeeding pain. lished in various cities of the United States and She complains, perhaps, bitterly, and the suffering Canada. A number of honest men have been drawn becomes so great, in occasional instances, that the into the scheme by baits of alluring commissions, and patient seems to be maniacal or to become completely have peddled the rotten shares of this firm of stockexhausted, not so much from muscular effort as from jobbers among their friends and neighbors, to the loss an agony that is beyond endurance. She appeals to of their own peace of mind and reputations. The plan her medical attendant to do something to relieve her of this swindle is neat and comprehensiv. The firm suffering, and her appeal is enforced by all the ap announced that it would operate on the law of averpearances of the greatest anguish, perhaps, that a ages, and by handling many mines the good ones human being is called on to endure. Any sympathetic would make up for the failures. Considerable blufi. person must feel impelled to grant this request, to re ing has been done in the way of crude mining operasort to some of the well known agents for lessening tions, but none of the “ mines" have proven successpain that medical science is now possessed of. The ful, and none are likely ever to be successful. only consideration that would deter him would be the This firm of sharpers began paying dividends on fear that these remedies entailed dangers upon the shares when no profits were earned, for which they woman that he dare not risk even to secure the im should be jailed for the common swindlers that they mense relief from pain that they would afford. It has are. Stock in the worthless companies was exchanged been demonstrated that such fear is not justified by for stock in equally worthless companies whenever facts. The dangers and disadvantages that, it is shareholders grew tired, and the victims of conspiracy claimed, result from the use of anesthetics in labor were tolled along by the “dividends" paid out of the are:-a prolongation of the process by weakening the money they had themselves furnisht. Recently cash uterin contractions and increasing the intervals be dividends had been suspended, and “scrip" divitween them; a disposition to post-partum hemorrhage ; dends substituted therefor. It is reported that this an increast liability to sepsis after labor by a relax firm has bilked something like 16,000 small investors, ation of the uterin muscle; and a subinvolution of in the United States and Canada, to the tune of several the uterus. These objections are ill founded if the millions of dollars. anesthetic is administered in a proper manner. Ac The methods for promoting all kinds of swindles curate observation in some of the large lying-in hos- have in recent years been refined down to an exact pitals in Germany has demonstrated that an anes science. Experience has proven that the most vulnerthetic, if not pusht too far, has no influence on the able class of people to be attracted by investing swinpower, duration, or frequency of the pains. By re dles, aside from women, are ministers, doctors, lieving the dreadful suffering in some cases that teachers and other professional people. There are in causes an exhaustion as profound as would follow a New York a number of concerns who make a business tremendous physical effort, the danger of post-partum of supplying classified lists of possible investors for hemorrhage is actually avoided. Subinvolution is the use of those who wish to exploit mining swindles

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