"We are headquarters for the active principles and other concentrate, true-blue remedies in granule and tablet form ready to dispense, for the physician and pharmacist alike at the same price. If you are interested, send for samples." This is quoted from the Abbott Alkaloidal Co.'s advertisement in this issue. See same on page 31, and send for samples. 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 fluid exudates in superficial affections, and is the only remedy that through an inherent hygroscopic property will relieve deep-seated congestions by inducing superficial hyperæmia and that without irritation." If you do not know Antiphlogistine, 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. 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. Wheeler Chemical Works: REDDING, CAL. 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. 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. 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; high 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.] Antiseptic Sphenoids ANTISEPTIC. ASTRINGENT. 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 The Medical World C. F. TAYLOR, M D., Editor and Publisher 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 subscription 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" 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 amount, 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 Equcational 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: MAY, 1906. 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 No. 5 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 confusing in study. He is aware that his brother practicians are as densely ignorant as he is himself, and he is content to remain in darkness. One of the greatest legal farces ever perpetrated is the average examination of the average commission in lunacy, as appointed by court for the declaration of the insanity and consequent incarceration of a given patient. The two physicians and the one layman constituting the "commission" know as little about the matter of insanity as they would about how to go about extracting aluminum from the clay bank along the road. The subject of inquiry, if he knows that such a commission is to visit him, and that upon their decision rest his hopes of liberty or his certainty of imprisonment, has good cause to become worried enuf to show it, or to make an answer or two answers not as lucid as might be expected when, presto, the decision is made that he is insane. Our asylums are filled with just such cases; criminal records teem with the evidence that many such commissions have perpetrated a great wrong. How many patients, slightly worried, deprest, or in a temporary melancholy state because of some great grief or loss, are plunged into hopeless insanity because of their brutal examination and incarceration at a time when their enfeebled minds could not endure another annoyance? These are matters which all thoughtful men recognize, and which are sufficiently reprehensible to make all conscientious men take a greater interest than they have formerly done. An erroneous impression maintains regarding the difficulty in mastering the principles and practise of psychiatrics. While it is true that many of the principles of the practise are based solely upon theories, and that the great majority of the rules and the diagnoses are essentially empirical, and that every case has intricacies and complications, it is also true that well defined laws are known whereby the interested investigator may sift the extraneous symptoms from the essential manifestations until he arrives at a diagnosis which is commonly correct. The subject is not as difficult as are many other branches of medicin, and it is a special field which will easily and well repay the time and study devoted to it. The books upon this obscure field of medicin are not numerous, but they are comprehensiv and practical, and are within the reach of every practician. While cases are not numerous in géneral practise, the principles of the study can be mastered without patients being at hand, and many matters connected with it may be cleared up in a satisfactory manner, simply by a study of the text books upon the subject. It is the duty of every practician to know something of the commoner mental aberrations and diseases, and no man should assume the responsibility of complicity in the incarceration of a fellow man on grounds of insanity, while he himself is absolutely ignorant of the valid symptoms and signs of the condition. Brief Points on the Diagnosis of Typhoid Fever in Children. It is more difficult to make a satisfactory diagnosis of typhoid fever in a child than in the adult. The Widal test and the diazo reaction are not available until late in the disease, and are not so certain as in the adult. The extreme cerebral congestion which arises at times, aids, too, in obscuring the diagnosis. Perhaps the most important factor to make search for is the absence of leucocytosis. Meningitis, either tubercular or non-tubercular, is the only disease with which the experienced clinician is apt to confound typhoid fever in a child. In typhoid, leucocytosis is absent, while in meningitis it is usually present, especially if the process be to any degree purulent. E. S. Wood has called attention, also, to the fact that in meningitis the chlorids of the urin diminish rapidly; heating the urin precipitates the phosfates readily, and the amount of indoxyl is increast: the diametrically opposit is the case in typhoid fever. Exact Prescribing. There is a growing tendency, fostered by specialists and professors in medical schools, when writing upon a given subject, to skim over the therapeutic phase of the subject. After long dissertations upon a given disease, rheumatism for instance, they sum the whole treatment in the too terse phrase: "The salicylates are indicated." While they themselves may be familiar with all the salicylates in all their fine points of difference, we are certain that the mass of the profession are not. To most of them, such an expression would simply mean sodium salicylate, because they are ignorant of the fact that there are other salicylates possessing features distinct from those of the sodium salt. We are aware that to surgery is conceded the privilege of declaring the operation "a success," even tho the patient die, but we decry any tendency to obliterate known facts and distinctiv features in medicin. There are great differences in solubility, rapidity of action, tendency to produce undesirable effects, disagreeability of taste, rate of elimination, etc., among different salts of the same base, and no physician is excusable for either being ignorant of them or of failing to take advantage of them. "Bromid" means to most practicians, potassium bromid. This, despite the fact that in most cases nearly any other bromid or salicylate would be better. These facts maintain thruout the materia medica, either because of indifference or of a habit which permits one to continue prescribing regardless of effect or result. Any practician who prescribes in this manner might almost as well have a number of mixtures made up ready, and he might label one "fits," another "rheumatism," and still others "diarrhea," "constipation," etc. Take the bromids, for example; we know that potassium bromid has many points in which it resembles the ammonium salt, yet we must also know that it has other actions differing essentially from the said salt. The sodium salt, also, has points of resemblance to the others, yet it has but half the toxic power of the potassium salt. The lithium salt has the advantage (valuable in many cases, if one but stop to consider) of being gently tonic and sometimes diuretic. As long ago as 1870, Dr. S. Weir Mitchell called attention to the fact that the lithium salt had twice the hypnotic power of the potassium salt, and that in some cases of epilepsy it acted after the potassium salt had failed. The bromid of strontium has been well exploited by Wood, who has proven it much less irritating and fully as efficient as the other salts. Many thoughtless practicians endeavor to gloss their conscience by making a "shot-gun" prescription when the bromid is called for, and prescribe a combination of the sodium, potassium, and ammonium salts, when they have no indication for inducing the action produced by such a combination, and could not tell what such combined action would be, any more than they could give a valid reason for such a combination. The basis of the fault is ignorance of the materia medica; and the remedy is to study drugs until you know the action of each, and then to prescribe them in such manner that exact effect may reasonably be expected. In many cases enemas of water are dangerous because of the violent peristalsis incited. We have seen patients with appendicitis in agony for hours, because their physicians persisted in employing enemas of warm water and utterly failed to note the consequent misery entailed or appreciate the danger incurred by such practise. Anesthetics in Obstetrical Cases. There is a prejudice in the minds of the majority of the better, class of general practicians against the use of anesthetics in the average case of obstetrics. So deeply rooted is this prejudice that men who are in all other respects most considerate of the interests of their patients, will permit their patients in labor to suffer until they are completely exhausted before administering an anesthetic and terminating the hopeless travail by instrumental aid. Even when forceps are to be used, many practicians, if the operation gives promise of being a short one, do not consider the anesthetic necessary. So firmly rooted is this bias against the use of anesthetics in midwifery in average cases, that this boon is not accorded many times when the sufferings of the woman are protracted and excruciating. Such a position is just as surely wrong as is the position often taken by the young and inexperienced practician, who is all too ready with his chloroform bottle and forceps, and who leaves in his wake a lot of repair work for the gynecologists, and numbers of victims who will never again enjoy good health. We do not believe that any woman, in normal health, with normal pelvis, and efficient expulsiv efforts of the contracting uterus, and with a normal fetus of average size, in the absence of any obstructiv difficulty or abnormal condition, ever should be given chloroform. Our belief is founded on the time honored dictum that "meddlesome midwifery is bad," and on both observation of the results achieved by those who do and those who do not employ anestheties, and on our own experience. But it is readily admitted that all of the above favorable conditions are frequently not found; yet even in the absence of one or more it is not always necessary to employ either an anesthetic or the forceps. The indications for the administration of an anesthetic are quite as distinct as are ever any indications in medicin, and are readily recognized by the well trained or the experienced practician. The great trouble with many of the profession to-day who have practised over ten years is that they had no adequate obstetrical training during their course of lectures for the doctorate, and have never learned anything about the refinements of the obstetrical art since graduation. Simply because a practician believes from experience in other cases that a woman will survive a difficult labor, and that the infant has good chance of being born alive, is no excuse for failure to interfere if the indication for such interference is present. There is another unwelcome truth which we wish to assert in this arraignment of the profession, and that is that in their inner souls many men are afraid to give chloroform, because they have had neither training nor experience in its use to justify them in presuming to guide a patient "into the very valley of the shadows of death." This deplorable condition is neither the fault of the patient nor of the anesthetic. We do not know of a single medical school in the United States today that gives its students anything approximating adequate training in practical clinical obstetrics. Many of the best of them only require their graduate to have seen one to three cases under the care of a "resident" often nearly as inexperienced as themselves. Too many of them will (and do) graduate doctors who have never seen a labor case thru to completion. What can be expected from such conditions? Only the minority of practicians can attend the best of the schools, and how shamefully inefficient is even the best of them when actual experience in the parturient room is made the test! There is, however, a remedy for these lax conditions of training, and the men now in the schools are taking advantage of the opportunity. The older practician can do the same, if he will. In every large city now may be found a lying-in hospital where instruction and experience may be obtained by either student or graduate, and this experience may be as protracted as the noviti. ate desires. Hirst, in his Text-book of Obstetrics, sums up the matter in few words, and yet so sensibly and completely that we quote him: "As the first stage of labor advances, the suffering of the woman increases with each succeeding pain. She complains, perhaps, bitterly, and the suffering becomes so great, in occasional instances, that the patient seems to be maniacal or to become completely exhausted, not so much from muscular effort as from an agony that is beyond endurance. She appeals to her medical attendant to do something to relieve her suffering, and her appeal is enforced by all the appearances of the greatest anguish, perhaps, that a human being is called on to endure. Any sympathetic person must feel impelled to grant this request, to resort to some of the well known agents for lessening pain that medical science is now possessed of. The only consideration that would deter him would be the fear that these remedies entailed dangers upon the woman that he dare not risk even to secure the immense relief from pain that they would afford. It has been demonstrated that such fear is not justified by facts. The dangers and disadvantages that, it is claimed, result from the use of anesthetics in labor are:-a prolongation of the process by weakening the uterin contractions and increasing the intervals between them; a disposition to post-partum hemorrhage; an increast liability to sepsis after labor by a relaxation of the uterin muscle; and a subinvolution of the uterus. These objections are ill founded if the anesthetic is administered in a proper manner. Accurate observation in some of the large lying-in hospitals in Germany has demonstrated that an anesthetic, if not pusht too far, has no influence on the power, duration, or frequency of the pains. By relieving the dreadful suffering in some cases that causes an exhaustion as profound as would follow a tremendous physical effort, the danger of post-partum hemorrhage is actually avoided. Subinvolution is never seen as a result of anesthesia, unless it is pusht too far." Every other experienced teacher and writer holds practically the same views. It is a question no longer suitable for discussion. The only views that now need expression upon the matter, are a condemnation of those who use anesthetics too frequently and when they are not indicated, and a like condemnation of those who do not use them when indicated. In other words, we make a plea that every practician will fit himself by experience so that he shall be competent to administer an anes. thetic when it is indicated. How Doctors are Classed as Investors. My mail, and perhaps the mail of many medical men, still indicates a great desire on the part of schemers to get the savings of doctors; and there are still evidences that doctors are disposed to be "easy"-that is, it is easy to induce them to part with their savings without adequate security. Moody's Magazine is "A Monthly Review for Investors, Bankers and Men of Affairs." Perhaps but few doctors read it. For this reason I will quote quite freely from an article entitled "Modern GetRich-Quick Schemes," by John Moody, appearing in the February issue of that magazine: As an illustration of how persistently and easily unsuspecting people are misled and swindled, instance the following: A very conspicuous concern has been operating for the past five years or so one of the largest and cleverest mining swindles ever known in the United States. Sumptuous offices are maintained in Broadway, New York, and about forty branch offices have been established in various cities of the United States and Canada. A number of honest men have been drawn into the scheme by baits of alluring commissions, and have peddled the rotten shares of this firm of stockjobbers among their friends and neighbors, to the loss of their own peace of mind and reputations. The plan of this swindle is neat and comprehensiv. The firm announced that it would operate on the law of averages, and by handling many mines the good ones would make up for the failures. Considerable bluffing has been done in the way of crude mining operations, but none of the "mines" have proven successful, and none are likely ever to be successful. are. This firm of sharpers began paying dividends on shares when no profits were earned, for which they should be jailed for the common swindlers that they Stock in the worthless companies was exchanged for stock in equally worthless companies whenever shareholders grew tired, and the victims of conspiracy were tolled along by the "dividends" paid out of the money they had themselves furnisht. Recently cash dividends had been suspended, and "scrip dividends substituted therefor. It is reported that this firm has bilked something like 16,000 small investors, in the United States and Canada, to the tune of several millions of dollars. The methods for promoting all kinds of swindles have in recent years been refined down to an exact science. Experience has proven that the most vulnerable class of people to be attracted by investing swindles, aside from women, are ministers, doctors, teachers and other professional people. There are in New York a number of concerns who make a business of supplying classified lists of possible investors for the use of those who wish to exploit mining swindles |