PRACTICAL POINTS The Mellier Drug Co. wish to call attention to the fact that in prescribing Tongaline physicians can always rely on giving their patients the gaultheria salicylic acid, provided the genuine Tongaline is dispensed. The Helvetia Milk Condensing Co., in speaking of the use of cow's milk in infant feeding, say: "Ordinary sterilization does not simplify the problem, as the milk is thus rendered more difficult of digestion; pasteurization is not effectiv; the large amount of cane sugar in 'condensed milk' is almost certain to cause derangement of the stomach and bowels." The Helvetia Co. claim that the conditions are perfectly met by the use of their "Evaporated Milk," which is simply pure, fullcream cow's milk, sterilized and evaporated to the consistency of rich cream. It can be modified in the same way as fresh milk, and is absolutely germ free. See adv. on page 16. There once was an ichthyosaurus, Who lived when the earth was all porous; When he first heard his name, Those of our readers who have used Cystogen will be interested in the Cystogen-Lithia tablets now put up by the same firm. They say of them: "Physicians will find these tablets of special value in the treatment of many conditions suggesting the addition of lithia as increasing the efficiency of cystogen. In rheumatism, gout, urinary deposits, ammoniacal urin, cystitis, etc., cystogen-lithia hastens the excretion of urates and uric acid and prevents the formation of calculus." See adv. on page 16. The Pettey Retreats, for alcoholic and drug addictions, claim that patients treated by the Pettey method have little, if any, tendency to relapse, unless they originally began the use of the drug as a dissipation. In that case, the same perverse traits of character will remain, and these cannot be overcome by therapeutic measures. See adv. on page 21. The Pabst Extract Laboratory writes us, that altho Pabst Extract has enjoyed and is still enjoy ing widespread favor with the medical profession, its value as a tonic has proven its best advertise ment, and the sales have increast from year to year until today it is sold in almost every civilized corner of the globe. See adv. on page 11. A nerve food and nutritiv tonic, for the treatment of consumption, bronchitis, scrofula, and all forms of nervous debility;-Wheeler's Tissue Phosphates. Have you tried this preparation? If not you will be interested in the adv. on page 29. There was a young man named McCall, Who went to a fancy-dress ball. He thought, just for fun, He would dress like a bun, And was eat by the dog in the hall. The long dark afternoons and evenings of winter are now coming on, and you will do well to see to your driving lamp equipment. If you need new ones see adv. of Dr. Reefy on page 4. This month Messrs. Wm. R. Warner & Co. present Ingluvin for the attention of our readers. This digestiv preparation, made from the gizzards of (Continued on page 20.) Circulation: October, 1906, 35,502. 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" 1520 Chestnut Street Philadelphia, Pa. VOL. XXIV. 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 Educational 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: "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 ration. alize our universal instrument-language. NOVEMBER, 1906. The Employment of Quinin in Pneumonia. There is an undoubted increasing tendency toward the use of quinin in pneumonia. This is noted among English, German, and American writers of prominence. This trend of practise has been gradually extending in the face of the fact that the users can give no definit reason why they use the drug, nor attempt any explanation of its mode of action. We are not referring to the practicians who employ the drug in enormous dosage with the avowed intention of "aborting" or "curing" the disease, but to the considerable proportion of the profession who employ it almost as a routine measure. The antipyretic status of the drug in this affection is fairly well establisht, and but few No. 11 clinicians now advocate its use for this purpose after the early stage. There are those who follow Binz in his vague belief in the "inhibitory" action of the drug on the bacteria; and there are others, capable, experienced, and thoughtful practicians, who have never heard of Binz or his theories, but have given quinin tentativly, and observing beneficial results, have continued giving it. The large number of those now employing the drug in all sections of the world cannot but fail to impress the thoughtful physician. It is frequently the case that empirical practise antedates by many years scientific verification. Recall how accurately quinin was used in malaria for a long time before we ever knew of the existence of the malarial parasite. Stranger things have happened in medicin than that future bacteriological investigation might award a definit standing to this drug in the therapy of pneumonia. Like many others, it has been our custom to employ it in cases in which there was no contraindication, but beyond believing that we got beneficial results we could give no more definit reason for our practise. In another column we quote a number of late writers anent the use of quinin in pneumonia. We have never employed the enormous dose; we have never "aborted" a pneumonia; we have never even tested the tolerance of the organism to the 37 grains daily; but for many years we have used it with satisfaction in doses of 2 to 5 grains every three or four hours thruout the course of this disease. We do not insist upon others following us. We merely, in the face of the well-known conservativ stand which the mass of the profession has taken regarding drug giving in therapeutics, call attention to this trend in practise, hoping that thru still wider and more varied experience under other environments and conditions, something definit may be learned. Postpartum Hemorrhage and Its Treatment. Occasionally, we regret to state, it is forcibly borne in upon us that many practicians in general practise are either incompetent to properly handle this emergency or habitually attend accouchements without a proper armamentarium. How many lives are thus needlessly sacrificed? A considerable number, we must believe. There can be no excuse for any practician deliberately agreeing to attend a woman in confinement when he has not with him the necessary drugs and appliances wherewith to combat emergencies which are well known to arise in a certain proportion of cases. If, perhaps, he be called in from the street or road, and has not his obstetric equipment with him, he cannot be blamed if serious emergency arise suddenly; but, if so called, he should at once send for whatever articles he might need. When the emergency confronts him minutes count for life or death, and he has then no time to dispatch a messenger. Nevertheless, the competent practician will often employ in dire emergency common household articles; but to be able to do this, he must understand thoroly the nature of the remedies he employs and the indications for their employment. Every practician can prepare himself to combat ordinary emergencies in labor if he will but peruse a modern text-book. We are not referring to those difficult cases where the aid, counsel, and strength of another practician may be secured, but solely to postpartum hemorrhage, which, when it comes, may exsanguinate the woman within the space of a very few moments. The matter is not a difficult one to study; the armamentarium necessary to equip one is neither too heavy, expensiv, nor too bulky to make a part of every physician's outfit who presumes to attend a case of confinement. Hemorrhage occurring within a short time following delivery is always due to one of the following causes: (1) An uncontracted uterus, (2) injuries along the birth canal, (3) the presence of foreign growths, (4) ulceration of the parturient tract. The two former, of course, make up the vast majority of all cases. To check the hemorrhage in the first class of cases, it is merely necessary to provoke the uterus to contraction; in the second, to repair the injury by surgical means. not necessary, on account of the rarity, to discuss the two latter causes, for the practician equipping himself to deal with the two former will be prepared to understand and to make a diagnosis of the two latter when present. It is It is better to guard against postpartum hemorrhage, than it is to allow it to occur and then attempt to check it. If every practician, as soon as the child is delivered, immediately would give a dram of the fluidextract of ergot, and either himself or by the aid of a nurse or husband, keep up firm kneading motions thru the abdominal wall upon the fundus of the uterus until it is firmly contracted, there would be few, if any, cases of postpartum hemorrhage from uncontracted or relaxt uterus. However, many practicians will not do this until after they have been thoroly frightened or until they have allowed a patient to die under their (mis) management. It is to be remembered that if one waits till the call for ergot is imperativ, that even if it be given hypodermically (supposing the improbable that the hypodermic syringe is ready for use), at least fifteen minutes must elapse before hope of any effect can be entertained. When it is recalled that many women die inside of five minutes from the beginning of a profuse postpartum hemorrhage, it is plain that the ergot, to be of use, must be given before any appearance of hemorrhage. Not all succumb so quickly, and there are cases where the flow is a scant but steady one; in such cases, ergot might act in time to be of benefit. The senseless argument that "the use of ergot predisposes to septicemia by causing the sinuses in the uterus to catch an undue amount of blood," has not been proven, and is not probable. Indeed it is contradicted by the success and immunity from postpartum hemorrhage enjoyed by those who employ it as a routine measure. The prophylactic precautions, then, are advisable in every case. In treatment of postpartum hemorrhage, it is well to have a settled plan of treatment thoroly fixt in one's mind, so that in the excitement of the moment everything will be done systematically and in order. We say "in order" advisedly, since some of the latter procedures are not in line with the principles of asepsis, yet if the other measures fail, as they may rarely do, one is justified in taking the chances of septic infection in the struggle against otherwise certain death. 1. Knead the uterus vigorously thru the abdominal wall. 2. Knead the uterus vigorously thru the abdominal wall and pass the disengaged hand thru the vagina to the fundus, kneading both inside and outside energetically, and sweeping all the blood clots out of the uterus. 3. Rub ice over the abdomen, or dash ether upon it. In the winter season snow may often be found upon the window sill. Even a towel wetted with cold water and slapt upon the abdomen may be promptly efficient. 4. Pass a piece of steril gauze soakt in ordinary table vinegar to the fundus, and scrub the interior of the uterus well with it. In absence of sterile gauze, one is warranted in using any cloth, for if the hemorrhage has not responded to the treatment before listed, it is serious indeed. 5. Pack the uterin cavity tightly with iodoform gauze or steril gauze. If none be at hand, any cloth may be used. But, it is criminal neglect to attend a case of confinement without having steril or antiseptic gauze at hand. 6. Hot water, thrown into the uterin cavity, will often act like magic, but it is often impossible to get the water quickly enuf, and if it is at hand, there is great danger of burning the patient thru the water being too hot. 7. Monsell's solution, iodin, or turpentine may take the place of vinegar, but on account of their very vigorous action, firm clots are apt to be formed in the uterus, which predispose the patient to grave danger of septic infection, later. If one has these methods firmly fixt in his mind, he can go thru them rapidly in order, however excited he may be. Not more than one full minute should be occupied in each; if the plan is going to succeed, markt improvement in the volume of the flow will be noted inside one minute. If one should fail, pass at once to the next without delay. When the hemorrhage is checkt, one has then time and opportunity to prepare to combat the anemia following the excessiv loss of blood. 1. Raise the foot of the bed on books, a box, or bricks. 2. Give a hypodermic injection of ether or nitroglycerin. 3. Give a rectal enema of a pint of hot water containing a small teaspoonful of table salt. 4. Surround the patient with bottles of hot water, and supply plenty of warm bed clothing. 5. Exhibit digitalis, strychnin, hot strong coffee, or alcoholics. 6. When reaction is thoroly establisht, give a hypodermic of morphin. 7. Bandage the arms and legs from extremities toward the trunk to force as much blood as possible to brain, heart, and large vessels. 8. Treat the remaining anemia along lines of general practise. All of the above is easy, and can be executed by any practician competent to attend a case of parturition. No one should attempt to excuse himself with doing less. If all patients were so treated, a death from postpartum hemorrhage would be almost unknown. In event of injury to the birth canal, make immediate coaptation by stitches, even if bunglingly done; for it will stop the hemorrhage, and if a more careful operation be demanded later, it can be done under more favorable circumstances. The Criterion of Success in the Treatment of Chronic Bright's Disease of the Kidneys. "Success" in the treatment of chronic nephritis does not mean what "success" in treating a curable disease would mean. We cannot hope to replace tissue in the kidney which has been annihilated by the ravages of disease, therefore we do not expect that a cure will result from our efforts in chronic nephritis. If we can induce improvement in the functional powers of the damaged kidney; if we can restore a functional activity even approximating normal potency; or if we can even check the progress of the depraved catabolism; then, indeed, we may claim to have achieved success in the treatment of this affection. That such results are possible, in many cases, is incontrovertible. Yet a majority of our profession invariably give a fatal prognosis as soon as they have made an unquestionable diagnosis of chronic Bright's disease. This erroneous and unwarrantable stand is taken as the result of "experience" that the chronic nephritic never permanently improves, temporary improvement generally being followed by an exacerbation which brings the victim one step nearer the grave. Such experience, however, is no proper guide. Such experience is the result of treatment in the old conservativ way, under which, of course, all patients died. And if another patient is to be treated in the same manner, then, certainly, our fatal prognosis is amply justified. But because a patient or a host of patients have succumbed to a faulty method of therapy, shall we say that all patients similarly afflicted must inevitably perish, no matter how treated? The Editor cannot subscribe to any such prognosis. If we admit the possibility of our method of treatment being in fault, we must concede the fallibility of our boasted experience. There are certain features of the old plans of treatment which are good, and which need no alteration. There are other features, and especially that phase of investigation of a given case which forms a basis of estimation as to the progress of the disease, which requires a rigid revision, if we would really keep our therapy abreast of the times. There are other features which have much good in them, but having the good counterbalanced by the injurious; in the end resulting to the detriment rather than the improvement of the patient. A single integral part of the old treatment, is, we believe, totally bad; i. e., the ingestion of stimulating diuretics. The dietary portion of the treatment is admitted by all to be of great importance; even those who employ drugs most generously concede this. But, under the old regime, we erred in prescribing the diet, or perhaps, more properly speaking, we made our rules too inflexible, and did not vary them to suit different individuals nor observe the results with sufficient care to admit of our modifying them from time to time to the advantage of a single individual. The object in dieting in chronic nephritis is to shield the diseased organ from all superfluous work, and to eliminate any articles which might act as irritants. Yet, in the effort to do this, we should scrupulously avoid injuring other organs or adding to their burdens, and we must also see that the nutrition of the patient is maintained at the highest possible level. This is where the old style of treatment was wrong, and this is where we began the course which doomed the patient. Even if a given dietary results in diminution of the albuminuria, if the patient continues growing weaker, or if edema increases, or if the general disease picture has a gloomier shade: then that diet table needs revision. If, in endeavoring to assist the overburdened kidney, we damage the heart or stomach, how can we hope to benefit the patient? The fact that patients do improve in general well-being, even while the albuminuria remains stationary or is even on the increase, is proof enuf that we have establisht a false criterion on the results of treatment in nephritis. If, then, we establish a new criterion, we shall be in much better position to estimate the results of treatment. The rate of progress in chronic nephritis is the only true criterion upon which one may properly estimate the results of treatment, dietary or medicinal. The amount of albumin is actually one of the least important of all the features in the disease. If, with other beneficial results, we can accomplish a reduction in the amount of albumin, it is well. But to make the reduction in the amount of albumen the sole object of our treatment, is to lash the already overburdened and deficient kidney to a degree which must rapidly annihilate what functional power yet remains. This is what the giving of stimulating diuretics does. It is quite as necessary to shun the goading of an overworkt organ as it is to make sure that the organism is receiving and assimilating enuf nourishment. Many, in their zeal for a rigid dietary, cut down the food supply till the luckless patient is really starving. One must remember when limiting the food and drink, that it is not possible to give the kidney complete functional rest. Enuf fluids and enuf food must be given to supply the economy. The albuminuria may be made a partial criterion of progress, if one is careful to estimate accurately the exact percentage of albumin in the twenty-four hours' total thru a series of days. The occasional analysis which merely estimates the amount in a given sample, is quite valueless. Indeed, it is worse than valueless, since very erroneous conclusions may be reacht thru dependence upon it. It must, moreover, be remembered that fluctuations in the amount of albumin are the rule rather than the exception, and this, too, regardless of medication or diet or course of the disease. It is hence necessary to make accurate measurements over a considerable time when one is considering the weight which the amount of albumin has in the course of events. It is customary to note a markt increase in the amount of albumin for a few days subsequent to any radical change in the diet, and this regardless of what the change may be. It is quite as apt to be noted on changing from a meat to a milk diet, as it is in changing from a milk diet to one of meat, or from either to a diet of vegetables, or vice versa. After a few days, the old level is again reacht. If the periodic fluctuations in the albuminuria tend toward improvement simultaneously with the betterment in the general condition of the patient, then one is warranted to a certain degree in feeling hopeful; if, on the other hand, such fluctuations progress in a parallel line with steady failure in the general condition, one has cause to regard the prognosis as gloomy. Where such parallelism is a prominent feature of the case, one may allow it to influence him in the selection of a diet, or it may point the way to a needed alteration in food. Another important criterion in searching for the elements of success in treatment of a given case, is the excretory power of the kidney. This is commonly supposed to be tested by administration of such drugs as potassium iodid and methylene blue, and watching for the time of their appearance in the urin; but a very little personal investigation along this line will convince the impartial observer that the time of elimination varies greatly in different individuals suffering with nephritis which seems to have reacht about the same stage in all of the cases subjected to observation. Moreover, the time |