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conducted in safe, scientific and legitimate channels, and it is no selfish belief that the best interests of all three, and that of the patient as well, will be promoted by the new regime."-Editorial in Medical Herald.

The Independent Medical Journal.

BY J. J. TAYLOR, M. D.

The world is ever ready to listen to a man who has earnest convictions and is willing to risk everything in his bold endeavor to express them.

The great creations, the towering monuments of all classes of journalism in all the world have been independent publications.

Man's best work has ever been accomplished when free from all restraining alliances, actuated by his own high sense of right, inspired by his love of truth and justice, he has labored conscientiously and often self-sacrificingly for the cause of science, of art, of humanity.

Thus working independently in his chosen field of activity, unfettered by official dictation or commercial interests, responsible only to the clientele which by the natural laws of attraction he has gathered around him, his work will have a power and an influence all its own. Such work is as everlasting as the eternal hills. By the side of this how puny and ephemeral seems the work of those who are the mere puppets of dictatorial masters, the fawning creatures of a fickle organization, or the human machines of a great commercial enterprise.

Now, let us see in what way these lofty sentiments apply to the purposes of this organization.

Medical journalism in this country at the present time is in rather a chaotic state. We have had for a great many years a strong and independent medical press, with characteristic enterprise searching out and publishing all that is newest and best in medical science, often at great financial sacrifice. These medical journals have for generations been the only means of intercommunication among the members of the medical profession of the United States and of representing its interests abroad. It is largely through the scientific ability of their editors and the enterprise of their publishers' that medical science in America has advanced. with such wonderful rapidity. They have published the great papers of our masters in medicine and surgery. They have made public

the correction of mistakes of misguided enthusiasts, so that the profession at large could be quickly warned and thus avoid needless injurious experimentation. They have made it possible for the doctor to pursue a post-graduate course without leaving his home and practice. They have fought the battle for higher medical education; have helped to conquer quackery and have advanced the fees for medical and surgical work, showing the doctor how to secure the proper reward for his services. They have fostered discussions among their readers by which investigation has been encouraged and the truth has been brought to light. It is stating the facts moderately to say that without the influence of this independent medical press the medical profession would be more than fifty years behind what it is today.

But the independent journals have done far more.

They have fostered the spirit of brotherhood among the physicians of the country, urging them to give up the petty jealousies that too often develop in professional circles, teaching them that competition should be exchanged for co-operation, and have urged the organization of town, county, district, State and National medical societies. By offering the use of their pages they have made. it possible for these societies to circulate their papers and to preserve their transactions.

Now, here comes another chapter in the development. These medical organizations have concluded that they no longer need nursing. They have suddenly taken it into their minds to start journals of their own, and have even openly threatened to turn around and eat up their former nurses. This is the second class of medical journals-the National and State medical society journals. For them we have no criticism, and towards them no animosity. They fulfill a useful purpose, and they have a right to a full and free opportunity for development. But in the light of certain loudly expressed boasts of an intention to kill off every independent medical journal, your speaker thinks it not necessary to waste editorial space in giving them the hearty and generous encouragement he has done in the past. Let them alone to work out their own destiny.

The third class of medical journals we have in this country consists of those published by manufacturing houses, more or less in the nature of house organs. Compared with European countries we have but a small number of these, and they are of comparatively insignificant importance.

Now, what are the practical conclusions in regard to this condition of affairs?

In the first place, every society journal should be required to have a distinct subscription price entirely independent of the members' dues. If not, then they should be required, according to law, to pay full third-class postage. If they are thus required to stand upon their merits as medical journals, so that members may subscribe or not, as they prefer, and thus the unfair element in their competition be eliminated, there would be nothing but a warm welcome for them in the ranks of medical journalism.

But even the society journals may have elements which may affect their permanency. Already, I am sorry to say, they are quarreling among themselves. Their editorships are too often regarded in the light of political plums, to be given to the favorite of one faction this year and to that of another next year, and to be scrambled and fought over always. The editor is in hot water lest in pleasing one faction he offends another. He has no personal independence. The position of the journal this year, under Editor Slashemupski, may be entirely reversed next year under Brother Smoothem downovitch. This I seriously regret, as I should like to see a brave, virile, consistent medical society press as a balance to the sometimes too individualistic tendencies of the independent press.

In the second place, all commercial house organs should be required to conform to the high principles of independent medical journalism or pay postage for what they really are. They should be discouraged by the profession. They generally do not correctly represent medical science. Did you ever see one of them contain even a slight criticism of any of the products manufactured by their own house? Can anyone doubt that that their self-interest will lead them occasionally to overpraise some of their own preparations? Have other manufacturers a fair show in their pages? We can not hope to meet their unfair competition when they can either give as a premium the full value of their subscription in medicine or other goods, or can give a subscription free with a certain order for their products. If they enter to play the game, they should be required to obey the rules.

I am sorry to see that the few we have in this country are being increased in number within the last two or three years, until I fear we may come to the position of France and Germany, where each manufacturer has his journal and a couple of "professors" with resounding nasal and gutteral titles, hired to write for them, whose principal duties seem to be to prepare abstracts of their articles to send to certain knee-bending journals in this country, testifying

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to the magic powers of "lungine" and "kidneyol," as reported in the Wurzburger Krankliche Dunder und Blitzenblatt. Some doctors in this country think that those are actual medical journals in good standing abroad. Physicians in subscribing for one of these manufacturers' publications, must know they are not getting unbiased medical science or opinion, and that if encouraged they will choke out all independent medical literature. Advertisers, in patronizing them, are helping to pay the advertising bills of their competitors who publish them and are nursing to maturity the serpent that will ultimately crush out their own existence.

Now, when all these abuses are corrected, the independent medical journal will once more have a fair field and can more easily maintain its usfulness, dignity and true importance.

Just a word, now, among ourselves: All medical journals, independent as well as others, should live up to their responsibilities and professions. No one should attempt to edit a medical journal until he has been in the general practice of medicine and surgery, or of the specialty for which the journal stands, for at least ten years. Closet journalism by impractical theorists is not only vapid and vain, but is often absolutely dangerous.

No one should assume the responsibility of loading the profession with a new journal unless he feels that he has a genuine mission to fulfill-a useful message to convey to his fellow physicians which no one else would be likely to undertake.

There are no magnificent financial rewards in the publication of an honest medical journal. There are no fancy dividends to stockholders-nor even plain ones-only a moderate salary for the editor and manager; less than the same intelligence and application would bring in other branches of publication or in ordinary commercial pursuits.

To realize the high ideals possible in medical journalism, we should be fair to the profession and fair to our fellow journalists. We should teach the profession that a good journal is worth paying for, and that they must pay a fair price for it if they want to read it.

Why do I ask a dollar for my journal? Because it is worth a dollar. It is as much worth it as one of my readers' visits to a patient is worth a dollar. If 480 pages such as we publish in The Medical Council, delivered in monthly installments, so as to be always fresh and up to the very last minute of medical and surgical progress, are not worth $1, then there is nothing in all human enterprise that is worth what it costs. Let us, then, brothers, have our legitimate subscription price and stick to it.

Now, fellow editors, in conclusion, let us give to our readers clean, scientific, practical and up-to-date medical literature. Let us inspire our readers to the best that is in them professionally, and encourage and help them to command and obtain a suitable reward financially. Let us exact the prompt payment of a proper subscription price. Let us allow none but respectable and reliable advertisements in our advertising pages, excluding disreputable quack propositions and dishonest financial schemes. Let us be true. creators and leaders, and we will always be able to command an appropriate following that will loyally stand by us through all ordinary vicissitudes.

Post-Operative Comfort.

Dr. William G. Le Boutillier, of New York City, in the Annals of Surgery for July, 1906, gives the followingg interesting points in relation to the post-operative comfort of the patient:

Thirst. At the conclusion of an operation of any extent the patient receives at once an enema of hot saline solution, to which, if there is any shock, half an ounce to an ounce of whiskey is added. In the majority of cases the salt solution is given alone, as a matter of routine, to supply fluids. Such an enema is repeated every three hours until there is no thirst or the stomach. is able to retain fluids and nourishment; or the pulse is of good rate and quality. The amount given varies from a pint to six ounces at each time, in any case being gradually reduced. These enemata of saline solution are usually discontinued before it is necessary to use an enema for the purpose of moving the bowels.

Beginning five or six hours after anesthesia is suspended, fluid by the mouth is allowed in moderate, and soon, in almost unlimited quantities. It is given at such temperature as the patient prefers. It is allowed, but patients do not, as a rule, ask for much. When the stomach contents are thick or very acid, water appears to act as a simple diluent so as to diminish the general discomfort and to reduce the frequency of efforts to vomit. From a suggestion of Dr. McCosh I have learned to permit the use of water freely instead of using the stomach-tube, even in cases where there is extensive peritonitis and considerable vomiting.

Patients suffer very little, sometimes not at all, from thirst, in such cases as previously were constantly begging for relief. It is believed that the elimination of the anesthetic occurs more quickly and that the secretion of urine is less interfered with.

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