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Circulation: April, 1904, 35,421.
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 of the stones.-FROUDE,
The Medical World
C. F. TAYLOR, M.D., Editor and Publisher
A. L. RUSSELL, M.D., Assistant Editor
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 enus (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 ratio < alize our universal instrument-language.
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"THE MEDICAL WORLD" 1320 Chestnut Street
In the Lying-in Chamber. At a confinement case is a time when a man is very apt to show his real nature. That is a place where one needs to be doing something all the time, even if it is only fanning the patient, feeling her pulse, or washing his own hands. The poor woman in her distress is horrified to see a callous doctor read the paper or enjoy the brilliancy of the sunrise from the window or porch at such a time. The situation is real, and is very serious to her. While he may be confident that he is attending her in the best possible manner, she feels that he is neglecting her and is cruel, if not ignorant. One of the best teachers of obstetrics in this country today always advises his students to “be busy in the lying-in room, even if there is really nothing to do.'
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 Eng: lish spelling of a centnry or iwo 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 Philo. logical Association, and list of amended spellings, publisht in the Century Dictionary (following the letter 2) 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 tot 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: tho (though);
program (programme); altho (although);
catalog (catalogue); thoro thorough):
prolog (prologue); thorofare (thoroughfare); decalog (decalogue); thru (through);
demagog (demagogue); thruout (throughout);
pedagog (pedagogue). "You are invited to extend notice of this action and to join in
Diagnosis and Treatment of Cases of
Poisoning. It is unfortunately true that a diagnosis previous to death is frequently impossible, yet it is the duty of all physicians called to cases of poisoning to exert themselves diligently to make an accurate diagnosis, in order that the proper antidote or treatment may be instituted, and also that the fullest possible data may be secured for the legal investigation which is generally sure to follow. It is a fact not generally known, even to the profession, that there is only one poison which has a symptomatology sufficiently definit and clear as to admit of an absolute diagnosis; all the others yield variable symptoms, and the diagnosis is always somewhat in doubt unless extraneous circumstances yield circumstantial evidence strong enuf to be trusted implicitly.
The first step in an attempted diagnosis is to it away where it will be secure from contaminexclude those diseases which more ar lessation or manipulation until there is time for a closely simulate poisoning in their symptoms. complete examination. When several persons Of those simulating irritant poisons, the most who have partaken of the same food or drink common are cholera, cholera morbus, acute simultaneously develop the same line of sympindigestion, ulceration of the stomach, acute toms, the suspicion of poisoning should be gastritis, gastro-enteritis, peritonitis, appendi- aroused; yet it must be remembered that only citis, hepatic or renal colic, and intestinal ob. one of such a party may be affected because struction in later stages. Those which re- only his portion has been tampered with, or semble poisoning by narcotics include hysteria, because the others may have a greater tolerance cerebral hemorrhage and thrombosis, epilepsy, for the drug. The ideal diagnosis would be convulsions due to organic cerebral lesion, based upon a chemical examination of the sustetanus, cerebritis, meningitis, uremia, and pected food or drink, yet it is only in the organic heart disease. It is always well to rarest of instances that this is practical. For take a comprehensiv survey of the surroundings three drugs, however, we have a test which is of the patient while striving to interpret the speedy, easy to perform, and reliable; and symptoms. A partially emptied bottle, or the every practician should be able to perform odor of one completely emptied, with or with. Reinsth's test for arsenic, mercury, or antiout a label, accompanied by the odor of the
mony. breath of the victim or the marks of corrosion Certain routine methods are advisable in the on the lips, tongue, or throat, would often treatment of poisoning, whether or not the make certain a diagnosis of poisoning by car- agent can be definitly ascertained, and the inbolic acid; chloroform and the crude opium dications are: (1) The removal of the poison preparations are also often recognizable. The from the stomach. (2) The administration of vomited matter and the feces should always be antidotes. (3) The elimination of the poison subjected to careful scrutiny; the odor of car- as speedily as possible. (4) Counteracting the bolic acid, of potassium cyanide, and of lau- constitutional effects of the poison and stimudanum are easily distinguishable; phosphorus lating the system. is luminous in the dark; and in arsenical The poison is removed from the stomach by poisoning one may often detect the insoluble inducing vomiting, or by the use of the stomach crystals of the trioxid of arsenic.
pump or tube. In many instances vomiting is one The following rules are safe to follow in of the symptoms, and it merely needs encouralmost all instances: (1) In cases of poisoning agement by administration of tepid water. The the symptoms appear suddenly, and often in emetic is a useful adjuvant to any plan of treatone seemingly in perfect health. (2) The ment, and the most convenient form is usually symptoms frequently arise soon after ingestion common ground mustard stirred in tepid water; of food, drink, or medicin. (3) If several the one tenth grain of apomorphin hypoderpersons have partaken of the same food or mically, or fifteen or twenty grains of sulfate of drink, they generally develop the same symp- zinc or copper are useful if at hand. Any toms,
antidote selected may be given in warm water. Disease, with few exceptions, is preceded The stomach pump is seldom at hand when by a variable period of indisposition and does needed, but a very serviceable one is impronot attack with the impetuosity of poisons. It vised by a piece of rubber tubing of sufficient must be remembered, however, that in some length, and a funnel. A pint of water should cases of poisoning, there is an unaccountable be used at a time, and at least five washings delay in the development of the symptoms; should be employed; it is generally advisable and the time of development is always influ- to add the antidote to the water used thru the enced by the condition of the stomach as to tube, as a certain amount is retained and will the presence of food, and the form in which the aid in counteracting the effects of the poison. poison has been ingested.
In undoubted cases of poisoning by strong corThe difficulties surrounding a diagnosis are rosiv poisons, it is not judicious to force or enaugmented in cases of chronic poisoning where courage violent retching lest perforation thru the doses are small and frequently repeated, or the thinner walls of the stomach or esophagus where poison is ingested during the course of result; in such cases it is better to rely on the any disease. Sudden and severe illness follow- antidote combined with copious draughts of ing soon after taking food, drink, or presum- water or milk. (Hemmeter, however, differs ably properly prepared medicin, is always sus- from other authorities on this feature, and adpicious. In such cases, when possible, always vises the use of the tube in such cases,
claiming subject the suspected food or drink to a rigid that, “ As such cases run great danger of a corexamination as to odor, taste, abnormal color, rosiv perforation we have personally used the or altered appearance; and place a quantity of tube, and let the patient take his chances,
which were better in these cases than in those sufficient oxygenation of the blood ; chloral where the tube was not used.")
and chloroform are useful in convulsions. Antidotes may be classed as (1) chemical, Excitement caused by too many visitors is and (2) mechanical. The mechanical antidote best avoided, and the patient kept quiet in acts by coating the poison or the stomach wall bed. If there is markt coolness of the surwith some insoluble material so as to delay ab- face, artificial heat should be employed. The sorption; the class is represented by milk, indication for stimulants is easily recognized. whites of eggs, fats or oils of any kind, and in short, the treatment must be symptomatic, powdered charcoal. The latter acts by ab- and the patient carefully watcht. sorbing the poison. Fats, oils and milk are contraindicated in phosphorus poisoning, since
Beware of Catarrh Cures. they but make the poison more soluble and It is well known that many secret catarrh hasten instead of retarding absorption. The cures contain cocain. The object is to get the proper chemical antidote for the various patient in the habit of taking the catarrh snuff, poisons may be found in tables publisht in all with every prospect that he will continue it books of reference, yet it is important to re- indefinitly. Other secret nostrums advermember the fact, that the compounds formed tised to cure catarrh, asthma, hay fever, bronby the various antidotes are but relativly harm- chitis, consumption, etc., to be taken interless, and must themselves be removed from the nally, are launched on the same basis, and for stomach as soon as the immediate danger is the same purpose. Inducements are made to over. It is always well in selecting a chemical
take “a full month's treatment, and then antidote to choose one which in itself has as instructions are given how to order, and the little power of harm as possible ; for instance, victim is told that the goods will bear no exwhen an acid is indicated to counteract an ternal marks. The reasons are obvious; the alkali, select some harmless substance like plan is transparent to those who will open vinegar or lemon juice.
Doctors should explain this to the Never place reliance in the fact that the laity whenever occasion offers. If we had a vomiting has been profuse, but wash out the law like that of Germany, requiring the formstomach or employ the antidote; cases are ula on every bottle or package, the ignorant recorded where vomiting had continued for could not so easily be entrapt into the slavery many hours, yet the autopsy revealed enuf of of drug habits. That such should exist in this the poison clinging to the gastric walls to cause
" land of the free" is an outrage. death. In cases of doubt, the “universal' antidote may be employed. It is prepared by
Electrical Equipment for the General Prac
tician. adding two parts of powdered charcoal to one part each of tannic acid and magnesia, and ad
For some time past we have intended speakministering in heaping teaspoonful doses
ing editorially regarding this matter, but comstirred in water, and frequently repeated. The
munities differ so widely, circumstances of physiologic antidotes are occasionally useful,
practise and finances are so variable, and above but too much reliance should not be placed all, the personal element of the operator enters upon them, for their use may add to existing
so largely into the case, that it is very hard to prostration, or in other untoward manner.
write so that all may derive the greatest instrucThe physiologic antagonisms of certain
tion. While we do not know what electricity drugs are well known; such as atropin to pilo
is, and while we do not at all understand how carpin ; strychnin to nitcotin; digitalis to
it produces results, or what its limitations may
be, there is nothing complicated or mysterious aconite; caffein to morphin; chloral to strychnin ; etc.; and they may be employed
about its workings or its management as applied against each other.
in medicin and surgery. Any man competent Claude Bernard has shown that if elimination
to practise medicin, may learn how to handle and absorption are kept fairly equal, harmful electricity therapeutically and successfully. It results do not accrue, or are reduced to the
cannot be learned in a moment, any more than minimum. The kidneys, skin, and bowels are
one can become a competent anatomist from the emunctories chiefly concerned in the elim- reading a quiz book; it requires study, just ination of poisons, and all should be stimulated
like anything else. There are now books * on to their highest activity. The systemic effects * The Röntgen Ray in Therapeutics and Diagnosis, publisht
by W. B. Saunders & Co., Philadelphia, New York and London, must be well considered ; anodynes must be
1903, at $4.50. Electricity in Medicin and Surgery, publisht by employed to subdue pain; strychnin, nitro
Boericke & Runion Co., New York, N. Y., 1901. Price, $3.50.
Static Electricity and the Uses of the Röntgen Ray, Snow. glycerin, and digitalis employed against danger Publisht by A. L. Chatterton & Co., New York, N.‘Y., 1903.
Price $3. of heart failure; and artificial respiration in
Electrotherapeutic Guide; Howe & Bennett.
Publisht by event of failure of respiration. Oxygen, National College of Electrotherapeutics, Lima, Ohio, 1901. Price $i.
Induction Coils ; Morrie. Publisht by Spohn & Chamberlain, when available, is valuable in combating in- New York, N. Y., 1901. Price $1.
the market which will induct the beginner from trical treatment: The Finsen light, the electric the simplest elementals thru to the more compli- light bath, the violet ray, etc., we advise all cated mechanisms and treatments, and tell one general practicians against attempting anything all that is known of the matter.
with them. The outlay is too great, and the If a practician is situated in a reasonably technic too difficult; the returns will not be populous community, and power current is commensurate, because the expense of operatconveniently obtainable, any general practician ing will be so heavy. can become a competent manipulator of elec- Radiography is quite a different matter. It tricity, and can ethically and legitimately em- is possible to get good fuoroscopic images by ploy the agent in his everyday work with bene- means of the static machine, and a few exfit to his patients and with profit to himself. If perienced operators have succeeded in making the practician be in a remote locality, and must excellent radiographs with the influence depend on the static machine alone, his field machine and suitable tubes and plates. This will be greatly limited and his results corre- is, however, the exception; since radiography spondingly unsatisfactory, on the one hand, in itself is a separate study and demands and disappointing on the other. However, special skill and experience if one expects to good work is possible with the static machine, do creditable work. We would not advise any to a limited degree, and many country practi- practician attempting to do radiographic work cians are making money and doing their with a static machine alone, except for amusepatients good with no other equipment. The ment or pastime. While the static machine great trouble with the average general practi- will make fairly good plates of such small parts cian and the static machine is, that the machine as the hand, it fails to do good execution in is bought by a man who knows as little of elec- the hands of the amateur in the very place tricity as he does of submarine navigation. He where assistance is most earnestly desired : In buys the machine, studies it until he can direct searching for stone in bladder, ureter, or kidthe sparks, and is then ready to apply the ney; in examination of the heart; in study of healing power of electricity to all comers." the lungs, etc. Truly, “fools rush in where angels fear to In partial fractures, or in fractures without tread.” Such a man will make a failure, and displacement, the fluoroscope frequently fails ever afterwards condemn electricity as useless, to give an image of anything like the actual or declare its employment a passing fad; and conditions; while the radiograph, properly he “knows, because he has tried it” (?). A taken, will generally detect any
fracture. Small man who purchases the proper books, and foreign bodies are frequently overlookt when studies them till he thoroly understands them; depending on the fluoroscope, while easily viswho then purchases a static machine suited to ible on a good radiograph. There are a few his needs, and who then studies it till he can advantages in the use of the static machine for operate it intelligently; who will then study radiographic work to balance the host of disthe books which teach the proper method of advantages. On account of the steadiness of applying a certain method for a certain com- its discharge there is less heating of the target plaint (provided he has the ability to, and has than when the induction coil is employed. previously properly diagnosed such complaint); Hence lighter and cheaper tubes may be emand who only then allows his patients to know ployed, and their deterioration is much less that he has the machine and he has the ability rapid than when subjected to the heavy impact to apply electricity as well as it can be applied from the coil. Since the cost of the tubes is a anywhere-such a man will make a success big item in running an X-ray equipment, this therapeutically and financially, so long as he consideration should not be lost sight ot. The does not allow his enthusiasm to run away with two models of static machines most used are his judgment, and begin declaring electricity a the Holtz and the Toepler-Holtz; the former panacea for all ills, as too many of the city is preferable for therapeutic work because its experts are doing. Such a man would make a discharge is steadier, its sparks longer, and its success anywhere. But the man who buys a effect less painful; for X-ray work there is little static machine principally for the “moral difference in the two types. effect " (?) it will have on those who see it in All static machines are easily influenced by his office, and who has not the time nor the in- climatic conditions and atmospheric change. tention of studying it until he knows something One must have a suitable place to keep a about it, is merely practising the methods of machine, and take as good care of it as one the quacks who prey upon the credulity of the would of a piano, if he expects it to work laity; and while he may get a few ill-gotten properly when he wants to use it. Very few dollars, they will be few, and he will probably doctors' offices in the country have a suitable “lose money on his machine."
place in which to stand a static machine, or to As to the more complicated methods of elec- protect it when placed.
We believe if a practician will study the sub- In simple dilatation, digitalis prolongs the ject in the books referred to, and give the sub- diastole and thus allows the heart a short rest ject the attention it demands after he has while the ventricles are being completely filled ; arranged for a suitable static machine and a it strengthens the systole, and thus aids in the place to keep it, that he can run such a complete emptying of the organ. In chronic machine with benefit to patient and doctor. valvular disease with waning compensation, as But we do not believe that any general practi- manifested by dropsy, deficient urination, and cian will find it profitable in a financial way to a weak, irregular and rapid heart, digitalis is go beyond this; he may own a few Crookes' indicated; but it must not be used indiscrimtubes and radiographic plates, and may do inately in such cases, for if the hypertrophy minor work for amusement of himself and exceed the dilatation as proven by arterial hypatients, but he should never base a diagnosis peremia, the drug will work injury. In mitral in an important case upon fluoroscopic exami- regurgitation digitalis aids in securing a more nation or radiograph made by himself with the complete closure of the valves and aids the static machine. In all large cities, now, there right ventricle in its struggle against the resistare men who are devoting their attention ex- ance in the pulmonary circulation. In mitral clusivly to this work. They have several stenosis it should never be used except when varieties of the static machine; they have large the right ventricle cannot keep up its work, and and perfect induction coils; they have unlimited anuria and dropsy are present.
In aortic stencurrent at hand and means of modifying it; osis it is only indicated when dropsy coexists they have the genuin Finsen apparatus ; they with evidence of back pressure in the lungs. have the scientifically constructed violet ray Even in aortic regurgitation digitalis is not apparatus, and bath cabinets; they have had always contraindicated. While it is true that extensiv and costly experience; and they the prolonged diastole which it induces admits usually have sufficient funds to back up the of a longer time for the back flow, it is also heavy drain on their finances. The general true that this is often more than balanced by the practician would better leave the advanced more forceful contractions of the ventricle inwork to such men, and remain content with his duced by the drug. In such cases with a weak, static machine, if he has one, or study the rapid and irregular pulse, digitalis is deserving matter carefully before investing. *
a trial. In advanced fatty degeneration digi
talis generally proves disappointing, and it The Use and the Abuse of Digitalis. should seldom be employed if there has been Probably digitalis is one of our most valu- angina pectoris. In pneumonia, with a failable drugs; certain it is that when it is indi- ing right ventricle due to inability to drive the cated, no other can take its place in a manner
blood thru a partially consolidated lung, digiapproximating the effect produced by digitalis talis often causes markt improvement in the itself. It is certain that no drug has been symptoms. more thoroly studied, and it is equally sure that In exophthalmic goitre, digitalis will slow the every teacher of therapeutics takes special pains pulse rate and soothe the tumultuously acting to instruct his students regarding the benefits heart; but it is frequently badly borne. In to be derived from the proper use of the drug nervous palpitation and paroxysmal tachycardia and the specific indications for its use. Yet, it is useless, but in the "simply irritable" notwithstanding, the drug is sorely abused; heart and in arythmia consequent upon simple many practicians, indeed, acting on the theory dilatation, it is frequently of service. that “ digitalis is a good heart stimulant,” It is the best diuretic we have in dropsy due give it in every case of functional or organic to heart and kidney disease, and it shows its heart trouble, whether indicated or not. Some best results when the pulse is soft and rapid. order it because they do not know what else to In dropsy due to liver disease it is a failure, give, but many more because they do not know and it seldom produces results in pleural effusthe drug. Of all drugs with which the practi- ions. cian should be perfectly familiar, digitalis Given a sharp clear-cut diagnosis, digitalis easily stands high in the list. It is quite as will seldom prove disappointing when used important to know the conditions calling for only where indicated. digitalis as it is to know the drug in its myriad effects.
Editor MEDICAL WORLD :-Inclosed find P. 0. order for Digitalis has three great effects: (1) it is a WORLD for 1904. I heartily commend your course in exposing
the “land sharks" who would swallow up the physician's hard powerful cardiac stimulant; (2) it slows a rapid
earned dollars by inducing him to buy worthless oil, mining, or heart and regulates its rhythm; (3) it acts as a other stocks. The country is flooded with worthless stocks. The
Boston banks are full of funds seeking safe investment. Now, if diuretic.
these stocks were such a good thing, the promoters would not
need to go around drumming up doctors to take a few shares. This editorial was written in response to an inquiry. Later we
E. W. CLARK. will consider the use of faradic and galwanic batteries.