The Medical World

C F. TAYLOR, M.D., Editor

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No. 10

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 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 Philo logical 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 pubHications of the National Educational Association as follows:

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 enn (enough) to the above list, and to conservativly adopt the follow ing 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," "unite," etc., retain present forms unchanged. We simply wish to do our duty in aiding to simplify and ratios alize our universal instrument-language.

Weaning of Babies.

finite,"

This is a process which directly affects the life and health of every child, yet the laity as a rule consider it a matter of so little importance that they seldom consult a physician until after the harmful results of injudicious weaning have been manifested. The physician, himself, oft-times is careless when consulted upon this matter, tho there are few practicians so illy informed as to fail to appreciate the gravity of the matter as concerns the health of both mother and child.

Weaning should never be done rapidly except in those instances where it is imperativ, as when the mother is suffering from consumption, great debility, typhoid fever, pneumonia, or other severe acute disease. Some consideration should be given the matter of weaning every child when it has reacht the age of ten or twelve months. If this age is reacht in hot weather, weaning may wisely be postponed until cooler weather. The best plan is to begin the weaning process while the mother yet has abundance of milk of good quality, so that one bottle of artificial food may be given each day, and at that feeding-time the breasts should be emptied by a breast pump. As time passes, and the infant becomes accustomed to the innovation, the number of bottles is gradually increast and the number of nursings diminisht, until artificial food has entirely supplanted the breast milk of the mother. Weaned thus, few infants will manifest serious disorders of digestion, either temporary or permanent. In some instances, there is so great a diminution in the quantity or quality of the mother's milk that the child no longer receives sufficient nourishment, and when this occurs, the plan outlined above should be taken up regardless of the age

of the infant. It is never wise, when it is possible to employ any of the mother's milk (poor quality or quantity excepted) to dispense with it entirely and suddenly; even if but one or two nursings daily can be furnisht, it may be very valuable. Before the age of ten months, if the milk become deficient in either quantity or quality, the physician should make a diligent study of the mother as regards her physical condition and personal habits, in order that he may be positiv that the deficiency is irremediable before ordering the babe weaned. Chemical analysis is the only scientific and accurate method of determining the food value of mother's milk, yet the expense of the procedure renders it imperativ in many instances that we employ less scientific measures. First, then, if a babe is growing at a normal rate, we assume that it is getting sufficient nourishment. If it is not growing normally, or if diarrhea or vomiting is persistent after other assignable causes have been eliminated, we assume that the milk is either insufficient in quantity or deficient in quality. If a child is unwilling to cease nursing after a proper length of time at the breast, or if it relinquish the nipple with a wail of dissatisfaction, the milk is likely insufficient.

Nurs

The health of the mother is always to be considered as much as that of the babe. ing longer than ten or twelve months puts a drain on the system to which few women should be subjected. The popular belief that a woman will not became pregnant while nursing has no foundation in fact, and should be explained to every mother who persists in nursing her infant for an unduly long time. Some women in whom the molimen appears while nursing, notice that the baby sickens each month when the flow appears. women should feed the baby artificially during the continuance of each flow, and usually the milk again becomes fit for use in a few hours after cessation of the flow. Should pregnancy occur, the mother should wean the infant at once, regardless of age, since no woman has the strength to nourish two bodies in this manner, and either the fetus or the infant would suffer in nutrition.

Such

Advice upon this matter is strictly in the province of the family physician; and he should realize this and act accordingly.

Simple Continued Fever.

There is a fever, common in the Southern States and occasionally observed in the northern sections, which is neither typhoid nor para-typhoid. It continues for two weeks to three months, and no lesion has yet been discovered. Cases coming to autopsy reveal nothing beyond a state of lowered vitality of

all tissues, and the deaths are rare indeed. While the fever generally has a slight morning remission and evening rise, it is seldom observed over 103° F. There is a slightly coated tongue, possibly slight gastro-intestinal derangement, malaise, etc.; but there is nothing essential but the fever. Quinin eliminates malarial origin, and the large percentage of recoveries removes the question of tuberculosis. Not many cases give a history of any affection preceding from which infection might have arisen as in pneumonia or pleurisy which sometimes leaves a local focus of infection which manifests itself by mild constitutional symptoms of septicemia. The disease has been studied by DaCosta, John Guiteras, Cain, Baumgarten, Goodhart, and Hale White, who respectivly labelled it "protracted simple continued fever," "thermic fever," "atypical continued fever of Nashville," "simple continued fever,' ""innominate fever," and "inexplicable fever." The name, simple continued fever is probably the best, and now has a recognized place in our text-books on medicin.

The diagnosis is an important point, since it is necessary to save the patients from being subjected to the hardships of typhoid fever treatment, when the exigencies of the case do not require it. Fortunately the Widal test admits of elimination of typhoid fever from consideration; remittent and intermittent fever may be set aside by proper therapeutic tests; miliary tuberculosis can usually be detected when carefully searcht for; and the fever sometimes attending chlorosis, hysteria, or nervous disorders ought not to baffle long, any practician of ordinary ability.

The treatment is entirely symptomatic, and merely includes tonic and supportiv measures. If practicians would study their cases closer, there would be fewer cases of "walking typhoid," "para-typhoid," etc., reported.

Reflex Cough.

Reflex cough is one of the symptoms most frequently misinterpreted by the careless and superficial diagnostician. Even after cursory examination has failed to reveal anything wrong with the bronchial tubes or respiratory apparatus, after divers expectorants, sedativ and stimulating, have failed to relieve, still the misguided medication is persisted in until digestion becomes deranged, and the after condition of the patient is worse than the first. Surely there is no excuse for this variety of malpractise at least there is no excuse for failure to suspect the true origin and for neglect in attempting to search it out. the summer season, especially, when a patient presents a history of an intractable cough,

In

which may be simply an annoyance, or which may be violent and distressing, and which is not accompanied by any evidence whatever of coryza, asthmatic attack, or bronchitis, it is high time for the practician to examin other parts of the body beside the thorax.

The "stomach cough" is known and recognized in many instances by experienced mothers or "old grannies," and the practician who gives a cough mixture is pretty certain to aggravate the case, if indeed he be fortunate enuf to escape ridicule at the hands of wiser, if unlearned, therapeutists. This variety of reflex cough is toucht upon but gingerly, when at all, by the text-books; yet every practician of experience has noted it. It comes from an overloaded or improperly functionating stomach, and promptly disappears after a cathartic and ingestion of digestants, with a little judgment regarding diet. Impacted cerumen in the ear is a not infrequent origin of reflex cough, and one which will likely baffle the man who makes "snap diagnoses." The nose is the organ most frequently at fault, and it is always deserving of an examination when the suspicion of reflex cough has been aroused. Cough, without coryza, may be induced by simple, chronic or by hyperplastic rhinitis; spurs, deflections, or abnormalities of the septum; congestion of the cavernous tissue covering the vomer; adenoid growths in the pharynx; enlargement of any of the turbinated bones; or by any vasomotor disturbance in the nostrils. If, upon inspection of the nose in cases of suspected reflex cough, any alteration, malformation, or unnatural irritability of the intra-nasal spaces be discovered, they should be promptly remedied by suitable application or surgical procedure. Even when nothing can be discovered, the nose is often at fault; in which case the application of a cocain solution at suitable intervals will confirm the suspicion and establish a diagnosis in the majority of cases. Failure of the cocain should not encourage one to abandon the search in the nose when other parts have been examined.

In any event, never let yourself be led into the error of a continued erroneous diagnosis regarding a reflex cough.

lieves that mild cases without diaceturia are aggravated by the oat cure, and his total failure belonged to this class.

His diet table when instituting treatment follows: 250 gm. oats; 100 gm. albumin; and 30 gm. butter, daily. A little black coffee or a little brandy or wine is allowed.

It has been known previous to the publication of this paper that the rigid "diabe ic diet, as outlined in the text-books of a very few years back, was not calculated to maintain the strength of the patient, and certainly was not productiv of practical results as regards cure or even improvement in any but exceptional cases. It was also recognized that a plain diet rich in carbohydrates was generally better borne by the average patient than the mixt diet containing but small proportion of carbohydrates. He is very fair in recalling the injurious effects following the craze for the absolute milk diet as promulgated by Winternitz; the "rice cure" of von Duhring; and the "potato cure" of Mosse; and he distinctly states his wish that such radically minded enthusiasts will not expect too much of the "oat cure." He reiterates an old axiom in medicin to the fact that all patients cannot be treated alike. Every one reading the paper (The Post-Graduate for April, 1904) will be convinced of his sincerity and of the value of the method.

It is simple, logical, and easily followed, and we advise its trial in suitable cases of diabetes. Just as to which cases are suitable for the oat diet, von Noorden is not yet prepared to state. He brings out the contra-indication mentioned above quite forcibly, and pleads for careful study of the effect on each individual case. If the profession will use this diet in the careful and conservativ.spirit which characterizes the originator's efforts, it will not be long before we will be able to classify the cases as to whether or not the diet is suited to them. Certain it is that a distinct advance has been made (altho it can hardly be dignified as a discovery) and much good will result.

Readers having diabetic patients upon whom they wish to test the effect of the diet should keep a complete record of the weight and general condition of the patient, the excretion of ammonia and acetone, as well as the exact amount of glycosuria, in order that they may report their results in a manner that will be logical and convincing to those who have not been fortunate enuf to have had the management of a case. The entire "family" working upon this problem can soon turn in thousands of reports, and this mass of testimony will be convincing as regards the merits or demerits of the dietary. Von Noorden used the oats prepared by Knorr or the oat groats

of Hoenlohe, but we do not doubt that the oat meal of domestic manufacture is as fine and wholesome as any brand from across the sea.

Alopecia Areata.

The feeling which pervades the professional mind regarding the futility of treatment in cases of alopecia areata is, in many cases, as in a too numerous group of other uncured maladies, well founded. But this intractability is perpetuated by a deficiency in diagnostic ability, and a consequent carelessness or error in therapeusis which is not excused by the obstinate character of the disease. There ought to be more care exercised in making a diagnosis. Perhaps ringworm is most frequently confused with alopecia areata, but the two should be easily differentiated. Ringworm is always scaly, and even if in some cases this is slight, it is always found on close inspection; alopecia areata never presents this feature. The broken off or nibbled appearance of the hair in ringworm is not at all like the total baldness of alopecia. In ringworm the baldness is incomplete, and scattered hairs remain ; in alopecia areata there is no evidence of inflammatory action, and no dilated follicles. Moreover, ringworm is contagious and more than one case is apt to occur in a family; alopecia areata is limited to the individual, and is a rarer complaint, only being contagious in cases of parasitic origin.

Such

Dermatologists differ in their belief as to the etiology of alopecia areata, some holding that it is always parasitic in origin, and others that it is a neurotic affection. Perhaps the most likely hypothesis is that two distinct etiological factors operate in some cases a neurotic factor, and in others a parasitic one. authorities as hold to the neurotic theory exclusivly, direct their chief effort to constitutional remedies; those adhering to the parasitic idea use exclusivly local measures. Since there is as yet no method of settling this dispute, the pathological germ never having been positivly isolated, it is the part of wisdom for the general practician to administer both constitutional remedies and to make local applications of antiseptics and parasiticides. It is also a fact that nearly all applications used are both stimulants and parasiticides, and hence meet the requirements of either theory. The constitutional remedy employed must be directed toward the toning of the nervous system, and the best of the class are the following: Arsenic, quinin, nux vomica, phosphorus, pilocarpin, the various iron preparations and cod liver oil. Duhring is one of the most enthusiastic exponents of the arsenic treatment. It is given in doses of 3 to 5 drops of Fowler's solution, or the solution of sodium arsenate,

three times a day, and must be continued thru an extended period. Nux vomica and iron fit in nicely with the arsenic. Pilocarpin has numerous advocates, and some advise its use hypodermically in doses of too of a grain in proximity to the affected part. Morrow, holding firmly to the opinion that the disease is parasitical in origin, believes that local measures are aided and energized by the internal administration of phosphid of zinc and strychnin; phosphorus, iron and strychnin; or phosphoric acid and strychnin.

Local measures should produce two results: An increast flow of blood to the part thru stimulation, and a positivly destructiv action against any parasite which may be present in the tissues affected. In this affection the skin will tolerate drastic measures so long as the unaffected part is not subjected to the medication. It is good practise to remove the loose hairs by grasping between the thumb and finger and pulling gently; the loose ones come out readily and those with firm attachment are not removed. In making application of the medicaments, the area included should not exceed a width of over one-half inch outside the actual area of baldness. With patients not seen oftener than once a week, it is not advisable to use the stronger remedies, but to employ some of the following: full strength of ointments of tar or sulfur; 5 to 15 percent beta-napthol ointment; oil of tar, pure or with alcohol, equal parts; equal parts of oils of cade, oliv, and turpentine, or the following prescription sulfur, 2 drams; beta-napthol, i dram; lanolin, 2 drams; and vaselin, q. s. to make an ounce. Once a week, an area not to exceed two square inches, may be treated with strong applications of carbolic acid, chrysarobin, or tincture of iodin containing four grains of bin-iodid of mercury to the ounce. If the involved area be small, or if there be several small patches, the stronger remedies may be employed regularly. One of the best of these, as commended by Robinson, is an ointment made by incorporating 10 to 60 grains of chrysarobin to the ounce of lard or vaselin; or painting the affected areas with pure carbolic acid, as advised by Bulkley. In children, or in those with very sensitiv skin, the carbolic acid may be weakened by one to three parts of alcohol. Such applications are followed by inflammation and later by exfoliation. Stelwagon advises applying a saturated solution of chrysarobin in alcohol; and after this dries, painting over with two or three coatings of collodion. Another strong application, but one which must be watcht, is made of equal parts of oil of turpentine, tincture of capsicum, and tincture of cantharides. This often requires weakening with oliv oil. Those who

have available the faradic or static current should try it in all cases, as very flattering reports have been repeatedly made upon the use of these forms of electricity.

An accurate prognosis requires both ripe experience and good judgment. Occurring from the age of five to that of fifty, it may be said safely that the younger the patient and the smaller the patch, the more favorable the case is for encouraging the hope of a pigmented regrowth. In some cases the areas are again covered with hair which lacks the pigment of the surrounding hair and the resultant contrast is nearly as distressing as the baldness. No case is hopeless; Crocker reports a case where the entire scalp was denuded, yet the hair returned, remaining white for a time, but eventually resuming its normal color. The first mark of improvement is when the hair at the periphery of the patch is no longer noted as loose when given a slight pull; next, fine hairs appear and gradually cover the patch; and finally the hair approaches the natural texture and regains its normal pigment. A favorable prognosis is generally safe when the patient is under fifty years of age.

The Interests of the Profession. American medical journalism is of vital interest to every American doctor. Any American doctor who does not feel that this is true fails to understand and appreciate his interests and his rights. In determining a question like this, every one should consider the welfare of the profession as a whole. To judge only from one's own surroundings, and the conditions existing in his own necessarily limited horizon, is narrow and selfish. Every true doctor will stand for the interests, dignity and welfare of the profession as a whole. Medical journalism is the organ of the profession as a whole; therefore its ideals should be the highest, and it should be devoted solely to the interests of the profession.

These thoughts are suggested by numerous letters that come to this office, a few samples of which we will here present.

Editor MEDICAL WORLD:-I admire your stand against the Brief and other professional parasites. It comes to me regularly, yet unsolicited and against my wishes. Wishing you continued success in your laudable labors. I am, yours very fraternally, Millville, Mo.

J. MORSE GRIFFIN,

Editor MEDICAL WORLD:-Inclosed find $2.00 for one year back and one to come. I don't think any other than the easiest kind of an individual would fail to see thru the graft the Medical (?) Brief has been handing out for the last ten years. I fail to see how any honest, half-awake man can countenance the besmircht thing. I was looking for some one to get after it and supposed it would be THE WORLD. You are all right, doing a good work, and an honest medical fraternity will be with you. T. D. WHITE. Orrstown, Penna.

DR. C. F. TAYLOR:-This is a small town with four medical men in it. The other day while in our local newsdealer's place, I noticed a new copy of the Medical Brief on the counter. The newsdealer askt me if it was a good "seller." He also told me that it had been sent to him, and he had been askt to keep it for sale. I have received a great many sample copies of the Brief, but always thought it about the poorest thing in medical journalism I had ever seen. May THE WORLD "live long and prosper." Shelburne Falls, Mass. J. S. OUTHOUSE.

Editor of THE MEDICAL WORLD; DEAR EDITOR :— I presume there are many physicians that feel as I do concerning quackery, patent medicins, and medical ethics, but prefer to remain silent rather than to express their views on account of either modesty or fear of criticism. But when I learned recently that our postmaster and news agent was trying to sell copies of the Medical Brief, and when I learned thru the columns of THE MEDICAL WORLD that the Brief was being sold in like manner all over the country, a sensation of disgust came over me, and I wish to express my sentiments to the profession thru your columns. I think the Brief is acting contrary to the wishes of the best elements of the medical profession. I fail to see how any conscientious M.D. can afford to give a medical journal taking such a course one iota of support. The recent act of placing it on sale to the general public has, in my estimation, stampt it as rotten to the core; and there must be something the matter with any physician who will remain a paying subscriber after being thus insulted. F. L. REDMAN.

Corinna, Me.

The Doctor writes privately that he wrote the above just as he felt, "mad and disgusted." But he then laid it aside for a week, hesitating to send it. Then he referred it to "one of the brightest physicians in this section," who said: "Send it along. It is all right. Those are my sentiments. There are thousands of physicians that approve of the course of THE MEDICAL WORLD, but do not like to express their views."

He also incloses a printed circular letter, mailed (according to postmark) in St. Louis, July 21, 1904, to the news agent, Mr. W. I. Burrill, Corinna, Me., which reads as follows:

Dear Sir:-We send you by mail today two sample copies of the Medical Brief to be placed on your stand for sale. The Medical Brief is the largest circulated medical journal in the world, its great popularity being due to the great number and variety of articles from physicians everywhere.

The Medical Brief is read not only by the medical profession, but by all professional classes interested in medicin and surgery.

We believe that we can interest you by offering you an inducement to keep the Medical Brief on sale. Retail price, single copies. Trade price.

Mailable at pound rates.

. . Io cents. .. 5 cents.

Front covers of unsold copies returnable, to St. Louis office.

The above undoubtedly came directly from the publication office of the Brief, for the circular has "The Medical Brief, J. J. Lawrence, A.M, M.D., editor and proprietor," etc., printed at the top, and it was sent in a printed Medical Brief envelope, and the name and address of the newsdealer is printed on a slip, which was pasted on the envelope, showing that a printed list was used in sending out the