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Circulation: December, 1905, 35,521.

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 off the stones.-FROUDE.

The Medical World

C. F. TAYLOR, M.D., Editor

A. L. RUSSELL, M.D., Assistant Editor PUBLISHT BY THE MEDICAL WORLD Co. 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 ss. 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.

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Language is a growth rather than a creation. The growth of our vocabulary is seen in the vast increase in the size of our diction. aries 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. Hish 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 Philological Association, and list of amended spellings, publisht in the Century Dictionary (following the letter z) and alse 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 pub Ecations of the National Educational Association as follows:

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You are invited to extend notice of this action and to join in securing the genera adoption of the suggested amendments. IRVING SHEPARD, Secretary."

We feel it a duty to recognize the above tendency, and to adop it in a reasonable degree. We are also disposed to add ent (enough) to the above list, and to conservativly adopt the follow ing rule recommended by the Americar Philological Association Drop fina! in such words as "defnite," "infinite," "favorite, etc., when the preceding vowel is shott. Thus, spell" opposit,' preterit," "hypocrit,' requisi," e.c. When the preceding vowel is long, as in " 'polite,' finite, unite, etc. retain present forms unchanged We simply wish to.de our duty in aiding e simplify and rate alize our universal instrument-language.

JANUARY, 1906.

Doctors Should Stand Together. The first of the year is a good time to make resolutions. It is a time to branch out into new avenues of thought-to broaden. In this connection there is one thing we want to say. We suspect that many of our readers, perhaps very many, are not members of the organized profession are not members of any medical society. Perhaps some are even opposed to organization of the medical profession. We wish here to state that we believe in an organized profession; we believe that every doctor owes it to himself and the work which he has chosen, to make himself a part of the organized profession. Why should not a man identify himself with his profession? Not to do so seems to indicate that the outsider is not worthy of a seat with his fellows.

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The goal should be membership in the American Medical Association; but that is by no means the whole kernel, for one gets much more direct benefit from his local and state societies. The door to the National Association is membership in your State Association; and the door to your State Association is membership in your county society. So the first step is, to gain membership in your county society. If your county has no society, you are the one to begin a movement among the physicians of your county toward the organization of a county society. Talk to your medical neighbors about it, and write to Dr. Geo. H. Simmons, Secretary American Medical Association, 103 Dearborn Ave., Chicago, Ill., for instructions for the organization of a county society. Affiliation with your medical

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co-workers will make a better man and a better doctor of you. Perhaps it will also be a benefit to them; but more probably the benefit will be mutual. Why not try it anyway?

However, when I sat down to write these lines, it was for the purpose of again urging any who may not have read the Principles of Ethics of the American Medical Association, to immediately, as a good beginning of the new year, send five cents to the secretary of the association above given, for a copy of the Principles of Ethics, and read it carefully. We know that many doctors were violently opposed to the old "code." The most virulent opposition came from those who had never seen a copy of the code. They imagined it to be an instrument of torture; whereas, if they had gotten a copy and quietly read it, they would not have found it to be such a dreadful thing after all. The Principles of Ethics are a modification and modernization of the old code. It is an important document, with possibilities for much good. No doctor has a right to oppose it, nor can he form an intelligent opinion concerning it, until he has read it. Fortunately we have the privilege of addressing many young members of the profession, and many students about to enter the profession. To these the above is opportune. We have the privilege of addressing, also, many who are not in affiliation with the regular profession, but who are adherents to the so-called "irregular" schools. While reminding these of the warm welcome which they have received in the WORLD "family," we wish to say that the above applies no less to them, for now the doors of the organized pro•fession are open to all legal practicians. The old regulars who have wandered away under false leadership, with a false understand ing of "independence," and who have become professional nondescripts-with these particularly we wish to plead. Don't be misled any longer. Get the document above referred to and see that it is a charter of dignified liberty, and not the instrument that you have imagined it to be. Round out your professional life within the ranks and in harmonious affiliation with your fellow workers, and not as a "kicker."

While I am earnest and sincere in the above remarks, at the same time I realize that organization, with consequent organization journals, means death to many now prosperous inde pendent journals. For example, a doctor who receives the excellent, able and enterprising Journal of the American Medical Association will have less need for THe Medical World than one who does not receive the Association Journal. But no true journalist, with the good of each individual doctor and the profession at

large at heart, will allow his private and personal interests to swerve him from his journalistic duties and obligations. It is better that the true interests of the profession be served than that THE MEDICAL WORLD or its Editor should prosper. If the practise of medicin is an unselfish profession, then medical journalism should also be an unselfish profession. His work is narrow and temporary who works for self and selfish interests.

If the evolution of the medical profession should demand or involve the death of THE MEDICAL WORLD and the financial discomfiture of its Editor, the Editor of this publication will nevertheless work for the evolution of the medical profession.

So I say again, and emphatically: Get and read the Principles of Ethics; join the organized ranks of medical workers; and if, by vir. tue of belonging to medical societies, the literature of such societies should crowd THE MEDICAL WORLD from your table, I will bid you a cordial adieu, conscious of having work for the highest good of yourself and of your and my (our) profession.

However, this is not a valedictory, for I have no doubt that there is yet much work for THE MEDICAL WORLD to do for the profession, and it will proceed to do it with the same courage and disregard to consequences to itself that has characterized it in the past.

The Treatment of Acute Rheumatism. We have no new drug nor any wonderful discovery to herald in this connection, but we believe the method of administration of the drugs in common use may well be reviewed with profit. Practically but two classes of drugs need be discust in this connection, for the overwhelming majority of the profession the world over have narrowed their treatment down to these two classes: i. e., the salicylates and the alkalies. Within the last two or three years, the unanimity of such decision is surprising; practicians of all schools in all countries, and practically all the great hospitals of Europe and America being united in their views and practise. The greater number of these experienced observers adhere to the belief that in the salicylates lies the greatest virtue, but a considerable class assert their belief in the theory that the alkalies have an influence in obviating cardiac complications and in shortening convalescence not possest by the salicylates.

There is no potent objection to the alkalies on the part of those pinning their faith to the salicylates, and recent observers of note express the belief that the alkalies (in some cases, at least) have power to ward off complications

and shorten convalescence, tho being devoid of influence upon fever curve or pain. It is admitted by those who use the alkalies most, that the salicylates have a definit pain relieving power which the alkalies cannot induce. We know that the salicylates have no power to prevent relapse, while it is possible that the alkalies, temporarily, may have such action. Such consensus of opinion would suggest a combination of the two great lines of drugs in the medication of all grave cases.

Differences, however, as to mode of administration and as to choice of salt are notable. Most of those employing the salicylates prefer the sodium salt, perhaps more from force of habit than from any valid reason. Many of the users of the alkalies prefer the potassium salt, but this practise is not unanimous, by any means. Wood (University Medical Magazine, January, 1895) favored the ammonium salicylate for reasons which we believe well taken: i. e., (1) It is freely soluble. (2) It is rapidly absorbed. (3) It speedily produces the characteristic action of the salicylates when administered in sufficient amount. (4) It is less de pressing than are the other salts. The point where many have failed in the use of the salicylates is that they have not given enuf of the drug at the outset. Two or three grains, even given hourly, will not do in grave cases. You must get the effect of the salicylate at the very outset, and it often takes 120 grains in the 24 hours to do this. The total daily amount is more important than is the method of administration, or the size and frequency of the dose. We prefer giving 10 grains every two hours until we have a pronounced effect upon the pain, then less frequently, unless an exacerbation is threatened. Many practicians employ 15 and 20 grains, until they get the effect. Quite a number of able clinicians stop the salicylates as soon as the pain is controled, but it has been our practise to continue the drug in progressivly lessening amounts for a considerable time. If one gives it too long or in too great quantity, it will cause profuse sweating and aggravate the inevitable anemia. Then, too, one must expect to occasionally meet, in susceptible patients, such untoward symptoms as severe vomiting, vertigo, aggravated tinnitus aurium, even actual deafness, epistaxis, and in rare cases activ delirium. We believe, in some susceptible cases, such symptoms can be controled, and yet the effect of the drug be obtained quite as readily, by administering it per rectum. And, if the gravity of the case demand heavy dosage for many hours, one should not forget to add a few 20 grain doses of sodium bromid.

Given as above, we do not think many practicians will find the salicylates disappointing.

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A Method of Shortening the Quarantine in Diphtheria.

The quarantine period in diphtheria is commonly distressing because the children are infectious for a long period after all symptoms have disappeared, and after they feel as well as ever. All that is necessary to shorten this period is to secure a disappearance of the Klebs-Loeffler bacillus from the secretions of the nose and throat. Recently French observers have been experimenting along this line, and it is now announced that by means of dried serum the germs may be banisht from the secretions of the throat within a period averaging six days subsequent to the disappearance of the membrane.

The dried serum is prepared with gum in cachets, and directions are given that one cachet be slowly dissolved in the mouth every hour. It is important that it is not quickly chewed and swallowed, but that it be dissolved slowly, so that the effect be maintained as long a time as possible. In case of involvement of the nasal passages, the dried serum may be insufflated.

No possible harm can follow the trial of the plan, and as it cannot provoke error in the bacteriological test, we can see no objection to it, and there is certainly much to commend it.

Need of Caution in the Use of the X-ray.

As with every new thing in medicin, the use of the x-ray has been "overdone," or at least done injudiciously and without sufficient investigation. General practicians all over the world have not hesitated to use the ray in every imaginable and demonstrable form of malady.

The first untoward results were manifested by severe burns and x-ray dermatitis, and for a long time this was supposed to be an ineradicable drawback to the treatment. No expert operator now deliberately allows his patient to be burned. Then epilation was noted in many instances, and this feature is yet to be positivly eliminated. Other objectionable symptoms have been frequently noted, such as brittleness of the hair, dry and thin skin, loss in weight, vasomotor and digestiv symptoms, nausea, and general neurasthenia. These symptoms developt in patient and operator alike and impartially. Lately numerous cases of necrospermia and azoospermia have been reported in both physicians and patients, and this even in

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