The Medical World

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

A. L. RUSSELL, M.D., Assistant Editor

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No. 4

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 pub lications 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 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.

"Buy September Wheat."

Are doctors such inveterate speculators? If not, why do so many circulars and circular letters continue to come to me, and presumably to all other doctors? I thought I had the speculation fever about killed out among the doctors. I certainly stopt a great deal of it; but after being whipt out, its policy is to "bob up serenely" after lying quiet for awhile, as tho nothing had happened. Here comes a communication from a Chicago firm headed "Speculation in Farm Products now Popular." "Buy September Wheat." Do they think that if a Philadelphia doctor wanted to speculate he would send all the way to Chicago to do it? I have received such communications from St. Louis, also, and I suppose the whole list of doctors in Philadelphia got the same. Does this indicate that doctors do such ridiculous things as to send their money half way across the continent for a firm of entire strangers to speculate with? If they do, do they ever expect to see their money again? I was talking the other night with a fire insurance man of large and wide experience, who comes into contact largely with the drug trade and to some extent with doctors. He said that doctors are all right in their own profession, but outside of it, particularly in business, "they don't know a thing." I referred to the ease with which they can be induced to invest in visionary schemes. "Yes," he said, "one can sell them a gold brick any time if they happen to have the money.

But going back to wheat: I have a very dear friend (not a doctor) who had saved a pretty snug little sum by some years of industry and thrift. A time came when all his accumulations were in cash; and then the tempter

came. How easy to put a large part of his money into wheat margins and see it grow from day to day. He did it, and it grew, and he was elated. How easy! How different from hum drum toil from morning till night as a retail merchant. He continued. His gains were wiped out. Then his principal was endangered. It, at least, must be saved. Some of the reserve must be brought forward for that purpose. But why make the story longer? His snug little fortune was all swallowed up in the whirlpool of the pit. One who had always been sensible, conservativ and thrifty was ruined in a few short weeks or months. He had to begin again at the bottom of the ladder, under much more trying conditions than the first time, and now after a second period of years of struggle, he has his head just above the waves. Think of this when a broker says to you, 66 Buy September wheat."

Analgesics at a Reasonable Price.

Please see the article entitled "How a Village Doctor Saves $45 Per Year on One Preparation," and our comments on same in March WORLD, pages 102 and 103. Continuing the effort to serve the daily interests of the average doctor, and knowing that many would put off from time to time the making up of a preparation like this in quantity (many would be too busy and others would procrastinate), and also knowing that many like tablets for convenience in dispensing, and that still others write prescriptions instead of dispensing, and that they would rather prescribe preparations of definitly known composition at a moderate price instead of a preparation of secret composition (tho knowing that acetanilid is the chief constituent) under a fanciful name at a fancy price,we sent the following letter to our leading pharmaceutical houses:

Gentlemen:-We have been publishing the well known fact that for years the physicians of this country and their patients have been paying an extravagant price for acetanilid mixtures under fanciful names, antikamnia, for example, and for combinations of such mixtures with quinin, salol, codein, heroin, etc,, chiefly in tablet form for convenience in dispensing. We wish to know, in order to inform the profession, what you, as legitimate manufacturing pharmacists, have done to meet the wants of the profession for a safe acetanilid mixture, at a reasonable price. Also, we wish to know what (if any) combinations of the same with quinin and other drugs in daily use you make in tablet or pill form for convenience in dispensing. Please give price of each to physicians, in ounce lots, for comparison with the prices of the proprietary mixtures with fanciful names. Physicians should have this information, and we propose to give it to them. Please give full information, and prices, for publication. Very truly,

THE MEDICAL WORLD.

We found to our gratification, upon receiving the price lists from the various firms, that this want is very well supplied, and that there is no excuse for physicians paying, or forcing their patrons to pay, the fancy prices charged

by the vendors of proprietaries under fanciful names. That sterling firm, Wm. R. Warner & Co., of this city, sent an exceedingly nice letter in reply, but markt it strictly not for publication in this connection, as they "have no antagonisms in connection with manufacturers," and refer us to pages 58, 69, 76, and 178 in their catalog. They further explain that the prices there given are not intended for publication ordinarily, because they are expected to protect the drug trade. They further add, "However, we would be willing to sell to the profession any of the articles indicated at the prices shown in the book, but would rather prefer not to be taken up too prominently in connection with any controversy that might arise." This position is fair, and the spirit admirable. We turned to the pages indicated, and there found a great variety of acetanilid preparations in tablet form, from simple acetanilid in tablets of from. I to 5 grains, to many different formulas of compound acetanilid tablets, tablets either plain or chocolate coated, and the prices are exceedingly reasonable. We hesitate to mention the prices here on account of not wishing to embarrass the firm in any way, but we suggest that you could not do better than to write for their catalog (Messrs. Wm. R. Warner & Co., 639 N. Broad street, Philadelphia), and after you get it indicate to your druggist what you wish him to carry in stock for your prescriptions, or send an order direct if you are in the habit of supplying medicins directly to your patients-country doctors cannot avoid doing some of this.

The following excellent reply came from Messrs. H. K. Mulford Company, of this city. Dr. C. F. Taylor, Editor MEDICAL WORLD.

Dear Doctor-In reply to your letter of the 3rd inst., we have pleasure in forwarding you, under separate cover, one of our catalogs. You will note that we list Acetanilid, together with following combinations:

Acetanilid Comp. No. 1, the formula usually employed for relieving migrain, contains:

gr. $1.40.

100.. 20C.; 500. . 75C.; 1,000. These preparations are offered by us not as substitutes for any preparations that are offered to physi cians under proprietary names, but as strict pharmaceutical preparations, the full quantities of ingredients being as specified on label. One hundred tablets practically represent an ounce. Very truly yours, H. K. MULFORD.

The Upjohn Company, of Kalamazoo, Mich., answer as follows:

C. F. Taylor, M.D., Philadelphia, Pa.

Dear Doctor:-Replying to your favor of the 3rd inst., will say that we do not manufacture any combinations which we put out as substitutes for the proprietary preparations, altho we fully realize that many of them are sold at an extravagant price. We do, however, manufacture several combinations in pill and tablet form which contain the ingredients you mention.

We are inclosing you one of our price lists in which we list several different acetanilid combinations, some in the form of pills, some in uncoated tablets, and some in chocolate coated tablets. Our list prices are subject to a discount of 25 percent, and we make special net prices on bulk quantities of 5,000 or more. You will note that we have checkt the list and would refer you to the following pages: 7, 26, 55, 56, 59, 84, 96, 103, 105, 117. Very truly yours,

THE UPJOHN COMPANY.

We note that the tablets are cheaper than the pills of similar composition. There is a wide selection of acetanilid tablets, both simple and compound, the latter embracing many useful combinations at reasonable prices. Messrs. Parke, Davis & Co., of Detroit, Henry K. Wampole & Co., and John Wyeth & Bro., of Philadelphia, reply by referring us to their catalogs, which they send, and in all of which we find an ample variety of acetanilid tablets both simple in 1 to 5 grains, and compound tablets showing many excellent combinations, at reasonable prices.

Do you here find food for thought? THE MEDICAL WORLD is publisht in the interest of the medical profession. The medical profession is learning the value of THE WORLD, for subscriptions have been pouring in during the last two years as never before. And we are learning better and better how to serve the interests of the profession, and the increast patronage by the profession gives us more courage than ever before. Let THE MEDICAL WORLD and the medical profession join hands closer than ever before to help each other, and to find evils and crush them.

So much for acetanilid (and combinations of acetanilid with other drugs) as an analgesic, or pain reliever. As is well known, acetanilid is a heart depressant, and the drugs combined

About twenty years ago a wonderful coal tar synthetic chemical was announced that would reduce temperature like magic. On account of this quality it was called antipyrin, and it was patented under that name. We thought that we had found the thing with which we could control fever with definit certainty, which would give us an undreamed-of power over disease. The medical press was filled with praises of this wonderful drug. But while it cooled the fever patient, many of them got cold-and are cold yet-in their graves. The alarm was sounded, and a rapid retreat was made. It would not do to subject the fever patient to such a risk. The heart depression was too great.

Antipyrin was soon followed by other coal tar derivativs, but now their power to relieve pain was brought into prominence, and they became known as analgesics rather than antipyretics, tho they are both. Their use in fevers were so condemned on account of the

danger of heart depression in connection with the non-resistance occasioned by prolonged or severe illness, that their use as antipyretics was lost sight of; but they could be given with apparent impunity for headache, neuralgia, painful menstruation, etc.,-conditions of a temporary nature and in which the heart resistance application, and the reasons therefor. So had not been reduced. So you see the changed

now drugs of this class are known as analgesics.

Acetanilid and phenacetin became, and still are, the most popular of this class. By some good fortune, acetanilid did not become patented, and so we have always had it at a very low price. For a while it had no special friends, because it was to nobody's special financial advantage to push it; while phenacetin was vigorously pusht for the great profit in it, and for awhile "antifebrine," which was only a copyrighted name for acetanilid, was pusht at about the same price as phenacetin, until the fact just stated was found out. Then arose "antikamnia-opposed to pain." By dint of very skilful advertising and liberal samples, this mixture of acetanilid with some bicarbonate of soda to increase its solubility, and perhaps some caffein to counteract the depressing tendency of the acetanilid, got a start. Knowing ones were surprised at this, for it was supposed that every one knew that it was a mere

mechanical mixture and not a definit, distinct and individual chemical, and if doctors wanted an acetanilid mixture, why not make it, at onetenth the cost? But antikamnia was persistently and very skilfully advertised, and to the great surprise of many, it continued to prosper. Perhaps one reason was its preparation in tablets convenient for dispensing. So in spite of the vast difference in price of about 30 cents a pound for acetanilid and $1.00 per ounce for antikamnia, the latter still prospered, mainly thru the medical profession-and perhaps there are some doctors still so in the dark as to pay, or have their patients pay, the extravagant price for antikamnia, when acetanilid is so cheap, and when it is now put up in tablets of various sizes, and numerous combinations of it with other drugs are put up into tablets, by our leading pharmaceutical manufacturing houses, at right prices.

But we are wandering from our subject. We started to consider phenacetin and acetanilid, the two drugs that have been the leaders of the antipyretic-analgesic group. (Antikamnia, and the numerous imitations of antikamnia, caused to come into existence doubtless by the surprising commercial success of antikamnia, are only acetanilid mixtures.) I intended to try to present the rather complex chemistry of these chemicals so simply that any reader could easily understand; but it is a difficult task, and perhaps many readers will thank me for quoting from Bartley's Medical Chemistry, page 460, simply this statement; speaking of phenacetin it says: "This compound is closely related to acetanilid." We know that they are closely related therapeutically. Phenacetin has been very popular. At $1 an ounce its manufacturers could afford to make it so, and foster the claim that it is less depressing than acetanilid. Many doctors believe this to be true; many don't. I cannot say. My observation has been limited, as I am not in practise (tho the rest of the staff is--and our numerous contributors), my specialty being medical journalism. No one man can be a successful editor and publisher and at the same time conduct a practise as it should be conducted. My observation is that these two drugs are about equally depressing. I have always counseled against the use of these depressing and blood destroying drugs; but there are painful conditions which with most people require a pain reliever, and these drugs are usually not as objectionable as opiates. I usually prefer pain to drugs when I must choose between the two evils; hence I have never taken but a single dose-a small one at that of any of this class of drugs, and I have forgotten what one it was, but I think it was a sample tablet of one of the numerous imita

As those who remember my editorials in the

last several years know, I have been opposed to phenacetin because of the following: It is made in Germany and imported from there into this and other countries, and the price charged to consumers in this country is about three times that charged to consumers in other countries. For example, it is $1 per ounce here, while just over the line into Canada it can be bought ence is not in the tariff; our tariff would make a for about 35 cents an ounce. And the differlittle difference, but very little. Our patent they do it. It is to this injustice that I have laws permit them to thus impose on us, and vigorously objected. The patent will run out in a few years, and then the price will take a delightful tumble.

*

In this connection I have been interested in the appearance of an American chemical of this class, an improvement upon all its forerunners in that it is claimed that it is positivly not depressing to the heart. It is called thermol, because of its effect on the temperature, and it is boldly recommended as an antipyretic in such serious diseases as pneumonia, typhoid fever, etc., as well as an analgesic in headaches, neuralgias, menstrual pains, etc. Today I called on the inventor, Dr. S. Lewis Summers, to get some final points before writing this, particularly as to its chemistry, and I finally got him to state the chemistry of the group so simply that I will present it here: Acetanilid acetic acid plus aniline. Phenacetin

phenetidin (a chemically com-
plex substance in the form of a brownish,
oily liquid, the chemistry of which I will
not attempt here) plus acetic acid.
Thermol = phenetidin plus acetic acid plus
salicylic acid.

These are not mechanical mixtures, as antikamnia is a simple mechanical mixture of its constituents in a mortar, but the constituents are put into special apparatus in definit quantities, and subjected to great heat and pressure for a long time. The result is a chemical union-the creation of a new and distinct chemical product, which is then washt of any accidental uncombined excess, and then tested and prepared for the market.

I askt Dr. Summers why the addition of the salicylic element should prevent depression. He referred to clinical experience, with the

possible explanation that, the phenetidin being the real source of danger, its neutralization by two acid radicals may be more complete, thus removing the danger and at the same time adding a valuable antiseptic property-the salicylic element. My experience is confined to a single case, a member of my family who must have drugs of this kind occasionally for pain, and she says that while phenacetin (which she long ago gave up, but I got her some a few days ago to see if it would not now act better than formerly) is fully as depressing as the various acetanilid mixtures, or more so; thermol is not; but thermol will not take the pain away quite as promptly, but "is more soothing.' I was told of a number of cases of typhoid fever, etc. in which thermol was successfully used, but I haven't access to the records. I was also told of a case of whooping cough in which the child watcht the clock for the time to take its 22-grain tablet of thermol, in order to continue to avoid the distressing paroxysms of another child near by, not taking the thermol. But this evidence-all I know at the present time (others may know more)is too meager and indefinit upon which to base an opinion. Besides, an inventor is naturally sanguin concerning his own preparation, and his claims perhaps would better be discounted somewhat. Hence the importance of impartial testimony. It is "up to" the profession to determin the value of thermol and act according to its findings. I am glad that it is the product of an American laboratory, for we Americans have depended far too long on foreign laboratories for these synthetic chemicals. As to price, it is 75 cents per ounce - much more expensiv than acetanilid, you see, but worth the difference if the inventor's claims are borne out by ample clinical tests.* It seems that such new things cannot and would not be conceived and achieved if it The were not for some prospect of profit. time, work, risk, initial expense for machinery, etc., are very great, and the result not always certain. But patents on processes run out in time, and then we have the really good things at a narrow margin of profit, as on sugar or salt. But copyrights on such proprietaries as antikamnia, neurilla, etc., never run out; no manufacturer except the owner of the copyright can ever make and sell a preparation under one of those names; but fortunately nothing of special scientific value is thus perpetually monopolized. They are simple mechanical mixtures, and their formulas, tho secret, are approximately known.

* Since the above was written, numerous clinical reports on the use of thermol in typhoid fever and pneumonia have been submitted to me. However, I have said enuf above for purposes of comparison of the different members of this group, and no more would be appropriate here.

Besides those you mention, the following were caught Boston Medical and Surgical Journal, Memphis Medical Journal, Cincinnati LancetClinic, Western Medical Review, Modern Medical Science, Canadian Journal of Medicin and Surgery, St. Louis Medical Review, Denver Medical Times, Texas Medical Journal, and Western Druggist. Very truly yours, Chicago. GEORGE H. SIMMONS.

[Thanks, Dr. Simmons. As my time permitted the examination of my exchanges, I found the article in some of the above, but I did not reach all. I would not have been caught if H. John Stewart had not lied. The profession should know how to size up the institution which he sought to advertise in this dishonest way.-ED.]

Thank you, Sincerely.

As a rule, I don't like the sometimes too prevalent habit of giving presents-particularly wedding presents, which latter custom has grown into a monstrous abuse. Articles given as presents are frequently not needed, usually not what would have been chosen by the recipient, and they always place the (unfortunate) recipient under obligations, and sometimes in an awkward position. I am very sensitiv in this matter, and have often felt, if either giving or receiving must be done, that it is "more blessed to give than to receive." But there are exceptions to all rules. My old friend Dr. W. F. Waugh has evidently finisht his season of travels, for the following note comes to me from him at Chicago:

DEAR DOCTOR TAYLOR-I send you herewith a pen made from a feather from the wing of an American eagle, with which to indite your editorials. May you never write anything unworthy that free and fearless bird, bold and dauntless with lofty flight and keenest of vision.

This I accept with great appreciation.