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

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"THE MEDICAL WORLD" 1520 Chestnut Street Philadelphia, Pa.

VOL. XXII.

JULY, 1904.

No. 7

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 thous and 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 pube lications of the National Éducational Association as follows:

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securing the general adoption of the suggested amendments IRVING SHEPARD, Secretary."

We feel it a duty to recognize the above tendency, and to adops 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 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.

Pure and Reliable Drugs.

Interests that are anxious to push their own products make a great noise about "pure drugs," magnifying the difficulty of the physician in getting reliable drugs. Desiring to learn the actual truth in the matter, we addrest the following letter to a number of our leading manufacturing pharmacists:

Gentlemen :-A certain medical journal, a well known organ for certain proprietaries, constantly has much to say about the "purity" and " reliability" of proprietaries, endeavoring to lead physicians to the conviction that the only way to get pure and reliable drugs is to prescribe proprietaries. What have you to say, as manufacturing pharmacists, as to the possibility of the medical profession being able to get pure, standard and efficient drugs; as tinctures, fluid extracts, syrups, elixirs, standard official combinations as compound syrup of squills, etc., solid extracts, powdered drugs, pills and tablets, both single and compound-in short, drugs in general?

I do not take a stand against proprietaries, nor do I expect you to do so in your reply. I wish only to know what facilities the medical profession has of obtaining standard, pure, efficient and reliable drugs other than in proprietaries, in the free and unrestricted channels of trade. Very sincerely,

(Dictated by) C. F. TAYLOR. The following replies were received:

DETROIT, MICH., 5/19/'04. Editor MEDICAL WORLD:-Anyone who claims that it is difficult or impossible to obtain pharmaceutical preparations of standard quality in the drug stores of this country displays a most lamentable ignorance of trade conditions. Nine-tenths at least of the drug stores of this country carry the products of the best manufacturers in stock for dispensing purposes. As these products afford the dealers an excellent profit, there is but little temptation to substitute, or to use inferior grades. The question of purity, we should say, has but little to do with the matter. Some proprietary articles are not adapted to preparation on a small scale, and doubtless numerous others have their important uses. But to claim that there is no assurance of getting pure goods without relying entirely upon some proprietary compound, is to give utterance to a very evident absurdity. Pure pharmaceutical and chemical products are made in greatest abundance. Dealers buy them as fast as made. It is not likely that

these goods are kept for exhibition purposes, or thrown
away; it seems but reasonable to say that they are put
to good use.
Very truly yours,

F. STEARNS & Co.,
Per J. W. T. KNOX.

General Offices, NEW YORK CITY. May 14, 1904. Editor MEDICAL WORLD:-In reply to your esteemed favor of the 12th, we do not know why it should be difficult for physicians to obtain thoroly reliable drugs. We know that there are a number of manufacturers with whom quality is a religion. Personally, we guarantee the quality of everything that bears our label. Very truly yours, SHARP & DOHME. PHILADELPHIA, June 3, 1904.

DR. C. F. TAYLOR,

Dear Doctor:-In reply to your letter in which you ask for a report as to the ability of physicians to secure pure, reliable products, we would state that the manufacturer of pharmaceutical products today is using his best endeavor to furnish the highest standard possible to offer.

On fluid extracts, tinctures, elixirs and standard products, the manufacturers do not content themselves with the ordinary means-exhaustion, percolation, repercolation, etc.-but the first step is submitting samples of the various crude drugs to chemical assay and pharmacological test.

Under separate cover we are sending you our catalog, and call your attention to Fluid Extracts, pages 128-149. You will note after certain preparations the standard or alkaloidal content. This applies to drugs the activity of which can be determined by alkaloids or extractivs. Such preparations as digitalis, ergot, colchicum, strophantus, etc., of which it is impossible to determin the activ principles by chemical test, are submitted to physiologic test on animals. In short, every method is used that will insure an activ and uniform product.

We will not purchase drugs that do not come up to our regular standard of strength. These preparations are sold according to the usual laws of competition, and their sale yields but a moderate profit. We believe that no manufacturer of proprietary remedies can take greater care than is exercised by the pharmaceutical manufacturer today.

In the using of such preparations as bromids or iodid of potash, calomel, quinin, morphin, in addition to the usual tests which are applied by the manufacturing chemists, we employ careful tests to insure an absolutely reliable product.

In conclusion, we feel that when our label is on a preparation that we are responsible for that preparation, and we certainly would not be willing to affix our label to a product that was not first submitted to a careful examination and test. Very truly yours,

H. K. MULFORD COMPANY,
H. K. Mulford,

NEW YORK, May 17, 1904. THE MEDICAL WORLD:-In reply to your favor of the 12th inst. we beg to say that in our opinion where members of the medical profession are able to draw their supplies from pharmacists of undoubted skill and probity, they may feel assured of obtaining standard, pure and efficient drugs, other than proprietaries.

As to proprietaries or pharmaceutical preparations, the same assurance may be had by employing products bearing the label of houses of establisht reputation, of which there is a considerable number in the different sections of the country. Yours truly, SCHIEFFELIN & Co., H. S. Livingston.

DETROIT, MICH., May 19, 1904.

DR. C. F. TAYLOR, Editor MEDICAL WORLD:-We are pleased to acknowledge receipt of your letter of the 12th inst. respecting the purity or reliability of pharmaceutical preparations.

From the very inception of our career down to the present moment our constant endeavor has been to

provide the physician with the best, the purest, the most reliable pharmaceutical products, of invariable standards of quality and strength. Never for an instant have we tolerated the idea, or even tacitly sanctioned the suggestion that anything less than the very best is good enuf for the use of the physician, or worthy to bear our label. Now, as of yore, our motto, "Medicamenta Vera," is our constant watchword.

Has this policy proved profitable? Has it workt to our advantage or disadvantage? You can judge for yourself when we say our label is accepted the world over as a certificate of purity and a guarantee of potency. No matter whether the prescription for a Parke, Davis & Co. preparation be filled in America, Europe, the remote Orient, in Africa, Australia, or the islands of the Pacific, the medical practician knows just what he is getting and just what results he may expect. Furthermore, no matter where or when a given product of our laboratories is dispenst, the medical practician knows that it does not vary in strength from a specimen of the same product that his patient may have obtained months or years before, or at a place thousands of miles remote.

These facts are the outcome of our elaborate and thoroly scientific system of drug standardization. Every crude drug and chemical product submitted to us for use in our manufacturing operations is thoroly tested by chemists, botanists, pharmacologists or other scientific experts, of whom a large and efficient corps is engaged in our service. Every important drug extract that we make is carefully assayed to determin its strength (in activ principle). Should the product vary from our standard, it is modified until its strength conforms exactly to the establisht formula. We have a very large and elaborately equipt analytical department, in which a considerable amount of the work consists in standardizing drug extracts. Furthermore, those important drugs-and the list includes not a few of the most powerful therapeutic agents-that cannot be assayed chemically are tested upon animals, i. e., physiologically. Among these may be mentioned digitalis, aconite, ergot, indian cannabis, strophanthus, convallaria, etc. We were the pioneers in drug standardization, first by chemical assay, and latterly by the physiologic method. In this connection it may interest your readers to know that we do not concentrate our extracts by heat in open pans. We use expensiv vacuum stills, in which evaporation takes place at a temperature so low that even the most delicate principles are not impaired. Even the chlorophyll, the green coloring matter of hyoscyamus, is not affected during the process of concentration in our laboratories.

Finally, not only can the physician obtain pure drugs and pharmaceuticals by specifying our products, but, per contra, by so doing he cannot obtain any but pure products. It is almost a physical impossibility for any but a thoroly standard product to get out of our laboratory. Our reputation is behind every bottle of pills, tablets, solid, powdered or fluid extract that we place upon the market. If any of your readers is seeking further light upon this subject, which we must admit is altogether too vast for thoro treatment at this time, we shall be very happy, indeed, to answer inquiries or to supply information.

Thanking you for the opportunity to direct your attention to our attitude toward the subject of pure drugs, and with kind regards, we remain, Very truly yours, PARKE, DAVIS & Co.

The above letters speak for themselves. It doesn't pay to claim too much; so when the proprietary man makes his oft-repeated speech about "purity, reliability, uniformity," etc., you can show him that it is possible to get pure and reliable drugs and pharmaceutical preparations without paying proprietary prices. We do not mean this as an argument against proprietaries, but as a reply to their oft-repeated claim that physicians shou'd prescribe proprietaries in order to get purity and reliability.

Contaminated Milk as a Disseminator of Disease.

The majority of authors and observers appear to pay their entire attention to the bactericidal side of this question, yet other contamination aside from bacteria often renders the milk unwholesome, if not distinctly pathological. Admitting that the contamination by bacteria is the most frequent cause of unwholesome milk, it is wise to look into the subject to a greater depth. Every practician is concerned in this matter. We hear a great hullabaloo when some epidemic sweeps thru a city because of contaminated milk, yet for one serious result in an epidemic we believe a thousand occurs in isolated cases. It is the isolated case, seldom recognized or investigated, that should receive a greater proportion of study and notoriety, until all practicians in both city and country get a true conception of the gravity of the whole matter, and raise such a storm of protest at the present filthy and ignorant methods of handling milk as will compel greater cleanliness and care.

There is no more subtile culture media for certain bacteria than milk, nor will any other fluid food become so quickly contaminated. Not only do bacteria find welcome lodgment in milk, but it will absorb noxious odors with great avidity. The nature of the fluid, and the methods of milking and marketing, expose it to numerous chances for absorbing filth and becoming contaminated. In itself so very unstable, it speedily undergoes decomposition, and develops within itself under suitable conditions, one of the deadliest poisons known to chemistry -tyrotoxicon. As if nature had not provided enuf perils, man adds to these by the addition of "preservativs," which may in themselves be poisonous, and by a neglect of proper methods of cleansing the receptacles employed. The cow, herself, is often the original source of danger, mainly because of man's ignorance and inhumanity, but other times because of her inherent taste for anything green. In the summer season, when water is scarce, she will drink from any pool within reach, however filthy; numberless bacteria thus absorbed cannot fail to reach the milk ducts. She will eat poisonous plants, a common example of which is the consumption of poison ivy, which produces the symptom known as "trembles," and when milkt in this condition the milk is poisonous. There are many other plants eaten by cows which render the milk unfit for use, even if not actually poisonous. It is a question whether the ensilage, which is now so commonly fed thruout the country during the winter, is a food of proper composition from which to derive milk. Cattle are often handled by brutal and ignorant men who chase them with dogs, or

worry them into extremes of fear or anger; the milk from cows in such condition has been known to cause gastro-intestinal troubles, fever, and headache-ample evidence of a mild toxemia. The cow, even in the pasture, will often lie down in manure in such manner as to foul the legs, loins, and udders, and this filthy condition is ten fold intensified when she is forced to lie down in the filthy winter stable. Those familiar with dairy countries will recall the fact that throughout the winter the accumulated manure of many weeks always forms a thick coating on the loins of the cows, and is only removed when the hair is shed in the spring. Many cows, in this filthy condition, are milkt without even so much as a thought about cleansing the udder. The hands and clothing of the usual stable attendant are hardly to be called aseptic. The motion of the arms, in milking, causes the clothing to rub over the loins of the cow, and the particles cannot help but fall in the pail directly underneath. remove this excess of hair and manure, it is a common practise to reinforce the strainer with one or more thicknesses of cheesecloth, and we have witnest the "emptying" of a considerable amount of fertilizer from such cloths several times in the course of a milking, because the cloth became so clogged that the milk would not run thru.

Cattle in poor health cannot give wholesome milk, even if no great excess of bacteria be present in the fluid. It is a well known fact that scarlet fever can be disseminated by milk, yet we have not as yet isolated or recognized the bacterium responsible. A cow suffering from any of the common diseases is not in fit condition to furnish marketable milk. Tuberculosis, anthrax, foot and mouth disease, garget, rinderpest, digestiv disturbances, ulcerated udders, open and running sores, etc., make animals unsuitable to furnish milk to the public; yet such animals may be seen supplying such milk in almost any dairy.

Even if the milk be drawn from the udder in a reasonable state of cleanliness, it is often contaminated as soon as it touches the receptacle, for these are usually constructed of tin with seams which afford admirable and inaccessible lodging-places for decomposed milk and multitudes of germs. The cans in which the milk is shipt are generally washt by male help, and consequently the cleansing is very imperfectly performed; the seams are here too, and another influx of some other bacteria occurs. We have smelled many noxious and strenuous odors, but the most heinous smell that ever assailed our nostrils came from a tightly closed can that was "cleaned" so well that it fairly shone, both inside and out, yet had been allowed to stand in the sun a few

hours on the depot platform after being returned empty to the shipper. This is not the exception; it is the rule. Another nauseating fact: The colostrum corpuscles are demonstrable in the milk after the birth of the calf up to the fifteenth day, at least, and such milk is distinctly able to produce pathological results. Did one ever know of milk being thrown away, or the calf being allowed to suck for fifteen days? We have repeatedly observed its being marketed on the third day, mixt with other milk.

The commoner diseases disseminated by milk are scarlet fever, diphtheria, cholera infantum, typhoid fever, etc. The typhoid bacillus will retain all its virulence in milk for forty days, and it has been discovered after even four months. The bacillus coli communis is an almost universal constituent of milk. We need not reiterate the devious and multitudinous ways in which the contamination occurs.

Another important point: Those who write most upon this subject insist upon pasteurization or sterilization of the milk as a safeguard. It is now definitly establisht that such treatment makes the milk more difficult. of digestion; moreover, it is questionable if the ordinary degree of heat employed in cooking has anything more than a temporary effect on the bacilli present. We do know that chemic change (as in the formation of tyrotoxicon) is not modified by any degree of heat or cold, and we firmly believe the chemic contamination is oftentimes more important than the bacterial invasion, grievous as that generally is.

As to the common use of preservativs: We know that their use not only works a chemical change in the constituents of the milk, but also has a definit effect upon the digestion of the milk. It is yet early to assert what the extent of the injury may be, some observers taking the ground that the formaldehyde and boric acid are harmless in themselves, and by inhibiting the growth of bacteria, work positiv good. It is possible that the medical profession, with their well known tendency to be radical in everything, have acted too hastily in condemning without complete investigation the preservativs used in milk.

The remedy, for the contamination of milk is, however, not in the addition of preservativs or antiseptics, not in sterilization or any other form of cooking, but in absolute cleanliness of the animal and attendant, the stable, food, and containers, and the sterilization of all vessels by heat after use and before again being filled.

Do not put the turpentine in the water when preparing a turpetine stupe; wring the cloth from the hot water, and then sprinkle the turpentine on the cloth. Twice the beneficial effect of the turpentine is thus secured.

The Glorious Fourth; but How About the Fifth ?

If an enemy to our country would punish us every Fourth of July as much as we punish ourselves, what would we think of it? The record for last Fourth of July, which was about an average, was 466 deaths and 3,983 injuries, resulting from "celebrating!" A battle which results in 466 killed and 3,983 wounded, ranks as a great battle; the American loss at Bunker Hill was 449. Every year we have a battle (or rather the results of a battle) in which our loss is much greater than at Bunker Hill. If the English were still our enemies, don't you think the above facts would give them a peculiar satisfaction? It is one thing to gain a victory, and another to use the results of victory with prudence. Many a victory leads to the final defeat of the victor. We gained a notable victory over a century ago; shall we indulge in annual self slaughter in celebrating it?

The Journal of the A. M. A. gives the following details: "406 deaths from lockjaw, 60 from other causes, and 3,983 injuries that were not fatal." The latter include loss of fingers, hands, arms, legs and eyes.

The following practical remarks are also taken from the same source:

Last year 64 percent of the total injuries and over 80 percent of the fatal injuries were the results of blank cartridges. Nearly all cities, it would seem, have at some time passed ordinances that control their sale, or the sale of the pistols in which they are used, but, as a rule, the ordinances have remained on the books unconsulted and non-enforced. It would not be a difficult matter to reduce this source of mortality greatly; the pistols and cartridges are sold usually by dealers in sporting goods or in "notion stores," and every policeman knows all such places on his beat. Confiscation of pistols from boys on the Fourth would also be of some service. Enforcement of the law is the chief thing that is needed. In Washington, where these matters seem to be controled better than in ordinary municipalities, Fourth of July tetanus is extremely uncommon, altho there is a fair number during the year from other causes.

The Clinical Importance of the Appearance of the Tongue.

The importance of the symptomatology of the lingual mucous membrane has been recognized by physicians from the earliest recorded date of the practise of clinical medicin. Whatever other attentions may be expected by the average patient on the approach of a physical examination, he always anticipates that his doctor will feel his pulse and look at his tongue. One of those items of research revealed the state of the circulatory, the other of his digestive organs. The physicians of olden times also lookt at the urin; but, it need hardly be added, the further chemical and physical examination was absolutely defectiv. Having regard to the state of the physical sciences down to within less than a century ago, it was a very natural consequence that

the physician of former times attacht an undue importance to the value of these three series of phenomena, on which his diagnosis and prognosis-and, of course, his treatment-were inevitably based. For him the tongue was the mirror of the stomach. Its mucous membrane being an essential and a specially sympathetic portion of the lining of the digestiv tube, its condition unfailingly indicated that of the latter-more particularly of the stomach, to which was attacht the leading role in the process of digestion. If the tongue was heavily furred, the gastric surface was also loaded with detritus, and an activ emetic was required to free it of its objectionable coating. This often gave considerable relief, but when it failed to do so, as frequently happened, the process was repeated again and again, sometimes with gruesome consequences. In a recent communication (Gazette des Hôpitaux, September, 1903), Drs. Mathieu and Roux have critically examined the value of lingual diagnosis, and clearly pointed out the reasons of its frequent failure. They point out, following Laségue, that the tongue is really a muscular mass, covered by mucous membrane. And they further proceed to indicate the important fact that the investment of this organ is really a false mucous membrane, derived from an invaginated process of the external layer of the blastoderm, and not, like that of the gastro-intestinal surface, from the inner layer of that structure. Accordingly, in pathologic processes, it comports itself more like a portion of skin than of mucous membrane. On this account, the physician must be guarded against attaching too much importance to the information yielded by the time honored examination of the tongue. The general conclusions at which Drs. Mathieu and Roux have arrived are: (1) The lingual mucous membrane is really a process of the cutaneous investment of modified structure; (2) its furred condition is the result of an "excessiv abundance" of filiform papillas, which form a dense thicket over its surface; (3) its (raw or) desquamated condition is usually the result of a form of superficial dermatitis.

Habitual Abortion: A Misnomer. Habitual abortion, as a medical term, should be allowed to drop out of use. It represents a theory which is no longer tenable; i. e., that the uterus falls into a "habit" of emptying itself at a certain period of gestation. The term "recurrent abortion, as suggested by Taylor, is much better. There is always a cause for recurrent abortion, and it is generally a cause amenable to a remedy. Syphilis is the great and, most frequent cause, yet many of us see many cases where syphilis can be absolutely

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excluded. Severe lacerations of the cervix are perhaps the next most frequent causativ factor. Another class of cases often presents this feature: Those where the mother or father, or both, are in a poor state of health-where the vital forces of both are at a low ebb at the time of conception and subsequent to such conception; and, also, where there is an unquestionably strumous diathesis. In the latter case no better proof of the actual causativ factor could be desired than the therapeutical test; i. e., a thoro course of "anti-strumous" medicin. This generally produces a complete absence of the accident if the attack has been energetic enuf and properly managed. In the syphilitic cases it may be noted that the tendency is toward a spontaneous relief from the misfortune. After a number of abortions, it will be noted that the product of conception is allowed to remain longer in the uterus before the expulsiv efforts are set up, however more deplorable may be the physical condition of the later fetus. In the strumous type the age of the fetus becomes progressivly less at each abortion, unless some radical treatment looking toward the upbuilding of the health of the parents is undertaken. In the syphilitic type, the abortions are usually accomplisht with difficulty or with some such complication as an adherent placenta, obstinate hemorrhage, failure of contractil power in the uterus, etc.; in the strumous type the abortions are easy and quickly completed as a rule.

In recurrent abortions the possibility of mechanical interference is always to be thought of whenever the causes enumerated can be excluded. Many women will repeatedly induce abortion on themselves, even when they have begun to feel the baleful effects of such practises upon their weakened constitutions, rather than undergo the throes of labor or think of "sacrificing themselves" (?) to maternal cares. A properly stern demeanor on the part of the physician will often bring these cases to a prompt confession when warnings of the evils to come would have no effect. If they are allowed to see that the physician suspects that they have been guilty of producing the repeated abortions and of deceiving him as to the cause, an accusing conscience will oft-times work an amazing change of heart.

In those cases which will not in any measure conform to any of the classes given above, and in many of them which fall in direct line with such classes, ten grain doses of chlorate of potash, three times daily, continued from the third month of pregnancy until its termination, is declared by Taylor to be efficient in checking the "habit."

Calcium chlorid, 30 grains to the ounce, is one of our most efficient local applications in hemorrhage.

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