minished; in eleven weeks it ceased and the drainage-tube removed. He has gained in weight from 138 to 168 pounds.

The deformity resulting consists in some flattening of the anterior and lateral sides of the chest, with elevation of the right shoulder and a right lateral curvature of the spine, which is less than might be expected. The change in the shape of the chest is due, of course, to a deficiency in the expansion of the lung, caused by strong adhesions between the lung and pleura.

The prevention as well as diminishiug the degree of the deformity is always greatly assisted by the early performance of respiratory gymnastic exercises, such as blowing water through tubes from one bottle to another; the object of these exercises is to cause expiration.

If the diagnosis has been made early the following method of treatment is highly recommended by Bulan and Dr. E. Flesher Ingal, of Chicago.

5

It

Both methods are almost identical. consists of inserting a trocar as large as possible in the intercostal space, the stylet is withdrawn and a Nelaton catheter (Bulan) or a double drainage-tube (Ingal) through the lumen of the cannula; the cannula is then removed so that the rubber tube remains in position in the thorax. The tube is securely fastened to the thoracic wall. By the method of Bulan a short glass tube is fitted in the catheter and to this is attached a long thin rubber tube, the end of which extends into a bottle of antiseptic fluid.

By lowering or elevating the bottle the force of the siphon can be easily controlled, and if the aspirating bottle is full it can. be changed while the rubber tube is compressed. By this method the empyema is evacuated gradually, the lung can expand as the pressure is relieved, and if the patient is able he can walk about with the bottle in his pocket.

Owing to the simplicity and ease with which either of the latter methods can be performed by the general practitioner, when he is far away from assistance, and draingage of the chest is demanded, either method certainly commends itself to him.

In cases where one or more fistulæ persist, and do not heal after operation for empyema, it may be due

1. To imperfect drainage caused by the opening not being in the most dependent part of the pleural cavity.

2. To a necrosis of the rib.

3. The drainage-tube being retained too long.

4. The most serious condition is where a cavity exists between the two layers of the pleura, caused by failure of the lung to expand on the one hand, and on the other a failure of the chest wall to fall in.

The first operation to remedy this defect was done by Estlander, of Finland, in the operation known by his name; later it was found that there were still cases which this latter operation did not cure, and Schele, of Bonn, advised a more extensive excision of the chest wall in an operation also known by his name. There is still another method which is to be known and utilized, where it can be done, which is known as "" decortication of the lung." It consists in releasing the thickened pleura over the bound down lung, thus permitting it to expand and fill out the cavity, and thus enabling it to resume its function. If the lung has undergone extensive atrophy, tubercular fibrinous contraction, this method just spoken of is not feasible.

The credit of having first successfully performed this operation on human, belongs to Dr. George R. Fowler, of Brooklyn, although in foreign literature this procedure is known as Dr. Lormes' operation, from a report of some experiments he made in 1893 on the cadaver without the knowledge of Dr. Fowler.

In conclusion, the following points may be summarized:

1. Make early diagnosis and operate as soon as pus is discovered.

2. In operating be sure you open the pleural cavity in the most dependent part to secure good drainage.

RABUTEAU'S

SOLUTION OF THE

Laureate of the Institute of France.

Prize in Therapeutics.

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Rabuteau's Elixir of Iron is recommended to those persons who may be unable to swallow the Dragees. Dose-a small wineglassful with meals.

Rabuteau's Syrup of Iron is specially designed for children.

Chalybeate medication by means of Rabuteau's Iron is the most economical and the most rational known to therapeutics. No constipation, no diarrhea, complete assimilation.

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"Thanks to their thin envelope of gluten, which is essentially assimilable, the MatheyCaylus Capsules are digested by the most delicate persons and never weary the stomach."-Gazette des Hôpitaux de Paris. PARIS CLIN & CO.-PARIS

AND OF ALL DRUGGISTS.

NEURALGIAS

PILLS OF DR. MOUSSETTE

The Moussette Pills of aconitine and quinium calm or cure Gastralgia, Hemicrania, Headache, Sciatica, and the most obstinate Neuralgias.

"The sedative action exerted by the Moussette Pills upon the apparatus of the sanguineous circulation by the intermediation of the vaso-motor nerves, indicates their use in neuralgias of the trigemini nerves (fifth pair), congestive neuralgias, and painful and inflammatory rheumatismal affections.

"Aconitine produces marvelous effects in the treatment of facial neuralgias when they are not symptomatic of intra-cranial Society of Biology of Paris, Meeting of Feb. 28, 1880.

tumor."

DOSE: Take three to six pills during the twenty-four hours.

ACCEPT ONLY

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SUBSCRIPTION PROBLEMS.*

BY C. F. TAYLOR, M.D.,

PHILADELPHIA, PA.,

EDITOR OF "THE MEDICAL WORLD. "

Experience has forced most of us to realize that ordinary business rules have been largely at a discount in the field of medical journalism. The country has been flooded with free sample copies without stint or limit, subscription accounts have been neglected until forgotten by both debtor and creditor, and in every way the doctor has been led to believe that the paying of a subscription to a medical publication is a matter of very little importance. There are several classes of medical publications that can afford to encourage and continue this very unsatisfactory business condition indefinitely. First and most reprehensible is the journal that is published for the purpose of "boosting" and "booming" proprietary medical preparations in which. the editor and publisher are financially interested. This kind of journal is likely to have "the largest circulation of any medical journal in the world." That is easy. It is only a matter of buying more paper and sending out more "sample' copies to keep ahead of the most enterprising legitimate competitor. But these copies are not sent out with the expectatation of obtaining subscriptions, but for the purpose of advertising proprietaries that are exploited in the reading columns, in editorials, answers to queries, etc. The plan is as transparent as that of the distribution of patent medicine almanacs free among the laity, in order to promote the sale of nostrums. It is strange that this It is strange that this plan has worked so well and so long among doctors, and it is strange that the strenuous Mr. Madden, third Assistant Postmaster General, has not gotten after this class of so-called "medical journals."

Possibly a little less reprehensible is the class of journals whose editors and publishers are not financially interested inproprietaries, but who can be hired, either directly or under the guise of an advertising contract or in some other way, to publish "clinical reports" concerning this, that or the other proprietary. This kind of a vendor can send his sample copies

* Read before the American Medical Editors' Association, at New Orleans, May 4, 1903.

broadcast as per contract with the chiefly interested parties, and thus eke out a living without much of an income from subscriptions.

Then there are the house organs, college organs, and medical book publishing organs. All these help to spoil the field, and make it hard for a purely legitimate medical periodical, which I will define as one which devotes its reading pages solely and entirely to the interest of its readers, and confines advertising matter entirely to the advertising pages; one which has no other interest than medical journalism, pure and simple.

Addressing myself now to the subject of strictly legitimate medical journalism, I will say that we must realize that among about 135,000 doctors living in all parts of the country, in various circumstances and conditions, we must expect various tastes. Many an anxious and ambitious editor has striven to suit every doctor; but the effort has always failed, and always will fail. ways will fail. It must necessarily fail, for what will suit one class will not suit another class with different needs and tastes. So let me beg any editor that yet may be cherishing that ambition to give it up.

It is natural for us to endeavor to satisfy our needs and gratify our desires. So it is with every doctor. Then if you produce a medical magazine that meets the needs and tastes of any considerable class of doctors, they will have your periodical, even if they have to pay for it. Here, then, is your field.

Having found your field, the next question is how to work it. Do it energetically, good naturedly, but in a strictly business manner. Try to find the doctors whom you can serve best, and thoroughly acquaint them with the service that you offer. When you have done so, if you don't get pay for your periodical it is largely your fault. It is not necessary that you cut off subscriptions as soon as the time paid for has elapsed, but it is necessary that you send bills, repeatedly in many instances, and finally a "dun" to the indifferent. This unwelcome missive will usually be received in the spirit in which it is sent. Abounding good nature and good fellowship is a valuable asset in the collection business. However, there is a time when continued indifference must be met with a cold proposition, as a

statement that if we do not hear from the debtor by a certain date we will have to send the account to a collection agency. This usually stirs the ire of some (only a few, however), who refer to it as a "threat,' and who sometimes say, "I never subscribed." This is met with a polite but straightforward letter, inclosing the original order, bearing the signature of the sender. Prompt remittance is the usual response to such a communication, sometimes with an apology, and but seldom with "stop my paper. The fact is, if you are supplying what the subscriber wants he does not want it stopped, and even if he does want to beat his way, when he finds that he can't do it he will pay up rather than lose what he really wants. The secret is in offering what is needed and wanted, and requiring pay for it.

The time comes when the "rag-tag" of a list that you have been working on must be closed up in some way. You have said that you would send the account to a collection agency after a certain date. The date arrives and passes, as you would rather indulge a little while longer. But the time comes that you must do something with those that you can't get any word from in any way whatever. These you finally send to a collection agency.

My experience with collection agencies may be of some interest, so I will here give it :

On September 25, 1901, we sent to The Newspaper Collection agency, Bennett Building, New York, N. Y., for collection subscription accounts amounting to $340.50. On October 31, 1901, we received from the agency $38.25: on November 30, 1901, $11.00; on December 31, 1901, $10.50; on January 31, 1902, $10.00; on February 28, 1902, $8.00. Total amount received was $77.75, which is 22.8 per cent. of the total amount due. Commission and charges were $19.63, which, subtracted from above, leaves $58.12, the net result to us.

On November 18, 1902, we sent to the same agency for collection subscription accounts amounting to $1,272.00. On November 30, 1902, we received $50.00 from the agency; on December, 31, 1902, $167.00; on January 30, 1903, $49.50; on February 28, 1903, $22.00; on March 31, 1903, $19.50. Total amount received was $306.00, which is 24 per cent. of the total

amount due. Commission and charges were $77.30, which, subtracted from above, leaves $228.70, the net result to us. This list is still in the hands of the agency.

Considering that these accounts were old, and that we had exhausted our efforts on them, this result is not entirely disappointing. Also we must consider that many of these debtors had died in the meantime, and many had moved.

As a matter of, information in this connection, in addition to the above-mentioned collection agency, the following firms make a specialty of collecting publishers' accounts: The H. O. Rose Commercial Agency, 324 Dearborn St., Chicago, Ill., and the Publishers' Collection Agency, home office St. Paul, Minn., with branches in New York and Chicago. This agency claims to be "the old reliable," and I think it was the original. I have never had any experience with any except The Newspaper Collection Agency, but the others would doubtless give excellent service.

In response to these efforts, occasionally a remittance is made very unwillingly, and in a very ugly spirit. My standing instructions are to refer any such letters to me. Unless it is an evident case of a "skin," squirming because he has to pay a debt, I answer the letter personally and in full, returning the money with the explanation that it is our business rule to not have a dissatisfied patron (if we know it), and not to receive a single dollar not willingly, even gladly, paid.

We are dealing, necessarily at a distance, with men who, in the main, intend to do the square thing, but whose lives are, from the demands of their profession, irregular, and who for this reason frequently neglect such details as remitting subscriptions. On the other hand, many are spoiled by receiving free samples of medicine, etc., as well as of journals, and who cease to realize the importance of paying for what they receive. Hence, this department of our business must be carefully systematized and receive patient and diligent attention.

We now send out very few sample copies compared to formerly, and with every sample copy a communication is sent calling attention to the sample, and soliciting a subscription.

If every medical periodical in our great country would attend strictly to the sub