An addition to the famous Unguentine family is "Unguentine Dermal Soap.' Those who use Unguentine need no further recommendation. The Dermal Soap is offered as a valuable aid in the treatment of chapt or rough skin, tetter, chafing, pimples, blackheads, and eruptions generally; to allay itching and for cleansing the scalp and freeing it from dandruff. Physicians will find many uses for it. See adv. on page 30 and write for free sample. Physicians having anything to do with public buildings, such as schools, hospitals, sanitariums, etc., should by all means investigate the "Standard Floor Dressing"; a preparation for the holding of dust. It should be used in all public buildings. See adv. on page 31. EQUITY SERIES Edited and Publisht by C. F. Taylor. "RATIONAL MONEY." By Prof. Frank Parsons, of Boston University Law School. The only book on the money question which is fair and just to gold, silver and every other product. Paper Covers. Price 25c. "THE LAND QUESTION FROM VARIOUS POINTS Over 700 F VIEW." By Various Writers. No other single book gives the various phases of the land question. No student of the land question, and really no voter, can afford to be without this book. Paper Covers. Price 25c. "THE CITY FOR THE PEOPLE." By Prof. Frank Parsons of Boston University Law School. Special Issue. This is considered one of the great books of this age. The principles elucidated apply far beyond the problems of cities. Contains more facts and arguments concerning Direct Legislation (the Initiative and Refer endum) than any other book in existence. pages. Paper, 50c.; Cloth, $1.00. "THE TELEGRAPH MONOPOLY." By Prof. Frank Parsons, of Boston University Law School. Here this question is presented in a fullness and completeness never before attempted. Paper Covers. Price 25c. "THE BONDAGE OF CITIES. Consists of Chapter III from "The City for the People," with important new matter and a Model Charter, for the preparation of which a fee of $100 was paid. Paper Covers. Price 25c. "THE ORGANIZATION AND CONTROL OF INDUS TRIAL CORPORATIONS." By F. E. Horack, A.M., Ph.D. Shows need of a National Incorporation law. Paper Covers, 207 pages. Price 25c. "THE STORY OF NEW ZEALAND." By Prof. Frank Parsons, Edited by C. F. Taylor. A magnificent, illus. trated, cloth bound volume of 860 pages. Price $3.00. "POLITICS IN NEW ZEALAND. Paper, 108 pages, plus 16 full pages of illustrations. Price 25c. "ELEMENTS OF TAXATION." By N. M. Taylor. The only popular book on the general subject of Taxation ever publisht. 168 pages. Price 25c. "THE RAILWAYS, THE TRUSTS, AND THE PEO PLE." By Prof. Frank Parsons; Edited by C. F. Taylor. In two volumes. Vol. I, Relations of the Railways to the Public. Vital facts from the railway history of the United States. Vol. II, The Railroad Problem in the Light of Comparative Railroad History_Covering the Leading Systems of Three Continents. Price 25c. vol. in Paper Covers. Both volumes bound together in Cloth, over 500 pages, $1.50. "EQUITY," publisht quarterly, 50c. per year; devoted to improved methods of government, as Direct Legis lation, Proportional Representation, etc. Send for sample. "EQUITY SERIES" 1520 Chestnut Street, Philadelphia, Pa. For consumptivs and asthmatic patients who must have a change of climate, what better can you do than send them to the Mennonite Sanitarium at La Junta, Col..? 4,000 feet above sea level. Buildings new and up-to-date. See adv. on page 19. "Guaiacol, locally applied, is rapidly absorbed by the skin and appears in the urin fifteen minutes after its absorption. Applied by painting it over the skin of the thigh, abdomen, or chest, in quantities of 20 to 50 minims, it causes a rapid reduction of body temperature and thereby the temperature in malarial fever, typhoid fever, and pneumonia falls as much as 7 degrees in the course of an hour or two, but soon rises again. "'-(Da Costa.) Pneumo-Phthysine combines the efficiency of the glycerin aluminum silicate paste as a local depletory agent with the more valuable quality which it possesses of holding in combination the activ elements-guaiacol, creosote, quinin, and formalin, and by the law of osmosis these valuable therapeutic agents enter the circulation rapidly or slowly, as influenced by a high or low temperature; thus becoming a means of automatically controlling the dose. See adv. on page 27. Waldex-PINE NEEDLE EXTRACT For bathing purposes in cases of Rheumatism, Gout, Nervousness, Sciatica and Skin Diseases. WALDEX COMPANY, 82 John St., New York 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. Entered at the Philadelphia Post-Office as Second-Class Matter, SUBSCRIPTION RATES: To any part of the United We cannot always supply back numbers. Should a num- Notify us promptly of any change of address, mentioning both old and new addresses. If you want your subscription stopt at expiration of the Pay no money to agents unless publisher's receipt is given. "THE MEDICAL WORLD" 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 English spelling of a century or two centuries ago with that of today! 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 also in the Standard Dictionary, Webster's Dictionary, and other authori tativ 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. MAY, 1909. Many of our readers are struggling along on an income of less than $1,800 a year, who should be receiving twice or three times that amount. Some of them are not doing over the $1,800 worth of practise, because they "refer to a specialist" every case in which there is prospect of a good fee. Some of them are doing work which should pay twice as much as it does pay them, but thru being afraid to get out of an old rut, are accepting ridiculously low fees. It is no excuse to say that your competitors compel you to accept low fees; these men are just as anxious to get a No. 5 proper remuneration for their work as are you. All you need to do is to get together and agree to raise your fees to a reasonable amount. Just as soon as the people understand that you really mean it, there will be no complaint worth mentioning. So long as physicians will render good medical service for insignificant fees, the laity will accept them. They will not do any talk about it in "front" of the physician, but laymen (many of them) have good sense, and they wonder why, when all other labor is better paid than formerly, the physician (whom they know is paying higher prices, not only for his medicin and supplies, but also for every expense incidental to the maintenance of his home, office, and practise) can afford to make the same charges he did in more economical times. Again and again we have detailed in these columns methods by which the physicians of a community can get together and compel their clientele to respect them in a higher degree by fixing an appropriate schedule of fees, and insisting on its payment. These associations have done much good; they have proven that this can be done, for it is being done every day-being done in many sections of the country. If you have never tried it, approach your competitor this very day with a proposition to get together and "talk the matter over.' Take our word for it, you will find him reasonable. The association is easily formed in any community where there is more than one doctor, and, if you are isolated, you can form your own association of one. If you are isolated, you can obtain for your services the same fees which physicians from a distance obtain when they visit in your neighborhood. It is quite likely you can fix your prices even lower than this (to encourage practise drifting your way) and still materially increase your income. If you are accepting such niggardly fees that you cannot afford to have a good "turn-out"; if you are too poor to buy late books and medical journals; if your clothes are shabby; if your office is a dingy and musty place; if your drugs are bought from irresponsible people merely because you can get them cheap; if you have no instruments; do not attempt to raise your fees, for you will err. Give the people something for their money, and let them see that they are getting it. They like it, and will pay for it. One of our subscribers writes: "I like THE WORLD because it uses me well. My business has netted me (March 8th) $1,000 since Christmas. The town has 150 population. I do all kinds of work; nothing in surgery too big for me, consequently my business runs about $400 to $500 a month." What this man has done, you can do. You can't do it if you are afraid to open an abscess, or cut off a finger. You can't do it if your clothes and driving outfit proclaim you poverty-stricken and out of date. You can't do it if you make visits and furnish medicin for 50 cents or 75 cents. You can't do it if you will attend a case of obstetrics, and give the necessary and proper after-attendance, for a fee of $5 to $7.50. You can do it if you will equip yourself so that you are not afraid to meet any doctor from anywhere, in consultation. We use the term "afraid," advisedly. We have known physicians, who, in their eagerness to make a diagnosis, would label a condition with a name, on their first visit; when a second visit revealed that the trouble in question was not anything like what they had said it was, they were afraid to "take back" what they had said, and, when the family suggested a consultation, were afraid, yes, morally afraid, to meet a man whom they had cause to fear might betray them by his greater skill or knowledge. If you are practising medicin in this criminal manner, you can't raise your fees. If you are reasonably equipped and are doing conscientious and thoro work, you can raise your fees; you will do it; you will do it now; and you will forever afterwards thank us for jolting you out of a shameful and ignominious rut. More glory and power to the doctor who fearlessly says "nothing is too big for me," and who not only has the nerve to tackle it, but who has the moral stamina to collect a just and reasonable fee for his skill. Poisoning by Illuminating Gas: Treatment: Postmortem Appearance. In view of the fact that suicide by inhalation of illuminating gas is of comparativly frequent occurrence, and that in many instances the question is raised as to the prior death of one of two persons found dead at the same time; also that many times it is a question of murder or of suicide, it is strange that text-books on medicin quite generally ignore this matter entirely. It may be that the authors feel that it is strictly a medico-legal subject, to be handled by those writing text-books upon this subject; but when we examin such books, we find but meagre information upon the matter. Moreover, very few practicians, comparativly, have works upon medico-legal medicin in their libraries. A little information along this line will, therefore, probably be appreciated by our readers. Before death, giddiness and headache are complained of, with vomiting, loss of memory, and abolition of muscular power. These are succeeded by semi-consciousness, convulsions, and complete unconsciousness. While various substances enter into various gases used for purposes of illumination, the poisonous effects are practically always due to the presence of carbon monoxid, and the treatment of gas poisoning is the same as the treatment of carbon monoxid poison. The patient is to be removed at once from exposure to the fumes and placed in good fresh air, and artificial respiration begun immediately, if unconsciousness has developt. If enuf consciousness remains to permit of swallowing, any stimulant, such as whiskey or aromatic spirit of ammonia (a dram in one-half glass of water), may be given at once. If an oxygen tank be immediately available, the gas may be passed directly into the mouth, the nostrils being closed and the mouth drawn closely about the tube; the nostrils are then released and the lungs comprest thru the chest wall as in the second motion of artificial respiration. If the body is cold, get hot water bags or bottles about it. If this is done, do not neglect to place cloths saturated with cold water about the head. Aromatic ammonia to the nostrils; rectal injection of ice water; friction of the limbs; mustard baths; and faradization of the phrenic nerves are useful adjuvants to resuscitation. Normal salt solution (a dram of table salt to a pint of water) may be injected into the rectum, or if facilities are at hand for sterilization, directly into the veins. If the injection be made into the vein, 6 to 12 ounces of blood may be withdrawn previous to the infusion. The postmortem appearance of a body dead from illuminating gas poison is characteristic. The surface, internal organs, and mucous membranes are a bright cherry red. The blood is bright red, fluid, and will not coagulate. The urin contains sugar, glycuronic acid, and lactic acid; or it may be entirely supprest. Heart, liver, and kidneys show degenerativ alterations, and there is rupture of the cerebral vessels. There is no specific odor to the body cavities. Treatment of Whooping Cough. There is an unquestioned and a growing disposition on the part of the profession to regard this disease lightly, to treat it indifferently, or to maintain in its presence a therapeutic nihilism. And this in the face of the fact that its mortality is higher than that of any of the other 'children's diseases," except scarlet fever. It is perennial in its manifestations, and spares no age, or sex, or condition. It is particularly distressing in the very young and the very old, and those enfeebled by other diseases, and it is these classes which chiefly contribute to its very high mortality. Instead of allowing our interest in it to flag, and our treatment of it to degenerate, we should feel the keenest interest in it and study the latest recommendations toward its alleviation. Prior to the suspicion that it was due to an infection by germs, there was excuse for the carelessness manifested, because not only had the doctors no clear idea of what their medication proposed combating, but also (partly because of this obscurity) their drugs were not efficient. With the advent of the certainty that the condition is due to infection, a new vista of treatment was opened, but few practicians availed themselves of it. There is abundant proof that treatment of whooping cough with antiseptic medication, alone or combined with other lines of treatment, is of markt importance in alleviating its worst features, and has an unquestionable influence in shortening the duration of the disease. Not many new drugs have establisht themselves in the confidence of the profession, partly because they have not been tested with any universality or general enthusiasm, and partly because well-known drugs proved their efficacy in the hands of those employing them properly. There is no specific against whooping cough, and it is necessary for the clinician to exercise his best judgment and discretion in the selection of indicated remedies here, as in other diseases, if he would hope for success. In a general way, and as the most important new principle not as yet in universal use, the application of antiseptics to the mucous membrane of the nose and throat, and as a spray in the room occupied by the patient, may be considered. Any non-irritating antiseptic will do. Inhalations by sprays and from steam medicated with any of the following drugs has given good results: Resorcin, carbolic acid, oil eucalyptus, creosote, naphthalene, quinin, and petroleum (lamp oil) have been used with good effect. Resorcin, 1 to 300, in solution, is applied directly to the pharyngeal mucous membrane every 4 hours; Moncorvo says it will cure the disease in from 9 to 14 days, and will abort some cases, if used at the very onset, in 24 hours. A 25 percent solution of carbolic acid is delivered from a steam atomizer two or three times a day, at a distance of 4 to 5 feet from the patient. Equal parts of oil eucalyptus, creosote, and carbolic acid may be employed; a dram of the mixture is added to a pint of hot water in a tin cup, a tin funnel is inverted over it, and the patient allowed to inhale the fumes for a few minutes several times daily. Naphthalene is burned in the room; quinin is used in solution, locally, to the fauces, or 5 parts each of the tannate and of sodium bicarbonate are added to 100 parts of pulverized acacia, and used by insufflation. Cocain, in 5 percent solution, is painted on back of tongue, tonsils, fauces, and when possible on the larynx itself, in obstinate cases. Among internal medications, camphor monobromid, in 5 grain doses three or four times a day, is serviceable. Icthyol, 1 to 3 minims, increast to 1 to 15 minims daily, internally, with a 3 percent glycerin solution by inhalation, has been highly commended. Pyridine, a dram poured on a plate and allowed to evaporate in the room, three times a day, has scored some astonishing results. Dram doses of peroxid of hydrogen, diluted with four times its bulk of water, given internally, is said to cut short paroxysms and shorten the duration of the disease. Opium, in various preparations, has been used extensivly, but it is a dangerous drug in little patients, and we do not favor its use, tho it undoubtedly alleviates the condition if pusht to the point of stupor. Aconite, belladonna, atropin, lobelia, ipecac, chloral, valerian, and cannabis indica are the older drugs; all have cer tain virtues when intelligently employed. Whatever campaign of treatment be decided upon, however, the physician has not done his full duty if he neglect making some effort toward the antiseptic line of treatment, since the results have been too brilliant to be longer ignored by those who make any pretense of being modern in their practise. Thoro ventilation of the room occupied by the patient, during both the day and night, is another essential too often ignored, to the detriment of the patient's comfort. Our Younger Brother. A young brother who has been practising, or "trying to practise," as he puts it, only 9 months, and that in Chicago (which he says "tells a tale of its own"), says that he would be interested in the early experiences of some of the older brothers; which he says "would probably serve to encourage some of us younger men." I guess we can sympathize with the young brother. Some may say, "get out of the city." But where shall he go? That is a perplexing question that must be settled by every young professional man. One of the graduation songs at Cornell University is entitled, "We Don't Know Where We're Going." But wherever a young professional man locates, let him remember the counsel given years ago by that charming writer, Dr. J. G. Holland. I cannot quote his words, but the substance of it was this: Your final success will be determined by the way in which you use the first ten years of your professional career. During these years you will have plenty of spare time. If you use it in close study, and particularly if you exhaustivly read up on every case that falls into your hands, at the end of your first decade of practise you will be regarded as one of the leaders of your profession in your community. Thus the masters are made. But if you idle your time during your early years, you will never succeed. Thus loafers are made. Business Talks to Doctors. As soon as I clear out the box in which are accumulated inquries, memoranda, etc., for this department, it begins to fill up again, and is always full when the time comes to write the next Business Talk. Among these memoranda, once in a very great while occurs a protest against this department, because of the space taken from purely medical matters. Here is one (I usually publish all of them, they are so few and far between), from an Ark. brother: As I have no money to invest (am not a business man, but a professional man) would rather have fewer "business talks " and more medicin. If you have not educated those easy prey fellows, I don't believe you ever can. them get a lesson like I got mine, which was by going security on other men's notes. Let Is not this a reason why they should be continued, rather than the opposit? Not only are new men coming into the profession right along, but new ways are constantly arising by which doctors may lose their savings. Into this office over 25,000 physicians constantly report financial experiences and ask financial questions. Is it not better that all should know these experiences and that questions be answered for all, than that each should "get his lesson like I got mine"? |