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they can. Literally "they work while he that it is not in the province of a medical sleeps.'

school to make its students adepts prior to The average physician is easily led into graduation. the prescribing of proprietaries by the argu- True enough, but the young physician has ments of the manufacturer, because he has a right to expect a foundation of instruction much of the inherent human trait of believ. in that direction that is a little more pracing what he sees in print, and accepting as tical than is generally the case. And he also truth what is told him concerning the proper. ought to be fortified by a consistent example ties of medicines. This fundamental weak- on the part of his teachers-a deficienoy that ness of all civilized people-oultivated as is glaring only too often. well as ignorant-medical men share equally In the last year at school more time ought with the lay public.

to be devoted to the teaching of this import. This innate tendency on the part of physi. ant practical subject. And the instructors cians could be materially controlled if they should inform themselves more thorougbly in had a better knowledge of legitimate materia the matter of prescription writing so that medica; if they thoroughly understood tbe they may be better able to instruct their physiological action of the important known pupils. Our medical teachers in many indrugs and chemicals, and if they had a stances show an inexcusable ignorance of the reasonable comprehension of pharmaceutical United States Pharmacopeia, and as to the compatibility and the allied subject prescrip- National Formulary that work may as well be tion writing.

a volume in Sanskrit so far as their familiar. We find that the physician is not trained ity with its contents is concerned. with the view of being able to withstand a What can be expected of a medical grad. negative pressure from within and the posi- uate whose instructors do not know the differtive force from without; negative within, be- ence between the United States Pharmacopeia cause of his conscious less of the fact that he and the United States Dispensatory, and are is unable to combine prescriptions with ther- unable to comprehend the points of dissimi. apeutic and pharmaceutic accuracy and posi- larity between an authoritative pharmacopeia tive force without by reason of his inability and commenting dispensatory? to resist the arguments of the trained manu. I will venture to say that one-half of the facturer when he points out the claimed ad- professors and other instructors in the medi. vantages of his particular nostrum.

cal colleges of the United States today could Now, we we are getting to the primary not intelligently describe the subject matter source of the difficulty.

of either of the above mentioned works. And The medical college does not give its grad. it is a self-evident fact that without a clear uate a sufficient working knowledge of pre- conception of what these books are and conscription writing. When the young doctor tain, no one can comprebend or teach ethical leaves school to enter active practice be is at and legitimate presoription writing. a loss as how to write, at the spur of the mo- In view of the known fact that we cannot ment, and in the presence of a suspicions pa- prevent the commercial instinct of the manu. tient, an order for the medicines that he may facturing pharmacist from attempting, with have in mind as meeting the indications. In all his resources, to accumulate wealth, and the bazy whirl of his excited brain there to accomplish this purpose in a manner that stands out in the midst of a conglomerate of experienoe has shown him to be most successremedies the name of the most recently ex- ful, that is, through the medium of the medi. ploited proprietary, whicb he remembers the cal prescriber, what can we do to minimize agent assured him was the best thing in the this admitted evil? therapeutic universe for just such a case. In answer I should say: teach the teachAnd down goes the name on the prescription ers, that they in turn may train the coming blank with a sigh of relief that will hardly generation of prescribers. The older nos. be echoed by the patient.

trum prescribers are firmly fixed in their This experience, repeated daily, leads bim habits and will in most instances bave to into the babit-easily acquired, but difficult be allowed to dose their patients with propri. to shake off-of writing for ready-made mix. etaries to their mutual graves. But with the tures and newly launched remedies.

younger and coming physicians something In defence of the medical college it may be can be accomplished in the way of guiding argued that the demands of modern medical their steps in a correct line, and we must plan education are so severe that there is not suffi. for them. cient time to devote to the acquirement of the At every possible opportunity (for instance technique of prescription writing.

occasions like this evening's meeting) let us And it might be further claimed that this remind the medical teachers of the duty they ability must be gained in actual practice- owe to their pupils, the profession-and ul.


timately to the general public-in that they sbould so familiarize themselves with the legitimate materials of medicine that they may, by force of example, always lead their

Issued Tenth and Twenty-Fifth of Evory Month. followers in the proper direction.

THOMAS A. HOPKINS, Every lecturer in a medical school should

Managing Editor. own a copy of the last revision of the United

Editorial Staff : States Pharmacopeia and a copy of the Na

0. E. LADEMANN, Internal Medicine. tional Formulary, ought to thoroughly ao


F. P. NORBURY, Nervous and Mental Diseases. quaint himself with the important features of R. B. H. GRADWOHL, Pathology and Bacteriology. each of these books, and then frequently re.

W. H. VOGT, Obstetrics and Gynecology.

WALDEMAR FISCHER, Ophthalmology. fer to them in the course of his leotures. By A. LEVY, Pediatrics.

W. T. HIRSCHI, Therapeutics. these oft-repeated reminders the young doc

A. F. KOETTER, Otology. tors will be lead into the habit of looking HERMAN STOLTE, Laryngology and Rhinology.

T. A. HOPKINS, Genito-Urinary Diseases. to these two very desirable sources for pres. ROBERT H. DAVIS, Dermatology. criptions, and this routine practice inouloa

Editorial Rooms, Suite 319-321 Century Building, St. Louis. ted early in their professional lives will leave lasting and valuable impressions. Thus they will be in a positiou to meet the

EDITORIAL nostrum vendors' specious arguments with some degree of self-confidence. We must not let those physicians who have

It is a happy oustom that makes the year's ing no medical college affiliations think they

end and beginning a season of greetings and can bide themselves in their obscurity and go

expressions of good on prescribing in their own reckless way

wishes; in the intimacy

The Season's without censure. They also have a duty to

of the family, between Greetings.

be perform and owe it to their profession that

friends, and even they do not by word or example render the

tween strangers, the ex. way of the reform now under progress any

change of felicitations result in a confortable more difficult. They should look to them. uplift. It is a form of giving which surely selves carefully, and see if they cannot pre

blesses both him that gives and him that rescribe rationally, as becomes scientific men,

ceives. As has been our custom for years who recognizing a definite pathological le- past we most heartily wish our readers each sion, meet the condition with a definite and

and all a Merry Christmas and a Happy known therapeutic measure; a remedy whose

New Year. May your new year be the best composition they know.

year, just as every year should be. If then they obtain favorable results they

will look for it with a sufficient degree of have a scientifio basis on which to plan sub

earnestness, happiness and prosperity in all sequent treatment in similar conditions. The your goings to and fro will be a matter of physician who is constantly vacillating from daily experience. You may not have noticed one nostrum to another, knowing nothing of it but people find pretty much what they are their composition, having no data bearing

bent on finding in this world, and he who upon their physiological action, and being in

enters 1907 with “a chip on his shoulder," the dark as to their therapeutic value is illy and bitterness in his heart, will surely find a adapted for a pattern for the young practi.

lot of unpleasant people and many unhappy

The real tioner who should have placed before him experiences before the year ends. ideals of a profession whose modern aim and

lesson of the life of Christ, whose birthday goal is exact scientifio metbods.

the world celebrates at this time, has insepar. In closing, let me summarize my sugges.

ably woven into it a deal of cheerfulness, tions: Let all physicians, especially medical helpfulness and good will; these are features

of the real Christian life; we have no purpose teachers, familiarize themselves with the United States Pharmacopeia and the National

to deliver a sermon, but we can wish for the Formulary, and restriot their prescribing as

readers of our journal no better things for

1907 than a full realization of the spitit of near as practicable to the preparations embodied in those two books.

Christmas throughout the year. 2701 Stoddard street,

If you

The appearance of pus in the breast of a THE FORTNIGHTLY INDEX.-A glance at woman who is not, or has not recently been the annual index inclosed with this issue will nursing, is suspicious of some unusual form give our readers a fair conception of our work of infection, e. g., tuberoulosis.

during the past twelve months.

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The time for stock-taking bas come again made up of concise, practical papers, from and a careful inventory may quite as advan. men of eminence, dealing with such points

tageously be taken by as their experience has shown them are liable

the man of medicine as to be overlooked or misapplied by the genRetrospect and Prospect.

by the man who follows eral practitioner. It is our purpose that the à mercantile calling; course for 1907 sball be, above all, practical,

even a medical journal the papers already promised indicate tbat we may find future advantage in checking up will bave those to address us who can com. and coming to a realization of bow fully it mand an audience anywhere. is fulfilling its mission. The year has been The managing editor feels his indebtedness one remarkable for general prosperity to all those who have by their contribu. throughout the country, as is shown in all tions and otherwise, assisted bim in making lines of commercial activity, and there are 1906 one of the better years of the FORTNIGHTfew of us who bave no reason to appreciate it Ly's existence, at the same time we would from its effect on some one or another phase thank our readers for the encouragement well of our lives. THE MEDICAL FORTNIGHTLY bave found in their appreciation of wbat we has experienced its share of good things of have had to offer; such an audience is inthe good times, and bas enjoyed a satisfied deed an incentive to enthusiasm. It is also sense of a very considerable degree of use. meet that we acknowledge our obligations to fulness. At the same time we must confess the advertising patrons; without their bearty to some disappointment that we have not co-operation in this work, our plans for enachieved a considerably greater degree of use. larging and improving could scarcely be confulness, having that healthy lack of complete summated. satisfaction which leads to continued effort toward better things.

Our readers will have noticed some change The development of the Sunday paper is in the editorial management recently made, one of the marvels of recent days; the influ. Dr. Norbury remaining with us only as edi.

ence of the Sunday tor of his department, Neurology, and in an

The “Funny"

paper is still an undeadvisory way. While we have deeply regretted

termined factor in the bis being compelled, on account of increasing


weal of the community. professional duties, to withdraw from the

We have expressed ouractive editorial management, we believe that selves freely in the matter of certain adver. the change has been effected without loss to tisements which appear in these papers, and our readers. Some further changes and ad. we had purposed giving some attention to the ditions to our editorial staff will be made so-called "Funny Side," it appearing that early in the future, it being our definite the fun is largely so frightfully overdrawn as purpose to give a considerable increase to be no longer humorous, making the sheet in the amount of translations and de- as a whole pernicious in its effects. The edi. partment work during 1907. THE MEDICAL tor of the Alienist and Neurologist may well FORTNIGHTLY continues the official journal of be quoted on the subject. He says that the the Medical Society of City Hospital morbid imagination of the "Sunday newsAlumni, and we hope to present consider- paper illustrators suggest the lunatic asylums. ably more original matter from this source The antics of Maud, Little Nemo, Panhandle than during 1906. The society is one of the Pete, Foxy Grandpa and the Kids, Jimmy, strongest in the city, it is doing splendid Buster Brown and others of that ilk can be work, bas most pleasing outlook, and duplicated in any well supplied asylum for our readers, other than members of the soci. the insane and indicate a ready vocation for ety, will have the benefit of this through lunatics. The fun of Buster Brown appears the FORTNIGHTLY.

the most rational and is indicative of a higher It is our purpose to resume our course of grade of reasoning insanity than the others. Post-Graduate lectures in an early issue. It is a sort of humorous paranoia that ought Among our readers we are so fortunate as to to soon end in silent terminal dementia. The include a large number of physicians who are antics of a few lunatics at large, if faithfully

a residents of smaller towns and of the coun- delineated would duplicate the entire pertry tributary to St. Louis who are compelled formances of the entire funny picture progby the circumstance of their location to do eny of our public press. The psychic influ- . some little of the lesser work of eachi and all ence of Foxy Grandpa series is especially bad of the specialties; for this class of readers on children, who are disposed to take many and as a matter of general interest, it has been of the pictured portrayals too seriously, gen. our custom to conduct what we have called erating in their minds irreverence and disre. our post-graduate course, and which has been spect of age."


The annual meeting of the Medical Society gists Association, the St. Louis Drug Clerk of City Hospital Alumni was held in the hall Association and the Alumni Association of

of the Medical Library the St. Louis College of Pharmacy to partioi

on the evening of De- pate. This joint consideration of a live topic The Hospital

cember 6th,

The an

follows up an excellent program recently carSociety Elects nual report of the offi. ried out by the Society of City Hospital AlOfficers.

cers showed that the so- umni, a report of which will be found in this ciety is in a very satis- issue.

factorily prosperous condition. The society elected the following officers for 1907 : President, Dr. W. C. G. Kirohner.


TIONS.—The annual colleotion for oharitable Secretary, Dr. W. H. Mook.

work in the various city hospitals took place Treasurer, Dr. Jules Brady.

the first Saturday and Sunday of December, THE MEDICAL FORTNIGHTLY continues the

the amount collected has not yet been an. official organ of the body, as heretofore.

nounced definitely, but returns have come in sufficient to indicate that the figure will be

about $40,000. The local postal authorities have lately been A RARE FORM OF INTESTINAL STENOSIS.concerned, because it has been discovered Gayanes (Rev. de Med. y Cir. Pract., July,) that physicians were publishes

publishes a remarkable and bitherto unre- . sending various speci. corded case of ileus. The obstruction resulted No More Bacteria by

mens to the city bacteri. from two constrioting circular bands of pro

ologist for examination liferated mesenterial fat about the small inMail.

through the mails and testines (ileus lipomatosa anularis). Death

this has been ordered followed a perforation of the rectum as the disoontinued. To those of us who have never result of a careless inflation with a carbon thought of using the post for this purpose it dioxide enema a day preceding the contemseems surprising that anyone could ever have plated operation. thought it safe to do so, and we congratulate St. Louis that it was stopped before a calam.

A PLAN FOR SAVING INFANT LIFE. - When ity resulted.

Alderman Broadbent, a brother of Sir Wm.
Broadbent, the King's physician, took office

as mayor of Huddersfield, on November 9, On January 12, 1907, there will be a meeting 1904, he derised a novel scheme to reduce inof pharmacists and physicians to take up the fant mortality. He offered to give parents

mutual relations of the living in a specified distriot of the city a

two professions. This guinea for every child born during his twelve The St. Louis Medical Society.

months in office and living at the end of meeting promises much interest, and we antici. twelve months. The result of the experiment

pate a large attendance. was announced recently, on the second anni. The following is the program:

versary of its inauguration. The rate of in

fant mortality in the Longwood district of MEDICINE AND PHARMACY.

Huddersfield, which is the experimental area, An analysis of the New Pharmacopeia, Mr. had averaged 122 per thousand for the preJ. M. Good. Discussion by Dr. J. L. ceding ten years. The period of the tests Boehm.

proved somewhat unfortunate.

There were The Mission of the National Formulary sericus epidemics of whooping cough and with Exhibit of Selected Preparations, Prof. measles, while the summer of 1906 was one of Francis Hemum. Discussion by Dr. Justin the deadliest recorded. The first baby to Steer.

earn the gift was born on November 10, The Ethics of Presoription Writing, Dr. 1904, and the last on November 8, 1905. The A. E. Taussig. Discussion by Mr. A. A. mothers notified the managing committee of Kleinschmidt.

the births of these babies. No fewer than The Et bics of Prescriptior. Compounding, 107 received the gift. Four died and one did Mr. Emil A. Sennawald. Discussion by Dr. not claim the gift and its fate cannot be 0. A. Wall

learned. If, however, it is reckoned as dead This meeting is gotten up by the St. Louis the average mortality works out 44 per thouMedical Society, which has invited the Al- sand as compared with the previous 122 per umni Association of the City Hospital, the thousand, certainly an astounding reduction. Cinchona Club, the St. Louis Retail Drug. -Med. Record.

REPORTS ON PROGRESS is imperative. In uncomplicated cases, the Comprising the Regular Contributions of the Fortnightly De- mortality following operation is almost an partment Staff.

accidental one. There were 110 cases of

Grave's disease with nine deaths, and but two SURGERY.

of these were in the last 64 operations. In

two sarcomas and six carcinomas there was JOHN MCHALE DEAN, M. D.

one operative death, which occurred on the Excision of Neck Cancer.-Crile (Jour. A. tbird day. Aside from these recorded there M. A., Vol.. XLVII, No. 22) in a well illus


was one death from pneumonia on the eighth trated article treats the subject of cancer of day. Pathologically, there is a change in the neck from an operative standpoint. The the gland which is essential to Grave's disauthor maintains that all cancers naturally ease or hyperthyroidism. This is in the have an operative stage, and that when taken greater number, size and shape of the cells in time the results as far as cure are con- and in the lack of normal colloid. cerned, are better than in other not super- Preparation.- Patients are prepared as to ficially located areas. Cancer at this site lung complications, and the rhythm and ten. seldom shows metastasis or are the deep tis. sion of the pulse, which sbould be carefully sues often involved. The chance of prema. investigated, as they are the danger signals. nent cure is accordingly greater. He advo- Anesthetic.- Very rarely is local anesthesia cates the blook dissection of the neck, re-employed, the preference being for the open moving all glands, and if necessary, the in- drop method of giving ether. The patients ternal and external jugular veins can be re- receive from 1.120 to 1-150 grs. of atropine moved. Temporary closure of the carotids and 1.6 gr. of morphine 20 to 30 minutes bemake clean dissection more easily accom- fore the giving of the anesthetic. plished. This is done by a pneumatic rubber Operation. The position of the patient is tube. Infection of the wound and lungs is head up (reverse Trendelen berg with a roll of guarded against by previously packing the gauze under the neck to elevate small tumors.) fauces with gauze after passing a rubber tube A transverse collar incision is made through through each nares in such a way that the the skin and platysma muscle, the sternohyoid external ends can be adjusted to the anes- muscles separated at the mid-lines. In exthetio inhaler the internal ends passing well ophthalmic goitre and complicated cases, the into the laryngeal space. In this way the anterior muscles on one side at least are se. anesthetic can be administered conveniently, vered as high as possible over the thryoid to at the same time lessening the danger of in- preserve the nerve supply and break the scar fection, and absorbing the mucus and blood effect. Cysts and encapsulated growths are that may be present. The author reports 132 enucleated; other goiters are extirpated, care cases operated on, and in the above number being exercised in preserving the parathythe lips, lymph glands and face were the roids to prevent tetany and in protecting most frequent sites. Of twelve cases oper. the recurrent laryngeal nerves. In this we ated on according to the block dissection, are aided by leaving the posterior capsule nine are living three years after without a re- of the gland in the extirpation. Sufficient currence is a strong argument in favor of this gland substance should be preserved to premethod of treating these cases. The author vent myxedema, and, as it depends upon the makes no mention of deformity following character of the gland, no definite rule can these dissection neck operations. In some be given as to what constitutes the proper extensive operations of this type the deform- amount. ity is appalling. Surgical Treatment of Goiter, Based upon

GENITO-URINARY. Three Hundred Observations.—(Abstract of a paper read before the Southern Surgical

T. A. HOPKINS, M. D. Association, Dec. 11, 1906, by C. H. Mayo, Rochester, Minn).-Tbe medical profession Syphilis of the Testicle.-In a consideraof America is taking a progressive position tion of syphilitic testicle (Am. Jour. of in recommending operation as the cure for Surg., Dec., 1906) Muren discusses the two goiter, including, also, that serious affection, forms: 1st. An epididymitis usually occur. exophthalmic goiter. The simple goiters in ring during the second period, sometimes of girls at puberty are not included in this rule. sufficient extent to attract the patient's atten. Excepting operation for malignancy and tion, but frequently existing as a small nodule Grave's disease, the great majority of opera

not noticed, and in either case responding tions are those of expediency and not of readily to anti-syphilitic treatment. 2d. Au necessity. Therefore, à low operative risk orchitis, or epididymo-orchitis, appearing as

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