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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.

Subscription to any part of the United States and Canada ONE DOLLAR per year. To England and the British Colonies, FIVE SHILLINGS per year. Postage free. Single copies, TEN CENTS. These rates must be paid invariably in advance.

Pay no money to agents for the journal unless publisher's receipt is given.


ERE we meet again in these columns the 19th century will have past away,

We cannot always supply back numbers. Should a number

fail to reach a subscriber, we will supply another, if noti and the 20th century will be begun. Did

fied before the end of the month.

you ever think how many people are born and die between the mile-posts and never witness the birth of a new century? It is a privilege that none of us can live to enjoy a second time.

The tendency to review the old century and prophesy concerning the new one is a natural one, but we will not indulge it here. So much of it has already been done, and so much more will be done in these closing days, that we will not add to the burden of thought in that direction.

Centuries are made of just ordinary days like to-day or yesterday. If a century is to be great, its days must be great, and we must make them so.

1530 Chestnut Street



JANUARY, 1901.

No. 1

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 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 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 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, recommend the following:

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join in 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 rationalize our universal instrument-language.

The beginnings and endings of centuries are arbitrary. It is only Christendom (a minority of humanity) which is now having a closing of a century. In fact, each day might be considered the ending of a century. However, our present arrangement is not only convenient, but some such arrangement is necessary. Thus we have time markt off in centuries, years, months, weeks and days; but the only natural divisions are days, lunar months and years.

Shall we substitute the customary New Year resolutions with New Century resolutions this year? Who will be so brave?

Is This Your Platform?

While it is always a good time to subscribe for a good medical magazine, it is in this month that the editor's "fancy lightly turns to thoughts of" new subscribers, more particularly than at other seasons. Our plans have been laid, and are now in process of execution, whereby our magazine will be better in 1901 than ever before in its history. Doubtless you have also laid plans. Have many of them of them taken on the guise of striving to be a better doctor, of taking more journals and of reading them more faithfully, of buying new books and digesting them thoroly, of living more in the light of the dawn of twentieth century medicin and less in the dark ness of arrogant empiricism of past years, of being less dead and more alive, of mastering the latest books while devouring the current medical literature, of condemning the writings of others less and bettering the truth by writing more yourself, of patching up that old quarrel with your opponent, of increasing your revenue by corraling dead beats so that your own bills will not stare you so long in the face, of joining the local and national organizations which are striving for the betterment of medicin? These things have made uneasy our head for some time past, so that we might make a rosy path for you in 1901. Are our efforts appreciated? Then get us a new subscriber; write us some of your successes and some of your failures. You have a few prescriptions you "swear by"; send them to us. Never mind the ones you have sworn at. After you get thru "resoluting," then act, quickly, decisively, and continuously thru the year. With best wishes for every WORLD reader, we will only say again, let us hear from you soon and to the point.


We love the enthusiastic man; he who has the "push" and energy to make things "hum." When we become seriously ill, we want an enthusiastic doctor to attend us. All the advances in art, civilization, mechanical triumphs, war, peace, and blessed medicin, have been made by enthusiastic men. Yet enthusiasm is seldom found absent from a tendency toward exaggeration; and such trend is deplorable and unfortunate.

Exaggeration in children is designated as lying; in the grown up professional man it is none the less so. The child

exaggerates thru a desire for self exaltation; and the motif in the grown up person is the very same. In a layman, it is bad enuf; but in a physician it is almost or altogether criminal. We all know physicians who are continually having "terrible" cases, and who are always "rusht to death." It generally takes them an hour of their valuable time to tell the garrulous old women, who love to listen. with gaping mouths, of some new and "terrible" case, even tho they "can not get time to eat." It is such men who label every case of simple fracture as a "very complicated case," and who term all cases of tonsillitis, "severe diphtheria." The fact that they worry both patient and friends does not influence them in the least. The fact that their words are deliberate untruths does not disturb their equanimity. The child who exaggerates, lies; and is reproved. The doctor who lies, along such lines, is revered by the laity as a great and wonderfully skilful man. Yet what must be the mirror of that man's inner soul? They can not help knowing that they are the objects of ridicule by sensible practitioners and by the more intelligent laity.

Dr. N. Senn has been announced as the Lecturer on Military Surgery in the University of Chicago. The opening course will be given with next fall's curriculum.

Herpes Progenitalis.

This rather insignificant genito-urinary affection is deserving of more attention than is usually devoted to it on the part of the physician. It is often very obstinate; indeed is occasionally incurable. The separate attacks are readily cured, but the eruption is prone to recur after coitus or any incidental irritation from clothing or perspiration. The patient, especially if he has subjected himself to the possibility of infection, will certainly insist upon the gravity of the case. Unless rapidly cured, and especially if his trouble be made light of, he will probably seek another doctor. Should the second practitioner have a little more diplomacy, tho less honesty, than yourself, the cure will be rapid and you will have lost a patient.

Predisposition to the eruption is caused by the neurotic or uric acid tendency; locally, the exciting cause may be any irritation, such as retained smegma, uncleanliness, phimosis, excessive coitus, existance of a specific discharge or contact with such a discharge in another, prolonged contact with irritating vaginal or uterin discharges, even tho they be non-specific. Often in obstinately recurring herpes progenitalis a complete cure is obtained by circumcision, even tho there be no markt phimosis present.

The eruption appears suddenly as a group of vesicles mounted upon inflammatory bases upon the skin or mucous surface, and accompanied by itching and burning. The surface of the vesicles is soon denuded, and small erosions remain. A mild balano-posthitis usually complicates the herpes, but occasionally it becomes severe enuf to occasion the suppurating buboes seen in gonorrhea and chancroids. While not often causing severe pain, the herpes are occasionally productiv of intense suffering resembling that of severe herpes zoster. To this variety is applied the In most cases term neuralgic herpes. there is a distinct interval between the attacks, but in rare cases one attack follows

another with such rapidity that new vesicles form as soon as the older eruption heals. When seen in the early stages, the diagnosis is easy if we remember that they appear suddenly after irritation or without known cause; burn and tingle constantly; and have but slight serous discharge from a red base. If seen in the vesicular stage, before maceration occur, no confusion with other genital affections is probable. After erosion takes place the differential diagnosis between chancroids, chancre, mucous patches, and simple balano-posthitis, is more difficult. The lesion of herpes is superficial, multiple, circular, is not indurated, rapid in development, does not spread, has a moist red surface, has only a slight serous discharge which is often noticeable only on pressure, and they heal rapidly if kept clean and well dusted with mild antiseptic and astringent powders.

Perfect dryness, protection from irritation, cleanliness, and mild astringents and antiseptics make up the most promising treatment. The cleansing fluid may be carbolic acid solution, 1 to 60; bichlorid of mercury solution, 1 to 5000; creolin solution, a dram to six ounces; or a 50 per cent. solution of hydrogen peroxid in water. After cleansing, the lesions are painted with silver nitrate, 10 grains to the ounce of water; dusted with zinc oxid, bismuth subgallate, aristol, europhen, or with a powder composed of boric acid 1 part zinc oxid 2 parts, agetanelid 2 parts; and covered with a thin layer of absorbent cotton. This cotton must be kept dry, and changed often, the not moist. If there be any evidence of neurotic or rheumatic tendencies, it is well to give appropriate treatment. The neuralgic form is rather intractable, but is best handled by thoro cleansing, dryness, silver nitrate solution, and the application of the following ointment:

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Differential Diagnosis between Chancre, Chancroid and Herpes Preputialis.


Origin:-Due to inoculation with blood or lesion discharges of a syphilitic.

Incubation :-From ten days to eight weeks. Average about three weeks.

Situation:-Generally on the genitalia.
Often on lips, nipples or hands.

Beginning:-Begins as an erosion, papule, tubercle, or ulcer. May remain without ulceration thru its entire course.

Surface:-Smooth, shining, dusky red, glazed; diphtheritic membrane, or scab or epithelial crusts.

Induration:- Almost

always present: firm, cartilagenous, or parchment like; sharply circumscribed; movable upon subjacent parts. Prolonged pressure by the examining fingers does not produce any change in it; usually persistent; gradually disappears under specific treatment.


Number:-Single; at times simulta- Frequently multiple; often on opposing Multiple; often ultimately confluent. neously multiple. surfaces by auto-inoculation.

Shape:-Round, oval, or symmetrically Round, oval, or unsymmetrically irregu-
lar, with border described as segments
of large circles.

Sensibility:-Very rarely painful.

Due to Inoculation with the discharge of
a chancroidal sore. Possibly caused by
pus from other sources.

Depth:-Usually superficial, cup shaped, Hollow, excavated, or "puncht out." or saucer shaped, or may be elevated.

Course:-Progressivly towards a cure, the sore often healing spontaneously. Relapses and phagedena are uncommon.

Histology:-A new cell growth. Very little destruction of tissue. Scrapings often show more or less epithelium.

No definit period. It may not be noticed None.
for two or three days.

Generally on glans penis and prepuce;
rarely on other genital surfaces. Seldom
on any other part of the body.

Prognosis:-Good locally; ulceration is at expense of the infiltrate; hence there is little ultimate scarring. Constitutional syphilis follows in the great majority of cases. In a few, it may not appear, or may be prevented from appearing by treatment.

Begins as a pustule or an ulcer. Always Begins as a group of vesicles, which
may coalesce or may ulcerate singly.


Secretion:-Scanty, serous, seldom auto- Abundant, purulent, readily auto-inocu- Only moderate secretion, auto-inocuinoculable, except in cases of mixt infection, when a chancroidal sore may be produced. On squeezing can not press out a discharge.

lable with difficulty. On squeezing, a small serous drop exudes. When this is wiped away, another drop can be prest out. This can be repeated several times.

Herpes Preputialis.

Due to:-(1) Mechanical irritation, as in sexual intercourse. (2) Chemical irritation, such as produced by acrid discharges or by uncleanliness. (3) To neuroses; often following fever, and particularly occurring in syphilitics.

Often very painful.

Irregular; may cicatrize rapidly or may
extend. Relapses and phagedena not


An ulceration, with more or less loss of
substance. Scrapings show granulation

Bubo:-Constant, painless, multiple, gen- Appears only in one-third of the cases.
erally bilateral.
Painful, inflammatory, single, or a sin-
gle one on each side.

Generally on the glans penis and the inner layer of the prepuce.

Rough, uneven, "worm eaten," warty, Bright red superficial granulations,
grayish, pultaceous sluf.
sometimes covered by diphtheritic

More serious locally, for there is tissue de-
struction. May refuse to heal, or be-
come phagedenic. Is never followed
by syphilis unless it is a mixt infection.

Only exceptionally present. Due to caus- Same as any local ulcer.
tics or other irritants, or to simple in-
flammation; boggy; inelastic; shades
off into surrounding parts, to which it
is adherent; disappears soon after ci-
catrization. Prolonged pressure causes
changes in shape, such as are noted in

Treatment:-Excision when seen early; Proper local treatment is curativ.
other purely local treatment is inef-

Irregular, circinate borders, representing segments of small circles; sometimes serrated.


Often painful.

Easily and quickly cured. Sometimes spreads by appearance of successiv crops of vesicles. Lesions preserve the polycyclic form. Likely to recur, especially in syphilitics and in uncleanly persons with long foreskins.

Originally an elevation of the epidermis in spots by an effusion of serum.

Rare. When it does occur, painful, inflammatory, single or a single one on each side.

Always good. Recurrences are frequent, especially in syphilitics. (The herpetic chancre closely simulates herpes preputialis.)

Local treatment is curativ. Tendency to spontaneous cure.

relieve; but occasionally no treatment seems to avail. In such case, use anodynes, and promise relief in five to ten. days.

When a patient comes to you with a history of repeated failures at the hands of other physicians, it is well to vary the classical treatment by the following modifications: First, try prophylaxis. After one attack has subsided under the treatment outlined above, have him use frequent applications during the interval between attacks, of aqueous solutions of hydrastis, 1 to 5; or water saturated with alum while hot, and applied frequently; these may be carried in the pocket in a small vial. After coitus, or exposure to any irritation, cleanse carefully without force, use the lotion, and follow by dusting with compound stearate of zinc (McK. & R.); orthoform; bismuth subgallate; or carbolized talcum powder.

Tone the system with arsenic; bichloride of mercury; peptonized iron and manganese; strychnin, etc. Regulate the bowels. See that the urin is normal and unirritating. Quiet the nerves with bromides and valerianates. Assure the patient, and give him all the attention he thinks he needs, and charge him for it; he will get better, and you will be less worried and much happier, and will have a better bank account.

It is the little things over which most patients exhibit greatest concern. Many a man would lay quiet thru an attack of typhoid who would make life miserable for himself and a dozen doctors with one little attack of herpes progenitalis. Be diplomatic as well as thoro. We append a table on differential diagnosis taken from White and Martin's Genito Urinary and Venereal Diseases. Master it; many a man is condemned to a three-year course of mercury which he never needed, and a life time of celibacy and misery afterward, which he has never deserved: all because of carelessness or ignorance on the part of some doctor. When you are sure you have

herpes preputialis, be able to confidently give reason for the belief that is in you. But, as you value your peace of mind, never confuse it with a genuine chancre; for there is but little to which you may turn for consolation in after years. Ignorance in medicin is no more of an excuse than is ignorance in law.

Extra Genital Chancres.

While syphilis is the great disease of the world, and has been thru all history, it is only of late years that any attention has been paid to the poor victim's assertions of innocency. In his doctor's eyes, the chancre condemned him, and he went hung" in the worthy practitioner's opinion, not alone as a syphilitic, but also as a brazen liar. Perhaps the "water-closet" story had become stale; perhaps, and more likely, our egotism and ignorance blinded us.

Certain it is that extra-genital chancres, which were formerly so rare, are rapidly becoming distressingly common. They are found in locations which preclude the suspicion of unnatural practices; they are observed on the lips and in the throats of irreproachable women; they are not rare in the aged in whom sexual passion is but a memory. Little wonder our attention is impelled. While none but the physician in activ practise imagins the extent of the hold which syphilis has upon our people, very few physicians have appreciated the gravity of the actual conditions confronting us. It is said that in Germany, when a physician examins a strange patient, he does not ask, as we do, "Did you ever have a chancre?" but puts his question thus: "How long since you had a chancre?" In a slang phrase, we will soon be "up to it."

One may be ever so familiar with the ordinary appearance of the genital chancre, and yet make a disastrous mistake when he finds one in another locality. If he finds a sore which is not a chancre, and he call it a chancre, trouble comes; if

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