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whole family sleep crowded together in one small room. However cautious he may be, the sufferer scatters the morbid matter secreted by his diseased lungs every time he coughs, and his relatives close beside him must inhale this poison. Thus whole families are infected. They die out, and awaken in the minds of those who do not know the infectiousness of tuberculosis the opinion that it is hereditary, whereas its transmission in the cases in question was due solely to the simplest process of infection, which do not strike people so much, because the consequences do not appear at once, but generally only after the lapse of years.
Our Monthly Talk.
My reply to Dr. Fly's letter last month was brief, but it is sometimes better to cover one point clearly, than to attempt to cover all the points that may be raised. Now let us take another phase of the main point raised by Dr. Fly's letter.
Pure individualism is impossible, except as Alexander Selkirk had to practise it on his lonely island. He was glad to be rescued from his accidental fate by a passing ship. He had undisputed ownership of everything on his island; all the timber, rock, sand, sea-front; all the streams, fish, game, soil-all that his eyes could behold; yet he was neither rich nor happy. He was glad to escape from his fate of pure "individualism." Here is a clear demonstration of the fact that it is the presence of people that gives value to land and all its privileges and products.
Degrees of segregation and "individualism" are possible without being ship-wreckt on a lonely island, but all the progress of the world has come by means of aggregation and cooperation, as opposed to segregation and individualism. Savages had to combine for purposes of defensiv and offensiv warfare, and in this way tribes were formed and perpetuated. But their cooperation went practically no further than warfare and the chase, and the distribution of the spoils of both. In distribution-according to need rather than power and greed-they have always been more just to and considerate of one another than civilized man.
Birth of Civilization.
Civilization dawned when different individuals began to cultivate special skill in special directions, each individual producing more than the individual need in his own product, thus having a surplus to exchange with others having a surplus in other lines. For example, the shoemaker could exchange a pair of shoes for a hat, to the advantage of both himself and the hat maker. This division of labor into distinct and separate lines has produced the wonders that have crowned human effort. The greatest of these wonders are not immense piles of masonry, like the Chinese wall, but intricate machinery that eclipses the deftest fingers, and never grows weary. The exchange made necessary by this division of labor has produced our immense commerce which is so proudly borne by our rivers and seas, and which keeps the iron horse
so busy on his tracks of steel, which tracks now gridiron our whole country.
Where is there room in this bee hive of cooperation for an "individualist ?" He is not possible except on a lonely island. However, in the immense and intricate industrial hive of this country, there are many ways for designing, cunning and unscrupulous men to get more than a just share of the product. Sometimes the egotism of these men leads them to think that they have done it all themselves! Their success is due entirely to cooperation, and not to individualism. Even an inventor is dependent for results upon the many industrious hands that put his invention into operation. An unused invention can produce nothing. Then let us appreciate how interdependent we all are. Personal egotism may suffer somewhat, but all the better for that.
Co-operation is either private and voluntary, for private gain, or public, for the general good. Of the latter kind may be mentioned armies and navies, for the public defense, police for the preservation of public order, courts for the administration of justice, the postal system for the cheap and prompt distribution of information, public schools for the making of enlightened citizenship, boards of health and sanitation for the preservation of the public health, etc., etc. All these have been steps in the evolution. ary unfoldment of the social organism. No ore would now think of abolishing any one of these, nor of placing any one of them in the control of private parties, for the exaction of profit from the general public. These things and many others have been, one by one, claimed for the public service-for the general gocd.
Private__co-operation operates in smaller spheres. The farmer is thought to be independent, but even if he should do all his work himself (if any do), he is dependent on the implement maker for the means of modern farming, and he must exchange his surplus grain for other necessities of his household. The shoemaker, even if he employs no journeymen, must depend on tool-makers for tools, tanners for leather, and his surplus shoes must go into the market for exchange for his other necessities of life. All this is co-operation of a private nature, and a kind which will, perhaps, never become public. Co-operation is more beautifully shown in a large manufactory, where each worker has his little part to do, the efforts of all resulting in the finisht product. Here both men and machines cooperate to the single object of the production of a product of a certain kind. Where is the individualist here? He cannot cope with such a power as cooperation. His methods are entirely inadequate, and he must retire to his lonely and poverty-stricken cave-or become a civilized
Results of Machinery.
The use of machinery is only one form of cooperation. Some of its advantages are summed up in an article entitled "Great Movements of the Nineteenth Century," in The Arena for July, by Professor Frank Parsons, as follows:
The development of industrial power and time and labor saving machinery is one of the principal
facts of the century. In raising wheat, from breaking the ground to sacking the grain, one hour with modern machinery will accom plish as much as twenty-two hours with the old-time plow, sickles, flails, etc. Four men with the aid of machinery can plant, raise, harvest, mill, and carry to market wheat enough to supply with bread one thousand people for a year. To shell 60 bushels of corn by hand takes 95 hours of labor time; with machinery 1 hour is enough. To make a plow by hand took 118 hours, with a labor cost of $5.34; with machinery now a plow is made in 34 hours, at a labor cost of 79 cents. To build a standard platform road-wagon with two movable seats and a leather dashboard takes 53% hours of labor time with machinery, against 2011 hours with the old hand tools, and the labor cost with machinery is $5.48 against $13.07 with hand work.
In sawing lumber by machinery, the saving of labor time is 375 to 1 and the saving of muscular exertion much greater still. One man with a doublesurface planer will smooth as many boards in a day as 40 carpenters with hand planes. To make 12 hardwood bedsteads now takes 41 hours and 64 minutes, against 571 hours by hand, or 14 to 1 in favor of machinery. The labor cost by hand was $141.90 and by machinery $6.06. One woman with a sewing-machine can do as much as 12 to 20 women with needle and thread. The sewing of 100 yards of Wilton carpet takes 14 hours by machinery and 27 hours by hand. The making of 100 lbs. of 6-oz. carpet tacks requires 8 hours to-day, against 810 with the old hand tools-100 to 1 in favor of modern methods. In the making of hainmers a man can do as much in a day with machinery as in 14 days without it. By machinery now one man can make as many 4-penny steel cut nails in a day as 130 men could make in 1813 (23,000 nails in 2 hours, against 260 hours to make that many nails in the olden time).
The making of a bar of soap in the early years of the century took twenty-fold the labor time that is required to-day. The labor cost of making 25,000 pounds of laundry soap is $3.25 now, against $43.20 in former years. A McKay machine enables one workman to Sole 300 to 600 pairs of shoes a day, while he could handle but five or six pairs in a day by former methods. The ruling of 100 reams of single-cap writing paper with faint lines on both sides required 4,800 hours with ruler and quill in 1819, while with the modern ruling machine the work is more accurately and uniformly done in 21⁄2 hours with full allowance for foreman's time, etc.-a ratio of 1,920 to 1 in favor of the modern method.
A good compositor will set 6 or 8 thousand ems in a teu-hour day by hand, while with a linotype he will set 50,000 to 70,000 ems in the same time. A modern printing-press with the help of 5 men will do the work of 3,000 to 4,000 persons. Franklin printed his paper on a little press with a big lever pulled down by hand for each impression, and making 60 or 70 impressions an hour. What would he think if he could see one of our giant steam cylinder presses printing, folding, cutting, pasting, and counting 70,000 or 80,000 papers an hour? Two persons with modern machinery print, fold, and gather the sheets for 1,000 pamphlets of 32 pages each in 7.6 minutes, while with a hand-press and bone folder 25 hours were needed-197 to 1 in favor of modern machinery. The total time consumed in making and printing the pamphlets was 21 times as great by former methods as at present. The labor cost of printing and binding 1,000 32-page pamphlets with the aid of modern machinery is 14 cents, against $7.10 by former methods.
To make 12 dozen pairs of trousers with machinery takes 1481⁄2 hours of labor time, against 1,440 hours by hand, with labor costs of $24 and $72 respectivly. For a dozen pairs of seamless halfhose, cotton, the labor cost is nine cents with modern machinery, against $1.30 by former methods-with labor time 80 to 1 in favor of modern machinery. With the old spinning wheel, one man could spin five hanks of No. 32 twist in a week; now 55,098 hanks are made in the same time-or 11,000 times as much for one man with the aid of two small boys. A girl in a cotton mill can turn out calico enough in a year to clothe 1,200 persons, more or less, depending somewhat on the size of the persons and the number of changes of cotton they have.
The railway, motor-car, bicycle, and automobile are fast relieving the horse of his ancient burdens and transforming him into a leisured aristocrat. A first class locomotiv will pull as much as 1,800 horses or 10.000 men and a day of labor with the railway (i. e., ten hours of labor for one man in connection with the railway service) will move as many tons of freight ten miles as 200 days with a two-horse wagon and driver. We cross
the ocean in five days instead of twenty-five or thirty, and go from Boston to San Francisco in less time than it took our great-great-grandfathers to go from Boston to Philadelphia. We travel a mile a minute in place of ten miles an hour, as in Franklin's day. The news from South Africa, China, and Europe is flasht round the world every day, so that our papers each morning print yesterday's news for the globe. When Washington died the fact was not known in Boston for two weeks after the event. In 1870, if A in New York wisht to hold a conversation with B in Chicago, he must travel 800 miles to do it; now he can go to his telephone or round the corner to a public station and talk to B by electricity, which is able to fly many thousands of miles a second.
For the Public Good.
Many kinds of industry have been begun as private enterprises, which have later been taken over by the general public, for the service of all. Systems of water supply for cities and towns were first establisht by private enterprise and private capital, for private profit. Most cities and towns have now learned that a cheap and adequate water supply is of such public importance, that it is good public policy that the same be owned and operated by the local government, for the service of all rather than for profit for a few. The public health depends largely on the water supply; so does public and private cleanliness-and it is a practical truism that "cleanliness is next to godliness." The efficiency of protection of property from fire depends largely on the water supply.
The manufacture and distribution of illuminating gas and electric lights are rapidly being taken out of private hands for reasons of public policy. Crime and disorder seek dark places. Thoroly light a previously dark alley of ill repute and its reputation will be immediately redeemed. A light is better than a policeman. Brilliant (well lighted) home life conduces to contentment, happiness, culture (reading and studying are made possible) and refinement. Hence we see that it conduces to good order for a city to keep its public places well lighted, and that to furnish good and cheap lighting facilities to its citizens helps to raise the standard of private life and of citizenship. Therefore many cities and towns have bought out the private lighting plants, and are furnishing light at the lowest price consistent with cost and efficiency of the service-the object being good and cheap light-service, and not profit.
As we go along, we will find that many other things belong to the field of public service, rather than private enterprise, for private profit. In former years there were many toll bridges thruout the country; now there are many more bridges than formerly, but very few of them are toll bridges. Cities, towns and counties have found it to be bad public policy to thus restrict the passage of persons and produce upon our highways, so the toll bridges have been bought with funds from the public treasury, and they have been thrown open, free to the public; and additional bridges have been built, for free public use from the start.
In certain parts of the country, the public spirit for the improvement of roads has been considered too slow; hence private companies have improved certain sections at private expense, first obtaining the privilege of collecting (Continued over next leaf.)
The Medical World
The knowledge that a man can use is the only real knowledge; the only knowledge that has
The Medical World
C. F. TAYLOR, M.D., Editor and Publisher.
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ADDRESS ALL COMMUNICATIONS TO
The President's Case.
We hoped to publish in this issue a
We cannot always supply back numbers. Should a number ringing editorial on the victory of modern
fail to reach a subscriber, we will supply another, if noti. fied before the end of the month.
surgery in gunshot wounds of the abdomen; but alas! the hoped for victory turned to defeat. In our exultancy we expected to go rather fully into the experiments upon dogs in the development of modern surgical treatment of gunshot wounds of the abdomen, and then, without taking into account the many ordinary No. 10 (but valuable) lives that have been and will be saved by operativ treatment developt by these velopt by these experiments, ask our antivivisectionist friends: How many dogs is a president's life worth? How many dogs would it be justifiable to sacrifice in order to save President McKinley's life? This, we hoped, would bring the question to them in a new and perhaps startling light; and might prove to them that those who experiment on the lower animals in order to find ways for saving human life and mitigating human suffering, are really humane; while those who object are not humane. But alas! Our come opportunity did not this time. While all that we have intimated concerning the progress in the surgical treatment of gunshot wounds of the abdomen is true,
"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 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 2) and also in the Standard Dictionary, Webster's Dic
tionary, 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:
"At a meeting of the Board of Directors of the National
Educational Association held in Washington, D. C., July 7,
1898, of the Department of
approved, and the list of words with simplified spelling adopted for use in all publications of the National Educational Association as follows:
tho (though); altho (although);
"You are invited to extend notice of this action and to
join in securing the general adoption of the suggested amend ments.-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.
we cannot take President McKinley's case as a text, as we hoped to do.
We are thus prevented from saying what we hoped to have occasion to say. But in this connection it might be of interest to present to our readers some editorial comments from the large weekly journals-comments which were written when it seemed probable that the President would recover.
American Medicine comments as follows:
The surgical aspects of President McKinley's case are of the greatest interest to the entire medical profession. The alienist and anthropologist may study the psychical traits and mental characteristics of his catiff assailant; the political economist and statesman will be interested in the causes of such crimes and the extent and the remedy for anarchistic teachings and practises; but the medical man will watch with trained eye the bulletins for the rise and fall of pulse and temperature, for those changes in the condition of the illustrious patient which indicate the triumph or failure of our present day methods of abdominal surgery. The Nation may be assured that the care of its chief executive is in the hands of surgeons of skill and ability, men already well known to the profession by their past splendid work, and may be confident that all that surgical art has attained and surgical science acquired, is known and utilized by them. We can but admire the courage of that surgeon who, when brought suddenly face to face with a condition of affairs requiring prompt action and quick decision, was not found wanting; but knowing thoroughly that the President's condition demanded immediate laparotomy, gave his patient the benefit of prompt surgery, thereby giving him the best and only chance for his life. Frequently it has seemed that an obscure citizen received better treatment than a patient of exalted position and power, because of delay in action, multiplicity of consultations, or fearfulness of assuming responsibility; but such was not the case with McKinley. The emergency hospital well equipt, the experienced surgeons, courageous yet not presumptuous, leave nothing in this instance to be criticized or regretted. And whatever may be the result of the skilful efforts to save the life of our beloved President, it becomes an imperativ duty of the profession to award to Drs. Mann and Park and their colleags the credit for their work, and to assure the laity of its confidence in their judgment and ability.
President McKinley's injury seems to be one offering exceptionally favorable prospects of recovery. The location of the wound in the stomach where peristaltic movement is comparatively limited and less likely to spread infection which would produce general peritonitis; the lack of injury to large vessels causing serious hemorrhage; the occurrence of the injury while
in good health and while the stomach was nearly empty, and especially the immediate operation by thoroughly trained surgeons and the assurance of the best possible nursing and after-treatment, give every reason for hope of rapid recovery. Even under the unfavorable circumstances of the battlefield, Makin's recent Surgical Experiences in South Africa" led him to offer a wounds of the stomach. With the best surgical comparatively favorable prognosis in cases of skill and all the advantages of a well-equipt modern hospital the prospects should be still brighter.
Medical Skill a Factor in the Nation's Welfare.-The nation awaits with eagerness the verdict of the physicians, recognizes the importance of medical skill when to that skill may be attributed the saving of its Executive, and sees that for us life has higher aims than the destructiv arts of war and the selfishness of political trickery. Situations can readily be imagined in which the entire fate of the nation may rest in the hauds of members of the profession which has for its mission the saving and prolongation of life and the alleviation of suffering. Perhaps out of this universal grief, because of the acknowledged skill of the operators and because of the patient investigation and experimentation that has within the past twenty years so advanced abdominal surgery as to render not only possible, but probable, the saving of the President's life, the profession may at last receive popular aid in its efforts to perfect the science and art of medicin, instead of being hampered by popular opposition to each successive step from those who will reap the benefit of every advance.
The surgery of the stomach has existed but little over twenty years. It is true that before 1880 occasional recoveries followed wounds of the stomach, more by good luck than good management, and gastrotomy, like cesarean section, has been practised all through the Christian era when surgeons were driven to it; but the last twenty years have revolutionized this branch of surgery. The discovery of anesthetics has made prolonged operations possible; Lord Lister's contribution of antisepsis has made operativ intervention practicable with a certainty of recovery which, were it not an everyday occurrence, would be considered miraculous. While in olden times wounds within the abdomen were treated "expectantly" and patients allowed to die of hemorrhage or peritonitis, many lives are now saved, as we believe that of our President has been, by early surgical intervention. In this progress Americans have had no small part. Gross, Parkes and Senn, by their thorough experimental studies, have thrown a flood of light into the study of abdominal surgery. The work of Gross on the Nature and Treatment of Intestinal Injuries," begun in 1841. was one of the earliest studies of this subject from an experimental standpoint, while Parkes, author of "Gunshot Wounds of the Small Intestines," was practically the first to show, by saving nine dogs out of nineteen by operation, while eighteen treated expectantly
all died, that operation offers the best hope for recovery in penetrating wounds of the abdomen.
The Advance of Surgery since the assassination of the lamented Garfield is so markt as to demand comment, particularly the advance in surgery of the peritoneal cavity. The introduction of scientific and systematic antisepsis and asepsis and a better knowledge of the physiology and pathology of the peritoneum are responsible for this splendid progress. The multiplicity of operations devised and successfully performed upon the stomach, such as gastrostomy, gastrotomy, pylorectomy, and, more recently, the operation for gastric ulcer, have shown the limits and possibilities of gastric surgery. Since 1846, when Sedillot performed the first gastrotomy upon a human being, until the present time, there has been a steady advance. In 1831 Rydygier operated first successfully for ulcer of the stomach, and the next year Czerny also reported a successful resection of a gastric ulcer; now medical literature is filled with reports of practicable operations on the alimentary canal. But it is unfair to compare the statistics of elective operations with the results of accidental and emergency surgery, in which shock, hemorrhage and the escape of intestinal and gastric contents into the peritoneal cavity may have occurred. A review of the statistics of gunshot-wounds of the abdomen is not encouraging. In less than 5 per cent. of those in which the peritoneal cavity has been penetrated have the viscera escaped injury. Of any 100 such wounds as they occurred during the Civil War there were 64 of the intestines, 17 of the liver, 7 of the stomach and kidneys, 3 of the spleen, and one-half of one of the pancreas. The general mortality has been very high, its rate being in our Civil War 87.2 per cent. and in general wars, as tabulated by Otis, 75.1 per cent. Even in the less grave injuries of civil life the mortality until recently has been generally much above 50 per cent. For a long time the results were so unfavorable, whether cases were treated by exploratory laparotomy or by the "do nothing" system, that surgeons were divided as to the proper plan of procedure; but present increast knowledge and experience have brought better results, and all are now agreed that early and rapid operation with arrest of hemorrhage, toilet of the peritoneum, removal of irritant and septic material and careful closure of any and all openings in the viscera, offers the best hope of saving life. All observations show that the chances of recovery rapidly diminish in proportion to the lapse of time before operation, the patient rarely surviving a section done a halfday or more subsequent to the injury. Körte, Reclus, Nogués, Morton and others have collected statistics giving the deathrate after operation varying from 65 per cent. to 78 per cent.; and personal reports from fifty-five of our American surgeons of all their cases of abdominal gunshot-wounds give a mortality rate of 70.66 per cent. Such statistics make us fully realize the gravity and uncertainty of the President's condition after the injury, and yet the prompt and skilful attention he received and the latest.
The present is not the time to deal with the problem of anarchism-the arrow aimed at it would overshoot its mark. Only when the heat of passion has subsided can Congress approach the subject in the proper spirit. The consideration and adoption of measures to improve the economic system with a view to preventing further spread of anarchistic sentiment belongs in the hands of the representatives of the people. The medical profession has, as a part of its responsibility, the extending of research into neurology and psychology, and the closer definition of the dangerous degenerat, whose motiv to commit a startling crime is often none other than that which impelled Herostratus to fire the Ephesian temple-a morbid vanity. It was Guiteau's desire to have his "name ring down the ages" that gave him the impulse to his foul deed. Preventiv medicin will in time be able to exercise its beneficial influence in this field. By lessening disease it will reduce the frequency of physical and mental degeneracy, but it must have the help of economic conditions, under which widespread poverty will be impossible.*
The following is the leading editorial from the Journal of the American Medical Association for September 14:
The Attempted Murder of the President. Our country has been called again to bow in sorrow and, at the same time, in humiliation. In sorrow, because an honest, laborious, wellmeaning patriotic public servant has been murderously assulted while doing his duty, and this without any cause whatsoever. In humiliation, because here, in this land of free speech, of free press, and of democratic government, where the poorest has as much to say who shall be ruler as the most wealthy; here, where the ruler is as a brother to the poorest citizen, where despotism is unknown and liberty in its broadest sense is the heritage and the right of all; here the anarchistic assassin plies his accurst work and excuses his deed by calling it a righteous