Covering the New United States Pharmacopoeia The National Containing the Natural History, Chemistry, Pharmacy, Actions and Uses of Medicines, including those recognized in the Pharmacopoeias of the United States, Great Britain and Germany, with numerous references to other Foreign Pharmacopoeias. In accordance with the new United States Pharmacopoeia, 1905, and by authority of the Convention. By HOBART AMORY HARE. B.Sc., M.D., Professor of Therapeutics in the Jefferson Medical College, Philadelphia, Member of the Committee of Revision of the U. S. P.; CHARLES CASPARI, JR., Ph.G., Phar.D., Professor of Pharmacy in the Maryland College of Pharmacy, Baltimore, Member of the Committee of Revision of the U. S. P.; and HENRY H. RUSBY, M.D., Professor of Botany and Materia Medica in the New York College of Pharmacy, Member of the Committee of Revision of the U. S. P. Imperial octavo, 1858 pages, 478 engravings. Cloth, $7.25 net; leather, $8.00, net. Thumb-index, 50 cents extra. T O practitioners of Pharmacy and Medicine this new work of the highest authority will be of great importance. Published September 1st, the date officially fixed for the new U. S. Pharmacopoeia to go into effect, it contains, by authorization of the Convention, every article in the new Pharmacopoeia, together with explanatory notes and instructions necessary to a full understanding of the brief official statements. In addition, it covers the essentials of the latest foreign pharmacopoeias, and the very important domain of unofficial drugs and preparations so largely in use. Of its authors, Prof. Rusby has treated the department of Phamacognosy, including the minor as well as the major drugs of the entire globe, a service never before rendered; Prof. Caspari deals with Pharmacy, giving full information regarding methods and products, with descriptions and explanations of the most approved apparatus and tests, and Dr. Hare has written the sections on Medical Actions and Uses, giving a direct and compact presentation of modern therapeutics. An Appendix of 60 pages contains all necessary tables, formulas, tests, etc., for practical use. The General · ndex, of about 90 pages, contains full reference to every name in the text, making it a reportory of the world's knowledge of drugs, and the Therapeutic Index, of about 40 pages, contains, under the name of each disease, references to all the medicines employed in its treatment, leading the reader to the points in the text where the conditions calling for its employment will be found. In a word, The National Standard Dispensatory is a complete library and encyclopædia of pharmacy and therapeutics. This single volume contains not only every article in the new U. S. Pharmacopoeia, with necessary explanations omitted from that work, but it also covers the great class of recognized unofficial drugs and preparations. It contains no fewer than 478 telling illustrations. The pharmacist possessing The National Standard Dispensa tory alone will need no other book. Sent postpaid on receipt of price by the publishers, to any address in the United PHILADELPHIA 96-708-710 Sansom St. Lea Brothers & Co. NEW YORK 111 Fifth Avenue By a special arrangement with the publishers we are able to offer the following magazines in conjunction with the Medical Fortnightly for one year at an unheard of price. Your order may be either NEW or a RENĚWAL, and each publication sent to a different address if desired. The only restrictions are that you must send cash with order and send it at once, as our offer is limited and subject to withdrawal at any time. MEDICAL OFFER No. 1. Medical Fortnightly... 6.50 Publishers Our Price Price 2.00 2.50 2.50 > $7.25 2.00 $5.00 3.00 7.00 5.00 OFFER No. 11. Publishers Our 12.00 Price Price Lippincott's Mag 2.50 Price Price Cosmopolitan or $4.00 (Including free copy of Dr. Black's "Card System for the Doctor.") Papers for the original department must be contributed exclusively to this magazine, and should be in hand at least one month in advance. French and German articles will be translated free of charge, if accepted. A liberal number of extra copies will be furnished authors, and reprints may be obtained at cost, if request accompanies the proof. Engravings from photographs or pen drawings will be furnished when necessary to elucidate the text. Rejected manuscript will be returned if stamps are enclosed for this purpose. COLLABORATORS. ALBERT ABRAMS, M. D., San Francisco. ARTHUR R EDWARDS, M. D., Chicago, Ill. Mr. REGINALD HARRISON, London, England. HOBART A. HARE, M. D., Philadelphia. FRANKLIN H. MARTIN, M. D., Chicago. LEADING ARTICLES ADENOIDS. HERMAN STOLTE, M. D. MILWAUKEE, WIS. ALTHOUGH the pathology and therapy of adenoid vegetations in the vault of the pharynx have been covered hundreds of times by the pen of experienced and able workers, still daily experience impresses upon the throat specialist the fact that there are many general practitioners who fail to remember the fact that William Meyer in 1870 taught the scientific world, that scores of children, who are forced to breathe continuously through the mouth, the air passage through the nose being blocked, who have to struggle all night with difficult breathing (snoring), who represent anemic debilitated condition of health, who suffer continuously from colds, coughs and earache, and who are often very deaf, that all these children can be relieved in the shortest space of time from their ailments by a short and miraculous surgical interference: the removal of adenoids. Thirty-six years have passed since this discovery, but still children are brought to the office daily, not so often by the family physician, as by intellectual parents, whose darlings show the ineffaceable traces of the long years of nasal No. 5 respiratory obstruction and altered type of respiration in their peculiar deformity of face, in the physique of the lungs and entire mental and bodily development. Are we not moved by pity and indignation that these things should go on for years without medical suggestion of the proper kind until all these conditions become nearly irreparable? We ask modestly are these children, in whom the diagnosis may be made by merely glancing at the patient at a distance, never seen by a physician? Sad to relate, they have been seen over and over again. They were treated with all kinds of tonics; were sent to summer resorts, to another climate; and the parents have done everything to have their children cured. However, the one so obvious advice, which constitutes the quickest and simplest cure, that is, the removal of the adenoids has never been suggested, due to lack of intelligence or perhaps forgetfulness. I can think of no other explanation. Even if the suggestion urging the advisability of such an operation was made by the parents it was suppressed by the medical adviser, who tells them that the operation is dangerous, or that the adenoid in a growing child would disappear gradually in the course of years or by the use of the much talked of breathing exercises, also if removed that they would reappear. All these suggestions are wrong or nearly so. Adenoids of a large volume never shrink of themselves, or without surgical interference to such an extent that they cease to produce all the detrimental influences, especially with regard to the pharynx and nose (catarrh and irritation and occlusion of the Eustachian tubes). In the meantime, while we are waiting for their disappearance, the persistent purulent discharge and deficient aeration of the lungs will have produced chronic gastritis and anemia, chronic bronchitis and a predisposition for the onset of tuberculosis of the undeveloped and weakened lung. On the other hand, the chronic obstruction of the Eustachian tubes and lack of middle ear ventilation, together with the existence of acute inflammations, have created irreparable fixation of the drum and ossicles and hardening of the mucous membrane lining of the middle ear. Then the other suggestion: Breathing exercises. have no hesitation in saying that I don't believe for a moment that any child who has well marked adenoids has been or ever will be cured by breathing exercises, whether the adenoid will be secondary to the nasal oatarrh or not, there can at any rate, be no doubt in well marked cases that they obstruct the air passages, and must thereby certainly prevent that ventilation of the lungs which is of such enormous importance. It logically follows that the obstruction, whether primary or secondary, must be gotten rid of as a primary step, towards enabling the patient to breathe freely and ventilate his lungs. This the surgeons have accomplished in the quickest and most complete manner by oper. ation, just as they would do in an analogous case in any other part of the body. However, the "breathing exercise" enthusiasts claim to produce a disappearance of the condition by the simple instructions: To put the child on its back three times a day for a half an hour at a time and make it breathe in and out as deeply as possible through the nose, the mouth being kept shut. damaged by wholesale performances in cases in which, to say the least, it was not indicated. Further, by faulty, or at least extremely hypothetical indications, and in but too many instances technically too insufficient execution, then by a dread of chloroform and a widespread reputation of reoccurrences due only to the faulty and incomplete execution. Thus we see, that the miscredit of the opera. tion is at least somewhat justified, because too many operations of slip-shod performance are being made. It is the duty of the specialist to prevent a good operation from falling into bad repute, and hence we have to come necessarily to a much more precise understanding as to the conditions under which operative interference should be recommended and as to how it should be carried out. tions, compressing the Eustachian tube openings, and closing half of the posterior nasal openings. This causes obstruction to these passages, and consequent upon this, are open In regard to the question of operation, adeBut do the adenoids disappear? Certainly noids may fitly be divided into three classes, not, on the contrary, they flourish. How accordingly as they cause (a) permanent, (b) can half an hour's oxygenation of the blood periodical or transitory, or (c) no symptoms. three times in twenty-four hours alter the The first class (typical) embraces the cases constitution in such a miraculcus way as to in which the nasopharyngeal cavity or vault make the actual obstruction of the air pass-is crammed full of genuine adenoid vegetaage disappear? It is my opinion, that the so highly praised breathing exercises for curing adenoid vegetations appear simply in the light of a scientific glorification of the obsolete advice so freely administered to the un-mouth, night snoring, thick voice, chronic fortunate sufferers, before William Meyer's beneficent discovery: "Keep your mouth shut, shut your mouth." I do not mean to state, that after the removal of the adenoids,piration may have already led to the pecuwell conducted breathing exercises are not of the greatest benefit to develop the lungs and to improve the general state of health. Now as to the imputation that the adenoids, although operated on, will grow again: To understand this limitedly true accusation often justly made, we must remember that the operation has since 1870, for years has been the private property in the hands of a few specialists and surgeons in hospitals, but by the general medical world was despised and maltreated. After 1890, the operation became the rage of the day; everybody performed it; everybody gave the anesthetic. The once limited indications became rapidly extended, especially when reflex neuroses became fashionable, and ultimately it seemed that every child required an operation for adenoids. The enthusiasm was followed soon by bitter disappointment on the part of the parents when the recurrence of removed adenoids occurred with a frequency never heard of in former days. The question asked by parents who were advised to have their child operated upon: But don't they always grow again? was and is justified. The operation fell extremely into dis-use and its prestige was partly and nasal catarrh and usually bronchial oatarrh. Obstruction of the Eustachian tubes leads to deafness. The altered type of res liar deformities of the face and chest (pig- |