(Eotncll Ituuerattg ffiihrarg 
 
 3tljata, JJsw fork 
 
 THE 
 
 CHARLES EDWARD VAN CLEEF 
 MEMORIAL LIBRARY 
 
 BOUGHT WITH THE INCOME OF A FUND GIVEN FOR 
 THE USE OF THE ITHACA DIVISION OF 
 
 THE CORNELL UNIVERSITY MEDICAL 
 COLLEGE 
 
 BY 
 
 MYNDERSE VAN CLEEF 
 
 CLASS OF 1874 
 1921 
 
RETURN TO 
 ALBERT R. MANN LIBRARY 
 
 ITHACA, N. Y. 
 
 Cornell University Library 
 
 R 119.G73 
 
 Suggestions to medical writers, 
 
 3 1924 003 453 952 
 
:: 
 
SUGGESTIONS 
 
 TO 
 
 MEDICAL WRITERS 
 
 BY 
 
 GEORGE M. GOULD, A.M., M.D. 
 
 Philadelphia 
 
 THE PHILADELPHIA MEDICAL PUBLISHING COMPANY 
 
 I goo 
 
\Azk. 3>< 
 
 Entered according to Act of Congress, in the year 1900, 
 
 By GEORGE M. GOULD, M.D., 
 
 In the office of the Librarian of Congress, Washington, D. C. 
 
 Press of 
 
 Edward Stem & Co., Inc. 
 
 Philadelphia 
 
PREFACE. 
 
 During the publication in the Philadelphia Medical 
 Journal of the editorial notes entitled, Suggestions to Medi- 
 cal Writers, I have received many requests that they 
 would be gathered and published in book form. In now- 
 doing so I have added an article entitled, History and 
 Psychology in Words, which, although having no special 
 medical significance, seemed pertinent and of service in 
 setting forth the logical connection of the medical and 
 evolution aspect to general philologic study. I have also 
 inserted an article on one phase of Medical Paleography, 
 that relating to signs and abbreviations. Several of the 
 paragraphs in Chapter II were contributed by two of the 
 collaborators of the Journal, who have kindly allowed me 
 to use them. I am grateful for the courtesy of Mr. H. O. 
 Hall of the Library of the Surgeon-General's Office, and 
 Mr. Francis E. Wessels, of Philadelphia, in permitting the 
 inclusion of their articles contributed to the Philadelphia 
 Medical Journal. 
 
 The editor of the worst-edited, most immoral, and, taken 
 as a whole, the most supremely vile "medical" journal I 
 have ever seen, thus commands his contributors : 
 
 After having written an article, try to read it over yourself. 
 If you cannot succeed, do not imagine we can, and send it, but 
 rewrite it. 
 
4 PREFACE. 
 
 The pathetic experiences which suggested this remark- 
 ably worded advice are also intimated in the further order : 
 " Write on white paper and use pen and ink." This editor 
 and all of his contributors do not fail roundly and fre- 
 quently to denounce ignorance and ignoramuses, but the 
 denunciations are in terms, by means of syntax, and with 
 a method of spelling that never before came together in a 
 typesetter's room. True to character, they are proud of 
 what they suppose learned and scientific, so they religiously 
 retain the diphthong in ancemia, gastrorrkcea, etc., but the 
 diphthong they retain is, I regret to observe, not the ety- 
 mologic one. They say anoemia, gastrorrhaea, hoemor- 
 rhage, etc. I suppose they would write aedema and oether, 
 and contend that aether is correct ! From all of which 
 appears the ancient but ever new truth that theory out- 
 runs action, and that preaching is easier than practising. 
 It is, however, equally plain that the nonpractising preacher 
 should not be stoned, nor should derision be expressed in 
 language which the poor sermonizer has rightly condemned. 
 " I can easier teach twenty what were good to be done, 
 than be one of the twenty to follow mine own teaching." 
 
 Philadelphia, January, 1900. 
 
CONTENTS. 
 
 Preface . 
 
 PAGE 
 
 3 
 
 Chapter I. 
 Introductory Suggestions as .to Medical English 7 
 
 Chapter II. 
 Titles, References, etc. . 32 
 
 Chapter III. 
 Orthography, Punctuation, Pronunciation . 40 
 
 Chapter IV. 
 The Use of Words 61 
 
 Chapter V. 
 Medical Paleography .... .... 86 
 
 Chapter VI. 
 Style . . . 104 
 
 Chapter VII. 
 Rules for Editors and Publishers of Medical Journals . 125 
 
 Chapter VIII. 
 Difficulties of Medical Reporting . . . . 132 
 
 Chapter IX. 
 Some Ethical Questions 139 
 
 Chapter X. 
 History and Psychology in Words 156 
 
 Index ......... 183 
 
The original of this book is in 
 the Cornell University Library. 
 
 There are no known copyright restrictions in 
 the United States on the use of the text. 
 
 http://www.archive.org/details/cu31924003453952 
 
CHAPTER I. 
 
 INTRODUCTORY SUGGESTIONS AS TO MEDICAL 
 ENGLISH. 
 
 One can read scarcely a sentence of medical English 
 without bumping against the fact that this is a strange sort 
 of a jumble — this iatric language of ours. We find that the 
 structures of the body and its diseases are named by words 
 that are not English. Even in the single-sentence title of 
 an article there will be a hodgepodge of Latin and English. 
 We should protest against this nonsense. Let us anglicize 
 our names of diseases, bones, nerves, veins, and muscles, 
 and quit dragging about with us the tags and barbarisms of 
 medievalism. It is long past the time when the medical 
 snake should have thoroughly sloughed and left behind the 
 old skin of a Latinity that is usually poor philology, sorrier 
 science, and the very superstition of English. There 
 are some terms which it may be difficult to anglicize, but let 
 us "force them to come in " by any amount of wheedling 
 or by downright compulsion. Take the tables of anatomic 
 parts and with a little good-will all the Latin names can be 
 anglicized without much trouble. A few of the muscle 
 names may bother one a little. Let us appeal to our anat- 
 omists and quizmasters and get them to help us with our 
 chronic philologic dyspepsia. The obstinate words must 
 be adopted and taught English manners. We have these 
 poor slaves on our hands ; it is we that brought them to this 
 land of freedom and enslaved them. It is both ridiculous 
 and useless to scorn them and keep them as outcasts. Let 
 us teach them good manners, and good service of our pro- 
 fession and of humanity. That is only sound sense, social 
 or linguistic. As for ourselves, let us never italicize such 
 terms ; do not let us flatter either the modern sticklers, or 
 
8 SUGGESTIONS TO MEDICAL WRITERS. 
 
 the old Latin spooks, but march these mummers and 
 mummified words straight out into the daylight of good 
 Anglosaxon English. They will feel much better there, 
 than when they are left flitting and hiding about the cellars 
 of some musty European cloister turned into a secret dis- 
 secting-room. The argument that the Latin titles to arti- 
 cles and names of organs are necessary in literature for the 
 cataloger's sake, or for any other reason, may be smiled at 
 in silence. I cannot help feeling that he is a better anato- 
 mist who says eustachian tube, squamous suture, etc., than 
 one who speaks of the Tuba eustachii, the Sutura squa- 
 mosa, etc. ; that he is a better clinician who speaks of puru- 
 lent otitis of the middle ear, or of pulmonary tuberculosis, 
 than one who says otitis media purulenta, and phthisis pul- 
 monalis. In this connection a word, many words of praise, 
 if they would better help, is deserved for the nomenclature 
 of neural terms advised by Professor Burt G. Wilder, and 
 the majority of the Committee of the American Anatom- 
 ical Association on revision of the nomenclature of such 
 terms. Of all the attempts to. modernize, shorten, and 
 make less incongruous our anatomic names, this is the best, 
 most common sense, and best built on general evolution 
 laws. We should do all we can to render it practical, or 
 rather practised. 
 
 Nearly all of us pull the old skin along behind us in our 
 prescriptions, thinking that we must at least write in 
 bad Latin the names of the articles we prescribe. The 
 reasons given for continuing this custom will not bear 
 investigation. In the first place, to write a prescription 
 with parts here and there in sick English, and other 
 parts in moribund Latin, illogically and whimsically 
 dumped together, is "neither fish, flesh, fowl, nor good 
 red herring." There are probably not a score of Ameri- 
 can physicians who can write off-hand a whole pre- 
 scription in correct Latin. Why should we 999,981 igno- 
 ramuses flatter the pride of these aristocrats and make 
 them laugh at us in their sleeves for our bungling ? " Don't 
 
MEDICAL ENGLISH. 9 
 
 want the patient to know what we are prescribing ?" That 
 is a confession a man would hardly make if he suspected its 
 implications. Ethically it implies a desire or a need to 
 bamboozle patients,— a method of treatment that is hardly 
 flattering to our character, or to our ability to cure. If we 
 need to do this, either our personal art or our scientific 
 ability is as medieval as is our language. If we feel bound 
 to humbug hysterics who will not have the good sense to 
 get well or to die, we have the chemic names for drugs, and 
 we can, as a friend of mine says he must do, keep a gallon 
 of pink pellets of sugar of milk for distribution, with 
 solemn directions as to taking. 
 
 Most of the patients we try to deceive with Latin are 
 sharp enough to find out what the words mean — if they 
 can read the doctor's handwriting — so there is nothing for 
 it but to " go the whole ourang," as the Darwinian convert 
 said. True medievalism, wherein such nonsense arose, 
 was minded to do the business thoroughly, and devised a 
 complete set of hieroglyphic signs for every drug; As 
 modern science approached, these stupids slunk back 
 again into their alchemic garrets and cloister-cellars, let us 
 hope to die, unless some medieval-minded modern wants 
 them, and will, more suo, galvanize them into life again. 
 
 Let us vow that from this day we will write every, 
 prescription in frank open-hearted English ! The dead, 
 wrinkled, dried ultramontane skin is not good science ; as 
 written, it is certainly contemptible philology, and, Heaven 
 help us ! it is not at all pretty ! And what a labor it has 
 been to trundle it all the way from Rome to Chicago ! 
 Strange that it has not been utterly worn out ; but it 
 is not more strange than the explanation that as in per- 
 sonality so in language, the first and last creation of 
 personality, the whole past somehow or other exists in 
 the present. Every word and every letter bears the 
 marks of at least 5000 years of history, and pathetically 
 tells of its 5000 years of struggle with ignorance, preju- 
 dice, and evil. But it as clearly points the way by evolution 
 
10 SUGGESTIONS TO MEDICAL WRITERS. 
 
 methods to unrealized ideals, and undreamed science. Ours 
 is the duty to obey the hints and suggestions. At least we 
 need not, like some middle-aged medical scatologist, make 
 up our prescriptions with snakeskins, and other such in- 
 describable things, from the Walpurgis Night of history. 
 But when we have anglicized our anatomies so that 
 they do not sound like a degenerate Roman of a thousand 
 years ago shouting at us moderns through a historic meg- 
 aphone ; when we have turned all the cacophonous jargon 
 of our prescriptions into honest and self-respecting 
 English, we find that our medical language is still largely 
 made up of a lot of Grecian odds and ends. These 
 -itises,. -otomies, -ectomies, -ostomies, etc., etc., are neither 
 English-looking nor English-sounding. They help to form 
 a strange and unique mixture, composed, first, of a com- 
 pletely undigested and almost indigestible Latin mass 
 thrust bodily into the English stomach, which is the prin- 
 cipal cause of our thousand year-long "stomach-ache," 
 and from which we are today in much distress, as evi- 
 denced by philologic intestinal borborygmus, tenesmus, 
 etc. Another considerable portion of the large Roman 
 feast has been well digested, that is anglicized, and it 
 gives us much of our strength. But our literary hunger 
 grew, and it still grows, and we have to feed on Greek 
 roots brought out two thousand years after the tree has 
 died {pace modern Greek and its praisers, — to us it is 
 dead) and transported over thousands of miles to our 
 shores. These roots, radices, radicals, it is true, are perhaps 
 better than nothing in our great word-hunger, and since 
 we are so foolish as to scorn our ancient but still good old 
 Anglosaxon market. But at least it is an Anglosaxon 
 stomach that we have, and that is the best assimilative 
 organ, philologic or socialistic, that has ever been created ; 
 it is also an Anglosaxon brain that uses the food, and that 
 is the best brain today on the globe. We may therefore 
 hope that by means of our good Anglosaxon stomach, 
 brain, and conscience, we may finally digest, cure and 
 
MEDICAX ENGLISH. . II 
 
 conquer all linguistic difficulties, and make our medical 
 language a real and not a parasitic part of the English 
 language. In so far as it remains semidetached, unassim- 
 • ilated, a gibberishlike half- English, just so long will medi- 
 cine be a half- science, and our art a trade. 
 
 And now, what is the great hindrance to the attainment 
 of this most desirable anglicization of medical language 
 and the scienciation of medicine itself? Nothing in the 
 world but the conservative sticklers who will not permit, or 
 fondly imagine that they are forbidding, progress in Eng- 
 lish philology. Of course they cannot do much harm, these 
 old ladies with their brooms, because, happily, tides, 
 whether oceanic or linguistic, do not pay much attention 
 to antique dames or brooms. The most unstable of all 
 created things is language. While in a way strictly evolu- 
 tionistic there are still a hundred unanswered whys as to 
 every law of phonology. Language is the very Proteus of 
 the old myth. Printing has undoubtedly served to fix in 
 some measure the form of words, but that subtle, water- 
 like instability and mutability of sound will never in the 
 least be harnessed to or much "broken" by the printed 
 word. The result is that we have, and especially in Eng- 
 lish is it peculiarly true, two languages, the spoken and the 
 printed. The word though should be spelled with two 
 letters, the Anglosaxon thorn letter th and o ; the word 
 laugh has three sounds, and so with nearly every word in 
 the dictionaries. 
 
 Shall we then start on the "fonetik tak?" Heaven 
 forbid! The sole reason that England and the English 
 language are what they are, the sole reason why the nation, 
 the race, and its tongue are the best we have, and are 
 bound, meek or not, to inherit the earth, is that they and 
 we are evolutionists, and not revolutionists, nor devolution- 
 ists. A language or a form of government is the handi- 
 work of a people, its art-products, the outcome of its 
 psychic life. The Anglosaxon way is to guarantee and 
 demand freedom for the individual, and that all changes 
 
12 SUGGESTIONS TO MEDICAL WRITERS. 
 
 shall be growths by slow increments of change. Advance 
 a step, make the little gain secure, then another step, and 
 so on until the continent and world is ours. In politics 
 this steady, unwearied, slow advance is the reason England 
 is what she is and we are what we are as nations. 
 
 And precisely so in language ! There must not be any 
 sudden cataclysms or revolutions. The fonetik fok are 
 crazy, and only to be likened to the French topsyturvyists 
 of 1793. They would be the destroyers of true progress, 
 and if there were the slightest danger of this wild com- 
 munism being translated into fact, they should every one 
 be gibbeted, body and soul. To destroy the literary pro- 
 duct of all time, which phoneticists would do, is a crime 
 against every element of civilization, for which no punish- 
 ment would be too great. 
 
 But there is no real danger from these foolish people. 
 If it pleases them to dream their dreams and live in an 
 impossible world, indifferent to the savage needs and 
 binding duties of this one, we may smile and pass on. It 
 is strange, however, that as intellectual as they are, they 
 cannot see one absolutely fatal objection to their theory, 
 which is this : The spoken language is not only not uni- 
 form as regards its sounds in any one city, State, or nation, 
 but the sounds never remain the same in any one place or 
 as spoken by any people for a considerable length of time. 
 It is probably a literal truth that no sound is the same 
 when made by any two persons, or at two different times. 
 Within large limits, both of time and place, these differ- 
 ences are trivial and might be ignored, but the far-traveler, 
 and the long-liver find the differences too intolerable for 
 any unvarying symbols. Hence it is that if a set of symbols 
 were made today for all the sounds used by the people of 
 New York, they would not suit the Chicago or Denver 
 folk, and none of them would be satisfied next year. Thus 
 it is that the written and printed language must always 
 remain practically a different language from the spoken 
 one. This is the lesson taught by Grimm's law, Verner's 
 
MEDICAL ENGLISH. 1 3 
 
 law, and to be learned in any study of ten minutes of 
 phonology or of etymology. Indeed, this is the very rea- 
 son or mechanism of the development of one language 
 out of another. 
 
 But because this is true, it by no means follows that 
 there is, will not be, must not be, any changes permitted 
 in the printed language. The organism that dislikes 
 change is very ill; the one that fights change is mori- 
 bund ; the one that does not change is dead. Language 
 is an organism, — and " tout est dit !" Hence that is not 
 a true, genuine, wise, or real conservatism which resists 
 all change. This extreme is as absurd as that of the 
 fonetik revolutionists. We medio-tutissimus people are, 
 of course, the sensible ones, and we are accomplishing 
 something. A few years ago a brave fellow undertook to 
 kill the ligatures ce and ce. There was a wild fluttering of 
 scared wings, and dire were the croaks and prophecies 
 and maledictions. Who to-day in medical writing writes 
 haemorrhage in the United States ? Two or three, who, 
 for other reasons, are foaming at the mouth with personal 
 hatred of the proposer and who would not ligature his arte- 
 ries if hemorrhage were sure to be the death of him. The 
 ligatures ce and ce are irritating to true English eyes and 
 ears, as are all umlauts, and the rest of the misty, musty, 
 nasal, cranky, throaty habits we formed while learning to 
 talk, and especially while we were learning to speak Eng- 
 lish. The sensible Englishman long ago began ridding his 
 speech, written or spoken, of ce and ce, and we find our- 
 selves in the thick of the process, pawing to get our hinder 
 parts free. The pernickety sticklers cry in alarm, and 
 mumble something about etymology, but they are like the 
 passionate convert who, praying vehemently concerning his 
 sins, checked himself with the thought, " Not so loud, God 
 might hear me." So, the appeal to etymology must be 
 made only to the ignorant. I do not know how many hun- 
 dreds or thousands of good English words there are com- 
 mencing with pre; now what is sauce for the goose is sauce 
 
14 SUGGESTIONS TO MEDICAL WRITERS. 
 
 for the gander, and if we must begin esophagus with a?, 
 then the sticklers must spell prae instead of pre, aequal 
 instead of equal, and aether instead of ether. Well, the old 
 sinners <z and ce, are dead and not even Fell's method can 
 resuscitate them, — so we need not make our requiescat too 
 long nor too high pitched. 
 
 The etymology argument against change in language 
 reminds one of the old story of the borrowed kettle : 
 " Your kettle was cracked when I got it ; I mended it be- 
 fore I returned it ; I never had your old kettle." The ety- 
 mologic kettle was badly cracked before the sticklers bor- 
 rowed it ; thousands, perhaps the majority of words, do 
 not tell any clear story of their origin in their present 
 forms ; may even tell horrible lies. The mendings by the 
 sticklers would really ruin or would have ruined the poor 
 old thing. Lastly, the sticklers never had the pot, — that 
 is, they have no idea of genuine etymology or progressive 
 linguistics ; in fact they do not even understand the first 
 principles of etymology and phonology. Moreover, borrow- 
 ings of etymologic pots and kettles were forever rendered 
 useless by the invention of printing, which at once made 
 unnecessary the absurd and impossible attempt at an accu- 
 rate or complete preservation of word histories by the 
 single shape or form of words. Not a sound or a letter of 
 wig tells of pilus, whence it came, and who, in the French 
 eau could suspect it to be derived from aqua ? It is the 
 dictionary-men's duty to tell us of the million interesting 
 things of word-origins and word-histories. The word we 
 use in writing, printing and speaking has far different and 
 higher duties than that of the historian. It has to make 
 history, not write it ! The first gasburners were constructed 
 in the shape of a candle ; the first railway cars in the shape 
 of a stage coach. The etymologic conservatives would 
 have our electric bulbs and Pullman cars return to the ear- 
 liest styles ! 
 
 Another most commendable advance upon the lines 
 already initiated and half carried out by Englishmen in 
 
MEDICAL ENGLISH. 1 5 
 
 the past, is the excision or " cur- tailing " of one of the 
 useless tails too many of our adjectives we inherited from 
 France. Somehow or other, can anybody tell us why? we 
 stupidly thought we must put another adjectival tail to 
 the thousands of words already sufficiently adjectived by 
 the capable and most efficient ic of the French. These 
 sensible people said domestique, scientifique, publique, etc., 
 and if we translate, it would seem that domestic, scientific, 
 public, etc., would be a sufficiency of adjectival caudaliza- 
 tion. Our ancestors, strangely enough, did not think so 
 and grafted a second tail to the first, so that the puppies 
 now trot about, or once did so, and according to the stick- 
 lers should forever do so, with this duplicating, tautologic 
 -al tail springing from the first. It is indeed a sorry tale ! 
 Domestical, scientifical, and publical ! Well, there are hun- 
 dreds of words in English in which we have already re- 
 lieved the poor dogs of the useless tail, and only the worst 
 sticklers now prefer the double tailed pets, even keeping 
 these at home. But there are others in which the surgical 
 operation is sometimes performed and sometimes not. 
 There are a few in which we have become so accustomed 
 to the appearance of two-tailed species that we can laugh 
 at these who grin at us, and wait awhile before demanding 
 the surgeon. Those with a terminal -ic in the root (as 
 medical, surgical, etc.), require the -al, perhaps, — and per- 
 haps not. 
 
 There is one further method of wise shortening in the 
 adverbialization of these -ic adjectives. The spirit of the 
 language has already done it with one word. Everybody 
 says public, not publical, and everybody says publicly, not 
 publically. In exact correspondence why should all the 
 adjectives ending in -ic not form the adverb by a direct 
 attachment of -ly, {-lick, or -like) instead of uselessly (not 
 uselessically) adding the al before doing so ? Why not 
 say scientificly, biologicly, etc. ? Having transverse, we do 
 not say transversic, or transversical, or transversically, but, 
 for the latter, simply transversely. There is no reason ex- 
 
l6 SUGGESTIONS TO M&DICAL WRITERS. 
 
 cept that in such things we are inclined to be perversically 
 perversical. It surely cannot be called unscientifical to 
 do so. 
 
 One of the most ridiculous of all the little farces that 
 the sticklers delight to play is that in which they feign 
 disgust at hybrid words. Knowing little about the forma- 
 tion of foreign languages, especially English, and more 
 especially medical English, a remarkably ugly Jack-in-the- 
 box is fashioned to spring out at every innocent who may 
 touch its house. Conjunctiva is of Latin extraction, and 
 -itis of Greek parentage, therefore by all that is pedantic- 
 ally holy, dare not unite the two ! A reverenced German 
 quotes Horace to us, in this connection, as to the folly of 
 putting a man's head upon a horse's shoulders. Well, in 
 fact, did Roman never wed Greek ? Did they never have 
 children? Were these children hybrids, and were they 
 impoteirt and sterile ? If the beings who made the words 
 could intermarry, why not their words ? The unconscion- 
 able stupidity mated with prejudice which is shocked at 
 hybrid works in medical English should be pickled and 
 given the place of honor in our museum of teratologic mar- 
 vels. The language is full of hybrids and to what one can 
 object in them, it is impossible to see. The puerile imper- 
 tinence of the contention is outrageous. Medical English 
 is itself, wholly and to its last syllable, just such a hybrid, 
 the youngster being of Greco-Roman stock with an English 
 foster-father to train him up in the way he should go. It 
 would be just as sensible to demand that all the words in 
 one article or in one sentence should be of one strain, 
 Greek or Roman, or Arabic, exclusively, as to demand that 
 our huge compound words should be of this immaculate 
 conception. One may use a word of Latin rooting in a sen- 
 tence in close contiguity with one of Greek ancestry ; why 
 does the dovetailing the two together become a sin against 
 the philologic Holy Ghost ? What is the marvelous power 
 of a little separating "m quad "? If one may not say con- 
 junctivitis, of course one must say, I suppose, mucous- 
 
MEDICAL ENGLISH. \J 
 
 membrane-of-the-eye-inflammation. The sole questions to 
 be asked about hybrid words are, are they useful, expres- 
 sive, short as possible, and better than others do they serve 
 the purpose to which they are put ? If so, this earnest, 
 busy, clear-headed profession of ours is going to use them 
 despite all croaking. 
 
 Finally, these gentlemen in a sort of despair, gave up 
 all the old-time arguments against change and said that it 
 was useless to try to make any, even the least and fewest 
 changes in language, because it was all an unconscious pro- 
 cess governed by hidden and immutable laws, and no one 
 person or body of persons could influence language, their 
 proposals positive or negative not being rejected or ac- 
 cepted, but simply ignored by the world. Exactly the 
 reverse of this is true, arid this theory of the philologisch 
 Unbewusste is false, root and branch. There is an instance, 
 thousands of years ago, of a written language being chosen, 
 even to the letters of the alphabet, and molded into shape 
 by a single man. Before printing, did not every scribe 
 who wrote do it with his consciousness ? Was not every 
 change effected the result of conscious design ? Was not 
 the invention of printing a conscious business down to 
 every dot and hyphen ? After printing became common 
 was not every word and letter drilled, marched and coun- 
 termarched through millions of consciousnesses, of proof- 
 readers, writers, critics, rhetoricians, grammarians, and 
 readers ? Has not every medical word, good or bad, that 
 has been added to our medical and scientific languages been 
 made by consciousness ?. Of the thousands that have been 
 killed and that are buried in the lexicon-cemeteries, did 
 they not die because men consciously chose not to use them, 
 consciously chose others in the place of them ? Surely 
 never concerning any other product of the human race has 
 consciousness been so constantly and instantly both father 
 and mother, both educator and lord ! This unconscious- 
 ness chatter, and shirking all responsibility for our lan- 
 guage, this laissez-faireism, is disgracefully untrue and 
 
l8 SUGGESTIONS TO MEDICAL WRITERS. 
 
 inethical. Wiser and truer it would be to preach the ac- 
 countability, rigid and continuous, for every word one 
 utters or writes. It is absolutely true, whether one con- 
 strues them literally, philologically, or morally, that " By 
 thy words thou shalt be justified, and by thy words thou 
 shalt be condemned." 
 
 In addition to the foregoing the following excerpts are 
 taken from a paper read at a meeting of the American 
 Medical Editors' Association held in Atlanta, Ga., 1896 : 
 
 One of the most amusing inconsistencies of a small 
 class of minds otherwise progressive, scientific and ra- 
 tional, is their unreasoning conservatism concerning the 
 spelling and use of certain words. On any other subject, 
 for instance therapeutics or surgery, they will welcome in- 
 vestigation, and further it, admitting the duty of improving 
 upon the old, and of pushing on toward a more simple and 
 perfect science. But if it is suggested that language, the 
 tool of thought, deserves consideration, is very clumsy and 
 archaic, is capable of being improved — at once they shrink 
 and are shocked at the temerity. 
 
 This attitude of hatred of innovation in one single 
 field of human activity, while admitting the law of prog- 
 ress in all other departments, is also coupled with a second 
 inconsistency, a dogmatism of conviction that the change 
 or modification of language urged is barbarous, almost 
 sacrilegious, that you are a sort of ill bred upstart and 
 ignoramus in advocating it, and that the old form you 
 desire to supplant is the correct one, while your newfangled 
 thing is absurd and is born of ignorance. The bigotry of 
 the average Englishman in these matters is a charming 
 exhibition of medieval-mindedness transferred to an age 
 of civilization and progress. He actually thinks that the 
 spelling-reformer, however infinitesimal and microscopic 
 the spelling-change advocated, is the product of " Ameri- 
 canism," and of American ignorance of how to spell. The 
 
MEDICAL ENGLISH. 19 
 
 American inheritor of the English dogmatism tries to hide 
 his feeling, shrinks from such laughable exposure of his 
 own ignorance, and even covers the sheep-skin of his 
 ignorance with the lion skin of erudition. I shall not soon 
 forget a contributor whose English was equal in barbarity 
 to that of our average senator, whose spelling by any 
 standard was atrocious, and whose medical ideas were of 
 course on a par with their means of expression, but he was 
 certain of one thing, that he wanted hemorrhage "spelled 
 rightly, with m." This to him was the symbol of scholar- 
 ship, — his nose was safely in the sand of erudition, but hh 
 whole body was delightfully visible. 
 
 I have had the pleasure of replying to but three or four 
 critics of a few tiny philologic reforms or changes that 
 seemed to me wise. Besides these four the world seems 
 content either to accept or to reject in silence. 'I was 
 struck by the fact that in all four their objections 
 were solely based upon two foundations: their personal 
 dislike of change, and their complete ignorance of phil- 
 ology. Concerning the argument, de gustibus, there is 
 surely no discussion, because taste, proverbially, is simply 
 a subjective affair. But dogmatic opinion upon a subject 
 in dispute, the deeply-rooted dogmatism about things 
 without a single minute's study of them or of their history, 
 — this in a supposedly scientific man is — let us call it 
 deplorable. It is amusing, even instructively amusing, 
 but it is once more, deplorable. Such a person, if a diag- 
 nostician, would be shocked if you asked him to pronounce 
 dogmaticly upon an unstudied question of therapeutics or 
 of mental disease ; or if a surgeon he would not express 
 the least judgment as to cataract extraction, etc., but with- 
 out an instant's study of philology he settles a philologic 
 dispute off-hand and forever. Five minutes of glancing 
 through any one of the hundreds of books on the subject 
 would have closed his lips,' but that does not give him 
 pause. He is sustained by the fact that "the English 
 language as now written is good enough for me," and there 
 
20 SUGGESTIONS TO MEDICAL WRITERS. 
 
 float through his mind hazy ideas that etymology de- 
 mands the present method, and that at best you are a very 
 bothersome and conceited person. 
 
 To one who has pondered the subject, however little, it 
 must be painfully apparent that every other product uncon- 
 sciously developed in the evolution of the race, whether 
 plows, guns, matches, or books, has been found capable 
 of betterment, and all civilization consists in improvement 
 of or improvement upon, the crude devices of early awk- 
 wardness. Why should language then be an exception to 
 the rule ? Those who have examined carefully aver that 
 our language is a sorry instrument of thought, and bears 
 about the same likeness to an ideal language that a hand- 
 sickle does to the best reaping and binding machine of our 
 day. It is plain, therefore, that the obstinate prejudice 
 against any change whatsover in it is most ill-advised and 
 unreasonable. 
 
 We do not advise radical changes. The proper attitude 
 of mind is one that welcomes slow and slight changes 
 toward shortening, thus lessening the severe burden of 
 education, and the expense of printing. Reform has a 
 double motive here, psychologic and commercial. It has 
 been estimated that our outrageous spelling costs one year 
 of school-life of every child. The financial saving by 
 lessening every printed page one line would probably pay 
 the expenses of our government, and perhaps also retire 
 on a life pension the Senate besides. This line could be 
 saved, and at least a day or two of the wasted school-life 
 spared by abolishing ce and ce, by lopping off a few redun- 
 dant tails of words, and by observing a half-dozen little 
 rules, — all of which are not only advisable but philologically 
 necessary, not only not improper but genuinely proper. 
 
 As to cz and w, these diphthongs are' difficult to write, 
 and they are against the genius of the language. They 
 have already been sloughed in a large number of words, and 
 those who oppose what they are pleased to call " the 
 mutilation of our beloved language," must answer our 
 
MEDICAL ENGLISH. 21 
 
 demand for a rule. Shall we reinsert the ce, and ce, in 
 words at present spelled with e and which were derived 
 from older words spelled with the darling diphthongs? 
 And if you spell hcemorrhage •, will you, as you should, pro- 
 nounce it he'-mor-aj? It seems to me the etymologic 
 sticklers are false to the old love, however true they may 
 be to the new. Most of our words, for example, beginning 
 with pre, are derived from the Latin prce. There are 
 possibly a thousand of these words, such as prescription 
 prepuce, pretend, preference, etc. Shall we spell them all 
 prescription, prcepuce, etc. ? Shall we also be (etymologic- 
 ally) correct and write hceresy, hceretic, anapast, pceony, 
 phcenomenon, mczander, hcematite, cether, dcemon, (Esthetic, 
 apharcesis, dimresis, archceology, palceography , gangrcene, 
 pcedobaptist, ccenobite, ccemetery, cczlestial, ceconomy, epicaene, 
 oesophagus, phcenix, solcecism, and hundreds of derivatives 
 and similar words as they are written ? Will you spell 
 diocese, diceccse ? Will you spell fancy, frantic and frenzy 
 with a very etymologically proper//?, instead of an incor- 
 rect/? If so, your phancy will make your readers phren- 
 zied, and you phrantic, I fear. Will you write tansy, treacle, 
 and treasure with a th ? If so, lay up your threasure in 
 heaven, and drink much threacle and thansy while your 
 days do last. 
 
 Etymologic spelling is a long-exploded absurdity. It 
 has led many a poor word- grubber into the quagmires of 
 absurdity. It was, says the great English etymologist, a 
 sort of mania in the sixteenth century, and has thrown 
 confusion and ridicule into the study of language. " Its 
 ignorant meddlesomeness introduced many false forms," 
 so that hardly any word now tells its genesis or history by 
 its written form. Every word must be examined separately, 
 its changes both of form and sound must be studied his- 
 torically, before we can know much about it. The final 
 dictum of Skeat is as follows : 
 
 The shortest description of modern spelling is to say that, 
 speaking generally, it represents a Victorian pronunciation of 
 
22 SUGGESTIONS TO MEDICAL WRITERS. 
 
 ' popular ' words by means of symbols imperfectly adapted to an 
 Elizabethan pronunciation, the symbols themselves being mainly 
 due to the Anglo-French scribes of the Plantagenet period, whose 
 system was meant to be phonetic. It also aims at suggesting to 
 the eye the original forms of ' learned ' words. It is thus governed 
 by two conflicting principles, neither of which, even in its own 
 domain, is consistently carried out. 
 
 It may be said that as many of our medical terms are 
 not derived from the Greek or Latin by a real and histor- 
 ical process, but are de novo creations, using the ancient 
 roots and stems as convenient materials of coinage, the 
 objection does not hold, and that our words do therefore 
 show their originals by their form. Alas ! not even this 
 poor excuse bears scrutiny. The centuries have infected 
 the modern word minter, and the inevitable hurry and des- 
 tiny of evolution will not let the need of condensation rest. 
 Even while we look at our printed dictionary the Zeitgeist 
 is telescoping our words. Who now says thyreoid and 
 choreoidf These forms are perfectly proper, and your dic- 
 tionary-man with the awful sword of etymology and con- 
 servatism held across his path, may be forced to write them 
 so, but he smiles sadly as he does it and shakes his head 
 despondently. Every one of the hundreds of words ending 
 in oid is derived (supposably) from the Greek «Sos. Why, 
 then, is it -oid and not -eid ; bulb and bulbar should be 
 bolb and bolbar, as they come from /JoA/Jos. Croup is from 
 A.S. kropen. How can an etymology-lover write hyoid? 
 What resemblance is there to the Greek word ? Our con- 
 venient compound word should etymologically be spelled 
 thyreo-hyoeid, instead of thyro-hyoid. Why is one who for- 
 bids one literal iota of change in present words so utterly 
 indifferent about the changes that have already crept in in 
 the past ? There are thousands of words in which Greek 
 i has been changed to English e, as e.g., all the words end- 
 ing in -rhcea. He is wrathful because one wants to change 
 them to -rhea; why not so to those who changed the orig- 
 inal i to e ? He is as idolatrous of his beloved thousand 
 
MEDICAL ENGLISH. 23 
 
 -hams, but the Greek was hat and not ha. One of the 
 most ludicrous instances of this imaginable is the very new 
 coinage which its author spells celiotomy. The anger of 
 enraged Jupiter was as nothing to that aroused by the sug- 
 gestion to shorten this to celiotomy. But in that word as 
 given out, there is, "once you trip on it," perhaps not 
 "twenty-nine," but at least two or three "distinct damna- 
 tions, one sure if another fails." Why in the name of holy 
 etymology, if derived from Greek koiXio. do we have c instead 
 of k, and why coe instead of coi? If the ccelia is derived 
 from the Latin, then why the hybrid ? Surely one who 
 pretends passionate devotion to pretty Ettie Mollie G., 
 must not at the same time be paying court to her hated 
 rival, the little illegit Miss Hybrida. 1 
 
 Every page of the dictionaries proves the absurdity of 
 trying to make spelling teach etymology ; and it is a fact 
 that nobody, certainly not spelling-reformers, more cer- 
 tainly not the conservatives, cares two beans for the 
 etymology. If we did not have the printed word to stamp 
 the coin it would be a different matter, but with diction- 
 aries everywhere to give the origins and histories of all 
 words, what imaginable service or usefulness is there in 
 attempting to load each down with its biography ? In 
 reading or speaking no one can think or wishes to think 
 of the roots of thousands of years old. As well demand 
 that your boquet of roses shall have their roots and soil. 
 The investigating botanist may do so, and may know all 
 about the root and branch and stem, but workaday folk are 
 not botanists or radical philologists. If one in reading had 
 to know or keep in mind a half-conscious recognition of 
 the etymology of each word, he would be able to read 
 about one book a year, civilization and science would stag- 
 nate, and we might, could, would, or should, all become 
 congressmen, millionaires, or jingos. 
 
 1 Another sorry "neoplasm is uranalysis, — analysis of ur — to replace an equally 
 absurd word, urinalysis, — alysis of urine. I have looked in vain for the words 
 alysis and ur. 
 
24 SUGGESTIONS TO MEDICAL WRITERS. 
 
 The only proper and sensible purpose of spelling is its 
 phonetic purpose. All the philologic tories of all Christen- 
 dom or heathendom combined cannot prevent the inevit- 
 able modifications — even entire changes of the spoken 
 sound. In that witches' caldron of modern English, 
 especially the medical variety, we have from every source 
 cooked a most remarkable hodgepodge of illogic and incon- 
 sequential conglomeration. Our ancestors have com- 
 manded us to eat of it, but let us not choke it down, 
 hiding our tears of disgust, and vowing it is incomparably 
 toothsome. We assuredly should not with glee add more 
 of the worst to the ollapodrida, and when we have a justi- 
 fiable opportunity to make it a millionth part better, we 
 should not set up a cry of revolt, and cry, Sacrilege ! In 
 an African forest the trail or pathway has constantly re- 
 curring detours, angles and curves, so that one walks 
 about twice as far as necessary to reach lands' end. No 
 object prevents following a straight line. Why is this ? 
 It is because once a tree blew down here across the path, 
 there a limb broke off, there a stone rolled down. So the 
 savage went around these objects, forming a new and 
 crooked path. When the termites devoured the tree the 
 new trail was more worn than the old one, and with 
 thoughtless imitation the men kept on laboriously winding 
 and twisting in their way instead of going straight on and 
 across. It is the barbarian's habit of mind to keep on 
 the unreasoning way his predecessor traveled. It is the 
 essence of civilization to make straight the way. The 
 incongruities of medical nomenclature and the stock-still 
 standing of irrational conservatism lead one to wonder 
 if we are ever to awaken to the need of philologic civili- 
 zation. No judicious reformer asks for revolution, but for 
 evolution : we need be in no hurry ; we should not make 
 profound and radical changes, because, among other 
 reasons, it is impossible to bring them about ; but 
 when men oppose every jot and tittle of change, when 
 they fight against one single conscious change of precisely 
 
MEDICAL ENGLISH. 25 
 
 the same kind as has already been a thousand times 
 wrought, — then surely one must with open-eyed astonish- 
 ment ask, Really, now, were you not born in Africa ? 
 
 I wish again to emphasize the limitation that we do not 
 advise one clean straight jump into phonetic spelling. 
 We seem like some mothers, — the uglier and sicklier our 
 orthographic child the more we love and cherish it. The 
 maternal love is wise, but the other is mania. Turn to 
 Germany and what do we find ? So far as phonetic writing 
 is concerned their language was already marvelously per- 
 fect, but because it was not entirely so, the Germans 
 within a few years past have made it so. How is it with 
 Germany as to science generally, and education, and espe- 
 cially as to medical science ? The thousands of our young 
 men sent to her laboratories is sufficient answer. Well, 
 this nation, as I have said, in a few years, and at one sweep, 
 has cut the Gordian knot of spelling, simplified and short- 
 ened education thereby, and while we are squirming and 
 making wry mouths over a few paltry and insignificant 
 changes, she has wholly reformed the language that 
 Goethe and Lessing wrote. 
 
 One of my four kind critics once wrote me remonstra- 
 ting, solely on the ground of euphony, against cutting the 
 -al off the tail end of many adjectives ; " he didn't like it," 
 he said, " it didn't sound well." He seemed wholly for- 
 getful that the overlong tail of a thousand such words had 
 already been lopped off, or perhaps had never grown out. 
 In some countries the sheeps' tails are so long that they 
 hitch a tiny wagon to each animal, so that it hauls its 
 caudal extremity instead of dragging it on the ground. 
 Now the difference between these sheep and our medical 
 Bo Peep <z/-pacas, is that the words grow no valuable wool 
 on their tails, and that we trail them on the ground be- 
 hind us as the ladies do their dress-trains. Sheep and 
 words and ladies are alike in the one important respect 
 that, in the poet's immortal lines, if we let them alone 
 they'll surely come home, dragging their tails (and much 
 else also) behind them. 
 
26 SUGGESTIONS TO MEDICAL WRITERS. 
 
 To my genial critic who wished his words and sheep 
 (his ladies, too, I wonder ?) to have tails and trails twice 
 too long, I sent the following skit, to illustrate the already- 
 recognized fact of the redundancy of many word-tails, and 
 to suggest that we either retail all the short-tailed curs, or 
 that we curtail all the long-tailed puppies. Either one 
 thing or the other ; if you refuse to say chemic and theo- 
 retic, then you must not say scientific and hydrochloric. If 
 you make us say chemical and theoretical, then, like a suck- 
 ing dove we will roar you for consistency and ask that you 
 be scientifical, or else we will prescribe nitrical and hydro- 
 chlorical acid for your alarming gastrical torpor and obsti- 
 nacy. My strabismic letter to my friend was as follows : — 
 
 Some Scientifical Difficulties. — The patient was at the 
 Polyclinical Hospital — a very sick woman ; she was ascitical and 
 cyanotical ; she had an anemical (dicrotical or anycrotical) mur- 
 mur; splanchnical and splenical dulness was pronounced. 
 Neither the allopathical nor the homeopathical consultants could 
 determine whether the affection was of extrinsical or intrinsical 
 origin, whether anabolical, katabolical, atrophical, septicemical, 
 lithemical, luetical, hemical, hemolytical, thermical, tabetical, 
 hepatical, or encephalical. The specialists were called in, and 
 laryngoscopical, ophthalmoscopical, gynecological and otoscop- 
 ical examinations were made. The laryngoscopical man said a 
 diphtherical membrane was forming, and the phrenical nerve 
 was pressed upon. The next averred the difficulty was esophor- 
 ical or exophorical, that a blennorrhagical inflammation, perhaps 
 a rheumatical iritis existed. After an endoscopical examination 
 the gynecological expert said pelvical (or pubical) disorder was 
 present and a bad cystical and chorionical state of affairs. The 
 ear-man claimed that the disease was specifical, that fhe otical 
 ganglion was syphilitica! and its condition pathognomonical. 
 The diagnostical and prognostical difficulties were certes becom- 
 ing most prolifical ! 
 
 As to therapeutical measures, one advised cardiacal and ton- 
 ical treatment, another hypodermical ; one thought hydriatical 
 methods good, another antiphlogistical, while still another sug- 
 gested hypnotical and soporifical agents. Galvanical and farad- 
 ical electricity, as well as statical and franklinical, were advised. 
 
MEDICAL ENGLISH. 2J 
 
 The surgeon after a diagnostical incision (under anesthetical pre- 
 cautions) spoke of a plastical operation. Caustical applications 
 to the throat were considered good, and the exhibition of prus- 
 sical, or of borical, nitrical and hydrochlorical acids, perhaps also 
 ■carbolical with malical and acetical acid drinks. The general 
 physician thought antineuralgical and antirheumatical prescrip- 
 tion sufficient, but the obstetrician would have added oxytocical 
 •ones. 
 
 The patient died of «/-coholical paretical dementia, superin- 
 duced, it is thought, by despair at the orthographical and phonet- 
 ical conservatism of progressive Americans. 
 
 If a word is an adjective can you make it more so by 
 tautologic caudalizations ? (There are a few words whose 
 stems end in -ic, such as vesical, clinical, logical, finical, etc., 
 and these require the -al to make them adjectives, but 
 these are provings of the rule, and the query, Why don't 
 you say vesic, logic, and clinic ? is the prompting of thought- 
 lessness. I would not object, however, in the least, to 
 clipping these also.) If a word needs two adjectival tails 
 why should we not say bestialic, linealic, etc. ? If these 
 were admitted of course the -al lovers would have to add 
 their pet to the word, and we should have bestialical, line- 
 alical, etc. — each sheep would then require two toy-wagons. 
 This reminds one of the wonderful word pockethandker- 
 chief. The primary good word was kerchief, a head-cover- 
 ing ; we now call a piece of lace or linen a pocket-hand- 
 head-covering. I am not unmindful of the hyperfinical 
 distinction that some hyperfinical folk have sought to estab- 
 lish as regards -ic and -ical, -ac, and -acal, that the -ics and 
 -acs denote primary objective attributes of or pertain to the 
 things, while the -icals and the -acals denote secondary 
 qualities — of the nature of or connected with the attribute 
 in -ic or -ac, i. e., more remotely and subjectively relating 
 to the thing. For example, a cardiac valve, the cardiacal 
 qualities of a drug; a historic answer ; a historical treatise ; 
 a comic paper ; a comical idea. But this contention is im- 
 possible of realization, i. Because hundreds of words by 
 
28 SUGGESTIONS TO MEDICAL WRITERS. 
 
 custom have become absolutely limited to either form 
 singly and alone. 2. Because not even the best writers 
 observe the distinction. 3. It is altogether too fine a dis- 
 tinction to be made by the ordinary workaday humanity. 
 4. It would not satisfy -«/ophiles, who want the -al on 
 the end of some of their words, without question, forever 
 and ever, world without end. Amen ! Think of saying 
 Arabical, Teutonical, Celtical, etc. ! We should, of course, 
 have to adopt bestialic and bestialical (or bestic and bestical), 
 clinic and clinical, syphilitic and syphilitical, and so on to the 
 end. It is quite plain this system- mongering and analogy- 
 craze leads us into sorry plights. In fact, it should be 
 apparent upon a minute's reflection that in a language so 
 utterly composite, illogical, and nonsystematic as ours, the 
 argument from or for analogy is absurdity itself. In one 
 respect this is an advantage, because when we can succeed 
 in battering down the dead wall of ancient prejudice, and 
 explode the arsenal of etymologic spelling, then we may 
 bring some order and sanity into the rebellious mob of Eng- 
 lish words. 
 
 Of one thing we may rest assured : All the tory immo- 
 bility of all the world cannot prevent change. It is as use- 
 less to attempt it as to try to stop the rising tide, or to stay 
 the resistless and silent forces of evolution itself. It is the 
 part of wisdom to guide evolution, not to fight it to 
 death ; to guide language-evolution in the interests of 
 brevity and perspicacity, not to cling irrationally to the old 
 ways which clear vision must see are doomed. The 
 language of Chaucer, and even of Shakespeare, as shown 
 in the original forms, is an utterly different language from 
 that we speak to day. The ordinary American, if he could 
 hear Chaucer speaking, or if he could listen to a phono- 
 graphic repetition of his actual speech, could not under- 
 stand a sentence, hardly a word of it. The printed form 
 cannot bind the ever-fluctuating pronunciation. The 
 province or function of the printed (or written) word is to 
 stand as a symbol or visible analog of the spoken word. 
 
MEDICAL ENGLISH. 20, 
 
 Etymology to the dogs ! Printing makes certain a record 
 of the etymology, and to seek to clog the word itself with 
 it is the worst of delusions. Our duty scientificly, soci- 
 ologicly, and philologicly is to keep the printed form plas- 
 tic. The crystallized language is a dead language, and 
 when there is no plasticity of language there is none of 
 the minds and civilization of those who speak that lan- 
 guage. There is a subtle, but all-powerful reaction and 
 retroaction of language upon mind. Men progressive in 
 science and sociology must be progressive in language and 
 the use of language. Prick a German word and it bleeds. 
 There is the pulsing heart of meaning behind it, flooding 
 it with sanguine significance. French words, and the 
 Greek derived or Latin-derived words of our own tongue 
 are as bloodless, dead and meaningless as are to us Chinese 
 pictographs. The comparison of the large, plastic, ener- 
 getic, capable German with the narrow, crystalline, sta- 
 tionary, incapable Frenchman, must at once spring into 
 view, and the prophecy is clear as to which one is to inherit 
 the future. The French birthrate is about equal to the 
 death-rate ; that of the Teuton is far in excess. Do we 
 believe in progressive Teutonism, and Anglosaxonism, or 
 in reactionism, toryism, arid ultramontanism ? 
 
 Specifically, the microscopic modifications I have urged 
 here are as follows : 
 
 1. Abolish in English words the archaic, unnecessary, 
 bothersome ce and a, supplanting it by e. 
 
 2. Cease adding the tautologic -al to adjectives having 
 already one adjectival suffix, -ic. It is already done in 
 thousands of words ; finish the job. 
 
 3. Drop the useless hyphen in words whose parts are 
 derived from classic languages. In ten thousand words 
 you have already done so ; finish with the rest. But retain 
 the hyphen in such compound terms as express a single 
 idea by two semifused English words, especially when both 
 are nouns. E.g., say antitoxin (not anti-toxin), culdesac 
 (not cul-de-sac), postmortem (not post-mortem), ventrofixa- 
 
30 SUGGESTIONS TO MEDICAL WRITERS. 
 
 tion (not ventro-fixatiori), etc. Keep the hyphen, when 
 it is necessary to avoid confusion and doubtfulness of mean- 
 ing, as in curet -spoon, he art- murmur, skin-disease, sleeping- 
 sickness, etc. 
 
 4. Drop the useless -te from curet, brunet,fourchet, eti- 
 qnet, cigaret, etc. You have already lopped it off from 
 cutlet, doublet, quartet, quintet, sextet, septet, racket, minuet r 
 fillet, corset, stylet, tourniquet, boquet, etc. Finish the job. 
 
 In the same way cut off the useless -me from many 
 words, writing program, gram, centigram, etc., just as already 
 we do telegram, anagram, diagram, epigram ; let us make an 
 end of it. 
 
 5. Use figures instead of spelling out numbers, at least 
 those above ten. 
 
 6. Anglicize foreign terms when a goodly portion of 
 your readers will not understand them in the originals. 
 Use italics as little as possible ; use as few foreign words 
 and terms as possible, because the vast majority of your 
 audience cannot understand them (even if you do) ; and 
 because there's a deal of silly conceit in airing exotics of 
 speech. 
 
 7. As to the spelling of chemic terms, accept the recom- 
 mendations of the American Association for the Advance- 
 ment of Science, which after years of dispassionate inves- 
 tigation advised that we drop the final e in bromid, iodid, 
 etc., and in bromin, iodin, atropin, quinin, etc. Say phenol 
 instead of carbolic acid, glycerol, instead of glycerin, etc. 
 
 8. Abolish all diereses and accents. They cannot teach 
 pronunciation, and they are useless luggage. Let us write 
 oophorectomy, cooperatioii, ptomain, leukomain, etc., without 
 the diereses. When a foreign word is Anglicized let us do 
 it completely, and not drag over into our domain the exotics 
 of foreign habit, leaving it, e.g., neither English nor French. 
 Leave to the poets the acute, the grave and the circumflex 
 accents ; they are foreign to the spirit of our own tongue. 
 
 9. Do not bother about hybrid terms. A mule is a bet- 
 ter animal than either its father or its mother. It is only 
 
MEDICAL ENGLISH. 31 
 
 finicky sticklers that are horrified by hybrid words. There 
 are many thousands of them in our language, good words, 
 too, that have been used for centuries, and that always will 
 be used. There is no earthly objection to them — and in- 
 deed we should rather welcome them if they are good words, 
 expressive and short. More than any other language ours 
 is adapted to receive them and use them, and there are more 
 of them in it than in any other language. Instead of being 
 ashamed of the fact we should be proud of it, as it shows 
 our receptivity and plasticity. If we are bound to have the 
 defects of our virtues, let us not be ashamed of the virtues 
 of our defects. 
 
CHAPTER II. 
 TITLES, REFERENCES, Etc. 
 
 Ambiguous or Insufficient Titles. — Is it not a sin 
 for a writer to bury information that may be of consider- 
 able importance, under a title that gives the reader not the 
 slightest suspicion as to the nature of the subject under 
 consideration ? Any person who has ever attempted to 
 investigate a subject in medicine knows only too well of 
 the annoyance and immense waste of time from this source. 
 The degree of ambiguity in titles varies from those in which 
 the writer gives absolutely no information as to his subject, 
 to those in which just enough is given to make it necessary 
 for the conscientious investigator to waste a half hour of 
 valuable time in looking up a reference which is of no use 
 for his purposes. As an example of the first degree, how 
 commonly we see men reporting " rare cases " and " un- 
 usual diseases" without anything more definite about them. 
 A teacher and writer of considerable repute reports a " Sur- 
 gical Clinic," without anything more definite either in the 
 title or in boldfaced type in the body of the article. Could 
 a sane man expect that any one who wanted especial in- 
 formation about empyema would consult that article ? Yet 
 that is the subject discussed.' Another writer reports 
 " Three Cases of Sarcoma and Epithelioma." Why not 
 entitle the article, Sarcoma of the Scalp, Epithelioma of the 
 Nose, etc. ? and save the time and patience of the man who 
 is looking up the literature of sarcoma of the superior max- 
 illa. We suppose that the first and main object of medical 
 writers is to impart information which in some way will 
 prove interesting or valuable to other members of the pro- 
 fession. Yet the writer not only renders a service to others, 
 
TITLES, REFERENCES, ETC. 33 
 
 but, by presenting proof of his attainments, may reasonably 
 expect to reap the benefits which naturally come to those 
 who possess superior knowledge when their ability is made 
 known. In your own interests, as well as in the interests 
 of medical progress, be explicit in your title when you re- 
 port your "recent experience in abdominal surgery," and 
 thus insure the wide dissemination of your opinion with 
 regard to tropical abscess of the liver and sarcoma of the 
 stomach. 
 
 English Titles and Nomenclature. — In addition to 
 the titles of articles expressing the exact nature or subject 
 of the article, we think that all terms, names, etc., should 
 be in English. Doubtless those who write these titles and 
 give diseases, anatomic terms, etc., their Latin equivalents, 
 have never seriously asked themselves why they do so. 
 What imaginable use the custom may have is certainly 
 beyond the wisdom of man to divine. To be sure it may 
 be supposed to suggest a certain classicism or erudition in 
 the writer, but that is a bit of humbug that is peculiarly 
 unamerican. When one is insecure as to his syntax he 
 may try to set himself right by antique spelling or Latin 
 hocuspocus, but the assumption of medievalism and the 
 mimicry of a dead language in reality make for ludicrous- 
 ness by very contrast. Perhaps there is a vague idea float- 
 ing about one's fancy that the Latin title is for the sake of 
 the indexers, the catalogers, and the foreigners who do not 
 know English ; but it would seem unnecessary to kill this 
 poor ghost of a reason, by hinting that the catalogers would 
 prefer good English to bad Latin, and that the educated 
 foreigner whose eye we wish to catch knows English quite 
 as well as Latin. There remains the fact that 99 out of 
 every 100 of our readers do know English well, while these 
 99 know Latin very ill, or not at all. The reductio ad ab- 
 surdum is given to the folly by the intermixture of English 
 and Latin in the one title or sentence. Surely Nick Bot- 
 tom would laugh at such bastardy as " Otitis media chronica 
 
34 SUGGESTIONS TO MEDICAL WRITERS. 
 
 with mastoid complications," or, " Dermatitis gangrenosa 
 infantum following vaccination," and yet such outrages are 
 daily perpetrated and the authors of them live on. Every 
 disease, every bone, muscle, or other tissue of the body has 
 or may have an exact and scientific name in English. The 
 memories of students and physicians are sufficiently heavily 
 loaded with the fact itself without adding the infliction of 
 names a thousand years old ; medical terminology and 
 nomenclature, moreover, have sins enough to bear without 
 still dragging this old slough of crackling skin. Let us 
 end mumbo-jumbo and live in the nineteenth century, and 
 let us write and speak in the most virile and living language 
 of the world. 
 
 Avoid Long Titles. — In the program of the meeting 
 of a learned American medical society, held A. D. 1898. 
 the title of one paper was made up of 40 or 50 words, and 
 another required 20 or 30 words. For the sake of mere 
 pity of librarians and catalogers, this sort of thing should 
 not be encouraged nor allowed. There are other and suf- 
 ficient reasons, but that one alone should suffice. A good 
 title is short ; its object is to classify and to catch the 
 student's eye. The longer it is, the less it is likely to do 
 so, thus defeating the author's first object. The classifica- 
 tion must be general, and not replace the detail and descrip- 
 tion which properly belong to the text. 
 
 References. — One who has bibliographic work to do 
 soon stumbles upon the fact that references to journals, 
 books, etc., are all too frequently incorrect or incomplete. 
 The student relying upon these references is often com- 
 pelled to hunt for hours or days for the original of a state- 
 ment or article when some careless footnote has sent him 
 on a fool's chase. " Bibliographies " are often the veriest 
 shams, appended to give a show of erudition, and their 
 indefinitenesses and imperfections are self- confessions of 
 the fact. When possible, every reference should be veri- 
 
TITLES, REFERENCES, ETC. 35 
 
 fied by one who transcribes it. If this cannot be done a 
 reference to the former transcriber of the reference should 
 be given. Much of this kind of error is occasioned by the 
 different methods which authors and publishers have of des- 
 ignating volumes, numbers, etc., and by the varieties of the 
 kinds, editions, and time of publications. It is therefore 
 advisable to give both the number and volume, as well as 
 the full dates of a reference. In some cases also the pub- 
 lisher and place of publication may be advisable. Refer- 
 ences should always be given in the original language in 
 which the article or title was written. The full title of an 
 article is necessary instead of none at all, or of one or two 
 words in it, in order to give help in index-hunting. An- 
 other great aid and saver of time would be the addition of 
 the page-number to a reference. In a word, there are three 
 good rules as to references: i. Accuracy; 2. Accuracy; 
 3. Accuracy ! 
 
 The Manuscript. — A little attention to several seem- 
 ingly unimportant matters on the part of medical writers 
 would be helpful in many ways and to quite a number of 
 people. Do not, for example, write on paper less in size 
 than " congress-letter " (which is about 8 by 10 inches), 
 and leave at least one inch of blank space at the left-hand 
 side. Good paper is the cheapest, and a moral man always 
 uses ink and pen not pencil. Do not write upon both sides 
 of the paper; number each page. Let the lines be so 
 widely separated that if necessary there is space to insert 
 words or sentences between them. It is advisable to type- 
 write manuscript when it is possible. Be doubly sure that 
 proper names (of which the type-setter may know nothing) 
 are written so plainly that there is no doubt as to their 
 proper spelling. Do not paragraph your manuscript ; leave 
 that to the editor, although, if you prefer to do so, indicate 
 your choice of paragraphs by the sign (^[) in the blank 
 space at the left side. For fear our meaning may not be 
 clear we will put this in another way : Commence every 
 
36 SUGGESTIONS TO MEDICAL WRITERS. 
 
 line at the same relative position, leave no blank ends or 
 beginnings of lines, nor any blank spaces. There are several 
 good reasons for this rule. Do not put footnotes at the 
 bottom of the page (or, worse still, upon, another page), 
 but run them in "solid " with the principal writing, indi- 
 cating them by two upright lines before, after, and at the 
 side. A single underscoring indicates italics, double un- 
 derscoring, sm'all capitals, like the headings of these sec- 
 tions, triple underscoring, full capitals. Unless you hate the 
 man to whom you send a manuscript do not roll it. The 
 greater your fame and your literary and scientific ability, 
 the more you may ignore these little suggestions, because 
 all journals and publishers are glad to get literary gold how- 
 ever disguised in deceptive quartz ; but if you are a kind- 
 hearted man you will consider the editor, typesetter, and 
 proofreader by attention to such seemingly trivial things. 
 Moreover, your work will more surely appear correctly and 
 to your satisfaction by a little forethought. Surely the 
 poor editor is biased in favor of a clean, tidy, and present- 
 able manuscript, and he is much inclined to think that clear 
 thinking will lead to a writing that requires the least work 
 to read and to prepare for the printer. 
 
 How to Make Temperature-Charts for Illustra- 
 tions of Articles. — The temperature-chart as made for 
 clinical purposes cannot usually be used by the photog- 
 rapher and engraver. A new one is required for illustra- 
 tion of a printed article. This causes possible errors, and 
 certain delays and expenses to the journal publishing the 
 article, so that we would advise writers to redraw the 
 chart in such a way as to economize space, to give a better 
 •artistic as well as scientific effect, and to aid clearness and 
 ease of understanding, and legibility in reading. There 
 are several things to be kept in mind : 
 
 I. Cut off the unimportant and blank parts of the paper, 
 the headings, etc., so as to crowd the temperature line and 
 other necessary details as closely together as possible. 
 
TITLES, REFERENCES, ETC. S7 
 
 Many things often written in the chart are much better 
 expressed in the " legend " (2. e., the explanation in fine 
 type below the cut) or in the body of the text itself. 
 
 2. Use charts ruled only with black ink, and ruled 
 clearly and sharply. Some manufacturers of blank charts 
 use colored inks in some of the horizontal or vertical lines. 
 Use black ink also in all writing, lines, or figures made 
 upon the chart. Draw the temperature-line, the essential 
 feature of the chart, exceptionally heavy arid clear. 
 
 3. Make all writing and figures required two or three 
 times the usual size of letters and figures in ordinary writ- 
 ing. This allows the photographer to reduce the whole 
 chart uniformly to one-half or one-fourth the size, and still 
 all details will be clear. Do not use the "running" or 
 cursive style of writing (as in letter-writing); but separate 
 each letter and "print" them, as the children say, in Ro- 
 man fashion. 
 
 4. When more than one line is required, as, e.g., to re- 
 cord the respirations, pulse -rate, or other synchronous phe- 
 nomena, do not use differently-colored inks, but different 
 kinds of interrupted lines in black ink, as, e. g., one con- 
 tinuous, one of dashes, one of hyphens, one of dots, or com- 
 binations of dots, dashes, stars, etc. 
 
 5. It is better not to use any of the blank clinical charts 
 in common use for redrawing, but to take a large sheet of 
 unruled paper, and rule it horizontally and vertically in 
 squares of about T 3 F of an inch. The changes or angles in 
 the direction of the temperature-line may be indicated by 
 pin-pricks through the paper before the line itself is drawn. 
 
 6. Get some enterprising publisher to advise and place 
 on sale blank charts corresponding to the foregoing sug- 
 gestions, not for clinical purposes, but for writers who wish 
 to reproduce charts with printed articles, or to show to audi- 
 ences at medical society meetings, etc. 
 
 Illustrations are perhaps often useless, but are some- 
 times necessary, and may even tell more than text as to 
 
38 SUGGESTIONS TO MEDICAL WRITERS. 
 
 the condition, — but not if they tell lies. If, for instance, 
 the cut is upside down it may not help the reader very 
 much. And it is not always the fault of the proofreader 
 or printer if this reversal is found in the printed page. 
 Sometimes only the author can know. When not self- 
 evident it would, therefore, be well for him always to indi- 
 cate the top, bottom, and right side of the cut. Occasion- 
 ally the scientific value of illustrations depends upon the 
 size or relative sizes of the pictures, but authors forget that 
 in reproducing or adapting originals for the printer's use 
 the cuts usually have to be reduced in size. When of im- 
 portance, instructions as to this detail should accompany 
 the MS., and in the legend the reader should be notified 
 concerning it. And there should be a legend ! It should 
 also accompany the original. It can then be properly in- 
 serted in the galley-proofs sent the author, who will thus 
 know if it is correct. Correspondence, trouble, and pos- 
 sible accident may thus be spared. The legend should also 
 be full and clear. All illustrations should be numbered in 
 regular order and every one should be referred to, by the 
 number, in the text. It is altogether too common that 
 authors fail to number cuts, to explain them in legends, 
 and more than once we have known illustrations to be 
 wholly ignored in the text. It is also strange that so many 
 do not understand that the smudgy proof of the illustration 
 in the galleys is not as it will appear when properly printed ; 
 it is sent to furnish the author with an opportunity to indi- 
 cate where it is to be placed, to verify or insert the legends, 
 to see if it is right side up, etc., etc. Despite this, letters 
 will appear with maledictions upon engravers, and savage 
 irony as to our art department, ordering non-insertion, etc. 
 We have known one tired, but not altogether disingenuous 
 editor who made it his custom in such instances to send 
 the wrathful contributor a courteous letter saying that a 
 new cut would be made to replace the bad one he justly 
 criticised, and that this would be guaranteed all right. A 
 last item refers to changes in cuts once made. Authors 
 
TITLES, REFERENCES, ETC. 39 
 
 often ask that details of cuts shall be made different, some- 
 thing inserted here or taken out there, as if it were a mat- 
 ter like changes in type. These things, of course, should 
 have been ordered in the original of the illustration. When 
 the photographer, engraver and etcher send the block to 
 us for the printer's use, little or nothing can be done in the 
 way of modifications. 
 
CHAPTER III. 
 
 ORTHOGRAPHY, PUNCTUATION, PRONUNCIATION. 
 
 As to Spelling. — Over 200 years ago a sensible man, 
 William de Bretaine, wrote as follows : 
 
 Neither will it become you to quarrel pedantically about the 
 orthography of a word; as whether to write Felix with a diph- 
 thong or an e simple ; but rather do you attend to the sense and 
 meaning of the things. What is it to us how many knobs Her- 
 cules has on his club, or whether Penelope was faithful or false. 
 Let every man mind his own business and do his own duty. A 
 wise man will employ his thoughts upon things substantial and 
 useful. It is not meet for a man of the world, or even for a man 
 of letters, to pester his brains with idle punctilios and disputed 
 trifles; that superfine curious sort of learning amounts to little 
 more than intellectual foppery, and serves no practical purpose. 
 Common sense is the treasure of the mind, and judgment is the 
 key to its storehouse. It mixes well with all other gifts ; even as 
 diamonds enhance the hue of rubies or emeralds. 
 
 This holds good to-day, of course, but with certain qual- 
 ifications. Those who in spelling advocate thoroughgoing 
 acceptance of the general custom will upon careful reading 
 find that the words of the astute William do not justify 
 their sort of laissez-faireism, but rather that of those who 
 spell as they please. Davy Crockett, when ridiculed in 
 Congress for his incorrect spelling, is said to have replied : 
 " He must be a very ignorant man who cannot spell a word 
 in more than one way." 
 
 Many seem to think the " spelling-reform " movement 
 beneath their dignity, and that they are attending to " the 
 sense and meaning of things," leaving such trivialities to 
 children and minds of small caliber. But in the specializa- 
 tion of function of civilization, the tremendous amount of 
 
ORTHOGRAPHY, PUNCTUATION, PRONUNCIATION. 41 
 
 printing done, and the number of bothered printers, type- 
 readers, and editors in the world, trifles become highly- 
 important matters by mere addition. The age is micro- 
 scopic, and its problems are hitherto unconsidered but 
 momentous little things. Those who petulantly exclaim 
 against botheration with " the diphthong or an ' e ' simple," 
 usually mean thereby that the e-simple faddists should not 
 bother with the diphthong-sensible folk. And as a rule 
 they are right. It is only necessary also to add the rider 
 that the diphthongers must not scold the e-simplers. A 
 good rule proverbially works both ways. 
 
 But why not accept the rule of the world ? Why not 
 spell English as the English do ? There are two or 
 three Yankeelike answers to such quetions : Why not, 
 e. g., govern, enact laws, raise, and cut and thresh 
 wheat, manage railways, medical associations, and do 
 everything else on the English models ? Well, we do 
 not and, frankly, we will not ; nor in spelling will we 
 abjectly imitate. "We are the people of King Shake- 
 spere ! " cry the uniformists — and in the five autographs 
 we have of the King, he spelled his own name five differ- 
 ent ways ! The truth is that not even the deadening and 
 crystallizing influence of conservatism and custom can 
 prevent the continuous change and growth in spelling and 
 language. The German scientists have almost revolution- 
 ized the spelling of their language in the past few years, 
 the England of Shakespere is but little less careless than 
 he as to orthography, and even France is in pain over the 
 laughable crystallization of her language. Change in lan- 
 guage simply will not stop. Then why not go over body 
 and soul to the fonetik fok? Solely because Anglosaxons 
 are not revolutionizers but evolutionizers. The method of 
 nature and of our civilization is by changes always slow and 
 slight in the existing thing. Upon this ground we deprecate 
 violent changes in the forms of our words in the direction 
 of phonetic absoluteness, and we advise the slow advance 
 according to the spirit of genuine Americanism and philo- 
 
42 SUGGESTIONS TO MEDICAL WRITERS. 
 
 logic progress. Three-fourths of the se's and oe's have 
 already been dropped, and their place supplanted by the 
 common-sense e. Let us do the same with the rest of the 
 lot. The greatest of historians ioo years ago wrote (Eco- 
 nomic, cera, musick, democratical. What smallest of histo- 
 rians would so spell now. 
 
 Neither will the curtailing process be stopped by au- 
 thority. Boswell says of Johnson : " I hope the authority 
 of the great master of our language will stop that curtail- 
 ing innovation by which we see critic, public, etc., fre- 
 quently written instead of critick, publick, etc." At this 
 time, too, one almost invariably spelled authour, errour, 
 inferiour, honour, domestical, etc., as here written. What 
 stickler would do so now ? But he fights the plan of carry- 
 ing the same law of change into the spelling of similar 
 words. We have deleted a full half of the useless -al's at 
 the end of our scientifical adjectives ; let us, with some 
 proper exceptions, lop off a lot more. Let us philogicly 
 and rightly change -our into -or, and -re to -er. Let us in 
 a hundred small ways shorten, concentrate, Anglicize and 
 Americanize our language ! 
 
 The greatest English philologist has said that " any one 
 who is utterly ignorant of the facts of the formation of the 
 English language has a much better chance of being lis- 
 tened to than- those who have studied the subject. I have 
 not been able to find, during 20 years' search, that there is 
 any other subject in which ignorance is commonly regarded 
 as a primary qualification for being chosen to write upon 
 it." We are reminded of this by the appearance of articles 
 even in medical journals sneering at "spelling reform" and 
 "reformers," and advising against the elision of the final e 
 in such words as bromid, quinin, etc. The writers seem to 
 know nothing of the history of the threshing of this old 
 straw ; for example, of the four years' investigation of the 
 American Association for the Advancement of Science, 
 and its unanimous recommendation "as to these e's, etc. 
 We assure our readers that they may spell chlorin, chlorid, 
 
ORTHOGRAPHY, PUNCTUATION, PRONUNCIATION. 43 
 
 etc., without the unnecessary and absurd e, and with per- 
 fect philologic and scientific correctness. Some " reform- 
 ers " are so hard-pressed that they feel impelled to reform 
 genuine reform. Nothing is more ridiculous than con- 
 servatism and dogmatism in philology — nothing except the 
 arguments used in their support. 
 
 There are two good things that have resulted from the 
 work of the reformers. The conservatives formerly built 
 the critical breastwork of their camp with what they thought 
 the indestructible masonry of etymology. It was soon in 
 ruins. Not one stone lies upon another. Philologically 
 the idea that antique spelling was necessary to tell the 
 etymologic history of a word was not magnificent nor was 
 it war. Then as a last resort the conservatives retreated 
 behind the hastily thrown up earthworks that all change in 
 language is unconscious, and could no more be brought about 
 by willed design than could any unconscious tendency of 
 cosmic evolution. The Dons were routed out of the rifle- 
 pits by the statement of the simple fact, the absolute reverse 
 of what had been alleged, that every change in the form of 
 words brought about since the invention of printing had 
 been purely a matter of conscious design and purposive 
 intention. 
 
 The Spelling and Pronunciation of Chemic Terms. 
 — We have received so many requests for a succinct state- 
 ment of the recommendations of the American Association 
 for the Advancement of Science, as to the spelling of cer- 
 tain chemic terms, that we copy from the "Stylebookof the 
 Chicago Society of Proofreaders " its account of the matter. 
 We trust that in the forthcoming revision of the U. S. 
 Pharmacopeia these recommendations may be adopted, and 
 thus end the sorry conservatism which still clings to an 
 antiquated nomenclature. 
 
 In 1887 a committee was appointed by the American Associ- 
 ation for the Advancement of Science to consider the question of 
 attaining uniformity in the spelling and pronunciation of chemical 
 
44 SUGGESTIONS TO MEDICAL WRITERS. 
 
 terms. The work of this committee extended through the follow- 
 ing four years. As a result of widespread correspondence and 
 detailed discussion at the annual meetings of the Chemical 
 Section of the American Association, the accompanying rules 
 were formulated and adopted by the Association : 
 
 General Principles of Pronunciation. — i. The pronunciation is 
 as much in accord with the analogy of the English language as 
 possible. 
 
 2. Derivatives retain as far as possible the accent and pro- 
 nunciation of the root word. 
 
 3. Distinctly chemical compound words retain the accent and 
 pronunciation of each portion. 
 
 4. Similarly sounding endings for dissimilar compounds are 
 avoided (hence -id, -ite). 
 
 Accent. — In pollysyllabic chemical words the accent is gener- 
 ally on the antepenult, in words in which the vowel of the penult 
 is followed by two consonants, and in all words ending in -ic, the 
 accent is on the penult. 
 
 Prefixes. — All prefixes in strictly chemical words are regarded 
 as parts of compound words, and retain their own pronunciation 
 unchanged (as ac'eto-, am'ido-, az'o-, hy'dro-, i'so-, ni'tro-, 
 nitro'so-). 
 
 Elements. — In words ending in -ium, the vowel of the ante- 
 penult is short i (as irid'ium) or y (as didym'ium), or if before two 
 consonants (as cal'cium), but long otherwise (as tita'nium, sele'- 
 nium, chro'mium). 
 
 In the spelling of sulfur / is used in the place of ph, and in all 
 derivatives (as sulfuric, sulfite, sulfo-, etc.). 
 
 Termination in -ic. — The vowel of the penult in polysyllables 
 is short (as cyan'ic, fumar'ic, arsenic, silic'ic, rod'ic, butyr'ic), 
 except (1) u when not used before two consonants (as mercur'ic, 
 prus'sic), and (2) when the penult ends in a vowel (as benzo'ic, 
 ole'ic); in dissyllables it is long, except before two consonants (as 
 bo'ric, ci'tric). Exceptions : ace'tic or acet'ic. 
 
 The termination -ic is used for metals only, when necessary to 
 contrast with -ous (thus avoid aluminic, amnionic, etc.). 
 
 Terminations in -ous. — The accent follows the general rule 
 (as plat'inous, sul'furous, phos'phorous, cobaltous). Exception : 
 ace'tous. 
 
 Terminations in -ate and -ite. — The accent follows the general 
 
ORTHOGRAPHY, PUNCTUATION, PRONUNCIATION. 45 
 
 rule (as ac'etate, vanadate) ; in the following words the accent is 
 thrown back : ab'letate, al'cholate, ac'etonate, an'timinite. 
 
 Terminations in -id {formerly -ide). — The final e is dropped 
 in every case and the syllable pronounced id (as chlo'rid, i'odid, 
 anhy'drid, ox'id, hydrox'id, sul'fid, am'id, an'ilid, murex'id). 
 
 Terminations in -ane, -ene, -ine, and -one. — The vowel of these 
 syllables is invariably long (as meth'ane, eth'ene, naphthalene, 
 an'thracene, pro'pine, quin'one, ac'etone, ke'tone). 
 
 A few dissyllables have no distinct accent (as benzene, xylene, 
 cetene). 
 
 The termination -ine is used only in the case of doubly 
 unsaturated hydrocarbons, according to Hofmann's grouping 
 (as propine). 
 
 Terminations in -in. — In names of chemical elements and com- 
 pounds of this class, which includes all those formerly ending 
 in -ine (except doubly unsaturated hydrocarbons), the final e is 
 dropped and the syllables pronounced in (as chlo'rin, bro'min, 
 etc., am'in, an'ilin, mor'phin, quin'in (kwin'in), vanil'lin, alloxan'- 
 tin, emul'sin, caffein, co'chin). 
 
 Terminations in -ol. — This termination, in the case of specific 
 chemical compounds, is used exclusively for alcohols, and when 
 so used is never followed by a final e. The last syllable is pro- 
 nounced -ol (as gly'col, phe'nol, cre'sol, thy'mol (ti), gly'cerol, 
 qui'nol.) Exceptions : al'cohol, argol. 
 
 Terminations in -ole.— This termination is always pronounced 
 -ole, and its use is limited to compounds which are not alcohols 
 (as in'dole). 
 
 Terminations in -yl. — No final e is used ; the syllable is pro- 
 nouncedjj// (as ac'etyl, am'yl, ce'rotyl, ce'tyl, eth'yl). 
 
 Terminations in -yde. — The_y is long (as al'dehyde). 
 
 Terminations in -meter. — The accent follows the general rule 
 (as hydrom'eter, barom'eter, lactom'eter). Exception : words of 
 this class used in the metric system are regarded as compound 
 words, and each portion retains its own accent (cen'time'ter, 
 mil'lime"ter, kil / ome"ter). 
 
 The endless-confusion argument as to spelling chemical 
 words will hardly avail, but those who oppose rational (and 
 we might add, national) progress in these things are them- 
 selves the greatest creators of the confusion they appear 
 
46 SUGGESTIONS TO MEDICAL WRITERS. 
 
 to detest. In fact this contention as to the spelling of 
 alkaloids and glucosids is old straw long ago thoroughly- 
 threshed out. In 1891 the American Association for the 
 Advancement of Science, after a four years' investigation, 
 advised that the e be dropped from all such words as bro- 
 mide, chloride, quinine, etc., and the logical reasons for the 
 advice have never been successfully met by the conserva- 
 tives. The latest and most thorough-going and scholarly 
 dictionary of the English language, The Standard, adopted 
 the recommendations of the Association and spells bromid, 
 chlorid, quinin, etc., and such journals as the Journal of 
 Analytical and Applied Chemistry, such chemists as Profes- 
 sors Caldwell, of Cornell University; Witthaus (in his 
 Manual of Chemistry) ; Leffmann, of Philadelphia ; T. 
 Sterry Hunt (Systematic Mineralogy), and many others, 
 use and advocate the simpler spelling. The pharmacopeia 
 itself is unable to be consistent, as e. g., lupulin, naphtha- 
 lin, etc. The argument that in such small things we must 
 follow the antiquated usage of the pharmacopeia is a boom- 
 erang emphatically asking why it perpetuates the endless 
 confusion by not catching up with the accepted advances 
 of progressive chemical and general science, and of wide- 
 awake men who do not think that philology is the single 
 branch of science untouched by change and progress. The 
 pharmacopeia always follows, never leads. If we should 
 await its orders, we should never have any progress of any 
 kind. Hundreds, we had almost written thousands, of 
 words ending with -in or -ine are being forced into the lan- 
 guage regardless of glucosidal or suicidal logic, so that any 
 attempt to establish a distinction between glucosids and 
 alkaloids by a terminal e is — well, let us say, simply laugh- 
 able. The naming of a drug is solely to differentiate it 
 from any other drug, and this is effectually done with- 
 out the terminal e contended for. We have no desire to 
 constrain contributors in their spelling, because, among 
 other reasons, progress is helped by such a parade of their 
 inconsistencies and redundancies. Those who do not like 
 
ORTHOGRAPHY, PUNCTUATION, PRONUNCIATION. 47 
 
 railway trains are privileged to employ stage coaches, and 
 they should not be too openly smiled at or frowned upon, 
 but we advise our readers that in this affair they may trust 
 and follow the advice of the Association for the Advance- 
 ment of Science. With hundreds of progressive scientists 
 and philologists, they may safely order quinin sulfate with- 
 out endangering their patients' lives by the terrible change 
 of getting a dose of a " glucoside " from the druggist. May 
 we not beg contributors to allow this useless and wornout 
 controversy to die, or rather to be buried ? 
 
 Another Spelling Difficulty. — A correspondent 
 writes a follows : 
 
 What good reason can be given for the cumbersome common 
 spelling of the word Pharmacopceia? Here we have an English 
 word ending in a diphthong and two vowels (frequently rendered 
 with four separate vowels, however), but only two sounds are 
 made out of them. It is true that the Greek is Pkarmakapoiia, 
 but poi-yah is understandable, while pe-ah for paiah is not. In 
 your dictionary you go one step to the good and spell the word 
 Pharmacopeia, and pronounce it far-mak-o-pe' -eh, but even your 
 spelling does not truly fit your pronunciation. Now your Eng- 
 lish ancestors seem to have had no great difficulty in deriving 
 poem, poet, etc., from the same origin— the Greek voxiv, therefore 
 what necessity of lexicography requires any spelling but Pharma- 
 copea, whose pronunciation would be self-evident, whose etymol- 
 ogy would be found in the dictionary the same as that of poet is 
 now, and whose spelling would be really comprehensible to an 
 English-speaking individual. Perhaps your reply to this may 
 succeed in clearing up one more bad spot in medical spelling. 
 
 To which we assent, and can only say that the sole 
 objection to adopting the suggestion is that a few objectors 
 would raise a fuss. Logic has nothing whatever to do 
 with English spelling or pronunciation, and nobody cares 
 less for etymology than the pernickety sticklers who talk 
 and make much of it. We remember to have had a very 
 amusing correspondence with one such, who was appar- 
 ently deeply grieved because one poor editor omitted 
 
48 SUGGESTIONS TO MEDICAL WRITERS. 
 
 diereses and hyphens in spelling zoology, cooperation, 
 intrauterine, etc. But, in the very letter of the critic he 
 spelled dieresis without the precious dots or hyphen, and 
 this word pharmacopea should have been adduced as an 
 additional instance. A still more striking one would have 
 been such words as diiodid, diiodoform, which would 
 require a very pepperbox of dots to satisfy demands. 
 Diacritic marks of all kinds are against the genius of our 
 language and people ; they should, and will be, abolished. 
 The only reason we fear to recommend pharmacopea is that 
 every rival, envier, and hater on other than etymologic 
 grounds will seize the occasion to belabor and to write 
 scornful letters and editorials green with rage. 
 
 Hyphenated Compounds, or Separate Words? — The 
 use of any sign or mark in printing must be to express mean- 
 ing, and consequently the hyphen in compound words 
 should be used only when it is necessary to prevent mis- 
 understanding or confusion of thought. When no such 
 confusion is likely or possible, we should not uselessly pep- 
 per our pages with it. Some writers (as e. g., Herbert 
 Spencer, with his " literally-descriptive," " apparently-arti- 
 ficial," " increasingly-important," etc.) are overfond of the 
 hyphen ; this maybe due to the self- flattery of supposed ac- 
 curacy, when omission would not in the least change the 
 meaning of the words. Sometimes the insertion of the 
 hyphen may increase confusion, and, often also, a comma 
 is preferable or does exactly as well. The trend of good 
 English usage is to abolish the hyphen except when it is 
 positively needed to make meaning clear. " Alligator for- 
 ceps," as Teall contends, naturally suggests "forceps to be 
 used on alligators." Medical writers are much given to 
 turning a noun into an adjective, and atoning for the sin 
 by means of a scapegoat hyphen,— as e.g., head-injury, 
 heart-disease, and all the rest. Perhaps we shall in time 
 have gut cut, face-smash, gastro-intestino-omentum-perf ora- 
 tion, belly opening, etc. But, as a rule, the hyphen does 
 
ORTHOGRAPHY, PUNCTUATION, PRONUNCIATION. 49 
 
 not atone, it only doubles the blunder, for foot injury can 
 confuse no reader, and is just as definite in significance as 
 foot-injury. Brevity and conciseness are excellent qualities 
 in medical writing, and within certain limitations are to be 
 commended, but life is not yet so short that we cannot take 
 time to say wound of the foot, cardiac murmur, renal stone, 
 vesical disease, etc., instead of the barbaric bunching 
 together of two nouns. 
 
 It is almost impossible to make lists of terms in which 
 the hyphen is needlessly or rightfully used, and we wish 
 only to emphasize the principle involved. Let us decide 
 to use or not to use the hyphen by attention in each special 
 case, asking only the question : " Is it necessary in this in- 
 stance to clarify understanding, or to prevent confusion on 
 the part of the reader ? " The famous advertisement, " Mrs. 
 Smithers has left off clothing and invites inspection " is, of 
 course, in dire need of a hyphen; and to facilitate clear- 
 ness, or to avoid misunderstanding, it must occasionally be 
 inserted between words printed without it, as in the notice 
 we have seen, " We have for adoption a dark skinned baby." 
 
 The working of the child's mind on the subject is shown 
 by the story told by Mr. Augustus C. Hare, of a little girl 
 who, on being asked to illustrate a certain hymn, brought a 
 sketch representing a little bear, under which were written 
 
 the lines : 
 
 " Can a woman's tender cares 
 Cease towards the child she bears ? " 
 
 Generally, however, the hyphen is used without any suf- 
 ficient reason. Those who wish more help than is to be 
 got from the foregoing, may consult Teall's The Compound- 
 ing of English Words. 
 
 Solid-word Compounds — The dictionary-makers have 
 been able to reach no uniformity in their recommendations 
 concerning the compounding of words, and have seemed to 
 pride themselves upon their differences. There is thus 
 the most lamentable confusion and contradiction in the 
 
50 
 
 SUGGESTIONS TO MEDICAL WRITERS. 
 
 usage even of the best writers. A thousand rules are 
 jeered at by the makers of another thousand, and everyone 
 is left to follow the promptings of whim and caprice. In 
 this state of affairs medical literature must show the same 
 confusion, and he would be a brave man who would attempt 
 dogmatically to formulate a set of unyielding laws and 
 rules. In general, however, it may be said that the ten- 
 dency of custom and the dictates of common sense are 
 more and more uniting to run words together in solid form 
 when there is fusion of idea or thought to be conveyed, 
 and especially when either of the two components cannot 
 stand alone as a separate English word. Thus, ilio- and 
 broncho- are not separable English words and the hyphen is 
 expunged in iliostomy, iliofemoral, bronchorrkea, bronchopneu- 
 monia, etc. There is no more need of the hyphen in 
 anti-toxin than there is in anti-pathy. The function, indeed, 
 of the hyphen, seems very often to be that of a sort of 
 stopgap, or a kind of .sop thrown to the Cerberus of con- 
 servatism which will not allow the complete fusion of two 
 etymologic elements, and "to save its face," conservatism 
 holds for a few years to the hyphen. It is a good rule to 
 kill a hyphen whenever seen, unless thereby clearness of 
 meaning is also killed. In the following illustrative list 
 we advise that these and words similarly conjoined be 
 spelled as given, — i. e., without hyphenation or space : 
 
 adenosarcoma 
 
 afterbirth 
 
 afterbrain 
 
 almshouse 
 
 angioneurosis 
 
 angiosarcoma 
 
 antemortem 
 
 antialbumin 
 
 antisyphilitic 
 
 antitoxin 
 
 armpit 
 
 arthroempyesis 
 
 backache 
 
 backbone 
 
 backset 
 
 backslide 
 
 balneotherapy 
 
 basioglossus 
 
 bedbug 
 
 bedridden 
 
 bedroom 
 
 bedside 
 
 beefsteak 
 
 biconcave 
 
 biconvex 
 
 bimanual 
 
 bloodworm 
 
 bloodwort 
 
 blowpipe 
 blowsy 
 bluestone 
 boneblack 
 boneset 
 boroglycerid 
 breadstuff 
 breakbone (fever) 
 breakdown 
 bricklayer's (itch) 
 brickmaker's (an- 
 emia) 
 bronchopneumonia 
 buttermilk 
 
ORTHOGRAPHY, PUNCTUATION, PRONUNCIATION. 5 1 
 
 bellyache 
 
 birthmark 
 
 bittersweet 
 
 blackberry 
 
 bleareye 
 
 blepharophimosis 
 
 blind worm 
 
 bloodletting 
 
 bloodroot 
 
 bloodshot 
 
 bloodstream 
 
 bloodvessel 
 
 cardiopneumatic 
 
 careworn 
 
 catgut 
 
 cerebrospinal 
 
 cesspool 
 
 cheesecloth 
 
 chickenpox 
 
 childbed 
 
 childbirth 
 
 childlike 
 
 chorioretinitis 
 
 choroidoretinitis 
 
 chylopericardium 
 
 climatotherapy 
 
 clubfoot 
 
 clubhand 
 
 coltsfoot 
 
 cottonseed 
 
 counterextension 
 
 counterirritation 
 
 cowpox 
 
 crosseye 
 
 culdesac 
 
 dacryocystitis 
 
 dairyman 
 
 dayblindness 
 
 dermatoneurosis 
 
 dextrorotatory 
 
 earache 
 
 earthworm 
 
 eightfold 
 
 electrocautery 
 
 electromassage 
 enterocolitis 
 enterogastritis 
 eyebrow 
 eyelash 
 eyelid 
 eyepiece 
 eyesight 
 faceache 
 fibrocartilage 
 fingerbreadth 
 fireproof 
 flaxseed 
 fleabite 
 footnote 
 footprint 
 foregut 
 forebrain 
 forearm 
 forehead 
 foreskin 
 fourfold 
 frostbite 
 gallstone 
 'galvanocautery 
 galvanopuncture 
 gastroenteritis 
 guineapig 
 guineaworm 
 gumboil 
 guncotton 
 gunshot 
 harelip 
 haircloth 
 hairpin 
 hamstring 
 handbook 
 handbreadth 
 headache 
 headlight 
 headpiece 
 heartburn 
 hemothorax 
 hipjoint (adj.) 
 
 horsehair 
 
 hourglass 
 
 humpback 
 
 hunchback 
 
 hysteroneurosis 
 
 ileomotor 
 
 ilecolic 
 
 iliofemoral 
 
 iliopectineal 
 
 incoordination 
 
 indoors 
 
 infraclavicular 
 
 infracostal 
 
 interparietal 
 
 intracapsular 
 
 ischiorectal 
 
 jejunoileostomy 
 
 kneecap 
 
 kneejerk 
 
 kneepan 
 
 laryngotracheot- 
 
 omy 
 levorotatory 
 lifetime 
 limestone 
 lockjaw 
 madhouse 
 madman 
 
 melanocarcinoma 
 microorganism 
 midwife 
 musculospiral 
 myxosarcoma 
 nearsightedness 
 neuroepithelium 
 neuroretinitis 
 nightblindness 
 nightclothes 
 nightdress 
 nightmare 
 nitromuriatic 
 northeast 
 oilcloth 
 onset 
 
52 
 
 SUGGESTIONS TO MEDICAL WRITERS. 
 
 ophthalmoblennor- 
 rhea 
 
 osteoarthritis 
 
 outbreak 
 
 outbuilding 
 
 outdoor 
 
 outflow 
 
 outgo 
 
 overlay 
 
 pneumopericar- 
 dium 
 
 portwine (adj.) 
 
 postmortem . 
 
 poorhouse 
 
 pseudocyesis 
 
 pseudocroup 
 
 pseudoganglion 
 
 psychophvsiology 
 
 puffball 
 
 quicklime 
 
 quicksilver 
 
 rainfall 
 
 ratsbane 
 
 rawhide 
 
 retropharyngeal 
 retrovaccination 
 ringworm 
 roundworm 
 runaround 
 scaldhead 
 scleroskeleton 
 seashore 
 seasick 
 seaside 
 seatangle 
 shotgun (prescrip- 
 tion) 
 silkworm 
 skullcap 
 silkwormgut 
 smallpox 
 splayfoot 
 stavesacre 
 stiffneck 
 stomachache 
 sunburn 
 sunlight 
 sunshine 
 
 sunstroke 
 
 supravaginal 
 
 tablespoon 
 
 tapeworm 
 
 teaspoon 
 
 thermocautery 
 
 threadworm 
 
 threefold 
 
 thrombophlebitis 
 
 tonguetie 
 
 toothache 
 
 typhomalaria 
 
 typhomania 
 
 underclothes 
 
 underfed 
 
 uterogestation 
 
 uterovaginal 
 
 vulvovaginal 
 
 watercourse 
 
 waterway 
 
 wordblindness 
 
 worddeafness 
 
 wryneck 
 
 xanthocreatinin 
 
 As to writing Dates, the Stylebook of the Chicago 
 Society of Proofreaders advises as follows : 
 
 When the year is given omit d, th, and st — as May 15, 
 1895- 
 
 Do not use r or n in dates, but March 23d, 22d of June, 
 etc. 
 
 In giving a series of two or more years, express them 
 thus: 1893-97; not 1893-7. 
 
 Do not shorten year, as '97 for 1897, excepting when 
 referring to college classes, as " Class of '97." 
 
 The Capitalization of Scientific Terms. — It is now 
 almost universally the custom to capitalize the names of 
 the genus in the biologic sciences. There are some note- 
 worthy exceptions to the rule to use lower case for the 
 species. These exceptions to the rule relate especially to 
 
ORTHOGRAPHY, PUNCTUATION, PRONUNCIATION. 53 
 
 those instances in which the name of the species is derived 
 from that of the discoverer. But just as it seems advisa- 
 ble not to capitalize the words joule, coulomb, sylvian, 
 galenic, etc., so we do not see the need of capitalizing the 
 species-name of plants and animals whether or not these 
 are derived from the proper names of men or of countries. 
 The honor is not less because the initial letter is not a 
 capital, and the fact that it is not capitalized helps toward 
 the desirable discrimination between genus and species. 
 We therefore advise the invariable capitalization of the 
 genus, and as uniformly the lower case for the species. 
 For example : Ascaris lumbricoides, Strongylus douglassii, 
 Papaver somniferum, Gadus morrhua, etc. , 
 
 Abbreviations of Titles of Medical Periodicals. 
 — A valued correspondent asks for a list of the abbre- 
 viations of titles of medical journals, for use in references, 
 foot notes, etc., when writing medical articles or books. 
 We regret that this is impossible. Our correspondent 
 has not chanced upon the List published as an Appendix 
 to Vol. XVI of the Index Catalog of the Library of the 
 Surgeon-General's office. This volume makes 382 pages, 
 and subsequent lists would swell it considerably. We 
 append lists of individual letter and separate word con- 
 tractions, to show the general principles governing the 
 construction of abbreviations, and in a general way, in the 
 interests of a desirable uniformity, we advise acceptance of 
 the rules and practice of the Index Catalog. 
 
 The abbreviations are prepared as far as possible in 
 accordance with the following principles : 
 
 1. To follow the exact order of the words of the title. 
 
 2. To make them as brief as is consistent with clear- 
 ness to those who are familiar with medical literature. 
 
 3. To follow strictly the orthographic usages of each 
 language. This disposes of the question of capitalization. 
 
 4. To attain uniformity. 
 
 Some exceptions to this last rule have been found ex- 
 
54 SUGGESTIONS TO MEDICAL WRITERS. 
 
 pedient. An abbreviation which is quite intelligible in the 
 body of a title is not always suitable as the first word, and 
 the context may make an abbreviation sufficiently clear in 
 a long title which in a short one would appear obscure. 
 The convenience of the reader is regarded as of more 
 importance than a rigid adherence to uniformity. The 
 following minor details, with the list of single-letter ab- 
 breviations, will assist in the comprehension of the scheme : 
 
 The article with which a title commences is omitted. 
 
 Prepositions as well as articles are entirely omitted in 
 English titles, and in other languages when their elision 
 would not lead to obscurity. 
 
 The place of publication is not added when it forms an 
 integral part of the title ; in such cases it is given without 
 abbreviation, except in instances of constant recurrence, 
 as London, Paris, Berlin, etc., which are condensed into 
 Lond., Par., BerL, etc., on all occasions. Nor is it added 
 to the titles of Transactions or journals the places of pub- 
 lication of which have been changed from time to time, as 
 the references in each instance furnish the locality. 
 
 Single-Letter Abbreviations. 
 
 a. aan, alia, auf, aus, aux, etc. 
 
 b. bei. 
 
 d. das, degli, dei, del, della, der, des, det, die, din, etc. 
 
 E. East. 
 
 e. ein, eine, einer. 
 
 F. Folge. 
 
 f. for, for, f ra, fur. 
 
 J. Jahr, Jahres, Jahreszahl, Jornal, Journal. 
 k. kaiserlich, koniglich, koninklijke. 
 k. k. kaiserlich koniglich. 
 1. las, les, los, etc. 
 M. Medical, Medicine, Medico, etc. 
 m. mit. 
 N. North. 
 
 D. neue, neueste, new, nouveau, nuova, nya, etc. 
 n. F. neue Folge. 
 n. p., n. d. no place, no date. 
 0. och, oder, over. 
 
ORTHOGRAPHY, PUNCTUATION, PRONUNCIATION. 55 
 
 p. par, pel, per, pour, pri. 
 ft. Quarterly, 
 r. real, reale. 
 S. Surgery, Surgical. 
 
 s. seinem, series ; e. g., 1. s., 2. s., n. s., new series. 
 U, und. 
 ii. iiber. 
 
 V. van, vid, von, voor, vor. 
 V. p. various places. 
 V. S. various sizes. 
 W. West. 
 z. zu, zur. 
 
 Sundry Word-Abbreviations. 
 
 Abhandl Abhandlungen. 
 
 Abstr. . Abstract. 
 
 Acad Academy. 
 
 Aerztl ... Aerztliche. 
 
 Allg. . Allgemeine. 
 
 Am American. 
 
 Amtl. . . . Amtliche. 
 
 An Anales. 
 
 Anat. fAnatomisch. 
 
 I. Anatomy, etc. 
 , f Annales. 
 
 I Annals. 
 
 Arb Arbeiten. 
 
 Arch. Archiv, Archives, etc. 
 
 Assoc. . . . . Association. 
 
 Austral Australian. 
 
 Bacteriol. . . ..... Bacteriology, etc. 
 
 Bait. ... Baltimore. 
 
 Beitr. . . Beitrage. 
 
 Ber Bericht. 
 
 Berl. . . . Berlin, Berliner, etc. 
 
 Biblioth. . . . Bibliothe'que. 
 
 Biol .... Biology, etc. 
 
 Bl Blatter. 
 
 Bol . . . Bollettino. 
 
 Brit British. 
 
 Bull Bulletin. 
 
 Calif. California. 
 
 Canad Canadian. 
 
 Centralbl. Centralblatt. 
 
56 
 
 SUGGESTIONS TO MEDICAL WRITERS. 
 
 Chem. . . . 
 
 Chir. 
 
 Clin. . . . 
 
 Coll. . . . 
 
 Compt.-rend 
 
 Cong. 
 
 Cor.-Bl. . 
 
 Deutsch 
 
 Edinb. 
 
 Gaz. 
 
 Gior. . 
 
 Handb. 
 
 Hosp. . 
 
 Indian. 
 
 Indiana. 
 
 Internat. 
 
 J. . . . 
 
 Jahresb 
 Klin. . 
 Lond. . 
 M. & S. J. 
 Mag. . 
 Mass. . 
 Med. . . 
 Me'm. 
 Mem. . . 
 Misc. . 
 Mitth. . 
 Month. . 
 N. Am. . 
 N. Eng. . 
 N. Orl. 
 N. York. 
 Nachr. . 
 Nat. 
 
 Northwest 
 Nouv. . . 
 Obstet. 
 Ophth. . 
 Pharm. . 
 Phil. 
 Phila. . 
 Physiol. 
 Pop. 
 
 Chemistry, etc. 
 
 Chirurgical, etc. 
 
 Clinical, etc. 
 
 College, etc. 
 
 Compte-rendu. 
 
 Congress, etc. 
 
 Correspondenzblatt. 
 
 Deutsche, etc. 
 
 Edinburgh. 
 
 Gazette. 
 
 Giornale. 
 
 Handbuch. 
 
 Hospital. 
 
 (spell in full) 
 
 (spell in full) 
 
 International. 
 
 Journal. 
 
 Jahresbericht. 
 
 Klinisch, etc. 
 
 London. 
 
 Medical and Surgical Journal. 
 
 Magazine. 
 
 Massachusetts. 
 
 Medical, etc. 
 
 Mdmoires. 
 
 Memoirs. 
 
 Miscellaneous, etc. 
 
 Mittheilungen. 
 
 Monthly. 
 
 North American. 
 
 New England. 
 
 TMew Orleans. 
 
 New York. 
 
 Nachrichten. 
 
 National. 
 
 Northwestern. 
 
 Nouveaux. 
 
 Obstetric, etc. 
 
 Ophthalmic, etc. 
 
 Pharmaceutic, etc. 
 
 Philosophic, etc. 
 
 Philadelphia. 
 
 Physiology, etc. 
 
 Popular, etc. 
 
ORTHOGRAPHY, PUNCTUATION, PRONUNCIATION. ^7 
 
 Prag Prager. 
 
 Proc Proceedings. 
 
 Pub Public. 
 
 Quart Quarterly. 
 
 Rap Rapport. 
 
 Rec Recueil. 
 
 Rep . . Report, etc. 
 
 Rev. ... Revue, etc. 
 
 Riv. ... Rivista. 
 
 Roy Royal. 
 
 San Sanitary. 
 
 Schweiz. . Schweizerisch, etc. 
 
 Soc. . • Society, etc. 
 
 South . . Southern. 
 
 St Saint. 
 
 Stud Studies. 
 
 Syst System. 
 
 Therap Therapeutic, etc. 
 
 Tr . . Transactions. 
 
 Univ. ... University, etc. 
 
 Untersuch. .... Untersuchungen. 
 
 Ver Verein. 
 
 Verhandl Verhandlungen. 
 
 West. ... Western. 
 
 Wien Wiener. 
 
 Ztschr . . Zeitschrift. 
 
 A Question as to an Adverbial Terminal is asked 
 us by an esteemed correspondent : If biologic and scientific, 
 etc., instead of biological, scientifical, why, then, not bio- 
 logicly, scientificlyf We are not quite sure that the 
 question is not asked in derision, as there are people 
 who delight to urge the ridiculousness of certain lacks of 
 analogies, or of some philologic illogic, upon an adversary, 
 forgetful that the beams in their own linguistic eyes are of 
 enormous size and innumerable. That sort of sarcasm has 
 no hurting or shaming power whatsoever. It seems a 
 reductio absurdum, and hence " a poser " — this question — 
 but is it so ? We have not yet advised the formation of 
 the adverb in this way, but we should not think a man fit 
 for the Inferno who dared the awful thing. Indeed, won- 
 
58 SUGGESTIONS TO MEDICAL WRITERS. 
 
 derful to relate, it is done every day by the sticklers them- 
 selves, in the words publicly, and scientificly. If instead of 
 scientifical and scientifically, of publical and publically, 
 scientific and scientificly, public and publicly are allowed to 
 go about thus publicly exposing themselves, something 
 must surely be ordered to prevent it. Is it politicly done ? 
 Is it not, indeed, unscientifical, and positively scan'lous ! 
 
 As to Pronunciation. — In modern psychologic works 
 one will find on almost every page the words, neziropsy- 
 chology, psychophysiology, psychophysics, etc. ; in reading 
 these and similar words one would not pronounce them, 
 nu-rop-si-kol' -o-je, si-kop-hiz-e-ol'-oje, si-kot-hiz'-iks, etc. But 
 there are a number of words in the medical dictionaries, 
 concerning which a similar barbarism of pronunciation is 
 laid down as lawful and proper. Of these words, apneu- 
 matosis, iliopsoas, hysteropsychosis, uropsammus, enteroptosis, 
 gastroptosis, trichoptilosis, uroxanthin, and metapneumonic 
 occur to us as examples. We are ordered to pronounce 
 them ap-nu-mat-o'-sis, il-e-op-so'-as, hister-op-si-ko' -sis, u-rop- 
 sam'-mus, en ter-op-to'-sis, gas-trop-to'-sis, trik-op ti-lo'-sis, 
 and met-ap-nu-mon'-ik. In all other words the p, as in 
 pterygoid, ptilosis, pneumonia, psoas, ptosis, psychology, 
 etc., has never been sounded in English. What, there- 
 fore, is the reason that when placed after other stems in 
 compounds the fact revives the spirits of the letters silent 
 and dead for thousands of years ? Let us, therefore, dis- 
 obey the dictionaries and pronounce, ptosis, ptilosis, psycho- 
 pterygoid, etc.j without the initial silent letters, whether in 
 the beginning or in the middle of a word. Let us say, 
 ah-nu-mat-o' -sis , il-e-o-so'as, metah-nu-mon' -ik, en-ter-o-to' - 
 sis, gas-lro-to'-sis, trik-o-ti-lo'-sis, si-ko-fiz'-iks, nu-ro-si-kol '- 
 o-je, sfen-o-ter-e-goid, etc. 
 
 Punctuation is a modern invention, and "overpunc- 
 tuation " of still more recent discovery. We fear that 
 printers are somewhat too prone to this hyperpunctilious- 
 -ness. In obedience to the sensible law that the tool is 
 
ORTHOGRAPHY, PUNCTUATION, PRONUNCIATION. 59 
 
 made for man, not man for the sake of the tool, it must be 
 admitted that the use of punctuation marks is to aid in the 
 expression of thought or to obviate doubtfulness of mean- 
 ing. When the absence of these marks confuses, or when 
 their presence makes meaning more doubtful they are cer- 
 tainly to be condemned. It is said that at Ramessa once 
 lived a hospitable prior who placed' above his door this 
 inscription : 
 
 Be open evermore 
 O thou my door ! 
 To none be shut, — to honest or to poor. 
 
 A more selfish successor indicated his feelings merely 
 by changes in the punctuation, as follows : 
 
 Be open evermore 
 O thou my door 
 To none ! Be shut to honest or to poor. 
 
 Many such printers' stories illustrate the power of punc- 
 tuation both for good and ill. In this as in most doubtful 
 cases the best plan is to read aloud what one has written 
 and see if the punctuation follows the inflections of the voice. 
 Thus the church notice, " A sailor going to sea, his wife 
 desires the prayers of the congregation." should have been 
 so punctuated and spoken as to avoid, " A sailor going to 
 see his wife, desires the prayers of the congregation." If 
 the compositor had heard the toast given, "Woman — 
 without her, man would be a savage," he would not, as the 
 story goes have set it up, "Woman without her man 
 would be a savage." 
 
 There are two methods of punctuation, called the open 
 and the closed ; in the former as few stops or marks are 
 used as possible, and in the latter as many, — this seems to 
 be pretty near an accurate statement of the matter. The 
 latter extreme, for extreme we believe it, is altogether too 
 common, and is often the fault of fussy printers and proof- 
 readers. But often it is not the least their fault, but that 
 of a slovenly, slipshod writer who sputters his sentences 
 
60 SUGGESTIONS TO MEDICAL WRITERS. 
 
 out with endless subordinate clauses, inversions, inter- 
 jected and interrupted odds and ends of sentences, etc., 
 into which sorry jumble the printer tries to bring some 
 light by a plentiful peppering of commas and dashes and 
 the like. Strangely enough this choppy, jerky style of 
 sentence-making is more habitual with English than with 
 American writers. It requires a multitude of commas 
 and dashes to keep this epileptoid syntax from falling into 
 grand mal convulsions. It would be good training for 
 schoolboys if they were required to write long accounts or 
 descriptions without a punctuation mark, and yet when 
 these should be read aloud they should admit of no mis- 
 construction or doubt as to the meaning. This would aid 
 in teaching the art of building sentences so that they shall 
 be clear and logical in and of themselves. The lawyers 
 have found the plan a wise one and write their deeds in this 
 way to obviate errors that would result from reliance upon 
 the little points, subject as they are to misplacing or omis- 
 sion, hence to doubt as regards meaning with the passing 
 of time. Perhaps as good a rule as one can frame is to 
 shake the punctuation pepper-box as little as possible, and 
 shape sentences so that they will require it as little as may 
 be ; but, one way or the other, leave no doubt as to the 
 meaning of what is said. Everyone knows when a period 
 is required, when an interrogation is demanded, and usually 
 when a semicolon is of service. The difficulty lies when 
 we come to commas, dashes, hyphens, and brackets. In 
 such cases when in doubt do not follow Hoyle's rule to play 
 trumps ; " pass," and "let the printer do the work for you. 
 
CHAPTER IV. 
 
 THE USE OF WORDS. 
 
 Anatomic Terms to be Preferred. — During the last 
 ten years the Association of American Anatomists, the 
 American Neurological Association, the American Asso- 
 ciation for the Advancement of Science, and the Anato- 
 mische Gesellschaft have adopted and published reports of 
 special committees on Anatomic Nomenclature. The ex- 
 tent of the agreement already reached may be seen from 
 the reports of the Anatomists for 1897 and 1898; the 
 second was printed in full in the Philadelphia Medical 
 Journal for February 25, 1899. From these two reports 
 are selected the names of some parts not infrequently 
 mentioned which are recommended for use in place of the 
 less convenient and usually longer synonyms. When the 
 distinctively Latin form differs from the English the latter 
 is given; e.g., precuneus for praecuneus, central fissure for 
 fissura centralis, gyre for gyrus, peduncle for pedunculus, 
 mesoccle for mesocoelia,metapore for metaporus, etc.; but in 
 all these cases the national English form at once suggests 
 the international Latin. The risk of ambiguity in a few cases 
 is obviated by the context. The Anatomists have as yet 
 passed only upon the bones, the muscles, and the central 
 nervous system, including the bloodvessels of the brain. 
 The cranial nerves have not yet been included, but there 
 can be little doubt that vagus will be recommended rather 
 than pneumogastric. 
 
 Use Instead of 
 
 Alba . . Substantia alba, or White matter 
 
 Arbor Arbor vitae 
 
 Axis Second cervical vertebra, or Epi- 
 stropheus 
 (61) 
 
62 
 
 SUGGESTIONS TO MEDICAL WRITERS. 
 
 Use 
 
 Instead of 
 
 Biceps ... . Biceps brachii 
 
 Calcar . . Calcar avis, or Hippocampus 
 
 minor 
 
 Callosal Fissure .... . Fissure of the corpus callosum 
 
 Callosum Corpus callosum 
 
 Caudatum ... . Corpus caudatum 
 
 Central fissure Fissure of Rolando 
 
 Chiasma ■ Optic chiasma 
 
 Cinerea . Substantia grisea, or Gray matter 
 
 Circulus . .... Circle of Willis 
 
 Clava . ... Processus clavatus 
 
 Coccyx Os coccygis 
 
 Corona .... . ■ • Corona radiata 
 
 Cortex Substantia corticalis 
 
 Crus .... • Crus cerebri 
 
 Dentatum Corpus dentatum 
 
 Diencephalon* . . Thalamencephalon, or 'Tween- 
 
 brain 
 
 Dorsal (horn, or cornu, and nerve- Posterior 
 
 rootj 
 
 Dura .... ... . . Dura mater 
 
 Endyma . . Ependyma 
 
 Epencephalon" Hindbrain 
 
 Epiphysis Conarium, Pineal body, or Pineal 
 
 gland 
 
 Falcial sinus Inferior longitudinal 
 
 Falx Falx cerebri 
 
 Fimbria Fimbria hippocampi, or Corpus 
 
 fimbriatum 
 
 Fissure Sulcus 
 
 Foramen magnum Foramen occipitale magnum 
 
 Gyre, or Gyrus Convolution 
 
 Habena Habenula 
 
 Hemicerebrum .... . Cerebral hemisphere 
 
 Hemiseptum Lamina septipellucidi 
 
 Hippocamp, or hippocampus . . Hippocampus major, or Ammon's 
 
 horn 
 
 Hippocampal fissure Dentate 
 
 Hypophysis Hypophysis cerebri, Pituitary 
 
 body, or Pituitary gland 
 
 * After the analogy of angel and organ from angelus and organum these five 
 names maybe regularly anglicized as mesencephal, etc. The sanction of these com- 
 pounds is no reason why on ordinary occasions brain should not be used instead of 
 encephalon. 
 
THE USE OF WORDS. 
 
 63 
 
 Use 
 
 Instead of 
 
 
 . . Os ilium 
 
 
 Island of Reil 
 
 Intercalatum . . . . . 
 
 Substantia nigra 
 
 
 . . Longitudinalis cerebri 
 
 
 . . Os ischii 
 
 
 . . Transition convolution 
 
 
 . . Transverse 
 
 
 . . Latissimus dorsi 
 
 
 Fillet 
 
 
 Nucleus lentiformis 
 
 Longitudinal sinus . 
 
 . . Superior longitudinal 
 
 Malar bone . . . 
 
 . . Zygomatic bone 
 
 Medicerebral artery 
 
 Middle cerebral 
 
 Medicommissure . . . . 
 
 Middle or Gray commissure, or 
 
 
 Massa intermedia 
 
 Meditemporal gyre 
 
 Middle or Second temporal 
 
 Mesencephalon* . . . 
 
 Midbrain 
 
 Mesocele, Mesocoele, or M 
 
 eso- Aqueduct of Sylvius or Iter e ter- 
 
 coelia 
 
 tio ad ventriculum quartum 
 
 Metaplexus 
 
 . . Choroid plexus of the fourth ven- 
 
 
 tricle 
 
 Metapore . . . . . 
 
 Foramen of Magendie, Apertura 
 
 
 medialis ventriculi quarti 
 
 Metatela .... 
 
 . . Tela choroidea ventriculi quarti 
 
 Metencephalon* . 
 
 Afterbrain 
 
 Myel, or Myelon . . . . 
 
 Spinal cord, or Medulla spinalis 
 
 
 . . Medulla oblongata 
 
 Occipital fissure . 
 
 Parietooccipital, or occipitopari- 
 
 
 etal 
 
 Oliva 
 
 Olivary body 
 
 
 Marginal portion of Callosomar- 
 
 
 ginal 
 
 Paracentral gyre 
 
 . . Paracentral or Oval lobule 
 
 Parietal fissure 
 
 . . Parietal division of the intrapari- 
 
 
 etal 
 
 
 Superior parietal lubule 
 
 Paroccipital fissure . 
 
 . . Occipital portion of the intrapari- 
 
 
 etal 
 
 
 Pia mater 
 
 Pons 
 
 . . Pons Varolii 
 
 Porta 
 
 . . Foramen of Monro 
 
 Postcentral gyre 
 
 . . Posterior central, or Ascending 
 
 
 parietal 
 
6 4 
 
 SUGGESTIONS TO MEDICAL WRITERS. 
 
 Use 
 Postcerebral artery 
 Postcommissure . 
 Postcribrum . 
 Postgeminum 
 
 Postgeniculum . 
 
 Postpeduncle 
 Prepeduncle . 
 Medipeduncle 
 Precentral gyre 
 
 Precerebral artery . 
 Precommissure 
 Precornu 
 Medicornu . . 
 Postcornu 
 Precribrum . . 
 Precuneus . . . 
 Pregeminum . . 
 
 Pregeniculum 
 
 Presylvian fissure 
 
 Prosencephalon* . . 
 
 Pseudocele or pseudocoelia . 
 
 Quadrigeminum 
 
 Restis . . 
 
 Sacrum . .... 
 
 Septum lucidum . . > 
 
 Splenium, genu, and rostrum 
 
 Sternomastoid . 
 
 Striatum . . ... 
 
 Subcalcarine gyre . 
 
 Subcollateral gyre ... 
 
 Subfrontal gyre . . 
 
 Subparietal gyre . . 
 Subtemporal gyre 
 Supercallosal fissure 
 
 Instead of 
 Posterior cerebral artery 
 Posterior commissure 
 Posterior perforated space 
 Posterior geminal body, or Poste- 
 rior optic lobes 
 Posterior or Internal geniculate 
 body 
 
 The three Peduncles of the cere- 
 bellum 
 
 Anterior central, or ascending 
 
 frontal 
 Anterior cerebral 
 Anterior commissure 
 
 The three "horns" of the lateral 
 ventricle 
 
 Anterior perforated space 
 
 Quadrate lobule 
 
 Anterior geminal body, or Ante- 
 rior optic lobes 
 
 Anterior or External geniculate 
 body 
 
 Anterior ascending branch of the 
 Sylvian 
 
 Forebrain 
 
 Ventriculus septi pellucidi, or 
 Fifth ventricle 
 
 Corpus quadrigeminum 
 
 Restiform body 
 
 Os sacrum 
 
 Septum pellucidum 
 
 Without the " Corporis callosi." 
 
 Sternocleidomastoid 
 
 Corpus striatum 
 
 Lingual 
 
 Fusiform 
 
 Inferior, or Third frontal, or Bro- 
 ca's convolution 
 
 Inferior parietal lobule 
 
 Inferior, or Third temporal 
 
 Frontal portion of Callosomar- 
 ginal 
 
USE OF WORDS. 65 
 
 Use Instead of 
 
 Supertemporal gyre . . Superior, or First temporal 
 
 Tentorial sinus . . .... Sinus rectus 
 
 Tentorium Tentorium cerebelli 
 
 Terma . .... Lamina terminalis, or lamina cin- 
 
 erea 
 
 Thalamus . Optic thalamus 
 
 Thoracic vertebrae Dorsal 
 
 Torcular . . Torcular Herophili, or Confluens 
 
 sinum 
 
 Trapezium .... . . Corpus trapezoideum 
 
 Triceps Triceps brachii 
 
 Tuber Tuber cinereum 
 
 Tuber ischii Tuber ischiadicum 
 
 Vadum Gyrus profundus 
 
 Vallis Vallecula cerebelli 
 
 Vulvula Velum medullare anterius 
 
 Ventral (horn, or cornu, and Anterior 
 
 nerve-root) 
 
 Zygoma Zygomatic arch 
 
 Foreign Words and Terms. — As to the use and an- 
 glicization of expressions from foreign languages it seems 
 clear that we should accustom ourselves to habits that will 
 lessen the mental labor of the reader and the printer. One 
 might indeed include the editor were it not that somebody 
 would cry, Selfishness ! But, at all events, any unnecessary 
 labor we put upon those who work for us is sure in some 
 way or other to react upon the thoughtless one, even if 
 it makes him only a little added expense, thus increas- 
 ing an already expensive indifference It cannot be 
 denied that we increase the mental friction of our read- 
 ers when we use expressions not readily understood by 
 most of them, or even when we break the easy flow of 
 our thought by italicized passages. Foreign terms should, 
 therefore, be anglicized when their use is at all common, 
 and the taking them into the language, if at all, should 
 be done frankly and quickly. The kindhearted lady's 
 pity for the lobster, expressed by bringing the cold 
 water in which it was placed slowly up to the boiling 
 
66 SUGGESTIONS TO MEDICAL WRITERS. 
 
 point, instead of one quick plunge in the hot water, 
 was, like much other kindness, very cruel in fact. 
 There is, we think, no use whatever in still considering 
 a thousand Latin anatomic terms as anything but thor- 
 oughly anglicized. They no longer need italicization, al- 
 though many of them have far better English equivalents, 
 as we have before contended. (Why also is not by the 
 mouth as good as per os, aged, or of age, as aetat, etc.? 
 Let us give the simple English equivalents of these and 
 such others as per vias naturales, sectio alta, sectio abdo- 
 minalis, atresia ani, per uretham, per anum, sine exan- 
 thema, sine vatiola, pro and con, nil, etc.) If, therefore, 
 we prefer the bombastic terms, let us omit the bother- 
 ation of italics. It is the same with many other visitors 
 that are sufficiently familiar and at home to have taken 
 out their naturalization papers. Among these are such 
 words and terms as post mortem, cul de sac, masseur, 
 masseuse, milliampere, centimeter, curet, currettage, ac- 
 coucheur, serte fine, felo de se, confrere, resume, enciente, 
 clottage, rale, epitome, role, raphe, en masse, par excellence, 
 etc. 
 
 In this class of words it is a curious and interesting 
 fact, that having disposed of their outlandish costumes 
 as a whole, those who employ them like still to tag them 
 with some mark of their "heathen origin" by a label or 
 ticket. Most everybody seems to think it necessary to 
 stick hyphens or accents into or about them, although 
 they may never have had these strange marks in their 
 native lands. Thus Mr. Robertson's name is Argyll 
 Robertson, not Argyll-Robertson, and ante mortem, felo 
 de se, post mortem, cul de sac, etc., are without hyphens 
 in their own countries. (Indeed we can see no valid ' 
 reason why many of these foreign compounds should not 
 be fused into a single English word, as e.g., postmortem, cul- 
 desac, etc.). Let us also forego the accents in rale, meter, 
 role, raphe, employe, centimeter, resume, etc., and, too, avoid 
 pretence by giving the English terminals -er instead of 
 
USE OF WORDS. 67 
 
 -re. Democracy is receptive and especially the American 
 type, but if we cannot make the foreigner over after our 
 own fashions, we would rather he had never immigrated. 
 A similar logic would seem to make us stop using capitals 
 in such words as galvanism, faradism, farad, ohm, frank- 
 linism, volt, coulomb, ampere, joule, thebesian, eustachian, 
 fallopian, cesarean, haversian, sylvian, meibomian, etc. 
 
 The struggles with the French accents are often quite 
 ludicrous. Thus one generally finds the grave placed 
 for the acute, and the reverse, and not infrequently such 
 a word as epitome gets the accent over the last e, but over 
 the first none whatever, grave or acute. While seem- 
 ingly quite grave, the disease of the sticklers is in reality 
 extremely acute — at least in type. The patient is subject 
 to delusions and seems, for example, to have some sort of 
 a hazy idea that accents and diacritic marks can teach 
 pronunciation. The fact is they do not serve that -func- 
 tion, and by the very nature of the case cannot do it. 
 Let us abolish them ; except, of course, in proper names. 
 
 Vernacularisms and Nationalisms. — In reference to 
 the favoring of good German instead of bad Latin, by Vir- 
 chow, a correspondent wisely calls attention to an impor- 
 tant middle course which is not seldom possible, whereby 
 we may combine the opposing tendencies of uniformity 
 and nationality. This consists in employing the terms 
 drawn etymologically from the classic languages, but so 
 united as to bear the stamp of the national language. 
 Vernacularism may run to mania and beget such absurd 
 localistic heteronyms as sea-horse, See-pferd, and chevat 
 marin, in place of the universal but locally-colored corres- 
 pondents, hippocamp, hippokamp, and hippocampe . Heter- 
 onyms (difference of form and spelling for translating a 
 term), as Wilder has long contended, should, when possi- 
 ble, be supplanted by paronyms in which the differences of 
 form are slight and principally in the terminations, — 
 "since each paronym suggests the original Latin name, 
 
68 SUGGESTIONS TO MEDICAL WRITERS. 
 
 the latter forms a bone between writers and readers of 
 different nationalities." Mononyms, of course, are also 
 preferable to polynyms. Thus, instead of pons Varolii, 
 we should use pons, and this word should be used instead 
 of pont, ponte, puente, Briicke and bridge by the respective 
 national writers. Organ, organe, organo, and Organ are 
 advisable geographic varieties of one word. 
 
 Particularly must the tendency be reprobated which 
 has, in speculative philosophy, created a jargon of Ger- 
 man terms bundled bodily over into our English garden, 
 and which in medicine is illustrated by the ludicrous terms 
 Anlage and Fundament, both accurately represented by 
 Wilder's fine word Proton, adopted from Aristotle, and 
 used to designate the primitive undifferentiated mass or 
 rudiment of a part. 
 
 Hybrid Words. — The reasonable view of hybrid terms 
 seems to be embodied in the following remark of Barclay 
 in 1803 : " Notwithstanding the opprobrium attached by 
 some to certain connections and intermarriages among 
 harmless vocables, I should be inclined not to reject the 
 cooperation of the languages (Greek and Latin) when ex- 
 perience shows it to be convenient, useful or necessary." 
 Abstractly, we may all prefer horses to mules, but this 
 need not hinder us from recognizing that, under certain 
 circumstances, the latter are more efficient than the former, 
 and that, in a given case, a horse may not be even so hand- 
 some as a mule. 
 
 Apparently, also, Professor Kolliker objects to hybrid 
 words as Barbarismen. Yet the German list, adopted by 
 a committee of which he was chairman, contains at least 
 14 compounds of Greek and Latin elements, viz., epidurale, 
 mesovaricus, parnmbilicales, parolfactorius, perichorioidiale, 
 suprachorioidea, choriocapillaris, sygomandibularis, phreni- 
 cocos talis, sphenopalatinum, sphenooccipitalis, occipitomastoi- 
 dea, and squamosomastoidea. 
 
 Was language made for man or man for language ? Is 
 
USE OF WORDS. 69 
 
 it a fetich or a useful tool ? There can be nothing but con- 
 tempt felt for the dilettanteism that would reject a good 
 word because its roots are found in two languages. There 
 are thousands of such existing words, and if this method 
 of formation had been more frequently used we should 
 have avoided many ridiculous examples of philologic 
 "jewels that on the stretched forefinger of time sparkle 
 forever." 
 
 A Protest Against a Bad German Habit. — There is 
 a growing habit with English writers, adopted from the 
 Germans, of carrying over to a subsequent compound term 
 the unexpressed half of meaning of a previous compound, 
 by the indication of the hyphen without the second part of 
 the hyphenated term. A book has lately been issued with 
 the astonishing title : Letter-, Word- and Mind- Blindness. 
 In every medical journal one will see such barbarisms as 
 light- and color-blindness, the cocain- or morphin-habit, 
 word- without color-blindness, soul- or mind-blindness, etc. 
 What physician has had a case of word- ? A similar mis- 
 take is less noticeable when one writes, e. g., cortical or soul- 
 blindness. Now, one might just as well say : myo- and 
 hyperopia, neur- and trach-oma, burs- and myos-itis. It is 
 well to avoid redundant words and verbosity when we do 
 not sin against the very soul of English, but this "inter- 
 rupted continuous suture" of meaning playing over and 
 down along a sentence, however Saxonic it may be, is by no 
 means Anglosaxonic. 
 
 As to Eponymic Designations. — It can scarcely be 
 said with truth that the sense of tradition is wanting 
 among medical men, and that the profession is not gen- 
 erous in tribute to the memory of distinguished members 
 of its guild. With this admission there seems to be no 
 reason for embarrassing our nomenclature with the innu- 
 merable eponymic designations that have crept into our 
 literature. Exceptionally it may seem unavoidable to use 
 
70 SUGGESTIONS TO MEDICAL WRITERS. 
 
 the discoverer's name for a disease whose nature is not 
 known, but we are convinced that such a course is not 
 always necessary and it should be avoided when possible 
 as obstructive of true scientific progress. Names should, 
 so far as selection permits, be descriptive, and, when given 
 to diseases, should be based upon some characteristic or 
 peculiarity, clinical or pathologic, so that they may have 
 practical significance and be clearly fixed in mind and 
 readily recalled to memory. These conditions are not 
 fulfilled by eponymic designations, which conduce rather 
 to confusion and uncertainty. To refer to a few concrete 
 instances, one may at times be left in doubt as to which 
 of the five affections described by Pott is meant when his 
 name is used, or which of the three with which the names 
 of Charcot, Cooper, Duchenne, Hebra, Paget, St. An- 
 thony, and St. John respectively are associated. In the 
 matter of operations and tests the conditions are some- 
 what different. Here it is often difficult to find a single 
 word or two that will convey as much as the name of the 
 deviser ; and in instances in which one man has devised 
 more than one operation ambiguity can be avoided by 
 specifying the part or parts to which the procedure in 
 question is applicable. Whenever possible, however, with- 
 out sacrifice of directness and brevity, eponymic designa- 
 tions should be abjured and the employment preferred of 
 those that convey in and of themselves an idea of the 
 condition that they are intended to describe. He uses 
 language best who makes the fewest words express clearly 
 the fullest meaning. Let us, therefore, prefer nephritis to 
 Bright 's disease, hereditary to Friedreich' s ataxia, paramy- 
 oclonus to Friedreich 's disease, paralysis agitans to Parkin- 
 son s disease, adrenal disease to Addison s disease, exoph- 
 thalmic goiter to Parry's or Basedow's or Graves' disease, 
 vertebral disease to Pott's disease, disseminated cerebro- 
 spinal sclerosis or amyotrophic lateral sclerosis respectively 
 to Charcot's disease ; osteitis deformans or psorospermiasis 
 respectively to Paget' s disease ; and so on, and so on. 
 
USE OF WORDS. 7 1 
 
 Paronymous Plurals. — One wonders why it is con- 
 sidered better English to ape the language from which 
 a word may have been derived by grafting upon the ac- 
 climatized word the foreign and illogic form of plural. 
 Those who should be, or who pretend to be, concerned for 
 the purity and logicality of our tongues are frequently 
 the worst enemies of purity and simplicity, delighting 
 in hodge podge and outlandishness. There are those who 
 even now contend for lentes, atlantes, animalia, etc., in- 
 stead of lenses, atlases, and animals, and they would cer- 
 tainly stickle for irides, enemata, carcinomata, fascia, etc., 
 etc., instead of the shorter, more idiomatic, more natural, 
 and in every way better, irises, enemas, carcinomas, fas- 
 cias. It is the hypocrisy of culture, the ignoramuses' 
 pretense of classicism, which keeps up the delusion that 
 the straightforward English formation is less worthy than 
 the transplanted variety. The regular English style of 
 forming the plural is held to be good enough for y 9 ^ 
 of our nouns ; why not also for the remaining T ^ 7 of 
 them ? 
 
 Contagion and Infection. — In connection with our 
 discussion of the "contagiousness" of leprosy it seems 
 not inopportune to make a plea for a more uniform and 
 more intelligent use of the words contagion and infection 
 and their derivatives. The Century Dictionary defines 
 infection as : 
 
 The communication of disease or of disease-germs, whether 
 by contact with a diseased person or with morbid or noxious 
 matter, contaminated clothing, etc., or by poisonous exhalations 
 from any source. 
 
 The definition would be more in accord with present 
 usage and modern notices if it read simply "the com- 
 munication of disease through whatever means." The 
 essential points are the transmission and the "develop- 
 ment of the disease." The mere conveyance of germs 
 is not infection, as their mere presence is not disease. 
 
72 SUGGESTIONS TO MEDICAL WRITERS. 
 
 Contagion is thus denned by the Century Dictionary : 
 
 Infectious contact or communication ; specifically and com- 
 monly, the communication of a disease from one person or brute to 
 another. A distinction between contagion and infection is some- 
 times adopted, the former being limited to the transmission of dis- 
 ease by actual contact of the diseased part with a healthy absorbent 
 or abraded surface, and the latter to transmission through the 
 atmosphere by floating germs or miasmata. There are, however, 
 cases of transmission which do not fall under either of these divis- 
 ions, and there are some which fall under both. In common use no 
 precise discrimination of the two words is attempted. 
 
 Thus, it will be seen that the definition here suggested 
 of infectioti comprehends also that of contagion. With 
 none of the diseases with which either or both of the terms 
 are associated need the transmission assume any particular 
 form. As we have already stated, the essential points are 
 transmissibility and generation of disease. Such differ- 
 ence as at present may be conceived to exist between the 
 two words is of degree and not of kind. We may here 
 point out that an intoxication differs from an infection 
 essentially in the matter of transmissibility. The infection 
 is transmissible because it is dependent upon a propagable 
 cause ; the intoxication is not transmissible for the opposite 
 reason. There are, further, certain diseases that, while 
 transmissible, are not in the present acceptation of the 
 term infectious. Among these are the parasitic diseases of 
 skin, intestine, muscle, etc. Let us, therefore, end the con- 
 tention that has been waged as to the distinctions between 
 the words infection and contagion and their derivatives, and 
 agree for uniformity's sake in their synonymity, making 
 their essential characteristics the transmissibility of the 
 diseases in connection with which they are employed. 
 
 A few Verbs give many people a great deal of trouble, 
 and though physicians are not worse sinners in this respect 
 than, e.g., lawyers, the frequency in medical writings and 
 speakings of certain errors gives us warrant for a passing 
 
USE OF WORDS. 73 
 
 allusion to them. Let us first take the two words, in the 
 use of which there are probably more blunders made than 
 in others : — lie and lay. In half of the clinics of the land, 
 a patient will be told to lay down, and when the event is 
 described it will be in this way — he laid down. Those thus 
 speaking and writing may, and probably do, know perfectly 
 the proper forms ; but habit asserts itself in unconscious 
 usage, and in this way shows us the need of correct ex- 
 amples and usage during childhood. Lie, lay, lain are the 
 " principal parts " of the intransitive verb, while lay, laid, 
 laid are those of the transitive form. Hence, of course, 
 we should say, / lay, I laid, I have laid (the patient or the 
 book) down, but I lie, I lay, I have lain, down to sleep. In 
 the same way one says, he (it, or she) lays (down the rules), 
 he lies, lay, has lain (down to rest). It is unfortunate that 
 in English a third verb, lie, to tell a falsehood, should exist, 
 so like or similar in form as to be a source of confusion. 
 Sit and set are also botherers, which few in all cases will use 
 correctly if speaking quickly and unconsciously. After 
 the hen lays or has laid the egg, the woman sets the hen, 
 but the hen sits. The patient is asked to sit down and sat. 
 When seated, or, having sitten, he set forth his symptoms. 
 Sit, sat, sitten; set, set, set ; seat, seated, seated. 
 
 Gotten is, perhaps, the more correct past participle of 
 get, but we prefer the simple form got, and believe that it is 
 fast taking the place of the longer word. We also fear 
 that the proper imperfect gat is likewise being dispossessed 
 by got. For the present we should say get, got, got. But 
 let us make a desperate effort to drop the word when it is 
 not needed, as it is not when we wish to indicate simple 
 possession. In / have got the forceps, he has got the sponges, 
 you have got bronchitis, etc., the speakers weaken their 
 language by the redundant word. The word get is also 
 misused and greatly overused in many other ways, as, e.g., 
 in to get left, to get rid of, to get hungry, etc. 
 
 Many err in the use, especially of the imperfect, of 
 thrive, throve, thriven ; shake, shook, shaken ; drink, drank, 
 drunken. 
 
74 suggestions to medicai, writers. 
 
 Thyroid, Choroid, etc., or Thyreoid, Chorioid ? — 
 The dictionary-makers have hardly dared to advise thy- 
 roid instead of thyreoid, and so the world goes on doing 
 one thing and the dictionaries advising another. Ety- 
 mologically, of course, thyreoid is demanded, but when 
 languages were made the makers neither knew nor cared 
 for etymology, and of all languages in the world English 
 cared and still cares less for it than any other. The 
 word wig contains neither a letter nor a hair of the 
 original pilns whence it came. And yet it is certainly 
 true that not always is custom or usage to govern us in 
 these things. In the case of choroid there seems no doubt 
 that we may safely write the word thus, and not chorioid, 
 or choreoid, when we mean the ocular structure. We need 
 choreoid for the chorea-signification, and as chorioid when 
 spoken has the same sound, good sense and good usage 
 have combined to extinguish chorioid, and chorioiditis, 
 leaving us the simple choroid and choroiditis, which have 
 become so universal that the more etymologically accu- 
 rate forms would smack of affectation should a writer 
 try to introduce them. The similar word hyoid has defi- 
 nitely settled to that form and not, e. g., to hyoeid. We 
 suspect that thyreoid is destined to lose its e, and become 
 simple thyroid, as nine-tenths of medical men doubtless 
 pronounce if not write it today. We should certainly 
 not consider one a philologic sinner who did so, and 
 would even excuse the lexicographer who should so set 
 it down in his word-book. There is a noteworthy anal- 
 ogy in our word dorsal from dorsualis, in which the u has 
 been chloroformed so silently that the conservatives are 
 not aware of it. 
 
 Carcinoma or Sarcoma — not Cancer. — The die 
 tionaries define cancer as (i) a crustacean, (2) a constel- 
 lation and a sign of the zodiac, (3) a malignant tumor, (4) 
 a plant. At a time when the several forms of malignant 
 neoplasm were undifferentiable there was perhaps some 
 
USE OF WORDS. 75 
 
 justification for the use of a single word to comprehend 
 them all ; but, as, with the development of histologic 
 methods and knowledge, it became possible to discrim- 
 inate a number of distinct varieties and give them appro- 
 priate names, the usefulness of such a term was largely 
 lost. On this account we think it better, on grounds of 
 precision and clearness, to discard the word cancer and 
 use in its stead the name of the specific form of malig- 
 nant disease under consideration, e. g., carcinoma or 
 sarcoma. 
 
 The Word Apoplexy is derived from a Greek root 
 meaning " to strike with violence," and it was originally 
 employed to designate sudden loss of consciousness, with 
 which often were associated stertorous breathing, turgid- 
 ity or cyanosis, and other symptoms ; sometimes there 
 was sudden loss of power, without derangement of con- 
 sciousness and other phenomena. As these conditions 
 were found in many instances to be dependent upon 
 rupture of a cerebral bloodvessel, with extravasation of 
 blood into the brain, the word apoplexy came to be used 
 as a synonym for interstitial hemorrhage wherever it 
 occurred. As, however, it became evident that the so- 
 called apoplectic symptoms resulted also from blocking 
 of cerebral vessels either by thrombus or embolus, these 
 conditions also became comprehended in the term. It 
 has, further, been learned that identical phenomena may 
 develop in connection with chronic nephritis and uremia. 
 It would, therefore, appear necessary to recast our con- 
 ceptions of the word apoplexy if it is deemed necessary 
 to retain it ; but as the significance and the usefulness 
 of the word seem to have been lost, we can get along 
 better without it than with it. It would certainly be prefer- 
 able to use the term cerebral hemorrhage, or thrombosis, 
 or embolism, for other forms of interstitial hemorrhage 
 or uremia, as the case may be, to indicate the existing 
 condition, rather than to ignore the differentiation by 
 
j6 SUGGESTIONS TO MEDICAL WRITERS. 
 
 using a term of such vague and uncertain significance 
 as apoplexy, which has been employed to designate a 
 number of unlike conditions. 
 
 Tuberculosis — not Consumption, not Phthisis. — 
 Tissue-destruction, breaking down and wasting, whether 
 in lung, in gland, in bone, in skin, in bowel, or elsewhere, 
 may result from various causes, sometimes determinable, 
 sometimes not. The process is itself not a distinctive dis- 
 ease or even condition. When, however, we know its origin 
 we may appropriately and correctly employ the specific 
 designation. It is thus more exact and more scientific to 
 speak of syphilis, or actinomycosis, or anthrax, or suppura- 
 tion, or tuberculosis, respectively, when the condition is rec- 
 ognized, than to use such a general term as consumption 
 or phthisis for any or all. Further, both of these terms 
 are most commonly used synonymously with tuberculosis, 
 especially of the lungs, and are associated in the lay mind 
 with the notion of progressive aggravation and incurability, 
 and sometimes the professional mind is not entirely free 
 from the same bias. For the foregoing reasons, we think 
 it would be well if the words consumption and phthisis were 
 expunged from our nomenclature as unnecessary and am- 
 biguous and replaced by the appropriate specific designa- 
 tion, such as tuberculosis, when this is really meant, or 
 other word that describes the disease present in so far as 
 this is determinable. 
 
 Exophthalmic Goiter. — Let us intermediate between 
 those who would say Basedow's disease and those who 
 would say Graves' disease, at the same time considering 
 those who would say Parry s disease, and agree for the 
 present upon exophthalmic goiter as, the designation for the 
 well-known symptom-complex, until perhaps we have 
 learned all there is to know about the disorder, or there 
 is reason for substituting another name. 
 
USE OF WORDS. "]"] 
 
 Confusion in the Use of the Term "Skiascopy." — A 
 correspondent writes us as follows : The Philadelphia Monthly 
 Medical Journal (March number) accepts and employs the word 
 "■skiascopy " as meaning examination by either skiagraph or 
 fluoroscope, or by both. The word was coined by M. Egger, 
 and introduced 15 years ago to designate the examination of 
 the refraction of the eye by the movements of the light and 
 shadow in the pupil, giving in a single word an equivalent 
 for "shadow test, fantascopie retienne," etc. With this mean- 
 ing the word has been adopted in every European language, 
 and has for years been more generally used than any other 
 to designate this important method of diagnosis. It may 
 .have been suggested in connection with the examination 
 by means of the x-rays, in ignorance of its previous mean- 
 ing. But if such use of it has your approval as an editor 
 and lexicographer, I wish you would state the reasons that 
 to your mind justify the introduction of such confusion into 
 the language, especially in the matter of indexes, catalogs 
 and bibliographies. We had a specimen of such confusion 
 when the same procedure was called " keratoscopy " ; 
 and the Index Medicus classed it under " Diseases of the 
 Cornea.'' 
 
 We do not quite agree that we accepted and used the 
 word skiascopy in the criticised manner. One of our 
 contributors did so, and we can be blamed only in per- 
 mitting it. But we heartily assent to the criticism. One 
 word cannot be used for two such different things as this 
 word is now made to cover. We suggest that as skiagram 
 and skiagraph are used for the finished printed picture 
 made by means of the x-rays, why should not the examina- 
 tion either by the skiagraph or the fluoroscope be called 
 skiagraphy or fluoroscopy, respectively ? Skiascopy would 
 thus remain for the original and proper purpose. If the 
 x-ray folks refuse to give up their stolen word the ophthal- 
 mologists may have to get on with retinoscopy. The accept- 
 ance of words by the public, even of science, is not always 
 a matter of law or of logic. It is often largely a matter of 
 whim and luck. 
 
78 SUGGESTIONS TO MEDICAL WRITERS. 
 
 Refract as a Transitive Verb. — A critic recently 
 took us to task, and most savagely, for using the word re- 
 fract in speaking of eyes and patients. We had dared the 
 barbarisms, T refracted the patient, ox his eyes were refracted. 
 Although punished we are still as refractory as ever, for 
 we have no sort of patience with the folk who think man 
 was made for language, instead of language for man. Why 
 do languages, so many of them, exist, instead of a single 
 tongue? The test of usefulness is supreme in all such 
 cases. From our ironic correspondent's tone one would 
 suppose that his own letter and language, indeed all dic- 
 tionaries, were not filled with proofs that words acquire new 
 meanings, and that intransitive verbs are made to serve 
 transitive functions. The word-fetich man, the sneerers at 
 change and progress in philology, are amusing people, at 
 least until dogmatism and silliness become monomanias. 
 To refract a person, or his eyes, are terms used thousands 
 of times every day by all oculists, and aid us so much in 
 expressing facts that if they were as illogical and absurd 
 as the pernickety sticklers themselves, they could not be 
 killed, nor can they be kept from the written language 
 when so habitual in colloquial use. The ocular structures 
 refract the rays of entering light. The oculist uses lenses 
 to measure and correct the abnormalities of the refraction ; 
 he therefore himself refracts by means of these tools. 
 What or whom does he refract ? Only the light ? Prima- 
 rily of course, yes ; but has the act no effect upon the eyes 
 or upon the patient ? We think it has. How then name 
 the effect ? As is done with thousands of other words, by 
 the use of primary terms, extended so as to include the 
 secondary effects. You do not spank a child or castigate 
 a philologic prude. In the first instance you only spank 
 the child's skin, as in the second you only irritate the tym- 
 panum of the egotist's ear. It is fortunate if any mental 
 change whatever results. 
 
 Dilatation or Dilation ?— A good deal of confusion 
 exists between medical writers as to the use of the words 
 
USE OF WORDS. 79 
 
 dilatation and dilation. As it always preferable to use 
 those words with the fewest possible syllables, because the 
 energy wasted in writing, speaking and reading redundant 
 words and syllables could be put to better use, the shorter 
 form is preferable. It is true that the dictionaries give both 
 forms without comment. However, when it is discovered 
 that etymology furnishes at least one good reason for using 
 the shorter form, it certainly seems that there should be no 
 question about its more general use. For instance, it is 
 found that dilation is derived from the good old Latin 
 word dilatare, whose past participle is plain dilatus. On 
 the other hand, dilatation is derived from the later Latin 
 of the scholastics and monks of the Middle Ages who made 
 it dilatatio and dilatatus. There is no reason for preferring 
 the Latin of the monks to the original article as a source 
 of English word-formation. As euphony is also better 
 served by the use of the shorter form, we advise every one 
 to employ it by preference. — Cleveland Journal of Medicine. 
 
 Sympathectomy is a word which appears in a recent 
 editorial of an esteemed contemporary. Whether coined 
 by the writer or borrowed, we cannot say. It is- altogether 
 new to us, and, we may add, hideous. The word is intended 
 to designate the operation of excision of the superior cer- 
 vical sympathetic ganglion, or briefly, sympathetic-excision, 
 but it cannot etymologically cover more than sympathy- 
 excision and even this coinage would be not a venial philo- 
 logic sin. "Zv/iTaOda means sympathy, and from o7v-»™.0>7tik6s 
 is derived the designation of the sympathetic nerve or sys- 
 tem. " Sympatheticectomy " might be admissible, but why 
 not be satisfied with excision of the sympathetic ? We see 
 no possible reason why the poor epileptic should be de- 
 prived of his sympathy— or of ours ! 
 
 The Adjective of Pons. — The use of pontine in recent 
 articles in the Journal, and of pontal in the new transla- 
 tion of Edinger's Nervous System, has led to a considera- 
 
80 SUGGESTIONS TO MEDICAL WRITERS. 
 
 tion of the whole question. If the Romans had derived 
 no adjective from pons it might be necessary for us to de- 
 cide between the analogies of montanus or montensis from 
 mons , of dentatus from dens ; and of mentalis from mens. 
 But pontilis, although postclassic, was the regular adjec- 
 tive from pons, and its English form (Anglo-paronym) is 
 pontile. Ponticus (English pontic) is the adjective of pon- 
 tics, the sea. Pontinus (English pontine) was originally 
 Pomptinus, and refers to a district of Italy. In short 
 pontilis and pontile are legitimate and sufficient, and the 
 use of any other adjective tends to cause confusion and 
 bring discredit upon medical and anatomic scholarship. 
 
 " It is to Be." — There is hardly a page of any newspaper 
 that does not offer examples of an expression, the origin or 
 meaning of which is beyond human understanding. Per- 
 haps medical journals also sin in this way. It is to be hoped 
 that, the plan is to be commended, the procedure is to be en- 
 dorsed and advocated, etc., are some of the forms of this 
 strange method of expression. If we mean that the plan 
 should be commended, that the proposal should be adopted, 
 etc., then why in all simplicity and directness not say so ? 
 If we mean that we hope, why make use of the highfalutin, 
 silly and meaningless circumlocution, it is to be hoped? 
 Man, it is said, takes infinite trouble in hunting up trouble ; 
 surely some writers give themselves great pain to make a 
 simple, short statement obscure and long-winded. 
 
 Pecilonymy or Terminologic Inconsistency. — A 
 common and undesirable literary habit is the use in one 
 and the same article of different names for the same part, 
 structure or tissue. In a certain article of five pages re- 
 cently reviewed, pituitary body occurs 12 times, and pituit- 
 ary 5 times in conjunction with other words. Hypophysis 
 is used twice, and its adjective, hypophyseal, once. Gland 
 alone occurs once. The replacement of corpus pituitarium 
 and glandula pituitaria by hypophysis is one of the points 
 
USE OF WORDS. 8 1 
 
 upon which there is agreement between the American 
 Neurological Association, the Association of American 
 Anatomists and the Anatomische Gesellschaft. Why not, 
 then, use hypophysis throughout, adding the synonym, 
 pituitary body, in parenthesis, at the beginning ? 
 
 Tubercular or Tuberculous ? — At the recent meet- 
 ing of a National Medical Society one essayist used the 
 term tuberculized to express the meaning usually served 
 by other words. It was plain that he did so with "malice 
 aforethought." When asked why not tuberculosed, tuber- 
 culotic, tuberculous, tubercular, tuberculated, tuberculate, 
 etc., he said tuberculized was the more correct word. 
 The controversy that has been raging on this subject 
 in the columns of the Lancet during the last year 
 (1899) is most amusing, although the correspondents 
 are in fighting earnest and do not wish to make us laugh. 
 All the philologists, however, differ from the writers who 
 would have it tuberculized or tuberculosed, etc.; they re- 
 semble the Irishman ; it is not nither nor is it nether — it 
 is nather, bedad ! 
 
 The correspondents, like ancient Gaul, are divisible into 
 three parts : (i) Those who would use tubercular always ; 
 (2) those equally dogmatic for tuberculous ; (3) those who 
 use both terms. The first two classes are outnumbered 
 by the third, and the members of this third class differ 
 each from another absolutely and eternally as to the 
 proper meanings or applications of the two words. The 
 "fun at the fair" comes out in these astonishing differ- 
 ences. The Lancet started the dance by the attempt to 
 limit the term tubercular to anatomic significance, whilst 
 restricting tuberculous to pathology. The first shillaly 
 that came down upon this microcephalic head was that no 
 such usage had ever been customary with medical writers, 
 but that instead, tuberculous has been restricted to "con- 
 crete objects," while tubercular has been used with both 
 abstract and concrete nouns. This writer is opposed to 
 
82 SUGGESTIONS TO MEDICAL WRITERS. 
 
 all who will not conform to such a usage, and in a sub- 
 sequent letter he brings etymology and Dr. Murray to 
 his support. The meanings of the terminations -ons, 
 and -ar, are shouted with each repetitive whack of the 
 blackthorn upon our poor heads, being emphasized by 
 "granular, granulous ; nebular, nebulous; nodular, nodu- 
 lous ; tubular, tubulous, etc." After much soreheaded- 
 ness and frolic, a wise correspondent whispers "Pedan- 
 try," and the headcrackers vanish to bind up their own 
 scalps. 
 
 What egregious silliness ! Suppose one attempts to 
 limit these words to the significance expressed in the 
 terminals : -ous, fulness or abundance of, and -ar (or -al, 
 which is the same thing), of the nature of, having the 
 quality of . he would at once, unless he were a philologic 
 fop, or an ignorant pedant, run up against the fact that 
 even in general English no such distinctions exist — that 
 numberless words are used regardless of such finicky 
 fussiness. Then when he turns to medical English he will 
 be unable to find another word to illustrate and bolster up 
 the contention. Most adjectives used to indicate pathologic 
 or anatomic significations end in -ic, and in -ic alone, and 
 will not even think of -ar, or -ous, as e.g., pneumonic, 
 syphilitic, necrotic, pelvic, albuminuric, phlebitic, nephritic, 
 pleu.ritic, choleraic, and a thousand more. Possibly the -al 
 sticklers, e.g., the Medical Record, the Medical Mirror, and 
 the Medical Press and Circular, would say pneumonical, 
 choleraical, syphilitica!, necrotical, pelvical, albuminurical, 
 nephritical, pleuritical, phlebitical, etc., but the argument 
 holds just as well, even then ! Others will not have any 
 adjectival terminal except -al, e.g., malarial, gonorrheal, 
 typhoidal, arterial, catarrhal, vaccinal, pharyngeal, brachial, 
 etc. There are many that will not submit to any other 
 caudal ization than -ous ; as, for instance, gangrenous, morbil- 
 lous, leprous, osseous, eczematous, etc. There is a small class 
 that will have only -ary, as bacillary, itrinary ; another that 
 objects to any but -y, or -ly, as measly ; and a considerable 
 
USE OF WORDS. 83 
 
 number of nouns, such as measles, smallpox, whoopingcough, 
 cerebrospinal meningitis, acne, forehead, etc., that aristocrat- 
 ically flock all by themselves, despising all adjectival and 
 democratic invitations. 
 
 In a word, if the distinction sought in tuberculous and 
 tubercular were worth making, it should be possible in all 
 the other adjectives, whereas it never has been made, the 
 thousands of such other words refusing to be so dealt with. 
 It is not, moreover, recognized or practised by the medical 
 writers of today. Who would know unless told, and who 
 would care after the telling, that in the Report of the Royal 
 Commission on Tuberculosis published last year tubercular 
 is used to qualify disease, and tuberculous to qualify an- 
 imals or carcases ? Who follows this fashion ? If the 
 etymologic significance of the terminals is preserved this 
 is a foolish distinction, and if usage is the guide it is one 
 flying in the face of every writer. There are not two 
 scientific treatises in the world on the subject of tubercu- 
 losis that make the same distinctions as to the meanings 
 of the two forms of the adjective. The dictionaries do not 
 even attempt to make them, and we doubt if a single writer 
 is logical and uniform in his use of them, even admitting 
 the validity of the premises he may have clutched out of 
 the air as his laws. 
 
 Conciseness and accuracy of meaning in the use of 
 words is desirable, but this is far from the pride of ignor- 
 ant erudition, and the fussiness of the finics. Indeed, the 
 distinctions attempted in the two words are destructive of 
 all accuracy and conciseness. If a man or an animal has a 
 single tubercle-bacillus pathogenetically at work in his tis- 
 sues, he is tuberculous, tubercular, tuberculized, tubercu- 
 late, tuberculosed, tuberculotic, tuberculic, tuberculal, 
 tuberculary, tuberculy, or whatever other form of the 
 word chance or whim may select. All the rules of all the 
 rulers will not change the pathologic fact, nor will they be 
 able to render the degrees, or the locations of the process 
 distinguishable by forms of the word. Any adjective must 
 
84 SUGGESTIONS TO MEDICAL WRITERS. 
 
 be held to mean, of the nature of , pertaining to, afflicted with, 
 infected by, having the quality or character of, full of, etc., 
 indiscriminately, and any attempt to classify adjectives or 
 to delimit adjectival significations is as ridiculous as the 
 famous plan of John Phoenix to use numbers from i to ioo 
 to make their degrees precise. The terminals, -osus, -ose, 
 -ous, denoting fulness or abundance, or others with differ- 
 ent meanings, do not signify when the pathogenic process 
 is instigated by living germs. In a little while one germ 
 will beget a million, and these will travel from lung to 
 intestine, or to knee joint, or from man to animal, and vice- 
 versa. If it is not true tuberculosis, but only resembles, 
 then we have tuberculoid, if you please, but this " abstract 
 and concrete" distinction is — well, let us say, it is in truth 
 both abstract and concrete ; and let us bid the pernickities 
 good-morning, with a resolution to use the form of the word 
 we please, and with the certainty that each means exactly 
 the same thing, and that every reader will understand 
 precisely what we mean. We prefer the single word 
 tuberculous. If we use both, and if we seek to draw 
 any distinction whatever between them, we shall not be 
 understood, and we shall distinctly differ from every other 
 distinguisher. Quieta non movere. 
 
 Misuse of the Word "Case." — According to the 
 dictionaries and common usage, a case is the instance or 
 history of a disease, the series of symptoms, circumstances 
 and treatment constituting the special occurrence of a 
 disease. Plainly and undoubtedly therefore the case is 
 very different from the patient. And yet in every page 
 of medical writings one sees an utter disregard of the 
 distinction, a usage not only inelegant and incorrect, but 
 often misleading and ludicrous. How in the world can a 
 case "be taken ill," "put to bed," "have a fever," or "die"? 
 The patient may thus be spoken of, but it is absurd to 
 speak of the case having a pulse-rate, or temperature, of 
 being comatose, or delirious, dead, or posted. "A case" 
 thus reported is quite likely to suffer cremation. 
 
use of words. 85 
 
 The Need of Exactness and Proper Terms in 
 Descriptions is illustrated in one way or another in almost 
 ever contribution to medical journals. "As big as a wal- 
 nut," or as " a fist," " an orange," a " croquet ball," etc., are 
 terms used of tumors, cysts, etc., instead of inches or cen- 
 timeters. Every man has an approximate inch measure 
 in his thumb, and inches divided by 0.4 give centimeters 
 near enough for practical purposes in many cases. The 
 descriptions of the feces, of pus, and of sputum often seem 
 calculated to make even doctors disgusted with food, and 
 to banish forever pea- soup, rice and sago, starch puddings, 
 prunes, egg-sauce, and other such things from the dining 
 table, and the dietary of sick and well. Surely these things 
 need not be if clinicians are not color-blind. In a recent 
 article the motion of a wheel in a machine-shop was de- 
 scribed as " revolving with the hands of a watch." Was 
 the plane of revolution horizontal ? — one is compelled to 
 ask. If so, of a watch face down, or face up ? In describ- 
 ing anything we should ask ourselves if all others will surely 
 understand the terms we use. All fists, oranges, pecans, 
 walnuts, finger-breadths, etc., are not of the same size, all 
 ordinary colors have accurate names, and the various de- 
 grees of fluidity, viscosity, and solidity may be appropri- 
 ately designated without making the gorge rise in rebel- 
 lion. A color chart and a pocket-rule should be included 
 in every physician's outfit. 
 
CHAPTER V. 
 MEDICAL PALEOGRAPHY. 
 
 Medicine is a forward-looking, not a backward-looking 
 science, and hence the study of the origins and evolution of 
 our guild and of its beliefs and customs are little thought of 
 by our earnest members. Our indifference to the history 
 of medicine was curiously and strikingly brought home to 
 me recently, when I began hunting for data concerning the 
 embryology of the signs used every day by physicians in 
 prescription-writing. I discovered that as the peasant 
 does not know what his "bow and scrape" mean, evolu- 
 tionally-speaking, 1 and as the young mother does not 
 understand why she dresses her infant in a skirt two or 
 three feet longer than the baby itself, 2 so the physician has 
 no suspicion of the origins of the signs used every day for 
 drams, ounces, scruples, etc. After consulting two or three 
 dozen cyclopedias, dictionaries, and technical handbooks, 
 I found that nobody knew, and that these signs are written 
 in the United States a million or several million times 
 every day, and by highly educated men without the slightest 
 suspicion or comprehension of their history. : ' 
 
 Their origin can be understood only by a general com- 
 prehension of the principal facts of the history of punc- 
 tuation and of general paleography. As to general pale- 
 ography, the best encyclopedias contain epitomes of the 
 subject which need not be reproduced here, except, per- 
 haps, to mention the roles played, i. by the expensive- 
 
 1 Spencer explains them as the initial movements of the captive, throwing himself 
 under the conqueror's feet. 
 
 2 The mother's skirt used for the newcomer, until this became a universal custom. 
 8 1 thought I should find the revelation of the mystery in a book I stumbled upon 
 
 on medical symbolism, but it does not even mention the existence of the mysteries 
 with which I was concerned. 
 
 (86) 
 
MEDICAL PALEOGRAPHY. 8j 
 
 ness of material upon which medieval writing was done : — 
 whether upon leaf, wood, bark, vellum, or other material, 
 there was a dire necessity for economy that resulted in 
 small writing, narrow spaces, and many contractions. 2. 
 To this necessity was added the constantly acting factor 
 of human laziness, which by a thousand devices tried to 
 shorten hours and lessen work by such labor-saving things 
 as abbreviations and signs. 3. As everything biologic 
 has its life-history of ambitious and plastic youth, adult 
 strength, weakening old age and death, so do all styles and 
 systems of handwriting. The development and decay of 
 majuscule, minuscule, uncial, cursive, and calligraphic 
 handwritings is of abundant interest psychologicly as 
 well as paleographicly. The increasing carelessness by 
 the fourteenth century finally led to such a degradation 
 that many of these contractions inaccurately applied be- 
 came the excuse for meaningless flourishes. 
 
 As a consequence we find these three factors working 
 together most powerfully as the middle ages advanced 
 toward the age of printing, to produce a vast and ludi- 
 crously complicated system of contractions, abbreviations 
 and signs the object of which was to spare writers labor, 
 and bookbuyers expense. It has been calculated that in 
 the French MSS. there were as many as 5,000 distinct 
 kinds of these artificial contractions. In England the 
 number did not rise above 1,000 — though even this is no 
 warrant for great congratulation except when viewed 
 relatively. 
 
 In English manuscripts according to Morris, a stroke 
 over a vowel signifies m or n; as in su, hi, hoiid, meaning 
 SU77Z, *h\m, hou»d. 
 
 An upward curl, above the line, signifies er; as in tnaif, 
 s s tte, for man^r, seme (serve). But if this symbol follows 
 the letter /, it means re; as in p die for p/rche. It arose 
 from a "roughly written e, the letter r being understood. 
 
 A small undotted i above the line means ri, the letter r 
 being understood, as before; hence p'nce, c x st, for prznce, 
 crj'st (Christ). 
 
00 SUGGESTIONS TO MEDICAL WRITERS. 
 
 A roughly written a (») in like manner stands for ra; as 
 in g^ce, p a y, for grace, pray. 
 
 A curl, of a form which arose from a roughly written 
 v(ior u), signifies ur ; as in Tne, o, for t«7-ne, our. 
 
 The reason for the upward curl after / being used for 
 re, arose from the fact that there was already a way of 
 writing per, viz. by drawing a stroke through the tail of 
 the/.- as in £il, for pml. Sometimes this sign stood for 
 par ; as m£ty for party. 
 
 A similar stroke, but curling, enabled the scribe to ab- 
 breviate pro. Thus we have £fit, j>ue, for prafit, proue 
 (prove). 
 
 At the end of a word, the mark -f signifies es or is ; and 
 the mark 9 signifies us ; as in word^ for word^j - or wordzV, 
 and J 9 for ]>us. 
 
 A rare mark of contraction is a.", for com ox con; as in 
 a-fort, o-seil, for comlort, co7ise\\ (counsel). 
 
 Other examples of contraction are q or qd for quod or 
 quod, i. e. quoth ; p* for ~pat ; ~p a for ~pou ; j for a«rf 4 ;i5for 
 ISat; and *p for "pat. Also ihc, itim, for iesus, \estim (Jesys, 
 Jesum), where the h came from the Greek H (long e), and 
 the c from the Greek C (S, s). 
 
 Sometimes a word is merely indicated by its initial 
 letter or by a few letters. 
 
 The nature and methods of making these contrac- 
 tions, abbreviations and signs will become clearer as we 
 proceed, but it is only study of the reproductions or of 
 the originals of medieval books and MSS. that will make 
 the matter plain. A careful comparison of the forms of our 
 own printed capital letters as modified in the small or 
 "lower case" letters, and then as further transformed in 
 the cursive or script style, will give one a glimpse into the 
 agencies of change made necessary first by the reduction 
 in size, and second by the desire in writing to avoid taking 
 the pen from the paper in making a new letter. That this 
 last object is still a factor in chirography is shown in almost 
 
 4 Sometimes anl, according to the dialect. 
 
MEDICAL PALEOGRAPHY. . 89 
 
 all writings ; for example by the frequent failure to dot the 
 letter i, and either by noncrossing the t, or doing so by long 
 loops and swirls. 
 
 Punctuation, properly speaking, began about the 
 eighth century A.D., but was not fixed until after the 
 invention of printing. Points of various kinds were used 
 after each word so far back as the oldest inscriptions. 
 These dots were sometimes single, sometimes double or 
 triple (in the form of a triangle) or quadruple (in the form 
 of a square, though also occasionally placed in the form of 
 a circle, diamond, etc., etc.). But the object was to sep- 
 arate words, not parts or entire sentences, and hence it 
 was not punctuation. One author, Aristophanes of By- 
 zantium, in the second century B.C., used a dot at the top 
 of the end of a complete sentence ; for an incomplete 
 sentence, corresponding to our own semicolon or colon, 
 he placed the point as we place our period ; corresponding 
 to our comma he placed the dot afrthe middle of the space. 
 The example of Aristophanes, however, was little followed 
 — a commentary upon the intelligence and conservatism 
 of the copyists — and most of the manuscripts of the middle 
 ages are poorly or not at all punctuated. In Caxton's Mal- 
 lory's Le morte dartkur the sole punctuation sign is a 
 slanting line, and an occasional reversed capital D, or 
 paragraph sign. 
 
 The Origin of Modern Punctuation Marks is 
 strangely omitted in the treatises and cyclopedias. Only 
 in the last edition of Chambers have I been able to find 
 anything approximating an explanation of, or even sug- 
 gesting, their evolution. It thus transpires that students of 
 evolution, history, and embryology, while spending their 
 lives in studying the origin of worlds or organisms, are in- 
 different to the origins of the letters, punctuation marks, 
 signs, and symbols they make use of every time pen is 
 placed on paper. The fact seems to be that our modern 
 
90 SUGGESTIONS TO MEDICAL WRITERS. 
 
 punctuation marks are the conventionalized relics of some 
 of the most used contractions of the medieval copyists. 
 With the increasing demand for books, as I have before 
 
 ijUalraAeAtJ? X Sfe yti^tractz. 
 
 ^4r*turrU? + ■$> 1/u»eyar. 
 
 SiijtiUa*umj?. . . . X « &uU&l<U>hu$cvr. 
 
 dcxebi, + ;>.,"«/v». ^stc-ul.vn'giyti&'nil/. 
 
 l/ltrtert.: XKK®K>(& ^4cid*cf (JJTrurL. 
 
 dCtAfn- :. ©K >©;>© ~ALvri tuyyLud/. 
 
 tA&r: so:©*-.:-* JVZ/r<riLJ folds. 
 
 . Vy/tiat : _ _ •*-. I^dz/di- Otuls. 
 
 _\%lJxrffiJv: 4» 9%6Ui/*Jtafahuvmj Oa&. 
 
 ffyjxfft/i _i*. rJwjfiAcrric &ids 
 
 ^•4-ddt,' , ._ a. d ,-isrda,. 
 
 ^4cr A ;A;A... flvr . K 
 
 Sfix:.- -- . A ; f A i/'/Jced' (Zor . 
 
 ^MefiA:. _ m. A ^A0fi/u£o' &yr 
 
 sEruyo ;.© fyeAMarutes- 
 
 — 3/^ti/l- - ® dd.... JB^dUvZrifyr^&- 
 
 j£s Q Cofi/uyitor &rids , 
 
 -JUftuvn-... <} t3MArf£-&rafe . 
 
 sEttu-r JE;& £t/wr. 
 
 ~ / Uu?ui.m/. «^P_ ^jt J&tU£'. 
 
 Mtwme+v . - ©,"£" M'Atifef ' fy$ ■ 
 
 diLtti q?;g 
 
 vAi;: O-v;©-^®-?- i/"uzeds ^U£ali>, 
 
 — Vtrl:. &*;©AeA. *2/o4a£l£/^>Uka/i.'. 
 
 — ^Mittfucc: m ©v .Mi/de^-^Zzs-cL/iMuz/^. 
 
 — Cau^t-.yUit: .-. c . fi^»c :6uisti£.J*&xea/jht/xll4.-. 
 
 — .Mit:i/HL m-9* J^^l f tiatt^/£,^4&a/i'. 
 
 — Gutstdtol^ -c.#/v. Cnt<&cl/Hiti& ' .4f/ca/i 
 
 Fig. i. 
 
 said, the necessity of lessening the cost of material and 
 of labor, united with laziness to develop crowded writing 
 and the tremendous system of contractions. The signs 
 
MEDICAL PALEOGRAPHY. 91 
 
 of some of these contractions finally developed into our 
 modern punctuation marks. Just as every letter of the 
 alphabet is the conventionalized simplification of the 
 picture of an object, so the period, comma, semicolon, 
 etc., are similar remains of pictures of omitted syllables 
 and letters. This may be illustrated as follows : 
 
 The Ligature, Dieresis, Umlaut, Circumflex, etc 
 • — The horizontal line above was an early sign of omission 
 of letters, as e.g , c for cum, aut for autem, a for annos, etc. 
 It probably arose from an earlier custom of the scribes of 
 placing such a line above an erroneous letter, syllable, or 
 word, to be erased later. To avoid the writing of the 
 second one of a double letter, this line was drawn over the 
 first, and the second was omitted — e.g., suma for summa, 
 etc. The line in case of m first, and then of n, was but a 
 rapid and cursive way of making the uncial m or n above 
 the preceding letter ; at first it was a waving line, our cir- 
 cumflex, 5 and then it became straight as a typical sign. This 
 line was also used as a ligature of <z and ce, at present still 
 used, and which was a mere picture of the linking or binding 
 of the two letters. We still use the line above vowels to indi- 
 cate their long sound, the modern significance not being 
 essentially different from that of the elder. At a later date 
 the scribes also used the line, which is only a hastily- 
 written ligature, or letter m, over the last letter of many 
 contracted words, e.g., qm for quoniam, quo for quomodo 
 (or quoniam), etc. The two dots of the dieresis and 
 umlaut, which were but hurried and habitually-shortened 
 ligatures, finally came to denote the separate pronunciation 
 of the shortened and contracted syllables, in which a letter 
 or syllable (as in zoology, cooperation, etc.) was omitted. 
 In our medical sign, da, the omitted n is indicated by the 
 straight lines above. 
 
 6 The circumflex, or straight line, was not always written horizontally. For 
 instance, StlOy was the contraction For suorum, in which J5 represented the letter r, 
 and m, crossed by cursive m, passed through the ~ , or circumflex and straight line to 
 the vertical line. 
 
92 SUGGESTIONS TO MEDICAL WRITERS. 
 
 The Period and the Colon. — The Latin scribes had 
 a large number of words to copy.ending in -mus and -nus. To 
 save labor and space, they began the contraction-process by 
 
 .AbrrtJncuJ '. A;XXi idnsdHemUruy. 
 
 - Ttwm&n- O." lib jPtuarv- 
 
 &AimL. OP fiturrUHV diums. 
 
 %<£._. .... ©-. ftuArit' ditvms. 
 
 Jlmalaama 223.A ~/fma£f<z>m/- 
 
 jimfthvra. : 3&&& ^CV^iLtcrf^ tfa/LmS - 
 
 „4™/iu/£a. *&&=?. Jrtotites. 
 
 Miuv aa ..... Of- cactts- 
 
 Annus -.._. ■rOrz i/fu^a,^. 
 
 j47(ti*TuyruM'm O ^rififtrurrvif . 
 
 dipuu- V. /(Ja&r. 
 
 Ca/cu . _ ty frmeUl/atzr . 
 
 __ 3>{u>utafo - V YC /^k^^fe^r 
 
 _ J^W? SP! J/iA/^M/a^^. 
 
 _&fLi- ...JR-^R. 
 
 'ftoj&r: TTiostU Jl&*C' 6i/dtc4 r . , 
 
 _ JafaJfru- QJ J6rt/i£rWater~crfJ>tirt-. 
 
 _1fitHe... ?7 v -----&rarJi{'. 
 
 ^ArciAmenj .../. J'aaila/luo,j4t2/e^iiali/im<. 
 
 ^Au^uu-.: .v. ; ..•.•:. ^/amd- 
 
 Araentzvnv. _ 3 ", g- «W- 
 
 Ct'rnatum/. 3M?1 JufouiJ ofi/jUv-er '. 
 
 tyiwm/; 0- Suu&j-ilu&r. 
 
 JraMa.. .^? CCay . 
 
 dri&f - V 'i//ieJ\d.m', (2 ' CmjUlkUwn/. 
 
 .Atfenicwnv. o-o *jlr*&ruc . 
 
 _ ^Ua/i^,L & /faatduj cfl/Ftwnicr. 
 
 writing these terminals thus : mp, )y>, in which the u was 
 half made and crossed with the long s, or/. It was not long, 
 of course, before the last trace of the u disappeared, and the 
 
MEDICAL PALEOGRAPHY. 93 
 
 long /was reduced to the two dots of its head and tail, that 
 is, our colon, so that m : stood for -mus, b : for bus, etc. It 
 
 jfwium/. r-Jfeid/. 
 
 __ 5**^__. W JWfc/^ 
 
 _, ./miat: ..®/- &tti> 
 
 — #otiz/riU LOP 
 
 Sainetvm/. B jte}a£/v. 
 
 ^-Marta&. "&$R3fo-^,- J .*/H(/afor&at/i/. 
 
 4/afurrLt VB. y4ri/afwr^r Sa^u. 
 
 ^—jir&nas. AB.BA. K /tcfmj6 / %>at<b< 
 
 JS/sinattwms ...BW StSmut/i/. 
 
 Boma>. .Jh;c2i;dh;c5 
 
 ta^^ne^tta^e^ . . ~z~- t-Jo l&m&nt?. 
 
 Catcinart' ., *fZ Je £tlcvn<y . 
 
 QUay ..JC J&ntc'- 
 
 Gzmfitwrtv. ...^^wl Cvm/i/wr . 
 
 /Wr._ -m--^f^^S^ 
 
 Cif'tatur - cap-. Safaris. 
 
 &ras.___ &$<.--- M/aax 
 
 Guru&if...- — * W/icte -lead/. 
 
 G*wr&/ ...--Gf'.-E i/f<?fu<f. 
 
 _^-Oa^ella6^.....^\% >P<>frA?A/. 
 
 Gforuzlwris =!£&''& Grvrutlwr.. 
 
 &a4u/a*e>. ...HE M &apulate- . 
 
 Crfm/fr.. --K --. — CcrtaltA 
 
 frnduvm'i - Crna* <^r uat&rn/. 
 
 6rn < u>&nn'--- --C.C tftarif J&rrv. 
 
 Gmw&tcnt':- C.C.C Czlahijsd/uvrfo Jurrn/. 
 
 'lC?fr:_ , C.C.U- /5u>mt7/h<vrfrJu>rw. 
 
 Fig. 3. 
 
 was at last seen that the upper dot was useless, and its omis- 
 sion left us our modern period, which finally was limited to 
 
94 SUGGESTIONS TO MEDICAL WRITERS. 
 
 indicate the completed sentence. It is interesting to ob- 
 serve the incompleted sentence is still indicated, by the 
 colon, which is also the half-way stage of the development 
 of the ^ into the period. 
 
 The Semicolon is what remains to us of the elision of 
 -tie and-et at the end of many Latin words. It was origin- 
 ally written thus, ; or with the comma reversed, in which 
 the reversed comma is the hurried and conventionalized 
 form of ti and the dot above is that of e. This form of 
 the reversed comma was finally replaced by the form as 
 we now have it, which was derived from the suppressed 
 ending -et, of many Latin words, the excised letters being 
 indicated, e.g., in this way: hab ; for habet, in which the 
 dot is the relic of trie e, and the comma is the trace of 
 the t. For a long time this semicolon was confined by the 
 scribes to words ending in ue, or et, as, e.g., qu ; for quan- 
 doque, quo ; for quoque, a; for apparet, o ; for oportet, I; 
 for licet, t ; for tenet, h ; for habet, s ; for scilicet, etc. It 
 was afterwards generalized to signify the omission of any 
 final syllable, and when printing came into existence and 
 the whole huge clumsy system of contractions was done 
 away with, the semicolon was given its present function. 
 
 The Zodiacal Signs illustrate the conventionalizing 
 of pictures. They are thus explained by Taylor : 
 . $ The caduceus of Mercury entwined by two serpents. 
 
 2 The mirror of Venus, with its handle. 
 
 S The shield and spear of Mars. 
 
 % The arm of Jupiter grasping the thunderbolt. 
 
 \ The mower's scythe of Saturn. 
 
 T The curved horns of the ram, Aries. 
 
 H The head and horns of Taurus, the bull. 
 
 / The arrow and a portion of the bow of Sagittarius. 
 
 V3 The circle is the head of the goat, the forelegs are 
 below, the body and tail are to the left, — the sign of Capri- 
 cornus. 
 
MEDICAL PALEOGRAPHY. 95 
 
 The Digits, as the name implies, are mere pictures of 
 the fingers. I is the first finger; II, III, IIII, respectively 
 
 faf0rcuMe&dlica,_---C.lA 4{OaUib / Sodi& : i . 
 
 fretou I =3;V- Qia/Ay. 
 
 Crocus .© cfafflon/. 
 
 — Vevi&rij — ®€. jyfrvn/of^£>fifie4/, 
 
 6wci/nUwms„ . . ,. .+ ; V;+ ft _ _ . . ^4 CnuMe-. 
 
 foy<ftallutt C CrifStals. 
 
 Cucwrlrttii/. i&;6 iSf <2uxM^it7. 
 
 Cu/vrtvm/. Y .g (oftfie/r . 
 
 fyatfuis _ (yattiA ~4-(ftqfej/u£l<: 
 
 Covfalearas. GhM^ ^^htfioonfaMy. 
 
 SW 6;c£ ^£2)<m/ . 
 
 ./unae/. 2 ^i/oru&wJ . 
 
 ^—Jpuvfkf . .a ffu&f-dzi/ . 
 
 jtfercuru/. ?,'$ €t/edn&tdart./ . 
 
 fowls %',%■ JAiorttdaw . 
 
 Vewwu* =. Q cnvutay . 
 
 J'aturn^- l£, jdtwrelay . 
 
 J0&J © rjvndiZM . 
 
 Styemz—. -8" 3/g&ft?. 
 
 Q'mcAma^^ 3 ^Jw^. 
 
 <3b&ri£ui/. ~EiSs;% Sfiences. 
 
 IJ'aec&s^V/mt'y Hi. - --.. ~£&&s vfyli/ tn^. 
 
 J>aAmds. _ :.® Jp£eaL>. 
 
 ^afetevm/.--. -. GHH'- /$nck c/ti*ft7. 
 
 ffizrnvm/. <?. .J#ons. 
 
 J&mdty. *9±\<£---~Sfylma<s of f<rvrL.. 
 
 ffiltrare'. 3 3 SfoEfak&r. 
 
 3jfiunw.^ <&*£■ 5&S%?7/. 
 
 Fig. 4. 
 
g6 SUGGESTIONS TO MEDICAL WRITERS. 
 
 the second, third, and fourth fingers. V is the fork of the 
 hand, IV and VI with I subtracted or added. VV (or X) 
 represents the two forks or the crossed thumbs. In the 
 Orient, reckoning by means of the positions and arrange- 
 ments of the fingers is carried on as high as to 10,000. 
 Our denary system is itself due to the fact of counting 
 by means of our ten fingers. Our so-called Arabic nu- 
 merals are not of Arabic origin, but came from India to 
 Bagdad about the eighth century, and were fixed and uni- 
 form by the fourteenth century. There is some doubt as 
 to the origin of the forms, but the same principles of con- 
 traction and conventionalization probably hold here as in 
 other signs. 
 
 Miscellaneous. — Several mathematic signs also illus- 
 trate the methods by which contractions are conven- 
 tionalized. In many large commercial signboards the & 
 of Brown & Co. will show plainly the original Latin con- 
 junction Et, the t being somewhat shortened. The steps 
 by which the sign -f, ox plus, came from et, are shown by 
 the series : 
 
 E7,IJ,V>H 6- &■%<*- + 
 
 In the Domesday Book et was made thus, 7, and older 
 forms were *•, *, etc. 
 
 The Comma. — The professional writers had a special 
 sign for the omission of the final syllable -us, so common 
 in Latin. In the earliest MSS. this was made thus, J, in 
 which is still plainly visible the concavity of the u, and 
 the long s tailed to it. In writing this hastily, the open 
 concavity became closed, resulting in the sign, 3. Thus, 
 U9 stood for ejus, oxmizj for omnibus, etc. This sign is 
 so similar to our comma, that the suggestion seems irre- 
 sistible that our comma was adapted from this convention- 
 alized 9 or 3. This sign was also used for -er, as e.g., in 
 the sign for cancer, in the table appended. It is possible 
 that our comma may have arisen by cutting off the upper 
 
MEDICAL PALEOGRAPHY. 97 
 
 part of the semicolon, as our period came from leaving off 
 the upper part of the colon, but the first suggestion seems 
 the more probable. 
 
 The Exclamation Point is said to be a conventional- ■ 
 istic use of the Greek Io /, the o, or dot being placed be- 
 neath the /. 
 
 The Interrogation Mark is a contraction of Qy, 
 (query) the mark representing the y below Q. 
 
 The Apostrophe was at first a small letter, the cur- 
 sive r, written above the space or previous letter, to 
 denote the omission of r, or a syllable with r in it, such as 
 er, or re. The slovenliness of the writers is exhibited in 
 the fact that they did not take the pen from paper to 
 make the apostrophe, but made a scrawling line up to the 
 sign, and again back to the next letter in order. That the 
 semicolon was sometimes used to indicate the omission of 
 er, is shown in the words, aer, cether, etc., of the old table 
 reproduced. 
 
 Just as the circumflex accent, derived originally from 
 the letter m, passed into a wave-line, and then into a hori- 
 zontal bar, so the initial letter m of the ' word minus 
 became such a bar, and is called by us minus. 
 
 It seems probable that the sign -=- (divided by) was 
 taken (with no very logical nexus) from the contraction of 
 the medieval scribes for est, in which the dot above the 
 line represented the e, and that below the t, while the long 
 f, made horizontal, was straightened into a dash. 
 
 Esse was at first written in this way : .<^., in which two 
 dots represent each an e, and the two wave-lines each a. 
 long s. This became •=■ by straightening the curving .r 
 lines, and finally the two dots were eliminated, leaving our 
 sign =, equal to. Other similar forms were = s for esses,. 
 — t for esset, and = mo, for essemus. 
 
 In lb, for libra, pounds, the horizontal line, denoting a. 
 
98 SUGGESTIONS TO MEDICAL WRITERS. 
 
 contraction or omission, is made across the /, and in £, 
 the two bars denote the double omission. The letter s, for 
 
 Stuliao ^+ Averts. 
 
 .yuimtu . v __ ._ fjjj J^tnoak/. 
 
 (franK/ms- .-- vr. ^ ' *nu*v/v4*afit7- 
 
 tkvnvrru' . - ■d2~5b .uurn/. 
 
 tytt&i/ .- G ; at lout?. r4-c6rcyt/. 
 
 tfy/isums ^ (%l*Oa/. 
 
 tfcrtis E. lAnJzftotisU 
 
 Jfytar Jatytfi/i e^- jOt^t'of 'Ju/fi/iu/L/ 
 
 Janot A .Sv^. 
 
 — ■ftevea'6 iR /fots&tbeAatiMy /facts. 
 
 ^2?tSfcj-. ® &rculart<'5fyie'. 
 
 JcrifVi) , uel Jtt/u/2As. 2j_ Sfov. 
 
 ^£aff. CaLwnvn,: I£;1q, . ., Ca^anuncJxmu^. 
 
 . &&&m<rfillj yl 4}&>t>d/Jfar?tz/. 
 
 tJazudc- ... / 
 
 ~£tZ-ms Pitt. .„,.^4fwwvC. 
 
 G>clc<ttij r d^ Sihe'J<4niM4fie' // Z&6My. 
 
 £tfha>iau<Uu) '. ,, ~y-K< . . ...-&tnaA<r&. 
 
 Mma , } - . Jdve/L/. 
 
 jCutlte. n" Sa/iuGss- 
 
 Jiutivm/ tffe?vnL<t . . X.-.Herm.. Cu&ojr'TfeMn&l ■ 
 
 ^M&tntuf. , <A> -£oad'j£m£'. 
 
 Mapnt&a/. ...MV;M 
 
 Maru^udu^ _ _ JA. ^tiuvnd/iUt';. 
 
 JAiluiJtix.. (Z. ^Ata^c^ti/. 
 
 Jtzfaz-.. ft ^4Mafe/a*fi*/ufai. 
 
 JM2,ila/. <£J jHaa&t' . 
 
 — f*nhna, me 3!fu,fasr<mat&fr . 
 
 Fig. 5. 
 
 shillings (solidi), formerly had a bar over it, 1, and the d of 
 pence (denarii), had its cross, g', both now economically 
 omitted. 
 
MEDICAL PALEOGRAPHY. 99 
 
 The "Dotting" of Digits, I, and J, and the "Tail- 
 ing" of the J, etc. — With the compression of writing, 
 
 i ACel^ . >K._- 
 
 «^£wi/ 18> ■4-JkmSA'.- 
 
 ^Ale^cuiieu. §f QtucA*H£>se<? . 
 
 frtuct/u; £ v_ ^/Le^iteeJ-^tfouxfMff 
 
 — J!u/'ti#ru: £ —„ ,4^^^-^^«^^ 
 
 ^MsitUr^ul^ty: s M ^Ms&iUic- / du/'j4zi*tce'. 
 
 .M^ca rut 4iu&.^ 
 
 d/v&l' N 4^uA^. 
 
 ^Au/mrrf. <D ~Aftr&. 
 
 ^Vox". />;<? ^ViltJiC. 
 
 Qlwns. o ; 9 . A. «!; ■$•"; g*_ OjL- 
 
 $a>i. V SfacstOJLi. 
 
 SJ/^ntr:. EoVA J?Jhntl'alO.<£s. 
 
 Ott'vziuiiris • )(- ► lUvucOm/. 
 
 (jjfyiafytio .'. ,if. Ojw/itum . 
 
 Otic/ialc-wiri/ O /?ra&! 
 
 ./%W;„ <£; /. ttyi/txfiri/. 
 
 Mikaltton/..... .__.■£> 
 
 fyx>dJiAjruj A 
 
 ■fofoHi }f_ ^Ae^nefsk/Zixttac.. 
 
 ffami/uin/. -Ti ...JUad* ., 
 
 'P-raeci/ii&twms KP. . -fli&XfuZaZe '', 
 
 fyiyiltuj P. 4'/?umI. 
 
 fijiAn^ i : X< flowde*'. 
 
 /ftsum&o.- Sc. fyutnu-e/ #(5w. 
 
 JWuftcaA* ^-*~ SofiWufy/. 
 
 fyurifaite'- v -t— *■- ^o /uJrififf. 
 
 ■flrtu/uiA/: PV;pp So fvw/iaA&. 
 
 Jfai/a/ a J-tfA^l. 
 
 ftaA&j jE/fiuUeJ YE.jaa^. dfua/^a-?/?. 
 
 Fig. 6. 
 
 confusion would arise, the letter i not being easily distin- 
 guishable from the upright strokes of other letters. To 
 
100 SUGGESTIONS TO MEDICAL WRITERS. 
 
 prevent this the i's were dotted. The dotting of the digits 
 in prescriptions is probably due to the same necessity of 
 avoiding mistakes, and was made doubly emphatic by 
 counting aloud as the digits were dotted. The force of 
 conservatism is shown by the continuance of the habit of 
 dotting they, when the tailing of the / made it into a. J. 
 Although by this tailing the dot became unnecessary the 
 dotting was kept up. ' I suppose the tailing of the last of 
 more than one digit in prescriptions was due to the natural 
 desire of a "nourish" at the end of a word, combined 
 with the distinction and clearness gained by thus differ- 
 entiating the last figure of a number. 
 
 The Z in Viz., and in Oz., has puzzled a great many 
 people. It is simply the rapidly cursive manner of making 
 the semicolon (whose origin has been explained) without 
 removing the pen from the paper. It is not accurately 
 pictured by the letter z used by modern printers, who 
 save a font of type by using the letter which comes nearest 
 the written conventionalism. In the old table of " Chym- 
 ical Signs " I have reproduced, the sign of uncia shows the 
 original manner of making the semicolon, which was doubt- 
 less -?, i.e., the dot and comma connected by a curved line, 
 and the tail to the comma not so long as with our cheap 
 paper is customary. In old MSS., quz stood for quandoque, 
 quoz for quoque, az for apparet, hz for habet, etc. We thus 
 understand why viz. stands for videlicet, and oz for ounce 
 (or ztncid), although there is no z in the words themselves. 
 
 Prescription Signs. — The paragraphs preceding the 
 last one prepared the mind to understand the origin of 
 viz., and oz., and the explanations of these two contrac- 
 tions were necessary to understand the signs used by phy- 
 sicians for drams and ounces. The first stroke of the sign, 
 g is the straightened out u of uncia, and the remainder of 
 the figure is simply our old, now well-understood, slurred, 
 cursive semicolon. In the sign for drachma the d has 
 
MEDICAL PALEOGRAPHY. IOI 
 
 entirely disappeared and the sign of the contraction has 
 become the sign of the whole word, — the Cheshire cat has 
 vanished, leaving only its grin ! 
 
 Jucadtuau. _Q. SiuzrtiU* 
 
 Suvri&l <3&&rttia- &E_. . . . £uwZZj-ce<n6£/. 
 
 Quantum/ jfa&cttz. . . q:S: „4su/f&^nt- auan&tu . 
 
 Suantum/X/'ilj <f.v: U^hatyowfUea^c- ■ 
 
 'Keoifu&ns _ . ®. ^/&n*aW/2x. 
 
 /Zectfie I$.;3. 3a/c£,. 
 
 /ZeaiUuj... @ 
 
 ^tntim/mus t2d ci KeOuluj of '(Znttmcrm/ . 
 
 __ Jnt>:JtzUa£;. . .&;%& . .. . JtelLlteJfc*:*/ 0>itZnis 
 
 Jtel/atiL/-- JJjfc J/tet/atedJ&au/uJ- 
 
 ■fte&rtU/ Q:(r\ ■&*>.. _ _ _ .^fcOort/. 
 
 JaceAa/uvrn.1 ^ , .{{_ <fugaA/ . 
 
 Jald/fcali vjf 4i&a£me'Ja/t> . 
 
 — CZmrrum,'. ._JC;X;>K;©* Jal iltnnumMU'- 
 
 Commute:.- Q . .£cmvmcn/<fa/b- 
 
 demy. b:0:O- 
 
 „tfa/itw. ©:■© :e . -JavJalt. 
 
 Juta/iisum/- •_ Ss -JuCzlitAe, dalfr. 
 
 J'aAo.^ 0- Jotyi,. 
 
 fdtZcvnuj "ft.;lL- -£ead/- 
 
 \fcorfuuj XXX± Jh&t/urtjk&myintkt' Zodiac. 
 
 /tmu^l. .^_..._.^< 
 
 Jea£/cs * Jtdti/&. 
 
 SiatMare^&%me&. . - - SB. ffij&U&MiuZisaMy •■■ 
 
 JoC- . ©- Jfe-Ji#n.- t or feid/. 
 
 JaiutAe'. aSt*- J7& d£c4ve-. 
 
 J'eciinduni'&AZ&rTi' s.a, da&rz&ny tz> 61/lty. 
 
 J/uUttu s\ J/utit/ 
 
 d/dMC . .V .:JfUJU&o/'lt/ / i}rU'. 
 
 Fig. 7. 
 
 The sign gr., used for grain, has not suffered, but in that 
 for scruple (9), the long f is crossed by the cursive r, and 
 
102 SUGGESTIONS TO MEDICAL WRITERS. 
 
 the whole conventionalized beyond the recognition of those 
 indifferent to evolution. The sign for one-half, fi, is, of 
 
 ft : \5? Jfkdfted'J/wntof ' (i/Jm/ 
 
 3: .tr. fouwf jferit . 
 
 dtamnuwts; ..2) i/vn?. 
 
 4u66wna/le'- =£i Jo </uili*Tt£' . 
 
 JfraEwn'<tyuA,J'/rtct&m'. SS& JaAM/iMfum/-£hy6& . 
 
 duu&num/ _._+:BB-- J -.^«/«<&4--'. 
 
 dlufcAu/u. $_ J/u/ftAur. 
 
 — #/u6xf:. ^ JuifiAuboftfePAUtw/iAw ■ 
 
 %/iknvm/ $v- ^Km&tal'/Vu/JHAuA/. 
 
 ■Jatavm/. X Jolcs. 
 
 Ja.'ttaAuJ ip fTa/Un/is . 
 
 jT&rra/. V- Sdrtik/. 
 
 *Al>0&r{i0ntias. ^_ £&r&,7r6e>rit--&aAtfis. 
 
 (a/oevt,:. C7.? 6Uca,u*tv Stvtffi/. 
 
 dtaiUa&s. _^t ^/auUd"6aA&s. 
 
 — Jj£c;ue£4/ifr: >Bb_ Jt&cwuj SomA/. 
 
 — Munwrv A?;® SatZkaf 4Uu*n/. 
 
 ZkncGvnc^ "K jfcnctitt*. 
 
 Jutiao 8 %dty.. 
 
 4/e*uu $ Cqyi&L* 
 
 *V/}num'- V. Uiim*. 
 
 — d&unv. -_VA-..._ / ^k£*£j(W' 
 
 — (&iW... vc /3wbrtc2yik*'. 
 
 ftufown/^.. .VR.___./^s*^W'. 
 
 'fyUrurfuvn/ ~ <bz-9- Wi/riot/. 
 
 WMruny* xx;o-iH> ^£. 
 
 'Knci*' ^ OnCfancc. 
 
 tUimcts*..- GJ $6t*ne'. 
 
 Vc6Ui&j _g tf/etcOib,. 
 
 tfmatm/.. ^; J- Ztno . 
 
 Fig. 8. 
 
 course, the contraction of semisiss, composed of the long 
 and the short s. 
 
MEDICAL PALEOGRAPHY. 103 
 
 By observing the sign in the appended table for Recipe, 
 it will be noticed that the first given, R, is made cursive and 
 conventional in the second, £. This indicates what is 
 undoubtedly true, that the sign with which we head our 
 prescriptions is not the symbol of Jupiter representing an 
 invocation to that deity, but is simply the initial letter of 
 Recipe crossed with the ligature denoting a shortening or 
 contraction. 
 
 From an old medical dictionary (Motherby's), I have 
 extracted two quarto pages of " Chymical Signs," which 
 make eight pages of ordinary duodecimo size. I have 
 reproduced these here in order to illustrate the methods 
 and objects in the sign-making which was so popular in 
 the middle ages. In the first place one gets a glimpse of 
 the desire to keep from patients the nature of the remedy 
 being used, and to illustrate the proverb omne ignotum pro 
 magnifico. To stimulate the belief in the mystery and 
 efficacy of the science, so called, was a method of increas- 
 ing the respect of the people for claptrap, or at best for the 
 crudest empiricism. The fact is commended to those who 
 contend for the retention of Latin in our prescription- 
 writing. 
 
 A study of the table will throw not a little light on the 
 principles and methods of making contractions, and of the 
 evolution of signs. 
 
CHAPTER VI. 
 STYLE. 
 
 Style. — We are often asked how one may acquire a 
 correct and cogent style of writing, and naturally and 
 rightly every young writer wishes to know if this can be 
 done. There are a few instances of persons, Cicero and 
 Voltaire, for example, able to say a commonplace in a way 
 to command attention,— who had style apart from matter, 
 but for the vast mass of writers this .would be not* only 
 undesirable, but also dangerous. In the final analysis it 
 must be confessed that as a rule style is not to be acquired 
 by any amount of conscious study, because it ultimately 
 depends upon a man's originality and the character, if one 
 may so speak, of his mentality. According to Buffon's 
 classic maxim, style is the man himself. The matter at 
 last resolves itself into the old discussion as to form and 
 content in art, and a judicial mind can have no tolerance 
 for the sillies who argue that form is everything ; for, 
 according to that longeared dictum, a painter could ex- 
 pend the technic acquired in a lifetime of industry in 
 painting rotten eggs, or a poet could waste the utmost 
 metric and linguistic skill in lilting elegancies and mean- 
 ingless mellifluousness. Unless the poet think great 
 thoughts and quiver with feeling his verses will never be- 
 come poetry. In precisely the same way, the ability to 
 write perspicuous and convincing prose will primarily and 
 ultimately depend upon the mental energy, the clearness of 
 thought, and the reality of emotion, of the writer. 
 
 But just as poetic sensibility must learn the art of 
 poetic expression, just as the painter must learn drawing, 
 color-blending, etc., so one who would best convey to 
 
 (104) 
 
STYLE. 105 
 
 another his experience and opinion by means of prose- 
 writing and printing, must learn the necessary and inter- 
 mediating art. For an art there is, although in acquiring 
 it many a poor man, forgetful of Le style c'est I'homme, 
 has lost his way in the labyrinths of dilettanteism. At 
 least there are hundreds of mistakes and wrong ways 
 that he may avoid by a little patient study. With much 
 aptness it has been said that " a great commander must 
 know how to pick his recruits, to drill them, and to handle 
 them when drilled, but he must still have something more, 
 — generalship ; and what generalship is in a commander, 
 that clearness of thought and of expression is in a writer." 
 He would indeed be a brave man who would attempt to 
 teach the higher qualities of generalship or of literary mas- 
 tery, but in the picking and drilling and handling, either 
 of recruits or of words, much may be learned by those who 
 have neither the ability nor the wish to become great gen- 
 erals or great writers. 
 
 We are attempting in these suggestions to writers to 
 give a few hints of the worst things to be avoided, and of 
 the best to be encouraged, but at last, to be sure, these 
 have nothing to do with style, they only caution about 
 some of the more striking blunders. They also need to 
 be supplemented by the study and often the memorization 
 of parts of a few manuals that any good bookseller can 
 supply, such as Roget's Thesaurus, the Stylebook of the 
 Chicago Society of Proofreaders, Hodgson's Errors in the 
 Use of English, White's Words and their Uses, and his 
 Every-day English, The Verbalist, and Cobbett's English 
 Grammar, by Ayres, etc. 
 
 Nearly all physicians are under the obligation of giving 
 to their profession the results of their experience. This 
 can be done only by the written and the printed page. 
 Deprived of leisure, engrossed with the facts and the 
 work of life, frequently with insufficient literary training, 
 physicians often betray an excusable but lamentable ina- 
 bility to write even correct English. Because of this fact 
 
106 SUGGESTIONS, TO MEDICAL WRITERS. 
 
 conscientious editors grow prematurely gray, and the files 
 of the conscienceless sort are inexhaustible mines of fun 
 for the jester and of irony for the cynic. It is when there 
 exists no need for writing except the need of conjoined 
 vanity and ignorance, doubled perhaps with the cunning 
 of the advertiser, that we get things that give shame to 
 gods and me.n and are fit to arouse the cacchinations of 
 the imps of hell. 
 
 Some of the general rules for writing are as follows : 
 
 1. Do not put pen to paper, or at least do not set the 
 typesetter at work, unless you have something to tell that 
 will probably prove of value to the profession or to the 
 science of medicine. Do not write to advertise yourself, 
 or for vanity's sake. 
 
 2. Think out in advance and clearly what you wish to 
 write ; so far as you are able, find what others have written 
 on the subject; arrange the order or sequence of what you 
 will say. 
 
 3. Avoid exordiums, introductions, and prefatory ex- 
 planations, plunging at once in medias res, and striking 
 out straight for your essential point with clear and strong 
 strokes, and without detours or tiresome indirections. 
 
 4. Use the fewest words possible to express the fact. — The 
 mistake of not doing so has been called perissology. The 
 following example of needless amplification occurs in a 
 special article by a distinguished neurologist in a leading 
 metropolitan medical journal: "The anterior column of 
 gray matter extends throughout the spinal cord, and the 
 upper enlarged intracranial end of the spinal cord, which 
 is known as the oblong cord or medulla (medulla oblon- 
 gata)." The information contained in these 32 words 
 might have been given in 15. 
 
 5. Avoid highfalutin. — The employment of bombastic, 
 lengthy, or ponderous terms, when briefer would suffice, 
 is not an uncommon literary sin. This is simply one form 
 of what may be illustratively called anatomic esotery. Now 
 that the choice is offered, the anatomist who deliberately 
 
STYLE. 107 
 
 says, e. g., aponeurosis for fascia, anfractuosity for fissure, 
 and convolution for gyre, thereby arrays himself with the 
 village orator, in whose turgid discourse a fire is always a 
 conflagration. Choose simple words arranged in short 
 though not in choppy and staccato sentences. Profound 
 interest in what you have to say, singleness of desire to 
 give to others what you have learned, will make you write 
 better English than all the grammars and rhetorics ever 
 compiled. 
 
 6. Stop when done. — If you have not made the matter 
 clear you will only befog it by explanations and variations. 
 Go back rather and rewrite what you have said. Have no 
 perorations, or long-drawn " clap-trap fortissimos in g," like 
 an opera singer hungry for applause. 
 
 Using Fine Tools Without Having Learned the 
 Trade. — A most interesting volume might be compiled of 
 the humorous blunders made by writers in the use of a 
 language they do not understand. " Translators, traitors " 
 {Traduttori traditori), is an old saw, to be exemplified, 
 probably, while there are two languages left in the world. 
 La de?niere chemise de V amour, for Love's last shift ; La 
 Perruque Inde"pendante, for The Independent Whig ; God 
 defends adultery for Dieu difend Vadultere ; Great is truth, 
 and it will prevail a bit, for Magna est Veritas et preval- 
 abit, etc., are well-known instances. There is an Arabic 
 translation of the Bible which translates " Judge not, that 
 ye be not judged," by, Be not just to others, lest others 
 should be just to you, and the traitorousness of our own 
 English translators is illustrated by the fact that in the 
 original of Job the words, Oh that mine adversary had writ- 
 ten a book, are (alas, that it is so !) badly misrepresented 
 by the King James' version. The mistranslation of tellu- 
 rische Magnetismus, as the magnetic qualities of tellurium, 
 it is said, made an eminent chemist much trouble in test- 
 ing tellurium for the magnetism. Every literary physician 
 could probably add a dozen words to Skeats' list of ghost- 
 words. 
 
108 SUGGESTIONS TO MEDICAL WRITERS. 
 
 This bastard imperialism of ours is on the road to the 
 production of a bastard English, and among the first offer- 
 ings in proof we are glad to give our readers to-day an 
 instance from medicine not without instructiveness in a 
 number of phases. There lies before us a pamphlet en- 
 titled, Extrat of my Original Work of the Grease in Yellow 
 Fever Urine, by a physician of one of our 1200 newly-ac- 
 quired islands. We copy verbatim : 
 
 Afterwards the war, now in the peace, when Cuba nid to go 
 rspidly to arrive the 15 or 20 million of white men, that she can 
 support ; and the agriculture go to reach the place that she deserv, 
 and owe to be, in this richer ground. I think it is necessary, to 
 open all the door to all the men of good will. 
 
 They are in Cuba two dangerous illnes, the malaria fever, and 
 the yellow fever. We know that the padudic manifestati6n is 
 owe to one protozoos, that is an ameba that had flagelas in num- 
 ber of one to four for each one ; that tad not envelop of quitinous 
 substance, that tad a voluminous nucleus, that can be see when 
 we add acetic acid ; the membrane that envelop the amebe is rich 
 in albumen, and in another substance vegetable, insomerum of 
 the vegetable filotum, the flagelas had not in its end cupping 
 glass. 
 
 The form of the paludic ameba is spherical when it is big and 
 strong, its reproduces by gems and by segmentation, they lives 
 in the waters richer in organic vegetables substances and in alka- 
 line medium, we can make by this way artificial and sterile 
 swampy, with ten part of boullon alkaline for 100 part of sterile 
 water. 
 
 They dont not belong to the gregarinas, nor to the coccideus, 
 they are not gregarinas because they have not quitinous in its 
 composition, and they are not coccideus, because they have not 
 its ovular phase. They are not simple ameba because they have 
 flagelas and nucleus. 
 
 Its breathing and its circulation is owe to the capillarity and 
 osmosis laws, its food itself by a hole. The writters have present 
 to the Academy of medicine in this town, several cases belong to 
 the reconcentrados, thad had present the two forms of beri-beri 
 illness, the atrophic and the swell forms. I have proved their that 
 beri-beri, is the product of famish and paludic intoxication The 
 
STYLE. 109 
 
 blood of all they for famish was-analyze by me, all have had the 
 paludic ameba. 
 
 For me the paludic access, is the result of the fight between 
 two amebas, the leucosyts, this probo ameba in the normal blood 
 and the paludic ameba ; ours owe as a doctor is to aid the leuco- 
 syts, so that its can win the paludic ameba. Both the leucocyts 
 and the plasmodic has the same compositi6n, life, etc. 
 
 In yellow fever we all think that they are one germs in its 
 cause, but ours means of dye and of culture can not put out at 
 our sight it. — Freire's cocus, Finlay's tetrageneus, Gibiei's cor- 
 mogenous, Stenberg's X and sanarelli' baccilus, has not full us, 
 as the cause of yellow fever. — The histological works of this ill- 
 ness is make much times ago. The clinical study is all in yellow 
 fever. Dr. Laine Mayor of Sanity of the American Army has 
 address one questionary to the Doctors in Havana, one of the 
 cuestion put their was that. — Are their one symptom that can be 
 pathologilical in yellow fever ? Yes sir can I ausuer and in the 
 urine you can always faind it ; it is the grease, you know per- 
 fectly well that yellow faver has a quickly evolution in 3 or 4 days ; 
 the fever and all the symptoms fall down and the infection of the 
 body has finish. — The terminical periodic begin and by the urine 
 you can make by surefy yours diagnossis, by the methodical ex- 
 amination of the urine you can see in it the fatness degeneracy of 
 the kidney, and say suretly the prognostic. 
 
 That is the pathological symptoms in yellow fever and you 
 can see it always in the urine. It is certainly that the kidney is 
 the entrails more affect The apparition of grease in the urine, 
 that I am the first in see and saying, show clear the fatness pro- 
 cess that is characteristical in yellow fever always urine is acid in 
 yelloow fever. And the colour is in direct relation witk the seri- 
 ous of the case. Yellow fever is one serious infection, that every 
 one can take by the water, or by breathing in contagious atmos- 
 phere, its evolution is in 3 or 4 day and give immunity, afterwards 
 of the remition of all the symptoms, the last periodic beginning 
 and it can finisched by two modes by cure or by death : in the 
 urine you can by the microscopical examination follow the illness 
 and make a certainly prognostic. 
 
 In proof of this I am going to refer you two case, one is cure, 
 the other is death. — Both taking bed in Angeles Hospital, in the 
 5 days of its illness afterwards of the characteristics remission. 
 
1 10 SUGGESTIONS TO MEDICAL WRITERS. 
 
 Both have had the same thermometer and pulse curve line, one 
 of they have and incoercibles vomit, insomnious near 48 hours 
 and cure hersself ; the other one rest quiet in his bed and only 
 have had furious delirium a few hours before his death. The frist 
 one, that is to say that, that cure had not jaundice ; the other one 
 that, that dead have had a pronounce jaundice. 
 
 Let us see now the urine, that of the woman, had a yellow 
 colour, reacti6n acid, specific weig h, 1,018 Albumin enough/ at 
 the microscope a great deal of grease and also epitelic cellule in 
 fatness degenaracy leucosy, kidney cellule and kidney cylinder, 
 in fatness degeneracy. In the man the urine had one brown yel- 
 low, reaction acid, albumen 3 grames by 1.000, a great deal of pig- 
 ment and bile acid. By the microscope you can see a great deal 
 of kiduey cellule in fatuess degeneracy. The analysis of the irune 
 show us the march of the kidney fatness degeneracy : in the 
 woman we can see the restitution ad integrum of the kidney tis- 
 sue, till the point to desappear all abnormal in the nrine an she 
 leave the hospital in the ten days of ters illnes, because she was 
 cure. The examinatton of the urine in the man let see that the 
 dead is the natural end of the fatness degenerancy that go in. in- 
 crease every day. In 120 grames of urine obtain by the sound, 
 afterwards of 24 hours of anurie. I have faund so great deal of 
 kidney cellule that I doubt very much that one can faind more 
 that in this nefritis parenquimatous acute, afterwards of this the 
 pacient had been taken by a complete anurie. This urine greasy 
 belong ouly to the yellow fever. Yellow fever-Histologie We 
 have make the following, post mortem examination. 
 
 Frist case belong to one Spanish man-Corujosegoud case be- 
 long to one Spanish man-Quintela Third case belong to one 
 American man Henry Smith. Fonr cases, has not deads of yel- 
 low fever. Patrick Smith. — For proves the grease we have put 
 the histological cuts of the liver and kidney into the accion of 
 osmic acid 1 by 100, and to Marchi method that showing very well 
 the fatness degenerancy because its dyers the grease in black 
 colonrs. In Patrick Smith case the reaction of the grease, have 
 not had place notwiths.tanding that the entrails cuts has put into 
 osmic acid solution for 4 hours. 
 
 In the liver of the 3 first case we can see the degenerancy and 
 infiltration of the grease in all the organ, the livers cellules was 
 full of grease and the same happen in the intercellular espace. 
 
STYLE. Ill 
 
 In Patrick Smith case his liver have not farness degeneracy, but 
 he had very much melanich pigment. Patrick Smith have not 
 lesions in Peyer's plates and his blood examination before of 
 deads by Coronado and Kramer have show us the Leveran's plas- 
 modie, we can affirm that he death of a paludic fever, and have not 
 give his blood the Widal's serum reaction I am going now to 
 refer the lesi6n of the kinneys we have observe two state, the first 
 congestion, that can go to the apoplexy of the glomerul ; and in 
 last and second state the fatness degeneracy that can be following 
 by the destruction of the kidney parenquima, we see also the 
 hemorrhage focus, that go to transform in purulent abcess, and 
 the necrosis of the Malpigio glomerul. We cannot see this lession 
 in Patrick Smith case. 
 
 As you can see the first organ that in yellow fever put out 
 first the fatness degeneracy is the kidney since the first day the 
 urine accuse mucine, s nee the second 6 third days the albumen 
 appear and the grease como sooner and vacillate like the illness 
 fluctuate, and by the microscopice examination we can make 
 snrely the diagnossis and the pronostic, and follow the kidney 
 destruction by the fatness process day by day and steps by steps. 
 In the five day of the illness jaundice appear and the pace of the 
 bile by the kidney filter add more elements to the destruction of 
 the cellules of this orgam, that had been before lessioned. — The 
 bacterioogic is for making in yellow fever we have employeed 
 Sanarelley's method and we have faund the baccillus in case that 
 dont not belong to yellow fever, and in truly case of yellow fever 
 we have not been able in faind it. 
 
 I think that I can now affirm that we possess now one sing 
 that always we can faind in yellow fever urine, that is the grease, 
 that put out the general degenerancy by the grease in yellow fever, 
 and that I am first to speak and to make appear. 
 
 's originates works. 
 
 i° Is the drarrhoa with our withot fever the porter and prop- 
 agator of the contagion ? 
 
 2°. Is beri-ber iilness the result of famish and paludic intoxi- 
 cation ? 
 
 3°. Hysterical grils. 
 
 4°. Phisiological destrut produce by the first evolution of 
 teeth. 
 
112 SUGGESTIONS TO MEDICAL WRITERS. 
 
 5° Antidifteric serum in the serious ulceration y mauth. 
 
 6°. One case of esphalum of the feet and anurie belong to one 
 boy of the reconcentrado that have beri-beri. 
 
 7°. Diarrhoa of blood in the childhood 
 
 8°. One case of Pott illness, cure. 
 
 9°. Paludic (marshy) dispeptic. 
 
 io. Biology of Laveran's parasite. 
 
 ii. Is the marshy (paludic) accee the result of fight between 
 two amebas, and is the leucosity [the white globul of blood] one 
 ameba ? 
 
 12. Is phosphoirc loss the consecuence of the destruction of the 
 organism ? 
 
 13. Differential diagnossis between yellow fever and bilious 
 malaria fever. 
 
 14. Clinical, histoligical and bacteriollogical diagnossis in yel- 
 low fever. 
 
 15. The grease in yellow fever urine. 
 
 16. The yellow fever germs. 
 
 17. It is enough only see in blood serum the mee melanic pig- 
 ment for making the diagnossis of malaria. 
 
 All this works has been read at the Academy of Medicine in 
 Havana city. 
 
 We should in justice to the author add that a full page 
 of errata is appended, in which we are told f or protologili- 
 cal, read protological, for ausuer read ausuer, for weih h, 
 read weigth, for fatness, read falnes, for seguod, read segond, 
 for drarrhoa, read drarrhcea, for destrut, read destrub, etc. 
 
 We have not the remotest desire to raise a smile at the 
 expense of our serious-minded coworker, but only to illus- 
 trate several valuable lessons or psychologic laws. We can 
 use our own native tongue so grotesquely as to traduce 
 our meaning, and unconsciously tell a sorry tale of our past 
 history and present ideals. But when we try to use a for- 
 eign language we must be doubly on our guard. The trou- 
 bles of our author with his -als, and -icals, terminical, bacte- 
 riollogical, protologilical, etc., will bring him the tear of 
 sympathy of the sticklers for all the -als. There are printed 
 every week millions of pages of quack medical literature, as 
 
STYLE. 113 
 
 sincere, innocent, and bunglesotne as this letter. As much 
 more is printed in which the ignorance is spurred, not by 
 egotism, but by grocer's bills. For example, why should a 
 self-styled scientist have the recklessness to print the non- 
 sense that one set of nerves transmits faradic electricity, 
 another galvanic electricity ? Scientific medical knowledge 
 is also at last itself only a tool, and when vanity or igno- 
 rance uses this tool, that an accident may have put into its 
 inexpert hands, the result is not mirth-provoking pseudo- 
 Spanish-English,, but may be the health and life of patients. 
 Fine tools (and what finer or more marvelous instrument 
 is there than language and science ?) should not be used 
 by clumsy hands and unskilled brains without some least 
 attempt having been made to learn the rudiments of the 
 technic. As well pretend to be a bacteriologist without 
 ever having peeped through a microscope. 
 
 Strabismic Construction. — By this term we mean the 
 fact that words are so misplaced in a sentence or so badly 
 chosen that they either fail to convey the meaning in- 
 tended, or positively mean the reverse of that desired. 
 They do not tell the story exactly. The Associated Press 
 despatches from Europe should be properly worded, be- 
 cause of the gravity of the news transmitted so far and by 
 such an expensive method as the cable, and yet in the 
 report of the Dreyfus trial the prisoner was asked if at 
 one time he was possessed of certain information. The 
 reply was thus translated : I only had incomplete informa- 
 tion. By these words we are undoubtedly to understand 
 that it was only incomplete information that he had, 
 whereas the words themselves tell us that the speaker 
 was the only person who had incomplete information. 
 This word, only, and another, alone, are frequently out 
 of place, and, according to the license of some writers, 
 may walk about in a sentence quite unrestrained, or sit 
 down wheresoever the whim may dictate, and often in 
 the most incongruous place. But the exact writer may 
 
114 SUGGESTIONS TO MEDICAL WRITERS. 
 
 exclaim, " Me this unchartered freedom tires." Some- 
 times the two words are interchangeable, but, as a rule, 
 each has its appropriate function and position. There is 
 often a lurking contempt in expressions with only, espe- 
 pecially if this word is misplaced. " He is only fitted for 
 this" has a different meaning from " He only is fitted for 
 this" (or " He alone is fitted for this-"). It is a good plan 
 to look at these words closely when we use them, and in 
 general to keep them in contact with the words to which 
 they refer. There are other and innumerable ways in 
 which writers fail in accuracy through this construction 
 louche, as the French call it. A frequent method is such 
 indefiniteness in the use of he, her, him, it, they, etc., that 
 the reader is unable to know to what the squinting pro- 
 nouns refer. This has been caricatured a hundred times, 
 — the following examples not being much more ridiculous 
 than many occurring in otherwise good medical essays. 
 This is said to have been the wording of a sign placed 
 in the field of a much pestered person : " If any mans or 
 womans cow or ox gets into this here corn his or her tail 
 will be cut off as the case may be." And this is the copy 
 of a genuine note : " Mr. A. presents his compliments to 
 Mr. B. I have got a hat which is not his ; if he have got 
 a hat which is not yours, no doubt they are the missing 
 one." Here is an instance in medical writing: "No one 
 as yet had exhibited the structure of the human kidneys, 
 Vesalius having only examined them in dogs." (To what 
 does them refer ?) Which is a word, too frequently used 
 in any sense, but especially when it is popped down too 
 far from the word to which it points — a result which has 
 been called " the sin of whichcraft." 
 
 Sentences that Suffer from Spastic Paraplegia 
 are altogether too common even in .the writings of good 
 thinkers and scientists. Let us choose the last sentence 
 that we tried to make stand steadily on its feet : 
 
 " Examination with the endoscope has, in a number of cases, 
 demonstrated that the inflammatory process, even after long du- 
 
STYLE. IIS 
 
 ration, may not extend, and, in the majority of cases does not, 
 deeper in this disease than to the mucous membrane, although, 
 in some chronic cases, especially if following the history of stone, 
 the muscular tissue, in some parts, and irregularly, may, more or 
 less, be also implicated." 
 
 It is such sentences as this that drive editors to drink 
 or to suicide. Shall one let them go, or endeavor to cure 
 their sorry disease ? One way for authors to correct this 
 paraplegic syntax is to attempt to transpose the modifying, 
 explanatory, and subordinate clauses, and to place them 
 so that the reader's mind is not every second brought up 
 with a jerk. One often feels as if he were being driven 
 slowly over a bad corduroy road. So far as possible a 
 good writer will enable his reader's attention to flow as 
 uninterruptedly as possible, or with a slow rhythm that is 
 very different from the " bumpetybump" of the foregoing 
 citation. In the first place all sentences should be of a 
 length that between periods and semicolons they can be 
 read aloud during a single expiration. Then, if we throw 
 the qualifying and adjectival clauses in front we are able 
 to get a flow, instead of spurts, of meaning. For example : 
 "In a number of cases examination with the endoscope 
 has demonstrated that the inflammatory process does not 
 usually extend deeper than the mucous membrane. Under 
 certain conditions, such as chronicity, or the history of 
 stone, some portions of the muscular tissue may be more 
 or less implicated." 
 
 Let us Stop the Use of the Subjunctive Mood ! — 
 The extraordinary simplicity of construction of the English 
 language, like every other product of civilization, has flowed 
 naturally from qualities of mind in the originators. It has 
 led to the designation of English as the grammarless lan- 
 guage. However this may be, it is undoubtedly of all the 
 languages of the world the freest from hard and fast gram- 
 marial formalism. Almost every adjective can be used 
 unchanged as a noun, and almost every noun as an adjec- 
 
Il6 SUGGESTIONS TO MEDICAL WRITERS. 
 
 tive, and there is the greatest liberty in the placings and 
 functions of all words. These free and uncomplicated 
 qualities have been and are potent factors in making Eng- 
 lish the world language it is certainly destined to become. 
 But in its evolution, like every other organism, it must bear 
 with it remnants and tags of old atrophied and useless 
 organs, wholly or partially outgrown. Our wonderful but 
 incurable spelling is one. Another is the subjunctive. We 
 have turned it over to the poets and other dealers in the 
 antique, but still, dilettantelike, one occasionally writes, 
 If the artery be not found, In case it be not so, etc. It may 
 be confidently said that in English the subjunctive is op- 
 posed to the genius-of the language and of its speakers, 
 that this subjunctive is rapidly becoming archaic, and the 
 sooner it is entirely disused the better. We are active- 
 minded people, will not submit, and so in grammar we have 
 no passive voice. We are positive and indicative-mooded 
 in our characters, and so we have, or are wisely hastening 
 to have, no subjunctive. If one says (not, if one say) if, it 
 it is only a passing supposition, neutralized by if it is so, if 
 it is not so, etc., in which all the doubtfulness necessary to 
 be conveyed, all the contingency admissible, resides in the 
 little supposition if and is not incorporated in the very 
 heart of the sentence, the verb. Let us abolish the use of 
 the subjunctive ! 
 
 Badly Chosen Words. — It is somewhat dangerous to 
 advise against the use of even the most foolishly chosen 
 words, because no one can foresee with what illogicality 
 Lord Demos may be pleased. If it suits his whim he will 
 pick up the most arrantly nonsensical word and use it in 
 the most whimsical way until even the aristocrats of lin- 
 guistics are compelled to fall into the habit ; the word thus 
 becomes perfectly legitimized and "received into the best 
 society." But at worst one may in the meantime give his 
 language strength and perspicuity by using the right words 
 in the right places, or at least by avoiding their employ- 
 
STYLE. 117 
 
 ment in the wrong places. We purpose listing a few of 
 the words most frequently misused in medical literature : 
 
 Apt, instead of liable, likely, or probably. Apt refers to an in- 
 herent tendency, the having an aptitude, and should not be 
 applied to conditions in which we mean likelihood or prob- 
 ability. "The tissues may be apt to heal," but the leg is 
 not "apt to be broken." 
 
 Where, instead of when. If we mean a time-relation, it is mani- 
 festly absurd to use an adverb of place. Not where, but 
 when the stomach is perforated, etc. 
 
 Where, instead of in which. The case where instead of the case 
 in which. 
 
 Alike ; two, or both things, cannot be alike. 
 
 Couple, instead of two. Two things may be coupled, i. e. , bound 
 together, but not necessarily or generally. 
 
 Get, instead of, or in addition to have. Get and got, commonly 
 used, are superfluous. 
 
 Expect, for think, suppose, etc. 
 
 Observe, for say. 
 
 Notable, for noteworthy. 
 
 Reliable, for trustworthy. 
 
 Section, or quarter, instead of place, country, neighborhood, etc. 
 
 Witness, for see, is one of a hundred examples of newspaper Eng- 
 lish, or highfalutin. 
 
 Recuperate, instead of recover. 
 
 Extend an invitation, instead of ask, or invite. 
 
 Above and below, instead of foregoing, following. When printed, 
 above may prove to be below, etc. 
 
 Bad cold, for severe cold. 
 
 Beside, instead of besides. The first means by the side of, 
 the second moreover, in addition to, etc. 
 
 I do not doubt but that, for I do not doubt that. 
 
 Each other is said of two, one another of many. 
 
 Bad health, instead of feeble, or delicate health. 
 
 Had I have known, instead of had I known. 
 
 Ought to, instead of should, — a very common error. 
 
 Healthy, for wholesome, or healthful. Exercise is healthful, 
 food is wholesome, a person healthy. 
 
 In respect of\ instead of in respect to 
 In regard of > 
 
Il8 SUGGESTIONS TO MEDICAL WRITERS. 
 
 Nicely for well. I am nicely has been called "the quintessence 
 of popinjay vulgarity." 
 
 As far as j instead of so far ag 
 
 As soon as ) 
 
 Whether or no, instead of whether or not. 
 
 No fewer than, instead of not fewer than. 
 
 No one of them, instead of not one of them. 
 
 I propose, for I purpose. 
 
 Previous to, instead of previously to. 
 
 Those who, instead of they that. 
 
 En passant, for in passing. 
 
 Avocation, for vocation, calling, or business. 
 
 Accident, instead of wound or injury. We have seen the expres- 
 sion "the accident was cured." 
 
 Once in a while, instead of occasionally, sometimes, etc. 
 
 Aetat, for of age, old, etc. 
 
 Can, instead of may, an irritating and common error. " The 
 specimen can be seen in the laboratory, " " the operation 
 can be performed in the private room," and similar ones 
 may be found in every page of medical writing. 
 
 Met with, instead of met, found, etc., is another exasperating ex- 
 pression, requiring the poor editor's blue pencil about ioo 
 times a day. " Such accidents are often met with and the 
 operator can expect," contains three most common errors. 
 " Begin with,'' is analogous blundering. 
 
 Arrived at, instead of reached, concluded, etc. In " The follow- 
 ing are the conclusions arrived at," the last two words are 
 useless. 
 
 As to the Use of Certain Words. — The world seems 
 determined to use where, when often it really means and 
 should use the words in which or when. It would be bet- 
 ter to use the former word when it is a question of place, 
 position, or location, and the last word when the indication 
 of time is desired ; and it is certainly better to speak of a 
 case in which than a case where. There is a habit quite 
 as inveterate of misusing the word apt, when one means 
 likely or liable. The subservient dictionaries in chronic- 
 ling the fact of this misuse seem to justify it. Indeed one 
 
STYLE. 119 
 
 can find warrant for almost any wrong usage in the word- 
 books or in all but the few very best writers. When we 
 wish to imply a tendency and mean suitable, adapted, expert, 
 inclined, prone, etc., we may correctly use the word apt, but 
 if we mean to express probability, the result of a calculation 
 of chances, etc., other words are more proper. Frequent is 
 often incorrectly used for common, and vice versa, and the 
 same may be said of since and as. That serves the pur- 
 pose in nine-tenths of the places wherein who and which 
 are used, and as regards among, we would suggest out of, 
 or simply of, as often better, — e. g., of 100 patients 20 were 
 over 10 years of age, etc. The Richmond 'Journal of Practice 
 correctly urges the use of the term surgical intervention, 
 instead of surgical interference. We should avoid the " split 
 infinitive," i. e., the insertion of words between to and the 
 infinitive, e. g,, to intelligently act, to thus operate, etc. 
 Some writers are overfond of the word very, and of people 
 instead of persons. We think it bad taste for one to write 
 the author, or the writer, when speaking of himself. It is 
 the prudery of egotism. A great physician recently wrote 
 concerning phlebitis of the veins of the leg, and not seldom 
 one will see such expressions as osteitis of a bone, neuritis 
 of a nerve, etc. Right side of the chest seems preferable to 
 right chest, right heart, etc., as applicable to mammals. 
 As pneumonia is used to mean inflammation of the lung, it 
 is redundant to speak of pneumonia of a given part of the 
 lung. It is often possible to distinguish between hemor- 
 rhage, thrombosis, embolism, etc., when writing apoplexy. 
 Oviduct is preferable to fallopian tube, and we could wish 
 never again to meet the constantly recurring expression 
 met with. Prepositions at the end of sentences are com- 
 mon with persons who wish to know " where they are at." 
 No and none are singular, but are not rarely conjoined with 
 improperly plural nouns and verbs. Too commonly the 
 statement appears that "the secretions were negative," or 
 "the examination was negative," when it is meant that the 
 results of examination were negative. Let us not talk or 
 write about doing operations, but of performing them. 
 
120 SUGGESTIONS TO MEDICAL WRITERS. 
 
 Concerning Logical Order in CoMPOsmoN.-^Many 
 writers forget that there is a gain to be derived from the 
 arrangement of the parts of their article in a logical order. 
 One may not be able to make clear what logical order is in 
 a general way, but in a special article its want may fre- 
 quently be observed. In a sentence there is a strong and a 
 weak method of placing the component words ; in a para- 
 graph there is one best manner of marshalling the sentences, 
 and in the entire article there is one proper plan of ordering 
 the paragraphs. One method will unfold the thought or in- 
 formation, making it easy for the reader to follow, and giving 
 a cumulative and convincing effect to the whole. Whether 
 the propositions summarizing an article are printed or not, 
 it is advisable to make them, as thereby an inversion or 
 failure in the logical concatenation may be detected. 
 
 "Immune to," "Immune from," etc — We have been 
 asked as to the proper preposition to use with immune ; 
 should it be. from, to, or against? The original significance 
 of the word immunis was, exempt from public service or 
 charge, the thought being one of a release from a common 
 duty or obligation. In applying the term in a medical 
 sense, the essential idea of exemption is preserved. It is 
 a matter of indifference whether the condition is of natural 
 or acquired (artificial) origin. Replace the word by its 
 nearest synonym, exempt, and the preposition from is 
 required. 
 
 The Bryant Index Expurgatorius was a word black- 
 list devised by the poet-editor to try, by its aid, to with- 
 stand the onrush of philologic depravity, whereby the 
 ignorant newspaper reporter and editor endeavored to hide 
 their ignorance and some other qualities worse than ignor- 
 ance. The newspaper men even of today still feel the 
 sting of Bryant's irony and do not lose an opportunity to 
 jibe at the failure (what they call failure) of the attempt to 
 teach them some degree of literary manners, and they think 
 
STYLE. 121 
 
 because they are more numerous, more unabashed and 
 powerful than they were in Bryant's day that their banal- 
 ization of English is therefore correct and a great success, 
 atfid that Bryant was a "failure." It would be just as true 
 and as sensible to say that laws against theft and murder 
 are failures because these crimes abound, or that boorish- 
 ness is beautiful if the majority turn boors. The famous 
 list was in large part made up of examples of highfalutin, 
 and of that indescribable combination of bad slang, worse 
 impertinence, and worst inaccuracy which can only be fit- 
 tingly designated as newspaper English. Of this class of 
 terms we might cite from the list of disapprovals : Artiste, 
 for artist ; casket, for coffin ; cortege, for procession ; darkey, 
 for negro ; devouring element, for fire ; gents, for gentlemen ; 
 inaugurate, for begin ; lady, for wife ; lengthy, for long ; 
 Mrs. Governor, Mrs. President, etc.; pants, for trousers; 
 party or parties, for person, persons ; state, for say ; would 
 seem, for seems ; settle, for pay ; locate, for settle ; in our 
 midst, for among us. Such a list would include hundreds 
 of similar terms, if some later Bryant were to remake it 
 today. 
 
 The newspaper man who sneers at " the Bryant Index " 
 has a confused jumble of an idea in his head that the index 
 failed because it sought to banish slang. This error arises 
 from a natural and ineradicable inability on his part to dis- 
 tinguish between slang and the banal. The one is the 
 lusty living brat of properly married intelligence and reck- 
 lessness, the other the bastard of stupidity and vanity. 
 Many slang words make excellent citizens when they grow 
 up and find their place in the world's work ; but the cant 
 of idealess conceit never gets into better literary society 
 than that of the " Knights of the Quill." 
 
 Bryant erred in including in his list some terms that 
 were not inherently wrong or vulgar, and which needed 
 only usage to make them proper and serviceable tools. 
 The error is one that the " pernickety stickler " is very 
 likely to make. It is a dangerous, even a fatal thing, this 
 
122 SUGGESTIONS TO MEDICAL WRITERS. 
 
 " art for art's sake " — the thinking more of how one says 
 it than of the thing said. In English, too, it is peculiarly 
 dangerful to prescribe or proscribe. It is, indeed, " a gram- 
 marless tongue," and of all languages it responds most 
 sensitively to the shaping mind of its makers, who, in their 
 vitalizing democracy, will not allow any habit of tool or of 
 tool-using to hinder them from realizing their ideals. 
 
 The Split Infinitive. — At a recent medical meeting 
 one speaker's scientific statements were criticised because 
 in the very act of stating them he had committed the liter- 
 ary crime of the split infinitive. There is, indeed, a cer- 
 tain truth in the proposition that the correctness of a 
 writer's language is an indication of the correctness of his 
 science ; because if a man is an accurate observer of facts 
 and a logical reasoner concerning them, he will also natur- 
 ally be a correct observer of the facts of words, their mean- 
 ings and uses. Humbug and quackery and medical crim- 
 inality, when expressing itself in print, creates a new 
 linguistic never before seen by gods or men. But this 
 inference may be drawn too absolutely, and hard and fast 
 logic is not often permissible as regards matters philologic, 
 especially if of the English variety. The London Academy 
 recently hit off the split-infinitive sticklers in a delightful 
 skit, of which we can spare space for the last paragraph 
 only: 
 
 There was one critic who seemed rather tired, and him I took 
 aside. " Does it really pain you all so very much ? " I asked, 
 He glanced round to see that he was not overheard : " Well, it is 
 like this," he said, frankly, "suppose you have to criticise style. 
 You may not know what style is, or you may not have time to 
 look for it. So you just glance at the infinitives. If they are split, 
 the man has no style ; if they are not split, he has, and your work 
 is all done without any trouble. That is what it seems to me to 
 really amount to." All unconsciously he had committed the ter- 
 rible offence : Everybody does. 
 
 This, of course, is a humorous exaggeration, designed 
 to say that it is absurd to go daft over the matter. As a 
 
STYLE. 123 
 
 rule we agree that it is best to avoid throwing the adverb 
 into the infinitive in this way, because generally it weakens 
 the sentence, and by placing it elsewhere we can more ac- 
 curately express what we wish. The last words of the 
 foregoing sentence are, from one point of view, criticisable 
 upon the same grounds as the split infinitive, and were 
 written to bring out this point. " We can more accurately 
 express," strikes us as less forceful than, " We can express 
 what we wish with greater accuracy." Take the two 
 sentences brought in as the best examples the London 
 Academy chaffer can find : " We have agreed to unanim- 
 ously think it wrong ; " the critic hastily corrected himself 
 and said, "We have agreed to think it unanimously wrong," 
 thus making matters worse, of course. " We have unan- 
 imously agreed, etc.," was naturally omitted by the carica- 
 turist. "This is what it seems to me to really amount to," 
 is a poor justification. There are a dozen more happy 
 ways of writing the sentence. Not alone with those who 
 have occasionally used the split infinitive will the gram- 
 marian's purgatory be filled, and yet those who have sinned 
 least in this way will probably be more speedily prayed out. 
 
 In Figures, or Spelled Out ? — Writers of equally 
 good judgment differ in their custom and advice in refer- 
 ence to spelling out numbers, or putting them in figures. 
 All agree, however, in advising that numbers above 100 
 should be given in figures. In medical writings we are in- 
 clined to place the dividing line (under which to be spelled 
 out), at 10 instead of 100. When giving statistical data so 
 that other figures are collated in the same paragraph we 
 would advise figures in all cases whatsoever. When but 
 one or two items referred to, and requiring the numerical 
 terminology, occur in a paragraph, it is as well to spell out 
 even in condensed scientific reports, especially numbers 
 smaller than ten. But good taste and judgment must de- 
 cide in all these matters, concerning which we do not 
 believe in rigid rules. We would in certain cases think it 
 
124 SUGGESTIONS TO MEDICAL WRITERS. 
 
 perfectly right to break the old rule that figures should 
 never begin a sentence. It would in the great majority of 
 cases be in bad taste, but sometimes it would be just as 
 ridiculous not to break the rule. A large majority of peo- 
 ple desire to be bound by, or to bind themselves with, ex- 
 ceptionless rules. They have missed the best part of educa- 
 tion, which is to have learned that the best rule in all cases 
 is to make or to break rules according to reason, taste, and 
 good common sense. 
 
CHAPTER VII. 
 
 RULES FOR EDITORS AND PUBLISHERS OF MEDICAL 
 JOURNALS. 1 
 
 By H. O. HALL, 
 
 Library, Surgeon-General's Office, U. S. A. 
 
 It is well known to all writers for periodicals that cer- 
 tain rules are laid down by editors and publishers, which 
 must be observed by authors if they expect to have their 
 contributions accepted and published. These rules are 
 very just and proper, and no one questions the right of the 
 editor to reject manuscripts which do not conform to the 
 rules laid down. I am not aware, however, that any one 
 has ever had the temerity to suggest the importance of 
 laying down certain rules for the government of the editors 
 and publishers, themselves. They have a happy-go-lucky 
 way of editing and publishing their journals according to 
 the dictates of their own consciences, and no one dares to 
 say them nay. That there is very great need for the es- 
 tablishment of some good, wholesome and uniform rules for 
 the government of this independent and aristocratic class 
 of public benefactors, I think I can clearly demonstrate. 
 The sins which they commit are numerous, and yet I am 
 sure they are more the result of thoughtlessness and care- 
 lessness, than of pure viciousness. They have a great 
 deal to answer for, however, and: if they do not repent and 
 turn from their evil ways I am afraid that in the world to 
 come they will have ample cause to regret, their misdeeds 
 in the society of librarians whose hopes of future happiness 
 they were the means of wrecking, unconsciously no doubt, 
 but none the less surely. 
 
 1 Republished by the courtesy of the Author from t<he Philadelphia. Medical 
 Journal of December 30, 1899. 
 
 (125) 
 
126 SUGGESTIONS TO MEDICAL WRITERS. 
 
 To the librarian and the indexer of periodic medical 
 literature the necessity for a reformation among publishers 
 and editors is more apparent than to the regular or casual 
 reader. To the ordinary reader or subscriber of a monthly 
 medical journal, for example, it is more agreeable than 
 otherwise to receive a nice fat anniversary number of his 
 favorite journal, twice the size of the regular issue, but to 
 the librarian and the bookbinder such a monstrosity is a 
 nightmare. The regular size of the journal, we will say, 
 is octavo ; for years it has been of that size, and the library 
 shelf on which the entire series is filed is adjusted to 
 accommodate volumes of octavo size. But, in celebrating 
 some anniversary occasion, the publisher, to please his 
 patrons, issues an " anniversary number " with great 
 flourish of trumpets. This number he enlarges to a royal 
 octavo, quarto or even a folio in size. When it reaches 
 the library it becomes a "white elephant." It will not fit 
 in oh the shelf with its fellow numbers among the unbound 
 periodicals, and when it is sent to the bindery with the 
 rest of the volume, the bookbinder is at his wit's ends to 
 know what to do with it. He may cut down the margin 
 till there is nothing left, and still it is too large to bind in 
 with the other numbers. It is too thick, even if he elimi- 
 nates the advertisements, to fold down into an octavo. 
 What shall he do with it ? He will either have to make 
 the entire volume of uniform size with the anniversary 
 number or else bind it separately. In neither case will it 
 fit in its place with the other volumes of the set. He may 
 possibly lay it on its side, or squeeze it in on top of the 
 other volumes if there is room, or stand it on its edge, let- 
 ting it stick out beyond all the other volumes, or file it in 
 another part of the library among the quartos, to be 
 searched for whenever wanted. Any way you fix it it is a 
 nuisance and will be a nuisance to the end of time, or till 
 the library is destroyed. How much better would it have 
 been if the publisher had adhered to the regular size of his 
 journal, and found vent for his exuberance in the addi- 
 
RULES FOR EDITORS AND PUBLISHERS. 127 
 
 tions of any number of " anniversary " pages of uniform 
 size with the journal. 
 
 This same difficulty arises when either by reason of 
 prosperity or adversity a journal changes its size — to a 
 larger or a smaller — in the middle of a volume, or in fact at 
 any time. It destroys the uniformity of the set and makes 
 trouble all along the line in every library where it is kept 
 on file. If it becomes imperative to change the size of a 
 journal it should always be done at the beginning of a 
 volume or a series, and at no other time. 
 
 Change of Title. — What has been said in regard to 
 changing the size of a journal, may be said with greater 
 emphasis in regard to changes of title. This is another 
 source of endless annoyance and trouble to the librarian. 
 With very few exceptions there is not a medical journal in 
 the entire list on file in the great library of the Surgeon- 
 General's office, which has reached the age of puberty, that 
 has not changed its title more or less frequently since the 
 day of its birth. No one outside of a library has any con- 
 ception of the annoyance and perplexity caused by these 
 changes. One single instance out of hundreds of the same 
 character will illustrate what I mean. Without desiring to 
 make any invidious distinction, I will give as an example 
 the very latest change of title which has come under my 
 notice, that of the North American Medical Review, which 
 changed title in October last to the Medicus. The North 
 American Medical Review was the successor to the Missouri 
 Valley Medical Journal. Now to give a complete history of 
 the Medicus, showing all the changes of title, requires no 
 less than eight different entries in the catalog. Were it 
 not for the amount of space it would take, it would be 
 quite interesting, if not instructive, to give here a list of all 
 these changes of titles. But the matter of so many differ- 
 ent entries to describe one journal is only a small part of 
 the trouble caused by these frequent changes. 
 
 It extends to the binder and the indexer of the journal 
 
128 SUGGESTIONS TO MEDICAL WRITERS. 
 
 under its various titles. The North American Medical Re- 
 view ended with No. 9 of Volume VII, and the Medicus 
 begins at No. 10 of Volume VII. How shall these journals 
 be bound is the question that puzzles the librarian. There 
 are nine numbers of Volume VII of the journal under the 
 old title, and three numbers of Volume VII under the new 
 title. It would not do to bind Nos. 10, n and 12 of 
 Volume VII (The Medicus) with Nos. 1 — 9 of Volume VII 
 (North American Medical Review). If you bind Nos. 10, 
 11 and 12 in one thin volume it would not be correct to 
 call it Volume VII of the Medicus, and if these three num- 
 bers are bound in with the twelve numbers of Volume 
 VIII (supposing it completes Volume VIII without an- 
 other change of title and volume), it could not be called 
 Volumes VII and VIII, So the librarian is perplexed to 
 know what to do. 
 
 But the trouble does not end here. The indexer has 
 also a problem to solve. An article which began in No. 9 
 of Volume VII of the North American Medical Review 
 is continued in No. 10 of Volume VII of the Medicus. 
 How is he to index an article which began in one journal 
 and continues with consecutive pagination, number and 
 volume of another journal ? This same difficulty is liable 
 to occur, and does often occur, when the title of any jour- 
 nal is changed. But, to complicate the matter still further, 
 as if there was a studied effort to try to dethrone the 
 reason of the poor librarian, No. 1 1 of the Medicus, the 
 second under the new title, comes out as Volume VIII, 
 No. 11. The preceding number was No. 10, Volume VII, 
 and all reference to its being a successor to the North 
 American Medical Review is religiously omitted. So any 
 one not acquainted with its previous erratic history will 
 not be able to tell whence it came or whither it goeth, or 
 why it should be called Volume VII or VIII. 
 
 I have gone rather fully into the details of this one case, 
 and it is by no means an extreme one, to show the great 
 annoyance and trouble caused by the careless and flippant 
 
RULES FOR EDITORS AND PUBLISHERS. 129 
 
 manner in which publishers change the titles of their jour- 
 nals without a moment's thought of the consequences to 
 others. 
 
 Another constant source of trouble is the mistakes made 
 in numbering the volumes and pages of journals. These 
 are generally the blunders of the printer in making up the 
 forms. But there is no excuse for them and they should 
 never occur. Sometimes the volume is not changed at 
 all at the beginning of a new year, and the old volume is 
 allowed to run on perhaps through the year, thus making 
 two volumes with the same serial number, or a volume is 
 skipped. Volume XI, for example, to give an instance 
 now in mind, is by mistake changed to Volume XIII, in- 
 stead of XII, and the following volumes are numbered XIV, 
 XV, etc. So that Volume XII seems to be omitted from 
 the set as it appears on the library shelf, when in reality 
 there is no gap. In one journal which has been running 
 many years, the volume has been changed every month for 
 the past year and a half. The printer has merely mistaken 
 the volume for the running number, notwithstanding the 
 fact that the running number is given also in its proper 
 sequence. 
 
 January, 1898, is called Volume LVI, No. 1 
 February, 1898, " " " LVII, " 2 
 
 March, 1898, " " " LVIII, " 3 
 
 and so on for 20 consecutive months. Sometimes the mis- 
 take is discovered after several numbers have been printed 
 bearing the wrong volume, but the indexer of the single 
 numbers has no means of telling till the volume is com- 
 pleted, whether the volume will be changed or not, so he 
 either has to leave the volume blank, or put on his index- 
 card the volume given on each number, right or wrong. 
 Mistakes in pagination give similar trouble to the indexer. 
 As the Apostle says : "These things ought not so to be." 
 A little care and a little forethought would save a deal of 
 trouble and perplexity. 
 
130 SUGGESTIONS TO MEDICAL WRITERS. 
 
 So I think there should be laid down a series of rules 
 for the guidance of editors and publishers, and I give here- 
 with a few that suggest themselves to me without attempt- 
 ing to cover the entire ground, for "there are others" 
 which might be added. 
 
 Rules for Publishers. 
 
 i. Never change the title of a journal if it can be avoided. 
 
 2. If a change of title is necessary, let it be made at the begin- 
 ning of a volume. 
 
 3. Whenever possible let the change of title be made as a sub- 
 title. 
 
 4. Never change the size of a journal in the midst of a volume — 
 always at the beginning, and avoid such changes as much as 
 possible. 
 
 5. Never publish a special number or a supplement of a size 
 differing from the regular issue. 
 
 6. Before going to press be sure that the volume, the number and 
 the pagination is correct, and in proper sequence. 
 
 7. Whenever possible, begin and end a volume with the calen- 
 dar year. 
 
 8. All journals which do not begin with the calendar year should 
 state the period to be covered by the volume, i. e. , when the 
 volume will end, so that the indexer will know whether to 
 use the compound year or not. A journal begun in March, 
 for example, may end its first volume in December, or it may 
 run on until February, but this fact is never known until the 
 volume is completed. Every number should state the vol- 
 ume and year covered, viz: 1899-1900, Volume I; or 1899, 
 Volume I. 
 
 9. The volume, running number, monthly number, place of pub- 
 lication, name and address of publisher and editor, should 
 appear conspicuously upon every number of a journal. This 
 would save a great deal of time in a library. 
 
 10. Advertisements should not be permitted among the reading 
 matter in a medical journal. Many of the journals devote 
 so much space to advertisements that it becomes necessary 
 to omit them when the volume is bound to avoid unwieldi- 
 ness and expense in binding. 
 
RULES FOR EDITORS AND PUBLISHERS. 13 1 
 
 ii. Begin each Volume with a new set of paginations. Continu- 
 ous pagination from one volume to another, or separate pagi- 
 nation for each single number, is objectionable. When each 
 number is paged separately there is difficulty in finding a 
 given page, for each number of the twelve has the same set 
 of pagination. In such cases the journal has to be indexed 
 by number as well as by page. 
 
 12. Every medical journal should issue an index with the last 
 number of each volume. If no index is to be published, or 
 if it is to be issued later, it should be so stated in the last 
 number of the volume. Journals sometimes have to keep on 
 the unbound shelves one or more years, waiting for an index 
 which may never come ; and not infrequently an index comes 
 after the volume is bound. 
 
 Of course, if medical journals are published merely to 
 be read and then thrown in the waste basket, all these sug- 
 gestions go for nothing. But such is not the case. They 
 are bound and preserved, and by many libraries and physi- 
 cians are indexed ; hence the need of some uniform system 
 governing their publication. 
 
CHAPTER VIII. 
 
 DIFFICULTIES OF MEDICAL REPORTING. 1 
 
 By FRANCIS E. WESSELS, 
 
 of Philadelphia. 
 
 Official Stenographer. 
 
 Since medical reporting within the last decade has be- 
 come a distinct, progressive, and important science in itself, 
 and since precise adaptability of stenographic writing to 
 medical terminology has become a permanent necessity 
 among medical men, in scientific debates, expert medical 
 testimony, etc., it is quite evident that the position of the 
 official medical stenographer is one of especial responsi- 
 bility and dignity. It is on a plane with that of the official 
 court reporter in the essential requirements of accuracy 
 and official record. In fact, from a standpoint of education 
 and nomenclature, the work of the official medical stenog- 
 rapher must of necessity be intellectually higher and require 
 greater skill in execution, in point of mental acuity, tenac- 
 ity, and extended vocabulary. 
 
 There are practically no " bugbears " to judicial report- 
 ing as compared with the reporting of scientific debates, 
 for the reason that in taking sworn testimony, the court 
 reporter is empowered to interrupt the witness, if his 
 remarks are not intelligible or if they are inaudible. Why 
 should not the same prerogative be extended to the official 
 medical reporter when the speech of the medical man is 
 not clear ? This is necessary in order to secure a perfect 
 pen-picture of the proceedings. 
 
 It may be conservatively estimated that one-third of the 
 
 1 Reprinted with the kind consent of the author from the Philadelphia Medical 
 Journal of February 24, 1900. 
 
 (132) 
 
DIFFICULTIES OF MEDICAL REPORTING. I33 
 
 medical men who speak in public are ignorant of the factors 
 which combine to make their remarks sometimes impossible 
 of intelligent interpretation. The day has come when the 
 medical man and the medical stenographer must work 
 hand in hand, in order to conserve to scientific literature a 
 truthful record of progress and discovery. I, therefore, 
 venture to point out the difficulties under which the official 
 medical stenographer labors in endeavoring to take down 
 scientific debates. 
 
 There are many types of indistinct speakers, the most 
 pronounced being of that class who have poor enunciation ; 
 there is another class whose members, while they have no 
 oral defects, lack essential carrying-power of voice. These 
 gentlemen, knowing their weaknesses, would materially 
 add to the correctness of a report by speaking within "ear- 
 shot distance " of the stenographer, or, at least, in tones 
 loud enough to be unmistakably heard at the stenographer's 
 table. Rarely the speaker will get too close to the stenog- 
 rapher. He has, however, been known deliberately to 
 stand with his back turned, place two hands upon the table, 
 or with one hand resting on the table or on the stenog- 
 rapher's chair, impart a friendly to and-fro motion of the 
 body, much to the. chagrin of the scribe. This has been 
 known to produce symptoms simulating paralysis agitans 
 or agraphia — sometimes even resulting in an upsetting of 
 the ink bottle ! I remember on several occasions being 
 " rocked in the cradle " of deep despair by such a procedure. 
 A reliable stenographic report cannot be made when the 
 speaker stands with his back to the stenographer. 
 
 Sometimes a noted professor, seated at the back of the 
 auditorium, will address a national assembly and the pre- 
 siding officer will request him to step forward, so that his 
 remarks may be accurately reported. But with that modest 
 bashfulness only known to those who have already won 
 their laurels, in his still small voice, he will decline to come 
 forward, stating, " Mr. President — I really have not much to 
 add to the very interesting paper of Dr. ," but never- 
 
134 SUGGESTIONS TO MEDICAL WRITERS. 
 
 theless he will talk inaudibly for perhaps a half hour and then 
 look for a verbatim report of his speech. The stenographer, 
 the while, with eyes, nose, ears, mouth, and eustachian 
 tubes open, endeavors to jot down unheard things ! The 
 country practitioner, however, who is unused to testing 
 his vocal powers more often assumes this role. Hon. 
 Thomas B. Reed, in his book on " Parliamentary Rules," 
 in speaking of qualifications of a certain official, says : 
 
 " Either he or his assistant should be a good reader, with a 
 clear voice, capable of being heard in all parts of the place of 
 meeting, even where there is considerable confusion. Too much 
 stress cannot be laid upon this qualification, since bad reading, ill 
 understood, breeds confusion, disorder, and misunderstanding." 
 
 This obviously applies to all classes of public speakers. 
 
 Mention might briefly be made of the fact that not in- 
 frequently one will hear a 300-word-a-minute talker. It is 
 very interesting to listen to a rapid speaker when he comes 
 in contact with a long word, for instance, monotrichloracety- 
 ledimethylphenylpyrazalon (hypnol) ! The speech of the 
 average rapid talker is likely to be incoherent, testing, to 
 the utmost, the mental capacity of the auditor, as well as 
 the stenographer. 
 
 Perhaps the most annoying custom which unfortunately 
 prevails in some well-regulated societies is a conversation 
 carried on at or near the stenographer's table between the 
 secretary and a member, or perhaps between two members 
 seated near-by on an extraneous subject, while an import- 
 ant discussion is in progress. Sometimes the stenographer 
 is directly interrupted by a question from a thoughtless 
 member or newspaper reporter, thus rendering a report 
 defective. This is inexcusable and should be prohibited. 
 The stenographer has but one ear under these circum- 
 stances and that is for the speaker. 
 
 The informality of several persons talking at once, each 
 presuming the other has obtained the floor, is another 
 unparliamentary feature of many meetings. " Wherever 
 
DIFFICULTIES OF MEDICAL REPORTING. 135 
 
 there is an assembly there is need of parliamentary law, so 
 that the assembly may proceed in orderly fashion, with as 
 little jar and discord as possible, and accomplish the work 
 to be performed. . . ,'"' 
 
 The drowning of a speaker's voice by the hum of a 
 trolley-car heard through an open window, or by the cough- 
 ing or sneezing of a member, or by the scraping of chairs, 
 or banging of doors, etc., should be noted. If the subject, 
 perhaps an important noun in a sentence, is smothered by 
 such noise, the word is irreparably lost. The remedy con- 
 sists in a proper location of reporter's table, rubber-tips 
 placed on chairs, etc., and members should be required to 
 do all coughing, sneezing, and banging of doors before the 
 meeting begins ! 
 
 Just in proportion as the careful surgeon in planning and 
 carrying out a major operation observes every detail in the 
 procedure, the stenographer likewise requires, in taking a 
 scientific report, the best location and all facilities at hand 
 — a table, distinct and separate from any other, a light on 
 the table, not reflected from chandeliers above, as this 
 often insures the annoyance of writing each penstroke in 
 a shadow three inches long and two inches wide. Notes 
 under those conditions are often made illegibly, and are, 
 therefore, not official nor reliable. 
 
 Finally, a most unparliamentary form of procedure that 
 is admitted in many national, State, and local medical 
 organizations in the country, is the nonobservance, strictly 
 speaking, by the presiding officer of requesting— and if not 
 complied with, then demanding — that each speaker, always 
 and in every instance, shall, upon rising, announce his 
 name and the city from which he comes. In a moderate 
 debate this is dismissed from the minds of chairman and 
 speakers, and never even thought of in the heat of debate, 
 when the stenographer has no chance of correctly verifying, 
 mentally or verbally, any method he may devise of number- 
 ing speakers or denoting them as, e.g., " red whiskers, i ; " 
 
 -' Honorable Thomas B. Reed, " Parliamentary Rules." 
 
136 SUGGESTIONS TO MEDICAL WRITERS. 
 
 " black hair, 2 ; " " long nose, 4 ; " " shorty, 5 ; " " lengthy, 
 6." Here is the authoritative statement of ex-Speaker of 
 the House of Representatives, Hon. Thomas B. Reed : 
 
 " Whenever a member desires to introduce business, he rises 
 in his place and addresses the presiding officer by his title as 
 ' Mr. Chairman,' ' Mr. Moderator.' The Chair thereupon recog- 
 nizes the member and says, ' Mr. A. has the floor! or simply, 
 •Mr. A? ... It will be seen by the proceedings just de- 
 scribed that the member, in order to introduce business, must 
 first obtain the floor, and in order to obtain the floor must first be 
 recognized by the Chair.'" 
 
 Undoubtedly the value of a speaker's remarks is depend- 
 ent upon the record of his name. His remarks might be 
 strikingly brilliant or brimful of research and scientific in- 
 vestigation, yet their value would be an unknown quantity 
 in the absence of authority, i. e., the name of the speaker. 
 To insure accuracy the name and city should also be writ- 
 ten upon the blackboard by the Secretary. The inability 
 to get speakers' names, or the responsibility imposed upon 
 the stenographer to get them himself the best way he can, 
 undoubtedly has a deteriorating effect upon note-taking. 
 Parliamentary law, as above intimated, requires that each 
 speaker shall be recognized by the Chairman before he is 
 allowed to speak, which means not only that he may have 
 the floor, but, in addition, that he must be recognized by 
 name, and this recognition is not to be made in one or two 
 instances, but throughout the entire meeting, when any 
 speaker addresses the Chair. The presiding officer is not 
 expected always to know byname everyone present ; there- 
 fore, a duty devolves upon each member to announce his 
 own name. In judicial proceedings the full name of the 
 witness is required to be announced before he is sworn so 
 that the stenographer may make due note of the same. 
 The testimony of a medical man in scientific debate is often 
 as important as the testimony of a witness in a legal case, and 
 his name should invariably precede his remarks. There is ' 
 
DIFFICULTIES OF MEDICAL REPORTING. 1 37 
 
 no rule so uniformly perfect and reliable as that parliamen- 
 tary mandate which requires the name of the speaker to 
 be announced. This is particularly noticeable in reporting 
 the proceedings of a body composed of foreign delegates. 
 I had the honor to be the official stenographer to the In- 
 ternational Commercial Congress of. 1899, and, anticipating, 
 as usual, the lapses of the various chairmen in parlia- 
 mentary etiquet who from day to day were appointed, I 
 devised the scheme of circulating among the delegates cards 
 to the effect that the speaker should kindly step forward 
 to a convenient place near the stenographer and hand him 
 his card or announce his name. This plan was a failure, 
 simply because it was not heeded. Telegraph messengers 
 were likewise employed to watch the speakers and get 
 their names as they finished speaking. This plan could 
 not be relied on, because, owing to the complexities arising 
 during a heated discussion, the boys would become utterly 
 bewildered. So that in many important debates two sten- 
 ographers were compelled to "take" simultaneously, not 
 only for the purpose of check-noting speakers whose re- 
 marks were partly inaudible, but also for the purpose of 
 assisting each other in obtaining the long foreign names 
 and titles. The time has arrived when public speakers 
 everywhere must recognize the minutice that the stenog- 
 rapher is required to observe, in order to do his work 
 properly. 
 
 I remember superseding a recognized competent stenog- 
 rapher in a certain medical society, because it was claimed 
 that he did not " get all " — not even names ! The stenog- 
 rapher's just excuse was that the majority of the speakers 
 were inaudible, owing to the fact that they occupied seats 
 in the rear. I said that I could not do any better than the 
 other stenographer under 'the conditions described. The 
 meeting came off at the appointed time, with these prefa- 
 tory remarks from the chair : " I would suggest that mem- 
 bers desirous of indulging in discussion occupy the front 
 seats, so that the stenographer can hear." The result was a 
 
138 SUGGESTIONS TO MEDICAL WRITERS. 
 
 satisfactory and full report of the proceedings, due entirely 
 to that one feature. 
 
 Distinct pronunciation of polysyllabic words is a pre- 
 requisite to intelligent comprehension of phonetic sounds 
 and, therefore, a precise recognition of spoken words. 
 Especial attention should likewise be given to the pronun- 
 ciation of materia medica terms and persons' names. The 
 past tense of verbs, adjectives, etc., should be decidedly 
 expressed, as in trusted, blessed. The -ing should never 
 be slurred over to sound like a en or in. The stenographer 
 is ever on the alert for the most delicate inflection or 
 accentuation, and opportunity should always be given him 
 for the accomplishment of his responsible task. 
 
CHAPTER IX. 
 
 SOME ETHICAL QUESTIONS. 
 
 The Image in the Mirror. — There is a story of a bird 
 that was cured of " the mopes " by means of a mirror placed 
 by the side of its perch. The image of itself was held to 
 be a real mate, and before it there was much strutting, and 
 in cuddling up next to it there was secured the greatest 
 and most satisfactory happiness. The incident is psycho- 
 logically analogous to the method whereby a certain class 
 of writers and even of physicians find their satisfactions in 
 life. Almost the whole tribe of novel-writers, many so- 
 called "artists" and poets, placing their center of gravity 
 in others, are nothing more than popularity-hunters, pos- 
 ing before the vanity images of themselves in the mirrors 
 of other peoples' minds. And the fact that no poem thus 
 produced, no novel, or work of art, is enduring, commands 
 the attention after image and imaged are gone, and proves 
 of how little value is the method. If created with the im- 
 age in mind and for the purpose of pleasing the image, it 
 is not an enduring work, — it is mere pose and strut and 
 self-satisfaction. One whom even Carlyle called the great- 
 est critic of his century, found nothing of value in the 
 poetry of Wordsworth, and even belabored it with con- 
 tempt and ridicule. When the world came to a very dif- 
 ferent conclusion, the great critic set himself to a rere- 
 view of Wordsworth, and after a careful study he reached 
 the same conclusion as before. And yet Wordsworth is 
 more precious to the English race than the combined au- 
 thors praised by Jeffrey. His age agreed with Jeffrey, 
 Wordsworth never having received $700.00 during his life 
 from the sale of his poems. The fact is a lesson as to the 
 
 (139) 
 
140 SUGGESTIONS TO MEDICAL WRITERS. 
 
 trustworthiness of the most expert contemporary criticism, 
 but it is of infinitely more significance as regards the 
 methods and ideals of literary production. Wordsworth 
 was oblivious of the method of the parrot and the looking- 
 glass, and hence he created hundreds of single lines each 
 worth more than the million books of the mirror-folk of the 
 last or of any year. The reason that the image-literature 
 is of no value is because the souls of the parrots are of no 
 value. Only slaves and toadies and sycophants wheedle a 
 master, and to choose the populace as a millionfold master 
 is not a proof of lessened but of increased stupidity and 
 cringingness on the part of the image worshipper. 
 
 All this is beside the mark as regards physicians ? By 
 no means ! First, as to medical literature it is entirely as 
 apropos as to the lay variety. Take our medical journals ; 
 what large proportion of writing and of editorials may not 
 properly be called image-literature, posing of authors be- 
 fore their own images in the glass ? If not exactly this, 
 how much of it is not slyly looking out of the corner of the 
 eye at the success of the journal ? In our books, what a 
 number are created with the authorial eye on the image — 
 for vanity's sake rather than in forgetfulness of self and 
 the image, and with sole attention to pure scientific and 
 sanitary progress ? The profession shares the universal 
 habit of ignoring the great and unselfish work, and is too 
 prone to let its earnest, image-ignoring writers and delvers 
 go unthanked, and to wear their lives out unhonored. The 
 keen-eyed editor of the Practitioner recently wrote : 
 
 It is, of course, in accordance with the general way of this best 
 of all possible worlds that the one officer of the Association who 
 has no share in the butyraceous honors so freely bestowed is the 
 Editor of the British Medical Journal. He is the Atlas on whose 
 shoulders rests the world of the Association. But one notes with 
 regret, though hardly with surprise, that there are no compli- 
 ments for him, and he must be thankful if he escapes a vote of 
 reduction of salary for refusing to turn the Journal into a literary 
 dustheap where cranks may shoot their rubbish. The whole 
 
SOME ETHICAL QUESTIONS. I4I 
 
 thing is a pleasing illustration of what Mr. Pecksniff called ' ' hu- 
 man nature." 
 
 There is often fully as much heroism and purity of 
 ideal in the renouncing of clap-trap, posing, and popularity- 
 hunting, 5n the part of many book-makers, editors, and 
 writers as in soldier or operating-surgeon. To say the 
 true, the needed, and the right thing when it is so easy to 
 say the pleasing thing is a noble though often a thankless 
 task. In our medical societies how frequently is the mir- 
 ror-strutter in evidence ? Certain men come to talk or 
 read papers, apparently only to air themselves and their 
 personal conceits. In our medical science, how much 
 effort is wasted on the thing the mirror-parrot has devised, 
 discovered, or first advocated ? How many operations 
 have been for the sake of the image in the mirror rather 
 than for the single good of the patient ? How accurate are 
 the statistics compiled with an eye on the personal mirror- 
 reflex ? Personal ambition and the desire for the respect 
 of one's fellows may be useful things, but they are not the 
 highest ideals, and may so easily degenerate into parrot- 
 satisfactions that they are to be kept in proper place and 
 well in hand. And, like mirror-literature, mirror-science 
 has no enduring quality. When the undiscriminating have 
 wasted their breath, the beggar for their applause finds 
 himself and his fads forgotten. The world will not long 
 honor those who fawn for its honoring. This is the irony 
 of egotism. 
 
 Literary Intolerance. — Every editor, and this in- 
 cludes even medical editors, occasionally receives angry 
 letters from subscribers concerning some article admitted 
 to his columns. It not seldom happens that the same mail 
 brings other letters expressing pleasure from the same 
 articles. The complainants may be right in their criticisms 
 and the praisers wrong in their pleasure, because even the 
 best of editors may occasionally err in selective judgment,, 
 and the most of us may make altogether too many mis- 
 
142 SUGGESTIONS TO MEDICAL WRITERS. 
 
 takes. But whether right or wrong, the critics usually 
 proceed upon one or more of several erroneous assump- 
 tions. The first pertains to the right of an editor to 
 expunge a sentence or paragraph with which he disagrees 
 in an otherwise acceptable article. That he has no such 
 right is shown by the fact that the critics would be the 
 first to deny it in the case of their own contributed letters 
 or articles. The second faulty assumption is that an article 
 contributed — and the same usually applies to reports, news- 
 items and quotations — receives a half endorsement, if not 
 a whole one, by the editor from the mere fact of insertion 
 in his journal. It seems stupid to republish in every num- 
 ber the old stereotyped notice, " This Journal does not 
 hold itself responsible for the views or statements made in 
 its columns except those in the editorial department," and 
 yet the letters of occasional correspondents make one 
 sometimes feel as if this were advisable. One may even 
 have recalled to mind the stanza of a great poet : 
 
 " There was an old man of Thermopylae, 
 Who never did anything properly ; 
 But they said, If you choose to boil eggs in your shoes, 
 You shall never remain in Thermopylae.'' 
 
 Again, it may be suspected that local feeling and even 
 a personal animus, indirectly at least, may have rarely 
 stimulated a passionate protest. If such is ever the case 
 the fact that editors are not omniscient may perhaps be a 
 sufficient reason for partial pardoning on the part of others, 
 although not by any means authorizing an overkind 
 leniency toward himself on the part of the editor. " Not 
 guilty, but don't do it again," may perhaps be the verdict 
 in both cases. 
 
 The facts suggest a thought as to the value and praise- 
 worthiness of toleration. The crudest way to put it would 
 be to say, too ungraciously it is true, that for the subscrip- 
 tion price no reader acquires the right to grumble when 
 displeased, nor in accepting it does a journal guarantee to 
 
SOME ETHICAL QUESTIONS. I43 
 
 please always and absolutely. An editor, indeed, may be 
 considered fortunate if he pleases thrice while displeasing 
 twice. Alas, that the single negative sticks in the memory 
 more persistently than four positives ! In a larger way it 
 might be urged that culture and civilization consist in great 
 part of the ability to listen to and observe things at 
 variance with and even repugnant to one's private belief 
 and to do so without acrimony. Magnanimity is one of the 
 rarest and most noble of human characteristics, and it 
 should not be forgotten that magnanimity is neither indif- 
 ference, egotism, cynicism, nor pity — but something far 
 higher than any or all of these. It is so fearfully easy to 
 convince oneself of one's own personal superiority that 
 the nobler virtue always insensibly tends to become the 
 lesser. Is it not true that every political partisan needs 
 to read a representative journal of the opposite party ? 
 What a deplorable narrowness does it show when readers 
 demand that their journals shall voice their own peculiar 
 views, and when a disagreeing or opposing view rouses 
 anger ! All of this is ultra medical, and extremes of party 
 feeling do not of course occur in the medical profession, 
 but glimpses and relics of old-time prejudices occasionally 
 appear at the editorial desk— although we protest that 
 none have done so at ours for some three months ! These 
 atavistic remains, as we have hinted, consist in most 
 emphatic reprobation of what some luckless contributor 
 has said. Might one definitively reply : Why not blame 
 the author instead of the editor or publisher, and also why 
 demand the uttermost agreement on the part of one's 
 fellows in matters either of science, ethics, or esthetics ? 
 Equanimity is a far more lovable virtue than unanimity. 
 
 Professional Control, Ownership, and Use of 
 Professional Literature is a matter of most serious 
 concern to our guild as a whole, and individually to every 
 physician. The question at issue is simply this : Does 
 the literature of our profession belong to us or to the lay 
 
144 SUGGESTIONS TO MEDICAL WRITERS. 
 
 publishers whom we have allowed to publish it without re- 
 muneration to us ? When a publisher pays a physician for 
 literary work the matter is on a different footing ; but 
 when the physician gives scientific articles or lends them, 
 without compensation, to be published in a journal, it is 
 plain that these articles are still the property of the author 
 or of the profession, not of the lay publisher. To cite an 
 illustration, we epitomize from a letter to the editor of the 
 Journal of the American Medical Association, published 
 March 6, 1897, an instance there set forth in detail, for 
 which we cannot of course vouch, and for the truthfulness 
 and accuracy of which the name of the writer of the letter 
 is the only proof we have, except we believe that the 
 charges there made were never answered. Who does not 
 deny the truth of a charge, by his silence admits its truth- 
 fulness — is, we have heard, an old rule of evidence. 
 
 According to this letter, the lay publishers of two med- 
 ical journals refused the editor and publisher of the Amer- 
 ican Year-Book of Medicine and Surgery the courtesy or 
 right to abstract or make quotations from the articles pub- 
 lished in the journals belonging to said lay publisher, or to 
 reproduce the illustrative cuts of these articles. This re- 
 fusal was intentionally made more insulting by the fact 
 that the editors and publishers who thus denied, accom- 
 panied the denial with the statement that they "had 
 always allowed the free use of the original matter contrib- 
 uted to it for all reputable purposes, provided that due 
 credit, etc." Moreover, it was expressly denied that this 
 course (or refusal) was " characteristic of our general 
 policy," and it was said that this "one instance" was ab- 
 solutely exceptional, etc. The editor of the American 
 Year-Book at once proved that there were other instances 
 in which the free use had been refused (e. g. to Sajous' An- 
 nual), and expressed his thanks for the insult that the 
 Year-Book, Sajous' Annual, etc., were not serials to be 
 classed as published for " reputable purposes." 
 
 As every scholarly physician knowns, the Jahrbucher 
 
SOME ETHICAL QUESTIONS. I4S 
 
 and other epitomes of medical science published in Germany 
 have been of inestimable service to the profession. In the 
 two serious attempts made in the United States to do such 
 work, this powerful lay publisher and his obedient medical 
 editor refused the use in any way of the medical articles 
 given or lent them gratis by members of the profession, 
 and then wrote of themselves the following astounding, 
 Pecksniffian, disgusting words: That they would be the 
 " last to countenance any action which might interfere in 
 the slightest degree with the fullest and freest dissemina- 
 tion of medical knowledge." Thus to misjudge the acu- 
 men of their readers was as wonderful an error of intellect 
 as the deed was an error of morals. The lesson to be 
 gathered is that the profession should own and control its 
 journals, and, especially, that being offered a number of 
 excellent ones thus controled and owned, it should support 
 them rather than journals whose lay owners have always 
 used them for purposes of unadulterated financial selfish- 
 ness, and for creating a monopoly of medical literature for 
 which they have not paid the producer a cent. A slavery 
 so absolute and extreme as this was never before illus- 
 trated in the history of the world, and it is a disgrace of 
 which we should make all haste to purge ourselves. 
 
 Big Books, or Little Books ? — In a general way, and 
 particularly as to certain things, the authors of medical 
 books and the buyers should be the judges as to the style 
 in which their volumes are made. They have heretofore 
 left this matter almost entirely to publishers. In the 
 highly important matter of the size of books the financial 
 advantage of the publisher may run squarely counter to 
 the best interests, not only of the author, but also of our 
 profession, and of the dissemination of knowledge. There 
 are certain exceptions, but we believe they are few, to the 
 rule that small books are by all odds preferable to big ones. 
 Books of reference, which are used only a few moments at 
 a time, may be large (when it is impossible to make them 
 
I46 SUGGESTIONS TO MEDICAL WRITERS. 
 
 small), but almost every other kind of book should be made 
 as small as possible. The reasons are sufficiently evident:— 
 
 1. The smaller the volume the less will be its expense, 
 and the terrible and continuous tax laid upon every mem- 
 ber of our profession for books should be made as light as 
 possible by every legitimate means in our power. We 
 have before us a volume containing more words and cost- 
 ing only one-sixth as much as another on the same subject. 
 The first is " handy," and small, and easy to read ; the ex- 
 pensive one is heavy, big, and hard to read. 
 
 2. The smaller the volume the more it will be read, be- 
 cause the reader will not so soon tire in holding it. Many 
 large books are frequently not consulted because, uncon- 
 sciously or not, one shrinks from the labor of taking them 
 down and holding them. 
 
 3. The necessity of condensing material into a smaller 
 number of words is, as a rule, of positive and decided ben- 
 efit to books, both in style and in clarifying the knowledge 
 conveyed. There are limits, to be sure, beyond which 
 epitomization should not go, but few authors have ever 
 reached them, and most of the volumes on the market 
 could have been made up of one-third or one-half the num- 
 ber of words with manifest profit to reader and to knowl- 
 edge. 
 
 But even if the number of words remains the same, 
 most of these volumes could have been easily reduced in 
 size and in weight 50%. We do not urge a reduction in 
 the size of the face of the type used, although it is true 
 that small type on the right paper is far less wearying than 
 large type on bad paper ; and when the right kind of paper 
 is demanded by us we may usually ask for a relatively 
 smaller type than is often thought necessary. 
 
 Broad margins- are pleasing to the eye, but they are not 
 necessary in scientific books in which esthetics must give 
 way to considerations of utility and lessened expense. 
 Moreover, one of the greatest reasons for broad margins is 
 sadly ignored. This is because the margin next to the 
 
SOME ETHICAL QUESTIONS. 1 47 
 
 "back " of the book must be broad in order to neutralize a 
 wretched slipshodness and a silly economy in binding and 
 in paper. When binding and paper are cheap, then the 
 wide expanse next to the stitching must be allowed, be- 
 cause the book and page will not open out and lie flat, and 
 this wasted paper and space is necessary for the curve and 
 to hide the expensive economy. 
 
 By far the greatest reasons for the existence of un- 
 necessarily big books is that buyers foolishly, and publish- 
 ers cunningly, prefer them large. But is it not long past 
 the time when physicians should have learned the folly of 
 the "most, *. e., the biggest, for the money," instead of the 
 most and smallest ? Every buyer should earnestly demand 
 of publishers that offered books shall not be as huge and 
 imposing, but rather as small and serviceable as possible. 
 The grand array on the shelves, whether for one's own 
 satisfaction or to make an impression, is scarcely a valid 
 excuse for depleting one's purse and for cumbering one's 
 bookcases. "It is magnificent, but it is not — literature." 
 
 Still another powerful reason for the big book lies in 
 the fact that it is the bigness that seems to justify us in 
 paying the big price, whereas we should prefer the small 
 book, if equally complete and scholarly, at the same or 
 even at a greater price. Let us quit buying books by the 
 pound ! 
 
 And lastly, it is only the big book at the big price that 
 pays the canvasser's expenses. At present we prefer to 
 pay a man several dollars to convince us of the value of a 
 book, rather than to order it direct. It would be far 
 cheaper and better to order the complete volume " on in- 
 spection," paying express charges both ways, rather than 
 to order from the "dummy." Publishers, we believe, 
 would be willing to accept this offer, and we doubt not 
 would prefer this plan of selling their books. 
 
 We have reserved to the last the single consideration of 
 dominating importance — that of the paper used in books. 
 It is by means of poor, bulky, cheap paper that books are 
 
I48 SUGGESTIONS TO MEDICAL WRITERS. 
 
 made poor, bulky, but expensive. By paying for paper 
 several cents a pound more than is customary, books could 
 be tremendously lessened in bulk and weight. This addi- 
 tional cost of thin, opaque, and tough paper increases the 
 cost of the volume none or only a few cents, so that is of 
 ho concern, and it is counterbalanced a dozen times by 
 narrower margins, smaller type, and better stitching. But 
 besides size, etc., the outweighing benefits of better paper 
 are the flat page, eaSe of ocular labor, and durability. 
 There is a vicious tendency toward the use of "loaded," 
 calendered, and rotten paper — principally because, it is 
 said, illustrations " show up " better upon it. This is a 
 fallacy. If the right quality of paper is used, illustrations 
 are as effective on a " dead-finish " paper as on that with a 
 sheen that irritates and tires the eyes. 
 
 The Size of Books and Articles. — As to articles 
 in medical journals every editor and experienced writer 
 knows how much more acceptable, how much more likely 
 to be read, are short, concise, rather than long and verbose 
 ones. Every writer for journals should limit his article to 
 an aspect as specific and single as possible, and not try to 
 cover too much space or too many phases of a subject. 
 Write more often if you please, but drive one nail at a time, 
 and drive that home. It hardly needs saying that one 
 should not attempt writing upon a subject until he is thor- 
 oughly certain ■ he has something new or valuable to say. 
 Writing for vanity's sake or to advertise the writer is the 
 bane of medical literature. We once knew a writer who in 
 his everlasting rehashes of well-known facts or opinions 
 was in the habit, When sending it to the editor, of accom- 
 panying his MS. with a $10 or $20 bill. The number of 
 our medical journals hungry for "copy" hardly makes this 
 necessary nowadays, except when the offering is of the 
 most flagrant worthlessness. Having something of value 
 to write about, endeavor to tell it in the fewest words pos- 
 sible,— subject of course to the proviso that you do not 
 
SOME ETHICAL QUESTIONS. 149 
 
 adopt the horrible note-book or reporter's style, in which 
 sentences are without a subject, or a predicate, or some 
 other necessity of English. Beware of staccato speech and 
 other evidences of vocal paralysis. 
 
 As to books, medical authors should use their earnest 
 influence to stop the intolerable manufacture of bulky 
 books, and especially of " Systems." The day of these 5, 
 10, or 20 volume systems, is, we hope, irrevocably past. 
 The busy man has no time for them, in the first place, and 
 he is beginning to grow conscious that they are born of 
 the publisher's desire and not of the scientist's demand. 
 His arms grow tired of holding them, and his pocket-book 
 thin in paying for them. They are commercial in origin, 
 not professional. One man's intelligence and experience 
 should penetrate and control every line of monographs, — 
 that man a master in his special field. To this rule there 
 is hardly more than one exception, and this relates to books 
 merely gathering and epitomizing the progress and litera- 
 ture of a period or a subject. And even here the exception 
 is not so decided as one would suppose, as special and ripe 
 editorial judgment and criticism are required not only to 
 winnow, and condense, but also to indicate a scientific 
 rating. In this class of books also heaviness and excess of 
 size are less objectionable than in others, because, like 
 dictionaries, they are essentially for short-time reference, 
 scarcely for a half-hour's continuous use. Medical men of 
 all kinds, whether writers or only readers, should unite in 
 sharp scorn of books made big for the publisher's benefit, 
 in which cheap and thick paper with too broad margins 
 shows clearly the motive and the deceit of selling printed 
 and folded paper instead of scientific literature. Good, 
 thin, light, and opaque paper is expensive; poor, thick, 
 heavy, and rotten paper is cheap ; many a book-buyer in 
 his ignorance does not know this, and publishers are well 
 aware of the buyer's mistake and encourage it, to the profit 
 of the seller and the loss of the buyer. 
 
ISO SUGGESTIONS TO MEDICAL WRITERS. 
 
 Collaboration-Books. — In the preface to one of the 
 least defective of modern composite books we find the fol- 
 lowing words as the best excuse the authors can adduce 
 for their work : 
 
 " It is unnecessary to discuss the ' collaboration-method ' em- 
 ployed, which has too often demonstrated its value to need either 
 defense or explanation in this place, except to point out its great- 
 est use, and the one to which no doubt it is indebted for its suc- 
 cess — namely, that by its means the student gains the point of 
 view of a number of teachers, reaping, in a measure, the same as 
 would be obtained by following courses of instruction under dif- 
 ferent teachers.'' 
 
 We feel constrained to point out what we think are 
 some fallacies lurking in this statement. It would be true 
 if the authors treated the same subjects ; but it is plain 
 that when they treat wholly different subjects the student 
 learns only the opinion and teaching of the single author 
 who writes on a single subject. It would also be true if 
 the editors dared or would be allowed to so edit and trans- 
 form the articles as to make them fuse into an organic or 
 a homogeneous unity. When an author signs his article 
 he would not allow an editor thus to make over his article. 
 The result is that the whole body of teaching of the work 
 represents the scientific and therapeutic results and beliefs 
 of no one brain, and not one of the hundred separate 
 authors would entirely, or frequently even in great part, 
 assent to the teachings of the articles bound up with his 
 in the same volume. This seems to us an argument 
 against the modern composite book, in which the multi- 
 tude of authors preserve their distinct and separate indi- 
 vidualities. 
 
 There are other objections to the composite book of 
 the type criticised : Confined as he is to a definite and 
 altogether too limited space, each author must deal in too 
 many glittering generalities. To the student or practi- 
 tioner the articles are not helpful ; they do not enter into 
 those details of diagnosis and treatment which are pre- 
 
SOME ETHICAL QUESTIONS. 15 I 
 
 cisely what the uninstrueted need. In a vague and soary 
 way, the author who is brilliantly getting over his ground, 
 showing off his own learning, but who is utterly indif- 
 ferent to the state of mind and needs of his uninstructed 
 reader, will say, for example, that a certain treatment may 
 be tried, and that it sometimes succeeds and sometimes 
 fails. All of which is quite as instructive as, and far 
 less amusing than, the experiences of Violet, the Quangle- 
 Wangle, and the 600 crusty crabbies. What kind of cases 
 are adapted ? How should the treatment be carried out ? 
 By what kinds of doctors ? Why and when does it fail ? 
 A hundred such questions arise in the mind of the average 
 reader of nearly every page of the patch-work composite 
 book. 
 
 Still another objection is evident : The learned authors 
 must display an erudition equal to that of the other fel- 
 lows ; and thus meaningless omniscience stares at one 
 from pages of mathematic formulas and diagrams for in- 
 stance, which not a reader will ever comprehend or get a 
 ray of light from. Colorless abstractions and showy 
 shams are thrown in as if the poor student were as con- 
 summate a mental prestidigitator as the great author, — just 
 as poor orators preface their profoundest and strangest 
 bits of knowledge with, " You have all read," "As all are 
 aware," etc. 
 
 All of which is especially true of the big "systems," 
 running into shelves-full of dumped-together treatises by a 
 hundred authors, in which the unfilled gaps, the overlap- 
 pings, and the contradictions have long been the butts of 
 ridicule of men with scientific and literary training. Such 
 books are good for publishers, but comparatively useless 
 and surely wasteful of the money and house-room of 
 physicians. 
 
 The only composite books that we judge of use to pro- 
 fessional men are those in which the work of individual 
 authors is rigidly wrought over, supplemented and ren- 
 dered organically unitary with the rest, by the dominating 
 
152 SUGGESTIONS TO MEDICAL WRITERS. 
 
 control of the responsible editor.. Better if the individual 
 authors merge their work anonymously into the homo- 
 geneity desired. But, when possible, and better yet, we 
 think, if authors preserve their own independence and 
 make their work stand for what it is, the product of per- 
 sonal experience and judgment. All good work rests at 
 last upon the character of the single man who actually did 
 the job. 
 
 Such are some of the dangers and disadvantages of 
 composite books, chiefly, those of the large systems of 
 many bulky volumes, appearing one after another, and 
 requiring a number of years before the completion of the 
 set. There are, of course, correspondingly great advan- 
 tages in the properly edited single volume composite- 
 books, in which, as we said, "the work of individual 
 authors is wrought over, supplemented, and rendered or- 
 ganically unitary with the rest by the dominating control 
 of the responsible chief editor." One of these advantages 
 lies in the perfection of specialist-work. Science has be- 
 come such a vast aggregation of facts and experience even 
 in a specialty of medicine that we are fast approaching 
 the time when the masters can only be specialists of a 
 specialty. Thus, the best exposition of such a subspecialty 
 can only be made by a person who has given long atten- 
 tion to it. Another advantage is that a composite-book by 
 a number of authors may be issued in a shorter time, the 
 results and opinions chronicled being more promptly 
 brought down to date, than if one or a fewer number 
 of authors worked a longer time upon it. The often ex- 
 emplified danger of lack of a harmonious view and over- 
 sight of the whole by a weak and a careless chief editor 
 remains. To this, attention has been called. On the other 
 hand we must not forget that the work of a single author 
 treating many subjects may be narrow, inaccurate, preju- 
 diced, and lack precisely the unity, the large outlook and 
 clear overlook gained by the composite work of a number 
 of authors, in proper subordination and with free control 
 
SOME ETHICAL QUESTIONS. I S3 
 
 by a chief editor. American editors and publishers have 
 excelled those of other nations in attaining the proper 
 balance between the extreme of the huge heterogeneous 
 undigested masses of dumped together multivolume knowl- 
 edge by one or two hundred independent authors, and the 
 myopia of books by a single author. 
 
 We hope that our writers and publishers will c >ntinue 
 to hold this literary and bibliographic preeminence. But 
 it cannot be done, we think, if we do not renounce both 
 the helter-skelter of the interminable " system " and the 
 individualistic narrowness of the monograph. 
 
 It can be done by choosing the good things of each — 
 the fulness of knowledge and experience of the specialists 
 unified and mutually completing each other, through the 
 domination and completeness of control of the chief 
 editor. Individual writers must be willing to subordinate 
 their single work to the perfection of the whole, and the 
 editor in charge must not shrink from demanding such 
 subordination and unity. In this way, our medical editors 
 and publishers can retain their present superiority in the 
 art of scientific bookmaking. 
 
 Duplicates of Articles Sent to Two Journals. — 
 Recently one journal charged another with the downright 
 stealing of an article from its columns without any recog- 
 nition of the supposed first appearance in the columns of 
 the injured journal. Some months ago a journal abstracted 
 an article and credited a certain journal No. 2, in which 
 the original appeared after its publication in more widely- 
 known journal No. I. The editor of journal No. i expos- 
 tulated in vain. In both these cases it was subsequently 
 learned that the authors of the articles had supplied the 
 two different journals with the same article — a proceeding 
 wretchedly impolitic for author and publisher alike. The 
 deceived journal justifiably feels like using a harsher adjec- 
 tive than impolitic. We trust no author will ever treat us 
 that way. It may be wise to publish an article synchron- 
 
1 54 SUGGESTIONS TO MEDICAL WRITERS. 
 
 ously in two journals, but it is not honorable to keep either 
 editor in ignorance of the fact. 
 
 Misunderstood Proverbs are constantly quoted, even 
 in medical literature, by rote, by those who do not know 
 the meanings of the words they use, and people who hear 
 or read the quotations imagine these have some signifi- 
 cance, when in fact on their face and without etymologic 
 knowledge they have no significance whatever. One of 
 the most common of these misused and misunderstood sen- 
 tences in Shakespere's " One touch of nature makes the 
 whole world kin." As Shakespere and his cotemporaries 
 understood the line it meant something very different in- 
 deed from what the pseudo-literary quoter of today thinks. 
 The word touch signified defect or bad trait, and not a good 
 one as is supposed, reaching down to the elemental or pri- 
 mal quality of life and feeling. The word came into use 
 from confusion with the word tache, sometimes misspelt 
 touch. The whole passage (in Troilus iii, 3) as used by 
 Shakespere shows he reprobated not praised the "one touch 
 of nature." 
 
 One of the most senseless of these proverb-blunderings 
 is the very common " The exception proves the rule," de- 
 rived from the Latin exceptio probat regulam. Now, any 
 school-child must see that an exception invalidates, not 
 proves, the rule. It positively disproves it. The explana- 
 tion of the nonsense consists in the fact that the old signi- 
 fication of proves is tests, as when St. Paul advises that we 
 should prove (z. e., test) all things to hold fast that which 
 is good. The Latin scholar also knows the definition of 
 probo. 
 
 In the saw, " The more haste the worse speed," a simi- 
 lar contradiction occurs if the words are considered apart 
 from their history. In Old English, speed really meant 
 success, and the proverb thus becomes luminous. So, also, 
 " God speed the plough " has significance if we understand 
 the word speed properly as prosper. 
 
SOME ETHICAL QUESTIONS. 1 55 
 
 In " God sends the shrewd cow short horns," shrewd 
 means ugly-tempered, or bad-dispositioned, not clever or 
 intelligent ; and in " Handsome is as handsome does," 
 handsome does not mean beautiful, but neat in the sense 
 of skilful. 
 
CHAPTER X. 
 HISTORY AND PSYCHOLOGY IN WORDS. 
 
 There is a story that a society of learned philologists 
 made it the first of its by-laws that no member would be 
 allowed to contribute a paper on the origin of language. 
 By this means only was it possible to shut off the vague 
 theory-spinners and prevent unendurable boredom. To a 
 great extent the reason for the rule still holds, because as 
 yet we have hardly gathered facts sufficient to enable us to 
 form any very clearly warranted induction as to the manner 
 in which animalian cries become articulate and thought- 
 conveying language. Noire has traced the beginnings of 
 speech to what has been called the yo-he-ho theory — the 
 cries of men working together. Similar guesses are the 
 bowwow and the pooh-pooh theories or other imitative 
 plans of the reproduction of sounds of animals or of inor- 
 ganic nature, as well as of those of man himself when emo- 
 tion passes into cries of various kinds. 1 
 
 The creation of language by onomatopoietic methods is 
 still a fact today, and in poetry the imitation of sounds by 
 words is quite an art, as e. g. : 
 
 " Rend with tremendous sound your ears asunder, 
 With gun, drum, trumpet, blunderbuss, and thunder." 
 
 " I love the language, that soft bastard Latin, 
 Which melts like kisses in a female mouth, 
 
 And sounds as if it should be writ on satin 
 
 With syllables that breathe of the sweet South ; 
 
 1 A writer, Mr. J. Donovan (Mind, July, 1892), contends that articulation origi- 
 nated in the impassioned intonations of festal excitement. One cannot help feeling 
 that before festival and religious dance came into being language must have become 
 a pretty complete and satisfying instrument. 
 
 (156) 
 
HISTORY AND PSYCHOLOGY IN WORDS. 157 
 
 And gentle liquids gliding all so pat in, 
 
 That not a single accent seems uncouth, 
 Like our harsh, northern, whistling, grunting guttural, 
 
 Which we're obliged to hiss, and spit, and sputter all." 
 
 Whatever theory we may accept as to the origin of 
 language, none will deny that it is and remains primarily 
 the product and expression of emotion. The ultimate 
 origin of the word mama, whether the infants' cry for food, 
 for the mother's breast (the mamma), or for the mother her- 
 self, is lost with the childhood language of the race, but its 
 preservation in all languages with one or all of the three 
 significations given, is a suggestively beautiful fact. Hun- 
 ger is the first of all bodily feelings or desires, and remains 
 the most fundamental and continuous of all. Physiology 
 is found to be the mother of language in an ever varying 
 but real sense, and in a multitude of ways of which the 
 proofs are found in nearly all the words we use, at least if 
 we run them down to their rootings. A curious demon- 
 stration of this may be seen in the fact that almost all of 
 our common words pertaining to the nose begin with the 
 sound sn. We need not stop here to show this in detail, 
 but the word-hunter may find lively interest in looking up 
 the etymologies of multitudes of words, such as, in Eng- 
 lish, snaffle, snap, snatch, snack, snarl, snark, sneer, sneeze, 
 sniff, snip, snipe, snite, snivel, s?wb, snore, snort, snot, snout, 
 snub-nosed, snuff, etc. 
 
 And by physiology as the mother of language, I do not 
 mean the outgrown theories which were so prevalent when 
 a crude Darwinism blew men off their feet and topsy-turvey 
 with its explanation of the origins and the causes of the 
 changes in words by the conformation of the palate, the 
 mouth, throat, ease of articulation, laziness, or even deform- 
 ity. The emperor, said one professor, might change the 
 map of Europe, but no man could possibly influence lan- 
 guage. The phase or partial truth existing in such dog- 
 matism should not make us inattentive to the fact that 
 primitive people are not unimaginative, that the origin of 
 
158 SUGGESTIONS TO MEDICAL WRITERS. 
 
 language is by logical necessity a highly imaginative and, 
 moreover, a conscious act. There is a somewhat silly at- 
 tempt of many evolutionists to ignore and belittle the part 
 of consciousness in the development of biologic phenomena, 
 and especially those of homo sapiens, and in linguistics it 
 is particularly fallacious. The process of language-making 
 never began and never ends ; it is going on all the time. 
 It is partly conscious, partly unconscious. Of course it is 
 absurd to speak of the individual consciousness, or any 
 number of such, as only in the smallest degree contribu- 
 tive, in changes such as those represented by Grimm's 
 law, extending over many centuries and a dozen races. 
 And the discussion as to whether the people as a whole, or 
 only their intellectual leaders originate the changes, is also 
 futile, because, as we see about us every day, both function 
 in this way. There is a continuous mutation going on in 
 language just as there is in the human spirit, an interaction 
 of conscious and unconscious, of the thoughtless people 
 and the purposive intelligent leaders. M. Breal who has 
 written an excellent book on Linguistics, thinks the doc- 
 tors of language are powerless and yet with delightful self- 
 contradiction he says that " for many centuries the culti- 
 vated Englishman spoke French, and left his own tongue 
 to the people, and since it is the province of culture to 
 retard the development of a language, English adapted 
 itself to the common want without the impediment of an 
 imperious tradition." 
 
 The reconciliation of the different views as to peo- 
 ple and cultivated, consciousness and unconsciousness, 
 would appear to be in the thought of the larger psychic 
 personality of the race ; perception and consciousness 
 are indeed indistinct in the populace, but rise to clarity 
 in the leaders ; this permits the creative impetus and 
 changeful spirit to be first grasped and recommended 
 by the clearer-headed initiative of the intellectuals ; but 
 the advice is accepted, rejected, or modified, by the less 
 articulate, yet still not nonexistent consciousness of the 
 common people. It must not, dare not, be forgotten that 
 
HISTORY AND PSYCHOLOGY IN WORDS. 159 
 
 language is an organism and cannot be created without a 
 creator ; it is an art product and demands an artist. No 
 philologist can be an atheist — so long, at least, as he is 
 a logician or even a scientist, for philology is a branch of 
 biology and it requires the merest modicum of intellect to 
 see that all physiology is mothered by mentality. Physio- 
 logic function is teleologic and is based upon purpose and 
 planned outcome. Evolution can only be the unrolling of 
 what was initially inrolled. The materialistic scientist has 
 the greatest and most amusing difficulties in trying to 
 avoid the teleology inherent in words and in facts. The 
 blindest of evolutionists is he who makes evolution blind ; 
 the most ignoring of scientists he who makes science ignor- 
 ant ; the sorriest of physiologists he who does not see that 
 as function precedes structure, so does mentality precede 
 function. Organs are but bundles of cells, and it is cell- 
 hunger and cell-function that make organic hunger and 
 somatic function. As no cell exists for itself, so we are 
 driven by a remorseless logic to the inference that back of 
 cells is intention, using cells, together with their organs, as 
 tools of design and for purpose. We thus reach a conclu- 
 sion, one which open-eyed observation indeed does not 
 need, that language, however physiologic in secondary 
 origin, is essentially psychic, because all physiology in 
 final analysis is psychic. Even hunger is psychic, a means 
 to an end, that end the purposes for which the entire 
 organism exists. The infant's mama means "I will be a 
 man and do what manhood requires." 
 
 When it strikes the imagination with its full force one 
 is astonished to recognize the immateriality of language. 
 It is the oldest, the most enduring, the most used of all 
 the things created by man, and yet it is neither here nor 
 there, neither now nor then. The living reality behind the 
 phonating larynx seems almost to forget and to scorn the 
 air-waves that die the instant they have been born. The 
 Ao'yos hides from its word, scarcely recognizing it ; no echo 
 of the printing office reaches the faraway editor-in-chief. 
 
l60 SUGGESTIONS TO MEDICAL WRITERS. 
 
 Like aerial hummings our alphabetic letters come down to 
 us as if from the ghosts of voices dead many thousands of 
 years ago. The mutations of sounds during these cycles 
 are the most subtle and indeterminate of studies of the 
 phonologists. It is mathematically true that no two per- 
 sons have ever uttered a sound or a word alike. Sound 
 has three components: i. The pitch, or number of air- 
 waves of which it is composed ; 2. The energy (loudness, 
 emphasis, accent), or the force and extent of the vibra- 
 tions ; 3. The timbre (overtones, qualities), or shape of the 
 waves. All these factors can never be alike in two per- 
 sons. Twins or dromios can never disguise their voices to 
 deceive even strangers. 
 
 That language must be held the most perfect, artistic- 
 ally, musically, philologicly, and as an instrument of the 
 psychic life, which has the purest vowel-sounds, which 
 uses them most, which secures the few modifications of 
 these necessary by the free parts of the tongue, the teeth, 
 and the lips. The ideal language must be highly voweled, 
 leaving these pure tones unbestialized by throat or nose, 
 and securing the slight and few modifications required by 
 light touches of the sensitive, educatable, responsive, mo- 
 bile tongue and lips. Despite the danger' of overvaluing 
 one's own, it is true that of the modern languages of civil- 
 ization, English undoubtedly comes far nearer this ideal 
 than any. In language-formation, as in the psychic life of 
 the racial or national speakers, the origins and rootings are 
 far off and deep, so that change must be slow, and conserva- 
 tism strong. Hundreds, and even thousands of years may 
 be required to demonstrate decided changes and progress ; 
 in the imperishable immateriality of language this progress 
 is shown with a conciseness and vividness unequalled by 
 any other product of the mind. And shown, I would say, 
 in an easily comprehensible and exciting way which should 
 stimulate philologists and educators to .popularize the 
 knowledge and bring it even to the common schools and 
 the common people. There are innumerable phases and 
 
HISTORY AND PSYCHOLOGY IN WORDS. l6l 
 
 facets whereby history may be mirrored and seen, and as 
 many connections of past and present, — every word, indeed, 
 is such — to incite the liveliest interest in the dullest pupil 
 or the most erudite investigator. Philology is not language- 
 learning. One may be able to speak or write but one 
 tongue and yet be profoundly learned in linguistics. As a 
 method of mental evolution and gymnastics there is no 
 study comparable to it. It has few or no uses ; it will not 
 help one to acquire money, fame, or power, but it will help 
 one to understand this world better even than any of the 
 physical and biologic sciences. Neither will it much help 
 one to acquire literary style, except to choose words some- 
 what moTe fittingly, for style is another name for genius, 
 and genius is not taught or learned of man. 
 
 One of the most curious things is man's incuriosity, — 
 first, concerning the world in which he lives, and second, 
 about himself. Science began with the study of the stars 
 rather than of the earth, and even now the average person 
 knows more about astronomy than about geology and 
 geography. Man desires to learn about the most distant 
 and objective before he does about things nearer himself. 
 Centuries and cycles go by before he thinks of asking a 
 few questions about himself, and when at last he does so, 
 it is of bones and dead structures he desires to know. 
 Physiology has but recently arisen and the physiologic 
 conception of disease and of cure constitutes a new era in 
 medicine just opening to our view. But even today it is 
 only corporeal physiology that interests us. If it is of 
 history we are eager to learn, it is of kings first, and wars, 
 and nations, — the history of religion, of commerce, of the 
 people, and of civilization, is the last and least we seek. 
 When science arises it is first of stars, worlds, and stones, 
 and when biology is born, it is at first and for a long time 
 only to morphology that we give attention. So confirmed 
 is the habit of outward looking that much of our modern 
 science is materialistic. The looker denies himself, and 
 the subject denies the subjective, forgetting in this philo- 
 
162 SUGGESTIONS TO MEDICAL WRITERS. 
 
 sophic suicide that subject and object are necessary correl- 
 latives, the one nonexistent without the other. There 
 cannot be a physics without a metaphysics. Hence of 
 psychology we know little. The ancient oracle seemed to 
 voice the spirit of life when it said " Seek never to know 
 who thou art." And yet it is true that, 
 
 "A man's best things lie nearest him, 
 Lie close about his feet ; 
 It is the distant and the dim 
 That we are fain to greet." 
 
 And language proves and illustrates both truths. Of all 
 the things he has created it is the one that lies nearest to 
 man's soul and the most precious. It is, or it may be, one 
 of the most exact of the sciences ; it is the first and most 
 continually used instrument of our psychic nature, it is the 
 most suggestive paleontologic "find" in the world, its 
 every word and letter is almost an epitome of the history 
 of civilization, — and yet few know or care a fig for it ! 
 People may know half a dozen languages and be utterly 
 ignorant of the abecedaria of linguistics. In schools 
 children and even adults are taught a hundred things of 
 infinitely less inherent value, abiding interest, or enlight- 
 ening beauty. If I had a child I would rather have him a 
 master of one book, that of Taylor, on the Alphabet, than 
 of a dozen things rated so highly by our schools and col- 
 leges. How few of even cultivated people know their 
 A B C's ! When the child handles his alphabet-blocks he 
 fumbles with a million mysteries leading directly and nat- 
 urally into every possible human science and into all 
 history. And yet not even his teachers have cared to 
 follow up any of these clues, and the ignorant pupils grow 
 up to become in their turn ignorant teachers. Language 
 illustrates how like dolts we stare in dazed incomprehen- 
 siveness at a thousand riddles flung down before us from 
 the sky and from the past. We may even pick up one of 
 these skilfully fashioned artistic enigmas and finding that 
 
HISTORY AND PSYCHOLOGY IN WORDS. 163 
 
 it cannot be eaten, or used as clothing, or fired out of a 
 gun, we throw it away and go on with our stomach-fillings 
 and our fantastic blunderings. 
 
 According to Taylor the letters of the alphabet were 
 invented about 1900 B. C, and, except a few, are conven- 
 tionalized pictures derived from the Egyptian hieroglyphic 
 writing through various stages of ideogram and phono- 
 gram. At first they were pictures or representations of 
 actual objects; second, symbols for suggesting abstract 
 ideas ; third, verbal signs standing for entire words ; fourth, 
 syllabic signs ; fifth, alphabetic signs, or letters, represent- 
 ing elementary sounds. The consonants were the vertebras 
 of the organism and were first invented, the vowels being 
 of a considerably later origin. Even today Semitic has 
 no true vowels. The greatest achievement of the human 
 race — for such is the creation of the alphabet, is of Semitic 
 origin, and to De Rouge, a Frenchman, we are indebted 
 for the knowledge, a discovery dating only forty years 
 back. Great aid has been given by the discovery of the 
 scrawled letters of the alphabet on the drinking cups and 
 plates of children, the broken pieces of which, thousands 
 of years old, are more valuable than the most prized 
 original MSS. of the greatest poems. What a strange fact 
 is this discovery, proving again how little we think of the 
 most important things, the tools of intelligence, and the 
 sine qua non of civilization. How many thousands of years 
 were required for pictures to become letters we cannot im- 
 agine, but the greatness of the task is suggested by the 
 fact that of all earth's races only the Phenicians have 
 ever invented an alphabet. Its value to humanity is shown 
 in the adoption with marvelous rapidity by all the races 
 of the world of this one alphabet fashioned in Egypt. This 
 universal adoption of it is a condensed account of universal 
 history, with aids and more than glimpses into politics, 
 numismatics, commercial supremacies, religious evolutions 
 and revolutions, and almost every phase of civilization. 
 
I64 SUGGESTIONS TO MEDICAL WRITERS. 
 
 A was originally the picture of an eagle. 
 
 B was that of a crane. In Corinthian the upper part of the B, 
 representing the crane's head, was not closed, but left 
 open, resembling somewhat our letter Z. 
 
 D was a hand. 
 
 F was the horned asp, the vertical stroke representing the body, 
 the bars the horns. 
 
 G is what is left of a picture of a throne. 
 
 H in combination with T, the Greek theta, was once the picture 
 of a pair of tongs. 
 
 K was a bowl. 
 
 L a lioness. 
 
 M was an owl ; its two ears are what is left. 
 
 N was the water-line, or wave-line. 
 
 P was once the picture of the shuttle. 
 
 Q, was the angle of the knee. 
 
 R the mouth. 
 
 T the lasso. 
 
 Y was introduced in Cicero's time to represent the Greek upsilon, 
 which up to this time had been represented by V. 
 
 Z was reintroduced in the first century B. C. to transliterate 
 Greek words. 
 
 U and V were made separate signs in about the fifteenth century, 
 V representing the consonantal and U the vowel sound. 
 
 W came first into use in about the eleventh century. It was 
 recognized that in English there had developed a sound 
 that was neither that of V nor of U, but a combination of 
 the two. To represent this we sound, two V's were first 
 put together, then the last stroke of the first letter was 
 made to cross the first stroke of the second. Finally they 
 were joined, as we now have them, and are of course 
 called double U. 
 
 In the fifteenth century when two i's were at. the end 
 of a word the last one was " tailed " in order to distinguish 
 better. The same was done with our initial I. This form 
 was finally called J and was used to denote the consonantal 
 sound. The Hebrew Jahveh with the initial sound of I or 
 Y, we call Jehovah, with our /sound. We say John, the 
 Germans, Johann. 
 
HISTORY AND PSYCHOLOGY IN WORDS. l6S 
 
 Paleography, and even graphology, are alluring studies, 
 and the development of our handwriting leads one into a 
 hundred bewitching by-paths. Taylor shows a little in- 
 stance in the evolution of our sign for plus (+) out of the 
 Latin conjunction et. The sign — (minus) is probably a 
 modification of M, the first letter of minus. There is strik- 
 ing proof of the popular ignorance and misconception as 
 to letters in the common use of the old English th, or 
 thorn-letter. It is, says Taylor, "the survival of a Scan- 
 dinavian rune which the Goths before they left their early 
 home on the Baltic had obtained from the Greek colonies 
 on the Euxine, centuries before the commencement of the 
 Christian era. It proves ultimately to be derived from the 
 Greek delta, which, after making the round of Europe by 
 the northern seas, rejoined in England the other letters of 
 the Greek alphabet which had come by the Mediterranean 
 route." It proves out that our letter y for the thorn-letter 
 is a mere substitute of writers and printers for the thorn- 
 letter. People who wish to appear as antiquarian or phil- 
 ologic scholars, without giving themselves the trouble of 
 learning a single fact to justify the pretense, constantly 
 pronounce, even indite, imitation lines, in which the mod- 
 ern printer uses ay for the old th. Every Fourth of July 
 hundreds thus air their assumed antiquarianism by pro- 
 nouncing y e as ye instead of as the. When the old printers 
 could not "space out" properly, or had no type of the 
 thorn-letter, they usedjp instead of th, and th was repre- 
 sented by y in such words as y c (for the), y' (for that), y" 
 (for thou), etc. In old medieval manuscripts are found : 
 ■ve, yai, yair, yaim,yat, etc., and the words should be pro- 
 nounced the, thai, thair, thaim (them), that. The alpha- 
 bet of the Chinese is not properly an alphabet, but has 
 stuck fast in the pictogram stage ; it is composed of some 
 40,000 conventionalized pictures. All words are of one 
 syllable, and position in writing, and accent in speaking 
 give the grammatic relations and functions. The Japanese 
 have advanced to a syllabary alphabet, but there stopped 
 
l66 SUGGESTIONS TO MEDICAL WRITERS. 
 
 short. This was a great improvement on the Chinese, but 
 still appallingly clumsy. There was an interesting account 
 in the newspapers recently of the work of a typesetter in a 
 Japanese printing-office. The letters are so numerous that 
 little boys have to run all about a large store-house for 
 types to get those desired. When the boys bring the 
 proper letters the typographer puts them in place. 
 
 We thus recognize one of the advantages of a small 
 alphabet. Combined into words these letters tell us and 
 only by inference all we know of the civilization, character, 
 and even of the very existence of some races. The data 
 of the great race called the Aryan, the father of all 
 European peoples and literatures, is thus guessed out from 
 its etymologic rags and tatters that have come down to our 
 modern languages. The Aryan was a "dolichocephalic 
 blonde," and his house was circular, roofed with clay, only 
 late supplied with windows, the walls made of twigs ; no 
 bricks or stone were used. Our Aryan forefathers were 
 rovers, and their wagon-wheels were of one piece, without 
 spokes or felloes. Cattle-rearing was a chief occupation, 
 although they had no domesticated hens, ducks, or geese. 
 Their clothing was originally Composed of hides and pig- 
 skins, but later they learned how to plait, weave, and spin 
 wool and flax, and they fastened the blanket at the left 
 shoulder, similar to the toga of the Romans. Of course 
 they were flesh-eaters and did not always cook their meat. 
 Wild fruits and cereals were also common articles of diet, 
 also milk — at least cream and whey. They probably knew 
 nothing of cheese. Mead and honey were in use, but not 
 wine. Strangers and enemies were at first one, as is likely 
 to be the case with primitive peoples, although hospitality 
 in time became a duty. They were an inland people un- 
 acquainted with the sea. A picture of the Swiss lake- 
 dwellers, and a glance in our museums at the articles found 
 beneath these houses on piles over shallow water, give us 
 a pretty good conception of them. It is further suggested 
 that at first the wife was obtained by capture (later by pur- 
 
HISTORY AND PSYCHOLOGY IN WORDS. 167 
 
 chase) and that she merged her individuality in that of her 
 husband's family, disproving the matriarchal theory as ap- 
 plied to the Aryans— indeed the wife was almost a chattel. 
 Time was measured, the month by nights, and the year 
 by lunar months; the hardships of winter and of night 
 were deeply impressed upon the imagination, a glimpse of 
 which is given in our own words fortnight and sennight. 
 Where they lived, what was their religion, how they 
 migrated and fathered us, these and many such things 
 are also intimated in the word-stems they have handed 
 down to us. 
 
 Taking our words as we find them and going back step 
 by step in their history, we learn that like the spirit which 
 begets them they are constantly undergoing change. A 
 new subtle meaning is always being put into them and 
 they lose their old significances with a silent and secret 
 elusiveness. When we collate them after a century or two 
 they are like antiquated photographs, and from still farther 
 dates and countries they are strangely exotic. Psychic . 
 revolutions and social histories are thus focussed in them. 
 
 There are, for example, words now applied only to 
 women which were once predicated of both men and 
 women. This can signify only that women monopolized 
 the qualities thereby expressed, and that the men un- 
 learned them, so that they became ludicrous as male char- 
 acteristics. How much longer we may call a man a flirt is 
 a question. The word is evidently going the way of 
 
 Coquet, which was once as much a male as a female virtue. 
 Women will find it difficult to prove, at least etymologic- 
 ally, that they have not trifled with love more than men 
 have . 
 
 Hag was once applied to men also. It perhaps tells a sad tale 
 of the cruelty to old women, who were forced out of the 
 town, lived in the bushes, became more hated by their 
 methods of "getting even," their superstitions, and those 
 of their cruel fellows. 
 
 Witch. Piers Ploughman, and even Beaumont and Fletcher, still 
 applied this word to men, but women evidently monopo- 
 
168 SUGGESTIONS TO MEDICAL WRITERS. 
 
 lized the business of the wizard, soothsayer, or wiseacre, 
 and so became by still later degradation the only witches. 
 
 Termagant was once applied to men as well as women. It 
 might appear ungracious to press this matter before ladies ! 
 
 Man, strange as it may seem, was once applied to woman. Its 
 significance at that time seems to have been " the thinking 
 animal." Was it woman's fault or man's egotism that 
 thoughtfulness was claimed as his attribute alone ? Either 
 horn of the dilemma it is not safe to seize. 
 
 Girl was applied by Piers Ploughman to both sexes. Does the 
 fact tell of the indiscrirriinating age when the child was 
 " it,' ' an age, I believe, not wholly past. 
 
 Hoyden was spoken of both boys and girls. The seriousness 
 of life made the boys l alas, scorn the playfulness which 
 girls might still longer exhibit. 
 
 Hussy. To be done with discourtesies, we can note the sorry 
 glimpse into domestic infelicity given by the transforma- 
 tion of housewife into hussy ; and of 
 
 Gossip, which has a peculiarly distressing history. It meant 
 once, Skeet tells us, god-sib, i. e. related in God, by the 
 sponsor in baptism, who, alas, became a crony and tale- 
 bearer of scandal. 
 
 Nobody ever pays any attention to dead words, and yet 
 there are thousands in every language, coffined, begraved, 
 and epitaphed in lexicons old and new, pathetic in their 
 uselessness, awkwardness, and denied immortality. They 
 are simply the only records left of myriads of the failed 
 experiments of mind with life. They have real and many 
 ghosts. Skeat has gathered and classified a type of words 
 he calls "Ghost-words." But the name is inappropriate 
 because they never had a ghost— they were never even 
 born. The doctors would call them examples of pseudo- 
 cyesis. They are words imagined, or the result of blun- 
 ders of copyists, printers, etc. I have lately come upon 
 one which may illustrate and serve as an addition to the 
 list. An amanuensis of an old lexicographer took down 
 the dictation of concurro, and without awaiting the defini- 
 tion hastily jumped at the meaning with an interjected 
 
HISTORY AND PSYCHOLOGY IN WORDS. 169 
 
 question: "Concur, I suppose?" The disgusted etymolo- 
 gist pettishly jerked out, "Condpg, rather !" and down went 
 the synonym, so that condog may be found in some old 
 word-books as a grave synonym of concur. 
 
 Just as a person, a family, or a race, may degenerate or 
 rise, weaken or grow strong, change occupation and char- 
 acter, — so it is with words. Not only are there dead 
 words, but there are thousands of old and dying ones, also 
 demonstrating failures and lived-up usefulness, or fruitless 
 wastes of mistake and misguidance. The teratology of 
 philology awaits its scientist and historiographer. There 
 are tramp-words, criminal words, pathologic words ; insane, 
 idiotic, and paralytic words. I do not mean words or argot 
 used by these classes of people, that is another affair ; but 
 words that bear the same relation to language as these 
 sick, vicious, and crippled people do to society. All of 
 which is but a corollary of the law that <l?vxrj lies behind 
 and causes $>v<n%, or that physiology is mothered by psy- 
 chology. 
 
 I cannot forbear mentioning a few examples of degen- 
 eration and of ennobling. Of the latter class there are but 
 few ; and how this fact fixes the attention and how it 
 tallies with the lives of families and of nations ! 
 
 Emulation, by Shakespere and older writers meant envy. 
 
 There was energy and aspiration in the people who 
 
 made it mean what it now means. 
 Companion. The value of friendship is nobly attested, even 
 
 under adverse circumstances, by the change in significa- 
 tion from that of a low fellow. 
 Spinster. Women, as is usual and right, come by their own and 
 
 proved their quality by transforming the meaning of this 
 
 word which once denoted a woman of evil life. The same 
 
 truth is found in 
 Peminine, now signifying womanly, which once, at best, meant 
 
 only womanish. 
 Liberal, once signified unscrupulous. Englishmen learned that 
 
 liberality may be separated from chicane and deceit, just 
 
 as with 
 
170 SUGGESTIONS TO MEDICAL WRITERS. 
 
 Generous they proved that the common people, not only those 
 of noble birth, could be unselfish and magnanimous. 
 
 Popularity, it is feared, may be in present danger of a reversion 
 to its older meaning of courting applause. It had risen 
 to better uses, but if the people love bad traits and dem- 
 agogic popularity, we shall be as badly off as in predemo- 
 cratic days. 
 
 Enthusiasm. "Our ancestors,'' says Leslie Stephen, "under- 
 stood by enthusiasm the state of mind of the fanatical sects 
 of the Commonwealth, or of the ' French Prophets' of the 
 eighteenth century. An enthusiast meant a believer in 
 sham inspiration. The gradual change of the word to 
 a complimentary meaning marks the familiar change which 
 was also shown by the development of sentimentalism 
 in literature. '' 
 
 Respectable. " Chesterfield speaks of the hour of death as ' at 
 least a very respectable one, ' and Hannah More thinks 
 a roomful of portraits of admirals ' a respectable sight. ' " 
 
 Imp, or Brat, once meant simply a child. It is sad to think that 
 the loveliness of children should be either so misconceived 
 or so nonexistent as to bring shame and contempt into 
 the terms. 
 
 Idiot was once used only of a private person, one not interested 
 in public or state affairs ; then of an uneducated simple- 
 minded person ; then of an ignorant and selfish one, and 
 so on. How few were the interests of people, how fate- 
 fully dominant the affairs of the government, while the 
 Greek i5£wr?/s was becoming the English idiot ! 
 
 Base. In the same way, what pride filled the hearts of the ma- 
 ligners, and how spiritless" were the silent poor while this 
 word passed from humble to its present degradation. 
 
 Slave. Before Slavs were slaves, slave meant glorious. 
 
 Disease once signified discomfort only, and by 
 
 Misery was understood avarice. The logic is as plain today. 
 
 Knave once denoted simply a servant, or boy, like the present 
 Knabe. Were they knavish or were the masters super- 
 cilious and neglectful ? The same question applies as to 
 
 Varlet, which was once the title of a groom. 
 
 Libertine, even in Shakespere's time meant nothing more than a 
 free-thinker. It is very probable that libertines used free- 
 
HISTORY AND PSYCHOLOGY IN WORDS. 171 
 
 thinking as an excuse for libertinage, and also that the self- 
 righteous applied the term with egotistic indiscrimination. 
 
 Miscreant, once simply an unbeliever, shows also the odium theo- 
 logicum, rather than that unbelievers were miscreants; 
 just as an 
 
 Infidel need not be a heathen or atheist to be untrustworthy. 
 
 Cupidity is noteworthy for its remarkable transformation, as it 
 is, of course, derived from cupid, who is supposed to laugh 
 at avarice and covetousness. The Latin cupere meant 
 simply to desire. That the engrossing object of desire be- 
 comes money is plain enough in the present-day character 
 of Cupid contrasted with our definition of cupidity. Of an 
 avaricious man by the name of Love, a mot-maker said 
 " Cupid is the God of love, but cupidity is Love's God." 
 
 Sensual, Bacon properly applied to all the senses. The engross- 
 ing domination of one sense is shown in the present lim- 
 itation. The same may be said of 
 
 Lust, which Bishop Hall thought of as eager desire of any kind. 
 
 Egregious. Milton's use was simply that of remarkable ; ours is 
 remarkably bad. 
 
 Silly, once meant timely, then innocent, then simple or foolish. 
 On German tombstones one will to-day find it to signify 
 blessed or beloved. 
 
 There are hundreds of words with most noteworthy ori- 
 gins or histories, in which interesting and startling lessons 
 are taught. Assassin, e.g., tells us of that astounding 
 "Old Man of the Mountains," who defied governments, 
 and created an army of death-dispensing and death-loving 
 slaves by means of opium narcosis, a mimic paradise, and 
 assassination. The pawnbroker's three balls tell us of the 
 pills of the medical or Medici family, while still physicians, 
 before they became bankers. The barber's pole is a whole 
 chapter in the history of surgery. What a glimpse into 
 history with its roads, caravans, etc., lies in the word trade, 
 the path trodden ! 
 
 Many such words could be listed by the pagefuls and 
 illustrate the sad truth that men are quick to see evil and 
 misrepresent good. One needs to go over such lists alone, 
 
172 SUGGESTIONS TO MEDICAL WRITERS. 
 
 ponderingly, and tracing out the subtle mutations, the nu- 
 merous sidepaths of alluring, if frequently of mournful 
 suggestion. There is no novel so dramatic and interesting 
 as Skeat's etymologic dictionary. 
 
 Many words in present use "may be caught in the very 
 act" of debasement. Only one may be cited. We Eng- 
 lish are nearing the danger-line in the word sentiment. A 
 man would prefer to be spoken of as having a good char- 
 acter rather than as a man of good feeling, although it was 
 only a little while ago that he would be more highly hon- 
 ored by the title of a man of feeling. It is a doubtful com- 
 pliment to call him a man of sentiment, but any of us 
 would deny that we are ever sentimental ; while to call a 
 man a sentimentalist would be positively insulting. We 
 smile derisively at Continental men kissing each other. 
 The histories of words are often the degree-marks of the 
 thermometer of national emotions, and so of national char- 
 acter. The disgusting liar Mercier cried out to Labori, 
 ''Our military justice is not the same as yours," and good 
 men thank God for the truth spoken by the stupid blun 
 derer, a truth very different from that meant by him, when 
 he sought to introduce the definition of honor as dishonor, 
 and to define justice by the word injustice. Fortunately, 
 words as well as national character change somewhat 
 slowly ; at least it takes more than a generation of soldiers 
 utterly to reverse the significance of the noblest of words. 
 
 The comforting result which we English will come to 
 is that though the debasement of words is common enough 
 with us, it is less so than with other people. Virility, 
 dignity, and honor, without undue self-flattery be it said, 
 are Anglosaxon birthrights, and though they may lead to 
 prides, egotisms, and overstrengths, they serve to put soul 
 and self-possession into words, and to prevent good ones 
 from growing weak and morbid. The essence of the mat- 
 ter is by means of changes in word-formation and word- 
 meanings to observe the psychic histories of the peoples 
 of which the words are merely the pointers and relics. 
 
HISTORY AND PSYCHOLOGY IN WORDS. 173. 
 
 To a biologist the charm of etymology and philology is 
 psychological. We get nearer the subtle and elusive 
 reality of spirit through words and language than in any 
 other way, and. when the psychologist is doubled by the 
 historian we shall have something worthy of the name of 
 a philosophy of history. 
 
 But the pbonologist must be a musician ! Because only 
 through an adequate realization of the function, power 
 and art of music and a fusion of its science and art 
 with that of linguistics, shall we have a genuine 
 comprehension of the history and meaning of word- 
 formation and language-making. In a general way the 
 same laws underlie both music and etymology, and in 
 a large yet clear sense, progress in the one is bound up 
 with or analogous to that of the other. Take as a single 
 illustrative fact the simple truth that half of the art of 
 singing consists in getting singers to open their mouths 
 and to make pure vowel tones. To this vowelization of 
 music there is an exact phonologic analog in what one may 
 designate the vowelization of language. Does the uncon- 
 scious, with the added conscious art-spirit of a people find 
 expression only in buildings, painting, sculpture, dress, 
 poetry, and music ? And not in the first and most direct, 
 most immaterial, ever living product of the spirit — lan- 
 guage ? The question is its own absurd answer, but in the 
 science of philology the fact seems hardly to have, been 
 suspected. I have looked in vain among the official phil- 
 ologists for any statement of a fact which appears to me 
 far more primal and fundamental than Grimm's Law or 
 Verner's Law, — the fact that the more barbaric a language, 
 the nearer its speakers are to the animal ; the more are 
 vowel sounds strangled in the pharynx, and hawked, 
 clicked, clucked, coughed, or buzzed, forth. The progress 
 toward civilization is accurately gauged by the progress in 
 vowelization, and in extinguishing the function of the 
 pharynx as a checker or modifier of sound in the produc- 
 tion of words. There is not a truer or more accurate gauge 
 
174 SUGGESTIONS TO MEDICAL WRITERS. 
 
 of the actual or possible civilization of a race than this 
 fact. Grimm was a German who used the word Ich a hun- 
 dred times a day and surely several times every Nacht and 
 every Woch, and yet he began his law with a consideration 
 of the progress forward, from the back of the tongue, of 
 the gutturals, to the dentals and to the labials, — i.e., only 
 of the mutes or stops — ignoring the first journey from the 
 pharynx and root of the tongue to the middle and front of 
 the mouth. This seems unaccountable. In English we 
 have wisely utterly stopped all these Ich, Nacht, and Woch 
 throaty abominations, just as the Germans, high or low, 
 had previously discarded numerous indescribable glottal 
 buzzes, pharyngeal clucks, gurgles, coughs, and hawkings, 
 of peoples "pawing to get their hinder parts free" from 
 animalian progenitors, and vainly trying to swallow, vomit, 
 or hawk out their makeshift of language from pharyngeal 
 or esophageal depths. 
 
 The significance of Grimm's law is that, although he 
 began in the middle of the process, and not at its begin- 
 ning as he should have done, when he did catch sight of 
 it the progress of phonation consisted in the least possible 
 interruption of pure tone, and that progressively by parts 
 of the mouth more and more towards the front — i.e., the 
 point of the tongue, the front teeth and the lips. Some 
 modifications and checkings and stoppings of vowel-sounds 
 there must be because the continuous tones are insufficient 
 for the creation of the large number of sounds and words 
 required in thought-expression. But English, par excel- 
 lence, proves that the modifications by the pharynx and 
 root of the tongue are not only unnecessary but are artis- 
 tically abominable. 
 
 Parenthetically, I may note two morbid variations, or 
 two impasses, which English phonologic evolution and good 
 sense have avoided, and we may therefore believe that in 
 the progress of civilized phonology, these bad experiments 
 will never be repeated. The French never do anything 
 that they do not overdo it, and hence their language evo- 
 
HISTORY AND PSYCHOLOGY IN WORDS. 1 75 
 
 lution illustrates the psychic law most patly. In the pro- 
 gress of vowel-modification from the throat forward, the 
 French first snuffed a part of their language from the 
 pharynx up into their nose via the postnasal and nasal 
 passages. These parts in normal beings, animal or human, 
 are designed and used for breathing, but the Frenchman 
 characteristically knew better and he learned to blow half of 
 his words out of his nose. The other half he bites, spits, or 
 kisses off in a petulant, superficial and dilettante way from 
 the teeth and lips. His egotism and superficiality have 
 made him enslave and tyrannize over almost every pure 
 vowel-sound, and his language at best is a lifeless, fragile, 
 crystalline toy, not a vital organism. 
 
 The umlauts and W sound of the Germans, also have • 
 lessons for us. They are extremes of lip-modifications, but 
 are too clumsy and indicative of too much good will rather 
 than malicious, morbid, conceited, or selfish. It is not 
 pretty, this rolling and sphinctering of over-mobile lips to 
 say oel, wir, wo, ueber, etc., but the vowel-sounds are not 
 stopped, or smelled, or twanged, or spat out. 
 
 Besides the foregoing, there are many facts urging the 
 conception that the character of a people and of its lan- 
 guage is almost identical. Hold to the thought that a 
 language is the racial soul expressing itself, is character 
 talking, and no other conclusion is possible. Is the Ger- 
 man not as awkward, plebeian, harsh, vital, guttural, adap- 
 tive, profound, as his language ? Does not the Spaniard 
 promise as much and perform as little as his speech ? Is 
 he not as cruel, orotund, verbose, pompous, good-mannered ? 
 Are French people not as selfish, hypocritical, tyrannous, 
 pretty, superficial, reckless, logical, and moralless, as their 
 tongue? And English,— how perfectly it answers the 
 common sense, the vigor, the dignified, concentrated, ab- 
 solute and accurate self-possession of its speakers ! When 
 Byron preferred the soft " bastard Latin " to the native 
 tongue he affected to stigmatize, he told a good deal more 
 than he was conscious of. We must remember it was 
 
176 
 
 SUGGESTIONS TO MEDICAL WRITERS. 
 
 Byron who spoke, and his term bastard was and remains 
 most apropos. Bastards are prone to procreate bastards. 
 A language may have a bad ancestry, and may be too 
 liquid and too watery, as may a people ; witness the Italy 
 of today. The admirable restraint, the marvelous conser- 
 vatism, whereby the English language and English people 
 have preserved a rugged virility, solid bones and upright 
 backbones beneath vigorous muscles, is solely-the reason 
 of England's greatness, present and to come, — is the reason 
 we had a Shakespere and a Cromwell ; it is also the reason 
 for what all admit, that this language, simple yet herculean, 
 limpid yet on occasion glacial, is destined to become the 
 language of the entire world of men. 
 
 What a suggestive and revelatory fact is the unique 
 monosyllabic character of English. Latin has been praised 
 for its conciseness, but take the common names of the 
 human body, those things that are nearest and dearest to 
 a man's self, his senses, his family, his domestic animals, 
 and the most important natural things among which he 
 lives and with which he works ; compare them with the 
 words for these things in Latin : — 
 
 ENGLISH. 
 
 LATIN. 
 
 ENGLISH. 
 
 LATIN. 
 
 Head 
 
 Caput. 
 
 Hand 
 
 Manus. 
 
 Skull 
 
 Cranium. 
 
 Thumb 
 
 Pollex. 
 
 Face 
 
 Facies. 
 
 Hip 
 
 Coxa. 
 
 Hair 
 
 Crinis. 
 
 Knee 
 
 Genu. 
 
 Ear 
 
 Auris. 
 
 Skin 
 
 Cutis. 
 
 Tongue 
 
 Lingua. 
 
 Throat 
 
 Guttur. 
 
 Cheek 
 
 Gena. 
 
 Back 
 
 . Dorsum. 
 
 Scalp 
 
 Pericranium. 
 
 Wrist 
 
 Carpus. 
 
 Brain 
 
 Cerebrum. 
 
 Arm 
 
 Lacertus. 
 
 Eye 
 
 Oculus. 
 
 Finger 
 
 Digitus. 
 
 Nose 
 
 Nasus. 
 
 Nail 
 
 .. Unguis. 
 
 Lip 
 
 Labrum. 
 
 Toe 
 
 Digitus pedis. 
 
 Chin 
 
 Mentum. 
 
 Thigh . . 
 
 . . Femur. 
 
 Neck 
 
 Cervix. 
 
 Shin 
 
 Tibia. 
 
 Breast 
 
 Pectus. 
 
 Heel 
 
 Calcaneum. 
 
 Lungs 
 
 Pulmo. 
 
 Blood 
 
 . . Sanguis. 
 
 Heart 
 
 
 Nerve 
 
 Nervus. 
 
HISTORY AND PSYCHOLOGY IN WORDS. 
 
 177 
 
 ENGLISH. 
 
 LATIN. 
 
 Sight . . 
 
 . . Visus. 
 
 Hearing . . 
 
 . . Auditus. 
 
 
 
 Smell . . 
 
 . . Olfactus. 
 
 Taste 
 
 . . Gustus. 
 
 Lame 
 
 . Claudus. 
 
 Blind . . . 
 
 Caecus 
 
 Deaf . . . 
 
 
 
 
 Sick . . 
 
 Morbidus. 
 
 
 
 Air 
 
 Aer. 
 
 
 
 
 
 
 
 
 
 Heat . . . 
 
 . Fervor. 
 
 Cold ; . 
 
 . . Frigus. 
 
 ENGLISH. LATIN. 
 
 Vein Vena. 
 
 Pain Poena. 
 
 Dog Canis. 
 
 Rat ...... Sorex. 
 
 Cow Vacca. 
 
 Hen Gallina. 
 
 Goose . . . Anser. 
 
 Cat Felis. 
 
 Horse Equus. 
 
 Pig Porcus. 
 
 Duck . . . . Anas. 
 
 Bull Taurus. 
 
 Earth Terra. 
 
 Clouds .... Nubes. 
 
 Hail Grando. 
 
 Frost .... Gelu. 
 
 Wind Ventus. 
 
 Work Labor. 
 
 Here are seventy words, all but three of which are 
 of one syllable. To express these most used of all 
 words the Romans had to enunciate one hundred and 
 sixty-six syllables. This is a convincing proof of the 
 compactness and decisiveness of the Englishman's char- 
 acter, not unallied with his taciturnity, his control of ter- 
 ritory seventy seven times as extensive as the homefarm, 
 and a foreign investment of twenty-five thousand million 
 dollars. 
 
 I do not know if others have noticed one method 
 whereby this shortening of our language is proved to be 
 an active process today : the tendency despite logic and 
 repugnance to throw accents back from penult to ante- 
 penult, .and even to the fourth, sometimes to the fifth 
 syllable. We no longer say re-ven' -ue, etc., and in many 
 such words a.s for' mida-ble the trend is obvious. In com- 
 pound words the accent is thrown back half-a-dozen syl- 
 lables. The one striking result is to make us disregard 
 and even scorn the ending syllables, and finally to lop 
 them off entirely, as in domestical, and a thousand similar 
 
178 SUGGESTIONS TO MEDICAL WRITERS. 
 
 words. We shall be soon saying scientific, instead of scien- 
 tifical, and scientificly, instead of scientifically. 
 
 Progress in the English language and in the English 
 civilization have gone on step by step, ever united and 
 ever interacting, since English history began. Traces of 
 the banal teutonic throatiness of vocalization, of a noncom- 
 prehension of I, still stick in the untutored Scotchman's 
 pharynx, but as the Englisman's virility and semiconscious- 
 ness strengthened, he rid himself of all of them. As the 
 national consciousness grew, the national language also 
 freed itself from tyranny, and the vowelization became 
 more free. The whole history of England is epitomized in 
 the history of those most important and significant of all 
 words, the pronouns, and is focalized in the story of the 
 commander of them all, the grandest word of English, or 
 of any language, the freed, dignified, splendid I. Magna 
 Charta could never have been forced from kings or aristo- 
 crats by people who swallowed their ego, hissed their ich, 
 or choked or hiccoughed with their ik ; it came only to 
 men conscious of their own nobility arid valor and who 
 expressed these qualities by the glorious English I, rolled 
 forth with purity, self-control, and self-consciousness. That 
 word is the revelation of the ideal of all history, the 
 promise too of civilizing evolution. 
 
 The animal or the savage man moved by pain, desire, 
 joy, or any one of hundreds of emotions, expresses these 
 by sounds which are recognized as more or less appropriate 
 or indicative ; they objectify the soul, as it were. The 
 sounds of inanimate nature are anthropomorphicly con- 
 strued by the poetic imagination as suggestive of similar 
 psychic movements and conditions. How far we judge 
 correctly of them, or how much, for example, we read into 
 the songs and calls of birds our own moods and phonologic 
 habits, are questions as doubtful as they are interesting. 
 But more or less accurately interpreted we have gone on 
 until there is in the mind of every sensitive and cultivated 
 person a considerable unity of result as to the significance 
 
HISTORY AND PSYCHOLOGY IN WORDS. 1 79 
 
 of musical sounds and of music. The vocal or instru- 
 mental repetition of sounds similar to those of a groan, 
 a roar of defiance, a shriek, the " come to me " of the 
 woodthrush, or the susurrus of an evening zephyr, induce 
 in us emotions, faint or strong, according to our sensitive- 
 ness, like those aroused by the original sounds in the 
 original circumstances. The mind in one of its most con- 
 stant phases thus becomes itself a musical instrument, 
 upon which life plays the thousand tunes and symphonies 
 of daily joys and sorrows. But the mind is the listener 
 also, as well as the player, and sits silent behind the in- 
 strument, to learn how others feel and what they think ; 
 the player also as well as the listener, to tell the others 
 how it is with this one soul. That in music there is this 
 more or less accurate interchange and perfect interpreta- 
 tion, every one will admit. 
 
 My thesis is that in linguistics, and especially in phonol- 
 ogy, in language qud language, there is a correspondence 
 hitherto unrecognized, almost an identity, with the musical 
 fact of psychic expression, and with musical significance, 
 interpretation, and progress. In the language itself, and 
 not only in what the words mean, there is a reflex of the 
 creating mind of the race. A language is a musical or an 
 art product, and as surely as any other will tell of the char- 
 acter of the artist. That the artist is a millionfold person- 
 ality instead of one individual does not change the law. A 
 Gothic cathedral that required a peculiar people, myriad 
 hands and a thousand years to create, speaks no more pecu- 
 liarly and distinctively of the \poxn of its builders than does 
 a Gothic language. Indeed, one may say the stones speak 
 far less clearly and precisely, because the language is im- 
 material. I would believe that this truth extends to the 
 veriest details, to the mutations of the forms of single 
 words, and to the nuances of pronunciation themselves. 
 Every dialect, every patois, especially our American Negro 
 language, is incontestable proof of this, and no better could 
 be desired than English pronouns. Pronouns are the most 
 
l80 SUGGESTIONS TO MEDICAL WRITERS. 
 
 precious and most used of all words, and yet how late in 
 evolution they arose in perfection. Even the child of the 
 most cultivated parents naturally says, Georgy wants, Boy 
 wants, before he says, me want, and this before he learns, 
 / want. All our English pronouns are monosyllables and 
 those nearest the personal life are the most perfectly vow- 
 elized; the one consciously designating the subjective life, 
 7, being pure tone, and the next most honored, you, but 
 little less pure, with the slightest added touch of modifica- 
 tion in we. Notice that in no other Teutonic tongue is 
 the representative of the conscious self a pure tone. We 
 have Ic, Ie, Ik, Ich, Ik, Jig, Jag, Ek, but not I. All the 
 " Laws " of all the philologists cannot explain the fact 
 except psychologically. Note also that our I refuses to be 
 mangled and shunted into the next following word, as in 
 many languages whose people love to be tyrannized over 
 and are incapable of holding their I with dignity and free- 
 dom. The French, for example, elide the half, the vowel, 
 too, of their je, and me, whenever apportunity offers, while 
 we will do nothing of the kind. I'm for I am, is a poor 
 colloquialism and we are ashamed to print it, and should 
 be ashamed to say it. 
 
 Notice the fact also that the same growing sense of 
 freedom of the English spirit has shaped its language with 
 a perfectly analogous freedom. Never before was there a 
 civilized language so absolutely grammarless. We have 
 stopped the nonsense of case-endings, inflectional, syntac- 
 tic, and terminologic puzzles, and have given our words a 
 single form. To put that in biologic language, we have 
 advanced from morphology to physiology, from form to 
 spirit. The spirit is so free that we can make almost any 
 noun into a verb, and any verb into a noun. " I first post- 
 aled him and then I wired him," said a man to me last 
 week, " but I could get no wire from him." Viewing this 
 wonderful dual march of English linguistic and English 
 political freedom, how utterly silly the blindness, dogmat- 
 ism, and materialism of "Die Lautgesetze wirken blind, mit 
 
HISTORY AND PSYCHOLOGY IN WORDS. 181 
 
 blinder Notkwendigkeit." Blindly indeed act the laws of 
 phonetics to him who sees no racial or common Conscious- 
 ness behind individual consciousness, no 
 
 " One far-off divine event 
 To which the whole creation moves." 
 
INDEX. 
 
 Abbreviation of titles of medical peri- 
 odicals, 5\ 
 Accents, French, 67 
 Accuracy in pagination, 129 
 Adjective of pons, 79 
 Adverbial terminal, question as to, 57 
 Alphabet, Chinese, 16$ 
 Alphabetic signs, origin of, 164 
 Ambiguous or insufficient titles, 32 
 Anatomic terms to be preferred, 61 
 And, origin of sign for, 96 
 Apoplexy, 75 
 Apostrophe, origin of, 97 
 Apt for liable, etc., 117 
 Articles and books, size of, 148 
 Avoid long titles, 34 
 
 Badly-chosen words, 116 
 Basedow's disease, 76 
 Bibliographies often shams, 34 
 Books and articles, size of, 148 
 Books, big or little ? 145 
 Books, collaboration, 150 
 Bryant index expurgatorius, 120 
 
 Cancer superseded by carcinoma or sar- 
 coma, 74 
 
 Capitalization of scientific terms, 52 
 
 Carcinoma or sarcoma, not cancer, 74 
 
 " Case," misuse of the word, 84 
 
 Certain words, use of, 118 
 
 Change of title, 127 
 
 Changes in meanings of words, 169 
 
 Charts for illustrating, 34 
 
 Chemic terms, spelling and pronunci- 
 ation of, 43 
 
 Chinese alphabet, 165 
 
 Choroid, thyroid, etc., 74 
 
 Chymical signs from Motherby's Dic- 
 tionary, 90, 92, 93, 95, 98, 99, 101, 102. 
 
 Circumflex accent, origin of, 91 
 
 Collaboration-books, 150 
 
 Colon, origin of, 92 
 
 Comma, origin or, 96 
 
 Comparison, exactness in terms of, 85 
 
 Composite books, 150 
 
 Composition, logical order of, 120 
 
 Compounds, hyphenated, or separate 
 words, 48 
 
 Compounds, solid-word, 49 
 
 Construction, strabismic, 113 
 
 Consumption or phthisis superseded by 
 tuberculosis, 76 
 
 Contagion and infection, 71 
 
 Coquet, 167 
 
 Dates, mode of writing, 52 
 Degenerate words, 169 
 Descriptions, exactness in, 85 
 
 Designations, eponymic, 69 
 
 Diereses, disuse of advised, 30 
 
 Dieresis, origin of, 91 
 
 Difficulties in medical reporting, 132 
 
 Difficulties, some scientifical, 26 
 
 Difficulty, another spelling, 47 
 
 Digits, the, 95 
 
 Dilation or dilatation, 78 
 
 Dilettanteism in language, 69 
 
 Diphthongs against the genius of lan- 
 guage, 20 
 
 Diphthong, use and abuse of, 41 
 
 Division-sign, origin of, 97 
 
 Dotting of digits, 99 
 
 Dram, origin of sign, 101 
 
 Duplicates of articles sent different jour- 
 nals, 153 
 
 Editors and publishers, rules for, 125 
 
 Elision of final <?, 42 
 
 English, medical, suggestions as to, 7 
 
 English, monosyllabic character of lan- 
 guage, 176 
 
 English titles and nomenclature, 33 
 
 Eponymic designations, 69 
 
 Equality sign, origin of, 97 
 
 Ethical questions, 139 
 
 Etymologic spelling an absurdity, 21 
 
 " Euphony " in superfluous suffixes, 2<j 
 
 Exactness in comparisons and descrip- 
 tions, 85 
 
 Exclamation point, origin of, 97 
 
 Exophthalmic goiter, 76 
 
 Figures or spelled out ? 123 
 Fine tools without learning trade, 107 
 First person singular in different lan- 
 guages, 178 
 Foreign words and terms, 65 
 French accents, 67 
 
 German habit, protest against a bad, 69 
 
 Ghost words, 168 
 
 Goiter, exophthalmic, 76 
 
 Gotten, 73 
 
 Graves' disease, 76 
 
 Greek z changed to e, 22 
 
 Grimm's law, 173 
 
 Habit, a bad German, protest against, 69 
 
 Hall, H. O., rules for editors and pub- 
 lishers, 125 
 
 Hatred of innovation, 18 
 
 Heteronyms, 67 
 
 Highfalutin, 106 
 
 History and psychology in words, 156 
 
 Hybrid words, 17, 68 
 
 Hyphenated compounds or separated 
 words, 48 
 
1 84 
 
 INDEX. 
 
 I, 178 
 
 Illustrations, exactness in use, 38 
 Illustrations, inability to alter, 38 
 Illustrations, temperature-charts for, 36 
 Image in the mirror, 139 
 Immune to or immune from? 120 
 Inconsistency, terminologic, 80 
 Index expurgatorius, 120 
 Infection and contagion, 71 
 Infinitive, the split, 122 
 Innovation, hatred of, 18 
 Interrogation point, origin of, 97 
 Intolerance, literary, 141 
 " It is to be," 80 
 
 J, tailing of, 100 
 
 Language, immateriality of, 159 
 Latin, use of, 8 
 Lay and lie, 73 
 Ligature, origin of, 91 
 Literary intolerance, 141 
 Literature, professional control and own- 
 ership of, 143 
 Logical order of composition, 120 
 Long titles, avoid, 34 
 
 Man, derivation of word meaning, 168 
 Manuscript, preparation of, 35 
 Meaning of words changed, 169 
 Medical English, suggestions as to, 7 
 Medical Paleography, 86 
 Medical periodicals, abbreviation of 
 
 titles, 53 
 Minus sign, origin of, 97 
 Mirror, image in the, 139 
 Misunderstood proverbs, 154 
 Misuse of the word case, 84 
 Mononyms, 68 
 Mood, subjunctive, use of, 115 
 
 Nationalisms and vernacularisms, 67 
 Nomenclature, English and titles, 33 
 Numbering volumes, accuracy in, 129 
 
 Order, logical, of composition, 120 
 
 Origin, modern punctuation marks, 89 
 
 Orthography, 40 
 
 Ounce, abbreviation for, 100 
 
 Ounce, origin of sign for, 101 
 
 Oz. and viz., 100 
 
 Pagination, accuracy in, 129 
 
 Paronymous plurals, 71 
 
 Paronyms, 67 
 
 Parry's disease, 76 
 
 Pecilonymy or terminologic inconsist- 
 ency, 80 
 
 Period, origin of, 92 
 
 Periodicals, medical, ^abbreviation of 
 titles of, 53 
 
 Perissology, 106 
 
 Pharmacopeia, spelling of, 48 
 
 Phonetic, purpose in spelling, 24 
 
 Phthisis, or consumption, superseded by 
 tuberculosis, 76 
 
 Plurals, paronymous, 71 
 
 Polynyms, 68 
 
 Pons, adjective of, 79 
 
 Pound, abbreviation for, 97 
 
 Preface, 3 
 
 Prescription signs, 101 
 
 Pronunciation and spelling of chemic 
 terms, 43 
 
 Pronunciation, as to, 58 
 Pronunciation, general principles of, 44 
 Protest against bad German habit, 69 
 Proverbs misunderstood, 154 
 Psychology and history in words, 156 
 Publishers and editors, rules for, 125 
 Punctuation, 58 
 Punctuation, history of, 89 
 
 Questions, some ethical, 139 
 
 References, 34 
 
 Reform rules, 29 
 
 Refract as a transitive verb, 78 
 
 Reporting, difficulties in, 132 
 
 Rules for editors and publishers, 125 
 
 Rules for writing, 106 
 
 Rules of reform, 29 
 
 Sarcoma or carcinoma, not cancer, 74 
 
 Scientific terms, capitalization of, 52 
 
 Scientifical difficulties, 26 
 
 Scruple, origin of sign, 101 
 
 Separate words or hyphenated com- 
 pounds, 48 
 
 Semicolon, origin of, 94 
 
 Sentences suffering from spastic para- 
 plegia, 114 
 
 Shilling, sign for, 97 
 
 Size of articles and books, 148 
 
 Size of journals uniform, 126 
 
 Skiascopy, confusion in use of the term, 
 77 
 
 Solid word compounds, 49 
 
 Spastic paraplegic sentences, 114 
 
 Spelling, 40 
 
 Spelling and pronunciation of chemic 
 terms, 43 
 
 Spelling difficulty, another, 47 
 
 Spelling, etymological, absurd, 21 
 
 Spelling-reform, 40 
 
 Split infinitive, 122 
 
 Strabismic construction, 113 
 
 Style, 104 
 
 Subjunctive mood, stop the use of, 115 
 
 Suffixes, superfluous, 25 
 
 Superfluous suffixes, 25 
 
 Sympathectomy, 79 
 
 Tailing of the J, 100 
 
 Temperature-charts for illustrations, 36 
 
 Terminal, adverbial, question as to, 57 
 
 Terminologic inconsistency, 80 
 
 Terms, anatomic, to be preferred, 61 
 
 Terms and words, foreign, 65 
 
 Thorn-letter, 165 
 
 Thyroid, choroid, etc., 74 
 
 Title, change of, 127 
 
 Titles, ambiguous or insufficient, 32 
 
 Titles, avoidlong, 33 
 
 Titles, English, and nomenclature, 33 
 
 Titles of medical periodicals, abbrevi- 
 ations of, 53 
 
 Tools, fine, without trade, 107 
 
 Tubercular or tuberculous, 81 
 
 Tuberculosis, not consumption or 
 phthisis, 76 
 
 Umlaut, origin of, 91 
 Use of certain words, 118 
 Use of Latin, 8 
 
 Verbs that give trouble, 72 
 Vernacularisms and nationalisms, 67 
 
INDEX. 
 
 185 
 
 Viz. and 02., 100 
 Volumes, uniform size, 126 
 
 Wessels, F. E., Difficulties in medical 
 
 reporting, 132 
 Where for when, 117 
 Word case, misuse of, 84 
 Words, and terms, foreign, 65 
 Words, badly chosen, 116 
 Words, changed in meaning, 169 
 
 Words, degenerate, 169 
 
 Words ennobled in meaning, 169 
 
 Words, history and psychology in, 156 
 
 Words, hybrid, 17, 68 
 
 Words, use of certain, 118 
 
 Writing, general rules for, 106 
 
 " Z" in viz. and in oz., 100 
 Zodiacal signs, origin of, 94 
 " &," the sign, origin of, 96