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it will take him to find ore, but charges according to his ability to
determine the best way to run the lead, or to open the mine, etc. As
ht as I know, all professional services are charged for upon a similar
basis, except the medical profession, where it has been the custom, it
seems, to estimate skill at so much per visit. Surgeons and specialists
have proven that skill can be charged for in the medical profession^
>Dr. Cartledge, for instance, will operate upon a patient, doing an
ovariotomy in a family abundantly able to pay ; for this service he will
charge five hundred dollars. He will perform a similar operation in
another family less able to pay, and will charge accordingly. His skill
in either case is just as great ; the amount of labor he performs in one
is the same as in the other. How, then, does he estimate his skill?
It is partly based upon the ability of the patient to pay. If I take
charge of a case of pneumonia in a man's family, and conduct it safely
through, or even if the patient dies, if the man is abundantly able to
l^y, I should be entitled to a good fee. My skill in managing the case



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T^ American Practitioner and News. 427

is ptofessional skill ; it has required long study and considerable expense
to prepare me to manage the case, as it has the surgeon to prepare him-
self for a certain operation, for which he estimates his skill to be worth
five hundred dollars ; yet I must charge for my case at so much per visit.
The suigeon charge^ for his skill, regardless of the time or labor
tequired in a given case.

I insist that the only way by which we can improve the condition
'Of things is to charge upon the basis of skill — not so much per visit.
My idea in preparing the paper was to suggest that we get away from
the custom of charging so much per visit, but render our bills for services
rendered, estimating our skill in the management of the case.

THOMAS L. BUTI.ER, M. D., Secretary.



Sm our Special OflTer to new eubscribers on one of the advertleing pages.



,^oreign (Eorrcsponbcncc-

LONDON LETTER.

[FROM OUR SPECIAL CORRBSPONDBNT.]

Death of Dr, SotUkey ; A Medical Man's Blunder : Sanitation for Clergy-
men ; Fever in West Africa ; A Test Case ; Condensed Food in the Port
of London ; A Case of Carcinoma ; a Fresh Hospital Ship,

Dr. Reginald Southey, for fifteen years physician to St. Bartholomew's
Hospital and lecturer of Forensic Medicine and Hygiene there, has died at
the age of sixty-four. In 1883 he was appointed a Commissioner in
Lunacy, an office which he resigned last year. Dr. Southey was educated
■at Christ C)iurch, Oxford, where he had a most distinguished career, being
elected RadcliflFe Traveling Fellow of the University in i860. His profes-
sional education was completed at St. Bartholomew's Hospital, and the
Berlin, Vienna, and New York medical schools.

Application has been made on behalf of the Treasury at the Glamorgan
Assizes at CardiflF for the discharge of the recognizances of a woman who
had been committed for trial for the wilful murder of her husband. Mr.
Justice Bucknill commented on what he stigmatized as the terrible blunder
of a doctor, who had certified before the local magistrates that death was the
result of a broken neck, and that a contusion on the side of the head might
have been caused by a billhook found on the premises. After the
woman's committal the body was exhumed by order of the Home Office,



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428 7 he American Practitioner and News.

and a post-mortem examination lield, when three doctors found that the
deceased had died of syncope, produced by lung inflammation. The judge
hoped that the medical man would compensate the woman for his terrible
blunder, and that it would go far over the face of the country that he was
under the deepest obligation to her.

At the Chapter House of St. Paul's Cathedral as series of lectures are
being given to the clergy on sanitation and hygiene, it being considered
that rt is most important that clergymen should be able to instruct their
poorer parishioners in matters of sanitation. Dr. Schofield, in his opening
lecture, expressed a hope that the time was coming when such lectures
would be totally unnecessary. Oxford has now placed hygiene on the list
of subjects for their local examinations, and he believed that in time the
subject would be considered a necessary one before any one entered holy
orders. It could be proved that 200,000 people died annually before their
time in Great Britain. Dr. Schofield dealt at length with the cause of
disease, effects of environment, occupation in life, and of bad air and bad
food.

Major R. Ross, of the Army Medical Department, who has returned
from the West Coast of Africa with the Liverpool Medical Expedition on
Tropical Diseases, reports that, although the expedition had been at work
only six weeks, the results were very successful. The authorities of Sierra
Leone have, on the advice of the expedition, decided to use every means to
exterminate the mosquito spreading malarial fever as well as the immediate
cause. Major Ross considers that other conditions were favorable to health
in West Africa, there being a good water supply. He thought that the
whites were not careful enough, and that the houses were badly constructed
and compared unfavorably with the residences of whites in India, which
were built on plans which gave the inhabitants every chance of life. It
appears that only one member of the expedition had suffered from malaria,
and he had slept one night without mosquito-curtains and was thus
infected. One of the party is proceeding round the West Coast in order to
instruct medical officers as to the best way of dealing with the mosquito.
The expedition thinks that the future of the West Coast is assured as soon
as. the colonial authorities take steps to extirpate the virulent mosquito in
the neighborhood of the principal towns. Of course it will be long before
the inland stations can be made healthy.

Attention has been drawn to the ages of several members of the medical
profession: Sir James Paget, eighty-five years of age; Sir Henry Acland,
eighty-four; Sir E. Sieveking, eighty-three, and Sir Henry Thompson,
seventy-nine.

The Society of Apothecaries has obtained the opinion of Sir E. Clarke
as to whether a holder of their license may legally describe himself as a
V physician" or "surgeon" or both. This eminent legal authority has
advised them that the L. S. A. does confer this right, and that the Society
of Apothecaries is justified in so advising its licentiates. In view of the



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The American Practitioner and News^ 429

opinion, the Society has invited the co-operation of the General Medical
Council in having the matter authoratively set at rest.

In a cutter's window in the East End a souvenir of an old-time war is
•on yiew. It is a saw which was used by a surgeon of the British Army
to amputate the limbs of wounded soldiers at Blenheim, Malplaquet, and
Ramillies.

According to the medical officer of health of the Port of London, dui*ing
the first six months of this year more unwholesome food has been seized
than in any previous half year^ It consisted of almost every description of
the commoner foodstuffs. Several supposed cases of plague were investi-
gated, but only one case actually arrived at Gravesend, and this was at once
removed to Port Sanitary Authority's Hospital. The vessel was disinfected,
the crew was daily medically inspected, and all the rats which could be
caught in the ship were cremated.

Mr. George Hamilton recently removed a large cylindrical-celled car-
cinoma which completely filled the. cecum. In the operation the cecum,
vermiform appendix, along with three inches of the ascending colon, and
three inches of the ileum were resected. The severed termination of the
small intestine was treated by interrupted sutures, and the cut end of the
small intestine was united by means of a Murphy's button to the ascending
colon. The patient made an uninterrupted recovery, and during two
months gained more than two stone in weight.

In the hospital ship provided by the Princess of Wales for the South
African campaign there are two hundred cots. The wards go the entire
width of the ship, and give one the impression of the light and spacious-
ness of a great hospital. There are two rows of cots in each ward wide
enough for change of position ; each is provided with a spring mattress and
a liberal supply of linen. Each bed has a movable frame which can be
raised to support the back, and a small table is attached for the use of the
invalid, at whose lightest touch it turns on its hinges to lay across the bed
for meals and for other purposes, x The operating chamber is on the lower
-deck, amidships. A perfect installation for working the Rontgen rays
apparatus is a gift of the Duke of Newcastle. In each of the wards are
small cooking-stoves, worked electrically and available for boiling water.
Three refrigerating chambers, with a capacity of 2i200 cubic feet, are for
provisions. Only one small ward for four officers is set apart on the ship.

Dr. Henry Hicks, the eminent geologist and specialist in mental dis-
eases, has died. He had been long on the Council of the Geological Society,
and devoted himself to the geological investigation in North and South
Wales and Scotland.

London, November, 1899.



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4^0 Th4 Americmn PracHHoiur and News.

HcpictDS anh bibliography*



Qoestloa-CompeiMis No. 4— OifntJalg of Medical CiMnisCry, <
asd Inorgailic. Containinji^ alto Qucations of ICcdkal Pbytict, Chemical Pbiloa-
ophy, Analytical Processes, Toxicology, etc Prepared Especially for Studeata
of Medicine. By Law&kncb Wolff, M. D.» Demonstratpr of Chemiatry* Jeffer.
•on Medical College; Member of the German Chemical Society, etc Fifth
edition. Thoroughly revised by Smith Ely Jblliffb, M. D., Ph. D., Professor
of Pharmacognosy, College of Pharmacy, City of New York, etc. 222 pp. Prioe^
^.oo. Philadelphia: W. B. Saanders. 1899.

With four editions of this questionKx>mpend scattered among the med-
ical colleges of the country, and over 175,000 copies of the series of like
publications already sold, little work is left for the reviewer beyond
announcing a new edition.

The author, in pleading Cor the advantages of such an aid to the quiz-
master, calls attention to the well-known fact that students in medical
schools find the pursuit of chemistry a very difficult thing among the
exacting tasks that fall to their lot.

This work in scope, mode of presentation, letter-press, and binding pre-
sents just the make-up that must make an}' study inviting. d. t. s.

Saiindera' Question-Compeiids No. 11— Essentials off Diaeasoa off the Skin. In-
cluding Syphilodermata. Arranged in the Form of Questions and Answers. Pre-
pared Especially for Students of Medicine. By Hbnry Stbi«wagon, M. D., Ph. D.,
Clinical Professor of Dermatology in the Jefferson Medical College, etc. Poarth
edition. Thoroughly revised: Illustrated. 276 pp. Price, |i. 00, net Philadelphia:
W. B. Saunders. 1899.

In this fourth edition of Dr. Stelwagou's Essentials of Diseases of the
Skin the entire book has been subjected to a careful scrutiny and reviaios^
and the text has undergone numerous small but important changes in
order that the subject-matter might reflect present knowledge of cutaneous
diseases. Several rare affections have also been briefly described. Among
them are hydroa vacciniforme, Mastomycetic dermatitis, erythema indura-
tum, phlegmonosa diffusa, hydradenitis suppurativa, epidermolysis bul-
losa, and conglomerative pustular perifolliculitis. The work is richly iiltts-
trated and in the style characteristic of the Saunders publications.

D. T. s.

A Compend off the Practice off Mediclae. By Danisi, E. Htroflas, M. D., Chief Resi-
dent Physician, Philadelphia Hospital; Physiciaa-in-Chief, Inaane Department^
Philadelphia Hospital, etc. Sixth physicians' edition. Thorataghly rertaed and
enlarged. Including a Section on Mental Diseases and a Very Complete Section
on Skin Diseases. 625 pp. Price, $2.25. Philadelphia : P. Blakiston's Son & Co.
1899.

In answer to a continued demand for the Compend of Medicine, the
author has much enlarged and made it far more complete than former edi-



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Tk€ American Prm:tiiioner €m4 News. 431

tions. While conceding the author's claim that the compend is the most
complete of works of its class, it can hardly be conceded, as claimed in the
title, that it contains a very complete section on skin diseases.

As a handy reference-book its great value is not to be denied. It has
the smallest possible number of waste or irrelevant words« and in the de-
scription and treatment of various diseases the salient features have been
caught with the happiest aptitude and facility on the part of the author.

Bound in flexible Russian leather, with full gilt edges rounded, there is
hardly to be found a more attractive book among medical publications.

D. T. s.

A Text^Book of Materia Medics, Therapeatics, and Pharmscology. By Gsorgb
Frank Buti^R, Ph. G., M. D., Professor of Materia Medica aad Clinical Medi-
cine* in the College of Physicians and Surgeons, Medical Department of the
University of Illinois, etc. Third edition, thoroughly revised. 874 pp. Price,
cloth, $4.00; leather, $5.00. Philadelphia: W. B. Saanders. 1899.

It is not to be expected that a great deal that is original or new can
have been collected within the recent past in regard to standard medica-
ments. The fact is, they have been generally neglected in the interest of
the newer remedies which also crowd one another from the stage with daz-
zling rapidity. What remains to be done in that regard is to present in the
form of improved plainness of statement the virtues the old remedies are
supposed or known to possess. This Dr. Butler and his publisher have
creditably accomplished. The work is especially excellent on the phar-
macal side, and in treating of remedies by groups the author has much
facilitated the understanding and remembering of important facts and
principles.

The reader is favored with an introduction in which the author defends
regular medicine against various interlopers, such as miraculous waters,
Christian scientists, and the like fads. While the reviewer would fully
agree with him as to the worthlessness of these fads except as means of
impressing the mind, he can not forbear asking whether we of the regular
profession ought not to cast out the beam from our own eyes, that we may
see clearly to remove the mote from our brother's eye.

Let us make sure and give assurance that placebos do not constitute a
large part of our prescriptions, and that possibly a majority of those that
are not had better be so, that our visits are only so many as the interest
and the peace of mind of our patient requires, that no hopeless and useless
. operations are performed, and no schemes of mere money getting are worked
on our patients.

When we of the regular profession have learned the Confucian maxim
of doing nothing unto others that we would not that they should do unto
us, then with clean hands and a clear conscience may we wage war against
the representatives of the various pathies who. in standing between patients
and such medicines as are dealt out by many doctors, may be doing less
harm than we sometimes think.



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432 The American Practitioner and News.

Dr. Butler is very conservative in regard to the various serums and
antitoxins. To the diphtheritic antitoxin he gives the credit of lessening
by, about fifty per cent the number of deaths from diphtheria, while itt
nearly all other cases this character of treatment is regarded as sub judice.

On the whole the work is quite a creditable presentation of its subject,
and, appealing as it does to Western pride, will doubtless continue to achieve
a creditable patronage. ' d. t. s.

The Nervous System and Its Constituent Neurones. Designed for the Use of

Practitioners of Medicine and of Students of Medicine and Psychology. By
Lkwei.lvs F. Barker, M. B., Former Associate Professorof Anatomy in the Johns
Hopkins University and Assistant kesident Pathologist to the Johns Hopkins
Hospital. With two colored plates and six hundred and seventy-six illustrations
in the text. 1122 pp.

There has been so much that is new and marvelous contributed in
recent years to medical studies in the line of bacteriology and organo-
therapy, that progress in the study of the nervous system has been in a
measure obscured or lost sight of. And yet in no department has more
radical modification of views taken place than in the minute anatomy of the
nerves. We have before us the first effort to present a comprehensive plan
of the development of the neurone concept.

This concept is essentially that every nerve <:ell is anatomically an
independent structure and connects with its fellows, not by actual fusion
but only by contact. The term neurone then applies to the histological
unit of the nervous system, and includes the whole element-cell body, pro-
toplasmic processes, axis-cylinder processes, and arborization and collaterals,
and on this conception all neurologists are coming to an agreement.

Certain of the most eminent investigators, however, notably Apdthy and
Held, are inclined to insist on a modification of this view and to contend
that in a certain considerable class of cases anastomoses of dendrites and
axones do normally take place. This, however, would only tend to enlarge
the unit, and would not do away with the neurone concept. It would be
impossible in the space allotted to us to do justice to the rich mine of new
material here first Opened in collected form for the profession. The mar-
velous inguenuity shown by the various investigators in the invention of
coloring and various other tests, the infinite patience indicated, and the
genius of interpretation, only the patient readers of the book can fully
realize. With an exalted opinion of the medical profession, we yet can not'
agree with the author that he aptly describes this book as written for the'
practitioner of medicine. Certainly the busy practitioner must experience
many interruptions before he can have mastered it.

The work of the author has not in large part consisted of original
investigations or contributions of facts, but he has in a masferTul way
combined the facts discovered by others and traced out their logical signifi-
cance.



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The American Practitioner and News. 433

For the student of pyschology the book has a usefulness that no other
work based on anatomy pretends to possess, and combines information to
be gained only by a search through the great mass of the world's high class
literature.

Indeed, for every progressive student, investigator, and thinker along
these lines it deserves the highest encomiums that can be bestowed upon it.

D. T. s.



Ohsixacis axxb Selections.



Therapeutic Uses of Nitro-Gi.ycerine. — In a paper on the phar-
macological action and therapeutic uses of the organic nitrates, published in
the September number of the Medical Chronicle, Dr. C. R. Marshall, Pro-
fessor of Materia Medica in the University of St. Andrews, devotes a page
to nitro-glycerine. He considers that it is serviceable only in diseases con-
nected with actual or relative spasm of unstriped muscular fiber. This
group may be subdivided into two main divisions — circulatory and respira-
tory — other conditions of this class (colic of various kinds, etc.) being much
better relieved in other ways. As regards respiratory diseases, spasm of
the bronchial tubes (asthma) is sometimes benefited by the administration
of nitro-glycerine, and relief in other kinds of dyspnea is said to occur.
That some influence is exerted on the bronchial muscles there can be no
doubt, but in most cases of asthma the results are disappointing. In pneu-
monia and other respiratory diseases there seems to be no rational basis for
the use of nitro-glycerine. This drug is of the greatest value in conditions
aflfecting the circulation, and, as far as experimental evidence goes, only in
conditions accompanied by an increase in arterial pressure. When this
occurs and gives rise to symptoms such as pain, these are often quickly
relieved by nitro-glycerine or any other rapidly acting vaso-dilator. But
cardiac pain is not always so caused, and in these cases vaso-dilators as a
rule fail to relieve. In some individuals severe cerebral effects are pro-
duced by small doses of nitro-glycerine ; others bear comparatively large
doses — even as much as a drop of pure nitro-glycerine — with impunity.
Under ordinary circumstances tolerance is quickly established. The most
common ill-effects produced by nitro-glycerine and vaso-dilators generally
are distressing palpitation and headache, the latter often of a severe kind
and persisting long after the vascular effiects have passed away. Other
effects are dizziness, tinnitus, and dilated pupils, hematuria and choreic
movements, and after large doses weakness in the legs, nausea, and vomit-
ing. The solid organic nitrates — erythrol tetranitrate, mannitol, hexa-
nitrate — are of value where gentle and prolonged dilatation of the blood-
vessels is required. Erythrol tetranitrate is especially useful as a prophy-
lactic in preventing the onset of anginal pain. — Lancet.

38



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The Americcun Practitioner and News. 435

There is a city (Seville, we believe) in which the " social evil " is
under complete control. The " red light " district is isolated, and no
female who lives in that quarter is permitted to leave it except when
she goes out to a country seat for vacation, and this she is compelled to
do whether she wishes to or not, but is still under the care of a super-
intendent, who sees that she does not ply her trade while at the rest
home. Further, the person who runs the house of prostitution is made
responsible for the doctor's bills resulting for attention given to parties
who become contaminated in her house. It is needless to ask if such
measures could be carried out in any American city.

This question of prostitution has been considered by many of the
wisest men of all ages, and as yet there has been no means devised to
even modify the manner of conducting it, and after all it is in about as
good shape as it can be.

THE SOUTHERN MEDICAL COLLEGE ASSOCIATION.



- While it is unfortunate for the medical profession of the South that
the medical colleges in their Association require attendance upon but
three courses of lectures for all students who matriculated and attended
a course of lectures before January, 1899, and while it is a serious mis-
take for the Association to allow a college to admit a student to
advanced standing within three months after the completion of a course
of lectures, the medical profession would accept in good faith the pro-
fessed determination of the Southern schools in the interest of higher
medical education were it not that some of these schools appear to
disregard some of the fundamental principles that are observed by
reputable colleges. This statement is true, if we are to believe the
statements in many letters written by students in attendance upon
lectures in these schools, and the records of such students during their
attendance upon lectures in another school.

It is recognized by every medical college that no student can by any
means be credited with attendance upon a course of lectures, or for work
done in any year of the graded course, except by ofiScial credentials
stating such facts, and signed by the officers of the college in which he
claims to have attended lectures. The mere statement of the student
that he has attended a course of lectures in a medical college, with the
presentation of a matriculation ticket, laboratory tickets, or receipts
for money paid, does not indicate in any degree th^t he is entitled to
credit for any part of a course of lectures.



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436 The American Practitioner and News.

A medical college may be justified in examining a student for
advanced standing who has official evidence that he has attended a
regular course of lectures in another college, though he may not have
passed an examination for advanced standing; or a medical college may
admit a student to advanced standing without examination who pre-
sents credentials of having passed an examination upon the branches



Online LibraryUniversidad de Buenos Aires. Facultad de Derecho yThe American practitioner → online text (page 103 of 109)