Notes on Appendicitis.

Dr. John B. Deaver, of the University of Pennsylvania, a leading authority upon the subject of Appendicitis, is doing most excellent work in the surgical treatment of that disease, having operated apon seventy-seven cases with but a single death, and that in a case too far gone to be a hopeful subject at the time of the operation. Dr. Deaver read an interesting paper upon the subject before the College of Physicians, Phila., Nov. 7th last. In that he expressed it as his opinion that a large number of the acute cases and also many of the chronic cases were caused by foreign bodies in the appendix. These may be fecal concretions, seeds, &c. The diagnosis he considered not to be difficult. As to treatment, he gives the following:"My rule is this: Given the case of a patient who suddenly develops severe abdominal pain, at first referred either to the epigastrium or about the umbilicus, and later to the right iliac fossa, accompanie 1 by nausea and vomiting, and following some dietary excess or indiscretion, and preceded as a rule by a history of in. testinal dyspepsia, and when examination reveals rigidity and tenderness over McBurney's point, I at once administer a purgative, prefer. ably castor-oil or salts. If this is not retained I give calomel. If, after the purgative has operated satisfactorily, the symptoms continue, along with an increase of intensity of the localized tenderness, I at once operate.'

The following paragraph is of great import

ance:

"The role the appendix plays in many cases of intestinal indigestion I am sure is important. This has been beautifuly shown in many of the cases of chronic appendicitis I have operated upon for digestive symptoms, which were so persistent before the appendix was removed, and entirely disappeared after recovery from the operation. I am so thoroughly convinced of the importance of this fact, that I believe a permanent cure can only be obtained in a certain pro portion of cases of chronic intestinal catarrh by removal of the apendix, should it reveal tender. ness, even when there has been no clear history of an attack of inflammation of this organ."

The Doctor thinks that very many of the cases reported as having died from other abdominal diseases, were the victims of appendicitis.

Attending Physicians and Consultation Fees.

An esteemed correspondent recently inquired: "In consultations, is not the attending physician entitled to a consultation fee in addition to his ordinary visiting fee?"

We answered, "Yes."

We

Our correspondent writes again, stating that some differ with us in opinion, and requesting a more elaborate exposition of the matter. fail to see how there can be any room for difference of opinion, so far as concerns the right of the attending physician to additional compensation for additional service. The expediency of the charge is a matter of consideration in each individual case, and both business sense and more generous sentiment may, in some cases, induce the physician to forego his right. As a rule, however, physicians are much more likely to err on the side of undercharge than overcharge. The whole visiting fee system is ridiculous, and no other body of professional men would submit to it. The physician should charge, as does the lawyer or architect, in proportion to the importance of the case, the skill possessed and required, and the time, labor and anxiety involved. Surgeons, at least the tiptop ones in city and country, do this for operative work, and physicians should do the same in medical cases.

A fee that may be large for the treatment of a case of simple diarrhea may be ridiculously small for a grave case of typhoid fever or pneumonia. A single visit by a man who is able to diagnosticate a case let us says of concealed aortic aneurism-is worth more than hundreds of visits by a man who mistake, the case let us say, for laryngitis. The man who removes a diseased uterus has not rendered any greater service than the man who restores to function a diseased lung, and the latter should be equally well paid.

However, so long as the idiotic custom of charging by visit exists, physicians are entitled to full payment such custom permits. A true consultation is undertaken for the benefit of the patient. As the term implies, it is the meeting of two (or more) physicians for mutual interchange of opinion. Both the attending physician and the one summoned to his assistance are, therefore, consultants, although, technically, the term may be restricted to the latter. They may be, often are, of equal ability and authority. Sometimes the attending physician is the superior. The attending physician gives more time to the consultation than does the consulting physician; for he remains after the latter has left the house. Like the consulting

physician, he comes at a fixed hour, and when

a question of convenience arises as to the hour, he is the one to suffer any inconvenience that may be necessitated. He assumes the greater responsibility, for in case of irreconcilable difference of opinion, it is his opinion that must prevail if he remains in attendance. He is, therefore, justly entitled to a consulting fee,

because he consults, and because this consultation involves additional time and trouble upon his part. Med. News.

Calomel in Malarial Cachexia.

Calomel, which is so constantly and so freely given in this country, is contraindicated in malarial cachexia. It adds to the already debilitated and anemic condition by diminishing the number of red globules of the blood. It impairs the ozonizing function of this vital fluid. and deranges digestion, and impairs nutrition; and when given to ptyalism, as is so frequently done, it charges the blood with fetid and effete material, destroys the plasticity of the fibrin, and increases the proportion of water. It also stimu lates and increases the waste of the tissues, and otherwise adds to the burden of an already struggling system; and to this may be added the fact that there is nothing in the pathology of the disease which calls for or indicates the specific action of mercury.-Dr. N. L. Guice, in Va. Med. Monthly.

Obstinate Malaria.

After the victim has fed on quinine till it has lost its medicinal effect; has drank Smith's tonic until it has become curatively inert, and has saturated himself with arsenic, vervain and the whole list of domestic remedies without restorative effect, what shall we do? I'll tell you. If there is noticeable periodicity about the thing, anticipate the molyma with a sweat. If a chill or its equivalent is due at 10 a. m., set the patient in a tub half full of water as warm as can be borne, with feet in a bucket of hot water. Throw a blanket around patient, leaving only the head exposed. That is, give your patient a hot sitz bath, letting him drink hot tea while in the bath. He will be profusely perspiring when the chill is due, and, of course, the chill will have no show at all-it will be strangled, aborted, jugulated.

For chronic malaria, such a sweat every other day, with sustaining constitutional treatment, will soon effect a cure.

When the patient leaves the tub he should go to bed, be wrapped up in blankets, and there lie and sweat for half an hour or an hour, according to strength. At the expiration of this time he should have a cool affusion, be wiped dry, and be well rubbed down with a woolen rag, or the bare hands of a healthy nurse.

Duly impressed with the natural tendency of nearly all doctors to exaggerate when discussing a pet remedy or method, I solemnly aver that,

properly followed out, this treatment will not disappoint you.-D. COOPER, in Med. Gleaner.

[Apropos of the subject of flexible splints, we reprint the following from the Cincinnati LanClinic.]

A Fraud.

ANDERSON, IND., FEB. 1, 1895.

Editor Lancet- Clinic:

An individual calling himself Dr. O. C. Wright, or Knight, about forty-five, heavy set, iron-gray hair, smooth face, heavy mustache, pompous and aggressive in manner, is circulating through the country selling a recipe for "Chydde's Solution" for making flexible cloth splints, making extravagant claims for superiority and cheapness of the product, which has no advantage, it is believed, over the alcoholic solution of shellac, familiar to every surgeon. This disciple of Ananias shows type written recommendations over the signatures (?) of numerous hospital authorities and prominent professional men of New York, Philadelphia, Pittsburg, Cleveland, Detroit, Cincinnati, Columbus, Chicago and other places, all of which, so far as I have been able to learn, are rank forgeries. Fully a dozen Cincinnati surgeons are quoted as having endorsed this "solution" and the "splint." I have made written inquiries relative to the matter, and in every case a positive denial has been made of any recommendation or even knowledge of the solution. I therefore feel it my duty to warn the profession against this fraud, whose sucess in making sales depends entirely on the alleged recommendations.

The recipe for the solution, as published in a local paper, is given as follows:

Legal Requirements for the Practice of Medicine.

[This information will be of such great interest to many readers that we republish it in full from our volume of 1894. Detailed laws of each State will be given soon.]

Of the six New England States, Maine, Massachusetts, New Hampshire and Rhode Island have no legal requirements for the practice of medicine. Connecticut has adopted a medical practice act which went into effect October 1, 1893, and in Vermont the law requires the registry of a diploma indorsed by a Board of Medical Censors, or a certificate of satisfactory examination by one of the boards.

Exclusive of the four States first named, the other States and Territories may be roughly grouped in the following three classes:

In Alabama, Arkansas, Florida, Maryland, Minnesota, Mississippi, New Jersey, New York (Act of May 9, 1893), North Carolina, North Dakota, Pennsylvania (after March 1, 1894). South Dakota, Texas, Utah, Virginia and Washington, the diploma confers no right to practice and has no legal value, except in tome cases to give its possessor standing before an examining board. The right to practice in each of these sixteen States is determined by individual examination before boards of examiners created by law.

In California, Colorado, Connecticut (since October, 1993), Delaware, Illinois, Iowa, Kentucky, Louisiana, Missouri, Montana, Nebraska, New Mexico, Oklahoma, Oregon, Tennessee, Vermont and West Virginia, the diploma is subject to supervision of some designated body vested by law with authority to deter mine its validity as evidence of its possessor's qualifications for the practice of medicine. Failing the possession of such a recognized diploma, the right to practice may be acquired by passing a satisfactory examination.

In Arizona, Georgia, Idaho, Indiana, Kansas, Michigan, Nevada, Ohio, South Carolina (since the repeal of the act of 1888), Wisconsin and Wyoming, the presentation of any kind of a diploma-provided only that it be from a chartered" medical institution-is the sufficient warrant in law for county clerks, clerks of courts, registrars of deeds and similarly qualified judges of medical fitness to admit to practice.

Formulas.

FORMULAS FOR THE ROUTINE TREATMENT OF

EPILEPSY.

.....gr. xx to gr. xxx

...gr. x to gr. xx

R. Potassii bromidi..

Sodii bromidi....

Aquæ....

Ammonii bromidı.

M. et fiat vapor.

....gr. v to gr. x .gtt. iii

-Times and Register.

M. Sig.-Take after meals in glass of water.

tion of many medical men to the distressed condition of some of their formerly fairly well-to-do patients.

The suggestion made by Dr. Smith, of Oxford, Kan., in the February WORLD, is one that can hardly be improved upon, and it is certain to my mind if the physicians of the United States, or any considerable number of them, would make a careful study of the symptoms of the disease of the body politic (so clearly shown in Henry George's great book, "Progress and Poverty"), they could as certainly diagnose the trouble which afflicts our nation and apply the remedy, were they permitted to do so, as surely as any one of our number can now diagnose and treat a simple case of intermitent fever.

That there is something wrong, and that the times are now and have been out of joint for a number of years, is too well known by thinking physicians in all parts of the country to need any repetition by me; nor will it be necessary for me to say that a certain proportion of them find a large number of their former patients now being supplied with medical attendance and medicines through free dispensaries, charity doctors, prescribing druggists, etc., not because they prefer to be known as objects of charity, as are the patrons of the first class mentioned, or because they are willing to trust to the druggist in the latter, but because, most of them, being honest, will not accept the services and medicines, in case the physician furnishes the latter, for the reason that they are denied the opportunity of producing wealth with which to pay him.

Many of our medical colleges have arrived at the conclusion that there are too many doctors, and with that idea in view have concluded to reduce the number by lengthening the term of study of the student; however beneficial this may be to the profession, the graduates of the future, and the dear people who will be served by them, it will not solve the problem of the increasing poverty and distress of the masses, nor will it put the idle man to work at producing wealth with which he can pay the physician for his services; and, until this is done, all other schemes for the relief of both physician and patient must fail.

Politicians of all schools have taken a hand at the the diagnosis and treatment of this case, and for years have struggled with the problem. We have seen the affairs of this great nation and people entrusted to the care of both the great parties; that is, we have seen the Republicans have the President and both Houses of Congress, and within the short space of two years saw the Democratic party restored to complete control of the affairs of the nation; but, alas, under either of these parties we have seen the condition of the masses grow steadily worse, until to-day, in this country, scarcely one hundred years of age, we see about the same differences of caste as are to be found in old Europe the multi-millionaire and the palace on the one hand (its occupant performing no productive labor) and the tenement house with all its misery, vice, crime and poverty, and those of its inmates who can find the opportunity to labor slaving for a wage scarcely sufficient to supply the cheapest and poorest food necessary to sustain the lives of themselves and their dependents. Verily, there is something wrong when conditions such as these are permitted to exist.

tain, and why (as suggested by my old friend of many That there is a way out of this predicament is ceryears ago, Dr. A. C. Matchette, of Bourbon, Ind., also in the February number of THE WORLD,) should not the physicians of the country, in a strictly non-partisan manner, make an exhaustive study of the situation that they may find the remedy for our ills? having done this, proceed to educate the people with whom they come in daily contact, and through the votes of the latter compel the politicians of all schools to legislate

in the interests of the masses and thus bring about an equitable distribution of wealth.

In my humble opinion, could Dr. Matchette's suggestion be carried out and a national organization be formed with headquarters in Washington, it would not be four years before it could bring such an influence to bear upon the law-making power of this country as to compel it to entirely change the existing condition of things.

My own opinion is that the adoption of the theory promulgated by Henry George in "Progress and Poverty" will completely emancipate the masses and make it possible for the poorest man in any community now, who is not disabled and unfit for work, to pay the physician full fees for his services; live five times better than he does under existing conditions; enable him to clothe, house and educate his children in such a manner as to make them an ornament to society, a credit to the country in which they were born and reared, and be happy, contented, industrious and patriotic citizens.

In other words, I believe that the adoption of the single tax is the way out, the thing that will abolish involuntary poverty, and the only hope of the people.

Should any of my brother physicians desire to communicate with me in regard to the formation of some such society, I will be only too glad to correspond with them on the subject. WM. GEDDES, M.D.,

1719 G Street, N. W., Washington, D. C.

[While we do not consider Mr. George's single tax theory a complete solution of our difficulties, we certainly commend the reading of his "Progress and Poverty." The needs of the times have brought an abundant and useful literature, and physicians cannot serve their interests better than by becoming acquainted with it. Don't fail to send ten cents to S. F. Norton, 544 Ogden Avenue, Chicago, for "Ten Men of Money Island." If you mention THE MEDICAL WORLD and make the request, The Monthly Sentinel will be included without extra charge.-ED.]

Physician $1.00

Editor MEDICAL WORLD:-One feature of your issue of February is the radical way in which you presented the social question of population and distribution of wealth, showing how it is to the improvement of the physician's income to study this question. So I now subscribe for a year, in expectation that each number will contain some article on social economy (political or ethical) from the physician's standpoint, of course.

As the money question (gold reserve, bonds, etc.) is prominent now, I will give you this pointer. The U. S. government had in circulation $346,681.016. demand notes, legal tender, payable in gold. A gold reserve was established, but at no time has the "gold reserve fund been equal to the whole of the outstanding national liabilities, which it was intended to be a guarantee for. It seems as though there has been a fraudulent transaction from the beginning. Back of some of the notes was, not gold, but wind simply. This seems to be an apology for banking. If the gold basis is not absolutely necessary, why have it at all?

New York City,

W. J. Bryan, M.D.

[Yes, Doctor; your remarks show that you have been thinking. The gold "basis" is the little end of the pyramid upon which we have been trying to balance our industrial welfare, with a crash about every ten years, each alternate one being a terrible one, as for example those of 1873 and 1893. Did you ever hear of postage stamps being below par? Yet what basis of value have they? Not gold. Simply the peculiar service they command, which is guaranteed by our government. They are "redeemed" by this service. What better basis for the value of money can we have than service? The various branches of our government are constantly serving us, for which service we pay taxes.

A promise by the government to receive (for taxesf customs, internal revenue, etc.,) is a better basis o value for money than a promise to pay gold, silver, or any other commodity. See chart below.-Ed.]

Redeemed By The Merchant

Redeemed By The Manuf

Manufacturer