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Volume XII.

SEPTEMBER FIFTEENTH

Editorial Department.

The Abuse of

Number 6

DR. F. T. ROGERS, of Providence, R. I., read a very practical and highly instructive paper before the American Academy of Medicine, at Philadelphia, on the result of a year's experience in endeavoring to lessen the dispensary abuse in the Rhode Island Hospital. The method adopted was to prominMedical Charity. ently display at the entrance of the dispensary a large placard, stating the services of the dispensary were given only to such patients as were too poor to pay, and that no others would be treated. A similar statement on the case card given the patient, and as the presentation of the card was essential for admission, this fact was forcibly impressed upon all applicants for gratuitous services, Exceptions were made to this rule in emergency cases, such as recent accident or sudden illness, and to cases where doubt existed as to ability to pay, but where delay in treatment would work hardship, and to the ignorant foreign classes who could not understand hospital rules.

The plan has been successful, and during the year 1,032 applicants were rejected, thus weeding out 41 per cent of unworthy applicants. The receipts of the hospital have been the same, and it is not unfair to conclude, says Dr. Rogers, that the hospital is in no sense poorer, has done less work, yet has done quite as much in relieving suffering among the deserving poor. Those who failed to come and had a real ailment, must have consulted a physician, and presumably paid for his services. Dr. Rogers concludes by this plan :

That the class of people who frequent charitable clinics, because they can get free treatment, and who think it a bit of shrewdness to thus beat the profession, will, in a large degree, be debarred from further attend

ance.

"2.

Those who seek such advice, because they do not know whom to go, are referred to some physician, thus relieving the dispensary from a large class of patrons and aiding the profession.

"3. The worthy poor are in no sense prevented from obtaining needed aid."

This plan is certainly a just one, and one which would work here in St. Louis without detriment to the colleges, the hospitals nor the dispensaries. It would work admirably in St. Louis if it were not for the personal animosity which just now seems to govern the discussion of the subject in some medical journals. It is deplorable that the personal element is uppermost in the controversy, and a desire for notoriety, rather than the legiti mate good to the profession over-rides the purposes of the so-called investigation of these journals. Not until, as Rogers says, "we eliminate those features of our professional life which degrade us into personalities and stand firm upon the platform of manliness, humanity and the welfare of our most honored profession," will the fight against the dispensary abuse be successful. Reform is "not needed so much of the hospital, nor of the patient, as of ourselves" (Rogers). F. P. N.

CONSIDERING that medicine is already acknowledged an overcrowded profession, there is room for remark on the exceptional harvest which has come with this year's medical college announcement season. Each school sends out its thousands annually, but 1897 is a banner year in this as well as in wheat. It is safe to say that all the recent graduates of our country's literary schools are liberally supplied, and that each is consequently impressed with the fact that we have too few medical men, and that his call to that field is unquestionable.

How They Are "Called."

The thrift of some physicians in urging young men to the study of medicine is also a matter of comment in every medical center. To be catalogued as preceptor of several bright young men is indeed an honor, but, unfortunately, the term preceptor is sadly debased, and too often means the urger, or the deceiver, the painter of alluring pictures, which are not true to life.

Not many miles from St. Louis there is a prosperous country physician who has succeeded in a financial way, as but few country physicians succeed. This man is an important feeder to St. Louis schools, he maintains a constant delegation of six or eight in our schools from his little county. Every man that he sends expects medicine to be an easy route to fame and fortune. We cannot help wondering, what is this promoter's conduct toward the few of the deluded who return and locate in his neighborhood. Certain it is that he will some day appreciate how ill-advised is thrift in this direction, but they will anticipate him in the discovery.

There is always room for the honest, enthusiastic, hard working man in medicine, but the man who is called to study medicine will hear the call without coaching. Men should not be urged to study medicine, there will be enough doctors if it is left to each man to discover for himself in what calling he is most needed. T. A. H.

THE star of empire is supposed to wend its way Westward. It would seem from rumors current in the whirly-gig of the present time, that we are soon

The Star of
Empire.

to see a reversal of this far-famed saying. Still, he who would rule empires, if he could, is setting his star of hope in the Eastern skies, and is preparing to send as the savior of poor inflicted humanity, his emissaries. to the Empire State and to Yankeedom. Yes, one of the Illinois fledglings in osteopathy, who imagines his wings are full grown, is now about to locate in the grand old State of Massachusetts, because, as he says, "the people there are educated and can appreciate true science." Ye gods and little fishes, has it come to this, that in the old Bay State, under whose sacred soil reposes the remains of the lamented Holmes, osteopathy can find lodgment because of the education of the masses? Surely the cradle of liberty, of free speech and free thought has rocked in vain if this is the status of education in that State. Here in the wild and wooly West, we poor satellites of the great East (?) can recognize shams and penetrate the inflations of quackery-who can tell what would happen if we had the prestige of a century at our backs ?

But then medical reform in New England always has poised on the centre and refused to move. Now, that the machine is moving, we hope that the medical profession will closely watch the movements of the bonesetters, lobby-workers and all-around pushers of the queer, whose power, though born-of-God (?) is apt to clog progress; yes, for unless some attention is given to these parasites the legislatures may become infected, and even a governor or two may find themselves not immune to that strange, subtle and ecstatic intoxication which hood-winked and captured the Governors of Missouri and Michigan, and the legislatures of Illinois, Missouri, Michigan and the Dakotas.

Wake up, ye Easterners, and be not dreamers; be not satisfied with your own little intellectual world, as magnificent as it is, but stir yourselves to prevent the Kirksville plague finding lodgment on such soil, hallowed by the memories, past and present, of true culture and intellectual refinement. Remember we have warned you, and, therefore, be on your guard.

F. P. N.

DR. S. S. COHEN, in a timely editorial in the Philadelphia Polyclinic, calls attention to the apparent reckless and thoughtless administration of mor

Morphinism and the Medical Profession.

phine by physicians. He says, "In how far physicians are responsible for the growing habit formed by patients, to whom they give injections for pain, for loss of sleep, for asthmatic attacks, or other apparently good reason, is a problem. Certain it is, that in many cases, the bold use of morphine gives relief and brings about recovery as nothing else can, and no bad habits results. Certain it is that, in other cases, one dose necessitates a second, this a third, and so on. Whenever this drug is prescribed, the possibility of inducing a habit should be kept in mind, and its repetition be jealously

watched. If due caution be thus observed, and the drug never given, unless nothing else will serve the purpose, the physician need not feel responsible for untoward consequences; but, in the absence of such caution, the blame will lie at his door."

In the writer's experience in the treatment of habituates, he has found at least nine out of every ten who charge the responsibility for the existence of the habit to some physician. Now, like Dr. Cohen, we do not vouch for the truthfulness of morphine user's statements, but it is no doubt true that neurotic subjects, especially, are apt to become victims of drug habits when these agents are indiscriminately administered to them by physicians. Then, again, the ease with which they can obtain their favorite drug only tends to add fuel to an easily kindled flame. Cocaine users have increased amazingly within the past two years, largely due to the patent medicine nostrums sold as catarrh snuffs, cold cures, etc. One case coming under the writer's observation was using a bottle a day of a patent "catarrh cure;" he had all the symptoms of "a cocaine fiend." In the Southwest especially, among the Mexicans, it is said that the cocaine habit has increased rapidly, until it bids fair to outstrip the alcoholic habit in the race for race dissolution. The medical profession can at least help to stem this tide toward dissolution, by caution in dispensing and in prescribing these drugs, and in encouraging the enactment of laws, ordinances, etc., to prevent indiscriminate usage of them. The "cocaine law" is being gradually added to the statutes of our States, and we hope to see even more strenuous efforts made to suppress this greatest of drug habits,

F. P. N.

THE Daily Lancet is now being published by the Bailey & Fairchild Co., of New York, and its general character will be changed to conform more closely to the newspaper idea. Dr. Joseph F. Edwards will remain its editor.

THE COLORADO STATE MEDICAL SCHOOL has another law suit on its hands. This time it is a member of last year's senior class, Mr. McDonald, who brings suit to obtain a diploma which he alleges they have unlawfully witheld from him.

BEDS FOR SICK AMERICANS IN LONDON, ENG.-As a memorial of the Queen's diamond jubilee the Americans residing in England have endowed a bed in perpetuity in each of the five leading London hospitals, each bed being endowed with the sum of £1,000. The beds will be especially for the use of Americans, but other patients may be received if all the Americans are well.

SOME INTERESTING FIGURES.-Prof. Schooling, in a recent paper before the Royal Statistical Society of London, says there are eight principal causes of insanity, and the percentage of each as regards every 100 of lunatics as follows: Drink, 33.6; domestic troubles, 15.1; mental anxiety, 13.4 old age, 13.2; adverse circumstances, 13: accidents, 6.5; religious excitement, 4; love affairs, 3.2.