I would add truthful way, also; and when a doctor does not answer that way, they think right when they think he does not know his business.

H. M. OCHILTREE, M. D.

Haddam, Kan.

TO THE MEDICAL COUNCIL:

Answers to Dr. Proud's questions: I was much pleased to read the queries of Dr. Proud, in the February COUNCIL, as similar questions are asked the general practitioner every day. I hope there will be a liberal response.

In replying to such questions no one can give answers that would be satisfactory in all cases. Different circumstances and different individuals require

different answers.

In answering the questions I shall give answers that I have given in my own practice and experience.

1. "She is seriously ill, but I do not consider her dangerous at present."

2. "There is always danger of complications, but I see no indications of anything of the kind at present."

3. The best plan is to find out at the first visit the cause to your own satisfaction. It is then easy to honestly explain.

4. "Of course, there is a certain amount of danger, but I have given it to a good many people and never had anyone die from it. If I thought there was more danger in your case I would not think of giving it. Your heart is all right, and really I do not think you need be a bit afraid."

5.

"It is very doubtful if anything will be of any use. But while there is life there is hope, and we will do all that can be done for him." (Give minute instructions as to medicine, care, etc.)

6. "No, sir. What makes you think so?"

7. "If she makes a complete recovery, as I hope she will, she will probably be stronger than she has ever been."

8. "I will give you something that will relieve it." (While speaking take out prescription blank and write. Hand prescription to her and give directions for its use.)

9. "Certainly I am. I would not neglect Eva any sooner than I would one of my own children. What put such an idea into your head?" (Probably some old granny has been telling them what ought to be done. It is well right then to warn the family against meddlesome friends. Tell them if they want their child to live to follow your directions and pay no attention to what neighbors say.)

10. "The fear of having it pulled stops the ache. A very common occurrence." II. "No better." 12. "Better to-day."

Ir cases 11 and 12, I never stop if I can avoid it, and make my answers as short as possible. By making short answers and not stopping, you gain several points. First, you avoid innumerable questions. Second, you get the reputation of being non-communicative. People will not be so apt to ask questions if they find they cannot find out anything. Third, patients will trust you with their secret ills, knowing that people can never get anything out of you. Nothing hurts a doctor so much as a reputation of being always ready to explain and tell every thing he knows.

(or if

13 and 14. He should enter without making unnecessary noise or undue haste. His manner should be calm, earnest, and confident. Never stop to pass remarks. with the neighbors, merely bow and say, "Good morning," as you pass to sickroom. As you reach the bedside, greet the patient with, "Good morning, Mary. How long have you been sick? patient is too young or too ill to answer, direct same question to mother or father). This question gives you a chance to learn the history of present illness. After you have obtained a full history make a thorough examination. If you can make a positive diagnosis it is best to say, "She has pneumonia," or whatever it may be. It gives people confidence in you if you positively know what the trouble is. Ifyou say, "I think it is thus and so, or we will have to wait a few days to make sure," etc., the patient is nervous, and the people commence to think about calling some one who has had more ex

perience. Besides, they expect you to give medicine "to break it up," and it looks queer to them for you to give medicine when you are not sure what the disease is. A veterinary surgeon of long experience once told me that he always explained what the trouble was whether he knew himself or not. If there was any hedging to be done he did it afterwards. Of course, there are exceptions, but in a majority of cases it is better to be positive than in doubt. The idea is to inspire confidence in your ability, which is half the battle.

After you have announced the disease it is as well to say, "You are feeling pretty bad to-day, Mary, but don't worry; you'll get along all right." Always be cheerful and leave the patient in as happy a frame of mind as possible.

Prescribe the medicines you intend to use and give explicit instructions as to their administration. The care of patient, temperature of room, food, etc. Do not prolong your visit. Say, "I will see you to-morrow about 5 P. M., when I hope you will be feeling more comfortable. Good-day."

Neighbors need not bother anyone. After the first greeting, I would pay no more attention to them than as if they were not present.

15. "She's sick." Never stop; and before he recovers from his astonishment you will be out of hearing. Some will be angry and some will be pleased; but in the end it will help you, for he will find out from some one what the trouble is and will respect you for not telling, and so will all his neighbors.

16. This is a very hard question to answer. But, in answer to question 13, I have given my ideas which will answer this also. People expect a doctor to know what the disease is and I don't believe in disappointing them. G. W. BOLKCOM, M. D.

Tower, Minn.

The Association of Medical Officers of the Army and Navy of the Confederacy will meet in the Judicial Room of the City Hall in Dallas, Texas, corner of Akard and Commerce Streets, on Tuesday, April 22, 1902, at 12 m.

D. D. SAUNDERS, M. D., Memphis, Tenn., President. DEERING J. ROBERTS, M. D., Nashville, Tenn. Secretary.

The Business Side

OF MEDICAL PRACTICE.

While we as physicians desire to be scientific students and practitioners of medicine, yet we desire also, for the welfare of our dependent ones and for the sake of our standing in the community, to secure a fair compensation for the services we render to our fellow-men and to society. To this purpose The Council will occasionally conduct a brief department in which may be discussed those subjects that pertain to the financial welfare of the practitioner and the profession. Ideas are solicited for this column.

Dr. Hamlet's Soliloquy.

By J. E. STUTE, M. D. Pitcairn, Pa.

To practice medicine, or not to practice, that is the question.

Whether 'tis nobler in the mind to demand our fee in advance, or give powders, tablets and pills, with a great number of visits, and receive no reward.

Then swear-loud and deep-each time we recall the dead-beats, who have our good offices received and our bills ignored.

To swear-and by swearing, say we will draw no more on our gray matter, or bear the thousand worries, and forego the sweet soothing influence of morpheus, to say nothing of calomel wasted.

'Tis a consummation devoutly to be wished.

To sleep, and perchance to dream that our erstwhile patients had succumbed, and in shuffling off this mortal coil, found the devil awaiting, whose claim could not be deferred.

There's the respect that makes calamity of so long life.

For who would not be freed from a horde of worthless patients, who make good promises, but seldom pay?

The work, the worry, the many nights' sleep we lose!

The condemnation (merited) for profanity and the impositions that the patient doctor from the unworthy takes, when he himself might swear less often, see

fewer patients, have more money, with something to drink more to our taste than the waters of Marah, if we would insist on prompt settlements.

Then the fear of that grim specter, Want, before death would not trouble;

And, when summoned to stand at the portals of lite and death to pilot the stranger through the perilous straits and amniotic seas, we should demand our fee in advance, 'twould puzzle our patients, but teach them rather to bear those pains they have, than fly to a doctor whom they owe for the last delivery.

on paying their doctor's bills the same as those of their grocer or coal man, and that without murmuring.

The physician's time, services, and medicines are his stock in trade, and answer to the dynamo that generates the force to keep himself and dependent family afloat. Why, then, is he singled out to gratuitously perform services and furnish material for those of another profession? There may be exceptions when the minister has been retired from service or is performing a service of love for his fellow-men without hope or expectation

Then the native hue and vision of the doctor would become more rosy, and enterprise of great pith and moment for want of cash would not be turned awry. For we would have money to burn.

Clergymen and Doctors' Bills.

TO THE MEDICAL COUNCIL:

The following are a few of the reflections that often recur to my mind as the result of being engaged in country practice for upward of a score of years:

The city practitioner has his grievances, not the least of which is the dispensary nuisance. Not that it follows that dispensaries properly managed and patronized are not a blessing, but the abuse of the system by being patronized by the well-to-do, thus cheating the honest physician out of a fee that rightly belongs to him. Whether or no he receives fees from the clergy the same as from members of other professions and crafts I am unable to say.

There may be good and sufficient reasons for members of the medical profession dispensing their services and medicines gratuitously to the clergy. However that may be, there certainly are as many good ones why this custom should be restricted to narrower limits. The average net income of the clergy compares well with that of the medical profession, while it exceeds that of many of their parishioners and that of the rank and file of our other patients who count

men or no profession is more willing to extend aid than the medical profession, and that without charge.

The picture of the "general practitioner," so graphically portrayed in Ian MacLaren's "Beside the Bonnie BrierBush," has its true type in many a country practitioner of to-day, though of course the conditions have changed. He braves the storms, riding through snowbanks, rivers of mud, fords streams when the freshets are on, undergoing exposures that result in serious sickness to himself and great anxiety to his family, all for some poor sufferer—often poor in purse. All this he does, often with poor prospects for pay. Does the dry goods merchant or grocery man take his goods from the shelf and give them to a certain class of customers? Is it a common practice for them to furnish the local clergy with what they need of their wares? Yet this is just what many physicians are doing right along, besides doing their share towards wiping out the church's indebtedness and paying the minister's salary. To my mind there is no right or equity about this custom, and the sooner it is done away with the better.

Still, I presume, we will keep right on in the same beaten track until incapacitated by age or other infirmity. The practice tends to lessen the self-respect of the recipient, as well as that of the public in general for him and his work. "The laborer is worthy his hire." Pay your minister well and let him in turn pay his bills-doctors' included.

A SUBSCRIBER.

Physicians as Benefactors.

From an excellent article by I. A. McSwain, M. D., Paris, Tenn., in the Charlotte Med. Jour., showing how well the physician performs his public duties as a teacher to prevent sickness, epidemics and degeneracy, we select the follow ing eloquent passage:

"What a difference between the motives of the honest and regular practitioners and the quack or patent medicine vendor is here manifested. The secret medicine manufacturer is sharp enough to take care of his trade by loading his nostrums with stimulants or narcotics, which he knows will by their use create in the subject their own demand; while the charlatan or quack has no other motive than of extorting as much as he can from the pockets of his credulous admirers.

"We assert that no motive akin to these ever finds lodgement in the true, honest purpose of a medical man with a conscience.

"The civilization and progress of which our country boasts and of which she is justly proud could never have been achieved and maintained by arms, however victorious, nor by statesmanship, however wise and great, nor by politicians however artful and cunning, had these factors, mighty as they are, not been supplemented by the self-sacrificing, selfdenying work of faithful intelligent medical men. And in this regard at least doctors, although as a class they may not be given to much religious display, certaintly do reproduce in a marked degree in the drama of the world's history the spirit and genius of the man of ancient Galilee, who became poor that others might be rich, and finally yielded up his life for his fellows."

We take great pleasure in commending to the busy doctor a convenient pocketbook for carrying in one book a daily, as well as ledger, occount of his patients. It is the invention of our esteemed brother and editor of THE Medical CoUNCIL, Dr. J. J. Taylor, Philadelphia. Send for this book, and see if we speak not truly, that it is as near perfection for the purposes for which it is designed as anything you have thus far seen. It does not deal with signs and dots and dashes and other cabalistic forms. When properly kept-and this is as easy as the keeping of an ordinary diary-it is a legal record, and will be accepted by any court as a book of original entry. It is always in your pocket or your grip. Price $1. -From The American Physician.

Old-Fashioned Fees.

Dr. John Radcliffe (1650-1714), a Yorkshire man by birth who removed in 1684 from Oxford to London, has come down to the present generation with the credit of an exceptional recipient of large fees. He has been described as a brusque, witty, somewhat dictatorial physician, who caught the fancy of royalty almost from the start. His strictures upon the feeble pharmacy of his competitors have been mentioned as contributing to his success as a treasurer of honorariums. For attendance on William III, during the first eleven years of his reign, he had on the average more than 600 guineas per annum, and was once "ordered 500 guineas out of the privy purse for the cures of M. Bentinck and M. Zulestein." On another occasion, having been sent to Namur to cure Lord Albemarle, after a week's residence in the camp abroad, his majesty gave him a treasury-order for

1,200, and the patient with a rare gratefulness presented him with 400 guineas and a diamond ring of "envious glitter. Dr. Gibbons, Radcliffe's neighbor, profited by his overflow to the extent of more than 1,000 per annum, and a certain apothecary by recommended patronage died worth £50,000. died worth £50,000. Allowance, however, must be made for high expenses and the depreciation of money-values since Dr. Thomas Young (1773-1829) was wont to say that no one should attempt to establish in London who had not a private fortune of £500 or £600 a year. As a whole, the present is a practical age abounding in competitors on the one hand and capricious patients on the other. In this fair land there are rumors of fortunes made during the hours of sleep, but somehow the statistics are not all on hand, or else popular faith may be

grace.

most precious possession in the world, this is only true to a certain extent, probably with the majority of people, although there are very many who hold other things dearer than life. While most people will sacrifice everything they have to save, or even only prolong, life, though it be a miserable one, there are others who will part with life in good health rather than yield up other things that they hold dearer, such as money or reputation. Note, for instance, the occasionally occurring suicides by business men because of the mortification of failure, or some other form of so-called disThen the miser parts with his life rather than with his wealth, and so on through the list. It is on this account, very largely, that lawyers obtain larger fees than physicians. There is no reason in common sense for this stupid medical practice of charging a uniform fee per office-call or house-visit regardless of other conditions; such, for instance, as the ability of the patient to pay; the importance of the disease for which the patient is being treated; the effort and time consumed by the doctor in reaching his patient and doing his work. We should charge according to these factors, and should avoid uniform charges and explanatory itemized accounts as much as possible, simply stating that so much is our fee for the services rendered, and if it is not satisfactory, some one else had better be consulted in the future. If

medical men will learn to be independent in matters of this kind, they will be more thought of by their patrons, and will get along better.-Ed.]

I am well pleased with the Physician's Pocket Account Book, as it is a great saver of time. DR. H. A. ARMSTRONG, La Junta, Col.

I have used your Pocket Account Book the past year, and like it very much. Brisbin, N. Y. Dr. VINCENT BURGISS.

LITERATURE.

Uric Acid Fallacies.

Frank Billings (American Medicine, ing "fallacies of uric acid:" October 12, 1901) enumerates the follow

I. That uric acid is toxic.

2. That it is a causative factor in any disease except gout.

3. That "uric acidema," meaning acid blood, exists.

4. That the chemical reaction of the blood may be altered by medicinal quantities of alkalies, or by diet.

5. That uratic deposits may be dissolved out by the administration of alkalies.

6. That lithia is a uric acid solvent of unusual potency.

7. That uric acid is an abnormal constituent of the urine.

8. That an excess of uric acid in the urine at one time or a deficiency at another time indicates an abnormal condition in reference to uric acid.

9. That rheumatism is due to uric acid.

Transverse Suprapubic Division of the Skin in Performing Abdominal Section.

Kreutzmann, of San Francisco (Amer. Gynec. and Obstet. Jour., December, 1901), reports a series of five cases of celiotomy performed by Küstner's method, with satisfactory results. Küstner, in 1896, published an account of his method which up to that time he had used successfully in This method consists in a eight cases. transverse division of the skin, subcutaneous tissue and fat, down to the aponeurosis of the abdominal muscles, above the symphysis, near the upper border of the suprapubic growth of hair. This transverse incision is then extended longitudinally with hooks, by pulling up and down the upper and lower borders of the wound, and the abdomen is entered in the usual way by longitudinally splitting the aponeurosis, dividing the muscle and opening the peritoneum. Kreutz