with only a small percentage of the money that he actually earns. There is enough business for all of the doctors in the land. The condition of medical practice, from a business point of view, is under-collected rather than overcrowded.

It is not now a case of too few patients, but of failure to secure compensation for the labor actually done. Not only are doctors poorly compensated as a class, but they work harder for what little money they get than any other class of persons. This condition is directly assignable to the failure of doctors to demand some compensation; some "crop for every acre that is under cultivation." If any doctor who attends to his practice could collect the money due to him with as little loss as would be tolerated in a well-conducted business house, that doctor would be in comfortable circumstances financially. It is a matter of custom among doctors to speak of what they "book" and what

they get as being two things entirely different. "I am pretty hard up," says a doctor, "I have not been collecting over $150 per month, but, of course, I am booking $500." The business man who would make such an announcement would expect it to cause lack of confidence in him in business circles. He would also see financial ruin staring him in the face.

Not only are doctors poor collectors, but they seem rather to encourage an expectation on the part of the public that doctors will continue poor collectors. Most of us have a sneering way of speaking of the "closefisted, penurious old cuss" who is the doctor who collects something from rich and poor alike for the work he does. We may deny it, but so inbred is our lack of business sense, that deep in our hearts we condemn the businesslike doctor, at the same breath condemning the public for its failure to pay.

There is one prominent surgeon in

44

Duncan, Flockhart & Co., Edinburgh and London

Chicago whose office is reached by the patient only after passing through an outer office in which the doctor's secretary demands and gets a tendollar bill. That pays for the first consultation, and it is retained regardless of future business arrangements. This does not work a hardship on the very poor, for this surgeon devotes several hours each day to free dispensaries and clinics where the poor are received and cared for. His office is reserved for his money-making, and by his good business methods he has been able to do more for the worthy poor, more for medical science, and more, incidentally, for his family and himself, than if he had gone ahead in the slipshod business way which is expected of medical men.

Poverty will be the lot of the medical profession until the doctor is not only convinced that the "servant is worthy of his hire," but until the doctor sees to it that the servant gets his

hire. Your grocer does not say to you, when it comes to an accounting, "Your bill is $50, but pay me $20, and we will call it square." Hundreds of doctors close their accounts in this way with people who are amply able to pay in full. Is it because the doctor feels that his services are not worth the compensation? If so, by all means be conscientious. Reduce your fees and make seventy-five cent calls. Don't charge two dollars if you think you are cheating your patient in so doing. But if you are charging two dollars a call and think that you are worth it, insist on getting two dollars and get it in a reasonable time. not apologize for your dun. Follow the example of your grocer, your butcher and your landlord in this particular of getting paid for what you do. Medical service ought to merit compensation, and prompt compensation, as much as do prunes, pork, sausage, or dog meat.-Chicago Clinic.

Do

A CLINICAL OBSERVATION OF ONE HUNDRED AND EIGHT CASES OF TYPHOID FEVER, WITH SPECIAL REFERENCE TO THERAPEUTIC FASTING.

R. M. Harbin discusses the treat

ment of typhoid fever and lays especial stress on restriction of the food given. Surplus food causes accumulations in the intestines, which augment the toxemia, cause diarrhea and increase the risk of hemorrhage. The author employs cocoa, coffee, egg albumen, peptonoids and broths of beef, mutton, chicken, oysters, etc., in prescribed amounts. Milk is undesirable, unless diluted two to five times with one of the other fluids, owing to its tendency to form curds. Some of the author's conclusions are

that: There is a greater degree of toxemia in cases associated with gastrointestinal disturbances. Emaciation occurs independently of the amount of food taken. A great majority of clinicians of long experi

Physicians

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ence feed typhoid patients in a very restricted manner. Fasting and a restricted diet are indicated, because of pathological conditions, and to a great extent eliminate the dangers of sthenic cases. The proper food management of the case will well nigh shield the patient from every danger incident to the course of the disease. The eliminative treatment, so-called, is irrational, except to mitigate the sins of over-feeding. What the patient loses in food is more than compensated by a lessened degree of toxemia. Peristalsis favors the absorption of toxins, and cathartics should be used only to remove undigested food. Nitrogenized food and water are essential to a normal nitrogen equilibrium, and there is little danger

The

from inanition in sthenic cases. presence of ulcers in the intestines should be assumed in every case of typhoid fever, and the proper treatment is rest, which is better attained

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