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Circulation: December, 1903, 35,610.

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"Keep Your Affairs Straight.","

This is January-the beginning of a new
year. Have you closed your books for last
year, and settled, by cash, "truck" or note,
your out-standing accounts? If not, do it
immediately. An account loses value the
older it gets. It is surprising how accounts
degenerate in value by age. Every day makes
a difference; every week makes a greater dif-
ference; every month a still greater difference,
and if you let a year go by without seeking
and obtaining a settlement, many accounts
will then be of no value at all. If you are
rusht, and anxious about patients seriously
ill, employ a book-keeper and collector, if
even only temporarily, to attend to this part
of your business for you. Perhaps you can
arrange to employ some good man in your
town in this way for a couple of weeks every
few months, if your business does not justify
steady employment-say the latter few weeks
of every quarter-March, June, September and
December. If you have been neglecting this,
make a beginning now-don't wait till March.

On the other hand, pay everything you owe
as promptly as you wish to be paid. Don't
let bills against you accumulate, and then
press all at once, thus embarrassing you and
injuring your credit. And see that you pay
for every medical journal that comes to you.
If there are any coming to you that you do
not want, pay up to date and stop them. If
any come to you without seeming to expect
pay, suspect them. Look for covert adver-
tisements in the reading matter, and if you
find that they are publisht in the interest of
certain preparations or firms, refuse to take
them from the post-office, and instruct your

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post-master to send notification of refusal to publication office. Keep on the lookout, and you will get your affairs straight; then keep them straight. This is what every man should do.

Speculation and Investments.

Say, you fellows who invested in oil stocks, gold stocks, copper stocks, and other speculativ schemes during the boom in such things before THE MEDICAL WORLD forced the sharks to seek other fields, how many of you are now receiving dividends from these investments? How many of you could get your money back if you wanted it? How many of you would like to get your money back, but can't? Where have gone your dreams of wealth and an easy time?

You have, perhaps, continued to work hard, and have saved up some more money. If you didn't get a settlement from all your patrons for the year during December, in order to start the new year right, you ought to have done so, and the best that you can now do is to do it during this month-January. It is best to have your patients settle every month; but in some parts of the country, particularly the parts depending on crops, only yearly settlements are possible. Occasional payments may be made during the year, but complete settlements are impossible in many cases except at the close of the year. Well, you have made your yearly collections, settled all your debts, if you had any, paid for all your medical journals (you should take from four or five to a dozen) for 1904 (including THE WORLD for four years in advance for $3.00, if you are not already a four-year subscriber), and you have a surplus. What are you going to do with it? Going to speculate again, and lose it?

Now let us think together a little while, and see if we can't find something better to do with it. Do you own the house that you live in? If so, does it need repairs? Has your wife every thing she needs, and all that she deserves? Is the education of your children progressing satisfactorily? How is your equipment for your work? How about your need for instruments and appliances? How many books have you bought during the past year? How about your driving equipment? Answer all these questions satisfactorily to yourself before you allow yourself to think of speculation; and if visionary speculativ schemes ever again tempt you, do please realize that "get-rich-quick" schemes nearly always, we might say always, result in anxiety, worry, and poverty. Don't throw away any more of your money. "Taking a flyer" is only throwing your money away. It is foolish and silly. Leave it only for foolsand be careful not to be one of them yourself.

If you have a surplus, and if you have no debts, if your home and family are satisfactorily provided for, if your library, office, and driving equipments are up to the proper standard, what will you do with your surplus? In the first place, turn a deaf ear to the speculator. Realize that illness and disability are possible; that old age is certain unless death supervenes; that misfortunes are possible; that the proverbial "rainy day" is coming; and that when these things come, you will want something better than stocks of defunct companies to depend on. Put your money in a safe place, or get your banker or lawyer to help you invest it in first mortgages on property known to you, keeping the amount well within the assessment valuation for taxation purposes -say not exceeding half the assest value. That will protect you against future depreciation in value. Do this for ten years, and if your neighbor invests in "get-rich-quick" schemes for an equal time, it would be interesting for you and him to compare notes-but you know without waiting ten years that your course would lead you toward competency and comfort, and his course would lead him to poverty.

The Typhoid Fever Epidemic at Butler, Pennsylvania.

All

One of the fiercest epidemics of modern times is raging at Butler, Pa., a town of about 18,000. Within a few days after the outbreak, over 1,200 cases were in existence and from 15 to 20 new cases were registered daily. The mortality was not high when the conditions were taken into consideration, tho of course accurate official statistics are not yet obtainable. parts of the town were affected, and no condition or age was exempt. Professional men were stricken impartially with the laborer; the people of means, living in luxury, quite as much as the poorer classes living in squalor. At the outset, nurses, physicians, and domestic help could, in many cases, not be obtained. Appeals for help were sent to adjoining towns, and a corps of physicians, nurses, and Red Cross Societies hurried to the scene. The State Board of Health visited the town, and after an investigation, establisht a temporary headquarters on the ground. The inhabitants, thoroly alarmed, were quick to follow sanitary suggestions. Every one began to boil all water for potable use.

At this writing the epidemic seems to be subsiding, but the town has been warned to prepare for at least a six weeks' further siege. The lay press is reporting three to four deaths daily, which will doubtless be greatly increast when the majority of the cases get into their third and fourth weeks. Scarlet fever and

diphtheria are present in the town, but neither less than $3.00, and who makes many of them, is widely diffused.

The trouble arose from the water in the town reservoir becoming infected. The bacteriological reports on the water at the present time do not show any very bad conditions, and it is hoped that the worst is now over. We will give our readers a fuller report when all the facts are obtainable. The lesson is a severe one, and the publication of the circumstance cannot be too widely diffused. Every town of that size could well afford to have some official whose business it would be to watch the water supply and see that it remains safely potable. Failure to take such action may result in epidemics elsewhere of equal virulence and extent. The people of Butler gladly cooperated with health officials, once they were told what they should do; doubtless had they been instructed earlier, their response would have been no less prompt.

One Phase of Contract Practise.

Where

It has become common among the profession to condemn without qualification any practician who accepts contract practise. This is, in many instances, wrong. the practician accepts or endeavors to secure contract practise solely for the sake of getting the work or of excluding competition, we admit that the plan is hardly ethical, nor is it for the best good of the profession, the laity, nor the practician. Yet all thru our country there are remote locations about industrial works where competition is unknown; there is only one doctor within reach, and he accepts contract practise for the following reasons: His patrons are often unable to pay fees commensurate with the services rendered, and hence make no effort to remunerate the practician, trusting to his compassion if misfortune overtake him. Hence, if he trusted to their voluntary payments, he could not exist. Consequently he accepts from them a certain stipend, paid monthly from the office of the company. This fee is often ridiculously small, sometimes being but $1.00 per month per family, yet in the aggregate it often amounts to several hundred dollars per month of certain and steady funds. We know many instances where such an arrangement is in operation, and the doctor has a fairly lucrativ practise, where if he trusted to his clientele to pay him after they got their wages in their own hands, he would be compelled to move immediately. There is, moreover, a certain amount of charity connected with the plan, because the practician can thus afford attention to those whom he could not possibly relieve in the ordinary course of hit and miss payments. The practician who never makes a visit for

cannot understand the conditions which confront many of his humbler brethren, and he should learn something of the facts before expressing his condemnation.

Such a form of contract practise is entirely ethical, and no blame should attach to those who engage in it. The other form, where it is entered into with the sole idea of getting money away from other practicians, is iniquitous in its conception and disastrous in its results. If any hardship be the result, it is upon the doctor who engages in it, and not upon his neighbor. It is useless to bring the alleged deleterious effect upon the laity into the discussion, for upon the class of people where this plan is in operation no ethical question would be germane, since their single idea regarding medicin and doctors is to secure medical service without paying for it.

Early Involution of the Uterus and Afterpains.

Many practicians allow their obstetric patients to suffer severely, and doubtless in many cases to lay the foundation for aggravation of slight indispositions which may occur in the course of the puerperium, by failing to relieve the annoying after-pains from which so many women suffer so acutely. There is no logical reason which can be adduced in support of such a course, and the reason given by such practicians (that such pains are caused by uterin contractions which are expelling clots and are a part of normal involution which ought not to be interfered with) merely reveals ignorance of the true conditions confronting them. There is no more reason why a woman should suffer with painful post-partum contractions of the uterus than reason why she should be allowed to be rackt with any other kind of relievable pain. The uterus will contract just as well if the pain is relieved, as if it is allowed to torture the patient.

Hirst, in his Text-book of Obstetrics, that we The matter is so well treated by Professor

quote him verbatim :

The involution of the uterus has been described as a continual process, moving on evenly from beginning to end. But as it depends primarily upon the contraction of the uterin muscle fibers, it is indicated graphically by a series of waves, representing contractions of the uterus of more or less force and frequency and intermissions of less firm contraction; the retraction of the uterin muscle, however, maintaining fairly well what is gained by contraction. Each case has a certain degree of individuality; in one the contractions are firm and the intervals between them are short; in another it is the reverse, and all gradations may be found between the extremes; but while there are in every case individual peculiarities, the action of the uterus after labor is governed by a few general laws. Thus in primipara, the uterus being more powerful, better supplied with muscular tissue than it will ever be again in a subsequent confinement, contracts so

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