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THE MEDICAL WORLD
post-master to send notification of refusal to If you have a surplus, and if you have no publication office. Keep on the lookout, and debts, if your home and family are satisfacyou will get your affairs straight; then keep them torily provided for, if your library, office, and straight. This is what every man should do. driving equipments are up to the proper stand
ard, what will you do with your surplus? In
the first place, turn a deaf ear to the specuSpeculation and Investments.
lator. Realize that illness and disability are Say, you fellows who invested in oil stocks, possible ; that old age is certain unless death gold stocks, copper stocks, and other spec
supervenes; that misfortunes are possible; ulativ schemes during the boom in such that the proverbial “rainy day” is coming ; things before The MEDICAL WORLD forced and that when these things come, you will want the sharks to seek other fields, how many of something better than stocks of defunct comyou are now receiving dividends from these panies to depend on. Put your money in a investments? How
could get your safe place, or get your banker or lawyer to help money back if you wanted it? How many of you invest it in first mortgages on property you would like to get your money back, but known to you, keeping the amount well within can't? Where have gone your dreams of wealth the assessment valuation for taxation purposes and an easy time?
--say not exceeding half the assest value. "That You have, perhaps, continued to work hard,
will protect you against future depreciation in and have saved up some more money.
value. Do this for ten years, and if your didn't get a settlement from all your patrons for neighbor invests in “get-rich-quick” schemes the year during December, in order to start the for an equal time, it would be interesting for new year right, you ought to have done so, and
you and him to compare notes, but you know the best that you can now do is to do it during without waiting ten years that your course this month January. It is best to have your would lead you toward competency and compatients st ttle every month; but in some parts fort, and his course would lead him to poverty. of the country, particularly the parts depending on crops, only yearly settlements are possible. Occasional payments may be made
The Typhoid Fever Epidemic at Butler, during the year, but complete settlements are
Pennsylvania. impossible in many cases except at the close of One of the fiercest epidemics of modern the year. Well, you have made your yearly times is raging at Butler, Pa., a town of about collections, settled all your debts, if you had 18,000. Within a few days after the outbreak, any, paid for all your medical journals (you over 1,200 cases were in existence and from should take from four or five to a dozen) for 15 to 20 new cases were registered daily. The 1904 (including The World for four years in mortality was not high when the conditions were advance for $3.00, if you are not already a taken into consideration, tho of course accurate four-year subscriber), and you have a surplus. official statistics are not yet obtainable. All What are you going to do with it? Going to parts of the town were affected, and no condispeculate again, and lose it?
tion or age was exempt. Professional men Now let us think together a little while, and were stricken impartially with the laborer; the see if we can't find something better to do with people of means, living in luxury, quite as it. Do you own the house that you live in? If much as the poorer classes living in squalor. so, does it need repairs? Has your
At the outset, nurses, physicians, and domestic thing she needs, and all that she deserves ? Is help could, in many cases, not be obtained. the education of your children progressing sat- Appeals for help were sent to adjoining towns, isfactorily? How is your equipment for your and a corps of physicians, nurses, and Red work? How about your need for instruments Cross Societies hurried to the scene. The and appliances? How many books have you State Board of Health visited the town, and bought during the past year? How about your after an investigation, establisht a temporary driving equipment? Answer all these ques- headquarters on the ground. The inhabitants, tions satisfactorily to yourself before you allow thoroly alarmed, were quick to follow sanitary yourself to think of speculation; and if vis- suggestions. Every one began to boil all water ionary speculativ schemes ever again tempt you, for potable use. do please realize that “get-rich-quick "schemes At this writing the epidemic seems to be nearly always, we might say always, result in subsiding, but the town has been warned to anxiety, worry, and poverty. Don't throw prepare for at least a six weeks'. further siege. away any more of your money. “Taking a The lay press is reporting three to four deaths flyer" is only throwing your money away. It daily, which will doubtless be greatly increast is foolish and silly. Leave it only for fools- when the majority of the cases get into their and be careful not to be one of them yourself. 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.
cannot understand the conditions which conThe trouble arose from the water in the town front many of his humbler brethren, and he reservoir becoming infected. The bacteriolog- should learn something of the facts before ical reports on the water at the present time do expressing his condemnation. not show any very bad conditions, and it is hoped Such a form of contract practise is entirely that the worst is now over. We will give our ethical, and no blame should attach to those readers a fuller report when all the facts are who engage in it. The other form, where it obtainable. The lesson is a severe one, and is entered into with the sole idea of getting the publication of the circumstance cannot be too money away from other practicians, is iniqui. widely diffused. Every town of that size could tous in its conception and disastrous in its well afford to have some official whose business results. If any hardship be the result, it is it would be to watch the water supply and see upon the doctor who engages in it, and not that it remains safely potable. Failure to take upon his neighbor. It is useless to bring the such action may result in epidemics elsewhere alleged deleterious effect upon the laity into of equal virulence and extent. The people of the discussion, for upon the class of people Butler gladly cooperated with health officials, where this plan is in operation no ethical quesonce they were told what they should do ; tion would be germane, since their single idea doubtless had they been instructed earlier, their regarding medicin and doctors is to secure response would have been no less prompt. medical service without paying for it.
One Phase of Contract Practise.
Early Involution of the Uterus and After
pains. It has become common among the profession to condemn without qualification any
Many practicians allow their obstetric papractician who accepts contract practise.
tients to suffer severely, and doubtless in many This is, in many instances, wrong. Where
cases to lay the foundation for aggravation of the practician accepts or endeavors to secure
slight indispositions which may occur in the contract practise solely for the sake of getting
course of the puerperium, by failing to relieve the work or of excluding competition, we ad
the annoying after-pains from which so many mit that the plan is hardly ethical, nor is it
women suffer so acutely. There is no logical for the best good of the profession, the laity,
reason which can be adduced in support of nor the practician. Yet all thru our country
such a course, and the reason given by such there are remote locations about industrial practicians (that such pains are caused by uterin works where competition is unknown ; there is
contractions which are expelling clots and are only one doctor within reach, and he accepts
a part of normal involution which ought not to
be interfered with) merely reveals ignorance of contract practise for the following reasons : His patrons are often unable to pay fees com
the true conditions confronting them. There mensurate with the services rendered, and
is no more reason why a woman should suffer hence make no effort to remunerate the prac
with painful post-partum contractions of the tician, trusting to his compassion if misfortune
uterus than reason why she should be allowed overtake him. Hence, if he trusted to their
to be rackt with any other kind of relievable voluntary payments, he could not exist. Con
pain. The uterus will contract just as well if sequently he accepts from them a certain
the pain is relieved, as if it is allowed to torture stipend, paid monthly from the office of the
the patient. company. This fee is often ridiculously small, Hirst, in his Text-book of Obstetrics, that we
The matter is so well treated by Professor sometimes being but $1.00 per month per family, yet in the aggregate it often amounts
quote him verbatim : to several hundred dollars per month of cer- The involution of the uterus has been described as a tain and steady funds. We know many end. But as it depends primarily
upon the contraction
continual process, moving on evenly from beginning to instances where such an arrangement is in of the uterin muscle fibers, it is indicated graphically operation, and the doctor has a fairly lucrativ by a series of waves, representing contractions of the
uterus of more or less force and frequency and interpractise, where if he trusted to his clientele to
missions of less firm contraction; the retraction of the pay him after they got their wages in their uterin muscle, however, maintaining fairly well what own hands, he would be compelled to move
is gained by contraction. Each case has a certain
degree of individuality ; in one the contractions are immediately. There is, moreover, a certain firm and the intervals between them are short; in amount of charity connected with the plan,
another it is the reverse, and all gradations may be
found between the extremes; but while there are in because the practician can thus afford attention
every case individual peculiarities, the action of the to those whom he could not possibly relieve in uterus after labor is governed by a few general laws. the ordinary course of hit and miss payments.
Thus in primipara, the uterus being more powerful,
better supplied with muscular tissue than it will ever The practician who never makes a visit for
be again in a subsequent confinement, contracts so