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The Kansas City Medical Index-Lancet
An Independent Monthly flagazine
Under the editorial direction of
P. T. BOHAN, Therapeutics
C. C. CONOVER, Diagnosis
DON CARLOS GUFFEY, Obstetrics
H. C. CROWELL, Gynecology
FRANK J. HALL, Pathology
J. E. HUNT, Pediatrics
JOS. LICHTENBERG, Ophthalmology
HERMAN E. PEARSE, Surgery
R. T. SLOAN, Internal Medicine
HALSEY M. LYLE, Dermatology
EDW. H. THRAILKILL, Rectal Diseases
J. M. BELL, Stomach
C. A. GOOD, Medicine
A. L. GRAY, Obstetrics
J. W. MCGILL, Rectal Diseases
L. A. TODD, Surgery
H. M. McCLANAHAN, Pediatrics
H. S. MUNRO, Psychotherapy
WALTER L. BIERRING, Medicine
A RETROSPECTIVE GLIMPSE INTO
notification of pregnancy, for official surMEDICAL MATTERS.
veillance by health authorities. During With this issue another year shall have the past year the salvarsan therapy seems passed, and it may be profitable to cast a to have developed into the treatment of retrospective glimpse into medical matters syphilis by the “Combined Salvarsan-Merwhich have apparently been of paramount cury Treatment." importance, perhaps mostly ephemeral. The immense expectation by our hopeful Medical interests are much wider at the
confreres of one particular form of treatpresent time, than was the case even a few ment and the minor fads are rainbow hued years ago. Education, publicity, preven- bubbles, they come and go, as Byron sang tive medicine, the various forms of thera- of his time: peutics, serum, vaccine and anti-treatment, tuberculosis, cancer, syphilis, these and
“Cowpox, tractors, galvanism and gas,
The bubble bursts, and all is air at last." many others have occupied the attention of physicians. We have had many important Fads practically, so much is "fads." Of medical and scientific meetings, including course experimental physiology, pathology, the International Medical Congress in Lon- bacteriology, immunity, susceptibility-are don during August. Many interesting gradually beginning to show us glimpses original and profitable suggestions were into the regions in which we suspected the made, for instance, Dr. Kerr, of Glasgow, light to be hidden-the human body. In strongly advocated establishing compulsory the time before medicine had any science, when the law of the survival of the fittest liant chapters in the history of medicine. reigned, we must admit that the human Now attention is directed to the pancreas, body was capable of weathering the envir- the supra-renal bodies, the spleen and the onment and survived. Survival of the pituitary gland. While no therapeutic triphysically unfit may not be even desirable. umph compared with that in connection
The unfit must be made fit. We must with myxedema has attended recent renot regard the present and near past as all searches, it is reasonable to hope that progimportant. The treatment of lues by mer- ress in treatment will soon follow. Until cury has been used in Europe four hundred about ten or fifteen years ago medicine, like years; we are told it has been used much the other sciences, in the absence of definite longer in China, while Egyptian mummies, medical knowledge was negative. whose bones show undoubted evidences of With hygiene, sanitation and bacteriolsyphilis, have been found impregnated with ogy medicine has become positive as a remetallic mercury. Salvarsan during the sult of the accumulation of facts. past year has not proven all sufficient, and In spite of our knowledge of the prevenchemotherapy has joined hands with mer- tion of yellow fever, malaria, plague, tycury. Says Longfellow:
phoid fever, rabies, lues, etc., Rosenau
says that we have but scratched the surface “From the barred vision of antiquity Reflected shines the eternal light of truth
and its environment, and he continues that As from a mirror."
the dawn of a positive program foreshadows
the day of useful achievements. "Magna therapia sterilans” is modified. During the present year we see the for
Prevention still plays the most important mation of a College of Surgeons that will role in tuberculosis, while tuberculin has place American surgery upon the high only a limited application in certain chosen place it deserves, that will be beneficial in cases.
an ethical sense. Undoubtedly the F.C.S. Sir James K. Fowler at the International will prove an advertising mark, and the Medical Congress said, that in the first surgeon, upon his honor, will have to sign place, the use in any form of tuberculin in his name that he will never, oh no, never the treatment of pulmonary tuberculosis divide a fee, under any guise whatever. is not free from danger, and is absolutely Still it is a step in advance which wili not inadmissible in any case where there is be unfriendly to the democracy of medicine. fever. Fever he regards as the guide to The question of the hour with the regular the activity of the disease, and general re- medical profession is the suppression of actions should be avoided.
quackery. The quack is a blot upon modern In cancer we believe in early diagnosis civilization; the extravagant promises, the and operation, judging from clinical state- smooth and honeyed words succeed in exments in the medical journals. Its etiology tracting the hard-earned money from the is defiant. Preventive medicine means pockets of their victims, thanks to the partmore than vaccination against disease, dis- nership of the doctor and the daily newsinfection and sanitation, it means as well paper. It is a question of tainted money. the study of heredity and eugenics; it aims The regular profession is not entirely free at the prevention of disease and improve- from those who think disease, imaginary ment of the race.
or real, is created for their benefit, and the We notice in the Journal of Experimental patient is to be exploited. Of course a Medicine that Noguchi has detailed his dis- medical college or society can not give us a covery of the treponema in 25 per cent of conscience. But we are optimistic even to the 200 cases of paresis that he has inves- the point, that the so-called “practical" tigated. The old discussion between Four- man, who is not seriously devoted to ethics nier and Charcot is soon to be settled in when they interfere with his "successful" favor of the former Old conditions are to onward march, even he improves. be reversed; there will be no waiting for There is indeed a great future ahead for secondary symptoms, but prompt therapeu- our profession if we accept Rosenau's paratic attention to primary syphilis is to de- phrasing of Victor C. Vaughan's admirable stroy the infecting organisms before they address: disperse and become disseminated through- "Preventive medicine dreams of a time out the system. Time will tell whether when there shall be enough for all, and there is hope that paretics will gradually every man shall bear his share of labor in disappear, and that a finding of an anti- accordance with his ability, and every man syphilitic serum will become a reality. shall possess sufficient for the needs of his
The striking success of the treatment of body and the demands of health. These thyroid insufficiency is one of the most bril. things he shall have as a matter of justice and not of charity. Preventive medicine
Preventive medicine considered just to all and quieted it for a time. “It dreams of a time when there shall be no
exists everywhere, no matter how strenuously a lo
cality may deny its existence. According to my unnecessary suffering and
observation those protesting most loudly are most deaths; when the welfare of the people guilty, if guilt it is. Moral mentors, standing so shall be our highest concern; when hu- upright that they lean backwards, grinding out manity and mercy shall replace greed and
moral maxims by the bushel, will not tend to clear
the situation." selfishness; and it dreams that all these
DR. DAVID MYERS, Lawton, Okla. (2): It is evithings will be accomplished through the
dent that Bill Shakespeare had the fee-splitting evil wisdom of man.
Preventive medicine in mind when he wrote, “Oh why rebuke you him dreams of these things, not with the hope
that loves you so much. I know not whether other that we, individually, may participate in
states are afflicted with the fee-splitting parasite
but I can vouch for Oklahoma. We have it in a most them, but with the joy that we may aid in
virulent form. Like all parasitic life it thrives where their coming to those who shall live after there is the most filth. us. When young men have visions the Dr. S. S. GLASSCOCK, Kansas City, Kans. (3): dreams of old men come true.” P.I.L. This is not a theory; it is a condition, one of the
most serious that American physicians have had to deal with, and it is here to stay.
DR. JABEZ N. JACKSON, Kansas City, Mo. (3):
This is not simply a matter of secret conversation REMINISCENT FEE SPLITLETTES.
among the physicians; the people are becoming conThe often repeated droplet eventually
versant with the fee-splitting. We should arrive at leaves its imprint. The repeated and per- rity of the profession.
some solution of the difficulty to preserve the integsistent, sporadically or endemically local
DR. J. F. BINNIE, Kansas City, Mo.. (3): The ized public confession of an existing evil to family practitioner ought to receive a dignified fee be abandoned will expectantly be fruitful if for service, judgment and diagnosis. He attends Mr. the confessor is sincere in purpose, though visit, making two or three visits daily; attends Mrs.
Brown through typhoid, charging $2.00 to $3.00 per his past may be retrospectively tinged. Brown when pregnant and receives a good fee; atAcquired learning fortified and embellished tends the children through diphtheria and the by the benefits of past errors will bring measles, receiving a yearly income from the famout the best there is in a man; and an
ily.” Should he receive a big fee for referring a argument based on the conviction that past confidence reposed in him to refer the case to the
case in the family to a surgeon? He owes it to the errors continued are unsafe and fatal to best surgeon that can be had ! the future of the cause is a winning argu- That some quiet "sawing wood” and ment.
knotty splitting still exists in some localiAnd so with the accumulative and almost ties is evidenced by some correspondence endless verbiage and written criticisms submitted to the Herald in confidence. For hurled broadcast in the cause of fee-split- instance: ting repression. The efforts are insidiously
Dr. ripening with reward. It is slow, perhaps,
Topeka, Kansas. but it is coming though some predict it is Dear Doctor: I have an operative case. here to stay, claiming men in high places, ple are willing and quite able to have the operation
of Wichita. serving on important committees, drafting done, but they want to go to Dr.
He has operated for me in the past and is one of resolutions and laying fundamentals in the
Wichita's best and most generous surgeons. Howopen for the evils abolition, while at home ever, the Wichita physicians in competition have cut they are 'sawing wood" and splitting fees their operation fees so low that I get little for my with a vengeance under cover.
share though I get half the fee. I would like to take be true in some instances but not universal
my work to Topeka in the future. What encourage
ment can you give me? Sincerely yours, ly. As in other reformations it may be
DR. X. necessary that some irreformables of this Replying: generation must pass with the frosts of
My dear Dr. X.: Your letter received. I will not time because they are mentally and char
only be glad to serve you in your present case, but acteristically mal-assimilants, so made by
also in your future work. I have some delicacy in the inherent absence of the Medelian bio. arranging a division of fees and prefer not to indulge logic germ-plasm, suggesting the applica- in fee-splitting, therefore, I would suggest that you tion of eugenics in eventually improving
fix the fee with your people, a fee they can afford,
me know of your arrangements with them, our own medical family.
and you can pay me directly for my services. This As opinion evidence we offer these “split- would make our work mutual and satisfactory all lettes."
round and no one could accuse me of giving you a
fee, neither could you be accused of accepting a fee Dr. A. L. BLESH, Oklahoma City (1): It had its
from me. origin in the time of Pean of Paris. The Medical Be sure to call and see me when in the city. Society of Paris was compelled to formulate a scale,
Very truly yours, Dr. (1) President's address, Southwest Medical Association, (2) Medical Herald, page 628, Vol. 81, 1912. October, 1912.
(3) Medical Herald, page 632, Vol. 31, 1912.
patient's account from one M.D. to another. Kansas City, Mo.
3d. That such rules should contain a My dear Doctor: You will remember me being in the class of 1895. I want to bring a case to you for
clause making the use of efficient detective a hysterectomy. I will leave it to you to arrange work mandatory on the president or some for my interests if you can do that. When will it other officer or committee created for the be convenient for the case to come? Let me hear Fraternally,
4th. That a committee with advisory Replying:
powers should be appointed to consider and Kansas City, Mo. Dear Dr. A.: I remember you very well. You can
report on the commission evil in general come at any time by wiring me the day previous to
and in particular to devise some practical starting. Our local society has lately put fee divis- scheme for the equalization of the fees of ion in bad odor, therefore, undiscussable and dis- general practitioners and specialists, intasteful, but I will see that your services rendered
cluding the establishment of liberal conand time from your business are cared for. I will look for you. Cordially yours,
sultation fees, and, where necessary, of
traveling fees for the family doctor, in maThe Topeka correspondence is interest- jor special cases; and also, if it is thought ing. Dr. X's letter tells much, much that
desirable, an average surgeon's fee bill. many would prefer to remain untold, yet
5th. That general practitioners should be it is the very evidence that better men are urged to use, toward such equalization of anxious to have made public for the better
fees, the power which they have of practiment of an existing evil, which, some say, cally dictating to the specialist what fee "will not down." The reply to Dr. X is
shall be charged in case of patients in moda remarkable dodging of the question by
crate or poor circumstance. putting the fee division in the hands of the
More opinion "splitlettes:" family physician and placing the surgeon in the position of receiving a fee for the
DR. MUNROE, Omaha: (4) Nine hundred and operation only, and having nothing to do
ninety-nine men of every one hundred are dominated
by the instinct to get, to have, and to hold, and the with giving any actual fee. We are told motive that prompts the physician who wants a'rake this is fast being popularized and enables off”' is the same motive that prompts the one who some to say they split no fees.”
stands up and fights fee splitting for all he is worth, The Kansas City correspondence is a di
after he is in the position to catch the plums that
come from operations for gross pathological prorect confidence reposed and a direct resusal on the fee splitting basis, but with a final Dr. MCCONAUGHY, York, Nebr.: Dr. Gifford's assurance that 'services rendered and time question may have been a “burning question," but I from business" will be cared for." How
think the fire has been quenched by the legislature
(of Nebraska). this is to be done is not revealed, but it is
DR. Wells, West Point, Nebr.: This “burning evident that the doctor will not face a split question” has a compliment which I think is comfee accusation, neither will he be sufficient- mendable; in the last year cases diagnosed by me ly unbusinesslike to lose the business. Thus and advice for treatment given, have gone to specialthe fee-splitting mysteries continue to en
ists and my only knowledge of their treatment was a
notice in the newspaper of having had treatment or twine and re-entwine till the income tax
an operation, without my knowledge. intricacies assume a simplicity in compari
DR. HILDRETH, Lyons, Nebr.: The fact that it son.
was necessary to pass a legislative act is a stigma on Other letters from other locations in the profession. You can not legislate men into doing Kansas, Oklahoma and Missouri, including
right if they are determined to do wrong. The men
taking the commissions are a little lower than men St. Louis, tell the story of a few direct re
giving them. fusals and many dodges and tumbles and
DR. RYMAN, Benson, Nebr.: A lot of tom-fool somersaults, with some difficult, but usually lawyers get together to make some sort of a comprosafe adjustment in lighting.
mise to cover up things, just like they did this. I (4) "The Burning Question,” by Dr. H.
object to an effort to hunt up and sacrifice some inGifford, and the discussion shows that Ne
dividual who may be caught, an innocent practition
er, caught in some combination that would not look braska has finally reduced fee splitting to exactly straight under the guise of an examination a legal as well as a medical supervision. and which would prejudice him unjustly. The doctor's paper gives these suggestions DR. BUTLER, Harvard, Nebr.: I have letters from in his summary:
St. Louis, Kansas City and Des Moines saying: 1st. The passage of rules by state socie
"Doctor, I will operate for the family physician, not
for the patient.” ties and state boards making fee-splitting
DR. A. C. Stokes, Omaha: Detective work is not punishable by expulsion and revocation of
beneath the dignity of the U. S. Government; it the license to practice.
should not be beneath the dignity of the state medi2d. That such rules should specifically
cal society. We should publish to the world that prohibit the transmission of funds on any
we are going to settle this question and settle it now.
DR. LANGFELT, Omaha: If we have so many (4) Western Medical Review, page 552, November, 1913. angels in this society, all disclaiming fee-splittings,