twins, or of delay in labor in the last stage of Bright's disease. The other doctor and I are not allowed testimony in the damage suit, as the man brought the suit as administrator; so I wish all the documentary evidence I can get for my attorney to use. I will say that all of the local profession are with us. H. B. VANATTA, M.D. Lerna, Coles Co., Ill. Rules of Practise and Fee Bill of the Physicians of Assumption, Ill. Revised July 1, 1903. Adopted January, 1900. We, the undersigned physicians of Assumption, Illinois, do hereby mutually promise and agree among ourselves and to each other, to be governed in our practise in the following rules, and charge for our professional services the prices and rates as publisht below, viz. : FIRST-That we will not bid for pauper practise. SECOND-That we will not attend the paupers, nor do the eleemosynary or public practise at a less rate than the regularly establisht and recognized Fee Bill of Assumption. THIRD That in the distribution of the pauper practise of Assumption, no one particular physician shall be favored in such practise by the public authorities, but the patient shall have the privilege of choosing his own physician. RATES. Ordinary office advice, not consuming much time and involving no unusual care in investigation (medicin extra). ... Careful investigation, by the introduc tion of a sound or catheter, the employment of chemical tests, the introduction of an exploring needle, the employment of a speculum, a stethoscope, an ophthalmoscope, or a laryngoscope .. Prescriptions, (medicin furnisht extra) Single visit in town. Night visit between hours of 10 p. m. and 6 a. m.. Extra patients in the same family, each Mileage-day; $1.50 first mile, 75 cents each additional mile Mileage-night; $2.00 first mile, $1.00 each additional mile. Obstetrics, uncomplicated-within three miles Detained services in obstetrics more than five hours, $1.00 per hour extra Delivery by turning, forceps or perforation Subsequent visits in town for the first three days, to be included in the charge unless complications render unusual attention necessary. Subsequent visits in the country, the same as in other cases. Attendance on small-pox, per visit, mileage extra. Vaccination. Consultation, mileage extra. Gonorrhea or syphilis, in advance. Minor surgical operations, like opening abscesses, dressing bruised fingers, bleeding, cupping, the formation of issues, and introduction of setons Dressing injuries of greater extent or danger, including the ligation or acupression of arteries in wounds of little importance, the amputation of a toe or finger, circumcision, the removal of the tonsils, the uvula, curetage, etc.. Dressing large or dangerous wounds, requiring the closure of important arteries, to arrest hemorrhage, adjusting fractures and dislocations involving difficulties, the operation for hemorrhoids, for hydrocele, tor harelip and strabismus, paracentesis, amputation of the breast, castration, the removal of tumors not involving great difficulties, staphylorrhaphy, laryngotomy, iridectomy, amputation or extraction of the eye, $25.00 to $100.00 Amputation of the arm, leg, foot or hand, 50.00 to 100.00 Capital operation, including the larger amputations, resections and exsections, the removal of the parotid gland, trephining, ovariotomy, herniotomy, lithotomy, celiotomy, the more difficult plastic operations, the reduction of dislocations which have resisted previous attempts, the adjustments of oblique fractures of the thigh, and those involving the neck of the femur or the knee joint, compound and comminuted fractures of the larger bones and joints, extraction of cataract and the formation of artificial pupil .. Administering chloroform or ether. Subsequent attendance the same as in other cases $100.00 and upwards 5.00 to 10.00 All Fees considered due when services are rendered. (Signed) J. H. Williamson, A. P. Rockey, O. L. Crow, J. E. Harper, R. W. Johnson, Wholesome Criticism is Better than Praise. Editor MEDICAL WORLD:-I inclose you my check to pay for four years' subscription to THE WORLD, and for "The Story of New Zealand." Now a word concerning THE WORLD. I like it and I do not like it, begging your pardon. I love to read it because so many medical men from all over the country express their belief and opinion in its pages, and from all of that we get a great assortment of experiences, all of great value to us fellows doing hard work in the field. I do not like it because it contains so much "trash stuff" at times. Of course I realize that such an expression is not the most pleasant thing in the world for the Editor to hear, and may even provoke a feeling of resentment; still, I feel as tho he would like to know with what esteem we receive his journal. I mean by "trash stuff" such articles that convey so little idea of the real condition of instances upon which information is desired, and which are signed with the names of men who claim the protection of social and medical laws because they prefix their names with "Dr." I mean by "trash stuff" such articles in which the writer of the article attempts to relate some extraordinary experience, and flatly fails to convey even the most salient features of his tussle. I mean by "trash stuff" such stuff written by some medical man, in which he lauds to the skies some prescription composed of from four to six ingredients, and where he extols its virtues for a certain named disease. I mean by "trash stuff" such articles in which the writer relates stereotyped treatment for a specified disease, pneumonia, for instance. Any medical man of any community who wishes to impart the impression that he is a strictly scientific fellow, and has nothing better than calomel, salts, Dover's powder, poultices, strychnin, digitalis, and alcohol to offer to his medical confreres for every case of pneumonia, and makes that his routine, should not be given a page of any editor's journal. I love to read a fellow who has a definit idea to convey, and who is specific in the therapeutic field; who can and does give the condition of his patient, and who gives his remedy not because it has been recommended for a certain named disease, but because there is present in the case a particular condition which will be relieved by a particular remedy. Does it not look like a pity to hear some physician go deeply into the study of his case, so far as concerns pathology, diagnosis, etc., and then when it comes to treatment, to absolutely fail to show where he attempts anything definit outside of a stereotyped routine? THE MEDICAL WORLD gives us many valuable contributions by able men; to read and study them proves a source of great satisfaction and profit. The extraordinary good qualities of these more than make good the shortcomings of those I have just condemned, and it is for this reason that I am willing to read THE WORLD Several years more. Respectfully yours, Versailles, Ohio. J. S. NIEDERKorn. [Frank, manly and respectful criticism is better than praise. We like it and always welcome it, when given in the proper spirit. Instead of receiving the above with "resentment," perhaps the Doctor will be surprised to see it publisht, with these remarks. We hope that he will give to "the family," from his own pen, something that is worth reading. We think he can do it, and we will expect him to do it. In the meantime, he may be taken up by some who consider that the remedies he mentions, if used skilfully, are quite enuf to use in pneumonia. Some of the best practicians use few remedies, but use them skilfully, and for definit purposes.—ED.] Editor MEDICAL WORLD:-About two years ago I reported a case of bed wetting and askt for help. I got some very good and wholesome instruction. A cure was effected by having the boy's eyes examined and fitted by a good oculist, as instructed by a reader of THE WORLD. N. H. BAKER. Gillette, Wyo. Nursing in the Country. The following very clear and pertinent remarks are from a doctor's daughter (whose father, however, we regret to state, has recently died). These lines are so apt that they deserve a place in these columns: Dr. W. C. Abbott, in his article on pneumonia in March WORLD, says the first step is to "move the patient into a clean, light, airy room." Suppose he were here in the Ozarks, where the family all eat, sleep and live in one room, or the patient is in a stuffy 8 x 10 bed room that opens into the living room, and has an extra bed in it, where two other adults sleep at night, and the "nurses" (?) under no consideration will permit one whiff of fresh air, lest the patient "catch cold." Country doctors who have to depend upon the neighbors, friends and the relativs, to do the nursing, can not insist too strongly on having the medicin given strictly as directed. I have seen the medicins passed around to be tasted and "analyzed," and compared with what Dr. Blank gave Johnny when he had mona," and the dose reduced or increast just as Dr. Blank had directed in his treatment; and the symptoms studied and compared to those given in the family doctor book, which father said are a curse to the people and the bane of the doctor. new I am not speaking at random, for the case was my brother, who was very, very ill with pneumonia away from home, and I never removed my clothes or scarcely ate or slept for eleven days and nights, and we came near losing him thru the other nurses tampering with the medicins and knowing too much about medicin, learned from patent medicin advertisements and the family doctor book. The people need to be educated along these lines, and the doctors could do it by means of the press; not by writing learned essays on "How to Nurse the Sick," but give a few instances that have resulted fatally, from not following the instructions; then offset that by a few cases where the patient's life was saved by the prompt action of the nurse, or at least the doctor's work was supplemented in the saving of it. Fowler, Mo. (MISS) ANNIE HOFFARTH. Diagnosis Wanted for Epidemic Eruptiv Dis ease. Editor MEDICAL WORLD:-There has been an eruptiv disease prevailing in this section for the past two months or more, and as the doctors cannot or do not agree as to the diagnosis of it; I want to give you the symptoms of a case I had recently, and ask you or the WORLD readers to kindly give your opinion of same. Mr. P., a young man 18 years of age, came to my office for treatment on February 5th, stating that he had had severe pain in head and back for two days. I found on examination that he had a temperature of 103° F., and pulse of 110. I prescribed for him, and told him to go home and go to bed. The next day he sent for me, stating that the symptoms were no better; suffering intense pain in head and back with high fever. I could not get to see him that day, but saw him on the following day, and found him with temperature of 102°, pulse 110; secretions generally inactiv, pains somewhat relieved (due as I supposed to the anodynes he had taken). I noticed a few small red spots on the side of his face near the chin; at the same time his mother remarkt that while rubbing his back with camphor the night before to relieve the pain she felt some bumps; on further examination I found a half dozen or more small hard papules on back and upper part of chest. On February 8th I found him with temperature of 99%, pulse 66, pain relieved, kidneys acting freely (up to this time they had been very inactiv), and almost the whole cutaneous surface covered with those elevated hard papules. On February 9th, temperature 99°, pulse 60. February 12th, temperature 98°, pulse 60, patient feeling fairly comfortable, with papules larger. On the apex of each was a vesicle filled with serum; the most of the older ones were deprest in the center. February 14th, I found temperature 100°, pulse 84, patient more restless, with an areola of redness around the base of each papule, while the serum in the vesicles was more turbid. February 15th, temperature 982°, pulse 60; some of the pustules are becoming dry and falling off, and the face not so badly swollen. February 18th, temperature and pulse normal. February 22nd, temperature and pulse normal, scabs nearly all off and patient feeling comfortable and has a good appetite. Now, my diagnosis of this case was smallpox, which I think was almost a typical case, tho the large majority of the cases are not so bad, the eruption not so great, and the secondary fever does not appear in a good many cases. My treatment in the early part of the disease was calomel to stimulate the secretions, and anodynes to relieve pain. When suppuration commenced, I gave calcium sulfid in doses 3 times a day, and applied 3 percent car gr. bolized oil to relieve the stinging and itching that he complained of at this stage. Maxton, N. C. worst cases. J.D. GROOM, M.D. [There are many things to be taken into consideration which can be done only on the spot. What effect has vaccination on this epidemic? Has it been tried? Is it contagious? If so, have you noticed any difference between the vaccinated and unvaccinated in regard to susceptibility? You say this is one of the True, it suggests small-pox in a mild form, but have you thought of chickenpox in a severe form? This thought is not considered as carefully as it should be under such circumstances. Read up on chickenpox and make careful comparison with your cases, and at the same time realize that chickenpox is sometimes quite a severe disease. A number of epidemics that were first thought to be a mild form of small-pox have been discovered to be a severe form of chicken-pox, and your patient above described strongly suggests this diagnosis. With this suggestion, and by carefully reading up the subject and examining your patients with this possibility in mind, you can doubtless reach a decision. It may be small pox, but we give you the above suggestion. Have our readers anything to say ?-ED.] Erysipelas. Editor MEDICAL WORLD:-I desire to report a case of erysipelas ambulans, and my experience with the streptolytic serum. Patient, a man aged 50, usual health good, was attackt December 30, the disease beginning about the nose and rapidly spreading over the face, head and neck; then more gradually continuing its course until the entire body had been covered down to the knees. Temperature ranged from 102° to 105°, pulse rapid and weak, delirium in the early stage. On the tenth day pneumonia was strongly threatened. Activ measures, however, aborted this. Treatment: Nourishing diet, tinct. mur. iron, quin., strych. and echinacea; locally I used ichthyol, tinct. iodin, tinct. mur. iron and other usual applications. Under this treatment the disease would occasionally seem to be checkt, only for the inflammation to return with renewed energy. On the twenty-eighth day of the disease I injected two bulbs, 20 cc., of streptolytic serum in the twenty-four hours; waited twenty-four hours longer, saw no change whatever. I then injected at one time four bulbs, 40 cc.; at the end of twenty-four hours more found patient no better; at this time I used two more bulbs, 20 cc. In twelve hours' time the temperature fell from 103° to below normal; patient was greatly prostrated and cold, requiring heat and activ stimulation for two hours before any reaction. The temperature was soon normal and remained so for several days. The inflammation was completely controled. Meantime patient had complained of aching pains in the joints, which seemed to grow worse. At the end of the week what appeared to be a violent case of inflammatory rheumatism set up, with symptoms closely resembling lockjaw accompanying. Rheu matic treatment was used, which entirely relieved these symptoms in two weeks. The patient is just now, at the end of ten weeks, able to be out, and is convalescing very nicely. This is my first use of the streptolytic serum, and whether these unpleasant complications were due to the large amount (80 cc.) of serum used or not, I am unable to say. I should be pleased to hear from others who have had experience with the serum in the treatment of this disease. B. DECATUR SMITH, M.D. Cincinnati, O. Ninth and Baymiller Sts. Did the Chickens Have Erysipelas? Editor MEDICAL WORLD:-Inclosed find P. O. order for $3, to pay for four years' subscription to your valuable journal. Not long since, a lady patient of mine developt a very classical case of erysipelas. She had been visiting her brother who has a large flock of poultry, and some of the fowls were suffering from what poultrymen call "swelled head." The sick chickens had been doctored by smearing plain vaseline on their heads. During her visit, my patient developt an acute coryza, and took some of the chicken's vaseline to smear over the bridge of her nose, hoping to thus relieve some of the disagreeable full feeling in her head. The coryza got better, but about five days later erysipelas developt. The eruption and swelling commenced on the bridge of the nose and spread over the entire face and scalp. Now, Mr. Editor, the interesting question is, did those chickens have erysipelas? Point Arena, Cal. D. A. MARSAN, M.D. We find that our criticism of Dr. Waugh's article, page 121, March WORLD, was not just to him. He gave the case, "An instance," as an illustration of the point he made in the first part of his article, viz., the widespread lack of accuracy in diagnosis. If the case is read in that light only, we see that it is a good illustration; and he writes that this only was his intention. So he did not fall into the very error that he pointed out, as we supposed. If the old "fly blister " were employed more frequently in cases of chronic sciatica and lumbago, we would see fewer cripples. Use but small blisters, and apply them frequently. Gained a Minute, Lost a Month. Editor MEDICAL WORLD:-Inclosed find P. O. money order for $3 for which please continue THE WORLD four years. Four weeks ago I sustained a fractured clavicle as a result of my horse falling on the rough, frozen ground. This is my first accident in six years' country practise, and would like to say to the brethren that there is truth in the old axiom, "When you want to go fast, go slow;" for in my effort to gain a minute I have lost a month. Physicians are liable for malpractise to their patients, corporations for injuries to its employes, and yet the country doctor has neither recourse nor sympathy from his patients when injured in their behalf, which to me suggests the organization of a Physicians' Mutual Benefit Association. Let's hear from THE WORLD. Millville, Mo. J. MORSE GRIFFIN. [Such associations are usually local, and perhaps better so, for then the management can be simpler, and there are less chances for dishonesty. For example, there is a physicians' benefit association connected with the Philadelphia County Medical Society. However, it pays death benefits only, I think, and not illness nor accident benefits.-ED.] Simplified Method for Giving a Hot Vaginal Douche. Editor MEDICAL WORLD:-It is often necessary to prescribe hot water as a vaginal douche, and it is not often given in a very efficient manner. As a general thing women use the douche sitting on a vessel. The different textbooks describe how it should be done, but it is very seldom that we can get our patients to use two to five gallons of hot water. I have a plan which I have never seen described or recommended in medical journals by which as good results can be obtained with the ordinary two quart fountain syringe as with the more elaborate douche-can or irrigating apparatus. It is used as follows: Either lying with hips on an ordinary bedpan or lying across the bed with feet on chairs and hips over the edge of bed, a rubber sheet or several folds of newspaper being utilized to conduct the water into a tub as described in works on gynecology, two quarts of very hot water can be made to answer the same purpose as several gallons under the old plan. The difference is simply this: Have the water in the fountain syringe considerably hotter than with the ordinary douche-can, then before inserting the nozle of the syringe into the vagina, insert a sponge or several sponges or a strip of gauze up near the uterus, large enuf to distend the vaginal folds slightly, then insert the nozzle back of the sponge or packing. Next, have the cut-off or stop-cock well under control and let the hot water into the vagina slowly until the sponge is saturated and the hot water begins to flow out over the outward parts, then stop the flow for a few seconds, and continue letting the hot water run very slowly so that twenty or thirty minutes are expended in letting the water out. The points I claim for this plan are: 1. Water can be continuously applied to the uterus hotter than by the common douche, because as soon as any runs over the sensitiv outward parts the flow can be stopt, yet the uterus continues to be bathed in hot water. 2. If any medicament is used in the water it takes less, and so is cheaper. 3. It takes so little preparation that a woman can do it all without the aid of an assistant, there being no heavy cans of hot water to lift. I will not say anything about the therapeutics of the hot water vaginal douche because it is fully discust in the various works on gynecology, but I would suggest that it would be oftener used if it were not for the trouble attending the administration. I do not know if this plan is original with me, but I know it should be generally known, and I take the medium of THE MEDICAL WORLD to give it to the often handicapt country physician who has to get along with so few of the conveniences of his more favored city brother. Philomath, Ore. C. H. NEWTH, M.D. A Gunshot Wound. The Editor MEDICAL WORLD:-A boy, 11 years old, living in the mountains of this state, received an accidental wound from an old army gun loaded with shot with paper between the powder and shot and paper on the shot. charge passed obliquely thru the arm from front to backward and upward, entering about four inches below the head of the humerus, and tore away two inches of the bone (that is, tearing out all the bone), driving some pieces into the flesh about the back part of the shoulder. The tissues were fearfully torn and badly powder burned, making a wound on back of the arm seven inches long, yet the artery and nerve were not wounded. After cutting away the ragged tissue and picking out all pieces of bone that could be found, the wound was washt with a 1 in 2,000 corrosiv sublimate solution, and dusted with boracic acid and powdered oxid of zinc, equal parts, and then wrapt in corrosiv gauze and left until next day. Dressing was the same each day until the powder burn sluft off, then the arm was pusht up until the ends of bone toucht, then bound in a flext position to a heavy paste board cut the shape of the arm and well padded. The wound was left open, however, not even a strip of adhesiv plaster being used to close it. Same treatment was continued, except that peroxid of hydrogen was poured over the wound and injected into places it would not run into itself, and an ointment of vaseline, boracic acid and oxid of zinc was smeared around the edges to prevent the dressing from sticking. The result was uninterrupted recovery, the bone having united and the muscles having filled in until the arm is full sized and is as useful as ever, except shorter, of course. The wound was received September 19, 1993; patient was well December 20. My object in leaving the wound open was to allow the muscles to fill in and replace what was torn away. If I had closed it on the back of the arm after the burn sluft off, which I was once tempted to do, it would have healed together and the arm would have been weakened by the loss of that portion of the muscles. As it is, I believe it will be as strong as the other. Trout, W. Va. J. D. THRASHER, M.D. [You are to be complimented on the excellent results following such a severe injury; it speaks well for your attention. Your report would have been more valuable had you given exact measurements of the arm after complete healing compared with the uninjured arm, and had photographs of the arm at time of injury and afterward. These are easily secured. It is possible that some of the good result may be ascribed to the cauterizing of the tissues from proximity to the muzzle at time of discharge, and consequent prevention of infection. This should have been included in your report. It is wonderful what recoveries follow proper treatment of gunshot wounds. If you had referred the boy to a hospital, they would have discharged him "cured" (?) in about six weeks, but he would not now have that arm. The profession did not keep up with gunshot wounds in the interval between the Civil and the Spanish-American wars; but the literature since the latter war is voluminous and instructiv, and plainly teaches conservativ surgery. You did well.—ED.] Stop the Paper. "I've stopt the paper, yes, I hev; But the editor got too smart, I am a man as pays his debts, I took his paper eleven years, I paid eleven years an' quit ! -Exchange. |