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OCTOBER, 1904]

Another Collection Agency Experience—A Correction ORIGINAL COMMUNICATIONS

Short articles of practical help to the profession are solicited for this department.

Articles accepted must be contributed to this journal only. The editors are not responsible for views expressed by contributors. Copy must be received on or before the twelfth of the month, for publication in the issue for the next month. We decline responsibility for the safety of unused manuscript. It can usually be returned if request and postage for return are 、received with manuscript; but we cannot agree to always do so. Certainly it is excellent discipline for an author to feel that he must say all he has to say in the fewest possible words, or his reader is sure to skip them; and in the plainest possible words, or his reader will certainly misunderstand them. Generally, also, a downright fact may be told in a plain way; and we want downright facts at present more than anything else.-RUSKIN. REFLECT COMPARE RECORD

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Another Collection Agency Experience, and a Bad One!

Editor MEDICAL WORLD:-Having read a number of articles in your journal setting forth unsatisfactory dealings with collecting agencies, I offer my experience, which may be timely in keeping some easy doctor out of a similar deal. Something like three years ago, one of the most suave and ingratiating men it has ever been my misfortune to meet, entered my office and informed me he represented the Sprague Collecting Agency of Chicago. After stating his methods (one of the requirements being a membership fee of $50), I told him plainly my experience with collecting agencies had been very unsatisfactory in every respect, and I would, under no circumstances, pay out money except as a commission on money actually collected. Now, this talk suited the ever ready agent. If I would place in their If I would place in their hands accounts to the amount of $500, I would not have to pay a cent, as the membership fee would be deducted from collections. So I gave him my note, upon that distinct understanding, due 90 days hence, for the sum of $50, and a batch of accounts amounting to over $500, among which was a judgment for $250, recently obtained in the justice court against a prosperous merchant of this city, which the agent assured me was easy to handle and sure collection. Now, I do not think I ever had even a report upon said accounts. I presume they were presented, however, as I read in the daily papers that the merchant (prosperous) against whom I had the judgment had made application in bankruptcy. I notified the said Sprague Collecting Agency of Chicago of the fact, and that they must have their attorney advance the application and prevent it. I have no knowledge of their making a single move in that direction; and when too late I had to employ an attorney at my own expense, and the man was adjudged a bankrupt. About this time received a notice from one of our local banks that they held my note for $50, given the "Sprague Collecting Agency. Upon investigation I found that my note, with

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several other notes given by prominent doctors, had been sold at a discount to the bank a day or so after they were given. I protested the payment of the note when due. Had two lawsuits in the lower courts, with judgment in my favor. But the case was carried to the Supreme Court where the decision was reversed, and only a few months ago I had to pay note and costs, amounting to $120, besides my attorney's fees for the fight against the bankrupt and three court trials. You will notice that Mr. Sprague Collecting Agency was rather an expensiv acquaintance. The other doctors paid their notes, and I am informed they never received a cent collected, never a second call for accounts, and have been unable to even get a report. I wish to say further that I stated the case in all its aggravating aspects to the parent office in Chicago, without relief or even an expression of regret. Denver, Col.

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JAS. M. WALKER. [Well, this is about the worst yet. tor, why didn't you incorporate the "understanding" in the note? These slick traveling agents will give any kind of a verbal "understanding," if they can only get your signature to a note; but the "understanding don't go, if it isn't stipulated in writing in the note, and this the agent is careful not to do, and you were careless not to require it before you signed the note. This magazine will benefit the medical profession hundreds of thousands of dollars every year if it can impress on the minds of doctors the importance of not signing papers that will lead to their being victimized. Always read a contract or note very carefully before signing, and if it doesn't suit you in every respect, don't sign. Remember you are bound by the written terms, regardless of any verbal "understanding.' Have it "written in the bond." And as I have frequently urged, don't enter any arrangement or agreement that contemplates the possibility of taking money out of your pocket. The pay for collecting should always come out of the funds collected for you.-ED.]

A Correction.

DEAR DOCTOR TAYLOR:-Your comment on my article is slightly in error when you say (page 377, September WORLD, bottom of second column) "a compromise of $34 instead of $36 was secured by the Company." It ought to be corrected, for the agreement-or rather the note, for such in reality it is-was secured on payment of $17. Thirty-four dollars was the cost of my two experiences, and not that amount for my experience with the Comstock Company alone.

Greenwich, N. J. S. M. SNYDer. [We are pleased to make the correction. We

were misled by your expression, "Here is a $34 experience;" "experience" being used in the singular number, as tho it were one_experience the Comstock experience.—ED.]

Editor MEDICAL WORLD:-Like many other M. D.'s, no doubt, I have noted with some interest the discussion from time to time relativ to collecting agencies, and especially of their "ways that are dark and their tricks that are vain." But while their ways may, or may not, be dark, we must confess that their tricks are not entirely vain, as attested by the long line of complaints that roll in regularly upon ye Editor, who, doubtless, like the rest of us, has troubles of his own." But we have been told, and experience has shown it to be true, that it is not best to meet troubles

more than half way; and it seems to me that that is

just about what a good many of the brethren have done, and have thereby shown remarkable success in collecting, not for the M.D., as has been said, but from him. After an exhibition of this kind, how can the guileless M. D. doubt their power to collect? Would that all our delinquents would respond as promptly as many of our brother M. D.'s seem to have done, almost falling over each other in order to pay a forfeit that I do not believe can be collected in, or before, any court in the land. What expense has been incurred until the accounts have been sent in? Can they get something for nothing? Do they not have to show value received, if called upon to do so? Let us hear from the brethren on this point. Prospect, Pa.

J. B. THOMPSON, M. D.

Is it Simple Continued Fever? Editor MEDICAL WORLD:-I have no disposition to propose a new disease as my caption would seem to indicate; for our modern, strenuous nosologists have discovered so many new diseases, and conjured up so many new names for old disorders, that it is up to the student to keep in mind the nomenclature alone, much less the diagnosis and treatment. My remarks shall be interrogatory, rather than insistent or dogmatic.

The question is: Have we, or have we not, a separate and distinct type of continued fever, but which is now classed as typhoid or paratyphoid? Since I have been practising in Indiana, now more than a quarter of a century, I feel sure that I have not seen more than half a dozen cases of this type; but whilst practising in the southern part of our country I frequently met a fever which ran, in brief, about the following course: There is a long prodromal stage, three, four or even five weeks. During this prodromal stage the patient is ill at ease from general malaise; whilst he is not very sick, yet he is not quite well; he complains of some weakness and is disinclined to much exercise; his appetite is capricious, he feels a need of food without an inclination to take it, and finds fault with everything. Until the fever develops he keeps out of bed, and if he be very ambitious keeps on his feet thruout the whole attack, constituting the socalled "walking typhoid."

After this antedromal stage of three weeks or a month he is found to have fever of a continued type. The fever is not very high,

rarely over 102°, with very little increase of the evening over the morning temperature. The fever burns on and on, week after week, four, six or eight weeks or even more. The longest case I ever saw was taken down about the first of September and the first time he was able to sit at the table and eat was Christmas day. There is no quasi self-limiting to fourteen or twenty-one days like typhoid proper. There are none of the accidents or complications which attend the typical typhoid-apparently nothing to guard against except asthenia.

I know nothing of the nature and pathology of simple continued fever except that it is neither contagious nor infectious. I have never seen two cases in the same household. It is claimed that the typhoid bacilli in minimo have been discovered in these cases, with none of the lesions of regular typhoid. In the misty past days of the humoral pathologists and the solidists a rational pathology, doubtless was found; the former claiming that some baneful ichor was tainting the blood, lymph, and other juices of the body, and that the fever was nature's laboratory to volatilize the offending material; and the latter, that some peccant material pervaded the organs and other solid tissues, and that the fever was nature's crucible to incinerate and convert into an innocuous ash the poisonous entity.

I know of no remedy that will cut the disease short except mercury. In a certain proportion of cases, a majority I think, the mercurial impression, slowly and carefully establisht, will supplant and cut short the disease; but in some cases which most resemble genuin typhoid in behavior, whilst they are thus cut short for a time, will rally as it were and run on the usual course to the end.

In parallel columns I will attempt to present the differential of the cardinal features of these two diseases:

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[Your communication gives evidence of a scientific and scholarly investigation; yet we believe you have reacht an erroneous conclusion. The differentiation of the various fevers has been so thoroly carried out by extended laboratory and clinical work by men of limitless advantages in the way of clinical material and equipment for detail investigation, that we do not believe any fever affecting any considerable portion of any civilized country has escaped accurate listing. It is unquestionable that we have a "para-typhoid fever," quite as distinctly as a typhoid fever; both these fevers with other modifying circumstances and environment, might contribute to the presentation of such symptoms as you describe. Even if you had noted a distinct type of fever not yet cataloged, you could not appropriate the name Simple continued fever," since this is already in use to designate an entirely different type of disease from the one you describe. See editorial in this issue. Simple continued fever has a prodrome of only two weeks.-ED.]

Comments on September WORLD. DEAR EDITOR: -THE WORLD deserves much credit for its efforts to expose some of the ways and means used by commercial medical publications (page 368). It may lose in advertising, but it ought to gain in subscribers. Every subscriber should constitute himself a committee of one to add at least one subscriber.

Nothwithstanding the warnings that are constantly being given by medical writers and teachers, and by the family physician, still one of the greatest evils goes on even in many localities where the people are intelligent and éducated. Every one should read carefully the article on "The beginning of the school age," on page 368, and show it to his teachers and call attention of the patrons of the school, to the evils therein suggested. Much can be done by the family physician among the patrons of the school in a quiet way without appearing to be "my brother's keeper." True, we often (I think I may say generally) see our admonitions go unheeded when we try to teach the people what is best to do for the health of individuals and communities. Sometimes we are regarded as meddlesome or officious. But we should do our duty whether it is appreciated or not. Every physician has seen the evils of confining children to the schoolroom, when too young to bear the great change.

The doctor who is always searching for something new ought never be regarded as a safe doctor. The last paragraph on page 369 on this subject is the best in the same amount of space I ever read. Most assuredly it is true that ". the man who becomes habituated to trying all the new things of which he hears, becomes valueless as a practician of medicin."

Persistent hiccup certainly does weary the attending physician. Often the source of reflex irritation cannot be discovered or located; and if discovered cannot at once be remedied. The young doctor who has never had a case would do well to mark and file away for future reference the articles on this subject on pages 371 and 399. If not before, when he has a case which has resisted all treatment for several days he will be glad to read all such articles. Even when the cause of hiccup cannot be discovered or cannot be at once remedied, suggestion will sometimes do much to relieve the patient. Strong pepper tea has stopt hiccup when all the usual remedies had failed. Do not forget strychnin when all else has failed. Give it until it shows that it has made an impression on the patient. Tell him the hiccup will stop when the medicin has taken effect, and it will rarely fail to do so.

The more I read about insomnia the more fully I realize that I know very little about it. There are so many and so different causes that each case is a study. Remedies which will relieve some cases will have an opposit effect on others. Drugs do very little good in my hands. Of course drugs will induce sleep, but they will not cure the habit. I think habit does have something to do in such cases. A habit of wakefulness is easily formed in some people.

In addition to the remarks I made on page 382 about "marks and brands" on tablets, etc., I would add that when it is necessary to use proprietary medicins, or when it is more convenient, if the medicin is in fluid form empty it into another bottle and put the label on yourself. Those who keep their own drugs can easily manage this; and those who do not handle their own drugs can easily arrange with the druggist to do this. It is always a good idea to have your patient undergo an examination after taking one bottle before prescribing another. Never give over two bottles unless you give something between times, if only a placebo. These additional remarks on this subject are the result of reading the article on page 378 and the Editor's comment thereon. But we should keep before us always that it is best not to use such remedies if we can get on at all without them.

Dr. Puderbaugh asks on page 381 if malaria caused premature labor in his patient.

In the absence of any further knowledge of the case than is given, I would answer unhesitatingly in the affirmativ. To the second question I would say that there is no doubt but what a child may have malarial poison transmitted to it while in utero. Pregnant women in this locality sometimes have to be treated to prevent premature labor when they are suffering with malarial troubles.

"Iowa" tells us that in his prohibition town he sells large quantities of peruna. This nostrum is one of the greatest curses in small prohibition towns that I have ever heard of. Hundreds of little country stores are being kept all over the state of Mississippi, and I have no doubt the same state of affairs exists in other prohibition states, for no other purpose in my opinion than to sell this and other intoxicating drinks, under the guise of medicins. Yet preachers, senators and others in high places give flattering recommendations (doubtl ss for a consideration) to the manufacturers of these socalled remedies. Our legislature, tho composed largely of prohibitionists, voted down by a large majority, a bill prohibiting the sale of these intoxicating drinks except when prescribed by a physician.

The umbrella in the sick room by Dr. A .C. Gore, page 393, is a good and somewhat original suggestion. Dr. Gore never writes anything that I do not enjoy well enuf to read more than one time. No doubt many a patient has been made more comfortable by his suggestion of the use of the umbrella in cleansing the room of foul air, reducing the temperature, etc.

I cannot answer for other localities than this the questions asked by Dr. H. B. Griswold on page 405. In country practise here it is almost impossible to use what an up-to-date lying-in hospital would call "antiseptic precautions. But in all our cases of labor we try to be clean and to have our patient and all the surroundings as clean as possible. But we often fail to do what we would do if we could. We should always make the best of our surroundings and the means that are at hand. Fortunately there are seldom any bad results in country practise on account of neglect of antiseptic precautions. The rubber pad is not much used. When we use forceps or do other minor operations in the lying-in chamber, we seldom have time to call in another doctor to administer the anesthetic. Of course the doctor administers the anesthetic until he is ready to operate. Not only in obstetric practise but in all other cases where it is necessary to operate, the country doctor has to depend on the nurse or those who happen to be present, to aid in giving chloroform as well as in many other ways. Very few country doctors think

they need another physician in the cases indicated by the doctor in his questions. He thinks it better to operate at once than wait perhaps several hours for assistance. Of course there are some doctors who will never undertake anything unusual without help, but there are very few such among my acquaintances in country practise except young doctors.

On page 408 is a summary of state requirements for the practise of medicin, and in the list of states empowered to issue temporary license, Mississippi is omitted. Mississippi has power to issue license which will be good until the next meeting of the board. In no case can the license be good longer than six months. Kendrick, Miss.

C. KENDRICK, M.D.

Drugs the Last Resort in Insomnia. BROTHERS:-On page 398 of September WORLD our honored Editor has written an excellent reply to query: Drugless Treatment of Insomnia. One exception, however: "The drugless treatment of insomnia is more of a fantasy than a fact." Don't pin your faith to that. In the first place, that sentence ought not to have been written. Why? It will probably induce scores of M.D.'s to give drugs more freely to this class of cases.

I doubt if there is a much greater evil prevalent among members of our profession than the almost indiscriminate use of narcotics, hypnotics, etc., to paralyze these insomniacs into an unnatural condition called sleep. "Find cause and remove." Good! And meantime use baths, electricity, massage, exercise, quiet, etc., as facts. The fantasy lies in regarding drugs as natural sleep producers at all. True, you will at times have to counterfeit sleep by the use of a drug. Make it your last resort. Henvelton, N. Y.

O. C. HAMMOND.

A Protest against the Use of Alcohol. Editor MEDICAL WORLD:-Your editorial on "The Treatment of Insomnia" in the September WORLD contains a recommendation against which I wish to protest. In the outset of your article you very properly condemn drug addiction and the "becoming a slave to some drug." And you point out how when such patients consult a careless practician he is probably "doped" with some deadening narcotic, and is indeed lucky if his last state is not worse than the first. After this good advice and warning, you go on in your recommendations as to treatment. Among other things you say "the taking of a small hot toddy on retiring gives an admirable vaso-motor dilating effect. To this last paragraph I most respectfully request permission to positivly object. In my opinion a hot toddy at bed time is more likely to result in an uncontroll

OCTOBER, 1904]

Ginseng for Persistent Hiccups-Is It -Itis or -Etis?

able appetite, a drug addiction and absolute slavery to its most deadly effects, than morphin, opium, or any other known narcotic. Please pardon my criticism, but I confidently appeal to the jury of your many thousands of most intelligent and impartial readers for an endorsement of my position.

A nervous, sleepless patient, will like nothing better than to be advised by his trusted medical attendant to take a small hot toddy at bed time. We all know too well how faithfully that advice would be carried out, except the "small"; and how the habit, the drug addiction, the slavery, would be likely to grow until the last state of the patient would be many times worse than the first.

The morphin habit is bad enuf, God knows; but it does not, like alcohol, make a brute out of a man, pauperize his family, and blight and curse all it touches.

For a physician to advise his patient to take alcoholic drinks continuously as a medicin is, in my opinion, one of the most dangerous and damaging things he can do.

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Ginseng for Persistent Hiccups. Editor MEDICAL WORLD:-In an editorial article (page 371, September WORLD) you speak quite fully of the above named annoyance, mentioning a large number of remedies, but you do not seem to consider any of them a specific. This, together with my own experience, recent and remote, with the difficulty, impels me to send you the following note of my own experience.

From my earliest recollections, and before, for that matter, hiccups were the bane of my existence. I very soon learned to expect an attack as often as every two or three weeks, and to consider myself very fortunate if the attack was postponed four weeks. Such an interval was the exception, not the rule. I would awake in the morning with a peculiar feeling in my stomach that told me I was in for a day's pull, and so it would prove. I would begin before breakfast and continue all day, and by night I would be sick. The idea of consulting a physician would have been hooted at, and I would have exposed myself to unlimited ridicule. I tried the popular schemes for relief, such as drinking nine swallows of water without breathing, putting my thumbnails together and seeing how long I could hold them and hiccup, and other schemes bordering on superstition, but with no result. I have been thus specific in detail to show that my case was no ordinary one. This condition of things continued till I was about fourteen years of age, when one day I was helping a neighbor in haying; as we went in to dinner, the lady com

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menced telling of her brother who was at one time very sick and was taken with what was called "death hiccups," but was cured with ginseng root. I listened, said nothing, but made a note of it and resolved to try it the first opportunity. The root grew plentifully in the woods, and I soon supplied myself and commenced to chew it regularly. As a result I noted particularly, I did not hiccup once in three years. I left off the constant use of the root, but the malady did not return. When I commenced the practise of medicin I prepared some tincture by drying the root very dry then grinding it and putting it in alcohol. I have used it in practise and it has never failed me. I have given it to a child of a few days old and to the aged and those very sick, with uniform success.

My last use of the drug was on the night previous to the receipt of the September WORLD. I had just returned from a journey of about seven hundred miles, during which time I had been living very irregularly, hardly eating at the same table twice, and about midnight I awoke with the hiccups. They were in the old form of sixty years ago. I waited some time, but they persisted. I secured some of the tincture, prepared it in water and between hiccups I drank it. No, not between, for I hiccuped and drank it and waited to hiccup again-and am waiting still!

Canonsburg, Mich. C. R. CROSBY, M.D.

Is it -Itis or -Etis?

Editor MEDICAL WORLD:-Will you kindly state in the October WORLD whether the profession has or has not settled upon any definit rules for the pronunciation of medical words of Latin or Italian origin? Twenty years ago nearly all American schools and colleges used the socalled English pronunciation in the study' of Latin, all vowel sounds being pronounced the same as in English. A few years later nearly all, if not all, American schools and colleges adopted the Continental or Italian method of pronunciation, in which the vowel sounds are very different, "a" having the broad sound as in "far,' e" as in "fete," "i" as the letter "e."

The dictionaries of today give the pronunciation of medical words of Latin origin the same as they would be pronounced in English. For example, in all words ending "itis" the "i" is long, as in "bron-chi-tis." Are the

dictionaries right? or are we to pronounce such words as they would be pronounced according to the Continental or Italian rules of pronunciation? If the Italian rules of pronunciation have been adopted by the profession as they were by the universities years ago, then "bron-chi-tis" should be pronounced

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