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these conditions are absent, simple percussion the mass of the medical profession today is and inspection will settle the diagnosis, no this deplorable lack of judgment. It is this matter what the tale the victim may unfold. deficiency which causes the wild oscillations

Constipation will be a pretty constant con- of the pendulum of medical practise in such comitant symptom, especially in the neuras- short periods. Because the reckless bloodletthenic and hysteric, and the pneumatosisting of a few decades ago workt such selffrequently is cured by simply correcting this evident harm, blood letting was entirely abancondition and keeping the bowels regular. The doned ; yet no man of judgment disputes the first struggle with the patient is when you fact that it is a measure of incalculable benefit attempt to convince her that the trouble is due in a truly indicated case. The radical teachin great measure to a vicious habit; but if she ing that we no longer needed the lancet, since can be caught by yourself or a companion we could now “ bleed a man into his own in the very act of air swallowing, she becomes blood vessels" with the aid of veratrum viride, convinced if not converted regarding the truth was responsible for much. Veratrum viride of your assertions. The air swallowing must be was all right-is yet all right-when indicated; stopt, and if control of the habit is not obtain- so is venesection. Only a few years ago we able otherwise, instruct the patient to keep the were instructed by a certain class of “aumouth open for a half hour at a time. No one thority," that the only treatment of the milk can swallow with the mouth open, and the relief used in the artificial feeding of infants worthy of the symptoms will soon aid you in getting an intelligent practician's attention was thoro full control of the case and the patient. The and complete sterilization. It took but a short intra-gastric application of galvanism is of bene- while to learn that but very few cases really fit, as are also cold sponging and massage of did well on such treatment carried out for any the epigastrium. Small frequently repeated continuous period. Then pasteurization was doses of belladonna, atropin, and arsenic have heralded as an infallible remedy for all baby proven of benefit in many cases. Bromid of troubles in connection with milk; now we strontium is efficient in combination with other know that both have their individual patients measures. If the case be neurasthenic, and for which each form of preparation is essenthere is a probability of the neurasthenia being tial, and that there are multitudes of babies for dependent upon the uric acid diathesis, salic- which neither will do. We recognize the fact ylate of sodium will prove more beneficial than that good judgment must be exercised in the the bromids. In cases where actual disorder of determination of the treatment of the food the digestiv function exists, of course it will be which each individual infant requires. necessary to give digestants, and to supervise We have never understood just why a comthe diet; yet such cases will generally be found plete medical education should dwarf a man's in the minority, and the patients will tell you natural good judgment so that he no longer that they "belch just the same no matter what allows his intellect to work for itself, but they eat."

blindly follows the self constituted “authorNearly every case may be quickly and per- ities," whose actual intellectuality is often inmanently cured if studied properly and sufficient ferior to his. Just because a man has secured attention be devoted to it.

a position in a medical school, because he has

written a book, or because he has elected to The Exercise of Good Judgment in the Prac- follow a specialty, is no reason why one should tise of Medicin.

give up before his assertions if one believes There is not as much truth as is generally them erroneous or based on false premises. We thought in the assertion one sometimes hears, have watcht several medical classes graduate, that “doctors are born, not made." It is and have had opportunity of estimating the true, indeed, that many good farmers are lost actual ability of the members of those classes; to the world in the effort to make doctors out today we see men of superior attainments and of them. A certain adaptability is a require ability following implicitly the instructions of ment if one would make a success in the their former classmates solely because they practise of medicin, but the main essential is have written a book which is well written and the possession of good judgment and the in- faultlessly illustrated, altho such authors were dependence to exercise it. No man, however decidedly the inferiors in intellect. We advise brilliant may be some of his mental attributes, reading what eminent men, or those particuwill ever become a really good doctor unless larly favored by having handled an unusually he possess good judgment in good measure. large amount of clinical material, may have to Any man, with good judgment and a fair say; but we implore our readers to digest what education, may become a good doctor and a they read thoroly, and to submit it to the test successful practician.

of their own individual judgment before comThe greatest weakness that we observe in mitting themselves to it. Some of the most

widely experienced men in the profession to- about school life? How much he could tell day are admittedly so radical in their special the teachers (if he would) of children about the line that we would hesitate to intrust ourself to age of puberty. If he does not, is he doing his them unless some other practician had made full duty? We are our brother's keeper. the same diagnosis and advised the same treat- There should be a system which would grade ment.

children physically, as well as mentally. The While specialism undoubtedly makes many strong should not be allowed to oppress the men very efficient in their chosen fields, it is weak. The physically insufficient should not dwarfing in its effect on most practicians, and be crowded with the same task assigned the many become narrow and prejudiced. It is a strong. Those mentally slow should not be fact that good judgment is more often found pusht into the ranks of those who grasp things in the better class of general practicians than quickly, lest they thereby be kept fatigued and in the average specialist when in the line of disappointed in the hopeless endeavor to “keep his specialty. The general practician is the up. Those having a mathematical trend broader of the two. If less experienced in the should be led and encouraged in that line, so special line, his diagnostic powers are more that they may enter pursuits from choice, which acute in a general way, and his summing up of will yield their most brilliant services to the the entire situation is generally more rational world and to humanity; those who are dullards and logical What is needed is less blind de- in arithmetic should be advised against a callpendence upon authority and more thought ing which involves constant delving in matheupon the case in hand, less thoughtless de- matics. We are well aware that some will say vouring of anything "new in medicin," and that the teacher should be the judge of these the exercise of more good judgment regarding things, and if the teachers were learned and that which one already knows.

capable, we would admit the assertion; but we We are not arraigning specialists, individ- must remember that only the exceptional ually nor as a class ; we are not eulogising the teacher is competent to pass judgment. This general practician; we are not under-rating the vicious plan is universal thruout our great school unusual application, opportunities, and talent system—the grandest in the world. The averusually required to constitute one an “author- age teacher knows nothing of psychology as ity;' but we are making our best plea for an affecting the children with whom she daily all around effort to bring into play that essential deals. She pushes and prods the slow and factor in all rational practise, and to combat backward child in the vain endeavor to keep that blind instinct to follow others thought- him in the same rank as bold and shrewder lessly, which so often results in making us, as a children. Mental dulness has generally a profession, ridiculous. Make yourself familiar psychological basis. Insufficiently fed; poorly with the investigations and conclusions of the developt; degenerate; unnaturally precocious; “ authorities," but be careful to digest what nervously sensitiv; mercilessly strenuous; they say.

healthy; weak; rich; poor; all are herded to

gether under the guidance of an innocent Duty of the Doctor with Relation to the Pub- teacher. Why! good farmers treat their cattle lic School.

better. Too few physicians appreciate the fact that A single example: A child with deficient it is their duty to take a deep interest in the eyesight; allotted a dark seat ; his eyes conchildren and their welfare. The word physi- tinually irritated by the ever present dust which cian literally means “teacher.” Unconsciously is not avoidable ; teacher unsuspecting ; parthe laity look to the profession for instruction ents careless ; upbraided for his dulness; proud along hygienic lines ; if such instruction is vol- and ambitious. What is the result? Can the untarily given in a proper and modest spirit, average teacher tell? Can any well read physiit is gladly and respectfully received ; if it is cian tell ? Then whose the duty ? An ignot given, the community either feels that the norant parentage; an innocent, as well as physician has not done his full duty, or that he ignorant teacher; a school board who only is incapable or careless. School boards and serve because they have nothing else to dosuperintendents of education are awakening to pity the child. the fact that they need the counsel and advice Physicians have the influence (would they of physicians, not alone in combating con- but exert it) to get good men on the school tagious diseases, but also in the construction board, who

ould listen to reason and sepse, or and arrangement of the school buildings. This to become candidates themselves for the office. is as it should be. And every physician If personally they feel incompetent, let them tendered a post on a school board should ac- shove an abler professional brother. Even if cept, and serve to the best of his ability. Who they are too diffident to serve personally, or to but he knows so well the dangers which hedge promote the interests of another of the profession, they may advise and suggest to the board

Real Estate Investments. elected. The honest and capable physician

Some have written us that doctors should will not be rebuft.

invest in real estate. We have also said so, We are fully aware that all needed reforms

but not in a speculativ way. In this conneccannot come “in a day." Will they ever

tion the following letter is of interest. come if those responsible are apathetic ?' If we could gain one little advantage for the weak,

Editor MEDICAL WORLD:-1 am loaded up with a

mass of worthless real estate. It is a hard fight to get opprest, or feeble child, would we not be re- the money to pay the enormous taxes that we have to paid? Act.

pay out here. I would not buy the stuff now; but I have it and cannot sell. It is just like stocks or any.

thing like that. A doctor has no business to buy any. Beg Your Pardon.

thing on speculation, or anything he does not need.

It is only an incumbrance; yes, a white elephant that We beg to apologize to our readers for pub- has to be fed yearly just at the time when you need lishing an article in February WORLD, pages 70

the money the most. If I had had THE WORLD'S and 71, on “ Malignant Skin Diseases and the

advice about investments years ago I might be much

better off, and not have so much tax to pay on goodFinsen Ray," by “H. John Stewart, M.D.," for-nothing lands and lots. It seems really that a docas an “ Original Communication." When the

tor is peculiarly liable to make such bad investments, article came, in December, I had a suspicion

because he is busy with patients, and is liable to go it

blind and say yes, when he ought to say no !! that all was not straight, so I wrote and askt

MAX WERDER, M.D. him if he had, or intended to, send the article

1107 Post street, San Francisco, Cal. to any other journal for publication, referring

Frank and John Jager, officers of the Model Gold Mining comhim to our rule at head of original communica- pany, have been arrested by the federal authorities and arraigned tions. On December 22 he answered, saying:

before the United States commissioner at Chicago, charged with

"misrepresenting their properties in advertising matter sent thru You need not hesitate about printing this

the mails.". An associaied press dispatch says that upwards of

$800,oco is involved in the case, and that the federal authorities article, for the same article will not appear in are determined to push it to a finish. - The Commoner. any other journal, you having received the

How many doctors' dollars are in that $800,000? original, and the carbon copy being still in my How many doctors' dollars are in many other compossession."

panies equally guilty of “misrepresenting their prop

erties in advertising matter sent thru the mails ?" The date was then too late to get the article Doctors, stick to your dollars—but don't fail to send in January WORLD, so it was scheduled for $3 to this office for a copy of “ The Story of New ZeaFebruary issue. During January I was very

land.". It is not a speculativ investment. If, after you

read the book, you are dissatisfied with the investbusy and got behind with my exchanges, not ment, return the book (in good condition) and get reading them till February issue was on press.

your money back. Imagin my chagrin when I found essentially the same article, with, however, a different On page 88, February World, first column, in title and a slightly different introduction, in :

about the middle of Mr. Shibley's letter, occurs this

expression : "the revolutionary process.” It should Gaillard's Medical Journal.

be, the evolutionary processes. Please turn to this Columbus Medical Journal.

page and mark the correction.
Courier of Medicin.
Southern Practitioner.
Medical Summary.

When people get to quarreling about their creeds, Medical Brief.

the devil stops being anxious about their deeds.
St. Louis Clinique.
Pacific Medical Journal.
Virginia Medical Semi-Monthly.

“If it is true that man's character is influenced It is possible that I have missed some, and

chiefly by the way he makes a living, The Story of

New Zealand,' by Frank Parsons, edited and pubthat the above list may not be all. The article lisht by C. F. Taylor, 1520 Chestnut street, Philadelin the above journals occurs under the uniform

phia, is as truly religious a work as has lately appeared.

Law may not be able to make a man moral, that is, title, “ The Finsen Light Cure," and is prac- force morality upon him, but it may give him an oppor tically identical, word for word, in all. In tunity to be moral and still make a living. It would THE WORLD, the title was different, and

be rash to say that New Zealand has solved the prob

lem of human government, but it has taken some steps the introduction was different. Mr. “H. in advance, and its wonderful civilization is worthy of John" has workt quite a “scoop," perhaps, careful study: This book is attractivly written, and in the interest of the institution mentioned

deserves a wide circulation. It is essential to every

well equipt library."-Springfield. Mass., Republic in the article. We will be on the lookout for him hereafter, and the institution will

Dear Doctor Taylor :-Inclosed find $2.00 to apply on subdoubtless learn finally that it is the best policy scription to The WORLD. I like your journal. You are honest

and fearless. I agree with your economic views, I like to see them to do its advertising honestly.

advocated in your journal. Doctors are standing in their own light when they do not try to bring about a more equitable distri

bution of wealth. If the masses bad more money we would get A very serviceable, artificial koumiss may be im- more. If there are only a few wealthy men in the country, there provised by adding half a cake of any good yeast to a

are only a few doctors who can benefit by it, whereas, if the whole quart of sweet milk in a half gallon container, and

people own the wealth, then we can all share in the prosperity. I

consider that you have rendered a great service to doctors all over setting it aside till fermentation is complete. It should

the country in your exposures of the various "get rich quick be kept warm but not hot. It makes a grateful and schemes that find so many “suckers" among our profession. nourishing drink.

Chicago, Ill.

J. H. GREER, M.D.

can.

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 if u ercellent discipline for an author to feel that he must

say all he has to say in the fowest possiblo words, or his roader is sure to skip them; and in the plainest possible words, or Ass reador will certainly misunderstand thom. Gonsrally, also, a downright fact may be told in a plain way, and we want

downright facts al present more than anything else.-RUSKIN. READ REFLECT COMPARE RECORD

about half as great here, and our incomes are scaled accordingly. On the contrary, expenditures are about twice as heavy there as here, so that the advantage of one locality over another seems to resolve itself largely into the question of congeniality of environment. Apropos of the example given, it may be said that perhaps collecting is easier in a new country. While fee bills are valuable to those immediately concerned, and instructiv as showing the generally low value placed on medical service, it seems to me that, comparativly, fees vary largely with local commercial conditions.

WALTER S. BOGART, M.D. Cleves, O.

75 to

5.00 to

As to Fees. DEAR DOCTOR TAYLOR : — In a recent article I take the position that medical services are an article of commerce, and should bear a definit relationship to the general commercial values of a locality. In support of this I submit the following practical argument:

I began practise in a frontier town of 100 inhabitants in Wyoming. I received $3 for day calls in town and $5 for night town calls. For ranch work I received $1 a mile. I never toucht a lance for less than $5; received $30 for rib fracture; $1 for a 4-oz. bottle of medicin or 2-oz. box of ointment; $20 to $25 for confinement; $15 for miscarriage, etc.

But-I had no competitor within forty miles; railroad tariff was 5 cents per mile and no competing line; my nearest point of supplies was 200 miles distant, with correspond ingly high freight rate; population was very sparse ; wages were very high, section bosses receiving $62 per month and house rent; ranch hands $30 to $45 and board per month, and the poorest land holder was worth nearly $10,000, while some were millionaires.

I am now practising in a town of 2,000, where the maximum is $1 for single calls and and we are often forced to settle for less; where a lancing is $1 to $2; prescriptions are filled for 50 cents; where $10 is high for difficult labor cases; where three miles adds 50 cents to our prices, etc.

But—there are five other physicians in the town and others near, with “ the cheapest city in America" but fifteen miles away, accessible by trolley for 1% cent per mile, where I can buy direct from the manufacturers. The best house in town rents for $15 per month, and a modern six-room cottage centrally located can be procured for $10 per month. Probably not a score of residents are worth as much as $10,000 each ; section hands get $1.25 per day and farm hands $12 to $20 and board per month.

To sum up: Recompense in general is

Fee Bill. A subscriber sends us the following copy of the fee bill of the Elkhorn Valley Medical Society (Neb.).

OFFICIAL BUSINESS. Ordinary prescription or advice . .$ .50 to $1.00 Physical examination, ordinary.

1.00 to 5.00 Physical examination, very close .

5.00 to 25.00 Electricity .

1.50 Dressing injuries

1.00 to

5.00 PRACTISE. Country visits $1.00 for visit and mile

age at the rate of fifty cents to $1.00
per mile, one way, according to cus-

tomary rates of locality. Town visits, daytime.

I 00 to 2.00 Additional patients in family

one half extra Distant patients, expense and .

25.00 to 150.00 Night Visits

double fee Dangerous contagious diseases.

double fee Removing tape worm .

10.00 Antitoxin, administration of

5.00 Consultation.

10.00 Certificate as family physician .

1.00 to

5.00 Written opinion.

1.00 to 10.00 Opinion involving legal issues .

10 00 to 100.co Vaccination.

1.00 to

5.00 OBSTETRICS AND GYNECOLOGY Natural delivery..

10.00 to 25.00 Delivery of placenta alone.

5.00 to 10.00 Forceps or turning .

15.00 to 25.00 Craniotomy or evisceration .

25.00 to 50.00

recent 10.00 to 25.00 Lacerated cervix or perineum .

old 50.00 to 100.00 Vesico-vaginal fistula .

100.00 to 350.00 Removal of ovarian tumors.

100.00 to 500,00 Removal of uterin, polypus or fibroids. 50.00 to 200.00 Vaginal examination

1.00 to 5.00 Uterin tampon or applications

2.00 to 3.00 Introduction of pessary

2.00 to 10.00 Curetment..

10.00 to 50.00 Hysterectomy.

100.00 to 500.00 Assistant at operation .

10 to 50 % of fee

SURGERY Circumcision

10.00 to 30.00 Phimosis or paraphimosis .

10.00 to 20.00 Opening small abscesses .

1.00 to 5.00 Appendicitis operations .

100.00 to 250.00 Adjusting truss .

1.00 to 5.00 Administration of anesthetics, (except in labor).

5.00 to 10.CO Amputation of finger or toe.

10.00 Amputation of breast

50.00 to 100.00 Amputation thru meta-carpus or tarsus . 10.00 to 50.00 Amputation thru forearm or leg. 25.00 to 50.00 Amputation at shoulder, or thru arm or thigh

50.00 to 100.00

5.00 to

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15.00 to 15.00 to.

Removal of foreign bodies from eye, ear,

Chancroid.

from $15.00 to. nose, pharynx, esophagus. $ 1.00 to $25.00 Gonorrhea, acute

from

10.00 to Amputation at hip: 100.00 to 300.00 Gonorrhea, chronic .

from

50.00 to Reducing dislocation of finger or toe

5.00 Administering anesthetic from 5.00 to. Reducing dislocation of jaw . 10.00 to 25.00 Administering antitoxin

from Reducing dislocation of hip.

25.00 to 100.00

(Serum to be furnisht by the patient.) Reducing dislocation of knee, elbow,

Laparotomy . .

from 100.00 to . shoulder .. 10.00 to 25.00 Hysterectomy.

. from 100.00 to . Setting simple fracture of finger or toe. 5.00 to 10.00 Hernia-radical operation : . from 100.00 to . Setting simple fracture of radius 10.00 to 25.00 Hernia-by taxis

. from 15.00 to . Setting simple fracture of ulna and ra

Fistula in ano.

from 50.00 to. dius. 10.00 to 25.00 Hemorrhoids, internal

from

50.00 to . Setting simple fracture of clavicle . 10.00 to 20.00 Hemorrhoids, external

. from 25.00 to. Setting simple fracture of arm .

10.00 to 25.00 Setting simple fracture of femur. 25.00 to 50.00

DISLOCATIONS.
Setting simple fracture of jaw.

10.00 to 25.00
Reduction hip joint.

from

50.00 to. Setting simple fracture of rib. 5.00 to 10.00 Reduction knee .

from

25.00 to Setting simple fracture of patella. 15.00 to 100.00 Reduction ankle.

from Setting compound fracture (antiseptic

Reduction shoulder.

from treatment) same as amputation of

Reduction elbow .

from

25.00 to, same part.

Reduction wrist.

. from

15.00 to Excision of tonsils, each . 5.00 to 15.00 Reduction jaw.

. from

15.00 to Excision of joints or bones .

25.00 to 100.00

FRACTURES. Removal of nasal polypus.

5.00 to 15.00 Plugging nares.

5.00 to 10.00
Fracture femur.

from

50.00 to. Laryngotomy or tracheotomy

25.00 to 100.00
Fracture leg.

. from 25.00 to. Harelip

25.00 to 50.00
Fracture ribs

from 10.00 to. Ligation of small arteries.

10.00 to 50.00
Fracture arm or forearm

from 20.00 to. Ligation of large arteries,

50.00 to 200.00
Fracture small bones.

from 10.00 to. Trephining

25.00 to 150.00
Fracture clavicle .

from 15.00 to . Plaster jacket.

10.00 to 30.00

AMPUTATIONS. Plaster of Paris dressing

5.00 to 10.00 Lithotomy or lithotrity.

100.00 to 350.00
Amputation hip joint .

from 100.00 to. Tenotomy.

from
25.00 to 50.00
Amputation thigh.

75.00 to Hernia reduced by taxis.

from
10.00 to 35.00
Amputation knee

75.00 to. Hernia reduced by operation

Amputation leg.

from 50.00 to. 50.00 to 200.00 Urethrotomy.

from
25.00 to 100.00
Amputation foot.

50.00 to. Paracentesis

10.00 to 50.00

Amputation shoulder joint. . from 100.00 to. Introduction of sound or catheter

from
3.00 to 25.00
Amputation arm or forearm.

50.00 to. Injecting hydrocele.

10.00 to 25.00
Amputation hand.

from

40.00 to. Radical operation (same)

25.00 to 50.00 Hemorrhoids, external

5.00 to 50.00

Answers. Hemorrhoids, internal.

25.00 to 100.00 Fistula in ano.

25.00 to 100.00 Editor MEDICAL WORLD:- In your January Fissure

20.00 to 40.00 number, page 22, Dr. Boynton asks three quesGonorrhea, in advance

10.00 to 30.00 tions, on which I will give an opinion in the Gleet or syphilis, in advance

25.00 to 100.00 Empyema, operation for .

50.00 to 100.00 order that the Doctor has propounded them : Opening mastoid

50.00 to 200.00 1. The doctor should call on his prospectiv Fee Bill of the Comanche Co., (Oklahoma,)

patient under the circumstances narrated, tho Medical Society.

it is not often done in the country.

2. He should send in his usual bill. This schedule of charges shall be considered our minimum rates.

3. The bill can be legally collected, if the MEDICIN.

husband engaged the doctor, and he was ready Office prescription.

from $ 1.00 to. to respond to the call, as a suit could be mainOffice consultation, examination . from 1.00 to Visit in city-day.

from

tained for breach of contract.

2.00 to. Second visit same day.

from
1.50 to.

Gilsum, N. H. I. A. LOVELAND, M.D. Visit in city-night.

from

3.00 to. Country visit regular fee — additional for first mile.

1.00 to.

“ Chamberlain's Cholera, Colic and Diarrhea Each subsequent mile.

from
.75 to.

Cure.'
Diphtheria visit.

from
2.50 to

Editor MEDICAL WORLD :- I notice that Dr. Consultation-in city

from 10.00 to. Consultation – in country, with

Martin, of Payson, Okla., would like the mileage added

10.00 to. formula of “ Chamberlain's Cholera, Colic and Unusual detention per hour. from 1.00 to. Medico-legal testimony as expert. from

Diarrhea Cure." The following is claimed by

50.00 to. Postmortem examination – legal

good authority to be the formula : investigation ..

. from 100.00 to .

R
OBSTETRICS,
Tr. capsicum

3xx Natural delivery

from
Tr. camphor

3xvj Instrumental delivery.

from

Tr. guaiacum. 35.00 to .

3xij

M. Complicated cases demanding extraordinary attention

from 25.00 to.

Lawton, Okla. W. W. SELWAY, M.D. Twins. .

from

25.00 to. SURGERY.

In rheumatic headache potassium iodid is the favorit Introduction catheter.

from 1.00 to. remedy. Brunton advises that it be given in small Vaccination.

from
1.00 to

doses at first, and increast to thirty grains three times a Syphilis .

from

50.00 to. day.

. from

. from

.

15.00 to.

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