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with prolonged and persistent effort it may be remarked that six bours is the average length of time before favorable symptoms appear.
Atropin, though in some respects a functional antidote, has been advocated by the medical profession at large, but if used at all, it must be administered with caution. It is said that one-twentieth of a grain can be given and repeated in an hour. But in my opinion there are strong contra indications for the use of atropin at all; the main and fatal objection is that it locks up the secretions and hence prevents the elimination of the poison. It also may cause a rise in temperature. It is a violent poison, also, and it is very easy to add atropin poisoning to opium narcotism. I therefore believe that it should never be used in the treatment or opium poisoning.
Brandy, ether, camphor, strychnine, caffein, strong coffee and electricity have all been used with tolerable success in the treatment of opium poisoning, and should be resorted to whenever the symptoms are sufficiently urgent to demand strong stimulation.
Another error is flagellation and rough attempts at rousing the patients to consciousness. More can be accomplished by traction of the tongue, or by Koenig's stimulant massage over the heart. Again, flagellation with cold, wet towels shocks the patient, while hot pack would prevent shock and at the same time favor elimination.
The following is a brief history of a case of laudanum poisoning: Mrs. H., aged 56, German, was so restive under the marital yoke that she determined to drink of the waters of Lethe and so end her troubles. At 10 a. m. she bought four ounces of laudanum, and between 10:30 and 11:30 drank it all in four doses. The size of the doses being marked by a faint line across the bottle. At 4 p. m. she was discovered in the usual narcotic
condition of acute opiism. Artificial respiration was necessary at once, as her breathing was only five or six respirations a minute. Lavage by stomach tube was instituted at once. At 7 p. m. I washed the stomach out with a one per cent. solution of permanganate, repeating the procedure in an hour. I also injected some of the fluid in the calf, a proceeding which I should not again do, on account of the sore which it produced. At 8:30 she was able to talk, and so mad at the idea of being rescued from the grave that her very anger helped to arouse her. I told her it was useless to attempt to suicide by opium, for the doctors, if they got hold of her, would pump her out. The next morning the husband arrived from the East, and he seemed to share in his wife's anger at her recovery; these feelings were intensified by my presentation of a modest bill for $25. As he said he was going back to Utah, we finally compromised on half rates. About two weeks later the same woman hired a house on Grand avenue, cut her radial arteries, took four ounces laudanum, turned on the gas, and died.
One of the most interesting cases I ever witnessed was that of a woman who had used three rectal suppositories, each containing a quarter of a grain of morphine and administered at an interval of four hours. She died about thirty-six hours after the administration of the last dose. This occurred before the treatment outlined above had been evolved, lavage and oxygen not being employed. Atropin, however, was, in pursuance of the treatment then in vogue, employed, ana the temperature six hours after its administration had risen to 103 degrees F., giving rise to the belief that the woman might also have been suffering from some unknown brain lesion. Had I the same case today, I believe that by the substitution of pilocarpine for atropin I might have saved her life.
THE LODGE QUESTION.
BY JOHN C. KING, M. D., BANNING, CAL.
In the October Practitioner, under the caption of “Original," appeared an article on the lodge. question, by E. Hall, of Canada. The lodge fight has waxed warm in Canada, where the universities have entered the lists against the lodge men. Of course, certain doctors can be found to defend the iniquitous system. Their arguments are passed from one section of the country to another-wherever the battle is fiercest. This identical article of Hall's seems to be a favorite. It has already appeared in the "original” columns of medical journals in other localities where the lodge men deemed it serviceable. Owing to the efforts of several of our county societies to suppress lodge practice, the supporters of the method doubtless supposed the same old “original” might do good work here. The lodge system of medical attendance originated in England, spread to the continent and to Canada, and our importations of medical men from our northern neighbor brought the contagion to us. In California the foreign element among doctors, and particularly the Canadians, are the worst sinners. When Riverside county society inaugurated a crusade against the Forester scheme of medical prostitution, every physician to their lodges in Banning and the adjacent towns of San Jacinto, Riverside and San Bernardino was a Canadian. Any reader of English medical journals knows the deplorable condition to which the lodge has reduced the English profession. In Canada all reputable medical men are striving to cast off the incubus. In our own country the system is growing, and, if not checked, will result in what Hall predicts and advocates:
“They (the doctors) will follow the same course as common laborers, namely, the doctors will lose their independence and become the employees of corporations and unions." The lodge question is not the contract question. The latter has become obsolete with the code of which it formed a part. The lodge men would have us believe the problems are the same. A contract may be honorable or dishonorable. Honorable contracts may be made with civil authorities to care for asylums, schools, penal institutions, quarantines, etc.; or with military authorities for the army, naval or Indian service; or with corporations, as railroad, steamship, mining and insurance companies; or with private firms, as in the laboratory of Parke, Davis & Co.; or with individuals, as the performance of a surgical operation for a definite fee; or with a lodge, to examine applicants or perform service for a fixed and just compensation. Dishonorable contracts may be made with any of the above classes. The civil authorities of Pickaway county, Ohio, advertised for bids from doctors for the pauper practice of the county, including drugs and daily visits to the poor farm, four miles from the city. It was knocked down to an eclectic physician at $40 per year. This was dishonorable on his part, because he accepted the position for inadequate pay, as an advertisement. It is dishonorable to contract to pay a hotel man, or any other drummer, a percentage on the business sent by him because one must secretly charge the commission to the patient, and because the drummer recommends the doctor for the commission alone, not for the reason that he knows, or believe in,
the latter's ability, thus trifling with the patient's health or life for coin. It is unnecessary to specify further. Every decent man knows that a con. tract is honorable or the reverse according to its terms. Among the dishonorable contracts for professional services may be: a contract to perform the impossible, to cure an incurable case; a contract with a drummer to pay him for bringing business; any contract that tends to destroy the dignity of the profession or the public esteem in which it is held. The physician is under peculiar obligation to his profession; his knowledge, his tools, his opportunities to keep pace with modern improvements
are all gratuitous gifts to him from the profession. He could not develop one of them independently for himself. Any contract designed to sell we knowledge and skill (which is not his prfvate property, but is the united property of the profession) below the market value to those who can afford to pay that value, is dishonorable. The merchant who persistently seils below cost will eventually “go broke, Meanwhile he is injuring all who deal in similar merchandise. Professional merchandise has a cost mark below which it cannot be sold without disastrous results to us all. The lodge offers the doctor one dollar per year per head and other considerations implied. No honorable gentleman can accept the position, because he would be selling his goods below cost to injure his neighbor doctor. He is unwilling to depend upon his own ability and reputation, but seeks to atone for his lack of both by underbidding his colleague and doing business below cost. Is he simply a fool? No; he takes the place for ulterior and dishonest purposes.
It is the drummer principle developed to perfection. The lodge doctor hopes to secure the families and acquaintances of the lodge
members, not on the basis of merit, but because he buys the member's influence by giving him something for nothing. Hall claims the man earning $2.50 per day is unable to pay for medical service. He can pay the girl who supplies his gonococci, he can pay for the beer that ruins his kidneys, he can pay his grocer and butcher and clothier. If he cannot pay his doctor the charity of our profession will care for him, regardless of a paltry dollar per year. The lodge, however, is not composed of poor men. Here in Banning the Foresters include business and ranch men with thousands of dollars apiece. The affair is business, not charity. Hall claims the lodge doctor receives "ample remuneration for his services.” If so, the remuneration consists in the “legging” that is done for him. According to Hall your medical bill is usually the measure of your misfortune. If you have employed a lodge doctor this is presumably the
If you have employed an honorable physician his bill is a fair measure of your triumph over misfortune. Hall glibly compares the payment of a $5000 policy by a life insurance company, after having received only a $50 premiuni, to a physician doing $50 worth of work for $3. The difference he overlooks is the fact that the insurance company must receive from members as a whole all it pays out to individuals, otherwise it fails. The lodge doctor does not receive from all what he pays to one individual. To make the cases parallel the doctor should receive from the lodge, in annual payments, a total sum equal to a fair bill against all members for medical services during an average lifetime. If some millionaire would agree, for a dollar per year per heaa, to pay each member $5000 at death, he would be assuming exactly the financial position occupied by the lodge doctor, and would be exhibiting equal
good sense. The fraternal feature of the lodge, so far as concerns the doctor, is a fraud. A true brother does not ask another to give him ten dollars for one. Nor does the lodge member dream of asking special and ruinous prices from any one but the fool doctor. Imagine a Mason demanding free treatment because he is a Mason. Hall's real argument for the lodge is socialism. He claims the State should remove tumors; that the doctor's wages should be merely the cost of subsistence. I do not suppose
tne Scuthern California Practitioner cares to dis social m, even though its valued "original" contributor claims to a socialist. In this connection, however, I would
suggest the propriety of a lodge attempting to procure the services of a barber or a bootblack for one dollar per year per head. The attempt, if successful, would demonstrate toat members of those professions actain no higher standard than do lodge doctors, and the socialistic principle would be advanced in a very practical and useful manner. If it be true that lodge practice is an evil, it is also true that we possess the remedy. It is professional ostracism. Do not consult witn, nor operate for, a lodge doctor, nor allow him to treat a case in our hospitals, nor admit him to a society. Ir he is connected with a college or a journal, black-list the institution. Force him into a sect by himself.
CLIMATOLOGY OF CALIFORNIA.
NO. 3 OF A SERIES OF PAPERS BY C. G. STIVERS, M. D., LOS ANGELES, CAL., ASSISTANT
EDITOR SOUTHERN CALIFORNIA PRACTITIONER, Passing to the consideration of the anyone on reference to standara climatic data for Southern California, works on the subject, and from the we will take as our basis of analysis records of the United States Weather the very useful table of Dr. Phillips Reports which records extend over of the United States Weather Bureau.
many years and have been taken in a careful and painstaking manner.
Other facts, like those relative to the Climatic Data.
soil, water, vegetation, amusements, transportation, etc., are always at
hand. Southern California presents a Temperature: Average or normal....
wonderful diversity of soll, as would Average daily range. Mean of warmest (mean max.)
be expected when it is remembered Mear of coldest (mean min.). Highest or maximum...
that it is bounded on the north, east Lowest or minimum..
and south by mountain chains, some Humidity: Average relative..
of which (the Sierra Madre and TeAverage absolute. Precipitation:
hachepi) are almost wholly granitic, Average in inches.. Wind:
while the lower ranges are of unalPrevailing direction. Average hourly velocity.
tered sandstone, shales, limestone and Weather:
clay. Average number clear days. Largest number clear days.
The alluvium is carried by the torSmallest number clear days. Average number fair days.
rents in the rainy season, and spread Largest number fair days.. Smallest number fair days.
over a wide area. As a general thing, . Average number cloudy days. Largest number cloudy days.
the drainage is good, owing to the Smallest number cloudy days.
marked declivity. The drinking water Largest number rainy days.. Smallest number rainy days.
is usually derived from wells, tunnels Largest number rainy days..
piercing the water-bearing strata or The above facts can be obtained by the hills, living streams in the canyons,
The data for as many months as desired, or
all the months of the year in these columns.
The average for the year in this column.
or from seepage and collection of the underground flow of some river, as is the case in the supply for the city or Los Angeles. The water, then, is usually removed from the danger of contamination, until it is actually in the reservoirs.
The Chamber of Commerce emphasizes the "all-the-year" feature in these words:
"Southern California--that is, the section we have indicated, especially including Los Angeles—has an "all-the year-round" climate. This is a rare and inestimable feature, possessed by very few sections of the world. It is well to specially insist upon this point, because very erroneous ideas prevail on the subject in the East, where it is generally believed, among those who have not spent an entire year with us, that the woole of California is a counterpart of Hades during the summer-a veritable fiery furnace, as its name would indicate. Strangers have yet to learn that California includes within its limits almost as great a variety of climates as may be found in the world. Take, for instance, an August afternoon in San Francisco and at Indio, in the Colorado desert. in the former place the inhabitants will be found attired in heavy overcoats and sealskin wraps, or seated around large, open coal fires; at the latter, a thin shirt and overalls are too warm for comfort. Los Angeles occupies a happy position between these two extremes, and our climate is shared, with slight variations, by the suburbs for twenty miles around, becoming somewhat moister and cooler toward the ocean; dryer and warmer toward the mountains.
Another advantage of Southern California's climate is the great variety which may be found within a small area.
. On the coast it is cool, almost cold, in summer, with some fog at night. Further inland are low plains which have an occasional frost, and belts where frost is never known; where the tomato ripens every month in the year and the banana flourishes. Back in the small interior valleys are localities where the mercury, in the middle of a hot summer day, will range up to or above 100 deg. This is a specially valuable peculiarity of Southern California as a health resort. In Floridå the highest elevation is about 100 feet above the sea. Here in Southern California the invalid may start in the morning from Santa Monica on the sea level; three-quarters of an hour by rail brings him to Los Angeles, several hundred feet above the sea, where the Ocean breeze loses much of its force. Another threequarters of an hour and Pasadena is reached, at an elevation of nearly 1000 feet. Half an hour more and the traveler is at Altadena, some 2000 feet above the sea level, whence a cable railroad and mountain trails lead to charming glens and benches, 6000 or more feet above the sea. The traveler, on Christmas day, can breakfast by the waves of the Pacific Ocean at Santa Monica or Long Beach, after a refreshing dip in their briny embrace, lunch under the orange and banana trees of Los Angeles, and dine, if he will, among the snow fields on the sides of the Sierra Madre Mountains, returning to sleep midst the fragrant gardens of beautiful Pasadena."
By thine own soul's law learn to live;
And, if men thwart thee, take no heed, And, if men hate thee, have no care.
Sing thou thy song and do thy deed; Hope thou thy hopes and pray thy prayer, And claim no crown they will not give.
John G. Whittier.