MARYLAND

made until the bill was sent. It was maintained by the defendant that only twelve of

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BALTIMORE, MAY 25, 1895.

It is always a matter of congratulation when the courts decide a question in favor of a physician when that physician Suits for Services. has the right on his side; and

all in the profession should

feel gratified that a few of their kind throw their apathy aside and by standing up for their rights thus establish a precedent which should help all others in the same condition.

In California a physician sent a bill for services rendered and the patient objected to paying the bill, not because it was larger than the number of visits justified, but because in his opinion the visits were too frequently made and were not all necessary.

Lorenzo D. Bulette, Esq., of the Philadelphia Bar, in recording this case in the International Medical Magazine, said that the plaintiff had visited and prescribed for the defendant's family sixty-six times, covering a period of thirteen months; and while all these visits were not especially requested by the defendant, they were received, the medicine taken and no objection was made.

As usual in such cases, the objection was not

there was no evidence that the others were necessary. It was argued for the plaintiff that when a physician undertakes to treat a patient he impliedly contracts to give him reasonable care and attention and if he fails to do so he becomes liable for any damage which may result from negligence.

The highest court of California decided for the plaintiff with little hesitation and said that it was presumed that all the professional visits made were deemed necessary and were properly made. It would be very unfortunate for the sick if the physician were compelled to prove the necessity of each visit before he made it. It is very gratifying to have these questions settled even if it is only a local decision. Physicians are imposed on daily and it is so often their own fault because they do not stand up for their rights but listen to all that twaddle about doing good and dispensing charity and meanwhile the butcher and the baker must be paid.

In Continental countries the physician sends no bills but at the end of each year, each visit or in some instances after each case of illness in a family the patient sends in a sealed envelope the amount which he thinks ought to be paid and the physician never by word or sign shows that the money has been received. No bills are sent and no money is handed by a patient to the physician. That is supposed to smack of the tradesman and in republican countries where lines of rank are so closely drawn the physician is far above the merchant and his mode of doing business must be different. That plan would not do in America, although a compromise between the two ways of remuneration would not be amiss.

The physician should not be paid as a tradesman, for the money given is in so many cases merely a token of appreciation and cannot pay for the saving of a life. If such matters have to be dragged into courts it is well that the physician has the strength to stand up for his rights and get them.

It would be well if medical journals would make it a point to give prominent notice to all judicial decisions involving physicians' rights where such decisions are from high courts and especially where such courts demand respect.

Nurse and Doctor.

THE recent decision of the College Association to demand a course extending over four years is probably a wise one. The objections brought against this advance were valid and were not made with the intention of blocking higher medical education.

The first class that enjoyed the three years' course has just been graduated and the thought was that if the four years' course were to follow on at once so many of the schools would nominally agree to this and yet virtually make no change in their work because they had not the facilities for giving four years of instruction. Many of the schools simply spread two years' work over three and now if this course were spread over four it would be too thin to cover all.

The decision is a wise one and had few opponents. There should be a course of medicine with an abundance of clinical teaching and personal bedside teaching so that the graduate will know as much as the clever nurse. It is well known that many a nurse with a short course of training in the wards is much better equipped to recognize a disease like typhoid fever than the doctor, who is supposed to be the superior of the nurse in medical knowledge. In comparing the intelligent and observant nurse with the recent graduate the latter suffers in some ways. One is practical and the other theoretical.

The physician, even if he has little or no knowledge of such a disease as typhoid fever, knows the book history, its symptoms and especially its pathology. The nurse, however, knows the disease from beginning to end and in the private family these little points are noticed. The case may present complications which the well educated but inexperienced physician may not recognize and yet the nurse with a short experience will appreciate at once the difficulty and if she be so disposed she may prejudice the family against that physician and his perplexity will become so evident to the family that they will make invidious comparisons.

If a medical course is intended to be made up of four terms of study, called by courtesy years, then it is only fair that clinical instruction should make up a large part of the last half of the course. If the profession of nursing continues to be followed by well educated women of good family and fine breeding, then the physician should be also her equal if not

her superior in intellect and knowledge and should never be in such a position that he is made ridiculous before the family. The trained nurse has grown to be a necessity in every sick-room where the saving of trouble is the rule and as the public becomes more and more accustomed to her, so will they grow more and more indispensable.

Of course the old objection will always be made that when a nurse knows too much she may interfere with the physician's orders and take it upon herself to do what has not been ordered. This is hardly true of the conscientious woman who has been properly trained, but it can very easily be conceived that occasions arise when the nurse may have to vary or change the physician's directions and yet not be considered meddling. If our colleges demand a genuine four years' course and give a fair graded curriculum with plenty of clinical work and if at the same time the nurses' training schools turn out a high class of nurses the result must be for the benefit of the sick.

Therefore, let the doctor have a chance and the more bedside work is done the better for physician and patient, and the medical profession will thus be raised to a higher plane.

***

NEXT week two important medical societies will hold meetings and from the preliminary

Two Important Meetings.

programmes excellent papers are promised. To the lay mind it looks as if physicians did little but attend conventions and these two meetings, one in Baltimore and one in. Washington, do follow rather close on the heels of the American Medical Association.

There will be this difference that these two societies which contain a limited number of members and which are very careful of the character of papers read, will pay all attention to work and will have no junketing. The Association of Physicians is probably the most representative body of general practitioners in this country and their transactions published in book form make up a most readable and instructive volume. Unfortunately, these two bodies hold their meetings at exactly the same time and in different cities, so that those desiring to hear both will have to make a choice, but those who select either will hardly regret the time taken.

The Association of American Physicians will meet in Washington next week. Dr. William Osler is president.

Dr. Harry H. Arthur, formerly resident physician at the Maryland University Free Lying-in Hospital, has removed his office to 1516 West Lexington Street.

Dr. James H. Fore, aged thirty-five years, of Sistersville, W. Va., died last week at the City Hospital. Dr. Fore was graduated at the College of Physicians and Surgeons in 1885. He was resident physician at Baywiew Asylum for a year, and then went to Sistersville.

The physicians of Allegany County, Maryland, have arranged affairs in the Western Maryland Hospital at Cumberland and have elected the following boards: Drs. A. L. Porter, W. F. Twigg, J. M. Spear, C. c. Jacobs, C. Brotemarkle, E. T. Duke, J. V. Twigg, W. W. Wiley, C. H. Brace, W. J. Craigen, M. A. R. F. Carr, H. B. Miller, F. G. Smith, H. W. Hodgson, George H. Carpenter, J. A. Doerner, F. W. Fochtman, C. H. Ohr, W. H. McCormick and J. J. Wilson. The staff will in turn elect a resident physician, the selection to be approved by the home board.

The American Gynecological Society will hold its Twentieth Annual Meeting in Levering Hall, Johns Hopkins University, Baltimore, on May 28, 29, 30, 1895. Physicians are cordially invited to be present. Morning session 9.30 A. M., afternoon session 3 P. M.

Address of welcome. Recent Experience in Ureteral Work, by Dr. Howard A. Kelly, Baltimore; Suprapubic Hysterectomy, by Dr. B. F. Baer, Philadelphia; Hysterectomy for Uterine Fibroids, by Dr. S. C. Gordon, Portland, Maine; The Use of Traction and Morcellation for the Removal of Fibroids, by Dr. T. Addis Emmet, New York; Ligation of the Pedicle with Catgut, by Dr. Archibald MacLaren, St. Paul; Abdominal Section for Puerperal Septicemia, by Dr. J. Montgomery Baldy, Philadelphia; The Present Treatment of Uterine Displacements, by Dr. Paul F. Mundé, New York; Alexander's Operation, by Dr. Clement Cleveland, New York; My Experience with Ventro-fixation and Alexander's Operation, by Dr. A. Lapthorn Smith, Montreal. President's Address. Renal Insufficiency in Gynecological Cases, by Dr. James H. Etheridge, Chicago; Total Extirpation of the Uterus, by Dr. Charles Jacobs, Brussels; Vaginal Hysterectomy for Conditions other than Suppuration and Malignant Disease, by Dr. Ernest W. Cushing, Boston; Vaginal Hysterectomy for Uterine Myomata and Disease of the Adnexa, by Dr. William H. Wathen, Louisville; Specimens Removed by Vaginal and Abdominal Hysterectomy, by Dr. R. Stansbury Sutton, Pittsburgh; The Treatment of Puerperal Eclampsia, by Dr. Thaddeus A. Reamy, Cincinnati; The Prophylaxis and Treatment of Eclampsia, by Dr. Edward P. Davis, Philadelphia; Deep Incision of the Parturient Cervix for Rapid Delivery, by Dr. J. Clifton Edgar, New York; Trachoma of the Female Genito-urinary Tract, by Dr. Arthur W. Johnstone, Cincinnati; Conservative Surgical Treatment of Septic Pelvic Disease, by Dr. Fernand Henrotin, Chicago; The Ultimate Results of Trachelorrhaphy, by Dr. Willis E. Ford, Utica; True Pelvic Cellulitis, by Dr. Ely Van de Warker, Syracuse; Prevention of Uterine Disease due to Childbearing, by Dr. W. Gill Wylie, New York; Deciduoma Malignum, by Dr. J. Whitridge Williams, Baltimore; The Value of Gauze Drainage, by Dr. Henry C. Coe, New York; Symphysiotomy in Canada and the United States, by Dr. Robert P. Harris, Philadelphia; Late Infection in the Puerperal State, by Dr. Egbert H. Grandin, New York; Artificial Abortion, by Dr. Henry J. Garrigues, of New York; In Memoriam-Dr. William Goodell, by Dr. Barton C. Hirst, Philadelphia.

WASHINGTON NOTES.

The Medical Society of the District of Columbia held its regular weekly meeting on Wednesday, May 15. Dr. Bedford Brown of Alexandria, Va., read a paper entitled NonInfectious Membranous Laryngitis; Its Prevention and Medical Treatment. It was discussed by Drs. Lovejoy, T. C. Smith, J. K. Bryan, Morgan, Stone and others. Dr. C. H. Stowell read a paper on Neuralgia of the Throat. This paper was discussed by Drs. Bryan and Magruder. Dr. J. T. Kelley presented specimens of: (1) Stone removed from the Bladder by Laparotomy. (2) Fibroid Tumor of the Uterus with Pelvic Abscess and Abscess of the Appendix Vermiformis.

The Washington Obstetrical and Gynecological Society held its regular meeting on Friday, May 17. Vice President, Dr. S. S. Adams, in the chair. The visitors of the Society were Dr. Meade of the State of Washington, Dr. Combe of Portland, Oregon, and Dr. Wallace Johnson of this city. Dr. Jos. Taber Johnson presented the specimens of Diseased Ovaries, removed from a woman who had been an invalid for eight years. He also presented the interesting specimen of a Tubal Pregnancy, the tube being unruptured and the fetus being of one and a half month's gestation. Dr. H. L. E. Johnson presented several interesting specimens. (1) Diseased Tubes; (2) a large Ovarian Cyst, where pregnancy also existed. The tumor was wedged down below the uterus, making it practically impossible for delivery to take place and on account of its position it would have been difficult to remove it by laparotomy on account of the uterus being in the way. After consultation, it was decided to induce premature labor and remove the tumor afterward, which was done very successfully. (3) An Ovarian Cyst. In this case there was blindness of the right eye and she had been treated by several oculists. The sight of this eye returned after the operation was performed, being a good illustration of hysterical amaurosis. Dr. J. Taber Johnson mentioned a case where reflex amaurosis from the ovary existed, but the sight was not restored by the operation of removing the ovary. The essay of the evening on Criminal Abortion, by Dr. J. Foster Scott, could not be read on account of the lateness of the hour.

A new Society of Ophthalmology and Otology has been incorporated by Drs. Wm. V. Marmion, Francis B. Loring, Stephen O. Richey and Anton Coe. The number of directors for the first year is limited to three. The Providence Hospital, The Washington Asylum Hospital, The Sibley Memorial Hospital, The Children's Hospital, for children under twelve years of age, The Eastern Dispensary, The Garfield Hospital and the Freedmans' Hospital are all anxious to receive emergency cases and have petitioned the Commissioners of the District to district the city, so that accidents occurring in certain districts will be sent to their respective hospitals. It is said that the Commissioners will do this at an early date. This will tend to largely reduce the number of emergency cases that have been treated so successfully at the Emergency Hospital for so long a time. The appointment of physicians to the poor will take place on December 1 next.

PUBLIC SERVICE.

UNITED STATES ARMY.

Week ending May 20, 1895.

Captain Charles Richard, Assistant Surgeon, will when relieved from duty at the Military Prison, Fort Leavenworth, Kansas, proceed to and take station at St. Louis, Missouri, for duty as Attending Surgeon and Examiner of Recruits.

Captain Peter R. Egan, Assistant Surgeon, is relieved from duty at Fort Custer, Montana, and ordered to Fort Assinniboine, Montana, for duty, relieving Major Charles B. Byrne, Assistant Surgeon. Major Byrne on being thus relieved is ordered to Fort Snelling, Minn., for duty.

Major William C. Shannon, Surgeon, upon the expiration of his present leave, is ordered to Fort Custer for duty.

First Lieuteuant Deane C. Howard, Assisttant Surgeon, will be relieved from duty at Fort Snelling, Minn., upon the arrival there of Major Charles B. Byrne, Surgeon, and will then proceed to Fort Custer, Montana, and report for duty at that post.

Captain Alonzo R. Chapin, Assistant Surgeon, having been found by an Army Retiring Board incapacitated for active service on account of disability incident to the service, is by direction of the President retired from active service this date, May 10, 1895.

Leave of absence for four months, to take effect on being relieved from duty at Fort Thomas, Kentucky, is granted Captain William J. Wakeman, Assistant Surgeon, United States Army.

UNITED STATES NAVY.

Week ending May 18, 1895. Assistant Surgeon L. L. Young to examination for promotion.

Passed Assistant Surgeon F. W. Olcott from the "Constellation," and to the "Enterprise."

BOOK REVIEWS.

LECTURES ON THE DIAGNOSIS OF ABDOMINAL TUMORS, by William Osler, M. D., Professor of Medicine, Johns Hopkins University; Physician-in-Chief, Johns Hopkins Hospital, Baltimore. Reprint from the New York Medical Journal, 1894. New York: D. Appleton & Company, 1895.

These lectures are from the pen of a keen observer and skilled diagnostician and the modest exterior of the little work hardly prepares one for the rich store of material within. Not only are the case-histories worthy of a thorough perusal, but the writer's deductions from each group of cases will be of great aid to the practitioner. This method of instruction will recommend itself to post-graduate students and will call to memory the famous practical courses in Vienna. Dr. Osler has produced a volume of lectures which should be brought more prominently to the physician's attention and which in their present form as reprints from a medical journal in small print do not come before the profession clad in the best garment. One point of instruction which is more interesting to the physician than to the patient is that many of the cases herein noted came to the post-mor. tem table and the diagnoses were in most instances confirmed or corrected. The photographic illustrations and drawings are very clear and well executed.

A BOOK OF DETACHABLE DIET LISTS. Compiled by Jerome B. Thomas, A. B., M. D., Visiting Physician to the Home for Friendless Women and Children, etc. Philadelphia: W. B. Saunders, 1895. Price, $1.50. These are much like a small pad of diet tables published several years ago by a prominent drug firm and like the original are of great service in the sick-room. While probably no physician will give a diet list unchanged and uncorrected to suit his particular skill, these will give useful hints and serve to fix the directions in the mind of the nurse. It is a question whether it is well to print in the directions the names of certain proprietary foods.

CURRENT EDITORIAL COMMENT.

LATINIZED PRESCRIPTIONS.
Kansas Medical Journal.

WE can hardly understand why a Latin word should be more difficult to read than English, written by the same hand, especially to those who are supposed to be familiar with Latin terms. Druggists, as a rule, are more familiar with the Latin names of drugs than with the common names.

DEATH AS IT IS.

New York State Medical Reporter. NINETY-NINE of every hundred human beings are unconscious several hours before death comes to them. All the majesty of the intellect, the tender beauty of thought or sympathy or charity, the love for those for whom love has filled all waking thoughts, disappear. A merciful unconsciousness sets in, as the mysterious force we call life slowly takes leave of the body. And what is has become what was. This is death.

CONSENT IN OPERATION. Medical and Surgical Reporter. LEGALLY considered, to justify a surgical operation upon a married woman, her consent and not that of her husband is necessary. A married woman cannot be compelled to submit to an operation; but if she voluntarily submit to its performance her consent will be presumed, unless she was the victim of fraudulent misrepresentation. Even if the disease resulting in death was caused by the operation, the surgeon is not liable if he performed the operation with the patient's consent, in a careful and skillful manner.

NERVOUS CHILDREN.

Archives of Pediatrics.

THE increasing tendency to nervous disease observed in recent years is becoming a subject of interest to workers in every department of medicine. This is especially true in pediatrics. The high tension of modern life is not felt by adults alone. Children and even infants are affected directly and indirectly by the same influences which generate nervous disorders in their elders. In addition to the necessary mental and nervous burdens which children must share in common with all members of modern society, numerous unnecessary burdens are thrust upon them. Never before has so much attention been devoted to childhood.