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NEW YORK, March 13th, 1888. To the Editors of THE N. Y. MED. TIMES: GENTLEMEN :-I have your note of the 11th inst., asking my opinion upon a question of professional ethics. In my judgment there can be but one answer to your question, and that is in the negative. If I call in a medical man who designates himself a "Homœopathic physician," it is because I do not wish to be treated allopathically, or eclectically, or otherwise than homoeopathically. There is an implied understanding between myself and the homoeopathist, that I shall receive the treatment which, by tradition and a general consensus of opinion, means small doses of a single drug administered upon the principle of "similia similibus curentur." If there is to be any variation from that method, I have a right to be informed of it and to be given an opportunity to decide. Common honesty demands that before a confiding patient is to be drugged with quinine, ron, morphine or other medicaments, either singly or in combination, he should be told that the "Homœopathist" has failed, and that relief can only be afforded by a change of system. An honest "Homoeopath," who has not succeeded, after doing his best with the appropriate homœopathic remedies administered on homoeopathic principles, should undoubtedly try anything else which he believes may save or relieve his patient. But when he reaches that point, the duty of taking the patient into his confidence becomes imperative. The patient may refuse to submit to the other system, or he may agree, but prefers a physician whose life has been specially devoted to practice under that other system. He may say to the "Homœopathist," you have failed, but I prefer to try

another gentleman of your own school, before resorting to a system that I have long since turned my back upon. Or he may say, well, if homœopathy cannot save me, I prefer to go to headquarters for allopathic treatment.

All this, gentlemen, is the logical sequence of the particular designation "Homœopathist." There may, of course, be gentlemen who in a general way favor the principle of small doses and "similia similibus curentur," to whom it would not apply. But such a physician would not stamp his school upon his work as a practitioner. If I call in such a man, I mean a physician pure and simple-calling himself neither homœopathist nor allopathist—the implied understanding is that I entrust myself to his best judgment in all respects. Such a man may be a graduate of the College of Physicians and Surgeons, and I will have no cause of complaint should he in an exigency deem it appropriate to administer the third potency of aconite. Or he may be a graduate of a college founded under homoeopathic auspices, and yet I cannot object if he thinks the occasion demands twenty grains of quinine. But if a physician calls himself allopathic and is summoned as such, it would be a fraud to resort to homoopathic treatment without full disclosure to the patient of what was proposed. If, however, we are to have a class of men who purpose, in the interest of humanity, to utilize the best they can find in any and every school, "pathist,' as a designation of fixed methods of practice, must be ignored, and the broad and noble title "physician," in its unreserved sense, be revived and substituted.

The patient will understand, when he sends. for one of this class, that he is to have the physician's best judgment in the unprejudiced use of the ripest fruits of modern discovery in every field. I see that I have done more than simply answer your question. But I am sure you will pardon a layman for taking advantage of the occasion to intimate the need of greater clearness of professional attitude-both as a matter of justice to the patient and as due to the integrity of the physician.

Respectfully yours,

GEO. C. BARRETT. From THE N. Y. MED. TIMES for April, 1889.

Iodized Glycerin.

Dr. G. Hammond points out that a mixture of tincture of iodine and glycerin produces a greater effect on the skin than the pure tincture, possibly because the glycerin tends to prevent the evaporation of the iodine, and thus enables the whole of its powers to be utilized.-London Medical Record.

Charcot's Method of Treating Progressive Locomotor Ataxia by Suspension.

Le Progres Medical, of February 23d, contains an article by Gilles de la Tourette, descriptive of the technique employed by Charcot in the treatment of progressive locomotor ataxia by suspension, recently promulgated by Gotchoukowsky, of Odessa. As this plan promises to be of considerable value in reliev ing this obdurate malady, a résume of the modus operandi will be of interest.

The means employed are the well-known Sayre's suspension apparatus, which does not demand special notice.

The various parts of the apparatus must be carefully adjusted in order to secure satisfactory results. Either extremity of the yoke, or suspending bar, should have two or three notches in order to allow for the head-sling sufficient adjustability to different-sized heads. It is important that traction during elevation does not wear solely upon the head and neck, as suspension could not be tolerated. The body must have a further point of support, which, however, muts not interfere with the stretching of the vertebral column. Hence, slings for the axilla are provided and made adjustable to the varying height and the weight of the patients. If the axillary piece is too short, compression of the brachial plexus with its attendant evils is produced, necessitating an interruption of the seance. If the sling is too long, too great a strain comes upon the neck, and the suspension becomes unendurable. Indeed, careful experiment must be made in order to determine the satisfactory fit of the apparatus, or harm will follow rather than good. Ordinarily as used, the yoke is hung from a portable tripod. But for this purpose it is preferable to swing it from a stationary hoop in the ceiling, since cases of ataxia are so unstable of station that they are liable, through fear of losing their equilibrium, to grasp the tripod legs convulsively and overturn it. Then with everything in readiness, the patient is slowly and progressively drawn upward, so as to accustom the muscles of the neck to the traction. The patient is cautioned against making movements, especially involuntary ones, when he feels himself leaving the ground, in order to avoid lateral displacement or torsion.

When the patient is swung up so that the ends of the feet, turn downward, do not meet the ground, he is lightly held to prevent twisting, while the time is carefully noted, and the length of each seance minutely regulated.

He is ordered from time to time to raise his arms slowly and vertically, in order to make this traction still more sufficient.

Generally, the longest séance ought not to exceed three or four minutes, three minutes being perhaps the average.

The duration of the first trial should last only half a minute, and be increased gradually to the limit mentioned by the sixth or eighth séance.

Further, it is necessary to consider individWhile, for example, two minutes of suspension ual pecularities, especially that of weight. may be tolerated by a patient weighing 150 to 200 pounds, it is different with those weighing

200 or more.

In these cases of excessive weight, the traction which comes upon the neck is very hard and painful perhaps throughout the day following the suspension. This ought not to be the case if the operation is carefully made.

Among some patients the desire to get well is so strong that they think they are obliged to suffer, without complaint, that which is too painful to secure good results.

The operation ought to cause neither pain nor fatigue, under penalty of being useless. Hence, while patients of light weight may readily bear three and a half minutes of suspension, heavier ones should not go beyond three minutes. Yet with them the traction, as may be readily understood, is very efficient.

The séances ought to be every other day, experience having shown the daily séances were more painful than useful. The time of day matters little, but regularity is indispensable.

At the expiration of the time, the physician relaxes the cord little by little, and the patient reaches the ground slowly without concussion. He is then relieved of his harness, and immediately seated for a short time to allow some rest.

The patient ought to be divested of his upper garments, in order to admit free play of the arms; the neck should be bare, or at least not surrounded by a tight collar.

The results so far obtained have been very remarkable in progressive locomotor ataxia, in a case of Friedrich's disease, with a jacket to correct the deviation of the vertebral column, and in two cases of neurasthenia, with marked sexual impotence, they have been satisfactory.

On the other hand, suspension has rather aggravated the symptoms of spasmodic paraplegia in a case of insular sclerosis. Two patients affected with paralysis agitans seem also to have received some benefit. However, in regard to progressive locomotor ataxia, particularly is it difficult to formulate very exactly the indications for treatment, the number of cases at present being too limited to yield a definite opinion. Probably it is certain it should not be applied in all instances; the recent cases

seeming to receive less benefit, though some of the symptoms are particularly influenced in a happy manner. The selection itself is a proof of the therapeutic value of a method which makes no claims to being a panacea. What can be said is this: Charcot has obtained among the patients who have been coming to the Saltpêtrière for many years, very encouraging improvement, especially where the malady has seemed to defy therapeutic treatment. Likewise, is it difficult to pronounce upon the duration of treatment, since the first ataxies who were submitted to suspension at the Saltpetrière four months ago, are still under treatment, and continue to gain in a progressive manner. In all cases, as Charcot has said, the trial may be made confidently, as it has always appeared, when satisfactorily applied, wholly uninjurious. EDWARD B. ANGELL, M. D., in Buffalo Med. & Surg. Journal.

Salix Niger (Black, or "Pussy" Willow).

This species of willow appears to have some peculiar properties not belonging to the genus. All, or nearly all, are bitter and astringent, and is a general tonic. Salicylic acid is a derivative of salicin.

The officinal tincture or fluid extract is now made from the buds (aments), called by children the "pussys" owing to their furry or fluffy appearance. It has a bitter and astringent taste. (An excellent tincture is made by Parke, Davis & Co., of Detroit.)

During the last few years several communications have appeared in medical journals, recommending the salix niger in diseases of the female sexual organs. It is suggestive that all, or nearly all, the species of willow contains salicin. Now salicin has been highly recommended in sexual erethism, and its use in doses of 5 to 10 grains is asserted to abolish temporarily the sexual appetite. Salicylic acid, and its salts, all have the same effect in large doses. Salicin is made from the bark of the willow, and some of the reporters who used the salix niger used a tincture of the bark of the shrub and its roots. It is probable that all parts of the plant possess the same properties. Culpepper's English Herbal, 1681, says: "The leaves, bruised and boiled in wine and drunk, stayeth the heat of lust."

The first physician who reported his experience with salix niger was probably Dr. F. T. Paine, of Comanche, Texas, who uses it for incipient ovarian disease, masturbation, etc.

Soon after appeared articles from other physicians in this country. The English physicians reported of its use. In the British Medical Journal for July, 1887, Dr. J. Hutchinson has

a paper. In the London Lancet for September, 1887, Dr. E. H. Tenwich states, "that he has found it "a sexual sedative of decided value; useful in ovarian hyperæsthesia, prostatorrhoea, spermatorrhoea, seminal emissions, and enforced continence."

Dr. Hutchinson writes: "In many women pain in the ovarian region is a constant attendant upon the menstrual epoch. In some this is due to organic disease, but in a large number it is one of the manifestations of the neurotic temperament.

Such cases are met with in all degrees of severity, from a slight amount of discomfort, along with indications of globus hystericus, up to hystero epilepsy in its most pronounced forms. It has always been a slur upon our profession that, when a method of treatment becomes popular or fashionable, other methods are entirely discarded.

At present, massage and isolation from relatives is the popular mode of treatment, and drugs occupy a secondary place, if, indeed, they have any place at all.

Pecuniary difficulties, however, stand in the way of isolation or massage ever reaching the masses, and drugs will always be in employ

ment.

Several drugs are in daily use against this ailment, but with only partial success, and it is with the view of bridging before the profession a remedy which in my hands has produced results which I never had before while I was employing the bromides, valerian, assafoetida, etc., that I have sent this short notice.

In the Transactions of the Texas State Medical Association," Dr. Paine reports many cases treated successfully with the drug.

He prescribed it in cases of ovarian hyperæsthesia, uterine neuralgia, etc., and also in spermatorrhoea, nocturnal pollution. His verdict on the drug is that it is a powerful sexual sedative, similar in its action to bromide, but without its depressing qualities. I obtained a supply of the fluid extract and have been employing it for some months.

The most numerous class of cases in which I exhibited the drug were women of a nervous temperament, in whom the nervous irritability reaches its height at the menstrual period, when, along with the general malaise, is added a very decided pain in one or other ovary.

They also suffered from hemicrania, the pain being situated above the left eye brow, and resembling the feeling as if a nail were being driven in the skull (clavers). Many of them, too, complained of a pain underneath the left breast, and extending round to the back. On one or two occasions I have noticed patients complaining of the above symptoms, and in

only a moderate degree, under favorable conditions as, for example, long-continued anxiety or alcoholism-go from bad to worse till they become hystero-epileptics. In cases of this kind it is supposed that the center of inhibition has in some way got out of gear, and the severity of the symptoms depends upon the amount of disturbance in this nerve center.

In cases where the ovarian distress was the symptom for which advice was sought, as being in the patient's eyes the most prominent, I usually succeeded in eliciting other indications of an irritable nervous system, and placed them upon half drachm doses of the fluid extract of salix niger three times a day. In quite seventyfive per cent of patients so treated a great amount of relief was obtained after two or three days' treatment. Not only was the ovarian hyperesthesia relieved but the nervous palpitation of the heart was abated, and the patient felt in every way stronger.

I have also given the drug in two cases of nocturnal emissions with marked benefit.

The pollution ceased entirely while the drug was being taken, and for several months thereafter.

Virile power or passion were not much, if at all, diminished, but the relief from the ailment gave them great satisfaction.

I might add considerable to the above experience, but it will suffice to add some observations of my own.

Salix niger appears to me to be an analogue of the bromides, but without the depressing effects of the latter. It is also an analogue of conium, but without its paralyzing effects on the nervous system. It acts in many respects similarly to hydrastis. It has the same tonic power, and probably acts on the arterioles by shutting off an undue amount of arterial blood, altnough no such experiments have been made with it on animals as have been made with hydrastis. It has some resemblance in therapeutical effect to serro cyanuret of potassium.-Dr. E. M. Hale, in N. Y. Med. Times.

[Salix Niger may be obtained of Parke, Davis & Co.]

Physicians' Fees.

C. Barlow, M.D., of Eaton, Ill., in an article to the Medical Age, says: As a rule, country doctors only collect from one-half to threefourths of their earnings. Sixty-five per cent. is perhaps a fair estimate of the average collections of the physicians of this county. The low fees and pauper practice render it absolutely necessary for our physicians to adopt the strictest economy in order to make ends meet.

As a result, their usefulness is materially limited, and the public suffers perhaps more seriously than the doctors themselves. We can only be accomplished physicians in proportion to the amount of funds we have to spend for journals, books and instruments, and other educational necessities; and we can no more do good work without them than a mechanic could do without tools. Then it follows that the public is interested in this matter as much as the profession is, and doubtless would assist in procuring the proper remedy if it could only be made to realize the necessities of the case. As reformations are only brought about through the efforts of influential citizens, I suggest that we commence reforming the minds of the laity, on the momentous question of physicians' fees, through the pockets of the wealthy and influential class of citizens. They do not want ignorant physicians to attend, and of course will not object to paying fees that will enable their doctors to keep themselves thoroughly up to the times.

In order to accomplish this, I would suggest thorough organization of physicians, and an increase in fees of from thirty-five to sixty-five per cent., as the case would warrant; so that the full amount of fees charged under the old system could be collected under the new. My reason for adopting this plan is simply this: Under the present system, the physician who refuses to visit a patient because he knows he will get nothing for it is nearly sure to lose some of his good paying customers as a result. Many wealthy people in the country will not employ a physician who withholds his services from the poor, or from the intermediate class who can, but will not pay their bills. Now, I propose to request the aforesaid wealthy citizen to pay the bills, especially for the latter class of non-paying customers, until he expresses a willingness to assist the doctor in procuring the enactment of such laws as will make it possible for the physician to collect a reasonable fee from all who are able to pay, or until they (the wealthy class) can realize the doctor's dilemma, and learn not to interfere when the doctor desires to collect a small fee from the dishonest man who can and will not pay his honest debts.

The public must be taught that the physician is also a business man, and as a matter of business proposes to collect money enough to support his family and purchase the necessary outfit to enable him to keep up with the times, and thereby give value received for the emoluments derived from professional services. After two or three years' diligent instruction of this kind, the good influential citizens would doubt less realize the situation, and would willingly

assist us in further educating the class who can but will not pay their bills.

The worthy poor, I think, are entitled to our services free of charge, and as this class of patients demand a good deal of our time and money, it is another argument in favor of collecting from all who are able to pay.

I would also suggest the further revision of the fee-bill. As a rule, we do not charge in proportion to services rendered. Instead of charging so much a visit in all cases, regardless of the importance of the case, we should charge more in proportion to the value of services rendered. When we bring to a successful issue an almost hopeless case, we should make a reasonable charge in addition to the regular fees. In surgical and obstetrical practice where life and limbs are saved, we do not charge enough. In ophthalmic practice, where we restore and preserve the sight of the patient, we do not charge enough. In fact, we do not charge enough for important services of any kind. We visit one man with pernicious fever and save his life, and visit his neighbor for a slight indisposition, and charge both alike. There is no equity about such a system of charging. It does the man who was not very sick an injustice, and tends to degrade the profession.

When we compare our charges with the charges made by gentlemen of the legal profession, we can see how ridiculously small they are. When a man is brought before a court to be tried for his life, he will not object to paying his legal adviser from one to ten thousand dollars, as the case may be; while the same man, after having his life saved by a physician, would be likely to object to a fee of ten dollars.

It is a fact that men will pay large fees to lawyers simply to gratify a revengeful disposition, and grumble at the small fee of the physician who saves their lives. We should charge in proportion to services rendered, and have it understood that our fees are due as soon as services are rendered, and if it is not paid in a reasonable time, one year at most, we should settle the account and take a note with security if necessary. If our customers persist in keeping our money, we should insist in demanding security and interest. We could afford to wait if we could get eight per cent. interest on our money. I do not advocate exorbitant fees, but reasonable ones; and that these be collected. We could afford to practice for the worthy poor for nothing, if we could collect our fees from all who could pay if they would, and live fairly well as the fee-bill now stands. It is a fact that the fees collected by country practitioners are inadequate to sufficiently remunerate the practitioner who has had a thorough

training preliminary to the study of medicine. We must educate the people, and if the line I have marked out be followed closely, the time is not far distant when it will be possible for medical men not only to live, but to lay something by for a rainy day.

Hospital Notes.

[From the PHILADELPHIA MEDICAL TIMES.] Philadelphia Hospital.

MUSCULAR STRAINS.

McClellan says, that in muscular strains he knows of nothing better than the alternate application of heat and cold as a stimulant to the lymphatics to carry off inflammatory effusion. A firm bandage should be applied to the affected limbs, and after a few days the patient should be instructed to step on the floor, so as to accustom himself to the act of walking. He considers lotions and liniments of very little use in the treatment of these very troublesome injuries.

FISTULA IN ANO.

McClellan cautioned his clinic against using a stiff probe in packing a fistula; the tissues in the ischio-rectal fossa are so yielding that a false passage might easily result. He advised that a soft catheter should be employed for this purpose.

Medico-Chirurgical Hospital.

HEART-DISEASE IN WOMEN.

Stewart thinks that organic diseases of the heart are so fatal to pregnant women that he would earnestly advise a woman with such a lesion not to marry.

A CASE OF TENIA.

The cases of tape-worm in which definite ymptoms are observed, which can with anysdegree of probability be attributed to the pres ence of the parasite, are so rare that the following case may have some interest :

Carrie Hogins, aged 25; born in Pennsylvania; widow; one child; mulatto. Suffered for two years, during which she has been passing joints of tænia.

Every morning, on leaving her home, she has a sense of compression, a "girdle," about the level of the nipple; lasts till 1o A. M.; after which feels well; roaring in ears at the same time; memory poor; some nausea, preceded by rumbling and "movements" in the abdomen, probably due to knowledge of worm's presence; appetite too good, especially at dinner; tongue normal; bowels fairly regular; menses sometimes very free, lasting a week;

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