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The Current Medical Thought resorting to a system that I have long since
upon. Or he may say, well, AN IMPORTANT OPINION BY JUDGE.
if homoeopathy cannot save me, I prefer to go
to headquarters for allopathic treatment. BARRETT.
All this, gentlemen, is the logical sequence Editorial Department, N. Y. MED. TIMES.
of the particular designation“ Homoeopathist.” March 11th, 1888
There may, of course, be gentlemen who in a Hon. Geo. C. BARRETT,
general way favor the principle of small doses Judge of the Supreme Court, etc.
and “similia similibus curentur,” to whom it Sir:-In behalf of our readers, will you
would not apply. But such a physician would kindly give us your opinion upon the follow
not stamp his school upon his work as a prac
titioner. If I call in such a man, I mean a ing question : Has a physician, designating himself an
physician pure and simple calling himself "Homoeopathist," and called as such to a pa
neither homoeopathist nor allopathist-the imtient, any legal or moral right to adopt other plied understanding is that I entrust myself to than homeopathic means in the treatment of
his best judgment in all respects. Such a man the case?
may be a graduate of the College of Physicians Respectfully yours,
and Surgeons, and I will have no cause of comTHE EDITORS.
plaint should he in an exigency deem it appropriate to administer the third potency of aco
nite. Or he may be a graduate of a college NEW YORK, March 13th, 1888. founded under homeopathic auspices, and yet To the Editors of The N. Y. MED. Times: I cannot object if he thinks the occasion de
GENTLEMEN :- I have your note of the uth mands twenty grains of quinine. But if a phyinst., asking my opinion upon a question of sician calls himself allopathic and is summoned professional ethics. In my judgment there can as such, it would be a fraud to resort to homebe but one answer to your question, and that is opathic treatment without full disclosure to the in the negative. If I call in a medical man patient of what was proposed. If, however, we who designates himself a “Homoeopathic phy. are to have a class of men who purpose, in the sician," it is because I do not wish to be treated interest of humanity, to utilize the best they allopathically, or eclectically, or otherwise than can find in any and every school, “pathist,” homoeopathically. There is an implied under- as a designation of fixed methods of practice, standing between myself and the homeopath- must be ignored, and the broad and noble title ist, that I shall receive the treatment which, "physician," in its unreserved sense, be re by tradition and a general consensus of opinion, vived and substituted. means small doses of a single drug administered The patient will understand, when he sends. upon the principle of "similia similibus curen- for one of this class, that he is to have the phytur.” If there is to be any variation from sician's best judgment in the unprejudiced use that method, I have a right to be informed of of the ripest fruits of modern discovery in every it and to be given an opportunity to decide. field. I see that I have done more than simply Common honesty demands that before a con- answer your question. But I am sure you will fiding patient is to be drugged with quinine, pardon a layman for taking advantage of the iron, morphine or other medicaments, either occasion to intimate the need of greater clearsingly or in combination, he should be told
ness of professional attitude-both as a matter that the “Homeopathist” has failed, and that of justice to the patient and as due to the integrelief can only be afforded by a change of sys- rity of the physician. tem. An honest “ Homoeopath,” who has not
Respectfully yours, succeeded, after doing his best with the appro
GEO. C. BARRETT. priate homeopathic remedies administered on From THE N. Y. MED. TIMES for April, 1889. homoeopathic principles, should undoubtedly try anything else which he believes may save or relieve his patient. But when he reaches
Iodized Glycerin. that point, the duty of taking the patient into Dr. G. Hammond points out that a mixture his confidence becomes imperative. The pa- of tincture of iodine and glycerin produces a tient may refuse to submit to the other system, greater effect on the skin than the pure tincture, or he may agree, but prefers a physician whose possibly because the glycerin tends to prevent life has been specially devoted to practice under the evaporation of the iodine, and thus enables that other system. He may say to the “Ho- the whole of its powers to be utilized.-London moeopathist,” you have failed, but I prefer to try Medical Record.
Charcot's Method of Treating Progressive Generally, the longest sèance ought not to
Locomotor Ataxia by Suspension. exceed three or four minutes, three minutes Le Progres Medical, of February 23d, con
being perhaps the average. tains an article by Gilles de la Tourette, de
The duration of the first trial should last only scriptive of the technique employed by Char
half a minute, and be increased gradually to
the limit mentioned by the sixth or eighth cot in the treatment of progressive locomotor
séance. ataxia by suspension, recently promulgated by
As this plan Gotchoukowsky, of Odessa.
Further, it is necessary to consider individ
ual pecularities, especially that of weight. promises to be of considerable value in reliev.
While, for example, two minutes of suspension ing this obdurate malady, a résume of the
may be tolerated by a patient weighing 150 to modus operandi will be of interest.
200 pounds, it is different with those weighing The means employed are the well-known
200 or more. Sayre's suspension apparatus, which does not
In these cases of excessive weight, the traction demand special notice.
which comes upon the neck is very hard and The various parts of the apparatus must be painful perhaps throughout the day following carefully adjusted in order to secure satisfac- the suspension. This ought not to be the case tory results. Either extremity of the yoke, or if the operation is carefully made. suspending bar, should have two or three notch- Among some patients the desire to get well es in order to allow for the head-sling sufficient is so strong that they think they are obliged to adjustability to different sized heads. It is im- suffer, without complaint, that which is too portant that traction during elevation does not painful to secure good results. wear solely upon the head and neck, as suspen- The operation ought to cause neither pain sion could not be tolerated. The body must nor fatigue, under penalty of being useless. have a further point of support, which, however, Hence, while patients of light weight may muts not interfere with the stretching of the readily bear three and a half minutes of susvertebral column. Hence, slings for the axilla pension, heavier ones should not go beyond are provided and made adjustable to the vary- ihree minutes. Yet with them the traction, as ing height and the weight of the patients. If may be readily understood, is very efficient. the axillary piece is too short, compression of The séances ought to be every other day, the brachial plexus with its attendant evils is experience having shown the daily séances were produced, necessitating an interruption of the more painful than useful. The time of day séance. If the sling is too long, too great a matters little, but regularity is indispensable. strain comes upon the neck, and the suspension At the expiration of the time, the physician becomes unendurable. Indeed, careful experi- relaxes the cord little by little, and the patient ment must be made in order to determine reaches the ground slowly without concussion. the satisfactory fit of the apparatus, or harm He is then relieved of his harness, and immediwill follow rather than good. Ordinarily as ately seated for a short time to allow some used, the yoke is hung from a portable tripod. rest. But for this purpose it is preferable to swing it The patient ought to be divested of his from a stationary hoop in the ceiling, since upper garments, in order to admit free play of cases of ataxia are so unstable of station that the arms; the neck should be bare, or at least they are liable, through fear of losing their not surrounded by a tight collar. equilibrium, to grasp the tripod legs convul- The results so far obtained have been very sively and overturn it. Then with everything remarkable in progressive locomotor ataxia, in in readiness, the patient is slowly and progres- a case of Friedrich's disease, with a jacket to sively drawn upward, so as to accustom the correct the deviation of the vertebral column, muscles of the neck to the traction. The and in two cases of neurasthenia, with marked patient is cautioned against making movements, sexual impotence, they have been satisfactory. especially involuntary ones, when he feels On the other hand, suspension has rather himself leaving the ground, in order to avoid aggravated the symptoms of spasmodic paraplelateral displacement or torsion.
gia in a case of insular sclerosis. Two patients When the patient is swung up so that the affected with paralysis agitans seem also to ends of the feet, turn downward, do not meet have received some benefit. However, in rethe ground, he is lightly held to prevent twist- gard to progressive locomotor ataxia, particularing, while the time is carefully noted, and the ly is it difficult to formulate very exactly the length of each séance minutely regulated. indications for treatment, the number of cases
He is ordered from time to time to raise his present being too limited to yield a definite arms slowly and vertically, in order to make opinion. Probably it is certain it should not this traction still more sufficient.
be applied in all instances; the recent cases seeming to receive less benefit, though some of a paper. In the London Lancet for September, the symptoms are particularly influenced in a 1887, Dr. E. H. Tenwich states, “that he has happy manner. The selection itself is a proof found it “a sexual sedative of decided value; of the therapeutic value of a method which useful in ovarian hyperästhesia, prostatorrhoea, makes no claims to being a panacea. What spermatorrhoea, seminalemissions, and enforced can be said is this: Charcot has obtained among continence." the patients who have been coming to the Salt- Dr. Hutchinson writes: “In many women pêtrière for many years, very encouraging im- pain in the ovarian region is a constant attendprovement, especially where the malady has ant upon the menstrual epoch. In some this is seemed to defy therapeutic treatment. Like- due to organic disease, but in a large number wise, is it difficult to pronounce upon the dura- it is one of the manifestations of the neurotic tion of treatment, since the first ataxies who temperament. were submitted to suspension at the Saltpetrière Such cases are met with in all degrees of four months ago, are still under treatment, and severity, from a slight amount of discomfort, continue to gain in a progressive manner. In along with indications of globus hystericus, up all cases, as Charcot has said, the trial may
to hystero epilepsy in its most pronounced made confidently, as it has always appeared, forms. It has always been a slur upon our prowhen satisfactorily applied, wholly uninjurious. fession that, when a method of treatment be
EDWARD B. ANGELL, M. D., in comes popular or fashionable, other methods Buffalo Med. & Surg. Journal.
are entirely discarded.
Al present, massage and isolation from relaSalix Niger (Black, or “ Pussy” Willow).
tives is the popular mode of treatment, and
drugs occupy a secondary place, if, indeed, This species of willow appears to have some they have any place at all. peculiar properties not belonging to the genus. Pecuniary difficulties, however, stand in the All, or nearly all, are bitter and astringent, and way of isolation or massage ever reaching the is a general tonic. Salicylic acid is a deriva- masses, and drugs will always be in employtive of salicin.
ment. The officinal tincture or fluid extract is now Several drugs are in daily use against this made from the buds (aments), called by ailment, but with only partial success, and it is children the “pussys" owing to their furry or with the view of bridging before the profession fuffy appearance. It has a bitter and astringent a remedy which in my hands has produced retaste. (An excellent tincture is made by Parke, sults which I never had before while I was emDavis & Co., of Detroit.)
ploying the bromides, valerian, assafoetida, etc., During the last few years several communica- that I have sent this short notice. tions have appeared in medical journals, re- In the " Transactions of the Texas State commending the salix niger in diseases of the Medical Association,” Dr. Paine reports many female sexual organs. It is suggestive that all, cases treated successfully with the drug. or nearly all, the species of willow contains He prescribed it in cases of ovarian hyperässalicin. Now salicin has been highly recom- thesia, uterine neuralgia, etc., and also in spermended in sexual erethism, and its use in doses matorrhoea, nocturnal pollution. His verdict of 5 to 10 grains is asserted to abolish tempor- on the drug is that it is a powerful sexual sedaarily the sexual appetite. Salicylic acid, and tive, similar in its action to bromide, but withits salts, all have the same effect in large doses. out its depressing qualities. I obtained a Salicin is made from the bark of the willow, supply of the fluid extract and have been emand some of the reporters who used the salix ploying it for some months. niger used a tincture of the bark of the shrub The most numerous class of cases in which I and its roots. It is probable that all parts of exhibited the drug were women of a nervous the plant possess the same properties. Dr. temperament, in whom the nervous irritability Culpepper's English Herbal, 1681, says : reaches its height at the menstrual period, "The leaves, bruised and boiled in wine and when, along with the general malaise, is added drunk, stayeth the heat of lust."
a very decided pain in one or other ovary. The first physician who reported his experi- They also suffered from hemicrania, the pain ence with salix niger was probably Dr. F. T. being situated above the left eye-brow, and rePaide, of Comanche, Texas, who uses it for sembling the feeling as if a nail were being incipient ovarian disease, masturbation, etc. driven in the skull (clavers). Many of them,
Soon after appeared articles from other physi- too, complained of a pain underneath the left cians in this country. The English physicians breast, and extending round to the back. On reported of its use. In the British Medical one or two occasions I have noticed patients Journal for July, 1887, Dr. J. Hutchinson has complaining of the above symptoms, and in only a moderate degree, under favorable con- As a result, their usefulness is materially limitditions—as, for example, long-continued anx- ed, and the public suffers perhaps more seri. iety or alcoholism—go from bad to worse till ously than the doctors themselves. We can they become hystero-epileptics. In cases of only be accomplished physicians in proportion this kind it is supposed that the center of in- to the amount of funds we have to spend for hibition has in some way got out of gear, and journals, books and instruments, and other the severity of the symptoms depends upon the educational necessities; and we can no more amount of disturbance in this nerve center. do good work without them than a mechanic
In cases where the ovarian distress was the could do without tools. Then it follows that symptom for which advice was sought, as being the public is interested in this matter as much in the patient's eyes the most prominent, I as the profession is, and doubtless would assist usually succeeded in eliciting other indications in procuring the proper remedy if it could only of an irritable nervous system, and placed them be made to realize the necessities of the case. upon half drachm doses of the fluid extract of As reformations are only brought about through salix niger three times a day. In quite seventy- the efforts of influential citizens, I suggest that five per cent of patients
treated a great we commence reforming the minds of the laity, amount of relief was obtained after two or three on the momentous question of physicians' fees, days' treatment. Not only was the ovarian through the pockets of the wealthy and influhyperästhesia relieved but the nervous palpita- ential class of citizens. They do not want igtion of the heart was abated, and the patient norant physicians to attend, and of course will felt in every way stronger.
not object to paying fees that will enable their I have also given the drug in two cases of doctors to keep themselves thoroughly up to nocturnal emissions with marked benefit.
the times. The pollution ceased entirely while the drug In order to accomplish this, I would suggest was being taken, and for several months there- thorough organization of physicians, and an after.
increase in fees of from thirty-five to sixty-five Virile power or passion were not much, if at per cent., as the case would warrant; so that all, diminished, but the relief from the ailment the full amount of fees charged under the old gave them great satisfaction.
system could be collected under the new. My I might add considerable to the above ex- reason for adopting this plan is simply this: perience, but it will suffice to add some obser- Under the present system, the physician who vations of my own.
refuses to visit a patient because he knows he Salix niger appears to me to be an analogue will get nothing for it is nearly sure to lose of the bromides, but without the depressing some of his good paying customers as a result. effects of the latter. It is also an analogue of Many wealthy people in the country will not conium, but without its paralyzing effects on employ a physician who withholds his services the nervous system. It acts in many respects from the poor, or from the intermediate class similarly to hydrastis. It has the same tonic who can, but will not pay their bills. Now, I power, and probably acts on the arterioles by
propose to request the aforesaid wealthy citizen shutting off an undue amount of arterial blood, to pay the bills, especially for the latter class altnough no such experiments have been made of non-paying customers, until he expresses a with it on animals as have been made with hy- willingness to assist the doctor in procuring drastis. It has some resemblance in therapeu- the enactment of such laws as will make it postical effect to serro cyanuret of potassium.--Dr. sible for the physician to collect a reasonable E. M. Hale, in N. Y. Med. Times.
fee from all who are able to pay, or until they
(the wealthy class) can realize the doctor's [Salix Niger may be obtained of Parke,
dilemma, and learn not to interfere when the Davis & Co.]
doctor desires to collect a small fee from the dishonest man who can and will not pay his
honest debts. Physicians' Fees.
The public must be taught that the physician C. Barlow, M.D., of Eaton, Ill., in an arti- is also a business man, and as a matter of busicle to the Medical Age, says: As a rule, coun- ness proposes to collect money enough to suptry doctors only collect from one-half to three- port his family and purchase the necessary outfourths of their earnings. Sixty-five per cent. fit to enable him to keep up with the times, is perhaps a fair estimate of the average collec- and thereby give value received for the emolutions of the physicians of this county. The ments derived from professional services. After low fees and pauper practice render it abso- two or three years' diligent instruction of this lutely necesary for our physicians to adopt the kind, the good influential citizens would doubt strictest economy in order to make ends meet. less realize the situation, and would willingly
assist us in further educating the class who can training preliminary to the study of medicine. but will not pay their bills.
We must educate the people, and if the line I The worthy poor, I think, are entitled to our have marked out be followed closely, the time services free of charge, and as this class of pa- is not far distant when it will be possible for tients demand a good deal of our time and medical men not only to live, but to lay somemoney, it is another argument in favor of thing by for a rainy day. 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
Hospital Notes. proportion to services rendered. Instead of
[From the PHILADELPHIA MEDICAL TIMES.] charging so much a visit in all cases, regardless of the importance of the case, we should charge
Philadelphia Hospital. more in proportion to the value of services
MUSCULAR STRAINS. rendered. When we bring to a successful issue an almost hopeless case, we should make a
McClellan says, that in muscular strains he reasonable charge in addition to the regular
knows of nothing better than the alternate apfees. In surgical and obstetrical practice where
plication of heat and cold as a stimulant to the life and limbs are saved, we do not charge lymphatics to carry off inflammatory effusion. A enough. In ophthalmic practice, where we re
firm bandage should be applied to the affected store and preserve the sight of the patient, we
limbs, and after a few days the patient should do not charge enough. In fact, we do not
be instructed to step on the floor, so as to accharge enough for important services of any
custom himself to the act of walking. He kind. We visit one man with pernicious fever
considers lotions and liniments of very little use and save his life, and visit his neighbor for a
in the treatment of these very troublesome inslight indisposition, and charge both alike.
juries. There is no equity about such a system of
FISTULA IN ANO. charging. It does the man who was not very McClellan cautioned his clinic against using sick an injustice, and tends to degrade the pro- a stiff probe in packing a fistula ; the tissues in fession.
the ischio-rectal fossa are so yielding that a When we compare our charges with the false passage might easily result. He advised charges made by gentlemen of the legal pro- that a soft catheter should be employed for this fession, we can see how ridiculously small they
When a man is brought before a court to be tried for his life, he will not'object to pay
Medico-chirurgical Hospital. ing his legal adviser from one to ten thousand
HEART-DISEASE IN WOMEN. dollars, as the case may be; while the same Stewart thinks that organic diseases of the man, after having his life saved by a physician, heart are so fatal to pregnant women that he would be likely to object to a fee of ten dollars. would earnestly advise a woman with such a
It is a fact that men will pay large fees to lesion not to marry. lawyers simply to gratify a revengeful disposi
A CASE OF TÆNIA. tion, and grumble at the small fee of the physician who saves their lives. We should charge The cases of tape-worm in which definite in proportion to services rendered, and have it ymptoms are observed, which can with anyunderstood that our fees are due as soon as sdegree of probability be attributed to the pres services are rendered, and if it is not paid in a ence of the parasite, are so rare that the folreasonable time, one year at most, we should lowing case may have some interest : Bettle the account and take a note with security Carrie Hogins, aged 25; born in Pennsylvaif necessary. If our customers persist in keep- nia; widow; one child; mulatto. Suffered ing our money, we should insist in demanding for two years, during which she has been passsecurity and interest. We could afford to wait ing joints of tænia. if we could get eight per cent. interest on our Every morning, on leaving her home, she money. I do not advocate exorbitant fees, but has a sense of compression, a "girdle," about reasonable ones; and that these be collected. the level of the nipple; lasts till 10 A. M.; We could afford to practice for the worthy after which feels well ; roaring in ears at the poor for nothing, if we could collect our fees same time; memory poor; some nausea, prefrom all who could pay if they would, and live ceded by rumbling and “ movements” in the fairly well as the fee-bill now stands. It is a abdomen, probably due to knowledge of worm's fact that the fees collected by country practi- presence; appetite too good, especially at dintioners are inadequate to sufficiently remuner. ner; tongue normal; bowels fairly regular ; ate the practitioner who has had a thorough menses sometimes very free, lasting a week;