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been plodding away attending to the ills of the multitude, and receiving therefor little thanks and less money.

FEES IN ST. LOUIS, Trutlı to tell, fees in St. Louis are at a ridiculously low figure now-adays. Surgical operations for which you would receive twenty-five dollars in Kansas City are daily performed here for ten dollars, and it is no uncommon occurrence for a doctor to take charge of an obstetrical case and see it through for ten dollars--yes, even five. There are very few physicians in this city who charge two dollars for a visit, the vast majority of visits being made for one dollar-while some physicians will make a call in consideration of fifty cents,

sit paid at once.

Office practice is little better. I doubt if there is a single man in this city, outside of the specialists, who dares to charge more than one dollar for a prescription, and the ordinary price is fifty cents to a dollar. I know some who are called reputable men who will gladly write a prescription for twentyfive cents, it paid at time of examination. Why is this? Simply because St. Louis is a college town." “

The presence of a medical college is perhaps a nice thing, ( for the specialists who make up the faculty ) but it is the ruination of fees—even respectable charges. Compare the medical charges in Cleveland—a college town—which are approximately the same as those governing our practice here, with those of Newark, N. J., a town not“ blessed” (7, with a medical college. “In Cleveland, an office visit is twenty-five to fitty cents. In NewJersey one to ten dollars. In Cleveland a visit from the family physician is one dollar, no extra charge for an hour or two detention, no charge for prescription to other members of a family. In New Jersey a visit from the family physician is from two to ten dollars, a dollar extra being charged for every hour's detention, and for each additional member of the family prescribed for. In Cleveland ordinary midwifery cases are from five to ten doilars ; in New Jersey the same ten to thirty dollars. In Cleveland the reduction of a dislocation of an elbow or shoulder and its subsequent treatment is five to ten dollars, while in New Jersey the same is twenty-five to fifty dollars. Other service in proportion. ”– Am. Lancet, September, 1887. )

The same thing will eventually come to pass with you in Kansas City. As long as eastern people are flocking to the - Mecca of the West” you will probably keep your present prices; but with a lull in the influx, with a “tightening ” of money matters, your rates will gradually decline.

OBJECTIONS TO COLLEGES. This will be the more marked when your colleges have turned out more and larger classes. The average country boy comes to the city to attend lectures. He is caught with the glamour of what he sees about him; he becomes imbibed with the idea that the life of the city doctor is that of the ideal physician, not remembering that “all is not gold that glitters,” he feels that many of the physicians he sees about him are in nowise superior to himself, and at graduation, encouraged perhaps by some professor who thinks he can control him in the future and thus add to his list of inen for whom he acts as consultant -hoping to form from his classes a group of medical satellites rev olving around him as the great central luminary, he settles down to practice only to find, too late, that he must do something to get bread and butter ; to do this, he must perforce resort to “ cutting, ( not surgery ) and the result is a brisk competition--a bidding, if you choose--a kind of a medical auction in which patients are knocked down to the lowest

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instead of the highest bidders. Besides this, the colleges offer the services of their learned professors gratuitously at the free dispensaries, 80 that it is no uncommon thing for patients to say, "Well, I can't afford to pay you a dollar for prescribing when I can go up to the Blank Medical College and receive treatment from the best doctors in the city for nothing. Thus it goes. And the really deserving men must suffer from these things. The only thing is for the men who are financially “ well-fixed ” like Drs. Spencer, Gregory, Tuholske, Todd, Johnson, Mudd, Bauduy, Shaw, Bauer, Hardaway, Steele, Papin, Love and others of this city, and Jackson, Tiffany, Griffith, Duncan, Logan, Johnson, Fryer, Lewis and others of yours, to keep up the price. Let the best men set the example, and the others may be induced to follow.

Perhaps I am saying too much about tees ; still, it is the "almighty dollar". for which most of us are in quest and the problem of the day in our cities is not how to get practice—that is easy—but how to gain a livelihood theretrom and lay up a penny for the time when the « gray shall mingle with the brown."

“Leaves have their time to fall

And wither in the winter's chilling blast," and the years slip by one by one, so that for many the autumn of life is not far distant-the winter's chilling blast must be provided for, so that, after all, anything which touches finance is of import to the great army of Reynold's "ignoramuses.” In this matter, we can hardly atford to Learn to labor and to wait,” but must be up and doing, for on the morrow cometh the day when we shall pass away and leave our families to the cold charity of the world. This could be no better illustrated than was done at the recent meeting of the American Medical Association when the President announced that the library and instruments of the lamented Dr. Jewell might be found on sale at a neighboring stand, the family finding it necessary to dispose of them in this way! And yet here was a man standing among the most eminent of his profession in the great city of Chicago !

ST. LOUIS MEDICAL SOCIETY. With the return of cool weather (and the noted specialists ) the societies begin operations. The St. Louis medical society has already opened for the winter's work. The first meeting was mostly devoted to reports from those who attended the International Medical Congress. And, en passant, the men who went from St. Louis and Kansas City together made a very decidedly firie-looking body, and as usual Missouri stood near the head of the procession in point of numbers as well as excellence, though it was a very peculiar circumstance that few of them took any active part in the deliberations of the Congress. It may be that modesty will yet be found ( by the aid of an Abbé condenser and homogenous immersion lens upon a microscope of good defining powers) to be a characteristic of Missouri doctors. All were highly pleased with the Congress, however, especially the social features of the affair. But to return to the St. Louis society (not intended as an illust ration of the old saying, "a step from the sublime to the ridiculous,”); the meeting was an interesting one and the indications are that considerable good work will be done during the year.

ADVERTISING DOCTORS. At this meeting the subject of an advertisement of Drs. D. V. Dean and F. D. Mooney (secretary of the society) was taken up. In the tele

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Medical Prestige.

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phone directory there appears on nearly every page in large black letters, an advertisement of one or the other of these physicians, giving statements as to their superior qualifications and ability to treat diseases in the most skillful and scientific manner. In justice to these gentlemen it may be said it was clearly shown that these advertisements were inserted by friends who were anxious to show their gratitude but neglected a consultation with the objects of their admiration regarding the manner. As it was evident the doctors were entirely ignorant of the matter they were fully exonerated by the society. But in spite of this the advertisement may, prove a Banquo's ghost in the future years when those interested think the matter entirely forgotten. It is in this way a very unfortunate thing for Drs. Dean and Mooney, who, though entirely innocent in the matter, may hereafter suffer from it.

MORAL: -- Don't have grateful patients; it you do—be sure to caution them to confine their gratitude to cash.

INDEX. St. Louis, Sept. 28, 1887.

MEDICAL PRESTIGE.

There is no question so little considered in the medical world to-day as that of its prestige, compared with that of twenty years ago. What do I mean by this term " prestige?” I mean that position that belongs to the professional man derived from his private character or deeds ; that element that places him and stamps hiin as the conservator of human health and happiness—the embodiment of true manhood.

In former years medicine had about it a mystic cloak that protected it from the vulgar gaze and machinations of the unscrupulous; and also from the masses, who lacked the knowledge and power to discriminate ; consequently the man of medicine was esteemed and valued at his true worth, who in his turn exercised all of the virtues and lived a life consistent with his noble calling, the result of which was a perfect confidence and trust in the man; and to couple the man or his profession with crime was the last thing thought of. How is it to-day? Is he not taken at his true worth? Yes. Is he not trusted ? No! As long as he can be utilized he is trusted, but as a man, he is not. Who of the physicians of years ago would have been approached, as we are to-day, and asked with brazen face to commit crime knowingly? Not one ! And any one guilty of such a breach of propriety, would have been meted out the full measure of their righteous indignation as his reward. Compare this with the experience of the modern doctor, and where does he stand? The mechanic, merchant, lawyer, and even the clergyman, will approach the family doctor, and wilfully, knowingly, ask him to commit abortion; and why? The mechanic will say that his family is already too large, that he cannot support more children ; the merchant's good lady is too delicate, and her standing in society will not permit of her having babies ; the lawyer and clergyman will make the same excuses. Do they do this without thought? No! they do it, because they take the man for what they think he is worth—they sum him up for his true value in their estimation, and what is that? A man that car. be bought for money, a scoundrel without conscience in the guise of a gentleman, a man without honor or any of the finer feelings, whose whole aim is the acquirement of wealth regardless of means. That these are facts is too well known to be disputed.

Now let me ask: How can a man respect another whom he believes to be: and treats as a scoundrel, or how.can he have contidence in one that he believes capable of murder? I say that the man who claims to be my friend, and deems me capable of crime, is a liar, and is something of a scoundrel himself ; he cannot admire me as a man and undervalue my professional integrity. Why do mothers, daughters and wives today go to the doctor to have him" bring them around all right?” It is because they, too, partake of the same opinion.

This loss of prestige has been insiduously but constantly growing, so that now the public in general has the tendency to look at the medical profession as tools to further their own hellish designs, taking no cognizance of the position in which they place us as men. . Is it not a horrible state of affairs? And how came it? Many are the reasons that can be given for this some of which I shall endeavor to enumerate.

1st, A too reckless disregard as to the character of men allowed to enter into the profession.

2nd, The imperfect enlightenment given to the world relative to medicine, and the popular desire of everybody to be “ gulled.

3d, Style--fashion. The lady must shine in society, and the husband will have her there, on the principle that “two is company, three is not. "

The most prolific sources of trouble are the two first. The charlatan has found that this is a field where he can revel and grow fat with the spoil, and many a weak, easy-going, honorable man has fallen prey to this, to save his patronage, until little by little the conscience has been silenced, and we may almost say they all do it. The literature usually gotten up to advertize patent remedies throws out hints and suggestions that the world is not slow to seize and utilize, because people are so willing to be deceived, so that anything pretending to be medical is taken as standard authority.

How shall we correct this growing evil? How can we again regain our former standing! Is it not about time to cry halt? Would to God that the medical profession would unite like men to stamp out this terrible practice that is growing in our midst--to the end that they may enjoy that grand and noble position so long held by our forefathers.

A STUDENT. Olpe, Kansas, Sept. 1, 1887.

SKIN AND GENITO-URINARY DISEASES.

DEPARTMENT CONDUCTED BY J. B. JONES, M. D.

[ Professor of Materia Medica and Therapeutics, University of Kans.is Wty.]

WHEN CAN SYPHILITICS SAFELY MARRY !

Dr. Prince A. Morrow, in the Journal of Cutaneous and Venereal Diseases, discusses the subject of the duration of the syphilogenic capacity in relation to marriage. He presents these conclusions :

1.' The facts of every day observation show that there is nothing When Can Syphilitics Safely Marry.--Jones.

419,

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certain in heredity : Many men marry with a syphilis in full activity of secondary manifestations, and never intect their wives or transmit the disease to their offspring.

2. The modern division of syphilis into secondary and tertiary periods based upon anatomical forms and processes does not furnish a safe criterion for determining the contagious or non-contagious character of the lesions.

3. The completion of the second stage does not always mark the definite disappearance of the virulent principle ; clinical experience shows that late lesions are exceptionally, but none the less certainly, the source of contagion.

4. The contagious activity of syphilis and its susceptability of hereditary transmission cease after the third or fourth year as a rule, yet observations show that the qualities sometimes continue in force much longer and may be manitest in the fifth and sixth year, and even later.

! 5. The aptitude of syphilitic parents to procreate diseased children may persist after the cessation of all specific manifestations.

6. The precise date when the syphilitic organism reaches the limit

6 of its contagious or transmissive power does not admit of mathematical expression.

7. This limit probably varies in different cases, and many circumstances contribute to advance or defer it.

8. The type of the syphilis, the constitutional peculiarities of the patient, the character of the treatment, the presence or absence of cer. tain conditions which are recognized as factors of gravity in syphilis, all exert a modifying influence.

9. All these elements should be considered in deciding upon the advisability of a syphilitic man to marriage. Each case must be studied upon its individual merits.

10. The direct paternal transmission of syphilis, without preliminary infection to the mother, may be classed among the most conclusively established facts of the medical science.

11. It is, therefore, a dangerous doctrine to teach that the sole risks a syphilitic man introduces into marriage consists in the contagious accidents he may bear upon his own person.

12. The arbitrary designation of a limit of three or at most four years as perfectly safe for a syphilitic man to marry, with or without treatment and irrespective of the actual existence of specific lesions, is unwarranted by science or the teachings of experience.

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PRACTICAL NOTES.

Treatment of Allopecia Areata.–Schachman reports twenty-nine cases treated with blisters. His method is as follows : A blister as large as the bald spot is applied 'npon the patch and left on until bullæ form, and then it is removed and the blister is dressed. When the skin is dry (usually on the third day) a new blister is applied, and so on up to three, six, or even ten blisters. The rest of the head is rubbed morning and night with a mixture of oil of turpentine 20 parts, ammoniawater 5 parts, and water 100 parts. If there is only one moderate sized patch, or a few small ones, blisters are applied to the whole at once.

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