The Chicago Clinic.

A HIGH-GRADE MONTHLY PERIODICAL DEVOTED TO THE BEST INTERESTS OF THE MEDICAL PROFESSION.

J. HOMER COULTER, M. D., Editor.

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LIFE INSURANCE EXAMINERS. We had almost concluded to make the title of these remarks Honest Life Insurance Examiners, but the very rasping sound and ignominious insinuation of the word in this conection compelled us to put it more mildly. Strange it is that there. should be a possibility of the waranted use of such expressions when referring to the medical profession, and yet such is verily the fact, as can be well substantiated by anyone who has had even a brief experience as medical director of a life insurance company.

True, it fortunately is, there are but few men in the profession who are evidently, or can by implication, be said to be intentionally dishonest in their examinations. We do not at this time refer to that class, but rather to that much more numerous class who are carelessly dishonest; in other words, those who will accept the appointment as examiner with the tacit or expressed agreement to make a thorough and careful examination, and to protect the

company in such, but who, perhaps, not realizing the importance of the matter, will send in a report bearing glaring evidences of haste or carelessness from start to finish. Such, coming to the medical officer, immediately places him a distance with his examiner, and an ineffaceable suspicion is justly aroused.

It is perhaps generaly known among those who accept the position of examiner that there is among insurance companies a so-called "black list," as well as an almost equally extensive "white list." Yet this seems to make little if any difference. It is plainly evident that no rules or laws can be promulgated by the companies which will make a careless man more careful or reliable. Lack of time either on the part of the examiner or applicant cannot be urged in paliation of hasty and "underdone" work. Such, indeed, is too often the ruse of the "foxy" agent to get his applicant passed. We do not fail to recognize the fact that the insurance field is crowded to almost the suicidal point in some quarters, and that competition is rife as it never was before in this line, but this fact, recognized by every examiner, should make him all the more rather than less careful in his work.

It is surprising how few examiners recognize the fact that they are the confidential medical representatives of the company. Fearful, too, of incurring the displeasure of the agent, they are too often led to give the applicant rather than the company the benefit of a doubtful case. While if they would but consider, they could not but realize that no medical director would be so suicidal as to allow a conscientious examiner to be replaced.

It is a strange fact that locality seems to

have some sort of peculiar significance, if not influence, on medical examiners. There is a city of considerable size, not a hundred miles from the Mississippi River, in which, with its thousand or more physicians, there is a lamentable dearth of reliable examiners. Such is a notorious fact among the medical directors whose companies do business in the city referred to. Indeed, it was a matter of serious consideration, in a convention of medical directors some time since, whether it would not be a paying investment for those interested to import a reliable examiner from another city, and give him a stipulated salary. One of those present very pertinently inquired what immunizing influences were to be employed in preserving him as a reliable examiner.

Not so peculiar, but equally true, is it that there is an Eastern Quaker city, well known to medical directors, as producing one or more perfectly reliable examiners to each block; in other words, the fraternity in Philadelphia apparently have an entirely different conception of the duties and obligations of an examiner, as well as a much. clearer idea of the necessities and wishes of the insurance company and its medical diC.

rector.

THE CONTROL OF TUBERCULOSIS. The recent move on the part of certain prominent members of the Chicago Medical Society looking toward the organization of a society whose end of existence and aim shall be the stamping out and control of tuberculosis has attracted more than local notice. It will be generally admitted that a more philanthropic movement could not well be inaugurated along any line.

It is proposed that this organization shall be of an educational nature, and that a large part of its efforts will be in the direction of educating the public, not so much as to the dangers of the disease, for those are already well known, but rather in teaching the people how they may personally and collectively aid in the dissemination of accurate and scientific knowledge concerning the best means of preventing infection in themselves and others.

This move, while starting with the medical society, and likely to be largely guided by their advise, yet is one which, coming so directly to the public good, will no doubt be a matter of such interest as to elicit the support of many educated and intelligent philanthropists, both in this city and elsewhere. When once the public has fully appreciated the possibilities in the case, then it cannot be doubted all the financial support necessary for success will be forthcoming. The example of Otto Young, Esq., who gave $60,000 for an annex for consumptives to the Home for Incurables, and that of King Oscar of Sweden, who gave 220,000 crowns toward the stamping out of the disease, will then be appreciated.

The daily press, a most necessary and efficient assistant in this crusade, has practically assured the organizers of its hearty support. With this medium or education ready and willing, the indorsement of such physicians as Drs. N. S. Davis, A. R. Reynolds, Henrotin, Billings, Reilly, Robison, W. A. Evans and others, and the moral support of the profession of Chicago, it seems certain that some very marked and practical results must follow the move

AUTO-ORCHIDECTOMY.

Gould informs us that the history of human male asexualization is lost in the mists of antiquity, though it doubtless was. Oriental in origin. Its use in modern periods has been practically limited to that of a therapeutic measure, and as a punishment for criminals. It is not our intention to refer to it in either of these phases in this connection.

A recent case appearing in one of the largest hospitals in the city was of this sort, and in its way quite unusual. The patient was a young man of twenty-eight, fairly vigorous and well proportioned physically; intellectually, he was apparently, at least, moderately endowed, and were the circumstances herein related unknown he would have been considered a more than ordinarily educated and intelligent young

man.

When brought to the hospital he was almost exsanguinated from loss of blood, but gave those in attendance no small amount of interest and amusement in his description of the acts which forced him to seek hospital aid in his efforts at auto-orchidectomy. He said that he was professionally a vocalist, and that his specialty was "impersonating female parts on the high-class vaudeville stage." Naturally, he possessed an unusually mellow, smooth and resonant falsetto voice; add to this a "Boston" accent and the really amusing features can be easily imagined. The patient maintained that "lately a somber dullness and hoarseness had been coming upon his voice and that the register was slowly but surely becoming lowered."

A friend (?) advised him that castration was the only sure preventive in the case. Acting upon his advice, he says he

"anointed the parts thoroughly with a mild cocaine solution, then, taking the razor, an attempt was made to remove the offending portion." As a result of this attempt both testicles were almost bisected, the spermatic cord of one and the vein in both cases were cut. Repair was out of the question, and, besides, any attempt at restoration was most strenuously and positively interdicted by the patient. The only reason offered by the eunuchistic enthusiast for being compelled to call help was, "with the rather unexpectedly free hemorrhage I became somewhat confused as to my anatomy."

The history of medicine gives few cases of this character, though doubtless many have existed. There are a number of cases reported where Cæsarean section has been done by the patient. The Romans are said to have used infibulation to prevent a change of voice in singers. Biblical history tells us "there be eunuchs who have made themselves." Another somewhat antiquated but quite appropriate reference from literature, corroborated by such an experience, is, "The fools are not all dead."

J. E.

The number of deaths among the younger members of the medical profession during the past six weeks has been very unusual and remarkable. No less

than twenty-eight have died in that time. who were under fifty years of age. Several of them were prominent men in their lines.

A number of cases of smallpox have been reported from towns along the Mississippi River, in both Illinois and Iowa. Vaccination is being thoroughly and systematically practiced, and as the cases seem unusually mild, no serious epidemic is feared. Leadville, Colo., and some points in Ohio are also victims of the dis

ease.

ABSTRACT.

Acute Otitis Medica.

Dr. Bulson ("Ft. Wayne Medical Magazine") says:

1. Consider earache as a warning note of danger to the patient, both as respects function of hearing and life, and carefully inspect the visible parts implicated in the inflammation.

2. Avoid opiates, which oftentimes but mask the symptoms, and if within the first few hours no relief from pain results from hot applications and local depletion, perform paracentesis, whether bulging of the membrane is present or not.

3. Incise the drum membrane at once if bulging is detected, indicating early perforation, as it is important to, if possible, control the character, extent and location of the opening in the drum membrane in order to limit destructive changes.

4. With the appearance of discharge, begin the process of cleansing, adopting nothing more than warm detergent and non-irritating antiseptic solutions, and using them sufficiently often to keep the parts free from collections of mucus or pus.

5. Keep the naso-pharynx free of discharge by detergent sprays, and cautiously use Politzer inflation to assist in removing discharges from the middle ear, as well as to aid in preventing depression of the healing drum membrane and possible adhesion.

6. To secure the best possible results, which are always desirable, and due both patient and physician, persistently follow treatment until all discharges have ceased and the perforation thoroughly closed.

Malaria.

In many forms of disease we often find that a combination of remedies act better than a single one. This fact has been so clearly demonstrated that even the strongest advocates of the single remedy are seeking in combination a surer and more speedy method of relief and cure. In malaria for instance, we often find cases where arsenic or quinine seem to be clearly indicated; the action of either one given singly fails to produce the desired effect, but when combined with some other remedy the beneficial result is speedy and lasting. We have often found when cinchona, either in the tinc

ture or some of its alkaloids, though apparently indicated, has failed in producing relief, a combination of cinchonidia or quinine, three grains; capsicum, one-half grain; nux, one-fifth grain, given three times a day, breaks up the trouble. In other cases Warburg's tincture produces the most satisfactory results where single remedies, however carefully selected, have failed. The combination of anti-kamnia and quinine enter now into the repertory of almost every physician. Dr. Francis Delafield, in a clinical lecture, gives a prescription for malarial fever which he says is very popular with the profession. "The arrangement with the quinine of acetanilid and arsenious acid, in the following proportions, gives very satisfactory results: Quin. sulph. gr. iii.; acid arsen., gr. 1-30; acetanilid, gr. ii.' Four of these capsules are taken in the 24 hours. "Why," says Dr. Delafield, "this combination is better than quinine alone, or when arsenic is added, or why adding two grains of acetanilid makes it more efficacious than one-thirtieth of a grain of arsenious acid and three grains of quinine, is a question I cannot answer. I have found it is so by personal experience, and I have found that the adding of the acetanilid gave me such results that I could not get along without it." This experience is that of every physician who finds in his daily work that there can be no iron-bound rule in therapeutics which will admit of no deviation. We cannot always define how or why certain combinations produced the desired effect, but until we can understand the why and the wherefore we are satisfied with the results obtained.-Med. Times.

An Apostle of Health.

There has seldom been more generous and unlimited public recognition of the life work of any man than we find in the eulogistic comments of the press upon the death of Colonel George E. Waring, Jr., whose life was lost in the humane task of improving sanitary conditions in the city of Havana. Our first regret was that he was stricken before the problems which he had undertaken were completely solved. It seems unlikely that a sanitary engineer of equal experience and capacity can be found to continue the work. There is no doubt that no other feature of administration in Cuba equals in importance those

connected with the sewage, water supply and street cleaning departments of this hotbed of deadly epidemics.

Although Colonel Waring was comparatively unknown until he became street cleaning commissioner of New York City, four years ago, he had been a close student and successful promoter of sanitary work for a score of years, and the many communities that had been so fortunate as to secure his services recognized his conspicuous success in public health work.

In the street cleaning problem here, not only his perfect conception of the relation of cleanliness to health but also his military training were combined in the perfecting of a system, which passed through the stages of ridicule, doubt, expectancy, and final triumph. He had accomplished what his predecessors in office had honestly attempted for a generation and had utterly failed to compass.

From being the object of the severest criticism of an unappreciative public, Col. Waring became an apostle of health whose fame was international.

It does not surprise us that the system he instituted cannot be carried on successfully under present auspices, for although the army is still here, the great general's personality is removed and cannot be recalled. The new Commissioner has not had the preliminary training.

Like most philanthropists, Col. Waring never thought of accumulating money and left scant provision for his family.

The Chamber of Commerce has undertaken to raise a fund of $100,000, the income of which shall be paid to Mrs. Waring during her lifetime, and afterwards the principal shall go to Columbia University for the endowment of a special department which shall bear his name.

It is a noble and generous undertaking worthy of the business men of the metropolis, and its completion will be a fitting testimonial to the life and character of George E. Waring. At the present writing nearly $90,000 has already been subscribed. Med. Rev. of Rev., Jan'y.

The Country Doctor in the Practice of Medicine.

The resources of the country doctor in the practice of medicine should be as ample as the fullness of the seas and as fertile as the lands of the earth. His courage and

faith must be sufficient to remove mountains, and his gentleness that of the lamb. His life must be one of perpetual sacrifices, and his death that of the laborer of whom it is said, "Well done, thou good and faithful servant," etc. All this is desired and even required by his patients, but the law very sensibly enacts as follows:

"One practicing in a small town or sparsely settled country district is not to be expected to exercise the care and skill of one residing in, and having the opportunities afforded by, a large city. He is bound to exercise the average degree of skill possessed by the profession in such localities generally."

The ordinary and reasonable care, skill and diligence which the law requires of physicians and surgeons is such as physicians and surgeons in the same general neighborhood in the same general line of practice ordinarily have, and exercise in like. cases. So while the doctor has the ideal for his motto in theory, the law requires only a percentage of that ideal in his practice. The country doctor, having to treat the same mechanism of God's handiwork as does his city brother specialist, merges almost daily into the surgical, gynecological and a dozen or more branches of specialism with his numerous patients. And while he has the pride and disposition to treat them all as well as they could be treated under any other circumstances elsewhere, how can he be expected to do so, and who knows better than the doctor himself that he cannot? However, he can treat such patients equal to his skill and environment, and the question of when and how to better their condition is one often perplexing. Again the law says: "If a physician or surgeon is not competent, or feels that he is not competent, to treat a case, it is his duty to recommend the employment of another; but if he is competent and so considers himself, and is in doubt concerning the case, he should use his best judgment as to consultations with other physicians and surgeons. But the refusal to accept the assistance of another in the treatment of a case imposes no high duty upon a physician or a surgeon." Thus it will be seen the law is not imperative, but leaves the acceptance or rejection of counsel or assistance entirely with the judgment of the physician or surgeon in charge of the case.

The country doctor is always open to