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Wine, beer and spirits to be forbidden, to estimate the cost of the epidemic to and drink of any kind unless in case of the community through loss of wages at urgent thirst ; but fruit, raw or cooked, $16,455. There was next to be considto be indulged in ad libitum. The gen ered the expense involved in connection eral result of such a diet he found to be with the treatment of these illnesses, a remarkable feeling of well-being ; the extending, on an average, over seven sense of fulness, bearing down, and weeks. He found that the average cost weariness, thirst and constipation soon of treatment for each patient received disappeared, and the patients have been into hospital in the course of the epi. able to walk many miles up to the eve demic was about $43.75. He was, of confinement. His own wife would therefore, well within the mark in estileap ditches and climb hills, and even mating the average cost of treatment of on one occasion ventured on a race for cases, overhead, at $25. It might be endurance. The ease and rapidity of taken that, in respect of a large proporthe deliveries in some 25 consecutive tion of the cases treated at home, the cases, some of whom had previously had cost of treatment was limited by the petedious or difficult labors, the small cuniary capacity of the household. The amount of liquor amnii, often not more cost of treatment upon this scale than a teacupful and sometimes almost in- amounted to $21,475. $25 was the acappreciable, were striking, and all with cepted estimate of the average amount out exception succeeded in nursing their incurred in connection with funeral exinfants, though some had not been able penses; and the expenditure arising in to do so before. The children were this connection falls to be set down at healthy but small, mostly weighing six $1850. Finally, they had to estimate pounds, and the circumference of the the value to the community of the lives head was under 36 cm. (14 inches), aver lost in the course of the epidemic. That aging 33 to 34. The restriction of albu human life had a distinct pecuniary minous foods had no injurious effect on value was a consideration which had the quantity or quality of the milk. probably never entered the mind of the

average citizen. Nevertheless, the mat

ter was one susceptible of actual demonTHE Cost Of AN EPIDEMIC.-As an stration. A quotation from the writings illustration of the pecuniary loss to the of Farr, the greatest authority on the community arising through the preva- subject, would best illustrate the posilence of infectious diseases, Dr. Camp tion of the matter. “As lands, houses, bell Munro, medical officer of health of railways, and the other categories in the county of Renfrew, in his annual re the income tax schedules are of value, port in the British Medical Journal, because they yield annual returns, so makes the following interesting state for the same reason and on the same

In the course of an epidemic of principle, the income of the population enteric fever in 1893 there occurred 859 derived from pay of every kind for procases, and 74 people lost their lives. fessional or other services, and wages, He put aside any reference with respect can be capitalized ; not precisely, it is to the immense amount of bodily pain true, unless the income of every person and suffering, the mental distress and living were returned at least as nearly anguish, the misery and wretchedness as incomes subject to income tax ; but involved in these figures. He confined sufficiently near to the true value to himself to the pecuniary aspect of the show that the value of the population question. Having before him an ap- itself is the most important factor in the proximate statement of the wages earned wealth of the country. . . The capiby each individual wage earner attacked talization of personal incomes proceeds in the course of the epidemic, together upon the determination of the present with the average period during which value, at any rate, of the future annual he was prevented by illness from pursu- earnings at that and all future ages." ing his occupation, he was in a position The value to the community of an in

*

dividual member was ascertained by de bined with hygienic measures, will ducting the capitalized future cost of probably bring about as good results subsistence of the individual from his with less annoyance, and with less excapitalized future income. Proceeding pense. upon these lines Farr arrived at the con 3. For chronic conditions, these being clusion that “the minimum value of the usually dependent upon either specific population of the United Kingdom or septic infection, local applications men, women and children—was $795 a will accomplish little or nothing, and head ; that was the value inherent in may do great harm, either by exciting them as a productive, money-earning acute inflammatory complications or by race.”

He estimated the value of the causing the postponement of more radipopulation of the United Kingdom at cal measures. the time he was writing as equivalent 4. In cases of adhesions from postto a capital sum of $26,250,000,000, partum inflammatory exudates, properly while the “capital ” of the country applied vaginal packing, with some elas(using the term in its ordinary sense) tic material, such as absorbent wool, amounted, according to Mr. Giffen's es will afford more prompt and satisfactory timate, to $42,500,000,000.

results than will local applications to Adopting Farr's figures as a basis for the vaginal vault and endometrium. the calculation, he has made a rough estimate of the value “ inherent in " the persons who died in the course of this

IMPLANTATION OF WOUNDED UREepidemic, “ as a productive, money-earn

TER IN THE BLADDER.- Pozzi (Ameriing race. He found that it amounted

can Medico-Surgical Bulletin) accidentto the very large sum of $67,700. ally divided the left ureter near its vesiSo that the pecuniary loss to the com cal end during the removal of a cyst of munity of Mid-Renfrewshire, arising in

the broad ligament, and at once secured connection with the epidemic, amounted

it by sutures in a small incision made in to the enormous total of $107,480. the bladder at a higher level. Union A consideration of these figures, Dr. was obtained, and during a second lapaMunro observes, might well suggest

rotomy, nine months later, Pozzi was the reflection whether any investment

able to prove that the implanted ureter was calculated to yield a better pecuni

was normal, except for a slight dilataary return than the expenditure in tion. volved in the operations of the Public Health Department, which had for their main object the prevention of epidemics. ABDOMINAL SECTION BY A Cow HORN.

- Dr. W. Q. Skilling of Lonaconing,

Maryland, reports in the American JourLOCAL TREATMENT.-In no depart nal of Obstetrics a case of abdominal secment of medicine have methods changed tion by a cow horn. The cow had poked so radically as in gynecology. Dr. J. the woman in the abdomen just above F. Baldwin has instituted, in the Colum the symphysis, a little to the right of bus Medical Journal, an inquiry into the median line, taking an oblique the value of local treatment and he curve to the right and making a rent formed the following conclusions : about six inches long. The intestines

1. Local treatment of the endome protruded through the peritoneum. Littrium possesses certain inherent dangers. ile blood was lost. The parts were

2. Acute or sub-acute inflammatory cleansed with hot water, the intestines conditions of the uterus, if not specific or replaced, the peritoneal wound closed septic in character, may be treated, by a continuous silk suture and the absometimes, with advantage by local dominal wound by a superficial and stimulating applications; although, if deep interrupted suture. The wounds good drainage is secured, the hot water healed by first intention and the patient douche and glycerine tampons, com made a rapid recovery.

MARYLAND

man whose wife had been under that physician's care and whom this enraged husband

Medical Journal. thought the physician had made insane by

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Here was a case of insanity probably only temporary in character or possibly a relapse of an old attack which had occurred before husband and wife had met or it may have been a case of prolonged delirium from fever and the physician is murdered in cold blood by a man who has no reason for his actions and no proofs of the doctor's supposed crime.

Another case recorded in the papers more recently happened in Brooklyn. A physician was called suddenly to a house which appeared to be vacant. He was told that the case was upstairs. He groped his way to the top floor and there he was seized upon by seseral men, bound, robbed and gagged and after his assailants had escaped he managed to free himself and give an alarm.

Few physicians hesitate to go into any house where they think that duty calls them and there is no punishment too severe for the man who would abuse a physician's devotion to duty and his work by decoying him to some lonely place and there by force and numbers overpower and perhaps inurder him.

These are some of the risks for which the life insurance companies do not provide and if the physician is a bad risk on account of exposure to weather and irregular life he must be a much worse risk where more seri. ous dangers threaten.

A physician's life is full of anxiety and trouble when he has many cases and is conscientious in his work, and in all instances where there may seem to be dangerimminent, as in the first and second cases mentioned, he should not hesitate to prepare himself for these dangers and not rush blindly into any rat hole for a few dollars.

The public rarely appreciates the devotion and heroism of a physician until disease and trouble come and then the doctor is an angel until his bill is presented.

* * * The young man,

the timid man and the perplexed needs a consultant and

whether this consulting phy The Consultant. sician is asked for by the phy

sician or by the family he comes, gives his advice and leaves and in many cases there is little satisfaction to the patient, to the attending physician, while the

BALTIMORE, AUGUST 10, 1895.

men

DR. CHARLES F. STILLMAN, in his work on Life Insurance Examinations, says that

physicians stand below The most other professional Dangers of Practice. as risks and adds

that it is because of their irregular lives and exposure to all kinds of weather. The young man who is waiting to step into the shoes of a busy relative or neighbor and wishes to inherit a large practice may think that some physicians will never die. As a rule, however, physicians undergo many risks and some of them are rarely thought of by those outside of the profession.

One not unusual risk is the danger of personal violence from real or fancied wrongs and every now and then there appear in the daily papers. startling statements of harm done to a physician by a patient or by friends of this patient.

A case is reported recently from Illinois, not far from Springfield, of a physician who was deliberately waylaid and murdered by a

man

family is told in every case that their doctor A PROMINENT daily paper of Baltimore takes is doing all that can be done. This is the the pains to point out three things that Baltisphinx-like remark whether the attendant is

more needs. If time and a fool or actually on the right track. For if

The

space would allow not the consultant offends the attendant, who is a Needs of Baltimore. only three, but perhaps good friend, that ends all his consultations in

three hundred things the future with this particular man.

could be mentioned that Baltimore and other The consultant's position is no sinecure for cities also need, and need very badly. This he will either offend the attendant or the paper, however, alive to the health and sanifamily and in many cases the family will tary needs of this city, says the following: wish to dismiss the regular attendant and "There are three things that Baltimore, have the consultant take charge and they can with every other American city, badly needs. not understand why this plan is not feasible They directly concern the health, well-being and then they rail against medical etiquette. and prosperity of all the people. As a matter of fact it does seem hard that the First, and probably foremost, is a sewage family cannot have just what physician they system that will abolish the ninety thousand wish and that they are obliged to stick to one wells that every year become more dangerous physician when they think another is better. to the community. It will cost money, but Medical etiquette is a sealed book to the Baltimore has reached a time and

a size laity and yet when a judge, in endeavoring to when it is abolutely necessary to face the situsettle a dispute on ethics between two physi- ation and prepare for the future. Paris is cians said that he could not make much out of spending thirteen millions of dollars to get medical etiquette but if the two physicians rid of wells somewhat similar to those in Balwould go home and behave like gentlemen timore. Every year Baltimore postpones the he thought that the trouble would be cleared matter increases the expense enormously. up, he probably understood the matter. If a Of almost equal importance is a better and man is a gentleman in the correct meaning of more expeditious system of garbage collecthe word and acts to others as he would have tion. At present this is not as promptly done them act towards him he will need no medical as it should be and the results are both odoretiquette.

ous and unhealthy. Colonel Waring says the That consultants have tricks and use them offscourings of a city should be divided into is certain. Indeed the time may come when a four classes : Paper and other rubbish, street school of consultation is established and men sweepings, garbage, ashes. If this can be will be taught how to conduct a consultation. done, he holds that the problem is practically The editor of the Journal of Practical Medi solved. But it will not be solved until the cine tells the following story of a successful removals are prompt and thorough. counselor which should be studied by all “The streets must be kept cleaner. Baltiwould-be consultants :

more must not depend too much on friendly “An acquaintance of ours enjoys a fine rep rains. There must be more and better cleanutation as a counselor. He always has some ing, even if more money has to be spent. The thing to suggest which has not been tried, best economy in the world is money spent for and always knows just what to do. Being cleanliness." favored with a call from him recently, we It takes money to make the streets of a city ventured to ask him why he thought he had clean and keep them in that condition and this reputation, and to what did he attribute Baltimore by its hilly streets and natural his success as a consulting physician. His drainage methods can have its streets cleaner reply was a surprise, and was to the effect at a comparatively less cost than most other that he thought it was due almost entirely to cities. As a matter of economy it is cheaper one thing; and believing this, he certainly to keep a city clean and lessen the amount of cultivated it more and more. This was : illness, and if no higher motives can appeal Keep well posted on all the new drugs, as to a city corporation this fact of economy fast as they appear. When called in consul. ought to have some weight. Baltimore still tation, you can mention one or two with quite remains unsewered and clings to the old privy a certainty that they had not been tried. This wells and these underground defects cannot has novelty to recommend it at least.”

be remedied too soon.

12

MEDICAL ITEMS.

Watertown, New York, has been visited by

an epidemic of typhoid fever. The water We are indebted to the Health Department supply is pumped from a river at a point just of Baltimore for the following statement of

below where two cemeteries drain into it. cases and deaths reported for the week end.

Mr. Christopher Heath has been re-elected ing August 3, 1895.

President of the Royal College of Surgeons,

England. Mr. Reginald Harrison and Mr. Cases

Pickering Pick have also been appointed
Diseases.

Deaths
Reported

Vice-Presidents.

At an annual meeting of the State Board of Smallpox...

Health of Pennsylvania, held July 11, at Pneumonia..

8

Marietta, Pa., Dr. S. T. Davis of Lancaster, Phthisis Pulmonalis.

15 Measles ....

who for three years has been the President of

27 4 Whooping Cough..

the Board, was succeeded by Dr. Pemberton Pseudo-membranous

8

Dudley of Philadelphia.

5 Croup and Diphtheria. } Mumps. .

A French gentleman, M. Guzman, has left Scarlet fever..

50,000 francs ($10,000) to the Assistance PubVarioloid.....

lique, the Paris Municipal Charity DepartVaricella.. Typhoid fever.

ment, to defray the cost of musical entertain9 7

ments to be given to the sick poor in the The heir to the throne of Russia has phthi- hospitals and asylums under its control. sis.

The Astley Cooper Prize of £300 ($1500) Medical students annually spend about will be awarded to the author of the best $750,000 in Edinburgh.

essay on diseases of the joints produced by An International Congress of Surgeons, to syphilis and gonorrhea. Essays, in English convene every five years, is proposed,

or accompanied by an English translation, Tuberculosis, cancer and rheumatism are

should be sent to Guy's Hospital, London, the three most common diseases in Califor

before January 1, 1898, accompanied by the nia.

usual motto and sealed envelope. For further

particulars, address Dr. Hale White, 65 HarDr. W. P. Munn of Denver, Colorado, has

ley Street, London, W. been appointed Health Commissioner of that city.

The death is announced in New York City

of Dr. William C. Jarvis. Dr. Jarvis was The American Academy of Railway Surgeons will meet in Chicago on September 25,

graduated from the University of Maryland 26 and 27.

in 1877 and after practicing a short time in

Baltimore went to New York, where his pecuNew York City has a hospital for the

liar talents soon placed him in the first ranks colored race, and it will be managed mainly

as a laryngologist. He possessed a wonderful by colored persons.

mechanical genius which brought to light the Among educated Germans no less than

well known Jarvis snare and other instrusixty-seven per cent., so the statistics say, ments. Dr. Jarvis was a man of great promhave imperfect or defective eyesight.

ise and his loss will be greatly felt. Inspectors of the New Jersey Dairy Com

Three women doctors have been appointed mission report an alarming spread of anthrax

in the summer corps of medical inspectors by among cattle, horses and mules in this State.

the New York City Board of Health. All of Professor Gurlt of Berlin has found that

them are spinsters : Miss Mitchell, M. D., in 31,803 cases of chloroform narcosis, 23 Miss Deane, M. D., and Miss Weiss, M. D. deaths occurred, and in 15,712 cases of ether The other doctors of the body offered no obnarcosis, 5 deaths.

jection to the selection of these three inspecThe Governor of New Mexico has approved tors, all of whom are said to be fully qualified the bill providing for the regulation of the to perform the duties of their office. Their practice of medicine and the establishment of salary is $100 a month, and the Sun has no a Territorial Board of Health.

doubt they will earn it by faithful service.

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