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ture of the long bones, is the reduction of where a skull fracture existed and no the fracture and the use of a blanket splint symptoms of skull 'fracture were present which is the simplest form of a splint and at examination but which developed 12 to very easy to apply. I never attempt to re- 24 hours after the injury. duce an impacted fracture of the femur In closing this article I will describe one and do not believe it good practice partic- night's work at the stock yards police staularly in elderly people. In case of com- tion—from midnight Saturday night until pound fracture I remove the clothing cov- 8 A. M. Sunday. ering the fracture, gently clean off any dirt On relieving the night surgeon at midif it can be removed easily, being careful night I was greeted by two Poles who not to remove any fragments of bone, cover wished to be “repaired” as the police officers the part with sterile gauze and cotton im- call it. There was a dance in progress
in mobilizing and get the patient to the near- the rear of a saloon "back of the yards" est hospital as soon as possible. I think at which one of these Poles had been enmuch harm can be done in a case of com- gaged to play the cornet. He had brought pound fracture by doing too much in the his best girl with him, but as he was busy first aid treatment.
playing, his girl danced with another Pole. Scalp wounds and their
treatment. After the dance while they were sitting A scalp wound in itself is looked upon at a table drinking beer the jealous muas a minor case, but it may develop into a sician proceeded to punch holes into his serious case. I never suture a scalp wound rival's scalp with the mouth piece of his without first cutting down to the bone and cornet while his victim retaliated by breakmaking sure there is no skuli fracture. ing the beer bottle over the cornet player's Many cases of skull fracture have been liead. His scalp was full of pieces of glass overlooked, for at the time of the dressing which I picked out with a pair of forceps of the scalp wound no symptoms of skull after shaving off nearly all of his hair. His fracture were apparent. It is our custom rival's scalp had half a dozen neatly punchto enlarge the wound if necessary, expose ed out holes causing one of the officers and examine the skull beneath and by this to remark, "I guess he used a leather punch procedure many a fracture has presented on him only the leather is still raw." I itself without a single skull fracture symp- tried to suture the punched-out spaces totom being present. Symptoms of skull gether but was not very successful so I fracture as a rule develop several hours applied a sterile dry dressing and bandage after the injury, except in cases of basal to control the bleeding. He was locked skull fracture, in which case the bleeding up in a cell adjacent to the cornet player, from the ears, nose or mouth are present and during the entire balance of the night early. I have been accustomed to pay threats flew thick and fast in Polish. On special attention to the eye findings in these went the dance and the girl who caused all
The inequality of the pupils, the the trouble probably found others to dance deviation of the eyes, turning toward the with her and buy her beer. I have seen side of the hemorrhage, the rapid ecchymo- cases of shooting and cutting in these dance sis of one or both eyes are important fac- halls where the music never ceased and the tors in making a diagnosis of skull frac- dancers danced on while the police and ture. Of course, paralysis of the extremi- the ambulance surgeon were removing the ties due to pressure of a blood clot on the wounded from their midst. brain is an important symptom but this A little while after treating the two Poles appears generally some time after the in
woman rushed into the station crying, jury, and the extension of the paralysis de- “Doctor, my baby has worms coming out pends upon the size and location of the of her ears. For a moment I thought the clot. I have seen a great number of cases woman had been drinking, but soon saw
that such was not the case. I later found that he was tossed up and over the mathat the woman and her husband were chine. He was carried into the station, not missionary workers. Learning that she being able to walk. When I first saw him lived but a short distance from the sta- he was suffering from shock for which I tion, I took my grip and went with her to gave him two drams of aromatic spirits of her home-a dirty old shack where I found ammonia. Upon examination I found both conditions that would almost turn the bones of his right leg so badly fractured stomach of a dog. In a dirty nightgown and in so many places that it looked like a was a twenty-months-old baby screaming flail joint from the knee to the ankle. I and tearing at its ears, which were covered user the bianket splint and had him rewith blood. Examination showed the left moved to the Englewood Hospital where ear to be full of blood, pus, and maggots! he is at the present time. X-rays showed I washed out the external meatus with a six separate fractures of both bones, the warm Lysol solution and removed four- bones being practically shattered. teen maggots and before I left, the little This night's work is a fair sample of that one was sleeping for the first time in three which comes to the ambulance surgeon at nights and what I told that mother and the various stations in Chicago. We have father before I left is unfit for publication learned that the most important factors and will "hold them" I think for a long to contend with in emergency surgery irtime to come.
respective of what the cases may be are, On returning to the station about 2:30 first, the control of hemorrhage, if there be A. M. I found a man sitting in a chair look- any. Second, to prevent shock. Third, to ing very ill. The police informed me that relieve pain. When we have done these he had been struck by a speeding automo- things we have done it seems to us about bile going about 50 miles an hour, and all we can do as ambulance surgeons.
THE HOSPITAL, DISPENSARY, AND CONTRACT-PRACTICE EVILS.
By LOUIS VON COTZHAUSEN, M.D., PH.G., PHILADELPHIA, PA. The absolute necessity of hammering The costs of maintenance of hospitals away constantly at this old and threadworn and dispensaries frequently are met by ensubject, in the hope of finally obtaining dowments of private individuals, who thus relief, must serve as my sole excuse for my erect to themselves permanent monuments temerity in making it the subject of dis- (with or without tablets mentioning their cussion.
names) out of their superabundance of Everybody, of course, gladly admits the Wealth-sometimes prompted by philanblessings and necessity of free hospitals thropy and charity, but probably more ofand dispensaries for the medical and sur- ten by vanity masqueracing as the former. gical treatment of the absolutely poor. Be that as it may, there is no denying
Nobody objects to doing a certain amount that, while these foundations do a great of deserved charity-work himself, nor does deal of good, they, on the other hand, anybody deny the absolute necessity of through the multiplications of unnecessary free treatment in connection with our medi- free institutions, foster pauperization of the cal colleges for the bedside-instruction public, together with impoverishment of and dispensary teachings of our future the medical profession, which is at least doctors. Ve hear of hospitals in Persia entitled to a respectable living. We might as early as the fourth century, which were go further and claim that they likewise enrecognized and supported by the govern- courage lack of thrift and growth of inment.
temperance among the working-classes by doing away with the necessity of saving If there ever was a promising and goud up a portion of their wages for possible fieid for moral, religious and political resickness. Thus free hospitals and dispen- forin, this is it. Physicians connected with saries founded by the rich are not unal- our hospitals (I mean only those in control loyed blessings.
of them, and not the poor drudges and Again, other institutions, hospitals, and supes who do all the work, while the others dispensaries are sustained in part or en- get all the influence and all the reputation tirely by state or city appropriations. which enables them to charge twenty dol
We probably have no right to criticise lars or more for advice, whether they are the private-endowment institutions for worth it or not, besides feeding frequently giving away advice, inedicines, nursing and their private offices with patients sent board free to those able to pay, as we do thither by their hospital-assistants by their not help to defray expenses, but we most request as it is claimed), are as a rule not certainly ought to object when they re- the self-sacrificing, nonegotistical, philanceive solicited or unsolicited state or city thropic, charitable men they were recently support, in which case such conduct be
painted by one probably of their number, comes criminally wrong.
who claimed that they ought to be paid a The appropriations are cbtained, it is al- salary. leged, on the plea of being intended for
I for one agree entirely with him in this the helplessly poor, and, if applied, possi- respect, believing that they ought to rebly, for those able to pay, or, still worse, ceive a salary commensurate with their real for erecting buildings, paying off mort- worth, abilities and the amount of work gages or bribing lobbyists, as occasionally they personally do, provided that they are rumored, this, in my opinion, becomes the prevented from using their power for bullybusiness of each and every taxpayer whose ing their inferiors and denouncing every share of the money is thus obtained under outside physician who is fool enough to false pretense and misused.
send his patients to them without considerI am told, that appropriations are usual- ing that by doing so he will probably sign ly graded according to the number of free his own death-warrant so far as the fu
patients treated. If this is correct, would
, ture patronage of the patient and of his this not naturally act as a stimulus for un- relatives and friends is concerned. For it conscientious doctors connected with such will be the rare exception, not the rule, if hospitals to swell the number out of the a patient returns to him without a flea ranks of the well-to-do in order to show having been put in his ear in regard to his a large number of free patients treated by doctor's inefficiency and the superior omthem and therefore the apparent but fraud- niscient attainments of the hospital phrulent necessity of official assistance? Are sician, we, indeed, certain that all members of our Furthermore, it ouglit to be forbidden profession are above such practices when to treat patients free in hospitals and disthey undoubtedly have an axe to grind? pensaries, unless they have proved them
We are assured that even our largest selves absolutely unable to pay: and under and oldest institutions are not above these no circumstances should it be permitted to practices, while in one of our renowned send patients to the private office of the sectarian hospitals the free beds are al- attending physicians, surgeons or to their legedly filled with the friends of the ven- chiefs when able to pay, but they should erable presiding officers, and in another he told to return to their family physician large institution, with friends, protegés unless the latter insists on their being and henchmen it is alleged, of one of our treated at the hospital, in which case they peerless political leaders--and why? Where should be required to bring a written note is the medical influential reformer who is from their physician to this effect. This willing to howl "graft"?
should, of course, not be necessary in acci
Under all circumstances, how- and their enforcement of strict rules laid ever, should such patients who are able to down for treating free only the proven abpay, if treated at all at the hospitals (which solutely poor, etc. practice should be discouraged) be com- Perhaps the "outsiders" generally are pelled to pay prices for treatment, board, considered ignoramuses by the hospital etc., according to their determined means; "elites", however studious and capable and, if anything, the charges should be so they may be, and probably correctly and high as to make them practically prohibi- justly are considered asses, because they tive.
have proved themselves such by their subAll physicians connected wth hospitals, mitting to such treatment by their hospital dispensaries, etc., and especially those in brethren, without squealing, for so many authority, found guilty of using said posi- years. To repeat, then, the poor benighted tions for private gain, self-advertisement D. F.'s might possibly be allowed to re(are there any who dù not?) or of stealing gain a little of their former prestige and the patients from outside physicians under practice. any plea should be summarily dismissed I will now take up the contract-practice after exposure.
evil, which, if anything, is more injurious This will, however, ilever come to pass to the average general practitioner than until the millennium. Not until it does will the abuses named, and gnaws more deeply the arbitrary distinction disappear between at the roots and absorbs the sap of their the two casts, that of the hospital-physician' individual practices. Undoubtedly, you the "elite" or "aristocrats” of the profes- have all suffered knowingly or unknowsion, and the “outsiders”, not M. D.'s, but ingly, from this cancerous, leprous evil, alD. F.'s, so called on account of their fool- though you may not have been brought in ish practice of practically permanently pre- as close contact with it as I have for the senting the others with their patients. Nor last twenty years.
We all undoubtedly will the hospital and dispensary evil ever frequently smile when we read the supbe a thing of the past until proper recogni- posed vaporings of the so-called “newtion is followed by exposure, consequent rich” in the joke-columns, and doubt their punishment, etc., following proper legis- truth. lation,
Nevertheless, our own profession now A great step toward relief, however, and then shows us similar comical specifrom this source will be made if state mens of codfish aristocracy, who, to our and city appropriations are entirely done knowledge, years ago did contract-practice away with in the case of private hospitals work at less than two cents a week ($1 a and dispensaries, which ought to be entire- vear) for every member of the society ly self-supporting, or if not, ought to be which employed them, and who now evicompelled to consolidate with others simi- dently, having thrived in the goods of this larly afflicted, so as to make them self-sus- world, think themselves far superior to taining and to reduce their ridiculous num- their professional brethren who always conber, most of which were started as ethical sidered professional etiquette. One of advertisements of ambitious doctors for these "new-rich M. D.s”, when recently self-advancement, depending on
official asked by me to join one of our medical support.
business associations which had been started City, county and state hospitals and dis- for our mutual protection, absolutely repensaries should, on the other hand, be fused to do so on the plea that he needed supported by the municipalities, after a no protection, as he had no poor patients rigid examination (nonpartisan) at unex- but did simply a check-practice business pected intervals and after a careful inspec- among the wealthy—a statement which I tion of the books, ascertaining the income know to be false. from private sources, their strict obedience We have at present very many otherwise
all-around good fellows in our midst who scab, who at least ciaims living wages even are engaged in contract-practice for which if below those wanted by those he supthey collect the same munificent salary of plants. less than two cents a week for each mem- While these amiable so-called ethical, ber. I am generous enough to consider would-be-professional, friendly, all-around their services worth more, even if they good fellows and comrades of ours pat us themselves consider themselves well paid, on the back while extracting our pocketas evidenced by their scramble for these book, or at least rob us of our income withappointments, and after obtaining them by out getting the benefit of it themselves to their fight to retain them. These gentle- any appreciable extent—thus possessing the men have, to our own personal knowledge, cupidity of the professional scab, but lacktaken many a patient from each and every ing his business abilities—they destroy our one of us general practitioners among the means of living and incidentally remove poor who before they joined these orders the foundation of their own professional paid us honestiy one dollar or more for standing and future. And why? Simply every visit, even if they were sometimes in order to advertise themselves and tempslow in doing so. They have nothing orarily to get the advantage of a measly against us personally. No, on the contrary, degrading wage-rate, lower than the lowas shown by the fact that they usually still est cut-rate in any inenial trade. If they employ us for those members of their fam- were poverty-stricken beginners in practice ilies who do not belong to the orders and we might possibly sympathize with them also come to us themselves when seriously and understand the reasons for their cutill, as they have no real confidence in the throat practices; but no, they usually are so-called “cheap skate" society-doctor, be- old and well-established physicians and apsides thinking, and correctly so, that no doc- parently prosperous. tor would but half try to do justice to his But where and what is the remedy? We patients at that price.
apparently so far have not succeeded in As mentioned before, these contract-prac finding even an approximate cure for this tice doctors are apparently friends of ours, cancerous evil. We might do some good or at least pretend to be, and I would like and make some headway by inducing our to consider them such. I ask in all serious- county, state and national medical societies ness, can men be considered true friends, to pass resolutions declaring such practices or must we necessarily consider them our absolutely unethical, not permissible, and most bitter enemies who are engaged in contrary to our rules and regulations, and the cut throat contract-practice which stabs by requesting those members engaged in at the very vitals of the medical-practice contract-practice to resign within a cerincome, dignity and prestige, and which tain stipulated period or be expelled from necessarily humiliates the entire medical the associations, and thus be branded as profession in the eyes of the public, the cutcasts of the profession. Whether or not educated population as well as the low, ig- we should be able to çlo so, time alone can norant class? These men attempt to steal tell. I have my doubts, but feel fully conour living in an unprofessional, contempti- inced that something must be done, and ble manner far below that of the car-strike that immediately.
A Voted Indiana Health Resort.
In the development of sanitaria in cess along certain lives as Mudlavia, one America, few institutions have enjoyed of the several health resorts for which Insuch rapid development and singular suc- diana is noted.