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and for some other doctor than all of the good friends you ever had will do for you and against the other doctor. I do not mean by this to convey the idea that this talk will have a great deal of effect; still all of us know it will have some, and in my opinion this is one of the reasons why the profession has not "set down" on these parties harder and sooner.
These "dead beats" hurt others besides the doctors. They do it in this way: The doctor, after having been workt by any number of them becomes somewhat suspicious of all new patients whose financial standing is not strictly "gilt edged," and may be the cause of the doctor and patient both being placed in an embarrassing position by a little anxiety being manifested by the doctor in regard to payment. Then again, some good people have a suspicion that we charge them more to make up for what we lose on these fellows. Then again, when we are working for these fellows, who neither pay us nor appreciate our services, some good patient who would be glad to do both may want us and can't get us because we are engaged, and thus both the doctor and his good patient are damaged.
On these points, says one, I agree with you; but how are you to get rid of him? I would do it in this way: Let the profession organize and heed the motto of our good old Commonwealth, "United we stand, divided we fall," and furnish to each other a list of those who can but don't pay them; then agree on their honor not to practise for anyone whose name is on this list except for the cash or its equivalent. When a new man moves into your neighborhood, even before he has sickness, if you can learn who has been his doctor, write him and learn what kind of a man he has been, so that you may know him in advance. "Oh, but," says one, "if you refuse to go to the poor fellow he may die, and that would be too bad." I say no, not so bad, because the country would be the gainer; besides he would probably miss a great deal of trouble. "But you surely would not refuse to go to see his wife because he will not pay you?" Yes, sometimes, because I have known her to be the cause of his not paying; and then if she were not the cause, with such a shiftless fellow for her to raise a family for, it would, I think, sometimes be an act of mercy for us to let nature remove her from this world of trouble as soon as she will.
The dead beat is not always a poor man -I mean poor financially speaking; for he may be well to do and impose on you because his credit is good. When you approach him for your bill he says, “Oh, well, I haven't got the money just now; but I will pay that sometime soon." However, he lets it run on for months and years, and either never pays it or it is the next thing to never. Ofttimes these fellows, by their bad business methods, will break; and leave the doctor entirely out in the cold. They will pay merchants, blacksmiths, preachers and all other bills cash, and then after buying all the necessaries and luxuries that they may think of, they will settle with the doctor if they have anything left; and thus the doctor is left to wait and wait. Now, I have been doing a little missionary work for the last fourteen years, trying to teach the truth that a doctor's bill is as just as anybody's account, and that if any account is to be first it should be the doctor's. Because when a man is well he can buy of any merchant he pleases; and he can look further for a blacksmith if one refuses him credit; but when he is sick and doctors are ten miles apart, it is a bad time to be forced to look for another doctor. And, gentleman, I am one to lend my heart and hand to the movement which will rid the profession of this unjust burden. Of course I except cases of deserving charity. G. G. THORNTON, M.D.
Gravel Switch, Ky.
Later. I desire to report to your columns the organization of a new medical association, which has for its object the advancement of the science of medicin and the protection of the profession from the "professional dead beat." It was organized at Perryville, Ky., on August 20, with a membership of nine doctors, by electing Dr. W. A. Brown, of Parksville, president, and your correspondent secretary. The name was left open for discussion at our next meeting, which will be held September 22. It will probably be "Medical Protectiv League" or "Association." We will meet regularly every three months and have papers by two or more members at each meeting, and reports of cases by any one who may desire to report. We propose to meet at the offices of the different doctors who are members, at different places, and thus spread the good work, gradually taking in more and more of the profession until we
stand united in this section at least. The following resolution was offered and unanimously adopted:
Resolved, That we, members of the Medical Protectiv League, will not practise for those parties who are, or who may hereafter be, blacklisted by other members of this association or by ourselves.
Exception No. 1.-If the party offers to give good security or the cash.
Exception No. 2.-Cases of accident left at the option of the doctor who may be called.
Exception No. 3.-Cases of charity.
Sudden Death One Week After Diphtheria. Editor MEDICAL WORLD:-I have had a case of diphtheria, the course and termination of which have puzzled me, and prompted me to tell THE WORLD in order that its readers may perhaps be more ready for a similar emergency.
The symptoms were mild at first, and antitoxin was not used until the larynx became implicated, when heroic amounts were given, and with good results, for the child ate and slept well for a week; then while out in the yard playing she said her stomach hurt, went in the house, had one fainting spell after another, and when I saw her two hours after, she was cold, even her tongue. She kept up a constant wail because of the pain in the stomach, and got up and down with seeming strength, altho the pulse was barely perceptible. Strychnin o grain and tinct. capsicum m. x, with tinct. opii. m. vij, and tinct. belladonna m. x, were given inside of fifteen minutes, but not the slightest reaction was visible, and in a little over an hour she died, conscious and suffering to the last. She was nine years old.
Now I hope to learn thru your valuable paper the mode of conduct to pursue in my next similar experience.
F. F. FEASTER, M.D.
Greenland, W. Va.
EDITOR MEDICAL WORLD:-It has been my lot for the past several months to come in contact with a large number of patients afflicted with this peculiar form of rheumatism. It is presumed that the WORLD readers are familiar with the history and etiology of the disease. A few cases that may be of interest, with treatment, will be given.
Case No. 1.-Mr. J. W., a bartender, consulted me on April 1, 1901, for a gonorrhea that was contracted the week previous. He claimed, to the best of his recollection, this was his first case. He
was nervous, appetite poor; urethral discharge copious, thick, and greenish in character. Family history good; no evidence of syphilis or rheumatism. On the fifth day after consulting me he returned, urethral discharge absent, appetite fair, nervousness not so perceptible; but left knee enormously swollen, painful and tender; ankle of the same side painful, but not as swollen as the knee. Diagnosed gonorrheal rheumatism. In the absence of evidence of exposure to wet or cold, and no previous attack of rheumatism, diagnosis was conclusiv.
Case No. 2.-Miss G. B. consulted me April 20, 1901, for urethral, vaginal, and cervical discharges. Had been treating herself for leucorrhea; was ashamed to consult the family physician. Her family history was inquired into; none syphilis or rheumatism. Her home was in a neighboring town, and as discharge became offensiv, both knees swollen and all joints of the body painful, would consult city doctor. She was examined by speculum; found subacute gonorrhea extended into the bladder, which resulted in a bad case of cystitis; purulent vaginitis and cervicitis also due to extension, and an added case of gonorrheal rheumatism. My hands were full. No time to expatiate on the wages of sin-it was work.
Case No. 3.-Walter B., lad of 19 years, May 1st consulted me. Said on micturition observed intense pain that reminded him of hot water passing thru urethra ; discharge was slight. Returned in a week; was brought in a cab. Joints of entire left side painful; knee and ankle very much swollen. In preceding cases the temperature was normal. In this case over 103° F.
Treatment: Case No. 1.-Large doses of bromid of potassium with salol, and iodid of potassium, 3 times daily. Quinin and antikamnia in 5 gr. doses every 4 hours. The joints were covered with antiphlogistin spread thickly and covered with surgeon's cotton and lightly bandaged. Repeated each day for four days, when discontinued. Have seen patient several times since. Recovery complete.
Case No. 2 gave considerable trouble.
Every complication had to be separately treated; bladder washt out with mild antiseptic solution and vagina and cervix similarly treated. The rheumatism was treated as in Case No. 1, with the exception that a tonic was prescribed in addition. After two months' persistent treatment patient discharged cured.
Case No. 3 treated exactly like No 1, symptoms abating in five days after treatment begun. C. McKANE, Ph.D., M.D. Savannah, Ga.
The Cumulativ Prepotency of the Sire. Editor MEDICAL WORLD:-I beg to submit this rule: "Several impregnations by one sire will result in the transmission of
his qualities more largely to his progeny of later birth." While first observing this in the lower animals, I have satisfied myself that it will be often noticed in human
families, where there are a number of children; but of course not universally. Would like others to observe.
If true, this is doubtless allied to the influence exerted by the first impregnation, as seen in horses, etc. J. E. SHORE, M.D.
Editor MEDICAL WORLD:-I wish some light on amenorrhea. Mrs. T. D., Misses. Mollie and Lizzie S., three sisters aged 40, 31 and 18 years, and Miss Nannie T., aged 28 years: none of these have ever menstruated. They have been in the hands of many physicians, without any benefit. All of them have been under my care for several years. I examined them expecting to find some mechanical obstruction but found them all normal. By the use of very powerful alterativ tonics I have been able to bring them to the best of health, but no menstrual function. These are only a sample of a great many I have seen. One more case of the kind will be of some interest: Miss Maimie B., aged 39. She has never had any symptoms of the menstrual flow, and being assured by her male friends that she could enjoy herself without danger of impregnation, she gave herself full rein at 34 years. her chagrin she conceived and bore a son.
I agree with Dr. Jas. A. Smith, that morphin does assist the veratrum in allaying puerperal convulsions. Also, it assists in controling hemorrhage, given with ergotin. If J. A. Meldon had given 15 drops of Norwood's tr. ver. vir. and gr. mor
phin I do not think he would have had any trouble. J. FRANK STONE, M.D. La Fayette, Ky.
Editor MEDICAL WORLD:-Looking over THE WORLD I saw the inquiry upon the subject of goiter. I have been practising medicin for over fifty years, and have had innumerable cases of goiter. I have not failed to reduce; can give any desirable number of references. My treatment has been alterativ, but never applying iodin. The only external application necessary is common adhesiv plaster over the enlargement. The medicin that has been a favorit is phytolacca, stillingia and iodid of potassa. I have used the compound stillingia, but would bank on the combination mentioned, with possibly the addition of sassafras. I do not write for
anything but for the sake of humanity. I have read THE WORLD many years, but you have not heard from me before. Excuse me, but I know that goiter can be reduced. I will help any who desire it in such a case. I have sometimes given an occasional pill biniodid under some conditions. D. A. JOHNSON, M.D.
Dundee, N. Y.
Sig. One pill half hour before meals.
Then after meals give a ten-grain pow der of caroid, or what would be a little better, eight grains of caroid, two grains boric acid, and two grains of charcoal. Your advice as to the laxativ is good. I am in the habit of using a tablet of aloin, gr., belladonna gr., and strychnin gr. One such to be taken each night. The above, with a properly regulated diet, will soon relieve this patient.
Dr. Moore, of Pomeroy, O. (page 396), can relieve his patient by using a comp. elix. of saw palmetto and santal, put up by Parke, Davis & Co. He must give it in dessertspoonful doses every three hours for the first two or three days, then the same dose t. i. d., after meals. Doctor, you won't cure this old gentleman, but you will make him very much better, and at least so that he can enjoy life.
I think Dr. Phillips (same page) would do well to give his flatulent patient a teaspoonful of a saturated solution of sodium phosphate (P., D. & Co.) in half a glass of warm water one-half hour before meals, and use ten grains of caroid powder after the meals. The sodium phosphate will keep the bowels regulated, and has a special affinity for these cases of flatuJency.
We have been having an epidemic of tonsillitis in this part of Kansas, and I want to tell you of a most elegant manner for handling the same. The first thing to do is always clear out the bowels. This I do by giving teaspoonful doses every half hour of a sat. solution of sulf. magnesia until desired effect is obtained, then spray the throat with
Quinin in Labor.-Tonsillitis. Editor MEDICAL WORLD:-Referring to Dr. Lazaro's query, page 364, will state that I have always used quinin in labor; at times in combination with strychnin, and on one occasion only have I had hemorrhage following its use. On that occasion I ordered 15 grains at a dose, and gave 10 grains again in three hours, and used no strychnin. Minute and oft repeated doses of fl. ext. ergot controled the hemorrhage. My deductions were that too much of the drug was used.
apropos at the present writing. It seems A prescription for tonsillitis might be to be well nigh a specific, a rheumatic tendency being present in most cases:
Tr. ferri chlor. Quinin sulf..
Acid phos. dil
Aquae vel elixir ad........... M. Sig. to 1 teaspoonful in water 1 to 2 hours after meals. May refill.
Such cases often have a spinal cause, and the underlying cause may be gout. Examin points where nerves leave spine for deposits in close quarters for the nerves. Use iodids (best ung. iodid hydrarg., rub.). The above has been used
for several "handsome" women.
Dr. Young's case (same page) is chronic catarrh of bile ducts. It is likely if he taps a little rufly his patient will confess to a sore spot in right hypochondriac region. Give phosphate of soda in hot water and milk at meals, cream of tartar freely at ten a. m. and at bed time, two grains quinin on rising and at 4 p. m., and grain strychnin before meals. Apply nitromuriatic acid on six-fold pad, 5x7 in., hot, wet, soft cotton, 40 drops for one hour twice a day, not over three times. Also use same acid in foot bath and sponge bath followed by bland "grease bath"
every eight hours. One pad treatment
beats a week of the same medicin inside. Cover pad with wool cloth and oil cloth if handy.
Dr. Thomas' case of hysteria page) would doubtless respond to ammonium chlorid taken on empty stomach.
Dr. Kraft's case of neuralgia (page 392) might be due to autoinfection simulating malaria. Compound jalap with teaspoonful extra of cream of tartar will clean out the infecting material when nothing else will. Follow with three grains quinin sulf; repeat in three hours. Give jalap second or third day if needed. Eucalyptus is the best drug for cleansing without undue stimulation of irritated nerves. Give to 1 dr. of the jalap compound in a glass of water on rising. Eat three meals that day, not too much.
For those causes of slow pulses like Dr. Thomason's (same page) I would give citrate of potassium and wine of colchicum with wine of antimony, may be, after meals. Lime water once or twice a week only, and potassium bicarbonate where an alkali is needed, to help digest fats, but give fats thru skin unless the lungs or weather prevent enuf oxygen being absorbed to use up fats. The alkali is indispensable to get rid of carbonic acid gas so oxygen can be received. Only a few fruits have enuf neutral salts to be of value. Barberries are said to combine the malates and citrates, but salts are cheap. Call them fruit salts and say you do not prescribe the fodder or roughness that goes with them, and you do not want the sugars. WORLD is taken up too much with cases and not enuf with causation. The cases have each an organ needing attention first, but what second? You may help an organ only to reveal others showing a diathesis. Eye symptoms and kidney symptoms are apt to go together, even in so slight a disease as chicken-pox. tex headache, tender scalp, nerve exhaustion," morning or after-meals spitting, constipation "unless patient uses drugs, are all symptoms of carbon excess, oxygen deficit. Now, as fats take much oxygen, sugars and starches less and leans least, you need not starve a patient unless the leans are too much for the kidneys, as would doubtless be the case in Dr. Snodgrass' and A. C. L.'s cases (next page). Dr. Loope's case (page 394) is most likely, judging from dry throat, complicated with auto-infection, the particular type being
rheumatic; salicylate of soda, ammonium chlorid, Rochelle salts, etc., are indicated. Avoid excess of any one food, especially what is liked best. In two weeks patient will be apt to see that food hurts him, and indulgence sets him back three days. Many dry throats are accompanied by a hack, or clearing of throat, sometimes believed to run in the family, but really due to family habit, such as eating cold and hot fats "to keep them from going to waste." Stone root is useful; also pareira brava.
It should be noted that Dr. Seafuse does not say his patient's liver and skin are normal. Perhaps a jaborandi sweat would remove enuf impurities to quiet the brain disorders. If such a case "always sleeps well" it may be on the principle of those who always eat well what they like but do not know what hurts them. However, the kidneys may be really excellent and accommodating enuf to do part of the work for the skin, if helpt by medicin for "costiveness." That points to the liver again. Thump over it. It is often but slightly tender, but a little is enuf to denote some retention of cholesterin, which is excitant unless in excess. Thin the bile with the acid pad, soda phosphate, etc. Soothe the ducts with coca and hydrastis. Change the nerve regulator to cimicifuga or pulsatilla.
Dr. Gibbs' case (page 398) is very likely gout. Dose of grey powder every third day and colchicum and alkali; perhaps also small doses of nitric acid before meals. Hot, wet cloth over kidneys for forty minutes at bedtime. Kidney symptoms are doubtless due to absorption of acid ferment products from a "slight" spot in bowels. Injections of ox gall may reach it, but colchicum will bring away vast quantities of acid mucus, the existence of which was unsuspected; and it succeeds where cascara has lost its effect."
Dr. Ballard's Case 1 is gout of the skin. Use antimony for itching, "hot, wet" over kidneys, "fruit salts." Locally, balsam of Peru diluted with white petrolatum and salicylic acid. Case 2. Look carefully for "congestion of lung" deposits, most likely left lower lobe, and worse when urates are not present in urin. Case needs air and exercise. There is doubtless naso-pharyngeal catarrh, the ache from which varies, but is apt to come awhile after rising. Patient rises late, likely, and brings it on at noon, instead