« ForrigeFortsett »
tor's calling and work is indeed more enob. In this place, it is but fitting to speak of ·ling, self-sacrificing and with a bigher end the niggardly practice of physicians encour. result than that of the lawyer. While the aging the various insurance companies who lawyer struggles over the mere dollars and pay for the first aid treatment for injuries of cents in dispute, the doctor struggles for the employes of corporations to cut their rates to life of his patient, besides which the posses. the absurd state so largely exposed in the sion of wealth fades into insignificance. Journal of the American Medical Associa
The practice of medicine at the present tion. In the issue of Maroh 31, 1906, there time requires a liberal preliminary and pro. is interesting reading concerning the rebuke fessional education. It requires residence given by the editor of the Journal to the presin hospitals without pay, it requires time for ident of the Maryland Casualty Company for post-graduate work. It requires money for the ridiculously low scale adopted by that expensive equipment, instruments of preci. company for payment of physicians employed sion and skill. Improvements in these in. by them. The president of that company struments leads to their disuse and the nec. denies the right of the medical press to proessity of buying new paraphenalia from time test against these low rates for service. He to time. And again, after a time of hard work says it is no man's business to protest against in practice, the up-to-date physician needs a them as long as physicians are content to rest, a change of scene and a relaxation from take the work and take the pay offered by labor. At the same time, after a while he them for such work. We contend with Dr. needs to visit medical centers of learning, Simmons that it is the province of the medical there to refresh himself by attendance with press to protest. We contend that the physi. the masters so as to avail himself of all the cian should refuse to give their services for new methods and advances since the time of niggardly fees. These accident and casualty his last post-graduate study. All this requires companies derive a large part of their revenue money. This money must be made by a from the practicing medical profession. judicious taxation of his patients, according They have at their disposal at all times the to their means. Mistakes are made by phy. honest advice and honest opinions of the sician as a rule in estimating the size of his medical men who are treating accident cases patient's pocket-books with a loss on the all over the country. They should be willing side of the physician. The layman is too to encourage the medical profession in the prone to take advantage of the physician in high oharacter of its work by lifting it out finance. The laity know how we estimate a of the commercial field in which they are try. fee by the means of the patient and some of ing to put it by elevating rather than by dethem know how to accordingly underestimate preciating their fee lists. They do not real. their financial standing with physioians. ize that such a depreciation long-continued More care should be exercised by the physi. will work great havoc to their own interests. cian in this regard.
Suppose for a moment, that a doctor could At the same time, the practice of some be bought" and sold” for the highest bid. physicians of remarking that such and such der; suppose bis opinion instead of being a specialist's fees are "too large,” or this or candid and bonest and straightforward, that surgeon's fee list "too high" should be whether it be good for the patient's pooket. depreciated. Instead there should be a laud. book or for the company's, was always de. able effort made to make the practitioner's pendent upon the amount of money offered clientele understand that the physician must to him, what state of affairs would follow be well paid if he is to give the best that is in with these accident and casualty oompanies ? him in the saving of human life. This de. Many and many a damage suit is averted, preciation of another physician by one physi. many and many a damage suit is settled out cian is most pernicious, and only serves to of court through the honest offices of the at. make the rates worse than they are now. tending physician, and always with an adWhen patients are brought to the surgeon vantage for the company; many and many a for operation, the practitioner should not fix case in court ends with a judgment ma. the fee for the surgeon. Let the surgeon at. terially reduced by virtue of the attending tend to that. If he gets a fee of the proper doctor's honest expression of opinion consize from the patient, the practitioner who cerning his patient's injury. What would has sent him the patient should not com. bappen to the accident and casualty commiserate with the patient afterwards, agree. paines if by their aptagonisn, their cheap ing with him that the fee was "exorbitant," methods, their commercializing tenedencies as is often done. Let him defend the higher they so brought it about that medical prostandard and let him also elevate his own fessional opinions could tbus be bartered ? standard. In no other way can this matter There is no reason to fear that this could be put in its proper place.
ever happen, yet these companies should be reminded at this time of their injustice and tunities for improvement go by and then their narrowness in viewing the matter of bemoan bis fate, when according to the law payment for medical attention.
of natural events, this ebb of work is really R. B. H. G. an opportunity to be ready for the flow when
"Let us then be up and doing,
With a heart for any fate, The past winter has been one of those re
Still achieving, still pursuing, markable seasons wben a wave of universal
Learn to labor and to wait."
F. P. N. good health has swept
over the entire country, A Lesson
and especially here, in from the Wave the Mississippi Valley, The City of St. Louis and the profession of Universal where climatic condi. have recently suffered great loss in the death Health. tions bave been suob as
of Dr. C. A. Snodgras, to insure no epidemics,
Health Commissioner and to prevent even the Dr. Charles A. of this city. Dr. ordinary diseases of winter in their usual Snodgras, Health. Charles A. Snodgras frequency. As a result of this rather uppre. Commissioner was born forty-two cedented state of good health, physicians of St. Louis. years ago on a farm in have had comparatively little to do. To the
Jackson county, Mo, public, upon whose woes the prosperity of
His fatber, William A. the physician depends, this has been a bless. Snodgras, and mother are living at an ading, but to many physicians it has been a vanced age and reside with his sister, Mrs. great hardship and trial. The young physi. Emily B. Mays, at Independence, Mo. cian, just entering practice, bas felt keenly Dr. Snodgrass gained bis collegiate educathe idleness which while expected, has been tion at the Missouri State University; after rather beyond the expectations of the most leaving this institution he taught for some sanguine, while to many thoughtful physi. years and spent his summers in post-graduate cians of established practice it has proven an study at the University of Chicago, where unmixed blessing, because it has created an be perfected himself in the branob of learnopportunity to avail themselves of the post. ing which was to be his life work. graduate school privileges, now so thoroughly In 1898, Dr. Snodgras came to St. Louis presented in our many excellent schools in and was attached to the Department of Anatthis country. The physicians supply dealers, omy of Washington University. His indonpharmaceutical houses and physicians' spec. itable will and close application to the study ialty dealers have not had a very prosperous of medioine while teaching in Washington winter, due to the lack of demand for their University enabled him to take the degree of goods. Now, reviewing conditions as they Dootor of Medicine at that university in the are all in all, it has been a good season, and year 1900. physicians should not complain, for after all As a bacteriologist he did some very valuathe public upon whom patonage depends, has ble work in the recent suit of the City of St. been blessed and profited, and after all the Louis regarding the Chicago drainage canal, public gives due consideration to medicine, his investigations being complete and conwhen the demand exists, and will always be vincing to men of science. a friend to progressive medicine.
In 1903 Dr. Snodgras was appointed city We quite agree with John Burroughs in bacteriologist by the Mayor of St. Louis, in believing that to share the common lot is wbiob position he worked unremittingly un. good enough for any one, and that “unlucky til his promotion to the position, first, of is the man who is born with great expecta. acting health commissioner, and finally-on tions,” especially in medicine. Such trying the removal of the former incumbent-health times as this past season give many a pbysi. commisisoner, of the city St. Louis. ciao an opportunity to take account of stock Dr. Snodgras, while employed in teaching and see what he really has to offer as services in Marshall, Mo., became acquainted with to a willing publio when the opportunity Miss Anna Gamble, a colaborer along edu. eventually comes. He should clean up his cational lines in this school, and the acstock, brush the cobwebs and dust off some quaintance led to their marriage. Two child. of his old ideas, put in new thoughts by ren, Alvin, aged five years, and Dorothy aged reading and study and visiting clinics, and three years, together with his wife, remain to thus make conditions really declare dividends mourn his untimely death, which nocurred by being better prepared for work when it as a result of double pneumonia on Friday, does come. We have little sympathy with April 6th, 2:30 p.m., at the City Hospital of the man who is contented to let such oppor. St. Louis, notwithstanding the ungrudging
to ele Howanis tae
and sedulous attention of bis professional ope and all, feel that in him they had a sucolleagues.
perior officer with whom they could consult Having been intimately associated with Dr. and confer, and that ideas or suggestions Snodgras for the last three years, and for the made to him found always ready and careful last year coming in daily contact with him, attention. In his death the medical profession perhaps an estimate by me of his sterling loses a valuable member, the city an honest, worth and singular upity of purpose will not upright, and conscientious servant, and his be amiss. Dr. Snodgras was a man whose family a devoted and loving husband and mind had never been contaminated by any father. Thougb his publio life was indeed thing small or selfish. The one ambition short, yet it stands out clearly and boldly. that possessed him—that shaped his every It serves to set up a standard that those who at was the desire to elevate the professional follow him must strive to emulate. If naught standing of medicine. He was just and rig- but this were left by him as a heritage his life orously honest. Simple in bis tastes and has served a noble purpose. H.J.SHERCK. mode of life-even childlike in his simplio
MEMORIAL MEETING OF THE ST. LOUIS MEDICAL ity-yet witbal the whole strength of his char. ' M. aoter seemed encompassed in the idea of
SOCIETY. stalwart manbood and professional zeal. Had Exercises in memory of Dr. Charles A. it not been for bis tenacity of purpose it Snodgras, health commissioner, were held by would indeed have been difficult for him to the St. Louis Medical Society in the society's attain that degree of scientific knowledge and hall, 3525 Pine street, at 4 o'clock Sunday, professional acumen which became his very April 15th. Dr. George Homan, president life, but which was accomplished by slow and of the society, presided. patient application in various and tiresome The invocation and benediotion were pro. struggles. Upon his promotion to the office nounced by Rev. John W. Day, pastor of of health comissioner his entire energy was the church of the Messiah. Short addresses devoted to a complete study of the various were delivered by Dr. Homan, Mayor Rolla departments under him, in order that, before Wells; Dr. W. G. Moore, Attorney Henry T. attempting any improvement, he might be Kent, president of the Civio League; Dr. W. J. thoroughly acquainted with every detail. To Miller, president of the Eclectic Medical Soaccomplish this purpose he gave each and ciety, and John H. Matthews, bookkeeper in every department careful and consistent the health department. At the close of the adstudy, making an extensive tour of the im. dresses, a memorial to Dr. Snodgras, prepared portant pathological laboratories of the coun. by a committee composed of Dr. Robert try, with the result that in a remarkably short Luedeking, Dr. John Joung Brown, Dr. O. time the several departments, their work and H. Elbrecht, Dr. W. G. Moore and Dr. L. divisions, were entirely familiar to him. As H. Behrens was read by Dr. Luedeking and a result of many important innovations bad adopted by a rising vote. been begun. There was in contemplation by Dr. Homan spoke of Dr. Snodgras as one bim the establishment of a tuberculosis who, in the apparent prime of vigor and clinic, at which those unfortunates afflicted official usefulness, was called away when with this grave disease were not only to be great possibilities of worthy achievements treated but to be educated in the methods seemed about to be realized. which had for their object not only tbe Mayor Wells' theme was "The Man as an benefit of the individual but the protection Offioial.” He referred to Dr. Snodgras as his of those who came in contact with him. loyal friend and publio fellow-worker; a man The idea of having diphtheria antitoxin sup- imbued with purity of thought and whose plied to all worthy poor and administered by whole being had been conservated to the up. The pbysicians connected with this depart. lifting of mankind. ment was another of the aims which was Dr. Moore, on behalf of the medical soshortly to be accomplished. The fight begun ciety, spoke on “Appreciation of the Man by by the St. Louis Medical Society against ir- the Medical Profession.” He reviewed step regular and irresponsible practitioners of by step the life of Dr. Snodgras, beginning medicine found in him a worthy ally and one with his birth in Lexington, Mo., January without whose aid the difficulties of this fight 2, 1864, to his connection with the health dewill be greatly increased.
partment. In the space of this brief article it is indeed Mr. Kent, on behalf of the Civic League, a difficult task to enumerate the many accom- spoke on "The Appreciation of the Man by plishments and plans that he had in view the Community at Large." He possessed the confidence of each and every Mr. Matthews spoke of the kindness and one of his subordinates. His simplicity of consideration with which Dr. Snodgras manner, his open-heartedness, made them, reated his subordinates.
REPORTS ON PROGRESS value in diagnosis is the succussion sound, Comprising the Regular Contributions of the Fortnightly De- and the examination by the stomach tube re
vealing the characteristic fluid and enormous
size of the stomach. The prognosis is grave, INTERNAL MEDICINE.
an extremely small number of recognized
cases have reouvered. Types of more moder0. E. LADEMANN, M. D.
ate severity probably occur and end in recov.
ery so that the prognosis, if these cases were Acute Dilation of the Stomach.-Herrick more accurately reognized, would not be so (Jour. A. M. A., March 31, 1906) speaks of grave as it is generally supposed to be. Some acute gastric dilation as a rare and extremely of the instances of late nausea and vomiting grave condition. Its recognition is not al. after anesthetics may be due to milder forms ways easy, yet important, as it is probable of acute dilation. Death when it occurs may that the earlier treatment is begun the better be within the first forty-eight hours, or it may is the outlook. He reports in detail two be delayed for more than a week. In general cases, one of them with a complicated pneu. the disease runs its fatal course within a monia ending in recovery, and the other ter week. Relapse may occur,and intermissions minating fatally. A comparative study of of several hours with cessation of vomiting the symptoms of these cases with those re- and improvement in symptoms have been corded in literature are in most respects quite noted several times. The treatment should identical. The onset is sudden. There may consist in frequent gastrio lavage, saline sobe a complaint of abdominal discomfort and lution by the bowel and under the skin, nupain, the latter may be quite severe. Vomit. trientenemata, strychnin and other stimulants ing large amount, which may be offensive, of hypodermatically. Change of posture to the a brownish, grayish, greanish or black color right or to the abdominal decubitus should is quite characteristic, It almost seems to be tried to relieve tbe possible diag of the run out of the patient's mouth rather than mesenterio vessels on the duodenum or the to be forcibly ejeoted. The urine is scanty; pressure of the overloaded stomach on the the bowels loose or constipated. The tem. same portion of the bowel. It has occurred perature is often subnormal, the skin cold to the writer that possibly the stomach might and clammy, small and rapid pulse, extreme be induced to contract by the application of ice thirst; in short the picture of collapse. to the abdominal wall, or of hot water or even The abdomen, especially the lower half, is hot air put into the stomach through the distended, though it may be flat if the stom. tube in the same way that the inert uterus ach be well emptied for the time being after confinement can be induced to contract through free vomiting. A slight peristaltic through these means. That the stomach wall wave was observed in one case. The per- has not entirely lost it elasticity and contraccussion note is drum like over the gas-con- tibility has been shown by its prompt shrinktaining part of the viscus and flat over the ing to the escape of gas when pricked postfluid. Fluotuation and the succussion sound mortem, as well as by the same contraction are clearly made out, the stomach tube with in the wall when at operation in a few cases draws a large amount, sometimes several the stomach has been opened and emptied of pints, of brownish, greenish or blackish rather its gas and fluid. In intractable oases gastrothin or gruelly fluid. This fluid generally jejunostomy is advocated. As etiologio faccontains bile, perhaps pancreatio juice and ors are given trauma, surgical operation, oversome altered blood. Free HCl, as a rule, is loading of the stomach, preceding or accomlacking; lactic acid has been found several panying diseased conditions. In some cases times. The odor is often offensive, almost the condition must be regrarded as idiopathic never feculent. The gas tbat escapes through as no cause whatever is discernible. Conthe tube or by belohing is often abundant cerning the pathogenesis, Herriok says that and may be of foul odor. H.S has been more careful histologic, chemical and bacterfound in one or two instances. The stom. iologio examinations are necessary before this ach, with or without the aid of distension, condition shall be made clear, and more atby air injected through the tube, can be out. tention should be given by the clinician to lined as greatly enlarged, extending to the noting the condition of the stomach as resymphysis. The abdomen flattens in contour gards location and size before and during as the fluid and gas are withdrawn by the operations and at the heginning of infectious tube. The diagnosis is not as easy as one diseases. A previously existing gastroptosis might think. To be considered are periton might predispose to acute dilation. So, too, itis, either general or local, intestinal obstruc. the condition of the stools during these attion, pancreatic cyst, uremia, postanesthetic tauks might show whether or not the same vomiting and acute pancreatis. Of especial peouliar blackish material found in the stom
drawe of brownis bereid om This
ach is present in the lower bowel, and in this drops of the concentrated hydrochloric acid, way throw some light on the possible pres. diluting the whole several times with distilled ence of duodenal obstruction.
water, an amethyst-violet color appears.
Fluids to be tested containing a large amount Santonin in the Urine.- Neubaus (Deutsche
of bilepigment should be diluted about ten Medizinische Wochenschrift, No. 12, 1906)
times with distilled water before testing. suggests the following as a reliable and effi.
The writer urgently recommends this reaccient test for santonin in the urine: A few
tion as more delicate than the tests of drops of Fehling's solution are added to sov.
Gmelin, Brucke, Fleischl, Rosenbach, Smitheral co. of urine, whereupon a dark green color
Marechal and Rosin. appears which changes to dark violet-red as the amount of copper solution is increased.
Aortic-Rupture and Arteriosclerosis in ChildOn adding an aoid, preferably acetio acid, the ren.-Oppenheimer (Virchow's Archiv, Bd. color turns to a light green. Stronger acids lxxi, Heft No. 1, 1906) reports in render it a darker green. The reaction is ex. interesting cases of arteriosclerosis in boys, quisite in the urine of children taking the age 9 and 10 respectively. In the first case ordinary dose of satonnin, while adults re. the child died from spontaneous rupture of quire a correspondingly larger dose of the the aorta. Oppenheimer regards the high drug. The only drug causing a similar reac blood pressure and a possible congenital tion wbich the author observed is rhubarb, al. weakness of the wall of the artery as responsithough differing from the santonin reaction ble for the condition, while the cause in the in an absence of the violet-red color on the second boy was undoubtedly of toxio origin. aditional adding of Fehling's solution, and The pathologic findings in each instance were the light green appearing when an acid is identical to those of typical arteriosclerosis. added is of a dirty tint.
Gastric Mucus.-Schütz (Archiv für VerSuicide by Means of Veronal.- Ebrlich danungs's Krankheiten, Bd. xl, Heft 5 and (Muenchner Medizinische Wochenschrift. 6, 1906) article embraces an elaborate disNo. 12, 1906) had the ocousion of observing course on pathologio variations in the secretwo cases of suicide by this means. The
tion of muous in the stomach. His studies symptoms in each case closely simulated consisted in examining the expressed contents opium poisoning, consisting in cyanosis, of a test meal one hour after its ingestion, unconsciousness. superficial respiration with an examination of the rising water obtained intervals of cessation, vomiting.cold extrem. after the stomach had been emptied, and the ities, pupil contracted to the size of a pin's stomach contents obtained by expression and head without any reaction, and a pulse vary. lavaging of the fasting stomach. He presents ing in volume (small) to complete impercep. in tabulated form the findings in 110 patients tibility. In the one case, à melancholiac with various gastric affections who had been with suicidal tendenoy, age 57, death ensued subjected to these three tests. In 52 per cent thirty hours after the taking of 15 grams of the cases the mucus present was in exand the other twenty hours after 11 grams. cessive amount, while in the remaining num
ber of patients it was either scanty or absent A Delicate Reaction for Bilepigment.-Kro altogether. Among the latter there were 9 küwicz (Muenchner Medizinische Wochen. · cases of achylia gastrica, 8 of motor insuffi. schrift, No. 11, 1906) published this test for cienoy, 7 of gastralgia, 9 of gastrio neurosis, the detection of bile in the urine in 1898, and 4 of anacidity, 3 of hyperacidity, 1 of ectahas since given the reaction a thorough trial sia, 2 of chronic catarrh, and one each of in testing for bilepigment in other fuids ulcer, subacidity, cicatricial stenosis of the (stomach contents, etc.). In making the test pylorio end, gastrosuccborrhea, constipation, three reagents are required, namely: (a) one renal calouli, acute dyspepsia and icterus. per cent aqueous solution of sulfanilic acid; In 28 cases of chronio gastric catarrh, 6 cases (b) one per cent watery solution of sodium of cancer of the stomach, one case of hepatic nitrite; (c) chemically pure concentrated cancer and in one of gastric ulcer the hydrochloric acid. The solutions a and b mucus was found excessive at all three should be kept in dark bottles. One cc, each tests. In the second and third tests alone, of solutions 8 and b are thorougbly shaken the mucous was found excessive in ten in a test-tube for a short time, when all save patients, among them one case of eotasia, a few drops of the contents (one-half co. at two of motor insufficiency, one of gas. the most) are poured out of the tube. To the trosucohorrhea, one of ohronio nephritis contents remaining in the tube an equal with dyspepsia and in three of gastric neuamount of the fluid to be tested is added rosis. The muous was found excessive in (about one-half co.). This mixture turns a only the second test in two cases of moto, ruby-red color and by adding one or two insufficiency and in one case of gastri