25c. and 15c. When such prices for grain prevail, collections from farmers become very slow and unsatisfactory. This is no longer a wheat-growing section, so the price of wheat, because of the foreign demand, does not affect us, except in the higher price for flour. Since people are generally employed and the prices of farm products improved, collections are better this fall than since 1893. Bryan, free trade and free coinage of silver would have been disastrous to this part of the country. Our strongest country banks must have suspended. GEO. COVERT, M.D.

Clinton, Wis.

The Doctor seems to be satisfied to collect 60 per cent. If bankers, who control money, the blood of commerce," couldn't do better than that, "our strongest country banks" would have to suspend. Then why should we be satisfied with it? If conditions were such that every man would receive absolute justice, no more and no less, every family would be able to pay for a physician's services, but no family would possess millions. This subject will be worth thinking about and talking about by physicians until every willing hand has an opportunity to earn a living and pay his doctor.-ED.]

The Economic Status of the Medical Profession.

Dr. Ely expresses pleasure at the publication of his letter on gold in January issue. Many think that all goldites are aristocrats; the following letter proves this to be untrue. I take great pleasure in publishing contributions from goldite sources, for I have been accused of discriminating against contributions from the gold side. While I cannot attempt to publish near all of the matter offered on economic questions, yet the fact is that I publish a far greater proportion from the gold side than from the opponents of gold. We are after the truth, and our opponents must have a fair hearing. But the following letter, while from a goldite source, is not on gold; and because of its length, and not being on the treatment of disease (tho directly concerning the medical profession) we put it in smaller type:

Editor MEDICal World:—Society is divided into three pretty well defined classes:

Ist. The producers; i. e., those whose hands do the actual work of production, as farmers, laborers, artizans, etc.

2d. The contributors; merchants, capitalists,

tradesmen, superintendents, professional men and the like.

3d. The drones; speculators, wealthy idlers who live upon the income of their wealth, coupon-cutters, gamblers, sharpers and the criminal classes generally.

Now, the products of industry are distributed with glaring inequality between the "producers" and the "contributors; " the latter receiving a share out of all proportion to the be the better apprehended when it is considered that a 15 per cent. rise in the retail price of industrial products, if paid to the producers would add 98 per cent. to their annual wage.

relative value of their services. This fact will

It is well to remember that, while the "contributors" are absolutely dependent upon the "producers" for the things they want, these latter, when it comes to the last resort, can get along in some fashion without assistance from the other class. Practical knowledge and manual skill are confined almost exclusively to the "producers." Their sort of knowledge is fundamental, but it fails to command that respect from the community at large which in the order of nature belongs to it.

While there is little room for debate that some occupations ought to yield a higher wage than others, the margin between $250 and $100,000 a year represents a ratio immensely greater than the relative value of the different kinds of service. And yet such differences exist, and even greater. These princely salaries are never paid to the "producers."

While the incomes derived from our profession are not exceptionally large, it would be well for us to consider this question as it relates to us.

A doctor spends three or four years of study in preparatiou for entering upon his work; so also does a carpenter or machinist. But, while the embryo doctor gives his whole time to his study, so that it is a total loss to him, the artizan is paid a small stipend during the years of his apprenticeship. On the face of it, there appears to be sound reason why a doctor should command a higher wage than the artizan. But there is another aspect to the case My observation of men has taught me that the acquisition of knowledge carries with it its own reward in the satisfaction in its possession. While it is true that there is an element in it of capital invested, it is not wholly a matter of dollars and cents. I am convinced that nearly the whole body of really earnest workers in the medical profession would be in it just the same, did it hold out to them nothing better than the prospect of an excellent social position and a fairly certain livelihood, such as is presented to carpenters and machinists. And yet, the notion is very widely spread that a doctor, in the fact alone that he is a member of one of the "learned pro fessions," is entitled to have a larger and better house to live in, more elegant and luxurious furniture, better food and more of it, finer

and warmer clothing and in greater variety; more, in fact, of every good thing of proper desire than the men who exhaust their physical and intellectual energies in devising and creating them. It matters nothing that your doctor" is a mere hanger-on to the skirts of medical science, with no higher ambition than to convert his rush-light of knowledge into a mill for grinding out the largest amount of money with the smallest possible expenditure of energy. He is a "doctor," and because a doctor he is therefore entitled to a larger share of this world's good things than common ordinary folks. He thinks he ought to have a larger income; that he ought to amass a fortune; and that he is entitled to an old age of luxurious idleness, simply in the fact that he is a "doctor."

Our fee-bilis are an evolution of this feeling, in some measure. Whenever the fees specified by them are exacted without the most thoughtful care, we take from our patrons in an hour the earnings of months, and often the savings of years of patient industry and thrift. To my mind, there is something radically inequitable in this; our services are not so transcendently more valuable than those of skilled artisans in other walks in life. Granted that they are more valuable, the intrinsic difference is magnified many times over in our fee bills. True it is that much of our work is done gratis, and that a good deal more is done for a merely nominal fee; but the great bulk of this sort of work is done, not by the grumblers who whine in public over their "bad collections," but by the quiet earnest workers for scientific advance

ment.

Now to the point: -Many of our brethren report such and such a "percentage" of their charges as collected, and the margin ranges all the way from 40 to 95 per cent. What does all this signify? Nothing; absolutely nothing beyond the operation of the personal factor. Your 40 per cent. man, in all probability, is one of those who "books" the full limit of the fee-bill and collects what he can, unless he is one of those who are too much absorbed in his professional work to get down to the drudgery of plying the "muck-hook"; while your 95 per cent. man is either a merciless collector, or one who charges about what he thinks his patrons can pay. And these differences will exist at all times and under all sorts of social conditions. There is a fair illustration of one of the high percentage men right here. Without knowing just what his collections amount to, it will be entirely safe to estimate that he collects 98 per cent. of all his fees-probably the other two per cent. also. And his collections were just as good in '93'94 as now or before the crash. Here is where the personal factor comes in play. Every instinct of one man is for "business," and such a one makes a good showing in his collections; another cares for anything else rather than for "business, " and such a man would

make a poor showing whether times are good or bad.

I know something of this matter from personal experience. Twenty years of trials have failed to make a good collector of me. Yet, since I got fairly into the professional harness, I have never failed to get enough out of my work to support my family vastly more comfortably than the average artizan, and I find no fault. That I haven't gotten more is due wholly to myself.

I have noticed for some time past a good deal of medical literature in several of our journals, which reads to my mind very much like whining; about an "overcrowded" profession, and an "underpaid" profession, a "waning" profession, and much more to the same purpose, coupled with suggestions aimed at imposing additional difficulties to getting into it a sort of trades unionism. To my mind, all this is undignified in the last degree, and, to the extent that it gets into the secular journals, it helps to drag down the profession in the public estimation; and it ought to. The man who has to go about in the community begging for consideration and respect is worthy of all the contempt that can be heaped upon him; he deserves no respect, and he will be likely to get what he deserves. And what is true of an individual is equally true of a body of men. Respect that is not the spontaneous tribute to excellence is coveted by no one but a quack. These complaints that we hear so much of these days are nothing more than the self-assertion of bald quackery; it is the very quintessence of quackery; the insertion of a bragging advertisement in the newspapers is a mere bagatelle in comparison.

The plain facts of the matter are that these alleged hundred thousand dollar incomes, supposed to be collected by certain of the more favored of our brethren in the cities, are responsible for our ranks being recruited from the great herd of mercenaries whose only ambition is to get rich and do it "nice and easy."

From whence do these whinings emanate? From the earnest enthusiastic workers for medical science? Never! But from a class of men who, too lazy to work out a living in agriculture, too stupid to catch on to the finesse of "business, or too clumsy with their hands to make respectable mechanics, gravitate into medicine, under the impression that it is a "nice easy job; "that its fat fees are to be had for the taking, and that it is "so respectable."

I have sometimes thought it would be an unmixed blessing to the profession, and to society as well, if collections could be so reduced as to weed out of its ranks the whole of this undesirable "material," and leave none but such as are devoted to science first and to lucre secondarily. None such need ever fear for his living or his respectability, or undue "competition."

What proportion of us ever brought into his

profession anything more than his time? Judging from my own observation, less than one per cent. All this talk about the thoussands one has "invested" in his profession, is nothing but rubbish. The vast majority of us have "invested" nothing but what every carpenter and machinist has invested in his trade. It is the simplest matter in the world for me to show $20,000 "invested "in my profession. But what of that? I chose to go into medicine because my tastes led in that direction; and if my tastes were to lead elsewhere now, there would I go, nor count my time as an "investment." If we have put large sums of money into our libraries and instruments, it is because the extra compensation yielded by our services has provided the means to do so. It therefore comes back to an investment of our time merely. So let there be an end of this disgraceful agitation for better pay and more distinguished consideration. Every doctor has an absolute monopoly of his time, his abilities and his reputation, and his remuneration is "all the traffic will bear "in the locality where he lives; and, in general, he gets all he is worth. If he can't make a respectable living, let him look to himself and see wherein he fails to deserve more, and it is dollars to road-dust that he will find either that he is not giving good service, or else that he is mentally unqualified to assume the responsibilities of medical work For one, I am nauseated with this eternally flaunting before the public its lack of appreciation and adequate support; it is an insult to society, wanton and uncalled for, and the certain badge of our lack of desert or our insatiable greed. While it is beyond question that there are individuals here and there whose talents fail of commanding that respect which is their due, it is also true that scientific medicine and its representatives are appreciated to the full extent of their deserts. If, as individuals, we deserve respect and liberal support, it will come to us as the spontaneous tribute to excellence. To sue for it, is degrading and is beneath the dignity of every right minded physician; and the more we beg, the deeper is our degradation the more we work for it as an ulterior object, the more surely shall we miss it; for society is quick to discern. If the medical profession cannot maintain the respectability of its social position upon the spontaneous tribute of society, it will surely go down-and it ought to. When that time comes, we shall have outlived our usefulness..

44

ing. It producers" should get full justice, and it "contributors" should get only their just due, and if there were no "drones," then every man would be able to pay a moderate fee to his doctor. This condition would be very desirable to all (except the greedy), and in every way more satisfactory to doctors, than the present condition of society, in which charity and loss from inability to pay is so large a factor in our practice. These problems are worth thinking about.-ED]

A Suggestion to the South.

C. F. TAYLOR, M.D.,

Philadelphia, Pa.

DEAR DOCTOR :-Your remarks in answer to Dr. Boswell of Wisner, Neb. in December WORLD, were timely and to the point. In this part of the country prosperity has not shown up yet. The doctors and farmers, in fact all classes, especially the doctors, would like a share of that prosperity promised the people by the present administration. Doctors are not, as a rule, collecting 25 per cent. of their bills this year. So far as I can learn, there is a short crop of cotton all over the cotton growing states except perhaps a few favored spots, and yet cotton is selling here in the markets from 3% to 5 cents per pound. Consequently all classes of creditors are making short collections, and the majority of laborers and farmers have not paid their debts, and have nothing to live on until the next crop is made. Can you give any reason for the low price of cotton? I would like to ask Dr. Boswell the following questions:

Ist. If the gold standard, high tariff, etc., have brought such prosperity to the North and West, why do they not bring prosperity to the South also?

2nd. What is the cause of the low price (31⁄2 to 5 cents per lb) of cotton?

Business of all kinds is at a low ebb in this section, and it is getting worse every year. Heretofore when farmers hauled their cotton loaded with flour and goods of various kinds to market they returned with their wagons for their own use; but they come back from market now with their wagons empty or nearly so. The future looks dark and gloomy. Fraternally yours, Sexton, Tex.

G. W. WOODS, M. D.

[The above is one of a number of similar letters that I have received recently from the cotton growing districts, concerning the price of cotton, one of which I sent to Dr. Boswell, in answer to which he asks the following pertinent question: "Why do not southern farmers raise more food products, as the cereals, pork, etc., so they will not have to buy these necessities?" This suggestion contains much food for profitable re

flection. Texas, for example, is too great a state to stake all on a single crop, and one which cannot be consumed at home. Her resources are vast, and she should not allow herself to depend upon the North for food.

Just why the price of cotton is so low I can hardly say. The price of wheat is now quite satisfactory on account of short crops abroad, and the price of other food products has been helped along with wheat. I am not informed as to the foreign crops of cotton; but, at any rate, would it not be well for southern farmers to become independent of those who manipulate the cotton market and the money volume? This is a remedy that is in their own hands, while we have not yet succeeded in making the money volume and the control of the same what we think it ought to be to maintain fair prices.

The great increase in the use of fabrics made from wool, linen and silk, better fabrics than those made from cotton, suggests the thought that perhaps the demand for cotton is relatively less than formerly. At any rate, the southern farmer will not miss it by supplying from his own farm as much as possible of his food requirements.—ED.]

Fluke.

ONE of our patiently investigating readers sends us the following note:

Fluke, page 21, January WORLD. After a half hour's tracing in Gould's Medical Dictionary, I finally found it under "Fasciola Hepatica," in the list of parasites, page 992, where about a half page is given to its history, description,

etc.

Electrical Treatment.

Editor MEDICAL WORLD:-Answer to Dr. W. T. Taylor, in WORLD for May, 1897, page 139.

This case is in all probability a case of exudation and proliferation about the involved joint; this being the result of malnutrition caused by the exposure and subsequent traumatism received.

The atrophy of the quadriceps extensor muscle is primarily due to the malnutrition, later to the pressure caused by the transudate and finally to non-use, with the result of insufficient oxidation

caused by deficient chemico-nutrition amounting to malnutrition.

The pain along the sciatic nerve is accounted for by the same causes, viz:— malnutrition and pressure.

The crepitus, likewise, is brought about by malnutrition and pressure causing deficient and perhaps changed synovial fluid.

Treatment:-The treatment that this case has received is very good as far as it goes, but it does not go far enough.

I, therefore, would advise the use of electricity in its proper form, and will try to make clear the mode of application and the reason why.

In adopting a definite line of treatment in electro-therapy as well as in any other, we must have a reason, a logical deduction for the same, and this I will base upon the following hypothesis, viz:-That living means nutrition, nutrition means chemical action, and chemical action under proper conditions means electric current. These conditions are a closed circuit combined with any two different tissues, the one acted upon, the other not.

Animal electric currents are proven to exist, for they can and have been demonstrated and actually measured; the action upon tissue is an "electro-motive force." It corresponds to the zinc of a primary battery. The electrolyte is the fluid conveying the food to the actedupon tissue.

The acted-upon tissue is always some other tissue electro-positive to acted upon.

This hypothesis holds true of both normal and morbid nutritional processes. As regards such processes it compels us to base our treatment upon the broad generalization that every such process is an "electro-positive focus."

That proliferation is an excessive chemico nutrition which the positive pole makes more excessive; the negative pole less excessive, that is, counter-acts.

In atrophy there is a deficient chemiconutrition which the positive pole stimulates and restores; the negative on the other hand makes more deficient or destroys.

The above hypothesis, based as it is upon well known chemical and physical laws, at once suggests the only proper

and rational line of treatment in electrotherapy.

At the site of swelling and inflammation we have excessive chemico-nutrition amounting to malnutrition and morbid processes. There then apply the negative pole of a galvanic current (the new Vole cell as supplied by the Kidder M'f'g. Co., giving best satisfaction) 10-15 milliamperes with sponge covered, well moistened electrodes of sufficient size to cover the entire area, for ten minutes, while the positive, acting now as the indifferent electrode, should be at least four times the square area in size and placed as near as possible to the origin of the nerve supply, in this case over the sacral region. Now reverse the polarity passing positive, now the active electrode, slowly up and down atrophied muscle group with 15 interruptions to the minute for five minutes. This is to be followed by passing the faradic current (high tension "Monell" apparatus) full length of coil n icircuit to point of tolerance, through entire length of limb five minutes rapid and five minutes slow interruptions, positive as the indifferent electrode to sacrum, negative passed up and down entire limb. This is to be repeated three times a week. One month's treatment will show results. Massage properly applied as an after treatment will not come amiss; the limb should be only moderately used at first.

ALBERT C. GEYSER, M. D. 836 East 165th street, New York, N. Y.

DR. SAJOUS has resigned as dean and Professor of Laryngology at the MedicoChirurgical College of Philadelphia. He continues as Chief Editor of the Annual and Analytical Cyclopaedia of Medicine, and will continue in private practice in diseases of the nose and throat, in this city.

IN Zululand the graves of the dead are decorated with the bottles of the attending doctors.

DR. F. C. PRICE, of Imlaystown, N. J writes: "I have used THE MEDICAL WORLD Visiting List for eight years, and have not seen any form of accounts that suits me as well."

Quiz Department.

Questions are solicited for this column. Communications not accompanied by the proper name and address of the writer (not necessarily for publication) will not be noticed.

The great number of requests for private answers, for the information and benefit of the writer, makes it neces sary for us to charge a fee for the time required. Thie fee will be from one to five dollars, according to the amount of research and writing required.

DR. R. A. PRICHARD, of Garner, Ky., asks for treatment for nasal catarrh and internal hemorrhoids.

Editor MEDICAL WORLD: - Kindly prescribe for my case of general pruritus. I wrote to you last year about it and thought I was cured; but it has returned this winter. I have used arsen-auro, sulphide of calcium, and various external applications.

Sikeston, Mo. JAMES E. FALSOM.

The above was referred to Dr. John V. Shoemaker, the distinguished specialist on skin diseases, who says as follows:

As regards paresthesia, or pruritus, its successful treatment necessarily depends upon recognizing the cause of the trouble. The liver is often at fault, when a mercurial purgative and saline will be useful; a debilitated state of the general system requires cod-liver oil, iron, mineral acids, phosphorus, etc. In many cases the pruritus is caused by disturbance of the central nervous system, and in such instances our efforts must be directed towards strengthening the nervous tone by means of silver salts, zinc, phosphorus, strychnine, etc. The application of galvanic or faradic electricity is of both general and local benefit. General treatment strikes at the