All terms are cash at the time of the service rendered, unless otherwise arranged. All bills are due and payable when services are completed. Statements of accounts will be rendered monthly. Prompt settlement is expected. Interest will be charged on all unpaid accounts of six months' duration. After one year unsettled accounts will be listed as undesirable with the county society. Patients listed as undesirable and strangers will be requested to pay in advance. There will be no gift visits made by members of the society in obstetrical or surgical cases. Fees for visits in after treatment of obstetrical or surgical cases will be at the regular rates. Fees for surgical dressings or treatments will be rendered according to the time and skill required. The physician can make any reduction of fees deemed proper, in the form of a gift, to the worthy poor. All office work cash unless otherwise arranged for. New York State Medical Association and Claim Men Hold The New York State Medical Society has held conferences with representativs of the casualty companies, and has agreed upon a fixt schedule of charges for services to injured workmen under the workmen's compensation law. A series of conferences have been held in the past to discuss this question as under the workmen's compensation law, as it now stands, it is provided that while regular weekly indemnities cannot begin until two weeks after the injury, the employer must pay for medical attendance. The problem was to fix a rate. This agreement is to last until next July. The law says that a physician shall charge according to the fees he would receive for treating such patients in the community in which they were injured. A further thing to be con-, sidered is that heretofore these patients have been receiving their care in the hospitals, giving no ¡fees to doctors, or the doctors have been able to collect only a small percentage of fees charged for this work. It should never be forgotten that these fees, according to this schedule, are considered just when used among individuals and families earning about $600 a year, for it is a known fact that east of the Rockies and north of the Mason and Dixon line three-fourths of the male wage earners and nineteen-twentieths of the female wage earners earn less than $600 a year. The cost of medical fees has worried the stock and mutual companies considerably and a reduction of 20% of the premium was offered to employers who would pay their own medical fees. In view of this, claim men and physicians have been working together in an endeavor to reach an equitable basis. Most of the conferences between the casualty men, which consisted of George C. Taft, Dr. W. L. Gahagan and H. S. Recknagel, and the committee of doctors, were held in the office of the society. Dr. Alexander Lambert, who is the treasurer of the medical society, is chairman of the committee of the medical society. Under the schedule a physician will charge $2 for an ordinary day visit at the home of the patient, including an antiseptic dressing when necessary, and $1 for each subsequent treatment at the office or $2 at the home. Hospital visits will be charged for at the rate of $1. Night visits between 9 o'clock and 7 o'clock a. m. will be charged for at the rate of $3. For a formal report at the request of the insurance carrier that rate will be $1. First attention at the physician's office including operativ procedure and the dressing of wounds will draw a fee of $1.50. Specific operations, including amputations, fractures, dislocations, sprains and other injuries calling for treatment call for specific fees. For an amputation of the hip, including first aid, operation and full treatment, the doctor will receive $75. For the amputation and subsequent treatment of the finger and toe the fee is $15. Laparotomy for traumatic peritonitis will command a fee of $50. Minor operations generally call for $5. For assisting at a major operation the fee is $10, and from $2 to $5 for similar work at minor operations. For an examination in lunacy including one day's attendance at court or before a commission, the fee is $50. Subsequent court or commission attendance will command $25 a day. Other general fees are as follows: Complete physical examination and report by other than attending physician, $3; autopsy, complete with written report, $50; autopsy, attending, but not performing, $10; microscopic and chemical analysis of organs, $50; testimony in court or before commission as to simple fact of injury, $10; testimony at coroner's inquest, $5; expert testimony, per day, $15 to $20; introducing catheter, $2; X-ray picture, including plates, $5; subsequent pictures, with plates, $3 each; administration of general anesthetic, $5. Treatment shall not extend over 60 days as provided by the law, section 13, from the date of injury except upon special arrangement with the insurance carrier. Reports respecting the condition of injured employees under treatment are to be made without extra charge. The schedules, endorsed by the society, are to be sent to all physicians in the State for their signatures. Mind Cure. Said the learned apothecary, as he handed me his pills, These will make you blithe and merry, they will cure all human ills. They will kill the microbes buzzin' in your vitals and your head, if you'll only take a dozen just before you go to bed." So I took them for the glanders, which had held me for a spell, for the mumps and yaller janders, and they made me sound and well. Oh, those pills I recommended, till I saw their sales advance, and their merits I defended every time I had a chance. Then the able druggist perished, and a new one took the store, and the pills I loved and cherished weren't compounded any more. Then a sample pill I carried to an analyst of fame, and around his study tarried while he analyzed the same. And his laughter made him totter when his task was done, by jing: "this is made of flour and water, and it wouldn't cure a thing!" Thus the man of science lilted, for his task had made him gay; and I humbled felt and wilted, as I took the pill away. Just the same, those pills had cured me, changed my health from bad to good, as the pharmacist assured me, on his honor, that they would!-WALT MASON in Philadelphia Bulletin. DEAR DOCTOR TAYLOR:-I have taken THE MEDICAL WORLD for many long years-am in my 71st year of life; was a Union soldier for the first three years of the Civil War. I could get around better than many men of thirty-five to forty years until I had a step-ladder accident, ten weeks since, when I injured an ankle, which is still very painful at times and it looks like tempting Nature to renew my subscription for four years, but I am doing it all the same. I wish THE WORLD and its staff a Merry Christmas and a Happy New Year. D. P. MORGAN. Clarksburg, W. Va. Dr. A. Y. Linville, of Winston-Salem, N. C., writes: "Glad you have returned from the war-torn countries to God's country. We have all enjoyed your Travel Talks, giving us an idea of every-day living abroad, splendidly told. I thank you for all this, and for your never-tiring interest in the financial condition of the hard-working doctor. Merry Christmas to you." This is applied to the vagina by a spoon, introduced thru a speculum. It raises the specific gravity of the vaginal secretion and the stimulated flow converts the powder to sublamin + Wright's solution + aluminum acetate + white lead. If applied to a septic wound or burn and rapid healing does not start promptly, it may be safely assumed that the patient is in need of surgical drainage or iodid of potassium, or both. The vagina should be well cleaned with dry absorbent cotton before each application of the above powder. The white lead is insoluble and precipitates in the vagina, and must not be mistaken for caseous discharge. Unguenti aquæ rosæ recentis..3 v M. et ft. unguentum. Or compresses of hydrogen dioxid solution, boric acid solution, or a saturated solution of picric acid may be employed.-New York Medical Journal. Dissolve the iodin in the alcohol, then add tannic acid and 1 oz. of syrup. Heat this to near the boiling point until it gives no evidence of iodin by the starch reaction (about 20 minutes). Then cool and add remainder of syrup. Each dram contains 2 grains of iodin. It may be administered in water or wine before meals, and avoids gastric disturbance.-Windgrave. A camphor and phenol compound useful as a stimulant and antiseptic where those drugs are indicated can be made as follows: R Camphor Phenol Liquid petrolatum .gr. xl ..gr. xx ...m. xl Quassia makes a good bitter tonic to combine with iron, and since it contains no tannic acid, is one of the few compatible drugs that can be found in this connection. J. C. Wilson finds the syrup of the iodid of iron serviceable in articular rheumatism and other forms of arthritis after the salicylates have failed. He uses the drug in maximum dosage. Ipecac in minute doses will often control intractable vomiting when organic disease of the stomach has been excluded. The nicotin of tobacco has been found to stimulate secretion of the activ principle of the adrenal gland, producing constriction of the blood vessels. Buchu is the drug of selection in chronic irritability of the bladder associated with desire for constant micturition. Please notice that our CLINIC department is not used to "boost" proprietary remedies, almanac fashion. THE MEDICAL WORLD has no interests other than to give to the medical profession the greatest amount of honest service possible. It has absolutely no interests in any proprietary preparation nor any medical supply house. Only such queries will be publisht as are likely to interest and instruct many others as well as the one asking No charge is made for this service to help. our subscribers. However, those who wish an immediate and personal reply by mail may obtain the same by inclosing two dollars to the Editor of this department, DR. A. L. RUSSELL, MIDWAY, WASHINGTON Co., PA. This is really a consultation in the interest of the patient, and should be charged to the patient-two dollars being a very moderate consultation fee. The Doctor agrees to give full, careful and immediate attention to such consultations. We reserve the right to publish in this department any such consultations that may be interesting and help. ful to our readers. Name and address will be withheld if requested; but anonymous communications will receive no attention. Come freely for help, but read up as fully as you can before coming to us. Autointoxication. DEAR DR. TAYLOR:-Will be pleased if you can find space in THE MEDICAL WORLD for account of following case: Child, female, 6 years. Two months previous to trouble had eaten nothing but potatoes, ice cream and sugar, sugar being eaten with potatoes. Child would not eat bread. Was called one week after child became sick on account of rash, which caused the parents to become alarmed, after the patient had lain around for one week or more with vomiting, loss of appetite, tongue slightly coated, no sore throat, constipation and cramps in stomach, as they called it. Patient had normal temperature. A rash appeared principally over forearm, pectoral and epigastric regions, tibial surface and back, a papular discrete rash, and, after four days these papules became pustular, and the redness became general with many papulo-pustular pimples. After this developt over body, palms of hands became same as body, which coalesced after the papules became pustular, and the entire palm came off in patches size of half a dollar, with new skin forming under as the top was ready to come off. At same time soles of feet were affected, while palms have peeled off, leaving red surface and soles acting similar to hands. Body was very itchy and child complained of itching and intense burning of palms and soles, which lasted for two weeks. Patient could not sleep without an opiate. No local application relieved burning. Urin, sp. gr. 1.018, somewhat turbid. Urates and phosfates present. Amount first two weeks was very scanty. At present writing, after seven weeks in bed, child has had a papulo-pustular eruption over breast from fifth rib down to lower border of stomach once each week. Note that the first eruption had disappeared for one week after remaining the first three weeks of sickness. This eruption remains for about three to four days and only effects anterior surface of chest, back and thighs. From beginning of sickness to present date, during the day or night, the temperature was normal or 1⁄2 degree sub. Heart 130, respiration 20 to 24. Child very nervous and hard to wait on. Child is gradually becoming weaker. Slightly coated tongue, never had the appearance of a strawberry tongue. Will be pleased to receive suggestions as to a EDITOR MEDICAL WORLD:-I have been having what I have termed a "neuritis." It seems to be at the insertion of deltoid muscle on left arm. Have had it for nearly a year and as yet have found nothing that gives it relief. Vibration, massage, electricity (both faradic and galvanic and high frequency) aggravates rather than relieves. Think I might have strained it in getting off of street cars, or raising a window in my office that would stick. Salicylates have no effect. There are times when I do not feel it at all and other times it seems worse than ever. Most of the time I cannot lie on it. It doesn't seem to bother when I have to use my left hand in making vaginal examinations nor in obstetrics. I generally use the arm or hand that is most convenient and it has happened this summer that my left was called into play more than the right. Sometimes it bothers me when I carry my medicin case; frequently when I put on a shirt or coat, and when reaching above my head. I am 47 years of age, weigh 185 pounds, general health good. Only started to use glasses a year ago and then only for reading. Have only three teeth out. Particular as to my diet. Live close to Mosaic law, altho I am not a Jew. Never use pork or its compounds. Seldom eat white bread or potatoes. Drink percolated coffee clear; use but little sugar or salt; never eat tomatoes nor potato salad. Generally have an attack of dysentery a year, in late summer or fall. Haven't been sick in bed for twenty years. Have practised medicin for seventeen years. Use neither tobacco nor liquors. Neither do I use them in my practise. Do not know how to swear, but chew gum. Some say neuritis is caused by bad teeth. Mine are extra good. Have three gold crowns, but no amalgam fillings. Have had patients with this same trouble but could give them no relief nor have I heard of any other doctor that did. Heard of one case here last year, a minister, who was cured by taking a long rest. I could not do that, as "loafing" kills me. If you, or any of your readers can suggest any help I would be most grateful. Will gladly answer any questions. Have been a WORLD reader ever since I have been in practise. Hoping to see some replies and wishing you long life and best of success, I remain CHARLES M. COLLINS. Utica Bldg., Des Moines, Iowa. [Since you give us insufficient data upon which to base a diagnosis, we are forced to accept your own. The prognosis in the type of neuritis you describe is generally good, and recoveries are frequent, tho it may persist for months or even years. Your trouble may be due to a sprain or to the local effect of "catching cold." Complete rest is the first indication, and it is unlikely that you will secure improvement unless you do give the arm rest. Immobilization by a splint would be the ideal method of enforced rest while you go about your professional duties. A fly blister over the affected area would probably do good previous to immobilization. A long course of applications of tincture of iodin, while the parts were immobilized, would be rational treatment. Immersion in hot water for several hours, once a day, would probably banish the pain, if bath were followed by fixation as suggested. Massage and electricity are harmful in the early stages, and should be reserved for the final treatment, in effort to combat any possible atrophy of muscular structure subsequent upon the long continued nerve inflammation. Nondescript pains, such as you mention, have been cured by injection into the area of a solution of quinin and urea hydrochlorid or of cocain. Another good method is freezing by ice and salt or by spraying ether by means of an atomizer, using an emollient ointment after the freezing.-ED.] Child Slow to Talk. EDITOR MEDICAL WORLD:-I would like to have some advice or your opinion on the following case: Girl, age 5 years, normally developt, bright looking, but has never talkt except saying a few words, as mamma, baby, etc. Understands everything said to her fairly well. She is very nervous at times, especially so on waking. Takes crying spells often and yells like insane. Family history good. None of relations on either side have been insane or had any disease that tends to lead to insanity. Have tried various treatments, among them the thyroid gland preparations, but none have in any way proved beneficial. Any advice that you or the profession at large can give me will be highly appreciated. Mill Spring, Mo. R. J. OWENS, M.D. [Your description is insufficient to enable us to identify the condition with any pathologic state. Some children are very slow in learning to talk, without being abnormal or pathologic in any way. We certainly do not advise "doping" her with thyroid or any other agent unless there is a clean-cut indication, and a clear idea of what is hoped to be accomplisht. We have known of a number of similar instances, in which the children learnt to talk by the time they were 8 or 10 years of age, and never, later in life, manifested any discoverable mental or physical abnormality traceable to their tardy vocal expression. We advise "hands off" unless some actual call for treatment be manifest, and simply persist in the effort to teach the child to talk. Speech may be stimulated by compelling the child to name the things she wants, particularly at the table.-ED.] Neuritis or Paraplegia. EDITOR MEDICAL WORLD:-About three months ago a very interesting case came to my notice and I am most anxious to have some one suggest something to give relief or effect a cure. This patient has been unable to use his legs or stand up without support for six years. Otherwise is normal and this case has baffled a great many of the profession, I being the thirteenth called to attend him. G. S., aged 49, married; height, 5 feet 8 inches; weight, 190 pounds; father of three children, all well and living, the youngest 12 years of age, the oldest 21 years. White. Austrian by birth. Father died at the age of 69 from pneumonia. Mother died at the age of 40 from tuberculosis. Occupation, operated a steam hammer. While at work, right side exposed to heat and left side exposed to draft. Perspired freely. Never had anything ailing him before, excepting about twelve years ago, when he fell on his back, striking a plank ("Am Kreuz," as Was confined to his bed for the patient said). about a week. Was obliged to have a helper about his work for two weeks more. Since then in perfect health up to his present illness. About six years ago a sensation of heaviness appeared in his limbs, and he gained the impression that his body was too heavy for his feet. During the first year had a great deal of pain thru the pelvic region, small of back and thru the limbs. The pain was most severe at night in the small of his back. When attempting to sprinkle the lawn with the hose, or coming in the presence of water anywhere, the pain seemed to be aggravated. The legs felt heavy below the knees. He had tried the Kneipp treatment, but in the language of the patient, "it put him on the bum." For the first year he was confined to his bed nearly the whole time. The second and third years he was up and around with the aid of a cane or crutches. The fourth and fifth years he was sitting in a chair most of the time; during all the six years unable to work. At present he is able to be about only with the assistance of crutches or canes. During all of the time, he had been suffering very severe cramps and in constant pain thru the pelvic region and small of back. The cramps were of a nature of knotted muscles. At the present time he does not complain of the cramps. The patient disclaims ever having had any venereal trouble, and when well, had been in the habit of taking four or five glasses of beer a day and after work a glass of whiskey. Examination of spine reveals no curvature or pressure on spinal cord. The patient's left leg is worse than the right. Is able to bend the right knee and ankle, as well as move his toes on this foot. The left leg, however, he must lift with his hands and cannot voluntarily bend it at the knee or ankle. Is, however, able to slightly move the little toes. No motion in the big toe. Ankle is swollen to twice its normal size. After sundown both legs and feet get cold.、 M. J. CAREY. Cleveland, Ohio. [We are not able to make a definit diagnosis, but suggest careful examination with neuritis in mind. We suggest the trial of prolonged hot baths, with ice to the head. We are publishing the case in hope of suggestions from other members of the family. How Do You Treat Arthritis Deformans? EDITOR MEDICAL WORLD:-By the medical profession arthritis deformans is known as one of the most persistent and intractable diseases; and during the acute stage, where several joints are involved at one time, as a very worrying and painful disease. I find myself a victim of the disease mentioned, and it would be difficult to adequately describe the miserableness experienced. Thru these lines I appeal to the medical profession. Any doctor who may read these lines and has had much experience with the above-mentioned disease who knows of a treatment that will favorably influence the course of or mitigate the suffering, will do me a great favor by writing me in regard to the matter. Is the extract of thymus gland worth trying? Fruitland, Md. J. I. T. LONG, M.D. (Yes, extract of thymus gland is worth trying, beginning with a small dose and gradually increasing. We have been moderately successful with a combination of colchicin, 1/150 grain, and methyl salicylate, 3 minims, in capsule, giving 1 or 2 capsules an hour after each meal. In addition, after the acute stage is passed, massage and passiv action are valuable to restore mobility. We would be glad to hear from our readers on this subject.— ED.] Paralysis Agitans. EDITOR MEDICAL WORLD:-I have been troubled more or less for four or five years with paralysis agitans in my right hand. I can't tell for the last two or three years if there is any material change. There is no pain and otherwise my health is good. I am 68 years old. Have been regular in the practise of medicin for 411⁄2 years, or since the spring of 1873. I do not use either whiskey, coffee or tobacco in any form or quantity; did use some coffee more than twenty years ago. I want relief. Can you give it? If not, do you know of anyone that can? I have been expecting every month to see an article in THE WORLD on such troubles, but have not so far. Any information will be gratefully received. Greenfield, Tenn. H. F. HUDSON, M.D. [Hyoscyamus: Full doses of the tincture will palliate the trembling. Hyoscin: Temporarily but effectually controls the trembling, but if used continually will lose its effect. Duboisin: Acts like the two preparations above, 1/100 grain by the mouth three times daily. Chloral. Depresses the motor tract of the spinal cord, and is of value in this affection. Spartein: Grain to grain 1⁄2, thrice daily, has proved of service. Gelsemium: In full doses quiets the nerve irritation; and a combination of gelsemium, conium and hyoscyamus is often used. Cannabis indica: In large doses lowers reflex activity. Picrotoxin has greatly benefited some cases. Opium with arsenic and hyoscyamin has given good results. Sodium borate: Grains 15 to 45, daily, in three or four doses, has given striking results in certain cases. Orchitic extract has been used with apparent benefit. Sulfur baths are certainly of great value in this disease. Cupping over skin of spinal region with dry cups to dilate the vessels of the cord and so improve its nutrition. Electric baths cause recovery or lasting improvement. The above list is extracted from various authors for your benefit, and some of the suggestions will doubtless make you more comfortable. You know, of course, that the disease is absolutely incurable.-ED.] Tobacco Smoking. EDITOR MEDICAL WORLD:-I would like to ask you a question. According to the consensus of medical opinion, is it in any way injurious for an inveterate tobacco smoker of years' standing to quit the habit entirely? In my opinion, it is not, but I would like to know the best opinion on this subject. GEO. NELSON DOLBECK. 111 East 28th St., New York City. [We have no knowledge of any publisht consensus of opinion representing any material proportion of the medical fraternity's ideas regarding this matter. Isolated individuals have, from time to time, ventured radical opinions on the subject. Our opinion is not worth more than that of any other intelligent practician of extended experience, but we have frequently observed cases where we were convinced grave harm had resulted from aged men suddenly abandoning a habit to which they had been accustomed from childhood. The too radical man frequently errs. Even if one be opposed to the use of tobacco, he need not be so rabid as to attempt convincing himself that it is altogether an evil. Smokers rarely suffer from constipation, and many tobacco users find it a positiv aid to digestion. We cannot think that so powerful a drug can be safely and abruptly discontinued after almost hourly indulgence thru a lifetime. We are not, however, advising any one to contract the habit.-ED.] Dysmenorrhea. DEAR DOCTOR TAYLOR:-Can you give me any advice in the following case? Miss A. W., aged 20, single, of good parentage (farmers), good home surroundings, is well-developt, well nourisht, weight 120 lbs., height 5 ft. 3 in., has convulsions every menstrual period for 4 years, usually 5 or 6 hours after the flow has started. I can find nothing that would cause same; pelvic organs seem normal; urin normal; bowels regular. These convulsions are both tonic and clonic. At times she will strike with hands and feet so violently that they must be held by strong men, these attacks lasting from 15 minutes to half an hour. If left alone she will go out of one into another from 1 to 10 or 12 seizures. I usually give her a hypo of hyos., morph. and dig., which usually puts her to sleep for 6 to 12 hours, wakes up and is over it until next time. When the attacks are tonic, then all her muscles are drawn up into a knot, mouth and eyes wide open. When such attacks are on she is certainly a sight to see. This |