Valentine's Meat-Juice In Hospital and Private Practice during Pneumonia and Influenza. Samuel W. Burns, M. D., Philadelphia, Pa.: Cavalier Dr. Enrico Ballerini, Late Surgeon to P 174 RICHMOND, VIRGINIA, U. S. A. START THE NEW YEAR RIGHT The New Johnson Kollman Dilator | YES, WE DID SAY IT is a very simple and satisfactory urethral dilator the $50 Kollman instrument, and costs you DOCTOR! INCORRECT DIAGNOSIS, INCOR- HUSTON'S HUSTON BROTHERS CO., Atlas World Building, Chicago, ILL The knowledge that a man can use is the only real knowledge; the only knowledge that has life and growth in it and converts itself into practical power. The rest hangs like dust about the brain, or dries like raindrops off the stones.-FROUDE. C. F. TAYLOR, M.D., Editor and Publisher. J. C. ROMMEL, M.D., Associate Editor. E. S. TAYLOR, Business Manager. SUBSCRIPTION RATES: To any part of the United States or Mexico, ONE DOLLAR per year, or FOUR YEARS for THREE DOLLARS in advance; to Can- ada ONE DOLLAR AND TWENTY-FIVE CENTS per year or FOUR YEARS for FOUR DOLLARS in ad- vance; to England and the British Colonies FIVE SHILLINGS SIX PENCE per year; to other foreign countries in the Postal Union, the equivalent of 5s, 6d. Postage free. Single copies, current issue, TEN CENTS; previous issues, from TEN to TWENTY-FIVE CENTS. These HOW TO REMIT: For their own protection we ad- vise that our patrons remit in a safe way, such as by postal money order, express order, check, draft, or registered mail. Currency sent by ordinary mail usually reaches its destination safely, but money so sent must be at the risk of We cannot always supply back numbers. Should a number fail to reach a subscriber we will sup- ply another if notified before the end of the Notify us promptly of any change of address, men- tioning both old and new address. If you want your subscription stopped at expiration of the time paid for, kindly notify us, as in the absence of such notice we will understand that it is the subscriber's pleasure that the subscrip- tion be continued and we will act accordingly. Pay no money to agents unless publisher's receipt ADDRESS ALL COMMUNICATIONS TO THE MEDICAL WORLD VOL. XXXVII JANUARY, 1919 Philadelphia, Pa. Influenza Still Lingers. The influenza epidemic has abated con- siderably; in fact, almost entirely. How- ever, here and there the disease still lingers, small outbreaks still occurring. The lessons of health, ventilation, the exercise of better judgment in exposure to inclement weather, drafts, etc., seem to have been quickly for- gotten. The health conditions in which the greater part of the people live are far from ideal. Even tho there were no fault to find with the health conditions, the "flu" would still spread, attacking the robust as well as the weakly. It has been found that more people succumbed to the "flu" between the there were a total of 66,772 deaths from in- sus, Washington, D. C., and 40,633 deaths from all forms of pneumonia during that period. These reports included only forty- six cities of the United States with an estimated population of 21,853,418. Multi- ply this by five to get a fair estimate of the number of deaths in the entire country dur- Nothing extraordinary seems to have been developed in the line of treatment, the usual variation still being shown in the articles published. Late investigators think the influenza bacillus of Pfeiffer to have been the cause of the epidemic. One of the treatments reported from abroad consisted of mercury salicylate, 1 grain, dissolved in oil and injected intra- muscularly. This is the maximum dose and must not be repeated too frequently. Also corrosive sublimate was given by intra- muscular injection. Excellent results were reported from the use of these two remedies. The probability is that influenza will re- main in evidence thruout the winter. Quar- antine will need to be used to prevent the spread of the disease. The less power the board of health has in any community, the more careful the individual physicians and It is estimated that 6,000,000 people died sulted in the death of 20,000,000 people in four and one-third years. So that it is seen how much deadlier has been the epidemic. In India it is estimated there were 3,000,000 deaths, half of the total number. In Bom- bay there were 15,000 and in Delhi 800 daily. In the Punjab there were 250,000 deaths. The natives in Cape Town, Africa, were swept down as by fire. In Samoa 80 Many organizations and other agencies are co-operating with the government to advance this good work. We must not stop until the war against these evils is won. The United States Public Health Service, 228 First Street, N. W., Washington, D. C., publishes six pamphlets, some one of which will be found adapted to any person. The list is as follows: Set A. For young men. Set B. Set C. Set D. For the general public. For parents of children. Set E. For girls and young women. Copies of these pamphlets and others explaining the government's campaign against venereal diseases and presenting the true facts of sex in a wholesome manner will be sent to any address free on application to the address above given. Prostitutes are still rampant. These creatures entice the young men who are away from their home and home influences and are often susceptible to such wiles. The young men who consort with prostitutes become infected and pass along the diseases to others. Recently there came into a doctor's office in Philadelphia a girl from another city. She had met a young man there and after knowing him only two days went out with him and submitted to coitus. She told the doctor she feared she was preg nant. On questioning she said she had a discharge. Probably gonorrhea and preg nancy combined. She did not know the young man's address, but had only his telephone number. Any man guilty of such a crime should be punished severely. Prostitution must be eliminated to prevent the spread of disease. Morals must be made higher and more secure for the benefit of the individual. Men must be taught and thoroly grounded in the idea of preserving womanhood, not destroying it. The sex subject is large and important. More consideration must be given to it. Doctors can do much to foster this work in their community. Let them all get a supply of these pamphlets and put them in the hands of the persons for whom they are published. Three per cent. of the million draftees whose examination blanks first reached the adjutant general's office in Washington had a venereal disease when they reported at camp. Some of the percentages by States are: Oregon, 0.50%; Montana, 0.89%; California, 1.15%; Wisconsin, 1.21%; New Jersey, 1.55%; Iowa, 1.63%; New York. 1.82%; Michigan, 1.95%; Kansas, 2.38%; Illinois, 2.44%; Pennsylvania, 2.62%; Ohio, 3.24%; Indiana, 3.33%; Louisiana, 3.32%; Missouri, 3.52%; Kentucky, 3.77%; Tennessee, 3.80%; Mississippi, 4.05%; Oklahoma, 4.50%; Texas, 4.70%; Georgia, 5.60%; South Carolina, 8.04%; Virginia, 8.68%; Alabama, 8.68%; Florida, 8.90%. Readjusting Fees. The great upward trend of prices has caused physicians everywhere to increase their charges for services. The physician has nothing to sell but his services. Consequently he must charge for them accordingly. The office fee of fifty cents has wellnigh disappeared. Physicians now almost everywhere charge one dollar or more for office treatment, even tho it be only to write a prescription. Usually considerable care and time are necessary to diagnose the ailment. Blood pressure, urinalysis, pulse, temperature, abdominal organs, eyes, ears, nose, mouth, lungs, etc., must be considered. In advance of all this the physician must keep himself up to date by constant purchase and frequent use of the new books on all the varied topics of medicine and the regular perusal of medical journals. This constitutes a part of the overhead expense of the physician and must be considered in making his charges for services. The public should not be allowed to get the idea that the doctor charges a certain sum for a visit, no matter what he does for the patient or how many patients he has in that one house to treat. Such a method would allow only the price of a home visit for an obstetric delivery. The charges should be regulated by the service rendered on each occasion. For instance, a surgeon will charge, say, two hundred dollars for an abdominal operation, such as one for intestinal obstruction. Yet a physician could hardly charge that amount even should he work hard and faithfully with a patient with intestinal obstruction and finally get the obstruction— impacted feces, for instance-removed. The patient could hardly be made to appreciate the fact that an abdominal operation was avoided and the patient therefore better off, and the service correspondingly worth more. No physician could collect the price of a surgical operation for preventing an operation by good treatment. But he could get more than the ordinary house charge for that service. In the frequent event that more than one patient is treated in the family during a home visit, a charge should be made for each patient. If the office fee is one dollar and the house fee a dollar and fifty cents or two dollars, the office fee of one dollar should be added for each additional patient after the first one. Three dollars for home visit is now not at all uncommon, plus mileage when rural mileage is involved. Of course fashionable doctors get much more than three dollars per house visit from aristocratic and wealthy people, but we are considering the matter from the standpoint of the masses of the people. If there are two families in the house, they should both be considered as two separate calls and charged accordingly. Obstetric fees in Philadelphia are now $25. You will not lose patients by charging for your services in this manner. Your patients want you, and you only. They will not change to some one else. And if all in your vicinity charge alike, it would be of no advantage to them. Another readjustment of fees is in prospect. A great effort is to be made to introduce health insurance laws in as many states as possible. No provision is made for the payment of physicians in these bills. That matter will be taken up after the passage of the bills. It will be a conflict between physicians and the legal sharks of the insurance companies, with prospects very poor for physicians. The rates in force in any given locality may be considered in the discussion; hence the lower the fees in use in the community, the lower the remuneration under the health insurance. In England physicians are receiving as low as $150 per annum net for a panel of 350 patients as a result of the health insurance law. Can we stand that in America? In any event, we must revise our fees and charge for our services. Many physicians have been very inadequately paid for their services who could have secured greater remuneration by charging as they should have done. Physicians help one another by requiring proper pay for their services, and we owe some consideration to our fellowpractitioners-that is to our profession. Diabetes. Diabetes is a difficult problem for the profession. One of the very best approaches to the study is by way of the physiological basis of carbohydrate absorption and metabolism. A new book on physiology and biochemis try* handles this subject very minutely and at great length. A careful study of the present status of the subject will well repay any physician. We quote these authors very freely in our presentation of the subject in the following lines. A careful study of the physiology and chemistry will teach the practitioner the underlying processes that must be considered in any intelligent effort to handle a very difficult problem, upon which all the light possible is needed. Assuming that the subject as generally presented is known to the practitioner and that glycosuria has been detected, the treatment then is sought. The determination of the assimilation limit for carbohydrates is of considerable aid in controlling the treatment of diabetes. For this purpose the patient should follow his usual diet, so that the urine will show the usual percentage of sugar. The diet should then be changed so as to consist of a part that contains no carbohydrates and another composed entirely of starchy food. The former should consist of eggs, fish, green vegetables, fat, etc., and the latter should consist of carbohydrates- 100 grams (31/3 ounces) of bread, divided into the two main meals, one of which is breakfast. This diet should be continued until the glycosuria disappears or attains a constant level. If the glycosuria ceases, the disease is classified as a mild diabetes, and the daily allowance of bread may be increased by 50 grams a day until the sugar again appears in the urine, showing that the assimilation period has been exceeded. The patient should then be instructed to eat in his daily food about three-fourths of the total daily amount of carbohydrate reached by this process. Implicit directions must be given him about his diet, exact quantities of food being administered. His urine should be examined weekly. By such treatment such patients may be kept in good health for years. Some cases seem to have recovered entirely from diabetes. When the limit to the amount of carbohydrate that the organism can utilize is passed, some of it appears in the urine, but not all the carbohydrate in excess of the amount metabolizable. The limit of ingestion below which diabetes is suspected is 100 grams (3 1/3 ounces) of sugar. person cannot digest and absorb If a this "Physiology and Biochemistry in Modern Medicine," by J. J. R. MacLeod, M. B., assisted by Roy G. Pearce, B. A.. M. D. Published by C. V. Mosby Co., St. Louis, Mo. Price, $7.50. |