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care of the disease without deformity. This position is found when the patient is placed comfortably in a recumbent position."
"1 On the continent of Europe the treatment of caries of the spine has been until recently almost entirely the enforcement of rest in a borizontal position. Kormann, in a very comprehensive review of the literature of the treatment of disease of the spine, quotes from all German authorities on the subject, who were almost unanimous against any treatment except that requiring confinement to bed.
In a discussion at the French Academy, the opinion of the leading French surgeons on the subject was brought out. Verneuil, Despres, Marjolin, Trelat, Ollier, are all quoted as in favor of treatment by the enforcement of absolute rest in a horizontal position for a long time.
Madelung, of Bonn, however, has recently published a paper in which he expresses great satisfaction in the new method of plaster-ofParis treatment of caries of the spine introduced by Dr. Sayre. He has tried it in thirty-eight cases. He mentions that the method is finding favor in Germany, and has been accepted by Langenbeck, Hueter, and others. He thinks the principle underlying the treatment introduced by Dr. Sayre has been sufficiently demonstrated to be regarded as established, although the technique may be improved upon hereafter.
Dr. Wyeth, and Dr. Stillman who claims priority, describe a method of treating spinal curvature by continuous extension. A plaster-ofParis jacket is applied, consisting of “two segments which come nearly together at the point at which the lesion is situated ; " these two are connected by rods, which are arranged so that they can be elongated and the amount of pressure upward and downward regulated at will. in the discussion which followed Dr. Wyeth's paper before the New York County Medical Society, Dr. F. H. Hamilton stated as his opinion that the value of extension of the spine in the direction of its axis was not as great as has sometimes been supposed. The muscles which are constantly strained in the effort to prevent the body from suddenly falling forward and causing painful pressure upon the seat of disease are relieved by extension, but if the patient is suspended no extension is made which reaches to the seat of the disease. A plaster jacket is incapable of maintaining extension of the spine. When a plaster jacket is applied, the arms being lifted, the chest is expanded; when suspension is removed, the thorax collapses and “telescopes within the plaster jacket,” and extension of the spine becomes practically nothing.
1 See also Owen, Lancet, November 23, 1878, page 734.
2 Bericht über Heilgymnastik u. Orthopädie, Schmidt's Jahrbuch, 1878, Bd. 179, No. 9, pages 265 and ff.
: Gaz. hebd., December 7, 1877, page 780.
Hospital Gazette, January 30, 1879.
As a substitute for plaster-of-Paris bandages, Mr. Adams? recommends a preparation of felt, which, when warmed, is quite flexible, but which becomes hard in a few minutes.
Dr. Coover” uses silicate-of-potash bandages instead of plaster-ofParis bandages. The former are much lighter, but they require three hours in order to become dry and hard.
Dr. Gibney gives the following figures to show the results of treatment of caries of the spine, as indicated by the tracings of the spine in one hundred and six cases. The treatment consisted of the application of a corset strengthened by strips of steel (the details of which are given). In ninety-two there was no increase of curvature. In four the curve there was a decrease. In fourteen there was an increase of these of one eighth to one half an inch. Of these, thirty were under observation from two to six months; ten, six to nine months; eighteen, nine to twelve months ; twenty-six, one to two years; four, two to three years.3
(To be concluded.)
THE MEDICAL SOCIETY OF THE COUNTY OF NEW YORK
ADJOURNED MEETING. APRIL 21st. Conclusion of the Discussion on the Abuses of Medical Charities. Dr. F. R. Sturgis, the author of the paper under discussion, gave a résumé of the principal suggestions for the institution of reforms which had been made by the various speakers at the last meeting, and spoke particularly of the points raised by Dr. Piffard : that this society had no authority to control the action of the profession, and that it was no use to appeal to the legis. lature for the prevention of the organization of still other dispensaries, since. according to the present law, they were obliged to grant a charter for such an institution to any five individuals who chose collectively to apply for one.
Prof. D. B. St. John Roosa, president of the New York State Medical Society, said that he wished to speak mainly on two points. In the first place, he agreed with Dr. Sturgis that the medical profession was to blame for the present condition of affairs, and he believed that the evils existed not only in the dispensaries, but also in the large hospitals. He thought it a crying shame that wealthy patients should be treated in elegant private rooms in these institutions, and yet that the physicians or surgeons who attended them should be
1 British Medical Journal, August 24, 1878; also Lee, Philadelphia Medical Times, Mareh 15, 1879, page 277.
2 Philadelphia Medical and Surgical Reporter, April 13, 1878, page 281.
8 For other references in regard to the treatment by plaster jackets, see Lancet, June 23, 1877; February 2, 1878, page 167. British Medical Journal, February, 1878, page 280; January 5, 1878. Edinburgh Medical Journal, September, 1878, page 215. Dublin Journal of Medical Science, December 1, 1877. Glasgow Medical Journal, September, 1878, page 40+. Medical Press and Circular, September 4, 1878, page 180. Cincinnati Lancet and Clinic, December 7, 1878, page 429.
4 Concluded from page 611.
allowed no compensation. These were, therefore, not hospitals at all, in the proper sense of the term, but simply boarding houses for people who wished to shirk their doctors' bills; and he considered such practices a fraud upon the dead men and women who had given their money for the establishment and maintenance of these so-called charities. If the medical staff connived at this outrage, it was a great wrong to themselves, and a still greater wrong to their professional brethren. The second point was that the medical profession could remedy the evil if they should unitedly take a firm stand, and absolutely refuse to attend any patient whatever (whether in hospital or dispensary) who was able to pay a fee. This unanimity of action, however, was essential to the success of the movement, or else the whole matter would come to naught. But, even if we failed now, Dr. Roosa believed that this agitation would have great influence in molding public opinion, and would go far towards bringing about that time when the profession would refuse to be dictated to any longer, and would demand the desired reforms as a matter of right. He felt perfectly confident, he said, that the day was coming when only paupers would be treated in dispensaries, and only paupers would be lodged in hospitals.
Prof. Willard Parker said that when he first came to New York, forty years ago, the condition of affairs here was entirely different from what it is now. Then there was only one hospital, the New York (which was indeed the only hospital in the city for more than eighty years), three dispensaries, and one eye infirmary; and there was no trouble at all, as these institutions were ample for the care of all the sick poor, and the physicians had plenty of work among the better classes. The population was then estimated at three hundred and twelve thousand. About the time of the great Irish famine, in 1846, however, there commenced an enormous influx of foreign immigrants (so that by 1850 there had been an increase of more than two hundred thousand in the population), and since then, with the growth of the huge tenement-house system, there had occurred a complete change in the city. With the presence of $0 many suffering poor in their midst, the people of New York (whom he believed to be more ready to respond to appeals for charity than any others upon the face of the globe) felt imperatively called upon to provide for their wants. About the year 1850 St. Luke's Hospital was founded, and since then hospitals and dispensaries had been multiplied to a marvelous extent, and, indeed, until they had become in many instances a curse rather than a blessing. There was therefore, at the present day, far too much indiscriminate charity, and people seemed to think that when they had given a sufficient amount of money their responsibility ended, not taking the trouble to see that it was judiciously expended by those to whom they entrusted it.
There were three classes in the community requiring the services of the medical profession: First, the well-to-do people, who paid the doctor cheerfully. (He was sorry to say, however, that this class was now considerably smaller in proportion to the population than it was forty years ago.) Second, the honest poor, or “ God's poor,” as they were sometimes called, who did the best they could, and were sure to pay the doctor sooner or later, although it might be but a small fee. Third, the pauper class, or “the devil's poor,” of which there was an enormous number in this city at the present time, who never paid anything at all, and who were dependent on the taxpayers for their support. The curse of intemperance, he thought, was to a great extent responsible for the large proportion of this class in the community.
The only remedy for the abuses mentioned that Dr. Parker could see was for the medical profession to make a strong effort and help itself, and in this he believed that they would be seconded by the taxpayers of the city. Such an effort would be directly to the advantage of (1) the physician, (2) the tax. payer, and (3) the recipient of charity. The tendency at the present day was to make drones out of a large number of the masses, altogether unproductive, and only a curse to the community in which they lived. As long as they were fed, clothed, and taken care of when sick by the city, or by charitably disposed private individuals or institutions, there was no incentive whatever to help themselves, and people thus accepting the bounty of others soon lost all sense of self-respect. As soon as these people were compelled to work for themselves, however, the manhood in them would assert itself, and they would no longer be the dependent creatures that they were before. He thought that it would perhaps be a good thing that this society should make the request of the managing boards of the various dispensaries in the city that they should appoint delegates to hold a conference with a special committee appointed for the purpose from the society, in regard to the remedying of the abuses which now prevail in these institutions, and that it was desirable that this committee should strongly urge upon the members of the boards the advisability of charging all patients who could afford it a small sum for medicines, as had been done at the New York Dispensary.
Dr. M. H. Henry believed that there never was an evil in the world which could not be remedied. Here he thought the remedy to be that medical charity should be confined exclusively to the regular district dispensaries in the city, and that these institutions should treat only the really destitute. Another aid to the removal of the abuses would be to open all hospital and dispensary appointments to competitive examinations; and still another, to diminish the number of physicians annually graduated by requiring examinations preparatory to attending lectures, and by generally raising the standard of medical examination. There should properly be only about one physician to every thousand inhabitants, but if we were to go on at the present rate of turning out doctors from the various schools, we would soon have one for every fifty. If these matters were attended to, he believed that the medical men of this city would be able to make a respectable livelihood.
Prof. A. Jacobi said that there could be no doubt that if there were fewer physicians there would be much less abuse to complain of, and he agreed with Dr. Henry that the present manner of making dispensary and hospital appointments was radically wrong. Whenever a vacancy occurred there were dozens of applicants for the place, all of whom based their claims to it upon the number of signatures of prominent medical men which they were able to show upon their letter of application, and there were many physicians of eminence who were willing to sign anything of the kind that was presented to them. Another abuse was that there were large numbers of men who used their dispensary appointments for making practice for themselves out of the better class of patients, while properly the dispensaries, and college clinics as well, should
refuse to treat any but the absolutely poor. He thought it was a terrible mistake, and one which would make the abuses greater than ever, to charge dispensary patients ten cents for prescriptions, as proposed by Dr. Sturgis. These institutions were established only for those who were not able to pay this amount, and this plan was scarcely less demoralizing to the public than that now in vogue in the out-door department of the New York Hospital. If this method were to prevail, the public would soon come to believe that ten cents was all that a physician's services were worth, and it seemed to him a serious question whether it would not be really better that all the dispensaries should be wiped out of existence.
After some further discussion it was unanimously resolved, on motion of Dr. Roosa, that it was the sense of the New York County Medical Society that the attending physicians and surgeons to the hospitals and dispensaries of this city should diligently inquire into the circumstances of all patients presenting themselves for treatment in them, and that they should refuse to treat those whom they had reason to suppose were able to pay a physician's fee.
EMMET'S PRINCIPLES AND PRACTICE OF GYNÆCOLOGY."
From the exceptional advantages which Dr. Emmet is known to have had for a quarter of a century in a hospital devoted exclusively to the diseases of women, together with a large private practice in the specialty, the profession have waited with justifiable impatience for the results here embodied, and we feel confident that these expectations will not be disappointed.
Though treating especially of the functional and surgical diseases peculiar to women, it is not wholly the book of a specialist; it is eminently the production of one familiar at least with general practice, and a book which no man in general practice should be without. The time happily has now passed when any physician or surgeon can afford to be ignorant of the ailments here described, — of the reflex or neurasthenic disorders radiating from that autogenetic zone of the female nervous system, the pelvis.
He who treats the heart or the liver, the stomach or the brain, in ignoranc of the fact that the uterus and the ovaries are the fons et origo of the most intractable and distressing disorders; that they play a much larger part in woman's organization than the mere production of offspring, will soon find himself distanced by wiser and more far-sighted competitors. The only danger is that the success which has of late followed the treatment of female diseases should give the impression that it is owing to local applications alone, and thus tempt beginners, especially, to neglect of general and constitutional measures, without a competent knowledge of which no special practice can be as a rule satisfactory. This is a point which our author fully recognizes, and one the observance of which we may be sure is one of the prime factors of his acknowledged success. He
says, “No man can prove successful as a gynæcologist who bas not mastered the principles of medicine, and stored up experience in the general treatment of disease.”
· The Principles and Practice of Gynaecology. By Thomas Addis Emmet, M. D., Sur. geon to the Woman's Hospital of the State of New York, etc. With one hundred and thirty Illustrations. Philadelphia : Henry C. Lea. 1879.