collodion to accelerate its evaporation and prevent spreading. The application is repeated every third day until the eschar is separated, and the raw surface is then covered with an antiseptic dressing. The author has treated over thirty cases of various forms of nævoid growth by this method with success.-British Medical Journal.

Venereal Warts.

Resorcin is recommended by Rohrer as superseding all other local applications:

R Resorcini, gr. xv.

Liq. petrolati, zj.

M. Fiat unguentum.

cent. Of this, 70 parts are added to distilled water, 85 parts, and syrup of orange, 15 parts. Of this mixture a soupspoonful is given every two hours. In certain cases of ulcer of the stomach its administration causes epigastric pain or cardialgia, but this commonly disappears in a short time. In infants the dose must be less. It is especially valuable in gastritis and gastroenteritis of infants, and also in cholera infantum.-Medicine.

The Use of Bisulphide of Carbon in
Tuberculosis.

Coramilas, of Athens, Greece, gave an

oughly cleansing the parts.

The following combination is quoted as being a very valuable caustic:

B Plumbi oxidi, gr. ij.

Potassii hydratis, gr. xx.
Aquæ, q. s. ad 3j.

M. Sig. Shake well and apply, by means of a brush, to the lesion. One or two applications are sufficient.-Journal of the American Medical Association.

Chronic Nephritis.

Moore recommends the following, which has given him excellent results in increasing elimination and overcoming the drowsiness of impending uræmic coma:

R Sodii benzoatis, 3iv.
Tincturæ limonis, 3j.
Aquæ dest., q. s. ad žvj.

M. Sig. Tablespoonful in half-glassful of hot water on arising in the morning, or as required. Journal of the American Medical Association.

Peroxide of Hydrogen in Round Ulcer of the Stomach.

Novikoff reports success in a certain number of cases of round ulcer of the stomach by the internal administration of peroxide of hydrogen. He uses a mixture of peroxide having a strength of 30 per

present time with the use of this agent. After detailing numerous experiments on animals with the bisulphide of carbon, and presenting a report of 64 cases, the author drew the following conclusions: (1) bisulphide of carbon has no disagreeable effects; (2) it has a strong action against tubercle bacilli; (3) by its action as a parasiticide, antizymotic, antiseptic, dissolving and penetrating all tissues, it cures tuberculosis; (4) it should not remain in obscurity, but take its place in therapeutics as a valuable remedy. British Medical Journal.

Lumbago.

The following combinations are recommended in the treatment of lumbago:R Antipyrini,

Sodii salicylatis, of each, 3j.
Aquæ, 3ij.

M. Sig. One teaspoonful four times daily.

The local treatment is important. As a liniment the following is recommended:R Methyl salicylatis,

Tinct. belladonnæ,
Tinct. opii, of each, 3ij.
Spiritus camphora, živ.

M. Fiat linimentum.

Sig. Apply locally twice daily with light massage.-Journal of the American Medical Association.

THE

Medical Bulletin.

F. A. DAVIS COMPANY, Publishers.
President, F. A. DAVIS.

Editor, JOHN V. SHOEMAKER, M.D., LL.D.
Business Manager, H. T. PEARCE.

Philadelphia, Jan., 1903.

DO PRIVATE HOSPITAL PATIENTS PAY?

THE imposing buildings, the ample hallways, the extensive and beautiful grounds by which some hospitals are surrounded create an impression in the mind of the generality of people that these institutions are liberally supported and well provided with money. Those who have occasion to visit friends who occupy private rooms are greatly pleased with the aspect, the cleanliness, and neatness of the apartments, the quiet deftness of the nurses, the smooth and easy working of the rules of management, and by the fact that a physician is always within call. They are justified in their commendations, but not in their conclusions.

A hospital is one of the most expensive institutions in a community. Modern buildings must be elaborately planned and erected under the supervision of a skilled architect. The work of construction demands large expenditures. When the walls and floors are in position furniture and fittings must be purchased. A corps of nurses must be engaged, and these must be governed by a selected head. There must be a superintendent to manage the strictly business aspects. Food must be bought for all these inmates and for the patients. Medicinal preparations, which are often expensive, must be secured and a competent pharmacist must be employed. Costly instruments are necessarily part of the property of every hospital. The x-ray apparatus is indispensable, but the care and use of this appliance involves considerable ex

pense. A hospital cannot be guilty of a narrow economy as regards the quality of food selected. The employees deserve to be well fed; the patients must be well fed. Inferior food will often defeat the very object for which sick people are placed in a hospital. Food must be properly prepared. Nowhere is bad cookery more inexcusable than in a hospital. Head cooks and assistants must be duly recompensed.

Here are large items of expenditure before a dollar is received in return. The executive officers of the hospital must all be liberally compensated. Superintendents, pharmacists, head nurses, staff nurses, not to mention those whose acquirements are less professional, demand good salaries. A narrow policy cannot secure, or at least cannot hold, competent officers. A poor service inevitably damages the usefulness of an institution. The efforts of the most skillful staff of surgeons, physicians, and specialists will be neutralized by an inefficient body of employees.

In order to meet these enormous liabilities of hospitals what are the assets? There are sums obtained through private contributors and appropriations from city or State. Some additional revenue may be derived from entertainments given for the benefit of the hospital fund. Then we have the payments of patients.

The ward patients can scarcely do more than pay for their keep. These individuals are of limited means. When ill they must draw upon their little savings, they must borrow from their friends, or they must be admitted free.

At this point the mind trained and devoted to business seems to see light. The private rooms and the private patients must pay the running of the hospital. It is easy for the business man to count the number of rooms, to estimate the weekly rate of each, to do a little example in multiplication and find a result. This result, however, never tallies with an actuality, for it does not take into account all the contingent sources of error. The problem is not

simply mathematical. The human element enters into the calculation. Hospitals lodge and feed sick and injured people, but they are not hotels. They are far more than hotels, and cannot be managed upon the same principles as hostelries. The object of the latter is to accommodate the public for a financial consideration, and every matter concerned with the establishment stands or falls upon a strict monetary basis. The prime aim of a hospital is to do good. For this purpose it has been conceived and erected. Every hospital in every civilized country is devoted to this aim. None is a money-making institution. The debts of the hospital must be met as far as possible, in as large a proportion as possible, by the receipts from the patients for whom it cares but these amounts never have sufficed and never will suffice in any properly regulated institution to pay its current expenses. The deficit must be made up from the other sources which we have indicated.

The conspicuous success of a hospital in a large community depends upon its reputation. Its reputation is due to the acknowledged ability of its medical and surgical staff. The members of the staff labor without recompense from the hospital and distribute their gifts alike and impartially to rich and poor. Whatever a medical man undertakes must be done to the best of his

ability. Having accepted the responsibility of a case, the spirit of his profession compels him to bestow, whether in or without the hospital, just as much care, study, and time upon Lazarus as upon Dives.

No matter how many private rooms are occupied, and no matter at what rates, there are always drawbacks which spoil the exactness of any little multiplication sum. Circumstances arise from time to time in the history of every hospital when private rooms are inhabitated by nonpaying patients. This is because some unfortunate who has occupied a good position in life is stricken at once by poverty and disease. All of his friends may not drop off and some influ

ential person asks for his admission to a hospital, under the general and popular idea, apparently, that a hospital always has an abundance and to spare. For various reasons such charges must be, and are, accepted, and, from the purely financial point of view, they mar the beautiful debit and credit account of the bookkeeper.

There is another fundamental feature in which a hospital differs diametrically from a hotel. The public seeks the latter from choice or compulsion. Sick people do not all voluntarily rush to the hospital. Those who have the means to become private patients often prefer to be treated at home. This is, in fact, true of the majority of people. They dread the isolation and strange faces of a hospital. They cling to the ministrations of home. This class includes those who come from the country to seek medical advice. They will generally choose, where the circumstances of the case permit, the comparative freedom of the hotel to the more strictly regulated life of the hospital.

The above considerations explain why it is that there is not always a rush of sick. people demanding admission, regardless of expense, to the best private rooms of a hospital. Physicians attached to a hospital are more peculiarly and more intimately interested in its reputation, success, and prosperity than any other class can possibly be, but they are none the less aware that they cannot always prevail upon their patients to enter the private room.

THE ABUSE OF HOSPITALS AND

DISPENSARIES.

THE out-patient departments of hospitals and charitable dispensaries are much abused. This is a matter to which attention has been drawn time and time again, not only in this, but also in all other American cities. We have read recently in the British journals a communication and comments upon the same subject as it occurs in London.

These institutions require a great deal of money in order to be properly managed and of benefit. For whom are they primarily instituted? For the worthy poor. To that class of people their services ought to be confined. Every emergency case receives first aid as a matter of course in any dispensary. Be the injured individual a millionaire or a pauper, his wounds must be dressed. This is humanity as practiced by the medical profession. At this point the matter differentiates. A solvent person should be referred to his family physician or to the pay ward of a hospital according to the nature of the case and the wish of the individual. The poor patient returns to the clinic to have his wound dressed and the course of treatment superintended. Vagrants may be sent to the city hospital. In the aggregate the out-patient departments expend considerable sums upon medicaments, instruments, bandages, and other necessary appliances. Anæsthetics alone constitute an important item.

These clinics accomplish a beneficent work, and they are instrumental in training young men in a practical knowledge of their profession. From the ranks of the chiefs and assistants come the teachers in our medical schools. The value of their training has always been highly esteemed. The manner in which they are notoriously abused is well known to every man who has ever served on a staff. Too often the deserving poor are crowded out by besotted wretches or by those who should be able to recompense their medical attendants. There is a large number of patients who patronize dispensaries and hospitals who would be perfectly able to pay the physician did not they waste their means in what, for them, is extravagance or in dissipation. The venereal patients, particularly, can always find money with which to acquire the disease, but not often to pay for its cure. Many a young and struggling doctor in Philadelphia and other cities would be glad dened to receive one-half or one-fourth of

an ordinary fee. If people of this kind prefer to attend a clinic they should, at any rate, be required to contribute to its treasury. In very few instances, however, is a gift ever offered. It would be right for the assistants to call attention to this aspect of their work.

It would appear that there is a class of well-to-do people who consider that they confer a favor upon a medical institution by seeking free advice. They come into the waiting rooms and glance with disdain at the shabby patients whom they see assembled. They are indignant at being required to await their turn. They refuse to be shown to the students and made the subject of a clinical lecture. Such as these have no right to free service, and should be turned away,-politely, of course, but with firmness. One would suppose that a sense of self-respect would prevent them from appearing in such a false position, but there are persons to whom the saving of a dollar or two is of more importance than a feeling of independence. The clinical material of a medical college is largely made up of the walking cases which seek its outdoor department, and if people cannot pay money they should be willing to be utilized in this

manner.

There is another species of patients who are familiar in every dispensary. They wander from one to another, they are, or pretend to be, too poor to buy their medicine and they have it furnished free of cost. They frequently succeed in gaining admission to the hospital wards and remain there contentedly as long as they are tolerated.

Between all the varieties of individuals who impose on medical charity, the expenses of charitable institutions are needlessly increased to a considerable extent. A catalogued report looks very well on paper as a testimony to the extent and scope of work done, but a certain proportion of this work should have been remunerative, either to the physician himself or to the institution which he represents.

DEATH OF A DISTINGUISHED PHY

SICIAN AND AUTHOR.

THE editor of THE MEDICAL BULLETIN desires to place on record his keen sense of personal loss as well as the loss to medical science in the death of Dr. Charles D. F. Phillips, of London, who died in that city. on November 13, 1904. The deceased was an able, amiable, and honorable man, a close student and observer, a sagacious practitioner, an excellent teacher and writer. He was a graduate of the University of Aberdeen. He had been examiner to Materia Medica at his Alma Mater and at the Universities of Edinburgh and Glasgow. He was for many years Lecturer on Materia Medica and Therapeutics at the Westminster Hospital Medical School in London. Dr. Phillips had attained the age of 74 years. He settled in London in 1867 and acquired a large and lucrative practice.

It was the privilege of the writer to enjoy the friendship of Dr. Phillips, whom he had met in England and in America. The deceased had often expressed a hope of again. coming to America, but it was not to be. We had looked forward with pleasure to such an event.

Dr. Phillips was a genial host and wellread scholar. His professional interest was strongly engaged in those branches with which his name was particularly connected. He was a member of numerous learned so

of THE MEDICAL BULLETIN for June. We had looked forward with eagerness to the time when the second volume should be issued. Out of his fund of large experience Dr. Phillips produced a work which could be consulted with a feeling of confidence. His clinical acumen was keen, and his judgment of the usefulness and comparative value of remedies and methods was always clearly expressed. This work is his monument which shall survive him to testify to his talents and the prominent part which he took in the advance of professional knowledge. The work is original in the sense that the author's mind had sifted all statements from various sources and had arrived at an independent judgment before placing it on record. This is high praise.

for a scientific book.

As a man and a scholar Dr. Phillips stood high among his contemporaries. We notice with surprise and sadness the meager and inadequate notices of his death which have appeared in the London journals. Are we so soon forgotten? Justice to the honorable and useful career of the deceased would certainly justify a more extended biography. The life and work of Dr. Phillips should be an inspiration to every student of medicine in Great Britain and America.

States.

The Medico-Chirurgical College

of Philadelphia is honored in having his name enrolled in the list of its Fellows.

Dr. Phillips had embodied his long and earnest studies in a most admirable and instructive work, published in 1892 and entitled "Materia Medica, Pharmacology, and Therapeutics." The work was divided into two volumes, one of which was devoted to inorganic and the other to organic substances. A third edition was in preparation, and the first volume, dealing with inorganic substances, made its appearance last year and was reviewed in the columns

Psoriasis.

Dr. S. M. H. has a patient, male, aged 62 years, with an itching and scaly eruption, especially below the knee and behind the elbows. The disease began in the form of isolated papules, each being covered with scales. The man suffers from rheumatic pain in and below the right shoulder. He is constipated, his tongue is coated, and he has symptoms of indigestion.

The disease is psoriasis, although itching, as a rule, is not a prominent feature of psoriasis. Exceptions occur, however, as