Society Proceedings

1909 Journal of the American Medical Association  
ment of injuries and ailments of various kinds. As here sug¬ gested, they were used in a bath, but they were evidently the ordinary simples of the time. Among them fennel, pellitory, which contains nitrate of potash, and camomile are still used as home remedies. Centaury, so named from the legend that by a decoction of it Chiron, the centaur, was cured, is a plant of the gentian family, which is still considered valuable as a bitter. HeyrifT is said to be still used in France as an internal
more » ... as an internal remedy for epilepsy. Herb-bennett-a name derived from the term "herba benedicta," or the blessed herb-was supposed to be particularly efficacious in driving away the devil. This was very probably one of the forms of valerian; we still use it in driving out devils, though we often are not very successful because the blue devils of hysteria do not yield readily. As external applications the common daisy and mallow from the marshmallow were used. The main virtue of these undoubtedly lay in the fact that they were thoroughly boiled before being applied, and therefore were probably aseptic. As they made a coating over the wound, they servedand this was especially true of the marshmallow-as a protective almost as efficient as the modern collodion. Apparently, they had many "blood purifiers" in the old days which we still have with us, their efficacy being due in part to suggestion and in part to their laxative effect. Danewort, a dwarf elder, for instance, was traditionall}' thought to have sprung up by a sort of spontaneous generation wherever »there had been an encounter between the English and the Danes. The mixture of these two virile bloods was supposed to make for wonderful blood-purifying properties in the herb that resulted; it is still employed sometimes because of its purgative properties. Flaxseed was employed for its sup¬ posed power over coughs; flaxseed tea was usually taken three cupfuls a day. The most efficient cough remedy that we have even at the present day when coughs are hard, is an abun¬ dance of fluid. Besides, flaxseed tea was a mucilage and all of the mucilages are valuable for their protective property for the throat irritated by the explosion of coughing. Evidently the drugs of our forefathers deserve less scorn than we have given them. Articles of commerce pass, as a rule, through several hands before they reach the consumer. A certain profit or commis¬ sion properly accrues to each of those that effect a sale. The price of such articles varies in accordance with the laws of political economy, being affected especially by the cost of pro¬ duction and of marketing, as well as by conditions of supply and demand. Occasionally, for reasons of expediency, goods are sold at a loss; but rarely are they given away gratuitously. The profession of medicine, while it has certain business aspects, differs radically from the various forms of commercial and industrial activity. It is, however, neither a business nor trade. The medical man, like his neighbors in the com¬ munity, must pay taxes and rent, and he must provide the necessities of life for himself and his family, and to meet these obligations he must have a definite source of income, prom esthetic considerations his expenses are greater than those of laymen occupying a corresponding social position. His work requires his personal attention, and he can not read¬ ily delegate it to others as can the business man; nor can he, like the manufacturer, multiply the product ofr his activity through the agency of machinery and subordinates. His op¬ portunities for relaxation, diversion and entertainment are re¬ stricted by the demands that may be made on his time at any hour of the day or night, and he can indulge in protracted holidays only at the sacrifice of income and practice. Throughout his entire professional career the physician ren¬ ders without pecuniary compensation a large measure of ser¬ vice in hospital and dispensary, in his office and in the homes of the poor. In addition he does a not inconsiderable amount of work for which he fails to receive the material reward to which he is morally and lawfully entitled. Physicians' fees necessarily differ in accordance with the nature of, and the time required in, a given case on the one hand and the skill and experience of the individual practi¬ tioner on the other hand. In every case the service, wholly apart from considerations of gratitude or other emotional factor, should be adequately compensated. The situation is in no wise changed if the exigencies of the case demand the ref¬ erence òr the transfer of the patient to a second physician or the calling of such a physician in consultation, with a view to clearing up an obscure diagnosis or formulating the prog¬ nosis or obtaining aid and suggestion in treatment, medical, surgical or otherwise. In each instance the physician gives his best skill and judgment in the interest and for the welfare of the patient, and the latter in turn should be ready and willing to compensate adequately each and all of those on whose service he makes demand. From the foregoing considerations it does not seem that there can be any fair or honorable division of the physician's fee. For one physician to make such division with another or to pay a commission, would mean the alternative of surren¬ dering a part of the compensation to which the first physician is fully and deservedly entitled for the service rendered by him or the making of an excessive charge against the patient and out of which the second physician receives his remunera¬ tion. Such a course would be compromising to both parties to the transaction and it could result only in the demoraliza¬ tion of both donor and recipient and the eventual commercial¬ ization of medicine. The physician who expects a commission or a division of the fee will be tempted to select that consultant or operator or specialist who yields the largest pecuniary re¬ turn, and who for this reason may charge the largest fee, or at times to advise consultation or operation when it is not actually demanded by the requirements of the ease, while such a keen rivalry might develop among physicians who divide fees or pay commissions' that one outbids the other in the desire to secure new business and more fees. Out of this sit¬ uation no advantage could redound to the benefit of the patient. What has been said with respect to the relations among physicians applies equally to druggists, instrument-makers and other tradesmen. The payment and acceptance of com¬ missions for articles purchased by patients merely puts an added burden on the latter, entirely without their knowledge and consent.
doi:10.1001/jama.1909.02550040066026 fatcat:sx3xm3i45nhwxmv5fmwpuhdoya