THE QUESTION OF "PHYSIC." of the article on tlie
question of fees number, we have received several, communications on the subject from professional brethren in various parts of India. One, for whose opinion we have a very high respect, points out that, in approving of the system of annual payments, we have omitted to insist upon a very important point, which is that, as such a form of remuneration is a compromise, and does not vary in amount from year to year with tinsickness of the patient, so it should always bo held to commence from the date of arrival in the station of either party tn the agreement. It could not be otherwise than unfair to tin: medical man that a period during which a family remains iu Since the
publication
which appeared in
our
last
health should not count to his benefit if he is to be called upon, to act, for a reduced honorarium only, on the setting in of sickness, which may occupy a large portion of his time, and cost him the greatest anxiety. It should therefore be considered open, every medical
to
man
to
decline such annual arrangements, am!,
require his full fee when they are not made ab origine. Our correspondent takes a still more liberal view of the waiter than we have ourselves done, and thinks that in the Mofutsi! to
there
are
dant
more
many who cannot afford to offer their medical attenthan lis. 100 per annum. He would give gratui-
tous advice to all unable to aft'ord this very moderate hono-
rarium, and accept nothing lower. This rate of remuneration should be required from unmarried planters residing in tin* neighbourhood of Mofussil stations, and should entitle them to the Civil Surgeon's advice in the station, the fee being increased, by special agreement, according to distance, if he has to visit them at their houses beyond the limits of the station. The svstem of taking one week's pay to represent the annual fee would, our correspondent thinks, be a good one, if fairly accepted by the. public; but it too often happens that the receivers of high salaries deduct two or three of the seven days which constitute a normal week, and forget that an additional fee should be paid for
midwifery
attendance.
But there is
subject which require.-? notice, writing as we did in Calcutta. There is in 'die Mofussil not only a question of fees, but a question of " physic." The appetite of adult human beings for " physic," or, more properly speaking, for drugs, jj unbounded. It might indeed be considered, as iirplied by the word "physic," to be one of the natural instincts of our va---, did it exist,in infancy; but in the child we study unperverted
attention,
one
other branch of the
and which
escaped
our
126
TIIE INDIAN MEDICAL GAZETTE.
instinct,
?nd
find that
children, wise in their early days, never drugs. A baby never takes kiudly to the drowsy syrups of Godfrey or Mrs. Johnson at first, but sputters them out of its mouth steadily, till, by their repeated administration, it has acquired a morbid appetite, and a taste for intoxiciation. "Whether the early physicking of infants by monthly nurses and anxious mothers produces a permanent effect upon the mind, we cannot say; but certain it is that the child, which once hated powders, generally grows up to revel in drugs, and to swallow Podophyllin and Per-Chlorodyne with intense delight. Patients, then, in general, desire to have drugs and plenty of them. Physicians, on the other hand, who have really studied their art, know that the curative properties of many drugs are purely imaginary; and. that disease is not to be remedied by converting the stomach into a receptacle for " mixtures." Ken of this class are happy in their knowledge of the truth, but are too often little thought of by their patients, who, as a rule, know ail about their ailments, and what should be given for them they know, for instance, when they are afflicted with liver," wo
fail to declare their abhorrence of "
"
"
and what blue
and
sometimes,
cure; "
black nastinesses are
necessary
for its
with refined delicacy, they do not trouble
"
to see them, but intimate to him that they have disorder, and require such and such medicines, or they merely state generally the action to be exerted on their " systems, and a^k for a searching pill," or a draught to touch as the desire of the liver. however, Morbid, up swallowing medicine often is, medicines and medical appliances are necessary for the treatment of disease ; how and by whom should they be supplied? In former days a paternal Government, with kind but extravagant hand, supplied medicine from its dispensaries to all persons who presented at them prescriptions signed by Government Medical Officers. In the early days of our service, we can remember being waylaid in the Pay Office by a fat and probably flatulent Baboo, who begged us to give him a prescription for Pevermuit." We some oil of peppermint, or, as he called it, have heard also that?we cannot say how many years ago?the quantity of castor oil given out from the Calcutta Government Dispensary used to be so large, that the whole city was supposed to labor under perpetual constipation, till it was discovered that most of the oil was not swallowed, but burnt in lamps. their
this
or
doctor
that
"
"
"
About fourteen years back the Government closed its dispensaries, even to its own servants, in Calcutta, and has for some time strictly forbidden the issue of medicines to any persons, not being its servants, in the Mofussil. Whence then is to come the necessary supply ? Patients who have hitherto received medicine free of charge at their Doctor's hands, expect to do so still, and even those to whom he gives advice without fee, grumble at being presented only with a prescription. It is the duty of the Doctor, say the patients, to provide us
with medicine. We cannot agree with them. We think it is unreasonable that the Medical Officer of a Civil Station should be
to
provide medicine
for the public. His stay at the add, his fees are both uncertain; the exigencies of the service, a change of appointment, his own sickness, may take him suddenly from the scene of his labors, and he may thus be subjected to a considerable loss. But we would take a higher view of the matter. We believe that the elevation of our social position depends on the separation of the science of medicine from the sale of drugs. The profession and the trade
expected and,
station
we
may
[May 1,
cannot be
wedded,
the latter.
The morbid
1866.
lowering the former to the level of appetite for drugs also can only be controlled by making it a little costly. Medicines should be bought and paid for by patients ; and we hold that it will be better for both physician and patient when it is agreed that the one shall give only advice, and the other pay some one else for the medicine prescribed, there will then be no temptation either to give or take unnecessary drugs. It behoves all sufficiently large communities to make provision for their wants in this respect, by arranging for the establishment of dispensaries; we believe that in many stations out of Calcutta such Dispensaries have been established, by private enterprise, in reliance upon a lately announced intention on the part of Government to close its Dispensaries, even to its own servants, in the Mofussil. Were this intention duly carried into effect, we believe that a considerable saving of public money, and a great amount of public good, would be effected. without
question of fees number, we have received several, communications on the subject from professional brethren in various parts of India. One, for whose opinion we have a very high respect, points out that, in approving of the system of annual payments, we have omitted to insist upon a very important point, which is that, as such a form of remuneration is a compromise, and does not vary in amount from year to year with tinsickness of the patient, so it should always bo held to commence from the date of arrival in the station of either party tn the agreement. It could not be otherwise than unfair to tin: medical man that a period during which a family remains iu Since the
publication
which appeared in
our
last
health should not count to his benefit if he is to be called upon, to act, for a reduced honorarium only, on the setting in of sickness, which may occupy a large portion of his time, and cost him the greatest anxiety. It should therefore be considered open, every medical
to
man
to
decline such annual arrangements, am!,
require his full fee when they are not made ab origine. Our correspondent takes a still more liberal view of the waiter than we have ourselves done, and thinks that in the Mofutsi! to
there
are
dant
more
many who cannot afford to offer their medical attenthan lis. 100 per annum. He would give gratui-
tous advice to all unable to aft'ord this very moderate hono-
rarium, and accept nothing lower. This rate of remuneration should be required from unmarried planters residing in tin* neighbourhood of Mofussil stations, and should entitle them to the Civil Surgeon's advice in the station, the fee being increased, by special agreement, according to distance, if he has to visit them at their houses beyond the limits of the station. The svstem of taking one week's pay to represent the annual fee would, our correspondent thinks, be a good one, if fairly accepted by the. public; but it too often happens that the receivers of high salaries deduct two or three of the seven days which constitute a normal week, and forget that an additional fee should be paid for
midwifery
attendance.
But there is
subject which require.-? notice, writing as we did in Calcutta. There is in 'die Mofussil not only a question of fees, but a question of " physic." The appetite of adult human beings for " physic," or, more properly speaking, for drugs, jj unbounded. It might indeed be considered, as iirplied by the word "physic," to be one of the natural instincts of our va---, did it exist,in infancy; but in the child we study unperverted
attention,
one
other branch of the
and which
escaped
our
126
TIIE INDIAN MEDICAL GAZETTE.
instinct,
?nd
find that
children, wise in their early days, never drugs. A baby never takes kiudly to the drowsy syrups of Godfrey or Mrs. Johnson at first, but sputters them out of its mouth steadily, till, by their repeated administration, it has acquired a morbid appetite, and a taste for intoxiciation. "Whether the early physicking of infants by monthly nurses and anxious mothers produces a permanent effect upon the mind, we cannot say; but certain it is that the child, which once hated powders, generally grows up to revel in drugs, and to swallow Podophyllin and Per-Chlorodyne with intense delight. Patients, then, in general, desire to have drugs and plenty of them. Physicians, on the other hand, who have really studied their art, know that the curative properties of many drugs are purely imaginary; and. that disease is not to be remedied by converting the stomach into a receptacle for " mixtures." Ken of this class are happy in their knowledge of the truth, but are too often little thought of by their patients, who, as a rule, know ail about their ailments, and what should be given for them they know, for instance, when they are afflicted with liver," wo
fail to declare their abhorrence of "
"
"
and what blue
and
sometimes,
cure; "
black nastinesses are
necessary
for its
with refined delicacy, they do not trouble
"
to see them, but intimate to him that they have disorder, and require such and such medicines, or they merely state generally the action to be exerted on their " systems, and a^k for a searching pill," or a draught to touch as the desire of the liver. however, Morbid, up swallowing medicine often is, medicines and medical appliances are necessary for the treatment of disease ; how and by whom should they be supplied? In former days a paternal Government, with kind but extravagant hand, supplied medicine from its dispensaries to all persons who presented at them prescriptions signed by Government Medical Officers. In the early days of our service, we can remember being waylaid in the Pay Office by a fat and probably flatulent Baboo, who begged us to give him a prescription for Pevermuit." We some oil of peppermint, or, as he called it, have heard also that?we cannot say how many years ago?the quantity of castor oil given out from the Calcutta Government Dispensary used to be so large, that the whole city was supposed to labor under perpetual constipation, till it was discovered that most of the oil was not swallowed, but burnt in lamps. their
this
or
doctor
that
"
"
"
About fourteen years back the Government closed its dispensaries, even to its own servants, in Calcutta, and has for some time strictly forbidden the issue of medicines to any persons, not being its servants, in the Mofussil. Whence then is to come the necessary supply ? Patients who have hitherto received medicine free of charge at their Doctor's hands, expect to do so still, and even those to whom he gives advice without fee, grumble at being presented only with a prescription. It is the duty of the Doctor, say the patients, to provide us
with medicine. We cannot agree with them. We think it is unreasonable that the Medical Officer of a Civil Station should be
to
provide medicine
for the public. His stay at the add, his fees are both uncertain; the exigencies of the service, a change of appointment, his own sickness, may take him suddenly from the scene of his labors, and he may thus be subjected to a considerable loss. But we would take a higher view of the matter. We believe that the elevation of our social position depends on the separation of the science of medicine from the sale of drugs. The profession and the trade
expected and,
station
we
may
[May 1,
cannot be
wedded,
the latter.
The morbid
1866.
lowering the former to the level of appetite for drugs also can only be controlled by making it a little costly. Medicines should be bought and paid for by patients ; and we hold that it will be better for both physician and patient when it is agreed that the one shall give only advice, and the other pay some one else for the medicine prescribed, there will then be no temptation either to give or take unnecessary drugs. It behoves all sufficiently large communities to make provision for their wants in this respect, by arranging for the establishment of dispensaries; we believe that in many stations out of Calcutta such Dispensaries have been established, by private enterprise, in reliance upon a lately announced intention on the part of Government to close its Dispensaries, even to its own servants, in the Mofussil. Were this intention duly carried into effect, we believe that a considerable saving of public money, and a great amount of public good, would be effected. without
