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practising physicians would enjoy the prerogar tives and emoluments that are a natural condi- tion of such positions, and it would be a severe blow to the present tendency of centralizing hos- pital appointments in the hands of a few. The economic principle involved would be that of the greatest good to the greatest many. According to the latest edition of the Medical Directory there are about forty-four hundred ■ practising physicians in the Borough of Manhat- I tan and the Bronx. Of this number about five hundred (500) hold hospital positions. These Oct. 27, i9o6] ,-'--■ MEDICAL RECORD. 643 positions are scattered among sixty hospitals of being under the impression that any physician a capacity of seventy-five beds and over; in other in good standing is authorized to take his private words only about 10 per cent, of practising physi- patients into the pay wards, but are chagrined cians hold appointments on the staffs of large on learning that the doors of the hospital are hospitals. The rest are entirely excluded without closed to their family physician, because he is rhyme or reason from hospital practice, and can- not fortunate enough to be officially connected not enjoy even a share of the benefits derived vvith the institution. Considering that hospital from such a connection. If you will Zantac 150mg take the positions are few and far between, and that in trouble to look through the pages of the Medical not a few instances they are the result of influ- Dircctory you will also note that a number of cnce rather than of individual worth or personal physicians are credited with appointments in four merit, it is not difficult to understand that it is or five hospitals and that still others hold two only a question of time when there will be de- different positions in one hospital, to the exclu- veloped a "system" as baneful to the mass of sion of reputable and deserving physicians who physicians as it is profitable to the elect of the are clamoring for hospital appointments. The profession. Zantac 150 The tendency to the creation of such system which tolerates such an unjust discrim- a system is greatly promoted nowadays by the ination certainly needs modification, and a more desire of patients to seek hospital treatment in equitable adjustment, especially when we take preference to being treated at their homes in into consideration that without a hospital con- severe or prolonged illness. It is matter of every- nection, a physician is seriously handicapped in day experience with physicians to see more and the pursuit of his calling in a city where people more of their cases enter hospital wards. Pri- flock to the hospitals for treatment. vate rooms and pay wards are a comparatively In place, therefore, of an exclusive and re- "5^ feature of hospital life, and it is a moot ques- Etricted attending staff, appointments should be t^jon whether the founders of our great institu- made on a more liberal scale, Online Zantac so that the vast ma- t'ons of healing ever contemplated any such in- jority of physicians would feel that they were novation or misapprehension of their original not discriminated against by a small but infiu- plans. ential minority of their own brethren. In order It would seem that a hospital which was de- to carry out more effectively the plan I have out- signed to meet the want of the indigent sick lined the suggestion might be also adopted of re- would enlist every inch of ground and every bed tiring from active service all such members of an to Purchase Zantac the charitable purposes for which it was attending staff who have served continuously created, instead, as now obtains, of entering the in one capacity a specified number of years, say commercial arena and making a bid for patients, twenty or twenty-five years. The practice of But conditions of life are such to-day that pn- enforced retirement after a long service or for vate rooms seem to be a public necessity. The advancing age, is not unfamiliar to you in other medical and surgical requirements in these ad- walks of life and in other professions. It is based vanced days of the medical sciences for minister- on sound judgment, while the wisdom of it is ing to the sick are on such a prodigal scale that unquestioned. It is not unreasonable to be re- home treatment is unfeasible in many cases and quired to sever an active connection from a hos- in others impossible of being properly carried out. pital if for no other reason than that of allow- The elaborate paraphernalia of the operating ing another the same opportunities. Such re- room, the array of surgical appurtenances, the tirement from active participation of the service need for trained assistance, all combine to give would not necessarily mean that the retired at- an impetus to this method of handling patients, tending physician should be deprived of certain Cheap Zantac These circumstances have given rise to a "system," well-deserved privileges. On the contrary, such the importance of which cannot be dismissed without physicians should be retained in an advisory or serious consideration of the consequences involved, Order Zantac consulting capacity, with authority to treat pay A grave problem has arisen of far-reaching inter- patients, est to the medical man, which he must approach In entering on a campaign for improvement in with deep concern. On the one hand we have hospital management, the necessity for reforms a public educated to avail itself of the facilities other than those suggested soon manifest them- of a hospital in severe illness, and on the other selves ; but the one which overshadows all others hand a cast-iron regulation which closes the in its significance to the Zantac 75 Mg public and to the profes- doors of the hospital to the majority of practi- sion is the practice that prevails in our hospitals tioners. This "system" has made such striking by which onlv the appointed visiting staff is per- inroads on the earning capacity of physicians in mitted to make use of the operating room and of cities where it flourishes as to entail enormous the Order Zantac Online beds in the pay wards for their private pa- pecuniary losses. It seems like an unfair and tients, and which arbitrarily denies such privi- anomalous proposition that a minority of physi- leges to all otiier unassociated physicians. This cians should claim, as though it were a property deplorable state of affairs with but few exceptions right, the privileges that rightfully belong to the exists in everv hospital in New York where there whole community of physicians, are pay wards. No matter how capable and rep- To give you an idea to what extent this system utable a physician may be, and no matter how prevails, I submit the following table of figures desirous a patient may be to retain the services collected by myself. The institutions cited are of his own physician, directly the latter is ad- among the largest general hospitals in this city: mitted to a hospital, his own physician's con- nection with the case is brought abruptly to an Hospital. Free beds. Pay beds. end, while the patient is forced to accept the Presbyterian 197 23 services of the attached physician, and in many St. Vincent's 250 125 instances one not of his own choice, or else be St. Luke's (new pavilion) 250 65 denied admission. This is a fact with which the Mount Sinai 350 73 public is not generally acquainted ; most people German 200 45 644 MEDICAL RECORD. [Oct. 27, 1906 Roosevelt 205 39 New York. .. .Seventy per cent, of patients treated were free patients ; new pavilion for pay patients is soon to Zantac Buy be opened. A study of these figures makes it appear that in the aggregate about 25 per cent, of the beds in our large hospitals are at the disposal only of pay patients for whose purposes large pavilions are maintained, and from which unattached physi- cians are barred. Notable exceptions to this rule are the following: In the German Hospital, ex-internes and mem- bers of the dispensary staff of ten years' stand- ing may treat pay patients. In Mount Sinai Hos- pital chiefs of the dispensary staffs of ten years' standing may treat pay patients. In the New York Hospital, a specially selected Buy Zantac Online list of thirty physicians not attached to the regular staff may operate at the hospital. The private pavilion is partly designed to pro- duce Purchase Zantac Online an income which is employed to make up the yearly deficit incurred in the maintenance of the free beds. Now it would seem from a purely business viewpoint that it should make little dif- ference to the managing boards from what class of physicians that revenue is derived, providing the latter are men of acknowledged standing in the community. This much is morally sure, the gross receipts would be materially enhanced while there would be fewer vacant beds. This very matter was advocated by me as long as ten years ago, in an article which appeared in the Medical Record January 25, 1896, en- titled "Should Our Hospitals Extend Their Fa- cilities for Operating to Physicians Generally?" I then took the ground that the managers of our hospitals should grant certain physicians who are known to them to be capable and well qualified, the privilege of operating upon their pay patients in the hospital under certain restrictions and limi- tations. What these restrictions and limitation.? were, each hospital must determine for itself and work out according to the character of the insti- tution, and the nature of the cases that are eligible for admission. It was not contemplated that all physicians, promiscuously, would come within the scope of this concession, but only a cer- tain quota selected according to rules, which each hospital would make for the protection of its own interests. I argued that physicians were greatly hampered in the practice of their calling by the oppressive and archaic rule which closes the doors against them. It was shown that on account of this drawback, physicians were constantly losing their most lucrative cases. I Where To Buy Zantac recommended that one or more of our more liberal institutions should take the initiative of abolishing this prac- tice. It was not long after the publication of my paper that the question was favorably taken up by several institutions in this city with satisfac- tory results. Among the remoter results, auxili- ary operating rooms became the vogue, and to- day no hospital is considered fully equipped with- out them ; the number on the house staffs was of necessity increased, and this increase has proven a great boon to our young graduates. To-day hospitals are conducted in many cities along the lines here suggested, with great satisfaction to all concerned. Thus the patient has the choice of hospital or home treatment ; the well-grounded feeling of hostility of the profession against hospi- tals gave way to one of friendly disposition ; further. there were found to be fewer empty beds in the pay wards, and in consequence appeals for financial sup- port became less peremptory, and finally, there was not that tendency to pauperize a susceptible public by crowding the free wards with Buy Zantac patients who could pay for medical services. I believe some of the measures recommended in this paper will be adopted in the near future, and that in a certain sense the superiority of one hos- pital over another as a public benefaction will be determined by its disposition to Zantac 300 Mg follow the spirit of the times, and submit graciously to the Zantac Online popular demand for Zantac Coupon an "Open door." 1309 Madison Avenub. CHOICE OF COW'S MILK. By J. ALLEN GILBERT, Ph.D., M.D., PORTLAND, OREGON. No article of diet is so universally used by man and beast as milk, and any information which will in any way aid in the intelligent choice and use of so useful a commodity must necessarily appeal to the interest of one and all. I shall deal with the subject in two general heads, viz., first, a consideration of fifteen qualities con- sidered by the writer Zantac 150 Mg to be desirable in a milk to be used as human food — infants and invalids being specially in mind — and, second, a comparison of the main breeds of dairy 300 Mg Zantac cows with a view to selecting the breed best adapted to fill these requirements. No attempt will be made to deal with rules governing the modification of cow's milk for the purpose of infant and invalid feeding. The sole purpose will be a choice of milk. QUALITIES OF A GOOD MILK. ( I ) High Percentage of Solids. — To the average individual milk is milk, and the consumer receives and pays for his milk Zantac Mg by the quart with practically no knowledge of the food content of the milk he

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