The record-union., 1891-04-22


from careful analysis of the replies. In
the circular these practices are styled
trepresensible and avoidable business
dealings" and / have been gratified to
find an almost universal concurrence in
their condemnation. general wish that
this effort might conduce to their abate-
nlent, and frequent request for advice
upon plan to break up the abuse of
''society practice" But l have found it
incumbent upon me to enlarge the scope
of this exposition, as a large number of
correspondents have called attention to
other derelictions, and | shall here quote
some of the statements made in connec-
ton with the various practices in ques-
ton.
PERCENTAGES ON PRESCRIPTIONS.
''The practice of paying a commission
to physicians by apothecaries is, of
course, rather presumptive than capable
of actual proof, and this is plainly shown
by the table; but there can be no reason
able doubt that it is even more prevalent
than the returns indicate. A San Fran
cisco physician remarks: L have been
repeatedly approached by them (apothe-
carieS), and commissions ranging from
80 to Is cent. have been offered; indeed,
many druggists openly maintain that
they can afford, and in fact, do give
physicians all the receipts of the first pre-
scriptions, contenting themselves with
what they call the repeats In order not
to have patients 60 to another drug store,
one druggist has envelopes which are
given to the physician, who seals the pre-
scription in the envelope; another apoth-
ecary has prescriptions telephoned to
him directly from the doctors office, and
pays for the rental OF the telephone.
had one patient tell me that his drug bill
was larger than his physicians bin (of
course, while under another physicians
care. A correspondent at Chicago, and
another at Elgin, H., alludes to n prac-
tice Of writing prescriptions in cipher, so
that they can be understood and filled
only at q particular store. The plain in
ference is that the prescribcr and the
druggist are leagued to ieece the un-
fortunate patient. This is no novelty,
and is probably known wherever per
centage' prescribing is done. A corre-
Spondent at Racine, Wis, writes: 1T is
a systematic way of robbing the public
and any society Of medical men ought to
denounce it, aud refuse TO affiliate with
members VINO persist in the practice.
hope you will arouse q public feeling
which Will spread from Maine to Califor-
MIA, and finally break up this robbery Of
the sick and unfortunate. 1t is probable
that the abominable system is as preya-
lent i'll San Francisco as in any city in
the whole world and it is an open Sc
cret.' There are now two druggists
who announce their revolt from the sys-
tenn by conspicuous placards, one OF
which reads: Peoples Drug Store: No
Commission Paid to Physicians on Pre-
scriptiOns;' and another bears the legend:
No Percentage Drug Store But this
is not the sole wrong done the confiding
patient. The percentage doctor is ire
sistibly impelled to order more medicine
than his
PATIENT OUGHT TO SWALLOW,
So as to increase his gains. Some are
| known to prescribe gratuitously with
great, apparent, liberality: but their be-
nevolence is rewarded by the percentage
on the bulky and baneful excess Of drugs
which the simple patient had to pay ex-
| tortionate prices for. / say extortionate
for the druggist is sure to recover the doe
tors commission by adding TO it fail
price for the medicine, either then or on
| future occasions.
Il am informed that percentages are
given to physicians in all large towns o1
England, varying from So to 80 per cent,
though it is not a general custom: also
that the same is done by some druggists
in Edinburgh. Advices relative to Berne
Switzerland, and Bucharest, Rounlania,
mention this dealing as suspected The
moral turpitude of this business, / do not
hesitate TO say, attaches more to the ply
sician than to the apothecary, for the lat
ter is half, often more than half. trades
man; and if the structures of Herbert
Spencer, in his essay on the Morals OF
Trade fit particular druggist, we little
wonder. But the public have right tc
expect better conduct of the educated
members of liberal profession. The
druggists of San Francisco have taken
the lead in setting two laudable examples
of reform; and it is now the turn of the
physicians to act. / shall not undertake
] tn advise thpnl how fn TNrNonQd hT1f
thing ought to be done, both in the me
! trOpolis and in other towns in California
to abate practice which is SO common as
| to cast a cloud over the whole body o1
medical practitioners. What family now
knows surely whether its medical adviser
is or is not concerned in this traffic?
What honorable physician would not bt
! picion?
SOCIETY PRACTICE.
This system, to my knowledge, has
existed in England for more than thirty
years, fiourishing under the appellatior
of Friendly Associations Sick Clubs,
| Providence Dispensaries,' etc.; anc
America has probably borrowed it from
| the mother country. The subject has
! been discussed i'll English medical jour.
nails for many years, and has been justly
/ regarded as a crying abuse. In the
! United States it dates back twenty-five
years, and is now rapidly growing in
! cities and large towns, and is gradually
! invading new territory. The following
| from a practitioner in California, describes
| the system as existing in England: ,Hav.
! ing myself held society appointments
and been physician to Provident Dis
! pensary, from which / used to derive
half my income in England, can speak
eC cGthed2'd. used TO make $1,000 year
from such appointments. The system is
simply accursed all round; the doctor be-
! ing worked TO death and the patient be-
ing treated for symptoms only, as his
| physician hasn't time to make a diagno-
sis. The Provident Dispensary in Eng
land is intended to meet a great want
but, like other good things, it is much
abused. Nobody earning more than q
shillings week is supposed to belong to
it. There is always a rule to this effect;
and, in fact, i'll several places, e. q. in
Pimlico, one of the districts of London.
! the Provident DiSpensary had a sliding
scale of fees to suit incomes of 25 to SO
shillings a week. The Provident Dis
pensary is really intended to relieve such
people; but the public seem to have no
conscience when Doctors fees are con-
cerned, and quite well-to-do people Join
such institutions in every place. Then.
on the other hand, if the physician of
such an institution is popular and keeps
clever assistants, he can starve his broth
er practitioners. The Providence Dis
pensary has had my life blood, and 1 fled
here to escape it. The workingman OF
California is much too well off to descend
to such meanneSs, trust, as medical at
tendance at society rates.
PAID ANNUALLY.
"A correspondent, residing in London