George's autocratic terms, and if necessary he would hand them over to a whole time doctor, without their having a voice in the matter. The converse holds good for the doctor, who will have to accept a certain. number of patients that may, under certain circumstances, be allotted to him. Finally, by the act, the Insurance Committees are expressly given the right to allow an insured person to contract out of the act, if he desires to make his own arrangements for medical attendance by his former doctor, when the latter is not on the panel; yet now Mr. Lloyd George insists that this privilege should not be conceded save in very exceptional cases, although such applications are being sent in by tens of thousands. And the worst of it is, that the act has been so insidiously drawn up that the Insurance Commissioners are given absolute and autocratic power to make any regulations they think fit for the working of the act, and there is nothing to prevent them altering or cancelling them and making new ones as often as they please; yet when made, and unless the commissioners choose to revoke them, such regulations become part of the act itself, and so are possessed of statutory force. Thus, by passing this act, Parliament has created a body outside of itself whose "regulations" become statute law of the country.

But the end is not yet. The first "panel doctors," who took service voluntarily, were for the most part the ne'er-do-wells of the profession. The great majority of those who have since joined have done so under force majeure threatening them with ruin, and have openly proclaimed the bitter resentment they cherish over the unscrupulous methods of their antagonist. Moreover, they have taken service for three

months only, and in that time much may happen. The last word will rest, neither with Mr. Lloyd George and his creatures, nor with the doctors, but with the insured persons themselves; and when they awake. to the fact that, without their even asking for bread a stone has been forced on them, they are likely to rebel to some purpose. At present they are not alive to what this wholesale, sweated, bureaucratically managed, compulsory cheap club doctoring means. But already events are happening that will teach them.

On January 20th an inquest was held in London on an insured person who died, as was proved at autopsy, from strangulated femoral hernia that was becoming gangrenous. The deceased had always enjoyed good health, but on January 14th, the day before the medical benefits of the act came into operation, he attended in a queue of between 200 and 300 people to put his name on the list of a panel doctor who had an office near by, but resided a long way off in another district of London. The patient at the time complained of abdominal pain, and the doctor, without examining him, gave him some medicine. He called on the doctor next day and, again without any examination, more medicine was given him. On the night of the 16th he became very ill indeed, but the panel doctor, living a long way off, and his address being unknown in any case, could not be had, and the patient died with his condition unrecognized on the morning of Jan. 17th. In defence, it was shown to the satisfaction of the coroner and the jury, that the unfortunate panel doctor had been engaged in complying with the clerical work exacted by the act for six hours at a stretch, that it had been the same all through the week,

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keeping him busy up to midnight, and that in consequence he had no time to attend to his patients, insured or otherwise, and was in fact rapidly losing all his private practice. The jury, returning a verdict of death from natural causes, added a rider "that more care should be exercised in future in the matter of examining insured persons by doctors under the National Insurance Act," but excused the doctor in this case "owing to the scandalous amount of work that was imposed upon him under the act."

The necessity of some scheme of state insurance against sickness for those whose income while, above the pauper line, yet affords them little or no margin wherewith to meet the changes and chances of this mortal life, is becoming generally recognized. But the risks of any insurance scheme should be assumed by those who give the insurance, not saddled on those whose means of livelihood it is to render the special service required. Moreover, it is highly desirable in the interests of medical science and of the community, for whose service medical science exists, that the best class of mind, culture, and character should be attracted to the practice of medicine, not merely in the case of the exalted few who dedicate their lives and themselves to a sacred mission, but also in the case of the large mass of practitioners who regard it primarily as a means of livelihood, even though sanctified to some extent, no doubt, to a greater or less extent by its altruistic character. Vexatious interference with freedom of action, the frequent conflict of duties between their essential work and state imposed red tape regulations, and the fact that in the future all practitioners who do not possess means sufficient at the out

set to support themselves while waiting for practice, will have to start in a panel practice where an immediate income will be forthcoming, but from the vortex of which it will become increasingly impossible ever to escape these forbidding conditions will assuredly deter from entering the profession men of promise, ability, and ambition, but without means. Those with means, on the other hand, will elect the higher class of practice, which will necessarily be incompatible with the regulation-bound service on the panel, so that the panels will be filled with men of an inferior calibre, to whom even any kind of medical work will be a rise in life. The few men who elect medical service in the spirit of the university missioner will not seriously affect the result. The standard of medical education, which has been raised by dint of so much painful and courageous effort, will again. sink, to meet the needs of the inferior grade of men who will become candidates for the state service on the panel.

To obviate such a condition of things arising in this country, should national insurance, which already has its advocates here, come forward as a possible measure, the medical profession must make itself strong and united enough to insist on being given a clear voice as to what it is possible for it to do, under what conditions it is willing to do it, and what remuneration it will accept as adequate.

The Benzoate of Soda Controversy. There can be no question but that the intelligent classes are beginning to realize there has been much misunderstanding concerning benzoate of soda and the following from the Independent (Nov. 7)

mentation and the resulting substances are harmful in the extreme. The evidence at hand leaves little doubt that benzoate of soda is infinitely to be preferred to the fermentative changes that all too often take place in the choicest of canned goods. Fortunately, therefore, as usually follows in problems of this character, once let truth and common sense prevail, and the benzoate of soda controversy will concern itself less with the question of the rational or legitimate use of this product than with the much more important and vital question of its abuse. The facts necessary to verify the statements that have been made ought not to be difficult to obtain, and with these at hand it should be easy to establish definite rules and regulations concerning the employment of this preservative that will not interfere or prejudice its proper use but will furnish ample protection against its evil application.

Anti-narcotic legislation that aims to control the abuse of habit forming or otherwise dangerous drugs assuredly deserves the support of every thinking person. The evils of drug habituation have grown rapidly during the past decade and the situation, as investigation has disclosed it, is one that may well occasion alarm. The conditions under which so many people live have produced certain nervous weaknesses that manifest themselves in vague, intangible desires. In one the condition may be a hyperexcitability requiring sedation, in another it may be an almost overpowering depression that cries out for stimulation. Whatever the state, the nervous equilibrium has been lost and the afflicted organism wants something, be it stimulant or narcotic, to restore a balance. Naturally with.

hundreds and thousands of human beings in such a receptive condition, the simplest circumstance like a toothache, a headache, or a slight operation on the nose or throat has all too often proven the starting point of a fatal drug addiction. The facility with which narcotic drugs could be obtained has been a constant factor in the evolution of many cases of habituation, and it is a sad commentary on human decency that there have been so many men—even some physicians-ready and willing to take commercial advantage of a lamentable affliction. That the time has come for the elimination once and for all of these vultures seems quite evident, but in the culmination of our wrath against those who prey on the afflicted, is there not danger that our zeal for effective legislation may lead us to impose needless, unwarranted and unwise restrictions on innocent and harmless parties? We refer particularly to the proposed law against cocaine which in addition to placing very definite regulations on those who are allowed to sell this drug-stating the exact amount that shall be carried in stock or purchased at any one time-proposes to forbid practicing physicians from using or having on hand cocaine in any other form than in solutions of four per cent or less.

This is hysteria, pure and simple, and one more example of the human tendency to let our just indignation at abuses blind us to the good to be derived from legitimate uses. The law as proposed is an insult to the honor and integrity of every decent physician and no medical man who respects himself and his calling should fail to express his indignation at this uncalled for and narrow-minded attempt to handicap his work. No physician should hesitate to voice his objection to such unwise legis

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lation. No one need fear that it will lay him open to suspicion to state openly that he disapproves of a law so unnecessary and pernicious. The recent comment by Dr. Wolff Freudenthal, one of the foremost laryngologists in the land (New York Medical Journal, Feb. 15, 1913) voices the sentiments of the profession so clearly and succinctly that it deserves repeating. As he well says "the proposal to forbid physicians the use of any stronger solution than four per cent. is so ridiculous that it is almost beyond discussion. In laryngological work we use twenty per cent. solutions every day in our office practice. In bronchoscopy, which at present is also being done in private practice, practice, that solution is pushed to the point of toleration; and in certain operations on the nose the writer as well as other col

leagues uses pure cocaine. Shall we be obliged to get a permit, whenever we operate for a deviated septum, or must the patient suffer pain because a few rascals in the profession have turned a valuable anesthetic into profane business? Because there are some abortionists with the diploma of M. D. in this city, are all obstetricians to be put under a special code?

Furthermore, it is scientifically wrong to keep cocaine in solution for any length of time, as it decomposes so quickly. Only those who use a great deal may do that. As a rule, however, every physician ought to prepare his own solution at the time he needs it. For that reason he must be able to get the pure cocaine, and not a four per cent. solution,

Finally, the writer would ask, why only regulate the sale of the opium and coca derivatives? Aren't there many other drugs that could be and are being sold fraudulently, and to the detriment of the patient?

One drug especially, that is being used in connection with cocaine so frequently, comes to our mind, viz., epinephrine. There are great chances for quacks to perform miraculous cures with that drug, and yet epinephrine is free, though it has brought about the death, as pointed out by the writer, of a number of cases. Would rhinologists care to be restricted in its necessary and legitimate use?

To prevent the injudicious sale of morphine, cocaine, etc., to the public is an entirely different matter, and nobody objects to having that regulated in a rational manner. But to restrict physicians in applying these drugs to patients is, to say it mildly,

erroneous.

It seems to us that a tendency prevails at present-not only in the Legislatureto restrict the already restricted physician. A regular physician is regulated by his education, his diploma, his associations and medical societies, while the quack is allowed to advertise his impossible cures, to sell his swindling medicines, and to carry on a large business without interference from anybody.

If a physician has been found to have committed any criminal action we should. have the right to disbar him, i. e., to take away his diploma. Otherwise he must have full freedom in the practice of his profession. We want to enlarge his sphere of usefulness, and not hamper it."

The whole trouble is that when we as a people focus our view on one phase of an evil, or have our attention drawn to one side of a question, we are too prone to jump at conclusions to take a part for the whole. Admittedly there has been an enormous increase in drug habituation. Grave abuses have attended-and still attend the sale