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The knowledge that a man can use is the only real knowledge; the only knowledge that has life and growth in it and converts itself into practical power. The rest hangs like
dust about the brain, or dries like raindrops of the stones.-FROUDE.
The Medical World
Second Class Matter.
For a long time we had been directing the attention of the medical profession to
the present law while it was in its formativ C. F. TAYLOR, M.D., Editor and Publisher. state in Congress; but many physicians did A. L. RUSSELL, M.D.,
not awake to the necessity of their looking L: C. ROMMEL,' M.D.; } Associate Editors. E. S. TAY R, Business Manager.
into the subject themselves. Too many of
them left it to us. We have done all that Entered at the Philadelphia Postoffice as
we could. But there remains a great deal
that the individual members of the medical SUBSCRIPTION RATES: To any part of the United States or Mexico. ONE DOLLAR per year,
profession and the medical societies must YEARS for THREE DOLLARS in advance; to Canada do if it is to be done. They must join with ONE DOLLAR AND TWENTY-FIVE CENTS per year, or FOUR YEARS for Four Dollars in advance; to Eng
us in our efforts. One of the things on land and the British Colonies, Five SHILLINGS Six PENCE per year; to other foreign countries in the
hand now is to bring great pressure to bear Postal Union, the equivalent of_5s. 6d. Postage free. on the Commissioner of Internal Revenue Single copies, current issue, Ten Cents; previous issues, from TEN to TWENTY-FIVE CENTS. These to induce him to rescind his action in rul
rates are due in advance. HOW TO REMIT: For their own protection we advise
ing that the physician must keep a record that our patrons remit in a safe way, such as by of remedies dispenst, inasmuch as the law postal money order, express order, check, draft, or registered mail. Currency sent by ordinary mail
passed by Congress and approved by the usually reaches its destination safely, but money so President does not call for such record.
sent must be at the risk of the sender. We cannot always supply back numbers. Should a num. The letter as well as the spirit of the law
ber fail to reach a subscriber, we will supply another, if notified before the end of the month.
should be obeyed. Notify us promptly of any change of address, mentioning both old and new addresses.
We have already heard of many physiIf you want your subscription stopt at expiration of the cians who are very bitter toward the law
time paid for, kindly notify us, as in the absence of such notice we will understand that it is the sub- for compelling them to keep these records. scriber's pleasure, that the subscription be And we have heard of some who have no
tinued and we will act accordingly. Pay no money to agents unless publisher's receipt is given. cares, for they do not dispense any remeADDRESS ALL COMMUNICATIONS TO
dies, and they are not exerting any effort in "THE MEDICAL WORLD" 1320 Chestnut Street
behalf of their confrères who dispense. We consider it the duty of all physicians to act
unitedly in this matter for the benefit of VOL. XXXIII APRIL, 1915
the profession, whether dispensers or not.
It appears that Smith, Kline & French Physicians Required to Keep Records in
Co., of Philadelphia, wholesale druggists Spite of the Law.
and manufacturers, by the aid of their atThe medical profession of the United. torney, J. C. Jones, and his "view" of the States has a large task before it. The law, prevailed on the Commissioner of Inworking of the national narcotic act has ternal Revenue to see the matter at issue proved to be more troublesome than was in the light of the druggists, the ulterior expected, owing to the United States
purpose of the druggists, of course, being Commissioner of Internal Revenue ruling to make dispensing by physicians so troublethat physicians must keep records of all some that the latter will write prescriptions, narcotic drugs dispenst in their offices and thus bringing more grist to the druggists' at the bedside of patients.
mill. The bill passed by the lawmakers does The Cincinnati Medical News for Februnot require any such record. As the ary gives a report of the annual meeting of Treasury Board is not empowered to make the Southwestern Eclectic Medical Assolaw, we cannot see how they can enforce ciation, at which Frank H. Freericks was a any such ruling. The bill as finally ap- speaker. He is there stated to be “the proved by physicians and druggists was official attorney for the Ohio State Pharworded to avoid such record keeping. maceutic Association and of the Ohio Valley Retail Druggists' Association." He was provided, that such physician, dentist or vetervery activ in his efforts to secure legisla- inary surgeon shall keep a record of all such drugs tion to prevent physicians from dispensing pensed or distributed, the date and the name and
dispensed or distributed, showing the amount disor at least require them to keep extensiv address of the patient to whom such drugs are disrecords.
pensed or distributed, except such as may be disNow the eclectics are entertaining him
pensed or distributed to a patient upon whom such
physician, dentist or veterinary surgeon shall in one state while eclectic physicians else
personally attend; and such record shall be kept where are howling about the national nar- for a period of two years from the date of discotic law and demanding its repeal. If pensing or distributing such drugs, subject to they would avoid further entanglements of inspection, as provided in this act. the kind they should watch the activities See particularly the words in italics. The of the druggists and their attorneys. following is the ruling of the Bureau oi The working of the bill is considered
Internal Revenue: onerous by druggists doing a strictly legiti- Where a physician personally visits a patient mate business and they are very much dis- and administer's any of the drugs coming within satisfied with it and are so expressing
the scope of the Harrison Act, he is not required themselves. Eclectic writers are blaming
to keep a record of such administration, but where
he leaves a supply of any of these drugs or prepthe bill on the American Medical Associa- arations to be taken by the patient in the physition and the regular profession. And other cian's absence, he will be required to keep a record physicians are placing the blame for the of such drug or preparation, the same as he would bill on the druggists.
in his office. A physician must keep a record of
all drugs or preparations dispensed or distributed So it looks as if we all must have had
in his office, whether administered personally or some share in it.
given to the patient to be carried away with him. It is the purpose of all trustworthy phy- We consider this ruling very unjust to sicians and druggists to secure proper con- physicians. In this connection the accomtrol of the narcotic traffic so that it may panying correspondence with the Bureau of be confined to legitimate use. To that end Internal Revenue may interest you. We the professions should work together. The hold that “personally attend in the course useless antagonism engendered between of professional practice" should include the pharmacy and medicin should give way to
leaving of necessary medicins for use befriendship and co-operation. The regulars, tween visits; and also include the dispenseclectics and homeopaths should forgeting of needed medicins at the office after what little animosity now remains among consultation; that the words of the law do them and consolidate. Then the united
not mean "personally administer." profession can secure fair and useful legislation. Without such much acrimonious
In our editorial last month on this law legislation may be attempted.
we said on page 84 that "When the physiThe question sometimes agitated by phy- cian *** does not personally attend-i. e., sicians of all schools is how to get together. personally see—the patient he must keep a
— It is like the question of how to resume record.” That editorial was written before specie payments that arose after the civil
the official interpretation by the Commiswar and was answered by Horace Greeley sioner was made. We are not the only that “the way to resume is to resume. editors who gave out interpretations that Similarly the way to get together is to get proved to be different from the internal together. Attend each other's meetings and
bureau's pronouncement when conferences and take an activ interest in
made. The Journal of the American Medthose affairs. If you want to have friends ical Association several weeks ago stated in be a friend—be friendly. And do not no- an editorial on this law that physicians tice any antagonism that may ensue, which
would be required to keep records of disis likely to occur here and there in some
pensing in their offices, but not of remedies prejudiced person.
dispenst at the bedside. The Bureau now
says that records must be made of dispensThese are the words of the new national
ing at the bedside. The fact that editors narcotic law :
and practicians almost generally believed Nothing contained in this section shall apply- that dispensing would not require to be re(a) To the dispensing or distribution of any
corded is fair proof that the general underof the aforesaid drugs to a patient by a physician,
standing of the law is substantially as we dentist or veterinary surgeon registered under this act in the course of his professional practice only;
have heretofore stated. And it must not be
forgotten that many editors and physicians have been studying and working with this bill for many months and shaping its wording, and thereby are in a position to give a fair opinion on its intendment and on the views of the legislators in whose hands the entire wording of the law was finally settled. Surely the makers of an article know their product !
such drugs so dispensed or distributed in the orice of the physician, dentist, or veterinary surgeon. A record must be kept also of these drugs left with a patient to be taken in the absence of a physician, dentist or veterinary surgeon. Only such drugs as are administered directly to the patient by the physician in person, when away from his office, are exempt from record.
We have gone to great length in our efforts to have annulled the unjust ruling of the Commissioner of Internal Revenue and we present herewith the correspondence on the subject:
PHILADELPHIA, PA., February 17, 1915. Bureau of Internal Revenue, U. 8. Treasury Depart
ment, Washington, D. 0.:
GENTLEMEN :- I have been informed that the Bureau has ruled under the Federal Narcotic Law that all physicians, dentists and veterinary surgeons must keep the specified record of all office dispensing of the affected drugs (except where expressly exempted).
On behalf of about 25,000 members of the medical profession represented in the readers of THE MEDICAL WORLD, I hasten to call this matter to your careful attention, believing that when a full appreciation of the intended and actual meaning of this law is had that it will be readily apparent that such a ruling is directly contrary to the intendment and provisions of this law, is inequitable and discriminatory, and would lend not one iota to the effectiveness of the law, but would create an embarrassment of the humane practise of the medical practitioner, of serious moment. I append hereto a statement roughly and generally presenting our views on this question.
As this ruling is of very considerable interest to the legitimate practitioner and this law soon goes into effect, I would greatly appreciate your opinion, which I may convey to our readers. I am and have been a champion of this beneficent law and endorse, without qualification, its purpose and value. Our only concern, which was the concern of Congress, is not to interfere unduly with the legitimate dispensing, by the physician, but to build a strong wall around it to insure its proper exercise. The country physician, who covers long and wide territories, must dispense so as to properly treat his patients. Our readers are chiefly general practise doctors and country physicians. If their liberties are unduly interfered with, there will be great disturbance all over this great country. We have kept our readers posted during the period of evolution of this law, and they are in favor of it and ready for it. But they will be greatly disturbed by a construction of it which robs them unduly of their ancient privilege of dispensing to their patients, either in the sick-room or their office. There are other features of the law that will prevent abuse. I beg you to realize the gravity of this matter.
Very sincerely yours.
(Signed) C. F. TAYLOR.
L'HILADELPHIA, Pa., February 25, 1915. Mr. David A. Gates, Acting Commissioner, Internal
Revenue, Washington, D. 0.:
DEAR SIR :--I thank you for your reply of yesterday to my letter of February 17. But, my dear Commissioner, your reply is very discouraging. I very greatly fear an uprising upon the part of the medical profession of this country when every dispensing by a doctor must be subject to official record.
I do not see how any construction of the law can be made to limit the exempting of physicians from record to such doses “as are administered directly to the patient by the physician in person" (this is quoted from your letter). And even then only when he is away from his office.
It is generally known that physicians seldom administer remedies by their own hands either at the bedside or in the office, but from time immemorial physicians have dispensed remedies to their patients to be given by the nurse or the attendant according to the physician's directions. I believe it to have been the intention of the law-makers to exempt from record such dispensing by physicians.
If it is not too late I sincerely hope that the ruling of the internal revenue department will be revised in harmony with the ancient and humane rights of physicians to dispense remedies to their patients. I think that such a construction of the law will be necessary in order to prevent great disturbance occasioned by attempts to carry out your construction of the law. Indeed, I fear that the law cannot be successfully executed, and hence will prove to be a dead letter unless a more reasonable construction is put upon it than your reply of yesterday now before me.
(Signed) C. F. TAYLOR.
TREASURY DEPARTMENT. OFFICE OF COMMISSIONER OF INTERNAL REVENUE.
WASHINGTON, D. C., March 2, 1915. C. F. Taylor, M.D., Editor "The Medical World,"
SIR :—Replying to your letter of February 25th I regret to advise you that this office considers it inadvisable to withdraw its requirement for physicians to keep a record of those drugs coming within the scope of the Harrison Narcotic Law, as are dispensed, distributed or administered in his office, as it is only thru this means that the government will be enabled to enforce the provisions of this law.
These drugs and preparations are so infrequently administered by reputable physicians in their office practise that the requirement that they keep a record of such administrations does not seem unreasonable or one that will cause any inconvenience to this class of physicians.
TREASURY DEPARTMENT. OFFICE OF COMMISSIONER OF INTERNAL REVENUE.
WASHINGTON, February 24, 1915. Dr. C. F. Taylor, "The Medical World," 1520 Chestnut
Street, Philadelphia, Pa.:
SIR :-Replying to your letter February 17th, you are advised that for purposes of checking up the quantity of drugs, coming within the scope of the Harrison Anti-Narcotic Law, received and dispensed, this office deems it necessary for a record to be kept of all
PHILADELPHIA, PA., March 3, 1915. Acting Commissioner of Internal Revenue, Treasury
Department, Washington, D. 0.:
DEAR SIR :- Thank you for your letter of March 2 in reply to my letter to you of February 25. I now see your point of view "as it is only through this means that the government will be enabled to enforce the provisions of this law."
I beg to say that the rigid regulations concerning or distributed, except such as may be dispenst or the obtaining of supplies of these drugs by physicians,
distributed to a patient upon whom such physiit seems to me, is a sufficient means of enforcing the
cian, dentist or veterinary surgeon shall personprovisions of the law. heartily endorse the rigid
ally attend; and such record shall be kept for a requirements connected with obtaining supplies of these drugs, and through this means I trust that any
period of two years from the date of dispensing physician who may abuse his power as a physician
or distributing such drugs, subject to inspection, may be caught and properly punished. If there is any as provided in this act." And legally recognized physician in this country who will Whereas, The official records of the discustake advantage of the fact that he can get these sions of this bill, prior to its enactment in the drugs because of being a physician and should make House of Representatives and in the Senate of improper use of them, he should be punished to the
the United States, and its whole history, clearly limit of the law. I think that the records required
show that no such restrictiv meaning was conof the supplies will be sufficient to lead the internal revenue authorities directly to such an offender with
templated by our national lawmakers as that out hampering the legitimate dispensing of these
expressed by the Commissioner of Internal drugs by the profession in general.
Revenue in the ruling just quoted, and It seems to me that the above should at least be Whereas, Such a ruling and similar rulings tried before issuing such burdensome restrictions upon will place tremendous and, as we believe, unphysicians as your department has done.
necessary burdens upon the medical profession, Very sincerely yours,
and upon the allied professions of dentistry and (Signed) C. F. TAYLOR.
veterinary medicin. Therefore, be it Please notice that it is because the Com- Resolved, That the Council of the Chicago missioner of Internal Revenue says that his
Medical Society, representing the three thousand office "deems it necessary,” etc., the mean
members of this organization, does hereby enter
an earnest protest against this or any other ofing of the law is changed, as shown above. ficial extension by regulation of the meaning of The words of the Commissioner are very
the federal narcotic law; and be it further different from the words of the law, as
Resolved, That while this body again places
itself upon record as being heartily in sympathy passed by Congress and signed by the Presi- with the purpose of the federal narcotic law, and dent. Thus we see the evil of bureaucratic pledges its co-operation with the authorities in law-making.
securing its rigorous enforcement, so that every possible physician or other person illegally and
inhumanly trafficking in narcotics may be brought The inclusion of apomorphin in the nar
to justice, it is absolutely opposed to this or any
other extension by bureau action of the law becotic law is a mistake, since this drug is not yond its clear and undoubted meaning as exnarcotic, its action being emetic, diaphoretic prest in the statute, as likely to prove detrimental and expectorant. In section 6 of this law to the best interests of the medical profession and
the millions of people depending upon it for the decocainized preparations of coca leaves are
alleviation of pain and the cure of disease. And excepted. Similarly apomorphin should be
be it further excepted from the working of this law. Resolved, That the secretary of this society be
directed to send properly attested copies of these resolutions to the United States Senators from
Illinois, to the Representatives in Congress from Chicago Medical Society Opposes Recording.
Cook County, to the Commissioner of Internal The following resolutions by the Chicago Revenue, and to the Illinois Medical Journal; and Medical Society against the ruling on nar
that these resolutions be published in the Bulletin
of the society. cotic recording should be emulated by all medical organizations:
The following resolutions were passed
by the society in favor of the uniform state Whereas, Wide publicity has been given to a
narcotic law : letter written by the United States Commissioner of Internal Revenue, in which the ruling is made Resolved, That we do hereby order the publithat “A physician, dentist or veterinarian must cation, in the Bulletin of the society, of the sokeep a record of all drugs covered by the pro- called United States Chamber of Commerce visions of this (the federal narcotic) law sold, Model State Narcotic Law, and recommend its bartered, exchanged or given away in his office enactment into law by our state legislature, in or place of business.” And
essentially the form proposed ; and be it further Whereas, This ruling is, in the opinion of this Resolved, That the Public Relations' Commitbody, distinctly at variance with the letter and tee of the society be authorized and directed to intendment of section 2 of the federal narcotic secure the introduction of said model law in law, which declares that “nothing contained in our state legislature, and that it be urged to this section shall apply to the dispensing or dis- facilitate and expedite its passage in every postribution of any of the aforesaid drugs to a sible way, taking all necessary precautions that, patient by a physician, dentist, or veterinary sur- as finally passed, it shall be in such form as to geon registered under this act in the course of curtail the illegitimate sale of narcotic drugs, his professional practice only: Provided, That restrict the handling of these substances to persuch physician, dentist, or veterinary surgeon sons properly authorized by law so to do, and shall keep a record of all such drugs dispenst provide for effectiv and human treatment of drug or distributed, showing the amount dispenst or addicts, while conserving at all points the best distributed, the date, and the name and address interest of the medical profession of this state of the patient to whom such drugs are dispenst and those intrusted to their care.