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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 off the stones.-FROUDE.

The Medical World physicians to write to their congressmen and

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"THE MEDICAL WORLD" 1520 Chestnut Street

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Philadelphia, Pa.

No. 6

The Harrison Law and the Commissioners'

Rulings. Opposition to the Harrison narcotic law has developed quite considerably thruout the medical profession; not, however, because of the law itself, but on account of the obnoxious rules formulated by the commissioner of internal revenue and foisted upon the profession in the guise of law. The Harrison law was originated in a humane effort to stop the nefarious traffic in narcotic drugs. that was destroying thousands of human beings annually. As such it was entitled to the approbation and assistance of everybody. We indorsed the Harrison bill, after it had been properly corrected so as not to interfere unduly with dispensing by physicians, and recommended its passage, urging

senators to vote in favor of the bill. Many physicians responded to our requests and a number of medical societies also became active in the matter. As a result of the endeavors of all who energetically interested themselves in this work, a bill was passed that was satisfactory to everybody connected with the legitimate handling of drugs.

Still, a few physicians are opposed to what seems to them an unnecessary intrusion on the practise of the healing art. Doctors of the right kind do not dispense narcotic drugs to habitués. These are the ones who consider the Harrison law as a monstrous imposition on a beneficent profession, and are righteously indignant over it. But as is the case with so much of our lawmaking, the good must suffer because of the evildoers. Few, if any, of the panderers to the dope fiends are within the medical profession, and those that are should be expelled. The trouble really is caused by the sale of the drugs thru persons having access to the narcotics in a surreptitious manner.

We can understand how a great many doctors feel resentment to the bill. Nevertheless, we counsel physicians to obey the law in its entirety and endeavor to stamp out the narcotic evil. As we have said, it is a necessary law and all physicians should be willing to shoulder a little burden for the benefit of mankind. We have, indeed, been shouldering a great part of humanity's burden, so let us bear a little more, unflinchingly and ungrudgingly.

We do not wish to be understood as favoring the rules formulated by the commissioner of internal revenue. We do not approve of them, and consider that they are unjust and not warranted by the law. But we recommend that doctors observe them until they are rescinded by the commissioner or congress.

Several medical societies have passed resolutions requesting the repeal of the law. The circumstances are such that the law should not be repealed. We feel that no good can come of antagonizing the law,

when the real objection is to the ruling of of their dope, are terrorizing certain sections the commissioner.

Some writers who had not paid the attention they should before putting their views into print are counseling physicians to accept the commissioner's rules as strictly necessary and justifiable. These are not written by physicians who are compelled by reason of their geographic situation to dispense remedies, or they would see the matter in a new light. Those who wrote prescriptions before will continue to do so now and are not troubled by the new law. But physicians practising in country districts are compelled to dispense remedies, and the needless burden of keeping detailed records becomes

onerous.

The great majority of physicians are required to dispense drugs on their rounds of visitation of the sick, and these are the ones to be considered most in the workings of the law.

The journals of the various medical organizations are the leaders in the effort to have the profession accept the commissioner's rule without a murmur. We have always stood by the dispensing physician, for we know his problems.

The idea of presuming that the commissioner of internal revenue is infallible and that he can do no wrong is too preposterous to think of. Yet that is the position taken by those who would have the profession accept his rules without question. And they condemn physicians who dare to object. The doctor must preserve himself if he would be of any benefit to his community. He cannot preserve himself if he is burdened with too much labor. It is to avoid this excess and unnecessary work of recording remedies dispensed that these physicians are raising their voices.

Let us briefly consider what has been the effect of the law. Philadelphia has its slum, called "the tenderloin." In that district some druggists and a number of dope peddlers sold narcotics unrestrictedly before the enactment of the Harrison law. Since March 1st, according to the police records, the use of these drugs has been reduced by 60%. What is being sold now is the supply laid in before the Harrison law went into effect and the police estimate that it will be consumed within a month, after which no more will be available. Some of the victims tried to substitute quinin, but it did not answer the purpose.

It is reported in the newspapers that drug habitués in New York, suffering from lack

of that city. Dope fiends of El Paso have crossed the river to Juarez, Mexico, because of the inability to secure dope in Texas.

One failure of our antinarcotic laws is the absence of power to commit the habitués to an institution where they will be compelled to remain until cured. Another failure is the absence of proper public institutions for that purpose. There are many good private institutions where these cases may be

treated; but commitments cannot be made by the courts except in a few states. The legislature of Florida has a bill in its hands to provide for establishing hospitals for the commitment and treatment of narcotic habitués. In Pennsylvania the habitués who applied for treatment and refused to stay a sufficient time were masters of their own destiny and are still abroad seeking the narcotics. Laws are needed to compel these narcomaniacs to be treated until well.

Many methods of treatment of narcotism have been publisht in this and other medical journals, but we believe it is better treated in a hospital or sanatorium where special attention is given to this class of cases, and where the patients can be under watchful care day and night. Physicians who have devoted years to the treatment of such cases are better able to treat them than those who have not treated that class of cases.

In these days, when any physician may be called on to look after a person who has been addicted to the use of the narcotics and now finds it impossible to get the drugs, it may be necessary to undertake the treatment of the case at his home. But if circumstances permit, it is better to send him to an institution.

State Narcotic Laws.

By this time most of the state legislatures have adjourned. An enormous number of narcotic bills has been introduced into them and been the bone of contention between doctors and druggists. As a result, many of the bills were deadlocked.

In Colorado House Bill No. 249, which was a model uniform state narcotic law, was enacted. It is in conformity with the national narcotic law and simplifies the work of Colorado physicians. It is a fair law, just to all concerned, and worthy of emulation in all our states.

In Connecticut the situation at the beginning of the legislative session looked almost hopeless for the physician. The druggists had a bill entered that required

physicians who would dispense any medicins to take an examination and secure a license as pharmacists. Another bill called for a detailed record of all dispensing by physicians. We think we can reasonably feel that it was due largely to the great efforts of this office in warning the profession in Connecticut by editorials and many letters to the physicians thruout that state that these bills were dropt, and eventually a satisfactory law was passed that does not unduly interfere with dispensing by physicians.

In Ohio, according to information we have received, two conflicting laws have been passed, one being the Hay narcotic law, House Bill No. 305, and the other a so-called poison law, House Bill No. 132. The former bill is a splendid uniform state narcotic law, in consonance with the federal law and will be acceptable to the physicians of Ohio. The latter bill, No. 132, was offered in the guise of a "poison" law, but is a narcotic law and does not permit dispensing by physicians unless record should be made in every instance, whereas the former law is fair to physicians. These laws conflict in their bearing on physicians. We are suggesting a new law to repeal the conflicting sections in the latter law.

In Florida House File No. 416 is a narcotic law aimed to prevent dispensing by physicians. Section 3 permits the physician, dentist or veterinary surgeon to "prescribe or administer," thus:

SECTION 3. Any duly licensed physician, a dentist or a veterinary surgeon may prescribe or administer any of the before-mentioned drugs or preparations or their derivatives for the treatment or cure of diseases in the course of their [? his] professional practise; Provided, that such phy

sician, dentist or veterinary surgeon shall not prescribe, dispense or furnish any of the beforementioned drugs to any person who may be addicted to the habitual use of these drugs * * *

No permission is given him to dispense and he is strictly ordered not to dispense to habitués, except under certain conditions as to treatment, etc. This method of "treatment by statute" is the newest wrinkle in the narcotic law schemes of the druggists. Just how far the druggists will attempt to carry such "statutory treatment" is beyond our vision. We would, indeed, be glad to see the ultimate limit. It would be delicious reading. It is utterly foolish to enact into

*Our latest information is to the effect that this bill was passed by the legislature and is now before the governor for his approval. We do not know if it has been amended or not.

law a method of treatment for any disease, for what is recognized as good treatment to-day may be overturned to-morrow by new investigations. "Statutory regulation' of treatment will prevent necessary investigations in treatment. The method is wrong in principle and opposed to the best public interest. Any bill with any such provision in it should be defeated on sight.

We understand that physicians can register as pharmacists in Florida on the payment of $15.

In New York the Bloch amendment to the Boylan law reduces the minimum quantity for exemption of heroin from 14 grain to % grain. Physicians may dispense the narcotic remedies only after a physical examination of the patient. Physicians are required to keep a record of all narcotics dispensed.

In Illinois Senate Bill No. 302 requires prescriptions to be written in English. This might give rise to some confusion. If by "English" is understood words defined in an American dictionary the end desired might not be attained. Aqua is in Webster's dictionary; hence is an "English" word borrowed bodily from the Latin. We might find a great many more words there that are both English and foreign. If the "English" prescription is intended to be read by the recipient, how about ordering Italian prescriptions for Italians, Spanish for Spaniards, German for Germans, Russian for Russians, Scotch for Scots, Yiddish for Jews, Chinese for Chinese, etc.? If the druggists hope that such a bill will enhance prescription writing we think they are mistaken, for doctors will dispense instead of write.

The profession thruout the country is gradually awakening to the necessity of being prepared to oppose bills emanating from the druggists and to advocate proper legislation affecting physicians. Things do not get done by themselves. If anything is to be done, it must be done by somebody. Committees of medical societies composed of physicians are not usually successful in handling medical legislation. This is being recognized more and more. When this kind of work has to be attended to, specialists should be secured for it. This is an age of specialism. Every man who has learned to do some particular thing is a specialist. When a person is sick he calls in a physician. When physicians seek to have proper medical legislation enacted they should engage a lawyer to look after it. The Western Medical Review for May, 1915, suggests to the members of the Nebraska State Medical

Association that such be done by that association.

Legislative committees composed of physicians can look after medical legislation in a limited way, but the assistance of a bright and active attorney is requisite. Such a man will be of use in any state.

The druggists' program is to have passed narcotic laws that will prevent the dispensing of narcotic remedies, either plain narcotics or mixtures containing a small quantity of narcotics, by physicians. To do this they are willing to misrepresent the medical profession, in order to achieve their ends. By placing the blame for narcotism on physicians they hope to influence legislators successfully.

After that is brought about they aim to pass poison laws that will prevent dispensing. When this has been successful they will endeavor to enact legislation that will stop all other medical dispensing by physicians. If the latter object can be achieved first they will gladly welcome it.

This is the program that the medical profession must be prepared to combat. Going to sleep in the daytime while the druggist is making his hay and feeding his helpers will not save the doctors. They must get busy now. All medical societies must have committees to look after this legislation, and at least one attorney must be engaged in each state to look after the legal end. It will cost the profession money; but they have got to spend it or feel the effects of their false The economic aspects of diseconomy. pensing by the physician is another subject, which we have touched on frequently and may do so again.

Actinotherapy and Heliotherapy. We will need to revise our views of the beneficial and harmful effects of fresh air and sunshine in health and disease. Many of our investigators and writers have been teaching that direct sunshine is one of the most beneficent forces of nature. It seemed a logical statement, for we have much evidence to show that plants grow luxuriantly in the hot sunshine, many of them failing and dying without it. There are exceptions, of course, for ferns, mosses, etc., are killed by the hot sun. As a consequence of many investigations on the effects of sunshine we have been lauding the sun's rays to everybody for all ills, recommending them to get out into the sunshine for their health.

In a previous issue* we described some November, 1914, WORLD, pages 432 and 433.

uses of sunlight and other forms of radiant light. The treatment of tuberculosis by cold air and sun's rays was depicted and the splendid results achieved were stated. But a careful review of the work of many authors in this field by Dr. Charles E. Woodrufft leads him to believe that the sun's rays are more harmful than beneficial. He says that sun baths to the naked body are slowly going out of fashion except in obesity, gout, rheumatism and sluggish metabolism. The short rays, which always accompany the visible light rays, are harmful. They increase the pulse, respiration, temperature and blood pressure and may start hemorrhages. In excess they cause headache, palpitation, insomnia and anemia. They are also harmful in general weakness from any cause and in the hysterical or neurasthenic.

The treatment of tuberculosis by sunbaths he says cannot be condemned too strongly, tho it is highly praised by a few who get good results from the other factors in spite of the injury done by the light. local lesions-injuries, ulcers, lupus, etc. The short rays, however, are beneficial in He believes, however, that the improvement is due to the irritation produced by the rays and the subsequent bactericidal effect of the increased flow of blood serum, and not to any direct beneficent effect on the body cells.

He quotes Finsen as stating that hair often grew on parts exposed to concentrated light. This thought has been followed by Dr. Franz Nagelschmidt, who uses a quartz lamp, a modification of the Kromayer quartz lamp, for the growth of hair on the scalp. An application of this intense light to the scalp for a period of 20 minutes once a month has caused a full

growth of hair to occur on completely bald protected by a layer of cotton wadding. heads. The parts not to be affected are Nagelschmidt treated 200 cases of alopecia areata; alopecia seborrhoica; premature, senile and seborrhea capitis. Nearly all these cases grew hair to match the previous occurred, accompanied by deep pigmentagrowth. Intense inflammatory reaction tion. Slight cases of alopecia areata received but one application; some cases of complete baldness recovered after four treatments.

Woodruff states that Charles Heater called attention to the fact that, in a person

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under tuberculin treatment ultraviolet light caused a more violent and prolonged effect, and that in using the quartz mercury lamp in skin affections in the tuberculous exposures must be reduced one-half; the ordinary period of 60 seconds will cause troublesome ulcers.

Rolliers found that blonds who did not tan in the sunshine did not improve under sunlight baths, while the best results were secured in those who took on a heavy coat of tan. According to Woodruff, this result indicates that the smaller the amount of light to penetrate the skin, the better the effect. He believes tanning of the skin is a protection against the sun's rays. Rollier thinks the light is changed into energy, but Woodruff declares it is only stepped down to infra-red frequencies (heat rays) in the brunets. In the blonds serious nervous lesions occurred, which Woodruff believes is the usual result of intense light. He found a great many people who migrated to a tropical climate sooner or later become affected with neurasthenia, which he attributes to the intense tropical light.

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Martin du Pan || (quoted by Woodruff) states that surgical tuberculosis in children unsuccessfully treated by outdoor heliotherapy can be cured or improved by indoor applications to the whole body of cooled light from the 7,000-candlepower mercury vapor quartz lamp devised by Vignard of Lyons. But he found it necessary to exclude 'some" of the ultraviolet rays by 4 mm. of glass. Under this light the skin rapidly tans, which Woodruff says protects the tissues from further injury by the short rays. The applications are made from 10 minutes to 3 hours at a distance of several feet or yards. Jacques Loeb found that 1 mm. of glass prevented all effects on seaurchin eggs of the ultraviolet light from the 3,000-candlepower Heræus quartz mercury arc lamp, even when applied 60 minutes at 6 inches distance, tho a few minutes' exposure to the naked light is lethal. Hence the benefit only occurs after exclusion of the ultraviolet light.

Rollier reports that large doses, especially in blonds, cause acute attacks resembling actinic shock or heat exhaustion, and in time a chronic nervous condition differing in no respect from tropical neurasthenia. These states are accompanied by marked phosphaturia. The neurasthenia so common

Quoted in November, 1914, WORLD, page 432. ||Revue Médicale de la Suisse Romande, September, 1914. Science, November 6, 1914.

in adult consumptives seems to be made worse by sun exposure.

Woodruff gives White of Colorado Springs, Burton Fanning, Havorka and others as corroborating his view that the sunlight increases temperature in the tuberculous, and even produces hemorrhage. He recommends cold and shade instead. Malgat found that if heat accompanies the light it may interfere with cure by causing tissue anemia and that the light may cause general anemia. Hemoglobin is found to increase in the cold and dark, and probably decreases with heat and light. Very likely light itself destroys hemoglobin, judging from experiments by Haussmann** with hematoporphyrin. Woodruff, in fact, says that it does.

Therefore it is the opinion of Woodruff that tuberculosis must be treated according to the climatic conditions in which the individual and his ancestors evolved and to which they were accustomed. The hot sun is not to be used in the treatment. Instead, the cold is the curative stimulus. He believes the white race will not survive tropical light and heat, and that tanning is a protective effort of nature. The white race, particularly the blond portion, should protect itself from the hot sun during summer, and those who do not tan in the sunshine are in extreme danger from its overstimulating effects on the body, especially the nervous system. To a certain extent we can become accustomed to it, but to what extent is not definitely known.

Getting Rid of Mosquitoes and Flies.

Sanitary science is making progress in many directions. One of the things that has received attention is the eradication of

mosquitoes to eliminate malaria. Dr. C. A. Campbell is teaching the cities of the South to build bat roosts. The bats are said to eat mosquitoes. For a long time human beings have been destroying bats, for no other reason than "because.' We remember in our boyhood days of killing, for no reason that we can tell, a number that lived in a barn. Now we find it highly desirable to cultivate these animals in order to preserve our own health. If bats eat mosquitoes, by all means let us have lots of them around and have them eat up the mosquitoes by night while we swat the flies by day.

**Jour. Amer. Med. Assoc., May 15, 1915, page 1660.

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