ist" lectured continually upon his shortcomings: then why is the "average doctor," meaning, of course, the family physician or general practitioner, continually lectured because he wants to read about and perfect himself in the actual duties of his work? He is the most important factor in the medical profession, but he sadly needs to assert himself and have things come a little more his way.

Professional efficiency, as applied to the general practitioner, is what society and "medicine" in its broader aspects needs to vitalize all of the other activities. Not proficiency in eugenics, sociology, research, administration, vital statistics, microscopic pathology, sanitary engineering, climatology, minute anatomy, biology, tropical disease or the host of other interesting things each so useful in their way; but the ability, by macroscopic and simple laboratory and other scientific measures added to common sense and close observation, to diagnose ordinary medical and surgical diseases with a fair degree of accuracy and manage their treatment effectively, scientifically and practically.

And no general practitioner or "average doctor" can have too great a degree of personal culture and discipline. The medical student who patiently devotes his younger years to text-book and laboratory study of the scientific underpinning necessary to give him breadth of view and grasp will ever regret it in his clinical work. If his teachers abandon the plan of making a multi-specialist of him, and teach all branches, not as pure science but as part of medicine, then he will profit by any and all of the theoretical subjects, even though he never gets time to follow up in detail a lot of them in later years.

But after the discipline, not so much the information, of all this is over; then the ways should part. The man who plans to make research work his life calling should go one way, while he who plans to minister to sick and injured people should go anther and very distinctly clinical way. To this latter man, operative surgery upon the cadaver is vastly more important than is learning to take opsonic indices and make Wassermann tests. The old European plan of "walking the hospitals" has never been improved upon so far as results are concerned.

Then there is a lot to study after one is out of college. Then is the time one really learns materia medica and therapeutics if

he ever does. Incidentally, this is the most important book study the young physician has before him, and there is nothing like discriminating drug selection along rigid physiologic indications to make one pick up the thousand and one points in pathology, symptomatology and diagnosis. Watch the young doctor who always has a materia medica upon his table: he is a comer. And old ones who have been losers can regenerate themselves in the same way, and many of them have done so because attractive alkaloidal therapy literature started then to studying materia medica all over again, or an eclectic book started them thinking along drug lines. By these or other routes they have found out that there is really something in drugs, and they have become professionally efficient.

Another way to make the. general practitioner efficient is for him to go right to work with his sleeves rolled up. Don't send for a surgeon to pass a catheter or open an ordinary abscess: do it yourself. Don't let the consultant deliver with the obstetric forceps: ask him to give the anesthetic. Don't send your patient to an eye specialist to see what the eye ground looks like in a case of Bright's disease or brain lesion: use the ophthalmoscope yourself. Don't tell your patient you will have to send him to a throat specialist to see if his vocal apparatus is out of gear: learn to use the laryngoscope. Don't depend upon the surgeon to administer salvarsan if you have a good many genito-urinary cases: learn to do it yourself. Doing things one's self makes one do a lot of them; in time, makes him efficient and gets practice. You don't hear that man complaining of the specialists getting all the work.

Another way in which the general practitioner becomes efficient is in doing enough laboratory work to keep up his interest in such advances. Get a microscope and a few reagents, and use them.

A practical way to increase efficiency in the general practitioner, if he has the time, is to dispense his own medicines.

Attending, not merely joining, medical societies increases efficiency. Reading short and concise books helps amazingly. It pays, for efficiency always pays, to regularly read from at least one very scientific research medical journal and selections from half a dozen distinctly clinical journals. We have no sympathy with the man who decries the science and research features of the fivedollar journal or derides the lack of re

search matter in the one-dollar journals: the really efficient doctor reads both kinds. You never hear the scientifically efficient doctor running down the medical journals, the medical societies, the post-graduate schools or the members of hospital staffs doing real charity work.

Although it is hard to convince some physicians of the fact, yet it is a fact that the physician of business efficiency is apt to add thereto professional efficiency.

Scattering one's energies does not tend towards professional efficiency. The active general practitioner is the man who most of all realizes his limitations. He should patronize the laboratory specialist most, but the other specialists in clinical lines when he feels his patient needs their services. Being ethical, high toned, generally informed and broad, associating with fellow practitioners, visiting hospitals and medical institutions, obedience to law, socially observing and a good citizen in every sense of the word-all these make a doctor professionally efficient.

Medical Economics and the Medical Societies.

We have been watching with some interest the course of a recently incorporated American Society of Medical Economics. Dr. Eliot Harris, of New York, is president and, in a recent address (we quote from Medical Review of Reviews), said:

"The disharmony between the work of the medical profession for the public and the work of the public for the medical profession is abnormal. There has been no organized direction of the economics of medicine on the part of the profession; it has been permited to drift without a proper guiding hand. The pendulum has been seized by the sociologists, who are aggressive to medicine, and they hold it fast on the public side. The mass of the profession is restless under the condition which spells injustice and poverty.

"We believe that the profession is very ready for the movement which plans to release the pendulum, which seems to have become stuck on its altruistic side, in order that it may swing freely toward an adjustment more normal than has heretofore obtained."

The movement, thus far, has not gained very great momentum, and is a little hard to estimate. Probably Dr. Harris has emphasized the interest of the profession while minimizing the public side; but it does not necessarily follow that this new society will be less interested in the great agitation for the bettement of public health than is the profession at large. The following is its declared aims:

1. To survey and study all matters of economics that can be practically applied for the benefit of the public health, the betterment of the economic condition of the practicing physicians, and of the profession of medicine.

2. To advocate and maintain a high standard of medical education and of professional conduct common to all physicians.

3. To expose, remedy, and suppress all forms of quackery.

4. To help in the enforcement of pure 'food and pure drug laws.

5. To punish dishonorable or unprofessional pratice of medicine under the authority of a medical tribunal.

6. To prevent fraudulent or deceptive advertising in connection with medical practice.

7. To investigate medical practice in general. 8. To aid in establishing certified pharmacies. 9. To oppose encroachments upon legitimate medical practice.

10. To limit and prevent the abuse of medical charity.

11. To assist in the extension of post-graduate instruction.

12. To lessen and adjust illegal and dishonorable practice of medicine.

These objects are all admirable in their way, although revealing a city flavor, which is natural to a society originating in New York City. We trust the new organization may prosper in proportion to its zeal tempered with wisdom.

Probably long association with county societies makes us hesitate in open endorsement of loosely affiliated movements, but societies have been dilatory in discussing it must be confessed that the county medical and working out this phase of the activities of the profession, and there is always a very proper fear of the untempered injection of commercialism.

To test the matter out, the editor delivered an address upon the subject before a conservative county medical society. The matter was well received and resulted in two later meetings continuing the general subject and appointing a committee to devise ways and means for the solution of certain local economic problems.

And we are impressed with the fact that, while The American Society of Medical Economics may arouse an interest in the subject, after all, the ideal way is to induce the county medical societies to study the subject from both the larger and from the local phases of the problems involved. If they do that, the State and National societies will coördinate the views expressed into a definite and tangible movement with the needed momentum for the accomplishment of tangible results.

THE MEDICAL COUNCIL gladly offers its pages for expression from county medical

societies and from The American Society of Medical Economics.

There is proper ground for doubting the wisdom of too many specialized medical societies. Some years ago the gentlemen interested more particularly in electrotherapeutics organized a national society, which has been maintained upon a high plane. Nevertheless, despite the admitted ability of its writers and speakers, the profession at large has not been particularly influenced by the work of this worthy society, and it is now moving to procure recognition for a section devoted to physical modalities in the American Medical Association.

Later, and probably not so scientifically based, arose specialized societies for the study of excellent but one-sided subjects, such as orificial surgery, spondylotherapy, intravenous medication, etc. These organizations always run the risk of unduly exalting some one man, some one means of treatment or even being imposed upon by commercially minded individuals. It seems to us that any group of enthusiastic gentlemen who become imbued with a very good but restricted idea need the balance and even the ballast of ordinary sand to keep them from going up too high in a balloon to get safely back to earth again, even if they have to throw the ballast overboard when coming down too fast, as ultimately happens to balloonists nearly every time.

We know perfectly well that medical societies seem to be slow sometimes; but, in the great summing up of any subject, the conclusions of the slow-moving medical societies generally prevail. Of course some medical societies do foolish things, sometimes even unjust things: so do some governments. We are talking about the long run and ultimate analysis, and in these things the medical society generally writes the decision. Then let us be a little patient and help them to do the various lines of work they should undertake, each man doing that for which he is best fitted.

Those of us who by training and inclination are fitted to advance medical economics should bring the matter to the fore in our county medical societies, and perhaps they may not be so hard to interest as one might think.

State Boards and the Young Doctor.

THE MEDICAL COUNCIL has been taking the part of the old doctor in his encounters with State Boards of Medical Registration, and we believe our contentions just

and that some reform in this matter is necessary.

But, on the other hand, it appears that it is a certain class of young men, rather than the aged, who are most insistent for lax regulations and universal reciprocity. Indeed, we fear that it is this policy upon the part of these young medical and pseudo-medical men that is preventing the older practitioners from securing what is equitably due to them. The boards hesitate to relax the regulations in favor of the old and experienced men, because certain young men would demand special consideration also.

This is most unfortunate. As we have said before, the young graduate has very little just complaint against the exactions made in his examination. State boards have done and are doing a vast deal of good in elevating medical standards. We believe some of them give too theoretical examinations, but they are coming to recognize this themselves. And a young man should be able to pass a theoretical examination. Young graduates of good schools are not making any complaints.

We wish to appeal to the American sense of fair play in this matter, and especially is it necessary to urge the young graduate of any school to remember that it is to the interest of the public that he submit cheerfully to legal and proper require

ments.

We have no sympathy with the young obstructionist, especially when his tactics result in unnecessary obstacles in the way of older men.

Prompt Collections.

EDITOR MEDICAL COUNCIL :

Impressed with your business talks, permit me to give some points. I am now in my eighty-first year, engaged daily in practice, but decline night work and obstetrics.

From July, 1865, to March 29, 1913—then living in Gainesville-I collected $82.78 out of every $100 on my books. The present month, April, all but 14 per cent. has already been collected.

As to my business methods, I extend indulgence only when needed. In more than fifty-seven years of active practice I know I have never lost any

thing by promptly and properly urging settlement

of my accounts.

Have a record of more than 400 cases of typhoid fever since May, 1883. The last twentynine cases have been treated with 1/16 grain doses mercury bichloride every two hours with adults; children in proportion. Recovery has been the uniform rule under this treatment with a potent germicide. Within a few days 40 per cent. of the bacilli in the urine have disappeared.

Investment Pointers. Oxford Linen Mills is said to be winding up its affairs.

Again we say, keep out of ten-cent store stocks; they are not very promising.

The country is getting dizzy craning its financial neck over too many "Blue Sky" laws. Better put this job up to Uncle Samuel, not to the States.

Better sail around the new terminal and harbor projects more or less distantly "adjacent to New York harbor." There is nothing very definite being constructed.

The Standard Oil Co., of California, since the dissolution proceedings, has been making_more money than in the past, as it earned 15.75 per cent. net during 1912.

Don't let go of express company stocks you may hold. Parcel post is creating a new business, and the old express companies have little cause for complaint or loss in volume of business.

Had we never been in a banana plantation, some of the Mexican plantation literature would charm us; but after one has actually seen the plantations, the pretty pictures somehow look different.

Chalmers Motor Company, of Detroit, issues a report of a highly encouraging nature as regards legitimate automobile stocks. And there are other companies making money. Unfor

tunately some of the "combines" are not doing well.

Mining is not a manufacturing industry, and mine stock is not an investment; it is a speculation. Sometimes it is a good speculation, but none except those who can afford to speculate should ever be induced to invest in mining stock. It is only fair to investors to say that, while William M. Judd & Co.'s "Market Associates" scheme is merely considered as a "blind pool," and probably legal, yet physicians should study the history of blind pools before becoming an "Associate."

The Goodrich Co. (not Goodyear), according to The Financial World, sold water, charitably called "good will," and appraised at sixty million dollars, at 862 cents, netting them nearly fiftytwo millions. Recently its common stock dropped to 291⁄2, making a paper loss to investors of about thirty-four millions. When will the public cease buying water stored behind paper dams?

Privately financed Carey Act irrigation companies in Colorado sold 34,409 acres to settlers, and only 640 acres, up to recently, of this vast tract are receiving water. In other States much the same condition prevails. Look out for Carey Act irrigation bonds. The weakness of State governments in properly supervising the carrying into effect of Federal plans is the main trouble in this business.

The Girard Company, of Wilmington, Del., has been taken over by The Girard Company Pharmaceutical Chemists, of Philadelphia. The new company reports having made a small profit upon a fair volume of business now rapidly increasing and promising to reach $60,000 for 1913. They report having no debts and as pushing vigorously for business. Many physicians invested in the original concern. They should not lose hope and sacrifice their holdings for nothing, as the new company appears to be wholly sincere in its efforts to rehabilitate the stock.

BEST IDEAS FROM RECENT

LITERATURE

The Cancer Problem.

Headed by Bergmann and Kenthe, numerous investigators have been utilizing the phenomenon of the deviation of complement in an effort to diagnose cancer in its early stages, and Leschke, as noted in Medical Record, April 5, 1913, has demonstrated that positive serological findings, when taken in conjunction with clinical evidence, are of value. Using a special antigen, the blood serum of cancerous patients gave 86.6 per cent. positive reactions, while that of patients suffering from other diseases gave but 7.6 per cent. positive reactions.

Several investigators have shown that in cases of malignant tumor the proteolytic activity of the blood enzymes is diminished. Dr. G. L. Rohdenburg, in New York Medical Journal, April 19, 1913, records a series of experiments with the blood catalase and in which he finds that the determination of catalase activity is probably of no diagnostic value in malignancy, as high catalase activity occurs in other conditions. In other connections it may be noted that it is not proved that inhibition is due to the formation of antibodies.

The laboratory diagnosis of malignancy was discussed very honestly by Dr. Henry Rihl Alberger in The Lancet-Clinic, April 26, 1913. Among other conclusions, he noted:

The personal equation in pathology, as in general surgery, is a very large factor. You have seen one man work in a situation and get beautiful results; another man work in the same situation and fail utterly. Why is it? The personal equation. You cannot limit that. Such men learn to work in their own way and get results.

I want to say one word about the diagnosis of curettage. That is, by all odds, the most difficult histological examination to make. There have been whole books written upon it; Cullen's "Cancer of the Uterus" devoted to that one subject; and when it is all boiled down it is hard to draw the line between malignancy and benignant structure. You have to use judgment.

I went to the State meeting in Terre Haute and a clinician there came to me and said, "I have one on you." I said: "I am very glad to know it, because it is through our mistakes that we learn." He said: "I sent you a specimen from a girl of sixteen. You sent back a report of malignancy. Great joke!" I said I did not think so, that he had laid a trap for me and I had walked into it. I thought from the histological appearance that the probabilities were it was malignant. Now, you take that same man in to see a patient, tell him nothing about the case or the previous history, tell him he must ask no questions of the patient or her attendants, he knows nothing about that person but that she is sick in bed, and I think he will say it is a pretty hard thing to make a diagnosis. In some cases it would not be difficult. In others it would be impossible. So it is with laboratory work.

Diagnosis of carcinoma of the uterus is the hardest thing you have to make, and I frankly admit there are a large percentage of errors made. If any of you send me specimens for diagnosis I would thank you if you would in case of error or discrepancies in the laboratory findings report them to me. Usually I do not

hear a word. Specimens appear, are turned out, and that is the last I hear of them. To a certain extent that sort of thing is soul-destroying. A man loses his ambition if he does that sort of thing exclusively.

To summarize, we may state briefly that for the intelligent study of malignancy we must have from a laboratory standpoint an understanding of the clinical aspects of the case, including age, duration, symptomatic effects, etc.; a knowledge of the gross appearance of the neoplasm and an intelligently obtained and properly prepared specimen for examination. If these are furnished the laboratory worker should be able to give satisfactory help to the physician in the solving of his problem.

In the January, 1913, number of THE MEDICAL COUNCIL, in an article upon the external treatment of cancer reference was made to cell proliferation. Since then this subject has been admirably discussed by Dr. LaR. Colegrove in New York State Journal of Medicine, April, 1913. Before reproducing a part of this article, we beg to refer to page 282, August, 1912, number of THE MEDICAL COUNCIL, in which Dr. Henry W. Cattell made the first American announcement, so far as we can find, of the treatment of

cancer by choline.

Dr. Colegrove has this to say:

We know now, thanks to the researches of Ross, that cell proliferation is a physiological process dependent upon the absorption of certain chemical agents or exciters of reproduction known as auxetics, some of which have been isolated in crystalline form as kreatin, xanthin and the globin from the blood, and that these agents are found in the remains of all dead tis

sues.

So, for instance, after an injury which has produced local cellular death these chemical substances are liberated which are taken up by the neighboring cells, causing them to proliferate and thus repairing the injury. In short, cell multiplication or proliferation is a physiological proc ess due to the absorption of certain chemical agents which are found in the liquid remains of all dead tissue, making cell death and cell birth intimately associated.

Having discovered that the mitotic division of the cells were due to certain chemical agents, and that epithelial cells responded to the same agents and that the action of these chemical agents were greatly augmented by the presence of certain alkaloids, the question naturally suggested itself -what relation, if any, do these substances bear to cancer?

Cancer is a growth of human cells, a malignant ceaseless proliferation with infiltration, and any hypothesis concerning its origin must coincide with certain indisputable facts such as the "age incident."

Cancer is a disease of senescence, attacking people as a rule between the ages of forty and fifty-five, during the prime of life, at the time of the greatest cellular vitality. No other disease is known to have such striking characteristics as to age period. What then is there in our bodies at this period that predisposes us to this terrible disease. May not the increased amount of these chemical agents in our system at this time be the basal cause? It is a well-known physiological law that cellular birth and death is continually taking place within us-the births predominating up to the age of thirty-five, during