a club in an endeavor to smash the business heads of able, careful and upright gentlemen who happen to be on the boards of editors of independent medical journals, the attacks will simply react, and leave certain hot-headed or indiscreet editors out of a job. What is worse, it will put back the "Propaganda for Reform" more effectively than will any other one thing.-EDITOR.]

The Legal Status of the Doctor.

EDITOR MEDICAL COUNCIL:

In your editorial of the September issue of THE MEDICAL COUNCIL, "Reciprocity is Winning," you seem to be highly elated over the requirements of a certain new medical registration law. You say: "Reciprocity is provided with every State in the Union, and old doctors who were in practice before the days of medical boards of licensure are provided for by very equitable, even generous regulations, but they must, very properly, demonstrate their practical fitness as physicians,"

The very "equitable and generous regulations" provide that the "Board shall afford him a practical clinical oral examination"-for which he Days $50.00.

as

Any doctor demonstrated his "practical fitness a physician" at the time when he received his license to practice in his particular State. That State is a part of a whole which forms the United States, and that license states that he is a fit person to treat the medical and surgical ills of any member of such State. Withdraw the State in question from the present United States, you withdraw a part from the whole; you have no longer a whole; by interfering with the rights and privileges of any set of members of such State, you ostracise that particular State; you have no longer a United States; you permit a licentiate to treat only a chosen few of the members of the United States; you form a class distinction inimical to the Constitution of the United States.

A licentiate of Germany, France, England, or any other country, may practice his profession at any place where his respective flag holds sway. We boast about freedom and unity; in reality we are not a United States, but a "house divided," where every little morsel exhibits its "keep off." We are not governed by kings, who obtain their scepter "by divine right," but by a mob of political "Schinderhannes," whom we elect by the "untrammeled," compared to whom that god-like Cæsar of the pyrotechnical display was but a pigmy.

Go to the land of the Druids for a practical definition of such words as unity and freedom.

If I am able to treat the ills of the denizens of Chestnut street, I should be able to treat those of Union Square. The Atlantic and the Pacific mothers experience similar difficulties in their endeavors to prevent "race suicide." It is about time that we assert our rights, that a united medical profession throw off the shackles of a dictatorial political branch, that united we apply to the proper source, demand our rights as citizens of the United States; let each member who has the welfare of his brother member at heart write to his Congressman, explain matters fully, and demand that all licentiates of the United States be permitted to enjoy benefits and privi

leges common to all, no matter where located, that a license to practice medicine in one State means a license to practice in any State as long as the possessor of such a license conducts himself with proper decorum.

The man who graduates to-day, who obtains his license through examination before a State Board, may now reciprocate with many States, but will he be able to do so in the future, when conditions, over which he has no control, force him to change his location? The late addition to the Minnesota laws show that such will not be the case for all applicants for license will be required to take a practical examination in laboratory work in pathology, histology, bacteriology and urinalysis and in clinical diagnosis; and according to Rule 20, "candidates shall submit to an examination in anatomy and such other branches as the Board shall deem advisable." So, cheer up, boys; "the worst is yet to come!"

If the latest endeavor of branch members gains recognition, "no member may practice surgery unless especially qualified." Qualification may be obtained by attending, for a period of about two years, a special to-be-created institution, probably to be located about a mile west of the Chicago River. Members representing the otolaryngological branch see similar needs, and so on all along the line. The younger members of the profession may see the day when a license issued by any State Board represents only an admission ticket to a school of a specialty, the choice of the particular variety of which to be left to the discretion of his mature (?) judgment. The possessor of such a license is a man without an occupation and without a country. Vivat, floreat, crescat, sancta stultitia! DR. F. A. GRAFE,

Cincinnati, Ohio.

Reciprocity and Medical Colleges. EDITOR MEDICAL COUNCIL:

If I remember correctly, the British doctor, upon obtaining his degree or L. R. C. P., has the privilege of practicing anywhere within the limits of the Empire. There are, of course, in every colony certain technicalities but not to the extent that there are in our States, and their men are scattered everywhere.

Why can not we work out National license regulations, allowing the graduate of a reputable medical college to locate in any State? With our advanced requirements for graduation, what do we mean by imposing such license restrictions?

To assume the rôle of prophet would be foolish, but I do believe that the future will show more National and less State medical legislation. The enormous grist of State enactment is incredible and unnecessary.

Eliminating spurious medical colleges will help to bring this about. Mushroom colleges exist for their own selfish gain. The Association of American Medical Colleges has established standards. If all of the State Boards of Medical Examiners decline to recognize the diplomas of colleges refusing to enter the association, they would be eliminated without legislation.

Worcester, Mass.

DR. R. C. FISH.

[It simply means that commerce has established interstate relations, that everything else is estab

lishing them, and the doctors are becoming restless for the same thing. According to Federal and State constitutions, the police power resides in the States. One court after another has ruled that the States have the right to establish each for themselves standards for admitting men to practice therein. Congress does not have the power to assume the functions of the individual States; but Congress does have the power to say under what conditions matters of interstate import are conducted.

If the doctors could induce Congress to do what Canada has done, establish a National Medical Council, it would be quite feasible to induce the Federation of State Medical Boards to accept credentials from such a national body. No Medical Council of the United States could legally force the States to accept its credentials, but doubtless there would be no difficulty at all in inducing them to do so. A National Board would not necessarily do away with State Boards; it would simply unify standards and, through the State Boards, make interstate reciprocity legal.

If the American Medical Association gets actively to work along some such line as this, placing existing licenses upon the same level as new ones, all this unrest and dissatisfaction will be done away with. The present political status of our medical licensure is a disgrace to the profession, in the United States.-EDITOR.]

Regarding Constructive Medicine. EDITOR MEDICAL COUNCIL:

In the September issue of THE MEDICAL COUNCIL, you ask how we are to make popular a "Made-for-Americans" therapy, and very truly say that the average doctor must become more independent, that he must work to a greater extent upon his own initiative and with balanced attention to the ideas of others: In other words, he must become more of an authority within himself.

The great trouble with the average American doctor lies in the fact that he gives too exclusive heed to the sayings of others. Insofar as I have noticed, the average American doctor is sorely lacking in well-informed independence. He is frequently far from being down-to-date, in that he relies upon published works (often old) rather than upon the findings of the men in the field, who are very frequently publishing this data in medical journals.

Many doctors, even some of the men who write text-books, still cling to "favorite prescriptions" and not infrequently are guilty of administering many drugs which are not indicated in the least. Many doctors carry with them at all times a copy of one of the numerous "formularies" and copy the prescriptions therefrom, regardless of the individual indications presenting. In many instances the patient is overdrugged, and unsatisfactory results follow in the wake of such practice.

Not long since I saw five different prescriptions, covering a total of eighteen drugs, ordered in the incipiency of a case of pneumonia. In addition thereto there were orders for two other lots of medicine, which brought the total up to twenty different remedies. And all of these were "favorite prescriptions," aside from one for calomel and one for a saline laxative. In addition, the doctor told me that he bled the patient and gave him

two or three different drugs from his pocket case. This patient was treated for pneumonia, as a disease total, and with little, if any, regard for the indications as they presented. Is it not possible that this patient succumbed to overmedication, rather than to pneumonia, per se?

A few years ago the intestinal antiseptics were introduced to the American doctor. Immediately thereafter the laboratory worker told us that it was impossible to render the gut wholly aseptic and consequently these agents were inefficient and should not be employed. The man who felt sufficiently independent to disregard the laboratory criticism, went ahead and employed these antiseptic agents, obtaining results. He did not insist that the whole bowel was rendered aseptic, but he did recognize the fact that there was a change in the discharges when the antiseptics were given to effect and that his patients often made prompt and complete recoveries. There are still many who cling to the teachings of those laboratory men, and who will not take cognizance of disagreeing clinical findings.

Therapeutic nihilism was the vogue not so very long ago and some doctors had the temerity to say that practically all drugs were worthless. In fact, the vast majority of the American doctors were of the nihilistic class for a time, and simply because of the writings of a few. There were some, however, who did not swallow everything that was handed them, but went ahead administering drugs as they were indicated, or as nearly so as possible. They got results and the laity awoke to the fact that these few were the successful practitioners, and there was a demand made that all doctors go and do likewise. Then the authors of text-books woke up, gave more attention to applied therapeutics and opened their eyes to the fact that drugs might not be worthless as they had previously contended.

While we must have laboratories to give us primary and theoretical ideas as to the use of drugs, and also must have writers to supply us with text-books, we should not disregard the findings of the medical-journal-reporting clinician, not even if he be far out in the country. All these things should be associated and work hand in hand. The laboratory worker and the authority who would give us a book, should each keep quiet until after they have been able to compare notes.

The

It is invariably the really well-informed but independent doctor, the man with a mind of his own, who is successful in every way. He does much of his own testing of therapeutic agents and knows what the various ones will do. only way in which we will show therapeutic progression will be through independent thought on the part of every studious American doctor. Let him study his cases, not as named diseases with favorite prescriptions therefor, but as combinations of symptoms and indications, with an agent for the possible meeting of each pathologic unit or group of symptoms presenting. If he does this there will be progression in medicine, and therapeutics in general will "come into its own." Then the American doctor will be recognized generally as a successful constructive physician.

Gardnerville, Nev.

GEO. L. SERVOss, M.D.

[We agree with this. Every doctor should read the standard books, take, and read, at least

one medical journal featuring research articles, as well as several distinctly clinical journals. The average doctor in the field can not advance himself or make creditable additions to medical knowledge unless he knows for himself what the research man is doing. On the other hand, it is deplorable that a small group of men eminent in science will not balance their own view-point by reading the class of medical journals that do not play up The Mutual-Admiration Society. There is a lot of journal writing which sounds trashy and is trashy. There is also some which sounds scientific but is just as trashy as the other class. It takes a broad man to discriminate. Extensive and all-inclusive reading is necessary to make one broad.-EDITOR.]

College of Surgeons of America.

There has been much criticism of this organization, some of it based upon its own announcements. We clipped many editorial expressions regarding the matter, expecting to use them in a composite abstract. But conference with a number of surgeons has convinced us that the College of Surgeons can not now be judged by its preliminary publications as to its aims and purposes; its announcements go beyond what the greater number of its membership aim to accomplish.

Some time since, we wrote to Dr. Franklin H. Martin, 31 North State street, Chicago, Secretary of the College of Surgeons, asking him directly if it was the aim to make a legal effort to limit the practice of surgery. He replied as follows:

"We expect to include general surgeons and all men practicing surgical specialties, as eye, ear, nose and throat, orthopedics, gynecology, etc., and, of necessity, men in the rural districts who necessarily must do more or less general practice but who are qualified scientifically to do surgery and who do the surgery of their community.

"The object of the college is not to curtail the rights of any man, no matter what his practice is, but our primary object is to insist that all men doing surgery, especially the major kind of surgery, shall be fundamentally scientifically equipped for that practice."

(Signed) FRANKLIN H. MARTIN.

Whatever the original aims may or may not have been, there appears to be a general impression among surgeons to whom we have talked that the actual outcome of the College of Surgeons will be merely to add another to our present organizations of specialists.-EDITOR.

With acid pyuria look for a kidney lesion.

The editor has been experimenting with alterative formulæ, and has devised the following: Thirty drops of U. S. P. tincture iodine (which contains potassium iodide) is carefully mixed with 60 drops of Fowler's solution of arsenic. The mixture is light amber in color. Add to this enough water to make 4 fluid ounces. The solution is perfectly clear and looks like water, and is given in 1-drachm doses. Do not put up in large quantities or attempt to keep it very long. Doctor, try this and let us hear results.

WE'RE FOND OF OUR JOB. That's why The Medical Council is full of enthusiasm. We are trying to make it infectious, contagious, transmissible and "catching"-this enthusiasm of ours. It's lots of fun running out to see patients and then coming back to the desk to write to and for doctors from the doctor's own point of view. And now truly, Doctor, you can have just as much fun as we do and be just as enthusiastic over your job if you do like we do-catch on to the other fellow's point of view and learn to read the medical journals for professional atmosphere and orientation.

Suppose you think of this, especially as regards the January Medical Council. It will be crammed full with points of view. Here are some of them:

Simple Spinal Curvature: Its Treatment and Cure," by Dr. Fred'k. D. Keppel, is not a surgical article. Every doctor can follow its suggestions.

"Fragilitas Ossium," by Dr. Chas. E. Remy, describes a rare condition, but one you may meet and should know about.

"Enteric Fever and Its Dietary, by Dr. S. R. Klein, is written from a wide and novel point of view, and besides it is very practical.

'Diaphragm-Heart Neurosis as Influenced by the Sex Function," is an interesting and up-to-date discussion that will surely interest you.

"Tonic Uterine Contraction Above the Internal Os During Labor," by Dr. M. B. Tuller, may help you out of a fix one of these times.

Auto-genesis of Bacterins," by Dr. A. D. Hard, is a thoughtful and interesting article.

"Minor Drugs in the Light of History and Modern Science, is an article in this series to prepare your minds for some rampant heresy that is full of saving help.

The editor has been looking up “The Hypodermatic Use of Quinine," and will tell about it. "A Candid Study of the Dispensing Problem" is another of several topics he will discuss.

Protection vs. Elimination in the Business of Practicing Medicine," "The Doctor's First Thousand Dollars: What Should He Do With It?" and Selling Out One's Practice" will be among the subjects discussed in "The Business Side."

The Business Side

OF MEDICAL PRACTICE

While we, as physicians, desire to be scientific students and practitioners of medicine, yet we desire also, for the welfare of our dependent ones and for the sake of our standing in the community, to secure a fair compensation for the services we render to our fellow

men.

Profitably Handling Alleged Undesirable

Practice.

Fortunes have been made from junk, others from by-products. Big fortunes have been lost in exploiting things too big to profitably handle. Even the junk-heap class of humans support business, such as it is; while most prosperous lines of business depend chiefly upon the fair-to-middling fair-to-middling classes who need honest goods at an honest price. Successful business classifies needs first and people afterwards.

The medical needs of humanity are the same in castle and hovel; physiology and pathology know little of class distinction. Medical luxuries are few and enjoy but little relative patronage.

When doctors were more evenly prosperous than they are to-day, one heard little of alleged undesirable practice; practice averaged up as fairly desirable all along the line. Plain and needed drugs and plain and needed surgery were dispensed by plain and needed doctors to plain people who

needed them.

Then elegance crept in some of it needed, most of it not-and trouble began for the doctor. Elegant pharmaceuticals, elegant technic, elegant equipment and elegant surroundings were not adapted to dispensing plain pills for plain people. And the doctor of elegant tastes wanted elegant practice; he crowded the cities and he neglected the country. So it is that to-day the men who are adding most usable knowledge to medical science are not, after all, the fashionable doctors on the "best street," but the capable doctor in army camp and charity hospital and on the village street.

And the necessary and useful portion of

modern medical elegance has become very expensive. Mr. Common People finds he cannot afford as much of it as the profession thinks he and his family needs; hence the growth of the modern hospital. Undoubtedly the hospital is a splendid thing, and undoubtedly it is an expensive one. So much is this the case that private benevolence is inadequate to support it, and`a paternal government is gradually being called upon to support the hospital; it is more and more being maintained by taxation.

Is it any wonder that Mr. Common People is coming to consider "free" medical treatment as much his right as is "free" education? Perhaps this is right, but where will it end? How long will Jones pay the freight in the form of ever-increasing taxation?

Forty years ago there were 149 hospitals in the United States, with 35,453 beds, inclusive of 51 institutions for the care of the insane. To-day there are 6,665 institutions with more than 600,000 beds and valued at $1,500,000,000. There are 65,000 physicians on their staffs.

The Modern Hospital, in an editorial, says: "By common consent, based upon the needs of the time, it is decreed that there shall be a bed in a good hospital for every sick and hurt man, woman and child, and that every resource of medical skill, seconded by the highest order of trained nursing, and aided by all the arts and sciences, shall be at the service of rich and poor for the cure of disease." Then it goes on to throw discredit upon practically all home care of the sick and speaks with regretful (!) asperity of "the old-fashioned family practitioner," whose position it alleges to be largely taken by the trained nurse.

From the standpoint of social service and the advancement of medical science there is much which is admirable in this propaganda; but don't get excited, Doctor, it will

never come to pass.

One of the States in the Union which provides for all its insane in State hospitals, spends 23 per cent. of its total income in so doing, 24 per cent. for education

and 2 per cent. for militia. Were it to provide for all classes of sickness and injury as it does for its insane, it would take its total income three or four times over and leave not a dollar for anything else. So we can dismiss the idea as chimerical, even conceding, for argument's sake, that it might be desirable.

We go into all this to prove that the momentum of this hospital propaganda is being borne down by its overweight of expense. Mr. Common People is beginning to be pretty roundly charged for hospital service in many places, and more of his class will be charged for it in future. Deficient appropriations will force many of the public hospitals to limit themselves to their more necessary function, the care of the sick and infirm poor. In this field it can do a splended service to humanity. When it comes to asking State legislatures. to appropriate public money to establish hospitals for the well-to-do class, there will be a sudden pause to the propaganda.

So, then, as we see it, clinical work will ere long divide into three classes: public hospital service for the poor, private hospitals charging for service, and a vastly increased volume of work for the private practitioner.

Because he will do his work better than formerly, the much-broadened family doctor will get more of it to do, and he will co-operate with hospital organizations that have turned back to him the greater bulk of the now much abused free dispensary work, as well as much of the surgery which can be properly done in the home. The rapidly approaching era of scientific common sense will put the doctor's work, viewed as a business, upon a more substantial basis, which will leave charity work to the hospitals and other charitable organizations, and in which Mr. Common People will be properly regarded as a desirable patient.

Medical colleges are turning out thoroughly trained men, the larger proportion of whom will become "family doctors."

Then, if the older men take post-graduate courses, drop subterfuge, avoid pseudoand ultra-science, and properly cater to the real needs of the public, there should be a vastly improved future for general practice.

And the only argument we care to offer in proof of these assertions is the living flesh-and-blood doctor of business sense and human sympathy who is making good in what many men would consider an undesirable practice. And his class is a growing one-a class of good doctors, scientific practitioners and honest men. They have long ago abandoned the foolish notion that most practice is undesirable. One must ever remember that most any class of practice can be made undesirable.

He Who Pays First Laughs Last.

No coin of the realm will buy what a laugh will purchase; it is the dessert of money. The best laugh is the last one, to turn around the old saw, and it is the best one because it is paid for. A laugh is both money and a commodity-a commodity which may be a drug on the market, may be bought cheap, may be had for nothing; and yet the best laugh is always expensive. And a laugh is money, a financial dessert used to pay for the last and the best in life's feast. Ordinary laughs will not buy what money will, but the best laugh buys what money will not.

It is December; therefore we laugh. This laugh cost us a lot of money; we have had to pay heavily in money and labor all through the year to have a good laugh now. We paid first; we laugh last. And it is a good laugh, an after-dinner cigar with a gold band on it. gold band on it. Have one like it on us, doctor! And here's a light:

Pay up in January. Start the year right. Don't laugh off your debts, but laugh after your debts are off. The good payer is the best laughter. The patient who laughs with you is the one who pays you first. The subscriber who laughs with us is the one who pays us early. We give away lots of