Vol. XXXV.

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"THE MEDICAL SUMMARY,"

No. 1

stuck to it, and we feel that we owe such success as we have attained to sheer persistency. We have seen scores of journals rise and fall. We have pegged away and laughed down discouragements. We believe in Emerson's law of conpensation; that for every gain there is a loss; that for every sorrow there is a joy; and so on throughout the whole gamut of life. That is the philosophy that has borne us up.

The circulation of The SUMMARY has gradually climbed up during this third of a century until it is now one of the most widely-read journals in the country. We have endeavored to fill our pages with matter that is clean and practical. We have ridden no hobbies; we are always chary of the new things foisted upon the profession, knowing that it is not everything that "makes good." We have endeavored to lead the profession along conservative and sensible paths. And such is our policy and platform for the future.

We wish to here thank our army of subscribers for their continuous support as well as the many who contribute to our pages. Also in the same rather perfunctory yet sincere and heartfelt manner we desire to express our appreciation to our numerous advertisers. Without generous advertising patronage no medical journal would more than pay expenses, and not more than a very few could expect to break even at that.

IS THE GENERAL PRACTITIONER SLIP

PING?

It is a quite geneal cry that the general practioner is losing much of his prestige and becoming more and more a feeder for the specialists. Doctors who are not too old and rusty feel the call to break into the specialist circle where the easy money and the easy life are supposed to exist. And still we believe there is to-day a great demand for the general practitioner-the erstwhile family physician. The only thing about it is that he must be better qualified and more versatile in his acquirements in order to cope with the evergrowing demand for new ideas in medicine and medical treatment.

One reason why the general practitioner finds himself losing is the fact that he neglects the little things and does not give enough attention to details. Here is an illustration that is somewhat illuminating: A gentleman was afflicted with chronic eczema of the hands, a case of three years' standing. He had tried different physicians in his town of ten thousand inhabitants and finally sought out a general practitioner in a near-by town and asked the doctor for help. "And were the physicians at home unable to do anything for you?" the newly-consulted physician asked. "About the only advice I could obtain from them," he replied, "was to use tar or castor oil on my hands." The new doctor "went after" the case, its history, etiology and all of its essential details. His treatment was therefore more accurately applied and in a few weeks the man was cured of his affliction.

A year or so ago one of the well-known SUMMARY contributors wrote an article in which a number of definite facts regarding the treatment of tuberculosis were pointed out. Just simple little things but definitely stated. The writer received a letter from California written by a consumptive who had read the article in question. He said: "Why don't physicians give their patients specific advice regarding diet, hygiene, etc., instead of the stereotyped suggestions about 'taking plenty of nourishment, bathing regularly and breathing pure air.' The general practitioner should get over his longing for the big game

and endeavor to be a good all-round doctor. The top is considerably crowded these days, but there is ample room at the bottom.

THE DOCTOR WITHOUT A FEE.

We have heard of the man without a country, and of late the doctor without a fee has been breaking into public print. A few months ago a physician in a small town in Illinois died. After his death it was heralded far and near that he never asked a fee. The good people in his community chipped in and bought a monument for his grave. It is needless to state that the doctor died broke. How much better if some of that monument money had gone to the doctor sooner; doubtless the doctor's wife needed shoes and his old Dobbin oats. Mayhap, the doctor might have remained among his feeless clientele a bit longer if those whom he served had come across at varied and stated intervals.

More recently a very similar case bobs up in Pennsylvania, in Montgomery county. The doctor told about in the daily papers never asked a fee. In the settlement of his estate he was found to be worth less than $500, and he owed seven times that amount. Perhaps his creditors are not among those who are enthusiastic about the no-fee plan of practicing medicine. The law of compensation is inexorable; somebody has to make up the deficits.

There is not much to these stories to which we can point a moral or adorn a tale. We believe in the humane and the human side of medicine; we haven't much use for the doctor who hasn't charity in his heart when charity is really needed. But the servant is worthy his hire, and the doctor who expects to make a living without asking for his fees is a freak of nature and a detriment to the profession as well as to himself. Charity and good work should not slop over; too often it is not appreciated by those who are served. Did you ever hear this story? A young doctor, recently graduated, started out to uplift the folks in a benighted slum region, and in every way he possibly could. At an unkempt and poverty-stricken home he made a professional call, and incidentally left a couple of dollars with the poor woman to

help keep the wolf from the cottage door. The next day when the young doctor called at this humble home he was met by a youngster who in his frankness opened the eyes of the kind-hearted young medical man by saying: "Mamma took that two dollars you gave her and got a real doctor with it."

WHY NOT RECIPROCATE?

It is a perennial discussion, that of state boards and their licensing boards. California has especially come into the limelight recently on account of her rigid examinations, presumably designed to discourage new doctors from butting into that

state.

The complaint is made that the questions presented to candidates in this and many other states are so technical and impractical as to border on silliness. For instance, how many SUMMARY readers can explain "how alcohols are derived from water," if they do not happen to be analytical chemists? Or who but an academic pathologist would be able to "tell how to distinguish a section of the thyroid gland from one of the prostate gland of an old man?" In reply to these and kindred questions we might like Puck, ask, "What's the use?"

State boards do much good: we believe in registration; we believe in organized and ethical medicine. But what is the use of the assinity that is displayed by many socalled leaders in many different states? The distribution of doctors would be better consummated without examinations gotten up to frighten newcomers away. The law of supply and demand in a large measure regulates the distribution of doctors. This ban upon the doctor who would move from one state to another is one of businessthe idea of freezing out competition. Does it ever enter the heads of these state arbiters that men should be kept away because they are "incompetent?" Never.

If a physician is entitled by reason of his morals and his knowledge of medicine and surgery to practice in one state there should be no law, human or divine, to keep him out of any state in the Union. The mockery and the inconsistency of it! Let's start a movement here and now to do away

with "states' rights" in this matter and the handicap and hardships that it works to members of the profession.

THE DOG AND GUN-WHAT ARE THEIR USES?

In a festive spirit and with a dash of sentiment we associate the dog and gun. There are many kinds of dogs as well as guns. Considered from utilitarian and humanitarian points of view, are canines and fire arms really worth while?

It is true that a great deal of sentiment is attached to the faithful dog, "man's truest and best friend," "the one that is ever ready to lick the hand that cuffs him," etc. All this sounds well but, after all, it is mostly gush. The dog in modern life has few uses. Tribal man found the dog useful as a companion and as a protector of his property and his loved ones. All

is has changed. In modern life the dog gives us little protection. On the other hand he is a menace because he frightens horses as well as nervous women and children. More than that he is a carrier of vermin and disease germs and especially the dreaded rabies. If it were not for so many useless dogs it is a pretty safe throw that hydrophobia would not exist and the expensive Pasteur Institutes and hydrophobia cures would not be necessary. The dog is a nuisance and an incumbrance to society at large.

And firearms! The same applies to them. Why are so many guns and revolvers bought and carried? It is simply a relic of a barbaric and feudal age. There is certainly little game in most parts of the country and we are in little danger of being attacked by wild beasts-unless it is a dog. Protection against burglars and highwaymen, then, is the only excuse for revolvers. As everyone knows, the owner of a revolver is in more danger than the person not thus protected (?). When shooting seems necessary the wrong individual too often becomes the recipient of the shot. The law should make it more difficult to purchase guns; the incentive to voluntary murder and suicide would be thereby lessened. Every gun owner should be registered and required to give strict account of his uses of firearms.

4

HOT OR COLD DRINKS IN MEASLES?

The time was when a patient taking measles was not permitted a drop of cold water. When it was found that cold water did not kill, the pendulum swung the other way and physicians began to advise the taking of cold water copiously in order to break out measles. These stereotyped bits of advice always get around to the laity in a little while and now the average lay individual is morally certain that cold water is the best thing to bring measles to the surface. There may be no contraindications to the alleviation of thirst in measles but after years of observation the writer is pretty well convinced that cold water is not always the correct things in this disease. It is a septic febrile condition and nearly always there is an upset stomach, and usually vomiting. Copious water drinking always aggravates this condition. It is our observation that hot drinks supplemented by diaphoretic drugs and measures are the best procedure in measles, at least until the rash is well developed. What has been the observation of THE SUMMARY family.

BROMIDIC TERMS.

Under the title, "Terms That Make Me Tired," the editor of the Red Back takes exception to these: "The busy practitioner," "A complication of diseases," "His lungs. were involved," "Heart failure," "Nourishment," "I put her on so-and-so."

How about these also: "The best doctor in town, if he would let whiskey alone," "A doctor oughtn't to have a cold," "He said he would give her the last remedy," "I wouldn't let Doc Blank doctor a sick cat for me," "Hard work and exposure," "He said if he'd got there ten minutes later-,” "Bronchitis," "Lung trouble," "Come as often as you think best, Doc; we don't care for expenses," "Take plenty of exercise," "The doctor said his fever was 103." "Lazy liver." "Chew your food well," "Drink lots of water between meals." "neurasthenia," "We gave him lots of cold water to bring the measles out," "Doc never lost a case of pneumonia," "scarletina," "His catarrh ran into consumption," and last, but not least, "The doctors disagreed."

CANNABIS INDICA.

This old remedy is especially serviceable in painful affections of the genito-urinary tract. Among these are tenesmus, strangury, chordee and spasmodic stricture. Ast a rule it is better given with other corrective drugs, as antiseptics and sedatives. Cannabis indica is of value in most conditions in which an opiate is indicated. Blair says: "It is a safer and more satisfactory remedy than heroin or codeine as the narcotic element in cough mixtures, such as the syrup of white pine."

At the International Medical Congress, which meets in London this summer, an exhibition of rare and curious objects relating to medicine, chemistry and pharmacy and allied sciences will be given. Among these will be the medical deities of savages, amulets, talismen and charms connected with the art of healing. The evolution of surgery and the instruments used throughout different ages will be shown as well as peculiar objects and drugs which have been employed to cure disease. Full particulars will be given to those interested on writing to Henry S. Wellcome, Secretary Historical Medical Exhibition, Wigmore street, London, England.

Experience has demonstrated that physicians who desire to study in Europe may find it much to their advantage to go in a Travel Study party. By so doing the expense may be greatly minimized, a better itinerary can be mapped out and certain advantages in the way of clinics and lectures can be more satisfactorily arranged. The coming International Medical Congress, London, August 6-12, 1913, gives a splendid opportunity for organizing an American tour of this sort and plans are now ready for a Travel Study tour leaving New York July 3d for the most important capitals and health resorts on the European continent. Physicians interested in such a trip should write for further particulars to Secretary Physicians' Travel Study Tour, 236 East 69th street, New York.

Absolute deafness cannot be merely tympanitic.