does not have enough sense, as stated by his former employer, to go out of his home for a loaf of bread unless some one goes with him, running a healing institute and also teaching students to become fakers like himself. I sent a young man to interview him, and this is what he reported to me: The course of instruction lasts for four months. All the education you need is to be able to read; you do not have to be examined by the state medical board; all you have to do is to advertise, and you can easily make from two to eight hundred dollars a month. You can treat all kinds of diseases.' This man and his partner treat cancer, tuberculosis, etc., yet they have not the least idea of the manifestations of these diseases, nor do they have a smattering of anatomy, physiology, pathology, etc. Yet our State, under its present law, is powerless to mete out justice to this monumental faker and his followers." This is the state in which the laboratory examination counts for 90 percent―a rule that absolutely excludes all but the most recent graduates. Let us ask a few questions in the light of the foregoing statement: I. Does the Colorado Medical Examining Board protect the people of that commonwealth against incompetent practicians of medicine? President Enos says, No. 2. Does the Colorado law protect the true physician from quack competition? See above. 3. Does this law do anything for the profession, or does it merely place the regular profession under the control of the State Board so far as it does anything? 4. Does this Board under the present state law protect the people, help the profession, or simply put power in the hands of the Board? It is the old story. Under the pretense of furthering public interests a machine for the subjection of the profession to the will of a bureaucracy is being developed. One only vantage ground is left the unfortunate doctor-these state laws that permit quackery of every description to go free, and fetter the regularly educated and Do we as a profession seek to push the uses of drugs to their utmost possible limit? Well-hardly. With that disassociation. from the practical aspect of everyday life, that has more than all else earned for us the contempt of legislatures and the public, the body of the "upper" or perhaps "noisy' ten has sought in every way to discredit drugs and to advocate every other therapeutic resource in which the quack can meet us without hindrance and beat us out of the field by his use of advertising. Sensible, isn't it! Guess we get what's coming to us. Edison won't be in it with the man who devises a way to put good advice under the hides of people dying for the want of it. -Gilhooley PURE REASON ABOUT "DRUGS" It seems so reasonable in every way, so moderate, so palpably and evidently true, that we cannot see why any physician should object to it: That we should only use drugs with a distinct idea of what we expect from them. Grant that simple proposition and all the rest follows logically; and you are a full-blown alkaloidist. For, to have a distinct idea of what you expect from your drugs, two things are necessary: that you recognize a need for something, or in other words, a disorder in the patient; and that you know just what the drug you select will do. Do you agree with me this far? Well, we'll go a step further: To know what any drug will do, it is necessary that it shall do something, and that that something will be the same thing whenever the same dose is given under the same circumstances. In other words, the effects of the drug must be uniform under uniform conditions. You can not possibly predict the effects that will follow if your drug does one thing today and will do something different tomorrow. Now we've got you just where we want you, for you can't get away from our next proposition: To obtain uniform effects from a drug the drug itself must be uniform. And that means, it must be an active principle or a chemical substance, each in a state of chemical purity. What is a "drug," anyhow, to the physician? To the druggist, opium is a "drug." To the physician, it is a combination of twenty-six or more drugs, each of which exerts a different effect, and each of which exists in a different proportion in each specimen of opium. We can not confidently foresee and predict the effects that will follow a dose of opium, for it may contain any proportion of morphine from 22 percent down to none at all, and each of the other principles in similarly variable proportions. We may say what we hope will result, or may result, or possibly or probably will result, but in truth we don't know what will happen. This was well enough so long as we could not do better; and the older doctors did great work, wonderful work, when we realize the imperfection of their tools. But as the allied branches of medicine advanced to a more scientific point, the uncertainties of the materia medica became so much more prominent that universal dissatisfaction resulted. Absolute pessimism, therapeutic nihilism, followed. Men ceased to use medicines except as a means of inducing curative suggestions. Faith in drugs failed, because the drugs were not good enough to inspire faith. From this depression drug medication. has been rescued by the genius of Burggraeve. This great man saw, half a century before the rest of us, that what was wanted in therapeutics was certainty; and that this was only possible through the use of remedies unvarying in nature, uniform in action. The history of the movement inaugurated by the Belgian savant is that of every really great advance in medicinethe slowest progress, fought at every step by the innate conservatism of the profession, and the financial power of the vested interests of pharmacy. The keynote of the latter opposition may be found in the remark of the then head of the most prominent supply house in America, George S. Davis: "The uncertainty of medicines is the life of the drug trade." Unfortunately it does not conduce to the prolongation of the patient's life; and in that we are more interested than in the financial interests of the drug trade. If the above reasoning has a flaw, please point it out. If not, how can you get away from the active-principle therapy? As Prof. Laura says: "The alkaloidal therapeutics impresses itself upon the physician who has a conscience, as a duty." You will see in life just what you are looking for. It depends upon the lenses of your mental vision. If they are black and smoky, you will see the shadows, the gloom; if they are clear and crystalline, you will see the rainbow of beauty.-Marden. OSLERIZING THE OLD DOCTOR We have on several occasions alluded to the difficulties experienced by the old doctor in his encounters with the examining boards. These are not by any means confined to the difficulty he must experience in passing examinations of the elementary branches of the medical course. If he has been a real physician he has devoted himself to each duty as it has appeared, and has not spent much time in looking up the rudiments of the profession; and these rudiments he has only remembered as they have come to him in his practice. Consequently many of the things which the recent graduate. can rattle off quite easily can only with a painful effort of the memory be recalled by the older practician, if at all. We are taking the standpoint that these medical laws are intended for exactly what they say, the protection of the people of the commonwealth from incompetent practicians; and looking at it from this point we will say that years of experience are worth more to a man than a knowledge of minute points in anatomy. To show the still To show the still further development of the injustice done to the older physicians, we may point to the fact that the laws of Utah forbid any physician appearing for examination before the State Medical Examining Board unless the college from which he was graduated at the time of his graduation exacted a four years' medical course. This looks on the surface like a very wise and exalted condition, but what does it imply? Dr. McIntyre, the accomplished secretary of the American Academy of Medicine, tells us that the first obligatory four years' medical course was established by the Northwestern University of Chicago in 1891, the University of Michigan following in 1892, the University of Pennsylvania in 1893. The Utah law therefore forbids any physician appearing for examination who was graduated previous to 1891, and with the few exceptions named, it shuts out all graduates previous to 1893. No matter how well qualified these gentlemen are, no matter if their names appear upon the diplomas of candidates who are admitted to examination, they are not even allowed to show their proficiency, or their lack of it, by examination, unless they are graduates of less than fifteen years' standing. Is it necessary for the protection of the people of Utah that no physician who has fifteen or more years' experience be allowed to practise in that state? FUNDAMENTAL PROFESSIONAL ETHICS Quite frequently we receive letters in which the writers complain bitterly of the unprofessional conduct of their competitors. The wonder is that these things are not more common, and still more that anybody should expect it to be otherwise. First we have that unavoidable, inexorable struggle for existence; and when six doctors are planted in a community that can not and will not support more than five, somebody has to feel the pinch. Ever been pinched, Doctor? Ever feel the pressure of an income a bit too small to cover the outgo? When the short blanket is pulled up and the uncovered toes get cold, do you ever feel tempted to warm them against your helpmate's warm feet? Men are all men, and even a doctor is very human; and every human being is yet an animal, with the needs, appetites and propensities of the animal; curbed by law, enlightened and broadened by education, softened by religion. But still the animal. If in that development that divides us from the next animal on the evolutional ladder we find our best and highest still fall short of the ideal, what are we to expect of the lowest, or of the masses? There's the key to the situation-what to expect! We must not expect the other fellow to be better than ourselves, but we do. That trick you played on him, by which you caught his best family, seemed pretty slick to you; but if he had played it on you, you'd have been hot all through. Ethics between physicians is the simplest matter in the world. As the Japanese say: "See not, hear not, speak not evil." Better yet, think not evil. The man who makes a resolute and persistent effort to think only good of and toward every other man will not suffer from the unprofessional acts of his colleagues. Every effort on their part to hurt him will only injure themselves. He who sneers at "that good, big-hearted man" who never has any but a kindly word for everybody, only disgusts his hearers, who are more likely to set the slanderer down a liar than to believe ill of the man they know to be a good one. The most unpopular man in a medical society is he who brings charges against a fellow member. Even if they are proved, we dislike the mean thing he has done. Every assault on another man turns out in the end to be a boomerang-it may hit its mark but it returns to the thrower, perhaps hits him-points to him as the aggressor. It is so very easy, if one only makes it an invariable rule, to think kindly of all, and to excuse their faults. Now; there's Simmons! ??? ! ! ! *** Do not join the knockers Klub; and avoid all fellowship with the folks who are trying to wear the face off the clock. -Elbert Hubbard GONE BACK HOME Chatting with a friendly druggist the other day, I happened to notice a remarkable shrinkage in the space he had formerly devoted on his shelves to patent medicines. Wondering if the besom of reform had struck him also, I asked about it. He looked regretfully at the shelves and remarked that not one-fourth as many sales of nostrums were made now as had been made two years ago. This is undoubtedly due, as the druggist himself admitted, to the crusade which has been made by Collier's and other journals, and especially to the work that CLINICAL MEDICINE has done in that time, fighting this evil. The importance of this matter is rapidly being realized; and the firm which sends out dope for quacks, to assist them in hum bugging the people and taking the doctors' revenues, is going to be called to swift account. Even now this business can no longer be carried on openly. We hear of medical societies calling great manufacturing chemical houses to account for supplying quacks and patent-medicine fakers, and some pretty strenuous denials are being made. One point is gained when these firms find it necessary to carry on their trade in secret, if at all. A year ago their representative informed us it was none of our business, but simply a matter of trade which concerned the manufacturer alone. (No, we forgot! it was the editor of the J. A. M. A. who said that. Well, we won't take back what we said before, but just let it stand.) But in making a fight on this point, CLINICAL MEDICINE is striking at the root of the evil. When the great chemical houses no longer supply quacks with their dope, a great point will have been gained. Each house that ceases this practice will naturally desire to obtain as much kudos for it as is possible, and may be expected to open up a fight against those who still continue it. It will not be long, when this movement gets under way, before this stable will be cleaned. And the patentmedicine men will have to set up their own factory, or go out of business. CONSISTENCY THE JEWEL. As the St. Louis Medical Review advertises among others anasarcin and the Peacock line of nostrums, we suspect that the editor's judgment is all right when it comes to determining the number of cents in a dollar. California State Jour. of Medicine. I think the use of adrenalin chloride the best treatment for this condition.-O. D. HAMLIN, California State Jour. of Medicine. [Adrenalin is controlled and supplied exclusively by Parke, Davis & Co.] I have noted marked change in the character of the pulse after the administration of 30 minims of adrenalin chloride.-Ibid. I believe in such case the use of a'cohol or adrenalin previous to the operation is a very important preventive measure.-Ibid. In the treatment of this form of shock the best results have been obtained by the use of morphine, alcohol and adrenalin.—Ibid. For tubercle it is by far the easiest to use the dead, dry bacilli, such as may be obtained from Meister Lucius Brunning, Hochst, a. M.—BINE, California Sta e Journal of Medicine. When an injection is to be made, the cap is sterilized with pure lysol.-BINE, California State Journal of Medicine. [Note: Lysol is a proprietary remedy and furnished exclusively by Lehn & Fink, and is not on the approved list of the Council of P. & C.!] "You stigmatize the German General Benevolent Society as the worst enemy of the medical profession in California, because it takes money out of the physicians' pockets; and in the same breath you praise the University of California Hospital immeasurably; and yet this University of California Hospital does the same thing that you allege the German General Benevolent Society does.-Letter from Dr. H. V. Kreutzmann, Cal. State Jour. of Medicine. -Comment: Orthodoxy is my doxy, heterodoxy is your doxy. They that live in glass houses shouldn't throw stones. A WORD OF TRIBUTE TO DR. WAUGH Our "fifteenth-anniversary number" would not be complete without a tribute to the earnest labors of my friend and colaborer, Dr. William F. Waugh, who has been associated with me in the editorial work of this journal almost from the beginning. Hence the beautiful picture of this strong, able, lovable friend and champion of the whole "CLINIC family," which appears on the following page. THE ALKALOIDAL CLINIC came into existence in 1894. For three years, along with many other duties, I carried the editorial burden alone. In January, 1897, Dr. Waugh came to help me. Since then we have been earnest yoke-fellows, and the growth in size, circulation and influence of this dear child of our hearts and brains owes much, very much, to his brilliant exposition of the therapeutic ideals with which the minds of both of us have been seething through these eleven hard-working but joyous years of earnest effort. When Dr. Waugh came to THE ALKALOIDAL CLINIC he was already a man of more than national reputation. A graduate of Jefferson Medical College in 1871, he served for three years as a surgeon in the United States Navy before settling down to the practice of his profession in Philadelphia. He immediately became prominent in the professional work of that city, an honor accorded only to unusual ability in this center of great men in medicine. He was one of the founders of the Medico-Chirurgical College and for many years held the chair of Practice of Medicine in that institution. His brilliant editorial work on The Times and Register, Medical World, and other journals, had made him known all over this country. Probably no man in America was, or is, more familiar with practical therapeutic thought than Dr. Waugh. The very diversity and broadness of his knowledge led him to an interest in active-principle therapeutics. Once interested he became one of its most enthusiastic and able advocates. This, and his pioneer-advocacy of intestinal antisepsis, brought us together. Through all these years of intimate association we have been so close in heart and work, so often seen together, that some of our friends (or was it one of our common enemies?) dubbed us the "alkaloidal twins." The name has stuck-and we like it! While temperamentally we at times differ widely, our ideals and ambitions are practically the same. Both of us are striving to lift therapeutics to a higher standard. Both of us see in the use of the active principles the means of salvation from the nihilistic tendencies which during the last decade have penetrated to the very heart of the tree of medical knowledge. Of Dr. Waugh's work on CLINICAL MEDI CINE I need say nothing. It is an open book, known and read by all of you. You know and I know that it is a great worknot finished but just begun, not our work alone but yours even more. While we have worked jointly with the thousands of members of the family in the creation of an alkaloidal literature, much of it is the product of his pen and brain, as well as the record of our joint experiences. This literary work is at its acme, and we hope to have Dr. Waugh a leader in carrying it forward for many years to come. Dr. Waugh doesn't know that I am writing this editorial. When it comes out in our fifteenth-anniversary number," where it will be linked with that of the great Burggraeve, I want it to be a complete surprise and a loving witness to my appreciation of the years of joint labor, joint. struggle and joint victory in behalf of a cause which we both love, and in the house of our friends-CLINICAL MEDICINE. |