THE RAGWEED DOCTOR with their hand on the pulse of a patient and think about their overdue insurance or their past-due rent or drug bills, instead of counting the beat of the pulse or considering its rhythm, or estimating the blood pressure, or questioning the quality of the blood as it passes under their finger-tips. Four Types of Doctors There are four distinct types of physicians with whom the laity should be concerned. First, there is the progressive young man with one or two years' hospital experience following his graduation from medical college. The second type is represented by the young man without hospital experience, who must gain his knowledge and develop his technic at the expense of the community. Some of these men develop into our ablest practitioners. Others, who were too anxious to "get busy" to put the time of a hospital-year into their training, soon cease to grow in a professional way, and their future is that of the next, the third, class; that is, the middle-aged or older vegetating, hibernating kind, who know nothing of vaccines or serum therapy, who ignore the physical demands of their patients for something more than pills and powders, who can see no good in mental therapy save for that patient whom they in ignorance call a "hysteric"-those whose egotism is surpassed only by their jealousy and who only too frequently do things for a price. To the fourth class belongs the middle-aged or older man, whose training has been the best to be had at the time he was graduated and whose subsequent work has been supplemented by frequent visits to the medical centers and whose reading keeps him abreast of the times. Two letters that were received following the publication of a well-intended effort to arouse some of the "dead ones" in a certain community indicate the self-satisfied egoism of men of the third class and the true professional spirit of those of the fourth. The first letter says in part: "Please allow me to voice my disapproval of the publication of your recent letter about the affairs of this county. Such letters do not help the profession mentally and put us to scorn with the laymen." The other letter, how different it sounds: "I am not sorry that the article was published. I am sorry that it is true, for many doctors are all but criminal in their lack of interest in their work, which means life or death to the patient. As Dr. Anderson, of Newport, Kentucky, says: 'Your call to the service of the healing art is not the call of wealth, or fame, or distinction, or ease or 1095 comfort, or long life, or popular favor, or personal aggrandizement, or social distinction. It is the call to war, a lifelong enlistment on the side of humanity in its grim struggle with disease and death.' In his reference to higher ideals he says: 'It makes a mute appeal from the silent graves of the untimely dead that ask of us their rightful years cut off.' "Doctor, if we receive the blame, is it not because we deserve it? In my town there are six physicians, and, to think! three of them do not believe in the use of antitoxin, even when we know that its use has reduced the mortality from diphtheria, in New York City, from 264 in every 100,000 inhabitants thirty years ago, to 28 per 100,000 now. In Chicago it has reduced the mortality in fourteen years 73 percent. And, yet, doctor, these three men are just as much entitled to practise medicine as you or I. No one can interfere and say that they may not practise. No doctor reviews their work, and not even the hand of the Omnipotent God is stretched out to save the little children that come under their care. Every Decoration Day some mother goes to the cemetery with flowers, to lay on the graves of her untimely dead who cry out for those rightful years, cut off because of these doctors' neglect in taking advantage of positive medical advances." The layman is to be blamed as much as the physician if he gets less than he pays for when he calls upon a physician in time of need. The layman chooses his physician as he chooses his grocer-because his neighbor trades there. Many laymen allow themselves to be "worked" by the professional parasites that are to be found in every lodge in the country. Let someone of the doctor's family become ill, and then he will realize how much or how little he and his professional brethren are giving to the community. You will find that doctor questioning the ability of his friends and probably calling in his bitterest enemy; and it is because he realizes that his enemy has an ability that is necessary at that time. Lodge practice has been making rapid strides in every direction in this country, and, while it may appear in the future as an economic necessity, the profession alone is to blame for its present encroachment. The future possibilities in this direction depend directly on two things-better work of the individual and greater cooperation among the physicians themselves. To overcome the demands of lodge and club practice, a higher grade of work must be done than can be afforded by a club- or lodgedoctor. When equally as good work can be secured from the lodge-physician for $2.00 a year as can be secured from the average practitioner who might charge $2.00 a visit, it is obvious that the former method will be taken advantage of by the laity. Too many physicians consider quantity of business and an early success to be the greatest thing to be desired. And, yet, this is too often the cause of their ultimate failure. Like the present epidemic of divorce among our trust magnates and newly rich, the old wife isn't good enough for the full pocketbook, but when the divorce has been secured, the man finds out too late that the new one is too much for his empty pocketbook. The layman should choose his physician as one who comes into his family as a counselor, as a friend, as one who can stand in the pathway of death. He should be chosen from among those of his own class; for the professional man, when he is a true physician, reaches a time when families who have been loyal to him, whom he has served in matters of life as well as death, are not only patients but more than friends, and he feels toward them that they are part of his own. Their loyalty expresses something of greater value than any fees that may have been paid to him. There comes a time, as the years go by, when the older physician has watched the infant daughter grow into womanhood and become a mother, that this second generation seems to him in many respects like grandchildren of his own. This is the Ideal, this is the Summum Bonum that the profession can give. This to him will be more than farms or rental property, stocks or bonds; for, after all, the more that he had of earthly possessions, the more does he worry for fear of their loss. Not but what the profession should give us something more than a livelihood, but it should give us more than a living it should give us happiAnd we, the doctors, should put into our profession measure for measure of what we take out. ness. C Guatemala-A Land of Promise By CARLOS F. SECORD, M. D., Chichicastenango, Guatemala ENTRAL America is now much before the people of the world, and there is great and growing interest shown toward that land by the American people. Many, however, think of the little Latin republics to the south of the United States as jungles where revolutions and yellow-fever incubate, and where nothing good can be found. In olden times it was asked, "Can any good thing come out of Nazareth?" and practically the same thought nowadays is prevalent concerning Central America. Twelve years ago the writer located in Guatemala, the largest of the Central American republics, and established a modern medical mission among the Quiche Indians, descendants of the ancient Toltecs; and he has been an interested student of the conditions of this country. As all things material obey the law of evolution, so Central America is today passing through a period of radical change, and nothing but good for the entire world can come from it. Favored with many distinct climatesfrom the hot, low-lying coast region, to the cold, dry heights of great mountains where the million Indians live and die in their ancient customs and as yet barely touched by civiliza tion, holding tenaciously to the traditions of their fathers-great and startling extremes are met: squallid poverty, ignorance and superstition are seen on the one hand, and modern cities, arisen as if by magic, exemplifying the height of civilization on the other. Starting with the banana plantations along the coast, a succession of products is met with, including sugar, cacao, coffee, and others, and then, as the altitude increases, corn, wheat, oats, and such like are encountered in great abundance. Old Mother Nature could not be kinder to her children than she has been to the bronzed races of the Southlands. Living being so easy, the people heretofore occupied themselves with conducting revolutions, which served as a safety-valve to their surplus energies, and incidentally to satisfy their ambitions; the better feeling, today, however, is against lawlessness, and there is a general desire for peace. All the Central American countries have struggled and suffered for centuries, before and after their liberation, and some of them still are in difficulties. Mexico enjoyed many years of peace and prosperity, her lands were cultivated, mines were opened up and count less industries established, until with advancing age the strong hand of Diaz weakened and restraint was removed from the lawless. Now under the reign of brigandage lives and property are being destroyed, and the whole thing has become a serious problem for the United States to solve. But, while unrest and revolution have been so prevalent in some places, Guatemala has rapidly forged ahead and today occupies an enviable position among the states of the isthmus. This is due largely to the superiority of the man at the head of affairs, a strong man possessed of a happy combination of energy with prudent executive ability and a special love for the people and government of the United States something so often lacking in the other rulers of the LatinAmerican lands. Under the present régime, the arts and sciences, including medicine, have been favored in a remarkable way, and the readers of this journal may remember the remarkable way in which the yellow-fever and later the smallpox epidemics were combated so successfully. Schools and hospitals have been multiplied, and special inducements offered for scientific research, especially as relating to tropical diseases and botanical investigations, and numbers of useful discoveries already have been made. President Cabrera personally is an ardent student of current scientific problems, and for this reason he is a sincere friend and protector of the medical profession and continually seeks its well-being and advancement. Recently a beautiful building was erected and dedicated as a maternity hospital, in honor of President Cabrera's mother, and the very latest methods are in use there, hundreds of poor women finding in him a true protector and their children recognizing in the greathearted man a benefactor and foster-father. The only love of his life has been that bestowed upon his mother, and now that she is dead he honors her memory by doing good. In November another handsome building will be formally opened, which is to be devoted to modern surgery and will be supplied with all modern approved apparatus and fitted with a perfect laboratory. In these two buildings American trained nurses The Iced Summer Drinks Their Effects and Defects By CHARLES F. LYNCH, D. V. S., Chicago, Illinois EDITORIAL NOTE.—This is the second paper in Dr. Lynch's series on "Food Adulteration and Sophistication," which began in the October number of CLINICAL MEDICINE. In a succeeding issue Dr. Lynch will discuss the adulterations of coffee, tea and spices; in another number, meat inspection; other topics being taken up from month to month. We urge our readers to peruse these papers carefully. They answer questions which every doctor is expected to be able to solve. E ACH successive summer the sale and consumption of carbonated beverages by the American public shows vast increases, from the baseball-fan who sits in the bleachers and sips his bottle of "root beer" or "cola" to the toddling youngster who takes his pennies to the corner grocery, there to exchange them for a bottle of beautiful sparkling "pop" just "off the ice." This form of beverage finds favor. As the hot, sweltering days of summer with their thirst and discomfort approach, the soda-man prepares to dispense his cold invigorating beverages, to assuage the thirst and dispel the malaise of his suffering patrons. This intention on his part is highly com THE ICED SUMMER DRINKS mendable when the beverage he serves is a pure, wholesome, unadulterated one. On the other hand, when an impure, unsanitary, artificially colored, dope-laden product is passed out to the unsuspecting customer, who is only too often an innocent child with highly sensitive digestive organs, the practice cannot be too severely condemned. Varieties, trademarks, and brands of the soft-drink products are legion. Many of the names used are flagrant misnomers of the product, the composition of which they pretend to portray. Even the common name "ginger ale" is in point of fact a misnomer, as the product is not an "ale" in the correct sense of the word, for by the term "ale" is understood a product which is formed by a process of alcoholic fermentation. Lead Not Infrequently a Contamination In considering the etiology of the epidemics of gastrointestinal disturbances which affect the children of our larger cities every summer, the role of the carbonated beverages in their production often is overlooked. While in the small child and bottle-fed infant milk of impure quality or of improperly balanced chemical composition is an all-absorbing factor, in the older child the carbonated drinks are an important source of danger and one demanding the attention of the intelligent up-to-date practitioner who desires to safeguard the health of his youthful charges. During the summer of 1910, while engaged in the service of the Chicago health department, I had occasion to observe an epidemic of severe gastroenteritis among the children of a district in the northwest part of the city, which was traced to contaminated carbonated beverages. Samples of the product from the factory in question were taken by Dr. Heide and myself and upon chemical analysis showed the presence of considerable quantities of lead salts, sufficient to produce symptoms of plumbism in a physician who drank a considerable quantity of the product. The effects of such a beverage on the delicate structure of the infantile gastrointestinal tract may easily be imagined. The etiology of this epidemic for several weeks was unintelligible to a score of practitioners in the involved area. None of them had thought to consider the popular summer drink as the cause of the severe gastrointestinal symptoms manifested by their patients. Prompt action by the city and state authorities in forcing a correction of conditions at the bottling plant resulted in an immediate subsidence of the outbreak. 1099 In considering carbonated drinks, one of the first points to be investigated is the sanitary conditions under which the product is prepared. Many of the socalled pop factories, especially in our smaller cities and the congested areas of the large cities, are located in most unsatisfactory places: basements, barns, coalsheds are often the home of such bottling plants. A clean, wholesome product is impossible amid such surroundings. Unclean bottles is another source of danger. No bottle should be used as a container for a beverage intended for human consumption (and more particularly so if intended for young children), which has not been thoroughly washed and sterilized. In many of our factories but little attempt is made at thoroughly cleaning the empty bottles and sterilization is rare except in those plants under strict supervision by health officials. Needless to state, the water used as a basis for the product must be pure and free from organic or bacterial contamination if the finished product is to be wholesome. Bacteria of typhoid fever, dysentery, tuberculosis, and other communicable diseases may readily be conveyed in pop-bottles. In many establishments rubber-faced lead stoppers are employed. This was the case in the plant responsible for the Chicago epidemic of gastroenteritis above referred to. The action of the carbon-dioxide gas with which all these carbonated products are charged and to which they owe their characteristic palatability acts most enthusiastically on these lead stoppers and the result is a heavy deposit of highly poisonous lead oxides in the liquid, with no change in the physical appearance of the beverage to warn the consumer of its injurious character. Carbonated beverages have another source of contamination with these deadly lead salts in the pipes through which the charged water is drawn to the bottling machine. If these pipes are lead or lead-coated, the oxidizing power of the carbonated water is sufficient to carry highly appreciable amounts of the lead salt into the product. Objectionable Artificial Sweetening and Coloring All carbonated drinks are made so as to have a pleasant sweetish taste, this appealing to the palate of our young American folk, who notoriously are fond of sweets. When this saccharine property is due to the presence of pure sugar, it also imparts a certain amount of food-value to the product. But, as is frequently the case, when the coaltar derivative saccharin is used as a substitute for sugar, |