Vol. X.

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"THEIR MASTER'S VOICE." THEN an institution of mercy and healing has been founded by the munificence of one man, its activities organized and directed by other men, masters in their profession, so that it stood like a city set upon a hill, a center of light and leading, a shining example among similar institutions, there is nothing sadder, nothing more painful to the thoughtful mind than to witness its vulgarisation and degradation at the hands of wellmeaning but ignorant and narrow men. It is pitiful to see high ideals trampled in the mire. It is pitiful to see the dollar mark break out on the walls and corridors of the House Beautiful and taint it with the modern leprosy so that we would fain cry "Unclean, unclean." It is pitiful to see a hospital staff so at the mercy of a lay board that its members retain their positions at the price of their self-respect. Lay boards of managers have in the past done some strange things, but it has been reserved for the Board of Managers of a once great hospital in Greater New York to distinguish itself and gain a real and deserved but bad eminence. Indeed it ought to change its name and call itself not the Board of Managers, but a Board of Trade. It has promulgated the following extraordinary rule for the staff of the hospital: The visiting surgeons are classified, ranked and assigned to duty not according to fitness or length of service in the hospital, but according to the number of "paying patients" they have sent to the hospital during the fiscal

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The man who sends the most private patients has first choice of the service, and so

on down the line until the man is reached who has sent in the fewest paying patients. He takes the leavings. In the eyes of the Board of Managers he is the yellow dog and a tin can is promptly tied to his tail "pour encourager les autres." It is difficult to see how any body of self-respecting gentlemen could allow itself to be persuaded to inflict so insulting and Its degrading a system on a visiting staff. members must have held the almighty dollar so close to their eyes they could see nothing else save its yellow glare. It is a matter of astonishment to the medical profession that the members of a self-respecting visiting staff could tamely submit to such ignominy. They have evidently heard "their master's voice" and the crack of the superintendent's whip. As a result of this base policy the hospital has already lost two of its best surgeons, men who have been associated with its honorable and brilliant past for over twenty years, and who refuse to accompany it on its downward path. The mem

bers of the staff who feel constrained to continue their relations with the hospital deserve the sympathy of the profession, the men who have resigned, that and something more.

A policy so cynical and vicious will not in the end redound to the advantage of the hospital. Harmony and mutual confidence are essential to the success of any enterprise, but when an institution deliberately pits its men one against the other, it sows the seeds of

suspicion, jealousy and dissension to reap in the future the fruits of a bitter harvest. Such an institution is false to its founder, false to benefactors, false to its patients, false to the public, and does not deserve the confidence of the community. The standing of a surgeon should be regulated by his professional fitness as determined by knowledge, experience, skill, devotion to the interests of the patients and ultimately the results which his treatment produces. This hospital has adopted the methods of the auction room. What it wants is not men of high attainments and scholarship, but rather men who can produce what is commonly known as "dough." It does not need a laboratory or scientific equipment, but an auctioneer's block and hammer, an advertising agent and a bale of green trading stamps. A. T. B.

THE LAW AND THE PRACTICE OF MEDICINE.

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N the New York State Journal of Medicine for February, 1908, will be found an editorial on "The Practice of Medicine by a Corporation Prohibited." In this article it was stated that the Court of Special Sessions of New York in the case of the people against a certain corporation called the John H. Woodbury Dermatological Institute had decided that Section 15, Chapter 344, Laws of 1907, prohibited any but a registered physician from practicing medicine and that the corporation was violating the law. This was appealed from, but the Court of Appeals of the State decided against the corporation, thus sustaining the lower court. This decision was the first of its kind in any State and has been used as a precedent by Mr. Vandiver, counsel of the Medical Society of the County of New York during the past year in the prosecution of several other corporations.

The Dr. Weeks Medical Office was twice convicted of advertising to practice medicine and fined $250. This institution was on 14th Street, and purported to be an anatomical museum with a physician in attendance, who advised individuals in regard to venereal diseases. As a result of the successful prosecution, the name of the Dr. Weeks Medical Office disappeared from the premises and the advertisements of the concern and the busi

JOURNAL OF MEDICINE

ness apparently was taken over by a registered physician.

The Dr. Bromley Co. advertised the sale of a treatment for the reduction of obesity, and included in their advertisements a diagnosis blank. The court found the corporation guilty and imposed a fine of $100.

The Policlinico Medico was conducted by a registered physician and by one Bernardo Mammone. Suit was brought against the latter and conviction secured and a fine of $100 imposed. After the conviction the premises occupied by the concern were deserted and the business theretofore done by these individuals under the name of Policlinico Medico discontinued.

The Universal Medical Institute conducted by Albert S. Del Gaudio was convicted and fined $100. The advertisements now appear under the name of a registered physician.

Another section of the law which is also new in Medical Practice Acts and is not in the laws of any other State will be found in Section II, Paragraphs a, b, c, d, e, as follows:

SEC. 11. Registry; revocation of license; annulment of registry.

Every license to practice medicine shall, before the licensee begins practice thereunder, be registered in a book kept in the clerk's office of the county where such practice is to be carried on, with name, residence, place and date of birth, and source, number and date of his license to practice. Before registering, each licensee shall file, to be kept in a bound volume in the county clerk's office, an affidavit of the above facts, and also that he is the person named in such license, and had, before receiving the same, complied with all requirements as to attendance, terms and amount of study and examinations required by law and the rules of the university as preliminary to the conferment thereof; that no money was paid for such license, except the regular fees paid by all applicants therefor; that no fraud, misrepresentation or mistake in any material regard was employed by any one or occurred in order that such license should be conferred. Every license, or if lost a copy thereof legally certified so as to be admissible as evidence, or a duly attested transcript of the record of its conferment, shall, before registering be exhibited to the county clerk, who only in case it was issued or indorsed as a license under seal by the Regents, shall indorse or stamp on it the date and his name, preceded by the words: "Registered as authority to practise medicine, in the clerk's office of county." The clerk shall thereupon give to every physician so registered a transcript of the entries in the register with a certificate, under seal, that he has filed the prescribed affidavit. The licensee shall pay to the county clerk a total fee of $1 for registration, affidavit and certificate. The Regents shall have power at any and all times to inquire into the identity of any person claiming to be a licensed or registered physician, and after due service of notice in writing, require him to make reasonable proof, satisfactory to them, that he is the person licensed, by virtue of which he claims the When the Regents find that a privilege of this act. person claiming to be a physician, licensed under this act, is not in fact the person to whom the license was

issued, they shall reduce their findings to writing and file them in the office of the clerk of the county in which said persons resides or practises medicine. Said certificate shall be prima facie evidence that the person mentioned therein is falsely impersonating a practitioner or a former practitioner of a like or different name. The Regents may revoke the license of a practitioner of medicine, or annul his registration, or do both, in any of the following cases:

a. A practitioner of medicine who is guilty of any fraud or deceit in his practice, or who is guilty of a crime or misdemeanor, or who is guilty of any fraud or deceit by which he was admitted to practice; or b. Is an habitual drunkard or habitually addicted to the use of morphine, opium, cocaine, or other drugs having a similar effect; or

C. Who undertakes or engages in any manner or by any ways or means whatsoever, to procure or perform any criminal abortion as the same is defined by Section 294 of the Penal Code; or

d. Who offers or undertakes by any number or means to violate any of the provisions of Section 318

of the Penal Code.

e. Proceedings for revocation of a license or the annulment of registration shall be begun by filing a written charge or charges against the accused. These charges may be preferred by any person or corporation, or the Regents may, on their own motion, direct the executive officer of the Board of Regents to prefer said charges. Said charges shall be filed with the executive officer of the Board of Regents, and a copy thereof filed with the secretary of the Board of Medical Examiners. The Board of Medical Examiners, when charges are preferred, shall designate three of their number as a committee to hear and determine said charges. A time and place for the hearing of said charges shall be fixed by said committee as soon as convenient, and a copy of the charges, together with a notice of the time and place when they will be heard and determined, shall be served upon the accused or his counsel at least ten days before the date actually fixed for said hearing. Where personal service or service upon counsel cannot be effected, and such fact is certified on oath by any person duly authorized to make legal service, the Regents shall cause to be published for at least seven times, for at least twenty days prior to the hearing, in two daily papers in the county in which the physician was last known to practice, a notice to the effect that at a definite time and place a hearing will be had for the purpose of hearing charges against the physician upon an application to revoke his license. At said hearing the accused shall have the right to crossexamine the witnesses against him and to produce witnesses in his defense, and to appear personally or by counsel. The said committee shall make a written re

port of its findings and recommendations, to be signed

by all its members, and the same shall be forthwith transmitted to the executive officer of the Board of Regents. If the said committee shall unanimously find that said charges, or any of them, are sustained, and shall unanimously recommend that the license of the accused be revoked or his registration be annulled, the Regents may thereupon, in their discretion, revoke said license or annul said registration, or do both. If the Regents shall annul such registration they shall forthwith transmit to the clerk of the county or counties in which said accused is registered as a physician, a certificate under their seal certifying that such registration has been annulled, and said clerk shall, upon receipt of Isaid certificate, file the same and forthwith mark said registration "Annulled." Any person who shall practice medicine after his registration has been marked "Annulled" shall be deemed to have practised medicine without registration. Where the license of any person has been revoked, or his registration has been annulled as herein provided, the Regents may, after the expiration of one year, entertain an application for a new license, in like manner as original applications for

licenses are entertained; and upon such new application they may, in their discretion, exempt the applicant from the necessity of undergoing any examination.

Acting under the provisions of this section, application was made to the State Board of Examiners, also by Mr. Vandiver acting for the County Society, for the revocation of the licenses issued to E. E. Conrad, F. G. Blinn, and Robert Ormsby, each of whom had theretofore been convicted of crimes in the County of New York. The State Board of Medical Examiners designated Dr. William Warren Potter, Dr. Lee H. Smith, of Buffalo, and Dr. Floyd Crandall, of New York, as a committee of three to hear and determine the application. The charges were presented on December 18, 1908. The committee took the charges under advisement, and after briefs had been submitted by the counsel for the Society and by the defendants, the committee recommended to the Board of Regents that the licenses of Doctors Conrad, Blinn and Ormsby be revoked. This recommendation was adopted and the licenses were revoked. Notice to this effect was served upon each of the individuals and filed with the Clerk of the County of New York and the clerks of the other counties of the State. Conrad and Blinn had been convicted of attempting to perform criminal abortions. Ormsby had been convicted of selling abortion drugs. These proceedings are the first of the kind ever brought in New York and will serve as a precedent hereafter in similar cases. W. R. T.

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THE 1910 MEETING.

HE coming meeting of the Medical Society of the State of New York occurs at Albany, January 25th and 26th. Perhaps the most important question which will come before the House of Delegates is that which relates to the change in the time of the Annual Meeting. In another column will be found a communication from Mr. Lewis, the Counsel of the Society referring to this and other subjects.

The scientific program contains three valuable symposia, one on Bone and Joint Changes, one on the recent and important subject of Vaccines and a symposium on Appendicitis which has been. arranged by the New York Surgical Society. Dr. C. H. Lavinder, of the Marine Hospital Service, will read a paper on Pellagra, illustrated by lantern slides which cannot fail to be instructive. As isolated cases of this disease are constantly appearing in different parts of the country, it is of importance that we should recognize it.

It is hoped that the meeting will be largely attended, both on account of the importance of the questions coming before the House of Delegates and because of the important subjects covered by the scientific program. A. T. B.

January, 1910

chronic alcoholics which crowd the hospitals. crowd the hospitals. This is not a medical problem, but sociological, and must be treated as such.

The causes of periodic drinking are different from those of the ordinary alcoholic. In a recent paper by Dr. Pearce Bailey, it is well pointed out how varied these causes are. Often it is a hidden unstable mental state, which may be an expression of a genuine psychosis, or it may be a recurrent explosion which in a few cases seems to resemble epilepsy, or it may be a recurrent sexual factor, in which the desire for alcohol is simply an expression of one factor in the general explosion. A very common form of periodic drinker is the man who persists in the delusion that he can drink moderately, and after a spree, he ceases to drink for some time; then begins gradually to nibble at it; this nibbling gradually increases until he goes on the regular protracted spree; but that form of the periodic drinker comes more into the question of the personal causes within a man, than those of his environment. In dealing with most alcoholics and in the majority of those given to any form of narcotics, we are dealing with the mentally crippled and mentally defective, and hopelessly deficient mass of humanity. After the alcohol or morphine has been removed, the residum is often worthless, and too weak to cope successfully with the problems of existence.

In a small minority, however, we find strong individuals who through mistaken ideas of stimulation, or through the endeavor to tide over some crisis, have been led unwittingly under the spell of the narcotic craving, which demands ever increasing doses of a given narcotic, and from which they cannot physically break away; the majority of narcotic addictees, however, are those with weak and crippled nervous systems, either inherited or acquired through an unhealthy infancy and environment. The treatment for narcotic craving is vastly more, in a broad sense, than mere medical treatment, or more than drugs can possibly overcome in any individual case.

From a purely medical standpoint, the treatment of alcoholism can be fairly divided into the treatment of the acute attack, and the endeavor to bring the patients into such a condition that they can with a clear brain consider what their future must be. The mere cessation of drinking or the tapering off of the addictee from acute or chronic alcoholism, is not sufficient to remove the desire for the narcotic which the enormous previous consumption has brought about. Many patients remain for weeks and months in some institution mentally watching the calendar and the clock for the time when they can get out and take a drink. This means sooner or later the return to their former habits, and a failure of that plan of treatment. The deprivation from a narcotic, does not mean an obliteration of the craving for it. This is true of any narcotic, whether of alcohol, opium, cocaine or tobacco.

The treatment of the acute exacerbation of alcoholism, or of delirium tremens, is too familiar to need description here. It is the step beyond this; the endeavor to straighten out an alcoholic and keep him straight, that I desire to bring to your attention.

After many years of endeavor to find something that would get a man on his feet with a clear brain, and with the craving for narcotics removed, I have finally come upon a mixture of drugs which produce the desired effect. As I have already published, this treatment was given to me by Mr. Charles B. Towns of this city, and consists of a mixture of 15% tincture of belledonna, 2 parts, and I part each of the fluid extract of xanthoxylum and the fluid extract of hyoscyamus. This is termed the specific. I have already fully described this treatment in an article published in the Journal of the American Medical Association of September 25th, under the title "The Obliteration of the Craving for Narcotics." Briefly, it is as follows:

From 6 to 8 drops of the specific are given every hour, day and night, until either the patient shows symptoms of belladonna excess, or with the cathartics about to be described, the patient has a certain characteristic stool. This specific is increased by two drops every six hours, until 14 to 16 drops are being taken; it is not increased above 16 drops. Usually an alcoholic can be given 4 C. C. pills at the same time that the specific is begun. After the specific has been given for 14 hours, a further dose of C. C. pills is given, either 2 or 4, depending upon the amount of action obtained through the use of the previous dose. If these have acted very abundantly, only two are now necessary. At the 20th hour of the specific, 2-4 more C. C. pills are given, and after these have acted, should the patient begin to show abundant green movements, an ounce of castor oil should be given, and a few hours later the characteristic thick green mucous putty like stool will appear. Usually the specific has to be continued, and at the 32nd hour 2-4 C. C. pills are again given, and a few hours later, the castor oil. The specific can then be discontinued.

Of course, in treating alcoholics, one finds in the majority of cases the necessity to stimulate them and to give them some hypnotic, but this can be done without interfering with the hourly administration of the specific. During the first 24 hours, with the older patients, or with one in the midst of his spree, there should be given whiskey in one drachm to two drachms doses, 4 or 5 times with milk. This should not be continued after the first 24 hours, and in young robust subjects, it is usually not necessary. The belladonna symptoms which would cause one to cut off the specific and wait until they have. subsided before beginning again are, extreme dryness of the throat or the beginning of delirium as shown by an insistence or incisiveness of