A Life Subscription is offered to the Reader suggesting a Feasible Prescription in this Tuberculous Case. THE NEED OF "EFFICIENCY Dr. Graham Lusk is responsible for the following story, and also for the moral. An American officer visiting St. Petersburg had his curiosity excited by the sight of a sentinel who was pacing to and fro in the middle of the palace courtyard. No one could tell him the reason but somebody investigated and discovered that sixty years before a little princess had found a flower growing in the middle of the yard and had expressed a desire that it be protected. Hence the sentinel. The order had remained in force and altho the flower had long since disappeared the sentinel still paced. So in the Guard never surrender. Few of the “visiting" die and none resign. This goes on forever, regardless of progress and the claims of people worth while. The new President of the Uni versity of Vermont, Dr. Guy Potter Benton, has introduced an efficiency test to ascertain the actual value of each member of the faculty to the institution, what work he is doing and what literature he is producing. A Committee on Efficiency is charged with the duty of ascertaining these things, and, we presume, with some power to make the useless member hump himself or get out. This scheme appeals to us wonderfully in connection with thoughts of our hospital staffs. We fear that if it were to be applied a great deal of dead wood would be gotten rid of. Why not apply it? A NEW PHASE OF CREMATION Speaking of Efficiency Committees, why not a Journalistic Clearing House and Crematory Committee which shall pass on the claims of medical journals to live? Crematories of large capacity would be needed, which implies an expense well nigh prohibitive. Perhaps we must continue to rely on the perspicacity and good judgment of the profession. THE FAMILY AND THE STATE According to the lay press, Dr. W. T. Belfield, of Chicago, has been advocating the limitation of families before mixed audiences, following, in his reasoning, the lines laid down by Dr. William J. Robinson, of New York. This is encouraging, indeed. There is one point that the doctor makes, however, that we think a bit unsound. Pointing out that the State takes unto itself the power to limit the number of wives that a man may have and to penalize him if he exceeds the limit of one, Belfield argues for the assumption by the State of the power to limit the size of families, penalizing, for example, the man earning three dollars a day who permits his wife to become the mother of more than three children. We approve of the idea but object to the strict methods suggested, as our belief is that not by force, but by education and the development of a deeper enlightenment must we attain decent. and better conditions. NOTABLE FIGURES IN PRESENTDAY MEDICINE The biographies of our so-called distinguished men are published over and over again, and most of us have become tired of reading them. Before the MEDICAL REVIEW OF REVIEWS appeared in its present form and while the features and policies which now distinguish it were being framed, a Department was suggested to be called Notable Figures in Present-Day Medicine. The idea was to publish biographical sketches of the men whom we ordinarily dub, eminent, with accompanying portraits. The permission of these men was to be secured, as well as their assistance. The Editor was opposed to this policy, on the ground that too many of our so-called distinguished men are nothing but accomplished advertisers, more eminent in the arts of self-exploitation than in those of medicine. He believes that there is a class of men in the profession who possess a veritable genius for exploiting themselves. They may be exceptionally able men, and then again they may not. Usually they are not. Then there is another, very large, class of men who, while presenting every degree of ability, are more or less devoid of the fac ulty of self-exploitation. In some in stances there is a total lack of the faculty, conjoined with extraordinary ability. It is the Editor's idea that the able men in the profession who are less well known than many less capable and less lovable types possessed of the aforesaid genius for self-exploitation ought to be made the subjects of biographical notices and that without their consent or assistance. These men, if approached, would refuse to be written up, as they would phrase it, or at any rate would be diffident about the matter. The profession is in terested in discovering its best men and cares nothing about their diffidence. Therefore we make no apology for the proposal to discuss these men without their consent. Our treatment of them we consider perfectly ethical, for the reason just stated, and also because no question of collusion can enter into the matter. They at least will be above suspicion. However, before we actually begin such a series of studies, we should like to have some expression of opinion in respect to our ideas. We suppose that the method to be pursued, in case we elect to take this matter up, will be to induce friends of those whom we wish to "write up" to undertake to furnish requisite data. In closing, we should like to say a word in respect to this matter of selfexploitation. It is not an evil thing in itself. If a man is worth while let him forge to the front as fast as possible thru his own efforts. We admire the thing in many. It is frequently justified. But it is an ugly and offensive thing too often. No harm will be done, we believe, if some of our unduly modest men are dragged into the limelight now and then, whether they enjoy the process. or not. We are all sick of the fakers. Let us make the acquaintance of some of the unpretentious aristocracy of the profession. We warn our readers that we will select types for study. wheresoever found, whether in the metropolis or the backwoods. Devoted to matters bearing on the economic bases of disease, preventive medicine in By BEVERLEY ROBINSON, M.D., New York. From the point of view of what is sane and true, it is a satisfaction to note that some physicians are now stating in emphatic terms what may and should be rationally expected from sanatorium treatment of the victims of tuberculosis, particularly when it attacks the lungs. by a few who are writing and speaking their minds that much of all the foregoing is sure and lamentable fallacy. Pulmonary tuberculosis at its primary stage, for which everything possible is being asked, on account of its alleged contagiousness, or on account of its alleged curability by simple and certain sanatoria methods, is now stated, as indeed has been a long time well known, to be not contagious, or so very slightly so that this phase of it can be, practically, almost ignored; and it is also fully recognized that quite as good curative results, indeed, perhaps, better, can be obtained in any healthful locality, with proper food and sanitation, as the sanatoria have been able to show. For several years past physicians have taught the public by written and spoken thought and word that the wide establishment of sanatoria was doing great and good work in diminishing disease, promoting cure and educating people to a better grasp of truly humane doing. To this end appeals without number have been made of all kinds and in different directions. Good men and women everywhere, high and low, rich and poor, private individuals and officials of all sorts and ranks, have agitated the question and sought funds and given counsel as to what to do, or what is best to be done. As a result it was boldly affirmed by many, and I regret to add, by some, who should I might almost write must-know better, that ultimately the great white plague would be abolished and humanity rid forever of one very great and imminent source of trouble and terror constantly around them. Now it is shown and insisted upon filled with the clinkers of bodily wear As to treatment of a medicinal kind, this is now known to be very simple, altho very effective. And so simple and effective is it that it is sadly ignored, or neglected, when and where it should be most insisted upon. As to the doing nothing, corporeally speaking, in many sanatoria, so long foolishly permitted but now in a measure corrected, that was bad treatment for both body and mind. With much increased, over-feeding, the emunctories of the economy could not work properly and soon became clogged and and tear, like to an over-charged furnace which is never raked, or cleaned sufficiently. As to mind and heart and courage, how can any of these be cultivated and strengthened by the constant lazy introspection and interchange of morbid, disordered thoughts which become a large part of daily, hourly, associations? As to the wretched effects of wrong teaching and doing upon our humanity, they are deplorable in the extreme. Formerly consumptives would have been lovingly, carefully, and indeed well taken care of, as far as possible in their own homes — homes of the well to do, or even of the relatively poor. It may be stated here that the very poor can not possibly take care of these unfortunates, and if they make the effort they are inevitably doomed to fail, besides bringing further and dire poverty to the nursing ones by reason of the dread disease's constant presence among the very poor. It is sad, but true, alas! and at present unavoidable, that the vast majority of the afflicted ones must remain among the poor in environments disgraceful to our socalled civilization. Until society awakens really in a far larger and more useful way than it has done to the necessity of getting rid of the causes of pulmonary tuberculosis -bad housing, poor and insufficient food and overwork-nothing radical and in the long run really worth while will be accomplished. The veneer of so-called charity is to be seen plainly enough, but where shall be found great and enduring results? I fail to see. What I do see and recognize is a large development among what are considered good, pious people of a selfish and harmful tendency to be self-protective. Theoretically, and from the viewpoint of moderate giving pecuniarily, they are perfectly willing to be righteous and useful. When, however, we ask for true humanity, i.e., the sacrifice, or exposure, of self, slight tho it really is, or would be, they hold back, or stand aloof. Not for them, but for a few others, perhaps, to step in the breach and do full duty. How happens it that we see this sad state of mind so often? Because of what does it exist? To my mind, it is in great part to be explained by the medical profession. They have taught falsely, tho not designedly, I firmly believe. The leaders of our profession have ever before them great duties and responsibilities, and if their instruction is defective, immense harm is sure to follow, and more to-day than ever before, owing to widespread information disseminated by the daily press. Once the public is imperfectly and erroneously guided and directed, it becomes a wearisome and sometimes nearly impossible task to steer it into right paths again. We see it everywhere; in politics, religion, socially, even in so-called science. I mean science which lasts but a short while and is soon revised or corrected. I do not mean that science which is the growth of years, decades, of laborious work and observation. In this there are fewer mistakes, faults, misgivings. This is frequently called empiricism. Properly boiled down, as it often is, and human error, as far as possible, eliminated, it becomes the truest, highest wisdom, and should be our mainstay and beacon of light. To sum up: Pulmonary tuberculosis will be as well treated in the aggregate, and far more humanely, by older, well-known methods, as in modern |