tioned. I know old women that have practiced obstetrics in the hills for 50 years with as low mortality as in any maternity hospital. I have attended 184 obstetric cases since I began practice and have only lost one woman, and this was an illegitimate birth by a girl 13 years old. She had convulsions before and after birth. The case was attended after I had graduated and I had another graduate physician in attendance with me in the case. The great trouble in medical colleges at present is that so many things are taught that are not essential for a successful practice. Take, for instance, anatomy. Only a very limited knowledge is needed for success in practice. The teacher of obstetrics considers anatomy of the female generative organs absolutely essential, and expects the medical student to master it in detail, while the old midwife, who does not even know what anatomy is, is as successful in the practice of obstetrics as the doctor with all his knowledge of anatomy. The average physician who has been in practice 10 to 15 years does not know any anatomy, and with his experience and forgotten anatomy is far more successful than the new recent graduate who knows Gray's "Anatomy" by heart backward. In materia medica as taught to-day the student may learn what a drug will do on a guinea pig or some animal, but don't learn what it will do in a case of a sick man. A physician does not need two years in a university after a high school course in order to begin the study of medicine. I left the public schools before I completed the common school branches, and I will treat the common diseases of this locality against any professor in Johns Hopkins and Harvard. In order to be successful in the practice of medicine one must use common sense. Overeducated physicians overdiagnose, overtreat, etc. The mortality in the "flu" epidemic would have been smaller if calomel purges and sledgehammer coal tar preparations had not been used. Physicians used to graduate in two fourmonth terms, and such graduates were as successful as the present day graduates. In former years colleges turned out physicians; now they turn out surgeons. Surgery is the traffic of the day. Almost every young doctor has a desire to locate in a city and become a famous surgeon. I believe in medical, surgical, mental, and physical methods of treatment. In many instances two or more of these methods should be used. The average present-day graduate only sees surgical treatment thru his surgical eyes and surgically trained mind. We physicians know all about surgical graft, and there is no use to discuss that here. We also know that the general public knows a little about surgical graft. A few years ago Nicholas Senn gave a lecture before the American Medical Association on the abuse of surgery. The unreasonably high requirements of medical colleges and state boards are doing away with the practice of medicine. It is making surgeons and drugless healers of various descriptions. The only treatment that the sparsely settled mountain people can be able to get is the drugless forms of treatment. Doctors Discriminated Against in Oklahoma. EDITOR MEDICAL WORLD:-It goes without saying that the majority of physicians are poor business men. No doubt, this is true; but, why? Because they are engaged in a business that calls them away at any time, anywhere and to anybody. Their time is entirely taken up relieving the "distressed either in body or mind," many times to the detriment of their own welfare, and occasionally they "wake up" to find out that they have been legislated against by lawyers well paid by druggists, and the physician finds out that he is not "in it" at all. Our governor has notified hundreds of doctors in this state lately that he will not approve of physicians' apothecary bonds for the lawful handling of alcohol unless they are registered pharmacists and engaged in that busi ness. Listen! Pretty soon, when doctors have given their patient a "round" of calomel, they will, no doubt, be required by law to ask their druggist if it would be a good plan to follow it up with oil!! Under the state law druggists have no right to sell one ounce of alcohol to dispensing physicians unless they are registered pharmacists and actively engaged in the drug business. All other physicians are refused bond. Now I suppose Oklahoma physicians can do without alcohol when dispensing their drugs; but it should not be a question what they can do; they should at least enjoy the same privilege as the ordinary druggist. I believe that physicians as a class are as trustworthy and honorable as the pharmacists of this state, and will go just as far to enforce the prohibition laws. Let me urge physicians everywhere to stand together and become mutually interested in each other to the extent that we will not hesitate to condemn anything and everybody who would tie us hand and foot while we meekly submit. If physicians fail to look after their own interests, they may look for more strenuous legislation against doctors later on. some some an intricate surgical operation in medical journal, and without practical instruction or proper training undertake such -operation? Autohemic therapy is a scientific procedure, as much or more than a surgical operation, for it embraces a thoro knowledge of physiological and biological chemistry, and to be successful necessitates thoro training in all details and technique. I took a ten days' training in autohemic therapy from the author, L. D. Rogers, M. D., of Chicago, two years ago. Since then I have treated autohemically 132 cases, good, bad, and indifferent. My percentage of success, in benefitted or cured, is 90%. The lowest percentage of success of trained autohemic practitioners so far that have come to my attention is 75%, and the highest 99%. I consider it a menace and an imposition on the public for incompetent They physicians to practice autohemic therapy. should first take a thoro course of instruction from the author, and then should be competent. P. C. JENSEN. Manistee, Mich. EDITOR MEDICAL WORLD: -Good gracious, doctors, wait a minute!! I am neither a mail order house nor a correspondence bureau. I do not have the time, the means or the stenographic force to answer you all in full about autohemic therapy. I gave all the necessary data in the November MEDICAL WORLD. Read it again and then do it. E. M. PERDUE. Kansas City, Mo. In Memory of Dr. C. F. Taylor. A whole-souled man has passed away, His plain good sense and ready pen His "Business Talks" with good sense teemed; The helpful hints we monthly gleaned In "Monthly Talks" his brilliant mind If life is judged in those far bounds C. W. CHAPIN, M. D. MONTHLY CLINIC. Please notice that our CLINIC department is not used to "boost" proprietary remedies, almanac fashion. THE MEDICAL WORLD has no interests other than to give to the medical profession the greatest amount of honest service possible. Those who wish an immediate response by mail may obtain same by inclosing check or money order for $2. The letter will then receive immediate attention and reply. Name and address of subscribers requesting assistance will be withheld if requested; but anonymous communications will receive no attention. Always sign your name. Come freely for help, but read up as fully as you can before coming to us. Dispensing Narcotics. EDITOR MEDICAL WORLD:-Will you kindly help us in answering the following questions? We write you because there is no satisfaction gotten from the narcotic inspectors. 1. May a doctor, after buying narcotics on blanks, dispense these narcotics in his general practice, he keeps strict account or record of everything, the patient not knowing that a narcotic is used? The patient pays for a call or R and is given the medicines. In other words, I am asking just how an M. D. may use narcotics in his general practice and be living strictly according to our narcotic laws. 2. Must one who dispenses his own medicines have to have a retailer's license to use narcotics? If you help us in regard to the narcotic laws, we shall be very grateful, for even lawyers here fail in getting any help from the narcotic offices. W. Michigan. [The doctor may dispense narcotics to his patient after purchasing them on the internal revenue blanks. There are certain regulations concerning the dispensing that must be observed. The quantity dispensed must be reasonable in amount, not large. It must be for cure of disease or alleviation of suffering incident to disease, and not merely supplying an addict with his "dope." In some states there is restriction on treating addicts, tho generally it can be done by the physician if he does so by reducing the amount of narcotic constantly. We believe it is always advisable not to let the patient know when he is taking a narcotic. Your registration with the collector of internal revenue of your district entitles you, so far as the United States internal revenue service is concerned, to dispense narcotic remedies as above stated. The national government is not concerned with any other remedies you dispense. We do not know what state or city laws you may have on this subject. Your state medical society officers may be able to tell you.-ED.] The Narcotic Law Tax. EDITOR MEDICAL WORLD:-Inclosed please find $4.00 check for 4 years' subscription to the MEDICAL WORLD. I want to urge you to work for a reduction of the narcotic revenue tax to $1.00, as it was in the beginning. Considering all things, the physician, in this matter, should not be made a source of revenue for the government. The reasons are too obvious to require stating here. Los Angeles, Cal. A. F. ZIMMERMAN, M. D. [Strictly speaking, the narcotic law tax is not a tax, but a registration fee. It is intended merely to cover the cost of registering physicians, dentists, veterinarians and dealers in narcotics for the purpose of restraining the narcotic traffic. As such, it should have remained at the figures in the original bill. The last Congress did wrong to raise the amounts. We need a representative in or at Congress to look after these things for the medical profession. We have plenty of medical societies, but not much is being done for us along this line. We cannot ask the medical societies at the national capital to bear this expense alone. And it seems that none of our national medical societies will take up the work.-ED.] Skin Grafting Following a Burn. EDITOR MEDICAL WORLD:-I wrote you a day or two since in regard to my daughter, who is badly burned. I have taken your journal so long and have so much confidence in it. This is my own daughter, and I am mighty deeply interested in the outcome of her case and ask you to please answer every question I asked in the letter in detail. Will you tell me if I could have success in skin grafting on her back? The burn is of the third degree, or at least goes thru all the layers of the integument to the muscular tissue on the right shoulder blade in a place as large as your two hands spread, and a place about the same size on the left side, but about six inches lower. Tell me when skin grafting should be done and the technique. Can it be done by a country practitioner? She was burned on the 7th of November and at this date, 18th, the flesh on the back and under sides of both arms to elbows is almost completely stripped off and it looks on the arms as if there were healthy granulations already starting. Local treatment was at first carron oil, and then ever since the second day we have used oxide of zinc ointment, with enough oxide of zinc stirred in to make a thick paste. Then covered the poultice and also the surface with the zinc powder. She is awful restless to-day after dressing on account of the raw surface being irritated by the dry powder. We cleaned off all the loose skin and debris and then touched up the raw surface with a warm solution of carbolized water with a gauze sponge, and then dried with a piece of dry gauze, then applied the dressing above spoken of. Temperature has been nearly normal for 4 or 5 days. I keep the bowels well open with alkaline solution and castor oil. Appetite fairly good. Tell me if our treatment is right, and what to do to prevent scarring, and drawing and contracting of the muscles and tendons. Adona, Ark. DR. W. A. LEE. [We suggest that you use warm bichloride of mercury solution to cleanse with if the wound is infected. If the wound is not infected use sterile salt solution, 1 dram of salt to the quart of sterile distilled water. This we offer in place of the dry powder and zinc oxide ointment you have been using. We think you can do the skin grafting yourself. When you have the surface covered by healthy granulations the Italian method can be used. It is described in text-books on surgery. Dr. M. J. Buck described his method in THE MEDICAL WORLD of February, 1916, pages 52 and 53. We have used Dr. Buck's method successfully a number of times. A broad surface like the back permits of skin flap sliding, wherein you undermine the skin in a large area adjoining the burn, leaving a pedicle to allow blood supply, and slide it over the burned area and stitch it in place. A little subcutaneous fat to be interposed between skin and muscle is advisable. This can te included with the skin flap. Outline a larger area than the defect, incise it all around except at the farthest point away from the tip, undermine it with a scalpel and slide it over the defect, leaving the skin flap attached at one point for nutrition of the flap. After the flap is in place it should be covered with dry sterile gauze and made airtight so that the tissues will grow in place; or better cover the skin with dry sterile gutta percha tissue and then the gauze. The dressing need not be changed for several days if it remains aseptic. This must be done under surgical conditions. It will probably be necessary to do a series of such operations in order to cover such large defects. Many country practitioners are doing this operation. If you feel any doubt about doing this operation yourself, take her or send her to the nearest hospital. After the surface has healed she will be able gradually to exercise her muscles and tendons, and will probably overcome muscular contractions, if any occur. There will undoubtedly be much scarring. The skin grafting is the best treatment for that.-ED.] Insomnia. EDITOR MEDICAL WORLD:-I have been a subscriber for almost twenty years. On the 23d day of last May I had a paralytic stroke of the left side and was unable to get around till about October 1st. My object in writing is to ask your advice in regard to my case. I can now get around with the aid of a cane: yet my left leg is almost powerless. But my worst trouble is insomnia. I will not take opium, bromides or chloral. Do you know of any preparation of passiflora, hyoscyamus, conium, can sativa nabis, cypripedium, ignatia or avena or any preparation or combination of two or more of the above drugs? New Florence, Pa. J. B. WAKEFIELD, M. D. [We think you need nitroglycerin and potassium or sodium iodide. Sleeplessness is due to the hardening of your arteries. These remedies should ease them up somewhat. You could use Daniel's pascarnata; or extract of hyoscyamus, % or 4 grain. Or the fluid extract in 1, 2 or 3 minim doses. These remedies can be combined to aid you. A little bromide is a valuable addition. In case you use the bromide you should make a solution rather than a pill or capsule. A dose of from 3 to 8 grains of bromide will not do you harm. We advise you not to use cannabis indica. The other remedies we have no experience with in this condition. You undoubtedly have high blood pressure. The pulvoids natrium compound of Dr. Thrush may help bring down the blood pressure. Read our answer in the Monthly Clinics in the December issue.-ED.] Specific Wanted for Hiccough. EDITOR MEDICAL WORLD:-Who can give me a "specific" for hiccough? I have just had four cases, that lasted from 2 to 4 days. I used all the remedies that are listed in my medical books; also those that are given in the "Brief" for the past two years. I did not succeed in stopping any two cases with the same treatment. When one would fail, I would try another. If there is a "specific" I want it. These cases were all healthy working people; regular habits, no disease and nothing to cause it that I could detect. Don't tell me to remove the cause, because I can't find any. PERRY G. SWEARINGEN, M. D. Houston, Texas. [We are unable to give you any specific for hiccough. We would be glad to hear from our readers who have any treatment to offer.-ED.] Care of the Expectant Mother. EDITOR MEDICAL WORLD:-Inclosed herewith two dollars (check) in payment of bill. Will you please take the trouble to look up a back number of MEDICAL WORLD, possibly back two years ago, containing an article on the care of the expectant mother. I can't recall the author. It was a series of directions and advice that this doctor handed his cases about to be confined. EDWARD E. GREEN, M. D. 456 Washington Avenue, Brooklyn, N. Y. [No doubt, you refer to Prof. J. O. Arnold's article in November WORLD, 1917, pages 409 and 410.-ED.] NOSTRUMS. Moras' Detoxyl and Eye Cream. EDITOR MEDICAL WORLD:-I am writing to ascertain what is considered to be the merit, if any, of "Detoxyls" and also of "Eye Cream" as put out by E. R. Moras, M. D., author of Autology and Autopathy, of Highland Park, Ill. Do these preparations belong to the class of Misbranding of Lower's Pure Blood Remedy. On July 5, 1917, the United States attorney for the Eastern District of Arkansas, acting upon a report by the Secretary of Agriculture, filed in the District Court of the United States for said district an information against Robert H. Lower, Hot Springs, Ark., alleging shipment on or about October 17, 1916, from the State of Arkansas into the State of Louisiana, by said defendant, in violation of the Food and Drugs Act, as amended, of a quantity of an article labeled in part, "Lower's Hot Springs Pure Blood Remedy," which was misbranded. Analysis of a sample of the article by the Bureau of Chemistry of this department showed the product to be a weak alcoholic solution containing sugars, small amounts of chlorids, iodids, and sulphates, probably as the sodium salts and vegetable extractives, among which are podophyllum and an atropine bearing drug. It was alleged in substance in the information that the article was misbranded for the reason that certain statements, appearing on the labels on the bottle and carton, falsely and fraudulently represented it as a treatment or remedy for syphilis, paralysis, catarrh, eczema, malaria, scrofula, ulcers, chancroids, sciatica, and all kinds of rheumatism, and all blood and skin diseases, when, in truth and in fact, it was not. On June 18, 1918, the defendant entered a plea of guilty to the information, and the court imposed a fine of $10.-Notice of Judgment No. 6353 CURRENT MEDICAL THOUGHT. Turkish Doctors in League With Disease The Armenian National Union of America inform us that Turkish doctors played a peculiarly shameful part in the crimes committed by the Turks upon the Armenian people has recently been disclosed by the publication, at Constantinople, of a pamphlet entitled "The Persecutions Directed Against Armenian Doctors in Turkey Dur ing the World War." The pamphlet, which is published by the Union of Armenian Doctors at Constantinople, charges the Turkish doctors not only with having plotted against the lives of the Armenian population, but also with having directed a special campaign against their Armenian colleagues. It is a situation unique in the annals of medicine. The charges brought by the Armenian doctors are substantiated by the testimony of some prominent Turkish doctors whose statements have appeared in the Turkish press. Many of these criminals are now in prison awaiting trial; others have fled the country. The charges may be summarized as follows: In 1915, when a Ministry of Deportations and Massacres was formed under the name of Special Organization (Techaliati Mahsousse), two doctors, one professor of legal medicine of the Faculty of Medicine, Constantinople, were placed at the head. It was they who helped to organize the scheme of sending the Armenians to the burning Arabian deserts, there to perish of hunger and thirst. Not only did these "men of science" do nothing to assuage this human suffering, but they exerted all their power to make it more insupportable and tragic, even going so far as to murder the Armenian doctors who tried to assuage the sufferings of the dying. At the beginning of the war the Armenian and Greek doctors, young and old, were sent to the most difficult and dangerous posts on the fighting fronts and to the contagious hospitals. The Turkish doctors, meanwhile, in posts of ease and safety, were turning the regular hospitals, which owed their existence to Christian initiative, into theatres of outrage and crime of every description. The staffs of these hospitals became rich with the money and goods plundered from their victims. Outrages against sex were so much the rule that recently, in the course of a trial of certain of the ringleaders at Trebizond, Besin Bay, Director of Customs, said the hospital was not a sanitary institution, but a screen for the licentious conduct of Turkish officials. In the clinics and regiments the Turkish doctors treated the sick by choking them, by beating them with whips, and even by kicking them to death. Thousands died following such treatment. Many of the sick died also, mysteriously, while being conveyed to the hospital, or on their way from thence after they had been pronounced cured. One of the most ghastly deeds was the wholesale inoculation of healthy Armenians with the virus of ty. phus. The losses sustained by the Armenian medical profession in consequence of the attack made upon its members is illustrated in part by a list of 67 doctors, ranging in age from 26 to 60 years, who were murdered outright; 52 Armenian doctors died of typhus. Of the Armenian pharmacists cited, 54 were murdered outright and 19 died of typhus. Of the Armenian dentists, 10 were murdered outright and 4 died of typhus. Fifteen medical students were also murdered. The list is by no means complete. This is worse than their German allies, however, who only signed a manifesto. (See MEDICAL WORLD, August, 1919, next to last paragraph of first column on page 268.) Training in Surgery. No adequate opportunity is offered for the development of the younger surgeon. He is too often obliged to learn by independent practice. Assistantships and fellowships for selected men should be established in all of the larger hospitals. The time best suited for such study and development would be at the end of their internships. Many of these men are forced into general practice and commercialized medicine to gain a livelihood. Division of labor by the surgical staff of most of the larger hospitals would result in much increased efficiency. An excellent example of this is found in the organization established by Halstead at Johns Hopkins, which has proved its efficiency by the development of men prominent in specialized surgery. His organization limits the field of work, permits intensive study, and supplies enough clinical material for extensive investigation.-T. J. WATKINS, Jour. A. M. A. Gleanings and Notes. Hormone Hunger: Harrower (Medical Record, August 16, 1919) advances the hypothesis of "hormone hunger" to account for the action of glandular products on the system. He says it is fair to believe that there is a principle made in the thyroid which stimulates ovarian function, and that this must reach the ovaries thru the blood. The ovaries must have some means of getting hold of this hormone. In passing thru the ovary, this organ absorbs the thyroid secretion. If the thyroid secretion is deficient in quantity, the ovary does not get as much as it needs. Hence "hormone hunger" results. This may be supplied by administering the gland tablets. This theory of Harrower is equivalent to the chemical theory of attraction. No doubt the glands live on something supplied them by the blood. Tell your patients the truth, and teach them how to live. In so doing you can teach them how to die. And if you have given your time, |