DEAR WORLD:-Instead of paying for tablets of acetanilid, quinin, and other drugs unpleasant to the taste, buy empty capsules and fill them yourself, by pressing the empty capsules into the dry powder until they are full. It is little trouble and expense, while very convenient. It is not necessary to form a pillular mass, roll out, divide, and put into the capsules, but use the dry powder. I did this years ago, long before I knew the druggist made into pillular masses. Let our friends try it. All hail to THE WORLD! CHARLES H. COCKEY, M.D. Editor MEDICAL WORLD:-You have certainly toucht a very sensitiv spot on antikamnia. One is awed at the popular use of antikamnia. The profession has gone awry on the use of proprietory medicins. It is much to be regreted that physicians have forgotten the art of prescription writing. The pharmacist and manufacturing chemist have taken away from the doctor of today the power to exercise his training as a physician, 'and made of him a mere dispenser of their products. They furnish him with a full description of the virtues of their remedies, and a detailed account of the diseases for which they are "specifics." Men in the profession who scorn the idea of doing anything unethical are lending their aid to the furtherance of this practise, which is simply nothing less than advocating the use of proprietary medicins. It seems to me that the doctor would profit more by not prescribing anything except he knows all about its composition. Would it not be wise to study well the effects of drugs, and once more do our own prescribing? The manufacturing chemist is looking to his own interests, and constantly knocking out the props from under the physician. Is it not time to call a halt, before the physician loses his prestige entirely? which he is rapidly doing. M. J. BUCK. Pittsburg, Pa. [In the matter of proprietaries, the physician should discriminate. While it is wrong to give one's self over completely to the use of proprietaries, it is equally wrong to condemn all. Many of them present a frank and satisfactory statement of their composition, and at the same time present a pharmaceutical merit and elegance impossible to attain by extemporaneous preparation, without suitable apparatus, etc. Concerning proprietaries, have this word constantly in mind: discriminate. Don't imitate; but realize that you are the doctor, and call on your own knowledge of drugs and their action to achieve the results that you desire; and among the proprietaries presented, discriminate carefully, and use any that you think you can use to the advantage of your patient, not forgetting for one moment that you are the doctor.-ED.] Acetanilid: Dispensing vs. Prescribing. Editor MEDICAL WORLD:-You are on the right track; so here's a dollar for one year's subscription. I long ago learned that acetanilid was the base of all the pain and fever preparations on the market, and have never used nor bought them. Acetanilid itself will double discount any of them. Combine with it what may be required. I find that salicylic acid greatly adds to its efficacy. In many cases, heart remedies may be required, but are seldom necessary when reasonable judgment is used, only giving enuf to accomplish the desired object, then to maintain it; but don't be afraid; give enuf to bring down the fever and stop the pain. Sthenic cases are the kind best suited to this remedy. The name of the disease cuts no ice here. Sthenic cases of any and all kinds, regardless of name or age. If one remedy was all I could have, it would surely be-acetanilid. I can do more good and less harm with it, in a shorter space of time, than with any known drug, taking all diseases as they present themselves to the general practician. All my sthenic cases get it, and all get well in short order. A few words about another matter. If you -all of you-will stop writing prescriptions and dispense your own medicins, keep your mouth shut, never, under any circumstances, let your patrons know what you are giving, but force them to come to you for what they get, my word and experience for it, your success, both as a curer of the sick and as a money maker for yourself, will improve to surprise This course will protect the profession you. everywhere. When you turn loose a prescription it frequently is the beginning of an endless chain, traveling from one to another for years, and perhaps from state to state, doing untold damage to doctors everywhere. Now, suppose we are all at this; it is a wonder to me that we do anything. We get only the severe cases. It costs from five to eight years' time and $3,000 to $5,000 in money-all this in the very prime of our young manhood- to get a diploma, which entitles us to a hearing before some medical board. Now, if we should run all these gauntlets safely, we may sign our name with the M.D. to the bottom of a prescription for fifty cents-to become everybody's property. M. E. JOHNSON. Pittsburg, Kansas. [New subscribers are always welcome. If all our subscribers will kindly show their medical friends what THE WORLD is doing for the profession, our subscription list-and our field of usefulness-would be doubled in short order.-ED.] Medical Preparations Advertised to the Laity. Our attention has been called to the fact that other preparations, besides antikamnia, which advertise in medical journals, also advertise extensivly to the laity; for example, Scott's emulsion, Mellin's food, syrup of figs, vapocresolene, hydrozone, etc. In this matter it is not always easy to draw an ethical line. It is generally admitted that it is proper to advertise prepared foods to both the profession and the laity. The same thing has long been, and is still extensivly practised concerning simple and harmless semidomestic remedies; but by so doing the firms so advertising run the risk of alienating a portion of the profession, who object to that sort of thing, whether rightly or wrongly we will not venture to say. But concerning drugs of a dangerous and deadly nature, there is no room for doubt. They should not be advertised to the laity. The Medical Brief Defended. Omaha, Neb., April 2, 1904. DR. C. F. TAYLOR, Editor MEDICAL WORLD; Sir-In the April issue of your journal, you ask the following question: "Is there anywhere a single WORLD subscriber who is a regular, bona fide, paid subscriber to the Medical Brief?" I am in a position to answer your question in the affirmative. I mean to say, that, I am a regular bona fide, paid subscriber for the Medical Brief. Now that I have answered your question, will you be good enough to answer a few questions not only for my own benefit as a subscriber to your journal, but all your readers who may be interested in knowing the real motive for your attack on The Medical Brief. Question 1.-If as you state, Dr. Lawrence has published the Brief in the interest of proprietary medicines in consequence of which he prospered at the expense of the profession; why did you keep silent for twenty years? Question 2. -Why did you not attack The Medical Brief as soon as you entered the arena of editors and launched forth your journal ? Question 3.-Is it not a fact that you attack the Medical Brief because Dr. Lawrence has been and is opposed to medico-political grafters? I mean the individuals who "graft" the medical fraternity exclusively, for instance, the small coterie of men who own and control the American Medical Association. Question 4.-Granting that Dr. Lawrence has published the Brief in the interest of proprietary medicines, is it not evident that there is another motive for your attack on the Brief than to benefit the profession, judging from your silence during such long period? Question 5.-Will you kindly tell your readers the true motive, or at whose instance you commenced your unwarranted attacks on the most liberal, broad-minded and liberty loving man? Of all the medical editors extant, there is hearted, more democratic and more tolerant not a brighter, more liberal minded, more openthan Dr. J. J. Lawrence, the Editor of the Medical Brief. Some time ago you refused to publish an article dealing with medico-political grafters, writer's views. Are your opinions infallible ? upon the plea that you did not agree with the Will you not admit that your journal is not an independent medium, hence has not the welfare of the profession in view, of which I judge from the fact that you refuse to publish the opinions and conclusions of physicians dealing with matters that are detrimental to the rank and file, and which matters also disgrace the profession? You are a member of the American Medical Association, which is owned and controlled by a small coterie of men, and because Dr. Lawrence is opposed to the impositions, grafting and black-listing of physicians who do their own thinking you are opposed to him. Isn't that "it"? Fess up. I dare you to publish this letter and to answer the questions. Yours etc., B. M. JACKSON, M.D. Perhaps the best way to begin is to here present the rejected article referred to. Upon receipt of the above letter I wrote requesting that the rejected article be sent to me again, together with my letter that accompanied the same. present the article with an apology for thus using that amount of space, but this will be the IS THE BODY PROFESSIONAL DISEASED, ARE DOCTORS OF MED- "What! the editor of this worthy journal a coward? I, an The writer hereof begs you not to be angry, but first to listen to his statements. If after due deliberations, you conclude that he is wrong, say so, and he will go before a commission to investigate his sanity; should you conclude that his statements are true, hence is right, he will accept your apology for calling him crazy. In the first place, the writer did not say, that the editor of this worthy journal is a coward, nor that you are diseased and in a lethargic state. He merely asked whether any one, two or all the conditions exist, in the medical profession. Preliminary to going into details, will you not agree with me that some-if not all-conditions, do exist? Of course you do. Own up. However, I shall attempt to give some details. In the December issue of this worthy journal, on page 565, there is an extract from the Columbus Medical Journal, entitled "Reciprocity in Medical Licensure", and it's essence is, that the Ohio Board of Medical Registration and Examination exact a $50.00 fee trom physicians coming from states with which Ohio reciprocates (?) Has the editor of this worthy journal made a single comment regarding this extortionate fee? Not one. Why? Are doctors of medicine reaping the dollars as fast as they are struck at the mint? Why should you pay $50.00 when your confrere who moved from Ohio to your state, has to pay but $10 oo? Besides, most of that $50.00 fee-if not all (?)-goes to the pockets of your confrers, who happened to have social or political pull, and were appointed members of the Board of Ohio? What? the law provides such extortionate fee? Who framed and lobbied in legislative halls that that law should be passed? Did you? Of course you did not. Not that only, nine-tenths of doctors of medicine did not know that any such law was being asked for in Ohio or any other state. The only men who were interested in the movement that our present medical registration laws be passed are, the men known today as political leaders in the profession; and political leaders always aim at personal benefits. What single benefit have you since these laws were enacted? Not one. Not that only, you have to struggle very much harder for an existence, and the laws are much detrimental to your very welfare. The laws have given men (and women) an impetus to start up all kinds of "healing arts" because the laws do not affect them I hope you know by this time, that in almost every state where Osteopaths, Christian Scientists, Vitopaths, Magnetic Healers, etc., etc., were and are being prosecuted for practicing without a license, the highest courts decided that these various "arts" do not practice medicine, hence do not come under the provisions of the law. The leaders of these various "arts" know, too, that Boards of Examiners have enough on their hands prosecuting regular M.Ds. for practicing without a "license," hence the former can safely go on sowing their seeds, and reaping the harvest. So, then, you, a doctor of medicine who spent time and money and perhaps, five, ten or thirty years in practice, are being held up for a fee which goes to the pockets of the men you tolerate as "leaders"; who in addition, compel you to take an examination You are also told every time you move from one state to another not to do this, that and the other on pain of having your license revoked, and any other kind of a "healer" (who, by the way, is making ten to your one dollar, and is also depriving you of many opportunities to make one) are not subject to any kind of supervision, nor can ever a law be passed which might affect them. A trust is a good thing for the promoters and owners of the stock, but the men who produce the wealth (labor) get little in The latter do not share in the wealth produced to the extent they ought to, for various reasons, (Chiefly) because they cannot "see" how communism can come to pass, and stay; but doctors are supposed to be intelligent men, why do they tolerate the medical trust to exist by reason of which "the leaders" have all the benefits, and the men who produce the wealth (every doctor of medicine who attends to his professional duties and tries to benefit afflicted mortals, may be compared with the men who labor and produce wealth) absolutely none. Not that only, every doctor of medicine is practically at the mercy of and pays tribute to a Board of Examiners. return. Before the laws were enacted you have been told the great (?) 187 benefits you may expect from organization. Organization is doubtless a good thing; but under what circumstances? Circumstances that would benefit the men joining the organization. A bricklayer belongs to a union because he derives benefits from the union, but chiefly because his pay today, is three times as great as it was when each one labored by virtue of his individual agreement; his hours of labor have also been materially reduced. What benefits have you from being, for instance, a member of the A. M. A. which is controled and owned by a small coterie of men. (See Wisconsin Medical Recorder for September, page 223. A Medical Trust?) You are not even granted the privileges of a member in the rankest organization! Ah! pardon me, you may spend your money if you wish to attend a meeting of the A. M. A. and receive the journal for which you pay $5.00 a year. Anything else, doctor? Why the very men with whom you shake hands at that meeting, hold you up for money and an examination if you wish to remove to the state wherein they reside! Have you ever heard of a brick-layer belonging to a union who is not allowed to work in another state unless he contributes a fee to the pockets of the "leaders" and passes an examination? A reader of this journal living in Missouri made a statement part of the profesthat the A. M. A. contains the most "brilliant sion; that it contains the "brainy" men of the profession; that brains and not numbers rule everything and everywhere." I wonder if he ever thought that mankind is ruled everywhere by men who have diseased, cunning, dishonest or crooked "brains." Reflect on my statement Dr. Howle; and at the time you do so, think of the men who rule everything and everywhere in your state, (Missouri). What a misfortune that "brains" and not numbers rule everywhere! I say, that the professionally brilliant men in the A. M. A., do not rule the medical profession, but the politically" brilliant.' " Will any of the readers dare make the statement, that the best qualified men in the profession, are appointed examiners? Ask any one of our recognized authorities in medicine, whether he asked for our present iniquitous, ignoble and detrimental medical Why, most brilliant men in and out of the registration acts. A. M. A., are teachers in medical colleges, are they ridiculous to the extent that they grind out M.Ds. for the purpose of having them examined and held up by political appointees? Were I a teacher in a medical college, I should consider the medical laws which provide for the appointment of politicians, to hold up and examine the men on whose sheepskins my signature appears, an insult. Aye! an avowed declaration that my ability to teach is a question to the law-makers (?); rather the men that asked for the laws and who may happen to be my pupils. Make up your mind, that lack of medical liberty, (Liberty! Is there much left in the United States? Yes, Yes! We still sing, My country tis of thee, Sweet land of Liberty, &c.) is not detrimental to any other class, but to medical men only; and toleration of a few medical aristocrats can neither be a benefit nor without hardships to those (and they are in the majority in the medical profession as well as under any other social and political condition) who tolerate the existence of aristocrats and politicians that rule. Do not forget, that the rank and file in the profession, particularly the graduates of five, ten and twenty, years ago, who "members" of the A.M.A. or not, are not even recognized by Boards of Examiners that reciprocate (?). either are Do not forget, that no leaders ought to be tolerated, and no organization can exist or ought to exist, in which the members thereof have absolutely no benefits and the leaders all; also, that leaders who are the exclusive beneficiaries in a particular organ"saw wood" and ization and the members merely "stand pat constantly pay tribute, are a menance, not only to the organization but the members themselves. Are the medico-political leaders not doing harm to the rank and file in the profession? Plenty. Do doctors of medicine derive a single benefit in return for tolerating the various Boards of Examiners who, divide the whole or are entitled to $15.00 per day for as many days as they are in session (See the various regis. tration laws) from the fees obtained from physicians exclusively? Not one; unless it be that they must not do this, that and the other on pain etc., In fine, if you can think of a more ridiculous condition than the one existing in the medical profession, I shall be obliged to you for naming it. Is the writer justified or not, in asking the quesB. M. J., M.D. 99'. tions? A graduate of a "regular" medical college; not "Rush" and which is affiliated with J. D. R., "the good Christian "Oil." And here is my letter that went along with the rejected manuscript: PHILADELPHIA, PA., December 16, 1903. DEAR DR.:-Inclosed returned as per your request. Much too lengthy for the kind of an article. I do not endorse your position as a whole, tho I do in a few (very few) particulars. I do not endorse nor admire the spirit in which the article is written. You do not sign your name to it, and it would be very "cowardly" for the writer of such an article to hide under a nom 188 The Medical Brief Defended I find that Dr. Jackson is a graduate (1899) of the Columbian Medical College, Kansas City, Mo. He writes me that since his graduation this college has consolidated with the Medico-Chirurgical of the same city. I am not acquainted with either institution. A further peep into his psychology is given by the following portions of the letter that accompanied the return of the manuscript: I am not ethical, because the medical fraternity forced me to be thus; I do not affiliate with the medical fraternity of Omaha, tho I have a few stanch friends; I am not a member of any medical society, because the medical societies of today are run in the interest of a few-specialists so-called and politicians. If any physician will prove to me an iota of fraternity in the present medical societies, I shall throw up my license and change my profession to street sweeping. I was born and raised in a country where the reigns of government are in the hands of a few, and I know that no greater evil can befall the medical profession in the United States than to tolerate a like condition, which seems to be the greatest object of the men who control the A. M. A. The letter was a long one, devoted mainly to a tirade against medical examining boards and the A. M. A. Also three articles of his, clipt from other medical journals, were inclosed, all quite lengthy, and all devoted to opposing medical laws and the A. M. A. With all the above before us, it is hardly necessary to give any further attention to Dr. Jackson's questions; but I will do so, if it will not weary the patience of our readers too much. Question 1.-I came into the field of medical journalism, not to fight, but to serve the daily medical needs of the average doctor. In the course of time I found that there were other ways of serving the interests of the profession, in addition to giving the diagnosis and treatment of disease. One of these was the exposing of frauds and other evils that were imposing on the profession. For some reason, other medical publications have failed to render this service to the profession. I saw my duty, and did it (and am still trying to do it), as letters received daily constantly affirm. Dr. Lawrence was in full tide of success (financial if not literary) when I entered the journalistic field. For years I heard it whispered about in medical and journalistic circles that the Brief was only an almanac for the advertising of Dr. Lawrence's proprietaries, but nobody would say it "out loud." It requires some courage to do what Dr. everybody else seems to be afraid to do. Lawrence and his combination seemed to be regarded as impregnable. No one seemed to he move the Brief there? The New York post- Louis. Also, the Brief has become worse and worse, in recent years, in the pushing of Dr. Lawrence's proprietaries in the reading columns. The Brief used to have no editorials at all. In recent years it has had proprietary medicine editorials galore. Last summer I lifted the veil a little, and the editorials suddenly dropt most of the proprietary puffing, but Dr. Lawrence couldn't stand it very long. During the past few months they have become as bad as ever again. And the Inquiry Department: That was an adaptation of our Quiz Column, or Department (which I started many years ago)-and can any one who reads that part of the Brief fail to see that its purpose is to push proprietaries in the replies? Can any one read the Brief and not see that it is a proprietary medicin almanac, and not a legitimate medical magazine? This has been known in certain circles for years. And isn't it time to say it right out to the profession? particularly when the almanac features are getting worse and worse, and the claimed "paid "circulation is. getting more and more monstrously absurd. Many proprietary medicins are all right. I have never said a word against one of Dr. Lawrence's proprietaries as such; but it is his Question 3.-The question is a ridiculous one. Dr. Lawrence need not talk about grafters. He has been working the most stupendous medical graft that was ever known in this country, and he has his immense fortune to show for it. As to medico-political graft, I do not know of its existence. Jackson says it exists, but I know nothing of it. He seems to indicate in his articles that it is the salaries of the State Medical Examiners. I will venture that there is scarcely one of them who does not lose more than he gains by attending to his duties as examiner. And as to the American Medical Association, there is less graft in it, compared to the importance and extent of its work, than in any institution I know of. Its chief salaried officer is its secretary and editor of its Journal, both offices filled by one man, whose salary is very low, compared with his many exacting duties and the magnitude of his responsibilities. Even if there were graft in the State Medical Examining Boards, and in the A. M. A., I have no connection with either, excepting that I am a member (a humble member, in the ranks) of the A. M. A. If there were any graft in it, I would have no access to it, so why should I defend it? You can bet your bottom dollar that if there were any graft there I would try my best to expose it. Your question is ridiculous on the very face of it, except that it brings out in bold relief the fact that Dr. Lawrence is the biggest grafter upon the medical profession of this country that was ever known. Question 4.-Glad you grant that Dr. Lawrence publishes the Brief in the interest of his proprietaries: No, there is no other motiv than what I have exprest freely-my interest in medical journalism, and in the welfare of the medical profession. What other motiv could I have? I have nothing against Dr. Lawrence personally, and as to "medicopolitical graft," that is too absurd to think of. Even if there were such a thing, my interest would be to expose it, certainly not to defend it. Question 5.-Answered above. I could expand for many pages in the same tenor as the above, but I fear too much space has thus been taken already. Perhaps the conclusion that all will reach is that Dr. Lawrence has been unfortunate in his defender. Let me further say that any man makes a grave mistake when he comes into any profes sion with a fighting spirit. It is no wonder that Dr. Jackson has no standing with the profession of his community. If he will dispel from his mind imaginary grievances-stop fighting a straw man-and seek affiliation with the best elements of the profession of his community, apply for admission into the local societies, etc., he will find himself among gentlemen, and in a fraternity; and all these hobgoblin notions will disappear from his brain. The arms of the medical profession are wide open to all fellow workers who are candid and reasonable. But if you approach a profession in a fighting mood can you expect a cordial reception? I have had a great deal of experience with the profession, and I have nothing to complain of. medical science. As to the state examining boards, they are filling an important niche in the progress of I would much prefer that one examination by a National board should give the right to practise medicin anywhere under the stars and stripes. But our plan of political organization will not permit that at present. I have gone over this repeatedly and fully since the question has been a live one. When our government was organized and our constitution written, this need was not thought of, hence not provided for. The states were given complete jurisdiction in such matters, each within its own borders. Now that you have come to this country, you should accept things as they are, as we do, until they can be changed-and I hope some time we can have a National medical law, which will displace all the state medical laws. The claim that the authorities of one state should give the right to practise in other states is entirely untenable. That would rob the invaded state of self government; and it would also bring the medical standard down to that of the lowest state. As to the claim that a college diploma should give the right to practise, I have often exprest my opinion. Teaching bodies and licensing bodies should be entirely separate and distinct. A teaching institution should teach; and a different body should pass judgment on the quality of the teaching. This division has now been accomplisht in the most of our states, and it is one of the most important steps in advance that has occurred in many decades. Colleges used to see how many students they could graduate; now they try to see how few of their students shall fail before the state board examinations, for wide publication is made of the record showing what colleges the successful candidates come from, and what colleges the failures come from. The importance of such a test, and the incentiv it is to excellence in teaching, is apparent. |