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A Common Fault.

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There is a habit common among the profession which is a relic of the darker days of medicin. We refer to the habit of prescribing such drugs as we know will derange digestion and assimilation, without having fully considered whether the exigencies of the case demand such harmfully meddlesome procedures. In the times when knowledge of physiology, of the rules governing digestion, of the manner in which drugs really acted when ingested was very limited-in short, in the days of pure empiricism, the physician was not expected to think of these things. His entire duty ceast when he had made an attempt at diagnosis, and had prescribed his crude drugs in sufficient quantity. But it is not so now. With our increast knowledge our responsibility has inNow the thinking man realizes that drug giving, without full consideration of the ultimate effect of such drugs on the various processes of the body, is often a very injurious plan. We know that study of the dietetics, physiology, and the hygienic considerations. influencing a given case, is frequently of greater importance than the mere giving of drugs. After diagnosis has been made, and remedies prescribed, it is yet necessary to consider what effect the indicated" remedies will have beside that of relieving or masking the symptoms. The thoughtless practician who prescribes opium in every case of diarrhea, while he may often succeed in checking the diarrhea, will often fail ignominiously, and will often have a much sicker patient after the medicin has been taken than before. A little bit of thought would have suggested that, inasmuch as this case of diarrhea is due to intestinal indigestion, very probably accompanied by masses of undigested food and putrefying feces within the intestinal canal, the logical procedure would have been to give a flushing purgation. In certain acute cases of rheumatism we admit that it is necessary to give salicylic acid in enormous quantities, for it is then a question of saving the heart before the rheumatic poison has permanently destroyed it; in malignant malarial infection enormous doses of quinin must be given; in a few other instances seemingly reckless therapeutics is justifiable, but the

instances are rare.

We plead for a more rational practise along such lines. We have all been taught that "if doubtful of being able to do good, make certain of doing no harm."

If you are afraid of the forceps because you do not know how to employ them, you will fail to "fill the bill" in many cases. If you fear them because you know what they have done in inexperienced hands, and yet can use them when necessary, your patients are fortunate.

Hoff's Prescription for Consumption.

We have met the gentleman who made the first "batch" of this preparation in this country. When he saw the article on page 246, June WORLD he said, "Give it to those fellows; they are frauds." When he saw the prescription on the above mentioned page he said, "The prescripton is all right. Dr. Hoff lives in Vienna, and that accounts for the difficulty of an American deciphering the prescription as written." Here is the prescription in plain English as he gave it to us. Turn to the above mentioned page and compare with the following:

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Speculations Again.

Did you ever know of a single instance where anyone who took "a flyer" in any of the numerous speculativ schemes that are advertised in circulars sent to doctors, in which the "small investor" did not lose his money? In short, did you ever know of a single instance that succeeded according to promises? Did you ever know of a single instance in which the investor even got his money back? Did you ever know of an instance that was not a total loss? Yet some people think it is "smart" to "dabble in stocks," and "take a flyer" occasionally! Isn't it a supremely foolish thing to do?

I must quote here a sentence in a letter from one of our subscribers: "A pen made from a quill pluckt from the wing of an angel and dipt in the colors of the rainbow, could not induce me to part with another $."

"MinAnd this from another subscriber. ing stocks are generally more worthless, and even more fraudulent, than lottery promises

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But here is something rich. Among the many things sent to me is a large, four-page circular, one page of which is occupied by an

imitation type-writer circular to doctors; here is a part of it:

and

DEAR DOCTOR :-Some time since, while the writer was chatting with the business management of the New York office of the U. S. I. of Boston, the local management, Mr. B, as he was running over a quantity of recent mail, remarkt "Doctor, Doctor,' turning to the writer, he said: "I have more inquiries from men of the medical profession than any other class of people, and I believe that they are the greatest buyers of mining stock." Being imprest with the remark, at the first opportunity I ran thru the stock ledger of the Mining and Commercial Company, of which company I was and still am the secretary, with a view of ascertaining how the medical profession was represented in my own company, and I found it as a class to have the greatest representation. Prominent among them are (a number of doctors are here named) and many others. The thought occurred to me: Why does this class take more kindly to the purchase of investiv securities? I found this answer to the query-First the ratio of their earning from their profession rank high among the professional incomes; secondly their employment and profession gives them little time to study or look after the average business venture; thirdly, the returns from loans and real estate investments are so slight, averaging about 3 percent per year, that there is little incentiv to make such investments. For these reasons they look kindly upon stocks that are safe, offer a greater return in dividends and are accompanied with no personal anxiety or risk.

I then askt myself the question: Why not go with my investment direct to that class most willing to give it consideration? (Then the letter goes on with its argument.)

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This gives doctors a chance to "see themselves as others see them." Look again at those three reasons, the second one, particularly: "Their employment and profession gives them little time to study or look after the average business venture." How true! This is why they are so "easy." A business man would look into the matter and see the bottom of it, and then he wouldn't go in; and what a business man does go into, he "looks after " to see that there is no cheating. That's the kind of men that the usual mining company doesn't want. They want 97 easy ones, like doctors; and it is sad to say, they get them. Are you one of them? If not yet, how soon do you think it will be before you are roped in. Promises will be bright and positiv; will you "tumble"? The chances are that you will, unless you keep the counsel of THE MEDICAL WORLD before you all the time, particularly at the critical moment. And when will I ever get paid for saving all of this money to the medical profession? In heaven, I suppose; but if the few rag-tag tail enders will pay up their subscriptions, I will be satisfied here-and also if our many friends will influence new subscriptions for us.

You

Now look again at the third reason. ought to be able to lend your money in your community. with good real estate security, at an interest of at least 5 or 6 percent. True, you can't "get-rich-quick" at that rate, but it is a fair rate of interest, and you shouldn't

want more. To show you what a good return it is, suppose you try paying it awhile; you will find it to be quite a burden. But the main thing is safety. When you earn your money, you want to get the good of it yourself. Think of you trudging around in the rain, mud and darkness earning more money, while some swindler is drinking champagne on the money that you previously saved.

The Removal of Skin Cancers.

The general practician must continually strive to perfect himself in every branch of practise, or progressivly lose prestige and see his patients drift to the quack or to the specialist. Perhaps there is no simple procedure more generally ignored than the removal of growths upon cutaneous surfaces. The markt tendency to recurrence of malignant growths, and the possibility of benign lesions assuming a malignant form, seem to have so horrified the average practician that he is anxious to refer the patient to the specialist, or willing to see them writhe in the horrors of the quack's treatment.

If the real facts were known and appreciated by the profession, such conditions could not mantain for any length of time. Moles and warts are easily removed by simple measures, and even epitheliomas yield gracefully to the strong caustics. Shrewd men study the tactics of their enemies even more than they consider their own, and it is the duty of every practician to learn all he can of the means and methods employed by both the specialist and the quack; of the specialist that he may improve and perfect his own knowledge, and of the quack that he may save himself loss of patients and be able to explain their reckless treatment and nefarious schemes.

It is along such lines that the general practician must do battle for existence. He can not hope for relief in legislation or diminisht competition. Competition will gradually grow more stern, and the struggle for supremacy yet more bitter, until even a modest living will not be within the reach of the inefficient practician.

The patient must always risk the results of treatment, and the chances are that he will take vastly lesser chances in skilful hands than under the ministrations of the quack. The qualified specialist will handle the case scientifically, and if you mantain your position, you must learn to do as well. Neither your conscience nor the law require more of you than "reasonable knowledge and skill." Any graduated physician may attain to vastly more than such a degree by study, attention, and work. If you do the studying and give due

attention, you will have patients who will furnish the work.

Many practicians are too dignified (?) to act as beautifiers. The best paying work of the specialist is generally "cosmetic" in character. We would rather be less ignorantly dignified; would prefer to know more, earn money, and benefit humanity. The patient of average intelligence will have more appreciation of the value of your services if you can remove a mole skilfully, than he would if he knew you could remove the lime from atheromatous arteries. But this is not the greatest feature. It is often possible to permanently remove an epithelioma when it first appears by application of caustic; where, if the case be treated expectantly or neglected, it may ghoulishly disfigure the person of the victim, or even destroy life itself.

The Brief.

see it

I don't receive the Brief any more. THE WORLD has evidently been cut off the Brief's exchange list. But I happened to prominently exposed for sale to the general public at a news-stand on Chestnut street, so I bought a copy of June number. I learned from the newsdealer that he handles the Brief every month, and I see in the magazine called the Bookseller, Newsdealer and Stationer that the Medical Brief is in the list of "returnable publications," which means that any newsdealer can return any unsold copies of the Brief, thereby taking no risk of loss in handling it. Is the Brief leaving the doctors for the general public?

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As was predicted, the editorials in the June number do not push proprietaries by individual name as freely as the editorials of a few months ago did; only one editorial in June issue is guilty of this, sanmetto and neurilla getting a boost on page 437; but proprietaries in general are boosted freely and repeatedly. The first editoral, entitled 'Organizations" is decidedly anarchistic. The opening sentence is this: "Organizations have always been an obstruction to progress and enlightenment." Is not such a sentiment surprising in these enlightened times? The argument goes on and winds up with a defense of "independent medical journals." Can the almanac organ of half a dozen or more proprietary medicin companies, all owned or controled by the editor, be considered an "independent medical journal ?" This and other editorials try to make anarchists of all the doctors who can be thus influenced; the effort is to make every doctor a free booter, not only indifferent to, but opposed to his local medical society and all other medical societies! It seems that the editor would like to see the profession put back

into the dark ages, if that would help him to push his proprietaries, and perhaps it would. And he can hire medical college professors and foreign hospital men to help him do it, as is plainly evidenced by the last two issues, tho the most of the contributions by these distinguisht men are not of much interest or value to the busy family doctor, an unduly large proportion of these articles being on eye diseases, and similar subjects outside the general field. eral field. But the object being to get the name, and supposedly the influence, of prominent medical men to bolster up a proprietary medicin almanac, any kind of an article will do.

We thought that "Old Doc" would, for once, just for the sake of appearances, give his characteristic "Well, boys," without boosting any of Dr. Lawrence's proprietaries; but he don't. Neurilla and chionia come in for his favors this time.

Beginning on page 489 is a thinly veiled trap for morphin victims, winding up with a boost for celerina, which, in Dr. Lawrence's family of proprietaries, might be styled as the oldest daughter-a nice, respectable girl, the only objectionable feature about her being the way her father boosts her in the reading columns, and she cannot be blamed for that.

The "Brief Talks," which according to the evidence that comes to this office cost Dr. Lawrence $5.00 each, are beginning to be invaded boosters; for example, there are three boosts in the first column of page 492.

Beginning on page 507 is a two page write up for papine.

We thought that this ventilation would clear the answers to queries of proprietary boosts, but they still continue-and how long will you continue to read them? Seng, celerina, chionia, sanmetto, neurilla, iodia, ecthol, etc., all get boosts.

How can we, without taking too much space, give you an idea of the contents of the big pile of letters touching on the Brief, that have been saved out from the subscription department, as per our instructions, during the past few weeks? We will pick out a few typical ones, as representativ of all the rest, and we will ask you if you don't feel inspired to help clear medical journalism of the incubus of commercialism?

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the Brief reaches my office, which it has done for years without a request on my part, it is transferred without opening to the waste-basket, for I cannot understand how any one can waste time by reading it, or any other of those fake publications that laud proprietary articles. Let the good work go on, Doctor. Right prevails always, and you will have every successful physician at your back. H. W. HITZROT, M.Ď.

McKeesport, Pa.

Editor MEDICAL WORLD: Inclosed find postal money order for $3.00 for four years' subscription to one of the best "all-round" medical journals publisht. I admire your loyalty to the profession. You are right. Show up "Dock" Lawrence and all of his kind to the rank and file of the profession. The Brief with its noxious "gas" comes regularly to my desk (its "gas" makes fine kindling). We need more of your kind of journalism. Yours, in the interest of the profession, W. B. HOOser.

Fairfield, Mo.

I admire the stand THE WORLD always takes against medical as well as political fraud. I have observed your "Monthly Talks" ever since you started them. They are "O. K.," every one of them. Your attack on the methods of the Medical Brief is just in line with the idea I have sustained for years. Doctors are looking for true, impartial facts, and not material, every word of which is molded to the interests of advertisers. Keep right along in the path you have mapt out. Stonington, Maine. B. L. NOYES, PH.G., M.D.

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Editor MEDICAL WORLD:-Find inclosed check for $5.00 for my subscription. I am enjoying your expose of the proprietary medicin pushers, and hope you will keep on being a "knocker." If it is necessary to help you out, I'll double my subscription, and undoubtedly many others would do the same. I don't know how far the $5.00 will carry me, but let me know when there is more due. Only be sure and don't shut me off; and if I should die before my subscription expires, you can send it free to some other brother. Yours for honesty and square dealing, PAUL PLUMMER.

Collinsville, Conn.

Have taken the Brief for more than 20 years, but I'm done.-DR. J. M. CARLTON, Wet Glaize, Mo.

Editor MEDICAL WORLD-I will venture two opinions relating to the present fight THE WORLD is making against "almanac" medical journals: First, the Editor will come out of it with more professional friends and consequently more subscribers than he entered with. Second, that THE WORLD has more long-time subscribers than any other medical journal publisht. Honesty and consistency are jewels most people recognize on sight, even tho scarce. It is insulting the intelligence of the profession to ask its members to pay $1.00 per year to a journal teeming from end to end with puffs (slightly disguised) of proprietary articles owned by the editor. I believe, Mr. Editor, the profession will stand by you in your attack on this form of swindle the same as it has in the past on get-rich-quick investment schemes. In the latter you did the profession a service, the value of which no one can estimate. S. M. MANN, M.D.

Grafton, Iowa.

DR. C. F. TAYLOR, Dear Doctor:-Inclosed find a letter from the editor of the Medical Brief, which explains itself. I promptly returned the check with thanks, saying that, as I am a member of the A. M. A., I could not accept the offer.

The real object of the Brief is so apparent that I

supposed everyone could see it. You are doing a good work, and I am glad you have the courage to show it up to the profession.

"6

The Christian Hospital" scheme was so transparent that I fired their literature into the waste basket and thought no more about it, until I saw your article showing up their whole plan.

I do not expect you to publish this, but I wisht to show my approbation of your work along this line. Sincerely yours, JOHN J. ORton. Randolph, O.

[If all members of the A. M. A. would take such a stand for the profession, it would be to their credit. But many, particularly the college professors, cannot muster up sufficient courage to return a check. The honor of the profession is maintained chiefly by the rank and file. It is a shame that so many of the leaders of the profession will talk like angels to their students, but will forget it all when a check is offered.-ED.]

DR. C. F. TAYLOR, Dear Doctor :-Inclosed please find $1.00 in payment of subscription for MEDICAL WORLD for 1904. I have so many journals to read, regular, homeopathic and eclectic, that I have thought several times to drop THE WORLD and one other old school journal, but the stand you have taken against unethical journalism, and your evident sincere desire to aid in every way possible the medical profession, has decided me to stick to THE WORLD if I have to drop all the other journals. Your political opinions are in strict accord with my own. Am pleased to observe that you are not afraid to attack the methods of the "Brief," because it is rich and powerful; you will find that it is not quite as powerful as the whole medical profession, so adhere to the admirable policy you have adopted and we will give you our support. Brockton, Mass. F. E. LADD.

[That is true. "The Brief is not as strong as the whole medical profession." Dr. Lawrence got his financial strength from the medical profession, but what has he ever done for the profession? His advertising pages frequently contain fakes and frauds, but it seems that he cares only for the money that comes his way, however much the profession may be cheated; and the reading columns of the Brief-well, the profession is getting "onto" them.

But maybe the Brief is going to leave the medical profession and go to the laity, like antikamnia. A few days ago I received a letter from a man in New York, asking for employment, saying as follows:

"I understand the Medical Brief is placing their journal on the news-stands, and I thought you might use a man in the same capacity."

I did not answer the letter. THE WORLD belongs to the profession, and not to the laity; and it is devoted to the interests of the profession.

Query: Will the medical college professors and other "high-up" members of the profession continue to write for the Brief, even if it goes to the laity? Yes; for unfortunately some of the biggest "grafters" are in the upper ranks of not only our profession, but of every other profession. They talk the loudest of high ethical standards, and are the first to violate them all. The nice talk is meant for the students; but there is a wide difference between their preaching and practise. Of course this does not apply to all the professors and other eminent men in the profession, but that kind of men can easily be found in this class.

The moral stamina of the profession exists in the ranks more largely than in any other class; it is with this class that we cast our lot and plight our faith. -ED.]

There are many other excellent letters that we would like to quote from, but space bids us call a halt.

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There are four pages of this letter, but the above is the point that I want to meet, and meet it squarely. Yes, the statement is true. It was my final course. I had attended medical college before, at Louisville, Ky. Before going there I had read medicin about three years, under preceptors, as was the custom at that time. After the course at Louisville I did about a year and a half of practical work, and then came up for a final course and graduation at Indianapolis. The college chosen was the Central College of Physicians and Surgeons, then newly organized. I was attracted to that institution by the able Professor of Practice, my friend the now lamented Dr. G. C. Smythe, of Greencastle Ind., and by the distinguisht surgeon, Dr. Joseph Eastman, who only last year passed to the silent majority. But the college, like John Brown's soul, goes marching on," and has made a record that every graduate may be proud of.

No, I was not "held up" for a State examination, nor an examination fee, as that was not the law at that time. If it had been I would have obeyed the law as I have always tried to do. My associations and inclinations have always led me to be patriotic in my public relations, and true to the profession and its highest ideals, in my professional relations. Not that I believe in passivly lying down" and have no independent opinions. I think my record shows that I believe in independent criticism in order to advance healthy progress; but I believe in patriotism first.

""

As to being held up" for a $50 fee, I here append the examination fees required by the different States: EXAMINATION Fee. Alabama.......$10 00

10 CO
10 00
20 00

Colorado................................................. 10 00
Connecticut.................. 15 00

IO CO

Arizona....

Arkansas
California

Delaware
District Columbia. ..... IO oo
Florida

10 00 ............................. 10 00

Georgia Idaho.... Illinois..... Indiana Iowa Kansas..

25 00
10 00
25 00
10 00
15.00

Ky. (registration fee).....
Louisiana

0 50 10 00

10 00

Maine....
Maryland
Massachusetts.

20 00

20 00

10 00

10 00 10 25 15.00 15.00

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Michigan

Minnesota.
Mississippi
Missouri
Montana
Nebraska (graduates of
Nebraska College $10,
all other applicants
$25.)

25 00

Nevada
New Hampshire. .......... 10 00
New Jersey....
25 00

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EXAMINATION FEE. New Mexico $25 co New York .............. 25 00 North Carolina.............. 10 00 North Dakota..

Ohio

........... 20 00 25.00

The Board may, in its discretion, dispense with the examination in case of a physician duly authorized to practise in another State; in which event the license fee is $50, accompanied by certificate or license issued by such other State. Oklahoma................

Oregon....

Pennsylvania......................................
Rhode Island

South Carolina

South Dakota...
Tennessee...

Texas.................

ceed Wyoming

.$5.00

10 00 15.00 I) 00 5.00 .... 20 co .... 10 00 15.00 15 00

5 00

10 CO 10 00 10 00

Utah

Vermont

Virginia Washington... West Virginia Wisconsin-must not ex.... 20 00 25 00

.......

Traffic in Tinsel.

Please refer to the remarkable letter from N. News Wood, on page 243, June WORLD, and our reply on the following page. No suit has been entered, and no more Christian Hospital literature has been received from our readers;

so evidently they have chosen the wiser course, and have concluded to "quit," at least for the present. But after "resting on their oars" awhile, they will think that the effect of our exposé has "blown over," and they will begin putting out their lines again, and try to sell their 65 cent" certificates," decorated plentifully with tinsel and blue ribbon, and gotten up to look like diplomas, for from $15 to $25, to the foolish or vicious hangers-on to the medical profession, with which to deceive the public. This kind of business can't go on in the medical profession as long as the present Editor lives and controls THE MEDICAL WORLD. If any WORLD reader receives literature from the "Christian Hospital," he is requested to send it here immediately. We have stopt this nefarious certificate selling game, and we will keep it stopt. If you know any doctor, or pretending doctor, who has bought one of these certificates, make him so ashamed of it that he will be glad to burn it up.

Do You Want to Buy a Degree?

A correspondent sends to Amer. Med. a letter from a socalled college in Detroit, which is self explanatory.

Doctor, Being Fin. Sec., of above, from March 1st I desire to inform you we are just now Issuing Honay Degrees to some of our best U. S. &c. Prof. and men up in standing. Knowing of your medical standing and profession if you are of the Desire and looking for LL. D., in Harness, write me Early when I will send you a Rekord of data" for filling out for the board to pass on, the only expence $10 for Issue of Same. Waiting a kind reply I am Dear Doctor

Yours Very Respectfully
E. M. LL. D.
Fin Sec

Fourth of July Injuries.

In treating contusions and lacerations caused by 4th of July explosivs, be sure to open the wound freely, and allow free drainage. The shock of the explosion frequently causes disturbances not visible on the surface, far from the visible seat of injury; particularly is this true of injuries of the hand, the most frequent part injured, the shock following the sheaths of tendons. These deep injuries, and possibly deep implantations of gun powder, are very likely to cause tetanus if not freely and completely opened.

In June WORLD, page 231, second column, 29th line from the top (about the middle of the column), by some slip the word aristol got in in place of aspirin in some of the earliest copies printed. If you have one of these, take a pencil and cross out aristol and write aspirin in the margin.

The itching of eczema may be relieved by painting the affected part with three percent aqueous solution of potassium permanganate and allowing it to dry on the lesion.

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