CORRESPONDENCE.

THE LICENSE TO PRACTICE. Editor MARYLAND MEDICAL JOURNAL.

Dear Sir:-In a recent number of your JOURNAL, under the heading of “License to Practice," you say, "It is the duty of every physician in the State to constitute himself a detective and report to the Secretary of the State Board of Medical Examiners all persons whom he knows or even suspects to be practicing medicine without a right." I would like to say that this must have been done to a very considerable extent, for in a conversation with the Secretary of the State Board of Medical Examiners, which was held over two months ago, he informed me that he had "a stack of names of men who had not only registered illegally, but had perjured themselves by doing so." Now, the question the profession of this city and State are asking is not about the number of illegal and perjured members of our profession, but what is the State Board of Medical Examiners going to do about this state of affairs? After an existence of nearly two and one-half years, does this body find that they have not the legal power to bring to the notice and assist the proper authorities in punishing the numerous law-breakers? If they have, why this delay in doing so? If they have not, why continue the farce of examining men for license to practice, causing decent and law-abiding men to come to this city from all parts of the State at great inconvenience and cost to them, plus the ten dollar fee to the examiners, while quacks, charlatans, faith healers, undergraduates, etc., go on as they did before? Indeed, they are in a better position, for most of them are now protected by a certificate to practice from either the Circuit Court of Baltimore, or some of the county courts. The Board of Examiners is a creature of the State Faculty; if the task of doing their full duty is too great for the present board, why not ask for assistance from the Faculty? There is no question but that the profession of this city and State

are interested in this matter, and will support any active and determined effort to enforce the existing medical law, and will condemn inactivity and indifference on the part of those who are supposed to be in authority to execute, or direct the execution of the law as it now exists-even though it is our venerable and respected State Faculty. Very truly,

WILMER BRINTON, M. D.

Not

EDITOR MARYLAND MEDICAL JOURNAL. Dear Sir:-I am very glad to furnish all information at my command on the subject of Doctor Brinton's letter, in this issue. As the counsel whom the State Board of Medical Examiners have consulted upon all legal questions arising in the performance of their duties, I have been obliged to advise them that there is not a line of any law, which imposes on them the duty of prosecuting violations of the law relating to the registration of physicians and surgeons, or to practicing as such illegally. only is their duty no greater than the duty which every reputable practitioner owes to his profession, or any citizen to his community, but there are perhaps considerations which might prevail, to prevent members of a board whose functions are judicial, so far as they go, from engaging as actively as other members of the profession in bringing violators of the law to justice. Nevertheless in the absence of any movement on the part of any other persons or organization in the medical profession, and in deference to the expressed wish of so many medical men, the Medical Examiners have expended much time, labor and pains in endeavoring to collect evidence on which to base prosecutions for violation of the law, which may yet result in securing sufficient evidence for the conviction of some of them. But in no case has any physician or surgeon outside the Board assisted to the extent of furnishing any evidence tending to prove the crime alleged, much less evidence legally sufficient to convict. Dr. Brinton's own case is a good illustration in point. Whatever names he

may have contributed to the "stack" of suspects, he will doubtless state frankly that he has never contributed the names of any witnesses who could prove the facts which constitute the crime alleged. If he had, and the Board had not forwarded them to the Grand Jury, he could and should have done so himself, for the Grand Jury is always sitting to receive such evidence, and the State's Attorney, Mr. Kerr, at the request of the Board, has promised to give immediate attention to the trial of such cases, and has offered to accept the assistance of any counsel suggested by the Board. Now, what are the facts necessary to be proved in the practical question for the profession? Substantially one, simple enough to state, but as experience has shown, difficult enough to prove, viz.: that contrary to his sworn statement the "suspect" was not "on or before June 1, 1892, practicing medicine in the State of Maryland." Bear in mind that the "suspect" himself, always the most valuable, and often the only, source of evidence on this subject, cannot be compelled to testify. But there are many facts, such as the actual residence, occupation and declarations of the "suspect" at the period, when he was a practitioner according to his affidavit, which would. suffice to establish the fact contrary to his affidavit, which are susceptible of proof by others. For instance, that about or subsequent to such date the "suspect" had applied to be entered as a student in the first year's course at a medical college, would be valuable evidence tending to prove he was not a practitioner at the date in question. And here I ask Dr. Brinton, if the Learned Faculty of which he is a valued member has ever offered or is even willing to furnish accusations or proof of this kind against ex-students of their college, who are suspected by reason of the last mentioned facts of having registered illegally, inasmuch as they have graduated since the date in question and have obtained registration and license without standing the examination required of all who have commenced to practice since the date in question. Let the Board hear from other colleges

on the subject, for it is a fact that it has received not even the offer of assistance in supporting the law from any of them.

The

But Dr. Brinton's letter foreshadows a question which the foregoing statement has probably made prominent in the thoughts of every interested reader. Is the law efficiently framed to accomplish its declared object of excluding illqualified and noxious practitioners and punishing violators? Obviously those interested in its enforcement will not desire to expose or anticipate any defects in advance of a test of it in the courts. But if there are apparently certain inherent weaknesses which contribute to make its immediate enforcement "the farce" Dr. Brinton describes it, he himself is one of the playwrights who composed this most amusing comedietta, and it would be unfair to him to give those he considers the actors on the boards credit for all the fun in it. State Board of Medical Examiners did not construct this law. It was offered in the last Legislature by your humble servant, the undersigned, and drafted by his hand, under the direction of a Committee representing the medical colleges and certain medical societies in the State, of which Committee Dr. Brinton magna and honorabillissima pars fuit. This Committee reached an agreement by vote on every significant word in it. Such legal abilities as your subscriber possesses were put gladly and gratuitously at the service of the Committee, and the probable legal consequence of every phrase employed was indicated to and understood by the Committee. The problem before the Committee was no easy one. They endeavored to express as nearly as possible the sentiment of their profession, and deliberately chose to risk the commission of certain errors in order to clearly avoid certain others. Not to specify further, the Committee will not object to the statement, that while the representatives of the colleges naturally desired high requirements for candidates for the privileges of the profession, they contented themselves with ensuring such within the near future, and preferred not to cause the slightest inconvenience or

difficulty to the practitioner supposed to have already vested rights in said privileges. If this left the gates ajar for the riff-raff Dr. Brinton describes, they will not be left open long, as additions to the professional ranks by perjury as to the date of the commencement of practice are necessarily diminishing and must soon cease altogether. I think a reasonable period of time and the cooperation of members of the medical profession, so earnestly recommended by your valuable JOURNAL, will cure most of the nuisance which Dr. Brinton naturally and rightfully finds hard to endure, but unjustly imputes to the State Board of Medical Examiners. For reflection will no doubt compel him to admit that they have no more responsibility than he in permitting the objectionable situation, and owing to his membership of the aforesaid Committee. on Legislation not as much share in possibly producing it. Certainly the Board is in no way reluctant to accept aid in the collection of evidence for prosecuting offenders, but would much prefer that this duty should be undertaken by other persons or organizations, to which it would render all the assistance in its power.

Very truly,

ARCHIBALD H. TAYLOR.

MEDICAL PROGRESS.

SEBORRHEIC ECZEMA IN CHILDREN. —Feulard (British Medical Journal) observes that attention must be given in the first place to the diet, which should be limited to milk, with the addition, in older children, of eggs. In the local treatment the first step is the removal of crusts, which may be effected by using warm coal tar lotions, preceded, if necessary, by poultices. After the crusts have been removed he uses gauze compresses soaked in a solution of resorcin (6 in 1000). These are kept constantly applied to the scalp by day, and are applied frequently to the face. By night an ointment is used, consisting of 1 part of balsam of Peru to 30 parts of vaseline. Later he uses fine starch powder, or a

powder consisting of equal parts of starch and carbonate of bismuth. Recovery is rapid if the instructions as to diet are strictly observed and the dressings used with regularity.

* *

*

MATERNAL IMPRESSIONS.-Old thecries are often "thrashed over" with the hope of finding more substantial support than previous investigation has given. Dr. Hubert Work starts out in his article on maternal impressions in the Medical News with a strong prejudice in favor of this inexplicable phenomenon. He addressed a number of inquiries to men on this subject and the replies published point to a belief in this mental influence. His conclusions from this and his own cases are :

1. That both physical and mental defects follow maternal mental impressions with such frequency as to establish the relationship of cause and effect.

2. That these conditions are the result of changes in the blood, chemical, circulatory, or both, seems probable.

3. That the probability of defects in the fetus, from mental causes, is dependent upon the "mental habit or mental characteristics" (Norbury), or susceptibility of the mother.

4. That maternal anticipation of defect in the child has in itself no influence in the absence of a strong impression.

5. That the impression need not be Jasting to cause defects.

6. That personal maternal injury is no more likely to mark the child than the sight of it in another.

7. That the defect is not necessarily similar in location or appearance to the object creating the impression, but is likely to be. The apparent constancy of likeness is due to the reporting of such cases only.

DIABETES.-Unschuld, in the British Medical Journal, draws attention to some of the less noticed symptoms in early diabetes. He quotes a number of illustrative cases in which the disease was masked by the presence of dyspeptic symptoms, nervous symptoms classed as neurasthenia, etc. Sometimes diabetes may quite accidentally be discovered.

MARYLAND

Medical Journal.

PUBLISHED WEEKLY.

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WASHINGTON OFFICE: Room 22 Washington Loan and Trust Co. Building. SEE PUBLISHERS' DEPARTMENT, PAGE 78.

BALTIMORE, NOVEMBER 10, 1894.

THE dispensing of drugs by physicians in their offices has assumed such proportions

that the pharmacists at their Drug Dispensing last meeting took up the by Physicians. question and decided to boycott all manufacturers who furnish physicians with their products for dispensing. There are two sides to every question and there are certainly two sides to this one. A physician has undoubtedly the right to dispense what he pleases, provided he does not attempt the compounding of complicated prescriptions without sufficient knowledge or skill; and yet outside the large cities and thickly populated districts where there are few or no pharmacists, the physician must of necessity be his own dispenser.

It is, however, not a good plan in general for a physician to dispense his own medicines except in case of the simplest remedies; for not usually having a large stock on hand, he may be tempted to substitute when the proper drug or combination is not available and thus run into that very danger of which he so

often accuses the pharmacist. There are certain simple remedies, such as anodynes and cathartics, which are not intended to be repeated and the nature of which it is often important to keep from the patient's knowledge. These the physician can with advantage dispense, for a prescription which in this enlightened ago can be read by almost any intelligent person, too easily shows what is being given and renders unauthorized repetition an easy matter and in some cases may lead to a dangerous drug habit.

There are certain advantages in dispensing medicines in the office besides those above stated, which almost anyone can see; for instance, the physician knows exactly what the patient is taking and when he will return for further advice and medicine. There are, however, numerous disadvantages which far outweigh anything in favor of office dispensing. The busy man will hardly like to stop to put up or dispense drugs in the office, make a record of what was given, label and wrap the box or bottle. It is much more satisfactory to write a prescription and have it compounded by a good pharmacist and most well-to-do patients prefer this.

While some men will continue to dispense in the office and all will occasionally give out simple drugs, it is not very likely from present indications that the physician will ever be able to do without the skillful pharmacist, who not only puts up neat and palatable prescriptions, but most often detects the errors made by physicians in prescription writing and dosage and hence is a desirable safeguard when poisons are prescribed.

The License to Practice.

***

THE opinion expressed by our correspondent in regard to the apparent delay in prosecuting persons who have illegally registered as physicians having the right to practice medicine in Maryland, is probably the opinion of many. It looks indeed at first sight as if it would be more sensible not to register and save the fee. Unfortunately in the question of this right the burden of proof lies on the shoulders of the Medical Examining Board and in order that there may be no false steps taken, deliberation is necessary. If some are practicing illegally and have perjured themselves in registering, it must be proven and to this end testimony is necessary so that the prosecuting

attorney may have some ground for bringing action.

It is not always difficult to question the constitutionality of a law and get opinions at variance with the implied meaning of the law, and decisions are so uncertain in jury trials that the Medical Examining Board naturally wish to make haste slowly. That they are working in the right direction no one should doubt and the fruits of their work will soon appear. Few things in Baltimore or Maryland are done hastily, but in a conservative part of the country like this the right comes slowly and is lasting when it does

come.

***

ORGANIZATION and concentration of work are the order of the day. The spread of dis

Maryland Health Officers Confer.

ease can never be stopped by single efforts. This the Secretary of the State Board of Health has appreciated when he called together the various health officers of the State, counties and cities of Maryland, for union of action. The health of the various parts of the State was discussed and united methods for stamping out disease were presented. In the case of typhoid fever, for example, it is only by an agreement of opinion as to the cause and prevention of this preventable disease that its morbidity and mortality rates can be reduced. This action on the part of the Secretary is very praiseworthy and it should be followed up by constant vigilance and quick action in time of danger.

***

WEEK after next, Cumberland will be the place of meeting of two medSociety Meetings ical societies. The Tri-State at Cumberland. Medical Society, consisting of physicians from Western Pennsylvania, Western Maryland and West Virginia, will meet in Cumberland on Tuesday night, November 20, and the next day the Medical and Chirurgical Faculty will hold its semi-annual meeting, which will be continued until Thursday, should the programme be long enough. Nothing has been spared to make both these meetings a success. A number of men from Baltimore will go up and read papers and some from other parts of the State will be there. The Baltimore and Ohio Railroad has offered reduced rates and the

committee in charge will make special arrangements at the hotels in Cumberland. In addition to that, the physicians of Cumberland will do all in their power to make the welcome a hearty one.

For those who go up on Tuesday afternoon there will be the meeting that night and the next day and if the State Society should see fit to convene but one day instead of two and if the programme can be finished without crowding or hurrying, those who wish it may take the night train that night from Cumberland and be in Baltimore the next morning in time for breakfast, and those who go to the Faculty's meeting only, may by spending two nights on the sleeping car be absent but one day and avoid a hotel bill. One thing may be assured and that is that the committee of arrangements will do all in their power to make every one comfortable and those who go will be repaid.

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THOSE Who believe that figures do not lie are fond of collecting them to prove some disagreeable fact. These are the Busy Doctors. persons who count the inhabitants of a place and the number of physicians and then by a process apparently easy apportion so many patients to each physician. If all these persons thus dealt out to each physician were constantly in need of his asistance, every physician would have enough to to, but in the present state of affairs when persons are taught to take care of themselves and keep well and when many are in a good condition in spite of having broken every sanitary command, then it is hard to understand how so many physicians are so busy that they hardly have time to eat and sleep.

The London Lancet is just now complaining of the alarmingly healthy condition of the people and how hard it is for the hospitals to have enough interesting cases. Most persons have time to do what they wish to do; it is very hard to find an opportunity for the disagreeable duties. Want of time and want of inclination are synonymous in this case. The physicians who say they are worked so hard are usually the ones who appear bright and early at the fashionable horse show, a foot-ball match or a "swagger function."

Many men are busy because they do not know how to concentrate their time and efforts and are unsystematic in their pursuits.