progress, we must hasten to keep abreast with them or we will become back numbers. Even business and business business methods change. A man in business fifty years ago would find conditions and methods entirely different nowadays.

Be careful in your business methods, as we point out in our "Business Talks to Doctors" every month. Send out your bills regularly and endeavor to collect all that is due to you. All physicians do a certain amount of gratuitous work, and hence should be careful to collect on their bills, for there is no sense in enlarging the gratuitous section of your accounts beyond the necessary point. One physician's carelessness in such a matter will teach a great number of people to be careless about all doctors' bills and will cause many doctors to lose money.

Thus you can see that you have a duty to your brethren in this particular. Be careful not to throw stones in a brother practician's way. Be broadminded toward all physicians and never speak unkindly of them. Evil words and chickens come home to roost. You will be better off with your neighboring practicians on good terms with you than otherwise, and regardless of any cause offered, do not take umbrage at it. Be charitable and lenient toward all. Make of the new year the best possible use to yourself and to all whom you may be of any service.

Suggestions on Some of the Methods Available

for Reduction of Blood Pressure.

It is not long enuf since the profession has appreciated what blood pressure means for any adequate treatment for this condition to have been formulated. Almost all practicians know something of high blood pressure, and many of them have already equipt themselves with a sphygmomanometer, yet very few have any conception of how to go about reducing high blood pressure when it is found. This little matter of therapy has not yet permeated the textbooks, and it is often puzzling to the practician to know what measures he can adopt to counteract the condition. While no definit or approximately complete line of therapy has been formulated, and while some of the measures known to be efficient are not available for the general practician, enuf is known to permit of his doing much to ameliorate the condition.

The action of the various nitrites is

quite generally known to those who have given the matter any attention, but there are many patients who cannot tolerate their ingestion, because of a splitting headache following their use. Hippurate of ammonia has been successfully used in such cases as a substitute for the nitrites. A restricted protein diet is a valuable form of treatment, and restriction of tobacco and alcohol are advisable in the majority of cases. Some clinicians permit the use of tobacco and alcohol, in moderation, provided only that dietary rules are strictly obeyed.

If the systolic pressure is 200, nitroglycerin or erythrol tetranitrate may be used for a few days, if well tolerated. A strictly fruit and vegetable diet is insisted upon, and some of the sulfur waters are given for their laxativ and intestinal antiseptic effect. Hot baths at not over 130° F. are used, and judicious open-air exercise is essential. Massage of back, arms and legs is of service. Bain asserts a powerful influence is exerted by the liver pack, and the general practician will do well to thoroly investigate this new use of an oldtime remedy.

If the early stage of arteriosclerosis seems imminent, the iodids are efficient in aiding the absorption of effused material and in relaxation of the smaller vessels. Of course, one must realize that iodids do not relieve high blood pressure, but the consequences of hypertension should be treated as well as the hypertension itself. The ideal drug would be one having the power to induce the excretion of the toxic products causing the alteration in the vessel walls, but since we have no knowledge of such a medicament, we must labor along with those we have. These few hints may be of service to some who are groping in value is known, it will be noted in our the dark, and when anything of any further

columns.

Leaving Gauze in Patients.

The surgeon may save himself much trouble if he will be careful in all operations, great and small, not to leave pieces of gauze in wounds or sew them up in the abdomen. This seems, at first glance, to be a useless admonition, as it goes without saying that the leaving of any foreign body not absorbable within the body is wrong. But it is a fact that many such

cases occur.

We have recently heard of one surgeon

who left a piece of gauze in a wound and after vainly trying to heal the sinus by the usual means instead of attempting to clean up the sinus, sent the patient home. The family doctor was called in, and digging into the sinus to find what might be at the bottom, he pulled out a piece of gauze. The members of the patient's family being present, he could not hide it, and an insurance company settled with the family for monetary damages. What a predicament the doctor would have been in had he not been thus insured! And, strange to relate, some months afterward he did the same thing and the insurance company again had to settle. Now, while this got the doctor out of a sad predicament, it did not eradicate the error.

Another surgeon, upon concluding an operation, left three pieces of gauze in a patient and instructed an interne in a hospital to remove them at certain times, which he specified. The interne failed to remove the gauze and the surgeon narrowly missed a lawsuit in consequence. The surgeon would be held responsible in this case.

Another surgeon injected bismuth paste on top of a piece of gauze, resulting in suppuration and troubles similar to those detailed above.

We wish to direct our readers' attention to these blunders and impress upon them the dangers involved and the possible results to both patient and surgeon. Be sure your gauze and instruments are removed before you close up a wound or leave a patient. Count your pieces of gauze before inserting them and after removing them. Have tapes attacht to all pieces of gauze left in wounds, even tho they be there but temporarily. If possible, have an assistant whose duty it is to care for all gauze used in wounds. By all means get the gauze and other foreign bodies out of the patient before he leaves the operating room.

Training Nurses in Small Towns. The need for trained nurses is felt everywhere. Hospitals are graduating classes of well-trained young ladies every year, and like the young doctor, they are out to make a living and are bent on a "career." The cities are probably best supplied with nurses on account of the presence of the hospitals and the greater possibilities for employment of nurses. But the physician in the small town and hamlet needs trained nurses to look after

his sick patients just as much as the city doctor, not to speak of the need of the sick people for such nurses.. We know the doctor should have their assistance and we know he can get them. And the way he can get them is to train them himself.

Every town or at least every county in the United States can have a training school for nurses. We are askt very frequently by ladies in different parts of this country for books and mail correspondence schools for nurses. We think the best possible plan for them all would be for the physicians in each community to arrange a course of instruction for nurses and secure a class of five or six young ladies or such as desire to study nursing and teach such a class every year or so as necessity arises or opportunity occurs. Each physician could teach a certain part of the work to the nurses. A regular course, such as would be arranged in a hospital, can be followed as nearly as desired, with lectures at specified times.

Among the subjects that should be taught are the care of the sick, changing of the clothing and bedding, temperature and ventilation of the room; keeping the sickroom chart showing the patient's temperature, bowel movements, urination, respiration, pulse rate; when and what medicin was administered, fluids drank; food given-quantity, variety and time. They should study anatomy and physiology, how to pass a catheter, how to give an enema, how to give special baths; diet; cooking; massage; infectious diseaseshow communicated and quarantined; hygiene; nursing in obstetrical and surgical cases; washing a newborn babe; care and feeding of infants; bandaging; asepsis and antisepsis, disinfection and a thousand and one things that will come up in the course of the instruction. The course can be as elaborate or as brief as the teachers desire.

Some books will be needed. It is not wise to start out with a large number of books for the class, but at first use the least number and add to the list as occasion requires. One rather comprehensiv book on the subject is "Practical Points in Nursing," by Emily A. M. Stoney. Price, $1.75. Publisht by W. B. Saunders Company, Sixth and Locust Streets, Philadelphia. Another is "Modern Methods in Nursing," by Georgiana J. Sanders; publisht by Saunders; price, $2.50. Additional books that might be useful according to the comprehensivness of the course are: Bacteriology and Surgical Technic for Nurses," by Emily A. M. Stoney; publisht by Saunders; price, $1.50. "Materia Medica for Nurses," by E. A. M. Stoney; publisht by Saun

ders; price, $1.50. The same subject, written by Lavinia M. Dock; publisht by G. P. Putnam's Sons, New York; price, $1.50. Same, by G. P. Paul; publisht by Saunders; price, $1.50. "Anatomy and Physiology for Nurses," by Le Roy Lewis; publisht by Saunders; price, $1.75. Nursing in the Acute Infectious Fevers," by George P. Paul, M.D.; publisht by Saunders; price, $1. "Reference Handbook for Nurses,' by Amanda K. Beck; publisht by Saunders; price, $1.25. "Dietetics for Nurses," by Julius Friedenwald and John Ruhräh; publisht by Saunders; price, $1.50. "Home Nurse's Handbook,' by Charlotte A. Aikens; publisht by Saunders; price, $1.50 (see August, 1912, World, page 358). Practical Fever Nursing," by E. C. Register, M.D.; publisht by Saunders; price, $2.50. "Textbook of Mechanotherapy (Massage and Medical Gymnastics)," by A. V. Grafstrom, M.D.; publisht by Saunders; price, $1.25. Same by K. W. Ostrom; publisht by P. Blakiston's Son; price, $1 (see August, 1912, WORLD, page 362).

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These books by no means exhaust the subject, but will make a very good start for any class of nurse training. We think the physicians in the small towns should begin now to train nurses for the care of the sick in their neighborhood. lighten the burden of care that the doctor must carry as well as be a great boon to the sick person and his relativs. Unquestionably it will add to the reputation of the teachers, tho we hope no physician will take advantage of his brother practicians in his neighborhood. If there be two doctors in the town, tho they be of two different schools, they should both be co-workers in this training school and each will reap the reward of friendliness and cooperation. Let all the doctors in the town have a part in the teaching. Let all schools of practise be represented on the teaching staff. It will benefit all. Medicin is universal; let us all be broadminded and universal in our ideas.

Physicians' Organized Study Travels. The rapid growth of intercontinental transportation facilities means the wiping out of needless racial and national prej udices, as well as of increasing exchange of knowledge, which is of much value for all peoples. In no calling is this so true as in the domain of medicin. The large body of distinguisht European physicians who made the recent International Congress on Hygiene and Demography at Washington an opportunity for touring the teaching centers of eastern America, brought this fact forcibly home to American practicians. As a result, there was formally organized at Philadelphia, on De

cember 7th, the American Physicians' Study Travels Society, that intends in succeeding years to make other countries its objectiv. Guided by the many years' experience of the European society, it is plain that a wellmanaged travel study party of doctors can make a trip thru a foreign country in a far more pleasant and profitable manner, and at less expense, than can be done by traveling alone. Clinics can be arranged in advance, lectures prepared and visits made to the best hospitals and health resorts, with the assurance of a hearty welcome from the leading men of the localities visited. For those unable to speak the languages of the continent, this disadvantage is reduced to a minimum and the benefits of the trip correspondingly increased by traveling with such a party.

The International Medical Congress that meets in London, August 6 to 12, 1913, gives a favorable opportunity to unite under one group such separate parties as are already preparing to visit Britain and the continent, and it was for this purpose that the new central society was formed. Dr. James M. Anders, 1605 Walnut Street, Philadelphia, is the presiding officer.

BUSINESS TALK TO DOCTORS.

Well, how about 1913? Will you make it a good business year? If so, how? First, you will have to do your professional work right.

Second, that done, you will have to use at least the ordinary business methods to get a fair and reasonable business return for your service.

Third, what are these? Presentation of bill, preferably by mail (even to your nextdoor neighbor) for service after the close of a case. Then the presentation of a statement at the first of every month, of total amount owed, preferably by mail, to every patron who is indebted to you. All business houses send out regular monthly

statements.

Fourth, look after debtors that are unduly negligent of your claims. There are various ways to do this, which have been repeatedly discust in this department. Hire a secretary or collector for a week or a month occasionally, to look after these things if you are too busy to do it yourself. Do this, or otherwise give rational attention to the financial end of

your business, and you will have no occasion to get into the toils of a collection agency.

These things are commonplace, aren't they? They read like a, b, c. But the thing is to do them. If all doctors would do them, there would be no occasion for the continuance of this department, except the investment feature.

And how about that? A Tennessee brother renews for 1913 and says: "I am taking your advice on investments strictly, and have not lost a penny yet." And he adds, "I thank you very much, indeed." New readers will ask what my advice is. It is simply this:

First, pay all debts. You have no right to invest for profit while you have a debt, unless it is one upon which you are regularly paying interest-then it is sometimes advantageous to pay low interest while carrying an investment which yields a higher interest. But I mean particularly small debts. In some communities doctors are not considered good pay. They are too neglectful. And some business houses that deal with people all over the country will not send goods on credit to doctors. They say it is too risky. They say that on 1,000 accounts with doctors there will be a heavy percentage of loss. I have been trying for years to remove from the medical profession this unsavory reputation. It has vastly improved in the last ten years, and in the last five years; it should be brought up to "normal" without further delay. Do you owe the grocer? the druggist? the baker? the milk man? Do you owe for instruments? for books? for medical journals? Do you own your home? Is the education of your children being properly lookt after? Has your wife the necessary money to look after the numerous household needs, and personal needs of herself and the children, or does she have to beg humbly and repeatedly for every dollar she gets? Is she enabled to assume and maintain the position in the society of your community that "the doctor's wife" should? or is she kept down, and not given opportunities for those useful activities of which she is capable? Here "endeth the first lesson" on doctors' investments. Only when everything in this paragraf is fulfilled are you ready to take up the next phase of the investment question for doctors, which is as follows:

Second-this one is very easy, but it is

the rock on which many doctors have been wreckt. It is easy because it is negativ. It is simply don't. Don't pursue any will-o'-the-wisp. Flaring advertisements, flamboyant circulars, enticing letters--beware of them all. Do you remember those enticing letters sent out by Julian Hawthorne a few years ago? They were classical-the best of their class. He and his fellows were on trial in New York City a short time ago on account of these letters and the money that they pulled out of the pockets of the gullible. I haven't watcht the papers to see the result of the trial. Suffice it to say that if any doctors sent money to him he will never get it back. This instance will serve as a text for this paragraf. Pay no attention to such entreaties by mail, and what is just as important, don't be taken in by slick agents that are traveling around offering opportunities for large profits. If you should be imprest by any of these things, promise yourself, or your wife, or promise me, that you will not close any such deal nor pay out a single dollar on any such deal until you consult your banker and get his approval. Do this and you will be pretty safe. If you can't leave your office to go with the agent to the bank, make an engagement to do so later in the day or the next day; or call your banker up on the phone. Don't be led into hasty closing or the signing of any paper by the agent saying that he must take the next train and can't wait. Many sign in haste and regret at leisure. Sign nothing except after the greatest deliberation. And when you die, don't let it be said in the papers that your estate consisted of stocks in gold mines, oil wells, tropical plantations, etc., worth many thousands of dollars on their face, but if put up at auction would bring about

15 cents.

Third. After living up to the above faithfully, the atmosphere is pretty clear. After you have accumulated some savings and kept the money in bank awhile to really be certain that you have got it and can keep it, you are ready to consider some safe and sound investment. Now go to your banker and talk to him and have confidence in him just like a patient talks to you and has confidence in you. He will know about any good local investment. Ask him about the stock of his own bank. Bank stock is usually a safe and profitable investment. He will talk to you about

railroad stock and bonds, municipal and state bonds, etc., and possibly real estate. City lots or farm land are usually considered "solid" investments; but both judgment and "luck" have much to do in determining the success of such investments. Agricultural lands have increast in value very greatly in the last ten years. Will they hold their present value? That is a question. Will they continue to rise in value? Doubtful, except in specially favored localities. And don't forget shares in a good building and loan association, preferably a local one.

The New Burlingame Telegrafing Typewriter Co.

Dr. George P. Hamner, of Lynchburg, Va., asks about the above, and also about the Toledo Automobile Devices Co. I wrote to the Readers' Service of World's Work for whatever information they could give, and this is their reply:

Answering your letter of December 6th, we beg to say that we have no information whatsoever about the Toledo Automobile Devices Company; nor can we undertake to prophesy as to the future of the New Burlingame Telegrafing Typewriter Company. This proposition, in our opinion, never did have any investment merit, and we do not think it ever will have. Our time nowadays is so far taken up with propositions about whose character there can be no doubt that we cannot find opportunity to keep in touch with the scores of propositions about whose character there are serious doubts.

We clipt the following from the Philadelphia North American:

$10,000,000 COMPANY ACCUSED OF FRAUD.

NEW YORK, Dec. 11.-The American Telegraf and Typewriter Company, of Brooklyn, a corporation capitalized at $10,000,000 has been indicted by the federal grand jury on a charge of using the mails to defraud.

OFFICE OF

P. W. Pearsall, M. D.

Mr.

TO PROFESSIONAL SERVICES TO DATE. (Items of which can be had at the office.)

An early settlement of this bill is requested.

Office Over Stover's Drug Store.

Phone, Residence or Office, No. 33.

Received Payment

The federal authorities have been unable to find George A. Cardwell, president of the concern, for whom an order of arrest has been issued.

Attorneys for Alfred Benesch and Edward J. Beach, brokers, have promised to have them appear to-morrow before United States Commissioner Shields. It is alleged that Benesch and Beach disposed of $200,000 stock in the company.

Dr. W. C. Roberts, of Owatonna, Minn., asks for information concerning the National Mercantile Rating and Credit Agency of Milwaukee, Wis., and Phoenix, Ariz. He says: "They are supposed to collect information regarding physicians for the benefit of life insurance companies. They have certain men in all the larger cities who report to them." Who can tell us about this concern?

A Georgia brother sends us a copy of the agreement blank that is used by the Mercantile Reporting Company, of Newark, N. J. The client is to give 40% of the first $50 collected, and 10% thereafter, 50% on claims required to go to court, and-here is a new wrinkle: an additional 10% for "recording, tabulating and office filing." Claims withdrawn in process of settlement are subject to the above commissions. Doctors very seldom get anything out of accounts given to agencies for collection. The agencies get something, but there is rarely anything left for the doctor. The doctor furnishes the accounts and has to go to much trouble, all for the agency's benefit, for practically all, usually entirely all, the returns are eaten up by the numerous fees, commissions, etc. Then why do doctors persist in giving their accounts to agencies? Follow the advice given in these Talks and you will have no occasion to patronize collection agencies.