The India Ink Method for Spirocheta. Joseph H. Barach, Pittsburg, Pa., (Journal A. M. A., November 26), cautions against the use of the India ink method in testing for the Spirochaeta pallida. This method consists in mixing the serum with diluted India ink on a glass slide and allowing it to dry in the air, and is so easy and requires so little technic that it is in danger of being almost universally used. By accident he discovered that the ink he was using (Higgin's) contained objects resembling spirochetes that might be readily mistaken for them by unskilled observers. A number of experienced laboratory workers also observed the same when their attention was called to it. Since then, in connection with Dr. George A. Holliday, he has examined all the obtainable inks sold as India inks and found in the most of them wavy fibers that closely resemble the spirochete. Hine's (Paris) India ink showed no actual fibers, but in the dark areas of the drying there were cracks which might be misleading. A culture of Higgins' India ink on Leoffler's blood mixture was negative at the end of seventy-two hours. He says that, since the accurate determination of the presence of Spirochaeta pallida is already often complicated by the presence of Spirochaeta refrigens, this use of India ink adds also another source of error. The spirochete-like objects he says seem capable of assuming various shapes and sizes, and, while most of them would not receive very serious consideration by experienced microscopists, he has come across some specimens, with a magnification of 1,300 diameters and higher which might delude even the experts. He offers his experience therefore as a warning against the India ink method in the diagnosis of syphillis by the finding of Spirochaeta pallida, especially by the non-expert and general practitioner, to whom it has been so strongly recommended. NOTES AND NEWS. Dr. W. C. Foster of Sunrise, Wyo., spent the holidays in Denver, Colo. Dr. Delroy Shingle has been elected a member of the city council of Cheyenne. Miss J. A. Brower of Topeka, Kan., has accepted the position of superintendent at the Wheatland Sanatorium. Dr. C. Y. Beard was recently elected to the office of Coroner for Laramie county, which office was formerly held by Dr. Desmond. Dr. G. P. Johnston is a valuable member of the Cheyenne city council and the newly elected President of its Board. Dr. Johnston was a member of the committee, which recently inspected several of the leading city water systems of Colorado, with a view to installing in Cheyenne the very best possible device for filtering the city water supply. A JOURNAL OF MEDICINE AND SURGERY Published Monthly by WESTERN MEDICAL REVIEW COMPANY, Omaha. Nebr. Annum, $2.00. The WESTERN MEDICAL REVIEW is the journalof Medical Association and is sent by order of the Association to each of its members, Per H. GIFFORD, M. D C. G. BEESON, Manager COLLABORATORS-SUBJECT TO REVISION. Crowley, C. F. Dunn, A. D. Davis, B. B. Foote, J. S. Artz, C. V. Hastings. Vol. XVI. OMAHA. Hamilton, H. P. Moore, R. C. Moriarty, Pierre C. McClanahan, H. M. Anderson, A. B., Pawnee City Poynter, Owen, F. S. C. W. M., Lincoln. Sward. E. J. C., Lincoln. OMAHA, NEB., MARCH, 1911. EDITORIAL. Medical Licensure and Reciprocity in Nebraska. No. 3 In an editorial article in the February number of the Review, Dr. F. A. Long of Madison, Neb., the state's delegate to the National Legislative Council of A. M. A. ,calls attention to the difficulties that the older physicians must contend with in securing reciprocal medical lisensure in other states. While we agree with Dr. Long in the main, we wish to call attention to the fact that all states are not unmindful of the claims of physicians of many years experience to special consideration in securing licenses by examination. In twenty-four states credits for years of practice are given to physicians applying for license by examination, the credits varying in each state. These states are Alabama, California, Delaware, Florida, Georgia, Idaho, Illinois, Iowa, Kentucky, New Mexica, Ohio, Oregon, Rhode Island, Texas, Vermont, West Virgina, Wisconsin and Wyoming. The credits allowed in any one of these states can be obtained by writing to the secretary of the state's board of medical examiners or to the editor of the Review. While Nebraska does not give any special credits for years of practice yet for some years the board of examiners has been giving special examinations to physicians of ten or more years of practice, laying special emphasis on the practical branches of the medical curriculum and the professional reputation of the applicant in his home community. This does not mean that a man absolutely deficient in knowledge of anatomy, chemistry, physiology or materia medica would be issued a license, but his examination in these branches is much less technical and searching than that given to recent graduates. This special privilege applies only to Nebraska physicians, as the reputability and professional standing of physicians from other states it not always easily or reliably obtainable. As Nebraska enjoys cordial reciprocal relations with about twenty-seven or twenty-eight states, more than any other state in the union, it can be readily seen that the older physicians of Nebraska are not at so serious a disadvantage at home or in other states as Dr. Long seems to believe; indeed the recent graduate, with the strict requirements as to preliminary preparation, years of attendance and searching examinations both written and practical, seems to be the one with the heaviest bandicap in many of the states. State Medical practice laws and boards of medical examiners are not intended to eliminate or cause unreasonable hardship to those at present engaged in legitimate medical practice, but are intended to raise the standard of professional qualification by enforcing more stringent requirements of those who are seeking to enter the ranks of the medical profession. Time will eliminate the older men rapidly enough and if the higher standard is enforced rigidly in regard to the recent graduate, the desired end will soon be accomplished. Dividing Professional Fees. At a meeting of the Erie County Pa. Medical Society, held Feb. 21, 1910, Dr. M. D. Mann, of Buffalo, presented a paper entitled "Dividing Professional Fees." The address was fully discussed and a resolution was unanimously adopted directing the president to appoint a committee to investigate the entire subject, including the causes and possible remedies. In obedience to such instructions a committee was appointed and the following are extracts from the report of this committee which appeared in full in the Journal A. M. A. for Feb. 7, 1911: "There is at least one profession that should be clean and have the confidence and trust of the public. Whatever may be its shortcomings in ability to help or save, the effort and purpose must be free from the taint of sordid commercial deals dependent on human suffering and woe. There is very often no more complete picture of helplessness than that of the sick who yearn for relief and know not where to seek it. If abuses exist, the profession must decide whether it will abolish them or allow them to prevail until the public is compelled to undertake the task. Your committee believes that the medical profession should perform the disagreeable work, and that an element is not afraid to expose or denounce iniquities which tend to degrade those who decently follow a noble calling. SECRET METHODS EMPLOYED The division of fees has been accomplished by numerous methods. All of them are more or less adroit, deceitful and dishonest. The principal effort has been directed to provide secrecy. In the course of time some operators have become bolder than others and have gradually converted the practice of surgery into a traffic of operating on commission. No one publicly justifies the commercial bargains. If it is defended privately, the excuse or argument is cynical, shifty, selfish or sophistical. After examination from every side there is no honest course except emphatic and unequivocal condemnation of this rather new species of hidden graft. No matter how cleverly the division of a fee is accomplished, it is done almost invariably without the knowledge of the patient. The person who pays for an operation does not know that part of the amount, which has varied from 25 to 60 per cent., ocasionally goes to the physician who recommended the operator. The physician and the surgeon are supposed to render their individual bills, and the afflicted person is entirely ignorant of the "gentlemen's agreement" or "community of interest" which has been introduced from the realms of high finance and legal honesty. The real purpose of the deal is to encourage the physician to send his patients where he can obtain a share of the money paid for relief or attempted relief. The surgeon may be highly competent or he may not be, and the physician may be influenced by financial encouragement. At all events, the performance must pay because it has flourished and been profitable at times when other methods would probably have failed. At times, the demands of the physicians have been quite high and some of the prosperous merchants in surgery may begin to wonder if they have not created a Frankenstein monster. CONTRACT PRACTICE AND OTHER EVILS Vicious, dangerous and cheap modes of practice have developed to a surprising extent in latter days. Medical and surgical relief under contract, and stultifying agreements with lodges, societies, benefit associations, etc., and underpaid services to life-insurance companies, have demoralized practice among young men and robbed others of just remuneration. These abuses are largely indefensible, being delusive to the patient and public, as the results are mostly ineffective, the service superficial and careless, and often of no genuine value. It is only just to young physicians and the public that this increasing abuse should be investigated and fully considered at a future time. There is much harm and humbug in the practice, and the physician should no longer be a tool for crude, cheap work. Positions held by medical men almost invariably yield totally inadequate compensation, and any protest is unavailing because the supply |