Medical organization and practice, to promote efficiency, requires two things:

1. That the public make the fullest use of efficient practitioners. 2. That medical men receive adequate income to provide the means

and methods necessary to efficiency.

These two things are interdependent.

This department is conducted as a forum for constructive discussion of these vital factors in medical progress.

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Doctor, What Do You Think of It?

What does the Medical Profession think of this governmental letting-down of the bars to quackery? What have the medical services of Army and Navy, the Public Health, or the American Medical Assotion done in protest against it?

HE SENATE COMMITTEE appointed to investigate Government activities for the relief of former service men made, about the last of October, a report that was sweeping in its criticism of many things and its condemnation of others, inclusive of some hospitals. Among other recommendations it suggested the elimination of politics from appointments, cancellation of certain contracts, reduction in personnel and the necessity for a get-busy management of affairs; and all of this largely due to the fact, as reported, that only 5,050 ex-soldiers have been rehabilitated out of 388,000 applicants. A part of the fault is due to unsuitable and poorly managed hospitals, some of them, it is alleged, selected and the personnel appointed for political reasons. latter charge may or may not be justified, but if it

This

is warranted by the facts, it is simply another instance of the fact that no sort of medical or hospital service can be effective when politically controlled.

THE AMERICAN PHYSICIAN does not care to embarrass any governmental board in its activities; but we have been on the ground in Washington sufficiently, and have talked with capable physicians in governmental activities rather directly to the point, and hence we are in position to assert that these physicians have been embarrassed by political pressure in their work, and therefore it is not at all remarkable that special investigation by the Senate finally became necessary and revealed the fact that too much politics was at the bottom of the whole trouble. Certainly a Senate committee would not so report without abundant justification.

Healing and Alleged Healing

While it is not our purpose to minimize in the least any criticism directed against certain hospitals and their medical management, we do wish to submit a verbatim copy of a Government bulletin which sheds a little light on the subject of what politics does when it mixes up with medical affairs. This bulletin is as follows:

From:

To:

Re:

1.

Information No. 97 Information No. 81 rescinded hereby.

July 14, 1921.

Phila., January, 1922]

4. Doctor, what do you think of it?

A Lesson For Us

Some man is ambitious to be elected to the Legislature. He tells his physician, who is not interested and who smiles quietly to himself, believing that Mr. Man has no chance for election. Mr. Man approaches other phyisicians. Nothing doing!

Then a chiropractic is approached. Business of handshaking and good fellowship. Mr. Chiro lines up Mr. Man to his way of thinking and secures the active help of all chiropractics and their friends in

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the district. Furthermore, the Chiropractic Association advertises regularly in the newspapers, and says a good word to the editors for Mr. Man. Don't forget that Mr. Chiro is exactly the kind of man that loves to break in as a political worker, while Mr. M. D. seldom takes an active interest in politics.

Mr. Man is elected and becomes The Honorable Frank Man. Then, when a bill comes up in the legislature granting all sorts of powers to a Board of Chiropractic Examiners, what does the Hon. Frank Man do? Go ask the Federal Board for Vocational Education.-T. S. B.

By H. W. CHAMPLIN, M.D., Towanda, Pa.

HE PEREMPTORY command of a general practitioner to me to remove the segments from

a pair of bifocal lenses prescribed for one of his patients and mine reminded me again of the antagonism between the family doctor and the specialist. The former allows his jealousy to deprive him and his patients of the help afforded by the practitioner who specializes in certain lines; and he shows his ill-feeling by assuming an air of superior knowledge in the other fellow's specialty. The same doctor sent a child back with the statement that his lenses were not right, and that I must change them. The eyes had been refracted under atropine, and some latent eye-strain corrected. Of course there was slight blurring of vision at first, but this was essential to the relief of headaches and other symptoms of eye strain. The doctor was a troublemaker instead of co-operating with the specialist to his own very great advantage as well as that of his patients.

Co-operation Needed

It is to the eye specialist that the family doctor manifests the worst spirit. He has some test letters in his office, and desires to determine if the glasses prescribed are right-being quite free with adverse opinions and criticisms, or, perhaps, expressing an equally unwarranted approval. His object is not to be so really mean as he is, but to show that his knowledge is not inferior to that of his fellow who has fitted himself for special practice.

In another way, also, the general practitioner vents his spleen most unworthily. According to him the

specialist has charged too much; he thus puts himself in right with the family to the disadvantage of the specialist.

The bad motive is due to this: The specialist has formerly been a fellow general practitioner who has at the expense of much time, money, and office equipment fitted himself for special practice. He has thereby gotten away from his co-worker and seems to be making more money with less hard work. Therefore the yet general practitioner "has it in for" his erstwhile fellow-worker. Or the specialist is a young man having had superior advantages, but has not had the experience of the family doctor; he manifests an over-weening desire to immediately acquire a highly lucrative practice. Such an attitude is not acceptable to the older men of the profession and accounts for the want of harmony between the general doctors and the specialists.

However, this animus is passing away, though, in spite of the apparent optimism, there is still an undercurrent of jealousy that does not tend to utmost good feeling and co-operation in the profession.

A young lady calls on the eye specialist with complaint of headaches hitherto incurable. She has taken headache palliatives until the last doctor has said it is not safe to take more; so as a last resort he has sent her to the oculist for refraction. Why has he not sent her first instead of last? He could then have treated her with profit and credit to himself.

Reciprocity Best for All

A most unworthy motive is that which prompts the family doctor to send his patients to a specialist in another town when entirely unwarranted by the suc

cess and reputation of the specialists. His patients are thus forced to incur extra expense and inconvenience to gratify an unworthy and unjust animosity.

This want of helpful and happy harmony in the medical profession has been the weakness that has permitted the osteopaths, chiropractors and optometrists to break into what ought to be and is strictly and exclusively medical work. It is true that "team work" is being practiced with more or less success in recent years. The same co-operation should be practiced by all medical practitioners whether nominally team work or not. By helping others we help ourselves if all adopt the method. But are we sure of reciprocity from the other fellow? Perhaps no one has ever tried it out more faithfully than the writer, and so far he is convinced that the millennium is not at hand.

THE AMERICAN PHYSICIAN wants to print both sides of a question; our pages are open. Doctor, what do you think?

Caution Patient, Using Argyrol, Danger of Argyria, Too Long Continued

CASE REPORT

By HYMAN I. GOLDSTEIN, M.D., Camden, N. J. Assistant in Medicine, Graduate School of Medicine, University of Pennsylvania, Phila., Pa.

I

HAD OCCASION to see a man in Atlantic City last summer who give the appearance of being very cyanotic. His face, lips and hands were a peculiar slate-blue color.

On examination, I found that Mr. Thomas R., was a Unitarian minister, aged sixty-one years. His home was in Boston, Mass., but owing to chronic bronchitis (?) he came to Atlantic City where he felt much better and therefore decided to remain here. He had influenza two years ago, scarlatina at thirty-two, smallpox at eighteen. He also had malaria. Nine years ago he had sore throat and was advised by his physician to use Argyrol. He continued the use of Argyrol twice daily for a year. He then noticed that he was turning "blue"-and has remained so.

There is a faint murmur (systolic) heard, after exercise, at the apex; otherwise general physical examination is entirely negative. Spleen was not palpable. Systolic blood pressure 122, diastolic 80. He "feels pretty good." Never had swelling of feet and legs. There is no clubbing of the fingers, no evidence of myocardial disease, of polycythemia, or emphysema, or congenital heart lesions.

Gottheil, November 21, 1909, reported before the

Medical Society of the County of New York a case of argyria in a man, aged thirty-seven years, who had syphilis. For seven years or more he was in the habit of applying a 10 or 15 per cent. solution of silver nitrate freely to his throat, several times a day. Undoubtedly, large amounts of the drug were gradually swallowed.

Crispin, of New York, in the Journal of the American Medical Association, May 2, 1914, page 1394, reported a case of argyrism in a young woman, who was taking collargol internally. Hexamethylenamin in ten-grain doses seemed to cause the dark color to fade, her complexion becoming several shades lighter.

Ballenger, of Atlanta, reported an unusual instance of poisoning with argyrol injected into the deep urethra and bladder, in a man aged 35, and mentions the fact that he has seen two patients with idiosyncrasies for argyrol when injected into the urethra.

Smith's case of argyria occurred in a man aged 55-after taking silver nitrate in quarter-grain doses, three times daily, for three months. The exposed surfaces, the skin of the hands and face, were chiefly affected. In the case reported by Guillemot, Michaux and Duval, silver nitrate pills were taken internally for tabes, a daily dose of 0.01 gm. for ten years.

In Lochte's case, argyria followed the use of injections of silver arsphenamin in a young woman, aged 21, who received seven (7) injections of neoarsphenamin, and later on was given injections of silver arsphenamin, which made her skin (face and body) a steel-gray color, also the eyes showed the same discoloration.

REFERENCES

1. Olson: Argyria localis due to organic silver preparations, J. A. M. A. 69; 87, July 14, 1917.

2. Stiger: Medicinal silver poisoning. Cor.-Bl. f. Schweiz. Aerzte 47; 1192, Sept. 15, 1917. 3. Savitz: Report of case of argyria. clinics 3; 59, 1920.

International

4. Smith: Report of case of Argyria. Illinois M. J. 38; 517, Dec., 1920.

5. Lochte: Argyria following silver arsphenamin injeetions. Therap. Halbmonatsh, 34; 334, June 15, 1920.

6. Guillemot, Michaux & Duval: Argyria; Bull. et mem.. Soc. Med. d. hop. de Paris, 44; 792, June 11, 1920. 7. Lancaster: Argyrol. Boston M. and S. J. 183; 565, Nov. 11, 1920. Ballenger: Atlanta Journal-Record of Medicine, July,

8.

1910.