of one hand and the rod moved back and forth over the inner surface of the lid and retrotarsal fold with the other; the lid is also stretched a little at the same time by pulling the rod forward.

The lower lids are treated in the same manner, only the lower lid is drawn up when the rod is introduced. This treatment may be applied every day at first, and later less frequently. If all the follicles are not expressed after a few treatments, they can be opened with a needle or knife point before massaging the lid.

The plain glass rod has given such excellent results by mechanically stimulating the conjunctiva and thus hastening the absorption and reduction of the follicles, and thinning and smoothing out the lids, that I believe the ground glass rod with its advantages, has a place in the treatment of this disease.

The pressure between the lid and thumb can be made as strong as you wish, and the tarsus as well as the deeper layers of thickened conjunctiva can be reached by the treatinent.

The rod can be used in connection with any other treatment, after expression with forceps, and in all stages of the disease, even in the acute form, to better apply argyrol or other drug. Of course at this time vigorous massage should not be used.

Other forms of treatment which I will only mention are electrolysis following scarification which Lindsay Johnson after twenty-five years still believes to be the best treatment.

Treatment with radium or x-rays has been reported by some to give good results. Jequirity is recommended again every now and then for old trachoma with pannus, but it seems to me to be somewhat severe, as is also the inoculation with the gonococcus.

Excision of a strip of infiltrated fornix alone or combined with excision of the tarsus is considered by many to be an operation for the last stages of the disease when it is too late for other methods of treatment or the other methods have failed.

There are the necessary operations for the sequellae of trachoma such as canthotomy and entropium operations; also peritomy for pannus, etc., of which I will not speak.

REFERENCES.

1. Jameson: A Different Operative Method in the Treatment of Trachoma, with Notes upon the Construction of an Instrument Devised for the Purpose. Oph. Record, Feb., 1901.

2. Coover: A New Operative Procedure in the Treatment of Trachoma. Oph. Record, Feb., 1909. 3. Hotz: Treatment of Trachoma by Expression of the Granules. Archives of Oph., Vol. XV, 1886.

4. Noyes: Text-book, Disease of the Eye, 1890.

5. Knapp: Demonstration of a Roller Forceps. Constructed According to the Mangle Principle for Pressing out Trachoma Granulations with Remarks, Tran. Am. Oph. Soc., 1891.

6. Kuhnt: Uber den Heilwert der Mechanischen Methoden in der Therapie der Conjunctivitis Granulosa. Zeitsch fur Augenheilk., 1899.

7. Liekernik: Die Mechanische Behandlung der Trachamotos-erkrankten Conjunctiva. Central f. Prakt. Augenheilt., Feb., 1904.

8. Lindsay Johnson: On some points in the History and Pathology of Trachoma and a new Treatment. Transvaal Med. Jour., Feb., 1913.

122 S. Michigan Boul.

A LITANY FOR DOCTORS.

From too few patients and from too many patients; from hypodermic syringes that won't work; from book agents; from consultants who steal our cases; from rheumatism; from collecting agencies; from stupid nurses; from people who are going to pay for visit next Saturday night; from antikamia calendars; from tire troubles and Christian Scientists-good Lord deliver us.

From the people who begin their letters to us, "Dear Sir"; from static machines in damp weather; from boils on the back of the neck; from debts and detail men; from Pa-pa-yans Bell blotters; from anti-vivesectionists; from nurses who know more than we do; from "cures" for tuberculosis; from "textbook" papers, from incurable cases of imaginary disease; from Bernard McFaddists; from tag days; from new methods of administering salvarsan; from "automobile" fractures; from infant foods; from anti-vaccinationists; from nature curers; from Immanuel Movers and the treponema pallida-good Lord deliver us.

From the people who call us "Doc"; from malpractice suits and deadbeats; from gossips; from overly-grateful female patients; from pretty nurses and jealous wives; from the doctor who succeeds in a case; from the wrong number" mistake; from consultations by telephone; from the counter-prescribing druggist; from lawyers and dentists; from samples of Sal Hepatica; from the man who wants us to help his lady friend out of trouble; from calls at 2 a. m.; from shoulder presentations; from optometrists and engine trouble; from the man who "cannot add anything to the paper, but merely wants to compliment the essayist"; from meta-amidopenylparamethoxychinolin; from New Thoughters and mining stocks; from breaking catgut; from neurasthenics; from "the sponge we left behind us," and from the dangers of tricresol 0.4 per cent.-good Lord deliver us. Amen.

-From the Lancet Clinic.

From the surgeon, whether of class or "group" A, B, C, or X, who removes a normal appendix through an incision for nephorraphy:

From Ohrspeicheldruesenentzuendung:

And from Phenyldimethylpyrazolonamidemethansulphonsaures natrium.

Good Lord, deliver us.

Medical circles throughout the middle west have been recently agitated by the formation of an association known as the "American College of Surgeons," whose avowed object is to regulate the practice of Surgery (sic) and to elevate the same. A consideration of the relations of this body to the medical profession, as far as they are apparent at the present time, will be of interest.

"A" The American College of Surgeons was incorporated at Springfield, Ill., Nov. 25, 1912. The object for which this association was formed as stated in its charter is "To establish a standard with minimum requirements for the practice of surgery by graduates of medicine, and to devise methods of ascertaining who meet these requirements, and to confer upon such persons a fellowship in this association."

This association, then, is composed of a body of men selected, for various reasons, by individuals in different parts of this country and Canada who were authorized by the incorporators of the association to act as mentors for their particular territory. The only qualification nec

in some cases exceedingly remote, and sympathy with the purpose of the organization, which in some instances at least appears to be due to a fear of wrath to come, as the board of regents will be under the domination of the incorporators and the latter are responsible to nobody.

In England the society after which the American College of Surgeons is patterned is the outgrowth of centuries of association with privileged classes in social and political life, and governmental affairs, a situation which has no counterpart in American life and institutions, and which is contrary to the spirit of American Medicine. As far as the relations of such a body to the welfare of the medical profession is concerned the Royal College has never accomplished anything for the mass of British practitioners which would entitle it to special distinction, except to favor the aggrandizement of the few at the expense of the many.

One of the objects of the C. of S. as specified in its charter, and apparently the chief one, is to determine who shall practice surgery. To the unprejudiced mind it would appear that in consideration of the authority vested in the university diploma, and that legally applying to State license to practice medicine, the assumption of this duty by a self constituted, unauthorized association is somewhat anomalous. The intention of this association to go to the various State legislatures and have the laws so amended as to relegate to them, or some other body, licensing power restricting the practice of surgery to those who have had special training and experience, is impracticable because in the general practice of medicine the line between medicine and surgery cannot be so definitely drawn and the restrictions placed on the country doctor would be such as to render him practically useless to his community. In the matter of restricting the practice of special surgery to the elect there appear the objections of definite division of field, emergencies, and above all, the fact that such a course would not conserve the public welfare as completely as claimed.

Better surgical work is undoubtedly needed. It would be a sad day for medicine if this were not generally recognized; but to fling hearges of "legalized murder" and accuse the man who is "nothing more" than a physician with at

tempting to practice surgery appears rather strange coming from those whose beginning in surgical fields was and is today marked by trails. that were not outlined in medical publications. Perfection of technic is essential to the surgeons, but it does not make the surgeon. In the absence of pathological knowledge and prognostic skill and good judgment the so-called surgeon is a greater menace to the public than the tyro in surgery. Likewise the physician who is entitled to the appellation has too much sense to attempt surgical work for which he has not been trained, while the one who lacks sense is a covert and even a greater menace than the ill-equipped surgeon. Medical standards have advanced more rapidly in the past fifteen years than during any period of fifty years in the history of medicine. We need further advances, but they should come through the various State boards of health and should be furthered by appropriate committees of the American Medical Association, the State societies and their constituent bodies.

We do not believe the assumption of these reforms by a self constituted body of medical men is advisable, especially when such organization is so palpably open to the charge of self advancement of its members that even the laymen are asking "What are you going to do about it?" Reasonable objection to the formation of a surgical oligarchy can not be made provided such an organization does not advertise itself in a manner offensive to the medical profession. We would all admire (their "gall") but do not care to wear the collar of their authority.

THE APPELLATE COURT DECISION

In our November issue we published the major part of the decision of the Appellate Court, entitled “The People, ex rel., G. Frank Lydston, appellant, vs. John E. Wayman, state's attorney, appellee," a case very materially affecting the legal status of the American Medical Association.

In the Journal, November 22, there is an editorial and also an article signed by the chairman and secretary of the board of trustees, both articles entitled "The Alleged Decision Against the American Medical Association."

We have no fight with the American Medical Association-in fact, we think that every member of the American Medical Association owns a

small portion, jointly with other members of that Association, and is, therefore, vitally interested in matters that relate to that society.

We maintain that, in right and justice, each member is entitled to know the affairs of the society. If the transactions of the society have been carried on illegally,—and it does look as if such were the case-why should not every member of the Society know it? If there was any question raised by anyone-member or non-member-as to whether or not the transactions of the society were legal actions, why should not the officers of the American Medical Association be the first to investigate if, through error or otherwise, the Association was breaking any of the laws of Illinois? They should be the first to know, and it should be their duty to ascertain such facts-not only to ascertain such facts, but also to publish them, so that each member might know.

The court, in its decision, took some pains to analyze the cause of this suit, and showed clearly that it is a question of vital interest to the society. The trustees should have had this decision published in the Journal, and they should accelerate in any way they may a decision by the Supreme Court.

ARE AUTOMOBILE REGISTRATION
LAWS VALID?

The Ohio State Automobile Association is waging a fight truly national in character in which it is aimed to restrain the secretary of state of Ohio from collecting registration taxes on motor cars, and victory has come to its initial efforts in that a Franklin county judge of the state has decided that the present high rate of registration in Ohio is illegal and really constitutes double taxation. The judge in reaching this decision does so on the ground that the present Ohio registration rate not only provides enough money to defray the cost of registration but also sufficient money to be used in road construction and maintenance. He further is correct in holding that moneys for road construction must come from a common tax and not a special registration tax. In that motor car owners in Ohio pay a personal property tax it is prima facie evidence that they are burdened with the double-taxation load against which they are protesting.

This initial victory demonstrates that the in

justices of certain abnormal motor car registration fees is at least filtering into the ears of the judiciary. Should this Ohio county decision be sustained in the supreme court of the state it will stand as a sufficient precedent in the legal world to cause motorists in every other state where high registration fees and personal property taxes are imposed to get busy and see what can be accomplished.

It has been a general under-current of conviction that states have not any right to charge registration fees in excess of the cost of the department, and New York and a few other states. made an agreement with the legislature that where a nominal registration fee is imposed it has been in lieu of personal property tax. These states have a much lower registration fee than some other states in which the motorist pays a personal property tax, and pays a wheel tax for the use of the highway in addition to the registration fee. In such states the warfare against illegal double taxation should be taken up with renewed effort. Give Ohio assistance and if the supreme court in Ohio backs up the movement there is a fighting chance that better justice will be meted out in other states in the immediate future.

This decision is of vital importance to every physician, for the profession is now suffering

from over-taxation.

PUBLIC HEALTH INSTRUCTION: SUPPLY AND DEMAND.

For the past twenty-five years qualifications in public health have been required of medical officers of health to population of 50,000 or over in Great Britain. This has led to a gradual increase in the institutions offering such instruction until at the present time seventeen universities and three examining boards in the United Kingdom offer such degrees at M. D. in State Medicine, Bachelor and Doctor of Science in Hygiene, Bachelor and Doctor in Hygiene and diplomas in public health.2

The requirements for these degrees have varied with the advance of knowledge in the field of preventive medicine, the tendency being to in

1. Local Government Act, England and Wales, 1888.

2. Public Health, London, September, 1913, page 349.

crease the requirements in practical experience in the details of administration and the enforcement of sanitary rules and regulations. The General Medical Council requires that graduates shall attend at least a nine months' curriculum: laboratory instruction shall cover at least four months: six months' practical study of details of administration under medical officers of health of large jurisdiction: or that the applicant himself shall have had three years' experience as a medical officer of health of a population of 15,000 or over. He must also attend a hospital for infectious diseases for three months. Finally, he must submit to an examination covering four days.

Medical literature on public health, school medical inspection and allied branches, especially that in the English journals, shows the almost universal D. P. H. qualification among English health officials. The reason, both for the number of courses offered and the large number of students, lies, of course, in the requirement by the appointive power of such qualification.

How does this compare with the attitude of American officials charged with the appointment of public health administrators? The question answers itself. We cannot admit that the ideals in American public health work are lower than in England, but there is a great difference, and politics too often "rules the roost." The greatly increased diffusion of popular information on the elements of preventive medicine in recent years here has increased the demand that contagious diseases should be controlled, that water and milk supplies should be made safe, and latterly that even the supply of defectives and criminals should be arrested at the source. Much excellent work has been done by American health officers. But the fact remains that there is no demand for competent full time health officers except in a few of our largest cities when measured by the financial returns offered. As the truth that money spent in prevention of disease pays fabulous returns gets under the hide of the public more and more communities will insist on competence rather than expediency in the appointment of public health officers, and naturally the pay will have to attract the right kind of

men.

There is not much to say about courses in pub

lic health instruction in this country. The University of Pennsylvania offered a course for certified sanitarians in 1906 to anyone competent to pursue the course, not necessarily medical graduates. In 1909 it amplified its course and gave the degree of Doctor of Public Hygiene to physicians after studies covering one college year. Thirteen persons have completed the course.

The University of Michigan has offered the degree of Master of Science of Public Health for a course covering one year and the degree of Doctor of Public Health for a course covering two years. To enter either course the applicant must possess the degree of B. S. or A. B. and M. D. Although these courses have been offered for the past three years no one has completed the course and the requirement of the bachelor's degree may soon be omitted.

Harvard University has offered the degree of Doctor of Public Health the past three years and this year Harvard and the Massachusetts Institute of Technology, combined, offer the Certificate of Public Health to medical graduates and Bachelors of Science in Biology for an elective year course in both institutions, the course to be approved by the Administrative Board in each

case.

The University of Wisconsin, in connection with the State Department of Public Health, offers a one-year course leading to a diploma of public health. This is open to those who hold a degree in medicine or in medical or sanitary science. The university also offers a two years course with the degree of Dr. P. H. The second year must be spent at the university in original research leading to a thesis. Only one person has obtained the degree to date.

The Detroit College of Medicine and Surgery offers a one-year course to medical graduates leading to the degree of Master of Public Health.

The University of Minnesota will probably offer a six weeks' course next summer for health

officers. This seems to cover the field in public health instruction except such partial courses in several medical colleges as are given in the regular medical course and such practical instruction as that in the so-called "School of Sanitary Instruction" of the Chicago Department of Health.

The few courses offered and the small attendance only emphasize the fact that the present

emoluments of health officers in this country are not sufficient to induce men to qualify for such a

career.

The experiment of trying a combination health department for several towns located within a few miles of each other, now being tried out in Massachusetts and soon to be installed in three small cities in Illinois, may prove to be applicable to many other groups of towns which separately could not offer sufficient inducements for competent sanitarians.

Thus may the hope of Dr. V. C. Vaughan, Dean of the Department of Medicine and Surgery, University of Michigan, come true:

"The people at large are beginning to realize the great value of preventive medicine, and there are many cities now looking for first-class health officers. It will be a long time before positions of this kind will be wholly divorced from political pull, but I am an optimist and believe that it will come in good time."

Dr. M. J. Rosenau, Director of the School for Health Officers, Harvard University and the Massachusetts Institute of Technology, also is optimistic and writes as follows: "It seems to me that there is a demand for this kind of education, and although politics now rules the roost, I think matters are going to mend and efficiency will sooner or later be the rule in health organizations."