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correctly in the Journal. Many of the secretaries fail to send us the minutes of their meetings, and then we publish the same according to clippings received which in many instances contain errors. When an error of this character creeps in, the Journal is taken to task about the same. This is wrong and the error is due to the County Secretary instead of the Journal. Always report the minutes of your meetings as soon as held to this office and no errors will occur.

The secretaries should inform the Journal of anything that has been done of a special nature. If papers have been read, send us the papers for publication; if the entire article cannot be obtained send us a synopsis of the of the same as only by this interchange of ideas can we succeed.

Our Annual State Society Meeting will be known as a Victory Meeting, and it is evident that the addresses and the major portion of the papers will pertain to war work in some form or other. Our exchanges also show that other states have this same form of meeting in mind. By the announcement of the A.M.A. the Atlantic City meeting will be a Victory Meeting.

We do need the co-operation of the component Societies to make this meeting one of the best that has ever been held, and to contribute to the Society such requests as already have been made. The Journal wishes to publish the pictures of all of their members who have done cantonment or overseas work.

The County Societies must send in the photographs of their members so that they will gain their proper recognition and if it is not done, the Journal cannot be responsible for the failure of their non-appearance.

All this data must be in the hands of the Journal not later than April 1st as we go to press on that date. Our Journal will be a

the appropriation for the Venereal Disease question and its eradication will pass.

Some objection has been raised relative to the full time health officer. When medical legislation is attempted and bills are presented which in the main show a betterment for the profession it is evident that some minor points are made exceptions. We should grant to the framers of these bills honor and good intent for their presentation. The medical legislation has been very lax due to the fact that the members of the profession are either not united as they should be for their own preservation and betterment or they show a too lax interest in measures of this character. We will admit that some changes might be made, but these are good bills and should pass, but if the profession is going to knock on minor conditions of the bills and present this or the other objection to their representative, no bill no matter of what character is going to be able to be passed on account of these objections as the representative does not know what is best to be done and it is on this account that many good bills have been presented and have been pigeon holed. These small variations should be lain aside when the object of the measure is for the good of the majority, and we should not thwart its usefulness by individual selfish

ness.

We hope that the profession as a unit will give its full support to the passage of the bills. that relate to medicine which are before this legislative board.

"OVER HERE."

Increasing experience and continued association in a professional relationship with our more severely wounded soldiers who are yet unfit to undertake the journey homeward continues to increase our knowledge of the surgical problems that are involved in the care that is required for their restoration to health and

large one and it will take a considerable length physical activity. It would be fatuous indeed

of time to make all corrections which are necessary prior to publication.

MEDICAL LEGISLATION.

The Journal has been credibly informed that the bill "To promote the protection of the public health, to provide for the appointment of county health officers in and for the various counties of the State, and to prescribe the compensation, powers and duties thereof," and

to attempt to set forth any dogmatic principles of treatment or express fixed opinions upon this or that method or form of surgical treatment. Neither do I believe that there exists among the medical officers now in France a unanimity of opinions regarding any single method. Every procedure that is being employed has its adherents as well as its opposers. No happy medium or routine form of treatment seemingly exists and one pursues the methods that personal experience dictates as

the means best suited to surmount the difficulties that confront the surgeon.

Personally I've seen over 5,000 cases of wounded soldiers and in addition to a physical examination I've had the opportunity of reviewing their clinical records of various services in which they had undergone treatment before reaching this base. I have been afforded the opportunity of noting the results secured from varied methods that were employed. While most all these methods represent much that is commendable yet they likewise give physical evidence of details and principles that are pernicious. The end results can as yet not be tabulated and final conclusions must be postponed until some future date.

It is here that I may make note that the results of imparted conclusions of writers who discuss any series of cases must be discounted unless they are based on statistics wherein each group of such series and each case has been followed until the soldier returned to full duty or was actually discharged from the service. There has been and will be, possibly by reason of pardonable enthusiasm, a tendency to publish personal experiences and conclusions on certain surgical conditions that came under an author's personal care. The series may deal with hundreds or even thousands of cases and so present an impressive array of cases. Unless that author has followed these cases beyond his own hospital base, from which they are frequently evacuated before the ultimate result is established, his conclusions may tend to lead one astray from dependable surgical axioms.

I am continually encountering cases which are far from convalescent and which might easily be considered as having undergone an "uneventful recovery" but which are in reality far from the recovered state and still require radical surgical work that bears no relationship to reconstructive surgery. I therefor believe firmly that we would all do well to simply set forth our results as far as we have been connected with any given condition and there cause our conclusions to be but tentative with the implied reservation that definite pronouncements must await more matured observations and summarization.

A personal experience with a goodly number of empyemas in which Dakin's solution had been used by others who preceded us while I was at Camp Sherman and in collaboration with Major W. T. Dodge and a like and continuing experience since my arrival in France strongly causes me to be inclined to speak in severest

and most emphatic terms of condemnation of Dakin's Solution for pleural irrigation. I have yet to see a case that did not evidence the prolongation of that condition. longation of that condition. I must yet be convinced that it is the solution par excellence and while holding myself open to conviction; I am becoming more and more impressed with the fact that it is a pernicious practice to employ that solution in empyema. He who inspires its employment and thoracotomy in preference to costatectomy without irrigation is subscribing to an unsurgical procedure that merits naught but condemnation. I have vet to see wherein it has any claim for preference.

While speaking of Dakin's solution and also while fully realizing that many able men are on record as testifying to its efficacy I am personally becoming more and more opposed to its use as I am forced to deal with conditions in which it has been employed. I realize that often it has been employed incorrectly and not in accordance with the technic established still my observations are based on surgical results wherein its proper method of use had been observed. I confess to

a regret to have to assume such an attitude and am still holding myself ready to subscribe to the use of Dakin's solution but thus far I've not encountered results that would cause me to employ it in any surgical condition.

Probably the most universal treatment, that was in vogue at the time that actual fighting ceased, for the treatment of battle wounds was that form commonly termed as "debridement."

As many know it calls for a wide and free dissection of all lacerated and infected tissues and the conservation only of vital anatomical structures. The resulting wound is not sutured but is drained, packed and left wide open. That method has without doubt prevented the loss of like from infection. It likewise accounts for the long period of hospitalization required by a wounded soldier and also will be the cause for continued hospital residence for reconstructive surgical procedures after the soldier is returned to the United States. The time element, while an important factor, becomes a matter of but minor consideration when we reflect that life has been saved and functional use will be largely regained when the benefits of constructive surgery are subsequently obtained. It also accounts for the wounded's delayed return home and is likewise the reason why so many of the profession are on duty in the Base Hospital centers in France. Debridement is a

recognized surgical practice and will be of continued value in industrial surgery.

As stated in the opening paragraph my relationship with increasingly large number of cases is leading me into large fields of surgical conditions that present fertile pastures for detailed observation. As passing days bring the final results and an opportunity is thus afforded for matured reflection and ultimate conclusions I am desisting from making any definite statements. I am hoping that the opportunity may be mine to discuss in detail the principles of war surgery and am collecting case records for that purpose. This communication is but intended to arouse an analytical attitude towards all such problems.

Sincerely,

FREDERICK C. WARNSHUIS, Major, M. C.

THE FAILURE OF GERMAN COMPULSORY HEALTH INSURANCE.

Prior to the entering of the United States into the world war, social insurance was under general discussion in medical, public health, social reform and philanthropic circles. Eight states appointed commissions to investigate the subject and submit reports and recommendations. With the return of peace it is highly probable that this discussion will be resumed. While the American Medical Association has taken no definite stand on the fundamental questions involved, it has, by the adoption of the resolutions presented to the House of Delegates in New York in 1917, indicated a minimum basis on which the medical profession will co-operate in case the plan is adopted by any state. To the majority of physicians the question is an open one on which they are keenly desirous of securing all the information possible. Much has been written in favor of social insurance from an economic and public health standpoint; many claims have been made regarding results in other countries; but little has been written in the form of definite criticism of the proposed plan and its results elsewhere. For this reason, the paper presented before the twelfth annual meeting of the Association of Life Insurance Presidents by Mr. Frederick L. Hoffman will doubtless arouse considerable discussion.

The primary purpose of the establishment of compulsory social insurance in Germany, according to Mr. Hoffman, was to hinder the rise, curtail the power, and ultimately destroy the socialistic movement in Germany. "By means of a cleverly devised terminology and downright methods of deliberate deception, the German working people were deluded into the belief" that compulsory health insurance was primarily intended for their benefit. In this way the German government hoped to bring about the complete subjection of German wage earners to the will of the bureaucratic and political machine. "All compulsory social insurance," says Mr. Hoffman, "rests on profound misconceptions of life and labor in a democracy, for it involves the

establishment of permanent class distinctions." After thirty years' trial in Germany, compulsory health insurance, he asserts, has not improved the health of the working portion of the community or the standard of public health, while financially it is at present in a condition of chaos. It has increased malingering among employees to such an extent that only 26.6 per cent. of the alleged illness in Leipzig was found to be real. As to the claim of improvement in the health of employees, in 18841885, in Dresden when the fund was established, the percentage of employees claiming sick benefit was 30.4, while in 1913, after twenty-nine years of operation, the percentage was 32.2; in other words, the amount of illness among the insured after thirty years of insurance was greater than it was in the beginning. There were 27.7 per cent. of deaths from tuberculosis among male wage earners, as compared with 21 per cent. for the same class in the United States registration area. Regarding financial conditions, the report of the sick fund for Konigsberg for 1917 shows that expenditures have increased 75 per cent. as compared with 1915, and that the assessment on wages has been raised from 4.5 per cent. to 6 per cent. to meet this increased expense. Dishonesty and deception on the part of patients, druggists and physicians with a general undermining of the morale of the community, are also charged. Some of Mr. Hoffman's conclusions bear on the social results of compulsory insurance. It has not checked the spread of socialism in Germany, he asserts, but has increased the demand of workmen for additional benefits; it has not improved the economic condition of the German wage earner, since the benefits that it provides were never adequate to meet more than the requirements of the minimum standard of living. It has not reduced disease nor improved public health conditions. In the field of sanitary reform the United States, in the last thirty years, he declares, has advanced far more rapidly without social insurance than Germany has with it. The death rate in Germany has not diminished proportionately as it has in this country. The condition of the medical profession in Germany has not been improved, but, on the contrary, the ethical standards of the profession have been perceptibly lowered. The sickness rate among German wage earners has not been reduced; increased demands on the funds both now and in the future will require either increased contributions from wage earners, withdrawals from the financial reserves, or both. The system has resulted in a lowering of social and individual morality and has fostered deception, dissatisfaction and dissimulation. The German experience in Mr. Hoffman's opinion, proves the inadequacy of social insurance as an effective means of securing the required degree of continuous social progress demanded by modern standards of labor and life.

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paper is a specific attack on the proposed social insurance plan, and as such should be considered by the student of the subject-Jour. A.M.A,. Feb. 1, 1919.

MICHIGAN WILL PROHIBIT THE DENTAL PARLOR METHOD OF PRACTICING DENTISTRY.

C. N. Johnson, M.A.D.D.S.,

Editor of the Dental Review,

913 Marshall Field Bldg., Chicago, Ill. The quack dentist is just as bad as the quack physician. Both are capable of doing great damage as has been abundantly demonstrated in the past. In most states legislation has been enacted to protect the people against the quack physician and a similar disposition is developing against the quack dentist. No intelligent legislator would for a moment think of patronizing a quack or sending his family to such a man. He is too well informed, and has too much at heart his family's interests to take such a chance as that. Why then should he be willing that his constituents, many of whom are not so well able to judge of such matters as he is, be subjected to this kind of imposition when he has it within his power to protect them?

Reputable men either in medicine or dentistry do not hide behind high-sounding and misleading names. These fictitious titles are merely bait to catch the unwary, and they have already caught enough to drag the name of dentistry into the dirt.

If all the endless aches and pains caused by these quack concerns were possible of concentration they would send a howl to heaven that would ring in the ears of legislators till they passed the needed measure to abolish such imposition. It is the tendency of the age to expose fraud and wrong doing. Investigations are in progress all the while against commercial combinations and monopolies. How much more important it is to expose the wrong which injures the individual instead of his pocketbook. This is a matter not only of money, but of the welfare and even the lives of the people who are represented by the legislators of the sovereign state, and no legislator will hesitate for one moment to protect his constituents if he only knows clearly and fully what is for their greatest good. Suppressing quackery is one of the most tangible benefits that any legislator can pass on to his people.

An amendment to the dental statute of the State of Michigan has been introduced into the Legislature, which aims to prohibit the practice of dentistry under a trade name, and the best interests of the people of Michigan requires that it should be passed.

New York State already has this law, and the Attorney General and the Assistant Commissioner of Education, Mr. Augustus Downing can attest to its value as a public health measure. The New York Law reads as follows:

The New York Law.

"A person shall be deemed guilty of a misdemeanor and upon every conviction thereof shall be punishedy a fine of not less than two hun

dred and fifty dollars, or by imprisonment for not less than six months or by both fine and imprisonment, who

"Shall practice dentistry under a false or assumed name or under the license or registration of another person of the same same, or under the name of a corporation, company, association, parlor or trade name, etc., etc." The exception being legally incorporated concerns in existence at the time of the passage of the act, who were permitted to continue, on condition that they employ only licensed dentists to operate, and that their advertising matter should conform with rules made by the Board of Regents. A further condition being that if any such corporation should cease to do business for any reason, it would not be permitted to resume.

It may seem anomalous that it should be considered against the public weal to practice dentistry under a trade name, and that nevertheless the very statute which erected this dogma should yet make exceptions permitting stated concerns to do the very thing declared thereafter to be illegal. But unfortunately, while the framers of the law did desire a wholesale house clearing, yet the State had already, through ignorance of the mischief which would ensue, granted corporation charters to certain concerns and the annulment of these charters was not possible in a single act regulating the future practice of dentistry. It is to be observed however that by creating regulatory powers over these dental corporations the Regents acquired opportunity greatly to mitigate the evil practices commonly attributed to such places.

Passing from the New York Law, which within a very few years has compelled some three hundred illegal practitioners to discontinue, and which has forced a large number of dental parlors out of business, let us discuss the need of such an act as Michigan is now contemplating.

Evils of Dental Parlor Methods.

The Dental Parlor men will probably ask, at any public hearing of this question which may be held: "Why do you object to our doing business under a trade name?" This question should be squarely met and answered, but before essaying such reply those men should in turn be asked: "Why do you wish to do business under a trade name?" The replies, if any be made, will not aim to disclose the truth but rather conceal it. The writer indeed would be most interested to hear the answers. He recalls being present at a meeting of advertising dentists when the New York bill was pending, and he asked this same question: "Why do you wish to do business under a trade name? Why not use your own name?" The man addressed hesitated a moment and then said: "Well you see, I am not a dentist!" and then hastily added "But I employ only licensed men, and they must be crackerjacks to work for me."

This brings out at once one of the prominent evils of such a system. A man, not a dentist at all, and consequently not even competent to judge the skill of the men whom he hires, may yet conduct a Dental Parlor and attract deluded patients by alluring, misleading and often impossible promises in his advertising matter.

Indeed the very trade name itself is almost invariably, in a very definite sense a deception. "The Roston Dental Parlors" probably has no Bostonian connected with it. The same is true of "The New York Dental Parlors," "The Chicago Dental Parlors" and places with like names. Since the war began, and the Red Cross has become a name to conjure with, we find "Red Cross Dental Parlors" springing up. These probably would be "closed up" were not the Red Cross officials too busy just now to attend to such affairs. Then of course we have "Painless Dental Parlors" all over our land, in every one of which painful operations are performed.

But "pain" is the great bugaboo of patients, and the word "painless" is the most psychologically attractive name that can be used. Alliteration likewise being useful we find the celebrated Dr. Parker of Brooklyn Borough, New York calling himself "Painless Parker." To give himself the right to use this name he even went so far as to have his name legally changed to "Painless Parker" by some western state. But New York declines to recognize the alteration of this name and holds that no Dr. Painless Parker has a right to a license in this state. Moreover under the law above cited it has prohibited the conducting of any Painless Parker Dental Parlors. As the law has already been tested in the Courts, Dr. Parker has yielded and has even agreed to have the state which altered his name, change it back to his original name, Randolph Parker, and any dental practice done by him in the future in New York State will be done in the name of Dr. Randolph Parker.

In a recent issue of Printer's Ink Dr. Parker defends his advertising methods, and it is not germane to our present subject to answer his arguments. But he says that dentistry is a business like any other business, and that men practice dentistry to make money. Unfortunately others have said the same thing. We have heard many a dentist state "I am not in business for my health.” It is against men who hold such views that the Community must be safeguarded by such statutes as New York has, and Michigan soon will have. Men in dentistry should be in dentistry not for their own health perhaps, but assuredly for the health of their clients. Men who think of the emoluments first and make the best interest of the patient secondary, or even more distant, should not be in practice at all.

While it may be true, as Dr. Parker says that many, altogether too many men practice dentistry because they look upon it as a ready means of earning money, nevertheless it is also true that there are literally thousands of dentists who have no thought at all of "How much can I make out of this patient?" but who invariably approach a case with the mental thought "How much can I do to benefit this patient." Undoubtedly these men render bills for their services, but they earn their fees not as these Dental Parlor men would have legislators believe, as men in business do, by selling wares, but rather as the minister does who dispenses ministrations. And it is exactly this class of dentists who have made dentistry the profession that it is; who have done the research work, founded the schools and taught in them, thus making it possible for Dr. Parker and

others who look upon dentistry as a business, to "do business" at all.

Purpose of Trade Names.

The true and chief reason why any men desire to practice under trade names is because they do not wish to practice dentistry as a profession, but as a business. They wish to use a Trade name so that none of their employes may become sufficiently known to their clients or identified with the business to be able to "open up in the same block and steal 'trade.'"

Perhaps one of the chief reasons why trade names should be prohibited may be made clear by contrasting two pictures.

The "Get Rich Quick Dental Parlors" hires ten young licensed dentists to work for them. These men are invariably watched. It is especially noted whether or not a particular operator seems to be attracting friendships among the office patients. If so, such patients are constantly transferred to other operators. Thus the individual patient is not treated by an individual dentist, but his teeth are cared for by the "Get Rich Quick Dental Parlors." Is it to be believed that such an institution can really engage the services of competent men? Would really capable men endure such an environment? If a skil ful young man, because of supposed necessity accepts temporary employment in such Dental Parlor, he makes this as temporary as possible. He saves as rapidly as he can and then goes into private practice. And one prominent purpose of the Trade Name is to handicap this really skilled man and make it impossible for him to win the esteem of patients. Hence such employe has nothing at all to work for but his salary, and it is a well known fact that such wage earners almost invariably do as little as possible for their wage.

Now let us examine the other picture. Take identically the same ten men, but set them up each in an office of his own. What will be his attitude towards any patients that may come in? For his own selfish sake, if you choose to put it so, he does the best that is within his powers for that patient Why? Because he has no salary, and his income therefore must depend upon his power to render service. AND HE DOES NOT USE PRINTER'S INK, HIS ONLY MEANS OF ADVERTISING HIMSELF IS THROUGH THE APPROVAL OF SATISFIED

PA

TIENTS. Hence it is abundantly evident that the Community is best served by that class of dentists who serve themselves best by doing their best. Men who ask themselves "How much can I do for this patient" rather than "how much can I make out of this patient."

Many of the Trade Dental Parlor men will try to befog the issue by declaring that better dentistry is done by them than by hundreds of private dentists. But the fact is that thousands and thousands of private dentists render better service than is obtainable in any or all of the Dental Parlors in the United States. That some private dentists render poorer service than the Parlors is not to be condoned by permitting the Parlors to continue. The fact, if fact it is, merely brings to the State one more problem to solve

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