A Sharp, but Well Intended Criticism Concerning What Should Be Admitted to Our Advertising Pages, Frankly Answered. DEAR DOCTOR TAYLOR:-Your fearless stand against frauds, medical, political, and commercial, induced me first to subscribe for THE WORLD, and has kept my name on your subscription list. What is true in my case applies to thousands of your subscribers, as you well know. I have not expected you to invert the world in a day, but don't you think, Doctor, the time has come to take another step forward and cut out some of the questionable ads. carried in THE WORLD? What about tongaline; manola; labordine; pneumo-phthysine; tanformal; unguentine; echitone; Micajah's uterin wafers; trophonine; listerine; Gray's tonic; sphenoids; germiletum; Naphey's wafers; vapo-cresolene; anasarcin; uric-antagon; and perhaps others I missed? Honest, Doctor Taylor, isn't it a pretty bum lot to admit into the pages of your beloved WORLD?

You criticise our Missouri brother for using bromo-seltzer with acetanilid (Jan. WORLD, page 9), but what assurance has any physician who uses any of the above with a U. S. P. drug at the same time, that he will not get a fatal synergistic action or an innocuous antagonism?

It occurs to me that in carrying these ads. you are in a degree responsible for degrading the weaker members of your readers into using these nostrums, and your position is analogous to what a prohibition paper would be which carried Old Tom Jones whiskey in its adv. columns, while hurling anathemas at rum editorially.

I have followed your position closely, Doctor, and am aware that you maintain that it is necessary to exclude only those advertised to the laity. It looks like hairsplitting to me, and in view of the recent exposures in the Journal of the A. M. A., demoralizing, degrading and little short of criminal to be a partner in the slightest degree in the perpetuation of the evil. I fervently hope you will see it in the same light, and THE MEDICAL WORLD will continue in the vanguard of this great movement. Success and the best of wishes for the new year to thee and thine. Fraternally yours,

Geneva, Pa.

A. W. CLOUSE.

[I guess it is pretty well known by this time that the Editor of this magazine never

dodges an issue. If anyone ever doubted this, the frank publication of the above should remove such doubt. Several (about 3 or 4) letters have been received recently on the above subject, and the above is chosen for publication and reply because it is the most complete, the most severe, and the most courteous of the lot. I do not know Dr. Clouse personally, but I wish to say that the spirit of the above does him credit. And also I wish to say here that the reply which follows, while being a reply to the above communication, is not intended as a reply to Dr. Clouse personally, but, rather, a reply to all who have recently become hypercritical of the adv. pages of medical journals. Now, let us be as frank (but not as severe) as Dr. Clouse, and take up, both in general and in detail, the merits of his communication.

It seems a long time ago since manufacturing chemists and pharmacists came to the aid of physicians; beginning, perhaps, with the separation of morphin from opium, and quinin from cinchona bark, and. the preparation of salts of these alkaloids. I say it seems a long time ago, but really it isn't many decades ago; but since then, which we will arbitrarily assume as a beginning of the modern movement of chemistry and pharmacy in aid of the medical profession, manufacturing chemists and pharmacists have been very activly at work, and the medical profession cannot now afford to turn its back on the wonderful advances made by these agencies, in the interest of both physician and patient. Let us keep this broad proposition in mind. Also let us keep in mind that these advances in chemistry and pharmacy in aid of the physician have been chronicled chiefly in the advertising pages of medical journals, except the preparations of those firms that have been smart enuf to "work" the reading matter of medical journals for free advertising, the most conspicuous of these preparations being the German patents, as phenacetin, sulfonal, trional, heroin, protargol, etc.

Doctors of the long ago who are still alive and who have kept up to the times, know the difference between the nauseous doses of former days and the elegant preparations of the present day. I have always stood for progress in pharmacy, as well as in other things. The manufacturing pharmacist who makes a specialty of one prepara

tion, or a limited line of preparations, has special facilities, machinery, etc., for his particular purposes, and develops superior skill in his one line, just like any other specialist; he can select the crude materials for his preparations better than those in the general line, because, as a specialist, he has a better opportunity to do so.

These, and many other facts have been freely acknowledged, and their advantages accepted by the profession. But because of some abuses (from which the advertising pages of THE WORLD have been exceptionally free), a small, but well intentioned class of critics have recently arisen in the profession, and in a spirit of prudery are trying to "kick over the entire bucket of milk." The scientific and economic contributions of chemistry and pharmacy to the needs of the medical profession are far too great to be thus sacrificed; and in spite of all that these misleading and misled critics can do the practical portion of the medical profession will continue to welcome the aid of progressiv pharmacy.

Dr. Clouse has not limited himself to generalities, but has (commendably) "spoken right out", giving names. Let us, in order to be fair and square, take them up in detail as he has mentioned them:

one

Tongaline: One of the best prescriptions for rheumatism that I know. The advertisements and literature make no secret of the constituent drugs upon which its action depends. Not one doctor in a hundred can write as good a general prescription for rheumatism, and being written, not druggist in 500, or 1000, could prepare it as well as the firm which has made a specialty of its preparation for years, and has special facilities for so doing; and, as this firm prepares it, it is always uniform. It is advertised to the medical profession only, to help doctors with a very stubborn class of cases. How many doctors say it should be driven from the advertising pages of medical publications? If so, why? If one medical man in a thousand should prefer to always write his prescriptions in full for rheumatism and trust to the corner druggist for its correct and up-to-date compounding, how does it hurt him if the other 999 prefer to use the advantages which a specialist in pharmacy offers? The advertisement will not hurt the critic if he will let it alone. He needn't read it if he doesn't wish to. Dr. Clouse next mentions manola. This

MED,

is a recent comer into the advertising pages of medical journals, and I confess that, not knowing anything against the preparation or the people putting it out, we have followed the example of many other journals in admitting it to our advertising pages. However, I have just critically examined their adv., and have written the company concerning proofs of statements made therein, and also concerning the composition of the preparation. However, many advertisements are briefly and tersely put, in order to attract attention and make an impression, while testimonials, composition and other details are given in circulars, pamphlets and other literature, which are extensivly circulated among the profession, and which can be had for the asking. I will await the company's reply to my letter; in the meantime, let me ask if the average doctor can write an equally good prescription for "a powerful reconstructiv alterativ tonic," and if the average druggist can fill the prescription, producing an equally good and elegant pharmaceutic product at as low a price? That is, can the patient be served. as well? If the wrappings and other "original package" features be objected to, the doctor can order accordingly.

Labordine: I have seen the formula in a little pamphlet issued by the company. On the strength of it, I immediately got a package for a member of my family, who frequently suffers from neuralgic pains. No heart depression was experienced. I wrote the company that in my opinion their adv. would be strengthened if they would put their formula in their advertisement.

Pneumo-phthysine: Before we would advertise it we demanded a sample, which, upon examination, appealed to us as doubtless a good local application in pneumonia; the sample was sent to one of our staff to try. While the word "specific" is used in different ways by different doctors, we have always discouraged any use at all of the word; and we think any use of the word in this or any other advertisement is unwise. But some latitude and toleration must be allowed, particularly as "specific" is used by the eclectics (a large and respectable body) in a different way from our usual understanding of the word; and a specific tendency in a method of cure need not necessarily mean certainty of cure. However, I think that use of the word should be avoided in this and every other advertise

know anything for or against it; do you? Turn to the adv. and see how it strikes you. We didn't see anything wrong about it when we accepted it. Do you think you, your interests or your ethical principles are endangered by this advertisement? If so, please explain.

The fact is, our advertising pages are guarded with unusual care. We always insist that advertisements shall be clean and above suspicion; that they shall be honest; that they shall not conflict with the interests of the profession. THE MEDICAL WORLD was the first and only medical magazine to refuse all advertisements of a speculativ nature, and to expose in its reading columns the many rascally schemers who prey on the medical profession. No other journal has done what it has in the way of showing up the practices of antikamnia, the Medical Brief, and other concerns that are using, rather than serving, the medical profession. Our record is well known to the rank and file of the profession, but, unfortunately, many loud and assuming "leaders" remain egotistically ignorant of our work, and think they are doing it all, while, as a matter of fact, they are doing more harm by indiscriminate onslaught on the good as well as the bad, than they are doing good by attacking the real evils. I do not mean Dr. Clouse, but he has, unfortunately, been influenced by that class of

This matter has been brought into prominence during the last few years, thru the agency of the Journal A. M. A., by men who are few in number, but whose influence is great; their intentions are good, but their judgment is-well, to say the least, is inaccurate and indefinit, and their knowledge of most that they criticise is limited, for they have, as a rule, never used the things they criticise, and their knowledge of the needs of the rank and file of the profession and the economic phases of the case as affecting the patient, is deficient. I have talkt this matter over many times, thoroly and deliberately, with many who are most interested, including some of the highest and most influential officials of the A. M. A., and with all there has been a woeful lack of any definable ideal, and no agreement between any two as to what standard shall be maintained. I have been driven to the belief that, upon this

question (as to what shall appear in the advertising pages of medical journals), every doctor and everyone else interested is a law unto himself. Hence, without wishing to appear egotistic, I am brought to the conclusion that my own judgment is about as good as that of anybody else, particularly so far as THE MEDICAL WORLD is concerned. I have had plenty of experience, and I have turned down a "mighty lot" of advertisements, and I expect to do so in the future. However, I will here ask my subscribers to help me in this matter. If you know any reason why any advertisement that you see in our pages should not appear, please be free and frank to say

so.

If any advertisement shall be shown to be dishonest, it will be immediately dropt (but I think we catch all these before they get in); if any advertisement shall be shown to be opposed to the interests of the medical profession, it should not find a place in these pages. As to ethical ideals concerning this matter, there is much latitude for disagreement-so much that I have not yet found two who agree; particularly as there has been so much "straining at a gnat and swallowing a camel" of late. I try to entertain a high ethical ideal (and live up to it), and yet one which will not interfere with the practical needs of a profession large in numbers, variously composed, scattered over a vast territory, and the members of which are variously circumstanced.

To illustrate the extreme position which a few men take, I present the following:

THE MEDICAL WORLD:-I am in receipt of your special offer designed to induce one to subscribe for THE MEDICAL WORLD. It is scarcely worth while to take up the subject of former correspondence with you on the subject of my reasons for not accepting your very generous proposition. It will save you time and some expense, however, if I again mention the fact that I take no journals that advertise proprietary medicins, without giving the formula. The last number I saw of THE MEDICAL WORLD, it would fairly rival The Journal of the American Medical Association in this line. I am not a member of The American Medical Association, because of what J deem the unethical advertising of its official journal.

I know of but one medical journal that can find a place on my table. That is The Pennsylvania Medical Journal. I would not take any other journal that I know of out of the post office, were it sent me gratis. I know of many physicians that take the same stand. In the coming years more of them will take the same stand.

There is much more that could be said along these lines, but this is sufficient, and I would

advise you to save your advertising material and postage, rather than to squander it on me. Very truly yours, W. W. LITTLE. Mosiertown, Pa., Jan. 8, 1906.

I can tell the doctor of another journal that will please his heart. It is Colorado. Medicin, the official organ of the Colorado State Medical Society, and constituent societies. It contains no advertising of any kind. It is publisht monthly by the society (address, Steele Block, Denver, Colorado), at $2 per year. Perhaps Dr. Little is acquainted with the journal (state organization journal) which has been the most severe in its criticism of the Jour. A. M. A. on account of the advertisements contained in the latter; I refer to the California State Journal of Medicin ($3 per year), edited by Dr. Philip Mills Jones, who devotes more of his space to what he calls the "nostrum evil" than any other medical editor, with criticism directed particularly at the Jour. A. M. A. Yet Dr. Jones welcomes Vin Mariani to his columns, with editorial endorsement, in spite of the fact that this preparation is perhaps the most prolific source of drug addiction in this country, and that a few years ago it was openly and enterprisingly advertised to the laity, and is now in England, I understand. I well remember seeing their pamphlets a few years ago, containing page after page of portraits of actors, opera singers, etc., with a testimonial from each beneath each picture. These pamphlets were distributed to the laity. Dr. Jones is an illustration of the fact that the most extreme among the critics are inconsistent, and that none of them can offer a standard that will appeal to any considerable number of the profession. So the best we can do is for all to do the best they can, seeking the highest, best and most practical good of the profession, and be mutually tolerant.

The best analytic summary of this subject that has appeared, is the following, from the Dec. 30th issue of the St. Louis Medical Review, page 549:

Our preceding articles have led us to the following propositions: (1) The spirit of "commercialism" lies in the fact that the primary object sought is the material benefit of the individual; public benefit is, when present, a secondary and incidental motiv. (2) When these ends are sought honestly, not pretending the thing that is not, or denying the thing that is, and when they are sought in a legitimate sphere, that is honest commercialism. (3) In profession

alism, the primary end is the rendering the service of a vocation; the reward is secondary, and is based on the theory that "the laborer is worthy of his hire." It is not accumulation of gain, but livelihood, that is looked for. (4) The physician must either prepare his remedies for himself or engage commercial men to prepare them for him. (5) Pharmacy is a commercial pursuit. (6) It must therefore be judged on commercial principles and its reward must be calculated in terms of gain, not of mere livelihood. (7) This implies the equity of acquiring property right in the results of labor, knowledge, exploitation, convection, and all the various factors that enter into a successful commercial undertaking; and so long as the methods are honest there is no sound reason why physicians should oppose it. (8) Proprietary medicins are, in many instances, only vastly more elegant, palatable, and in every way superior forms of the various stock mixtures kept at hand by every dispensing physician, and to be found in every hospital formulary and even in the various national pharmacopeias, for use either alone or as a base, as occasion may require. Therefore (9) a proprietary is not objectionable simply because it is a proprietary. (10) Nor because it consists of a mixture of substances in place of being a definit chemical compound. (11) It is objectionable if, being a definit chemical compound, its chemical constitution, or being a mere mechanical mixture, its essential component ingredients are kept secret. (12) It is objectionable if, while containing any potent drugs, of markt physiological action or toxic character, it is exploited to the laity. (13) This objection, however, cannot reasonably be made to apply to remedies of known composition, therapeutically classifiable as laxativs, tonics, and the like, which contain no potent or toxic drugs, but may be regarded as legitimate domestic medicins; to mineral waters and beverages as such, to external applications, disinfectants, nutrients, and the like.

Yet, that very issue contains the antikamnia adv., which I thought might be discontinued at the end of the year, in harmony with (12) above; but as the antikamnia adv. has been continued ever since (up to Jan. 16), we must infer that it is not considered by the editor as containing any "potent drug of toxic character," or that he is not acquainted with the methods and practises of the Antikamnia Chemical Co., so often exposed in our pages. It is well known that antikamnia is an acetanilid mixture, dangerous in the hands of the public, and that it is exploited directly to the laity, as we have so often shown, and therefore it should be excluded from the advertising pages of medical journals, under rule (12) above given.-C. F. T.]

The newest game in mining promotions, which has made its appearance in New York, is this heart-to-heart sympathetic talk from miners direct to investors upon the assumption that confidence, which has been lost in promoters, can be revived in this These smooth talks show the master hand of clever schemers.-Financial World.

way.