have been practically eliminated by the practice of foreign inspection, and inland quarantine has long since been repudiated by advanced hygienists as unnecessary, if not quite useless. In the prevention of yellow fever the necessary outer defenses are but three, and these so simple that they would soon be recognized under the dreadful name of quarantine. These steps are notification immediately on the appearance of yellow fever, given by the health officer of the invaded locality to the health authorities of other localities, and prompt arrangements to regulate travel by means of detention and surveillance. Notification presupposes that the health board of a given locality will know when yellow fever invades that locality, but local boards of health in the South, as a rule, have not and cannot get this priceless information, for there are no laws requiring physicians to report infectious diseases. Assuming Southern health boards to know what is going on under their official noses, they would still have to acquire the habit of acting with promptness and good faith toward each other, and this desideratum should not be difficult of attainment. These initial difficulties being cleared away, the regulation of travel would be very simple. This business should be turned over to the federal government, and with the present distribution of United States public-health officials delay need not occur. Wherever decent local sanitary government exists, the safety of public health is practically assured if the movements of people out of infected localities be governed by detention and surveillance. The meaning of detention is obvious, and it is applied only to the sick and those known to have been exposed. Surveillance applies to all outgoing travelers, and covers the period of incubation of yellow fever, dating from the time of departure. It includes reasonable care in ascertaining and certifying the probability of non-exposure, and the timely transmission of names and destinations (including address) of passengers en route to the authorities of other localities. Perhaps yellow fever is making its last great demonstration in the United States. The oversanguine proclaim the final disappearance of yellow fever from American soil with the termination of the present fight at New Orleans. It is a vain boast. Recent operations have demonstrated the scientific means of suppressing yellow fever. The means of excluding yellow fever have undergone no improvement. We may hope for the announcement sometime in 1905 that yellow fever has been suppressed in New Orleans, but the announcement that the disease has been extinguished, if made before November, 1906, will be premature. Several years must pass before one can say confidently that the means of excluding yellow fever from any of the Gulf States have been made effective. Yellow fever will appear and reappear, and quarantine will reappear at intervals so long as health officers are unable to recognize yellow fever in less than epidemic proportions. When good notification laws are enacted and enforced, when boards of health are organized for constant instead of intermittent service, when all quarantine matters are entrusted to the general government, and when the ugly features of quarantine have been replaced by simple notification, detention and surveillance, it will then be time to promise the complete and final disappearance of epidemic yellow fever. Medical Items. A PLAGUE of mosquitoes has fallen on the city of London. DR. MILTON R. WALTER has removed from Baltimore to Chicago. DR. EDWARD J. BERNSTEIN has removed from Baltimore to Kalamazoo, Mich. BOSTON is alarmed about the prevalence of typhoid fever on her watershed. DR. JOSEPH C. WUNDER of Baltimore fell from a porch and fractured his lower jaw on September 1. DR. EDWIN GEER was painfully injured about the head and face by falling from a street car on September 6. ON July 20 the Cecil County Medical Society held its quarterly meeting at Elkton. Addresses were made by Dr. S. T. Earle of Baltimore and Dr. R. M. Stump of Perryville. THE prize for the best essay on the treatment of trachoma has been awarded by the Hungarian government to Professor Kohut of Konigsburg. Its value is 1000 Kronen. ON July 11-12 two very interesting meetings were held by the Allegany and Garrett County medical societies, at which Dr. S. T. Earle made addresses on the power invested in the county medical society under the new constitution. ON September 7 the sewerage commission met and began preparations for actual work by appointing three consulting engineers-Randolph Hering of New York, Samuel Gray of Providence, and Frederick P. Stearns of Boston. On August 14 one of the most valuable anatomical collections in the world was lost in the fire which destroyed the Medical Hall of the University of Pennsylvania. The loss is estimated at $150,000. The anatomic collection cannot be replaced. THE secretary of the French Society for the Encouragement of Cremation reports that there are now 90 crematories in Europe and America; that up to this year 125,000 bodies have been incinerated. The largest number of incinerations so far reported in one place is 370 in the year 1904 in Buenos Ayres. A MEETING of the Prince George County Medical Society was held on July 1 in Wash ington, D. C. The Faculty was represented by Dr. S. T. Earle, president, and Dr. T. H. Brayshaw, councilor. While the meeting was not a large one, those present were deeply interested in the reorganization plans, and expressed their hearty co-operation. AMONG the Americans who were made honorary fellows of the Royal College of Surgeons of Edinburgh at the fourth centenary on July 22 were Dr. W. S. Halsted and Dr. Howard A. Kelly of Baltimore, Dr. W. W. Keen of Philadelphia, Dr. Wm. T. Mayo of Rochester, Minn.; Dr. Charles McBurney of New York, and Dr. John Collins Warren of Boston. The THE Internal-Revenue Department has decided that after December I all druggists who sell patent medicines containing whiskey or other distilled spirits as their chief ingredient must pay the special liquor-dealer's tax. manufacturers of these medicines must pay the special tax imposed on rectifiers and liquor dealers. Baltimore druggists are very much exercised over this announcement. THE venerable Dr. Norman Bruce Scott of Hagerstown died on September 21, aged 86. Dr. Scott was born in 1819 at Bruceville, Carroll county, and practiced medicine at Hagerstown for 50 years, from 1844 to 1894. He was a great-nephew of Dr. Upton Scott of Annapolis, the first president of the Medical and Chirurgical Faculty of Maryland. His son, Dr. J. McPherson Scott, is an ex-president of the Faculty and secretary of the State Board of Medical Examiners. THE rigors of quarantine in some parts of the South amount to damage as severe as the yellow fever itself could inflict. The mails and freights of all sorts are stopped, and such communities have maintained absolute isolation by surrounding themselves with an armed cordon. This sort of quarantine is very expensive, and the conditions of living within such a cordon are extremely difficult. One Louisiana town is said to have refused a consignment of carbolic acid. Coal oil and steel rails have been excluded from some towns. THE regular quarterly meeting of the Medical Association of Howard county was called to order at 2 o'clock on July 4. The minutes of the preceding meeting were read and adopted. Dr. Augustus Stabler of Montgomery county read a very able paper on septicemia, which was discussed by Drs. Rogers, Gambril, and Nichols. Dr. Gambril spoke on the impor tance of first aid in surgery. Cases were reported by Drs. Rogers, Williams, Gambril, Nichols, and Owings. Dr. Williams represented the Council of the Faculty. TWELVE governors of Southern States have issued a call for a quarantine convention at Chattanooga on November 9 and 10 for the purpose of obtaining a modern system of quarantine. "This is necessary," they say, "if we would save our land from the demoralizing and brutalizing tendencies of panic-inspired quarantine." Governor Warfield of Maryland was one of the signers of the call. The other signers were the governors of Tennessee, Louisiana, West Virginia, Virginia, Florida, Mississippi, Missouri, Kentucky, South Carolina, Georgia, and Texas. AMONG the recent vagaries of quarantine are the following: The governor of Arkansas refused permission to Dr. Chassaignac to pass on a special train through a small strip of Arkansas on his way to the relief of an infected place in Louisiana. The State Board of Health of Arkansas resigned, and the governor appointed a new board. The new board immediately instituted quarantine against Louisiana and Missisippi. One or two boards of health refuse to recognize certificates which do not bear the words "Not paid for." A citizen of Memphis, returning from a visit in Maryland and bearing a certificate from the State Board of Health of Maryland, was detained on her arrival at Memphis until her friends were notified and identified her. THE one hundred and seventh semiannual meeting of the Medical and Chirurgical Faculty was held at Deer Park, Garrett county, on September 21 and 22. The House of Delegates had two meetings-one at 6.30 on Thursday and the other at 9 A. M. on Friday. The first general meeting of the Faculty occurred at 8 P. M. on Thursday, with a series of brief reviews of recent medical progress. Dr. T. B. Futcher gave the review in medicine, Dr. Frank Martin the review in surgery, Dr. Guy Hunner in gynecology, and Dr. Frank D. Sanger in laryngology. Dr. Wm. S. Thayer made an address on "Some Public Duties of the Physician." On Friday morning the program was as follows: "Palliative Operations for Intracere bral Tumors," Dr. Harvey W. Cushing; "Tumors of the Thyroid," Dr. Frank J. Kirby; "Report of Eight Cases of Lateral Sinus Thrombosis, With a Discourse on the Advisability of Ligat ing the Internal Jugular Vein Before Opening the Sinus," Dr. H. O. Reik; "Artificial Interruption of Pregnancy in Toxemia-(a) Time to Interfere; (b) Methods to Be Used," Dr. J. M. Rowland. In the afternoon the visitors were the guests of the medical societies of Garrett and Allegany counties. In the evening at 8 o'clock Dr. Charles A. L. Reed of Cincinnati delivered an address entitled "The American Family." The attendance at this meeting is said to have been considerably larger than at any semiannual meeting in recent years. The proposed medical-practice act was freely discussed, and was referred back to the committee for further consideration and to be reported at a special meeting of the Faculty to be held later. THE third annual meeting of the Cumberland Valley Medical Association was held at Mount Holly Springs, Pa., August 29, 1905. Dr. V. M. Reichard, Fairplay, Md., presided. The session was called at 11.45 A. M. Major James Evelyn Pilcher Carlisle welcomed the association to the county of Cumberland and to Mount Holly Springs. Drs. Pilcher, Ramsey, and Miller were named as a committee to revise the constitution and by-laws of the association. After routine business the following addresses and papers were presented: The president's address, by Dr. V. M. Reichard, Fairplay, Md., entitled "The Physician's Debt to His Profession;" "Diaphragmatic Hernia of Twenty-one Years' Standing," Dr. J. Bruce McCreary, Shippensburg; "Medical Lessons of the Far East,” Dr. J. E. Pilcher, Carlisle; "Our Relations to the World at Large," Dr. Chas. F. Palmer, Chambersburg; "Eye-Strain," Dr. Augustus C. Maisch, Hagerstown, Md. The association adjourned at 2 o'clock, and at 3 o'clock sat down to a dinner in the dining hall of Mount Holly Inn. Major James Evelyn Pilcher was toastmaster. Toasts were responded to by Drs. McCreary, Ramsey, Devilbiss, Keller, Reichard, Amberson, and Spangler. At the end of the banquet the nominating committee made the following report, which was adopted: President, James Evelyn Pilcher, M.D., Carlisle; vice-presidents, D. F. Unger, M.D., Mercersburg; Augustus C. Maisch, M.D., Hagerstown, and Geo. C. Borst, M.D., Newville; secretary, J. J. Coffman, M.D., Scotland; assistant secretaries, Drs. P. R. Koons, Mechanicsburg; H. C. Devilbiss, Chambersburg, and D. C. R. Miller, Mason and Dixon, for Washington county, Maryland; treasurer, J. J. Koser, M.D., Shippensburg, Pa. MARYLAND MEDICAL JOURNAL A Journal of Medicine and Surgery Vol. XLVIII No. 11 BALTIMORE, NOVEMBER, 1905 Whole No. 1050 ON SOME PUBLIC DUTIES OF THE PHYSICIAN. By W. S. Thayer, Professor of Clinical Medicine, Johns Hopkins University. ADDRESS DELIVERED BEFORE THE MEDICAL AND CHIRURGICAL FACULTY OF MARYLAND AT DEER PARK, SEPTEMBER 22, 1905. Most of us are familiar with the oft-expressed regret for the passing of the day when the family physician was the sole counsellor with regard to all fleshly and many spiritual ills of his patient, and it must be acknowledged that, along with the many advantages which spring from the modern tendency toward concentration and limitation of one's field of action, there are some drawbacks. The patient, passing from one adviser to another, with whom there is, perhaps, but a formal acquaintance, is too likely to miss the support arising from the old confidence and faith in the familiar and trusted friend; while, on the other hand, it is doubtless true that this old confidence and faith, this friendship and reliance, inevitably broadened the physician and developed in him a capacity for beneficent personal influence which often surpassed even that of his brother of the clergy. This personal influence the urban practitioner of today is unquestionably losing to a certain extent. He no longer occupies in the family quite the same place that he formerly filled. And the same change is taking place, little by little, even in the life of the country doctor, for with modern methods of transportation the advantages and disadvantages of the increased tendency toward specialism are offered freely to the rural population. It is not uncommon for those of us who practice in town to be visited by the patients of our country brethren, who, too often with a false conception of the superior powers of the city physician, seek his advice without consulting him who is their safest guide and counsellor, in much the same manner as the patient in the city consults, upon the advice of friends or on his own fancy, this or that "specialist"-a misty and magical name today of the limits of wnose domain they have, alas, a sadly hazy idea. But although time has doubtless taken something from the peculiarly charming personal relations which have often existed between doctor and patient, yet it has brought abundant compensation both to the public and to the medical profession. On the one hand, division of energy and concentration of forces have given to the physician an insight into the nature and cause of disease which has put into his hands powers of which in days past he had little fancy; and this very fact, on the other hand, affords the public an ever-increasing assurance of protection from many of its most dreaded enemies. The physician may have lost some of his personal influence, but he has gained invaluable capacity for practical public service. But a capacity for public service and knowledge of certain means which may prevent the spread of disease and save human life are not gains which can be enjoyed at leisure. The possession of such knowledge, of such capacity, of such opportunities implies the duty to make use of all, Of some of those duties which have grown upon us in late years I would speak briefly today. It is, after all, but a relatively short time since microscopical, bacteriological and chemical methods of investigation first took a regular place in the practice of medicine. When many of us who are here today entered upon the exercise of our profession the use of most of these methods of study was limited to a few special workers in the laboratories of universities or schools. Today they are invaluable for the accurate diagnosis of many of the most important maladies with which we have to deal. With the increasing demands for more complicated and finer methods of diagnostic investigation the curriculum of our medical schools has broadened, the time required for medical training has lengthened, the advantages offered to the student have greatly increased. But if the practitioner enters upon his work today with a broader basis of information and experience than was true of the graduate of 20 years ago, it is nevertheless often difficult or impossible for him to utilize many desirable or, indeed, one may in some instances say, necessary diagnostic procedures, inasmuch as the old-time demands of practice have in no way diminished, while the new methods of investigation impose upon him more work than one man can accomplish in 24 hours. And although to the city practitioner the laboratories of hospitals and special students are of considerable assistance, yet the expense associated with the relegation of this work to private investigators is beyond the means of a great part of the urban public, while distance and the lack of special arrangements deprive the majority of rural residents of all these advantages. Here, however, our State and local boards of health are rapidly offering to the busy practitioner the necessary assistance. Today, for any physician in the State of Maryland, the Board of Health undertakes, gratuitously, examinations of the blood to assist in the diagnosis of typhoid fever or malaria, of cultures from the throat in cases of suspected diphtheria, of the sputa whenever |