[Written for the MEDICAL BRIEF.] Reply to Dr. Allen Osmun's Article on Examining Boards, in "Items of Interest," a Monthly Magazine of Dental Art, Science and Literature, at Page 811, for December, 1900, 115 Madison Avenue, New York.

BY R. C. BAYLY, A. M., M. D. Decatur, Ill.

Dr. J. Allen Osmun, on Dental Jurisprudence in Its Relation to State Examining Boards, has made a notice of me; and it seems not improper to give him some courteous attention in this paper. He says: "Since January, 1900, there have been published every month, a series of articles in the MEDICAL BRIEF, from the pen of Dr. R. C. Bayly, of Illinois, in which he has taken very decided views as to the rights, privileges and immunities of physicians in regard to the rights of examining boards and boards of health to control the practice of medicine." Dr. Osmun then says, that "The Supreme Court of the United States has passed on all the questions involved, and the opinion of that Court is of course binding and final." The case referred to is that of Dent vs. West Virginia. This case came up on appeal to the Supreme Court of the United States, from the Supreme Court of Appeals of the State of West Virginia. On March 8, 1882, the Legislature of the State of West Virginia passed an act prescribing the qualifications and conditions upon which the profession of medicine should thereafter be practiced in that State. The ninth section of this act provides that the following, and no others, shall hereafter be permitted to practice medicine in this State.

"First.-Graduates of a reputable medi cal college in the school of medicine to which the person desiring to practice belongs.

"Second. All persons who have continuously practiced in that State ten years prior to March 8, 1881.

"Third.-All persons who might be admitted to practice on an examination by the State Board of Health of West Virginia.

"Dent was a physician, and had been practicing in the town of Newburg, Pres

the prohibition reaches every law, whereby an act is declared a crime, and made punishable as such, when it was not a crime when done.”

This definition of ex post facto law is really a perfect explanation of the Practice Acts generally, for they are laws "Whereby an act is declared a crime and made punishable as such, when it was not a crime when done;" that is, when the act is committed.

Crime is the violation of law, but the West Virginia law by which Dr. Dent was tried made the doctor a criminal for practicing his profession, when really the practice does good and no harm to any one. Common sense, reason, and all fair dealing declare the conduct of the West Virginia Board outlawry.

The objection to the doctor that the college from which he graduated did not come under the word "reputable," is evidently an objection without a reason; that is, without law. The fact is, Dr. Dent was maltreated and robbed, as an examination shows.

Blackstone says, "That which is not reason is not law. There is no reason, and, therefore, no law for the conduct of the Board, the act of the legislature being unconstitutional. The fact of such a procedure in an enlightened State is prima facie evidence of political corruption.

If the Board had any real ground of objection to Dr. Dent's diploma, it is noticed that he had for years enjoyed a lucrative property practice, which gave him a living. This, of course, was taken away when his right as a citizen doctor was taken from him. When a physician has been in the practice for the greater part of his business life, he is not qualified to successfully engage in another pursuit for support, and consequently to rob him of his property interest in practice, makes a pauper of him, and he is compelled to live upon the charity of others, or go to the poor house; and hence the action of the Board is looked upon as the most devilish robbery known to the history of theft. It was outlawry under the assumed form and pretext of law.

Dr. Osmun quotes from the decision of Judge Field, as follows: "The unconstitutionality asserted consists in its alleged

conflict with the clause of the Fourth Amendment, which declares that no State shall deprive any person of life, liberty, or property, without due process of law; the denial to the defendant of his right to practice his profession without a certificate required by law, constitutes the deprivation of his vested right and estate in his profession, which he has previously acquired."

I believe Judge Field, in his statement, is correct, but I do not know whether Dr. Osmun gives the decision in toto, of which the quotation I have made forms a part or not. In another place Judge Field is represented as saying: "No one has a right to practice medicine without having the necessary qualifications of learning and skill, and the State only requires that whosoever assumes, by offering to the community his services as a physician, shall present evidence of it by a certificate or license from a body designated by the State as competent to judge of his qualifications." I do not dissent from these words of Judge Field, and I have so declared in my writings on the subject, that while a State has the right to authorize a Board of competent doctors to license medical students to practice medicine, and, also, that the legislative power of a State may charter a medical college to graduate students, and thus make doctors, the State has no authority to interfere, nor take from full-fledged physicians their rights and immunities as doctors, except by forfeiture on account of the violation of law; nor has the State any authority whatsoever to levy a tax upon the profession.

Judge Field, in his decision, above quoted, simply makes two declarations that touches the points in my papers on medical legislation, to-wit: First, The denial to the defendant of his right to practice his profession without a certificate required by law, constitutes the deprivation of his vested right and estate in his profession, which he has previously acquired.

This is what I say most emphatically; but when he has a diploma, or certificate, or a legal license, whether or not it be from the State in which he resides, or from a State, or legally chartered college

of some other State in the United States, then, and in that case, to deny him his rights and privileges by a State or State Board of Examiners, as in the case of Dr. Dent, it is robbery in the fullest sense of the term. The reader will take notice that Judge Field, of the Supreme Court, in the decision alluded to, does not touch this point at all.

But, Second, He emphasizes the authority of the State to give the right to professionals, but he does not hint the main question that has made up the discussion of medical legislation to bar and tax doctors, as the unreasonable and most damnable repudiation of justice and honest principle is carried on in the legislation and execution of the Medical Practice Acts. No, sir! A judge who would do such an abominable thing would, I have no doubt, be treated to a most elegant coat of tar and feathers. What, then, does Dr. Osmun mean by his empty assertion, that Dr. R. C. Bayly's law is "fearfully and wonderfully made?" Either he or the Supreme Court of the United States is wrong. It is not so, for we agree. Where does the Supreme Court and what I have written on this subject differ?

The fact is, Dr. J. Allen Osmun, from a legal standpoint, and reasoning is so illogical, and his conclusions are so absurd, that it is not necessary to give them more than a passing notice.

He does not, from what he says, know anything of the real import and bearing of Judge Field's decision, so far as he has given it, and attempted to apply it in his article.

Dr. Osmun again says: "In the articles referred to, the Doctor also argues that a license to practice medicine is a judicial record or proceeding within the meaning of the provisions of the Federal Constitution, which provides that "Full faith and credit shall be given in each State to the public records and judicial proceedings of every other State." To this language of the Constitution, Dr. Osmun says: "This is absurd." What is a public record, Dr. Osmun? When "the State Board of Health" of West Virginia issues a certificate to a physicfan to practice, is it a private or a public record of the State? It is put on the State Board of Health

records; that is, it is a public record of the State, because made by the State Board officials on the public business books, in which the records of the State are found; they, the diplomas, certificates and licenses, are directly or indirectly of statutory authority, and, therefore, are public records of the State of West Virginia.

Dr. Osmun says: "A license is in no sense a public record within the meaning of that provision of our Constitution." But since it is a part and parcel of the public records of the State, if it is not within the meaning of the Constitution, what does it mean, and within what document does it have a meaning? Let him answer, if he can. Dr. Osmun knows but little of what is within the meaning of the Constitution. That this may more fully appear, I quote his language again. He says: "It is seriously argued that because one has been admitted to practice in one State he has a constitutional right to practice in any other State. In support of this contention, it is stated that the provisions of our Federal Constitution declare that the 'citizens of each State shall be entitled to all the privileges and immunities of citizens in the several States.' This provision of our Federal Constitution does not mean that a citizen of the State of Indiana, who comes to the State of New Jersey, brings with him into this State the privileges and immunities which he enjoyed as a citizen of the former State, but rather upon his arrival in this State he at once becomes possessed of all the privileges and immunities which pertain to citizenship in this State." Who ever heard before that a citizen going from one State to another does not bring with him the privileges and immunities of the State from which he comes? I confess I never heard of it before. Citizenship does not come from the State, but from the United States, and to secure and perpetuate mutual friendship and intercourse among the people of the different States of the Union, the free inhabitants of each of the States-it was ordained-shall be entitled to all the privileges and immunities of free citizens in the several States, and the people of each State shall have free ingress and egress to and from any other State, and shall enjoy therein all

the privileges of trade and commerce, subject to the same duties, impositions, and restrictions as the inhabitants thereof respectively; that no impositions, duties, taxes, or restrictions shall be laid by any State on the property of the United States, or on any other State, or its citizens in the Federal Union. But the Medical Practice Acts levy duties and unreasonable taxes on citizens going from one State to reside in another, denying the right of free ingress and egress of the citizens respectively.

Chief Justice Story, in his book on this subject, at page 205, says: "For example, it is declared that the citizens of each State shall be entitled to all the privileges and immunities of citizens of the several States." Suppose an attempt is made to evade, or withhold these privileges and immunities, would it not be right to allow the party aggrieved an opportunity of claiming them, in a contest with a citizen of the State, before a tribunal, at once national and impartial?" On page 207, Justice Story again says: "The next inquiry, growing out of this part of the clause, is, who are to be deemed citizens of different States, within the meaning of it? Are all persons born within a State to be always deemed citizens of that State, notwithstanding any change of domicile, or does their citizenship change with their domicile? The answer to this inquiry is equally plain and satisfactory. The Constitution having declared that the citizens of each State shall be entitled to all privileges and immunities of citizens in the several States, every person who is a citizen of one State and removes into another, with the intention of taking up his residence and inhabitancy there, becomes, ipso facto, a citizen of the State where he resides, and he then ceases to be a citizen of the State from which he has removed his residence."

The language of this great legal man can not be misunderstood; it is that the Constitution declares what every Ameri. can freeman is proud of-that he is a citi. zen of the United States; and it makes no difference whether he resides in Indiana or Illinois, he is still entitled to all the privileges and immunities of citizens in

each and all the "several States" under the flag.

I claim to be, not a citizen of Illinois, but of the United States of America, and I am, therefore, entitled to all that belongs to me as in common with all the citizens of the United States; and anywhere in the "several States," I am domiciled. I have a perfect right to all my property of every description.

If my property interest is of a professional nature, as in the practice of medicine, being a legally qualified physician, no one, no body of men, have authority to interfere with it. And the party or parties taking it from me, or taxing it in any way, excepting for the legitimate support of government, are rogues, and robbing me of it, even under the assumed form and pretext of law, as the Medical Practice Acts do, are outlaws, and ought to be hung.

As to what Dr. Osmun says about the police power of the State, is nonsense, because the exercise of the police is only intended to put down riots and fighting on the street, and other violent outlawry; to assist in keeping the public peace, and to help rob the doctors in the execution of the Medical Practice Acts.

[Written for the MEDICAL BRIEF.] Suggestions in the Treatment of Gonorrhea.

BY ALVA D. JONES, B. S., M. D., Clinical Instructor in the Laboratory of Peditrics and Assistant in the Practice of Medicine; Kentucky School of Medicine and Hospital, Louisville, Ky.

Recognizing the fact that there is nothing new under the sun, it is with some little hesitancy that I undertake to write a few words upon the practical treatment of gonorrhea. Much has been written upon this time-worn subject, and we are still confronted with the unsolved problem of a cure for gonorrhea. It would seem that a specific was out of the question, but the physician of to-day has at his disposal means that, judiciously used, unquestionably would prove satisfactory upon the whole, if not specific. The trouble has been that the physician could

not exercise his knowledge at a time when it was most useful, namely, in the early stages. However, the people are beginning to perceive that gonorrhea can no longer be classed as a mere cold, and having become enlightened as to seriousness of the trouble, especially as to the many possible complications, they are beginning to consult the physician in the primary condition, and not after it has become complicated through mistreatment and neglect.

It is my uniform rule to immediately place the patient upon Sanmetto internally, dose being one drachm before meals and at bedtime, taken with plenty of water, hot preferred. Not only is the hot water the preferable vehicle in which to give Sanmetto, but it also stimulates the liver to activity, and the bowels are consequently kept normal. However, should the patient be constipated, he should be given some saline laxative, as citrate of magnesia in the effervescent form. Where the urethra is especially sensitive, it is best to make the urine decidedly alkaline, as Sanmetto tends to neutralize or return it merely to the normal reaction. I find the citrate of potassium in dosage of five grains, given with the Sanmetto, to act admirably. After the first week, I place the patient, in addition to the above, upon salol, in dosage of ten grains. The combination of these three drugs makes the ideal internal treatment, and to be continued throughout the course of the disease. The urine is rendered bland and sterile, and the membranes soothed and kept in the best possible condition to resist the gonococci. It will also be noticed that the salol is dissolved in the Sanmetto by the citrate of potassium, making a really elegant combination.

Turning to the local treatment, which I generally institute about the tenth day of the disease, I believe the permanganate of potash irritation, of one to ten thousand, to give the best results. After the urethra has become accustomed to it, the solution can be made somewhat stronger, but, personally, I prefer the weaker strength. With an unusually sensitive urethra, I use the less irritating borac acid in saturated solution. In irrigating, I use the small, flexible, rubber,

catheter, attached to the Valentine apparatus, in preference to the glass nozzle so frequently used. Previous to inserting the catheter, I always see that the patient has flushed out the urethra by urinating. When passing the catheter into the urethra, I have the fluid flowing from it, that the discharge may be washed out of the urethra as the catheter is advancing, thus avoiding the danger of carrying infection to the previously healthy tissue. I merely advance the catheter a reasonable distance beyond where infection is believed to have advanced, and I seldom find it necessary to irrigate the membranous portion of the urethra, when the case has reached my hands sufficiently early. The careful attention to the above rules will usually prevent the tendency to infection of that part, and my results have led me to believe that infection of the posterior urethra usually accompanied by a subsequent prostatitis, is frequently due to lack of care in the handling of the irrigator, rather than the natural tendency of the disease to invade these parts.

Many patients are so situated as would preclude the possibility of their reporting to the office morning and evening for this local treatment. In such cases, I have found that a solution of hydrogen dioxide, one to eight, used as an injection by the patient, gives excellent results, espeIcially where instructions are carried out with reference to urinating, and then injecting clean warm water previous to the hydrogen dioxide solution.

In conclusion, I might say that chordee is controlled by nightly dosages of the bromides, and with rectal insertion of suppositories of belladonna and opii, if necessary. I have not thought it necessary to refer to conformance with the rules of hygiene other than thus generally, the abstinence from alcoholic liquors and such beverages as coffee, etc., being universally required.

Acts Naturally.

Dr. J. A. Thompson, Annona, Tex., says: In the cases that I have used Chlonia for constipation, I find that it gives relief by causing gentle and regular action of the bowels.