exploitation of cancer, tuberculosis, and other diseases.

The "patent" medicines, which are rarely patented, and the proprietary medicines, which are practically identical with the so-called "patent" medicines, are covered by the Food and Drugs Act of 1906, commonly known as the Pure Food law. This law has done a great deal of good by fixing responsibility for products both in food and in drugs, but its common name, Pure Food law, has made people think that everything bearing its guaranty, name, or number is altogether admirable. This is a serious mistake. Its provisions and its field of application are both limited. The Food and Drugs Act applies only to products in interstate commerce-things manufactured and sold within the boundaries of a single state are not affected.

If a drug product is to be sold in states other than the one in which it was manufactured, it must fulfill certain conditions. Its "label," which by the interpretation of the courts includes all the contents of the package, must state whether it contains alcohol, morphine, opium, cocaine, heroin, alpha-eucain or beta-eucain, chloroform, canabis indica, chloral hydrate, or acetanilid, or their derivatives. These eleven drugs and their derivatives must be declared, with the amount of each used. But other poisonous drugs, such as aconite, arsenic, carbolic acid, prussic acid, and strychnine, may be used and not declared.

The patent-medicine manufacturer must be careful in the statements he makes in the trade package, which includes the bottle, its label, and all circulars, boxes, or cases that go with it. He must make no

statement which is false or misleading about the composition and origin of his medicine, and he must be careful not to make false or fraudulent claims for its curative virtues. Doctor Cramp, of the American Medical Association, puts this very clearly: '

Under the Food and Drugs Act, then, the manufacturer of a medicinal product may be declared guilty of misbranding if the statements he makes (on the trade package) regarding the composition or the origin of his products are either "false or misleading"; he may also be found guilty of misbranding if the statements he makes (also on the trade package) regarding the curative effects of his preparations are both "false and fraudulent.”

However, the patent-medicine maker and seller slips by Uncle Sam's grave requirements very easily and happily. He then betakes himself to the newspapers, in which he can make practically any boast of the curative effects of his medicine. No one molests him, and the people believe him, for in their minds does not the Pure Food law also insure them pure medicines?

Doctor Cramp gives us this clever rule for finding the false ingredient in a newspaper advertisement for patent medicine:

From the claims made in the newspaper advertisements and circulars subtract those that are made in the trade package; the difference, you are justified in assuming, is falsehood!

STATE LEGISLATION

Besides these Federal laws, various states deal separately with the medical quack. During the past

1 Arthur J. Cramp, M.D., "The Nostrum and the Public Health," reprint from The Journal of the American Medical Association, May 24, 1919, p. 4.

two years nine states have passed laws prohibiting the advertising of treatment for venereal diseases, and in some cases the advertising of nostrums to treat these diseases. This legislation was in most instances the result of the war-time campaign against venereal diseases. It has undoubted value, but two limitations must be pointed out.

As these are state laws, they do not affect business done through the mails, as such. These state laws, and the Federal law, however, are mutually supplementary, and each is necessary to the other's most complete effectiveness.

Quacks often get around these laws by using a form of words which does not come strictly within the wording prohibited by the terms of the statute. Then they trust to a narrow legal interpretation to save them should they be prosecuted.

In addition to these special laws the legislation of each state in the Union regulates the practice of medicine within its own borders. These medicalpractice acts need to be strengthened in some respects. The custom of recognizing by courtesy and without new examinations a doctor who has been registered and licensed to practice in another state covers many abuses of quackery.

These state laws regulating the practice of medicine apply to obvious cases. Under them a man, posing as a doctor, "practicing medicine" without legal license to do so, can be prosecuted and convicted. So can the licensed fraud. A doctor who has started out honestly enough may fail to make a success of ethical practice; he may start a profitable "institute" or a business by mail; or he may hire himself

to some "professor" and for a small, regular salarytwenty-five dollars to fifty dollars a week-do the "examining and prescribing" while the "professor" takes in from two to eight thousand dollars monthly. The license of such a man can be revoked, and he may be punished further if he is found guilty of actually taking money with the intent to defraud.

The hospital or dispensary has only just begun to come under public supervision, although it is sound policy that any organization doing public work should be under some degree of public supervision. The delay has probably been due to a theory that the public interests were protected by the licensing of individual practitioners of medicine, who must be the active professional agents in these institutions. It has come to be recognized, however, that the institution, as such, should be under direct supervision of a health authority representing the public; consequently state or local laws licensing hospitals or dispensaries are being passed. New York, Massachusetts, and Ohio are examples of states in which dispensaries must be licensed. The Massachusetts law defines a dispensary as follows:

SECTION I. For the purposes of this act a dispensary is defined to be any place or establishment, not conducted for profit, where medical or surgical advice or treatment, medicine or medical apparatus, is furnished to persons nonresident therein; or any place of establishment, whether conducted for charitable purposes or for profit, advertised, announced, conducted or maintained under the name "dispensary" or "clinic," or other designation of like import.

Any organization advertising itself as a clinic, dispensary, or medical institute would come under this

law, and therefore under the supervision of public authority. In the case of Massachusetts this is the State Department of Health, but in Chicago it is the City Department. In any case, the license law gives to some public authority a power to acquaint itself with facts through inspection, and to use these facts for public information. During the first year of operation the Massachusetts Dispensary law, passed in 1918, put out of business nine quack or commercial dispensaries in the city of Boston.

LAW ENFORCEMENT

The value of all these laws, however, depends upon their aggressive enforcement. Their purpose is often defeated because the person who has suffered from the quack fails to make a complaint. Only after the public realizes that it is being defrauded will it look for the law to redress its grievance. Many immigrants are so unsuspecting that they are easily fooled. Even if they do appreciate that they have been duped, their ignorance of English, or of the means of legal redress, usually renders them passive. It is neither just nor wise that the public should thus place the responsibility of initiative upon the individual who is aggrieved. An aggressive public agency, rather than a passive one, is needed for the adequate protection of the immigrant against the medical quack.

Beginnings in this direction have been made by various agencies, both public and private. Prominent among these are the state bureaus of immigration. The California Commission of Immigration and Housing, whose work is notable in so many ways,