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It seems strange, almost absurd, that entrance requirements have not already been placed upon a basis of uniformity. It is well nigh scandalous that it has not been established. Ignorance should not be tolerated. anywhere among those who contemplate entering upon the study of medicine and the colleges throughout the length and breadth of the land should agree without unnecessary delay upon the minimum of preliminary or entrance qualifications. This once done it would be a comparatively short step to the standardization of the methods of teaching, as well as the length of the undergraduate terms. Finally, with these two essentials agreed upon, the licensing boards would be compelled to establish uniformity of methods of examination, and likewise, the states could no longer withhold indorsements of licenses. The Association of American Medical Colleges can be depended upon to establish the first two propositions, namely, the uniformity of entrance requirements and the length of collegiate terms and methods of teaching. It will then be "up to" the examining boards and state authorities, to use a trite expression of the day, to see that their methods become of uniform standard and that reciprocity is established with promptitude. I am resuaded, from considerable observation and experience, that interstate reciprocity in licensing is best accomplished through the avenues named, and indeed that only in this way can it be accomplished with fairness to all the variant interests, with lasting credit to the profession, and with substantial benefit to the licensees who expect to derive advantages from this privilege. Reciprocity was given considerable consideration by the president of the American Medical Association at Boston in his presidential address. Dr. Mayo thought that what was needed was a higher standard of requirements and more and better supervision of professional schools. At the present time each state has its own standard of requirements. The conditions now with reference to reciprocity in medical license are well nigh intolerable and restrain the individual freedom guaranteed by the constitution. The borders between states are imaginary lines, yet a physician on one side of the border could not relieve human suffering on the other side without becoming amenable to the law or subjecting himself to vexations examinations which he had already successfully passed in his own state. This must be met and speedily, by agreement between examining boards as to the minimum of requirements. After all, this is but a part of the educational problem. If we can solve this, licensing boards could at once adopt more. uniform examinations and reciprocity.

The Ownership of the Prescription.-Colorado Medicine is out with a new argument from analogy as to who owns the prescription. It states that the Supreme Court has decided an architect who "receipts for professional services" can protect his work and his client cannot build two houses on the same plans, while the architect who receipts for "plans and specifications forfeits his rights to ownership, therefore the patient who pays for professional services does not own the prescription. The best argument by analogy in this much debated question is that the physician's prescription is comparable to a ticket to a theatre seat or a railroad journey for one trip only, and this should be taken up by the agent, who complies with the order which it contains, and not repeated unless a new prescription or order was reissued by the physician or company.

Deaths from Diphtheria Inexcusable. In a recent bulletin the Chicago health department states: "Every death from diphtheria should be made the subject of judicial inquiry, as other avoidable deaths resulting from negligence, culpable ignorance or criminal malpractice now are. This shows how thoroghly the value of antitoxin in diphtheria has been established.

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The Value of Medical Expert Testimony.(Bryce, Southern Clinic).-If the medical profession has made itself the laughing-stock of the people in any way, it surely has done

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more through the medium of its socalled experts on the witness stand than by all other means. The readiness with which medical men may be found to testify on either side of any case and refute the testimony of each other is something remarkable. if we are to look upon medicine, chemistry or surgery as anything of a science. The effect of such conflicting testimony by men supposed to be fairly or exceptionally representative of the scientific side of the profession is damaging to the entire profession, to the cause of the case pending in the courts, and to the moral tone of the witness's opinion and utterances. There is not the slightest doubt that personal friendship, pecuniary pressure, and prejudice are the largest contributors to this evil so frequently perpetrated in our courts in cases involving life, honor, property and happiness. The remedy in a measure consists in the selection of competent and unpurchasable medical experts, and in permitting no other kind of medical men to appear upon the witness stand, whether it involves the ownership of a hound dog or the chastity of some good woman whose profligate husband would exchange her,

under the lax divorce laws of our land, for the more attractive animal frequenting the resorts of the demi-monde. Regarding the competency of a medical witness, it should not be inferred that because a man stands well in his community as a general practitioner he is competent to give expert testimony in matters of which he is altogether ignorant from want of personal experience in his daily work. In matters concerning the insane, for example, we would attach far more value to the testimony and opinion of a sensible nurse or attendant in an insane asylum who had ample experience in such capacity than to any number of medical experts whose only expertness consisted in experience gained in the treatment of infantile flatulency or adult bellyache. Now, however honest and well-intentioned these men may be they lack the very qualifications for which they are summoned and are therefore liable to do more harm than good in their testimony as experts. They may be summoned to whitewash their friends or damage other testimony, but this is not expert testimony, and the juries of the land know it, have no respect for it, and it should not be allowed.

MAJOR JOHN M. BANISTER, of the United States Army Medical Service, giving his observations during three years spent in the Philippines, says that scarlet fever, diphtheria, and yellow fever are unknown in these islands. He remarks: "As far as I have been able to learn not a single case, of either of these diseases ever occurred in the archipelago."

JAPANESE LOSSES IN THE WAR.-According to the Tokio correspondent of the Times (London), the Japanese Minister of War, speaking at a banquet of representatives of the medical service, said that Japan at one time during the war had 1,200,000 troops under arms. Of this number 70,000 died and 310,000 were wounded or sick, but only 15,000 died of sickness, and 9,800 died of wounds after coming under treatment.

THE PULSE IN TUBERCULOSIS.-M. Durand says the pulse rate is a valuable diagnostic sign in tuberculosis as indicating the severity of the disease and its probable duration. If the pulse rate is maintained above the condition is serious, and desperate if it exceeds 120 for several days. Thus examination of the pulse enable us to recognize curable forms of tuberculosis or at least those of slow progress. In doubtful cases of consumption don't fail to take the temperature. A slight rise toward night is one of the first signs.

SOCIETY PROCEEDINGS

THE MEETING OF THE BRITISH MEDI-
CAL ASSOCIATION.

TORONTO, CANADA, August 29, 1906.
I.

The British Medical Association held its annual meeting at Toronto, August 21-25, under the presidency of Dr. Reeve, the dean of the Medical faculty, University of Toronto. Toronto is a beautiful city, and the University buildings are well adapted for the purposes of a congress. The hospitality of our Canadian cousins has been unbounded, and I think everyone has been charmed with his visit to the great Dominion. Some 1600 members and visitors attended, the British

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taken. He is of opinion that if the symptoms do not yield after three or four months of medical treatment, an exploratory operation should be done. If the growth could not be removed, the opening of the skull would do gocd, inasmuch as it would infallibly prevent blindness supervening on the optic neuritis; in itself no small thing, since these cases might go on for years. As regards optic neuritis his experience warranted him in saying that this first appeared always on the same side as the lesion. The chief risk of the operation was from shock; the patient should be kept warm with hot water cans on the operation table, which should be fitted with a proper adjustable head rest, and throughout the operation, the brain should be kept irrigated with 1-5000 corrosive sublimate solution at a temperature of 115 deg. F. This prevented cooling of the nerve tissues and tended much to prevent shock and also stopped capillary oozing. The brain tissue should be handled as gently as possible. The skull should be opened by first making a trephine hole, then by marking out the area of bone to be removed with a saw, and finally removing the bone with bone forceps, all trac-. tion being directed carefully away from the nerve substance. There was never any need to remove parts of the brain in order to expose the growth; the brain could always be pulled aside with spatulas. All vessels, arteries and veins, should be ligatured as long as possible. Bleeding to the bone could always be arrested with wax, and troublesome venous oozing was at once arrested by the administration of oxygen. As regards anesthetic Sir Victor uses chloroform; by means of the Vernon Harcourt regulator this could be administered in any desired amount. While opening the skull and dura 2 per cent of chloroform in the air sufficed completely to anesthetize, but in the subsequent procedures often per cent was enough to keep the patient sufficiently under the quantity being again raised to 2 per cent during the closure of the wound. Asepsis and antisepsis should be carried out with the greatest care, as operations on the central nervous system are particularly liable to be followed with septic infection.

Dr. W. S. A. Griffith delivered the address in Obstetrics on "The Teaching of Obstetrics," and Sir James Barr the address in Medicine on "The Circulation Viewed from the Periphery." Dr. Donald MacAlister was the president of the Therapeutic section and in his address advocated reciprocity between Canada and England in medical practice. As he is president of the General Medical Council in Great Britain he evidently spoke with authority.

Prof. Arthur Robinson, the president of the section of Anatomy gave some introductory remarks on the teaching of anatomy in universities and medical schools. He concluded as follows: "It should, therefore, be the object of anatomists to avoid entangling medical students in a superfluity of detail. They should insist upon a thoroughly sound knowledge of the general relations and arrangements of the more important organs and parts of the body, a good knowledge of the general principles which underlie the relationships and arrangements and the advantages derived from them. They should endeavor to make their students acquainted with the general laws of growth and development and with abnormal conditions so far as they are produced by deviations from general

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laws of growth and development, and, carrying on the work done in the Biological Department, they should draw attention to man's relations to other animals in all cases where such relations are evident, and are instructive of the methods by which man has been evolved and the means by which he retains his place in the world. In addition, however, they must see that their students acquire a sufficient knowledge of the detail of the various parts of the body and their relationships to enable them to deal successfully with any emergency of daily life."

An interesting discussion on arterio-sclerosis engaged the combined attention of the sections of Medicine and Pathology, and Prof. Welch, Dr. Klotz, Prof. Aschof, and Dr. Clifford Allbutt among others took part in the discussion.

The following is a synopsis of th econtribution of Mr. Oskar Klotz, Resident Pathologist Royal Victoria Hospital, to the discussion on the Forms of Arterio-sclerosis, their Classification and Experimental Production: Experimental arterial lesions which can be produced in animals are two kinds: either a degenerative one, affecting mainly the media, or a regnerative one, in which the intima proliferates, while little or no degenerative change is seen. It is found, too, that the substances which are used to produce the former belong to the class of high pressure does not in itself lead to the medical lesions noted; there is a direct degenerative action of the drug on the muscle fibres of the Elastic fibres become affected later. media. The latter once giving way leads to aneurismal dilatation. The degeneration is of a fatty nature. The intimal regeneration is consequent to bacterial toxins, the proliferation being confined to the endothelial and subendothelial cells. When only intimal lesions are present aneurisms are not formed. The character of these lesions can be compared to those in man to a certain extent. Here lesions entirely of a degenerative nature are met with in the Moenckeberg type of peripheral arterio-sclerosis, and with the form of this disease as it is found in the aorta, both of which processes are confined to the media. The experimental bacterial lesions of vessels simulate the endarteritis chronica deformans which develop the pearly intimal plaques. RICHARD T. HEWLETT. (To be continued.)

A GEORGIA INDEPENDENT SOCIETY.-The "Atlanta Constitution" is authority for the statement that a new State Medical Association is being formed through the efforts of a number of leading physicians of Georgia. The promotors insist that they are in no sense making a fight on the Georgia Medical Association, but objecting to some of the features of the American Medical Association they are forming a body in which they will be free to act for themselves.

MAKING COCAINE FIENDS.-William Jay Schieffelin, the wholesale druggist, declared at a hearing at Albany, that there were drug stores in New York City which gave away cocaine for the purpose of developing the habit and creating customers. He says that 20 per cent of the cocaine manufactured in this country is converted to illicit uses. His remarks suggest that the public is insufficiently protected against unscruppulos druggists.-Texas Med. News.

CLINICAL THERAPEUTICS

A forum of original experience, to which scientific contributions are invited. Responsibility for views promulgated imited to author.

VIOFORM-ITS USE IN OTOLOGY.

B. P. REKO, M. D.

CHICAGO.

Ear Department, Rush Medical College.

THIS but an attempt to record my experience with vioform as to its clinical aspect in otology. Its value in general surgical work has been extensively demonstrated by Tavel, Krecke, Schmieden, Wehrle and others. It has been recommended as a substitute for iodoform and, indeed, the chemical and bacteriological tests as well as the clinical investigations would undoubtedly confirm that opinion. Therefore I can restrict myself to a mere recapitulation of the acknowledged facts.

Vioform is a derivative of chinoline, whose antiseptic, antizymotic and antipyretic properties become still more prouounced by the introduction of one atom of iodine and chlorine. It is a grayish-yellow powder of great stability to light, heat and moisture. It is practically insoluble in water and, as it is much lighter than water, it forms a thin film on the surface. Compared with iodoform, it possesses the following advantages:

I. Its bactericidal power is greater than that of iodoform, whose styptic, deodorizing and infection preventing action it retains.

2. It is non-irritant, being neutral and therefore non-caustic.

3. It is non-toxic.

4. It is stable and readily sterilized without decomposition.

5. It is practically odorless.

Its only disavantage is that it cannot be used for subcutaneous injections, since abscess formation is liable to occur.

My attention was first directed to this preparation at the Ear Clinic of Prof. Politzer in Vienna, and afterwards in the Austrian army, where vioform has been adopted for use.

My intentions were to keep record of the effects of this remedy in cases of middle-ear suppuration, based on the rhodan kali (potassium sulphocyanide) test of the saliva.

Prior observations at the clinic of Prof. Politzer led me to ascribe great value to this test in diseases of the middle-ear, since absence or only traces of rhodan kali (potassium sulphocyanide)-KCNS-in the saliva suggests a disease of the middle-ear with lesion of

Vide: Alexander & Reko: "Beitrag zur Verwertung der Rhodanprobe des Speichels bei Ohrenerkrankungen." Wiener Klinische Wochenschrift, 1902, No. 42.

the tympanic plexus, while the reappearance or increased amount of rhodan kali (potassium sulphocyanide) during the course of the disease would indicate a favorable progress.

Where bilateral suppuration permitted a more critical comparison of the different antiseptics en vogue, I improved the opportunity to test the superiority of vioform over jodol, airol and dermatol. In all observed cases vioform acted as an ideal antiseptic and siccative, hastening the reappearance of the rhodan kali (potassium sulphocyanide) in the cases where a cure was performed. In acute suppuration I found it of better advantage to follow the dry treatment and use boric acid for the first days after perforation, as it readily dissolves in the secretion, and does not easily interfere with drainage. The after-treatment consisting of the use of vioform as dusting powder finished the process of resorption speedily. Of special interest to me were cases of radical operation, where I could observe, whether or not vioform would shorten the time of recovery, which in uncomplicated cases amounts to about four weeks, as indicated by the typical reappearance of the rhodan kali (potassium sulphocyanide) at that time in all our observed cases (fifteen) at the Ear Clinic of Prof. Politzer. Unfortunately my observations in this direction were limited to a single case of radical operation during the time of this investigation, but in this case the decided favorable action of vioform on the course of the healing process was very much pronounced. The granulations were clean and small, and the restoration was performed in two weeks, as shown by the rhodan kali (potassium sulphocyanide) test. Similar results were obtained by Lindt and Siebenmann, who use vioform exclusively. Lindt observed that vioform does not tend to favor abnormally marked granulations, and does not harm epithelial growth in the exposed middle-ear cavities after radical operations.

Siebenmann found that wounds after radical operations were repaired quicker than by airol or dermatol. "Vioform is recommendable for after-treatment in radical operation, as it excites less granulations than under the application of iodoform, and the new formation of epithelium progresses quicker therefore."

My observations are not limited to the use of vioform in otological cases. I use vioform very extensively in my private practice after operations in the nose, where tampons of vioform gauze may be left for days without becoming malodorous owing to decomposition. From my observations I am led to the conviction that vioform deserves first rank among the antiseptics in use in rhino-laryngology.

MEDICAL MISCELLANY

Juglans is a good vermifuge and it is claimed that it has destroyed tape. worms.

MORTALITY FROM HOMICIDE AND VIOLENCE. The number of homicides and deaths by violence in the United States in 1905 was 9,212, as against 8,482 in 1904. Suicides, 9,082, as against 9,240 in 1904. Killed on steam railroads, in 1905, 3,142; injured, 15,904. Killed on electric and elevated railroads, 464; injured, 2,622. These statistics, collected by the Chicago Tribune, are unofficial, but perhaps they are none the less trustworthy on that account. We murder and manslaughter nine times as many as the Germans; four times as many as the English, Scotch and Welsh. America seems to be a little careless, to put it mildly.

THE KLEPTOMANIAC.-"A New York specialist got, on a certain morning, the card of one of the richest of our Western millionaires. He went down instantly and found a welldressed man, who said:

"I am here, sir, on a delicate and painful matter. My wife is a victim of kleptomania, and, knowing your skill in mental diseases, I have brought her on for treatment under you.'

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'Bring the lady to see me tomorrow morning,' said the physician.

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'It will be best not to bring her to your office,' faltered the millionaire. 'The sight of other patients might excite her. gestgest'I'll receive her in my drawing-room. Will that be better?' asked the physician. "Oh, much better,' said the other, in a relieved tone.

"And the next day the Western millionaire led into the physician's drawing-room a young woman of singular beauty. She was magnificently dressed, but her eyes were furitive and restless, and when she thought no one was looking at her, she secreted under her coat three or four valuable ornaments. physician and the Westerner smiled slightly at one another.

The

"The physician, after his examination of the patient, told the husband to return the next day alone.

"And when I come,' the husband answered, 'I'll bring back these things that she has taken.'

""Do,' said the said the physician. "I will,' said the Westerner.

"But he didn't. He won't. He and his wife are thieves, and they have worked their kleptomania dodge in nearly every city in America."

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