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Still, reasoning from analogy is not, strictly speaking, scientific, but it serves as a working hypothesis until science enables us to demonstrate the principles or laws upon which a recognized fact is based. Starting with facts which will stand the test required in mathematical demonstration, it seems that the last decade of the nineteenth century, with its scientific equipment, is destined to become the most marvellous era in the his

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preciate, while they were quite willing to believe that causes which produced like effects must be interchangeable. far from being the case, clinical evidence showing beyond question that most purgatives, both directly and indirectly, produce more or less derangement of function, hence the means used to overcome one disease but precipitates another, and chronic maladies, many of them brought about by this cause alone, furnish ample opportunities for the industrious and promising quack.

Philosophy aside, the value of flushing the colon with properly sterilized water, hot, tepid or cold, according to the spec

tory of medicine. The experiments of
Dr. STERNBERG relating to the possibility
of producing artificial immunity from dis-
ease, and the observations of Prof. WELCH,
concerning the influence of soluble
poisons in the blood, are facts pregnantial
with far-reaching possibilities to the pres-
ent and all future generations, but it re-
mains for the clinician to interpret aright
these facts. Modern therapeusis, running
in lines parallel with scientific research,
seeks results, not from the study of coin-
cidences and analogies, but from the study
of both scientific and clinical facts.

RECTAL INJECTIONS.

The employment of enemata as a means of relieving diseased conditions, while not a new therapeutic measure, is a valuable one, and its merits demand more attention at the hands of practitioners than they have heretofore received. In presenting the subject for consideration at this time, however, it is not deemed advisable to discuss the advantages of medication by means of rectal injections, as the benefits to be derived from the use of water are so numerous and apparent that medicated enemata may be left to the good judgment and intelligence of the physician.

Originally employed for the removal of retained fæces, the practice doubtless fell into disuse owing to the fact that relief might often be obtained by the exhibition of irritant purgatives, an alternation which the laity were quick to ap

indications present, will be readily admitted in a long list of formidable diseases, some of which may be mentioned, as follows: Habitual constipation, with or without mental depression

or active cerebral manifestations due to auto-infection, being so common, might be permitted to head the list; all occult nervous affections, associated or not with the uric acid diathesis, would naturally attract our notice, as it is well known that disordered innervation is generally conducive to the absorption of poisonous products from the alimentary tract. They are also serviceable in disease dependent upon pelvic congestions, such as uterine. displacements, ovarian pains and hemorrhoids, for they contribute materially, though indirectly, to relieve the original cause, viz. hepatic insufficiency. In appendicitis, perityphlitis and abscess, for which the ameba coli communi is now held responsible, they are invaluable. Mild, and even severe cases of dysentery and diarrhoea are often brought to a favorable termination without enemata, but it is safe to say that, with appropriate diet, all cases would be decidedly benefited and many fatalities avoided by the adoption of this simple means. Enemata should find a place in the treatment of other disorders of this character, notably in the collapse of cholera morbus, yellow fever and cholera, as well as in the conduct of cases of pleurisy or typhoid fever.

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CORRESPONDENCE.

THE NEW YORK STATE LAW CONTROLLING THE PRACTICE OF MEDICINE.

TO THE EDITOR:

In the report for 1890 of the Board of Health of the State of Illinois on Medical Education in the United States and Canada, it is shown that in the decade from 1879 to 1889 there were 128,005 ma. triculants in the various medical colleges, both regular and sectarian, with 40,495 graduates; the medical profession of this country being aug. mented by an annual addition of more than 4,000 physicians.

During the period mentioned there has been a slight increase in the number of colleges; while those that exact educational requirements for ma. triculation, and attendance on three or more courses of lectures have increased almost 300 per cent. And a better indication of the determination of the colleges to send out well-equipped graduates, is shown by more than twenty per cent. of the colleges now requiring four years of medical study as a requisite for graduation.

This action by the colleges is in conformity with the increasing number of States that have passed laws regulating the practice of medicine; the advantages of such legislation being so apparent, argument in its favor is supererogatory.

After many efforts, and at a rather late date, the State of New York has enacted laws controlling the practice of medicine that seem to promise much for the future. These laws may be divided into three sections: the first providing for the preliminary education of medical students; the second regulating the licensing and registration of physicians and surgeons; and the third providing for the establishment of boards of medical examiners.

The first section requires that a matriculate must be a graduate in arts, science, or philosophy, from some college in good standing; or in lieu thereof he must have passed an examination in arithmetic, grammar, geography, orthography, American history, English composition, and natural philosophy, or in some substantial equiv. alent of one or more of the foregoing, the exami. nation being conducted under the authority of the Regents of the University of the State of New York.

The second section requires the applicant for registration to be over 21 years of age; to have certificates of moral character from two legally licensed physicians; a diploma conferring the degree of M. D. from some legally incorporated medical college in the United States, or a diploma or license conferring the right to practice medicine and surgery in the country in which it was

granted; evidence that the applicant has studied medicine three years including three courses of lectures in different years, in some legally incorporated medical college or colleges, no two of the above courses of lectures beginning or ending in the same calendar year; the candidate must pass examinations in anatomy, physiology, hy. giene, chemistry, surgery, obstetrics, pathology and diagnosis, therapeutics, practice and materia medica. In the last three departments the questions must be in harmony with the tenets of the school selected by the candidate. A fee of $25 must be paid in advance.

The third section provides that boards of examiners shall represent the medical society of the State and the homoeopathic and eclectic medical societies. Each board consists of seven members, each of whom serves for three years, appointed by the Regents of the University from a list of at least fourteen nominees submitted by each society.

One of the most important features of the State law is that the Regents may accept licenses from other State Boards of medical examiners maintaining an equal standard, without further examination. The general adoption of this comity would make the reformation of medical practice much more national in character; and it would seem to be the feasible extension of an existing principle, for in all States having such laws medical officers of the army, navy and marine hospital service are exempted from such examinations, those of the government being accepted as evidence of their professional competency.

I am indebted to the courtesy of Ralph W. Thomas, the law and medical examiner for the University, for the information that since the law has gone into effect there have been 87 applicants for admission to the examination, of whom 18 were rejected because they failed to meet the requirements of preliminary education, and of three courses of medical lectures in three different years. He states that in New York it is preferable "to require a high standard of education before admission to the medical examinations, and then a fair test of the candidate's ability to prac. tice medicine by the examination, rather than a low and imperfect preliminary and medical standard of education and an unduly severe medical examination."

The public, as well as the medical profession, has been confronted for years by an increasing number of medical colleges, offering nearly every inducement excepting more extended and thorough teaching to the matriculates. The consequence has been that the value of the degree of Doctor of Medicine has been lessened, and, most important, the public has been subjected to not

inconsiderable risks from the exercise of their vocation by poorly qualified practitioners.. To recognize the existence of an evil suggests a remedy, and the State has as much right to prescribe the requirements necessary to practice medicine, as it has those to practice law, or those to pursue a vocation that may endanger the health or welfare of its citizens.

Examinations do not necessarily furnish evidence that the successful candidate can practically apply his knowledge. But the chances are greater that one possessing knowledge will successfully meet an emergency than that a partially informed person will do so.

It does not seem that the law of New York exercises any invidious distinction; nor could any of its provisions be omitted without weakening its force.

The application is satisfactory to the public and the profession, and there is every indication that it is accepted, as is sunshine or any other salutary feature of daily life.

S. T. ARMSTRONG, M. D., Ph. D.,
Visiting Physician Harlem Hospital; Secretary Section of
Public Health, N. Y.; Academy of Medicine, etc.
155 W. 54th Street, New York.

Book Notices.

the true characteristics associated with
any special disease, but as an aid to diag-
nosis. The general practitioner will find
⚫here just the particular information wanted
when he meets with those complicated
morbid conditions that tax his skill and
ability to their utmost. Even its faults
may be deemed commendable, as Our
author is by no means optimistic in re-
spect to therapeutics. But, having a true
scientific exposition of the malady before
him, the intelligent physician is placed at
an advantage over his less progressive
associates who depend on empiricism and
the pathology of by-gone days, and can
readily make requisition upon his thera-
peutic armamentarium in the combat with
disease.

THE POCKET PHARMACY, WITH THERAPEUTIC
INDEX. (A Resumé of the Clinical Ap-
plications of Remedies adapted to the
Pocket-case, for the Treatment of Emer-
gencies and Acute Diseases.) By JOHN
AULDE, M. D., Member of the American
Medical Association. 12mo, pp. 204.
New York: D. APPLETON & Co., 1892.
Price, $2.00.

THE PRINCIPLES AND PRACTICE OF MEDI-
CINE.-Designed for the use of practic-
ioners and students of medicine. By
WILLIAM OSLER, M. D., Professor of
Medicine in the Johns Hopkins Uni-peutics;
versity, etc., etc. Cloth, 8 vo., pp.
1079, New York: D. APPLETON & Co.,
1892. (Price, $5.50.)

DR. OSLER'S encyclopædic work has now been before the profession less than six months, but time serves only to add to its deserved popularity. Expressing the views and conclusions of an eminent clinician, who has been guided in his inquiries by strictly scientific methods, the book is well calculated to serve as a reliable guide to the specialist as well as the general practitioner, although the latter class will gain from its perusal and study the greater benefits. If one were asked to mention the most prominent and valuable features of the work, the natural response to the inquiry would run about as follows: It is especially full in pathology, not merely as a means of studying

The author of this little book has already acquired a reputation as a writer on Theraso that, this, his latest presentation to the profession, is likely to be opened with anticipations of pleasure and profit from its perusal. Nor will these expectations be disappointed.

The "Pocket Pharmacy" may be looked upon as the outcome of a transition period, in which the tendency is to substitute for the nauseous combinations and poly-pharmacy of old style drug medication, a simpler and pleasanter mode of administering medicine. The author distinctly recognizes the fact that disease is primarily a derangement of all functions; and he finds, as was to be expected, that, if restorative medicines are to be adapted to this stage of disease, "small doses are to be preferred,-in fact, they are necessary."

Fortunately, the effect of medicines on abnormal conditions is within the range of

clinical observation; and it is but simple
justice to say, that the author of the Pocket
Pharmacy has rendered an important
an important
service to the profession by the precision
with which he has pointed out the chemi-
cal sphere of the several drugs discussed
in this little volume.

The physician who adopts the practical
suggestions herein offered, will find them
very helpful; while his patients will be
gratified to find that to the distress of ill-
ness it is not always necessary to add the
distaste of drug combinations, which are
dreaded by sensitive palates almost as
much as the disease they are intended to

cure.

Nor need the smallness of the dose
here indicated, deter from the utilization
of the directions of the Pocket Pharmacy,
for it is now well established that small
doses, frequently repeated, have a much.
greater, though a less disturbing, effect
than large ones. It was JOHN HUNTER
who taught that "medicines have visible
and invisible effects—their invisible effects
are often their specific effects, and indeed
their specific effects are often greater when
they are invisible effects." What will
now be desired will be an extension of
the list of medicines so far presented, so
as to include the more precise clinical
uses of other leading drugs in the materia
medica.
P.

THE INTERNATIONAL MEDICAL ANNUAL AND
PRACTITIONERS INDEX.-A work of refer-
ence for medical practitioners. PERCY
WILDE, M. D., Editor. Cloth, 8 vo.;
pp. 644. New York: E. B. TREAT, 1892.
(Price, $2.75.)

The Annual, during its ten years of
existence, has made wonderful progress,
and in the form of a single compact vol-
ume, presents briefly but intelligently, an
epitome of medical progress from year to
year. Equipped with a large staff of em-
inent contributors, specially qualified for
the different departments, it will prove of
great practical utility for those who desire

to have at hand in condensed form an ac-
count of the most recent advances in the
treatment of all diseased conditions. The
present volume contains sections upon the
following topics: New Remedies, New
Treatment, Recent Advances in Bacterio-
logy, Medical Photography, Sanitary
Science, Suppositories in the treatment of
Disease, Improvements in Pharmacy, New
Medical and Surgical Appliances, and closes
with a list of publications of the year. To
this should be added the observation that
a good index is furnished, which makes
consultation of its pages a source of satis-
faction.

THE ELECTRO-THERAPEUTICS OF GYNECOL-
OGY. BY AUGUSTIN H. GOELET, M. D.,
Fellow of the New York Academy of
Medicine, etc. Cloth, 2 vols., 12 mo.;
pp. Vol. I, 194; Vol. II, 203. Detroit,
Michigan: GEORGE S. DAVIS, 1892.
(Price, 50 cents per volume.)

Since the advent of electricity in gynæ-
cology, according to Apostoli's method,
a considerable number of physicians have
given it more attention than they had pre-
viously, because they knew practically
nothing of its possibilities in this special
field. An elementary work, therefore,
that dealt with the subject in a practical
manner from the very beginning, was a
desideratum, and this is substantially the
scope of the work undertaken by Dr.
GOELET. That the book is creditable to
the author goes without saying, as he is
well known as a conservative and faith-
ful exponent of the facts as he observes
them. The first volume is devoted to a
consideration of the physiological action
of galvanic and faradic currents, static el-
ectricity and its currents, closing with a
description of the apparatus required.
Volume II, deals with electro-therapeutics
exclusively, a chapter being devoted to
disorders of menstruation, one to diseases
of the uterus, one to diseases of the ap-
pendages and broad ligaments, and an-
other to pelvic tumors, thus practically
covering the entire field of gynæcology.

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are assigned to different writers, men qualified by their work to estimate the value of methods of treatment. For the most part, the book is composed of brief abstracts from current literature, and following these abstracts, where deemed expedient, explanatory remarks, suggestions, or other information bearing upon the topic follow in parentheses.

Diseases of the skin is assigned to Dr. MALCOLM MORRIS; diseases of the eye, to Dr. HENRY POWER; orthopædic surgery, to Dr. W. J. WALSHAM; gout, rheumatism and rheumatoid arthritis, to Sir A. E. GARROD, and the remaining sections are cared for by equally popular and reliable authorities, although, like those contributing to the Annual, they are mostly English authors. The progressive physician will find it to his interest to provide himself with both reference books.

Current Literature.

PIPERAZIN IN THE URIC ACID DIATHESIS.-The above reference to Prof. BARTHOLOW concerning the influence of nitric acid in lithæmia, prompts me to mention the new remedy-piperazin, recently brought to the attention of the medical profession for the relief of this disorder. Heretofore, lithia salts have been regarded as our most potent agent in correcting this diathesis, but it has been shown experimentally that piperazin possesses an activity fifteen times that of lithia, while the clinical evidence is decidedly in its favor. The daily dose of fifteen grains is readily dissolved in a pint or a quart of pure water and the solution drunk ad libitum.

TO HEIDENHAIN we are indebted for our knowledge concerning the functions of the Malphigian tufts and the epithelial cells lining the convoluted tubules, viz.: That the former excretes mainly the liquid portion, while the latter eliminates principally the urinary solids. It will be obvious,

therefore, that with exact clinical observation from the introduction of a definite chemical product like piperazin into the circulation, much valuable information may be gained concerning the role played by uric acid,-whether it exists pre-formed in the circulating fluids, or whether it is a product developed de novo within the kidney itself. This is an extremely interesting question, but it must be submitted finally to the test of the experimental physiologist before the clinical results can be calculated with mathematical exactness. Notes on New Remedies, June, 1892.

"RAILROAD KIDNEY."-Railroad kidney is the name applied by Dr. CYRUS EDSON (Dietetic Gazette, May, 1892), to disorders of the renal function as it occurs among railway employés, or in those who travel much, on account of the intitimate association of all travellers with dirt. Under the most favorable circumstances, dirt will fasten itself upon all exposed portions of the person, and thus an extra amount of work is thrown on the kidneys, and no doubt in persons suffering from disease of these organs, much harm may attend a prolonged journey. We must bear in mind at the same time that the peculiar motion associated with train-riding arrests the functional activity of excretory organs, and with our knowledge concerning the rapid absorption of poisonous products from the alimentary tract, too much stress should not be laid upon the presence of a little dirt externally.

DIAGNOSIS IN DYSENTERY.-Diagnosis in disentery is a matter of no small importance. Time was when all affections of the lower bowel were submitted substantially to the same treatment-opium and astringents; but with a better knowledge of the pathology, improved methods must be followed. Dysentery may be either catarrhal, amebic or diphtheritic. The amebic form may be of a chronic character, with acute exacerbations, and this practically covers the entire field. Evidently the treatment must vary according to the conditions present, and for this reason diagnosis is of the utmost importance. While opium and astringents may be of service in the acute catarrhal forms, this routine practice in the diphtheritic forms would be quickly fatal, while at the same time the plan would prove utterly fruitless in those cases due to a micro-organism.

It would be well, perhaps, if all cases of dysentery were regarded as directly or indirectly due to bacterial infection. Although no micro-organism can be detected in connection with catarrhal dysentery, there is good reason to believe that bacterial products may bear a casual relationship to the derangement of function which we witness; and the same is true as regards diphtheritic conditions affecting the lower bowel. The matter is

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