leges see to it that no one shall be appointed on a board who is unfriendly to them, with possibly one or two exceptions in States where politics is strictly partisan and boards use their political position to down a medical college; hence, all who graduate "pass" and receive licenses to practice.

These are facts and not merely suppositions. The theories advanced may be contrary to these assertions, but I had some legal training and am a sticker to facts. Supposing now physicians who have been in practice for years and by reason of some event or mere desire wish to remove to another State, they, too, must go before these examiners. pay a “fee” ranging from ten to fifty dollars (depending upon the degree of greed of licensing boards in the various States) and "pass" an examination. None of these are being kept out of any particular State, because they take as many examinations as the boards want them to, and they finally pass. But they do not forget the imposition of the board, hence they become Medical Nihilists and down a confrere every time they get a chance. Who can blame them? Is a physician of California not as good as one of Kansas? Why should a Kansas physician ask the one from California to pay an extortionate fee and pass an examination on every subject studied at a medical college? Supposing the California physician was practicing a single subject, i. e., obstetrics, or eye and ear, or chemistry, or pathology, or gynecology, or surgery, or any other; or, even if a general practitioner, why should he be asked a few technical questions when he has been devoting all his time to practice-facts and not theories-and necessarily forgot the theories? Is it consistent with good fellowship to impose upon one another in this manner? Ah, these laws keep out the advertising physician! Such a claim is preposterous on its face. Is there any State free from advertising physicians? Not that only, physicians who wish to advertise have formed "medical companies," and, being soulless, they disgrace the profession. But is an advertising physician not preferable as a competitor to "the Nihilists" who declare that physicians are frauds and the drugs they use a curse to humanity? And must a whole profession be kept in bondage because there are a few black sheep in it? Let us stick to facts and not delude

ourselves with "theories," and we cannot help conclude that Boards of Examiners should fill a more important niche (and there are plenty of them) than to hold up and impose upon their confreres. Why do not the boards pass laws governing preliminary education and laws which shall define what a college in good standing shall be? Why do they not try to remedy the roots of the evil instead of tinkering with the branches? Why do they not let the branches live or die, as may be their destiny? Ah, there would not be sufficient revenue for them! Physicians, then, must submit to it nollens vollens. Must they in fact? Cannot physicians get together and, by virtue of numbers, compel the Legislatures to repeal these laws? Some one says "we have passed reciprocity (?) laws, and are passing them as fast as Legislatures meet.' Do the States which have such laws reciprocate? Please find out whether California reciprocates with any State, notwithstanding the fact that such law has been on the statute books for some time. Besides, is it "reciprocity" when some boards have passed a law with a $50 fee? (See laws of Iowa and Ohio.) Does one call it "reciprocity" when it is practically a means of holding up physicians for more revenue? For whose benefit are these fees? Do the rank and file receive a single benefit in return for allowing themselves to be held up? Last year, from new graduates only, the boards collected about $85,000. Who benefited from this amount other than the Boards of Examiners? I am basing the figures on 5,700 graduates and the average fee at $15. Have the boards kept any one from practicing in return for this amount? Emphatically no. And every time a physician moves to a new State he must pay a fee de novo, and, of course, take an examination. Is not a Christian Scientist, Magnetic Healer, Vitopath, Neuropath, or any other kind of nondescript better off? Decidedly so. Not that only the laws do not say that any one of these nondescripts is such in one State and not in any other, as the laws do regarding a physician. Many physicians will corroborate me that in numbers of instances they have been asked by ignorant laymen whether they have “qualified" as physicians in a particular State. The laws on the statute books explicitly declare that a physician recognized in one State shall not be recognized as

such in any other. Hence, the people have practically no respect, aye! treat a physician with contempt.

I grant that every State has a right to regulate its internal affairs, but is a fever in California a tumor in Kansas? Is cryoscopy defined in California as one thing, and another in Kansas? Why shall not a physician of California be entitled to courtesy when moving to Kansas and not be recognized a8 such per se, the same as a lawyer, preacher, engineer, etc.? But again, is the rank and file a body of non compos mentis individuals? Must they create their own shepherds to lead them? Is each one not capable to control his own political destiny and individual welfare? I hear some one say "that the best men in the profession are members of the A. M. A., and we are simply following (following is good) the dictates of these men who ought to know what is good for the profession." In the first place I deny that a few individuals know better what is good for the profession, chiefly because the average physician is in his right mind and knows best what is good for himself; secondly, the professionally brilliant men in the A. M. A. do not meddle with the political destinies thereof, because they themselves are comfortably situated -they may go and come and do as they please and no one dares question them-and either do not take an interest or do not care to know how detrimental the conditions are to the rank and file; thirdly, the political element in the A. M. A. regulate and control the political welfare of the rank and file, hence they always aim at personal benefits exclusively.

What single benefit has a physician from his membership in the A. M. A.? Can any one name a single one? Let us hear of it. The A. M. A. is publishing a journal, and the revenue derived therefrom is the main concern of the chief promoters of that organization. Why, it used to be that any one who paid $5 for a year's subscription to the journal was by virtue thereof entitled to membership in the A. M. A.; lately, they changed it so that one pays $5 a year "membership fee" and receives the journal gratis. In other words, they changed tweedle-dee to tweedle-dum. Physicians must think and not tolerate a few to use their political position for the purpose of furthering their own

political ambitions to the detriment of the rank and file. Such a condition may be permissable in a strictly political organization, but is disgraceful in a professional one. The A. M. A. is not an organization for the benefit of the American Medical Profession, but is managed and run strictly in the interest of a few. In proof of this I mention the fact that no one who attempts to criticise the disgraceful conditions extant is allowed a voice within the councils, and, more particularly, within the pages of the journal, which is supposed to be owned by, for and in behalf of the men who are members of the A. M. A. Is the individual who runs that journal a Medical Pope? Are his opinions infallible? Does he know it all, and are the rank and file in the profession a lot of ignoramuses? Honestly and truly, it grieves me to see so many intelligent men follow like sheep, receiving in return therefore contempt at the hands of the shepherds and disgrace from outsiders.

Physicians must get together and organize an association whose motto shall be: "Equal rights to all and special privileges to none. Fraternity and Progress." Then, and then only, will they regain the confidence of the people and be treated with the deference they are entitled to, as men of a noble profession.

ACUTE THYROIDISM FOLLOWING CURETTAGE.

By BROOKS H. WELLS, M. D., New York.*

Since the time when the Roman matron measured with silken ribbon the throat of the bride before and the day after marriage, to determine by its rounded increase that she had been a pure virgin, the sympathetic relation of the thyroid gland to the pelvic organs has been vaguely known; but hardly more than a decade has passed since we began to appreciate the various facts that will in time lead to an accurate knowledge of the functions and physiology of this and the other ductless glands.

Under certain conditions there occurs in those individuals who have been the subjects of a thyroid tachycardia a virulent acute toxemia characterized by a well-marked

Reported at the Clinical Society of the New York Polyclinic Medical School and Hospital. Stated meeting, held January 4, 1904.

group of symptoms. This toxemia may follow operations upon the thyroid itself, operations upon the pelvic organs, or, more rarely, operations upon the breast or other parts of the body, or any marked nervous strain.

The exact mechanism by which the function of the gland is disturbed or excited is not definitely known. The disturbances after operations on the thyroid itself have been attributed to an outpouring of toxic material into the blood; either as the result of the manipulation to which the gland is subjected or from a leakage and absorption from its cut surfaces. These causative factors can be ruled out when the thyroidism follows operations on other parts of the body. In cases similar to the one recorded below it seems certain that the condition is the result of a reflex disturbance of the central nervous centers and the sympathetic centres that control the activity of the thyroid gland or, as has recently been suggested, of the parathyroids.

The condition is often rapidly fatal, death occurring within the first three or four days from cardiac exhaustion. When recovery ensues the symptoms rapidly or gradually disappear until the individual reaches the status present before the attack.

The following case of acute thyroid poisoning following curettage seemed to possess features of interest which made it worthy of record:

Mrs. X., aged 53 years, had passed the menopause at the usual time, but during the last six months had had repeated small bleedings from the uterus, which was not enlarged, and was freely moveable. She was nervous, thin and poorly nourished. For many years she had had a slight enlargement of the right lobe of the thyroid, an excitable, rapid pulse and slight tremor, but no protrusion of the eyeballs. Auscultation of the chest revealed a few bronchial rales. No other pathological condition was discovered. To exclude the possibility of beginning cancer of the fundus uteri as a cause for the post-climacteric bleeding a curettage of the uterus was performed under strict asepsis on November 5th, at 10 A. M. The scrapings from the endometrium were examined by Dr. Jeffries, pathologist at the Polyclinic who reported that they showed only a moderate grade of endometritis. There were no further symptoms, local or general, that could be referred directly to the curettage.