in your criticism of the California State Board of Medical Examiners. Oa October 4th, 1902, you say with reference to cryoscopy and Hanot's cirrhosis, "neither of these questions is exactly fair as testing a practitioner's qualifications." On October 25th you say, "as a whole the California State examination was eminently fair.".... Cryoscopy and Hanot's cirrhosis were the same on October 4th as on October 25th. Why this change in your opinion? I wish also to explain briefly the attitude of the PACIFIC MEDICAL JOURNAL and to analyze concisely Dr. Tait's letter published October 25th.

This journal has no fault to find with the Board of Examiners as a Board, nor does it object to the law if fairly administered. We do object, however, to unfair questions, and we do object to any school being discriminated against.

For many months before the examinations which have caused this discus. sion took place, it was common rumor among the physicians of this city and State that Dr. Tait had openly said he intended to "turn down" the students of a certain San Francisco school when they came before him for examination. So frequent and so convincing were these reports that many friends of the school in question urged the officers of the school not to permit their graduates to go before the board. I am not saying these charges against Dr. Tait can be proven. I am not saying they cannot be proven, but we can sometimes judge by results.

In the August examination nine subjects were examined upon; five of the examiners had one subject each, three of the examiners had no subject, and one examiner, Dr. Tait, had four subjects. The students from the college in question passed the five examiners who had one subject each with a general average of from 80% to 90%, while in the four subjects examined upon by Dr. Tait, these same students averaged from 30% to 50%, or sufficiently low to reduce their general average to less than 75%, the required percentage. Is not it a just conclusion that either Dr. Tait was unfair, or that the other five examiners were incompetent, and which do you think is the more probable? Dr. Tait says: "A few questions may have been asked rather to test the kind of teaching done in some of the schools, than to catch the students." Are we to infer that Dr. Tait asked but two kinds of questions, one to test the kind of teaching done in some of the schools, and the other to catch the students?

I would also remind Dr. Tait that the law does not make the Board of Examiners inspectors of colleges. This very statement upon his part is simply additional proof of his animus against this particular medical school. The law of the State, however, provides that a medical examiner shall not know whose paper he is examining, and it is true that the students from these favored schools went into the examination room with their badges and college colors on, grouped themselves together, and were treated with special favor, and it can be further proven that Dr. Tait went directly to more than one graduate of the school which was believed to have his disfavor, and asked these graduates their numbers, and later returned and asked them who were their instructors in such and such subjects. Do you suppose Dr. Tait did this out of magnanimity of heart, and to protect these students against unjust measures? The law says: "In said examinations the applicant shall be known and designated by number only, and the name attached to the number shall be kept secret by the Secretary until after the board has finally voted upon the application." Will Dr. Tait explain how he is to "test the kind

VOL. XLVI-3.

of teaching done in some of the schools," when he does not know whom he is examining nor the school from which the applicant comes? Has Dr. Tait convicted himself?

Perhaps Dr. Tait could enlighten us also regarding a particular student from the college discriminated against, who did not receive his official standing until thirty days after the examination closed, and then found that the standing had been reduced several points in several subjects from the gradings given him by the individual examiners three weeks before, and that these reductions were sufficient to bring the applicant's grading to 743%, and accomplish his rejection. I ask, had this applicant been finally voted upon when the gradings were first given him, and if not, was his name kept secret until his rating was determined?

I agree that to define intussusception as "the susceptibility of some people to disease" is unpardonable in an applicant for a license to practice medicine, but it is certainly no more culpable than to give as a symptom of morphine poisoning, dilated pupils, or to say that the eruption of measles "consists of small papules which dry up and form scabs which fall off leaving no scar." These were some of the answers given by students who passed and who represent Dr. Tait's "respectable element" of the profession.

[Since the above was written we have discovered that the question regarding intussusception was asked at the May examination, which examination was a special one and attended only by the graduates of the pet schools, and most of the applicants succeeded. It is conclusive, therefore, that the answer above referred to was given by one of the pet graduates of one of these pet schools.]

With the libel suit against Dr. Tait and another member of the board, neither this journal nor the college discriminated against has anything to do. These two members of the board charged a practitioner in this city with being an ex-convict. According to court records in this State, the man was never convicted of any crime, and it will be the province of the court to determine who is wrong.

I believe, Doctor, you are a just man, and holding the prominent position you do in the medical profession and the American Association, you should listen to these matters without prejudice, and give a fair hearing and a just decision.

Such controversies here are not new. For 10 or 15 years we have been criticized by this same element, whom I have often designated Pharisees. We have prospered regardless of their criticisms. But it becomes tiresome to be forever misrepresented.

They have wasted a lot of energy in trying to annihilate us; they fear opposition; they are chasing the delusion that they are THE PROFESSION. If you have any influence with these gentlemen, advise them to employ their energies in securing medical knowledge, rather than by abusing their betters in the profession. Friendly rivalry is above criticism; any other kind is beneath a professional gentleman. Yours very truly,

D. A. HODGHEAD.

In ten days a stereotyped note, used in reply to all communications and articles, was received, saying the letter had come to hand and would receive attention. Ten days later came the following letter:

17

THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION.
61 Market Street.

CHICAGO, Nov. 24, 1902.

DR. D. A. HODGHEAD,

San Francisco, Calif.

Dear Doctor: In regard to the inconsistency (as you call it) of our editor. ials, we specifically mentioned in the first the one question as not being exactly fair. In the other we said, quoting your letter, "As a whole the California State examination was eminently fair." I do not think there is any inconsistency about it. Very truly yours,

GEORGE H. SIMMONS.

Upon receipt of this letter this telegram was sent:

DR. GEORGE H. SIMMONS,

61 Market St., Chicago:

SAN FRANCISCO, Dec. 5th, 1902.

Do you intend publishing my letter? If so, when? Answer at my expense. Fifty-two hours later came the reply:

DR. D. A. HODGHEAD,

1025 Sutter St., San Francisco:

CHICAGO, Dec. 7th, '02.

Your letter not supposed by us for publication it will not be published

now.

JOURNAL AMN. MEDICAL ASSN.

We would like to ask the medical editors of America what particular directions should accompany a communication addressed to a journal, in order that the editor may know whether or not it is intended for publication. Our communication was addressed to the editor of the Journal of the American Medical Association. It was in answer to an editorial and a letter published in that journal. Was it necessary that an additional letter be sent to the editor explaining that the communication of November 5th was intended for publication? Is the editor of the Journal of the American Medical Association dense, or is he a coward and trying to hide behind a subterfuge? If one analyzes the editorial of October 25th he will readily understand that the editor of the Journal had been influenced by other things than by the letter published. In that he says: "It does not appear from later information that any injustice was done to anyone on account of the questions mentioned.' What was that later information? The editor published a letter reflecting upon many physicians, upon a medical school, and on the PACIFIC MEDICAL JOURNAL, and when a reply to that communication is sent to him he creeps out under a thin subterfuge that he did not suppose that letter

was for publication. The private opinion of this editor may be a very great desideratum; however, it is not regarded as so sacredly necessary that men should pen long communications with the faint hope of receiving in return some little crumb of comfort. Personally, we care nothing more for the private opinion of the editor of the Journal than we do for the private opinion of any other prominent medical man, and if this editor were fair and just he would have granted the same opportunities for defence in this case as he had given for attack.

A large number of the medical men reflected upon by the Journal are members in good standing of the American Medical Association, and are entitled to just as many rights and privileges as is the editor of the Journal, who is their servant and is paid for his services.

The medical profession should know that the editor is influenced in this matter by a small clique in California who appear to have his ear, who have done his bidding, and who are at the bottom of a large part of the disturbance in the profession on this Coast.

We ask the profession of America who has acted fairly and boldly in this matter? We want to know if one member of the American Medical Association has privileges which another may not enjoy. We want to know if the pages of the Journal, the organ of the Association, are to be employed to slander members of the Association, and when a courteous reply is returned no recognition is given, and the flimsy excuse is offered that it was not supposed to be for publication.

Is Dr. Simmons the man for editor of the Journal of the American Medical Association?

WHAT IS CRYOSCOPY ?

The Medical Standard has the following to say in regard to cryoscopy:

The medical profession in San Francisco, or at least that portion of it con nected with the local medical colleges, is rent in twain over the word "cryos. copy." At the recent licensing examination, given by the State Board of Medical Examiners, the candidates were subjected to a rather severe test, and, as a consequence, there was a large percentage of failures, among them several graduates of one of the local schools. It is now asserted that the examination in pathology contained a number of "catch" questions, presum

ably prepared by an instructor in a rival institution, and possibly designed to "throw down" outsiders. The editor of the PACIFIC MEDICAL JOURNAL takes exception, especially to two of these questions, i. e., to one asking a definition of Hanot's cirrhosis, the other, the meaning of the word cryoscopy.

The first question does not seem particularly difficult; still, many textbooks do not mention the disease by this name, and the student can not be expected to know every pathological condition by the name of its discoverer; that it is an unpractical question there is no denying. The second question is one that probably not one physician in a thousand could answer. The word is not to be found in any dictionary of medicine or work on urinary examination, diagnosis or general medicine, so far as we have been able to learn. The only description of the word we have found is in Hektoen and Riesman's fine work on Pathology. Nevertheless, the term occurs frequently in the current literature, and is descriptive of a valuable diagnostic procedure. For the information of our readers we reproduce in part the definition given by the book just mentioned.

After pointing out the fact that in the course of disease of the kidneys the urine is poor in solids and, especially in nitrogen compounds, the authors continue as follows: "While the diminution of solids can be estimated to some extent by quantitative chemical analysis, it is far more easily and certainly determined by a physical method, which consists in a determination of the freezing point of the urine-the method known as cryoscopy. This was introduced into medicine by Korányi, and by Caspar and Richter (in 1901). The freezing point of any liquid is governed by the number of mole. cules contained in solution; the quality of the molecules is not of consequence, except that those of very large size-albumins and other colloidsdo not influence the freezing point to any extent. The freezing point, therefore, is an index of the molecular concentration of a liquid, and also of the osmotic pressure or tension, since this is always proportionate to the molecular concentration. Normal urine has a freezing point from 1.3 to 2.3° C. below that of distilled water. Nephritis and other morbid states of the kidney cause this depression of the freezing point below that of distilled water to be lessened, indicating that there is a diminution of solids, or hyposthenuria.”

It will be readily seen that the medical press, whenever it expresses an unprejudiced opinion, sustains the position taken by this JOURNAL in regard to these questions by the Board of Medical Examiners for the State of California. We have never claimed that the Board was unfair. We have claimed that at least one member was prejudiced against one school, took measures during the examination to ascertain what students were from that school, and discriminated against them. It was the boast of certain members in the medical profession who lobbied the law through the Legislature, that they intended by means of this law to show a certain medical school in this city where it stood, and to use the law for the injury of this school. We believe the Board of Examiners permitted itself to be misled by this one member, and coincided