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bronchitis and broncho-pneumonia, and is scarcely second to any other in the treatment of croupous pneumonia.

In regard to the potency—I have used the 3x of Aconite, of Belladonna, Bryonia, Drosera, Eupatorium, Ipecac, Phosphorus, Spongià and Tartar Emetic. Occasionally I have used the 30x of these remedies. Squilla and Sulphur I have used at the 30x attenuation; scarcely ever lower. I have used the tincture of Pothos, being exceedingly careful about securing a good preparation. Kali Bich. and Tartar Emetic are prepared by dissolving a ten grain powder of the 3x trituration in four ounces of water, of which one to two teaspoonfuls is prescribed. Hepar Sulphur is prescribed, usually, in the sixth attenuation and given in the same manner.

In case of improvement the remedy is continued, but the interval between doses is prolonged. No change of remedy is made if there is marked improvement.

MEDICAL LEGISLATION AND MEDICAL EDUCATION.*

BY HARRIS H. BAXTER, M. D., CLEVELAND, O.

The control and regulation of the practice of medicine by law has been constantly before the medical profession for the last quarter of a century. At first the desired object was the suppression of medical mountebanks and impostors, and the elimination of the ignorant, though honest, practitioner. That the most stringent lawa have not entirely accomplished this end, is a disappointment to many. It should be borne in mind however, that laws, prescribing penalties for burglary, theft and other offenses, are upon our statute books ; and almost daily in our courts men are convicted and receive sentence to severe punishment. Notwithstanding, thieves, burglars, and other criminals are at large and plying their trade throughout the common. wealth. I believe our medical laws have accomplished as much in the suppression of medical crimes, as have other laws, in the suppression of other crimes. We may therefore pass this feature as something almost if not quite accomplished, and turn our attention to other features of the law.

Elevating the standard of medical education was an oft repeated and popular campaign slogan of fifteen and twenty years ago, and

*Read before the Academy of Medicine of Toledo and Lucas County, Feb. 5, 1909.

most of the medical legislation of more recent date has been directed to this object. Much good has been accomplished in the efforts to establish a standard, or rather standards of medical education. This evolution has resulted in changes of standard so varied and so rapid, that it has been difficult always to know just what is demanded. The natural result follows: The Medical profession is in a condition bordering on chaos upon this subject. This state of uncertainty is increased by the suggestion of still other changes. Before colleges preceptors and students have had time to become acquainted with the standard of requirement, another change is proposed and by sheer persistence its adoption is secured. Each state seemed to vie with every other state in the enactment of new and hitherto untried regulations; or one state with what it considered a high standard, as soon as any other approached near enough to demand reciprocity, would adopt some new regulation which renders reciprocity impossible.

Uniformity of medical laws in all the states is a condition much to be desired, but nothing approaching this can be secured until these kaleidoscopic changes in educational requirement cease. Let those states which may be considered in the advance in this movement (of which Ohio is one of the foremost) stand still long enough for the profession to catch its breath and look about and see where we are at,” long enough for the other states to come up to our standard.

The object originally sought has been attained. Laws are on the statute books for punishment of charlatans and impostors. The educational standard has been raised to a plane commensurate with the honor and dignity of a learned profession. There let it rest.

One of the motives which influence some in advocating more stringent requirements, and which is more or less openly declared, is a desire to reduce the number of physicians. The most ready means of accomplishing this is to cut off the supply. Hence the severity of requirements proposed. With this proposition I have no sympathy.

If this sentiment prevailed in the profession, the charge that we are seeking to form a medical trust, would be sustained.

An article in the New York Medical Journal says: “At the same time the requirements for the men who desire to enter the medical profession are being increased until now, in nearly every State, they are so great that it is impossible for one to comply with them and receive a license to practice until he is about 27 or 28 years of age, so that, if it takes five years longer to build up a practice sufficient for one's support, the man who desires to become a physician finds it impossible to meet the requirements unless he has an independent income or is fortunate enough to find a backer with sufficient faith in him to advance the necessary funds."

To extend the time of preliminary study beyond that now required would be to place additional obstacles in the way of entrance to the medical profession. If this be the object of such extension, it is all the more reason why it should not be accepted. What the medical profession needs, to keep it in the fore front of the professions, is men of brains rather than men of money. It is too unusual to find both of these in the possession of the same individual. It is said that science.creates nothing; it only explains. It may also be said that education creates nothing: it only develops, polishes and im. proves what already exists.

The time has come when the demand for further medical legislation in this state, relating to medical education, at least, should cease. The law governing medical practice is not perfect. It never will be.

The law in this state became effective in March 1896. Every legislature since, except one, has been importuned to amend the same. Each amendment has improved and strengthened it in some particulars but has afforded an opportunity for the insertion of words, phrases or sentences, or changes in the wording, that were neither desired or desirable. In some instances this has been done clandestinely.

There is no limit to the extent to which any individual may carry his preliminary or other studies, and his scholastic attainments: but there is nothing in the study or practice of medicine that makes a higher standard of scholarship then is attained in a first grade High School necessary.

Let the agitation of the subject of medical education cease. Let the American Medical Association, the American Institution of Homeopathy, and the National Eclectic Association dismiss their Councils of Education, or at least curtail their powers and sphere of duty Give the profession, and educational institutions an opportunity to settle upon some solid and permanent basis. Give prospective medical students an opportunity to acquire some degree of confidence as to what will be demanded of them.

202 Osborn Building.

Involution growths in the breast are very often cystic, even though the mass appears to the feel to be solid throughout. Carci. nomatous degenration is sometimes found in the cyst wall of these originally benign growths.

THE DIAGNOSIS AND TREATMENT OF PLACENTA

PREVIA.*

BY HUDSON D. BISHOP, M. D., CLEVELAND, 0.

A placental implantation over some portion of the lower uterine segment constitutes one of the really serious complications met in obstetric practice. It occurs probably once in 1,000 cases and its infrequency necessarily carries with it a certain lack of definiteness and decision in diagnosis and treatment on the part of the average general practitioner. The subject of this paper, therefore, should be of interest to all of us who do obstetric work.

The chief clinical feature of placenta previa is hemorrhage. The time of the first appearance of this symptom is usually given as during the later months of pregnancy, usually not until after the fifth münth. In a series of 197 cases reported by Doranth the largest number of the cases had the first appearance of hemorrhage at the eighth and ninth months and at term. In another series of 169 cases reported by Pinard, however, next to the largest number of cases showed the onset of the hemorrhage at the first month. The only explanation of this wide divergence of statistical evidence is that one or the other of these men was mistaken as to the diagnosis between placenta previa and abortion.

My observation leads me to the belief that many cases of accidental abortion are in reality cases of placenta previa terminating in abortion. It is true in this as in everything else in diagnosis that we see only what we know. Since I knew that placenta previa often terminated in abortion, I have been surprised at the number of cases of abortion in which I have been satisfied that the real condition causing them was placenta previa. I will cite two cases illustrating the line of reasoning by means of which this conclusion was reached.

An accidental abortion occurred at the second month of a fourth pregnancy. I performed dilatation and curettage. I suspected placenta previa when blood came with a gush at the first insertion of the dilator. This was confirmed when I found a marginal implantation of the placenta upon digital exploration. The history of this pregnancy showed the usual signs of pregnancy but with a normal flow at the first month, a slight show at the middle of the second month and a week later uterine contractions with positive signs of inevitable abortion. The second pregnancy showed a history of irregular hemorrhage during the first three months with premature birth and excessive hemorrhage at the beginning of the ninth month. The first pregnancy terminated in accidental abortion at the third month.

*Read before the Cleveland Homeopathic Medical Society, January, 1909.

At the present time I have a patient who is in the fourth month of her fifth pregnancy. Her previous pregnancies have terminated in two abortions, one premature birth with death of the fetus, and one full-term birth with antepartum and postpartum hemorrhage. In all of these pregnancies hemorrhage was a symptom during the early months. The present pregnancy has had hemorrhage as a symptom at the exact times of the menstrual period, this hemorrhage being accompanied with pains and a markedly increased flow. I have made a provisional diagnosis of placenta previa as the present condition but at the urgent solicitation of the patient am following conservative treatment.

The history of these patients points conclusively to placenta previa for, as syphilis was ruled out in both cases, there is no other way to account for the symptoms.

It is stated by Strassman that placenta previa results in abortion in 18 per cent of the cases. Such being the case, we ought to regard all cases of threatened abortion, at least after the first month of gestation, as strongly pointing to placenta previa. The definite diagnosis of placenta previa during the early months of pregnancy must always be a matter of great doubt. The earlier the appearance of the hemorrhage, the greater the doubt. The appearance of a normal flow at the first period following impregnation of the ovum is so common that it would seem to have no significance; but repeated appearance of a so-called menstrual flow or its appearance after a cessation of one or more months in a woman showing other signs of pregnancy should constitute a suspicious symptom.

Hemorrhage during the later months of pregnancy is always an accidental hemorrhage or is due to placenta previa. Many of the cases diagnosed as accidental hemorrhage are placenta previa of the lateral or perhaps marginal type. The differential diagnosis between these forms of hemorrhage is made by vaginal examination. If we can feel the placenta with the examining finger we are sure of a diagnosis of placenta previa. If it cannot be felt, we are forced to consider the case as one of accidental hemorrhage until later developments prove it to be otherwise. The essential factor in making this diagnosis is the ability to penetrate the os. If placenta previa, this can usually be done with ease if the case is in the later months of pregnancy. If during the earlier months with placenta previa,

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