when this remedy is indicated, an irregular fever, therefore it would be the best remedy in some cases of chronic malarial fever.

KALI BICHROMICUM: There is no remedy in materia medica as well indicated for membranous croup as this. The cough of Kali Bichromicum is hoarse, although frequently accompanied by a thick tenaceous expectoration. This indication is found in every work on materia medica in connection with this remedy.

PHOSPHORUS: Indicated for a cough which is generally dry, and there is a deep-seated hoarseness, with pain as of pressure upon the anterior surface of the chest. The cough is aggravated by dust or smoke or a change of air; more indicated in bronchitis than in pleuritis, therefore, rather the opposite of bryonia.

POTHOSS FOETIDUM: For spasmodic croup, in which we have the cyanosis due to a temporary cessation of respiration, with perhaps, a general convulsion, there is no remedy like this. In other words it is as near a specific for Miller's asthma as we can find anywhere. In many cases of asthma it is well indicated in the first stage of the disease.

SPONGIA: Has a hoarse, dry cough, more hoarse than that of any other remedy. The aggravation occurs in the fore part of the night, the reverse of Hepar Sulphur, which has an aggravation in the fore part of the day. More indicated in laryngitis than is phosphorus.

SQUILLA: This remedy resembles bryonia more in its pathogenesis, than does any other. It has the sharp pains in the chest, but in addition, has a fluent coryza, with conjunctivitis. The cough is rather more paroxysmal than is that of bryonia. It is frequently indicated in cases of capillary bronchitis and broncho-pneumonia.

SULPHUR: The chief characteristics in this remedy is dyspnea. This occurs, or is aggravated in the middle of the night, and is usually relieved by the sitting posture, the patient usually getting out of bed for the purpose of obtaining relief. The cough is usually dry and not often paroxysmal. The inhalation of dust and smoke aggravates it, as well as the dyspnea which accompanies it. This is the best remedy we have for asthma, and where there is much dyspnea it should always be considered.

TARTAR EMETIC: This is one of the grandest remedies we have for a cough. It's indications are a general moist rale, heard over the principal portion of the chest, and yet the patient is unable to expectorate and thereby rid himself of the irritating contents of the bronchial tubes. It is one of the best remedies in capillary

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, Spongia 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 laws 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 commonwealth. 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 in

come 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 improves 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. Carcinomatous 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, O.

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 month. 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 ir

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