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The Association of American Medical Colleges has prescribed for its members a medical course of four sessions of six months each; and if reports be true, but few colleges have dropped out. In this action the Association is in advance of the Boards of Health of some states. This fact makes the situation embarrassing for its members. Those colleges which are members of the Association are at a disadvantage with those which are not.

So long as State Boards of Health shall not prescribe the four years' course for medical colleges, the three-terms course will continue with many of them, and this will result in the latter having the largest classes, a consequence that will, by no means, be agreeable. This course on the part of many colleges will the more certainly be taken because the Association has no "legal standing" with the Medical Boards. This is no fault of either party; but a consensus of opinion might be had, and a consequent uniformity of action adopted, if both parties so willed. But as long as they do not act the Association will "have a name to live while it is dead."

State Boards of Health have their states behind them, while the Association has no legal power to enforce its requirements. With it, it is simply conformity or withdrawal, while the withdrawal carries with it no serious. consequences like those attending a disregard of the decisions of Boards of Health. In such a state of things medical colleges occupy an embarrassing position.


But it seems, according to our esteemed contemporary, The Maryland Medical Journal, that the deans of some medical colleges have discovered a defect in the language of the resolution adopted by the Association prescribing a four years' course, which will afford a way of escape. It does not tell us what the fortunate defect is; but we venture the prophesy that it will avail nothing. One does not contemplate with complacency a hot poker when the cool end is held by the other party. He does not care to "tackle" the party or the poker. The Boards of Health hold the power, or at least claim and exercise it, which brings medical colleges to the point of obediThe mandate is simply obey or die. Life is balanced on obedience; and hence, as colleges desire to live, they strive to obey. With the Association it is reputation; with State Boards it is life. Reputation may be recovered; not so life. It is not difficult to determine which road to take. The Association is practically a useless angle of this triangle. This is to be regretted; but who or what can alter the fact?


It is a useless matter for medical colleges to contend with State Boards of Health about the terms of admission or the time to be spent in colleges. There is no gain in it for them that ought to be a ruling motive in their management. The higher the grade of the preliminary education on the part of a matriculant is made, the better for the school. Its tasks will be easier because of the greater intelligence of the classes; and four years are more remunerative than three. Colleges should rather lead the Boards than the Boards, them. But boards and colleges are not the only parties concerned in medical education.

The student is a sine qua non; and quite an important factor though he may acquire no legal rights by matriculation which a Board of Health is bound to respect; yet common justice and common sense, which stand behind and under all laws, ought not to be ignored to the injury and detriment of a medical student. Preliminary requirements may be placed high -to that of an A. B., if he be previously and sufficiently, as to time, warned of it, so that he may have time to grow up to it. But it would be a reprehensible injustice if the knowledge of such a requirement should come to him only when he comes to register. If he had matriculated on a “first grade teacher's certificate," and at the beginning of his third year he should be confronted with a law that required him to present a diploma granting him the degree of A. B. at the time he should apply to the Board for registration, all would say that the requirement of him was unjust and an out. rage on a helpless victim. But the law would be made to say that the matriculant acquired no right at that time, and by this act that would excuse him from a requirement legally existing at the time of his graduation.


It may be said or thought that no State Board of Health would be or could be guilty of such an act of injustice. Let it be so considered.

But something very similar to this has been done. A student matriculates at a time when graduation may be accomplished in two terms of five or six months. He enters college and completes one session. During the interval between the end of the first session and the beginning of the second, a Board of Health decrees that a student must attend three terms of five months each before he can graduate. According to the ruling of these Board-courts, that student will be obliged to attend three terms before he can graduate. He began while the two-terms law was in force, but when he finishes the second term under the three-years law, his course is extended through an additional term. In like manner, if a student matriculates under the three-years law, and a four-terms law is enacted before his third session is completed, that law denies to him graduation at the expected time, and obliges the attendance through another term. This being the law as interpreted, it is evident that the number of terms that will be made necessary, will be but a temporary provision of but little, if any, real or practical benefit, or consideration to students matriculating from year to year, or to colleges either.

It would free this question of all doubt and embarrassment if Boards of Health would ordain that every student may graduate according to the terms-law in force at the time of his matriculation, and this would do no injury or injustice to school, student, or public. It has been the custom with medical colleges, and custom sometimes has the force of a law.


Lanphear, of St. Louis, in the Journal of the American Medical Associaton, lays down these rules for trephining for insanity:

1. Every depressed fracture of the skull should be subjected to operation at the time of accident, regardless of the amount of depression and irrespective of pressure symptoms.

2. Every case of prolonged unconsciousness following a blow in the frontal region should be trephined for exploratory purposes; upon both sides if necessary.

3. The skull should be opened in all cases of insanity dependent upon trauma, at the earliest possible moment after development of the mental symptoms.

4. Operation is justifiable in every case of serious suspicion of tumor; abscess or softening of the frontal (or any other accessible) region.


5. Operation is advisable in every insanity following cerebral or meningeal hemorrhage in which localization is possible, the clot accessible and the mental trouble of recent development.

6. Every case of insanity developing in the history of otitis media suppurativa deserves immediate exposure of the favorite site of cerebral abscess.

7. Trephining for the purpose of breaking up adhesions of an old meningitis has been successfully practiced, though it is not to be strongly advised.

8. Establishment of permanent drainage beneath the scalp is permissible in the beginning of a terminal dementia succeeding chronic hydrocephalus.

9. Operation for epileptic insanity is advisable whenever there are symptoms pointing to a focal lesion.

10. Experimental trephining in the early stage of general paralysis of the insane is considered worthy of further trial.

II. Operation should be done for even a suspicion of the existence of a gummy deposit in the bone or meninges.

12. The formation of fenestræ in the skull is permissible whenever there is evidence of intra-cranial pressure, even of unknown origin.


Fütterer (Medicine, Aug. '95), of Chicago, has made a valuable contribution to clinical medicine, in his study of the liver as an organ of elimination of corpuscular elements. The following are his conclusions:


The liver eliminates germs or corpuscular elements from the blood

2. The bile does not destroy germs, but allows. them to multiply. 3. Relapses of typhoid fever may be caused by typhoid bacilli entering the intestinal canal by way of the ductus choledochus.


Tubercular enteritis can be caused in the same way.

5. Diarrhoea in general sepsis may also be caused in this way.


6. Typhoid bacilli may form the nucleus of gall-stones. (Dufourt, Chiari.)

7. Typhoid bacilli, on their way through the liver, can cause inflammation of the gall-ducts. (Dupré.)

8. There is a condition deserving the name cholecystitis typhosa. (Gilbert and Girode.)

9. Typhoid bacilli may be found in the gall-bladder eight months after a typhoid fever, if an obstruction prevents their being eliminated into the intestinal canal. (Dupré.)

10. lodide of potassium injected hypodermically can be found in the gall-bladder after the lapse of five minutes, and probably even sooner.





T affords THE MEDICAL HERALD much pleasure to announce the election to the presidency, of Dr. Frederic S. Thomas, of Council Bluffs, and the selection of Dr. Donald Macrae, Jr., to succeed him as Secretary. Dr. Macrae is a chip off the old block, and will do his duty well.

Dr. Thomas' connection with the society of which he is now the honored President, dates back to 1888, when the plan for its organization was formed by himself and Dr. Macrae; the first meeting being held September 27th of that year. Dr. Thomas has served as Secretary of the Society ever since, and much of its success is due to his untiring efforts in that capacity.


Dr. Frederic S. Thomas, the President-elect of the Medical Society of I the Missouri Valley, was born at Chatham, Columbia County, New York, September 23rd, 1845. His father was of Welsh and English ancestry, while his mother was grandfather was a tinental Army during War. The doctor ents, while a boy, to where he obtained his very young he eniment, and particibattles of the Civil medical lectures from ical College in Keoin the class of '70. Van Buren County, to Western lowa to country." Doctor

Frederic S. Thomas, M. D.

German. His paternal member of the Conthe Revolutionary came with his parWarsaw, Illinois, education. While yet listed in an Illinois regpated in some of the War. He attended '66 to '70, at the Medkuk, lowa, graduating He practiced awhile in Iowa, and later came "grow up with the Thomas did a country


practice in the eastern portion of Pottawattamie County for fifteen years, then removing to the county-seat (Council Bluffs) where he has since resided. For the last eight years the doctor has been a teacher in one of the medical schools of Omaha, and at present occupies the chair of Mental Diseases in the Creighton Medical College of that city.

His practice, while not limited, is largely in mental and nervous diseases, having charge of the insane of Pottawattamie County, and being one of the commissioners for the insane of that county.

Dr. Thomas is the possessor of a happy disposition, a ready fund of wit, and is an expert at repartee, having few equals as a story-teller. He is blessed with a charming wife and three interesting daughters, Ethyl, Edyth and Evelyn. Miss Edyth has made quite a reputation as an elocutionist, although but twelve years of age, and has been honored with an invitation to give a recital at the Atlanta Exposition. C. W. F.

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