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AMERICAN MEDICAL ASSOCIATION'S STANDARD OF

REQUIREMENTS.

The measures of reform in medical education, as prescribed by the Association of American Medical Colleges, have been adopted in principle if not to the letter by all the regular and reputable colleges of the North, thus placing medical education upon a firm basis, giving the medical diploma a specific value and supplying the public with doctors who are at least well grounded in the rudiments of scientific medicine.

The medical schools of Louisville, whose sentiments were from the first in accord with the movement, lost no time in uniting with the Association; but the leading schools of the Southern States, for reasons best known to themselves, preferred to organize an association of their own, whose standard of minimum requirements for matriculates should be lower and terms of study shorter than the standard set forth by the Northern Association.

The effect of this has been to fill the dissenting Southern schools with students to the prejudice of the Louisville and other border line colleges who had adopted the higher standard. That this state of affairs should be allowed to continue is unjust and injurious to the schools above named; but this is a trifling consideration when compared to

the damage done the cause of medical education and the demoralizing influence upon the public mind of the lower standard adopted by the Southern schools.

The schools which by their geographical situation could so ill afford to join the ranks of high reform have nevertheless pursued the prescribed course with uncomplaining fortitude, but not without the hope and indeed conviction that relief would come in good time.

That such relief is on the way seems to be indicated by the following extract from the proceedings of the American Medical Association which met in Denver last month. It was unanimously adopted.

Whereas, The American Medical Association did, at Detroit, in 1892, unanimously resolve to demand of all the medical colleges of the United States the adoption and observance of a standard of requirements of all candidates for the degree of doctor of medicine which should in no manner fall below the minimum standard of the Association of American Medical Colleges; and

Whereas, This demand was sent officially by the Permanent Secretary to the dean of every medical college in the United States and to every medical journal in the United States, now, therefore, the American Medical Association gives notice that hereafter no professor or other teacher in nor any graduate of any medical college in the United States which shall, after January 1, 1899, confer the degree of doctor of medicine or receive such degree on any conditions below the published standard of the Association of American Medical Colleges, be allowed to register as either delegate or permanent member of this Association.

Resolved, That the Permanent Secretary shall, within thirty days after this meeting, send a certified copy of these resolutions to the dean of each medical college in the United States and to each medical journal in the United States.

Notes and Queries.

NOTE ON THYROID EXTRACT.-One who has followed the history of the use of drugs of animal origin must thereby have acquired skepticism. The clinical results which have followed the administration of thyroid extract, however, in myxedematous and allied cases would seem to be sufficiently established and pronounced to justify absolute belief in the potency of this substance as a therapeutic agent. Nevertheless, in his recent very elaborate rescearch, Dr. Cunningham believes that he has demonstrated that the symptoms of thyroidism, so-called, are not produced by any substance which exists originally in the thyroid gland, but that they are the outcome of toxins, ptomains, or other poisonous organic principles, which are the result of post-mortem changes in the gland; and he further affirms that while these extracts hasten the death of the dog that has suffered complete thyroidectomy, even feeding such an animal on the fresh thyroid gland fails to put aside sensibly the fatal issue; statements apparently founded upon good experimental evidence and which certainly tend to befog what we had supposed to be clear knowledge.

Under such circumstances I hesitate very much even to report clinical facts bearing upon the subject; nevertheless, four recent cases seem to me to be worthy of being noted, although the happenings may have been coincidences. In these four cases the exhibition of thyroid extract has been followed by violent outbreak of gouty or rheumatic symptoms, not existent at the time at which the drug was given. In one of these cases the patient never had had rheumatic symptoms before to her knowledge. In a second case, that of Mrs. D., the patient was of distinctly gouty tendency, had had from time to time gouty attaeks, but was free from any lithemic or arthritic symptoms when I first unsuspectingly gave her thyroid extract for obesity. In about ten days or two weeks she had a violent outbreak, confining her to bed. She was taken off the thyroid, put on appropriate treatment, and rather rapidly convalesced. An antilithemic diet was insisted upon and maintained. April 10th or 11th she began again to take five grains of thyroid extract three times a day, being at that time in greatly improved health and without evidences of diathesis. To-day, April 20th, her sister reports at the office that Mrs. D. is in bed, with great pain and swelling in the ankles as before. Miss M., another case, was a young lady, about sixteen years of age. She had once in her life suffered from slight rheumatic symptoms. She came under treatment for recently developed goitre, dermographia, and various nervous symptoms. About February 22d, she was put upon nine grains a day of extract of thyroid, increased about March 1st to fifteen grains, and decreased March 7th to six grains. March 11th she had a severe rheu

matic outbreak. The thyroid extract was withdrawn, a simple tonic given; the rheumatism rapidly disappeared. On March 22d she was again put on thyroid extract, which was followed in about ten days by a return of the rheumatic symptoms.

My object in reporting these cases is not to claim that the extract of thyroid was the cause of the rheumatic symptoms, but simply to call the attention of the profession to the subject, so that careful observation may be made upon a wider scale. — H. C. Wood in Philadelphia Medical Journal.

HISTORIC DEATHBEDS.-One of the penalties of greatness in these days is the intrusion of the newspaper reporter into almost every circumstance of private life. It is of course inevitable that princes and potentates and politicians should live ever in the public eye, but it is surely hard that they should also have to die, as it were, before the footlights. The deathbed should be unprofaned by the prying of a foolish or morbid curiosity; even those who have lived most in the public ways that public manners breed have a right that the curtain should let fall silently on the last scene of all. Medical details of a historic case may legitimately be given in the proper place and in the proper way, but they are altogether out of place in ordinary newspapers. How can it interest the public to be informed that a dying statesman presents the symptom known as Cheyne-Stokes respiration? That relatives and friends should strive to piece into some semblance of meaning the stray words which fall from the beloved lips before they are closed forever is natural. But that other watchers at the bedside should gather up the mutterings of delirium and permit them to find their way into the press is much to be regretted. We are willing to admit that the position of those who are called upon to attend the sick or dying bed of a person of national eminence is often one of great difficulty. On the one side there is the natural desire of the public, as represented by the press, to obtain authentic information, and on the other, the obligation of reticence which is laid upon every one who enters the sick-room, and not least upon the medical advisers. It is by no means easy for a medical man to maintain perfect reticence when reporters lie in wait for him at every corner. A casual word may be expanded into an interview, and even a look may be translated into a statement of opinion. In regard to the incidents which have led to these remarks being made, some excuse may perhaps be found for indiscretions in the free communications made by some members of the dead statesman's family. We do not feel called upon to attempt to apportion exactly the responsibility for the indiscreet publicity which has been permitted with regard to the last hours of Mr. Gladstone, but we would venture to express the strong opinion that when the supreme moment approaches a man is entitled to the sympathetic protection of those around him. Neither his relations and friends, nor his spiritual and medical advisers, have any right to let the public hear his cry of agony, or to repeat words muttered in the apathy of approaching dissolution. Certain French

words believed to have been uttered by the dying statesman have been twisted by a foreign newspaper unfriendly to this country into affording apparent ground for conclusions as to Mr. Gladstone's opinions which are tantamount almost to a charge of want of patriotism. We repeat, we do not feel called upon to apportion the exact measure of blame that should rest on any particular individual for the disclosures which have called forth many criticisms not only throughout the medical profession, but among the educated public. Whatever others may think it permissible or expedient to do in regard to the privacy of the deathbed, the duty of the medical man is clearly expressed in the words of the Hippocratic oath: "Whatever in connection with my professional practice, or not in connection with it, I see or hear in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret."-British Medical Journal.

SYMPHYSIOTOMY FOR DYSTOCIA DUE TO A LARGE FETUS.-Lepage (Ann. de Gynéc. et d'Obstét., March, 1898,) in an article on eight cases in which symphysiotomy was performed, specially refers to one instance in which the pelvis was normal, and yet the operation was required on account of the large size of the fetus. The mother, a two-para, aged twenty-eight, had in her first confinement been delivered with difficulty, and by forceps, of a large dead-born infant. In the present pregnancy the uterus was larger than normal, and palpation revealed a large, hard fetal head above the brim. There were frequent and severe pains; the head presented, O. D. P., but did not engage, and dilatation went on slowly. The fetus was alive. Symphysiotomy was performed, the parts were held apart with Farabeuf's écarteur, and the head was brought down to the vulva, the écarteur being removed at this stage and the pubic bones approximated. Natural efforts expelled the child, which was with some difficulty resuscitated. It was a male, and weighed 5,200 g. (over ten lbs.), while the occipito-mental diameter of the head measured 14.9 cm. (nearly six inches). There was marked ossification of the cranial bones, and the promontory mark was on the right parietal boss. The puerperium was satisfactory.—Ibid.

THE GERMAN HOSPITAL of San Francisco has opened its doors to the Red Cross Society for the care of sick soldiers. The San Francisco branch of the Red Cross has raised over $30,000.-Medical Record.

DR. MAYROGENIS, of Athens, is said to be the last survivor of the Greek war of independence. He was born in 1798, and was one of the first

to rise against the Turks in 1821.-Ibid.

DR. EDWARD JACKSON has resigned his chair of diseases of the eye in the Philadelphia Polyclinic, and has been elected emeritus professor.

DR. ALFRED STENGEL will from October, 1898, have editorial charge of the American Journal of the Medical Sciences.