THE BOSTON for us to have, medical laws created that will
provide that it shall be essential for a young man
Medical and Surgical Journal.
Thursday, July 19, 1906.
A Journal of Medicine, Surgery and Allied Sciences, published at
Boston, weekly, by the undersigned.
Subscription Terms: $5.00 per year, in advance, postage paid,
for the United States, Canada and Mexico; $6.50 per year for all
foreign countries belonging to the Postal Union.
All communications for the Editor, and all books for review, should
be addressed to the Editor of the Boston Medical and Surgical Journal,
707 Paddock Building, 101 Tremara Street, Boston.
All letters containing business communications, or referring to the
publication, subscription or advertising department of this Journal,
should be addressed to the undersigned.
Remittance should be made by money order, draft or registered letter,
payable to
D. C. HEATH & COMPANY,
120 Boylston Street, Boston, Mass.
STANDARDS OF MEDICAL EDUCATION.
In a recent address before the Medical Society
of South Carolina the president of the society,
Dr. Edward C. Register, of Charlotte, brought
to the attention of his hearers certain matters
which should be of interest to the profession at
large. The address concerned itself with the
standard of preliminary education for students of
medicine. It appears that in 1858 the first
medical legislation in the state of North Caro-
lina was a law creating a board of medical
examiners and entitling only licensed physicians
to testify as experts in court. In 1885, the law
was amended, making it a misdemeanor to prac-
tise medicine in the state without a license, and
in 1897, all applicants for examination before the
medical examining board were obliged to have
a diploma from a reputable medical school.
These requirements, however, apparently did
not sufficiently raise the standard for admission
to medical practice. A large percentage of the
applicants for license were not primarily pre-
pared to begin the study of medicine. Many had
sufficient professional attainments, but were
defective in the ordinary branches of knowledge.
In other words, uneducated men were being
admitted to the medical profession. In view of
these facts, Dr. Register makes the following
pertinent statement:
"
The medical profession of North Carolina,
if it wants to keep in line with other states and
other countries, ought to undertake to correct
these defects in our system; legislative changes
should be advised. We need, and it is practical
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beginning the study of medicine, or before he can
obtain his license, to have an essential, non-pro-
fessional knowledge, certainly to the point where
he can speak and write the English language
correctly."
It is clear that this is a perfectly correct state-
ment of a most unfortunate condition. Medicine
has unquestionably suffered more than other
professions in admitting to its ranks men without
education who still were able to conduct a suc-
cessful practice on its financial side. This, no
doubt, has been in great measure due to the char-
acter of the studies required for the attainment of
a medical degree. There are two fundamental
ways out of the difficulty, both of which have been
practised in this country. The first is to make
the medical course itself so difficult that none
but properly prepared students can successfully
pass the examinations. By this means the unfit
students are gradually eliminated during the
progress of the medical course. The method is,
perhaps, in a measure unfair to the student, and
it is certainly a burden to the medical school to
admit totally unfit students even for a relatively
short time. The other main method naturally is
to so raise the standard of the entering require-
ments that only those who are capable of master-
ing the strictly professional work shall be admitted
to the medical schools. This method has been
adopted by a number of our leading universities
through the requirement of a bachelor's degree,
or an equivalent evidence of preliminary work
done before entrance to the medical school is
permitted. Whether or not this is going too far
in the attempt to purge our medical schools and
the profession of unfit men is open to question;
but there can be no doubt that this method fully
does away with the situation which Dr. Register
bewails in South Carolina. Dr. Register, for
example, believes that the demand of a prelimi-
nary college course is not practical and is destined
to do harm.
It is in general perfectly clear that the problem
is an extremely complex one, and it is also
reasonably clear that in this country an absolutely
uniform standard of preliminary requirements
cannot be maintained. It has been proved
possible, and probably desirable, in Baltimore,
Boston and certain other great centers of medical
education, to demand a preliminary college
course. Such action in North Carolina and in
many other Southern and Western states would
be unwise and presumably detrimental to the
best progress of medicine in those localities.
The problems presented in various parts of the We have before us a brief statement from Dr.
country are widely different, and unreasonable as Eugene F. Cordell, librarian of the medical
it may at first sight appear that we can have library of the University of Maryland, which
two or many standards in a single profession, it is, illustrates the active work which is being done,
nevertheless, true that from a practical stand- not only at that library, but also at many others
point, unless minor medical schools are to be throughout the country. The library of the
entirely eclipsed, less rigid requirements in certain University of Maryland has an interesting history.
localities must still be practised for many years It was founded in 1813, and is connected with the
to come. This apparently is Dr. Register's idea department of the history of medicine in the
in North Carolina. He wishes the standard university, the professor of that chair, now Dr.
raised, but not to a point prohibitive of obtaining Cordell, being the director of the library. The
medical students. library now contains 6,280 volumes, 1,080 of
This fact should not in the least be a cause for these having been added during the year. Forty-
discouragement. Although it is ultimately de- six journals are regularly received. There are
sirable that a definite and relatively fixed stand- also 4,200 pamphlets, of which 200 have been
ard of medical education, both preliminary and added during the year. There are 120 registered
during the medical course, be established through- members, but the library is open throughout the
out the country, it is inevitable, and we think year to all readers, and students of the university
desirable, that each section of the country should are given special privileges. A significant addi-
work out its own problems, always looking toward tion to the library during the year was the collec-
an improved standard, but not to a self-destructive tion of the late Prof. George W. Miltenberger,
degree. If the general tendency is upward, there numbering 949 volumes, many of great value.
can be no doubt that ultimately a satisfactory This is but an example of what other libraries
situation will be reached. The men of poor edu- are also doing, and there is no reason to doubt
cation will inevitably go to the wall, and their that the rank and file of the medical profession
educationally more favored comrades will usurp will come more and more to look upon these
both the practice and the influence in the pro- libraries as centers of information, thereby incul-
fession which is their just due. In the meantime cating a habit of consulting original sources in
it is desirable that no injustice be done. the prosecution of their work. There is small
reason to doubt that the libraries are increasingly

GROWTH OF MEDICAL LIBRARIES. used, and that much work requiring references to
One of the striking ways in which medicine literature is produced which would be quite
has developed in this country during the past impossible were books of reference not ready of
twenty years is through the increase in the num- access. Medical libraries, therefore, however
ber and efficiency of libraries devoted to the small their beginnings may be, should receive the
medical sciences. Not many years ago, what earnest support of all those physicians who look
few medical books were available were to be upon medicine as something more than a trade
found in general libraries where, for obvious and who wish to surround it with that element
reasons, physicians at large were not likely to of scholarship which only books
can bring.

resort in great numbers. This has now been

wholly changed and there is a very large number
of libraries in our large cities devoted solely to EXPERT TESTIMONY IN CRIMINAL CASES.
the uses of physicians. Some of these libraries In view of some recent developments in New
have their own buildings, and many of them, York, tending to throw more or less discredit on
although not separately housed, have all the the present system of employing insanity experts
advantages which come from concentration. in criminal cases, there has developed in the
The medical library, therefore, as an institution community a renewed agitation in favor of a
has evidently come to have a very definite place. standing commission of expert alienists, whose
It is significant that within the past few years province it shall be to decide as to the mental
the Boston Public Library has transferred many condition of prisoners on trial. It is very prob-
medical books and periodicals to the Boston lematical, however, whether such agitation will
Medical Library on the ground that they could result in any definite action in the near future.
be more conveniently and advantageously used In a recent interview Dr. Frederick Peterson,
there than in a great general library such as the who was for some years at the head of the New
Boston Public Library. York State Commission in Lunacy, is quoted as

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expressing complete dissatisfaction with the exist-
ing system of calling expert witnesses. He
declared that it tended to bring those acting in
this capacity into such disrepute that the best
men were often disinclined to accept retainers.
"
I think," he went on to say, " that some system
by which the question of the insanity of a prisoner
could be referred to an impartial commission of
medical experts, appointed by the court, would
be an excellent thing. In France and Germany
there are lists of experts from whom the court can
appoint a commission, but in this country and
England there is nothing of the sort. Experts
are called only in cases where there is a certain
amount of doubt, and it is only human that they
should be inclined to take the view of the side
which retains them. The experts on either side
can answer in diametrically opposite ways
honestly enough, because they are being ques-
tioned, not about the real man in the dock, but
about two different Frankensteins called forth by
counsel to suit their own purposes. No wonder
the twelve good men and true are confused. A
regular commission of experts would leave
hypotheses alone."
This question is perennial. There are from
time to time evidences of a possible solution, but
so long as our jury system remains, it is some-
what unlikely that the courts will feel justified
in assuming the responsibility of the appointment
of commissions of experts, however desirable it
may seem to those in authority. We have long
been of the opinion, and we have no doubt, as also
expressed by Dr. Peterson, that the opinion is
widely held, that justice would be as well sub-
served and with far less loss of dignity were many
disputed cases settled by a qualified commission.
The present system is unquestionably defective, at
least from the medical standpoint, and places a
burden upon a conscientious physician which he
should not be called upon to bear. Agitation and
protest are no doubt useful, and may ultimately
lead to some fundamental reform. At present,
however, the situation shows small evidence of
amelioration.
MEDICAL NOTES.
boston and new england.
Acute Infectious Diseases in Boston.
For the week ending at noon, July 18, 1906, there Turk and the other a Swede.
were reported to the Board of Health of Boston
the following cases of acute infectious diseases:
Diphtheria 39, scarlatina 19, typhoid fever 16, Monthly
measles 25, tuberculosis 52, smallpox 0.
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The death-rate of the reported deaths for the
week ending July 18, 1906, was 18.19.
Boston Mortality Statistics. The total
number of deaths reported to the Board of Health
—
for the week ending Saturday, July 14, 1906,
was 174, against 201 the corresponding week of
last year, showing a decrease of 27 deaths and
making the death-rate for the week 15.07. Of
this number 90 were males and 84 were females;
168 were white and 6 colored; 108 were born in
the United States, 63 in foreign countries and 3
unknown; 38 were of American parentage, 119
of foreign parentage and 17 unknown. The
number of cases and deaths from infectious dis-
eases reported this week is as follows: Diphtheria,
34 cases and 3 deaths; scarlatina, 26 cases and
1 death; typhoid fever, 12 cases and 2 deaths;
measles, 36 cases and no deaths; tuberculosis, 41
cases and 15 deaths; smallpox, no cases and no
deaths. The deaths from pneumonia were 19,
whooping cough 4, heart disease 23, bronchitis
3 and marasmus 8. There were 8 deaths from
violent causes. The number of children who
died under one year was 39; the number under
five years 54. The number of persons who died
over sixty years of age was 35. The deaths in
public institutions were 53.
There were 2 deaths and 1 case of cerebrospinal
meningitis reported during the week.
Retirement of Dr. Thomas B. Shea-. Dr.
Thomas B. Shea, who has efficiently served as a
—
health commissioner of the city of Boston for a
number of years, has resigned his position and
has accepted a position which he formerly held
of chief medical inspector. Ex-alderman Michael
W. Norris has been designated by Mayor Fitz-
gerald to take Dr. Shea's place on the Board of
Health.
Smallpox on an Incoming Steamer.
Several persons suspected of having smallpox
—
arrived in Boston July 15 on the steamship Cymric
from Liverpool. Precautions were at once taken
by the City Board of Health and the suspects
removed to Gallop's Island. Late reports show
that two persons were apparently suffering from
incipient smallpox, and that certain others, which
were at first suspected, show no further sign of
the disease. Those who are still detained at
quarantine are both young immigrants, one a
—
Water Investigation. According to the
Connecticut
—
Bulletin of the State Board
of Health, on account of the small appropriation
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 made at the last session of the state legislature for
investigation of the pollution of streams and
natural waters of the state, the Board of Health
was unable, on the first of January, 1906, to
renew the contract with Professor Smith, of the
Yale Medical School, for water analysis. There-
fore, during the first six months of the year, the
Board could make no regular examination of
reservoirs. The investigation was practically
confined to special analyses of water, mostly well
water, sent in by the health officers of different
towns. The Board has, however, made arrange-
ments, beginning July first, to have these analy-
ses carried on under the direction of Professor
Conn, of Wesleyan, at the state bacteriological
laboratory, in Middletown. As the laboratory
is in continuous operation, the additional work
does not involve any great expenditure, and the
board will be enabled to resume the routine
examination of reservoir water and to accomplish
much more with the appropriation available.
It has been the custom to examine monthly a
certain number of reservoirs, and the following
year to make analyses of those in other parts of
the state, and thus all the reservoirs have been,
in turn, investigated. Special examinations of
well and other waters are made on the applica-
tion of the town health officers only, subject to
the approval of the county health officers. In
future these applications should be forwarded
directly to Professor Conn, who will send to the
applicant proper receptacles for the water to be
analyzed and full directions for collecting it.
Professor Conn will have as his assistant Mr.
James A. Newlands. Mr. Newlands has studied
at the Massachusetts Institute of Technology
and, before coming to the state laboratory, was
engaged in water analysis under Prof. Andrew
Smith, at Beloit, Wis.
NEW YORK.
Vacation Schools. The Federation of
Churches has also opened twenty vacation schools
—
in Manhattan, two-in Brooklyn and one in Jersey
City. Dr. B. R. Hoobler is the health superin-
tendent of these schools.
Mortality among Children.—The bulletin
of the State Department of Health for May shows
that during that month there were 2,107 deaths
of children under five years of age, of which
1,223 occurred in New York City, and 884 in
the rest of the state. This is considerably below
the mortality of last year and of several years past.
While there was a larger number of deaths from
measles and resulting bronchopneumonia in May,
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1906, the mortality from these diseases was more
than counterbalanced by that from other causes
in the same month of last year.
Laboratory of the Vanderbilt Clinic. —
Plans have been filed with the Building Depart-
ment for altering and enlarging the laboratory
of the Vanderbilt Clinic of the College of Physi-
cians and Surgeons. When these improvements
have been carried out the laboratory will be
double its present size.
Summer Work of Board of Education. —
The Board of Education began its summer work
on July 9, and this includes all the boroughs of
the city except Richmond (Staten Island). The
same plan of study, exercise and play as hereto-
fore will be carried out. This year there are over
thirty vacation schools and about ninety-five
playgrounds. The latter include a number of
roof gardens on the roofs of public school build-
ings, where bands play in the evenings. Last
year the playgrounds were enjoyed by about
3,000,000 persons.
A Centenarian. Mrs. Mary Fay died re-
cently in the City Hospital, BlackwelPs Island,
—
at the alleged age of 105 years. Dr. Philip
O'Hanlon, the coroner's physician, who made
the post-mortem in her case and who has per-
formed some 4,500 autopsies, reports that he
has never seen a woman of from forty to fifty
years who seemed better preserved. The body
was exceptionally well nourished, and the teeth
in both upper and lower jaws were in perfect con-
dition. An atheromatous condition of the arteries
was found, however, and death was attributed to
old age. Mrs. Fay was born in England, of
Irish parents, and had lived in this country for
forty years.
The Removal of Patients. On July 2 the —
Board of Aldermen passed an ordinance, presented
at the request of Coroner Harburger, to the effect
that no superintendent of a hospital in the City
of New York, or other person in authority, shall
order or suffer the removal of any patient while
in a dangerously sick or precarious condition to
another hospital, unless such patient shall, after
admission, have developed a contagious or
infectious disease, or require care not specially
within the range of treatment practised by such
hospital. The penalty prescribed for a violation
of the ordinance is a fine, not to exceed $100, for
each and every offense. The special purpose of
this measure is to prevent the alleged practice
among the large private hospitals of the city of
turning dying patients over to Bellevue Hospital not suspected that he was suffering from an illness
in order to keep down their own death-rate. likely to prove so quickly fatal. It is reported
that his death was due to a disease of the heart;
Veto of Ordinance Regarding Hospital his final illness was of about two days' duration.
Patients. Acting Mayor McGowanhas vetoed Dr. Odiorne was the son of the late Frederic
the foregoing ordinance regarding hospital Odiorne and a brother of the late John L. Odiorne,
—

patients, recently passed by the Board of Alder- formerly president of the Cambridge Common
Council. He was prepared for college at the
men. This, it seems, imposed a fine for a hospital Cambridge Latin School, entered Harvard Col-
superintendent to refuse to receive a patient sent lege in 1891, graduating with the class of 1895.
to Ids institution, as well as a fine for transferring During his college course he was popular in his
a patient while in a critical condition to another class and at one time was manager of his class
team. He was graduated from the
hospital. In his veto message, the acting mayor baseball
Harvard Medical School in 1898 and thereafter
states that he does not believe that the aldermen served as house
pupil at the Massachusetts Gen-
had the legal authority to impose this ordinance eral Hospital on the surgical side. Shortly after
on the hospitals of the city, many of which are entering private practice in Boston he became

organized under the state laws, and expresses the the assistant of Dr. J. Collins Warren, with whom
that the of its he was closely associated up to the time of his
opinion carrying out provisions death. About a year ago he was appointed on
would lead to confusion. Another objection, he the
out-patient surgical staff of the Massachusetts
states, is the omission of any clause exempting a General Hospital. He was a member of the
crowded hospital from complying with these Tennis and Racquet Club of Boston, the Loyal
provisions, and he regards it as manifestly unrea- Legion and many medical clubs and societies.
his work had so
sonable to require an institution whose every Since leaving the hospital
bed is occupied to receive a patient, under a assured. shaped itself that his future was practically
He was a man of quiet manner, pre-
penalty of $100. possessing personality and very marked ability.
Another Tuberculosis Sanatorium. The His loss will be keenly felt by a large circle of his
immediate as well as by many
Martin farm in the Seventh Ward of the city of older in theacquaintances
—

profession with whom he had from

Yonkers, Westchester County, consisting of 110 time to time been associated.
acres of land, has been purchased by Alexander
Smith Cochran, of Yonkers, who purposes im-
proving the property and erecting on it a com- Miscellany.
plete sanatorium for the treatment of tuberculosis. A FURTHER METHOD OF COMBATING
The cost of land, improvements, buildings and
TUBERCULOSIS.
equipment will amount to more than $500,000.
When completed, the entire property will be Numerous methods of combating tuberculosis
are showing themselves in unexpected quarters.
turned over to the city, as a gift, together with An excellent
an endowment fund sufficient to pay all the
suggestion is made by our contem-
porary, the Boston Evening Transcript, which we
expenses of administration and maintenance for quote as follows :
at least five years. The offer was made to the "
People who were born and bred in the coun-
and Health try and who still live there are, as a rule, curiously
municipal authorities on July 2, the
afraid of fresh air. From their living-rooms,
Department and Board of Aldermen at once especially the ' parlor,' they rigidly exclude every
approved the site and gave permission for the approach of outdoor air, except at house-cleaning
erection of the buildings. The main building will time, and they are more cautious still as to
have twenty-five beds, and accommodation for sleeping-rooms. The farmers, in spite of their
outdoor employment, suffer not a little from
many more patients will be provided in tents. It seems a pity When these coun-
The preference will be given to incipient cases of consumption.
try dwellers might have their lungs filled with
tuberculosis, but more advanced cases will not pure, fresh air, day and night, sleeping or waking,
be excluded. that the poisoned air they breathe at night should
be allowed to offset the good effects obtained
through the day's work in the field. And if
Obituary. enlightened visitors, paying guests and summer
boarders who have learned that one's manner of
WALTER BURLINGAME ODIORNE, M.D. life rather than one's place of living may be
Dr. Walter B. Odiorne died suddenly at the depended upon to prevent consumption would
home of his mother in Cambridge, on July 15, at but circulate their knowledge in a practical way
the age of thirty-three years. Although some in country places their vacations would accom-
anxiety had been expressed for a number of plish something besides a refreshing of their own
months regarding Dr. Odiorne's health, it was health."

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