can not impose, as a legal requirement, upon any medical man a higher degree of efficiency than is compassed in the common-law requirement of "ordinary skill and care," as determined by prevalent conditions of society.

Let it be granted, without going into invidious personalities, that many of the existing medical schools of this country are inadequate and inferior. Nevertheless it is, in the long run, better that they all be allowed to exist, and be subject to the natural law of the survival of the fittest, than that any arm of the State be given power to dictate which shall and which shall not exist. In the main, a censorship such as some would propose to establish over medical education would be more dangerous and hurtful to medical science than even the inferiority which may be conceded in many of our schools. We say nothing here of the rights pertaining to the schools themselves, or of the more fundamental consideration underlying the whole matter that a censorship of schools is essentially incompatible with free government. We confine ourselves to the sheerly educational aspect of the subject, and point out that no forced elevation of educational standards can be either practicable or permanent.

For the present, the standard of preliminary requirements adopted by the American Medical Association and its tributary organization, the Association of American Medical Colleges, is sufficient; and the prevailing standard of medical colleges is adequate. We can not all go to Johns Hopkins, or to Harvard University, or even to Rush Medical College. Whether we would if we could is a question that might possibly offer two sides, incredulous as such an idea may appear to the adherents of these institutions. However that may be, we are assured that there is, and will continue for some time to be, a demand for graduates of less pretentious colleges. Festina lente. Make haste slowly.

WE

THE HYPOTHETICAL QUESTION AND ITS ANSWER.

E can not refrain from commenting with approval upon the answer given by Dr. R. B. H. Gradwohl, of St. Louis, to the hypothetical question put to him by the State in the now famous Doxey case recently tried in this city. The case, as almost everyone knows by this time, was a murder trial, in which the defendant was accused of poisoning her husband with arsenic, the alleged motive being the obtainance of the insurance money on the policy of the deceased. Dr. Gradwohl was called in the capacity of an expert witness, and the usual long-winded hypothetical question was propounded to him, setting forth with customary incoherence and bias the clinical symptoms, the post-mortem findings, and the toxicological report, upon which the witness was requested to give his expert opinion as to the cause of death.

As a preliminary and strictly categorical answer to the question, Dr. Gradwohl declared that it did not admit of intelligent reply; that it did not represent a correct recital of the real course of events, and therefore could not serve as the basis for a scientific interpretation of those events. If he had restricted himself to this negative attitude, the witness would have rendered no inconsiderable service to medical jurisprudence by his frank and deserved criticism of a farcical procedure. But he felt and rightly-that his duty to the case at bar and to the spirit of his oath required a more positive and constructive declaration; and in his detailed opinion he still further clarified and emphasized the true inwardness of the expert witness and the hypothetical question.

He said, in effect, that the question, looking beyond its bias and distortion to the facts on which it was evidently based, resolved itself into three aspects. First, there were the clinical symptoms of the decedent's last illness to be considered; second, there were the pathological findings at the autopsy; third, there were the discoveries of the toxicologists, which in this instance consisted of the finding of one-third of a grain of arsenic in the form of arsenious acid. Of these three phases, the first and the second, while they might have pointed to arsenical poisoning, might with equal likelihood have pointed to a dozen other causative conditions, and were therefore of themselves valueless as premises for expert opinion. The third, while it brought the consideration of arsenic into the question, was not sufficient, either of itself or in connection with the other two negative phases, to warrant an expert opinion of death by arsenical poisoning. The net effect of the testimony. therefore, was that the content of the hypothetical question, divested of its bias and its prejudiced coloring, and read in the intelligence of the actual course of events, did not furnish any adequate premises for an impartial expert opinion.

We believe that Dr. Gradwohl's estimate of the situation in this particular case will meet the assent and approval of all disinterested medical men who are acquainted with the facts in the case. And we believe, further, that most fairminded physicians will agree that the same evaluation applies to the vast majority of hypothetical questions and expert opinions in similar cases. As we pointed out in a recent editorial on the subject, a thoroughly honest hypothetical question and an equally honest answer to it would, in almost every such instance, result in a negative, non-committal opinion, which would leave the entire matter where it ought to be a question of fact for the jury. Dr. Gradwohl's testimony in the case under discussion furnishes a concrete demonstration of our argument. It is a singular and fitting coincidence that the expert witness to point our moral should be found in the gentleman who formerly presided over these editorial pages— a circumstance which we may be pardoned for regarding as additional ground for our gratification.

WE

THE SPY SYSTEM.

E understand from reports in the public press that the Missouri State Board of Health has recently been engaged in the prosecution of a campaign of spying upon certain medical practitioners for the purpose of catching them in a criminal conspiracy to obtain an abortion. The plan pursued by the Board is to depute a woman to call upon the physician and solicit him, with representations of money, or by appeals to his sympathy, to procure an abortion upon her. If she succeeds in persuading him to consent to the crime, she then lodges information against him, upon which he is haled before the police bar and either indicted for criminal conspiracy, or disbarred from practice, or both.

We do not believe that the Board will receive the support or approval of either the public or the better element of the profession in such a course. The spy system has never been in much favor with Anglo-Saxon peoples; and while it is doubtless necessary, in certain cases and under certain conditions, to employ it for the detection of crime and criminals, yet it is always looked upon in the light of a necessary evil, in which no right-feeling man cares to take an active part, and by common consent it is made use of only where every other means have failed to accomplish the purpose in view. It is regarded, at best, as a species of dirty

work, only to be employed when absolutely necessary to circumvent equally dirty work with its own weapons.

This natural sentiment of disfavor among decent men toward spying applies even to the legitimate practice of secretly watching a suspect's movements, and to the perhaps justifiable measure of obtaining under false pretenses incriminating information from criminals and their accomplices. To these species of spying, however, the citizen is willing to concede the justification of necessity, or at least of expediency, in the enforcement of social order. But for that kind of spying which has for its avowed purpose the procuring of the commission of crime, no right-minded person has anything but contempt and disgust, and no excuse is valid. Apart from the despicable baseness of a deliberate temptation, cleverly and insinuatingly pressed upon a weak individual by those who are presumed to be the guardians of public morals, and the disgusting degradation of the decoy employed in the nauseating business, we fail to see what possible end, either of justice or of morality, is subserved by such a course. Social and civic laws are enacted for the purpose of protecting men against their weaknesses and criminal tendencies, and for representatives of the law to go about deliberately enticing men by playing upon their emotions and passions, to commit crimes, for the express purpose of making examples of them, is, to say the least of it, both uncalled for and contemptible. We are strongly of opinion that it is even more than this. No less a legal authority than Blackstone declares it to be a settled principle of law that "Whoever procureth a felony to be committed is an accessory before the fact, and whoever in any wise commands or counsels another to commit an unlawful act is accessory to all that ensues from that unlawful act."

At all events, as we have already said, the Missouri Board will not command the respect or the endorsement of the profession or the public by measures of this kind. Abortion is a bad enough crime, heaven knows, and calls for all the moral and legal suasion that righteous men can bring to bear upon its abolition. But we can dispense with any such underhand and questionable methods of dealing with it as those recently adopted by the Missouri State Board of Health.

Echoes of the Convention.

O

The President's Address.

NE hardly knows whether to wink a quizzical eye, or to be righteously indignant, at the sophomoric character of the speechifying indulged in at the general opening exercises. As between the visiting Association and the receiving hosts it was, perhaps, excusable that there should be a rather fulsome exchange of smug felicities, especially on the part of Governor Hadley, who is nothing if not a jollier, and no flattery from his lips appeared too fulsome for his audience to complacently swallow. But from the President of the Association to his own, one was justified in looking for something more than nauseating compliments and platitudinous back-patting, and it must have made any sensible man angry to see so magnificent an occasion frittered away in such petty small-talk. It will be a long time before Dr. Welsh has another chance to deliver a message, under such inspiring conditions, to several thousand listening men and women, representing the medical science of the greatest country in the world, gathered for the express purpose of hearing him speak, and all hanging upon his word; and if he has any sense at all of the fitness of things, he must feel intensely chagrined every time he recalls how he wasted the opportunity.

Dr. Welsh is a man of long, and presumably ripe, experience. Has that experience taught him nothing more profound or inspiring than that the Council on Chemistry and Pharmacy has rendered signal service to medicine and pharmacy? Has he learned nothing in his busy life more interesting than that the antivivisectionists are waging a hopeless and mistaken campaign? Could he find nothing more momentous with which to fill the expectant and climactic hour than a fulsome praise of Messrs. Simmons and McCormack? At least one man in the audience left the hall more in sorrow than in anger that so vast and pregnant an occasion had been wasted-so far-called and high-tuned an assembly had been cheated out of a great and moving message.

000 000

Medicine and Insurance.

One of the most impressive addresses of the entire convention was delivered by a layman—the address made at the banquet of the Medical Editors' Association by Mr. Hoffman, the statistician of the Prudential Life Insurance Company. The ostensible topic of Mr. Hoffman's address was the debt which life insurance owes to the current medical press, but its real and most profound significance was its demonstration of the determinate relation which life insurance bears to medical progress. There, in the statistician's coldly precise figures, representing the life insurance risk in terms of mathematical percentage, is the ultimate gauge of all medical achievement and advance. All that research and clinical practice and preventive medicine have accomplished is there expressed in its actual net effect upon human life and expectancy. And only that part of all of medicine's labor which really and truly tells for the conquest of disease and the preservation of life finds representation in the tables of the life insurance actuary, reduced to the most simple and exact formula. In this case, indeed, figures do not lie—and they are the only gauge of medical progress that does not lie. It would seem the

part of wisdom for both medicine and insurance to cultivate closer and more intelligent relations with each other.

000 000

Legislative Infatuation.

The extreme legislative line upon which the Association is treading, and the readiness with which it may overstep that line into the realm of absurdity, are well illustrated in the resolution of the House of Delegates to seek legislation compelling the public press to withhold news of suicides. Someone evidently perceived the ridiculousness of a proposal to prohibit the public press from printing the news, for the resolution was quickly amended to one requesting the press to curtail such news. But the incident is a straw in the wind, showing the tendency of the organized medical mind to assume legislative dictation over anything and everything that comes within its consideration, whether it pertains to medicine or not. The House of Delegates had better, perhaps, have requested the newspapers to suppress the account of the Nautch smoker!

It is greatly to be regretted that the convention should be marred by so unsightly a blot as the episode of the surgical smoker at the Railroads Club. There are, of course, always a certain number of black sheep in every flock, and it is to be expected that, even in a convention of physicians, there will be a few whose tastes lead them to sample the dregs of the city which they are visiting. But that a large company of some two hundred and fifty surgeons, gathered at a public place, should permit themselves to be entertained by immoral exhibitions, is a stigma upon the profession which the more respectable element will find difficult to erase. It is the more unfortunate occurring at a time when the medical profession is, so to speak, on probation with the public, and subjected to the most searching scrutiny of its critics and antagonists, who, we may be sure, will not fail to make the greatest possible capital out of the disgraceful incident-as, indeed, they will be justified in doing.

It will doubtless be the opinion of the Association that the least said is soonest mended. Such, however, is not our view of the matter. It has already become public, and if the profession at large is to divest itself of all responsibility for the outrage upon public morals we at least, as a representative of the honorable contingent of that profession, believe that it can best be purged by a frank and public mention of the incident, for the express purpose of regretting and repudiating it.

000 000

A Remarkable Object Lesson.

In the joint sessions held by the Sections in Pathology and in Therapeutics one could not but be struck with the almost hopeless lack of community or understanding between the exponents of the two subjects. The therapeutists did not seem to know what the pathologists were talking about, and the pathologists did not appear to care much what the therapeutists were saying. It was a remarkable object lesson of the great gulf fixed between pathology and therapeutics, and of the urgent need for a better working understanding. No wonder there is so much therapeutic nihilism! Pathology has come to stay, and if therapeutics