ORIGINAL COMMUNICATIONS

Short articles of practical help to the profession are solicited for this department.

Articles accepted must be contributed to this journal only. The editors are not responsible for views expressed by contributors. Copy must be received on or before the twelfth of the month, for publication in the issue for the next month. We decline responsibility for the safety of unused manuscript. It can usually be returned if request and postage for return are received with manuscript; but we cannot agree to always do so. Certainly it is excellent discipline for an author to feel that he must say all he has to say in the fewest possible words, or his reader is sure to skip them; and in the plainest possible words, or his reader will certainly misunderstand them. Generally, also, a downright fact may be told in a plain way; and we want downright facts at present more than anything else.-RUSKIN.

That a certificate of registration showing that an examination has been made by the proper board of any state, on which an average grade of not less than 75 per cent. was awarded, the holder thereof having been at the time of said examination the legal possessor of a diploma from a medical college in good standing in the state where reciprocal registration is sought, may be accepted, in lieu of examination, as evidence of qualification. Provided, that in case the scope of the said examination was less than that prescribed by the state in which registration is sought, the applicant may be required to submit to a supplemental examination by the board. thereof in such subjects as have not been covered.

QUALIFICATION No. 2.

That a certificate of registration, or license issued by the proper board of any state, may be accepted as evidence of qualification for reciprocal registration in any other state. Provided, the holder of such certificate had been engaged in the reputable practise of medicin in such state at least one year; and also provided, that the holder thereof was, at the time of such registration, the legal possessor of a diploma issued by a medical college in good standing in the state in which reciprocal registration is sought, and that the date of such diploma was prior to the

*By Beverly D. Harison, M. D., Secretary American Confederation of Reciprocating. Examining and Licensing Medical Boards: Secretary Michigan State Board of Registration in Medicin, and Ex-President Michigan State Medical Society, Sault Ste. Marie, Mich.

legal requirement of the examination test in such

state.

At the present date the following states are activly engaged in endorsing each other's licenses thru reciprocity, either upon the basis of Qualification No. I or upon the basis of Qualifications Nos. 1 and 2: Wisconsin, Indiana, Iowa, Maryland, Kansas, Nebraska, Minnesota, Wyoming, North Dakota, Missouri, Nevada, Ohio, Illinois, Maine, New Jersey, Georgia, South Carolina, Vermont, Texas, Michigan, Virginia. Of the above twenty-one states, sixteen reciprocate under both qualifications. There are two classes of practicians affected by medical reciprocity, viz.:

First: Recent graduates of medical colleges who have obtained their state license thru the qualification of a state board examination (Qualification No. 1).

Second: Older graduates of medical colleges who obtained their state license thru the qualification of registration upon the basis only of their recognized medical diplomas prior to the date of the double state qualification of diploma and board examination (Qualification No. 2).

Practicians under Qualification No. 1 at the present time approximately form 10 per cent. of the total of practicians, while those practicians under Qualification No. 2 form nearly 90 per cent.; and in this class will be found also at least 90 per cent. of the experienced and notable men in the profession. the professors and teachers in medical colleges and members of state medical boards.

A measure of reciprocity, then, that includes simply those members of the profession in Class I, the recent and inexperienced practicians whose claims for consideration. thru reciprocity are subject to a great deal of discount owing to their recent graduation, and which excludes 90 per cent. of those practicians to whom reciprocity is really a deserving and relieving measure, seems to me to be unworthy the consideration of intelligent and self-respecting members of the profession. Consequently it does not seem an equitable or legal measure for a state medical board to commit itself to the policy of recognizing for interstate exchange certificates of registration or licenses obtained solely upon the basis of a state board examination.

Boards who adopt this policy in reciprocity of an absolute requirement of a state board medical examination, create a legal

distinction between an examination conducted by a state medical board and an examination conducted by an authorized and reputable medical college, both examinations covering the same ground.

Previous to the establishment of a state examination the law recognized for license the examination made by a reputable medical college. It should, therefore, follow that a college examination, up to the date of the enactment of a state examination law, would be held as equal in law to the latter if retroactive legislation is to be avoided. This phase of the question is covered by an act of Congress passed last January, applicable to medical reciprocity in the District of Columbia, as follows:

The board is authorized to issue an endorsement of a license of another state if the applicant acquired the right to practise medicin and surgery in such jurisdiction under conditions equivalent to those with which he would have had to comply in order then to have practised medicin and surgery in the District of Columbia.

This act of Congress recognized, therefore, as an equal qualification with that of a state board examination an examination made by a reputable and recognized college, up to the date when the former became a legal requirement in the state.

The principles of law involved in the above are becoming gradually recognized among the greater majority of the better states, and as a sequence of such recognition these states reciprocate under both qualifications of the American Confederation. There are states, however, whose law seemingly specifically requires in reciprocity the absolute requirements only of Qualification No. 1. Examples of such states are Ohio and Illinois. California, in addition. to the requirements of Qualification No. 1, requires that the "legal requirements of the state at the date of the license should in no degree or particular be less than those of California at the time that such certificate shall be presented for registration to the latter board."

Acts of this nature create a favored class of practicians, from the fact that a licentiate in California whose qualifications are such this year that he is able to go to other states in reciprocity will be subject to the loss of his status in the event of even a very slight raise in the California standard, as the state in reciprocity would also be obliged to require the increased standard. This same principle of an inequitable law would also apply to those states which rec

ognize as a qualification for reciprocity the provisions only in Qualification No. 1. The reputable and well-qualified practician of several years ago, in obtaining his state license complied with all the legal requirements at that time. He could not have been expected in law to pass a state board examination when the provision for such examination did not exist, nor was it possible in his course in college for him to attend a certain number of hours upon the subject of Bacteriology when no such course was given in the college.

It follows, then, that every time the standards of such states are increased, a certain percentage of the legal practicians in such states are disfranchised in the matter of medical reciprocity. Unquestionably this is not only an injustice, but also it would seem to be illegal, from the fact that thru the executiv of the state, qualifications legally acquired are being taken away without due process in law.

Of course it was to have been expected that the obstacles and hindrances to reciprocity of the nature quoted above should arise, from the fact that every state in the Union, under its police power, has had authority to regulate the practise of medicin in a manner thought best by its legislature: and it was not expected, or perhaps even possible, under the circumstances, for medical acts to be either uniform in their requirements, or that these requirements should in every case be in harmony with constitutional law. Undoubtedly time and proper knowledge of the defects will remedy the matter. The fact that some twenty of the better states have been able to adopt a broad and liberal measure of reciprocity within a period of some three years is ample evidence of not only the popularity of the question of medical reciprocity, but is also evidence of its absolute necessity to the medical profession as an economic measure.

There are other hindrances to medical reciprocity which might be eited, and which time, patience and good nature only will overcome. Among those hindrances might be quoted the position of the New York Board of Regents on the subject. It announces its belief in reciprocity and admits its legal ability to reciprocate with other states, but gives as a reason for not doing so that the requirements of no other state in the Union are equal to the requirements of New York. A critical examina

tion of the New York standard of preliminary and medical education demonstrates the fact that several of the reciprocating states above enumerated have very much higher requirements, and while this difference can be demonstrated as easily as it is possible to demonstrate that two plus four more than equals two plus two, New York insists that the New York two plus two more than equals the two plus four of other

states.

And what is true of New York is equally true of some of the other eastern states.

However, as a hopeful sign, New York has recently admitted, in a half-hearted sort of way, that possibly she might be able to add correctly if approached in the proper spirit.

Another obstacle met with in medical reciprocity is the unique and ludicrous position of a board which advocates reciprocity upon the lines advocated by the Colorado board. From the fact that the Colorado medical law demands as a requirement for registration: (1) a recognized diploma, or (2) a state board examination, it will be readily seen that any practician who has a recognized diploma and a moral character can register in Colorado. The minimum requirement in reciprocity is (1) a recognized diploma, and in addition, (2) a state board license; therefore the additional qualification of a state license is unnecessary in order to comply with the Colorado requirements, and reciprocity is not a material question or necessary as far as laws similar to that of Colorado are concerned, for she demands simply a portion only of the minimum of reciprocity requirements. Certainly reciprocity under Qualification No. 2 would benefit a large percentage of licentiates of Colorado, but it would not be a material or legitimate reciprocity as far as the interests of other states are concerned, but rather would be an "inequitable restriction."

Still another obstacle might be mentioned that of the quality of support given to reciprocity by medical societies or associations. These associations which represent secular medicin are usually narrow and prejudiced and without the necessary knowledge, experience and authority, and often attempt to usurp the authority of the several boards. As an example, the Reciprocity Committee of the A. M. A. might be quoted. Its membership is composed of those who either have no official position

or opportunity to be effectiv in the cause, or those who, having had the position and opportunity to be useful, have proved themselves absolutely incompetent. The present chairman is known chiefly thru the impossible and ridiculous reciprocity schemes he has fathered, and only recently he wrote to the members of his committee that "with nearly fifty states of different standards, reciprocity based upon equity seems to me neither attainable nor desirable." Another prominent member of the committee advocates a committee of members of the A. M. A., whose duty should be to instruct members of state medical boards in their official duties, and who writes of "Reciprocity with a big R," and that "will o' the wisp-medical reciprocity." With a committee membership made up of members of a quality such as quoted, is it strange that the Committee on Reciprocity, A. M. A., is regarded by those who are doing practical work in this field as a possible obstacle and hindrance to the cause of reciprocity? B. D. HARISON.

Sault Ste. Marie, Mich.

Not a True Government Diploma. Editor MEDICAL WORLD:-In replying to a letter written by G. W. Henry, M. D., you made the statement in the January WORLD that the United States had never chartered a medical college. If you will pardon me for my inquisitivness, I would ask you how I may reconcile your statement with the following words which appear on my diploma:

"In virtue of authority granted by the United States of America."

I received my diploma from the George Washington (formerly Columbian) University, and was under the impression that the charter was issued by Congress.

Austin, Ill. E. B. GRAHAM, M. D.

[I thought of the medical colleges in the District of Columbia when I wrote that reply, and my impulse at the time was to cover that feature of the question; but I thought that my argument would be clearer to omit that complication from consideration at that time and in that connection. Congress governs the District of Columbia just like a legislature governs a state; and Congress governs the city of Washington just like councilmen govern other cities. So Congress can and does charter institutions in the District of Columbia, but such authority does not extend into the various

states; and diplomas from such institutions are regarded as coming from D. C. institutions rather than from Government institutions-the District of Columbia being in this respect a separate commonwealth governed by Congress, just like each state is a separate commonwealth governed by its legislature.-Ed.]

Further Arguments for a National Medical Law.

Editor MEDICAL WORLD:-You say on page 497, December WORLD, that we cannot have a national medical law, because the Constitution does not provide for it. It depends entirely on what the national medical law is, whether it would be unconstitutional or not. There is nothing expressly against it, like there is against the establishment of a national religious law, in Article I of the Amendments. If it is not expressed in so many words, it is implied, that the National Government can pass and enforce a national medical law.

Section 1, Art. VIII, of the Constitution says: "Congress shall have power:

"To provide for the common defense and general welfare of the United States.

"To raise and support armies and repel in

vasions.

"To make all laws which shall be necessary and proper for carrying into execution the foregoing powers."

Now, if the national law is one for the common defense and general welfare of the United States, and death and disease are enemies of our people and our government, are an "invasion," which they are-for one disease alone, tuberculosis, the white plague, kills almost twice as many of our citizens every year as we lost in battle during the whole of the Civil War-then it is expressly provided for in the Constitution that Congress shall have power to pass and

enforce a national medical law.

Congress can give us a Public Health Department, and make its secretary a member of the President's Cabinet; it can establish a national medical board, and require all doctors who begin practise after its adoption to pass it. It can pass a pure food law and require all articles of medicin offered for sale to have its true name and formula printed thereon. It can regulate or prohibit the sale of any obnoxious drug or compound. In fact, it can do any and all things that it would be lawful for the people to do if we had direct legislation. In the March WORLD, 1902, page 106, I pointed out that it is necessary for the general welfare of the United States that its citizens be strong and healthy, for a weak and sickly people cannot long survive as a nation or lead the great procession of the world's progress; that a person, when he is sick, becomes not only non-productiv in the body politic, or body economic, but a burden as well. That a Health Department would be perhaps the most complex of any department. It would have to be divided into dozens of parts, yet all these parts must be operated as a whole. It would require chemists, druggists, microscopists, bacteriologists, doctors and specialists, all working together as one man. This could

not be without being a part of the government to enforce quarantine, vaccination and such requirements where one man violating them would endanger others. The government, by specializing and systematizing the whole field, could stamp out nearly if not all contagious diseases.

We can have a Health Department or a national medical law if all the doctors will agree, and ask Congress for it. I would like to ask every member of the WORLD family, what national medical law would you like to have Congress pass? Would you give one dollar toward having the bill prepared and presented to Congress? Will the Editor give us what he thinks the bill should embody?

Sherrard, W. Va.

T. B. Cox, M.D.

[The Editor gives publicity to the above, with which, as a general statement, he heartily agrees; but as he is convinced that the regulation of the practise of medicin. is embodied in the "police powers" impliedly granted to the states by the constitution, he cannot consistently work along a contrary line. However, he wishes it were not so; and he hopes that there may be found a way, sometime, to get and enforce a national medical law.-ED.]

What is Pneumonia?

Editor MEDICAL WORLD:-Pneumonia is described in our recognized text-books as being an acute, infectious, inflammatory disease of the lungs with constitutional symptoms, self-limited and terminating by crisis. in from 5 to 9 days. Is this the truth? or do we accept it because it has always been so taught us? Does it not seem just as reasonable to think of it as a constitutional disease with local manifestations in the lung, and curing itself by its own antitoxin as soon as it can be manufactured in the course of the disease in from 5 to 9 days? Or is it a specific local infection of the lung, with the constitutional manifestations caused by the toxins of the disease, just as the constitutional manifestations of diphtheria are caused by the toxins manufactured during the course of the disease? In either case, whether the disease be local with constitutional manifestations or whether it be constitutional with local manifestations, does it not seem reasonable that the disease is self-limited only because the economy manufactures its own antitoxin after the disease is established? We know that other specific inflammations are not self-limited; that if left to themselves they will last indefinitly. In diphtheria, when a sufficient dose of antitoxin is administered it is followed in a

few hours by a fall of temperature to or nearly to normal and a general improvement of the constitutional manifestations. Yet while the local lesions cease to cause the trouble manifest before the administration of antitoxin, the inflammatory process does not disappear immediately. The same phenomena hold good in pneumonia. As soon as the crisis is reached there is a general improvement of the constitutional manifestations, but the lung is apparently as solid as it was 24 hours previous to the crisis, and remains so for 2 or 3 days and then gradually clears up just as the lesions of the throat do in diphtheria. I think I am perfectly safe in saying that no one believes he has a specific for pneumonia, and I very much doubt if any drug or set of drugs has any influence whatever on the course of the disease. The very best we can do is to look after the comfort and well-being of our pneumonia patient and keep the economy. just as near par as possible while we wait for nature to assert herself; and admit that nature cures pneumonia with an antitoxin. Then think of the lives that might be saved, the firesides that might be still unbroken, the misery and hardships families and communities might be spared, if we had at our command this same antitoxin to administer as soon as a diagnosis of pneumonia is made without waiting for nature to do her work for us, for we know by sad experience she sometimes fails. Should it not be an inspiration for some Pasteur, Koch or Behring to bring forth the specific for this terror that is only second to the great white. plague?

Paoli, Ind.

Pneumonia.

J. I. MARIS.

Editor MEDICAL WORLD:-When I tell you that I have only had one case of pneumonia which lasted over three days in twɔ years, you may not think that I am a fit person to give advice; but I am a believer in the idea that pneumonia can be aborted in a majority of cases. To illustrate, I will give the history of a case I saw last Jan. On Jan. 10th I was called to see Mrs. K.. and found the following: Patient well nourished, 39 years old, family history good. During the previous night had a chill which lasted for half an hour. Pulse 120, resp. 30, temp. 103°; pain in chestmore on right side; cough and expectora

tion of light mucus; moist rales and slight dulness on percussion. My treatment was as follows: I gr. calomel tablet every 3 hours until bowels moved or 4 are taken; if no movement in 3 hours after last, give a saline; aconitin 1-134 gr. every 15 min. until pulse drops to 100, then every half hour until temperature begins to drop, then extend time to 1 or 2 hours between doses until temperature is normal; after bowels. move give 4 grs. of quinin sulf. every 3 hours until 5 doses are taken, then put your patient on an expectorant mixture. Try this and you will be surprised how many cases you will cure in 2 or 3 days. E. D. TALLMAN.

838 W. 87th St., Chicago.

Recognition and Definition of Pneumonia.

Editor MEDICAL WORLD:-In regard to the article from the Medical Record, "Is pneumonia incurable?" in a recent WORLD, I would like to say a word or two; and first of all we must decide just the condition that shall go by the name of pneumonia. Shall we call every acute inflammation of the lungs (excepting, of course, acute miliary tuberculosis) pneumonia, or shall we call that pneumonia only which runs the stages of engorgement, red and gray hepatization? If we adhere to the former stand, then pneumonia can be aborted; if to the latter, it cannot.

There is no doubt that every day there are cases of inflammation in the lungs stopt by activ interference which otherwise would run the three stages aforementioned; for instance: A young, robust man works out during a cold, wet day, and is taken with a chill, followed by fever, and severe pain in the lungs. When seen the next day his temperature is 103 degrees; pulse full and bounding; has characteristic rusty sputum. He is given a good calomel purge, followed by a saline, and this again is followed up with the combined sulfocarbolates of lime, zinc, and soda, aconite and counter-irritation over the lungs. By the third day the temperature is down to 100 degrees, and is normal by the fifth. For two weeks more he raises a great quantity of thick yellow sputum streaked with blood.

Was this pneumonia or was it not? One thing is certain: if the expectant form of treatment had been followed he would have had it; but as it was, the process did not go beyond the engorgement stage, as there was