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Medical Association from pages 569 to 603 appears a very complete report of the present status of medical education and medical colleges in the United States. Our readers are strongly urged to give this report a most careful reading. In the meantime our quotations below, for the purposes of this editorial, are a short synopsis of its main points, utterly disproving the contentions set forth in the editorial so extensively quoted above.

And to commence with: These findings are not the sole product of a conspiracy on the part of the Carnegie Institute and the A. M. A. to down, by the most merciless methods deserving medical colleges; to the contrary, they are mostly built upon reports of the medical colleges of the United States themslves, assistance being rendered by the above institution and even a member of the United States Bureau of Education.

All these forces joined to formulate: First: conditions under which aspirants to a medical education in the hereafter shall be accepted as students, demanding graduation from recognized high schools or academies, and attendance at colleges; or an equivalent amount of knowledge otherwise attained and not to be judged by the college to which the student applies for admission, but by officials in no manner connected with such institution and having authority for such examination, such as county and state superintendents of instruction, heads of colleges and universities, etc.

Secondly: That similar requirements shall be enforced in regard to the amounts of work to be given and done in the medical colleges, before an aspirant for graduation shall attain that goal.

By the adoption of these requirements medical schools very quickly found out to what extent they came up to these standards and for convenience fell into the following groups, though representing all manner of gradation.

First "A+" Colleges, which in every respect fulfill the self imposed requirements.

Second "A" Colleges, those which need improvement in certain respects, but which are otherwise acceptable.

Third "B" Colleges, those which, under their present organization, might be made acceptable by general improvements. Fourth "C" Colleges, those which require a complete reorganization to make them acceptable.

Now as far as the state is concerned where these lines are written the investigations of the Carnegie Institute to which our contemporary takes such violent exceptions, and which are on record in print, tally exactly with the findings of this latter day exhaustive investigation.

Now what about the state from which our contemporary hails?

In the first place it has eight so called medical colleges, which are not classified at all, called in the report irregular colleges; then it has nine colleges besides. In class A+, two; in class A, ons; in class B, one and in class C, five!

Recently the New Mexico State Board of Medical Examiners adopted a resolution that hereafter colleges rated in class C by the Council on Medical Education will not be considered in good standing with that board. This makes 15 state boards, which have adopted such measures. It is very surprising that this terrible conspiracy of state boards to down poor, persecuted colleges has escaped our editorial scribe's attention; we respectfully remind him of it; especially since it may occur that hundreds of young men and women appear with their diplomas before these awful boards to be told that their diplomas are worth nothing in their eyes. Four years of wasted time and endeavor! And yet these poor mortals are attracted to these cheap John Schools, as are insects to a gas light. An examination of the report will show that it is to these inferior schools that these boys are irresistably drawn, even if the expense is as great, or greater in them, than in the schools of the highest standing.

What is the reason?

Is their educational equipment such that they cannot hope

to be admitted to the best schools? Or is the instruction in these schools such that students with limited preparation may not fail of a diploma? Or are both these causes active in alluring these benighted mortals past the portals of these inferior schools?

We especially emphasize that sectarian schools are not part of this discussion. Be they schools Eclectic, Homeopathic, or so called Regular, it does not matter, so long as any one of them furnishes all the education, which is not required by the Carnegie Institute or the Council of Medical Education, but demanded by the times, i. e. the people, whom these students are to serve eventually, and in their direst needs at that. Does any physician claim that to supply this demand we need three colleges here, and nine in our neighboring state, and eight inferior concerns thrown in for good measure in the latter?

Does any teacher pretend that the educational requirements demanded of medical students is unnecessary and a hard ship? Does he realize that there were quite a few students fifty years ago, who had the education now demanded of medical students and that this education was to their advantage in their subsequent career? And as it will be to those who are coming on now?

Suppose all the statements made in that editorial were true, what then? Who would be hurt? The people, who are entitled to the best there is in the medical profession? The students, who pay for and are entitled to the best medical education their money, their time, their work and their aspirations entitle them to? The medical colleges which supply everything students and suffering mankind can hope for? No, indeed.

Who then is left to be hurt? Evidently medical schools, which do not comply with the demands of any or all of these, and who cares? Only he who is an anachronism in time, in morals, in everything that is dear to progress; and a progressive medical journal is far from its best work, which will give space and voice to such echoes of a forgotten past.

A. S. v. M.

Corrosive Sublimate Poisoning

Following the death of the Georgia banker, who took a Bernay's antiseptic tablet in mistake for aspirin, and died from the kidney degeneration following, there has been a perfect epidemic of suicidal and accidental deaths from sublimate. We get daily bulletins on these cases in the newspapers. Legislation has already been proposed to make such deaths less likely of occurrence, the favorite being the compulsory molding of these tablets in unique shapes. For instance, some want them to be diamond shape, others triangular, still others coffin-shape. The trouble will be that no two state will agree upon the same style, and there is danger that the unfortunate manufacturer will be compelled to put out forty odd varieties to meet the requirements of as many different sections of the country. After all, it isn't the shape, size, color, or style of container of these tablets that counts so much as the more rigid enforcement of our laws concerning the dispensing of poisons. The laws are generally all right as they are; the trouble is that the average American is temperamentally lawless and inexcusably careless. Why should any man or woman have bichloride of mercury tablets around his or her house, anyhow?

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One hears a good deal of the benefit derived from the use of serum in cases of persistent bleeding, e. g., in the newborn, the icteric, and in hemophilia; and many such cases successfully treated have been reported. The trouble is that many of our readers are so situated as not to be able to procure at once horseserum when they want it. Diphtheria antitoxin has been used, but has never become popular. Should you be unable to procure the horse-serum, try human blood. Do not try to make a serum from it. With a sterile syringe draw blood, 15 to 30 c.cm., from a vein of father, mother, sister or brother of the patient and at once inject it into the subcutaneous tissue of the patient. You may repeat the procedure in eight to twelve hours and you will hardly have to use more than three injections.-Interstate Med. Journal.

Treatment of Tumors of the Bladder

*By A. C. STOKES, M. D., Omaha

Treatment of neoplasms of the urinary bladder offer many difficulties. It is often unsatisfactory. Physicians do not see cases of tumors of the bladder until late. They come for symptoms of metastasis, or they have severe urinary disturbance, and even then radical treatment is often postponed because of a feeling of the possible unsatisfactory outcome. It is my purpose in this paper to spend the time allotted in the discussion of diagnosis and treatment and not of pathology. Suffice to say that most tumors of the bladder are papillomata or adenoma in the beginning but usually develop malignant characteristics later.

The diagnosis of tumors of the bladder must depend upon urinary symptoms for its earliest indication. The final demonstration must depend upon the use of the cystoscope. Perhaps the most constant early symptom of tumor in the bladder is hemorrhage. This may be small in amount or profuse and the amount of the hemorrhage bears no relation whatever to the size of the tumor. Urinary tumors oftentimes have very little, if any, hemorrhage, while there are instances of very small tumors accompanied by a very great deal of hemorrhage.

The second most constant symptom of tumor of the bladder is undoubtedly frequent urination, particularly in the day time, not necessarily arising at night and often followed by tenesmus. These two symptoms are usually the symptoms that bring the patient to the physician. If his urinary history has shown either of the two symptoms, a careful study of his bladder and kidneys should be made by all the known methods for diagnosis. If a tumor of the bladder is present the simple introduction of the cystoscope will solve the entire question. The greatest trouble is, that patients complaining of a slight amount of urinary frequency or tenesmus are frequently not examined fully for some time, or, if they have a little hemorrhage at times it is allowed to pass until by the time the actual diagnosis of tumor of the bladder is made the growth has extended to such a distance that it is almost impossible to offer hope.

*Read before the Nebraska State Medical Association, at Omaha, May 13th, 1913.

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