established, and the Committee do not doubt that they, as well as others, will cheerfully co-operate with the Convention and the profession in this desirable reform. Another circular was addressed to distinguished medical practitioners residing in all the States and Territories of the Union, soliciting replies to the following four questions. 1. Is it the custom of your State or neighborhood to require of young men, who desire to study medicine, any particular amount of preliminary education? 2. If so, what are the details of your standard? 3. By what authority, whether of a State Medical Society, local Association, or common consent, is this standard established? 4. What may be considered the general sentiment of the profession your vicinity, in regard to the establishment of such a standard as is contemplated in the 5th resolution of the National Medical Convention of May, 1846? The Committee have been favoured with very full and explicit answers to this circular from thirty-nine gentlemen, representing twentyone States of the Union. The replies which have been received to the first three questions, establish the fact, not only that there is no uniform standard of preparatory education exacted of medical students throughout the United States, but that there is no general rule adopted in any particular state or district, which has been authorized or recommended by Medical Societies or other official bodies, or established by common consent and custom. The whole subject is left to private preceptors, many of whom recommend, and a few exact, an elevated standard, while others leave it to the discretion of the students themselves, or their parents. But all the letters of the practitioners indicate, without an exception, the cheering fact, that the profession is alive to the want of a standard, is desirous that one should be established by the Convention, and is willing to sustain it. The fourth question was designed to elicit the general sentiment of the profession in regard to the nature and extent of the preliminary education which should be required of medical students. On this subject, the correspondence shows a considerable diversity of opinion; and the standard of different writers varies from a "common school" education up to the highest collegiate attainments. Some advocate a different scale in different sections of the country, while a majority is in favour of having the standard uniform throughout the Union. And, notwithstanding the individual differences of ideas, there is a sufficient general concurrence in the views of the writers to enable the Committee to recommend a scale which is chiefly based upon their united suggestions. Your Committee are aware of the difficulties the Convention would discover in fixing the standard of preliminary education for medical students as high as would be desirable. Entirely destitute of the means of legal compulsion, and depending for success, as the Convention must, solely upon the force of professional and pubiic opinion, nothing could be hoped from a standard above the circumstances of the country and the times. The existing evil can be reached only by the concurrent action of private medical preceptors, and the medical schools of the country. The chief responsibility rests with the preceptors; and to them the Convention should make its strongest appeal; but at the same time they should be encouraged and sustained by the co-operation of the schools, without which, indeed, the efforts of preceptors could be but partially successful. The object to which the Committee has directed its labours, it is believed, can be best effected by the Convention in the following way: Ist. By establishing a uniform standard of preliminary education for medical students, which shall be of a moderate character-in the first instance, too low, rather than too high-and yet of such extent as will insure both the knowledge and the mental discipline necessary to those who would enter a profession full of labour and responsibility, without excluding meritorious young men of limited means and opportunities. 2d. By earnestly recommending every medical preceptor to exact this standard of every young man, before admitting him into his office; and having exacted it, to grant him a written certificate to that effect, specifying also the period of his admission into the preceptor's office, as a proper warrant and credential for the student, when about entering a medical college. 3d. By requesting all the medical colleges of the country to require such a certificate of every student applying for matriculation; and, in publishing their annual list of graduates, to accompany the name of the graduate with the name and residence of his preceptor, the name of the latter being clearly and distinctly presented as certifying to the qualification of preliminary education. These ideas the Committee have put into the form of distinct resolutions, which they append to their report, submitting both for the consideration of the Convention, and, if it think proper, its adoption. 1st. Resolved, That this Convention earnestly recommends to inembers of the medical profession throughout the United States, to satisfy themselves, either by personal inquiry or written certificate of competent persons, before receiving young men into their offices as students, that they are of good moral character, and that they have acquired a good English education, a knowledge of Natural Philosophy and the Elementary Mathematieal Sciences, including Geometry and Algebra; and such an acquaintance, at least, with the Latin and Greek languages, as will enable them to appreciate the technical language of medicine, and read and write prescriptions. 2d. Resolved, That this Convention also recommends to the members of the Medical profession of the United States, when they have satisfied themselves that a young man possesses the qualifications specified in the preceding resolution, to give him a written certificate, stating that fact, and recording also the date of his admission as a medical student, to be carried with him as a warrant for his reception into the medical college in which he may intend to pursue his studies. 3d. Resolved, That all the medical colleges in the United States be, and they are hereby recommended and requested to require such a certificate of every student of medicine applying for matriculation; and when publishing their annual list of graduates, to accompany the name of the graduate with the name and residence of his preceptor, the name of the latter being clearly and distinctly presented as certifying to the qualification of preliminary education. Signed by JAMES COUPER, L. P. BUSH, Peoria District Medical Society.-Pursuant to public notice a number of the regularly qualified practitioners of medicine of Peoria, Tazewell, McLean, Woodford, Putnam, Bureau, Stark, Knox, and Fulton counties, in the state of Illinois, met at the court house in the city of Peoria, on Tuesday the 13th of July, and organized the "Peoria District Medical Society." The following persons were admitted as members :-Rudolphus Rouse, Peoria; A. G. Henry, Pekin; Francis A. McNiel, Peoria; L. A Hanaford, Trivoli; Edward Dickinson, Peoria; Joseph C. Frye, Peoria; Elwood Andrew, Peoria; Thomas J. Moore, Trivoli; S. Christy, Farmington; G. H. Hickman, Farmington; O. N. Williams, Farmington; Wm. Cromwell, Pekin; M. B. Van Petten, Trivoli; H. H. Sexton, Galesburgh; E. M. Colbourne, Bloomington; Uri P. Golliday, Kickapoo; Alvah Leonard, Kickapoo: John L. Huff, Maquon; Charles Cutter, Princeville; T. P. Rogers, Washington; John Riley, Henderson; Alanson Stockwell, Tremont; E. V. Garfield Toulon; Jerome B. Tenney, Tremont; John Murphey, Peoria; G. P. Wood, Washington; Robt. B. M. Wilson, Peoria; John B. McDowell, Lewiston; Thomas Hall, Toulon; A. H. Lace, Bloomington; N. S. Tucker, Peoria. The following officers were elected for the ensuing year: Vice Presidents.-A. G. Henry, M. D., J. C. Frye, M. D. Corresponding Secretary.-Jno. Murphy, M. D. Treasurer.-E. Dickinson, M. D. Censors.--Drs. R. Rouse, E. M. Colbourne, T. P. Rogers, H. H. Sexton and Thomas Hall. The next meeting of the society will be held at the court house, in the city of Peoria, on the first Tuesday of November next, to which all qualified Physicians, desirous of becoming members, are invited to attend. The delegates to the American Medical Association, will be appointed at the November meeting. An address will be delivered by the President-one or more lectures, by persons appointed for the purpose-after which, the nature, pathology, and treatment of congestive fever, will be discussed by the members of the society. E. ANDREW, Secretary. Account of a Physical Sign of Pneumonia of the Apex of the Lungs. By WM. M. BOLING, M. D., of Montgomery, Ala.-My experience, so far as it extends, is confirmatory of the opinion that pneumonia, commencing at the apex of the lung, is, in proportion to the number of cases, the most frequently fatal form of the disease. I have met with about six cases of this affection, at least have recog. nized, or identified about that number. They all proved fatal. I will notice three of them :-In one, the subject of which was a powerful and robust Irishman, 30 years old, fond of a dram," but not decidedly intemperate, and previously in good health,-the disease supervened on an attack of acute bronchitis, about the fifth day, and proved fatal on the fourteenth day, counting from the first of his illness, In the second case, the patient was a rather delicate negro woman about 28 years old, the attack commenced during a slight indisposition of a catarrhal character, and proved fatal on the thirteenth day. The other patient was a strong and robust negro woman, about 22 years old, previously in good health, and in her case the termination. was on the ninth day. The general symptoms and march of the disease, in these, did not differ in any material point, from those in the more common form of pneumonia, except in the point of commencement, and in this perhaps that the morbid alteration had proceeded to a less extent, at the time of death, than is commonly the case in the latter; that is, death supervened from a less extensive local disease. In the other cases, the lung ran most rapidly into a state of hepatization, the solidification not being preceded by the crepitant bronchus, but by a total absence of the respiratory murmur, while the chest over the affected part remained still resonant on percussion. My object, however, in the present remarks, is simply to speak of a physical sign that was present, in each of the three cases detailed, which I presume also to be present in others of the same character, the observance of which may probably lead to a correct diagnosis at an earlier period, in some instances, than it would otherwise be made. This is a fine mucous or crepitant rhonchus, seemingly seated in the larynx, loud enough to be heard distinctly at the distance of two or three feet from the patient, and so persistent, that it is not removable, or but momentarily, by any effort to expectorate which the patient may make, while at the same time there are present none of the signs of bronchitis or laryngitis. Though it is exceedingly annoying to the observer to hear it, because it impresses him with the belief that it is distressing to the patient, and he looks with a feeling rather of impatience for an attempt, by an effort to expectorate, for its removal; the patient seems perfectly indifferent to its presence, which would not be the case were it really produced by the presence of a small quantity of tenacious mucus in the larynx itself. The sound, then, is only seemingly produced in the larynx, for on applying the stethoscope immediately under or just above the clavicles, it will be discovered to proceed from the apex of one or the other lung, which will be found the seat of inflammatory action. It would seem that the sound there produced in the pulmonary vesicles, must be conveyed by the larger bronchial ramifications, numerous and superficial at this point, to the larynx, where, in consequence of the thinness of the tube, or rather the thinness of its covering, and its proximity to the surface, the deceptive impression of its production in this organ, from the presence of a small quantity of viscid mucus, is created. It is the indifference of the patient to the presence of the sound, but still more especially its persistence, which constitutes its peculiar and distinctive feature, and upon which its value as an evidence of pneumonia commencing in the apex of the lung depends. In other affections of the lungs and air passages, more especially in bronchitis, we may have a somewhat similar sound produced in the larynx itself, by the play of the passing air through a small quantity of viscid mucus there collected; but under such circumstances, it is removable by coughing, or an effort to expectorate, and once removed may not return again, or only after a considerable interval, when a fresh collection of mucus has taken place. The patient, too, does not manifest the same indifference in regard to its presence, but the mucus producing it soon excites an effort for its removal. As pneumonic inflammation, in the greater number of cases, commences at the base of the lung, the inexperienced stethoscopist, on observing the general symptoms of pneumonia present, may neglect to apply his instrument over the apex of the organ in attempting to discover the location and extent of the disease, and failing to detect any physical evidences of morbid action near the base, might at once attribute the symptoms present to inflammation, somewhat circumscribed, of the central portion of the pulmonary texture; too limited in extent, and too remote from the surface, to give rise to the peculiar physical phenomena. To be sure, were he to examine the entire chest, the disease would be detected. The recollection of the sign which I have named, leads at once to its locality. It is altogether probable, that in a number of instances of this kind, the exact seat of morbid action has escaped my own observation, as the peculiar sign which I have spoken of, I considered indicative of the most extreme danger, long before I discovered its connection with inflammation, commencing at the apex of the lung.-American Jour. of Med. Sci. Case of Ligature of Common Carotid, for removal of Parotid Gland.-By A. B. SHIPMAN, M. D., Professor of Surgery in Indiana Medical College.-(Communicated by Dr. Norris.)—Mrs. VOL. X. 54 ætat. |