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tively immune. In other words, the tubercle bacillus is a serious menace only to those who are in some way predisposed, for it is hardly credible that all the persons who present merely these insignificant latent lesions should have had the good fortune to encounter only nonvirulent bacilli. What the nature of this predisposition is, whether it is altogether in- nate or to some extent acquired, and whether, if it is acquired, any method will be discovered whereby it can be detected in time and in Purchase Trileptal Online some way removed, are large questions to which the future may possiblv have answers. Nov. lo, 1906] MEDICAL RECORD. 743 Till-: MEDICAL UCENSE LAW IN NEW YORK. \\ iiiiN one compares the present conditions of med- ical practice in the United States with those which existed only fifteen or twenty years ago it is evi- dent that great nrogress has been made. .\t that time the regulation of practice was only in its infancy, and the attempts which were being made in some few States to protect the public from irreg- ular practitioners of all sorts, and even from out- and-out quacks and ignorant charlatans, were re- garded with suspicion and disapproval by many in and out of the profession. The pioneer efforts of the Illinois State Board of Health met wit>i strong opposition, not only from the faculties of the small and inefficient colleges who feared a loss of stu- dents and of the fees they paid, but even from edu- cated physicians with no college connection, who resented the slight restrictions then placed on med- ical practice as an interference with personal lib- erty. Gradually, however, the idea took root, and one State after the other passed laws regulating practice and establishing educational standards, to which all Trileptal Cost not already following their profession must conform before receiving permission to treat the sick. There is now practical unanimity regard- ing the necessity of medical license laws, and every State has such laws in force. The conditions have changed, and vastly for the better, but they are far from Trileptal Tablets perfect. A lesser evil has been substituted for a greater one, for it is unquestionably an evil that the educated physician practising his profession law- fully and skilfully in one State should become acrim- inal and a quack in the eye of the law if he at- tempted to continue his activity, after removing to another State, without submitting to a second ex- amination under a licensing board. A federal license law has been suggested as the remedy for this evil, but the form of Trileptal 450 Mg government under which we live renders this impossible. Each State is sov- eieign in this respect, and the federal government cannot coerce it. The only remedy lies in universal reciprocity, but this is manifestly impossible as long as the requirements in each State are not uniform. At present no two State medical license laws are the same ; some are rigid and some are lax, and if reci- procity were now general, the poorly prepared can- didates, in whatever place they intended to practise, would naturally come up for examination in the States where this was the most easy, and the general standard would fall to the level of the lowest. Until the laws in all the States are made uniform, or practically so, universal reciprocity in medical licens- ure must remain impossible. The Educational Council of the American Medical Association has been very active of late in the endeavor to raise the standard of preliminary and professional education in the various States, and the work it has done is commendable, but we ques- tion whether it will ever succeed in bringing about uniformity in the medical laws. The solution of the problem rests with the practitioners in each State. If they will interest themselves in the subject, and will use their influence to obtain amendments to the present laws, the time will come when all the States will have requirements which are practically equal, and then universal reciprocity will naturally follow. New York State was among the first to enact a medical license law, good in its way, but not per- fect. It is the Empire State of the Union, with the largest population and the greatest number of med- ical practitioners, and it ought to establish Buy Cheap Trileptal a standard to which the medical laws of the other States would conform. But before it can set itself up as an ex- ample for other States to follow, it must amend its requirements in several important respects. The Post-Graduate for October contains a thoughtful article by Dr. Frank Van Fleet on Order Trileptal "Needed Re- forms in the Medical Laws of the State of New York," which is worthy of study by legislators in other States as well. The writer, whose familiarity with medical legislation in this State qualifies him to speak with authority, pronounces our present law defective on four Trileptal Vs Tegretol counts: "(i) It is cumbersome; 12) It discriminates in favor of certain classes; (3) It does not accomplish the purpose for which it was enacted ; (4) It is unjust in its method of enforce- ment." The first objection calls for no comment, for it is a question of form rather than of matter. The second count relates to the fact that there are three distinct examining boards, composed of regular, homeopathic, and eclectic physicians, respectively. This provision of the law is bad, in that it does not safeguard the people against ignorance in the one branch which is the end and aim of medical study — the cure of disease. \ man who has passed the examination before any one of these boards is a legally qualified physician and entitled to treat his patients in any way he pleases. It is conceivable that a student with a knowledge of only the home- opathic or eclectic materia medica may be qualified by his own board, and then decide to throw over sectarian practice ; but he is really unqualified so far as regards therapeutics, and has practically been ad- mitted to practice without examination in the most essential branch. Again, if the State recognizes two "schools" as distinct from regular practice, there is no reason why Trileptal Acne it should not recog- nize a dozen others. So long as this distinction exists the osteopaths have a strong argument Trileptal 150 Mg for their demand for a separate board to examine their candidates and grant them a license to practise their own or any other therapeutic eccentricity. If they should gain their point it is difficult to see how recognition could then be refused to the naturo- paths, the vitapaths, and even Mother Eddy's nihilists. The law is also defective in that it does not define clearly the practice of medicine. Everyone knows instinctively in what this consists, yet a judge in this city not long since ruled that the practice of medicine consisted in the giving of drugs. One might treat Cost Of Trileptal a mild case of typhoid fever without giving a single dose of any drug listed in the Phar- macopoeia, yet no sane man outside of the legal pro- fession would Trileptal 135 Mg contend that he was not practising medicine in caring for the patient. The law is also unjust, in that it throws the burden of enforcement upon the county medical societies — homeopathic, eclectic, or regular — instead of using the machinery already provided for the conviction and punishment of other malefactors. So far as the requirements, preliminary and pro- fessional (materia medica and therapeutics ex- 744 MEDICAL RECORD. [Nov. lo, 1906 cepted), are concerned, the New York law is all that could be desired, and no other State can object to reciprocity on this ground ; but in some respects it should be amended. There should be but one exam- ining board to examine all candidates, and as long as the State recognizes the two schools in addition to regular medicine, representatives of each of these schools should be in the board; the law should clearly define in what consists the practice of medi- cine, or, as Dr. Van Fleet prefers, "the practice of the healing art;" and, finally, it should make pro- vision for Trileptal Generic Name the punishment of offenders against the law, and not leave this to the initiative of individuals or societies. The State of New York should have a medical practice law as perfect as any law can be - — one which could be taken as a model in the fram- ing of the laws of other States, and it would so be taken if it were really model in all its provisions. Then what now seems to be the Utopian dream of universal reciprocity would become a fact, and a physician licensed after examination to practise in any one State would be entitled, after complying with the necessary formalities, to follow his profes- sion anywhere in the United States or its dependen- cies. It rests, then, with the physicians of the in- dividual States to secure the enactment of perfectly satisfactory and practically uniform medical practice law, and thereby bring about universal reciprocity in medical licensure. Plans of Tegretol Vs Trileptal the Sea View Hospital. The plans of the proposed Trileptal Coupon hospital for tuberculosis on Staten Island, to be called the Sea View Hospital, were recently submitted for approval to the State Board of Charities. The plans call for the erec- tion of eight buildings, each four stories in height, for the wards, a dining hall and kitchen building, an amusement hall, and administration buildings, at a total cost of $2,000,000. The approval of the plans was strongly opposed by Dr. Stephen Smith, who objected not only to the cost but also to the plan of construction. The present approved treat- ment of tuberculosis, he said, is by means of fresh pure air and sunshine — practically outdoor life. This result can best be secured in simple one-story structures, varying in design from the tent, the shack, the lean-to, to the pavilion with numerous windows extending from floor to ceiling and wide verandas. He objected Buy Trileptal Online therefore to the plan before the Board which provided for four-story buildings each accommodating Trileptal 60 Mg one hundred patients distrib- uted in four wards one above the other. Tliese buildings are to be of reinforced concrete and there- fore permanent, whereas hospital buildings for in- fectious diseases should be susceptible of ready re- newal. Since he believed the food of the patients Trileptal 150 should be made up chiefly of milk and eggs with fruits and cereals. Dr. Smith took exception to the expenditure of over $340,000 for a dining hall and kitchen building. He thought also that the Order Trileptal Online build- ings designed for the accommodation of nurses, attendants, and help, and the "Amusement Hall" were on much too large a scale and too expensive. Indeed, the proposed cost of the entire hospital was, he held, excessive. He said that it is estimated by competent authority that a hospital or sanatorium for the exclusive treatment of tuberculosis could be constructed in all its appointments for a sum not to exceed $400 per patient, but the plans for the Sea View Hospital called for an expenditure Cheap Trileptal of $2,638 per patient. If the buildings were economic- ally constructed, on strictly scientific, medical, and sanitary principles, the money apportioned would provide for 5,276 instead of 800 tuberculous poor of New York. Dr. Smith's main objections would seem to be well taken. There is a manifest tendency at this time to a liberality bordering on extravagance in hospital construction, and it is legitimate to in- quire whether such expenditure is altogether justifi-

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