of; and that some provision should be made, some law enacted, by which the ignorant and illiterate should not be permitted to enter our profession is evident. I think this matter should start with the medical colleges, which ought not to be permitted to admit the illiterate men that come in seeking professional honor. There is where it should start, and from no question of private policy and private gain should such medical institutions and such a state of things be permitted to exist. It making this statement, I am entirely within the limit of facts. It is known to every man connected with the faculty of a medical college that the conditions under which these gentlemen are admitted at times, and the conditions under which they are graduated, are a disgrace to every institution it concerns. I make no exception, and I claim that it applies

to all.

It has been my duty in the past to be an examiner on the State Board where I impartially come in contact with graduates from every medical college in the State of Georgia, and I can certainly testify to the fact that the board is painfully impressed with the illiteracy, the absolute ignorance, of some of these graduates in regard to plain every-day matters, such as grammar, spelling, etc. And, Mr. President, in my capacity as a teacher in a medical college, I can testify to the same thing, and I can say, I do believe, as the doctor suggested in his paper, that it should be the effort, sought by this Association, by some method of legislation, to have a certain plan adopted whereby preliminary qualifications should be exacted for entrance into the study of medicine, by which men should be required at least to be able to read, to write, and spell correctly the English language. [Applause.]

Dr. J. S. Todd, Atlanta: I should do myself an injustice did I not thank Dr. Anthony for his able paper, and congratulate the medical profession of Georga that he is on

the Board of Examiners. I wish also to say that Dr. Olmsted has made my speech verbatim et literatim et punctuatim, and I indorse every word he has said. I did not think he would get up and do it, but he has. The success of homeopathy is not due to there being truth in the dogma, similia similibus curantur, but to the efficient training which their students get in four-year colleges, as well as the rigid examinations to which they are subjected before they are allowed to study medicine. Arm an intelligent man with a dogma, and he is dangerous. I am not vaporing when I say the Board of Health stands in danger of being washed away. My statements, I am afraid, will crystallize into a rain that will severely injure, if not destroy, the entire board at the next meeting of the legislature. Dr. Stewart, of Rockdale county, has given warning that the Dental Board has got to go. They have pulled his teeth, but they have not stopped his tongue. I can testify, after having been four years on a committee to secure a Board of Health, that he was the main factor in defeating it several times. He says he is not only going to wipe out the Dental Board, but the Medical Board will also hear from him. He is a wonderful worker, and I tell you, gentlemen, if you do not talk to your members of the legislature when you go home, you need not be surprised, when you wake up some fine morning, to find that the Board of Health has been abolished, and

"None pities him who in the snare,

Warned before, would not beware"

Dr. Louis H. Jones, Atlanta: The discussion has been so free on Dr. Anthony's paper that there is not very much left for me to say. I can commend all that has been said along the line of a great necessity for a higher education. among medical students. As a teacher for the last seven years in a medical college, giving daily instruction for six

months in a year, I have had an opportunity to note the deficiency of a large number of young men who apply for graduation in medical colleges. Oftentimes, they are men of good natural ability, but have not had much preliminary education. They are deficient in both writing and spelling, and under these circumstances it is exceedingly difficult, if not impossible, to turn men out of medical colleges in three or four years with a proper medical education. Whether the State can rectify this, except through the sentiments of its Association, and the members of the medical profession as individuals, I do not know. I believe the medical colleges are making an honest endeavor to elevate the standard of education among their graduates, and I sincerely trust that the Medical Board of Examiners will yearly increase the rigidity of their examinations. If it is necessary to reject men with diplomas from medical colleges in the State, let it be done; it will elevate the standard of medical education, and there will be forced into the profession a class of men who are properly prepared to enter one of the learned professions.

THE CREPITANT OR VESICULAR RALE AN INTER-PLEURAL SOUND AND NOT CAUSED IN THE PULMONARY TISSUE.

BY LOUIS H. JONES, M.D., ATLANTA, GA.

Even among the most intelligent and truthful of our patients, we can often attach but little importance to subjective symptoms; we are forced to rely for a correct knowledge and accurate diagnosis of a case upon such signs as we can elicit by a physical examination. If we are to draw correct conclusions, our methods must be accurate, our deductions must be logical; they must stand the test of careful scientific analysis; they must conform to known physical laws.

Believing that in our text-books on physical diagnosis, and in the lectures of a majority of teachers of this branch, that certain sounds heard in connection with diseases of the lungs are misinterpreted, I have thought it well to lay before the Association some of the views held by a most distinguished physician, now dead, and to add to his testimony the results of my own limited experience. Partionlarly do I desire to do this in regard to the origin, seat and cause of what is known as the crepitant or vesicular râle. First let us see what the recognized authorities say: DaCosta, in speaking of the vesicular or crepitant râle, says: "Its name indicates its seat. It is caused by agitation of fluid in the air-cells, or in the finest extremities of the bronchial tubes; or, to adopt a view now held by many, by the foreing open during inspiration of the air-cells agglutinated by exuded lymph. The first stage of pneumonia is the state in

which this râle is mostly engendered." Again, in speaking of pleural friction, he says: "It may be so much like crepitation that even long practice in auscultation will not enable us to determine at once whether the fine sounds we hear are the friction of a roughened pleura or the vesicular râles of an inflamed lung."

Loomis says of crepitant râles: "There are several views as to the production of these sounds; that they are due to the bubbling of air through a liquid in the pulmonary vesicles and terminal bronchioles; that at the end of expiration a viscid secretion glues the walls of the vesicles together, and their separation on inspiration gives rise to the crackling sounds; and that they are produced in the pleura independently of the pulmonary parenchyma.”

Osler, in speaking of pneumonia, says: "Very early there is heard at the end of inspiration the fine crepitant râle, a series of minute cracklings heard close to the ear, and perhaps not audible until a full breath is drawn; whether this is a fine pleural crepitus or is produced in the air-cells and finer bronchi, is an open question."

In speaking of pleurisy, Osler says: "There is another pleural friction sound which closely resembles, and is scarcely to be distinguished from, the fine crackling crepitus of pneumonia. This may be heard at the commencement of the disease, and also, as pointed out by McDonell, Sr., of Montreal, when the fluid has receded and the pleural layers have come together again."

Page says: "Crepitant râles are made in the air-cells, and are the only vesicular râles that exist. They are very fine, uniform crackling râles, heard only at the (tip) end of inspiration, and are unchanged by coughing. They are caused by the forcible separation of agglutinated cell-walls, as in the first stage of lobar pneumonia or agitation of thin fluid in the air-cells, as in pulmonary edema. They are heard also in the third or resolving stage of pneumonia,