entered into with the security holders; and finally to "invite deposits" by advertisements in the newspapers and by circular letters to those whose names and addresses are on the corporation's books.

It is at this point that the stock or bond holder's bewilderment usually begins. Is it to his advantage to enter into the agree ment with the committee and depository? It is seldom possible for any one to give a very positive answer to that question, one way or the other, at the outset. A good deal depends upon the terms of the agreement, and the inexperienced investor acts wisely if he seeks competent interpretation of them. His aim should be to find out whether or not the agreement gives the committee unreasonable authority over the deposited securities, and whether or not it obligates him to pay excessive fees.

But, of course, very much more depends upon the character of the securities he holds. If they are shares of capital stock, or junior bonds, he will probably do well to seek the services of his committee. Frequently, in the case of prior bonds, it is possible to say pretty definitely that they do not need "protection" - that it will not be possible to disturb them in any kind of reorganization. In any event, there is always plenty of time to decide what attitude is best to take. Experience has taught that the larger and more extensive the interests represented by a committee, the more influence it is able to exert on reorganization. Hence, all are usually liberal with extensions of time, in which to receive deposits of securities.

Meanwhile, the business of the bankrupt corporation is being carried on, almost as if nothing had happened, by the receivers, acting always on the authority of the court in which they were appointed. Their particular aim, of course, is to devise some plan for increasing economy and efficiency in operation. If they require new money for any purpose, they may, with the sanction of the court, sell receivers' certificates a type of security that usually takes precedence over all bonds and other forms of the corporation's indebtedness.

In due time, a scheme of reorganization is proposed. In this the stockholders are supposed to have but little voice. They

are the owners of the property, and in theory, at least, are expected to bear practically all the burden of providing whatever new capital is considered necessary to put the corporation on its feet. It does not always work that way, however. The stockholders have found many times in practice that they can, if they will, get off much easier. They may say to the bondholders, who are the creditors: "We are willing to furnish so much new money, and no more. If that is not satisfactory, you may take the property." And the bondholders are nearly always unwilling to take physical possession through foreclosure, because that would shift the burden of finding the new capital entirely to their shoulders. It seems cheaper to compromise. So, through their committees, they agree to make some contribution, as well as to accept a reduction of their claims, and the reorganization plan is forthwith declared effective.

The final step is taken by a reorganization committee, which offers new securities in exchange for the old. The total amount of the new is frequently greater than the total of the old, but the proportion carrying obligatory charges against the new corporation's earnings is usually much less. In this exchange transaction, a new element enters-the banking syndicate. Its principal functions are to assume the responsibility of making up whatever deficit there may be in the new capital contributions- or "assessments"; and to undertake the sale of whatever additional securities the plan may authorize.

It is important to point out that stockholders or bondholders, who are either unable, or do not see fit, to pay their assessments in reorganization, are ordinarily denied the right to participate. Therefore, they lose all chance to make up the losses resulting from the receivership, by sharing in the corporation's future prosperity. Apparently, they are absolutely helpless, and it is from this phase of American reorganization methods that grave injustices so frequently result. Perhaps we shall have in this country some time a system similar to that of the English Reconstruction Acts, which seem to provide justice for all at small expense.

BY

IN TEN years 56 medical colleges have gone out of existence, half as many as are left. This means a new era in American medicine, for the bad colleges have been killed off and the good ones maintained and improved.

When I was a boy of eighteen, just out of high school, I entered a medical college. It was what was known in our city as a "sundown" college — that is, its lectures and classes were held in the evening, so that students might earn a living during the day and study at night.

Except for the work in the dissecting room, instruction was wholly didactic. The professors - physicians in active practice each came to the lecture room for an hour, on two or three evenings a week, and read his lectures.

That was all no laboratory work, either chemical, biological, pathological, or bacteriological; no clinics - it only by accident that I saw a single case of disease or a surgical operation during my entire course and at the end of three years of this sort of "education" the student was given the degree of "M. D.," which was the only license required to practise medicine and surgery in our locality.

My medical alma mater long ago vanished. And with it, in the last half dozen years, have gone nearly fifty other medical colleges some of them better, many of them a good deal worse, equipped to train physicians. In 1904, the United States contained 166 medical schools - nearly half of the world's supply. In June, 1913, there were only 118 in this country, and by January 1, 1914, there will be only 110.

It did not even require a high-school education to enter a medical college when I was a boy. To-day sixty of the remain

ing medical schools require at least one year of preliminary college work of university grade in addition to a high-school, diploma and fifteen more will have this entrance requirement beginning in 1914 The "sundown" medical colleges have nearly all gone out of business and the diplomas issued by those that still remain are not recognized in most states. time professors and instructors largely replaced the busy physicians who once filled the chairs of nearly all the medical schools. Laboratory research and clinical observations and experience are now the rule, as these vital details of medical education were formerly the exception.

Fullhave

It takes four years of medical college work now, instead of three, to obtain the degree of M. D. and, when obtained, it carries no guaranty that its holder will be allowed to practise. Formerly, it was sufficient to have a school's diploma. Today, every state has its medical examining board-in a few states two or even three such boards and no one may practise medicine without passing an examination to the satisfaction of the board. True, there are four states of which, remarkably enough, Massachusetts is one - the others being Colorado, Oregon, and Tennessee

- in which one need not hold the degree of M. D. to be admitted to practice. But five years ago there were eight states in which this condition prevailed — and today in Colorado the state board sees to it that no non-graduates are licensed. And there are six states in which the boards now require a medical graduate to have had two preliminary years of college work, four more that require one year of college besides the medical course, and twentyfive in which the laws insist on at least a

high-school education before taking up the study of medicine.

These are only a few of the milestones that mark the recent progress in medical education in America - a progress which the United States Bureau of Education recently referred to as the most marvelous chapter in the history of educational standards. It is all of that. It is by all odds the most important fruit of the warfare against quackery, "patent medicines," and medical frauds generally that the American Medical Association is waging ceaselessly, with ever-increasing vigor and efficiency.

The quack flourishes to a large extent because there have been many, and still are a few, medical colleges which give degrees practically to any one willing to pay for them; because there are still a few state medical licensing boards which will accept any sort of a degree as evidence of the applicant's scientific status and professional skill.

"Patent medicines" are bought and consumed by the public in large measure because of lack of confidence in physicians — a lack arising from the incompetence and ignorance of a large proportion of practitioners who obtained their diplomas from colleges similar to or worse than the one from which I escaped only by the accident of not having the necessary $50 for a "graduation fee."

One of the most interesting volumes of recent years is "Nostrums and Quackery," published by the American Medical Association, in which the facts about many of the "cures" for consumption, cancer, liquor and drug habits, "female weakness," "diseases of men," obesity, skin diseases - everything in the list of real or fictitious ailments — are set forth. And behind every one of these, and behind the various "medical institutes" and similar frauds, are men holding medical degrees. The striking fact, however, is that hardly any of these medical fakers is a graduate of any of the honorable group of medical colleges that have long maintained the highest standards of education.

A good many agencies are coöperating with the American Medical Association in the effort to put at least the worst of

the quacks into jail or out of business. In the campaign of education, conducted by the Association under the general title of "The Propaganda for Reform," the active support and assistance of many periodicals besides the medical press and of writers who are not physicians have backed up the efforts made through the columns of the Association's own Journal. A larger proportion of the American people than ever before now realizes that any physician who advertises that he can cure any disease is a quack and a menace to society; that advertised drugs sold directly to the public are either useless or dangerous and nearly always fraudulent; that there are few, if any, specifics and no panaceas.

The Post Office Department, through fraud orders, has checked the activities of some of the worst of the "mail-order" medical swindlers; state authorities in some cases have been able to convict a few of the quacks—not of quackery, but of financial frauds and in many instances to obtain the revocation of the licenses of others to practise medicine. The Pure Food and Drugs Act of the Federal Government, and similar laws in several states, have forced most of the "patent medicine" dealers to publish their formulas - but, with the exception of a very few states and a very few drugs, there are no legal prohibitions against the sale of any sort of poison or nastiness, under the name of medicine, to any one who wishes to try experiments with his own life and health.

The campaign of publicity has resulted in greatly curtailing the activities of the worst offenders, both quacks and drug vendors. No journal that makes a pretense to self-respect to-day will publish the advertising of the most glaringly fraudulent of these medical fakes. The better class of publications refuse practically all medical advertising and the list of such publications is increasing almost daily. Yet, so long as the bunco-steerer's maxim holds true, that "there's a sucker born every minute," and some newspaper proprietors continue to conduct their publications on the late Mr. Barnum's theory that "the public likes to be humbugged, so long there will be a medium for quacks' and dope-vendors' advertising.

One of the early discoveries the Ameri

Medical Association made in its campaign was that the physicians themselves were not only being imposed on by manufacturers of proprietary remedies but in many instances were being cunningly used to introduce their patients to nostrums which the patients thereafter might be expected to buy without the formality and expense of consulting the physician. "To avoid substitution" a slogan that appeals to everyone "always prescribe an original sealed package," is the way in which more than one drug manufacturer has made thousands of physicians his agents. "On any patient not mentally unbalanced," comments the Council on Pharmacy and Chemistry of the Medical Association, "the result would be that the next dose he thought he needed would be purchased from the druggist direct." And if it seems absurd that any considerable number of physicians would prescribe proprietary remedies of which they do not know the composition

except as the manufacturer tells it to them ask any druggist to let you look over his prescription files.

It would take a chemist to recognize off-hand that "sodiotrilithis anhydrosulphate," with a formula “¿Li2O. NaO,SO,.,HO” doesn't mean anything at all

but it takes a pretty honest doctor to admit to the glib salesman for a drug house that he doesn't know what the latter is talking about when he describes a new "ethical" preparation in such language. And the average medical graduate of the old-fashioned schools may be excused if he doesn't recognize common sugar under the alias of "hyperoxidized carbo-hydrates" when offered under a proprietary name as a remedy for tuberculosis.

So long as its own members were prescribing frauds, however innocently, the Association could not consistently decry the frauds that were perpetrated directly on the public. So, in 1905, it established its Council on Pharmacy and Chemistry, with laboratories in which every sort of proprietary medicine is analyzed and tested. As a result of the publication of these analyses, a physician must be wilfully ignorant if he prescribes a compound of

which he does not know the exact composition and probable effect. And, hav ing thus "cleaned house" - a proces that must always be continuous to be effective and is so in this instance - the Association is bringing its heaviest batteries to bear on the quack doctors and the publicly offered nostrums and “cures while the Council on Medical Education is making gigantic strides in its effort a insure that the physicians of the futu shall without exception be men of the highest scientific training and profes sional standards.

For that purpose, the American Medical Association in 1904 voted to establish a permanent Council on Education. Dr Arthur D. Bevan, of Chicago, was made chairman, a position he still holds, and Dr. N. P. Colwell was chosen secretary, and has since given his entire time to the work į of the Council.

Very early in its existence the Council called a conference of representatives of medical colleges and state licensing boards. at which the "ideal requirement" of medical education and licensing was stated and agreed upon as including preliminary education equal to university entrance requirements; a year of college work devoted principally to physics, chemistry, and biology, and four years in a medical college, the last to bring students in actual contact with cases at the bedside: a diploma from a medical school in good standing to be required of all licentiates. the standing of the school to be determined by investigation; an examination before a state licensing board; the recognition by each state of licenses that have been granted by others.

Modest enough qualifications, it would appear to the ordinary observer. Yet, such were the conditions of medical education in America, it was almost revolutionary even to dream of enforcing these requirements. Johns Hopkins University, ever since the establishment of its medical department in 1893, had required two or more years of college work as a prerequisite to entrance; Harvard Medical School had had similar requirements since 1900, Western Reserve since 1901, and the Rush Medical College of the Univer

ty of Chicago since 1904. But there the t stopped. Not another one of the 166 edical colleges existing in the beginning 1905 required even one year of college ork as a preliminary to undertaking he study of medicine. Only a few of em even required that applicants be igh-school graduates. A considerable roportion of them accepted students ithout any real educational tests.

The loudest protests against the Counil's proposal came from physicians who eld financial interests in the "proprieary" medical colleges. A very large proortion of the 166 were of this character chools organized, owned, and operated by practising physicians for their personal profit and prestige. Some were "sunlown" colleges, some of them pretended to give continuous instruction - none of none of hese purveyors of commercialized "education" gave anything like adequate medical training. They were of all possible grades between poor and very bad. Some of them were sheltered under the wings of reputable universities, which lent their names, without adequate investigation and on the strength of the respectability of the physician-proprietors, to enterprises in many instances questionable and in almost every case inadequate. Others were baldly and frankly mere "diplomamills" that dealt out degrees with lavish hands degrees that many state boards accepted and issued licenses upon.

"You would deprive the poor boy of his opportunity to enter a profession," was the main argument put forth against the establishment of entrance requirements

that would necessarily put many of these colleges out of business, since they depended, for their students, upon the fact that it was easy to get into and through them. But Dr. Colwell's first tour of inspection of medical colleges clearly demonstrated that the average cost to the student in the proprietary colleges was from 25 to 100 per cent. more than the average cost in the best-equipped and most thorough institutions. Since then the plea for the "poor boy" has not been heard so often.

The Council had to have the facts about the medical schools of the country if it was to accomplish anything, and nobody had ever collected these facts. Therefore, most of Dr. Colwell's time for the first two years was devoted to the personal inspection of every medical college he could find listed in any state.

"I found medical colleges, issuing diplomas that entitled their holders to practise in many states, that had absolutely no equipment except a roll-top desk, a chair, and a card-index of 'prospects,' Dr. Colwell told me. A very large proportion had not a single instructor who gave his full time to the work; more had either inadequate laboratories or no laboratories at all; some possessed good laboratory equipment never used by the students. Some of the more pretentious medical schools had no clinical facilities worthy of the name. There were enough fairly good medical colleges to supply all the reasonable needs of the Nation for physicians, with proper support and increased facilities, but the average of efficiency was