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                         THE HOSPITAL BULLETIN

   Published Monthly in the Interest of the Medical Department of the
                         University of Maryland

                          PRICE $1.00 PER YEAR

   Contributions invited from the Alumni of the University. Business
                        Address, Baltimore, Md.

      Entered at the Baltimore Post office as Second Class Matter.

               VOL. V BALTIMORE, MD., MAY 15, 1909 NO. 3




                        THREE ESOPHAGEAL CASES.

                     BY RICHARD H. JOHNSTON. M. D.,

             _Lecturer on Laryngology in the University of
                 Maryland, Surgeon to the Presbyterian
                         Hospital, Baltimore._


The esophagoscope has passed the experimental stage in the diagnosis and
treatment of esophageal lesions. Its usefulness has been demonstrated so
often that it would seem superfluous to dilate upon its value. Its use,
however, is not as general as it should be. There are still those who
consider esophagoscopy unnecessary or impracticable. At the Presbyterian
Hospital we have had numerous instances of its practicability, and with
us it has become the routine practice to examine all patients
complaining of obscure esophageal symptoms. Dr. Chevalier Jackson
records the case of a patient whose only symptom was a lump on
swallowing. She appeared to be a neurasthenic, and his advice to have
the esophagus examined was ignored by the family physician. Two months
later, with the patient etherized for a radical antrum operation, he
passed the esophagoscope and found a malignant growth.

Three interesting cases have recently come under my observation, and
they illustrate so well the value of the esophagoscope I shall report
them somewhat in detail. The first patient was seen with Dr. E. B.
Freeman; she was 67 years old. The morning before she came to the
hospital, while eating ham, she swallowed a large piece that had not
been sufficiently masticated. It lodged in the introitus esophagi and
remained there. When she came to the hospital she had swallowed neither
solid nor liquid food for nearly thirty-six hours. A half hour before
examining the esophagus she was given a hypodermic of morphia and
atropia. With the patient in the sitting position the throat and upper
end of the esophagus were anesthetized with 10 per cent solution of
cocaine. Jackson's laryngeal speculum was introduced and the larynx
pulled forward. A large mass resembling somewhat an ulcerative
epithelioma was seen, and proved to be the piece of ham. Dr. Freeman and
I removed it piecemeal with Pfau's foreign body forceps. It required
about forty-five minutes to remove it entirely. The patient stood the
ordeal well, and was able to go home the same afternoon. For about a
week she had temperature, cough and expectoration, but ultimately made a
good recovery. In this case the esophagoscope probably saved the patient
an esophagotomy. The second patient was a female, thirty-three years
old, referred to me by Dr. J. F. Chisolm, of Savannah. While at an
oyster supper she attempted to swallow a large oyster, with the result
that she choked for a few seconds and then had a sense of fulness in the
region of the larynx. The next day she had some difficulty in
swallowing, so that she took only liquids. The second day afterward
swallowing was decidedly painful; she grew rapidly worse, until the
fourth day her condition was serious. She reached this city the morning
of the fifth day, with a temperature of 100 degrees and extreme
prostration. The examination of the esophagus was made under ether with
the head in the extended position. No foreign body was found, but the
upper end of the esophagus was red, swollen and edematous, and seemed to
be closed. The patient was given cold milk and ice bags to the throat.
For two days she suffered excruciating pain on swallowing, and it looked
as if we would have to resort to rectal feeding. The next day there was
slight amelioration of the pain, which gradually disappeared. In this
case the esophagoscope enabled us to see at once that a foreign body was
not present, and that the symptoms were due to a severe, acute
inflammation, probably caused by a piece of shell attached to the
oyster.

I was asked by Dr. A. M. Shipley to examine a patient who had been
referred to him for probable cancer of the stomach. The man was sixty
years old and had had some trouble in swallowing for about two months.
Attempts to pass the stomach tube were unsuccessful. The patient was
examined in the sitting position after cocaine anesthetization. No
difficulty was experienced in passing the esophagoscope. About three
inches below the cricoid cartilage the progress of the instrument was
arrested by a tumor partially closing the esophageal lumen. The
esophagoscope showed that the tumor was too low for removal. In this
case the patient can be dilated through the esophagoscope and made more
comfortable for the short time he has to live.

919 North Charles street.




                     SYPHILITIC OSTEO-PERIOSTITIS.

                          BY C. G. MOORE, '09.

                       _Senior Medical Student._


The bony manifestations of syphilis occur as secondary and tertiary
lesions, and as Keyes, of New York, has pointed out, these so-called
“nodes” are simply local periosteal congestions, accompanied by serious
effusions without cell hyperplesia. Any bone in the body may be affected
by syphilis, but certain of them suffer by preference, such as the thin
bones of the nose and pharynx—that is, those exposed to climatic changes
and injuries, such as the bones of the skull, ulna, tibia, etc.

We must call special attention to injury as a powerful pre-disposing
cause of bone syphilis, for, when we consider that bone lesions may be
the only manifestations of existing syphilis, with the presence of a
bone lesion before us, with an antecedent history of an injury, we must
not forget that we may overlook the true nature of the disease, and
hence must be constantly on the alert for the syphilitic taint.

Lancereaux classified the bone lesions under three heads, viz.:

(a) Inflammatory osteo-periostitis.

(b) Gummy tumor of bone.

(c) Dry caries, atrophic form.

(1) Inflammatory osteo-periostitis is the most frequent form, and is
characterized by inflammatory phenomena, vascularization and exudation
of a serio-glutinous material. It may be either diffuse or
circumscribed, and located, as its name implies, in the area of contact
with the osseous and periosteal surfaces. The pain is aching, acute,
throbbing or boring in character, while tenderness upon pressure and
percussion is most exquisitely excruciating. The diagnosis of
inflammatory osteo-periostitis is comparatively easy, if we remember the
characteristics, viz., an oval, painful, boggy or even hard bony lesion,
accompanied by nocturnal exacerbations of pain, with a concomitant or
antecedent history of syphilis. Ostitis with parenchymatous thickening
is somewhat less positive in its character, but with nocturnal pains
which are usually constant.

(2) Gummy tumor of bone develops either under the periostum, in the
substance of bone, or in the medullary canal. It is simply an
intensification of the process found in the inflammatory form just
described, the difference being that the cell hyperplasia is more
abundant. Much of the new material collects in a circumscribed space,
and being more rapidly formed and less capable of organization, it
entails more profound lesions by its retrograde metamorphosis. Generally
tumor of the bone is, therefore, a much more serious form of disease
than osteo-periostitis.

In the long bones the medullary canal is the usual seat of deposit. The
bone becomes hypertrophied in a porous manner, the Haversian canals and
canaliculi become enlarged and filled with a gummy material which
resembles a solution of gum arabic. In the flat bones, especially the
cranial bones, the cancellar tissue is attacked, and may cause a
separation of the two tables, and often necrosis of one or the other
plates results. If it happens to be the inner one which undergoes
carious degeneration, brain symptoms will develop.

(3) Dry Caries.—According to Virchow, dry caries is always due to
syphilis. This affection is a miniature gummy ostitis. Around one of the
vascular canals the gummy material is deposited, this gummy material
being later absorbed, leaving a stellate induration. This goes on
leaving a funnel-shaped depression, its point leading into the diploe,
which may be plainly appreciated by palpation. The essential features of
this caries is the fact that no sequestra are formed, no pus extruded,
nor is the skin but rarely involved.

The following is a case of syphilis in which osteo-periostitis
developed:

On January 22nd, 1909, R. B., age 35, white, a housewife, applied to the
Medical Department of the University Hospital Dispensary for treatment,
complaining of rheumatism in her back and a sore shin. The patient has
been married 14 years and has had four children; the two eldest are the
only ones now living. Three years ago she gave birth to a full-term
child which only lived a few minutes after expulsion.

One year later she gave birth to another child, which was not at full
term, but about six months advanced. She says two days previous to this
birth she fell down stairs and struck on her abdomen. When the child was
born its thigh was fractured, and the physician who attended her said
the fracture was caused by the fall.

Her father died nine years ago, at the age of 68 years, of apoplexy; her
mother was killed a few years ago in an accident. She has two brothers
and three sisters, all living and in good health, as far as she knows.
She is at present living with her husband, and says he is apparently
well and sound, but drinks heavily, and when under the influence of
liquor abuses her a great deal. Patient denies ever having had
tuberculosis, syphilis, diphtheria, typhoid, scarlet fever, malaria,
grippe, gonorrhoea, or any of the nervous or malignant diseases. She
sometimes has a sore throat when she takes cold, but it only lasts a few
days. She has complained of rheumatism in her back and limbs for the
past three or four years, and thinks it is worse at night.

Patient never complained of any trouble other than those mentioned until
three years ago, when her third child was born. She says that at that
time her hair fell out, and an eruption, which itched slightly, broke
out all over her body, including her face, but only extended down her
arms as far as her wrists. This lasted a few weeks, then seemed to
subside, but never entirely disappeared, and when she gave birth to the
still-born child, one year later, it broke out again worse than before.
She went to Dr. McElfresh, who treated her for about three weeks, giving
her some medicine to take internally, also some sulphur ointment. She
for a time got some better, but owing to her circumstances was unable to
continue treatment with Dr. McElfresh, and has done nothing for her
condition until the present time. For the past four months she has been
suffering with a pain in her right shin; this has been gradually getting
worse, and one week ago began to swell and cause her considerable pain,
being worse at night, and sometimes hurting her so much that she is
unable to sleep, hence her reason for coming to the dispensary.

Upon questioning her in regard to her general health, she says she feels
as well as she ever did, with the exception of the previously mentioned
pain.

Her appetite and digestion are good, and her bowels are regular, and she
has no lung, heart or kidney trouble. She has had no headaches, nausea,
or vomiting, and her menstrual periods have always been regular and
painless.

Upon examining patient I found her to be well nourished and well
developed, weighing 142 pounds. Her color was good and her pupils about
normal in size, reacting to light and accommodation. Both patella
reflexes were absent, also Romberg's sign, and there was no enlargement
of the mastoid, epitrochlear, post-cervical or inguinal glands. Her
pulse was 84 to the minute, regular in rate and force. The tension and
volume was good; her temperature was 98.6°. Her heart was normal in
size, and on auscultation the sounds were clear and no murmurs were
heard. The expansion of both lungs was good, the respirations being 20
to the minute.

Percussion and auscultation were negative; all the abdominal organs
seemed to be normal. There was an ecchymotic area under her left eye,
which she says was caused by her husband striking her two years ago when
intoxicated.

There was a circular reddish macular papular, non-itching eruption which
does not disappear on pressure, varying from the size of a bird shot to
that of a nickel, and is confined to her back, chest, shoulders and
arms, most profuse on the left side, and is not seen on the lower limbs
at all. On her left shoulder some of these lesions have developed into
pustules, which have become infected and slightly ulcerated; these give
her slight pain.

In the corner of her mouth is a scar which looks like the initial sign
of lues, but she claims it appeared a few weeks after the breaking out
on her body. On examining her mouth no mucus patches or scars were
found.

She now has an osteo-periostitis on the anterior aspect of her right
tibia. It is moderately swollen, slightly reddened, and is very painful
(the pain is aching, acute and boring in character) on pressure, and on
tapping the bone with my finger above and below this point it caused her
intense pain. (Patient claims she has never received any injury in this
location.)

Upon consulting Dr. McElfresh, he remembered the case and said that he
had treated her for a short time about two years ago for the initial
symptoms of syphilis, but since then has never seen her.

She is now receiving the mixed treatment of protiodid of mercury, gr. ¼,
with a saturated solution of potassium iodid three times a day, starting
her on ten drops, then increasing it one drop each time taken. I
requested her to return when the medicine is finished.




  DISCUSSION BY DR. WARNER HOLT, OF WASHINGTON, OF THE PAPER ON THE
    CHEMICAL CO-RELATION BETWEEN THE SALIVARY GLANDS AND THE STOMACH,
    BY JOHN C. HEMMETER, OF BALTIMORE.

  _Read Before the Society for Experimental Biology and Medicine, of
    New York, Meeting in the Rockefeller Institute for Medical
    Research, on December 16, 1908._


Dr. Holt said in part: “This experimental study by Dr. Hemmeter is not,
as it might appear to be, only an inquiry into the physiology of a
limited part of the digestive apparatus, but it is an attempt to solve a
biologic problem and to get at the broad basic principles that underlie
the chemical co-relation of the organs.

“When a worker occupies himself with the effect of the extirpation of
one organ of digestion upon the organs in the next segment of the
digestive apparatus, he naturally thinks of phenomena of exclusion or
loss of function in one or the other of the segments following the one
extirpated, but instead of phenomena of exclusion it is conceivable that
those of exaggerated activity in the other segments of the digestive
tube might result.

“For '_a priori_' we cannot know whether the influence that one segment
of the digestive tract exerts upon the succeeding segment is that of
stimulation or of inhibition, or of both, viz., of stimulation under one
set of conditions and inhibition under another set of conditions. In the
investigation of the problem of a chemical co-relation between the
salivary glands and the stomach, Dr. Hemmeter has done meritorious work,
a great part of which it has been my good fortune to observe and assist
in personally; though I am a physician in the employment of the
government at Washington, I consider myself a post-graduate student of
Professor Hemmeter. I have seen personally four of his animals that had
successfully been nursed through the Pawlow operation and extirpation of
the salivary glands after months of the most trying work. It required a
great deal of perseverance to persist in this kind of work, especially
when some of the best animals that had emerged safely from the
vicissitudes of the operation for an accessory stomach and from the
removal of all the salivary glands on one side of the head succumbed to
the third operation in the attempt to remove the remaining salivary
glands on the other side.

“The history of these operative failures, though they will never be
told, constitute a large part of the merit of those who have worked with
Dr. Hemmeter in this research. No matter what the final outcome of the
future investigation of this problem will be, whether affirmative or
negative, the intrinsic value of such work will be appreciated by all
who are to the least degree conversant with the history of physiology.
Nowadays we are too liable to forget the hard plodders in experimental
work who have started the solution of a problem, and when the last word
has been said the worker of the beginning is generally forgotten.

“In this connection I desire to quote an expression of Prof. William H.
Welch concerning the merit of the work of ex-Surgeon General Sternberg,
done since the first Yellow Fever Commission was appointed, in 1879 (see
Medical News. June 21, 1902. p. 1198). Dr. Welch said 'that Sternberg's
work with yellow fever would stand forever; that it was a common thing
in these busy days to forget the steps which led up to an important
discovery. All that Dr. Sternberg had done in the study of yellow fever
was necessary work, and it had to be done just in the way that he did
it. The ground had first to be cleared. If it were not so, the discovery
had not been possible; and later discoverers themselves would have had
to hunt out the large host of microorganisms which Dr. Sternberg had
described and laid aside.'

“And similarly I can say of Dr. Hemmeter's efforts that, no matter what
the eventual outcome of this problem will be, all that he has done was
necessary work, and it had to be done just in the way that he did it.

“Just one more idea and I shall have finished. It concerns the
demonstration of such research work in places at a distance from the
experimentor's laboratory. Such demonstrations are always attended with
great difficulty. They usually require four animals, two or three
janitors to transport them, and as many laboratory assistants as the
director of the laboratory can manage to take with him. The technique of
these operations, the high-grade sensitiveness of operated animals, the
refinement with which chemical tests should be made, all require for
their safe conduct that the experimentor should work only with those men
who are used to his system. The animals themselves are always influenced
in one way or other by the presence of strangers. I remember in one
animal which was demonstrated on March 17th, at the University Hospital,
the demonstration at which Dr. Satterthwaite was present, a most
unexpected change in the quality of the gastric secretions took place.
This was a control animal which had undergone no operation whatever. He
was simply taken along to show the proteolytic power of a normal dog and
compare it with the operated dogs. His gastric juice had been previously
tested on several occasions, and always found to be of regular standard,
but on the night of the demonstration before the Medical Society this
animal's gastric juice was practically inactive, containing no HCL nor
pepsin.

“Dr. Hemmeter has already informed you that in some animals the loss of
gastric juice after extirpation of the salivary glands is only
temporary, and that in varying time—in some cases three weeks, in other
animals three to four months—there is a gradual resumption of gastric
secretion. This resumed secretion, however, never becomes as effective
as it was in the same dog before an operation. The question when to
begin to make observations on an operated animal depends entirely upon
the state of this animal; if the dog eats his food with appetite, he has
no fever, and his digestion appears to be satisfactory; then the
observations may be begun, even if it is only one week or ten days after
the last operation. One of the most valuable animals that was used in
this series of experiments was so injured in the effort to transport him
to another laboratory that he could not be used for further
experimentation. The dog struggled so in his holder while he was being
transported in a wagon that the partition of true mucosa which separates
the accessory from the plain stomach was broken through. This had
happened once before in transporting a dog from the laboratory to Dr.
Hemmeter's country place, and his associates in the Medical Faculty,
becoming aware of the great labor and cost involved in such operations,
and the rarity with which they succeed, advised that no further Pawlow
dogs be sent to other laboratories.”




                 AN INTERESTING CASE OF SCROTAL HERNIA.

                         BY G. E. BENNETT, '09.

                       _Senior Medical Student._


_Patient_—George Kolubaher.

_Age_—Sixty-six years.

_Occupation_—At present a farmer; formerly worked as laborer in stone
quarry.

_Complaint_—Patient entered the hospital on January 21, 1909,
complaining of great pain and discomfort in the right inguinal region
and in the scrotum of the same side.

_Physical Examination_—Inspection showed an enormously enlarged scrotum,
more marked on the right side, and a prominent swelling along the right
inguinal canal, which was most marked when standing. Marked
discoloration on the skin of the scrotum and inner side of both thighs,
probably due to use of counter-irritants.

_Palpation_—Mass soft and freely movable, showing no skin attachments;
slight impulse on coughing. Slightly painful on pressure. Some gurgling
when manipulated.

_Percussion_—Slightly tympanitic.

_Remarks_—Contents of the sacs were forced into abdominal cavity after
prolonged manipulation, returning to original condition as soon as
pressure was taken away.

History of patient shows nothing of interest except that of the present
condition, which began suddenly twenty years ago. While lifting a heavy
block of stone had a feeling as though something had “given away” in his
right side. This sensation was immediately followed by one of intense
pain and general discomfort. The day following the patient noticed a
small lump in the right inguinal region that disappeared on pressure,
returning when he lifted any heavy object.

For eighteen years the condition gave him no serious discomfort except
for the wearing of a truss and becoming larger. Two years ago the truss
was discarded as being useless.

One week ago conditions grew suddenly worse, and patient was confined to
bed. Has suffered a great deal of pain and has been unable to sleep.

On January 22, 1909, patient was operated upon by Professor Winslow.
Operation as follows:

Patient was brought to the operating room at 11.30 A. M., anesthetized
and prepared for an aseptic operation.

Incision about five inches in length was made parallel to Poupart's
ligament and immediately over the inguinal canal, passing through the
skin and subcutaneous fat. The external ring having been exposed a
grooved director was passed into same, passing under the aponeurosis of
the external oblique muscle; fibers of same were split, using the
director as a protective guide. The sac was exposed and carefully
dissected free from its surrounding tissues, and upon examination was
found to be continuous with the covering of the testacle (giving the
appearance of a congenital hernia). The sac was next opened and found to
contain small intestines and a Meckel's diverticulum. Following this the
intestines were replaced in the abdominal cavity. Digital examination
through the internal ring showed the bladder to be adherent to the
peritoneum at the margin and toward the median line. The sac was tied
close to the internal ring, cut free. The distal portions of the sac
were drawn upward, bringing the testacle into view; sac was cut close to
same and sutured so as to enclose the greater part of it.

The margins of the internal oblique and transversalis muscles were
sutured to Poupart's ligament by a mattress suture. The aponeurosis of
the external oblique was re-established into normal position by
suturing, and the skin closed by subcutaneous silver wire suture silk
having been used for all other sutures.

Sterile dressings were then applied and cardboard splints to keep limb
immobile. Then bandaged with crenolin. The patient left the operating
room at 1 P. M. in good condition.

_Notes of Interest_—

That a hernia, apparently congenital, should not have made an earlier
appearance.

The presence of a Meckel's diverticulum in the sac, this being the
condition that gives rise to a true Richter's hernia.

That a hernia of so large proportion should have caused so little
trouble to the patient.

Patient recovered in very short time, leaving the hospital in good
condition.




                    THE TEACHING OF THE SPECIALTIES.

                         BY HIRAM WOODS, M. D.

            _Read Before the University of Maryland Medical
                     Association, April 21, 1909._


Teaching specialties to undergraduates must be carefully separated from
the same teaching to post-graduate students. The latter may be supposed
to have given such thought to their future career as to have reached the
conclusion that they wish to devote themselves to a certain line of
work. It is not these men whom I propose to discuss, save to say, in
passing, that the average six weeks' or two months' course offered by
post-graduate schools is totally inadequate. As a rule such courses
attract a large number of men who do little more than follow the
clinical work of some well-known specialist and pick up what they can.
Either prolonged hospital experience, as interne or clinical assistant,
or a special _individual course_, with a competent teacher, is needed
for a decent foundation in special work.

It seems to me that with undergraduate work the first important step is
to secure the attention of the men, and convince them that there is
something in the special course worthy of notice. There is a state of
mind, not unnatural to the undergraduate, regarding specialties. Most of
them propose to begin professional life as general practitioners. They
think they will never have use for knowledge in the so-called
specialties, and that the little they will need in order to get a
passing mark can be easily crammed at the close of the session. As a
matter of fact, it is easy to frame questions so that this “crammed”
information is of little use, and the most liberal grading hardly ever
brings such men _up_ to a passing mark. The mental attitude of these men
is unjust to themselves, their teacher and the patients who, in the near
future, will entrust to them their physical welfare. The very term
“general practitioner” implies a general knowledge of medicine. If one
lives in a city, where the services of specialists are readily obtained,
he may, if he desires, refuse certain cases, and take only such as he
wants—say such as belong to internal medicine. But in so doing he
becomes a specialist himself, and if he has neglected a properly
prepared special course for undergraduates while a student he will miss
information of great use to him as an internist. Many men, however, do
not practice where specialists _are_ easily obtained, and, perforce,
_must_ take cases which would logically come under one or other of the
recognized specialties. Here is a professional responsibility which it
is the aim and duty of a special teacher to enable his student to meet.
May I illustrate by directing attention to two troubles which it is my
own privilege to explain to our students? Iritis, in eye, and acute
otitis media, in ear diseases, are very common troubles. Both are, as a
rule, readily diagnosed, and both offer good prognosis. Yet the
responsibility for eyesight in one, and may be life in the other, may
depend on the diagnostic ability and therapeutic resources of the man
who _first_ sees the case. Men are blind and children dead because a
general practitioner has not known enough of what was offered him when a
student to make a correct diagnosis. The red eye has been called
conjunctivitis and treated with nitrate of silver, in spite of the
absence of purulency, while the small, inactive pupil has escaped
notice. The ear pain has been called “earache” without an aural
examination, a hops bag and opium have been ordered, and the doctor has
gone home with that false sense of security which is so dangerous. Why?
If his teacher has known his business, it is not because he was not told
how to look for iritis and acute inflammation of the drum, but because
he had not given the subjects sufficient thought to get them drilled
into his thinking apparatus. Probably he could tell the diagnostic
points of iritis, if asked, or the signs of ear-drum inflammation; but
this was “crammed” information, not part of his real knowledge.

If it is the duty of the student, anticipating general practice, to
think about the specialties taught during his undergraduate course, it
is still more the duty of his teacher to present him only such things as
the general man needs. He will make a grievous blunder if he tries to
make specialists of his men. His selection of subjects should be limited
to the diseases which are of common occurrence, and stress should be
laid on _diagnosis_. If one knows, first, what to look for, and secondly
how to recognize signs and symptoms, he will generally find proper
treatment. Troubles which would lead the patient to go to the specialist
_primarily_, without consulting his family physician, should receive
little attention.

Two other classes of lesions in such organs as are usually handed over
to specialists should receive attention in the undergraduate
course—those which are apt to cause remote or reflex disturbances, and
those which are definitely symptomatic of central lesions. The first
should, in my judgment, be dwelt upon only to such an extent as to
enable the student to know causative relation and method of diagnosis.
Treatment, unless very simple and easily within the reach of the medical
man—i. e., the general practitioner—should be given little time. As to
the second class, every neurologist knows that Tabes Dorsalis would
often be diagnosed early, and proper treatment instituted, if the
physician had known the meaning of association of gastric crises with
Argyll-Robertson pupil, and had seen enough of these things to have them
in his every-day thoughts. One could present many other illustrations,
but this shows what is meant. With the student convinced of the
necessity of thinking about the specialty taught, the instructor careful
in selection of his subjects, a duty rests on those who fix the
curriculum.

It is unfair to students to use four years for work which can be done in
three. I believe that the object of the establishment of a four-year
course was to furnish a year in which students, freed from the
responsibility of examinations, might have time for guidance in clinical
observation. The ideal plan, in my judgment, is to get rid of didactic
lectures and examinations by the end of the third year, and to devote
the fourth to clinical observation. Genito-urinary work, gynaecology,
rhinology, neurology, ophthalmology, otology, cannot be learned from
text-books or lectures, at least in such a way as to become integral
parts of a man's daily thinking. And to my mind this is the only special
information which will help the general practitioner in his daily work.
A few hours spent in a large clinic brings more instruction than a whole
year of lectures. The personal contact of man to man, the exchange of
thoughts and impressions, are what sink in. A student is not to be
blamed if he fails to attend these opportunities when he knows that in a
few weeks he must face the ordeal of examinations on the didactic work,
and that the result of these will determine his graduation. To put into
a few words my idea of teaching specialties—it is the duty of the
student to realize that nothing is put into the undergraduate course
which is not important to _him_; it is the duty of the teacher to select
only what _is_ important to the general practitioner; it is the duty of
the school authorities to so arrange the curriculum as to give students
enough time to observe special practice personally, in small sections,
so that what is taught may be so impressed by observation as to become a
real factor in their medical thought.




                     A CASE OF SPORADIC CRETINISM.

                       BY E. SANBORN SMITH, M. D.

                      _Class of 1900, Macon, Mo._


Karl B. is the son of sturdy parents, both of whom were born and reared
in the Swiss Tyrol. He had never developed like the other children—was,
in fact, much smaller at five and a half years than the
fourteen-months-old baby. He was dull, placid, taking no note of his
surroundings, sitting or lying just where he was left, and never evinced
any disposition to play or converse with the other children. I saw this
child on the 4th day of January, 1908, in a purely accidental manner.
The parents had been told by their attendant that the child had either
rickets or was an idiot, and they in consequence had kept the child in
the background for two or three years, being very much chagrined and
mortified at the prospect of bearing through life the burden of hopeless
idiocy. The child had such classical symptoms of cretinism that I asked
permission of the family to treat him for awhile, though it required
some persuasion, because of the fact that they felt it was time and
money wasted. On the 5th day of January, 1908, the child was five years
and a half old, twenty-eight inches in height, circumference of chest
twenty-one, abdomen twenty-three. He was given one and one-half grains
of thyroid extract twice daily, the dose being gradually increased until
he showed signs of irritability, with accelerated pulse. The child's
extremities soon warmed up, the circulation became better, the hair
began to grow, the child for the first time in its life walked and
talked, began to take note of surroundings and to play with the other
children.

Just one year after the beginning of the treatment—January 5, 1909—the
child was thirty-five and three-quarter inches in height, chest
twenty-three, abdomen twenty-three.

This disease, sometimes known as cretinoid or myxoedematous idiocy, was
first described by Fagg in 1871. Since then a number of cases have been
published, both in England, on the Continent and in America, showing
that the disease is not confined to any one country. While the disease
is comparatively rare, cretins are more common than was formerly
supposed. The disease seems to be in reality a pachydermatous cachexia,
and it is now, I believe, well established that it is caused by
congenital absence of the thyroid gland or to the presence of something
which abolishes its functions. Little is known as to the causes of its
destruction or abolishment of function. As a rule only one case occurs
in a family, the other members presenting nothing abnormal in their
mental or physical development, hence the term sporadic. It has been
more frequently reported in the Tyrol, in Switzerland, a coincidence
which makes this child's case all the more interesting, in that both its
parents are physically and mentally well up to par and the other
children possess even more than the average intelligence.

_Symptoms_—The symptoms are practically identical with those of the
myxoedema which follows the removal of the thyroid gland in adults. The
symptoms of cretinism in most cases in infants make their appearance
during the first year, occasionally, however, not until the child is
three or four years of age. The appearance of the cretin is very
striking, and so characteristic that when once seen the disease can
hardly fail to be recognized. The child is much dwarfed, the fingers and
toes are short and stumpy, the cutaneous tissues seem to be thick and
boggy, but do not pit on pressure, as in ordinary oedema. The facies is
extremely characteristic. The head seems large for the body, the
fontanel is open until the eighth or tenth year, the forehead is low and
the base of the nose broad, so that the eyes seem unusually wide apart.
The lips are thick, the mouth half open and the tongue protrudes
slightly, the cheeks are baggy and the hair is coarse, short and
straight, and the skin has the peculiar leathery feel of elephant skin.
The abdomen is pendulous, large, streaked with prominent veins, and
reminds one of rickets. The skin is dry, the voice husky and rough.
There is but one word which describes the peculiar clumsy manner of
walking—that word is waddle. The child actually waddles like a duck. The
temperature is always subnormal, and one of the things the mother will
always call to your attention is the fact that the child has such cold
hands and feet and requires so much more cover than the other children.
Cretins are dull, placid and good natured, never quarrelsome.

_Treatment_—There is no tendency toward spontaneous improvement. These
cases have until the last few years been considered hopeless and
condemned to a life of idiocy. Really, in the treatment of cretinism in
the adult marvelous results have been got from the administration of the
dried and dessicated extract of the thyroid gland of the sheep. This has
led to its use in the myxoedema of infancy. The results are astounding.
The child grows mentally and physically, takes note of surroundings to
which it formerly paid no attention whatever, and can be taught almost
as well as a perfectly normal child. In all cases the thyroid extract
must be kept up indefinitely, the dose being gradually increased,
otherwise the improvement ceases at once.




                                 ITEMS.


At the commencement of the University Hospital School for Nurses, held
May 5th, the following nurses received their diplomas. The address to
the graduates was delivered by Dr. A. M. Shipley:

Miss Elizabeth Getzendanner was the president of the class, and Miss
Lucy B. Squires was the secretary.

Those who received diplomas were:

               Miss Catherine Mabel Dukes, Maryland.

               Miss Anna May Green, North Carolina.

               Miss Laura Schley Chapline, West Virginia.

               Miss Louise Dorsey Pue, Maryland.

               Miss Grace Schoolfield Tull, Maryland.

               Miss Annie Lou Wahm, South Carolina.

               Miss Eva Sidney Chapline, West Virginia.

               Miss Beulah Ophelia Hall, Georgia.

               Miss Elizabeth Getzendanner, Maryland.

               Miss Emily Lavinia Ely, Maryland.

               Miss Lucy Bright Squires, North Carolina.

               Miss Gertrude Hedwig Tews, Germany.

               Miss Helen Mary Robey, Maryland.

               Miss Blanche Almond, Virginia.

               Miss Lillie Booker Carter, Virginia.

               Miss Mary Barton Saulsbury, Maryland.

               Miss Vera Wright, Maryland.

                  *       *       *       *       *

The alumni of the University will be pained to learn of the recent
illness of Prof. S. C. Chew. THE BULLETIN is glad to report that he is
now convalescing. No member of the Faculty is more esteemed and beloved
than is Professor Chew.

                  *       *       *       *       *

Dr. Leonard O. Sloane, of Juneau, Alaska, who has been visiting
Baltimore for several weeks, has left the city. He came to this city to
avail himself of the opportunities for clinical instruction offered by
this University, and was much pleased with the work he was able to see
at the University Hospital, the Woman's Hospital, the Hebrew Hospital
and at Bay View. He is physician to St. Ann's Hospital, at Juneau, and
is a progressive and able member of our profession.

                  *       *       *       *       *

In the recent examinations held for commissions in the medical corps of
the United States Army, Dr. J. S. Fox, one of the surgeons at the St.
Francis Xavier Hospital, was a successful contestant, and the War
Department has notified him that he will be commissioned a first
lieutenant and will be ordered to proceed to a post in the West. One
hundred doctors took the examination for the appointments, but only
thirteen were successful. Dr. Fox, who will be one of the youngest
surgeons in the Army, was high up in the list of the fortunate ones.

Dr. Fox is a son of the late Dr. T. S. Fox, of Batesburg, who was a
distinguished surgeon in the Confederate Army. He is a nephew of Mr. J.
T. Fox, of that town. Dr. Fox is twenty-nine years of age, and was born
in Batesburg, S. C. After completing the high school at that place he
entered Richmond College, Richmond, Va., and was there for three years,
when he entered the Medical College at Baltimore. Fourteen months ago he
came to Charleston to accept an appointment as one of the house surgeons
of the St. Francis Xavier Infirmary, and during his stay in this city
has made a fine record for himself, and now has many friends here.

As soon as his commission arrives he will leave here for Fort Sam
Houston, Texas, the station designated in the orders of the War
Department. There are at present several troops of the Third Cavalry and
a battalion of light artillery from the Third Field Artillery Regiment
stationed at this important post, which is considered to be one of the
most agreeable army posts in the South. On October 1, Dr. Fox will be
ordered to report to Washington, where he will be detailed to attend the
Army Medical College for a period of eight months.

                  *       *       *       *       *

The Council on Pharmacy and Chemistry and the Board of Trustees of the
American Medical Association have adopted a vote of thanks to Daniel
Base, Ph. D., professor of analytical chemistry, Department of Medicine,
University of Maryland, for his co-operation and assistance in
investigating products and for special research work done at the request
of the Council.

It has been definitely decided that the new operating room which is to
be built at St. Joseph's Hospital is to be dedicated to the memory of
Dr. Isaac Ridgeway Trimble, who died of septicemia after performing an
operation upon an infected kidney at the hospital, as a result of which
the patient lived. A tablet bearing Dr. Trimble's name and the incidents
surrounding his martyr-like death will be placed in the operating room.

                  *       *       *       *       *

Dr. John R. Winslow read a paper on “A Case of Tuberculosis of the
Fauces and Lingual Tonsils, Caused by Tuberculin Injections,” before the
Section on Laryngology and Rhinology, Friday, March 26, 1909. At the
same meeting Dr. J. N. Reik read a paper on “The Present Status of the
Surgical Treatment of Purulent Disease of the Nasal and of the Aural
Cellular Spaces: a Comparison.”

                  *       *       *       *       *

Dr. and Mrs. A. Duvall Atkinson, who have been spending a few days in
Washington, have returned to their home, 924 North Charles street.

                  *       *       *       *       *

Under the title of leading men of Maryland, “The Star” has this to say
concerning Dr. Louis McLane Tiffany:

Dr. Louis McLane Tiffany is not only one of the best-known men in
Maryland, but enjoys a reputation that is international as an operating
surgeon. He has performed successfully many unusual and difficult
operations, and has contributed much to his profession by original
research. He was born in Baltimore, October 10, 1844, and is related to
the well-known McLane family of Maryland and Delaware. He received his
bachelor of arts degree from Cambridge University, England, in 1866, and
upon his return to Baltimore entered the University of Maryland as a
medical student, his degree as doctor of medicine being conferred upon
him in 1868. He soon attained prominence in his chosen work. For many
years he has been professor of the principles and practice of surgery at
the University of Maryland. He has been operating surgeon of many of the
Baltimore hospitals, has performed operations on prominent persons all
over the country, and is the author of a number of treatises on
particular phases of surgery. Dr. Tiffany helped to found the Maryland
Clinical Society, is a member of the Medical and Chirurgical Faculty of
Maryland and an active or honorary member of many other societies.

                  *       *       *       *       *

Recently there was unveiled at St. Timothy's Church, at Catonsville,
Md., a beautiful memorial window designed and executed in Favrile glass
to the memory of Dr. Charles G. W. Macgill, who was president of the
First National Bank of Catonsville and a physician widely known in that
part of Baltimore county. This memorial, the subject of which is St.
Luke, is in three panels, the figure of the evangelist being in the
center opening, while a splendid landscape is carried out in the two
side panels. On a scroll carried by St. Luke is the text: “For to one is
given by the Spirit the gifts of healing.” 1 Cor., xii: 8-9. At the base
of the window is the dedicatory inscription: “In Loving Memory of
Charles G. W. Macgill. Born May 10th, 1833. Died April 28th, 1907.”

                  *       *       *       *       *

At the coming meeting of the American Medical Association Dr. Henry D.
Fry, of Washington, will read a paper on “An Ovarian Abscess Containing
a Lunbricoid Worm Within the Cavity;” H. D. Hynson, Phar. D., “The
National Formulary: Its Genesis, Character and Exigent Utility.”

                  *       *       *       *       *

Dr. W. L. Hart, class of 1906, first lieutenant, United States Army, has
been ordered to accompany Company G, Engineers, to San Francisco, Cal.,
and then to return to Washington Barracks, D. C.

                  *       *       *       *       *

The following physicians have consented to act as admitting physicians,
Maryland State Sanatorium: Dr. Gordon Wilson, Baltimore; Dr. Charles H.
Conley, Adamstown; Dr. Guy Steele, Cambridge; Dr. Paul Jones, Snow Hill;
Dr. Henry Fitzhugh, Westminster. Drs. Guy Steele and C. H. Conley are
members of the Board of Managers.

Dr. A. M. Shipley, class of 1902, has been elected consulting surgeon to
the Sydenham Infectious Hospital, and Dr. H. O. Reik, of 506 Cathedral
street, consulting otologists.

                  *       *       *       *       *

Dr. H. E. Palmer, of Tallahassee, has been elected president of the
Florida State Medical Association for the ensuing year.

                  *       *       *       *       *

The marriage of Miss Elizabeth P. Elliott, daughter of Mrs. Warren G.
Elliott, to Dr. Gordon Wilson, associate professor of medicine in the
University of Maryland, will take place on Saturday, June 5, 1909. The
ceremony will be performed at 6 o'clock at Old St. Paul's Protestant
Episcopal Church, Charles and Saratoga streets, by the rector, Rev.
Arthur B. Kinsolving. Owing to mourning in the bride's family, the
marriage will be a quiet affair.

                  *       *       *       *       *

Another wedding of interest to take place in June is that of Miss Lila
Holmes Trenholm, daughter of Mr. Glover Holmes Trenholm, a graduate of
the Training School for Nurses of the University Hospital, and
granddaughter of the late Prof. Julian Chisholm, to Dr. Walton A.
Hopkins, class of 1903, of Annapolis, Md.

                  *       *       *       *       *

At the annual meeting of the Cecil County Medical Society, held in
Elkton, Md., April 29, 1909, Dr. C. P. Carrico, of Cherry Hill, was
elected president for the ensuing year.

                  *       *       *       *       *

Dr. George H. Steuart, class of 1898, is located at Ottoman, Va.

                  *       *       *       *       *

Prof. Samuel C. Chew, the nestor of the Medical Faculty of the
University of Maryland, is confined to the University Hospital with a
bad attack of grip. Dr. Chew is one of the oldest and most beloved of
the medical fraternity of Baltimore. He has been connected with the
University of Maryland for more than fifty years, graduating with the
class of 1858. All of us wish Dr. Chew a rapid restoration to his former
good health.

Forty professional men were present May 1, 1909, at the Colonial Hotel,
where the fourth annual reunion and banquet of the Pennsylvania Branch
of the General Alumni Association of the University of Maryland was
held. Dr. Eugene F. Cordell was one of the guests; others were Dr.
Charles P. Noble, president of the Pennsylvania Branch, and Dr. J. C.
Beale, secretary and treasurer, both of Philadelphia.

The banquet was held in the new assembly room, which was tastefully
decorated with plants, flowers and the colors of the University. The
banquet committee consisted of Drs. Z. C. Myers and S. K. Pfaltzgraff,
of York; J. S. Classen and J. C. Beale, of Philadelphia.

                  *       *       *       *       *

It is reported that Dr. John Cox Keaton, class of 1907, of Georgia, has
been shot in the abdomen by an irate husband.

                  *       *       *       *       *

At the annual meeting of the Cecil County Medical Society, held at
Elkton, Dr. St. Clair Spruill spoke on “Surgical Conditions of the Right
Side of the Abdomen.”

                  *       *       *       *       *

The New York Medical Journal says concerning the April 13th meeting of
the Philadelphia Pediatric Society: “The paper of the evening was read
by Dr. Compton Riely, of Baltimore, on 'The Early Diagnosis and
Treatment of Pott's Disease.'”

                  *       *       *       *       *

The following of our alumni are upon the staff of the Hospital for the
Women of Maryland, John street and Lafayette avenue, Baltimore: Dr.
Charles H. Riley, Dr. J. Mason Hundley, Dr. Archibald C. Harrison, Dr.
Robert T. Wilson, Dr. Samuel T. Earle and Dr. George W. Dobbin. Dr. G.
W. Billups, class of 1906, is resident physician.

                  *       *       *       *       *

Mr. and Mrs. William T. Schultze, of 822 Newington avenue, Baltimore,
have announced the engagement of their daughter, Dr. Anna D. Schultze, a
graduate of the Woman's Medical College and resident physician of the
Good Samaritan Hospital, to Dr. John R. Abercrombie, dean of the Woman's
Medical College, a graduate of the University of Maryland of the class
of 1895, and at present instructor in diseases of the skin, University
of Maryland. No date has been fixed for the wedding.

                  *       *       *       *       *

At the coming meeting of the American Medical Association Dr. I. S.
Stone, of Washington, will read a paper on “Some Minor Gynecologic
Matters Which Are Often Overlooked.”

                  *       *       *       *       *

Dr. Charles H. Medders, of Baltimore, who sued the Western Maryland
Railroad for $5,000 for services rendered in a collision four years ago,
was rendered a verdict for $150.

                  *       *       *       *       *

At the annual meeting of the Montgomery County Medical Association, held
in Rockville, April 20, 1909, the following of our alumni were elected
to office for the ensuing year: Vice president, Dr. Wm. L. Lewis, of
Kensington; secretary-treasurer, Dr. John L. Lewis, of Bethesda.

                  *       *       *       *       *

The Baltimore City Medical Society has elected our alumni to the
following offices for the ensuing year: President, Dr. Jacob Hartman;
board of censors, Dr. Randolph Winslow.

                  *       *       *       *       *

Dr. G. Lane Taneyhill, of Baltimore, is a member of the House of
Delegates of the American Medical Association from Maryland at the
present meeting of the American Medical Association, at Atlantic City.

                  *       *       *       *       *

Dr. A. E. Ewens, of Atlantic City, was a member of the Committee on
Section Meetings at the recent meeting of the American Medical
Association. Dr. Daniel Jenifer also had the honor and pleasure of
serving upon this committee. Dr. Jenifer was also a member of the
Committee on Post-office and Telephone. Dr. A. E. Ewens also served on
the Committee on Badges.

                  *       *       *       *       *

Dr. Thomas A. R. Keech, class of 1856, and Mrs. Keech, of Washington, D.
C., celebrated at their home, 416 B street, northeast, on April 13,
1909, the fiftieth anniversary of their marriage. The house was
beautifully decorated with cut and potted plants. A collation was
served. The family are of English descent, having emigrated and settled
in Southern Maryland about 1750. Dr. Keech is a son of the late Rev.
John Reeder and Susan P. Keech.

                  *       *       *       *       *

Dr. John Herbert Bates, class of 1907, of Forest Park, Baltimore, a
former resident physician of Bay View Hospital, and until recently a
resident physician at the Church Home and Infirmary, has located at 4002
Main avenue, Forest Park.

                  *       *       *       *       *

The third annual banquet of the General Alumni Association of the
University of Maryland was held Thursday, April 22, 1909, at the Eutaw
House, Baltimore. About 90 were present. The affair was a thoroughly
enjoyable occasion, but more enthusiasm would have been evident if more
of the members of the various faculties had been present. The
Pharmaceutical Department, with less professors than the other
departments, had most members present. The speeches were witty and
instructive, and teemed with expressions of loyalty to the University.
As oft iterated and reiterated, this body is the only real live alumni
body at the University of Maryland. It has been doing since its
inception, and is still doing, and if the University ever be rejuvenated
much of the credit will be due to the constant agitation of this body
for a larger and better university. Most alumni banquets consist of a
feed, good, better or worse, as it might happen to be, and a slew of
speech artists of more or less renown, who bubble over with big words of
encouragement and prediction, but rest on their oars here. Indeed, the
societies exist for a banquet once a year and a cyclone of hot air. What
do words accomplish? Nothing. It is action that the University of
Maryland needs, and more than anything else men of action—strong men,
broad-minded men, men who can subordinate their success to the success
of the institution, men in every sense of the word. I am glad to say the
General Alumni Association has an abundance of men of such character
among its membership who are doing something for the good of the Old
University, and who have an object in view. What is this object? The
creating of ways and means for the betterment of the University.

At the business meeting immediately preceding the banquet the following
recommendation of the special committee appointed for the purpose of
formulating a plan for the participation of the alumni in the management
of the University was adopted unanimously.

The plan provides that the Board of Regents of the University shall be
enlarged by the addition of five members, one each from the five
departments, who shall have had their degrees for 10 years or more. It
provides for the election of a committee on nominations, to consist of
the president of the association and one representative from each of the
five departments. This committee shall select three representatives from
each of the five departments as nominees for the alumni in good standing
in the association to vote upon. Votes may be cast in person or by mail.
After the election of the five members of the council they shall
determine by lot who are to serve for one, two, three, four or five
years, respectively.

Any vacancy is to be filled by the remaining members of the Alumni
Council from the department from which the member was originally chosen.
The secretary of the General Alumni Association shall act as the
secretary of the alumni regents, who shall select their own chairman for
one-year terms.

The committee consisted of the following well-known alumni of the five
departments of the University:

Medical—Dr. B. Merrill Hopkinson and Dr. E. F. Cordell.

Pharmacy—Dr. John F. Hancock and Dr. J. Emory Bond.

Dental—Dr. L. H. Farinholt and Dr. Joseph C. Heuisler.

Law—Messrs. B. Howard Haman and Jas. W. Bowers, Jr.

Academic (St. John's College)—Dr. J. Frederick Adams and Dr. A. L.
Wilkinson.

No further action, however, can be taken in the matter until approved or
vetoed by the Board of Regents.

The president, John B. Thomas, Phar. D., introduced the toastmaster,
Henry P. Hynson, Phar. D., who was in a particularly bright and witty
mood. The speakers were: Hon. J. Barry Mahool, the Mayor of Baltimore;
John C. Hemmeter, M. D.; Addison Mullikin, Esq., LL. B.; Charles
Caspari, Phar. D.; Joshua W. Hering, M. D., Comptroller of the State of
Maryland and a graduate of the class of 1855, of Westminster, Md.

Those who were not present do not know what they missed. It was a live
banquet, something doing every minute, and the committee in charge of
the arrangements are to be congratulated upon the thoroughness with
which they accomplished their task.

Committee—T. O. Heatwole, chairman; Oregon Milton Dennis, LL. B.; Eugene
Hodson, Phar. G.; Arthur M. Shipley, M. D.

Among those present were: William Tarun, Dr. J. W. Bird, J. Huff, Dr.
Compton Reilly, J. Cromwell, Dr. Randolph Winslow, Dr. R. B. Hayes, C.
V. Mace, L. M. Allen, Dr. R. H. P. Bay, Dr. I. J. Spear, H. H. Richards,
Dr. J. F. Hawkins, Dr. W. V. S. Levy, T. Marshall West, S. W. Moore, I.
H. Davis, Dr. C. V. Matthews, F. J. Valentine, E. B. Howell, A. P.
Scarborough, G. F. Dean, G. A. Bunting, John C. Uhler, C. S. Grindall,
Dr. J. C. Hemmeter, Dr. A. M. Shipley, John Henry Keene, Dr. Robert L.
Mitchell, Judge H. Stockbridge, N. H. D. Cox, Dr. J. H. Holland, Dr.
Charles Caspari, Jr., H. P. Hynson, F. V. Rhodes, J. E. Hengst, O. C.
Harris, A. S. Binswanger, Dr. St. Clair Spruill, Dr. E. F. Cordell, Dr.
Nathan Winslow, Dr. J. M. Hundley, Daniel Base, Dr. Charles E. Sadtler,
Addison Mullikin, H. W. Jones, Dr. G. Lane Taneyhill, Dr. L. B. Henkel,
Jr., Dr. I. G. Dickson, F. J. S. Gorgas, Dr. T. O. Heatwole, J. W.
Bowers, Jr., Dr. J. W. Hering, Alfred E. Kemp, Oscar B. Thomas, J. B.
Thomas, Eugene W. Hodson, John F. Hancock, W. M. Fouch, D. R. Millard,
Emory Bond, C. A. Volkmar, Frank Black, H. P. Hynson, J. W. Westcott,
Dr. C. H. Medders, B. Elliott, Dr. Eugene Cordell, Leroy Oldham, A. R.
Dohme, B. A. Lillich, Oregon Milton Dennis, L. W. Farinholt, T. E.
Latimer, Ambrose Murphy, Dr. Henry Kennard, Dr. Herbert Zepp.

The “Clinic,” the year book of the College of Physicians and Surgeons,
Baltimore, which has just been issued, is dedicated to the memory of the
late Dr. Isaac Ridgeway Trimble, who gave his life that another's might
be saved. Dr. Trimble was a graduate of the University of Maryland,
class of 1884, and at the time of his death was Professor of Anatomy in
the College of Physicians and Surgeons.

                  *       *       *       *       *

Dr. A. J. Edwards, class of 1898, of Bristol, Tenn., is spending a few
days around the Hospital renewing old acquaintances.

                  *       *       *       *       *

Dr. Luther Bare, of Westminster, Md., was a recent visitor to the
University Hospital.

                  *       *       *       *       *

The banquet of the Medical Alumni Association will be held on the
evening of May 31, 1909.

                  *       *       *       *       *

Dr. and Mrs. B. Merrill Hopkinson, who have been spending the week at
the Hotel Chamberlin, Old Point Comfort, Va., have returned to the city.

                  *       *       *       *       *

The University of Maryland baseball team defeated the Midshipmen on the
Naval Academy grounds recently by the score of 2 to 0. Anderson, the box
artist, struck out twenty of the middies. The team this year has been
more than successful, and compares favorably with the teams of the
larger colleges. It is undoubtedly the premier team of Baltimore this
year, and in any other institution would arouse untold enthusiasm by its
notable victories.

                  *       *       *       *       *

Dr. Fitz Randolph Winslow, class of 1906, of Hinton, Va., paid a flying
visit to the Hospital recently.

                  *       *       *       *       *

Dr. J. W. Hering, class of 1855, of Westminster and State Comptroller,
who has been visiting his son and daughter-in-law, Dr. and Mrs. Joseph
T. Hering, at the St. Paul, Baltimore, has returned to his home, in
Westminster.

                  *       *       *       *       *

Amongst those who responded to toasts at the recent banquet of the local
branch of the Haverford College Alumni Association was Dr. Henry M.
Thomas.

                  *       *       *       *       *

Dr. Fitz Randolph Winslow writes from Hinton, Va., in the Valley of the
Shenandoah, the garden spot of Virginia, and for picturesque scenery
unexcelled in no part of the world, that he is doing nicely. He has seen
three goitres and heard of a wonderful cure for the same from an old
mountain woman. She took her own medicine, and claims to have been
benefited, so he gives the recipe: Put your hands behind your back, bend
over and take a horse's head between your teeth. Unfortunately, he
forgot to find out the statuo quo of the horse, so you might try the
dead or the quick, as suits your convenience. Her goitre is still very
apparent, but, sad to relate, she has no teeth left with which to finish
the job. This is only one specimen of the gross ignorance and
superstition of the hill people. They treat or mistreat themselves often
when ill principally by making teas of various herbs, such as boneset,
etc. Skunk oil is a panacea both internally and externally. He expects
no respectable disease can live in the same neighborhood with such an
odoriferous medicament.

                  *       *       *       *       *

Dr. John Chaplain Travers, class of 1895, of Cambridge, who recently
left for the Philippines, where he will enter the government service,
gave a farewell entertainment before leaving at the residence of Capt.
James C. Leonard.

                  *       *       *       *       *

Dr. J. Clement Clark, superintendent of the Springfield State Hospital,
presided at the third meeting of the Maryland Psychiatric Society, which
was held at the Sykesville institution. Among those present were: Drs.
J. C. Clarke, Marshall L. Price, Wm. F. Wohwartz, R. R. Norris, F. J.
Flannery.

                  *       *       *       *       *

It gives us pleasure to announce that Dr. Charles H. Mayo, of Rochester,
Minn., one of the renowned Mayo brothers, has accepted the invitation of
the Faculty of Physic to deliver a course of lectures on diseases on the
thyroid gland in the fall.

                  *       *       *       *       *

Dr. Lee Cohen, of Baltimore, will read a paper at the coming meeting of
the American Medical Association on “Post Operative Tonsillar Bleeding:
Its Surgical Control, with Mention of Cases;” Dr. R. L. Randolph, of
Baltimore, on “Rodent Ulcer of the Cornea;” Dr. Samuel Theobald, of
Baltimore, on “Reflex Aural Neurosis Caused by Eye Strain, with Report
of Cases.”

                  *       *       *       *       *

One of the marked developments of the Democratic State Central Committee
was a practically unanimous sentiment in favor of the renomination of
Dr. Joshua W. Hering, class of 1855, for State Comptroller. State and
county leaders were outspoken in their opinion that Dr. Hering's
popularity throughout the state, as well as his excellent record as
Comptroller, make his nomination virtually a matter of course.

                  *       *       *       *       *

The condition of Dr. R. A. Warren, of Hot Springs, Va., class of 1907,
who was operated on recently at the University Hospital for
appendicitis, is reported to be favorable.

                  *       *       *       *       *

Dr. Randolph Winslow desires to acknowledge cards from Drs. M. Zaki and
M. Teufik, 166 Mohamed Aly street, Cairo, Egypt. These are two of our
popular Egyptian students, and are located as noted above, where they
have met with unexpected success. Drs. Heilig, Moose, Kerr and
Pearlstine, four of our recent Southern alumni, paid their respects to
the University recently. The three former are located in North Carolina,
the latter in South Carolina.

                  *       *       *       *       *

The last regular meeting of the University of Maryland Medical
Association was held in the amphitheatre of the University Hospital,
Wednesday, April 21, 1909, and the program was as follows: 1.
“Preliminary Training Necessary for Those Contemplating the Study of
Medicine,” Dr. Randolph Winslow; 2. “The Teaching of Therapeutics,” Dr.
C. W. Mitchell; “The Teaching of the Specialties,” Dr. Hiram Woods.

The meeting was well attended and the papers were both instructive and
interesting. Dr. A. M. Shipley, the president, occupied the chair. This
is the last meeting of the society until the fall. Dr. Woods' paper
appears elsewhere in this number.

                  *       *       *       *       *

Dr. Richard H. Johnston, of Baltimore, will read a paper on “Benign
Tumors of the Turbinate Bodies Clinically and Pathologically
Considered,” at the coming meeting of the American Medical Association.

                  *       *       *       *       *

The Council on Medical Education of the American Medical Association in
its annual report has this to say concerning college mergers:

Another encouraging fact to be noted is the mergers being made among
medical schools whereby stronger schools are resulting. Notably in
Indiana, all of the regular schools in the state merged into the medical
department of Indiana University, while in Kentucky all of the medical
schools merged into the University of Louisville. In Cincinnati the two
regular schools merged into the University of Cincinnati; in Minnesota
Hamline merged into the medical department of the University of
Minnesota.

There are numerous other cities where mergers might be brought about if
those interested in general education and those in medical education in
each city would work together to secure them. For example, if all the
medical colleges of any large city, such as Chicago, Philadelphia, St.
Louis or others, could be merged into one great university medical
school, such as are to be found in Berlin, Paris or Vienna, it would be
of the greatest possible advantage to medical education in America.

In the evolution of general and medical education in this country it is
becoming more and more evident that a well-rounded university needs a
strong medical department, and it is now equally clear that a medical
school cannot reach the highest stage of its development except as the
medical department of a strong university. It is evident that within a
few years the medical schools of this country will, with few exceptions,
be the medical departments of universities. Fortunately for the medical
school, the university needs the medical school quite as much as the
medical school needs the university, so that almost any independent
medical school of real merit can secure desirable union with a
university. And this change will solve most of our present problems in
medical education.

Since our last conference there have been five important mergers of
medical colleges by which nine medical schools are replaced by four
stronger ones. These mergers were as follows:

1. At Louisville, Ky., the Louisville and Hospital Medical College, the
Kentucky School of Medicine and the University of Louisville Medical
Department united, retaining the name of the University of Louisville
Medical Department. This leaves but one regular medical college in
Louisville, where there were five colleges two years ago. As a direct
result of this merger, the school has received $25,000 from the city of
Louisville, and steps have been taken to build a new city hospital,
which is to be largely under the control of the medical school.

2. At Cincinnati the merger between the Medical College of Ohio and the
Miami Medical College has been completed, the new school to be the
Medical Department of the University of Cincinnati. The building of an
enormous new city hospital has already been started near the university
campus, and a new medical college building will be erected adjoining
this hospital. The outlook for this new school is very encouraging.

3. The Keokuk Medical College, College of Physicians and Surgeons,
located at Keokuk, Iowa, has turned all its property and good will over
to the Drake University, College of Medicine, at Des Moines, Iowa.

Amalgamation of the Cooper Medical College with Leland Stanford
University is announced. Henceforth the San Francisco institution will
be designated the School of Medicine of Stanford University. The
affiliation was given approval sometime ago, and it only remained for
the board of trustees of the University to formally accept the gift.

Why can't the independent medical colleges of Baltimore come together?
Such an event would accrue to the best interests of all concerned, and
would greatly tend to eliminate Baltimore as one of the dark spots upon
the medical educational horizon.




                          NURSES WIN DIPLOMAS.


In spotless white and amid a bower of flowers, 16 pretty young women
were handed their diplomas yesterday as graduates of the University
Hospital School for Nurses by the Dean, Prof. R. Dorsey Coale. There
were 17 nurses to graduate this year, but one of them, Miss Catherine M.
Dukes, is seriously ill and could not attend.

After the conferring of degrees Dr. Arthur M. Shipley gave the young
nurses advice as to their future. The opening prayer was delivered by
Rev. Edwin B. Niver, rector of Christ Protestant Episcopal Church, and
benediction was pronounced by Rev. Dr. Hemsley, of Oakland, Md.

The hall of the University was crowded with friends and relatives of the
graduates. It was decorated with carnations and potted palms, and around
the pillars was twined black and red bunting, the University colors. The
nurses, preceded by Professor Coale and Dr. Shipley, entered the hall in
pairs, carrying bouquets of Marguerites.

Dr. Shipley said that much of the nurses' training had been under his
supervision, and he felt a personal interest in them. Women, he said,
invariably scared him, but someone informed the physician that was not
always so, for Dr. Shipley is to become a benedict today.

“You have chosen a work that is second to none in the world,” said Dr.
Shipley. “You have before you possibilities that are almost limitless.
You are on the threshold of a life that is to be of your own making, for
the chief danger of the individual nurse is drifting. It is so easy to
forget the old-time standards and call them old-fashioned. Old-fashioned
they may be, but they have stood the test of generations of correct
living and thinking.”

At night the graduates were given a farewell reception and dance by the
undergraduates.




            Dispensary Report, April, 1908, to April, 1909.
                                   OF
                          UNIVERSITY HOSPITAL


                   Department.   New Cases. Old Cases.
                 Surgical             1,703      4,448
                 Medical              1,709      3,199
                 Genito Urinary         765      2,933
                 Nervous                399      1,971
                 Women                  733      1,279
                 Stomach                421      1,108
                 Throat and Nose        622      1,039
                 Children               761        997
                 Eye and Ear            712        903
                 Skin                   473        907
                 Tuberculosis           190        703
                 Orthopedic              31        120
                                     ——————     ——————
                                      8,519     19,609

                 Total new cases      8,519
                 Total old cases     19,609
                                     ——————
                 Grand total         28,128

                                               JOHN HOUFF, M. D.,
                                                   Dispensary Physician.




              DISPENSARY PHYSICIANS AND CHIEFS OF CLINIC.


=Medical Department=—Dr. J. M. Craighill, Chief of Clinic; Drs. W. H.
Smith, G. C. Lockard, J. F. O'Mara, R. C. Metzel, H. J Maldeis, A. B.
Hayes, H. D. McCarty, E. S. Perkins, J. F. Adams, H. L. Sinsky, Clarke,
Todd.

=Surgical Department=—Dr. John G. Jay, Chief of Clinic; Drs. M. T.
Cromwell, T. A. Tompkins, Jr., J. F. Adams, J. H. Smith, R. B. Hayes.

=Stomach Department=—Dr. R. A. Warner, Chief of Clinic; Dr. W. W.
Eichenberger.

=Nervous Department=—Dr. J. F. Hawkins, Chief; Drs. G. M. Settle, F. J.
Wilkins, N. M. Owensby.

=Throat and Nose Department=—Dr. H. C. Davis, Chief of Clinic: Dr. L. J.
Goldbach.

=Eye and Ear Department=—Dr. E. E. Gibbons, Chief of Clinic; Dr. Wm.
Tarun.

=Women Department=—Dr. Wm. K. White, Chief of Clinic; Drs. H. W. Brent,
E. S. Perkins, R. L. Mitchell.

=Genito Urinary Department=—Dr. Wm. D. Scott, Jr., Chief.

=Skin Department=—Dr. J. R. Abercrombie, Chief.

=Children's Department=—Dr. A. B. Lennan, Chief; Dr. H. Schoenrich.

=Tuberculosis Department=—Dr. Gordon Wilson, Chief.

=Orthopedic Department=—Dr. Compton Riely, Chief; Dr. S. Demarco.

                                               JOHN HOUFF, M. D.,
                                                   Dispensary Physician.




                               MARRIAGES.


Dr. Wm. B. Warthen, class of 1905, of Bartow, Ga., an ex-resident
gynecologist in the University Hospital, and one of the most popular
members of his class, a hale fellow and one of the most loyal alumni of
the University of Maryland, was married at Macon, Ga., April 15, 1909,
to Mrs. Sallie Bell Newsom, of Davisboro, Ga. The Bulletin and friends
of Dr. Warthen extend to him their best wishes for a long, successful
and happy marriage.

                  *       *       *       *       *

Mrs. Lavinia E. Thomas has issued cards announcing the marriage of her
daughter. Miss Alice Saunders Thomas, to Dr. Edward Barney Smith, class
of 1907, on April 21st, 1909, at Creeds, Virginia. Dr. and Mrs. Smith
will be at home after May 1, 1909, at Woodleigh, N. C.

                  *       *       *       *       *

The marriage of Miss Helen Ashby, daughter of Prof. Thomas A. Ashby and
Mrs. Ashby, to Mr. Harry T. Giddings, of Baltimore, took place April 28,
1909, at the residence of her parents, 1125 Madison avenue, Baltimore.

                  *       *       *       *       *

Miss Edna Wright, only daughter of Mr. K. J. Wright, a prominent
merchant of Hurlock, Md., and Dr. G. Roger Myers, a well-known physician
of Hurlock, were married Wednesday afternoon, April 28, 1909, at the
home of the groom's parents. Rev. L. F. M. Myers, of Philadelphia, a
brother of the groom, officiated at the ceremony. After a honeymoon
spent at Atlantic City and other Northern points of interest, the couple
will make their home at Hurlock.

                  *       *       *       *       *

Miss Julia C. Cherbonnier, of Baltimore, and Dr. Eugene F. Raphel, class
of 1906, of Wheeling, were married at St. Ann's Catholic Church March
12, 1909, by Rev. C. F. Thomas, assisted by Rev. Wm. M. Clements. The
bride was given in marriage by her father, Capt. A. V. Cherbonnier. Her
maid of honor was Miss Jeannette Raphel, sister of the groom. The groom
was attended by his brother, Alexis A. Raphel. Among the ushers were Dr.
J. Holmes Smith, Jr. Dr. and Mrs. Raphel will make their home at
Wheeling, W. Va.

                  *       *       *       *       *

Dr. Arthur Marriott Shipley, class of 1902, for a number of years
assistant resident surgeon, and later superintendent of the University
Hospital, now associate professor of surgery, University of Maryland,
was married May 6, 1908, at Eutaw Place Baptist Church, at 8.30 P. M.,
to Miss Julia Armistead Joynes, daughter of Mr. Tully Armistead Joynes,
of Baltimore.




                                DEATHS.


Dr. Hugh A. Maughlin, class of 1864, of Baltimore, died Saturday, April
17, 1909, at his home, 121 North Broadway, Baltimore. Dr. Maughlin was a
prominent member of the Grand Army of the Republic. Rev. J. Wynne Jones,
pastor of Abbott Memorial Church, Highlandtown, who is the chaplain of
Wilson Post, of which Dr. Maughlin was a member, conducted the funeral
services. Burial was in Greenmount Cemetery.

                  *       *       *       *       *

Dr. Newton Clark Stevens, class of 1875, a member of the Louisiana State
Medical Society, died at his home, in Ama, January 28, 1909, aged 62.

                  *       *       *       *       *

Dr. Howard E. Mitchell, class of 1882, of Ellerslie, Md., died at the
Western Maryland Hospital, Cumberland, Md., April 6, 1909, 48 hours
after having been struck by a train, aged fifty-four.

                  *       *       *       *       *

Recently at Cavite, Philippine Islands, Mrs. Mary Gibbs Morris, wife of
Dr. Lewis Morris, class of 1890, surgeon United States Navy, was
gathered unto her father. Her husband was born in Baltimore, and is the
son of the late Capt. C. Manigault Morris, commander of the Florida,
Confederate States Navy.

                  *       *       *       *       *

Dr. William Hungerford Burr, class of 1884, a member of the American
Medical Association, for four years surgeon in charge of the Santa Fe
System Hospital and surgeon to the Clark Coal Company, Gallup, New
Mexico, died in the Santa Fe Hospital, Albuquerque, New Mexico, April
13, 1909, from pneumonia, aged forty-nine.

                  *       *       *       *       *

Dr. Edgar T. Duke, one of the most prominent physicians of Allegany
county, died April 3 at his home, on Bedford street, Cumberland, the
result of an attack of pneumonia. He was 43 years old, a son of Major
and Mrs. J. E. Duke, and was a native of Charlestown, W. Va., coming to
Cumberland with his parents when a young man. He studied pharmacy with
the late Dr. John F. Zacharias, and later read medicine under the late
Dr. G. Ellis Porter at Lonaconing, graduating at the University of
Maryland in the class of 1891.

Dr. Duke was in love with his profession, and was for a number of years
secretary of the Allegany County Medical Association. He was prominent
before the association for his special papers, and was also prominent on
the church lecture platform. Hardly a church in Cumberland but that has
had Dr. Duke's services.

He was a member of Chosen Friends' Lodge, No. 34, Independent Order of
Odd Fellows, of which body he was secretary for some years, and also a
past presiding officer, and was connected with other fraternal
organizations.

Dr. Duke was also a member of the American Medical Association, the
Medical and Chirurgical Faculty of Maryland and the Tristate Medical
Association. He assisted in organizing the Western Maryland Hospital
Training School for Nurses and was one of the lecturers. He was an elder
and the Sunday school superintendent in the Presbyterian Church.

He was noted for his kindness. He was also active in the Young Men's
Christian Association and was chairman of the boys' work committee. His
father is a prominent Confederate veteran. His funeral took place
Thursday afternoon, April 15, from the First Presbyterian Church. At the
present time Dr. Duke's aged mother is very ill.

Dr. Duke leaves a widow, formerly Miss Gardner; his parents, one
brother, Mr. Harry K. Duke, and one sister, Mrs. Mary Campbell, all of
Cumberland.

                  *       *       *       *       *

Dr. Edward Pontney Irons, an alumnus of the University of Maryland, and
one of the oldest physicians in the city, died Sunday, April 4, 1909, at
the home of his sister, Mrs. William P. Lowry, 1023 Harlem avenue. He
was 84 years old.

He was born in this city, a son of Dr. James and Rebecca Irons, who were
of English and French-Irish ancestry, and descendants of the earlier
settlers of the state. He entered business and was variously employed in
a number of the Southern States. In 1863 he returned to this city and
entered the University of Maryland.

After graduation in 1865, when the Civil War was nearing its end, he
acted as assistant surgeon in the Officers' Hospital at Annapolis. A
year later he went to Alabama, but remained only a short time. He
returned and opened a practice here, which he maintained.

He retired from active work about seven years ago. At that time he was
subordinate medical examiner for the Royal Arcanum, of which he was a
member. He was also a member of the Masons, the Baltimore Medical
Society and the Medical and Chirurgical Faculty of Maryland.

In 1857 he married Miss Anna Rebecca Sewell, a daughter of Thomas H.
Sewell, a Baltimore manufacturer. A daughter, Mrs. James W. Ramsey, is
the only survivor.

                  *       *       *       *       *

Dr. Benjamin Franklin Laughlin, class of 1904, died at his home, at Deer
Park, Md., aged 31 years. He first located at Blaine, W. Va., where he
practiced. He was taken ill at Kingwood, W. Va., some months ago, and
was later sent to a Baltimore hospital, but he showed no signs of
improvement. He was a son of Dr. and Mrs. J. W. Laughlin, Deer Park, and
a brother of Hice Laughlin, a prominent Baltimore and Ohio official,
Grafton, W. Va.

Dr. George C. Farnandas, class of 1852, of Baltimore, died Sunday, April
4, 1909, at his home, 1721 Maryland avenue, Baltimore, of old age. The
funeral took place from his late home, 1721 Maryland avenue. Dr.
Farnandas was 80 years old. Before the Civil War he had a large
practice, but gave it up so that he might travel. He was well known to
the older generation of Baltimoreans. The services were conducted by
Rev. J. H. Eccleston, rector of Emmanuel Church.

The honorary pallbearers were Dr. N. K. Keirle, Dr. James M. Craighill,
Dr. Samuel T. Earle, Mr. Thomas H. Robinson and Mr. Wm. P. Trimble, of
Harford county. Burial was in Greenmount Cemetery.

                  *       *       *       *       *

Mrs. Virginia Blackwell Carder, aged 38 years, wife of Dr. George M.
Carder, class of 1891, of Cumberland, Md., died March 17, 1909, after a
struggle of two weeks against the ravages of a mastoid abscess.

Mrs. Carder was preparing to visit her sister, Mrs. Gay Breton Leroux,
in Douglas, Ga.

Suddenly she was stricken, and when an operation became necessary Mrs.
Carder insisted that her husband, a surgeon who has kept constant vigil
the last two weeks, perform the operation. The operation was apparently
very successful, and Mrs. Carder was improving, when complications in
the form of typhoid fever set in. Prof. C. W. Mitchell, of Baltimore,
and Drs. J. T. Walker and Harry Hyland Kerr, of Washington, were called
by Dr. Carder, and all said everything possible was being done for her,
but held out no hope.

                  *       *       *       *       *

Mrs. Carder was the daughter of Thomas Callan, of Narrows Park, and,
besides her husband, leaves a little son (Robert Callan Carder), two
brothers (George S. Callan, of Duffields, W. Va., and Charles T. Callan,
of Little Orleans, Md.), and one sister (Mrs. Leroux). Miss Mary L.
Callan, a sister, was accidentally drowned in the Potomac at Little
Orleans.




=In Pneumonia= the inspired air should be rich in oxygen and
comparatively cool, while the surface of the body, especially the
thorax, should be kept warm, lest, becoming chilled, the action of the
phagocytes in their battle with the pneumococci be inhibited.

                           _Antiphlogistine_

                      (_Inflammation's Antidote_)

applied to the chest wall, front, sides and back, hot and thick,
stimulates the action of the phagocytes and often turns the scale in
favor of recovery.

=Croup.=—Instead of depending on an emetic for quick action in croup,
the physician will do well to apply Antiphlogistine hot and thick from
ear to ear and down over the interclavicular space. The results of such
treatment are usually prompt and gratifying.

   Antiphlogistine hot and thick is also indicated in Bronchitis and
                                Pleurisy

               The Denver Chemical Mfg. Co.      New York




Certain as it is that a single acting cause can bring about any one of
the several anomalies of menstruation, just so certain is it that a
single remedial agent—if properly administered—can effect the relief of
any one of those anomalies.

¶ The singular efficacy of Ergoapiol (Smith) in the various menstrual
irregularities is manifestly due to its prompt and direct analgesic,
antispasmodic and tonic action upon the entire female reproductive
system.

¶ Ergoapiol (Smith) is of special, indeed extraordinary, value in _such_
menstrual irregularities as _amenorrhea_, _dysmenorrhea_, _menorrhagia_
and _metrorrhagia_.

¶ The creators of the preparation, the Martin H. Smith Company, of New
York, will send samples and exhaustive literature, post paid, to any
member of the medical profession.




                          TRANSCRIBER'S NOTES


 1. Silently corrected typographical errors.
 2. Retained anachronistic and non-standard spellings as printed.
 3. Enclosed italics font in _underscores_.
 4. Enclosed bold font in =equals=.