NEWS NOTES

The Buffalo gnat is the latest "cause" of pellagra.

be carriers of other intestinal parasites. Many adults are also affected.

While the sale of patent medicine is decreasing in this country, it is said to be

It is said that since the beginning of the present year the total number of deaths from cholera in Italy has passed the 30,000

mark.

Life in the isles of the sea has its drawbacks. Treating a native of Guam for cerebral syphilis, Kerr (U. S. Navy) found in his stools the eggs of hookworm, whipworm, and ascaris. Some wormy, eh?

The State Board of Health of Illinois is making another effort to compel physicians to report births and deaths. The law provides a payment of a fee of 25 cents for each report made by physicians, coroners and midwives.

We learn from an eastern newspaper that Mrs. Elizabeth Hillman of Wilkes-Barre, Pennsylvania, who was 99 years old last. March, was operated on for appendicitis two weeks before, and had completely recovered. If this intense competition among surgeons continues even the cemeteries will not be safe.

In a bulletin of the Department of Agriculture, Smith contributes further facts showing the striking resemblances between crown-gall of trees and human sarcoma. The specific bacterium, bacillus tumefaciens, was found in the tumor cells, and these in strands of tumor-tissue extending to the secondary growths. With cultures of this, the disease was reproduced.

Dr. Olin West of the Tennessee State Board of Health states that a careful survey of White and Warren Counties in that state shows that more than 50 percent of the children between the ages of six and fifteen are suffering from hookworm disease, while large numbers of them are found to

the sale of American patent medicines abroad has increased 300 percent, and the trade in nostrums, which was always large in England, has penetrated to Europe and extended into Asia and Africa, the value of exports going beyond $7,000,000.

Up in northern Wisconsin there is a wellknown quack, "Dr." Till, whose principal stock in trade is a "plaster" which he seems to apply indiscriminately to all who come to him for assistance-and it is said they come in droves. According to Dr. H. M. Bracken, Secretary of the Minnesota State Board of Health, Dr. Till's plasters are responsible for at least three deaths in Minnesota. It seems that the applications are dirty, and that following the severe counterirritation, sepsis has occurred in a number of cases.

We have read with interest the comments, pro and con, growing out of the charges which have been made against Dr. H. W. Wiley, the food chemist of the Agricultural Department. While it is difficult to arrive at the exact truth from what appears in the newspapers, yet it seems that if Dr. Wiley erred it was rather from a desire to increase the value of the important service in which he was engaged; and certainly no fraud against the Government was intended. We are pleased to observe that many medical societies in all parts of the United States are lending their endorsement to Dr. Wiley's cause, and that the President has stood by him.

We have just received the program of the Thirteenth Annual Session of the National Medical Association of physicians, dentists and druggists, which was held in Hampton, Virginia, August 22-24. The membership of this association consists entirely of negro professional men. Judging by the character of the papers submitted and the large numbers of subjects discussed, the

society is doing excellent work. It certainly deserves the commendation and assistance of every white physician. The writer was pleased to note that the president of this association is Dr. Austin M. Curtis, of Washington. Dr. Curtis was a member of the class of 1891 of the Chicago Medical College. The writer remembers him very well.

The writer is enjoying his work in the Berlitz School of Languages, in which for the last two months, he has been renewing his acquaintance with German. He can warmly recommend the work of this school to anyone desiring to study any of the modern languages, including German French, Italian and Spanish, either by personal attendance or through the books for self-instruction which the school publishes and supplies. The Berlitz School is the largest institution of its kind in the world, and has branches in all the principal cities in North and South America and in Europe. A student who begins work in one city may continue it in another if he so desires. Why don't you learn a language, Doctor, in your spare moments? It doesn't take much time and may be is almost sure to be of inestimable service to you. You can easily do it. If you are interested, call upon or write to The Berlitz School of Languages, Auditorium Bldg., Chicago.

When medical ethics, so called, gets away from common sense, common justice, and brotherly kindness, it is not a very nice thing, and that is what seems to have occurred in England. For instance: The general medical council of that realm has recently ordered the removal of the name of Dr. F. W. Axham, on the ground of "infamous conduct in a professional respect." Dr. Axham has for forty-nine years enjoyed an unblemished record in the medical world and is considered one of the most distinguished surgeons in England. His sole offense consisted in having acted as anesthetist to "an unregistered person practising in the Department of Surgery." This "unregistered person" was a bonesetter of great renown, whose successes during the last ten years are the subject

of a laudatory article in the English Review. Other physicians who have received the same stigma from the general medical council are several practitioners who have been employed by the Eugene Sandow Institute. While CLINICAL MEDICINE has broken many a lance against quackery, it has no sympathy with those of the Pharisaical caste who ruin the reputations and careers of men who do not follow exactly in the beaten path.

It has long been known that there are certain individuals who harbor the typhoid bacillus, which they may carry about for years, personally remaining all the time in perfect health. It is now known that many of the "mysterious" epidemics of this disease, which cannot be traced to the ordinary means of transmission, really are due to individuals of this class, whose excretions may simply swarm with the specific germ.

A case of this kind has just been discovered in Chicago. Recently an epidemic of the disease appeared in the Englewood district, six cases being reported in one neighborhood within a single day. Inquiry disclosed the fact that the milk supply of families in which the disease had occurred came from a farm just outside the city limits. Three years ago the daughter of the farmer, a girl now twenty years old, had typhoid fever. This girl has charge of the washing of the milk-cans, and it now seems quite certain that the germs which she has harbored infected the milk supply of a large number of people in that particular section of Chicago. The inference is natural that when any individual recovers from typhoid fever, if he is engaged in any occupation which brings him into contact with food production or food distribution, the urine and feces of such person should be repeatedly examined, and until he is found to be free from the dangerous bacteria, he should not be permitted to engage in any occupation of that

nature.

No doubt millions of typhoid germs are constantly being distributed by milkmen, bakers, grocers, cooks, dish-washers, and others.

According to to Public Health Reports, issued by The Public Health and Marine Hospital Service, 23,552 cases of smallpox and 385 deaths were reported in this country during 1910. This is an average of 43.27 cases for each 100,000 inhabitants, and 1.63 deaths in each 100 cases. The important and interesting statement is made that vaccination does not always protect from the disease, as follows:

"Japan, as a nation, is probably as well or better protected by vaccination than is the United States, and, yet, in 1907-8 there was an outbreak of smallpox in Japan in which 19,101 cases were reported, with 6,273 deaths. Vaccination did not there modify the type of the disease to that found in America. In that outbreak among 5215 smallpox patients, 1527 were found who

had never been vaccinated. This is interesting, as indicating a relatively small number of unvaccinated individuals. The epidemic apparently was one of considerable virulence, the general death-rate per hundred being 42.25 among the cases in 1907 and 32.32 among those in 1908, while the deaths among the unvaccinated were 69.4 per hundred cases. Kitasato believes that the virulence of the disease varies and that when it reaches the high point attained in Japan during 1907-8, individuals who have been previously vaccinated, and even those who have previously had an attack, contract the disease. In this outbreak there were 242 cases in seven prefectures in which the patients had previously had the disease. Of these 57 died."

1.

PHYSIOLOGY

What is the function of the sudoriparous, or sweat glands? Where is the dominating sweat-center located, and how is this excited to action? (q1p10)

To excrete the sweat. The sweat-glands consist of a delicate homogeneous membrane lined by epithelial cells, whose function is to extract from the blood the elements existing in the perspiration. The dominating sweat-center is located in the medulla, although subordinate centers are present in the cord. The sweat-center is excited to action by mental emotions, increased temperature of blood circulating in the medulla and cord, increased velocity of blood, the influence of certain drugs, rise of external temperature, exercise, etc.

2. Describe the normal pulse. State the factors active in its maintenance. Give the rate during infancy, adult life, youth, old age. (q1p22)

The pulse is the sudden distention of an artery in a transverse and longitudinal direction, due to the injection of a volume of blood into the arteries already full of blood, at the time of ventricular systole. Factors active upon its maintenance are blood pressure, caliber of blood-vessels, influence of vasomotor nerves, inhibition, of accelerator and inhibitory nerves, mental emotion, and other causes. Rate during adult life, 72; youth, 90 to 110; old age, 60 to 70.

3.

Describe the patellar reflex and state upon what its integrity depends. (q2p38)

The patellar reflex consists in a contraction of the extensor muscles of the leg and a movement of the foot forward when the ligamentum patellæ is struck sharply. The quadriceps extensor tendon must first be slightly stretched by putting one knee over the other, or a book or other object under the leg, and hanging the leg over the edge of a table. Its integrity depends upon a healthy condition of the entire reflex-arc, consisting of tendon, afferent (or sensory) nerve, posterior roots, and anterior horn of the spinal cord, the efferent (or motor) nerve, and the muscle itself.

4. Describe minutely the formation, elimination, and passage of urine.

The elimination of the constituents of the urine from the blood is accomplished by the processes of filtration and secre

tion. The water and highly diffusible inorganic salts pass by diffusion through the walls of the blood-vessels of the glomerulus into the capsule of Mueller, while the urea and remaining organic constituents are removed by true secretory action of the renal epithelium. The filtration of urinary constituents from the glomerulus into Mueller's capsule depends largely upon the blood pressure and rapidity of blood flow in the renal artery and glomerulus. The products of the filtration and secretion flow into the pelvis of the kidney, where it passes off through the ureters into the urinary bladder.

5. What ferments are secreted during the process of digestion? Give their reaction, action, and function.

Ptyalin, by salivary glands; alkaline in reaction; converts starch into sugar.

Pepsin, by gastric glands; acid;

Rennin, by gastric glands; acid; coagulates caseinogen in milk.

Amylopsin, pancreas; alkaline; converts starch into maltose and dextrin.

Trypsin, pancreas; alkaline; converts albuminates into albumoses.

Steapsin, pancreas; alkaline; breaks up fats into fatty acids and glycerin, from which soaps and emulsions are formed. Envertin, pancreas; aikaline; converts cane sugar into dextrose.

MATERIA MEDICA AND THERAPEUTICS

1. Give the classification of phenacetin, somnal, hydrogen dioxide

Phenacetin is classified as analgesic, depressant. Somnal is classified as hypnotic and diurectic. Hydrogen dioxide is classified as an oxidizing agent for pus.

2. Name ten official alkaloids.

Quinine, atropine, morphine, hyoscine, aconitine, strychnine, cocaine, eserine, pilocarpine, sparteine.

3. What is meant by hemostatics? Describe their mode of action. Name several.

Hemostatics are agents which, when administered internally, arrest hemorrhage. Agents which have this action when applied ocally are called styptics. Hemostatics act by causing the

vessels to contract. Styptics act in the same way, besides causing formation of a clot in the mouth of the wounded and bleeding blood-vessel. Emetine, hydrastine, digitalis, cotarnine, adrenalin, ergot are hemostatics. Among the styptics may be named the actual cautery, acids, silver nitrate, alum, collodion, vegetable astringents.

4. Give action of absorbable metal upon the circulation. Name one, and explain its therapeutic uses.

Metals in themselves are never absorbable, but the union of them with other elements may render them soluble and capable of absorption. Thus metallic iron is dissolved by hydrochloric, nitric, and sulphuric acids. Such a preparation, taken internally, acts as a roborant by improving digestion and increasing the hemoglobin-content of the blood. It is a favorite remedy in chlorosis. Locally. certain ferric solutions stop bleeding by their astringent and coagulant action

5. Give derivation of ichthyol and its therapeutic application. Ichthyol is derived from shale containing fossil remains of fishes. The largest deposits are in the Tyrol. The rock is treated with sulphuric acid, and the resulting ichthyolsulphonic acid neutralized with ammonia or soda. Ichthyol is used externally in eczema, psoriasis, acne, erysipelas, inflamed and rheumatic joints, contusions, sprains, glandular swellings, and inflammatory affections of the female genitalia.

6. What are the effects, uses, and doses of calcium chloride? Calcium chloride is employed internally in the treatment of scrofulous enlargements of the glands of the neck. In cases where deficient bone formation is present. in the treatment of boils, pruritus, and to increase the coagulability of the blood in hemophilia, urticaria, and hemorrhage. It owes its activity to the calcium contained. In hemorrhages it should be used for a short time only, as its prolonged use diminishes the coagulability of the blood by exhausting the fibrin-ferment. The dose is from 5 to 30 grains.

7. Describe hypnotics and the two classes into which they may be divided. Give examples.

Hypnotics are agents used to induce sleep. They may be divided into two classes: those which relieve insomnia when due to pain, and those which have no influence over pain, relieving insomnia when due to nervousness and allied conditions. Morphine, codeine, hyoscine represent the first class, chloral hydrate and sulphonal, the other.

8. Name some soluble salts of iron.

Ferric chloride, ferrous iodide, ferric sulphate, ferric nitrate, iron and ammonium citrate, iron and ammonium sulphate, iron and ammonium tartrate, ferrous sulphate.

9. From where are the following alkaloids obtained: quinine, strychnine, hydrastine, atropine, physostigmine?

Quinine from cinchona; strychnine from nux vomica; hydrastine from hydrastis; atropine from belladonna; physostigmine from calabar-bean.

10. What are the uses of the bromides?

Bromides are indicated when overexcitement of nervous protoplasm is present, as occurs in epilepsy, hysteria, convulsions, seminal emissions, nervous insomnia, headache, migraine neuralgia, also in nervous vomiting. The bromides are given in large doses until the bromide effects are obtained. These are then maintained by smaller doses at infrequent intervals

OBSTETRICS

1. Define dystocia, hydrocephalus, funis, phlebitis, caput succedaneum.

Dystocia: abnormal, difficult or extremely painful labor. Hydrocephalus: collection of serous fluid in the cranium. Funis: the umbilical cord. Phlebitis: inflammation of a vein. Caput succedaneum: the swelling found upon the heads of many children if there has been much molding of the skull.

2. Name at least three causes in the fetus causing increase in size which may delay or interfere with labor.

Hydrocephalus, tumors, such as spina bifida, and anasarca. 3. What is ischio pagus parasiticus?

By this term is designated a monstrosity or congenital deformity growing out at the hips and which grows and acts like a parasite.

4. How would you treat a case of hourglass contraction?

In hourglass contraction the upper uterine segment is contracted upon the placenta and the lower segment and cervix uteri are dilated, and a ring is thus formed, which resembles an hourglass, hence the term. The treatment consists in removal of the placenta by hand, the patient being under an anesthetic. The fundus is gently pressed back into place, under aseptic and antiseptic precautions, with sterile gauze, and the interior of the uterus is then packed, to hold it in place and cause uterine contraction.

5. Mention regulations for diet during normal pregnancy. If albuminuria should develop, meat and other nitrogenous food must be restricted. If the patient becomes anemic,

without albuminuria, then meat, eggs, and milk should be par taken of in abundance. The patient should live simply and avoid foods which are likely to produce dyspepsia, heartburn, and colic, such as sweets, pastry, fried food, sauces, spiced dishes, and heating drinks. If the patient suffers from constipation, she should use fruits and coarse cereals. The stomach should not be overloaded, especially at night.

6. Bound the true pelvis. Define brim; false pelvis. Name the bones which form the obstetrical pelvis.

The pelvis is formed by the sacrum, coccyx, and two ossa innominata. The brim, or inlet, is bounded, in front, by the crest and spine of the pubes; behind, by the promontory of the sacrum; laterally, by the ileopectineal line. The false pelvis comprises the upper and expanded portion above the ileopectineal line. The obstetrical pelvis is formed by the fifth lumbar vertebra, sacrum, coccyx, and two innominate bones.

7. Enumerate the symptoms which indicate the death of the child in the womb, and state what course should be pursued in such a condition.

Cessation of fetal movements and heart-sounds; cessation of abdominal growth; appearance of milk secretion, retrogressive breast changess; peptonuria; palpation may disclose the macerated skull. The treatment consists in immediate evacuation of the uterus, after a positive diagnosis has been made.

8. What are the two most reliable diagnostic indicatioms for inducing abortion? How would you treat a case of threatened abortion?

The two most reliable indications for inducing abortion are a justominor pelvis with a very small outlet, and, secondly, placenta prævia.

Threatened abortion is treated by putting the patient to bed and giving general physical and mental rest; ordering light nutritious diet; giving uterine sedatives, such as small doses of morphine and viburnin.

9. Describe the liquor amnii and state its functions.

The amniotic liquor is an almost clear fluid of alkaline reaction, of a specific gravity of 1002 to 1028, and contains various salts, urea, ammonium carbonate, albumen, lanugo, sebaceous matter, and epithelium from the fetal kidneys and bladder. The average quantity at the end of pregnancy is 680 Grams. The fluid is partly fetal and partly maternal. Its uses are, to allow the fetus to have freedom of movement without much muscular exertion; to protect against violence and sudden change of temperature; to receive the urine secreted in the last months of pregnancy; and possibly to supply water to the fetus. 10. Give the pelvis measurements.

The measurements of the female pelvis are as follows, in inches: Internal conjugate, 4 1-4 to 4 1-2. External conjugate, 71-2 to 81-2.Pelvic inlet, anteroposteriorly, 4; transverse, 5; oblique, 4 1-2. Pelvic cavity, anteroposteriorly, 4 1-2; transverse, 4 1-2; oblique, 4 1-2. Pelvic outlet, anteroposteriorly, 5; transverse, 4; oblique, 4 1-2. Interspinous, 91-4 to 10 1-2. Bitrochanteric, 11 1-2 to 12 1-2. Intercrestal, 10 1-2 to 11 1-2.

1.

PHYSICAL DIAGNOSIS

What is meant by the term pathognomonic? Give three examples. Pathognomonic refers to certain diagnostic signs or phenomena which point out the nature of a disease or illness; as Koplik's spots in measles, strawberry tongue in scarlet-fever, Argyll-Robertson pupils in posterior sclerosis.

2. What would be the finding in an examination of the blood in pernicious anemia?

In pernicious anemia, the blood would show: a diminished number of cells; relative increase in amount of hemoglobin; poikilocytosis; presence of nucleated red cells. There may be a diminished number of leukocytes. Free hemoglobin staining the sympathetic ganglion and ductless glands, as well as the liver.

3. In what diseases are the following conditions found-(a) clubbing of fingers; (b) loss of patellar reflex; (c) Cheyne-Stokes respiration; (d) wrist-drop; (e) pain in knee; barrel-shaped chest; (g) Koplik's spots; (h) pain in the testicle and glans penis; (i) Argyll-Robertson pupil; (j) strawberry-longue?

(a) Pulmonary tuberculosis; (b) locomotor ataxia; (c) severe disease just before death; (d) lead poisoning; (e) hip-joint discase; (f) emphysema; (g) measles; (h) renal calculi; (i) locomotor ataxia; (j) scarlet-fever.

4. Give the differential diagnosis between mastoiditis and otitis media.

In mastioditis the pain is more superficial, the area behind the ear is painful, red, hot, swollen, there is exudation and infiltration into the surrounding area, and swelling. No light is transmitted on transillumination. There may be no leukocytosis. In otitis media, the pain is more deep seated and all of the symptoms of an abscess appear, the ear-drum bulges out, there is leukocytosis, indican in the urine, light is transmitted on transillumination.

diet for a time, after which tonics and good food are required.

Another example: In acute bronchial catarrh it is well to give frequently repeated doses of the defervescent or dosimetric combinations until the skin has been roused into free action, after which we may administer stimulating expectorants, such as the carbonate and chloride of ammonium. What we aim at is first to throw the skin into action and lower the temperature, measures which relieve both the catarrh and the pyrexia; and then to give well-chosen tonics, and especially tonic expectorants.

These arrangements are not contradictory, nor even inconsistent: each has its turn of usefulness, and then gives way to another. Such alternations do not indicate changes of opinion or caprice; they demonstrate a clear-sighted view of the case. As wheat is sown, grows and ripens ere it is cut, so complex plans of treatment have, then, several stages.

It may be laid down as a broad rule that the toleration of iron diminishes as the age increases. With old persons iron rarely agrees very well, and then only in very small doses. As age advances the system seems to grow less tolerant of the drug in any form; and the dose must be diminished. It is often better to give old people vegetable tonics with alkalis and easily digestible food, than to give iron. I get good results from such drugs as quassin, strychnine arsenate, sodium bicarbonate or sodoxylin.

There are two different states found in women where iron is either totally contraindicated or to be given with great caution. The first is the condition of amenorrhea in