be paid in advance.

A concerted action on the part of a few pioneers in this matter will place the practice of medicine in many districts upon a business basis that will be advantageous the to community as well as physician. By following this plan people can be taught the advantage of "protecting" their health. They can be taught that it is better to count on health protection as a legitimate expense of living, rather than an unfortunate expense when affliction visits them.

A campaign of education can be commenced in a community on the plan followed in Philadelphia by Benjamin Franklin, when the formation of independent colonies of America was suggested. In the "Autobiography" of Franklin this plan is explained.

These are just a few suggestions, but they are enough to get a start. CHARLES V. CROSS.

San Francisco, Cal.

[What do our readers think of these. ideas? Let us discuss them through these pages, endeavoring to elaborate something tangible for the betterment of our profession.-ED.]

CHOLERA AND ITS PREVENTION

Our health authorities are a good deal disturbed over the appearance of cholera in the East. The disease comes to us from Italy, where its presence has been officially denied. There are, at this writing, fifteen cases of the scourge at the Swinburne Island Hospital, in New York harbor, and there have been five deaths, among them one resident American, former day watchman at the Hoffman Island quarantine station. Single isolated cases have been reported at Auburn, New York, and at Brooklyn, but there seems to be no tendency to spread from these points.

The New York health department is watching the situation closely, taking all possible precautions to prevent the fixing of cholera upon our coast, while the Public Health and Marine Hospital Service is

Such care is essential, for cholera is a treacherous disease. Dr. Doty, New York's Health Commissioner, believes that it may be transmitted by "carriers," individuals who have no symptoms of the disease but whose intestinal canals nevertheless are well supplied with the germs. With a pure water supply, well-cooked food, and hygienic and cleanly methods of living, there is not much danger of wide dissemination of cholera.

It is wise to bear in mind that the cholera vibrio does not thrive in an acid medium, but best in the alkaline bowel. In treatment, rectal injections of tannic acid and the internal use of lactic acid have been advised. As a prophylactic expedient, how much simpler to provide each individual in threatened territory with an ample supply of tablets containing the Bulgarian lactic-acid bacillus, the most rapid producer of lactic acid known. Something about treatment next month.

house in Jacksonville, Fla., and, when in Cuba, he and Dr. Jas. W. Jobling of Tennessee were detailed to take charge of the laboratory division of the first-division hospital corps, with headquarters at Camp Cuba Libre. Dr. Schaare was born in Chicago, in 1875; was educated in the public schools, in the West Division High School and Manual Training School of this city, also the Chicago Atheneum. He is a graduate of The Chicago College of Medicine and Surgery, class of 1902, and is now professor of medical surgery in the same institution, being also instructor in surgery in the Post-Graduate Hospital. Both he and Dr. Emil Lofgren, formerly

Health Commissioner of the city of Rockford, and past surgeon of the Spanish veterans of this city, are members of THE CLINIC "family." We join all our readers in congratulating Dr. Schaare upon the honor which has been given.

Dr. H. W. Wiley is urging upon Congress the wisdom of prohibiting the promiscuous distribution of drugs on doorsteps, in mailboxes and other places where they become accessible to children. He believes that the manufacturer should be held responsible for this form of advertising. Dr. Wiley is absolutely right. The indiscriminate handing out of purgative pills and headache cures in this way is fraught with danger, especially to children. When the people are sick, they should be taught to go to the doctor for advice and to the druggist for their supplies.

Dr. W. O. Nance of Chicago, who was elected a member of the city council this spring, has introduced an ordinance prohibiting the use of roller towels in public places. This is a good idea, and we hope that Dr. Nance's ordinance may become a municipal law. There is far more danger in the roller towel than there is in the public drinking cup. Wherever the public towel is a necessity, individual towels can be provided at small additional expense, or the convenient and sanitary paper towel, which has recently been introduced, may well be used in its place. We shall be glad to see Dr. Nance's city ordinance become a state law.

While the fear of tetanus infection is very natural in St. Louis after the experience of some years ago, the present scare appears hardly justified. According to The Post-Dispatch, Dr. Smith vaccinated at little boy four years old, who died from tetanus a month after he had been vaccinated. The period of one month after vaccination shows that the tetanus could not have been due to this prophylactic measure, because tetanus occurs much more rapidly, the period of incubation being only very short. Besides, the virus for vaccination which is in use now is very

carefully tested, since the unfortunate experience in St. Louis above referred to, when the virus prepared by the city had been found badly contaminated.

Dr. Oscar Dowling, who is at the head of Louisiana State Health Department, has fitted up a "demonstration train" of three cars, which is sent by the State from station to station to preach the gospel of health and long life. These cars are fitted up with a model sickroom, showing modern methods of ventilation and ideal sanitary conditions. There are also demonstrated, in these cars, modern ways of preventing and curing such diseases as are common among the people of the different sections, and instruction is given concerning sickroom foods and how to prepare them. Health lectures are given at the places where the cars stop, the purpose being to present the facts to the people in such a plain, yet comprehensive, way that the dullest may understand.

The latest plan of publicity in fighting disease is the "motion-picture show." How popular instruction can be given, in this manner, concerning the spread of tuberculosis was shown by Dr. Harvey D. Brown at the last meeting of The Wisconsin State Medical Society. Similar pictures are being exhibited in nickel shows all over the country. By giving health instruction, these much-criticised amusement halls may become a means of doing great good. Why should not physicians everywhere persuade the local managers to do work of this kind? The film-makers now provide pictures which illustrate the dangers of infected milk, how disease is conveyed by flies, and other important influences at work in the production of disease. Some of these films have been made in cooperation with The National Red Cross Association, and have its endorsement. Any manager can procure these if he will.

An important law, which went into effect on July 1, in Iowa, was one providing that inmates of state penal and insane institutions shall undergo the operation

known as vasectomy upon the recommendation of the surgeon and physician of any of these institutions, if such an operation is deemed necessary to prevent the procreation of persons likely to inherit insanity or criminal instincts, or if it will, in the judgment of those physicians, tend to restore the health of the patient. A penalty of $1000 is prescribed for the performance of the operation without the consent of the chief surgeon of the institution where the patient is confined.

According to Dr. Wm. H. Welch, of Johns Hopkins University, practically all children of the lower classes of society are affected with tuberculosis in a latent form by the time they reach the age of fifteen or sixteen, but this latent affection is distinctly preventive, and gives, in most cases, an immunity against the disease in later years. This statement was made by Prof. Welch at the annual meeting of The National Association for the Study and Prevention of Tuberculosis, in Denver.

The physician who desires to keep up to the times should be able to read the contributions of the great German and French scientists in the original. His ability to do this will give him a wonderful stimulus, and add decidedly to his professional standing. The writer studied German when he was a young man in college, but having become rusty, he is now brushing up at the Berlitz School of Languages, where a working knowledge of any of the modern languages can be obtained in an astonishingly short time. If you cannot go to the school itself (there are branches in every large city in the United States) the next best thing is to obtain the books and study at home-but you ought to take the course in person if you can. The book, "German With or Without a Master", is sold for $1.25. The corresponding French and Spanish books, $1.00. If you are interested, address the Berlitz School of Languages, Auditorium Building, Chicago.

The following nice little comment upon certain articles in the March number of THE AMERICAN JOURNAL OF CLINICAL

MEDICINE appeared in a recent issue of The Monthly Bulletin of the Pan American Union, of which the Hon. John Barrett, of The International Union of American Republics, is the editor: "What One Practician Has Accomplished in Mexico,' by Robert Gray, M. D., Pichucalco, Chiapas, Mexico, appearing in The American Journal of Clinical Medicine for March, tells of some of the difficulties physicians find in establishing themselves in Mexico. 'Alkaloidal Practice in Guatemala,' by Carlos F. Secord, M. D., 'A Doctor's Life in Spanish Honduras,' by John Abbott, M. D., and 'Conditions and Medical Practice in Bolivia,' all deal with the life of the medical profession in these different countries, as the titles indicate. We can recommend them for the perusal of the ambitious medical student who is turning his eyes to the horizon of Latin America."

By a recent decision in the U. S. Circuit Court, H. K. Mulford Company were enjoined from marketing adrin, their brand of epinephrine, the active principle of the adrenal gland-the patent claims of Dr. Takamine having been upheld. The firm of H. K. Mulford Company will appeal this case to the higher court, but meanwhile will discontinue the manufacture and sale of adrin and products containing it. In a recent statement, this firm expressed the opinion and this will be concurred in by thousands of progressive physiciansthat the granting of product patents on medicinal substances is a hindrance to rather than a means of promoting progress in the practice of medicine. They believe that these patents are not only contrary to the object and spirit of the patent law but also contrary to the best interests of pharmacologic practice in the United States. With this view we are inclined to concur. The enormous profits made in this country by German manufacturers under the protection of these patents-patents, by the way, which are not permitted in Germany itself-amount to nothing less than "graft," by means of which millions and millions of dollars are abstracted from the American purse to go into the coffers of the great German dye-houses.

Owing to some delay in preparing the questions for the June article, it was impossible to get the matter to the editor in time to have it inserted under the article headed "The Purpose of This Department," and the remainder of the State-Board Questions and Answers which were left over from the May issue were inserted, instead. The article above mentioned was intended to head the list of questions given below.

Below will be found a representative list of questions, which are supposed to represent as nearly as possible the average state-board examination, as the questions were selected from a large list of examination questions asked by a number of state medical examining boards from all over the United States.

In some of the states, you will find the questions given by the Board of Examiners easier, and in others, harder, perhaps; but I believe this will prove to be a fair average, and if any of the readers of this journal desire to test their powers and ability in writing answers and test their powers in a real examination, write the answers to these questions, using only one side of the paper, and send to my office, accompanied by $1.00 in money-order or currency, for postage, mailing, and time required to grade papers, and they will be looked over carefully and mistakes will be pointed out to you, and your attention called both to good and bad points.

This small amount is required, owing to the work required to grade, the additional clerical help required, and the time consumed in doing this work, and the test and experience thus obtained should be of much benefit to any one in future examinations.

The answers to these questions will be given in the next issue of CLINICAL MEDICINE.

1. What are the indications for amputation in gangrene of an extremity?

2. What are the signals of danger in general anesthesia? 3. Give the treatment of painful cicatrix, adherent cicatrix, contracted cicatrix, exuberant cicatrix.

4. Mention the most common sites of epitheliomata. 5. Give classification of asphyxia, and definition of each form.

6. Classify aneurisms. What are their predisposing and exciting causes and the usual locations?

7. Give the principal methods of abdominal drainage with which you are familiar. What method do you consider best? 8. What important tissues may be wounded accidentally during an operation for femoral hernia?

9. Name and describe four forms of talipes.

10. Give briefly Cohnheim's theory as to origin of tumors. What conditions justify amputation of a limb? PHYSIOLOGY

1. What is the function of the sudoriparous glands? Where is the dominating sweat-center located, and how is this excited to action?

2. Describe the normal pulse. State the factors active in its maintenance, and give the rate during infancy, youth, adult life, and old age.

3. Describe the patellar reflex and state upon what its integrity_depends.