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diff --git a/old/52967-0.txt b/old/52967-0.txt deleted file mode 100644 index bcfb278..0000000 --- a/old/52967-0.txt +++ /dev/null @@ -1,2149 +0,0 @@ -The Project Gutenberg EBook of The Hospital Bulletin, Vol. V, No. 3, May -15, 1909, by Various - -This eBook is for the use of anyone anywhere in the United States and most -other parts of the world at no cost and with almost no restrictions -whatsoever. You may copy it, give it away or re-use it under the terms of -the Project Gutenberg License included with this eBook or online at -www.gutenberg.org. If you are not located in the United States, you'll have -to check the laws of the country where you are located before using this ebook. - -Title: The Hospital Bulletin, Vol. V, No. 3, May 15, 1909 - -Author: Various - -Release Date: September 2, 2016 [EBook #52967] - -Language: English - -Character set encoding: UTF-8 - -*** START OF THIS PROJECT GUTENBERG EBOOK THE HOSPITAL BULLETIN, MAY 15, 1909 *** - - - - -Produced by Richard Tonsing, The Online Distributed -Proofreading Team at http://www.pgdp.net (This file was -produced from images generously made available by The -Internet Archive) - - - - - - - - - - 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=. - - - - - -End of the Project Gutenberg EBook of The Hospital Bulletin, Vol. V, No. 3, -May 15, 1909, by Various - -*** END OF THIS PROJECT GUTENBERG EBOOK THE HOSPITAL BULLETIN, MAY 15, 1909 *** - -***** This file should be named 52967-0.txt or 52967-0.zip ***** -This and all associated files of various formats will be found in: - http://www.gutenberg.org/5/2/9/6/52967/ - -Produced by Richard Tonsing, The Online Distributed -Proofreading Team at http://www.pgdp.net (This file was -produced from images generously made available by The -Internet Archive) - -Updated editions will replace the previous one--the old editions will -be renamed. - -Creating the works from print editions not protected by U.S. copyright -law means that no one owns a United States copyright in these works, -so the Foundation (and you!) can copy and distribute it in the United -States without permission and without paying copyright -royalties. 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