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OF TH E 

•School oj^ Medicine 










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THE HOSPITAL BULLETIN 



OF THE 

UNIVERSITY OF MARYLAND 



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VOL. VIII. 



MARCH IS, 1912. 



* 



No. 1 



CONTENTS 



ORIGINAL ARTICLES— 

The Public Should Be Educated in Regard to 
Cancer the Same as Is Being' Done in 
Tuberculosis. A. Aldridge Matthews, M.I). 

Is Syphilis Hereditary? E. K. Tullidge 

An Analytical Study of Fifty Cases Treated 
in the Gastro-Enterological Department of 
the University of Maryland. Reviewed 
with special attention to the Anthropomet- 
ric Measurements. Albert Hynson Carroll. 
M.D.. and Edward A. Loper and Edward 
P. Kolb, Class of 1912 



The Symptomatology of Typhoid Fever and 
Its Complications. C. W. Rauschenbach, 
Senior Medical Student 10 

1 EDITORIALS 13 

4 Retrospect and Prospect. 

Second Call for Dinner. 

ITEMS 15 

UNDERGRADUATE NOTES iS 

BIRTHS 19 

MARRIAGES 19 

7 DEATHS 19 



111 



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THE HOSPITAL BULLETIN 

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Entered at the Baltimore Post-office 
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Vol. VIII 



BALTIMORE, MD., MARCH IS, 1912. 



No. 1 



THE PUBLIC SHOULD BE EDUCATED 
IX REGARD TO CANCER THE SAME 
AS IS BEING DONE IN TUBERCU- 
LOSIS. 



By A. Aldkidge Matthews. M.D. 



Cancer is almost the only disease which is on 
the increase in the civilized world. 'Whether this 
is a true increase or whether it is due to the pro- 
fession recognizing the disease more accurately, 
and the statistics being better kept by the profes- 
sion, by institutions and by the Government, 1 
canm it say, but I am inclined to think it is the 
latter: but nevertheless we have to admit there is 
a decided increase of cancer mortality in the rec- 
ords of today over former ones. 

This world-wide disease is not confined to any 
certain people, but occurs among all races of man- 
kind, and is indeed found throughout the verte- 
brate kingdom. Domestic animals are more sus- 
ceptible to it than animals in the wild state. Dr. 
C. W. Mayo explains this fact as being due to 
their longer life, the disease being more common 
in the relatively aged in both man and animal. 

The medical profession, with the aid of the 
press, the National Government and the anti- 
culosis societies, have put on foot a crusade 
against tuberculosis, and it is being brought 
forcefully to the laity, who are taking an active 
part in causing a universal reduction in tubercu- 
losis. The public must be educated along these 
line: — that cancer is a local disease in its incip- 
iencv. and is curable when properly cared for in 
the majority of cases: until this is done we can- 
not hope t'i reduce the cancer mortality. If 
the laity were properly informed in regard to this, 
mid make it much easier and more satisfac- 
tory to reduce and keep down the mortalit) of this 
dreaded disease, and this education must come 
through the physician, directly and indirectly; so 
the sooner it is begun, the sooner we may expect 
results. 



There are precancerous conditions which, if 
taken bold of when such, would prevent cancer 
formation. Most cancer deaths are due to delay, 
and are therefore unnecessary. The first or cur- 
able stage has been ignored, and cure has been 
sought only when the disease has become incur- 
able. This delay is not always due to the patient 
himself, but often to his physician, either directly 
or by advising him to wait and see what the fu- 
ture will develop, or by temporizing with some 
placebo which he knows is valueless, but which 
the patient ignorantly supposes to be curative. 

As Greenou.Ldi has said ( referring to benign 
breast tumors I, no tumor is innocent and incapa- 
ble of harm until removed. 

Childe of Portsmouth, England, more than any 
other English or American writer, has emphasized 
the true importance of the early signs of cancer. 
I le calls them danger signals, and compares them 
with the danger signals in other conditions. Dan- 
ger signals in cancer, just as on the railroad or at 
sea, mean that there must lie immediate and effi- 
cient action in order to prevent disaster. The 
physician who neglects the danger signal in a can- 
cer patient is just as much responsible for the 
disaster to his patient as the engineer is to his 
passenger if he neglects the danger signal and 
runs into an open switch. Cliilde's danger signals 
are briefly as fi illi iws : 

T. Cancer of the breast. I fere the danger sig- 
nal is a small lump or thickening of any kind. In 
a woman over 35 years old this lump is a cancer 
from the start in at least go per cent, of cases. In 
a woman of any age the finding of a lump in the 
breast should be immediately followed by its 
mi ival. 

2. Cancer of the uterus. The danger signal 
here is an irregular bleeding, especially after the 
menopause, or the onset of a discharge in a 
woman who has been free from it previously, or 
the change in character of a previously pn 
discharge SO that it becomes more profuse, more 
foid or more irritating. 



v, 



THE HOSPITAL BULLETIN 



3. Cancer of the lip, mouth and tongue. The 
danger signal here is any sore that will not heal. 

4. Cancer of the skin. The danger signal here 
is any sore that will not promptly heal, or any 
wart or mole which suddenly begins to grow 
rapidly. 

5. Cancer of the stomach and intestines. Here 
the danger signals are not so apparent as on the 
surface of the body. After 40 years of age the 
onset of obstinate indigestion, persistent collicky 
pains in the abdomen, persistent diarrhea, and 
especially vomiting or the passage of blood in the 
stools, are the danger signals, and their real cause 
must be determined at once. 

It is unfortunately too true that a large number 
of people notice these danger signals themselves, 
but do not apply to a physician until ample time 
has been given for the incurable stage to develop. 

Quoting from Childe again, it is unfortunate 
that a patient will run to a dentist with a tooth- 
ache much more quickly than to a physician on 
account of symptoms pointing to a malady which, 
if neglected, will prove fatal. Many people will 
not bother with the early warning symptoms if 
there is no pain and no impairment in general 
health. The patient waits for these to come on 
before they admit the possibility of cancer, and, 
unfortunately, the physician may countenance a 
similar delay. Yet there is nothing more certain 
than that pain and cachexia are never present in 
the early curable stages, but come on only when 
the disease is hopeless, the early danger signals 
have been neglected and help has been asked only 
on the appearance of appending death. 

( Ine of the most common sites for cancer in the 
female is the breast. At a meeting of the Ameri- 
can Surgical Association held in May, 1907, a 
symposium on cancer of the breast showed the 
percentage of cures following the radical breast 
operation was from 20 to 40 per cent. i\\ cases 
where there was no axillary involvement at the 
time of operation the percentage has increased 
from 70 to 80 per cent. Eighty per cent, of tu- 
mors of the breast are malignant or become so. 

Drs. Greenough's, Simmons* and Harry's report 
from Massachusetts General Hospital show that 
early operation done and not complete gave bet- 
ter results than a radical operation done late or 
after axillial involvement, and their total cures 
were 20 per cent. The conclusion to be drawn 
from this is that a radical opera! ion should be 
dime as early as possible. 



In England the statistics for 1905 show that 
cancer is more fatal to women than tuberculosis, 
there being 100 deaths per 100,000 for the former 
to 94 for the latter. The English statistics fur- 
ther show that while at present more women are 
affected with cancer than men, the proportion of 
males having cancer has increased more rapidly 
since 1850 than females. Omitting carcinoma of 
the breast and uterus, the disease is more common 
in male than in female. The English statistics 
for 1906 show that I in 11 in all men and 1 in S 
of all women 35 years of age or more die eventu- 
ally of cancer. The statistics of the United States 
are not as complete as those of England. They 
show deaths from malignant disease in 1850 were 
9 per 100,000, while in 1900 they had increased 
to 43, or nearly fivefold in 50 years. 

The deaths from cancer alone in 1890 were 47 
per 100,000, but had increased to 60 per 100.000 
in 1900. The deaths from tuberculosis in 1890 
were 245 per 100,000, but had decreased to 187 
per 100,000 in 1000. In New York State, where 
very good statistical records are kept, these 
showed an increased mortality in proportion to 
the population 25.4 in the 10 years from 1896 to 
1906, while the tuberculosis ratio decreased 4.9. 
The death proportion in the State of Minnesota 
for the year 1908 was 1 in 17 from cancer. The 
United States census report for 1900 showed 
that 1 death in 29 was due to cancer. 

Since 1880 the comparatively excellent figures 
of the State of Massachusetts show an increase 
from 5.21 to 8.80 for the same period. Accord- 
ing to the Government mortality 'statistics of the 
twelfth census, cancer had made a gain of 12. 1 
deaths per 100,000 during the past 10 years, and 
in 1909 cancer held ninth place as a factor in the 
cause of death. It is further worth noticing that 
cancer showed an increase in every State except 
Maryland and South Dakota from 1908 to 1909. 

Kelly claims that the uterus is the most fre- 
quent site of primary carcinoma, although he 
gives no figures to prove his statement. 
There are many authors who disagree with him 
on this subject. He also states that the fundus is 
more likely to be attacked at and after the meno- 
pause, while the cervix is more susceptible while 
the menses persist. 

Martin in "Osier's System" states that about 
one-half of all cancers arise in the stomach. 

Reich's figures at Hamburg (1879 t0 r 895 > dis- 
close that 50.2 per cent, of all cancers were gas- 



THE HOSPITAL BULLETIN 



3 



trie, while gastro-intestinal tract furnished 75 per 
cent, to 80 per cent, of all carcinomata. The 
combined analysis of 70.00(1 eases of cancer dem- 
onstrated over 21,000 I 33 per cent.) to be gastric. 

I uttle clan. is that So per cent, of all cancers oi 
the intestines occur in the rectum. 

We must not forget that cancer occurs in early 
life as well as later. While it is true the vast ma- 
jority "l' cancers occur in the latter half of 
life, it has occurred in infancy. Reigle reported 
■ me case of cancer of the stomach in a child six 
weeks .ild. 

In New York there were six deaths reported 
in 1000 from cancer in children under 10 years 
of age. 

According to Fisk, this increase is well shown 
for each age period as indicated in the following 
table : 

Per cent. 
\-c. 1880. 1907. increase. 

Below 20 years 0.19 0.21 10 

20 to .30 years 0.45 0.36 46 

30 to 40 years 0.2 3. 50 

50 to 60 years 1 1 .8 22.9 94 

Over 60 years 2.4 45.8 90 

The relation of carcinoma to sexes presents some 
important facts. Bland of Philadelphia found 
15,379 cases of cancer ending fatally from 1879 
to 1004; that the deaths among women were twice 
as numerous as those among men. This was due 
to the great frequency of the cancer of the uterus 
and breast. 

Welch reports the proportion of gastric cancers 
being five in men to four in women. 

Tuttle claims that 60 per cent, of rectal cancers 
are in men. 

Wile of Xew York reporting from the census 
claims 5.5 per cent, of all deaths in the male for 
the year 1909 as compared with 5.1 per cent, in 
1908. For females 8.1 per cent, of all deaths as 
compared with ~.$ per cent, in 190S were due to 
cancer. 

Well might the Registrar-General of England 
generalize by stating that of women living at the 
age of 36 years and upward one out of nine will 
die of cancer. 

Templeman has called attention to the fact that 
cancer deaths have doubled in the past 25 years, 
going from 7.27 in 10,000 of population to [6.9a 
in 10,000 population over 20 years of age. 

I think possibly the best definition of cancer 



has been given by L. S. Pilcher, who describes it 
as follows : 

"It is a lawless proliferation of the pre-existing 
epithelial cells in luxuriant, irregular-arranged 
masses that invade underlying and surrounding 
tissue primarily, destroying them and finally 
themselves, attaining a mass that can no longer 
be adequately nourished by an accessible blood 
supply, and which itself then falls into central 
decay, while at the periphery the process still 
goes on." 

These growths closely resemble the embryonic 
development of cells in the power of cell multi- 
plication and in the continuance of type in the 
metastasis and transplantation of the growth. 

It is generally supposed that a carcinoma often 
develops from severe injury, but there is no evi- 
dence that single injury does any more than call 
attention for the first time to a pre-existing tumor 
or hasten the growth of an early malignancy. 
Trauma as a cause has not been established by 
any of our statistics. Dr. C. W. Mayo says it is 
an apparent fact that in classifying the causes 
which may render precancerous conditions active 
we should include nerve fatigue, such as is seen 
in the modern business world. The organs of 
convenience, i. <\. stomach, bladder and large 
bowel, which were added late to primitive life, 
have poor cell resistance and are prone to cancer 
degeneration. 

It is a well-recognized fact that cancer often 
develops from chronic irritation, such as epitheli- 
oma of the lip, from irritations caused by the pipe 
stem in inveterate smokers, or by a jagged tooth ; 
or fibromyomata of the uterus and breast, 
ulcer of stomach and bowel diverticulitis, and 
many other conditions of such character. Mac- 
Carry of Rochester has found in a study of 
5000 appendices which had been removed for 
chronic subacute appendicitis that 0.5 per cent. 
of these were carcinomatous, and the diagnosis 
of 23 per cent, of these was not suspected at the 
time of removal, but detected later in the lab. ra 
t. iry. 

I have said nothing as to the etiology, because I 
have nothing new to say. 

The occurrence of the majority of cancers after 
30 years of age is rather against Cohnheim's the- 
ory of cell inclusion. The effect of dietary indis 
cretions is suggestive in the fact that over 40 per 
cent, of all cancers are localized in the alimentary 
tract. This is no more conclusive than asserting 



THE HOSPITAL BULLETIN 



trauma as a factor because over 20 per cent, are 
mammary or uterine. 

Heredity I do not think plays any important 
pari or has any bearing on the etiology. 

The present search for the parasitic origin of 
the disease has received but little encouragement. 
Whether the present era of animal experiments 
will link carcinoma to tuberculosis in some way, 
as the recent experiments of Dickson, Smith and 
Fox have suggested, or whether the disease may 
he transmitted through the agency of some yet 
undiscovered parasite, statistics give no testi- 
mony. 'We should not give up this idea entirely, 
for practically all of our acute diseases with which 
the people of our universe are affected are due to 
bacterial infection, and therefore we should con- 
tinue to search diligently for the germ of cancer 
so that an antagonistic remedy may be developed 
for its cure. 

We cannot hope to cure cancer with our pres- 
ent knowledge of its cause. The most optimistic 
internist cannot claim a single cure. Serum ther- 
apy has revolutionized the treatment of many 
diseases, but has been of no help in cancer. 
The X-ray, which at first promised so much, is 
now regarded as of little value except in the most 
superficial skin cancers. The treatment of cancer 
by radium is in the experimental stage. 

The question has been asked me a number of 
times why cancer did not affect the young. It 
does, as I stated above, but not often, and this 
reason is possibly due to vigorous growth of the 
cells in the young, which are less subject to can- 
cer, but more susceptible to poison; but the active 
lymphatics of the young cause a rapid dissemina- 
tion of the disease when it does occur. In very 
old people cancer travels very slowly on account 
of the obliterated and sclerosed condition of the 
lymphatics, and the same obtains, as a rule in 
tlie various infections of the old. I have noticed 
a number of times in cases of cancer about the 
face and the breast in the aged that its progress, 
as a rule, was very slow. 

The possible reason why the laity are often so 
afraid to have precancerous conditions removed 
is that they know of cases which have been oper- 
ated upon, and the condition progresses just the 
same until death. The reason for this is, of 
ci nirse, delay. 

The public should he instructed that the danger 

is lvl in the operation, hut in the delay. Anothei 

■ I why distrust in cancer operations exists 



is that hopeless cases often go to the surgeon and 
are operated upon where no good results could be 
expected, and consequently the death is charged 
more to surgery than to the true cause, whereas 
if the patients had not been operated upon they 
might have served as living examples of delay. 

Therefore, we should put everv effort forward 
to inform the public in regard to the prophylactic 
treatment of cancer. I hope and believe that in 
the near future there will be a better treatment 
for cancer than the knife, but at present it is the 
only true concpieror, so far as we have one, and 
this conquest is only made when the attack is 
made in the precancerous or incipient stage. 



IS SYPHILIS HEREDITARY 



By E. K. Tullidge, 
Baltimore, Md. 



To discuss syphilis as a hereditary disease we 
must first define disease, which, according to Mc- 
Farland, "is the inharmonious relation of the indi- 
vidual to his environment," and second, obtain a 
clear, distinct idea of the term hereditary. 

In the true biological sense this term is much 
misused in medicine and surgery, being applied 
to many pre-natal conditions that have nothing to 
do with it. In biology the term "hereditary" is 
used to describe conditions transferred from 
parent to offspring by peculiarities of the germ 
plasm. It does not refer to accidental conditions 
of pre-natal life by which the health or perfection 
of the offspring is affected. These conditions are 
termed "congenital." 

Alanv of the present-day biologists differ as to 
whether acquired characteristics can lie trans- 
mitted to the offspring or not. If not, then there 
can be no such thing as a hereditary disease or de- 
formity. Lamarck and Darwin believed firmly in 
inheritance and in the transmission of acquired 
characteristics; Darwin making it the basis of his 
theory of evolution. 

VVeissmann, Francis Galton, Adami, and per- 
haps the majority of the present-day biologists, 
doubt or disbelieve its possibility. It seems certain 
that experimental characteristics, i. e.. mutilations 
such as result from circumcision, amputations, 1111- 
cleations, etc.. arc not transmitted, but it appears 
certain that spontaneously acquired varia- 
tions from the normal may be transmitted. 
\daini has suggested that heredity may be ex- 



THE HOSPITAL BULLETIN 



plained upon the assumption that the idioplasm, 
or that part of the protoplasm possessing vital 
properties, is composed of a mass of molecules 
which form a central ring, to which side rings 
may be attached, or from which they may be de- 
tached without alteration of the central primative 
ring. Environment causes the central ring to have 
attached certain side chain combinations, and in 
this way the modifications of the tissue cells are 
consummated. In the same way environment con- 
ditions lead to further modifications in the forms 
of new lateral chain combinations. Those lateral 
chains that are last developed are the least stable 
and the most readily lost, while those which have 
been attached for a long period of time are not 
readily loosened. Thus it is that conditions pro- 
duced by the lateral chains which have been active 
for generations tend to persist, while those recent 
changes in structure or alterations of environ- 
ment produce with the general idioplasm combina- 
tions too weak to lie transmitted. 

The hereditary conditions thus far considered 
refer to immediate peculiarities, as the possession 
hv the parent of a peculiarly situated lock of white 
hair, which peculiarity is transmitted to the child, 
or the parent has six fingers or toes, which also 
appear in the offspring. 

In connection with certain diseases, hereditary 
conditions are, however, more remote, thus in 
haemophilia, or "Bleeders' disease," we find a cer- 
tain mode of transmission. The male suffering 
from the conditions may not transmit it to his 
immediate offspring, though his daughters art- 
very apt to transmit it to their sons, thus skipping 
a generation. 

Consanguinity is a dangerous hereditary con- 
dition from its tendency to accentuate family 
weakness, this danger being in proportion to the 
deviations from normal of those concerned. 

Atavism is another peculiarity in which the 
traits of remote ancestors may make their appear- 
ance, such as flat-foot, receding forehead, prog- 
nathism or protrusion of the lower jaw, and 
massive projecting ears, all characteristics of the 
lower animals and simian race. 

Many pathologists divide the subject of heredity 
into two divisions, namely, true heredity, or that 
condition just discussed, and false or apparent 
hereditv, commonly mistaken for heredity proper, 
and to which is accredited those modifications of 
the embryo by conditions occurring in pre-natal 
life. Thus certain infectious diseases, such as 



smallpox and syphilis, may he transferred from 
mother to foetus through the placental circulation 
and cause the disease acquired from the parent. 

Those predispositions or tendencies which oc- 
cur in the offsprings of tuberculous, cancerous 
and neurasthenic subjects may depend upon trans- 
mitted physiologic peculiarities, or may be nothing 
more than the result of lack of vigor of the germ 
plasm, whose development results in a feeble indi- 
vidual. 

1 luman ova are free, or almost free, from yolk, 
and are relatively very small. There has not been 
a single observation, according to Adami, showing 
that the mammalian ova is phagocytic, i. e., able 
to take up foreign particles. That minute sperma- 
tazoa should act as carriers is still more unlikely, 
and the possibility that they do so has been nega- 
tived by Gartner. 

Adami has shown that the minimum number of 
tubercle bacilli that will set up peritoneal infection 
in the guinea pig is eight; in the rabbit 24 to 30, 
and Gartner, after obtaining the seminal ejacula- 
tions from tuberculous guinea pigs, found that 
only five out of thirty ejaculations contained a 
sufficient number of bacilli to cause the disease. 
Rohlff did not once succeed in rendering rabbits 
tuberculous by injecting them with semen of men 
suffering with phthisis. Gartner concludes that 
the semen emitted by a phthisical patient does not 
on the average contain as many as 10 bacilli. 

From these experiments of Rohlff and Gaertner, 
Adami calculates that on the average, human 
seminal ejaculations contain more than 226,000,- 
000 spermatazoa, and if the semen contained not 
10, but 1000 spirochetes, the chances that an indi- 
vidual spermatazoa fertilizing the ovum should 
bear with it a spirochete and so lead to germinal 
infection are as one is to 226,000. If 1,000,000 
ratio would be 1.226, only one of 85,000,000,003 
spermatazoa having a chance of fertilizing an 
ovum. One may draw his own conclusions as to 
the chance of a spermatazoon conveying the dis- 
ease from father to the offspring. It is so ab- 
surdly minute as to be almost nil. 

That cases of syphilis in the new-born are most 
often of late intrauterine acquirement is made evi- 
dent by Chiari, who states that in 90 per cent, of 
infants presenting signs of syphilis the liver is the 
seat of the most syphilitic disturbances. Infection 
through the placenta amply explains the condi- 
tions in infants, for all the blood on its way 
through the placenta passes through the liver. 



THE HOSPITAL BULLETIN 



which is thus the organ first subjected to infection. 
Adami specifically states that whenever there are 
active and specific manifestations of tuberculosis, 
syphilis or other infective diseases of the new- 
born child, the condition is of intrauterine acquire- 
ment, and not inherited. This statement he sup- 
ports by referring to the various stages to which 
one may find the disease developed in the new- 
born. 

After an interesting series of observations of 
experiments on healthy does, Freichmann con- 
clude! that bacilli introduced into the uterus out- 
side of the amnion may some day later be found 
in the amniotic fluid, whether through the pla- 
centa < from maternal affection), through the wall 
of the foetal sac, or by passage into the developing 
ovum before the sac has developed, organisms 
may infect the embryo. These various means are 
adequate t<> explain the phenomenon without call- 
ing upon improbable infection of the ovum or 
spermatazoon prior to fertilization. 

Children of syphilitic or tuberculous parentage 
who exhibit certain stigma as foetal cachexia, mal- 
nutrition, senile expression, senescence, even mal- 
formations, are those who have acquired these 
characteristics presumably by the germ plasm pre- 
senting modifications and disturbances peculiar to 
the parental germ cell. 

After weighing the many arguments upon the 
passage of foreign substances through the pla- 
centa advanced by Bonnett, Hofbauer, Wallgren, 
Polano, Schmidlechner, Liedauch and others who 
have experimentally proven the transmission of 
iron, fat, albumosis, toxins of diphtheria and tet- 
anus, the organisms of pneumonia, relapsing fever. 
various infections due to pyogenic organisms and 
typhoid fever, which of the many mentioned is 
most frequently transmitted, due no doubt to its 
motility, it i< apparent that the functions of the 
placenta are not limited to mere absorption by 
osmosis. The adverse condition, namely, the 
transmission of materials from the foetus to the 
mother, lias been demonstrated by Savoy and 
Guserow. Therefore, we may safely say that it 
seems hardly probable that infection of the foetus 
may occur without some transmission of the or- 
ganisms, or their toxins, to the mother, and vice 
versa. 

The reason why the manifestations are not ap- 
parent at the time of delivery is due probably to a 
latent stage or period in which the spirochete de- 



velops a provisional immunity only to be followed 
by manifestations of the disease in later life. 

Keyes states, after citing "Colles's law." that the 
mother of such a syphilitic child ( Colles's Child), 
although herself remaining health}- many vears, 
almost invariably ultimately breaks out with ter- 
tiary syphilis (choc en retour), and that therefore 
the mother of a syphilitic child, even though she 
remain apparently sound, is syphilitic. 

In conclusion, let us suppose that should a father 
transmit the disease apparently only to the foetus 
by the fertilization of an ovum by a spermatazoon 
conveying a spyrochete, and to which spermata- 
zoon has been given its one 85.000,000,000 of a 
chance, according to Adami, and should this one 
spirochete be sufficient in itself to produce the 
disease, which is highly improbable and unlikely, 
the infection would not only be confined to the 
embryo, but would involve the placenta as well, 
and from there be transmitted to the mother. The 
condition would be a disease not the result of 
peculiarities of the germ plasm, but the result of 
an exogenous or mechanical infection, which we 
must admit in the true biological sense is only con- 
genital. 

The explanation of the erroneous use of the 
word "hereditary" in connection with this disease 
by the profession is probably due to the only re- 
centlv acknowledged definition of the term. 



The following letter has been received by Dr. 
Randolph Winslow from Dr. Judson J. Davis, 
class of 1891, of Beaufort, X. C. : 

Dr. Randolph Winslozv, 

Baltimore. Md.: 

Dear Sir — As an old friend and well-wisher of 
m\ old "Alma Mater," I am writing you to ask if 
you can find two or three young M.D.'s who will 
take up some good practices in the eastern section 
of this State. There are three or four fine open- 
ings in this section for young men of good char- 
acter who wish to get in a work that will bring- 
in money at once. I have nothing to sell, and only 
have the interest of my old college and my native 
seetii in at heart. If any of the young men who are 
to graduate this spring wish further information 
about these openings, I will gladly give same upon 
request. 

■With best wishes for you and the University, 
Yours very truly. 

T. 1. Davis. 



THE HOSPITAL BULLETIN 



AN ANALYTICAL STUDY OF FIFTY 
CASES TREATED IX THE GASTRI >- 
ENTEROLOGICAL DEPARTMENT OF 
THE UNIVERSITY OF MARYLAND- 
REVIEWED WITH SPECIAL ATTEN- 
TION TO THE ANTHROPOMETRIC 
MEASUREMENTS. 

By Albert Hynson Carroll, M.D., 

and 

Edw. A. Looper and Ebw. P. Kuli:. 
Class of 1912. 



Any new method or aid in the diagnosis of 
pathological conditions is not only of interest to 
the specialist, but to the profession as a whole. 

The general practitioner appreciates and makes 
use of the Widal test in typhoid, and the Was- 
herman reaction in luetic conditions. 

The obstetrician often can predict the outcome 
of a definite ease, basing his prognosis on a knowl- 
dge of die pelvic measurements. 

The gastro-enterologist has developed a valu- 
able aid in the diagnosis of splanchnoptosis by 
studying the anthropometric measurements, and 
in his effort to arrive at an index. 

Eecher and Lenhoff obtained an index which 
was arrived at by dividing the jugulo-pubic 
distance by the circumference of the waist, and 
multiplying this by 100. The higher the index, 
the -mailer is the capacity of the thoracic cavity. 
The error lies here in measuring' over and around 
such a variable part of the anatomy as the ab- 
di imen. 

R. S. Smith" based his observations on the 
varying depths of the thoracic cavity. His in- 
vestigations showed that in enteroptotic women 
the depth ranged from 13 to 17 cm., while in 
vigorous ones it was from 16 to 20 cm. 11. 
Stiller, a-- early a- 1896, pointed out the heredi- 
tary condition and elaborated the "floating tenth 
rili" idea, an anomaly often occurring in the 
habitus enteropti iticus. 

1 [emmeter, in attempting to arrive at an index, 
has taken measurements from fixed bony land- 
marks. The measurements given in this report 
are obtained according to his method. Although 
the number of cases investigated is small, the re- 
sults are significant. 



The mass of figures obtained in any such series 
of measurements soon become unwieldy and are 
perhaps of value mostly for statistical purposes. 
Although the securing of such data is quite 
tedious, the study is a most interesting one. and 
serves also to give more accurate information 
as to the relationship existing between the various 
forms of neuroses associated with splanchnoptosis. 

The size and form of the thorax as seen and 
estimated by such measurements, indicates closely 
the position of the abdominal viscera, and al- 
though we can not predict with mathematical 
exactness the position of the viscera, it will fie 
found to correspond very closely indeed to the 
outward sign-. 

Visceral prolapse may be either congenital or 
acquired. When acquired it is usually the re- 
sult of child-bearing or of excessive hard work. 

In the congenital form I think that a far 
greater number of males are affected than is 
generally suspected. Nearly all of the observers 
constantly refer to the "enteroptotic woman." In 
our clinic we treat almost as many males as fe- 
males for prolapsed viscera. 

In congenital splanchnoptosis at least, the dis- 
placements accompany a lessened capacitv of the 
thoracic cavity, which is primarily determined by 
the structure of its bony framework. And when 
such displacements are corrected the neuroses ac- 
companying such displacements are quite fre- 
quently eliminated or improved. At the same 
time those forces which were lacking, for the 
proper development of the thoracic walls exert 
a profound effect on the abdominal musculature, 
and those supports which normally hold the vis- 
cera in position. 

W. J. Butlerf reviews the previous literature 
and adds some interesting observations concern- 
ing the acquired as well as the hereditary form 
of the enteroptotic habit. He believes that evi- 
dences are observable during childhood, but that 
actual ptoses are practically first seen at the 
period of puberty. 

It is not a satisfactory state of affair- to be 
content alone to relieve this condition which often 
only evidences itself in later life, but we should 
seek ways of preventing its full development. 

The frail child should be watched, and its 
tendencies more intelligently fought by main- 
taining a fair state of nutrition in order to direct 



1. 1/. A., October, linn. 



Uour. A. If. I„ I mi- 1 1911 



8 



THE HOSPITAL BULLETIN 



it to a more vigorous adult condition. Much has 
been said of late regarding treatment but I have 
not seen systematic muscular exercises advocated 
for such children. It appears to me that if, in the 
frail child, properly directed exercises; the kind 
that would tend to increase the diameters by 
strenghening the respiratory muscles, and hence 
the capacity of the chest, and which would develi ip 
the muscles in the abdominal walls were insti- 
tuted, many cases which in adult life are classed 
as suffering with Glenard's disease, would escape 
with none or only a few symptoms of this dis- 
tressing condition. 

hi the analyses of these gastroenterological 
cases attention has been especially directed to the 
study of the anthropometric measurements. This 
collection does not consist of a chosen group, but 
represents rather fairly the type of cases coming 
before our clinic at the University of Maryland 
from year to year. 

Each of these histories was prepared by two 
students working in the dispensary clinic under 
direction, and later it was read by one of them 
before the entire class and criticised at the weekly 
clinic. In nearly every case the patient was pre- 
sented also at this time and seen by Dr. J. C. 
1 [emmeter while the history was being read. Any 
suggestions or alterations then made by him were 
incorporated before it was finally accepted and 
filed for future reference. 

It is interesting to know that 16 per cent, were 
cases of gastroptosis or enteroptosis and that 68 
per cent, were cases of hypochlorhydria or were 
anacid in character. Eight per cent, were carci- 
noma and io per cent, were cases of acute gas- 
tritis. In one case of lead poisoning the gastric 
symptoms were marked, but there was only a 
slight wrist drop and no blue line on the gums. 
In an undiagnosed but carefully studied case, with 
no etiological factors discoverable to explain a 
persistent vomiting of months' duration, a recent 
operation in this hospital discovered a gummatous 
testicle. There was no history of lues, and any 
venereal disease had been stoutly denied by the 
patient, nor was there any clinical evidence of 
specific trouble. Several gastric and one duo- 
denal ulcer were diagnosed and operated on by 
Dr. J. Holmes Smith and Dr. St. Clair Spruill. 

The "X-ray bismuth meal" method was of de- 
cided value in confirming the diagnosis in several 
ulcer cases and in one of spasm of the cardiac orifice 



of the stomach, but in a case of post-operative 
"viscuous circle vomiting" the shadow picture 
was of no diagnostic value.* 

SPLANCHNOPTOSIS GROUP. 

In this group (16 per cent, of the whole num- 
ber) the anthropometric measurements showei 
marked deviations from the distances between 
established bony landmarks in normal individuals. 

It is now generally accepted that when the 
infrasternal angle, i. e., the angle formed by 
drawing straight lines from the extremities of 
the tenth ribs to the xyphoid, is narrow and 
measures 75 ° or less, that a displacement of the 
viscera may be present. If with the above small 
angle one or both tenth ribs, Stillers sign, are 
movable or floating, expectations are heightened. 
Again, if the base of a triangle which has for its 
apex the xyphoid and for its sides lines drawn 
from the xyphoid to the two ant. sup. spines of 
the ilium is nine and one-half inches or over, and 
the chest is narrowed in both its transverse and 
arterio-posterior diameters, a positive diagnosis 
can often be predicted from inspection alone. 

In these cases the angle averaged 64.5 : . 

The anthropometric measurements averaged a? 
follows : 

From manubrium to xyphoid, 8.15 inches. 

From manubrium to umbilicus, 14.43 inches. 

From manubrium to symphysis, 21.19 inches. 

From xyphoid to right ant. sup. spin, ilium. 
1 1 inches. 

From xyphoid to left ant. sup. spin, ilium. 10.9 
inches. 

The distance from "spine to spine" was 9.75 
inches. 

The circumference of the chest at the level of 
the xyphoid was only 29.65 inches. 

The weight averaged 121 pounds and the height 
5 feet 6 inches. 

The youngest was 27 years and the oldest was 
48, with a combined average of 40. 

Of these, 35 per cent, were women, 75 per cent. 
were white and the remainder were colored. 

The floating tenth rib, which has been men- 
tioned previously, occurred in 65 per cent, of these 
cases, 50 per cent, having bilateral movable tenth 
ribs. 

It will be noted that the infrasternal angle i- 



•It is to lie remembered that to this clinic and to Dr. 
Hemmeter, who was aided in the laboratories by Dr. Frank 
Martin, belongs the honor of originating and firsl calling 
attention 10 this method, although other observers later have 

rediscovered his method. 



THE HOSPITAL BULLETIN 



small. In no case was it as great as 75°. In only 
a few of these cases were both tenth ribs firmly 
attached. The left was more often freely mo\ 
able than the right. 

There was a noticeable narrowing in both the 
transverse and in the anterio-posterior diameters 
of, the thorax, with a marked elongation of this 
structure. 

This observation is of distinct diagnostic sig- 
nificance as regards congenital enteroptosis, and 
was associated, as is almost universally the case, 
with marked infirmities of the entire nervous sys 
tern. In all these cases the stomach was markedly 
displaced, and in several instances the greater 
curvature extended tei the level of the pelvic brim. 

The heart was also noted to be displaced toward 
the middle of the thorax in these gastroptosis 
cases where the lateral and anterio-posterior di- 
ameters wire narrowed. About 33 per cent, of 
ises e: hibited associated neurasthenic con- 
ditii in-. 

In 36 per cent, of these eases there was a 
diminished secretion of I TCI. but in one case there 
was a hyperchlorhydria of 38 . The total acidity, 
combined acids and acid salts averaged 45°. In 
all these cases mucus was present in the test meals 
or in the washings, and often in large amount. 

The ' >ppler Boas bacillus was found in several 
- in which there was no suspicion or evidence 
of malignancy. 

The "modified glyco-tryptophan" test for can- 
cer was made in a number of suspicious cases, but 
rile results were negative. 

Chronic Mucous Gastritis. — Sixty-eight per 
cent: of these case-, were chronic in character. 
high percentage can, however, be accounted 
or lie the fact that each ease is kept under obser- 
vation for a sufficient period to make a fairly ac- 
curate diagnosis. Chronic cases naturally return 
a sufficient number of times to allow of a urinary, 
fecal, complete physical and blood examination 
being made, as well a-- an analysis of tile Stomach 
contents after test meals. 

Acute attacks of gastritis, which are. however, 
often quite transient in character and frequently 
relieved by a few treatments, neglect to return un- 
til a later date, if at all. for discharge. This ren- 
ders the data already obtained valueless. I I 
the high average per cent, of chronic case-. 

In these cases of chronic gastritis 40 per cent, 
showed a condition of an acidity; 33 per cent. 
showed a condition of hypoacidity: 21 per cent. 



showed a condition of hyperacidity. The total 
acidity averaged 33.05 . There were nearly twice 

as many males as females; 52 per cent, were 
white and 48 pel" cent, were colored. 

The anthropometric measurements of the above 
class were : 

M. to X., 8.02 inches. 

M. to l'., 1 4.24 inch.-. 

M. to S., i' 1. ''3 inches. 

X. to R. S. S., in. vi inches. 

X. to L. S. S.. 10.8X inclh 

S. to S., 9.61 inches. 

C. at X.. 30.01 inches. 

A. at X..V7.34 . 

Weight, 131.'' pounds; height, 5 feet 5 A 
inches: age, 36 years. 

It will be observed here that the length of the 
line from the manubrium to the symphysis is only 
19.65 inches, while in the enteroptosis group it 
was 21.19 inches. Also the circumference at X. 
was less in the enteroptosis group, being only 
29.65 inches. The distance between the spines 
of the ilium is also less in this last group, while 
the height is practically the same in both. The 
angle in this second series also exceeded the first 
group by 13°, while the patients averaged 10 
pounds heavier. 

CARCINOMA GROUP. 

Measurements averaged ; 

M. to X., 9 inches. 

M. to U., 13.25 inches. 

M. to S., 21.80 inches. 

X. to R. S., 1 1. 12 inches. 

X. to L. S., 1 1. 12 inches. 

S. to S., IO.62 inches. 

C. at X., 31 inches. 

Angle at X.. 82. 5 '. 

Weight, km: pounds; age, 47 years. 

Three white; one colored; one male; three 
females. 

There was an absence of IIC1 in all these ca-e-. 
Oppler Boas bacillus was present in three of 
them. Blood was found in only one c 

: 1 1; \stkitis. 

Measurements: 

M. to X., 7.9 inches. 

M. to I'., 14 inches. 

M. to S., 10.41 inch' 

X. to R. S. S., 10.66 inch 

X. to L. S. S., IO.66 inches. 

S. to S., 0.33 inches. 



IO 



THE HOSPITAL BULLETIN 



C. at X., 30.33 inches. 

Height. 5 feet O 1 .. inches; weight, 139 pounds: 
age, 28 years. 

HC1 was diminished in three-fifths of these 
cases ; two-fifths showed an anacid condition. 

Among the rarer diseases which were discov- 
ered after the patient had applied for relief of 
"stomach trouble" was one case of tubercular and 
another of amebic dysentery. There was one 
case of gastric crices with tabes dorsalis, one of 
true gastralgia, and many which were secondary 
to chronic appendicitis, tubercular invasion, pelvic 
disorders, floating kidney, and so on. 

One ulcer case showed a hyperchlorhydria of 
90 free HC1. There was one case in which 
rumination accompanied a hyperacidity, and one 
of wind swallowing. 

The average measurements for the entire group 
were as follows : 

M. to X.. 8.34 inches. 

M. to I'., 12.46 inches. 

M. to S., 20.50 inches. 

X. to R. S. S., 10.74 inches. 

X. to L. S. S., 10.71 inches. 

S. to S., y.74 inches. 

C. at X.. 30.71 inches. 

Angle ai X.. 77.09 . 

The smallest substernal angle was 45°; the 
largest was 95°. 

Four per cent, of the angles were between 90 
and 100° : 3d per cent, of the angles were between 
<jO° and 8o° : 42 per cent, of the angles were be- 
tween 80° and 70 ; 10 per cent, of the angles 
were between 70° and 60 ° ; 2 per cent, of the 
angles were between 60" and 50 ; 2 per cent, of 
the angles were between 50° and 40 . 

The average age of these patients was yj years. 
The youngest was 13 and the oldest 57. The 
average weight was only 13 1.5 pounds, and the 
height was 5 feet 5 '4 inches. 

Jt was interesting to note that in many of the 
cases in which enteroptosis existed there had been 
no previous history obtainable of marked or at 
times of any real gastric disturbances until 
shortly before applying for treatment. These 
cases often, from their general abearance, do not 
suggest a condition of displaced viscera until dis- 
robed. The diagnosis then should be as easily 
made as is the condition of contracted pelves to 
the obstetrician or the probable present or past 
existence of adenoids to the rhinologist, 



These cases fairly well represent the clinical 
material available for study, as they are similar 
t<> the class of patients presenting themselves 
from year to year at the dispensary clinic, where 
over 1700 treatments were given in the "stomach 
box" alone to over 500 patients in 1910. 

Of these, 65 per cent, were males, 35 per cent, 
females, 67 per cent, white and 33 per cent, col- 
ored ; J2 per cent, were married. The youngest 
treated was 12 years old, and the oldest 67, the 
average being 34 years, and the average above 30 
was 42 years. Over 50 distinct occupations were 
represented, and of these "laborers, housewives 
and tailors" were far in the majority. 

There has been but little effort in this analysis 
to draw any conclusions. We endeavored only 
to arrive at averages in regards to age. sex, occu- 
pations, anthropometric measurements, chemical 
examination of gastric contents, etc. 



THE SYMPTOMATOLOGY OF TYPHOID 
FEVER AND ITS COMPLICATE >NS. 



By C. \Y. RauschenbacHj 

Senior Medical Student. 



In the consideration of the symptomatology 01 
typhoid fever it should be borne in mind that 
typhoid, or enteric, fever varies considerably in 
individual cases both as regards character and 
intensity, this being due partly to the virulence 
and localization of the poison and partly to a 
mixed infection. 

Statistics show that at least 50 per cent, of all 
cases occur during the months of August. Sep- 
tember and Octoberj and two-thirds of all cases 
between the ages of 15 and 30; yet you should be 
ever mindful of the fact that in the temperate zone 
it is an endemic disease, affecting those of all ages, 
the youngest and oldest cases reported being, re- 
spectively, aged six months and J^, years. 

There is no one early symptom of the disease 
which is diagnostic, but it is the syndrome, viz., 
chilly sensations, headaches, lassitudes, inapti- 
tude for work, anorexia, diarrhea, epistaxis, ab- 
dominal pain, which come on insidiously ami 
grow progressively worse, which is suggestive. 
Any "lie of the above symptoms may. however, 
so predominate the scene that unless you are a 
careful examiner you may fail to elicit the other 
symptoms from the patient, and hence may mis- 
take the condition for one of an acute neurotic. 



THE HOSPITAL BULLETIN 



ii 



pulmonic, gastric or nephritic disorder by the 

predominance of their respective symptoms. Dur- 
ing this stage the patient usually meanders about 
the house, and finally takes to bed. 

During the first week after going to bed the 
most characteristic conditions which will aid you 
in your diagnosis are noted, viz., the steady rise 
of fever, the evening record rising a degree to a 
degree and a half higher each day until reaching 
103-104 Fahr.; the relative bracchycardia, from 
100 to 110, with a pulse of full volume, low ten- 
sion and very often dichrotic. and finally toward 
the end of the week the enlargement of the spleen, 
the outcropping of the rose spots, and tympanitis 
clinch the diagnosis. All during this period the 
patient usually complains of a cough, bronchitis, 
headaches, and may even have mental confusions 
and wandering at night. 

During the second week after taking to his bed 
all the symptoms become aggravated, the fever 
remains high, the morning remissions are slight, 
the pulse becomes rapid and loses its dichrotic 
character, the face looks heavy, and the tongue in 
severe cases becomes dry and covered with a 
brownish fur. 

In the third week the temperature shows 
marked morning remissions, and there is a grad- 
ual decline in the fever. Diarrhea and meteorism 
may now occur for the first time, and vou also 
have the coming on of the signs of weakness, viz., 
loss of rlesh. feebleness of the heart and muscular 
tremors. 

With the fourth week convalescence usually be- 
gins, the temperature reaches the normal point, 
the diarrhea stops, the tongue cleans and the de- 
sire for food returns. 

SPECIAL SYMPTOMS AND SERUM DIAGNOSIS. 

Rose spots are characteristic hyperemic spots 
which appear from the seventh to tenth day. and 
usually first upon the abdomen. They are slightly 
raised, flattened papules, which can be distinctly 
felt by the finger, of a rose-red color and disap- 
pearing upon pressure. They come out in suc- 
cessive crops, and after persisting for two to three 
days disappear, occasionally leaving a brownish 
stain, especially in brunettes. These spots occa- 
sionally appear first upon the back and lower por- 
tion of front chest wall instead of upon the abdo- 
men, and. indeed, in the past season this has been 
the rule instead of the exception at this hospital. 

Blood. — Nearly all cases of typhoid are associ- 
ated with an anemia, some reaching* as low as 



1.300,000 R. 1!. C. In all uncomplicated cases 

there is a leucopenia, with a relative lymphocyto- 
sis. I hie to the anemia, the hemoglobin is re- 
duced, but the color index is plus 1. It should 
also be remembered that typhoid is a bacteremia. 

G astro-intestinal Symptoms. — The symptoms 
of this tract should be considered merely as mani- 
festations of hyperirritability, and hence you may 
have either constipation, diarrhea, or alternately 
constipation and diarrhea. 

Bronchitis is one of the most frequent of the 
initial symptoms. Epistaxis precedes typhoid 
more frequently than any other febrile affection. 

Ehrlich's Diaso Reaction. — This test has fallen 
into disuse hecause of its unreliability, i. c, not 
all cases of typhoid react, and a positive reaction 
occurs in miliary tuberculosis, malaria, and occa- 
sionally in other conditions associated with high 
temperatures. 

Widal's Agglutinative Test. — As regards this 
test, it should, in the first place, be borne in mind 
that the formation of agglutinins is a process 
which proceeds simultaneously with the establish- 
ment of immunity, and therefore the reaction 
rarely develops before a week or 10 days. It is 
not absolutely diagnostic, as other microbic infec- 
tions may give the reaction, but these conditions 
are rare, and in only 2 l / 2 per cent, of cases is it in 
error, whilst it is present in 00 per cent, of all 
cases of typhoid infection. This reaction may 
persist for many years after the disease, ami hence 
the fact of having had typhoid before. or having 
been immunized against it by vaccines should 
always be taken into consideration. It should 
also lie borne in mind that the reaction is not an 
index as to the severity of the disease, as you may 
readily obtain agglutination in mild cases and 
again secure none in severe cases, or vice versa. 

Recovery of Typhoid Bacilli. — The recovery of 
typhoid bacilli from the patient's blood or from 
suspected rose spots i s absolutely indicative that 
the illness is that of typhoid, but this is a pro- 
cedure not practical for the average physician. 
The recovery of typhoid bacilli from the feces 
and urine, a difficult procedure, does not. however. 
necessarily indicate that the condition is typhoid, 
as carriers, and even those who have not had the 
disease, sometimes harbor them in their gall-blad- 
der and kidney. 

SYMPTOMS OF COM PLK ATI0NS. 

Hemorrhage. — From the end of the second to 
the beginning of the fourth week one should al- 



12 



THE HOSPITAL BULLETIN 



ways be on the alert for hemorrhage, and espi ■ 
ally if tympanitis be present. The most charac- 
teristic symptoms of it are a sudden drop of six 
to seven degrees of temperature within a few 
hours, with a corresponding rise in the pulse and 
respiratory rates, and the former may even cross 
the temperature curve. Later blood will appear 
in the stools, either fresh or tarry, and there is a 
soft, boggy mass in the abdomen. You should 
not. however, wait for the blood to appear in the 
stools before starting treatment, but if the other 
symptoms above mentioned be present it is best 
to always presume hemorrhage to be present and 
immediately institute treatment, for by such a 
procedure you can do your patient no harm, and 
in the majority of cases it will later be found by 
the blood in the stool that hemorrhage has oc- 
curred. 

Perforation. — The symptomatology of this seri- 
ous complication as described in the various 
standard textbooks would never lead one to make 
an early diagnosis of perforation, but would 
necessitate the oncoming of a peritonitis before 
recognition. This was first pointed out by Dr. 
Bagley of this city. Perforation usually first man- 
ifests itself by the sudden oncoming of sharp 
lancinating pains over McBurney's point, extreme 
tenderness over the same area, and muscular 
rigidity due to a spasm of the rectus muscle. The 
occurrence of these three cardinal signs without 
any other reactions would warrant an explora- 
tory laparotomy, as typhoids, relatively, bear op- 
erations exceedingly well. You should never wait 
for the Hippocratic fades, thready pulse, vomit- 
ing, leucocytosis, shallow respirations, etc. — as 
these are symptoms of peritonitis, and after their 
development the chances of the patient are mark- 
edly les-ened. From the above it is seen that it is 
absolutely essential that everyone treating a case 
of typhoid should become perfectly familiar with 
his patient's abdomen, and especially so if hem- 
orrhage has occurred, as 20 per cent, of all per- 
forations are preceded by hemorrhage. 

7 he Symptoms of Typhoid in Children. — Ty- 
phoid runs a much milder course in children, and 
the severity of the symptoms bears a direct rela- 
tii mship to the age of the patient, i. e.. the younger 
the patient the less severe the symptoms and 
course of die disease. There is frequently a sud- 
den onset, with fever, prostration and vomiting. 
c hills and epistaxis are e< >mparatively rare. There 



may be absolutely nothing characteristic of the 
alimentary tract or there may be mild constipa- 
tion or diarrhea. The skin eruption is less abun- 
dant, less constant and less characteristic than in 
adults. The initial rise in the temperature curve 
is more rapid, the remittant character during the 
second week is less marked, and the average dura- 
tion is shorter than in adults. The pulse is rela- 
tively rap/id, and dicrotism rare as compared with 
adults. As a rule, the nervous manifestations are 
much more prominent than the intestinal symp- 
toms, but the extreme neurotic disorders are rare- 
ly seen, headaches and mild delirium at night be- 
ing the chief manifestations. Occasionally in 
severe cases the nervous symptoms may simulate 
meningitis. 

Resume. — From the foregoing it is seen that 
the salient points upon which a conclusive diag- 
nosis of typhoid may he established are: 

1. The demonstration of the specific causal 
agent, the typhoid bacilli, in the body of the pa- 
tient. 

2. By the demonstration of the changes in the 
blood and tissue fluids giving their, specific agglu- 
tinative properties, and 

3. The recognition of a symptom-complex, 
viz., the temperature curves, the intestinal symp- 
toms, the characteristic rash, the enlarged spleen 
and other less prominent symptoms: character- 
istic of the reaction of the organism to the typhoid 
bacillus. . 

The Eta Chapter of the Phi Sigma Kappa gave 
an "At Home" to their friends at their new home, 
816 Park avenue, February 0. i')i2. 



Extracts from some letters : 

"With my best wishes for a successful year."' — 
George H. Steuart. M.D., class of 1800. of Otto- 
man, I 'a. 

"Can"t afford to he without The Bulletin, as 
it keeps me in touch with what is going on at the 
old University. I find something in every number 
that is both interesting and instructive, ['ve en- 
joyed Prof. Winslow's 'See America First'; also 
Prof. Ashby's 'A Hurried Trip Through Eu- 
rope.' "—/r. C. Curry. M.D., class of [881, Flem- 
ington, W. J 'a. 

"1 enjoy reading Tin: BULLETIN very much, 
and am always glad when it comes to my desk." — 
T. . I. Matthews, M.D., class of 1890, Castalia, 
North Carolina. 



THE HOSPITAL BULLETIN 



13 



THE HOSPITAL BULLETIN 

A Monthly Journal of Medicine and Surgery 

PUBLISHED BY 

THE HOSPITAL BULLETIN COMPANY 

608 Professional Building 

Baltimore, Md. 



Subscription price, 



$1.00 per annum in advance 



Reprints furnished at cost. Advertising rates 
submitted upon request 



Nathan Winslow, M.D., Editor 



Baltimore, March 15, 191: 



RETROSPECT .VXD PROSPECT. 



In 1893 the Medical School of the University 
of Maryland had been So years in existence, and 
there was not one cent of endowment. Some years 
previously a futile attempt was made to secure 
fund-, to the extent of appointing a committee, 
whose names were published in the animal an- 
nouncement, and there the effort ceased. In 1893 
J >r. Eugene E. Cordell, then and now an enthusi- 
astic anil loyal alumnus, had a clear vision of the 
urgent necessity for an endowment, and sounded 
a clarion note of warning- and a ringing appeal 
for aid. This appeal fell upon deaf ears and on 
stony hearts. In 1897, at a meeting of the alumni 
held in Chemical Hall in the Medical School, Dr. 
Cordell again sounded the alarm and called for 

criptions. Dr. Randolph Winslow of the class 

■ose and said he wished to be the first to 

contribute to a fund for the endowment of the 

".Medical School, and a number of others also 

.■'■d their support. The fund increased very 
slowly, but during the year 1007. as a result of 
the centennial celebration of the founding of the 
University, a considerable increment was secured. 
Funds were established for various purposes, 
hut practically fur two great objects — in 
the endowment of the Medical School, (2) an 
endowment fund for general University purpi 
In the nearly five years that have elapsed since the 
centennial celebration these funds have gradually 
grown, mostly through the unselfish efforts of Dr. 
* '< irdell, and the total amount of the funds now in 



hand is considerably more than $40,000. This is 
not a large sum. but it is a long way better than 
nothing, and it is increasing steadily. The Fac- 
ulty of Physic fund, which can he applied to the 
chair of pathology, at this writing amounts to 
$16,882 in hand. The Robinson bequest has been 
paid and is in the hands of the trustees of the 
Endowment Fund, though a generous deduction 
was made by the State for the collateral inherit- 
ance tax. We are therefore making progress 
and we must not be discouraged., but must re- 
double our efforts, and look forward. 



SECOND (ALE FOR DINNER. 



Twelve months have rolled around since we 
first began the effort to raise $100,000 for the 
endowment of the department of pathology. The 
work was undertaken because we saw an impera- 
tive need, and because there was no one else who 
seemed able or willing to make the effort. It is 
an effort that is not only distasteful to the writer, 
but one for which he feels his unfitness. He has 
expended his energies mostly upon the graduates 
of the Medical School, and wdiile the results have 
not been in proportion to the effort, he is pro- 
foundly thankful to the considerable number who 
have responded to the call. A widespread inter- 
est has been aroused, and we believe there arc 
many others who, as time and opportunity pre- 
sent, will contribute to the cause. Since the ap- 
peal was first made, in March, 1911, conditions 
have greatly changed, and we are now confronted 
with the necessity of supplying six paid labora- 
tory instructors, who must devote their entire 
time to teaching and research. A school will not 
be in good standing that does not comply with 
this requirement, and its graduates will not be 
allowed to practise in New York. The Council 
on Medical Education of the American Medical 
ociation and the Association of American 
Medical Colleges view askance schools that do not 
have their scientific chairs filled by full-time, sal- 
aried instructors. The University of Maryland 
must not lag in the rear, but must keep in the 
advance. This will still further strain our re- 
sources, and make it still more imperative that we 
receive assistance from our friends. Many of us 
in our travels who may have neglected to re^p 
to the call to dinner, or who may have been 
crowded oul by others more vigilant than our- 



V 



14 



THE HOSPITAL BULLETIN 



selves, know how pleasant is the voice of the 
dusky herald as he passes through the train and 
cries "Second call for dinner!" We also are now 
passing through the train, and we loudly cry, 
"Second call for dinner!" 

The subscriptions to March i, 191 2, are as 

follows : 

Robinson bequest $5000 00 

Dr. Hugh Hampton Young, J. H. U. . . 100 00 

Prof. R. Dorsey Coale, Ph.D 100 00 

Dr. S. J. Meltzer, LL.D., New York. . . 10 00 

Dr. Gideon Timberlake 25 00 

Dr. Gordon Wilson 50 00 

Mr. H. P. Ohm 10 00 

Dr. Samuel W. Moore, D.D.S 25 00 

Dr. A. Sagebein, D.D.S. , Cuba 5 00 

Thomas C. Basshor Company 10 00 

Hospital Bulletin 10 00 

Maryland Medical Journal 5 00 

Miss C. M. Selfe 5 00 

Mr. George Lewis, Florida 50 00 

Mr. J. Henry Smith 25 00 

Mr. R. A. Krieger 5 00 

Summers Printing Co 15 00 

Williams & Wilkins Company 50 00 

Geo. W. Walther & Co 15 00 

Muth Bros. & Co 10 00 

Dr. John J. R. Krozer, 1848 50 00 

Dr. Eugene F. Cordell, 1868 10 00 

Dr. John G. Jay, 1871 25 00 

Dr. C. R. Winterson, 1871 10 00 

Dr. Chas. H. Diller, 1872 20 00 

Dr. Joseph T. Smith, 1872 10 00 

Dr. W. J. Young, 1872 25 00 

Dr. Isaac S. Stone, 1872 10 00 

Dr. Thomas A. Ashby, 1873 100 00 

I )r. David W. Bulluck, 1873 100 00 

Dr. Robert Gerstell, 1873 5 00 

Dr. Randolph Winslow, 1873 100 00 

Dr. James W. Humrichhouse, 1873. ... 25 00 

Dr. 1 1. T. Harrison, 1874 5 00 

Dr. John D. Fiske, 1875 5 00 

Dr. Wilmer Brinton, 1876 100 00 

Dr. Wm. E. Wiegand, 1876 10 00 

1 >r. Thomas Chew Worthington, 1876. . 5 00 

Dr. R. II. P. Ellis, 1877 10 00 

Dr. I.. Ridgely Wilson, 1880 5 00 

Dr. Charles S. Mitchell. 1881 100 00 

1 )r. 1.. Ernest Neale, 1881 100 00 

Dr. F. L. Meierhof, 1S81 50 00 

I >r. James M Craighill, 1882 25 00 



Dr. J. M. Hundley, 1882 250 00 

Dr. Henry Chandlee, 1882 25 00 

Dr. Benjamin F. McMillan, 1882 10 00 

Dr. Charles C. Harris, 1883 10 00 

Dr. Louis W. Talbott, 1883 25 00 

Dr. Isaac H. Davis, 1885 100 00 

Dr. B. Merrill Flopkinson, 1885 25 00 

Dr. J. C. Perry, 1885 100 00 

Dr. H. C. Reamer, 1885 10 00 

Dr. Frank Martin, 1886 100 00 

Dr. John R. Winslow, 1888 50 00 

Dr. C. W. McElfresh, 1889 100 00 

Dr. Joseph E. Gichner, 1890 25 00 

Dr. St. Clair Spruill, 1890 150 00 

Dr. Rupert Blue, 1892 100 00 

Dr. Frank J. Kirby, 1892 50 00 

Dr. Andrew J. Crowell, 1893 10 00 

Dr. Walter B. Kirk, 1893 5 00 

Dr. Martin J. Cromwell, 1894 50 00 

Dr. Charles T. Harper, 1894 50 00 

Dr. Henry Lee Smith, 1894 10 00 

Dr. Geo. H. Hammerbacher, 1894 25 00 

Dr. Harry Adler, 1895 100 00 

Dr. Jose L. Hirsh, 1895 50 00 

Dr. John McMullen, 1895 5 00 

Dr. Joseph W. Holland, 1896 50 00 

Dr. R. W. Sturgis, 1896 2 00 

Dr. Robert H. McGinnis, 1897 5 00 

Dr. Compton Riely, 1897 50 00 

Dr. Guy Steele, 1897 15 00 

Dr. Page Edmunds, 1898 50 00 

Dr. Albert J. Bossyns, 1898 5 00 

Dr. Edward E. Lamkin, 1898 25 00 

Dr. L. W. Armstrong, 1900 10 00 

Dr. S. Demarco, 1900 50 00 

Dr. M. S. Pearre, 1900 5 00 

Dr. Irving J. Spear, 1900 50 00 

Dr. William Tarun, 1900 50 00 

Dr. John Houff, 1900 25 00 

Dr. Wm. II. Smith, 1900 25 00 

Dr. J. D. Reeder, 1901 50 00 

Dr. Nathan Winslow, 1901 50 00 

Dr. Wm. R. Rogers, 190T 25 00 

Dr. Frederick N. Nicholls, 1902 15 00 

Dr. Arthur M. Shipley, 1902 250 00 

Dr. II. C. Davis, 1902 10 00 

Dr. II. L. Rudolf, 1902 25 00 

Dr. Wilbur P. Stubbs, 1902 5 00 

Dr. Hugh Brent, 1903 25 00 

Dr. A. R. Hunter, 1903 25 00 

Dr. Louis B. Henkel, 1903 25 00 

Dr. G. C. Lockard, 1903 25 00 



THE HOSPITAL BULLETIN 



15 



Dr. Geo. S. M. Kieffer, 1903 25 00 

Dr. H. J. Maldeis, 1903 25 00 

Dr. Howard J. Iglehart, 1903 25 00 

Dr. Howard W. Jones, 1903 25 00 

Dr. John T. O'Meara, 1903 25 00 

Dr. Fred L. Wilkins, 1903 25 00 

Dr. Albert L. Wilkinson, 1903 25 00 

Dr. R. C. Metzel, 1904 10 00 

Dr. Ejnar Hansen, 1904 10 00 

Dr. Charles Bagley, Jr., 1904 25 00 

Dr. Alvin B. Lennan, 1904 25 00 

Dr. Walter Van Sweringen, 1904 25 00 

Dr. M. A. Weinberg, 1904 25 00 

Dr. Herbert E. Zepp, 1904 25 00 

Dr. Robert Bay, 1905 100 00 

Dr. B. F. Teft't, 1905 100 00 

Dr. Edward L. Bowlus, 1906 5 00 

Dr. Joseph A. Devlin, 1906 10 00 

Dr. W. F. Sowers, 1906 25 00 

Dr. R. W. Crawford, 1906 25 00 

Dr. Matthew L. Freilinger, 1906 10 00 

Dr. Leo Karlinsky, 1906 20 00 

Dr. J. F. Hawkins, IQ06 25 00 

Dr. Richard C. Hume, 1906 10 00 

Dr. Frank S. Lynn, 1907 25 00 

Dr. T. H. Legg, 1907 5 00 

Dr. Albert H. Carroll, 1907 25 00 

Dr. Edgar S. Perkins, 1907 25 00 

Dr. W. Cuthbert Lyon, 1907 5 00 

Dr. Thomas H. Phillips, 1908 25 00 

Dr. J. N. Osborn, 1909 5 00 

Dr. E. H. Kloman, 1910 25 00 

Terra Mariae, 191 1 3 5° 

Latin- American Club. 1912 25 00 

Total $9630 50 

Additions for the month. $185. 



ITEMS 

Profs. Randolph Winslow and R. Dorsey 
Coale attended the recent meeting of the Associa- 
tion of American Medical Colleges held at Chi- 
cago. Dr. Winslow was elected a member of the 
Executive Council of the association for the com- 
i n i> - two years. 



Dr. A. W. Valentine, class of 1904. of 606 
North Carolina avenue S. E.. Washington, D. C, 
writes as follows : 

"Enclosed find check in payment of bill. 1 'In 
hope that everything is progressing satisfactorily 



in putting the University of Maryland upon an 
everlasting foundation. Not much enthusiasm 
over here; wish you could send a few spellbinders 
over to wake 'em up." 



Prof. R. Dorsey Coale is in receipt of the fol- 
lowing letter : 

"My Dear Dean — It gives me great pleasure to 
convey to you the wishes of the 'Latin-American 
Club' for the rapid and complete success of the 
noble work already begun for the endowment of 
the pathological chair of the University. 

"This work will undoubtedly place our institu- 
tion on an equal footing with the most modern 
universities of today. Toward this end the mem- 
bers of this club send their small contribution of 
$25, and hope in the future to be able to do more 
for our Alma Mater, conjointly and individually. 
"Sincerely yours. 

"Andreas G. Martin. 

"Class of 1912." 



"U e would be pleased if some of our readers 
could give us the addresses of the following 
alumni : Dr. Howard Steele Holloway, class of 
1903, who was for a time in Jacksonville, Fla. ; 
Dr. Roscoe C. Carnall, class of 1905, formerly 
located in Wavcrly Mills, S. C. ; Dr. Alexander R. 
Mackenzie, class of 1910, who was at Sparrows 
Point and later at Blakeley, W. Va. ; Dr. Alvin 
("lay McCall. class of 1910, formerly of Folkstone, 
N. C. ; Dr. Eugene B. Howie, class of 1910, of 
North Carolina ; Dr. Max Joseph Fiery, class of 
iqio, and Dr. Frank Paul Fiery of the same class; 
Dr. Lafayette Lake, class of 1906, recently located 
in Jackson, La. 



Dr. Albert J. Underbill, of the Walbert Apart- 
ments, assistant in the genito-urinary department 
at the University of Maryland, begs to announce 
that in future he will limit his practice to the 
treatment of genito-urinary diseases. 



Dr. Charles I. Stotlemyer, class of 1802. is lo- 
cated at Hagerstown, Ind. 



Dr. Robert Parke Bay, class of 1905, has been 
appointed visiting surgeon to Mount Street Hos- 
pital, Baltimore : Dr. E. H. Kloman. class of >• • 
visiting gynecologist; Dr. Hoaglaml Cook Davis, 



i6 



THE HOSPITAL BULLETIN 



class of [902, visiting laryngologist ; Dr. C. XV. 
Mitchell, class of 1881, visiting physician; Dr. 
Claude C. Smink, class of 1909, visiting physician. 



Report of cases entering the dispensary 
ments of the University Hospital for J 
1912 : 

DISPENSARY. 

New. Old. 

Surgical 157 399 

Medical 109 236 

Genito-urinary 56 242 

Eye and ear 54 78 

Tuberculosis 39 56 

Ni ise and throat 36 63 

Children 28 52 

Stomach 26 52 

Nervous 12 84 

Gynecological 46 79 

Skin ' 26 36 

Orthopedic 2 4 

Rectal 3 14 

Total 594 1305 

X-ray, 60 cases. Laboratory. 



depart- 
anuary, 



Total. 
456 
345 
298 

132 

95 
99 
80 
78 
96 

1 -'5 

62 

6 

17 



1889 



Dr. Dempsey William Snuffer, class of 1906, 

leckley, W. \'a.. writes: "I'm always glad to 

pay for The Bulletin, as well as receive it. 

It keeps me well informed as to the workings of 

the University." 



Dr. Louis YVinfield Kohn, class of iqto, is lo- 
cated at 429 Wyoming avenue, Scranton, Pa. 



Dr. Frank Oldham Miller, class of 1902, of 
Ellicott City, Md., writes that "The Bulletin 
is my only means of keeping track of former 
classmates and their whereabouts." 



Dr. Thomas B. Owings, class of 1852, of Elli- 
cott City, Md., one of the oldest alumni of the 
University, has retired from active practice dur- 
ing the past \ear. 



Dr. William Emrich, class of 11)02, j s physician 

to the Maderia Mamore Railroad at Porto Bello, 

miles from the mouth of the Amaz&n, Brazil. 



Miss Emily L. Ely. University Hospital Train- 
ing School for Nurses, class of 1909. and Mis- 



Elizabeth Getzendanner, of the same class, are 
both nursing in Jacksonville, Fla. 



Dr. James Madison Lynch, class of 1904, an- 
nounces that on January 22, 1912, he opened 
offices at 6 and 8 Dehumor Building, Asheville. 
N. C, for the practice of general surgery. 



Dr. Oakey S. Gribble, class of 1905, was a re- 
cent visitor to the University Hospital. Dr. Grib- 
ble has been wintering in the South. 



Dr. Charles Augustus Overman, class of 1903, 
has forsaken medicine to enter upon the study of 
law, and is now an intermediate in the law school 
of the University of Marvland. 



Dr. Compton Riely, class of 1897, has been ap- 
pointed a member of the visiting staff to the 
Church I [ome and Infirmary. Dr. Riely special- 
izes in orthopedic surgery. 



Dr. Edward E. Lamkin, class of 1898. who has 
been confined to the University Hospital with a 
fractured arm, which he had plated, has suffi- 
ciently recovered to return home. 



Miss Anna S. Grubbs, University Hospital 
Training School for Nurses, class of 1911, has 
joined the staff of visiting nurses, ami will work 
in the Hampden District. 



Dr. John Wilson MacConnell, class of 1907. of 
Davidson, N. C, writes as follows: 

''January 25. 1912. 
"I take pleasure in paying my subscription to 
The Bulletin, for I would not like to miss a 
number. It keeps me in touch with the Maryland 
men as no other publication could. All goes well 
with us here. As you know, I am physician to 
Davidson College and locum tenens professor of 
biology, and have been for the past three years. 
1 am hoping that a regular professor will be 
elected soon so that I may give all my time to my 
medical work. A good many of our graduates 
go to the University of Maryland. In all the de- 
partments now at Maryland we have over a dozen 
men from Davidson, and at Hopkins we have 
eight in the Medical School. I am anxious to see 
Maryland raise the standard to two vcars of col- 



THE HOSPITAL BULLETIN 



17 



lege work as a minimum entrance requirement. 
The course as now given is all right, but with 
advanced entrance requirements the Students 
could cover more ground and assimilate more 
rapidly the teachings of the professors. No 
school lias a more able faculty than that at Marx- 
land now, and though we often say 'there were 
giants in those days,' it can he safely said also 
thai 'thou dost not inquire wisely when thou say- 
est that Eormer times were better than these,' for 
.Maryland is better today than ever and has 
greater promise for a glorious future. 

"I would like to get in touch with some of the 
alumni who will go abroad this summer. I want 
to visit the European clinics, and would much pre- 
fer having a companion. 

"With all good wishes, I am, 
"Sincerely. 

"John W. MacConnell." 



Dr. Joseph Blum, class of 1885, has retired 
from a practice covering a period of 27 years, and 
will make his future home in Xew York, after a 
residence of 50 years in Baltimore. 

Dr. Blum leaves Baltimore with many regrets, 
conspicuous among these his severance of ties 
with the members of the medical profession, but 
these regrets will be appeased by recollections of 
the most pleasant relations that have always ob- 
tained between his medical friends and himself. 

Dr. Blum takes advantage of these columns in 
bidding farewell to the members of the medical 
profession of this city. 



The Randolph Winslow Surgical Society has 
been formed by 35 University students, 23 
seniors and 12 juniors, the object being to pro- 
mote closer relationship among the students of 
the medical department. The organization has 
the worthy aim of promoting in the hearts of its 
members a deep sensibility of their debt to their 
Alma Mater. 

The officers, all members of the senior class, 
are: Henderson Irwin, president; H. A. Bishop, 
vice-president; Michael Yinciguerra, secretary; 
E. P. Kolb, treasurer, and R. E. Abell, historian. 

The honorary members are Professors Ran- 
dolph Winslow, J. Holmes Smith, Arthur M. 
Shipley, Frank Martin, St. Clair Spruil. J. \Y. 
Holland and Nathan Winslow: Drs. W. T. Cole- 



man. Robert I'. Bay, Frank S. Lynn, Frank J. 
Kirby. I 'age Edmunds, J. Holmes Smith. Jr., and 
J. A. Tompkins. 

The movement which resulted in the formation 
of the societ) was Mailed hy Mr. Irwin, its first 
president. ( >n the committee that assisted him in 
formulating plans for its organization were 
Messrs. Abell, Bishop, Cochran, Sellers and 
Tullidee. 



Dr. B. Merrill Hopkinson, class of 1SS5, has 
been appointed for the twenty-third consecutive 
year president of the Baltimore Athletic Club. 



Dr. J. Dougal Bissell, class of [888, of 305 W. 
81st street, Xew York, has been elected profe 
and surgeon to the Woman's Hospital in Xew 
York. He was formerly assistant to Professor 
Cleveland, and was advanced upon the retirement 
of Dr. Bache Emmett. 



The schedule for the University of Maryland 
baseball team, C. Harry Stevens, manager, for 
the coming season is as follows: 

March 20 — Navy, at Annapolis. 

March 2- — Washington College, at Chester- 
town. 

March 30 — Western Maryland College, at 
Westminster. 

April 2 — Mount St. Mary's College, at Em- 
mitsburg, Md. 

April 6 — Dickinson College, at Carlisle, 1'a. 

April 10 — Mount St. Joseph's College, at Balti- 
more. 

April 13 — St. John's College, at Annapolis. 

April 17 — Rock Hill College, at Baltimore. 

April 20 — Randolph-Macon College, at Ash- 
land, Va. 

April 22 — Fredericksburg College, at Freder- 
icksburg. Va. 

April 27 — Pending. 

April 30 — Pennsylvania State College, at State 
College, Pa. 

May 1 — Pending with Ursinus College. 

May 4 — Baltimore Medical College, at Haiti- 
more. 

May 7 — Seton Hall College, at South Orange, 
N.J. 



Dr. Baird U. Brooks, class of 1905, of West 
Durham, X. C, is a patient at the Union Prot- 



iS 



THE HOSPITAL BULLETIN 



estant Infirmary, where he will be operated on 
by Dr. John M. T. Finney. 



UNDERGRADUATES' NOTES 



Under the Supervision of E. A. Loo per. 



Dr. J- Righton Robertson, class of 10,10, an- 
nounces the opening of his office in the Miller 
Walker Building, Augusta, da., March 1, 191 2. 



The basketball team has closed its season. 
Following is an account of receipts and expendi- 
tures lor the season : 

Expenditures. 

Incidental expenses $38 32 

I 'riming — posters, etc 9 00 

Equipment, suits, etc 70 OO 

Expenses of team to other schools 287 39 

Total expenses ?-P4 71 

Receipts. 

From games : 

From Maryland Medical College $10 00 

From Columbia University 5° °° 

From City College of New York 55 oo 

From Maryland Medical College 9 00 

From Loyola College 10 50 

From Catholic University game 2000 

From Georgetown game 20 00 

From Swarthmore game 84 

From Mt. St. Mary's game 5 65 

From Mt. St. Joseph's game 4 85 

Refund traveling expenses 140 43 

Total receipts $326 27 

( !i 1st f( ir year $7 n 44 



The theater benefit given on February 7 at the 
New Academy of Music for the benefit of the 
track team was fairly successful, though as yet 
about $70 worth of tickets are out for which no 
returns have been made to the treasurer of the 
Alumni Athletic Association. The expenses were 
as follows : 

Printing and postage of ticket- $27 01 

Paid Academy of Music 158 75 

Total $186 66 

Received Erom theater tickets $249 50 

Part of the sum received, however, was do- 
nated by persons who did not use the theater 

ticket-. 



The Athletic Association is certainlv to be com- 
mended upon the progress it has made in the short 
time since its organization at the beginning of 
the school year. The students are becoming 
more and more interested in its maintenance, and 
display much enthusiasm at each athletic meet. 
It seems unnecessary to prophesy that this will 
undoubtedly be the most potent factor in stimu- 
lating greater class spirit among the student-. 

An interesting field meet was held January i~ 
between the University and the Cross Country 
Club in the Fifth Regiment Armory, in which the 
University boys made a very creditable showing, 
taking off a number of the honors. Timanus, of 
the sophomore class, proved himself quite an 
athlete, obtaining the highest number of indi- 
vidual points, winning third place in the 50-yard 
hurdle and second place in the shot put. Porter 
and Shriver of the freshman class also won hon- 
ors, Shriver winning the 16-pound shot put, and 
Dorter second place in the pole vault. 

It has been proven that the University contains 
quite a number of good athletes who are only 
handicapped by lack of proper training, which 
they have been unable to obtain during the year 
on account of the proper facilities and the lack of 
time. However, they have always shown them- 
selves to be good sportsmen, and have sustained 
the reputation of always playing fair and honest 
games. 

* * ■':■ 

A benefit performance was given at the Acad- 
emy Wednesday, February 7. to increase the ath- 
letic fund. Most of the professors and students 
at the University attended. Quite a nice sum was 
realized, which will greatly enlarge the equipment 
for the coming year. 

:;: $ :- 

Quite a number of the senior students of the 
University intend taking the competitive exami- 
nations at the various hospitals in the city. The 
University men always show up well in these ex- 
aminations, the class of 1911 being represented 
by interne- in the principal hospitals of the city, 
having five of its members at Bayview. one at St. 
Joseph's, one at the Church Home, two at the 



THE HOSPITAL BULLETIN 



19 



Hebrew Hospital, one at Eudowood and one at 
Kernan's, besides the appointments at the Uni- 
versity I [1 ispital. 

:;; :[: '■',: 

The senior students have been greatly inter- 
ested in the practical clinics given at the different 
hospitals under the direction of professors of the 
various departments. The class is divided into 
sections to meet Dr. Hiram Woods at the Presby- 
terian Eye and Ear Hospital on diseases of the 
eyi and ear, Dr. Irving Spear at Bayview Insane 
Asylum on mental diseases, Dr. R. Tunstall Tay- 
lor at Kernan's Hospital for Crippled Children 
on orthopedic surgery and Dr. John R. Winslow 
in the dispensary of the University Hospital on 
diseases of the nose and throat. 



FRATERNITIES. 

The members of the Chi Teta Chi Fraternity 
entertained with an informal smoker at their 
Chapter House Saturday evening, January 2~ . 

The Xu Sigma Xu Fraternity gave their an- 
nual fraternity dance at Albaugh's, Wednesday, 
January 31. 

On Friday evening, February 9, the Phi Sigma 
Kappa Fraternity entertained with a tea party. 
which was followed by a dance, at their Chapter 
House "11 Park avenue. 



BIRTHS 



Mr. and Mrs. Joseph Wright of Easton, Md., 
are receiving congratulations upon the birth of a 
son. Mrs. Wright was formerly Miss Ann Eliz- 
abeth Chapman, University Hospital Training 
School fur Nurses, class of 1906. 



On February 5, 1912, Addison Clarke, son of 
Dr. and Mrs. Sydenham Rush Clarke. Dr. 
Clarke is a member of the class of 1905. 



MARRIAGES 



Dr. Napoleon Bryan Stewart, class of 1910, 
was married to Miss Edna May Revell in Tren- 
ton, X. J., November 29, 1911. The marriage 
was announced at the annual banquet of the Phi 
Sigma Kappa Fraternity and came as a great sur- 
prise to Dr. Stewart's friends. The couple, aided 
by Dr. Ralph C. P. Truitt, class of 1910, were 



married by the Mayor of Trenton, the parents of 
both having full knowledge of the marriage and 
plans. Dr. Stewart is the son of the late Dr. 
Stewart of Delta, Pa., and Mrs. Stewart is the 
daughter of Air. and Mrs. Frank S. Revell of 
Anne Arundel county. 



Dr. Vernon Francis Kelly, class of 1904, of 
3705 Falls road, Baltimore, was married to -Mis^ 
Laura E. H. Spangler, daughter of Mr. Charles 
W. Spangler at noon Thursday, March 7, 1912, 
at the residence of the bride. Liberty Heights 
avenue, Forest Park, the Rev. Dr. George 1\. 
Crose of Grace M. E. Church, Baltimore, per- 
forming the ceremony. The bride wore a blue- 
broadcloth traveling suit, with hat to match, and 
a corsage boucjuet of violets and orchids. The 
house was decorated with palms and pink roses. 
The couple, after a trip North, will reside at 3705 
Falls road. 



Dr. Arthur Edward Ewens, class of 1904, of 
Atlantic City, N. J., was married to Miss Flor- 
ence Lane Johnson, daughter of Mr. and Mrs. 
Edward Stockton Johnson, of Atlantic City, on 
Tuesday, February 27, 1912. The couple will 
reside at the Le Grand Apartments. Dr. Ewens 
was well known at the University and was very 
popular with his class. He was so unfortunate 
as to lose his mother, Mrs. ITenrietta Hill Ewens. 
who died in Baltimore during the latter part of 
January. 



DEATHS 

Dr. Gilbert C. Greenway, class of 1868, died 
at his home. 118 Wilberforce avenue. Hoi 
Springs, Arkansas. Januarv 19, 1912, aged 70 
years. Dr. Greenway was a native of Virginia. 



Dr. James S. Lovell Muscey, class of 1891, of 
Tearisburg, Va., died at Pembroke, Ya., Decem- 
ber 29, 7911, as the result of a carriage accident, 
aged 45 years. 



Dr. Thomas Robert Dougher. class of 1900. of 
Avoca, Pa., a member of the staff of Pittston 
Hospital, died at his home February 16, 1912, 
from meningitis following an attack of pneu- 
monia, aged 64 years. 



Dr. George Edward Hurst Harmon. C S. X. 



20 



THE HOSPITAL BULLETIN 



i retired), class of 1872, died at the residence of 
his aunts, Mrs. M. E. Harmon and Miss Sarah A. 
Hurst, at Cambridge, Md., March 5, 1912, of a 
complication of diseases. Dr. Harmon was the 
son of the late Dr. George and Mrs. Mary Eliza- 
beth Hurst Harmon. After graduation Dr. Har- 
mon practiced medicine for a short time, then 
entered the medical corps of the Navy, filling sev- 
eral important posts. At the time of his retire- 
ment, in 1910, Dr. Harmon was in command of 
the Navy Medical School Hospital, Washington, 
D. C. Besides his aunts, Dr. Harmon is sur- 
vived by a sister and an uncle. 



Dr. Norton Royce Hotchkiss, class of 1891, died 
at his residence in New Haven, Conn., January 
30, /I912, of leukemia, from which he had suf- 
fered for years. Dr. Hotchkiss was 41 years of 
age. lie was born at Fort Mill, S. C, August 
23, 1870, and was educated in public schools, later 
studying medicine at the South Carolina Medical 
College and the University of Maryland. He set- 
tled in New Haven the year of his graduation, 
and had been most successful. 

Dr. Hotchkiss was a member of the American 
Medical Association and the Association of Mili- 
tary Surgeons of the United States, and presi- 
dent of the New Haven Medical Association. He 
served under Governor Woodruff (1897) as sur- 
geon-general of the State. He was a director of 
the Elm City Hospital and an attending surgeon 
at St. Raphael's Hospital. Dr. Hotchkiss was 
interested in fraternal organizations, and at the 
time of his death was a thirty-second degree Ma- 
son. He is survived by his widow, formerly Miss 
Lucy E. Belk of Portsmouth, Ya., and three 
children. 



Dr. Peter H. Latham, class of 1876, died at his 
home in Weatherly, Pa., January 2^,, from dia- 
betes, aged 62. Dr. Latham was coroner of Car- 
bon county, Pennsylvania, and for many years 
visiting physician at the Laurytown Almshouse 
and local surgeon for the Lehigh Yallev Railroad. 



Dr. Mathias Adolph Edward Borck, class of 
1863, died at his home in St. Louis January 20, 
1912, from senile debility, aged yy years. Dr. 
Borck was an acting assistant surgeon in the 
United States Army, and later assistant surgeon 
of the Tenth Maryland Volunteer Infantry and 



Third Maryland Volunteer Cavalry during the 
Civil War. He took a course and graduated at 
Washington University, St. Louis, Mo., in 1874, 
and was professor of surgery in the St. Louis 
College for Medical Practitioners, of which he 
was one of the founders. 



Dr. Nathan D. Tobey, class of 1863. died at his 
home in A'aughan, N. M., January 10. 1912. aged 
74 years. Dr. Tobey was a member of the 
Golden Belt Medical Society and formerly presi- 
dent of the Salina (Kans.) Medical Association. 
Dr. Tobey practiced medicine in Salina. Kans.. 
for 25 years. For three years he was editor of 
the Salina Herald. 



Dr. John L. Blair, class of 1868, died at his 
home in Mercersburg, Pa., December 31. 1912, 



aged 66 years. 



Dr. John Fletcher Powell, class of 1853. of 304 
West Lanvale street, Baltimore, died at his home 
February 15, 1912, from senile debility. Dr. 
Powell was born in Baltimore, and received his 
early education in private schools and at Phillips' 
Academy, Andover, Mass. 

During the yellow-fever epidemic in Norfolk 
and Portsmouth in 1855, in which 31 physicians, 
natives and volunteers died, Dr. Powell was ap- 
pointed by this city as one of the health officers 
for the Old Bay Line steamers. For three 
months he traveled on the steamers, exercising 
quarantine supervision. • 

He spent one-third of the time ashore aiding 
the sick and studying the disease. As physician 
of the Baltimore City Jail Dr. Powell during the 
Civil War had more than 900 Confederate prison- 
ers under his care there. For more than half a 
century he was a member of Concordia Lodge of 
Masons. He was also a member for 55 years of 
the Medical and Chirurgical Faculty of Mary- 
land. 

He is survived by a widow, who was Miss Alice 
A. Tilyard, and five children. 



Dr. Julius Levin, class of 1905, formerly of 
Chicago, was found dead in his apartments in 
Johnstown, Pa., February T2, 1912. from acci- 
dental asphyxiation by carbon monoxid. aged ^2 
years. 



THE HOSPITAL BULLETIN 

Published Monthly in the Interest of the Medical Department of the University of Maryland 
PRICE $1.00 Pi;n YEAR 



Contributions invited from the Alumni of the University, 
Business Address, 608 Professional Building, Baltimore, Md. 



Entered at the Baltimore Post-office 
as Second Class Matter 



Vol. VIII 



BALTIMORE, MD., APRIL IS, 1912. 



No. 2 



PRACTICAL EXPERIENCE WITH SPINAL 
ANESTHESIA.* 



By Louis Winfield Kohn, M.D., 1910, 
Interne Stale Hospital, March, 1911. 



By spinal, subarachnoid or lumbar anesthesia 

is understood a method of rendering portions of 

the animal organism insensible by tbe injection 

of local anesthetics into the subarachnoid space 

if the spinal canal. 

Some of the anesthetics employed for this pur- 
pose are cocaine, tropococaine, novocaine and 
stovaine. During my connection with this hos- 
pital it has been my fortune to witness, and at the 
same time study, this mode of anesthetization, the 
immediate effects and results produced. What 
l nowledge I have acquired in this type of anes- 
thesia has been gained during my service mi- 
ller the staff surgeon. Dr. E. G. Roos, who has 
employed this means of anesthetization in con- 
junction with 80 or more operative cases. 

I will now endeavor to relate some of our prac- 
tical experiences with this form of anesthesia, 
hoping at the same time to make such as interest- 
ing as possible. The anesthetic of choice with 
Dr. Roos is stovaine, because of its comparative 
harmlessness if properly employed. The solution 
employed is from Billon of Paris, and contains 4 
per cent, stovaine. The dose varies according 
to the condition of the individuals and their ap- 
parent ages. The dose commonly emploved by 
Dr. Ron-, i- from 4 to 6 cgm., although as low as 
1 '• _ cgm. and as high as 7 cgm. have been used. 
From our experiences here certain operation- 
have been performed where either the anesthesia 
was incomplete or not of such lasting effect as to 
allow completion of operation. In such a case a 
general anesthetic has been resorted to. To over 
come any such occurrence the patient is always 

*Read before LKckawanna County Medical Society Novei i- 
ber :\ inn. al Scranton, Pa. 



ordered to be prepared for general anesthesia in 
conjunction with other preparation-. 

The material required for the injection of the 
anesthetic is a- follows: First, a wire probe with 
a piece of sterile cotton wound on one end. This 
is clipped into carbolic-acid solution (05 per 
cent.), and the spot where the needle is to be in- 
troduced is touched with this carbolic applicator. 
This spot is thus rendered antiseptic and some- 
what anesthetic. This carbolic spot is allowed to 
evaporate to dryness before puncturing, thus in- 
suring no entrance of carbolic acid into the spinal 
canal. Second, a cannula, long and thin, beveled 
at its pointy end expressly made for this purposi , 
hollow and of small caliber throughout its length. 
Third, a mandrel or puncturing rod, which fits 
into the cannula and is withdrawn as soon as you 
have determined that the subarachnoid space is 
near. Fourth, a glass syringe properly graduated. 
The one employed by Dr. Roos is of the Luer 
type and of 2 c. c. volume. Fifth, the stovaine 
solution, which come- in vials of 2 c. c. volume; 
each e. c. of the stovaine solution contains 4 cgm. 
of the active principle stovaine. All of this mate- 
rial should be kept separate and away from the 
other instruments. They should be sterilized by 
boiling in distilled water. 

The preparation of the patient will now be dis- 
cussed: — The nurse is instructed to prepare the 
patient for operation, for general anesthesia and 
for spinal anesthesia. In preparing for operation 
the proposed site of operation is thoroughly 
cleansed in accordance with the hospital method. 
viz.. tincture of green soap and water, followed 
successively with alcohol, ether and bichloride of 
mercury solution ( 1-5000). Then aseptic dress- 
ings are applied. By preparation for general an- 
esthesia is meant the withdrawal of all nourish- 
ment for a period of at least 12 hours before op- 
eration, the administration of calomel, grs. 2. in 
divided doses of gr. ' 1 every quarter hour, begun 
at least 18 hour- before operation, and the ad- 
ministration of MgSo4 sol., 1 oz.. an hour after 



22 



THE HOSPITAL BULLETIN 



all calomel has been given. A simple enema is 
also given at least six hours before operation for 
the purpose of evacuating the lower bowel and 
avoiding unnecessary defecation during the oper- 
ative procedure. \Ye next resort to the prepara- 
tion for spinal anesthesia, and this is accomplished 
by thoroughly cleansing and aseptically preparing 
the entire back of the patient I between parallel 
lines, one running through the seventh cervical 
spinous process above and the other through the 
lower border of the sacrum below as well as be- 
tween the midaxillary lines on the sides) as for 
operation described above. It has also been a 
custom in the majority of our cases to administer 
two hours before operation by hypodermic injec- 
tion morphia sulphate, gr. %, and hyoscine hydro- 
bromide, gr. i-ioo, for the purpose of slightly 
depressing the cerebral cortex, thus bringing 
about a certain degree of hypnosis, which is of 
advantage in that it materially aids in the produc- 
tion of a quicker anesthetic effect as well as the 
avoidance of any ill psychic influences. The pa- 
tient is ordered to the operating-room at a stated 
time. The surgeon and his assistants prepare for 
the operation and the anesthetic administration. 
Thorough asepsis on the part of the surgeon, his 
assistants and nurses are insisted upon and rig- 
idly observed. The instruments are all sterilized 
by boiling in distilled water. 

Preparation for the Administration of the An- 
esthetic. — The patient is placed upon the operat- 
ing table, but instructed to sit up across the width 
of the table with the buttocks resting near the 
extreme edge of the one lengthy side, whilst the 
legs will hang from the knees down on the other 
lengthy side of the table. The patient is also in- 
structed to fold the arms and bow the back so as 
t<> bring about a strong lumbar flexion. This 
flexion increases the height of each interspinous 
space and facilitates the proper introduction of 
the needle. An assistant at the same time, by 
passing an arm from behind forward around the 
patient's neck, greatly supports and steadies the 
patient. The dressings (as a result of previous 
preparation ) are next removed and the back ex- 
posed. The approximate site for injection is 
again antisepticized with alcohol and bichloride 
of mercury solution, followed by washing with 
sterile water and then dried. A sterile towel is 
then employed, the upper edge of which is applied 
crosswise over the back so as to coincide with the 
upper border of the iliac crests. We now know 



that the interspinous depression found near the 
junction of this towel with the spinal column is 
between the fourth and fifth lumbar vertebrae. 
Having once found this intervertebral space, we 
next ascertain the point for injection. This point 
is about i mm. to the right or left of the midline. 
Dr. Roos usually enters between the second and 
third lumbar vertebrae, although he has injected 
into all the interspaces between the twelfth dorsal 
and fourth lumbar vertebrae. In operations upon 
the gall-bladder or stomach he has injected be- 
tween the twelfth dorsal and first lumbar verte- 
brae. These points are easily located upon inspec- 
tion and palpation. 

The Mode of Injection. — Having located the 
point for entrance, it is touched up with the car- 
bolic-acid applicator. As soon as this carbolic 
spot has evaporated to dryness the top of the vial 
(containing the stovaine) is next broken and the 
glass syringe filled with stovaine. The cannula 
( with the puncturing rod or mandrel within its 
hollow viscus) is then introduced directly for- 
ward at a right angle to the skin. As soon as you 
feel that resistance is overcome you have pierced 
the interspinal ligament, and now it behooves you 
to draw out the puncturing rod. If you should 
have entered the subarachnoid space spinal fluid 
will drip out of the cannula; but if not, then push 
the cannula slightly forward, and after having 
overcome a slight resistance, due to the dura ma- 
ter and arachnoid membranes, spinal fluid will 
begin to drip forth. An assistant is then in- 
structed, after having allowed a few c. c. of spinal 
fluid to drip out, to place a finger over the mouth 
of the cannula. Then the surgeon arranges his 
dose in the glass syringe and connects the syringe 
to the mouth of the cannula (at the same time 
steadving the cannula). He then draws out some 
spinal fluid so as to dilute the stovaine solution, 
and then injects the entire contents of the syringe 
into the canal. A piece of aseptic gauze is placed 
over the point of injection as soon as the cannula 
is withdrawn. The patient is then slowly placed 
upon the back and a pillow is placed under the 
head. 

While waiting for anesthesia to appear all 
preparations for operation are being completed. 
A sterile sheet is also interposed between the 
head and body, so as to cut oft" from the patient 
any possible view of the operation. The ears are 
stuffed with cotton, so as to avoid hearing the 
clanging of instruments, verbal remarks, etc. 



THE HOSPITAL BULLETIN 



23 



The eyes are covered with a towel, so as to cut 
off from view anything of occurrence in the oper- 
ating-room that may have a depressing effect 
upon the patient. A small pledgel of cotton | well 
spread out) is stuck on to the tip of the nose, 
overhanging the anterior nares. This piece of 
cotton will serve as a safeguard to the respira- 
tions, indicating inspiration and expiration by its 
up and down movement, as well as the nature of 
the respirations, whether -hallow or deep and 
whither diaphragmatic or due only to the acces- 
sory muscles. As soon as anesthesia is recognized 
the operation is begun. 

In sonic eases the desired anesthesia comes on 
immediately after injection. In other eases it 
may lie necessary to raise the head end of the 
table so as to hasten on the anesthesia. This i> 
due to the fact that the stovaine solution is of a 
lower speeific gravity than the cerebro-spinal 
fluid, and just as soon as the head end of the table 
i- elevated, just so soon does the spinal or heavier 
fluid buoy the stovaine or lighter fluid upward, 
and in consequence we have our quicker anes- 
thetic effect. At times, again, when we have a 
sudden too profound anesthesia as well as hyp- 
nosis, we can lower the head end of the table, 
thus causing the stovaine to be buoyed in the op- 
posite direction, viz., toward the lower end of the 
spinal canal. The result is that the anesthetic 
influence will be confined to the lower spinal cen- 
ters only. In the majority of our cases the anes- 
thetic influence made itself manifest during a 
periofl varying from one to four minutes. Four 
minutes were usually given as the allotted time 
for the production of anesthesia t( > its full extent. 
In order to know whether anesthesia has occurred 
one must compare the sensibility of a place out- 
side of the anesthetic zone with that of a place 
where anesthesia is expected. This is done by 
pinching. If a non-anesthetized area is pinched, 
the patient will give vent to an expression of 
pain, or, if the countenance is watched, will wince. 
< In the other hand, by pinching the tissues below 
the level of injection, viz., perineum, genitals, 
thighs, etc., they will seem to have lost a certain 
degree of sensibility. The anesthesia seems to 
extend from below upward as high as the umbili- 
cus, and often times higher. Cases were noted 
where upon pinching the anterior surface of the 
chest as high as the second rib no sensibility was 
experienced. Within four minutes, as stated 
above, complete anesthesia is usually encountered. 
The senses of pain, touch and posture have disap- 



peared, and instead the patient only experiences 
;i feeling of numbness in the legs. Together 
with this, motor paralysis has occurred in the ma- 
jority of ease-. The patient could not move the 
limbs; reflexes were abolished and the character- 
istic ankle-drop was apparent — in general, a pic- 
ture of a flaccid paralysis. Then, again, there 
were cases where insensibility was most promi- 
nent and motor paralysis not so apparent. In- 
stead, only a generalized weakness occurred, 
nevertheless concomitant with thorough muscular 
relaxation. The efficiency of our anesthesia was 
easily demonstrated upon stretching the sphincter- 
am muscles and dilating the cervix uteri. The 
abdominal muscles, as well as the intestinal mus- 
culature, in nearly all of our cases underwent 
thorough relaxation. The patients absolutely 
have no feeling below the [joint of injection, and 
the limbs appear to them as dead. We have had 
certain patients upon whom, after waiting for 
15 minutes, the stovaine produced no appreciative 
anesthetic effect. In these cases chloroform an- 
esthesia was resorted to, and it is surprising to 
know how small an amount of chloroform was 
required throughout the operation. It also ap- 
peared in the majority of these cases to Dr. Roos 
and those present that extraordinary excellent 
muscular relaxation occurred. In certain cases 
where numerous operations were performed upon 
the same person, and where the effect of the spinal 
anesthetic wore oft, chloroform was resorted to 
and a very small amount was required in each 
case. The effect of the stovaine in our cases 
lasted no less than one hour; on the other hand, 
the effects wore off in periods varying from one 
to five hours. 

During the operation an assistant remains at 
the head of the table. He encourages the patient, 
watches the pulse, respirations and general ap- 
pearance of the patient, as well as complications 
should they arise. If the condition of the patient 
permits, water or lemonade may be given to 
quench thirst. In one case of a man operated 
upon for hemorrhoids there was a great desire 
for smoking. 1 lis wish was gratified by the pres- 
entation of a lighted cigar, which the patient en- 
joyed throughout the operation, none the worse 
for bis experience, liis last words upon leaving 
the hospital were: "Isn't it great stuff?" In an- 
other case of a young woman, upon whom a bi- 
lateral salpingectomy and appendectomy had been 
performed, it was hardly possible just after the 
operation to convince her that she had been oper- 



24 



THE HOSPITAL BULLETIN 



ated upon, although she remembered the operat- gastric carcinoma, where a gastroenterostomy 

ing-room, with its other attending incidents that was performed, and operable gastric carcinoma, 

dav. It is nevertheless true that in some cases the where a partial gastrectomy and gastro-duoden- 

senses are more or less obtunded, whilst in others ostomy was done, 

no such effect is at all noted. The accompanying table will give you an idea 

During the anesthesia it has occurred at times of some work done under this form of anesthesia. 
that the patient became nauseated and vomited. Besides the cases named, numerous other opera- 
By lowering the patient's head somewhat this tions upon patients of all ages and in worse con- 
nausea has been overcome. Aromatic spirits of ditions were performed. 

ammonia has also been efficiently employed for Another good feature which may be attributed 

this purpose. At times also the patient turns pale to the spinal anesthetic is the change it has 

and perspires profusely, while the pulse occasion- brought about in the time required for the per- 

ally also, as in general anesthesia, loses some of formance of our operations. The surgeon, the 

its better characteristics, and for this purpose assistants and nurses must be on the alert in order 

such stimulation as is found necessary is em- to make quick time and finish before the effect of 

ployed. No other complications or sequelae of our anesthetic is lost. Dr. Roos was exceedingly 

account occurred in any of our cases, but. on the elated at the finish of his service because of the 

contrary, T dare say, nearly every case recovered rapidity with which he was forced to operate, as 

with remarkable rapidity. well as the excellent results he attained. He is 

It was plainly seen that nearly every ease en- still employing stovaine in all of his private cases 
joyed a more speedy immediate recovery than wherever possible, and maintains that if spinal 
those operated upon under general anesthesia, anesthesia can be recommended fur operative 
The patients were not so depressed just after cases with pulmonary tuberculosis, heart and kid- 
operation as were the other eases. There was ney lesions, as well as such depressing conditions 
no nausea or vomiting after operation. What did contraindicating general anesthesia, it certainly 
prevail in certain cases fur a few hours was that can be recommended for sound, healthy individ- 
dead feeling in the legs, which gradually disap- uals. His future ideas are to employ the smallest 
peared. The patients were immediately put on efficient dose, injected into the lumbar portion of 
liquid or soft diet, as was consistent with the case, the spinal canal, at the same time observing 

We have tried this form of anesthesia on an proper technique and asepsis. In conclusion. I 

excellent variety of eases, some of which doubt- must say that our results during the past 10 

less would not have fared so well with a general months with this form of anesthesia has been 

anesthetic. For examples may lie mentioned trail- gratifying. 

matie amputations and gunshot wounds of the Up to date. Dr. E. (1. Roos at the State Hospi- 

abdomen, who came into the hospital shocked and tal has operated upon 221 eases under spinal 

apparently pulseless : also cases such as inoperable anesthesia. 

Name. '■■_ Operation. Stovaine. Time. 

Mrs. E. H. 90 vis. Nailing a fractured femur 6 cgm. i'j hours. 

)Irs II. S. 50 " Amputating leg above ankle. Setting fracture femur of 

1 ither leg 7 I hour. 

Mrs. M. C 36 " Resection head of femur 6 2 hours 5 min. 

Mrs. S. M. 7N " Plaster cast to fractured femur sA 1 hour. 

J. F. 20 " Plaiting fractured femur 1 i'j hrs. -f- chlor. V2 oz. 

Mr<. I-;. Mel). 60 " Partial gastrectomy and gastro-duodenostomy 5 " 2'4 hrs. + chlor. % oz. 

for Yj, hrs. 

M. A. 3 " Prolapse rectum 2 54 hr. -{-}£ oz. chlor. 

for i _. hr. 

F. W. 17 " Bilateral salpingectomy and appendectomy 5 1 hour io min. 

W. M. 05 Prostatectomy, suprapubic 6 1 hour. 

Mr. W. 1'. 27 " Section for ruptured ectopic and dil. and curett.,, Bab- 
cock repair and amput. cervix C< 1 hr. 25 min. + l oz. 

chlor. = 'j hr. 
Mr. B. 1 >. 2.? " Dil. and curett. and section for bilateral salpingectomy. 

hysteropexy, bilateral oophorectomy 5 " 1 hr. 10 min. + l oz. 

chlor. for ' -j hr. 

G. S. 14 mos. Herniotomy and appendectomy 1 A and A> oz. chlor. — to v> 

min. 

C. M. 13 yrs. Gunshot wound, abdomen 4 35 min. 

J. E. 13 " Curett. necrosed tibia '. 4 10 min. 



THl HOSPITAL BULLETIN 



25 



IMS H )RV ( IF THE ANAT( IMISTS OF THE 
UNIVERSITY OF MARYLAND.* 



Bj Ernest S. Bulluck, M.D., 
Wilmington, N. C. 



Alter the close of the Revolutionary War the 
colonists turned their attention to affairs at home 
with such success that our country grew in trade 
and population for the first 20 years with sur- 
prising rapidity. At the close of this period one 
finds the people of Baltimore calling for increased 
efficiency of its physicians and a separation of the 
worthy from the unworthy practitioner. ■ 

I leading this movement we find Dr. Wiesen- 
thal, who advocated the formation of a medical 
society, ft was after his death that the proposed 
organization was completed by his son Andrew, 
and beginning as the "Medical Society of Balti- 
more," it later evolved into the present Medico- 
Chirurgical Faculty of Maryland. 

Under the auspices of this society in the year 
1789 dissection was attempted. The body of a 
criminal was procured, but the populace inter- 
fered, took possession of the body and put an end 
to the project. Despite this discouragement, Dr. 
Andrew Wiesenthal lectured throughout the year 
to a class of 15 students with such success that 
the formation of a medical school was proposed 
for the following session. The proposed school, 
however, was never inaugurated, so the doctor 
continued his private course. 

About this time Dr. John Beale Davidge moved 
to Baltimore, ire was an Annapolis boy who, 
having graduated from St. John's College, had 
spent several years studying anatomv at the Uni- 
versity of Edinburgh and later graduated at Glas- 
gow University. 

He came to the city when a youth with train- 
ing and ambition, and after six years of practice 
started a private course of lectures on anatomy. 
For five years he continued this course of instruc- 
tion. In 1807, having drawn about him Drs. 
James Cocke and John Shaw, he founded the 
"College of Medicine of Maryland," which was 
later to become the Medical Department of the 
University of Maryland. Dr. Davidge, to aug- 
ment the teaching facilities in this department of 
the new school, built at his own expense a small 



•Throughout this sketch I am constantly indebted to the 
historical researches of Eugene F. Cordell, Professor of II is- 
lory of Medicine in the University Of Maryland. 



anatomical theater and procured a subject for 
dissection, but the fact became known; a crowd 
gathered, which grew into a mob, who proceeded 
to demolish the building and destroy its contents. 

It was now deemed best to procure land on the 
outskirts of the city, and to obtain legal protec- 
tion they applied to the Legislature for a charter 
for a medical college. The petition was favored 
and the charter granted on December 18, 1807, 
there being only four other medical schools in 
this country at that time. 

Under the new charter the teaching of anatomy 
was divided between Davidge and Cocke. Lec- 
tures began at once, delivered at the homes of the 
teachers. During this year the class numbered 
seven only, and there were no dissections. The 
following year the lectures were delivered in a 
dilapidated old schoolhouse on the southwest cor- 
ner of Fayette street and McClellan's alley, 
which was for four years the home of the Med- 
ical Department of the University of Maryland. 
Professor Cocke was an able anatomist, having 
had the advantage of instruction under Sir Ashley 
Cooper. He was also a good lecturer, and in 1812 
was given full charge of the department of 
anatomy. . 

At this time, the money having been previously 
raised by lottery, the present medical building, 
corner Greene and Lombard streets, was begun, 
to be completed the coming session. 

The session of 1813 found the school in the 
new building, and Dr. Cocke was to have deliv- 
ered the first lecture, but he fell ill and died at the 
hour appointed for the lecture. He was the 
school's first secretary, and the building, in which 
he never lectured, owed much for its existence 
to his keen business intuition. Dr. Davidge 
taught obstetrics for a while, but he again as- 
sumed the duties of anatomist. 

At this time practical anatomy did not consti- 
tute a prominent part of the course, and dissec- 
tion was not compulsory. The present office of 
the dean was given over to the work, as the second 
floor of the building was not completed. There 
being no demonstrator at this time, the room 
usually fell in charge of the most zealous student. 
Such a student was Godman of Annapolis, and 
when, in 1817, Dr. Davidge was confined with a 
broken thigh, Godman, conscious of his ability, 
rose to the occasion and delivered the lectures 
with such enthusiasm, mastery of words, gifts of 
speech and power of imparting knowledge that he 



26 



THE HOSPITAL BULLETIN 



lent new interest to the subject and completely 
won the admiration of his fellow-students. 

At the end of his course he wanted to stay with 
the school, hut she offered him no inducement, 
lie then made his home in the country. After a 
few years he founded a school of anatomy in 
Philadelphia. He later held many professorships 
ami wrote extensively on anatomical and other 
subjects, and although his final attainment was 
great, it was without connection with the Cniver- 
sity, who lost in him the greatest anatomist of 
his time. 

Some years later, owing to the resignation of 
Dr. Gibson. Dr. Davidge delivered the surgical 
lectures, and Dr. William Howard, an able assist- 
ant, was appointed to help in the anatomical work. 
The work was thus divided until 1S21). when Dr. 
Davidge was found to have cancer of the antrum 
of Highmore. The course of the disease was 
very painful and rapid, and he was soon confined 
to his home. 

For the remainder of the year his lectures were 
delivered by Nathan R. Smith, a promising young 
surgeon, who had previously taught anatomy in 
Jefferson Medical College. For the coming ses- 
sion Dr. John D. Wells was elected. He taught 
for one year, then returned to his home, where he 
later died of tuberculosis. 

At the suggestion of Dr. Wells the lectureship 
was awarded t'> 1 >r. Benjamin Lincoln of Burling- 
ton, Vt., whose lectures were so satisfactory that 
at the end of the year the full professorship was 
tendered him, but he firmly refused, and returned 
to the enjoyment of his home, which he valued 
more highly than professional honors. 

In 1831 the chair was filled by Dr. Thomas II. 
Wright of Baltimore, a prominent and able phy- 
sician, but not particularly interested in the study 
of anatomy. He proposed that a Dr. Turnbull 
be appointed to assist him. Finding that the fac- 
ulty had not acted upon his suggestion, he imme- 
diately resigned. During the same year the 
learned Eli Geddings was unanimously elected to 
that chair, which he held for five years, reflecting 
great honor upon the school. His resignation was 
due to the unsettled conditions in regard to the 
State control of the institution. 

After leaving the University he returned to his 
native State and became professor of surgery in 
the medical College of Sentli Carolina, from 
which school he had obtained his degree at the 
close of its first session. 



In 1837, following Professor Geddings, the 
anatomical department again fell into the capable 
hands of Dr. Nathan R. Smith. After teaching 
for a year lie resigned and left the University, 
but the duration of his absence was not long, and; 
after a few years we again find him at the head 
of the department. 

Previous to this time Dr. William Nelson 
Baker, whose father was a prominent member of 
the school's faculty, was conducting a private 
course in anatomy in the building in Cider alley, 
just behind the University. Flis class had been 
large and his ability recognized, so he was elected 
to the position vacated by Dr. Smith. Fie con- 
ducted the department with vigor and great suc- 
cess until 1841, when he died, having just attained 
the age of 30. He is represented as having been 
a man of great personal beauty and attractions, 
talented and with every promise of a brilliant 
future as a lecturer, anatomist and surgeon. 

The chair of anatomy was again unoccupied, 
and Dr. Miltenberger. "the venerable old uncle" 
of the present professor of obstetrics, was sent 
North to hear the lectures of Dr. Joseph Roby of 
Boston. So favorable was the report of Dr. Mil- 
tenberger that Dr. Roby was immediately elected 
to the vacancy. After the assumption of his du- 
ties Dr. Roby's electors were more than satisfied. 
He worked from 9 to 3 o'clock daily, and was 
very particular about his dissections, censuring the 
smallest nick of the knife and insisting that the 
linen should be perfectly clean and white. During 
his administration dissection became compulsory 
(1848), there at this time being no American 
school that demanded dissection of its students. 

This marked a new era in the teaching of anat- 
omy, and was the beginning of the method that 
is destined to supplant the lecture. Indeed, the 
practical value of dissection seemed to have been 
realized at an early date, for we find advertised 
in the catalogues "abundant dissecting material." 
which notice has been recopied even to the pres- 
ent day. 

During this same year illuminating gas was 
introduced into the dissecting hall "at great ex- 
pense," and offered the opportunity to work at 
night. 

After 15 years of service, during which time 
anatomical study at the University reached such 
importance that it commanded honorable recog- 
nition from all the great medical schools of our 
country, Dr. Robv's health began to fail, and from 



THE HOSPITAL BULLETIN 



27 



then until two years later, when he died of tuber- 
culosis, his lectures were delivered by the ever- 
efficient Dr. Nathan R. Smith. 

The year i860 opens with I )r. William A. 1 lam- 
mond, U. S. A., as professor of anatomy. 
Through his efforts microscopes were placed in 
the museum and one of the largest collections of 
slides in the country was at the command of the 
students. 

Ihe University of Maryland prides itself upon 
being the first school in America to teach micro- 
scopical anatomy, so another onward stride was 
made to a more perfect comprehension of this 
great suhject. 

1 [ammond withdrew from the University at the 
beginning of his second year and the lectureship 
again fell to the "ever present help in time of 
need." Nathan R. Smith, who completed the term 
and turned the department, in 1862, over to Chris- 
topher Johnson. This new teacher was an ar- 
dent student of histology and a skillful microscop- 
ist. and his work did much to promote the growth 
of this new phase of anatomy. 

Previous to 1866 the professors of anatomy had 
also taught physiology, hut now the anatomist 
was relieved of this branch ; physiology being 
grouped under one lectureship with hygiene and 
general path 1I1 igy. 

In 1869, after the retirement of our so many 
times professor of anatomy, Nathan R. Smith, 
Christopher Johnson was elected professor of 
surgery. The vacancy was now awarded to 
Francis T. Miles, a South Carolinian, who had 
spent about 20 years at various other schools in 
anatomical work. 

A few years later the course of instruction was 
extended from four to five months. Miles was an 
eloquent and attractive lecturer and continued 
in the department until eleven years later, when 
he was transferred to the department of phys- 
iology, where he served with great distinction. 

Dr. J. Edwin Michael, having spent six vears 
as demonstrator of anatomy, was awarded the 
professorship in 1880. During the following year 
the course was again extended, this time to five 
and one-half months. Again in 1890 the addi- 
tion of one month was made to the course. At 
the same time. April. 1890, Michael was trans- 
ferred to the chair of obstetrics. His previous 
position was then awarded to Randolph Winslow 
of North Carolina, who had since his graduation. 
t6 years before, pursued the subject with such 



fervent zeal and masterly understanding as to 
clearly demonstrate his fitness for the position. 

During the same year the course which had 
previously been two years, was extended to three-. 
The resignation of Louis McLane Tiffany was 
si 11 hi to follow and the school must have another 
professor of surgery. The material was reviewed 
and. as had ever been the case, the best surgeon 
was found in the dissecting hall. Another anato- 
mist was transferred. Dr. J. Holmes Smith, then 
demonstrator of anatomy, was made its professor. 

The course was now made to cover seven and 
one-half months and later extended to its present 
length. During the nine years that he has occu- 
pied the chair of anatomy he has greatly enlarged 
the scope of its practical work. As a lecturer, he 
is unassuming, clear, concise, separating the 
wheat from the chaff and deply impressing all 
essentials, and it is hoped that his term of service 
may he as long as it has been successful. For the 
vacancy that must some day occur the university 
will not find herself unprepared, fur she has in 
her present demonstrator, Dr. Holland, a man 
of rare ability as a dissector with God-given 
genius for teaching. With the few words that 
denote wisdom and the generous manliness that 
encourages the weary and inspires the vigorous, 
he rules by his presence and receives co-opera- 
tion anil admiration in return. 

The anatomical department gives to the student 
the most useful knowledge that he gains. It 
teaches the fundamentals upon which all future 
medical training must he based, so what could 
be more fitting and proper than that it should 
have mothered our school from the beginning. 
The other departments have drained it of its 
good men as they arose. 

The chair of surgery owes its nearly every 
occupant to the dissecting hall. The school of 
anatomy has ever been the backbone of the uni- 
versity, and who would not cherish the tender 
memory of our greatest department and those 
who made it? 



Dr. William L. Rodman, professor of surgery 
in the Medico-Chirurgical College of Philadel- 
phia, lectured in the University on "Surgery of 
the Stomach and Breast" on Friday and Satur- 
day, March 22 and 2,}. Dr. Rodman was the 
guest of Prof. Randolph Winslow during his stay 
in this city. 



28 



THE HOSPITAL BULLETIN 



REPORT OF A CASE OF ABIOTROPHIC 
CORTICAL DEGENERATION WITH 
SECTION OF POSTERIOR SPINAL 
ROOTS FOR RELIEF OF SYMPTOMS. 



By C. W. Rauseneach and W. M. Scott, 
Class of 1912. 



Name — O. L. 
Address — Baltimore. 
Age — Seventeen years. 
Sex— Male. 

Occupation — None. 

Social Condition — Single. 

Complaint — "Spasms of arms and legs." 

Family History — Father living and well. 
Mother living but in the Springfield Hospital 
because of insanity. Two brothers and two sis- 
ters living and well ; no nervous trouble. One 
sister died at the age of seven ; cause, membran- 
ous croup. Mother's form of nervous trouble 
"was sent to the above-mentioned hospital be- 
cause of spells of nervousness coming on several 
times during the day and night, evidenced by sud- 
den outbreaks of temper, with crying for about 
half an hour, and then hysterical laughter for 
about the same period of time. Occasionally she 
would run about the house, but never injured her- 
self, nor was she ever absolutely unconscious. 
These fits would usually begin after some minor 
favor was asked of her or whenever she became 
excited." Family history is negative to malig- 
nancy, tuberculosis and kidney diseases. 

Past History — At the age of ten had measles ; 
no complications. Negative to diphtheria, scarlet 
fever, pertussis, chorea, sore throat, rheuma- 
tism, typhoid, malaria, influenza, pneumonia and 
pleurisy. Has always been healthy, but was de- 
livered by instruments. 

Habits — Smokes no cigarettes, cigars or pipe. 
Drinks no alcoholics (father is a wine drinker, 
but never becomes intoxicated). Denies ever 
having masturbated. Drinks coffee in modera- 
tion. Has regular habits as to sleep and meals, 
but always has been excitable. 

Present Illness — Began about nine years ago. 
four months after being hit in left eye with a 
baseball. Began soon after being severely pun- 
ished by father, who first noticed a twitching and 
contraction of the left wrist when in a semi-flexed 
position. This soon involved the entire arm and 
had spastic contractions which could not be con- 
in 'lied. In a short time the ri^ht leg became in- 



volved and several other groups of muscles. The 
contractions occurred mostly in the flexors and 
could not be controlled, and they became worse, so 
that they would remain flexed for a short time. 
Then in two years the left arm became involved 
and in another year the left leg, but the involve- 
ment of this side has never been so severe. After 
a time the erecti muscles became involved with 
these contractions. These contractions are nor 
marked at night when asleep, but may be in- 
creased when awake by excitement or other 
causes. 

Gastro-intcstinal Tract — Some indigestion 
after meals with eructations of gas. Somewhat 
constipated. 

Pulmonary and other tracts are negative. 

LABORATORY FINDINGS. 

Urine — Albumin and sugar are absent, reac- 
tion acid, specific gravity 1032, straw color, aro- 
matic odor, some sediment, few epithelial cells 
and hyaline casts, little mucus and granular de- 
bris. 

Blood — Leucocyte count, 7200. 

Haemoglobin, 87 per cent. 

Blood pressure, no. 

Three Wassermans made and all proved nega- 
tive. 

Physical Examination — At the time of exami- 
nation patient, a white boy, 17 years old, sitting 
in a semi-recumbent position, showing no evi- 
dence of acute pain, but having numerous vio- 
lent involuntary contractions of his extremities 
and more marked on his right side and suffering 
from dyspnoea. His mentality is exceptionally 
good and his intellectual faculties are well devel- 
oped. 

Head of medium size, covered with a thick 
crop of black hair, no areas of alopecia, no scars 
noted, occipital protuberance prominent. Eyes : 
The right eye is smaller than the left, pupils are 
equal and somewhat dilated, react normally to 
light and accommodation, field of vision normal, 
ocular motion good, sclera of a pearly hue. con- 
junctiva somewhat anaemic with tortuous vessels, 
ocular tension normal. Ears are large, low set. no 
tophi, nor mastoid or accessorv sinus tenderness, 
no discharge, hearing on the right side is ob- 
tunded. Nose is prominent and large, cartila- 
genous portion is slightly displaced to the right 
and the left nostril larger than the right. 

Mouth — Palate is broad and slightly dome- 



THE HOSPITAL BULLETIN 



29 



shaped, mucous membrane is anaemic, tonsils arc 
slightly enlarged, peritonsillar ring is injected, 
pharynx is bathed with a serous secretion from 
the posterior nares, teeth are in a good state of 
preservation, minis firmly adherent, no pyorrhoea. 
Tongue protrudes slightly to the right and has 
a fibrillary tremor, dorsum is of a good color and 
is nut coated. 

Neck is short, well rounded and developed. 
There is a spasticity of sterno-cleido-mastoids and 
especially of the right : no tracheal tug, no ab- 
normal pulsations, submaxillary glands are pal- 
pable but not markedly enlarged. 

Chest is markedly distorted, covered with heavy 
and well-developed muscles, which are in a state 
of constant contraction, there is a marked flar- 
ing outward of the entire costal margin on both 
-ides, causing the lower opening of the thorax 
to lie expanded and greatly resembling- a much- 
exaggerated Harrison sulcus. Costo-xiphoid an- 
gle is about 85 degrees, no scars noted, expan- 
sion equal on both sides, but respirations entirely 
of a thoracic type, which is greatly impaired by 
the tonic contractions of these muscles, frequently 
causing dyspnoea. After deepest inspiration the 
chest measures 71 cm. and after the fullest expira- 
tion chest measures 67 cm. Palpation of the chest 
no friction fremitus, no abnormal pulsations felt, 
tactile fremitus is normal. Percussion of the 
chest normal except at the right apex where per- 
cussion note is flattened. Auscultation of the 
clu st : Breath sounds very hard to ascertain be- 
cause of the numerous contractions of the mus- 
cles, but his respiration is harsh, somewhat puerile 
in character, short and jerky. 

Spine — Xo spinal tenderness, no kyphosis or 
other abnormalities, has a linear scar 30 cm. in 
length and beginning at the fifth dorsal vertebrae 
and extending downward. This scar is due to 
a laminectomy. All the muscles of the back are 
in a state of clonic contractions. 

Heart — It is impossible to ascertain the exact 
condition because of his constant involuntary 
movements. The heart -sounds are, however, 
very rapid and distant — no murmurs made out. 

P. M. I. is neither visible nor palpable. Palpa- 
tion over the precordium showed no distinct 
shock nor thrill. 

Liver — It is impossible to palpate it because of 
rigidity of the muscles of the abdomen, but there 
are no areas of tenderness over it. 

Abdomen — Has a verv flat abdomen, muscles 



are very well nourished and hard as a board from 
their tonic contraction and especially marked on 
the right side. There are no areas of tender- 
ness. There is no distention of the abdomen 
nor meteorism. Because of abdominal rigidity it 
is impossible to palpate the spleen or kidneys. 

Inguinal glands are palpable on both sides, but 
not markedly enlarged, there is no phimosis, para- 
phimosis, no scars and genitalia are apparently 
normal. 

Lower Extremities — Muscles of the right side 
are somewhat atrophied and in a state of tonic 
contraction with intermittent clonic contractions 
causing- involuntary and inco-ordinate movements 
of the leg. The tonic contractions of the muscles 
of the right leg produce an abduction of the foot 
which he cannot voluntarily overcome. No scars 
noted, joints are not swollen, inflamed nor ten- 
der, and there is no roughening of the tibia. Left 
leg : There is a marked atrophy of the muscles 
of the thigh and leg and they are not in a state 
of tonic contraction but are flaccid. There are no 
joint involvements, no scars, foot drop is pres- 
ent and the skin is loose and inelastic. 

Upper Extremities — Well developed, muscles 
are in a state of clonic contraction causing a 
marked extension and separation of the fingers, 
which also have athetoid movements and espe- 
cially of the right. No scars, glandular enlarge- 
ments nor joint involvements. Pulse is of low- 
tension, small volume, very rapid (150 per min- 
ute), and there is no marked fibrosis of the ra- 
dial vessels. 

Neurological Examination. — Patient's intelli- 
gence very well developed, talks intelligently on 
all topics of the day ; speech, apparently no evi- 
dence of aphasia or of articular disturbances ; rec- 
ognizes all objects well, memorv for remote and 
recent events is exceptionally good : at present has 
no use of left lower limb; no evidence of hemi- 
plegia : all muscles except those of expression and 
mastication are in a spastic condition. 

Motor Examination— The muscles of the neck, 
shoulder and back are of good muscular power. 
The extensors of both arms and flexor group of 
left arm possess their normal muscular power, but 
the flexors of the right arm are somewhat weak- 
ened. Both the extensors and flexors of the right 
forearm are also weakened. The flexors of the 
left thigh are paralyzed, those of the right are 
weakened: and the extensors of the left thigh 
have also partially lost their normal muscular 



30 



THE HOSPITAL BULLETIN 



power. The flexors of both legs and the extensor 
of left are markedly weakened. There is a weak- 
ening of the flexors of the right foot and the ex- 
tensors of the left foot, and a paralysis of the 
flexors of the left foot producing a foot drop. 

Trophic Disturbances — All the muscles are 
somewhat atrophied, there is a marked atrophy 
of those of the left limb. Over the right ichial 
tuberosity there is a small decubital ulceration 
about the size of a penny. 

Abnormal Movements — There is a constant, ir- 
regular, uncontrollable, partly atheoid, partly 
choreiform contraction of the muscles of the entire 
body with the exception of those of mastication, 
expression and lower left extremity. These move- 
ments occur both during rest and activity-. Dur- 
ing -deep the inco-ordinate contractions cease and 
the muscles are somewhat relaxed. During ex- 
citement the contractions become most violent, 
causing profuse perspiration, tetanic contractions 
of respiratory spinal muscles, causing respectively 
dyspnoea and a semi-opisthotonic position. At 
times the arms may be violently affected with lit- 
tle or no involvement of the leg; and conversely 
the legs may be violently affected with little or no 
involvement of the arms. 

Co-ordination of Muscles — He has absolutely 
110 control over the affected muscles and attempts 
to perform actions requiring co-ordination of 
these muscles exaggerate the passive atheoid and 
choreiform contractions. 

Rcflc.vcs — The abdominal, cremasteric, left 
plantar and left Babinski are absent; ;'. e., they 
do not respond at all to stimuli. The left ankle 
clonus is suggestive and the right is positive. 
Right Babinski markedly positive. The triceps 
reflexes are exaggerated ; the periosteo-radials, 
the right knee and tendo-achilles are not obtain- 
able due to the tonic contractions of the muscles 
concerned in these reflexes ; and the knee and ten- 
do-achilles of left limb fail to react to stimuli. 
There is a presumptively positive left Kernig's 
sign, which, however, is in all probability due to 
an atrophic shortening of the posterior group of 
muscles of the thigh which are the flexors of 
the leg. 

Sensory Examination — Muscular and pain 
senses are normal. 

Temperature Sense — There is analgesia over 
inguinal, hypogastric, lower half of dorsal, lum- 
bar and sacral regions and extending over the but- 
tock. There is decreased perception of sensation 



over right leg, left thigh, upper half of anterior 
surface of left leg. Over posterior and lower half 
of anterior surface of left leg there is a misinter- 
pretation of temperature sense causing feelings 
of warmth when either heat or cold are applied. 
There is also complete analgesia of entire left 
foot. 

Tactile Sense — There is complete anaesthesia 
over lower inguinal, and hypogastric regions, 
over back beginning at fifth dorsal vertebra, ex- 
tending downward to buttock and outer and dor- 
sal surface of left foot. 

Stereognostic Sense — Apparently normal. 
There is a numbness, paleness and coldness of 
the entire left limb. 

Cranial Nerves — The auditory nerve on left 
side is somewhat involved causing an obtunding 
of the sense of hearing in left ear. There is an 
involvement of both spinal accessory nerves, espe- 
cially of the right, causing a tonic contraction of 
the trapezius and sterno-cleido-mastoid most 
marked in the latter muscle. Hypoglossal is in- 
volved, causing the tongue to protrude slightly 
to the right of medium line. All the other cra- 
nial nerves are normal. 



ITALIAN SUPERSTITION IN REGARD 
TO PLACENTA. 



By Ejnar Hansen, M.D., 

New York, X. Y. 



Dr. J. Johnson of Copenhagen writes in Uge- 
skrift for Laeger an amusing account of a disgust- 
ing superstition found among the lower classes 
in Italy. 

In 1907 the water in the public well in Maggi- 
one became so bad that the mayor sent samples of 
it to Dr. Bellucci, professor in chemistry in Pe- 
rugia, asking him to have them examined. 

The examination showed that the water was 
contaminated by organic matter. Dr. Bellucci 
expressed the opinion that some dead animal was 
at the bottom of the well, and that it. would be 
necessary to empty and thoroughly cleanse it. 
This was done. No animal was found, but the 
bottom was filled to a height of four to five feet 
with numerous clay bowls, carefully bound up, 
and each containing a decayed mass, which on 
closer examination proved to be human placentae. 
These were so numerous that Bellucci found the 
space filled by them measured nearly two and a 
half cubic yards. By questioning a number of 



THE HOSPITAL BULLETIN 



3' 



the inhabitants he found that the throwing of the 
placentae into the well was an ancient custom, so 
strictly kept that it had been impossible to keep 
the well covered. 

This discovery started Dr. Bellucci on the trail 
concerning the Italian superstition in regard to 
placenta {vide Archivia per I'antropologia e la 
Etnolpgia, Vol. XI), and he found that in the pop- 
ular superstition placenta was always connected 
with either involution of uterus or lactation, or 
both. If placenta is nut promptly expelled, the 
magical art is resorted to. 

In many places the husband's hat is placed mi 
the patient'.- head or his trousers are placed on 
her abdomen. Still better, horseshoes are some- 
times used, part of the shoe being introduced into 
the vagina. In other pari- the woman must blow 
into a bottle, and at the same time all windows 
and doors must be kept open, otherwise the uterus 
will not retract. 

When at last the placenta is expelled, it must be 
placed in a bowl underneath the bed exactly below 
the -boulders of the patient. There it remain- for 
three days until the flow of milk has started. As 
soon as that has taken place the placenta i- buried, 
sometimes with salt, symbolic of sagacity, or with 
grain, symbolic of richness. 

The placenta must he buried in a moist place, 
beneath the outlet from the roof, in a dunghill or 
in a cemetery. It is best to throw it into a spring 
or a well, as was done in Maggione, because the 
moisture of the burial place is very important to 
the lactation. If the placenta dries up, the milk 
will stop ; but, on the other hand, the action of the 
placenta on the water makes it lactiferous. 

Placenta is also used to hasten the involution 
of uterus, and is then placed on the abdomen of 
the patient. The afterpains are alleviated if the 
patient drinks a cup of soup made from the pla- 
centa, or if a few drops of blood are pressed and 
mixed with the yolk of an egg and given to the 
woman. 

A very strange custom prevails in Sardinia. If 
a child is still-born, the navel cord is not cut, but 
the attendant awaits the expelling of the placenta. 
As soon as it arrives it is placed on a pan and 
fried, the child being kept close beside the pan. 
The hope of the parents and the attendants is that 
the heat will drive the baby's soul into the body 
through the uncut navel cord, and that the child 
may be brought to life. 

Xew York, January, 1912. 



"PREVENTIVE MEDICINE AMONG OUR 
YOUTH." 



By C. I''. Steosnider, M.D., 
District Director of Sanitation, North Carolina 

Stale Bmn-d of Health. 



The management of the child from infancy to 
the age of 10 year- is the period of phenomenal 
development, and it is during this period that 
the foundations are laid of those factors which 
make most for success in after life — a well-de- 
veloped body, sound health and a good digestion. 
In so far as these fall short of the normal, just so 
far does the individual miss bis full effectiveness 
in the world's work. 

The loss to the State of North Carolina in earn- 
ing power from preventable diseases, such as tu- 
berculosis, typhoid fever and hookworm, i- enor- 
mous, even though we are already in possession 
of prophylactic measures of every-day medicine 
which, if conscientiously applied to each member 
of the community, would produce incalculable 
results. 

Few will deny that the recent victory of Japan 
over Russia, which was up to this time thought to 
be the peer of any nation as regards army effi- 
ciency, was due to Japan's sanitation. Russia 
lacked that fundamental which so many sections 
of our State are deficient in today, and thai is 
the application of the principles of sanitation. 
Japan taught the world the most practical and 
demonstrative lesson ever enunciated in sanita- 
tion. War records previous to the Kusv '-Jap- 
anese War showed that equally as many, and oft- 
times more, men succumbed to disease as to 
bullets. 

So long as it is considered good business policy 
to study and apply devices which make labor 
more effective, there is nothing vague or vision- 
ary in applying to the future laborer health-saving 
devices which will make him physically and men- 
tally fitter for his work. 

Since the foundations of a sound physique are 
laid in infancy and childhood, and if neglected 
cannot be rebuilt, we have a problem worthy of 
our most earnest consideration. When we con- 
sider the cost of living out of proportion to the 
increase in wage we have a condition which en- 
hances rather than lessens these hereditary and 
congenital weaknesses which cause many deaths 
in earlv infancy. 



32 



THE HOSPITAL BULLETIN 



The question of hygiene and sanitation is an 
educational one which will take much time to 
get firmly fixed in the minds of our good people. 

We must make it plain to our people that no 
man has a right so to keep his house or so to live 
his life in a civilized community as to jeopardize 
his neighbor's health or happiness. Again, the 
duty of keeping clean in a physical sense is as high 
as that of moral cleanliness. 

Is it not infinitely wiser to prevent the pollu- 
tion of our drinking water or food than to fight 
the result of that pollution, as is the case with 
typhoid fever gotten by drinking dirty surface 
water or eating food polluted by flies which have 
cnme in contact with a typhoid fever case? 

Again, is it not wiser to prevent soil pollution 
by using sanitary privies and thereby eradicate 
hookworm disease, which at present exists in the 
C entral and Eastern part of our State to the ex- 
tent of from 36 to 58 per cent., than to allow this 
easily-preventable disease to go on sapping the 
life-blood out of our beloved children, dwarfing 
them mentally and physically for life, and in nu- 
merous cases, directly and indirectly, by other 
diseases, causing death? 

Shall we not vaccinate all our people at a cost 
of 2$ cents each, rather than leave some hundreds 
to die annually and other thousands to be branded 
with scars, a living shame to the community? 

\\ ould it not be wise to prevent stagnant water 
around our homes and thus not have a mosquito 
hatching place and screen our home at a small 
ci 1st against the mosquito, which causes malaria 
or bilious fever, than to allow this pest to enter 
our homes and cause long illness and ofttimes 
death ? 

Then we must start with the little ones, and 
after seeing that their mothers are instructed in 
the hygiene and clothing, remove the notion that 
the children must of necessity have measles, 
whooping-cough and hookworm disease by show- 
ing them that these diseases are ideal foundations 
on which to build future woe in the shape of con- 
sumption. 

The best way to fight consumption or any other 
disease is with a sound body, the boy who would 
grow up to lie a man of affairs must have sound 
lungs, stomach, eyes, ears, teeth and good muscu- 
lar development. 

Every school in the State should have a medi- 
cal supervisor or inspector to inspect the exes, 
mouth, ears and general condition of all children 



in attendance, in order that disorders may be de- 
tected at a time when they could be cured. As an 
example, cross-eyes, detected early, can be cured ; 
ear trouble, detected early, can be cured : diseased 
tonsils, removed early prevent rheumatism and 
poor health. Hundreds of our friends are today 
going through life cross-eyed, or blind, near or 
far sighted, or deaf, or dwarfed mentally or 
physically from hookworm disease, as a result of 
not receiving attention at the proper time. 

For the advancement of so important an issue, 
let us place the far-reaching and lasting good of 
this work before our lawmakers and insist that 
they at least appropriate as much for the pro- 
tection of their wives and little ones as for that 
of their swine, cattle and poultry. 

Shall we make preventive medicine a very real 
power in our State? Or shall we be content to 
consider it a side issue? 

Goldsboro, N. C. 



Prof. Randolph Winslow has received the fol- 
lowing note in reference to his recent series of 
articles upon his trip to the Pacific Coast : 

'"Tis wonderful why one, when writing about 
fish, can't maintain the same conservative, mod- 
erate statements they do when expressing them- 
selves about mountains, canyons, geysers, rivers, 
lakes and other marvelous footprints of the Crea- 
tor. Who the devil ever heard of a fish being 
caught and cooked under such circumstances ? 
In spite of the fish yarn, you have written us a 
series of most interesting and instructive papers. 
\\ hen your surgical day is passed, you can turn 
your attention to travel and recording what 
you see. 

'"Yours truly, 
"D. W. Bulluck (class of 1873 ). 

"Wilmington, X. C." 

For the fish story see January Bulletin, page 
203, illustration on page 204. 



Dr. William Clinton Marett. class of 1911, has 
resigned as a member of the medical staff of the 
tuberculosis hospital at Bayview, and has accepted 
a position as assistant resident physician at 
\\ hitehaven Sanatorium, Pa. He will enter upon 
his new duties Tune 1. 



Dr. Harry Benjamin Messmore, class of 1910, 
is located in Brownsville, Pa. 



THE HOSPITAL BULLETIN 



33 



THE HOSPITAL BULLETIN 

A Monthly Journal of Medicine and Surgery 

PUBLISHED BY 

THE HOSPITAL BULLETIN COMPANY 

608 Professional Building 

Baltimore. Md. 



Subscription price, . . . $1.00 per annum in advance 

Reprints furnished at cost. Advertising rates 
submitted upon request 



Nathan Winslow, M.D., Editor 



Baltimore, April 15. [912. 



AN EXPLANATION AND AN APPEAL. 



For a year we have been publishing the names 
of those who have subscribed to the Pathological 
Endowment Fund, until the number has grown 
so large that it is inconvenient to publish the list 
in full. We shall, therefore, cease to present the 
names of each individual in each issue of Tine 
Bulletin, and shall only mention the names of 
new subscribers month by month. We shall, 
however, publish the amount subscribed by the 
individual classes of the medical alumni in each 
issue, as well as the total amount pledged, up to 
the first of each month. 

As will be observed, almost every class that has 
left the portals of the Medical School in the past 
40 years has thought enough of its Alma Mater 
to make some contribution to this fund. A few 
classes have nut responded as yet to our appeal; 
in some instances, doubtless because they have 
n.l bein solicited to do so. If any member of 
these classes should notice that his class is not 
represented in this list, we hope he will hasten to 
send us a contribution, in order that his class may 
have some part in this work. If anyone notices 
that his class has only a small sum credited to it. 
we hope he may add something to the class fund. 
If anyone thinks he can increase his contribution 
comfortably, his generosity will be greatly appre- 
ciated. 

The past month has been rather barren of re- 
sults. There has been so much to occupy our at- 
tention that not much effort has been bestowed on 
this enterprise. We hope, however, that the ad- 



vent of spring will lighten our labors, and that 
coin, to say nothing of green and \ ellou -backed 
bills, may flow so abundantly into the coffers of 
our friends that they will have enough to spare 
us some of the overflow. 
Friends, help us! 



CONTRIBUTIONS BY CLASSICS. 



848 . 

SOS. 

871. 
872. 
873. 



*74 

8/5 

876 

*77 

880 

8S1 

882 

883 

885 

886 

sss 

889 

890 

892 

003 

894 

895 

896 

897 

898 

900 

901 

902 

903 

904 

905 

906 

007 

909 

910 

911 Terra Mariae 

012 Latin-American Club. 



$50 


00 


10 


00 


35 


00 


''5 


00 


430 


00 


5 


00 


5 


00 


i'5 


00 


10 


oo 


5 


00 


250 


00 


310 


00 


35 


00 


235 


00 


100 


oo 


50 


00 


100 


00 


175 


00 


150 


00 


15 


00 


'35 


00 


'55 


00 


52 


00 


70 


00 


80 


00 


215 


00 


'75 


00 


305 


00 


300 


00 


145 


00 


200 


00 


130 


00 


no 


00 


5 


00 


50 


00 


3 5o 


25 


00 



Total subscriptions to April I, 1912. $0805 50 

Subscriptions in March: 
Dr. Nathan Winslow. IQOI (second 

contribution ) §5° 03 

Dr. Randolph Winslow. 1873 1 second 

contribution) 100 00 



34 



THE HOSPITAL BULLETIN 



Dr. Erasmus II. Kloman, 19x0 (sec- 
ond contribution ) 25 OO 



Additions for the month $175 00 



ITEMS 
By request, we publish the following list of the 
class of UJ05, with their present locations, so far 
as we are able to ascertain : 

Elmer Hall Adkins. 

Julian Warrington Ashbv, Hugheston, W. Ya. 

Samuel Luther Bare, Westminster, AIL 

Robert Parke Bay, 1701 Guilford avenue, Bal- 
timore, Aid. 

Chandos M. Benner, Taneytown, Md. 

lames Snow Billingslea, Armiger, Aid. 

Alvah Parrish Bohannon ; can't locate: in the 
State of Virginia; not in practice. 

Vance VV. < Irabham, Bamberg, S. C. 

Baird U. Brooks, West Durham, N. C. 

Frank Burden, Paw Paw, W. Va. 

Ira Burns, Relief Department, Pennsylvania 
Railroad Co., Wilmington, Del. 

Roscoe C. Carnall, Waverly Alills, S. C. 

John Joseph Carroll, 120 Chestnut street, 
Holyoke, Mass. 

Edward Lawrence Casey, Woodstock, N. H. 

Sydenham Rush Clarke, 423 Hawthorne road, 
Roland Park, Aid. 

Edward V. Copeland, Round Hill, Va. 

Arthur Bascom Croom, Alaxton, X. C. 

Charles Callery Croushore, 108' West 2d street, 
Greensburg, Pa. 

Frederick De Sales Chappelier, Lewes, Del. 

Seth De Blois, Newport, R. I. 

David Alphonse DeVanny, 132 East 61st street. 
New York, N. Y. 

Alpheus Wood Disosway, Plymouth, N. II. 

Manuel Dueno, Anasco, Alayaguez, Porto Rico. 

James Eugene Dwyer. 

John Alartin Elderdice, Alardela Springs, Md. 

Oliver Justin Ellis, South Royalton, Vt. 

Harry Aloore Felton, 109 Climax street, Pitts- 
burgh, Pa. 

Edwin Ferebee Fenner, Henderson, W. Va. 

William Henry Fisher, Centreville, Aid. 

John Shaw Gibson, Gibson, X. C. 

Milton R. Gibson, Alaxton, X. C. 

Leo J. Goldbach, 2217 East Pratt street. Balti- 
more, Aid. 

Archibald Wright < iraham. 



William W. Hala, Xew York, X. Y. 

Samuel William Hammond, Lambert's Point, 
Norfolk, Va. 

George Blight Harrison. 

Henry Hiram Hodgin, Red Springs, X. C. 

Henry C. Houck, 1914 Pennsylvania avenue, 
Baltimore, Md. 

Hammer Carson Irvin, Jr., Roanoke Rapids, 
X. C. 

Brooke I.« Jamison, Jr., Emmitsburg. Aid. 

Francis White Janney. The Walbert, Balti- 
more, Md, 

Harry Aquilla Jenkins, Assistant Surgeon, U. 
S. X., now on board U. S. S. Alontana. 

Oswald Ottmar Kafer, Xewbern, X. C. 

Xagib Kenawy, 11 Boulevard de Ramleh, 
Alexandria, Egypt. 

Eugene Kerr, Alonkton, Aid. 

Herbert L. Kneisley, Hagerstown, Aid. 

William A. Knell, Augusta avenue ami Fred- 
erick road, Irvington. 

Kalil Alagib Koury. 

Edgar Brown Le Fevre, Inwood, W. Va. 

Julius Levin; died in Johnstown, Pa., February 
12, [912. 

George William Alahle; died in Baltimore, Aid.. 
February 20, 191 1. 

James P. Alatheson, Charlotte, X. C. 

James G. Alatthews, Paulsen Building. Spo- 
kane, Wash. 

George Skinner AlcCartv. 

Harry Downman AlcCartv, 613 Park avenue. 

John 1'. McGuire, Clarksburg, W. Va. 

William Cuthbert AIcGuire, Huntington, W. 
Ya. 

Roscoe Conkling Metzel, 1824 West Xorth 
avenue, Baltimore, Aid. 

Harold Edson AIinei-,51 Alaple street, Holyoke, 
Mass. 

Robert Levis Mitchell, 21 12 Alaryland avenue, 
Baltimore, Aid. 

William Morris Alitchell, 80 Kennedy street. 
Bradford, Pa. 

John Albert Nice, Alt. Airy, Aid. 

Oscar S. Owens, Alanchester, Ya. 

John W. Parker, Jr., Williamston, S. C. 

W. Arlett Parvis, Acting Assistant Surgeon, 
U. S. A. ; at present at Sorocco, X. AI. 

John William Pierson, 2806 East Baltimore 
street. Baltimore, Aid. 

Daniel E. Remshurg, Cresson, Pa. 

Samuel T. R. Revell, Louisville, Ga. 



THE HOSPITAL BULLETIN 



35 



William James Riddick, Assistant Surgeon, 
I". S. N. ; at present at Naval Station, Guanta- 
namo, Cuba. 

William Wordsworth Riha, Danvers Hospital 
for Insane, Danvers, Mass. i ?). 

John L. Riley. Pocomoke City, Md. 

John Edgar Rooks. 

Anton George Rytina, 2204 East Monument 
street, Baltimore, Md. 

Edgar McQueen Salley, Saluda, N. C. 

Albert Leigh Sanders, 1113 North Gilmor 
street, Baltimore, Md. 

Sturat Baskin Sherard, Gaffney, S. C. 

John Holmes Smith. Jr., 2205 St. Paul street. 
Baltimore, Aid. 

W. Henry Smithson, Jr.. New Park, Pa. 

James Albert Stone, Shallotte, N. C. 

Benjamin Franklin Tefft, Jr., Anthony. R. I. 

William E. Ellicott Tyson, 2609 Past Jefferson 
street, 1 )etroit, Mich. 

Frederick J. Wass, 136 East Duvall street. 
Jacksonville, Fla. 

William Benjamin Warthen, Davisboro, Ga. 

We would he very glad if some of our readers 
can supply the missing addresses. 

Dr. James G. Matthews, class of 1905, of 
Spokane, Wash., was a recent visitor in Balti- 
m< ire. 



Miss George Allen Hutton, class of 191 r. Uni- 
versity Hospital Training School for Nurses, is 
recovering from pneumonia at the University 

1 lospital. 



Dr. Francis Miles Chisolm, class of 1889, has 
given up his offices in the Farragut, Washington, 
D. C, and will devote his entire time to his home 
office, 1032 Rhode Island avenue N. W., Wash- 
ington. 



Dr. George W. Dobbin, class of 1894, was op- 
erated on for appendicitis at the Mercy Hospital 
March 15, 191 2. He is reported to be doing well. 



Dr. Bennett Bernard Browne, class of 1807, 
has been confined to his home. 510 Park avenue. 
Baltimore, with a slight attack of blood poison- 
ing, caused by a slight abrasion of the skin, incur- 
red while operating. 



Dr. John C. Hemmeter, class of [884, gave a 
lecture on the "Physiologic Foundations of Piano 
Technic" before the Florestan Club, 522 X. 
Charles street, Baltimore, on March 11,1. 1012. 



We would be very glad if any of our readers 
can give us the present address of Dr. Vernon 
Hastings McKnight, class of IQIO. 



Dr. Robert Alexander Warren, class of [907, 
is located at Midway Inn, Hot Springs, Va. 



The following charter has been granted the 
Alumni Athletic Association : 

THIS IS T( ) CERT! FY that the subscribers- 
Irving J. Spear, residing in Baltimore City; 
Nathan Winslow, residing in Baltimore City: 
Daniel Base, residing in Baltimore Citv; 
Fred H. Vinup, residing in Baltimore Citv, ami 
James W. Bowers, residing in Baltimore City, 
all of whom are citizens of the State of Marvland, 
all being of full legal age, do hereby certify that 
we do, under and by virtue of the General Law 
of this State authorizing the formation of corpo- 
rations, associate ourselves with the purpose of 
forming a corporation. 

1. The name of the association is the "Alumni 
Athletic Association of the University of Mary- 
land, Incorporated." 

2. We do further certify. That the purpose 
fi ir which said corporation is formed and the busi- 
ness or objects to be carried on and promoted by 
it are the promotion and advancement of athletics 
at the L T niversity of Maryland, the creation and 
maintenance of high standards of sportsmanship 
among the students of the LTniversity of Mary- 
land, and for social and literary purposes, and that 
the said corporation is formed upon the articles, 
conditions and provisions herein expressed, and 
subject in all particulars to the limitations relat- 
ing to corporations which are contained in the 
General Laws of this State. 

3. We do further certify, That the principal 
office of said corporation will lie located in Balti- 
more City. 

4. H'c do further certify. That the said corpo- 
ration is to have no capital stock. 

5. We do further certify, That the said corpo- 
ration will be managed by eight Directors, and 
that Irving J. Spear, Nathan Winslow. James W. 
Bowers, John Henry Skeen, B. Merrill Hopkin- 
son, Samuel W. Moore, Daniel Base and John B. 



36 



THE HOSPITAL BULLETIN 



[seal. "I 
[seal.] 

I SEAL.] 

[seal.] 

[seal.] 



Thomas — all of whom are citizens of the State 
of Maryland and actually reside therein— are the 
names of those who shall act as Directors of the 
said corporation for the first year, or until their 
successors are duly chosen and qualified. 

In witness whereof , We have hereunto set our 
hands this first day of December, in the year 
nineteen hundred and eleven. 

Witness: 
Ws. to all. 

John Henry Skeex. (Signed.) 
Irving J. Spear. 
Nathan Winslow. 
James W. Bowers. 
Fred H. Vinup. 
Daniel Base. 
State of Maryland. City of Baltimore, to wit.: 
Before the subscriber, a Notary Public of the 
State of Maryland, in and for the City of Balti- 
more, personally appeared on this first day of 
December, nineteen hundred and eleven. Irving 
J. Spear, Nathan Winslow, Daniel Base, Fred H. 
Yinup and James \Y. Bowers, and did severally 
acknowledge the foregoing certificate to be their 
act. 

Witness my hand and notorial seal, 

Johx Henry Skeex, 

Notary Public. 
I, one of the Judges of the Supreme Bench of 
Baltimore City, do hereby certify that the fore- 
going certificate has been submitted to me for 
examination : and I do further certify that the 
said certificate is executed in conformity with 
the law. 

Carroll T. Boxn. 



ATHLETICS. 
The basketball season has closed with a credit- 
able record of clean playing" and good sportsman- 
ship on the part of the University team. 



The Pennsylvania Chapter of the General 
Alumni Association of the University of Mary- 
land has elected the following officers for the 
coming year: 

President, Dr. Lewis H. Adler, class of 1859, 
of Philadelphia; vice-president, Dr. J. Bruce 
McCreary, class of 1892, of Shippensburg ; sec- 
retary. Dr. J. C. C. Beale of Philadelphia : execu- 
tive committee, Drs. Frank IT. Gaverik. class of 
1888, and Harry C. Stover, both of Harrisburg; 
William J. Steward, class of [904, and W. H. 
Lowell, both of Lancaster; James C. Clawson, 
class of 1855. and Robert C. White, both of 
Philadelphia : Edwards F. Winslow of Bryn 
Mawr; Z. C. Meyers, class of 1890, and R. S. 
Xeiman, both of York. I'a. 



The lacrosse team has cancelled the remaining 
games of its schedule because of lack of practice. 
The game played with the Navy team on March 
28 resulted in an easy victory for the middies, 
and was the only game played by the University 
twelve during the season. 

The baseball team is making a strong bid for 
the intercollegiate championship of the State. 
Five games have been played, of which number 
the University boys have won three. The team 
is putting its best play against the colleges, and 
has been handicapped by an accident to Wood- 
land, who sprained his ankle at the Westminster 
game. The record of the games is as follows : 

The initial game of the season was played 
March 20 against the Navy at Annapolis. A 
great deal of local interest centered in the game 
because of the fact that Harry Ruhl and Harry 
Butler, both former St. John's College boys, 
played on the University team. The score was 
5 to 3. in favor of the Navy. 

The Baltimoreans started the scoring in the 
opening session, when they chalked up a run on 
Sherrill's hit, a pass to Whitworth, followed by 
O'Neill's single. Navy went one better in the 
third, on a fielder's choice, and Vaiden's long- 
drive to left, which was good for three sacks, but 
he stretched it into a homer on Beach's poor 
handling of the throw-in. 

In the fourth the visitors added two more, and 
Navy evened things up with a tally in the same 
session. In the sixth the middies clinched the 
game, when they registered two more, on a base 
on balls, an error and wild pitch by Woodland. 
. Vinson, Navy's star twirler of last season, was 
on the mound for four innings. Seibert, a south- 
paw, who replaced him, was more effective. 

NAVY. MARYLAND. 

AB.R.II.O.A.E. AB.R.H.O.A.E. 

Osborne, If.... 4 1 " 11 Butler, 3b 5 110 1 

Valden, 3b 4 12 2 Sherrill, c 5 1 2 S 1 

Fisher, rf 4 1 1 Whitworth, If. 4022 11 

Abbott. 21. 4 2 1 O'Neill, ss 4 2 3 2 

Hall. II. 4 2 13 " 1 Smith, lb 4 19 

Adams, ss 411030 Jenkins, rf.... 400000 

livers, ci :•■ 10 10 Ruhl. 2b 4 15 2 

Hicks, <• 3 1 12 2 Beach, of 2 10 10 1 

Vinson, p 1 1 Woodland, p... 3 4 

Seibert, p :: 1 1 1 1 Woods, p 1 10 



Totals 34 5 8 27 12 2 Totals 3G 3 8 24 13 4 

Navj 00210200 x— 7, 

Maryland 10020000 0—3 

Two-base hit — Vaiden. Three-base hit — Vaiden. Left on 
iias--s -Navy, 7 : Maryland, 8. First base on errors—Navy, 3 ; 
Maryland, 2. Innings pitched— By Vinson, 4; by Seibert, 5; 



THE HOSPITAL BULLETIN 



37 



by Woodland, 6V4; by Woods, 3%. Struck out— By Vinson, 5; 

by Selbert 7: bv W Hand, 3; by Woods, 3, Bases on balls— 

<iiT Vinson 2; off Selbert, I: off Woodland, 3, I his -oil Vin- 
son 5: "IV Selbert. 2; off Woodland, 7: off Woods, 1. w iid 

pitch— W Hand. Dmpire— Mr. McA1 f Baltimore. Time— 

2.10. 



Howard. S. Batters hit— Bealle (2). Struck out- By Woods, 
i'. ; by Howard, 5. Time— 2.10. Umpire— Dooley, W. M. C. 



The next game, played .March iy against 
Washington College at Chestertown, resulted in 
a victory For the .Maryland boys — 3 to o. 

The University team showed great improve- 
ment over the playing during the Navy game, 
1 bach W'illse having detected the errors made in 
the former game and put the knowledge to good 
use in the practice held. 

The work of Woods for the Varsity was of a 
high order, as he allowed hut three hits and 
walked one man. Biddle, for Washington Col- 
lege, was touched up for seven hits and gave sev- 
eral hases on balls. 

The University started its scoring in the first 
inning. 

1 larry Ruhl played a star game for the Univer- 
sity at the first base. This was Ruhl's first try- 
out in this position, and he made good. 

WASHINGTON. UNIVERSITY OF MD. 

AB.R. H. O. A.E. AB.R. H. O. A.E. 

Meckins. 3b.... 4 o 4 1 Butler. :VI> 3 2 2 11 

Brown If 4 2 2 Beach, of 4 1 2 

Kelly 2b 4 (I 3 2 WMtworth, c. 4 1 1 1 2 

Porter. 11. 4 12 11 Jenkins, 2b.... 4 13 

Karrett cf 3 00200 O'Neill, ss 4 00220 

Lewis, ss 3 2 1 Smith, rf 4 110 

Long c 3 13 2 Ruhl. lb 4 1 113 11 11 

Wallace, rf.... 3 10 Blnlock. If 4 10 10 

Biddle. p 3 15 Woods, p 4 5 

Totals 31 3 25 14 2 Totals 35 3 7 2113 

Score by innings : 

University of Maryland 10 10 1-3 

Washington 0-0 

Two-base hits— Butler, Blalock, Brown. Three-base hits— 

1 g, smith. Sacrifice hits— Washington, 2: University of 

Maryland. 1. Stolen bases— University of Maryland. 2: Wash- 
ington. 1. Double plav— Biddle lo Porter. Bases on balls- 
Off Biddle, 3; off Woods, 1. Batters hit— By Biddle, 3: by 

W Is. 1. Strnek out— By Biddle. 3; by Woods. 5. Passed 

ball— bv Woods to catcher. Left on bases— Washington, 4: 
University of Maryland, 7. Time of game— 1.55. Umpire — 
Pensmith. 



The third game was played against Western 
Maryland College March 30. Our boys won — 
8 to 4. Woodland did splendid work, but was 
hurt in the fifth inning and has been unable to 
play since. The score was : 

UNIVERSITY OF JIli. WESTERN MARYLAND. 

AB.R. II. O. A.E. AB.R. H. O. A . E. 

Holler. 3b 6 10 13 1 Jones, of 4 10 2 

Beech if 422200 Spragne, lb.... 4 011 1 1 

Wbltworth, c. 6 2 2 10 2 Bealle. c 4 2 3 9 3 

Smith rf 3 o 1 Graefe. if 3 II 1 

Nitsche, rf.... 2 » « Myer, If 211100 

Cooper, of 221100 Foltz, ss 3 3 1 

Jenkins 2b.... r, 1 2 2 2 1 FriesleV, 8b.... 3 14 

oNeill. ss 4 2 1 Hill. 2b 3 2 1 

Ruhl lb 4 0111 1 Howard, p 3 1 

Woodland, p... 2 ooooo 

Woods, p 2 1 1 Totals 29 4 5 27 11 3 

Totals 40 8 S 27 11 3 

University of Maryland o n l o 3 o l i 2—8 

Western Maryland 2 o l o 1—4 

Two-base bits— Bealle. Jenkins. Three-base bits— Bealle (2). 
Stolen bases— Butler. Wliitworth (2), Jenkins. Cooper (2). 
Bealle Bases ( ,n balls— Off Woods, 1; off Woodlawn. 3; Off 



The fourth game, slated against Mt. St. Mary's 
College April 2 at Emmitsburg, Md. ( was called 
off because of rain. 



The fifth game was played against Dickinson 
College at Carlisle April 6, anil gave the Mary- 
land team a victory of 3 to 2. The weather was 
ideal and the game well attended. The Mary- 
land boys showed their superiority over the Car- 
lisle boys both in fielding and in batting. The 
score was as follows : 

UNIV. OF MD. DICKINSON. 

R. II. o. A.E. R.H.O.A.B. 

Butler, ss 2 11 Stechel, ss 13 12 

Jenkins. 2b 2 5 11 Goldstein, c 2 2 10 

Whitworth, O....0 2 10 1 Hoeh. of 2 1 11 1 

Smith, of 3 1 Henderson, lb...O 13 2 

Nitsehe. If 1 2 Grimm, 2b„ 1110 

Ruhl. lb 1 10 Rowley, rf 10 

O'Neill, ss 1 2 4 Price, 3b 14 

Morton, rf (I Patterson. If 

Wood, p 14 Shaffer. If 3 

Brenneman, p... 1 1 

Totals 5 1127 11 2 York, p 14 



Totals 2 6 27 12 5 

University of Maryland 1 n n 1 2 1 0—5 

Dickinson o o o 1 1—2 

Two-base hit— Smith. Home run— Hocn. Bases on balls— Off 
York, 1 ; off Wood, 9. SI ruck out— By York, 3. 



The sixth game was played against the Balti- 
more (International League) team, and was won 
by the Orioles by a score of 16 to 6. The Univer- 
sity team kept in reserve its best players for later 
college games and put its weakest team against 
the Orioles, trying out a new pitcher in one 
inning. Nine runs were scored in this one 
inning. Much interest was added to the game 
in the fact that Unglaub, a University of Mary- 
land man in the days of Micky Whitehurst, was 
playing on the Oriole team, and made one run 
against the boys of his Alma Mater. After the 
fourth inning Manager Dunn of the Orioles 
changed his line-up, bringing in his reserves. The 
Sun writes: "In the field the losers played cleaner 
ball than the Orioles, but several errors of omis- 
sion were costly." Several. hundred students sat 
in the grandstand and cheered the University- 
boys. The score was : 

BALTIMORE. 
Play. i. AB. R. 1B.TB.SH.SB.SO.BB.PO. A. E. 

F. Maisel. ss 3 2 2 2 10 1112 

Twombly, ss 2 o o 1 1 

I'orcoran. rf 4 2 4 6 

Cooper, rf 2 0000010000 

Gettman, ef 2 3 12 10 2 

Murray, cf 2 1 2 10 1 

Schmidt, lb 3 1130101900 

G. Maisel. lb 2 i 5 o o 

Walsh. If 6 125 2 00000 

1 'a rent. 2b 1212 102021 

Unglaub, 2b 3 1110000021 

Murphy 3b 3 2 2 3 o 2 4 

Payne, c 3 12300011101 

Russell, p 5 10 13 10 

Totals 41 10 17 29 7 4 9 27 11 7 



38 THE HOSPITAL BULLETIN 

onv^ ^b^shI^o.bb.po .a. e. Dl "" Wllliai » T " Arnold > ^ of l8 75- died at 

Butler 3b i 2 2 2 o o l 1441 his home, 8233/ \Y. Lombard street, Baltimore, 

Until, lh -111-101 1 1 

Whitwortb, c- 5 11 o 0510 March ?. iQi-2, after a lingering- illness, ased 67 

Smith, cf 5 2 -j 5 11 1 1 ° - J & 6 -> "S" 1 ' 

Nitsche, if 5 1000210301 years. 

Jenkins, 2b 3 2 2 2 2 4 4 1 

3K S:::::::::::::::"i .1 o o o ,1 ii o !.' o o Dr. Arnold was born in Baltimore, the oldest 

^J"- r p f • p J g J \ !! II J \ \ \ \ son of the late Francis and Sarah Mitchell Arnold. 

Sen' lE^lE^.i o o l o o 3 o He was educated at the old Lester Academy of 

•Rowe J _o _o _o _o _o l _o. _o _o _o West Baltimore, and then entered the medical 

'i'» tals •■. .•■■■;* ! ; ,, ; ' r - - 6 10 5 M 1G 5 department of the University. After graduating 

*ltatted for < ooper in the ninth. r J o o 

Two-base hits-Parent (2), Corcoran (2), Gettman, Payne, there, he took a course at the Baltimore College 

\Y:ilsh. Murphy, .Murray. Smith. Three-base hits— Schmidt, r rwit.,1 ^..r.-ror,- 

Walsh. Smith. First has.' on errors— Baltimore, 4: Univer- ul uciiidi ouigti_\. 

sity of Maryland, 4. Left on bases— Baltimore, 11 ; rjniversity . 

of Maryland, 12. Tinu— 2.15. Umpire— Mullaney. Dr. Arnold never married. He gave up the 

To date the consensus of opinion of the sport- practice of medicine because of ill-health about 

ings news editors is that the Maryland team may 20 years before his death. He is survived by 

well be proud of Butler, Ruhl and Woods. three sisters and three brothers. Interment was 

. . in Loudon Park Cemetery. Baltimore. 

BIRTHS 

March 9, 191 2, Mary Eleanor Tucker, daughter 

of Dr. Henry McKee Tucker, class of 1899, and ])r John Guy Ho llyday, class of 1868, died at 

Mrs. Tucker, of Raleigh, X. C. his officej 7U Frederick avenue. Baltimore, March 

15, 1912, of pneumonia, in his 67th vear. 

In February. Virginia Katheryn Messmore, Dr Hollyday was born in Hagerstown, Md., 

.laughter of Dr. John Lindsey .Messmore, class May I0< lS ^ the son of Richard T all( , Susat] 

of 1909, and Mrs. Messmore, of Masontown, Pa. (R agan ) Hollyday, and grandson of Colonel 

Pagan of Hagerstown, a hero of the War of 181 2. 

DEATHS Richard Tilghman Hollyday, Dr. Hollyday's 

Dr. John Evans Mackall, class of 190S, died at father, was a farmer and slave-owner, and was 
his home on Bright street, Elkton, Md.. April 4, born at the old Hollyday estate in Queen Anne's 
1012, after a three weeks' illness of typhoid fever, county, Readbourne, which only a few years since 
aged 29 years. Dr. Mackall was the son of Mr. passed out of the hands of the 1 follyday family, 
and Mrs. William H. Mackall of Elkton. He Dr. Hollyday was educated in private schools 
was educated in the public schools of Elkton and and at Hagerstown Academy until he was 16 
Delaware College. For two years after his grad- years of age, when the Civil War began. Dr. 
nation he was vice-principal of the Elkton High Hollyday and a companion started to join the 
School, resigning to enter the University of Confederate Army, but after their intentions lie- 
Maryland, where he graduated in medicine in came known were forced to hide for several 
1908. He then served for some time on the staff months in an attic in Dr. Hollyday's home, in 
of physicians of the Atlantic Coast Line Hospital order to escape capture by Union soldiers. They 
at Rocky Mount, N. C. He began practicing in then joined the First Maryland Cavalry at Fred- 
Elkton about a year ago. Dr. Mackall was 1111- crick, and served throughout the war. After it 
married. was over he came to Baltimore and studied medi- 

The funeral took place from his home on April cine at the University, graduating in 1868, and 
8, Rev. William Schouler of Trinity P. E. Church being a house student during that year. For six 
officiating. The Cecil County Medical Society months subsequently he served as a member of the 
met at the Union 1 lospital in Elkton and attended medical staff of Bayview Hospital. He was for 
the funeral in a body. The pallbearers were Wil- many years attending physician at St. Joseph's 
Ham Pepper Constable of Baltimore, Ormond Monastery. St. Mary's Industrial School and 
Chaytor of Wilmington, Del; Stanley Evans of Mount St. Joseph's College. Dr. Hollyday was 
Elkton, and Drs. Robert L. Mitchell, class of a member of the Protestant Episcopal Church, but 
1905, of Baltimore; II. Arthur Mitchell and became a convert to the Catholic Church, and re- 
Howard Bratton, both of Elkton. ceived the last sacrament at noon the day before 



THE HOSPITAL BULLETIN 



39 



his death. He married in [873 Miss Virginia 
Lamar, who survives him. Mrs. Hollyday was 
seriously ill at the time of her husband's death, 
and was at the home of her son-in-law, Capt. 
Samuel C. Cardwell, Fort Monroe. Dr. Holly- 
day had lived for many years at "Minnefield," on 
Edmondson avenue, extended. He was a mem- 
ber of the Masonic Order, and was connected 
with main- of the most prominent families of the 
Si.ue. Besides his wife, he is survived by one 
son, Guy Tilghman Orme Hollyday: two 
daughters, Mrs. Virginia Ambler Cardwell ami 
Miss .Minnie Frances Hollyday. and a sister. Mrs. 
Thomas F. Billop. He was buried in Loudon 
Park Cemetery. 



UNDERGRADUATE NOTES 



Under the Supervision of E. A. hooper. 



During the past month the Charles W. Mitchell 
Medical Society has been organized, composed 
of 40 University students, 2^ seniors and 15 
juniors, with honorary members from the faculty. 
The object of the society is to stimulate greater in- 
terest in the progress of medical science, and to 
bring the professors and students into closer re- 
lationship. Meetings are held each month, at 
which time certain students and honorary mem- 
bers are called upon to read and discuss papers oi 
interest to the members of the society. At the or- 
ganization the following officers were elected: 
Dr. Charles Mitchell, honorary president: G. C. 
Battle, president; \Y. M. Scott, vice-president; 
S. E. Buchannan, secretary; E. A. Looper, treas- 
urer; B. J. McGoogan, historian; C. R. Edwards, 
correspi mding secretary. 

The names of the charter members are as fol- 
lows : 

Drs. Samuel Chew, Chas. Mitchell, Hiram 
Woods, John C. Hemmeter, E. F. Cordell, J. M. 
Craighill, Jos. E. Gichner, Cordon Wilson, Irving 
Spear, Chas. McElfresh, Jose Hirsh, Harry Ad- 
ler, W. 1 1. Smith. R.H. Johnston, H. D. McCarty, 
G. C. Lockard, \\*. Coleman, H. U. Todd: R. E. 
Ahcll. R. A. Allgood, C. C. Cattle. 11. A. Bishop, 
R. A. Bonner, S. E. Buchannan, J. D. Cochran. J. 
I). Darby, E. W. Frey, W. E. Gallion, D. ('). 
George, I. E. Hair. M. Hinnant, H. Irwin. E. S. 
Johnson, E. A. Looper, B. J. McGoogan, \Y. 



.Michael. W. M. Scott. J. D. Sharpe, E. A. Sher 
rill, T. 1'". Stevens, C. J. Stallworth, J. Terry, \\ . 
II. Yeager, J. M. Birch, R. lb Norment, V. E. 
Edwards, W. II. Toulson, W. O. Wrightson, 
II. J. Slucher, W. II. Scruggs, McDaniels, C. R. 
Edwards, E. G. Breeding, F. b\ Callahan, C. A. 
Hayworth and E. D. Murphy. 

At the last meeting of the University of Mary- 
land Medical Society a very instructive and en- 
tertaining lecture on The Eye, illustrated with 
stereopticon views, was delivered by Dr. Hiram 
Woods. Dr. R. Tunstall Taylor also read an in- 
teresting paper on the treatment of Anterior 

Poliomyelitis. 

* * * 

Dr. C. B. Williams of Philippi, W. Va., is tak- 
ing post-graduate work at the University Hos- 
pital. 

■:.. t- * 

The editor of Terra Murine announces that the 
annual has gone to press, and will be ready for de- 
livery May 1. Quite a number of the students 
have already engaged copies, and a large edition 
is being published. 

* * * 

G. H. Lebret and H. R. Rich, senior students, 
have been sick in the University Hospital during 
the month, where they have undergone opera- 
tions. 

The University baseball team opened up the 
season in Annapolis with a game against the 
Naval Academy. March 20. The score was 5 to 3 
in favor of the Navy. 

Several of the senior students have already se- 
cured hospital appointments for the coming year. 
Mr. W. II. Yeager has been appointed superin- 
tendant of the Tuberculosis Hospital at Bayview, 
with Mr. G. C. Battle as assistant. Mr. E. A. 
Sherrill has secured an appointment in the surgi- 
cal department at Bayview, and Mr. E. P. Kolb 
will be at the Robert Garrett Hospital for Chil- 
dren, while Mr. J. D. Darby has been appointed 
resident in the lying-in department of the Univer- 
sity Hospital. 

* :!- * 

On March 25 the first regular meeting of the 
Randolph Winslow Surgical Society was held, 



40 



THE HOSPITAL BULLETIN 



at which time two interesting papers were read 
and discussed. The papers were "Some Facts 
Dealing with the Development of Aseptic Sur- 
gery," by R. A. Allgood, and "Surgical Aspects 
of Some Tumor Masses Found in the Neck," by 
Robt. E. Abell. 



FRATERXITIES. 

The Kappa Psi Fraternity entertained at its 
Chapter House, 1415 W. Fayette street, with a 
progressive card party on Washington's Birthday. 
Many of the old alumni and about 80 guests en- 
joyed the occasion. 

The Chi Zeta Chi annual fraternity dance 
was held at Lehmann's February 2$. The dance 
was given by members of the Delta Chapter of the 
University, Rho Chapter of the College of Phys- 
icians and Zeta Chapter of the Baltimore Medical 
College. Mrs. Nathan Winslow and Mrs. H. U. 
Todd were sponsors from Delta Chapter. 



IN HONOR OF DR. HIRAM WOODS. 

The annual banquet of the Nu Sigma Nu Fra- 
ternity was held at the Hotel Belvedere March 
15 in honor of Dr. Hiram Woods. Dr. John C. 
Hemmeter acted as toastmaster, and delivered a 
paper on "The Correlation of Medicine and Reli- 
gion.'' This was followed by a series of talks 
relating to medicine in general and the fraternity. 
Among the other faculty members present were 
Drs. Hundley, Tarun, Hirsh, Adler. Taylor and 
Spruill. Those from the Hopkins Chapter were 
Drs. Ioarker, Welch, Finney and Cullen, and M. 
F. Dabney, A. W. Williams, F. Paschel and R. 
T. Dotson. 



The Baltimore Club of the Phi Sigma Kappa 
Fraternity gave its initial banquet at the Hotel 
Rennert Saturday night, March 2. The banquet 
was an extremely pleasant occasion, and was at- 
tended by nearly all of its alumni members. The 
toasts of the evening were principally relative to 
the Building Fund and the coming convention in 
Baltimore. 

The speakers of the evening were Mr. G. H. 
Emory, "Law and Medicine": Dr. Vernon B. 
Cecil, vice-president St. John's College, "St. 
John's"; Dr. II. A. Cotton, medical director New 
York State Hospital, "Older Days"; Dr. Arthur 



M. Shipley, professor of pathological surgery and 
materia medica in University of Maryland, "In- 
fluence of Fraternities on Student Life"; Mr. 
Donald McLean, "The Council": Dr. Frank S. 
Lynn, "The Coming Convention" ; Dr. Nathan 
Winslow, "The Building Fund": Mr. R. C. Wil- 
liams of "Swarthmore," and Mr. W. H. Toulson, 
"Eta Chapter." Mr. Gilbert J. Morgan acted as 
toastmaster. 



BOOK REVIEWS 

International Clinics. A Quarterly of Illus- 
trated Clinical Lectures and Especiallv-Pre- 
pared Original Articles on Treatment. Medi- 
cine. Sursjery, Neurology, Pediatrics. Obstet- 
rics, Gynecology, Orthopedics, Pathology, Der- 
matology, Ophthalmology, Otology, Rhinolog} , 
Laryngology, Hygiene and other topics of in- 
terest to students and practitioners. By lead- 
ing members of the medical profession through- 
out the world. Edited by Henry W. Cattell, 
A.M., M.D., Philadelphia. Vol. I, 22d series. 
1912. Philadelphia and London: J. B. Lippin- 
cott Company. Cloth, $2 net. 
All of the articles in the present volume are 
above the normal in interest, but several stand 
out pre-eminently, namely, "Experimental Polio- 
myelitis," by Simon Flexner, M.D., of the Rocke- 
feller Institute for Medical Research: "The Pres- 
ent Status of Our Knowledge Concerning the 
Etiology of Pellagra," by John Funcke, M.D. : 
"An Abstract Report of a Case of Transplanta- 
tion of a Testicle." by Levi J. Hammond. M.D., 
and Howard A. Sutton. M.D.. and "An Account 
of the College of Physicians of Philadelphia," by 
G. E. de Schweinitz, M.D. 

As usual, there is a wide selection in the topics 
discussed, with a great wealth of information con- 
cerning the latest thought in the various special- 
ties. 



Some Rough Notes on Modern Diagnostic 

Methods. New York : Fellows Company. 

The above pamphlet contains in abbreviate! 
form the essence of practical laboratory methods, 
such as the technic for the examination of blood, 
urine, sputum, the Wasserman reaction, serums, 
vaccines, etc. It is an extremely useful mono- 
graph, which the above-mentioned concern will 
gladly furnish upon request of physicians free of 
charge. 



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, 608 Professional Building, Baltimore, Md. 



Entered at the Baltimore Fost-ofHce 
as Second Class Matter 



Vol. VIII 



BALTIMORE, MD., MAY IS, 1912. 



No. 3 



A FRIENDLY C< >NTR< >VERSY BETWEEN 
TWO PHYSIOLOGISTS CONCERN- 
ING THE MECHANISM OF THE 
LESSER CIRCULATION (RETURN 
OF BLOOD FROM THE GILLS TO 
THE SINUS VENOSUS) IN ELASMO- 
BRANCH FISHES. 



By John C. Hemmeter, M.D., Phil.D.. LL.D. 
Professor of Physiology, University of 

Maryland, Baltimore, Md. 



In the Zeitschrift fiir Biologiche Technik und 
Methodik, Bd. 2, p. 236, November, 191 1, I pub- 
lished an explanation of the forces that bring the 
blood back from the gills to the sinus venosus in 
the heart of the selachii. This heart consists of 
sinus venosus, which is the first part of the heart 
located in the pericardium toward the caudal end ; 
this empties into the single auricle, and this into 
the powerful ventricle. The ventricle sends its 
blood through the bulbus arteriosus and aorta to 
the gills. 

Whilst the blood pressure in large specimens 
of dogfish, for instance, may be very considerable 
in the ventral aorta going to the gills, the vessels 
returning the blood from the gills show no posi- 
tive pressure whatever, and we did not succeed in 
measuring whether there was any negative pres- 
sure with the instruments at our disposal at the 
Woods Hole laboratory during the summer of 
1911. In three vigorous specimens of mustelus 
canis the pressure in the ventral aorta was 88, 92 
and 96 mm. of mercury, respectively, but after the 
blood had been passed through the fine capillary 
network of the gills and re-collected again it 
shows no positive pressure whatever; but there 
is some slight evidence that the blood appears t<> 
be sucked caudad toward the sinus venosus. 
What causes this force to bring back the blood 
from the gills to the heart? 

The influence of the respiratory motions of the 



fish in favoring the return of blood to the sinus 
venosus has been described by me on page 238 
of the above article. 

But during a great many experiments I noticed 
that the pericardium was a very tough bag, and 
that it did not collapse to any noticeable degree 
when the ventricle contracted, but was about the 
same size during the systole and during the dias- 
tole of the ventricle. The ventricle is the strong- 
est and most muscular part of the heart. When 
it contracts it becomes very much reduced in size, 
but as the pericardial sac does not become smaller 
during the ventricular systole, the thin-walled 
sinus venosus and auricle are sucked into the 
space vacated by the ventricle. In other words, 
there is a slight negative pressure created in the 
pericardium when the auricle and ventricle con- 
tract, and this is filled by the aspirating into this 
new space of the sinus venosus. This negative 
pressure is sufficient to fill the sinus venosus from 
the sinus of Cuvier. At times the respiratory 
muscles of the fish which draw the water into the 
mouth and out through the gill slits, contract 
simultaneously with the ventricle. Now, in some 
of these fishes the respiratory muscles (coraco 
branchial) exert a traction upon the pericardium, 
thus, as the ventricle gets smaller in size, cre- 
ating a negative pressure in the pericardium, 
this sac, far from collapsing and following the 
ventricle, is pulled in the opposite direction by the 
outside traction of the respiratory muscles. 

In the elasmobranch fishes there is an open 
canal which connects the pericardium with the 
peritoneum, known as the pleuro-peritoneal canal 
I pericardio-peritoneal canal would be a more 
correct designation), which drains the pericar- 
dium toward the peritoneum; owing to valves in 
this canal, however, no fluid can enter from the 
peritoneum into the pericardium. Therefore, a 
negative pressure is possible in the pericardium, 
but not a positive pressure, for if a positive pres- 
sure were ever created in anv conceivable manner 



4-' 



THE HOSPITAL BULLETIN 



it would be spent toward the peritoneum through 
this canal. Delicate water manometers tied into 
the abdominal side of this canal indicate always 
a slight negative pressure with each systole of 
the ventricle; never a positive pressure. 

So the explanation I offered was that the re- 
turn of blood toward the sinus venosus from the 
gills was clue to a negative pressure in the peri- 
cardium caused in the manner described. When 
I explained this mechanism to my friend, Frof. 
G. H. Parker, who was working in the same 
laboratory (that of the. United States Fish Com- 
mission at Woods Hole, Mass.), he informed me 
that this discovery had already been made by 
Leon Fredericq at Liege, and in the article writ- 
ten by me I credited Fredericq with having first 
explained the respiratory circulation in the fish 
and the return of blood to the heart in this man- 
ner. On the 8th of February, 1912, I received 
the following letter from Professor Fredericq : 

"Most Honored Colleague — I have read in a 
very interesting article by you ( 'Methodik der 
Gleichzeitigen Registrierung des Atmungs- und 
Herzrythmus beim Selachier') in the Zeitschrift 
fiir Biologiche Technik und Methodik, Novem- 
ber, 1 9 1 1 , p. 2T,(>, a description of a method con- 
cerning the return of blood from the gills to the 
sinus venosus in the fish which you credit to me. 
You will oblige me very much by indicating 
where you have found this method described, as 
I cannot recall having published anything con- 
cerning this subject. In expressing my thanks 
in advance, will you please accept the assurance 
of my most cordial sentiment ? 

"Leon Fredericq. 

"P. S. — You may reply in English or German, 
just as you prefer." 

Thereupon I communicated again with Pro- 
fessor Parker, who sent me the following letter: 

"Dear Dr. Hemmeter — The idea I had about 
the return of blood to the heart of a fish applied 
to those cases where, as in the skate, the walls 
of the pericardium are firm. My notion was that 
the contraction of the ventricle in a firm-walled 
chamber would of necessity cause the auricle to 
fill by sucking in blood from the venous sinus, 
etc. Such a condition would imply a negative 
pressure in the blood cavities immediately behind 
the heart. I remember talking this over with Dr. 
Willem at Naples, and he told me that this nega- 
tive pressure had been demonstrated by Leon 



Fredericq at Liege for certain fishes. This con- 
versation was in 1893, and the whole affair is nat- 
urally somewhat hazy to me now, but I believe 
I never knew whether these observations of 
Frederick's were published or not. I am sorry 
I can't send you more satisfactory information. 

"Spaeth and I have just completed a hard half- 
year's work, and we are beginning to feel more 
ourselves again. With kind regards to Mrs. 
Hemmeter, I am, 

"Very truly yours. 

"< 1. H. Parker. 
"Zoological Laboratory, Harvard University. 

"Cambridge, Mass., February 13, 1912." 

( )n receipt of this letter from my friend. Dr. 
Parker, I sent the following communication to 
Professor Fredericq : 

"Baltimore, February 15. 191 2. 
"M. le Professeur Leon Fredericq: 

"My Dear Colleague and Honored Friend — 
From the error I have made in my article 0:1 
'Methodik der Gleichzeitig. Registrierung.' etc.. 
in the Zeitschr. f. Biologic. Technik., Hft. 5. Bd. 
2, November, 191 1, p. 236, attributing to yourself 
a physiologic contribution which you say that you 
have never published, you will recognize one of 
the embarrassing accompaniments of your great- 
ness, for discoveries are credited to you which 
you have never made. 

"( )n the other hand, the error slmws what un- 
desirable complications we may be led into by 
overconfidence in our friends whom we know as 
great authorities. Inclosed I hand you a letter 
from my friend, Prof. G. H. Parker, professor of 
zoology at Harvard University, Cambridge. 
Mass. 

"Parker worked in the Marine Biological 
Laboratory at Woods Hole, Mass., all of last 
summer, and I asked him about this very physio- 
logic question concerning the return of blood 
from the gills to the heart in fishes, and he gave 
me to understand that you had done this work. 
Knowing Parker to be one of the greatest zoolo- 
gists of our country and a very thorough and 
broadly-educated man, I did not doubt his state- 
ment, nor did I take the trouble to look up any 
reference on the subject. 

"As I was teaching your contributions t" res- 
piration to my students every year, it seemed ^,, 
natural and self-evident that you should also 
have made this discovery on fishes. If you desire 



THE HOSPITAL BULLETIN 



43 



me to correct this error, I will send a letter to that 
effect to Prof. .Martin Gildem'eister, the editor of 
the above Zeitschrift. 

"I may add that this mechanism of the nega- 
tive pressure created in the pericardium of the 
elasmobranchs during the contraction of the au- 
ricle and ventricle was worked out by me at 
Woods Hole last summer, and I did not claim it 
as an original piece of work, because Parker 
stated thai you had already made this discovery. 
As you now disclaim ever having done such 
work, it will be best for me to publish my experi- 
ments on this subject. 

By invitation of Prof. 11. J. Hamburger I hope 
to be in Groningen next fall to attend the meet- 
ing of the International Physiologic Society. 
Perhaps I will have the pleasure of seeing yon 
and meeting you there. 

"My new work. 'Manual of Physiology," was 
published this week in Philadelphia. Can you 
tell me the exact date of the meeting of physiol- 
ogists in ( ironingen ? 

"Hoping you are well, and with kindest re- 
gards. ] am, 

"Yours very sincerely, 

"J. C. Hemmeter. 
"739 University Parkway, 

"Roland Park, Baltimore." 

On March io, 1912, I received the following 
reply from Professor Fredericq : 

"Institute of Physiology, LTiiversity of Liege, 

"February 29, 191 2. 

"My Dear Colleague Hemmeter — Thank you 
for your kind letter. Herewith I return Profes- 
sor Parker's letter. I cannot imagine how 1 )r. 
Willem could have made the mistake of attrib- 
uting to me merits which I do not possess. In- 
deed, I have never undertaken any work on the 
circulation of bony fish. With regard to other 
fish, I limited myself to the collection of blood, 
but never made any experiments in the circulatory 
mechanism. 

"It does not seem worth while to trouble you 
with writing a correcting article. You will cer- 
tainly have the opportunity of some day correct- 
ing this pi lint, which is of no importance to me. 
in your future publications. 

"I am glad of the opportunity which brought 
us in contact with each other, and hope to have 
the pleasure of meeting you in Groningen in 1913. 

"Your friend. Professor Hamburger, has been 



to see me at Liege last week. I le told me of your 
splendid work and that the congress opens the 
first Tuesday in ( (ctober, 1913. 

"Yours very devotedly, 

"I J 1 IN Frederk q." 

I publish this correspondence not simply be- 
cause it authorizes me to publish under my own 
name an important contribution to the compara- 
tive physiology of the circulation, but, what I 
esteem far higher, it gives evidence of the high- 
minded manner in which men with warm, sane 
hearts adjust their differences. Ton frequently 
we see men who claim extraordinary mental cul- 
ture attack their confreres in a disingenious man- 
ner calculated to injure their good name and self- 
respect. 

The correspondence with Professor Fredericq 
illustrates how leaders of thought in natural 
science, if they are true lovers of science, will 
naturally observe the "Golden Rule." 



Among the alumni elected to official positions 
at the last meeting of the Medical and Chirurgical 
Faculty are : 

President — Dr. Archibald Cunningham Harri- 
son, class of 1887, of Baltimore, Md. 

Vice-President — Dr. Charles Fitzsimmons 
Davidson, class of 1888, of Easton. Md. 

Alternate to American Medical Association — 
Dr. William Royal Stokes, class of 1891, of Bal- 
timore. Md. 

Councillors — Dr. Josiah Slicer Bowen, class of 
1903, of Mt. Washington, Md., and Dr. Guy 
Steele, class of 181)7, ot Cambridge, Md. 

Committee on Scientific Work — Dr. Arthur 
Marriott Shipley, class of 1902, of Baltimore. Md. 

Library Committee — Dr. John Whitridge Wil- 
liams, class of 1888; Dr. Ridgeley Brown War- 
field, class of 1884, and Dr. Carey Breckinridge 
Gamble, Jr., class of 1887, all of Baltimore. 

Trustee Finney Fund for Three Years — Dr. 
Samuel T. Earle. Jr.. class of 1870. of Baltimore. 



We would be glad to know the present loca- 
tions of Dr. Max Joseph Fiery, class of 1910; Dr. 
Frank Paul Firey, class of 1910; Dr. Lafayette 
Lake, class of 1906; Dr. Eugene P.. Howie, class 
of 1910, and Dr. John Edgar Rooks, elas- of v >• -. 



44 



THE HOSPITAL BULLETIN 



THE FUNCTIONS OF AN ALUMNI AS- 
SOCIATION.* 



By William Herbert Pearce. M.D., 'gi. 



Mr. President, Ladies and Gentlemen — 'When 
I received the invitation extended me by the 
Chairman of your Committee, Mr. Baker, to 
respond to a toast on this occasion, I was em- 
barrassed by its flattering character. 

After the initial intoxication of this signal 
honor had subsided, however, I began to ask 
myself what it all meant. Why should I be 
asked to address Dickinson Alumni ? I am not 
a graduate of Dickinson ; I never got out of her 
Prep. School. Like Ben Tillman, I am a product 
of the cornfield. The feeling that there was a 
sinister motive back of this flattering honor 
haunted me. I found myself vacillating between 
gratulation and ' apprehension — one moment 
gloating over the realization of a long cherished 
ambition, and the next, crouching with fear at 
the forebodings of an evil omen. For a moment, 
when buoyed up by the hope of preferment, I 
recalled President Woodrow Wilson's declaration 
that the most interesting men he had ever met 
were not college graduates. Then those words 
of Darwin came to me — "I barely escaped the 
blighting influence of Cambridge." And I thought 
of Herbert Spencer — the supreme man of our 
age — who refused to subject his imperial intellect 
to the levelling influence of college routine, and 
foreordained conformity. 

In this state of exaltation I said, "At last the 
colleges are beginning to recognize merit out- 
side their fold." This period of hopefulness was 
short-lived, and I again sank into the slough of 
despond, concluding I had been tricked. In sheer 
desperation I went to my old friend, Dr. Taney - 
hill — that incomparable generalissimo of confused 
situations — and pleaded with him to reveal the 
secret that actuated his committee, and this is 
what he told me: "You know." said he, "the 
Alumni of Dickinson College, as a class, are so 
given to self-depreciation and to such excesses of 
modesty that both they and their Alma Mater 
have suffered as a consequence. The graduates 
of other colleges. Harvard, Yale, Princeton, Co- 
lumbia, Hopkins, Chicago, and all the rest, are so 
proud of their respective Alma Maters that in 



•An address delivered at the annual banquet of the riickin- 
siui College Alumni Association, February 11. 1910, at the Hotel 
Rennert, Baltimore, Mil. 



their attitude toward each other and the world 
they display the most disdainful hauteur. "Not 
so with the Alumni of Dickinson," he continued, 
"they disparage their own achievements — de- 
preciate their own motives, and discredit their 
own professions." When I inquired how he ac- 
counted for this anomalous situation he replied, 
"You know association begets assimilation, and 
we attribute it to the modesty of Dickinson's 
President. Now, in order to remedy this defect 
in the character of our Alumni, our Committee 
suggested asking you, for the sake of contrast, 
to speak with real bona fide Alumni, that they 
might furnish an object lesson in the great advan- 
tages that accrue to our graduates, whereby they 
hoped to inspire in the modest sons of this noble 
Mother, a laudable pride both in her and in 
themselves." "Then," said I, "your proposal is 
to make a fool of me in order to create a grate- 
ful consciousness in your Alumni." "Exactly 
so," said he ; "we believed you to be a man of 
benevolent impulses, and surely there can be 
nothing worthier than the sacrifice of one's self 
for the happiness of others." When I protested 
that I had had no experience in making a fool 
of myself — since I got married — and did not 
know how to proceed, he replied, "Be natural." 
This, ladies and gentlemen, explains why an 
undergraduate Prep, is inflicted upon you to- 
night. 

While it is true that I never got out of the 
Prep. School, I am free to confess that two boy- 
ish dreams overshadowed every other ambition 
that crossed my youthful pathway. One was to 
become a graduate of Dickinson, and the other, 
to be a Methodist preacher. Both of these worthy 
ambitions were traceable to a devoted Mother, 
who was as noble in character as she was ex- 
alted in her aspiration for me. When a mere 
child she took me to the Methodist Church and 
held up to me as models those preachers who 
had been trained at Dickinson. Well do I recall 
her admiration for George Bacon and Fred 
Heisse. They were, to my childish imagination, 
the Bossuet and Massillon of the American pul- 
pit. But a fuller appreciation of the transcendent 
thaumaturgical power of Dickinson was realized 
at a later period. Though still a small boy, well 
do I remember when the distinguished President 
of your Baltimore Association — Dr. Wilbur M. 
Pearce. went to college. I had known him as the 
son of a farmer, and had always thought of him 



TH1L HOSPITAL BULLETIN 



45 



as belonging to a similar sphere to that in which 
1 had been born. He went forth from among 
us a typical country lad, and you can imagine 
my surprise, amazement and consternation when, 
two years later, lie returned caparisoned in all 
the habiliments of the ultra-fashionable, draped 
in a long-tailed broadcloth coat, and crowned with 
a stove-pipe hat — not made to shine — but shin- 
ing himself in a mannerism that would have put 
to shame Beau Brummel, or Harry Lehr. As 
T gazed upon his resplendent form. I said to 
myself, "Great is Dickinson!" I was unsophisti- 
cated enough to believe that this external trans- 
formation had been accompanied by a corre- 
sponding internal metamorphosis. Is it surpris- 
ing that Dickinson should have become for me 
the hub of the universe? To Dickinson I deter- 
mined to go. 

I landed in the Prep. School just before Presi- 
dent Reed made his debut in Carlisle. I shall 
never forget my first impression of the new 
President. In after life there are but few things 
more amusing than the first impressions of our 
juvenile period. I can better convey to you, 
perhaps, this juvenile idea by an illustration, 
rather than a description. Dr. Johnson, the great 
Sultan of English literature, was once standing 
on a street corner in London, conversing with 
David Garrick, the celebrated actor, when Bishop 
1 I. Tsley drove by with gay and brilliant equipage, 
that flashed and spun ; whereupon Garrick re- 
marked : "There goes Bishop Horsley, looking 
as though he might say to one of the Apostles, 
'Here, Sir, hold my horses.' " 

Shortly after Dr. Heed's arrival in Carlisle it 
was announced that standards were to be raised, 
and that only men of large mental calibre would 
be able to measure up to the new requirements. 
The wisdom of my withdrawal was hinted at, and 
finally a committee of commiseration waited upon 
me and advised me to discontinue my studies, and 
return to the farm, adding that I was wasting 
both my time and my father's money. In ex- 
tenuation, they further suggested that I become 
an agricultural specialist. "For," said they, "it is 
evident that Nature has better equipped you for 
gathering apples than picking potato-bugs." 

The toast to which 1 am to respond is. The 
Functions of an Alumni Association. While 
it is true that I have no Collegiate Mother, I 
have a Medical Mother, and from my relation- 
ships to her have been derived those experiences 



that form that basis of my remarks. When we re- 
flect upon the debt of gratitude that each of us owe 
our Alma Mater it seems strange to suggest that 
we need a memorial of her; and yet this is the 
most important function of an Alumni Associa- 
tion. We are ever prone to forget — to forget the 
best things of life. Even Jesus of Nazareth 
found it necessary to leave a memorial of Him- 
self to His disciples. In reference to the Holy 
Eucharist, He said, "This do in remembrance 
of Me." 

Bernard Shaw, in his great drama of Caesar 
and Cleopatra, in the farewell scene, makes 
Caesar forget even the all-conquering Cleopatra. 
The profoundest emotions that stir the soul of 
man are soon forgotten. 

"Never a tear bedims the eye, 

That time and patience will not dry." 

It is necessary, in order to preserve the most 
priceless things in life, in some way to memorialize 
them. To appreciate the importance of a Me- 
morial to our Alma Mater, one has but to reflect 
upon the inspiring influence that great teachers 
make upon our whole career. Who shall measure 
the influence of such men as Werner at Freiburg, 
Dollinger at Munich, Arnold at Rugby, Tappan 
at Ann Arbor, Hopkins at Williamstown, White 
at Ithaca, and Agassiz at Cambridge. 

Air. Emerson, in writing to his daughter, said, 
"It makes little difference what your studies are, 
it all lies in who your teacher is." President 
David Starr Jordan says, "In my own education 
nothing meant so much to me as contact with a 
few great men whom I knew face to face." These 
words of President Jordan are a rehearsal of a 
chapter of my own experience. When I entered 
the halls of my Alma Mater, eyes I had, but saw- 
not — ears, but heard not, and on njy slumberous 
soul rested the weary weight of all this unin- 
telligible world. I knew not the power of har- 
mony and the deep power of joy that reveal the 
life of things, until my heart had been fired to 
flame by the concentrated influences of my Alma 
Mater. Within her sacred walls I had a new 
birth — an intellectual renaissance ; aye, the con- 
scious palingenesis of my whole psychic being; 
here my soul began to expand like a flower open- 
ing to the light. Through her I was admitted 
to the arcana of Nature — made to feel a kinship 
with the remotest star, and at home with the 
journeying winds. The horizon of my certain- 
ties was widened and separated by a firmer line 



4 6 



THE HOSPITAL BULLETIN 



from the impalpable obscure that surrounds us 
on every side. To her I owe the inspiration of 
all those swirling eddies of thought that have 
engulphed my eager spirit in the lure of the 
Questioning Infinite that bends over us and throbs 
about us. From her — 

* * * "I have learned 

To look on Nature, not as in the hour 

Of thoughtless youth ; but hearing oftentimes 

The still sad music of humanity." 

The second function of an Alumni Association 
is the advancement of the interests of our Alma 
Mater. There are relatively few Alumni that 
are able to make financial contributions to their 
Alma Mater, but it is in the power of every 
Alumnus to render her valuable service. Mr. 
Eeecher once said, "There comes a time in every 
man's life when nothing can take the place of 
friends." This statement is just as true when 
applied to institutions as it is to individuals. 

A word of commendation or an expression of 
confidence not infrequently yields large returns. 
I personally feel that a plea for Dickinson Col- 
lege can be made upon the highest possible 
grounds. So far as I know, she has not a James, 
or a Royce, a Dewey, or a Giddings, a New- 
combe, or a Gildersleeve : but she has an asset 
more valuable than each or all of these to the 
formative period of youth, and that is an atmos- 
phere of morality more distinctive than that of 
the Universities manned by these great teachers. 
YVe live in an age that is insane on the subject 
of intellectual education, and one that almost 
whoHy ignores that which is of infinitely greater 
importance — moral discipline. Herbert Spencer 
acutely observes, "The intellect is but the servant 
— th': emotions are the masters." The need of 
the hour is discipline of the feelings — we are fast 
becoming a nation of neurasthenics. Support 
your Alma Mater — her atmosphere has moral 
tone. 

A third function of an Alumni Association 
is the preservation of the friendships of our stu- 
dent days. It is not without valid reason that 
the friendships of this period should be guarded 
more carefully than that of any other. All of 
the true, permanent and unselfish friendships of 
life are formed in youth. In the attachments of 
a later period we cannot avoid the alloy of selfish- 
ness. I care not how much certain personalities 
may attract us, it is impossible to exclude from 



consciousness the idea of reciprocity. It is only 
in the joyous exuberance of youth that our spirits 
unconsciously respond to all that is best in the 
yearnings of kindred natures. Our college days 
not only constitute the period when the stable 
friendships of life are formed, but they furnish 
also the conditions most favorable for the growth 
of genuine attachments. 

In Agassiz's eulogy of Humboldt he gives an 
impressive account of the influence that trained 
men exert upon each other. "What a rendezvous 
for the initiated was Agassiz's own chamber in 
the University of Munich ! Here in one room was 
a museum, a laboratory, a library, a bedroom, a 
dining-room, and a fencing- room. Professors 
and students alike called it "The little Academy." 
Here they worked and talked and thought, shar- 
ing not alone the discoveries of the mind, but 
dividing also, with cheerful generosity, their scant 
meals and slender earnings. 

The friendships cemented in college life alone 
are a sufficient justification for its existence. 
President Jordan well says, "In college you find 
the men you trust in after life, and one who 
does not fail you then will never after give you 
cause for regret." 

The fourth and last function of an Alumni 
Association I shall enumerate is keeping alive the 
college spirit. There is among college men an 
esprit de corps that we call college spirit, which 
is produced by the distinctive atmosphere of 
college life. Four hundred years ago, in the old 
University of Greifswald, Ulrich Von Hutton 
defined the college spirit as "Gemeingeist unter 
freien Geistern," comradeship among free spirits. 
Comradeship embraces the intimacy of friendly 
relations, and implies the pursuit of similar ac- 
tivities. The word in its derivation denotes 
chamber-mate — the living, as it were, a common 
life. It is in the intimacy of human intercourse 
that the highest values of life inhere. 

George Eliot, in writing to a friend, says: 
"There is nothing half so sweet in life as the 
delicious new friendship I have formed for Mr. 
Herbert Spencer : we have a delightful 
camaraderie in everything." The college spirit is 
more than comradeship ; it is comradeship among 
free spirits. The true picture of the college spirit 
is that of co-workers sedulously searching for 
truth ; for it is knowledge of the truth that makes 
free. "Ye shall know the truth, and the truth 
shall make you free," said Jesus. Is it not in 



THE HOSPITAL BULLETIN 



47 



freedom from ignorance, selfishness ami vice that 
we find abundance of life? Is there not need in 
the world of this college spirit? The mission of 
the scholar is not in seclusion, but in the currents 
of life. 

Though the avenues of after life lead in di- 
verging directions, it is possible through Alumni 
Associations and annual reunions to cherish the 
memory and advance the interests of our Alma 
Mater — to preserve the friendships of our student 
days — tn keep alive the college spirit, and in 
sweet memory to tread again the paths we loved 
so well in the long ago. 

"Each fainter trace that memory holds, 

So darkly of departed years, 
In one broad glance- the soul beholds, 

And all that was, at once appears." 



-PELLAGRA. 



Edw. A. Looper, Senior Student. 



The first authentic description of pellagra was 
made in 1762 by Gasper Casal, a Spanish phy- 
sician, who gave it the name of Alal de la Rosa. 
As early as 1735 he observed this peculiar affec- 
tion among the peasants of the Asturias, but his 
writings were not published until after his death 
in 1762, by Joseph Gracia. 

Trapolli of Milan is credited with having given 
the disease its present name, in 1771, pellagra 
( Ital. pelle, skin; agra, rough.) 

From the articles of the long list of authors 
from that time down to the present the progress 
of the disease can be traced throughout Europe, 
from Spain to Southern France, from Italy to 
Upper Egypt, in parts of Africa, Austria, Servia, 
Bulgaria. India, Mexico, Barbadoes and certain 
areas of North and South America. Italy seems 
to have suffered more from the ravages of the 
disease than any of the other European countries. 
At one time it was estimated that one in every 
nineteen of the inhabitants in Northern and 
Central Italy suffered with the disease. 

Pellagra has been known to exist in the United 
States less than 30 years, but its increase has 
been so rapid and prevalence so far reaching 
that it has become one of the gravest problems 
in the South today. Cases have been reported 
in 30 States of the Union, with the greatest num- 



•Read before Mitchell Medical Society, April 4, 1912 



bers in Georgia, North and South Carolina, Ken- 
tucky and Tennessee, where the warm climate 
undoubtedly plays a prominent part in its greater 
prevalence. 

Etiology. — The cause of pellagra has as yet 
not been definitely determined ; however, several 
theories have been projected, the older of which 
is the Zeistic theory, whose adherents claim that 
damaged maize is in some way responsible for 
the malady. 

Neusser contends that the poisonous principle 
is toxico-infectious in character, and is developed 
by the action of the bacterium maidis upon dam- 
aged or fermented maize. 

Lombroso claims to have produced similar 
symptoms to pellagra, experimentally, in animals 
by injecting them with a toxine produced by the 
action of certain fungi and aspergilli upon fer- 
mented maize. 

Much evidence has been given for and against 
the Zeistic theory, but at present it is undoubtedly 
losing ground, becoming supplanted by the idea 
that the disease is due to a specific parasite. 

In 1910 Lombroso reported that his experi- 
ments and researches in Italy had led him to 
believe that pellagra was caused by the sand- 
fly or buffalo-gnat, and was a definite parasitic 
disease. His theory is based upon several im- 
portant facts and has gained many adherents. 

Mizell, in 1911, formulated the theory that a 
cotton-seed poison was responsible for the infec- 
tion, and produced its affects by nutritional dis- 
turbances. Whatever the exciting cause may be, 
it is an indisputable fact that the impoverished 
condition of large masses of people, poor hygienic 
surroundings, alcoholic excesses and exposure to 
the sun's rays, are undoubtedly important pre- 
disposing factors. Any age may be affected, but 
most cases have been reported in adult life from 
the third to the fifth decade. In America women 
have seemed more susceptible than men. The 
first manifestation of the disease is usually in 
the spring months. The warmer climates afford 
the principal territories for greatest development 
of the disease. Pellagra is certainly not infec- 
tious, contagious nor inherited. 

Symptoms. — There are two varities of pel- 
lagra, the acute and chronic form ; the latter is 
the common variety, and the one usually de- 
scribed. 

The symptoms may be divided according to 
the systems most generally affected, viz. : dis- 



4 8 



THE HOSPITAL BULLETIN 



turbances in the gastrointestinal tract and 
cerebro-spinal system, and the characteristic skin 
manifestations, erythemato-squamous and pig- 
mentary in character. 

The appearance of the disease is usually in the 
spring months, the onset being insiduous, and 
frequently preceded for several weeks by a pro- 
dromal period in which the patient experiences 
an increasing sensation of languor and general 
malaise, followed by increasing weakness and loss 
of interest in things, with neglect of customary 
duties and dread of exertion. 

The first complaint is usually of some gastro- 
intestinal disturbance, which may manifest itself 
ln r anorexia, burning sensation in epigastrium, 
excessive desire for drink, and often an associated 
diarrhea, stomatitis and not infrequently exces- 
sive secretion of saliva simulating ptyalism. The 
tongue may be red and coated, with prominent 
papillae. Nausea and vomiting is apt to ensue. 

Tenderness along the spine and pain in the 
back is frequently complained of. The tempera- 
ture may remain normal through the disease, but 
cases have been reported where the temperature 
was subnormal, and in others it ran from 102°- 
ro8°. The pulse is usually elevated from 80-160. 
The diarrhea is characteristically obstinate, re- 
sisting- all medication and dietary correctives. 

The characteristic manifestations of pellagra 
are the cutaneous phenomena, which, according 
to Stelwagon, may be divided into three stages — 
the first, a congestion or erythema; the second, 
with added scaliness, thickening and pigmenta- 
tion ; and the third, a tendency to atrophic thin- 
ning. 

The first stage of the eruption usually makes its 
appearance in the early spring, developing rather 
suddenly, with symmetrical distribution of an 
erythemato-squamous character, generally limited 
to the parts of the body exposed to the sun's rays. 
The entire face is often covered with a symmetri- 
cal distribution, producing the typical pellagra 
"mask," while an erythematous circlet around the 
neck, first described by Casal, is very character- 
istic. 

The most common seat for the lesions are the 
hacks of the hands, spreading from the ulnar to 
the radial sides, but sparing the nails and palms, 
and having a distinct line of demarcation at the 
cuff line. When the feet are similarly exposed 
thev are usually affected in the same way. ( )c- 



casionally the genital region of both sexes may 
be affected. 

The color of the erythema very closely re- 
sembles the appearance of the skin after ordinary 
sunburn, at first being a dull red, and later of 
dark brownish hue. The eruption may be dry or 
moist in character, and in the milder forms may 
desquamate in a few weeks in the form of fine 
scales. 

It is common for the skin to become infiltrated, 
thickened and swollen, with burning, itching- 
sensations, which may later result in anesthesia. 
The superficial or deeper layers of the skin may 
be the seat of the inflammation. After a short 
while the epidermis exfoliates, leaving the under- 
lying surfaces red and frequently fissured, greatly 
resembling a first degree burn. 

Pigmentation takes place with each and suc- 
ceeding attacks, and with the deep infiltration 
leaves the organs covered with a corded, irreg- 
ularly roughened epidermis, which has given 
the disease its distinctive title of "rough skin." 
With the appearance of winter the cutaneous 
eruptions usually show improvement, only to have 
a recrudescence in the following spring. 

After repeated attacks the skin becomes 
wrinkled, thickened and lax, and takes on a senile 
appearance, presenting a bluish red or dark brown 
color, with a tendency to exfoliate in flakes (Stel- 
wagon). 

The inflammation affects the mucous mem- 
branes as well, giving the cardinal red color to 
the buccal cavity, with similar changes in the 
rectum. 

The nervous manifestations of pellagra, which 
at first were betrayed by headache, vertigo, 
tremor and lassitude in the early stages of the 
disease, become progressively worse, often re- 
sulting in profound mental depression, occasional- 
ly in a settled melancholia, which may be inter- 
rupted by periods of illusions and hallucinations, 
and often followed by stupor. These symptoms 
may continue until the patient is profoundly pros- 
trated, with resulting death from emaciation, or 
the course may be more chronic, terminating in 
true pellagrous insanity. 

However, insanity is not as frequent a com- 
plication as is generally considered, for according 
to the Dunning Report of Pellagra in Italy only 
10 per cent, of the patients of that country become 
insane. 

Prognosis. — The prognosis of pellagra is at 



THE HOSPITAL BULLETIN 



49 



best very grave, although in countries where the 
disease is endemic, and in mild attacks, the out- 
look is fairly favorable. In the severe cases the 
average duration of cases is five years, but it 
may continue for 10 or 15 years. 

Most of the cases in the Smith arc of the acute 
variety, generally proving fatal within a shorter 
duratii m. 

Treatment. — As our knowledge in regard to the 
etiology of the disease is indefinite, we cannot 
exercise proper prophylactic precautions, but we 
can profit by the example given us by the Italian 
Government, where they have shown that 
prophylactic measures cat) reduce the prevalence 
wonderfully. They have accomplished their 
brilliant results by elevating the hygienic en- 
vironment of the poorer classes and excluding 
damaged maize from the dietary of their 
peasantry. Laws have been enacted for the in- 
spection and condemnation of suspected f 1 

products, and compelling the authorities to re- 
port all pellagrous patients. Commissions have 
been formulated to further study the disease, in- 
stitutions have been founded for the care of the 
sick, and modern "dietary kitchens" have been 
established in the poverty-stricken districts, with 
the result of an enormous decrease in the num- 
ber of cases in that country. 

Whether damaged maize is or is not responsible 
for the disease in this country, scientific men have 
assigned enough value to its relation to pellagra 
for the National Pellagra Conference, held in 
Columbia 1 1909), to declare: "That while corn 
is in no way connected with pellagra, evidences 
of the relation between the use of spoiled corn 
and the prevalence of pellagra seem so apparent 
that we advise the continued and systematic studv 
of the subject, and in the meantime we commend 
to corn growers the great importance of fully 
maturing corn on the stalk before cutting the 
same." 

The medicinal treatment of the disease is dis- 
appointing. Xo specific remedies have been 
found. The hope of improvement lies in placing 
the patient under good hygienic surroundings and 
improving the general health by good food and 
such tonics as are indicated. Arsenic, in the form 
of Fowler's solution, and the iron preparations 
have been principally used, with good results at 
times. Atoxyl, quinine and strychnine have been 
recommended. 

Cole and Wintrop have reported success by 



transfusing blood in a few individuals. Salvarsan 
has been tried recently, with evident improvement 
in the symptoms of the few cases reported. 



A CASE OF CEREBRAL LUETIC ENDAR- 
TERITIS WITH A TEMPORARY OC- 
CLUSION OF A LOWER ANTERIOR 
BRANCH 1 IF THE MIDDLE ( ERE- 
BRAL ARTERY, CAUSING A TEMPO- 
RARY ANEMIA 1 IF BR< ICA'S O >NV< >- 
LUTK IN. 



By MlLFORD HlNNANT and HENDERSON IkwI.V, 
Senior Medical Students. 



This case, which was treated at the University 
of Maryland Hospital, is a typical case with many 
of the characteristic symptoms. 

Name—W. T. C. 

Address — 

Occupation — Foreman on Railroad. 

Age — Thirty-eight years. 

Sex — Male. 

Race — White. 

Social Condition — Single. 

Chief Complaint — Disturbance of speech. In 
the words of patient lie has "trouble in speaking 
and in using my right hand properly." 

Family History — Mental troubles negative. Pa- 
tient's mother is nervous and excitable at times: 
negative to drug habits: constitutional inherit- 
ances, so far as tuberculosis, syphilis, nephritis, 
cardiac diseases and malignancy, is negative. 

Previous Medical History — During childhood 
he had nothing except whooping cough. His 
adolescent stage was uneventful as to any medi- 
cal conditions. Since reaching the adult stage 
the patient has been very strong and healthy, ex- 
cept for an occasional attack of indigestion, for 
which he was treated by a physician. For the 
past three months be has been suffering with 
headache and dizzv spells, for which he was also 
treated: the nature of this treatment could not be 
obtained. 

Present Illness — The patient's trouble began 
by having a constant headache, numbness at 
times (which was almost constant) of the right 
arm. forearm and fingers, and peculiar sensa- 
tions in the right side of the face. 1 lis vision 
was only slightly disturbed. 

On July << the patient was advised to go for 
a little outing to see if the fresh air would prove 



?o 



THE HOSPITAL BULLETIN 



beneficial. The patient went to Curtis Bay. and 
after being there for about two hours, he began 
to feel as if he were going to faint. He had no 
pain, but realized that he was getting weak and 
felt very queer. He then went to a friend's 
house and very soon afterwards he could not talk, 
and tried to write, but all he could do was to 
make a few signs. He was perfectly conscious 
of his surroundings but could not express him- 
self. At the same time he lost the entire use of 
his right arm and hand. 

Physical Examination — Thorax, well formed, 
lung expansion equal on both sides ; palpation 
and percussion negative; auscultation, normal re- 
spiratory sounds. Heart inspection, P. M. I. in 
fifth interspace in mid-nipple line ; palpation con- 
firms inspection ; percussion, area of cardiac dull- 
ness normal : auscultation, over the apex there is 
a soft systolic flow : over the base there is a soft 
murmur; no appreciable accentuation of the 
second sound. 

Abdomen soft ; spleen not palpable ; liver dull- 
ness normal ; no masses to be felt, no hernia, 
no tenderness. Upper and lower extremities are 
very well formed and show no scars nor in- 
jury. 

SPECIAL EXAMINATII >N. 

Head, fair amount of brown hair; skin clear. 

Ears, well-formed and in normal position, but 
a partial deafness exists on both sides. 

Exes, react to light and accommodation; area 
of vision diminished ; slight retraction of both 
upper lids. 

Neck, normal. 

Kidneys, normal. 

Bladder, normal. 

Blood, leucocytes 14,605 ; hemaglobin 95, 
blood pressure 95, 'YVasserman reaction, positive. 

Urine, reddish-amber color, a few epithelial 
cells, leucocytes and granular casts. Albumen and 
sugar negative; sp. gr. 1030. reaction acid. 

Stomach contents, normal. 

Spinal Fluid — Leucocyte count 30 to a field, 
stained smear shows increase in leucocytes of 
small variety. 

Fundi of the Eyes — Normal. 

.V put 11 in — Negative. 

Nervous Examination — Intellect only fair; 
memor) is poor; speech articulation is disturbed; 
speaks indistinctly: speech is thick. He recog- 



nizes objects but it is difficult to articulate their 
names. Gait, normal ; moves his limbs well. 

Motor Examination — The right arm is weaker 
than the left. The grip of the right hand is 
weaker than that of the left. The motor power 
of the lower extremities is about equal. There is 
no tremor or spasm of any of the muscles of the 
body. The muscles of the right side of the face 
are weak. This is particularly marked in the buc- 
cinator. 

Co-ordination of upper and lower extremities 
is not good, showing more disturbance of the 
right side than of the left. 

Romberg's sign, positive. 

Babinsky's sign, present in right foot. Nega- 
tive in the left. 

Kernig's sign, negative. Superficial reflexes 
increased. 

Deep reflexes, knee reflexes increased on both 
sides. Tendo-Achilles increased on right side, 
normal on left. Periosto-radial and triceps more 
marked on left than on right side : no cervical 
rigidity ; no spinal tenderness. 

Sensations, tactile good, pain good, tempera- 
ture good, muscular sensations fair. 

Treatment. — The patient was admitted to the 
hospital at 8 P. M. on July 6; was given a purge 
and then strychnine gr. 1/60, morphia, gr. 1/10. 
He was given strychnine gr. 1/30 t. i. d. until July 
15: at this time he was given nitro-glycerine gr. 
1/100 and this was kept up until August 12. 

( In August 12 patient -was discharged. His 
articulation was good : his face and hand were 
useful : he had a good color and the troubled face 
had given way to a pleasant expression and he 
was in good condition generally. 



Dr. William \Y. Braithwaite. class of 1909, 
sailed for Panama on the 23d. Dr. Braithwaite 
has been appointed to the Isthmian Canal Com- 
mission Hospital (550 beds) at Cristobal. He is 
a native of North Dakota, and lived for some time 
in Southern Maryland before coming to Balti- 
more and entering the University. 



Dr. Marshall Langdon Price, class of 1903. is 
a member of the recently-appointed Sanitation 
Commission, which will confer with a similar 
commission of the District of Columbia with ref- 
erence to the disposal of sewage in the District 
anil the sections of Maryland contiguous to the 
District. 



THE HOSPITAL BULLETIN 



5i 



TECHNICAL AND SCIENTIFIC QUALIFI- 

CATK »NS OF A TEACHER OF 

PHYSIOLOGY. 



By John C. J [emmeter. 

Member of the Deutsche Physiologische Gesell- 

schaft; Professor of Physiology, University 

of Maryland. 



< >ur country was the only one in which it was 
legal tn organize medical schools by an associa- 
tion of private individuals during the latter half 
of the last century. The result was an exuber- 
ance of so-called schools that were in reality stock 
companies organized by private practitioners with 
a view to benefiting either directly from the tui- 
tion fees or indirectly from consultation work 
brought by students and graduates. 

As medicine became more and more an exact 
science by the growth of anatomy, physiology, 
chemistry, pathology, bacteriology, it became evi- 
dent to even the egotistical managers of what 
might without exaggeration be called "Commer- 
cial Medical Schools" that certain subjects were 
beyond the ability of the "physicians" as then 
educated, and they were compelled nolens volens 
to elect specialists in chemistry — men who had 
obtained the degree of Doctor of Philosophy in 
one of our foremost endowed universities by .1 
thorough and intensive study and research work 
in chemistry. This was a step forward, but 
physiology was still taught largely in a dilettan- 
tish, amateurish way by practitioners who had no 
special, or at best only a very superficial, train- 
ing in physiology. 

Chemistry is not a science that is based on many 
adjuvant or collateral branches of human knowl- 
edge — a preliminary A.B. in a good college ap- 
parently still equips a man to enter on this special 
study. But physiology demands of its devotees 
a thorough training in numerous other independ- 
ent sciences. Chemistry is a structure of human 
knowledge self-sufficient in itself; perhaps physics 
may be considered as an adjuvant science indis- 
pensable to an understanding of chemistry. 
Physiology — the science of the regular processes 
that go on in living things — requires a preliminary 
training in chemistry, physics, botany, general 
biology ami anatomy. 

To be a physiologist a teacher must make him- 
self an expert in hundreds of little and major 
operations where the instrumental technique — the 



asepsis and the knowledge of anatomy — indicate 
whether a teacher is a dilettante or a trained ex- 
perienced physiologist. 

In addition, the science of life has in the last 
20 or 25 years been so enormously extended, 
such a wealth of literature has accumulated and is 
constantly being added to, that unless a teacher 
speaks, reads and writes at least three modern 
languages it is almost impossible to keep abreast 
of the progress of his own time in the advances 
that are made. 

Personally, I have found that my own course 
in physiology requires readjusting and remodel- 
ing every year, so that my system of physiologic 
discipline has not been alike in any two years, and 
it would be fatal to inculcate into the mind of any 
class of students that such a course could be so 
given that all lectures, demonstrations and confer- 
ences would be exactly alike in two consecutive 
years, for to them this would soon mean that the 
science had stood still, and that means stagnation. 
A teacher must never cease occupying himself 
with one research or another if he desires to be a 
true university teacher, for only as a research 
worker can he gain a deep insight into the whole 
biochemic and biophysic driving mechanism of 
the living substance. 

Strange as it may seem, the absorbing interest 
and training in clinical medicine exceedingly 
rarely fits a man for the teaching of physiology, 
whereas a training of exhaustive thoroughness 
in phvsiology is the best preparation imaginable 
for the clinician. The reason for this divergent 
mutual utility between clinical medicine and physi- 
ology is to be sought in the fact that only exact 
and objective sciences can be fundamental to 
other sciences. And medicine is not an exact 
science. But physiology is becoming one of the 
most exact and objective sciences that the human 
mind has formulated ; it postulates absolute eman- 
cipation from the intuitive and imaginative func- 
tions of the mind and unconditional submission 
to the hard yoke of objective investigation. A 
kind of mind that is only exceptionally and exceed- 
ingly rarely developed by a medical training. 

The period during which the medical faculty 
could appoint practitioners of medicine to fill the 
positions of teachers in physiology has passed 20 
years ago. It is just as impossible for a practi- 
tioner of medicine to teach physiology as it is for 
him to satisfactorily fill the chair of chemistry. 
A highly-specialized physiologic technique has 



THE HOSPITAL BULLETIN 



become indispensable, in addition to tbe thorough 
grounding in the facts, doctrines and hypotheses 
of the science itself, and to have physiology taught 
by one who by habit is accustomed to thinking 
only clinically gives physiologic science a twist and 
warp in the hands of such a man which distorts 
its aim and makes true understanding of the nor- 
mal processes of life practically impossible. From 
()/</ Maryland for May, 1907, p. 66, we quote the 
following: "In order to have physiology taught 
in the highest and most skilful manner. Dr. and 
Airs. J. C. Hemmeter have made an agreement 
with the trustees of the Endowment Fund of the 
University of Maryland, which was made in 1907. 
The following extract is taken from this agree- 
ment as it apeared in Old Maryland for May, 
1907, p. 66: 

"In beginning an Endowment for a Chair of 
Physiology in the University of Maryland, Prof, 
and Mrs. John C. Hemmeter 'recommend and re- 
quest' that the Board of Trustees observe the fol- 
lowing conditions: 'The first installment of 
$1500, together with future yearly contributions 
, and such legacies as will be bequeathed for this 
same purpose, are to be kept at interest until the 
principal has accumulated sufficiently to yield a 
salary of at least $3000 annually to the professor 
holding the chair at the time when this amount 
shall have accumulated. 

" 'If at that period a larger salary is required 
for a professor, the $3000 annually accumulating 
from this fund may nevertheless be utilized for 
this purpose, provided the administrative body of 
the University of Maryland at that time agrees to 
supply the difference' needed to complete the 
amount required. 

' 'It is urgently desired that the benefits accru- 
ing from this fund shall not be available or 
granted to any teacher who is not a trained 
physiologist. By that we mean that he must have 
made a special study of physiology for at least 
four years in the laboratories of physiology of 
one or other of our larger universities, such as 
Harvard, Yale or Columbia of the City of New 
York. 

''We distinctly desire to have it understood 
that the benefits from this fund are not to be 
granted to teachers who simply have a degree in 
medicine only, and have no special training in 
physiology. "What we understand by special 
training is defined in the preceding. Tbe object 
>' this is to make the leaching of physiology more 



and more objective, and not to depend upon lec- 
tures exclusively, but more upon laboratory work. 

" 'In awarding the professorship it is our desire 
that candidates who are born and educated in this 
State, and particularly alumni of this University, 
shall be given the preference ; but if none such can 
be found who have gone through special training 
either in Europe or in the large universities of 
this country, candidates from any State or nation- 
ality may be selected.' 

"The founders of this fund do not state the 
amount it is their intention to give to it. but de- 
clare that provision will be made in their wills 
for its increase. The fund now amounts to $5400." 
The founders of this fund should insist upon the 
conditions of high and exclusive scholarship, tech- 
nical training and ability, together with a broad 
experience. For broad experience, conservative 
yet penetrating critical judgment, a fanatical en- 
thusiasm for truth and exactness, together with a 
warm, sane heart, are qualifications sine qua non 
in physiologic discipline. The thought may oc- 
cur why medical men are to be excluded from the 
chair of physiology, since the writer is himself a 
clinician. It is because of this very fact that he 
is best able to realize his own shortcomings as a 
teacher of physiology, and that as far as the Uni- 
\ ersity of Maryland is -concerned, the list of 
clinician physiologists will end when his activity 
in that chair ends. His successor will be a trained 
physiologist pure and simple, and the days of the 
last Medical Mohican in that science are come 
when he terminates his connection with this 
University. 



Governor Goldsborough has appointed the fol- 
lowing alumni as coroners : 

Northern District — Dr. Henry C. Algire, class 
of 1895, of 3640 Roland avenue. Dr. Algire is 
37 years of age and a native of Baltimore. He 
succeeds Dr. G. Milton Linthicum. 

At Large — Dr. Henry C. Hyde, class of 1899, 
of 1024 E. North avenue. Dr. Hyde is a native 
of Baltimore and is 43 years of age. He is a lec- 
turer on pathology and bacteriology in the Uni- 
versitv of Maryland. 



Dr. J. Burr Piggott, class of 11)07. is now lo- 
cated at the Thomas, 1400 M street N. W., Wash- 
ington, D. C. 



THE HOSPITAL BULLETIN 



53 



THE HOSPITAL BULLETIN 

A Monthly Journal of Medicine and Surgery 

PUBLISHED BY 

THE HOSPITAL BULLETIN COMPANY 

608 Professional Building 

Baltimore, Md. 



Subscription price, . . . $1.00 per annum in advance 

Reprints furnished at cost. Advertising rates 
submitted upon request 



Nathan Winslow, M.D., Editor 



Baltimore, May 15, 1912. 



"WE HAVE PIPED UNTO YOU, AND YE 
HAVE NOT DANCED." 



The above quotation about expresses the situa- 
tion in regard to the pathological endowment 
fund. We have called unto you, and you have 
not responded. We have piped in dulcet tones, 
and you have not jigged. Ross R. YVinans, a 
recluse and misanthrope, died recently in this 
city. I lis estate is supposed to he worth about 
$4,000,000, and was left to relatives and friends. 
Not one cent was left to charitable or philan- 
thropic institutions. A. half million dollars was 
left to a fine young woman at Newport, R. I., 
who had been attentive to him when he was 
ailing. We congratulate her on her good for- 
tune. A man has the right to dispose of his 
property in accordance with his own wishes, but 
one would think he would rest more comfortably 
if he had left something to the unfortunate and 
suffering. Dr. Pearsons of Chicago died recently 
at a very advanced age and left scarcely enough 
to give himself a decent buriel. During his life- 
time he gave away all his property to small and 
needy colleges : his benefactions amounting to sev- 
eral million dollars. He certainly chose the bet- 
ter part. Medical schools must have money mure 
than can be obtained from students' fees. What 
a Godsend $500,000 would be to us ! However, 
we are not proud. If you can't give that amount, 
we would be pleased to have contributions of $25 



ach from our Alumni. Don't wait until you are 
lead, give now. 

CONTRIBUTION BY CLASSES. 

848 $50 OO 

868 10 00 

< s 7i 35 00 

~!<J2 JO OO 

*7S 430 00 

• s 74 5 00 

*75 5 oo 

876 115 00 

877 10 00 

880 5 OO 

881 250 00 

882 310 00 

883 35 00 

885 - ? 35 00 

886 100 00 

888 50 00 

889 100 00 

890 175 OD 

892 I 50 OO 

893 15 03 

894 135 00 

895 155 00 

896 52 00 

897 80 00 

898 105 OO 

899 25 00 

900 215 00 

901 175 00 

902 305 00 

903 300 00 

904 145 00 

905 200 00 

906 130 00 

907 1 10 00 

909 5 00 

ijio 50 00 

t) 1 1 Terra Mariae 3 5° 

912 Club Latino-Americano 25 00 



Total subscription to May I, 1912. .$9895 50 

srnscKiPTioxs in april. 
Dr. Joseph T. Smith, 1872 ( second con- 
tribution) $5 00 

Dr. Walter S. Phillips, 1897 10 oo 

Dr. John A. Tompkins, Jr., 1898 25 00 

Dr. Arthur J. Edwards. 1899 25 00 

Dr. C. B. Williams, W. Va 25 00 



Additions for the month $90 00 



54 



THE HOSPITAL BULLETIN 



ABSTRACT 

In a very instructive article on "Cartilaginous 
Tumors of the Larynx" {Annals of Otology, 
tihinology and Laryngology, December, 1911), 
Dr. James J. Carroll, class of 1893, of Baltimore, 
after reviewing- the literature on the subject, re- 
ports the following case, which came under his 
observation in October, 1907, and which has not 
been reported previously : 

L. T. T., white, single. 34 years old, a railroad 
engineer, had always enjoyed good health until 
lie contracted lues in 1904 and had both primary 
and secondary lesions. Patient took antisyphilitic 
treatment for a year, after which he stopped the 
medicine because he was free from symptoms. 
Pour months before coming under observation 
patient began to get hoarse, the hoarseness grad- 
ually giving way to aphonia. About a month after 
the hoarseness came on he began to have some 
difficult}' in breathing, and two months later he 
noticed an enlargement of his throat in the region 
of the larynx. He came to St. Joseph's Hospital. 
October 26, 1907, to find out the cause of his 
hoarseness. Examination showed the patient to 
be in excellent physical condition, all organs nor- 
mal except the larynx. He was aphonic and had 
some difficulty in breathing, which was aggra- 
vated by the recumbent position and by walking. 
He had a short, quick, metallic cough, which was 
made worse by lying down. There was no diffi- 
culty nor pain upon swallowing. Exteriorly there 
was a swelling over the thyroid cartilage on the 
left side. Xo glandular enlargements were felt 
in the neck. Laryngoscope showed a large rose 
colored subglottic tumor. Its surface was even, 
smooth, clean and free from ulceration. It lay 
just under the vocal cords, attached loosely to the 
under surface of the posterior half of the right 
cord and firmly connected with the posterior two- 
thirds of the left cord. The apex was free, round- 
ed, and came within 5 or 6 mm. of touching the 
anterior wall below the commissure. The base 
was attached to the posterior wall and to a slight 
degree to the lateral walls. The right cord was 
congested and moved pretty freely, but not en- 
tirely to the middle line. The anterior third of 
the left cord was free from congestion, but the 
cord itself was fixed to the side of the larynx. 
The right arytenoid moved freely on attempt at 
phonation, but the left had only a slight motion, 
of a rotary character, with no approximation to 



the median line. There was a little thin mucus 
about the laryngeal cavity, but no muco-purulent 
secretion. A few drops of cocain and adrenalin, 
injected into the larynx, made no change in size 
or contour of the tumor. A radiograph taken 
by Dr. H. Ashbury showed very clearly a more 
or less circular shadow, the upper boundary of 
which was about on a level with the middle hori- 
zontal plane of the thyroid cartilage, and the lower 
boundary fell a little below the ring of the cricoid. 
The anterior border was free, while posteriorly 
the shadow of the tumor was continuous with 
the shadow of the cricoid plate. 

As the patient had had syphilis, he was put on 
antiluetic treatment for a month, although the 
larynx did not present a picture which in any way 
resembled the usual syphilitic lesions of the 
larynx. The growth was also not malignant in 
appearance. Of the benign tumors it suggested 
most strongly a chondroma or an internal struma. 
A positive diagnosis between these two was not 
ventured without a histologic examination. The 
patient was exhibited before the Rhino-Laryngo- 
logical Section of the Baltimore City Medical 
Society. November 29, 1907. 

The large size of the tumor and its position 
below the cords precluded the possibility of remov- 
ing it by an endolaryngeal operation ; the external 
operation was therefore decided upon. A prelimi- 
nary tracheotomy through the third ring was 
done on December 11, 1907. On the 14th laryngo 
fissure was performed by the late Dr. I. R. Trim- 
ble, with the patient under chloroform. A vertical 
incision was made in the skin in the median line 
from the hyoid bone to the second ring of the 
trachea where it joined the tracheotomy wound. 
After the thyroid cartilage, the cricothyroid mem- 
brane and the cricoid cartilage were well exposed, 
a vertical section was made through the last two, 
exposing the lower part of the tumor. The 
growth filled almost the entire subglottic space, 
leaving only enough room between the apex of 
the tumor and the anterior commissure to pass a 
grooved director. The lower surface of the 
growth was smooth, pale red. slightly irregular 
and free from ulceration. To expose the mass 
satisfactorily the section had to be extended up- 
wards through the entire thyroid cartilage, which 
was exceedingly hard to cut. With the sides of 
the thyroid cartilage pulled apart, ample room was 
obtained for manipulation. Laryngeal reflexes 
were abolished by cocain and the bleeding checked 



THE HOSPITAL BULLETIN 



55 



b) adrenalin. Tumor was quite firm to the touch. 
Its free bonier faced anteriorly and to the right, 
the attachment being posteriorly and along the 

left wall of the larynx. The enveloping mem- 
brane, largely mucous membrane, was opened at 
the apex. A grayish-white granular material 
OOzed through this opening, not unlike boiled 
grits in appearance and consistency. The bulk of 
the tumor was removed with curette and most of 
the enveloping membrane with scalpel. After 
the u>e of the curette the plate of the cricoid was 
seen denuded of mucous membrane and peri- 
chi mdrium. The exact site of the growth was the 
left half of the cricoid plate, the posterior half of 
the cricothyroid membrane and the adjacent thy- 
roid cartilage. The origin was evidently from the 
cricoid, the thyroid being affected by extension. 
The tumor was as large as a medium-sized Eng- 
lish walnut, measuring about an inch in both ver- 
tical and horizontal diameters. Its upper surface 
under the cords was more flattened than the lower 
facing the trachea. In closing the wound the 
sides of the thyroid cartilage were brought to- 
gether with silver wire. The cricoid ring was not 
sutured and the tracheotomy tube was brought 
up from the tracheotomy wound and inserted here, 
the original wound in the trachea being allowed 
to close. The tube caused a good deal of pain 
anil cough, and was removed on the second day 
after the operation. Wound was firmly healed 
en the twentieth day. Patient recovered with a 
much-improved voice, good easy breathing and 
no cough. Perfect vocal function could not be 
expected on account of the unavoidable destruc- 
tion of a good part of the left cord. At this writ- 
ing there is no evidence of recurrence. A histo- 
logic examination of the tumor was made by Dr. 
E. H. Hayward, whose report is as follows : 

"The specimen consists of several small frag- 
ments of tissue, pink in color and of the consis- 
tency of muscle. There is no evidence of any old 
calcareous deposits on cutting the prepared speci- 
men. Histologically there is seen a groundwork 
of material similar in structure to hyaline carti- 
lage. Scattered throughout this are irregular 
nests of cartilage cells, many spindle-shaped fi- 
brous tissue cells, areas of myxomatous degenera- ' 
tion with fairly numerous stellate cells, and some 
small calcareous deposits. The most numerous 
and characteristic elements are the cartilage cells. 
They are rather atypical and show no regularity 
in arrangement. They are collected in scattered 



masses, separated by immature fibrous tissue and 

by elements of degeneration. Manv of the cells 
are without capsules." 

He concludes his article as follows: 
i. There should be uniformity of nomencla- 
ture. The term enchondroma should retain the 
meaning given it by Virchow, and should not be 
applied to growths of the larynx, these being 
either chondroma, ecchondroma, ecchondrosis or 
mixed tumor. 

2. Ecchondroses of the larynx should be re- 
garded as overgrowths of cartilage, not real 
tumors. 

3. Although chondroma has been known to 
recur, and even to metastasize, it is not an in- 
vasive neoplasm in the broad sense of the term, 
and should be looked upon rather as benign than 
malignant. 

4. Although the clinical aspect of the disease 
is quite definite, the etiology is still much in doubt. 
In 1888 Bruns said "cartilaginous tumors of the 
larynx are so rare that the study of every case is 
of the greatest value in order to establish the 
clinical course of the disease and to furnish data 
for proper therapeutic measures." The clinical 
course of the disease has been pretty clearly de- 
termined by the various cases published since 
Bruns' article. The histologic and pathologic 
phase of the subject has been well brought out by 
Alexander's work. The etiologic phase, however, 
lags behind and invites further wi irk and careful 
investigation. 

512 Professional Building. 



ITEMS 

Dr. Robert Tarke Bay. class of 1905, delivered 
an illustrated lecture on "Fractures" before the 
Howard County Medical Society at Ellicott City, 
March 19, 1912. 



The following committee report was adopted 
at the meeting of the Alumni Advisory Council: 

To the University of Maryland Alumni Advis- 
ory Council : 

Gentlemen — We beg to submit fur your con- 
sideration the following suggestions to be offered 
the Faculty of Physic. 

(1) That it is the sense of this body that every 
effort be made and no sacrifice be considered too 
great to comply with the recent requirements of 
the American Association of Medical Schools, 



56 



THE HOSPITAL BULLETIN 



calling- for the establishment of four full-time pro- 
, fessorships. 

(2) That the inauguration of physical thera- 
peutics as a separate lectureship is a timely inno- 
vation in the line of progress. 

(3) That the effort to establish an endowment 
fund for the chair of pathology, inaugurated by 
Prof. Randolph Winslow, is worthy of highest 
commendation and merits earnest support. 

( 4 ) That in our opinion, no student should be 
admitted to the third year until all previous con- 
ditions shall have been met. We believe the per- 
centage of failures at the State Board Examina- 
tions will thereby be materially reduced. 
Respectfully submitted. 

Signed: Harry Adler, Chairman, 
G. Lane Taneyhill, 

JoSEfH GlCHNER. 



Dr. Arthur M. Shipley, class of 1902, has re- 
moved to 1827 Eutaw place, Baltimore, Md. 



The members of the Adjunct Faculty of the 
Medical Department of the University of Mary- 
land are : 

Doctors — 

J. R. Abercrombie, S27 X. Eutaw street. 

J. F. Adams, 1316 X. Charles street. 

H. A. Adler, 1904 Madison avenue. 

II. E. Ashbury, 1020 Cathedral street. 

Daniel Base, Pharmaceutical Department, Uni- 
versity of Maryland. 

Robert I'. Bay. 1701 Guilford avenue. 

Hugh Brent, 906 X. Calvert street. 

Albert 11. Carroll. 906 X. Calvert street. 

Henry M. Chandlee, 742 \Y. North avenue. 

William G. Clopton, 2611 E. Fayette street. 

C. C. Conser, 11 13 X. Fulton avenue. 

J. M. Craighill, 1730 X. Charles street. 

M. J. Cromwell, The Latrobe. Charles and 
Read streets. 

II. C. Davis, 114 W. Franklin street. 

S. De Marco, 1604 Linden avenue. 

I 'age Edmunds, The Wentworth, Cathedral 
and .Mulberry streets. 

A. L. Fehsenfeld, Garrison and Fairview ave- 
nues. 

George A. Fleming, 1018 Madison avenue. 

John S. Fulton, 2211 St. Paul street. 

E. E. ( iibbons, 1 102 W. Lafayette avenue. 

Joseph E. Gichner, 1516 Madison avenue. 

Thomas C. < iilchrist, Professional Building. 



R. C. Harley, 1309 W. North avenue. 

J. F. Hawkins, 1618 Light street. 

George Hemmeter, 800 Harlem avenue. 

Jose L. Hirsh, 1819 Linden avenue. 

Joseph W. Holland, 1624 Linden avenue. 

John Houff, 15 X. Monroe street. 

J. Mason Hundley, 1009 Cathedral street. 

II. C. Hyde, 1024 E. Xorth avenue. 

J. Knox Insley, 2938 E. Baltimore street. 

John G. Jay, 817 X. Charles street. 

Richard 11. Johnston, 807 N. Charles street. 

H. \Y. Junes. Augusta and Frederick avenues. 

Leo Karlinsky, 11 14 Chesapeake street. 

G. S. M. Kieffer, Morrell Park. 

Frank J. Kirby. no E. Xorth avenue. 

E. 1 1. Kloman, 1619 St. Paul street. 

F. Levinson. 

G. C. Lochard, 163 1 W. Lafayette avenue. 

F. S. Lynn. 1619 St. Paul street. 
Harry D. McCarty, O13 Park avenue. 
Charles W. McElfrcsh, 1415 Linden avenue. 
H. J. Maldeis, 437 E. 25th street. 

Frank Martin, ioon Cathedral street. 

Mm. I. Messick, 1606 Madison avenue. 

Roscoe C. Metzel, 1903 W. Xorth avenue. 

Robert L. Mitchell, 21 12 Maryland avenue. 

J. F. O'Mara, 1042 Edmondson avenue. 

Elisha S. Perkins, The Rochambeau. 

Oliver Parker Penning. 171 1 St. Paul street. 

William Queen, Arlington. 

J. Dawson Reeder. 639 X. Fulton avenue. 

Compton Riely, 2025 X. Charles street. 

Harry M. Robinson, 20to Wilkens avenue. 

George M. Settle, 2435 Maryland avenue. 

H. L. Sinskey, 1616 E. Baltimore street. 

C. C. Smink, Lauraville. Md. 

William F. Sowers. 2311 Edmondson avenue. 

Irving J. Spear, i8'0 Madison avenue. 

St. Clair Spruill, 1002 Cathedral street. 

J. H. Smith, Jr., 2205 St. Paul street. 

Joseph T. Smith, The Cecil. 

William H. Smith, 3429 Chestnut avenue. 

II. W. Stoner, 2229 E. Federal street. 

Wilbur Stubbs, 647 X. Calhoun street. 

William Tarun, 613 Park avenue. 

R. Tunstall Taylor, 2000 Maryland avenue. 

G. Timberlake, Professional Building. 
Homer U. Todd, 1027 X. Gilmor street. 
J. A. Tompkins, Jr., 905 Cathedral street. 
A. J. Underbill. 1812 X. Charles street. 
A. DeT. Yalk, Kernan Hospital. 

Fred H. Vinup, 1221 Hollins street. 



THE HOSPITAL BULLETIN 



57 



I. 11. von Dreele, W. 56th street, Hampden. 
William K. White. [818 X. Charles street. 
R. (I. Willse, 1127 Madison avenue. 
Gordon Wilson, 1318 N. Charles street. 
John R. Winslow, The Latrobe, Charles and 

Read streets. 

Nathan Winslow. 3304 Walbrook avenue. 
Hiram Woods. S42 Park avenue. 



The annual smoker given by the Adjunct Fac- 
ulty to the Senior Medical Class will be held on 
Friday, May 24, at S 1'. M., in Davidge Hall, 
Lombard and Greene streets. 



The commencement of the University Hospital 
Training School for Nurses was held on Wednes- 
day, May 15, 1912, at 8 I'. M.. at Lehmann's Hall, 
Baltimore. 

The Program was as follows: Music. Prayer, 
Rev. Arthur B. Kinsolving, T).D. Music. Ad- 
dress t" the ( Jraduates, Randolph Winslow. A.M., 
M.D.. LL.D. Music. Conferring of Diplomas. 
R. Dorsey Coale. rh.D., Dean of the University. 
Music. Benediction. 

Those who received diplomas were: 

Mattie Estelle Coale, Maryland. 

Agnes May Lynch, Florida. 

Marion Campbell Smith. Maryland. 

Alice Maud Wells, Canada. 

Lucy Lee Harvey, Maryland. 

Mary Juliette Miles. Maryland. 

Eulalia Murray Cox, West Virginia. 

Bernice Victoria Conner, Maryland. 

Lena Elizabeth Stouffer, Maryland. 

May Katherine Steiner, Maryland. 

Eliza Nalley Ridgley, Maryland. 

Ann Ethel Logue, Pennsylvania. 

Lilian Freeman Blake. Maryland. 

Blanche Louise Prince, Maryland. 

Ethel Mayotta Dawson, Maryland. 

Lucy Marian Lilly, Georgia. 



Dr. George Yellott Massenburg, class of 191 1. 
formerly attached to the staff of the Church 
Home and Infirmary, has been appointed a resi- 
dent surgeon in the Santo Tomas Hospital of 
Panama Citv, Panama. 



The annual smoker of the General Alumni As- 
sociation will be held Friday, May 31, in the hall 
of the Medical and Chirurgical Faculty of Mary-* 
land, 121 1 Cathedral street, Baltimore. Gov- 
ernor Goldsborough has promised to attend, sub- 
ject to the contingencies of public business. Rev. 
Charles Fiske, rector of St. Michael's and All 
Angels' Protestant Episcopal Church, will speak, 
and Mr. Leroy < Hdham will entertain with South- 
ern songs and stories. The Bentztown Hard. Mr. 
Folger McKinsey, will also be one of the guests, 
and Dr. P.. Merrill Hopkinson is arranging the 
musical program. Tickets are $1, and are ob- 
tainable from Dr. Nathan Winslow. class of 
1901, at O08 Professional Building. 



Dr. Anton G. Rytina, class of 1905. has re- 
moved to The Shirley, Baltimore. 



Prof. Hemmeter, who is himself an artist and 
composer, lectured to the students of the Pea- 
body Conservatory of Music on April iSth on 
the Physiologic Ftmdamentals of Piano Tccli- 
nique. He has made this subject peculiarly his 
own. and according to the Peabody Conservatory 
faculty there is no one who can even remotely 
control it like our physiologist. He has received 
the following letter from Prof. Harold Randolph, 
the director at the Peabody Conservatory of 
Music. 

"Dear Dr. Hemmeter : 

"I have been so busy and harrassed with our 
Opera Class that until the performance was over 
I had neither sense nor memory. This alone can 
explain my delay in thanking you more fully for 
your most interesting and stimulating lecture. 

"You brought out man}- points that were new 
to us and shed fresh light on many of the old 
ones upon which we have been harping for many 
years. 

"I am sorry to think that any one — either a 
student or teacher — should have been prevented 
from hearing it. 

"With warmest thanks from all of us, 
"Very sincerely yours. 

Harold Randolph." 

Prof. Hemmeter is considering an invitation to 
give three lectures on the same subject at the 
April 27, 1912, Cincinnati Conservatory of Music, 
and one lecture each on "77k' Physiol. Funda- 
mentals of the Human Voice in Speaking and 
Singing." and on "Rhythm and Harmony in Rela- 
tion to Auditory ami Brain Physiology." 

A Philadelphia publishing house has sent their 



58 



THE HOSPITAL BULLETIN 



representative with a flattering offer to publish 
these investigations and studies on the borderline 
between music and physiology in book form. 



S. Lynn, class of 1907, have been elected honor- 
arv members of Chi Zeta Chi Fraternity. 



Dr. John Guirley Misseldine, class of 1911, 
passed the Nebraska State Board medical exami- 
nations with third honors, and is practicing at 
Oxford, Neb. 



Dr. Eugene Wright, class of 1908. is superin- 
tendent of the Church Home and Infirmary, Bal- 
timore. 



Leslie's Weekly, issue of April 4, 1912. shows 
a picture of the first intercollegiate baseball game 
of 19 1 2, being the game played between the Uni- 
versity of Maryland and the Naval Academy on 
March 20, 1912. The picture shows the grounds 
crowded with spectators. 



Dr. Harry Montrose Slade, class of 1884. of 
Reisterstown. Md., was appointed health officer 
o.f Baltimore county, to succeed Dr. James F. H. 
Gorsuch, class of 1876, of Fork, Md. 



The following alumni have been appointed dis- 
trict health officers of Baltimore county : 

First District— Dr. Marshall B. West, class of 

1901, of Catonsville. 

Third— Dr. Henry Alan Naylor, class of 1900, 
of Pikesville. 

Fifth— Dr. Cyril E. Fowble, class of 1910, of 
Arcadia, Md. 

Sixth — Dr. Joseph S. Baldwin, class of 1874, 
of Frecland. 

Seventh— Dr. Eugene W. Heyde, class of 1892, 
of Parkton. 

Eighth — Dr. Benjamin Robert Benson, class of 
1873, of Cockeysville. 

Ninth — Dr. Richard C. Massenburg, class of 
1884, of Tow son. 

Tenth— Dr. Josiah T. Payne, class of 1868, of 
Sunny Brook. 

Twelfth— Dr. William E. McClanahan, class of 

1902, of Baltimore. 



Drs. Randolph Winslow, class of 1873; A. M. 
Shipley, class of i<p2; E. H. Kloman, class of 
[910; Nathan Winslow, class of 1901, and Frank 



Hyman R. Weiner, senior medical student, 
1630 McCulloh street, has been elected resident 
physician at the Harrisburg Hospital, and re- 
ceived notification of his election April 29. The 
hospital has 104 beds. 



We regret to note that Dr. Marshall B. West, 
class of 1901, of Catonsville, has pneumonia. 



Miss Elizabeth C. Patterson, University Hos- 
pital Training School for Nurses, class of 1911, 
has resigned as assistant superintendent of nurses 
of the University Hospital. 



We have been asked for the addresses of the 
following alumni of the University Hospital 
Training School for Nurses : 

Miss Vera Wright, class of 1909, Presbyterian 

Hospital. New Orleans, La. 

Miss Mary Barton Saulsbury, class of 1909, 
Guilford Apartments, Baltimore, Md. 

Miss Emily Lavinia Ely, class of 1909, care of 
Miss Flanagan, Jacksonville, Fla. 

Miss Lucy Briscoe Barber, class of 1910. 1403 
Madison avenue, Baltimore, Md. 

Miss Gertrude Anne Garrison, class of 1910, 
"Havendale," Burgess Store, Ya. 

Miss Mary Morgan Kirnmel, class of 1910. 304 
E. Lafayette avenue, Baltimore. 

Miss Sarah Lillian Long, class of 1910. 21 X. 
Carey street, Baltimore. 

Miss Lula Conway Price, class of 1910, 21 X. 
Carey street, Baltimore. 

Miss Florence Dandlet King, class of iijio, 
Baltimore Eye and Ear Hospital, W. Franklin 
street, Baltimore. 

Miss Sarah Ambrose Lee, class of 1910, 21 X. 
Carey street, Baltimore. 

Miss Mary Constance Wiggin, class of I'M'). 
U. S. Xaval Hospital, Norfolk, Ya. 

Miss Marie Belle Murchison, class of 1910, 
1403 Madison avenue, Baltimore. Md. 

Miss Yirginia Opie McKay, class of 1910, 21 
X". Carey street. Baltimore, Md. 

Miss Cora Nellie Burton, class of 1910. 640 W. 
North avenue, Baltimore, Md. 

Miss Anne .Melisse Drye. class of 1910. 21 N. 
Carey street, Baltimore, Md. 



THE HOSPITAL BULLETIN 



59 



Miss Pauline Brook Pleasants, class of 
311 E. North avenue, Baltimore, Md. 

Miss Frances -May Meredith, class of 
1403 Madison avenue, Baltimore, Md. 

Miss Margaret Means Taylor, class of 19 
N. Carey street, Baltimore, Md. 

Aliss Adele Davis Barrett, class of [910, 
Carey street. Baltimore, Md. 

Miss Ellen Coleman Israel, class of 1910 
Madison avenue. Baltimore, Md. 

Miss Agnes Kirk Holland, class of 1910, 
Carey street. Baltimore, Md. 

Miss Naomi Viola Hissey, class of [907, 
Carey street. Baltimore, Md. 

Miss Mary Erie Grimes, class of 1907, 
Carev street, Baltimore, Md. 



1910, 
1910, 
10. 21 

21 N. 

. 1403 
21 N. 
21 N. 



We are glad to report that Dr. Frank S. Lynn, 
class of 1907, who has been ill with pleurisy, has 
sufficiently recovered to be out again. 



Dr. Thomas A. Ashby, class of 1873, of 1 1 25 
Madison avenue, was a guest in Lexington, \ a., 
during the past month. He was initiated into the 
Phi Beta Kappa Fraternity, to which he was re- 
cently elected, at his Alma Mater, Washington 
and Lee University. Phi Beta Kappa is said to 
be the oldest Greek letter society in the country, 
having been established at William and Mary in 
1770. Election now is accorded only to men of 
eminence in their special line of activity. Dr. 
Ashby made the trip by automobile, accompanied 
by Mr. William C. Page, who was his companion 
1 hi his trip to Europe last year. 



Dr. Howard V. Dutrow, class of 1904, for- 
merly of Frederick, Md., who has been stationed 
in the hospital at Ancon, Canal Zone, was elected 
secretary and treasurer of the Medical Associa- 
tion of the Isthmus Canal Zone at the regular 
monthly meeting of the association held in the 
Ancon Hospital on Wednesday evening, March 
13, 1912. 

Dr. Dutrow's selection to the position is quite 
an honor. The association has a membership of 
over too and is affiliated with the American Med- 
ical Association. It is analogous to the Medical 
and Chirurgical Faculty of Maryland, and has the 
same designation as all State associations. Col. 



W. C. Gorgas is one of the ex-presidents of the 
association. 

For the past six years Dr. Dutrow has been em- 
ployed in the medical service of the United States 
Government at Panama, and for some time pasl 
has been stationed at the Ancon Hospital, the sec- 
ond largest hospital in the world, in the capacity 
of assistant chief of clinic eye, ear, nose and throat 
department. The Ancon Hospital is the principal 
Government hospital on the Isthmus. 



Dr. Howard A. Kelly's "Clycopedia of Ameri- 
can Medical Biography" is deeply interesting to 
University of Maryland men. We regret that a 
sketch of Corbiu Amos does not appear in this 
book, inasmuch as we have so long been accus- 
tomed to regard his diploma as an "outward vis- 
ible" evidence of the veneration in which the be- 
holder should keep our school. Dr. Cordell has 
named quite a few other distinguished Maryland 
physicians (Old Maryland, April, 1912) whom 
he deems more than worthy of a place in its 
pages, but, in spite of its omissions. Dr. Kelly's 
book will meet a much-needed requirement of the 
medical profession, and will continue in service 
as an authentic record for many generations. 
Among the University alumni and professors 
whose sketches appear in this book are : 

Doctors — 

Isaac Edmondson Atkinson, class of 1865, late 
dean of the medical school of the University, 
and father of Dr. A. Duvall Atkinson, class of 
1894. 

Ashton Alexander, provost from 1837 to 1850. 

Roberts Bartholomew, class of 1852. 

Henry Willis Baxley, class of 1824, one of the 
founders of the first dental college in the world. 

Alexander Hamilton Bayly, class of 1835. 

George W. Boerstler, class of 1820. 

Thomas Hepburn Buckler, class of 1835. 

Elisha DeButts, professor of chemistry in the 
University from 1809 (then the College of Medi- 
cine in Maryland ) until his death, in 1831. 

James Cocke, one of the founders of the Uni- 
versity, partner of Dr. John Beale Davidge. 

William Alexander Clendenin, class of 1S40, 
ophthalmologist. 

Samuel Chew, class of 1829, professor of prin- 
ciples and practice of medicine, 1852-1863, father 
of Emeritus Professor Chew. 

Julian J. Chisolm, professor of surgery in the 



6o 



THE HOSPITAL BULLETIN 



University, and father of Dr. Frances Miles Chis- 
olm. class of 1889. 

Joshua I. Cohen, class of 1823, probably the 
earliest aurist in America. 

[ohn Beale Davidge, founder of the University. 

Francis Donaldson, class of 1846, first profes- 
sor of physiology in the University of Maryland, 
and father of Dr. Donaldson, class of 1883. 
( To be continued.) 



MARRIAGES 

1 )r. William Cuthbert Lyon, class of 1907, was 
married to Miss Bella Eleanor Flaccus, daughter 
of Mrs. William Flaccus of Ben Avon. Pa., on 
Friday, April 12, 1912, at Ben Avon. Dr. and 
Mrs. Lyon are spending their honeymoon in Eu- 
rope. They will be at home in Baltimore after 
September 1, 19 12. 



Dr. Bennett F. Bussey. class of 1894, of Texas, 
Baltimore county, Maryland, was married on 
April 26. 1912, to Miss Katherine M. Craig, 
daughter of Mr. and Mrs. Robert Craig, also of 
Texas. The couple were married in Baltimore 
at the residence of Cardinal Gibbons by Rev. R. 
C. Campbell of St. Joseph's Catholic Church of 
Texas. The bride was attired in a traveling suit 
of steel gray, with black hat, and carried a bou- 
quet of pink roses with a shower of lilies of the 
valley. The witnesses were Miss Mary Craig, 
sister of the bride, and Dr. Henry S. Jarrett of 
Towson. Dr. Bussev is a former president of the 
Baltimore County Medical Association and a 
member of the Medical and Chirurgical Faculty 
' if Maryland. 



DEATHS 

David Thomas Bowden, class of 1889, chief 
surgeon of the orthopedic department of the Pat- 
erson General Hospital, died at his home in 1'at- 
erson, X. ]., March 18, 1912, aged 46 years. 



Dr. William II. Feddeman. class of 1888. of 
Roland Park. Md., died April 12. 1912, at the 
Northampton Court Hotel, Baltimore. Dr. Fed- 
deman was a native of Virginia and came to Bal- 
timore about 20 years ago. He graduated from 
the University with honors and served in the Uni- 
versity Hospital for a time. He had a large prac- 
tice, and of late years his health had begun to 
break because of overwork. He i^ survived by 



his wife and a daughter, Miss Emma Feddeman. 

Medical Director George E. H. Harmon, 
U. S. X., class of 1872, died at Cambridge, Md., 
March 5, 1912, aged 64 years. Dr. Harmon en- 
tered the service December 20. 1873, as an Assist- 
ant Surgeon, being retired because of age on 
March 5, 1910, in the grade of Medical Director, 
with rank of Captain. 

Dr. Harmon was the dean of the Medical Corps 
of the Navy. His service afloat covered over 17 
years. He has seen active duty in almost every 
part of the world, and always did credit to the 
corps and his country. He was in command of the 
Naval Hospital at Yokohama. Japan, from Sep- 
tember 2"j, 1900, to December 24, 1902. and of the 
Naval Hospital at Washington, D. C, from July 
30, 1908, to June 20, 1910. Dr. Harmon had a 
high sense of duty and marked executive ability. 
He gave many valuable contributions to literature 
on subjects of naval medicine. His kindly nature 
and marked general and professional ability made 
him many friends. Dr. Harmon was never mar- 
ried. He was an active member of the Associa- 
tion of Military Surgeons since 1902. 



Col. Louis W. Crampton, Medical Corps. U. 
S. A., class of i8(>o. died at San Bernandino, Cal.. 
April 12, T()i2. from pneumonia, aged 63 years. 

Dr. Crampton was born in Maryland Mav 8. 
1848. He graduated from the University in (869, 
and became an Assistant Surgeon in the Army on 
June 26, 1875. He was granted the following 
promotions: Captain, June 26, 1880; Major, Sep- 
tember 6, 1895; Lieutenant-Colonel, August y, 
1903, and Colonel, April 23. 1908. 

He served with troops at Fort Sheridan, Fort 
Spokane, Fort Meade, and in Washington, D. C. 
and St. Louis as medical supply officer. lie 
served two terms of duty in the Philippines, the 
second as Chief Surgeon of the Philippine Divi- 
sion, and had returned to the United States, 
after being relieved of this duty, and was await- 
ing retirement at San Bernandino when he was 
stricken by death. Dr. Crampton was a member 
of the American Medical Association. 



As we go to press we learn of the death on 
Mav 11, 1912, of Dr. Ephriam Hopkins, class of 
1859, for many years a practitioner in Darlington, 
Harford county, Maryland. Dr. Hopkins was a 
brother of Dr. William Worthington Hopkins, 
class of 1 8^8. who died last vear. 



THE HOSPITAL BULLETIN 

Published Monthly in the Interest of the Medical Department of the University of Maryland 
PRICE &I.OO PER YEAR 



Contributions invited from the Alumni of the University, 
Business Address, 608 Professional Building, Baltimore, Md. 



Entered at the Baltimore Post-office 
as Second Class Matter 



Vol. VIII 



BALTIMORE, MD., JUNE IS, 1912. 



No. 4 



ADDRESS TO THE GRADUATES OF THE 
TRAINING SCHO( >L FOR NURSES OF 
THE UNIVERSITY HOSPITAL, MAY 
15, i<;i2. 



By Randolph Wixsr.ow, A.M.. M.D.. LL.D. 



Young Ladies of the Graduating Class of iyu: 
Certain days in our lives stand forth separate 
from all other days, and are epochs in our his- 
tory. One such day we are assembled to cele- 
brate on this occasion, the Commencement Day 
of the class of 1912. For three long years of 
arduous effort you have looked forward to the 
time, when amid the plaudits of your friends, the 
fragrance of flowers and the discourse of delight- 
ful music, you should receive the coveted di- 
plomas, testifying that you are qualified and 
equipped for the exercise of your professional 
calling. This time has now arrived, and it is 
my pleasant duty to extend to you the hearty 
congratulations of your officers and teachers, as 
well as my personal felicitations, upon the com- 
pletion of the years of strenuous training and 
■ >f work well done; and to bespeak for each of 
you a useful, honorable and successful career. 
While your term of pupilage ceases with the 
conclusion of these exercises, I wish to warn 
you that you must not imagine that your days 
1 >f stud}' are over; in fact they have but just 
begun. You must either go forward or fall to 
the rear, you cannot stand still. You have hith- 
erto been lead and guided, but in the larger and 
freer life upon which you are now entering you 
will have to assume individual responsibility ; and 
you must be prepared to meet these responsi- 
bilities as they arrive. You will need, therefore, 
lo continue to study not only text-books and 
journals, but the various conditions of disease 
with which you come into contact, as well as 
the individual patients themselves. Study per- 
sistently, observe carefully, and keep accurate 



notes of your cases. Strive not only to excel in 
your professional work, but to add to your store 
of knowledge, and of general culture. You have 
chosen a life of service, and you will have to 
sacrifice ease and pleasure to a large extent. You 
will be brought in contact with all kinds of people, 
some of them kind and considerate, some rude 
and churlish. To each class you must be patient 
and gentle, soft of speech, unruffled in temper, 
and of unfailing cheerfulness. You must remem- 
ber that those who are brought low by sickness 
and suffering are not altogether responsible for 
their actions and words, and that they may do 
and say that which they would not do or say 
under other circumstances. You will only too 
often be called upon to minister to those who 
are passing through the valley of the shadow of 
death, and it may be your duty and privilege not 
only to alleviate their physical pain and distress, 
but at times to speak words of hope and cheer 
to those who are without hope or light. This 
responsibility may not be avoided or lightly put 
aside, and a ministering angel is she who not 
only soothes the anguish of those who are about 
to pass over the river, but shows the way of 
salvation to those who are perishing. Cherish 
high ideals, have a broad charity, and emulate 
the examples of those noble women who have 
only recently been summoned to "come up 
higher" — Florence Nightingale and Clara 
Barton. 

Florence Nightingale may well be called the 
founder of modern training schools for nurses. 
Previous to her time nurses were usually well 
meaning but ignorant women, without education 
and devoid of the most elementary knowledge 
of caring for the sick; often some old crone. 
loquacious and egotistical, who was ready to do 
the wrong thing whenever the opportunity of- 
fered. Frequently the nurse was a loving mem- 
ber of the family, a devoted mother or wife, who 
sacrificed herself unselfishly, but who did not 



62 



THE HOSPITAL BULLETIN 



possess the necessary qualifications. Florence 
Nightingale was born of English parents at Flor- 
ence, Italy, in 1820, and died at London in 1910, 
aged more than 90 years. She attended a train- 
ing school for deaconesses in Germany in 1849, 
and subsequently continued her studies in the 
hospitals of London and Paris. Upon the out- 
break of the Crimean War the cry came from the 
field, "Are there no devoted women among us 
able and willing to go forth and minister to the 
sick and suffering soldiers at the hospitals of 
Sentari?" Miss Nightingale responded and 
selected 38 female nurses, and went to the front. 
They found conditions most deplorable, the hos- 
pitals filthy and infected with vermin, and cholera 
and pestilence raging. Order was soon brought 
out of chaos, new conditions were brought about, 
and death yielded to recovery in ever increasing 
proportions. From her custom of visiting her 
patients at midnight she became known as the 
Lady with the Lamp, and has been immortalized 
in the lines : 

"A lady with a lamp shall stand 
In the great history of the land, 
A noble type of good, 
Heroic womanhood." 

She accompanied the troops into the field, and 
was often under fire, and rendered such heroic 
service that she became a national heroine, and 
was the recipient of the highest honors. A pop- 
ular subscription of $250,000 was raised and pre- 
sented to her, which she refused to accept, and 
asked that it be used to found the Nightingale 
Home and School for Nurses at St. Thomas' 
Hospital, London. Notwithstanding the impair- 
ment of her health from her work during the 
Crimean War she lived to a very ripe old age, 
known and honored the world over. 

Clara Barton was born at Oxford, Mass.. in 
1821, and died at Glen Echo, Md., in [912, aged 
91 years. She was a school teacher at Borden- 
town, N. J., but on account of poor health re- 
moved to the city of Washington shortly before 
the Civil War, and obtained a clerkship in the 
Patent Office. Upon the outbreak of the war she 
volunteered for service in caring for the sick and 
wounded, and like Florence Nightingale devoted 
herself to her self-imposed task with such as- 
siduity and success that her fame spread far and 
wide. When war broke out in 1870 between 
Germany and France she again responded to the 



call of humanity and rendered invaluable services 
to the sick and wounded. Upon her return to 
the United States she succeeded in gaining gov- 
ernmental recognition of the Red Cross Conven- 
tion, and was chosen the first president of the 
American Red Cross, which position she retained 
until her death. These women had a broad virion 
of their duty to humanity and they did not shrink 
from the performance of this duty even at the 
sacrifice of comfort, health and lift-, if need 
he. I hope that we may be spared the horrors of 
war and of the pestilence that walketh in- dark- 
ness, but if these calamities should befall us I 
am sure that you will not fail to do your duty, 
as those of whom I have just spoken did theirs. 
One may be as much of a hero, however, in the 
performance of the every-day duties of life as 
in the sudden and thrilling episodes of a spec- 
tacular character. I believe that a life spent 
in the service of our fellowmen will not fail of 
recognition by the Almighty, and that the ulti- 
mate sacrifice, the laying down of one's life that 
others may live, will not fail of its reward. In 
the recent appalling disaster upon the sea some 
met their fate with words of praise and of prayer 
upon their lips ; others looked death in the eye 
without quailing, and met their doom doing their 
best to save the weak and helpless. May God 
in his boundless love have mercy upon them all. 
Folger McKinsey, the Bentztown bard, pays a 
beautiful tribute to these heroic soul- who died 
that others might live. 

"I'm glad, Jack Astor, you died that way! 

Goodby, Jack Astor, Goodby! 
I am glad you showed us what men become 

When they look death straight in the eye. 
You'd been a bad fellow, 1 guess, in a style 

That you didn't yourself think had; 
But you died like a thoroughbred gentleman — 

Goodby, Jack Astor, I'm glad !" 

"They say he was bad, and I guess he was, 

But I think God will forget; 
There's a bit of the bail in the best of men. 

And there's going to lie lots of it yet: 
But it washes out in the end, my friend. 

When we try jack Astor's plan, 
Who saved the women and saved the kids, 

And turned and died like a man." 



THE HOSPITAL BULLETIN 



63 



" "vstor, and Archibald Butt, and Case — 

Goodby, brave spirits, goodby! 
Why, even the men that live bj mistakes 

Arc gentlemen when they die. 
Soldiers and heroes and all that men 

J n their manly measure should be, 
When they look dead straight in the eye of fate 

( >n the land or on the sea !" 

'Idie hest preparation for a heroic death is to 
live a godly life, and 1 do not wish to seem to 
condone a careless life, even when it culminates 
in the greatest sacrifice that one can make. 
"Greater love hath no man than this, that a man 
lay down his life for his friends.'* It may be that 
in the supreme moment of self abnegation God 
will forgive and forget our past misdeeds. John 
] lay expresses the same sentiment in his poem, 
Jim Bludsoe. 

"He weren't no saint — hut at judgment 

I'd run my chance with Jim, 
'Longside of some pious gentlemen 

That wouldn't shook hands with him. 
He seen his duty, a dead sure thing — 

And he went for it thar ami then ; 
And Christ ain't a-going to he too hard 

On a man that died for men." 

We live in a momentous age, in fact, in the 
most wonderful period of the world's history; 
time anil space are being annihilated, and the 
viM.ins of the prophets and the dreams of the 
poets are being fulfilled. In 1513 \ asco Nunez 
de Balboa, from the crest of a hill on the Isthmus 
of Panama, first saw the vast ocean lying at his 
feet, which on account of its tranquility he 
called pacific, and Pacific ( teean it has remained 
to this day. Soon the thought was entertained 
of connecting the Atlantic and Pacific < (ceans by 
means of an artificial waterway, and now the 
dream of the centuries is an almost accomplished 
fact. The voyage of Columbus in 1402 was for 
the purpose of discovering a more direct route 
from Europe to the Indies, and he went to his 
grave with his hopes unrealized. In our day the 
fulfillment of his dream is at hand. The con- 
struction of the Panama Canal is the most stu- 
pendous engineering undertaking that the world 
has ever seen, and with its completion, a little 
more than a year hence, the greatest triumph 
of mind over matter will have occurred. This 
triumph will have been accomplished by means 
of American brains and American money. What 



has enabled our countrymen to successfully ac- 
complish this colossal task, which the French 
undertook and gave up in despair? The French 
had the necessary engineering ability, and they 

expended vast treasure in the undertaking, but 
they were not able to compete with the pestilential 
diseases of the Isthmus, and their employes died 
like flies. It is on account of the better sanita- 
tion inaugurated by the Americans that the canal 
has been built. The Isthmus of Panama, like 
Cuba, Porto Rico and the Philippine Islands, has 
become a location in which men can live and 
work in as much safety and in almost as much 
comfort, as in the temperate zones. I'm- this 
change from a tropical inferno to a tropical para- 
dise the University of Maryland is to a large 
extent responsible, and by this change the con- 
struction of the canal has been made possible. 
In 1891 James Carroll, an enlisted man in the 
United States Army, graduated from the Medical 
School of this University, and in [899 he was 
appointed a member of the yellow fever commis- 
sion, whose duty it was to investigate the cause 
and prevention of yellow fever, lie voluntarily 
subjected his hand to the bite of a stegomia mos- 
quito that had bitten a yellow fever patient, and 
promptly contracted the disease, and in his own 
person proved his faith that yellow fever is con- 
veyed from person to person by means of this 
variety of mosquito, and by no other means. By 
destroying the breeding places of the mosquitoes, 
and by screening the habitations of persons liv- 
ing in the tropics, yellow fever has been prac- 
tically wiped out, as has malaria also. All honor 
to Carroll, and to Lazear, and to Reed, the other 
American members of the yellow fever commis- 
sion, all of whom have passed from works to 
rewards. 

Xot only in Panama, but in various parts of 
our own country, we see stupendous undertak- 
ings inaugurated and, in a few years, carried to 
a successful completion ; so that the physical char- 
acteristics of the land are in many places being 
entirely transformed. The great miasmic 
swamp area of Florida, known as the Everglades, 
is being drained, and a vast tract of ooze and 
slime, where alligators and reptiles, with furtive 
Indians, hold sway, will soon be added to the 
productive lands of the country. In passing I 
may say that this reclamation is being accom- 
plished by .Mr. Frank Furst, a citizen and resi- 
dent of this city. On the other hand, the Vast 



6 4 



THE HOSPITAL BULLETIN 



arid areas of our Western domain are being ren- 
dered fertile and productive beyond comprehen- 
sion by the impounding of the mountain streams 
into artificial lakes, and the irrigation of the 
waterless lands. As one travels through New 
Mexico, Arizona, Nevada and other far Western 
States, he crosses vast tracts of dry alkaline 
plains, where the dust is stifling and the heat 
like that of a fiery furnace ; where no foliage is 
to De seen except, perhaps, gray sage bushes 
and thorny cacti, and where the ground is cracked 
and parched and uttering its prayer for rain. 
If by chance some one with a vision hears the 
cry and brings water to these thirsty deserts, 
they blossom as the rose and bring forth some 
thirty, some sixty and some many hundred fold. 

The vivid flash of the lightning as it extended 
across the heavens, associated with the deafening 
crash of thunder, has brought terror to many 
from time immemorial. It seemed to the af- 
frighted spectator that the wrath of God was 
about to be visited upon the earth, and that sin- 
ful men were to be overwhelmed by the righteous 
indignation of the Almighty. Benjamin Franklin 
saw a vision, and from his experiments in 1746 
with his kite we have the electricity harnesed 
and made to serve the useful purposes of man. 
In 1844 Samuel F. B. Morse, already an artist 
of note, succeeded in interesting the Government 
in a device of his invention, and the first tele- 
graphic message in the world, "What hath God 
wrought," was sent over the wires from Wash- 
ington to Baltimore. The submarine cable now 
connects the nations of the world with each 
other as with friendly hand clasps beneath the 
sea; and the telephone enables us to hear the 
voice of loved ones who may be many hundred 
miles away. A few years ago the Italian, Mar- 
coni, succeeded in sending messages through the 
air and over the seas, without wires, and this 
invention is of the most far-reaching importance. 
The recent tragedy of the sea, the wreck of the 
leviathan Titanic, was robbed of some of its 
horror by the heroic devotion to duty of its 
wireless operator, Phillips, who continued to 
send out the cry for help, until the great ship 
plunged beneath the waves, and he met his fate 
in the icy waters. The call was heard, however. 
and more than 700 lives were saved. 

Who has not admired the wonderful flight of 
the eagle or the soaring of the vulture, and how 
many persons have dreamed of flying through 



the air? Those mythological personages, Dae- 
dalus and Icarus are represented to have at- 
tempted flight from Crete to Sicily with wings 
made of feathers and wax. The youthful Icarus 
flew too high, and the heat of the sun melted 
the wax and he fell into the sea and was drowned, 
but the more prudent Daedalus kept at a lower 
level and reached his destination in safety. Since 
that time men have not trusted themselves to 
wings of feathers and wax, but the dream of 
flight through the air has been entertained from 
time to time as an object not beyond successful 
accomplishment. Through the genius of Count 
Zeppelin the dirigible airship has become a 
reality, and regular passenger service is main- 
tained between certain cities in Germany. It is, 
however, still a hazardous and uncertain voyage, 
and one can embark more safely, though more 
slowly, in an ox-cart. A few years ago Orville 
and Wilbur Wright saw a vision, and the heavier 
than air aeroplane was evolved, and though far 
from perfect at present, C. P. Rogers was able 
to cross from the Atlantic to the Pacific Coast 
at a speed of more than a mile a minute. These 
are some of the wonderful results that have 
been accomplished in our day, by those who 
have seen visions and have followed the light. 
Many others equally as startling might be men- 
tioned, did time and opportunity permit. Truly 
the impossible is being made possible, and in our 
time is the prophecy being fulfilled, that "it shall 
come to pass in the last days, saith God, I will 
pour out of My spirit upon all flesh * * * 
and your young men shall see visions, and your 
old men shall dream dreams." I have preached 
you a very drowsy and prosaic sermon, and I 
must not tax your forbearance farther. 

Let duty be the guiding spirit of your lives. 
Be faithful in little things, and if a great and 
overwhelming crisis should overtake you, you 
will be faithful even unto death. Be loyal to 
yourselves, to your school, to your patrons and 
to your calling. Have a broad vision ; look up 
and not down. Observe the signs of the times, 
and go forward. Be hopeful and helpful. A 
life of service to others is the ideal life. Success 
is relative and depends upon the point of view. 
The most successful life is the one of the greatest 
usefulness. 

In this broad sense I again wish you useful, 
honorable and successful careers. 



THE HOSPITAL BULLETIN 



65 



SOME FACTS DEALING WITH THE DE- 

VELOPMENT OF ASEPTIC 

SURGERY.* 



By R. A. AllgooPj '12. 



The first record of surgery \vc have is 400 
years B. C, or the time of Hippocrates, who is 
generally known as the Father of Medicine, but 
I think he lias a just right to he called the Father 
hi Surgery, for he discoursed wisely and elabo- 
rately of fractures, of joints, of the structures 
and diseases of the tones, of ulcers, of fistulas and 
hemorrhoids. In addition to this, his writing' 
deals with trephining, with reduction of hernia, 
with herniotomy and lithotomy by both the peri- 
neal and suprapubic route. 

lie descrihed pneumothorax and opened and 
drained the chest for empyema. 

This was a good start on the road to success 
of surgery, but the traveling was slow until the 
century that is immediately behind us, which 
brings with it memories we are not likely to 
forget. 

, Twelve years ago we began the present century 
by celebrating the achievements of the last cen- 
tury, and the more we inspect those 100 years of 
progress, the more remarkable they appear. 

In 1894 Billings wrote: "More progress in the 
art of surgery has been made since 1800 than had 
been made in the 2000 years preceding that date." 
And I think that all men of today will agree that 
Joseph Lister has been the leading factor in the 
progress. 

He was born on April 6, 1827, at Upton, in 
Essex county. England. He is not a Scotchman. 
as many think, though his notable work was done 
in Scotch universities. 

Joseph Lister followed his father's trade as a 
wine merchant in London for a while after his 
father's death, but in spite of the claims of busi- 
ness he felt the claims of science more strongly. 

One cannot say just when it was that Lister 
began constantly turning his mind to the problem 
of a remedy for wound infection — perhaps he 
himself could not tell us — but he must have been 
dwelling upon such things very early in his career. 

We may conceive of the conditions in those old 
hospitals and in wounds in general from the de- 



*Kead before Randolph Wiuslow Suglcal Society, ftfarcb 

22 1012 



scription in the books and from the tales of men 
whose professional memories go back 35 years 

or more. 

In (he hospital surgical sepsis ran until sec- 
ondary hemorrhage, erysipelas, septicemia, pye- 
mia and hospital gangrene were endemic ; some- 
times wards, wings or whole institutes were closed 
i:i vain attempts to stamp out these disorder^. 
( Iperations in private houses, especially in the 
country, were less dangerous than in hospitals, 
but in private-house operations the mortality was 
high. 

Sometimes a surgeon would wear the same old 
operating coat for years, and would pick waxed 
ligatures from the button-hole of his assistants, 
who carried them there for the convenience of his 
chief. Old hands will tell you such stories by the 
score, but to the modern surgeon such practices 
are uucondonable. The explanation the men of 
the early part of the eighteenth century gave of 
septic fevers was that all septic fevers are due to 
sympathetic action of the nervous system, as when 
a part is injured nature contends for a cure by 
stopping the function of all the uninjured organs, 
and thus turning aside their blood supply to the 
injured part, setting up inflamation and so at- 
tempting a cure. 

Lister remained in Edinburgh in the early part 
of his life until i860, his thirty-fourth year, and 
it was during the last of this period that he began 
his bacteriological studies in connection with 
aseptic surgery. With an eye single to this great 
problem, he kept a lookout for what the rest of 
the world was doing, and it was at this time that 
the significant researches of Pasteur attracted him. 
Louis Pasteur was five years Lister's senior. The 
son of an old Peninsula war veteran, he was well 
educated for a scientific career, and by i860 he had 
convinced himself of the importance of the role 
played by microbes in the production of fermenta- 
tion as opposed to the old views of Liebig that 
it is a change in organic fluids and tissues set in 
motion by the excess of oxygen of bodies in a 
state of decomposition. After the demonstration 
of the cause of fermentation, there followed ex- 
periments and discussions on spontaneous genera- 
tion and the establishment of Pasteur thesis of 
the non-existence of such generation. 

Lister's growing belief in an external agent 
as the cause of wound infection was strengthened 
and confirmed by Pasteur's researches, for in 1867 
he was able to write. Turning now to the ques- 



66 



THE HOSPITAL BULLETIN 



tion how the atmosphere produces decomposition 
of organic substances, we rind that a flood of light 
has been thrown upon this most important sub- 
ject by the researches of Pasteur. 

He believed at this time — and for many years 
afterwards — that the air was the vehicle which 
brought poison to wounds, though he recognized 
then — and with increasing perception as the years 
passed — that all foreign substances, as clothing, 
skin, instruments, sponges, ligatures, were also 
contagion carriers. Even before finding a satis- 
factory antiseptic, he insisted that operators and 
dressers should be scrupulously clean, and he em- 
ployed many deodorant lotions about the wounds. 

He had then decided that putrefaction and sup- 
puration were distinct processes, and were due to 
distinct causes. He regarded wound infection as 
putrefaction, and what wonder, considering that 
putrefaction did frequently occur and simulate 
inflammation of the most virulent type! 

The science of bacteriology was in its infancy. 
and no one appreciated the different forms of 
i irganisms, much less the distinction between 
pathogenic, pyogenic and saprophytic bacteria. 

At this time Lister's ingenuity was exercised 
especially in some cases of compound fractures in 
which the mortality had always been great, and 
it was in such cases in 1864 that he proposed to 
use his new remedy. He recognized that the most 
severely lacerated simple fractures healed with- 
out special disturbance, and, convinced as he was 
that it was the air admitted to compound frac- 
tures which rendered them dangerous, he sought 
to reduce them to the simple state by excluding 
air or by opposing to the air a barrier which 
should render harmless its offending germs. So 
lie wiped out the wound with pure carbolic acid 
and then sealed it with lint soaked in carbolic acid. 
The exudation mingling with the acid formed a 
paste which soon hardened into a scab. In order 
to prevent too rapid evaporation of the agent, he 
laid over this dressing a block-tin shield. So long 
as active inflammation did not appear, the car- 
bolic scab was painted daily with more carbolic, 
to keep in a fresh supply of the germicide, and the 
shield was reapplied daily. The surprising suc- 
cess of this treatment in the cases of compound 
fractures led to its employment in abscesses and 
fresh wounds. 

Sometimes it was impossible to secure exudate 
of proper quality to mix with the carbolic for a 
paste, so an artificial paste of linseed oil, carbonate 



of lime and carbolic acid was tried. This was 
Lister's famous antiseptic putty. 

Until 1877 antiseptics came and went; the car- 
bolic spray was used and was banished. Air was 
found not to be a dreaded enemy and carrier of 
disease, but a kindly friend when properly used. 

Surgical cleanliness, a germ-free environment, 
became recognized as the one thing needed. 

So today we have aseptic surgery in the place 
of septic surgery, because heat, soap and water, 
the nailbrush, alcohol and a few simple chemicals 
have replaced the use of non-sterile instruments, 
sutures and dirty hands, all of which go to make 
the past century one of progress in relation to sur- 
srerv. 



The following postal was received from Dr. 
Michael Manna, class of iQio, of Tanta, Egypt : 

"Dear Dr. Nathan Winslow: 

"Yesterday I sent you by mail $5. Please for- 
ward one of them to Dr. Cordell for Old Mary- 
land, and the rest are what George and myself 
owe to the Bulletin. 

"If I can get spare time, I will collect from be- 
tween my papers the scattered notes I have on 
two operations I performed lately and send them 
to you. One of them is a Caesarian section on 
a woman 25 years old for a contracted pelvis. 
Am sure you will be surprised to hear me calling 
it a bloodless operation. Only a few small 
sponges were used from the beginning to the end. 
The other operation is peculiar for its rarity. 
It was a large abscess of the spleen complicating 
malaria. I had to perform a laparotomv for it. 
The abscess contained about two pints of pus ; 
the whole spleen looked like a bag of pus floating 
freely in the abdomen. Result is splendid in both 
operations. 

"Best regards to you, Profess >r> Winslow. 
Coale. Mitchell, Shipley and all." 



Dr. Joseph Collins, class of 1909. of Calvert. 
Cecil county, Md., was seriously injured in a 
runaway June 3. His buggy was overturned and 
he lay for several hours before someone found 
him and carried him to a nearby house. His 
head is badly cut, and his knee sprained, and it 
will be weeks before he will be able to resume 
his practice. 



Dr. John Willis Abbitt. class of iqio, has been 
appointed a coroner in Portsmouth, Ya. 



THE HOSPITAL BULLETIN 



07 



BREAST AFFECTIONS— A SERIES OF ioo 

CASES. 



By Randolph WinsloWj M.D.. LL.D., 

Professor of Surgery, University of Maryland, 

and 

Nathan Winslow, A.B., M.D., 

Associate Professor of Surgery in the University 

of Maryland. 



From a series of ioo cases of affections of the 
breast occurrng in the University Hospital dur- 
ing the past few years, we have been able to elicit 
the following facts : Sixty-three were carci- 
nomas, 3 sarcomas, 20 fibroadenomas, 3 adeno- 
cystomas, t adeno-fibro-cystoma, 1 systic fibro- 
ma, 2 galatoceles, 3 tubercular mastitis, 1 peri- 
canilicular fibro-myxoma, abscess 3. 

All but one were women, or 99 per cent.; the 
male had a fibro-adenoma ; 69 of the patients were 
married, 27 single ; the social status of 4 was not 
recorded ; 88 were of the white race, 12 of the col- 
ored ; 76 did housework, the occupation of 10 was 
not stated: one was a farmer, 2 sales women, 1 a 
stenographer, 1 a cook, 1 a factory hand, 3 laun- 
dresses, 1 a dressmaker, 2 were teachers, 1 a clerk, 
1 a music teacher. 

The right breast was affected in 40 instances, 
the left in 58 ; in the remaining instances the af- 
fected organ was not mentioned ; 94 of the indi- 
viduals were subjected to operation, with 92 oper- 
ative recoveries ami 2 deaths.* Two refused op- 
eration, and in 4 the involvement was too exten - 
>ive for an operation. 

The tumor came under the observation of the 
surgeon within the first week of its discovery by 
the patient in five instances ; within one month in 
5; within two months in 6; within three months 
in 9 ; four months 3 ; five months 1 ; six months 
7 ; nine months 4 ; one year 6 ; two years 16 ; three 
years 5 : four years 2 ; five years 1 : six years 2 : 
seven years 2 ; fourteen years 1 ; eighteen years 1 . 
twenty-eight years 1 ; not stated 13. 

Taking the series as a whole, the largest num- 
ber of cases came under the observation of the 
>urgeon during the third decade of life, there hav- 
ing been 25 between 30 and 40 years of age, while 
the fourth decade presented a nearly equal propor- 
tion, with 2^ cases: 48 per cent, of all the cases 



♦Deaths. One followed a palliative operation and oc- 
curred quite suddenly: cause unknown. The other prob- 
ably resulted from pneumonia. 



came to the hospital for treatment during the pe- 
riod between 30 and 50 years of age. 

Carcinoma: The cases of carcinoma were 63 in 
number. The period of greatest frequency was in 
the fourth decade, when 19 cases occurred, which 
corresponds with previous statistics. Of this se- 
ries only 3 occurred before the thirty-fifth year, 56 
at a later period, 3 not being recorded ; 10 oc- 
curred before the fortieth year, 49 afterwards. 
The youngest age recorded was 17 years. In 
this case a supposedly fibro-adenoma was re- 
moved, but a microscopical examination, made 
by I'rof. Hirsh, showed the tumor to be under- 
going beginning adeno-carcinomatous changes. 
The next youngest in our series was 26 years 
of age. Fifty-seven of the 59 cases with age 
recorded occurred after the thirtieth year of age. 
The oldest patient was 82 years old ; she was op- 
erated on and made a good operative recovery. 
( )f the 12 colored patients in the general list, 7 
were affected with carcinoma, or 58.3 per cent. 
The youngest of these was 37 years of age. These 
figures seem to indicate that in the colored race 
cancer is not only relatively less frequent, but is 
also actually less prevalent than in the white, for 
of the 88 white patients, 55 were the subjects of 
carcinoma, 62.5 per cent., as compared with 58.3 
per cent, for negroes. A family history of can- 
cer was obtained in 16 instances, and of trauma 
in 14. The growth had ulcerated in 10, and was 
attached to the skin or muscles in 26. The axil- 
lary glands were palpable in 32. The growth was 
located in the upper and outer quadrant in 15, 
lower and outer in 6, upper and inner in 9, lower 
and inner in 1. The size varied from that of a 
marble to a clenched fist, and even larger in sev- 
eral instances. The growths were removed by 
llalsted's radical method in 37 instances, and by 
Meyer's method once; the breast and axillary 
glands without removal of the pectoral muscles 
in 19. In 3 involvement was too extensive for 
successful removal, and 2 refused operation. 

The importance of subjecting every growth to 
a thorough microscopical examination was dem- 
onstrated by the following case: The operator, 
thinking he was dealing with a fibro-adenoma. 
enucleated the growth, but subsequently he was 
informed the growth was carcinomatous, and the 
patient returned for a breast amputation. In an- 
other instance, after having removed a doubtful 
growth, the operator was advised that a frozen 
section indicated carcinoma. He therefore im- 



68 



THE HOSPITAL BULLETIN 



mediately performed a radical operation, and 
later was informed that the growth, on further 
microscopical examination, was innocent. Thus 
even frozen sections are not invariably reliable, 
but under such circumstances as mentioned above 
it is the best policy to remove the breast at the 
time of the original operation and not delay, even 
though, as in this case, the operative procedures 
were more mutilating than was necessary. 

The diagnosis appended to the charts in the 
cancer series was simple carcinoma, 37 ; sirrhus 
carcinoma, 20 ; medullary carcinoma, 1 ; adeno- 
carcinoma, 5. In eight instances there was a his- 
tory of post-operative recurrence, but as no post- 
operative history was obtained of most of the 
cases, a definite statement cannot be made as re- 
gards the actual number of recurrences. 

A history of more or less pain was obtained 
from 42 of these patients. 

In the cancer series a growth was known to 
have been in existence for the following periods: 
One week, in 9 cases ; two weeks, in 1 ; three 
weeks, 1 ; two months. 2; three mouths, 8; four 
months, 4 ; six months, 5 ; nine months, 3 ; one 
year, 10; two years, 10; three years, 4; four 
years 1 ; five years, 1 ; seven years, 2 ; fourteen 
years, 1 ; twenty-eight years, I. 

Glancing at the length of existence of the tumor 
in the cancer series, forcibly reminds us that as 
soon as a lump is discovered in the breast it 
should be removed. In one case the growth wa- 
in existence for 5 years, two for 7 years, one for 
14 years, one for 28 years, and quite a number 
from one to two years. Surely, if all of these 
had been extirpated in their incipiency, at least 
some of the cancer victims would have escaped. 

Sarcoma: There were three cases of sarcoma. 
The time of life at which they occurred was as 
follows: 34 years, 51 years ami 52 years. Al- 
though this series is very small, the ages are 
rather remarkable. Sarcoma, as a rule, occurs 
before the fortieth year. Here we have two after 
the fiftieth. One of these cases was a myxo-sar- 
coma. There was pain in two. 

Adeno-Fibroma: There were 20 cases of 
adeno— fibroma, distributed as follows : The old- 
est patient with adeno-fibroma was 45. The 
greatest number of cases occurred between the 
ages of 30 and 40, during which decade nine cases 
came under observation. To our mind, there is 
no doubt that some of these tumors would have 
eventually undergone malignant degeneration if 



they had not been extirpated. There was pain in 
six of these cases. 

Fibro-Myxoma: There was one case of libro- 
myxoma, occurring in a colored girl aged 17 
years. 

Cystic-Fibroma: One case of cystic-fibroma 
was observed, occurring in a white woman 27 
years of age. There was pain in this case. 

Tubercular Mastitis: There were three cases 
of tuberculosis of the breast, occurring at the fol- 
lowing ages: 40, 44 and 60. Of these three 
cases twowere mistaken for malignant disease and 
one was correctly diagnosed clinically. The diag- 
nosis in the other cases was made by means of 
microscopical examination. There was some pain 
in all these cases. The last case two years sub- 
sequently returned to hospital complaining of se- 
vere pains in right breast. On examination no 
lump was palpable : the breast soft and apparently 
not affected; it was, however, amputated, with 
nu relief of pain. 

Galatocele: Two cases of galatocek- were ob- 
served, occurring at the following age-: one at 
2}, years and one at 35 years. There was pain 
in one of these cases. 

Adeno-cystoma: There were three cases of 
adeno-cystoma, aged, respectively, 16. 21 and 47 
years. There was pain complained of in two of 
these cases. 

Adeno-fibro-cy stoma: One case of adeno-fibro- 
cystoma was observed, aged 51 year.-. 

Ether was used as an anesthetic in practically 
all cases, but in one serious case the induction of 
insensibility to pain by the use of I IMC tablet- 
was thoroughly tested. At A. M. hyocine gr. 
1/200, cactine gr. 1/134. morphine gr. 's was ad- 
ministered hypodermically, and the same dose was 
repeated at 10.30 A. M. When brought to the oper- 
ating table at 10.45 A. M. the patient was asleep, 
but could be awakened sufficiently t<> understand 
what was said to her. and would protrude her 
tongue if told to do so, but would not -peak in 
answer to questions, and would lapse immediately 
into slumber. The plantar reflex was present : 
the pupils were dilated ; the respirations were 
deep and the pulse was full (120 per minute), 
but regular and of good tension and volume. The 
breast and axillary glands were removed with- 
out great inconvenience to the patient. When re- 
turned to bed she continued to sleep profoundly 
not awakening until 5 P. M., when she regained 
consciousness without nausea or other bad effect. 



THE HOSPITAL BULLETIN 



69 



The skin was moist and the glandular activity 
was apparently not affected. Her condition for 
several days following operation was satisfactory, 
then she grew progressively worse until death. 

The importance of subjecting the extirpated 
growth to a microscopical examination was illus- 
trated by a case which was diagnosed carcinoma 
and on pathological examination proved to be 
fibro-adenoma ; another, diagnosed clinically 
fibro-adenoma, was found to be undergoing ma- 
lignancy; still another, diagnosed carcinoma, on 
microscopical examination showed tuberculosis of 
the breast; another was diagnosed sarcoma, and 
was later fi imid to be scirrhus carcinoma ; another, 
diagnosed carcinoma, was. in fact, tuberculosis of 
the breast : still another was diagnosed carcinoma 
of the breast, and was really a fibro-adenoma, and 
finally one diagnosed fibroma was found to be 
ai leno-carcinoma. 

The 12 cases occurring in colored persons were 
as follows : 

Carcinoma 7, aged 37, 39, 43, 47, 58, 62 and 56 
years, respectively. . 

Sarcoma I. aged 51 years. 

( ialatocele r, aged 25 years. 

Adeno-cystoma 1, aged 16 years. 

Fibro-myjcoma 1, aged 17 years. 

Tuberculosis of breast 1, aged 62 years. 

The writers are aware that they have not made 
any specially valuable contribution to medical 
knowledge by the tabulation of these cases. The 
number is too small, the records too meager and 
the pathological investigations too superficial to 
enable us to do more than show the general char- 
acteristics of an unselected series of 100 cases. 
Of several facts, however, they are convinced 
from their own observation, as well as from the 
recent literature on the subject of mammary tu- 
mors. ( )ne of these facts is that it is impossible 
to know whether a given growth is innocent or 
malignant until a proper microscopical examina- 
tion has been made. If possible, a frozen section 
should be made by a competent person and re- 
ported "ii immediately, in order that the surgeon 
may be guided as to the necessity of performing 
a radical or a partial operation. When, however, 
there is a well-grounded doubt as to whether the 
tumor is benign or otherwise, the patient should 
be given the benefit of the doubt, and the radical 
operation should be performed. Secondly, no 
girl or woman is justified in keeping a growth in 
her breast, and this injunction is the more imper- 



ative as the woman advances in aye. All breast 
tumors should be removed in their incipiency; be- 
nign tumors may become malignant, and malig- 
nant tumors in a short time may become diffused 
and beyond successful and permanent eradica- 
tion. Thirdly, carcinoma probably is somewhat 
less frequent in proportion to other neoplasms 
than is generally taught ; 63 per cent, of our cases 
were carcinomata, but this is probably too low 
a percentage for a normal ratio, and sarcoma oc- 
curs in only a small percentage of cases (3 per 
cent, in this series), which is probably more fre- 
quent than is normal. 



REMARKS AT THE ANNUAL REUNION 

OF THE MEDICAL ALUMNI ASS< >- 

CIATK >N, fUNE 1, 1012. 



By Michael Vinciguerra, 1912. 



Professors, Doctors and Fellow-Students: 

It is easy to imagine in what state of perplexity 
I find myself when you consider that I am 
facing at present not only my classmates, but 
my illustrious teachers, whom for many years 
I have been accustomed to listen to with great in- 
terest and profit. 

To be present at this gathering is a great honor, 
and to stand before this audience I consider it 
a great privilege. I am sure that on such an occa- 
sion as this there is ample room for an orator to 
be at his best in order to meet the great task 
before him, but since I have not the gift of 
speech-making, and since I have to deal with a 
"foreign tool of expression," I trust you will 
pardon me should I say less than what I feel. 

hirst and foremost it is my fervent desire to 
extend my thanks to those who for many years, 
and day after day, have tried to infuse within 
us the best that medical science offers — I mean 
you. my most esteemed teachers. It is my wish 
to impart to you — you, the delineators of our 
future careers — you, the guides of our tortuous 
and rough path — you, the stimulators and sources 
of anything that is of any good within us, it 
is to you, I have said, that I, as well as the class 
of 1912, eagerly desire to extend our sincere 
gratitude for the constant effort you have made 
during the past years to inculcate in our minds 
and heart the best of your vast knowledge and 
long experience. Nor does our sentiment of ap- 
preciation toward you end with the expiration of 



7° 



THE HOSPITAL BULLETIN 



these feeble words of recognition (I have said 
words of recognition), for really I have no such 
utterances as to meet this task. I am destitute of 
any expression of thanks for what we owe you, 
and for this reason I am compelled to burv in 
silence most of our debt of duty that by right 
should be accorded you. 

At present the only thing that we have 
stored at the bottom of our hearts is our 
knowledge of being ever your debtors. In this 
acknowledgment there is the signature of each 
and every student of the class of 1912 who, while 
not promising you that we shall be successful 
physicians, do promise and assure that we shall 
endeavor our utmost to become at least desir- 
able citizens. 

Our actions shall be ever directed so as to give 
you no opportunity of regretting the time, effort 
and energy that you have consumed upon us. 

Next in order I would like to thank you, my 
kind classmates — ever desirable companions — 
faithful and sincere friends in necessity — I wish 
1 were able to appropriately express to you my 
warmest sentiment of appreciation for the numer- 
ous courtesies you have constantly shown me. 
Ever since the first time that I have had the for- 
tune of meeting you I have seen in your eyes ever 
an inviting glance ; in your face always an encour- 
aging, smile, accompanied with friendly words. In 
case of necessity I have found you constant and 
faithful — in case of action, ready to act. 

But this is not all. You have even gone a little 
farther. You have unanimously elected me a 
member of the "House Committee" and secretary 
of your class. Also secretary of the Randolph 
Winslow Surgical Society — positions that ought 
to have been occupied by a better person and a 
more qualified student than myself. Of course 
all these pleasant and not to be forgotten, un- 
forgetful events, all converge toward one di- 
rection. 

They conspicuously set forth reflections of 
your kindness toward strangers — a reflection 
of your hospitality toward foreigners — a reflec- 
tion of sacrifice and egotism for altruism — quali- 
ties that can be found only in a civilized nation 
and among those students that are free from 
selfishness. 

Gentlemen, I owe you more than I can do you 
justice in words. The time that I have spent with 
you shall be a sweet remembrance of my future 
davs. 



I admit that I do like America very much, 
but I must confess that I like you more. In the 
past I have been very happy to be and to study 
with you ; at present I rejoice to eat, drink and 
chat with all of you, and in the future I would 
be only too glad if I could spend the rest of 
my days in your company. 

Teachers, classmates and friends, let me thank 
you at least once more, and since this is the last 
time that we shall all meet together allow me to d< 1 
this by shaking your hands. 

June 1, 1912. 



The Medical Alumni Association held its 
annual meeting at the Hotel Caswell on Satur- 
day, June 1, 1912, at 8 P. Air The President, 
Dr. Charles E. Sadtler, class of 1873, presided. 
The toastmaster was Dr. G. Lane Taneyhill, clas.s 
of 1865. The orator of the evening, Rev. Lynn 
Harold Hough, D. B., pastor of Mount Vernon 
Place Methodist Church, used as his subject. 
''The Measure of a Man." Professor Arthur M. 
Shipley, class of 1902, made a short address. 
Solos were rendered by Mr. Hobart Smock and 
Dr. B. Merrill Hopkinson, class of 1885. Dr. 
Robert Abell, president of the class, responded 
to the toast to the class of 191 2. 

The menu was as follows : 

Little Neck Clams 

Olives Radishes 

( uimbo a la Caswell 

Bay Shad, Maitre de Hotel Saratoga Chips 

Crab Flake en Cases 

Filet of Beef 

Mushrooms Green Peas 

Lettuce with Tomato Salad 

Neapolitan Ices 

Cafe Noir Cigars 

The new officers for 1912-13 are: President, 
Dr. C. R. YVinterson, class of 1871 ; vice-presi- 
dents, Drs. W. E. Wiegand, class of 1876; H. L. 
Naylor, class of 1900; W. S. Maxwell, class of 
1873 ; recording secretary, Dr. Nathan Winslow, 
class of 1901 ; assistant recording secretary. Dr. 
J. C. Macgill, class of 1891 ; corresponding sec- 
retary, Dr. John I. Pennington, class of 1869; 
treasurer, Dr. John J. Houff, class of 1900. Ex- 
ecutive committee : Drs. G. Lane Taneyhill, class 
of 1865 ; B. M. Hopkinson, class of 1885 ; Geo. A. 
Fleming, class of 1884; Y. L. Norwood, class oi 
1885 ; H. C. Houck, class of 1905. 



THE HOSPITAL BULLETIN 71 

TUP HOSPITAL BULLETIN mer & er » and to ma ' <e one strong and high-class 

medical school. Something must be done: the 

A Monthly Journal of .Medicine and Surgery unaffiliated, unendowed medical school is an an- 

fublished by aclironism, that cannot much longer exist. The 

THE HOSPITAL BULLETIN COMPANY Faculty of Physic is determined that every per 

60S Professional Building sonal sacrifice shall be made to comply with the 

Baltimore Md demands of the times, and that we shall have ,1 

first-class school or none. 

In the meanwhile don't forget the pathological 

Subscription price, . . . $1.00 per annum in advance endowment fund, which is sadly needing contri- 

Reprints furnished at cost. Advertising rate-, buttons. 

submitted upon request CONTRIBUTION BY CLASSES. 

1848 S50 OO 

Nathan Winslow, M.D., Editor [868 IO °° 

___ lS 7i 35 00 

1872 70 00 

Baltimore, Junk 15, 1912. i8 73 430 00 

1874 5 °° 

THE AMERICAN MEDICAL ASSOCIA- ^ 75 5 °° 

TI< )N AND THE MEDICAL COL- „ 76 ' 15 °° 

LEGES. Ic ^ 7 IOO ° 

1880 5 00 

1881 250 00 

Since 1904, the Council on Medical Education 1882 jio 00 

has done a great, though somewhat arbitrary work, 1883 35 00 

in the collection and compilation of facts concern- 1885 235 00 

ing medical education in this country ; the publi- 1886 100 00 

cation of State Board statistics ; and the investi- 1888 50 00 

gation and rating of medical schools. 1889 100 00 

In 1904, there were 166 medical colleges in the 1890 175 00 

United States. In the eight years that have 1892 150 00 

elapsed since then, 46 schools have gone out qf 1893 15 00 

existence, and 120 are still in operation. There 1894 135 00 

has been a great advance in medical education, 1895 155 00 

even in the weak schools. An inspection of the 1896 52 00 

schools has been recently completed, and they 1897 80 00 

have been rated in accordance with this investi- 1898 105 00 

gation. While injustice may have been done to 1899 25 00 

some, there can be no doubt as to the general 1900 215 00 

accuracy of the ratings. There are still too many 1901 185 00 

medical colleges, and it is the avowed purpose of 1902 305 00 

the American Medical Association to compel the 1903 300 00 

merging or extinction of schools until there shall 1904 145 00 

not be more than 70 left. These must be thor- 1905 200 00 

oughly equipped for the proper instruction of 1906 155 00 

students in medicine. It will be a matter of the 1907 no 00 

survival of the fittest. The Council is exerting 1909 5 00 

pressure to compel the merging of the University 19 10 50 00 

of Maryland, College of Physicians and Surgeons, 191 1 Terra Mariae 3 5° 

and Baltimore Medical College, into one institu- 1912 Club Latino Americano 25 00 

tion, and the closing of other weaker schools. An 

effort is now being made to accomplish this Total subscriptions to June 1. [912.. $9956 5° 



72 



THE HOSPITAL BULLETIN 



XEW SUBSCRIPTIONS IN MAY. 

Dr. W. Ward Olive, 1906 $25 00 

Dr. Marshall B. West. 1901 10 00 

Frank P. Marsden, Esq 10 00 

E. A. & B. M. Watts 10 00 

J. J. Landragan, Esq 5 00 

Cash 1 00 

Additions for the month $61 00 



THE ONE HUNDRED AND FIFTH AN- 
NUAL COMMENCEMENT. 



The annual commencement of the University 
of Maryland was held at the Lyric, Saturday 
afternoon, June 1, 1912, at 4 o'clock. The order 
of exercises was as follows: 

Overture — "Raymond" A. Thomas 

Selection — "Quaker Girl" Caryl 

Waltz — "Enchantress" Victor Herbert 

1. Music — March, "Tannhauser" R. Wagner 

2. Prayer by Rev. Thomas Grier Koontz. 

3. Music — Song. "Rosary" E. Nevin 

4. Address to the Graduates. Edgar H. Gans, LL.D. 

5. Music — "U. S. Patrol" Thomas 

6. Conferring of Degrees by the Provost of the Uni- 

\ ersity. 

Candidates for the Degrees "Bachelor of Arts" and 
"Bachelor of Sciences" presented by the Dean 
of the Faculty of Arts and Sciences. 

Candidates for the Degree "Doctor of Medicine" 
presented by the Dean of the Faculty of Physic. 

Candidates for the Degree "Bachelor of Laws" pre- 
sented by the Dean of the Faculty of Law. 

Candidates for the Degree "Doctor of Dental Sur- 
gery" presented by the Dean of the Faculty of 
Dentistry. 

Candidates for the Degree "Doctor of Pharmacy" 
presented by the Dean of the Faculty of Phar- 
macy. 

7. Conferring of Honorary Degrees. 

8. Music — "Chanson Sans Paroles" Tchaikowsky 

9. Award of Prizes. 

10. Music — March, "Lorraine" Ganne 

L II. Fisher, Director of Orchestra. 

There were 22S graduates. They were pre- 
sented by the deans of their respective depart- 
ments, and were classified as follows: 

Bachelor of Arts 16 

Bachelor of Science 3 

DoctO? of Medicine 75 

Rachelor of Laws 50 

Doctor of Dental Surgery 50, 

D01 ir of Pharmacy -jz 



Students who received degrees are : 

Bac helor or Arts. 

Edgar Stanley Bowlus. 
John Arthur Brashears. 
Clarence Leewood Dickinson. 
Charles Griffith Haslup. 
Herman Richard Holljes. 
Robert Spencer Hopkins. 
Spencer Drummond Hopkins. 
Wilhelm Lcntz. 
Benjamin Michaelson. 
Frederick Appel Miller. 
Louis Earnest Payne. 
Charles Holland Riggin. 
Raymond Staley. 
Arthur Everett William- 
George Leiper Winslow. 
Samuel Rowland White. Jr. 

B H Illl.ou OF SCIENCE: 
Philip Langdon Alger. 
William John Jones. 
Kenneth Edgar Wilson. 

Doctor or Medicine. 
Robert Ephraim Abell. South Carolina. 
Reese Alexander Allgood. South Carolina. 
Robert Glenn Allison, South Carolina. 
Angel Virgilio Aviles, Ecuador, S. A. 
George Cullen Battle, North Carolina. 
Grover Cleveland Beard. North Carolina. 
Bernard Mark Berngarlt. Mankind. 
Harry Aloysius Bishop. District of Columbia. 
Robert Alexander Bonner, Maryland. 
Sidney Eli Buchanan, North Carolina. 
William Thomas Chipman, Delaware. 
Charles Peter Clautice, Maryland. 
Wilfred Rivers Claytor, South Carolina. 
James Daniel Cochran, North Carolina. 
Thomas Joseph Conners, Connecticut. 
John Dade Darby. Maryland. 
Russell Hardy Dean, Jr., Florida. 
Harry Deibel, Maryland. 
John Bernard Donovan, Maine. 
James Archie Duggan. Georgia. 
John William Ebert, Virginia. 
Ernest William Frcy, Maryland. 
William Edwin Gallion, Jr.. Maryland. 
Dawson O. George. Maryland. 
Abraham Goldstein, New York. 
William Granville Haines. Maryland. 
Judson E. Hair. South Carolina. 
Edward II. J. Hennessey. Connecticut. 
Milford Hinnant, North Carolina. 
James Edward Hubbard, Maryland. 
Henderson Irwin, North Carolina. 
Edward S003 Johnson, Maryland. 
John Kent Johnston, Florida. 
Charles Luring Joslin. Maryland. 
M. Randolph Kalm, Maryland. 
Edwin Paul Kolb, Maryland. 
Daniel Henry Lawler, Connecticut. 



THE HOSPITAL BULLETIN 



/5 



Simmi Geilech Lenzner, Now York. 

Moses Louis Lichtenberg, Maryland. 

Bertrand Allen Lillich, Pennsylvania. 

liverett Alexander Livingston, North Carolina. 

Enrique Llamas. Colombia, S. A. 

Edward Vnderson Looper, Georgia. 

Benjamin J. McGoogan, North Carolina. 

Andres Martin G. de Pcralta, Cuba. 

William Michel, Maryland. 

Benjamin Newhouse, Maryland. 

John Charles Norton, Maryland. 

Roger Vinton Parlett, Maryland. 

Robert Bruce Patrick, South Carolina. 

Philip Pearlstein, Texas. 

Charles \Vm. Rauschenbach, Maryland. 

Harry Herman Rich, New Jersey. 

Joseph Rottenberg, Maryland. 

Wilbur Moate Scott, Georgia. 

Jay I ). Sharp, Indiana. 

Everett Alanson Sherrell, North Carolina. 

David Silberman, Maryland. 

John Andrew Skladowsky, Maryland. 

Clarke Jackson Stallworth, Alabama. 

John Clinton Stansbury, Maryland. 

Grover A. Stem. Man land. 

Thomas F. A. Stevens, Maryland. 

Jesse Cunningham Stilley, Pennsylvania. 

Edward Charles Straessley, Pennsylvania. 

William C. Terry, North Carolina. 

John Henry Traband. Jr., Maryland. 

Gerardo Vega y Thomas, Cuba. 

Michael Vinciguerra, New Jersey. 

Harold Homer Webb, Virginia. 

Edwin V. Whitaker, Louisiana. 

Hyman R. Wiener, Pennsylvania. 

Robert Cleveland Williams, North Carolina. 

W. Howard Veager, Pennsylvania. 

Henn Zimmerman. Massachusetts. 



University 



prize. 



Prizeman'. 
gold medal, Charles William 



Rauschenbach. 



Certificates of Honor. 
Edwin Paul Kolb, William Granville Haines, 

Robert Ephraim Abell, Robert Alexander Bonner, 

William Michel. 

Bachelor of Laws. 

Benjamin Baker. Horace Edgar Flack, 



Joseph Allien Baker, 
Charles William Bald, 
Lewin Wethered Barroll, 
Robert Dixon Bartlett, 
Levin Creston Beauchamp, 



William Earl Fraley, 
Llarry Walter Ganster, 
Lawrence Wolf Goldheim. 
John Biddison Gout rum. 
Homer Ewing Holt, 



1 [yman Nathaniel Blaustein, Edward Everett Johnston, 



Ubert Page Boyce, 
Karl Edw. Meikle Hubert. 
Raymond Herman Bubert, 
Francis James Carey, 
Malcolm Joseph Coan, 
Henry Doeller, Jr., 
Allan Herbert Fisher, 



Josiah Purnell Johnson, 
William Leigh, Jr., 
Lewis Rudolph Lemke. 
Harry Oscar Levin, 
William Penn Lewis, Jr., 
George Wash. Lindsay, 
James Russell Manning, 



Nathaniel Thos. Meginnis, 
Louis Mitnick, 
Carl Gage Mullin. 
Albert Graham < Iber, Jr., 
William Allen Owings, 
Frank Robert Paterson, 
Philip Benjamin l'erlman, 
Samuel Benjamin Plotkin, 
Virtume P. Alphonse Quinn, 
Alfred Nicholas Reichert, 
Richard Hynson Rogers, 



Ernest Ruediger, 
Charles George Sehrt, 
Everard Pattison Smith. 
Thos. Alexander Smith, Jr., 
Clarence Edward Steer, 
John Samuel Turner. Jr., 
George Ross Veazey, 
Samuel Woodson Venable, 
Edward Philip Waldschmidt, 
George Schubert Weikart. 
David Angle Wolfinger. 



Doctor op Dental Surgerv. 
Leslie Talmage Allen, Canada. 
William Lurty Baugher, Virginia. 
Don Allen Bernhardt, West Virginia. 
Harry William Binder. Maryland. 
John Aloysius Black, New Jersey. 
Paul Hewitt Blanchard, Vermont. 
David F. Blatt. Maryland. 
William Henry Bond, Georgia. 
Harold Ellsworth Bonney, Virginia. 
Aubrey Hopper Burk, New Jersey. 
John Osborne Camp, Connecticut. 
Walter Herbert Clark, New Hampshire. 
Roy Ben Dawson, West Virginia. 
Luke William Delaney, New Jersey. 
Robert Henry Ellington, North Carolina. 
Francis John Ellison, Maryland. 
Henry Edward Fitzpatrick, New Hampshire. 
Dawson Young Flook, Maryland. 
Arthur Clay Foard, Maryland. 
Isaac I. Ganzburg, Connecticut. 
Herbert Thomas Grcmpler, Maryland. 
Joseph John Hamlin, North Carolina. 
J. Francis Healey, New York. 
Frank Trump Herr, Maryland. 
Robert Lee Hicks, South Carolina. 
Thomas Halliday Hoffman, Pennsylvania. 
David Thomas Borthwick Llouston, New Jersey. 
Hamilton Jefferson, Georgia. 

John Frederick Marshall Keighley, Rhode Island. 
Frederick Leo Kenna, New Jersey. 
Walter Scott Kennedy, New'York. 
George Earle Kirschner, Pennsylvania. 
William Llewellyn Lloyd. Maryland. 
John Alexander McClung. Virginia. 
Joseph Maurice Mansir. Maine. 
Alfred Eugene Martin, New Jersey. 
Curtis Whitney Merrill, Rhode Island. 
Frederick Olmsted Moore, Vermont. 
Miguel Montesinos, Porto Rico. 
Henry Forman Ortel, Maryland. 
Lawrence Randolph Outten, Delaware. 
George Kernodle Patterson, North Carolina. 
Berkeley Miller Pemberton, Virginia. 
Ralph Ray, North Carolina. 
John L. Remsen. New Jersey. 
Paul Salles, Louisiana. 
Carl Edward Schlieder, New York. 
Elton Ashbv Sims, Maryland. 



74 



THE HOSPITAL BULLETIN 



Albert James Sinay, Connecticut. 
Meyer Everett Sinskey, Maryland. 
Wylie Isaac Smith, New Jersey. 
Minot Benton Stannard, New Jersey. 
Joseph B. Steinberg, Maryland. 
Henry Streich, Maryland. 
James J. Sullivan, New Hampshire. 
Herbert Ambrose Thrift, Rhode Island. 
Norman Charles Thurlow, Maine. 
Carlos A. Walker, Maryland. 
Owings C. Woods, South Carolina. 

Prizeman. 
University prize, gold medal, Leslie Talmage Allen. 

Honorable Mention. 
Thomas Halliday Hoffman. 

Doctor of Pharmacy. 

Hugh Kelly Borland, Maine. 

Sidney Joseph Brown, Florida. 

Benjamin Bruce Brumbaugh, Maryland. 

Clarence A. Davis, South Carolina. 

Hermann Dietel, Jr., Texas. 

Ethan Oglivie Frierson, South Carolina. 

Harry Sherman Harrison, Maryland. 

Henry Felix Hein, Texas. 

Lee Hodges, South Carolina. 

Dennis Paul Lillich, Pennsylvania. 

George Lucius McCarty, Virginia. 

John Gordon Mclndoe, Maryland. 

Charles Edwin McCormick, Maryland. 

Frederick Minder, Maryland. 

Carrie G. Mossop, Maryland. 

Robert Reginald Pierce, Maryland. 

Lloyd Nicholas Richardson, Maryland. 

Joaquina Ruiz de Porras, Porto Rico. 

Thomas Stanley Smith, Virginia. 

John Alfred Strevig, Pennsylvania. 

Harold A. Swartz, Maryland. 

Randall Cholmondeley Ward, West Virginia. 

Daniel Andrew Warren, Maryland. 

James J. Wolfe, Maryland. 

John Stanley Yakel. Maryland. 

Prizeman. 
Gold medal for general excellence, Hermann Dietel, Jr. 

Certificates of Honor in Order of Merit. 

Lee Hodges, 
Henry Felix Hein, 
Sidney Joseph Brown. 

Special Prizes. 

Simon medal for superior work in chemistry. Her- 
mann Dietel. Jr. 

Junior Class — Horordble Mention in Order of Merit. 

B. Olive Cole, 
James W. Watkins, 
Thomas A. Crowcll. 



ABSTRACT 



TECHNIC OF RESECTION OF RIB UNDER 
LOCAL ANESTHESIA. 

At the recent meeting of the Medical and 
Chirurgical Faculty of Maryland Dr. Charles 
Bagley, Jr., class of 1904, in a paper on the tech- 
nic of resection of rib under local anesthesia, had 
the following to say (Journal A. M. A., May 
18. 1912) : 

Dr. Charles Bagley, Jr., Baltimore. — "General 
anesthesia does not seem to be altogether safe. 
The lung, which has perhaps been the seat of 
pneumonia, is now mechanically compressed by 
the accumulation of pus in the pleural cavity. In 
addition, air is allowed to enter the cavity during 
operation as the pus escapes, possibly causing 
serious difficulty. Local anesthesia, if it can be 
successfully produced, seems to be the proper 
method of protecting these patients against the 
severe pain of the operation. The patient is 
placed on the side opposite the disease. The 
field of the operation is prepared either in the 
usual manner or by the iodin method. The eighth 
rib is selected and the area infiltrated with 
Schleich's solution, beginning just to the inner 
side of the apex of the scapula and then extend- 
ing three inches outward in the direction of the 
rib, care being taken to inject this solution into 
the true skin. An incision is then made from 
within a half inch of the outer extremity. The 
fibers of the latissimus dorsi muscle are now 
exposed and infiltrated with the solution, then 
divided. On retraction the periosteum will be 
exposed and may be anesthetized by vigorously 
rubbing in powdered cocain on an applicator, or 
injecting Schleich's solution under the surface, 
both methods seeming to act well. An incision 
is then made in the periosteum in the direction 
of the rib, an inch and a half long, and midway 
between the upper and lower border. From 
either end of the incision a cross-incision is made, 
extending from the upper to the lower border of 
the rib entirely through the periosteum. A 
periosteal flap is then formed above and below 
and is dissected from the outer surface of the 
rib. A pledget of cotton in a small mosquito for- 
ceps is dipped into the powdered cocain and the 
exposed surface of the rib vigorously rubbed until 
it is insensible to pain. Care must be taken that 
the wound is dry in order that blood and serum 



THE HOSPITAL BULLETIN 



75 



may not cause the cocain to flow along the lower 
portion of the wound and be absorbed. When the 
rib is partially cocainized the separation of the 
periosteum is again undertaken with a periosteum 
elevator. After final cocainization, the bone is 
divided by Liston's forceps, only the point of the 
blade being used, the instrument being held in 
a vertical position. When about one inch of the 
bone is removed a glistening surface is seen 
underneath. This is injected with Schleich's solu- 
tion and an incision as large as desired made in 
the direction of the rib. Drainage-tubes are in- 
serted anil a couple of tucks of gauze placed at 
the angle of the wound, all secured by a safety- 
pin. Sutures are omitted — to save time and be- 
cause of the importance of securing" primary 
union in the presence of infection." 



ITEMS 

Dr. Raymond Garrison Hussey, class of 191 1, 
who has been resident physician at the tubercu- 
losis hospital at Bayview, has resigned to accept 
a like position at the State Sanatorium, Sabillas- 
ville, Md. 



Dr. Norman Thomas Kirk, class of 1910, has 
passed the Army examinations and will receive 
his commission in the United States Medical 
Reserve Corps (active) as First Lieutenant July 
1, 1912. 



Miss Florence V. King, class of 1910, Uni- 
versity Hospital Training School for Nurses, has 
charge of St. Luke's Hospital, Fayetteville, N. C. 



Miss Mattie Estelle Coale, class of 1912, Uni- 
versity Hospital Training School for Nurses, will 
engage in district nursing here in Baltimore. 



The following appointments at the University 
Hospital for the coming year have been an- 
nounced : 

Assistant resident surgeons : Dr. FitzRan- 
dolph Winslow, class of 1906; Drs. Robert 
E. Abell, William E. Gallion, Edward E. Looper 
and Henderson Irwin, all of the class of 1912. 
Assistant resident physicians: Drs. Charles W. 
Rauschenbach, Reese A. Allgood, William M. 
Scott and Judson E. Hair, class of 1912. Resi- 
dents at the maternity hospital : Drs. Louis Har- 
riman Douglass, class of 191 1. John D. Darby 
and William Michell, class of 1912. Assistant resi- 



dent gynecologists: Drs. William L. Byerly and 
Louis Kyle Walker, both of the class of 191 1. 
Resident pathologist: Dr. Moses L. Lichtenberg, 

class of '912, and alternate, Dr. Robert A. Bon- 
ner, class of 1912. 



The following alumni have died during the 
year : 

Robert Atkinson, class '54, died at Baltimore 
May 22, aged 79. 

Norman F. Hill, class '82, died at Baltimore 
May 13, aged 61. 

Jno. R. T. Reeves, class '58, died at Cbaptin. 
Md.. April 14, aged 79. 

Richard Sappington, class '51, died at Balti- 
more, Md., May 14, aged 84. 

Stephen H. Griffith, class '90, died at Gaffhey, 
S. C, May '13, aged 44- 

Thos. H. Beltz, class '63, died at York, Pa., 
May 1 1 , aged 69. 

Edwin G. Darling, class '82, died at Laura- 
ville, Md., June 6, aged 52. 

G. E. Milton Smith, class '88, died at Balti- 
more, Md., May 22, aged 43. 

Van E. De Lashmott, class '54, died at Shel- 
burn, Ind., May 25, aged 79. 

Robt. H. Gantt, class '09, died at Fort Sam 
Houston, Tex., June 10, aged 27. 

Win. Worthington Hopkins, class '58, died at 
Havre de Grace, Md., August 4, aged 74. 

Geo. W. Truitt, class '75, died at Baltimore, 
.Md., July 11, age 65. 

Joel W. Nixon, class '78, died at St. Louis, 
Mo., August 25, aged 62. 

Luther M. Zimmerman, class '64, died at 
Woodsboro, Md., September 13, aged 71. 

Jos. Penn Chaney, class '52, died at Breatheds- 
ville, Md., October 3, aged 81. 

Lawrence Sterling Alexander, class "(>8, died 
at St. Augustine, Fla., November 6, aged 68. 

Jno. Reese Uhler, class '61, died at Baltimore, 
Md., October 9, aged 72. 

Napoleon B. Nevitt, class '57, died at Accotink. 
Va., September 25, aged 81. 

Oliver J. Gray, class '02, died at Wilmington, 
Del., September 29, aged 31. 

Geo. Edward Gilpin, class '82, died at Berkeley 
Springs, W. Va., November 3, aged 65. 

Harry V. Harbaugh, class '07, died at Cam- 
bridge. Md., November 10, aged 28. 

Andrew C. Dukes, class '71, died at Columbia. 
S. C, November 30, aged 61. 



THE HOSPITAL BULLETIN 



Wm. E. Gaver, class '88. died at Mt. Airy. 
Md., December 31. aged 48. 

1 'ierre G. Dausch, class '68, died at Baltimore, 
Md., November 26, aged 65. 

Summerfield Berry Bond, class '83, died at 
Baltimore, Md., December 21, aged 50. 

Wm. F. Hengst. class 'j6, died at Baltimore. 
Md., December 4, aged 57. 

Benj. F. Price, class '$'. died at Mt. Carmel, 
Md., December 15. aged 76. 

Jos. V. Milton, class '01, died at Lacy Springs, 
Ya.. December 16, aged 35. 

Wm. C. P. Boone, class '72, died at Baltimore, 
Md., December 30. aged (17. 

Enoch George, class '72. died at Denton. Md., 
January 12, aged 61. 

Louis W. Morris, class '85. died at Salisbury, 
Md., February 2, aged 46. 

1 lilbert C. Greenway, class '68, died at Hot 
Springs. Ark., January 19, aged 71. 

Norton R. Hotchkiss, class '91, died at New 
Haven. Conn., January 30. aged 41. 

Mathias A. K. Borck, class '63, died at St. 
Louis. Mo., January 20, aged ~~. 

Harry B. Gantt, class '80. died at Baltimore, 
Md., January 20, aged 54. 

John L, Blair, class '68, died at Mercersburg, 
Pa., December 31, aged 66. 

Jos. L. Muncey, class '91, died at Penhook, 
Ya., December 29. aged 45. 

Nathan D. Tobey, class '63, died at Vaughn, 
N. M., January 19, aged 74. 

Peter H. Lathan, class '76, died nt Wetherly, 
Pa., January 23. aged 62. 

Julius Levin, class '05, died at Johnstown, Pa., 
February 12, aged 32. 

Geo. E. H. Harmon, class 'jz. died at Cam- 
bridge, Md., March 5, aged 64. 

Thos. Robert Dougher, class '09. died at 
Avoca, Pa., February 16, aged 2~. 

Daniel Thos. Bowden, class '89, died at Pat- 
terson. N. J., March 18, aged 46. 

William T. Arnold, class '~^, died at Balti- 
more, Md., March 31, aged 67. 

Jno. Evans Mackall, class '08, died at Elkton, 
Md., April 4, aged 2<>. 

Floyd W. Rogers, class '02. died at Newport, 
R. I.. March 26, aged 52. 

Wm. II. Feddeman, class '88, died at Balti- 
more, Md.. April 12, aged 46. 

Louis AY Crampton, class '69, died at San 
Bernardino, Cal., April 12, aged 63. 



Wm. A. Henchman, class 'j^,. died at Mc- 
Keesport, Pa., April 19, aged 63. 

John W. Fields, class '60, died at Chincoteague 
Island, Ya., May 4, aged 75. 

Ephraim Hopkins, class '59, died at Darling- 
ton, Md., May n, aged 75. 

J. R. Bromwell, class '71, died at Washington, 
D. C, May 25, aged 70. 

H. E. Bowman, class '39, died at Farming- 
ton. Iowa, April 29, aged 93. 



(Continued From May Number.) 

Among the University alumni and professors 
whose sketches appear in Dr. Kelly's Cyclopedia 
of American Medical Biography are : 

John Fonerden, class of 1823, whose friendship 
with Johns Hopkins probably furnished the 
motive for the founding of the Johns Hopkins 
Hospital. 

Charles Frick, class of 1845, and professor of 
materia medica and therapeutics in the University, 
in whose honor the Frick Library of the Medical 
and Chirurgical Faculty of Maryland is founded. 

Aaron Friedenwald. class of i860, president 
of the Medical and Chirurgical Faculty of Mary- 
land. 1889. 

Eli Geddings, professor of anatomy and physi- 
ology in the University from 1851 to 1857. 

John D. Godman, class of 1818, the anatomist. 

Horace H. Ilayden, who received the honorary 
degree of M.D. at the University in 1840, founder 
of the Baltimore College of Dental Surgery. 

William Travis Howard, professor of physi- 
ology in the University of Maryland, 1866; pro- 
fessor of diseases of women and children, 1867, 
and becoming emeritus professor 1897, Univer- 
sity, LL.D., 1907. 

Horatio Gates Jameson, class of 1813, one of 
the founders of the Washington Medical College 
and later president Ohio Medical College, editor 
Maryland Medical Recorder, and who preceded 
Lord Lister in antiseptic surgical work. 

Christopher Johnston, class of 1844, founder 
Maryland Medical Institute, professor anatomy 
and physiology in the University from 1864 to 
1869, and professor of surgery from 1869 to i88r, 
died 1891. ( )ne of Maryland's greatest surgeons. 

Thomas Sargent Latimer, class of i8(n. 
surgeon in the Confederate Army, editor Balti- 
more Medical Journal, and for many years presi- 
dent of the College of Physicians and Surgeons. 



THE HOSPITAL BULLETIN 



77 



( leorge Warner Miltenberger, class of 1840, 
■ lean of the University faculty, and professor of 
obstetrics, professor of therapeutics and materia 
medica, professor emeritus and honorary presi- 
dent of the Faculty, after spending over half a 
century in the service of the University. 

Robert Brown Morrison, class of 1874, clinical 
professor of dermatology in the University, and 
pioneer dermatologist of Maryland. 

Russell Murdock, lecturer on diseases of the 
eye and ear in the University, 1868-69. 

James Croxall Palmer, class of 1834, later 
surgeon-general United States Navy, served in 
Mexican and Civil Wars, died 1883. 

John Williamson Palmer, class of 1846, first 
city surgeon of San Francisco, a writer of note 
and one of the editors of the Century and Stand- 
ard dictionaries. 

( iranville Sharp Pattison. appointed to the 
chair of anatomy, physiology and surgery in the 
University of Maryland in 1820, and who enjoyed 
a high reputation as an anatomical teacher. 

Nathaniel Potter, first professor of principles 
and practice of medicine in the University, and 
holding this position until his death in 1843. 

William Power, class of 1835, lecturer in 1841 
at University Hospital, giving two remarkable 
lectures on exploration of the chest, successor of 
Elisha Bartlett, a great clinical teacher. 

Joseph Roby, professor anatomy and physii '1' >gy 
in the University, 1842. 

George Henry Rohe, class of 1873, organizer 
of Springfield Hospital. 

Irving Collins Rosse, class of 1866, army 
surgeon. 

Moses John DeRossett, adjunct to the professor 
of chemistry in the University and professor of 
chemistry in the Dental School. 

Nathan Ryno Smith, professor of surgery in 
the University, 1827. 

David Stewart, class of 1844, lecturer in the 
University on pharmacy, first independent pro- 
fessor of pharmacy in the United States. 

Charles Alexander Warfield, president of the 
University in 1812-13. 

John Doane Wells, professor of anatomy and 
surgery in the University from 1829 to his death 
in August, 1830. 

Thomas Henry Williams, class of 1849, as- 
sistant surgeon in the United States Army, and 
afterwards surgeon in the Confederate Army. 



Henry Parke Custis Wilson, class of 185 1. prac- 
tically the founder of gynecology in Maryland, 
died 1897. 

Caleb Winslow, father of Drs. Randolph and 

John R. Winslow, and grandfather of Drs. Na- 
than and FitzRandolph Winslow. 

William Maxwell Wood, class of 1829, native 
of Harford County, Md., army surgeon during 
Seminole, Mexican, Chinese and Civil wars, 
surgeon on Minnesota at time of battle between 
Monitor and Merrimac. 

William Zollickhoffer, class of 1818, botanist. 



Among the medical men who attended the 
smoker of the General Alumni Association on 
May 31 at the Hall of the Medical and Chirurgi- 
cal Faculty were Drs. Charles E. Sadtler, Ran- 
dolph Winslow, Nathan Winslow, Eugene F. 
Cordell, J. M. Hundley. C. F. Nplen, B. M. Hop- 
kinson, T. A. Ashby, C. R. Winterson, J. W. 
Holland, F II. Davis. L. 1'.. Henkel. Jr.. John C. 
llemmeter, H. M. Robinson, and the following 
members of the graduating class: George E. 
Bennett, Bernard M. Berngartt, Grover C. Beard, 
I leorge Cullen Battle, Charles P. Clautice, W. 
Thomas Chipman, Thomas Joseph Connors, John 
Bernard Donovan. John Dade Darby, Harry 
Deibel, James Archie Duggan, John W. Ebert, 
Ernest William Frey. William Granville Haines, 
Edward Sooy Johnson. Everett A. Livingston, 
Bertrand Alley Lillich, Gerard Henry Lebret, 
Benjamin J. McGoogan, Andres ( i. Martin, Phil- 
lip Pearlstein, Joseph Rottenberg, 1 irover A. 
Stem, John A. Skladowsky, John C. Stansbury, 
W. C. Terry, John Henry Traband. Jr., Michael 
Yinciguerra, Harold Hamer Webb. R. C. Wil- 
liams. The attendance at the banquet was as 
follows : 

Alumni, guests, newspaper representatives, 4''; 
medical graduates, 29; dental graduates. 14: 
pharmacy graduates, 21 ; academic graduate-;. 12: 
unclassified, 18. 



Drs. Thomas Gay Whims, class of 1911, of 
Lasker, N. C. ; Samuel J. King, class of 1903. 
formerly of Grand Junction, Col., but now located 
at Zanesville, Ohio ; William V. Parramore, class 
of 1910, of the Georgia State Sanatorium; Morris 
Ramsey Bowie, class of 1908, of Somerset, Col. ; 
Guy Philip Asper, class of 1903, of Chambers- 



78 



THE HOSPITAL BULLETIN 



burg, Pa. ; Charles R. Richardson, class of 1903, 
of Belair, Md., and John Nelson Neill Osburn, 
class of 1909, of Martinsburg, W. Va., were 
among the recent visitors to the University 
Hospital. 



At the one hundredth commencement of the 
I Iniversity and the one hundred and fifth of the 
medical school, honorary degrees were conferred 
as follows : Rev. Thomas Grier Koontz, Doctor 
of Divinity, presented by Mr. Philemon H. Tuck ; 
Edgar Hilliary Clans, Doctor of Laws, presented 
by Judge Henry D. Harlan, and Robert Dorsey 
Coale, Doctor of Medicine, presented by Dr. Ran- 
dolph Winslow. Professor Winslow, in recom- 
mending Dr. Coale for the degree, made the fol- 
lowing remarks : 

"Mr. Provost — I have the honor to present for 
the degree of Doctor of Medicine, honoris causa, 
one whom the Regents have adjudged worthy of 
this distinction and whose name is mentioned in 
their mandate. Robert Dorsey Coale, for 28 years 
professor of chemistry and toxicology in the Uni- 
versity of Maryland, and for the past 12 years 
dean of the Medical Faculty of the same institu- 
tion. Born and raised in Baltimore, Professor 
Coale received his early education in the private 
schools of this city, but having a predilection for 
military life, he entered the Pennsylvania Military 
Academy at Chester, Pa., from which he gradu- 
ated in 1875. Upon the opening of the Johns 
Hopkins University in 1876 he became a student 
in the department of chemistry, and he has the 
distinction of having been the first matriculate of 
this famous institution, from which he received 
the degree of Doctor of Philosophy in 1881. In 
1883 he was made lecturer, and in 1884 professor 
(jf chemistry and toxicology in the University of 
Maryland, of which chair he is still the incum- 
bent. In addition to his activities as teacher and 
chemist, he has been especially identified with the 
Maryland National Guard, and upon the outbreak 
of the Spanish-American War was commissioned 
Colonel of the Fifth Maryland Regiment, U. S. 
V., Infantry, and served in the field with this regi- 
ment during the hostilities. In consideration of 
his scientific attainments and the valuable services 
rendered the ?\ledical School during many years, 
I request that be lie admitted to the degree of 
Doctor of Medicine in this University, honoris 
causa. 



The financial report for The Alumni Athletic 
Association of the University of Maryland, Inc., 
for the past year is as follows : 

Receipts. 

Membership dues $314 50 

Sale of theater tickets 267 00 

Donation from Law School 50 00 

Donation from Dental Department 44 00 

From raffle of instruments 89 80 

Guarantees, etc., received from track team 14 00 

Guarantees, etc., received from lacrosse team. . . 16 60 

Guarantees, etc., received from baseball team. . . 133 00 

Guarantees, etc., received from basket-ball team 326 27 

Total receipts $1255 17 

Disbursements. 
Theater Benefit — 

Paid Academy of Music $158 75 

Printing, etc 12 65 

Postage on tickets IS 26 

Refund over-payment 2 00 

$188 66 

Track Team — 

Suits, pole and shot $43 65 

Printing 5 00 

Expenses to meet 74 52 

Medals for meet 41 00 

164 17 

Basket-ball Team — 

Equipment $101 00 

Printing, postage, etc 9 00 

Expenses to games 308 81 

418 81 

Lacrosse Team — 

Stationery $3 00 

Postage 1 00 

Expenses to Annapolis IS 00 

Equipment 28 80 

47 80 

Baseball Team — 

Expenses to games $255 00 

Equipment — part payment 25 00 

280 00 

Association Expenses — 

Stationery and supplies $40 20 

Postage (stamped envelopes) 20 80 

Clerical work 2 00 

Gists incorporation 8 00 

Membership A. A. U 7 50 

78 50 

Miscellaneous — 

Two footballs $10 00 

Use M. A. C. grounds 5 00 

Walbrook Athletic Club 25 00 

Instruments for raffle 28 00 

68 00 

$1245 94 
Balance May 30, 1912 $0 23 



THE HOSPITAL BULLETIN 



79 



ENGAGEMENTS 

The engagement is announced of Dr. Howard 
J. Maldeis, class of 1903, of 437 East 25th street, 
Baltimore, to Miss Louise Cecil Watkins, 
daughter of Mr. and Mrs. W. M. Watkins of 
Kate avenue, Arlington, Md. The wedding will 
take place in the early fall. Miss Watkins was a 
member of the class of 1913, University Hos- 
pital Training School for Nurses. 



MARRIAGES 

Dr. William Shepherd Hall, class of 1899, of 
S14 Park avenue, Baltimore, was married to 
.Mrs. Katherine Turner Kurtz of Roland Park, 
in Philadelphia, June 1, 1912. The wedding was 
witnessed by the young son of the bride, her 
cousin and brother-in-law. 



BIRTHS 

In March, 1912, to Dr. Granville Hampton 
Richards, class of 1908, and Mrs. Richards, of 
Port Deposit, Md., a daughter. Mrs. Richards 
was Miss Mary Emma Wright, class of 1908, 
University Hospital Training School for Nurses. 



February 3. 1912, to Dr. Jacob Wheeler Bird, 
class of 1907, and Mrs. Bird, a daughter, Helen 
Brayshaw Bird. Mrs. Bird was Miss Mary 
Mclntire Wilson, of Centerville, and former as- 
sistant superintendent of nurses in the University 
I Tospital. 



DEATHS 

Dr. Josiah R. Bromwell, class of 187 1, of 
Washington, D. C, died at his home, 1147 Con- 
necticut avenue. May 25, 19x2, after a lingering 
illness. He was a native of Frederick County, 
and after graduation located in Loudoun County, 
Va., where he remained for ten years, spending 
the past thirty in Washington. He is survived 
by his brother, Dr. John Bromwell, class of 1807, 
of Mount Airy, Md. Dr. Bromwell was buried 
in London Park Cemetery, Baltimore. 



Dr. Ephriam Hopkins, class of 1859, died at 
his home in Darling-ton, Harford County, Md., 
Saturday, May 11, 191 2. aged 75 years. Dr. Hop- 
kins was the son of the late Dr. Wakeman B. 
Hopkins, class of 1828, and Mrs. Hannah R. 
I [opkins, and cousin of the late Dr. William 
W'orthington Hopkins, class of 1858, who died 
August 4, 191 1. Dr. Ephriam Hopkins was born 



in 1837 near Darlington, Md., and received his 
earlier education in the schools of that vicinity, 
later matriculating at the University, from which 
he was graduated with honors in 1858. For a 
time he practiced in Darlington, then located 
about four miles from West Chester, Pa., where 
he had entire medical charge of the large Chester 
County Almshouse, with a department for the 
insane, and here did the work of two physicians, 
as this almshouse was at that time also the hos- 
pital of the county. About 1895 Dr. Hopkins re- 
turned to Darlington and purchased the beautiful 
Joseph Jewett residence, where he resided until 
his death. He married Miss Rachael M. Johnson, 
a lady of rare talents, who survives him. Two 
sisters and a brother are still living. Dr. Hopkins' 
two sons died some years ago, just as they were 
about grown. He was a loyal member of the 
Society of Friends, and counted his warmest 
friends among its members. 

Dr. Hopkins was an alumnus of whom the 
University may always he proud. Never robust, 
yet possessed of indomitable energy, he success- 
fully conducted a practice that many men half 
his years could not have attempted. His practice 
was widespread and his neighborly spirit kindly 
enough to make no distance too great if he could 
alleviate suffering by his presence. He was a 
keen diagnostician, a tactful physician, a splendid 
and kindly nurse, and a friend to all of his patients 
and neighbors. He was one of the few physicians 
who possessed business ability in combination 
with professional skill. 

His death was undoubtedly due to his devo- 
tion to his duty, as his last illness was contracted 
through taking a patient to a hospital. His physi- 
cians agreed that he literally laid down his life for 
another, following the call of duty as he saw it. 
His life was markedly free of excess of any kind, 
and he was always so active he seemed a very 
part of the community in which he lived. 

Dr. Nathan R. Smith, late professor of surgery 
in the University, wrote of Dr. Hopkins to a 
colleague as follows : 

"It gives me great pleasure to bear testimony 
to the superior intelligence and industry with 
which he has distinguished himself in the pursuit 
of his studies, taking the very front rank of his 
class. He has witnessed much of my private 
practice, aided me in many operations, and him- 
self operated skillfully under my observation, and 
I, without reserve, commend him to all with 



8o 



THE HOSPITAL BULLETIN 



whom my name has influence as one in every 
respect worthy of entire confidence." 

Dr. Hopkins was buried in Darlington Ceme- 
tery. Messrs. Charles Y. Thomas and Thomas 
Wheeler of the Society of Friends officiated. The 
pallbearers were Messrs. Johns Hopkins, Thomas 
C. Hopkins, James Massey, William Dick, Wil- 
liam Scott and Norman Smith. 



OLDEST ALUMNUS DIES. 

We have just learned of the death of Dr. 
Humphrey E. Bowman, class of 1839, on April 
29, 191 2, at the home of his daughter in Farming- 
ton, Iowa. Dr. Bowman was the oldest living 
alumnus of the University for several years pre- 
ceding his death, and we regret that we did not 
know this and accord him earlier the recognition 
this fact merited. We believe the honor now 
goes to Dr. John VV. C. O'Neill, class of 1844, 
of Gettysburg, who was born in 1821, with a 
close second in Dr. John J. R. Krozer, class of 
1848, of Baltimore, who was born in 1827. 

Dr. Bowman was born in Loudoun County, 
Ya., August 17, 1818, and grew to young man- 
hood there. He received his higher education at the 
College at Marietta, Ohio, later matriculating at 
the University and graduating in 1839. He 
located at Shelbyville, Mo., and practiced there 
and in Newark, Mo., for over thirteen years. 
Fie returned to Baltimore two years after his 
graduation to marry Miss Ann M. Ellery. After 
leaving Newark he engaged in mercantile pur- 
suits at various places, relinquishing medicine 
because of failing health. In 1861 he went to 
Iowa, locating at Farmington, where he has since 
made his home, with the exception of a short 
time spent in Missouri immediately following the 
Civil War and a brief period spent later in Chi- 
cago. He lived for many years with the daughter 
at whose home he died — Mrs. James W. Lapsley. 
He is survived by five children, W. H. Bowman 
of Keokuk, Iowa; C. A. and C. H. Bowman of 
Mt. Sterling; Mrs. James Lapsley of Farmington, 
and Airs. E. E. French of Chicago, 111.; and 
seven grandchildren and two great grandchildren. 
At the time of his death he was almost ninety- 
four years of age, and one of the oldest citizens 
of Van Buren County, and probably one of the 
oldest graduate physicians of Iowa. 

Added to his keen intelligence he possessed a 
fund of wit and humor that delighted those for- 
tunate enough to know him. For years it has 



been his fancy upon each recurring birthday to 
write a verse or verses appropriate to the oc- 
casion. Perhaps it would be a letter of thanks 
for some little token of remembrance, or perhaps 
an expression of his own feelings. 

The Daily Gate City of Keokuk writes of him : 
"Dr. Bowman always retained the tine bearing 
of a typical Southern gentleman. Tall and straight 
as an arrow always, despite the weight of many 
years. His intellectual faculties were unimpaired 
through all his long life. He had lived in Iowa 
for many years and his individualitv was so 
marked, and his goodheartedness and cheer ex- 
tended to all with whom he was associated, that 
his acquaintance was far extended. He was 
always proud of the State of his nativity and of 
his lineage. His career in life was straight and 
true, and his ideals high. Thus he lived and 
bore with him the good will of his neighbors. 
and dying he is mourned with a deep sorrow." 

Dr. Joseph C. Benzinger, class of 1863, died 
at his home, 1906 E. Baltimore street. Baltimore, 
May 4, 1912, of heart disease, aged 68 years. 
Dr. Benzinger was a surgeon of Volunteers dur- 
ing the Civil War. 



DISPENSARY CASES. 
April i, 191 1, to April i. 1912. 

Clinics. New. Old. Total. 

1— Surgical 1754 5392 7*4$ 

2 — Genito Urinary. . 721 3033 3754 

3 — Medical 120S 2300 3517 

4 — Eye and Ear 740 1200 1940 

5 — Women 604 1087 1691 

6 — Nervous 286 1 383 [669 

7 — Children 605 843 [448 

8— Stomach 424 889 1313 

9 — Throat 562 688 1250 

10— Lung 492 (\V' 1 128 

1 1 — Skin 297 479 776 

12 — Orthopedic 40 40 80 

13— Rectal 41 3 8 79 

Total 7774 18,017 25,791 

Total new cases 7-774 

Total old cases 18,017 

Grand total 25,791 

John Houff, M.D.. 
Dispensary Physician. 



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, 608 Professional Building, Baltimore, Md. 



Entered at the Baltimore Post-office 
as Second Class Matter 



Vol. VIII 



BALTIMORE, MD., JULY IS, 1912. 



No. 5 



A STUDY OF THE SYNCHRONOUS 
HEART BEAT AND RESPIRA- 
TION' IN THE MUSTELUS 
CANIS. 



From the U. S. Bureau of Fisheries Labora- 
tories, Woods Hole, Mass.) 



By Albert Hynson Carroll. M.D. 



The following experiments, which I had not 
heretofore considered of marked physiological 
interest, appear in a new light since the publica- 
tion of Hemmeter's important contribution to the 
comparative physiology of the circulation in the 
"dogfish." Xo. 1 (Zeitschrift fur Biologische 
Technik mid Methodik, Bd. 2. p. 236, Nov., 191 1 ). 

The friendly controversy between this author 
and Prof. Leon Fredericq which followed, Xo. 2 
(Tin-: Hospital Bulletin, May 15, 1912, page 
No. 1. Vol. 8). evidenced the lively interest mani- 
fested in the scientific world concerning any new 
contribution, and induces me to publish the ex- 
periments which led me to the discovery that the 
heart beat and respiration in the resting dogfish 
are concurrent, i. e., have a ratio of "1 to I." 

Such a ratio has been reported in man in one 
case by S. \Y. Morris. No. 3 (Archives of Inter- 
nal Medicine, iyii. p. 691. Synchronous Cardiac 
and Respiratory Rate). 

The pathological picture was a complicated one. 
II ere there existed an aortic mitral and tricuspid 
insufficiency, with hypertrophy and dilation ac- 
companying passive congestion of the lungs. 

The tracings from the jugular pulse and apex 
beat definitely eliminated the possibility of either 
heart block or a pseudo-bradycardia resulting 
from extra systoles. In this pathological state 
the intra-thoracic pressure determined to a great 
extent the heart rate. 

This extreme ease points to the urgent neces- 
sity for a thorough physiological training of the 
members of the medical profession. 



Such training is necessarily based on knowl- 
edge gained through constant searching for new 
truths. A physiological phenomenon may lie 
marked or obscure in a lower form. A compara- 
tive study broadens and strengthens our concept 
of these vital principles. 

That the heart beat and respiration in animals 
bear a certain definite ratio to each other is 
familiar to all. I nder normal conditions it is 
quite constant. It is about "4 to 1" in man. In 
the mustelus canis I have found it to lie "1 to 1" 
under normal conditions. This unusual ratio is 
exhibited with great constancy. 

The dogfish can be secured in unlimited quan- 
tities. It is admirably adapted for physiological 
experimentation. The blood stream can be either 
inhibited or lessened at will by vagus stimulation, 
or accelerated by stimulating certain areas which 
appear to be analogous to the sinus node of Keith 
and Flack. Xo. 4 (Altered Respiration and Its 
Effect on the Heart Beat) has been studied and 
the effects of various chemicals have been investi- 
gated, and will appear in a later paper. 

In earlier experiments on the heart beat and 
respiration of the dogfish, working with Dr. J. C. 
llemmeter, we attempted to demonstrate a syn- 
chronous heart beat and respiration by placing a 
soft rubber ball connected with a tambour in 
the pharynx of the fish, by inserting a cannula 
connected with a recording mercury manometer 
into the pericardial cavity and recording the two 
tracings simultaneously. 

Although records from each were obtained. 
nothing definite was demonstrated. The negative 
results were probably due to the physiological 
and mechanical disturbances caused by the bulky 
mass in the pharynx, and because the condition 
nf sub-atmospheric pressure normally present 111 
the pericardial cavity was undoubtedly destroyed. 
And perhaps partly because of the mechanical 
irritation to the heart as it beat against the can- 
nula. 



THE HOSPITAL BULLETIN 



Later, however, I was able to demonstrate that 
this supposition was a correct one. 




1— ANTERIOR. 




processes which bring about and maintain heart 
rhythm. Whatever the governing factors may be, 
the activity of these centers depends upon a "nor- 
mal supply of balanced blood," as emphasized 
by I.oeb and so clearly demonstrated by Linhard 
and others. No. 5 (J. Linhard, The American 
Journal of Physiology, May, 191 1). 

It appears that the balance is determined largely 
by the CO, content, and that the excitabilitv of 
the respiratory center toward the adequate stimu- 
lus to activity is governed by the O tension 
present. 

The heart is the mechanical means or pump, 
the proper functioning of which determines the 
blood flow to the respiratorv centers. Hence, if 




•OSTKRJOR. 



we alter the rate or force of the heart, we alter 
the quantity of blood pumped, and we expect to 
observe corresponding changes in the mechanical 
response of the respiratory muscles. 

Similarly, if we experimentally alter the re- 
spiratorv movements, we will alter the nature of 
the blood, and particularly will we alter the flow 
of the blood in the mustelus canis. 

In a dogfish the pericardial cavity is analogous 
to the thoracic cavity in mammals. A portion of 
2— LATERAL. its walls are elastic. To the fixed and elastic por- 

tions are attached a series of muscles which 
It is not my object in this paper to investigate shorten at each respiration. Each respiration is 
the physiologj of the respiratory center or those accompanied by a swallowing movement, which 



THE HOSPITAL BULLETIN 



83 



alters the pull of these muscles at their attach- 
ments and markedly alters the negative intra- 
pericardial pressure. Each inspiration favors 
diastolic tilling and expiration assists systolic 
empt) ing < if the heart. 

DESCRIPTION OF PERICARDIAL SAC. 

Space prevents giving but a brief description 
of the tissues which act mechanically during res- 
piration in bringing about a rhythmical altera- 
tion in the negative intra-pericardial pressure. 

The drawings No. 1, Xo. 2 and Xo. 3, from .1 
wax cast of the pericardial sac. show the anterior, 
lateral and posterior views of the dilated peri- 
cardium. 

The heart-shaped portion of Xo. 1 is occupied 
by the ventricle V, and is firmly attached to and 
underlies the caricoid cartilage. The portions of 
Xo. 2 marked M and (a-b) ( c-d ) represent the 
attachment of the upper three of the five pairs 
of respiratory muscles, which are attached to the 
most movable portions of the pericardium. S. S. 
are lateral margins of the venous sinus where 
the blood from the lateral sinuses and the vagus 
fibres enter. 

Fig. 2, "K" is the mesial line where the anterior 
margins of the auricle approach each other. It 
will be noted that the portion of the heart sac 
containing the auricle is much larger than the 
portion containing the ventricle V (about 3 to 1 ). 

Fig. 3. H. S. are the points of entrance of the 
vessels from the abdomen. V ventricle. A au- 
ricular portion. 

The pericardium lies between the clavicles and 
ventral to the esophagus. It contains the sinus 
venoses, ( S. V. ) , Xo. 2 the auricle ( A ) and the 
ventrical (V). The caudal portion, or base ( W ). 
is occupied by the thin-walled but rather inelastic 
venous sinus and the auricle. The sinus is trans- 
versely placed, and is somewhat diamond-shaped. 
The cuvierean ducts empty into it laterallv ( S.S. ). 

Cranial to the sinus the sac is enlarged and 
rounded for the very thin and elastic walled 
auricle. Ventral to the latter portion is the some- 
what rounded pyramidal portion, with its apex- 
directed caudad, in which lies the ventricle. The 
aorta D occupies the apical portion. 

Leading from the pericardium is a large open- 
ing into the abdominal cavity, the pleuro-perito- 
neal canal. Two hepatic sinuses, placed close 
together mesially, enter the venous sinus from the 
abdomen and carrv visceral blood to the sinus. 



The base is somewhat concave, broader vcntrally 
than posteriorly. The dorsal half is quite flexible, 
and is occupied by part of the auricle. The an- 
terior walls near the base are rigidly fixed to the 
overlying cartilaginous pectoral arch. The lateral 
walls are also rigidly attached near the ba>c. 

There are several ways in which the pressure 
within the cavity can be altered. The lateral 
sides are rounded and approach others in the 
ventral mesial line. ( K ) Xo. 2. These walls 
also are flexible (a-b; c-d), and are capable of 
being moved inward and outward by the action 
of the muscles attached to them. Five peniform 
bilateral sets of muscles are attached to the sides 
of the sac (M), and extend to the gill arches. 
These are the principal inspiratorv muscles. Each 
inspiration shortens these muscles, three pairs of 
which are connected with the movable portions 
of the pericardium, thus increasing its capacity. 

This pressure is also altered by each dilation 
and contraction of the heart chambers. A ma- 
nometer connected with a cannula, carefully in- 
serted into the sac through the pectoral arch, 
shows this to be a fact when the respiration is 
artificially stopped. 

Again, the apex of the pericardium is drawn 
downward at each inspiration. This was shown 
by watching the movements of one end of a 
curved wire which had been inserted through a 
small opening in the pectoral girdle, the other end 
of which rested in the apex. When the respira- 
tory group of muscles pull upward and outward 
on the sides of the sac, the acute apical angle is 
widened as the apex approaches the base, and the 
capacity of the cavity is increased. 

The result of this rhythmical alteration at each 
respiration and heart beat is the drawing into 
the sinus and auricle of the venous blood. A 
true estimation of the importance of this me- 
chanical effect on the heart beat is only had when 
the extremely low blood pressure in the veiv >us 
system in the dogfish is appreciated. 

METHODS. 

A medium-sized dogfish (80 cm. in length ) was 
selected and placed in a tank of fresh sea water 
and allowed to become accustomed to its new 
surroundings. At the end of a half hour its 
respiration was counted. It was then placed in 
a box-like operating holder, ventral surface 
uppermost, and securely fastened with bands 
around the nose, just dorsad to the pectoral fins 



84 



THE HOSPITAL BULLETIN 



U.S. f*i'sA< ri'ts /_*&<n-«.tffrw 



G~3 3 fji 



llllilillil^ 






M»>t- 3 9 >**. enu»< 



MVJVJVIVIUVJVJVI 



VlUVlMUUMU\JUU vl ^VlUMViUU.VlViVlVlVlVJUUVJuVlUV 



lilllllllll 



\JMUMM\IWd\J\J\N\J\JVI 



VWVlMVJVKWMMVIVlVKIMViViMM^ 






^l//rrC A4. . «-^ 3'f»; *>/- 



NO. 1— TAIL ELEVATED. 



NO. 3— TAIL AGAIN ELEVATED AND 1 TO 1 RATIO RE- 
ESTABLISHED. (THE DRUM HAD TO BE MOVED 
EACH TIME THE FISH WAS CHANCED IN POSITION 
IN ORDER TO READJUST THE WRITING LEVERS. 



#44&f fi. V fi*+ them 



II Hi 



mmmmC 



ft****** S3' 






vvvyuyvTOpvuppuuw 1 '" 



". 3d fi-*^! ?W*^7'<' - 



VVYVYVVYYYVY Y.V \ J v- Y H H-H H 






SHOWING 



Nil. 2— TAIL AND HEAII AT THE SAME LEVEL. IiLllllJi 
NUT ENTERING VENUES SINES IN SUFFICIENT 
QUANTITY Til FILL THE VENOUS SINES AND I'D 
STIMULATE IT TO "SET THE PACE." HEART 28, 
UESP. 56. 

4, 5, 6— TRACING Nos. 1. 2 AND 3. 
THE CONCURRENT HEART HEAT AND RESPIRATORY EFFORT— RATIO OF 1 TO 1. 



THE HOSPITAL BULLETIN 85 

and around the- tail, replaced in the tank of water angular opening centrally through the caracoid 

and another respiratory count made and recorded, cartilage. Great care is used to avoid trauma to 

first, with the dorsal surface uppermost; second, the heart, which almost completely tills the peri- 

with the ventral surface uppermost: third, with cardium. The opening is then extended forward 

the head elevated, and fourth, with it depressed, about 1 cm., sufficiently to expose the heart. The 

In view of the later observations, it is inter- box is again placed in the sea water tank with the 

esting to note that there was practically no re- mouth and gills submerged. If heart tracings 

spiratory alteration following these alterations in are desired, the apex of the ventricle can be 

position. (See table No. 1, Exp. 1.) picked up with small blunt forceps and a thread 

When it is nece.sarv to operate, a light anes- tied around tlle d P of il - Another thread is 

thesia. one just sufficient to last until the heart attached to the skin by a sharp hook above the 

was exposed, was found to be better than deep th,rd P 11 arch aml somewhat laterally to record 

anesthesia. Ten c.c. of a 10 per cent, alcoholic an - v respiratory movement. These threads are 

solution of chloratone in 1000 parts of sea water connected to the recording levers of a kymog- 

proved to be an excellent anesthetic, and was ra P 110n ' 
almost universally used. August 28. 191 1. Experiment No. 1. Effect 

When from shock or from some other unex- °" Respiration by Changing the Position o\ the 
plained cause the heart of a dogfish or sand 

shark was found to exhibit fibrillary contractions. A sma11 fish was secured in the holder and the 

a mild stimulation of the vagus for a few seconds holder versed vertically with the fish's head 

would usually restore it to its normal rhythm. "Ppermost and just beneath the surface of the 

This was interesting, since it recalled that Garrev, water - Res P lratoI 7 rate varied from 45 to 47 

No. 6 (Walter E. Garrey, American Journal of durm S the followin g »our ; 10 A. M, respiration 

Physiology, 1892. Some Effects of Cardiac 46; 10.30 A. M., respiration 4 5; 12 M., respira- 

Nerves Upon Vent. Cont). experimenting with tlon 445 5 P - M - respiration 46; July 27. 9.30 

dogs" hearts, found that vagus stimulation only A ' M - respiration 46. 

met with a small percentage of success, and then The fish vvas now allowed to swlm fre ely in the 

when the dogs were in a very poor condition. tank ' an<1 a PP ear ed perfectly normal. It was 

again secured and placed in the holder in the 

to expose the heart and the vagus nerves. Nva ter tank, head downward, overnight: 9.40 A. 

No. 7. For a detailed description of the tech- M., respiration 48; 10.30 A. M., respiration 48; 

nique of exposing the heart and vagus nerves as T -2 M., respiration 46 ; 6 P. M., respiration 47. 
developed by Hemmeter and the author, see The fish was then placed laterally in the water. 

Zur Technik von Vagusexperimenten am Scyl- ventral surface downward. Respiration was 47, 

Hum. Zeitschrift fur Biohgische Technik and and remained constant for an hour. It was next 

Methodik, Nov., 191 1, I. C. Hemmeter. turned over with the dorsal surface downward. 

A curved incision, reaching from one-fifth gill Th e respiration remained at 47. Position evi- 

slit to the other, is made through the skin, across dently affects the rate of respiration but little. 
and above the pectoral arch. From its center a pj s)l pj^ pj sh pj ^ 

forward incision is made, extending well up to- Exp. No. 1. Table 1. No. 1. No. 2. No. 3. No. 4. 

ward the mouth. Starting at each dorsal crevice Dorsal surface up Resp. 45 40 32 29 

of the fifth gill slit an incision is made posteriorly Ventral surface up Resp. 47 40 31 30 

to the laterallines, and then carried forward along Head " p Res P- -* 6 4* 32 33 

,, .. nM_ 1 ■. 1 1 - a Tail up Resp. 48 40 \\ vt 

tlie lines 3 to 5 cm. The lateral skin flaps are OJ "" 

reflected. Blunt dissection is employed if it is August 31, 191 1. Experiment No. 2. To Dis- 

wished to expose the underlying vagus nerves. cover the Ratio of Respiration to Heart Beat in 

The "ramus cardiacus" is found on each side the Mustelus Canis: 
entering the cuvierian duct or sinus, which opens A fish was lightly anesthetized and secured in 

into the pericardial sac. The ventral skin flaps the box-like holder. A very small opening was 

are dissected back and the cartilagenous pectoral made through the pectoral arch, just sufficiently 

arch laid bare. The dissection is then carried large to observe and count the heart beats. The 

anteriorly until the pericardium is reached. holder was now submerged in the sea water tank 

The heart is exposed by making a small tri- and respiration and heart rate counted. The 



86 



THE HOSPITAL BULLETIN 



heart beat only once in every two respirations: 

Respiration Q A. M., 40; 9.15 A. M., 48; 10.30 
A. M., 52. 

Heart 9 A. M., 25; 9.15 A. M., 24: 10.30 A. 
M., 26. 

Any violent effort to escape would be followed 
by an irregularity of both breathing and heart 
beat. It was observed that at times a firm pres- 
sure when holding the fish quiet on the abdomen 
■would cause a short period of synchronous breath- 
ing and heart beating, due to an increased flow 
of venous blood into the heart from the large 
abdominal veins. 

It now occurred to me that since the opening 
of the pericardial sac had negated the normal sub- 
atmospheric intra-pericardial pressure, that the 
blood was not returning in sufficient quantity to 
the venous sinus, and that the local mechanical 
stimulating effect normally due to its pressure was 
altered or lacking. 

I elevated the tail of the fish, and in this way 
"allowed gravity to play the role normally enacted 
by the sub-atmospheric intra-pericardial pressure 
iu filling the venous sinus," making an angle of 
about 20 degrees with the surface of the water. 

Almost at once the heart rate was increased, 
equaling the number of respirations per minute, 
each auricular diastole immediately occurring 
after the closure of the gill clefts. 

The opening in the pericardium was enlarged. 
The apex of the ventricle was picked up by small 
blunt forceps and a thread tied around the tip of 
it. Another thread was attached to the skin by 
a sharp hook above the third gill arch. The 
threads were connected to the recording levers of 
a kvmographion. In a few moments the heart 
beat and respiration ratio became *'i to I." (See 
tracing Nos. 1, 2, 3, Exp. 2.) 

July 25, 191 1. Experiment Xo. 3. Both vagus 
nerves exposed and pericardium opened, show- 
ing venous sinus. 

"1" shows inhibitions of auricle after stimulat- 
ing right vagus. 

"I 1 " shows inhibition of auricle after stimulat- 
ing left vagus. 

A and A 1 = auricle accelerated by stimulating 
certain as yet not precisely located areas in the 
venous sinus. 

Too strong a current causes inhibition due to 
escaped currents. 

July 26, 191 1. Experiment No. /. Right and 
left cardiac branch of vagus exposed and peri- 



cardium opened. Auricle and ventricle connected 
with recording levers. Times 32 per min., show- 
ing that both auricle and ventricle can be accel- 
erated as well as inhibited bv stimulating the 
vagus and the "accelerator areas" in the venous 
sinus. 

It will be evident from a study of the tracings 
that this acceleration of the auricle and ventricle 
is a true acceleration, and not a fibrillation. The 
Y. S., which apparently contains in its walls cer- 
tain as yet illy-defined accelerator fibres, is the 
pacemaker for the beat. It always beats first in a 
strong heart, i. c., one in good condition. Again, 
I have cut both vagus branches, singly and simul- 
taneously, and noted that there was no alteration 
of the heart beat or the blood pressure. No ac- 
celerator nerve or branch of the sympathetic ner- 
vous system has been found leading into the heart 
tissue by various earnest biologists and campara- 
tive anatomists. It appears to me that I have 
demonstrated that the heart beat originates in the 
V. S., and that a balanced blood, at a definite 
pressure and quantity, determines the rate of the 
heart beat by its mechanical as well as perhaps its 
local chemical action on these pace-making and 
accelerator venous sinus areas. 

The rigid structure of the cartilaginous walls 
of the vessels or channels leading into the V. S. 
laterally precludes the possibility of the beat origi- 
nating in them. 

CONCLUSIONS. 

First — The negative intra-pericardial pressure 
is altered markedly at each respiratory effort in 
the mustelus canis, but is always a negative pres- 
sure ; otherwise, the low blood pressure in the 
venous system would not cause the blood to enter 
the Y. S. 

Second — Without a proper amount of fluid, 
mechanical as well as a possible local chemical 
stimulation to a normal beat is lacking. 

Third — Accelerator fibres do not appear to 
exist in the main vagus trunks, and none have 
been observed macroscopically to enter the heart 
tissue by way of the venous channels, but there are 
certain areas in the walls of the Y. S. which posi- 
tively respond to stimulation with a weak current. 

Note. — I wish to thank Dr. Hemmeter for en- 
couragement which led to the observing of these 
phenomena, and the University of Maryland 
Laboratories for the use of apparatus, and Dr. 



THE HOSPITAL BULLETIN 



87 




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THE HOSPITAL BULLETIN 



Francis B. Summer, Director of the U. S. Fish- 
eries Laboratories, Woods Hole, for an abundance 
of experimental material. 

906 N. Calvert St., Baltimore. 



IMPROVED TREATMENT OF TUBERCU- 
LAR BONE ABSCESSES.* 



By \V. Saulsbury Niblett, M.D., 1911. 



Since the recognition of tubercular abscesses 
and sinuses the evolution of the treatment has 
been more or less in a chaotic state, and is far from 
satisfactory. Many methods have been suggested 
and tried, but the attempt to go into this subject 
very deeply is confusing and almost hopeless as 
to the enumeration of the various methods of 
treatment; therefore, the object of this paper is in 
the nature of a small contribution of our experi- 
ence at the Kernan Hospital and the Hospital for 
Crippled Children, and while we all agree that the 
subject is as yet meager, we will give the meth- 
ods of treatment that have come under our own 
observation. 

It might be well, before we consider the treat- 
ment to briefly summarize the pathological 
changes that take place in the development of 
tubercular abscesses and subsequent sinus for- 
mation. 

The cause of the disease has been known since 
the time of Koch, but the exact pathology is con- 
fusing, this being especially so in joint tubercu- 
losis. The tubercle bacillus enters the spongy 
portion of the body of the vertebra and in the 
marrow of the spongy portion of the ends of long 
bones, and not the shaft. As you all know, 
there are various theories as to why tuberculosis 
occurs in the ends of long bones and not, as a 
rule, in the shaft. Some say the vulnerability is 
due to the arrangement of the blood vessels — 
that is, the lack of anastomosis in the end ar- 
teries — and that small emboli of a conglomerated 
mass containing the tubercle bacillus from some 
other focus lodge in the end arteries around the 
epiphysis of long bones. 

Ely of Denver advances a theory that it is due 
to the fact that we find lymphoid marrow, or red 
marrow, in the end of long bones, and this gives 
a foothold for tuberculosis. As there is more red 
marrow in the bones of children, this explains 



'Read before th" Baltimore County Medical Association, 

.May I.".. 1912. 



why we see more bone tuberculosis in children 
than in adults ; but joint tuberculosis is rare in 
children under one year of age. 

The blood or lymph is the medium through 
which the tubercle bacilli are conveyed to the 
bone from some other focus. It may enter by 
direct extension. After the tubercle bacillus en- 
ters the bone it sets up a low grade of inflamma- 
tion, causing a small spot of hyperemia, probably 
due to the toxin formed by the organism. This 
forms a small granulomatous area in which may 
be found the characteristic yellow or gray tuber- 
cle, which may be composed of one or more giant 
cells having several nuclei, surrounded by a mass 
of epithelioid cells, and these, in turn, surrounded 
by lymphoid cells. 

This area becomes larger and opaque, and is 
surrounded by a hyperemic area which spreads 
by peripheral extension, and results in tubercular 
granulation tissue. During the later or reparative 
stage of this process the area becomes less vascu- 
lar, and is converted into a dense fibrous tissue, 
but in the center of which degeneration and ne- 
crosis take place. This is called caseation. If 
caseation takes place without suppuration, it is 
called "caries sicca," but if it takes place with 
suppuration it is known as "caries necrotica," it 
being secondary or consecutive, and will point in 
the line of least resistance, burrowing its way by 
the weight of the contents of the abscess, infect- 
ing the soft tissues as it goes, thus carrying the 
tubercular disease into different parts, rendering 
the treatment of the diseased soft tissues equally 
as hard as that of the original focus. 

An area of caries necrotica may become walled 
off and result in a cloaca or become calcified ; but, 
as a rule, abscesses and subsequent sinus forma- 
tions are frequent complications, indicating the 
destructive character of the osteitis and the low 
grade of resistance on the part of the host. A 
tubercular abscess and sinus is surrounded by a 
pyogenic membrane, that is, a wall of granula- 
tion tissue filled with tubercles if the tissues are 
vulnerable to tuberculosis and are secondarily in- 
fected ; if not, they will not be found. 

Bearing these points in mind, one will be better 
able to treat tubercular abscesses and sinuses. 
Among the various forms of treatment may be 
mentioned the following: Evacuation of the ab- 
scess and immediate closure ; evacuation and 
drainage; evacuation and injection of iodoform- 
erlycerine; evacuation ami swabbing out with car- 



THE HOSPITAL BULLETIN 



89 



bolic acid, followed by alcohol ; washing out with 
hydrogen peroxide or 40 per cent, formalin, iodo- 
form ether, zinc chloride solution, tincture of 
iodine; evacuation and injection of Heck's bis- 
muth paste or injection of chalk powder and 
vaseline; vaccines in mixed infections, and, 
finally, tuberculin used both locally and sys- 
temically ; the new tuberculin used systemically 
and the old tuberculin used in abscesses or sinuses. 

One will readily conclude from the numerous 
methods here mentioned that the use of any one 
of these has not proved entirely satisfactory in 
the hands of orthopedists in all cases. We have 
used all of the above methods, but have found by 
experience that better results are obtained by the 
following' treatment; We must bear in mind that 
nature is engaged in a local, germicidal warfare, 
and well-directed assistance in building up the 
general condition of the patient will enable her to 
conquer. Remember to treat, first of all, the pri- 
mary focus by the best means possible, and that 
the treatment of the abscess is secondary ; there- 
fore, not only orthopedic, but all hygienic meas- 
ures must be enforced, such as sufficient sleep. 
fresh air, sunlight, good, nourishing food, proper 
clothing, etc. All of these are most important 
adjuvants, but too much stress cannot be laid 
upon the importance of good food, fresh air and 
sunlight, as these are the most important agents 
required not only in phthisis, but in bone tuber- 
culosis. 

Other measures should be employed to improve 
the general conditions, such as tonics and altera- 
tives, which must be selected according to each in- 
dividual case. We have had good results from 
using olive oil, hypophosphites. strychnine, tinc- 
ture of nux vomica, potassium iodide, tincture of 
ferric chloride and syrup of the iodide of iron. 

Now, as to local treatment, we have found that 
the existence of a tubercular abscess does not 
necessitate immediate evacuation, so we find that 
the expectant treatment, combined with thorough 
mechanical treatment, often yields good results. 
If the abscess is very large and deeply placed, 
there being no signs of pressure symptoms, we 
have found that if the part is put at rest by trac- 
tion and fixation, and the patient allowed plenty 
of fresh air, sunlight and good food, the contents 
of the abscess will become absorbed or the case- 
ous material will become encapsulated. There- 
fore, we religiously discourage immediate evacu- 
ation of the abscess unless it has signs of second- 



ary infection, because an abscess that is opened is 
not only most prone to secondary infection by 
pyogenic cocci from the skin and hair follicles if 
left open for 24 hours, but may cause a dissemina- 
tion of tubercle bacilli by way of the blond or 
lymph, setting up miliary tuberculosis or menin- 
gitis, or it may cause the formation of a sinus 
which will probably not only discharge as long as 
the disease is active, but is ''the gateway by which 
death so often enters." 

In cases in which the patient has a great deal 
i/t pain, due to pressure on nerves, blood vessels or 
bowels or interference with digestive or respira- 
tory functions, we advocate incision, evacuation 
1 >f the abscess and immediate closure. Under no 
circumstances do we allow an abscess to be left 
alone when the skin is becoming reddened from 
tuberculous infiltration, because it will ultimately 
break down and most likely become secondarily 
infected. 

All abscesses secondarily infected should be 
opened at once, swabbed out with carbolic acid, 
followed by alcohol, which will destroy the re- 
maining tubercular germs and the secondary in- 
fection. There should be no fear of absorption 
by using pure carbolic acid, followed by alcohol, 
for it unites with the albuminous material, form- 
ing an albuminoid, which is absorbed by the lym- 
phatics and destroys the bacteria beyond the focus 
of the disease. 

In some convalescent cases of bone tubercu- 
losis, where the focus is circumscribed and easilv 
accessible — for example, in the condyles of the 
femur — erasion may be done, always by the use 
of an Esmarch bandage and a tourniquet. The 
cavity is swabbed out with tincture of iodine and 
filled with the following mixture: Yellow wax. 
one part ; lanolin, five parts ; bismuth subnitrate, 
15 grains to an ounce of the mixture, after which 
the incision is closed. We believe this procedure 
has, by direct extension, saved many joints from 
infection. This does not, of course, apply to 
tubercular foci within the joint or vertebrae. 

Secondary abscesses recurring after once being 
opened, avacuated and closed are opened the sec- 
ond time, evacuated and the cavity filled with a 
mixture of precipitated chalk powder and vase- 
line or with Beck's bismuth paste. We have had 
good results from most case-- by the use of this 
method of treatment, generally two or three in- 
jections being necessary. 

There are certain cases, however, that refuse 



go 



THE HOSPITAL BULLETIN 



to heal under any local treatment, and ultimately 
result in the formation of an obstinate sinus. 
Here we have a rather difficult condition to treat, 
but. again, we have greater success by the use of 
Beck's bismuth paste or by the use of a chalk 
mixture ; but in the use of the former one has to 
be somewhat cautious to guard against bismuth 
poisoning, although we have had only one case 
poisoned by bismuth. As some patients seem to 
have a marked idiosyncrasy for the substance, we 
are using the chalk mixture almost exclusively. 

Lately we have been using old tuberculin 
locally with fair results. It is very stimulating 
to the sluggish granulations, and converts the 
creamy pus into sero-sanguinous pus. After two 
or three injections the sinuses appear healthy and 
the discharge is markedly decreased. 

The technique is very simple, and consists of 
the injection of about 120 m. of 1-500 old tuber- 
culin into the depths of the sinus by means of a 
small, soft-rubber catheter, which is then with- 
drawn as one or more injections is made, in the 
endeavor to bring the tuberculin into immediate 
contact with the walls of the sinus. 

After three or four injections the strength of 
the tuberculin is increased from 1-500 to 1-250, 
or even stronger. This is governed by the reac- 
tion, both local and systemic. The injections are 
given biweekly. Generally there is some systemic 
as well as local reaction. Frequently the pa- 
tient's temperature may reach 101-101.5 . with 
marked lassitude, but this is less marked after the 
first two or three injections, and usually disap- 
pears entirely after subsequent treatments. Great 
care must be taken to prevent the use of strong 
tuberculin, as it will cause a rise of temperature. 

( )ur feeling in the matter is that the sooner we 
get the sinus closed or thoroughly plugged — 
aside from the treatment of the granulations with 
the tuberculin, or some other substance, to stimu- 
late the walls of the abscess or sinus — the better 
it is for the patient. 
Kernan's Hospital. 



IN MEMORIAM 

At a meeting of the Regents of the University 
of .Maryland on June 19, 1912, called on the oc- 
casion of the death of the Honorable Bernard 
Carter, LL.D., the following minute was adopted 
and placed upon their records: 



The Regents of the University of Maryland 
deplore deeply the loss which the institution un- 
der their charge and themselves personally have 
sustained in the death of the Honorable Bernard 
Carter, LL.D., Provost of the University. 

Succeeding the late Severn Teackle Wallis 
in the office of Provost 18 years ago, Mr. Carter 
manifested during that whole period the deepest 
interest in the welfare of the University. While 
it would have been natural that from his own pro- 
fessional studies he should have bestowed his spe- 
cial thought upon the school of law, in which he 
had been at one time an instructor, yet in the ad- 
mirable addresses which he made to the assem- 
bled classes of students in the several schools of 
the University on the commencement occasions 
he showed always a full appreciation of the na- 
ture and importance of their respective studies. 

From his experience in his own profession of 
the law, in which he had attained the highest dis- 
tinction and had won by the consent of all and 
enjoyed for approximately a quarter of a century 
the position of leader of the bar, he knew the diffi- 
culties and discouragements which the young 
votaries of science encountered in the early pe- 
riods of their careers. From this knowledge he 
manifested by his words and by his looks a deep 
and sympathetic interest in the students before 
him, and he showed them by his wise counsels 
how their trials were to be met and overcome. 
And thus his words of encouragement and stim- 
ulation seemed a benediction upon the work in 
which the young graduates of the University 
were about to engage. 

From early life Mr. Carter had taken a deep 
interest in the work of the church to which he 
was attached, and for this reason, and especially 
from his knowledge of ecclesiastical history and 
law, he was for many successive years elected a 
delegate to the Diocesan Convention of Maryland 
and on several occasions a deputy to the Trien- 
nial General Convention of the Episcopal Church, 
of both of which bodies he was always regarded 
as a most influential and valuable member. 

In all of these fields of labor, that of the coun- 
cils of the church, that of his own profession and 
that of the academic work of the University of 
Maryland, he was governed and guided by his 
earnest and devoted Christian faith. As was his 
faithful and conscientious labor, so be his reward. 

Daniel Base, 

Secretary. 



THE HOSPITAL BULLETIN 



91 



THE HOSPITAL BULLETIN 

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Nathan Winslow, M.D., Editor 



Baltimore, July 15, 191 2. 



UNIVERSITY LOSES HER PROVOST. 



The news from Xaragansett Pier, R. I., June 
13. H)i2. that Bernard Carter, Provost of the 
University since 1894, had died suddenly that 
morning, was a great shock to University men 
and Marylanders in general. Mr. Carter had not 
been well for some months, but his death was 
wholly unexpected. He had gone to Naragansett 
but the day previous to that upon which he was 
stricken, and was anticipating a pleasant vacation 
there. 

Bernard Carter was born in Prince George's 
county July 20, 1834, and is descended from the 
Carter family of lower Virginia and the Calvert 
family of .Maryland. His father, Charles Carter, 
was the son of Bernard Moore Carter and grand- 
son of Charles Carter, of Shirley, on the James 
River. Robert Carter, wdio was known as "King" 
Carter of colonial times, was a direct ancestor. 
Bernard Carter was a grandson of "Light Horse" 
Harry Lee and first cousin of Gen. Robert E. Lee. 
His mother was Rosalie Eugenia, daughter of 
George Calvert, son of Benedict Calvert, and 
grandson of Charles, the sixth Lord Baltimore. 
Mr. Carter was also a direct descendant of 
Rubens, the painter, through his great-grand- 
father, Henry J. Stier d'Aertzlaer of Antwerp, 
Belgium, who tied to this country in 1784 to es- 
cape scenes and dangers of the French Revolu- 
tion, but returned in 1805, when Belgium was 
annexed to France, to prevent the confiscation of 



his large landed estates. His daughter married 
( leorge Calvert. 

Bernard Carter graduated from St. James' Col- 
lege, Washington county, Maryland, in 1852. re- 
ceiving his degree of master of arts from that 
school three years later. He then studied law at 
Harvard, where he graduated in 1855. He then 
came to Baltimore, and was admitted to the bar, 
entering the office of J. Mason Campbell. He 
always lived and practiced here, and soon became 
a leader of the bar of the State. In 1865 he was 
admitted to the bar of the Supreme Court of the 
United States, his first argument before that court 
being in the case of the steamer "Louisiana," re- 
ported in "Wallace's Reports." He was always 
a corporation lawyer, having immediately after 
his admission to the bar evidenced a distaste for 
criminal suits. At the death of J. Mason Camp- 
bell he was appointed chief counsel of the Penn- 
sylvania Railroad Co. and its subsidiary branches, 
and remained with it throughout its growth from 
a small local transportation line to its present 
influential position, waging its battles in the local 
courts, the Court of Appeals, in the Federal, Dis- 
trict and Circuit courts, and the United States 
Supreme Court. 

In 1861 he was the nominee of the Democratic 
party for State's Attorney of Baltimore, and in 
1864 for Attorney-General of the State. He was 
not elected, owing to the strong Republican trend 
of those days. He served in the First Branch of 
the City Council in 1869 and 1870, and as chair- 
man of the Ways and Means Committee did much 
toward the economical building of the present 
City Hall. In 1867 he was a delegate from Balti- 
more to the Constitutional Convention of the 
State, and through his work at that convention 
was appointed a member of the committee on 
revision and compilation, to which were referred 
all sections of the Constitution which had been 
adopted for arrangement, revision and correction 
before being finally passed upon. In 1895 he was 
counsel to the Board of Police Commisioners. He 
was often urged to run for Congress, but 
repeatedly refused. Once he was induced, against 
his own better judgment, to be a candidate for 
the United States Senate, but failed of election. 
He was City Solicitor from 1883 to 1889, and 
again in 1900, but only remained in the office a 
few months, as its duties conflicted with those of 
a corporation whose counsel he was. 



92 



THE HOSPITAL BULLETIN 



Mr. Carter married April 20, 1858, Miss Mary 
IS. Ridgely, daughter of David Ridgely, of White- 
marsh, Baltimore county, Maryland, and had 12 
children, of whom nine, three daughters and six 
sons, are living. Charles H., Bernard M. and 
Shirley were associated in law with their father; 
John Ridgely Carter is a member of the diplo- 
matic service ; George Calvert Carter entered the 
ministry and is rector of St. Andrew's Protestant 
Episcopal Church of Washington, and Julian 
Carter is a well-known real estate man of Balti- 
more ; Mrs. A. Robinson White, of Relay, Mrs. 
Ernest Law, of Philadelphia, and Mrs. Arthur 
Lyman Fiske, of New York, the three daughters, 
are equally well known. Mrs. Carter died some 
years ago. Mrs. Fiske and Rev. George Carter 
and Bernard M. Carter accompanied their father 
to Newport and were with him at the time of his 
death. 

He was buried from his Baltimore home, 1212 
Eutaw place, on Saturday, June 15, 1912, at 11 
o'clock. Services were held at Old St. Paul's 
Church, of which he was a vestryman and active 
member, having taken part in all of the ecclesi- 
astic discussions of the State, and were conducted 
by the rector, Rev. Arthur B. Kinsolving, and the 
rector emeritus, Rev. J. S. B. Hodges. The hon- 
orary pallbearers were Chief Justice J. Hunter 
Boyd and Judge Henry Stockbridge of the Court 
of Appeals, Chief Judge Harlan of the Supreme 
Bench of Baltimore, Judge John C. Rose of the 
United States District Court, Francis J. Gowan 
of Philadelphia, general counsel of the Pennsyl- 
vania Railroad ; Gamble Latrobe, general local 
agent of the Pennsylvania Railroad, and John J. 
Donaldson, James L. McLane, Arthur W. 
Machen, George C. Wilkens, William A. House, 
John S. Gittings, Michael Jenkins, Douglas H. 
Thomas, William Shepard Bryan, F. H. Bethell, 
Dr. Cary B. Gamble, Jr., Robert Crane and Rob- 
ert W. Johnson. The active pallbearers were the 
five sons who were able to be here (John Ridgely 
Carter being in London at the time) and a 
nephew, Carter M. Bowie. Interment was in the 
family lot in Greenmount Cemetery. 

Bernard Carter became a professor in the Law 
School of the University in 1878, and in 1895 
became Provost. His lectures were noted, and 
the University claimed him among the many 
"giants" who have honored her halls. A giant 
in stature and mind, he loomed large in the legal 



horizon of his day. Entering the legal world, as- 
he did, in a day when telephones and telegraphs 
and typewriters were unknown, when the entire 
profession of the State numbered but about 125, 
and when Maryland was noted for its able law- 
yers, he remained a representative of that day 
until he died. Progressing with the progress of 
the times, he never lost his old-school manner or 
his old-school method of grappling with details. 
He was always courteous, and his kindness to 
timid witnesses was proverbial. His self-control 
was remarkable, and he was never known to take 
an unfair advantage. He was loved and revered 
by the younger lawyers and looked up to by all. 

In politics he was a Democrat, and though he 
gave his time almost entirely to his profession, 
occasionally he consented to use his talents in 
behalf of his party and made several telling 
speeches in favor of Democratic principles. 

Bernard Carter's name has shed luster upon 
the University, even as the names of Roger B. 
Taney and Severn Teackle Wallis did in that 
elder day when they, as provosts, guided its des- 
tinies. It is fitting that the men who stand at the 
head of our venerable institution should be, as 
they have always been, the men at the top rung 
of Maryland's bar and men who are regarded as 
the foremost citizens of the State of Maryland. 
We await with interest the appointment of Mr. 
Carter's successor, and hope that he will be given 
a freer hand in the upbuilding of the University. 



THE STEAM ROLLER AND THE MED- 
ICAL COLLEGES. 



We have heard much of the steam roller as 
applied to practical politics of late, and Chicago 
has been especiallv prominent in the enforcement 
of steam-roller methods in the selection of candi- 
dates for high governmental offices. The steam 
roller is also being applied to the medical colleges, 
with the object of crushing out of existence a 
large proportion of those that are now in more or 
less active operation. This juggernaut also oper- 
ates in and from Chicago through the Council on 
Medical Education of the American Medical As- 
sociation. While the methods are drastic, the 
writer is not inclined to quarrel with the intent of 
the Council, which is to reduce the number of 
medical schools in the United States about one- 
half and to improve those that remain. Among 



THE HOSPITAL BULLETIN 



93 



the edicts that have been handed down is one that 
is in the line of progress, though it will doubtless 
inflict serious injury to many institutions. This 
is a ruling passed at the recent meeting of the 
Association at Atlantic City that alter January I, 
11,114, all schools wishing to be classified in Class 
A must require a year of college work in chem- 
istry, biology and physics, with one foreign mod- 
ern language, in addition to a completed four- 
years' high-school course. This rule goes into 
effect a year and a half from now ; hence time will 
be given to notify prospective students of the in- 
creased requirement. The University of Mary- 
land will loyally comply with this ruling at the 
appointed time. 

The demand is also made by the various organi- 
zations that have authority to do so that the 
laboratory branches be filled by full-time, expert, 
salaried teachers, and our school is now reorgan- 
izing its staff in such a manner as to comply with 
this requirement. This means that the clinical 
teachers will receive no salaries, and that the reve- 
nues of the school will be devoted to the scientific 
departments. The battle is not always to the 
strong nor the race to the swift, but it is going 
to be a very bard matter for the weak and the 
slow medical schools to survive in this struggle. 
The question that concerns us is, Can we survive ? 
We believe we shall, but only by the self-sacri- 
ficing labors of the teachers and the financial aid 
of our alumni and friends. We again ask the 
assistance of all of you in raising the $100,000 
pathological fund. 

CONTRIBUTION BY CLASSES. 
1848 $50 OO 

1868 10 OO 

1871 35 00 

1872 70 OO 

1873 43o 00 

1874 5 00 

1875 5 00 

1876 115 00 

1877 10 OO 

1880 5 00 

188 1 250 00 

1882 310 00 

1883 35 00 

1885 235 OO 

1886 IOO OO 

1888 50 OO 

1889 IOO OO 

1890 175 OO 



1 8; »-' 1 50 OO 

1893 15 00 

1894 1 35 00 

1895 155 OO 

1896 $2 OO 

I897 80 OO' 

1898 105 OO 

1 891 ) 25 OO 

1900 215 OO 

1901 240 OO 

1902 305 OO 

!9Q3 3'5 00 

1904 145 00 

1 905 2 I O OO 

1906 165 00 

1907 1 10 OO 

1908 10 OO 

1909 s °o 

1910 50 OO 

191 1 Terra Mariae 3 50 

1912 Club Latino Americano 25 00 



Total subscriptions to July I, 1912. .$10,056 50 

NEW SUBSCRIPTIONS IN JUNE. 

Dr. II. U. Todd, 190S S10 00 

Dr. W. F, Sowers, 1906 (second contri- 
bution ) 1 o 00 

Dr. J. Holmes Smith, Jr., 1905 10 00 

Dr. H. J. Maldeis, 1903 (second contri- 
bution) 15 00 

Dr. Chas. W. Famous, 1901 5 00 

Dr. Nathan Winslow, 1901 ( third con- 
tribution) 50 00 



Total $100 00 



WHO SHALL IT BE? 



Whether the University of Maryland is to 
stand still or advance is the momentous question 
the answer to which is awaited with bated breath 
by alumni, friends and well-wishers. The River 
Jordan must be crossed, the bridges of the past 
burned so that there may be no turning back, if 
the venerable institution is to occupy its erstwhile 
commanding position among its sister-institutions. 

The question which is at present uppermost in 
the thoughts of the alumni is, Who shall be the 
Moses to lead the University of Maryland into the 
chosen land and hold her there? If words made 
institutions of learning, we would be well 



04 



THE HOSPITAL BULLETIN 



founded : but we know that actions only count, 
and that to insure actions we must have a leader 
of broad mind, one endowed with the ability to 
attract men. a man vested with authority to seize 
the helm and guide the ship into a safe harbor. 
The death of Provost Carter forces some action 
upon the University, and affords a golden oppor- 
tunity to once and forever remedy the anomaly 
of an institution conducted by a head without au- 
thority to act for her welfare. If the occasion is 
permitted to pass, and the same old lines are pur- 
sued without change, then those who today hold 
the destinies of the University in trust will be held 
culpable by future generations, and their motives 
will be adjudged as selfish and their viewpoint as 
narrow. The' question before the L "niversity to- 
day is one which eliminates persons ana holds up 
for view only the interests of the University and 
her future, and personal ambitions and personal 
losses alike must be forgotten and the upbuilding 
of the University must be the only end sought. 

The alumni hope that there are enough pro- 
gressives in the Board of Regents to read the 
reactionaries, if there be any, out of its body. 
Rocks are ahead of us if a change be not effected. 
The life of the institution is hanging in the bal- 
ance. The predatory rich are exerting every 
means to force us to close up. This is no mere 
ranting, but an actuality. It is reported that Dr. 
Griffith Davis, an alumnus of our institution, while 
in conversation with Dr. Franklin P. Mall, pro- 
fessor of anatomy in the Johns Hopkins Univer- 
sity, said there is room in Baltimore for two med- 
ical schools only, whereupon the following reply 
was evoked : "There is only room for one — the 
Medical School of the Johns Hopkins University. 
Let the other schools combine. We (the Johns 
Hopkins ) intend to crush them all." Such, fel- 
low-alumni, members of the Faculty of Physic, 
members of the Board of Regents, is the state of 
affairs. We are surrounded by our enemies. Are 
we going to stand idly by and see the good old 
ship go down ''. Don't for one moment think it 
unshakable, for it is not. Still, it is hard to believe 
that an institution which turned out Carroll, Blue 
and Carter has reached the end of its usefulness. 
As a matter of fact, the University of Mankind 
ought to be serving the State and nation many 
years after all of us of today have been called be- 
fore our Master. However, in order to insure 
continued existence and usefulness, the Board of 
Regents must do its part. They must seize every 



opportunity to advance the material as well as 
educational interests, and today offers them an 
occasion fraught with possibilities — the appoint- 
ing of a Provost — a Provost in being as well as 
name. To be or not to be — that is the question ; 
whether the University of Maryland is going to 
die a slow and agonizing death or is to take on 
renewed life and vitality is the absorbing question 
which is agitating the minds of all true friends of 
our institution. The answer will be read in the 
name of the man who is appointed Provost. 



ABSTRACT 



THE PXEUMOCOCCUS IX SURGERY. 
Dr. Arthur M. Shipley, class of 1902, in a 
paper read before the Medical and Chirurgical 
Faculty of Maryland, April 24, 191 2 (Journal 
A. M. A., May 25, 1912),, said: 

"For many years the pneumococcus was looked 
on as being of interest only to the internist, but 
there is scarcely any tissue in the body immune to 
its attacks and, as a pus-producer, it ranks next to 
the well-known pyogenic organisms. Therefore, 
it frequently becomes the cause of distinctly sur- 
gical conditions. Some of the serious complica- 
tions of pneumonia, such as empyema and abscess 
of the lungs, are often due to the pneumococcus. 
Other conditions are thrombophlebitis, arthritis, 
osteomyelitis, parotitis, cholangeitis and cholecys- 
titis, mastoiditis, puerperal sepsis, and, especially, 
pneumococcic peritonitis. The sources and 
avenues of infection still remain uncertain. The 
peritonitis may be a part of a general sepsis, it 
may be secondary to an infection elsewhere, or 
it may be primary. Clinically the peritonitis is 
often secondary to pneumonia. In these cases 
the weight of evidence is in favor of the blood- 
stream as the carrier of the infection. Pneu- 
mococcic peritonitis must not be confused with 
lobar pneumonia with referred abdominal pains 
and tenderness. The morbid anatomy of this 
type of peritonitis closely resembles that of the 
pleura under like conditions. The pus is rather 
characteristic. It is odorless, yellow or yellowish- 
green and contains flakes of fibrin. The onset is 
sudden, with a sensation of chilliness and, per- 
haps, a rigor. Diarrhea often precedes the attack 
and there is great pain, vomiting, prostration, 
leukocytosis, rapid elevation of temperature, and 
a rapid small pulse. Tympanites is usually not 
marked, the abdominal wall being rigid and 



THE HOSPITAL BULLETIN 



95 



scaphoid. A characteristic doughy feel has been 
spoken of. The progress of the disease is more 
rapid than that of other types of peritonitis. The 
prognosis is extremly grave, f ew patients having 
recovered. The treatment is that for suppurative 
peritonitis — nothing by mouth, rapid operation. 
little anesthetic, pelvic drainage and normal salt 
solutii in by the rectum. 



ITEMS 



We are indebted to Old Maryland for the fol- 
lowing locations of the class of 191 2 in as far as 
is at present known : 

Hebrew Hospital — Benjamin Newhouse, path- 
ologist; David Silberman, assistant resident sur- 
geon: Harry Herman Rich, assistant resident 
physician. 

Springfield, Mass. — Henry Zimmerman. 

Santiago, Cuba — Gerardo Vega. 

Sudlersville, Md. — Charles L. Joslin. 

Beatrice, Ala. — Clarke J. Stallvvorth. 

Annapolis. Md. — Roger V. Parlett. 

Laurel, Del. — William T. Chipman. 

Windsor Locks, Conn. — Daniel H. Lawler. 

Ansonia, Conn. — Edward H. J. Hennessey. 

Bay view Hospital — John A. Skladowsky and 
Henry Diebel, resident physicians, insane depart- 
ment ; R. Bruce Patrick, resident surgeon ; E. A. 
Sherrill and George C. Battle, tuberculosis de- 
partment. 

Municipal Tuberculosis Hospital — W. Howard 
Yeager. chief resident physician. 

Homeopathic Hospital — James A. Duggan, res- 
ident physician. 

Marine Hospital — John C. Stansbury. 

Presbyterian Eye, Ear and Throat Hospital — 
Edwin V. Whitaker. 



We are asked to publish the following report 
of the receipts and expenses of the smoker given 
by the Adjunct Faculty to the graduating class of 

Received from members of the Faculty. .$100 oo 
Disbursed : 

To caterer $71 40 

Music 12 oo 

Cigars, postage and incidentals. . 16 60 

Total $ioo 00 



The engagement is announced of Dr. James 
1 fugh Bay, class of 1908, of Havre de Grace, Md., 
to .Miss Mary Barton Saulsbury, University I fos- 
pital Training School for Nurses, class of I (joy, 
of Baltimore, Md. Miss Saulsbury is a daughter 
of the late Dr. and Mrs. Thomas Bascom Sauls- 
bury, of the Eastern Shore, and a sister of Mrs. 
William G. Pugh of Govanstown, Md. Dr. Bay 
is a son of Mr. and Mrs. Thomas A. Bay, Jarretts- 
ville, Harford county. Maryland. The marriage 
will take place in the early fall. 



Dr. Charles Alfred Goettling, Jr., class of 1.910, 
is located at Denmore Park, Baltimore, Md. 



Dr. William Douglas James, class of 18S1, is 
located at East Brady, Pa. 



Dr. Ernest L. Griffith, class of 1907, is located 
at 311^2 10th street, Huntington, W. Ya. 



Dr. Charles O'Donovan, class of 188 1, received 
the degree honoris causa of LL.D. from Loyola 
College. 



Dr. Archibald A. Chisolm, class of 1897, is the 
only alumnus located in Newfoundland. He is 
at Manuels, Harbor Main, Newfoundland. 



Dr. Randolph Winslow and his daughter, Miss 
Eliza Winslow, sailed for Panama July 13. 



The new internes at the University Hospital 
assumed their duties July 1. 



So far as we are able to trace, there are but two 
alumni of the University located in Idaho. They 
are Dr. Joshua T. Price, class of 1868, Ilo, Lewis 
county ; Dr. William M. Mitchell, class of 1905, 
Weiser, Washington county. 



The Alumni Athletic Association has elected 
the following officers for the ensuing-year: 

President — Dr. Nathan Winslow. class of 1901. 

Yice-President — Dr. Charles E. McCormick 
( Pharmaceutical Department). 

Secretary — Dr. George M. Settle (Adjunct 
Faculty). 

Treasurer — Dr. Robert L. Mitchell, class of 

Board of Directors — Medical : Dr. I. J. Spear, 



96 



THE HOSPITAL BULLETIN 



class of igoo; Dr. Robert P. Bay, class of 1905. 
Law : Mr. Cyril Hansell, Mr. James W. Bowers. 
Pharmaceutical : Dr. Daniel Base, Dr. Charles E. 
McCormick. Dental: Dr. B. M. Hopkinson, class 
of 1885 (Medical School); Dr. Clyde V. Mat- 
thews. 

Manager Football Team — E. Holt Stevens, 823 
North Fulton avenue. 

Manager Basketball Team — H. H. Warner, 
1009 Madison avenue. 

Advisors to Teams — Football : Robert L. 
Mitchell (1905), R. G. Willse (1909), Frederick 
H. Vinup (1909). Baseball: YV. H. Smith 
(1900), R. G. Willse (1909), Robert P. Bay 
(1905). Basketball: H. M. Robinson (1909), 
Homer U. Todd (1908), G. M. Settle (Adjunct 
Faculty). 



Col. Louis M. Maus, U. S. A., class of 1874, 
and Capt. Perry L. Boyer, U. S. A., class of 1899, 
are located at Chicago. 



Dr. Ernest Zueblin of Pittsburgh was a recent 
visitor to the University Hospital. 



The following alumni were present at the ban- 
quet of the Alumni Association of the University 
of Maryland School of Medicine at the Caswell 
June 1, 1912: Drs. Win. H. Pearce, Henry H. 
Weinberger, John I. Pennington, FT. J. Hill, Ran- 
dolph Winslow, J. R. Winslow, Leonard J. Tur- 
lington, Wm. E. Wiegand, A. Trego Shertzer. 
John W. Linthicum, H. Louis Naylor, E. M. Reid, 

A. D. McConachie, W. R. Eareckson, Geo. A. 
Fleming, H. C. Silver, W. S. Love, S. R. Waters, 
C. R. Winterson, V. L. Norwood, H. C. Houck, 
Wm. J. Coleman, A. L. Kirk, James H. Wilson, 
H. C. Davis, Joseph Gichner, J. Tyler Smith, John 
Houff, B. M. Hopkinson, C. Urban Smith, W. A. 

B. Sellman, Nathan Winslow, G. Lane Taneyhill, 
Chas. E. Sadtler, S. Demarco, Howard Kahn, 
Eugene F. Cordell, H. E. Zepp, H. H. Biedler, A. 
Carroll, W. F. Sowers, H. J. Maldeis, II. A. Nay- 
lor, James H. Jarrett, H. M. Robinson, Geo. H. 
Stewart, Joseph T. Smith, P. S. Fuld, J. H. Reh- 
berger, F'R. Winslow, W. B. Kirk, Louis B. 
Henkel, Jr., G. Carroll Lockard, James T. King. 
M. C. Freilinger, E. H. Kloman, James M. Craig- 
hill, John II. Robinson, Robert P. Bay, Hiram 
Woods, Edw. M. Wise, Ceo. S. M. Kieffer. 



Rt. Rev. Luther B. Wilson, M.D., class of 1877, 
formerly a bishop in the Methodist Episcopal 
Church in Philadelphia, has been transferred to 
New York city. His headquarters will be 150 
Fifth avenue. 



Rev. Lynn Harold Hough, in speaking at the 
alumni banquet of the Medical School at the Cas- 
well, June 1, said in part: 

"One way in which to measure a man 
is by his physical vigor and efficiency. I am not 
forgetting that a great deal of the world's work 
had been done by her invalids. But, on the whole, 
the man physically fit has the truest outlook and 
the best opportunity. The man who is in the 
right bodily condition, other things being equal, 
will run the farthest and think the most clearlw 
Your profession stands for keeping people phys- 
ically at their best. When the physician's mil- 
lennium comes we will not send for doctors simply 
when we are sick ; we will have them examine us 
periodically to keep us well. 

"The second method by which you can measure 
a man is his strength of mind. It is the tempta- 
tion of a man in any profession to become en- 
grossed in the routine of his daily work and to let 
the advance guard of the profession sweep by him. 
But the man who measures up to the standards of 
his calling will read the great journals of his pro- 
fession. He will know what the men who are its 
leaders are about. He will follow the story of 
what experimenters in laboratories across the 
ocean are doing. He will be a constant student of 
the literature of his line of work. This is to jus- 
tify that fine old phrase which called the practice 
of medicine a learned profession. And in all this 
the power of a man's mind is enlarged, the grasp 
of his intellect is increased, and the instruments 
of his thought become more sharp and effective. 
So using his mind, he approximates the standard 
in respect of this way of measuring a man. 

"Another test of a man is the power of his per- 
sonality. Here are two men. One knows as 
much as the other. But one has a vivid, magnetic 
personality. He makes himself felt by the sheer 
force of personal vitality. He is the man who 
wins. You may feel very scornful about the Em- 
manuel movement, and you have a right to do it. 
But there is this much truth in the movement: 
A man who has a hearty, vital, vigorous person- 
ality adds an intangible but very valuable some- 
thing to the power of the medicine he prescribes. 
The contagion of a life full of wholesomeness and 
health is of real value in the sickroom. The phv- 



THE HOSPITAL BULLETIN 



97 



sician who lias a potent, commanding personality 
adds very much to his other powers. 

"The last standard I want to suggest for the 
measure of a man is reverence. You can tell a 
great deal about a man by what he reveres and 
how much he reveres it. Dr. Oliver Wendell 
Holmes, that brilliant and genial physician and 
in iet. once said, 'There is a little plant called rev- 
erence in my soul's garden which I like to have 
watered about once a week.' The only thing the 
matter with this remark is that if the plant is to 
he kept alive it really needs water more than once 
a week. 

"There is a type of reverence which is based on 
ignorance. It knows little of the bad of life. It 
knows little of the hard and brutal facts of the 
world. It has a childish, innocent reverence. 

"There is another kind of reverence more im- 
pressive and more comanding. Here is a man 
who has looked life full in the eye. He has been 
struck down once and again by hard and disil- 
lusioning facts. He knows the worst of life, and 
heavy lines of experience and struggle have come 
on his face. It is the face of a warrior, a veteran 
in life's fight. But his eyes still gleam with noble 
reverence. Although he knows the world, he has 
not become bitter, he has not become a cynic. He 
is a man of noble confidence, though again and 
again he has faced the worst of life. 

"No group of men have a better opportunity to 
develop this virile reverence than the men who 
follow the medical profession. I feel like congrat- 
ulating you on your profession and on the con- 
tribution you can make to the life and health of 
the world." 



Dr. Page Edmunds, class of 1898, was elected 
vice-president of the Baltimore & Ohio Associa- 
tion of Railway Surgeons at its twenty-second an- 
nual meeting held in Philadelphia June i, 1912. 
Dr. Edmunds read a paper on "Supra-Pubic 
Prostatectomv." 



Dr. S. W. Hammond, class of 1905, is located 
at 123 West King street, Martinsburg, W. Va. 



Dr. Clifton Norwood DeYilbiss, class of 1910, 
formerly a resident in the University Hospital, is 
located at Laytonsville, Md. 



Dr. Joseph Connor Joyce, class of 1908, is lo- 
cated at Arnold, Anne Arundel county, Marvland. 



As far as known, all of the members of the 
class of 1912, University Hospital Training 
School for Nurses, have taken up private nursing. 



Dr. Alexander C. Abbott, class of 1884, of Phil- 
adelphia, Pa., and Dr. John S. Fulton, class of 
i88r, of Washington, D. C, are members of the 
Committee of One Hundred on National Health 
of the American Association for the Advancement 
of Science. 



Dr. T. Morris Chaney, Jr., class of 1906, of Old 
Fort, N. C, was a recent visitor to Baltimore. 



Dr. William Cuthbert Lyon, class of 1907, who 
is spending his honeymoon abroad, writes us 
from Berlin. June 26, having previously visited 
Paris and Venice. 



Dr. Henry C. Ohle, class of 1886, of 1205 W. 
Fayette street, who lost his eyesight through an 
infection received from pricking his finger while 
operating two and a half years ago, is consider- 
ably better, and believes that he will be able to 
recognize his friends within six months, and to 
resume his practice. Dr. Ohle has been operated 
upon six times, and after 16 months of blindness 
he is now able to see indistinctly, as through a 
maze. We sincerely hope that the present outlook 
may be verified, and that Dr. Ohle may walk 
among us again, seeing clearly. 



Miss Mary E. Sullivan, class of 191 1, Univer- 
sity Hospital Training School for Nurses, is as- 
sistant superintendent of the University Hos- 
pital. 



Dr. Z. C. Myers, class of 1881, of 278 W. 
Market street, York, Pa., was operated on re- 
cently at the University Hospital. He is re- 
ported to be doing nicely. 



Surgeon George Young, U. S. P. H. and M. 
H. S., class of 1887. is stationed in Chicago at 
1 44 1 Clarendon avenue. He is also City Health 
Commissioner. 



Dr. C. L. Jennings, class of ioo r >, is located at Dr. Robert P. Bay, class of 1905, read a paper 

332 W, Monroe street, Jacksonville. Fla. before the meeting of the Maryland State Dental 



98 



THE HOSPITAL BULLETIN 



Society, his title being "Early Diagnosis of Oral has been appointed superintendent of the new 
Tumors." Havre de Grace (Md.) Hospital. 



Dr. Charles W. Mitchell, class of 1881, was a 
classmate of Governor Woodrow Wilson, and was 
overjoyed when told of his nomination. Dr. 
Mitchell said: 

"This has been a great day for me, but really, 
you embarrass me when you ask me to give you 
an interview over the outcome of the fight for 
the nomination." But when reminded of the fact 
that he was a classmate of the nominee he began 
bv paving a glowing tribute to Wilson. 

"I have been intimately acquainted with Gov- 
ernor Wilson for the past 35 years, ever since 
we were college boys together, and I am not at 
all surprised at his success, because he possesses 
every characteristic and trait that makes him 
what was apparent to all of us when at college. 

"Yes, we graduated from Princeton in the 
same class — the class of 1879 — and I might add, 
in passing, that another of our classmates has only 
recently been appointed by President Taft as a 
member of the Supreme Bench of the United 
States. He is Maklen Pitney." 

Then turning to the political situation in general 
and the achievements of Governor Wilson, Dr. 
Mitchell said: "Politics in this country has come 
to the parting of the ways, and it is a question 
between the privileged classes and the people at 
large. I regard the selection of Governor Wilson 
as the logical move for the convention to have 
made. It is a splendid triumph for this distin- 
guished gentleman, a moral picture and the down- 
fall of the machine. Personally speaking, Gov- 
ernor Wilson is a man of wonderful intellectual 
achievements, absolute integrity, splendid cour- 
age and unselfish in his devotion to the interests 
of the whole people. I do not have the slightest 
doubt of his election, and he will make an excel- 
lent President. In the face of the nomination of 
Woodrow Wilson there is removed every possible 
need or reason for the organization of any third 
partv, for he embodies every ideal to appeal to 
the people at large, and I have no doubt but that 
many Roosevelt followers will flock to him on 
election day." 



Dr. Herbert Seth Anderton, class of 19 10, has 
passed the Board of Medical Examiners of the 
State of California. 



The following item is clipped from The Star 
of Wilmington, N. C. Dr. Bulluck is a graduate 
of the class of 191 1 : 

"It is gathered from the State press that Dr. 
Ernest S. Bulluck, a conspicuously talented and 
successful young physician and surgeon of Wil- 
mington, was the recipient of a really signal honor 
at the hands of the North Carolina Medical So- 
ciety recently in session at Hendersonville. He 
was made vice-president of that august assembly 
at a much earlier time of life than the honor 
usually comes to the few who attain it. It is note- 
worthy that the society, composed as it is of the 
most eminent physicians and surgeons of the 
State, should show its marked appreciation of 
the young men of the profession. Its distin- 
guished favor is to be higly prized, and its broad- 
ness certainly is manifest in its consideration of 
young men of mark. 

"Young Dr. Bulluck read before the societv a 
paper on "The Practical Application of Iodine in 
the Preparation of Patients for Operations," and 
it is observed that this production brought forth 
extensive discussion and approval on the part of 
many of the State's best-known surgeons. 

"It will be gratifying to the young Wilmington 
doctor's host of friends to know this, and it cer- 
tainly gives pleasure to The Star to favorably 
mention any of the rising generation who. by 
singleness of purpose and patient industry, are 
striving earnestly to attain mastership in the va- 
rious paths of endeavor." 



Miss Mary Louise Gephart, University Hos- 
pital Training School for Nurses, class of 191 1, 



MARRIAGES 

Dr. Roscoe Drake McMillan, class of 1910, was 
married to Miss Gertrude Anna Garrison, Uni- 
versity Hospital Training School for Nurses, class 
of 1910, at the home of the bride, "Havendale," 
Burgess Store, Va., June 10, 1912. Mrs. Mc- 
Millan is the daughter of Mr. and Mrs. Lewis 
Ellison Garrison. 

The bride wore a gown of white princess satin 
trimmed with princess lace, and carried lilies of 



THE HOSPITAL BULLETIN 



99 



the valley and roses. The maid of honor. Miss 
Genevieve McMillan, wore spangled chiffon over 
blue satin, and carried sweet peas and roses. The 
bridesmaids, Misses Louise Blundon, Raphael 
Skinner and Florence Edwards, wore gowns of 
crepe meteor. The best man was Mr. Kenneth 
Craig Denny of Red Springs, N. C, and the 
ushers Messrs. Herbert L. Garrison, J. M. Mc- 
Callum and Howard Rice. 

The house was decorated with daisies and 
ferns. The ceremony was performed by Rev. A. 
J. Reamy, in the presence of a large number of 
friends and relatives. 

Dr. and Mrs. McMillan left immediately after 
the wedding for Washington, where they will 
spend a few days, afterwards motoring through 
North and South Carolina. 



Dr. Newton Webster Hershner, class of 1906, 
of Mechanicsburg, Pa., was married to Miss 
Wilna Anna Landis, also of Mechanicsburg, on 
Tuesday. June 18, 1912. The couple will be "at 
home" after August 1 at 213 West Main street, 
Mechanicsburg. 



Dr. Louis E. Langley, class of 1910, of 1129 
Baldwin street, Williamsport, Pa., was married to 
Mrs. Nora L. Burke of Centerville, Md., at Bal- 
timore, Saturday, June 29, 1912, at 10 A. M. Dr. 
Langley is 28 years of age, and was a very popu- 
lar member of the class of 1910. His first wife. 
Mrs. Daisy E. Langley, died some years ago. Dr. 
Langlev has a son, E. Surran Langley, five years 
of aee. 



Dr. Harry Downman McCarty, class of 1905, 
of 613 Park avenue, Baltimore, was married to 
Miss Mary Maitland DuBois of Ruxton. Md., at 
Baltimore, June 24, 1912. Dr. McCarty is a mem- 
ber of the Adjunct Faculty of the University of 
Maryland, and is 30 years of age. 



Dr. John Shaw Gibson, class of 1905, of Gib- 
son, N. C, was married to Miss Edna Iona Ebert, 
daughter of Mrs. Emma E. Ebert and the late 
John W. Ebert, on Tuesday, June 11, 1912, at the 
Second English Lutheran Church of Baltimore. 
Only the immediate relatives of the contracting 
parties were present. Dr. and Mrs. Gibson left 
for a sea trip to Boston, and will visit in New 
England and New York, returning to Gibson, 
N. C, August 1. 



CORRESPONDENCE 

In Dr. Howard A. Kelly's Cyclopedia of Amer- 
ican Medical Biography, the following statement 
is made with reference to the life of Dr. Horatio 
Gates Jameson. "His sons were all physicians, 
and died leaving no descendants." While the 
statement is absolutely correct, we fear that it 
may be misconstrued to mean that there are no 
lineal descendants of Dr. Jameson now living, 
which is incorrect, as the following communication 
from his grandson, Gen. Horatio Gates Jameson 
Gibson, U. S. A. (retired), shows: 

1412 21st St. N. W., Wash., D. C, June 12. 

Editor Hospital Bulletin, 

University of Maryland, Baltimore, Md.: 

In reply to your letter of June 10 asking infor- 
mation in regard to the descendants of my grand- 
father, Dr. Horatio Gates Jameson, I take great 
pleasure in giving you all the information that I 
have gathered in regard thereto in the last 30 
years : 

His sons, as you state, were all physicians, and 
died early, leaving no children. The last to lin- 
ger on the scene was his namesake, who lived and 
practiced his profession at Mt. Washington, near 
Haltimore, for some years prior to his death in 
1865. He married, but his only child died in 
infancy. 

All Dr. Jameson's children passed away some 
years ago. Of their children the following sur- 
vive : Catharine Rebecca Maze, Horatio Gates 
Jameson Gibson, George Fisher, Emily Shevell 
Alricks, Annie Helen Latimer, Robert Strettel 
Jones Fisher ; and of the next generation there are 
living: Anna Margaret Hopkins, Horatio Gates 
Gibson Schissler, Robert John Schissler, Horatio 
Gates Jameson Gibson, Katharine Fisher White, 
Agnes Gibson Wallace, Henry Kendrick Gibson, 
Robert Fisher Gibson, Charlotte Packard Far- 
quhar, John Jameson Gibson, Robert Barry 
Fisher, Catharine Fisher, Helen Fisher, Catharine 
Latimer Ross, Emily Latimer, Jannette Latimer, 
Robert Fisher Latimer, Catharine Fisher Mar- 
shall, Ellen Mason Young, Annie Marshall Cole. 
Of the next generation there are: Katharine Vir- 
ginia Wylie, William Hopkins, James Herron 
Hopkins, Katharine Lispenard White, Walker 
Gibson White, Arthur Farquhar, Robert Gibson 
Farquhar, Charlotte Farquhar. The latest gen- 
eration has : Andrew Wylie, Katharine Virginia 
Wylie, Margaret Wylie, Craig Wylie and the 



100 



THE HOSPITAL BULLETIN 



children of Robert and John Gibson, as well as 
those of Robert Barry Fisher and Robert Fisher 
Latimer, of whom I have no knowledge. Robert 
Gibson married Hattie McKenney of Centerville, 
Md., and John Gibson married twice, and both 
have children. 

My grandfather's eldest daughter, Cassandra 
Jameson, married Rev. William J. Gibson, and 
had several children, of whom only one survives — 
Catharine Rebecca Maze of Carroll, la. 

My mother, Elizabeth Jameson, married Rev. 
John Gibson, and had several children. 'William, 
who became a commander in the navy, married, 
but had no children. He wrote and published 
"A Vision of Faery Land and Other Poems," 
"Poems of Many Years and Many Places," 
"Translation of the Poems of Goethe," reviewed 
and approved by Bayard Taylor, Paul Cams and 
other literati. Horatio Gates Jameson, now like 
"his namesake in the Revolution, "a general in 
the army"; John, who became president judge of 
the 19th judicial district of Pennsylvania; Rob- 
ert, who became a lawyer, and in 1861 joined the 
army of Sterling Price in Missouri, served in the 
"battle of Carthage, and soon after was stricken 
with typhoid fever and died ; William followed in 
1887, and John in 1890. Margaretta Rebecca 
Mitchell married Hiram Schissler, and had sev- 
•eral children — Katharine Chevelle, Anna Mar- 
garet, Horatio Gates and Robert John. Kath- 
arine married Frederick Jean Nelson, a lawyer 
of Frederick, Md., but had no children. Anna 
Margaret married James H. Hopkins of Pitts- 
burg, in Congress 1875-77 an d 1883-85, and had 
several children — William, Katharine Virginia, 
James Herron. William is now a captain in the 
Marine Corps of the L T nited States, and Kath- 
arine Hopkins married Horace Wylie, and had 
several children — Andrew, Katharine, Margaret 
and Craig. Margaretta Schissler died in 1879. 
and Katharine Nelson in 1889. My mother, 
Elizabeth Gibson, died in 1855. William Gib- 
son married Mary Dulany Addison, but had no 
children. Horatio Gates Gibson married Har- 
riett Leavenworth Atkinson, and had several 
children. Of these are living Horatio Gates, who 
adopted the profession of his grandfather and 
namesake, and is one of the physicians in charge 
of the New York State Hospital at Central Islip, 
Long Island, and is often consulted as an alienist. 
He married Elizabeth McGrann, but has no chil- 
dren. Catharine Fisher Gibson married Frank 
Ilullis White, and had two children — Kath- 



arine Lispenard and Walker Gibson. Agnes Gib- 
son married George Weed Wallace, but has no 
children. Henry Kendrick Gibson married Ger- 
trude Davis, but has no children. John Gibson 
of York married Helen Packard, and had several 
children — Robert Fisher, who is the rector of the 
Episcopal Church in Williamsport, Pa., ordained 
after serving two terms as Mayor'of York. Char- 
lotte Packard, who married Frank Far- 
quhar, and has several children — Arthur, Robert 
Gibson and Charlotte. John Gibson married 
twice, and has two children. He is employed in 
the Westinghouse electrical business in Phila- 
delphia. 

Catharine Jameson married Robert Jones 
Fisher in Cincinnati in 1836 whilst her father was 
president of the Ohio Medical College, and lived 
the rest of her days in York, where her husband 
was president judge for 30 years. She had sev- 
eral children — George, Catharine, Emily Shevell, 
Annie Helen and Robert Jones. George Fisher 
married Mary Barry, and had several children — 
Robert Barry, Catharine and Helen. They reside 
in Baltimore. Catharine (York) married James 
M. Marshall, later a colonel in the army, and had 
several children — Catharine Fisher, Ellen Mason, 
Annie. Ellen married Dr. George Bright Young 
of the U. S. Marine Hospital Service, and has sev- 
eral children. Annie married Capt. James A. Cole 
of the army, and has children. Emily Shevell 
married Levi B. Alricks of Harrisburg, but had 
no children. Annie Helen married James W. 
Latimer, later president judge in York, an office 
filled by three members of the family, and had 
four children — Robert Fisher, Catharine, Jan- 
ette and Emily. Catharine Latimer married 
Brooks Ross of Delaware, and has two children. 
Robert Jones Fisher married twice — Harriet 
Tyler of Brattleboro, Vt., and Louise Martin of 
Washington — but has no children. He was As- 
sistant Commissioner of Patents under President 
Harrison, and is now the attorney for the Eastern 
Railroad Association, and resides in Washington. 

My grandfather's second wife had a son by her 
first husband — Jesse F. Ely. He is a prominent 
business man in Baltimore, and as I saw but little 
of my grandfather after 1840, you may be able 
to obtain some information from him which my 
sojourn in York, at West Point, Mexico and 
California denied me the opportunity of obtaining. 
Very truly yours, 

H. G. Gibson, 
Brigadier-General, U. S. A., Retired. 



THE HOSPITAL BULLETIN 

Published Monthly in the Interest of the Medical Department of the University of Maryland 
PRICE Sftl.OO PER YEAR 



Contributions invited from the Alumni of the University, 
Business Address, 608 Professional Building, Baltimore, Md. 



Entered at the Baltimore Post-office 
as Second Class Matter 



Vol. VIII 



BALTIMORE, MD., AUGUST IS, 1912. 



No. 6 



AMEBIC DYSENTERY. 11 



By Roscoe McMillan*, M. D., ( 1910) 
Red Springs, N. C. 



Historically, dysentery is among the oldest of 
described diseases, some symptoms and treatment 
being known as far back as 1600 B. C. 

Hippocrates was the first to describe it as an 
infection. In regard to the geographical distri- 
bution, Ayrs has commented on the fact that "of 
dysentery it may be said where man is found 
there will some of its forms appear." 

The term dysentery implies a symptom rather 
than a single pathologic entity, but the recent 
words of Shiga, Flexner and others render the 
etiologic classification clearer. The, old clinical 
distinction of endemic, epidemic and sporadic 
dysentery hold good, as well as those of acute and 
chronic, and the pathologic varieties — catarrhal, 
ulcerative and diphtheretic. But the etiologic 
classification is perhaps the best. 

First — The chemical, as from irritating foods 
and metals, such as copper, arsenic, mercury, lead, 
etc. 

Second — The bacterial or bacillary, as the 
Shiga, Flexner and B. Pyocyaneus. 

Third — Protozoal, or the amebic type. 

Lambl, in 1859, was the first one to offer the 
suggestion of a specific cause for dysentery. 
Koch, however, three years before this had de- 
monstrated ameba from sections in an ulcerated 
bowel, showing a relationship between the para- 
site and the intestinal lesion. In this country the 
first ameba were discovered by Osier in 1890, and 
shortly after confirmation came from Stengel and 
from various sources, and now the disease has 
been found to exist scattered over many sections 
of this country and in all parts of the world, but 
it is essentially a tropical or semi-tropical disease, 



*Rpad at meeting of N. C. Siate Medical Society, June IS, 
1912, llendersouville, N. C. 



and prevails more extensively in warm climates 
and in connection with poorly-drained soil. In 
certain sections of the South, right here in our 
own neighborhood, conditions are almost ideal 
for the prevalence of this infection, so this subject 
should be one of lively interest. But, unfortu- 
nately, it is scarcely regarded by the profession 
in a light at all befitting its high importance. It 
is a very regrettable fact that by most physicians 
in private practice, and even in the best hospitals 
in the Southern sections of the United States, it 
is not recognized as a distinct disease. 

The records of most of them — 90 per cent. I 
venture to say — classify amebic dysentery under 
the general term of "chronic dysentery." 

Amebic dysentery is a colitis, very rarely an 
ilio-colitis, caused by the ameba dysenteriae of 
Councilman and LoefHer. It is considered by most 
authorities different from the ameba found in the 
stools of healthy man, to which alone the name 
ameba coli is given. It would be very interesting, 
did time permit, to discuss the various views ad- 
vanced by pathologists as to the real etiologic fac- 
tor in these cases. 

The parasite is water-borne, or it may be con- 
veyed by contaminated soil to the mouth by dirty 
hands, or from eating green vegetables grown in 
sewage polluted ground. The parasite is from 
15 to 20 m. diameter, having an outer zone 
(ectosarc) which is clear, and an inner zone ( en- 
dosarc) which is granular. It contains a nucleus, 
several vacuoles and perhaps some foreign bodies, 
as bacteria, blood cells, etc. Its movement is char- 
acteristic. It moves by putting forth protrusions 
of the ectosarc in various directions, for a time not 
changing its location ; then presently the endosarc 
gushes forth into an unusually long protrusion, 
and the ameba move across the slide. 

The essential feature of the disease is always 
an ulceration. Inflammation of mucosa is more 
or less general. The submucous coat becomes 
edematous ; there is infiltration, and this raises 



102 



THE HOSPITAL BULLETIN 



the mucous membrane in round patches, necrosi; 
sets in and the membrane sloughs. The ulcers 
formed are either round, oval or irregular. They 
extend to various depths, so sometimes perforation 
of gut becomes a complication. The ameba are 
also found in the tissue, around the ulcers, in the 
lymph spaces and in small blood vessels. Ab- 
scess of the liver Is one of the most serious com- 
plications, and this probably takes place through 
the portal vessels. 

The characteristic lesions of the disease are 
always found in the large bowel, and the gener- 
ally accepted belief is that the primary site of in- 
fection is in the cecum, whence the infection is 
carried by natural forces throughout the colon 
and rectum. It is claimed by some that the distal 
portion of the ileum is sometimes involved, but 
this is denied by the best authorities. 

The symptoms do not differ much from those 
due to ulceration of intestine from other causes. 
Loose stools, discharges of mucus, pus and blood, 
tenesmus, abdominal distension, loss of appetite, 
strength and flesh, and a progressive anemia. 
But these are not always constant or clearly de- 
fined. 

The disease is essentially a chronic one, and oc- 
casionally during its course there are times when 
the patient thinks he is well, or great deal better, 
as most all of the symptoms have subsided, going 
even so far that patient may suffer somewhat 
from constipation. The parasites are, so to speak, 
under cover, and soon break out under certain 
conditions favoring a renewed activity. When 
the diarrhea occurs it does not follow any set 
rule, as great deal depends on the location of the 
ulcers. If they are low down in the rectum, 
there are frequent evacuations, accompanied by 
marked tenesmus. If the lesions are in sigmoid 
or above it, the movements may not exceed two 
or three per day. Mucus sometimes is absent, 
but blood or blood-streaked mucus is fairly con- 
stant. 

As I have said, the symptoms are not always 
constant or clearly defined, so a bedside diagnosis 
should not be relied upon entirely. By making 
a careful examination per rectum and by using 
some of the simple methods of examination, the 
diagnosis should present no difficulties. The 
ulcers are characteristic. They show a tendency 
to extend in direction of circular muscle fibers 
of the gut, and they are covered with white or 
f'ull gray pellicles, the removal of which leaves 



a raw bleeding area. The miscroscope should be 
used, the slide being warmed to body temperature 
and specimen carefully handled. The ulcer should 
be scraped and should be free from mucus and 
fecal matter, the cover glass firmly pressed down 
on slide. When present, the ameba, with their 
characteristic movement, is sufficient for diag- 
nosis. 

Leucocytosis is always present, and is in pro- 
portion to the severity of the disease. 

The diagnosis and treatment is of utmost im- 
portance. The utter hopelessness of a great num- 
ber of cases is clue to their being allowed to drag 
on until they yield to no treatment at all. The 
actual sources of infection are numerous, so pro- 
phylaxis becomes a complicated problem and its 
scope beyond the prescribed limits of this article, 
but I do want to emphasize hygienic and sanitary 
measures. The first in regard to the patient. 
This includes fresh air, sunshine and cheerful 
surroundings. In some cases change of climate 
may be helpful, especially through its effect on 
the general health. The sanitary measures in re- 
gard to those in close proximity to patient. In- 
struct the nurse or attendant upon the absolute 
necessity of destroying all discharges from the 
bowel and cleansing hands after waiting on 
patient. The infectious agent is probably in the 
main water-borne, and the danger of contaminat- 
ing the water supply should be carefully ex- 
plained. 

Second — Rest is always of great importance. 

Third — Diet. For a few days it is well to 
restrict him to liquids. Predigested foods, pep- 
tonized milk, soft toast and soft-boiled eggs are 
sometimes well borne. 

Fourth — Medication by mouth. I don't believe 
there is any known drug administered by the 
mouth which will retain sufficient potency after 
going through some 20-odd feet of intestine to 
have any direct influence on the ameba. I am 
fully aware that ipecac coated with salol, given 
in large doses, is lauded by many whose opinion 
is entitled to all respect, but, speaking generally, 
the administration of medicine by the mouth 
should be resorted to only in the presence of clear- 
cut indications. The routine administration of 
any of the so-called specifics is strongly con- 
demned, but I do believe that in the beginning 
and from time to time a mild mercurial purge 
should be given. 

Fifth — Local Treatment. Irrigations per rec- 



THE HOSPITAL BULLETIN 



103 



turn with cleansing antiseptic solutions constitute, 
in my opinion, the main dependence in a large 
number of cases. A wide diversity of opinion 
exists even here as to the most effective solution 
to use, but solutions of quinine are most widely 
approved, beginning at 1 to 5000 of a body-warm 
solution, used twice a day for a few days and 
gradually increasing to 1 to 1000. At least half 
a gallon should be introduced before any of it is 
allowed to return. Later, as patient improves, 
every other day or twice a week should be often 
enough. This should be kept up for some weeks 
after patient seems cured, and certainly until 
repeated examinations fail to reveal any 
ameba. The success of this treatment depends 
on certain details in carrying out the irrigations, 
namely, marked elevation of hips, insertion of 
small rectal tube 3 or 4 feet into colon and re- 
taining the fluid for at least 15 or 20 minutes. 
Other solutions, as boric acid, common salt, Hy- 
drastis and silver nitrate, have been used and 
recommended by some. 

When the rectum is very irritable, a preliminary 
injection of some anodyne solution, as cocaine 
or opium, will be required. 

But in spite of all I have said, some cases do not 
yield to rectal lavage of any of the solutions I 
have named, no matter how thoroughly used, 
and in these cases I think surgery offers a very 
promising field. The operation of choice is ap- 
pendicostomy, in which the caliber of the appendix 
is used as a means for successful medication of 
the large bowel. If for any reason the appendix is 
absent or has suffered disease, the cecum is the 
next resort. The solutions for use here are the 
same as used per rectum. L T nderstand, I do not 
claim this as a curative procedure, but it does 
offer in certain cases the only possible means of 
gaining access to the ulcers when they are situated 
very high up. I will not go into the technique 
of operation, but if it is performed under proper 
conditions by competent operators, it should give 
no larger mortalitv than operation for appendi- 
citis. The disease itself is by no means free from 
danger to life, as one single complication, such as 
amebic abscess of liver, causes a far greater mor- 
tality rate than that of appendicostomy. 



REPORT ( )F CASE. 



By Charles Wesley Roberts, M. D., (iqo6) 
of Douglas, (la. 



Dr. Albert Hynson Carroll, class of 1907, is 
at Woods Hole, Mass., as the guest of Dr. Leo 
F. White, professor of chemistry at Clark Uni- 
versity. 



Mr. President and Gentlemen of the 

Eleventh District Medical Society: 

With your kind permission I desire to invite 
your attention to the following case report, feel- 
ing that it is one of sufficient importance and in- 
terest to command your careful consideration 
during the few moments allotted to me on the 
program. I have given the history and after- 
treatment somewhat in detail, and if it proves 
tiresome to you to the extent of boring, I shall 
seek to reinstate myself in your good-will by 
alluding to the fact that it is the lack of impor- 
tant detail in our current literature and textbooks 
that makes us search for help in vain, authors 
evidently looking upon minute detail as of trifling 
significance : 

W. D. N. ; age 26; born in South Carolina; 
family history negative as affects this report. 

Personal History. — Had typhoid fever when 
16 years of age, lasting some two weeks, from 
which he made complete recovery. Soon after 
attack he weighed more than ever before and 
was in perfect health. 

Present trouble began five years ago as fol- 
lows: After taking food patient would have 
formation of gas on stomach, and some two or 
three hours after meals would have extreme col- 
icky pain in epigastric region of such severity as 
to require something for relief. Patient says he 
would take some soda or drink water or take 
some food and the pain would be relieved. This 
pain was accompanied by tenderness in the epi- 
gastrium, nausea, but no vomiting. Pain did not 
come after every meal, but would usually have 
at least one attack during each day. He rarely 
ever had attacks at night, and does not remem- 
ber to have had an attack on getting up before 
breakfast. 

Patient says that he consulted several phy- 
sicians for this "stomach trouble," and when he 
took medicine and was careful about his diet he 
would get better, so that there would be intervals 
of weeks or months when he was practically free 
from pain. After some three years of suffering 
of the above type patient says he began to have 
pain radiate through to back about the region of 
the eleventh or twelfth dorsal vertebrae and 



104 



THE HOSPITAL BULLETIN 



around into the left axillary region. Attacks 
were more severe and produced such nausea as 
to cause vomiting, which would usually relieve 
the attack. This vomiting was productive of 
only stomach contents making his teeth very 
sharp. Attacks came with the same regularity, 
but usually about two or three hours after a 
meal. After about a year of this type of suffer- 
ing, during which time, under treatment and diet, 
he would get better, to have a return of symp- 
toms after intervals of partial reliej, patient 
says all symptoms became exaggerated, pain was 
more constant and of such severity as to cause 
him to double up in bed, and would radiate all 
over upper abdomen, produced vomiting more 
often, and his general health began to fail. His 
condition grew gradually worse until patient was 
confined to bed, and for some three months pre- 
vious to his admittance to hospital he vomited 
every clay, after nearly every meal, and became 
emaciated, losing some 25 or 30 pounds. On 
one occasion patient vomited a large quantity 
of clear blood, and says that this was accom- 
panied by extreme weakness. No history of 
dark or tarry stools. 

( hi admittance to hospital patient presented 
the appearance of extreme emaciation, was very 
sallow, with hollow cheeks and eyes, very pale 
conjunctivae, and was constantly eructing gas. 
Physical examination revealed nothing abnormal 
about chest, kidneys, genitals or abdomen save 
about epigastric region. On distention of stom- 
ach with a seidlitz powder it was found greatly 
enlarged, reaching below umbilicus an inch or 
more. Nothing could be palpated about the py- 
lorus, but patient complained of tenderness about 
this region. Gall-bladder area was negative. 
The first day in hospital patient was given full 
diet, and he took all that was given him because 
he was extremely hungry. There was no pain or 
vomiting until the second day, when attack came 
suddenly, causing the vomiting of all solid food 
taken the day before, along with about one-half 
gallon of sour fluid mixed with mucus and an 
occasional streak of blood. This vomited matter 
when left in a glass vessel for an hour showed 
the three-layer formation seen in atonic dilata- 
tion of the stomach or retention of food from 
any cause — i. c, solid food at bottom, a clear 
area of liquid and top layer of mucus. Chemical 
examination showed free hydrochloric acid and 
no lactic acid. Microscopic examination re- 



vealed an abundance of yeast cells. After vom- 
iting the patient was relieved and ready for more 
food. 

A Saltzer-Ewald test meal gave the following 
findings : Free hydrochloric acid, 30 ; total 
acidity, 50 ; no lactic acid. Some three days later 
a second test meal was examined and gave about 
the same findings. Urine examination showed 
no albumen, sugar or bile. Hemoglobin was be- 
tween 50 and 60. Patient weighed 115 pounds. 

Now, the history in this case and findings 
after admittance to hospital pointed very defi- 
nitely to pyloric obstruction, and it was fair to 
presume that this obstruction came from a healed 
or partially healed gastric ulcer. The sallow ap- 
pearance of the patient led us to suspect gall- 
bladder involvement, but careful examination 
showed no evidence of such complication, and 
on further questioning of the patient we learned 
that this was a family characteristic, exaggerated 
in this case by the marked anemia. 

To sum up the history, we have the following: 
A slowly-developing stomach trouble, with inter- 
vals of relief, followed by another onset, and 
finally vomiting, causing temporary relief, then 
vomiting of blood — a chain of symptoms point- 
ing pretty definitely to gastric ulcer. The find- 
ings after admittance to hospital showed posi- 
tively that the patient had pyloric obstruction, 
and the test meals led us to exclude from the case 
the question of cancer as a cause. The finding 
of blood-streaked mucus and a constant, rather 
high free hydrochloric acid content argued in 
favor of an active ulcer. 

Exploratory laparotomy was advised and read- 
ily accepted. L T nder ether the upper abdomen 
was opened through the right rectus, the gall- 
bladder palpated and found free from adhesions, 
compressible and without stones. Ducts nega- 
tive. Head of pancreas enlarged, but not woody- 
hard, rather giving the sensation of an edema- 
tous condition. On retracting the abdominal 
walls a large scarlike area involving the pyloric 
end of the stomach came into view. The entire 
ring of the pylorus was involved in a thick, rather 
hard mass, not permitting any penetration of the 
pyloric opening. No active ulcer condition as 
evidenced by a crater-like feel in any part of this 
scarlike area could be made out, but the mass 
seemed to be simply an edematous infiltration of 
the pylorus, with a very evident scar showing in 
the wall and extendins: well around the stomach 



THE HOSPITAL BULLETIN 



105 



near the pyloric end. Several small glands were 
noted about the mass and in the meso-colon of 
the transverse colon. 

Posterior gastroenterostomy was decided 
upon as an operative measure for relief and rap- 
idly performed by the suture method without 
clamps, making an anastomotic opening of some 
two and one-half inches between the posterior 
wall of the stomach and the first part of the 
jejunum. 

Patient was put to bed in the Fowler sitting 
posture, which was maintained throughout the 
convalescent period. Normal saline proctocylsis 
begun at once and kept up at intervals for three 
days. Soon after being returned to bed patient 
vomited small quantity of dark fluid. This was 
the last vomiting, there being no more while in 
hospital, nor any since being discharged. 

The convalescent period was absolutely un- 
eventful, patient being allowed warm water, one 
ounce at a time, the first night after operation, 
the quantity subsequently gradually increased. 
Liquid nourishment was given the second day 
and semi-solid diet the fifth day. At the end of 
the first week after operation patient was taking 
a fairly full diet. On the morning of the third 
day, following a dose of castor oil the night be- 
fore, patient had a good bowel movement, con- 
taing considerable dark, disorganized blood — a 
typical tarry stool. There were no abnormal 
stools after this. Wound healed primarily, and 
the patient was allowed out of bed on the elev- 
enth day and was discharged on the eighteenth 
day following operation. 

There was absolute and immediate relief of 
all symptoms, and the result has been so gratify- 
ing that I have had Mr. Norton come down with 
me that you might see him and ask any questions 
that may interest you. It is now some four 
months since the operation, and patient has re- 
mained well and free from symptoms and has 
gained about 40 pounds. 



A CASE OF SIX MONTHS' MISCAR- 
RIAGE INDUCED BY MEASLES 
AND COMPLICATED BY 
TUBERCULOSIS. 



The announcement is made that Dr. Eugene 
Bascom Wright, class of 1909, will, on Septem- 
ber 1, succeed Dr. Chadbourne Andrews as su- 
perintendent of the Hebrew Hospital, a position 
held for several years by Dr. Charles Bagley, 
Jr., class of IQ04. Dr. Wright was for several 
years resident physician at the Church Home and 
Infirmary, and on September 2, 1911, succeeded 
Dr. Don Peters as superintendent. 



Written and Attended by Chas. W. Rauschen- 
isach. Senior Student, Under the Guidance 
of E. H. Kloman, Ph. G., M. D., Associate 
in Abstract. 



This case is brought to the attention of the 
readers of the Hospital Bulletin because of the 
rarity with which such a condition, as here pre- 
sented, i;;. seen. 

The probable cause of abortions in pregnant 
women who are suffering with measles is an acute 
infectious deciduitis. Some writers believe that 
the uterine contractions are caused by the irrita- 
tion of the exanthem as it occurs in the mucous 
membrane of the uterus, this disturbance being 
analogous to the fever, cough, photophobia, 
coryza, bronchitis and vesical tenesmus which 
so frequently complicate the eruptive fevers. 
Therefore we see no reason why the same ex- 
planation does not hold good for abortions occur- 
ring in any of the eruptive fevers, as is given for 
the above mentioned complications. The patho- 
logical "changes are marked by small or large 
inflammatory changes in the decidua, and within 
these patches many different varieties of bacteria 
have been found, but no specific one. Measles 
will terminate the vast majority of pregnancies, 
and the eruption will occasionally be noticed on 
the foetus. Kaltz had eleven cases of measles 
complicating pregnancy and nine of these abort- 
ed. The usual percentage to abort in these cases 
is given as at about 75. The chief dangers in 
the puerperium in these cases are hemorrhage, 
pneumonia, occasionally uterine sepsis, and the 
double danger of the lighting up of some old 
tubercular area by the combined drain of preg- 
nancy and measles. 

The patient is a primiparous colored girl. 
of good physique and stature, and 19 years 
of age. Her menses first appeared at the age 
of 13, had been regular, lasting four to five days, 
and unassociated with pain. 

Her family history is absolutely negative as 
to the bearing on this case. Her past history is 
negative, except that she has had all the symp- 
toms of a pulmonary tuberculosis for the past 



io:> 



THE HOSPITAL BULLETIN 



five months, viz., night sweats, coughs and 
flushes of heat. 

Her general physique is good and her muscu- 
lature firm and well developed. She shows no 
signs of any other disease, but her pelvis is slight- 
ly generally contracted. Her pelvic measure- 
ments are as follows : 

Distancia spinarum 23 cm. 

Distancia cristarum 25 cm. 

Intertrochanteric 20, cm. 

Baudeloque 18 cm. 

The present pregnancy was associated with the 
usual morning nausea and vomiting ; but unas- 
sociated with any of the special symptoms or com- 
plications, except that one week prior to the mis- 
carriage she had a severe vomiting spell. 

Upon our arrival at the house we found the 
patient in a talking delirium, lying upon a broken- 
down bed in a miserable dirty back room, just 
under the roof, when the sun was shining with 
the temperature of a boiler-room. In one corner 
of the room, lying upon a coal stove and covered 
with flies, lay the baby, placenta, cord and mem- 
branes all attached. 

We subsequently learned that the child had 
been delivered 18 hours previous to our arrival, 
by a colored midwife. As far as could be ascer- 
tained, the delivery was normal and uncompli- 
cated. As previously stated, the woman was 
found in a delirious state, with a temperature 
of io3.5°F., and her measle rash well out and 
covering her entire body. As the patient's skin 
was of a very dusky hue they appeared as small 
black papules, hard in consistency and giving a 
grating sensation to the hand when passed over 
them. She had a pulse rate of 135 beats per 
minute, which was of fairly good tension, small 
volume, and well sustained. Her respirations 
were 25 per minute. She also had a very severe, 
dry, hacking cough, and had lain in the same 
muttering delirium as above described the entire 
previous night ; her lochia was scanty, of the 
characteristic normal fleshy odor, red in color, 
and contained no clots, membranes nor shreds. 
Her other genital and excretory organs were 
normal and functioning. As we considered the 
patient in too serious a condition we deferred 
further examination. 

We immediately administered an ice sponge, 
t«i which she reacted fairly well, coming out of 
her delirium, and for the first time that day. 
taking an interest in her surroundings. We then 



gave instructions that she be given an ice sponge 
every two hours until our next visit unless she 
went to sleep, when she was not to be disturbed. 
We also made them take out the windows in the 
room to afford better ventilation. 

The following morning we found that she was 
still comatose and obtuse, but her delirium had 
left her. She had spent a very restless night, 
but had gotten a little sleep. Her lochia had now 
become very scant and possessed a very foetid 
odor. We now directed that she continue to be 
sponged and be given a glass of water even- two 
hours while awake. 

Upon seeing the patient in the evening of the 
same day she had responded very nicely to our 
plan of treatment her temperature being 99.2° F.. 
a drop of 4 F. ; her pulse no, a drop of 25 
heats, and her respirations remaining at 25 
per minute. Her greatest response, however, 
showed itself in her mentality, though still being 
a little drowsy ; she had not had any further 
delirium, was aware of her surroundings and 
answered questions somewhat intelligently, tier 
measle rash was now most prominent on her 
lower extremities and, in fact, that on her face 
was disappearing. She had slept some during 
the day and had eaten, for the first time in 48 
hours, two pieces of toast, a soft boiled egg, and 
a glass of iced tea. She had, however, developed 
a most annoying complicating bronchitis anil 
laryngitis, which greatly added to the distress. 
This complication also aggravated her cough 
and the continuous coughing caused her to have 
a constant throbbing headache. The sponges were 
now ordered discontinued. 

The next day, i. e., the third day of our treat- 
ment, we found that she had not slept any the 
previous night, her bronchitis had become so 
severe that she could not talk above a whisper, 
and she had a remittance of temperature to 
1 02.5 ° F. Just what caused this recrudescence 
of temperature could not be ascertained. We 
now administered the following prescription to 
alleviate her cough, bronchitis and laryngitis: 

Syrupi Senegae 

Syrupi Squillae aa dr. ii 

Ammonii Chloridi dr. i 

Flixiri Terpini Hydratis et 

Herioni oz. i 

Syrupi Strobi Pini Com- 

positi — q, s oz. ii 

She was given a drachm of the above every 






THE HOSPITAL BULLETIN 



107 



two hours. This seemed to lessen her cough, 
which became moist, and cleared up her bron- 
chitis. She was stifl kept on a light diet, con- 
sisting of soft boiled eggs, mutton broth, toast, 
and tea, either hot or iced. Just what caused her 
laryngitis was not quite apparent to us, but it 
was our opinion that it was tubercular induced by 
the measles lighting up her tuberculosis. 

On the fifth day we deemed that the patient's 
condition warranted making a physical examina- 
tion of her chest. Her chest, on inspection, was 
well developed, and showed no evidence's of 
rachitis or emphysema. The skin, covering it was 
loose and inelastic, and the respirations apparently 
equal on both sides, but increased. On palpation 
tactile fremitus was found to be absent, but the 
respirations in the upper left lobe were some- 
what retarded. Upon percussion we found al- 
most flatness in the upper left lobe and slightly 
impaired resonance in the bases of both lungs 
posteriorly, apparently due to hypostasis. On 
ausculation harsh tubular-like breathing was 
heard over the left apex, i. e., the breathing was 
loud in character, expiration harsher and longer 
in duration than inspiration; and vocal fremitus 
increased over the same area. Numerous moist 
sibilant rales were heard throughout the chest 
both on inspiration and expiration, and some of 
a musical twang, in all probability due to the 
bronchitis. Pectoriloquy was negative. We 
next had a sputum examination made and the 
tubercular bacillus was found to be present. 

The patient subsequently made fairly good 
progress towards recovery. Her temperature 
slowly descended, but she still had her nightly 
remissions. Her pulse and respiratory rates have 
also gradually descended until at present they 
are nearly normal. 

At the time of discharge, which was ten days 
after beginning treatment, the patient was able 
to get out of bed and sit around. Her breasts 
were perfectly normal, in fact they never had 
developed milk: her uterus well involuted, in the 
pelvis, and occupying its normal position ; her 
lochia of a serous character, moderate in amount, 
and normal odor : and all her excretory organs 
functioning. Finally she was advised to go to 
the Tubercular Department of Pay View Asylum 
by Or. Lee, which advice, however, was not ac- 
cepted. 

This report is incomplete without the descrip- 
tion of her present physical condition, which un- 



doubtedly would show some interesting sequelae ; 
but as all know the members of her race bear 
ever in mind such instinctive fear of hospitals, 
that with all the persuasive powers we could 
command we were unable to get her to consent 
to permit an examination at hospital. 

Child. — The child was a female, well formed 
for eight months. It weighed four pounds and 
an ounce, and was 33 cm. long. There were no 
blemishes upon its body, nor any other evidences 
which would tend to show that the child had 
contracted rubella from its parent. The cord, 
placenta and membranes were perfectly normal, 
but small, and presented no anamolies. 

Resume. — There can be no doubt that the 
patient had pulmonary tuberculosis, as the bacilli 
were found in the sputum, nor any doubt that 
she did not have measles (but some other exan- 
thematous disease simulating measles) as there 
were six other children in the house afflicted with 
typical cases of measles. As to just what caused 
the miscarriage is all a matter of probability, the 
most likely cause being measles. Our whole treat- 
ment consisted of but simple palliative measures 
which aided nature to combat the morbid con- 
dition and aid in the elimination of the deleterious 
materials formed bv the disease. 



Prof. Randolph Winslow received the follow- 
ing letter from Dr. Gerardo Vega, class of 1912, 
shortly before leaving for his Panama trip : 
"Dear Professor: 

"This is just to tell you that I have passed suc- 
cessfully the State Board, which was quite strong. 
I never thought it was so strong. I was called 
by the examiners, five in number, and was con- 
gratulated upon my good preparation, which 
makes me feel proud of my dear old Alma Mater. 

"About the negro uprising, I will tell you 
everything is quiet and safe, so if you will kindly 
tell me when you expect to pass around here or 
Santiago, I would like to see you. Please remem- 
ber me to all my dear professors. 

"My father sends you his respects and hopes 
to see you when you pass on your way South. 

".My best regards to all, 

"Your humble servant, 

"G. Vega. 

"Havana Manique 127." 



io8 



THE HOSPITAL BULLETIN 



SEPTIC SORE THROAT. 



By Nathan Winslow, M.D. 



During the month of February Baltimore was 
visited by an epidemic of sore throat which the 
profession soon realized to be of an unusual type. 
Unlike ordinary tonsillitis, it was obstinately re- 
sistant to treatment, was accompanied in many 
instances by enormous swelling of the cervical 
lymph glands, and displayed a marked tendency 
to secondary involvement of distant structures. 
The course and characteristics of the malady were 
so unlike the familiar forms of tonsillitis that the 
profession early realized it was dealing with 
something new. As the affection was follewed 
by death in some few instances, it does not seem 
amiss that the readers of The Hospital Bulle- 
tin be posted on its symptomatology, apparent 
mode of transmission, treatment and complica- 
tions. A peculiarity of the disease in Baltimore, 
as in Chicago and Boston, where similar epi- 
demics had already occurred, was its following 
the route of certain dairies. In this city it was 
observed that most of the cases were limited to 
patrons of the Hygeia Dairy, and after further 
investigation it was learned that the milk sup- 
plied by this dairy had not been pasteurized dur- 
ing the prevalence of the epidemic, due to a break- 
down in the pasteurizing apparatus. The chief 
interest centering in the malady, however, was 
the number and seriousness of the complications — 
enlargement of the cervical glands (with or with- 
out suppuration), broncho-pneumonia, peritonitis, 
pleurisy, nephritis, erysipelas, peritonsillar ab- 
scess, otitis media, endocarditis, septic arthritis, 
etc. It was due to this array of complications, 
many of which might and some of which did 
prove fatal, that the attention of the profession 
was focused upon it. During the epidemic 14 
cases came under my care. Of these six were 
adults and eight children, six males and eight 
females. In one the cervical lymph glands sup- 
purated after the patient had been ill six weeks. 
The abscess was opened and drained, and the 
child then proceeded to make an uneventful re- 
covery. In two there was suppurative otitis me- 
dia ; in two arthritis ; the others escaped compli- 
cations. 

In every case observed by me there was a his- 
tory of a sudden, abrupt, sharp onset, ushered in 



with chills, rapidly followed by severe muscular 
pains and headache. There was rapid rise in tem- 
perature, in one case reaching 104 4-5 Fahr. 
The fever frequently exhibited an intermittant 
character. A temperature which had been 102° 
Fahr., or higher, would gradually subside. The 
patient would be so much improved that visits 
would be discontinued. In a few days another 
summons would be received, and the patient 
would be found presenting the original symptoms, 
only aggravated. In every instance the throat 
was red, swollen and congested. In some patients 
the tonsils were markedly enlarged ; in others not 
apparently involved. In only two of my cases 
was there a thin grayish membrane on the tonsils. 
In neither did it entirely cover the tonsils, but 
occurred in patches. Within a short period after 
the onset there was swelling of the cervical and 
submaxillary lymph glands, which enlargement 
occasionally reached huge proportions. The pa- 
tients generally complained bitterly of pain upon 
swallowing. A particularly noticeable feature 
was the excessive prostration, which was entirely 
out of proportion to the severity of the tonsillitis. 

Bacteriological examinations in Baltimore, as 
in Chicago and Boston, revealed the presence of 
a streptococcus presenting peculiar characteris- 
tics. The organisms occurred in chains or pairs, 
and were surrounded by a capsule, which led 
some observers to believe they were dealing with 
the pneumococcus. The germ grew abundantly 
on blood agar. 

A noticeable feature of the Baltimore epidemic 
was the localization of those affected to a well- 
defined territory. The characteristics of these 
cases were entirely dissimilar to symptoms of 
tonsillitis presenting in cases elsewhere in the 
city. Another noteworthy peculiarity was the 
limitation of the victims almost entirely to users 
of the Hygeia Dairy. This fact led observers to 
believe milk was in some way connected with the 
malady. When one takes into consideration that 
4.6 per cent, of the cows ( Capps and Miles, Jour- 
nal of the American Medical Association) supply- 
ing milk to the dairy in Chicago whose consum- 
ers were afflicted were affected with mastitis from 
the exudate of which a similar organism was ob- 
tained in pure culture, and that farmers and milk- 
ers in contact with these cows were afflicted with 
the same form of sore throat, one naturally con- 
cludes contaminated milk to be the medium 



THE HOSPITAL BULLETIN 



109 



through which the human infection occurred. In 
confirmation of these views the above writers 
report the recovery of a virulent streptococcus 
from the milk of a cow and the throat of a girl on 
the same farm who was ill with sore throat and 
arthritis. 

Considering the number and the seriousness of 
the complications, the prognosis should be 
guarded. 

Prophylactic treatment consists in examining 
the cows from which the milk is obtained. If 
diseased udders are found, the milk should be 
condemned. During such an epidemic as Balti- 
more passed through reliance should not be placed 
in the pasteurization of the milk by the dis- 
tributing dairies, as it is well known that pas- 
teurization often is imperfect, but all milk con- 
sumed should be boiled. 

Every line of local throat treatment seemed to 
be equally unavailing. The simple, ordinary 
mouth washes, such as salt water, assisted by an 
occasional mopping off of the infected area with 
a 5 per cent, carbolic-acid solution gave as good 
results as any. The antipyretics in my hands 
were rank failures. Build up the resistance pow- 
ers of the patient with good, easily-digested, nu- 
tritious food. The complications should be treated 
as such diseases would be treated under ordinary 
circumstances. 

The only case upon which I had to operate 
developed a suppurative cervical adenitis. The 
patient, a boy of three years, had been ill for six 
weeks, when a fluctuation was made out back of 
of the ear. At the time he was running a tem- 
perature which fluctuatetd between 102 and 
104 4-5 Fahr. He was operated in the morning. 
By evening his temperature had dropped to nor- 
mal and remained there. Drainage was insti- 
tuted. Recovery was uninterrupted. 



BOOK REVIEWS 



Miss Louise Gephart, L T niversity Hospital 
Training School for Nurses, class of 191 1, is 
superintendent of the Havre de Grace Hospital 
of Harford County (-Incorporated), Havre de 
Grace, Md. 



Dr. John R. Winslow, class of 1888. is spend- 
ing a vacation at Edgeclift" Hotel, Gloucester, 
Mass. 



International Clinics. A Quarterly of Illus- 
trated Clinical Lectures and Especially Pre- 
pared Original Articles on Treatment, Medi- 
cine, Surgery, Neurology, Pediatrics, Obstet- 
rics, Gynecology, Orthopedics, Pathology, 
Dermatology, Ophthalmology, Otology, 
Rhinology, Laryngology, Hygiene and Other 
Topics of Interest to Students and Practition- 
ers. By Leading Members of the Medical 
Profession Throughout the World. Edited 
by Henry W. Cattell, A.M., M.D., Philadel- 
phia, U. S. A., with the collaboration of 
William Osier, M.D., Oxford; A. McPhe- 
dran, M.D., Toronto: Frank Billings, M.D., 
Chicago ; Charles H. Mayo, M.D., Roches- 
ter; Thomas H. Rotch, M.D., Boston; John 
G. Clark, M.D., Philadelphia; James J. 
Walsh, M.D., New York : J. W. Ballantyne, 
M.D., Edinburgh ; John Harrold, M.D., Lon- 
don ; Richard Kretz, M.D., Vienna. With 
regular correspondents in Montreal, London, 
Paris, Berlin, Vienna, Leipsic, Brussels and 
Carlsbad. Volume XI, twenty-second series. 
1912. Philadelphia and London: J. B. Lip- 
pincott Company. Cloth ; $2 net. 

The present volume is teeming with questions 
vital to the medical profession, such as Pellagra, 
a Lecture on the Present Status of Epidemic 
Poliomyelitis, the Dangers of the Underfeeding 
of Infants, Direct Method of Examination of the 
Larynx, Trachea, Bronchi, Esophagus and Stom- 
ach, and Cerumen in the Ears. 

Perhaps the most important of all the contribu- 
tions is that by Simon Flexner on the present 
status of epidemic poliomyelitis. At any rate, 
owing to the enormous increase and general dis- 
tribution and present excessive presence of polio- 
myelitis, it is the most timely. Dr. Flexner rightly 
states that the medical profession of this country 
should awaken to the fact that we have amongst 
us a severe epidemic of this disease. He is also 
of the opinion there is no telling how long it will 
remain : therefore, the sooner the profession and 
the public come to a realization of this, and the 
fact that the only method we have at present for 
its control is isolation, the better for all. Since 
the summer of 1907 epidemic poliomyelitis has 
extended from the Atlantic seaboard, where it 
first appeared, throughout the length and breadth 



I IO 



THE HOSPITAL BULLETIN 



of this country. It was not until 1909 that 
experimenters were able to transfer the malady 
to animals — in this instance the monkey — 
and is done by directly injecting the cerebro- 
spinal fluid from an affected individual di- 
rectly into the brain of a monkey. This experi- 
ment taught us that the incubation period was 
from three to thirty days, averaging about eight. 
According to the author, it has been definitely 
proven that the cause of the disease leaves the 
body through the pharyngeal and nasal mucosa, 
and that the disease is contagious. Admitting 
these conceptions of the disease, he states, its pre- 
vention lies in the employment of the same meth- 
ods used in diphtheria, scarlet fever, etc. The 
sick should be separated from the well. The dis- 
charges which contain the virus must be de- 
stroyed, and a sufficient time must be allowed for 
isolation to make it at least highly probable that 
the infectious agent has disappeared from the 
nasal and buccal secretions. Work done on a pre- 
ventive serum leaves the writer full of hope of 
finding a therapeutic control for the disease. This 
article alone is well worth the price of the vol- 
ume. The article on pellagra is also of more than 
ordinary merit and can be read with both pleasure 
and instruction. 



The Pituitary Body and Its Disorders. Clini- 
cal States Produced by Disorders of the 
Hypophysis Cerebri. By Harvey Cushing, 
M.D., Associate Professor of Surgery the 
Johns Hopkins University; Professor of 
Surgery (Elect) Harvard University. An 
amplication of the Harvey lecture for De- 
cember, kjio. 319 illustrations. Philadel- 
phia and London: J. P>. Lippincott Com- 
pany. Cloth. $4 net. 1912. 
Recent investigations of the glands of internal 
secretion have thrown much light on many mala- 
dies whose etiology was heretofore hidden in 
darkness. Surgery has done much in clarifying 
the atmosphere. With our present knowledge, 
however, the explanation of many phenomen 1 
remains in darkness. • The work done on the thy- 
roid blazed the way for the solving of the part 
the other ductless glands played in the human 
economy. One of the last of the ductless rests 
to be brought into daylight is the pituitary body. 
Its existence has been known for many years, 
but its use has remained hidden until a com- 
paratively recent date. Much of the credit for 



the solving of its status is due Harvey Cushing 
of the Johns Hopkins University and his cowork- 
ers in that institution. During the past few years 
Cushing has done monumental work in experi- 
mental and clinical pituitary surgery. He has 
proven some of the theories brought out by 
brother workers, and disproved many fantastic 
ideas of the past. Perhaps the most important 
feature of Cushing*s observations on this gland 
are the variations of the symptoms according to 
whether the gland is in a state of over or minus 
activity, and the perfection of a surgical method 
of attack. Undoubtedly Cushing's investiga- 
tions upon this organ will stand as a masterpiece 
of its kind, especially as a basis for future experi- 
menters to follow. Though much is known con- 
cerning the activities of the ductless glands, 
many problems remain unsolved. Those inter- 
ested in what has been and what is being done in 
pituitary surgery are fortunate in being able to 
obtain under one cover and at a moderate price 
the labors of Cushing and his co-operators on the 
hypophysis cerebri. The book is an amplifica- 
tion of the Harvey lecture, delivered in Decem- 
ber, 1910, before the New York Academy ol 
Medicine. It contains not only the work done 
up to the date of the delivery of the lecture, but 
that done since then; a historical review of the 
subject, anatomy, physiology, morphology, path- 
ological anatomy, organo-therapy, chemistry of 
the gland, clincal manifestations of disordered 
function, symptomatology and treatment. Every- 
body — internist, surgeon, pathologist, chemist, 
radiologist, neurologist, oculist, gynecologist, etc. 
— should be interested in this contribution to 
medical literature, as the symptoms are refer- 
able to practically every organ of the body. For 
instance, in pituitary insufficiency there is in- 
terference with vision, amenorrhea, non-develop- 
ment of the genital organs, enlargement of the 
sella tursica, high carbohydrate tolerance, etc. 
With these features the volume should appeal es- 
pecially to those who desire to be abreast of the 
times, as there is not the least doubt in the mind 
of the writer that pituitary faults are at present 
overlooked as much as thyroid were in the past. 



Dr. William Tarun, class of 1900, has been 
forced to give up his practice for a while because 
of illness. We wish him a speedy restoration 
to his usual good health. 



THE HOSPITAL BULLETIN 



1 1 



THE HOSPITAL BULLETIN 

A Monthly Journal of Medicine and Surgery 

PUBLISHED BY 

THE HOSPITAL BULLETIN COMPANY 

608 Professional Building 

Baltimore, Jin. 



Subscription price, . . . $1.00 per annum in advance 

Reprints furnished at cost. Advertising rates 
submitted upon request 



Nathan Wlxsi.ow. M.D., Editor 



Baltimore, August 15, 1912. 



DR. ERNEST ZUEBLIX. 



There have been many inquiries directed to us 
concerning Dr. Ernest Zueblin. The editor has 
frequently been asked who is he, where is he 
from and what lias he done? We therefore take 
this occasion to publish the data we have in hand. 

Dr. Zueblin, Professor (elect) of Medicine in 
the University of Maryland, after five years of 
stud)- at Heidelberg. Zurich and Lausanne, was 
awarded the degree of M.D. from the last insti- 
tution in 1903. In 1903 and 11)04 he did gradu- 
ate work at Munich under Professors Midler and 
Bauer.; in [904-1905, he was assistant to 
Geheimrat Professor Leube at University 
of Wurtzburg; 1905-1906, assistant to Pro- 
fessor C. Roux at University of Lausanne: 
[906-1907, first assistant to Geheimrat Professor 
W. Fleiner at Heidelberg; [907-1909, associate 
physician at the sanitarium of Dr. A. Widmer at 
Valmont. Territet, post-graduate work at Munich 
and lierlin under Professors Ewald, Rosenheim 
and Strauss: [909-1911, assistant to Professor 
Max Einhorn ( Xew York ), pathologist to Tuber- 
culosis League Hospital, Pittsburgh; 191 1. at- 
tending physician to Western Pennsylvania Hos- 
pital ; ii)ii-ii)i2. attending physician Allegheny 
General Hospital, Pittsburgh. Dr. Zueblin since 
graduating from University of Lausanne has been 
engaged continuously in institutional work in the 
universities of Europe and the United States. Dr. 
Einhorn of Xew York gives him the highest rec- 



ommendations, ana those who have met him at 
the University of Maryland have been very fav- 
orably impressed with him. As far as can be de- 
termined now, he is the man for the place, 
and his election has been well received by his 
coworkers to be in the department of medicine. 
Dr. Zueblin has a very attractive personality, 
and we feel will soon win the respect, friendship 
and love of his fellow-workers, students and 
alumni. It is needless to slate after such an ex- 
perience in post-gradute work that he is eminently 
fitted for the position. The Bulletin extends, 
in the name of the Faculty of Physic, Adjunct 
Faculty, alumni and students a most cordial wel- 
come to Professor Zueblin as a member of our 
Faculty, and bespeaks for him the loyal support 
of the members of his department. 



AX EXPLANATION. 



In the July issue of The Bulletin the edi- 
torial, "Who Shall It lie." was wrongly inter- 
preted by many. In justice to the medical mem- 
bers on the Board of Regents, the editor feels' 
constrained to explain to the readers of Tut: 
Bulletin that they are on the right side. Each 
and every one of them stands for progress. They 
have the best interests of the Medical School and 
University at heart, and will not stop at anything 
within their power to advance the University. 
Those outside the Board of Regents are loudly 
calling for trustees not connected with the teach- 
ing bodies. The editor desires to impress upon 
the alumni and those interested in the uplift of the 
University of Maryland that the members of the 
Faculty of Physic ( and this includes the Faculty 
of Dentistry and the Faculty of Pharmacy) have 
and are endeavoring to bring this happy result 
about. They are fully alive to the needs of the 
institution, as much so as any of us, but how to 
accomplish the change is what is bothering them. 
The law faculty is the stumbling block. 

These men say they are satisfied with condi- 
tions. Their school, unhampered by such expen- 
sive requirements as laboratories, clinics, etc., is 
flourishing. Their expenses are naturally much 
smaller than those of the other schools. They do 
not outwardly state, however, that they are ap- 
parently interested only in the "come back" they 
get from the old cow. Sooner or later, as in the 
case of the School of Medicine, the old cow will 



112 



THE HOSPITAL BULLETIN 



go dry. The Law School is not so strong that it 
can withstand the stress of competition from a 
law school of high standard which is bound, 
sooner or later, to be organized in our midst. At 
that time the University of Maryland Law School 
will find itself in an identical plight as that which 
the Medical School faces today, but it will then be 
too late to change the organization of the schools. 

By "reactionaries" was meant the members of 
the Law Faculty, and from their present actions 
it seems they are more interested in their pocket- 
books than the success of the University of Mary- 
land. 

All hail to those members of the Faculty of 
Physic, who, in order to supply six full-time men, 
were willing to forego any remuneration for their 
own services. The editor could not and would 
not let the impression go forth that they were or 
are negligent to their trust. 



VACATION TIMES. 



Every schoolboy rejoices when the school bell 
rings for the last time and he is released from the 
routine of school life "and is free to follow the 
bent of his own erratic inclination. To those 
who are older and whose work is of a more seri- 
ous character vacation time is also none the less 
pleasant. It is an old and trite saying that "All 
work and no play makes Jack a dull boy." Not 
only do school boys and girls require a time of 
rest and recuperation, but it is very essential that 
everyone, and especially those who are bearing 
heavy responsibilities, should have a time in 
which to refresh their minds and bodies and to 
drink in new truths at the font of nature. Phy- 
sicians become so engrossed in their duties that 
many of them forget to take the necessary time 
in which to secure a change of scene and sur- 
roundings. It is, however, becoming more and 
more recognized that a physician becomes a more 
useful member of the community when he takes 
a reasonable time for his own recreation and 
instruction. 

University work ceased on June i, and most 
of the students have scattered far and wide. The 
closing of the accounts and records of the past 
session and the preparations for the next session 
kept the various members of the Faculty in the 
city until the middle of July, but several have 
now left on more or less prolonged leave of 



absence. Professor Hemmeter is spending the 
summer in Maine, as the cooler weather of the 
North is beneficial to his health. Professor 
Neale, as usual, spends the summer at Ocean 
City, Md. Professor Gilchrist has gone to Eng- 
land. Professor Ashby has taken a house at 
Roland Park and will spend the summer at that 
delightful suburb, while Professor Winslow is 
again indulging his fondness for travel by mak- 
ing a journey to Cuba, Panama and Central 
America. 

In consequence of the absence of Professor 
Winslow we cannot present a long list of new 
subscriptions to the pathological endowment 
fund, but are pleased to be able to announce sev- 
eral very acceptable contributions, which, if not 
as large as the donors would like them to be, at 
least are evidences of their good-will and con- 
structive sympathy. We are engaged in an enor- 
mous struggle to put and keep our school on a 
satisfactory basis. All teachers of practical 
branches must serve without salary hereafter. 
We can do no more. If you love your Alma 
Mater, help us to sustain her. 



CONTRIBUTION BY CLASSES. 



848. 
864. 

868. 

871. 

872. 

873- 
874. 

875- 

876. 
877. 
880. 
881. 
882. 

883. 

885. 

886. 



889. 
890. 
892. 

893- 
894. 

895- 
806. 
897. 
898. 
899. 



$50 00 
20 CO 
10 00 
35 oo 
70 00 

430 00 
5 00 
5 00 

115 00 
10 00 

5 00 
250 00 
310 00 

35 00 
235 00 
100 00 

50 00 
100 00 
175 00 
150 00 

40 00 
135 00 
155 00 

52 00 

80 00 
105 00 

50 00 



THE HOSPITAL BULLETIN 



"3 



190 1 240 00 

1901 240 oo 

1902 305 00 

1903 3'5 00 

1904 145 00 

1905 210 00 

n>o() 165 OO 

1907 1 10 00 

T908 20 00 

1909 5 00 

1910 50 00 

191 1 Terra Mariae 3 5° 

19 1 2 Club Latino Americano 25 00 



Total subscriptions to August 1, igi2.$io,i36 50 

NEW SUBSCRIPTIONS IN JULY. 

Geo. H. Cairnes, 1864 $20 00 

S. Griffith Davis, 1893 25 00 

Geo. H. Stewart, 189*; 25 00 

Henry Lyon Sinskey, 1908 10 00 

Total $80 00 



ABSTRACT 



Dr. Watson Smith Rankin, class of 1901, sec- 
retary to the State Board of Health of North 
Carolina, presents an argument ( Old Dominion 
Journal, July, 1912) setting forth the value of 
vital statistics in the work of safeguarding the 
health of a community, in which he says, in part : 

The happy girl of sixteen, in her exuberant 
health, accepts her greatest blessings as a natural 
inheritance, as natural as the sunshine, and gives 
it as little thought. Her attitude to health is one 
of indifference. Time passes and girlhood fades 
into womanhood ; death knocks at her door ; her 
baby answers the summons ; blinded with the bit- 
ter tears of sorrow, she falls on Providence. Her 
attitude to health is one of fatalism. Time moves 
on, and observation, sharpened with the friction 
of the years, discerns relationship between pre- 
existing and subsequent disease, between environ- 
ment and disease, and slowly there is evolved a 
consciousness of control over disease-producing 
factors. Health fatalism recedes as the light of 
the most powerful fact of the nineteenth century 
— the preventability of diseases — enters her mind ; 
the spirit of the dead baby calls her attention to 
the terrible meaning of the needless death, awak- 
ens her conscience to its part in the great conflict 



of life and death, and a raw recruit enters the 
army of health workers. Her eagerness to do 
something will not permit of the development of 
nature plans. The desire to serve overbalance-* 
ability to serve: public health is more philosophy 
than science. Her attitude to health is one of 
unco-ordinated enthusiasm, characterized by spas- 
modic and sporadic efforts to prevent disease. 
Finally, with the novelty of the new idea worn 
off, with the sedative effect of the fatigue of 
sporadic and exaggerated effort, cold reason re- 
sumes her throne, and puts the blunt question : 
Where are the fruits of your labor? Exactly 
what do you seek ? What evidence is there to in- 
dicate the value or futility of your effort ? The 
health enthusiast begins to think, to seek some 
fixed point from which progress may be measured, 
and vital statistics as an absolute necessity in 
health work is recognized. With that discovery 
philosophy gives way to science, and exuberant 
enthusiasm to steady, rational effort. The atti- 
tude to health is rational, scientific. 

These four mental attitudes to health — the in- 
different, the fatalistic, the enthusiastic and the 
rational or scientific — are found in varying pro- 
portions in the public opinion of different places, 
and so in accordance with the dominant mental 
attitude is the attitude of the Government to 
health work, indifferent, fatalistic, enthusiastic or 
rational. 

The indifferent and fatalistic types of mind are 
passing rapidly into extinction. God speed them ! 

The enthusiastic type of mind is still rare 
enough to be appreciated when found. This type 
makes a good supporter, but a bad counselor for 
the health officer. People of this type are vision- 
ary ; they have schemes for cleaning up the town 
or county in less time than it takes to bathe a 
baby ; they regard a board of aldermen or com- 
missioners as an absolute and not as a representa- 
tive power ; they waste valuable energy in vain 
endeavor to scale the heights, rather than take 
the more circuitous path of popular education 
that will surely in the end bring them in sight of 
the promised land ; they appraise a health officer 
by the amount of appropriation that he is instru- 
mental in securing, by the number of speeches he 
makes, and by the amount of literature he scat- 
ters, some by the wayside, some upon the stony 
ground, and, thank God, some upon good soil. 

The scientific attitude to public health recog- 
nizes society in its entirety and not as unrelated 



114 



THE HOSPITAL BULLETIN 



fragments, not as so many thousand or million 
individuals, but as Herbert Spencer saw it, as a 
unity, a "social organism." To the scientific mind 
the individual is to the social organism what the 
cell is to the cellular organism ; the industrial or 
social class to the social organism, what the organs 
or groups of cells of like function are to the cellu- 
lar organism. In the one as in the other, units 
and classes or organs are mutually dependent and 
bound into a co-ordinated potentiality. 

This social organism may become diseased just 
as the cellular organism, and like it exhibit dis- 
ease phenomena or symptoms. These disease 
phenomena or symptoms are as essential in the 
diagnosis and treatment of diseases of the social 
organism as they are necessary to the proper 
diagnosis and treatment of diseases of the cellular 
organism. 

As a symptom in the cellular organism is the 
expression not of one, but of many cells, so 
symptoms of disease of the social organism are 
civic rather than individual expressions. These 
symptoms are in terms of per thousand or per 
hundred thousand population. — in short, in the 
very nature of the case they must be statistical. 
Inasmuch as they relate to conditions of life, they 
are properly called vital statistics. * * :;: 

The doctor who recognizes only the common 
characteristics of a disease and overlooks the 
peculiarities contributed by certain individual fac- 
tors, and who treats disease by rule of thumb 
methods, and ignores individual modifying fac- 
tors, is not to be classed as a first-rate scientific 
physician. Likewise, the sanitarian who gives 
the general tonic treatment of sanitary education 
to every sick town or county, and fails to meet 
the special indications in each particular town or 
county, falls far short of his opportunities as a 
health officer. 

I repeat, for emphasis, there is a symptomatol- 
ogy of disease of the social organism : it is as nec- 
essary in the intelligent treatment of diseases of 
the social organism as is a knowledge of the mean- 
ing of symptoms in the treatment of diseases of 
the cellular organism. My endeavor in this paper, 
so far, has been to call your attention to just 
enough of this symptomatology to show its ex- 
istence and suggest its inestimable value. It is 
admitted that the symptomatology of diseases of 
the body politic is not a perfect science yet. As 
the symptomatology of personal diseases was 
relatively simple and undeveloped fifty years ago 



as compared with the present, so will develop the 
symptomatology of public disease in the near 
future. But even now, the fact should be recog- 
nized that a health administration that pursues its 
course without a close study of symptoms, of vital 
statistics, is unscientific, pursuing its way with- 
out compass or chart on the ocean of life blindly 
working in the dark, and may find some day, 
when the light of truth breaks through the clouds 
of ignorance, that all its building has been on the 
shifting sand of opinion, and not upon the rock 
of eternal fact. My first point then is, that scien- 
tific health work must rest on a basis of vital sta- 
tistics, and that such statistics are in their mean- 
ing analogous to the symptoms of personal 
disease. 

Another value of vital statistics, second only to 
their value in the intelligent treatment of disease 
of the social organism, is their influence in re- 
moving public health work from politics. Once 
the people have grasped firmly the fact that a 
health officer is one who reduces death rates or 
increases average longevity, the health work of 
this country will be established upon a basis of 
genuine merit and not upon popular whim or 
political favor. A government that re-elects, 
elects or maintains any person who has not or 
does not show the effects of his work in a definite 
saving of human life and health, will never be 
tolerated. The health officer who can "deliver 
the goods," pardon the slang for its expressive- 
ness, will be in demand, can command his own 
salary, and even better than that, deserve it. 
When that good time comes the best minds in 
medicine will he shifted from curative to pre- 
ventive medicine, the newest specialty will lie the 
greatest specialty, the specialty that pays best and 
affords the greatest opportunity for glorious 
achievement — public health will have come into 
its own. 

In conclusion, the only method of health work- 
that will ever be effective must rest upon a system 
of facts furnished by vital statistics. 

The ideal in the public health work of this 
State for which we incessantly long is a State- 
wide enforcible vital statistics law, that, with the 
powerful pressure of public opinion and that 
primal instinct, self-preservation, will make it im- 
possible for the State itself to ever become 
afflicted, for any length of time, with a public 
health administration that cannot justify its ex- 
istence in a decrease in the State's death rate — 



THE HOSPITAL BULLETIN 



£15 



the absolute test of efficiency in health administra- 
tion ; that will make every one of the one hundred 
county health officers of this State competitors in 
a great life-savin.; contest with the other ninety- 
nine; that will forever divorce public health work 
from politics; that will give the health officer the 
exact recognition, rating; and compensation that 
he merits as indicated by the death rate of his 
constituency ; that will make public health work 
as attractive to strong men as it is needed by a 
grievously and needlessly sick social organism; 
that in the course of a few years will change the 
death rate in North Carolina from 18.4 per thou- 
sand to 12 or 13 per thousand, which means the 
saving of ten thousand lives a year with the con- 
comitant amount of sickness, suffering and 
anxiety that goes with so great a loss of life ; an 
ideal that will at least suggest that ecstatic vision 
wherein the old ideals and old order of things 
have passed away, and, in their place, a new 
heaven and a new earth adorned as a bride for 
her husband. 

I Editor's Note. — Dr. Rankin's comment on a 
health officer who can "deliver the goods" is per- 
haps borne out in Boston's recent appeal to the 
physicians of America to enter the lists for chair- 
manship of her Board of Health. Everywhere a 
call is being made for competent men, and places 
await them.l 



ITEMS 



Dr. \\illiam J. Todd of Mount Washington 

has the following to say of Dr. Horatio Gates 
Jameson. Jr., and thus adds to our history of the 
descendants of Dr. Jameson of the class of 1913: 
1 loratio ( iates Jameson, youngest son of 
Horatio (iates Jameson and Catherine ( She veil ) 
Jameson, was born in Baltimore, < )ctober 1, 1815 ; 
graduated at the Ohio Medical College in 1836; 
commenced the practice of medicine in' Cincinnati, 
then to lialtimore city, later at Church Hill, "on 
the high road running between Elkton and 
Easton," in Queen Anne's county, .Maryland, in 
1841. Dr. Jameson continued to practice medi- 
cine on the Eastern Shore until about 1843, when 
he removed to Baltimore city, thence to Baltimore 
county, locating at Brooklandville, on the Rider 
estate ; then to the village of Rockland, on the 
Falls road turnpike, living in an old stone house, 
lately remodeled and occupied by Mr. Bryan, the 
owner of Rockland Flour Mills. August 23, 



1856, Dr. Jameson bought a small tract of land 
on Hare llill from Mr. Johnzey Hook, known 
then as "Hector's Hop Yard," upon which he 
built the large and comfortable house lately owned 
by Mrs. Jane Wright. Dr. Jameson died in this 
house of tuberculosis in August, 1865. 

His wife was Sarah McCulloh I'ortcr (married 
in 1841 ), daughter of Parnell and William Porter, 
a merchant of lialtimore city. She survived him 
only a few weeks, dying at the house of her sister, 
Mrs. William Hanna. in Baltimore city. There 
was only one child by this union, a daughter, 
Kate, who died about the age of six years. 

Dr. Jameson was a man of versatile accom- 
plishments. He was musical, playing skillfully 
upon the flute, his favorite instrument. He was 
also an artist of some note. 

He was tall, slender and inclined to stoop 
shoulders ; had a deep, musical voice ; very amia- 
ble and mild in manner. As might be expected of 
one who was a painter and musician, he was exact 
as to the carrying out of the details in the treat- 
ment and nursing of his patients. 

A lady who recalls Dr. Jameson states: "He 
was the first physician to use a buggy in this sec- 
tion ; he had a large practice, requiring long 
drives." 

Indirectly, the death of Dr. Jameson was due 
to a severe wetting he received while on his way 
to see his patients. He was crossing Jones Falls 
on horseback, when a washerwoman flaunted a 
piece of the wash in the face of the doctor's horse, 
which became frightened and unmanageable, 
throwing the doctor on his back into the water. 
Not heeding the fall and the wetting, he continued 
on his way, seeing several patients, returning ho ne 
late, with his clothing wei and he chilled. From 
this accident and exposure he contracted a severe 
cold, from which he never recovered, and which, 
no doubt, was the primary cause of his death. 

The late Thomas Wright of Rockland remem- 
bered this man, and called upon him for medical 
advice. Dr. Jameson saw his patients profession- 
ally almost to the day of his death. 

After the death of Mrs. Jameson their home- 
stead was purchased by Dr. Steele, who remained 
a short time, and then sold to .Admiral Porter, 
whose mother, with another son, spent the last 
years of her life there. 

Dr. Jameson was a descendant of a David 
Jameson, a graduate of the renowned University 
of Edinburgh, who emigrated to this country 



n6 



THE HOSPITAL BULLETIN 



about 1740, landing in Charlestown, S. C. Leav- 
ing there, he settled in Pennsylvania. His de- 
scendants of the fourth and fifth generation re- 
sided in Shippensburg and at York. In 1796 he 
was living and practicing his profession in Ship- 
pensburg, Pa., where it is believed he died. David 
Jameson was lieutenant-colonel of the Provincial 
forces and colonel of the Revolutionary forces of 
Pennsylvania. 

His commissions as captain, brigade-major and 
lieutenant-colonel, also as colonel of militia of 
Pennsylvania during the Revolutionary War, are 
in the hands of his maternal great-grandson, who 
is Horatio Gates Gibson, Colonel Third Regiment 
Artillery and Brevet Brigadier-General of United 
States Army, Washington Barracks, Washington, 
D. C. Of this man's children, two sons, Horatio 
Gates and Thomas, followed the profession of 
their father. Thomas settled in York. Pa. 



The University of Maryland record at the re- 
cent State Board examinations is as follows : 



3 >> 



>-. 



Dr. Edward Sanborn Smith, class of 1900, of 
-Macon, Mo., is spending a unique vacation cruis- 
ing in the Mississippi and its branches. He is 
accompanied by his friend, Harry M. Rubey. 
president of the Rubey Trust Co. of Macon. The 
two left St. Paul, Sunday, July 15, to cruise down 
the Mississippi to Grafton, then up the Illinois 
River, through the Illinois-Michigan Canal and 
Chicago River, across Lakes Michigan and Huron 
to Georgian Bay, Canada, and back to St. Paul, 
in all some three thousand miles. The trip is be- 
ing made in the 50-foot launch Elizabeth. Dr. 
Smith will have charge of the engine-room. Mr. 
Rubey will be the skipper. The bill of fare for 
the voyage will be "jest plain country eatings" — 
fish, roast beef and corn, corn dodger, molasses, 
potatoes and strong coffee. Dr. Smith says : 
"The purpose of our voyage is to study naviga- 
tion, to hunt up picturesque shore lines and to 
take good pictures of the natives and the scenery. 
If our adventures justify it, I'll order the cook to 
write a book about them between meals. Should 
we be boarded by pirates, we have a phonograph 
which sings Casey Jones and other deadly 
weapons for self-protection." The Elizabeth has 
a luxurious library, state and observation rooms, 
but the greatest attention has been paid to the 
motive power and steering apparatus. The boat 
on a smooth course will easily cover 12 miles an 
hour. We wish Dr. Smith much enjoyment from 
his "simple life outing." 



4 
9 
n 
12 

25 
44 
48 
49 
53 
54 
57 
59 
61 
66 
67 
83 



91 
92 
93 
96 
97 
98 
103 
105 
114 
115 
125 
137 
141 
142 
143 
148 
149 
150 
151 
152 
153 
15S 
159 
160 
161 
162 
163 
165 
166 
167 
171 
177 
181 



S C = B^S^B_.-- > 

u < 00 ft o ft o S* en ft a ■< 

1912 75 100 85 97 80 75 78 86 90 766 85 

1911 71 75 .. .. 65 .. 69 67 

1911 84 98 86 87 84 75 88 84 89 775 86 

1912 77 90 76 77 82 67 85 67 75 696 77 
1912 71 88 80 88 75 79 75 70 79 705 78 
1912 86 75 92 90 82 65 68 79 70 707 78 
1912 75 90 81 94 75 80 79 84 80 738 82 
1912 94 90 96 97 87 90 88 94 88 824 91 
1912 47 90 79 70 75 71 50 72 554 62 
1912 94 85 88 S9 75 79 75 88 85 758 84 
1912 54 85 77 79 75 75 59 67 63 634 70 
1912 80 90 88 89 75 75 67 84 68 716 80 
1912 84 90 96 92 78 80 76 74 75 745 83 
1912 87 76 93 94 76 75 S3 75 96 754 S4 

1905 75 .. 78 

.... 82 88 92 .. 82 

1912 89 95 94 92 82 79 93 90 87 801 89 

.... 87 94 86 .. 94 

.... 87 S7 86 .. 95 

1912 75 80 91 81 83 81 78 76 79 724 80 

79 89 ^8 91 

1912 64 90 67 75 75 70 80 75 72 668 74 

.... 87 89 75 .. 82 

1912 64 92 93 94 75 75 75 87 86 741 82 

.... 80 82 87 .. 90 

.... 89 83 81 .. 90 

1912 80 96 86 94 75 79 66 55 75 706 78 

1912 64 92 83 55 75 75 79 58 75 656 73 

1912 72 95 75 88 80 73 63 69 85 700 78 

.... 83 86 90 .. 84 

1912 74 85 74 75 75 73 75 77 68 676 75 

.... 65 76 57 .. 44 

1912 76 84 87 94 75 75 80 75 80 726 81 

.... 87 78 67 .. 76 

.... 80 79 80 .. 85 

1912 90 90 95 94 81 92 81 77 93 793 88 

.... 73 80 75 .. 84 

1912 92 80 97 94 84 75 87 81 75 765 85 

1912 77 84 96 91 79 88 84 92 86 777 86 

1912 91 80 72 91 75 65 79 75 85 713 79 

.... 75 82 70 .. 75 

.... 63 71 54 .. 57 

.... 85 81 76 .. 75 

.... 84 75 75 .. 96 

1912 89 84 99 92 75 88 75 96 89 787 87 

.... 90 89 66 .. 83 

1912 83 84 S5 91 82 85 86 S7 85 768 85 

1910 .. .. 82 75 .. 78 

.... 74 75 79 .. 66 

1911 76 96 95 86 .. 76 

1912 80 87 86 93 75 86 69 74 93 743 83 



The staff of the University Hospital for 1912- 
1913 is as follows: 

Medical Superintendent — William J. Coleman, 
M.D., class of 1908. 

Assistant Resident Surgeons — F. R. Winslow, 
M.D., class of 1906; Robert E. Abell, M.D., class 
of 1912: William E. Gallion, Jr., M.D., class of 
1912; Edward A. Looper. M.D., class of 1912; 
Henderson Irwin, M.D., class of 1912. 

Assistant Resident Physicians — Charles W. 
Rauschenbach, M.D., class of 1912: R. A. All- 
good, M.D., class of 1912: Wilbur M. Scott, 
M.D., class of 1912; Judson E. Hair, Jr., M.D., 
class of 1912. 

Assistant Resident Gynecologists — William L. 
Byerly, M.D., class of 191 1 : L. K. Walker, M.D., 
class of 1911. 

Resident Pathologist — M. L. Lichtenberg, 
M.D., class of 1912. 



THE HOSPITAL BULLETIN 



ii7 



The various newspapers of Baltimore are advo- 
cating former Governor Edwin Warfield as the 
choice of the majority of the officers of the 
University for Provost to succeed Bernard 
Carter, provided he is able to give sufficient time 
to the needs of the University. The Board of 
Regents meet in September, and have as yet given 
no indication of the course to be pursued by them. 



Dr. J. Holmes Smith, professor of anatomy and 
clinical surgery, and Dr. J. Howard Maldeis, lec- 
turer in histology and embryology, will in future 
devote their entire time to teaching and will dis- 
continue the practice of medicine. 



Criticism doesn't hurt an institution founded on 
solid merit. Out of the smoke of discussion we 
may expect a greater University of Maryland to 
arise. — Evening Sun, August 12. 



Dr. William Emrick, class of 1902, now located 
in Brazil", is a truest in Baltimore. 



Dr. Frank Lynn, class of 1907, is out of town 
because of ill health. 



The president of the board of directors of the 
Skin and Cancer Hospital of Maryland has an- 
nounced the following appointments of our 
alumni : 

Surgeon-in-chief, Dr. George Hauer Everhart, 
class of 1890. 

Surgeons, Drs. Robert Bay, class of 1905 ; E. 
H. Kloman, class of 1910, and Hoagland Cook 
Davis, class of 1902. 

Consultants, Drs. Eldridge C. Price, class of 
1874; William Dulaney Thomas, class of 1887; 
Wilbur F. Skillman. class of 1900; Clarence K. 
Jump, class of 1885, and George Latrobe Ewalt, 
class of 1900. 



Dr. Jurgi Elias Sawaya, class of 1910, is lo- 
cated at 628 San Martin, BuenOs Ayres, Argen- 
tina. 



Dr. J. A. Hughes, class of 1909, is located at 
Strong;, Northumberland county, Pennsylvania. 



Dr. William Royal Stokes, class of 1891, is re- 
covering from a severe attack of malaria, al- 
though it will be some time before he is able to 



resume his work at the Department of Health. 
The Baltimore Sun writes of him: 

"In addition to his work at the Health Depart- 
ment, Dr. Stokes has the chair of bacteriology 
at the College of Physicians and Surgeons, which 
is connected with the Mercy Hospital. He is 
also bacteriologist for the State Board of Health. 

"He organized the bacteriological laboratory 
at the Health Department soon after the election 
of Mayor Hooper, and has developed it gradu- 
ally as funds were provided by the city. It is 
now regarded as one of the best equipped labora- 
tories in the country. Physicians from New 
York, Chicago and other cities have commended 
it. Dr. Stokes devotes all his time to the work. 
For some time he has been directing the manufac- 
ture of serum for the prevention of typhoid fever. 

"The study of bacteriology is a hobby with 
Dr. Stokes. No matter how often the adminis- 
tration changes politically, there is never mention 
of a successor to him. Health Commissioner 
Bosley recently remarked, on being asked if Dr. 
Stokes would retain his position : 'You bet he 
will. I would almost as quickly think of having 
no Health Department as I would of having a 
Health Department without Stokes.' " 



Dr. Gilbert Tyson Smith, class of 1897. was 
recently a guest in Baltimore, and while stopping 
at the Baltimore Athletic Club told of his recent 
adventures and his future plans. Dr. Smith 
spent last year along the eastern coast of Alaska 
as surgeon to the Alaska-Canada Boundary Sur- 
vey. Most of last winter was spent at Rampart 
House, a trading post, 250 miles up the Porcupine 
River, a tributary of the Yukon. Last fall an 
epidemic of virulent smallpox broke out among 
the native Indians, and he was put in charge of 
the situation by the Canadian Government. He 
stamped out the disease, and lost but one of the 
98 patients suffering with the disease. To eradi- 
cate the germs Dr. Smith destroyed by fire the 
cabins occupied by the Indians, and even burned 
the hospital which the Government had erected at 
a cost of several thousands of dollars. But the 
necessity for this severe measure was so great 
that his course was received with commendation 
by Alaska and Canada alike. He is now in 
< Htawa, Canada, preparing for a hunting trip in 



n8 



THE HOSPITAL BULLETIN 



the far Northwest in the spring. He will travel 
through Europe during the winter months. 

For his trip in the spring he has purchased the 
Vera, one time a San Francisco man's yacht, 
Inter an opium smuggling craft, and perhaps yet 
to see her weirdest adventures under his guid- 
ance. The ship lies in harbor at Victoria, B. C. 
The first stop will be Nome. Alaska, which Dr. 
Smith expects to reach in three weeks after starl- 
ing. Then, as Dr. Smith says : "Hunting big 
game along the coast, as well as inland, we shall 
make our way gradually north of Alaska into 
the Arctic Ocean, with Ranksland as our goal. 
There we will camp for the winter. For months 
we shall be frozen in, so to speak, in the Arctic 
night. 

"Hazardous? Yes, extremely so; but it ap- 
peals to me, and if I must die I should as soon 
be buried under Arctic ice as in Greenmount 
Cemetery. I am unmarried and footfree. Were 
it otherwise, of course I would not think of go- 
ing. But it is no trip for a man who fears a 
rough, harsh life, far beyond the luxuries of 
civilization. 

"While my main purpose will be to hunt, I 
expect to do some little exploring, for, if lucky, 
I will reach that part of the world of which prac- 
tically nothing is known. No, I will not try for 
the Pole, for I am a rival of neither Peary nor 
Dr. Cook." 



county. Dr. Wright was a member of the Phipps 
Dispensary staff of Johns Hopkins during the 
time he was connected with Eudowood Sana- 
torium. 



Dr. Andres Martin, class of 1912, writes from 
Havana that the Cuban situation "is getting bel- 
ter every day." 



Current report says that Dr. Josephus Arthur 
Wright has been appointed superintendent of 
Sydenham Hospital, but we have not as yet been 
able to corroborate the statement. Dr. Wright 
is a graduate of the class of 1881. 

After graduation from the University of 
Maryland he became physician in charge at the 
Confederate Soldiers' Home, Pikesville, where 
he remained four years. Leaving the home, he 
practiced on the Eastern Shore, returning 10 
Baltimore five years ago to become assistant resi- 
dent physician at Eudowood Sanatorium. He 
lives with his son. Dr. Arthur L. Wright, class 
(if [908, 2505 W. Pratt street, assistant surgeon 
for the Baltimore & Ohio Railroad Co. 

Dr. Wright is 52 years old. He received his 
early education in the public schools of Wicomico 



The following alumni successfully passed the 
Maryland State Board examinations held in 
June : 

Robert Alexander Bonner, Charles Peter 
Clautice, John Dade Darby, Harry Deibel, John 
William Ebert, Ernest William Frey, Dawson 
Orme George, William Granville Haines, Jud- 
son Elam Hair, Jr., James Edward Hubbard, 
John Kent Johnston, Edward Sooy Johnson, Ed- 
win Paul Kolb, Moses Louis Lichtenberg, Wil- 
liam Michel, Benjamin Newhouse, Roger Vinton 
Parlett, Charles William Rauschenbach, Jay D. 
Sharp. Thomas F. A. Stevens, John Henry Tra- 
band, Jr., William Howard Yeager, all of the 
class of 1912. 

Alvah Parrish Bohannan, class of 1005. 

Henry Benedict Athey, class of 101 1. 

John Francis Bryne, class of 1910. 

Samuel Hopkins Cassidy, class of 1911. 



Dr. Thomas Boyle Owings is seriously ill at 
his home, Owings Glen, near this city. Dr. 
Owings was born at Roxbury Mills. September 
24. 1830. He was the son of the late Dr. John 
Hood and Mrs. Amanda Clementine Owings. 
He was educated in the public schools of this 
county, and, after reading medicine under his 
father, entered the University of Maryland, from 
which he graduated in 1852 with high honors. 
He first located on the Baltimore county side of 
Ellicott City shortly after he graduated. He 
served as County Commissioner for about 2$ 
years. Dr. Owings was twice married. His first 
wife was Miss Margaretta Clark, daughter of the 
late David and Maria Clark, of Howard county, 
and his second wife, who is now living, was 
Miss Nellie Polk, daughter of the late Col. Wil- 
liam C. Polk, formerly of Delaware, and Mrs. 
Sarah A. Polk, who now resides at Sykesville, 
Carroll county, and who is in her 93d year. 

In 1868, the time of the great flood along the 
Patapsco River, when the larger portion of Elli- 
cott City was washed away. Dr. Owings' first 
wife, six children and several servants, together 
with his house and contents, were washed down 
the river by the raging waters. The present Mrs. 
Clarence W. Watson of West Virginia, wife of 



THE HOSPITAL BULLETIN 



119 



Senator Clarence \V. Watson, and Dr. Clark 
< Iwings of Boston, Mass., were the only mem- 
bers of Dr. Owings' family except himself to 
escape death at this time, and the reason for this 
was that they were away from home, visiting at 
their grandfather's. Dr. ( >wings was away an- 
swering a professional call, and arrived at the 
bank on the Patapsco just in time to see his 
house, with his family and servants sitting on 
the roof, carried down by the flood. Dr. Owings 
was almost crazed with grief, and it took the best 
efforts of those along the river to prevent the 
doctor from plunging into the flood in a useless 
attempt to save those that were clear to him. 

Dr. Owings retired from active practice in 
[9] 1, owing to ill-health, but at that time he hail 
rounded out 60 years as a practicing physician. 

We sincerely wish for Dr. ( Iwings a restoration 
to health and usefulness in the community he has 
helped so many years. 



Dr. Thomas J. Murray has opened an office at 
104 East Main street. Meriden, Conn. 



The staff of nurses of the Annapolis Emer- 
gency Hospital resigned in a body July 31. Miss 
Rosamond Minnis, University Training School 
for Nurses, class of 1907, who led the retiring 
body, had been in charge of the hospital for some 
time. She will become superintendent of the 
Atlantic Coast Line Hospital at Rocky Mount. 
N. C. Miss Alice Frances Hell, University Hos- 
pital Training School for Nurses, class of 1907, 
will succeed Miss Minnis as superintendent of 
the Annapolis Emergency, entering upon her 
duties September 1. 



Dr. Ralph Steiner, class of 1883. 607 W. 7th 
street, Austin. Tex., is president of the State 
Board of Health of the State of Texas, with head- 
quarters in Austin. 



year. Dr. Stallworth has just passed with a more 
than creditable average the examination of the 
State Examining Board of Medical Licensure 
for Alabama. 



Dr. Claude Jackson Stallworth, class of 10 1-2. 
of Beatrice, Ala., has been elected resident phys- 
ician of the Presbyterian Eye. Ear and Throat 
Hospital of Baltimore, succeding Dr. William 
( iee. resigned. Dr. Stallworth was educated in 
the public schools of Alabama and the Daphne 
State Normal College, graduating there with 
honors in K)o8. He then studied three years in 
the Atlanta College of Physicians and Surgeons, 
entering the University of Maryland in his senior 



Dr. Charles Wesley Roberts, class of [906, of 
Douglas. Ga., sent us "case report for The Bul- 
letin', check for two years' subscription to The 
Bulletin and best wishes for all my teachers 
and friends connected with the University." A 
fat envelope like that gladdens the hearts of the 
recipients and all who know its contents. 



MARRIAGES 



Dr. Gains William Billups, class of 1906, of 
2224 W. North avenue, was married July 24. 
1912, to Mrs. Josephine Long, daughter of Capt. 
G. M. Mullin. The ceremony was performed 
at the Church of the Prince of Peace, Walbrook, 
the assistant rector, Rev. James Grattan Mythen, 
officiating. The bride wore a blue serge travel- 
ing dress, with hat to match, and was attended by 
her sister. Mrs. Nathaniel G. Sexton, as matron 
of honor. The best man was Dr. Edgar Shirley 
Perkins, class of 1907. A wedding-breakfast was 
served at the home of the bride's sister, Mrs. 
William J. Brown. The couple left for a wed- 
ding trip to Cape May, and will reside at 2224 
W. North avenue upon their return. 



Dr. Louis Harriman Douglass, class of 191 1. 
a resident physician of the University Hospital, 
and Miss Helen Rowles of Parksley, Accomac 
county, Virginia, were married at Towson on 
Tuesday, July 30, 1912. The ceremony was 
performed by Rev. W. H. H. Powers, rec- 
tor of Trinity Protestant Episcopal Church. 
Mr. and Mrs. J. S. Downing served as attend- 
ants. The bride was a guest of Dr. Douglass' 
parents, having come to Baltimore to attend the 
Democratic Convention. She and Mrs. Downing 
were students together in the Nurses' Training 
School of the Maryland Homeopathic Hospital. 
Dr. and Mrs. Douglass were the attendants at 
the wedding of the Downings last December. 



Dr. John Joseph Carroll, class of 1905, of 185 
Chestnut street, Holyoke. Mass. ( formerly of 
120 Chestnut street), was married June 15, [905, 
to Miss Joanne Marie Sullivan. There were no 
cards, the wedding being very quiet, owing to 
illness in the familv of the bride. 



120 



THE HOSPITAL BULLETIN 



Dr. James Edward Hubbard, class of 1912, 
and Miss Lillian E. Godwin, daughter of Mr. and 
Mrs. James C. Godwin of Easton, Md., were 
married on July 17, 1912, at 6 A. M., at the home 
of the bride's parents in Watson, the Rev. W. II . 
Litsinger of Calvary Methodist Church officiat- 
ing. The ceremony was witnessed by the imme- 
diate relatives only. A wedding breakfast was 
served at the house, and the couple left on the 
early morning train for the North. They will 
reside in Easton until October 1, when they will 
remove to Baltimore, and Dr. Hubbard will en- 
ter upon his duties as resident physician in the 
James Lawrence Kernan Hospital for Crippled 
Children. 



DEATHS 

Dr. John Addison Moorman, class of 1868, 
Bellevue Hospital Medical College, '7^, a member 
of the Medical Society of Virginia, formerly of 
Haleford, Ya., died at his home at Hendrick's 
Store, Ya., July 16, 1912, from nephritis, aged 
68 years. 



George R. Patrick, class of 1879, a member of 
the A. M. A. and a practitioner of high rank in 
Gaston county, X. C., died at his home in Lowell 
June 19 from cerebral hemorrhage, aged 57 years. 



We regret exceedingly to announce the death 
of Mrs. Nora Gorman Ballenger, wife of Dr. 
Edgar Garrison Ballenger, class of 1901, of At- 
lanta, Ga., July 18, 1912. Mrs. Ballenger was a 
daughter of Mr. William H. Gorman of Catons- 
ville, and a niece of the late Senator Arthur Gor- 
man of Maryland. She married Dr. Ballenger 
in April, 1904. Death was due to typhoid, from 
which Mrs. Ballenger had been ill for several 
weeks. Interment was in Loudon Park Ceme- 
tery. She is survived by her husband and a little 
son and daughter. 



Dr. John Barron, class of 1877, died at his 
home, 2236 Barclay street, August 3, 1912, of 
heart failure. Dr. Barron was born in Clonmell. 
Ireland, March 26, 1843. His parents emigrated 
to America in 1845. ^ e was educated at Loyola 
College and St. James' Institute, matriculating 
at the University in 1844. lie practiced for a 
time in Philadelphia, later locating in Govans- 
town, where he practiced for over 30 years, lie 
is survived by a widow and three daughters — 



Misses Katherine T.. Elizabeth D. and Marie M. 
Barron. 

Dr. Barron was buried on Tuesday, August 
6, requiem mass being celebrated at St, Ann's 
Catholic Church by Rev. Lucius Johnston. 
Burial was in St. Mary's Cemetery at Govans- 
town. 



William Porsons lvey, class of 1883. died at 
his home in Lenoir, N. C, June 28, 1912, from 
cerebral hemorrhage, aged 55 years. Dr. lvey 
was for many years assistant superintendent of 
the Morgantown State Hospital and a member 
of the State Board of Health. He was a member 
of the Medical Society of the State of North 
Carolina. 



Dr. Henry Rowland Walton, class of 1850, for 
60 years a practitioner of medicine in Annapolis, 
died shortly before midnight August 8, 1912, at 
his home on Francis street of general debility. 
Dr. Walton was born in St. Mary's county Feb- 
ruary 29, 1828, the son of the late Col. John Wal- 
ton and Mary Egerton Duke. On his mother's 
side he was a direct descendant of Leonard Cal- 
vert and of Duke, who came to Maryland with 
Leonard Calvert on the Ark and Dove in 1634. 
lie was 84 years old. He graduated from St. 
John's College in 1847 and from the medical 
school of the University of Maryland in 1850. 
Then he spent two years under Professor Charcot 
in I'aris. He returned to Annapolis and began 
active practice, which was uninterrupted until 
he became too feeble to attend to his patients. 
It is said that Dr. Walton was one of the first, if 
not the first, physician in Maryland to administer 
an anesthetic. He married Miss Julia Ballard 
Kent, daughter of Governor Kent of Maryland, 
She died some years ago. His surviving children 
are Misses Catharine and Agnes Walton and 
Messrs. J. Alphonsus and Lawrence Walton, all 
of Annapolis. He was buried from St. Mary's 
Catholic Church, Annapolis, Monday, August 10. 



John W. Field, M.D., class of i8fto, for many 
years postmaster of Chincoteague Island, Ya., 
a member of the Virginia Legislature from 1865 
to 1867 and at one time a member of the Mary- 
land and Yirginia Boundary Commission, died at 
his home on Chintoteague Island. May 4. 1912, 
aged 75 years. 



THE HOSPITAL BULLETIN 

Published Monthly in the Interest o£ the Medical Department of the University o£ Maryland 
PRICE $1.00 PER YEAR 



Contributions invited from the Alumni of the University, 
Business Address, 608 Professional Building, Baltimore, Md. 



Entered at the Baltimore Post-office 
as Second Class Matter 



Vol. VIII 



BALTIMORE, MD., SEPTEMBER 15, 1912. 



No. 7 



A SUMMER CRUISE ON THE SPANISH 
.MAIN. 



r>v Randolph Winslow, M.D. 



1. New York to Colon via Jamaica. 

Colonel Goethals, the chief engineer of the 
Panama Canal, several months ago gave notice, 
that those who wished to see the construction 
work of the canal before the water was turned 
in would have to be in a hurry to do so, as the 
actual work of excavation was practically fin- 
ished. This is therefore my excuse for making 
a trip to the tropics in midsummer. As a matter 
of fact, I found I had chosen the most favorable 
time for visiting' the Isthmus and the adjacent 
lands. There are four steamship lines plying 
between New York and Colon, but I have no re- 
gret in having chosen the Hamburg-American 
Line steamship, Prinz August Wilhelm for the 
voyage. The ship is staunch and comfortable, 
though not speedy. The officers are vigilant, 
capable and affable, and the cuisine is excellent 
and abundant. The staterooms are large, and are 
kept cool with electric fans, and every effort is 
made to keep the passengers contented and 
happy. Promptly at 2 P. M. on July 13, 1912, the 
hawsers were cast off, and we started on our 
25- day cruise. To my surprise, the passenger list 
was quite large, and consisted of a number of per- 
sons returning to their work in Cuba and the 
Canal Zone, as well as tourists, salesmen, natives 
of the Spanish-American countries and travelers 
of various races and tongues. Passing down 
the Jersey coast, the Barnegat light blinked us a 
cheerful bon voyage, and for the next four days 
we pursued an almost due southern course upon 
a smooth sea. passing San Salvador, or Watling's 
Island, which is supposed to have been the first 
land discovered by Columbus in 1492, early on 
the morning of July 17. Some hours later we 



came to a stop at Fortune Island, one of the Ba- 
hamas, where we took on 36 negro laborers, as 
well as fresh fish. This is a small island inhabited 
almost entirely by blacks, who eke out an exist- 
ence by fishing and serving as stevedores on the 
ships. These men are taken aboard when the 
ships go south, and are put off on the return trip, 
after having earned enough ready money to meet 
I heir needs for several weeks. The scene from 
the ship is very pretty ; the green foliage of the 
island in a setting of marine blue, the white 
houses embowered in palm groves, and the hurry- 
ing boats filled with dark-skinned natives, made a 
typical tropical picture. We did not go ashore, 
however, and soon the rythmical chug of our pro- 
peller indicated that we were again on the move. 
The short stop, however, was an agreeable break 
in the monotony of the voyage. After passing 
Castle Rock Lighthouse we were again in the 
open ocean, and the fresh southeast trade winds 
kicked up a rough sea. The Bahamas are a large 
group of small islands lying off the coast of Flor- 
ida and the eastern end of the Gulf of Mexico, 
belonging to Great Britain and inhabited mostly 
by negroes. They are said to be delightful places 
in which to spend a winter vacation, with an 
abundance of wild fowl for the hunter and waters 
teeming with splendid fish. We were now ap- 
proaching the coast of Cuba, and Cape Maysi, 
the extreme eastern end of the island, was passed 
in the night. Early on the morning of July 18 
we were running along the desolate-looking and 
rugged southern coast of the province of Oriente, 
made famous by the blockade of the American 
fleet in 1898. About 9 o'clock we passed through 
the narrow entrance to Santiago harbor, and 
shortly thereafter cast anchor. Owing to a quar- 
antine declared by Jamaica against Cuba on ac- 
count of a few cases of plague at Havana, we 
were not allowed to land, and we spent the day, 
like Moses, viewing the promised land from afar. 
This was much to be regretted, as Drs. Infante, 



122 



THE HOSPITAL BULLETIN 



Brooks and Sagebien came out in a motor-boat 
to meet us. and they could neither board the ship 
nor could we accept their highly appreciated cour- 
tesy. Passengers who did not expect to go far- 
ther on the ship were permitted to land. From 
y in the morning to 6 in the evening we lay in the 
harbor unloading freight into scows, and then 
made a bee-line for Kingston. Jamaica. 'When I 
reached the deck early the next morning the 
mountainous coast of Jamaica was in full sight, 
and not long thereafter Kingston harbor was ap- 
proached. The coast here is dangerous, and sev- 
eral wrecks were in sight. Kingston is situated 
on a bay which is separated from the sea by a 
long sickle-shaped spit of land forming almost a 
semi-circle several miles in length and only a few 



Steaming up the harbor we passed the United 
Fruit steamer Mandeville hard aground on a 
sand bar, and upon our return two weeks later 
we found her in the same unfortunate predica- 
ment. We landed at Kingston about 9.30 A. M., 
and were almost at once surrounded by a clamor- 
ing mob of dusky coachmen, who were most per- 
sistent in their solicitations, and would not take 
"no" for an answer. Their favorite expression 
was, "Doc. here is your carriage," or "Take you 
up. Doc. ?" I do not know why they suppose all 
the white male passengers from the ships to be 
doctors. The weather was hot, and as there had 
been no rain for nearly six months, the streets and 
foliage were white with dust. The city was 
almost entirely destroyed by earthquake and fire 




KING STREET, LOOKING NORTH. KINGSTON. JAMAICA. 



hundred feet in width. This acts as a break- 
water, and never mind how rough the water is on 
the outside, ships are safe when in the harbor. 
( In the end of this tongue of land is situated Port 
Royal, formerly a large town of ill-repute, but 
after various catastrophies by earthquakes and 
otherwise, it is now only a British military and 
naval establishment. About 200 years ago Port 
Royal was destroyed by an earthquake, and a 
large portion of its site was submerged in the sea. 
There is a tradition, probably apocryphal in char- 
acter, that for a long time the houses could be 
seen at the bottom of the sea as ships passed over 
them. We were subjected to a rigid quarantine 
examination, but were permitted to land, and in 
that respect were more fortunate than the pas- 
sengers of the Prinz Joachim, of the same line, 
who were held up several days two weeks later. 



two or three years ago, but the houses have been 
rebuilt with reinforced concrete, hence are sup- 
posed to be both fire and quake proof. The busi- 
ness houses and public buildings are quite fine 
structures, and the residences are pretty bunga- 
lows surrounded by beautiful flowers and vines. 
The Myrtle Bank Hotel is a large structure of 
the Spanish mission style of architecture, beauti- 
fully situated on the bay, where the fresh sea 
breeze blows constantly during the day and a land 
breeze at night. We had an opportunity to attend 
a dance at the hotel, and to see fashionable society 
in this colonial metropolis. The guests at this 
function were all white, the ladies were dressed in 
the height of style, and some of them were very 
handsome, and the gentlemen were fine-looking 
men, who looked very uncomfortable in full-dress 
suits. Dancing was evidently hot work, as there 



THE HOSPITAL BULLETIN 



123 



were long intermissions between the dances, dur- 
ing which the parties sat under the trees and 
cooled off. The population of Jamaica is 98 per 
cent, negro, varying from nearly white to jet 
black in color. Many of them are good-looking, 
well dressed and educated, the majority, however, 
are plain "niggers." Negro women, barefooted 
and scantily attired, come long distances, carry- 
ing large baskets filled with vegetables and fruits 
on their heads, or driving diminutive donkeys so 
heavily laden with produce as to almost hide the 
animals from sight. The stores are good, and 
merchandise is reasonable in price, owing to the 
absence of duty. The clerks, and often the pro- 
prietors, are mulattoes, but one receives polite at- 
tention and good service. 



I embarked in one of the latter craft and drove 
around the city. As has- been said, the long-con- 
tinued drought has parched the foliage and caused 
much dust and discomfort, but wherever there 
was water the flowers were abundant and the 
yards attractive. The Governor lives on the edge 
of the city at the King's House, which is a new 
concrete building erected since the earthquake. 
Here in a spacious home, with large, airy rooms 
tilled with solid mahogany furniture, a splendid 
swimming pool and ballroom, and beautiful lawns 
and grounds, His Excellency is able to pass away 
the time in a pretty comfortable manner. The 
policemen are all negroes, and not only do they 
perform their duties effectively, but they are very 
striking-looking in their uniforms of white coats 




HARBOUR STREET, KINGSTON, JAMAICA. 



One local custom is somewhat embarrassing 
and inconvenient to visitors, especially those 
whose stay is very limited, and that is the closing 
of stores at 4 P. M. Upon our return trip a num- 
ber of passengers wished to make purchases, but 
we arrived just as the stores were closing, and as 
the next day was a holiday, we were unable to 
spend some of Uncle Sam's good money and had 
to bring it back with us. I may say here that 
American money passes current everywhere in 
these parts, and when they give the price as so 
much "gold," it means our currency, whether coin 
or bank bills. There are several street-car lines, 
and one can get a good idea of the appearance of 
the city and of the people by investing a few pen- 
nies in car rides, or, better still, by taking one of 
the rattling vehicles drawn by rat-like ponies. 
Being enticed by the siren song of a dusky Jehu, 



and helmets and dark blue pantaloons, with broad 
red stripes down the legs. I saw two of them 
haling a young buck to the lock up; the police- 
man seemed to enjoy the occasion, but the culprit 
was wailing loudly. Tropical fruits in abundance 
are to be had at a small cost, cocoanuts just off the 
trees, pineapples just plucked and sweet as honey, 
mangoes, alligator pears and other fruits that are 
but seldom seen in our country. On the other 
hand, lemons are not to be had, and limes are 
used instead, and oranges are scarce. The great 
fruit product of Jamaica, however, is the banana, 
and an enormous traffic is carried on in this pala- 
table and valuable food fruit. The loading of a 
fruit ship with bananas at Kingston is a sight not 
Id be forgotten when once seen. We took on 
27,000 bunches of bananas at Kingston. They 
are harvested when still very unripe, green and 



124 



THE HOSPITAL BULLETIN 



hard, and are brought in trains to the dock ; here 
they are unloaded and carried by negro men and 
women on their heads to the ship, where they are 
piled up carefully in refrigerated holds. These 
banana loaders are mostly as black as coal, wear 
a minimum of ragged clothing, and sing and 
curse and babble in a jargon that is unintelligible 
to the visitor. They frequently stop to quarrel, 
and sometimes to fight, and during our visit a 
number of women got one of the foremen down 
and gave him a good beating. The foremen also 
are impartial, and club the women as freely as 
thev do the men. Several hundred of these peo- 
ple lying like animals on the wharf asleep, or later 
shouting, singing and cursing, as well as polluting 
the atmosphere with malodorous effluvia, made a 
Plutonic scene indeed. While standing on the 
deck waiting for the ship to leave I was addressed 
by a gentleman who recognized me, but whom I 
did not know. He was Dr. Mindis, a graduate 
of the Dental School, who is living and practicing 
his profession in Kingston. 

The trip from Kingston to Colon takes about 48 
hours, and is by no means a pleasant one, as the 
Caribbean Sea is always a rough stretch of water, 
and many people pay tribute to Xeptune. I did 
not miss any meals or pay the above-mentioned 
tribute, but I was glad to see the shores of the 
Isthmus on the morning of July 22, and to dis- 
embark at Colon a few hours later. 



THE TREATMENT OF ANEURISMS OF 
THE ARCH OF THE AORTA AND OF 
THE INNOMINATE ARTERY BY THE 
INTRODUCTION OF FOREIGN BOD- 
IES INTO TFIE SAC. 



Among the University alumni practicing in 
the District of Columbia are : 

Washington — Francis B. Bishop, class of 1883, 
1913 I street N. W. ; Edward M. Blackwell, class 
of 1890, Lieutenant-Commander, U. S. N., care 
Navy Department; Rupert Blue, class of 1892, 
Surgeon, U. S. P. H. and M. H. S. ; Wm. Sinclair 
Bowen, class of 1888, Stoneleigh Court, Connec- 
ticut avenue and L street. ; Albert Joseph Carrico, 
class of 1896, 2903 14th street N. W. ; Francis 
Miles Cbisholm, class of 1889, 1632 Rhode Island 
avenue N. W. ; Horace Benjamin Coblentz, class 
of 1896, 1432 U street N. W. ; George Robert Lee 
Cole, class of 1887, 418 7th street S. W. ; George 
Wythe Cook, class of 1869, 3 Thomas Circle 
N. W. : Louis W. Crampton, class of 1869, Col- 
onel M. C, U. S. A., care Adjutant-General's 
office ; Frederick L. Darrow, class of 1910, interne 
Providence Hospital: Henry D. Fry. class of 
1876. [929 [9th street N. W.; A. W. Valentine, 
class of 1904, 606 N. Carolina avenue S. E. 



By Reese A. Ai.lgood, '12, Senior Medical 
Student. 



We have had recently a very interesting case 
of aneurism of the transverse aorta in this hospi- 
tal, which was treated with good temporary re- 
sults by the Moore-Carradi method. This was a 
case of nine months' duration in a man 46 years 
of age. 

This case belongs to the class of aneurisms with 
physical signs, for the tumor is easily recognized 
by inspection, although there are a few pressure 
symptoms present. For example, for about three 
weeks before the appearance of the tumor he had 
a constant cough ; also he had some difficulty in 
breathing and swallowing. A few attempts have 
been made to induce coagulation of the blood in 
an aneurism by the permanent or temporary intro- 
duction of foreign bodies, such as wire, needles, 
horse hair, catgut, etc., into the sac. The method 
rests upon the well-known fact that if freshly 
drawn blood be whipped with a bundle of fine 
rods the fibrin collects upon them. The first case 
of permanent introduction of foreign bodies was 
that. of Moore (1864) ; this was a large aneurism 
of the arch of the aorta which had destroyed part 
of the bony wall of the thorax and threatened to 
rupture the skin. He introduced through a fine 
cannula twenty-six feet of fine iron wire, mov- 
ing the cannula about so as to coil the wire within 
the sac; coagulation promptly followed and pulsa- 
tion ceased for a time, but inflammation set in, 
pulsation returned and the patient died on the 
fifth clay. 

On March 2^, 1871, Dr. Dornville introduced 
14 inches of fine iron wire into an aneurism of 
the aorta that projected through the sternum. 
The tumor became firmer, but continued to in- 
crease in size, and on April 9 he introduced nine 
needles each two and one-half inches long. Fatal 
hemorrhage occurred on the 23d. The needles 
and the wire were found in a dark fibrinous 
coagulum. 

In April. 1872, Mr. Murray presented a patient 
to the Roval Medical and Chirurgical Societv and 



THE HOSPITAL BULLETIN 



125 



read an account of three other cases all treated by 
this method. 

In the first case an aneurism of the aorta and 
innominate, eighteen or twenty needles were in- 
troduced and left in for 24 hours. Then 24 feet 
of wire were inserted. The patient had no symp- 
toms, but died suddenly two weeks after the last 
attempt. 

Case II. Aneurism of aorta. Needles were in- 
serted at two different times, erysipelas began at 
the puncture and caused death. 

Case III. Aneurism of aorta and innominate. 
Twenty feet of catgut were inserted, and at 
autopsy it was found softened with no coagula 
upon it. 

Case IV. The one shown to the society was a 
sacular aneurism of the subclavian. Five or six 
trials of complete transfixion with 20 or 30 long 
needles for several hours were followed each time 
by consolidation, lessening of size and relief of 
pain. 

Dr. Lewis introduced 24 feet of horse hair into 
an aneurism of the right subclavian afterwards 
without any beneficial result. 

In January, 1879, Mr. Christopher Heath in- 
troduced three pairs of fine sewing needles, mak- 
ing each pair cross in an aneurism of the left sub- 
clavian artery. The needles were withdrawn on 
the fifth day and the tumor became solid. The 
patient died a few days later of bronchitis and the 
aneurism was found full of dense fibrins. 

In 1890 McEwen's practice for inoperable 
aneurism consisted in the introduction of a long 
needle into the aneurism tumor, where it re- 
mained 24 hours, during which the needle was 
moved sufficient to scratch the intima and pro- 
duce sufficient irritation to induce the formation 
of a white fibrin thrombus. This method is very 
uncertain. 

In 1870 Carradi, like Moore, introduced into 
an aneurism 40 c. m. of wire, and then con- 
nected the extremity of the wire with the positive 
pole of a battery, the negative being applied to 
the neighborhood of the aneurism ; he failed, and 
so did his immediate followers. 

I limner of this city, in a careful study and 
compilation of the reported cases treated by this 
method up to 1900, combining the statistics of 
the thoracic and abdominal cases, collected 14 
cases in which Moore's method of wiring alone 
had been adopted. Of these 14 cases. 8 were 
thoracic and 6 were abdominal. Two of the ab- 



dominal cases were apparently cured (14 per 
cent, recoveries.) 

With the combined method (Moore-Carradi ) 
there are 23 cases — 17 thoracic and 6 abdominal. 
Four of these, or 17 per cent., recovered, includ- 
ing three thoracic and one abdominal. 

Since Carradi introduced the combined method 
in 1879 great improvements in the technic have 
been made, especially by American and British 
surgeons, who have applied this treatment more 
often than those of other countries. The chief 
improvement lies in the better wire; the silver 
wire best not to exceed No. 28 gauge (0.0085 
mil.) in diameter. Gold wire is preferred by 
Stewart of Philadelphia ; silver blended with cop- 
per alloy is preferred by Finney and Hunner. 
Some use only 10 feet of wire, while others use 
30 to 50 feet. Also the number of milliampheres 
varies, as Finney says he never uses more than 
70, while Keen says he has used as much as 200 
without appreciable bad affects. 

D'Arcy Powers, 1903, improved the technic by 
utilizing an apparatus devised by G. H. Catt. 
This consists in a closely packed wire which is 
twisted through a fine canula previously intro- 
duced into the sac, where it expands, thereby in- 
suring a better distribution of the wire network 
and reducing very greatly the time required to 
insert many inches of wire. 

Case I. Name, T. P. ; age, 46 ; occupation, 
laborer ; married ; complaint, a tumor in the neck. 

Family history negative. Past history negative 
as to diseases having a bearing on his condition, 
with the exception of syphilis, although he posi- 
tively denies having had syphilis. On March 3 
a positive Wasserman was made, which probably 
is the etiological factor of the disease. The patient 
entered this hospital with a large pulsating, ex- 
pansive tumor in and above the episternal notch. 

The treatment was about as follows: He was 
at once put to bed and kept quiet for a few days ; 
then an operation was performed by Professor 
Winslow. He was brought into the operating- 
room, the field of operation having been pre- 
pared for an aseptic operation while in the ward 
by painting the skin with equal parts of alcohol 
and tincture iodine. No anesthetic was used. A 
fine trocar was introduced into the sac and a 
silver wire was passed through this trocar into 
the cavity. Owing to the difficulty of passing the 
wire, only six feet were introduced, and with the 
needle still in the sac the galvanic current was 



126 



THE HOSPITAL BULLETIN 



connected with the wire for ten minutes with a 
current of twenty milliampheres. The greater 
part of the wire curled up on the right side, and 
soon it was noticed that this side was firmer to 
touch than the left. Six days later another opera- 
tion was performed similar to the first, with the 
exception that two pieces were used, the former 
sixteen feet long, the latter only four feet, and a 
current of 40 milliampheres was passed for 20 
minutes through both separate pieces. Subse- 
quently about 15 feet of wire was introduced, 
making about 40 feet altogether. 




i'n:. 1. case 1. 
Aneurism of arch of aorta.— Dr. R. Winslow. 

This operation gave the patient very little pain 
and was a great success, for instead of the pul- 
sating expansive tumor we now had a tumor with 
very slight pulsations ; and it is firm to touch, 
whereas before the operation it was very thin 
and soft and threatened to rupture. This treat- 
ment undoubtedly prolonged this patient's life, 
but he died in about three months of hemorrhage. 

Case II. On January 2, 1912, Lillian Halla- 
way, age 38, entered the University Hospital, 
complaining of a swelling in median line of the 
chest. She first noticed this swelling about two 
years previous to entrance, but had pains in the 




FIG. II. CASE I. 
Skiagram of aneurism of arch of the aorta, showing about 
40 feet of silver wire.— Dr. H. Winslow. 

chest six months before she first noticed the 
swelling. Physical examination shows a tre- 
mendous pulsating tumor of upper thorax, ex- 
tending into neck. The pulsations are in all di- 
rections and (synchronously) with the heart beat. 
The manubrium and the five upper ribs near their 
costo-sternal margin are entirely eroded. The 
tumor extends up into the neck and has two 
marked projections, ear-like at the apex, marked 
pulsations over entire mass. Expansile walls are 
very thin. 

Patient emaciated and unable to speak above 
a whisper, breathing labored. 

Family History: Mother and father living and 
well ; two sisters and five brothers all living and 
well. No history of rheumatism, tuberculosis, 
malignancy ; no history of nervous trouble. Had 
two children born dead. No live children. No 
other history of lues. 

Past History: Had whooping-cough when 
quite young. Negative to measles, mumps, diph- 
theria, scarlet fever and all -other diseases of 
childhood. Negative to typhoid fever and pneu- 
monia ; had an attack of malaria several years 
ago, from which she fully recovered. Venereal 
history negative as regards gonorrhea. No sore 
throat, eruptions over body or hair falling out. 
No history of lues at all. 



THE HOSPITAL BULLETIN 



127 




FIG. III. CASE II. 

Aneurism of arch of aorta protruding through chest wall.— 

Dr. R. Winslow. 

Habits: Has not slept well for past several 
years. Drank beer moderately until about a year 
ago. Drinks one or two cups of coffee once a 
day ; uses a great deal of snuff. Drinks five or 
six cups of tea a day. 

Menstrual History: Her menses appeared at 
the age of 13; occur irregularly and last from 
four to ten days, with great pain. She saw her 
last period last September. The flow has always 
been very profuse at time of menstruation. She 
savs that just before the period began there was 
a small "pimple" or "pustule" on lahia, which 
suppurated and disappeared with period. These 
were noticed only during the last four or five 
years of her menstrual life, but did not appear 
every month. No abortions or miscarriages. 

Present Illness: Last April she noticed a slight 
bulging in chest at about the middle of sternum, 
which gradually grew larger, extending upward. 

There has been constant pain since about four 
months before she noticed the swelling. This 
pain is of a dull, stinging character over entire 
front and upper part of chest. She says that at 
every throb of her heart the pain is more intense. 

There is considerable difficulty in speaking, 
and great pain when she speaks. There is also 
pain on swallowing; sometimes causes violent 
coughing spells. 



Alimentary Tract: She has suffered for several 
years with vomiting spells. Says she doesn't re- 
member the time, if before or after meals. The 
vomitus was of a greenish color and bitter taste. 
Says there was occasionally a trace of blood in 
the vomitus. Appetite has always been good. 
She says she often has indigestion. The pains are 
in the epigastric region. No great loss of weight. 
Says she would lose a few pounds, but would 
soon gain them back. Very often suffers from 
diarrheal attack in summer; has noticed some 
blood in stools. 

Pulmonary Tract: No history of cough before 
the present illness. No bronchitis. Some hoarse- 
ness at present. No spitting of blood. 

Cardie Vascular System: Some swelling of 
ankles before the present illness, which was 
transient. Negative to dyspnea, palpitation and 
all other symptoms connected with this tract, ex- 
cept the severe pains over the heart during the 
present illness. 

Nervous System: When patient was 16 years 
of age she began suffering with epileptic fits, 
which occurred about two or three times a month 
until eight years ago, at which time she came 
here for treatment and was apparently cured. At 
the time of these "spells" she would become un- 
conscious and fall immediately where she was at 
that time. The unconsciousness usually lasted 
about one hour. She says that two or three days 
before the attack she could tell they were com- 
ing on. 

Notwithstanding the fact that she has a nega- 
tive history to lues, she gave a positive Wasser- 
man reaction. The X-Ray shows a large tumor 
mass filling upper chest, extending from heart 
into the neck. Erosion of the sternum and ribs 
and spinal vertebrae posteriorly to the tumor. 

January 15, 1912, patient brought to the oper- 
ating-room and the field of operation prepared 
for an aseptic operation by painting the surface 
with dilute tincture iodine; then a needle was 
introduced into the pulsating tumor and 36 feet 
of fine silver wire was introduced through the 
needle. The needle was then withdrawn and the 
wound closed with a collodion dressing. The 
patient was then removed to her bed in the ward, 
no worse off as a result of the operation. 

Patient's breathing gradually got more labored, 
and on January 18 she died without any rupture 
of the aneurism having- occurred. 



128 



THE HOSPITAL BULLETIN 



GASTRIC ULCER. 



By Nathan Win.--i.oWj M.D 



During the past decade indurated ulcer of the 
stomach has passed from the domain of medicine 
into that of surgery. This has been brought about 
chiefly by the accidents secondary to ulcer ; com- 
plications which are in themselves necessarily sur- 
gical. The investigations of the Mayos have 
definitely proven at least 60 per cent, of gastric 
cancer engrafted on an old ulcer base. As the 
large majority of ulcers of the stomach involve 
the lesser curvature immediately above the 
pylorus, the thickening resulting from the chronic 
inflammatory process may cause obstruction to 
the free passage of food into the intestines. The 
ulcerative area may extend through the entire 
thickness of stomach wall and set up either an 
acute localized or generalized peritonitis. Follow- 
ing the erosion of a vessel serious hemorrhage un- 
controllable by medical means may endanger life. 
The last, but not the least important factor in 
compelling the shifting from the internist to the 
surgeon, was the realization that medicines do not 
give permanent relief. Therefore gastric ulcer 
as soon as recognized, and when the patient is in 
prime physical shape, should in every instance be 
referred bv the doctor to the surgeon, else sooner 
or later some one of the above mishaps may 
ensue. To assure the patient the best prospects 
of cure and the return of health as in other 
surgical affections, the malady should be recog- 
nized earlier. 

Heretofore, the lack of prompt recognition has 
accounted for the poor operative results, but to- 
day with a definite clinical picture there is no 
reason why these sufferers should not be brought 
to operation before the last stages of starvation, 
and thus be saved not only years of suffering, but, 
also, the possibility of death from cancer. The 
only case upon which I have been privileged to 
operate occurred in the service of Dr. Randolph 
Winslow at the University Hospital. The patient, 
a woman, with perforating ulcer of the stomach 
and peritonitis, died. 

With this object-lesson before me; I desire to 
impress upon my readers the urgency of thor- 
oughlv acquainting themselves with the mani- 
festations of ulcer of the stomach. 

Ulcer of the stomach may be classified as in- 
durated and non-indurated or mucous, or surgical 



and non-surgical. The non-surgical ulcer gives 
rise to no definite symptomatology. It occurs as 
an erosion of the mucous membrane, from which 
blood seeps, and is practically impossible of de- 
tection, even after the stomach is opened. It is 
the indurated ulcer with which surgery is con- 
cerned, and as to all intents and purposes the por- 
tion of the duodenum, which is above the bile 
duct opening, is physiologically a portion of the 
stomach ; what is said concerning ulcer of the 
stomach applies equally as well to duodenal ulcer. 
The first portion of the duodenum, at least that 
part above the common bile duct is developed 
from the foregut, and like the stomach is con- 
cerned with the preparation of food for digestion 
and takes no part in absorption. Indurated ulcer 
is essentially chronic, and involves not only the 
mucous membrane, but also some or all of the un- 
derlying tissues. In the stomach proper it occurs 
with about equal frequency in man and woman, 
but in the duodenum in the ratio of three in man 
to one in woman. It is generally solitary, but 
may be multiple. By far the majority are situated 
in or near the pylorus. Heretofore hyperchlor- 
hydria has been insisted upon as a necessarv ac- 
companiment of ulcer. Later investigators, how- 
ever, have determined that too much dependance 
cannot be placed upon the outcome of stomach 
analysis, as an ulcer is frequently present when 
there is an hypochlorhydria. Thus as in many 
other maladies experience teaches us to place 
more weight upon the existing clinical signs, 
rather than upon the results of the laboratory ; 
not that the laboratory findings are not of value, 
which would be a mistake, but more as a con- 
firmatory than as a negative aid. The svmpto- 
matology of ulcer of the stomach is characteris- 
tic. The patients complain of gastric disturbances 
which have extended over a period of many vears. 
The periodicity of attacks of pain, coming on 
some three or four hours after meals, sour eructa- 
tions, belching of gas, vomiting and hematemesis 
are typical. The pain is at its worst during the 
height of digestion, in order to alleviate which 
the patient soon learns to take more food, a glass 
of milk, or resorts to bicarbonate of soda or other 
mild alkalies, or induces vomiting'. The pain, 
however, may occur on an emptv stomach, and 
especially at night, as a consequence of which the 
patient places food near the bed to use as needed. 
In the beginning the patient eats large quantities 
of food, but as the disease progresses he obtains 






THE HOSPITAL BULLETIN 



129 



more relief by munching more frequently smaller 
quantities. During the later stages there may be 
almost complete loss of appetite. Although pain 
is one of the most prominent symptoms, it must 
be distinctly borne in mind that it is not always 
present. Much emphasis was formerly placed 
upon the reference of pain to the left subscapular 
region, but this is not a reliable symptom. When 
present it is usually seated in the epigastrium, for 
ulcer of the stomach to the left, and of the duode- 
num to the right of the mid line. Vomiting may 
not exist until stenosis of the pylorus occurs, but 
there is always some gastric distress and eructa- 
tion of sour, bitter, acrid, fluid or belching of 
sour gas. Great stress was formerly laid upon 
hematemesis, but this symptom may never occur, 
as the ulcer base is not covered with a granulation 
tissue, but is smooth and of a grayish color. Ero- 
sion of the teeth as a result of the action of the 
acid vomitus is not uncommon. Initially the nu- 
trition is good, but as the disease progresses ow- 
ing to the ingestion of insufficient quantities of 
food or retention in the stomach due to thicken- 
ing of the pylorus, emaciation and even cachexia 
ensue. Constipation is a constant concomitant. 
In a few instances a tumor may be felt. If the 
ulcer be seated in the pyloric region, obstructive 
symptoms, through the deposit of inflammatory 
products, will arise, as a result of which there will 
be dilatation of the stomach and retention of food. 
The index of retention is the recovery of food 
eaten six or seven hours previously. Such an 
attack may last for days or weeks, to be followed 
by a period of relief, and sooner or later a re- 
mission. In the beginning the intermission be- 
tween the attacks may be of some duration, but 
as the disease progresses the interval between is 
shorter, and the attack itself more prolonged. 

A history of prolonged gastric disturbances and 
discomfort, pain arising four or five hours after 
meals, and relieved by the ingestion of food, 
bicarbonate of soda, milk, etc., periodicity of at- 
tacks after apparent cure, eructation of sour, 
acrid, bitter liquids, munching of food after re- 
tiring at night, recovery of blood from stomach 
contents with a high hydrochloric index is 
pathogmonic of ulcer of the stomach. 

The question of treatment in gastric ulcer is 
intimately tied up with its complications. In per- 
forating ulcer the opening may be closed by 
suture and drainage instituted. This is the sim- 
plest line of action and is especially applicable to 



patients in bad condition. I followed this method 
in the above mentioned case. 

If the patient's condition warrants the ulcer 
bearing area may be excised, or either of the 
above operations may be combined with gastro- 
enterostomy by the no-loop method. Gastro- 
enterostomy by itself ofttimes fails, and will in- 
evitably do so unless there is pyloric obstruction. 
It has been proven when the pylorus is patent 
food instead of passing through the stomach- 
bowel opening will preferably follow the natural 
course. If the ulcer be situated in or near the 
pylorus and obstructs the passage of food gastro- 
enterostomy, when performed by the posterior 
no-loop method, gives excellent results. This is 
done preferably by suture. Owing, however, to 
the possibility of the development of cancer on 
the ulcer base some operators, and especially Rod- 
man, practice and advise pylorectomy with gastro- 
enterostomy at place other than resection. Ulcers 
of the body and the lesser curvature should, if 
practical, be excised. Ulcer of the duodenum has 
not the same tendency to undergo malignant de- 
generation as ulcer of the stomach ; therefore, 
there is not the urgent necessity of excision as in 
gastric ulcer. Here gastroenterostomy is the 
usual line of procedure, but if the indications war- 
rant the ulcer may be excised. 

Mayo, in a series of 18 acute perforations oper- 
ated by suture alone, and states that only one re- 
quired a secondary gastrojejunostomy, the per- 
foration having seemingly put an end to the 
disease. Acting upon the observation he has 
twice, in chronic gastric ulcers where the condi- 
tions were such that he could not excise and 
where gastroenterostomy was not indicated, ex- 
posed the crater of the ulcer, thus producing the 
picture of an acute perforation, then closed the 
defect with a favorable outcome. In the early 
days of ulcer surgery pyloroplasty was a favorite 
method of overcoming the obstruction, but was 
followed by so many relapses requiring secondary 
operations that it has been to a large extent aban- 
doned. The operative technic of gastric and 
duodenal ulcer has reached such a point that the 
mortality is neglible and may be summed up as 
follows: Ulcers to theileft of the pylorus are 
excised ; in the pylorus either a pylorectomy or 
no-loop gastroenterostomy is chosen ; in case of 
perforation the opening may be sutured or better 
the involved area excised — abdominal drainage 
being instituted, no matter which is employed ; 



130 



THE HOSPITAL BULLETIN 



gastro-jejnnostomy answers well for duodenal 
ulceration. 

In conclusion, I desire to emphasize the im- 
portance of early exploratory operation in stom- 
ach affections, producing invalidism. There 
should be no conflict between medicine and sur- 
gery in this field. If after a reasonable length of 
medical treatment the symptoms remain unabated, 
surgery should be called in as a diagnostic and 
possibly therapeutic measure. 



DROP FINGER, WITH REPORT OF CASE. 



By Nathan Winslow, M.D., Baltimore, Md. 



The finger is heir to many injuries, some of 
which are common, others less frequently seen. 
Amongst the rarer injuries is the condition known 
as drop or mallet finger. Not having seen such a 
condition until recently, the writer believed it of 
sufficient interest to bring to the attention of the 
readers of The Bulletin, so that when dealing 
with finger injuries they may bear in mind its pos- 
sibility. As the name implies, there is a dropping 
of the terminal phalanx of the finger, as a result 
of either complete or partial rupture of the ex- 
tensor tendon near its insertion, following a blow 
to the tip of the extended finger causing forcible 
flexion. The deformity may be merely a slight 
dropping or the bending may be as much as a 
right angle. 

In recent cases the finger should be extended 
and a splint applied after thoroughly padding the 
parts. The splint should include not only the 
finger, but also the wrist of the affected hand, so 
as to thoroughly relax the tendon and thus favor 
union. If this procedure proves ineffectual, the 
tendon should be exposed by an incision, and the 
torn end sutured into the periosteum of the base 
of the terminal phalanx ; and the finger and wrist 
immobilized as recommended above. 

CASE. 

Mrs. M. consulted me during the early part of 
November (iqii) about an injury she had sus- 
tained to the middle finger of her right hand 
which she had incurred by striking the tip against 
a board a few weeks previously. The blow was 
so severe that the finger felt numb, and on ex- 
amination she noticed the end phalanx flexed and 



voluntary extension impossible. She was able, 
however, to straighten the finger with the aid of 
her other hand, but the deformity recurred as 
soon as the support was released. When I saw 
the patient the deformity was typical of the con- 
dition, and the diagnosis readily made upon the 
receipt of the history of the accident. Splintage 
in extension was ordered, and immobilization was 
maintained for six weeks. Though the finger is 
still somewhat swollen and at times painful, it is 
functionally perfect, voluntary extension and 
flexion being' almost normal. 



The following have received appointments as 
clinical assistants at the LJniversity Hospital for 
1912-1913: 

S. A. Alexander, North Carolina. 
John T. Beavers, North Carolina. 
B. Karl Blalock, North Carolina. 
Earle G. Breeding, Maryland. 
J. M. Buch, Cuba. 
Humphrey Butler, Maryland. 
Leo M. Cavanaugh, Maryland. 
Vernon H. Condon, Maryland. 
Frederick L. Detrick, Virginia. 
Idalberto Fajardo, Cuba. 
Leonard Hays, Maryland. 
Ploward E. Lecates, Maryland. 
Elmer Newcomer, Maryland. 
Norbert C. Nitsche, Maryland. 
Walter A. Ostendorf, Mar viand. 
Harry C. Raysor, South Carolina. 
William Henry Scruggs, Jr., Georgia. 
Hamilton J. Slusher, Virginia. 
W. Houston Toulson, Maryland. 
Moody R. Troxler, North Carolina. 
Grady 1!. Wells, South Carolina. 
Cleveland D. Whelchel, Georgia. 
Thomson B. Woods, South Carolina. 



Among the University alumni practicing in 
Maine are: 

Hebron — Ralph Norvel Knowles, class of 1909. 

Lewiston — Jos. Wm. Scannell, class of 1906, 
471 Main street. 

Machias — Harry Otis Johnson, class of 1903. 

Rumford — Louis M. Pastor, class of 1906. 

Washburn — Fay Frederick Larrabee, class of 
1906. 

Winterport — Wm. A. Ellingwood, class of 
1908. 



THE HOSPITAL BULLETIN 



131 



THE HOSPITAL BULLETIN 

A Monthly Journal of Meficine and Surgery 

PUBLISHED BY 

THE HOSPITAL BULLETIN COMPANY 

608 Professional Building 

Baltimore, Mu. 



Subscription price, . . . $1.00 per annum in advance 

Reprints furnished at cost. Advertising rates 
submitted upon request 



Nathan Winslow, M.D., Editor 



Baltimore, September 15, 1912. 



PROF. JULIAN J. CHISOLM AND MISS 
HELEN KELLER. 



It will be a source of gratification, as well per- 
haps as a great surprise, to learn that Professor 
Chisolm was connected in any way with the won- 
derful case of Helen Keller, or to put it more 
correctly, the case of the wonderful Helen Keller. 
Blind, deaf and dumb, without the light of the 
dav and almost without that of the mind, she has 
become one of the most highly educated woman 
in the world. She can speak not only English 
fluently, but French and German also; she can 
read Latin and Greek and is conversant with 
many other branches of learning. In an address 
before the Congress of Otiologists, held in Bos- 
ton recently, she gives Dr. Chisolm the credit for 
advice that led to her restoration to society as a 
useful and highly intelligent integer. It gives us 
pleasure to reproduce the following extract from 
the Baltimore Sun: 

Chisolm and Helen Keller 



Baltimore Specialist Suggested Her Education. 

[From the speech by 1 ielen Keller to the 1 Hiolo- 
gists' Congress in Boston.] 

"I was about six years old before any of the 
specialists whom my parents consulted was brave 
enough to tell them that I should never see or 
hear. It was Dr. Chisolm of Baltimore who told 
them my true condition. 'But,' said he. She can 
be educated,' and he advised my father to take 



me to Washington and consult Dr. Alexander 
( Iraham Bell as to the best method of having me 
taught. 

"Dr. Chisolm did exactly the right thing. My 
father followed his advice at once, and within a 
month I had a teacher, and my education was 
begun. From that intelligent doctor's office I 
passed from darkness to light, from isolation to 
friendship, companionship, knowledge. The par- 
ent wdio brings his child to your office, to your 
hospitals, should find in you, not a teacher, per- 
haps, but one who understands how far it is pos- 
sible to right the disaster of deafness." 

Dr. Chisolm was not only a great ornament to 
the University of Maryland, and a teacher of 
great force and erudition, but he was also a very 
prominent citizen. He retired from teaching in 
1894 and died in 1903. 



O >MBINING THE MEDICAL SCFIOOLS 
I IF BALTIMORE. 



Medical education in this country is in a state 
of rapid evolution, and is at this time in a transi- 
tional condition. On the one hand we have some 
of the State universities and the highly endowed 
private schools, demanding qualifications that are 
almost impossible of attainment. On the other 
hand there are many schools of very low grade 
that bring disrepute on the medical profession. 
There are also other institutions that do not main- 
tain the most advanced standards, that are never- 
theless doing as useful work as the first men- • 
tioned class, but of a somewhat different charac- 
ter. If an institution is so well endowed that it 
can demand that all candidates for admission 
shall have academic degrees, it is its right to do 
so, and it ensures a highly desirable class of stu- 
dents. It does not seem proper, however, that the 
profession of medicine shall be an aristocracy 
rather than a democracy, and there must be 
schools where those whose circumstances of one 
kind or another have prevented their obtaining a 
college education, may nevertheless secure a medi- 
cal training. 

It is a question as to the desirability and pro- 
priety of exacting such high standards, and cer- 
tainly at this time but few colleges can do so. 
The Baltimore medical schools belong to this 
middle class, that give excellent training in medi- 
cine, but only require a completed four years 
high school course for admission. There are 



132 



THE HOSPITAL BULLETIN 



too many medical colleges in this country, and an 
effort is being made to reduce the number and to 
improve those that remain. The suggestion has 
come from many sources, to merge the three 
larger schools here, and to form one school, bet- 
ter equipped and better financed than the three 
separate schools. 

It is with pleasure that we notice an interest in 
this matter aroused in this city, as the following 
editorial from the Baltimore Sun of August 28, 
1912, indicates: 

COMBINING THE MEDICAL SCHOOLS. 

"If the University of Maryland, the College of 
Physicians and Surgeons and the Baltimore 
Medical College can be consolidated, and the com- 
bined endowment funds used to create a medical 
school of the very highest rank, it would be a de- 
sirable thing. 

"Doubtless there would be many incidental diffi- 
culties in the way, but the men capable of guid- 
ing a great medical school ought to be capable of 
surmounting these difficulties. 

"Of course, any consolidation of the kind must 
retain the historic and honored name of the Uni- 
versity of Maryland, an institution which has 
done so well with the comparatively meager funds 
it has had at its disposal as to give assurance of 
yet better service if it should ever become pos- 
sessed of an ample purse." 

This desirable result can be easily accomplished 
if the citizens of this city will come to the aid of 
the medical schools. The citizens of Baltimore 
have been very liberal to another university, and 
we now appeal to them to help us to form and 
maintain another high-grade medical school here. 



KEEP A-PULLIX'. 



When you've got a thing to say. say it. Some 
people have something to say, others make a lot 
of noise, but say nothing. The Universitv of 
Maryland is passing through a transition. The 
opportunity for broader efforts is within her 
grasp. At no time in her history has she been in 
such a maelstrom of unrest. Nobody km >ws 
what tomorrow will bring forth. Surprises are 
the order of the day. Progress is the rally call. 
The daily papers are giving us kindly notices and 
arc bringing our needs to the attention of the 
public. We need it all: but. alumni, we need 
above all your kindly advice and sympathy. As- 



sist us by your counsel, and exert whatever influ- 
ence you may possess with the several faculties 
for the appointment of a paid head of the institu- 
tion. The Bulletin desires to sound your senti- 
ment in this matter. Its pages are at your dis- 
posal. But come what may — always keep a-pull- 
in' for a better day. 



THE PATHOLOGICAL ENDOWMENT 
FUND. 



The chairman of the endowment committee 
has been away on a vacation, and everybody else 
has been away. The heat and humidity have been 
equal to that of the Canal Zone, and the dog days 
have been unusually oppressive. No efforts have 
been put forth to add materially to the pathological 
fund, and nobody has surprised us by insisting on 
giving a large donation to the fund. We cannot 
report, therefore, any great increase, but are 
thankful for the little that has occurred. 

CONTRIBUTION BY CLASSES. 

1S4S $50 00 

1864 20 OO 

1868 10 00 

1871 35 0CI 

1872 70 00 

1873 430 00 

1874 5 00 

1875 5 00 

1876 115 00 

1877 10 00 

1880 5 00 

1881 250 00 

1882 310 00 

1 883 40 00 

18S4 40 00 

1885 235 03 

1886 IOO OO 

1888 50 OO 

1889 100 00 

1890 175 00 

1892 150 00 

1893 40 00 

1894 135 00 

1895 155 00 

1896 52 00 

1897 80 00 

1898 105 00 

[899 50 00 

1900 215 00 



THE HOSPITAL BULLETIN 



133 



1901 240 00 

1 902 305 00 

1903 315 °o 

1904 145 °° 

1905 210 00 

1 ( of 1 1 65 00 

1907 1 10 00 

1908 20 00 

i9°9 5 00 

1910 50 00 

I'M 1 Terra Mariae 3 5° 

hm 2 Club Latino Americano 25 00 

Total subscriptions to Sept. 1, 1912. £10,181 50 

NEW SUBSCRIPTIONS IN AUGUST. 

Dr. L. W. Talbott, 1883 $5 00 

Dr. B. F. Bussey, 1884 40 od 

Total $45 00 



ITEMS 



Dr. Charles Wesley Gardiner, class of 1901, is 
located at 449 State street, Bridgeport, Conn. 



We are in receipt of the following letter from 
Dr. Love, and are glad to "pass it on" to our 
alumni : 

September 10, 1912. 
Nathan Winslow, M.D.: 

My Dear Doctor — In reply to your request for 
the treatment of tetanus as used in the Frank- 
lin Square Hospital, will state that for the past 
five or six years we have been using the Bacilli 
method, which is the administrating hypoder- 
mically of carbolic acid. I generally order a 2 
per cent, solution of carbolic acid : 

R Acid carbolici 5 
Aq. distillat 245 

Of this I give hvpodermically 30 m. (1.84 c.c. ) 
containing acid, carbolic, gr. 3/5 (.0387 gm.) 
every three hours, and gradually increase the 
dosage or shorten the interval until patient gets 
from grs. viii to xv (0.5 to 1. gm.) daily. 

There is no selective point for the injection. 

With this as curative treatment we try to con- 
trol convulsions with chloral, chloretone, bro- 
mides or morphia in suitable doses. During the 
administration of carbolic acid the urine is ex- 
amined daily. 

Enemas of normal salt solution given daily. 



There have been nine cases of tetanus treated 
at the Franklin Square Hospital during the past 
seven years, with one death, and this case re- 
ceived serum treatment, but no carbolic acid. 
Three cases received each one injection of serum 
and the Bacilli treatment. Five cases received 
the carbolic acid treatment only. 

I believe Dr. P. Kintzing treated the larger 
number of these cases besides several other cases 
in his private practice. Naturally we first disin- 
fect the wound. Very truly yours, 

William S. Love, 

Class of 1890. 



Dr. Benjamin Newhouse, class of 1912, who 
was for a time resident pathologist at the lie- 
brew Hospital, is now resident surgeon in the 
Emergency Hospital. Washington, D. C. In his 
examinations before the State Board in Maryland 
Dr. Newhouse received 100 in surgery and 97 in 
obstetrics. 



Dr. Nathan Winslow, class of 1901, left on the 
nth for a trip to St. Augustine and Jackson- 
ville, Fla. 



Dr. John C. Hemmeter, in the Baltimore Even- 
ing Sun of July 18, has the following to say con- 
cerning the report on the medical schools made by 
Abraham Flexner to the Carnegie Foundation : 

"To do justice to the past and present state of 
the systems of medical education in this country, 
we must take into consideration the political en- 
vironment under which they were created. At a 
period in the history of our people when the State 
was incapable or unwilling to provide for financial 
support of secondary schools and universities, 
there was no other way of securing the institu- 
tions and teachers except by private undertakings. 
Naturally, this method of organizing medical 
schools was abused, and in many cities these so- 
called colleges were started for egotistical pur- 
poses, exclusively, not really to advance either 
medical discipline or science, and Dr. Prichett is 
right in condemning such schools. He and Flex- 
ner may be pardoned for being too sweeping in 
their otherwise laudable and correct generaliza- 
tions. 

"To understand the European professional edu- 
cation one must appreciate what Dr. Pritchett 
and Mr. Flexner admit, namely, that it is based 
on an exceptionally high level of secondary school 



134 



THE HOSPITAL BULLETIN 



discipline in Germany. A standard of this kind 
has not yet been attained in America. 

"Dr. Pritchett states that a system of education 
is to be judged not by its occasional brilliant suc- 
cesses, but by the general level of performances 
of those whom it undertakes to train. Exactly 
so, and judged by that method the University of 
Maryland is an institution of learning that need 
not be ashamed of its record, for among its alumni 
today are professors in our largest and most 
richly endowed American universities. It has 
produced such men as William T. Councilman, 
professor of pathology at Harvard University : 
Homer Wright, professor of pathology, Harvard 
Medical School; Alexander C. Abbott, professor 
of bacteriology, University of Pennsylvania ; Wil- 
liam T. Howard, professor of pathology, West- 
ern Reserve University; Major James Carroll, 
discoverer of the transmission of yellow fever 
by the bite of a specific mosquito. 

"In addition to these men, I might mention Gen. 
Rupert Lee Blue, the present Supervising Sur- 
geon-General of the United States Marine Hospi- 
tal Service, and also Dr. Henry R. Carter, who 
first announced and discovered the so-called ex- 
trinsic method of incubation of the yellow fever 
infective agent. 

''When an institution like the University of 
Maryland turns out so many original discoverers 
and brilliant thinkers this could not possibly be 
accidental, as Dr. Pritchett would suggest when 
he states that 'a poor school may from time to 
time bring forth great practitioners.' In the same 
manner some are inclined to assign the brilliant 
work of our alumni not to the training of inspir- 
ing teachers who are competent masters of the 
subjects they teach in the University of Mary- 
land, but they fictitiously assign their brilliancy 
to laboratories and other universities in which 
some of our alumni took short post-graduate 
courses. If this were applied to the very univer- 
sities that Dr. Pritchett lauds in this manner, 
these institutions would be robbed of the credit 
of having trained and developed some of the best 
minds among their alumni. For. upon investiga- 
tion, it is found that the alumni of Harvard, Yale 
and Johns Hopkins have taken post-graduate 
courses in Germany, Austria, England and 
France. 

"It is not the short post-graduate course, which 
rarely exceeds one year, that develops the great 
thinker and research worker, but the constant, 



enduring guidance of the professor who conducts 
his pupil for several years, beginning with the 
very first instruction he ever receives in medicine. 

"In the Johns Hopkins University itself the 
dean of the Department of Medicine, both pro- 
fessors of ophthalmology, the professor of psy- 
chiatry and the professor of neurology are alumni 
of the University of Maryland. 

"On page 289 of the report Dr. Abraham Flex- 
ner gives some interesting statistics of the money 
spent in five German universities for professional 
salaries, the number of their assistants, the cost 
thereof, the number of servants and the laboratory 
expense. I can judge only of my department at 
the University' of Maryland and can say that the 
professor of physiology receives more salary at 
the University of Maryland than is devoted to 
that purpose at Berlin, Leipzig, Koingsberg, 
Griefswald or Giessen. That he has three paid 
assistants, which number is exceeded only by the 
University of Berlin, and that our laboratory ex- 
penses are greater than those of Konigsberg, 
( iriefswald or Giessen. The reason why Berlin 
and Leipzig spend more for assistants and labora- 
tory expenses than the L T niversity of Maryland 
does is due to the fact that they teach four times 
as many students. 

"The entire volume written by Dr. Flexuer on 
Medical Education in Europe represents the most 
scholarly and comprehensive contribution to this 
subject ever published in America." 



The following alumni have been appointed to 
positions in the City Health Department : 

Health. Warden, Thirteenth Ward, Dr. John 
Henry Yon Dreele, class of 1910, succeeding Dr. 
Vernon F. Kelly, class of 1904; salary, $900 per 
annum. 

Health Warden, Fourteenth Ward, Dr. Edwin 
Kemp Bartlett, class of 1887, succeeding Dr. 
William Caspari : salary, $900. 

Dr. Marshall G. Smith, class of 1887, has re- 
tired as Health Warden of the Nineteenth Ward. 



Dr. Arthur Dean Bevan of Chicago, a director 
of the American Medical Association, will be the 
guest of Prof. Randolph Winslow during the 
month of September, and will take an active in- 
terest in the proposed merging of the Baltimore 



THE HOSPITAL BULLETIN 



135 



Medical College and the College of Physicians 
and Surgeons with the University of Maryland. 



Dr. John J. R. Krozer, class of 184S, and 
nestor of the University alumni in Baltimore, 
took an automobile ride for the first time in his 
life on September 4. Dr. Krozer rode but four 
squares, and it took some persuasion to induce 
him to enter the car. Dr. John C. Harris, class 
of 1862, was with him. Dr. Krozer is 85 years 
of age, and says he prefers a horse and buggy 
any day to the machine. 



Dr. Charles A. Hollingsworth, class of 1881, 
has been appointed postmaster of Belair, Md. 
Dr. Hollingsworth has been a practicing physician 
in Belair for over 30 years. He is 55 years of 
age. lie married a Miss Young, daughter of the 
late Colonel Young, and has four sons and a 
daughter. He received notification of his appoint- 
ment by a telephone message from the First As- 
sistant Postmaster-General. 



Dr. Thomas Chew Worthington, class of 1876, 
spent the summer at his country place in Balti- 
more county. 



Dr. Eugene Bascom Wright, class of 1009, 
resident physician at the Church Home and In- 
firmary since September 2, 1911, has succeeded 
Dr. Chadbourne Andrews as resident physician 
of the Hebrew Hospital. 



Dr. Walter IT. Mayhew, class of 1901, is an 
assistant resident physician at the Maryland Tu- 
berculosis Sanitarium, at State Sanatorium, Md. 



Dr. William J. Coleman, class of 1908, has been 
reappointed superintendent of the University 
Hospital for the coming year. 



Dr. Charles A. Waters, class of inir, is on the 
X-ray staff of the Johns Hopkins University. Tt 
gives us pleasure to announce to his friends that 
he is making good in his chosen line. 



The residence of Dr. August Horn, class of 
[888, 40 E. 25th street, Baltimore, suffered slight 
damage by being struck by lightning during a 
heavy rainstorm in August. The chimney was 
struck and a number of bricks thrown into the 
street. The current then ran from the chimnev 



down the metal cornice of the adjoining house 
in the form of a ball of fire, jumped to an unused 
wire, dropped a few sparks and disappeared. 



The following University alumni are members 
of the faculty of the College of Physicians and 
Surgeons, Baltimore : 

Charles F. Bevan, M.D., class of 1871, profes- 
sor of principles and practice of surgery, clinical 
and genito-urinary surgery. 

George W. Dobbin, A.M., M.D., class of 1894, 
professor of obstetrics and gynecology. 

William Royal Stokes, M.D., Sc.D., class of 
1891, professor of pathology and bacteriology. 

Archibald C. Harrison, M.D., Class of 1887, 
professor of anatomy and clinical surgery. 

Cary B. Gamble, Jr., A.M., M.D., class of 1887, 
professor of clinical medicine. 

Charles E. Simon, A.B., M.D., class of 1890. 
professor of clinical pathology and experimental 
medicine. 

Anton G. Rytina, M.D., class of 1905, associate 
in genito-uninary surgery. 

Francis W. Janney, M.D., class of 1905, asso- 
ciate in ophthalmology and otology. 

William T. Watson, M.D., class of 1S91, asso- 
ciate in medicine. 

S. Griffith Davis, M.D., class of 1893, lecturer 
on anesthetics and assistant demonstrator of 
anatomy. 

W. Milton Lewis, M.D., class of 1888, assistant 
in clinical laboratory. 

Joseph L. Kemler, M.D., class of 1907, assist- 
ant in ophthalmology and otology. 



Drs. Archibald C. Harrison, class of 1887 ; 
George W. Dobbin, class of 1894; Cary B. Gam- 
ble, class of 1887; William T. Watson, class of 
1891, and William Royal Stokes, class of 1891, 
are on the visiting staff of the Mercy Hospital. 



Dr. George W. Dobbin, class of 1894, is one of 
the visiting obstetricians to the Maternite Hos- 
pital of the Mercy Hospital. 



Among the admitting physicians to the State 
Sanatorium are Drs. Robert S. Page, class of 
1898, Belair, Md. ; Guy Steele, class of 1897, 
Cambridge, Md.; James McFaddin Dick, class of 
1895, Salisbury, Md. : Louis Bernard Ilenkel, Jr., 
class of 1903, Annapolis, Md. ; Henry Maynadier 
Fitzhugh. class of 1807. Westminster, Md., and 



136 



THE HOSPITAL BULLETIN 



Guy Walter Latimer, class of 1901, Hyattsville, 
Md. Dr. Guy Steele is also a member of the 
board of directors. 



Dr. William B. Fellers, class of 1910, is located 
at 12^2 Campbell avenue S. W., Roanoke, Va. 



Dr. Benjamin F. Carpenter, class of 1899, of 
Belton, S. C, was a recent visitor to the Univer- 
sity Hospital. 



At the last meeting of the Alumni Athletic As- 
sociation it was decided to support football, base- 
ball and basket-ball during the coming season. 
Drs. Mitchell, Todd and Bay were appointed a 
committee to arrange for a track meet in the early 
fall. Dr. R. G. Willse has consented to act as 
coach for the football team during the season. 



Dr. Russell Hardy Dean, Jr., class of 1012, is 
practicing with his father in Jacksonville, Fla. 
Their office is located at Monroe and Cedar 
streets. 



The six full-time teachers in the University of 
Maryland for the season of 1912-13 will be Drs. 
I. M. Macks (pathology), J. Holmes Smith 
(anatomy), R. Dorsey Coale (dean, chemistry). 
T. L. Patterson (physiology and biology), H. J. 
Maldies (histology and embryology), and a sixth 
to be appointed. 



The following alumni are members of the dis- 
pensary staff of the Mercy Hospital : W. Milton 
Lewis, M.D., class of 1888 (skin diseases) ; F. W. 
Janney, M.D,. class of 1905, Joseph I. Kemler, 
M.D., class of 1907 (diseases of eye and ear), and 
Anton George Rytina, class of 1905 (genito- 
urinary surgery ). 



The staff of the University of Maryland Ma- 
ternity Hospital for 1912-13 is as follows : 

Prof. L. E. Neale, M. D.. director, class of 1881. 

Drs. L. H. Douglas, class of 1911; John D. 
Darby, class of 191 2, and William Michel, class 
01 [912, resident physicians. 



Among the University alumni practicing in 
Georgia are : 

Albany — John Cox Keaton, class of 1907. 
Atlanta — Edgar G. Ballenger, class of 1901, 



Atlanta National Bank Building ; William Zellars 
Holliday, class of 1882, The Grand Building; 
Herbert Jerome Rosenberg, class of 1908, Grant 
Building. 

Baxley — P. H. Comas, class of 18S2. 

Brunswick — Julian P. Harrell, class of 1906, 
502 T j Gloucester street. 

Byronville — Edgar.B. Watts, class of 1904. 

Cedartown — Wm. Allen Chapman, class of 
1887. 

Dalton — Harlan L. Erwin, class of 1904. 

Davisboro — Wm. Benj. Warthen, class of 1905. 

Donaldsonville — Nathaniel L. Spengler, class 
of 1903. 

Douglas — Charles Wesley Roberts, class of 
1906. 

Dudley — Josiah B. Walker, class of 1S90. 

Fitzgerald — Edwin J. Dorminy, class of 1890. 

Gainesville — Henry Latimer Rudolph, class of 
1902. 

Graymont — Rufus Cecil Franklin, class of 
1907 ; Virgil E. Franklin, class of 1896. 

Harrison — Elijah S. Peacock, class of 1891. 

La Grange — U. R. Allen, class of 1882, R. F. 
D. No. 5. 

Louisville — Samuel T. R. Revell, class of 1905 ; 
Jefferson D. Wright, class of 1882. 

Macon — Thomas E. Clackshear, class of 1S04, 
Grand Building ; Jos. W. De Guid, class of 1893, 
5725-2 Cherry street ; Weems R. Winchester, class 
of 1874, 610 Mulberry street. 

Manchester — Herbert Melvin Foster, class of 
1910. 

Marietta— J. D. Malone, class of 1884. 

Mt. Vernon — Charles Hicks, class of 1877. 

Osierfield — Redding Hamilton Pate, class of 
1898. 

Quitman — Samuel S. Gaulden, class of 1886. 

Reidsville — Orlando L. Alexander, class of 

1875- 

Rochelle — J. A. Bussell, class of 18S8; Charles 
D. McRae, class of 1888. 

Sandersville — George Skinner McCarty, class 
of 1905 ; William Rawlings, class of 1875; Oscar 
L. Rogers, class of 1897. 

Savannah — Craig Barrow, class of 1900, 26 
Liberty street. East ; Julian Ford Chisohm, class 
of 1000, 6 E. Liberty street; Benjamin Harrison 
Gibson, class of 1909, 14 W. Liberty street ; Ray- 
mond V. Plarris, class of 1907, 118 E. Park ave- 
nue ; John Smallbrook Howkins, class of 1897, 18 



THE HOSPITAL BULLETIN 



137 



E. Liberty street; Everett Iseman, class of 1909, 
1 1 E. Jones street; Bartolo Pedro Oliveros, class 
of 1883, 26 W. Harris street ; S. Latimer Phillips, 
class of 1885, 232 Bull street; Harry Young 
Righton, class of 1907, 101 E. Walberg street; 
Marion Russell Thomas, class of 1902, 204 E. 
Oglethorpe street. 

Statesboro — Lehman \Y. Williams, class of 
1909. 

Stilson — Henry Newton King, class of 1910. 

Thomasville — Harry Ainsworth, class of 1901. 

VVadley — Ralph Leland Taylor, class of 191 1. 

Warthen— E. T. May, class of 1885. 

Waycross — Richard C. Dodson, class of 191 1. 



Dr. J. Whitridge Williams, class of 1888, has 
returned from a trip abroad, and is at his cottage 
at Watch Hill, R. I. 



Dr. John R. Winslow, class of 1888, spent the 
month of August at Gloucester, Mass. 



Dr. Charles S. Woodruff, class of 1891, is 
spending several months at Port Dalhouse, On- 
tario, Canada. 



Dr. John Turner, class of 1892, has returned 
from a visit to New York, from which city he 
motored through Connecticut. 



The following letter has been received from 
Dr. Russell H. Dean, class of 1912: 

"Dear Dr. Winslow : 

"A line from Florida to cool you off. As hot as 
it is, it cannot touch Baltimore last year, but it 
does not miss it far. I am writing to impose some 
trouble on you. I am enclosing a check for two 
bones. Please put half to the Alumni Association 
and tack the other on the subscription list of the 
Hospital Bulletin, and pardon my delay in 
sending the former. 

"I can*t complain of overwork, but have got 
together enough to get this writing paper. Have 
given six anesthetics and removed two adenoids; 
the rest has been of the K NmO, variety (3). Not 
exactly setting the world afire, but I could not see 
my way clear to the ball game this morning. I am 
enjoying it, as I have no board to pay yet, for if 
I did I expect I would have an awful uneeda and 
sardine appetite. 

"Hope to see you this November at the conven- 



tion. I am planning to get there, and may take the 
hoard if it is convenient — as Florida board is No- 
vember 11, 1912— I may be able to get there in 
time. 

"Hope you have that auto now. 

"Kindest regards to yourself and all, including 
your father. Fraternally, 

"R. H. Dean, Jr." 



Dr. Albert H. Carroll has returned from a trip 
to the United States Fisheries Laboratories at 
Woods Hole, Mass. 



Dr. Roscoe I). McMillan, class of 1910, of Red 
Springs, N. C, will present a paper before the 
next meeting of the Atlantic Coast Line Surgeons, 
to be held in Richmond. The title of his paper 
will be "First Aid to the Injured, with Special 
Reference to Shock." This paper will appear 
later in The Bulletix. 



Dr. Nathan R. Gorter, class of 1879, spent part 
of the summer in a camp in Canada with Dr. 
Thomas S. Cullen. 



Dr. Perry Carman, class of 1901, has been vis- 
iting in Atlantic Citv. 



Dr. Arnold Dwight Turtle, class of 1906, First 
Lieutenant Marine Corps, U. S. A., at present 
surgeon at the Presidio, San 'Francisco, ran a 
losing race with death last week, when he raced 
across the continent to be with his father, Staff 
Quartermaster Sergeant Dwight S. Tuttle, who 
died three days before Dr. Tuttle reached Balti- 
more. Sergeant Tuttle is survived by his wife, 
two sons. Dr. Tuttle and Amos Tuttle, and three 
daughters, Mrs. John G. Lang and Misses Olive 
and Leslie Tuttle of Baltimore. 



Dr. Walter S. Carswell, class of 1895, occupied 
his cottage at Ocean City during August. 



Dr. Austin F. Robinson, class of 1903, spent 
the month of August on the Maine coast. 



At the fourteenth annual meeting of the Amer- 
ican Proctologic Society, held in Atlantic City 
June 3 and 4, 1912, Dr. Samuel T. Earle, class of 
1870, of Baltimore, reported a case of primary 
tubercular ulceration of the right buttocks, which 



138 



THE HOSPITAL BULLETIN 



was not connected with the rectum by a fistulous 
tract. In this respect it differed from the one re- 
ported by him in his work on "Diseases of the 
Anus, Rectum and Sigmoid," Fig. 62, page 201. 
It was excised by the thermo-cautery knife, after 
which it healed very promptly. 

Dr. Earle also reported a very aggravated case 
of pruritus ani, which had resisted local applica- 
tions, autogenous vaccines and treatment by the 
X-ray. Under local anesthesia he found an ulcer 
over the posterior commissure just above the in- 
ternal sphincter, which connected on each side 
with numerous submucous and subcutaneous su- 
perficial fistulae which enveloped the entire anal 
margin and connected with each crypt of Mor- 
gagni. The ulcer was incised, the scar tissue at 
its base removed, and the fistulous tracts were all 
opened up. There was only an occasional twinge 
of itching following the operation, and he made a 
speedy recovery. 



Dr. J. Fred Adams, class of 1894, is at his 
country home at Catonsville for the early autumn. 



Dr. Charles C. Harris, class of 1883, of Cathe- 
dral street, spent early August in Atlantic City. 



Dr. John G. Jay, class of 1871, spent part of 
August in Quebec and points along the Sagueway 
river. 



Dr. Cary B. Gamble, class of 1887, recently 
made a canoe trip from Biddeford Pool to Me- 
gantic, Maine. 



Dr. John McMullen, class of 1895, passed as- 
sistant surgeon Public Health Service, has re- 
ceived notification that he has passed the exam- 
inations for promotion to the rank of surgeon. 
Dr. McMullen has done considerable research 
work in diseases affecting immigrants. 



Dr. Charles W. Mitchell, class of 1881, read a 
paper on the feeding of infants at the July meet- 
ing of the Baltimore County Medical Association. 



Dr. C. Urban Smith, class of 1889, spent the 
summer on the Severn. 



It is reported that Mrs. J. B. Thomas will equip 
a lecture hall at the Dental School of the Univer- 



sity of Maryland as a memorial to her father, Dr. 
James Howell Harris, who died September 12, 
1910. The room will be known as Harris Hall. 
Dr. Harris was connected with the school from the 
time it was organized until the time of his death. 
The bronze bust of Dr. Harris, which was pre- 
sented to the school by the senior class, will be 
placed in this hall. 



Dr. Robert Garrett, class of 1890, assistant su- 
perintendent of the Maryland Hospital for the 
Insane, has been visiting in Atlantic City. 



Dr. Isaac C. Dickson, class of 1897, who has 
been very ill with appendicitis, is now on the way 
to recovery. 



Dr. Howard J. Maldeis, class of 1903, is in re- 
ceipt of the following letter from Mr. Alberto 
Garcia de Ouevedo, of the second year class, of 
Mayaguez, Porto Rico : 
"Dear Dr. Maldeis : 

"It was my idea to write you ever since I came 
down home, but thinking I was going to use some 
of your always busy time, I hesitated in doing so, 
but I do it now with the greatest pleasure. 

"Our island was visited a few months ago by 
bubonic plague, and had it not been for the ac- 
tivity of the sanitation department of the island 
it would have been a serious matter, but, fortu- 
nately, everything is all right now. The people 
were greatly alarmed, but gradually came back to 
their nerves again. 

"A few days ago I looked by the scope the Ba- 
cillus Pestis. I help my brother a little in his labo- 
ratory, and have had some bacteriological labora- 
tory experience this summer. 

"My brother sends his regards to you, and 
"I am, sincerely, 

"A. G. de Ouevedo." 



Dr. Alexander D. McConachie, class of 1S90, 
spent the week ends of July at Buena Vista and 
the month of August on a motor trip through the 
North. 



Dr. Gordon Wilson, Professor of Clinical Med- 
icine, spent the month of August in Newport and 
York Harbor. 



THE HOSPITAL BULLETIN 



139 



The Baltimore News contains the following 
item concerning Dr. Marshall Langton Price, class 
of 1902 : 

"Dr. Marshall L. Price, secretary of the State 
Board of Health, has been appointed a member of 
the committee to represent the American Medical 
Association at the joint conference to be held at 
the Willard Hotel, Washington, September 
18-20, to consider changes or modifications in the 
present model law for the registration of vital 
statistics. 

"Besides the American Medical Association, 
other organizations to take part in the conference 
are the American Bar Association, the American 
Public Health Association and the conference of 
Commissioners on Uniform State Laws. The 
International Congress on Hygiene and Demog- 
raphy will be held in Washington the following 
Monday, and it is thought that many who will be 
present for the one event will also attend the 
other. 

"Those on the committee with Dr. Price, who 
is the sole Baltimore representative, are Dr. J. M. 
McCormick, secretary of the State Board of 
Health, Bowling Green, Ky., and Dr. William 
C. Woodward, health officer of the District of 
Columbia." 



Dr. J. William Ebert, class of 1912, of Luther- 
nlle, Md., has been visting in Winchester, Va. 



Dr. Clarence W. Heffinger, class of 1881, of 
Sykesville, Md., is visiting in Murray Hill, An- 
napolis. 



Among the University alumni practicing in 
Indiana are : 

Camden — Chas. Edward Scholl, class of 1873. 

Gary — James Alexander Craig, class of 1908, 
652 Broadway. 

Hagerstown — Chas. I. S. Stotelmyer, class of 
1892. 

Indianapolis — Wm. R. Mayo, class of 1890, 715 
N. Alabama street; Jos. W. Ricketts, class of 
1909, Central avenue and 32d street. 

Jamestown — Thomas B. Johnson, class of 1906. 

Logansport — John Henry Reed, class of 1885, 
416^ Broadway. 

Philadelphia— John S. Bell, class of 1884. 

Rockport — Arthur White, class of 1854. 

Seymour — Grayson R. Gaver, class of il 



Dr. John C. Hemmeter, class of 1884, spent the 
month, of August in North East Harbor, Maine, 
as the guest of Dr. Thomas E. Satterthwaite of 
New York. 



Dr. St. Clair Spruill, class of 1890, is spending 
a vacation on the Magothy river. 



MARRIAGES 

Dr. Maurice Eubanks Broadas Owens, class 
of 1910, was married on September 1, 1912, to 
Miss Maysville Jane Freeman, daughter of Mrs. 
M. W. Freeman, 845 W. Fayette street. Miss 
Freeman left Baltimore August 25 and reached 
Spokane, Wash., September 1. The ceremony 
was performed there at the residence of Dr. A. 
Aldridge Matthews, class of 1900, and brother of 
Dr. James G. Matthews, class of 1905. Dr. 
Owens is located at Long Lake, about 30 miles 
from Spokane, and he and Mrs. Owens went 
there immediately after their wedding. 

Mrs. Owens is a graduate of the University of 
Maryland, department of pharmacy, of the class 
of 1907, and stood third in her class. Dr. Owens 
was then a student in the medical school, and 
graduated in 1910, winning the gold medal. He 
then served for a year in the University Flospital, 
leaving there to go to the State of Washington. 
He is a South Carolinian by birth. Mrs. Owens 
is a Virginian. She is also a graduate of the 
Shaftsbury College of Expression, and was prin- 
cipal of the Shakespeare College of Expression. 



Dr. Joseph T. Smith, class of 1872, of The 
Cecil, is at Eaglesmere, Pa., for several weeks. 



DEATHS 

Abel Huston Thayer, class of 1876, died at his 
home in Grafton, W. Va., September 8, 1912. 

Dr. Thayer was born in Garrett county, Mary- 
land, August 25, 1842, the son of Stephen and 
Rebecca ( McCleary) Thayer, and was descended 
from American Revolutionary ancestors. 

He began the study of medicine at Winchester 
Medical College, which was burned during the 
Civil War. He served as surgeon of the Sixth 
West Virginia Cavalry, U. S. V., during the en- 
tire war, serving with the Army of the Potomac 
and with Sheridan in the Valley of Virginia, and 
was a member of the West Virginia Constitu- 
tional Convention of 1872. He then entered the 



140 



THE HOSPITAL BULLETIN 



University of Maryland, graduating in 1876. He 
began the practice of medicine in Webster, \Y. 
Ya., and then located at Grafton, where he re- 
mained until his death. He was a member of 
the West Virginia Legislature of 1887, and again 
in 1889. In 1901 he was president of the West 
Virginia State Medical Society, and in 1903 took 
a special course in the New York Post-Graduate 
School and Hospital. Dr. Thayer was an Episco- 
palian, and was for years senior warden of St. 
Mathias Protestant Episcopal Church at Grafton. 
He was a member of the Sons of the Revolution, 
American Medical Association, the Military Or- 
der of the Loyal Legion, Grand Army of the Re- 
public, Royal Arch Masons and National Asso- 
ciation of Railway Surgeons. 

He married November 26, 1868, Miss Virginia 
Love of Grafton, who died in 1885, leaving two 
children — Arthur L. and Howard B. Thayer. Dr. 
Thayer married again October 30, 1890, Miss 
Kate Virginia Samsell of Grafton, by whom he 
had six children — Dorothy, Katherine, Marguer- 
ite, Helen. Richard S. and Abel H. He is sur- 
vived by his widow and four children of the sec- 
ond marriage and the two of the first. 



Dr. William Kirkwood Robinson, class of 181)3, 
died at his home, 306 Kingsley Drive, Los An- 
geles, Cal., August 24, 1912, after an illness of 
several months. He had been living in the West 
for some years, and specialized in ear, nose and 
throat work. His remains were cremated in Los 
Angeles, in accordance with his request. He is 
survived by his widow, who was a Miss Yickers. 
of Chestertown, Md., daughter of the late Harri- 
son W. Yickers, and his father. Dr. R. K. Robin- 
son, Sharon, Md. ; one brother, John A. Robinson, 
Belair. Md., and three sisters, Mrs. John W. 
Staton, Snow Hill, Md. ; Mrs. McAllister, Balti- 
more, Md.. and Mrs. Ziegler, Chambersburg, Pa. 
Dr. Robinson was 43 years of age. 



BOOK REVIEWS 



Practical Anatomy. An Exposition of the 
Facts of Gross Anatomy from the Topo- 
graphical Standpoint and a Guide to the Dis- 
section of the Human Body. By John C. 
Heisler, M.D., Professor of Anatomy in the 
Mcdico-Chirurgical College of Philadelphia. 
With 366 illustrations, of which 225 are in 



color, by E. F. Faber. Philadelphia and 
London : J. B. Lippincott Company. 1912. 
Leather ; $4.50 net. 

From an experience of many years in the dis- 
secting-room the reviewer can certify to the wis- 
dom of Heisler's arrangement of his material in 
his book on "Practical Anatomy." Undoubtedly 
the best way to study anatomy in a systematic 
manner in the abstract is to take up the several 
systems independently of each other. In this way 
the student gets a broad grasp of the subject, but 
when it comes to the dissecting-room the student 
is confronted with another problem. Here he 
finds the organs and structures in relationship 
with each other — the body in an orderly whole, 
and not dissociated as in textbooks. Therefore, 
if a general textbook be employed, the average 
student finds himself at sea in approaching the 
subject. Some few students we are aware, after 
bitter experience, learn to correlate the dissection 
by skipping about in the book before them and 
finding out what structures are to be found in the 
region under study. Heisler"s idea of describing 
the structures as the student reaches them, in our 
judgment, is ideal if used in conjunction with a 
standard textbook, and should enable the dis- 
sector to save time and gain a more intelligent 
grasp of human anatomy as it actually presents 
itself. The division of the contents into sections 
on the upper limb, the lower limb, the head and 
neck and the thorax and abdomen cannot, from a 
practical view, be improved upon. The reviewer 
has long since learned that medical students' inter- 
est in any subject is proportionate as they can see 
the practical utility resulting therefrom. Heisler 
has attempted to supply this incentive by includ- 
ing in smaller type such information, either med- 
ical or surgical, as has a practical bearing on the 
part under discussion. In order to familiarize the 
users with the desirability of simplicity and uni- 
formity in anatomical nomenclature the Basle 
Anatomical Nomenclature is used wherever feasi- 
ble, and where not employed is included between 
parenthesis. Explicit directions are everywhere 
to be found as to the best and simplest method of 
making the dissection. The illustrations, many 
of which are colored, are excellently executed, 
true to nature and made from original dissections 
by the author. It supplies a long-felt need in the 
dissecting-room, is practical, accurate, sufficiently 
full for its purposes and dependable. 



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, 608 Professional Building, Baltimore, Md. 



Entered at the Baltimore Post-office 
as Second Class Matter 



Vol. VIII 



BALTIMORE, MD., OCTOBER IS, 1912. 



No. 8 



A SUMMER CRUISE ON THE SPANISH 
MAIN. 



By Randolph Winslow, M.D. 



2. Colon, Panama and the Canal Zone. 

Colon is situated on an indentation of the coast 
of the Isthmus of Panama, called Limon Bay. 
This bay, though on the Atlantic side, looks to- 
wards the north, and at certain seasons of the 
year is an unsafe harbor. In order to obviate this 
serious disadvantage and to protect the entrance 
to the Canal, the United States has built a break- 
water about two miles in length, which to a very 
large extent converts this open roadstead into a 
land-locked harbor. If this is not sufficient to ac- 
complish the purpose, another breakwater upon 
the opposite side will also be built, leaving only a 
narrow entrance through which ships will pass. 
Strong fortifications are also being constructed to 
defend the canal from attack from the sea. Colon 
was formerly called Aspinwall, and was built upon 
a marshy island, scarcely above sea level. Like 
most Spanish-American towns, its streets were 
unpaved, and were the depositories of all kinds of 
filth. The first effort of the United States after 
securing control of the Canal Zone was to clean 
up these pestilential cities and towns, and to ren- 
der them safe from yellow fever, malaria and 
< >ther zymotic diseases. The streets of Colon and 
Panama have therefore been raised, curbed and 
macadamized or paved, and will compare favor- 
ably with cities of similar size in our own coun- 
try. 'Water-works have been established and an 
abundant supply of pure water furnished for both 
drinking and bathing, while previously the drink- 
ing water was obtained by catching rain water in 
cisterns, which were also the breeding places of 
mosquitoes. Colon has about 17,000 inhabitants. 
of a very mixed character, whites of varying 
shades, negroes, Chinese, Hindoos, and people of 
almost everv race and color. The houses are 



mostly wooden and are ramshackly in appearance, 
though there are a few good stone buildings. The 
town derived its importance from being the start- 
ing point of the Panama Railroad, and will cer- 
tainly continue to increase in population and pros- 
perity from its location at the entrance of the 
Panama Canal. Although Colon and Panama are 
within the Canal Zone, they are exempted from 
the control of the United States except in the mat- 
ter of sanitation and of preserving order. The 
railroad tracks separate Colon from Cristobal, 
which is the American settlement and is entirely 
within the jurisdiction of the L'nited States. Here 
the Canal Commission has its great commissary 
establishment, laundry and many other offices. 
The Colon Hospital was built by the French and 
came under the control of the Americans in 1904. 
It consists of many detached buildings situated on 
the waterfront, and some of them actually erected 
on piles in the bay. It is said to have accommoda- 
tions for 500 patients. There are several long 
wdiarfs at Colon and Cristobal at which large ships 
can dock, and there are usually six or more steam- 
ers taking on or discharging cargoes all the time. 
The Panama Railroad was opened in 1855 and ex- 
tends 47 miles from Colon to Panama. As first 
constructed, it was a narrow-gauge road running 
over swampy ground to the hills, but it has now 
been relocated upon a higher level, and is a broad- 
gauge, double-tracked, well-ballasted road. It 
runs nearly parallel with the canal, but at only a 
few points is the canal actually visible from the 
train. All along the line of the railroad one sees 
the towns in which the employes of the Canal 
Commission dwell, the houses being raised from 
the ground in order to permit a free circulation 
of air under as well as through them. They are 
usually two stories in height, surrounded by porti- 
coes well screened, and situated on an eminence; 
and every effort is made to make the life of the 
employes comfortable and happy. The heavy 
work is mostly done by West Indian negroes, but 
the overseers and bosses are white Americans. 



142 



THE HOSPITAL BULLETIN 



As has been stated, the county is flat, marshy and 
covered with jungle for 25 miles, when it becomes 
hilly. These hills are the continuation of the 
Andes mountains, but do not attain any great alti- 
tude. Gold Hill being the highest point through 
which the canal is cut, somewhat more than 500 
feet in elevation. One of the detached, more or 
less conical, hills is called Balboa hill, as it is sup- 
posed that Balboa first saw the Pacific Ocean 
from its summit in 1 5 13. At Las Cascadas a bat- 
talion of marines is stationed, and at Empire the 
10th infantry has its post. These are elevated, 
healthy locations, and the camps are kept in beau- 
tiful condition. The Canal Zone is policed by 
fine-looking mounted officers, who go about their 



though a line is now being built. There are no 
detached residences in Panama as far as I could 
see, but the people live over stores or other utili- 
tarian buildings. Earthquakes do not occur on 
the Isthmus, hence the houses are several stories 
in height. As has been said, the streets are now 
well paved and are kept scrupulously clean, but 
formerly they were filthv and ill-kept. The popu- 
lation is very mixed, mostly not white, and with 
a deepseated dislike of the American gringo. As 
an illustration of this, on the 4th of last July 
there were athletic sports held in the citv, at 
which American soldiers, unarmed, were present. 
Two soldiers having a personal quarrel, and prob- 
ably under liquor, went upon a vacant lot to settle 




FRONT STREET, COLON. 



duties in a very businesslike manner. Descending 
on the Pacific side we reach Panama in 2 1 / hours 
from the time of leaving Colon. The conductors 
and engineers of the trains are Americans, and 
the nasal twang of the Yankee is very much in 
evidence. Panama city is situated on a bay of 
the same name and has a population of between 
30,000 and 40,000. It is quite a bustling town, 
with many stores, narrow streets and scrawny 
horses attached to dilapidated carriages. A ride 
within the city costs 10 cents a passenger, but 
that means in American coin. I paid a driver the 
amount he asked and supposed I had given him 
the correct fare, but I had paid in Panamanian 
money, which is one-half the value of our cur- 
rency, and he was mad all through about it. 
There are no street cars at present in Panama, 



their dispute in the usual manner, when they were 
fired on by the native police. Of course, their 
comrades came to their aid and a melee ensued, 
in which two Americans were killed and several 
wounded. It is thought that this was a political 
act to force American intervention in order to 
prevent the election of the popular candidate for 
the presidency. It was with great difficulty that 
the American troops were kept from entering the 
town and killing the police. For the size of the 
city the police force is very large, though the in- 
dividual members of it are very small. The Amer- 
icans with no arms, except bayonets, were anxious 
to attack the whole Panamanian police force, 
armed with modern rifles. Our Government has 
demanded satisfaction for the attack on its citi- 
zens and the punishment of those who were the 



THE HOSPITAL BULLETIN 



'4.5 



ringleaders in the outrage. The native women 
wear their hair down their backs and a silk shawl 
around their shoulders in the Spanish fashion ; 
while children are frequently seen clad only in the 
garb of nature. Some of the churches and the 
cathedral are of interest, as well as of antiquity. 
There are ancient and useless fortifications over- 
looking the sea, dating from the early days of the 
city. The present city, however, is not the first 
one of the same name, but is located about five 
miles from old Panama, which was sacked and 
destroyed by the English freebooter, Sir Henry 
Morgan, in 1670. The original city of Panama 
was founded in 1511), and after its destruction by 



Pacific entrance of the canal. Here one finds 
steamship lines to Peru, Chile and the other coun- 
tries on the western coast of South America, as 
well as the Pacific Mail steamships plying be- 
tween Panama, Central America, Mexico and 
San Francisco. 

The name Balboa is very prominent on the 
Isthmus ; I have already mentioned Balboa hill 
and Balboa port, and one is constantly reminded 
of the historic personage who first gave the Pacific 
1 Icean its name, as the standard coin is the balboa, 
equal to 50 cents in our money. Immediately con- 
tiguous to Panama is the American settlement of 
Ancon, where the administration headquarters are 




CENTRAL AVENUE. PANAMA, AND NATIONAL HANI l. 



Morgan was rebuilt on its present location ; it is, 
therefore, the oldest city of continental America. 
At one time it was the port through which the 
Spanish treasure came from Peru and the western 
coast ; subsequently it lost much of its importance, 
which was in a measure regained on the opening 
of the railroad in 1855. 

With the completion of the interoceanic canal 
in the near future, it is bound to become one of 
the important ports of the world. Panama Bay 
is shallow and there is a daily variation of 21 feet 
in the tide, so that the water comes against the 
sea wall of the city at full tide, and recedes a long 
distance at the ebb. Ships, therefore, cannot ap- 
proach the city, but land at Balboa, which is the 



located. Here also is the large and comfortable 
Hotel Tivoli, built by and under the control of the 
Canal Commission. The fare is $5 per diem ; but 
one gets a good airy room, clean sheets and bed 
linen, and beds that are not overtenanted, as well 
as good meals. It is said that these essential 
requisites cannot be obtained in the hotels in the 
native town. The view from the hotel porch is 
beautiful, as the blue waters of the bay are spread 
out before us, dotted with islands of emerald 
green and animated with sail and steam boats of 
various kinds. Still higher on the hill back of the 
hotel is the great Ancon Hospital, erected by the 
French and taken over by the Americans in 1904. 
This hospital consists of many detached buildings, 



U4 



THE HOSPITAL BULLETIN 



usually of one story, but some are two stories in 
height, severely plain in construction, with 
screened windows and doors through which an 
abundant flow of air is permitted. The Americans 
have erected but few additional buildings, and the 
institution is a monument to the excellence of the 
French physicians and builders. Its original cost 
was several million dollars. The capacity of this 
hospital is about 1500 beds, 400 of which are for 
surgical cases. The Americans took charge about 
June, 1904, and up to the time of my visit on 
August 23, 1912, a little more than eight years, 
123,000 patients have been admitted. Dr. Her- 
rick, the chief surgeon, very courteously took Dr. 



physicians or to the hospital, but are turned over 
to the Canal Commission. The staff are treated 
very well, however, as the chief physicians re- 
ceive $6000 a year, besides comfortable houses 
and equipages, and the junior officers are also well 
paid. It was a great pleasure to me to find Dr. 
Howard V. Dutrow, class of 1904, at work at the 
hospital, and I am indebted to him for many 
courtesies. Dr. James C. Perry, class of 1885, is 
chief quarantine officer of the Isthmus, and is an 
important factor in preventing the introduction 
and spread of infectious diseases. 

The Canal Zone extends five miles on each side 
of the canal and is under the exclusive control of 




PALM AVENUE. CRISTOBAL, CANAL ZONE. 



Felty of Hartford, Conn., and myself through 
the surgical wards and showed us some very in- 
teresting cases, especially of fractures treated with 
intramedullary splints. Not only, however, are 
medical and surgical patients treated, but the va- 
rious specialties — eye, ear, throat and nose, 
gynecology, and even obstetrics — are under the 
care of skilled attendants. The reputation of the 
hospital has become so extended that pay patients 
from the surrounding countries as well as from 
Panama seek the skill of the physicians and sur- 
geons attached to the hospital. 

While I was there the wife of the present Presi- 
dent of Panama was a patient in the pay pavilion. 
The fees for the private patients do not go U< the 



the United States. There were and are native 
villages within this strip, but many of them will 
be covered with water when Gatun Lake is filled, 
and they have already been removed to higher 
land. Most of the American settlements will also 
be abandoned, and the Zone will be to a large ex- 
tent depopulated, only leaving a sufficient force of 
employes to care for the canal. I did not have 
time and opportunity to get a good idea of the 
country or to estimate its advantages as a place 
of residence or business. There did not seem to 
be much arable land in the portion through which 
I traveled, nor did I see anything under cultiva- 
tion except bananas. The canal employes receive 
their food supplies entirely through the cold- 



THE HOSPITAL BULLETIN 



145 



storage plant at Colon, which must be replenished 
every two weeks. The foliage, while abundant, 
was not especially pretty, nor were the flowers of 
the same delicacy and beauty as in more temperate 
climes. There were, however, some curious and 
attractive flowering plants. 1 presume there must 
be an abundant bird and animal life in the less 
frequented regions, but they were not in evi- 
dence in the parts I visited. As to the climate, it 
is hot, but not more so than that of Baltimore in 
mid-summer, and there is usually a good breeze, 
but the great humidity is very unpleasant and de- 
pressing to those who are not acclimated. Some 
of our officials have now lived there ten or more 
years, and not only appear to live comfortably, 
but to enjoy life. 



INITIAL ADDRESS TO THE 
AND SENIORS. 



JUNIORS 



Delivered by Ernest Zueblin, M.D. 



"Not enjoyment and not sorrow- 
Is our destined end or way ; 
But to act, that each tomorrow 
Finds us farther than today." 

The pleasures of the seaside, or of the tool 
mountains, or the recreation at your homes, per- 
haps, has come to a close. The possibility of alle- 
viating the sorrows of suffering mankind will com- 
pensate you, I hope, for the regret you feel in leav- 
ing so many pleasant scenes behind. You have an- 
swered the call of your Alma Mater in assembling 
again in her halls. I wish to extend a cordial 
welcome to all my pupils. After the idleness of 
the vacation you feel the necessity of resuming 
your studies. You know that much work has to 
be done before you reach the rank of an accom- 
plished physician. For some of you it means the 
entry into a new field of activity, and I venture 
(luring the sometimes tedious preparatory studies 
of former years you longed for the moment to 
get into closer contact with the professional du- 
ties, the application of your knowledge to the re- 
lief of suffering patients. For some of you this 
year means the completion of your studies, after 
the careful instruction you owe to the knowledge, 
experience and personality of your previous teach- 
ers, among whom stands prominently Prof. C. 
W. Mitchell. It is with regret that you have 
heard that the accumulation of work in the inter- 



est of the University induced your former teacher 
to restrict his teaching in medicine for the benefit 
of the juniors only. As you may be accustomed 
to the methods of my distinguished predecessor, 
you may regret this change. But every teacher's 
aim is the same ; it is to see you advancing on the 
way to become a distinguished physician, gifted 
with knowledge, experience and untiring energy 
in the fight against human disease, and provided 
with all the necessary qualities that will assure 
you a prominent standing among the members of 
the medical profession, as well as a numbering 
among the benefactors of humanity. So, in the 
acceptance of the honor conferred upon me by 
the decision of the Board of Regents and by the 
members of the Faculty of Physic of our famous 
Alma Mater, let me hope that our work, based on 
mutual understanding, will be successful for all 
of us. 

Medical science has a peculiar attraction for 
her disciples; like a mountain we see it rise from 
the plain, and we wish to reach the top in order 
to obtain from there a more distinct view of the 
world. On the way to this elevated position we 
have to overcome many difficulties, and on the 
stony path there are moments when our strength 
seems to fail, and where a word of encourage- 
ment, of good cheer from our guide sets free new 
resources of unknown energy. In the course of 
your studies you learn how your knowledge is 
built up from little facts, which by themselves 
seem unimportant, but which are quite significant 
in the final outcome from cause and effect. Medi- 
cal education is a process of evolution — the con- 
tinuous development of the student into the prac- 
titioner. The final result depends greatly on the 
personal contact of the teacher with his pupil. 
It is greatly influenced by the interest and en- 
thusiasm of the teacher in his work and the in- 
dustry displayed by the student. A certain 
affinity between teacher and pupil has to be 
created ; mutual understanding in the ways and 
aims of education has to be cultivated in order 
to accomplish a good result. The teacher has to 
reply on a certain collaboration on the part of 
his students. Thoroughness, perseverance and 
love for the work has to be fostered in the stu- 
dent. Considered from this point of view, medi- 
cal teaching comprises an eminent task, which 
becomes still more difficult in the hands of an 
outsider. Just as medical science has become a 
benefit to the whole of humanity, so the methods 



1 4 6 



THE HOSPITAL BULLETIN 



of its teaching, not restricted to one particular 
seat of learning, find their way everywhere. What 
seems good for one place may be helpful to an- 
other if the proper conditions prevail. So, my 
friends, in beginning our work I hope that my 
experience with eminent clinical teachers of your 
own and of the old country will turn out to the 
benefit of our Alma Mater and of her students. 
Knowing that our work is based on the accom- 
plishments of our ancestors and predecessors, we 
try to continue only with the aim to adapt it to 
the present and future requirements. So this 
does not mean that I discredit the work already 
accomplished ; only it means that in the course of 
time I wish to develop your clinical knowledge 
on the basis you owe to your previous teachers. 
The medical profession can be viewed under 
very different angles; To some men it means a 
successful way for making money; for the ac- 
quisition of all the means that contribute to the 
happiness of life. It is justified that every work 
receives its true reward, be it good or bad. If 
you analyze the lives of medical men who, owing 
to their work and to their personal qualities, have 
reached eminence, you will find the medical pro- 
fession meant more to them than a safe, success- 
ful, prominent position in life. Physical as well 
as spiritual life is a process of evolution, and a 
process greatly influenced by education, surround- 
ings and ethical training. I assume that all of 
you. brought up and strengthened in the prin- 
ciples of religion, remember that one of the prin- 
cipal manifestations of spiritual life and one of 
the most important commandments is that of 
charity. To my mind, there is hardly any other 
profession where charity and science amalga- 
mated can do more for humanity. Science taken 
for itself may be compared to a limelight pene- 
trating into the darkness of ignorance, but leav- 
ing the heart cold. In the contact with human 
suffering we often feel depressed and discour- 
aged, and our wish to abolish all evil is felt in- 
tensely. But sentiments alone avail nothing ; 
scientific help and sentiments combined can re- 
lieve human sufferings. Charity blended with 
medical science and experience is the source from 
which we can draw new energies, destined to 
adorn the existence of mankind. Daily expe- 
rience shows us the truth that a good man alone 
can become a good physician, a man with a firm 
character, gifted with that idealism that holds 
out against all difficulties of life. A physician 



remaining all the time on the ground of thor- 
ough science may inspire his circle of students 
and patients with admiration, and his knowledge 
may be a great blessing for his patient. Yet he 
is apt to consider suffering human beings as 
mere material for observation and experimenta- 
tion, and he may even try in his cases remedies 
which will not stand the test of ethical judgment. 
His presence sends forth a cold, bright light: it 
will not warm the heart of his human patient, 
who is in need of sympathy and kindness as well 
as of medical treatment, if no word of sympathy 
or kindness for the patient accompany his actions. 
How different the atmosphere that emanates 
from the physician who brings to the bedside 
knowledge and psychological understanding of 
the suffering ! Without many words the under- 
standing between patient and physician is estab- 
lished. In the former the comforting feeling is 
aroused that he can trust his doctor in everything. 
And even if our efforts to save a human life are 
of little success, the refined physician can render 
great services in alleviating the patient's physical 
and mental sufferings when he is about to de- 
part from this life. If we consider the role of the 
family physician to whose faithful services whole 
families are indebted for his devotion and skill 
where he is not only consulted in medical ques- 
tions alone, but where his advice is highly accred- 
ited, can money be the just compensation for such 
help? The financial equation remains often be- 
low the standard, but even then it does not equal 
the satisfaction experienced in the physician's 
soul, knowing that he has done his best for his 
cases. "Xoblesse oblige," if not immediately, it 
will later on. If we investigate into the motifs 
of generous donators. we may not unfrequently 
find that the example of an unselfish, persevering 
physician created in the mind of the donor the 
desire for such noble actions. So it will also be 
your task by your work, by your learning and 
your professional services to impress on your 
patients the commandment of charity, and in do- 
ing so you may be of great help in the progress 
of science also. 

Science gradually directs us to a higher stand- 
point for observation of mankind. Just as daily 
experience shows the truth of the old maxim 
"mens sana in corpore sano," we observe how a 
diseased body transforms the mentality of chronic 
suffering patients. We feel compassion for them, 
and all our efforts are tended to alleviate their 



THE HOSPITAL BULLETIN 



'47 



physical and psychical condition. The high edu- 
cation given to the physician has rendered him 
as solid, as resistant as a rock, against which the 
waves of ignorance, of superstition, of selfish- 
ness and ingratitude of the public are of no avail. 
During the years of studies you have reared and 
elevated among your fellow-students the senti- 
ments of friendship, of collegiality, which does 
not admit thoughts of animosity or jealousy. 
When you have entered a practical life, you will 
never foresake these noble convictions which 
adorn your professional life. No doubt science 
has an elevating influence on yourself, and if the 
progress of medical science represents a glorious 
history, written with the blood of its promoters, 
you certainly acknowledge these results of un- 
tiring work of past generations. Science does not 
only include the obligation of recognition ; it 
kindles our energy to contribute to the best of 
our ability to its further progress. Among the 
alumni of our University you certainly remember 
the name of Dr. James Carroll, who offered his 
life as a martyr for the progress of medical 
science. His assertion, "Truth will prevail," 
should also enter into our convictions, and we 
should be able to accomplish for humanity as 
much as he did. My friends, if ethical training 
and medical science corrobate each other, let me 
hope that you will show the world what a mind 
enriched with acquisitions of medical science, 
>trengthened by exercise and led and inspired by 
an ardent and sensitive heart can accomplish for 
humanity. 

With such a view into your future let us. my 
friends, begin the work. Which are the neces- 
sary requirements I have to expect from you ? 
Thoroughness, perseverance and love for your 
work have already been briefly mentioned. In 
a task in which your future happiness, your pro- 
fessional success is at stake, I have to insist on 
the necessity of pursuing your medical studies in 
this clinic also thoroughly. I cannot lay enough 
stress on this quality, as it seems to me the "one" 
essential for the medical man — one factor upon 
which your future depends. You may analyze 
the factors which contributed to the fame of 
clinical teachers, and you will always find that 
they were thorough in the least details of their 
work. Hardly any fact, even seemingly unim- 
portant to the patient, escaped their attention in 
taking the history. Thoroughness characterizes 
their examination of the whole bodv, where all 



organs may suffer. After the exhaustion of the 
means of clinical physical examination, they try 
to unite all findings, all knowledge, every expe- 
rience, and a kind of medical instinct allows 
them to separate primary cause from secondary 
consequences as much as possible. Their diag- 
nosis dives to the bottom of the cause of disease, 
and after a careful consideration of prognosis the 
treatment is before all causal, if necessarily symp- 
tomatic and prophylactic. In a process where 
analysis is followed by synthesis, where clinical 
findings and didactic knowledge or the symptom- 
atology, of pathology complete each other, 
where the body of the patient does no longer 
mean an organ in which darkness prevails and 
wherefrom only little information is transmitted 
10 its outer surface. As long as our physical 
means are not yet able to transilluminate com- 
pletely the human organism, we are still obliged 
to train our senses, our mind, so as to penetrate 
the secrets of the body by mental analysis. The 
future will show that the patients will learn to 
distinguish very well the thorough physician 
from his colleague, who does not think it worth 
while to concentrate his interest on his patient's 
disease, and who, without a careful examination, 
resorts to symptomatic, in many instances to un- 
successful, treatment. I know that untrained 
human beings are naturally inclined to avoid diffi- 
culties. In education it is one of the most im- 
portant tasks to create in the pupil that sentiment 
of responsibility in the work to be accomplished, 
to develop in the pupil the courage to tackle diffi- 
culties directly and with enthusiasm (nee aspera 
terrent). It means, no doubt, a hard task not to 
follow the tendency toward lesser resistancv, not 
to take it easy. History and daily observation 
demonstrate that the world belongs to the con- 
queror. Also, with reference to the success of 
the medical student in doing thorough work, he 
will not only merit the recognition of the patients, 
the encouragement of his teachers, but most valu- 
able of all will be the personal satisfaction expe- 
rienced by the success in treatment of disease. 
It may appear easier in the beginning not to care 
much about the quality and quantity of the work- 
accomplished, but later on the results and conse- 
quences of the work done are quite different. 
Once started into medical practice, no more 
within reach and control of the medical teacher, 
the practitioner will learn his mistakes at the 
risk of his patient's welfare. Thoroughness 



M 8 



THE HOSPITAL BULLETIN 



means an important habit to adopt during your 
studies, but which will become second nature 
and then pay itself manyfold by the success it 
warrants. If the fatal results in surgery are 
often caused by very little errors and small neg- 
lects, so in medicine carelessness may cause 
almost similar consequences. So, my friends, I 
shall judge your fitness for a good final grading 
by the evidences you give of your thoroughness 
in your studies and in the examination of the 
cases. 

Before we begin our work let us consider a 
certain outline of our clinical studies, first for the 
junior men, then that of the seniors. After the 
completion of your previous studies it is most im- 
portant to master the principles of physical diag- 
nosis and to make extensive use of your expe- 
rience, first in normal cases among yourselves, 
and later, when you have become familiar with 
the physical signs of normal conditions, you will 
train your senses on your patients. Then, not- 
withstanding the excellent preparatory instruction 
given to the student as soon as he enters the 
practical clinical studies, it seems, that he has first 
to be taught to use his senses. His power for 
close observation of the patient has to be devel- 
oped, as the outward observation of the patient 
already in many instances can furnish important 
information of the case. The ear requires the 
subtle training of the musician to differentiate 
the quality, the tonality of the sounds transmitted 
t<> the surface of the body. The delicate touch 
of the fingers has to be trained to differentiate 
the outlines, the resistancy, the qualities of vibra- 
tion of the underlying organs. The acuity of 
smell has to be educated in order that pathological 
changes imparted to the air, may not be over- 
looked. All these requirements, in addition to 
your practical training in the manipulation of in- 
struments and apparatus, in the chemical and mi- 
croscopical clinic, diagnostic methods, etc., are 
important factors in medical diagnosis, and they 
are obtained only by an assiduous, thorough train- 
ing in the methods of physical diagnosis. Hand 
in hand with this instruction in following the 
medical clinic you will reach the understanding 
of the cases, of the methods of examination, of 
differential diagnosis and the principles of treat- 
ment. Frequent study of your textbooks on in- 
ternal medicine will complete your knowledge of 
the clinical features of the presented cases. So, 
with vour collaboration, 1 hope that our work 



will be so successful that whenever questions are 
addressed to you they will be answered readily, 
so showing the senior men that your knowledge 
increases every day, and that you are keen to 
enter into friendly competition. The necessity 
of practical and theoretical understanding in clini- 
cal medicine is obvious. In lectures on didactic 
medicine you will gradually get acquainted with 
the terminology, symptomatology, pathological 
anatomy, diagnosis, prognosis and treatment of 
human internal disease. If we briefly outline the 
task of this year for you, the senior men, your 
instruction is partly didactic, mostly practical. 
Certain chapters of internal medicine require a 
more detailed discussion. In the previous year, 
I assume, you have had clinical cases demon- 
strated by my predecessor, Professor Mitchell. 
Xow, each one of you will in turn be assigned one 
clinical case, which you will thoroughly examine 
and then submit your clinical findings to me for 
control, for discussion of the differential diag- 
nosis, prognosis and your plan of treatment. This 
will be done here in public, in presence of the 
junior students. From time to time you will re- 
port on the course of treatment of your cases ; 
also on the changes of its clinical features. Grad- 
ually seeing that you have mastered the general 
routine examination, it will be the aim of our con- 
ferences to enter more in detail of the clinical 
aspect of cases, comparing them with the material 
you have already seen and with pathological 
specimens, so that at the end of your term you 
will have gained a thorough knowledge of the 
different internal diseases, didactically as well as 
practically. With your clinical instruction at 
this place and the clinical material from the poli- 
clinic, a great field of work is opened to you, and 
in appreciating your zeal, your understanding and 
your earnest work, I wish to help you all to be- 
come thorough, well-experienced practitioners in 
internal medicine. So, gentlemen, the plan I have 
briefly outlined means a great task, but I count on 
your earnest perseverance in your work, and 
gradually I expect to watch your further progress, 
so let me hope that, following the device of our 
Alma Mater. Omnia probate qnoci boiuan est 
tenetc, we will accomplish our duties. 



Dr. Russell Hardy Dean, class of 1912, of 
Jacksonville. Fla., has been forced, because of 
ill-health, to go to the mountains of North Caro- 
lina for relief. 



THE HOSPITAL BULLETIN 



i4'» 



REASONABLE AND PLEASURABLE. 



By X vi ii \v Wixsi n\v. Al.l ' 



Travel has been made so safe, reasonable ami 
comfortable these days that everybody should, if 
possible, become acquainted with his own conn 
try. Instead of hibernating at a summer or moun- 
tain resort, sitting around and gossiping, better 
use can be made of the time at your disposal by 
visiting new scenes and getting new ideas. With 
this object in view, accompanied by Mrs. Winslow, 
T sailed September 11, [912, from Baltimore on 
the Merchants & Miners' steamship Suwannee 
for Savannah and Jacksonville. This vessel is one 
of the best appointed coastwise steamers that 
sails out of any Atlantic port, being fully 
equipped with every convenience necessary to the 
comfort of its passengers and providing a sub- 
stantial and excellent cuisine. 

The trip down the bay was made at night, and 
the next morning by 8 found us passing between 
the capes into the ocean. Thursday was spent on 
the ocean, as well as a part of Friday, the Savan- 
nah River being entered about 9 P. M. on the lat- 
ter day and the boat docked by 11, where it re- 
mained until 7 P. M. Saturday, sailing thence to 
Jacksonville, which was reached 10 A. M. Sun- 
day morning. 

Savannah is situated on the south bank of the 
river of the same name, 18 miles from the sea, 
on a level plateau about 50 feet above sea level. 
It is a very attractive city, with numerous parks 
and some very pretentious buildings. Every- 
where you turn you run into a small square or 
park, not, as in Baltimore, posted with signs of 
"Keep Off the Grass," but given over to children 
as play and airing grounds. The streets are well 
paved, mostly with vitrified bricks, and well-made 
roads lead into the surrounding country, thus 
offering opportunity for enjoyable auto and 
buggy drives. 

The show place of Savannah is the Ronaven- 
ture Cemetery, with its magnificent live oaks, 
from which hang in festoons streams of Spanish 
moss. While in this city we called upon Miss 
Raines, a graduate of the University Hospital 
Training School for Nurses, now superintendent 
of Oglethorpe Sanitarium, and were shown 
through the hospital, which accommodates about 
35 patients. It is a very attractive and well 
equipped building. While there 1 met Or. Ray- 



mond V. Harris, class of [907, who took us 
around the city in his motor car. We traversed 
miles of well-paved streets and well-made COlin 
try roads, passing through substantial develop 
ments, dotted with attractive, modern homes. The 
courthouse, city hall, custom-house and postoffice 
are all modern and architecturally pleasing. Sa- 
vannah leaves the impression of a conservative, 
but substantial town, not going ahead too rapidly, 
but steadily and naturally. This impression was 
afterwards verified when I learned that in point 
of export trade Savannah ranks seventh, being 
next in importance to Baltimore. 

The River Queen has made the Savannah 
River famous. This lady, who, together with 
her brother, keeps a river lighthouse, never fails, 
night or day, to salute a passing vessel — at night 
by waving a lantern, by day a handkerchief. By 
some a romance is supposed to be attached to the 
action, and the common story is that the woman 
became demented by the loss of her lover at sea, 
and since then has saluted each vessel, hoping that 
he may yet pass by and recognize her. The story 
as related is very pretty and has a natural ring, 
but is a myth, the woman being entirely rational 
and never having had a lover — at any rate, one 
who was lost at sea. 

Jacksonville is a 12-hour sail from Savannah. 
It is situated on the west bank of the beautiful 
St. Johns River, 25 miles from the ocean. It is 
very progressive, and jumping by leaps and 
bounds both in population and commercial impor- 
tance. Everything going into or coming out of 
lower Florida must pass through its walls, thus 
making of it a commercial mart of great impor- 
tance. It is a large lumber, citrus, turpentine and 
produce shipping center. The streets, though 
narrow, are well paved, mostly with vitrified 
brick. In the business section are to be seen a 
number of modern office, banking and trust build- 
ings. Here are also to be found numerous parks. 
full of bright-colored flowers, live oaks, syca- 
mores, chinatree, magnolia and palm trees. The 
banana tree grows in this latitude, but only ex- 
ceptionally bears fruit. The residential districts 
are attractive and contain quite a number of im- 
posing houses. 

While here I called up Dr. Norman M. Heggie, 
class of 1502. who is a leading eye, ear, nose and 
throat specialist. He has built up a large practice, 
and we are glad to announce is held in the greatest 
respect by his associates and clientele. He took 



15° 



THE HOSPITAL BULLETIN 



us in his automobile around the city and a long 
ride to Pablo Beach, 18 miles from Jacksonville, 
on the Atlantic Ocean. On this ride we passed 
through miles of pine forest, from the trees of 
which turpentine was being extracted. At Jack- 
sonville there is a large ostrich and alligator farm. 
It was indeed a rare sight to see over 700 alliga- 
tors, of all ages and sizes, in one enclosure. 

While I was in Jacksonville I had the pleasure 
of seeing, besides Dr. Heggie, Dr. Russell Dean. 
class of 1912; Dr. James D. Love, class of 1897: 
Dr. Charles Leitner Jennings, class of 1906, and 
caught a glimpse of Dr. George Walter, class of 
1910, as he flew past in his auto. Dr. Robert H. 
McGinnins, class of 1897, and Dr. James B. Par- 
ramore, class of 1909. were out of the city. I 
called up Drs. Charles Edward Terry, class of 
1903 ; Fred J. Waas, class of 1905, and Dr. Louis 
Stinson. class of 191 1. by phone, but could get no 
aibwer, so was compelled to forego the pleasure 
of seeing them. 

With Miss Nettie Flannigan, class of 1901, of 
the University Hospital Training School for 
Nurses, who is superintendent of the De Soto 
Sanitarium, we spent a very pleasant afternoon 
automobiling around the surrounding country. 

A dav was also spent in St. Augustine, the old- 
est city in the United States. It is 40 miles dis- 
tant from Jacksonville, located on the Matanzas 
River, and is a place of great historic interest. 
Here is to be seen the Old Spanish Mission Build- 
ing, without doubt the oldest building in America, 
the records of which are preserved in the archives 
of the Church of Rome. The Ponce de Leon and 
Alcazar hotels are magnificent samples of old 
Spanish architecture, and the "Fountain of 
Youth." discovered by Ponce de Leon on Easter 
Sunday of 15 13. a quaff of whose waters was sup- 
posed to restore youth, never fails to interest. It 
possesses, however, one peculiarity — the water 
rises and falls without any apparent reason or 
cause. Old Fort Marion, the only example of 
medieval fortification in existence on this conti- 
nent, was built in 1565 by Menendez, and named 
San Juan de Pinos. It was rebuilt as Fort Marion 
during the seventeenth century. The City Gates, 
like those of Panama, remain to tell of the Old 
World civilization that once dwelt within the city 
walls ; the slave market, which was never so used 
save in rare instances ; the narrowest street in the 
United States, but seven feet wide at its east end; 
the Cathedral of St. Augustine, built in 1797: the 



old Franciscan Monastery, now the arsenal of the 
Florida National Guard, and the houses of 
coquina, a shell formation — one after the other 
present a panorama of never-ending interest and 
entertainment. 

The return voyage was over the same route. 
Outward bound Dr. Adam Clark Walkup, class 
of 1909, of Mcintosh. Fla.. was among the ship's 
company. He had been spending a few weeks' 
vacation in New York, and was on his way home. 
Dr. Walkup was looking in the best of health, and 
told me he had been very successful and was 
building up a good practice. 

Although the trip was replete with many new 
and novel sights, and was thoroughly enjoyable 
from beginning to end, my greatest pleasure and 
satisfaction was in the evident prosperity and hap- 
piness of our alumni now located in those cities. 



Prof. Randolph Winslow is in receipt of the 
following letter from Dr. Edward L. Meierhof, 
class of 188 1 : 

"My Dear Dr. Winslow : 

"Enclosed please find my promised instalment 
as a contribution to the P. E. F. I have just re- 
turned from abroad, where I had attended the 
clinics at Jena, Yienna and Berlin. The old town 
of Jena I found very interesting. It is the home 
of the great Zeiss Optical Works, which cover 
about three of New York city blocks, or more. 
Some of the profits of this institution are given 
to the support of the university and hospitals. It 
is also the home of Ernst Haechel. whose popular 
book, 'The Riddle of the Universe,' has helped 
to spread his name and fame. Yienna has a new 
hospital devoted to nose and throat diseases. It 
is splendidly equipped, especially for teaching. 
It is part of the Allgemeines Krankenhaus. and 
is attended by many 'Ainerikanische Aertzte.' 

"Berlin is a lively and hustling town. There 
are not as many of our countrymen pursuing the 
furtherance of clinical knowledge as in Yienna. 
although I profited very much by my stay in 
Berlin, as well as in the other places. 

"With best regards, from 

"Yours sincerely. 

"E. L. Meierhof.'' 

P. S. — I think you are the youngest man I have 
had the pleasure of knowing. 



THE HOSPITAL BULLETIN 



15 r 



THE USE OF IODINE IN OBSTETRICAL 
PRACTICE. 



(In 264 cases with no infection.) 



From the Clinic of Dr. Sprigg and Dr. Keller, 
Columbia Hospital, Washington, D. C. 



By Willis Linn, M.D., Resident House 
Surgeon. 



Following the marked success of the use of 
iodine in preparation of surgical cases, it occurred 
to us, as perhaps it has to others in the same line 
of work, that its use in obstetrical cases might be 
of benefit. The objection was raised by some 
that the use of iodine in the external genitalia 
would be far too irritating. We have not found 
that it causes any irritation, the patients complain 
for a moment directly after it is applied, but aside 
from this transitory burning the irritation caused 
is negative. The method pursued is as follows: 
As soon as the patient is placed on the delivery 
bed the pubic hairs are clipped with scissors ; 
shaving is unnecessary and causes much more in- 
convenience after delivery. The parts are then 
dried of mucus and any amniotic fluid that may 
be present, if the membranes are ruptured, a 
50 per cent, solution of tincture of iodine in alco- 
hol is then applied, commencing at the um- 
bilicus and including the lower portion of the 
abdomen, the entire genitalia well down on the 
buttocks and inner side of legs and thighs. A 
sterile vulval pad is then put in place, and the re- 
mainder of the preparation consists in merely 
placing the patient on a sterile bed pan and plac- 
ing the sterile covers on. These last are not 
done, however, until bulging is marked. In using 
the flat sterile bed pan in delivery cases, the Kelly 
pad is done away with altogether. Time and ex- 
pense are thus both saved and the pan is much 
easier to sterilize than is the pad. The method 
is quick. The slop and dirt of the old bichloride 
preparation is done away with, and the inflamma- 
tion which certainly occurred in some cases when 
using the bichloride is overcome. We have had 
no cases of inflammation following the use of 
iodine. Dr. Charles Duffy of Pittsburgh tells me 
that he has seen two, but that the use of glyceride 
of starch applied locally cleared them up in less 
than 24 hours. In hospital maternity work, 
where cases are constantlv being sent in, which 



have been examined by septic fingers before de- 
livery, we separate the labia as far as possible 
and carry a sponge on a hemostat well up into 
the vagina, thus applying the iodine to the in- 
terior. Of course, in these cases, we are going 
against the advice of Bovee, who showed the 
surgical world that iodine acts best on a dry 
held, but we have gotten results that prove that 
iodine will and does sterilize the vaginal canal. 
It is doubtlessly better on a dry field, but in cases 
that have been previously examined it is well to 
use it in the interior as well. In that large class 
of the cities' poor and lower classes, where a phy- 
sician is often not called until delivery is all but 
complete, it has proven very satisfactory ; and 
in the private home, where trained assistants are 
so often wanting and the old method was hard to 
carry out, it should be most satisfactory. 

I see no reason why it could not be intrusted to 
midwives, and in this way might save not a few 
lives from that most dire of obstetrical results — 
puerperal sepsis. The 50 per, as it is now com- 
monly called, does not end its usefulness in ob- 
stetrics here, for after the cord has been tied and 
cut its application to the end of same assures at 
least a clean field. This will not appeal to men in 
hospital work where the technique is certain, 
but in the "private home" and in the hands of 
the midwife it seems to us that it would not be 
amiss. We do not claim for the method that it 
is original with us, but it does surely possess the 
following advantages : 

1. It is quick. 

2. It is sure. 

3. It shows the exact field of operation which 
has been sterilized. 

4. It can be done without assistance from 
anyone. 

5. Aside from the temporary burning it 
causes no inconvenience to the patient. 

6. It does away with the wet, sloppy "bi- 
chloride bath." 

7. It brings results. 

May 19, 1912. 



The engagement is announced of Dr. William 
Gwynn Queen, class of 1909, of Arlington, Md., 
t<> Miss Loretta Wholey, daughter of Mr. and 
Airs. William Wholey, of Staunton, \"a. The 
marriage will be performed at St. Francis Cath- 
olic Church on Tuesday, October 15, 191 2. 



152 



THE HOSPITAL BULLETIN 



THE HOSPITAL BULLETIN 

A Monthly Journal of Me u ine and Surgery 

PUBLISHED BV 

THE HOSPITAL BULLEI IN COMPANY 

608 Professional Building 

Baltimore, Via 



Subscription price, . . . $1.00 per annum in advance 

Reprints furnished at cost. Advertising rates 

submitted upon request 



Nathan Winslow, W.D., Editor 



Baltimore, October 15, 1912. 



BERI-BERI CLINIC. 



Professors Zueblin and Spear will hold in the 
amphitheater of the University Hospital on Mon- 
day, October 21, at 8.30 P. M., a clinic on beri- 
beri, with exhibition of cases. All those inter- 
ested in this disease, rare in this section, are cor- 
dially invited to be present. 



DR. J. HOLMES SMITH, Sr. 



The editor of The Bulletin' cannot let pass 
the retirement of Dr. Smith from active practice 
in order to devote his entire time to the depart- 
ment of anatomy without recording our senti- 
ments concerning the act. A protocol was is- 
sued by the Regents of New York that medical 
schools to be registered in that State must have 
at least six full-paid instructors in the laboratory 
branches. In order to meet this command, Dr. 
Smith, without a murmur, consented to forego 
the remuneration of a large and lucrative surgical 
practice. Such acts of unselfishness marks a 
man — a patriot not alone to the cause of educa- 
tion, but also to an ideal, a greater Universitv of 
Maryland. The Bulletin appreciates the mo- 
tive which induced Dr. Smith to devote his atten- 
tion to pedagogical work, and desires to take this 
opportunity in wishing him many years of use- 
fulness in his newly-mapped-out career. 



THE OPENING OF THE SESSION 1912-13. 



The loOth annual session of the medical de- 
partment of the University of Maryland began on 
October 1. At this time i.t is impossible to state 



how many students will be in attendance, as the 
enrollment is still going on. It is thought, how- 
ever, that there will be fewer new students than 
usual, owing to regulations enforced by the New 
York Board of Education. There have been many 
applications for advanced standing from students 
of other colleges, who wished to obtain better 
clinical facilities than those ottered by the institu- 
tions in which they had taken their first two years' 
work, but we were unable to accept them, owing 
to the New York regulations. These were not 
conditioned students, but men who had success- 
fully completed their first two years in respectable 
schools which we have hitherto recognized and 
which we still believe to be good and honorable 
schools. We think that the New York ruling in 
regard to these schools is unduly drastic, but we 
have obeyed their mandate. We are glad to an- 
nounce that the State Board of Medical Examiners 
has taken supervision of the entrance require- 
ments of medical students in this State, and that 
Professor ( His of the Baltimore Polytechnic In- 
stitute has been appointed official examiner of the 
credentials of prospective medical students. Stu- 
dents are therefore only admitted to the medical 
colleges when they present certificates from Mr. 
Otis giving them premission to do so. The ad- 
mission of students is therefore entirely out of the 
hands of the deans, which simplifies the situation 
very much. The uncertainty in regard entrance 
requirements and the rapid advancement of edu- 
cational qualifications will undoubtedly deter many 
from the study of medicine, and the entering 
classes will probably be smaller than usual this 
winter. 



IMPR( >YEMENTS AND CHANGES. 



Much has been done since the last session to 
put the medical school on a better basis. First of 
all, six full-time salaried instructors have been 
secured ; and a new professor of medicine, who is 
also a full-time teacher, for this winter at least. 
The anatomical and chemical theaters have been 
beautifully renovated, and a fine museum has been 
established. A balopticon has been purchased ami 
will be set up in the lower hall. 

Davidge Hall has not only had a coat of paint, 
but a steam-heating system has been introduced. 
New shelving has been put in the library, thereby 
greatly increasing its capacity. Many new books 
have been donated and some bought. The main 



HE HOSPITAL BULLETIN 



'53 



lobb) of the medical school has had a fine terazzo 
floor laid. .Much painting and calcimining has 
been done in the lecture-rooms and laboratories. 
A new clinical laboratory has been established at 
the hospital. The Eormer lying-in hospital has 
been converted into a polyclinic for general medi- 
cal and children's diseases. New apparatus has 
been purchased, and a new spirit of enthusiasm 
and of optimism prevails. 



Til!': PATHOLOGICAL FUND. 



Festina lente, or make haste slowly, is doubtless 

a safe adage, but it has its disadvantages when ap- 
plied practically. The above aphorism is forcibly 
impressed on the mind of the writer by the pres- 
ent state of the endowment fund. It certainly 
does not make haste in any direction except slow- 
ly. The best that can be said of it is that it does 
progress slowly. Hope deferred maketh the heart 
sick. Please do not defer your contributions un- 
til our heart becomes too sick for recovery. All 
of which means : Please help us out. 

CONTRIBUTION BY CLASSES. 

1848 $50 OO 

1864 20 OO 

1868 IO OO 

1871 35 00 

1872 81 84 

!873 44i 83 

1874 5 00 

1875 5 00 

1876 115 00 

1877 10 00 

1880 5 00 

1881 250 OO 

1882 310 00 

1883 40 00 

I 884 40 00 

1885 235 00 

1886 100 00 

1888 50 00 

1889 100 00 

1890 175 00 

1892 150 00 

1893 40 00 

!894 135 o° 

1895 155 00 

1896 52 00 

1897 80 00 

1898 105 00 

1899 =;o 00 



1900 21 5 00 

I ' I > I 260 OO 

I 00_' 33O OO 

1903 ■ 3*5 00 

1904 i35 00 

1905 220 00 

1906 165 00 

1907 no 00 

[908 20 00 

1909 5 00 

1 010 50 1 

191 1 Terra Mariae 3 50 

1012 Club Latino Americano 25 00 

Total subscriptions to < let. 1, 1912.. $10,250 17 

NEW SUBSCRIPTIONS IN SEPTEMBER. 

Dr. Win. I\. White, 1902 $25 00 

Dr. Watson S. Rankin, 1901 20 00 

Class of 1872 1 1 84 

Class of 1873 11 83 

Total $68 67 



1)1 



ERNEST ZUEBLIN. 



Some time back The Bulletin notified its 
readers that Dr. Charles VV. Mitchell was com- 




I)R. ERNEST ZUEBLIN 



154 



THE HOSPITAL BULLETIN 



pelled, owing to press of other duties, to give up 
the chair of Practice of Medicine and limit his 
efforts in medical teaching entirely to his first 
love, the children's department. Coincidently 
with this announcement there appeared' the call 
to the vacancy and its acceptance by Dr. Ernest 
Zueblin, together with a short sketch of the ap- 
pointee's life and qualifications, and the prognos- 
tication that he was the right man for the place. 
A closer acquaintance with our new professor 
has strengthened us in our previous opinion of 
him. We are particularly impressed with the 
method he has employed in organizing his depart- 
ment. The slightest detail does not seem too 
small to merit attention. He is, according to a 
slang expression, "on the job," and if his enthus- 
iasm and earnestness are criteria, we bespeak for 
the medical department of the University of 
Maryland a prestige second to none in the coun- 
trv. 



ITEMS 



The most recent work published by a member 
of the faculty of medicine is a Manual of Prac- 
tical Physiology, bv Prof. John C. Hemmeter, 
LLD.. Ph.D. 

A number of highly interesting and valuable 
reviews and comments upon Professor Hem- 
meter's Manual of Practical Physiology have 
been received. These are by authorities so emi- 
nent and who give their opinion so rarely that 
the editor believes they should be brought to the 
notice of the readers of the Hospital Bulletin. 

One is by Prof. H. J. Hamburger, the pro- 
fessor of physiology at the Royal University of 
Groningen, who writes: 

"May I heartily congratulate you on the com- 
pletion of this excellent work? It will be a splen- 
did adviser to me and I shall not fail to recom- 
mend it to my students immediately at the begin- 
ning of the next course in the warmest manner." 

Dr. E. Laqueur has published a review of it in 
the Biochemisches Centralblatt. He begins in the 
following manner: 

"This Manual of Physiology deserves to attract 
the attention also of German students and 
readers ;" and after reviewing the various chap- 
ters in some detail he continues : 

"An extensive series of vivisection operations, 
though clearly and concisely given, will hardly be 
capable of execution by German students, in the 



time at their disposal, but their concise yet com- 
prehensive presentation is well suited to give the 
student a picture of the physiological operations 
which are so important for our modern concepts. 

"The illustrations are highly instructive, those 
from the Woods Hole Laboratory of the United 
States Bureau of Fisheries being so simple, yet 
clear, that one cannot fail to detect the experi- 
enced work of Professor Hemmeter." 

Professor Brubacker of Jefferson Medical Col- 
lege: 

"In the first place, let me congratulate you on 
the successful manner in which you have accom- 
plished your object. In the part of the book re- 
lating to muscle and nerve, and to physiology of 
the heart, the experiments are well selected, the 
methods of performing them carefully indicated, 
and therefore the student himself should have no 
difficulty repeating them. In the latter half of the 
book the experiments seem rather difficult to 
carry out by students in classes, owing to the ap- 
paratus required and the inherent difficulty of 
some of the problems. With small groups and an 
efficient demonstrator, they will prove most in- 
structive. I hope the book will have a large sale, 
and thus contribute to the development of physio- 
logical science along practical lines." 

Prof. William T. Councilman, Harvard Uni- 
versity : 

"I have received and gone over your Manual 
of Physiology, which I think is extremely good." 

Prof. J. B. Pawlow, director of the Imperial 
Russian Institute for Military Medicine, St. 
Petersburg : 

"Highly Honored Colleague — I bring my best 
thanks for the kind presentation of your book, 
Manual of Physiology, which I have read with 
great interest. The working out of a normal plan 
for practical demonstration and study of physi- 
ology is the most important object of the present 
time, and. in which you have succeeded." 

Professor Pawlow is universally acknowledged 
to be the foremost physiologist of the day. 



Dr. William Wilhelm Craven, class of 1903, of 

Huntersville, N. C, was appointed resident physi- 
cian in the McKeesport (Pa.) Hospital shortly 
after graduation, and served there a year, then 
went to North Carolina, where he opened an office 
in Huntersville. Dr. Craven remained in Hun- 
tersville a little more than a year, and had a most 
excellent practice, but decided to give it up to 



THE HOSPITAL BULLETIN 



155 



accept a position as physician for the Carolina, 
Clinchfield & Ohio Railway Co., which at that 
time was extending its lines through the moun- 
tains of Western North Carolina. He served 
with them two years, then returned to his former 
location in Huntersville and again took up his 
practice there. Dr. W. S. Davidson, class of 
1887. is also located at Huntersville. 



Dr. George C. Battle, class of 19 12. has re- 
signed as assistant resident physician of the 
Municipal 1 [ospital for Tuberculosis because of 
ill-health. 



Dr. Dempsey William Snuffer, class of 1906, 
of Becklev. W. Ya., has been appointed president 
of the board of health for Raleigh county, West 
Virginia, for a term of four years from Septem- 
ber 1, 1912. 



Dr. John Turner, Jr.. class of 1892, has re- 
signed as physician to the city employes at Loch 
Raven. 



Dr. Ernest Zueblin, whose opening address to 
his students is published elsewhere in this issue, 
arrived in Baltimore on September 18 and spent 
the 19th in the University Hospital attending to 
patients. 



Dr. Calvin Todd Young, class of 1903, of Plant 
City, Fla., was a delegate from Florida to the In- 
ternational Congress on Demography, held in 
Washington recently. Dr. Watson Smith Ran- 
kin, class of 1901, secretary of the State Board of 
Health of North Carolina, was also a delegate 
from North Carolina, and both he and Dr. Young 
availed themselves of the opportunity to slip over 
from Washington to visit their old friends at the 
Universitv. 



Dr. Howard Steele Holloway, class of 1903, 
formerly assistant resident physician at the Uni- 
versity Hospital, has located at Chattahoochee, 
Fla. 



The sophomore medical class has elected offi- 
cers for the coming year as follows : President, 
Mark' V. Ziegler of Maryland; vice-president, 
Franklin B. Anderson of Maryland; secretary, 
Michael J. Egan, Jr., of Georgia ; treasurer, Bas- 
com L. Wilson of North Carolina ; sergeant-at- 



arms, Lyle Leeland Gordy of Maryland, and his- 
torian, Dorsey Paul Etzler of Maryland. The 
honor committee consists of John Lowry of North 
Carolina, Harry Jesse Gilbert of New Jersey, 
Lyle Leeland Gordy of Maryland, Louis Diener 
of Yirginia and Xevins B. Hendrix of South 
Carolina. 



Dr. William Michel, class of 1912, will hold a 
German class during the coming year for the ben- 
efit of the resident staff of the University Hos- 
pital. 



Among the recent visitors to the L T niversity 
Hospital were : 

Dr. Charles E. Terry, class of 1903, of Jack- 
sonville, Fla. 

Dr. Norman S. Dudley, class of 1901, of 
Church Hill, Md. 

Dr. L. M. Allen, class of 1896, of Winches- 
ter, Ya. 

Dr. J. Ernest Dowdy, class of 1909, of Win- 
ston-Salem, N. C. 



Dr. William T. Rowe. class of 1890, of Meyers- 
dale, Pa., had the misfortune to be thrown from 
his automobile on October 8 while returning 
home from the funeral of a brother physician — 
Dr. John S. Garman. Dr. Rowe turned aside to 
avoid crashing into a carriage ahead of him in 
which were attendants at the funeral, and his ma- 
chine plunged over an eight-foot embankment. 
He was severely cut about the face. 



The Baltimore Xezvs of September 25 gives 
rather an interesting account of the life of Dr. 
John Samuel Fulton, class of 188 1, whose work 
in the International Congress on Tuberculosis 
and the International Congress on Demography 
is so well known. Of his life it writes: 

"Though born in Ohio (in Fremont, in 1859), 
John Samuel Fulton was educated in Maryland, 
having received his bachelor of arts degree from 
old St. John's (1876) and his doctor of medicine 
degree from the University of Maryland. He is a 
loyal son of the State of his adoption, a fondness 
shown first of all by his marriage with a Mary- 
land girl. Miss Nancy White of Salisbury, where 
he practiced as a young man, and by the pride 
he takes in his Maryland and Baltimore citizen- 
ship. It is said that he never misses an oppor- 
tunity to register and vote, and keenly feels his 



i 5 6 



THE HOSPITAL BULLETIN 



responsibility in all matters of public welfare. 
'A good citizen' is the verdict of 'those who are 
familiar w ith the man and his work. 

"However, his manifold duties as a 'public 
hygienist' have not interfered in the least with 
his responsibilities as a father. To his three sons, 
the eldest of whom has just received his bachelor 
of arts degree from the Hopkins, he is said to be 
a 'boy with his boys,' enjoying their sports and 
pleasures with the same zest and heartiness as if 
he were a college lad himself, lie is equally de- 
voted to his daughters, the eldest of whom grad- 
uates from Goucher this coming June. The sport 
he is most fond of is sailing. In fact, it is said 
he never will be old, because he always sees 
the happy side of things and generously makes 
allowance for shortcomings of the 'other fel- 
low.' " 

The News goes on, and in writing of the per- 
sonal qualities of Dr. Fulton, quotes his secretary 
as follows : 

"He is the kind of man who believes in giving 
every fellow his chance. He looks at humanity 
not merely as a man, but as a collection of indi- 
viduals in which every allowance should be made 
for everybody. 

"Maybe I could best illustrate that by a little 
incident that happened the other day. A letter 
came for Dr. Fulton from a woman way off 
somewhere and containing most unreasonable 
requests. Among other things she wanted all the 
literature of the Congress to be mailed to her free 
of charge, as she had not the money to pay for 
it. I called Dr. Fulton's attention to it, but in the 
great rush of our work put it aside, intending not 
to bother him with it again until later. The very 
next morning he asked me about it and told me 
to be sure to give that poor woman all she had 
asked for. 

"As a Baltimorean you ought to know that he 
was one of the men who were chiefly responsible 
for getting up the big tuberculosis conference in 
Baltimore in 1904, just before the fire, and that 
for years he was the secretary of the Maryland 
State Board of Health." 

And The News showed up the humanness of 
the man by asking him if he was not proud and 
happy over his work in Washington and receiving 
the answer, "Not half so proud as I am of that 
little senior of mine up at ( lonelier." 



Dr. FitzRandolph Winslow, class of 1900. 
served as superintendent of the University Hos- 
pital during the absence of Dr. William J. Cole- 
man upon his vacation. 



Miss Esther E. Brewington, University Hospi- 
tal Training School for Nurses, class of 1907, has 
been appointed assistant to Miss Rosamond Min- 
nis, class of 11)07, m the James Walker Memorial 
Hospital in Wilmington, Del. 



Dr. Wallace Sellman. class of m;o3, formerly 
of Fairmont, W. Va., has temporarily discon- 
tinued the practice of medicine. 



Miss E. Janie Guerrant, University Hosptial 
Training School for Nurses, class of 1904, who 
was operated upon recently in the University 
Hospital for an injury to her knee, is doing nicely. 



Dr. George M. Settle of the Neurological De- 
partment has returned from a vacation, which 
he spent in Savannah and Jacksonville. 



Dr. Gideon M. Van Poole, class of 1899, Major. 
Medical Corps, U. S. A., is stationed at Fort 
Washington, Md. 



The sixth full-time man to be appointed in the 
University is Dr. Bert Jacob Asper, class of 191 1 . 
who will be instructor in pharmacology and clin- 
ical microscopy. 



Dr. Frank Lynn, class of 1907, who has been 
visiting in Ohio, has returned home and resumed 
his practice. 



The University building has been completely 
renovated. The laboratories which were built 
upon the surgical ward porch have been opened. 
One will be used by the visiting staff for special 
work and the other for the general routine work 
of the hospital. A new steam plant has been in- 
stalled in Davidge Hall. The museum has been 
completely overhauled and the specimens so ar- 
ranged that they can be used for teaching pur- 
poses. A terrazzo floor has been laid in the main 
hall of the University building. The old mater- 
nity building has been reconstructed and opened 
as an annex to the dispensary, and will be used 
by the medical department. The library will be 



THE HOSPITAL BULLETIN 



i.v 



Open four hours daily, from 12 to 4, instead of 
two hours, as heretofore. 



Dr. Thomas Henry Legg, class of 1907, of 
Union Bridge, Md., was a recent visitor to the 

I Diversity I lospilal. 



Tampa — Lester Julian Efird, class of 1903, 405 
[Boulevard ; Rollin Jefferson, class of 1903, 609 >4 
franklin street; J. Brown Wallace, class of 1897, 
1 >;>'_• Franklin street. 



Dr. Morris R. Bowie, class of 1908, of Somer- 
set, Colo., who has been spending the summer in 
Scotland, is the guest of Dr. Albert Hyson Car- 
roll, class of 1907, for a few days 



Among the University alumni practicing in 
Florida are: 

Tionifay — R. S. Maneely, class of 1904. 

Citra — Robert Lawson Kennedy, class of 19 1.0. 

Daytona — James E. Rawlings, class of 1904. 

Jacksonville — Samuel Gilman Glover, class of 
1910, resident physician St. Luke's Hospital; 
Howard S. Holloway, class of 1903, Bay and 
Laura streets; Franklin Pierce Hoover, class of 
1884, Mutual Life Building; Chas. L. Jennings, 
class of 1906, 332 W. Monroe street ; Claude Joy- 
ner, class of 1888, 400 W. Ashley street ; John 
Hartridge Livingston, class of 1878, 304 Newman 
street; Jas. D. Love, class of 1897, 501 Laura 
street; Robert Lee May. class of 1890, 17 W. 
Beaver street ; Robert H. McGinnis, class of 1897, 
501 Laura street; J. Denham Palmer, class of 
(872, Doty Building; James It. Parramore, class 
of 1909, 412 E. Monroe street; Louis Stinson, 
class of 191 1, 107 Ocean street; Charles Edward 
Terry, class of 1903, City Hall; Fred. J. Waas, 
class of 1905, 108 W. Adams street; George Wal- 
ter, class of 1910, 131 W. Adams street. 

Lake City — Abner J. P. Julian, class of 1883. 

Lakeland — Cicero W. Love, class of 1902. 

Lake Weir — Hugh W. Henry, Jr., class of 189T. 

Lawtey — George W. Brown, class of 1889. 

Mcintosh — Adam Clark Walkup, class of 1909. 

New Smyrna — William C. Chowning, class of 
1904. 

Ocala — Arthur L. Liar, class of 1889. 

1 )rlando — Sylvan McElroy, class of 1907. 

Plant City — Calvin T. Young, class of 1903. 

Ouincy — Clyde C. Mack, class of 1904. 

Sanford — Oscar Wcntworth King, class of 
1007; Samuel Puleston, class of 1902. 

Tallahassee — Benjamin J. Bond, class of 1904; 
Fred Clifton Moore, class of 1003 ; Henry Ed- 
wards Palmer, class of 1892. 



Dr. John Rawson Pennington, class of 1887, of 
4620 Kenmore avenue, Chicago, 111., presented a 
paper on the X-rays as an Aid in making Diag- 
nosis of Conditions in the Rectum and Other 
Portions of the Large Intestine at the fourteenth 
annual meeting of the American Proctologic So- 
ciety, held in Atlantic City, N. J., June 3 and 4, 
1 912. Dr. Pennington stated that "while the rec- 
tum is easily inspected by various specula, and 
the sigmoid is less readily accessible by the use of 
sigmoidoscopes, such as the one with insufflation 
devised by him, the colon is inaccessible and its 
exact position difficult to ascertain. Very often 
it is also difficult to determine and locate patho- 
logic conditions in the large intestine. 

"Until recently the means of diagnosis have 
been limited to those used in other portions of the 
alimentary canal, viz., inspection after dilatation 
of the bowel with air or water, palpation, percus- 
sion and trans-illumination. All of these are 
open to the objection that they are uncertain. 

"The writer observed in the latter part of 1899 
that by introducing some agent into the large 
bowel which would cast a shadow, the X-rays 
may become useful in making a diagnosis of con- 
ditions in the twin cavities. It is only recently, 
ho\ve\ er. that such procedures have become of 
practical value. 

"A bismuth meal is useful in diseases of the 
stomach or duodenum, the agent being suspended 
in milk, acacia water, thick soup or some similar 
vehicle. 

"But for the large bowel the action of bismuth 
per os is very slow. One author estimates that it 
requires from 12 to 15 hours for the bismuth mix- 
ture to reach the ileo-cecal valve ; about 24 hours 
to gain the transverse colon, and 36 hours to pene- 
trate to the sigmoid. By the method advocated 
this is done, so to speak, instantaneously. 

"Coming now to the technic : The patient's 
bowels are first cleansed by means of laxatives 
and injections. He is then placed in the knee- 
shoulder position, and from 25 to 30 ounces of the 
mixture used for casting the shadow injected into 
the large intestine. For this purpose the author 
uses an ordinary irrigator and a short rectal tip. 



158 



THE HOSPITAL BULLETIN 



A long rectal or colonic tube for administering the 
injection is unnecessary. After the suspension is 
injected the patient lies on his right side for a few 
moments so part of the menstrum may pass into 
the cecum. He is then placed in either dorsal or 
ventral position on the radiographic table and the 
picture taken." 

Dr. Pennington is one of the best known of 
the University alumni. He takes a most promi- 
nent part in the work and meetings of the Ameri- 
can Proctologic Society. He occupies the chair 
of rectal diseases in the Chicago Polyclinic and 
Hospital. 



Among the University alumni practicing in 
Illinois are: 

Cairo — Henry W. YVickes, class of 1892, Sur- 
geon U. S. P. H. and M. H. S. 

Charleston — Christopher C. Webb, class of 
1 881. 

Chicago— Philip Adolphus, class of 1858, 1639 
Washington Boulevard ; Metellus R. Barclay, 
class of 1889, 838 N. Clark street; Perry L. 
Boyer, class of 1899, Captain M. C, U. S. A., 
Federal Building; John H. Chew, class of 1863, 
1223 Astor street; Daniel David Coffey, class of 
1903, 1347 Noble street; Lawrence De Lancy 
Gorgas, class of 1883, 1504 E. 57th street; Louis 
M. Maus, class of 1874, Colonel M. C, U. S. A., 
Central Division; Chas. W. Morrow, class of 
1887, 6334 Monroe street; John Rawson Pen- 
nington, class of 1887, 31 N. State street; David 
Salinger, class of 1894, 31 N. State street; Oliver 
Tydings, class of 1877, 31 N. State street; An- 
thony Kimmel Warner, class of 1885, 1024 Bel- 
mont avenue; George Young, class of 1887, Sur- 
geon U. S. P. H. and M. H. S., City Hall. 

Collinsville — Lay Gordon Burroughs, class of 
1906. 

Fort Sheridan — Gideon McD. Van Poole, class 
of 1899, Major M. C, U. S. A. 

Grand Tower — William Robert Gardinar, class 
of 1910. 

Peoria — Leonard H. Spalding, class of 1869, 
805 N. Jefferson avenue. 

Sullivan — Geo. Brinton Kessler, class of 1890. 



A portrait of Dr. James H. Jarrett, class of 
1852, of Towson, Md., will be on exhibition at 
the meeting: of the Baltimore County Medical 



Association, October 16, 1912. Dr. William J. 
Todd will read a sketch of Dr. Jarrett's life, and 
the picture will be later presented to the Medical 
and Chirurgical Faculty of Maryland. Dr. Jar- 
rett has practiced in Maryland for fifty years. 



Dr. Lewis Mines Allen, class of 1896, of Win- 
chester, Ya., was elected secretary-treasurer of 
the Shenandoah Valley Medical Society at Har- 
risonburg, Ya. 



Dr. Ernest Seth Bulluck. class of 1911, of Wil- 
mington, N. C, has been taking a post-graduate 
course in New York. 



Mr. Howard E. Lecates of the Senior Class, 
who recently underwent an operation on the neck, 
is recuperating at his home in Delaware. 



Dr. Melchoir Gist Cockey, class of 1879, °f 
Salina. Kansas, was a recent visitor to Baltimore 
and to his former home in Cockevsville, Md. 



Dr. Lawrence E. McDaniel, class of 191 1, has 
been appointed resident physician to Blue Moun- 
tain House, Pen Mar. Md. 



Among the recent visitors to the University 
Hospital was Dr. Thomas Malcolm Bizzell, class 
of 1908, of Goldsboro, N. C. 



The class of 1908 of the Medical School will 
hold a reunion in Baltimore in May, 1913. 



Miss Mary Louise Gephart. University Hospi- 
tal Training School for Nurses, class of 191 1, has 
resigned as superintendent of the Havre de Grace 
Hospital and has resumed private work. 



Dr. William Tumor W'ooton, class of 1890. of 
Hot Springs, Ark., was elected president of the 
Medical Association of the Southwest at the meet- 
ing held in Hot Springs, Ark., on October 10, 
19 12. Dr. Wooton has an office in the Dugan- 
Stuart Building in Hot Springs. The Medical 
Society of the Southwest was organized in 1905, 
and its membership is limited to members of the 
State societies of Arkansas, Missouri, Texas, 
Kansas and Oklahoma. The next meeting, at 






THE HOSPITAL BULLETIN 



159 



which Dr. Wooton will preside, will he held in 
Kansas City in 1913. 



Dr. William Cuthbert Lyon, class of 1907, has 
(1. mated a chloroform bottle to the operating- 
room. 



We are glad to announce that Dr. Joseph E. 
( iichner. class of 1890, who recently suffered a 
painful injury to his foot, necessitating amputa- 
tion of a toe, has sufficiently recovered to resume 
his work. The injury was incurred on a motor- 
boat. 



Dr. llyman R. Wiener, class of 1912, of the 
Harrisburg Hospital, was a recent visitor in Bal- 
timore, and took occasion while here to look up 
his old friends at the University Hospital. 



Miss May Katherine Steiner, University Hos- 
pital Training School for Nurses, class of 1912, 
has been appointed assistant superintendent of the 
Annapolis Emergency Hospital. Miss Alice 
Frances Bell, class of 1907. is superintendent. 



In reply to the letter of an alumnus, we beg to 
state that Dr. Howard T. Robinson, class of 1904, 
is located at Grantsville, Garret county, Md. ; 
Dr. Oscar Wentworth King, class of 1907, is at 
San ford. Orange county, Fla., and Dr. Claude J. 
B. Flowers, class of 1907, is at 1609 Market 
street, Harrisburg, Pa. 



MARRIAGES 

Dr. George Wilmer Yourtree. class of 1902, 
of Burkittsville, Md., was married to Miss Laura 
Eleanor Hightman in St. Luke's Lutheran 
Church, Burkittsville, Md., on September 25, 
1912, by Rev. Charles J. Hines. Miss Elizabeth 
Hightman was maid of honor, and Howard 
Yourtree. brother of the groom, was best man. 
Dr. 11. W. Gray of Washington was an usher, 
and Misses Evelyn Yourtree and Ruth Shafer 
were flower girls. After a trip to Bermuda the 
couple will live at Burkittsville, where the groom 
has built up an extensive practice. 



Dr. Howard J. Maldeis, class of 1903, was mar- 
ried to Miss Louise Cecil Watkins, a member of 
the 1913 class of the University Hospital Train- 
ing School for Nurses on Saturday, September 
7, 1912. at 11.30 A. M. at the residence of the 



bride's father, Mr. W. Maurice Watkins, Kate 
avenue, Arlington. Rev. E. M. Heffer, pastor of 
Arlington Methodist Episcopal Church, officiated. 
The couple spent a honeymoon in the North, and 
returned in time for Dr. Maldeis to take up his 
duties at the University. They will reside on 
Kate avenue, Arlington, Md. 



Dr. James Hugh Bay, class of 1908, of Havre 
de Grace, Md., was married to Miss Mary Barton 
Saulsburv, University Hospital Training School 
for Nurses, class of 1909, on Tuesday, September 
10, 1912, at 4 o'clock, at the home of the bride's 
sister, Mrs. William G. Pugh, Govans, Md. Miss 
Saulsbury is a daughter of the late Dr. and Mrs. 
Thomas Bascom Saulsbury of the Eastern Shore. 
She was formerly superintendent of the training 
school of the Maryland Homeopathic Hospital of 
Baltimore. Dr. Bay is the son of Mr. and Mrs. 
Thomas A. Bay of Jarrettsville, Md. 

The ceremony was performed by Rev. Dr. Mc- 
Millan, pastor of the Govans Presbyterian 
Church, and was witnessed only by a few relatives 
and close friends of the couple. The parlor was 
beautifully decorated with golden rod and ferns. 
The bride wore a traveling suit of brown, with 
hat and gloves to match. A reception was ten- 
dered Dr. and Mrs. Bay immediately after the 
ceremony, and at 6 o'clock they boarded the Mer- 
chants & Miner's Line for a trip to Boston. They 
also visited Niagara and returned home via the 
Hudson. They will reside in Havre de Grace. 



BIRTHS 

A son has been born to Dr. Dwight Gray 
Rivers, class of 1910, of Fort White, Fla., and 
Mrs. Rivers, formerly Miss Martha Yenable 
Edmunds, University Hospital Training School 
for Nurses, class of 1910. 



Dr. Emile Bonniwell Quillen, class of 1904. of 
Rocky Mount, N. C, and Mrs. Quillen, formerly 
Miss Leila Griffith Owings, L'niversity Hospital 
Training School for Nurses, class of 1905, have 
announced the birth of a daughter. 



DEATHS 



It is with much regret that we announce the 
death of Mrs. Georgie Davis Knipp, wife of Dr. 
Harry Edward Knipp, class of 1887, of 1002 West 



l()0 



THE HOSPITAL BULLETIN 



Lanvale street, Baltimore, on October 14, 1912, 
of tuberculosis. Mrs. Knipp was the daughter of 
George H. Davis of Carroll county, and although 
there were three sons in the family, she bore her 
father's full name until her marriage. She was a 
graduate of the State Normal School, and taught 
for some years in Carroll and Baltimore counties. 
She was married to Dr. Knipp seventeen years 
ago, and was all of her life a great church worker. 
She is survived by her husband and a daughter. 
Miss Minna Knipp, and a son, George Adam 
Knipp, three brothers and four sisters. One of 
the brothers surviving is Dr. Charles R. Davis, 
class of 1890, of 923 North Carrollton avenue. 



Dr. Robert Morris Dawson, class of 1869, died 
at his home at Bay Hundred, Talbot county, Md., 
September 8, 1912, aged 73 years. He is sur- 
vived by his wife. Dr. Dawson was born March 
12, 1839, at Royal Oak, Talbot county, Md., the 
son of Major John Dawson. He was educated at 
the Maryland Military Academy and Fort Ed- 
ward Institute, New York, and served in the Sec- 
ond Maryland Cavalry, C. S. A. After the war 
he entered the office of Dr. W. G. G. Willson of 
Easton, Md., and later matriculated at the Uni- 
versity of Maryland, graduating in 1869. He 
practiced at Royal Oak for eight years, and later 
moved to Bay Hundred, where he continued his 
practice until recently. Dr. Dawson was also 
much interested in agriculture and owned a large 
farm which he personally conducted. 



Dr. James H. Butler, class of 1857, died at his 
home, 1507 Bolton street, on September 26, 1912, 
of apoplexy. Dr. Butler had not been well for 
several weeks prior to his death, but he spent part 
of each day in his office in the custom-house, and 
went as usual on the day of his death. He re- 
turned to his home for lunch about noon, and 
complained of not feeling well. He suffered the 
attack shortly after reaching his home, and a phy- 
sician who was summoned said he died soon after 
having the stroke. Dr. Butler was born in Balti- 
more in 1836, and when quite young became asso- 
ciated with the banking-house of Samuel Win- 
chester at Baltimore and North streets, later be- 
ginning the study of medicine in the office of the 
late Dr. Geo. W. Miltenberger. He entered the 
University and was graduated in 1857, and ap- 
pointed resident physician of the University Hos- 



pital, then the Baltimore Infirmary. At the death 
of Dr. Berwick B. Smith, demonstrator of anatomy 
at the University, Dr. Butler assumed his duties. 
During the Civil War he served as a surgeon in 
charge of the United States Army Hospital in 
Baltimore. In 1876 he ran for Congress, but was 
defeated by Thomas Swann. He then entered 
the customs service (1877), and was made exam- 
iner of drugs, holding that position until 1892, 
when President Harrison made him an appraiser 
at Baltimore. At the time of his death he was, in 
point of service, the oldest appraiser in the ser- 
vice. Dr. Butler was an active member of Asso- 
ciate Congregational Church, a member of Ori- 
ental Lodge of Masons and Beauseant Com- 
mandery of Knights Templar, and was a member 
of the board of managers of the Masonic Temple. 
He is survived by one daughter, Miss Mabel 
Butler, his wife, formerly Miss Kate Griffis, hav- 
ing died four years ago. He was buried from his 
home on Monday, September 30, services at the 
cemetery being conducted by Oriental Lodge of 
Masons. The honorary pallbearers were Gen. 
Thomas J. Shryock, John M. Carter, C. C. Isaacs, 
A. H. Fetting, William D. Waxter, Charles C. 
Homer, Jr., Harry A. Remley, George F. M. 
Hauck, Dr. Walter B. Piatt, P. E. Tome, George 
Cook, William F. Stone, F. Holmes Hack, J. Car- 
lisle Wilmer, J. J. Bell and John Straughn. 
A local paper writes of Dr. Butler: 
"Dr. James H. Butler, for 35 years connected 
with the United States Treasury Department, 
was buried in Baltimore last week with high 
Masonic honors. President Carter of the Vet- 
eran Association, of which he was a member, 
describes him as a man whose whole life, profes- 
sional, official, as churchman, husband, father. 
Mason and friend, was one to be admired and 
emulated, and adds : 'As we journey along the 
highway of life we are often reminded of the 
casualties of battle. A moment ago we touched 
elbows with a companion and friend; noting the 
failure of contact and we turn to ascertain the 
cause. He has fallen, and the silent comrade at 
our side mutually affirms the lesson — in the midst 
of life we are in death.' " 



On September 30, 1912, Dorothy Whiting, in- 
fant daughter of Dr. John William Ebert, class 
of 1912. and Mrs. Ebert. Burial was in Win- 
chester, .Ya. 



THE HOSPITAL BULLETIN 

Published Monthly in the Interest of the Medical Department of the University of Maryland 
PRICE $1.00 J J ER YEAR 



Contributions invited from the Alumni of the University, 
Business Address, 608 Professional Building, Baltimore, Md. 



Entered at the Baltimore Post-office 
as Second Class Matter 



Vol. VIII 



BALTIMORE, MD., NOVEMBER 15, 1912 



No. 9 



A SUMMER CRUISE ON THE SPANISH 
MAIN. 



By Ran .ph Winslow, M.D. 



3. The Panama Canal. 

Almost from the time that Balboa climbed the 
hill on the Isthmus of Panama and saw both the 
seas, separated by only a few miles of land, the 
conception of uniting the Atlantic and Pacific by 
means of an artificial waterway was entertained. 
Numerous suggestions were made by different 
persons at an early period. Angel Saavedra pro- 
posed to pierce the Isthmus of Darien in 1520, 
and Antonio Galvao suggested a canal across 
Panama in 1550. Simon Bolivar, President of 
Columbia, caused a crude survey of the Isthmus 
to be made in 1830, and the United States Gov- 
ernment made complete surveys of the Panama 
and Nicaragua routes in 1872-1875. The vision 
was clear, but the time of its accomplishment 
was still far in the future. While the United 
States was negotiating with Columbia for per- 
mission to build the canal, the latter country 
awarded the franchise to a French company 
which, under the leadership of the distinguished 
de Lesseps, began work on a sea level canal in 
1 88 1. It was soon discovered that a sea level 
canal was not practicable and later the specifica- 
tions for a lock canal were substituted. After 
the expenditure of a vast sum of money and the 
sacrifice of thousands of lives, the work was dis- 
continued for lack of funds in 1889. In 1894 a 
new French company obtained a concession for 
10 years, and work was continued in a desultory 
manner. The plans of the French engineers 
called for a canal 75 feet wide and 16 feet deep, 
and they actually completed some 15 miles of 
excavating at sea level, but made but little im- 
pression on the elevated and more difficult por- 
tions of the work. The French* failed partly for 



lack of efficient machinery, but chiefly on account 
of the pestilential diseases that caused a holo- 
caust among their employes. The time for the 
completion of the canal, however, drew on 
apace, impelled by unexpected and irresistible 
events. As the discovery of gold in California 
was the direct cause of the building of the Pana- 
ma Railroad, so the Spanish War is the imme- 
diate factor in the completion of the canal by 
the United States. The record-breaking voyage 
of the battleship Texas from San Francisco to 
Cuba during the Spanish-American War will be 
readily recalled, and this showed the necessity of 
a shorter means of transferring our warships 
from one coast to the other. The feverish haste 
in completing the waterway is due to the urgency 
of preparing for the national defense, rather 
than to the advisibility of seeking new and 
shorter commercial trade routes. From both 
defensive and commercial aspects, however, the 
completion of the canal is a matter of the great- 
est importance. The canal will be about 50 miles 
in length from deep water to deep water. Begin- 
ning about three miles from shore a channel has 
been dredged 500 feet wide and 41 feet deep, 
and, discarding the completed French canal en- 
tirely, a new canal has been excavated, of the 
width and depth mentioned, to Gatun. The total 
length of the sea level portion of the canal on 
the Atlantic side is about 7 miles. At Gatun 
the great dam is thrown across the Chagres Val- 
ley, nearly i l /> miles in length and y 2 mile in 
width at its base, and rising to a height of 115 
feet above mean sea level. This dam impounds 
the waters of the Chagres River and converts 
an area of swamp and jungle into a lake 164 
square miles in extent, with a depth of 85 feet. 
Ships approaching from the Caribbean are raised 
from sea level to the Gatuh Lake 85 feet by 
means of three huge double locks, each 1,000 feet 
in length and no feet wide, and as tall as a six- 
story warehouse. The locks are constructed of 



1 62 



THE HOSPITAL BULLETIN 



solid concrete, with a central wall dividing them 
into pairs. In both the middle and side walls are 
huge culverts as large as a railroad tunnel, 
through which water is allowed to flow into the 
lock chambers and to fill them gradually and 
quickly without the disturbance that would occur 
if they were filled by allowing water to rush in 
from the end. It will probably take about 15 
minutes to fill or empty each lock. The locks 
are closed by great steel gates 7 feet thick, 65 
feet wide and from 47 to 82 feet high. Inter- 
mediate gates are also placed in the locks in or- 
der to save time and water when small vessels 
are being passed through.' There are also emer- 
gency contrivances to take the place of the usual 



sage of the largest ships. In order to prevent 
too great a pressure of water, a spillway has 
been constructed, by means of which the excess 
of water may be allowed to escape. The lake 
extends from Gatun to Bas Obispo, a distance of 
24 miles, with a channel varying from 1000 to 
500 feet and a depth from 85 to 45 feet. At 
Has Obispo the great Culebra cut begins, and ex- 
tends 9 miles across the backbone of the Isthmus. 
This is the most difficult piece of engineering of 
the construction, as the crest of the hills had 
to be cut down from about 500 feet to 85 feet. 
The canal prison in this section has a bottom 
width of 300 feet and a length of 9 miles. The 
Culebra cut at its widest point is nearly x / 2 mile 




WEST CHAMBER LOOKING MIRTH PEDRO MIGUEL LOCKS. PANAMA. 



gates in case of any accident to the latter. Ships 
will not be allowed to enter the locks under their 
own steam, but will be drawn through by electric 
locomotives in order to prevent accidents. Be- 
sides the Gatun locks, there are two others at 
Pedro Miguel and Miraflores, the former con- 
sisting of but a single pair and the latter of a 
double pair of chambers. Their construction and 
dimensions are similar to those at Gatun, and by 
their means ships are lowered on the Pacific 
side. The water for the canal is obtained from 
the Chagres River, which, during the dry season, 
is an insignificant stream, but in the wet season 
is a raging torrent. By means of the dam at 
( iatun the waters of this river are impounded 
into a lake already mentioned, which will furnish 
at all times a sufficient depth to permit the pas- 



across. The soil and rocks seem to have but 
small cohesive properties here, and landslides 
are constantly taking place which cause much 
extra labor for their removal, and delay the open- 
ing of the canal. Since my visit, in July, several 
slides have occurred. In order to overcome this 
tendency to slide, the hill on both sides is being 
cut back on terraces at different levels, causing 
an appearance like gigantic steps. I was able to 
ride the whole length of the Culebra cut in a 
private railroad motor car and to get an accurate 
idea of the magnitude of the work, and to see 
the great steam shovels scooping out the sides 
of the hill, and the compressed air drills making 
holes in the rocks ; while now and then ex- 
plosions of dynamite would cause the earth to 
tremble and gave an impression of an artillery 



THE HOSPITAL BULLETIN 



163 



engagement. The long trains of dirt cars were 
constantly coming and going, removing the debris 
to dumps, where low places were being filled in. 
or to Balboa, where the great causeway is being 
constructed between the mainland and the islands 
in the bay. The high level section of the 
canal ends at Pedro Miguel, where there is a 
dam and locks that lower ships 30 feet to the 
level of another artificial lake \ l /i miles in length. 
The Mirarlores locks, in two pairs, lower ships 
55 feet to the Pacific sea level section of the 
canal, which is about 8 miles in length and ter- 
minates at deep water in the bay. l'alboa is the 
Pacific entrance to the canal, as Colon is its At- 
lantic port. The tide on the Pacific side varies 



saving of 9540 miles. In like manner, the dis- 
tance from our east coast to points on the west 
coast of South America, Japan, China and the 
Philippines will be lessened by thousands of 
miles. While at Colon a large party from our 
ship took a launch up the canal to Gatun. The 
water in the harbor was rough and in the trough 
of the waves the boat would sink so low that 
nothing but the sky and sea could be seen, and 
this was on a clear, calm day. Going up the 
new American canal we turned into the French 
canal and passed up that waterway to the great 
dam. The French canal is not used, except to 
bring supplies to Gatun. Along the banks of 
this canal is an enormous amount of cast-oft 




CULEBRA CUT LOOKING SOUTH. 



about 20 feet daily, while on the Atlantic side 
there is only from 1 to 2 feet variation, hence 
it will be much more difficult to maintain the 
necessary depth in the Pacific section than in the 
other sections. I have briefly described the 
canal from Colon to Panama, but have omitted 
any reference to the number of cubic yards of 
excavation or of the number of barrels of con- 
crete used in the construction of the locks and 
dams as being too vast for the comprehension of 
the lay mind. It is supposed that the first ship 
will pass through the canal about a year from 
now, though it will not be opened officially until 
a later period. The time of passage through the 
canal will be from 8 to 10 hours. From Xew 
York to San Francisco, via Cape Horn, is 14,840 
miles ; via the canal the distance is 5300 miles, a 



machinery, dredges, steamboats and junk which 
is rusting and rotting and not worth breaking 
up and selling for old iron. Reaching Gatun, we 
viewed the locks, and then walked a mile along 
the crest of the dam to the spillway; the heat 
was not oppressive, though the humidity was 
unpleasant. There were over 30 feet of water in 
the lake, but it was interfering with work on 
the locks, so the spillway was open and the water 
was escaping. When the lake is filled, the sites 
of many of the towns along the canal will be 
covered with water, such as Gorgona, the seat 
of the immense machine shops; Matachin, and 
many others. The railroad formerly was located 
in the bed of the lake, but it has been recon- 
structed upon higher ground well above the 
level of the lake. Upon the completion of the 



i6 4 



THE HOSPITAL BULLETIN 




AERO VIEW OF THE TANAMA CANAL. 



canal it is the intention of the commissioners to 
abandon most of the present towns and to de- 
populate the Zone, leaving only enough employes 
to care for the canal. It is also thought that the 
luxuriant tropical growth will soon obliterate 
the evidences of the work and that the canal will 
appear as a natural stream. A few miles from 
Colon is the ancient town of Porto Bello, which 
was an important place in former days, and was 
sacked by Morgan and other buccaneers. It is 
now of importance only on account of the ex- 



cellent stone quarries, from which the good stone 
for the construction of the canal has been ob- 
tained. It has been announced that ships will 
sail through the canal on January i, 19 14, and 
it will be a wonderful sight to stand on the porch 
of the Young Men's Christian Association Build- 
ing at Culebra, situated high up on the hill, and 
witness the first ship pass through the great cut 
far below. The dream of the ages will then have 
been realized and the vision of the seers shall 
have become an accomplished fact. 



S< )ME POINTS OF INTEREST AS REGARDS LONG BONE FRACTURES.* 



By A. Aldridge Matthews, M.D. 
Spokane, AYash. 



There is today at hand an era of better treat- 
ment for fractures, and it behooves all of us who 
expect to treat these cases not only to familiarize 
ourselves with the best methods, but also to per- 
fect ourselves in the technic if we hope to secure 
the results for our patients which they are certain 
to demand. 

I feel a hesitancy in saying anything further 
on the open method of treating fractures, for in 
the last couple of years the literature has been 
Hooded with articles along this line. While at 
first there was much controversy as to the open 
method, of late the opposition is gradually com- 
ing over to this side. I myself at first did not 
receive the idea with very open arms, but as some 
of you gentlemen who heard me give a paper 
mi this subject as early as two years ago will re- 
member. I was partial to the open method in 



•Read before Tri-State Meeting at rortland, Ore., .Tune 6, 
1912 (Washington, Idaho and Oregon). 



many fractures, and considered it the only treat- 
ment in some. There are some today that I did 
not class as such then, but I think are better 
treated by that means. 

I consider the proper view in regard to the 
treatment of fractures is to treat the individual 
as you yourself would want to be treated if in 
his plight. If this thought would pass through 
our minds, I believe that there would be some 
fractures treated differently than they are. 

There are certain things that one has to con- 
sider. Scudder has said ''an approximate re- 
duction that is non-anatomic, if followed by 
union, and by a functionally useful part and no 
apparent deformity to the patient and his non- 
professional friends, is a good result." I agree 
with Dr. Scudder, but the public are demanding 
even more than this ; the)' want almost anatomical 
exactness, and if such is not gotten there is dis- 
satisfaction ; therefore, it behooves us to obtain 



THE HOSPITAL BULLETIN 



16.= 



a good cosmetic as well as anatomical function- 
ing result, and this endeavor has its influence 
upon popularizing the open method of treatment. 
Patients want to see their X-ray pictures, so that 
they can know that the ends of the bones are in 
apposition, and if after being discharged they 
End the ends not in apposition, they want to 
know why. 

Our patients should be told what ultimate re- 
sult to expect, and this result should not be over- 
rated, for often perfect restoration to normal can- 
not be had. 

This has been brought about through the X-ra> . 
Individuals often go and have X-rays taken on 
their own accord, and have them interpreted. 
X-rays are sometimes taken for a purpose, such 
as to try and institute malpractice cases, increas- 
ing slight deformities, making them appear gross. 
This is not an uncommon thing to be done when 
suits are brought. I know of one case which was 
X-rayed many times at different angles, and the 
worst appearing deformity introduced in the suit 
as evidence. 

We should remember that an X-ray should al- 
ways be taken in two directions — at right angles 
to each other — to get the proper interpretation. 
I have seen a number of X-rays taken, one view 
showing a very good result apparently and an- 
other at a right angle showing overriding or 
great deformity. This js especially true in 
oblique fractures, and where there is a convexity 
or concavity in line of the rays. To interpret 
these skiagrams correctly it requires some study 
and experience, as well as a knowledge of osteol- 
ogy, including the development of the epiphyses. 

There are certain conditions which make it im- 
possible to have all of our fractures X-rayed, 



while I admit it should always be done when pos- 
sible ; but when these conditions arise, such as 
fractured pelvis, thigh, etc., where one cannot 
get their patient to an X-ray or an X-ray be got- 
ten to them, they should be treated in the manner 
that one is most certain will give the best results, 
and the most certain method is unquestionably 
the open method. I do not mean to advise the 
open method except under the most favorable 
circumstances, where one can depend upon abso- 
lute cleanliness in the strictest sense. 

I am well aware that the use of the X-ray in 
routine fractures, especially in the country, is 
impracticable and even impossible in many cases, 
but that does not mean that one should not profit 
by what others have learned by the use of the 
X-ray. 

Since Dr. Lane's excellent article on open 
treatment of fractures the profession has taken 
to this method without discretion, and many cases 
have been operated upon by men poorly equipped 
and qualified to do this work, and worse results 
gotten thereby than if the closed method had been 
adhered to. I have been unfortunate enough to 
have had several of these cases come under my 
care in the past few months. 

As regards materials to be used for the open 
method in long bones, as a whole I prefer the 
metal plate and screws ; I do not mean to exclude 
other devices, for there are conditions and places 
where the plate cannot be used and other methods 
more satisfactory used, such as nails, pegs, wire, 
screws, staples, etc. Bone clamps for holding 
the fragments until union of the bone and relaxa- 
tion of the muscles is sufficient to keep them in 
their normal position by external support should 
be condemned, or anv device which communicates 



,.. - -'-■-: ~r 








— 


A 


. 


m 


8 




C 



FIG. 1. 

A represents the various sizes of drill points. 

E, silv.r plate, the holes drilled, which may be cut the desired length. 

C, ordinary carpenter drill (reciprocating), found most satisfactory in my bone work. 



1 66 



THE HOSPITAL BULLETIN 



with the air. as there is great danger of infection, 
which it is practically impossible to prevent. 

The plate which is shown in several of the cuts 
is made of silver, and varies in size. I have been 
using them for the past six or seven years. I 
had a quantity made with screw holes, as is shown 
in the Fig. 8 ; also screws, but the silver screws 
I discarded, and used the ordinary steel ones. 
The reason for discarding the silver ones was 
that they were too soft, and it was a common 
tiling to twist off their heads. The plate, as you 
see, is quite long, and 1 cut it off the length that 
I desire; it is very pliable, and has this advan- 
tage over the Lane plate in that respect, and there 
is no chance of breaking or the screw holes break- 
ing out on account of it being brittle. I have seen 
reports of this happening with the steel plate, 
but I understand now these plates can be had of 
some more pliable and softer material. The ad- 
vantage of the pliable plate can readily be seen. 
It will give to a degree, and often will save the 
pulling out of the screws or breaking the plate. 

The silver, and later bronze, wire which was 
so popular three or four years ago has been re- 
duced very much in bone work since the plate 
method has become prevalent, and righth so. 
While there are still many places where the wire 
has its use. such as patellar, olecranon and in 
comminuted fractures of long bones where there 
are many fragments and considerable of the 
shaft is involved. I wish to condemn the use of 
the wire for encircling long bones, as is often 
done in oblique fractures, for it may cause an am- 
putation of the bone ; especially this should be 
borne in mind in the treatment of children where 
there is much growth of the bone yet to take 
place. Dr. Blake of New York has recently re- 
ported an incident of this character. It is also a 
poor device to suture long bones with, for ;t 
allows too much motion, often causing bowing 
and displacement. 

I have tried and own several drills, but the 
most satisfactory one is shown in Fig. i, which 
I gol at a hardware store. It is the ordinary 
two-way cutting carpenter drill, known as re- 
ciprocating drill, and the drill points, which can 
be had of any size, the regular steel bits. These 
bits can be improved upon : it is a disadvantage 
to have the thread the whole length, being much 
better to only thread it one-half inch from point. 
for if one is not careful the soft tissue in prox- 
imity with it will wind around when drilling, 




Flo. 2. — Fractured femur with application of silver plate. 
Radiograph taken about 12 weeks after plate being applied. 



which could nut happen if the upper part of the 
bit were round and smooth. 

To insure the best results in the open method 
of treatment in fractures the operation should 
be performed with neatness and dexterity, with 
the aid of proper instruments to insure as little 
trauma to the tissue as possible. 

Dr. Joseph A. Blake has said what one sur- 
geon may be able to do rapidly, accurately and 
cleanly would be impossible for another ; so there 
are considerations to be taken into account other 
than the condition pre-ent in the patient. In 
fact, there is no province in surgery in which the 
result depends more upon the mechanical skill 
and cleanliness of the operator. 

The majority of my plates have eventually 
come back to me for removal. While the opera- 
tion of removal is trivial, the wound usually heals 
unite slowly; especially is this the case in the leg. 
The reason for this may be on account of the 
tendency to swelling, etc., after operations and 
injuries to these parts. 

A point that has been brought very forcibly to 
my attention in several direct injury cases causing 
fracture is that they are very much slower in 



THE HOSPITAL BULLETIN 



167 




PIG. 3.— Same as Fig 



hut different view. 



getting union than indirect injuries, and that 
there is a much greater tendency to bone death. 
Whether this is due to injury of the nerve or 
blood supplies I am not prepared to say, but am 
inclined to think that is the most probable cause. 
C'rile has demonstrated in animals that fright and 
shock is a cause for delayed union. Mild infec- 
tion does not seem to interfere with the healing 
of a fracture, but on the contrary seems to stimu- 
late the formation of callus ; but infection severe 
enough to cause necrosis of tissue manifestly will 
prevent union. 

One of the greatest improvements toward the 
avoidance of infection is the improvement of our 
instruments. We now have devices for reducing 
Fragments; also various bone clamps for holding 
the plate and fragments, ami must of all. the 
traction devices, such as that devised by Ridlon 
of Chicago. The modification of his by 1 )r. 
Eikenbary of Spokane is the best one T have 
seen and one that I use. which is shown in 
IT.;. 4. The great advantage of this in frac- 
tures of the lower extremity is that we can oper- 
ate and apply our plaster without removing the 
stretcher, get any amount of traction, which is 
constant: also lessening the number of hand- to 



help, and there is no chance of breaking the plate 
or device used to hold the fragments while the 
external dressings are being applied, for this is 
quite liable to happen when held by hand. < >ur 
external dressings, whether plaster or what not, 
are the supports which have always been and are 
most relied upon now, even with our internal im- 
provements, and should never be neglected. 

If there was no danger or bad results con- 
nected with the open operation, it would unques- 
tionably be the ideal method to treat all fractures. 
But it has been found that infection may take 
place, and an infection in a fracture is a com- 
pound fracture, for an open treated fracture is 
nothing more than that, and is always a serious 
condition, and has frequently led to the loss of 
limb, or even life. 

Danger of primary wound infection has been 
eliminated in other operations, and there is no 
reason why it should not be done here, and this 
can only be achieved by the highest technical 
skill, for bone freshly opened seems to have less 
resistance to infection than any other tissue of the 
body. Lane of London has worked out this 
technic, and has shown us what good results can 
be had. 

As regards the preparation for these opera- 
tions, or any operation, soap and water has been 
relegated to the background for at least tj hours. 
My routine for preparing the field for any oper- 
ation is to have the part shaved, thoroughly 
washed with soap and water the night before, then 
washed with alcohol and allowed to dry ; then a 
sterile towel is applied to the part, with no further 
preparation until the patient is placed on the oper- 
ating table, where the operative field is swabbed 
off with benzoin or benzoin and iodine 1-1000 and 
allowed to dry, which removes the oil from the 
skin, and it is also a disinfectant; then apply a 
liberal coat of one-half strength tincture iodine 
with alcohol and allow to dry. 

In compound fractures these wounds should 
not be washed with soap and water, as we did 
formerly, but the part shaved either dry, or use 
alcohol or benzoin to wet the part for shaving, 
and then apply the iodine. The gross dirt should 
be picked or trimmed away from the wound and 
part painted with iodine, the projecting bone frag- 
ments also painted, then allowed to dry before 
being returned. This method is much more sim- 
ple and easier than the older methods, and very 
much more satisfactorv. 



1 68 



THE HOSPITAL BULLETIN 



I wish to take this opportunity to thank Dr. 
W. W. Potter for the excellent X-ray work he 
has done for me, some of which is shown here. 

"Since writing this article I have been favor- 
ably impressed with Sherman's steel plate. They 
seem to fill the bill very satisfactorily, and have 
quite an advantage over the Lane plate and also 
over the silver plate that I have used so much, 
and recommend it in my article." 

Case I. — White ; male ; age, 37. Was run over 
by a dirt car, causing a severance of all the ex- 
tensor muscles of the anterior thigh and a com- 
pound fracture of the left femur. Patient was 
in extreme shock when he came under my care, 
and after waiting a short while, and by the use of 
stimulants, I was able to go ahead and sew the 
muscles together ; put the patient up in long side 
splints with extension. This I kept on for about 
a week, but on account of the drainage it was 
necessary to remove the splint and apply a plaster 
one, so that I could get better access to the wound 
through a window in the cast. The wound re- 
mained open, and after the lapse of about 10 
weeks I removed my plaster and found there was 
absolutely no union. When I opened down on 
the bone I found that necrosis of both ends had 
taken place, and it was necessary to resect the 
dead bone. Then I applied a silver plate with six 
screws, which is shown in Fig. 2. This patient 
made an excellent recovery, but has about three 
inches shortening. 

Case II. — White ; male ; age, 23. Had a crush- 
ing injury to right leg, causing a compound com- 
minuted fracture. His foot was also crushed. 
and it was necessary to remove four of his toes 
and one of the metatarsal bones. This was done 
some time after the accident, and the dorsal part 
of the foot was skin-grafted, as the skin was torn 
off from the upper part of the ankle clear down. 
I applied a silver plate with five screws. This 
patient made an uneventful and most satisfactory 
recovery. 

Case III. — White; male; age, 46. Compound 
comminuted fracture of both bones of right leg. 
The injury was caused by direct violence, a heavy 
blow being received on the leg. driving out a 
piece of bone about two inches long from the 
middle of the shaft. This patient I operated 
upon immediatelly, found the proximal and 
distal fragments together, and the intervening 
piece driven out in the soft parts. By consider- 
able traction I was able to separate the fragments 



and work this intervening piece up into position, 
and applied a long plate with a screw in either 
end and one in the middle, which pulled up and 
held the intervening fragment in position. 

Case IV. — White; male; age, 37. Had a 
crushing injury received to middle of shaft of 
left leg, causing a compound and much com- 
minuted fracture of tibia and fibula. This case 
1 operated upon immediately ; found the bone for 
about' six inches in the tibia comminuted and the 
fragments very much displaced in every direc- 
tion. These fragments I molded into position 
and wired as best I could. This patient made an 
uneventful recovery, and is doing hard work, 
which requires the use of his leg all the time. 

Case V. — White; male; age, t>7- Engineer by 
trade ; referred to me by the Drs. Abrams of Hill- 
yard ; was shot accidentally by a 48-caliber bullet 
through the lower end of his humerus, bullet 
passing directly through the arm. This case I 
did not see until the day following the accident, 
and then reduced the fragments and secured them 
together with a steel peg and wires. This patient 
made an uneventful recovery, and is now work- 
ing at his trade : has good motion, sufficient as not 
to interfere with his work, and I anticipate will 
eventually improve considerably over his present 
condition. He suffers no inconvenience whatso- 
ever from the wire or from the steel peg in the 
bone. 

Case VI. — White: male: age. 25. Has had a 
fracture of right radius, due to a direct violence 
blow. This fracture was put up in splints, and 
it was thought reduced, but upon taking an X-ray 
it was found there was considerable overriding, 
so the physician in charge attempted to reduce by 
the open method, and wired. The patient was 
then put up in splints and kept there for several 
weeks ; the wound remained open, and after some 
time the splints were removed and an X-ray again 
taken. ( I regret that I have not these X-rays b 1 
show, but I was fortunate enough to see them. 1 
As the sinus persisted, the arm was again opened. 
wire removed, but the deformity was left. 

This patient fell into my hands several weeks 
after this. He had a very limited motion and con- 
siderable ankylosis of his fingers, and almost 
complete ankylosis of the wrist, and was very 
much incapacitated thereby. I suggested to him 
the opening down and correcting the deformitv. 
which he consented to having done. When I 
Opened down I found the bone, with the distal end 



THE HOSPITAL BULLETIN 



169 




I'lii. 4. — Traction device ;is appears when applied to patient : it can be nsed either on one or both legs at a time, as is desired. 



bowed out ; it was with much difficulty that I was 
able to get it clown in line with the approximate 
end, which I succeeded in doing by applying a 
plate. When a plate was taken, three weeks after 
the operation, it could be seen that the constant 
strain and pulling of the lower fragments had 
pulled the screws up a little. It was necessary to 
remove this plate, as a sinus persisted. This was 
done by my associate during my absence, about 10 
weeks after the plate had been applied. At that 
time the patient was doing and had been doing 
splendidly, but after the removal of the plate for 
some unknown reason the patient was taken ill 
immediately, and died within the next few days 
from some rather obscure condition, it being pos- 
sibly a septic condition, although the wound was 
laid wide open and packed at the time the plate 
was removed and no stitches taken. This is the 
first and only fatal case of this character that I 
have had. The bone was thoroughly united, and 
apposition, I am told, was excellent. 

Case I'll represents a man hurt in a wreck 
in which he had both legs fractured. 1 did not 
see him until about id weeks after his injury, 
and at that time he had an ununited fracture of 
his right leg, with a great deal of crepitus and a 
number of sinuses running pus scattered all along 
his mid thigh. An amputation had been advised, 
and he was sent here for that purpose. 

After examining him I advised a resection and 
removal of about the middle third of his thigh 
bone, for it was very plain to see that the fracture 
was comminuted and a quantity of dead bone 
was present. The right leg was united. 

On September 21, 1909, I opened and removed 
two large spicule* and then resected both of the 



ends of the femur. The bone removed was dead, 
and some of it had a worm-eaten appearance, 
showing absorption was taking place. Then I 
applied a silver plate with three screws below and 
two above. After a very protracted stay in the 
hospital he managed to get a good, useful leg, 
which he can walk about on very well, although 
it is about six inches shorter than it was before 
the accident ; but he wears a high shoe on his 
foot and uses a cane. Fortunately, the other leg 
is about four inches shorter than it was formerly, 
on account of the overriding from the other frac- 
ture. This may be called a fortunate mistake. 

In an X-ray taken shortly after the operation 
a slight bending of plate and a little displace- 
ment of ends is possibly due to the position in 
which it was put up following the operation, and 
the soft parts were puckered up in the middle 
thigh, which gradually contracted and took care 
of the slack. 

I took an X-ray recently, two years and nine 
months after plate was applied. Recently a sinus 
which formed, healed and reformed two or three 
times, was responsible for my taking the last X- 
ray, which shows the middle screw in the lower 
fragment is loose and has worked its way almost 
out. I will remove the screw, but will not disturb 
the plate unless further trouble develops, which 
I rather think is doubtful, on account of the sinus 
healing up a couple of times previous. 



Dr. S. DeMarco, class of 1900, has returned 
from a huntirtg trip in the wilderness of Maine. 
He hoped to bring back a moose, a bear and sev- 
eral deer, but some of the boys "don't know yet 



what he got. 



170 



THE HOSPITAL BULLETIN 



ADDRESS OP PROF. ADOLPH BICKEL 
OF THE UNIVERSITY OF BERLIN DE- 
LIVERED TO STUDENT BODY OF THE 
UNIVERSITY OF MARYLAND, OC- 
TOBER 5, 1912. 



It has been a great pleasure to me to be the 
guest of such an ancient and distinguished uni- 
versity. You may be interested to know that 
in a journalistic endeavor 1 have been associated 
with your professor of physiology for several 
years. For being the editor-in-chief of the In- 
ternational Archives of the Pathology of Diges- 
tion and Metabolism — I selected your Professor 
Hemmeter as my American editor after the 
death of Dr. Christian A. Flerter of New York. 
But yesterday at dinner I discovered that Pro- 
fessor Hemmeter and 1 are fellow-alumni, for he 
studied at the same school, the Konigliches Real- 
gymnasium at Wiesbaden, which is my native 
city. So that I may claim a personal acquaint- 
ance with your teacher and in addition to this I 
am familiar to a limited degree with the edu- 
cational and scientific history of the University 
of Maryland. 

For wherever medicine has a student it is 
known that it was James Carrol who discovered 
that yellow fever is transmitted by the bite of a 
specific mosquito, and so heroically submitted 
himself to the bite of an infected mosquito, vol- 
untarily made himself the object of experiment 
and suffered a severe attack of yellow fever, 
from which he later on died. To have produced 
such a brilliant discoverer and martyr to science 
is an achievement of which any university can 
be proud. It is known also that your alumnus 
Henry C. Carter led up to this great discovery 
by his thorough study of the extrinsic period of 
incubation of yellow fever. It may be said that 
the scientific work of Carrol and Carter on the 
etiology of yellow fever made possible the con- 
struction of the Panama Canal. And 1 con- 
gratulate the Regents of this University on hav- 
ing produced such an alumnus as Gen. Rupert 
L. Blue, who stamped out the bubonic plague 
from San Francisco, and now holds the highest 
medical office within the gift of the United 
States Government. 

A well-known saying of the gospels is to the 
effect that "a prophet is not without honor ex- 
cept in his own country." From what I heard 
of your professors during my short trip in this 



country, I know that they are considered most 
effective teachers; but it is to the department of 
physiology that your greatest reputation in Ger- 
many is due, for your professor of physiology 
has published some of his most brilliant research 
work in Germany, and I can assure you that the 
German Physiologic Society is proud of his 
membership and that nothing would gladden the 
hearts of the German confreres more than to 
hear that the Regents had more liberally endowed 
the laboratory of physiology — for from this 
source we may expect the most telling research 
work, espscially in that specific domain, Physi- 
ology of Digestion, in which he is an authority 
of international reputation. Some of his dis- 
coveries have already been confirmed in my own 
institute. 

I urgently recommend the encouragement of 
physiologic and pathologic research in this uni- 
versity, and with such able teachers as you are 
foitunate enough to possess this University can- 
not fail to rise to higher and higher standards. 

May the interests of the University of Mary- 
land be united to the noble purpose of higher 
medical education, so that it may resume a 
standard that is destined by Divine Providence. 

Professor Hemmeter in introducing him said : 

"While the Americans as a nation believe in 
high tariff, there is no tariff on intellect, and 
while the American people do not believe in 
monarchs, they are always glad to welcome the 
monarchs of science. The great physiologist, 
Ludwig, of Leipsig, once said to my teacher, 
Prof. FT. Newel Martin : All das Wasser welches 
uns trennt kann die Flamme der Bewunderung 
nicht loschen, die ich fur Ihre rastlose Thatigkeit 
empfinde, which means 'All the water that sepa- 
rates us cannot extinguish the flame of admira- 
tion which I feel for your wonderful and restless 
activity,' and these are the words that I feel 
are due in introducing to you Prof. Adolph 
Uickel, whose only address in America will be- 
to you, my students." 



The Senior Class election of officers resulted as 
follows : Norbert C. Nitsch, president ; Claudius 
A. Hayworth, vice-president; Frank P. Callahan, 
secretary ; Elmer Newcomer, treasurer ; Hamilton 
J. Slusher, chairman of executive committee ; 
Earle Griffith Breeding, editor-in-chief. The re- 
maining officers will be elected at some future 
date. 



THE HOSPITAL BULLETIN 



i/i 



THE HOSPITAL BULLETIN 

A Monthly Journal of Medicine and Suryery 
PUBLISHED BY 

THE HOSPITAL BULLETIN COMPANY 

608 Professional Building 

Baltimore, t»' u. 



SECURING FUNDS. 



Subscription price, . . . $1.00 per annum in advance 

Reprints furnished at cost. Advertising rates 

submitted upon request 



Nathan Winslow, M.D., Editor 



Baltimore, November 15, 1912. 



STATUS OUO. 



We arc pleased to announce that, having com- 
plied with the New York rules in regard to six 
salaried, full-time instructors, as well as meeting 
their other requirements, the Medical Department 
of the University of Maryland has been regis- 
tered for four full years by the educational de- 
partment of the State of New York. This means 
that our graduates are eligible to appear before 
the Board of Examiners of New York, and, if 
successful in passing the examinations, they will 
be licensed to practice in that State. This is no 
empty honor, as there are many schools that are 
placed in class A by the American Medical Asso- 
ciation that are not registered by the New York 
authorities, and whose graduates cannot practice 
in New York until they have taken an additional 
rear in some other institution. Moreover, those 
schools that are registered cannot give advanced 
standing to the students of non-registered schools. 
As we have declined to give advanced standing to 
the students of some of these "accredited" schools, 
whom we formerly accepted, it is with great satis- 
faction that we are able to state that the enroll- 
ment of students for the present session is but 
little less than that of last year, and that the new 
men entering upon the study of medicine are of 
an exceptionally good class. The work of the ses- 
sion began promptly, and has been conducted with 
enthusiasm. The new men who are now filling 
their first terms of service with us are not only 
well qualified for their positions, but are proving 
themselves valuable acquisitions to the school. 
On the whole, then, we are well satisfied with the 
present status. 



Some months ago the cry "On to Homewood!" 
resulted in bringing $1,000,000 to a celebrated in- 
stitution of this city. Within the past few weeks 
the threat that another institution would leave 
Baltimore and go to Chicago unless $700,000 was 
raised in the city and State resulted in securing 
nearly half a million dollars for that institution. 
It is time for the University of Maryland to bestir 
itself and to adopt a slogan which the people will 
hear and heed: "Help us or we close." The 
closure of the medical and other professional 
schools of the University of Maryland, after an 
honorable and useful existence of more than 100 
years, would also be a calamity to the city and 
State that they could ill-afford to suffer. We 
must have outside assistance in the near future 
or die of starvation. We believe we shall receive 
this assistance. In the meanwhile, let each alum- 
nus contribute something to the pathological fund. 
We would like to have the department of path- 
ologv endowed by the alumni and largely con- 
ducted by them. At the present time the funds 
available for this purpose approximate $20,000. 
We need $100,000 for the department, and an 
endowed professorship of pathology could be 
founded for $50,000. The additions to the fund 
in October were insignificant, but better than 
nothing. 

CONTRIBUTION BY CLASSES. 

1848 $50 00 

1864 20 OO 

1868 IO OO 

1871 35 00 

1872 81 84 

1873 441 83 

•1874 5 00 

1875 5 00 

1876 115 00 

1877 10 00 

1880 5 00 

188 1 250 00 

1882 310 00 

1883 40 00 

1884 40 00 

1885 235 00 

1886 100 00 

1888 50 00 

1889 100 00 

1890 1 73 00 

1892 150 00 



i-2 THE HOSPITAL BULLETIN 

1893 40 00 been permeated by the university idea, which 

1894 135 00 represents organized co-operation. 

'■^95 J55 °° It is an interesting fact that Maryland was 

1896 52 00 quite in line with Northern States in this regard 

1897 80 00 at the start, for the university idea was projected 

s 1 15 od by the founders of Maryland in 1C40, and even 

1899 5° °° in 1784, as you know, the charter of St. John's 

1900 215 00 College at Annapolis authorized it to enter into 

1901 270 00 an alliance with a Maryland university. This, 

1902 330 00 we have been told, was the dream of George 

1903 315 00 Washington, a matriculate of St. John's. 

I0°4 135 00 But further, in 1812, history tells us that the 

!9°5 22 ° °° University of Maryland was constituted as such 

J9°6 175 °° by an act of the General Assembly which em- 

I9°7 no 00 powered the then College of Medicine of Mary- 

I 9°8 20 00 land ( chartered in 1807) to annex to itself other 

x 9°9 5 00 faculties, viz., those of divinity, law and the 

I 9 I ° 5° O0 sciences in the city and "precincts" of Baltimore. 

1911 Terra Mariae 3 5° You are aware, however, that no such annexa- 

10 12 Club Latino Americano 25 00 tion took place, one reason being that the theo- 

logical department never materialized. The pro- 
Total subscriptions to Nov. 1. 1912. .810,280.17 visions of the charter relating to such a depart- 

NEW subscriptions IN OCTOBER. ment were s«mingly impracticable. The de- 

_, XT „ T ^ .. ^ partments of law and medicine, however, pro- 

Dr. A. S. Dudley, iqoi Sio 00 , , , , 

_ _ T t, , „ „ ceeded to operate together under the charter. 

Dr. R. L. belts. [808 10 00 ,. . , ,, , „, . . , • .-,0 

_ _ . „ , - lour body added the dental department m 1882 

1 Ir. ( ). A. Howard. 1006 10 00 , . . , . . ... 

and in 1904 the department of pharmacy, which 

.„ , „ had for 60 years led a separate existence. I 

lotal Smoo ' it .1 r . .i 1 

venture to recall these facts, as they have a 

bearing on the future of the University. 

CORRESPONDENCE ^ ou have been successful for several reasons. 

and first, I believe, because you have taken care 

September 25, 1912. tQ secure soun( j an d efficient teachers in your 

To the Honorable, the Board of Regents of the several departments ; men who have realized 

L niversity 01 Maryland. their opportunities and responsibilities, and have 

Gentlemen: had the practical experience necessary to make 

The relations of modern universities to educa- their teaching attractive and forceful. AYe all 

tional as well as social and economic progress know that it is the quality of the teaching more 

are burning questions in our country just now. than anything else that has enabled you to en- 

In respect to the organization of our universi- roll more than 1100 pupils during the session of 

ties, we have come to realize that the time is at 1911-12. Teaching is an art not easily acquired, 

hand when the average Medical and Law School, It is usually inborn. Many of the most learned 

] tental College or School of Pharmacy ought and even the most distinguished men in profes- 

not to struggle along trying to keep up a separate sional life do not possess it. And yet it is essen- 

existence, since it can operate more effectively tial in a successful teaching body. But you have 

and with less expense under the aegis of a uni- been rich in achievements. Not to go beyond 

versity. the limits of our own profession, the names of 

"La union fait la force" is an adage that has Nathan R. Smith and Elisha Bartlett would have 

almost universal application in successful or- shed luster on any institution. And, again, some 

ganization, of the most distinguished professors of medicine 

One has but to point to the great strides made now in office in other universities were graduates 

by Yale. Harvard and Columbia since they have of your old University. And you have been 



THE HOSPITAL BULLETIN 



173 



pioneers. I am told that you were the iir>i 
medical institution to introduce compulsory dis- 
section of the human body. You were the firsl 
in put the teaching of hygiene and medical juris- 
prudence into the curriculum. You were also 
the first to make the teaching of the diseases of 
women and children the specialties that they are 
now. 

Your progress has. however, been hindered 
b) lack of funds and lack of appreciation on the 
part of the people of Maryland of what you have 
done and are doing. 

Idle modern university, embodying as it dues 
the highest ideals in education, needs and should 
have more genera! support than it has. In the 
medical department large sums are necessary to 
fulfill its requirements and the more active the 
movement in the direction of larger, more nu- 
merous and better ecpiipped laboratories, the 
greater the progress that can be made, as we 
know, toward the ultimate eradication of disease. 
The department of physiology in the University 
of Maryland is liberally supplied with money, 
but other departments have not been so fortunate. 
But to come to the question of the hour. Who 
is to be selected to fill the vacancy caused by the 
death of your late provost; a man who honored 
the University and was honored by his position, 
Bernard Carter, the able jurist and patriotic citi- 
zen, known for his rare ability as well as for 
his charming social qualities the whole length 
and breadth of our land? Whom will you now 
select to guide the destinies of your institution 
with dignity and success? 

You will naturally have in view a representa- 
tive man in touch .with the university idea, with 
the education movements of the day and their 
leaders; a man also of attractive personality and 
ripe experience. I am unaware if the pecuniary 
stipend would justify the acceptance of the posi- 
tion by President Fell of St. John's College, nor 
am I qualified to represent him in any way; but 
it strikes me that inasmuch as he has put himself 
mi record as favoring such an expansion of the 
institution as to include among its departments 
a school of technology, a school of music and a 
school of the fine arts, he can be said to have 
the University idea. His other qualifications 
-peak for themselves. Respectfully your>. 
Thomas E. Satterttiwaite. 
A.B. (Vale), AI.D. (Columbia). LL.D. (Uni- 
versity of Maryland), Sc.D. (St. John's). 



ITEMS 

Prof. Adolph von Bickel of the University of 
Berlin, who is the director of the Institute for 
Experimental Medicine associated with the Uni- 
versity of Berlin, was the guest of Prof. John 
( ',. I lemmeter on October 4, 5 and 6, at his resi- 
dence, 739 University Parkway, Roland Park. 

I 'rofessor Bickel had been summoned to this 
country by .Mr. J. Green, president of the Na- 
tional Biscuit Company, to treat Mrs. Green, 
who was suffering from pernicious anemia. He 
also attended the Congress of Hygiene and 
Demography at Washington. He is editor of 
several German journals and an investigator of 
rare ability. While in this country he delivered 
no other address except the one at the University 
of Maryland on October 5. 



Kappa Psi Fraternity held an informal smoker 
at their new home, 242 W. Hoffman street, on 
October 9. 



The Randolph Winslow Surgical Society is now 
upon a firm basis, and its members are looking for- 
ward to an exceptionally prosperous year. 



Among the University alumni practicing in 
Idaho are: 

Bo — Joshua T. Price, class of 1868. 
Weiser — Wm. M. Mitchell, class of 1905. 



The following officers were elected by the 
Junior Medical Class : President, William S. 
Walsh ; vice-president, James Furman Dobson ; 
secretary, George Loutrell Timanus ; treasurer, 
Clarence C. Hoke; historian, .Alfred Mordecai. 



The Phi Sigma Kappa fraternity have opened 
their home at 1222 Mt. Royal avenue. 



Prof. A. M. Shipley gave an interesting address 
upon anti-vice at the smoker tendered University 
of Maryland students by Prof. Howard A. Kelly 
of Johns Hopkins Hospital. 



The Latin-American Club, one of our most 
solid organizations, at a meeting held early in 
October elected the following officers : President, 
J. M. Buch, M., '13; vice-president, V. P. Rei- 



174 



THE HOSPITAL BULLETIN 



necke, D.. '13; secretary, Herman M. Perez, M., 
'13; treasurer, I. H. Fajardo, M., '13; historian, 
K. de Jongh, D., '13. 



The Freshman Medical Class has elected the 
following officers for the coming session : Presi- 
dent, Cecil Rigbv ; vice-president, E. L. Bishop; 
treasurer, G. 1'.. YVilkenson; secretary, B. B. 
Brumbaugh. 



Among the University alumni practicing in 
Delaware are : 

Uelmar — S. Howard Lynch, class of 1906. 

Dover — Edward F. O'Day, class of 1890. 

Georgetown — George Frank Jones, class of 
1889. 

Gumboro ( R. F. D, Millsboro) — Oliver A". 
James, class of 1906. 

Laurel — William Thompson Jones, class of 
1895. 

Middleton — Dorsey W. Lewis, class of 1896. 

Reedy Island (Port Penn P. O.) — Lawrence 
Kolb, class of 1908, army surgeon, U. S. P. H. 
and M. H. S. 

Wilmington — C. Anthony Beck, class of 1901, 
1836 W. 4th street: Ira Burns, class of 1905, P. 
R. R. Station ; Gerald L. Dougherty, class of 1908, 
1901 Delaware avenue; Thomas H. Phillips, class 
of 1907, 624 X. Franklin street ; William Marshall 
Priest, class of 1909, 8th and Adams streets; 
Meredith Ivor Samuel, class of 1900, 1016 Wash- 
ington street. 



Dr. Josephus A. Wright, class of 1881, has 
resigned as superintendent of Sydenham Hos- 
pital, and has been succeeded by Dr. Samuel T. 
Nicholson, a graduate of Hopkins in 1910. Dr. 
Wright succeeded Dr. Robert A. Warner, class 
of 1895. 



The Baltimore and Ohio Railroad Company 
will build an emergency ward at the University 
Hospital within the next few months. It will 
be one of the best equipped and most modern in 
the city. Dr. Page Edmunds will be in charge 
when completed. The present ward H, on Greene 
street, will be torn down and remodelled at a 
cost of $4500 to $5000 to meet this new de- 
mand. There will be an operating-room com- 
pletely equipped with all the necessary emergency 
instruments, a special room for the seriously 
injured and a sun parlor and room fcr the less 



seriously injured. At present it is planned to 
have only those patients injured on the Balti- 
more and Ohio treated in this ward, and will be 
the only one maintained by the railroad companv. 



Prof. Randolph Winslow was given a surprise 
on Tuesday afternoon, October 22. when a re- 
ception was given in his honor by the resident 
physicians of the University Hospital in honor 
of his sixtieth birthday, which occurred on the 
following day, October 23. When he appeared 
before his class he was presented with a bouquet 
of 60 American Beauty roses, one for each year 
of his age. Dr. Winslow has taught at the uni- 
versity more than 39 years. 



Dr. James B. Parramore, class of 1909, of 
Jacksonville. Fla.. has decided to limit his prac- 
tice to surgery and gynecology. 



We wrote and asked Dr. Darius Cleveland 
Absher, class of 1909, of Mount Airy, X. C, to 
let us know what he had been doing since he left 
school. We think his reply is far better put than 
we could frame it. so we reproduce it for the 
benefit of our readers. He writes : 

"I am willing to tell the little there is to tell, 
although I am sure it will not be interesting. The 
first thing I did after leaving the university was 
to 'go up against' the Xorth Carolina Board, 
and I am glad to say they "saw fit to let me by." 
I then located at Xorth Wilkesboro. X. C, and 
became associated as interne with a small pri- 
vate hospital (the Wilkes Hospital ) for about 15 
months, gaining some good practical experience, 
and at the same time I was engaged in some 
private practice and 'taking unto myself a better 
half.' In the fall of 1910 I went to Xew York, 
where I took courses in operative surgery at 
the Xew York post-graduate and at Bellevue, 
and attended clinics at several other hospitals in 
Xew York, Philadelphia and Baltimore. In Jan- 
uary, 191 1, I located in Mount Airy, doing gen- 
eral practice and some little surgery, and hold 
the position of municipal health officer. I am 
a member of my State Medical Society and of 
the A. M. A. — as I think every reputable phy- 
sician should be. 

"I am exceedingly glad to hear of the pro- 
gressive steps the University of Maryland is tak- 
ing — raise the standard higher, both in entrance 
requirements and in better teaching, w> that e\ cry 



THE HOSPITAL BULLETIN 



175 



alumnus of the old school may be able to point 
with pride to our old Alma Mater and her red nil 
— then every alumnus will be glad to stand by 
their Alma Mater and push her still higher, but 
then she won't need it so much. Now is her 
hour of need and I would that every alumnus 
would stand shoulder to shoulder, both financial- 
ly and otherwise, in pushing the old university 
to the front and in making her the peer of any 
school in America. I long to see the day when 
the school will be in reality the State University 
of Maryland, and supported and made great as 
such. 

"With greetings to all of the eld boys, I am." 

Dr. Absher served for one term as vice-presi- 
dent of his county medical society, and while at 
North Wilkesboro was secretary and treasurer 
of its county medical society, so he has not hesi- 
tated to give his time and work to the uplifting 
of his profession. His plea for the university 
is as timely as it is forceful, and we appreciate 
his spirit of love for his Alma Mater. 



By request we give the following locations of 
the class of 1909: 

Darius Cleveland Absher, Mount Airy, N. C. 

A. Marvin Bell; address unknown. 

George E. Bennett, 1127 Madison avenue, Bal- 
timore. 

Clarence Irving Benson, Port Deposit. Md. 

William John Blake. Benwood, W. Va. 

William Ward Braithwaite. Christobal, Pan- 
ama. 

Norman Irving Broadwater, Oakland, Md. 

Maxey Lee Brogden, Swansea, S. C. 

Paul Brown ; address unknown. 

Howard Barton Bryer, Newport, R. I. 

Miguel A. Buch y Portuondo, Santiago, Cuba. 

William S. Campbell, Albany, Mo. 

Arthur E. Cannon, Clifton, S. C. 

Arthur Judson Cole, Holbrook, Mass. 

Clarence Bythell Collins, Calvert, Md. 

1 '.ranch Craige, El Paso, Texas. 

Carroll Augustus Davis, Arrington, Nelson 
county, Virginia. 

Thomas Robert Dougher; died Februarv 16, 
1012. 

J. Ernest Dowdy, W'inston-Salem. N. C. 

Arthur Louis Fehsenfeld, Forest Park, Aid. 

Harry Baldwin Gantt, Jr., Millersville, Aid. 

Robert H. Gantt; died June 10, 191 1. 



Benjamin Harrison Gibson, 403 East Bolton 
street. Savannah, Ga. 

William Thornwell Gibson, Batesburg, S. C. 

Thomas Gilchrist, 151 1 Green street, Philadel- 
phia, Pa. 

Julian Mason Gillespie, l*. S. P. H. S., Hono- 
lulu, I lawaii. 

Edwin B. <i la.ll, 98 Emerson street, Haver- 
hill, Mass. 

Morris Baldwin Green, Hamilton, Md. 

Jose Y. de Guzman, Soto, Porto Rico. 

Simon Wickline Hill, Regent, N. D. 

Joseph Ward Hooper, James W alker Memorial 
I lospital, Wilmington, N. C. 

James A. Hughes, Strong, Pa. 

Preston Hundley, Montross, Va. 

Everette Iseman. 11 East Jones street, Savan- 
nah, Ga. 

< ieorge Edward James, Newport, N. J. 

Charles Herbert Johnson, 714 Linden street, 
Camden, N. J. 

Adam Seanor Kepple, 1 lannastown, Pa. 

Howard Kerns, Granite Falls, A I inn. 

William Walter Kettle, 714 Glesian street, Port- 
land, Ore. 

Ralph Norvel Knowles, Hebron, Maine. 

Edgar Miller Long, Hamilton, N. C. 

Samuel Herman Long. 1922 East Baltimore 
street, Baltimore. Md. 

Ross Simonton McElwee, Statesville, N. C. 

James Finney Magraw, Perryville, Aid. 

William E. Martin, Roslyn, Md. 

John Sanford Mason, Whiting Block. Albu- 
querque, N. M. 

James William Meade, Jr.. Fishing Creek, Md. 

John Lindsey Messmore, Masontown, Pa. 

Cleland G. Moore, Schuyler, Neb. 

James Leftwich Moorefield. Guilford College, 
N. C. 

Charles A. Neafie, Blackwell's Island, New 
York. N. Y. 

John Standing Norman, Bladenboro, N. C. 

John Nelson Neill Osburn, Martinsburg, W. 
Va. 

James B. Parramore, Jacksonville, Fla. 

Lytle Neal Patrick. Gastonia, X. C. 

Thomas Alexander Patrick, Fayetteville, Tenn. 

Samuel Jackson Price; address unknown. 

W'ilmer Marshall Priest, Wilmington, Del. 

Lynn J. Putnam, Shenandoah. Iowa. 

William Gwynn Queen, Arlington, Aid. 

Fred Wharton Rankin, North Carolina. 



i 7 



THE HOSPITAL BULLETIN 



Jemil Abdallah El Rassy, Syria. 

Joel Cutchins Rawls, Franklin, Ya. 

Budd Jameson Reaser, Martins Creek, Pa. 

J. W. Ricketts. Central avenue and 32d street. 
Indianapolis, Ind. 

John William Robertson, Onancoek, Ya. 

Harry M. Robinson, 2010 Wilkins avenue, Bal- 
timore, Md. 

Louis Hyman Roddy, Cameron, Texas. 

John T. Russell, Eastport, Aid. 

John G. Schweinsberg, 1120 West Cross street, 
Baltimore, Md. 

Andrew John Shakhashiri, Syria. 

Reed A. Shankwiler, Detroit Tuberculosis San- 
itarium, Detroit, Mich. 

Furman Thomas Simpson, Westminster, S. C. 

Hugh W. Smeltzer, Creendale, Ya. 

Claud C. Smink. Lauraville, Aid. 

Maurice Isaac Stein, 531 Cumberland street. 
Baltimore, Md. 

Xeal Summers Stirewalt, McConnellsville, S. C, 

Charles Franklin Strosnider, Newbern, N. C. 

Charles LeRoy Swindell, Black Creek, X. C. 

Asa Thurston, Taylorsville, X. C. 

Alfred Chase Trull, Haverhill, Mass. 

Frederick Henry Vinup, 1221 Hollins street. 
Baltimore, Md. 

Adam Clark Walkup, Mcintosh. Fla. 

John Bruce Weatherly, Altamahaw, X T . C. 

Walter Franklin Weber; address unknown. 

T. Hayne Wedaman, Pomaria, S. C. 

Lehman W. Williams, Statesboro, Ga. 

R. Gerald Willse. 1127 Madison avenue. Balti- 
more, Md. 

Eugene Bascom Wright. Hebrew Hospital, 
Baltimore, Md. 



The following resolutions were adopted and 
ordered spread on the minutes of the Anne Arun- 
del County Medical Society at their regular meet- 
ing held at Annapolis, Md., Tuesday, October 8, 
1 9 1 2 : 

"Resolved, Whereas God, in His infinite wis- 
dom, has chosen to remove from our midst our 
friend and fellow-practitioner of medicine. Dr. 
Henry Roland Walton (Universit) of Maryland, 
class of 1850) ; 

"Resolved, That the Anne Arundel County 
Medical Society extend the family of our deceased 
friend and fellow-practitioner. Dr. II. Roland 
Walton, their heartfelt sympathy in their hour of 
affliction ; 



"Resolved, That a copy of these resolutions be 

forwarded to the family of the late Dr. Walton. ; 

"Resolved, That a copy of these resolutions be 

published in the official organ of 'The Medical 

and Chirurgical Faculty of Maryland ;' 

"Resolved, That a copy of these resolutions be 
published in the Maryland Medical Journal : 

"Resolved, That these resolutions be entered 
upon the minutes of this meeting, held the eighth 
day of October, 1912." 
Respectfully, 

Louis B. Henkel, Jr., 

Secretarv. 



Dr. Arthur Dean Bevan of Chicago was the 
guest of Dr. Randolph Winslmv on November 7, 
and while here was entertained in the University 
Hospital, where he met representatives from both 
the Baltimore Medical College and the College of 
Physicians and Surgeons of Baltimore. 



A called meeting of the executive committee of 
the University of Maryland General Alumni As- 
sociation was held at the office of Judge Dawkins 
on October ir. 19,12. The following were pres- 
ent: Dr. Charles E. Sadtler (1873), president; 
James W. Bowers, vice-president; Flon. Walter 
I. Dawkins. Frank V. Rhodes. John B. Thomas, 
Eugene W. Hodson, John H. Skeen and Dr. H. F. 
Gorgas. Dr. Nathan Winslow was nominated 
fi a- corresponding secretary for the coming year, 
nominations to be presented to the meeting of the 
Association on Academic Day, November 12. 
The directors nominated from the medical school 
were Drs. St. Clair Spruill 11890) and Harry 
Adler (1895). New members were nominated 
for the Advisory Council, Drs. Charles E. Sadtler 
1 1873), E. F. Cordell (1868) and Harry Adler 
1 1805 being nominated to represent the meidcal 
school. The nominees were elected at the meet- 
ing on November 12 immediately preceding the 
annual banquet. 



■ Academic Day, November 12, 1912. marked the 
one hundred and twenty-third anniversary of the 
founding of St. John's College, the department of 
arts and sciences of the University. At 10.30 
o'clock the formal exercises began at Westminster 
Church. Fayette and Greene streets, the St. John's 
Cadets, the University faculty and students and 
alumni marching in a body to the church, lead by 
the St. John's Band. The academic march — "The 






THE HOSPITAL BULLETIN 177 

University of Maryland" — was given on the or- The Cross-Country Club game, although not 

gan hy Robert L. Haslup, and the invocation de- an Ai exhibition, showed excellent material, 

livered by Rev. Dr. Thomas Grier Koontz, pastor which after a little practice should develop a 

of the church. The acting provost, Judge Henry bright future. 

Stockbridge, made an address of greeting, fol- The lineup for the „ ame was ag follows . 

lowed by an address on the life and work of Her- ^ ,. ...... 

, „ J „ , , , , Kl> Colhson (captain). 

nard Carter. Provost, and by Arthur George r , TT ,, „ , ' f, 

. ., ., • , , .... ' K.J 1.1, Cooley, Krantz. 

Brown, and a sirmlar tribute to 1 ihn Wirt Kan- T TT _ _ 

, ,. . ,. , , , ,. , L.H.B Ross. 

dall, also a former provost and who also died - ., 

during the year, by Philemon 11. Tuck. Dr. B. :' ........ . . 

",..,. ,, „ , „ „ , lr L Stephens manager). 

Merrill Hopkrason, Messrs. Edgar T. Paul, Ho ' , / 

hart Smock and lohn 11. Richardson rendered . ,.' ' ' ',' , 

. . , • . _ „ ., ... L.ti Blackmore. 

solos during the meeting. Dr. r.rnest /uebhn _ „ __ . 

, ,' .... , ,.,. , ™ , ., R.l Kennard. 

made an address on Aims of Clinical leading, T ~ _ „ „ 

„ r , . r L. 1 Dorell, Bung. 

and referred to the martyrs of the profession T „ ,, 

, , . ,.,.'. , . L.I'. Rogers. 

who had given their lives in order to advance .. ., „, 

,. , ' , . _ „ ... . , ... .. K.b. .Murrey. 

medical teaching. Dr. /.uebhn paid a high tribute 

to the medical men of America, and said that their 

progress was being watched the world over, and Manager II. II. Warner issued a call for 

that workers everywhere are stimulated by the basket-ball practice, which was answered by 15 

achievements in medicine in America. men . but tw ° of tht old men turning out— War- 
ner and Porter. A cracking good schedule will 
be announced, including Loyola, University of 

It was announced on Academic Day that Prof. Pittsburgh, Catholic University, Carlisle, St. 

and Airs. John C. Hemmeter had made a gift of John's and others. 

securities to the amount of $5000 to be applied to 

the fund to support the Hemmeter chair of physi- . , . „. at 1 -n 

, . . ' . , , Academic Day was November t_\ 1912. Pro- 

ologv, bringing the amount of the endowment up . ,.,,.:,. , , . . , , , 

Z lessor /.uebhn delivered the principal address. 
to Sio.ooo. 

. . . , rx . . Among the University alumni practicing in 

Among the recent visitors to the University _ ... 7 

, , . ,' „ „ „ . California arc: 
Hospital were Drs. lames B. Parramore, class ot 

1909, of Jacksonville, Ida. ; Watson Smith Ran- Bakersfield-Byron Rees Rees, class of 1900, 

kin, class of 1901, of Raleigh, N. C. ; Brooke L. ° ld Flsh Budding. 

Jamison, class of 1905, of Emmitsburg, Md, and Chico— Oscar Stansbury, class of 1873. 

Thomas Brooks, class of 1910, of Santiagi >. Cuba. Danville— H. C. Reamer, class of 1885. 

Los Angeles — Chas. Lewis Allen, class of 

1887, Pacific Electric Building; Frederick S. 

athletics. Gate, class of 1898, Nadeau avenue ; Josiah Evans 

A call for football practice was issued by Coach Cowles, class of 1880, American Bank Building : 

Willse and was answered by a large squad, repre- Roy S. Lanterman. class of 1893, Grosse Building ; 

senting practically every department. The fol- Joseph A. Le Doux, class of 1889, McLaughlin 

lowing dates were announced : Building; Wm. K. Robinson, class of 1893, 610 S. 

Oct. 26 — Cross-Country Club. At home. Broadway; Benjamin Mosby Smith, class of 1888, 

Oct. if) — Maryland Agricultural. At College 3 r 4 W. 64th street. 
Park. 

Nov. 2 — Open. At home. Since the advanced preliminary requirements 

Nov. 9 — University of Pittsburgh. At Pitts- have gone into effect, Dr. Coale informs us that of 

burgh. about 165 registered by the special examiner of 

Nov. 16 — Delaware College. At Delaware. the State Board of Medical Examiners, Mr. Otis. 

Nov. 23 — St. John's. At Annapolis. the University of Maryland has matriculated 93. 

Nov. 27— Rock Hill. At home. or more than half of the total number. 



i 7 8 



THE HOSPITAL BULLETIN 



Among the University alumni practicing in 
Massachusetts are : 

Ashfield — John Edwin Urquhart, class of 1883. 

Athol — George J. Bassow, class of 1899. 

1 '.iston — Wm. Thomas Councilman, class of 
1878, 240 Longwood avenue; Richmond Favour, 
class of 1904. 2121 Washington street; Henry P. 
Frost, class of 1889, Boston State Hospital; 
Woodbury Dudley James, class of 1881, 82 War- 
ren street; Chas. Lusby Pearson, class of 1883, 
427 Marlboro street ; Isaac J. E. Shapira. class of 
1897, 238 Huntington avenue; Harold Walker, 
class of 1871, 147 S. Huntington avenue; James 
Homer Wright, class of 1892, 95 Mountfort 
street. 

Brookline — Arthur Alden dishing, class of 
1904, 108 Marion street. 

Fall River — Clarence W. Stansfield, class of 
[906, 1274 X. Main street. 

Foxboro — Irwin Hoffman Neff, class of 1889. 

Haverhill — Alfred Chase Trull, class of 1909, 
48 White street. 

Molbrook — Arthur Judson Cole, class of 1909. 

Holyoke — John Joseph Carroll, class of 1905, 
120 Chestnut street; George L. Kinne, class of 
1887, 265 Maple street ; Harold E. Miner, class of 
[905, 51 Maple street; Allen T. Moulton, class of 
!'M 1, interne House of Providence. 

Lawrence — Walter Daniel Riordan, class of 
1003, 187 Newbury street; Myer Schwartz, class 
of if>02, 261 Common street. 

Lowell — Charles Ephraim French, class of 
r893, Runels Building; Arthur E. Gillard, class 
of 1887, 32 John street ; Frederick Augustus War- 
ner, class of 1873, Lowell General Hospital. 

Lynn — Elias Xathanson, class of 1908, 242 
Summer street. 

Northampton — Garrett J. Hickey, class of 

1893. 

North Attleboro — Amzi Beddell Shoemaker. 

class of 1908. 

Siiuthbridge — William Stanislaus Conway, 
class of 1910. 

Sw ampscott — Edward Van D. Bray, class of 
1894. 

West Medway — Samuel Butler, class of 1904. 



held for the visiting members of the fraternity 
at the University Hospital and Johns Hopkins 
on Saturday. November 30. 



The Nu Sigma Nu Fraternity have opened 
their new home at 618 West Lombard street, 
where they are preparing for the bi-annual con- 
vention of the fraternity to be held in Baltimore 
November 29 and 30. Special clinics will be 



We regret exceedingly to announce that Dr. 
John Clements Harris, class of 1862, of 773 
West Lexington street, was stricken with paraly- 
sis on the afternoon of October 31, and his con- 
dition is serious. Dr. Harris has been living for 
years alone in the big house on Lexington street 
and was found there alone and unconscious. He 
was taken to a neighboring residence and his 
only relative, a brother, James S. Harris, of 
Everett, Kent county, Maryland, was notified. 



ENGAGEMENTS 



The engagement is announced of Dr. Elijah 
Emera Nichols, class of 191 1, of Pikesville, Md., 
to Miss Caroline Estelle Lauer, daughter of Airs. 
Henry Lauer, of Walbrook. The wedding will 
take place in the early spring. 



MARRIAGES 

Dr. Herbert Jerome Rosenberg, class of 1908, 
of Atlanta, Ga., was married to Miss Rosalie 
Loeb, daughter of Mr. and Mrs. Marcus Loeb. 
Tuesday, November 5. 1912. The ceremonv took 
place at the home of the bride, 439 Washington 
street, Atlanta, and was performed by Rev. Dr. 
Marx. After a honeymoon spent in the North, 
the couple will live at 409 Washington street, At- 
lanta, where the Doctor is engaged in the practice 
of his profession. Dr. Rosenberg is the son of 
Mr. and Mrs. A. Rosenberg: of Greenwood, S. C. 



Mrs. Sovena Jane Smith has announced the 
marriage of her daughter. Miss Maude Fowble 
Smith, University Hospital Training School for 
Nurses, class of 1908, to Mr. Thomas Reese 
Cornelius, on Saturday, October 26, 1912, at 
Trinity Church, Towson. Md. Mr. and Mrs. 
Cornelius will be home after December 1, 1912, 
Giddings -avenue, Govans, Md. 



DEATHS 

Dr. Robert Ferguson Chapman, class of 1865, 
who has been in active practice for almost 50 
years, died on the morning of November 12. 10,12. 
at his home, 121 West 120th street. New York. 
Dr. Chapman was born in La Plata, Md., July 24, 



THE HOSPITAL BULLETIN 



179 



1S41. and was the son of Gen. John Chapman and 
Susan Pearson Chapman, and was descended on 
both paternal and maternal side from the early 
English and Scotch settlers of .Maryland and Vir- 
ginia of [633 and [635. He studied at Charlotte 
I [all Academy, and later graduated at Yale with 
the cla^s of [862, being the only Southerner in 
the institution at the time of his graduation. He 
received his A.M. from Yale in 1KO5. lie studied 
medicine for a while at the College of Physicians 
and Surgeons of Columbia University, and then 
Matriculated at the University of .Maryland, grad- 
uating in [865. I le settled in Southern Maryland 
and practiced there for a while, moving; to New 
York in [872. ( )n July 12, 1X70, Dr. Chapman 
married M is-, Nannie Duvall of Baltimore, who 
died two 3 ears agi >. I le was a member of the Psi 
L'psilon fraternity of Vale and of St. Andrew's 
I '. I'.. Church of New York. Dr. Chapman is sur- 
vived by one son, Robert Fendall Chapman, of 
New York, a graduate of the College of Phy- 
sicians and Surgeons of Columbia University of 
the class of 1895. 



ternity throughout the State received the news 
of his death with the utmost sorrow. He is sur- 
vived by three sons and three daughters. 






Dr. I. Denham I 'aimer, class of 1872, of Jack- 
sonville. Fla., died on November 3, 1912, from 
the effects of a bullet wound accidentally re- 
ceived. Dr. Palmer was in his offices in the 
Doty Building and had as a patient a young man 
who lived some distance from the office, and 
who carried the pistol as a method of protection 
because of the present unrest in Jacksonville. 
After Dr. Palmer had finished his examination 
the patient drew his coat across the table to put 
it on and the pistol was thrown to the floor. It 
struck at such an angle that the instant discharge 
sent the bullet into Dr. Palmer's thigh, from 
whence it glanced upward through his body. 1 >r. 
Palmer was rushed to St. Luke's Hospital in- 
stantly, this being about 2 P. M., but he died at 
7.30 P. M. 

Dr. Palmer was born in Monticello. and be- 
longed to one of Florida's oldest and most aris- 
tocratic families, lie attended the public schools 
of Florida and then matriculated at the univer- 
sity, from whence he was graduated in 1872. 
He practiced in Fernandina until 1905. when he 
removed to Jacksonville. He did yoeman service 
in the work of conquering and stamping out yel- 
low fever during the epidemic in Jacksonville, 
Memphis, Tenn.. and Fernandina, Fla. He was 
respected and loved by all, and the medical fra- 



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Prof. Theophilus Ciesielski in his paper, "I low- 
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Female," opens the old, old question ; the riddle 
of many ages. He states : "After studying, 
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control this enigma of nature. For 33 years I 
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but now at length I am satisfied that I ought not 
to delay, for it may well happen that someone 
else may not hesitate to make this same discovery 
public." 



i8o 



THE HOSPITAL BULLETIN 



Whether the conclusions drawn are true or 
not, the article shows the result of careful, pains- 
taking, scientific investigation extending over a 
number of years, and that the theory is not hastily 
concocted. After years of experimentation upon 
the cannabis plant with ineffectual results, Dr. 
Ciesielski noted finally that female plants impreg- 
nated with fresh pollen produced male plants ; 
female plants dusted with stale pollen produced 
female plants. Not satisfied that he had entirely 
solved the question, the author also investigated 
the problem in animals with the same results. He 
noticed that a doe rabbit served once only by a 
buck, which had not had connection for some 
days, produced a litter of two or three females, 
but if a buck was used which had had connec- 
tion the day before, then she would bear two or 
three males. He states that he has proved the 
truth of this law in horses, dogs, cattle and man. 

If the observations prove true, the author has 
made the world his debtors. At any rate, true 
or not true, his labors should be an incentive to 
others not alone in this field, but also in every 
line of medical research. It is, indeed, a rarity 
that we see a man in these times holding back 
any investigation and testing its value over such 
an extended period of time. Another paper well 
worth while is "The Modern Treatment of 
Gout," by Marcel Labbe, M.I). '"The Diagnosis 
and Treatment of Locomotor Ataxia," by Wil- 
liam J. Maloney, should interest the readers of 
the "Clinics." Besides the articles mentioned 
above, there are a number of others which con- 
cern pertinent topics of the day. Taken all in 
all, the present number is the best resume of 
modern problems in medicine. 



Internal Medicine. By David Bovaird. Jr.. 
A.B., M.D., Assistant Professor of Clinical 
Medicine in the College of Physicians and 
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most of the books on the market are either too 
cumbersome for their purposes or too skimpy. 
What students desire is an authorative book, de- 
void of statistical compilations and debatable 
theories. They desire facts stated dogmatically. 
If the subject under discussion is dealing with 
debatable matter, they desire the most likely 
hypothesis and nothing more. Such a volume is 
Bovaird's "Internal Medicine." It covers the 
field thoroughly and in a most satisfactory man- 
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ling of matter which other authors take for 
granted is known; for instance, the minute and 
detailed manner in which he describes the tech- 
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the number and quality of illustrations included 
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THE HOSPITAL BULLETIN 

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^ It is the spirit actuating the givers as much as the amount 
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1 82 



THE HOSPITAL BULLETIN 



A SUMMER CRUISE ON THE SPANISH 
MAIN. 



By Randolph Winslow, M.D. 



4. COSTA RICA AND SANTIAGO DE CUBA. 

One's preconceived ideas of geography are apt 
to be very much upset by actual travel. I had sup- 
posed Costa Rica to be situated due north of 
Colon; but, as a matter of fact, one sails almost 
due west to reach Port Limon, the only seaport 
on the Atlantic side of this Central American re- 
public. Leaving Colon at 2 P. M., we reached 
Port Limon about 8 o'clock the next morning. 



Having been duly lined up and examined, and 
found free of cholera, yellow fever, smallpox and 
bubonic plague, we were permitted to tempt fate 
by jumping into a rowboat when it rose on the 
crest of a wave and rowing ashore. Port Limon 
is an unattractive town of 5000 inhabitants. There 
is a small but pretty park, with the customary 
bandstand in its center. The houses are mostly 
of frame construction, and are not ornamental. 
The United Fruit Co. is the most important factor 
in the life of the town, and, indeed, in the finan- 
cial and commercial affairs of the country. This 
company maintains good lines of steamships ply- 
ing between New Orleans and Costa Rica, as well 
as between New York and Port Limon. The 



, No. 193 Puntarenas 



C**-"* /UAt 




PTJNTABENAS, COSTA RICA. 



Some ships put in at Bocas del Toro. which is a 
thriving town at the extreme northern part of 
Panama, to load bananas, but our itinerary did 
not call for a stop at that place. There is no har- 
bor at Port Limon, but an open roadstead, which 
is both uncomfortable and dangerous. Ships can 
dock at the piers in good weather, but during 
storms they must cast loose and put to sea or seek 
protection behind an island. Fortunately, we were 
favored with fairly pleasant weather, though the 
water was by no means smooth. As much for- 
mality is observed on entering port in one of these 
bantam republics as is customary in the large sea- 
ports of the Great Powers. The flag of the coun- 
try is run to the head of the foremast, and when 
the quarantine and customs officers approach the 
band plays the national hymn of the country. 



banana trade is almost entirely in the hands of the 
United Fruit Co., though the Atlantic Fruit Co. 
also exports this fruit in smaller quantities. Costa 
Rica is a mountainous country of 23,000 square 
miles area, with a population of 390,000. The in- 
habitants are less mixed in character than are 
those of the other Central American countries, 
and are mostly of pure" Spanish origin. On the 
coast there is a considerable number of West In- 
dian negroes, who are in the employ of the fruit 
companies, but in the interior the people are white, 
with some admixture with Indian blood. Landing 
at Port Limon, and passing inspection, the next 
thing to do is to get American money changed 
into that of Costa Rica. The colone is the na- 
tional unit of currency, being equivalent to about 
44 cents in our money. A narrow-gauge railroad 



THE HOSPITAL BULLETIN 



183 



runs from Limon to San Jose, the capital, about 
103 miles, but only one train leaves daily from each 
terminus. For the first 20 miles the road traverses 
a Hat, jungle-covered, swampy region, sparsely 
settled with negroes, whose shanties are collect I 
here and there into miserable-looking villages. 
The negroes appear to be the same happy-go- 
lucky people that we find in our own Southern 
Stales, and here and there the) were seen dancing 
and making merry to the music of some broken- 
down instrument. Soon we were ascending the 
mountains, ever increasing in altitude, until 6003 
feet is reached. The ride over the mountains is 
very beautiful. In many places broad highland 
valleys, with cultivated fields, are seen, or pasture 



delayed by a landslide. Costa Rica is a land in 
which earthquakes arc of frequent occurrence, 
and our route passed through Cartago, formerly 
a town of 15,000 population, which was almost 
completely destroyed about two years ago, it has 
been partially rebuilt with one-story concrete 
bouses, but there are still many vacant -pots, and 
many others on which only rude shacks arc lo- 
cated. Andrew Carnegie's palace for the Central 
American Court was situated in this town, ami 
was also destroyed. 1 understand it will be re 
built at San Jose. A statue of a former President 
was turned completely around, so that it faces in 
the opposite direction to that in which it was orig- 
inally placed. Descending from Cartago 11 miles, 



Vista del Campo C. K 




VISTA DEL CAMPO, COSTA RICA. 



lands on which herds of cattle and other stock 
were contentedly grazing. The steep sides of the 
mountains were covered with coffee bushes, where 
they could get the sunshine and rain. The coffee 
industry is one of the chief sources of revenue of 
the people. They claim that Costa Rican coffee 
is the best in the world, but the coffee I drank 
was about the worst I had ever tasted. Rut per- 
haps I was not sufficiently educated to appreciate 
it. One disadvantage in traveling by rail in this 
country is the frequent landslides and washouts 
that occur, so that one can never tell when he goes 
into the interior whether he will be able to get 
back again in any reasonable time. W'e were as- 
sured that there would be no such catastrophe 
during our visit, as it only occurred later in the 
year; nevertheless, a few davs later the train was 



we come to San Jose, situated on a plateau 5000 
feet above sea level. The situation is beautiful — 
almost like a huge amphitheater surrounded by 
mountain ranges. The city is attractive in ap- 
pearance, with low houses of Spanish type, tinted 
in varying colors. The streets are rather narrow, 
but are fairly well paved and are kept clean. 
Trolley lines run in several directions, and there 
is considerable bustle in the streets, with carriages 
numerous and cheap, drawn by good horses. Oc- 
casionally one of the heavy-wheeled carts, drawn 
by slow-moving oxen, rumbles by. The yoke does 
not rest on the neck, as with us, but is attached 
to the horns, and the driver guides his team with 
.1 goad, with which he strikes them. Buzzards sit 
upon the roofs of the houses and wander about 
the streets, and doubtless they are important mem- 



iS 4 



THE HOSPITAL BULLETIN 



hers of the street-cleaning department. These 
birds are black, but have lead-colored heads, and 
differ in appearance from the turkey buzzard of 
the temperate zone. We secured rooms at the 
Imperial Hotel, which is imperial only in name. 
The accommodations were crude and the fare 
poor. Early breakfast, from 6 to 7.30, consisted 
of poor coffee, rolls with bad butter and two eggs. 
Late breakfast, 12 to 1, was really a lunch of soup, 
one meat, vegetables and dessert, and dinner, 6 to 
7. was about the same as lunch. None of the 
food was good, but some was not as bad as the 
rest. One of the great needs of all these Central 
American cities is decent hotels. Even in ( luate- 
mala City the hotel accommodations are very in- 



and other objects, made by the ancient Indians 
and exhumed from their graves. The Presiden- 
tial Palace is an unpretentious building, one story 
in height, with two handsome reception-rooms, 
furnished in red and gilt. I only suspected it to 
be the Presidential residence from the fact that a 
sentry was on guard in front of the building. 
There is but little militarism in Costa Rica, the 
standing army consisting of only 500 men. They 
say they have no need of an army, as Uncle Sam 
will not let them fight, and, besides, they are too 
busy to engage in warfare. 

The Hall of Congress is situated across the 
street from the Imperial Hotel, and is a very nice 
and well-furnished room. We were courteously 



Arbol de la V 




Alillol, UK 1A TAX. PEACE TREE. 



different. Strange to say, the Theatro Nacional 
in San Jose is one of the most magnificent theaters 
in the two Americas, and there is probablv no 
playhouse in the United States that compares with 
it in beauty. We heard a poor performance of 
Lucia di Lammermoor by an Italian juvenile com- 
pany, liven if the singing was rather indifferent, 
at least one had the opportunity to see the fash- 
ionable life of this little republic. People here ap- 
pear very much as they are in other civilized coun- 
tries; the ladies were dressed in the latest fash- 
ions, and many of them were very attractive in 
appearance. The gentlemen were good-looking, 
tin mgh rather swarthy, and were in conventional 
dress. There is a National Museum, with a good 
collection of Indian pottery and implements, and 
-nme remarkable sold figures of animals, bells 



received by the Speaker and members of Con- 
gress, who expressed great interest in the ap- 
proaching Presidential election in the United 
States. There is a large and substantial cathe- 
dral, as well as several churches in the city, which 
have been more or less damaged by earthquakes. 
The Latin-American peoples are music-loving 
and light-hearted ; they like to walk around the 
little parks, listening to the excellent bands and 
casting admiring glances at the girls. The girls 
are pretty, and wear their hair down the back or 
tied behind the neck with a ribbon matching in 
color the inevitable silk shawl that is worn around 
the shoulders. A girl may go barefooted, but she 
wears a silk shawl over her shabby dress. We 
were fortunate in being invited to visit the home 
of a prominent gentleman and lady on the out- 



THE HOSPITAL BULLETIN 



[8: 



skirts of the city, and to obtain some idea of the 
home life of the better class of the people. This 
home is a typical Spanish house, of only one story, 
surrounding an open court or patio, in which were 
flowers and shrubbery and a rare collection of 
tropical birds, while in the surrounding grounds 
were almost a'll kinds of tropical fruits and vege 
tables. The question is often asked. Is the climate 
\i'i\ hot? In the central elevated portions of 
Central America the climate is cool and bracing, 
but on the coast it is hot and debilitating. At San 
Jose light wraps and overcoats were very com- 
fortable after dark. Daylight ends suddenly and 
night sets in. There is no twilight, as in more 
northern countries. A very noticeable character- 



sailed for Colon on the return voyage. At Limon 
we took on 50 huge sea turtles destined to Eu- 
rope. Two of them died before reaching Colon. 
They are placed on their backs and are unable to 
turn over. We also took on a motley deck load 
of Jamaican negroes — men. women and children 
— who lived, ate and slept on the open deck for 
three days and nights. Many of them were sea- 
side, and they must have suffered intensely, but 
they got off at Kingston as lively as rabbits. We 
only stopped a few hours at Colon, and then put 
out across the Caribbean Sea to Kingston. We 
stayed here 24 hours, taking on a cargo of 
bananas, and as it was a holiday to celebrate the 
emancipation of the slaves, the stores were closed 







CALLE DEL PADRE PICO-PADRE PICO STREET. 



istic of the people is their uniform politeness — 
from the Speaker of Congress to the policemen 
we were treated with marked courtesy. A visit 
to the market was interesting, though perhaps not 
very appetizing. San Jose is situated nearly mid- 
way between the two seas, and has an inter- 
oceanic railroad connection. The Pacific slope is 
more populous and more prosperous than the At- 
lantic side of the country. Coffee is the standard 
product on the west, as bananas are on the east. 
Doubtless the country is largely undeveloped, and 
will become a more important center as American 
capital and industry is attracted to a larger de- 
gree. 

From San Jose I retraced my steps toward-- the 
coast, arriving without mishap at Port Limon, 
where, after an uninteresting stay of 24 hours, we 



and there was nothing to do. Early the next 
morning we were approaching the Cuban coast, 
and soon thereafter the grim walls of Morro Cas- 
tle came into view. The entrance to the harbor 
of Santiago de Cuba is very narrow, only a few 
hundred feet wide, and two ships cannot pass 
abreast. Morro Castle is an ancient fortification 
situated on a bluff overlooking the entrance and 
absolutely dominating it. It is now practically 
dismantled, and is not formidable as a defense. 
From the sea the city is not visible, and it is only 
after traversing a narrow and crooked channel 
that ships enter a considerable-sized bay, and the 
town is seen situated at its upper end. As the 
narrow entrance is easily defended by means of 
earthworks and torpedoes, we can readily under- 
stand why Sampson did not risk his ships in an 



[86 



THE HOSPITAL BULLETIN 



attempt to force the passage ; and if Hobson had 
succeeded in sinking the Merrimac across the 
channel instead of on the edge of it, the Spanish 
ships would have been bottled up. The harbor, 
with its islands and heavily-wooded hillsides, is 
very picturesque, and the city, with its varicolored 
buildings, is like a signet in a ring. The bay is 
rather shallow, and ships must anchor at some 
distance from the shore, though some of the 
smaller ones dock at the wharves. Drs. Brooks 
and Miranda kindly came out to meet us and took 
us ashore in Dr. Brooks' motor-boat. They then 
took us an auto ride through the city and as far 
as the Treaty Tree, where the capitulation of the 
city took place in 1898. San Juan Hill could be 
seen at a little distance, but our time was so lim- 
ited we could not visit it. Santiago is an at- 
tractive-looking city of Spanish type, with low 
houses and narrow streets within the city, and 
with beautiful villas in the suburbs. The location 
is hilly and the houses rise in tiers, so that from 
many of them a beautiful view of the harbor is 
had. The negro insurrection had only recently 



been suppressed and many troops were quartered 
in the city. A company of infantry marched past 
to embark for Havana, looking very much like 
United States regulars. It is said that 6000 ne- 
groes revolted, and that 5000 were killed and 
1000 taken prisoners. In consequence of this in- 
surrection several thousand United States ma- 
rines were sent to the island, and as we came up 
the coast we passed a transport rilled with them 
returning home. It is a great regret to me that 
I could not land when T was in Santiago harbor 
nil July 18, and an equal disappointment that our 
captain would only allow us two hours on our sec- 
ond visit. My sincere thanks are extended to the 
University of Maryland men who did their best 
to entertain us on both occasions. About 40 miles 
from Santiago is Guantanamo Bay, a large sheet 
of deep water, which is a United States naval sta- 
tion. Passing Cape Maysi, we left the Caribbean 
Sea, and after four days of pleasant sailing on the 
Atlantic Ocean we sighted land near Barnegat 
Light, and passing along the electrically-illumi- 
nated New Jersey coast, dropped our anchor in 
New York Bay on August 6 at 11 P. M, 



THE AIMS OF CLINICAL TEACHING TX MEDICINE. 



By Ernest Zuetslin, M.D., 
Professor of the Principles and the Practice of Medicine, University of Maryland, Baltimore. 



Our academic pageant must certainly leave a 
vivid impression upon the spectators and must 
show to the world the realization of the principles 
"cresat, floreat, et fructat" of our Alma Mater. 
To the members of our communion, however, 
Academic Day has a far different meaning; it 
is the visible sign of our strength and union 
in the interests and in the progress of our in- 
stitution dedicated to spread culture and scien- 
tific knowledge among our nation. The view of 
such a distinguished assembly alone already con- 
veys to the mind the sensation of happiness in 
belonging to the medical faculty of such a re- 
nowned University. 

If on this occasion we miss the late Provost, 
Bernard Carter, and John Wirt Randall, both 
members of the Board of Regents, whose activities 
in the interests of our Alma Mater we cannot but 
appreciate, still we feel ourselves united with the 
spirit of the departed and with the memory of all 
the men who have contributed to the glory of our 



school. With reference to their aims, with refer- 
ence to our present duties, we recognize the obli- 
gation to contribute our best to the progressive 
evolution of the University of Maryland. View- 
ing this assembly one realizes the great responsi- 
bility of preparing the student for his practical 
and professional duties and assuring him the 
greatest benefit from his studies. The teacher 
must start with a clear conception of the course 
to follow, and must be familiar with the means at 
his disposal in order to make his task successful. 

In a country like the United States, where 
everything is in full development and the work 
accomplished in the different universities proves 
the continuous growth towards perfection, the 
task of the professor of the practice of medicine 
becomes very important and attractive. The 
American medical institutions, encouraged by tin- 
financial support of broadminded donors, are 
trying to give their students the very best instruc- 
tion and to offer them splendid material for their 



THE HOSPITAL BULLETIN 



,87 



clinical and practical training. The methods of 

medical instruction in these institutions is based 
on the heritage of scientific knowledge of pre- 
vious centuries, and shows a wonderful improve- 
ment, arousing the interest and admiration of the 
universities in the old country. Just as the splen- 
did invention of Marconi has overcome space, so 
human intelligence makes the whole world akin, 
so medical science finds its way everywhere, 
American medical science and research is red >g- 
nized as a very important factor in the untiring 
fight against disease, and its accomplishments 
exert an attractive influence on the graduates of 
European universities. In increasing numbers 
foreign doctors wishing to complete their studies 
come to American universities, and when they 
return to their mother country they take pleasure 
in reporting to their colleagues the creditable 
work they have witnessed on their way from east 
to west through the continent of unlimited pos- 
sibilities. Broadminded men, taking so much in- 
terest in the successful growth of the American 
universities, however, are always busy finding new 
means for better instruction. Comparison with 
the methods of foreign centers of learning leads 
them to adopt new ideas for harmonious co- 
operation among their teachers and so to increase 
the practical benefits of a thorough and systematic 
training of the students. It is remarkable to 
watch this work, accomplished in such a short 
time, and American universities can be proud of 
their showing in competition with foreign insti- 
tutions. So the medical profession by its knowl- 
edge, its thorough experience, will add to the glory 
of the American nation. Among the prominent 
facts of American medical accomplishments I can 
mention only a few : the world-wide reputation of 
the Rockefeller institution for medical research. 
whose investigations have contributed so much to 
our present knowledge ; the energy shown in the 
fight against the white plague ; the work of sani- 
tation pursued in transforming pest and plague- 
ridden cities into the most healthful and delightful 
cities of the world, Havana, for instar.ee; ar; ac- 
complishment we owe to the ingenious work of 
Gen. Leonard Wood. At the present time we 
notice with satisfaction a well organized army of 
philanthropists and eminent scientific men arrayed 
in the bloodless battle against human suffering 
and disease instead of the old-time bloody con- 
quest of territories. These disciples and pro- 



moters of science do not only devote all their 
time, all their energy, their genius to difficult re- 
search work, but their enthusiasm in science and 
in the progress of new methods in preventing and 
healing diseases leads them to pay with their lives 
for their beautiful discoveries. The martyrdom 
and heroism of Dr. James Carroll, our alumnus, 
who offered himself to be infected with the deadly 
agent of yellow fever, and who died from the re- 
mote effects of this dreadful disease a few years 
after voluntary submission to infection, is an 
unique accomplishment in the annals of the his- 
tory of medicine. If we consider that the other 
two members of the Yellow Fever Commission, 
Major Walter Reed, U. S. A. ; Dr. Jesse W. La- 
zear, also died as the victims of these dangerous 
investigations, and that owing to their discoveries 
the proper ways of prophylaxis of yellow fever 
have been found, we must admire such heroism. 
Such examples kindle our enthusiasm in scientific 
work, and following their steps we should be able 
to contribute to humanity by our own work. It 
is no doubt a great privilege for the University 
of Maryland to claim Dr. James Carroll, the im- 
mortal martyr of science, as one of her alumni. 
Dr. James Carroll's teachers of the University of 
Maryland had their share in kindling in their 
pupil this admirable devotion, enthusiasm and 
love for science. The history of the University 
of Maryland, the accomplishments of our Alma 
Mater, in relatively short time, is a splendid proof 
of the high ideals of this institution. The great 
distinction the university enjoys among other 
American and foreign universities is the result of 
the work accomplished by its famous teachers and 
alumni. As different members of the same body, 
gifted with different talents, by faithful, untiring- 
perseverance in their work, by their personality, 
their genius, by a noble demonstration of the 
ideals of life, they all have contributed to their 
best ability to the glory of the university, and it 
is such a difficult task to render full justice to all 
the prominent medical men who, by their contci- 
butions, have added to the fame of the university, 
and through them have won the recognition of 
other institutions here and abroad. 

A review of the accomplishments of the Uni- 
versity of Maryland in the past fills us with ad- 
miration of the work done by teachers connected 
with this school. The names of Dr. George 
Brown, Dr. Nathaniel Potter, Dr. Elisha Bartlett, 
Dr. William Power. Dr. Samuel Chew, Prof. 



[88 



THE HOSPITAL BULLETIN 



Richard McSherry, Prof. Samuel S. Chew, Prof. 
C. W. Mitchell recall to the memory of the audi- 
tors the qualities of these excellent men, to whom 
we feel greatly indebted. The scientific work 
originated in the laboratories and clinics of the v 
university proves that the men in charge of the 
medical instruction are working hard for the 
spread of science and experience. They have 
acquired not only distinction in this country, also 
the} are well known among foreign scientific 
writers and investigators. 

Among the number of clinical and scientific re- 
sults, only a few may be mentioned which have 
greatly contributed to the renown of our Alma 
Mater. Owing to the untiring work of all the 
members of the surgical department its fame in 
successful operations has spread almost over the 
entire country. Valuable scientific information 
can be ascribed to different papers written by the 
members of our faculty. So our knowledge has 
greatly improved with regard to the surgery of 
infants, of the thyroid gland, the pathology of the 
hyoid bone, the surgery of the gall-bladder, tuber- 
culosis of the kidneys, tubercular peritonitis, 
Meckel's diverticulum, etc. The four large vol- 
umes on the diseases of the stomach form the 
first complete work on diseases of the stomach 
published in the English language, and are highly 
accredited by the most renowned clinical teachers 
as a standard work for the whole medical world. 
Not less renowned are the two volumes of diseases 
of the intestines and the manual of Physiology by 
the same writer; they all furnish a splendid proof 
of the competency of the teachers at this univer- 
sity. 

The medical profession is also indebted to 
teachers of the University of Maryland for va- 
rious scientific discoveries. The N-ray, until re- 
cently employed only in the demonstration of dis- 
eases of the bones, was first used in the recogni- 
tion of diseases of the digestive tract by teachers 
in the University of Maryland. The Heterochylia, 
later confirmed by Ewald and Boas in Berlin and 
now an established fact in medical science, was 
discovered in the laboratory of the University of 
.Maryland. 

Also the intubation of the duodenum, published 
in 1897, is due to the same skillful and untiring 
investigator of our school. The causal connec- 
tion existing between the salivary glands and the 
stomach secretion, showing that the extirpation 
of the first mentioned organs results in a loss of 



secretion of the gastric glands, is another result of 
the scientific work carried out in the University's 
laboratories. These results, though attacked by 
investigators who were not familiar with the tech- 
niCj were confirmed in Bickel's laboratory in Ber- 
lin. Recent discoveries in the physiology of the 
heart demonstrating that no chemical substance 
is produced in the myocardium, that was arrested 
by stimulation of the vagus, so that the inhibition 
of the heart calls forth another explanation. To 
accomplish this latter discovery the faculty of 
medicine allowed several wagon-loads of valuable 
instruments of precision kymographs, etc., to be 
transported to the laboratory of the United States 
Fish Commission at Woods Hole, Mass., where 
the scientific investigators, Professor Hemmeter 
and Dr. Albert H. Carroll, were working. This 
liberality on the part of the Medical Faculty in 
encouraging scientific research work deserves 
especial praise. Scientific investigation in met- 
abolism carried out in the laboratory of our hos- 
pital demonstrates the capital importance of a 
careful study of quantitative dietetics. The care- 
ful analysis of the blood serum, the defective or 
insufficient elimination of nocive substances 
through the kidneys represent an enormous 
amount of work, which by its practical applica- 
tion in the change of diet secured the suffering 
patients remarkable improvement or recovery 
from their ailments, which until then had baffled 
the skill of other physicians. Careful study of 
gastro-intestinal cases by recent means of inves- 
tigation allow an accurate localization and diag- 
nosis of the pathological process, which condi- 
tions stood the proof of the autopsy in vivo, by 
the surgical members of our faculty are certainly 
accomplishments which corroborate the impres- 
sion that the members of the University of Mary- 
land stand in the foremost rank of American 
medical authors. The "History of Medicine" has 
received valuable contributions from one of the 
members of our faculty. Not only the remote 
Augustean ideas on medicine and the Greek era 
have become more accessible to our understand- 
ing, but also the life and accomplishments of 
famous members of the medical profession — such 
men as Charles Frederick Wiesenthal, Henry 
Keerl. ( iustavus Brown — all the facts in regard 
to the lives of past and present members of our 
University have been carefully colrected in the 
"History of the University of Maryland," so that 



THE HOSPITAL BULLETIN 



[89 



future generations will derive therefrom valuable 
historical information. 

These allusions will demonstrate that the Uni- 
versity of .Maryland stands in the foremost rank 
of scientific work and any oiie associated with 
the interests of this scientific body must experi- 
ence a satisfaction and pleasure in joining these 
ranks of progressive workers and wish to help 
as much as possible in the realization of plans 
destined to increase the fame of our Alma Mater. 
Elected to the chair of practice of medicine. I 
wish to thank the Board of Regents and the mem- 
bers of the Faculty of Physic of the University 
if Maryland for this high distinction. In ac- 
cepting such a position, I feel the great responsi- 
bility of my work and am impressed with the 
accomplishments of my predecessors. It is there- 
fore my sincere wish to maintain the high stand- 
ard of medical teaching at the L T niversity of 
Maryland. I hope that my previous medical 
training with prominent medical professors of 
this and of the old country, their ideals of pro- 
gressive teaching will help me to justify the con- 
fidence of the Faculty of Physic. I hope that 
mutual understanding with the members of the 
faculty will favor a successful work for the best 
of our institution, so contributing steadily to a 
still greater future for our Alma Mater. 

Medical instruction nowadays has become such 
a complex question that the task of best benefit- 
ting the student appears very difficult. Influenced 
by many different factors, by local conditions, 
the results vary accordingly. First of all, the 
aims in teaching the students the essentials for 
their future profession are to be considered ; next. 
the resources of the institution, and finally, the 
standard of the students ; their psychic and ethical 
qualities forming a great factor in successful 
teaching. 

In regard to the splendid results in surgery, 
the question arises whether more weight should 
be laid on a careful instruction in this sister 
branch of internal medicine. Xo doubt the con- 
quests of the knife in the hands of a skillful sur- 
geon and the wonderful results in the warfare 
against disease and death inspire admiration: 
whereas, in internal medicine the results of treat- 
ment appear only slowly and after much pains- 
taking labor. The student may feel inclined to 
devote himself more to surgery than to internal 
medicine. At the conclusion of their studies a 
greater number of them tend their efforts to be- 



come famous surgeons and only a small percent- 
age of promising pupils remain faithful adherents 
to internal medicine. Since, with the security 
of careful asepsis the autopsy in vivo very often 
discloses without much trouble the real cause of 
disease, is it still necessary for the student to 
undergo thorough training in the methods of phy- 
sical diagnosis? Js it justifiable to subject the 
patient to laborious, time-robbing methods of in- 
vestigation? Is it necessary to resort to the use 
of expensive apparatus for the sake of a more 
definite diagnosis, where the knife and the ex- 
perienced eye can easily control the morbid pro- 
cess in regard to its extent and its localization? 
In my opinion, the student's training in internal 
medicine is of primary importance, since we have 
not yet reached the time where the public itself 
willingly and freely submits to the more ex- 
tensive benefit of the surgeon's knife. We all 
agree that a specialty considered only for itself, 
severed from its relationship to other disciplines, 
separated from the broad foundation of general 
medicine, is likely to lead to errors. More and 
more we have to demand that the specialist un- 
dergoes a through training in the principal 
branches of general medicine, as a reliable basis 
upon which to build his specialty. For the good 
surgeon, it is of the greatest importance that his 
connection with the principles of internal medi- 
cine are never severed. Notwithstanding the 
excellent preparatory instruction given to the stu- 
dent, as soon as he enters upon the practical clini- 
cal studies it seems that he has first to be taught to 
use his senses. His power for close observation 
of the patient has to be developed, as the outward 
observation of the patient in many instances can 
furnish important information in the case. The 
ear requires the subtle training of the musician 
to differentiate the quality, the tonality of the 
sounds transmitted to the surface of the body. 
The delicate touch of the fingers has to be trained 
to differentiate the outlines, the resistancv. the 
qualities of vibration of the underlying organs. 
The acuity of smell has to be educated in order 
that pathological changes imparted to the air 
may not be overlooked. These requirements are 
important factors in medical diagnosis and they 
are obtained only by an assiduous, thorough 
training in the methods of physical diagnosis. 
Next to these simple means of diagnosis, human 
genius has furnished us with much expensive ap- 
paratus as valuable helps to a more accurate un- 



1 90 



THE HOSPITAL BULLETIN 



derstanding of the pathological processes. The 
young student may think his diagnosis incom- 
plete without resorting to these elaborate means 
of investigation. In professional practice, how- 
ever, the public unfortunately not always con- 
sents to such tedious methods of clinical diag- 
nosis. Often the patients lack understanding of 
the advantages of such methods; often their 
financial resources are restricted and forbid such 
expense. In some instances we remark the great 
difference in results between surgery and internal 
medicine. 

Modern surgery, as an exact science, has ad- 
vanced by leaps and bounds owing to the im- 
mense opportunities of proving in every case the 
correctness or incorrectness of diagnosis by the 
autopsy in vivo in internal medicine. In a lew 
diseases i mly — typhoid fever, diphtheria, tuber- 
culosis, relapsing fever, malaria — the control of 
diagnosis is obtained by the laboratory methods; 
for instance, by examination of the blood. And 
still so many changes and complications within 
the internal organs escape our attention because 
of the impossibility of post-mortem examination. 
It must be our aim to destroy the opinion that 
medical diagnosis in this country often is re- 
garded as a matter of clever guessing without 
the necessary demonstration whether one is right 
or wrong. The value of post-mortem examina- 
tions, where every mistake made in diagnosis is 
revealed, can never be overestimated. There is 
some truth in the assertion that students will 
learn only by the mistakes of their professors, 
and later by their own in the position of hospital 
physicians. Unless they are taught by their own 
mistakes, they will never become good diagnosti- 
cians. Unless they have acquired this quality of 
takin> v advantage of exceptional opportunities dur- 
ing their years of study in the hospitals their pa- 
tients will lie inadequately cared for. The percent- 
age of post-mortems among patients who die in 
our hospitals is absurdly small as compared with 
that in other civilized countries. Few hospitals 
are able to hold post-mortem examinations on 
in per cent, to 25 per cent, or even less of their 
dead. In foreign hospitals, well over 75 per cent, 
is the rule; in Vienna practically 100 per cent. 
Even in the old Montreal General Hospital of 
the splendid Royal Victoria Hospital, the hos- 
pital reserves the right to perform an autopsy 
upon every patient dying within its walls. Noth- 
ing could more advance medical science and 



nothing could more increase the efficiency of 
every-day practice than the education of the 
vast mass of the population, so that they may- 
appreciate the fundamental necessity of autopsies 
if they are to have physicians of any value to 
them when their time comes to be ill. It should 
lie the aim of medical education that the well 
trained physician wdierever he is called, even to 
the remotest corners far distant from the centers 
of civilization, should be trained so that his 
close observation, his well-trained eyes, ears and 
fingers render him valuable service. These qual- 
ities direct him to the right diagnosis, even under 
unfavorable extrinsic circumstances. Supposing 
that later on a surgeon and pathologist are called 
to control the physician's findings, is it not grati- 
fying if his diagnosis is confirmed by these pro- 
fessional friends? Does it not mean a great 
blessing to the patient if his case, in the eyes of 
his physician, becomes transparent, when close 
observation, accurate examination, personal ex- 
perience and thorough knowledge of pathology 
and symptomatology contribute not only to diag- 
nosis, but prognosticate the chances for recovery? 
At all times the diagnostic skill of clinical teach- 
ers has attracted hundreds of students and post- 
graduates, and their lessons were followed with 
eager interest. It cannot he denied that these 
masters, too, are handicapped by external condi- 
tions, that in some instances they were mistaken; 
but this meant only a stimulant to them in aim- 
ing at higher perfection of their methods. 

If we admit the primary importance of clinical 
training of the medical student, the practical 
solution of this problem will never be absolutely 
objective. Every teacher, enthusiastic of his own 
methods, imparts to his teaching his personal 
character. As a rule medical instruction follows 
the laws of evolution. It means a gradual rise 
from simple tasks to more complex problems, 
mail the pupil reaches a position from where we 
see him safely and independently advance on the 
way to perfection. The course of evolution 
from the medical student to the accomplished 
medical man reminds me of the construction of 
a skyscraper : these long-lasting monuments of 
human skill and genius in modern technic. From 
the solid foundation, amalgamated with mother 
earth, we see the big steel frame point toward 
the sky, gradually the gaping spaces are filled 
out and finally we see the work completed as a 
beautiful monument, able to face all elements; all 



THE HOSPITAL BULLETIN 



191 



extrinsic influences of its surroundings. The 
Foundations of the students' knowledge arc the 
natural sciences, anatomy and physiology, upon 
which all the subsequent instruction is built. If 
the greatest care lias not been taken to make this 
basis as strong as possible, if there are unfilled 
gaps left, the energ) of the. studenl is generally 
ncit strong enough to reinforce these weak points 
of his knowledge by personal studies. The work 
of previous teachers deserves our appreciation, 
and training in the principles of clinical medicine 
forms only a necessary and important link in the 
chain of influences to which the student must be 
exposed. Our main object must always be to 
give the student practical as well as theoretical 
knowledge; so that when he has to show the ex- 
tent of his knowledge before the State board and 
bi fore the public, he will be able to qualify as a 
most useful member of the medical profession. 

Theoretical knowledge has to precede practical 
instruction: therefore, the student had better 
master didactic medicine in his third year. Be- 
sides his training in physical diagnosis, he must 
study the dispensary, for this prepares him for 
a greater and. more successful understanding of 
the medical clinic. At the dispensary, under the 
supervision of the professor, the student acquires 
his experience in history taking, in the practice 
of physical diagnosis, in judging the cases with 
regard to prognosis and treatment. There, in 
daily contact with the suffering of poorer pa- 
tients, the student sees that medicine means a 
much larger field of activity than is generally 
admitted. Not disease itself only, but diseased 
individuals have to he cared for; often the social 
surroundings have to be improved before any 
evident success is to be hoped for. This is the 
opportunity at which the student shows the qual- 
ities of hi, character and where he can excel in 
following the demands of charity. At first the 
student follows the medical clinic as an auditor, 
listening to the clinical exposition of the cases 
presented and taking advantage of the answers 
of the senior students, who- are called to examine 
and debate on the clinical cases. Unfortunately 
the medical classes are always large, and there- 
fore the difficulty which arises is how to find 
space large enough to teach juniors and seniors 
together. No doubt the system of co-education 
of juniors and seniors offers many advantages. 
The junior student, eager to progress in the un- 
derstanding of clinical medicine, has an oppor- 



tunity to show his teacher that he can ably ans- 
wer the questions calculated for the senior. For 
the senior this co-education is a powerful stimu- 
lant to a more thorough knowledge. He generally 
dislikes to expose his ignorance to the criticism 
of his junior fellow-students. So first-class work 
bei omes second nature to the senior student. He 
experiences the advantages to himself, and the 
good habit is formed. The principal aim in the 
instruction of the senior student is his practical 
clinical training. In the clinic, at the bedside of 
the patient, the framework of his knowledge is 
filled out by important details in the symptoma- 
tology, pathology, diagnosis and treatment of 
each case. He is entrusted to work out his 
clinical cases carefully, to make most of the ex- 
aminations himself, to discuss thoroughly before 
the whole audience his findings. Allowed to fol- 
low his patient more closely in the ward, the stu- 
dent is fortunate to gather important informa- 
tion on the course of the case, reporting upon it 
to his teacher. A short review of the case may 
be helpful and leave a deeper, longer-lasting im- 
pression in his memory. Conferences on clinicnl 
fatal cases conjointly with the professor of pati. 
ology may be another help for clinical instruc- 
tion. So step by step the clinical teacher will 
see his pupil grow into a medical personality to 
whom he can entrust any case, convinced that the 
pupil will do his best work. This is the aim of 
clinical teaching and the sincere wish of the 
teacher is to conduct all his pupils to careful 
training, to reliable practical experience and per- 
fect knowledge. 

With the teaching of the students, the task of 
the clinical professor is far from being com- 
pleted. His influence has to extend to his as- 
sistants, who conscientiously do the work in the 
different wards. In making rounds in the wards 
there is so much opportunity to control and ad- 
vance the work of the young colleague; to help 
him to reach the goal of an accomplished phy- 
sician and teacher. His interest in medical prob- 
lems, in useful ingenious research work, can be 
aroused and trained. The medical clinic, an in- 
stitution destined to promote medical science and 
control by close observation on a greater scale 
the assertions and suggestions of outside investi- 
gators, must aim to give its alumni and the mem- 
bers of the medical profession reliable informa- 
tion about the value of new methods of diagnosis 
and treatment. Rut also to outside physicians 



102 



THE HOSPITAL BULLETIN 



anil to alumni the medical clinic has to be the 
seat of learning wherefrom valuable information 
can always be obtained ; it has to favor genuine 
research work, accomplished by its own means. 
The practitioner, conscious of some lack of ex- 
perience in certain branches of clinical medicine, 
should always find there an opportunity for post- 
graduate work. Cases doubtful in regard to diag- 
nosis should be referred to the medical clinic for 
further careful observation and examination. A 
similar suggestion might be made for insurance 
and medico legal cases, where greater opportuni- 
ties are available for a better interpretation of 
the pathognostic features. Without doubt, there 
are many factors that make the task of the pro- 
fessor for the practice of medicine very attrac- 
tive, and which can only be briefly mentioned. 
The resources of our institutions are well known 
and much appreciated. In this work, gradually 
expanding, it is to be hoped that more influential 
and benevolent men may become interested in 
the present and future tasks of the University 
of Maryland, and from their abundant financial 
means will contribute to the success of our ideals 
in medical teaching. The standard of students, 
the psychical qualities of the medical man, is a 
vast and important topic which may be better 
exposed before the students themselves. 

Finally, I would mention one point of interest 
to the medical profession. It is the conviction of 
the leading classes that medical art in this coun- 
try is still in its infancy and that with all our 
distinguished medical men difficult medical cases 
cannot be treated properly at home. As a proof 
of the proverb. "A prophet is not without honor, 
except in his own country." Every vear we no- 
tice quite an exodus of wealthy patients making 
their way to the clinics of Europe. It is an open 
question whether they will receive better atten- 
tion over there than they would have at home, 
but this means a serious danger to the fame of 
the American profession. At this instance an 
experience of a Baltimorean may be quoted, who 
visited Professor Strumpell at Breslau. The 
professor asked the patient where he was from. 
The answer from the patient, ''From Baltimore, 
sir." Professor Strumpell said : "Then go back 
and put yourself under the care of one of our 
distinguished members of the faculty of the Uni- 
versity of Maryland." So it will be the duty of 
the universities to join the ranks of benefactors 
to humanity to show the public that the medical 



profession gets an instruction in all branches of 
medicine, comprising physical treatment, balneo- 
climato-dietotherapy ; that reliable institutions 
are directed by well experienced doctors just as 
in the old country, and that the results compare 
favorably with those reported from abroad. No 
doubt this aim will be reached in time and fos- 
tered by the financial help of the public, this on- 
ward movement to perfection in all branches of 
medical experience and teaching will add another 
laurel to the reputation of the American nation. 
In conclusion of my discussion of the aims of 
clinical teaching of medicine, I only hope that the 
work at the medical clinic has but begun viribus 
unitis of the past ami the present. In such a task 
the interest of the University of Maryland and 
its medical faculty is not only at stake, but also 
the interests of the entire medical profession. 
In the proper education of the medical students, 
we have to contribute our share to humanity as 
well as to the benefit of our country, whom we 
try to serve with our best. 



A PROBABLE CASE OF INFANTILE 

PARALYSIS IN ANCIENT 

EGYPT. 



By Etnar Hansen. 



Dr. Hamburger of Copenhagen, wdio, besides 
his duties as a physician, devotes part of his time 
to the study of the art of ancient Egypt, speaks 
of human abnormalities often met with ; some 
easily recognized by everyone, but also others 
misunderstood by the Egyptologist on account >u 
lack of anatomical and pathological knowledge. 
Many of these last named are often explained as 
being a mistake of the artist. 

The following is from an article in Ugeskrift 
for Laeger by Dr. Hamburger: 

"In the Egyptian division of "Ny Carlsberg 
Glvpothek," Copenhagen, you will find a 'Stc!.'' 
(monumental stone plate) dating from the eigh- 
teenth dynasty, about 2500 years before Christ. 

"< In this plate can be seen three human figures 
surrounded by hieroglyphics. The principal fig- 
ure is a man with a bowl in his left hand ; his 
head is shaven, which indicates he is a pries 1 . 
Around his hips is a cloth, reaching to his knees, 
but made of such transparent material that both 
his thighs are easily seen. Behind him you see a 
woman, his wife. In her left hand she is carrv- 



THE HOSPITAL BULLETIN 



193 




Engraving from a Library in Copenhagen, which illustrates 
the possibility that the ancient Egyptians suffered with 
infantile paralysis. 



ing a sacrificial bowl ; the right hand is leading a 
sacrificial lamb. In the farthest right corner you 
see the figure of a little child. 

"The hieroglyphics tells us the man's name is 
'Ruiiia,' and that he is the caretaker of the temple. 

"The goddess to whom he is making an offer- 
ing is the Syrian 'Astarte,' who, according to 
Herodotus, had a temple in Memphis, in lower 
Egypt. The names of the man and woman are 
Syrian ; the boy's name Egyptian. 

"When you look closely you will see that the 
figures are cut very distinctly by the artist, with 
precision and delicacy, but also that there is some- 
thing wrong with the man's leg. 

"Of course, this abnormality has been noticed, 
and in the catalogue you read : The drawing is 
not especially good. The man's one foot and leg 
is absolutely deformed; the 'Stele' is possibly 
from a later period, when the Egyptian art ivas 
decadent. If the aforequoted Egyptologist had 
been a physician, he would surely not have made 
that statement. 

"In this case there is undoubtedly no misdraw- 
ing. The artist has produced a man with a 



'withered' leg. The foot is in the typical Equinus- 
position. The slight flexion of the hip and knee 
joints is not enough to raise the heel so high from 
the ground. There is a shortening of femur, 
tibia and fibula. The whole leg is diminished in 
size. Another thing that speaks for the correct- 
ness of the drawing is the way Ruma is carrying 
his staff. 

"It is originally the kind of cane Egyptians of 
quality used to carry, but in old pictures we al- 
ways see them carrying it in front of them, and 
parallel with the body. 

"Ruma is carrying his cane in an unusual way, 
crosswise from the shoulder, in the bend of the 
elbow and alongside the withered leg, apparently 
as a support. 

"If the artist has drawn the man as he was in 
life, it seems natural to think of either infantile 
paralysis or coxitis as being the cause of the de- 
formity, and of these two infantile paralysis seems 
the most probable. 

"The stone tells us a little tale of 3500 years 
ago. The Syrian Ruma who has had an attack 
of infantile paralysis does not die of it ; he grows 
up with his withered leg and his pes equinus ; he 
marries a Syrian woman, and they both emigate 
to Egypt, where he becomes a priest in Astartes' 
temple, in Memphis. A son is born in Egypt ; the 
hieroglyphics give us his Egyptian name. 

"Ruma dies, and the artist draws his picture 
on a tombstone, carefully bringing in the withered 
leg and the pes equinus. 

"The drawing does not tell whether poor Ruma 
ever was treated by an orthopedic specialist, but 
if he was, the treatment was not very successful." 

221 W. 57th Street, New York. 



Among the University alumni practicing in 
Arkansas are : 

Camden — George W. Hudson, class of 1875. 

Dardanelle — A. H. McKenzie, class of 1872. 

Fort Smith — Errett Campbell Myers, class of 
1870. Arkansas Valley Transit Building. 

Hot Springs — Jos. Smith Horner, class of 1883, 
AZ° l A Central avenue; Wm. Turnor Wooten, 
class of 1899, Dugan-Steuart Building. 

Pine Bluff — Thomas Littleton Savin, class of 
1896, Barraque and Pine streets. 

Texarkana — Leonce J. Kosminsky, class of 
.1906. 



194 



THE HOSPITAL BULLETIN 



THE HOSPITAL BULLETIN 

A Monthly Journal of Medicine and Surgery 

PUBLISHED BY 

THE HOSPITAL BULLETIN COMPANY 
608 Professional Building 

Baltijioke, I'd. 



Subscription price, . . . $1.00 per annum in advance 

. Reprints furnished at cost. Advertising rates 

submitted upon request 



Nathan Winslow, M.D., Editor 



Baltimore, December 15, 1912. 



[LLNESS OF PROF. JOHN C. HEMMETER. 



Professor Hemmeter has been in poor health 
for some time, but has been able ti 1 attend to his 
duties at the University and to his private prac- 
tice. He arranged and was present at the 
Academic Day exercises, and at the luncheon at 
the Emerson Hotel on the same day. Two days 
later he was taken ill and has been under the care 
of Prof. Zueblin since that time. It is with great 
pleasure that we announce an improvement in his 
condition, though it may be some time before he 
will be able to resume his work. 

Professor Hemmeter is a great ornament to 
the University, and his enforced absence is a 
great loss to us. May the good God restore him 
to health and usefulness! 



CLINICS AT THE UNIVERSITY 
HOSPITAL. 



The month of November was especially sig- 
nalized by the visits of many distinguished men 
to the University Hospital. Early in the month 
1 >r. Arthur Dean Bevan, professor of surgery in 
Rush Medical College, met the representatives of 
the three Baltimore medical schools at a luncheon 
given by the hospital, and urged the necessity of 
a combination of these schools. We believe his 
efforts will bear fruit in the near future. Later 
the Interurban Orthopedic Club attended a clinic 
held by Drs. Randolph Winslow, Irving I. Spear 
and Conrpton Riely. The next day Dr. Fred H. 
Albee of New York demonstrated his method of 
grafting a piece of bone from the tibia into the 
vertebral column in Potts' disease. The operation 



is not difficult, and the results are said to be re- 
markable. 

The Xu Sigma Xu Fraternity held its annual 
convention in Baltimore during the Thanksgiving- 
holidays and attended a clinic at the hospital, at 
which Drs. R. Tunstall Taylor, Jose L. Hirsh 
and Hiram Woods gave instructive discourses. 
We were also favored with two very instructive 
clinics for our senior class by Dr. Richard C. 
Cabot of Harvard Medical School. Dr. Cabot de- 
parted from the usual way of conducting clinics 
by adopting the cjuiz method. The students were 
taken by surprise when he called them by name 
and made them work out the subject. This meth- 
od is by no means new to them, however, as Pro- 
fessor Mitchell has long taught in this manner, 
and the other clinical teachers to a large extent do 
the same. Professor Cabot's clinics were on heart 
disease and neurasthenia, ami we were able to 
supply him with a good supply of illustrative 
cases. 



A HANDSOME GIFT. 



The Academic Day exercises on November 12 
were dignified and striking, though perhaps a 
little sombre, as two of the addresses were me- 
morial tributes to our late Provost, Bernard Car- 
ter. LL.D.. and to John Wirt Randall, LL.D., 
President of the Board of Governors and Visitors 
of St. John's College and a Regent of the Uni- 
versity. Prof. Ernest Zueblin made an enthusi- 
astic and inspiring address on the "Aims of Clini- 
cal Teaching." The most important feature of the 
1 iccasion, however, was the announcement by the 
acting Provost, Judge Stockbridge, of an addi- 
tional gift by Prof, and Mrs. John C. Hemmeter 
of S5300 towards the endowment of the Hem- 
meter chair of physiology. Their gifts now 
amount to about $10,000. The amount available 
for the department of pathology now approxi- 
mates $20,000, and is slowly increasing, though 
not in proportion to the effort that has been ex- 
pended in the endeavor. Will not some generous- 
ly disposed people aid us to raise the $100,000 we 
need so sorely? 

CONTRIBUTION BY CLASSES. 

1848 $50 OO 

1 Si 14 20 OO 

1868 IO OO 

1 87 1 35 00 

1872 81 84 



THE HOSPITAL BULLETIN 



195 



E873 • 44i 83 

1874 5 00 

1875 5 00 

1 N71 > 115 00 

1 877 10 00 

1880 5 00 

1 ss 1 252 00 

1 882 310 00 

1883 40 00 

1 ss 1 40 00 

1885 235 00 

1886 100 00 

1S88 50 00 

1889 100 00 

1890 175 00 

1 892 1 50 00 

[893 40 00 

1894 135 00 

'?95 155 00 

1896 52 00 

1897 80 00 

i.'mS 115 00 

[899 55 00 

1900 215 00 

1901 270 00 

1902 330 00 

[903 340 00 

1904 • 135 00 

1905 220 00 

[906 175 00 

1907 no 00 

s 20 00 

M H 9 15 00 

1910 50 00 

191 1 Terra Mariae 3 5° 

]'ii-' Club Latino Americano 25 00 

Total subscriptions to Dec. 1, 1912. .$10,322 17 

NEW SUBSCRIPTIONS IX NOVEMBER. 

I [orace M. Simmons, 1881 $2 00 

I. Royston < ireen, 1899 5 00 

Daniel A. Watkins, 1903 25 00 

John S. Norman, 1900 10 00 

Ti >tal $42 00 



Mr. Albert O. McFaddin of the junior med- 
ical cla^s, who has been for several months con- 
lined to the hospital suffering from typhoid 
fever, has fully recovered and is now attending 
his class lectures. 



ITEMS 

A committee of one member from each depart- 
ment of the University was appointed in Sep- 
tember to consider the selection of a provost to 
succeed the late Bernard Carter. The members 
of the committee are Philemon H. Tuck of the 
Department of Arts and Science, Dr. Thomas 
A. Ashby of the Department of Medicine, Joseph 
C. France of the Department of Law, Dr. 
Timothy O. Heatwole of the Department of 
Dentistry and Dr. David M. R. Culbreth of the 
Department of Pharmacy. The committee will 
recommend to the Board of Regents at its meet- 
ing this month that Dr. Thomas Fell, for 26 
years president of St. John's College, be named 
as Mr. Carter's successor. The plan as proposed, 
according to current rumor, is that Dr. Fell will 
be asked to open an office at the University and 
give Saturdays and at least two afternoons a 
week to the work of the entire institution. An 
office force will be selected to assist him. The 
Sun, in speaking of Dr. Fell, says: 

"Dr Fell is regarded as one of the leading 
educators of this part of the country. His abil- 
ity as an administrator has been tried as the 
president of St. John's College. In the opinion 
of all who have watched the growth of that in- 
stitution under his leadership he has been remark- 
ably successful. 

"When he assumed charge of the old institu- 
tion, which was founded in 1696 and thus ranks 
as one of the oldest colleges in America, a great 
deal of its prestige had been lost, and there was 
danger that it would suffer the same fate as a 
number of other small colleges had. 

"With signal ability Dr. Fell set to work to 
restore St. John's to its former position. When 
he took charge there was a long-standing mort- 
gage of $30,000 hanging over the school. 
Through his efforts that has been entirely wiped 
out. The final accomplishment of his adminis- 
tration was the merging of St. John's with the 
University of Maryland." 

Dr. Fell was born in Liverpool, England. July 
15, 1851. His father was a surgeon in the Eng- 
lish Army, and was killed in the Crimean War. 
Dr. Fell was educated at the Royal Institution 
School of Liverpool and at King's College, Lon- 
don. He later entered the University of London, 
and then studied for a year at the University of 
Munich. He came to America in 1882. and in 



196 



THE HOSPITAL BULLETIN 



1884 was elected professor of ancient languages 
at New Windsor College, New Windsor, Md. 
In 1886 he was elected to the presidency of St. 
John's College, being the 12th president of its 
now 123 years of existence. St. John's College 
has conferred upon him the honorary degree of 
doctor of philosophy, and the University of the 
South that of doctor of civil law, while Hampton- 
Sidney College has honored him with the degree 
of doctor of laws. His standing as an educator 
is recognized everywhere. Dr. Fell is a member 
of the American Philological Association, the 
National Educational Association, the Phi Sigma 
Kappa Fraternity, the University Club of Balti- 
more and the Cliosophic Society of Princeton 
University. 



Among the University alumni practicing in 
Colorado are: 

Boulder — Wni. J. Baird. class of 1881. 

Canon City — Wm. Booth, class of 1865. 

Denver — William C. Mitchell, class of 1889, 
California Building; Edmund C. Rivers, class of 
1879, if>32 Welton street; William A. Sedwick, 
class cf 1893, Metropolitan Building. 

Fort Logan — J. R. Shook, class of 1899, Major 
M. C.,U. S. A. ' 

Grand Junction — Samuel J. King, class of 1903. 

Somerset — Morris Ramsey Bowie, class of 
1908. 



Dr. Louis McLane Tiffany, class of 1868, who 
was operated upon recently by Drs. Frank Martin 
and George Walker at the Union Protestant In- 
firmary, is reported to be considerablv improved. 



Dr. William F. Wegge, class of 1886, of Cas- 
well Block. Milwaukee, Wis., was a member of 
the commission of five appointed to report upon 
the sanity of John Schrank, assailant of Col. 
Theodore Roosevelt. Copies of the ruling of the 
commission in declaring Schrank a paranoiac 
have been requested by large libraries through- 
out the country, and will be supplied to them. 



Dr. John Turner. Jr., class of 1892, has just 
returned from a trip covering several thousand 
miles by way of Colon, Panama, San Francisco, 
Salt Lake City, Denver, Omaha, Chicago and 
Pittsburgh. Shortly after his return he was the 
victim of a telephone hoax, some anonymous 



person telephoning the coroner of the Northern 
District that Dr. Turner had died. Dr. Turner 
is in the best of health, and responded in person 
to the many inquiries concerning his supposed 
death. 



Dr. Henry Waters Kennard, class of 1889, has 
been appointed assistant superintendent of the 
School for Feeble-Minded at Owings Mills. He 
will shortly resign his commission in the State 
Militia as lieutenant of Company A, Medical 
Corps. He has been actively engaged in the 
National Guard for a number of years, par- 
ticipating in the recent encampment and in work 
at the armorv. 



Dr. John I. Pennington, class of 1869, is se- 
riously ill at the Mercy Hospital, suffering from 
the effects of a fall from a street car. Dr. Pen- 
nington boarded the car and, finding it was go- 
ing south instead of north, leaped off, missed his 
footing and fell on his head. The accident oc- 
curred near St. Paul and 23d streets. Dr. Pen- 
nington was placed aboard the car and hurried 
to the office of Dr. A. C. Harrison, 31 E. North 
avenue. Dr. Harrison examined him and took 
him at once to the Mercy Hospital, where he is 
reported to be improving. 



The American Surgical Association has ap- 
pointed a committee consisting of Drs. William 
L. Estes, South Bethlehem, Pa. ; Thomas W. 
Huntington, San Francisco. Cal. : John B. 
Walker, New York City; Edward Martin, Phil- 
adelphia, and John B. Roberts, chairman. 313 S. 
17th street, Philadelphia, to report on the oper- 
ative and non-operative treatment of closed and 
open fractures of the long bones and the value of 
radiography in the study of these injuries. Sur- 
geons who have published papers relating to this 
subject within the last 10 years will confer a favor 
by sending two reprints to the chairman of the 
committee. If no reprints are available, the 
titles and places of their publication are desired. 
John B. Roberts, 

Chairman. 

313 S. 17th Street, Philadelphia. Pa. 

We are aware that several alumni of the Uni- 
versity have published papers on the open method 
of treatment, and we hope that some of them 
will respond to this call. 



THE HOSPITAL BULLETIN 



[97 



Bishop 1 uther Barton Wilson, a member of walked in and disputed the question with us— 

the medical class of 1877 and son of Dr. Henry said he was perfectly sure he hadn't died lately, 

M Wilson class of 1850. now resident head of and then— Oh, cruel!— he told the tale. And 

the Methodist Episcopal Church of New York, though the world says medical men are solemn, 

celebrated Ins 5 6th birthday November 14. I9"- we have proof that they can laugh right heartily. 



\ meeting of the [nterurban Orthopedic Club 
was held on November 18 and 19, in Baltimore, 
with headquarters at the Belvedere Hotel. ( >n 
Monday the members attended a clinic in the am- 
phitheater of John- Hopkins Hospital, where 
from c) to 12.45 they witnessed and heard of work- 
done by physicians connected with that institu- 
tion. Dr. Henry M. Thomas, class of 1885, pre- 
sented a case of periodic paralysis with muscular 
dystrophy. The club was then entertained at 
luncheon at the home of Dr. Howard A. Kelly, 
later going to the Children's Hospital School, on 
Green Spring avenue. Among the cases pre- 
sented were two of fracture-dislocation of spine, 
bv Dr. Howard Elmer Ashbury, class of 1903. 
The club then attended a business meeting at the 
Baltimore Country Club, dining there. On No- 
vember 19 the first clinic was held at the Union 
Protestant Infirmary, and at 1 1 A. M. the visitors 
repaired to the University Hospital, where they 
observed the following program: 

1 1. 00 — Dr. Randolph Winslow, class of 1873. — 
"Fracture of Neck, of Femur and of Surgical 
Neck of Humerus. Operative Treatment." 

11.15 — ^ r - Compton Riely, class of 1897. — 
"Remarks on Spinal Abscess. Exhibition of 
Radiograms and Presentation of Cases.'' 

11.45 — l Jr - Irving J- Spear, class of 1900. — 
"Results After Section of Posterior Spinal Nerve 
Roots. Exhibition of Cases." 

At 12.15 a clinic began at the Mercy Hospital. 
Dr. A. C. Harrison, class of 1887, demonstrated 
the use of the Downey extension apparatus in 
treatment of fracture of the femur. The after- 
noon was spent in inspecting the Kernan Hospital 
and Industrial School for Crippled Children, after 
being entertained there at a luncheon given by 
Dr. R. Tunstall Taylor, clinical professor of or- 
theopedic surgery at the University. 



Several "University-ites" are much amused be- 
cause of a visit recently paid us by an alumnus 
of about two years ago. We understood that he 
had been piloted across the Styx, and had writ- 
ten "dead" in big letters across the card in our 
list which bore his name. One day recently he 



Dr. Murray P. Whichard. class of 1910, has 
sent us the following interesting letter in response 
to a query of ours concerning a rumor that he had 
moved to Porto Rico. W T e think it of sufficient 
interest to his fellow-classmates to reproduce it 
here. Dr. Whichard writes: 

"Dear Dr. Winslow: 

"Your letter of inquiry received a few days 
ago, and will endeavor to answer you as best I 
can. After taking the North Carolina Board in 
1910 I came to the extreme western section of 
the State and began a rough country practice, 
but soon landed a contract practice with a big 
lumber concern, which paid me a salary of $150 
per month, and was also allowed to do a general 
practice in connection ; but this concern was of a 
short life and discontinued business after I had 
been with them five months. I was sorry for this, 
but I know I have gotten some valuable experi- 
ence, which I could not have gotten any other 
place. 

"I am located in a small mountain town of 
about 200 inhabitants, and there is not a physician 
nearer than 20 miles in any direction, so you see 
I have quite a large territory to cover, and all 
my work has to be done on horseback, as the 
country is too rough to use a buggy. 

"I suppose it would shock Dr. Neale's modesty 
to know of one of his students doing an internal 
podalic version without anesthetic or assistant 
and under conditions where asepsis is practically 
unknown. 

"This has been my experience three times in 
the two years I have practiced here, and every 
case recovered without even so much as develop- 
ing a temperature, and it would be difficult to 
mention the number of curettements I have done 
without an anesthetic. 

"I also assisted Dr. R. J. Oler in an operation 
for peritonitis of 10 days duration with the entire 
abdominal cavity filled with pus, with recovery, 
and the interesting thing about the operation was 
the patient had a fecal fistula, which closed spon- 
taneously three months after the operation. 

"I notice you state you have heard I was in 



i.iS 



THE HOSPITAL BULLETIN 



l'orto Rico ; that is a mistake. I have been in 
North Carolina since I graduated. 
"Respectfully yours. 

"M. P. Wiiiciiakd." 



Mr. Howard Lecates of the senor class was re- 
cently operated on for appendicitis, but. we are 
glad to report, has entirely recovered. 

Mr. E. Kilbourn Tullidge of the senior class 
was operated on recently in the University Hos- 
pital, deviated septum, has recovered. 



Dr. Charles T. Fisher, Jr., class of i<)Oi, of 
Princess Anne, Md., was a recent visitor to the 
University Hospital. 



Airs. Ethel Palmer Clark, superintendent of 
nurses in the University Hospital and a member 
of the Training School for Nurses, class of 1906. 
has just returned from a flying trip to Jackson- 
ville, where she was called on business. 



A daughter was born recently to Dr. and Mrs. 
A. Aldridge Matthews of Spokane. Wash. Dr. 
Matthews was a member of the class of 1900. 



A daughter was born recently unto Dr. and 
Mrs. Eugene F. Raphel of Fairmont, YV. A'a. Dr. 
Raphel was a member of the class of 1905. 



Prof. Randolph Winslow will attend the com- 
ing meeting of the Southern Surgical and Gyneco- 
logical Association, to be held at Old Point Com- 
fort, December 17, 18 and 19. After the conclu- 
sion of the meeting Dr. Winslow will visit his 
daughter, Mrs. Herbert F. Carroll, in Richmond. 
Virginia. 



Dr. J. Mason Hundley, class of 1SS2, will also 
attend the meeting of the Southern Surgical and 
( iynecological Association. 



Dr. Nathan Winslow, class of 1901, was elected 
president of the University of Maryland Medical 
Societv at their meeting on December 10. 



The basket-ball team of the University of Mary- 
land was defeated by Georgetown University on 
Wednesday, December 11, by a score of 20 to 18. 
At the end of the regular time the score was 18 
to iS, necessitating an extra period of five min- 
utes to decide the winner. 



Dr. Robert Bruce Patrick, class of 1912, is tak- 
ing a special course at Johns Hopkins Hospital in 
diseases of the genito-urinary tract under the di- 
rection of Dr. Hugh H. Young. 



Dr. Don Peters, a graduate of the University 

of Virginia and formerly superintendent of the 
Church Home and Infirmary, has been appointed 
an assistant in the dispensary, surgical depart- 
ment, of the University Hospital. 



We are glad to announce that, according to 
latest reports, Dr. Hemmeter is progressing 
nicely. 



UNDERGRADUATE NOTES 



Under the Supervision of E. K. Tullidge. 



The Phi Sigma Kappa Fraternity entertained 
representatives from 26 universities and col- 
leges in the United States during its biennial con- 
vention, which was held in Baltimore. Novem- 
ber 17, 18 and 19. 



The clinical assistants gave a smoker to the 
internes and members of the Senior faculty on 
the eve of November 12. Everyone thoroughly 
enjoyed the event, and left with a firm convic- 
tion of the generositv of their hosts. 



Mr. B. Karl Blalock, after a short illness in 
the hospital, has recovered and is now able to 
resume his duties as clinical assistant. 



The house men are preparing to hold their 
tenth annual dance for the Training School for 
Nurses. 



The Latin-American Club is contemplating 
the purchase or erection of a new clubhouse near 
the University. 



The following men have been appointed by 
Editor-in-Chief Earle Griffith Breeding t>> serve 
upon the staff of Terra Mariae : Frederick 
Leonard McDaniel. Franklin Clyde Craven. 
Charles Reid Edwards and W. Houston Toulson. 
all of the senior class. Editor Breeding request^ 
all the members of the senior classes of the va- 
rious departments to have their pictures taken 



THE HOSPITAL BULLETIN 



[99 



with cap and gown before December [8. He also 
requests that all class groups be taken and handed 
in to him on or before that date. 



Professor Ashby reports an excellent showing 
for the senior class in their re-examinations in 
October, but one man having tailed. * 



The Charles W. Mitchell Medical Society held 
a meeting' on the evening of November 2j. Ham- 
ilton J. Slasher of the senior class was elected 
president for the coming year. 

The reception held by the Kappa Psi Frater- 
nity at their home, 242 East Hoffman street, mi 
the evening of November 29 was well attended. 
Many of the season's debutantes were present. 



At a special meeting of the Randolph Winslow 
Surgical Society held on Tuesday evening. No- 
vember 26, 1912, the following officers were 
elected for the ensuing year: President, Earle 
Griffith Breeding; vice-president, E. Kilbourne 
Tullidge; secretary, T. Ruffin Pratt; treasurer. 
Clarence W. Judd; historian, Robert Raymond 
Sellers. All are members of the senior class. 



NU SIGMA NU NOTES. 

The seventeenth biennial convention of the Nu 
Sigma Nu Fraternity was held at the Hotel Bel- 
vedere, Baltimore, November 29 and 30, under 
the auspices of the Beta Alpha Chapter of the 
Cniversity of Maryland and the Beta Beta Chap- 
ter of Johns Hopkins University. 

About 34 chapters of the medicals schools of 
the United States and Canada were represented. 

The entertainment consisted of a clinic given 
Friday afternoon by members of the fraternity 
at Hopkins. In the evening a model initiation 
was given by Beta Alpha. Saturday morning 
a clinic was given in orthopedic surgery at the 
University of Maryland by Dr. R. Tunstall Tay- 
lor. Dr. Jose L. Hirsh followed with an interest- 
ing talk on luetin and its aid in the diagnosis of 
syphilis. Dr. Hiram Woods made a short ad- 
dress on the "Conservation of Vision." Follow- 
ing this a luncheon was served at Beta Alpha 
I luuse, 816 W. Lombard street. 

Tn the evening a banquet was held at the Belve- 
dere. Dr. Henry J. Prentis of the University 
of Iowa was toastmaster, and Dr. Torald Soil- 



man of Western Reserve University and Dr. Wil- 
liam Welch of Johns Hopkins made the principal 
addresses. Dr. John C. Hemmeter, professor 
of physiology and gastroenterology in the Uni- 
versity, of Beta Alpha Chapter, was elected to 
the council officers. The convention then ad- 
journed to meet two years hence in Philadelphia, 
where they will be the guests of the chapters of 
the University of Pennsylvania and the Jefferson 
Medical College. 



MARRIAGES 



John Charles Norton, M.D., class of 1912, of 
Hagerstown, Md., was married on December 3. 
[912, to .Miss Ruth Cleveland Atkinson of Balti- 
more. The bride is the daughter of Mr. and 
Mrs. William A. Atkinson of 322 N. Fulton ave- 
nue, Baltimore, and an accomplished musician. 

Dr. and Mrs. Norton were fellow-students in 
St. Martin's Academy, where they met. Dr. 
Norton later took a course in pharmacy in the 
University of Maryland, and upon its comple- 
tion entered the medical class of 1912. He is at 
present practicing in Hagerstown, and is assist- 
ant medical examiner of the Western Maryland 
Railway Company. 

The ceremony was performed at St. Martin's 
Catholic Church by the assistant pastor, Rev. 
Carroll Smythe, in the presence of the imme- 
diate families and a few intimate friends. The 
bride was attired in a blue traveling suit, with 
picture hat to match, and carried a bouquet of 
chrysanthemums. She was given in marriage 
by her father. There were no attendants. A 
wedding breakfast was served at the residence 
of the bride's parents, and the couple left for a 
Northern tour. They will be at home after Janu- 
ary 5 on the Washington Boulevard, Hagers- 
town. 



DEATHS 



Dr. William Hand Browne, class of 1850. one 
of the most distinguished alumni of the Univer- 
sity of Maryland, died at his home in Sherwood. 
Aid., on December 12, 1912, after an illness of but 
one week of acute bronchitis, aged S4 years. Dr. 
Browne, while a graduate of the medical depart- 
ment, never practiced medicine, and his distin- 
guished work was done through other channels. 
He was born in Baltimore in 1828, and graduated 
at the University of Maryland in 1850. He did 



21 K ) 



THE HOSPITAL BULLETIN 



much literary work — was editor of the Southern 
Review from 1867 to 1868 and of the Southern 
Magazine from 1870 to 1875. His best work was 
done, however, as editor of the State Archives of 
Maryland. All the large libraries of England and 
America contain copies of this work, and the 
records of .Maryland are perhaps more complete 
than those of any other of the thirteen original 
States. 

Dr. Browne has been known for many years as 
one of Maryland's most scholarly and cultured 
men. Among his widely read and known books 
are his "Maryland — The History of a Palatinate ;" 
"I ieorge and Cecilius Calvert, Barons of Balti- 
more," and "Life of Alexander II. Stephens." 
He compiled, in collaboration with Col. Richard 
.Malcolm Johnston, the '"Clarendon Dictionary of 
the English Language." He also translated many 
( ierman and French works into English, and 
edited "The Trail of Rauf Coilyear," a Scottish 
metrical romance of the fifteenth century. At the 
time of his death he was professor emeritus of 
English literature of the Johns Hopkins Univer- 
sity. He was librarian of the Hopkins from 1879 
to 1891, being the second to fill that office. At the 
time he became librarian the library contained but 
7000 books ; at the time of his resignation it con- 
tained over 40,000 volumes. In 1880 he was ap- 
pointed associate in English literature, in 1891 as- 
sociate professor, and became the head of the de- 
partment in 1893, resigning in June, 1910. His 
kindly sympathy, ready wit and great learning 
endeared to him his many students, and his ad- 
vice was always eagerly sought. 

His wife died some years ago. She was Miss 
Mary Catherine Owings of Baltimore. His chil- 
dren, all of whom were with him when he died, 
are Dr. Arthur Lee Browne, Mrs. Charles W. 
Hoff, Miss Lucy H. Browne, all of Baltimore ; 
Prof. William Hand Browne, Jr., of the North 
Carolina Agricultural and Mechanical College, 
Raleigh, N. C, and Sidney H. Browne of New 
York. The pallbearers were selected from his 
most intimate friends and associates. They were 
Prof. Basil L. Gildersleeve, Dr. James W. Bright. 
Dr. E. C. Armstrong, Dr. E. H. Griffin, H Oliver 
Thompson, Dr. Bernard C. Steiner, Clayton C. 
Hall, Edward Lucas White, Henry Kellogg and 
1 )r. Cecil Dabney. 

Dr. Browne was an authority, even in his stu- 
dent <lays, on matters concerning the history of 
Maryland and the South. He loved the country 
and spent as much time as possible there, and 



much of his work was done in the library of his 
home in Rnxton. He made several trips to Eu- 
rope, but was not an ardent traveler. He was 
very fond of music and a performer of consider- 
able skill on the flute. Sidney Lanier, the poet, at 
his death, left his flute to Dr. Browne, and he 
loved to use it. According to the Baltimore Sun: 

"Music, reading and walks through the country 
about his home constituted his recreation during 
the closing years of his life ; in the summer of 
ii.il 1 he told his friend, Professor Gildersleeve, 
that he had just finished reading Livy from cover 
to cover as a means of passing the time pleasantly. 
He possessed great facility in composing verse, 
and this served as a congenial occupation during 
his leisure moments. 

"The late Rev. John B. Tabb, the poet-priest 
and professor of English at St. Charles' College, 
was a great admirer and a warm friend of Dr. 
Browne. When Father Tabb died a few years 
ago there were few who mourned for him more 
than did Dr. Browne. The priest and the his- 
torian often took trips together, and were closeted 
for hours in heart-to-heart talks. Father Tabb, 
who enjoyed the reputation of being one of the 
leading educators in English in this country, al- 
ways went to Dr. Browne whenever there was a 
dispute over any question in that branch, and his 
decision was accepted as infallible. 

"Dr. Borwne was a leading member of the 
Maryland Historical Society and of the Sons of 
the American Revolution, and his contributions to 
the historical lore of those bodies were of great 
value. 

"An inaccuracy that aroused the resentment of 
the historian was the use of black and orange as 
the colors of Maryland. The proper colors are 
black and gold, he always declared with much em- 
phasis, and was always ready to explain their 
heraldic significance. 

His death marks the passing of another of the 
University's great sons to the ranks of the im- 
mortals. Dr. Browne was perhaps the most dis- 
tinguished alumnus of the medical school who won 
his laurels in other lines, and in the world of 
literature and education his worth will be long 
remembered. Of the great company of well- 
known men who studied in our Alma Mater in 
those earlier days before the Civil War, there are 
now but a handful left. We mourn deeply their 
going, but rejoice in the work that Maryland's 
sons are leaving behind for the world to remem- 
ber. 



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, 608 Professional Building, Baltimore, Md. 



Entered at the Baltimore Post-office 
as Second Class Matter 



Vol. VIII 



BALTIMORE, MD., JANUARY IS, 1913 



No. 11 



REPORT OF A CASE OF BRONCHI >S- 
COPY FOR MULTIPLE FOREIGN 
BODIES (ALMOND SHELL AND 
PULP) IN A CHILD TWO YEARS OF 
AGE. WITH SOME OBSERVATIONS 
UPON BRONCHOSCOPY IN INFANTS 
AND YOUNG CHILDREN.* 



By John R. Win-slow. B.A., M.D., 

Clinical Professor Nose and Throat Diseases 

in the University of Maryland. 



On January 5, 191 1, at 2 P. M., in accordance 
with a telegraphic appointment, I met Dr. F. ( 1. 
Wright of Chambersburg, Pa., at the University 
Hospital in consultation upon the case whose his- 
tory follows : 

Iona B., aged two years, was playing upon the 
floor two days previously when her mother's at- 
tention was attracted by her crying, and she 
noticed that the child was blue in the face and 
breathing badly. She immediately held the child 
up by its feet, slapped her back, and running her 
finger down the throat removed a large amount 
of almond shell and pulp. This resulted in 
greatlv improved respiration, and the mother sup- 
posed that the nut had all been removed. 

Since this time, however, the child has at times 
exhibited embarrassed respiration and occasion- 
ally cyanosis. 

Examination. — Respiratory movements much 
shallower on left side and respiratory sounds lost 
below the second rib : no rales present ; tempera- 
ture, 98^°; pulse. ri8; respiration, 28; slight 
supraclavicular retraction on left; right lung 
normal. 

The patient was admitted to the University 
Hospital and the larynx examined under cocaine 



'Abstracted from paper presented to the American Laryn- 
gological Association at its Annual Meeting in Atlantic 
City, X. J., May, 1912. 



with the direct Jackson's speculum. Nothing was 
seen in the glottic nor subglottic space, and real- 
izing the impossibility of passing a bronchoscope 
through a larynx of such size without undue 
force, tracheotomy was determined upon. 

Meanwhile a radiograph was obtained, which, 
as was to be expected from the nature of the ob- 
ject (nut), revealed no foreign body, but only 
enlarged peribronchial glands. 

On January 6, 191 1, at 3 P. M., I performed a 
low tracheotomy, assisted by Dr. F. G. Wright, 
under chloroform anesthesia. 

Immediately subsequently, with Dr. II. C. Da- 
vis in charge of the patient's head and the bron- 
choscopes, I passed a 7 mm. Jackson's tube into 
the left lower lobe bronchus, which was sys- 
tematically examined. The tube was, however, 
too large to enter the upper lobe bronchus. A 
considerable amount of milky pulp was found in 
the bronchus and removed with mops; no shell 
could be discovered. 

I had expected to employ suction with Killian's 
aspirator, in the hope of aspirating the material 
from the smaller bronchus, but the patient became 
cyanotic, the pulse weak, and oxygen and amyl 
nitrite had to be administered. 

The bronchoscopic examination was of neces- 
sity discontinued, having occupied about 30 
minutes. 

The tracheotomy wound was left open, long 
sutures were inserted in the lip, and the nurse in- 
structed to pull the wound open should the patient 
cough. 

The following day (January 7) the tempera- 
ture shot up to 103. 4 F. ; respiration, 140. Em- 
barrassed respiration, diminished resonance, with 
loss of inspiratory and expiratory murmur below 
the second rib, were present on left side ; tubular 
breathing was heard at left apex. 

Subsequently marked cough with expectoration 



202 



THE HOSPITAL BULLETIN 



developed. In short, the patient manifested well- 
marked pneumonia. 

At this period Dr. C. W. McElfresh was called 
in consultation and placed in charge of the med- 
ical treatment of the case. 

From the 9th to the 15th the patient went 
through the varying phases of a typical pneu- 
monia. 

On January 13 the tracheotomy tube, which 
had been inserted the day following the operation, 
was permanently removed, and the patient was 
able to breathe through the mouth readily. 

On January 17, the thirteenth day, the patient 
was discharged from the hospital to return home ; 
temperature, 97.3 ; pulse, no; respiration, ,24. 
Tracheotomy wound nearly closed ; general con- 
dition much improved. The subsequent history 
of the case is derived from two letters sent by 
Dr. Wright. The first, dated February 16, 191 1, 
reports : 

"Dear Doctor — The child is still alive, but very 
ill. When she first came home she was very well, 
except a running ear and a solid patch a little 
larger than a silver dollar in the left apex. It 
seemed as though the trouble would subside and 
the foreign body become encapsulated, but she 
developed an influenza (everyone here has it), 
and after a week of coughing developed a pneu- 
monia involving at least the whole of the upper 
left lobe. After having the pneumonia one week 
the scar in the trachea opened spontaneously, and 
I opened the skin, allowing a free discharge. The 
next day she coughed up an oval piece of almond 
kernel about 6x3 m.m. That was four or five 
days ago, and she is slightly improving. If she 
gets well, will send full data. Wright." 

An extract from the second letter, dated Feb- 
ruary 29, 1 91 2, gives the final outcome of the 
case: 

"Dr. John Winslow : 

''Dear Doctor — Today I examined lona B. 
The child is apparently perfectly well, with no 
signs to show where the trouble in the chest was. 

"The scar in the neck is rather broad, but the 
trachea seems solid. After a slow convalescence 
she recovered fully. Very truly yours, 

"Fairfax G. Wright." 

A more unfavorable case could scarcely be 
imagined than this one, presenting many diffi- 
culties: 



1. The child's age (two years) and under- 
development. 

2. The nature of the foreign body, a pulpified 
nut, furnishing multiple particles which were 
splattered all over the lung surface, and doubtless 
entered every bronchiole. 

3. The bronchus involved, the left, the most 
difficult to examine. 

I have hesitated whether to call this a success- 
ful or an unsuccessful case. While technically I 
did not succeed in removing all of the foreign 
body by bronchoscopic methods, yet I am firmly 
convinced that had the nut pulp not been removed 
from the main bronchus, tracheotomy alone would 
not have enabled the child to clear its lung and 
survive the first pneumonia. 

From a life-saving standpoint the case was 
most successful, and one in whose outcome every- 
one concerned has reason to feel gratified. 

The pathologic condition in such a case is well 
illustrated in that reported by F. E. Hopkins 
(Transactions American Laryngological Associa- 
tion, 191 1 ). 

A female child, four years of age, inhaled a 
peanut. Careful bronchoscopic examination at 
two sittings failed to reveal a foreign body, and 
the child died on the second day. 

"Autopsy showed many (24) small fragmants 
of nuts scattered throughout the lungs and 
around each a pneumonic area. 

"Instead of a single nut occluding the trachea 
or larger bronchi, the many fragments of the 
well-chewed nut were shot into the smaller 
bronchi." 

Thomas Hubbard reports similar autopsy find- 
ings (ibid.) in a peanut case in his practice. 

Cases of foreign bodies in the lungs of young 
children and infants (say of four years and un- 
der) are coming under our care in increasing 
numbers, because through the writings of Kil- 
lian, Jackson, Ingals, Coolidge, Halsted, Mosher, 
Hubbard and other masters of bronchoscopy the 
general profession is being educated to recognize 
these conditions and their proper method of treat- 
ment. 

These cases constitute the most difficult in the 
whole field of bronchoscopy, both on account of 
the small size of the respiratory passages at this 
period of life and the difficulties of instrumental 
manipulation, as well as the nature of the objects 
usually encountered. 



THE HOSPITAL BULLETIN 



203 



While a young child is liable to place almost 
anything in the mouth and inhale it, owing to the 
small size of the glottis (6 mm. infants, Jackson; 
7 mm. 3 years, Killian), large objects cannot pass 
through into the lower passages. Therefore, 
many of the foreign bodies commonest in adults 
are rarely found in the lungs of very young chil- 
dren (pieces of bone), while those encountered 
belong to the class most difficult of removal — ■ 
small or multiple objects (nut shells, pulp, beads, 
pins, beans, pebbles, etc.). 

The younger the child the greater the difficulty 
and urgency, and the mortality is high, despite 
successful removal. So that it has seemed to me 
that these cases constitute a group of themselves 
well worthy of the discussion of this representa- 
tive body, and for this purpose I have brought the 
subject before you. 

What is our best course of procedure in this 
class of cases ? Should we tracheotomize at once 
as the primary procedure, or has the advent of 
bronchoscopy largely abolished the necessity for 
this operation? 

The desirability of upper bronchoscopy (with- 
out tracheotomy) is obvious, and it should be the 
routine method were there no disadvantages as- 
sociated with it. 

In prebronchoscopic days tracheotomy was the 
method of choice, whose success is attested, 
among numerous others, by the remarkable series 
of four cases of foreign bodies in the bronchi of 
small children under two and one-half years of 
age, reported by our fellow, T. H. Halsted 
( Transactions American Laryngological, Rhino- 
logical and Otological Society, 1902). 

In these young children upper bronchoscopy 
has serious objections attached to it. The ana- 
tomical structures are small, rendering the ma- 
nipulation of instruments difficult and resulting 
in loss of time and irritation of tissues. 

A study of the cases reported show that while 
upper bronchoscopy has been frequently at- 
tempted for the removal of foreign bodies in 
infants, in a large percentage, if not the majority 
of the cases, tracheotomy has become ultimately 
necessary for successful removal. 

Now, if such be the situation, why not tracheot- 
omize at once and operate by the easier and more 
certain route (lower bronchoscopy) ? 

In a recent article (Dcutsch. mcd. IVoclien- 
schrift. June 29, 191 1) G. Killian has made a 



most valuable contribution, in which he calls at- 
tention to another aspect of this subject, namely, 
the frequency with which tracheotomy or intuba- 
tion becomes necessary after upper bronchoscopy, 
even when successful reporting a series of 19 
cases under seven years of age, some of them per- 
sonal and some derived from literature. He also 
cites a series of 35 cases reported by Schneider 
of Moscow, of which five required intubation or 
tracheotomy. He concludes that these procedures 
stand in a causal relation to upper bronchoscopy, 
inasmuch as the changes necessitating them oc- 
cur within a relatively short period (6-37 hours) 
afterward ; that the site of the change is the sub- 
glottic space, as evidenced by the stridor and the 
results of intubation or tracheotomy, and in a few 
cases by direct or indirect laryngeal examination. 

We know from both clinical experience and 
post-mortem evidence that inflammatory swell- 
ings are prone to occur in the subglottic space. 
Children from the seventh, and especially from 
the fourth, year downwards are especially liable 
to such swellings after upper bronchoscopy. 

The selection of method must be individual, 
depending upon a number of considerations. 

1. Age of the patient. As Killian has demon- 
strated, it is more a matter of physical development 
than of age ; nationality also may have a bearing. 
At least my intubation experiences have shown 
me that in certain nationalities (Italian) the 
larynx is smaller than the corresponding age. 

Some years ago Ingals announced that he had 
rarely found upper bronchoscopy satisfactory in 
children under three years of age. 

Recently Finder, apropos to an unsuccessful 
case of a piece of bone in the right bronchus of 
an 1 1 -months-old child, reported to the Berlin 
Laryngological Society, stated that henceforth he 
will resort to inferior bronchoscopy in all children 
in the first year of life. 

In discussing this case E. Meyer went still fur- 
ther, and considers inferior bronchoscopy prefer- 
able in children six years of age and under. 
Briining advises it in all children under two years 
of age as a routine procedure. 

Xehrkorn recommends low bronchoscopy in all 
young children. 

Jackson, however, regards tracheotomy as be- 
ing "unnecessary nine times out of ten," and be- 
lieves that it should be limited to dyspneic cases. 



204 



THE HOSPITAL BULLETIN 



I should like to know whether he intends this to 
apply to these very young children. 

2. The nature of the foreign body is of great 
importance in determining this question. 

Objects which are liable to swell so that they 
cannot be withdrawn through the subglottic space 
(beans) should be removed by the lower route 
(Nehrkorn, Killiau). 

Likewise brittle objects, which are liable to be 
broken into several fragments, or multiple ob- 
jects, necessitating a great deal of manipulation; 
objects which are irritating in themselves and cer- 
tain to be followed by pulmonary inflammation 
(peanut shells, pepper corns), should be removed 
without irritation of the subglottic space by in- 
struments. 

3. The duration of the condition is of a de- 
termining moment. The presence of a foreign 
body rapidly produces a catarrhal condition of 
the air passages in children, increasing the vul- 
nerability of the mucous membrane to instrumen- 
tal manipulation. Therefore, when the foreign 
body has remained for a long time, tracheotomy 
is indicated (E. Meyer. Killian). 

4. The side affected must be considered, for 
it is much more difficult to remove a foreign body 
from the left bronchus, especially by upper bron- 
choscopy. Among 13 cases in children collected 
by Killian, in nearly two-thirds the foreign body 
was found in the left bronchus. 

5. The condition of the subglottis space is of 
paramount importance. This should always be 
determined by direct or indirect laryngeal exami- 
nation before undertaking upper bronchoscopy. 

Any outspoken subglottic swelling constitutes 
a contraindication to upper bronchoscopy. 

The passage of the bronchoscopic tube will in- 
evitably result in the necessity for the tracheot- 
omy. It is, therefore, better to perform this oper- 
ation primarily and employ lower bronchoscopy. 

In conclusion, it seems to me that the present 
situation with regard to foreign bodies in the 
lungs of young children has been well sum- 
marized in the advice of Hubbard: "When in 
doubt do tracheotomy." 

REFERENCES. 

Halstead, T. H., Transactions American Laryn- 
gological, Rhinological and Otological Society, 
1902. 

Killian, (i., Transactions Laryngological, Rhin- 
ological and Otological Society, 1907. 



Killian, G., Dcutsch. med. Woch., June 29, 
1911. 

Briinings, W., Zeitschr. fur Ohrcnheilk., De- 
cember, 1910. 

Finder. J'crhandl. dcr Laryug. Gcscllsch. zu 
Berlin, 191 1. 

Meyer, E., Verhandl. dcr Laryug. Gcscllsch. 
~u Berlin, 191 1. 

Hubbard, Thomas, Transactions American 
Laryngological Association, 191 1. 

Jackson, Chevalier, Transactions American 
Laryngological Association, 191 1 (discussion). 

Hopkins, F. E., Transactions American Laryn- 
gological Association, 191 1. 



FIRST AID TO THE INJURED WITH 
SPECIAL REFERENCE TO SHOCK. ;: 



By Roscoe McMillan, M.D. (1910). 

Local Surgeon, A. C. L.. 

Red Springs, N. C. 



Mr. President, Ladies and Gentlemen: 

We can scarcely wonder that accidents are in- 
creasing from year to year when we stop to 
consider the increase in rapid locomotion of 
many kinds, the factories, mines, workshops, 
railroads, etc., all over the country. While the 
ratio of accidents, compared with the number 
of employes, is not increasing, the total number 
of accidents are increasing every year. A recent 
report from the Interstate Commerce Commis- 
sion says, "Accidents on the railroad seem to be 
increasing steadily." 

The nature of employment, surroundings and 
method of conducting the work determine the 
number of injuries. There is no doubt the 
actual number of fatal cases resulting from in- 
juries will be greatly lessened by prompt and 
skilful treatment. 

In this brief article I am exerting my energies 
toward railway accidents entirely. I am glad to 
say nearly every large railroad company has its 
own surgical staff. As I stand today looking 
into your faces, I am thoroughly convinced the 
Atlantic Coast Line has a very select, well- 
equipped and competent surgical staff, ready to 
meet any and all emergencies as they arise. But. 
gentlemen, it is a well-known fact that it is im- 
possible for a surgeon to be delegated to every 



•Read by title before Atlantic Coast Line Surgeons Asso- 
ciation, Richmond, Va., October ij. 1912. 



THE HOSPITAL BULLETIN 



205 



train on the railroad, and as it happens all ac- 
cidents do not happen at an appointed time or 
place when the surgeon can be at the scene of 
trouble. But it is possible for every road to have 
its responsible employes systematically taught 
the elementary principals of first aid to the in- 
jured, especially the great importance of con- 
trolling hemorrhage, protecting an open wound, 
and even so far as relieving a broken limb to 
some extent, pending the arrival of a surgeon. 
I know a lack of knowledge of some of these 
elementary principals is in a great measure re- 
sponsible for loss of life. Every railroad should 
be compelled by law to carry first-aid packets on 
every train, and more should be placed at sta- 
tions on the road. These packets should consist 
of at least two rubber tourniquets, a package of 
aseptic gauze, absorbent cotton, half dozen mus- 
lin bandages of different widths, adhesive plaster 
and a bottle of antiseptic tablets. 

Injuries on the railroad are peculiar only in 
their great severity and varied character. On 
this account, and because of the horror so com- 
monly preceding and attending these injuries, 
there is, as a rule, more shock from these than 
from any other class of injuries. There are few 
problems of more interest to the railroad sur- 
geon than shock. In railroad accidents, where 
we have to deal with fractures, dislocations, 
lacerated wounds, etc., we have to deal with a 
lowered condition of all the vital functions of 
the body, especially of the circulatory system. 
It is a critical moment to see patients lying be- 
side the track, or wherever they may be, with a 
small thready pulse, a lowered condition of 
respiration (may be full, fast or slow), blanched 
skin and mucous membranes, skin cold and clam- 
my, muscles relaxed, eyes sunken, mouth half 
open and absolutely indifferent and careless as 
to their surroundings. 

It is needless to say, gentlemen, the condition 
calls for immediate, wise and conservative ac- 
tion. There are several different forms of shock. 

First. — Psychic shock. This is produced by 
emotion ; it is a condition brought about by the 
terror a conscious person has of a seemingly in- 
evitable and terrible accident. This usually pre- 
cedes the injury; sometimes there is no injury 
at all, still the condition is found. 

Second. — Injury to nervous system. 

Third. — Hemorrhage causing: shock. 



The first thing to do in all cases is to find out 
what has caused the shock and try to lessen any 
further shock by removing the cause if possible. 
See at once if all bleeding has been controlled ; 
if hemorrhage continues, this must be controlled 
first. Then ascertain the physical condition of 
patient. Inexperienced surgeons are frequently 
so anxious to attend to the wounds, they entirely 
neglect the wounded person. They go through 
the very long, but proper, aseptic technique neces- 
sary for the local injury, and are very much sur- 
prised on completing the dressing to find the 
patient is dead. 

The absence of any serious wound to the head 
or spinal column, and the fact that no great 
hemorrhage has taken place externally or in- 
ternally suggests psychic shock. For this form 
restore heat to the surface and give full doses of 
morphia and atropine hypodermatically, which 
will in a great measure diminish the urgency of 
symptoms. 

The second and last forms are, of course, more 
serious and difficult to treat. The wounded sur- 
faces should be handled very carefully on 
account of the psychic effect of pain; also on 
account of the production of dangerous shock- 
producing afferent impulses that attend manipu- 
lation of tissues having a nerve supply. Support 
the circulation ; give moderate doses of strych- 
nine, or digitalis, ammonia, caffeine, ergot, etc., 
frequently repeated. Each and every case must 
be treated as a case unto itself. Alcohol will 
sometimes tide over a bad case temporarily, but 
continued large doses do more harm than good. 
Support circulation mechanically by use of sa- 
line infusion; the only trouble is to obtain sterile 
water. If possible, use at least 500 c.c. of nor- 
mal salt solution, to which at least 15 c.c. of a 1 
to 1000 solution of adrenalin chloride has been 
added. This should be given subcutaneously and 
repeated as necessary. In severe cases bandage 
the abdomen and extremities to force the blood 
into the heart, head and lungs. Make patient 
as comfortable as possible. Secure absolute 
rest, both mentally and physically. . Gain pa- 
tient's confidence, calm his fears; if this cannot 
be done, use small amount of some anodyne. 

I believe in delaying operations while pa- 
tient's condition is not so good, but if we do de- 
lay we must see that the wound is clean. Wash 
it until you know it is clean, then twice as long 
again. 



206 



THE HOSPITAL BULLETIN 



REPORT OF FOUR UNUSUAL CASES.* 



By A. At.dridge Matthews, M.D., 
Spokane, Wash. 



I think it would be a good policy for members 
of our Society to make it a point to report cases 
which are interesting or unusual. There are 
many conditions which are acceded as being rare 
from the records, but in reality are as a whole 
common, so common that they are not worth while 
to make record of ; the acute emergency gall blad- 
der work, ruptured pyosalpinx, causing general 
peritonitis, foreign body appendicitis, other than 
due to fecal concretions and such. 

I take this opportunity to report four cases, one 
of ruptured pyosalpinx, causing general perito- 
nitis, and three cases of appendicitis, one being 
due to an ordinary brass pin, one to an apple seed 
and one pin worms. I was prompted to do so by 
reading articles by W. N. Buckman and R. H. 
Fowler, both of New York, and from whose 
papers I take the liberty to quote as regards 
statistics which they have compiled. 

The first report will be the ruptured pyosalpinx, 
but before reporting will run over briefly some 
data that I have gathered on the subject. 

There have been recorded but 91 cases of rup- 
tured tubal or ovarian abscesses, causing general 
peritonitis, and adding my one case, making 92. 
While this is the first case of this character I have 
ever seen, although I had the opinion that it was 
much more common in so frequent a disease as 
pyosalpinx, 92 instances of ruptured tube and dif- 
fuse peritonitis are few enough indeed to warrant 
the belief that this complication, if not rare, is at 
any rate unusual. On the other hand, if one 
could add to these 92 the unrecorded cases, the 
reports buried here and there in the literature and 
the instances of perforation protected by localized 
peritonitis, the figures would be large enough, no 
doubt, to show that rupture is a complication too 
infrequent to gainsay conservative treatment of 
pyosalpinx, but sufficiently common to be born in 
mind in the management of every case of purulent 
tubal infection. 

Of the 92 cases recorded, many were post- 
mortem notes, and in many the history is very 
meager. Therefore the literature of this lesion is 
not susceptible to complete statistical analysis. 



•Read before Spokane Countv Medical Society, November, 
1912. 



Thirty-six of these cases were not operated upon, 
all died, and from the autopsy findings the diag- 
nosis was made. Forty-six were operated upon, 
36 recovered and 10 died. 

The diagnosis of these conditions is not at all 
an easy matter, and one has to consider the per- 
son's history. The most common mistake is to 
call it appendicitis, and it can well be associated 
with it or ectopic gestation. The anatomic diag- 
nosis is not essential, however, since peritonitis is 
usually evident ; the indication for operation is 
therefore established. 

It is of interest to note, in looking up the rec- 
ords of such cases, there is a history of repeated 
attacks of severe pain before the onset of the 
peritonitis, the final attack being the most severe, 
and followed by collapse and the peritonitis. 

The diagnosis of peritonitis due to a ruptured 
hollow organ is easily provided by history of sud- 
den violent pain and collapse or weakness, fol- 
lowed by great or entire relief of pain and the 
development of peritonitis signs and symptoms. 

Toward the recognition of a ruptured pus tube 
as the source of such a peritonitis, the most im- 
portant thing to bear in mind is its occasional 
occurrence and to consider it as about fifth in role 
of rupturing organs following the appendix, gall 
bladder, bowel and stomach. Localization of pain 
and tenderness low down in the iliac region, the 
history of gonorrhea or a recent pregnancy or 
uterine instrumentation fortify us, especially if 
there is a great tenderness and a mass or fullness 
in the vaginal fornix, especially if it be on the left 
side, where an appendix abscess is not likely to be 
found. If the patient is known to have had a 
pyosalpinx, especially if she has given such 
evidence of activity as repeated attack of pain, the 
diagnosis of ruptured pus tube is presumptive. 
Finally, if a previously palpated tense tube is now 
felt flaccid or collapsed, the diagnosis may be 
made with much assurance. 

January 20, 1912. 

Case I. — C. B. ; female ; married ; age 24 years ; 
occupation housewife; family and past history 
has no bearing on present condition. Has two 
children, both living, youngest two years old. 
Had a miscarriage last fall (about four months 
ago). Has had more or less pain in right side 
low down for past year, and much more notice- 
able since miscarriage. 

Between three and four weeks ago pain became 
much worse, and at last menstrual period passed 



THE HOSPITAL BULLETIN 



207 



lots of clotted blood and pus, and since a discharge 
purulent in character has continued. About this 
time (two weeks ago) she had an attack which 
she though to be influenza, the soreness in the 
lower abdomen and right side was worse, and she 
would have sweats and chills, and chilly sensa- 
tions being continued up to the time of perfora- 
tion. 

For the past few days the slightest jar or mov- 
ing about would cause considerable pain, and to- 
ward the last she could hardly walk on account 
of pain which would radiate across lower abdo- 
men ; along with this she had a frequent desire to 
urinate. Yesterday A. M. she attempted to lift 
her two-year-old child, and when doing so had a 
severe sudden lancinating pain low down in her 
abdomen, and she could not straighten up, the 
pain soon became general and the belly very tense, 
vomiting several times. 

She called her family physician, Dr. John Kaul- 
bach of Edwall, who referred the case to me. I 
saw her about 30 hours after the rupture had oc- 
curred. Her condition was most critical; pulse 
120, temperature subnormal, with a facies of peri- 
tonitis ; the belly was not much distended, but 
board-like. I held out very little hopes of her re- 
covery to her family, for I truly believed she would 
die. 

Vaginal examination was very unsatisfactory 
on account of extreme tenderness, but I could 
elicit a fixed uterus and a mass on right side. 
Patient was then transferred to the surgery, 
where 1 made a midline incision low down. 
There was a purulent peritonitis with a quantity 
of free pus in belly cavity. A general matting up 
of all the pelvic organs, and I broke into a large 
abscess ; whether it was the one which had rup- 
tured or another I was not certain, as the patient's 
condition did not warrant me doing anything fur- 
ther, as she was almost moribund, so inserted 
drainage tubes into the pelvis. (Might mention 
here that appendix was not involved.) 

Patient was given 700 c.c. normal salt infusion 
under her breasts and put to bed in a sitting pos- 
ture, with continuous valine solution by rectum, 
which was kept up for four days. Patient made 
a fair recovery, and was able to leave the hospital 
on the twenty-seventh da)'. 

Shortly after leaving the hospital the old pelvic 
infection began to give her more trouble, and she 
returned February 17, 1912, and I removed both 
tubes (double pyosalinx) and appendix. She 



had also been suffering with cramps (severe gas 
pains, as she expressed it), which would come and 
go. This was due to the intestines being very 
much matted, and held together by adhesions, 
many of which I released. She was again able 
to leave the hospital on the twenty-fifth day after 
the operation, and returned home, only to return 
again after about one month for intestinal ob- 
struction due to adhesion, and she left the hos- 
pital for the third time on the twenty-fifth day 
after the operation, and has been well and gaining 
ever since, but for some time she was bothered 
with more or less discomfort from adhesions, 
especially after eating heartily. When I saw her 
a few days ago this had disappeared. 

The three following reports are appendix cases, 
first due to an ordinary brass pin, second pin 
worms and third to an apple seed. 

Statistics showing foreign bodies in general as 
predisposing cause of appendicitis present consid- 
erable variation. L T p until 1906 foreign bodies 
had been found by the late George Fowler in 
one-fifth of 1 per cent, of 2000 cases, Murphy 
found foreign bodies in 2 per cent, of 2000, and 
Mitchell 7 per cent, in 1400 cases. 

At Cook County Hospital on post-mortems of 
3750 subjects Herneck found foreign bodies in 
the appendix in but two instances. But two cases 
came under Dr. Osier's observation in 10 years 
of pathological work in Montreal. Sharp-pointed 
metallic bodies represent a class by themselves ; 
they have rarely been found in the large surgical 
clinics, and their occurrence represents a curiosity 
and the ordinary domestic pin is the most com- 
monly encountered body of this character, and it 
is estimated by Barnes that out of 94 cases of true 
foreign bodies in the appendix, he has tabulated 
the pin composing 54 per cent. 

One would naturally suppose that a pin would 
lead to a rapid perforation, but this is not usually 
the case, according to Fowler, and he further 
states that it may be found free from deposit, rusty 
or corroded. It may form a nucleus for a fecal 
concretion, and be either partially or entirely sur- 
rounded. In cases where the pin has not been 
entirely surrounded, it is the head that is most 
usually covered with soft or hard fecal matter. 

Case II. — A. D. ; age two years ; boy. Child 
previous to this illness was strong and well. 
Mother noticed that when child would lie on back 
(making muscles of belly tense) that he would act 
as' though it hurt him ; also lifting and handling 



208 



THE HOSPITAL BULLETIN 



him would make him cry, but this did not excite 
any anxiety with the mother until she noticed the 
child walked drawn over to the right side, and 
would lay with right leg drawn up. 

Child was brought to my office on June 8, with 
history as above stated. Upon examining him 
found a distinct mass in right iliac region, very 
tender, temperature 101 and pulse 120, and I 
made the diagnosis of an appendicular abscess 
which had previously been made by their family 
physician. 

I had the youngster transferred to St. Luke's 
Hospital and operated. Upon opening the abdo- 
men over the mass I broke into an abscess con- 
taining two or three ounces of pus, which was 
gently mopped out ; then I inserted my finger into 
the cavity and ran against something sharp, which 
I thought to be a needle. I did not remove my 
finger, but passed a forceps down and caught the 
pin. The appendix came up readily with the head 
of the pin still imbedded in it. 

Appendix removed and stump inverted. The 
sixteenth day after the operation the youngster 
had obstruction symptoms, which subsided with- 
out any surgical interference, and left the hospital 
a short while later. 

Case III. — School girl ; age nine years. Family 
and past history of no interest regarding present 
trouble. Present trouble had existed for several 
months. She would complain of soreness in 
abdomen often and occasional severe pains that 
would cause her to go to bed for part of the 
day, and usually her mother thought she had a 
temperature, she having been a trained nurse. 

Her family physician, Dr. J. F. Hall, who re- 
ferred the case to me, saw her in this attack and 
one previously very much similar. 

Her temperature was 101, pulse 100. There 
was not very much rigidity over abdomen, but 
a decided tenderness over the appendix region 
on pressure. We made a diagnosis of sub- 
acute appendix and advised removal, which was 
done March 3, 1912. Upon removing the ap- 
pendix I was rather surprised not to find a more 
abnormal organ, so went in search for other 
trouble, but with no avail. 

After operating, upon examining the appen- 
dix, which seemed to be moderately full and 
soft, it did not show any decided inflammatory 
condition, but was a little clubbed at the end. 
Upon opening it to my great surprise I found 



it absolutely full of pin worms, which were very 
motile. 

Patient left hospital on the eighth day, and Dr. 
Hall tells me he has relieved her by proper 
medication of thousands of these worms, and 
the girl is now perfectly well. 

Case IV. There is no especial interest, ex- 
cept being unusual, so will not go into detail. 

Male, 40 years old. History of chronic ap- 
pendicitis for some time. I removed sub-acute 
appendix and found an apple seed and a small 
fecal concretion therein. Patient made an un- 
eventful recovery. 



DIAGNOSIS OF SYPHILIS. 



By E. KlLBOURNE TULLIDGE, 

Senior Medical Student. 



Today it is surprising how unerringly the diag- 
nosis of syphilis may be made clinically without 
the aid of laboratory tests. However, before the 
introduction of the present assurative measures of 
diagnosis many physicians balked before placing 
the patient upon a long prescribed treatment ex- 
tending over several years, because of the appear- 
ance of the initial sore alone, it being the usual 
custom to wait until the development of the sec- 
ondary stage before administering anti-luetic 
remedies. 

It has certainly been a great stride in the science 
of medicine that enables us today to definitely tell 
a man in half an hour under favorable conditions 
that he has the organisms of syphilis growing 
within his body. Owing to the tenacity with which 
nature guards her secrets, it has only been within 
the last few years that this refinement of diagnosis 
has been possible. It is by no means easy to dis- 
tinguish the spirochete pallida from other organ- 
isms frequently found in the body; just as the 
Klebs-Loeffler bacillus at times is unrecognizable 
from other organisms that do not cause diph- 
theria. 

There are five scientific methods employed for 
the diagnosis of lues: 

1. The discovery of the organism itself in the 
body, usually ascertained by the dark field illumi- 
nator. 

2. The inoculation of the organism into the 
lower animals, such as the ape, chimpanzee, male 
guinea pig. 

3. The Wasserman test. 






THE HOSPITAL BULLETIN 



209 



4. Growing the organism in specially prepared 
culture media outside of the body. 

5. The skin test, Noguchi's reaction. 

The first of these methods may be employed in 
several ways. The dark field illuminator has been 
exhibited for the past few years at practically all 
gatherings of medical men and constantly used by 
Dr. Timberlake in the genito-urinary department. 
This instrument places the spirochete in the same 
relation to the eye as a grain of dust bears in a 
rav of sunlight entering a dark room. The organ- 
ism when seen in this sphere appears slender, 
spiral in shape, presenting from four to twelve 
curves, pointed at each end; it may appear in- 
creased in length, due probably to the presence of 
two organisms in the act of division. It is often 
confused with the spirochete refringens, which 
does not present as uniform or as many curves, 
and is thicker and coarser. 

Another method occasionally used in differen- 
tiating the organism which may be employed with 
very little trouble and with satisfactory results is 
the one known as the Burri India Ink method. A 
puncture is made in the neighborhood of a chancre 
or condylomatous patch, antiseptic precautions 
being used, and the exuding fluid, with as little 
blood as possible, is placed on a clean sterile slide, 
where it is mixed with one drop of corresponding 
size of India ink, free from bacteria. The slide is 
then brushed with a piece of cardboard or cigar- 
ette paper, in somewhat the same fashion as blood 
is smeared for microscopic examination. Smear 
dries very quickly, and may be examined with an 
oil emersion lens. Organisms present will appear 
white or gray upon a blackish or slate-colored 
background. 

The great drawback to this method is the con- 
fusion occasioned by the presence of ordinary 
saprophytic organisms contained in India ink not 
especially prepared. However, upon studying the 
specimen, should no other spirillum be present, it 
is quite safe to make the diagnosis of treponema 
pallida. 

The Wasserman test has been so thoroughly 
discussed by the medical journals for the past 
year that it will be hardly necessary to go into its 
technique. 

In inoculating the disease into lower animals 
the male guinea pig is the animal best to use, af- 
fording the same results, with less financial ex- 
penditure, as the monkey. The material collected 
from the chancre or condylomata of the suspect is 



injected into the animal's testicle, which at the 
expiration of a week or ten days will show the 
presence of the spirochete if examined. 

The Noguchi method is a cutaneous one, and 
has been well described in the journals of the. 
American Medical Association, Vol. LIX, No. 14, 
dated October 5, 191 2, and April 20, 191 2, and 
the journal of Experimental Medicine, 191 1, Vol. 
XIV, 557. The reaction is caused by the injec- 
tion cutaneously of Luetin prepared from the pure 
killed cultures of the Luetic spirillum. This 
causes an eruption varying from inflammatory 
nodules to pustular formations lasting for several 
days, as a rule. The reaction may occur almost 
immediately, but in some cases it may commence 
as late as three or four weeks after inoculation. 



THE DEVELOPMENT OF ANTISEPTIC 
AND ASEPTIC SURGERY. 



By Emmet James Stewart, 
Junior Medical Student. 



The technique of wound treatment has, during 
the last 20 years, become more complicated by the 
general adoption of the antiseptic system. Much 
detail work has become necessary, the exact per- 
formance of which is alone a guarantee of good 
results. It matters not how many changes in the 
practical application of the method, which was 
first described by Sir Joseph Lister, the principle 
remains the same. In those days the "antiseptic 
method" of Lister stood forth in relief against all 
other methods. It was based on the germ theory 
of infection, and consequently the only method 
which in a systematic way sought to prevent the 
entrance of micro-organisms into wounds. In 
the course of development it has come about that 
the words antiseptic and aseptic are used in a 
somewhat different sense from that which they 
first imparted. Under aseptic conditions we at- 
tempt to destroy all living germs on hands of sur- 
geon, on the dressings, instruments and skin of 
patient to be operated on beforehand, while under 
the antiseptic method we attempt, after operating 
on the patient, to destroy all micro-organism by 
washing out the wound with various chemical an- 
tiseptics and dressing wound with dressings which 
have been impregnated with antiseptics. 

'We would today include Lister's antiseptic meth- 
ods among our modern aseptic methods. It will be 



2IO 



THE HOSPITAL BULLETIN 



of interest in this connection to follow the changes 
which have taken place in the latter until the sys- 
tems in use today have been developed. Not many 
years after Lister's publications attention was 
called to the great inconvenience of the spray dur- 
ing operations and the application of dressings. 
So great had been the results of wound treatment 
since the Listerian method had been developed, 
and so firm had the belief in all its details become, 
that it seemed a hazardous proceeding to discard 
anything which was deemed necessary by this 
method. Lister's method in regards to antiseptic 
sprays was based on the principal that infectious 
germs are everywhere suspended in the air, and 
that to render them harmless it was necessary to 
use a spray. But the drawbacks of the spray was 
that it drenched both patient and surgeon, it hin- 
dered close inspection by the surgeon, and it also 
cooled of! the patient during serious operations. 
It was now shown that while the spray had some 
influence on the germs, it did not destroy their 
vitality. About the same time Trendelenburg, 
and also Brims, had found that the results of anti- 
septic treatment was equally good whether the 
spray was used or not. So the spray was dis- 
pensed with, and this marked one step forward in 
the development of antiseptic surgery. 

In 1885 the experimental method was for the 
first time applied to determine the germicidal power 
of various antiseptics after thorough washing 
with soap and water, carbolic acid, boric acid and 
corrosive sublimate, and other disinfectants were 
tested by Foster in these experiments with culture 
media. He came to the conclusion that corrosive 
sublimate alone prevented the development of 
germs. 

Shortly afterwards Kiimmel, and somewhat 
later Fuerbringer, repeated these experiments in 
a more satisfactory manner. The question 
whether or not sterilization of the hands soon 
after their contamination with septic material is 
possible is one of grave importance to the obstet- 
rician and surgeon. This question was settled by 
Kiimmel, who came to the conclusion that, 
under ordinary circumstances, cleaning with 
soap and water, followed by an immersion and 
rubbing in a 6-1000 solution of thymol, a 1-1000 
solution of bichloride or a 3-100 solution of car- 
bolic acid, was a sufficient guarantee for ordinary 
purposes. 

To Fuerbringer belongs the credit of having 
first called attention to the fold and fissures of the 



skin as places which harbor impurities, and also 
showed how difficult it was to dislodge the impuri- 
ties by mechanical means, and, more important 
than this, he called attention of surgeons to the 
difficulty of disinfection of the fingers in the re- 
gions of the nails. He gave the following method : 
After cleaning the hands and nails, the nails being 
always cut short, the hands should be washed for 
one minute with soap and water, then for one min- 
ute in alcohol, and after alcohol has evaporated 
put hand for one minute in 1-1000 solution of 
bichloride or a 3-100 solution of carbolic acid. 

In sterilization of instruments, according to 
plan of Lister, the instruments were put in a 
trough containing a carbolic solution 1-20. Later 
it was recognized that mechanical cleaning was 
the most important part of the process of steriliza- 
tion. Dry sterilization of instruments was at first 
tried from a desire to prevent rusting. Redard 
discovered that steam under pressure at 110° C. 
absolutely sterilized in from 10 to 15 minutes, but 
that sterilization by boiling liquids could only be 
accomplished at a temperature of 120° C. After 
some experimenting he decided on a mixture of 
40 parts of calcic chloride and 60 parts of water, 
which boils at 1 10° C, as a suitable medium. But 
he did not turn these results to any further prac- 
tical use, believing in the superior efficiency of 
steam. 

It appears that Davidsohn, a pupil of Robert 
Koch, first emphasized the advantages of steriliza- 
tion by boiling, but to Schiramelbusch belongs the 
credit of first having introduced the method into 
surgical practice. After a series of experiments 
in von Bergmann's Clinic he demonstrated its 
efficiency and simplicity. Instead of using pure 
water, he recommends a 1 per cent, solution of 
plain washing soda. This serves two purposes — 
it intensifies the sterilizing power of the boiling 
water by removing grease and dirt from the sur- 
face of the instruments and it prevents rusting. 

In regard to dressings by Lister's original 
method, dressings impregnated with chemical an- 
tiseptics were used. But gradually chemical im- 
pregnated dressings were discarded, and at pres- 
ent time they are not used, except in the case of 
iodoform gauze. We strive to accomplish the 
same end as Lister did, when he described his car- 
bolized gauze to prevent wound infection, but we 
now try to do this by aseptical precaution before 
and during the surgical manipulation and before 
the dressings are applied. At the present time we 



THE HOSPITAL BULLETIN 



211 



use gauze sterilized by means of heat, and do not 
irritate the wound by antisepticallv impregnated 
gauze. These are some of the advances which 
have been made in the development of antiseptic 
and aseptic surgery. 



SYMPTOMS AND TREATMENT OF 

SHOCK. 



By Porter P. Vinson, 

Junior Medical Student. 



Shock was probably first recognized by Wil- 
liam Clowes in 1568, but it remained for John 
Hunter to give the first accurate description of the 
characteristic symptoms in 1784. Clowes attrib- 
uted this peculiar condition to the presence of 
some foreign body, either in the wound or circu- 
lating freely in the blood. This opinion, with 
slight modifications, existed for quite a number 
of years ; in fact, it was one of the foremost theo- 
ries until the latter part of the nineteenth century, 
when Golt of Strasburg made his classical experi- 
ments on the frog. When a frog was suspended 
with his legs downward and then tapped on the 
mesentery it was noticed that the heart was sud- 
denly arrested. 

After a variable length of time it began to beat 
again, but was much paler than before, less blood 
being thrown into the aorta. If the frog was now 
placed in a horizontal position, however, the heart 
asumed a natural color, there being a normal vol- 
ume of blood thrown into the aorta at each con- 
traction. This arrest of the heart was due to a 
vaso-motor paralysis produced by mechanical irri- 
tation. This very wonderful experiment of Goltz 
has been, and is today, the basis of the most 
widely accepted theory of shock. 

Fisher accepted Goltz's conclusions, but he 
added that in this vaso-motor paralysis a large 
aim 'iint of blood accumulates in the large abdom- 
inal veins, and when this paralysis is prolonged 
the patient dies from anemia of the brain and 
overdistension of the right side of the heart, due 
to this unequal distribution of the circulating 
blood. 

Shock, therefore, in its broadest meaning, may 
be defined as "sudden vital depression due to an 
injury or emotion which makes an untoward im- 
pression upon the nervous system." Surgical 
shock, with which we are most concerned, is the 



impairment or inhibition of the vaso-motor sys- 
tem due to an injury. 

The pathology of shock is more or less obscure. 
It has been studied by Hodge, who made observa- 
tions on the microscopical changes in the nerve 
cells of dogs and cats before and after long elec- 
trical stimulation. He found that the outline of 
the cells were irregular, the nucleus was smaller, 
irregular and stained darkly ; also that the cells 
in the cerebrum and cerebellum were decidedly 
smaller, and this was accompanied by an enlarge- 
ment of the pericellular lymph space. He con- 
cluded that the same changes occurred during 
shock as during this overstimulated condition. 

The symptoms depend in a large measure on 
the severity of the shock, this depending, in turn, 
on the mental condition of the patient, and may 
vary from a temporary faintness to a profound, 
continued and finally fatal vital depression. 

The symptoms may come on almost immedi- 
ately, or may be delayed for some time, surgical 
shock usually coming on during operation. 

Under the severer forms of shock we recog- 
nize two types : First, the torpid type, or that ac- 
companied with very much depression. This 
torpid type shows the following characteristic 
symptoms : Great pallor of the skin and mucous 
membranes ; loss of facial expression : eyes dull 
and pupils dilated and reacting only very slowly 
to light ; forehead covered with a cola sweat ; 
muscular tonus markedly lessened ; irregular, 
shallow and sighing respiration ; irregular and 
weak heart action ; diminished sensibility ; sub- 
normal body temperature, and mental torpor. 

In rare cases we may have nausea and vomit- 
ing, and there may be relaxation of the sphincters, 
causing the involuntary passage of urine and 
feces. 

Next w r e have the nervous type, or that accom- 
panied with great activity on the part of the 
patient. He becomes extremely restless ; tossing 
about in bed and crying out in delirium. The 
pulse is thready, or possibly almost imperceptible : 
the respiration is irregular and shallow. 

The above-mentioned symptoms may clear up 
in from two to twenty-four hours spontaneously, 
or they may persist to such a marked degree that 
it requires our best attention to revive the patient. 

Those symptoms arising from purely emotional 
causes rarely require treatment, so our attention 
will be confined to the treatment of "surgical 
shock." 



212 



THE HOSPITAL BULLETIN 



We should, in all surgical procedures, first ex- 
amine our patient to ascertain if there is any prob- 
ability of his not being able to withstand the 
operation without severe shock. If we find upon 
examination that he is liable to suffer from shock, 
we should be prepared for it, and the family 
should be duly warned. 

In weak patients we should, if possible, use a 
local rather than a general anesthetic, for the 
local anesthetic, by rendering the peripheral 
nerves insensible, blocks effectually the pathway 
for any impulse to travel to the vaso-motor center. 

In case you find it necessary to use a general 
anesthetic, it is well to give your patient one- 
twentieth grain of strychnine and three grains 
of caffeine citrate hypodermically an hour before 
the operation. Hot coffee may also be given at 
this time. 

Have the room warm and keep the patient well 
covered. It is a very good plan to keep the oper- 
ating table warm, either by especially constructed 
hot-water pipes or by hot-water bottles. 

Use dry gauze in preference to moist dressing. 
Keep the extremities well covered, and in some 
cases it may be well to bandage the lower iimbs. 

Warm whisky mixed with water, as an enema, 
during the course of the operation, is highly rec- 
ommended. 

The treatment as outlined above is preventive 
rather than curative in character, and when we 
have the active symptoms of shock manifesting 
themselves it becomes necessary to resort to more 
active treatment. In this case we should give one- 
thirtieth grain of strychnine and one-fiftieth grain 
of atropin. Normal saline solution with the ad- 
dition of one drachm of adrenalin chloride solu- 
tion (1-1000) should be given by hypodermo- 
clysis, but care should be taken not to give it too 
rapidly nor in too great an amount. 

Tincture of digitalis should be given by the 
mouth in io-drop doses whenever the patient is 
able to take it. 

In the restless cases give morphine sulphate, 
one-sixth grain. 

Finally, we may resort to mechanical methods 
to revive our patient. These consist of the prac- 
tice of artificial respiration and lowering the head. 
This latter procedure allows the blood to reach 
the anemic brain, and may be of very great ser- 
vice. 

Usually our patient will react to shock without 



any treatment whatsoever, but we also find cases 
which, even with our very best treatment, we are 
unable to restore to normal. 

It is well for us to bear in mind this condition 
of vaso-motor inhibition and paralysis, and in all 
surgical procedures be prepared to combat in a 
measure its untoward and sometimes disastrous 
termination. 



CERTAIN DISEASES OF OLD EGYPT. 



By Ejnar Hansen, M.D. 



It may be doubted whether there is truth in the 
old saying that "medicine" is the mother of 
science, but at least medicine may be called a 
good helpmate, stretching out a helping hand in 
many directions, and especially to the archeol- 
ogist. 

Normal prehistoric skeletons have been carefully 
examined by medical authorities many times, and 
the science of anthropology is built up upon recent 
examinations and comparisons of the different 
discoveries. Only in late years and by help of an 
extremely well-developed microscopical and bac- 
teriological technique has it been possible to trans- 
fer the studies to the pathological field and to 
take the first step in the study and description of 
the diseases of the old and prehistoric peoples. 

Dr. J. W. S. Johnson of Copenhagen writes a 
very interesting account in "Ugeskrift for 
Larger" about different diseases found among the 
old Egyptians. Evidence of caries of bones in 
mummies was found several years ago, and the 
excavations of the burial place at Dakka in 1909 
gave us much material for study and further in- 
creased our knowledge of certain bone diseases. 
Four out of ten excavated skeletons showed a 
diseased condition of the spine, and these four 
skeletons came from only two graves. The one 
grave contained skeletons of a man and a woman, 
both with carious destruction of small vertebrae. 
The other tomb contained skeletons of two men 
and a nine-year-old boy. One man had a kypho- 
sis caused by the destruction of two vertebrae. 
The boy had five vertebrae partly destroyed and 
grown together in a solid mass. The microscop- 
ical examination of these cases has not vet been 



THE HOSPITAL BULLETIN 



213 



published, but it seems impossible to eliminate 
tuberculosis as the cause. 

There are here two possibilities. This is either 
the ravage of tuberculosis in a single family or a 
collection in one place of patients with this par- 
ticular disease. Why the latter should be the 
case we do not know; therefore the first is the 
more probable. 

Dr. Marc Armand Ruffer, president of the 
Egyptian Department of Health, has for a long 
time "undertaken microscopical examinations of 
normal and pathological tissues in mummies. He 
describes bis methods in Cairo Scientific Journal 
I Vol. IV, No. 40), and according to his report he 
found the following diseases among the old 
Egyptians: Arteriotherom, anthracosis pulmo- 
num, croupous pneumonia, cirrhosis of liver, ab- 
scesses of kidneys and bladder, calcified Bilharzia 
eggs, and several times he has been able to prove 
the presence of bacteria in liver and lung tissues. 
Jn one case the liver and lungs were so filled with 
a micro-organism so similar to plague bacilli that 
the proof of plague lacked only a few abscesses. 
In another case he found abscesses with colon 
bacilli. He has not yet been able to prove the 
presence of tubercular bacilli. 

Gibbosities seems to be rather common, and 
were also found in the ape mummies. YVe know 
now that many apes die of tuberculosis. 

So long as the presence of tuberculosis has not 
been positively proven, we can only guess, as has 
been done in many hip diseases analogous with 
coxitis tuberculosa. 

Dr. Ruffer found in one mummy spondylitis, 
arthritis cubiti with fistula, and an infection in 
the ilio-sacral joint. 

Science is approaching nearer and nearer to the 
correct diagnosis of these cases. 

Dr. G. E. Smith and M. A. Ruffer have exam- 
ined a humpback mummy from the twenty-first 
dynasty (about 1000 years B. C.) This was 
found in a tomb at Deir el Bahari. The de- 
struction was in the fourth last dorsal and 
first lumbar vertebrae : there was plenty of new 
bone tissue; the spinal column was very much 
bent, and the point of the angle was made of the 
eighth and ninth dorsal vertebrae. In the right 
side was found a broad flat intumescence spread- 
ing downwards and outwards into the right fossa 
ilica. There were no fistulae in the skin ; the in- 
tumescence was at the place of the psoas muscle. 



A more detailed account of this case by the 
above-named doctors and an introduction by Dr. 
K. Sudhoff can be found in "Znr historischen 
Biologic der Krankheitserreger" (Vol. III). 



In writing to Mrs. Hemmeter concerning the 
illness of Professor Hemmeter, Carl Anton 
Ewald, professor of medicine at the University 
of Berlin, says in German : 

"Undoubtedly he has worked too much again, 
but I am glad to know that everything is being 
done to save this active and brilliant mind to us 
and to American medicine. But absolute rest for 
a mind that is so much in love with work is a very 
difficult matter to enforce, and you will have to 
have patience with him. I am very glad and 
comforted to know from the latest reports that 
he is improving. I congratulate him and you on 
his election as honorary member of the German 
Phvsiolosfical Society." 



Among the University alumni practicing in 
Kentucky are : 

Lexington — Abram L. Blanding, class of 1881. 

Louisville — Henry R. Carter, class of 1879, 
Surgeon U. S. P. H. and M. H. S., Marine Hos- 
pital. 

Richmond — C. J. Bales, class of 1878. 

Russellville — John K. W. Piper, class of 1893. 



Among the University alumni practicing in 
Louisiana are: 

Coushatta — Wm. A. Boylston, class of 1871. 

Haughton — John E. Rooks, class of 1905. 

Xew Orleans — YYm. Henry Block, class of 
1895. 832 Canal street; Wm. Buford Clark, class 
of 1882, 1301 Magazine street. 

Shreveport — Emmet A. Welsh, class of 1887, 
Lew Building:. 



Among the University alumni practicing in 
Iowa are : 

Carlisle — Wm. Edgar Sperow, class of 1894. 

Des Moines — David Wilson Smouse, class of 
1876. Knights of Pythias Building. 

Sabula — Franklin D. Ayers, class of 1892. 

Shenandoah — Lynn J. Putnam, class of 1909. 

Waterloo — Ernest J. Waddey, class of 1891, 
Lafayette Block. 



214 



THE HOSPITAL BULLETIN 



THE HOSPITAL BULLETIN 

A Monthly Journal of Medicine and Surgery 

PUBLISHED BY 

THE HOSPITAL BULLETIN COMPANY 

COS Professional Building 

Baltimore, IV \>. 



Subscription price, . . . $1.00 per annum in advance 

Reprints furnished at cost. Advertising rates 

submitted upon request 



Nathan Winslow, M.D., Editor 



Baltimore, January 15, 1913. 



THOMAS FELL, A.M., Ph.D., LL.D., THE 
NEW PROVOST. 



At the meeting of the Board of Regents, held 
Tuesday, January 9, 1913, upon the recommenda- 
tion of the committee appointed for the purpose 
of selecting a Provost in place of the late Bernard 
Carter, Dr. Thomas Fell, President of St. John's 
College, Department of Arts and Sciences, was 
chosen for the position. Undoubtedly the selec- 
tion will meet with the approval of even- 
alumnus, as Provost Fell is an educator of wide 
experience and in touch with modern educational 
methods. The University is to be congratulated 
upon its choice, and is indeed fortunate to have 
such a man at its head. For the first time in the 
more than one hundred years of its existence the 
University of Maryland has a real head ; as a 
consequence of which we can confidently look 
forward to the institution taking on new life and 
expanding into new fields of usefulness. This 
appointment marks an epoch in our history, a 
passing of the old order of events and the celebra- 
tion of a new birth. Our dreams for a better and 
greater University of Maryland, we feel assured, 
will now come true. During the past decade 
there has been a gradual change of view by those 
in charge of the destinies of our Alma Mater. 
Some were too discouraged to perceive it, but 
others had stout hearts, and sincerely believed 
that the Board of Regents were alive to the neces- 
sities for change in the method of conduct of the 
affairs of the institution. Their faith has been 
justified, and undoubtedly will be further re- 
warded by still greater changes in the organic 



reorganization of the institution in the near fu- 
ture. Remember, in the meantime, however, that 
a transition is on, and that the authorities need 
your help, sympathy and encouragement. Do not 
expect of Provost Fell too much in the beginning. 
Give him time to become thoroughly acquainted 
with the affairs of the institution, and The Bul- 
letin predicts that he will evolve a new institu- 
tion upon the framework of the old. 

For the present it is planned that Dr. Fell will 
open an office at the University and give Satur- 
days and at least two afternoons a week to the 
institution as an entirety. It is also proposed to 
have an office force to assist him. 

Dr. Fell is regarded as one of the leading edu- 
cators of this part of the country. His ability as 
an administrator has been tried as the president 
of St. John's College. In the opinion of all who 
have watched the growth of that institution under 
his leadership, he has been remarkably successful. 

'When he assumed charge of the old institu- 
tion, which was founded in 1696 and thus ranks 
as one of the oldest colleges in America, a great 
deal of its prestige had been lost, and there was 
clanger that it would suffer the same fate as a 
number of other small colleges had. 

With signal ability Dr. Fell set to work to 
restore St. John's to its former position. When 
he took charge there was a long-standing mort- 
gage of $30,000 hanging over the school. 
Through his efforts that has been entirely wiped 
out. The final accomplishment of his adminis- 
tration was the merging of St. John's with the 
University of Maryland. 

Dr. Fell was born in Liverpool, England, July 
15, 1851. His father was a surgeon in the Eng- 
lish Army, and was killed in the Crimean War. 
Dr. Fell was educated at the Royal Institution 
School of Liverpool and at King's College, Lon- 
don. He later entered the University of London, 
and then studied for a year at the University of 
Munich. He came to America in 1882, and in 
1884 was elected professor of ancient languages 
at New Windsor College, New Windsor, Md. 
In 1886 he was elected to the presidency of St. 
John's College, being the twelfth president of its 
now 123 vears of existence. St. John's College 
has conferred upon him the honorary degree of 
doctor of philosophy, and the, University of the 
South that of doctor of civil law. while Hampton- 
Sidney College has honored him with the degree 



THE HOSPITAL BULLETIN 215 

of doctor of laws. llis Standing as an educator feci that he is entitled to eat a bountiful Christ- 
is recognized everywhere. Dr. Fell is a member mas dinner without having' in some measure 
of the American Philological Association, the helped to bring good cheer to others less fortu- 
Nalional Educational Association, the Phi Sigma natc than himself. We give presents to our fami- 
Kappa Fraternity, the I "niversity Club of Haiti- lies and friends, and receive tokens of love and 
more, and the Cliosophic Society of Princeton esteem from them in return. The same custom 
University. might be appropriately established between insti- 
The formal induction into office of Dr. Fell tutions of learning and their children and friends, 
should be made a memorable occasion. No stone The college gives far more to its pupil than it 
should be left unturned to make it as impressive receives in financial returns. The young man 
as possible. The event, in our opinion, is of receives instruction, training, inspiration and op- 
greater importance than our recent centennial portunities that are of the greatest use to him. 
celebration, as it marks a new departure in the For these, mayhap, he pays a moderate charge 
career of the University of Maryland, and should, and then calls the account square. But the ac- 
therefore, be celebrated befittingly. count is not settled ; institutions, like individuals, 
We have no patience with those who cry, "We require financial assistance, and to whom can they 
have permitted our opportunity to pass." Oppor- turn for help, with the same expectation of re- 
tunity knocks more than once at every gate ; it is ceiving it, as to their own alumni, who have been 
knocking at ours now. nurtured and strengthened and sent on their way 
"They do me wrong who say I come no more t0 batt,e with and overcome the obstacles that 
When once I knock and fail to find you in ; confront them ? 
For every day I stand outside your door, The University of Maryland has given much 
And bid you wake and rise to fight and win. and has received but little. There is urgent need 
Wail not for precious chances passed away ; for at least five endowed chairs, but at present we 
Weep not for golden ages on the wane ; are endeavoring to raise funds for but one de- 
Everv night I burn the records of the day ; partment, that of pathology. We need $100,000 
At sunrise every soul is born again. for this purpose, and have about $20,000 in hand. 
Laugh like a boy at splendors that have sped, Friends and fellow-alumni, the need is great. 
To vanished joys be blind and deaf and dumb ; Will you not help us, in such measure as you can, 
My judgments seal the dead past with its dead, to raise this fund ? 

But never mind a moment yet to come. contribution by classes. 

Though deep in mire, wring not your hands and „ „ „. 

& ' & J jg 4 3 $5000 

weep ; ~l 

T1 , , „ , , T ,, „ 1864 2000 

1 lend my arm to all who sav i can ! 

1868 1000 

This is an opportunity ; let us help Provost Fell 1871 35 00 

to grasp it. 1872 81 84 

■ 1873 49183 

THE HOLIDAYS— GIVING AND RECEIV- 1874 : 5 00 

ING. 1875 5 00 

1876 115 00 

The college exercises closed on December 21, 1877 10 00 

and were resumed on January 3. We hope that 1880 5 00 

all students and teachers alike have enjoyed the 1881 252 00 

respite from classes and have returned to their 1882 310 00 

work refreshed and invigorated. The Yuletide is, 1883 40 00 

for most of us, a time of good cheer ; a time of 1884 40 00 

family gatherings and of social festivities. It is 1885 235 00 

also a time for sharing with others, of giving and 1886 100 00 

receiving. However pleasant it may be to re- 1888 SO 00 

ceive gifts, w r e believe "it is more blessed to give 1889 100 00 

than to receive." The writer personally does not 1890 175 °° 



2l6 



THE HOSPITAL BULLETIN 



1892 150 00 

1893 40 00 

1894 135 00 

"^95- • r J 55 00 

1896 52 00 

1897 80 00 

1898 115 00 

1899 55 oo 

1900 215 00 

1901 270 00 

1902 330 00 

1903 34o 00 

1904 135 00 

1905 220 00 

1906 175 00 

1907 no 00 

1908 20 00 

1909 1 5 00 

1910 50 00 

7911 Terra Mariae 3 5° 

1912 Club Latino Americano 25 00 

Total subscriptions to Jan. 1, 1913. .$10,372 17 

NEW SUBSCRIPTIONS IN. DECEMBER, I912. 

Randolph Winslow, 1873 $50 oo 



ITEMS 

It is with much pleasure that we acknowledge 
receipt of a paper from Dr. Najib Kenawy, class 
of 1905, of Alexandria, Egypt, upon the sub- 
ject of gastroenteritis. He says that at this time 
the physicians of Egypt are having much discus- 
sion as to the proper method of treatment, and 
tells in his paper about treatment by hypodermic 
injections of sea water. This will be published 
in The Bulletin within the next few months. 



Among the University alumni practicing in 
Arizona is : 

John Holt Lacy, class of 1879, at Miami. 



The following alumni were among those who 
successfully passed the examinations of the 
State Board of Medical Examiners in Decem- 
ber, and to whom licenses to practice have been 
issued : Drs. Bernard Mark Berngartt, James 
Archie Duggan, William Edwin Gallion, Jr., 
Moses Randolph Kahn, John Charles Norton, 
John Andrew Skladowskv, all of the class of 
1912, and Dr. Isidore Isaac Hirschman, class of 
1911. 



We are glad to announce that Dr. William 
Tarun, class of 1900, who has been away for 
some time owing to ill-health, has sufficiently re- 
covered to return to Baltimore and resume his 
practice. 



Among the University alumni practicing in 
Alabama are : 

Birmingham — Joseph Thomas Coulbourn, 
class of 1886, Woodward Building; William 
Groce Harrison, class of 1892, Empire Building; 
Howell Towles Heflin, class of 1893, 109^2 N. 
20th street; Devotie Dennis Jones, class oi 1872, 
5602 Second avenue, South; E. Laurence Scott, 
class of 1906, Woodward Building; Lewis Green 
Woodson, class of 1887, Woodward Building. 

Childersburg — Thomas Jefferson Powell, class 
of 1866. 

Dadeville — Eugene Walker Hart, class of 
1891. 

Equality — James Columbus Cousins, class of 
1891. 

Roanoke — William Gibson Floyd, class of 1878. 



Dr. William Fulford Sappington, class of 
1001, of Webster's Mills, Pa., visited the hos- 
pital December 13, bringing a patient for opera- 
tion. Dr. Sappington has had 20 cases of ty- 
phoid fever recently under his care. 



Dr. Isadore Isaac Hirschman, class of 191 1, 
who recently passed the State board examiners, 
is connected with the State Sanatorium at Sa- 
billasville. 



As we go to press we are informed that the 
council on education of the American Medical 
Association has rated the University of Mary- 
land as a Class A school. 



Dr. Nathan R. Gorter, class of 1879, of 1 W. 
Biddle street, has been appointed Health Com- 
missioner of Baltimore, succeeding the late Dr. 
James Bosley. Dr. Gorter was born in Baltimore 
county, Maryland, April 25, i860, son of Gosse 
Onno and Mary Ann Polk Gorter. His father 
was descended from early Dutch settlers, and his 
mother's family was of Scotch-Irish origin. He 
was educated in the Anne Arundel County Acad- 
emy 'and the University of Maryland. Since 
graduation he has practiced in Baltimore, and has 
won an enviable reputation both as practitioner 



THE HOSPITAL BULLETIN 



>i 7 



and a teacher. He filled in 1884 the chair of sur- 
gery in the Baltimore Polyclinic. From 1898 to 
1904 he was surgeon to the Cambridge Hospital, 
and since 1894 he has been consultant in surgery 
to that hospital, lie is a member of the Medical 
and Chirurgical Faculty and the American Med- 
ical Association. He is a member of St. Paul's 
Protestant Episcopal Church, and belongs to the 
Maryland and Baltimore Country Clubs, the 
Baltimore Athletic Club and the Bachelor's Cotil- 
lion Club. He married May 4, 1898, Miss Mary 
Gordon Norris. 

In the Health Department Dr. William Royal 
Stokes, class of 1891, has been bacteriologist for 
many years, and will retain that position. 

After his appointment Dr. Gorter said : 

"I was much pleased when the late Dr. Bosley 
was reappointed by the Mayor, and deeply regret 
that he was not spared to fill out his allotted time. 

"When the present vacancy occurred many of 
my friends were kind enough to express their 
wish that I should be appointed Health Commis- 
sioner, and when Mr. Preston tendered me the 
position I felt it was a public duty which I should 
accept. 

"The Mayor is deeply interested in the devel- 
opment of the Health Department, fully realizing 
that the health of the citizens of Baltimore is the 
fundamental factor in the development of our 
city. His wish is to have one of the most up-to- 
date departments of health in the country, and I 
know we will have his most hearty co-operation 
in the continual development of our department. 

"I fully realize the responsibility of directing 
the department, which has as its duty the safe- 
guarding of the health of the citizens of Balti- 
more, and my first duty will be to thoroughly fa- 
miliarize myself with the working of the integral 
parts of the Health Department. 

"I ask and confidently expect the hearty co- 
operation of the medical profession and of the 
citizens of Baltimore in the continued upbuilding 
of this very important department of the city 
government." 



Tbe engagement is announced of Miss Lucy 
Perry, daughter of Mrs. S. M. Perry, of Atlanta. 
Ga., to Dr. Emmett O'Brien Taylor, class of 
191 1, of Greelyville. S. C. The marriage will 
take place in the early spring. Dr. Taylor wrote 
us recently and said that he enjoys reading the 
Bulletin. He adds the following, which may 



comfort some of his classmates in the same boat: 
"I am not getting rich down here, but am getting 
three square meals a day and a goose-hair bed to 
sleep on at nights. That's not bad, after all. You 
bet I get my sbare of the spoils. How could a 
U. of M. man do otherwise?" 



Dr. 1 lenry R. Carter, class of 1879, senior sur- 
geon of the United States Public Health Service, 
has been placed in charge of the United States 
Marine Hospital in Baltimore. Dr. Carter is a 
native of Virginia, and attended the University 
of Virginia three years, and then entered the Uni- 
versity of Maryland, graduating in 1879. He 
entered the United States Marine Hospital Serv- 
ice the same year. He was the first officer of the 
service to receive a commission to go to Panama 
after the United States took control of the hos- 
pital. He took a foremost part in the work of 
making the canal region a fit habitation for Amer- 
ican men. His work in the yellow fever epi- 
demics of 1893, 1897, 1898 and 1899 is known 
everywhere, and the first instance in the far South 
where an epidemic of yellow fever was suppressed 
was when he was working in Southern Missis- 
sippi in 1898. For four and a half years he was 
director of hospitals in the Canal Zone, and re- 
cently located at the Government Hospital in 
Louisville. Ky., from where he came to Baltimore 
to take the place left vacant by Dr. W. P. Mcin- 
tosh, who has been transferred to Louisville, Ky. 
Dr. Carter has been stationed in Baltimore twice 
before. The University is glad to welcome him 
to Baltimore, and considers that his work will 
always be linked with Finlay's in connection with 
pioneer work in yellow fever. 



UNDERGRADUATE NOTES 



Under the Supcri'ision of E. Kilbourn Tullidge. 



At a meeting of the senior class, the remaining 
offices were filled as follows : Honor committee, 
T. Ruffin Pratt, chairman; Manly Coke Smith, 
Yertie Edward Edwards, Frederick R. Devine, 
William Tillman Martin ; sergeant-at-arms, Ed- 
gar E. Travers ; poet. Frederick Leonard Mc- 
Daniel ; associate editor of Old Maryland, 
Charles Reid Edwards. 



Mr. John Thomas Beavers of the senior class, 
who was operated on in the Uniyersity Hospital 



2l8 



THE HOSPITAL BULLETIN 



earl)' in January for chronic appendicitis, is now 
convalescing: and will soon be out again. 



Mr. Franklin Dashiell Murphy of the senior 
class was operated on for imperfect nasal septu 
late in December. Although the operation proved 
successful, he has been suffering intensely from 
shock. 



Among the new men entering the hospital as 
clinical assistants is Gerard Lebret, who, it will 
be remmbered, was confined to bed in the hos- 
pital during the greater part of his last year's 
session. 



Everyone is anxiously awaiting the publication 
of the 1913 Terra Mariae, which is under the 
direction of Editor-in-chief Earle Griffith Breed- 
ing of the senior class. Mr. Breeding informs 
us that the book will be, both in size and contents, 
larger and better than in former years, and con- 
sequently a higher price will have to be asked. 
It will be ready for publication about the first 
of May. Copies will be reserved for those mak- 
ing a deposit of $1 with Mr. Breeding. 



At a meeting of the clinical assistants, the 
executive committee appointed the following 
men to arrange for the annual house dance to be 
held on Friday evening, January 17, 1913, at 
Albaugh's Parlors : Messrs. Earle Griffith Breed- 
ing, Harry C. Raysor, Robert Raymond Sellers, 
H. W. Butler and Norbert Charles Nitsch. In- 
vitations have been extended to the internes and 
members of the senior faculty. 



Mr. George Ward Disbrow, class of 1913, was 
operated on in the hospital on January 8 and is 
now convalescent. 



Manager H. H. Warner of the basketball 
team states that though the squad has been un- 
der the direction of Professor Pennington of the 
Central Y. M. C. A., it has exhibited poor show- 
ing, which Mr. Warner states is due to the lack 
of support and co-operation on the part of the 
faculty of the various departments of the Uni- 
versity. The members of the team complain that 
they are unable to obtain leave of absence on 
days of practice, and are thus handicapped. 
"Practice makes perfect" is an old maxim, and 



if we expect to turn out a team worthy to repre- 
sent the University we must give them an oppor- 
tunity to practice. The games played and the 
scores are as follows : 

Seton Hall College — At South Orange, N. J., 
42-21. 

Columbia University — At New York, 41-16. 

City College of New York — 20-18. 

Georgetown University — At Washington, D. 
C, 20-18. 

Loyola College — At home, 21-16. 

In the Georgetown game, Peters (law, 1915) 
and Peppers (law, 1915) showed excellent speed 
and clever passing. It will be noted, however, 
that the University lost in each game, although 
they were much improved in the later games. 

The remaining games will be played with 
Swarthmore at Swarthmore on January 10; Mt. 
St. Joseph's, at Baltimore Y. M. C. A., January 
15; Catholic University, at home, and George- 
town University, at home. 

The line-up is as follows : 

Forivards — Peters (law, 1915), Gavis (law, 
1915), Timanus (medical, 1914). 

Center — Hughes (dental, 1915). 

Defense — Thomas (medical, 1916), Peppers 
(law, 1915). 

Substitutes — Gardner (pharmacy, 1913), Zim- 
merman (law, 1915). 



MARRIAGES 

Mr. and Mrs. Albert G. Tews announce the 
marriage of their daughter, Miss Gertrude Hed- 
wig Tews, University Hospital Training School 
for Nurses, class of 1909, to Mr. Lewis S. Cole 
of Jessups, Md. The couple will be at home after 
February 1 at Jessups. Mrs. Cole is a native of 
Germany. 



Dr. Frank Sidle Lynn, class of 1907, and Miss 
Clyde Clayton Dawson, University Hospital 
Training School for Nurses, class of 1908, were 
married in Norfolk, Va., on Saturday, December 
14, 1 912. The ceremony was performed at the 
Hotel Monticello by Rev. William Cox, a cousin 
of the bride. Mrs. Lynn is a native of Griston, 
N. C. 



Dr. William A. Ellingwood, class of 1908, of 
Winterport, Maine, was married on November 



TI1IC HOSPITAL BULLETIN 



219 



28, 191 2, to Miss Ruth Anne Kellam of Onan- 
cock, Ya. The ceremony was performed by Rev. 
L. M . Betty at the home of the bride's sister, Mrs. 
I. C. W. Leatherbury, and immediately after- 
wards the couple left for their home in Winter- 
pi irt. Mrs. EMingwood is a graduate of the 
Woman's College, Lynchburg. Ya. Dr. Elling- 
wood was for a time after his graduation resident 
physician of the Presbyterian Eye, Ear and 
Throat Hospital of Baltimore. 



Miss Mary Dorsey Mitchell, daughter of Dr. 
Alexander Mitchell, class of 1877, of Glencoe, 
Md., was married on Saturday, January 11, to 
Mr. Warren Keach Magruder of Baltimore. 
Mrs. Alagruder was operated on at the Balti- 
more Eye, Ear and Throat Hospital on Friday 
night, and left the Hospital to be- married in 
Emmanuel Church, returning there immediately 
after the ceremony, although she will be out in 
a few days. 



Dr. Moses J. Fine, class of 1910, surgeon of 
the steamer Voltunro of the Uranium Line, was 
married to Miss Lillian Eilman of 183 Bergen 
street, Brooklyn, in Knights of Pythias Hall, 432 
Hopkinson avenue, Brooklyn, on December 31, 
1912. Dr. Fine's fiancee had decided that if the 
marriage could not take place in 1912 she would 
wait until 1914, for she would not "tempt fate" 
by a wedding in 1913. Dr. Fine's ship came to 
Brooklyn from Rotterdam, and the trip was ex- 
ceedingly rough, and time after time the gales 
retarded the steamer's progress. When the boat 
docked at Halifax, several Halifax physicians 
offered to take his place so he could proceed to 
New York by rail, but he stuck to his post, and 
although the ship was two days late, won the 
race with time, and was married two hours after 
the boat reached port. 



DEATHS 



After his graduation he went back to Queen A; mes 
county to practice, remaining there till 1888. 
Then he came to Baltimore and established the 
Winchester Manufacturing Co., manufacturing 
largely his own preparations. This company was 
recently absorbed by Sharp & Dohme. He mar- 
ried Miss Alice Bryan, daughter of William R. 
Bryan, of Queen Anne's. He is survived by his 
widow and two sons, Clifford B. and William 
Valentine Winchester, all of Baltimore, and a 
brother, Julian. R. Winchester, and a sister, Mrs. 
Julia W. White, both of Queen Anne's. 



Dr. Benjamin T. Winchester, class of 1875, 
died at his home in Windsor Hills, January 14, 
1913, after an illness of 10 weeks, aged 62 years. 
He was born in 185 1 in Queen Anne's county, the 
son of I. W. and Josephine R. Winchester. Dr. 
Winchester was educated in the Yan Metter-Mon- 
roe private school in Carroll county, later entering 
the medical school of the University of Maryland. 



Dr. Alfred B. Giles, class of 1880, of Forest 
and Callaway avenues, was stricken with an at- 
tack of the heart while taking a bath, and died 
shortly afterwards. He called to his wife to bring 
some aromatic spirits of ammonia. She hurried 
to the bathroom and found him unconscious. Dr. 
Arthur L. Fehsenfeld, class of 1909, was hur- 
riedly called, but by the time he reached the house 
Dr. Giles was dead. Dr. Giles was 50 years of 
age, the son of the late Judge William P. Giles, 
and was well known in the Walbrook and Forest 
Park section of the city. He is survived by his 
wife, Airs. Georgia Giles, and one son, John 
Steward Giles. 



It is with the deepest regret that we announce 
the death of Dr. Oliver Parker Penning, class of 
1897, of 171 1 St. Paul street, on December 28, 
191 2. Dr. Penning has been ill for several years, 
and his death was not unexpected. 

Dr. Penning was born in Darlington, Harford 
county, Maryland, January 26, 1869, the son of 
S. E. and Alice Markland Penning. He was 
graduated from the Havre de Grace High School 
in 1886, and later entered the University of 
Maryland, graduating in 1897. He was for a 
time clinical assistant in the University labora- 
tory. From 1898 to 1899 he was resident phy- 
sician of the University Hospital, and from 1902 
to 1904 assistant demonstrator of anatomy and 
assistant in surgery. He was a member of the 
Medical and Chirurgical Faculty of Maryland, 
the University Hospital Medical Society and the 
Baltimore City Medical Society. He was presi- 
dent of the Splint Club, and of the Landmark 
Lodge of Masons, St. John's Chapter, Crusade 
Commandery. 

Death was due to splenomyelogenous leukemia. 
With him at the time of his death were his 



220 



THE HOSPITAL BULLETIN 



mother, Mrs. Alice Markland Penning; his sis- 
ters, Mrs. John Coulbourne and Mrs. Joseph E. 
Goodwin, and his brother-in-law, Mr. Coul- 
bourne. The funeral took place from his home 
on Tuesday, December 31. Services were con- 
ducted by Rev. Walter Haupt of Havre de Grace, 
and interment was in Greenmount Cemetery. The 
honorary pallbearers were Drs. George H. 
Cairnes, class of 1864: William I. Messick, class 
of 1895; William J. Coleman, class of 1908; Jo- 
seph W. Holland, class of 1896; Frank Martin, 
class of 1886, and St. Clair Spruill, class of 1890, 
all of Baltimore. 

The active pallbearers were Drs. Henry B. 
Thomas, class of 1888 ; Howard E. Ashbury, class 
of 1903, and J. Royston Green, class of 1899, and 
Messrs. J. C. Taliaferro, Hugh L. Pope and Lynn 
R. Meekins. 

Dr. Penning was of an extremely lovable dis- 
position, and will be greatly missed in the Uni- 
versity set. He was a loyal alumnus, and was 
always interested in every move made for the 
good of the University. By his death the Univer- 
sity has lost a firm supporter. We extend our 
deepest sympathy to Dr. Penning's family. 



We also regret to announce the death of Dr. 
Richard C. Massenburg, an alumnus of the class 
of 1884, a Confederate veteran, a physician of the 
old school, and, above all, a man of the very high- 
est type. Dr. Massenburg was a credit to his 
school and to his profession, and was loved by all 
who knew him. 

He was born in 1845 in Hampton, Va., the son 
of a druggist there. Later his parents removed to 
Macon. Ga., where his father for many years con- 
ducted a drug business under the name of Mas- 
senburg & Son, an older brother of Dr. Massen- 
burg being the partner. At the age of 17 he en- 
tered the Confederate Army, and at the close of 
the war returned to Macon, later returning to his 
original home in Hampton. After spending sev- 
eral years there he came to Baltimore and entered 
the Maryland University, graduating in 1884. 
Dr. Massenburg located at once in Towson, where 
he has been ever since. He conducted a drug 
store in connection with his practice. Of late 
years his son, George Yellow Massenburg, was 
associated with him, but gave up pharmacy to 
study medicine, graduating in 1911. Dr. George 
Massenburg was for a time resident physician at 



the Church Home and Infirmary, and recently has 
been a resident physician in the Government Hos- 
pital at Ancon, Panama. He was on his way 
home at the time of his father's death, but did not 
reach here until after the funeral. 

Dr. Richard Massenburg was one of the prin- 
cipal organizers of the Baltimore County Medical 
Association, and was for years secretary of this 
association. 

He was a member of the old Towson Guards, 
and later of the First Regiment. Maryland Na- 
tional Guard, retiring with the title of major. He 
was devoted to the interests of the South, and the 
Confederate flag was always in evidence in his 
home on festal occasions, and he loved the air of 
Dixie. 

At the time of his death Dr. Massenburg was 
health officer for his district. He married Miss 
Carrie Lee, daughter of the late Wesley Lee of 
Towson. He is survived by his wife and his son, 
Dr. George Massenburg, and one daughter, Mrs. 
H. Courtenay Jenifer of Towson. 

He was buried on New Year's Day from his 
home. Services were conducted by Rev. Dr. W. 
H. H. Powers of Towson. The pallbearers were 
all members of the Baltimore County Medical As- 
sociation, and were Drs. William L. Smith, Harry 
M. Slade, class of 1884; James F. H. Gorsuch, 
class of 1876; Harry S. Jarrett, Josiah S. Bowen, 
class of 1903, and Richard F. Gundry. He was 
buried in Prospect Hill Cemetery. Towson. 



Dr. Thomas Clinton Baldwin, class of 1804. 
died at his home in White Hall, Baltimore county, 
Maryland, January 3, 1913, of Bright's disease. 
Dr. Baldwin was 44 years of age. He was born 
at Baldwin, Md., and attended lectures at the Bal- 
timore Medical College, later entering the L di- 
versity, graduating in 1894. After his gradua- 
tion he located at Stewartstown, Pa., where he 
built up a large practice. Later he removed to 
White Hall, and was for some years health officer 
for the Seventh district. During his life he also 
practiced for some years at York, Pa., where he 
was Health Commissioner. He married Miss 
Ella McDonald, who survives him. Three sons — 
Bruce, Donald and Maurice Baldwin — also sur- 
vive. 

lie was buried on January 6. 1913, from Center 
Presbyterian Church, White Hall, and burial was 
in the cemetery adjoining the church. 



THE HOSPITAL BULLETIN 

Published Monthly in the Interest o£ the Medical Department of the University of Maryland 
PRICE $ l.OO PER YEAR 



Contributions invited from the Alumni of the University, 
Business Address, 608 Professional Building, Baltimore, Md. 



Entered at the Baltimore Post-office 
as Second Class Matter 



Vol. VIII 



BALTIMORE, MD., FEBRUARY IS, 1913 



No. 12 



S< 'Ml'. RECENT TUBE CASES. 



By Richard II. Johnston, M.M., 
Associate Professor of Laryngology in the Uni- 
versity of Maryland, Baltimore, Md. 



In September, i')i-. I was asked by a physician 
u< see his little daughter who. a week previously, 
had swallowed a penny. The father, thinking 
that the foreign body would pass through, paid 
no special attention to the incident until the 
mother noticed that the little patient was having 
difficulty in swallowing and that she would awake 
several times at night fretting with pain in her 
throat. The father then had X-ray pictures made, 
which showed a shadow at about the seventh 
cervical vertebra, or at the upper end of the 
esophagus. The patient was taken to the L'ni- 
versity Hospital, where she was immediately pre- 
pared for operation. The preparation in these 
crses is very simple. The patient is taken to the 
operating-room in her street clothes and wrapped 
in a sheet which is securely pinned so as to re- 
duce movements of the arms and legs to a mini- 
mum. She is then placed on the table with the 
head straight and not over the end of the table. 
An assistant holds the head while the arms and 
legs are attended to by a nurse. Xo anesthetic 
is used : this point cannot be too stronglv em- 
phasized since cocaine is dangerous and ether is 
unnecessary, except possibly in those cases in 
which the foreign body has sharp edges or hap- 
pens to be a pin. The patient was placed on the 
table as above described; with the head held 
straight, Jackson's modified child's laryngoscope 
was passed; this tube measures \- cm. in length 
anil 10 mm. in the inside diameter. When the 
larynx was reached the spatula end of the tube 
was honked around the cricoid cartilage, which 
was easily raised and the upper end of the 



esophagus exposed. The penny was immediately 
seen lying slightly posterior to the middle line 
with edges transverse. Forceps were introduced 
through the tube, the penny seized and promptly 
removed. The operation did not take two min- 
utes. The little patient was not hurt, the mem- 
brane was not injured, and ten minutes after the 
operation we took her home in her father's auto- 
mobile. She made an uneventful recovery. I 
have described this case in detail to emphasize 
the value of the straight position of the head ami 
the advantage of using a short instrument in 
upper esophagoscopy. This combination makes 
esophagoscopy easy and practically free from dan- 
ger. For four years 1 have used the straight 
position of the head in direct laryngoscopy, and 
for some time in upper esophagoscopy in chil- 
dren, hut only recently have laryngologists 
adopted it to an\- extent. It simplifies the work, 
and I find that as my experience increases I am 
able to work oftener without anesthesia, local or 
general. 

Case II. — In September, 1912, Mr. S., 39 years 
old, was referred to me by Dr. J. F. Hempel. 
The patient had always led an active life and had 
been a powerful man. Mis normal weight was 
[86 pounds. Three months before I saw him he 
noticed that certain foods did not seem to pass 
down as well as formerly. The difficulty in swal- 
lowing increased rapidly, and when 1 saw him at 
the Presbyterian Hospital it was painful to see 
the muscular contractions of the face and neck 
when he attempted to swallow milk. His weight 
was 143 pounds. Mis throat was so sensitive 
that, even after the injection of morphine and 
atropine, my attempt to examine him under local 
anesthesia failed. The next day in the presence of 
Dr. Murphy of Cincinnati and Dr. Arrowsmith 
of Brooklyn, we examined him under ether anes- 
thesia and found a hard, firm stricture about an 
inch below the cricoid cartilage. The smallest 



222 



THE HOSPITAL BULLETIN 



Hunt's bougie was passed through the esophago- 
scope and coaxed through the stricture. We then 
found a second and a third stricture, both of 
which were successfully dilated. The next day 
the patient swallowed milk. Because of the three 
strictures, it has been difficult to pass a French 
bougie, but with a Bunt's bougie the esophagus 
has been kept open, so that the patient now eats 
everything 1 . lie has gained 13 pounds and feels 
well and strong. We expect to use French bou- 
gies shortly. This case is reported because benign 
stricture at the upper end of the esophagus in 
adults is rare, and because of the successful treat- 
ment of the three strictures by a simple method. 
One of the interesting features of the case was 
that no cause could be found for the obstruction. 
It may be well to emphasize the dangers of cut- 
ting and forcibly divulsing benign strictures of 
the esophagus. In an experience of five years I 
have had no bad symptoms from the use of Bunt's 
bougies except pain or soreness for a few days 
after the first treatment. In children I use the 
two smallest, and in adults the three smallest 
bougies at the first treatment. No attempt is 
made to force the stricture for fear of setting up 
fatal mediastinitis. If after the first treatment, a 
small French bougie will not pass easily, re- 
course is had to Bunt's bougies again. These are 
passed every five days until all swelling has sub- 
sided and no blood appears. Then the French 
bougie is tried again and usually passes without 
trouble. The patient is then taught to pass the 
bougie, which he uses at home regularly for a 
time and later every six months. I have always 
believed that cutting benign strictures or trying 
to force dilatation by powerful divulsors through 
the esophagoscope is dangerous, because we have 
no means of knowing just what we are doing. 
With graduated olive points beginning with 
1 mm. we can always tell what the dilatation 
will be. ( )ne can swallow through a small open- 
ing, and it is not necessary to try to produce a 
lumen equal to the normal esophagus. I have 
kept in touch with all my stricture cases, and, ex- 
cept for the slight trouble of passing the bougie 
every few months, they are all well. 

Case 111. — In July, i<)i2. a boy, seven years 
old, was brought to me from Crisfield. Mel., with 
the history of having inspired a grain of corn 
four days previously. His breathing was labored, 
temperature was 102 degrees and pulse 120. The 
patient had a hoarse, croupy cough; the respira- 



tory murmur over the right lung was almost 
abolished. The boy was taken to the Presby- 
terian Hospital, ether was administered and the 
bronchoscope passed with the head straight on the 
table. My experience with the straight position 
of the head convinces me that the bronchoscope 
is more easily passed than with the head over the 
end of the table, as is advocated by most opera- 
tors. After the patient is anesthetized, the separa- 
ble speculum is passed and the larynx brought into 
view. The bronchoscope is then passed through 
the laryngoscope, and with a gentle, twisting mo- 
tion slips between the vocal cords. The laryngo- 
scope is removed while an assistant steadies the 
bronchoscope ; the head, which together with the 
body is raised on cushions, is allowed to drop to 
the plane of the table ; the operator takes his seat 
at the end of the table and pushes the tube fur- 
ther down, controlling the movements of the head 
with the free hand. In this method it is remark- 
able how little extension of the head is necessary 
for successful work. No assistant is required to 
hold the head over the end of the table, and the 
operator has a comfortable seat which enables him 
to work more quickly. In very young children 
the cushions are used, but the head is dropped 
before the bronchoscope is passed. The grain of 
corn was located wedged in the depths of the 
right bronchus; it was seized with forceps and 
removed. The patient recovered promptly. The 
grain of corn was swollen twice its natural size. 

Case IV. — A little boy, two years old, inspired 
a watermelon seed two weeks before I saw him. 
He had a croupy cough and his temperature was 
eleyated. He was placed on the table and the 
larynx examined with the head straight. Noth- 
ing abnormal being found, a 5 mm. tracheoscope 
was passed, and as soon as it was pushed between 
the vocal cords the foreign body was seen. He- 
cause it was so slippery, it was grasped with diffi- 
culty, but was finally removed. After the opera- 
tion edema of the glottis developed and a tra- 
cheotomy had to be done. He wore the tube four 
days, and after its removal made an uneventful 
recovery. 1 wish to emphasize the ease with 
which the larynx can be examined in children 
with the head straight on the table. The position 
is the same as for upper esophagoscopy described 
above. The instrument is the same and is intro- 
duced as easily in infants as in older children. 
Anesthetics are never used. For the removal of 
foreign bodies or papillomata in the larynges of 



THE HOSPITAL BULLETIN 



223 



children, the method is far superior to extension 
with the bead held over the end of the table. The 
greatest advantage of the method is that no 

trained assistant is required, since the head can he 
held properly by anyone. The great disadvantage 

of the "Boyce position" is the fact that one must 
have special training to hold the head just right. 
Case V. — This case illustrates the ease with 
which tumors may be removed from any part of 
the larynx in adults with the right instrument and 
the proper position of the head. For a long time 
I have been doing direct laryngoscopy in the sit- 
ting position with the head straight, which gives 
the advantage of complete relaxation of the neck 
muscles. This position, with the use of the instru- 
ment described above or the small, separable 
speculum, makes it possible to examine and oper- 
ate in all larynges with ease. Most direct 
laryngoscopes are too large, and to make the 
work more difficult are introduced between the 
incisor teeth. I nder these conditions, unless the 
patient has a long neck and small teeth, it is prac- 
tically impossible to see the entire larynx without 
pulling so forcibly on the speculum as to cause 
pain. If, perchance, the operator sees the growth. 
he is in such a cramped position successful re- 
moval is very difficult. These difficulties are 
removed and the examination made almost as 
easily as with the mirror by using the small specu- 
lum and passing it between the right or left bi- 
cuspid teeth with the head straight, or nearlv so. 
and turned slightly to right or left. The tube is 
carried quickly down, the end hooked around the 
epiglottis and the entire larynx exposed. Prac- 
tically no force is exerted on the instrument and 
often its weight exposes the larynx. The instru- 
ments that I use are made with separable handles, 
so that the vertical part of the handle can be re- 
moved when one wishes to examine a patient in 
the prone position. The patient was a man, 30 
years old, who, four years ago. had a papilloma 
removed from the left vocal cord by the indirect 
or mirror method. For three years his voice was 
clear. About a year ago huskiness made its 
appearance, and this was soon followed by hoarse- 
ness. Because of a large uvula and an over- 
hanging epiglottis, a satisfactory mirror examina- 
tion was impossible. A growth, apparently on 
the left vocal cord, was seen, and to this I at- 
tributed the hoarseness. Following my usual cus- 
tom, I anesthetized the larynx with 20 per cent. 
alvpin solution for examination and operation 



through the direct laryngoscope. The result of 
the examination shows how superior the tube is 
to the mirror in patients with a low-hanging 
epiglottis. The patient was seated on a low stool 
with head straight ami turned slightly to the 
right. The small 10 mm. tube was introduced 
between the left bicuspid teeth and passed down 
to the epiglottis, which was hooked forward, ex- 
posing the larynx. The tumor, which was indis- 
tinctly seen with the mirror, proved to be under 
the cord and not on it. On the right false cord a 
large tumor mass, extending down over the true 
cord and preventing proper approximation of the 
cords, was seen. This growth was causing the 
hoarseness. With Pfau's universal handle and 
different cutting tips, the masses were quickly re- 
moved. Some of the growth was attached to the 
right cord and a small tumor was located in the 
anterior commissure. After removal alcohol was 
applied. These applications will be continued 
some time to destroy any small particles which 
may be left. 

The apparent difficulties connected with direct 
laryngoscopy, bronchoscopy and esophagoscopy 
have prevented many laryngologists entering 
these fields. Instead of trying to simplify the 
work, it seems to me that new instruments are 
being introduced, which tend to greater difficul- 
ties for the beginner. With a few instruments 
one can do successful work. For the larynx no 
tube is as satisfactorv as the small, modified Jack- 
son model with the light at the end. For bron- 
choscopy many laryngologists prefer the Bruen- 
ing's hand light, because the light carrier in the 
Jackson tube is liable to become clouded with 
blood or mucus. This objection is overcome by 
having a second carrier loaded to introduce if 
occasion demands. I can handle the Jackson tube 
with greater ease and prefer it for that reason. 
For upper esophagoscopy in children no instru- 
ment is better than the modified Jackson tube, 
because of its ease of introduction with the head 
straight. The only objection to it is that one can- 
not see far ahead of the tube because the light is 
not strong enough. I have tried all manner of 
tubes, and have come back to Jackson's models 
because I think they are the simplest and easiest 
to handle. When one learns direct laryngoscopy 
by simple methods, bronchoscopy and esoph- 
agoscopv are easy. As the work is simplified it 
becomes more and more fascinating. It will never 
reach its highest grade of development for the 



224 



THE HOSPITAL BULLETIN 



greatest number, however, until simplicity of 

methods and instruments is insisted upon. 

I have notes of three more cases which are of 

some interest. 

A male, 54 years old, was referred to me with 
the history of trouble in deglutition of five years' 
duration. His trouble was peculiar, in that food 
which had been swallowed 24 hours before would 
come up entirely undigested and almost in its 
original state. Sometimes for days he would 
swallow perfectly. The continued lack of nour- 
ishment pulled him down from a strong healthy 
man to a mere shadow. At times pain was severe. 
Before the examination he was given morphine 
and hyoscine hypodermically. The esophagoscope 
was easily passed and nothing found until the 
cardia was reached. Here two distinct openings 
were seen, one of which to the left led into a 
pocket two or three inches in depth, which was 
filled with milk and undigested food. After 
pumping the pocket out the mucous membrane 
could he seen. To the right the puckered appear- 
ance of the cardia was distinct. To enter the 
diverticulum the upper end of the esophagus had 
to be carried to the right. When the pocket was 
emptied the walls immediately collapsed, so that 
the opening was difficult to find. The esoph- 
agoscope was easily pushed into the stomach. 

Some weeks ago a man came to the University 
Hospital with the history of having swallowed 
almost nothing for three weeks. lie had had 
trouble for a long time; there were times when he 
could swallow without difficulty. Hut for three 
weeks he had vomited constantly. At the request 
of Dr. Zueblin I examined his esophagus under 
deep ether anesthesia. Local anesthesia was 
deemed inadvisable, because from the man's high- 
ly nervous state we thought .of a cardiospasm. 
Repeated attempts to pass a stomach tube had 
failed. The esophagoscope showed that the upper 
part of the esophagus was normal. When the 
cardia was reached the examination of its walls 
showed no pathological lesion, and the ease with 
which the tube was pushed into the stomach made 
the diagnosis of cardiospasm. The pink mucous 
membrane of the stomach contrasted strongly 
with the pallor of the esophagus. 

In July, ii)i2, I was consulted by Miss R., 30 
years old, for a stubborn cough of six months' 
duration which had followed "grip." She bad 
taken all the usual cough remedies with only 
temporary benefit. A bronchoscopic examination 



showed inflammation of the trachea, which so 
often is a sequel of "grip" and which can usually 
be cured by the application of silver nitrate 2 to 
10 per cent, solution. Six applications relieved 
the cough entirely. 

Before closing I wish to refer briefly to a case 
of papillomata of the larynx in a child. Before 
the introduction of the direct larvngoscope, such 
cases were always a bugbear to the laryngologist. 
So difficult of treatment were they that splitting 
the larynx was advocated by some of the more 
radical throat surgeons, and the operation was 
done with impairment, if not ruin, of the voice, 
because in small larynges it is difficult to ap- 
proximate the two halves properly or so much 
tissue is destroyed by this radical procedure. The 
treatment now is along logical lines, thanks to the 
direct laryngoscope. I have no hesitancy in say- 
ing that it is never necessary to open the larynx 
for the removal of these growths, and that it is 
rare that a tracheotomy has to be done. It is, 
however, better to perform the latter operation if 
the child is in danger of suffocation, because the 
larynx can be cleaned out in two or three sittings 
through the direct laryngoscope and the tracheal 
tube removed permanently. The patient was a 
cln'lil, [9 months old, referred to me by Dr. A. M. 
Shipley for aphonia of several months' duration 
and attacks of cyanosis, especiallv on crying. At 
the University Hospital the boy was pinned in a 
sheet and examined with the direct laryngoscope, 
the head being held straight on the table. The 
diagnosis of multiple papillomata was made and 
most of the growth at once removed through the 
tube with I 'fan's forceps. Two such operations 
resulted in the complete removal of the tumors. 
Applications of alcohol were made to the larynx 
once weekly, with the result that the growths 
disappeared completely, and up to this time — one 
year after the first operation — have not returned. 
This result is exceptional, for most cases have to 
be treated several years. I mention this case sim- 
plv to condemn laryngotomy in the treatment of 
tumors of the larynx, except, of course, in 
malignancy. 

Appendix. — Recent experience has convinced 
me that the high frequency spark is the best 
treatment for papillomata of the larynx in adults 
and in children. In a patient, 07 years old, with 
a large papilloma of the right laryngeal surface 
of the epiglottis, two applications of the spark a 
week apart caused the total disappearance of the 



THE HOSPITAL BULLETIN 



growth, so that in a month it was impossible to 
tell whence it bad sprung. The microscope did 
not show malignancy, Init such growths in old 
people are practically the precursor of cancer 
from degeneration if they arc not promptly and 
radicalh removed. The spark is applied through 
the direct laryngoscope after anesthetizing the 
membrane with alypin (20 per cent, solution). 
In my work I use the spark about a quarter of 
an inch long, because with this length it is under 
absolute control. In multiple papillomata in chil- 
dren it is just as easily applied through the direct 
laryngoscope without anesthesia by holding the 
bead straight on the table. The tumors are 
burned with the spark, turn pale and disappear. 
The normal tissue is not injured unless the spark 
contact is prolonged. 

807 North Charles street. 



PREP \RATK IN ( >F PATIENT FOR OPER- 
ATK )N. 



By George Loutrell Timanui 

Junior Medical Student. 



When patient enters hospital for operation, a 
thorough examination is held, and any abnormal 
conditions are treated by regular routine methods. 

Patient is disrobed and placed in a clean bed 
with hygienic surroundings. 

Methods used in different hospitals will be read 
at end of this sketch, and contain most informa- 
tion that could be obtained on the subject. 

The most important issue is the preparation of 
the site of operation. This is a most difficult 
process to render skin absolutely sterile, due to 
the existence of hair follicles and ducts of seba- 
ceous and sudoriferous glands which present 
crevices for the lodgment of myriads of micro- 
organisms. 

The process of sweating is one of the most effi- 
cient means of rendering the skin sterile. The 
longer this is continued the more perfect is the 
sterilization. 

Infection is the outcome of fertilization, and it 
is the surgeon's endeavor to limit the infective 
substance, thus accomplishing septic results. 

Infection is rare where large amounts of fluids 
are used, provided the same are sterile, due to the 



dilution of the toxines. It is therefore better, if 
this is true, to apply plenty of sterile water than 
so many chemicals. 

The hair on the site of operation should be re- 
moved. This is accomplished by shaving the 
parts after the application of soap and water. 
This will also remove scales of the skin and oil 
that may be present on the surface. Care should 
be taken in shaving not to cause any scratches, 
thus offering sites for infection. 

Dr. W. E. Dreyfuss has given an efficacious 
method for the removal of hair. The mixture is 
as follows: Barii sulphid, 2*, parts; saponis pul- 
\is. 5 parts : talci veneti pulv.. 35 parts; benzalde- 
hydi. q.s. Take 1 oz. of powdet, add 3 oz. of 
water; apply paste thickly with shaving brush; 
allow to remain five minutes, then with a sponge 
and sterile water moisten, and at the end of an- 
other five minutes wash off mass; hair will come 
away with water applied. 

After hair has been successfully removed, wash 
parts thoroughly with tinctura of green soap and 
sterile water. Gauze or a rubber sponge should 
be used in the washing. Do not use a brush. 
Parts should be handled gently. Ether should 
next be applied, but should not be allowed to re- 
main, for it boils at temperature of the body, and 
may burn the part. This will dissolve all remain- 
ing fats and oils present. Wash ether away with 
alcohol, and then cover parts with sterile gauze, 
over which is placed a pad of cotton and bandages 
sufficient to hold in place. 

Monyhan cleanses skin with soap and water, 
then applies a compress and allows same to re- 
main 24 hours. This compress is composed of 
2-3 layers of lint soaked in a I per cent, formalin 
solution, a 1-60 part carbolic acid solution or a 
r-2000 bichloride of mercury. The two latter 
solutions are apt to cause irritation. A second 
washing is given after 24 hours. 

If there are any cracks or fissures in the skin, 
these should be rendered sterile with carbolic ap- 
plied with a cotton swab, and the acid neutralized 
after a few minutes' application with alcohol. 
The actual cautery may lie applied for this pur- 
pose. 

The room in which patient is confined should 
be regular in temperature, and not too hot. 

The body should be covered with a sterile sheet. 
Hair should be wrapped in a sterile towel. A 
shirt opening in the back is best, so it can be easily 



226 



THE HOSPITAL BULLETIN 



removed. Long linen stockings should be placed 
on the patient. 

CHOICE OF ANESTHETICS. 

There are certain symptoms present in differ- 
ent individuals who are presented for operation 
which contraindicate the use of certain drugs or 
anesthetics. In diseases of the kidney ether is 
likely to cause suppression of the urine and thus 
cause coma and death. In diseases of the respira- 
tory tract, as asthma, emphysema, bronchitis, the 
vapors of ether are very irritating and likely to 
aggravate the condition. In operations on the 
face and mouth, where it is impossible to keep 
patient anesthetized, in certain sensitive mucous 
membranes of the respiratory tract irritation to 
same may cause rapid rate of respiration and 
cough in anesthesia. All of these conditions are 
contraindications to ether, and are best treated 
by chloroform. 

In any disease of heart, chloroform is always 
contraindicated, and ether should be given. 

Some people cannot take ether or chloroform. 
These should be given nitrous oxide, which will 
render patient unconscious within 30 seconds to 
2 minutes. There are no after-effects. Ether is 
often preceded by nitrous oxide. 

A. C. E. mixture, or 3 parts of ether, 2 of alco- 
hol and 1 of chloroform, is sometimes given. 

In the giving of anesthetics the simplest meth- 
ods possible are those most employed. The cloth- 
ing should be loose about neck and body should 
not be in cramped position. Patient lying on back 
with arms folded across chest. Tongue should 
be kept forward. 

LOCAL ANESTHESIA. 

These are many in number. The application 
of cold to a part, spraying of ether to part or 
combination of ether, chloroform and menthol. 
The application of ethyl chloride, otherwise 
known as kelene, to the part to be anesthetized is 
a satisfactory method. Part becomes reddened, 
then white. These methods are, however, only 
fit for skin operations. 

Hvdrochlorate of cocaine, discovered by Keller 
of New York, either applied locally by drop- 
ping, as in operations on the eye. or by the 
subcutaenous injection a per cent, of Y2-2 is the 
agent most frequently employed for this purpose. 
An Esmarch bandage applied above the point of 



injection will prevent cocaine intoxication, and 
will at the same time increase anesthetizing 
power. Before injecting the cocaine the parts 
to be injected should be rendered sterile, also the 
instrument used. The needle should be pushed in 
deeply and fluid expelled on withdrawal of 
needle, most being deposited directly beneath the 
skin. 

Corning in 1885 described a method of inject- 
ing 8-15 111. of a 2 per cent, sterile solution of 
cocaine in the sub-arachnoid space. Anesthesia 
usually extends as high as the umbilicus and may 
go as high as the nipples. This will allow opera- 
tion on the lower extremities, as well as on the 
organs of the pelvis, uterus, bladder, ovaries, etc. 

University Hospital. — Routine in preparing- 
patient for operation : Patient on entering put to 
bed, mouth or rectal temperature taken, pulse and 
respiration. Leucocyte and red blood cell count 
taken ; hemaglobin and clotting test performed ; 
thorough urinary and physical examination of pa- 
tient, laying stress on heart, kidneys and lungs, 
is made. 

Night preceding operation give patient light 
supper; 8 P. M. 1 oz. of castor oil; '> A. M. next 
morning give enema. If restless during night. 
give opiates to quiet patient. Next morning give 
no breakfast, not even water. 

Before going to operating-room give J4 gr. 
morphine and 1/150 gr. of atropine. Place pa- 
tient on table, examine teeth to see if false and 
try to find any other foreign bodies in mouth. 
Lips, nose and eyelids greased with cold cream 
and eyes are hermetically sealed with a thin sheet 
of rubber, over which is placed a pad of wet cot- 
ton, and then anesthetic is started. 

As soon as patient is fairly well asleep the field 
of operation is shaven and then thoroughly 
cleaned by washing with soap and sterile water 
for 15 minutes. Then all remaining soap and 
fatty secretions are dissolved out by the applica- 
tion of ether, which is in turn washed off by 
alcohol. A pad saturated with 1-1000 of bi- 
chloride is then placed over field. Sterile towels 
are then placed around point of incision and pa- 
tient is covered with sterile sheets. 

Hopkins. — Routine treatment of patient for 
operation : Starting at noon the day before 
operation, no dinner is given; that is, no solid 



THE HOSPITAL BULLETIN 



227 



foods, but a light diet of liquids. One ounce of 
Epsom salts is given. At night an enema of 
water and glycerine, ,5 oz. of each. Xext morn- 
ing another enema and, if necessary, another be- 
fore operation. Patient is compelled to drink 
large quantity of water, it being quickly ab- 
sorbed and will often prevent necessity of cath- 
eterization. Patient may have ounce of sherry 
or cup of strong coffee if desired before going 
to operating-room. 

Before patient is removed to operating-room, a 
hypodermic of 54 §T- of morphine and 1/120 of 
atropine is given. The evening before operation 
patient is washed and field of operation shaven. 
Just before operation, field is washed with ben- 
zine and painted over twice with a 3J/2 per cent, 
solution of iodine. 

If patient has not been washed the day before, 
do so before operation with alcohol and soap; no 
water is used. 

Dr. Cullen of Hopkins suggests shaving to be 
done in operating-room to prevent worry of pa- 
tient. That in acute appendicitis cases never give 
cathartic or enema. Never give calomel the day 
before ; it is too irritating. 

City Hospital. — Routine treatment of patient 
for operation : The diet up to 24 hours of opera- 
tion should not include anything that is very 
indigestible, but patient should have fair amount 
of food. Evening before patient is given a full 
bath and field of operation scrubbed and shaven. 
A laxative should be given evening before op- 
eration. 

Morning of operation a soap and water enema 
is given. Before operation patient is given 1/60 
gr. of atropine ; no morphine. It is said same 
seems to make patient sick after anesthetic. If 
female, a vaginal douche of 1-4000 bichloride, fol- 
lowed by sterile water, is given. After anesthetic 
is started, field of operation is again scrubbed with 
soap and water. Gauze is better than a brush for 
this purpose. Soap is thoroughly washed off and 
ether is applied, which is in turn washed off by 
alcohol. A piece of gauze saturated with a one 
to two thousand bichloride solution is then ap- 
plied and allowed to remain until incision is 
made. 



IK )\\ LEG GEX1 V VRUM. 



By A. Schapiro, 

Junior Medical Student. 



We would appreciate it very much if some of 
our readers could give us the addresses of Dr. 
Howard Steele Holloway, class of 1903, and Dr. 
Lafayette Lake, class of 1906. 



Typical genu varum is the result of external 
bowing of the femur and of the leg bones. The 
maximum curve is generally near the knee. Bow- 
leg may be the result of lateral bending of the leg 
bones alone, the femur being unaltered. An an- 
terior curvature of the tibia gives another form 
of bow-leg. Operative correction is demanded in 
all severe cases. Before the age of four or five 
years mild deformities may be corrected by me- 
chanical appliances ; after that age operation af- 
fords the only prospect of cure. 

METHODS OF OPERATING. 

(1) Linear Osteotomy. — Note which bone or 
bones are most seriously affected. Usually in 
typical genu varum both the femur and tibia are 
badly curved. Note which part of the individual 
bone is most bent ; it is this point which must be 
divided. 

(a) If osteotomy of the middle third of the 
femur is indicated, make a vertical incision 
through the soft parts down to the bone on the 
outer or antero-external side and proceed as in 
supra-cordylar osteotomy, in this case, however, 
cutting the bone from without inwards. 

(b) If the tibia is most affected incise vertical- 
ly the soft parts down to the bone over the inner 
surface of the bone at the point of greatest curva- 
ture. Introduce the osteotome and then turn it 
transversely to the bone and divide the cortical 
bone of the inner and outer sides of the tibia, and 
especially that of the anterior margin. Be careful 
not to injure the anterior tibial vessels and nerves 
which lie close to the outer surface of the bone. 
Fracture the posterior layer of the cortical bone 
by manual force. Forcibly fracture or bend the 
fibula. If this is impossible, palpate the fibula 
and make a small incision down to it through the 
soft structures of the outer side of the leg. In- 
troduce a very narrow osteotome and divide the 
bone. 

(c) If femur and tibia are both markedly 
curved, operate on both at the same sitting. 

The object of the surgeon is to over-correct the 
deformity. If division of one bone is insufficient, 
then divide the other as well. If this is insuffi- 
cient, repeat the operation at whatever places it 
may be needed or demanded. MacEwen has per- 



228 



THE HOSPITAL BULLETIN 



formed ten osteotomies on the same patient at 
the same sitting and obtained a good result. 

2. Cuneiform osteotomy is particularly suit- 
able in cases of anterior curvature of the tibia. 
Render the limb bloodless. Apply an elastic con- 
strictor. 

I i i Make a longitudinal incision down to the 
bone over the most prominent part of the tibia. 
This cut need not be much larger than the width 
of the chisel, as the wound in the soft parts can 
easilv be made to slide in various directions to 
expi se different portions of the bone. Reflect 
the periosteum with the soft parts. Keep the 
wound open with retractors. 

Step 2. — With an ordinary chisel outline the 
base of a wedge by cutting through the cortical 
bone. This base corresponds to the apex of the 
angular deformity and should be smaller than 
that which is believed to be needed. With the 
chisel cut through the cancellous bone and re- 
move a wedged-shaped portion of bone. Do not 
cut through the whole thickness of the bone ; the 
posterior undivided portion, corresponding to the 
apex of the wedge, is easily fractured by manual 
force. Straighten the limb. If sufficient bone 
has not been removed, it is easy to slice off more 
with a chisel until the minimum amount, which 
permits of correction, has been removed. If the 
fibula interferes with the correction, the fibula 
must be bent or broken by manual force or di- 
vided with an osteotome. 

Style 3. — If the wound tends to gap introduce 
a few sutures. Apply aseptic dressings. Im- 
mobilize. It is well to elevate the limb for 24 
hours or longer. Subsequent treatment same as 
for simple fracture. 

3. Oblique Osteotomy. — In some eases, espe- 
cially of anterior curvature of the tibia, wdiere 
there is much shortening, oblique division of bone 
permits of elongation. To attain elongation it 
may be necessary to lengthen the tendo achillis 
by means of any one of the well-known methods. 

5. Osteoclasis. 

(a) Manual. — Grasp the bone affected above 
and below the point of the greatest curvature and 
bend it straight and produce a fracture. In the 
very young a green stick fracture is a desirable 
lesion to produce. It is often necessary to sup- 
port the point of greatest convexity on a padded 
wedge (if wood before sufficient force can be ap- 
plied. It may be necessary to produce multiple 
fractures. 



( b ) Instrumental. — The necessary fracture or 
bending may be more precisely and definitely pro- 
duced by an osteoclast. Probably Grattan's 
osteoclast is the best. Place the limb in the in- 
strument in such a fashion that the movable arm 
is applied to the point of greatest convexity, while 
the opposite or concave side of the limb is sup- 
ported by two parallel fixed arms of the osteoclast. 
By means of the screw make a movable arm press 
against and fracture the limb. By whichever 
means the limb is straightened, it must be fixed 
in good position by plaster of Paris or apparatus 
and treated as an ordinary fracture. In the treat- 
ment of bow-legs osteotomy and osteoclasis seem 
to give about equally good results. 



The condition of Dr. Charles Wellman Mitchell, 
dean of the medical school of the University of 
Maryland from 1897 to 1900, and professor of 
children's diseases and associate professor of 
medicine at the same institution, who has been 
dangerously ill of the grip at his home, E. 
Chase street, is said to be much improved. Until 
the appointment of Dr. Ernest Zueblin last fall 
Dr. Mitchell was full professor of medicine at the 
University. He is popular among the student 
body as well as the faculty of the University and 
the staff of the hospital. 

The Baltimore Sun has the following to say 
regarding Dr. Mitchell: 

'"lie is a member of the modern school which 
holds to the tenet that a physician can never af- 
ford to give up his books. Like many others in 
this country, he acquired an excellent knowledge 
of German many years ago, and by that means 
he keeps in close touch with the latest discoveries 
in the profession in Berlin, Vienna and the other 
centers of learning in Austria and Germany. He 
has taken courses at some of the German univer- 
sities. 

"lie was a classmate of Woodrow Wilson at 
Princeton, and, although he has never made a 
stump speech in behalf of Governor Wilson, he 
has spoken forcefully of him wherever he has 
gone. 1 )r. M itchell's writings are marked by their 
purity of English, lucidity of style and thorough 
grasp of his subject." 



Dr. J. Holmes Smith. Jr.. class of 1005, has 
been commissioned an assistant surgeon in the 
I nited States Public Health Service. 



THE HOSPITAL BULLETIN 



->-> i 



THE HOSPITAL BULLETIN 

A Monthly Journal of Medicine and Surjjery 

PUBLISHED BY 

THE HOSPITAL BULLETIN COMPANY 

008 Professional Building 

Baltimore, Vn. 



Subscription price, . . . $1.00 per annum in advance 

Reprints furnished at cost. Advertising rates 

submitted upon requtst 



Nathan Winslow, M.D., Editor 



Baltimore, February 15, 1913. 



THE NEW PROVOST AND HIS PREDE- 
CESSORS. 



As has been announced, Thomas Fell, LL.D., 
D.C.L., president of St. John's College, has been 
elected Provost of the University under salary 
and with executive functions. This is an im- 
portant step in the history of this institution, as 
the Provosts hitherto have been unsalaried offi- 
cers, whose duties have been nominal rather than 
actual. Those who have occupied this position 
in the past have been men of the highest stand- 
ing in the State and nation. Hon. Robert Smith, 
Secretary of the Navy. Attorney-General and 
Secretary of State, respectively, was the first 
Provost, serving from 1813-1815. He was suc- 
ceeded by Right Rev. James Kemp, D.D., S.T.D., 
Episcopal Bishop of Maryland, who served from 
1815-1826. The Hon. Roger B. Taney, LL.D.. 
Chief Justice of the Supreme Court of the United 
States, was Provost from 1826-1839. Dr. Ashton 
Alexander, a prominent physician of Baltimore, 
was Provost from 1830-1850. He was followed 
by Hon. John P. Kennedy. LL.D., Secretary of 
the Navy in 1852, soldier, lawyer, statesman and 
scholar, who served as Provost from 1850- 1870. 
L T pon his death Hon. Severn Teackle Wallis, 
LL.D., a distinguished lawyer, eminent citizen 
and gifted orator, was elected to the vacant chair, 
which he filled until his death in 1894. Air. Wal- 
lis is well remembered by graduates of the Uni- 
versity between 1870-1S94, as most of them re- 
ceived their diplomas from his hand. The next 
incumbent was Bernard Carter, LL.D., formerly 
a professor in the Law School, and recognized as 



the leading lawyer of the State. Mr. Carter 
served from 1894 to his death in 10,12. 

The times have changed, and it has becore 
necessary that we should change with them. An 
active head of the University has become a neces- 
sity, and Dr. Fell, the eighth in lineal succession, 
is the first to assume actual executive functions. 
Let us all, therefore, uphold his hands in every 
effort for the good of the University. 



THE PATHOLOGICAL ENDOWMENT 
FUND. 



The pathological endowment fund is not in- 
creasing a; rapidly as is desirable ; fortunately in 
one way ( r another it does grow. Our efforts 
have been somewhat relaxed recently ; we must 
brace up and go at it again. 

Don't be backward, boys ! Step up to the cap- 
tain's office and pass over the coin! If you can't 
give much, give what you can ! 

CONTRIBUTION BY CLASSES. 

1848 $50 00 

1864 20 OO 

1868 IO 00 

1871 35 00 

1872 81 84 

i8"3 491 83 

1874 5 00 

1875 5 00 

1876 115 00 

1877 10 00 

1880 5 00 

1881 252 oo 

1882 3 10 00 

1883 40 00 

1884 40 00 

1885 235 00 

1886 100 00 

1888 50 00 

1889 100 00 

1890 175 00 

1892 150 00 

1893 40 00 

1894 135 00 

1895 155 00 

1896 52 00 

1897 80 00 

1C98 1 1 5 00 

1899 55 03 

1900 215 00 



-W > 



THE HOSPITAL BULLETIN 



1901 270 00 

1902 330 00 

1903 340 00 

1904 135 00 

1905 220 00 

1906 185 00 

1907 120 00 

1 908 20 00 

1909 15 00 

1910 50 00 

191 1 Terra Mariae 3 50 

1912 Club Latino Americano 25 00 

Total subscriptions to Feb. 1, 1913. $10,392 17 

NEW SUBSCRIPTIONS IN JANUARY, I913. 

M. C. Freilinger, 1906 $10 00 

W. C. Gordon, 1907 10 00 

Total $20 00 



THE NEW RATING OF THE MEDICAL 
SCHOOLS. 



The Council on Medical Education of the 
American Medical Association has published its 
estimate of the standing of the various medical 
colleges of this country. We are pleased to an- 
nounce that after a careful inspection by a joint 
committee of three, from the Council on Medical 
Education and the Association of American Medi- 
cal Colleges, we have been placed in Class A. 

The task of elevating the standard of medical 
education and of crushing out the unfit schools 
goes on relentlessly. By merger and dissolution 
the number of medical schools has been reduced 
from 160 in 1904 to 1 16 in 1912, and several other 
mergers and closures are announced as likely to 
occur in the near future. 

Such agencies as the New York Board of Edu- 
cation, the Council on Medical Education, the 
Association of American Medical Colleges and 
the various State Examining Boards are exerting 
a powerful influence, both potential and moral, on 
medical education, and those schools that cannot 
or will not come up to modern requirements will 
be forced to close their doors. 

The fact that we are in Class A does not mean 
that we can rest satisfied with our present condi- 
tion, hut in every way we must continue to ad- 
vance. It will be one of the first duties of the 
new Provost to trv to raise funds for the endow- 



ment of the medical department. Without en- 
dowment the modern medical school cannot exist 
much longer. We need $500,000 to put us thor- 
oughly on our feet. Who will help us to get it? 



ITEMS 

Dr. James D. Love, class of 1897, 501 Laura 
street, Jacksonville, Fla., announces to his pa- 
tients and his friends in the medical profession 
that his practice is now limited to the diseases 
of children. 



Dr. Joseph Firey, class of 1910, is located at 
the Medical Building. Portland, Ore. 



Dr. William C. Terry, class of 1912, of Ham- 
let, N. C, writes us as follows: 

"I am very much interested in the University 
and its alumni, and want to keep in touch with 
the happenings of the old University." 

Dr. Terry is building up a fine practice, and 
was recently appointed assistant surgeon to the 
Seaboard Air Line, local division. 1 lamlet is a 
new and growing town of 3500. 



Dr. Moses J. Fine, class of 1910, surgeon of 
the Steamer Yultunro of the Uranium Line, can 
be reached at 1893 Bergen street, Brooklyn, N. Y. 
Dr. Fine spent his honeymoon in Norfolk, OH 
Point, Washington and Baltimore. While in Bal- 
timore Dr. Fine dropped in the hospital to greet 
his old acquaintances. 



Dr. Henry Frederick Vinup, class of upg, 
1 22 1 Hollins street, has been appointed assistant 
surgeon of the Fourth Regiment, Maryland Na- 
tional Guard, to succeed Dr. J. Harry Ullrich. 
Dr. Vinup is health warden for the Eighteenth 
Ward. He reported promptly at the armory and 
vaccinated the officers and men of Major Albert 
S. Gill's battalion. 



■Dr. Louis Mines Allen of Winchester, Ya., 
was a recent visitor to the University Hospital. 



Dr. A. D. McConachie, class of 1890, who was 
chief surgeon of the Maryland National Guard 
during the administration of the late Governor 
Crothers, is being mentioned for a position as 
assistant surgeon in the Fourth Regiment to suc- 
ceed Dr. E. A. Smith. Dr. .McConachie was a 



THE HOSPITAL BULLETIN 



231 



brigadier-genera] on the staff of the late ( iovernor 
t rothers. 



Dr. Rupert Blue, class of 1892, Surgeon-Gen- 
eral U. S. P. II. S., and well known for his work 
in eliminating plague from western coast cities 
Of America, will deliver lectures at the Univer- 
sity on tropical diseases. < Hhers who will lec- 
ture during this course are Dr. Henry R. Carter, 
class of 1879, Surgeon U. S. P. H. S., the yellow- 
fever expert : Dr. Charles Wardell Stiles, and Dr. 
James Archibald Nydegger, class of 1892, Sur- 
geon l\ S. P. H. S. Dates for these lectures will 
be anni nmced later. 

Dr. Henry R. Carter is a native of Virginia, 
studied at the Universities of Virginia and Mary- 
land, and entered the (then) Marine Hospital 
Service the year of his graduation, 1 8~<j. His 
service has been almost entirely in sanitary work, 
especially in connection with yellow fever. Dur- 
ing- the yellow-fever epidemics of 1893, 1897, 
1898 and i8<;<) Dr. Carter did yeoman service. 
In McHenry, Miss., in 1898, an epidemic of yel- 
li i\v fever was suppressed for the first time in the 
history of the world, once the disease had gained 
headway. Dr. Carter's work in this instance has 
been copied with success in recent epidemics. In 
iqio the University conferred upon Dr. Carter 
the honorary degree of doctor of laws. Dr. Car- 
ter is now stationed at the Marine Hospital at 
Baltimore, and we are very glad the students are 
given this opportunity to hear him. 

Dr. Rupert Blue was born in South Carolina 
in t868. He was graduated from the University 
of Maryland in 1802. and became an interne in 
the Marine Hospital Service during the same 
year. The following year he was commissioned 
Assistant Surgeon, and promoted to the grade of 
Past -Assistant Surgeon in 1897 an d Surgeon in 
1909. He was commissioned Surgeon-General of 
the Public Health and Marine Hospital Service 
January 13, K;i2, which appointment was won 
by noteworthy and meritorious service, especially 
evidenced in the suppression and eradication of 
bubonic plague in San Francisco in 10.07, which 
work brought him instantly into such prominence 
that his fitness for the position of Surgeon-Gen- 
eral could not but be recognized. Dr. Blue re- 
cently spent some time in Europe studying pre- 
ventive medicine as practiced there, and in 1910 
graduated from the London School of Tropical 
Medicine. In Mav of the same vear he was de- 



tailed to represent the Public Health and Marine 
Hospital Service at the International Congress 
on Medicine and Hygiene at Buenos Ayres, and 
while there took advantage of the opportunity 
to study possible routes by which plague and 
yellow fever might be brought into the United 
States from South America. His last detail be- 
fore his appointment as Surgeon-General was at 
Honolulu to act in an advisory capacity to the 
1 [awaiian Hoard of Health and other departments 
of the Territorial Government to inaugurate a 
program to reduce to a minimum the introduction 
and spread of yellow fever or plague in the Ter- 
ritory after the opening of the Panama Canal. 
The students of the University will recall 1 )r. 
Blue at the time that the honorary degree of 
doctor of science was conferred upon him in 1909 
by his alma mater. 

Dr. Stiles is a graduate of the I "niversitv of 
Leipzig, class of 1890. and the University of 
Paris, class of 1896. He has done much work in 
the investigation of the hookworm disease in 
North Carolina, and will talk to the students 
along that line. 

Dr. Nvdegger entered the Marine Hospital 
Service July 1, 1892, and was commissioned a 
Surgeon February 4, 1899. 



Dr. Eugene B. Howie, class of 19 10, is located 
at 1 23V2 Fayetteville street, Raleigh, N. C. 



Dr. William Culbert Lyon, class of 1907, has 
been commissioned an assistant surgeon in the 
Medical Reserve Corps, United States Army. 



There will be three more meetings of the Uni- 
versity of Marvland Medical Societv this season. 



Dr. Isaac Cockey Dickson, class of 1897, who 
has been very ill with peritonitis, has recovered 
sufficiently to resume his practice. 



Dr. Frank Paul Firey. class of i<)io, is located 
at Northwest Building, Portland, < )re. 



Dr. Nathan Ryno Gorter. class of 1879. I W. 
Biddle street, has recently been appointed Health 
Commissioner of Baltimore to succeed the late 
Dr. James Boslev. Dr. Gorter was born in Bal- 



232 



THE HOSPITAL BULLETIN 



timore county, Maryland, April 25, i860. 1 le 
is the son of Gosse Onno and Mary Ann Polk 
Gorter, and on his father's side is a descendant 
of Dutch ancestors, and on his mother's side 
of an old Maryland Scotch-Irish family. He 
was educated in Anne Arundel County Academy 
and at the University of Maryland. Since his 
graduation Dr. Gorter has practiced in Balti- 
more, and. while his practice has been general, 
he inclines strongly to surgery, in which branch 
he has gained an excellent reputation, and is one 
of the best-known physicians in the city. Dr. 
Gorter is a brother of Judge James P. Gorter of 
the Supreme Bench of Baltimore City. The 
late "Al" Gorter was another brother. Thirteen 
years ago he married Miss Mary Gordon Xorris 
of Baltimore. 

It is not expected that Dr. Gorter will make 
any changes in the department. Dr. William 
Royal Stokes has served as bacteriologist for 
main' years. 



Dr. Roscoe C. Carnall, class of 1905. is located 
at Ballsville. \ a. 



Dr. John Samuel Fulton, class of 1881, 22 it 
St. Paul street, has been appointed secretary to 
the State Board of Health to succeed Dr. Mar- 
shall L. Price, who recently resigned. In accept- 
ing this office, which pays S2500 a year, Dr. 
Fulton gave up a $5000 place in Washington. 
The members of the State Board are highly elated 
over Dr. Fulton's acceptance, and believe with 
him as the guiding head of the department it will 
embark upon an exceptionally bright future. 
The Evening Sun had the following to say upon 
his selection : 

"The State Board of Health has made an ex- 
cellent choice in selecting Dr. John S. Fulton as 
secretary, add the public is to be congratulated 
on his acceptance. X'early the whole of Dr. Ful- 
ton's professional life has been devoted to the 
study of questions connected with public hygiene. 
and he brings to his work not only expert knowl- 
edge and training, hut genuine personal enthus- 
iasm for its duties. Such a position requires 
sound judgment as well as special equipment, 
and Dr. Fulton's record appears to show that he 
possesses this happy and necessary combination 
of practical sense and scientific attainment." 



In accepting such a position. Dr. Fulton sim- 
ply comes home again, as he is distinctly a Marx- 
lander. He was educated in this State, gradu- 
ated from her oldest medical institution, served 
her many years as a private practioner in the 
counties, and then in Baltimore, and was from 
1896 to \<)0/ secretary to the State Board of 
Health, and therefore well acquainted with the 
work to which he is returning. He was for sev- 
eral years editor of the Maryland Medical Jour- 
nal, and afterwards became secretary-general of 
the International Congress of Tuberculosis; and 
with the unusual combination of a personal 
knowledge of county and city practice and State 
and National and international public health work 
comes to the work he resigned in IQ07 better 
equipped for it, possibly, than any other health 
board secretary in the country, and The Bulle- 
tin joins with the Evening Sun in congratulat- 
ing the public upon Dr. Fulton's acceptance. 

Dr. Fulton was born in 1859, at Fremont, ( >., 
oldest son of Rev. William Fulton, D.D.. of Glas- 
gow, Scotland, and Nancy < )rgan Fulton of 
Cable, O. He came to Maryland in [863 when 
his father became rector of All Hallows Parish, 
Snow Hill, Md., in 1869. He entered St. John s 
College, Annapolis, in 1872, graduating in 1870: 
then entered the office of Stephen P. Dennis. 
M.D.. Salisbury, as a student of medicine, and 
taught in the public schools for two vears. He 
graduated in medicine at the University of Mary- 
land in 1881. In 1888 Dr. Fulton married Nancy 
Helen White of Salisbury. Md. 



Dr. Alvin Clay McCall, class of 1910, is lo- 
cated at Rocky Mount, X. C. 



Mrs. Ethel Palmer Clark, superintendent of 
the University Hospital Training School for 
Xurses. and a graduate of the class of 1906, was 
recently elected president of the Maryland State 
Association of Xurses. 



Dr. Alexander Ross Mackenzie, class of 1910, 
is located at Pevtonia. W. Va. 



At the recent meeting of the Alunuue Associa- 
tion of the University Hospital Training School 



THE HOSPITAL BULLETIN 233 

for Nurses the following officers were elected to < )scar YV. Fletcher, Sanford, Accomac county, 

serve for the coming year: Virginia. 

I 'resident— .Miss Clara E. Query, class of 1005. David Franklin, 122 W. Lee street. Baltimore. 

First Vice-President— Miss -Mary Gavin, class George W. Hafele, died May 3, 1911. 

of 1008. William 1). Hammond, Hagerstown, Md. 

Second Vice-President— Mrs. Page Edmunds. Emil Heller Henning, 2000 Hollins street. Bal- 

formerly Miss Millicent Geare, class of 1905. timore, Md. 

Secretary — Miss Jane R. Garner, class of 1911. David Ernest Hoag, . 

Treasurer — Mrs. Nathan Winslow, formerly J. Howard Hodges. Harper's Ferry, Aid. 

Miss Margaret K. Massey, class of 1903. William Murray Hollyday, 330 X. Charles 

Executive Committee — Miss M. E. Rolph, class street, Baltimore, Aid. 

of 1895; Mrs. Frank Lynn, formerly Miss Clyde J. Knox lnsley, 2938 E. Baltimore street, Bal- 

C. Dawson, class of 1908; Miss S. A. How- timore, Md. 

strawer, class of 1908. and Mrs. Ethel Palmer Joseph Connor Joyce, Arnold, Md. 

Clark, class of 1 9od. John Daniel Kerr, Jr., Clinton, Sampson 

county, North Carolina. 

_, . ,. . ., , .. .. - , Lawrence Kolb, Assistant Surgeon, U. S. P. 

Bv request, we publish the following list ot the _ - 

,-'„',. ,_ . .. , H. S.. Reedy Island, Port Penn, Del. 

class of 1908, with their present locations, so tar J 

,. , Louis Charles LaBarre, 024 Hamilton street, 

as we are able to ascertain : < ? t 

/"i 1 ni 1 \ 1 r- i- 1 • i Allentown, Pa. 
Charles Rhodes Anderson, Care, rredenck 

. ,-• ■ • Paul P. Lane, Wavcross, W'are countv, Geor- 

county, \ lrgima. ' - ' • ' 

James Leland Anderson, Alain street. Green- & la " 

ville S C Charles Evans AIcBrayer, First Lieutenant, 

James Hugh Bay, Havre tie Grace, Aid. Medical Corps, U. S. A., Fort Howard, Aid. 

Joseph Francis Barry, . J ohn J- McGarrell, . 

Thomas Alalcolm Bizzell, Goldsboro, Wayne Allen McLean, Wagram, Scotland county, 

county. North Carolina. North Carolina. 

Grover Cleveland Bolin, Neeses, Orangeburg John Evans Mackall, died April 4, 1912. 

county, South Carolina. Joaquin S. A'liranda y Castillo, Cuba, West 

Alorris Ramsay Bowie, Somerset, Gunnison Indies, 

countv, Colorado. P.lias Xathanson, Summer street, Lynn, Alassa- 

William Underdown Charlton, 1803 S. 15th chusetts. 

street, Philadelphia, Pa. Yerlin Xolt, Columbia City, Whitley county. 

Solomon L. Cherry, 1605 N. 5th street, Phila- Indiana, 

delphia, Pa. Lester Dimmitt Norris, 3d street and Central 

William Joseph Coleman, University Hospital, avenue, Cincinnati, O. 

Baltimore, Aid. Frederick James Pate, Pembroke, Robeson 

Piatt Walker Covington, . ( Last at county, North Carolina. 

Rockingham, N. C.) Roy Clifford Potter, . 

Frank Garnett Cowherd, Rockhill, York county, Jaroslav Radda, 230 E. /2d street. New York 

South Carolina. City. 

James .Alexander Craig, C» 1 3 Jefferson street, Russell Wesley Raynor, Vienna. Dorchester 

Gary. Ind. county, Maryland. 

W. Cole Davis. First Lieutenant, Aledical David Samuel Rhone, 447 Kaighn avenue. 

Corps, U. S. A., now stationed at Manila, P. I. Camden, X. J. 

( i. L. Dougherty, 1901 Delaware avenue, Wil- < Iranville Hampton Richards. Port Deposit, 

mington, Del. Maryland. 

Slocomb Rupert Edwards. Siler City, Chatham Luther Allen Riser, Leesville. Lexington 

county, Xorth Carolina. county. South Carolina. 

William A. Ellingwood, Winterport, Waldo Ramon Luis Rodriguez, San German, Alaya- 

county, Alaine. guez county. Porto Rico. 



-34 



THE HOSPITAL BULLETIN 



Herbert Jerome Rosenberg, Grant Building, 
Atlanta, Ga. 

Adin Adam Rncker, Rntberfordton, Ruther- 
ford county, Xorth Carolina. 

Louis Hamilton Setb, McDaniel, Mil. 

Leo George Scheuricb, Tomah, Monroe county, 
Wisconsin. 

Amzi Bedell Sboemaker, North Attleboro, 
Bristol county, Massachusetts. 

Henry Lyon Sinskey, 1610 E. Baltimore street, 
Baltimore, Md. 

Frederick Snyder. 691 Broadway. Kingston. 
Ulster county, New York. 

Arthur < Igburn Spoon, Revolution Mills, 
Greensboro, N. C. 

Leo Fleischer Steindler, 1203 W. Xorth ave- 
nue, Baltimore, Md. 

D. Hoster Swengel, Mt. Carmel. Abbeville, 
South Carolina. 

James Thomas Taylor, Madison, Rockingham 
county, Xorth Carolina. 

Horace B. Titlow, 3035 O'Donnell street, Bal- 
timore, Md. 

Homer Ulric Todd, J^j X. Fulton avenue, Bal- 
timore, Md. 

Charles Manly Walters, Union Ridge. Ala- 
mance county, Xorth Carolina. 

Frederick Chauncey Warring. 1803 St. Paul 
street, Baltimore, Md. 

Henry 1 Iarry Weinberger, 724 W. Fayette 
street, Baltimore Md. 

T. Marshall West, Fayetteville. N. C. 

Edgar Harold Willard, Mount Pleasant, Md. 

Philip R. Williams, . 

Franklin Davis Wilson, South Xorfolk, A "a. 

Cato Franklin Winslow, dead. 

Arthur Leon Wright, 2105 W. Pratt street, 
Baltimore. Md. 

Arturo Xelava. Xicaragua. 

John Edward P.erridge Ziegler, Hayward, Wis. 

We should be very glad if any of our sub- 
scribers would till in the missing addresses. 



tra of the Medical and Chirurgical Faculty of 

Maryland : 

Violins — Drs. Moses J. Lichtenberg, class of 
1912; Harry L. Whittle, class of 1903, and Leo 
John Goldbach, class of 1905. 

Trombone — Dr. Harry Stoner, class of 1907. 

This is the first physicians' orchestra organized 
in the United States, though there is one in Ber- 
lin and another in Vienna. 



Dr. Andres Martin G. de Peralta, class of 1912, 
is located at Palma Soriano, Oriente, Cuba, where 
he is doing general medical and surgical work. 



Dr. Enrique Llamas is located at 145 N. 18th 
street. Philadelphia, Pa., where he is visiting dis- 
pensary physician to the eye department of Will's 
Eye Hospital. 



Among the University alumni practicing in 
Kansas are : 

Bolton — Christopher Brenner, class of 1906. 

Fort Leavenworth — Wm. X. Bispham, class of 
1897, Major M. C, U. S. A., Military Prison. 

Fort Scott — Robert John Whitfield, class of 
1893, Masonic Temple. 

Hays — Jos. H. Middlekauff, class of 1879. 

Salina — Melcher Gist Cockey, class of 1870. 

Wakefield — Charles Hewitt, class of 1868. 



UNDERGRADUATE NOTES 



Under the Supervision of E. Kilboitrn Tullidge. 



Messrs. Franklin D. Murphy and Frederick L. 
McDaniel. members of the senior class, took the 
United States Civil Service Examinations on 
Wednesday, February 5. 1913, for positions of 
physicians (male) in the Indian service. 



Dr. ( ierardo Vega y Thomas, class of 1912, is 
at present assisting Professor Fortun, one of 
Havana's oldest and best-known surgeons, and 
is located at Espada No. 134, Havana, Cuba. 



The following alumni of the University of 
Maryland are members of the physicians' orches- 



President Xorbert C. Nitsch of the senior class 
has been confined to his home during the past 
week bv a severe attack of influenza. 



The annual dance of the clinical assistants was 
held Friday evening. January 17, 1913, at Al- 
baugh's Parlors. The patronesses were Mesdames 
Randolph Winslow. S. E. Xeale. Arthur M. Ship- 



THE HOSPITAL BULLETIN 



235 



ley. Gordon Wilson, Hiram Woods, John W. 
Holland, Nathan Winslow and R. H. Johnston. 
The affair was a decided success, there being 
plenty to eat, good music, and lots of pretty girls. 



The Delta Chapter of Kappa l'si Fraternity 
is preparing to hold its annual dance at Schman's 
Hall on the evening of February 17, 1913. 



A successful dance was given by the Nu Sigma 
Nu Fraternity at Albaugh's Parlors Friday even- 
ing. January 3] . 1913. 



A delightful theater party was given by the 
Phi Sigma Kappa Fraternity Friday evening, 
February 7, 1913, to see Daniel D. Carter's latest 
play. "The Master Mind." 



The following- invitation has been received by 
the Kapp. Psi Fraternity: 

The President and Directors 

of 

The Panama-Pacific Universal Exposition 7 

to be held in San Francisco in 1915 

have the honor to extend to 

KAPPA PSI FRATERNITY 

A cordial invitation to hold its 1915 meeting in 

San Francisco. 

This city has been selected by Congress, with 
the approval of the President of the United 
States, as the official site for celebrating the unit- 
ing of the waters of the Pacific and Atlantic 
through the Panama Canal, the greatest physical 
accomplishment achieved by man. The Exposi- 
tion will not only attempt to show that which is 
most advanced in Invention, most interesting in 
Art and of greatest scientific value, embracing 
all that is most important in the material progress 
of the world, but it will be the aim of the directors 
to make it rank in intellectual interest above all 
previous expositions ; to bring together so much 
of wisdom, so much of practical scientific 
thought and so much of broad grasp of the 
world's important problems that the progress 
of mankind shall be advanced a quarter of a cen- 
tury. 

I" assist in achieving this aim. we invite your 



presence in the city of San Francisco in the year 
Nineteen Hundred and Fifteen. 

Bent. I. Wheeler, 
President, University of California. 
David Starr Jorden, 
President. Leland Stanford University. 
Rudolph J. Tanssig, 
Chairman, Committee on Exposition, 
Wm. Brisbane Walker, 

Director of Congresses. 
Chas. I. Moore, 

President. 
F. S. Stiffe, 
Dircctor-in-Chicf of Foreign and Domestic 
Participation. 

[seal.] 



An examination in major surgery was given 
in Davidge Hall by Prof. Randolph Winslow to 
the members of the senior class on Tuesday, Feb- 
ruary 4, 1913. 



Prof. Hiram Woods has announced that he 
will hold his final examination on the eye for the 
senior class earlv in February. 



William Frank McDaniel of the freshman 
medical class, who has been confined to the hos- 
pital with an attack of chronic appendicitis, has 
recovered. 



At the State Board examinations, held in 
Man-land recently, two members of the senior 
class made exceptionally good showings — Leon- 
ard Hays received a general average of 85 per 
cent, and Ross B. Kolb an average of 82 per cent. 



Examinations for entrance to Bayview Hos- 
pital were held on Tuesday, February 7. 1913. 
The subjects were medicine, surgery and clinical 
pathology. 



On Wednesday, February 5, Dr. C. W. Stiles, 
U. S. P. H. S., gave an illustrated lantern lecture 
in Chemical Hall on the "Hookworm." 



Other weekly lectures on Tropical Medicine by 
members of the U. S. Public Health Service have 
been arranged by Professor Zueblin, to be held in 
Anatomical Hall on Tuesday of each week at 2 
o'clock P. M. 



236 



THE HOSPITAL BULLETIN 



Students desirous of taking the Pennsylvania 
State Board Examination in June will be required 
to show evidence of having delivered six obstet- 
rical cases, assisted in six surgical operations, ad- 
ministered six anesthetics and witnessed six 
autopsies. 



The first of a series of interesting and instruct- 
ive clinics conducted by Prof. Irving J. Spear on 
mental diseases at Bayview Hospital was held 
on Saturday, February i, 1913, the subject being 
stigmata, degeneration, imbecility and idiocy. 
Professor Spear has announced his remaining 
clinics to be as follows : Dementia precox, para- 
noia, February 15; general paresis, March 1 ; se- 
nilitv and organic dementia, March 8; psychosis 
due to intoxication, March 5 ; maniacal and de- 
pressive insanity. 



Prof. L. E. Xeale desires to announce through 
The Bulletin that he will welcome all candi- 
dates of the senior class desiring interneship in 
the obstetrical department of the hospital at, his 
home, io5 E. Read street. 



A communication from Dr. N. Travis Gibbs of 
42 W. 75th street, New York, states that there 
are several vacancies at Blackwell's Island, and 
requests those desiring interneship there to com- 
municate with him at their earliest convenience. 



The price of Terra Mariae will be $2.50 if a 
deposit of $1 is made with Editor-in-Chief Breed- 
ing before March 1, otherwise $3 per copy will be 
charged. 



MARRIAGES 



Dr. James Erwin Diehl, class of 19] i, was mar- 
ried on Saturday morning, Jenuarv 18, 1913. at 
11.30 o'clock, in Raleigh, N. C, to Miss Lillie 
May, daughter of Mrs. Mary Eleanor Tucker of 
Raleigh, X. C. Dr. and Mrs. Diehl will be at 
home after February i at the Trenton State I [os- 
pital. 



Dr. William Herbert Pearce, class of iS«)i, of 
2105 X. Charles street. P>altimore, was married 
on Tuesday, February 4. 1913, to Miss Sarah 
Frances Ferguson, daughter of Mrs. Hugh Fer- 



guson, of Charleston, S. C. The couple were 
married at the home of the bride. 21 George 
street. The ceremony was performed by Rev. 
Dr. Duffy Fill, and was witnessed by members 
of the two families only. Dr. ami Mrs. I'earce 
will be at home after February to at 2105 N. 
Charles street. 



DEATHS 

Dr. Robert John Price, class of i8o(>. died at 
his home 4 11 Vienna, Aid., January 15, i < » 1 3 , of 
paralvsis, aged "/$ years. Dr. Price was born in 
Centreville, Md., October 13, 1838. He was the 
son of John C. and Elizabeth Downing Price, 
both natives of Maryland and descendants of 
English ancestors. He was educated in the pub- 
lic schools of Baltimore, Centreville Academy and 
the University of Maryland. He also attended 
clinical lectures in the University Hospital, and 
in the same year in which he graduated entered 
upon his professional career at Vienna. He was 
one of the best known and most popular physi- 
cians in Dorchester county, and one of the most 
successful. 

Dr. Price was at one time a member of the 
School Board, and for many years physician to 
the almshouse. 

He was twice married, and is survived by the 
following children by his first wife, who was 
Miss Laura Jump of Queen Anne : Mrs. Charles 
Uearn, Mrs. Jacob Cook and Miss Emma Price 
of Baltimore; Mrs. Lloyd (!. LeCompte of 
Vienna and Alfred Price of Philadelphia: and by 
his second marriage, to Miss Emma Lester of 
Richmond, Va., by the following three children: 
Fester. Benson and Richmond Price. 



Dr. Edward Fawrence Casey, class of 1905, 
died at his home in North Woodstock, X 11 , 
December to. 1912, aged 30 years. 



Dr. George W. Davis, class of 1869, died on 
Sunday, January \<>, [913, at his home near 
Pleasantville, Md.. aged 69 years. Dr. Davis had 
been in ill-health for some time, and his death 
was not unexpected. lie is survived by his 
widow, who was Miss Mary J. Beaumont. Dr. 
Davis enjoyed a large and lucrative practice, and 
was much beloved. He was buried on Wednes- 
day, January 22, at the Old Baptist Church, 
Jarrettsville, Md. 



HOSPITAL BULLETIN 

OF THE 

UNIVERSITY OF MARYLAND 

VOLUME VIII 

FEBRUARY 15, 1912-FEBRUARY 15, 1913 



CONTRIBUTORS TO VOLUME VIII 



Allgood. R. A 65, 

Bickel, Adolph, M.D 

Bulluck, Ernest S., M.D 

( larroll, Albert Hynson, M.D 7. 

] lanson, Ejnar, ALL) 30, 

Hemmeter, John C 41. 

] [innant, Milford 

Irwin. Henderson 

Johnston, Richard H., M.D 

Kloman, E. H.. Ph.D., M.D 

K< ihn, 1 -1 mis Winfield, M.D 

Kolb, Edward P 

Linn. Willis. M.D 

Lew iper, Edward A 7, 

McMillan, Roscoe, M.D 101, 

Matthews, A. Aldridge, M.D 1, 164, 



AGE 
124 
170 

25 

8i 
192 

5 1 
4') 

22 I 

105 

21 

7 

47 
204 
206 



PAGE 

Xiblett. W. Saulsbury, M.D 88 

I'earce. William Herbert, M.D 44 

Rauschenbach, C. W 10. 28, 105 

Roberts, Charles Wesley, M.D 103 

Schapiro, A 22J 

Scott, W. M 28 

Stewart, Emmet James 200. 

Strosnider, C. F., M.D 31 

Timanus, George L 22^ 

Tullidge. E. K 4, 208 

Vinciguerra, Michael 69 

Winslow, John R., B.A., M.D 201 

Winslow. Xathan, M.D. . .67, 108. 128. 1 }o, 140, 
Winslow. Randolph, A.M., M.D., LL.D. .61, 

6", 121, 141. l6l l8l 

Zueblin, Ernest, M.D 145, 186 



INDEX TO VOLUME VIII 



PAGE 

Abbitt. John Willis 66 

Abbott. Alexander C 07 

U>sher, Darius C 174 

Abstract 74, 94, I [3 

Academic Day i~(> 

Adams, J. Fred 138 

Address of Prof. Adolph Bickel 170 

Address to Seniors and Juniors, Initial 145 

Adjunct Faculty 56 

A 1 land -nine Gift n 14 

Aims of Clinical Teaching in Medicine 180 

Allen. Lewis Mines 158, 230 

Alumni as Con iners ! 52 

Alumni Association 96 

Alumni Association. The Functions of an.. 44 

Alumni Athletic Association 35, 95, 136 

Alumni Advisory Council 55 



PAGE 

Alumni at Mercy Hospital 135 

Mercy Hospital Dispensary 136 

Skin and Cancer Hospital 117 

State Sanatorium 135 

City Health Department 134 

Alumni in Alabama 216 

Arkansas [93 

California 1 77 

G ilorado [96 

Delaware 1 74 

District of Columbia 124 

Florida 157 

( lei irgia 136 

Idaho 95, 173 

Illinois 158 

Indiana 139 

1 1 >wa 213 



'38 



THE HOSPITAL BULLETIN 



PAGE 

Kansas 234 

Kentucky 2 I 3 

Louisiana 213 

Maine 130 

Massachusetts 178 

Faculty Officers 43 

P. & S. Faculty 135 

Alumni Banquet Address 96 

Alumni Passing State. Board 1 18, 216 

Alumni as District Health Officers 58 

Amebic Dysentery 101 

American Medical Association and the Medi- 
cal Colleges ~i 

American Surgical Association 196 

Analytical Study of Fifty Cases Treated in 
the Gastro-Enterological Department of 
the University — Reviewed with Special 
Attention to the Anthropometric Measure- 
ments 7 

Anatomists of the University of Maryland, 

History of the 2^ 

Anderton, Herbert S 98 

Aneurisms of the Arch of the Aorta and of 
the Innominate Artery by the Introduc- 
tion of Foreign Bodies Into the Sac, Treat- 
ment of 124 

An Explanation and An Appeal 33 

An Explanation 1 1 1 

Anne Arundel Count)' Medical Association. . 176 

Arnold, William T 38 

Ashby, Thomas A 59, 199 

Asper, Burt J 1 56 

.Athletic Association 18 

Athletics 36 

Baldwin, Thomas C 220 

Ballenger, Edgar G 120 

Barron, John 1 20 

Baseball Team 17, 39, 58 

Basket-ball Team 18, 198, 218 

Battle, George C 1 54 

Bay, James Hugh 159 

Bay, Robert Parke 15. 55, 97 

Beavers, John T 217 

Bell, Alice Frances 119 

Benzinger. Joseph C 80 

Beri-Beri Clinic 152 

Bevan. Arthur D 134, 176 

Bickel, Adolph von 1 73 

Bickel, Prof. Adolph. Address of 170 

Billups, Gains \Y 1 19 

Bird, Jacob W 70 

Births 19, 38, 79, 150 

Bissell, J. Dougal 17 

Bizzell, Thomas M 158 

Blair, John L 20 

Blalock. B. Karl 198 

Blue, Rupert 231 

Blum, Joseph 17 

Bone Fractures, Some Points of Interest as 

Regards Long 164 

Book Reviews 40, 109, 140, 170 



PAGE 

Borck, Mathias A. R 20 

1 Sowden, David T 60 

Bow-Leg — Genu Varum 227 

Bowman. Humphrey E 80 

Howie. Morris R 157 

Braithwaite. Wm. W 50 

Breast Affections — A Series of One Hun- 
dred Cases 67 

Breeding, Earle Griffith' 198 

Brewington, Esther E 156 

Bromwell, Josiah R 79 

Bronchoscopy for Multiple Foreign Bodies 
I Almond Shell and Pulp) in a Child Two 

Years of Age 201 

Brooks, Baird U 17 

Browne, Bennett Bernard 35 

Browne, William H 199 

Bulluck, David W ^ 2 

Bulluck, Ernest S 98. 158 

Bussey, Bennett F 60 

Butler, James H 160 

Cancer, The Public Should Be Educated in 
Regard to, as is Being Done in Tubercu- 
losis 1 

Carman, Perry 137 

Carnall, Roscoe C 232 

Carpenter, Benjamin F 136 

Carroll, Albert Hynson 103, 137 

Carroll. John Joseph 1 19 

Carswell. Walter S 137 

Carter. Bernard, In Memoriam 90 

Carter, Henry R 217, 235 

Cartilaginous Tumors of the Larynx 54 

Case of Infantile Paralysis in Ancient Egypt. 192 
Case of Six Months' Miscarriage Induced by 
Measles and Complicated by Tuberculosis. 105 

Casey. Edward Lawrence 236 

Cerebral Luetic Endarteritis with a Tempo- 
rary Occlusion of a Lower Anterior 
Branch of the Middle Cerebral Artery. 
Causing a Temporary Anemia of Broca's 

Convolution 49 

Certain Diseases of Old Egypt 212 

Chaney. T. Morris. Jr 97 

Chapman. Robert F 17S 

Charles VV. Mitchell Medical Society 39, 100 

Chisolm. Archibald A 95 

Chisolm, Prof. Julian J., and Miss Helen 

Keller 131 

Chisolm, Frances Miles. .• 35 

Chi Zeta Chi 19. 40, 58 

Clark, Ethel P 198, 232 

Clarke, Sydenham Rush 10 

Class of 1905 34 

Of 1908 158, 233 

Of 1909 175 

Of 1912 95 

Clinical Assistants 130 

Clinics at the University Hospital 19, 194 

Coale, Mattie E 75 

Coale, R. Dorsey 15 



/ 



THE HOSPITAL BULLETIN 



239 



Cockey, Melchoir G 

Coleman. William J 

Collins, Joseph 

Combining the Medical Schools of Baltimore. 

Commencement. The ( )ne Hundred and Fifth 
Annual J 2, 

Correspondence 

Cortial Degeneration, Report of a Case of, 
with Section of Posterior Spinal Roots for 
Relief of Symptoms 

Crampton, Louis W 

Craven, William \Y 

Curry, W. C 

Cyclopedia of American Medical Biography. 

59. 

Davis, ( ieorge W 

Davis, Hoagland Cook 

Davis, Judson J 

1 )awson, Robert M 

Dean. Russell Hardy, Jr 136, 137, 

Deaths 19, 38, 60, 75, 79, 120, 139, 

159, 17S, 199, 219, 

DeMarco, S 

Development of Antiseptic and Aseptic Sur- 
gery 

DeVilbiss, Clifton N 

Diagnosis of Syphilis 

i lickson, Isaac C [38, 

Diehl, James E 

Disbrow, George W 

Dispensary Cases 

1 )ispensary Report . . . .' 

Dobbin, George W 35, 

Douglass, Louis H 

Dougher, Thomas R 

Drop-Finger, with Report of Case '. 

Dysentery, Amebic 

Ebert, J. William 139, 

Editorials 13, 33, 53, 71. 91, 111, 

'i 1 - 152, 171. 193. 2I 4. 

Edmunds, Page 

Ellingwood, William A 

Ely, Emily L 

Emrich, William 16, 

Engagements 1 . . .79, 

Ewens, Arthur E 

Egypt, Certain Diseases of Old 

Feddeman, William H 

Fell. Thomas. A.M., Ph.D., LL.D.. the New 
Provost [95, 

Fellers. William B 

Field. John W 

Field Meet 

Fine, Moses J 219, 

Firey, Frank P 

Firey, Joseph 

First Aid to the Injured, with Special Ref- 
erence to Shock 

Fisher, Charles T., Jr 

Flexner Report on Medical Schools 

Football Team 

Fraternities 19, 



'MM'. PAGE 

1 58 Freshman Class Officers 174 

135 Friendly Controversy Between Tw<> Physiol- 

i)i> ovists Concerning the Mechanism of the 

131 Lesser Circulation (Return of Blood from 

the Gills to the Sinus Venousus) in Flas- 

78 mobranch Fishes 4: 

99 Full-Time Teachers 136 

Fulton, John Samuel 155, 232 

Functions of An Alumni Association 44 

28 ( iamble, Gary 15 138 

60 ( iardiner, Charles W 132 

154 < rarrett, Robert 138 

12 ( larrison, ( lertrude A 98 

( iastric Ulcer 128 

yj Gastro-Enterological Department of the I ni- 

23G versity, Analytical Study of Fifty Cases 

15 Treated in the 7 

6 General Alumni Association 176 

160 General Alumni Association, Pennsylvania 

148 Chapter 36 

' rephart, Mary L 98, 109. 158 

235 ( Hbson, John S 99 

169 Gichner, Joseph E 159 

Giles, Alfred B 219 

209 Goettling, Charles A 95 

97 Gorter, Nathan R 137, 216, 231 

208 Greenway, ( Gilbert C 19 

27, 1 Gribble, Oakey S 16 

236 ( iriftith, Ernest L 95 

218 Grubbs, Anna S 16 

80 Guerrant, E. Janie 156 

16 Hall, William S 79 

135 Hammond, S. W 97 

1 19 Hanna, Michael 66 

19 Harmon, George E. H 19 

130 Harris, Charles C 138 

101 Harris, James H 13S 

160 Harris, John C 178 

I leffinger, Clarence W 139 

221) Hemmeter, John C 35, $/, 133, 139, 

97 176, 194, 213 

218 Hereditary, Is Syphilis 4 

16 Hershner, Newton W 99 

117 Hirschman, Isadore 1 216 

178 History of the Anatomists of the University 

19 of Maryland 25 

212 Holidays, The — Giving and Receiving 215 

60 Hollingsworth, Charles A 135 

Holloway, Howard S 151; 

214 1 tollyday, John Guy 38 

136 Hopkins, Ephriam 60, 79 

120 Hopkinson, Dr. P>. Merrill 17 

18 Horn, August 135 

230 Hospital Appointments 30 

231 Hotchkiss, Norton R 20 

230 House Dance 218 

1 Ioule, Eugene B 231 

204 I Iubbard. James E 120 

198 Hundley, J. Mason 198 

133 1 lughes, J. A ii7 

177 I [ussey, Raymond G 75 

40 Iiutton, George -Mien 35 



-4° 



THE HOSPITAL BULLETIN 



Improved Treatment of Tubercular Bone 

Abscesses 

' Improvements and Changes 

Initial Address to the Seniors and Juniors. . 

In Memoriam 

Internal Medicine 

International Clinics 40. 109. 

[nterurban 1 Orthopedic Club 

[odine in ( Obstetrical Practice, The Use of. . 
Italian Superstition with Regard to Placenta. 

Items 15, 34. 55. 75- 95. : l 5> 

[33. [ 54. 173. lS .V 214, 

Ivey. William P 

James. William D 

Jameson. Horatio G 99, 

Jarrett, James H 

J ay, John < 1 

J ennings, C.I 

Joyce, Joseph C 

Junior Medical Officers 

Kappa Psi 40. 173, 199, 

Keep A-Pullin' 

Kelly, Vernon Francis 

Kenawy, Najib 

Kennard, Henry W 

King. Florence V 

Kirk. Norman T 

Kloman, E. H 

Kohn. Louis Winfield 

Knipp, Harry E 

Krozer, John J. R 

Lacrosse Team 

Lamkin, Edward E 

Langley, Louis E 

Latham. Peter II 

Latin- American Club 173, 

Lebret. G. H 39, 

Lecates. Howard E 158, 

1 -tgg, Thomas Henry 

Lend a Hand 

Levin. Julius 

Llamas. Enrique 

Love. James D 

i .ove, William S 

Lyon. William C '>o. 

Lynch, James M 

Lynn. Frank Sidle 59, 117. 156, 

Lvon. William C 1 59, 

McCall, Alvin 

McCarty, I tarry D 

McConachie, Alexander D 138. 

McDaniel. Lawrence E 

McFaddin, Albert O 

McKnight, Vernon II 

McMillan. Roscoe C 98, 

McMullen, John 

MacConnell, John Wilson 

Mackall. John Evans 

Mackenzie. A. R 

Maldeis. Howard 1 79, 138, 

Marett. Wm. C... 



PAGE 
88 

14s 
90 

1 So 
i?> 
197 

: 5 r 

3° 

2 3° 

I _': I 

95 

115 

[58 

138 

97 

97 

173 

235 

1 3-' 

19 

216 

196 

75 

75 

15 

16 

159 

135 
36 
t6 

9 I 

20 

198 

218 

i.,x 

i57 
18: 
20 
234 
230 

133 

97 

[6 

218 

23 1 

2 ^- 

99 

230 

[ S 8 
195 

35 

i37 

t3« 
16 

38 

2 3-' 

1 5 1 

3 2 



PAGE 
235 

23 i 

57 

220 

1 98 

35 
12 

135 

70 
230 
199 

186 

150 
3 2 
38 

155 
16 

119 



Marriages 19. 60. 79. 08. ng. 

139, 159, j 78. 199, 218. 

Martin. Andreas 15. 118, 

Massenburg. George Y 

Massenburg, Richard C 

Matthews. A. A 

Matthews, lames G 

Matthews, t. A 

Mans. Louis M 

Mayhew. Walter H 

Medical Alumni Association 

Medical Schools. The New Rating of the. . . 
Medical Society, Charles W. Mitchell.. . .39. 
Medicine, The Aims of Clinical Teaching in . 

a leierhof . Edward L 

Messmore, Harry Benj 

Messmore. John Lindsey 

Michel. William 

Miller. Frank O 

Minnis. Rosamond 

Miscarriage, A Case of Six Month-'. In- 
duced by Measles and Complicated by 

Tuberculosis 105 

Misseldine. John G 58 

Missing Alumni 15 

Mitchell. Charles W 228 

Mitchell. Mary D 219 

Moorman. John A 120 

Murphy. Franklin D 21S 

Murray. Thomas J .' . 119 

Muscey, James S. Lovell 19 

Mustelus Canis. Study of the Synchronous 

Heart Heat and Respiration in the 82 

Myers. Z. C 97 

Newhouse, Benjamin 133 

Nichols. Elijah E 178 

Norton. John C 199 

Nu Sigma Nu 19, 40. 178. 199, 235 

1 obstetrical Practice, The Use of Iodine in. . 151 

< O'Donovan, Charles 95 

Ohle. Henry C 97 

< Oldest Alumnus Dies 80 

( Opening of the Session 1012-13 152 

Operation. Preparation of Patient for 225 

Overman. Charles Augustus 16 

( hvens, Maurice E. B 1 y » 

< 'wings. Thomas B 16, 118 

Palmer. J. Denham 1 ~~ ) 

Paralysis. Infantile. A Probable Case of. in 

Ancient Egypt 102 

Parramore. James B 174 

Pathological Endowment Fund.. 1 3. 33, 53, 
71. 92, 112. 132. 152. 153, 171. 104. 215. 220 

Patterson. E. C 58 

Patrick, George R 120 

Patrick. Robert B 198 

Pearce. William H 236 

Pellagra . 46, 252 

Penning. < lliver Parker 210 

Pennington, John 1 157. 196 

Feters. Don 198 



THE HOSPITAL BULLETIN 



-4' 



P \GE 

Phi Sigma Kappa \<>. 40, [98 

Physiology, Manual of Practical [54 

Physiology, Technical and Scientific Qualifi- 

catii his of a Teacher <>t 51 

Pituitar) Body and Its Disorders no 

Piggott, J. Burr 52 

Plac< nta, Italian Superstition with Regard to. 30 

Pneumococcus in Surgery >)4 

Powell, John F 20 

I 'radical Anatomy [40 

Practical Experience with Spinal Anesthesia. 21 

Preparation of Patient for < Iperation 22$ 

Preventive Medicine Among ( lur Youth. ... 31 

Trice. Marshall L 50, 1 39 

Pride, Robert J 236 

Prof. Julian J. Chisolm and .Miss Helen 

Keller 131 

Provost, The Late 90, 92 

Provost, The New, Thomas Fell 117. -'14 

Provost, The New. and I lis Predecessors. . . 229 
Public Should Be Educated in Regard to 

Cancer the Same As Is Being Done in 

Tuberculosis 1 

Queen, William Gwynn 151 

Quillen, Emile Bonniwell 159 

Randolph Winslow Surgical Society. ... 17, 

39. [ 73> [ 9'J 

Rankin. Watson S 1 13 

Raphel, Eugene [98 

Reasonable and Pleasurable 14') 

Remarks at the Annual Reunion of the Medi- 
cal Alumni Association. June I, 1912 69 

Renovation of University Buildings 156 

Report of a Case of Abiotrophic Cortial De- 
generation with Section of Posterior Spinal 

Roots for Relief of Symptoms 28 

Report of Case 103 

Repi irt 1 if 1' >ur Unusual Cases 20 > 

Result of State Hoard Examinations 117 

Retn ispect and Prospect 1 ^ 

Rich.H. R 39 

Richards, Granville II 70 

Riely. Compton 16 

Rivers, Dwight Cray 159 

Ri iberts, Charles \Y nq 

Robertson, J. Righton 18 

Robinson, Austin E 137 

Ri ibinsi m. William K 140 

Rodman, William 1 27 

Rosenburg, Herbert J 178 

Rowe, William T 155 

Rytina, Anton G 57 

Satterthwaite, Thomas E., Letter from 172 

Sawaya, lurgi E 117 

Seci ni'l Call for Dinner 13 

Securing Funds 171 

Sellman. Wallace 15(1. 217 

Senior Class ( Ifneers 170 

Se] ii ic S< ire Throat 1 08 

Settle. George M 156 

Shipley, A. M 5(1. 173 



PAGE 

Shock, First Aid to the Injured with Special 

Reference to 204 

Shock, Symptoms and Treatment of 211 

Slade. I tarry M 58 

Smoker, Annual. Adjunct Faculty ^7, 94 

Smoker, Annual. General Alumni Associa- 
tion 57, 77 

Smoker by ( linical Assistants 198 

Smink, C. C to 

Smith. C. Urban 138 

Smith, Edward S 1 16 

Smith, ( iilbert T 117 

Smith. Joseph T 131) 

Smith, Dr. J. 1 [olmes, Sr 117. 15.; 

Smith. Dr. J. I [olmes, Jr 22^ 

Smith, Maude F 178 

Snuffer, Dempsey William 16, 155 

Some Facts Dealing with the Development of 

Aseptic Surgery 65 

Some Points of Interest As Regards Long 

Bone Fractures 164 

Some Recent Tube Cases 221 

Sophomore Class ( (fficers 15; 

Spinal Anesthesia. I 'radical Anesthesia with. 2t 

Spruill, St. Clair 139 

Staff. Maternity Hospital 136 

Stallworth, Claude J 119 

Status Quo 17: 

Steam Roller and the Medical Colleges ()2 

Steiner, May K [59 

Steiner, Ralph 119 

Steuart. Ceo. H 12 

Stewart. Napoleon Bryan to 

Stc ikes, William R 117 

Stotlemyer, C. 1 15 

Study of the Synchronous Heart Beat and 

Respiration in the Muslelus Canis 82 

Sullivan, Mary C 97 

Summer Cruise on the Spanish Main. . . 121, 

141. I'M. 181 
Surgery. A. septic. Some Facts Dealing with 

the Development of 6^ 

Surgery, Development of Antiseptic and 

Aseptic 209 

Surgical Society, Randolph Winslow. ... 17, 

39, 199 
Symptomatology of Typhoid Fever and Its 

Complications 10 

Symptoms and Treatment of Shock 21 1 

Syphilis, I Jiagnosis of 208 

Syphilis, Is It Hereditary 4 

Tarun, William 1 to, 216 

Taylor, Emmett < )'Brien 217 

Technic of Resection of Rib Under Local 

Anesthesia 74 

Technical and Scientific Qualifications of a 

Teacher of Physiology 51 

Terra Marie 39, 218 

Terry, William C 230 

Tews, Gertrude Hedwig 218 

Thayer, Abel Huston 139 



„ /4 *V*££ 



THE HOSPITAL BULLETIN 



Theater Benefit 

The Pathological Endowment Fund 

Throat, Septic Sore 108, 155, 

Tiffany, Louis McL 

Tobey, Nathan D 

Training School for Nurses 



Address to the Graduates of 

Alumnae of 

Commencement of 

Treatment of Aneurisms of the Arch of the 
Aorta and of the Innominate Artery by 
the Introduction of Foreign Bodies Into 
the Sac 

Tube Cases, Some Recent 

Tubercular Bone Abscesses, Improved Treat- 
ment of 

Tucker, Henry McKee 

Tullidge, E. K 

Turner, John 

Tuttle. Arnold D 

Typhoid Fever and Its Complications, 
Symptomatology . 

Ulcer, Gastric 

Undergraduate Notes 18. 39, 198. 217, 

Underbill, A. J 

University Hospital Appointments 

University Hospital Staff 

University Loses Her Provost 

University of Maryland Medical Society. . . . 

Vacation Times 

Valentine. A. "W 

Van Poole, ( rideon M 

Vega. ( ierardo 

Vinup, Fred 



■AGE 

18 
132 

196 

20 

58 
61 

232 

57 



124 

221 

88 

38 

198 

137 

10 
128 
234 

15 

75 

117 

9 1 
39 

1 12 

15 
156 

107 
230 



PAGE 

Visitors to Hospital 155 

Visitors to University Hospital 177 

Walton, Henry R 120 

Ward at Hospital, B. & 174 

Warren, Robert Alex 35 

Waters, Charles A 135 

Wegge, William F 196 

We Have Piped Unto You and Ye Have 

Not Danced 53 

Weiner, Hvman R 58, 159 

West. M. B 58 

Whichard, Murray P 197 

Whims, Thomas Gay ~~j 

Who Shall It Be. ..' 92 

Williams, C. B '39 

Williams. J. Whitridge 137 

Wilson, Gordon 138 

Wilson, Luther B 96, 197 

Winchester. Benjamin T 219 

Winslow, FitzRandolph 156 

Winslow, John R 109. 137 

Winslow. Nathan 133, 108 

Winslow. Randolph 15. 7,2, 95, 174. [98 

Woodruff, Charles S 137 

Woods, Dr. Hiram, In Honor of jo 

Wooton, William T 15S 

Worthington, Thomas Chew I35 

Wright. Ann Chapman 19 

Wright, Eugene Bascom 58. 105. 135 

Wright, Josephus A 1 18. 174 

Young, Calvin T 155 

Young, George 07 

Yourtree, George W 159 

Zueblin, Ernest 96, Tit. 153. 155