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and the essay or paper be considered by them worthy of publication. If publisht, the distribution of said essay shall be entirely under the control of said Trustees. In case they do not publish the said essay or paper, it shall be the property of the College of Physicians of Philadelphia."

The prize is open for competition to the whole world, but the essay must be the production of a single person.

The essay, which must be written in the English language, or if in a foreign language, accompanied by an English translation, must be sent to the college of Physicians of Philadel phia, Pennsylvania, U. S. A., before January 1, 1901, addressed to Richard C. Norris, M. D., Chairman of the William F. Jenks Prize Committee.

Each essay must be typewritten, distinguisht by a motto, and accompanied by a sealed envelope bearing the same motto and containing the name and address of the writer. No envelope will be opened except that which accompanies the successful essay.

The Committee will return the unsuccessful essays if reclaimed by their respective writers, or their agents, within

one year.

The Committee reserves the right not to make an award if no essay submitted is considered worthy of the prize. JAMES V. INGHAM, M. D., Secretary of the Trustees.

June 15, 1899.

University of the State of New York-Medical

Examination.

[From the Med. Review of Reviews (rearranged).] QUESTIONS, WITH ANSWERS, IN PATHOLOGY AND DIAGNOSIS.

1. Describe the process of bone repair. Answer: The blood and other exudates are gradually absorbed. The neighboring connective tissue cells proliferate and form granulation tissue. Under the influence of the cartilage and periosteum cells this tissue changes into cartilage or osteoid tissue resembling bone, but containing no lime salts. In the course of a few weeks this callus becomes truly osseous by a transformation practically identical with the normal development of bone from cartilage, periosteal and other fibrous tissue. Much of the redundant callus, however, is absorbed, so that the repaired bone approximates the normal size and shape.

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2. Describe the process and terminations of simple inflammation? What is productive inflammation?

Answer: The process of simple inflammation is characterized by hyperemia, dilatation of the vessels and retardation of circulation; an exudation from the vessels, of lymph and blood cells and a proliferation of the cells exuded and of the tissue involved.

Such a process may be acute or chronic. Its termination may be resolution with absorption of exudate and return to normal condition, or suppuration may occur, or other specific inflammation supervene.

Where the exudate becomes organized, as it often does when that exudate is fibrinous or the process is chronic, new vessels permeate the tissue and connective tissue cells form. This is called productive inflammation.

3. What degenerative changes take place in arteries?

Answer: Fatty degeneration.
Calcification.

Amyloid degeneration. Hyalin degeneration. 4. What are tube casts? How are they recognized and what is their clinical significance?

Answer: Casts of the uriniferous tubules in the kidney, composed of various substances there exuded, and of sufficient consistency to maintain their form. They are recognized thru the microscope, in urinary deposits, by their shape, size, outline and general appearance. They usually signify some form of renal inflammation.

5. How do the diphtheritic exudates differ from simple catarrhal exudates?

Answer: Simple catarrhal exudates consist of serum, fibrin or pus, mixt with mucus degenerated epithelial cells.

Diphtheritic exudate may be that of simple catarrhal inflammation, or, as is more common, may be a fibrinous exudate infiltrating the mucous membrane, or, mingled with pus cells, epithelial cells, blood, granular matter and bacteria, forming a pseudo-membrane over the inflamed tissue. This pellicle alone, or with it the tissue beneath, may undergo necrosis. Among the bacteria may be found the Löffler Bacillus Diphtheriæ.

6. What structural changes take place in cirrhosis of the liver?

Answer: New connective tissue is formed varying in character, amount and distribution in different cases. Depending upon those variations, the hepatic cells may be flattened or atrophied from pressure, or, from interference with the portal circulation, they may atrophy or become fatty, or they may become bile-stained.

The hepatic and portal veins, the gall ducts, and, less frequently, the hepatic arteries, may become obliterated by pressure.

7. Thru what avenues do bacteria enter the system and how are they eliminated?

Answer: The nose and respiratory tract, the mouth and alimentary canal, the anus, the genital tract and thru abrasions of the skin.

Elimination may take place by egress thru any of the above avenues, or inside the body by simple death, or by destruction by the systemic reaction, leucocytes, phagocytes, etc., or artificially by means of antiseptic drugs.

8. What secondary changes take place in the heart in chronic mitral regurgitation?

Answer: The left ventricle becomes

dilated and hypertrophied. Later the right ventricle is hypertrophied, and in the last stages may become dilated.

9. What aids to diagnosis are utilized in the treatment of persons affected with stomach lesions?

Answer: The stomach tube and washing of the stomach.

Electricity-illumination for diagnosis, perature chart. electrization in treatment.

Regulation of diet.

Surgical procedures.

10. What causes general anemia? Make a diagnosis of general anemia.

Answer: (1) Loss of blood, hemorrhage. (2) Improper assimilation of nutritive products and lack of sunlight. (3) Abnormal expenditure of blood constituents, pregnancy, lactation, etc.

Diagnosis-The symptoms and appearance of the patient readily suggest the diagnosis.

Differentiated chlorosis by the fact that the hemoglobin is not reduced disproportionately to the loss of red cells.

In pernicious anemia megaloblasts are found.

In leucocythemia the white cells are greatly increast in proportion to the red. In pseudo-leucocythemia there are enlarged glands.

11. Mention and differentiate the species of taenia.

Answer: Tenia solium-Head with four suckers and a beak of twenty-five or more hooks. Top of head pigmented. The mature segment contains the central uterus which bears eight or ten branches on each side, which ramify like a tree.

Tenia mediocanella-Head, four suckers, but no hooks. The segments broader and thicker than the solium. The branches of the uterus are twenty or more in number, and branch dichotomously.

Bothriocephalus latus-The largest tapeworm. The head a little club-like swelling with two slit-like suckers on the side. The adult segments short and wide; the uterus thick and tortuous, but not branching, with the sexual opening on the ventral surface, instead of at the side, as in the preceding.

12. Give the normal boundaries of the liver.

Answer: The upper border or surface is opposite the fourth intercostal space.

The lower anterior border is about even with the right free costal border in the adult male, except at the left, where it lies

a little lower than the ensiform. In the female and the child the border is below the costal border.

To the left the liver extends just beyond the median line, to the right it lies against the chest wall.

13. What are the characteristic lesions of typhoid fever? Give pulse and tem

Answer: The solitary and agminated glands of the intestine are swollen in the first week; they then become ulcerated and more or less necrosed, and finally healed in the fourth week. The inflammation may involve only Peyer's patches or the solitary glands as well, or the solitary glands in the colon.

Temperature Chart-First week, steady, gradual rise of temperature, higher in evening and lower in the morning, but each day this difference becomes less; second week, a steady, high temperature, with but little variations; third week, greater variations, the morning temperature beginning to fall; fourth week, decline of both morning and evening temperatures by gradual lysis. This chart varies almost infinitly.

The pulse chart is not characteristic. In an uncomplicated case the pulse rapidity follows the heighth of the temperature.

14. Differentiate varicella from variola. Answer: Varicella is a much less severe disease than variola. There is slight rise in temperature when the eruption appears, instead of a high fever and fall of temperature with the appearance of the eruption in the latter disease. The eruption rapidly dries up, not going on to severe suppuration. The history of the patient and knowledge of existing epidemics aid the diagnosis.

15. Make a diagnosis of renal colic by exclusion.

Answer: From nephralgia by general knowledge of the patient, not hysterical, not menstruating, etc.

From biliary colic by watching the course of the symptoms and locality of the pain, and by absence of digestive disturbances and jaundice.

From constipation by noting the condition of the bowels and giving a cathartic.

From appendicitis by the character of the pain and absence of tumor and local tenderness.

From cancer by age and general condition of patient. In cancer hemorrhage might be very profuse.

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A Physician Who Has A Small-Pox Case. It is rather interesting to consider the position of a physician who has the misfortune to be called to a case which develops symptoms of small-pox. It is self-evident that the patient is to be pitied. If it occurs in a city too small to support a regular hospital for contagious diseases, the suggestions for his management will vary from shooting him to a shanty in the suburbs. It is not to his predicament, however, that we would call attention, but to the less manifest troubles of his medical attendant.

They begin with the question of reporting the case to the health board. In all

probability, in these days of quite general vaccination, it is a case of varioloid. There is no history of contagion—volunteered— and the symptoms are irregular. The medical student sticks a pin into the fact that a patient with excruciating backache should be suspected of having variola; unfortunately the first case of it he meets may not complain of backache at all. What he does have is a patient with fever, developing a suspicious rash. What about reporting it

to the Board of Health?

d-d if you don't. You hardly expect It is a clear case of d-d if you do and the gratitude of the patient or his family. If the diagnosis should be erroneous, human nature is not yet up to the plane of forgetting it the next time any members of the family are sick. Reporting an undoubted case will bring upon you the maledictions of the business men because the

trade of the town is seriously injured at once. The one case is magnified to twelve in the neighboring towns, and farmers dare not drive through the place.

Nevertheless, as a conscientious physician you cannot do otherwise than do your best to preserve the health of the community; at your next visit a red card is on the house. You feel repaid for the lamentations of the family, and the bad feelings of the business men by the satisfaction of knowing that you are a public benefactor, and that you have by your timely warning kept the dread disease from claiming many

other victims.

How does the public express to you its appreciation and gratitude? In all sorts of fashions, giving you glimpses of human nature you had not before experienced. A respectable number see nothing surprising They expect, of course, that you always do or worth mentioning in the whole matter.

So.

Some friends continue to come into the office and you feel that they will stand by you tho you are in trouble. But certain ones will maintain that it is shameful that you go on the street after coming out of a pest house. Many will back away from you if they find themselves by chance in proximity. Your practice will be almost limited to the few who have not heard that you are the small-pox doctor. You can not play whist in your club, you can not go to church, you can not go anywhere, for there are sure to be some nervous bodies there whose misery would spoil your comfort.

Of course you have changed all your clothing and left your old suit to be burned;

you have scrubbed up with bichloride but you get to have a very active sympathy with the lepers of Palestine. However, this is all a part of a doctor's life, and the moral is that you ought not to have been a doctor.

You are finally able to cheerfully answer all sorts of fool questions about small-pox, and to be contented with your one patient, but you do finally lose your temper over a thing unworthy of your notice. Somebody who objects to the compulsory vaccination of his children proclaims that the whole affair has been gotten up by the doctors who have faked a case because their business got dull.-Charlotte Med. Jour.

Lactic Acid in Alopecia.

Médicine Moderne, March 18,1899, states that many Dutch physicians speak highly of the efficacy of lactic acid in baldness. It is used in a 33 per cent. or 50 per cent. solution, the oily matter of the hair having previously been removed by a mixture of alcohol and sulfuric ether. The acid is applied with vigorous friction until the scalp is reddened and irritated. The scalp is then dressed with vaselin. A weak application of sublimate lotion after the acid frictions might serve to prevent pustulation.

Recently it has been found that a 33 per cent. alcoholic solution of the acid is efficacious without producing an unnecessary degree or irritation.—Medical Review of Reviews.

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contracted the disease, and have enjoyed perfect health during their residence among us, especially if varied with flying visits to their mother country. No northerner, however, should unnecessarily expose his person to the possibilities of contracting this disease, altho the type found here is mild, and, under the new regime, we expect to see it entirely extirpated from the island." *** * * * * *

"There are certain precautions a foreigner must observe while residing in the tropics. He should wear light linen outer clothing and thin undergarments; he should bathe frequently. He must not, at first, expose himself too much to the sun overheating might bring on tarbardillo ' (sunstroke), particularly if the individual is of plethoric constitution. Too much exposure to night air in the lowlands is apt to cause malaria. The excessive abuse of alcoholic stimulants will produce deplorable results. The continuous passage of the poisonous alcohol thru the liver, already excited to increast activity by climatic conditions will certainly produce biliousness, if not an acute congestion and inflammation of the gland. Dysentery and diarrhea can usually be avoided with a little care. The bowels should be made to move regularly, and purges, if necessary, should be taken. The newcomer to Cuba finds such an abundance of most exquisite fruits that he is apt to gorge himself with them and thus bring on intestinal disorder. Fruits should be eaten in moderation until the system is used to the new order of things. No water should be used for drinking purposes unless filtered or boiled. "

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heart, but he thinks he knows more than the doctor, if he could only express himself.

The average patient has just enuf of medical learning to misquote. Best tell him simply that he is sick and that you can make him well, perhaps, if he takes the medicines according to directions.Denver Medical Times.

Gleanings.

Benzoic acid used as a gargle is valuable

in sort throat.

Canabis sativa is a remedy for gonorrhea and impotence.

Alcohol is claimed to be a specific in locol carbolic acid poisoning.

Do not overlook the value of nux vomica in the treatment of atonic dyspepsia.

Calomel, 80 grains to one ounce of vaselin, is said to promptly relieve pruritus vulvæ.

Jaborandi, internally and locally, is said to give good results in the treatment of erysipelas.

Salicylic acid, one dram; boric acid, one ounce; hot water, two quarts, is Thiersch's solution.

It is claimed that in the enuresis of children lycopodium is sometimes more efficient than belladonna.

Dr. H. T. Patrick says that persistent yawning may be one of the earliest symptoms of general paralysis.

We have received a beautiful lithograph entitled "The First Meeting of the Medical Society of London," suitable for framing, from the Mellier Drug Co., St. Louis. If you have not received a copy, we think that one will be sent you

Macrotin is useful at the climacteric : headache, mental derangement, flushes, free upon request to the above mentioned firm.

heats and insomnia.

Dr. Leuf, of Philadelphia, says that a patient with pulmonary tuberculosis and a pulse that remains at or above 100 is doomed. He has watcht this for a long time and in many cases, and has yet to see it fail.-Medical Summary.

San Francisco, Cal. This is an elegant volume of over 200 pages, and a great many maps and charts. The latter are very ingeniously planned in a way to tell their story at a glance. Offcial documents like this contain much excellent matter, which is not as highly appreciated as it deserves, I suppose because people do not have to pay for it.

Book Reviews.

"Hand book of Constitutional Law;" by Charles E. Chadman, and publisht by the Home Study Publishing Company, Conneaut, Ohio; 206 pages, paper binding, price, 50 cents. The author in a very clear and logical way gives a condensed account of the adoption of our federal constitution and follows it with a full abstract of our federal and State constitutions and amendments thereto, together with the citation of many of the decisions of the courts construing the same. This is a very useful book for those who wish to post up on constitutional law -and we should all do it.

Annual Report of the Health Department of

The prominent instrument house of Lentz & Sons, 18 N. 11th street, Philadelphia, have issued a 5th edition of their catalog of Microscopes and accessories, Bacteriological Apparatus, Diagnosis. This is an attractive catalog of 136 Laboratory Supplies and Instruments for Clinical pages, and it can be gotten for the asking. But don't neglect to appreciate it on this account, for its selling price would be about one dollar if gotten up to sell. This catalog covers a field that is rapidly growing in importance, and the physician, whether old or young, who neglects it will soon be clast among the "fogies." Get this catalog and see what you need to work with.

"Keil's Medical, Pharmaceutical and Dental Register-Directory and Intelligencer for Philadelphia and vicinity." Fifth edition. Publisht by George Keil, 1715 Willington street. Price, $3. In addition to names, it contains full information as to colleges, hospitals, asylums, societies, etc. Very useful, or rather indispensable, to those who need this line of information.

Gray Summit, Mo., June 5, '99.

Dr. C. F. Taylor, Philadelphia, Pa.

Dear Doctor:-My subscription to THE MEDICAL WORLD expired with the April number, but I don't feel like I can do without it, so I enclose one dollar for another year. I like THE WORLD not only for its many interesting and instructing articles on professional subjects, but also enjoy reading the Editor's Monthly Talks. You argue just as I think. It is a mighty task you have undertaken, but it is a work out of which much good may come, and of which the toiling millions are in dire need If every publisher would show his patriotism and unselfish interest in this way, we would soon cease to hear the mournful cry of oppression and want that is now going up from nearly every part of the country. Let the good work go on, and as it goes on may it gather force and weight and volume until its power is recognized in every municipality, and until the great load of oppression that is slowly but surely grinding the bone and muscle of the nation into the dust, and dwarfing and corrupting our moral and mental abilities, is removed, and its promoters are made to see and understand the effects of their greed for gain without regard to results. Yes, Mr. Editor, "hit 'em again," and keep right on hitting 'em. Success to you and THE WORLD. Yours truly,

W. M. WHEELER, M. D.

Our Monthly Talk

A legal friend presents the following thoughts upon the amending of our constitutions :

Amending Our Constitutions.

"Have our citizens forgotten that all of our constitutions, both state and national, make ample provisions whereby they can be amended? It seems so. A year or two ago the legislature of Pennsylvania past a law for a graduated taxation of inheritances. The courts held

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