Various

“ If one lives in a city, where the services of specialists are readily obtained, he may, if he desires, refuse certain cases, and take only such as he wants—say such as belong to internal medicine. But in so doing he becomes a specialist himself, and if he has neglected a properly prepared special course for undergraduates while a student he will miss information of great use to him as an internist. Many men, however, do not practice where specialists are easily obtained, and, perforce, must take cases which would logically come under one or other of the recognized specialties. ”

“ In the evolution of general and medical education in this country it is becoming more and more evident that a well-rounded university needs a strong medical department, and it is now equally clear that a medical school cannot reach the highest stage of its development except as the medical department of a strong university. It is evident that within a few years the medical schools of this country will, with few exceptions, be the medical departments of universities. ”

“ The ideal plan, in my judgment, is to get rid of didactic lectures and examinations by the end of the third year, and to devote the fourth to clinical observation. Genito-urinary work, gynaecology, rhinology, neurology, ophthalmology, otology, cannot be learned from text-books or lectures, at least in such a way as to become integral parts of a man's daily thinking. And to my mind this is the only special information which will help the general practitioner in his daily work. A few hours spent in a large clinic brings more instruction than a whole year of lectures. ”

“ Either prolonged hospital experience, as interne or clinical assistant, or a special individual course, with a competent teacher, is needed for a decent foundation in special work.
It seems to me that with undergraduate work the first important step is to secure the attention of the men, and convince them that there is something in the special course worthy of notice. There is a state of mind, not unnatural to the undergraduate, regarding specialties. Most of them propose to begin professional life as general practitioners. ”

“ As a matter of fact, it is easy to frame questions so that this “crammed” information is of little use, and the most liberal grading hardly ever brings such men up to a passing mark. The mental attitude of these men is unjust to themselves, their teacher and the patients who, in the near future, will entrust to them their physical welfare. The very term “general practitioner” implies a general knowledge of medicine. ”

“ Troubles which would lead the patient to go to the specialist primarily, without consulting his family physician, should receive little attention.
Two other classes of lesions in such organs as are usually handed over to specialists should receive attention in the undergraduate course—those which are apt to cause remote or reflex disturbances, and those which are definitely symptomatic of central lesions. The first should, in my judgment, be dwelt upon only to such an extent as to enable the student to know causative relation and method of diagnosis. ”

“ No member of the Faculty is more esteemed and beloved than is Professor Chew.
Dr. Leonard O. Sloane, of Juneau, Alaska, who has been visiting Baltimore for several weeks, has left the city. He came to this city to avail himself of the opportunities for clinical instruction offered by this University, and was much pleased with the work he was able to see 59at the University Hospital, the Woman's Hospital, the Hebrew Hospital and at Bay View. He is physician to St. Ann's Hospital, at Juneau, and is a progressive and able member of our profession. ”

“ Yet the responsibility for eyesight in one, and may be life in the other, may depend on the diagnostic ability and therapeutic resources of the man who first sees the case. Men are blind and children dead because a general practitioner has not known enough of what was offered him when a student to make a correct diagnosis. ”

“ In the investigation of the problem of a chemical co-relation between the salivary glands and the stomach, Dr. Hemmeter has done meritorious work, a great part of which it has been my good fortune to observe and assist in personally; though I am a physician in the employment of the government at Washington, I consider myself a post-graduate student of Professor Hemmeter. I have seen personally four of his animals that had successfully been nursed through the Pawlow operation and extirpation of the salivary glands after months of the most trying work. ”

“ When a worker occupies himself with the effect of the extirpation of one organ of digestion upon the organs in the next segment of the digestive apparatus, he naturally thinks of phenomena of exclusion or loss of function in one or the other of the segments following the one extirpated, but instead of phenomena of exclusion it is conceivable that those of exaggerated activity in the other segments of the digestive tube might result. ”

“ It is not these men whom I propose to discuss, save to say, in passing, that the average six weeks' or two months' course offered by post-graduate schools is totally inadequate. As a rule such courses attract a large number of men who do little more than follow the clinical work of some well-known specialist and pick up what they can. ”

“ Maryland, Surgeon to the Presbyterian
Hospital, Baltimore. The esophagoscope has passed the experimental stage in the diagnosis and treatment of esophageal lesions. Its usefulness has been demonstrated so often that it would seem superfluous to dilate upon its value. Its use, however, is not as general as it should be. There are still those who consider esophagoscopy unnecessary or impracticable. At the Presbyterian Hospital we have had numerous instances of its practicability, and with us it has become the routine practice to examine all patients complaining of obscure esophageal symptoms. ”

“ The head seems large for the body, the fontanel is open until the eighth or tenth year, the forehead is low and the base of the nose broad, so that the eyes seem unusually wide apart. The lips are thick, the mouth half open and the tongue protrudes slightly, the cheeks are baggy and the hair is coarse, short and straight, and the skin has the peculiar leathery feel of elephant skin. ”

“ Gummy tumor of bone develops either under the periostum, in the substance of bone, or in the medullary canal. It is simply an intensification of the process found in the inflammatory form just described, the difference being that the cell hyperplasia is more abundant. Much of the new material collects in a circumscribed space, and being more rapidly formed and less capable of organization, it entails more profound lesions by its retrograde metamorphosis. Generally tumor of the bone is, therefore, a much more serious form of disease than osteo-periostitis. ”

“ Hemmeter has already informed you that in some animals the loss of gastric juice after extirpation of the salivary glands is only temporary, and that in varying time—in some cases three weeks, in other animals three to four months—there is a gradual resumption of gastric secretion. This resumed secretion, however, never becomes as effective as it was in the same dog before an operation. The question when to begin to make observations on an operated animal depends entirely upon the state of this animal ”

“ The abdomen is pendulous, large, streaked with prominent veins, and reminds one of rickets. The skin is dry, the voice husky and rough. There is but one word which describes the peculiar clumsy manner of walking—that word is waddle. The child actually waddles like a duck. The temperature is always subnormal, and one of the things the mother will always call to your attention is the fact that the child has such cold hands and feet and requires so much more cover than the other children. ”

“ The pain is aching, acute, throbbing or boring in character, while tenderness upon pressure and percussion is most exquisitely excruciating. The diagnosis of inflammatory osteo-periostitis is comparatively 45easy, if we remember the characteristics, viz., an oval, painful, boggy or even hard bony lesion, accompanied by nocturnal exacerbations of pain, with a concomitant or antecedent history of syphilis. ”

“ The technique of these operations, the high-grade sensitiveness of operated animals, the refinement with which chemical tests should be made, all require for their safe conduct that the experimentor should work only with those men who are used to his system. ”

“ Certain as it is that a single acting cause can bring about any one of the several anomalies of menstruation, just so certain is it that a single remedial agent—if properly administered—can effect the relief of any one of those anomalies. ”

“ The examination of the esophagus was made under ether with the head in the extended position. No foreign body was found, but the upper end of the esophagus was red, swollen and edematous, and seemed to be closed. The patient was given cold milk and ice bags to the throat. For two days she suffered excruciating pain on swallowing, and it looked as if we would have to resort to rectal feeding. The next day there was slight amelioration of the pain, which gradually disappeared. ”

“ Hemmeter is not, as it might appear to be, only an inquiry into the physiology of a limited part of the digestive apparatus, but it is an attempt to solve a biologic problem and to get at the broad basic principles that underlie the chemical co-relation of the organs. ”

“ She is at present living with her husband, and says he is apparently well and sound, but drinks heavily, and when under the influence of liquor abuses her a great deal. Patient denies ever having had tuberculosis, syphilis, diphtheria, typhoid, scarlet fever, malaria, grippe, gonorrhoea, or any of the nervous or malignant diseases. ”

“ The sac was exposed and carefully dissected free from its surrounding tissues, and upon examination was found to be continuous with the covering of the testacle (giving the appearance of a congenital hernia) . The sac was next opened and found to contain small intestines and a Meckel's diverticulum. Following this the intestines were replaced in the abdominal cavity. Digital examination through the internal ring showed the bladder to be adherent to the peritoneum at the margin and toward the median line. The sac was tied close to the internal ring, cut free. ”

“ The following is a case of syphilis in which osteo-periostitis developed:
On January 22nd, 1909, R. B., age 35, white, a housewife, applied to the Medical Department of the University Hospital Dispensary for treatment, complaining of rheumatism in her back and a sore shin. The patient has been married 14 years and has had four children; the two eldest are the only ones now living. ”

“ The third annual banquet of the General Alumni Association of the University of Maryland was held Thursday, April 22, 1909, at the Eutaw House, Baltimore. About 90 were present. The affair was a thoroughly enjoyable occasion, but more enthusiasm would have been evident if more of the members of the various faculties had been present. The Pharmaceutical Department, with less professors than the other departments, had most members present. The speeches were witty and instructive, and teemed with expressions of loyalty to the University. ”

“ The child is much dwarfed, the fingers and toes are short and stumpy, the cutaneous tissues seem to be thick and boggy, but do not pit on pressure, as in ordinary oedema. The facies is extremely characteristic. ”

“ The Baltimore City Medical Society has elected our alumni to the following offices for the ensuing year: President, Dr. Jacob Hartman; board of censors, Dr. Randolph Winslow.
Dr. G. Lane Taneyhill, of Baltimore, is a member of the House of Delegates of the American Medical Association from Maryland at the present meeting of the American Medical Association, at Atlantic City.
Dr. A. E. Ewens, of Atlantic City, was a member of the Committee on Section Meetings at the recent meeting of the American Medical Association. Dr. ”

“ William Hungerford Burr, class of 1884, a member of the American Medical Association, for four years surgeon in charge of the Santa Fe System Hospital and surgeon to the Clark Coal Company, Gallup, New Mexico, died in the Santa Fe Hospital, Albuquerque, 77New Mexico, April 13, 1909, from pneumonia, aged forty-nine. ”

“ This is only one specimen of the gross ignorance and superstition of the hill people. They treat or mistreat themselves often when ill principally by making teas of various herbs, such as boneset, etc. ”