The course of instruction at the Army Medical School will be of eight months' duration, commencing on the first of October next succeeding the preliminary examination; it will consist of lectures and practical work in such subjects as are peculiarly appropriate to the duties which a medical officer of the army is ordinarily called upon to perform. During this course of instruction the candidates will be held under military discipline, and character, habits, and general deportment closely observed; if for any reason a candidate should be deemed undesirable he may at any time, on the recommendation of the Surgeon-General, be honorably discharged by the President.

The final examintaion shall comprise the subjects taught in the school, namely: Duties of medical officers, Medical Department administration and customs of the service, military hygiene, clinical microscopy and bacteriology, military surgery, military and tropical medicine, sanitary chemistry, Hospital Corps drill, operative surgery, ophthalmology and optom etry, X-ray work. It will be preceded by a thorough physical examination.

Candidates who, in their final examination, obtain a general average of 80 per cent and upward shall be given certificates of graduation at the school, and those whose aptitude, as determined by the faculty, is deemed satisfactory and who, in addition to their fine examination, pass a successful clinical examination, will be selected for commission in the Medical Corps. Candidates claiming a knowledge of ancient or modern languages, higher mathematics, or scientific branches, other than medical, may be given a special examination therein.

The relative standing of the candidates thus selected for commission will be determined by the total number of points obtained in, the pro fessional subjects of the preliminary examination as well as in the final, clinical, and special examinations, and for aptitude.

Candidates who fail to receive commissions because of lack of vacancies in the Medical Corps at the time of graduation may receive them in the order of their standing as vacancies occur before the graduation of the next class. The remaining qualified candidates, if any, will be preferred for selection for volunteer commissions and for assignment on active duty in the Medical Reserve Corps.

Any candidate who, at his final examination, fails to qualify mentally shall not be entitled to a re-examination. Any candidate who qualifies mentally but fails physically shall, upon the recommendation of the Surgeon-General of the Army, be given an opportunity to be reexamined physically with the next class, and if then found qualified may be commissioned

without further mental examination, his standing in the class being determined by the aggre gate of the marks obtained in the examinations already passed by him.

The act approved April 23, 1908, gives an increase in the corps of six colonels, twelve lieutenant-colonels, forty-five majors, and sixty captains or first lieutenants. The increase in the higher grades insures promotion at a reasonable rate all through an officer's military ca reer. The first advancement to the grade of captain takes place after three years, instead of five, as heretofore, and this rapid promotion, together with the liberal pay now given all officers of the army, offers such manifest advantages to young physicians that the very best and most representative graduates of our medical schools should be attracted thereby. As accepted candidates for the Medical Corps are appointed first lieutenants of the Medical Reserve Corps during their service and instruction at the Army Medical School there is no delay in receiving the pay of lieutenant, and no final loss of relative rank in the corps to those who successfully pass through the school, as no appointments are made to the Medical Corps except from the succesive graduating classes from the school.

The period of instruction at the school, although an anxious time for the candidate, is looked back upon by the graduates as a most pleasant and profitable part of their service. The time of all students is fully occupied, but those who work steadily and faithfully and are well grounded in medicine need not fear failure at the end.

The large number of vacancies created by re cent legislation makes it certain that all successful candidates will be recommended for commission for several years to come.

as

Suppurating arthritides do not always require exposure of the joint or even large incisions, irrigation and drainage. Such treatment invites mixed infection and ankylosis. If the pus be very thineven though of streptococcic origin-thorough piration (which may need to be repeated) and immobilization may effect a rapid cure with perfect function. Purulent arthritis and periarthritis as it occurs in small children as a complication of one of the exanthemata (often in connection with trauma) is often quite amenable to conservative, and even ambulant, treatment: aspiration, or irrigation and drainage, and immobilization. Judgment is needed, of course, to determine what cases are amenable to this conservative surgery, and what point in the treatment it must be abandoned in favor of more extensive intervention.

An hypertrophied lingual tonsil sometimes causes much discomfort, giving a heavy, sore feeling to the base of the tongue. It may be necessary to remove it.

It will be to the advantage of the candidate to pass the required examination and secure a commission at as early a date as possible.

Applications for permission to appear for examination prepared in accordance with requirements before mentioned, should be sent to The Adjutant-General of the Army, and when completed will be filed in this office until the next succeeding preliminary examination shall have been decided upon, when formal invitations to appear before a board will be issued. Applicants are advised to file the necessary papers as early as practicable, in order that the places of examination may be arranged most conveniently to applicants, due regard being had to the interests and necessities of the service.

To illustrate the general character of written questions submitted, a few examples from the records of an Army Medical Examining Board recently convened are hereto appended. There are now 103 vacancies in the Medical Corps of the Army.

R. M. O'REILLY, Surgeon-General U. S.Army. Approved by the Acting Secretary of War, May 23, 1908.

War Department, Surgeon-General's Office, Washington, May 25, 1909.

Book Notices

Gynecology and Abdominal Surgery, Volume II. In two large octavos. Edited by Howard A. Kelly, M. D., Professor of Gynecologic Surgery at Johns Hopkins University; and Charles P. Noble, M. D., Clinical Professor of Gynecology at the Woman's Medical College, Philadelphia. Large octavo volume of 862 pages, with 475 original illustrations by Mr. Hermann Becker and Mr. Max Brodel. Philadelphia and London: W. B. Saunders Company, 1908. Per volume: Cloth, $8.00 net; half morocco, $9.50 net.

The second volume of Kelly and Noble's book deals more particularly with abdominal surgery. Spleen, pancreas, liver and stomach are considered by such excellent surgeons and writers as Moynihan, Ochsner, Murphy, Kelly and others.

We cannot quite see why diseases of the breast should be included in a text-book of this sort, although the chapter upon this subject by Bloodgood, of Johns Hopkins, is one of the very best of all the monographs and is profusely illustrated by numerous colored plates, photographs, etc.

Whitridge Williams writes in his usual interesting way concerning extra-uterine pregnancy. The longest chapter in the book is that by Murphy on intestinal surgery. The services of Hermann Becker, Max Brodel and others help to make this chapter one of the masterpieces of modern book publication. The concluding chapter in the volume is by Noble and deals with surgery of the kidney.

It is hard to find words that will express the masterly way with which each phase of the many subjects considered in these two volumes is handled by the author to whom the work is allotted. Every person who wishes to do abdominal surgery

must have these two volumes upon his shelves for constant reference. Especially should we extend our praise to the clearness and detail with which all operative procedures are described and to the mas terly illustrations of the various operative steps coming from the art laboratory of the Johns Hop kins Hospital.

NATIONAL ASSOCIATION FOR STUDY

AND PREVENTION OF TUBERCULOSIS. Transactions of the Fourth Annual Meeting, Chicago, Ill., June 5 and 6, 1908.

Aside from the general transactions of the Society the columns contain many excellent contributionstoo many, in fact, for so brief a notice to touch upon with justice.

The following list of titles and authors from the table of contents will perhaps give the most im partial notice, for every contribution is in its line deserving of special mention:

The Campaign in the United States-By Living. ston Ferrand, M. D.

With a State Sanatorium Secured, What NextSymposium.

Tuberculosis in Hospitals for the Insane—By H. A. Tomlinson, M. D.

Tuberculosis in Prisons-By H. C. Sharp, M. D. The Orphan Asylum and Its Duties to Its Wards -By Ethan A. Gray, M. D.

Employment for Arrested Cases of TuberculosisBy Charles J. Hatfield, M. D.

Tuberculin Tests-By Arnold C. Klebs, M. D. Clinical Study of the Effects of Tuberculin Treatment on the Serum Agglutination of Tubercle Bacilli By Hugh Kinghorn, M. D., and David C. Twichell, M. D.

Immunity Production by Inoculation of Increasing Numbers of Bacteria, Beginning with One Organism; Preliminary Report-By Gerald M. Webb, M. D., and William W. Williams, M. D.

The Heart in Pulmonary Tuberculosis-By Lawrason Brown, M. D.

The Changes in the Lungs in Systemic Blastomycosis as Contrasted with Those of TuberculosisBy E. R. LeCount, M. D.

Acute Pylephlebogenous Miliary Tuberculosis of the Liver with Clinical Picture of Acute Infectious Jaundice; Primary Tuberculosis of Mesenteric Glands-By Aldred Scott Warthin, M. D.

The Clinical Application of Bacterial Vaccines in Cases of Pulmonary Tuberculosis-By Sherman G. Bonney, M. D.

Explanation of Seemingly Paradoxes in Modern Phthisio-Therapy, with Particular Reference to Sun, Air, Water and Food as Remedial Agents-By A. Adolphus Knopf, M. D.

The Municipal Anti-Tuberculosis Work in Boston-By Edwin A. Locke, M. D.

Report of the Committee on Clinical clature.

Nomen

Epoch-Making Contributions to Medicine and Surgery. Epoch-Making Contributions to Medicine, Surgery, and the Allied Sciences; Being Reprints of Those Communications Which First Conveyed EpochMaking Observations to the Scientific World, Together With Biographical Sketches of the Ob servers. Collected by C. M. B. Camac, M. D., of New York City. Octavo of 435 pages, with portraits. W. B. Saunders Company, 1909. Artistically bound, $4.00 net.

for

The contributions to medical literature are be coming so voluminous that it is ofttimes difficult to isolate the work of those whose endeavors conThis stitute an epoch-making event in medicine. work undoubtedly occupies a unique position among the volumes which are daily being produced the edification and interest of the medical man. The contents are divided into seven chapters embracing the subjects of antisepsis, circulation of the blood, percussion of the chest, oscultation and the stethoscope, vaccination, anesthesia, and puerperal fever. Each chapter is preceded by portrait of the leading scientist who did more than any other to place the subject under discussion in the high plain of scientific attainment which it occupies today. Following the portrait in each chapter, a number of the succeeding pages is occupied with an account of his life and works, which is in turn followed by a discussion of the various subjects. In glancing over the various chapters, surely the collector of these selected the contributions of men who in truth did, and who always will, through their work, influence the science and art of medicine.

This work should have a place in the library of every physician and student who reverences the memory of those men whose unselfish endeavors have so materially aided in placing medicine among the exact sciences of today. The book is attractively gotten up, the type clear and bold, and the half-tones distinct and artistic. The reviewer feels that he cannot too strongly recommend the possession of this book by all true students of medical science.

Saunders' Pocket Medical Formulary. Saunders' Pocket Medical Formulary. By William M. Powell, M. D., author of "Essentials of Diseases of Children." Containing 1,831 formulas from the best known authorities. With an appendix containing posologic tables, formulas and doses for hypodermic medication, poisons and their antidotes, diameters of the female pelvis and fetal head, obstetric table, diet lists, materials and drugs used in antiseptic surgery, treatment of asphyxia from drowning, surgical remembrancer, tables of incompatibles, eruptive fevers, etc., etc. Ninth Edition, adapted to the 1905 Pharmacopeia. Philadelphia and London: W. B. Saunders Company, 1909. In flexible morocco, with side index, wallet and flap. $1.75 net.

Our old friend, Saunders' Pocket Medical Formulary, is again before us, with many of the standard prescriptions revised and improved. For those who feel the need of such a work, none excel this little publication.

Primitive Secret Societies.

A Study in Early Politics and Religion. By Hutton Webster, Ph. D., Professor of Sociology and Authropology in the University of Nebraska. Octavo of 227 pages. New York (1908): The Macmillan Company.

As stated in the preface, the scope of this work

precluded any attempt to supply a detailed examination of the various secret societies. It contains much interesting data on the beginning of secret societies and a valuable bibliography containing practically all of the more important contributions on the subject. The work had its beginning in a thesis for the degree of Doctor of Philosophy at Harvard University and is a scholarly treatise which should not be read with the idea of whiling away an idle hour. For one who is interested in the subject, however, it is well worth reading. The style is somewhat heavy, but the facts are clearly and logically presented.

Nervous and Mental Diseases. By Archibald Church, M. D., Professor of Nervous and Mental Diseases and Medical Jurisprudence in Northwestern University Medical School, Chicago; and Frederick Peterson, M. D., Professor of Psychiatry, Columbia University. Sixth Edition, revised and enlarged. Octavo volume of 944 pages, with 341 illustrations. Philadelphia and London: W. B. Saunders Company, 1908. Cloth, $5.00 net; half morocco, $6.50 net. A critical review of this well known text-book is unnecessary. That it has passed to the sixth edition is sufficient indication of its worth. The section on nervous diseases has been enlarged somewhat, a chapter on psychasthenia has been added, and recent views concerning the motor area have been incorporated. The section on mental diseases has been revised and an article on psychotherapy added. As a text-book on nervous and mental diseases, it continues to be one of the best in the English language.

Diseases of the Genito-Urinary Organs and the Kidney.

By Robert H. Greene, M. D., Professor of GenitoUrinary Surgery at the Fordham University, New York; and Harlow Brooks, M. D., Assistant Professor of Clinical Medicine, University and Bellevue Hospital Medical School. Octavo of 605 pages, profusely illustrated. Philadelphia and London: W. B. Saunders Company, 1908. Cloth, $5.00 net; half morocco, $6.50 net. This work was carefully reviewed about a year ago. The fact that it became necessary to publish another edition speaks eloquently for the fact that its merits have appealed to those interested in this subject, and thus the reviewer is assured that the good words spoken of it at that time have met with a hearty response among the profession, who, in less than a year, have exhausted the first edition.

Mind and Its Disorders.

By

A Text-Book for Students and Practitioners. W. H. B. Stottart, M. D., F. R. C. P., Assistant Physician to Bethlehem Royal Hospital. Philadelphia: P. Blakiston's Son & Co., 1012 Walnut street, 1909.

The book is divided into three sections. In the first, which deals with normal psychology, an attempt is made to correlate mental processes with their physical substitutes in the nervous system, the transcendental psychology of modern schoolmen being ignored as useless to the practical physician of today.

In the second section the psychology of the insane is treated in a similar manner. The classification adopted in the third section almost coincides with that of Kreaepelin. It is not an exhaustive text book on psychiatry, but a perusal of

its pages will go a long way toward giving one an understanding of mind and its disorders.

The stumbling block in the study of psychiatry to the average student and practitioner is his defective knowledge of normal psychology and of the psychology of the insane. Parts I. and II., covering these topics, make up about one-third of the book and are the most valuable portion of it. The chapters on mental diseases are succinctly written and may be read with much profit.

As an introductory work for students and practitioners, the reviewer knows of no work in the English language to compare with it. The book truly supplies a long-felt want and it will be ap proved by the profession.

Books, Pamphlets, Etc., Received.

From W. B. Saunders Co., Philadelphia:

Medical Chemistry and Toxicology. By James W. Holland, M. D. Second revised edition, octavo of 655 pages, fully illustrated. Price, cloth, $3.00 net.

Primary Studies for Nurses. By Charlotte A. Aikens. A text-book for first-year pupil nurses. 435 pages, illustrated. Price, cloth, $1.75 net. : Epoch-Making Contributions to Medicine and Surgery and the Allied Sciences. Collected by C. M. B. Camac, M. D., New York. Octavo of 435 pages, with portraits. Price, $4.00 net.

Constipation and Intestinal Obstruction. By Sam'l G. Gant, M. D. Octavo of 559 pages, 250 original illustrations. Price, $6.00 net; half morocco, $7.50 net.

Saunders' Pocket Formulary.

By William M. Powell, M. D., containing 1,831 formulas. Flexible morocco side index, wallet and flap. Price, $1.75 net.

Text-Book of Materia Medica, Pharmacology and Therapeutics. By George F. Butler, M. D. Sixth revised and enlarged edition. Octavo of 708 pages. Price, cloth, $4.00 net; half morocco, $5.50 net.

From Lea & Febiger, Philadelphia:

Progressive Medicine. A Quarterly Digest of Advances, Discoveries and Improvements in the Medical and Surgical Sciences. By Hobart Amory Hare, M. D. March, 1909. Vol. XI., No. 2. $6.00 per annum.

From J. B. Lippincott Co., Philadelphia:

International Clinics. A Quarterly of Illustrated Clinical Lectures and Especially Prepared Original Articles. W. T. Longscope, M. D., Philadelphia. Vol. I., 19th series, 1909.

From Funk & Wagnalls Co., New York: Self-Control and How to Secure It. By Prof. Paul Dubois. A popular yet strictly scientific exposition of the basis of mental control, and how perfect balance may be obtained. Price, $1.50 net; by mail, $1.60.

From L. Webster Fox, A. M., M. D., Philadelphia: The Value of Morphine Derivatives in Ocular Therapeutics. (Reprint Ophthalmic Record, August, 1908.)

High Frequency Current in Ophthalmic Practice. (Reprint Journal of Advanced Therapeutics.)

COMPLETE SERIES, VOL. LVIII, No. 5 NEW SERIES, VOL. III, No. 5

$2.00 YEARLY

Contributed Articles

PRINCIPLES OF THE MODERN TREATMENT OF GONORRHOEA.*

JOSEPH L. BOEHM, PH. G., M. D., Professor of Diseases and Surgery of the GenitoUrinary Organs, St. Louis College of Physicians and Surgeons.

In this advanced era of pathology and bacteriology, it may seem rather puerile and elementary for one to address a medical assembly on the treatment of gonorrhoea. It is the firm conviction of the writer, that too much cannot be written or spoken about the treatment of this universally prevalent disease, and that it is a sad commentary on our American literature, to peruse most of our text books on genito-urinary diseases and read some of the antiquated methods of treatment of urethral gonorrhoea. Ofttimes more stress is laid on some particular favorite drug of the author, than on a thorough consideration of the correct principles of treatment, in which all drugs are of minor importance.

Almost every drug in the pharmacoepia or dispensatory has at some time or other, been used or recommended as valuable in the treatment of this disease. Notwithstanding the arrogant claims of many pharmaceutical chem ists;

There is no specific drug or treatment for the cure of gonorrhoea. There is no drug or chemical that can be applied to every urethra with equally good results.

It is our purpose in this paper to deal with the principles of treatment, and not dwell on any specific remedial agent or method of treatment. It is of minor importance what drug or chemical is used or what method of application is resorted to, provided the cardinal principle is adhered to, embodied as follows:

*Read in the Symposium on Gonorrhoea, at meeting of the St. Louis Medical Society, May 1st. 1909.

The successful treatment of gonorrhoea consists in the proper understanding and use of the surgical principles of rest and free drainage, and the methodic use of certain classes of drugs and bactericidal agents primarily, and secondarily endeavoring to repair as well as possible any damage to the urethral mucosa and adnexa, resulting from the proliferation and growth of the gonococcus.

Remember, that each urethra has a distinct individuality; some are leathery, others are intolerant and irritable. According to Robinson, "the gonococcus is the king of beasts among germs, as it practically prepares the road for all the pathogenic germs by trauma of the mucosa, producing atria for infection."

Analyzing this cardinal principle, we must then consider as the elements of treatment the following: Prophylaxis, free drainage, rest, bactericidal agents, repair and regeneration of destroyed and damaged mucosa, abnormalities of urine, as hyperacidity, oraluria, phospha

turia, etc.

DRAINAGE.

Evacuate all pus from the urethra, by free drainage, not by the introduction of any for eign material into the urethra, as gauze, etc.; but between the intervals of micturition, the penis should be suspended in a comfortable position, in a dressing retainer and fresh cotton applied to the glans, after each urinary act. A congenitally narrow meatus is an ob stacle to free drainage. By no means should the filthy tobacco pouch be used where the meatus and glans is kept constantly bathed in the pus exuding from the urethra, into the cotton at the bottom of the pouch. No bandage should be applied directly to the penis that is constricting in any sense. The pus of gonorrhoea is as essential to and symptomatic of this diseased condition as pyrexia is in typhoid or pneumonia. When the typhoidal temperature is temporarily reduced with cold and hydro