DENTAL INTERNE (MALE).

Government Hospital for the Insane.

The United States Civil Service Commission announces an examination on August 4, 1909, at the places mentioned in the list printed hereon, to secure eligibles from which to make certifications to fill a vacancy in the position of dental interne (male), at $600 per annum, with maintenance, in the Government Hospital for the Insane, Washington, D. C., and vacancies requiring similar qualifications as they may occur.

The Department states that it reserves the right to terminate the appointment at the expiration of one year of service if it is deemed advisable to do so. The examination will consist of the subjects mentioned below, weighted as indicated: Subjects.

Weights.

This examination is open to all citizens of the United States who comply with the requirements.

This announcement contains all information which is communicated to applicants regarding the scope of the examination, the vacancy or vacancies to be filled, and the qualifications required.

Applicants should at once apply either to the United States Civil Service Commission, Washington, D. C., or to the secretary of the board of examiners at any place mentioned in the list printed hereon, for application Form 1312. No application will be accepted unless properly executed and filed with the Commission at Washington. In applying for this examination the exact title as given at the head of this anouncement should be used in the application.

As examination papers are shipped direct from the Commission to the places of examination, it is necessary that applications be received in ample time to arrange for the examination desired at the place indicated by the applicant. The Commission will therefore arrange to examine any applicant whose application is received in time to permit the shipment of the necessary papers.

Issued July 6, 1909.

Australian Authorities Exclusion of English

Proprietaries.

A number of well-known English manufacturers of proprietary preparations have been unable to secure the admittance of their products into Australia, the Australian authorities basing the exclusion on the ground that the wrappers of the preparations in question contained extravagant claims as to their value. The article will be delivered to the consignee, however, if the importers will remove the objectionable wrappers and circulars.

A Home for Nurses.

James A. Patten has donated $40,000 for the erection of a home for nurses of the Evanston Hospital, Evanston, Ill. This structure will be connected with the main hospital and will provide accommodations for forty employes, including nurses and internes.

Progress in Cuba.

With the beginning of the present fiscal year the Republic of Cuba established a Bureau of Information, President Comez appointing Leon J. Canova, an American newspaper man, who has resided in Cuba eleven years and has a wide acquaintance with the Island, as its director.

Parties wishing information of any nature concerning Cuba can obtain same, free of charge, by writing to Leon J. Canova, U. and I. Bureau, (Utility and Information Bureau,) Department of Agriculture, Commerce and Labor, Havana, Cuba.

Leprosy, Plague and Smallpox in Amoy. Leprosy, plague, and smallpox are present in Amoy, consequently the Philippine authorities have imposed a quarantine on all vessels coming from Amoy and arriving in a Philippine port after April 15, of this year. All vessels arriving after that date are required to enter quarantine at Mariveles quarantine station, where the passengers are disembarked and placed in detention barracks, and the vessel, after inspection and disinfection is permitted to proceed to Manila. The crews, with the exception of the captain and such officers as are exempted by the quarantine boarding officer, remain aboard during their stay in the Philippines. The local shipping firms have arranged for a floating disinfectant plant from the Philippine authorities. In the future all Chinese passengers embarking from this port for the Philippine Islands will be bathed and have their belongings disinfected at this plant under the supervision of the service officer; thus when the disinfection has been completed the passengers are permitted to enter the Philippine Islands without the necessity of detention at Mariveles quarantine station.

Smallpox in Naples.

During the week ended June 13, 25 cases of smallpox with 4 deaths were reported at the health office of the city of Naples.

A case of smallpox was discovered at the examination of steerage passengers for the steamship Hamburg, June 8. The patient was transferred to the Cotugno Hospital for contagious diseases. Ten contacts were returned to the boarding house in which all had been lodged and where they will be held under strict observation for 2 weeks. The lodgers have been vaccinated, and the boarding house has been disinfected.

Book Notices

A Text-Book of Materia Medica, Pharmacology and Therapeutics.

By George F. Butler, A. M. Ph. G., M. D.-Professor and Head of the Department of Therapeutics, and Professor of Preventive and Clinical Medicine, Chicago College of Medicine and Surgery, Medical · Department Valpariaso University; Physician to Francis E. Willard Hospital, etc. Sixth Edition thoroughly revised and enlarged, and adopted to the Eighth Revision (1905), of the U. S. Pharmacopoeia. W. B. Saunders Company, Publishers. The first edition of this book appeared in 1896 and it was revised and reprinted in 1898 and again in 1899; it was reprinted in 1900 and again in 1901; it was revised and reprinted in 1902 and reprinted in 1903; it was revised and reprinted in 1906 and reprinted again in 1906; and was revised and reprinted

in 1908. This shows how large a demand there has been for this work. In both the writing and the reasoning the author has had in mind the needs of the medical student and the desires of the medical practitioner. The book contains 908 pages. It has a very full table of contents and has a general index and a clinical index, both of which are fairly complete. The introduction, which is a succinct discussion of the history of medicine, and the chapter of Pharmacology and General Therapeutics is well worth a careful perusal. On pages 32 to 40 the author rightfully makes frequent reference to Jacque Loebs' work on Physiologic action of Ions, but omits references to Mathews' work, which is likely of equal or even greater note than Loebs. On pages 611 to 627 the author presents a most interesting chapter under the caption, "Animal Extracts (Organotherapy)." He discusses, necessarily briefly the uses of antitoxin serums, etc. The main portion of the work is that which deals with the most used substances of medicine, the drugs. This subject matter is presented for the most part in short attractive paragraphs, each paragraph bearing a heading indicating its contents. The pendulium of drug Therapeutics which swings first far in the direction of polypharmacy and returned far in the course of drug nihilism is now beginning to have an established position. Such works as Professor Butler's will facilitate the gaining and retaining for drugs their proper position in Therapeutics.

The Exploits of a Physician Detective. By Geo. F. Butler, M. D. Professor and Head of the Department of Therapeutics and Professor of Clinical Medicine, Chicago College of Medicine and Surgery. Author of "The Isle of Content," "Love and Its Affinities," etc. Chicago Clinic Publishing Company, 1410 E. Ravenswood Park. The reviewer read this book from cover to cover. It was not of such intense interest as to cause him to lose hours of sleep over it, but neither was the book so uninteresting to cause it to be laid aside unread. It likely furnished the author more pleasure and recreation than it will afford the average novel reader.

A Pocket Formulary.

By E. Guinn Thornton, M. D., Assistant Professor of Materia Medica in the Jefferson Medical College, Philadelphia, Ninth Edition revised. Lea & Febirger, Publishers, Philadelphia and New York. While it is generally considered a better practice for a physician to write his prescriptions for the particular needs of his patient there can be no harm come from his first getting suggestions from what so ever a source. This little medical formulary will offer a multitude of suggestions in a comparatively few pages. The book will just fit the coat-pocket. It is nicely bound and nicely printed.

BOOKS, PHAMPHLETS, ETC., RECEIVED. Treves' Operative Surgery, New (3rd) edition, Vol. I. A manual of operative surgery by Sir Frederick Treves. 775 pages, with 193 engraving and 17 full-page plates. Price, $6.50 net.

From J. B. Lippincott Co.:

International Clinics, a Quarterly of Illustrated Clinical Lectures and Especially Prepared Original Articles. By W. T. Longscope, Phila. Vol. XI, 19th series, 1909. Imperial Octavo, 2088 pages, 1734 illustrations, 541 in colors. Price, cloth, $7.50 net.

From Lea & Febiger:

Progressive Medicine, Quarterly Digest of Advances, Discoveries and Improvements in the Medical and Surgical Sciences. By Hobart Amory Hare, M. D., Phila. Vol. XI. No. 2, June, 1909. Octavo, 317 pages, with 52 illustrations. Price, $6.00 net.

From Longmans, Green & Co., New York City: Further Advances in Physiology by Leonord Hill, M. D. Price, $4.20.

From Moffat, Yard & Co., New York City: Tuberculosis-A Preventable and Curable Disease. 115 illustrations. By Adolphus Knopf, M. D., New York City. Price, $2.00 net; by mail, $2.20. From World Book Co., Yonkers, N. Y.:

Human Physiology, an Elementary Text-Book of Anatomy, Physiology and Hygiene. By John W. Ritchie, Virginia, Illustrated by Mary H. Well

From Eclectic Medical Institute, Cincinnati.
Sixty-fifth Annual Announcement of the Eclectic
Medical Institute.

Polypi in the ear (as in the nose) indicate diseased bone conditions. Removal of the polyp does not prevent recurrence; removal of the diseased bone does.-American Journal of Surgery.

A feeling of discomfort in the mouth while eating may be the first signs of a calculus in one of the salivary ducts.-American Journal of Surgery.

When paraffin is injected subcutaneously allowance should be made for increase in the size of the mass by the growth of connective tissue around it.American Journal of Surgery.

Diverticulum of the bladder, associated with cystitis, may produce symptoms resembling those of prostatic hypertrophy.-American Journal of Surgery.

A mediastinal tumor may be present for some time without other symptoms than cough, expectoration, loss of flesh and slight fever-thus simulating pulmonary tuberculosis. A skiagraph will determine the condition; laryngoscopy is also helpful for adductor paralysis is frequently an early sign.-American Journal of Surgery.

Probably the most important step in radical inguinal hernioplasty is the total removal of the sac. It should be traced back to the loose peritoneum itself, exposing the deep epigastric vessels, the ligature or sutures to be applied at that level. To leave even a little projecting knuckle of peritoneum invites recurrence.-American Journal of Surgery.

Preauricular pain and tenderness points to an enlarged lymphatic gland, a decayed tooth, an affection of the parotid or a neuralgia of the fifth nerve; auricular tenderness itself indicates some affection of the auricle or the external canal; post-auricular tenderness may be hysterical or indicate mastoid disease. American Journal of Surgery.

In many instances where a patient is supposed to have merely a sprain of the ankle, there is some fracture around or into the joint. Signs of fracture should be carefully sought for. Where nothing can be found around the ankle on examination and the patient still continues to complain of pain and weakness, a skiagraph may show a transverse fracture of the os calcus which is held in place by the flexor muscles.-American Journal of Surgery.

Lipoma of the scalp may also simulate a wen. Both grow gradually, are semi-fluctuating and are movable on the deeper parts. Aspiration for diag nostic purposes is not a wise procedure; for if the tumor be a cyst, the contents may readily flow out through a puncture hole, making it difficult to remove the cyst wall at operation.-American Journal of Surgery.

A diffuse swelling of the orbit, moderate exophthalmos, intense pain and tenderness and marked edema, mean an infection extending deeply into the orbital planes. Unless early treatment is instituted, the eyesight may be lost, or the infection may extend along the course of the optic nerve resulting in meningitis or sinus thrombosis. Wherever there is fluctuation, early incision is necessary; and free drainage of the infected area is of paramount importance.-American Journal of Surgery.

COMPLETE SERIES, VOL. LVIII, No. 8 NEW SERIES, VOL. III, No. 8

$2.00 YEARLY

Contributed Articles

EXPERIMENTAL ARTERIO-SCLEROSIS.

By LEON K. BALDAUF, M. D.

Assistant City Pathologist from the Laboratory of Pathology and Bacteriology of the Health Department, St. Louis.

Owing to reports of spontaneous arterial lesions recently observed in rabbits, much doubt has been thrown upon those as experimentally produced. These spontaneous lesions have been described by Miles and Johnstone, by Fisher in poorly nourished animals, by Ophuls and by Kaiserling. Miles and Johnstone and Kaiserling question seriously the acceptance of many of these experimentally produced lesions and suggest that many so described occurred spontaneously. Miller and Pearce, however have recently met the objections of these observers successfully. Miller has shown that in Jores exhaustive review of attempts to reproduce the lesion experimentally no mention is made of successful attempts. He considers also the unsuccessful attempts to reproduce the lesion by subcutaneous and intraperitoneal injection of adrenation as significant. Miller also shows that in Loeb's series of one hundred normal rabbits and in Meronescu's series of three hundred no lesions were found. Pearce, after a careful examination of the aortas of fifty-one normal rabbits, as controls, found spontaneous lesions in three. He concludes

with this statement: "It would appear, there fore, that while spontaneous arterial degeneration may occur in rabbits, it is not as constant a condition in all localities as the investigations of Miles and Johnstone indicate." "In my opinion the occurrence of spontaneous lesions in the rabbit does not diminish the importance of the lesions due to adrenalin, but, on the contrary, increases their importance as

an example of a lesion occasionally occurring naturally, but which may be produced experimentally. The rabbit thus becomes a peculiarly valuable animal for the study of vascular lesions, for the interest of the adrenalin lesion lies not so much in its arterio-sclerosis like nature as in the opportunity offered for the study of degenerative and reparative lesions of arteries."

During the past winter the writer has examined carefully the aortas of a number of large rabbits used at the laboratory of the city bacteriologist in the Pasteur treatment for hydrophobia. In none did he find a lesion in the aorta.

While the finding of spontaneous lesions demonstrates the necessity of large controls in recording experiments of this kind, the locality where these lesions were observed must also be taken into consideration. It has been clearly shown that animals in certain regions are subject to certain diseases, for instance, the spontaneous occurrence of goitre in the dog and sheep in different parts of this country.

The production of experimental arteriosclerosis is necessary, first that the etiology of the disease may be defined, second that the stages in the production of the lesion may be determined and third that, from the knowledge thus obtained, the structure of the lesion produced under other conditions may be thoroughly understood.

A fairly uniform conception of the disease which is to be reproduced renders comparisons relatively easy. With arterio-sclerosis no such uniformity exists. Even the recent articles abound in varied descriptions. Terms as atheroma, arterio-sclerosis, arterio-capillary fibrosis are used separately, each applied to supposedly distinct processes. With some, the conditions of atheroma is stamped as degenerative and affects arteries; arteri-sclerosis is more inflammatory and affects arterioles; while

con

arterio-capillary fibrosis is used in nection with the smallest arterial branches. With others the term arterio-sclerosis is used in a comprehensive sense; according to these, the various names correspond to different manifestations of a single process. At the 21st Kongress fuer innere Medezin, held at Leip zig, Marchand defined human arterio-sclerosis as follows: (1) Arterio-sclerosis in a wide sense consists of changes in the arteries which lead to discrete or diffuse thickenings of the vascular coats, especially of the intima. Associated with the vascular thickenings is a fatty degeneration confined to the intima and a deposition of lime included in the media. (2) The process is primarily degenerative. Its course consists in part of inflammatory changes, in part, of the production of new tissue. (3) Pure hypertrophy of the media must be dissociated from arterio-sclerosis, likewise syphilitic arteritis of medium and small size arteries. (4) The growth of connective tissue in the intima is hy per-plastic in character, the elastic elements arise from a splitting of the fibres of the internal elastic membrane. In the so-called inflammatory processes, the fibres are formed as in ordinary scar tissue. (5) Arterio-sclerosis is primarily the result of abnormal mechanical effects (functional strain of the arteries, long continued rise of pressure) combined with general or local disturbances (malnutrition, toxic or infectious processes, effects of temperature) and hereditary influences. (6) A large part of the media and adventitia of the thoracic aorta, after syphilitic infection becomes sclerotic. In many cases, there is the production of gummatous heaps in the vessel wall. This expression (gummatous) must not be applied to the general thickening of the intima. It is preferable to consider this disease as "schwielege Aortensklerose" Aortitis, Mesaortitis productiva Chiaris. (7) The arterio-sclerotic process in the aorta originates in an injury to the elastic elements, primarily to the elastic muscular layer of the intima. The elastic elements of the media are also involved. In the medium and small sized vessels, the internal elastic tissues are affected. (8) The superficial fatty (atheromatous) endarteritis of the aortic intima in young individuals is in part a manifes tation of this process. (9) The degeneration of the elastic elements is due to stretching of a

more or less extensive portion of the vessel wall, in consequence of which a thickening of the intima results. The diffuse thickening (of Thoma) has a compensatory meaning. (10) In the nodular form of arterio-sclerosis, the degenerative character stands always in the foreground, it signifies always a destruction of vessel wall. (11) The idea of Thoma, that the thickening of the intima (in both cases) is produced by a slowing of blood current, is incorrectly conceived. (12) Calcification of the media of the arteries of the extremities, especially of the lower, must be distinguished from the ordinary arterio-sclerosis. It is often, however, associated with thickening of intima. (13) The sclerosis and calcification of these vessels permit of no definite conclusion concerning the simultaneous existence of arterio-sclerosis of the aorta or other blood vessels. (14) Arteriosclerosis is not seldom accompanied by an hypertrophy of the left ventricle in consequence of general increased resistance to circulation especially through atrophy of the kidney. The heart hypertrophy arising from sclerosis of the splanchic vessels (Romberg, Hasenfeld, Hirsh) is exaggerated. (15) It seems necessary to use for the total process (atheromatous endarteritis and arterio-sclerosis) the term arterosklerose or sklerartherose.

Gilbert and Lion were the first investigators who succeeded in producing sclerotic and calcareous changes in the arteries. Their methods varied. The right carotid of rabbits was exposed, a stylet introduced and by careful mannipulation the aorta slightly injured. Into the ear veins of a number of these animals, cultures of a virulent organism were introduced. At the end of eight days vegetations occupying definitely the site of injury and varying in size

from a millet to a lentil seed were visible. His

tologically at the periphery were cells derived from the cellular elements of the intima, in the centre calcareous degeneration, the calcification extending into the wall of the middle coat. In another group the injection of organisms was not preceded by traumatism. In a third group bacterial toxins were used.

Their conclusions in which Crocq concurs are as follows:

The traumatism alone is incapable of producing acute aortitis.