4. About what is the size of an air cell, and about how many constitute a lobule? 5. Define a nerve, a plexus, a commissure and a decussation.

PRACTICE.-Dr. A. A. Smith.

1. Give prominent symptoms and treatment of pleurisy.

2. Give symptoms of pericarditis, also treatment for same.

3. Give treatment of spasmodic croup. 4. Give definition, symptoms and treatment for acute gastritis.

5. What is varicella?

6. Give differential diagnosis features in variola and varicella.

7. Give symptoms and treatment of diphtheria.

8. Name some of the principal eruptive diseases.

MATERIA MEDICA AND THERAPEUTICS.-Dr. W. A. O'Daniel.

1. Describe the methods of massage and its therapeutic uses.

2. Give the most important therapeutic uses of water.

3. Give the modes of applying heat and cold and the physiologic action of each.

4. Do acids produce "salivation" in a patient taking the various preparations of mercury? If so, why so?

5. Give the dose and physiologic action of liquor potassii arsenitis? Also the antidote for poisoning by arsenic?

6. How would you prepare quiniæ-sulphas for hypodermic medication? Write a prescription for same.

7. Describe the difference between acute alcoholism and compression of the brain?

8. Give the dose, physiologic action and therapeutic uses of the official preparations of hydrastis canadensis? Also its antagonistics and incompatibles?

The American Medical Association. Section on Materia Medica and Therapeutics. The following papers and discussions have been promised for the meeting at Denver, Col., June 7-10, 1898:

"Yellow Fever: Its Etiology and Treatment." Discussion by Surgeon-General George M. Sternberg, M. D., of Washington, D. C.; Prof. John Guitéras, M. D., of Philadelphia; Sollace Mitchell, M. D., of Jacksonville, Fla.; T. S. Scales, M. D., of Mobile, Ala.; G. B. Thornton, M. D., of Memphis, Tenn.; H. M. Bracken, M. D., of Minneapolis, Minn.; P. E. Archinard, M. D., of New

Orleans, La.; Prof. William H. Welch, M. D., of Baltimore, Md.; Captain R. S. Woodson, M. D., Assistant Surgeon United States Army, of Fort McPherson, Ga.; Prof. William Pepper, M. D., LL. D., of Philadelphia, Pa.

"Aims of Modern Treatment of Tuberculosis." By Prof. Edwin Klebs, M. D., of Chicago. Discussion by Charles Denison M. D., of Denver, Col.; Prof. William Pepper, M. D., LL. D., of Philadelphia, Pa.; Prof. William H. Welch, M. D., of Baltimore, Md.; Prof. William E. Hughes, M. D., of Philadelphia, Pa.

By

"Serum-therapy of Tuberculosis." Prof. S. O. L. Potter, M. D., of San Francisco, Cal. Discussion by Prof. James M. Anders, M. D., of Philadelphia, Pa.; C. C. Fischer, M. D., of St. Louis, Mo.

"The Therapeutics of Pulmonary Phthisis." By Paul Paquin, M. D., of St. Louis, Mo.

"The Practical Value of Artificial Serum in Medical Cases." By P. C. Remondino, M. D., of San Diego, Cal.

"The Present Status of Serum-therapy." By George W. Cox, M. D., of Chicago, Ill.

"Biological Activity of the Antitoxins." By Prof. Joseph McFarland, M. D., of Philadelphia, Pa.

"Glandular Extracts." By Prof. Isaac Ott, M. D., of Easton, Pa.

"The Use of Remedies in Diseases of the Heart and Blood-vessels." By T. Lauder Brunton, M. D., D. Sc., F. R. S., of London.

"The Mescal Button." By Prof. D. W. Prentiss, M. D., of Washington, D. C., and F. P. Morgan, M. D.

"The Modern Intestinal Antiseptics and Astringents." By William Frankhauser, M. D., of New York. Discussion by Boardman Reed, M. D., of Philadelphia, Pa.

"A New Non-amylaceous Flour for Diabetics and Dyspeptics." By N. S. Davis, Jr., A. M., M. D., LL. D., of Chicago, Ill.

"The Solution of Ethyl Nitrite." By D. J. Leech, M. D., of Manchester, Eng.

"A Contribution to the Effects of Coffee in Excess." By Prof. William Pepper, M. D., LL. D., of Philadelphia, Pa.

"The Treatment of Insomnia." By Robert T. Edes, M. D., of Jamaica Plain, Mass. "Are there Therapeutic Principles?" By Solomon Solis-Cohen, M. D., of Philadelphia, Pa.

"To What Extent is Typhoid Fever Favorably Modified in Its Course, Duration, Termination or Sequelae by the Administration

of Drugs?" By Frank Woodbury, M. D., of Philadelphia, Pa.

"Strychnine." By J. N. Upshur, M. D., of Richmond, Va. Discussion by Prof. J. H. Musser, M. D., of Philadelphia, Pa.; Walter M. Pyle, A. M., M. D., of Philadelphia, Pa. "Methods of Teaching Materia Medica and Therapeutics." By Prof. G. H. Rohé, M. D., of Baltimore, Md.

"The Study of Materia Medica and Therapeutics." By H. M. Bracken, M. D., of Minneapolis, Minn.

"A Contribution to the Pharmacology of Cannabis Indica." By C. R. Marshall, M. A., M. B., Pharmacological Laboratory, Downing College, Cambridge, England.

"The Place of Hydrochloric Acid in the Treatment of Diseases of the Stomach." By Boardman Reed, M. D., of Philadelphia, Pa. "The Continuous Use of Digitaline in the Vasomotor and Cardiac Lesions of Senility." By Henry Beates, Jr., M. D., of Philadelphia, Pa.

"Home Remedies vs. Patent Medicines." By Prof. Adolph Koenig, M. D., of Pittsburgh, Pa.

"Opium in Bacterial Diseases." By J. P. Farnesworth, M. D., of Clinton, Ia.

"The Great Therapeutic Importance of a Rational Adaptation of Cathartic Remedies to the Physiological Functions of the Gastrointestinal System." By E. D. McDaniels, M. D., LL. D., of Mobile, Ala. Discussion by Prof. John M. Dunham, A. M., M. D., of Columbus, O.

"A Recognition of Temperament: A Factor to the Selection of Remedies, and their Dosage in Disease." By J. E. Moses, M. D., of Kansas City, Mo.

"On Some Preparations of the National Formulary." By C. Lewis Diehl, Ph. G., of Louisville, Ky.

"The Use of Stimulants in Acute Diseases." By E. B. Hershey, M. D., of Denver, Col.

"Codeina." By A. K. Minich, M. D., of Philadelphia, Pa.

"Therapeutics of Idiopathic Epilepsy." By Prof. J. N. Barnhill, A. M., M. D., of Columbus, O.

"The Use of Drugs in Diseases of the Uterus." By Prof. John M. Dunham, A. M., M. D., of Columbus, O.

"Why the Pharmacopeial Preparations Should be Prescribed and Used by the Profession." By Leon L. Solomon, M. D., of Louisville, Ky.

"The Use of Electricity by the General

Practitioner." By Caleb Brown, M. D., of Sac City, Ia.

"The Relation of Pharmacal Legislation to Pharmacal Education." By Willis G. Gregory, Ph. G., of Buffalo, N. Y.

"The Uric-Acid Diathesis: Its Cause and Maladies Arising from It. Is it a Cause or an Effect of Bright's Disease of the Kidneys?" By H. V. Sweringen, M. D., of Fort Wayne, Ind.

"The Sulphocarbolates." By Prof. William F. Waugh, M. D., of Chicago, Ill.

"Incompatibles," By E. A. Ruddiman, Ph. M., M. D., of Nashville, Tenn.

"Fraudulent Claims-The Remedy." By C. C. Fite, M. D., of New York.

"The Selection of Diuretics and Lithontriptics in Diseases of the Urinary Tract." By Ernest L. Stephens, M. D., of Fort Worth, Texas.

"Life-history of the Bacillus Tuberculosis in its Relation to the Treatment by Tuberculin." By Robert Reyburn, M. D., of Washington, D. C.

"The Chemistry of the Albuminates." By F. E. Stewart, M. D., of New York.

The following have also promised papers, subjects to be announced very soon, together with the day assigned for each discussion and paper:

Dr. R. S. Woodson, U. S. A., of Fort McPherson, Ga.; Dr. Dudley W. Buxton, of London, Eng.; Prof. I. E. Atkinson, of Baltimore, Md.; Prof. George F. Butler, M. D., of Chicago, Ill.; Prof. Joseph P. Remington, of Philadelphia, Pa.; Prof. Ernest B. Sangree, A. M., M. D., of Nashville, Tenn.; Dr. L. A. Sayre, of Lawrence, Kas.; Dr. T. M. Balliet, of Philadelphia, Pa.

The chairman will be pleased to receive and place upon the programme subjects for discussion and papers. John V. Shoemaker, M. D., chairman, 1519 Walnut street, Philadelphia, Pa.

Recent Drugs in Dermatology.

Dr. J. Abbott Cantrell reviews the list of new drugs that have arisen primarily in the expectation that they would do away with iodoform. The first considered was dermatol, or bismuth salicylate, which has scarcely sustained the advantages claimed for it, as it is a stimulant, but at the same time an irritant. In the many cases where it was employed in place of iodoform, it did not lessen, but rather increased the discharge and inflammation, even to the point of acting as a caustic.

Alumnol, rather astringent in its action, is of notable efficacy in eczema, intertrigo, and acute dermatitis; non-parasitic sycosis, however, was cured in only one instance, while such contagious affections as impetigo, tinea versicolor, scabies and pediculosis did not respond as quickly as with other remedies.

Labarraque's solution, applied in full or diluted strength, was found of marked benefit in ivy poisoning; a cure could often be assured in from four to six days. Salol gave good results in the vesicular and pustular varieties of eczema, also in eczema rubrum and squamosum. In impetigo contagiosa and zoster there was marked benefit, while the vegetable parasitic affections responded as follows: Tinea circinata and tinea versicolor were cured, while tinea sycosis and tinea tonsurans were not influenced.

Acetanilid, one of the astringent group, is valuable where moisture or high grades of inflammation exist as complications. It is of service in all forms of eczema, and good results were obtained in instances occurring in silver and bronze workers. In In herpes zoster, syphilitic and non-syphilitic ulcerations, and in ringworm, good results followed its use.

Salicylic acid is indicated as a stimulant in those cases where we hope to restore the normal functions of a part, as in eczema with thickening and infiltration.

Resorcin, which has quite similar properties, is of service where parasites have congregated, as in superficial ringworms.

Sulphur and ichthyol are both astringents, and are best employed wherever exudation or denudation are constant symptoms; as in eczema, all forms of acute dermatitis, cases where serum and pus are formed, and a soothing or palliative effect is required.

Betanaphthol was found to be an excellent stimulant is cases of acne and seborrhoea, alopecia, and scabies. Iodol, in the form of ointment, gave best satisfaction of all of the iodin group in the treatment of ulcerations. Am. Jour. Dermatology.

The History of the Clinical Thermometer.

A letter from Dr. Edward F. Wells, of Chicago, contains certain interesting details regarding the history of the clinical thermometer. He writes as follows: "Dr. Donald Maclean, in his very readable 'Personal Reminiscences of Syme,' says of the year 1859 that the clinical ther

mometer had not then been invented.' In 1745-46 Cleghorn encountered, in Minorca, an epidemic of pneumonia and published his observations upon the same in a volume entitled, Epidemic Diseases of Minorca,' London, 1762. On page 261 of this work, in describing the symptoms of the disease, he says: "The internal heat was in several very moderate; in some, less than natural; but for the most part it was so intense as to raise the thermometer to the 102nd degree, and often in the afternoon to the 104th.' The history of the clinical thermometer, since the idea of using it in measuring the temperature of the body in disease, first occurred to Sanctorius in the earliest years of the seventeenth century, is enveloped in considerable obscurity, yet it is certain that, with the published observations of Donne (Arch. Gén. de Méd., 1837), Zimmermann (Prager Vierteljahrschrift, 1852), and others, it is not historically correct to say that the clinical thermometer had not been invented in 1859, however true it may have been that it was not in common use."-University Med. Mag.

Anesthetization of Children.

Chloroform as an anesthetic for young children is, even in Great Britain, becoming daily less used. For a considerable time a somewhat heated discussion has been sporadically breaking out in regard to the relative anesthetic properties of chloroform and ether, but the best authorities appear to have agreed that for very young children chloroform is not the most satisfactory anesthetic. Mr. Hewitt, anesthetist to the London Hospital, reports satisfactory results from nitrous oxid and oxygen. He says: "The best results from the gas I have had with rather debilitated women or children, the patients whom we should expect to behave best under a comparatively light form of anesthesia. In looking over my notes I find that in my three best cases, the patients were children between eleven and thirteen years of age. In all three cases the patients had had other anesthetics on previous occasions and had suffered more or less severely from distressing after effects." Mr. George Rowell, senior anesthetist to Guy's Hospital, having come to the conclusion that chloroform was not indicated for young children, and passing by gas and air, and gas and oxygen, both unsuitable for use by practitioners generally, Mr.

His

Rowell was led to employ ether. methods are described as follows: "Ether, as is well known, has to be given very slowly, so that it takes eight or ten minutes to narcotise a child. There is, however, one test of good surgical anesthesia in the young which is certain and invariable, that is the absence of swallowing, coughing, straining, held respiration, or any alteration in the system of respiration in response to a strong ether vapor suddenly applied. Upon the recognition of this fact Mr. Rowell's method of anesthetization is based. Consequently when a child is once so deeply narcotised as to have lost these reflexes, it is an easy matter to keep it at this uniform depth by taking away the vapor for a few breaths and then re-applying it until this stage is again reached. To attain this condition is, in Mr. Rowell's opinion, best done by giving A. C. E. mixture gradually upon a towel, or Skinner's inhaler, for about a minute and a half, beginning with a drop at a time. When the child, at the end of this period, can freely breathe, the vapor proceeding from a completely wetted single layer of flannel on the inhaler, a stronger vapor of A. C. E. is given from a sponge in a Rendk's mask, and when this is freely respired a drachm or two of pure ether is added. When the reflexes, excited by the ether vapor, are almost or quite gone, the first sponge is removed, and a fresh sponge containing two or three drachms of ether only is rapidly substituted for it, and from this time the administration is continued

with strong ether vapor, the mask being applied only when shown to be necessary by the presence of the reflexes referred to. The following advantages are claimed for this method. (1) The time required to produce good anesthesia is rarely more than four minutes. (2) The guides to the anesthetist are clear. (3) Flaccidity and freedom from movement during the operation are complete. (4) The after-effects bear comparison with those after any other method. (5) The method is safe. Mr. Rowell recommends it especially for children under five or six and for any child with obstruction in the upper air channels."-Pediatrics.

The Malarial Parasite.

After several premature announcements of the discovery of the "malarial germ"-based upon mistakes in observation and inadequate investigation- the veritable germ has finally

been discovered, and we now know what it is that causes these fevers, and why the malarial parasite gives rise to successive paroxysms of fever, occurring at regular intervals, and why quinine acts as a specific in the cure of fevers of this class. The discovery was made in 1880 by Laveran, a surgeon in the French army, who was stationed in a malarial region in Algeria at the time the observations were made which led to his notable discovery.

Upon examining the blood of his patients under the microscope, with a high-power objective, Laveran became satisfied that certain bodies observed by him in all his cases of malarial fever, but which were not to be found in the blood of healthy individuals or of persons suffering from other diseases, were, in fact, living parasites. Laveran described the pigmented parasitic elements observed by him as presenting themselves under three principal aspects, which he supposed to represent different stages in the development of a single parasite.

At the time his report was published he had found these bodies in one hundred and eighty persons examined by him in Algeria and Tunis, and who were suffering from some form of malarial fever.

The discovery of Laveran was first confirmed by Prof. Richard, whose researches were made in 1882 at Philippeville, Algeria, a locality where malarial diseases prevail. This author stated, as the result of his observations, that the parasite first invades the red blood-corpuscles and develops in them, shell of the corpuscle remains and the amebaapparently feeding upon them until a mere like parasite contains numerous dark-colored pigment granules.

These pigment granules are no doubt an excretory product remaining after the parasite has appropriated the organic nutriment contained in the red blood-corpuscles. When these are completely disorganized, the pigment granules are set free and are then picked up by the white blood-corpuscles, which apparently act as scavengers of the blood.

It has long been known that persons suffering from malarial fevers become anemic on account of the loss of red blood-corpuscles which occurs during the progress of the disease; and also that there is an accumulation of black pigment in the spleen and elsewhere in individuals who have suffered repeated attacks of intermittent fever.

The discovery of Laveran makes it clear how this destruction of the red blood-cor

puscles is effected, and enables us to account for the origin of the masses of pigment granules which are found, post mortem, in the spleen of an individual who at any time during his life has been a victim of the disease under consideration; for this pigment is insoluble, and may remain stored away in the spleen for years without giving rise to any unpleasant symptoms. The destruction of the red corpuscles by the malarial parasite seems to be the principal evil resulting from its presence in the blood of an infected individual, and the febrile paroxysms are believed to result from this destruction and the accumulation in the blood of the products developed as a result of the vital activity of the intra-corpuscular parasite.

The regular recurrence of the febrile paroxysms is believed to depend upon the fact that a large number of parasites complete the cycle of development at the same time. Now it has been ascertained by the Italian physician Golgi, and confirmed by other investigators in various parts of the world, that there are at least three different kinds of malarial parasites, and that each kind gives rise to a distinct type of fever.

Thus the fever which recurs every second day-tertian intermittent-completes its cycle of development in forty-eight hours, while the third-day type-quartan-is due to a parasite which requires a period of seventy-two hours to complete its cycle of development. In both of these types blood drawn during the febrile paroxysm is seen, under the microscope, to contain many corpuscles enclosing spore-like bodies arranged in the form of a rosette. These are the reproductive elements which, when set free by the disintegration of the corpuscles, invade other corpuscles, and, in fact, constitute the seed from which another crop is developed.

These spore-like bodies when they first invade a red corpuscle are comparatively small, but they may be seen to undergo constant changes in their form; as they increase in size pigment granules are developed in the interior of the semi-liquid mass which constitutes the body of the ameba-like parasite; later, when the parasite has nearly attained the dimensions of the corpuscle itself, indications of its approaching "segmentation" are seen; and finally this process results in the formation of a group of spore-like bodies arranged in the form of a rosette, as already described.

That type of intermittent fever-quotidian -in which a paroxysm occurs every day is believed to be due to the same variety of

the malarial parasite as produces the "tertian" or second-day type, the daily paroxysm resulting from the presence of two distinct groups of the parasite in the blood of the infected individual, each of which completes its cycle of development independently and on alternate days-usually at a different hour of the day.

There are also seen in the blood of malarial fever patients, and especially of those suffering from autumnal fevers of a remittent type, larger pigmented bodies, some of which are spherical in form and have attached to their periphery long, whip-like processes-flagella. These are endowed with active movements. Other motionless bodies, also containing pigment granules, are crescentic in form. These bodies no doubt represent certain stages in the development of the parasite.

The malarial parasite has as yet not been detected in the air or water of the marshy localities which are recognized as the source of malarial infection in man. This is not surprising, in view of its size and of the fact that a multitude of microscopic plants and animals are found in such localities, and that among them the extremely minute, spore-like body which we detect in the blood and believe to be the cause of the malarial fevers, would be very difficult to recognize. This parasite belongs to the class of microorganisms known as "protozoa," which includes a vast number of species of low animal organisms, including the little jelly-like masses of protoplasm known as amebae.

The life history of the malarial parasite outside of the blood of infected individuals is still unknown, but similar parasites have been found in the blood of certain birds, and it is not improbable that it has some other "intermediate host" than man. It has been suggested that the mosquito may play an important part as an intermediate host, but this has not been definitely determined.George M. Sternberg, M. D., Surgeon-General of the United States Army, in The Youth's Companion.

The Methods of Hernia Specialists.

We are frequently asked if there is anything essentially different in the treatment of hernia as employed by the advertising specialists and the methods known to the profession generally.

So blatant are the specialists in their pretensions and so boastful in their assertions of rapid and permanent cure that the consci