The Haversian Canal

Hmmm... This may be helpful.

Drawn by Boris Veysman, resident, Yale School of Medicine, published in the British Medical Journal. Found via GruntDoc, Clinical Cases and Images and Dr. RW.

First day of class; I'm already behind. Sweeeet....

MedGadget is hosting the polling, so get rolling and start voting.

From the Tulane Daily News

In a one-hour premiere on Tuesday, Jan. 10, at 7 p.m. central time on PBS (check local listings), NOVA sciencenow will introduce viewers to Tyler Curiel, professor and chief of hematology and medical oncology at the Tulane University School of Medicine. Curiel worked heroically in the aftermath of Hurricane Katrina to try to rescue the irreplaceable research from his lab.

During the segment, Curiel recounts the dramatic and moving story of working under extreme conditions in an attempt to save key scientific research and preserve the memory of his friend, Andy Martin. Martin was a Tulane medical student who had been diagnosed with sinonasal undifferentiated carcinoma (SNUC), a rare form of cancer.

Up to the time of his death, Martin had worked tirelessly in Curiel's lab at the Tulane medical school to extract the only known living cell line of SNUC in the world. Were Curiel's extraordinary efforts enough to save this invaluable research, which could one day lead to breakthroughs in treatment for the disease?

Give some pocket change (or more) to Wikipedia! You know you use it! But don't listen to me, read the appeal for help of Wikipedia's founder, Jimmy Wales.

Some formats work on the web. Garland, a major publisher of scientific works, provided searchable, but not browsable text of one of its classic titles, Molecular Biology of the Cell to the National Library of Medicine. This is worthless in terms of electronic access because anyone who's using PubMed quite likely ALREADY OWNS THE BOOK! It is useful, but clearly it has been intentionally handicapped, and thus stands as a testament to the ailing status of science, crippled under the weight of publishers intent on their copyrights.

In my humble opinion.

From the New England Journal of Medicine's Image Challenge. It's not actually hairy, but it looks that way, because it's actually disordered overgrowth of filiform tastebuds, which normally look like this under a microscope.

While the cause is not exactly known, a good guess is that the relatively hot, chemically bizarre, cigar smoke has exposed the cells of the tongue's surface to so many thermodynamic insults and killed so many of them so many times (causing the survivors to reproduce more often, increasing the risk of genetic mutation), that the cell line evolved or may be stuck in some heat-shock like response, constantly protecting itself more and more with more and more layers, or structural protein. These would all be somatic: this wouldn't be passed on to offspring, the evolution is local to this cell population, which, in this case provided a thicker barrier to further insult. Different smokers realize different possible outcomes, each based on probabilities, which are all to complex, right now, to calculate based on the individual. We can only talk about the population. But some other smoker got tongue cancer. Another got emphysema; another got COPD and lost his vocal cords. Another died of the third heart attack. Etc, etc, etc.

Is up at Random Acts of Reality, which more usually hosts the posts of an emergency med tech on some island west of France. I hear they have a nice clock tower. Seriously, an excellent blog I can only hope to emulate.

TerraPass: for-profit, expensive, and well designed and marketed. Wharton School in Philadelphia.

DriveNeutral: not-for-profit, inexpensive, and poorly designed and marketed. Presidio School of Management in San Francisco.

Edit 15 January 2007: DriveNeutral has redesigned. They're my clear favorite at this point.

I'm in the room for an address from the President of Tulane University, Dr Cowen, who is also a commissioner of the Bring Back New Orleans Commission, responsible for the education committee. [ed: here's the audio of the address (56 min, 13 MB, low volume)]. Seven reports from the seven committees are due out to the larger commission and the public next week.

The big issue, according to Dr Cowen, is the levees, and I addressed that in a previous post. The second issue is housing. The two main options are

• Level select neighborhoods, like the lower ninth ward. While perhaps the most responsible thing to do, he didn't think the politicians had the stomach for it.

• Offer a one-year right of return where people have one year to go back. If a neighborhood can consolidate and demonstrate a plan, it can stay, otherwise, option one is executed. He thought this was most likely.

• The third option is on the front page of the New York Times: A Big Government Fix-It Plan for New Orleans. This is obviously out of the task force's control. Basically, the government will buy back property at no less than 60% of the pre-Katrina value and then sell the titles back to developers in the future.

Other news, from zee presidente: the furloughs from LSU have topped 500. Lusher, one of the crown jewels of New Orleans otherwise abysmal educational system, is now chartered by Tulane and 1000 students, K-12, will be in class next week.

The clinical faculty recruiting effort in the committee is producing results. 25 students will be placed at Ochsner, and others are being placed in hospitals around the city, like Touro.

The big news was hearing from a commissioner of the Bring Back New Orleans taskforce that those really are the three urban planning options on the table. There's of course been speculation, but hearing it from a commissioner is different.

A short article on being married to a radiologist. Courtesy of Sumer's Radiology and Grand Rounds at Random Acts of Reality.

This is huge! Copyright-safe searching through Google. It's available on the advanced search page.

In the style of a Fermi problem 'never' can be defined by comparing something's half-life to the life of the universe. Examples (somebody check my math: in the spirit of a Fermi problem I rounded a lot):

If a protein of 100 amino acid residues had to assume every possible conformation at the theoretically fastest rate (the period of a molecular vibration is about 10^-13 seconds) then it would take 10^85 seconds or 10^77 years to have a 50% chance of finding its native, biologically active conformation. (paraphrased from Lehninger's Principles of Biochemistry, 3rd Ed.)

How long would a 1000 monkeys have to type to have a 50% chance of punching out Hamlet? There are about 167,000 characters in unique sequence, 96 characters on the keyboard, and a good typist can type 100 words a minute, or about 8 characters per second. The monkeys will be there (96^167)/8 or about 10^320 seconds.

How long would one have to watch an empty room at standard temperature and pressure for a 50% chance of observing every molecule of air in the room spontaneously aggregrate in one half of the room? Assuming air is one, pure, ideal gas, the average speed of these air molecules at 20 degrees C is 300 m/s; there are 6.022x10^23 molecules in a mole of any gas; 1 mole of gas occupies 22.4 liters. Let the room be 5mx5mx3m: all the particles would appear on the left side of the room once in 10^300000000000000000000000 seconds.

Compare those times to the predicted lifespan of the universe, when the last black hole is expected to disintegrate: about 10^80 seconds. Is this a long time? The age of the universe to date is about 4x10^17 seconds.

From the Washington Post: Displaced Students Return To La. for 2nd College Try

Terry Hartle of the American Council on Education said university administrators don't want to be seen as poaching students from the hobbled Gulf Coast schools.

I knew this was the position of the medical schools, I didn't realize it applied to universities generally.

"Not too many operations in the city have as much economic clout as the university," said Professor Richard Teichgraeber,

Tulane was the largest private employer in the city before the storm, now they're the largest employer period. By far.

I was actually in New Orleans yesterday, so I could have observed this reunion first hand, but, alas, I drove in during the day, then had a meeting at 5:30, then came down with the flu! Needless to say, the drive back to Houston today was not pleasent.

This one I really enjoyed:

"I felt like I was cheated out of a semester of the college experience," said freshman Thomas Gibbs, who lived with his parents in Alexandria last semester, commuted to classes at Georgetown and missed months of workouts with the Loyola baseball team.

Waah.

May 13th is the combined graduation for Tulane University. Presidents Bush (dad) and Clinton will both speak.

An interesting lecture on IT conversations by Microsoft Research sociologist Marc Smith.

Sociology provides insights into web communities, essentially collective action through computing. Keywords: "collective action dilemma theory", "interactive sociology", "social network theory", "social software".

What's the opposite of socializing? Getting work done? Well, a lot of getting work done is socializing, so, perhaps they aren't antonyms.

Online community is out (?) Isn't it nice to not answer the question "Is it really a community?" What about groups? Typically too small. Groups are two to eight, ten, twelve people. This 'communities' are 100,000 people.

Key Authors

• Bob Axelrod, Evolution of Cooperation, says we're all engaged in a game, playing risky transactions with each other over and over. The repitition that lets us be social and be successful being social. There is some math behind this called the prisoner's delimma.

• Elinor Ostrom, Governing the Commons: The Evolution of Institutions for Collective Action. Humans are actually good at collective projects; we're only faced with a prisoner's delimma is we treat each other that way. We, in the US, have collectively lost sight of this. Individualism killed the hive? She says there are 7 or 8 things that can be used to fix this.

• Erving Goffman. How do we "do 'being social". By extension, how do we do being social on the net? How many pictures do I need to contribute to be in good standing?

• Edward Tufte, who says pictures really matter.

• Garrett Hardin, who says that all commons will fail because people will take advantage of each other. Perhaps not, not when the membership is large enough.

• Brian S Butler, The Quality of Online Social Relationships. What do we call these things? Are they online communities? Groups? How about voluntary organizations, like the Shriners. 80 to 90% contribute very little.

• What this sites become are virtual 'Shelling Points', a term borrowed from architecture. (Thomas Shelling). Places on a landscape where it seems obvious to meet other people engaged in certain kinds of behavior. One in a million? There's 768 of you on the internet and you can meet at the shelling point. And when we get together, we might even get something done!

• Paul Resnick, Yphrum's Law. Systems that shouldn't work, but do. Like Ebay. If I send money out, then sometimes something will come back. How do you make sure things come back more often? Reputation.

Back to Ostrom's 7 or 8 things:

• Group boundaries are clearly defined.

• Rules governing the use of collective goods are well matched to local needs and conditions.

• Most individuals affected by these rules and policies can participate in modifying the rules and policies.

• The rights of community members to devise their own practices is respected by external authorities.

• A system for monitoring a member's behavior exists; this monitoring is undertaken by the community members themselves.

• A graduated system of remediation is used.

• Community members have access to low-cost, conflict resolution mechanisms."

So there are two general methods for reputation. Graduated system of sanctions, and histories.

There are two things that happen to people when they look for one of this groups? They find to many, and can't tell one from another. When you are walking a city and it's dinner time, you follow rich information to your choice: the movement of other people, smells, colors, shapes, crowds, music.

Then there's a lot of stuff about usenet. Blah, blah. Here's the database report. The experiment appears to have been stopped gathering data in November 2005. More stuff about Marc's predictions of the future.

You can also read Daniel Steinberg's summary of this talk on the O'Reilly Network, and a summary at Julie's Blog.

Is up! At Clinical Cases, a really superb site with lots of, well, cases.

Tulane Reopens 17 January Expecting 88% Return.

Five months after Hurricane Katrina caused at least $200 million in damages and closed its doors for a semester, Tulane University gladly welcomed back first-year students yesterday (Jan. 12) for move-in to residence halls in preparation for the spring semester.

Tulane rolled out the red carpet with "Welcome Back" banners and flags on buildings and light poles, as well as numerous signs promoting its "Orientation Déjà Vu" activities for the entering class. While students and their parents moved boxes and luggage out of car trunks and down sidewalks, members of the news media photographed and videotaped the festivities.

On hand to report on Tulane's renewal were the Christian Science Monitor, the Chronicle of Higher Education, the Associated Press, NBC, National Public Radio, the Los Angeles Times and Fast Company magazine, in addition to local television stations.

Tulane will reopen for classes on Tuesday (Jan. 17). Approximately 88 percent of Tulane students are expected to return for the spring semester.

We took our friends to Chili's for dinner on Saturday in Harvey, a West Bank suburb of New Orleans. We had to wait for an hour. He's a contractor (recently went from a one-man operation to ten workers, can't imagine why). She's a registered nurse with a real estate license. She about quit both real estate and nursing to work at Burger King when she heard about the $6500 signing bonus, but it's paid out over several months, so not exactly a great deal in the long run. McDonalds probably does need to pay $13/hour, because, the one we went to, which was paying $10/hour, took thirty minutes to deliver the food. Not a big fan of the golden arches, but when you're hungry and you gotta get on the road, and there's no food at home because you're living there, you do what you gotta do. But $10/hour isn't enough to hire burger-flippers! Wow. Hey, more power to 'em, I say, but, wow.

Pictures of the Lower Ninth Ward (which flooded twice) and Lakeview (where the levee broke, shots include the new construction) will be up on Flickr soon. Also need to get a link to the video of me directing traffic to clear a flooded on ramp this evening. The story will tell itself.

Over at GruntDoc. Vol 2, No 17. I think the Navy collectively has the most Grand Rounds at this point.

Unplug the Wacom Tablet's USB connector. Open the Wacom Tablet Properties and plug the Wacom tablet back in. Don't know

I really like the paper in Edward Tufte's books, Monadnock Dulcet. A number of folks have been collectively trying to find out what he uses and how to get it in small sizes and I finally contacted his executive editor, Carolyn Williams, who informed me Visual Display of Quantitative Information is printed on 80 lb paper, and Envisioning Information and Visual Information are printed on 100 lb stock. I need to contact Monadnock about getting on of those two weights cut in the three sizes I want: monarch, 8.5"x11" and 11"x17".

Update, 20 January 2006. Called Lisa in the marketing department of Monadnock paper. She can put you in touch with a local distributor who can, hopefully, arrange for some 80 lb or 100 lb to be cut down for you. Minimum order is 1100 sheets of 23"x35", which is about 150 pounds of paper. A typical box of paper at Office Depot is about 55 pounds. Each 23"x35" sheet should yield eight pieces of 8.5x11. Her number is (603)588-8646.

Olmsted Kirk, (713)868-1531, is Monadnock's distributor in Houston. They can cut to order. Ten reams of 8.5"x11" or five reams of 11"x17" 80 lb Dulcet is $282.35. The paper, 100 pounds of it, is $265.85 and there is a flat cutting fee of $16.50 per 100 pounds of paper. So it's 28.24 per ream for 10 reams of 8.5"x11" or $56.48 per ream for five reams of 11"x17". The heaviest 11"x17" paper at Staples is a 28 lb Hammermill product which goes for $23.65 per ream. My brother is an artist; he said Olmsted Kirk's price sounds very reasonable.

Tulane University Magazine - Bring New Orleans Back Commission's Education Committee Report

The commission heard the education committee's report on the 17th.

After the presentation by Cowen, the committee voted to turn over the recommendations to the mayor.

Forgive me if that makes me less that optimistic about the chances of these recommendations actually seeing implementation. All but one of the committee 'final reports' for Mayor Nagin's commission are out. Most are in PowerPoint. The report on levee recommendations is the lone exception. Otherwise, not a paragraph to be seen. That makes me feel safe. No. Really.

A story to keep your eyes on:

Google Resists U.S. Subpoena of Search Data - New York Times

I studied all weekend. That's it. Just studied. Wanna know about the anterolateral system? Sphingolipids? Calcium²⁺ regulation in the smooth muscle of your colon? Didn't think so.

I did scrub in for open heart surgery twice last week, though. Coronary artery bypasses on and off pump. Got to hold the heart. Beating and not beating. Oooooooooo. This week? Going around with an ENT (ear nose and throat doctor, aka, otolaryngologist). ENTs have a seriously split personality: most people know the half that it is sniffles and ear aches. The other half is surgery for seriously disfiguring and life-threatening trauma (claw-hammer-to-the-eye type stuff) and cancer (smoker cancers like tongue, vocal cords). We'll see.

Nicholas Wade, in the New York Times, paraphrases Emilie Marcus, editor of Cell, regarding the use of photo-editing software in the preparation of images for publication:

Rather than having journal editors acting as enforcers, she said, it may be better to thrust responsibility back to scientists, requiring the senior author to sign off that the images conform to the journal's guidelines.

While on staff at the Naval Academy I was involved in the disciplinary system. One thing that I think every staff member there comes to realize over their tour is that midshipmen do dishonorable things. Those who are caught are not necessarily the worst. The presence of a system of discipline creates conversations about integrity — applied, theoritical, deontological, consequentialist. The effect of the system extends far beyond the walls as the graduates develop through their careers as leaders in uniform, public service, and the private sector. The occasional scandal, while sad, does help reinvigorate those conversations around the country.

However, it also becomes quite clear that no prescriptive solution exists because the concievable scenarios are infinite. In fact, the set of all possible scenarios is a continuous, unbounded infinity. Quite large indeed. While guidelines and a system of discipline are appropriate, it doesn't make much sense to me to require people to be signing agreements that they have acted with integrity. It is the conversation, the thinking, that prepares each individual mind to navigate the seen and unseen ethical, dare we say, moral, challenges encountered every day. Moral crimes may be adjudicated in high courts with pomp and circumstance, but the crimes are typically committed through a series of poor judgements during the course of one's daily routine.

So I disagree that authors should sign off on some guideline. Integrity should be assumed and lapses should be dealt with swiftly and harshly. To further the conversation.

I record all the audio for our class lectures and post them on my site so anyone can download them. To date lectures have been downloaded 844 times; the average lecture has been downloaded 17.2 times, ranging from 42 times for Dr Blake's collagen biochemistry lecture, to 2 downloads of Physiology's Membrane Transport Three lecture. Biochemistry's 13 lectures have been downloaded 299 times(range: 4—42); Physiology's 21 lectures have been downloaded 268 times (2—23), and Neuroscience's 15 lectures have been downloaded 277 times (2—41).

Two major populations visiting the site: the normal internet traffic that plots essentially as a horizontal bar (average download size in this group is independent of visit rate, it simply varies around the site's average file size); this is the grey arm in the graph. A small group (the green arm) visits regularly, but not exorbatantly, and downloads huge amounts of data—1000 times more than the normal traffic!

A few additional groups broke out, but I'm speculating about what they are. A tight cluster of machines have visited between 450 and 800 times and each has downloaded 15 to 20 KB. That's about how big my homepage is. There's a cluster in red that seems to come out of the cloud and increase until plateauing at 20 MB. I think these are the search engines and each one has probably accidentally downloaded an audio file (each is about 10 MB) and quickly learned not to do that again! Finally, there's a group that downloads slightly, but clearly, more than the typical user (the vertical axis is log scale). I'm completely speculating that these are spammers, but I think the number of machines is roughly the same as the number spam hits I get on my blog. I'm about 10% sure though. Finally, note the abrupt drop in activity at 1000 hits. Those labels aren't covering up any points, they just stop. I suspect this will grow longer over time. That, at least, is a testable hypothesis.

It will be interesting to run this again after the tests next week.

The number of hits is not the number of times a person visited, it is the number of times that computer asked for a file. Sometimes the machine may have already downloaded the file very recently, so the server tells it to check its cache. A page with images will also cause the hit count to go up because each image is a separate file request.

Minus the obvious robots (about 3000 of them), it appears that five hundred attempts were made to submit a comment to this blog in the last 25 days. However, only two comments have actually been submitted. Either I'm misreading my stats and I'm actually just really unpopular, or I'm being terribly rude by denying a lot of comments. I'm don't know, please help me figure this out. If you are reading this, please try to provide a comment. If it doesn't work, please e-mail me at nolson@tulane.edu.

Thanks,

Niels

I have recently figured out how to read my log files and draw some basic conclusions about how people use my site. This was in part motivated by a thread Professor Edward Tufte started on his site.

Here's a collection of things I've looked into over the years that get to the nitty gritty technical concepts involved.

First, the privacy policy of an organization that thinks about this issue a great deal: The Electronic Frontier Foundation's privacy policy.

IP address tracers are readily available free services on the net and will generally lead the investigator to an internet service provider. Providers fundamentally have to track IP addresses and associate them with the people who are paying the bills. If the government is interested in an IP address, it can subpoena the billing records from the internet service provider and then send an agent to the physical address to pick up the person.

If one really want to get into the weeds, some search phrases to start with are border gateway protocol and root server.

One may say "Why, can't I just use a whois search to find the registrar of any IP address?" Well, not any more. As many more machines continue to be added to the internet, the original global routing table scheme filled up. Most ISPs now control the delivery of packets to their subscribers through randomly assigned IP addresses that they register en bloc. This saves on registration costs (less than all subscribers have machines online at any given time), slows growth of the global routing tables, and does reduce the odds that to much information will be associated with one IP address. It also makes it harder to trace attacks, but it doesn't make it harder for governments to issue subpoenas.

Cookies, which the search engines also use, are a different story. Philip Greenspun has an excellent write-up on the spying potential of cookies (scroll down to the napkin drawing).

While resistance to a subpoena is probably argued on the assumption that the matter will end up in court, (otherwise, why the subpeona?), merely delivering a subpoena can be very coercive. Many people and businesses would decide it is in their best interest to cooperate, rather than spend time and money resolving the issue.

The big picture remains the same: if the information is recorded, the government can get it unless it's privileged communication, that is, the witnesses's relationship to the client would have to be spousal, attorney-client, clergy-parishoner, or psychotherapist-client. Even these few privileges only come into play in court, and only bear on what is actually admitted as evidence. Nothing prevents the government from using the subpoeneaed information for something else, once the information is in hand.

There is an interesting dilemma here: in order to know anything about my visitors, I have to collect some information for some period of time. But the first piece of information that has to be collected really is the IP address, which is fundamentally tracable. What is the best policy? To keep the information for no more than one month? Three months? Keep no log files at all and know nothing about who visits? From a consequentialist standpoint, I'm not sure it matters, as the content of this site is hardly controversial.

Cut to Cure summarizes an article every medical student should be interested in: digital rectal exams are not indicated in trauma patients. Probably want to make your attending aware of the study before being ordered to perform said examination....

was up two days ago, at Kevin, M.D., but hey, I got tests next week, I'm slacking. Volume 2, No 18.

The big 250! And those tunes are great!

"Sir, sir?" "He just collapsed." I'm a basic life support instructor, I figured I should probably see what had happened. Sitting in the bookstore cafe studying biochemistry for my exam tomorrow, a man had just collapsed at the entrance. He was wearing a plaid flannel shirt and jeans. Fifty, red beard turning white. Maybe overweight, but not obese. He had moderate convulsions, was lying on his left side, trying to right himself. Both arms were strong and he was grossly coordinated, though still convulsing and having difficulty getting traction with his feet. His cowboy boots were sliding on the tile floor. He didn't hit anything on the way down, except maybe breaking his fall with some boxed looks-like-a-book-but-it's-really-a-toy things, which had been stacked up by the door and had tumbled. He wanted to sit, so we held his shoulders while he braced himself with his arms behind him, legs sticking straight out in front. I was kneeling on his right side. I could feel the muscles of his upper back and shoulder convulsing under my hand. His pupils were equal and not dialated.

At least two store employees had said they were calling 911.

"Sir, what's your name?" "Sir, can you tell me your name?" "Sir..."

He turned to look at me. "Fred." He was either unsure about this or he was scared. My guess was scared. He can turn his head, presumably focus. I could see the whites of his eyes all the way around his irises. Not flushed, not sweating.

"Fred, has this happened before?"

"No..." Unsure. Eyes track together.

"Does anything hurt?"

"No..." Why does everyone keep asking if he has heart trouble? No expression of pain on his face, just fear. His speech seems clear, despite the limited vocabulary sample thus far.

"Do you feel any numbness?"

"No..." Convulsions were lessening. He could coordinate well enough to hold himself up.

"Can you feel your hands and feet?"

From above and behind me, "Is ya wife heah?"

"Yes..."

"Ah ya diabetic?" Ah, so this is hypoglycemia. The insightful Texan over my left shoulder was a man dressed about like Fred, of about the same age, clean shaven, glasses, a white straw hat, and a Santa Claus belly.

"Yes..."

"What's your wife's name?" I asked.

"Maurine. Baker." I could still feel the convulsions, but lessening.

An employee went to page his wife. She was well groomed in brushed camel and a white perm. She kept her composure. "He needs some sugar."

A couple of us went to the cafe. "Here, this doesn't have any added sugar." The sophmore juice expert was struggling with her own freshman 15. "You don't understand: it's the sugar he needs." The four dollar, 16 ounce bottle of juice still had 27 grams of sugar. That'd work. Everything was in glass bottles. Why can't they sell plastic? It's not like they're recycling the glass. "Here, this is banana..." but I was already walking back to Fred. I felt I had been short with the juice expert...

Fred seemed ok with the juice. So I asked the texan "How did you know what was going on?" "I was cop for thirty years. I seen this now and again."

EMS arrived. Blood glucose: 21 mg/dl (normal is between 75 and 115 mg/dl). They gave him oral glucose; I made small talk with his wife and the retired texan. They'd stayed in a motel and skipped breakfast. She and Fred were in town for the basketball game; their son was going to Texas A&M. I congratulated her on her son going to college as the techs helped Fred onto the stretcher. It was awkward. Maurine asked that they wait and observe for a bit before making any decision to transport him. I think she was thankful when they offered to load him in the truck to observe, the onlookers made her uncomfortable.

From 1908 to 1910 Abraham Flexner, an informed layperson acting under the auspices of the Carnegie Foundation, reviewed virtually every medical school in the United States. Enticed by the (false) thought that the review would bring needed funds from the wealthy Carnegie Foundation, the schools gave Flexner access that was and remains unequaled. In reality, of 150 schools reviewed, fewer than 80 survived.² This is what he had to say about Tulane in his legendary Bulletin Number Four.

LOUISIANA
Population, 1,618,358. Number of physicians, 1798. Ratio, 1 : 900.
Number of medical schools, 2.
NEW ORLEANS: Population, 992,169.

(1)¹ MEDICAL DEPARTMENT OF THE TULANE UNIVERSITY OF LOUISIANA. Organized in 1834, the school affiliated with the University of Louisiana in 1845, and with Tulane in 1884, at which date the University of Louisiana became Tulane University. In 1902 it assumed its present status as an organic part of the university.

Entrance requirement: A four-year high school education or its equivalent, administered by the academic authorities. The actual standard is somewhat below the nominal standard, though gradually rising towards it.

Attendance: 489.

Teaching Staff: 75, of whom 17 are professors. The laboratory branches are in charge of five men, who give their entire time to teaching and investigation.

Resources available for maintenance: Endowment funds, aggregating about $900,000, yield an income of $26,000 annually; fees amount to $67,500. The budget of the department amounts to $101,781.

Laboratory facilities: New and excellent laboratories are provided for the work of the first and second years. The professors in charge represent modern ideals, and are enthusiastically engaged in reconstructing the entire school on progressive lines. The anatomical museum is one of the best in the country. The library is small.

Clinical facilities: The school enjoys unusual privileges and opportunities in the Charity Hospital, an institution of 1050 beds. Recently an additional ward for surgery and gynecology has been added, full control of the services being vested in the Tulane faculty by the terms of the gift. The abundant material is freely used by the medical faculty, though certain defects of organization, equipment, and relationship must be corrected in order to render the situation ideal. The main point, however, is secure, for the position of the medical school in the hospital is ensured through legislative enactment. The professorship in medicine has recently been filled by importation without any friction whatsoever.

The dispensary service is adequate.

Postgraduate instruction in specialties is offered by the New Orleans Polyclinic, affiliated with the Tulane University.

¹At the time there was a second medical school in New Orleans, the Flint Medical School, which had an attendance of 24 and access to a 20 bed hospital, which averaged 17 patients a month.

²Paul Starr, The Social Transformation of American Medicine. Basic Books; 1982.

Barbados Butterfly is hosting Grand Rounds from downunder today. Go check it out. I'll be studying.